To determine the association between attention-deficit hyperactivity disorder （ADHD） and nocturnal enuresis （NE） and its relation to the effectiveness of NE treatment in children undiagnosed with developmental disorders. A total of 154 children with NE （112 males and 42 females） were included in this study, aged ≥5–＜15 years, presenting at the Department of Pediatrics, Showa University Fujigaoka Hospital, between January 2016 and June 2017. None of the participants was diagnosed with developmental disorders. We retrospectively evaluated Attention-Deficit Hyperactivity Disorder Rating Scale-IV （ADHD-RS-IV） scores, Dysfunctional Voiding Symptom Score （DVSS）, NE clinical characteristics, and efficacy of NE treatment. The mean age was 8.0±2.0 years （standard deviation）. Sixty-seven （40.3％） patients presented with daytime incontinence （DI）. The mean total ADHD-RS and DVSS scores were 7.7±8.0 and 6.6±4.3, respectively, and they were significantly correlated （p＝0.049）. ADHD-RS scores were significantly higher in patients with DI than in those without DI （p＝0.0006）. ADHD-RS scores and large-volume DI （a DVSS subscale item） were significantly correlated. Six months after treatment initiation, patients with ＜50％ improvement （nonresponder） in NE had significantly higher total ADHD-RS scores than those with ≥50％ improvement （responder） （p＝0.007）. Even in patients not diagnosed with developmental disorders, ADHD characteristics may influence the clinical course of NE. Evaluation of ADHD characteristics using a screening tool such as the ADHD-RS is important in the NE treatment.
To clarify predictors of outcomes that can indicate the appropriateness of discharging patients to their own homes following acute ischemic stroke and percutaneous mechanical thrombectomy （PMT）. This study included 99 patients with acute ischemic stroke who were hospitalized in the Department of Neurology at Hospital A and underwent PMT between April 2014 and December 2018. Of these, 32 and 67 patients were discharged to their own homes or to other hospitals, respectively. The following items were retrospectively collected from medical records within 3 days of PMT: age; sex; familial cohabitation and employment status; serum albumin level; consciousness disorders; National Institutes of Health Stroke Scale （NIHSS）, at the most severe time and at 24 hours postoperatively; Brunnstrom recovery stage （BRS） in upper limbs, fingers, and lower limbs; oral intake; independence in activities of daily living such as eating, grooming, toileting, and walking; and higher brain dysfunction. We identified significant differences between the groups in terms of consciousness disorders, both NIHSS scores, BRS, oral intake, independence in eating and grooming, and higher brain dysfunction （p＜0.05）. Multiple logistic regression analysis revealed the following significant predictors of outcomes: NIHSS score at 24 hours postoperatively （odds ratio ［OR］: 1.35; 95％ confidence interval ［CI］: 0.152-0.448） and oral intake （OR: 10.46, 95％ CI: －2.252 to −0.095）. NIHSS score at 24 hours postoperatively and oral intake are useful predictors of patient outcomes following PMT for acute ischemic stroke. These can be assessed even when bed rest levels are low.
We evaluated the treatment results and aortic remodeling of Stanford type B aortic dissection （TBAD） following thoracic endovascular aortic repair （TEVAR） to determine the optimal timing to operate. Based on the duration from the onset of TBAD to surgery, 17 patients who underwent TEVAR for TBAD were divided into early （n＝10, TEVAR＜3 months from onset） and late （n＝7, TEVAR≥3 months from onset） groups. True- and false-lumen areas were measured at four levels （A-D） using contrast-enhanced computed tomography before and after TEVAR: A, immediately after the left subclavian artery branching; B, descending aorta at the tracheal bifurcation; C, aortic annulus; and D, diaphragm. The durations from the onset of TBAD to TEVAR were 46±25 days and 7.0±5.3 years in the early and late groups, respectively. No major intraoperative complications were observed in either group. However, the early group had one case of retrograde type A aortic dissection 54 days after TEVAR. In the early group, true-lumen area increased at all levels, except at level A, whereas false-lumen areas decreased at all levels （p＜0.05）. The late group showed no tendencies, except for an increased true-lumen area at level B. A difference in early aortic remodeling was observed—true-lumen area enlargement and false-lumen area decrease were more marked in the early group than the late group. TEVAR is useful when performed early after TBAD onset （within 3 months） and results in good aortic remodeling. In the late phase, the effect might be relatively smaller.