Objectives: This study examined a more effective pain management method, without sucrose, on heel lance in preterm infants using the Premature Infant Pain Profile (PIPP). Design: In a nonblinded, randomized controlled, two-period, two-sequence crossover trial, 25 infants were randomly allocated to intervention (a Brahms lullaby with non-nutritive sucking, facilitated tucking and holding) or standard care (facilitated tucking and holding). Setting: Local Perinatal Medical Centre's NICU in Japan, July 2014 until June 2015. Outcome measures: The primary outcome variable was PIPP, and secondary outcomes were heart rate (HR), oxygen saturation, and abnormal HR (> baseline mean plus 2 SDs, or <120 minus 2 SDs). Results: The infants were 33.8 weeks gestational age at birth, 1,983.7 g birth weight, and 32 to 35 weeks postconceptual age. At all 10 measurement points, constructed of every 30 seconds postheel lance, mean PIPP of infants during the intervention (3.6 to 2.4) was significantly lower than during the standard care (8.0 to 4.6) (range, P=0.0039 to P<0.0001). All PIPP reduction rates from the 30 seconds point were similar between the two groups. The HR of preterm infants at the 120 seconds points were significantly lower (P=0.0151), and the HRs of 6 points were considerably lower during the intervention than during the standard care (range, P≤0.0879 to P≥0.049). The abnormal HR total number was significantly lower during the intervention (2) than the standard care (23) (frequency ratio=0.087, P<0.0001). Conclusion: This method demonstrated stronger analgesia, early pain relief, and maintenance of homeostasis on heel lance in preterm infants.

In order to further investigate immunoglobulin (Ig) abnormalities in patients with myotonic dystrophy (MyD), we examined 65 patients with MyD for their serum concentration of IgG in relation to their immunological functions as well as other clinical and laboratory findings. Turnover of IgG was also examined. We found significant and selective reduction of serum IgG in patients with MyD. The serum concentration of IgG in patients with MyD had a significant negative correlation with duration of illness, which suggested that serum IgG levels in MyD decreased constantly throughout the disease course. Peripheral blood lymphocyte subpopulations, including functional T cell subsets, in vitro lymphocyte proliferation, and in vitro IgG production were normal. The plasma cell population in bone marrow was also normal. The IgG turnover study using 125I-labelled IgG as a tracer revealed an increased extravascular IgG pool, and an increased capillary permeability of intravascular IgG into the extravascular compartment, in patients with MyD. These observations suggested that the Ig abnormalities in patients with MyD were not due to a broader immunological derangements as previously postulated by other authors. The abnormal distribution of IgG is a possible factor leading to reduced serum concentration of IgG in patients with MyD.

The abnormal HR total number was significantly lower in the intervention group (2) than in the standard care group (23) (frequency ratio=0.087, P<0.0001). 3) Figure 2 was incorrect and has since been corrected in the article. The correct Figure 2 is shown below.

The objective of this study was to confirm physiological reactions in the breast and brain in mothers during breastfeeding and collect basic objective data, aiming at effective support for breastfeeding. Ten healthy women who were exclusively breastfeeding their babies participated in this study. Changes in the concentration of oxygenated Hb (oxyHb) and deoxygenated Hb in the breasts and frontal cortex of these women during breastfeeding lactation were measured using double-channel near-infrared spectroscopy (NIRS). Changes were measured in three conditions: (1) in both breasts; (2) the ipsilateral breast and frontal cortex; and (3) the contralateral breast and frontal cortex. OxyHb and total Hb (totalHb) levels in the bilateral breasts decreased significantly after the onset of breastfeeding in comparison with prebreastfeeding levels. These two values repeatedly increased and decreased thereafter. In the frontal cortex, regardless of which breast was involved, oxyHb and totalHb levels increased significantly in comparison with prebreastfeeding levels. Similar hemodynamic changes occurred simultaneously in the bilateral breasts during breastfeeding regardless of the feeding or nonfeeding side. Hemodynamic changes were also noted in the frontal cortex, but the reactions in the breast and prefrontal cortex were different and not synchronous, confirming that the physiological circulatory dynamics during breastfeeding vary among organs.

Maternity record handbooks are a basis for Japan's maternal and child health measures. The major significance of these handbooks is allowing the management of information regarding maternal and child health from pregnancy to delivery and infancy in a single handbook [23]. To date, more than 30 countries have adopted similar handbooks to improve maternal and child health, and