Sedation in gastroenterological endoscopy has become an important medical option in routine clinical care. Here, the Japan Gastroenterological Endoscopy Society and the Japanese Society of Anesthesiologists together provide the revised "Guidelines for sedation in gastroenterological endoscopy" as a second edition to address on-site clinical questions and issues raised for safe examination and treatment using sedated endoscopy. Twenty clinical questions were determined and the strength of recommendation and evidence quality (strength) were expressed according to the "MINDS Manual for Guideline Development 2017." We were able to release upto-date statements related to clinical questions and current issues relevant to sedation in gastroenterological endoscopy (henceforth, "endoscopy"). There are few reports from Japan in this field (e.g., meta-analyses), and many aspects have been based only on a specialist consensus. In the current scenario, benzodiazepine drugs primarily used for sedation during gastroenterological endoscopy are not approved by national health insurance in Japan, and investigations regarding expense-related disadvantages have not been conducted. Furthermore, including the perspective of beneficiaries (i.e., patients and citizens) during the creation of clinical guidelines should be considered. These guidelines are standardized based on up-to-date evidence quality (strength) and supports on-site clinical decision-making by patients and medical staff. Therefore, these guidelines need to be flexible with regard to the wishes, age, complications, and social conditions of the patient, as well as the conditions of the facility and discretion of the physician.

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Repetitive nerve stimulation testing of the ulnar nerve was systematically performed on 21 normal controls and 120 patients with myasthenia gravis (MG). Diagnostic sensitivity increased from 0% in MG in remission and 17.2% in ocular MG to 100% in severe generalized MG. Six types of responses were observed in MG and could be classified into two distinct patterns based upon disease severity: ( 1 ) in mild MG, an abnormal decremental response at low rate of stimulation, normal response at high rate of stimulation, and prominent posttetanic facilitation and exhaustion phenomena; and (2) in severe MG, abnormal decremental responses at low as well as high stimulation rates and less common posttetanic facilitation and rare posttetanic exhaustion phenomena. This difference is most likely due to the severity of the neuromuscular block in MG. Oh Methods and MaterialsFor study of neuromuscular transmission we used the Harvey-Masland method with the surface-recording electrode on the abductor digiti quinti muscle and the surfacestimulating electrode on the transsulcal segment of the ulnar nerve [ 111. For the recording electrode, the active electrode was placed over the belly of the muscle and the reference electrode over the tendon. For stimulation of the nerve, we used the supramaximal 0.2 msec stimulus duration.Each subject lay on a bed with the forearm and hand fixed on a stand with a heavy base (281. The nerve was stimulated at 3isec for 2 seconds, at 5isec for 1 sec-ond, and at 50/sec for I second, using DISA 14 and 1500 EMG machines. There was at least a I-minute interval between each test. Immediately and 4 minutes after tetanic stimulation at 50isec, the nerve was stimulated at S/sec for 1 second each time.The peak-to-peak amplitude of each muscle potential was measured. The percentage of decrement or increment was calculated by comparing the first response with the lowest or highest among the first five responses at the low rate of stimulation and during t h e first second at the high rate of stimulation. When the results differed by 2 standard deviations from the mean in controls, they were considered abnormal.Posttetanic facilitation and exhaustion phenomena were defined as having occurred when the decremental response at Sisec immediately after and 4 minutes after tetanic stimulation showed improvement or aggravation, respectively, compared with the response at 5isec prior to tetanic stimulation.The present analysis is based on 2 1 normal controls a d 120 patients with MG. M G was diagnosed by a combination of clinical examination and consistent reversal of signs and symptoms upon parenteral administration of edrophonium or neostigmine. Among 103 patients with symptomatic MG, the test was performed in 79 before any medication was started (no-anticholinesterase group), in 18 after anticholinesterases had been discontinued for at least 12 hours (anticholinesterase-off group), and in 6 patients with myasthenic crisis within 6 hours after administration of anticholinesterase medication.

Background: Capturing epidemiological signatures is essential to document burdens of disease and to design health care services, including prevention measures, clinical interventions, and policies. There are large geographical and ethnic variations in the epidemiology of allergic and immunological diseases. Various data are available from North America and Europe, but the epidemiology of allergic and immunological diseases in Asia is not well documented. Objective: To characterize epidemiological signatures of allergic and immunological disease in young children in Japan. Methods: This was a national, multicenter, prospective birth cohort study: Japan Environment and Children's Study (JECS). A general population of 103,060 women was enrolled during pregnancy. Allergic and immunological outcomes were assessed among young children using questionnaire data. Results: The prevalence of caregiver-reported immediate food allergy was 7.6%, 6.7%, and 4.9% at age 1, 2, and 3 years, respectively. Hen egg allergy was most common (5.4% prevalence at age 1 year) followed by allergies to cow milk and wheat. Several patterns of allergic symptom clusters were identified. Physician diagnosed, as reported by the caregiver, non-IgE mediated gastrointestinal food allergy affected 0.5% of infants. By contrast, caregiver-reported gastrointestinal food allergies affected 1.4% of children. Kawasaki disease affected 0.3% and 0.4% children, respectively, at age 1 and 3 years. Primary immunodeficiency disorders affected 0.005% children at age 3 years. Conclusion: These data provide important epidemiological signatures of allergy and immunology in young Japanese children including the age-specific prevalence of allergic disease, Kawasaki disease, and primary immune deficiency.

BackgroundDue to the rapid development of information and communication technologies, cyberbullying has emerged as a threat to adolescents. This study aimed to investigate the prevalence and correlates among profiles of traditional bullying, cyberbullying, and combined bullying among Taiwanese high school students.MethodsThis cross-sectional study employed two-stage cluster sampling in Taipei City, Taiwan. In total, 2028 high school students completed an anonymous questionnaire between March and May 2018. Nominal logistic regression analysis was performed, adjusting for clustering, to examine the correlates of each type-role category of bullying.ResultsThe prevalence rates of cyberbullying, traditional bullying, and combined bullying were 9.9, 13.3, and 9.4%, respectively, indicating that one-third of students were involved in one of these types of bullying; 48.7% of those involved in cyberbullying also experienced traditional bullying, and 41.5% of those involved in traditional bullying also experienced cyberbullying. In any type of bullying, not only being a victim but also being a bully/bully-victim was significantly associated with at least one mental health problem (serious psychological distress, self-harm, or suicidal ideation), except in the case of cyberbullying bullies/bully-victims. Internet abuse and alcohol use were more concentrated among bullies/bully-victims than victims for all types of bullying, and a similar trend was observed among types of schools and school climates, suggesting that specific behavioural circumstances or school backgrounds are associated with bullying perpetration.ConclusionsBullying is a prevalent and complex phenomenon among adolescents in Taiwan, where traditional bullying and cyberbullying frequently overlap and are likely to occur against specific backgrounds. These facts should be taken into account in future bullying prevention and support programmes in Taiwan.