門田 行史

BACKGROUND: Otitis media (OM) is a common pediatric infection worldwide. Conventionally, accurate diagnosis depends on in-person pneumatic otoscopy, which is not always accessible, contributing to delayed care and inappropriate prescribing, especially in underserved settings. Rapid advances in telemedicine and digital tools have accelerated the development of remote approaches for assessing pediatric ear diseases, while diagnostic quality maintenance, care models, and real-world outcomes have not been comprehensively mapped in children. OBJECTIVE: This study aimed to map existing telehealth technologies and operational models used for pediatric OM and report their diagnostic and implementation outcomes to guide practice and further research. METHODS: PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guided this scoping review (protocol not registered). MEDLINE (via PubMed), Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for original English-language studies (published between January 1, 2010, and February 9, 2026) reporting the clinical implementation of telemedicine or digital health in children (<18 years) with suspected or confirmed OM. We excluded reviews, editorials, and protocols; conference abstracts; adult-only studies; and purely technical evaluations. Two reviewers independently extracted and charted the study characteristics: telemedicine model, technology, users, comparators, outcomes, and limitations. Findings were synthesized using practice-oriented mapping that aligned technologies with care models and implementation conditions. RESULTS: Fifty-two studies across 18 countries and various settings met the inclusion criteria. Sample sizes ranged from 6 to 3950, with heterogeneous reporting units (children, ears, episodes, or screening assessments). Asynchronous store-and-forward tele-otoscopy was the most common approach. The rest used synchronous or hybrid models. Image capture by trained personnel and review by experienced clinicians yielded substantial diagnostic consistency with in-person microscopy (κ 0.68-0.89, sensitivity 72%-94%, specificity 93%-98%, where available). However, the diagnostic yield was highly dependent on the training level: structured instruction improved video capture by parents and nonspecialists, whereas brief or written-only guidance resulted in low rates of diagnostically useful videos. Telemedicine approaches improved access, supported perioperative follow-up, and, in some contexts, reduced reexaminations and promoted more judicious antibiotic use. Televisits without otoscopy were associated with lower confirmation rates of middle ear effusion during tympanostomy tube placement. Evidence was heterogeneous, with predominantly small single-site studies, variable reference standards and operator training, and rapidly evolving device ecosystems. CONCLUSIONS: This review provides a practice-oriented map of telehealth approaches for pediatric OM. Tele-otoscopy and adjunct digital tools are feasible, achieving diagnostic accuracy comparable to in-person assessments while enhancing access and service efficiency. However, important evidence gaps remain, including the need for large multisite trials, evaluation of long-term child outcomes, economic evaluations, and robust external validation of artificial intelligence-based diagnostic tools. Standardization of image capture protocols and integration into hybrid care models should be prioritized for scaling up.

OBJECTIVE: This study aimed to evaluate the dynamics of the neutrophil-to-lymphocyte ratio (NLR) during the initial hospitalization of patients with eating disorders (EDs) and to assess its potential as a biomarker for monitoring disease severity and treatment response. METHODS: A retrospective chart review was conducted with 55 patients aged ≤ 16 years diagnosed with anorexia nervosa or avoidant/restrictive food intake disorder and admitted to Jichi Medical University Hospital between 2015 and 2021. Sociodemographic and clinical characteristics including sex, age, rate of weight gain, percentage of ideal body weight (%IBW), tube feeding treatment, and NLR were obtained. Statistical analyses used a mixed model for repeated measures to assess NLR changes regarding %IBW and other clinical factors. RESULTS: The NLR at admission was lower in the malnourished state but increased with weight recovery. MMRM revealed that tube feeding treatment (β = 0.538) and restoration of %IBW (β = 0.029) significantly predicted an increase in the NLR. The interaction between tube feeding and the quadratic term of %IBW was also significant, indicating distinct patterns of NLR changes: without tube feeding, NLR increased linearly with weight recovery, whereas with tube feeding, NLR exhibited a non-linear, upward-convex parabolic trend. DISCUSSION: These findings suggest that NLR may offer an objective recovery marker less influenced by patient self-report. Monitoring NLR before and after tube feeding may help distinguish true physiological recovery from transient stress responses, providing complementary information to conventional assessments. Further research is warranted to establish its clinical relevance.

Seizures in patients with developmental and epileptic encephalopathies (DEEs) are often highly resistant to various antiseizure medications. Perampanel (PER) is a novel antiseizure medication that non-competitively inhibits the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor and is expected to reduce seizure frequency not only for focal seizures and generalized tonic-clonic seizures (GTCS) but also for other seizure types. This study aimed to clarify the long-term therapeutic efficacy and tolerability of PER in patients with DEEs. We analyzed data regarding patients' background characteristics, medication retention, trends in seizure frequency, and adverse events obtained from 24 patients with DEEs who had been on PER treatment for 60 months. The retention rates were 62.5% and 46.9% at 12 and 60 months, respectively. At 60 months after PER initiation, the rate of patients with > 50% seizure reduction was 33.3%, 33.3%, 38.5%, 54.5%, 54.5%, and 36.4% among patients with atypical absence seizures, tonic seizures, focal seizures, GTCS, myoclonic seizures, and atonic seizures, respectively. The frequency of adverse events was 70.8%. PER showed long-term efficacy in various seizure types. PER is a promising treatment option for patients with DEEs.