We made researches into various factors underling the loneliness of the elderly, based on interviews conducted in july 1995 with old people living alone in Hiroshima City. Loneliness was assessed by LSO, and as related factors, such items as period of living alone, self-assessment on solitude, lifestyle, self-rated health status, competence for daily work, social support network, morale, self-esteem, depression, and subjective symptoms of stress were examined.
We made multiregression analysis using loneliness as a dependent variable and other factors as independent varibles. The results were as followed.
The loneliness of old people living alone was significantly correlated with self-esteem and instrumental support.

We experienced two cases of rotavirus-related acute encephalopathy.  Each case followed a different clinical course.  The first case is 2-year and 11-month-old girl who had generalized tonic-clonic convulsion at onset. She was severe enough to a require respirator but she recovered without any sequelae.  The second case is 2-year and 2-month-old girl who had a vague symptom of continuous fretfulness. Her EEG showed a slow wave and her brain MRI detected abnormal signals in the cerebellum. Her motor function was recovered but higher brain dysfunction and light cerebellum symptoms remained.   There wene two types of clinical condition on rotavirus-related encephalopathy; Convulsion type and cerebellum lesion type.  Since the latter type is hard to diagnose and to treat, an effective therapeutic strategy should be established.

A 31-year-old healthy mother of twins developed Guillain-Barré syndrome in her fourth gestational week of pregnancy. Impaired motor coordination, sensation, and joint position sense were observed. Immunoglobulin therapy was not performed given the early stage of pregnancy. She received rehabilitation to accommodate changes in her body shape and movements necessary for pregnancy, childbirth, and childcare. The patient delivered a healthy baby by cesarean section. By 42 weeks postpartum, she was capable of almost all housework activities and childcare. Family support was important in this case. Patient-oriented intervention, which included periodic confirmation and establishment of goals in each phase and continuity of intervention, was also essential.

　We report five cases of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Five women (27-38 years), Who-presented with psychiatric symptoms, neurological complications, and decreased consciousness, were diagnosed with anti-NMDAR encephalitis after testing positive for serum anti-NMDAR antibodies. The mean（±SD）for hospitalization duration was 272.4（±144.8)days. All patients presented with respiratory failure due to central hypoventilation and required mechanical ventilation for 50.2（±13.1）days on average. Four patients showed no abnormal findings upon brain MRI, one showed high intensity lesions in the right temporal cortex and bilaterally in the hippocampus on T2 weighted images. Higher brain function assessment revealed an overall decrease in intelligence, attention, memory, and executive function in all patients. Temporal assessments revealed progressive improvement in these dysfunctions over several years. Four patients presented with deep venous thrombosis, articular contracture, ectopic ossification, and compression paralysis during the first immobility episode. Two had severely impaired communication and ability to perform activities of daily living when admitted for rehabilitation. However, eventually all the patients attained a premorbid state.
　Anti-NMDAR encephalitis possibly results from reversible synaptic dysfunction；therefore, it has a better functional prognosis compared with classical limbic encephalitis and other paraneoplastic neurologic syndromes. Previous studies found abnormalities in the limbic area on MRI in about 25％ of patients, although other findings were non-specific. Prevention of disuse syndrome due to prolonged immobility is important in acute phase rehabilitation. Our study shows that long-term temporal assessments of higher brain function are necessary and useful in the chronic stage.

Introduction: The career support system was introduced in Okayama University Hospital in 2008, and the number of users has exceeded 150. Methods: To examine changes in perceptions of the system and its users, we conducted a questionnaire survey of supervisors and the colleagues of system users in FY2011 and FY2018. Results: Compared to 2011, the following items were significantly higher in FY2018: "I have experience working with users of the support system", "I think this system is useful for the medical office", and "This system makes the medical office more appealing". In the analysis of the colleagues of system users only, in addition to the aforementioned three items, the item "Users of the system are able to do their jobs to the degree expected" was significantly higher in FY2018. Conclusion: The effectiveness of the career support system is becoming more recognized, and the evaluation of the work content of the system's users has improved.

Purpose：Chronic cough is one of the symptoms that lead to a reduction in the quality of life insomnia, such as the decline in physical strength. For chronic cough due to metastatic lung tumors, and we experienced an example of after use pregabalin, showed a reduction of symptoms. Case：This case is a 75-year-old man. Abdominoperineal rectal amputation was performed in rectal cancer. Adjuvant chemotherapy has been performed, but multiple lung metastases appeared one year after surgery. Chemotherapy was continued, but lung metastases progressed, it became the policy of anti-cancer treatment ended 4 months after 2 years after surgery. Cough worsened since then, it was referred introduced to palliative care department. Because we thought respiratory tract irritation increased by organic disease is the cause, it starts from 50 mg／day pregabalin, it was increased by 25～50 mg while aware of potential side effects, such as drowsiness during the day. Cough relief at 125 mg／day, night sleep wasalso secure and possible. Conclusion：Pregabalin which is effective in neuropathic pain, there is a possibility that the suppression of hyperexcitability of nerve cells that are its pharmacological action, is also effective in chronic cough, it becomes choice of antitussive different mechanisms of action and opioid there is a possibility that may.

;Small, dense low density lipoprotein (LDL) has been suggested to be highly atherogenic as a result of their low-binding affinity to LDL receptors, their prolonged plasma half-life and low resistance to oxidative stress. Although marine n-3 polyunsaturated fatty acids (PUFAs) have beneficial effects for the prevention of cardiovascular diseases, there is little information on detailed fatty acid composition in LDL particles. In the present study, LDL subfractions were isolated from the plasma of 45 clinically healthy Japanese women by density gradient ultracentrifugation using a light fraction of 1.025-1.034 g/ml (LDL-I), an intermediate fraction of 1.034-1.044 g/ml (LDL-II), and a dense fraction of 1.044-1.060 g/ml (LDL-III). A clear relationship between the frequency of fish intake and increases in plasma n-3 PUFAs was apparent. Although plasma n-3 PUFAs in women with small-sized LDL using non-denaturing gradient gel electrophoresis (GGE) did not show a significant difference, n-3 PUFAs and n-3 PUFAs/n-6 PUFAs in dense LDL-III subfraction increased in the small-sized LDL group using GGE, compared to those with buoyant LDL particles. The result of enriched n-3 PUFAs in dense LDL subfraction suggests that n-3 PUFAs may help prevent atherosclerosis in the arteries of Japanese women with small-sized LDL.
Low density lipoprotein cholesterol measurement ; Lower case en ; Human Females ; Japanese language ; Plasma

Objective: Clinical studies suggest that maintaining a lower postprandial glycemic response is important for improvement and prevention of metabolic syndrome and type 2 diabetes mellitus. Amylose, an ingredient in many food grains, is a major factor for the lowering of postprandial glycemic and insulinemic response. The aim of the present study was to determine the influence of rice with different level of amylose on postprandial glycemic and insulinemic response in mice and humans.Materials and Methods: The two types of rice used in the study contained 29 wt% (high amylose rice) or 17 wt% (low amylose rice) amylose. In mice and humans, postprandial glycemic and insulinemic responses were measured and then the area under the response curves of both rice groups were compared.Results: In mice, comparisons of postprandial glycemic response showed high amylose rice was lower than that for low amylose rice in all time points. Notably postprandial glycemic responses for high amylose rice at 15, 30, 45 and 60 min were significantly lower (19%, 31%, 16% and 17% respectively). The area under the glycemic response curve for high amylose rice was a remarkably 16% less than for the low amylose rice. In humans, postprandial glycemic response at 30 min and insulinemic response at 60 min for high amylose rice were significantly lower than for low amylose rice (15% and 40% lower, respectively). Furthermore, general linear measurement multivariate analysis after adjustment for eating time and hemoglobin A1c at baseline showed that postprandial glycemic response at 30 and 60 min and insulinemic response at 60 min, and the area under the glycemic response curve for high amylose rice were significantly lower than for low amylose rice in human.Conclusion: The higher amylose content of the rice lowered the postprandial glycemic and insulinemic response, demonstrating the potential to prevent or improve metabolic syndrome and type 2 diabetes mellitus.
Rice ; Minute of time ; Laboratory mice ; Syndrome ; Diabetes Mellitus, Non-Insulin-Dependent

To clarify the views and needs on Rx-to-OTC switches in patients afflicted with lifestyle-related diseases such as hypertension, diabetes and/or hyperlipidemia, our survey was conducted with 199 patients at a pharmacy in Tokyo, Japan.Of the 199 patients, 159 people were patients afflicted with lifestyle-related diseases.One hundred and ten patients afflicted with lifestyle-related diseases were seventy-year-old and older, and 149 of the patients have been to a hospital at least once in the past year.Thirty-six point five percent of the patients afflicted with lifestyle-related diseases replied that they wanted to use Rx-to-OTC switches when they had been ill and/or injured.The main reasons that they wanted to use Rx-to-OTC switches were “convenience” and “always the same drugs”.On the other hand, the main reason that they did not want to use Rx-to-OTC switches was “I want to have a detailed examination”.Twenty-three point nine percent of them replied that they wanted to switch their prescription drugs to Rx-to-OTC switches. We believe that the usage of Rx-to-OTC switches after the establishment of a support system to secure safety can be the answer to the issues of the rise in medical care expenditures and doctor shortage.

Objectives: A survey was conducted to investigate the usability and safety of fentanyl sublingual tablets (FST) and to examine problems associated with their proper use.

Methods: Subjects were 18 cancer inpatients who received FST for breakthrough pain in their pharmacological cancer pain management. Changes in the pain score and the occurrence of adverse effects (nausea, vomiting and somnolence) were compared before and after FST administration.

Results: The pain score before FST administration was 6.4±2.4, and this was significantly improved to 3.4±2.8 at 30 min after administration (p<0.01). Somnolence occurred significantly more often 30 min and 2 h after FST administration than immediately before administration (p<0.05). There were no differences in the occurrence of nausea and vomiting before or after FST administration. Nine patients receiving FST therapy developed xerostomia, but there were no significant changes in the pain score or occurrence of adverse effects while they had xerostomia.

Conclusion: It is essential to observe the oral condition to judge whether FST therapy is indicated, and FST should be administered after providing sufficient oral care. The results indicate the possibility of increased occurrence of somnolence as an adverse effect.