Acetaminophen is commonly used as the global standard of analgesics. For example, the WHO lists acetaminophen as an essential drug and various clinical guidelines in many countries include acetaminophen as a first-line drug for pain relief because of it's efficacy and safety profile. In particular, there is not significant risk of such as gastrointestinal disorders, renal dysfunctions, bleeding, or cardiovascular events, and it is considered to be a safer option than non-steroidal anti-inflammatory drugs(NSAIDs). In Japan, however, NSAIDs are widely used to treat pain while the use of acetaminophen for pain relief is quite limited. This difference could be attributed to the low approved dose of acetaminophen in Japan, which is less than half of that used elsewhere. This lower approved dose causes difficulty in obtaining analgesic effect with acetaminophen. In January 2011, however, the approved dose of acetaminophen in Japan was increased to the world standard dose, making it easier to obtain an analgesic effect. In the near future, an increase in the use of acetaminophen for pain relief can be expected in Japan. NSAIDs are common drugs for pain in Japan, but often require co-prescription of a gastric mucosal protective agents, H₂- blockers, or proton pump inhibitors(PPI) to prevent gastrointestinal disorders. On the other hand, acetaminophen has much less risk of such adverse reactions and there is no need for co-prescription of digestive medicines. Thus, increased use of acetaminophen could decrease the cost for pain relief in Japan. (Jpn J Pharmacoepidemiol 2012; 17(2): 75-86)

Guidelines for the usage of psychoactive drugs for behavioral and psychological symptoms of dementia (BPSD) were issued by the Japanese Ministry of Health, Labour and Welfare in July 2013. Using the Anatomical Therapeutic Chemical (ATC) classification with prescription data, we surveyed the usage of psychotropic drugs in patients with dementia. N05C (hypnotics and sedatives) was the most frequently prescribed class of drugs [9,920 (19.7%) individuals]. In addition, there are few prescription ratios of risperidone in comparison with 5.6% and the survey in the UK. Although anti-anxiety drugs should not be used as per BPSD guidelines, etizolam was prescribed in a considerable proportion of patients (6.2%). In addition, with respect to prescription of combinations of antipsychotics in the same month, the highest rate was found for risperidone and tiapride [209 (2.4%) individuals]. In addition, 39 individuals were prescribed antipsychotics that are contraindicated for patients with diabetes. When the number of the clinical departments is as above 2, the ratios to become the contraindicated prescription, careful administration prescription of the antipsychotic increase with significant difference (p<0.01). The increased of the number of the clinical departments tended to increase the ratio of the contraindications and careful administration prescription. Thus, the need for a family doctor to prevent such situations was suggested, which was introduced by the 2014 Medical Treatment Fee Revisions.

Event-related potentials (ERPs) were recorded from 9 normal subjects engaged in a somatosensory target discrimination task. Subjects were instructed (1) to keep a mental count of each target or (2) to rotate a grip in the direction of abduction after each target stimulus using the right hand. Target stimuli were electrical pulses delivered randomly through ring electrodes to the left second digit with probabilities of 0.2, and nontarget stimuli were delivered to the left fifth digit with probabilities of 0.8.
P 100 was prominent in somatosensory tasks, and had a widespread distribution on the scalp without having any relation to kinds of tasks, therefore, P 100 reflects the sensation of somatosensory stimulation. N 140 was largest at Fz in both counting and movement tasks, so our result supported the hypothesis that N 140 is generated in the frontal lobes regions. Moreover, N 140 latency was shorter during movement than during counting. These results indicate that N 140 is related to carrying out movement. P 300 was largest at Cz during counting, and largest at Pz and C4' during movement. These results also indicate that P 300 may have multiple intracerebral generators since P300 origin differs based on the kind of tasks or stimuli. In addition, the appearance of P300 after nontarget stimuli indicates that P 300 reflects a non-selective postdecision closure of cognitive activity. In conclusion, each component of ERPs may have a specific origin and specific characteristics.

Limb lymphedema is a serious complication following surgery or radiation therapy for malignant soft tissue tumors. We have recently experienced two cases where we provided symptomatic relief for lymphedema as part of palliative care for patients with sarcoma in the advanced stage. For the treatment of lymphedema, complex physical therapy (manual lymphatic drainage, compression, and exercise therapy), elevation of the affected limb, and skin care were carried out after ruling out the presence of deep venous thrombosis. Inelastic bandaging provides containment and effectively arrests the progression of swelling that stretches the skin. Since obstructive masses interrupt the entire lymphatic quadrants, lymphatic drainage is focused on creating a collateral flow in the truncal territories and in the limb. No complications associated with treatment were observed. In spite of refractory edema due to disease progression in both cases, the swelling of the affected limb or patients' subjective symptoms were temporarily improved by the treatment. While aiming to reduce swelling, the provision of comfort, relief from pain or other swelling-related symptoms, and maintenance or restoration of function are desirable and beneficial outcomes. Palliative therapy for lymphedema may lead to an improvement of the quality of life (QOL) of patients with sarcoma in the advanced stage.

Introduction : To detect major symptoms of dementia, especially symptoms of non-Alzheimer-type dementia, we tried to develop an informant-based questionnaire, the Dementia differentiation questionnaire-41 items (DDQ41).
Methods : The DDQ41 consisted of 11 questions on symptoms of early dementia (Q-Dementia11), 8 on Alzheimer's disease dementia(Q-ADD8), 9 on dementia with Lewy bodies (Q-DLB9), 8 on vascular dementia (Q-VD8), 5 on frontal lobe signs (Q-Frontal5), and additional 2 questions on urinary incontinence and speech disturbance. Caregivers of the 575 outpatients, who included only 1 diagnosis of dementia disease, checked the DDQ41.
Results : Mean score of Q-Dementia11 in the MCI group was significantly lower than that in the other dementia groups. Mean score of Q-ADD8 in the ADD group was not significantly different from that in the other dementia groups. Mean score of Q-DLB9 in the DLB group was significantly higher than that in the other dementia groups. Area under the ROC curve of Q-DLB9 was 85.6%, and sensitivity and specificity were 82.6% and 77.7%(cut-off : 3 items/4 items), respectively, for DLB.
Conclusion : We developed the DDQ41, an informant-based questionnaire sheet, for detecting symptoms of dementia. It may be useful in detecting frontal lobe signs and symptoms of non-Alzheimer-type dementia, especially those of DLB.

Purpose: The aim of this study was to evaluate the short-term outcome of physiotherapy in patients with acetabular labral tears and to assess the effectiveness of physiotherapy according to the severity of the labral tear. Materials and Methods: Thirty-five patients who underwent physiotherapy for treatment of symptomatic acetabular labral tears were enrolled. We evaluated the severity of the acetabular labral tears, which were classified based on the Czerny classification system using 3-T MRI. Clinical findings of microinstability and extraarticular pathologies of the hip joint were also examined. The International Hip Outcome Tool 12 (iHOT12) was use for evaluation of outcome scores pre- and post-intervention. Results: The mean iHOT12 score showed significant improvement from 44.0 to 73.6 in 4.7 months. Compared with pre-intervention scores, significantly higher post-intervention iHOT12 scores were observed for Czerny stages I and II tears (all P<0.01). However, no significant difference was observed between pre-intervention and post-intervention iHOT12 scores for stage III tears (P=0.061). In addition, seven patients (20.0%) had positive microinstability findings and 22 patients (62.9%) had findings of extra-articular pathologies. Of the 35 patients, eight patients (22.9%) underwent surgical treatment after failure of conservative management; four of these patients had Czerny stage III tears. Conclusion The iHOT12 score of patients with acetabular labral tears was significantly improved by physiotherapy in the short-term period. Improvement of the clinical score by physiotherapy may be poor in patients with severe acetabular labral tears. Determining the severity of acetabular labral tears can be useful in determining treatment strategies.