The tongue possesses a complex muscular structure, and its motor functions are also intricate. Therefore, it would be beneficial to use a computational physiological model of the tongue to examine its vital functions in normal and pathological conditions. Thus far, the studies of tongue models have focused on symmetric movements for normal speech. For clinical purposes, it is necessary to develop a physiological model to deal with daily vital activities such as mastication and swallowing. To do so, we constructed a full 3D physiological model of the tongue based on MRI data from a normal subject, and verified the basic functions of the model based on anatomic and physiological knowledge. In this study, the model was applied to clinical issues: prediction and verification of the changes in movements of the tongue with a tumor before and after partial glossectomy, respectively. Tongue protrusion and lateral bending motion were examined for the prediction and verification. The simulation results were consistent with the observations for a patient with a tumor in the tongue. Comparisons of the simulation and observation in the clinical case showed that the model could predict potential effects of the glossectomy on the tongue movements. It is suggested that the model is a useful tool for pre-operative planning of glossectomy.

Introduction: This study examined the effectiveness of the modified Hospital Elder Life Program (HELP) for preventing delirium, which was adjusted to be used in acute internal medicine wards at general community hospitals in Japan.Methods: The pre-intervention group consisted of 751 patients aged 70 years or older hospitalized at Nishiyodo Hospital and Amagasaki Medical Co-op Hospital between January and July 2013. The post-intervention group consisted of 775 patients aged 70 years or older hospitalized between March and July 2017 and between October and December 2017. To address risk factors for delirium, a multicomponent intervention (modified HELP) consisting of the following was implemented: handing out pamphlets, orientation to maintain activity levels, sleep improvement, early initiation of rehabilitation, provision of glasses, hearing aids, and dentures, and the termination of continuous intravenous infusion. The Delirium Screening Tool was used to calculate the percentage of inpatients who developed delirium.Results: Of the 751 patients in the pre-intervention group, 108 (14.4%) developed delirium and 88 (11.4%) of the 775 patients in the post-intervention group exhibited delirium (odds ratio: 0.70; 95% confidence interval: 0.48-1.01; p=0.06).Conclusion: The modified HELP, adjusted for use in Japan, did not significantly reduce the rate of delirium during hospitalization. Therefore, a more universal intervention method is needed in the future.

Medical university students were divided into 5 types according to the process they used to decide on a course when entering a university, and the relationship between the decision-making process and occupational identity after entering the university was examined. The largest number of students, approximately 50%, were of the “meeting” type, followed in descending order by the “early decision” type, the “changing during 4 years” type, the “deciding at the last moment” type, and the “avoidance” type. There were differences in the frequency of decision-making types among departments, including the nursing department, which showed a large number of students of the “early decision” type. We examined the relationship between the decision-making process and occupational identity after entering the university and found that students of the “early decision” type were stable after entering the university, whereas students of the “avoidance” type had the lowest scores on all 4 subscales of occupational identity. This tendency was seen during the 4 years of university, and the importance of deciding on a course when entering the university was indicated.

Case: A 40-year-old woman. Clinical diagnosis: Autistic disorder with mild mental retardation. Case report: The patient underwent pancreaticoduodenectomy for the treatment of her pancreatic cancer. We held several conferences with individuals from different medical fields and examined the influence of the patient's autistic disorder on the perioperative conditions. The senior author, a clinical psychologist, conducted repeated individual, acceptive, and sympathetic interviews with the patient and her family and maintained supportive relationships with them as an honorary family member. Thus, the clinical psychologist helped reduce the patient's anxiety about the medical treatment. Conclusion: The participation of a clinical psychologist in the medical conferences enabled the medical staff to understand the complications involved and provide mental support to the patient and her family. Palliat Care Res 2010; 5(2): 323-326

Nobody studies economic evaluation of acupuncture and moxibustion in Japan. To establish a method of economic evaluation of acupuncture and moxibustion, we introduced case study of economic evaluation of acupuncture and moxibustion at work. In addition, we examined a course of study that annex economic evaluation to a study of acupuncture and moxibustion. This manuscript introduces two case studies of economic evaluation and essential points of economic evaluation.

Objective : To research reports of economic analysis of acupuncture therapy.
Method : Searches were performed in Medline for reports of cost description, economic, randomized controlled trial, cost effectiveness, or cost benefit. Studies were included if they reported original data from any form of standard economic analysis.
Results : A total of 15 papers was found. These studies were investigated as follows : angina pectoris, carpal tunnel syndrome, stroke, knee osteoarthrosis, low back pain, musculoskeletal disease, migraine, acupuncture analgesia. On the other hand, only one paper was found in Japan.
Conclusion : Almost studies were noncntrolled trial, non-rigorous and retrospective studies. In future there is a need for high quality and rigorous studies of the cost and benefits of acupuncture.