PEG is an operation for enteral feeding. Its indications and contraindications have to be sufficiently considered with possible medical complications as well as ethical aspects taken into account. Patients who use PEG are rarely treated, managed and observed in only one department. Underlying diseases are treated in the department for psychosomatic diseases or neurosurgery. The creation and management of the stoma are done in the department of gastrointestinal disease or gastrointestinal surgery. Since the diseases are mostly chronic, patients are often referred to convalescent wards and care and welfare institutions, or discharged for care services. At the time of preparation of a PEG and during the period of its management on the ward, sufficient explanations need to be given to the patients' family members. Team management using a critical path, where staff members share the information, is very important.  Once the stoma is built, it is often managed regionally. Therefore, it is important that through academic societies or via case review meetings, or else employment of regional cooperative PEG passes, a system of close cooperation between hospitals, clinics, welfare institutions, families, and administration has to be built, so that the entire region can take care of the patients and provide support for life.

　　The present study was conducted to shed light on the fact about mental health care for the staff in a general hospital. It is well-known that hospital doctors and nurses suffer from high levels of stress.　　Early detection of worries and concerns of workers is important in mental health care. The improvement of mental health and prevention of stress-related disease should be considered according to the occupational category. There are few hospitals which have the specialists in mental health care for the staff.　　It is helpful to use unique support tools for encouraging employees in to recognize what causes them to feel stressed and understand problems that come from their environment.　　Over the period of 10, we have practiced mental health care for the hospital staff.　　We report the results of our efforts.

　　It is said that diabetes is one of the factors contributing to the onset of dementia and accelerating its progression. The number of dementia cases is expected to increase steadily year by year. Such being the circumstances, we encountered an elderly woman with diabetes and dementia, who managed to lower her blood glucose values to a proper level somehow or other, thus lightening the burden of caregivers. We shall hereby report the case because we thought it would make a good example for care in the region where the population is rapidly graying. The woman, then at age 80, visited our hospital complaining of languidness. Her blood sugar level was so high (random blood glucose level: 1,096 mg/dl) that she was hospitalized at once. By a stepwise insulin reinforcement therapy, the blood glucose levels were under control. During the stay in hospital, she was also diagnosed as having senile dementia. She was provided with effective health care and education for the control of blood sugar levels. Having snacks between meals was strictly prohibited. Considering that she was an elderly person living alone, only internal medicines were given. As a result, her blood glucose levels were elevated to about 300 mg/dl, but the combined use of GLP-1 injection and internal medicine once a week had good control over blood glucose levels. So, the patient was discharged from the hospital.

  To assess the effect of pre-germinated brown rice on metabolism of glucose and lipids, blood parameters of glucose and lipids were measured before and after 3 months of intake of test rice, which was mixed with pre-germinated brown rice (PGBR) and white rice in a ratio of 1:1, in patients with diabetes mellitus type 2 (DM). Glycosylated hemoglobin A1c (HbA1c) was significantly decreased from 6.40±0.23% to 6.23±0.19 after 3 months of intake of PGBR. The fasting plasma glucose level was not changed by intake of PGBR, but serum insulin level and HOMA-IR were decreased slightly. As the decrease of LDL-cholesterol (LDL-c) and the increase of HDL-cholesterol (HDL-c) were slightly observed after 3 months of intake of PGBR, the LDL-c/HDL-c ratio was decreased significantly from 2.03±0.13 to 1.83±0.12. These changes were significantly larger in the high PGBR in take group than in the low PGBR in take group. These results suggested that the PGBR intake might have potentialities as one of therapeutic methods for diabetes mellitus type 2 and also be useful in the freatment of hypercholesterolemia.

　　A 63-year-old woman was admitted with complaints of thirst and polyuria about 1 year after ceasing therapy in November, X and in October, X+1. Her blood glucose levels at the beginning of her admissions were 347 at the first admission and 486 at the second admission. We administered glargine, a long-acting type insulin, 8U/day, and　a short-acting insulin, glulisine, 4U/day, during the first admission. We administered glargine, a long-acting type insulin, 4U/day, and a short-acting insulin, glulisine, 3U/day, during the second admission. We also administered a GLP-1 receptor agonist, liraglutide, 0.3mg/day. Blood glucose levels (mg/dl) during the 5 days of the first admission were as follows: first, -, -, 347, and 180; second, 273, 266, 109, and 188; third, 75, 192, 186, and 182; fourth, 93, 194, 91, and 144; fifth, 78, 95, 124, and 127. In the second admission, blood glucose levels were as follows: first, -, -, 486, and 299; second: 140, 137, 195, and 128; third: 101, 122, 114, and 108; fourth: 101, 123, 123, and 137; and fifth, 89, 136, 111, and 129. CGM data showed an average of 128mg/dl and standard deviation of 34 during the first admission. CGM data showed an average of 125mg/dl and standard deviation of 20 during the second admission. The reduction of insulin and rapid flattening of blood sugar were achieved by GLP-1 receptor agonist with promotion of insulin secretion and suppression of glucagon secretion.