In this paper we report two incidents of ciguatera fish poisoning (CFP) that occurred in 2008 on Kakeroma Island in Kagoshima Prefecture, Japan. A family consisting of father (42 y.o.), mother (39 y.o.), daughter (11 y.o.) and son (6 y.o.), as well as a friend of the family (male, 78 y.o.) consumed sliced flesh (sashimi) and developed typical symptoms of CPF 4-5 h later: diarrhea, vomiting, and paresthesia of the extremities. Additionally, the two male adults (42 and 78 y.o.) developed mild hypotention (84/48 and 94/40 mmHg, respectively) and bradycardia (36 and 50 bpm, respectively) and were rushed to the ER of the nearest hospital, located on an adjacent island. The implicated fish were caught together off the west coast of the island and were identified as Variola louti and Lutjanus monostigma based on analysis of 16S rRNA gene coded on mtDNA. Remnants of the implicated fish and other fish caught on the same occasion were examined by the official mouse bioassay method (MBA), which defines the minimum amount of CFP toxin needed to kill a male mouse of ddY strain of 20 g body weight within 24 h as one mouse unit (MU). A significantly high toxicity was detected in the V. louti (0.2 MU/g) eaten by the family and the L. monostigma (0.8 MU/g) eaten by the elderly man. Other specimens of Lethrinus nebulosus, Variola albimarginata, Lutjanus gibbus (2 specimens), Aphareus rutilans, and Sphyraena forsteri (2 specimens) were found to be nontoxic (< 0.025 MU/g).
The medical records regarding island inhabitants (ca. 1,500) kept at Kakeroma Tokushukai Clinic, the only medical facility on the Island, and also at Setouchi Tokushukai Hospital, a nearest hospital on an adjacent island (Amami) revealed 6 CFP outbreaks involving 13 cases between 2005 and 2008. The estimated frequency of CFP was 10.0 incidents/10,000 persons/year and the morbidity rate was 21.7 cases/10,000 persons/year. The symptoms and signs observed in the patients and the implicated fish species, L. monostigma and V. louti, were typical of CFP in this region.

A natural course of asymptomatic neuroepithelial cysts (NECs) is poorly understood due to its rarity.Herein we report a 23-year-old female patient of an asymptomatic NEC which grew in size from 1 cm to 5 cm and caused progressive symptoms seven years after its incidental finding. Partial resection of the cyst was performed for decompression and pathological examination and effectively achieved symptoms alleviation and regression of the cyst. Our case showed the importance of regular follow-up because NECs may show symptomatic change even in the late phase.

Physicians expect nurses to be able to understand electrocardiographic (ECG) findings.However, many nurses have difficulty learning how to interpret ECGs.We suspect that the reason for such difficulty might be the nurses'mental responses to ECGs, rather than improper teaching methods.
1) We performed a questionnaire survey to investigate the mental responses to ECGs based on the responses of 197 experienced nurses and 43 new nurses and on an additional survey of 37 nurses who took ECG evaluation tests.
2) Almost all nurses recognized the necessity and importance of understanding ECG findings, and most wished to master ECGs.On the other hand, many nurses said that they disliked ECGs and did not feel competent interpreting ECGs.In particular, their perceived lack of competence in interpreting ECGs was greater than their dislike of ECGs.
3) The nurses'perceived lack of competence interpreting ECGs tended to result from feelings that developed during nursing school.Many nurses continued to have such feelings even after they began working.
4) Nurses with a poor understanding of ECGs reported many factors as being associated with their perceived lack of competence.In addition, such negative feelings toward ECGs (such as fear of making a mistake) made these nurses avoid ECGs.We believe that these feelings were likely a factor in why many nurses had difficulty mastering ECGs.
5) Nurses should be provided with appropriate ECG training that carefully considers the perceived incompetence and fear of many nurses regarding ECGs.

Objectives: Despite the fact that the total energy intake of Japanese people has decreased, the percentage of obese people has increased.This suggests that the timing of meals is related to obesity.
The purpose of the study was to investigate the relationship between the timing of meals and obesity, based on analyses of physical measurements, serum biochemical markers, nutrient intake, and lifestyle factors in the context of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents of Toon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medical examinations between 2011 and 2013. These medical examinations included. (1) physical measurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers (total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors such as family structure and daily habits (22 issues), exercise and eating habits (28 issues), alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups (FFQg);and (5) a questionnaire concerning the times at which meals and snacks are consumed.
Results: The values for body mass index (BMI) and waist circumference were higher for participants who ate dinner less than three hours before bedtime (<3-h group) than those who ate more than three hours before bedtime (>3-h group). The Chi-square test showed that there was a significant difference in eating habits, e.g., eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after 9 p.m., between the <3-h group and the >3-h group.
Multiple linear regression analysis showed that skipping breakfast significantly influenced both waist circumference (β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed only influenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waist circumference and BMI than eating dinner <3-h before going to bed.

Objective: Despite the fact that the total energy intake of Japanese peoplehas decreased, the percentage of obese people has increased. This suggests that the timingof meals is related to obesity. The purpose of the study was to investigate therelationship between the timing of meals and obesity, based on analyses of physicalmeasurements, serum biochemical markers, nutrient intake, and lifestyle factors in thecontext of Chrononutrition.
Participants and Methods: We analyzed data derived from 766 residents ofToon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medicalexaminations between 2011 and 2013. These medical examinations included. (1) physicalmeasurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers(total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors suchas family structure and daily habits (22 issues), exercise and eating habits (28 issues),alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups(FFQg); and (5) a questionnaire concerning the times at which meals and snacks areconsumed.
Results: The values for body mass index (BMI) and waist circumference werehigher for participants who ate dinner less than three hours before bedtime (<3-hgroup) than those who ate more than three hours before bedtime (>3-h group). TheChi-square test showed that there was a significant difference in eating habits, e.g.,eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after9 p.m., between the <3-h group and the >3-h group. Multiple linear regressionanalysis showed that skipping breakfast significantly influenced both waist circumference(β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed onlyinfluenced BMI (β = 0.581).
Conclusion: Skipping breakfast had a greater influence on both waistcircumference and BMI than eating dinner <3-h before going to bed.

Enrolled in our study were 16 seriously handicapped persons (9 males and 7 females) institutionalized in our medical center. They were 20 to 58 years of age (mean 35 yrs). In the previous study, we found they had no evidence, serological or clinical, of osteomalacia but were verified as having significantly low bone mineral density (BMD) at the calcaneus and lumbar vertebrae. Serum levels of 25-OH-vitamin D were low and positively correlated with the lumbar vertebral BMD. Thus we postulated that low BMD was at least partly due to the lack of ultraviolet exposure. In the present study, the lumbar vertebral BMD of the above subjects were measured before and after increasing their exposure to sunlight. We found that mean lumbar BMD increased signigicantly from 770 mg/cm² to 786 mg/cm² (P<0.05, Wilcoxon, paired test). The Z-score also increased significantlyfrom 78 ± 13% to 80 ± 12%(P<0.05, Wilcoxon, paired test).
These findings suggest low BMD could be corrected to some extent by increasing sunlight exposure of institutionalized persons. Former members of farming communities who are retired, handicapped, or otherwise limited to indoor activity, can also recover their BMD and prevent osteoporosis by an increased daily exposure to sunlight.

Purpose: Primary tumor location of colon cancer has been reported to affect the prognosis after curative resection. However, some reports suggested the impact was varied by tumor stage. This study analyzed the prognostic impact of the sidedness of colon cancer in stages II, III, and liver metastasis after curative resection using propensity-matched analysis. Methods: Right-sided colon cancer was defined as a tumor located from cecum to splenic flexure, while any more distal colon cancer was defined as left-sided colon cancer. Patients who underwent curative resection at Nara Medical University hospital between 2000 and 2016 were analyzed. Results: There were 110 patients with stage II, 100 patients with stage III, and 106 patients with liver metastasis. After propensity matching, 28 pairs with stage II and 32 pairs with stage III were identified. In the patients with stage II, overall survival (OS) and recurrence-free survival (RFS) were not significantly different for right- and left-sided colon cancers. In the patients with stage III, OS and RFS were significantly worse in right-sided colon cancer. In those with liver metastasis, OS of right-sided colon cancer was significantly worse than left-sided disease, while RFS was similar. Regarding metachronous liver metastasis, the difference was observed only in the patients whose primary colon cancer was stage III. In each stage, significantly higher rate of peritoneal recurrence was found in those with right-sided colon cancer. Conclusion Sidedness of colon cancer had a significant and varied prognostic impact in patients with stage II, III, and liver metastasis after curative resection.