Severe burn injuries often result in significant long-term physical complications with scarring and contractures, but cancers associated with chronic burn scars are relatively rare. We report a case of a 58-year-old man with skin cancer arising from a healed burn scar. He initially suffered from an extensive fire burn on both lower limbs as a child. The burn scars extended from his upper thighs to his toes bilaterally and caused severe contractures which immobilized the ankles in plantar flexion. Two years ago, he noticed a small ulcerated lesion on the right heel and self-treated it with topical ointments. However, the ulcer increased in size and became malodorous. He presented to a clinic with a large, ulcerated, tumorous lesion, and histology proved it to be squamous cell carcinoma. He subsequently underwent a right below-the-knee amputation, and the previous scars presented on the stump. Thus the patient received a total surface bearing prosthesis with an Icelandic roll-on silicone socket system, which is ideal for patients with extensive scarring at the stump because it may reduce prosthesis-induced stump injuries by evenly distributing the patient's weight in the socket. After he left the hospital, he walked so far with the prosthesis every day that small ulcers often developed at the right popliteal fossa. However, he did not take care to treat these lesions properly, so we had to educate him on how to treat them. Patients such as these will often require education for self-management, family involvement and regular follow-up to monitor scar ulceration and watch out for any malignant transformation.

This study was conducted to examine the prevalence of undernourished elderly in community-dwelling elderly people, and to analyze the correlation between under-nutritional status and health status and physical fitness of the elderly.The subjects comprised 1758 residents (757 men and 1001 women) aged 70 or over living in Itabashi-ku, Tokyo, who took part in an interview and biochemical blood examination as part of the “OTASHA-KENSHIN”. In this study, we set the ‘under-nutrition group’ as serum albumin level ≤ 3.8 g/dL (normal group serum albumin level ≥ 3.9 g/dL). Based on this standard, 124 subjects (72 men and 52 women) were found to be undernourished. Physical fitness was measured by handgrip strength, knee extension power, and walking capability (usual and maximal walking speed).The prevalence of undernourished elderly was significantly higher in men than in women, and in those living alone or with a spouse compared with those living with children. It became clear that the lifestyle and health status of the under-nutrition group was generally poor compared with those of the normal group. Handgrip strength and knee extension power were significantly lower in the under-nutrition group than in the normal group of men. Although usual and maximal walking speed tended to be lower in the under-nutrition group, there was no significant difference. In women, a significant difference in handgrip strength, knee extension power, and walking capability was not seen between the two groups.These results suggest that an intervention program for the undernourished elderly living in the community should target an improvement not only of nutrition but also of physical fitness.

Background: High heart rate (HR) has been associated with an increased risk of cardiovascular disease and mortality due to all causes. The present study was conducted to examine the effect of exercise adherence on longitudinal changes in resting heart rate among a population of community-dwelling elderly.Methods: The subjects were 133 men and 209 women aged 65 and older who participated in a baseline survey in August 1992 and were subsequently followed annually for 8 years. Resting HR was measured in the sitting position. The independent variable was the longitudinal change in differences of HR (Δ) from 1996 to 2000. Dependent variables were age, heart rate, smoking habit, TMIG index of competence score, and states of exercise adherence during the period 1992-1996.Results: Multiple regression analysis showed that heart rate in 1996 and smoking in men, and heart rate, TMIG index of competence score, and exercise adherence during the period 1992-1996 in women were significantly associated with longitudinal change in HR.Conclusion: Exercise adherence reduced the increase in HR of elderly women. These results suggest the importance of exercise adherence in elderly women.

We provide “student-selected components (SSCs) “ for 3rd-year students at our school. They work with local NGOs and identify SDH that affect the underserved population including people in isolation, poverty and/or homelessness. Since most students are from privileged families, those encounters made a strong impression on students who create a short video to advocate for people they have met. We describe the process of developing this program and explain the models and theories that underpin this education.

We have developed and operated a browser-based questionnaire system for Kampo medicine based on conventional questionnaires and review of systems to reveal implicit Kampo wisdom both in patients' questionnaire data and in some Kampo specialists' examination data. However, the questionnaire data were found to be inaccurate because too many questions were included and cumbersome input steps were required. The purpose of the present study was to solve these problems and to develop a new patient-centered questionnaire system with fewer questions and an easier input method. After analyzing inquiry database from collaborating institutes and hospitals, we deleted, combined, and added questions. We changed the evaluation method of symptoms from a visual analogue scale to a simple staged evaluation, and introduced another method to evaluate the main symptoms in each time of visit using a visual analogue scale. At the same time, a tool for predicting Kampo pattern diagnoses based on the questionnaire data was implemented. We have already started collecting more accurate and reliable data using the new questionnaire system. It is expected to support routine practices and facilitate more precise clinical research on Kampo medicine.

We have previously reported on a predictive model for deficiency-excess pattern diagnosis that was unable to predict the medium pattern. In this study, we aimed to develop predictive models for deficiency, medium,and excess pattern diagnosis, and to confirm whether cutoff values for diagnosis differed between the clinics. We collected data from patients' first visit to one of six Kampo clinics in Japan from January 2012 to February 2015. Exclusion criteria included unwillingness to participate in the study, missing data, duplicate data, under 20 years old, 20 or less subjective symptoms, and irrelevant patterns. In total, 1,068 participants were included. Participants were surveyed using a 153-item questionnaire. We constructed a predictive model for deficiency, medium, and excess pattern diagnosis using a random forest algorithm from training data, and extracted the most important items. We calculated predictive values for each participant by applying their data to the predictive model, and created receiver operating characteristic (ROC) curves with excess-medium and medium-deficiency patterns. Furthermore, we calculated the cutoff value for these patterns in each clinic using ROC curves, and compared them. Body mass index and blood pressure were the most important items. In all clinics, the cutoff values for diagnosis of excess-medium and medium-deficiency patterns was > 0.5 and < 0.5, respectively. We created a predictive model for deficiency, medium, and excess pattern diagnosis from the data of six Kampo clinics in Japan. The cutoff values for these patterns fell within a narrow range in the six clinics.