Objective: Poor R wave progression in right precordial leads is a relatively common electrocardiogram (ECG) finding that indicates possible prior anterior myocardial infarction (MI); however, it is observed frequently in apparently normal individuals. In contrast, reversed R wave progression (RRWP) may be more specific to cardiac disorders; however, the significance of RRWP in daily clinical practice is unknown. The purpose of this study was to clarify the significance of RRWP in clinical practice.Materials and Methods: We analyzed consecutive ECGs obtained from 12,139 patients aged ≥20 years at Mito Kyodo General Hospital in Ibaraki between November 2009 and August 2012. Our setting is a secondary emergency hospital in the community, and the study participants were inpatients or patients who visited the general or emergency outpatient departments. RRWP was defined as RV2 < RV1, RV3 < RV2, or RV4 < RV3. Regarding ECGs considered to show RRWP, we confirmed the presence or absence of an abnormal Q wave and whether ultrasound cardiography, contrast-enhanced computed tomography, coronary angiography, and/or left ventriculography were performed to obtain detailed information.Results: RRWP was identified in 34 patients (0.3%). Among these patients, 29 (85%) had undergone cardiac evaluation. The final diagnosis was previous anterior MI in 12 patients (41%) and ischemic heart disease (IHD) without MI in 5 patients (17%). All 17 patients with IHD had left anterior descending (LAD) artery stenosis. The other patients were diagnosed with dilated (two patients, 7%) and hypertrophic (one patient, 3%) cardiomyopathy, left ventricular hypertrophy (one patient, 3%), or pulmonary embolism (one patient, 3%). Only seven patients (24%) were normal.Conclusions: RRWP is rare in daily clinical practice; however, it is a highly indicative marker for cardiac disease, particularly IHD with LAD artery stenosis.

Microscopic polyangiitis (MPA), an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, is a systemic disease that damages all organs through predominantly affecting small vessels. However, few cases of MPA are related to aneurysms on medium-sized muscular vessels, and whether subarachnoid hemorrhage (SAH) is associated with MPA is still unclear. An 85-year-old woman with rapid progressive glomerular nephritis caused by MPA complained of sudden severe headache due to SAH 2 days after admission and subsequently underwent surgery. Cerebrovascular disease occurring simultaneously with MPA might result in poor prognosis, and the complications exacerbate the condition and lead to high mortality; thus, physicians should pay more attention to cerebral aneurysms concurrent with MPA. Among patients with MPA, it is important to identify priority cases and investigate the intracranial vessel environment. To the best of our knowledge, this is a rare report about SAH associated with MPA. We recommend that the presence of cerebrovascular disease should be considered in patients with MPA to improve their prognosis.

A 79-year-old man with elevated blood glucose was started on insulin therapy. IgG4 was as high as 1,830 mg/dL, and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) confirmed diffuse pancreatic enlargement and accumulation of FDG. Based on the above, autoimmune pancreatitis (AIP) was diagnosed, but steroid treatment was not performed. IgG4 later declined, and FDG accumulation in the pancreas disappeared on FDG-PET/CT at the age of 83 years. AIP was thought to have gradually remitted spontaneously over time. FDG-PET/CT is useful for evaluating AIP activity.

A 52-year-old woman was transported for reduced consciousness. Her blood glucose was only 19 mg/dL, but her blood immunoreactive insulin and insulin antibody levels were high at 250 μU/mL and 50 U/mL, respectively. She had no history of insulin treatment, but she had been taking coenzyme Q10 supplements for three months. Her human leukocyte antigen serotype was DR4. After stopping coenzyme Q10, her hypoglycemia disappeared and immunoreactive insulin and insulin antibody levels normalized. Based on the above, she was diagnosed with insulin autoimmune syndrome caused by coenzyme Q10. It is necessary to be aware of the onset of insulin autoimmune syndrome due to coenzyme Q10. Its pathogenesis requires clarification.

Objectives: The aims of this study were 1) to elucidate the relationship between social capital and health by ward in Tomi City, Nagano Prefecture, in order to clarify the regional social resources available to support long-term care prevention utilizing self- and mutual support of regional residents and 2) to comprehensively investigate the activation of regional networks.Materials and Methods: We analyzed elderly (aged 65 years or older) individual survey data from 7,199 residents from all wards within Tomi City in 2014 (number of valid responses: 5,546; valid response rate: 77.0%). The social capital indicators used for the analysis included participation in community activities, regional managerial position experience, and general trust. The health indicators included self-rated mental health, activities of daily living, and depression. Standards for a “good” result for each indicator were established, and the percentages of each were tallied up by ward. Spearman’s rank correlation coefficient and principal component analysis were used to investigate correlations between social capital and health.Results: The results for overall respondents indicated correlations between participation in sports and hobbies and activities of daily living (p<0.01) and self-rated mental health (p<0.05). Participation in nonprofit organizations/volunteer activities and participation in community center workshops exhibited correlations with activities of daily living (both p<0.05). In respondents aged 65–74 years, participation in community center workshops and general trust were found to be correlated with activities of daily living (both p<0.05). Meanwhile, in respondents aged 75 years or older, correlations were noted between participation in sports and hobbies and participation in nonprofit organizations/volunteer activities and activities of daily living (p<0.05 and p<0.01, respectively). By creating a distribution map using principal component analysis, we were able to grasp the characteristics of the distribution of “community participation/connections with people” and “health” in each ward.Conclusions: Our results point the way forward for future long-term care prevention support in Tomi City by clarifying the correlation between social capital and health by ward.

Purpose: The aim of this study was to clarify psychosocial factors supporting elderly men who were living alone in a heavy snowfall area where the population aging rate exceeded 40%.Methods: The authors conducted semi-structured interviews with six elderly men living alone. As the method of analysis, we conducted a hierarchical cluster analysis of the contents of the interviews via text mining.Results: As a result, we found the psychosocial factors supporting the elderly men living alone. We divided the factors into six categories: “well-planned roof snow removal”, “interaction with young people”, “realization of the meaning of life via driving”, “engagement in leisure and recreational activities”, “living a life aligned with personal preference” and “insistence on living alone”.Conclusion: Formal and informal networking that avoids debasing these psychosocial factors required for the continuance of living life alone is necessary.

Objective: This study investigates the presence or absence of reminiscence experiences in older adults when using aromas. Focusing on 40 scents familiar to Japanese people, our objective was to determine points of caution for aroma selection and use in reminiscence therapy.Materials and Methods: The participants were 118 community-dwelling older adults aged 65 years and older. They were asked about the experience of recalling the past in response to stimuli of 40 aromas on the Japanese version of the University of Pennsylvania Smell Identification Test (UPSIT-J). In addition, an olfactory visual analog scale (VAS) was used to evaluate olfactory function. Furthermore, a questionnaire-based survey was administered instead of asking participants to actually smell the odorants in the UPSIT-J.Results: At least 70% of the participants experienced recalling the past triggered by 16 aromas including sandalwood and yuzu fruit. Furthermore, 15 of the scents demonstrated a significant association with age, gender, and olfactory function.Conclusion: These results suggest the importance of considering method, age, and gender when selecting olfactory stimuli. In addition, frequently recalled aromas might evoke reminiscence in older adults.

Objective: Postoperative management of children having cerebral palsy (CP) with mental retardation is difficult. This report presents a case of severe CP with mental retardation, which resulted in anorexia and condylar fracture of the femur following a surgery for bilateral lower limb joint contracture.Case report: A 14-year-old male was diagnosed with CP having severity of Gross Motor Functional Classification System Level V, and severe mental retardation. Due to bilateral spasticity in hip adduction, knee flexion, and valgus of the feet, tenotomies of the adductors of both hips, bilateral lengthening of the hamstrings and bilateral tenotomy of the peroneal tendons were performed. At 4 weeks postoperatively, knee casts were used; thereafter, knee extension braces were attached for 12 weeks. After surgery, he showed severe anorexia for 8 weeks and weight loss of 8.8 kg (from 35.2 kg to 26.4 kg) during the 4 months of hospitalization. Six months postoperatively, he was diagnosed with supracondylar fracture of the right femur.Discussion: Severe CP with mental retardation requires attention to the physical symptoms caused by stress related to the hospitalization, surgery, fixation by casts, and braces. Moreover, care must be taken not to increase the risk of fracture by fixation or immobility of the postoperative cast, because it can lead to the progression of low bone mineral density.

Objective: Enrollment in graduate schools presents a useful opportunity for registered nurses to enhance their expertise in their nursing field and gain better opportunities to achieve their desired career advancements. This study investigates the predictors associated with registered nurses’ interest in enrolling in master’s programs of nursing graduate schools.Materials and Methods: For the predictors associated with interest in enrolling in master’s programs of nursing science, we evaluated items related to registered nurses’ perceptions of their work environments and their impressions regarding master’s programs in nursing. The analyzed subjects were 3,611 female registered nurses working in 30 hospitals in Mie prefecture, Japan. Multiple linear regression analyses were conducted to investigate registered nurses’ predictors of interest in enrolling in master’s programs of nursing graduate schools. We included the variables with Variance Inflation Factor (VIF) less than (<) 2 in the statistical model.Results: Full-time nurses were more interested in enrolling in master’s programs than part-time nurses. Registered nurses who felt that they could keep up with courses in graduate schools, that they would be able to acquire skills to contribute to society, and that their colleagues were competent, showed stronger interest in master’s programs. Registered nurses who were under the impression that graduate school teachers were dedicated to their students showed lower interest in master’s programs. Registered nurses who felt that their superiors were competent and that they were expected to perform well by physicians also showed lower interest in master’s programs.Conclusion: Predictors significantly associated with registered nurses’ interest in enrolling in master’s programs of nursing graduate schools were determined. Further studies are required to gain a more detailed understanding of the nurses’ attitudes investigated.

Objective: Human papillomavirus (HPV) vaccination was introduced in Japan in April 2013, as a national immunization program for girls aged 12–16 years, after an initial introduction in 2010 as a public-aid program for girls aged 13–16 years. The Yuri-Honjo district had the highest vaccine coverage among women aged 17–51 years in 2017, due to the original public-aid program. The aim of this study was to evaluate the differences in the vaccine types of HPV16/18 infections between 2008–2012 (pre-vaccine era) and 2013–2017 (vaccine era).Materials and Methods: We evaluated whether HPV vaccination was associated with a decrease in the prevalence of HPV16/18 and high-risk HPV and the incidence of HPV-associated cervical lesions. A total of 1,342 women aged 18–49 years, covering both the pre-vaccine and vaccine eras, who visited Yuri Kumiai General Hospital and underwent HPV genotype tests from June 2008 to December 2017 were compared.Results: Among women aged 18–24 years with higher vaccine coverage (68.2%), the prevalence of HPV16/18 and high-risk HPV decreased from 36.7% and 69.4%, respectively, in the pre-vaccine era to 5.8% and 50.0%, respectively, in the vaccine era (p=0.00013 and p=0.047, respectively). Among those with cervical intraepithelial neoplasia grade 2− and grade 2+, HPV16/18 prevalence decreased from 30.0% to 2.7% (p=0.0018) and from 81.8% to 36.4% (p=0.030), respectively. In this age group, the rate of HPV16/18 positivity decreased significantly. Among age groups with lower vaccine coverage, HPV prevalence did not significantly differ between the two eras.Conclusion: The prevalence of HPV16/18 and high-risk HPV significantly decreased in women aged 18–24 years, most of whom were vaccinated. HPV vaccination effectively reduced the prevalence of HPV16/18 infections in the Yuri-Honjo district.