A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection

The purposes of this study were to examine reliability and validity of ADL index for older people at home, and relationships between ADL score and various factors (ex. self-assessment of health status and physical fitness level, and exercise frequency/week), and to examine the screening basis for execution of physical fitness test based on distribution of ADL score. A questionnaire consisting of 12 ADL items and a physical fitness test of Ministry of Education, Science and Clture were administered to 5, 715 subjects 65 years or more age (male: 2, 745; female: 2, 970) . As a result of examining test-retest reliability of the ADL index, significant high correlations were shown among 12 ADL items (0.674≤r≤0.886), and in overall score (r=0.943) . The ADL score was significantly related to age and physical fitness test scores, and tended to be higher in subjects with a higher self-assessment of health status and physical fitness level, and with more frequency. It was suggested that these results prove the utility of the present ADL index. Further, as the result of examining relationships between distribution of overall ADL score and physical fitness test scores, the following screening bases were considered to be valid for judgement whether the physical fitness tests could be executed. The three screening bases using overall ADL score were: 1) 12 or under; 2) over 13 to under 24; 3) 24 and over. The four bases using item score were: 1) a category 1 response for items 1, 5 and 6; 2) a category 2 or 3 response for items 1, 5 and 6, and a category 1 response for items 3 and 4; 3) a category 3 response for items 2 and 14; 4) a category 1 response for items 10 and 12.

The purpose of this study was to propose useful ADLs (activities of daily living) and scales to estimate ADL ability on community older people from the viewpoints of aging, physical fitness level, and interrelationship among ADL. The survey constructing of 15 ADL items and physical fitness test of Ministry of Education, Science and Culture were carried out on 458 older people. Each ADL item was constructed with 3 level scales.
As the results of this study, the following 12 ADLs were proposed as useful ADL items; in the locomotion domain, jumping across a ditch, walking, running, up and down stairs, and transfer; in the manipulation domain, taking bedding in and out, buttoning a shirt; in stability domain, standing in the bus or train, dressing while standing (trousers), standing on one foot with eyes open; in the posture-change domain, sitting up, standing up from the floor. These items were significantly related to age and physical fitness elements contributed largely to achievement of each ADL. Since significant high correlation was found between the index using 12 ADL items and that using 15 items, it is considered that the 12 items scale can account for the variance corresponded enough to that of 15 items scale, and that the new index is practical and simple.
In further research, it will be required to examine validity of each ADL item and index by using more large sample, and to clarify the relation to various factors influenced to ADL ability level.

The number of patients with osteoporosis is an estimated 12,800,000 in Japan. Osteoporosis represents a risk factor for becoming bedridden, and also for increased mortality. It would thus be important to take measures to prevent non-examination and treatment interruption as their rate is high. We recruited participants at a health-supporting event for local residents at our pharmacy on April 14, 2019 and obtained consent from 40 individuals to participate in this study. At this event held by a pharmacy, we conducted bone density measurement and osteoporosis-related preventive education by pharmacists, considering the influence the event had on health-related awareness and behavior in the local residents. Knowledge of osteoporosis was higher after than before the events. Participant health and lifestyle awareness was not observed between before the event and one month after the event. However, one month after the event, several changes could be observed in the behavior of 79.4% (27/34) of the participants. Based on these results, bone density measurement and osteoporosis-related preventive education by pharmacists are suggested to increase osteoporosis-related knowledge among local residents and to promote behavior change related to healthcare and osteoporosis.

The objective of this case report is to introduce a simple technique for simultaneously taking a closed-mouth impression and functionally generated path (FGP) for a full coverage crown restoration. A monolithic zirconia crown was the restoration of choice. An alginate impression of the abutment tooth was taken to fabricate a custom-made closed-mouth impression tray covering the abutment tooth and the adjacent teeth. The tray had an FGP table and an abutment tray in cameo and intaglio surfaces, respectively. The impression was taken with silicone impression material after adjusting the abutment tray and inscribing the FGP using self-curing acrylic resins. Plaster casts were made from the impression, and a zirconia crown was fabricated. The crown was cemented to the abutment tooth with minimal adjustments. This simple technique resulted in a well-fitting crown that accounted for mandibular movements. Using the custom closed-mouth impression tray incorporating an FGP table simultaneously aids in fabricating an accurately fitting restoration that incorporates harmonious mandibular movements using a single impression capture.
Acrylic Resins ; Casts, Surgical ; Crowns ; Dental Impression Technique ; Dental Occlusion ; Jaw Relation Record ; Silicon ; Silicones ; Tooth

Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient’s pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.

Purpose: Endoscopic submucosal dissection is a promising method for the resection of superficial gastric neoplasms. To date, several institutions have used proton pump inhibitor injections over the perioperative period. However, there is very little evidence regarding their efficacy. To overcome this limitation, we compared procedural outcomes and the prevention of adverse events of proton pump inhibitor injection with an orally administered active potassium-competitive acid blocker alone.Participants and Methods: We enrolled a total of 150 patients treated for superficial gastric neoplasms at a single institution between April 2015 and December 2018. Patients treated for 2 days with proton pump inhibitor injections following 12 days of oral potassium-competitive acid blocker (proton pump inhibitor group=80) were compared with patients treated for 14 days orally with potassium-competitive acid blocker alone (potassium-competitive acid blocker group=70) using propensity score analysis. We evaluated intragastric pH levels prior to endoscopic submucosal dissection, frequency of intraoperative major bleeding, procedure time, en bloc resection rate, curability, ulcer reduction rate 14 days after endoscopic submucosal dissection, and adverse events (including perforation and postoperative bleeding).Results: Propensity score analysis yielded 43 matched pairs. The comparison demonstrated similar values for the outcomes. For all cases, we observed intragastric pH levels >6.4 prior to endoscopic submucosal dissection. Postoperative bleeding rates were 2.3% (1/43) in the proton pump inhibitor group and 0.0% (0/43) in the potassium-competitive acid blocker group (P=0.315).Conclusions: Oral potassium-competitive acid blocker alone was as effective as proton pump inhibitor injection, with a low incidence of adverse events. Based on these results, proton pump inhibitor injection might be omitted during gastric endoscopic submucosal dissection.