Purpose : The purpose of the present study was to examine the relationship between respiratory function and ADL/QOL among community-dwelling elderly requiring support or care.
Methods : The study included 87 elderly aged ≥65 years who were certified to require support (yousienn)or care (youkaigo)level 1-3 and who used day care at a rehabilitation center. We evaluated their respiratory, mental, physical, and swallowing functions. ADL, IADL, and QOL were estimated using a questionnaire. Spearman's rank correlation test and multiple regression analysis were used to examine correlations of the functions with ADL/QOL.
Results : Respiratory, physical, and swallowing functions showed statistically significant correlations with ADL/IADL/QOL. Multiple regression analysis showed that forced expiratory volume in 1 second and swallowing function were related to ADL, IADL, and QOL (SF8body & mental).
Conclusion : ADL and QOL were associated with respiratory function in elderly subjects requiring support or care. Our data suggested that pulmonary rehabilitation to enhance respiratory and swallowing functions in elderly requiring support or care may improve their ADL and QOL.

In this study, chemiluminescence technique was employed to compare the effect of tonifilyneedling and ginger-seperated moxibustion on Zusanli in regulating the phagocytosis of the neutrophil in the aged rats. As a result, both methods were proved to be able to elevate the phagocytosis and anti-bacteria effect of the neutrophil, and the later method was found more remarkable. So it concluded that acupuncture and moxibustion are both the effective ways in anti-aging and health-protection.

OBJECTIVE: To evaluate the effectiveness of family-engaged multidimensional team planning and management for patients with severe stroke and low functional status and to identify factors predictive of improved outcome at 1 month after admission. METHODS: We retrospectively evaluated 50 patients who underwent family-engaged multidimensional rehabilitation for recovery from severe stroke due to primary unilateral cerebral lesions. The rehabilitation consisted of three phases: comprehensive multidimensional assessment, intensive rehabilitation, and evaluation. Functional Independence Measure (FIM) scores were calculated and used to predict the patients’ status at discharge. RESULTS: Although all FIM scores significantly improved after 1 month of rehabilitation, the motor FIM (mFIM) score improved the most (from 20.5±1.0 to 32.6±2.0). The total FIM (tFIM) and mFIM scores continued to improve from the first month to discharge (mean mFIM efficiency, 0.33). The high-efficiency patient group (mFIM efficiency ≥0.19) had a significantly higher discharge-to-home rate (44% vs. 13%), lower frequency of hemispatial neglect, and more severe finger numbness than the low-efficiency patient group (mFIM efficiency <0.19). The regression analyses revealed that besides lower mFIM and cognitive FIM scores at admission, unilateral spatial neglect, systemic comorbidities, and age were predictive of worse 1-month outcomes and tFIM scores (conformity, R²=0.78; predictive power, Akaike information criterion value=202). CONCLUSION: Family-engaged multidimensional team planning and management are useful for patients with severe stroke and low functional status. Furthermore, FIM scores at admission, age, unilateral spatial neglect, and systemic comorbidities should be considered by rehabilitation teams when advising caregivers on the probability of favorable outcomes after rehabilitation.
Caregivers ; Cerebrovascular Disorders ; Comorbidity ; Fingers ; Humans ; Hypesthesia ; Perceptual Disorders ; Rehabilitation ; Retrospective Studies ; Stroke ; Symptom Assessment

Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

1）We had the opportunity to study medical education in Thailand and Singapore while we visited medical schools in those countries as a member of the Japan Tropical Medicine Association.
2）In Thailand, undergraduate medical education last for 6 years, which is the same length as in Japan. All lectures are in English. Medical students in Thailand are more deeply related to patients at bedside learning than are students in Japan. In Singapore, undergraduate education lasts for 5 years, and lectures are in English. In the third year, medical students start clinical medicine. Recently, a new program has been adopted in which medical students can easily choose their specialties right after graduation.
3）Japanese medical students study medicine in Japanese. In contrast, greater emphasis should be placed in Japan on medical education in English.

Physical performance measures, such as gait speed, one-legged stance and hand-grip strength, are known as assessment measures of motor function and predictors for adverse health outcomes, and widely used for assessing motor function in preventive programs for long-term care or screening of frail elderly. However, there is no standard assessment sheet for feedback of the results. In the present study, an assessment sheet on physical performance measures for community-dwelling older adults was developed. A pooled analysis of data from six cohort studies, including urban and rural areas was conducted as part of the Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging. The pooled analysis included cross-sectional data from 4683 nondisabled, community-dwelling adults aged 65 years or older. Quintiles were derived according to age and sex group for six physical performance measures, i.e., hand-grip strength, one-legged stance, and gait speed and step length at both usual and maximum paces. The assessment sheets, which indicated the physical performance level according to age and sex, were developed by fitting third order polynomial curves to the data. The reference values in the present assessment sheet were considered to be derived from better represented community-dwelling older adults by using more large-scale population-based cohort data than that in the previous study. The assessment sheet should be useful for feeding back results on physical performance measures to elderly individuals and help them better understand their own physical performance levels.

We report the case of a 62-year-old man who was admitted for acute cerebral infarction linked to a cardiac calcified amorphous tumor (CAT). The patient, who had been on hemodialysis for about 10 years, was referred to our hospital with dysarthria, and left hemiplegia. Brain magnetic resonance imaging (MRI) showed acute cerebral infarction in right parietal lobe of the cortex, and transthoracic echocardiography revealed moderate aortic valve stenosis and a mobile mass measuring 8 mm×5 mm in diameter attached to the aortic valve. The mobile structure was thought to be related to the cerebral infarction. Aortic valve replacement was performed. On the basis of the pathological examination, a cardiac calcified amorphous tumor was diagnosed. The patient was discharged from our hospital without any complication.