A sixteen-year-old girl with neuropsychological dysfunction after cerebral encephalopathy came to our hospital for evaluation of her cognitive impairment and ability to acquire compensatory skills for communicative dysfunction. Neuropsychological examinations revealed low scores on FSIQ, VCI, WMI and PSI by WISC-Ⅳ. We intervened using a process-orientated speech-language-hearing therapy to improve her cognitive, language and communicative skills for a year. After that, we evaluated her cognitive ability by WISC-Ⅳ and LCSA. As a result of our intervention, her word knowledge, idiom and mental expression, sentence expression and reading social condition and expression scores in LCSA performance were improved but each IQ by WISC-Ⅳ was preserved. In ST intervention for pediatric neuropsychological dysfunction, the patient evaluation should be made not only using IQ by WISC-IV but also by measuring other communicative skills such as by LCSA.

OBJECTIVE: Accumulating evidence suggests that oxidative stress plays a role in the pathophysiology of schizophrenia and that the potent antioxidants may be potential therapeutic drugs for schizophrenia. This study was undertaken to examine the effects of the potent antioxidant sulforaphane (SFN), found in cruciferous vegetables, on behavioral abnormalities (e.g., hyperlocomotion and prepulse inhibition [PPI] deficits) in mice after a single administration of the N-methyl-D-aspartate (NMDA)-receptor antagonist phencyclidine (PCP). METHODS: Effects of SFN (3, 10, and 30 mg/kg, intraperitoneally [i.p.]) on hyperlocomotion and PPI deficits in the adult male ddY mice after administration of PCP (3.0 mg/kg, subcutaneously [s.c.]) were examined. RESULTS: Administration of SFN (30 mg/kg, intraperitoneally [i.p.]), but not low doses (3 and 10 mg/kg, i.p.), significantly attenuated hyperlocomotion in mice after PCP administration (3.0 mg/kg, subcutaneously [s.c.]). Furthermore, administration of SFN (3, 10, and 30 mg/kg, i.p.) attenuated the PPI deficits in mice after PCP administration (3.0 mg/kg, s.c.) in a dose-dependent manner. CONCLUSION: These results suggest that SFN has antipsychotic activity in an animal model of schizophrenia. Therefore, it is likely that SFN may be a potential therapeutic drug for schizophrenia.
Adult ; Animals ; Antioxidants ; Humans ; Male ; Mice ; Models, Animal ; N-Methylaspartate ; Oxidative Stress ; Phencyclidine ; Schizophrenia ; Thiocyanates ; Vegetables

Case: A 40-year-old woman. Clinical diagnosis: Autistic disorder with mild mental retardation. Case report: The patient underwent pancreaticoduodenectomy for the treatment of her pancreatic cancer. We held several conferences with individuals from different medical fields and examined the influence of the patient's autistic disorder on the perioperative conditions. The senior author, a clinical psychologist, conducted repeated individual, acceptive, and sympathetic interviews with the patient and her family and maintained supportive relationships with them as an honorary family member. Thus, the clinical psychologist helped reduce the patient's anxiety about the medical treatment. Conclusion: The participation of a clinical psychologist in the medical conferences enabled the medical staff to understand the complications involved and provide mental support to the patient and her family. Palliat Care Res 2010; 5(2): 323-326

Objectives : In Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), full scale intelligence quotient (FSIQ) and the index scores are thought to be solely important and supplemental subtests are not taken into account in the score.However, in assessment by intelligent tests it is required that we analyze the result from many directions. Accordingly, the factor of “Cancellation” was taken up and the importance of adding a focus on the qualitative side of the test results was examined. Methods : Some 412 children who received WISC-IV in our developmental evaluation center were divided into three groups according to their intellectual level, and of these, 30 persons were assigned to each group [total of 90] selected at random to comprise the sample. By comparing the index scores and the scaled scores for each group,we have classified the procedures of deletion into six types. Results : The more the intellectual level increases, the lower the “Cancellation” scaled score becomes compared to the other subtests. Further, the scaled score was lower in the type of deletion procedure such as systematic linear strategy. Conclusion : In the high intellect level group, the scaled “Cancellation” score was lower than the other subtests, it was thought to be because there were many “order type” subjects using a systematic linear strategy. It was also considered that attention to the qualitative aspects as well as quantitative is important in “Cancellation”. Therefore, when assessing high intellect children with developmental disabilities in the future, a clinical examination that incorporates “Cancellation” to detect executive function disabilities such as persistence or poor planning ability is desirable.

We report a case in which feelings of abdominal distension and discomfort of the abdominal wall caused by malignant ascites were relieved by ultrasound-guided rectus sheath block. Case report: A 59-year-old man developed gastric cancer with malignant ascites and experienced feelings of abdominal distension, but no nausea, dyspnea, poor mobility, or limb edema. Symptom control was inadequate with diuretic therapy and abdominal paracentesis. Feelings of distension improved temporarily with ultrasound-guided rectus sheath block. A percutaneous catheter was then used to administer an infusion of 0.25% ropivacaine triweekly until his death 20 days later. Conclusion: Feelings of abdominal distension is one of various symptoms of severe ascites and is difficult to manage. Ultrasound-guided rectus sheath block can be used to relieve this symptom on a case-by-case basis.

We performed a prospective study to determine whether the walking pattern of children with flatfoot can be influenced by using shoes and custom-modeled insoles. One hundred and thirty-two children (mean age ; 4.20±2.53) who had been referred by a physiatrist, and who were diagnosed with flatfoot at the brace clinic in our institute, were assigned to three groups : The first group was asked to walk barefoot, the second one to walk with shoes without insoles and the last one to walk with shoes with insoles. We measured walking speed, cadence, step length, step width, the duration of right and left stance phases, both double-limb stance phases, both swing phases, walking angle, and toe angle using a 2.4 m sheet-type Gait Analyzer, the Walk Way MW-1000 ^TM, at the individual's self-selected speed. Compared with the barefoot group, a significant increase was observed in the group using shoes with custom-modeled insoles in both walking speed and step length on both sides, and there were reductions in swing phase and walking angle on both sides (paired t-test ; p<0.002).

We report a case whose left lower limb neuropathic pain accompanied by pelvic tumor invasion was remarkably eliminated by ultrasound-guided sciatic nerve block. Case report: The subject was a sixty year old male. Pharmacological therapy was given according to the WHO analgesic ladder, but his left lower limb pain failed to respond to drugs. His intractable lower limb neuropathic pain was alleviated by ultrasound-guided sciatic nerve block. Drug delivery can be achieved with a percutaneous catheter and a disposable infusion pump. Infusions were run at 5mlh^-1 with 0.1% ropivacaine. Conclusion: Neuropahic pain is sometimes hard to be controlled only by opioids or adjuvant analgesics, but there is a possibility of providing pain relief by combination use with nerve blocks. Interventional techniques can be highly effective but also have the potentiality to produce significant adverse effects. Many patients have factors which would be considered a near absolute contra-indication to the use of nerve blocks such as immuno-compromise or impairment of coagulation. Skillful application of peripheral neural blockade with ultrasound imaging broadens the options for providing optimal pain management. Palliat Care Res 2011; 6(1): 313-315

Systemic administration of opioids rarely causes pruritus, although its mechanism is still not clearly understood. We report an intractable pruritus induced by a change in the dosage form of opioids with the same dose by the conversion ratio, which promptly disapeared with opioid switching. A 80-year-old female experienced worsening dorsal pain and abdominal pain due to recurrent pancreatic cancer. The relief of pain was insufficient with the administration of oral hydromorphone 10 mg/day, changing to continuous intravenous hydromorphone 3 mg/day considering adjustability. The next day, her pain was reduced, but the pruritus appeared. Administering oral and topical antihistamines was ineffective. Her pruritus tended to worsen with continued administration of continuous intravenous hydromorphone at the same dose. Hence we switched to fentanyl patch 0.6 mg/day. The following day, her pruritus significantly decreased, and two days later, her pruritus almost disappeared. This case suggests that opioids switching to fentanyl patch may be effective to relieve pruritus caused by hydromorphone.

Background/Aims: Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC. Methods: A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018–2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA. Results: No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation. Conclusions EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.

Approximately 40%–65% of new fitness club (FC) members cancel their membership within 6 months. To prevent such cancellations, it is essential to identify members at high risk of doing so. This study developed a model to predict the probability of discontinuing FC membership among new members. We conducted a cohort study and enrolled participants from 17 FCs in Japan. We asked 5,421 individuals who became members from March 29, 2015 to April 5, 2016 to participate in the study; 2,934 completed the baseline survey, which was conducted when the participants became FC members. We followed up the participants until September 30, 2016. We excluded 883 participants with missing values and 69 participants under aged 18 years; thus, our analysis covered 1,982 individuals. We conducted the random survival forest to develop the prediction model. The mean follow-up period was 296.3 (standard deviation, 127.3) days; 488 participants (24.6%) cancelled their membership during the follow-up. The prediction model comprised 8 predictors: age; month of joining FC; years of education; being under medical follow-up; reasons for joining FC (health improvement, relaxation); and perceived benefits from exercise (maintaining good body weight, recognition of one’s ability by other). The discrimination and calibration were acceptable (C statistic: 0.692, continuous ranked probability score: 0.134). Our findings suggest that the prediction model could assess the valid probability for early FC cancellation among new members; however, a validation study will be needed.