Initial gastrointestinal endocrine cells (GIECs) likely appear at the proximal and distal sites of abdominal intestines and may take a close topographical relation with neural elements in the gut. We examined immunohistochemically-stained sections from 10 fetuses at approximately 8–18 weeks of gestational age (36–155 mm of crown-rump length). Irrespective of whether physiological herniation was present (early 5 specimens) or absent (the other 5), the duodenum and jejunum had well-developed mucosa with villi containing abundant flask-like chromogranin-positive cells. In the earlier 5 specimens, the rectum, standing up to a level of the umbilicus, had a lumen and villi with a few positive cells, but the colon carried neither the lumen or chromogranin-positive cells. The initial GIECs seemed to appear in the basal payer of the epithelium at the distal and proximal foci depending on double pathways of neural crest cell migration. Less number of the colic chromograninpositive cells, more than 5-times difference in density relative to small intestine, was seen in the larger 5 specimens. The appearance of GIECs was delayed at the anal transitional zone (a border area between the columnar and squamous epithelia).The reactivity of neuronal nitric oxide synthase was restricted in the myenteric plexus, whereas clusters of slender calretininpositive cells existed in the lamina propria or core of villi in the duodenum and colon. Relatively small, round or oval positive cells were also seen in the basal layer of the columnar epithelium. Therefore, calretinin-positive cells might exist closely to GIECs in the developing villi.

Neck epaxial muscles, which are differentiated for suspending the head, occupy a large space posterior to the cervical lordosis. Limited information exists regarding developmental process that determines the muscle fiber direction and bony attachment of neck epaxial muscles. We examined histological sections of 28 human fetuses aged approximately 7–18 weeks (crown-rump length, 20–150 mm). In place of the underdeveloped lordosis, the transverse process of cervical vertebrae was shifted anteriorly at the cervicothoracic junction. The semispinalis and longissimus were distinguished by the direction of muscle fibers connecting between the surface aponeurosis and transverse process. The semispinalis capitis and splenius capitis had a bulky anterior margin without bony attachments. The obliquus capitis inferior continued to both the rectus capitis posterior major and the semispinalis cervicis, but the obliquus capitis superior was consistently independent. Muscle attachments to the scapula were quite different from the final morphology: 1) the levator and rhomboidei usually extended inferiorly along the developing scapula beyond the inferior angle and 2) the splenius capitis or semispinalis cervicis rarely issued an aberrant bundle attaching to the scapula. The scaleni, rhomboidei, levator scapulae, iliocostalis and longissimus were arranged in parallel from the anteromedial to the posterolateral planes and together formed a thick oblique muscle bundle originating from the cervical transverse process and running toward the upper thoracic vertebra and ribcage. The transient oblique muscle bundle seen in early fetuses seemed to provide the so-called intermediate axial muscle between the epaxial-hypaxial muscles: a concept postulated in recent molecular neurology and embryology.

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: The purpose of this study is to evaluate hangeshashinto rinse for oral discomfort in terminally-ill cancer patients and to compare the effectiveness of hangeshashinto rinse with or without honey rinse. Methods: Patients with oral discomfort were randomized to receive either hangeshashinto rinse or hangeshashinto with honey rinse as first-line treatment. Patients performed oral rinse three to five times a day for 2 weeks. Further, oral wetness, halitosis, oral mucositis, mouth discomfort, compliance of rinse were then evaluated before and after the intervention. Results: 144 patients were enrolled during this period and 22 patients completed the study (hangeshashinto 13 / hangeshashinto with honey 9). After the intervention, oral wetness was improved, and end-tidal concentration of hydrogen sulfide was decreased in both cases. Although there was no statistically significant difference, oral discomfort by subjective and objective evaluations, also and symptom of oral mucositis were improved. Other volatile sulfur compounds decreased. Frequency of rinsing between groups receiving hangeshashinto or hangeshashinto with honey did not differ, however, the acceptability was slightly better in the honey combination group. Conclusion: Both hangeshashinto rinse and hangeshashinto with honey rinse reduced end-tidal concentration of hydrogen sulfide and improved oral wetness. Oral rinse by hangeshashinto or hangeshashinto with honey may be effective for oral discomfort in terminally-ill cancer patients.

OBJECTIVE: Traditional Japanese food appears to be healthy but contains a small amount of milk products. Type 2 diabetes (T2DM) patients commonly reduce their energy intake to control their blood glucose levels. However, nutritional guidance for diabetes does not emphasize calcium (Ca) consumption. The aim of this study is to estimate the nutritional status of Ca and other nutrients, which affect bone and Ca metabolism, in T2DM patients. METHODS: This observational study was conducted with Japanese T2DM patients (n = 96; M/F = 50/46; age: 61.6 ± 10.1 years). We estimated nutrient intake using a simple food frequency questionnaire. RESULTS: Median total energy intake was 1750 kcal/day (1440-1970). Their median daily intake of Ca, vitamin D, and vitamin K was 451 mg (336-560), 10.2 µg (8.5-12), and 206 µg (84-261), respectively. Only 17.7% of the study subjects were found to take more than 600 mg/day of Ca. Protein and salt intake was 78 (64-90) and 10.6 (9.3-12.2) g/day, respectively. Male subjects had more salt, less Ca and vitamin K than female. Daily Ca intake was positively associated with total energy, protein, and lipid intake but not with carbohydrates. Vitamin D intake correlated only with protein intake. CONCLUSION: The daily Ca intake of Japanese T2DM patients appears to be insufficient and could depend on protein and lipid intake. Additionally, these patients should have specific recommendations to ensure sufficient intake of Ca with protein and lipid during energy restriction.
Asian Continental Ancestry Group* ; Blood Glucose ; Calcium* ; Carbohydrates ; Energy Intake ; Female ; Humans ; Male ; Metabolism ; Milk ; Nutritional Status* ; Observational Study ; Vitamin D ; Vitamin K

Introduction: There has been no case report in which hyperpigmentation developed on the skin area where a transdermal fentanyl patch was applied in a patient. Case report: A 43-year-old man with recurrence of postoperative rectal cancer was treated by cetuximab plus irinotecan and panitumumab plus FOLFIRI. For cancer pain, transdermal fentanyl patch (Fentos®) was administered, and radiation from behind was performed. Hyperpigmentation then appeared on the chest and the abdominal skin sites where the patches were applied. The hyperpigmentation nearly disappeared four months after the fentanyl patch was discontinued. Discussion: The cause of the pigmentation was possibly due to post inflammatory hyperpigmentation secondary to contact dermatitis. It was desirable to conduct patch test and skin biopsy for making an accurate diagnosis. Conclusion: We should pay a careful attention to hyperpigmentation of the skin where a transdermal fentanyl patch is applied.

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.

We three students of Saga Medical School visited medical centers in the United States and the United Kingdom as an elective course in the sixth year of medical education. One of us went to Sutter Medical Center, Santa Rosa, California, in the United States for 4 weeks, and two of us went to the University of Leicester in the United Kingdom for 4 weeks. These experiences led us to reconsider Japanese medical education, medical system, and hospital volunteers from different points of view.