Background/Aims: Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease. Methods: We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists. Results: Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom. Conclusions Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.

The purpose of the present study was to examine the associations of replacing accelerometer-measured sedentary behavior (SB) with physical activity (PA) and depression in a sample of Japanese frail older adults using an Isotemporal Substitution (IS) model. Among 139 frail older adults, accelerometer was utilized to identify the daily average time spent in SB, light-intensity PA (LPA), and moderate- to vigorous-intensity PA (MVPA). Depression was assessed using the Geriatric Depression Scale-Short Version-Japanese (GDS-S-J). The relationship between SB, LPA, and MVPA with depression was examined with three models of multiple regression analysis: single factor model, partition model, and IS model. As results, LPA times was negatively associated with GDS-S-J scores in the single factor model (B = -0.09, p = 0.007) and the partition model (B = -0.13, p < 0.001). In the IS model, replacement of 10 minutes of SB with an equal amount of LPA time showed a significant negative association with GDS-S-J scores (B = -0.09, p=0.003). These results suggest that replacing a small amount of SB with LPA may be associated with an improvement in depression in frail older adults.

An oropharyngeal cancer patient often suffers from dysphagia either due to their disease or as a conse­quence of their treatment. Here we report a case of a 61-year-old female with the oropharyngeal cancer-related dysphagia, which was effectively treated with Kampo medicine. After four weeks of treatment with hangekobokuto, her swallowing function was improving. Concomitant use of bakumondoto reduced a feeling of xerostomia. She could return to work. The treatment with Kampo medicine might be effective to reduce the cancer-­related symptoms and to improve the quality of life of the cancer patients.

We treated a pediatric patient suffered from anxiety disorder with ogikenchuto in combination with Western medicine. The case was a teenage girl with long-term neck pain. After entering junior high school, she had palpitations and was afraid while interacting with other students, experienced headaches, struggled to get out of bed in the morning, and developed anorexia and dizziness upon standing up. She was diagnosed with anxiety disorder and orthostatic dysregulation (OD) associated with autistic disorder at a pediatrics department. Pediatricians prescribed aripiprazole and midodrine hydrochloride. And she was referred to our department for treatment with Kampo medicine. Her condition was presumed to be various deficiencies with kikyo, kigyaku, suitai, and kankikyo. She was prescribed 9 g of ogikenchuto extract per day, and the symptoms improved. Kankikyo should be considered for OD patients with psychosomatic symptoms, and ogikenchuto may be one of the prescription drugs for such condition.

Africa ; Asian Continental Ancestry Group ; Hemorrhagic Fever, Ebola ; Humans ; Military Personnel

Purpose: The aim of this study was to clarify the factors contributing to the evaluation of perceived care in inpatient palliative care services from the aspect of informal caregiver after their loss of the patient to cancer. Method: A questionnaire was mailed to 9,684 bereaved subjects who had lost family members at one of 103 palliative care units in Japan to evaluate their sociodemographic characteristics and the evaluation of perceived care. An institution survey was performed to collect organization-related variables. The evaluation of perceived care was rated by the Care Evalutaion Scale (CES), the Good Death Inventory (GDI) and single item of overall satisfation. Result: A total of 5,810 responses were analyzed (response rate＝60％). Uni-variate and multivariate analysis was performed to clarify the determinants of each scale. Significant determinants of the score in the evaluation of care identified were: the rate of private room (100％), independent facility, palliative care physician being night-time duty, the number of nurses at night (＞0.1 per bed), sending a letter to every bereaved family, holding a memorial services for every bereaved family and having a religious background. Conclusion: In conclusion, the evaluation of palliative care from the aspect of informal caregiver was influenced by various organization-related variables.

We investigated original texts for yokukansan, a familiar Kampo formula, focusing on the classical literature Xue-shi yi-an (薛氏医案) . Yokukansan was described in the Bao-ying jin-jing-lu (保嬰金鏡録) written by Xue ji (薛己) in 1550, the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551,the Bao-ying cuo-yao (保嬰撮要) by Xue kai (薛鎧) in 1556, and the Xiao-er dou-zhen fang-lun (小児痘疹方論) in 1550. The phrase “one's own work” was used in “Bao-ying jin-jing-lu (保嬰金鏡録)” and in the Xiao-er dou-zhen fang-lun (小児痘疹方論) by Chen wen-zhong (陳文仲). However, there was no mention of “one's own work” in the same title, the Xiao-er dou-zhen fang-lun (小児痘疹方論), as summarized by Xiong zong-li (熊宗立).
Yokukansan was found only in the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551, but not in the other copies of the same text. Therefore, it seems likely that yokukansan was created by Xue ji (薛己) himself.
Yokukansan was previously thought to have originated with the Bao-ying cuo-yao (保嬰撮要). However, based on use of the phrase “one's own work” in the classical literature, it appears that the original text for yokukansan should be the Bao-ying jin-jing-lu (保嬰金鏡録). Therefore, yokukansan seems to have been made by Xue ji (薛己), and not Xue kai (薛鎧), who was his father.

It has recently become a practice to focus attention on the necessity of therapies for the functions of eating, including exercises for swallowing and training for eating, for patients with difficulties in eating or swallowing. With the remunerations for healthcare under the National Health Insurance Scheme revised in April 2006, the limits put on the frequency of computation for patients in less than three months after onset were removed, and it became a practice to assess the degrees of devotion to inpatients. With our ward designed for specific types of rehabilitation, we have thus far provided functional therapies for eating to patients with disorders in eating or swallowing. But those therapies have been provided to them in a self-centered and haphazard manner because of a lack of knowledge on the part of caregivers while the methods were not standardized. On the basis of a fact-finding survey recently conducted on consciousness about therapies for the functions of eating, we have analyzed the present situation and formulated a record which would enumerate methods and steps to cope with items about which staffers feel apprehensive and the items on which attention should be focused. We also held study meetings on techniques for salivary gland, intraoral and facial massage, compiled an illustrated booklet designed to introduce those steps, and made it accessible in an exclusively designed van. As a consequence, it became feasible to make perpetual use of a standardized functional therapy for dysphagia, and this methodology made it possible to continuously provide a standardized functional therapy for dysphagia, eventually leading to the recovery of the intraoral environment and the maintenance and recovery of intraoral functions, and enabling patients with disorders in their eating or swallowing to enhance their pleasure of eating food and enhance their confidence.

Purpose: To investigate the characteristics of sudden abdominal condition change that occur in a palliative care unit, we evaluated the association between these conditions and family acceptance at time of death. Methods: We retrospectively investigated the medical records of 30 terminally ill cancer patients who died of sudden abdominal condition change in our unit between January 2010 and March 2013. We focused particularly on the course of sudden change, symptom relief, explanation of the condition, and family acceptance at time of death. Results: The average time from onset of sudden change in abdominal condition until death was 20.6 hours and the median was 13 hours. Of the 30 total cases, 23 occurred in less than 24 hours. Frequent symptoms during the sudden change were abdominal pain in 28 patients, decreased blood pressure in 21, lowering of consciousness in 12 and disturbed behavior/excitement in 10. Impending symptoms were observed in 18 patients. For patients with good acceptance by family at time of death (21 patients), symptom relief was significantly better, frequency of disturbed behavior/excitement was significantly less, and prior specific explanation was significantly frequent, compared to the poor acceptance group (9 patients). The good acceptance group tended to be have a longer hospital stay, as well as longer time between sudden change and death. Conclusions: Death by sudden abdominal condition change came within 24 hours in a majority of cases. We consider that prior detailed explanation and improving symptom relief helps improve family acceptance.

Engaging in physical activity was proved to have positive effects on physical and mental health in children. Built environment is an important correlate of physical activity participation. School recess provides a daily opportunity for children to be active during school day. Therefore, the purpose of the present article was to review literatures regarding 1) physical activity during school recess, 2) the relationship between recess physical activity and school physical environment, 3) intervention for physical activity promotion during recess by changing school physical environment, and to explore trends of current researches and assignments of future research. A review was conducted and included studies published to May 31, 2011. Twenty-two studies were selected in 1) and showed boys often engaged in more physical activity than girls, but the results on differences in physical activity between ages were inconsistent. Six studies were selected in 2) and indicated recess physical activity was associated with playground environments such as equipments, marking, and surface situate. School environment intervention was observed to be a potential method for promoting physical activity in children by 8 studies in 3). Playground environment with marking, additional play equipments, and designated activity zones increased physical activity during recess. Most researches regarding recess physical activity was conducted in U.S., Australia, and Western countries, and confirmed the effectiveness of recess to promote physical activity. However, few studies on this topic were conducted in Japan. Further researches are needed to draw a conclusion about the possibility of recess to promote physical activity among Japanese children.