Few reports have yet investigated adequate cognitive rehabilitation for patients with chronic cognitive disorder. In this report, we describe a case of cognitive rehabilitation 10 months after onset of cerebral infarction in the right middle cerebral artery region, resulting in a good outcome. The patient was a 44-year-old right-handed male, with primary symptoms of inattention and left hemispatial neglect. The patient had not undergone any neuropsychological evaluations or cognitive rehabilitation until 10 months after disease onset. After 30 days of both direct attention training and metacognitive strategy training, including time pressure management, improvement of his cognitive disorder was achieved. The teaching of internal methods to improve metacognition with a high level of evidence was effective even 10 months after onset. Furthermore, it is important for therapists who provide cognitive rehabilitation using metacognitive strategy training to understand patients' remaining functions based on neuropsychological assessment, and to consider and teach compensatory methods so that they can be effectively used by patients in situations of daily life.

Few reports have yet investigated adequate cognitive rehabilitation for patients with chronic cognitive disorder. In this report, we describe a case of cognitive rehabilitation 10 months after onset of cerebral infarction in the right middle cerebral artery region, resulting in a good outcome. The patient was a 44-year-old right-handed male, with primary symptoms of inattention and left hemispatial neglect. The patient had not undergone any neuropsychological evaluations or cognitive rehabilitation until 10 months after disease onset. After 30 days of both direct attention training and metacognitive strategy training, including time pressure management, improvement of his cognitive disorder was achieved. The teaching of internal methods to improve metacognition with a high level of evidence was effective even 10 months after onset. Furthermore, it is important for therapists who provide cognitive rehabilitation using metacognitive strategy training to understand patients' remaining functions based on neuropsychological assessment, and to consider and teach compensatory methods so that they can be effectively used by patients in situations of daily life.

Objectives: This study surveyed Japanese anesthesiologists’ knowledge of the cost of medicine and their attitudes toward cost containment to determine how these factors may affect their choice of medication and provide insight into reducing healthcare expenditures.Materials and Methods: In this cross-sectional study, Japanese anesthesiologists’ knowledge of medicine prices and their attitudes toward cost containment were surveyed to identify barriers in lowering the cost of anesthesia. The proportion of participants who correctly guessed the cost of the five most frequently used types of drugs within 25% of the actual price was determined, and their attitudes regarding drug prices and barriers to achieving cost containment were analyzed.Results: In total, responses to 60 questionnaires were analyzed. The proportion of participants correctly guessing the price within 25% of the actual price for each of the five drug categories, including neuromuscular blocking agents, inhaled anesthetics, intravenous anesthetics, opioids, and neuromuscular blockade reversal agents, was 30% (n=18), 18.3% (n=11), 6.67% (n=4), 30.0% (n=18), and 63.3% (n=38), respectively. Participants believed they had adequate access to information on prices, that the cost of a product influenced their decisions regarding product use, and that more information about cost might change their use of the drugs but did not believe that they had adequate knowledge about product prices.Conclusion: The proportion of participants with acceptable price estimates is small. Educating anesthesiologists about the cost of anesthetic agents may be required to encourage cost-containing behaviors. This study is the first survey to assess Japanese anesthologists’ knowledge of the cost of medicines.

To screen for additional treatment targets against tongue cancer, we evaluated the contributions of extracellular signal-related kinase (ERK), AKT and ezrin in cancer development. Immunohistochemical staining showed that ERK and ezrin expressions were significantly higher in invasive squamous cell carcinoma than in carcinoma in situ. To investigate the roles of ERK and ezrin in cancer development, we used the non-woven silica fibre sheet Cellbed with a structure resembling the loose connective tissue morphology in a novel 3D culture system. We confirmed that the 3D system using Cellbed accurately mimicked cancer cell morphology in vivo. Furthermore, cell projections were much more apparent in 3D-cultured tongue cancer cell lines than in 2D cultures. Typically, under conventional 2D culture conditions, F-actin and cortactin are colocalized in the form of puncta within cells. However, in the 3D-cultured cells, colocalization was mainly observed at the cell margins, including the projections. Projections containing F-actin and cortactin colocalization were predicted to be invadopodia. Although suppressing ezrin expression with small interfering RNA transfection caused no marked changes in morphology, cell projection formation was decreased, and the tumour thickness in vertical sections after 3D culture was markedly decreased after suppressing ERK activity because both the invasion ability and proliferation were inhibited. An association between cortactin activation as well as ERK activity and invadopodia formation was detected. Our novel 3D culture systems using Cellbed™ are simple and useful for in vitro studies before conducting animal experiments. ERK contributes to tongue cancer development by increasing both cancer cell proliferation and migration via cortactin activation.
Carcinoma in Situ ; metabolism ; pathology ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Cell Culture Techniques ; methods ; Cell Movement ; Cell Proliferation ; Cytoskeletal Proteins ; metabolism ; Extracellular Signal-Regulated MAP Kinases ; metabolism ; Humans ; Neoplasm Invasiveness ; pathology ; Phosphorylation ; Podosomes ; pathology ; Proto-Oncogene Proteins c-akt ; metabolism ; Silicon Dioxide ; Tongue Neoplasms ; metabolism ; pathology ; Tumor Cells, Cultured

  Less than 0.5% of hot springs in Japan is natural carbonated hot springs.   Therefore, the spread of artificial bicarbonate (CO2) water in Japan starts by developing the gas-permeable membrane.   There are two methods to produce artificial CO2 water. The first is gas-permeable membrane method and the second is pressurizing stir method. Both are widespread. Because the gas-permeable membrane method is provided by stable concentration in medical treatment, generally the stirring methods spread because a price is cheap.   There is a custom of whole body bathing in Japan from old days, and the CO2 warm water bathing has spread all over Japan in about ten years recently.   The vasodilation effect can be caused by the CO2 in warm water of 41 degrees Celsius (approximately 1,000ppm: max saturation under conditions of atmospheric pressure), which is the temperature favored by Japanese people. This differs from the vasodilation caused by the nitric oxide (NO) by thermal, and the reason is thought to be the participation of hormone from a blood vessel endothelium such as prostaglandin E2.   When CO2 penetrates from the epidermis and it reaches the dermis, it enhances the entering blood vessel to the capillary of the dermis.   The blood vessel is enhanced according to the concentration of CO2.   A wide capillary increases volume flow of blood, sends the tissue oxygen and nourishment, and accentuates the renewal of the skin.   By the use of this mechanism, arteriosclerosis obliterans using the footbath and the pressure sore treatment in the medical, and cosmetics with CO2 water are widespread in the beauty industry in Japan.   Moreover, a vasodilated vessel carries the febris easily from the warm water to the inside of the body, and raises the body temperature high early.   Body temperature increases CO2 water 1.5 degrees Celsius, tap water 1.0 degrees Celsius by the warm water hole body bathing of 41 degrees Celsius 15 minutes from before bathing.   　This phenomenon of CO2 warm water raises the body temperature easier than the tap water, and works as a heat stress for the human body.   It provides to increasing of the immunity (natural killer cell activities) and the heat shock protein (HSP) caused by this stress, and it consequentially enhances health promotion.   In addition, using the bulla from unstable CO2 to clean the hair and the hair root and to improve the blood circulation of the scalp is becoming popular in Japanese hair salon. Though custom of the drinking CO2 water has been performed in Europe from long ago, it became popular in Japan several years ago, for the appetite increase with small and for the diet with large amount. These spread as one of the dieting methods of a woman from last 2 years.   Japan is a country that can use the favor of high concentrate artificial CO2 warm water anywhere, for the development and the widespread of the high concentrated artificial CO2 producting apparatus.

 Hot sprigs elements and balneological effects of Tokyo 23 wards, which is not recognized as hot spring region were considered. The density of the hot spring’s source in this region is high compared to other parts of the country. Moreover, a useful element and temperature for the balneological treatment was confirmed by the hot springs with deep digging in a lot of places.  The hot springs in Tokyo can be classified into the NaCl strong salt hot springs, NaHCO3, and the sodium metasilicates. The strong Na-Cl (salt) springs are recognized in hot springs found by deep digging, and exists everywhere in Tokyo. The hot springs of the NaHCO3 are localized in Ohta ward by moderate depth digging. The hot springs including with the rich sodium metasilicates in Ohta ward by shallow digging. If the hot springs in Tokyo are to be used the balneologically, the following effects are expected.  Thermal and warm keeping effects can be expected from the strong Na-Cl (salt) springs. Cleanness and smoothing effects of the skin can be expected of NaHCO3. Hyperkeratosis of the skin can be expected from rich sodium metasilicates.

OBJECTIVEClarifying the characteristics of attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood is important for the prevention and management of this disorder. The purpose of this study was to determine the prevalence of ADHD symptoms in Japanese preschool children based on evaluations performed by parents or teachers.

METHODSA questionnaire survey was performed to evaluate the estimated prevalence of ADHD symptoms in preschool children in Niigata City, Japan. The first survey, conducted in 2003, involved an evaluation of ADHD symptoms by their school teachers. The second survey, conducted in 2006, involved an evaluation of the symptoms by parents. The teacher survey included 9,956 children, and the parent survey included 7,566 children. Parents and teachers assessed ADHD symptoms in children using a 14-item questionnaire based on DSM-III-R. Children with a score of 8 or higher were classified as having ADHD symptoms.

RESULTSThe overall prevalence of ADHD symptoms was 2,349/7,566 (31.1%) in the parent survey and 431/9,956 (4.3%) in the teacher survey, with a prevalence ratio of 7.2 (95% CI: 6.5-7.9). Likelihood ratio test indicated that variables significantly associated with the presence of ADHD symptoms were gender, age, school type, interaction between gender and observer, and interaction between school type and observer (each with P < 0.0001).

CONCLUSIONSThe large difference between the estimated prevalence of ADHD symptoms in Japanese preschool children from teacher and parent surveys suggests that compared to teachers, parents consider their children's symptoms much more serious. Thus, parental evaluation of ADHD symptoms using DSM criteria may be inappropriate for ADHD screening.

OBJECTIVESThe 5-year survival rate for pancreatic cancer is known to be lower than that for cancer at any other site in the body, and the proportion of pancreatic cancer deaths among all cancer deaths has been increasing in Japan. The aim of this study was to investigate pancreatic cancer mortality in the light of temporal and geographical trends in the 47 prefectures of the country between 1968 and 2002.

METHODSTo survey the geographical aspects of pancreatic cancer mortality, we mapped the direct age-adjusted mortality rates of persons aged 40 years and older by sex in seven 5-year periods (1968-1972 to 1998-2002). We also evaluated the changes in period and birth cohort trends using estimable functions based on the age-period-cohort models in each prefecture.

RESULTSDuring the observation period the Hokkaido and Tohoku regions had high mortality rates for both sexes. No significant increase in period trends was observed from 1973 to 2002, but significant increases in cohort trends were observed from 1913 to 1962-in two prefectures, for males, and in four prefectures, for females.

CONCLUSIONSThe results of this study reveal a combination of time trends in pancreatic cancer mortality and changes in period or birth cohort trends. The changes in cohort trends in each prefecture were more variable than the period trends. This finding probably indicates the need for further investigation of the cohort-related factors involved in the prevalence of pancreatic cancer. Further research on mortality in the 47 prefectures needs to be conducted while taking the two time effects into account.

OBJECTIVEIn this study, we used an intervention approach to examine the effects of physical exercise on elderly people living at home in a rural area.

METHODSTwo regions in a village were randomly assigned as the control and intervention regions. The subjects were 60 years of age or older and were able to carry out their activities of daily living independently. The numbers of subjects were 56 and 81 for the control and intervention regions, respectively. In the control region, lectures on health were provided twice. In the intervention region, instructions on ten types of physical exercise were provided six times during this three-month study. In addition, the subjects in the intervention region were instructed to do, exercises by themselves at home three days per week. The effects were compared by evaluating motor functions in maximum step length, 10-m full-power walking parameters, right knee extension torque, right hip flexion torque, and stepping time on a 40-cm staircase; data were obtained before and after the intervention.

RESULTSAnalysis of covariance (ANCOVA) showed significant improvements in right maximum step length, the mean of the right and left maximum step lengths, and right hip flexion torque in the intervention region.

CONCLUSIONThe three-month physical exercise program improves the motor functions of the elderly.

OBJECTIVEAlthough exercise therapy intervention for frail elderly people was not of great interest in the past, it has recently drawn attention as a method to prevent and improve conditions requiring care since the enforcement of the Long-Term Care Insurance Law and the revision of the long-term care insurance system. This randomized controlled trial was performed to evaluate the effects of exercise therapy using the Takizawa Program.

METHODSIn this randomized controlled trial, we evaluated the effects of exercise therapy on the frail elderly, including those who need a high level of care, in terms of two factors: the range of motion and the functional independence measure. The subjects were 145 females admitted to special nursing homes for the elderly. They were stratified according to their care levels and randomly assigned to either the exercise therapy intervention group or the control group.

RESULTSThe range of motion values in the flexions of both shoulders, the right knee extension, and the dorsal flexions of both ankles significantly increased only in the exercise therapy intervention group. The functional independence measure score did not improve in the exercise therapy intervention group.

CONCLUSIONExercise therapy should be used for the frail elderly requiring a high level of care.