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Objectives　Although self-reported questionnaires are widely used to collect information on medication use in epidemiological studies, their validity for studies involving older adults has not been sufficiently assessed. This study evaluated the validity of self-reported medication use using questionnaires in comparison with drug notebooks.Methods　The study enrolled 370 older community dwellers who participated in an aging sub-study survey of the Tsuruoka Metabolomics Cohort Study between April 2019 and March 2021. Medication use was assessed by comparing self-reported questionnaire data with drug notebook records. We analyzed medications used for hypertension, dyslipidemia, myocardial infarction, angina, diabetes, rheumatism, osteoporosis/metabolic bone disease, constipation, anxiety/depression, dementia, asthma, allergy, thrombosis, and thyroid disease. Moreover, gastrointestinal (GI) medications, steroids, and antipyretic analgesics were assessed, and data on injectable medications for osteoporosis/metabolic bone disease was collected. Using drug notebook records, we identified regular medication users by assessing whether they had received oral medication prescriptions covering over 28 days and took the medication within the 90 days preceding the day of their survey. To define medication categories, we used Anatomical Therapeutic Chemical (ATC) classification codes. Sensitivity, specificity, and kappa statistics were calculated for each medication using drug notebooks as standards. Those who did not bring their drug notebooks on the day of the survey were defined as non-medication users.Results　The mean age (standard deviation) of the 370 participants (146 men and 224 women) was 73.3 (4.0) years. The sensitivity and specificity for each medication were as follows: hypertension (0.97, 0.97), dyslipidemia (0.93, 0.98), myocardial infarction (0.24, 0.99), diabetes (0.94, 1.00), rheumatism (1.00, 1.00), osteoporosis/metabolic bone disease (0.82, 0.99), constipation (0.71, 0.98), GI conditions (0.63, 0.97), anxiety/depression (0.36, 1.00), dementia (0.67, 1.00), asthma (0.67, 0.98), allergy (0.57, 0.99), thrombosis (0.88, 0.98), steroids (0.80, 0.99), thyroid disease (1.00, 1.00) and antipyretic analgesics (0.75, 0.96).Conclusions　Although sensitivity and specificity differed by medication categories, the results of our population-based cohort study suggested that self-reported questionnaires on medication use among older adults are valid, especially for medications with high sensitivity (≥ 0.8).

Objectives　Food environment improvement involving salt reduction requires improving access to and labeling low-sodium foods. Assessing the implementation status of these measures is also necessary. However, to date, no established methods exist for assessing the availability of low-sodium foods in communities. In this study, we aimed to devise a survey on the availability of low-sodium foods as a community food environment assessment method in order to establish common assessment methods, criteria, and practical measures, as well as standardization nationwide.Methods　A preliminary survey on the availability of low-sodium foods was conducted in Kitakyushu City in four stores with nationwide representation. Consent for providing information on handled product lists was obtained. The on-site lists collected through direct investigation by surveyors were compared with the handled product lists provided by the stores and analyzed to identify survey challenges and examine feasibility and the potential for accuracy. The definition of low-sodium foods, which emerged as a challenge in the preliminary survey, was confirmed. Preliminary survey data were carefully reviewed to establish classification criteria for low-sodium foods and create a low-sodium food list to serve as a reference for on-site surveys. Forms for recording the results of on-site surveys and a survey manual were developed. Registered dietitians conducted on-site surveys using the manual to confirm its applicability.Results　The preliminary survey results revealed that the on-site lists had fewer omissions and greater feasibility than store-provided lists. After clearly defining low-sodium foods, we established classification criteria (three major categories, seven subcategories, and 37 minor categories) considering the ease of on-site investigations and purchases. Three forms for recording survey results were developed, including a standard input form allowing detailed documentation of the availability of individual low-sodium foods, an aggregation form for a quantitative assessment of low-sodium foods availability, and a display form visualizing the availability of low-sodium foods by store. Furthermore, a survey manual was developed explaining the purpose and approach of the low-sodium foods availability survey, definition and classification criteria for low-sodium foods, and the three forms for recording survey results. Findings indicated that all registered dietitians could conduct on-site surveys using the manual and successfully collect and organize data.Conclusion　On-site surveys using the manual and documentation forms enabled easy and accurate assessments of low-sodium foods availability. Thus, this standardized method to assess the availability of low-sodium foods could be a food environment assessment method for regional salt reduction initiatives.

A 62-year-old woman was diagnosed as a hemophilia A carrier (factor VIII activity 35%) on preoperative examination of an ovarian tumor. A total of 35,600 units of recombinant factor VIII products was administered perioperatively. On postoperative day 95, a subcutaneous hematoma formed and immunosuppressive therapy with prednisolone was started based on an APTT of 66 seconds, factor VIII (FVIII) activity of 3%, and FVIII inhibitor of 1 BU/ml. During this treatment, the patient was hospitalized due to ankle joint bleeds and required hemostatic treatment, but the inhibitor disappeared and FVIII activity recovered to 30% after postoperative day 438 with cyclophosphamide. F8 analysis revealed the patient carried a heterozygosity of p.Arg391Cys, which has previously been categorized as cross-reacting material (CRM)-positive severe hemophilia A. No high-risk mutations for inhibitor development were found. We also report the results of a desmopressin acetate hydrate test administered to the patient to prepare for future treatment in case of hemorrhage, since high-dose FVIII administration may have been a factor in inhibitor development.

A 44-year-old woman was diagnosed with acute myeloid leukemia (RUNX1::RUNX1T1 translocation) and received induction chemotherapy with idarubicin hydrochloride and cytosine arabinoside. The pneumonia that had been present since admission worsened, and a drug-induced skin rash appeared. On day 17, she presented with respiratory failure and shock, complicated by hemoconcentration and hypoalbuminemia. This was considered capillary leak syndrome due to pneumonia and drug allergy, so she was started on pulse steroid therapy and IVIG, and was intubated on the same day. On day 18, venovenous-extracorporeal membrane oxygenation (VV-ECMO) was started due to worsening blood gas parameters despite ventilatory management. Bronchoalveolar lavage fluid was serous, and both blood and sputum cultures yielded negative. The patient was weaned from VV-ECMO on day 26 as the pneumonia improved with recovery of hematopoiesis. She was disoriented, and a CT scan on day 28 revealed cerebral hemorrhage. Her strength recovered with rehabilitation. After induction chemotherapy, RUNX1::RUNX1T1 mRNA was not detected in bone marrow. The patient received consolidation chemotherapy, and has maintained complete remission. Severe respiratory failure during induction chemotherapy for acute leukemia can be fatal, but VV-ECMO may be lifesaving.

Objectives　Though having a high salt taste threshold has been associated with hypertension, its exact determinants remains unclear. This study aimed to identify the determinants of salt taste threshold in a community-based population and to determine the relationship between salt taste thresholds and the simultaneous presence of multiple determinants.Methods　Of the 1,117 participants of the baseline survey of the Kobe study, a cohort study of healthy urban residents, aged 40-74 years, with no history of cancer or cardiovascular diseases, nor undergoing treatment for hypertension, diabetes, or dyslipidemia, was conducted. Among them, 1,116 underwent the salt taste threshold test, and urine samples were collected to determine their estimated salt intake. The salt taste threshold test was carried out using SALSAVE ® , with a salt taste threshold of 0.6% defined as normal, and that of 0.8% or more defined as high. A binomial logistic regression model was used, with high salt taste threshold as the objective variable, and life and family status, education, smoking and alcohol drinking status, intake status of salt dried fish, stress indicators, and daily salt intake (estimated from the urine sample) as the explanatory variables. A binomial logistic regression analysis was conducted, through multivariate analysis using the forced entry method, with factors influencing salt taste threshold as explanatory variables, and salt taste threshold (normal/high) as the objective variable. This analysis was performed excluding the urinary sodium-to-potassium ratio to account for multicollinearity with the estimated daily salt intake.Results　The mean age was 60.9±9.0 years for men, and 58.0±8.7 years for women. The salt taste threshold was normal in 80.9% (n=903) of the participants (73.6% [n=251] men and 84.1% [n=652] women), and high in 19.1% (n=213) of the participants (26.3% [n=90] men and 15.9% [n=123] women). Multivariate analysis revealed that smoking habits were significantly associated with a higher salt taste threshold, with an odds ratio (95% confidence interval) of 2.51 (1.33-4.74) for all participants. The odds ratio for a high salt taste threshold was 1.45 (1.03-2.03) for the top 25% estimated daily salt intake group, showing a significant association with a high salt taste threshold. In the analysis by sex, smoking habits were associated with higher salt taste thresholds, while an association with estimated daily salt intake was observed only in men.Conclusion　Smoking status and estimated daily salt intake were associated with higher salt taste thresholds in healthy urban residents.

Aim: To prevent falls among older adults, healthcare professionals need to assess these individuals from multiple perspectives. This study aimed to group community-dwelling older Japanese people based on their physical, mental, cognitive, and oral functions and comorbidities, and compare the history of falling in these groups., Methods: Data were obtained from a cross-sectional survey conducted in 2015 among older residents of a ward of Tokyo. For the survey, a questionnaire was distributed to all residents aged ≥65 years without a certificate of long-term care (n = 132,005). Questions were posed concerning respondents' physical, mental, cognitive, and oral functions; comorbidities; and experience with falling in the past year. Cluster and logistic regression analyses were performed., Results: A total of 70,746 participants (53.4%) were included in the analysis. The mean age was 73.6 years old, and 44.9% were male. Four groups were identified in the cluster analysis: the "good general condition group" (n = 37,797, 52.4%), "poor mental function group" (n = 10,736, 14.7%), "moderate physical function group" (n = 13,461, 19.0%), and "poor general condition group" (n = 9,122, 12.9%). A logistic regression analysis with adjusting for socio-demographic characteristics, health behaviors, and fear of falling showed that the odds ratios for the experience of falling within the past year were 1.44 (95% confidence interval: 1.34-1.53), 1.54 (1.44-1.65), and 2.52 (2.34-2.71) in the poor mental function, moderate physical function, and poor general condition groups, respectively, with the good general condition group as the reference., Conclusions: We classified community-dwelling older adults into four groups based on multiple functions and found possible variations in the risk of falling by group. These findings suggest that such classification may be useful for the prevention of falls.

Objectives　We selected assessment items that can be used to evaluate the physical, mental, and social functions of community-dwelling older people comprehensively and easily, and examined whether these items could predict a future transition to the requirement for nursing care and dementia.Methods　We conducted a self-administered mail survey of 4,439 community-dwelling older people, who were not certified as requiring nursing care in 2011. The items for the survey were shortlisted out of a total of 54 items that were selected by referring to existing scales, and the evaluation items were determined by pass rate and factor analysis. The cut-off point of the total scores was estimated by ROC analysis using the certification of requiring long-term care (support level 1 or higher) and level of independence in the daily lives of older people with dementia (independence level I or higher) in 2014 as external criteria. The predictive validity was examined by binomial logistic regression analysis using the cut-off point of the total score and the score of the sub-domains as explanatory variables, and the requirement of nursing care and independence level of dementia in 2014 as objective variables.Results　A factor analysis of 1,810 subjects with no deficiencies in the 54 items identified 24 items in five domains (mental health, walking function, Instrumental Activities of Daily Living (IADL), cognitive function, and social support). During the ROC analysis, the cut-off point of the total score was estimated to be 20/21 points (nursing care: AUC 0.75, sensitivity 0.77, specificity, 0.56; dementia: AUC 0.75; sensitivity 0.79, specificity 0.55). The binomial logistic regression analysis showed that persons with a total score of less than 20 points in 2011 were significantly more likely to be certified as requiring nursing care (odds ratio 2.57, 95%CI 1.69-3.92, P<0.01) or show a decline in their independence level of dementia (odds ratio 3.12, 95%CI 1.83-5.32, P<0.01) in 2014. The scores of mental health, walking function, and IADL were significantly associated with certification of requiring nursing care, while walking function and cognitive function were significantly associated with dementia.Conclusion　We believe that the selected items in this study can successfully predict a transition to needing nursing care and dementia in the future. In the sub-domains, the results suggested an association with physical and mental function, as has been previously reported, but little association with social function.

Aim: Interprofessional communication and collaboration is essential for a better end-of-life and death, where individual dying people are respected and their satisfaction is the goal. The aim of this study is to explore 1) ethical conflicts viewed by care staff of geriatric institutions, 2) their views about geriatric medicine, and 3) their views about religion in the context of institutional end-of-life care., Methods: Semi-structured interviews were conducted by Buddhist priests and researchers with nine care workers who worked in nursing homes or long-stay geriatric hospitals. This interview was conducted as part of a research project that investigated the feasibility of the engagement of religious workers in the geriatric care setting., Results: Regarding ethical conflicts, six themes were merged: difficulty in knowing the will of the person being cared for, dissonance with the family, older person's wish to die, losing the purpose for living, staff not being used to death, and families not being used to death. Regarding geriatric medicine, eight themes were merged: gratitude for cooperation, persuasive explanation, not accepting death, not allowing patients to share a peer's death, cold attitude, being drug therapy centered, not being person-centered, and heavy burden for patients. Regarding religion, five themes were merged: expectation for salvation, barrier to hospitals, already involved in nursing homes, explicit religious traits are acceptable, and favorable character of religious workers in institutions., Conclusions: Communication between geriatric physicians, care staff, and mainstream religious workers, with the aim of providing a better quality of end-of-life and death, is beneficial in a super-aged society.

Objective　Several studies have suggested that high dietary Na/K ratio and body mass index (BMI) increase the prevalence of hypertension. However, there have been a few reports on the combination of these two factors and their relationship with hypertension. This study aimed to examine the association of the combined estimated 24-h urinary Na/K ratio (24h-u-Na/K) (high or low) and BMI (high or low) with the risk of high blood pressure.Method　We performed a cross-sectional study involving 1,112 participants (340 men and 772 women) of the Kobe Orthopedic and Biomedical Epidemiological study (KOBE study) who had no cardiovascular diseases or current anti-hypertensive medications. Sex-specific analyses were performed. The 24h-u-Na/K ratio was calculated from an estimation formula using collected spot urine. Participants were divided into four groups based on their 24h-u-Na/K ratio (low or high) and BMI (low or high), with the cutoff points being the median and 25 kg/m 2 , respectively.　Participants with systolic blood pressure (SBP) ≥130 mmHg or diastolic blood pressure (DBP) ≥80 mmHg were diagnosed with high blood pressure. Odds ratios (ORs) for high blood pressure according to the combined risks of high 24h-u-Na/K and BMI were examined with a logistic regression analysis.Results　The average SBP/DBP for men and women was 122.7/77.9 and 113.3/69.1 mmHg, respectively, and prevalence of high blood pressure among men and women was 47.4% and 21.3%, respectively. The mean BMI was 22.8 kg/m 2 for men and 20.9 kg/m 2 for women. The median 24h-u-Na/K was 3.2 for men and 3.1 for women. The prevalence of high blood pressure (men, women) was the highest in the group in which both 24h-u-Na/K and BMI were high (60.0%, 62.9%; men: P=0.273; women: P<0.001). In the same group, the multivariate-adjusted ORs for high blood pressure were significantly higher for both men (2.59; 95% confidence interval [CI]: 1.15-5.86) and women (10.78; 95% CI: 4.87-23.88) compared to the reference group with both factors classified as low. Women with low BMI but high 24h-u-Na/K also demonstrated a higher risk for high blood pressure (OR: 1.62; 95% CI: 1.10-2.40).Conclusion　The risk of high blood pressure was the highest when both BMI and 24h-u-Na/K were high. The current specific healthcare guidance in Japan is focused on obese individuals. However, in order to prevent hypertension more effectively, additional focus should be placed on the Na/K diet. Increased intake of vegetables and fruits and reduced intake of salt should be strongly recommended.

Aim: To clarify the conditions under which dignity is maintained by reviewing the decision-supporting process for a case., Methods: We conducted both a longitudinal epidemiological survey and action research in parallel in a large housing complex district in Tokyo, Japan, using the community-based participatory research framework. Through collaboration with community professionals, we supported an isolated elderly man who refused medical intervention for three years until his death. After his passing, we re-examined all of his records, conducted in-depth interviews with the community professionals, and held a conference to review the process of managing this individual., Results: Concerning support for the decision-making, three conclusions were obtained from the data: 1) a decision is not always stated explicitly; 2) a decision should be supported by the team, because mind sometimes changes; and 3) supporting decision-making is a process in itself. For the maintenance of dignity in the medical setting, the following were kept in mind: medical context is not all that is important; supporters should wait for the right moment to intervene, and support should be provided to help the patient keep in touch with other people and the community., Conclusions: While precisely defining dignity can be difficult, we explored the conditions under which dignity could be maintained by reviewing the decision-supporting process for a single case. Geriatricians may encounter difficult and complex cases such as this in the clinical setting, but guidelines cannot cover such diverse cases.

Objective　To explore health-related and socioeconomic factors that can predict future deterioration in Psychological Distress Scale (K6) scores.Method　We conducted a baseline (2010, 2011) self-administered questionnaire survey of the Kobe Orthopedic and Biomedical Epidemiological study (KOBE study) involving 1,117 participants who had no previous history of cancer or cardiovascular diseases and were not under treatment for hypertension, diabetes, or dyslipidemia. We used the Japanese K6 as an indicator of stress and defined K6≧5 points as a high-stress group and K6<5 points as a low-stress group. A four-year follow-up survey (2014, 2015) was conducted on 1,004 people (follow-up rate of 90%). We excluded 39 participants with missing values, and 185 people whose K6 score was higher than 5 points at baseline. A final total of 780 participants' scores were examined for: gender, age, living situation, physical activity level, average sleep time, as well as the K6 score, the Japanese Hearing Handicap Inventory for Elderly (HHIE-S), and the Japanese Oswestry Disability Index (ODI). We conducted a logistic regression analysis using K6≧5 points at the four-year follow-up survey as the dependent variable and each factor at the baseline survey as the independent variable.Results　Of the 780 subjects analyzed, 132 (16.9%) were highly stressed (K6≧5 points) at the four-year follow-up point. A logistic regression analysis found age (40s/70s) (odds ratio 3.38, 95% confidence interval 1.45-7.86), living situation (single/living together) (odds ratio 1.98, 95% confidence interval 1.07-3.68), and ODI scores (every 1%) (odds ratio 1.05, 95% confidence interval 1.01-1.09), to all be significantly associated with high stress.Conclusion　This study suggests that age, living situation, and ODI scores are related to future stress.

In recent years, human immunodeficiency virus(HIV)-negative Pneumocystis pneumonia(PCP)onset has been occasionally seen in breast cancer. In particular, dose-dense epirubicin and cyclophosphamide(EC: ddEC)therapy, in which EC is administered every 2 weeks, has been generally used in clinical practice for early stage breast cancers. PCP may develop before and during postoperative chemotherapy. We report the cases of 2 patients who developed PCP during postoperative adjuvant chemotherapy. Case 1: A 62-year-old woman, who underwent postoperative EC therapy, developed PCP during the 4th EC cycle. During EC therapy, steroids(prednisolone[PSL])were administered at an average dose of 11.4mg/day, and the number of lymphocytes at the initiation of the 4th EC cycle was 516/mL. Case 2: After receiving 4 cycles of postoperative ddEC, a 27-year-old woman developed PCP after 1 cycle of docetaxel(DTX)administration. During ddEC therapy, PSL was administered at a dose of 17.14mg/day, and the number of lymphocytes at DTX administration was 311/mL. The onset of PCP is presumed to be related to the steroid dose administered and the number of lymphocytes. Therefore, determining effective indicators in patients at a high risk of PCP onset is important.

Aim: The aim of this study was to assess the feasibility of rice-farming care among elderly people with cognitive impairment as a tool for social inclusion., Methods: Eight elderly individuals with cognitive impairment (7 men, 1 woman, mean age 68.3 years old) participated in the program over 25 weeks. The cognitive function, well-being, and depression were assessed before and after the program period. The degree of participants' independence during the program was also assessed. Semi-structured interviews with the participants and caregivers were held after the program period., Results: The average participation rate was 93.0%. There were no unexpected events, and the subjects carried out farmwork almost independently. Regarding their well-being, two participants who scored below the cut-off criterion of mental health before the study scored above the cut-off after the study. Regarding depression, two participants who scored positive with a two-question case-finding instrument no longer scored positive after the study. Interviews with the participants showed that they enjoyed the program, especially because they had peers, a role, and gained positive emotions. Interviews with the caregivers showed that they had recognized for the first time what people can do with their skills., Conclusion: The results of the present study indicate that rice-farming was a feasible method of care with a positive impact on the well-being and depression of elderly people with cognitive impairment and enhanced their social participation, drawing out their individual strengths.

This study aimed to evaluate the health-related quality of life(QOL)using EQ-5D-5L scores for patients who underwent surgery for colorectal cancer. A total of 30 consecutive patients(14 men and 16 women; median age: 67.5 years)from the outpatient clinic of our institute in January 2017 were eligible for this study. The primary tumor was located in the colon(n= 18)or rectum/anu(s n=12). Twelve patient(s 40.0%)had cancer recurrence, and 3 patient(s 10.0%)had a stoma. In addition, 11 patients(36.7%)underwent chemotherapy. The median EQ-5D-5L score for all the patients was 0.867(range, 0.324- 1.000). The EQ-5D-5L score of patients with recurrence was significantly lower(0.820)than that of patients without recurrence( 0.948)(p=0.002). Furthermore, the EQ-5D-5L score of women(0.834)was significantly lower than that of men (0.942)(p=0.015). No significant difference was noted between the EQ-5D-5L score and other factors, such as age, cancer stage, location of primary tumor, absence/presence of chemotherapy, and absence/presence of stoma. In conclusion, using EQ-5D-5L scores, female gender and cancer recurrence were found to be associated with low QOL of patients after surgery for colorectal cancer.

The patient was a 73-year-old man with ascending colon cancer and synchronous liver metastases. A right hemicolectomy with a lymph node dissection was performed for the primary lesion. The resected specimen revealed a KRAS codon 12 mutation. After 6 courses of chemotherapy with capecitabine, oxaliplatin, and bevacizumab(Bv), we performed a partial hepatectomy and resection of the peritoneal dissemination. A computed tomography(CT)scan 5 months later revealed the recurrence of the liver metastases. After 8 courses of chemotherapy with 5-fluorouracil, Leucovorin, irinotecan, and Bv, we performed a partial hepatectomy. CT scan after 13 months revealed a recurrence in the peritoneal dissemination in the Douglas pouch and the right subphrenic space; therefore, we performed a low anterior resection and resection of the peritoneal dissemination with curative intent. CT scan after 19 months revealed a recurrence in the right subphrenic dissemination, a lung metastasis, and pleural dissemination. Chemotherapy with 5-fluorouracil, Leucovorin, and Bv was administered for 2 years and 5 months. After 5 years and 9 months of the primary operation, the patient is alive. Recently, we have focused on the mechanism of multidrug resistance through NAD(P)H: quinone oxidoreductase-1(NQO1)overexpression, which can be used to determine the role of an enzyme in sensitivity to toxicity and carcinogenesis. In this case, the pathological examination of the resected specimen revealed NQO1 negative expression. In conclusion, NQO1 may play a significant role in chemotherapy resistance in colorectal cancer patients.

The optimal method for diagnosing cochleovestibular neurovascular compression syndrome(CNVC)remains controversial, and the aim of this study is to develop a standard diagnostic instrument for the condition. The clinical features of 53 sides of 50 patients with a combination of vertigo, tinnitus, and/or hearing loss were retrospectively evaluated. The following five clinical features were evaluated and given a score of 1 or 0:1)a long history of recurrent vertigo, tinnitus, or hearing loss;2)neurological findings related to positional vertigo, nystagmus, tinnitus, or hearing loss;3)neuro-otological findings involving tinnitus, audiometry, or vestibular testing;4)auditory brainstem response(ABR)evaluation with the detection of a low 25-75% II wave amplitude on the contralateral side and delayed interpeak latency in the I-III or I-V waves(usually low II wave amplitude combined with double peaks and a wide-based form)during ABR evaluation using 80 and 90dB clicks;and 5)the detection of vascular contact with the eighth cranial nerve on magnetic resonance imaging-constructive interference in steady state or air computed tomography imaging. Finally, the sum of these scores was evaluated. For cases in which more than one of the features of the items 1), 2), or 3) were present, the score was evaluated based on the most representative of the items., Results: The patients were divided into those with scores of 4-5 and those with scores of 2-3. All the patients with scores of 4-5 exhibited CNVC, while those with scores of 2-3 had other diseases. Therefore, CNVC should be suspected in patients with scores of 4-5, but can be ruled out in those with scores of 2-3.

Objective: Previous studies reported that presenteeism costs the enterprises more than absenteeism. It becomes more important for corporate management to evaluate the outcomes of health promotion initiatives for their employees using work performance scales in Japan. We previously developed a Japanese version of Work Limitations Questionnaire (WLQ-J), a presenteeism scale developed by Lerner D. et al., and conducted an internet survey to examine the reliability and validity of WLQ-J with 710 employees from an IT company and a medical institution as subjects and reported the study results (Ida et al, 2012). The objective of the present study is to examine the reliability and validity of WLQ-J with employees from more companies and industries than those included in the previous study., Methods: We analyzed for 4,440 employees from 14 companies and 9 industries as subjects, who were selected from a total of 4,712 employees who answered both WLQ-J and Brief Job Stress Questionnaire (BJSQ) on the internet or paper survey conducted from September 2014 to January 2015., Results: The subjects' average age was 40.3±11.8 years (33.2±9.5 years in the previous study), with the percentage of males and females being 77.9% and 21.1%, respectively. The factor structure of WLQ-J accorded with that of the original version of WLQ. This supports the factorial validity of WLQ-J. In addition, sufficient internal consistency was recognized by Cronbach's alpha of the whole scale (0.87 for the present study and 0.97 for the previous study) and the subscales (0.77-0.94 for the present study and 0.88-0.95 for the previous study). The four subscale scores of WLQ-J were significantly correlated with the stress response of BJSQ with correlation coefficients of 0.28-0.64 for the present study and 0.39-0.60 for the previous study (p < 0.01 for both studies). Moreover, criterion-related validity of WLQ-J was also supported by the significant dose-response relationship between the subscale scores of WLQ-J and stress response of BJSQ (p < 0.01 for the previous study and p < 0.001 for the present study)., Conclusions: The present study demonstrated the reliability and validity of WLQ-J in a population of employees from more companies and industries than those in the previous study, with its average age and percentage of males and females close to those of the whole Japanese industries. This suggests that WLQ-J is available as a stable scale for presenteeism in different populations in Japan.

A woman in her 70s was diagnosed with a protruding mucosa-associated lymphoid tissue (MALT) lymphoma during a secondary health examination. After eradication of Helicobacter pylori, a biopsy revealed gastric follicular lymphoma (FL) and the lesion was still protruding one year later. 18 F-fluorodeoxyglucose positron emission tomography showed focal nodular hypermetabolic activity, suggesting that FL may have transformed into a diffuse large B-cell lymphoma. Upper gastrointestinal endoscopy, colonoscopy, and capsule endoscopy showed no other lesions in the gastrointestinal tract, and bone marrow biopsy showed no permeation into the marrow. Therefore, this lesion, which appeared as a submucosal tumor, was limited to the stomach. Laparoscopy and endoscopy cooperative surgery was performed, because it allows for correct pathological diagnosis while removing only a minimal portion of the stomach wall. Histological findings showed follicular structures consisting of abnormal lymphoid cells. Immunohistochemical analysis revealed that neoplastic cells were positive for CD20, CD79a, Bcl-2, CD10, and c-MYC, but negative for CD3, CD5, and cyclin D1. Finally, we diagnosed this lesion as a primary gastric FL.

Objective　From April 2008, specific health checkups have been implemented to prevent metabolic syndrome (MetS) and related cardiovascular diseases based on assurance of medical care for the elderly in Japan. In its "Standard Health Checkup and Counseling Guidance Program," 22 standard question items are recommended to assess health conditions of Japanese citizens. However, there are few community-based studies to clarify the relationship between question items and new onset of high risk conditions for cardiovascular diseases such as MetS. Accordingly, we performed a 5-year follow-up study of community dwellers who participated in health checkups of National Health Insurance beneficiaries in Habikino City, Osaka.Method　Lifestyle factors assessed by standard question items in 2008 were defined as exposures at baseline survey. In the analysis of MetS, we followed-up 4,720 participants without MetS; and in the analysis of hypertension, we followed-up 3,326 participants without hypertension until the end of March in 2013. New-onset MetS or hypertension during follow-up were defined as outcomes. Cox proportional hazard model was used to evaluate the relationship between lifestyle factors and the incidence of MetS or hypertension after adjustment for age and waist circumference.Results　The median follow-up period for incidence of MetS was 3.1 years for men and 3.6 years for women. We observed 570 new cases of MetS during follow-up. For men, "taking dinner within 2 hours before going to sleep" and "body weight increase by 10 kg or greater from 20 years old" were significantly associated with MetS (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.09-1.88 and HR, 1.33; 95% CI, 1.19-1.75, respectively). Occasional consumption of alcohol in men was negatively associated with MetS. For women, "increase or decrease of body weight by 3 kg or greater within 1 year" and "body weight increase by 10 kg or greater from age of 20" were significantly associated with MetS (HR, 1.83; 95% CI, 1.40-2.40 and HR, 2.02; 95% CI, 1.52-2.68, respectively). Daily alcohol consumption from 1 to less than 2 gou (about 23 to 45 g of ethanol) in women was positively associated with MetS (HR, 2.64; 95% CI, 1.51-4.64). We observed 1,045 new cases of hypertension; however, except for daily alcohol consumption for men, no lifestyle factors were associated with incidence of hypertension.Conclusion　Most standard question items of specific health checkups did not predict new-onset MetS or hypertension, at least within 5 years. Thus, development of more predictive question items is warranted.

The importance of cellular metabolism has long been known as Warburg effect; cancer cells are characterized by mitochondrial defect that shifts towards aerobic glycolysis. Recently, many reports have revealed that immune metabolism is a key factor for controlling immune cell proliferation and differentiation. Resting lymphocytes generate energy through oxidative phosphorylation and fatty acid oxidation, whereas activated lymphocytes rapidly shift to glycolysis. Especially in T cells, more precise mechanism of regulating metabolism have been clarified on differentiation from naïve T cells to effector T cells. Similar studies have also been carried out to characterize B cell and myeloid cell metabolism. Metabolic regulation is considered to be particularly important in autoimmune diseases. Metabolic changes in these diseases might not only reflect the chronic activated immune-status but also associated with their pathogenesis. Here, we review what is known on the altered metabolism in systemic lupus erythematosus (SLE), mainly focusing on T cells and B cells, and how they contribute to SLE pathogenesis. We also discuss how immune metabolic defects can become targets of future SLE therapy.

Objectives This study demonstrated the relationship between experience as a health promotion volunteer (Hoken-hodouin) and medical costs in Japan. The study area was Suzaka City (March 2016 population: 51,637) in Nagano Prefecture, Japan, where a total of about 300 women have been engaged and trained as health promotion volunteers since 1958.Methods A cross-sectional survey was conducted in 2014 using a self-administered questionnaire, which included items on experiences as a health promotion volunteer, age at engagement, leadership status, and satisfaction with the experience. Eligible study participants were all residents of Suzaka aged 65 years or over. Medical cost data from April 2013 to March 2014 were collected for women aged 65-74 years who were beneficiaries of the Japanese National Health Insurance (n=2,304). Medical consultation rates and costs for treatment at outpatient and inpatient clinics were analyzed as outcomes. Adjustments were made for age, marital status, educational level, cohabitation status, equivalent income, alcohol use, smoking status, awareness about a healthy diet, and walking time per day.Results Of the 2,304 study participants, 1,274 (55.3%) had experience as health promotion volunteers. Poisson regression analysis revealed that volunteers' experience was positively associated with outpatient care rates (adjusted relative risk [RR]=1.04; 95% confidence interval [CI]=1.02-1.07), and negatively associated with inpatient care rates (RR=0.74; 95% CI=0.56-0.98). Multivariate regression analysis revealed that the adjusted geometric means of outpatient and inpatient care costs were 7% and 23% lower, respectively, among participants with volunteer experience than that among those with no volunteer experience (140,588-151,465 JPY for outpatient costs; 418,457-539,971 JPY for inpatient costs). These associations were stronger among participants who began health promotion volunteer at age 60 years or more, those who had leadership roles, and participants who had high levels of satisfaction regarding their volunteer experience.Conclusion These results suggest that experience as a health promotion volunteer is associated with lower medical costs, particularly for inpatient care.

RAS mutation is an established predictive biomarker of resistance to anti-epidermal growth factor receptor(EGFR)therapy in metastatic colorectal cancer. In addition, previous studies identified mutations in ERBB2, FGFR1, PDGFRA, BRAF, MAP2K1, PTEN, and PIK3CA as potential mechanisms of resistance to anti-EGFR therapy. Testing for these mutations might be necessary to determine eligibility for anti-EGFR therapy in patients with metastatic colorectal cancer. CancerPlex®is a nextgeneration sequencer for 413 cancer genes. An analysis panel includes genes that may be associated with resistance to anti- EGFR therapy. A 65-year-old man with unresectable rectal cancer, multiple lung metastases, and a bulky liver metastasis was evaluated for expression of genes associated with resistance to anti-EGFR. The analysis found that all genes indicating resistance were wild-type genes. Cetuximab monotherapy was administered after rectal resection, with dramatic shrinkage of the metastatic tumors. A more accurate selection of patients according to tumor genetic status using CancerPlex®might improve the risk-benefit profile of anti-EGFR therapy.

We report a case of panitumumab-resistant rectal cancer with HER2 gene amplification detected by CancerPlex®. A 51- year-old man was diagnosed with an obstructive rectal cancer having lung and adrenal metastases. He underwent the Hartmann 's operation, and KRAS mutations were not detected. After the surgery, 3 courses of CapeOx plus bevacizumab were administered as first-line chemotherapy; however, the lung and adrenal metastases progressed. Subsequently, 24 courses of IRIS/panitumumab was administered as second-line chemotherapy, and the metastases slowly progressed. Six courses of regorafenib were administered as third-line chemotherapy followed by a course of TAS-102 as fourth-line chemotherapy. Subsequently, a left femoral head metastasis and cerebellar metastases were detected. The patient received best supportive care including palliative femoral head replacement and stereotactic irradiation for the cerebellar metastases, and he died of cancer 3 years 5 months after the primary surgery. The comprehensive genomic analysis focusing on 413 cancer-related genes with CancerPlex®revealed that EGFR, BRAF, KRAS, NRAS, and HRAS had no mutations; however, ERBB2 amplification was detected. Furthermore, immunohistochemical staining revealed overexpression of HER2 protein in both the primary and bone metastatictumor. HER2 and EGFR independently promote the RAS-RAF-MAPK pathway. In the present case, the efficacy of anti-EGFR therapy may be attenuated because of ERBB2 amplification in the metastatic tumor.

A 58-year-old man was admitted with the complaint of bloody stools. Colonoscopy and computed tomography revealed a rectal cancer with a liver metastasis and multiple lung metastases. After administering a regimen comprising 3 courses of XELOX plus bevacizumab chemotherapy, the sizes of the primary and metastatic lesions decreased remarkably. Abdominoperineal resection was performed for local control of the cancer; the specimen from the initial tumor was found to be KRAS wild type. After 14 courses of XELOX chemotherapy, brain metastases were detected. Although 3 courses of IRIS plus panitumumab were administered, the liver, lung, and brain metastases spread rapidly. A comprehensive genomic analysis focused on cancer-related genes with CancerPlex®found a mutation of the BRAF gene(I326V). BRAF is a downstream molecule of KRAS in the RAS-RAF-MAPK pathway. Therefore, this mutation of the BRAF gene has the possibility of causing resistance against panitumumab that was found in this case. Furthermore, we expect that the systematic analysis of oncogene and suppressor oncogenes will enable us to choose the optimal regimen of chemotherapy or molecular targeting therapy for each patient with colorectal cancer.

Transforming growth factor (TGF)-β family is a cytokine family with various biological processes and forms a highly homologous group of three mammalian isoforms, TGF-β1, TGF-β2, and TGF-β3. Most of the attention on TGF-β family in immunology has been mainly focused on TGF-β1 in that TGF-β1 induces anti-inflammatory regulatory T cells (Treg), and inflammatory T helper 17 (Th17) cells in combination with interleukin-6. Although little attention has been focused on the immunological roles of TGF-β2 and TGF-β3, the function of TGF-β3 for maintaining immunological homeostasis has recently been identified such as the induction of Th17 cells and direct regulatory effects on humoral immunity. TGF-β1 and TGF-β3 shares similar anti-inflammatory or pro-inflammatory functions, but exhibits significantly different effects on fibrosis and chondrogenesis. For the clinical application of TGF-βs, the mechanisms by which each TGF-β isoform regulates immunity has to be elucidated. In this review, we provide an overview of the effects, cellular targets, and therapeutic potential of TGF-βs on immune responses and autoimmune diseases.

Purpose: The present study aims to develop a self-administered dementia checklist to enable community-residing older adults to realize their declining functions and start using necessary services. A previous study confirmed the factorial validity and internal reliability of the checklist. The present study examined its concurrent validity and discriminant validity., Methods: The authors conducted a 3-step study (a self-administered survey including the checklist, interviews by nurses, and interviews by doctors and psychologists) of 7,682 community-residing individuals who were over 65 years of age. The authors calculated Spearman's correlation coefficients between the scores of the checklist and the results of a psychological test to examine the concurrent validity. They also compared the average total scores of the checklist between groups with different Clinical Dementia Rating (CDR) scores to examine discriminant validity and conducted a receiver operating characteristic analysis to examine the discriminative power for dementia., Results: The authors analyzed the data of 131 respondents who completed all 3 steps. The checklist scores were significantly correlated with the respondents' Mini-Mental State Examination and Frontal Assessment Battery scores. The checklist also significantly discriminated the patients with dementia (CDR = 1+) from those without dementia (CDR = 0 or 0.5). The optimal cut-off point for the two groups was 17/18 (sensitivity, 72.0%; specificity, 69.2%; positive predictive value, 69.2%; negative predictive value, 72.0%)., Conclusion: This study confirmed the concurrent validity and discriminant validity of the self-administered dementia checklist. However, due to its insufficient discriminative power as a screening tool for older people with declining cognitive functions, the checklist is only recommended as an educational and public awareness tool.

Case 1: A 61-year-old man who had a diagnosis of low rectal cancer with lateral pelvic lymph node (LPLN) metastasis and multiple liver metastases underwent low anterior resection with LPLN dissection. The initial surgery was followed by chemotherapy, and then an extended right hepatectomy with partial resection of the liver was performed. Subsequently, a lung metastasis was detected, and the lung was partially resected. The patient was alive 9 years and 6 months after the initial operation. Case 2: A 53-year-old man had a diagnosis of low rectal cancer. After 5 courses of mFOLFOX6 plus bevacizumab, he underwent low anterior resection with LPLN dissection and resection of the peritoneal metastasis. The patient was alive 6 years and 3 months after the surgery without any signs of recurrence. Case 3: A 48-year-old man had a diagnosis of low rectal cancer and multiple liver metastases. He underwent low anterior resection with LPLN dissection and right hepatic lobectomy. He subsequently showed liver and lung metastases. The patient received systemic chemotherapy, and is alive with recurrent disease. We report 3 cases of Stage Ⅳ low rectal cancer with LPLN metastasis, and propose that LPLN dissection is important as a part of R0 resection for Stage Ⅳ low rectal cancer.

The patient was a 73-year-old woman. She underwent right hemicolectomy and D3 lymph node dissection for cecal cancer in June 2003. Although a peritoneal dissemination was intraoperatively noted around the primary tumor lesion, it was resected concurrently and thus R0 surgery was accomplished. Postoperative adjuvant chemotherapy was not performed. During the follow-up on an outpatient basis, a solitary left lung metastasis was found and partial left upper lobectomy of the lung was performed in December 2004. A solitary liver metastasis was identified in the liver (S3), and lateral segmentectomy of the liver was performed in June 2007. The patient was alive with no evidence of recurrence 11 years and 9 months after resection of the primary lesion and 7 years and 9 months after the hepatectomy. Long-term survival can be achieved by performing resection without residual cancer even in some cases with metachronous metastatic recurrences in multiple organs. Metastasectomy should be considered proactively when the patient is in a good general condition and R0 resection is possible.

A 71-year-old woman diagnosed with Fournier's gangrene caused by penetration of a rectal carcinoma was referred to our hospital. Emergency drainage and sigmoid colostomy were performed. Pathological examination of a biopsy sample showed moderately differentiated tubular adenocarcinoma. Abdominoperineal resection with bilateral salpingo-oophorectomy and hysterectomy was performed with curative intent after 4 courses of chemotherapy with S-1 and oxaliplatin. The postoperative pathological diagnosis was StageⅡ (pT4bN0M0). The patient received tegafur/uracil and Leucovorin as adjuvant chemotherapy. Seven months after the curative operation, partial pneumonectomy was performed for the recurrence of the rectal carcinoma in the right lung. Eight months after pneumonectomy, recurrent tumors were observed in the right lung and subcutaneous fat layer of the right buttock along the drainage site. The tumor in the right buttock was excised along with part of the gluteus maximus, and partial pneumonectomy was then performed. Three years and 6 months after the emergency drainage, the patient is alive with no evidence of recurrence. After drainage for rectal carcinoma complicated by Fournier's gangrene, the possibility of recurrence around the drainage site should be considered.

Background: Cisplatin plus pemetrexed is considered the standard of care for the first-line treatment of patients with advanced non-squamous non-small-cell lung cancer (NSCLC). However, little is known about the efficacy and safety of this regimen in Japanese patients in a daily clinical setting., Methods: We retrospectively analyzed 40 patients who received cisplatin (75 mg/m/(2)) and pemetrexed (500 mg/m(2)) as a first-line treatment for advanced non-squamous NSCLC., Results: Recorded Grade 3 or 4 hematological toxicities included neutropenia in 7 cases (17.5%), leukopenia in 5 cases (12.5%), anemia in 1 case (2.5%), thrombocytopenia in 1 case (2.5%), and febrile neutropenia in 1 case (2.5%). Grade 3 or 4 nonhematological toxicities included anorexia in 3 cases (7.5%), infection in 1 case (2.5%), rash in 1 case (2.5%), and increased transaminase expression in 1 case (2.5%). Therefore, the adverse events were mostly mild. There were no treatment related deaths. The overall response rate was 37.5%, median progression free survival was 5.6 months, and median overall survival (OS) was 18.8 months. In an epidermal growth factor receptor (EGFR) mutation status subgroup analysis, the median OS of patients with wild-type EGFR or unknown status (n=28)was 16.8 months., Conclusion: Cisplatin plus pemetrexed was well tolerated as a first-line treatment and effective in Japanese patients with advanced non-squamous NSCLC.

Aim: The aim of this study was to develop a self-administered dementia checklist (SDC), in order to help community-residing older adults realize their declining functions and encourage them to begin using necessary services, and to examine its factorial validity and internal reliability., Methods: A panel of dementia clinical experts developed a questionnaire according to pre-selected items and conducted a self-administered survey with community-residing people aged 65 + (n=2,483). The team developed a scale through an exploratory factor analysis and item response theory (IRT) analysis (Study 1). Using this scale, they conducted a self-administered survey with community-residing people aged 65 + (n=5,199), conducted another exploratory factor analysis, and developed a 10-item scale. A confirmatory factor analysis was subsequently conducted and reliability coefficients were computed., Results: The exploratory factor analysis of the proposed 37 items extracted 5 factors: Factor 1 was named "subjective decline in daily living functioning," and Factor 2 was "subjective cognitive decline" in the early stage of dementia. The team developed a 20-item scale by selecting 10 items from each factor which had high factor loadings and high slope values in the IRT analysis (Study 1). After the exploratory factor analysis of the 20-item scale, they developed a 10-item scale by selecting 5 items from each factor which had strong associations. The confirmatory factor analysis verified the 2-factor model. The Cronbach α coefficients for the subscales of Factors 1 and 2 were 0.935 and 0.834, respectively, and 0.908 for the overall 10-item scale., Conclusion: The authors developed a 10-item SDC with 2 factors and confirmed its factorial validity and internal reliability.

Autoantibodies are associated with various autoimmune diseases. Systemic lupus erythematosus (SLE) is an autoantibody-associated autoimmune disease which affects multiple organs. Although both genetic and environmental factors are implicated in lupus pathogenesis, the etiology of the disease remains elusive. The discovery of CD4(+)CD25(+) regulatory T cells (Tregs) that characteristically express forkhead box p3 (Foxp3) gene have greatly advanced our understanding of immune systems in autoimmune diseases. CD4(+) Tregs can be classified into two main populations: thymus-derived naturally occurring Tregs (nTregs) and induced Tregs (iTregs) generated from CD4(+)CD25(-) precursors in the periphery. Recently, accumulating evidence suggests that these Tregs play important roles in the regulation of humoral immune responses. In this review, we discuss recent findings on the role of Tregs in SLE.

Objectives: We examined the effects on employee vegetable intake of a long-term intervention in an employee work cafeteria., Methods: The subjects were approximately 1,200 employees (aged 19-61 years) of an industrial company in Fukui prefecture. We promoted the intake of typical Japanese style meals that combined three elements (staple foods, main dishes and vegetable dishes) to increase vegetables intake. We displayed all items on the menus of the employee cafeteria using three colors (yellow, red and green to denote three elements) to indicate healthy food choices for the maintenance of a healthy food environment. We advised employees to choose meals containing the three elements at the time of payment, for nutritional education (appropriate portion choice: APC). We evaluated the ratio of APC at the same time. To calculate the mean daily intake per person, we carried out a questionnaire survey similar to the "semi-quantitative food frequency questionnaire" and asked about the frequency and approximate intake of vegetables., Results: The APC was 63.5% after one year of intervention, significantly increased to 82.1% after two years (p < 0.001), and was 80.0% after three years of intervention (p < 0.001). Vegetable intake at breakfast (p < 0.001), lunch (p < 0.001) and dinner (p = 0.011), and from vegetable juice (p = 0.030) significantly increased after three years of intervention. The consumption of pickles significantly decreased after three years of intervention (p = 0.009). It was estimated that the vegetable intake of men increased from 167.3 to 184.6 g, and that of women from 157.9 to 187.7 g., Conclusions: Employee estimated vegetable intake was significantly increased and that of pickles was significantly decreased by a long-term intervention (three years) in the employee work cafeteria.

Regulatory T cells (Treg) are important mechanisms that regulate autoimmunity and CD4+CD25+Foxp3+ regulatory T cells (CD25+Treg) have been extensively investigated. Recently, we have identified CD4+CD25-LAG3+ regulatory T cells (LAG3+Treg) that express an anergy associated transcription factor Egr2. Egr2 regulates IL-10 production in response to IL-27, and Egr2-deficiency in T cells and B cells results in systemic autoimmunity with increased IL-17 production. Moreover, addition of Egr3 deficiency to Egr2-deficient mice significantly accelerates systemic autoimmunity without functional impairment of CD25+Treg, indicating cooperative autoimmune-regulation by Egr2 and Egr3. The linkage between Egr2 and systemic autoimmunity is also suggested by the fact that stimulation with Ly108, a candidate lupus susceptibility gene in lupus-prone NZM2410 mice, induces Egr2 expression in T cells. Collectively, LAG3+Treg and Egr2 are the unique regulators of autoimmunity and further examination may help to understand and control immune responses.

We report a case of hyperammonemic encephalopathy related to 5-FU in an aged patient with recurrent colon cancer treated with FOLFIRI therapy. An 80-year-old man underwent right hemicolectomy for cecal cancer. After 10 months, surgical resection was performed for its local recurrence. He was then treated with FOLFIRI therapy, and during the fifth course, he presented with a sudden onset of congestive disturbances. Through radiographic examination and laboratory data, only hyperammonemia was found; he was therefore diagnosed with hyperammonemic encephalopathy. By starting branchedamino acid solutions for its treatment, his consciousness and serum ammonia were promptly improved. Hyperammonemic encephalopathy related 5-FU is caused by increasing ammonia production and its metabolic inhibition, and is worsened by renal dysfunction, dehydration, constipation, infections, or body weight loss. On account of the potential decrease of metabolic function of liver and kidney, an aged person tends to have hyperammonnemia more than a youth. Clinicians should be aware of the adverse events associated with hyperammonemia when then administer a large amount of 5-FU to elderly patients.

Objectives: To examine the reliability and validity of the simplified Japanese version of the WHO-Five Well-Being Index (S-WHO-5-J), which reduces the original 6-point scale to a 4-point scale., Methods: Subjects were selected from 4,439 community-dwelling elderly living in Tokyo. Their mean age +/- SD was 74.2 +/- 6.6 years, and 2,475 (55.8%) were female. We mailed a questionnaire to all potential subjects, and collected 3,068 (69.1%). We analyzed the data from 1,356 questionnaires that had no missing values for the following items: S-WHO-5-J, Geriatric Depression Scale short version (GDS-15), age, gender, persons living together, need of care, subjective rating of health, physical pain, subjective memory impairment, activities of daily living (TMIG Index of Competence), social support, housebound, and subjective feeling of economic affluence. The mean age +/- SD of the sample was 73.2 +/- 5.9 years, and the proportion of females was 51.1%. An additional analysis compared the number of missing values between a simplified version and an original version using the data of 2,034 subjects from another study., Results: A factor analysis identified only one factor and showed high correlation coefficients between total score and items (0.79-0.87) and between all items (0.52-0.82) and a high Cronbach's alpha (0.889). The S-WHO-5-J was correlated to the GDS-15, to the item on mental health and to factors that affected mental health, physical health (subjective rating of health, physical pain, illness), physical function (walking, falling, nutritional status, oral health care), memory impairment, activities of daily living, and social function (housebound, interaction with others, social support). Additional analysis showed that there were fewer missing values for the S-WHO-5-J than for the WHO-5-J., Conclusion: The S-WHO-5-J is a reliable, valid, and convenient measure of mental health for large samples of community-dwelling elderly persons.

A 62-year-old woman with acute lymphoblastic leukemia in first complete remission was treated with unrelated cord blood transplantation, but exhibited primary graft failure. She then underwent HLA-haploidentical peripheral blood stem cell transplantation from her daughter. The conditioning regimen consisted of fludarabine 30 mg/m(2)/day for 6 days, intravenous busulfan 3.2 mg/kg/day for 2 days, and thymoglobulin 1 mg/kg/day for 2 days. Voriconazole was administered to prevent fungal infections. The patient achieved prompt hematopoietic recovery. Fever was observed 21 days after the second transplant, followed by sigmoid colon perforation and a liver space occupying lesion (SOL). A filamentous fungus was detected in a percutaneous biopsy of the liver SOL. In spite of changing the antifungal drug from voriconazole to liposomal amphotericin B, the patient died on day 41. The fungus was identified as Mucor indicus, a type of zygomycete. Although Mucor indicus inhabits soil, an infectious disease is extremely rare, and breakthrough infection after voriconazole prophylaxis had not been reported until now. It is mandatory to consider preventive antifungal treatment for drug-resistant fungal infectious diseases in patients after neutrophilic recovery with a strongly immunocompromised state after a HLA-haploidentical transplant.

IL-10 is an anti-inflammatory cytokine with an important role in preventing inflammatory and autoimmune responses. IL-10 is also important for suppressive function of inducible regulatory T (iTreg) cells, several types of which were reported in succession. Type1 regulatory T (Tr1) cell is a representative of IL-10-prroducing regulatory T cells. Although specific surface markers or origin of Tr1 cells have not fully been clarified yet, IL-27 was recently reported to induce IL-10 production in T cells and be an inducer of Tr1 cells. We previously reported that CD4(+)CD25(-)lymphocyte activation gene (LAG-3)(+) Treg (LAG3(+) Treg) is one of the peripherally inducible Tregs and functions as an immune-regulator through IL-10 production. We found that the expression level of Egr-2, a transcription factor required for T cell anergy induction, is elevated in LAG3(+) Treg and that forced expression of Egr-2 induces LAG-3 expression and IL-10 production. Egr-2 has been suggested to be a key player of regulatory function in LAG3(+) Treg. In this study, we review Tr1 cells and the mechanism of IL-10 induction by IL-27 in T cells. Also, we introduce LAG3(+) Treg and discuss the therapeutic potential of these regulatory T cells.

Many patients with POEMS syndrome have osteosclerotic plasmacytoma. Radiation therapy is useful for patients who have localized lesions, although chemotherapy is necessary for patients who have widespread lesions. Thus, evaluation of these lesions is important to determine the therapeutic strategy. We evaluated the activities of lesions in two patients with POEMS syndrome by (18)F-FDG positron emission tomography (PET)/computed tomography (CT) scan. In the first patient, PET/CT scan revealed osteosclerotic lesions, which were not detected by Ga-scintigraphy or plain X-ray. It also detected residual disease activity and relapse. In the second patient, lymph node involvement was suggested by (18)F-FDG uptake, and plasmacytoma was confirmed by subsequent biopsy. In the extramedullary lesions of this case, FDG uptake was as marked as in myeloma, whereas bone lesion was only detectable by CT scan. In POEMS syndrome, the PET and CT are complementary, and the combined PET/CT scan is considered to be very useful for evaluation of involved lesions.

We present a case of amebic colitis and liver abscess complicated by acute myeloid leukemia (AML) with high serum procalcitonin (PCT). A 61-year-old Japanese man seen at our hospital for severe diarrhea and high fever was found to have multiple ulcers in the transverse and sigmoid colon and rectum by colonoscopy and biopsies were conducted. Immature leukocytes with mild anemia and thrombocytopenia were seen in peripheral blood, necessitating bone marrow aspiration and biopsy that yielded a diagnosis of AML (FAB M4Eo). Serum C-reactive protein and PCT were extremely elevated. Blood cultures for bacteria and fungi were negative. Multiple low-density areas in the liver were found in abdominal computed tomography. Histological colon biopsy findings revealed amebic colitis, strongly suggesting amebic liver abscess. Metronidazole treatment was initiated for amebiasis and subsequent standard chemotherapy for AML was followed after fever was lowered. Hematological and cytogenetic CR was maintained with good clinical condition. Few case reports have been published in Japan to date on amebic colitis and liver abscess complicated by AML and no reports have been made on PCT elevation caused by amebiasis. In conclusion, differential diagnosis of amebiasis is necessary in addition to that of bacterial or fungal infection in serum PCT elevation.

This is a case of a 58-year-old woman who underwent mastectomy for advanced right breast cancer (T2N2M0, stage IIIA, ER+, PR+, and HER2 0) at another hospital 13 years ago. Tamoxifen was administered after the operation. Two years later, bone and lung metastases appeared and she was transferred to our hospital. Hormonal therapies, epirubicin- cyclophosphamide-5-FU, doxifluridine, paclitaxel, vinorelbine, and capecitabine were ineffective. We planned a sixth-line chemotherapy comprising gemcitabine combined with docetaxel, but not paclitaxel. Partial response was obtained by treatment with 3 courses of gemcitabine-docetaxel. The same treatment was continued and the patient is alive in a good condition without progression for 14 months.

Here, we present the case of a 73-year-old woman in whom abdominal computed tomography showed an abdominal tumor (13 cm in diameter) in the backspace of the posterior gastric wall. Its feeding artery was detected to be the left gastric artery by abdominal angiography. We diagnosed it as a gastrointestinal stromal tumor (GIST) of the stomach and performed an operation. Peritoneal dissemination was observed and the tumor was connected to the gastric wall by a stalk. Histologically, the tumor consisted of spindle-shaped cells. Immunohistochemical staining showed positive c-kit and CD34 expression and negative SMA and S100 protein expression. Therefore, we diagnosed this as a case of extragastric pedunculated GIST of the stomach with peritoneal dissemination. After surgery, internal use of imatinib was started. The patient is still followed up 15 months after the operation. Combination therapy of tumor resection and imatinib chemotherapy might improve the prognosis of patients with GIST of the stomach with pedunculated growth.