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本研究の目的は、ケアラーのQOLに焦点をあてたケアラーアセスメントを軸とするケアラー支援ツール開発プロセスと評価の概要をまとめ、開発と評価から見えてきたケアラーへの包括的支援の課題を考察することである。実践参加型の開発・評価の方法により、開発したツールを用いてケアラー108名を対象に調査と評価を実施した。最終的に、4つの柱(ケアラー自身/ケアラーのケア役割/生活/ウェルビーイング)を明確にしたケアラーアセスメント/セルフアセスメントシートと支援計画表を開発した。包括的ケアラー支援プロセスモデルとして、アセスメント、支援計画、実施、評価の流れを示した。ケアラーへの包括的支援の課題として、アセスメント内容の精緻化、運用面や効果面の工夫、多様なケアラーを包摂した支援方法の検討、ケアラー支援モデルの更なる精緻化にむけた理論的検討、包括的なケアラー支援のための政策上の明確化による体制整備をあげた。, This study is aimed at summarizing the process of the development and evaluation of the tools including Carer Assessment and to explore the challenges of the comprehensive support for carers. Using a participatory method, the evaluation studies were conducted using the developed tools (Carer N=108). The final version of Carer assessment sheet, Self-assessment sheet for Carer, and Carer support plan were developed with the clarification of the four pillars (Carer, Caring role, Carers’ life, and Carers’ wellbeing). The process of Assessment, Planning, Implementation, and Evaluation was shown with the Comprehensive Carer Support Process Model. The challenges of the comprehensive support for carers include the necessity of the elaboration of the contents of assessment, the necessity of the effective way of usability, the consideration of the support methods for the diverse carers, the theoretical consideration for elaboration of the Carer support model, and the establishment of a system for the comprehensive carer support through clarification at the policy level.

Purpose We developed preference weights of the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer) in Japan. Methods We used best–worst scaling (BWS) and composite time trade-off (cTTO) to determine the preference weights for ASCOT-Carer states in the general population. TTO values were applied to convert the BWS scores to utilities. The sample number was approximately 1000 for the BWS survey and 200 for the TTO survey. Whereas face-to-face surveys by computer-assisted interviewing were adopted for the TTO tasks, a web-based survey was used for the BWS tasks. In the BWS tasks, the ASCOT-Carer states were presented, and the “best,” “worst,” “second best,” and “second worst” domains in a profile were selected. A mixed logit model was applied to the BWS data. Results The respondents’ background was similar to that of the general population, although the number of people in the age and sex categories was equal. The preference weights for calculating the utilities of the ASCOT-Carer states were estimated. The estimated utilities of the ASCOT-Carer states were distributed between 1 and 0.02. All preference weights were consistent. The item with the highest preference weight was level 1 in the “space and time to be yourself.” The least preferred item was level 4 in the “space and time to be yourself” and “control over daily life” domains. Conclusion We established Japanese preference weights for ASCOT-Carer states, the first weights of an Asian country. The estimated utilities can contribute to the measurement of caregivers’ social care-related QoL and perform of cost-effectiveness analyses.

BackgroundDuring the COVID-19 pandemic, many people refrained from going out, started working from home (WFH), and suspended work or lost their jobs. This study examines how such pandemic-related changes in work and life patterns were associated with depressive symptoms.MethodsAn online survey among participants who use a health app called CALO mama was conducted from 30 April to 8 May 2020 in Japan. Participants consisted of 2846 users (1150 men (mean age=50.3) and 1696 women (mean age=43.0)) who were working prior to the government declaration of a state of emergency (7 April 2020). Their daily steps from 1 January to 13 May 2020 recorded by an accelerometer in their mobile devices were linked to their responses. Depressive symptoms were assessed using the Two-Question Screen.ResultsOn average, participants took 1143.8 (95% CI −1557.3 to −730.2) fewer weekday steps during the declaration period (from 7 April to 13 May). Depressive symptoms were positively associated with female gender (OR=1.58, 95% CI 1.34 to 1.87), decreased weekday steps (OR=1.22, 95% CI 1.03 to 1.45) and increased working hours (OR=1.73, 95% CI 1.32 to 2.26). Conversely, starting WFH was negatively associated with depressive symptoms (OR=0.83, 95% CI 0.69 to 0.99).ConclusionsDecreased weekday steps during the declaration period were associated with increased odds of depressive symptoms, but WFH may mitigate the risk in the short term. Further studies on the longitudinal effects of WFH on health are needed.

The Japan-Lithuania Joint Seminar was held at Japan Lutheran College in September 2019 as an exchange program between the two countries, financially supported by the Japan Society for the Promotion of Science (JSPS) and Lithuanian Research Council (LRC), and as part of the 110th anniversary celebration of Japan Lutheran College. Under the theme “Technologies in social care: Considering future directions for social work professionals in Japan and Lithuania,” the seminar aimed to discuss the universal theme of “welfare and technology.” In this seminar, the participants aimed to compare the situations while taking account of these differences between the two countries, and to discuss what changes technology would bring about to practice, education and research in social work and welfare as we face the rapid technological innovation. Although both countries have different cultures and welfare systems, there are certain common challenges for the future. First of all, we need to understand problems caused by technology use such as ethical dilemmas, after clarifying the definition and scope of technology. Another common issue is the need to establish an educational and vocational training system for social work professionals to learn technology and to increase technology awareness., リトアニア日本二国間セミナーは、リトアニア学術会議（LRC）と日本学術振興会（JSPS）の助成を受けた二か国間交流事業として、ルーテル学院の創立110 年記念事業の一環でルーテル学院大学にて2019 年9 月に開催された。本セミナーは、「社会的ケアとテクノロジー：日本・リトアニアのソーシャルワーク専門職の未来を探る」をテーマとし、普遍的なテーマである「福祉とテクノロジー」について、両国の状況を踏まえて比較しながら議論し、技術革新が急速に進むなかで、テクノロジーがソーシャルワーク・福祉の実践、教育、研究領域にどのような変化をもたらすのかについて討論することを目的とした。両国の文化や制度は異なるが、今後に向けた共通課題があることがうかがえた。第一に、テクノロジーの定義や範囲を明確化した上で、倫理的ジレンマなどのテクノロジー利用の問題点を理解する必要がある。ソーシャルワーク専門職がテクノロジーについて学び、テクノロジーに関する認識を深めるための教育及び専門職研修体制を構築することも共通の課題である。

Due to the absence of standardized Quality of Life (QoL) measures for informal family caregivers of recipients of long-term care (LTC) in Japan, translation and cross-cultural adapted LTC outcome measures are needed for research and evaluation. In this study, we assessed the validity and reliability of the factor structure and response system of the translated and cross-culturally adapted Japanese version of the Adult Social Care Outcomes Toolkit for Carer (J-ASCOT-Carer). Participants were 872 informal family caregivers of adults who lived at home and required LTC services. Almost half (46%) of the participants were between 50 and 59 years old, 85% were employed, and 69% resided with their care recipients. We used the combined factor analysis and item response theory approach. Model fit indices included factor loading, path coefficients, root mean square error of approximation, standardized root mean square residual, and comparative fit index. This study confirmed the one factor structure that was identified in the original English version of the ASCOT-Carer. The values for the model fit indices indicated a good fit. Moreover, the validity and reliability of the response system were confirmed. Therefore, the J-ASCOT-Carer is a reliable assessment instrument to measure QoL of Japanese caregivers of adults requiring LTC.

Improving the quality of life of carers is the ultimate goal of carers’ policy and support services. This paper discusses issues and challenges in conceptualising and comparing carers’\ud quality of life in England and Japan, based on developing a Japanese-version of the self-completion Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer). Since supporting\ud carers in employment is a key concern in both countries, we particularly focus on this group of carers.

Background During the COVID-19 pandemic, many people refrained from going out, started working from home (WFH), and suspended work or lost their jobs. This study examines how such pandemic-related changes in work and life patterns were associated with depressive symptoms. Methods An online survey among participants who use a health app called CALO mama was conducted from 30 April to 8 May 2020 in Japan. Participants consisted of 2846 users (1150 men (mean age=50.3) and 1696 women (mean age=43.0)) who were working prior to the government declaration of a state of emergency (7 April 2020). Their daily steps from 1 January to 13 May 2020 recorded by an accelerometer in their mobile devices were linked to their responses. Depressive symptoms were assessed using the Two-Question Screen. Results On average, participants took 1143.8 (95% CI −1557.3 to −730.2) fewer weekday steps during the declaration period (from 7 April to 13 May). Depressive symptoms were positively associated with female gender (OR=1.58, 95% CI 1.34 to 1.87), decreased weekday steps (OR=1.22, 95% CI 1.03 to 1.45) and increased working hours (OR=1.73, 95% CI 1.32 to 2.26). Conversely, starting WFH was negatively associated with depressive symptoms (OR=0.83, 95% CI 0.69 to 0.99). Conclusions Decreased weekday steps during the declaration period were associated with increased odds of depressive symptoms, but WFH may mitigate the risk in the short term. Further studies on the longitudinal effects of WFH on health are needed.

Background: During the corona-virus disease 2019 pandemic, many people refrained from going out, started working from home (WFH), and suspended work or lost their jobs, and these lifestyle changes could affect their mental health. This study examines how such pandemic-related lifestyle changes were associated with the risk of depression. Methods: An online survey among participants who use a health app called CALO mama was conducted from April 30 to May 8, 2020 in Japan. Depressive symptoms were assessed using the two-question screen. Participants consisted of 1,238 men (mean age = 51.0) and 2,086 women (mean age = 43.2), and their number of daily steps from January 1 to May 13, recorded by an accelerometer in their mobile devices, was linked to their responses. Results: On average, participants took 900 fewer weekday steps during the governmental declaration of a state of emergency. Depressive symptoms were more prevalent among women than men (45.9% vs. 32.4%). Among women, a decrease in walking and increased time spent on childcare were associated with an increased risk of depression. Conversely, starting WFH was negatively associated with risk for women. Among men, more weekday steps in the pre-declaration period were protective against depression. Men who worked longer during the declaration period, however, had an increased risk for depression, but WFH mitigated their risk. Conclusions: Prevention of social isolation and physical inactivity due to home-bound lifestyles, the promotion of WFH, and gender-specific measures such as prevention of longer working hours and more support for home childcare are needed.

It is plausible that the coronavirus disease 2019 pandemic and related lifestyle changes affected dietary patterns, but existing studies have limitations owing to a cross-sectional design. Using longitudinal data, we examined dietary changes in people due to the pandemic and related lifestyles. We conducted an online survey on lifestyle changes during the pandemic from April 30 to May 8, 2020, among users of a health app called CALO mama provided in Japan. We retrieved and linked the dietary data for 5,929 participants from January 1 to May 13, 2020. Generalized linear mixed models were used to estimate the frequencies of food intake associated with the pandemic and lifestyles. During the governmental declaration of a state of emergency, the frequency of intake of self-made meals (incidence rate ratio [IRR] = 1.05), vegetables (IRR = 1.06), and snacks increased (IRR = 1.04). Similarly, working from home was associated with increased rates of intake of self-made meals (IRR = 1.02), vegetables (IRR = 1.02), fruits (IRR = 1.06), and snacks (IRR = 1.04). In contrast, working hours (self-made meals: IRR = 0.997, fruits: IRR = 0.99, snacks: IRR = 0.99 [per hour]), time spent on childcare (self-made meals: IRR = 0.99, vegetables: IRR = 0.99, fruits: IRR = 0.98 [per hour]), and depressive symptoms (self-made meals: IRR = 0.93, vegetables: IRR = 0.92, fruits: IRR = 0.90) tended to be negatively associated with the frequency of food intake. This study showed that the pandemic affected dietary patterns in various ways. It is important to record and notice such changes and modify them to the recommended balance during a prolonged pandemic to ensure healthy eating habits.

Narcolepsy with cataplexy is most commonly caused by a loss of hypocretin/orexin peptide-producing neurons in the hypothalamus (i.e., Narcolepsy Type 1). Since hypocretin deficiency is assumed to be the main cause of narcoleptic symptoms, hypocretin replacement will be the most essential treatment for narcolepsy. Unfortunately, this option is still not available clinically. There are many potential approaches to replace hypocretin in the brain for narcolepsy such as intranasal administration of hypocretin peptides, developing small molecule hypocretin receptor agonists, hypocretin neuronal transplantation, transforming hypocretin stem cells into hypothalamic neurons, and hypocretin gene therapy. Together with these options, immunotherapy treatments to prevent hypocretin neuronal death should also be developed.In this review, we overview the pathophysiology of narcolepsy and the current and emerging treatments of narcolepsy especially focusing on hypocretin receptor based treatments.Among hypocretin replacement strategies, developing non-peptide hypocretin receptor agonists is currently the most encouraging since systemic administration of a newly synthesized, selective hypocretin receptor 2 agonist (YNT-185) has been shown to ameliorate symptoms of narcolepsy in murine models. If this option is effective in humans, hypocretin cell transplants or gene therapy technology may become realistic in the future.

Background Universal school lunch programmes are expected to cover all children equally, compared with selective programmes that may stigmatize socially vulnerable children. However, the effectiveness of universal programmes in closing dietary disparity has not been empirically proven. We evaluated whether Japan’s universal school lunch programmes contribute to a reduction in the socioeconomic status (SES)-related gradient in fruit and vegetable intakes. Methods We analyzed data for 719 school children aged 6–12 years in a population-based survey conducted in the greater Tokyo metropolitan area. We measured dietary intakes using a validated self-administered brief diet history questionnaire for young children (BDHQ-10 y). We assessed parental education, annual household income and maternal employment status as SES indicators of children. We used multiple regression to estimate mean fruit and vegetable intakes by parental education and household income, and the contribution of school lunch to reducing the SES-related gradient in fruit and vegetable intakes. Results Compared with children with high maternal education (>15 years), those with low maternal education (

To better understand the habitat choices of Japanese sea cucumber Apostichopus japonicus juveniles, we investigated their responses to various stimuli. Specifically, their phototactic, thigmotactic, and geotactic responses were tested by placing sea cucumber juveniles in appropriately designed test tanks, while their responses to turbulence were tested in tanks in the presence or absence of wind-driven waves. Sea cucumber juveniles showed clear negative phototaxis, but there was no clear evidence of thigmotaxis or geotaxis. The juveniles frequently appeared at the surface of the water in a tank lacking turbulence, but much less frequently in a tank with turbulence. We conclude that sea cucumber juveniles choose their habitat via a combination of phototaxis and their limited ability to attach to hard substrates.

Benzo-15-crown-5 and dipicolylamine are contained as the binding sites in a ditopic azoprobe (15C5-Azo-n-dpa). However, the selectivities of guest-induced supramolecular chirality for cations and anions were dramatically altered by a slight change in the spacer length of (15C5-Azo-n-dpa)2–γ-CyD complexes in water.

We examined the diel activity pattern of the sea cucumber Apostichopus japonicus with or without the presence of food and predators. We also tested whether they have the capability for time–place learning. In the feeding experiment, juvenile and adult sea cucumbers were fed at either 00:00 or 12:00, at a fixed feeding place for 12 days, and the presence of animals in the feeding area was recorded. In the predator experiment, juvenile sea cucumbers were kept in a tank with or without a filefish, and the emergence of juvenile sea cucumbers outside the oyster shell area was recorded. Juvenile sea cucumbers did not show a diel activity rhythm, whereas adults were nocturnal, but this was altered by feeding at 12:00. Neither juveniles nor adults appeared in the feeding area before feeding time, suggesting an inability for time–place learning. Juvenile sea cucumbers hid under the oyster shells during the daytime and were active at night in the presence of a filefish, but without a filefish, they also showed high activity in the daytime. We suggest that sea cucumbers change their activity depending on the presence of food and predators, but without the influence of time–place learning.

Background: Pain is regarded as one of the most common nonmotor symptoms in Parkinson's disease (PD). In particular, musculoskeletal pain has been reported as the most common type of PD-associated pain. Crowned dens syndrome (CDS), related to microcrystalline deposition in the periodontoid process, is the main cause of acute or chronic cervical pain. Case Presentation: This report describes the case of an 87-year-old woman who had severe bradykinesia, muscle rigidity, gait disturbance and neck pain. Laboratory examination revealed marked elevations of white blood cells (10,100/µl) and C-reactive protein (CRP; 8.63 mg/dl). She was primarily diagnosed with severe and untreated PD, corresponding to Hoehn and Yahr scale score IV, with musculoskeletal pain and urinary tract infection. The patient was treated with antiparkinsonism drugs, antibiotic agents and nonsteroidal anti-inflammatory drugs, but they had only limited effects. Cervical plain computed tomography (CT) scanning detected remarkable crown-like calcification surrounding the odontoid process. Based on CT findings, the patient was diagnosed as having CDS with PD, and was immediately treated with corticosteroid. The severe neck rigidity with pain and the serum CRP level (0.83 mg/dl) of the patient were drastically improved within a week by the additional corticosteroid therapy. Conclusion: Severe neck rigidity and bradykinesia in this patient might have strengthened the chondrocalcinosis around the odontoid process. Cervical plain CT scan is necessary and useful for the definitive diagnosis of CDS. CDS should be considered as a differential diagnosis of a possible etiology for musculoskeletal pain related to rigidity and bradykinesia in PD.

Background: Myelitis is one of the rarest neurological complications of the varicella zoster virus (VZV) infection. Focal muscle weakness with or without sensory disturbance occurs in approximately 5% of the cases after acute VZV infection, with complete recovery in 50-70%. Case Presentation: This report describes two rare cases of elderly patients with VZV myelitis secondary to dermatomal zoster rash. Patient 1 was a 79-year-old woman who developed paraplegia, numbness and decreased sensation in the left arm and below thoracic (Th)-10 after sacral zoster. Spinal cord MRI showed a high-signal-intensity lesion at the cervical spinal nerve 2 on a T2-weighted image. Patient 2 was a 73-year-old man who developed right flaccid leg weakness and urinary retention after right dorsal Th 5-8 zoster. Spinal cord MRI showed a high-signal-intensity lesion at Th 3-4 on a T2-weighted image. In both cases, although the conventional single polymerase chain reaction (PCR) assays all showed negative results, the original nested PCR assay detected VZV DNA in the cerebrospinal fluid (CSF) specimen collected on admission. In addition, the anti-VZV IgG antibody by enzyme immunoassay and antibody index were elevated in the CSF specimens during the clinical courses of both patients. On the basis of these findings, both patients were diagnosed with VZV myelitis and were treated with high-dose acyclovir and corticosteroid. This combined treatment was appropriate and effective for the improvement of their functional outcomes. Conclusion: The detection of VZV DNA in CSF by nested PCR assay and the evaluation of the antibody index to VZV had significant diagnostic value.

We report a novel supramolecular chirality induced by the twisted structural change of two ditopic azoprobes (15C5-Azo-dpa) inside the chiral cavity of γ-cyclodextrin (γ-CyD) due to multi-point recognition of guest ions by 15C5-Azo-dpa molecules in water.

Cerebral infarction (CI) is thought to be a multifactorial disease that is affected by several environmental factors and genetic variants. N-type voltage-gated calcium channels (VGCCs), which are expressed primarily in the neurons, have various roles in neuronal functions and are especially involved with neurotransmitter release at the sympathetic nerve terminals. We considered the α1B subunit of the N-type voltage-gated calcium channel (CACNA1B) to be representative of the general characteristics of this channel type. The aim of the present study was to assess the association of the human CACNA1B gene with the occurrence of CI via a haplotype-based case-control study that used single nucleotide polymorphisms (SNPs) from the Japanese population. A total of 165 CI patients and 314 controls were enrolled in the case-controlled studies that examined three SNPs of the human CACNA1B gene (rs7042521, rs11137351, rs10780199). There were significant differences between the CI and control groups for the overall distribution of the genotypes and the presence of the recessive rs10780199. Multiple logistic regression analyses revealed that even after adjusting for confounding factors (odds ratio: 1.716), the frequencies of the A/G and G/G genotypes of rs10780199 in the CI group were significantly higher than those observed in the control group (p=0.021). Furthermore, the C-C-G and G-G-G haplotypes of rs7042521-rs11137351-rs10780199 were significantly more frequent in the CI group than in the control group (p=0.024 and p

BACKGROUND Elastin microfibril interfacer 1 (EMILIN-1) is a negative regulator of the transforming growth factor-beta (TGF-beta) signaling, which is involved in blood pressure (BP) homeostasis. Emilin1 knockout mice display elevated BP. The aim of the present study was to assess the association between the human EMILIN1 gene and essential hypertension (EH) using a haplotype-based case-control study. METHODS A total of 287 EH patients and 253 age-matched controls were genotyped for the five single-nucleotide polymorphisms (SNPs) used as genetic markers for the human EMILIN1 gene (rs2289408, rs2289360, rs2011616, rs2304682, and rs4665947). Data were analyzed for three separate groups: the total subjects, men, and women. RESULTS For the total, the genotypic distribution of rs2289360, rs2011616, and rs2304682 differed significantly between control and EH (P = 0.010, P = 0.009, and P = 0.008, respectively). For the total and men, there were significant differences noted between the controls and the EH patients for both the dominant model (GG vs. AA+AG) (P = 0.006, P = 0.021, respectively), and the recessive model (AA vs. AG+GG) (P = 0.028, P = 0.038, respectively) of rs2011616. For the total and the men, logistic regression analysis indicated that the AG+GG genotype of rs2011616 was significantly higher in EH patients (P = 0.033, P = 0.043, respectively). The frequency of the G-G-T haplotype (established by rs2536512, rs2016116, rs17881426) was significantly higher in EH men (P = 0.007), and the G-A-T haplotype (established by rs2536512, rs2016116, rs17881426) was significantly higher in control men (P < 0.001). CONCLUSIONS We confirmed that rs2289360, rs2011616, and rs2304682 in the human EMILIN1 gene, as well as the haplotype constructed using rs2536512, rs2011616, and rs17881426 are useful genetic markers of EH in Japanese men.

Objectives The aim of this study was to investigate the relationship between cerebral infarction (CI) and the human apurinic/apyrimidinic endonuclease 1/redox effector factor-1 (APE1/REF-1) gene using single-nucleotide polymorphisms (SNPs) and a haplotype-based case–control study. Design and methods We selected 5 SNPs in the human APE1/REF1 gene (rs1760944, rs3136814, rs17111967, rs3136817 and rs1130409), and performed case–control studies in 177 CI patients and 309 control subjects. Results rs17111967 was found to have no heterogeneity in Japanese. The overall distribution of the haplotype-based case–control study constructed by rs1760944, rs3136814 and rs1130409 showed a significant difference. The frequency of the G-C-T haplotype was significantly higher in the CI group than in the control group (2.5% vs. 0.0%, p > 0.001). Conclusions Based on the results of the haplotype-based case–control-study, the G-C-T haplotype may be a genetic marker of CI, and the APE1/REF-1 gene may be a CI susceptibility gene.

G-protein-coupled purinergic receptor P2Y2 (P2RY2) has an important role in the process of atherosclerosis related to cerebral infarction (CI). The aim of this study was to investigate the relationship between the P2RY2 gene and CI through a haplotype-based case-control study, including the separate analysis of two gender groups. A total of 237 CI patients and two control groups (control 1, 254; control 2, 255) were genotyped for five single nucleotide polymorphisms (SNPs) in the human P2RY2 gene (rs4944831, rs1783596, rs4944832, rs4382936, rs10898909). Among women, the distribution of the dominant rs4944832 phenotype (GG vs. GA+AA) differed significantly between the CI patients and the control 1 group (P=0.043) and between the CI patients and the control 2 group (P=0.029). Logistic regression analysis showed that the GG genotype of rs4944832 was significantly more prevalent in the female CI patients than in the control 1 (P=0.021) and control 2 groups (P=0.005). For all subjects, the overall distribution of the haplotype established by rs1783596-rs4382936-rs10898909 was significantly different between the CI patients and the control 1 group (P=0.027). For all subjects, the frequency of the T-A-G haplotype (rs1783596-rs4382936-rs10898909) was also significantly higher (P=0.031), whereas the frequency of the T-C-G haplotype (rs1783596-rs4382936-rs10898909) was significantly lower (P=0.029) in the CI patients than in the control 1 group. The present results indicate that the T-A-G haplotype of the human P2RY2 gene is a susceptibility haplotype for CI in Japanese subjects, and that the GG genotype is a genetic marker for CI, particularly in Japanese women.

N-arylmethyl aromatic thioamides were reacted with n-BuLi (2 equivalents), and then treated with silylpropyl chloride and silyl chlorides. As a result, these electrophiles were introduced to the carbon atom adjacent to the nitrogen atom of thioamides via thioamide dianions. The efficiency of the reaction was largely influenced by the substituents on the aromatic ring of thioamides. The reaction of thioamides having pyridyl groups was not always successful and depended on the position of the nitrogen atom of these groups. Reduction of the resulting thioamides with LiAlH4 proceeded smoothly to give the corresponding secondary N-1-silylarylmethyl amines in good yields. In contrast, the reduction of thioamides bearing pyridyl groups gave complex mixtures. In these cases, the use of DIBAH successfully gave the desired secondary amines.

本研究の目的は、(1)フォーマル・ケア(FC)とインフォーマル・ケア(IC)組み合わせの実態、(2)夫・息子によるケア(3)介護の受け手と担い手のケア選好を中心に、ジェンダーとライフコースの視点から要介護時のケア実態と選好について探索的に分析することである。調査対象はN県C市の地域在住の要支援・介護高齢者(11事例、うち女性が8事例)とその主介護者である。事例分析の結果、(1)介護者の健康状況などによりFCとICの多様な組み合わせの実態があり、時間的変化も考慮すべきこと、(2)退職後などのライフコースにおけるタイミングが関連しジェンダー役割にとらわれずに夫や息子によるケアが行なわれる側面があること、(3)受け手と担い手のケア選好の違いや、適応的選好となることからケア選好把握に困難が伴うことがわかった。分析方法などの課題はあるが、本研究は要介護時のケア実態とケア選好を把握し、FCとICのあり方を議論することが、利用者の主体性を尊重したケアマネジメント実践に重要なことを示したといえるだろう。

Dear Sirs, A 65-year-old woman was admitted to the neurology ward of our hospital with a suspected diagnosis of acute meningo-encephalitis. No antecedent flu-like episode was reported. Past medical history included a pelvic tumor which was initially diagnosed as a leiomyoma of the uterus. It had enlarged to a diameter of 10 cm in her pelvic space. On admission, her temperature was 37.6°C; her eyes were open but she was disoriented. The Glasgow Coma Scale score was 14 (E4 V4 M5) points. Signs of meningeal irritation were present. Other neurologic findings were normal. No involuntary movements were evident at admission. CSF analysis on admission showed leukocytes 51/mm3 with 134 monocular cells and 18 polymorphonuclear leukocytes, total protein concentration 23 mg/100 ml, and glucose 67 mg/100 ml (plasma glucose 119 mg/100 ml). HSV and HHV-6 DNA were not detected in CSF using the polymerase chain reaction method. CSF culture and cytology were negative. She was initially treated with acyclovir, panipemem–betamipron (a carbapenem-like antibiotic), vancomycin, and corticosteroids. However, on the 2nd hospital day, she became comatose, and her electroencephalogram demonstrated marked generalized slowing consisting of δ and θ waves. On the 8th hospital day, she exhibited tonic–clonic seizures and oral dyskinesia, which were treated with intravenous anticonvulsants. Her respiration was controlled with an endotracheal tube without the assistance of mechanical ventilation. Cranial MRI revealed abnormalities of high intensity in both, predominantly in the left, limbic area, mainly hippocampus and amygdala, on FLAIR and diffusion images, whereas gadolinium-enhanced T1-weighted image revealed no abnormality in these areas (Fig. 1). Her neurological condition did not improve despite the above treatments, and her comatose state persisted. The anti-NMDA-R antibody was detected in both serum and cerebrospinal fluid. On the 40th hospital day, she underwent surgical removal of the uterus and bilateral accessory organs. The pathological diagnosis was carcinosarcoma with neuroendocrine differentiation of the uterus. Microscopic findings of the tumor were as follows: on HE staining, solid nests of viable atypical cells were observed in the uterine tumor, though this tumor exhibited extensive necrosis. The majority of the atypical cells had scant cytoplasm and spheroid nuclei with granular chromatin, exhibiting frequent mitoses and marked venous/lymphatic infiltration. On immunohistochemical examination, most of this tumor was frequently positive for synaptophysin, neuron-specific enolase (NSE), and CD56. Chromogranin immunoreactivity was also noted. Immunoreactivity for keratin, myogenin, and desmin was detected in only a few neoplastic cells. We also examined whether the tumor exhibited NR1/NR2 subunits ectopically by immunohistochemical staining using a monoclonal antibody to NR1. The tumor was found to exhibit membranous NR1 staining (Fig. 1). She died from complications of multiple organ failure. No autopsy was performed. Fig. 1 Cranial MRI (a–c). Abnormalities of high intensity in both, predominantly in the left, limbic area, mainly hippocampus and amygdala, were revealed on FLAIR (a) and diffusion images (b), whereas gadolinium-enhanced T1-weighted image (c) shown no ... Anti-NMDA-R encephalitis is characterized by prominent psychiatric symptoms, dyskinesias, seizures, autonomic instability, and central hypoventilation [1, 2, 4]. The clinical manifestations in our patient were typical of this disorder. Dalmau and colleagues reported that about 55% of women with anti-NMDA-R encephalitis older than 18 years had an underlying tumor, usually mature or immature ovarian teratomas [2]. They confirmed that components of ovarian teratomas that contained nervous tissue exhibited NR1/NR2 subunits of NMDAR ectopically [1, 3]. Other tumors previously found in association with anti-NMDAR encephalitis did not exhibit subunits of NMDAR. The tumor in our patient was composed mostly of poorly differentiated neuroendocrine carcinoma, a histopathologically rare tumor of the uterus. There are no previous cases of carcinosarcoma with neuroendocrine differentiation reported in association with any paraneoplastic neurological syndromes. This is the first report of tumor cells with neuroendocrine differentiation associated with a paraneoplastic neurological syndrome and exhibiting NR1/NR2 subunits of NMDAR.

A rapid and comprehensive analytical method for d - and l -enantiomers of proteinogenic amino acids was developed using ultra-high performance liquid chromatography (UHPLC) equipped with a circular dichroism (CD) detector. Pre-column derivatization reagents were examined for enhanced sensitivity and selectivity for UV and CD detection: 4-fluoro-7-nitro-2,1,3-benzoxadiazole (NBD-F) was selected. The method, using a CD detector, does not require separation of optical isomers on a column to calculate the enantio ratio (% D ) using the g-factor value and produces a simple chromatogram in comparison to other reported methods. Using this advantage, combined with UHPLC technology, analysis time for the derivatized proteinogenic amino acids was within 5.5 min. The UV detection limit was 4.9–23 pmol/injection and the CD detection limit was 11–64 pmol/injection. The method was applied to the analysis of d - and l -amino acids in food samples. d -Ala, d -Asp, d -Glu and d -Ser were detected at high concentrations in some Japanese black vinegars, fermented milks and yogurts. The results were identical to the results determined by the OPA method. We suggest the UHPLC–CD method would be useful in screening the d -amino acid content of foods and in helping to clarify the importance and reason for the presence of d -amino acids in foods.

Cerebral infarction (CI) is thought to be a multifactorial disease that is affected by several environmental factors and genetic variants. N-type voltage-gated calcium channels (VGCCs), which are expressed primarily in the neurons, have various roles in neuronal functions and are especially involved with neurotransmitter release at the sympathetic nerve terminals. We considered the α1B subunit of the N-type voltage-gated calcium channel (CACNA1B) to be representative of the general characteristics of this channel type. The aim of the present study was to assess the association of the human CACNA1B gene with the occurrence of CI via a haplotype-based case-control study that used single nucleotide polymorphisms (SNPs) from the Japanese population. A total of 165 CI patients and 314 controls were enrolled in the case-controlled studies that examined three SNPs of the human CACNA1B gene (rs7042521, rs11137351, rs10780199). There were significant differences between the CI and control groups for the overall distribution of the genotypes and the presence of the recessive rs10780199. Multiple logistic regression analyses revealed that even after adjusting for confounding factors (odds ratio: 1.716), the frequencies of the A/G and G/G genotypes of rs10780199 in the CI group were significantly higher than those observed in the control group (p = 0.021). Furthermore, the C-C-G and G-G-G haplotypes of rs7042521-rs11137351-rs10780199 were significantly more frequent in the CI group than in the control group (p = 0.024 and p0.000). In conclusion, significant differences were noted between the CI and control patients for the specific SNPs and haplotypes in the CACNA1B gene. The results indicate that these polymorphisms and haplotypes might be genetic markers for CI.

BACKGROUND Oxidative DNA damage is involved in the pathophysiology of essential hypertension (EH), which is a multifactorial disorder. Apurinic/apyrimidinic endonuclease 1/redox effector factor-1 (APE1/REF-1) is an essential endonuclease in the base excision repair pathway of oxidatively damaged DNA, in addition to having reducing properties that promote the binding of redox-sensitive transcription factors. Blood pressure in APE1/REF-1-knockout mice is reported to be significantly higher than in wild-type mice. The aim of this study was to investigate the relationship between EH and the human APE1/REF-1 gene through a haplotype-based case-control study using single-nucleotide polymorphisms (SNPs). METHODS We selected five SNPs in the human APE1/REF-1 gene (rs1760944, rs3136814, rs17111967, rs3136817, and rs1130409), and performed case-control studies in 265 EH patients and 266 age-matched normotensive (NT) subjects. RESULTS rs17111967 was found to show nonheterogeneity among Japanese subjects. There were no significant differences in the overall distribution of genotypes or alleles for each SNP between EH and NT groups. In the overall distribution of the haplotype-based case-control study constructed based on rs1760944, rs3136817, and rs1130409, the frequency of the G-T-T haplotype was significantly higher in the EH group than in the NT group (2.1% vs. 0.0%, P = 0.001). Multiple logistic regression analysis also revealed significant differences for the G-T-T haplotype, even after adjustment for confounding factors (OR = 8.600, 95% CI: 1.073-68.951, P = 0.043). CONCLUSIONS Based on the present results, the G-T-T haplotype appears to be a genetic marker of EH, and the APE1/REF-1 gene appears to be a susceptibility gene for EH.

Human vascular diseases such as myocardial infarction (MI) and cerebral infarction (CI) are thought to be affected by several environmental factors and genetic variants. It has been suggested that the expression of the KCNN4 calcium-activated potassium channel is associated with the developing vascular smooth-muscle cells of human neointimal hyperplasia. The aim of this study was to investigate the relationship between single-nucleotide polymorphisms (SNPs) in the human KCNN4 gene or haplotypes and the incidence of MI or CI in Japanese.Three hundred thirteen MI and 176 CI patients with 290 controls were enrolled in two independent case-control studies that examined the use of a haplotype-based case-control study involving five SNPs of the human KCNN4 gene (rs670950, rs2306801, rs2306799, rs347519, and rs3786954).There were significant differences between the MI and control groups in the overall distribution of genotypes and dominant or recessive models of rs670950, rs2306799, and rs3786954. Multiple logistic regression analyses revealed that even after adjusting for confounding factors (odds ratio: 1.96), the frequency of the G/G genotype of rs2306799 in the MI group was significantly higher than in the control group (p=0.005). Furthermore, the G-T-A haplotype of rs2306799-rs347519-rs3786954 was significantly more frequent in the MI (88.8%) than in the control group (83.6%).The specific SNPs and haplotypes in the KCNN4 gene showed significant differences between MI and control patients. These results indicate that these polymorphisms and haplotypes could be genetic markers for MI.

Quantitative EEG (qEEG) findings in Parkinson disease (PD) have been reported in only five previous studies. In these studies, the sample size was small and the distribution of qEEG changes was not estimated. This is the first qEEG evaluation not only employing multiple logistic regression analysis but also estimating the distribution of qEEG changes. The subjects comprised 45 PD patients without remarkable dementia and 40 age-adjusted normal controls. The lack of ischemic lesions in all subjects was confirmed by MRI. Absolute power values were measured for four frequency bands from delta to beta. The electrodes were divided into six, viz. frontal pole, frontal, central, parietal, temporal, and occipital locations. We calculated the spectral ratio, i.e., the sum of the power values in the alpha and beta waves divided by the sum of the values in the slow waves. The dependent variable was either PD or normal control; the independent variables were the spectral ratios, age, sex, and Mini-Mental State Examination score. The significant predictive variables in PD were the spectral ratios at all electrode locations except for the frontal pole (frontal location: P = 0.025, other locations: P < 0.01). PD presented diffuse slowing in the qEEG when compared with age-adjusted normal controls.

The objective of this study was to evaluate the executive dysfunction (ExD) in Parkinson's disease (PD) using the Behavioral Assessment of the Dysexecutive Syndrome (BADS), which provides a wide-range assessment of ExD. The BADS and the Unified Parkinson's Disease Rating Scale (UPDRS) were investigated in 63 nondemented PD patients who revealed scores of >or=24 points on the Mini-Mental State Examination based on the DSM-IV. Multiple logistic regression analysis was performed to evaluate the predisposing factors to ExD, which was defined as

The measures used in previous studies did not consider the situation where an individual exhibits impulsive behavior. The present research examines the relationship between self-reported measures and behavioral measures of impulsive abandonment and panic behavior in a problem-solving situation. The self Impulsive Behavior Questionnaire was the self-reported measure of the impulsive behavior tendency. The 91 undergraduate participants were grouped based on this score (high, n = 31; middle, n = 33; low, n = 27) were used. The behavioral measures were the correct detection and commission errors on the Continuous Performance Test. The result showed that the high impulsive group made a significantly higher number of commission errors than did the low group. The findings of this study support a consistent relationship between behavioral and self-reported measures.