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A geriatric health services facility had been working to improve end-of-life care since 2014. In 2017, the facility introduced the My Wishes notebook, which confirms individual's medical choices and distributed the Explaining Practices and Intentions of End-of-life Care book in 2018, in order to help their staff improve care for older adults. Care staff used their learning in caregiving for older adults. This study aimed to clarify the change in end-of-life care and staff thinking at a geriatric health services facility after the introduction of the My Wishes notebook.We requested cooperation from all care staff at a geriatric health services facility, and focus group interviews were conducted with 13 staff members over two days in June 2019. The responses in relation to two parameters, the staff members' thoughts and the change in end-of-life care, following the introduction of My Wishes were recorded and qualitatively analyzed.Six categories of responses were extracted from the qualitative analysis: "Difficulty in using My Wishes", "Effects of the use of My Wishes ", "The practice of sought care", "Intentional involvement with patients' families", "Self-confidence in end-of-life care", and "End-of-life care becoming common practice".After the introduction of My Wishes, the care staff found that there were difficulties in using My Wishes, such as writing on paper and difficulties in them hearing. On the other hand, they felt the effects of using My Wishes, such as knowing a new side, feeling further possibilities of care, and activating communication among interdisciplinary healthcare providers. Then, while intentionally engaging with patients' families, they will seek and practice the care that the older adults want. Furthermore, while repeatedly searching for and practicing the care that older adults want, they will gain confidence in providing care and change to normalize these care practices.

The purpose of this study was to clarify the care methods used by healthcare staff in service facilities to draw up wills for elderly individuals with dementia in daily life and the final stage in decision-making support.A questionnaire survey was conducted among healthcare staff in a geriatric health service facility in August 2020.There were 45 subjects (16 males [35.6%]; 29 females [64.4%]). The average age was 42.2 (±12.3) years old, and the mean number of years of experience in a geriatric health service facility was 17.4 (±10.7) years. Deathbed care was provided to ≥90% of the subjects. A factor analysis of items related to decision making in elderly individuals with dementia revealed the first factor to be "support and communication to draw wills", the second factor to be "support and communication for expression to realize decision making", and the third factor to be "understanding, communication, and family support for decision-making realization." The totals of each of these three factors and "having confidence in care focusing on the viewpoint of elderly individuals with dementia" were significantly different. The correction between the Personhood of Approaches to Dementia Questionnaire Japanese version and the three subscales of decision making in elderly individuals with dementia had a significant coefficient of correlation.More polite communication methods are necessary for the formation, expression, and realization of the intentions of elderly individuals with dementia to support their decision making.

Purpose This study aimed to clarify the effects of dementia care mapping (DCM) for one year in a healthcare center for older adults. DCM was conducted between September 2016 and August 2017. The care staff include nurses and caregivers in a narrow sense, medical staff, such as a physician, physical therapists, and occupational therapists worked on DCM as care staff in this study. Results There were 24 participants, with an average work experience of 7.21 (±4.74) years. In comparison to the baseline evaluation, the final assessment of self-efficacy through person-centred care showed significant improvement in 'Forecasting and Problem Solving on the Job' within 'Perceived Job Competence of Care Workers'. Six main categories of content were extracted from focus group interviews: 'Awareness,' 'Change of Elderly People under the Care of Staff throughout the Development of Mapping', 'Affirmative Feelings of Care Staff for Mapping', 'Negative Feelings for Mapping', 'Need for the Efficacy and Efficiency of the Mapping', and 'Mapping Based on the Age of the Participant and Future Prospects for Mapping'. The results of person-centred care showed that both the older patients and the staff noticed changes through the development of mapping. Conclusion The developmental evaluation, based on collaboration by medical and welfare staff can improve self-efficacy through the practice of person-centred care and improves the ability to solve problems during the provision of care.

Rationale Oral cancer often causes secondary primary cancers in the upper gastrointestinal tract. However, there are no reports of secondary primary cancers in patients with oral squamous cell carcinoma and malignant lymphoma of the small intestine. This report describes a case of metachronous multiple primary cancers of the tongue and small intestine malignant lymphoma. Patients concerns The patient was admitted to our department with the chief complaint of pain in the right tongue. Partial tongue resection and supraomohyoid neck dissection were performed. One year after surgery, the patient experienced abdominal pain and bloody stools. Diagnosis Diffuse large B-cell lymphoma (DLBCL) was diagnosed via histological examination. Interventions A terminal ileum resection was performed. Postoperatively, the patient received 6 courses of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP). Outcomes Five years after his initial diagnosis, there is no evidence of recurrence, metastasis, or other primary cancer. Lessons Oral cancer patients should always be followed up owing to a possibility of malignant tumors in other areas.

Background: Limited data are available regarding the characteristics and prognosis of patients with stroke due to varicella zoster virus (VZV) vasculopathy. Methods: We studied 4 patients (2 men and 2 women; age, 38-63 years) from a single center who developed acute ischemic stroke due to VZV vasculopathy. The virological diagnosis was confirmed by detecting VZV DNA and/or the IgG antibody to VZV in the cerebrospinal fluid. Results: Three patients were taking immunosuppressive agents, including prednisolone and/or methotrexate, at baseline. Each patient had a characteristic skin rash prior to stroke, with the interval from rash to stroke onset ranging from 13 to 122 days. Two patients experienced antecedent cranial nerve palsies; one had the third, seventh, ninth, and 10th nerve palsies and the other had the fourth nerve palsy before stroke. Cerebral infarctions were located in the anterior circulation lesion (n = 1), in the posterior circulation lesion (n = 2), and in both lesions (n = 1). Intracranial arterial stenosis was only identified in one patient on magnetic resonance angiography. A high plasma d-dimer level was detected in 1 patient, whereas high β-thromboglobulin and platelet factor 4 levels were detected in 2 patients. As a result of combined therapies with acyclovir, steroid, and antithrombotic agents, neurological symptoms markedly improved in 3 patients, whereas 1 patient was left with moderate hemiplegia. Conclusions: Cranial nerve palsies may be prodromal symptoms of VZV-associated stroke. Increased levels of thrombotic markers may support the use of antithrombotic agents, although the benefit of combined treatment should be determined through larger studies.

(-)-Epigallocatechin-3-gallate (EGCG), which is largely found in green tea, is known to eliminate reactive oxygen species and associated inflammatory responses in vitro and in cells. However, the in vivo mechanisms underlying the effects of EGCG on the amelioration of metabolic disorders are not fully understood. In this study, we examined whether dietary supplementation with EGCG reduces inflammatory responses in peripheral leukocytes of a non-obese type 2 diabetes animal model, Goto-Kakizaki (GK) rats. GK rats at 9 wk of age were fed a control high-fat diet (46 energy % from lard and corn oil) or a high-fat diet containing 0.1%, 0.2%, or 0.5% EGCG (w/w) for 25 wk. The oxidative stress markers 8-hydroxydeoxyguanosine (OHdG) and total malondialdehyde (MDA) were reduced by supplementation with EGCG at 0.1%, but not at 0.2% or more. Significant reductions in the mRNA levels of genes related to inflammatory responses (TNF-α, IFN-γ, IL-1β, IL-6, IL-18, MCP-1, CD11b, and S100a6), 8-OHdG, and total MDA were induced in peripheral leukocytes of GK rats by EGCG supplementation at 0.1%, but not at 0.2% or more, compared with rats fed the control diet. The present results suggest that supplementation with a low dose of EGCG reduces oxidative stress and the expressions of genes involved in inflammation in peripheral leukocytes of GK rats.

A 36-year-old man was admitted to our hospital because of urinary retention and muscle weakness affecting all 4 limbs after receiving a H1N1 09 influenza vaccination. Magnetic resonance imaging demonstrated multiple lesions in his brain and spinal cord. Furthermore, nerve conduction study showed acute sensorimotor neuropathy, and anti-GM2 antibodies were detected in his serum. Based on the temporal association and exclusion of alternative etiologies, we made a diagnosis of acute disseminated encephalomyelitis (ADEM) and Guillain-Barré syndrome (GBS). To our knowledge, this is the first case of co-morbid ADEM and GBS after influenza vaccination with positive anti-ganglioside antibodies.

We measured arm movement on the sagittal plane of parietal lobe damaged patients and control subjects. In neurological patients, (1) the hand height did not become lower as the motion duration became shorter; (2) the hand jerk of measured trajectory increased when motion duration lengthened. These results suggested that the parietal lobe is involved with realizing smooth arm movement. The performance of patients with parietal lobe lesions may reflect their difficulties in planning a trajectory with smooth movement.

The purpose of this study was to assess the influence of different reconstruction factors in N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-I-123 iodophenyl)nortropane (I-123 FP-CIT) single-photon emission computed tomography (SPECT) images for the diagnosis of dopaminergic system neurodegeneration (DSND). Seventy-three patients (38 females, 35 males) suspected of DSND were included in this study. The patients were divided into 3 groups on the basis of their final clinical diagnoses; patients with Parkinson disease (group 1, n = 36), patients with other DSND (group 2, n = 19), patients without DSND (group 3, n = 18). FP-CIT accumulation in the striata was evaluated visually and semiquantitatively. SPECT images were classified visually as normal or abnormal based on the previous report. For semiquantitative analysis, we used DaTView software (Aze Corporation), and specific binding ratios (SBR) and asymmetry indices (AI) were calculated. Visual and semiquantitative evaluations for different reconstruction factors were compared among the 3 groups. In the visual evaluation, there were no differences among DSND diagnostic capabilities of attenuation and scatter correction by computed tomography attenuation correction scatter correction, computed tomography attenuation correction, Chang attenuation correction, and non-attenuation and -scatter correction. In the semiquantitative evaluation, receiver operating characteristic analysis of SBR and AI for clinical DSND diagnostic ability (group 1+2 vs 3) showed no significant difference among the reconstruction factors by multiple comparisons. Although the values of SBR and AI were changed and image quality could be improved when attenuation correction and/or scatter correction were applied, the clinical impact of these reconstruction factors for the diagnosis of DSND was negligible.

Background and Purpose —The aim of this study was to investigate the frequency, possible predictive factors, and prognosis of deteriorating ischemic stroke in 4 clinical categories according to the classification of the Oxfordshire Community Stroke Project (OCSP). Methods —A total of 350 patients with first-ever ischemic stroke who presented within 24 hours of onset were enrolled. Based on the OCSP criteria, cerebral infarctions were divided into the following 4 clinical categories: total anterior circulation infarcts (TACI), partial anterior circulation infarcts (PACI), lacunar infarcts (LACI), and posterior circulation infarcts (POCI). Clinical deterioration was defined as a decrease of ≥1 points in the Canadian Neurological Scale (CNS) (in TACI, PACI, and LACI) or Rankin Scale (RS) (in POCI) during 7 days from the onset. In each clinical category, deteriorating (D) and nondeteriorating (ND) patients were compared in terms of their background characteristics, risk factors, vital signs, laboratory data, and cranial CT at the time of hospitalization. The acute-phase mortality and functional outcome were also compared. Results —The subjects comprised 86 patients (24.6%) with TACI, 63 (18.0%) with PACI, 141 (40.3%) with LACI, and 60 (17.1%) with POCI. Overall, 90 patients (25.7%) deteriorated. The frequency was very high in TACI (41.9%), followed by LACI (26.2%) and POCI (21.7%), whereas it was very low in PACI (6.3%). There were some clinical variables that differed significantly between D and ND groups. In the patients with TACI, early abnormalities of the cranial CT and significant stenoses in corresponding arteries were more frequent in the D than the ND group. In those with LACI, the CNS and hematocrit were lower in the D than the ND group. In those with POCI, cerebral atrophy was more severe and significant stenoses in vertebrobasilar arteries were more frequent in the D than ND group. The mortality of the D groups of patients with TACI and POCI exceeded 35%, and the functional outcome was worse in the D group than in the ND group of patients with TACI, LACI, and POCI. Conclusions —The frequency of deterioration in acute ischemic stroke significantly differed among the OCSP subgroups, and deterioration worsened the prognosis. There were some factors that could predict deterioration: early CT findings in TACI, large-artery atherosclerosis in TACI and POCI, and stroke severity in LACI. Further research to find sophisticated radiological and chemical markers appears to be needed.

(-)-Epigallocatechin gallate (EGCG), a major catechin in green tea, is an antioxidant associated with the reduction of oxidative stress in vitro. However, the mechanisms underlying the effects of EGCG on adipose tissue-related metabolic disturbances in vivo are not understood. This study examined whether dietary supplementation of EGCG reduces the oxidative stress-associated inflammatory response in the mesenteric adipose tissue of non-obese type 2 diabetic Goto-Kakizaki (GK) rats. GK rats were fed a normal diet or diet containing 0.1, 0.2, or 0.5% EGCG (w/w) for 25 weeks. The mRNA levels of IL-1β were significantly reduced in GK rats given 0.1% EGCG (0.059 ± 0.008; means ± SEM in arbitrary unit) compared with those in GK rats given a control diet (0.135 ± 0.011), but not in those given 0.2% EGCG (0.123 ± 0.012) or 0.5% EGCG (0.112 ± 0.019). The mRNA and protein level of other genes for inflammatory responses such as IL-18, TNF-α, MCP-1, CD11s, CD18, and resistin were also significantly reduced in rats given 0.1% EGCG, but not in those given ≥ 0.2% EGCG. This suggests that supplementation with EGCG at relatively low concentrations (0.1%) in GK rats reduces expression of genes and proteins involved in inflammation in adipose tissue.

The purpose of this study was to estimate the diagnostic accuracy of 123I-metaiodobenzylguanidine (MIBG) scintigraphy to diagnose Lewy body disease (LBD), including Parkinson’s disease (PD) and dementia with Lewy bodies, and to clarify the relationship between MIBG parameters and the clinical findings. One hundred-and-forty-four patients with parkinsonism without diabetes mellitus or a history of cardiac disease were retrospectively selected in the study. Clinical diagnosis was confirmed by follow-up during more than 6 months by neurologists. All patients underwent MIBG imaging at 15 min (initial) and 4 h (delayed) after the tracer injection, and clinical features such as Hoehn and Yahr (H–Y) classification or symptoms specific to parkinsonism were also investigated. The heart to mediastinum ratio (H/M) and the washout ratio (WR) of MIBG were calculated, and correlation with the clinical features was analyzed. Ninety-seven and 47 patients were diagnosed as LBD and Parkinson’s syndrome (PS), respectively. Initial and delayed H/M were significantly lower and WR was significantly higher in LBD than in PS (p