Our neuropathological studies on amyotrophic lateral sclerosis (ALS), especially about Bunina bodies, fragmentation of Golgi apparatus and cortical ubiquitin-positive and tau-negative neuronal inclusions, are reviewed in this paper. Bunina bodies, which are small eosinophilic intraneuronal inclusions in the remaining lower motor neurons, are generally considered to be a specific pathologic hallmark of ALS. At present, only three proteins (cystatin C, transferrin and peripherin) have been shown to be present in Bunina bodies. Fragmentation of Golgi apparatus was frequently observed in neurons containing Bunina bodies and TDP-43 positive inclusions. In 1991, new ubiquitin-positive and tau-negative inclusions were first reported in extra-motor neurons of hippocampal granular cell layers and frontal and temporal cortices. These inclusions were more frequently observed in ALS patients with dementia. In 2006, TDP-43 has been identified as a major component of the inclusions.

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A central problem in clinical psychiatry is that in the absence of objective diagnostic biomarkers for mental disorders, psychiatrists depend on subjective examinations in order to properly diagnose their patients. Many researchers have studied genetics and investigated objective tools such as magnetic resonance imaging for use as diagnostic markers to aid subjective examinations. None of these findings, however, have been replicated consistently enough to merit widespread clinical use.
In this article, I would like to describe briefly the trajectory of my life's work from cancer research to biomarker research for mental disorders, seeking for developing technical innovation in the practice of medical psychiatry. It was the excellent advance in psychiatric practice that a Near Infrared Spectroscopy (NIRS) technique has been exclusively approved by the Ministry of Health, Labour and Welfare as one of dozens of the Advanced Medical Technology to assist in the differential diagnoses of depressive states. However, a search for more essential biomarkers should be continued, to offer better care to people with mental-health problems.

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Objective : To determine the impact of an intervention in which a child's urinary cotinine value is told to smoking family members on stage of behavioral change for smoking cessation, and to investigate factors that contribute to the progression of stage of behavioral change among smoking family members. Methods : Participants were smoking family members of children enrolled at five kindergartens in two cities in Japan between December 2009 and January 2011. The stage of behavioral change before and after the intervention and related variables were measured by self-administered questionnaires. Statistical analyses were performed using the Wilcoxon signed-rank test and multivariate logistic regression analysis. Results : Valid responses were obtained from 110 participants in 101 households. Before the intervention, 39 participants (35.5%) were in the first half of the pre-contemplation stage, 53 participants (48.2%) were in the latter half of the pre-contemplation stage, 18 participants (16.4%) were in the contemplation stage, and no participants (0.0%) were in the preparation stage. A significant difference in stage of behavioral change was found before and after the intervention (z=-3.350, p=0.001). The stage of change progressed after the intervention. The lower the stage of behavioral change for smoking cessation before the intervention (odds ratio [OR] 11.90, 95% confidence interval [CI] 2.24-63.30, p<0.01) or the higher a parent's anxiety regarding the children's health (OR 4.23, 95%CI 1.34-13.30, p<0.05), the more the intervention led to a progression in the stage of behavioral change. Conclusion : A biochemical feedback intervention for smoking family members who are in the first half of the pre-contemplation stage could lead to progress in the stage of behavioral change among smokers, and this progress might lead to an increase in the number of quitters.

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Background & Aims : The aim of the present study was to verify the impact of progressive muscle relaxation (PMR) in combination with breathing technique (breathing PMR) on self-control for stress management in patients undergoing treatment for type 2 diabetes mellitus. Methods : Twenty-four patients participated and were followed during a 2-month pre-intervention (baseline) period and a 6-month intervention period. Changes in salivary amylase concentration, blood pressure, heart rate, HbA1c level, and objective indices including relaxation scales, coping behavior scales, and mental health patterns extracted from semi-structured interviews were assessed before and after the interventions. Results : There were significant differences in the physical indices (salivary amylase concentration, blood pressure, heart rate) and relaxation scales between the pre-intervention and post-intervention periods (p<0.05-0.01). The HbA1c levels during intervention were stable in a better range compared with those of previous year (p<0.05-0.01). Subjective indices including coping behavior scales, mental health patterns, and other complaints tended to improve during concomitant breathing PMR. Conclusions : Continuous breathing PMR during treatment for type 2 diabetes mellitus may improve self-control and stress management.

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A 63 year-old female with past histories of diabetic nephropathy and unilateral nephrectomy for renal cell carcinoma was transferred to our hospital. Edema was observed in her whole body and arterial blood gas analysis showed metabolic acidosis (pH 7.247, base excess -12.3mmol/L). White blood cell counts and c-reactive protein were also increased. Chest X-ray and computed tomography showed pleural and pericardial effusion. Noninvasive positive pressure ventilation (NPPV) and renal replacement therapy (RRT) were introduced after admission. Left thoracic drainage was performed on the 3^rd day and the pleural effusion was exudative with no bacteria and no malignancy. Both her blood culture and autologous antibodies were also negative. The pleural and pericardial effusion decreased and her general condition and inflammatory parameters gradually improved as RRT was continued. NPPV was removed on the 4^th day, and she was transferred to the previous hospital on the 8^th day. It was supposed that the cause of this course was uremic pleuritis because her pleural effusion was exudative and her condition was improved by repeated RRT. We should pay attention to this disease because it can develop in any phase of renal failure.

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A 39-year-old male was admitted to our hospital due to an attack of gallbladder stones. He complained of poorly controlled diabetes and obesity. Elective cholecystectomy was planned, and a low carbohydrate diet during the perioperative period was recommended. His hemoglobin A1c (HbA1c) was improved from 8.5% (JDS) to 5.6% and his bodyweight was decreased from 97 kg to 88 kg during the 2.5-month interval. We were able to safely perform cholecystectomy. A low carbohydrate diet seems to be safe and effective for improving the condition of patients prior to surgery. Physicians should advise obese patients with diabetes to follow a low carbohydrate diet during the perioperative period, because it can have dramatic effects on the body weight and glycemic control.

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A 52-year-old woman underwent partial mastectomy and axillary lymph-node dissection three years ago. The pathological diagnosis was papillotubular carcinoma and no metastases were found in axillary lymph nodes. Recently, the patient complained of general fatigue, appetite loss and lumbago, and consulted another hospital. Laboratory tests revealed hypercalcemia. CT showed para-aortic lymphadenopathy. The patient was transferred to our hospital. Because of para-aortic lymphadenopathy and the high level of soluble interleukin-2 receptor in serum, we suspected malignant lymphoma. After hypercalcemia was improved following administration of zoledronic acid hydrate and elcatonin, the patient was transferred to the department of hematology in another hospital. By cervical lymph node biopsy, the diagnosis was a CD5-positive diffuse large B-cell lymphoma. The patient was treated with chemotherapy, but died seven months later.

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We herein report on a very rare case of primary accessory breast carcinoma in the axilla of a male. A 64-year-old man was admitted to our hospital for treatment of an axillary tumor, measuring 13×13×11 cm in the right axillary area. Core needle biopsy revealed invasive adenocarcinoma. Immunohistochemical findings for tumor cells were positive for both ER and PgR positive and Her 2, CK5/6, CEA, EGFR were negative. CT, MRI and FDG-PET/CT examinations showed neither tumors in any other organ nor apparent lymph node swelling in the right axillary area. We suspected an accessory breast cancer or lymph node involvement from occult breast cancer. The patient underwent a mastectomy with axillary lymph node dissection. Phathological findings of the resected mass was a low grade adenocarcinoma with tubular formation. After surgery, FEC₁₀₀×4 and weekly pacritaxel×12 followed by tamoxifen was performed as adjuvant therapy. There has been no evidence of recurrence for 8 months after the surgery.

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A 33-year-old male underwent the outpatient surgery for an anal fistula in a surgical clinic. High fever (40°C) and severe buttock pain occurred on the second postoperative day, and an antibacterial medicine was administered to him by an internist. However, his buttock pain and physical status gradually got worse, and he was admitted to another hospital on the fifth postoperative day. Despite antibacterial therapy, he developed shock on the same day, and was referred to our hospital. Laboratory data performed on arrival showed disseminated intravascular coagulation and multiple organ failure caused by septic shock. He died about 9 hours after the arrival to our hospital although we provided intensive care to him, including circulatory assist such as intra-aortic balloon pumping and percutaneous cardiopulmonary support to him.
This is the first report of severe toxic streptococcal syndrome following surgery for an anal fistula. It is important to prevent postoperative infection even in a minor operation such as anal fistula.

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A 86-year-old male was admitted to our hospital due to anemia and elevation of tumor marker. Computed tomography (CT) and colonoscopy showed sigmoid colon cancer. He complained of poorly controlled diabetes and obesity. Elective sigmoidectomy was planned, and a low carbohydrate diet during the perioperative period was recommended. His hemoglobin A1c (HbA1c) was improved from 8.4% (NGSP) to 6.1% and his bodyweight was decreased from 57 kg to 50 kg during the 2 month interval. We were able to perform sigmoidectomy safely. A low carbohydrate diet seems to be safe and effective for improving the condition of patients prior to surgery. Physicians should advise obese patients with diabetes to follow a low carbohydrate diet during the perioperative period, because it can have dramatic effects on the body weight and glycemic control.

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The aging society is rapidly growing in Japan, and more elderly patients are requiring medical treatment. However, elderly patients are often unable to undergo the same medical treatments as younger patients. Palliative care is offered for even benign illnesses in elderly patients in our department after considering the patient's condition and background. Such medical treatment is called "silver care." We herein present cases of "silver care" and propose the philosophy of "silver care" as a future medical treatment in Japan.

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Surgeons should perform all operations safely and seek to improve surgical procedures. The Alexis device is useful for preventing surgical site infection and maintaining the operative field. We use the Alexis retractor to hold the gastric wall (double retractor method) and esophagus hiatus in order to obtain a good operative field. This report describes one of the applied methods for using the Alexis device.

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In this study, we investigated the health-related quality of life (QOL) in home care patients with intractable neurological diseases (IND) to clarify the factors correlated with the health-related QOL. We administered a questionnaire to 43 study subjects (home care patients with IND and their family members), who consented to study participation. The health-related QOL was evaluated with the MOS 36-Item Short-Form Health Survey (SF-36). Concerning the factors correlated with the health-related QOL, we used the Barthel Index (BI), Frenchay Activities Index (FAI), and Nottingham Adjustment Scale Japanese Version (NAS-J) to assess basic ADL, instrumental ADL, and psychological adjustment, respectively. The SF-36 subscales of physical functioning, role physical, role emotional, and social functioning were positively correlated with both BI and FAI scores, and all of the SF-36 subscales with NAS-J subscale scores. Thus, the health-related QOL of home care patients with IND was correlated not only with basic and instrumental ADL, but also psychological adjustment.

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Objectives : This is to study how we can provide desirable guidance to Indonesian nurses who came to Japan and acquired the certificate based on the EPA. Subject & Method : We review the job descriptions of nurses working at public health centers in a certain region of Indonesia and some findings of a survey conducted on EPA nurses in comparison with Japan's guideline for training new graduate nurses. Results : At health centers in Indonesia, care services such as assistance with eating and toileting for hospitalized patients are left to their family members. Emergency drills are not incorporated. Of the EPA nurses, 27.3% have no experience of meal assistance. As for incident reporting which is one of the first year goals in Japan, 24.2% EPA nurses have had no such opportunities in Indonesia. As far as disaster prevention is concerned, 69.7% of them have no experience at all. Conclusion : It is apparently necessary to give guidance particularly on rehabilitation assistance, incident reporting and disaster control.

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