Depression is found in about 40% of patients with Parkinson's disease (PD). The main characteristics of depression in PD is inability to experience pleasure, however, the symptoms such as severe anxiety, suicidal idea, daily fluctuation of mood, depression associated hallucination and delusion are relatively rare. In more than half of these patients, the cause of depression is closely linked the pathophysiology of PD itself. The feature of depression in PD is limited and is equivalent for the words of anhedonia/apathy, although the feature of "depression" is also occasionally found in PD. Indeed, recent studies suggested the features of depression, apathy (anhedonia) and dementia were independent in PD. As the mechanism of anhedonia/apathy in PD, the disturbance of acetylcholine and other monoamine system such as noradrenaline as well as dopaminergic system is indicated. The dopamine system that concerns with anhedonia/apathy is considered to be originated from ventral tegmental area in the midbrain project to nucleus accumbens, amygdala and mesolimbic system. Malfunction of these neurons cause the inactivation of emotion and motivation as the disruption of frontostriatal circuits, and this is related to the anhedonia/apathy in PD. Moreover, recent studies have shown that the dysfunction of amygdala and the disruption of its connectivity in the brain is suggested to the etiology of depression in PD. In the treatment of depression, at first, the sufficient medication for motor symptoms is needed, because depression in PD is linked the pathophysiology of PD. In the next step, anti-depressants are used. Some dopamine agonist such as pramipexole is also effective.
In Japan, urinary screening for 3-year-old children has been obligatory since 1961. The system was reconsidered and has been under review since 2012 by The Japanese Society for Pediatric Nephrology. In the process, the following were analyzed: (i) frequency of urinary abnormalities identified on screening; (ii) diseases identified from urinary abnormalities; (iii) clinical course of children found to have urinary abnormalities; and (iv) screening for asymptomatic urinary tract infection (UTI) as a way of screening for congenital anomalies of the kidney and urinary tract. A computerized literature search was conducted, and study reports issued by the Ministry of Health, Labour and Welfare study group, and data of Akita and Chiba City were reviewed. The prevalence of abnormal results at the first urinalysis was high, but at the second urinalysis the prevalence decreased in the range 1/6~1/20. The prevalence of tentative diagnosis at the third urinalysis was almost identical to the school urinary screening results. Serious illness was not found in children who had hematuria alone. In contrast, diseases requiring immediate attention were found in children with proteinuria, although the prevalence of proteinuria was not high. The dipstick method for leukocyturia was inefficient. The importance of two consecutive urinalyses before detailed examination, the lack of usefulness of screening for hematuria in 3-year-old children, and the importance of proteinuria were confirmed. Screening for asymptomatic UTI using urinary leukocytes was very inefficient.
Due to advances in minimally-invasive surgical treatment, diseases that have conventionally required hospitalization, can now be treated in same day surgery. Among such treatments, same day inguinal hernioplasty is now the worldwide gold standard. Due to the National Health Insurance (NHI) point system, however, such day surgery is not yet standard in Japan. In our clinic, day surgery for inguinal hernia has been performed for 873 patients since 2014, with favorable outcomes. It is extremely important to perform under balanced anesthesia, and to occlude the hernia orifice with a minimum delamination procedure due to the surgical techniques necessary for safe day surgery. Day surgery is less-invasive and low in cost with many benefits for busy modern people who have a difficulty in taking off work. We should further improve surgical techniques to continuously perform such a minimally invasive the day surgery in the future.