Koritsu-shi (solitary death) refers to cases of death in which the deceased was living in a one-person household. In Japan, koritsu-shi cases have received significant attention as a major social problem because the aging population has led to an increase in single-person households. However, because the definition of koritsu-shi is unclear and carrying out a national level survey of households where the occupant has died is difficult, the actual situation surrounding koritsu-shi has not been elucidated. As koritsu-shi is legally treated as an unnatural death, statistics on koritsu-shi have been reported in many areas (Tokyo, Osaka, Kobe) under the medical examiner system. Of these areas, statistics from the Tokyo ward area have revealed the most information and show that the proportion of unnatural deaths involving koritsu-shi has been increasing year after year, with 36% of cases being koritsu-shi in 2016. Each year showed that koritsu-shi was higher in men than women. Although the deceased were predominantly male in cases of middle-aged koritsu-shi, both sexes are affected more evenly in single-elderly cases. However, the overall incidence was higher in men when the numbers of middle aged and elderly people are tallied against the higher numbers of elderly women. In men, the characteristic cause of death is chronic alcoholic liver injury with other cases mostly being categorized as unknown due to postmortem damage. Even within the densely populated Tokyo ward area, spatial clustering was detected with regard to the incidence of koritsu-shi per ward. There are many points that are consistent between reports of koritsu-shi in the Tokyo ward area and other areas. However, it is not easy to compare results among different regions due to the unclear definition of koritsu-shi and insufficient bias exclusion. Koritsu-shi cases are expected to increase in Japan in the future. Future efforts should focus on finding the deceased as soon as possible after death, or even pursuing the possibility of preventing koritsu-shi in cases when an individual living in a one-person household suddenly collapses at home. In addition, to reduce the effect of loneliness and social isolation among those living in single-person households to improve health outcomes, it is important that medicine and public health efforts address the problem of koritsu-shi.

Before dabigatran was introduced in 2011, vitamin K antagonist was for nearly 50 years the only oral anticoagulant available. Including dabigatran, there are now four non-vitamin K antagonist direct oral anticoagulants (DOACs), which has greatly increased treatment options. However, the increased number of options has led to some confusion in the selection of appropriate anticoagulants in specific cases. In this paper, we outline the characteristics of each individual DOAC on the basis of recent reports.

Autoimmune hepatitis (AIH) is a progressive inflammatory liver disorder characterized by serologically elevated transaminase levels, increased levels of immunoglobulin G (IgG), and the presence of autoantibodies. AIH in childhood often presents acutely, and the incidence of cirrhosis at the time of diagnosis is higher in children than in adults. We report a case of AIH treated with methylprednisolone (mPSL) pulse therapy in a 15-year-old boy. The patient was referred to our hospital due to transaminitis without subjective symptoms. He did not have a family history of hepatitis or autoimmune disease, and was generally in good condition. Laboratory examinations revealed transaminitis and hyperphosphatasemia, and elevated levels of serum IgG. Tests for serum anti-nuclear antibody (ANA) and anti-smooth muscle antibody were both positive. Screens for viral hepatitis, drug-induced liver injury, and metabolic diseases such as Wilson disease were negative. Liver biopsy showed portal and periportal lymphocyte and interface hepatitis. There were no bile duct changes. Conventional treatment of AIH in childhood consists of prednisolone (1-2 mg/kg/day), and the remission rate is high. However, relapse during treatment is common. In response to relapse, the dosage is increased and the treatment period is extended, which can lead to the characteristic side effects of corticosteroids. Compared to conventional treatment of pediatric AIH, mPSL pulse therapy is reported not only to normalize aminotransferase in a shorter time span, but also to reduce the side effects of corticosteroids. In our patient, one course of mPSL pulse therapy was selected, because the patient and his family hoped for a shorter period of hospitalization. The patient was hospitalized for only 8 days, and his levels of serum aminotransferase, IgG, and ANA quickly improved. Apart from the already high rates of cirrhosis at diagnosis and relapse during treatment, AIH in childhood also often presents with complications of overlap syndrome, which can lead to a worse prognosis. It is important that both pediatricians and physicians cooperate during transitions of care.

Background: We have observed that patients with restricted thumb opposition sometimes develop dysfunction of the intrinsic muscles around the metacarpal joint of the middle finger. Therefore, we developed a middle finger abduction exercise program which focuses on improvement of intrinsic muscle function during post-operative rehabilitation after thumb carpometacarpal arthroplasty. We report on the efficacy of the program herein.

Methods: Three patients with Eaton stage III-IV thumb carpometacarpal arthritis were included in the study. The effects of the exercise program were recorded. Ultrasonography and surface electromyography were used to evaluate the effects of the exercise in two healthy volunteers.

Results: Five minutes of exercise resulted in a 1- to 2-point improvement in the Kapandji opposition score, and a 1- to 3-cm improvement in thumb opposition to the base of the small finger. Ultrasonography and electromyography revealed that adductor pollicis, abductor pollicis brevis, opponens pollicis, and abductor digiti minimi contractions became more synchronous.

Conclusion: Our middle finger abduction exercise program improves thumb opposition significantly. The program may be particularly useful for post-operative rehabilitation after thumb surgeries: thumb opposition can be improved without thumb motion, which can be painful in the early post-operative period.