Background : Most surveys regarding excessive daytime sleepiness (EDS) in university students have used only questionnaires. The present study was performed to clarify the causes of EDS and the characteristics of students with EDS using a sleep diary, polysomnography (PSG), and multiple sleep latency testing (MSLT) in addition to questionnaires.
Methods : Medical students with and without EDS were recruited using a poster. EDS was defined as Japanese Epworth Sleepiness Scale score ≥ 11, and all participants underwent PSG and MSLT. They were also asked to record a sleep diary for 1 month and to complete the Japanese version of the Pittsburgh Sleep Quality Index, the Sleep Hygiene Index, and lifestyle questionnaires. Sleep disorders were diagnosed based on the International Classification of Sleep Disorders, and the characteristics were compared between students with and without EDS.
Results : Among the 59 students who participated in the study, 33 were classified as having EDS and the remaining 26 did not have EDS. In the EDS group, 16 students were diagnosed with insufficient sleep syndrome (ISS), six had narcolepsy, five had insomnia, three had idiopathic hypersomnia, one had delayed sleep-wake phase disorder, one had obstructive sleep apnea, and one had periodic limb movement disorder. The questionnaires revealed that the most important factor for EDS was poor sleep hygiene due to their lifestyle.
Conclusion : The survey including PSG and MSLT revealed that approximately half of the medical students with EDS showed ISS followed by narcolepsy, insomnia, and other sleep disorders, and the main characteristic of the students with EDS was poor sleep hygiene.

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Aim : The prognostic impact of frailty in patients with heart failure (HF) is of interest because the cascade of frailty and HF accelerates deterioration. However, few studies have examined the deterioration of frailty in older HF patients. Therefore, we examined changes in frailty and death within six months after discharge from the hospital to clarify the reasons for the poor prognoses and to explore risk factors that influence each of them.
Methods : This was a single-center prospective cohort study of hospitalized HF patients aged 80≧ years. Frailty was measured using the Clinical Frailty Scale (CFS). Reasons for poor prognosis were examined, and discharge attributes were compared between the CFS worsening and death groups and the CFS maintaining/improving group at six months after discharge.
Results : The subjects consisted of 96 patients (89.3±4.6 years), and their CFS at six months was that 68 had improved or maintained, 12 had worsened, 14 had died, and two were missing. Reasons for worsening frailty included worsening cardiovascular disease and comorbidities, fall fracture, and dementia. Risk factors that could influence mortality (e.g., BNP, hemoglobin, CFS) were similar to previous studies, and few risk factors were found that could influence frailty deterioration (e.g., ACE-I/ARB not prescribed).
Conclusions : Some older HF patients experience worsening of frailty and death after hospital discharge. However, the potential factors associated with frailty deterioration are unknown, suggesting that treatment and care approaches should be tailored to individual conditions such as cardiovascular diseases, comorbidities, fall risk, and dementia.

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Reminiscence is a non-pharmacological intervention that involves a narrative and reflective process of recalling past thoughts, feelings, and experiences. The positive effects of reminiscence intervention for cognitively intact older people have been reported ; however, the physiological mechanisms underlying the effect on the frontal lobe during and after the reminiscence are not well understood. We have demonstrated increased oxygenated hemoglobin concentrations in the right frontal lobe and decreased deoxygenated hemoglobin concentrations in both the frontal lobes during reminiscence in cognitively intact older participants using near-infrared spectroscopy. Furthermore, the mood state of older participants was evaluated using Profile of Mood States and increased subjective health perception scores and showed a significant improvement following reminiscence compared with pre-reminiscence. Reminiscence-based intervention activated the frontal lobe and provoked positive emotion in the mood state and health perception in cognitively intact older participants. These findings may improve treatment strategies of older adults for better quality of life.

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We herein describe the treatment of a patient who suffered temporal bone osteomyelitis after multiple craniotomies and gamma knife irradiation procedures. A 61-year-old woman exhibited an epidural abscess between the sequestrated autologous temporal bone graft and the artificial dura on computed tomography 3 years after three craniotomies including two sessions of gamma knife irradiation. For treatment, debridement of the bone graft and artificial dura, dural reconstruction with fascia lata, cranial hard tissue reconstruction with titanium mesh, and soft tissue and skin reconstruction with a free latissimus dorsi muscle flap were all performed in one procedure. We were able to successfully perform one-stage hard and soft tissue cranial reconstruction while controlling infection by the contribution of well-vascularized flap tissue and obtained good surgical results.

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