This study investigated older people living

alone who maintain their health through interactions in activities conducted by community organizations. Method：Data were collected using semi-structured interviews conducted on six older persons who had been living alone for more than a year and participating in community organizing activities. The interviews were recorded, transcribed verbatim, and then qualitatively analyzed using the KJ method. As a result, the following six factors were found to constitute interactions in activities conducted by community organizations. Older people living alone who maintain their health through interactions in activities conducted by community organizations work on?〘Friendly connection with a friend〙and〘Maintenance of a friendly connection〙with having〘Acquisition of a sense of fulfilment and comfort〙．Moreover, they got 〘A sense of relief that I can feel where my heart is〙and〘Cognitively well-controlled everyday life〙，while they experienced 〘Loss of mental and physical space〙．These findings suggest that public health nurses should support individually assessing the physical, mental, and social skills of older people living alone, as well as support health promotion activities conducted by community organizations.

Tumescent local anesthesia can alleviate the burden of varicose vein surgery, while endovenous thermal ablation is a new treatment, and endovenous laser ablation（EVLA）and radiofrequency ablation（RFA）are becoming common due to their recent inclusion in insurance coverage. In this study, surgical outcomes were compared among patients who underwent varicose vein stripping（ST group, 311 patients），EVLA using a laser with wavelengths of 980 nm（980 nm group, 191 patients）and 1470 nm（1470 nm group, 717 patients），and RFA（RF group, 53 patients）．The operation time was significantly longer in the ST group than in the other groups, and pain and bruising were higher in the ST and 980 nm groups. There were no significant differences in the incidences of endovenous heat-induced thrombosis in all groups. Class 3 events were observed in 4 patients in the 1470 nm group, but were improved by oral anticoagulants. Complications of thromboembolism did not occur in any group, and venous recanalization was required in only one patient in the 980 nm group. These results show that 1470 nm EVLA and RFA shortened the operation time and reduced postoperative pain without causing serious complications, which suggests that these procedures are useful for treatment of varicose veins.

In contrast to Ca2+-dependent contraction of vascular smooth muscle（VSM），sphingosylphosphorylcholine（SPC）/ Rho-kinase（ROK）pathway, which induces Ca2+-independent VSM contraction, contributed to abnormal VSM hypercontraction such as vasospasm. After extensive screening of various food-derived components, we found that nobiletin, a citrus flavonoid, which suppressed the SPC-induced

Ca2+-sensitization of VSM contraction with little inhibitory effect on depolarization-induced Ca2+-dependent contraction by 40 mM K+.

Furthermore, in the simultaneous measurement of［Ca2+］i and force, nobiletin inhibited the SPC-induced Ca2+-sensitization of VSM contraction without change of ［Ca2+］i, but had slight effects on 40 mM K+-induced Ca2+-dependent contraction and［Ca2+］i. We previously reported that SPC induced ROK translocation from cytoplasm to cell membrane, and activation of ROK led to the increase in phosphorylation levels of myosin phosphatase target subunit1（MYPT1）and myosin light chain（MLC），suggesting that activation of ROK plays an important role in vasospasm. Nobiletin significantly inhibited the SPC-induced phosphorylation levels of MYPT1

and MLC. These results suggest that nobiletin is

a promising candidate for novel therapeutic drug target for abnormal VSM contraction leading to vasospasm.

［Background and purpose］

Paroxysmal sympathetic hyperactivity（PSH）is a syndrome characterized by paroxysmal hyper-activation of sympathetic system which can manifest as tachycardia, high blood pressure, hyperventilation, hyperthermia, perspiration, and excessive muscle rigidity. In this study, we examined the actual state of the PSH following traumatic brain injury（TBI）as there were few reports of PSH associated with TBI.

［Clinical cases and method］

Ninety-seven patients with TBI were included

in this study. PSH was diagnosed according to the criteria reported by Baguley et al. In order to verify factors for developing PSH, and factors influencing outcome three months after injury,

we analyzed epidemiologic, physiological and biochemical data, and images of computed tomography scan.

［Results and interpretation］

Eleven patients were identified as having PSH, and incidence was 11.3%. PSH was significantly frequent in young, severe patients, and in those with focal injury. Multivariate analysis clarified that severity of TBI, PSH, and diffuse injury significantly and independently influenced poor prognosis after injury. The results suggest that

we may expect better outcomes if we find and treat PSH in the early stage following injury even in serious TBI cases.

Rho-kinase-mediated Ca2+-independent vascular abnormal contraction causes cerebral vasospasm after subarachnoid hemorrhage and vasospastic angina. We identified sphingosylphosphorylcholine（SPC）as the key molecule of Ca2+-independent contraction. The ideal condition for the

therapeutic agent for cerebral vasospasm is to specifically inhibit Ca2+-independent contraction without affecting Ca2+-dependent one. We found the ideal drug eicosapentaenoic acid（EPA），while EPA also suppressed vasospasm after subarachnoid hemorrhage clinically. However, lipophilic EPA can’t be administered intravenously. In this way, it’s urgent to find a new water-soluble compound.

We screened plant-derived compounds and focused on flavonoids, acacetin and biochanin A. Acacetin slightly inhibited 40 mM K+-induced contraction in porcine coronary vascular smooth muscle strips, but inhibited SPC-induced contraction fast and strongly. In contrast, biochanin A inhibited 40 mM K+-induced contraction more strongly than SPC-induced contraction. Both acacetin and biochanin A strongly inhibited SPC-induced Rho-kinase activation and myosin light chain

phosphorylation. The morphological changes induced by SPC in human coronary smooth

muscle cells were inhibited by acacetin and biochanin A.

In summary, the difference in the position of the phenyl group is involved in the inhibitory effect

on SPC-induced abnormal contraction in post administration.

A 38-year-old man was referred to our hospital for detailed examination of a gastric polyp which was suspected to be early gastric cancer. Esophagogastroduodenoscopy revealed a semipedunculated polyp in the fornix. The shape of the polyp was like a raspberry. There was no atrophy of the gastric mucosa, and anti-Helicobacter pylori antibody was negative. Strip biopsy was performed, pathological examination showed that the lesion was a foveolar-type gastric adenocarcinoma. Complete en bloc resection was achieved, in accordance with the current

Japanese guidelines. Raspberry-like foveolar-type gastric adenocarcinomas have been found as intramucosal carcinoma of a few millimeters in size and is a good indication for strip biopsy. We reported a case of foveolar-type gastric adenocarcinoma resected by strip biopsy with a review of the literature.