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We report on a 44-year-old woman who was diagnosed with toxic epidermal necrolysis (TEN) during the recovery phase from autoimmune limbic encephalitis with anti-glutamate receptor antibodies. Both, autoimmune limbic encephalitis and TEN are very rare diseases. The co-existence of the two diseases has not yet been reported. We speculate that the total of 18 drugs needed for the treatment of encephalitis might have increased the risk of TEN. Similar reports would be required to elucidate the pathophysiology of the co-existence.

Dialysis patients often develop constipation and changes in intestinal bacterial flora. Indoxylsulfuric acid (IS) levels rise as glomerular filtration decreases, and patients with renal failure have high IS. Elevated IS is also caused by increased indole due to altered intestinal flora (Takayama et al, Am J Kidney Dis. 2003). We investigated whether administering partially hydrolyzed guar gum (PHGG) (Sunfiber: a product of Taiyokagaku Co., Ltd., Japan) ameliorates constipation and improves nutritional status in dialysis patients, while decreasing IS levels. Thirty-five patients on maintenance dialysis (mean age, 71 ± 9; male/female= 22/13) ingested PHGG (10 g/day) for 6 weeks. Defecation was scored before and after PHGG intake using a modified Constipation Assessment Scale-Long Term (Japanese version). Nutritional status was rated according to the Geriatric Nutritional Risk Index (GNRI) before and after PHGG intake. IS was measured in 8 patients taking PHGG orally for 24 weeks, for comparison with those in 8 patients not on PHGG. Constipation scores decreased from 7.9 to 5.0 (p 〈.01) and GNRI increased from 95.0 ± 5.0 to 95.9 ± 5.7 (p 〈.05), reflecting amelioration of constipation and improved nutritional status. The ratio of IS after to that before PHGG intake was calculated to analyze the magnitude of IS change. The ratio in patients not on PHGG was 1.2 ± 0.3, i.e. IS rose, while that in patients taking PHGG was significantly reduced (0.8 ± 0.3, p 〈.05). Our results indicate PHGG consumption to ameliorate constipation and improve nutritional status, and that continued intake reduces IS, in dialysis patients.

Background In recent years, various psychological interventions have garnered attention as effective support methods to promote self-management and comprehensively understand those with physical and psychological problems associated with knee pain. The purpose of this study was to implement an instructional design (ID) based self-management program for outpatients diagnosed with KOA and to verify the effectiveness of the program. Methods In this single-arm uncontrolled before-after comparative intervention study, 41 subjects diagnosed with symptomatic knee osteoarthritis participated in an intervention program. Their pain, physical function, self-efficacy, self-care agency, and daily life difficulties were evaluated. A mixed-effects model was employed to examine the changes in each outcome from baseline to immediately before and after the intervention, and after one, three, and six months. Results "Pain at the beginning of walking," "pain from standing to sitting position," and "pain after longdistance walking" reduced significantly immediately after the intervention and after one month. "Pain when climbing stairs" reduced significantly immediately after the intervention and after one, three, and six months. The sit-to-stand test showed significant improvement from baseline to immediately after and one, three, and six months after the intervention. Self-care agency scores improved significantly immediately after the intervention and after one and six months. Conclusion The intervention program effectively improved physical function, self-care agency, and selfefficacy, and reduced pain from one to six months. Innovation: This program could lead to an increase in the healthy life expectancy of the older adults. [ABSTRACT FROM AUTHOR]

Background Maintaining physical activity is important for older adults. "Self-care agency" is the ability to perform self-care, which is defined as people following their own will, managing themselves, and maintaining activities. We investigated the relationship among physical activity and self-care agency, demographic factors and physical condition in older adults. Methods Self-care agency was assessed by using the Self-Care Agency Questionnaire developed for Japanese patients with chronic diseases. Among 175 older adults aged 65 years or older living in a rural area, responses from 83 who performed physical activities were analyzed. Correspondence analysis was conducted to characterize demographic factors and self-care agency. Results A higher proportion of women than men were engaged in physical activity. Irrespective of age and sex, many of the participants performed stretching exercises, walking, radio exercises, TV exercises, and participated in community circles. Participants who engaged in physical activities had significantly higher selfcare agency scores than inactive participants. Among the active participants, the self-care agency score was significantly higher for women than men (P = .04) and was also significantly higher for participants aged ≥ 75 years compared to those aged < 75 years. Individuals with a high self-care agency tended to participate in local programs and perform brief physical activities at home. Conclusion Physically active older adults demonstrated high self-care agency. Their activities were easily carried out in their daily lives, with activities varying by age and sex. Support from community health experts is needed to promote suitable physical activity among older adults tailored for age and sex, especially among older adults who have low self-care agency. [ABSTRACT FROM AUTHOR]

Background Self-care agency is an important determinant of self-care behavior. The purpose of this study was to identify the causal relationship between self-care agency and healthy behavior, and to construct a conceptual model of healthy behavior among older people living in a rural community. Methods This study was conducted as a crosssectional survey at the Hino, a town in western Tottori Prefecture, Japan. Participants who were enrolled in the Good Ageing and Intervention against Nursing Care and Activity Decline (GAINA) study from 2014 to 2018 (467 new participants) were initially investigated. Of 398 participants aged = 65 years, 5 were excluded due to missing data, and thus 393 were analyzed. Nurse researchers conducted face-to-face interviews with participants to check the accuracy of data obtained from a selfadministered questionnaire, which included demographic information, physical condition (comorbidities, knee pain, low back pain, and locomotive syndrome), healthy behavior, and self-care agency. Correlations among variables were investigated by Pearson's correlation coefficient analysis, and path analysis was performed to assess causal relationships. Results A total of 393 persons (160 men and 233 women) were investigated, ranging in age from 65 to 92 years, with a mean age of 75.1 years (SD: 6.9 years). Path analysis revealed poor fit of a model in which pain and locomotive syndrome were factors inhibiting healthy behavior. When the model included only self-care agency, the indices of model fit were almost satisfactory (Goodness-of-fit index = 0.967, Adjusted goodnessof- fit index = 0.900, Comparative fit index = 0.951, and Root mean square error of approximation = 0.088), and the coefficient of determination (R2) was 0.38. The selfcare agency items with the greatest influence on healthy behavior were the ability to "grasp the techniques/tips needed to maintain health," and the ability to "persist with healthy behavior.". Conclusion Self-care agency can promote healthy behavior among community-dwelling older people. Regardless of physical problems such as pain and locomotive syndrome, older people have the potential to adopt positive healthy behavior if they acquire self-care agency. [ABSTRACT FROM AUTHOR]

Scleredema adultorum, also known as scleredema of Buschke, is a rare connective tissue disease with unknown etiology, which is characterized by diff use skin induration of face, neck, upper chest, back, shoulders and arms. Although there is no established treatment for this disease, the efficacy of phototherapy has been reported. We herein describe a case of scleredema adultorum successfully treated with narrow-band ultraviolet B and discuss a potential mechanism explaining its efficacy for fibrotic skin diseases. [ABSTRACT FROM AUTHOR]