In this study, two male patients were complicated by malignant diseases, hepatoma and lung cancer, after the diagnosis with RS3PE syndrome. Since two patients who complicated with malignant diseases (hepatoma and lung cancer) were excluded from this study because malignant diseases might affect the clinical course of PMR and RS3PE syndrome, 24 patients were included in this study.After the diagnosis, all patients were treated with initial dosages of 10 -20 mg per day oral prednisolone according to 2015 Recommendations for the management of PMR (11). Clinical assessments included symptoms and the measurement of serum CRP by standard laboratory methods because elevated levels of CRP are common in patients with PMR and RS3PE syndrome (12). Visits were scheduled every 2 to 4 weeks, and at each visit the dosage of prednisolone was tapered by a tapering schedule of 1 to 2.5 mg reduction when no specific symptoms were complained and CRP was normal or nearly normal. Prednisolone free remission was defined as the absence of clinical symptoms and normal levels of CRP with discontinuation of any drugs which control the diseases including corticosteroids. A relapse was defined as an aggravation or reappearance of clinical symptoms associated with an elevated CRP. If the disease activity relapsed after dose tapering, the prednisolone was increased to dosages related to the disease requiring.

Introduction] The purpose of this study was to investigate the differences in the preference of enteral tube feeding between elderly inhabitants of Mugi town, Tokushima Prefecture, Japan, and their parents in various physical conditions. [Methods] This population-based questionnaire survey studied 300 randomly selected participants aged 65-80 years. Respondents were to consider a situation where eating was difficult, and were questioned on their desire for tube feeding, using a visual analogue scale (VAS) ranging from "do not want tube feeding (0)" to "want tube feeding (100)." [Results] Valid responses of 103 (34.4%) participants were analyzed. Under conditions of being "healthy," "bedridden," "with dementia," and "bedridden and with dementia," the median (IQR) of the VAS values for the desire for tube feeding were 31.8 (3.3 to 83.8), 19.3 (2.4 to 52.3), 5.2 (0.7 to 18.9), 4.0 (0.3 to 15.2) for respondents and 55.2 (11.6 to 92.2), 48.7 (5.5 to 85.5), 9.0 (1.2 to 46.8), 5.1 (0.1 to 36.5) for parents, respectively. The VAS values for the parents were significantly higher (p=0.001, 0.002, 0.001, and 0.01, respectively for the four conditions described) for the same items. [Conclusion] Surrogate decisions made by family members often differ from what the patients would have desired.

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Geographic maldistribution of physicians is a serious problem in Japan, resulting in a few physicians in remote areas. We distributed questionnaires to 396 medical students at Tokushima University from 2013 to 2016. We examined the intensity of medical students toward medicine in remote areas by using a visual analog scale and investigated what medical specialty they chose after two years of clinical training. The intensity of interest in medicine and the intensity of willingness to contribute to it in remote areas were statistically higher among medical students who intended to choose general medicine. After graduation, only five participants chose to specialize in general medicine. Of the 14 medical students who originally chose general medicine, six chose internal medicine, three chose general medicine, and the others chose surgery, neurosurgery, anesthesiology, orthopedics, or emergency medicine. This study demonstrated that medical students who intend to choose general medicine have a higher intensity of willingness to contribute to medicine in remote areas, indicating that the support program for these students to become general practitioners after graduation increases the number of physicians in remote areas.