Tokushima Prefecture is at risk of natural disasters including heavy rain, flooding, and high tides, but the greatest concern is a Nankai Trough earthquake.　The probability of a Nankai Trough earthquake occurring within the next 30 years is estimated to be around 80%, and Tokushima Prefecture, with its large population, public facilities, and medical facilities along the coast, is expected to suffer significant damage.

　In case of major disaster occurs, medical teams from all over the country will come to the affected areas to provide various types of support.　Until then, it is important for the affected people to cooperate with each other.　To do this, it is important to prepare in advance. 　　At evacuation shelters, people will live together.　And life in a different environment than usual will continue for a while.　Try to live your life as usual even at the evacuation shelter.　If the toilets are dirty, people will refrain from drinking water, which can lead to dehydration and various illnesses.　Be sure to drink water frequently. 　　Also, avoid sleeping on the floor in evacuation shelters such as gymnasiums.　Sleeping on the floor increases the risk of infection, and it is difficult for elderly people to get up, so their activity level decreases.　If cardboard beds are provided at evacuation shelters, elderly people should use them. 　　Families should discuss how to act in the event of a disaster and where to meet.　Patients with chronic illnesses should check the medications they usually take.

At the symposium on preparation for the Nankai Trough megaquake, I spoke mainly about what I learned through JMAT activities.　First, I introduced the efforts of the Tokushima City Medical Association in response to large-scale disasters such as the Nankai and Tonankai earthquakes from 2005 to the present.　Next, I presented the activities of the JMAT Tokushima Team 14 during the Noto Peninsula earthquake, including points of reflection.　Finally, I extracted voices from 31 doctors of the Ishikawa Medical Association one year after the Noto Peninsula earthquake from an archive created on their website.　From these experiences, we, the Tokushima Medical Association, believe that during a disaster, we must first serve at emergency relief stations, decide on duty rotations, strive for the recovery of our own hospitals as much as possible, and fight believing that one day we will recover, while relying on the support of DMAT, JMAT, and other relief organizations.　At that time, let us unite as Tokushima Prefecture, support each other, and work towards reconstruction.

The Noto Peninsula Earthquake, which struck on January 1, 2024, caused devastating damage, particularly in the Noto region of Ishikawa Prefecture.　In response to this disaster, I was deployed as a member of the Tokushima Disaster Medical Assistance Team （DMAT） and engaged in medical relief activities in the affected area. 　　Disaster medicine differs significantly from routine clinical practice, as it involves complex challenges such as limited medical resources, disrupted communication, restricted physical access, and interactions with victims from diverse backgrounds and circumstances. 　　This article provides an overview of the DMAT system and its operations, shares firsthand experiences from the Noto Peninsula Earthquake, and discusses key lessons learned and challenges encountered through this deployment.

　In Tokushima Prefecture, efforts are being made to strengthen the medical care system for disasters, including the anticipated Nankai Trough megathrust earthquake.　These efforts include facility improvements, the training of DMAT （Disaster Medical Assistance Team） and disaster medical coordinators, as well as conducting drills and training programs.　Additionally, the prefecture is working to enhance its disaster response capabilities not only through government initiatives but also by collaborating with medical institutions and other relevant organizations both within and outside the prefecture.　Moving forward, it will be necessary to continue these efforts while further reinforcing the system through the utilization of digital technologies and other innovations.

　Allergic rhinitis （AR） is a type I allergic disease of the nasal mucosa, characterized by sneezing, watery rhinorrhea, and nasal congestion.　A recent epidemiological survey revealed that nearly half of the population develops AR in Japan. 　　Histamine is a major chemical mediator that induces AR symptoms by binding to histamine H1 receptor （H1R） during the development of AR.　We found that histamine-mediated stimulation of H1R induces upregulation of H1R gene expression through the activation of protein kinase Cδ, and that the elevated receptor expression levels in the nasal mucosa enhance histamine signaling, thereby exacerbating AR symptoms.　Antihistamines not only block histamine signaling through H1R but also suppress histamine-induced upregulation of H1R transcriptional activation. Moreover, they exert a suppressive effect on basal H1R transcription in the absence of histamine, which may be part of their inverse agonist action. 　　Recently, light-emitting diodes that emit energy at a wavelength of 310 nm, corresponding to narrowband-ultraviolet B （NB-UVB）, have been developed, and these devices are small enough to be used for intranasal phototherapy.　To develop a phototherapy using NB-UVB for the treatment of AR, we examined the effects of NB-UVB irradiation on H1R gene expression.　Our findings demonstrated that low-dose NB-UVB irradiation suppressed PMA-induced upregulation of H1R mRNA in a wavelength-specific, dose-dependent, and reversible manner, without inducing apoptosis.　We then conducted an in vivo study using a rat AR model.　Our findings demonstrated that intranasal pre-irradiation with NB-UVB dose-dependently suppressed upregulation of H1R mRNA in the nasal mucosa, leading to the alleviation of nasal symptoms without causing DNA damage.　These findings suggest that phototherapy with low-dose NB-UVB can be applied effectively and safely for the treatment of AR.　Since phase I and early phase II clinical trials confirmed its safety, we are currently conducting an investigator-initiated clinical trial in patients with pollinosis.

　Background and objective : The limitation of visiting mothers, homecoming delivery, attending the deliveries, and childbirth preparing classes were affected to mothers in many hospitals. This study aimed to clarify the correlation between the condition of postnatal depression and level of labor and delivery support during the COVID-19 pandemic.　 　　Methods : The women who gave birth at Anan Medical Center for 5 years, from May 2019 to May 2024, participated in our study.　The Edinburgh Postnatal Depression Scale （EPDS） values were evaluated at their 2-week postpartum checkup. 　　Results : The ratio of high EPDS（≧9 points） women to all subjects after attending the delivery was prohibited were 1．58 times increased compared to that before limitation of attending the delivery（9．8％ versus 15．5％; odds ratio.　0．59 ; P value = 0．0097）.　Remarkably, among primiparas, the ratio of high EPDS women is larger than that before attending the delivery was prohibited.　On the other hand, among multiparas, there was no significant deference between before and after limitation of attending the delivery.　 　　Conclusion : Decline of labor and delivery support can have a great influence on primiparas. Especially, family attending the delivery may give emotional support to mother during childbirth. Primiparas tend to fall into a postnatal depression, so they need to be carefully observed under decline of labor and delivery support.　Pediatricians should play a role of supporting maternal and children’s health such as perinatal visit, medical checkup and vaccinations for babies.

　In the acute phase of stroke, it is imperative to initiate appropriate medical intervention without delay following the onset of symptoms.　Consequently, there exists a critical need to establish a streamlined and precise prehospital transport system to ensure the rapid conveyance of patients from the emergency scene to specialized medical institutions. 　　In recent years, the emergence of mechanical thrombectomy has markedly transformed therapeutic strategies for patients with acute ischemic stroke.　Conventional intravenous thrombolysis with tissue plasminogen activator has demonstrated limited efficacy in achieving recanalization in cases involving major cerebral artery occlusion and has yielded only modest improvements in clinical outcomes.　In contrast, mechanical thrombectomy has exhibited significant therapeutic benefit in patients with large vessel occlusion. 　　In Tokushima Prefecture, initiatives are currently underway to develop a stroke patient transport protocol aligned with the ongoing advancements in stroke treatment.　As part of these efforts, the Stroke Center, in collaboration with the Tokushima Prefectural Fire Department, implemented a prehospital stroke scale in January 2022, thereby facilitating the prompt identification and direct transfer of patients likely to require mechanical thrombectomy to the stroke center.　Furthermore, an ICT-based platform, JoinTriage, has been introduced to enhance communication between emergency medical services and the stroke center.　JoinTriage enables Emergency Medical Services personnel to efficiently assess patients using the prehospital stroke scale and instantly transmit the data to the stroke team, thus accelerating the initiation of endovascular therapy. 　　This paper presents the outcomes of these initiatives and delineates the developmental trajectory of the newly established stroke transport protocol in Tokushima Prefecture.

Case report 　　We report two cases of patients with cerebral infarctions recurring in different areas during or early after the administration of recombinant tissue plasminogen activator （rt-PA） for the treatment of acute cerebral infarction. 　　Case 1 : An 85-year-old female was admitted to our institution due to numbness in her left hand.　The patient was found to have right conjugate deviation, left hemispatial neglect, and left upper and lower limb paralysis.　Magnetic resonance imaging （MRI） revealed an acute cerebral infarction in the right parietal lobe and rt-PA was administered as treatment.　Ten minutes later, the patient developed aphasia and right hemiplegia.　Angiography showed occlusion at the distal end of the contralateral internal carotid artery in addition to occlusion in the distal right middle cerebral artery.　Mechanical thrombectomy was performed on the left side and complete recanalization was achieved within an hour.　The patient’s neurological symptoms resolved completely.　Postoperative examination was suggestive of a cardiogenic embolus, and anticoagulation therapy was thus initiated. 　　Case 2 : A 73-year-old male presented to our hospital with vomiting and difficulty moving.　Right upper limb ataxia and dysarthria were observed.　A right cerebellar infarction was observed on MRI and rt-PA was thus administered as treatment.　The patient’s neurological symptoms were partially resolved.　However, 2 h after the end of rt-PA administration, left hemiplegia and right conjugate deviation developed.　A follow-up MRI revealed multiple new cerebral infarctions in the right middle cerebral artery.　Since atrial fibrillation was detected during medical treatment, anticoagulant therapy was initiated. 　　Conclusion : In these two patients, cardiac thrombi were partially dissolved by rt-PA and embolic cerebral infarction recurred after rt-PA therapy, which is a rare complication that should be noted.

　　Social work aims to increase clients’ well-being of clients by working with people and their environments.　Systems theory is a method for assessing how people interact with their environments.　Previously applied in family therapy, this theory uses a systems approach to analyzes difficult situations and brings change by introducing systemic changes.　The patient was a 40-year-old man with congenital hemophilia complicated by a factor VIII inhibitor and HIV infection.　He lived with his father and was supported by his brother, who lived nearby.　He visited the pediatrics department twice daily for an injection of painkillers for hemophilic arthropathy.　Although we recommended a transfer to the internal medicine department by hospitalization due to a hemorrhage in the right femoral muscle, the patients was anxious about hospitalization and confused by potential environmental disruptions.　Visualization of this situation using biological, psychological, and social models has revealed mutual problems.　The family system was built as a closed system in which all family members did not like changing environments.　After assessment using systems theory, we believed that if the father became a gatekeeper, we could intervene.　Multidisciplinary intervention made it possible to transfer the patient to the internal medicine department, and he regained a stable life by receiving regular injections of anti-hemophilic medications three times a week.　Systems theory is a useful tool for finding ways to provide personalized support in social work.

　The patient is a 53 year old female.　She was born with a hiatal hernia of the esophagus.　She was brought to our hospital with orbital pain, fever, and vomiting, and was diagnosed with perforation of the transverse colon within the hernia sac, as CT showed prolapse of the stomach, small intestine, and transverse colon into the left thoracic cavity and increased fatty tissue density around the prolapsed intestinal tract.　The mediastinum was markedly deviated to the right, with left atelectasis and decreased lung capacity.　The patient underwent a hiatal hernia removal, resection of the transverse colon perforation, and colostomy.　On the second postoperative day, CT showed a left pneumothorax.　A recheck of the immediate postoperative chest x-ray showed that the left pneumothorax was already present, and it was thought to have developed intraoperatively.　It was thought that the patientʼs lung damage was caused indirectly by pleural traction and decreased intrathoracic pressure during intestinal evacuation against a background of decreased lung capacity due to prolonged pressure and evacuation of the prolapsed intestine.　We report a rare case of pneumothorax despite the absence of hernia sac injury during hiatal hernia surgery, with a discussion of the literature.

　　The patient is a 67-year-old woman.　At the age of 65, she underwent implantation of a biventricular pacemaker with defibrillator function due to heart failure accompanied by left bundle branch block, and had been under follow-up care at our hospitalʼs cardiology department. Around February 10th of year X, she developed dizziness, which did not improve, so she visited our hospital’s cardiology department on February 15th.　Differential diagnosis for dizziness due to heart disease was conducted, but no abnormalities were found.　A blood test was conducted to investigate conditions such as anemia, and the chloride （Cl） level was found to be above the measurable range, prompting a referral to our department for further evaluation of hyperchloremia.　In our department, no abnormalities other than the elevated chloride level were found.　There was no history of massive saline infusion, renal dysfunction, or diuretic use, so an arterial blood gas analysis was performed.　Hyperchloremia was confirmed, but metabolic acidosis and respiratory alkalosis were not observed, and the anion gap was low, leading us to suspect pseudohyperchloremia.　Upon confirming the patient’s use of medications containing bromine or iodine, it was revealed that she regularly took an over-the-counter analgesic （Naron Ace） containing bromovalerylurea.　It was concluded that her dizziness was caused by chronic bromide poisoning.　After discontinuing Naron Ace, the symptoms showed improvement and eventually disappeared.　Bromine poisoning is a toxic condition caused by bromine compounds.　Bromovalerylurea, a bromine compound, was discovered in 1907 and has been used as a sedative and hypnotic, but due to its toxic symptoms and potential for dependence, it is banned in most countries today.　However, in Japan, over-the-counter analgesics containing bromovalerylurea are still sold and easily obtainable.　Bromine poisoning can be acute or chronic.　In the past, acute poisoning from large doses taken for suicide was frequently reported, but since 1990, all 10 reported cases in Japan have been chronic poisoning due to long-term use.　Symptoms of chronic poisoning range from nonspecific symptoms such as vomiting and fatigue to neurological abnormalities, including consciousness disturbance, vertigo, dysarthria, and extrapyramidal symptoms.　There have been reports of chronic bromine poisoning in the elderly even with regular doses, making it a condition that should be considered in differential diagnoses in routine clinical practice.