Little is known about early death after admission during the terminal phase in advanced cancer patients. We retrospectively analyzed data from 510 advanced cancer patients who were at the end-of-life between August 2011 and August 2016, and found that 83 patients (16.3%) died within 3 days after admission to our institute. We divided the deceased patients into those who died within 3 days (early death group) and those who died after more than 4 days (non-early death group) after admission. Prevalence of delirium, cancer pain, dyspnea, nausea and vomiting, and fatigue patients showed no significant differences. Mean hydration at the end of life was significantly more per infusion for early death group than non-early death group. Continuous sedation and mean opioid use was significantly less for early death group than non-early death group. The risk factor of age, sex, clinical stage, histological state, overtreatment of chemotherapy, comorbidity had no significant associated with early death. The primary site of cancer, the number of metastatic sites, the consciousness level, and the performance status might be predictors for early death after admission in advanced cancer patients at the end-of-life.

Using several electrophoretic techniques, this study examined the effects of 3 weeks hindlimb suspension on the patterns of isomyosins, myosin heavy chain (HC) isoforms and myosin light chain (LC) isoforms in the soleus muscle of the rat. The suspended soleus showed a shift in the HC isoform distribution with a marked increase in fast HC isoforms and a commensurate decrease in HCI. In addition, the change in the fast HC isoforms consisted of the expression of HCIId and HC IIb absent in the normal soleus. In contrast to HC isoforms, suspension did not lead to appreciable changes in LC isoform distribution. Analyses of electrophoresis under nondenaturing conditions demonstrated that the normal soleus expressing HCI and HCIIa isoforms contained two isomyooins. Although, of the two isomyosins observed in the normal soleus, the faster migrating band most likely represented the HCIIa-based one (FMas), its mobility was not identical with that of the HCIIa-based isomyosin (FMaf) found in fast-twitch muscles, migrating in the order FMaf>FMas. FMas was designated as intermediate isomyosin (IM) . Some of the suspended soleus contained slow isomyosin (SM) and IM whereas the others comprised FM 3 and/or FM 2 as well as SM and IM. In spite of the expression of HCIIb and HCIId in the suspended soleus, FM 3 and FM 2 observed in these muscles exhibited distinct mobilities from either HCIId-based or HCIIb-based isomyosins comprised in fast-twitch muscles. These results suggest that some of newly expressed HCIId and/or HCIIb isoforms in the suspended soleus are associated with not only fast but also slow LC isoforms and function as a constitutive element of the myosin molecule.

We have several choices against bleeding and obstruction in advanced gastric cancer patients such as surgical or endoscopic therapy. But we have few reports about palliative radiation. We conduct this study that we perform palliative radiation for unresectable advanced gastric cancer patients between April 2006 and March 2014 in single center. In the aim of the therapy, to stop gastric bleeding were 8, and to improve obstruction depend on gastric cancer were 4. Response rate of stop bleeding was 63％, and improve obstruction was 50％. Median duration of stop bleeding was 103 day, and improve obstruction was 52 day. Overall survival time was 567 day, survival time after the start of radiotherapy was 105days. Radiotherapy was limited in cases because onset time of response needed in comparison with surgical or endoscopic therapy. However, given minimally invasive therapy and a certain response, we can choice it so much more.

Physicians expect nurses to be able to understand electrocardiographic (ECG) findings.However, many nurses have difficulty learning how to interpret ECGs.We suspect that the reason for such difficulty might be the nurses'mental responses to ECGs, rather than improper teaching methods.
1) We performed a questionnaire survey to investigate the mental responses to ECGs based on the responses of 197 experienced nurses and 43 new nurses and on an additional survey of 37 nurses who took ECG evaluation tests.
2) Almost all nurses recognized the necessity and importance of understanding ECG findings, and most wished to master ECGs.On the other hand, many nurses said that they disliked ECGs and did not feel competent interpreting ECGs.In particular, their perceived lack of competence in interpreting ECGs was greater than their dislike of ECGs.
3) The nurses'perceived lack of competence interpreting ECGs tended to result from feelings that developed during nursing school.Many nurses continued to have such feelings even after they began working.
4) Nurses with a poor understanding of ECGs reported many factors as being associated with their perceived lack of competence.In addition, such negative feelings toward ECGs (such as fear of making a mistake) made these nurses avoid ECGs.We believe that these feelings were likely a factor in why many nurses had difficulty mastering ECGs.
5) Nurses should be provided with appropriate ECG training that carefully considers the perceived incompetence and fear of many nurses regarding ECGs.

1）Palliative care education by means e–learning was performed from December 3 to 25, 2009, for 1256 hospital medical staff. We used the same true–or–false questions to assess their understanding before and after the e–learning course.
2）Regardless of the staff member’s experience, the total scores on the test were higher after the course than before the course. Therefore, this e–learning course had an effect on basic knowledge for multiple types of medical staff.
3）The percentage of correct answers was particularly improved for questions about topics we had emphasized: drug dependence and side effects.

There were no reports about long survival predictors in palliative care settings. We divided categories into more than 31 days of hospitalization (short period hospitalization) and more than 61 days of hospitalization) (long hospitalization) and analyzed prognostic factors in multivariate methods. We measured the association between the long hospitalization and short period hospitalization groups with regard to terminal symptoms (cancer pain, delirium, nausea and vomiting, fatigue, and dyspnea) and treatment (hydration, continuous sedation, and opioids). In the more than 31 days of hospitalization group, sex (Odds Ratio 0.502), consciousness (Odds Ratio 0.258), and calcium levels (Odds Ratio 0.559) were statistically significant. In the more than 61 days of hospitalization group, the serum CRP level (Odds Ratio 0.254) was statistically significant and serum calcium level (Odds Ratio 0.376) exhibited a trend. The prevalence of fatigue and amount of hydration were significantly low in the more than 31 days of hospitalization group. There were no differences in terminal symptoms and treatment in the more than 61 days of hospitalization group.