Background: Rehabilitation and palliative care for advanced/terminal cancer patients share a same goal of enhancing patients' quality of life (QOL). Aim: The aim of this study was to identify the patients' narratives during the rehabilitation session, by analyzing words reflecting their ideas and hopes. Method: Out of forty-seven advanced/terminal patients' narratives during the rehabilitation session from April through September in 2011, the rehabilitation therapists recollected the impressive words. Then, the words were grouped into four categories of "total pain" concept by their meanings. Result: Out of a total of 215 words identified, 60% was grouped into physical aspect, 14% into psychological, 10% into social, 7% into spiritual and 9% into mixed aspects. Discussion: If rehabilitation therapists only deal with physical aspects of enhancing their QOL, 40% of patients' wishes will be ignored. Conclusion: Rehabilitation for advanced/terminal cancer patients might need multidimensional interventions with a concept of "total pain".

Purpose: The goal of rehabilitation for advanced cancer patients is to improve their quality of life (QOL). The meaning of QOL can only be determined by an individual patient. Rehabilitation begins with exploring the patient's hope. Here, we report a case suffering to express hope with difficulties by terminal stage lung cancer with brain metastases. Case: An 83-year-old male who was diagnosed with lung cancer (adenocarcinoma) and brain metastases admitted to palliative care unit because of progressive disease against chemo-radiotherapy. On admission, he could eat independently and walk to bathroom with slight assistance. A few weeks later, he had an epileptic seizure, right-hemiplegia and disturbance of consciousness. This episode made it drastically difficult for us to communicate orally with him. And, we tried hard to know the patient's hope by assessment using activities of daily living (ADL) observation and non-verbal communications. He revealed to be eager to eat even in a PS grade 4. He sometimes could talk a few words and, by rehabilitation techniques, he started to enjoy eating independently. For about three weeks, he could eat until the day before he died. Discussion: Eating behavior could be influenced by proper way of rehabilitation. Conclusion: ADL observation and non-verbal communication could be an effective rehabilitation approach to stimulate feeding behavior resulting in the improvement of patient's QOL.

Regenerative muscles are required for swallowing and mastication, and are important for functional recovery from diseases involving oral muscular defects. Therefore, we generated three-layer hybrid sheets, similar to oral mucosal structures containing submucosal muscles, using rabbit oral mucosa epithelial, mesenchymal, and myoblastic progenitor cells, and examined the structural proteins. Each cell type was obtained from rabbit oral mucosa using enzymatic digestion. Isolated mesenchymal and myoblastic cells were multi-differentiated into osteoblasts, adipocytes, and chondrocytes or myotubes. Isolated epithelial cells were cultured on collagen gels containing isolated mesenchymal cells for 2 weeks, and these epithelial–mesenchymal cell sheets were laminated onto myoblastic cell sheets. The engineered hybrid sheets were multi-stratified in the epithelial and myoblastic layers in a time-dependent manner, expressing intermediate cytoskeletal filament proteins of epithelium and muscle. Hybrid sheets also expressed extracellular matrix basement membrane proteins. Immature cell markers for epithelial and myoblastic cells were observed continuously in hybrid sheet cultures. We established engineered three-dimensional rabbit oral mucosa hybrid sheets containing each immature cell type in vitro.

Purpose: Type 4 gastric cancer (GC) has a very poor prognosis even after curative resection, and the survival benefit of splenectomy for splenic hilar lymph node (LN; #10) dissection in type 4 GC remains equivocal. This study aimed to clarify the clinical significance of splenectomy for #10 dissection in patients with type 4 GC. Materials and Methods: The data of a total of 56 patients with type 4 GC who underwent total gastrectomy with splenectomy were retrospectively analyzed. Postoperative morbidity, state of LN metastasis, survival outcomes, and therapeutic value index (TVI) of each LN station were evaluated. TVI was calculated by multiplying the incidence of LN metastasis at each nodal station and the 5-year overall survival (OS) of patients who had metastasis to each node. Results: Overall, the postoperative morbidity rate was 28.6%, and the incidence of #10 metastasis in the patients was 28.6%. The 5-year OS rate for all patients was 29.9%, and most patients developed peritoneal recurrence. Moreover, the 5-year OS rates with and without #10 metastasis were 6.7% and 39.1% (median survival time, 20.4 vs. 46.0 months; P=0.006). The TVI of #10 was as low as 1.92. Conclusions The clinical significance of splenectomy in the dissection of #10 for type 4 GC is limited and splenectomy for splenic hilar dissection alone should be omitted.