Purpose: To investigate the characteristics of sudden abdominal condition change that occur in a palliative care unit, we evaluated the association between these conditions and family acceptance at time of death. Methods: We retrospectively investigated the medical records of 30 terminally ill cancer patients who died of sudden abdominal condition change in our unit between January 2010 and March 2013. We focused particularly on the course of sudden change, symptom relief, explanation of the condition, and family acceptance at time of death. Results: The average time from onset of sudden change in abdominal condition until death was 20.6 hours and the median was 13 hours. Of the 30 total cases, 23 occurred in less than 24 hours. Frequent symptoms during the sudden change were abdominal pain in 28 patients, decreased blood pressure in 21, lowering of consciousness in 12 and disturbed behavior/excitement in 10. Impending symptoms were observed in 18 patients. For patients with good acceptance by family at time of death (21 patients), symptom relief was significantly better, frequency of disturbed behavior/excitement was significantly less, and prior specific explanation was significantly frequent, compared to the poor acceptance group (9 patients). The good acceptance group tended to be have a longer hospital stay, as well as longer time between sudden change and death. Conclusions: Death by sudden abdominal condition change came within 24 hours in a majority of cases. We consider that prior detailed explanation and improving symptom relief helps improve family acceptance.

Purpose: We evaluated the significance of support for leaving the palliative care unit temporarily in end-stage terminally ill cancer patients. Methods: We retrospectively investigated the medical records of 27 terminally ill cancer patients who died within 15 days after leaving our palliative care unit temporarily, between January 2011 and December 2012, and distributed a questionnaire to their bereaved family. Results: The age of the patients ranged from 29 to 91 years. Ten patients left the unit without stay and 17 left overnight. The destination of 24 patients was their home, while three had other destinations. For 11 patients, the main purpose of leaving the unit was to finish business, and for 9, was to see their houses once again. After returning to the hospital, the comments of 15 patients were affirmative, and those of 6 were negative. Questionnaire responses were obtained from 18 persons. Families reported anxiety regarding and difficulty with adaptation to the sudden change when the patients left the unit, apparatus support, patient transfer, and patient care. Conclusions: It was useful for the terminally ill cancer patients and their families to receive support when leaving the palliative care unit temporarily. Strategies to cope with the sudden change at the time of leaving the unit could help families feel reassured and secure.

Purpose: To investigate the indications for use of the Japanese version of the Liverpool Care Pathway (LCP), we evaluated the conditions of patients using and those not using the LCP. Methods: We retrospectively investigated the medical records of 71 LCP patients and 60 non－LCP patients who died in our palliative care unit between March and December 2013. Results: There was no significant difference in patients’ background between the LCP and non－LCP groups. For patients in the non－LCP group, sudden changes in condition were significantly more frequent and deep continuous sedation was used significantly less than in the LCP group. In the LCP group, the average duration on the LCP was 4.0 days, and the beginning criterion was met by three－point or more of all the patients. The initial assessment was achieved except for one case. In the non－LCP group, reasons for not using the LCP were a sudden change in condition (35 patients), a rapid change in medical condition (14), and a risk of falling (4). Conclusions: The LCP met the beginning criterion and was started at suitable time in the LCP group. The LCP is not useful for all patients; it cannot be used for a patient with sudden or rapid changes in condition, or at a risk of falling.

A whole body indirect calorimeter provides accurate measurement of energy expenditure and the respiration quotient over long periods of time, but has limitations to assess dynamic changes in energy metabolism due to the small amplitude of the signal in relation to the size of the room. The present study aimed to improve algorithm for the whole body indirect calorimetry by adopting a deconvolution with a regularization parameter. Performance of the new algorithm was compared with trends identification (Med. & Biol. Eng. & Comput 34 : 212, 1996) against four validation tests. In a simulated problem, in which metabolic rate cycled with a period of 20 min, mean square errors (MSEs) computed at every 1 min by the deconvolution (0.0036 for O₂ consumption and 0.0017 for CO₂ production) were smaller than those for trends identification algorithms (0.0198 and 0.0142). Deconvolution algorithm clearly separated individual CO₂ infusion of 8 min intervals, while trends identification could no longer separate them. During the validation by ethanol combustion, which produced a near-steady state condition, the deconvolution (MSEs were 0.0022 for O₂ consumption and 0.0010 for CO₂ production) performed better than trends identification algorithms (MSEs were 0.0086 and 0.0041). When validated against direct measurement of gas production rate during non-steady state condition, produced by a human subject intermittently exercising in the calorimeter, deconvolution (MSEs were 0.0032 for O₂ consumption and 0.0038 for CO₂ production) performed better than trends identification algorithms (0.0182 and 0.0167). The new algorithm significantly improved transient response of the whole body indirect calorimeter.

Purpose：We evaluated that the current state from which a palliative care unit receives emergency admission of cancer patients at home. Methods：We retrospectively investigated the medical records of 393 cancer patients who hospitalized in our unit between January 2013 and December 2014. The patients were shared with a group of two, schedule admission (schedule group) and emergency admission (emergency group), and it was compared with a result on discharge and with a hospitalization period. We investigated admission process, the date and time of admission, and reason for admission in emergency group. Results：The number of patients was 224 of schedule group and 169 of emergency group. The mortality rates were 81% in schedule group and 78% in emergency group (not significant). An emergency group for an average of 24.3 days was shorter for 9 days than schedule groups in a hospitalization period of dead leaving patients (p<0.05). In emergency group, admission process included 128 completed-interviews with the hospitalization, 11 incompleted-interviews before admission and 30 first visits, and 129 patients (76％) admitted within the weekday daytime. Many patients had a complaint of severe pain, appetite loss and oral absorption difficulty, and so much. Conclusions：An emergency group admitted the various processes and the much symptom. There were a lot of cases of early hospital death, but also admitted return at home, and our unit played the role of emergency admission.

Objective: To develop and confirm the validity of a Biological Prognostic Score using only blood test results for prediction of prognosis in patients with advanced cancer. Methods: We conducted parametric survival time analysis using blood test results, age, sex, and primary diagnosis as independent variables, and event of death as a dependent variable, among patients in a palliative care unit (a development cohort). We then developed the Biological Prognostic Score (BPS). Thereafter, we confirmed the accuracy of the BPS and the Palliative Prognostic Index (PPI) prospectively among patients, who withdrew or withheld further curative or life-prolonging therapies, in other facilities (a validation cohort). Results: We developed the BPS, which consists of cholinesterase, blood urea nitrogen, and total iron-binding capacity, from 122 patients in a development cohort. We then examined 195 patients in a validation cohort and found that the area under the receiver operating characteristic curve for 1-9 week survival prediction was BPS=0.76-0.86 and PPI=0.69-0.73. Discussion: Our results suggest that the BPS was valid. It will be necessary to perform further examinations in multiple facilities and to explore more generalized parameters that could replace total iron-binding capacity in our BPS.

Methods: Study participants comprised five healthy volunteers (mean age, 27.2 years) and 27 patients with LSS (mean age, 58.4 years) who were individually assessed using 3.0 Tesla magnetic resonance imaging. Intraspinal ADC and FA values of 10 intervertebral discs from healthy volunteers and 52 intervertebral discs from LSS patients were measured. Also, intraspinal canal area, Schizas classification (A: normal, B: mild stenosis, C: severe stenosis) and correlations with symptoms were investigated. Clinical symptoms were checked for the presence of low back pain (LBP), intermittent claudication (IMC), and bladder and bowel dysfunction (BBD). Results: Compared to healthy individuals, LSS patients had significantly lower ADC (p<0.05) and significantly higher FA values (p<0.01). In Schizas classification, stenosis worsened from A to C. ADC values decreased significantly while FA values increased significantly in that order (p<0.05). A positive correlation was found between intraspinal canal area and ADC values (r=0.63, p<0.01) and a negative correlation between intraspinal canal area and FA values (p=−0.61, p<0.01). No correlations were noted between LBP and ADC or FA values. On the other hand, ADC values were significantly lower (p<0.05) and FA values were significantly higher (p<0.05) in patients with IMC or BBD. Conclusions Intraspinal DTI parameters such as ADC and FA values were associated with the Schizas classification, intraspinal canal area, and clinical symptoms, suggesting that ADC and FA may be useful for quantitative assessment of LSS.

Methods: Study participants comprised five healthy volunteers (mean age, 27.2 years) and 27 patients with LSS (mean age, 58.4 years) who were individually assessed using 3.0 Tesla magnetic resonance imaging. Intraspinal ADC and FA values of 10 intervertebral discs from healthy volunteers and 52 intervertebral discs from LSS patients were measured. Also, intraspinal canal area, Schizas classification (A: normal, B: mild stenosis, C: severe stenosis) and correlations with symptoms were investigated. Clinical symptoms were checked for the presence of low back pain (LBP), intermittent claudication (IMC), and bladder and bowel dysfunction (BBD). Results: Compared to healthy individuals, LSS patients had significantly lower ADC (p<0.05) and significantly higher FA values (p<0.01). In Schizas classification, stenosis worsened from A to C. ADC values decreased significantly while FA values increased significantly in that order (p<0.05). A positive correlation was found between intraspinal canal area and ADC values (r=0.63, p<0.01) and a negative correlation between intraspinal canal area and FA values (p=−0.61, p<0.01). No correlations were noted between LBP and ADC or FA values. On the other hand, ADC values were significantly lower (p<0.05) and FA values were significantly higher (p<0.05) in patients with IMC or BBD. Conclusions Intraspinal DTI parameters such as ADC and FA values were associated with the Schizas classification, intraspinal canal area, and clinical symptoms, suggesting that ADC and FA may be useful for quantitative assessment of LSS.

Methods: This prospective, single-arm study included 11 patients (eight men; mean age, 62.7 years) with ≥3-months’ chronic pain history due to lumbar disease. Subcutaneous TCZ injections were administered twice, at a 2-week interval. We evaluated low back pain, leg pain, and leg numbness using numeric rating scales and the Oswestry Disability Index (ODI; baseline and 6 months postinjection); serum IL-6 and tumor necrosis factor-α levels (baseline and 1 month postinjection); and clinical adverse events. Results: Intractable symptoms reduced after TCZ administration. Low back pain improved for 6 months. Improvements in leg pain and numbness peaked at 4 and 1 month, respectively. Improvements in ODI were significant at 1 month and peaked at 4 months. Serum IL-6 was increased at 1 month. IL-6 responders (i.e., patients with IL-6 increases >10 pg/mL) showed particularly significant improvements in leg pain at 2 weeks, 1 month, and 2 months compared with nonresponders. We observed no apparent adverse events. Conclusions Systemic TCZ administration improved symptoms effectively for 6 months, with peak improvements at 1–4 months and no adverse events. Changing serum IL-6 levels correlated with leg pain improvements; further studies are warranted to elucidate the mechanistic connections between lumbar disorders and inflammatory cytokines.

Purpose: In this multicenter retrospective observational study, we examined the early effects of romosozumab in patients with severe osteoporosis in terms of time-course changes in bone metabolism marker, improvement in bone density, and adverse effects. Materials and Methods: Patients with severe osteoporosis were included. We investigated the progress of TRACP 5b and P1NP before and 1–2 months after the administration of romosozumab. We also investigated the bone density of lumbar spine, femoral neck, and the entire femur, measured by the DXA method, before and 5–7 months after the administration of romosozumab. Results: A total of 70 patients (7 males and 63 females, age 75.0±3.6 years) participated in this study. Significant improvements in TRACP 5b and P1NP levels were observed before and 1–2 months after romosozumab administration. The average bone density of lumbar spine, femoral neck, and the entire femur were measured before and 5–7 months after romosozumab administration;and a significant increase only observed in the lumbar spine. Conclusion Consistent with the findings of previous clinical studies, romosozumab has both bone formation-enhancing and bone resorption effects (dual effect). In addition, romosozumab also demonstrated improvement in bone density from the early phase after the administration, though the result was only seen in the lumbar spine.