Animals ; Dogs ; Duodenum ; physiology ; Male ; Myoelectric Complex, Migrating ; physiology ; Sphincter of Oddi ; physiology

　　Our ward encounters many cases (approximately 80 every year) requiring end-of-life care. The experiences of nurses, as well as of patients’ families and friends, vary widely and nurses appear to be anxious about providing mortuary care, known as Angel care. There is no standardized manual, and therefore medical care professionals need to optimize good Angel care practices in order to alleviate nurses’ anxiety around the issue. We administered a questionnaire regarding the situation of Angel care to 208 ward nurses in our hospital and extracted difficulties in providing Angel care reported by the 173 respondents. Less than 5% of nurses, regardless of length of nursing experience, experienced no anxiety. Nurses found it difficult to conduct basic technical procedures: 51.7% had difficulties in closing the deceased patient’s mouth and 40.2% had difficulties judging whether the results of mortuary makeup resemble antemortem appearance. Ninety-five percent of nurses wished to study Angel care in the future should learning materials be available. In conclusion, more than half of nurses were anxious about providing Angel care regardless of length of their nursing experience and number of cases handled. Nurses are greatly interested in Angel care and wish to learn more if learning materials are made available.

Objective The aim of the present study was to determine the role of the duodenum in controlling sphincter of Oddi(SO) motility using conscious dogs after total duodenectomy. Methods In a control group (n=6), a cannula was implanted into the duodenum opposite to the papilla to allow sphincter of Oddi manometry. In a duodenectomy group (n=6), the papillae were preserved at total duodenectomy and sutured to the jejunum anastomosed to the stomach (neoduodenum). The cannula was implanted opposite to the implanted papillae. Interdigestive and postprandial sphincter of Oddi and duodenal or neoduodenal motility were recorded by manometric and myoelectric methods. Results Duodenectomy disrupted SO cyclic motility. Conclusions During the interdigestive period, the duodenum has a distinct role in regulating sphincter of Oddi cyclic motility.

A 69 year old man who was admitted with hoarseness and diagnosed as aneurysm of the diverticulum of the ductus arteriosus was reported. Operation was performed through a median sternotomy under partial cardiopulmonary bypass. Saccular form aneurysm, had a stalk attaching to left pulmonary artery, was repaired using Dacron patch prosthesis. His postoperative course was uneventful except transient left pleural effusion. Because of fragirity of aneurysm in the adult, early surgical intervention is recommended. To our knowledge, this is 11th surgically treated case to be reported in the literature in Japan.

Purpose: This study investigated the current state of critical hemorrhage during home palliative care for terminally ill cancer patients. Methods: We conducted a retrospective medical chart review of 7 cancer patients (1.4%) who received home palliative care from our clinic and died of critical hemorrhage at home from October 2007 to December 2014. Results: Four patients were male, the mean age was 70±11 years, and underlying diseases were different. None of the patients were accompanied by medical staff at the onset of bleeding. Six patients died at home and one patient was admitted to hospital for hemostasis. Six patients had a pre-hemorrhage episode more than 24 hours before critical hemorrhage occurred from the same site. One patient was administered a hemostatic agent, hemostasis was attempted in one, and one was given sedation. Six patients wanted to die at home, and did die at home. Discussion: If terminally ill cancer patients have critical hemorrhage at home, our options are limited. The results of this study suggest the importance of hemorrhage risk assessment and advance care planning.

Appropriate clinical communication between patients and physicians requires better cooperation based on patientphysician rapport and consensus development through information sharing.Developing appropriate clinical communication is also important for safer and more reliable clinical care. The aim of the present study was to illustrate an effective politeness strategy for appropriate clinical communication.
1) We conducted focus-group interviews and performed qualitative analysis on the basis of the results of interviews of both patients and physicians.We also performed an Internet survey and organized an Internet-based discussion ofthe politeness strategy and its effectiveness.
2) Patients may consider physicians' overuse of honorifics as feigned politeness, Both patients and physicians recognize that such overuse may work against the development of rapport-based cooperation.
3) Patients may expect physicians to use simpler honorifics, such as “-san.”However, by using honorifics physicians can show respect to patients and establish a more intimate relationship with patients through both positive and negative politeness strategies.
4) When physicians can better understand and use local dialects, the effects of positive politeness may reduce the psychological distance between patients and physicians, have a relaxing effect on patients, and improve clinical information gathering.
5) A positive politeness strategy, such as admiring and talking optimistically, may have different effects depending on the patient's condition or“face.”If successful, this strategy can contribute to the behavioral changes of patients.

We describe a 52 year old woman who had an aneurysm involving the common hepatic artery directly originating from the aorta. It was successfully treated by aneurysmectomy without needing the arterial reconstruction. An aneurysm of the common hepatic artery that has an anomalous origin from the aorta is very rare and only 4 cases including the present case were reported in Japanese literature on our survey. The features and management of hepatic aneurysm are discussed.

The purpose of the present study was to investigate the effects of long-term exercise training on immune function in elderly individuals. This study was conducted on 27 sedentary subjects including 7 males and 20 females aged 66.1±4.2 yrs. (range of 60 to 77 yrs.) who participated in a 12-month exercise program. The subjects attended the exercise program 4.4 ± 1.7 times per month. Peripheral blood samples were taken prior to, and at 5 and 12 months during the exercise training program. Each lymphocyte subset (natural killer: NE, T, cytotoxic T: Tc, helper T: Th, memory-Th and NKT) count in the samples was measured using flow cytometry. Results indicated that NE and Tc cell counts were not significantly altered. Whereas, T and Th cell counts were significantly elevated after 12 months, and memory-Th and NET cell counts were significantly elevated after 5 and 12 months of exercise training. These results suggest that long-term exercise training may be a stimu lus to increase and or maintain immune function in elderly individuals.

OBJECTIVE: To investigate Japanese physicians' use of dialects related to geographic areas and to elucidate how physicians respond to dialect-using patients.
METHODS: We conducted a web-based open survey, to which 170 anonymous physicians reported. We examined the following 1) whether dialects are used during communication with patients; 2) how to communicate with patients using dialects; and, 3) reasons for having difficulty in communicating with patients who regularly use dialects. Geographical areas were divided into the following 8 areas Hokkaido-Tohoku, Kanto, Koshinetsu-Hokuriku, Tokai, Kinki, Chugoku, Shikoku and Kyushu-Okinawa.
RESULTS: Of 170 physicians, 61.2% (95% CI: 53.4-68.5%) reported using dialects. These proportions differed by geographic area (F= 8.141; p<0.001) . Physicians practicing in Shikoku and Chugoku used dialects most frequently, while those practicing in Kanto and Hokkaido-Tohoku used dialects least frequently. Many dialect-using physicians thought that physicians should use the same dialect as dialect-using patients. In addition, dialect-using physicians were more likely to think that a physician-related factor was responsible for having difficulty in garnering clinical information.
CONCLUSIONS: Use of dialects by Japanese physicians during communication with patients seems common and may differ by geographic areas. Physicians' use of dialects could be a useful tool for effective clinical communication.

A kainic acid microinjection into unilateral occipital cortex induced an experimental model of occipital lobe epilepsy in cats and rats. Elicited focal seizures in the occipital cortex promptly propagated to the bilateral cortices and also to the subcortical structures. Behavioral and EEG observations were well correlated to the human occipital lobe epilepsy. Metabolic study using 14C-deoxyglucose autoradiography in rats demonstrated a rapid propagation of the hypermetabolic area in the parietal, frontal, temporal and contralateral occipital cortices and also to the thalamus, basal ganglia, MRF and lateral geniculate body. The result shows that not only Meyer’s loop but also subcortical fasciculus between occipital lobe and other lobules may have an important role in the mechanism of seizure evolution and propagation of the occipital lobe epilepsy