A survey through general questionnaires was performed on those who visited the Hijiori, Yutagawa and Akakura hot springs in Yamagata Prefecture for thermalisme.
A total of 548 replies were obtained and they were analyzed in comparison with the survey results reported by Sugiyama et al. about 30 years ago.
Most of visitors were regular customers living in Yamagata Prefecture. Further, most of them, both men and women, were of age 60 or over. This fact was remarkably different from the investigation results of 30 years ago.
The degree of satisfaction among visitors as to the effectiveness of thermalisme was high among most of those who visited there to relieve pain but not so high among those who visited there for their health or for resting.

The authors investigated the activity of Kikyo-to on the intestinal hormones, cholecystokinin (CCK) and secretin, released in healthy humans. The clinical efficacy of Kikyo-to on the abdominal symptoms associated with chronic pancreatitis was also investigated. In healthy volunteers, Kikyo-to (5g) significantly increased plasma CCK and secretin concentrations 30 minutes after treatment. In chronic pancreatitis patients, abdominal pain, abdominal tenderness, nausea and diarrhea were decreased by treatment with Kikyo-to (7.5g/day; divided into three doses). In conclusion, Kikyo-to improved the complaints of chronic pancreatitis, especially abdominal pain. The presumed mechanism was that Kikyo-to stimulated pancreatic exocrine secretion by the release of intestinal hormones, CCK and secretin.

Objective: The aim of this study was to investigate the palliative care for cancer patients provided by a long-term care unit. Methods: We retrospectively investigated the medical records of 194 patients who hospitalized in our long-term care unit between April 2010 and December 2014. The patients shared with a group of two, narcotic drugs non-use period (previous group; until March 2012) and narcotics use period (later group; in April 2012 or later), and it was compared with a background, hospitalization period, result on discharge, narcotic drug administration, symptom relief. And it was surveyed hospitalization dynamics of our palliative care unit for comparison. Result: Cancer patients were 16 (22%) in previous group of 74 patients and were 79 (66%) in later group of 120. The proportion of cancer patients in later group increased to three times (p<0.001). In later group, the average hospital stay was shortened to half (144 days, p<0.01) and the mortality discharge rates increased (78%, p<0.05). Narcotic drugs were administered to more than half (57%) of cancer patients in later group, and pain relief was significantly better. In the period of later group, number of hospitalized patients in palliative care unit was also increased. Conclusion: It was suggested that the long-term unit can perform palliative care for cancer patients in cooperation with the palliative care unit.

Objective: We retrospectively studied the adaptation and limits of applying Biological Prognostic Score Version-2 composed only of blood test results to prognostic prediction in end-of-life non-cancer patients. Methods: The prognostic score was calculated from the cholinesterase, blood urea nitrogen, and white blood cell counts of hospitalized end-of-life non-cancer patients, divided into three groups with cutoff values, and prediction accuracy analysis, survival analysis, and simple regression analysis were performed. Results: Diagnostic accuracy of 204 non-cancer patients at the same cut-off value and predicted survival time as cancer was 79% accurate at 3 weeks survival and 63% at 9 weeks. Specificity and negative predictive value were highly accurate, sensitivity and positive predictive value were low. In the survival analysis, the discrimination between the 3 groups was significant (p<0.05), but the regression coefficient in the regression analysis was not significant (p=0.43). Conclusion: The prognostic prediction using this score for non-cancer patients has high prediction accuracy in the case of good prognosis. It is suggested that clinical use of this score is also possible if used cautiously.

Objective: The aim of this study was to establish criteria that would indicate whether fertility preservation therapy would likely be safe for patients aged 40 years or less with endometrioid endometrial cancer based on their DNA methylation profile. Methods: Forty-nine fresh-frozen tissue samples from patients with endometrial cancer from an initial cohort and 31 formalin-fixed paraffin-embedded tissue samples from a second cohort were subjected to genome-wide DNA methylation analysis using the Infinium MethylationEPIC BeadChip. Results: Epigenomic clustering of early-onset endometrial cancer was correlated with the widely used recurrence risk classification. Genes showing differences in DNA methylation levels between the low-recurrence-risk category and intermediate- and high-risk categories were accumulated in pathways related to fibroblast growth factor and nuclear factor-κB signaling. DNA hypomethylation and overexpression of ZBTB38 were frequently observed in the low-risk category. Eight hundred thirty-one marker CpG probes showed area under the curve values of >0.7 on the receiver operating characteristic curve for discrimination of patients belonging to the low-risk category. By combining marker CpG sites, seven panels for placing patients into the low-risk category with 91.3% or more sensitivity and specificity in both the initial and second cohorts were established. Conclusions DNA methylation diagnostics criteria using up to 6 of 8 CpG sites for LPP, FOXO1, RNF4, EXOC6B, CCPG1, RREB1 and ZBTB38 may be applicable to recurrence risk estimation for patients aged 40 years or less with endometrial cancer, regardless of tumor cell content, even if formalin-fixed paraffin-embedded biopsy or curettage materials are used.

In patients with unresectable hepatocellular carcinoma (HCC) without both macrovascular invasion and extrahepatic metastasis, the initial treatment choice recommended is transarterial chemoembolization (TACE). Before sorafenib came into wide use, TACE had been pointlessly carried out repeatedly. It was in the early 2010s that the concept of TACE refractory was advocated. Two retrospective studies from Japan indicated that conversion from TACE to sorafenib the day after patients were deemed as TACE refractory improved overall survival compared with continued TACE, according to the definition by the Japan Society of Hepatology. Nowadays, phase 3 trials have shown clinical benefits of several novel molecular target agents. Compared with the era of sorafenib, sequential treatments with these molecular target agents have gradually prolonged patients’ survival and have become major strategies in patients with HCC. Taking these together, conversion from TACE to systemic therapies at the time of TACE refractory, compared with before, may have a greater impact on survival and may be considered deeper in the decisions-making process in patients with unresectable HCC who are candidate for TACE. Up-to-date information on the concept of TACE refractory is summarized in this review. We believe that the survival of patients with unresectable HCC without both macrovascular invasion and extrahepatic metastasis may be dramatically improved by optimal timing of TACE refractory and switching to systemic therapies.