The modified Richmond Agitation-Sedation Scale (RASS) seems to be one of the best monitoring indicators for palliative sedation. We translated the modified RASS into Japanese according to the standard methods of conducting linguistic validation. The modified RASS revised two points from the original RASS for use in palliative care setting: deleted the description about the ventilator, and added some descriptions to clarify the meaning of RASS+1. In addition, we have deleted the description “rubbing sternum” in the procedure for RASS assessment, and then translated the modified RASS into Japanese. The translators and our research team members repeatedly discussed the linguistic validity until we agreed that the translated Japanese version is equivalent to the English one. The use of the Japanese version of the modified RASS to monitor palliative sedation may help to perform appropriate, and safe palliative sedation.

With the official launch of the new Japanese board of cardiovascular surgery, there are various changes compared to the old system, such as the choice of training period. We conducted a questionnaire survey to find out how U-40 members perceive and understand the new system. Based on the results of the survey, we discussed and presented the current situation and prospects of the new system at the 52nd Annual Meeting of the Japanese Society for Cardiovascular Surgery.

The purpose of this study was to clarify the effects of bicycle ergometer training and prostaglandin E₁ (PGE₁) for patients with intermittent claudication. Subjects were divided into four groups : the medication group (M), the PGE₁ group (P), the exercise group (E) and the PGE₁ and exercise group (PE). The P group was injected with 10μg of PGE₁, the E group performed bicycle ergometer exercise 3 times a week for 6 weeks, and the PE group was injected with PGE₁ and performed exercises. The maximal walking distance (MWD) was evaluated by a treadmill test. Muscle oxygenation level was measured by near-infrared spectroscopy and recovery half time (T_1/2) was calculated. MWD was significantly improved for P (142%), E (216%) and PE (240%) groups. T_1/2 was significantly improved in the E and PE groups. This study indicates that improvement of MWD was a result of development of muscle perfusion in lower limbs and PGE₁ injection may support exercise therapy.

Purpose: The review of the published reports was performed with the aim of systematic collection and integration of information related to "signs and symptoms" along with their changes among patients after upper gastroesophageal surgeries. Methods: The PubMed and the Japanese healthcare literature database were searched by the following keywords:"gastric cancer" "esopha∗ cancer" "surgery" and "symptom" As a result, 37 articles related to gastric or esophagus cancer were identified. The data were extracted according to each sign and symptom, and were evaluated and discussed. Results and Conclution: Standardized instruments for gastrointestinal symptoms included evaluations about dysphagia, difficulty in swallowing, reflux etc. The incidence of signs and symptoms, or postsurgical recovery processes are different among individual patients. Healthcare professionals should support patients continuously and systematically so that patients can take appropriate health maintenance behavior according to their signs and symptoms.

The first examination of the new board of the Japanese cardiovascular surgery took place in 2022. As it is a transitional period for the new system, many doctors are not familiar with the changes and details of the new system, and some have their concerns. Here, we held a round-table discussion with doctors who actually took the new board of the Japanese cardiovascular surgery under the new system, and we summarized their opinion.

Purpose: This study aimed at identifying difficulties among post thoracic esophagectomy cancer patients during outpatient follow-up. Methods: Patients who had radical esophagectomy at a cancer center hospital in Japan were prospectively observed and were interviewed by a certified nurse assigned at esophageal surgical outpatient division. Their responses were documented in medical records and were analyzed by content analysis method. This study was approved by the study hospital's research ethics committee. Results: The data from 66 patients were obtained. Content analysis yielded 221 extracts, 25 categories, and 65 codes of difficulties, including: concerns or signs/symptoms associated with dietary intake, physical activity, and anxiety. Implications: The majority of post-thoracoabdominal esophagectomy patients experienced multiple dysfunctions and symptoms after discharge. The results underscore the significance of nurses' role in assessing and instructing patients to address these issues.

Background: Patients having thoracic esophagectomy, a standardized treatment for esophageal cancer patients in Japan, are known to have various postsurgical signs and symptoms for a period of time. The current status of nursing interventions at outpatients need to be clarified. Purpose: This study aimed at identifying the nurses' interventions for cancer patients at the outpatient setting who previously had thoracic radical esophagectomy. Methods: Patients who had esophagectomy at a cancer center hospital in Japan were prospectively observed and interviewed by outpatient nurses between January 2009 and December 2010. Their documented responses in medical record were prospectively investigated and were qualitatively analyzed via content analysis method. This study was approved by the study hospital's research ethics committee. Results and discussion: The data analysis of nursing interventions for 66 patients yielded 372 extracts, 12 categories, and 74 codes. Nurses were assessing patients' signs and symptoms affected by postsurgical changes, and were utilizing patients' active self-monitoring skills. The results also showed the significance of facilitating postsurgical recovery in relation to nutritional intake and physical activity in patients' daily life. Implications: Based upon the study results, the development of a systematic program is underway, which facilitates esophageal cancer patients' postsurgical recovery.

A 55-year-old woman with fever and consciousness disorder diagnosed as infective endocarditis was transported to our hospital. She had atopic dermatitis. A mobile vegetation at the mitral valve was revealed by the transesophageal echocardiography, and a computed tomography (CT) scan showed cerebral infarction, left renal infarction and suspected embolization of the vegetation. Streptococcus aureus was detected in the blood culture test. We conducted emergent surgery, mitral valve plasty was performed. On the second day after the operation, the hemoglobin began to decrease, and the hemodynamics became unstable. The contrast CT examination revealed arterial bleeding from the left kidney, which had an infarction before the operation. We performed emergent catheter liquid embolization for the superior polar branch of the left renal artery, and the hemodynamics improved thereafter. There has been no report of renal hemorrhage after cardiac surgery for infective endocarditis. This case reminded us that cardiac surgery for infective endocarditis may cause various complications of organs.

We report a successful case of fulminant myocarditis treated with central ECMO with a transapical left ventricular vent (TLVV). A 33-year-old man was diagnosed with fulminant myocarditis with acute biventricular failure. Using a cardio-pulmonary bypass, we introduced central ECMO with ascending aortic perfusion, right atrial venous drainage and TLVV. After ancillary circulation, his cardiac function gradually improved. The endotracheal tube was removed 5 days after the surgery (POD 5), and he was weaned from ECMO on POD 7 and discharged on POD 38. Although there are many cases in which peripheral veno-arterial ECMO (VA-ECMO) is used for fulminant myocarditis, there is a drawback to VA-ECMO : left ventricle (LV) unloading may be incomplete. Insufficient LV unloading may cause pulmonary congestion or disadvantage in myocardial recovery. TLVV can be used as a solution to unload the left ventricle. Central ECMO with TLVV should be useful therapy for fulminant myocarditis.

A 76-year-old man with a complaint of dyspnea was diagnosed with acute severe mitral regurgitation due to ruptured chordae tendineae. For improvement of pulmonary congestion, we introduced IMPELLA 5.0® and extra-corporeal membrane oxygenation before valve surgery. After two-days' IMPELLA 5.0® support, mitral valve replacement surgery with a bioprosthetic valve was performed and IMPELLA 5.0® was withdrawn. We report a successful case of a bridge to surgery using IMPELLA 5.0® with mitral valve regurgitation accompanied by acute left heart failure with severe respiratory failure.