Objective: This study aimed to clarify the preferred place for end-of-life care and the perceptions of palliative care among elderly people living in areas with a high aging rate and limited healthcare resources. Methods: A questionnaire survey was conducted in June 2022, one and a half years after the palliative care team (PCT) was established, in a community with an aging population of over 40%. Results: Among 1,298 patients aged 65 years or older, 475 (36.6%) provided valid responses. Of these, 317 (66.7%) expressed a preference to spend as much time as possible at home for end-of-life care, and 157 (49.5%) indicated that it would be difficult to spend their final days at home. In addition, 277 (58.3%) of respondents had heard about palliative care, and 437 (92.0%) had never heard of PCT at the hospital. Conclusion: Our findings revealed the preferred place for end-of-life care and awareness of palliative care among elderly people living in areas with a highly aging population and limited healthcare resources. It is necessary to promote palliative care in hospitals and develop a collaborative system with community healthcare providers.

Multiple endocrine neoplasia type 1 (MEN1) is an inherited autosomal dominant disease presenting with pancreatic neuroendocrine tumors (pNETs), parathyroid tumors, or pituitary tumors. Using the PubMed database, we reviewed the literature on information regarding the proper diagnosis and treatment of MEN1-associated pNET. Many cases of MEN1-associated pNET are functioning pNETs. Gastrinomas and insulinomas tend to occur frequently in the duodenum and pancreas, respectively. In addition to diagnostic imaging, the selective arterial secretagogue injection test (SASI test) is useful for localizing functioning pNET. The standard treatment is surgical resection. However, in the case of a functioning pNET, the tumor should first be accurately located using the SASI test before an appropriate surgical method is selected. In cases of a MEN1-associated non-functioning pNET that exceeds 2 cm in diameter, the incidence of distant metastasis is significantly increased, and surgery is recommended. In cases of unresectable pNET, a somatostatin analog has been shown to demonstrate antitumor effects and is considered to be a promising treatment. In addition, molecular-targeted drugs have recently been found to be effective in phase III clinical trials.
Diagnostic Imaging ; Duodenum ; Gastrinoma ; Incidence ; Insulinoma ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors ; Pancreas ; Pituitary Neoplasms ; Somatostatin

OBJECTIVES: Endoscopic laryngopharyngeal surgery (ELPS) is a minimally invasive transoral surgery that was developed to treat superficial larygo-pharyngeal cancer, in which a mucosal lesion is resected transorally while preserving deeper structures by subepithelial injection. The purpose of this retrospective study is to evaluate voice outcome in patients who underwent ELPS for superficial hypopharyngeal cancer. As important structures in producing voice, such as intrinsic laryngeal muscles, their fascia, and recurrent laryngeal nerve, are located in the medial side of the piriform sinus and the postcricoid region of the hypopharynx, we focused on patients with cancer lesions involving these regions. METHODS: From April 2010 to March 2011, 25 consecutive patients with superficial laryngopharyngeal cancer were treated with ELPS at Kyoto University Hospital. Among the 25 patients, 11 patients with cancer lesions on the medial side of the piriform sinus or the postcricoid area were studied. Preoperative and postoperative voice functions including maximum phonation time (MPT), mean flow rate (MFR), jitter, shimmer, soft phonation index (SPI), and noise-to-harmonic ratio (NHR), were compared retrospectively. RESULTS: Five of 11 cancer lesions had submucosal invasion and no lesion had invaded the muscular layer pathologically. T stage was classified as Tis in 5 cases, T1 in 4 cases, and T2 in 2 cases. All lesions involved the medial side of the piriform sinus and 2 also involved the postcricoid area. Vocal fold movement was normal in all cases after the surgery. Average preoperative and postoperative values for MPT, MFR, jitter, shimmer, SPI, and NHR, were 22.7 seconds and 23.4 seconds, 165 mL/sec and 150 mL/sec, 1.53% and 1.77%, 3.82% and 5.17%, 35.5 and 36.6, and 0.13% and 0.14%, respectively. There was no statistical difference between preoperative and postoperative data for all values examined. CONCLUSION: ELPS is useful in preserving voice function in the treatment of superficial hypopharyngeal cancer. Preserving the deeper structures including intrinsic muscles and their fascia may be important for preserving voice function as long as the lesions are superficial.
Fascia ; Humans ; Hypopharyngeal Neoplasms* ; Hypopharynx ; Laryngeal Muscles ; Muscles ; Narrow Band Imaging ; Phonation ; Pyriform Sinus ; Recurrent Laryngeal Nerve ; Retrospective Studies ; Vocal Cords ; Voice*

Purpose: To examine the feasibility of the Integrated Palliative care Outcome Scale (IPOS), a comprehensive palliative care scale, for non-cancer patients. Methods: Twenty non-cancer patients and 20 healthcare providers who provide care to the participating patients were asked to complete the IPOS questionnaire, and cognitive interviews were conducted with them. The interviews were analysed using content analysis, a qualitative analysis method. Results: About half to 90% of both patients and healthcare providers answered that they did not find it difficult to answer or understand all items of the IPOS. Therefore, we confirmed its surface validity, and the content validity of the IPOS was confirmed. Conclusion: The surface validity and content validity of the IPOS for non-cancer patients were confirmed, and it became clear that the IPOS can be used as a comprehensive assessment tool for the palliative care of non-cancer patients.

Purpose: Owing to the increasing mortality rate in Japan, basic nursing education on the end-of-life care is essential. This study determined the educational learning outcomes of the angel care practice that involves angel makeup based on the reflective descriptions of nursing students. Methods: About 87 students enrolled in the “Seminar in Adult Nursing Practice (Nursing at the End-of-Life: Angel Care)” course at Iwate Medical University School of Nursing in June 2021 consented to participate in the present study. After experiencing the roles of patient, family member, and nurse in the angel care practice, the participants reflected on the care they provided to the patients and their families. Their descriptions on the practice sheets were analyzed to determine the learning outcomes of the angel care practice. Results: “Awareness of the importance of angel care,” “understanding angel care through practice,” and “motivation and concerns as a nurse” were the learning outcomes of the angel care practice for nursing students. Conclusion: The practice that incorporates angel care along with lectures provides nursing students with an opportunity to learn ways to maintain their patient’s dignity.

Background/Aims: Recent studies indicate that probiotics, which have attracted attention as a treatment for irritable bowel syndrome, affect intestinal homeostasis. In this study, we investigated whether Zygosaccharomyces sapae (strain I-6), a probiotic yeast isolated from miso (a traditional Japanese fermented food), could improve irritable bowel syndrome symptoms. Methods: Male Wistar rats were exposed to water avoidance stress (WAS). The number of defecations during WAS and the visceral hypersensitivity before and after WAS were evaluated using colorectal distension. Tight junction changes were assessed by Western blotting. Some rats were fed with strain I-6 or β-glucan from strain I-6. Changes in the intestinal microbiota were analyzed.The effect of fecal microbiota transplantation after WAS was evaluated similarly. Caco-2 cells were stimulated with interleukin-1β and tight junction changes were investigated after coculture with strain I-6. Results: The increased number of stool pellets and visceral hypersensitivity induced by WAS were suppressed by administering strain I-6. The decrease in tight junction protein occludin by WAS was reversed by the administration of strain I-6. β-Glucan from strain I-6 also suppressed those changes induced by WAS. In the rat intestinal microbiota, treatment with strain I-6 altered the β-diversity and induced changes in bacterial occupancy. Upon fecal microbiota transplantation, some symptoms caused by WAS were ameliorated. Conclusions These results suggest that traditional fermented foods such as miso in Japan are valuable sources of probiotic yeast candidates, which may be useful for preventing and treating stress-induced visceral hypersensitivity.