Although continuous deep sedation (CDS) is sometimes used for terminally ill cancer patients to alleviate intolerable symptoms, there are few studies that comprehensively investigated CDS in general ward, including the rate of discussions by multiple occupations. The aim of this study was to retrospectively investigate the present state of CDS for patients in the general ward who were referred to the palliative care team (PCT). A total of 938 terminal cancer patients who were consulted with PCT between August 2012 and October 2015 were enrolled. Of the 938 patients enrolled in the study, 246 patients died in the general ward before the end of November 2015. Of the 246 patients, 28 patients (11.4%) were treated with CDS to alleviate intolerable symptoms in the terminal period. The mean duration of CDS was 4.1±3.1 days. Lung cancer was the most common in primary disease. The primary reason for starting CDS was dyspnea. All CDS were performed with midazolam. The discussions on CDS by multiple occupations were performed in all cases. We conclude that on weekdays the PCT visited the patient every day and was able to sedate all cases with sedation discussion by multiple occupations.

We report a case in which feelings of abdominal distension and discomfort of the abdominal wall caused by malignant ascites were relieved by ultrasound-guided rectus sheath block. Case report: A 59-year-old man developed gastric cancer with malignant ascites and experienced feelings of abdominal distension, but no nausea, dyspnea, poor mobility, or limb edema. Symptom control was inadequate with diuretic therapy and abdominal paracentesis. Feelings of distension improved temporarily with ultrasound-guided rectus sheath block. A percutaneous catheter was then used to administer an infusion of 0.25% ropivacaine triweekly until his death 20 days later. Conclusion: Feelings of abdominal distension is one of various symptoms of severe ascites and is difficult to manage. Ultrasound-guided rectus sheath block can be used to relieve this symptom on a case-by-case basis.

We report a case whose left lower limb neuropathic pain accompanied by pelvic tumor invasion was remarkably eliminated by ultrasound-guided sciatic nerve block. Case report: The subject was a sixty year old male. Pharmacological therapy was given according to the WHO analgesic ladder, but his left lower limb pain failed to respond to drugs. His intractable lower limb neuropathic pain was alleviated by ultrasound-guided sciatic nerve block. Drug delivery can be achieved with a percutaneous catheter and a disposable infusion pump. Infusions were run at 5mlh^-1 with 0.1% ropivacaine. Conclusion: Neuropahic pain is sometimes hard to be controlled only by opioids or adjuvant analgesics, but there is a possibility of providing pain relief by combination use with nerve blocks. Interventional techniques can be highly effective but also have the potentiality to produce significant adverse effects. Many patients have factors which would be considered a near absolute contra-indication to the use of nerve blocks such as immuno-compromise or impairment of coagulation. Skillful application of peripheral neural blockade with ultrasound imaging broadens the options for providing optimal pain management. Palliat Care Res 2011; 6(1): 313-315

Objective: Doping is strongly prohibited in sports.  Sports pharmacist was born in 2010 in Japan, and the anti-doping activity is expected.  On the other hand, doping by arising from a lack of knowledge about prohibited substances in athletes, so-called “unwilling doping” is developing into a social issue.  In this study, we investigated the percentage of prohibited substances in all drugs and prescriptions in a general hospital, to collect information to prevent an unwilling doping.
Methods: We constructed system to extract the drugs corresponding to prohibited substances in the prescription order entry system in Otaru Municipal Hospital, and we analyzed 3,306 prescriptions of 10 to 59 years old patients, from July to September 2010.
Results: Thirteen point five percent of our hospital drugs met definition of the prohibited substance.  The number of prescriptions including prohibited substance(s) was 350 (10.6%), and its category was different from each age-group and clinical department.
Consideration: Because prohibited substances are included in approximately 10% of prescriptions, athletes are exposed to danger of becoming an unwilling doping.  Pharmacist should be well informed about prohibited substances to prevent athletes from unwilling doping.  And they should provide information promptly and adequately for athletes.

BACKGROUNDIn an earlier study, we identified a locus for Moyamoya disease (MMD) on 17q25.3.

METHODSLinkage analysis and fine mapping were conducted for two new families in additional to the previously studied 15 families. Three genes, CARD14, Raptor, and AATK, were selected based on key words, namely, "inflammation", "apoptosis", "proliferation", and "vascular system", for further sequencing. A segregation analysis of 34 pedigrees was performed, followed by a case-control study in Japanese (90 cases vs. 384 controls), Korean (41 cases vs. 223 controls), Chinese (23 cases and 100 controls), and Caucasian (25 cases and 164 controls) populations.

RESULTSLinkage analysis increased the LOD score from 8.07 to 9.67 on 17q25.3. Fine mapping narrowed the linkage signal to a 2.1-Mb region. Sequencing revealed that only one newly identified polymorphism, ss161110142, which was located at position -1480 from the transcription site of the Raptor gene, was common to all four unrelated sequenced familial affected individuals. ss161110142 was then shown to segregate in the 34 pedigrees studied, resulting in a two-point LOD score of 14.2 (P = 3.89 × 10(-8)). Its penetrance was estimated to be 74.0%. Among the Asian populations tested (Japanese, Korean, and Chinese), the rare allele was much more frequent in cases (26, 33, and 4%, respectively) than in controls (1, 1, and 0%, respectively) and was associated with an increased odds ratio of 52.2 (95% confidence interval 27.2-100.2) (P = 2.5 × 10(-49)). This allele was, however, not detected in the Caucasian samples. Its population attributable risk was estimated to be 49% in the Japanese population, 66% in the Korean population, and 9% in the Chinese population.

CONCLUSIONss161110142 may confer susceptibility to MMD among East Asian populations.

ELECTRONIC SUPPLEMENTARY MATERIALThe online version of this article (doi:10.1007/s12199-009-0116-7) contains supplementary material, which is available to authorized users.