Some terminally ill cancer patients are treated with palliative sedation（PS）to alleviate their suffering. There have been very few studies in Japan investigating PS in the home. Thus, the aim of the present study was to investigate PS at home for terminally ill patients. A retrospective chart review was performed of 117 cancer patients who died at home between August 2012 and July 2014. Of the 73 who patients died at home, 24（33％）had received PS. The mean duration of PS was 4.4±6.0 days. Patients receiving PS were started on a mean dose of 12.8±6.2 mg/day midazolam；the mean dose at the end of PS was 12.4±6.5 mg/day midazolam. The primary reason for starting PS was delirium（n＝22）. PS in the home was feasible and was an essential treatment for cancer patients at home. We conclude that PS can be used safely and efficaciously to treat terminally ill cancer patients with refractory symptoms in their own home.

A 75-year-old woman was admitted with complaints of progressive portprandial abdominal pain and weight loss. A bruit was audible in the epigastrium. Angiogram showed narrowing of the lower abdominal aorta with complete occlusion of the celiac, the superior and inferior mesenteric arteries. A 6mm Gore-Tex graft was first anastomosed from the supraceliac abdominal aorta to the superior mesenteric artery. A saphenous vein graft was then inserted proximally to the Gore-Tex graft and distally to the celiac artery. The postoperative course was uneventful. During two years of observation symptoms have disappeared and patient returned to a normal weight.

Taping is widely used by sports trainers to prevent injury and to protect affected sites post-injury. However, it is not clear whether taping affect the perception of somatosensory stimulation. We sought to clarify the effect of taping on somatosensory stimulation using somatosensory evoked potentials (SEPs). We recorded SEPs following transcutaneous electrical stimulation of the right medial forearm in ten healthy volunteers. SEPs were recorded from 9 electrodes on the scalp under control, elastic-taping and white-taping conditions. Subjects relaxed on a comfortable reclining seat without taping in the control condition, while they were subjected to taping along the muscle of forearm with tension (elastic-taping) and without tension (white-taping) in the taping conditions. Results showed that the peak amplitude of N140 did not differ significantly among the three conditions but the peak amplitude of P250 was significantly lower in the elastic-taping condition than control and white-taping conditions. Elastic-taping with tension along the muscles changes various afferent inputs from muscle spindle or skin, and this may affect the perception of somatosensory stimulation.

The aim of this study is to clarify the diet and complementary and alternative medicine among terminal cancer patients followed at home. A cross-sectional survey of bereaved families of 200 cancer patients who were received home care by 5 palliative care clinics in Kobe in 2014. The response rate was 66％. The average age of the patients was 74 years old. The family members received the information about diets from books, magazines, and newspaper（48％）and medical staff（46％）. The patients actively took in tea（64％）, dairy（62％）, and soy（60％）. The patient avoided alcohol（49％）, fat（31％）, and salt（31％）. The question asking the complementary and alternative medicine（CAM）, 32％ respondents answered using CAM, of which 28％ took mineral supplements, and vitamins. Due to the paucity of the evidence about the diet and CAM for cancer patients, the patient and family tend to practice the general diet therapy.

The aim of this study was to clarify diet and meal preparation for terminal cancer patients followed at home. A cross-sectional survey was administered to bereaved caregivers of 200 cancer patients who received home care from five palliative care clinics in Kobe in 2014. The response rate was 66% and the average age of the caregivers was 62 years. Overall, 57% of caregivers reported distress regarding diet and meal preparation for patients. The independent determinants of distress were: the experience of coaching from medical staff （P=0.012）; how to help patients with eating; difficulties in cooking and meal preparation （P=0.001）; and helping with eating for anorexic patients （P=0.004）. Due to the paucity of the evidence about diet and meal preparation for cancer patients, caregivers may not be receiving sufficient specific and practical dietary instruction from medical staff.

Objective: The aim of this study is to explore the factors associated with the burden of home care for doctors. Methods: In July 2013 a survey was mailed to a cross-section of clinics and hospitals in Kobe City. Results: Questionnaires were sent to 1,589 clinics and hospitals and 899 (57%) responded. Of these, data from 807 respondents were available for analysis. The burden of home care was felt to be considerable for 30% and slight for 31% of respondents. Determinants associated with the burden of home care were; 80 years and older doctors (P=0.05), particular medical measures (P=0.036), building links with other medical facility or care staff (P=0.002), and ensuring the sufficient time and staff (P<0.001). Conclusion: The majority of doctors reported a burden associated with home care.

Objective：The aim of this study was to investigate the current status of home care provided by hospitals and clinics in Kobe City. Methods：In July 2013 a survey was mailed to a cross-section of all clinics and hospitals in Kobe City. Results：Questionnaires were sent to 1,589 clinics and hospitals and 899（57％）responded. Regular and urgent home visits by doctors were provided by 50％ and 65％ of respondents, respectively. End-of-life care for dying patients at home and in nursing homes was provided by 31％ and 18％ of respondents, respectively. The average time spent on home visits was 2.3±1.7 days per week. Care for cancer patients, participation in national palliative care lectures, and holding a discussion at the admitting hospital before discharge for home care, were performed by 23％, 7.0％, and 6.9％ of respondents, respectively. Conclusion：The majority of hospitals and clinics in Kobe City provided home care.

The aim of this study was to investigate the end of life care provided by long-term care facilities and nursing homes. A cross-sectional survey of all long-term care facilities and nursing homes in Kobe was performed in July 2013. Questionnaires were sent to 350 facilities with an 89.7％ response rate. In total, 121（39％）of respondents stated that end of life care was available, and 151（48％）responded that facilities were willing to provide end of life care for terminally ill residents. One hundred fifty-two（48％）and 183（58％）of respondents answered that facilities were available for managing residents with percutaneous endoscopic gastrostomy, and transfusion, respectively. Seventy-two（23％）of respondents reported that facilities for managing the use of narcotics were available. In conclusion, a minority of long-term care facilities and nursing homes ware available for providing end of life care for residents, though approximately 50％ were willing to do so.

Chronic pancreatitis (CP) is pathologically characterized by the loss of exocrine pancreatic parenchyma, irregular fibrosis, cellular infiltration, and ductal abnormalities. Diagnosing CP objectively is difficult because standard diagnostic criteria are insufficient. The change of parenchymal hardness is the key factor for the diagnosis and understanding of the severity of CP. The ultrasonography (US) or endoscopic ultrasonography (EUS) elastography have been used to diagnose pancreatic diseases. Both strain elastography (SE) and shear wave elastography are specific diagnostic techniques for measuring tissue hardness. Most previous studies were conducted with SE. There are three methods of interpreting SE; the method of recognizing the patterns in SE distribution images in the region of interest, the method of using strain ratio to compare the hardness of adipose tissue or connective tissue with that of the lesion, and the method of evaluating the hardness distribution of a target by histogram analysis. These former two methods have been used primarily for neoplastic diseases, and histograms analysis has been used to assess hardness distribution in the evaluation of CP. Since the hardness of the pancreas increases with aging, it is necessary to consider the age in the diagnosis of pancreatic disorders using US or EUS elastography.

Background/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting. Methods: Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO. Results: A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033). Conclusions Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.