The primary aim of this study was to estimate the number of cancer patients who wanted home death based on the bereaved family survey.A postal survey performed on 1,137 bereaved family members in 4 regions to clarify the degree what they believed that the patient actually died where s/he had wanted on the Good Death Inventory, and to explore the preferred place of death. We calculated estimated number of patients who had wanted home death as a total of (1) the actual number of home death × the percentages of the family members who agreed that the patient actually died where s/he had wanted, and × the actual number of hospital death × the percentages of the family members who disagreed that the patient actually died where s/he had wanted and home was the preferred place of death. Estimated number of cancer patients who wanted home death was 32.8%［95%C.I., 31.7, 33.9］ in the surveyed regions, and 31.2%［95%C.I., 31.1, 31.4］ for national data.

Background: Video laryngoscopy is beneficial in difficult airway intubation; however, various factors complicate the process. These devices come in different designs, and their usefulness may vary by type. In this study, we compared the effectiveness of several video laryngoscopic .instruments across three simulated difficult intubation scenarios using manikin models. Methods: Training simulators for tracheal intubation were set to four conditions: (i) Normal (mouth opening:50 mm, normal neck); (ii) Head tilt disorder (mouth opening: 50 mm, rigid neck); (iii) Trismus (mouth opening:20 mm, normal neck); and (iv) Head tilt disorder + trismus (mouth opening: 20 mm, rigid neck). Seventeen dental anesthesiologists attempted oral tracheal intubation using the following video laryngoscopes: Airway Scope;McGRATH (Normal blade [size 3]); McGRATH (X-blade); and i-view. Evaluated parameters included total intubation time, glottic visualization time, tube induction time, success rate, and difficulty grading of tracheal intubation (Cormack-Lehane classification and the Numerical Rating Scale [NRS]). Statistical analysis was conducted using mixed models, incorporating two-way ANOVA, Tukey’s test, two-way ANOVA without repeated measures, and Kruskal-Wallis test, with P < 0.05 deemed statistically significant. Results: Intubation time using i-view was significantly longer for head tilt disorder and trismus compared to other video laryngoscopes (head tilt disorder: P < 0.001 for all, trismus: P = 0.021 vs. Airway Scope, P = 0.028 vs. X-blade). The Cormack-Lehane grade was notably high (P = 0.001) for tracheal intubation with i-view in the head tilt disorder scenario, with intubation failing in three cases. In the combined situation of head tilt disorder and trismus, intubation time with Airway Scope was shorter (P < 0.001 vs. X-blade), achieving a success rate of 100%. However, all attempts with i-view were unsuccessful. The NRS score was significantly higher for i-view compared to the other video laryngoscopes (P < 0.001). Conclusion Video laryngoscopy effectiveness varies by type in difficult tracheal intubation cases. The Airway Scope or McGRATH instrument appears more suitable for such cases, as indicated by the metrics of intubation time, success rate, and difficulty level.

Background: Video laryngoscopy is beneficial in difficult airway intubation; however, various factors complicate the process. These devices come in different designs, and their usefulness may vary by type. In this study, we compared the effectiveness of several video laryngoscopic .instruments across three simulated difficult intubation scenarios using manikin models. Methods: Training simulators for tracheal intubation were set to four conditions: (i) Normal (mouth opening:50 mm, normal neck); (ii) Head tilt disorder (mouth opening: 50 mm, rigid neck); (iii) Trismus (mouth opening:20 mm, normal neck); and (iv) Head tilt disorder + trismus (mouth opening: 20 mm, rigid neck). Seventeen dental anesthesiologists attempted oral tracheal intubation using the following video laryngoscopes: Airway Scope;McGRATH (Normal blade [size 3]); McGRATH (X-blade); and i-view. Evaluated parameters included total intubation time, glottic visualization time, tube induction time, success rate, and difficulty grading of tracheal intubation (Cormack-Lehane classification and the Numerical Rating Scale [NRS]). Statistical analysis was conducted using mixed models, incorporating two-way ANOVA, Tukey’s test, two-way ANOVA without repeated measures, and Kruskal-Wallis test, with P < 0.05 deemed statistically significant. Results: Intubation time using i-view was significantly longer for head tilt disorder and trismus compared to other video laryngoscopes (head tilt disorder: P < 0.001 for all, trismus: P = 0.021 vs. Airway Scope, P = 0.028 vs. X-blade). The Cormack-Lehane grade was notably high (P = 0.001) for tracheal intubation with i-view in the head tilt disorder scenario, with intubation failing in three cases. In the combined situation of head tilt disorder and trismus, intubation time with Airway Scope was shorter (P < 0.001 vs. X-blade), achieving a success rate of 100%. However, all attempts with i-view were unsuccessful. The NRS score was significantly higher for i-view compared to the other video laryngoscopes (P < 0.001). Conclusion Video laryngoscopy effectiveness varies by type in difficult tracheal intubation cases. The Airway Scope or McGRATH instrument appears more suitable for such cases, as indicated by the metrics of intubation time, success rate, and difficulty level.

Background: Video laryngoscopy is beneficial in difficult airway intubation; however, various factors complicate the process. These devices come in different designs, and their usefulness may vary by type. In this study, we compared the effectiveness of several video laryngoscopic .instruments across three simulated difficult intubation scenarios using manikin models. Methods: Training simulators for tracheal intubation were set to four conditions: (i) Normal (mouth opening:50 mm, normal neck); (ii) Head tilt disorder (mouth opening: 50 mm, rigid neck); (iii) Trismus (mouth opening:20 mm, normal neck); and (iv) Head tilt disorder + trismus (mouth opening: 20 mm, rigid neck). Seventeen dental anesthesiologists attempted oral tracheal intubation using the following video laryngoscopes: Airway Scope;McGRATH (Normal blade [size 3]); McGRATH (X-blade); and i-view. Evaluated parameters included total intubation time, glottic visualization time, tube induction time, success rate, and difficulty grading of tracheal intubation (Cormack-Lehane classification and the Numerical Rating Scale [NRS]). Statistical analysis was conducted using mixed models, incorporating two-way ANOVA, Tukey’s test, two-way ANOVA without repeated measures, and Kruskal-Wallis test, with P < 0.05 deemed statistically significant. Results: Intubation time using i-view was significantly longer for head tilt disorder and trismus compared to other video laryngoscopes (head tilt disorder: P < 0.001 for all, trismus: P = 0.021 vs. Airway Scope, P = 0.028 vs. X-blade). The Cormack-Lehane grade was notably high (P = 0.001) for tracheal intubation with i-view in the head tilt disorder scenario, with intubation failing in three cases. In the combined situation of head tilt disorder and trismus, intubation time with Airway Scope was shorter (P < 0.001 vs. X-blade), achieving a success rate of 100%. However, all attempts with i-view were unsuccessful. The NRS score was significantly higher for i-view compared to the other video laryngoscopes (P < 0.001). Conclusion Video laryngoscopy effectiveness varies by type in difficult tracheal intubation cases. The Airway Scope or McGRATH instrument appears more suitable for such cases, as indicated by the metrics of intubation time, success rate, and difficulty level.

Herein is reported our experience of radiation therapy using a real-time tumor-tracking and gated radiotherapy (RTRT) system for inoperable pancreatic cancer. Three unresectable pancreatic cancer patients were treated with intraoperative electron beam radiation therapy, at the time of open biopsy, and postoperative external beam radiation therapy using an RTRT system with a 2.0 mm diameter gold ball implanted into the pancreas. The total BED's (alpha/beta=10) was intended to be equivalent to that of delivering 60 Gy by 2.0 Gy/fraction, while the actual dose schedules were individualized. The movement of the pancreas was analyzed based on the 3-dimensional marker positions during the RTRT. The side effects and tumor responses were evaluated. During the RTRT course, the average movement of markers in the x (left to right), y (cranial to caudal) and z (dorsal to ventral) directions were 3.0 mm (1.7- 5.2 mm), 5.2 mm (3.5 - 6.8 mm) and 3.5 mm (2.7 - 5.1 mm), respectively. During and after the course of postoperative radiation therapy, no acute side effects of RTOG grade II or higher were detected. The objective tumor responses, as evaluated by CT scans 3 months after the treatment, were 2 partial responses and no response in one patient. Using the RTRT technique the margin of treatment planning and the possible errors in target localization were reduced, and the 3-dimensional movement of the internal marker implanted in the pancreas was able to be analyzed.
Aged ; Computer Systems ; Female ; Humans ; Middle Aged ; Pancreas ; Pancreatic Neoplasms/*radiotherapy ; Radiotherapy/*methods ; Radiotherapy Planning, Computer-Assisted/*methods

Purpose: Total or proximal gastrectomy of the upper-third early gastric cancer (u-EGC) often causes severe post-gastrectomy syndrome, suggesting that these procedures are extremely invasive for patients without pathologically positive lymph node (LN) metastasis. This study aimed to evaluate the clinical applicability of a stomach function-preserving surgery, local resection (LR), with prophylactic left gastric artery (LGA)-basin dissection (LGA-BD). Materials and Methods: The data of patients with u-EGC (pathologically diagnosed as T1) were retrospectively analyzed. Total gastrectomy was performed in 30 patients, proximal gastrectomy in 45, and subtotal gastrectomy in 6; the LN status was evaluated assuming that the patients had already underwent LR + LGA-BD. This procedure was considered feasible in patients without LN metastases or in patients with cancer in the LGA basin. The reproducibility of the results was also evaluated using an external validation dataset. Results: Of the 82 eligible patients, 79 (96.3%) were cured after undergoing LR + LGA-BD, 74 (90.2%) were pathologically negative for LN metastases, and 5 (6.1%) had LN metastases, but these findings were only observed in the LGA basin. Similarly, of the 406 eligible tumors in the validation dataset, 396 (97.5%) were potentially curative. Tumors in the lesser curvature, post-endoscopic resection status, and small tumors (<20 mm) were considered to be stronger indicators of LR + LGA-BD as all subpopulation cases met our feasibility criteria. Conclusions More than 95% of the patients with u-EGC might be eligible for LR + LGA-BD.This function-preserving procedure may contribute to the development of u-EGC without pathological LN metastases, especially for tumors located at the lesser curvature.

Systemic administration of opioids rarely causes pruritus, although its mechanism is still not clearly understood. We report an intractable pruritus induced by a change in the dosage form of opioids with the same dose by the conversion ratio, which promptly disapeared with opioid switching. A 80-year-old female experienced worsening dorsal pain and abdominal pain due to recurrent pancreatic cancer. The relief of pain was insufficient with the administration of oral hydromorphone 10 mg/day, changing to continuous intravenous hydromorphone 3 mg/day considering adjustability. The next day, her pain was reduced, but the pruritus appeared. Administering oral and topical antihistamines was ineffective. Her pruritus tended to worsen with continued administration of continuous intravenous hydromorphone at the same dose. Hence we switched to fentanyl patch 0.6 mg/day. The following day, her pruritus significantly decreased, and two days later, her pruritus almost disappeared. This case suggests that opioids switching to fentanyl patch may be effective to relieve pruritus caused by hydromorphone.

Purpose: To investigate the association between skin advanced glycation end-products (AGEs) levels, blood antioxidative vitamin and carotenoid concentrations, and severe erectile dysfunction (ED) in community-dwelling men. Materials and Methods: This cross-sectional study used the 5-Item International Index of Erectile Function to identify 335 community-dwelling men with ED. The accumulation of skin AGEs was assessed noninvasively by measuring skin autofluorescence. Background-adjusted multivariable logistic regression analyses using the inverse probability of treatment weighting method were performed to evaluate the effects of AGEs, vitamins, and carotenoids on severe ED. Moreover, multiple linear regression analyses were performed to assess the association between skin AGEs levels and serum carotenoid concentrations. Results: The median age of study participants was 57 years. Of the 335 men, 289 (86.3%) and 46 (13.7%) were classified into the mild/moderate and severe ED groups, respectively. Multivariable analyses revealed that skin AGEs levels, blood vitamins C and E, lutein, zeaxanthin, β-cryptoxanthin, α-carotene, β-carotene, total lycopene, and cis-lycopenes concentrations were significantly associated with severe ED, whereas all-trans lycopene concentrations were not. In the multiple linear regression analyses, serum zeaxanthin concentrations were negatively and significantly correlated with skin AGEs levels. Conclusions Higher skin AGEs levels and lower blood antioxidative vitamin and carotenoid concentrations were significantly associated with severe ED. Serum zeaxanthin levels were negatively and significantly correlated with skin AGEs levels, suggesting the possible effects of zeaxanthin on ED by decreasing tissue AGEs levels.

Purpose: The study aimed to compare the diagnostic performance of washout-parametric imaging (WOPI) with that of conventional contrast-enhanced ultrasound (cCEUS) in differentiating focal liver lesions (FLLs). Methods: A total of 181 FLLs were imaged with contrast-enhanced ultrasound using Sonazoid, and the recordings were captured for 10 minutes in a prospective setting. WOPI was constructed from three images, depicting the arterial phase (peak enhancement), the early portal venous phase (1-minute post-injection), and the vasculo-Kupffer phase (5 or 10 minutes post-injection). The intensity variations in these images were color-coded and superimposed to produce a single image representing the washout timing across the lesions. From the 181 FLLs, 30 hepatocellular carcinomas (HCCs), 30 non-HCC malignancies, and 30 benign lesions were randomly selected for an observer study. Both techniques (cCEUS and WOPI) were evaluated by four off-site readers. They classified each lesion as benign or malignant using a continuous rating scale, with the endpoints representing "definitely benign" and "definitely malignant." The diagnostic performance of cCEUS and WOPI was compared using the area under the receiver operating characteristic curve (AUC) with the DeLong test. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Results: The difference in average AUC values between WOPI and cCEUS was 0.0062 (95% confidence interval, -0.0161 to 0.0285), indicating no significant difference between techniques. The interobserver agreement was higher for WOPI (ICC, 0.77) than cCEUS (ICC, 0.67). Conclusion The diagnostic performance of WOPI is comparable to that of cCEUS in differentiating FLLs, with superior interobserver agreement.