Purpose: This study was performed to evaluate the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in older patients with colorectal cancer (CRC) undergoing curative resection. Methods: We retrospectively analyzed 244 older patients (aged 75 years or higher) with pathological stage II or III CRC who underwent curative surgery between 2008 and 2016. The optimal value of CAR was calculated and its correlation with the clinicopathological factors and prognosis was examined. Results: The optimal cutoff value of the CAR was 0.085. High preoperative CAR was significantly associated with high carcinoembryonic antigen levels (P=0.001), larger tumor size (P<0.001), and pT factor (P=0.001). On multivariate analysis, high CAR was independent prognostic factor for relapse-free survival (P=0.042) and overall survival (P=0.001). Conclusion Preoperative elevated CAR could be considered as an adverse predictor of both relapse-free survival and overall survival in older patients with CRC undergoing curative surgery.

Although there have been studies reporting the efficacy of palliative radiation in treating liver tumors, there are very few reports in Japan. Therefore, this study aimed to evaluate the effect of palliative radiation on pain in patients with liver tumors. Between December 2014 and November 2016, 15 patients received palliative radiotherapy of 8 Gy in a single fraction for primary or metastatic liver tumors. Among them, 12 patients were assessed for pain before and after the radiation therapy using the Numeric Rating Scale (NRS). A decrease in the NRS score post radiation therapy was reported in all cases. No grade 3 or higher acute phase adverse events were observed. In conclusion, palliative irradiation managing pain due to liver tumors is possibly effective in relieving pain and well tolerated.

BACKGROUND/AIMS: The prevalence and severity of irritable bowel syndrome (IBS) declines with age, but the cause of this is unknown. This study tested 2 hypotheses: (1) autonomic nervous system responses to eating and bowel distention, measured by heart rate variability (HRV), differs by age in IBS patients and (2) HRV is correlated with colonic motility and IBS symptoms. METHODS: One hundred and fifty-six Rome III positive IBS patients and 31 healthy controls underwent colonic manometry with bag distention in the descending colon, followed by ingestion of an 810-kcal meal. HRV, evaluated by low frequency (%LF; 0.04–0.15 Hz) component, high frequency (%HF; 0.15–0.40 Hz) component, and the LF/HF ratio, was measured during colonic distention and after the meal. Motility index and subjective symptom scores were simultaneously quantified. RESULTS: Both colonic distention and eating decreased %HF and increased the LF/HF ratio, and both indices of autonomic nervous system correlated with age. In IBS patients, %HF negatively correlated with the postprandial motility index after adjusting for age. The %HF and LF/HF ratios also correlated with psychological symptoms but not bowel symptoms in IBS patients. CONCLUSION: Decreased vagal activity is associated with increase in age and greater postprandial colonic motility in patients with IBS, which may contribute to postprandial symptoms.
Autonomic Nervous System ; Colon ; Colon, Descending ; Eating ; Gastrointestinal Motility ; Heart Rate ; Humans ; Irritable Bowel Syndrome ; Manometry ; Meals ; Postprandial Period ; Prevalence ; Prospective Studies

This study evaluates the pertinent cutoffs of Timed Up and Go (TUG) and Chair Stand (CS) tests for detecting cognitive impairment risk in Japanese elderly. Subjects were community-dwelling adults aged 65 or older (N = 455, 129 men and 326 women). Cognitive function was examined using Urakami’s test for Alzheimer’s disease; physical function was examined by TUG and CS. The maximum score for cognitive function was 15; impairment was defined as 12 or less. Receiver operating characteristic (ROC) analyses were performed to find an appropriate cutoff of TUG and CS for cognitive impairment. Furthermore, the sensitivity and specificity of the combined use of these measures independently distinguishing between subjects with and without a risk for cognitive impairment were determined. Fifty-four subjects (12%) scored as impaired on Urakami’s test. The optimal TUG cutoff for cognitive impairment was 6 seconds and 9 seconds for CS. The combined use of TUG and CS, based on a subject being positive on at least one measure, yielded sensitivity of 78% and specificity of 50%. Area under the ROC curve of TUG and CS were respectively 0.67 and 0.66. When divided into two groups according to the TUG cutoff value, the odds ratio of cognitive impairment in the slower group was 2.1 (95% confidence interval 1.25-3.37). For CS cutoff, the slower-group odds ratio was 3.57 (95% confidence interval 2.20-5.81). For TUG and CS combined, the slower-group odds ratio was 2.11 (95% confidence interval 1.03-4.34). TUG and CS are thus potent predictors for cognitive impairment among elderly adults.

The aim of this study was to understand the use of complementary and alternative medicine (CAM) in cancer patients in Japan. This study was part of the Japan Hospice and Palliative care Evaluation 2016 (J-HOPE2016) Study. A multicenter questionnaire survey was conducted on a sample of bereaved family members of cancer patients who died at palliative care units. Data suggest that 54% of cancer patients use CAM. In comparison with a previous study in 2005 in Japan, categories of CAM vary widely; CAM previously included supplements mostly, but now exercise and mind and body therapy are also used. Most cancer patients use CAM without any harmful influence on their household economy and cancer treatment; however, in some patients, CAM incurs a large expense and a delay in starting cancer treatment. Therefore, it is important for medical staff and patients to have an opportunity to discuss CAM use. Multiple logistic regression analysis shows that CAM use is significantly associated with younger patients and highly educated families; moreover, there is a possibility that family members who use CAM have a high level of psychological distress. We must pay attention to the physical and the psychological aspects of cancer patients who use CAM and their families. Further studies are needed to investigate the use of each category of CAM, and to understand patients who use CAM and who die at home or in hospitals other than palliative care units.

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.

In order to understand the current status of terminal care for cancer patients and to investigate the significance of palliative care units (PCUs), we reviewed 414 cancer patients who died at our hospital during the 2-year period since October 2013 (PCU: 219 patients, general wards: 195 patients) based on their history of anticancer therapy and use of palliative care. Compared with PCU patients, those in the general wards were older, the diagnosis was delayed, and disease progression was more rapid. It was suggested that these factors had a negative impact on the opportunity to receive standard anticancer therapy and palliative care. Among the patients who received chemotherapy, the median interval from the final treatment to death was 110 days for those in the PCU while it was significantly shorter (55 days) for those in the general wards. Chemotherapy was administered within 1 month before death to 2% of patients in the PCU versus 32% of patients in the general wards, so the rate was much higher among the latter patients. In order to provide appropriate terminal care for cancer patients, the PCU seems to be important. Irrespective of the timing of cancer diagnosis and progression, it is important to increase general social awareness of palliative care and advanced care planning in order to promote the use of palliative care strategies.

A 78-year-old woman who had a history of left deep venous thrombosis was referred to our hospital with a sudden hemoptysis. Thoracic computed tomography showed a solitary pulmonary nodule in the right lower lobe. Based on her medical history of deep venous thrombosis, she was tentatively diagnosed as having pulmonary embolism and successfully treated by inserting an inferior vena cava filter and anticoagulant therapy with warfarin [Please confirm whether previous sentence is correct]. However, the lung nodule on thoracic computed tomography was still depicted four months later. With suspicion of a malignant tumor, including possible lung cancer, a right segmentectomy was performed. Pathological assessment of the resected specimen showed the tumor was derived from the right bronchial wall, but was not ruptured into the intratracheal lumen, as well as coexistence with intraalveolar hemorrhage near the tumor. The lung nodule was diagnosed as bronchial schwannoma. Thus, the origin of the hemoptysis was found to be pulmonary embolism due to deep vein thrombosis, and not by bronchial schwannoma, which was also present in the lung.

Tuberculous spondylitis, or so-called Pott's disease, seems to be overlooked because of a lack of severe inflammation in the insidious generating process and tends to cause non-specific symptoms, such as back pain, fever, weakness, and weight loss. Diagnostic delay is common and the results can be disastrous. Discriminating between Pott's disease and other diseases, such as malignancy and pyogenic infection, is difficult. However, the inflammatory process in Pott's disease tends to spare the disk space, while that of pyogenic infection typically affects the area. Herein, we present a patient with Pott's disease who showed the characteristic clinical and radiological findings.

Irritable bowel syndrome (IBS) is a common chronic disorder seen in gastroenterology and primary care practice. It is characterized by recurrent abdominal pain or discomfort associated with disturbed bowel function. It is a heterogeneous disorder with varying treatments, and in this regard physicians sometimes struggle with finding the optimal approach to management of patients with IBS. This disorder induces high health care costs and variably reduces health-related quality of life. IBS is in the class of functional gastrointestinal disorders, and results from dysregulation of central and enteric nervous system interactions. Psychosocial factors are closely related to their gut physiology, associated cognitions, symptom manifestations and illness behavior. Therefore, it is important for the physician to recognize the psychosocial issues of patients with IBS and in addition to build a good patient-physician relationship in order to optimize treatment. This review focuses on the interaction between psychological and physiological factors associated with IBS by using a biopsychosocial model. In this article, we describe (1) the predisposing psychological features seen in early life; (2) the psychological factors associated with life stress, the symptom presentation, and their associated coping patterns; (3) gut pathophysiology with emphasis on disturbances in motility, visceral hypersensitivity and brain-gut interactions; and finally (4) the clinical outcomes and effective treatments including psychotherapeutic methods.
Abdominal Pain ; Enteric Nervous System ; Gastroenterology ; Gastrointestinal Diseases ; Health Care Costs ; Humans ; Hypersensitivity ; Illness Behavior ; Irritable Bowel Syndrome ; Primary Health Care ; Quality of Life ; Stress, Psychological