Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy. Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions. Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44–8.40; p<0.001). Conclusions Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.

Objective: To evaluate the efficacy of high-flow nasal cannula oxygen (HFNC) for dyspnea in patients with advanced disease. Methods: A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Ichu-shi Web. Inclusion criteria were: 1) randomized controlled trials evaluating the effect of HFNC on dyspnea; 2) aged 18 years or older with advanced disease with hypoxemia; 3) control group was conventional oxygen therapy or noninvasive positive pressure ventilation. Exclusion criteria were: 1) patients in intensive care unit, 2) weaning from ventilator. Results: Six studies (4 from database searches, and 2 from hand searches) were included. In the 2 studies evaluating short-term intervention, one showed HFNC was more efficacious, and the other conventional oxygen was more efficacious. In the 2 studies evaluating long-term interventions: one showed HFNC was more efficacious, and the other showed no significant difference. In the 2 studies evaluating the intervention during exercise, one showed HFNC was more efficacious, and the other showed no significant difference. Conclusion: HFNC may be effective for dyspnea in patients with advanced disease associated with hypoxemia.

Objective: To evaluate the efficacy of fan therapy for the relief of dyspnea in patients with chronic progressive disease. Methods: A systematic electronic database search of all available articles published before October 23, 2019 was conducted using Ichushi-Web of the Japan Medical Abstract Society databases, CENTRAL, EMBASE, and MEDLINE. In addition, a hand-search for updates was performed using PubMed on June 30, 2020 and December 7, 2021. The inclusion criteria were: 1) any RCTs comparing the effect of fan therapy with any other intervention, and 2) patients aged ≥18 years. Exclusion criteria were: 1) duplicate references, and 2) conference presentations. Results: We identified 110 studies, of which 10 met our criteria for inclusion. Finally, five studies were used in the meta-analysis. Fan therapy significantly improved dyspnea in patients with chronic progressive disease compared to control groups with a standardized mean difference of −1.43 (95% confidence interval: −2.70 to −0.17, I2=94%, p<0.0001). Conclusion: Fan therapy was found to be effective in reducing dyspnea in chronic progressive disease.

Sleep disorders are risk factors for hypertension. This adverse effect is especially affected in women. Nevertheless, the impact of sleep habits on the cardiovascular response remains unclear in young women. This study aimed to determine whether sleep habits could affect blood pressure regulation at rest and during exercise in young women. Twenty-two young women participated in this study. The Pittsburgh Sleep Quality Index (PSQI), resting blood pressure (BP), and BP response to the 2-minute isometric handgrip exercise, which consists of 25% maximum force production using left hand, were measured. Beat-by-beat arterial BP changes during exercise was measured using the Finapres™ device, and it was averaged every 30 sec before and during exercise; BP reactivity was evaluated by the delta change from rest to exercise. The PSQI score was 5.2 ± 2.2. The resting systolic and diastolic BPs were 105 ± 7 mmHg and 62 ± 7 mmHg, respectively. BP reactivity to the exercise were Δ 4 ± 7 mmHg, Δ 4 ± 7 mmHg, Δ 6 ± 7 mmHg, and Δ 7 ± 9 mmHg, for each 30-sec interval. Poorer sleepers (PSQI > 4.5) showed a tendency toward lower resting systolic BP compared with better sleepers (PSQI < 4.5) (p = 0.069). Systolic BP reactivity to the last 30 sec of exercise was correlated with the PSQI score (r = 0.484, p = 0.022). In conclusion, sleep quality may affect the cardiovascular regulation at rest and during exercise in young women.

The median time of brain metastasis from the diagnosis of breast cancer is approximately 3 years. In this case report, a 69-year-old woman demonstrated cerebellar ataxia. Brain magnetic resonance imaging revealed enhanced lesions in bilateral cerebellar hemispheres. She had undergone surgery, radiation, and chemotherapy for uterine and breast cancer 24 years prior and 16 years prior, respectively. Although she had not received any anticancer treatment for 10 years, no recurrences were identified using whole body scans. A partial tumor resection was performed and the histological diagnosis was an adenocarcinoma from breast cancer. As no extracranial lesions were found, gamma-knife irradiation was performed, without additional systemic chemotherapy. One month posttreatment, the tumors dramatically reduced in size and the patient completely recovered from cerebellar ataxia. Systemic chemotherapy is not always required for brain metastasis from breast cancer with a long interval period, as long as no evidence of extracranial recurrence is detected.
Adenocarcinoma ; Aged ; Brain* ; Breast Neoplasms* ; Breast* ; Cerebellar Ataxia ; Diagnosis ; Drug Therapy ; Female ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Neoplasm Recurrence, Local ; Prognosis ; Recurrence* ; Whole Body Imaging

　　The platelet counts documented in most of the studies using the fully automated hematology analyzer XE-5000 are values measured by impedance technology (PLT-I). If blood specimens showing an anomalous particle-size distribution curve in the area where platelet counts are low are used (exceptionally low platelet count samples), the counting method is automatically switched over to an optical method (PLT-O). In the present study, we examined the usefulness of the XE-5000 by comparing PLT-I with PLT-O, using blood samples with low platelet counts collected from patients who visited our hospital between January 1 and March 31, 2012. Dilution linearity left nothing to be desired in either of the two, but simultaneous reproducibility was higher in PLT-O than in PLT-I. The correlations of PLT-I and PLT-O with visual counts were high, working out at r＝0.889～0.984. In the exceptionally low platelet count samples, the correlation coefficient was high in PLT-O than in PLT-I. The cases showing low platelet counts frequently presented giant platelets and/or red cell fragments. Therefore, measuring the samples with low platelet counts requires a high degree of precision. In the samples with exceptionally low platelet counts, PLT-O exceeded PLT-I in simultaneous reproducibility and correlation with visual counts. Thus, our study demonstrated the usefulness of the XE-5000 that could enumerate PLT-O automatically and speedily.

We report a patient with gingival metastasis of lung cancer in whom the use of sedatives was successfully avoided by employing holistic care approaches. A 64-year-old man had been receiving chemotherapy with the diagnosis of advanced lung cancer. Eighteen months later, a rapidly growing gingival metastasis was observed. Arterial embolization was performed, but it failed to control the bleeding. No active treatment was performed, and he was subsequently transferred to our hospital. He desired death, with markedly pessimistic views, and wished to undergo deep and continuous palliative sedation (DCPS) due to severe total pain (particularly psychological and spiritual) from the beginning. However, he died peacefully before receiving DCPS. We present a literature review of gingival metastasis from lung cancer, as well as our assessment and palliative care for the total pain of this patient.

When patients hospitalized in a palliative care unit die, particularly when their deaths were not peaceful ones, we, as health professionals, feel distressed, senses of helplessness and defeat, and even regret. However, busy daily clinical practice usually does not allow us to express these feelings. After going through such an experience repeatedly, your self-efficacy may be reduced and you could feel burned out. In this study, through the experience of coping with the death of a liver cancer patient who died of necrotizing fasciitis resulted from bedsore, a death conference was organized for us, health professionals who had been directly concerned with the patient, to discuss questions, conflicts, and dilemmas that arose when we provided care and express feelings that had been repressed. And other participants in the conference, who had not been directly concerned with the patient, gave their affirmative views. The conferences served to: (1) promote mutual understanding, trustful relationships, and teamwork among us, (2) increase our awareness of palliative care, and (3) allow us to cope with stress and prevent us from feeling burned out. These effects are considered to help implement improved health care. In the former part of the conference remarks were divided into three categories, (1) regret, (2) questions, conflicts, and dilemmas, and (3) senses of helplessness and defeat, and in the latter part affirmative views were mainly stated.