We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.

Purpose: This study aimed to implement an end-of-life care simulation that was assessed at one facility (University A) on nursing university students in a different educational environment (University B), and assess the simulation through a review. Method: After the simulation, participants were asked to freely comment on the review sheet and the contents were analyzed. There were 12 participants. Results: Comments on the review sheet were summarized in 13 categories: self-understanding of nursing, realization of one’s positive view regarding nursing, acquisition of knowledge regarding communication, acquisition of knowledge regarding end-of-life, gaining learning opportunities, realization of effects from debriefing, positive change one experiences regarding nursing, acquisition of knowledge regarding nursing, realization of reality, assessment of teachers’ involvement, assessment of implementation method, assessment of the atmosphere of the venue, and assessment of experiences. Conclusion: Participants of the simulation can be expected to gain a similar learning experience regardless of the learning environment.

Objectives: The relationship between weight-related load and bone mineral density (BMD)/bone microstructure under normal load conditions using high-resolution peripheral quantitative computed tomography (HR-pQCT) remains unconfirmed. The study aims to investigate the differences in effect of body mass index (BMI) on BMD/bone microstructure of loaded and unloaded bones, respectively, in Japanese postmenopausal women. Methods: Fifty-seven postmenopausal women underwent HR-pQCT on the tibia and radius. Correlation analysis, principal component (PC) analysis, and hierarchical multiple regression were performed to examine the relationship between BMI and HR-pQCT parameters. Results: Several microstructural parameters of the tibia and radius correlated with BMI through a simple correlation analysis, and these relationships remained unchanged even with an age-adjusted partial correlation analysis. PC analysis was conducted using seven bone microstructure parameters. The first PC (PC1) reflected all parameters of trabecular and cortical bone microstructures, except for cortical porosity, whereas the second PC (PC2) reflected only cortical bone microstructure. Hierarchical multiple regression analysis indicated that BMI was more strongly related to BMD/bone microstructure in the tibia than in the radius. Furthermore, BMI was associated with trabecular/cortical BMD, and PC1 (not PC2) of the tibia and radius. Thus, BMI was strongly related to the trabecular bone microstructure rather than the cortical bone microstructure. Conclusions Our data confirmed that BMI is associated with volumetric BMD and trabecular bone microstructure parameters in the tibia and radius. However, although BMI may be more related to HRpQCT parameters in the tibia than in the radius, the magnitude of association is modest.

Objectives: Physical activity to maintain bone mass and strength is important for hip fracture prevention. We aim to investigate the relationship between physical performance/activity status and bone mineral density (BMD)/hip structural analysis (HSA) parameters among postmenopausal women in Japan. Methods: Sixty-two postmenopausal women diagnosed with osteoporosis (mean age: 72.61 ± 7.43 years) were enrolled in this cross-sectional observational study. They were evaluated for BMD and HSA in the proximal femur by dual-energy X-ray absorptiometry and underwent several physical performance tests, the Geriatric Locomotive Function Scale of 25 questions (GLFS-25). Principal component analysis (PCA) was used to summarize data on the BMD/HSA parameters. Partial correlation analysis, multiple regression analysis, and structural equation modeling (SEM) were performed to investigate the relationship between physical performance/activity status and BMD/HSA parameters of the proximal femur. Results: In a partial correlation analysis adjusted for age and body mass index (BMI), GLFS-25 scores were correlated with HSA parameter (|r| = 0.260–0.396, P < 0.05). Principal component 1 (PC1) calculated by PCA was interpreted as more reflective of bone strength based on the value of BMD/HSA parameters. The SEM results showed that the model created by the 3 questions (Q13, brisk walking; Q15, keep walking without rest; Q20, load-bearing tasks and housework) of the GLFS-25 had the best fit and was associated with the PC1 score (β = −0.444, P = 0.001). Conclusions The GLFS-25 score was associated with the BMD/HSA parameter, which may reflect the bone strength of the proximal femur as calculated by PCA.

Objectives: The relationship between weight-related load and bone mineral density (BMD)/bone microstructure under normal load conditions using high-resolution peripheral quantitative computed tomography (HR-pQCT) remains unconfirmed. The study aims to investigate the differences in effect of body mass index (BMI) on BMD/bone microstructure of loaded and unloaded bones, respectively, in Japanese postmenopausal women. Methods: Fifty-seven postmenopausal women underwent HR-pQCT on the tibia and radius. Correlation analysis, principal component (PC) analysis, and hierarchical multiple regression were performed to examine the relationship between BMI and HR-pQCT parameters. Results: Several microstructural parameters of the tibia and radius correlated with BMI through a simple correlation analysis, and these relationships remained unchanged even with an age-adjusted partial correlation analysis. PC analysis was conducted using seven bone microstructure parameters. The first PC (PC1) reflected all parameters of trabecular and cortical bone microstructures, except for cortical porosity, whereas the second PC (PC2) reflected only cortical bone microstructure. Hierarchical multiple regression analysis indicated that BMI was more strongly related to BMD/bone microstructure in the tibia than in the radius. Furthermore, BMI was associated with trabecular/cortical BMD, and PC1 (not PC2) of the tibia and radius. Thus, BMI was strongly related to the trabecular bone microstructure rather than the cortical bone microstructure. Conclusions Our data confirmed that BMI is associated with volumetric BMD and trabecular bone microstructure parameters in the tibia and radius. However, although BMI may be more related to HRpQCT parameters in the tibia than in the radius, the magnitude of association is modest.

Objective: This study evaluated the effectiveness of an end-of-life care simulation as a way to improve nursing students’ resilience. Methods: In total, 61 baccalaureate nursing students were randomly assigned to control or education groups. In this randomized controlled study on an end-of-life care simulation, resilience was measured at baseline, and after the simulation. Result: At the baseline, the two groups showed no statistical differences in their resilience scores. However, the total score, and scores for the factors “I am”, “I have”, and “I will/ do” were significantly higher for the education group than the control group in the post-test. The total scores and three factor scores within the education group were also significantly higher in the post-test than at baseline, but in the control group only the “I am” factor significantly increased over time. Conclusion: The end-of-life care simulation scenario showed the potential to increase the resilience of participants, especially their ability to build trusting relationships with others and expand their network, and to set goals and grow toward them.

Background: and Purpose Although numerous measures for stroke exist, stroke remains one of the leading causes of death in Japan. In this study, we aimed to determine the long-term survival rate after first-ever stroke using data from a large-scale population-based stroke registry study in Japan. Methods: Part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry is an ongoing population-based registry study of stroke, which covers approximately 1.4 million residents of Shiga Prefecture in Japan. A total 1,880 patients with non-fatal first-ever stroke (among 29-day survivors after stroke onset) registered in 2011 were followed up until December 2016. Five-year cumulative survival rates were estimated using the Kaplan-Meier method, according to subtype of the index stroke. Cox proportional hazards models were used to assess predictors of subsequent all-cause death. Results: During an average 4.3-year follow-up period, 677 patients died. The 5-year cumulative survival rate after non-fatal first-ever stroke was 65.9%. Heterogeneity was present in 5-year cumulative survival according to stroke subtype: lacunar infarction, 75.1%; large-artery infarction, 61.5%; cardioembolic infarction, 44.9%; intracerebral hemorrhage, 69.1%; and subarachnoid hemorrhage, 77.9%. Age, male sex, Japan Coma Scale score on admission, and modified Rankin Scale score before stroke onset were associated with increased mortality during the chronic phase of ischemic and hemorrhagic stroke. Conclusions In this study conducted in a real-world setting of Japan, the 5-year survival rate after non-fatal first-ever stroke remained low, particularly among patients with cardioembolic infarction and large-artery infarction in the present population-based stroke registry.

BACKGROUND: Although fat accumulation in human organs is associated with a variety of diseases, there is little evidence about the effect of a fatty pancreas on the development of subclinical chronic pancreatitis over the clinical course. METHODS: We conducted a prospective cohort study from 2008 to 2014 of patients who underwent a medical checkup consultation for fat accumulated in the pancreas. Patients included in the analysis were divided into a non-fatty pancreas group (n = 9710) and fatty pancreas group (n = 223). The primary end point was the odds ratio (OR) for chronic pancreatitis associated with fatty pancreas, which was diagnosed using ultrasonography. We used a multiple logistic regression model to estimate the OR and the corresponding 95% confidence interval (CI). RESULTS: Ninety-two people were diagnosed with chronic pancreatitis, including both presumptive and definitive diagnoses. Twelve people were diagnosed with chronic pancreatitis by ultrasonography among the 223 patients with fatty pancreas, and 80 patients among 9710 were diagnosed with non-fatty pancreas. The crude OR was 6.85 (95% CI 3.68, 12.75), and the multiple adjusted OR was 3.96 (95% CI 2.04, 7.66). CONCLUSIONS Fat accumulation in the pancreas could be a risk factor for developing subclinical chronic pancreatitis.
Adipose Tissue ; diagnostic imaging ; pathology ; Adult ; Alcohol Drinking ; epidemiology ; Female ; Humans ; Japan ; epidemiology ; Life Style ; Logistic Models ; Male ; Middle Aged ; Pancreas ; diagnostic imaging ; pathology ; Pancreatitis, Chronic ; diagnosis ; epidemiology ; etiology ; Physical Examination ; Prospective Studies ; Risk Factors ; Smoking ; epidemiology

Purpose: To clarify the contents of nursing students’ feedback after they participated in a terminal care simulation. Method: Free description type answer sentences were analyzed qualitatively using Berelson’s content analysis. Results: Participants were 39 students. Feedback contents were divided into 334 recording units. As the result of analysis, 13 categories, including “acquisition of knowledge on communication,” “evaluation on method of implementation,” “self-understanding on nursing,” “self-positive-prospect on nursing,” “acquisition of knowledge on terminal care,” “evaluation on simulation ambience,” “acquisition of learning opportunities,” “self-positive-changing on nursing,” “effect of debriefing,” “effect of experience,” “feeling of reality,” “acquisition of knowledge on nursing” and “evaluation on faculty’s intervention” were formed. Conclusion: It was suggested that simulated patients contributed to making end of life clinical settings because the realism of the simulation had been apparent from the results. To make the terminal care simulation more developed, future studies should investigate how to give a briefing, and so on.