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Objectives: Early palliative care reportedly contributes to the quality of life by improving coping skills in patients with cancer. The aims of the study are to (1) Build a self-coping system that makes it possible to perform a session of home-based heart rate variability biofeedback (HRV-BF) with resonant breathing in patients with sleep disturbance and to acquire its techniques early on, and (2) Examine its short-term efficacy and feasibility., Methods: A randomised, open-label, comparative study was conducted in the presence or absence of home-based HRV-BF with resonant breathing using a portable HRV-BF device prior to bedtime. The participants were 50 patients with incurable cancer with sleep disturbance who underwent a hospital practice of HRV-BF with resonant breathing. The primary end point was the rate of change in sleep efficiency for 10-14 days. The Japanese version of the Pittsburgh Sleep Quality Index (subjective indicator) and actigraphy sleep parameters (objective indicators) were used for sleep assessments., Results: The completion rate and implementation rate in the home-based HRV-BF group (n=25) were 96.0% and 91.4%, respectively. This group showed a significant improvement in sleep efficiency, sleep duration and the low-frequency component of HRV. Sleep latency worsened in this group, but a significant difference was not observed., Conclusions: A home practice of HRV-BF with resonant breathing made it possible to acquire its techniques early on and improve sleep and autonomic function; therefore, our study showed high short-term efficacy and feasibility required for a self-coping system., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

"Functional somatic syndromes" is one of the new terminologies in the medicine. However most of the primary-care physicians have already noticed the existence of the patient appeal their physical symptoms which is medically unexplained for a long time. On the other hand, the psychiatrists looked same physical symptoms as a symbolic representation of the patients' psychological conflicts, somatoform disorders. This new terminology "functional somatic syndromes" intends to integrate those two dimensions and to understand the patient as a whole person. In this special issue, we show the multi-dimensional aspects of "functional somatic syndromes" and intend to serve the clue to understand the patients with symptoms to all primary-care physicians in Japan.

The core pathological concept of functional somatic syndrome (FSS) is the discrepancy between patients' subjective experience of somatic symptoms and objective explanation by medical evaluation. Based on the discrepancy, the somatic symptoms with medically unexplained origins maintains, prolonged chronically, and grow up to FSS owing to various factors; physiological pathways, mood disturbance such as anxiety or depression, doctor-patient relationship, psychosocial stresses, alexithymia and alexisomia, and lack of support systems. As the pathology becomes more and more complicated, the psychosocial stresses, mood disturbance, and physiological dysfunction become more significant. Thus, the pathology falls into a vicious circle. Patients with FSS have common problems or characteristics, and have several overlapped diagnoses. FSS should be treated from aspects of both the similarity and the difference.

Functional somatic syndrome (FSS) with abdominal pain include functional gastrointestinal disorder, chronic pancreatitis, chronic pelvic pain syndrome, which generally contain autonomic dysfunction. Regarding the treatment of FSS, it is important to know about FSS for a therapist at first. Secondly, the therapist should find out physical dysfunction of patients positively, and confirm objectively the hypotheses about both peripheral and central pathophysiological mechanisms as much as possible. Heart rate variability is an easy method, and useful to assess autonomic function. After grasping the patient's explanatory model about the illness, the therapist showes the most acceptable treatment for the patient at last.

Background: Ghrelin plays a major role in the regulation of food intake (FI), which makes it a strong candidate for the treatment of anorexia., Objective: We attempted to evaluate the clinical response to repeated ghrelin administration in patients with anorexia caused by functional disorders, such as functional dyspepsia (FD)., Subjects and Methods: Subjects included in this study were those who 1) were diagnosed with functional anorexia, including FD and other eating disorders with the exception of anorexia nervosa; 2) were lean (body mass index (BMI)<22 kg/m(2)); and 3) exhibited decreased FI. Subjects received an i.v. infusion of ghrelin (3 microg/kg) for 30 min twice a day (before breakfast and dinner) for 2 weeks. We investigated the effects of ghrelin administration on FI, appetite, hormones, and metabolic parameters., Results: Six patients with FD were enrolled in this study. Ghrelin administration tended to increase daily FI in comparison with levels before and after completion of treatment, but this difference that was the primary endpoint of this study did not reach statistical significance (P=0.084). Hunger sensation was significantly elevated at the end of drip infusion (P<0.0001). No severe adverse effects were observed., Conclusions: These results suggest that ghrelin administration is safe and that this treatment has stimulatory effects on appetite in patients with FD. Further studies are necessary to confirm the efficacy of ghrelin treatment for anorexia-related disorders.

The prevalence of gastroesophageal reflux disease (GERD) is increasing in Japan. Symptoms of GERD negatively affect their quality of life and sleep. There are several reasons for sleep disorder with GERD as follows. Nocturnal GERD symptoms sometimes directly avoid sleeping. Sleep apnea syndrome and GERD are sometimes concomitant. The both are sharing similar risk factor such as obesity and cause sleep disorder. When untypical symptoms of GERD are not diagnosed, patients are severely anxious about their physical condition. Then they feel stressful and sometimes get secondary depressive state including sleep disorder. We had better take care about patients' psychosocial factors and treat symptoms of GERD and sleep disorder together with holistic approach.