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Background: Most patients with metastatic cancer request information regarding their prognosis, most notably when death is clearly approaching. Several clinical indices are used to predict the prognosis of end-stage cancer based on performance status and clinical factors. For example, the Palliative Prognostic Index (PPI) includes a range of scores from 0-15 based on factors that include performance status, oral intake, presence of edema, dyspnea at rest, and delirium. For scores greater than six, survival for an additional three weeks was predicted with a sensitivity of 80% and a specificity of 85%. However, the predictive power of these indices is currently insufficient; the quality of life of end-stage breast cancer patients would be markedly improved with a more accurate prediction model. Breast cancer subtypes based on the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses are important prognostic factors with respect to the outcome of initial breast cancer therapy; the subtype defined by these parameters was also identified as an independent prognostic factor for outcomes in cases of metastatic breast cancer. However, the prognostic impact of breast cancer subtype with respect to end-stage disease remains unclear. In this retrospective observational study, we evaluated the relationship between survival time and associated clinicopathological factors, including breast cancer subtype, in order to develop a more accurate prognostic model for end-stage breast cancer patients. Methods: Seventy-three patients with end-stage breast cancer who were admitted to our hospice care unit from January 2014 to December 2018 were enrolled in the study. Patients in this unit were not provided with anticancer therapy but did receive highest-quality supportive care. The primary endpoint was survival time from the admission. Patient information, including age, PPI, disease-free interval (DFI), the number of treatments for the metastatic disease, metastatic site, and breast cancer subtypes were collected from medical records. Breast cancer subtypes included Luminal (Lum), Lum-HER2, HER2, and triple negative (TN) with respect to those that were HR+HER2−, HR+HER2−, HR−HER2+, and HR−HER2−, respectively. The study was approved by the ethical committee of the Oikawa Hospital (OHCT022). Results: The median survival time was 23 days (1-359 days). From the univariate analysis, PPI scores of less than six were associated with significantly shorter survival (14 days vs. 36.5 days, P = 0.001). Patients diagnosed with Lum-HER2 subtype, those who were older and were without liver metastasis, those with a shorter DFI, and those who underwent fewer treatments for metastatic disease showed a tendency toward a favorable prognosis, although these findings did not reach statistical significance. Multivariate logistic regression analysis revealed that a PPI score less than six (P = 0.001), Lum-HER2 subtype (P = 0.003), absence of liver metastasis (P = 0.001), and DFI lower than the median (33 months; P = 0.028) all contributed to longer survival time. Discussion & Conclusion: In addition to the PPI, breast cancer subtype can be used to provide more precise prognoses for end-stage breast cancer patients. Survival of patients diagnosed with the Lum-HER2 subtype was longer than that observed among those with any of the other subtypes who had not undergone any anticancer treatment for metastatic disease; these results suggest that anti-HER2 therapy may be associated with critical immunological modifications. Taken together, our results indicate that breast cancer subtype should be included to provide a more accurate prognostic model for end-stage breast cancer patients. Citation Format: Masahiro Oikawa, Yumika Setoguchi, Yasuko Enomoto, Kazuhumi Hisamatsu, Tetsuaki Inamitsu, Tatsuji Oikawa. The prognostic impact of breast cancer subtype based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses for end-stage disease [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-43.

Objective: To assess the psychosomatically subjective symptoms of subjects with neurotic tendencies complaining of halitosis. Design: Breath malodour was measured in 368 patients using organoleptic test and gas chromatography. Neurotic tendency and subjective symptoms were assessed using the Cornell Medical Index (CMI). Results: Of the 79 subjects who met the criteria for neurotic tendencies according to CMI scores, 58 (73.4%) had oral malodour, whereas 21 (26.6%) did not. Coated tongue, periodontal pocket, and daily drinking were significantly more common in subjects with oral malodour. On the CMI questionnaire, subjects with no oral malodour more frequently responded ‘yes’ to questions about fatigue and psychological problems in their families. Additionally, many answered that they had perceived their own bad breath. Conclusions: Difficulties experienced by subjects with neurotic tendencies and oral malodour may manifest primarily in oral conditions, whereas those experienced by individuals with neurotic tendencies and no oral malodour may manifest primarily in psychosomatic symptoms.

We've had many opportunities of treating psychiatric problems of patients with cardiovascular diseases(CVD). Several studies have shown the close relationship between psychological factors and CVD. Depression and anxiety increase a prevalence of and worsen a prognosis of CVD. Looking at these patients, we must consider the following: psychotropics-induced hypotension and QT prolongation (antipsychotics and tricyclic antidepressants), cardiovascular drugs induced psychiatric symptoms(diuretics), and cardiac and psychiatric drugs interaction, especially in cytochrome P450 activity(fluvoxamine and paroxetine). Besides a psychopharmacological treatment, psychological approaches based on a therapeutic relationship are important in a cardiac rehabilitation setting.

Functional somatic syndromes (FSSs) are common in dental as well as medical practice. Many patients with unexplained symptoms in oro-maxillo-facial areas visit dentists, but they are not diagnosed and treated properly. Temporomandibular disorder, atypical facial pain, and glossodynia (burning mouth syndrome) are included in dental FSSs. These diseases overlap with each other and with FSSs in other organs, such as myofacial pain syndrome, tension-type headache, fibromyalgia, and chronic fatigue syndrome. They coexist with mental disorders, such as anxiety disorder, mood disorder, and somatoform disorder. Multidisciplinary and holistic approaches should be applied to dental FSSs; pharmacological therapy (antidepressants), physical therapy, and cognitive-behavioral therapy. Clinicians have to support a patient in"enjoying his/her life with symptoms". Dental specialists in "oral medicine" with psychosomatic viewpoints are now required.

ATP-dependent Ca2+ uptake by brain microsomes was classified into two fractions according to the sensitivity to saponin. Properties of each fraction of Ca2+ uptake were examined and compared with those of inside-out membrane vesicles of erythrocyte and cardiac sarcoplasmic reticulum. The concentration of saponin for 50% inhibition (IC50) of major saponin-sensitive Ca2+ uptake was 11 micrograms/ml, and this uptake was enhanced by calmodulin. The minor saponin-insensitive Ca2+ uptake fraction (IC50; 90 micrograms/ml) was not affected by calmodulin but was enhanced by oxalate or 0.1 M KCl. The IC 50 of saponin for inside-out membrane vesicles of erythrocyte and cardiac sarcoplasmic reticulum was 11.3 and 114.8 micrograms/ml, respectively. A characteristic ring-like saponin-cholesterol micellar structure was observed electron microscopically in most membrane vesicles of brain microsomes and erythrocyte membrane vesicles but not in the cardiac sarcoplasmic reticulum. These observations indicate that saponin-sensitive and insensitive Ca2+ uptake was derived from plasma membranes and endoplasmic reticulum, respectively. Saponin proved useful for distinguishing the Ca2+ transport activity of plasma membrane from the Ca2+ uptake of other cellular organelles in the membrane preparations.

An inhibitor of lipoxygenase of arachidonic acid, nordihydroguaiaretic acid, shortens actin filaments, as judged by electron microscopic observation of negatively stained actin filaments, actin sedimentability and measurement of specific viscosity, at concentrations that inhibit the migration of phagocytic cells. At higher concentrations (more than 10 microM) nordihydroguaiaretic acid strikingly inhibits myosin ATPase activity. Thus nordihydroguaiaretic acid has a severe side effect on the cytoskeleton.

Low concentrations of saponin selectively increase the permeability across the plasma membrane as small “pores” about 10 nm in diameter form over the membrane. To characterize the microsomal fractions from canine brain (B-MS), the effect of saponin on ATP-dependent Ca-uptake was compared with findings on rabbit skeletal muscle (S-MS) and canine cardiac muscle (C-MS).