We performed this study to investigate whether serum cell-free DNA testing（liquid biopsy）of either methylated SEPT9 or methylated SST, which are possible biomarkers of HCC, in combination with AFP may improve clinical performance for the detection of HCC. Study subjects included 25 healthy controls, 15 patients with chronic liver disease without HCC, and 38 patients with HCC. Methylation level of serum cell-free SEPT9 and SST was measured by methylation-sensitive restriction enzymes followed by multiplex droplet digital polymerase chain reaction. According to receiver operating characteristic curve analysis to discriminate between non-HCC group（including control group and chronic liver disease without HCC group）and HCC group, area under the curve（AUC）was 0.73 by AFP and 0.73 by mSEPT9, whereas it was only 0.59 by mSST. Regarding combination tests, although negative predictive values were almost same between the AFP + mSEPT9 test and the AFP + mSST test（75.0% vs 72.2%），a positive predictive value of AFP + mSEPT9 test was higher than that of the AFP + mSST test（79.4% vs. 66.7%）．In conclusions, methylated SEPT9 was a better companion marker of AFP for HCC screening than methylated SST.

This study aimed to clarify the process in which nurses involved in terminal cancer care infer the concerns and true feelings of their patients who find it difficult to express such feelings. A qualitative descriptive study design was applied. The research participants were 8 nurses from 2 facilities who provide care for terminal cancer patients in general wards. Interviews were conducted with each research participant through a semi-structured interview. A verbatim record was created from the recorded data of the interview and analyzed using the modified Grounded Theory Approach. The process assessment and intervention in the patient's "concerns and true feelings" was as follows：First, the nurse provided《care to make the patient physically comfortable》．Next, the nurse〈built a rapport〉with the patient. They《probed further into the patient’s concerns and true feelings》，and this finally led to an〈intervention into the patient’s concerns and true feelings〉．In contrast,〈hesitating to intervene〉may also prevent the intervention from happening. The nurse had〈accrued the experience〉that, in either of these cases the intervention may or may not happen. Factors impacting the《probing of the patient’s concerns and true feelings》included〈timing〉and〈the involvement of the medical team〉．Reflections on both experiences of being able and not being able to intervene led to the accumulation of clinical knowledge on "concerns and true feelings."

Background：Recently, it has been shown that hydrogen gas has a strong antioxidant effect. Therefore, molecular hydrogen is drawing attention as a new therapeutic strategy against tissue damage caused by peroxides in post-ischemic reperfusion injury.

Methods：In the present study, we investigated the effect of consuming 1000 ml/day of either carbonated water（CO2-water）or hydrogen-molecule-added carbonated water（H2/CO2-water）for 26 days on physiological and laboratory parameters. Thirty-nine healthy volunteers were recruited and put on either of the water regimens using a cross-over design with 31-day washout period.

Results：Among physiological parameters, SPO2 significantly increased by 0.43% after drinking CO2-water, whereas after drinking H2/CO2-water, systolic and diastolic blood pressure decreased significantly by 5.2 and 2.8 mmHg, respectively, and H2 concentrations in end-expiratory air increased by 38% although statistically not significant. As for the biochemical and blood cell parameters, by the CO2-water regimen, total bilirubin, γ-GTP, cholinesterase, CK-MB, Ca, erythrocyte and platelet counts significantly decreased（P<0.01）．However, the differences were all found small when compared to the allowable limit of within-individual variation of each parameter, called reference change value（RCV）．Whereas by the H2/CO2-water regimen, γ-GTP and CK-MB significantly decreased（P<0.01），but the differences were again within the RCV, and thus regarded as not clinically significant. Comparison of differences between the two regimens showed that only heart rate and total bilirubin were significantly higher by the H2/CO2 regimen, but of minor degree.

Conclusion：Reduction of blood pressures observed in the H2/CO2-water regimen may represent an antioxidant effect of hydrogen molecule in water, although an additional trial by increasing H2 concentration and/or longer drinking period is required to fortify the finding. As for the influences on other physiological and laboratory parameters, statistical differences were observed in several parameters by either of the regimens. However, in comparison to the RCV, the changes were within physiological ranges, and thus there was no safety concern in drinking either of the water preparations.

Patients living with non-cancer respiratory diseases may die without being aware of their own end-of-life, as their function deteriorates with each exacerbation and recovery. Patients focus on coping with their daily physical conditions and reach the end of life without making decisions about their future. Families experience psychological pain, conflict, and regret at the end of life without knowing the patient’s wishes. We thought it was necessary to support patients and their families in thinking about the end of life, communicating their intentions, and living their lives according to their physical condition. The aim of this study was to clarify research trends and issues of decision-making support in end-of-life care for patients with non-cancer respiratory disease in Japan by reviewing domestic and international literatures. The Web version of the Central Journal of Medicine, CINAHL, and MEDLINE were searched using the keywords "not cancer," "respiratory," "end of life," and "Japan ". Fourteen articles were included in the analysis. Eight themes were extracted: "care for dyspnea," "difficulty in confirming patient's intention," "lack of understanding of the disease," "family distress in proxy decision-making," "delays in the timing of decision-making support," "conflicts among nurses," "difficulties in multidisciplinary team support," and "the need to create decision support guidelines and systems. There were few reports on the decision-making support for patients and their families when introducing home oxygen therapy or non-invasive positive pressure ventilation therapy in preparation for exacerbations, or in preparation for sudden changes. Further research is needed to address the issues of end-of-life care decision making support for patients with non-cancer respiratory disease.