Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan; Division of Internal Medicine, Japan Community Health Care Organization Saga Central Hospital, Saga, Japan; Division of Respiratory Medicine, Saga Prefectural Medical Center Koseikan, Saga, Japan; Clinical Research Center, Saga University Hospital, Faculty of Medicine, Saga University, Saga, Japan; Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan; Division of Respiratory Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan; Division of Internal Medicine, Imari Arita Kyouritsu Hospital, Saga, Japan; Division of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan; 9Division of Respiratory Medicine, National Hospital Organization East Saga Hospital, Saga, Japan; Division of Internal Medicine, Kouhoukai Takagi Hospital, Fukuoka, Japan; Education and Research Center for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan Background: Comparative effects on physical activity of mono and dual bronchodilators remain unclear in patients with treatment-naïve chronic obstructive pulmonary disease (COPD). We sought to compare the changes in physical activity before and after tiotropium and tiotropium/olodaterol treatment in treatment-naïve COPD patients. Methods: A prospective, multicenter, randomized, open-labeled, and parallel interventional study was conducted. Eighty Japanese patients with treatment-naïve COPD were randomized to receive either tiotropium or tiotropium/olodaterol treatment for 12 weeks. Spirometry and dyspnea index were assessed, and COPD assessment test (CAT) and the 6-minute walk distance (6MWD) were conducted before and after treatment. Evaluation of physical activity was assessed by a triaxle accelerometer over a 2-week period before and after treatment. Results: There were no differences in the mean age (69.8 vs 70.4 years), body mass index (BMI) (22.5 vs 22.6 kg/m) and mean % forced expiratory volume in 1 second (%FEV1) at baseline (61.5 vs 62.6%) between the two groups. Changes in FEV1 (mean±standard error, 242.8 ±28.8 mL) and transient dyspnea index (TDI) (2.4±0.3 points) before and after tiotropium/ olodaterol treatment were greater than with tiotropium treatment (104.1±31.9 mL, p<0.01 and 1.5±0.3, p=0.02, respectively). Changes in the duration of physical activity with 1.0–1.5 metabolic equivalents (METs) estimated in the sedentary position following tiotropium/olodaterol treatment (−38.7±14.7 min) tended to be reduced more than with tiotropium treatment (−4.6 ±10.6 min) (p=0.06), although those with ≥2.0 METs numerically increased with both treatments (+10.8±7.6 min for tiotropium/olodaterol vs +8.3±7.6 min for tiotropium, p=0.82). Tiotropium/ olodaterol treatment reduced the duration of physical activity with 1.0–1.5 METs (regression coefficient, −43.6 [95% CI −84.1, −3.1], p=0.04) in a multiple regression model adjusted for cofounding factors such as age, FEV1, total CAT scores, 6MWD, and TDI. Conclusion: This is the first study to report the impact of dual bronchodilator on physical activity in treatment-naïve COPD patients of Japanese with low BMI.

Background: Bronchodilators improve lung function, QOL and exercise tolerance in patients with COPD, however effects of bronchodilators in physical activity (PA) are still unclear. We investigated the effects of an introduction of bronchodilators on pulmonary function, dyspnea, QOL and PA in patients with treatment-naïve COPD. Methods: This is a prospective, multicenter, randomized interventional study included 80 treatment-naïve COPD subjects who were randomized to receive either tiotropium (Tio) or tiotropium/olodaterol (Tio/Olo) treatment for 12 weeks. The subjects were examined by pulmonary function tests, BDI/TDI, COPD assessment tests and PA measured using a triaxle accelerometer before and after treatment. Results: The differences in FEV1.0 after administration of the bronchodilator for 12 weeks were 242.8±28.8 ml for Tio/Olo vs. 104.1±31.9 mL for Tio (p<0.01). The TDI index score was 2.4±0.3 for Tio/Olo vs. 1.5±0.3 for Tio (p=0.02). Duration of PA≥2.0 Metabolic equivalents (METs) increased in both groups (+10.8±7.6 min vs. +8.3±7.6 min in the Tio/Olo vs. Tio group, p=0.82). Duration of PA 1.0-1.5 METs, which represents the sedentary position, tended to reduce more in the Tio/Olo group (-38.7±14.7 min) than the Tio group (-4.2±10.6 min) (p=0.06). The Tio/Olo treatment significantly reduced PA 1.0-1.5 METs (regression coefficient -43.6 [95% CI -84.1 -3.1], p<0.01) after applying multiple regression model with adjusting following factors; age, FEV1.0, CAT, 6MWD and TDI. Conclusion: These data suggest that Tio/Olo improves not only pulmonary function, but also reduces the time in the sedentary position in patients with treatment-naïve COPD.

Background:Comparative effects on physical activity of mono and dual bronchodilators remain unclear in patients with treatment-naïve chronic obstructive pulmonary disease (COPD). We sought to compare the changes in physical activity before and after tiotropium and tiotropium/olodaterol treatment in treatment-naïve COPD patients. Methods:A prospective, multicenter, randomized, open-labeled, and parallel interventional study was conducted. Eighty Japanese patients with treatment-naïve COPD were randomized to receive either tiotropium or tiotropium/olodaterol treatment for 12 weeks. Spirometry and dyspnea index were assessed, and COPD assessment test (CAT) and the 6-minute walk distance (6MWD) were conducted before and after treatment. Evaluation of physical activity was assessed by a triaxle accelerometer over a 2-week period before and after treatment. Results:There were no differences in the mean age (69.8 vs 70.4 years), body mass index (BMI) (22.5 vs 22.6 kg/m2) and mean % forced expiratory volume in 1 second (%FEV1) at baseline (61.5 vs 62.6%) between the two groups. Changes in FEV1 (mean±standard error, 242.8±28.8 mL) and transient dyspnea index (TDI) (2.4±0.3 points) before and after tiotropium/olodaterol treatment were greater than with tiotropium treatment (104.1±31.9 mL, p<0.01 and 1.5±0.3, p=0.02, respectively). Changes in the duration of physical activity with 1.0-1.5 metabolic equivalents (METs) estimated in the sedentary position following tiotropium/olodaterol treatment (-38.7±14.7 min) tended to be reduced more than with tiotropium treatment (-4.6±10.6 min) (p=0.06), although those with ≥2.0 METs numerically increased with both treatments (+10.8±7.6 min for tiotropium/olodaterol vs +8.3±7.6 min for tiotropium, p=0.82). Tiotropium/olodaterol treatment reduced the duration of physical activity with 1.0-1.5 METs (regression coefficient, -43.6 [95% CI -84.1, -3.1], p=0.04) in a multiple regression model adjusted for cofounding factors such as age, FEV1, total CAT scores, 6MWD, and TDI. Conclusion:This is the first study to report the impact of dual bronchodilator on physical activity in treatment-naïve COPD patients of Japanese with low BMI.

Background: Physical activity measures are valuable for assessing the progression of chronic respiratory diseases. The 4-m gait speed (4MGS) test is an established functional assessment in the elderly. However, the relationship between the 4MGS and daily activity in patients with chronic respiratory diseases has not been fully understood. The present study aimed to investigate whether the 4MGS predicted daily activity, including physical activity level (PAL), in patients with chronic respiratory diseases. Methods: We enrolled 57 patients with chronic respiratory diseases, including interstitial lung disease and chronic obstructive pulmonary disease, and evaluated the correlations between the 4MGS and various clinical parameters, including respiratory function, the 6-min walk test (6MWT), and daily activities, by using an accelerometer. Linear regression analysis was performed to identify significant predictors of daily activity. Results: The 4MGS was significantly correlated with daily step counts and PAL, as well as the 6 min walk distance (r = 0.477, p < 0.001; r = 0.433, p = 0.001; and r = 0.593, p < 0.001, respectively). In the multivariate linear regression analysis, the 4MGS, % predicted forced expiratory volume in 1 s, and body mass index were independent predictors of PAL. Receiver operating characteristic analysis revealed that a 4MGS <1.07 m/s was the optimal cutoff for predicting an inactive PAL (area under the curve, 0.728; 95% confidence interval, 0.589-0.866). Patients with a slower 4MGS had significantly reduced daily activity than did hose with a preserved 4MGS, despite similar modified Medical Research Council dyspnea scale measures and respiratory parameters, such as oxygenation profiles. Conclusions: The 4MGS test is a simple screening test and a useful predictor of worsening daily activity in patients with chronic respiratory diseases. (C) 2019 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Background: The effects of pharmacologic treatment on physical activity (PA) are still unclear, especially in treatment naive patients with COPD. We investigated the effects of a newly introduced bronchodilator on pulmonary function, dyspnea, QOL and PA in COPD patients. Methods: In this prospective, randomized interventional study, 78 treatment naive COPD subjects without any other diseases that might reduce PA were recruited. The subjects were randomized to receive either tiotropium (Tio) or tiotropium/olodaterol (Tio/Olo) combination treatment for 12-weeks. PA levels were measured with a triaxle accelerometer for 2 weeks were administered before and after 12-weeks treatment. Results: Adjusted mean forced expiratory volume in 1 second (FEVl.0) after administration of the bronchodilator for 12-weeks was 224±156 mL with Tio/Olo vs. 105±203 mL with Tio (p<0.01). The duration of PA at ≥ 2.0 METs were improved in both groups after 12-weeks treatment. The change in the duration of PA at ≥ 2.0 METs was increased in both the Tio/Olo (17.7±53.4 min) and the Tio (5.7±50.6 min) group (p=0.37), which tended to greater increase in the Tio/Olo. The change in the duration of PA 1.0-1.5 METs, which represent the sedentary position, was decreased in both the Tio/Olo (-55.0±116.4 min) and the Tio (-36.2±123.1 min) group (p=0.54), which tended to decrease in the Tio/Olo. Conclusion: Tio/Olo significantly improved FEV1.0 compared with Tio in patients with treatment naive COPD. Both Tio/Olo and Tio decreased the amount of time spent in the sedentary position, and increased the duration of ≥ 2.0 METs PA.

Background: Due to advances in medicine, patients with pulmonary diseases have become candidates for surgery under general anesthesia. They often consult pulmonologists to assess their tolerability for surgery. The purpose of this study was to evaluate the significant characteristics responsible for postoperative pulmonary complications (PPCs) and the preclusion of the planned surgery. Methods: The clinical data of 462 consecutive patients who consulted at the Department of Respiratory Medicine before surgery under general anesthesia were used in this study. The relationship between the patient's characteristics and their outcomes were analyzed. The patients who were scheduled for lung resection were excluded. Results: Of the 386 patients who underwent planned surgery, 353 had no PPCs (Group A) and 33 developed PPCs (Group B). Planned surgery under general anesthesia was precluded in 31 patients due to respiratory problems (Group C). The significant predictors for PPCs consisted of a higher age, male gender, asthma, gastrointestinal surgery, cardiovascular surgery and a lower percentage of the predicted forced expiratory volume in 1 second (% predicted FEV1). The significant factors associated with the preclusion of planned surgery included interstitial pneumonia (IP), dermatologic surgery and a lower % predicted FEV1. The predicted probability of PPCs in Group C was significantly higher than that in Group A and lower than that in Group B (all p-values < 0.05). Conclusion: The common clinical finding for predicting PPCs and encouraging the preclusion of the planned surgery under general anesthesia was a lower % predicted FEV1. (C) 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Background: Rapidly progressive interstitial pneumonias (RPIPs) associated with clinically amyopathic dermatomyositis (CADM) are highly resistant to therapy and have a poor prognosis. Multimodal therapies, including direct hemoperfusion using a polymyxin B-immobilized fiber column (PMX-DHP), have a protective effect on RPIPs. We evaluated the effects of PMX-DHP on CADM-associated RPIPs. Methods: We retrospectively enrolled 14 patients with CADM-associated RPIPs and acute respiratory failure treated with PMX-DHP, corticosteroids, and immunosuppressive agents. Clinical manifestations were compared between survivors and non-survivors at 90 days after PMX-DHP. Results: The survival rate at 90 days after PMX-DHP was 35.7% (5/14). Before PMX-DHP, the survivor group exhibited a significantly higher PaO2/FiO(2) (P/F) ratio and serum surfactant protein-D (SP-D) levels and significantly lower lactate dehydrogenase (LDH) and ferritin levels than the non-survivor group. Platelet counts were significantly decreased after PMX-DHP therapy in both groups, but remained higher in the survivor group than the non-survivor group over the course of treatment. Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody positive patients demonstrated a poor 90-day survival rate, lower platelet counts and P/F ratio, and higher LDH levels than anti-MDA-5 antibody negative patients. Conclusions: CADM-associated RPIPs with anti-MDA-5 antibody is associated with a very poor prognosis. A higher P/F ratio and SP-D level, lower LDH and ferritin levels, higher platelet counts, and anti-MDA-5 antibody negativity are important prognostic markers in patients with CADM-associated RPIPs treated with PMX-DHP.

Five alkaloids were isolated from the epigeal part of Oxytropis myriophylla. Three alkaloids were identified as N-benzoyl-β-phenylethylamine, N-trans-cinnamoyl-β-phenylethylamine, N-cis-cinnamoyl-β-phenylethylamine and the structures of two new alkaloids were elucidated to be N-benzoyl-β-hydroxyphenylethylarnine(2), N-trans-cinnamoyl-β-hydroxy-phenylethylamine(5). The absolu.te structures were established by modified Mosher method.

Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow obstruction and pulmonary emphysema. Persistent inflammation and remodeling of the lungs and airways result in reduced lung function and a lower quality of life. Galectin (Gal)-9 plays a crucial role as an immune modulator in various diseases. However, its role in the pathogenesis of pulmonary emphysema is unknown. This study investigates whether Gal-9 is involved in pulmonary inflammation and changes in emphysema in a porcine pancreatic elastase (PPE)-induced emphysema model.Gal-9 was administered to mice subcutaneously once daily from 1 day before PPE instillation to day 5. During the development of emphysema, lung tissue and bronchoalveolar lavage fluid (BALF) were collected. Histological and cytological findings, concentrations of chemokines and matrix metalloproteinases (MMPs) in the BALF, and the influence of Gal-9 treatment on neutrophils were analyzed.Gal-9 suppressed the pathological changes of PPE-induced emphysema. The mean linear intercept (Lm) of Gal-9-treated emphysema mice was significantly lower than that of PBS-treated emphysema mice (66.1 ± 3.3 μm vs. 118.8 ± 14.8 μm, respectively; p < 0.01). Gal-9 decreased the number of neutrophils and levels of MMP-9, MMP-2 and tissue inhibitor of metalloproteinases (TIMP)-1 in the BALF. The number of neutrophils in the BALF correlated significantly with MMPs levels. Interestingly, Gal-9 pretreatment in vitro inhibited the chemotactic activity of neutrophils and MMP-9 production from neutrophils. Furthermore, in Gal-9-deficient mice, PPE-induced emphysema progressed significantly compared with that in wild-type (WT) mice (108.7 ± 6.58 μm vs. 77.19 ± 6.97 μm, respectively; p < 0.01).These results suggest that Gal-9 protects PPE-induced inflammation and emphysema by inhibiting the infiltration of neutrophils and decreasing MMPs levels. Exogenous Gal-9 could be a potential therapeutic agent for COPD.

The role of {112} slip activity on the deformation of bcc ferritic single crystals with different crystallographic orientations was studied numerically using a crystal plasticity finite-element method. Peeters model [Peeters et al., Acta Mater., 49 (2001), 1607] was utilized to predict development of dislocation structures as well as work-hardening behavior. To examine the effect of the {112} slip activity in detail, the simulation was carried out using original Peeters model in which development of cell-block boundaries (CBBs) along the {112} planes was not taken into account, Peeters model in which development of CBBs along the {112} planes was taken into account (extended-1 model), and Peeters model in which {112} slip activity was not taken into consideration (extended-2 model). The predicted stress-strain curves were in qualitatively good agreement with the experimental results for all cases when the original and extended-1 models were used, whereas two-stage work hardening observed for the crystal with {100} <011> was not predicted when the extended-2 model was used. Concerning development of CBBs, the extended-1 and extended-2 models gave better prediction as compared to the original model. The abovementioned results suggested that the extended-1 model gave the most appropriate predictions among the models in terms of work-hardening behavior and development of CBBs, showing that it was more reasonable to take into account both {110} and {112} slip systems and development of CBBs along not only the {110} planes but also the {112} planes.

Most of voice conversion (VC) methods were dealing with a one-to-one VC issue and there were few studies that tackled many-to-one / many-to-many cases. It is difficult to prepare the training data for an application with the methods because they require a lot of parallel data. Furthermore, the length of time required to convert a speech by Deep Neural Network (DNN) gets longer than pre-DNN methods because the DNN-based methods use complicated networks. In this study, we propose a VC method using autoencoders in order to reduce the amount of the training data and to shorten the converting time. In the method, higher-order features are extracted from acoustic features of source speakers by an autoencoder trained with source speakers’ data. Then they are converted to higher-order features of a target speaker by DNN. The converted higher-order features are restored to the acoustic features by an autoencoder trained with data drawn from the target speaker. In the evaluation experiment, the proposed method outperforms the conventional VC methods that use Gaussian Mixture Models (GMM) and DNNs in both one-to-one conversion and many-to-one conversion with a small training set in terms of the conversion accuracy and the converting time.

Electroless plated metals have been used for wiring and electrodes in the manufacture of electronic devices. To obtain plated patterns, etching and photoresist are generally used. However, through catalyst patterning by printing, we can obtain metal patterns without etching and photoresists by electroless plating. Solution-processed indium-gallium-zinc oxide (IGZO) has received significant attention for showing high performance and ease of preparation in air atmosphere. In this study, we prepared an electroless plated pattern by catalyst printing as electrodes of IGZO TFT. There are few reports on the application of plated metal electrodes prepared by catalyst printing to the source and drain electrodes of IGZO TFT. The prepared IGZO TFT exhibits a typical current-voltage (I-V) curve. The plated electrodes caused many problems such as performance degradation. However, our result showed that the plated metal electrodes can drive IGZO TFT. In addition, we confirm plated metal growth into the catalyst layer by cross sectional scanning electron microscopy and energy-dispersive X-ray spectroscopy (SEM/EDS) of the plated Ni. We discuss the relevance of the measured work function (WF) of the electrode materials and the performance of IGZO TFT. (c) 2017 The Japan Society of Applied Physics

A 72-year-old woman was admitted to our hospital with a solitary right lung nodule. She had no symptoms and no abnormal physical findings except for bladder cancer. Tumor markers were mildly elevated but no other abnormal laboratory data were found. The nodule was diagnosed to be pulmonary mucosa-associated lymphoid tissue lymphoma on computed tomography-guided needle biopsy. Thereafter, she first underwent surgery for bladder cancer. The lung nodule was found to have slightly increased at three months and then disappeared at 15 months after the biopsy. The notable clinical course of this rare disease suggests the effectiveness of a non-interventional treatment strategy.

Background: Pulmonary emphysema is characterized by irreversible airflow obstruction, inflammation, oxidative stress imbalance and lung remodeling, resulting in reduced lung function and a lower quality of life. Galectin (Gal)-9 plays a crucial role in the modulation of innate and adaptive immunity. Objectives: To investigate whether Gal-9 reduce pulmonary inflammation and lung remodeling in experimental emphysema mouse model. Methods: Emphysema was induced in C57BL/6 mice by intratracheal administration of porcine pancreatic elastase (PPE) (2 IU) once on day 0. Gal-9 (3 µg/body) or PBS was administered subcutaneously, once daily from day -1 to day 5. Results: Gal-9 suppressed pathological changes of emphysema induced by PPE. The mean linear intercept length (Lm) of Gal-9-treated emphysema mice was lower than that of PBS-treated emphysema mice (66.1 ± 3.3 µm vs. 118.8 ± 14.8 µm, respectively, P < 0.01). Gal-9 decreased neutrophils and matrix metalloproteinase (MMP)-9 in the bronchoalveolar lavage fluid of emphysema mice, but did not reduce levels of pro-inflammatory cytokines and neutrophil chemokines, keratinocyte-derived cytokine (KC), chemokine ligand-2 and chemokine ligand-5. Interestingly, functional assays revealed that Gal-9 inhibited chemotaxis of PMN towards KC. In Gal-9 knockout mice, Lm after PPE administration was significantly increased compared with that in wild type mice. Conclusion: Subcutaneous administration of Gal-9 decreases the severity of elastase-induced inflammation and airspace enlargement by inhibiting the chemotaxis of neutrophils and decreasing MMP-9. These results indicate that Gal-9 may be an effective therapeutic agent for the treatment of emphysema and COPD.

Background: In chronic respiratory diseases, it is difficult to evaluate daily exercise tolerance, physical activity and profile of oxygenation. While those evaluations are important to maintain their QOLs, those studies have not been fully performed except COPD. Aims & Methods: To investigate a predictor of daily activity and near respiratory failure in outpatient routine practice, we evaluated 4-meter gait speed (4MGS), 6MWD and pulmonary function testing in our outpatient clinic, and 24-hour pulse oximetry monitoring, daytime step counts and duration of physical activity by using electronic accelerometer in community-living 24 patients with stable chronic respiratory diseases (interstitial pneumonia 17 patients, COPD 4, CPFE 3, respectively) not receiving supplemental oxygen. We analyzed the relationship among the values. Results: The mean PaO2 at rest was 81.9 Torr ranged from 63.3 to 95.4 Torr. The daily step counts and duration of activity time were strongly correlated with %FEV1 (p=0.001), and the step counts were correlated with 4MGS, 6MWD (p=0.034, p=0.039, respectively). The mean %diurnal time with SpO2<90% was only 4.3%, while there were 13/24 case (54.2%) that observed lowest SpO2<90% during the 6MWD. Conclusion: %FEV1, 4MGS and 6MWD were useful to detect daily activity level. This study also suggested that patients with near chronic respiratory failure reduce their daily physical activity to avoid the oxygen de-saturation without awareness. We need to predict their daily activity by testing 4MGS and 6MWD with measuring SpO2,even if SpO2>90% at rest and on ambulatory pulse oximetry monitoring in their daily life.

Hyperbranched polystyrene bearing ammonium salts (HPS-NR3+Cl-) behaves as an excellent stabilizer of ruthenium, rhodium, iridium, palladium, and platinum nanoparticles from 1 to 3 nm in size uniformly dispersed in the polymer matrix. The catalytic performance of the resulting metal-polymer composites, M@HPS-NR3+Cl-, is dependent on the metal. This dependence was investigated by assessing the hydrogenation of alkenes and arenes. The utility of M@HPS-NR3+Cl- as reusable catalysts in aqueous/organic biphasic systems was demonstrated by examining the catalysis of the hydrogenation of aromatic compounds containing various functional groups by Ru@HPS-NR3+Cl-. (C) 2015 Elsevier Ltd. All rights reserved.

OBJECTIVE:A randomized, crossover, double-blinded placebo-controlled and non-blinded active drug-controlled, comparative clinical trial was conducted to evaluate the efficacy and safety of sublingual fentanyl tablet.METHODS:Subjects were patients treated with strong opioids at fixed intervals for chronic cancer pain and with oral morphine as rescue medication for breakthrough pain. Sublingual fentanyl was administered at doses that were 1/25th (high dose) and 1/50th (low dose) of the dose of rescue morphine and was compared with placebo and oral morphine. The primary endpoint was pain intensity difference at 30 min after administration. (Clinical Trials Government; NCT00684632).RESULTS:Fifty-one patients were enrolled in the investigation. Their mean pain intensity in visual analog scale before rescue medication prior to the investigation was 60.96 (16.44, standard deviation) mm. Compared with placebo, the low and high doses of sublingual fentanyl showed significant analgesic effects (least squares mean difference, 4.54 and 8.49 mm; P = 0.014, P < 0.001, respectively). Adverse reactions were observed in 17.6%, the most common being constipation, nausea and somnolence. The incidence of adverse reactions during the high-dose administration period was higher than that during the low-dose and active control drug administration periods.CONCLUSIONS:Patients treated with strong opioid analgesics at fixed intervals for chronic cancer pain and with oral morphine at doses up to 20 mg as rescue medication were investigated. The doses of sublingual fentanyl to treat breakthrough pain were determined from rescue morphine doses by use of conversion ratios. In these patients, administration of sublingual fentanyl at doses determined by a conversion ratio of 1/50 was effective and safe. Further studies are needed to validate the use of this conversion method.