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The injection of supercritical CO 2 into the deep underground increases the pore pressure in the geologic formation, first locally around the injection point, later spreads radially throughout the formation. The range of pressure increase depends on the injection rate, injectivity and reservoir volume. The increase of pressure in the reservoir may cause several problems, including fracturing of sealing layer, fault reactivation and changes in other hydrogeological conditions. In order to reduce the pressure buildup in the reservoir during CO 2 injection, two methods were studied in this paper by numerical simulations using the TOUGH2 code. One describes production of formation water as proposed by Buscheck et al. in 2014 (dual-mode well), and the second method describes production of formation water via a second well during CO 2 injection. We employed a simple reservoir model based on available data of the CCS demonstration project at the Tomakomai area in Hokkaido, Japan. The efficiency and influence of two reservoir volumes, and a hypothetical placed production well, on pressure build-up in the storage formation were tested. Two models with different volumes, and an injection rate of 1 Mt/yr were applied and three cases were simulated for each model. The first case only considered injection of CO 2 for 100 years without production. The second case examined the dual-mode well, in which formation water was produced for 5 years prior to the start of CO 2 injection for 100 years. The last (third) case assumed utilization of an observation well for producing water in parallel with CO 2 injection. Judging from the results, the following conclusion can be drawn: 1) The dual-mode well with short duration of water production (5 years) was not so effective to maintain the reservoir pressure in the large reservoir volume considered here. The method would be better suited for smaller reservoir, otherwise a very long-term production would be necessary. 2) Water production in parallel with injection was very effective in order to maintain the reservoir pressure and to avoid harmful effects on the overlying seal layers and other hydrogeological conditions. The methods can be applied to make CCS technology much more sufficient through increasing the effective capacity of injectable CO 2 . It may also lead to more opportunities related to site selection. However, it has to be emphasized, that the effectiveness of the production strategies investigated here may highly depend on site conditions. Therefore, the results obtained in this study should be regarded as a preliminary evaluation for the Tomakomai site specifications. Further investigations would be necessary, when more data become available through the site investigation and even operations.

For appropriate advance care planning, functional prognostication is necessary. However, there are no studies of functional prognostication in patients with cancer. The aim of this study was to develop a functional prognostic scoring system for patients with advanced cancer.In this multicenter prospective observational study, 1896 patients were enrolled. First, Cox regression analysis and the combination of forward and backward variable selection were used to identify the best subset of predictors. Second, the prognostic score value was defined from each regression coefficient of a significant prognostic factor. The Functional Palliative Prognostic Index (FPPI) was calculated by summing the prognostic scores.Patients were classified into three groups by the FPPI. For walking, the 14-day functional survival probability was 72.8% for group A (score 0), 28.4-72.8% for group B (score 1), and 28.4% for group C (score 2-3). For eating, the 14-day functional survival probability was 71.8% for group A (score 0-3), 29.6-71.8% for group B (score 3.5-5.5), and 29.6% for group C (score 6-9). For communicating, the 14-day functional survival probability was 76.6% for group A (score 0-6.5), 22.6-76.6% for group B (score 7-10), and 22.6% for group C (score 10.5-16). Regarding each item, group B functionally survived significantly longer than group C, and group A functionally survived significantly longer than either of the others.We firstly developed a functional prognostic scoring system for patients with advanced cancer. This FPPI system promises to be helpful in advance care planning.

11582 Background: Although naldemedine, a new peripherally-acting mu-opioid receptor antagonist, was approved for the management of opioid-induced constipation (OIC), its safety and effectiveness in real world clinical practice is unknown. Methods: We conducted a real world registry study in 14 hospital palliative care teams and inpatient palliative care units in Japan between April and December 2018. Consecutive cancer patients who received naldemedine for OIC were enrolled in a 7-day observational study. All treatment and assessment procedures were performed according to the accepted clinical practice. The primary outcome of the study was the proportion of patients who experienced spontaneous bowel movement within 24 hours after the initial administration of naldemedine. Adverse events, which indicated a possible or stronger causal relationship with naldemedine treatment, were reported according to the Common Terminology Criteria for Adverse Events (CTCAE) ver 4.0. Results: Overall, 204 patients were enrolled in the study. The mean age of the patients was 63±14 years, and 103 (50.5%) were male. The most common primary cancer site was lung (23.5%), followed by gastrointestinal (13.7%), and urological organs (9.3%). The proportion of patients undergoing active cancer treatment was 59.9%. Oxycodone was the most frequently used regular opioid (n = 115, 56.4%), and the median oral morphine-equivalent daily dose of opioids was 30 mg (interquartile range: 20-60 mg). Magnesium oxide (64.2%) and Senna (17.2%) were used as concomitant laxatives. All patients received 0.2 mg of naldemedine orally once daily. Most patients (90.2%) completed the 7-day observation. In 146 patients, spontaneous bowel movement was observed within 24 hour after the first administration of naldemedine (71.6%, 95% confidence interval 65.4-77.8%). Nearly two-thirds of the patients experienced increased frequency of spontaneous bowel movement in the week after naldemedine administration. The most prevalent adverse events were diarrhea (CTCAE grade 1-2, 35 cases; grade 3, 1 case) and abdominal pain (CTCAE grade 1-2, 10 cases; grade 3, 1 case). No serious adverse events including gastrointestinal perforation were reported. Conclusions: Naldemedine for opioid-induced constipation is safe and effective in the real world oncology and palliative care settings. Clinical trial information: UMIN000031381.

Spontaneous bladder rupture (SBR) is a rare but life-threatening condition. Its diagnosis is challenging; symptoms might present solely as ascites during onset or with features of frank peritonitis. When SBR causes peritonitis, arterial perihepatic enhancement can be detected on a contrast computed tomography scan. SBR should be suspected when patients have acute abdominal pain and risk factors including previous pelvic irradiation, urethral catheterization, and binge alcohol drinking. We present the first case report of arterial perihepatic enhancement due to SBR.