Risk factors for nausea and vomiting requiring the daily administration of 5-HT3 receptor antagonists in radiotherapy combined with temozolomide for high-grade glioma.

Radiotherapy combined with temozolomide (TMZ+RT) is the primary treatment for high-grade glioma. TMZ is classified as a moderate emetic risk agent and, thus, supportive care for nausea and vomiting is important. In Nagoya University Hospital, all patients are treated with a 5-hydroxy-tryptamine 3 receptor antagonist (5-HT3RA) for the first 3 days. The daily administration of 5-HT3RA is resumed after the 4th day based on the condition of patients during TMZ+RT. Therefore, the present study investigated risk factors for nausea and vomiting in patients requiring the daily administration of 5-HT3RA. Patients with high-grade glioma who received TMZ+RT between January 2014 and December 2019 at our hospital were included. Patients were divided into two groups: a control group (patients who did not resume 5-HT3RA) and resuming 5-HT3RA group (patients who resumed 5-HT3RA after the 4th day), and both groups were compared to identify risk factors for nausea and vomiting during TMZ+RT. There were 78 patients in the control group (68%) and 36 in the resuming 5-HT3RA group (32%). A multivariate analysis of patient backgrounds in the two groups identified age <18 years, PS 2 or more, and occipital lobe tumors as risk factors for nausea and vomiting. Nausea and vomiting were attenuated in 30 patients (83%) in the resuming 5-HT3RA group following the resumption of 5-HT3RA. The results obtained highlight the importance of extracting patients with these risk factors before the initiation of therapy and the early resumption or daily administration of 5-HT3RA according to the condition of each patient.

Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late-onset gestational hypertension.

AIM: This study aimed to determine whether 1-night screening of oxygen desaturation in women with uncomplicated pregnancy about 1 month before the due date is useful to predict late-onset gestational hypertension (GH) after 37 weeks of gestation. METHODS: We recruited 102 women with uncomplicated pregnancy between 34 and 36 weeks of gestation. These women then completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for obstructive sleep apnea, and recorded their oxygen saturation (SpO2 ) and physical acceleration profiles during nocturnal sleep for 1 night at home using a portable pulse oximeter and actigraph, respectively. Thereafter, their blood pressure was monitored weekly until delivery. RESULTS: Pulse oximetry data between 34 and 36 weeks of gestation revealed that three women had an oxygen desaturation index (ODI) ≥5.0 and seven had a minimum SpO2 < 90%. During follow-up until delivery, two women with an ODI ≥5.0 and a minimum SaO2 <90% developed GH at 37 weeks of gestation. Among clinical measures at recruitment, body mass index (BMI) and pulse oximetry measures appeared available for the prediction of GH. The positive predictive values (95% confidence intervals) of the criteria using these measures were 0.67 (0.26-0.67) for ODI ≥5.0, 0.29 (0.10-0.35) for minimum SpO2 <90%, and 0.07 (0.02-0.07) for BMI ≥25.0. CONCLUSION: For the prediction of late-onset GH after 37 weeks of gestation, pulse oximetry measures about 1 month before the due date are particularly useful because of their high positive predictive values.

Long-term reliability of sweet-tip type screw-in leads.

BACKGROUND: Active fixation leads have provided stable atrial and ventricular pacing; however, long-term follow-up data have not been satisfactory. The purpose of this study was to investigate the long-term reliability of active fixation leads and their electrical characteristic stability. METHODS: A total of 1196 pacing leads were implanted in 830 patients consecutively between 2002 and 2013. In this retrospective study, we were able to trace 1092 leads in 750 patients to investigate the prognosis of implanted leads. The measurement values (including pacing thresholds, sensing amplitudes, and lead impedances of both the atrial and ventricular leads) were obtained from medical records at the time of implantation and during follow up at the outpatient device clinic. All pacing leads were FINELINE II Sterox EZ Leads (Boston Scientific, MN, USA), which are sweet-tip type screw-in active fixation leads, except for the shock leads in patients with implantable cardioverter defibrillator. RESULTS: The mean follow-up period was 51.3±29.2 months (median, 48 months). A total of 1092 leads were implanted in either the atrium (682 leads) or the ventricle (410 leads). Venous access was achieved through cephalic vein cut down (CVC) method (914 leads) or the subclavian vein puncture (SVP) method (178 leads). The overall lead survival rate was 99.6% at both 5 and 10 years. Lead fracture was observed in 4 of 1092 leads (0.37%), all of which were implanted by the SVP method. No lead fracture occurred among patients wherein CVC method was applied (p<0.01). Device-related infection was observed in four patients (0.53%). CONCLUSIONS: The overall reliability and stability of sweet-tip type screw-in leads were satisfactory throughout the long-term follow-up period (median, 4 years). Because it was associated with less lead fractures, cut-down access from the cephalic vein may be recommended as the first-line approach when considering the importance of long-term durability of pacing leads.

Impact of overnight oximetry findings on cardiac autonomic modulation in women during second trimester of uncomplicated pregnancy.

AIM: Although sleep-disordered breathing (SDB) might impose an underlying health threat upon some pregnant women, the influence of SDB on the health status of most pregnant women is not discernible. In order to find out which pregnant women should be evaluated for clinically meaningful SDB during the second trimester, the present study aimed to determine which overnight oximetry findings significantly affect maternal resting cardiac autonomic modulations. MATERIAL AND METHODS: Overnight arterial oxygen saturation (SaO2 ) was monitored at home using pulse oximetry by 64 women with uncomplicated pregnancy between 24 and 28 weeks of gestation. We then determined the impact of the findings on maternal resting heart rate variability (HRV) using 5-min photoplethysmography. RESULTS: A relatively increased oxygen desaturation index (number of oxygen desaturation events where SaO2 fell >3% below the baseline saturation/h) of ≥3.0 in five women did not significantly impact HRV. On the other hand, events associated with profound oxygen desaturation (minimum SaO2 ≤ 90%) in three women were associated with decreased HRV, including high- and low-frequency powers. CONCLUSION: Parasympathetic activities of cardiac autonomic modulations might be attenuated in women who experience profound night-time oxygen desaturation, even if the incidence of significant events is quite low. The oximetry finding of minimum SaO2 ≤ 90% might be a valuable criterion for clinically meaningful sleep-disordered breathing among women with early uncomplicated pregnancy.

Family preference for place of death mediates the relationship between patient preference and actual place of death: a nationwide retrospective cross-sectional study.

BACKGROUND: Discrepancy between preferred and actual place of death is common in cancer patients. While previous research has elucidated the factors associated with congruence between patients' preferred and actual place of death, it is not known how the perspective of the family influences the place of death. This study examined whether family preference for place of death mediates the relationship between patient preference and actual place of death. METHODS: A total of 258 cancer patients (home death, n = 142; hospital death, n = 116) who had received terminal care in Japan were analyzed. Measures included patients' demographic variables, patient and family preferences for place for death, actual place of death, patients' functional status, use and intensity of home care, availability of inpatient bed, living arrangement, and amount of extended family support. RESULTS: Patient-family congruence on preferred place of death was 66% in patients who died at home and 47% in patients who died at other places (kappa coefficient: 0.20 and 0.25, respectively). In a multiple logistic regression model, patients were more likely to die at home when patients were male (odds ratio [OR], 95% confidence interval [CI]: 2.53, 1.06-6.05) and when their family preferred death at home (OR, 95% CI: 37.37, 13.82-101.03). A Sobel test revealed that family preference mediated the relationship between patient preference and place of death (p<0.05). CONCLUSIONS: This study is, to our knowledge, the first to unveil the role of the family in the relationship between patient preference and place of death in Japan. In order to honor patients' wishes to die at home, supporting caregivers in the family may be an essential component of terminal care.

Japanese people's preference for place of end-of-life care and death: a population-based nationwide survey.

CONTEXT: Japanese people's preferred place of end-of-life care may be affected by their experiences, perceptions, and knowledge related to the end of life. OBJECTIVES: The aims of this study were to clarify the Japanese population's preferences for the place of end-of-life care and death and to identify the determinants of each choice of preferred place of end-of-life care within their experiences, perceptions, and knowledge. METHODS: A total of 2000 Japanese people aged 40-79 years participated in a cross-sectional nationwide survey. RESULTS: Fifty-five percent (n=1042) responded. Regarding place of end-of-life care, approximately 44% of the general population preferred home, 15% preferred hospital, 19% preferred palliative care unit, 10% preferred public nursing home, 2% preferred private nursing home, and the remaining 11% was unsure. Multinomial logistic regression analysis revealed that the following factors affect people's preferences regarding place of care: 1) experiences, such as "visiting hospital regularly" and "experiencing home death of relatives," 2) perceptions, such as "giving due thought to their own death on a daily basis" and "perceiving lower home palliative care costs to be appropriate after comparing hospital admission fees," and 3) knowledge of "home care nursing" and "24-hour home palliative system by physicians and nurses using insurance." These factors correlated with preference for hospital, palliative care unit, or public nursing home, when compared with the preference of home. CONCLUSION: The present findings may help to develop an effective end-of-life care system in Japan, in line with people's various preferred locations for such care.

Plasma n-3 polyunsaturated fatty acid and cardiovascular disease risk factors in Japanese, Korean and Mongolian workers.

The favorable role of n-3 polyunsaturated fatty acid (PUFA) in cardiovascular disease (CVD) has been demonstrated in animal experiments and in humans in Western countries, but its effect remains controversial in Asian populations. An observational study of Japanese, Koreans and Mongolians with extended histories of remarkably different frequencies of fish intake was conducted to examine whether differences in plasma n-3 PUFA affects CVD risk factors. We conducted a cross-sectional study in workplace settings and determined body mass index (BMI), blood pressure, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride (TG), glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and fatty acid composition in plasma. A total of 411 Japanese, 418 Korean and 252 Mongolian workers aged 30-60 yr participated in this study. The Japanese ate fish more frequently and had remarkably higher values of eicosapentaenoic acid, docosahexaenoic acid and n-3 PUFA, and lower values of BMI and HOMA-IR, followed by the Koreans, and then the Mongolians. In age groups, the Japanese and Koreans showed a similar tendency of increase in n-3 PUFA with increasing age. General linear measurement multivariate analysis after adjustment for gender, age, smoking, drinking, exercise habits and BMI showed n-3 PUFA was associated with HDL-C and TG in the Japanese, while it was associated with systolic blood pressure in the Koreans, and TG in the Mongolians. In conclusion, an increase in n-3 PUFA was associated with HDL-C and TG in the Japanese and Mongolians, but these beneficial effects were not constant across the three Asian ethnic groups.