Increased white blood cell count is associated with an increased demand for unfractionated heparin during veno-arterial extracorporeal oxygenation in lung transplantation.

BACKGROUND: This retrospective observational study aimed to examine whether clinical inflammatory parameters were associated with the requirement dosage of unfractionated heparin (UFH) to maintain the range of ACT in veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during lung transplantation surgery. METHODS: Among all patients who underwent lung transplantation using V-A ECMO from January 2021 to May 2022, 27 patients were included. These patients were divided into two groups based on whether the infusion rate of UFH was increased from the initial infusion rate (7-8 units/kg/h) (increased group, n = 10) or the infusion rate was maintained or decreased (non-increased group, n = 17). The infusion rate was adjusted with an activated clotting time (ACT) target of 160-200 s. RESULTS: At 1-2 h after starting ECMO, ACT was significantly lower (179.0 (166.5-188.5) versus 224.0 (193.0-242.0) sec, p = 0.006) and white blood cell (WBC) counts were higher in the increased group (12.6 ± 3.3 versus 9.5 ± 4.0 × 103/µL, p = 0.046). The UFH infusion rates were higher in the increased group during the surgery. The cutoff value of WBC count at 1-2 h after starting ECMO for discriminating the need for increasing the UFH dosage was determined as 10.2 × 103/µL (sensitivity 90.0%, specificity 58.8%, area under the curve 0.712) and discrimination of this cut-off value was confirmed as statistically significant (p = 0.018). CONCLUSION: These data suggested that WBC count was associated with the requirement of an increase in the UFH infusion rate of V-A ECMO during lung transplantation surgery. Further evaluation is necessary to clarify the role of WBC count in determining the optimal UFH dosage.

Survival Prediction of Patients Who Were Terminally Ill Using the EORTC QLQ-C15-PAL Scores and Laboratory Test Values.

Background: Prognostics for patients with cancer is especially important for the supportive care of those who are terminally ill. We previously found that symptom scores as patient-reported outcomes (PROs)-such as dyspnea and fatigue scores-some biochemical parameters, the palliative performance scale (PPS) scores, and symptom clusters were useful prognostic factors; however, the predictability of a prognosis based on these factors remains unclear. Objective: To identify appropriate three-week survival predictive factor(s), in terms of performance, in patients who were terminally ill. Design: We collected symptom scores as PROs using the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL). Setting/Subjects: We used data from terminally ill patients with cancer who were hospitalized at the palliative care unit of the Higashisumiyoshi-Morimoto Hospital (Osaka, Japan) from June 2018 to December 2019 (n = 130), as well as additional data obtained from the same clinical study from January to March 2020 (n = 31). Measurements: To evaluate predictive performance, indices such as sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated. Results: We found that the presence of a symptom cluster showed high sensitivity but low specificity and that a higher PPS value (>30) showed high specificity but low sensitivity, suggesting that these factors could provide relevant information for survival prognosis (less than or equal to three weeks). Conclusion: Symptom clusters obtained from patients is important for effective supportive care of those who are terminally ill.

Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer.

PURPOSE: The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. METHODS: We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. RESULTS: The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach's alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively). CONCLUSION: In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

The role of EORTC QLQ-C15-PAL scores and inflammatory biomarkers in predicting survival in terminally ill patients with cancer.

BACKGROUND: The clinical use of patient-reported outcomes as compared to inflammatory biomarkers for predicting cancer survival remains a challenge in palliative care settings. We evaluated the role of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative scores (EORTC QLQ-C15-PAL) and the inflammatory biomarkers C-reactive protein (CRP), albumin (Alb), and neutrophil-lymphocyte ratio (NLR) for survival prediction in patients with advanced cancer. METHODS: This was an observational study in terminally ill patients with cancer hospitalized in a palliative care unit between June 2018 and December 2019. Patients' data collected at the time of hospitalization were analyzed. Cox regression was performed to examine significant factors influencing survival. A receiver operating characteristic (ROC) analysis was performed to estimate cut-off values for predicting survival within 3 weeks, and a log-rank test was performed to compare survival curves between groups divided by the cut-off values. RESULTS: Totally, 130 patients participated in the study. Cox regression suggested that the QLQ-C15-PAL dyspnea and fatigue scores and levels of CRP, Alb, and NLR were significantly associated with survival time, and cut-off values were 66.67, 66.67, 3.0 mg/dL, 2.5 g/dL, and 8.2, respectively. The areas under ROC curves of these variables were 0.6-0.7. There were statistically significant differences in the survival curves between groups categorized using each of these cut-off values (p < .05 for all cases). CONCLUSION: Our findings suggest that the assessment of not only objective indicators for the systemic inflammatory response but also patient-reported outcomes using EORTC QLQ-C15-PAL is beneficial for the prediction of short-term survival in terminally ill patients with cancer.

Comparison of Patient Self-Reported Quality of Life and Health Care Professional-Assessed Symptoms in Terminally ill Patients With Cancer.

BACKGROUND: Few studies evaluated whether health care professionals accurately assess several symptoms for patients with cancer in palliative care units. We determined the agreement level for several symptoms related to quality of life (QOL) between patient-reported QOL assessment and health care professional-assessed symptoms based on the Support Team Assessment Schedule (STAS). METHOD: An observational study was performed with terminally ill patients with cancer hospitalized in the palliative care unit between June 2018 and December 2019. Patients and health care professionals independently assessed 7 symptoms at the time of hospitalization and after 1 week. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C15-PAL). In examining the proportions of exact agreement, "exact agreement" referred to the pairs of the scores (QLQ-C15-PAL vs STAS) being (1 vs 0), (2 vs 1), (3 vs 2 or 3), or (4 vs 4). The relationships of physical functioning between QLQ-C15-PAL and Palliative Performance Scale (PPS) were examined. RESULTS: Of 130 patients, approximately 60% had PPS scores from 40 to 60. The highest mean score on QLQ-C15-PAL was for fatigue (63.8). The exact agreement on symptoms between patients and health care professionals ranged from 15.4% (fatigue) to 57.7% (nausea and vomiting). The mean of the transformed QLQ-C15-PAL and proportions of exact agreement were negatively correlated (R 2 = 0.949, P < .05). The physical function scores in QLQ-C15-PAL for each PPS group showed no differences. CONCLUSION: We expect patient-reported outcomes including QLQ-C15-PAL to be added to health care professionals' assessment of serious symptoms such as fatigue in terminally ill patients with cancer.

[Temporary use of centrifugal pump for pump thrombosis in patients with paracorporeal ventricular assist device].

Nipro paracorporeal ventricular assist device( VAD) is often associated with pump thrombosis which causes severe complications such as brain infarction, often requiring pump change. However, Nipro VAD pump is an expensive device and it is difficult to change pumps frequently at a short interval. We have temporarily used Rotaflow centrifugal pump for recurrent pump thrombosis in patients with Nipro VADs. From January 2012 through December 2013, 19 patients underwent Nipro VADs implantation at our institution, and 9 of them underwent pump change from Nipro pumps to Rotaflow centrifugal pumps. A total of 25 Rotaflow centrifugal pumps were used in these 9 patients, with the total circulatory support duration of 526 days. The median support period was 15 days (range;2-128 days). There were 2 cerebrovascular accidents and 1 Rotaflow pump circuit thrombosis during this period. Change from Rotaflow to Nipro VAD pump resulted in decrease in hematocrit by about 3 point. There was no difference in liver or renal function between before and after the pump change. Our results suggest that temporary use of Rotaflow centrifugal pump for recurrent pump thrombosis in patients with Nipro VADs may be a promising alternative.

An anthropomorphic pelvis phantom for optimization of the diagnosis of lymph node metastases in the pelvis.

OBJECTIVE: An anthropomorphic pelvis phantom was made by the modification of a National Electrical Manufacturers Association (NEMA) phantom, currently the most popular one, and its clinical usefulness was evaluated. METHODS: The NEMA plus bone phantom was made by placing the pelvic bone model in the NEMA phantom. The NEMA plus bladder phantom was made by placing an imitation of the urinary bladder in the NEMA phantom. The pelvis phantom was also made by placing both the pelvic bone model and the bladder in the NEMA phantom. Four kinds of phantoms were imaged by both 2D and 3D dynamic modes, and for each phantom, prompt coincidence count rates, random ones, true plus scatter ones, and single photon rates were measured and these coincidence count rates were compared with those from the actual clinical data. After image reconstruction, the contrast ratio and image noise were also investigated. RESULTS: For the random coincidence count rate, the data obtained from each phantom showed good correspondence to the clinical data. The prompt coincidence count rates and true plus scatter ones of the clinical data were different from those obtained from NEMA phantom, NEMA plus bone one and NEMA plus bladder one, whereas there was a good correspondence between the data of the pelvis phantom and the clinical data. For the contrast ratio and image noise, there were discrepancies between the data of NEMA phantom and pelvis phantoms. CONCLUSIONS: We made an anthropomorphic pelvis phantom by the simple modification of a NEMA phantom. This phantom showed performance similar to that of the actual human pelvis, suggesting clinical usefulness in the evaluation of new acquisition protocols and reconstruction algorithms.

Improvement of the diagnostic accuracy of lymph node metastases of colorectal cancer in 18F-FDG-PET/CT by optimizing the iteration number for the image reconstruction.

OBJECTIVE: Improvement in the diagnostic accuracy of lymph node (LN) metastases of colorectal cancer by optimizing the reconstruction parameters was studied, including a phantom study and clinical studies. METHODS: In the experimental study, the contrast ratio was evaluated using a standard image quality phantom, changing the iteration number of ordered subsets expectation maximization algorithm from 2 to 6. In the clinical study, 89 patients with preoperative colorectal cancer who received 18F-2-deoxy-2-fluoro-D: -glucose positron emission tomography/computed tomography (PET/CT) were studied. Their LN metastases were visually assessed when systematically changing the iteration number, and the optimal iteration number was determined. After the appropriate cut-off value of maximum standardized uptake value was determined, the improvement of the diagnostic accuracy of LN metastases was evaluated for the proximal nodes and the distal ones using the reconstructed images with the optimal iteration number. This was compared with the conventional method that had an iteration number of 2. RESULTS: In the phantom study, it was confirmed that the contrast ratio improved when the iteration number increased. In clinical evaluation, the optimal iteration number was determined to be 5 by visual assessment. When the cut-off value of 1.5 was used, which happened to be the best number, the sensitivity/specificity/accuracy improved from 52%/91%/72% to 77%/89%/83% for the proximal nodes, and from 63%/90%/84% to 91%85%/87% for the distal nodes, respectively. CONCLUSIONS: When the iteration number of the reconstruction algorithm was optimized, the sensitivity of LN metastasis improved by more than 20%, and the accuracy exceeded 80%. Optimization of the image reconstruction parameters in the diagnosis of LN metastases using PET/CT is clinically important.

Nickeladihydrofuran. Key intermediate for nickel-catalyzed reaction of alkyne and aldehyde.

The formation of a nickeladihydrofuran by oxidative cyclization of an alkyne and an aldehyde with nickel(0) has been demonstrated; the transformation of the nickeladihydrofuran into an enone by decomposition, a lactone by carbonylation and an allylic alcohol by treatment with ZnMe(2) suggests that nickeladihydrofuran is an important key intermediate in a variety of catalytic reactions.

Diagnosis supporting algorithm for lymph node metastases from colorectal carcinoma on 18F-FDG PET/CT.

OBJECTIVE: We studied the improvement of the detect-ability of lymph node (LN) metastases from colorectal cancer in (18)F-fluorodeoxyglucose positron emission tomography (FDG PET)/computed tomography (CT) by analyzing the acquired counts with a statistical method. METHODS: Thirty-nine metastatic LNs from 32 cases with colorectal cancer were included in this study. "Uptake region" was defined as the site where counts were higher than the average plus 3 standard deviations (SDs) on each transaxial image of FDG PET. After the initial uptake regions were selected, these high accumulation areas were automatically excluded from consideration thereafter. This method was repeated and new uptake regions were identified. This method was repeated up to five times. After that, the stacked-up uptake regions were compared with computed tomography (CT) images, and the high accumulation areas that were superimposed on the normal structures, such as intestine, vessels, and ureters, were excluded from the consideration. The remaining uptake regions were diagnosed as metastatic LNs, and the detectability of LN metastases was calculated. We then compared these statistical results with the results obtained on the basis of visual assessments by radiologists. RESULTS: Our proposed method showed the best results when the procedures were repeated three times in the light of detectability. After being repeated three times, this method detected 15/23 (65.2%) metastatic LNs in the first LN group, 16/16 (100%) in the second-third LN groups and 31/39 (79.4%) in the total LNs, whereas the radiologists diagnosed 8/23 (34.8%) of metastatic first LNs, 12/16 (75.0%) in the second-third LNs and 20/39 (51.3%) in the total LNs. A statistically significant difference was observed between the result of iteration number 3 and that by radiologists as for the second-third LNs and the total LNs. CONCLUSIONS: This study suggests that our proposed statistical method could improve the detectability of LN metastases from colorectal cancer. Our method will help radiologists to detect small metastatic lesions such as LN metastases.

Increased remnant lipoprotein in patients with coronary artery disease--evaluation utilizing a newly developed remnant assay, remnant lipoproteins cholesterol homogenous assay (RemL-C).

AIM: Remnant lipoprotein is an emerging risk factor for coronary artery disease (CAD); however, the development of a specific remnant lipoprotein assay has struggled due to its heterogeneous nature. This study aimed to evaluate the clinical importance of a newly developed assay for remnant lipoprotein, RemL-C, in patients with CAD. METHODS: This assay utilizes surfactant and phospholipase-D to selectively degrade and solubilize remnant lipoprotein. One hundred and sixty consecutive CAD patients who underwent coronary catheterization were recruited. RESULTS: Remnant liporotein, RemL-C, was significantly higher in CAD patients (p< 0.001). Additionally, TG, hs-CRP, ICAM-1, VCAM-1, and homocysteine were significantly higher, but HDL-C and adiponectin were lower with LDL-C unchanged. Since RemL-C levels correlated with plasma TG levels, two subgroups, normotriglycedemic and normolipidemic CAD groups, were extracted. In both groups, RemL-C was still significantly higher than controls. HDL-C, but not RemL-C, was associated with the severity of CAD. RemL-C significantly correlated with TG-rich lipoproteins, in particular VLDL and IDL, when limited to normolipidemic CAD patients. CONCLUSION: Remnant lipoprotein, measured by RemL-C, was increased in CAD patients independent of TG levels, indicating impaired remnant lipoprotein metabolism in these patients. CAD severity was associated with HDL-C, but not with remnant lipoprotein, indicating differential roles of lipoproteins in the development of coronary atherosclerosis. This study therefore provides clinical significance to assess coronary risk by measuring RemL-C, particularly among patients with normal TG levels.

Reversible carbon-carbon bond formation between 1,3-dienes and aldehyde or ketone on nickel(0).

The reversible oxidative cyclization of dienes and aldehydes with nickel(0) proceeded to give eta(3):eta(1)-allylalkoxynickel complexes. The treatment of these complexes with carbon monoxide led to the formation of the corresponding lactone and/or the regeneration of a butadiene and an aldehyde concomitant with the formation of Ni(CO)(3)(PCy(3)). The scission of the nickel-oxygen bond of the allylalkoxy complexes with ZnMe(2) leading to eta(3)-allyl(methyl)nickel was very efficient to suppress the reverse reaction of the oxidative cyclization. The methylated eta(3)-allylnickel compound underwent the reductive elimination. The carbonylative coupling reaction of the eta(3)-allyl(methyl)nickel proceeded as well under a carbon monoxide atmosphere. Similarly, the addition of Me(3)SiCl to eta(3):eta(1)-allylalkoxynickel complexes was also efficient for the inhibition of the reverse reaction. The resulting eta(3)-1-siloxyethylallylnickel complex was treated with carbon monoxides followed by the addition of MeOH to give the expected hydroxyester. This method is efficient as well even for the eta(3):eta(1)-allyl(alkoxy)nickel complex containing acetone as a component, which was so prone to undergo the reverse reaction hampering its isolation. The isolation of the eta(3):eta(1)-allylalkoxynickel complex containing ketone as a component was made easier by the use of heavier butadiene and ketone, such as 2,3-dibenzyl-1,3-butadiene and benzophenone or by the use of cyclobutanone. The reaction with styrene oxide gave the eta(3):eta(1)-allylalkoxynickel containing phenylacetoaldehyde, an isomer of styrene oxide.

Formation of nickeladihydropyran by oxidative addition of cyclopropyl ketone. Key intermediate in nickel-catalyzed cycloaddition.

Cyclopropyl phenyl ketone underwent oxidative addition to Ni(PCy3) generated from Ni(cod)2 and PCy3 to give a nickeladihydropyran, which is a key intermediate for the Ni(0)-catalyzed homo- or heterocycloaddition to give cyclopentane compounds having two carbonyl substituents at the 1,3-position.

Asymmetric [2+2] photocycloaddition of cycloalkenone-cyclodextrin complexes to ethylene.

The enantioselective [2+2] photocycloaddition of cycloalkenone-cyclodextrin complexes to ethylene was examined. Photoreaction of alpha-, beta-, and gamma-cyclodextrin complexes of various cyclohexenonecarboxylates and cyclopentenonecarboxylates in the presence of ethylene in the solid state or in aqueous suspension gave corresponding photocycloadducts with chiral induction.

AlMe3-promoted oxidative cyclization of eta2-alkene and eta2-ketone on nickel(0). Observation of intermediate in methyl transfer process.

AlMe3 can promote the oxidative cyclization of eta2-alkene and eta2-ketone on nickel(0) to give an intriguing nickel-aluminum dinuclear complex having a bridging methyl group, which might be an intermediate for the nickel-catalyzed cycloisomerization of o-allylacetophenone or o-allylbenzophenone.

Dimerization of terminal alkynes catalyzed by a nickel complex having a bulky phosphine ligand.

Ni(cod)(2)/P(t)Bu(3) system catalyzed the dimerization of terminal alkynes to give (E)-head-to-head dimerization products, in which the stannylacetylene dimer could be applied to a one-pot synthesis of a conjugated enyne, when combined with Migita-Stille coupling.

Increased serum iron may contribute to enhanced oxidation of low-density lipoprotein in smokers in part through changes in lipoxygenase and catalase.

BACKGROUND: Increased oxidative stress is considered to be causative for cardiovascular disease (CVD) in smokers, but its mechanisms are still unclear. We compared oxidative stress markers between male smokers and male nonsmokers. METHODS: Twenty-three healthy men (11 nonsmokers and 12 smokers) were enrolled, and blood samples after 12 h of fasting were collected to assess plasma lipids and oxidative stress markers. The effects of iron loading on 12-lipoxygenase (12-LO) expression and activity in human umbilical vein endothelial cells (HUVECs) were tested in vitro to investigate the relevance of iron to oxidation potential in vivo. RESULTS: Higher levels of plasma-oxidized low-density lipoprotein (LDL) and lipid peroxide (LPO), and higher oxidizability of LDL were observed in smokers than in nonsmokers. Higher levels of serum iron and lower levels of plasma vitamin E were observed in smokers than in nonsmokers. Stepwise multiple regression analysis showed that serum iron was an independent determinant for both plasma-oxidized LDL and lag time of LDL oxidation. Iron loading enhanced 12-LO expression threefold and its activity 1.5-fold. Moreover, iron loading decreased catalase expression by 50% and significantly reduced its activity by 75%. CONCLUSIONS: Enhanced oxidative stress in smokers may be due to increased iron levels. Iron-induced modulation of expression and activity of 12-LO and catalase may be relevant to increased iron-related oxidative stress as observed in smokers.

Stepwise growth of polypalladium chains in 1,4-diphenyl-1,3-butadiene sandwich complexes.

A series of 1,4-diphenyl-1,3-butadiene multinuclear palladium sandwich complexes are synthesized by stepwise growth of palladium chains within a sandwich framework.

New direction in organopalladium chemistry: structure and reactivity of unsaturated hydrocarbon ligands bound to multipalladium units.

Examination of the manner of interaction between Pd(0) and allylpalladium(II) complexes, both being involved as key intermediates in Pd-catalyzed allylic coupling, led us to discover a new role for such combinations in affecting the stereochemistry of the transformations. A similar investigation of the system involving Pd(0) and allenyl/propargyl complexes of Pd(II) led to the discovery of dinuclear Pd(I)bond;Pd(I) complexes containing bridging allenyl/propargyl ligands, which exhibited novel structural and reactivity aspects of great synthetic significance. A systematic comparison was made between the structure, stability, and reactivity of allyl and allenyl/propargyl ligands in dinuclear complexes and those in mononuclear counterparts. On the basis of MO calculations, coordination behavior specific to the ligands of the dinuclear complex is attributed to the occurrence of the back-donating interaction from filled Pdbond;Pd bonding orbitals to vacant ligand pi* orbitals. Similar bonding features are the origin of the ready synthesis of novel one-dimensional sandwich complexes composed of conjugated polyene ligands and linear polypalladium chains. A substitutionally labile dipalladium complex reacts with an equimolar amount of trienes or alkynes to give formal [4pi + 2sigma] or [2pi + 2sigma] adducts, respectively, which undergo further unique transformations with additional unsaturated substrates.