Pre-operative Assessment of Psychological Characteristics and Mood States in Living Donor Kidney and Liver Transplantation.

BACKGROUND: Past studies have indicated that psychological problems in both transplant recipients and donors increase during the pre-operative period. However, few studies have evaluated the pre-operative psychological status of both the recipient and the donor. METHODS: This study included the donors and recipients of 36 adult living donor kidney transplants (LDKT) and 12 adult living donor liver transplants (LDLT) between January 2012 and December 2014. Their personalities were assessed using the Tokyo University Egogram (TEG) and the Yatabe-Guilford Personality Inventory (Y-G), while their mood states just before transplantation were evaluated via the Profile of Mood States (POMS). RESULTS: On the TEG, the mean Adapted Child (AC) score of the LDLT recipient group was significantly lower than that of the LDKT recipient group. On the Y-G, no differences in the distribution of the five personality types were recognized among the four groups. POMS depression scores in the LDLT recipient group were significantly higher compared with the other groups. CONCLUSION: LDLT recipients exhibited a depressive mood just before transplantation, and also had a low AC score. Therefore, clinicians should pay careful attention to potential medical non-adherence and post-operative depression in LDLT recipients. Based on these pre-operative assessments of personality and mood states, the transplant team should include post-operative care to support the quality of life of the recipients as well as the donors.

Radiation streaming experiment through a labyrinth of the 12 GeV proton accelerator facility at KEK(2)--TLD REM-counter method.

The doses of radiation streaming through a labyrinth were measured using thermoluminescence dosemeters (TLDs) and neutron moderators for TLDs at the neutrino beam line of the 12 GeV proton accelerator facility of High Energy Accelerator Research Organization (KEK). The calculated doses using the Monte Carlo code, MCNPX basically agreed with the experimental results. However, unexpectedly, the calculated neutron doses were smaller than the measured ones along the upstream side of the labyrinth.

Review of combination of peritoneal dialysis and hemodialysis as a modality of treatment for end-stage renal disease.

Because the contribution of residual renal function (RRF) to total solute clearance is often significant in continuous ambulatory peritoneal dialysis (CAPD), loss of RRF over time can lead to inadequate dialysis if appropriate prescription management strategies are not pursued. Additionally, declines in ultrafiltration caused by increases in peritoneal permeability may limit continuation of CAPD therapy. Peritoneal dialysis and hemodialysis (PD + HD) combination therapy (complementary dialysis therapy) is an alternative method. This therapy allows the patient to maintain daily activities, as with CAPD, while undergoing once-a-week HD supplements for the insufficient removal of solutes and water. This therapy allows for the continuation of PD without shifting to total HD in PD patients who continue to have uremic symptoms even after individualization of the PD prescription. This treatment option is psychologically more acceptable to patients and may be expected to provide such accompanying beneficial effects as peritoneal resting, improvement of QOL and reduction in medical cost.

Assessment of aortic atherosclerosis and carotid atherosclerosis in coronary artery disease.

The present study investigated the relationship between aortic atherosclerosis and carotid atherosclerosis, and studied the effects of coronary risk factors for these arteries. The subjects consisted of 78 patients with coronary artery disease (CAD) and 69 patients without CAD. All subjects underwent enhanced computed tomography and B-mode ultrasonography within a short time period to determine the extent of aorta and carotid atherosclerosis. Significant correlations between maximal aortic wall thickness (MAWT) and aortic wall volume (AWV) with carotid intima-media thickness (IMT) were demonstrated. MAWT, AWV and IMT were significantly higher in patients with CAD compared with controls (p=0.009, p=0.024, p=0.001, respectively). Furthermore, there were significant differences in MAWT, AWV and IMT among groups classified by the number of coronary artery stenoses, and no significant differences among groups classified by risk factors, but it was shown that MAWT, AWV and IMT increased gradually as the risk factors increased in number. MAWT, AWV and IMT had positive correlations with age, systolic blood pressure and triglyceride, and a negative correlation with high density lipoprotein-cholesterol. This study demonstrated that both aortic atherosclerosis and carotid atherosclerosis are closely correlated with coronary atherosclerosis, and that the atherosclerosis indices are independently associated with age and hyperlipidemia.

Assessment of the presence and severity of esophagogastric varices by splenic index in patients with liver cirrhosis.

PURPOSE: To determine whether spleen size is related to the severity of esophageal varices or associated gastric varices and liver functions in patients with cirrhosis. METHOD: The authors retrospectively studied spleen size on CT (splenic index [SI] = length x width x height of the spleen), liver functions, and the results of esophagogastric endoscopy in 110 patients with cirrhosis. They also analyzed SI in 112 controls. RESULTS: In controls, body weight, height, and age affected the SI. The SI in patients with uncompensated cirrhosis was greater compared with the SI in those with well-compensated disease (p = 0.0363). The SI in patients with esophageal varices was greater than in patients without esophageal varices (p<0.0001), but patients with and without gastric varices had similar SI values. The SI in patients with the red color signs (red wale marking, cherry red spot, and hematocystic spot) on esophageal varices or with risky varices (enlarged tortuous varices with beady, nodular, or tumor shape associated with red color signs) was greater than in patients without these signs (p = 0.0029 and p = 0.0030, respectively). CONCLUSION: The SI is a good indicator of the severity of esophageal varices and hepatic functional reserve in patients with cirrhosis.

Assessment of portosystemic shunt by summation of radioactivity during 201thallium chloride portal scintigraphy in patients with chronic liver disease.

BACKGROUND/AIMS: Portal scintigraphy is a useful non-invasive method for the determination of portosystemic shunts in patients with liver cirrhosis. Several procedures have been reported for its execution in clinical practice but most of them failed to show sufficient sensitivity for the diagnosis of portosystemic shunt. In the present study, we evaluated whether summation of radioisotope counts obtained during intrarectal or intraduodenal administration of 201thalium chloride is useful for increasing the diagnostic yield of porto-systemic shunts in patients with chronic liver disease. METHODOLOGY: Seven patients with chronic viral hepatitis and 8 with liver cirrhosis secondary to viral hepatitis were enrolled in this study. Following the conventional protocol, 201thalium chloride was administered per rectum and the 60-second-heart-to-liver uptake (conv-H/L-R) ratio was calculated after 20 min. Continuous measurement of the radioactivity signals during 20 min were also done and the summated heart-to-liver uptake (sum-H/L-R) ratio from the total radioactivity count were calculated. Measurement of the conventional heart-to-liver uptake (conv-H/L-D) ratio and the summated (sum-H/L-D) ratio were also done as described above after the intraduodenal administration of 201thalium chloride by endoscopy. RESULTS: All ratios (conv-H/L-R, conv-H/L-D, sum-H/D-R, sum-H/L-D) were significantly higher in patients with liver cirrhosis than in those with chronic hepatitis. Among all heart/liver ratios, only the sum-H/L-R ratio was significantly different between patients with and without esophageal varices. Serum hyaluronate level and other liver function tests were found to be significantly correlated with all heart-to-liver ratios, but they were more strongly correlated with the sum-H/D-R and sum-H/L-D ratios than with the conv-H/L-R and conv-H/L-D ratios. CONCLUSIONS: The results of this study showed that the heart-to-liver ratio calculated by summation of radioactivity is better than the conventional method for the diagnosis of portosystemic shunt in patients with chronic liver disease.

Personality and dietary habits.

BACKGROUND: The personality of healthy individuals has not been well studied in relation to health consciousness, dietary habits and actual food intake, simultaneously. OBJECTIVE: Our objective was to study the association between personality and dietary habits. DESIGN: Information on dietary habits, including taste preferences and the frequency of food consumption, was collected through a questionnaire from 76 male and 394 female students. The personality of students was determined by a modified NEO-FFI test. Health status, height, body weight, body fat percentage and blood pressure were measured by physical examination. Main outcome measures were personality scores as indicators of a healthy dietary pattern. RESULTS: Food intake was influenced by neuroticism (N), extraversion (E), openness (O) and agreeableness (A) of personality. Taste preferences and receptivity to dietary advice were also influenced by personality: the odds ratios (ORs) between the high and low tertiary points of the NEO-FFI scores for salty and sweet taste preferences were significantly higher in the group that scored high for neuroticism (N) (salty taste preference: OR = 2.25, NS in males and OR = 2.39, 95%CI = 1.16-4.93 in females; sweet taste preference: OR = 21.00, 95%CI = 2.40-183.99 in males and OR = 3.33, 95%CI = 1.61-6.91 in females). On the other hand, the groups with high scorer for O and A did not like salty tastes. The groups with high scores for A and C were receptive to dietary advice. High scores of each N, E, O, A, and C factor were characterized by distinguishable, dietary habits and lifestyle. For nutritional or health education, group classes are sufficient for high A and O. High C scorer displayed discrepancies between health consciousness and dietary habits, so intervention or a close follow-up by medical professionals would be necessary to improve the health of individuals in this group. High E scorer possessed a confident attitude towards their health, but they were not interested in developing healthy habits. High N scorer was adverse to receiving health information and learning healthy dietary habits. CONCLUSION: Personality determined by NEO-FFI test was related to dietary habits and health attitude. Effective health education methods must take the personality of the targeted individuals into consideration.

Clinicopathological and biological assessment of lung cancers with pleural dissemination.

BACKGROUND: This study provides the surgical outcome of lung cancer patients with pleural dissemination, with the assessment of the clinicopathological and biological prognostic factors. METHODS: Forty-three patients who underwent operations were studied. Vascular endothelial growth factor (VEGF) and autocrine motility factor receptor (AMFR/gp78) expression was immunohistochemically evaluated. RESULTS: In total, the overall 3 and 5-year survival rates were 31.4% and 13.1%, respectively. The patients who underwent the pleuropneumonectomy had a worse outcome than those who underwent limited operations (pleurectomy plus parenchymal resections were less than pneumonectomy). VEGF and AMFR/gp78 were highly expressed in primary tumors. Among the patients who underwent limited operations, pathological types other than adenocarcinoma and high expression of VEGF were significantly associated with a worse outcome. The pathological type was the only characteristic to retain a significant independent prognostic impact on overall survival. CONCLUSIONS: The results imply the validation of limited operation for lung cancer with pleural dissemination for the local control. High frequency of VEGF and AMFR/gp78 expression conform to the interpretation that patients with pleural dissemination have a high-risk of systemic disease.

Health consciousness of young people in relation to their personality.

Personality of targeted individuals can be assumed to influence behavior modification by health education. In this study the influence of personality on health consciousness was analyzed by a questionnaire for lifestyle, health consciousness, and the NEO-FFI personality test. Subjects were 942 new students in the Tokyo University of Agriculture who were surveyed in April, 1998. Separately performed health examination data were used to verify reliability of answers to the questionnaire. Among students, 83.2% of males and 90.4% of females felt themselves to be healthy, and more than 80% students desired to improve their health more. The rate of having no physical complaints, however, was only 31.7% in males and 20.4% in females. Distribution of NEO-FFI scores of neuroticism (N), extraversion (E), openness (O), agreeableness (A), and conscientiousness (C) corresponded well between males and females, except for significantly higher scores of O and A in females. Odds ratios (ORs) between high and low tertial points of NEO-FFI score for health consciousness were significantly elevated in the high scoring groups of E and C (OR = 6.26, 95% CI = 1.46-26.82, and OR = 6.04, 95% CI = 1.42-25.71, respectively) in males. On the contrary, high N and O groups had low health consciousness. Smoking habit was associated with high E scores (OR = 2.24, 95% CI = 1.13-4.43). Dietary habits, regular eating time, and avoidance of salty foods were associated with high C scores in both males and females. The OR of regular eating time was 2.66 (95% CI = 1.42-1.98), and 2.20 (95% CI = 1.31-3.71) for males and females, respectively. The OR of avoidance of salty foods were 2.09 (95% CI = 1.11-3.91), 1.87 (95% CI = 1.11-3.16) for males and females, respectively. Significant associations between lifestyle and personality require further study for risk association analysis and for relationship to interventive practices for prevention of lifestyle associated diseases.

Assessment of hepatic functional reserve in cirrhotic patients by computed tomography of the caudate lobe.

In order to investigate whether the size of the caudate lobe of the cirrhotic liver is related to the hepatic functional reserve, the morphometric analysis of the caudate lobe was preformed retrospectively using computed tomography in 106 consecutive patients of whom 67 had compensated (group 1), and 39 uncompensated (group 2) liver cirrhosis. In 51 patients, hepatic measurements were repeated in follow-up. Age- and gender-matched controls were studied. The size of the caudate lobe and the ratio of the caudate to right lobe were correlated with liver function. The caudate lobe was larger in the study patients than in the controls, and larger in group 1 than in group 2 (P<0.01). The caudate to right lobe ratios were also greater in the study patients especially in group 1 (P<0.01). In follow-up, the regression coefficient for the caudate to right lobe ratio was positive in group 1 and negative in group 2 (P<0.05). Even though the caudate lobe of patients with uncompensated liver cirrhosis was larger than that of the controls, patients with compensated liver cirrhosis had a larger caudate lobe and higher caudate to right lobe ratio compared to the patients with uncompensated liver cirrhosis. The caudate lobe may have played an important role in maintaining proper liver function in these patients.

[13C]-urea breath test for assessment of cure of Helicobacter pylori infection at 1 month after treatment.

Although the [13C]-urea breath test has been reported to provide high specificity and sensitivity, its reliability in determination of cure, including when and how the assessment of cure is made, is not fully established. Here we evaluate the reliability of judgment of cure after 1 month of therapy using the [13C]-urea breath test, including the appropriate time to assess its cure. Our subjects were 199 H. pylori-infected patients (144 men and 55 women; 50.5+/-0.76 years) who underwent cure therapy, took the breath test at 1 month, and underwent both the breath test and invasive tests using endoscopy at 6 months after completion of therapy. Accuracy of the breath test in judgment of cure at 1 month was investigated by comparing the results at 1 month with those at 6 months when cut-off value of the breath test was set at 5 per thousand. Chronologic alterations of the delta13C value were also analyzed in cured patients who underwent the breath test at 1, 3, and 6 months. In 167 (94.9%) of 176 patients whose breath test values were less than 5 per thousand, cure was reconfirmed at 6 months. In 14 (60.9%) of 23 patients whose values were greater than 5 per thousand, cure was demonstrated at 6 months. The mean delta13C values of 33 cured patients who took the breath test at 1 month and repeated the breath test at 3 and 6 months for any reasons were 4.14+/-0.74 per thousand, 2.02+/-0.23 per thousand, and 1.72+/-0.19 per thousand, respectively, and the value at 3 months was significantly smaller than that at 1 month. The reliability of assessment of cure by only the breath test at 1 month was sufficiently high (94.9%) once the patients were judged to be cured. However, because the breath test at 1 month yielded a high false-positive rate and the breath test values at 3 and 6 months were similar, evaluation of cure of H. pylori infection by the [13C]-urea breath test should preferably be done at 3 months after treatment to minimize false-positive results, or the concept of a borderline group should be established for patients with positive but relatively high delta13C values (5-10 per thousand) who repeated the breath test 3 months after treatment.

Correlation between measurements using a new halitosis monitor and organoleptic assessment.

Halitosis is known as unpleasant oral odor and is a health concern among the general public. Previously, we reported on a new portable monitor with a zinc-oxide, thin-film, semiconductor sensor which demonstrated simplicity of handling, high reproducibility and correspondence for organoleptic assessment. The results suggested its usefulness for the diagnosis of halitosis. Using the monitor, oral air samples of 94 subjects were measured in a field survey, and the values were compared with the organoleptic rates of corresponding samples assessed by two judges. A highly significant correlation (r = 0.824, P < 0.01) was demonstrated between the measures obtained by the two methods. The results suggest that the monitor is useful for not only a clinical study but also a field study of halitosis.

Chronic nausea in advanced cancer patients: a retrospective assessment of a metoclopramide-based antiemetic regimen.

The purpose of this retrospective study is to assess the frequency and intensity of chronic nausea in patients admitted to the Palliative Care Unit and the results of a metoclopramide-based treatment regimen. We reviewed the medical records of 100 consecutive patients admitted to the Palliative Care Unit at the Edmonton General Hospital until death during 1992-1993. All patients had terminal cancer and normal cognitive function. All patients completed the Functional Analogue Scale for appetite, nausea, pain, activity, shortness of breath, and sensation of well-being at 1000 and 1600 hours every day. Patients who complained of nausea initially received metoclopramide 10 mg every 4 hr orally or subcutaneously (Step 1). If nausea persisted, dexamethasone 10 mg twice daily was added (Step 2). Step 3 consisted of a continuous subcutaneous infusion of metoclopramide of 60-120 mg/day plus dexamethasone. If no response was observed, other antiemetics were administered (Step 4). Upon admission to the unit, 32 patients (32%) presented with nausea. During the average admission of 25 +/- 13 days, 98 patients (98%) developed nausea. Twenty-five patients (25%) required other antiemetics because of bowel obstruction (18), extrapyramidal side effects (3), or other reasons (4). Most patients without bowel obstruction achieved excellent control of nausea using the metoclopramide-based regimen. During the first 5 days and last 5 days of admission, nausea had significantly lower intensity than the rest of the symptoms that were monitored. Our results suggest that, although nausea is very frequent, it can be well controlled in the majority of patients using safe and simple antiemetic regimens.

Capsules and suppositories of methadone for patients on high-dose opioids for cancer pain: clinical and economic considerations.

The dose ratio, analgesic efficacy, toxicity and cost of methadone for cancer pain were evaluated in a retrospective review of 50 consecutive patients treated on a Palliative Care Unit. Patients were switched from hydromorphone 267.7 +/- 178.8 mg sc per day to custom-made capsules (24) or suppositories (26) of methadone for reasons of uncontrolled pain (24), toxicity (8), both (15) or other (2). The change in opioid occurred over 2.5 +/- 3.6 days, with another 4.4 +/- 3.7 days required to reach stable methadone dose. The ratio of stable methadone dose to final hydromorphone dose was 1.07 +/- 0.9 (oral) and 1.88 +/- 1.27 (rectal) (p = 0.01). Visual analogue scores for pain intensity (0-100 mm) declined from 50.8 +/- 22 to 40 +/- 20 (p = 0.01). The most frequent toxicities were constipation (46), sedation (42) and nausea (18). Six patients developed respiratory depression. Total cost of treatment was Canadian $116.77 +/- 157.17 for methadone capsules and Canadian $105.34 +/- 146.35 for methadone suppositories, vs Canadian $3450.51 +/- 5098.58 (p = 0.0001) for hydromorphone parenteral solution and Canadian $1801.21 +/- 2661.52 (p = 0.0001) for hydromorphone powder. It is concluded that methadone is an effective and inexpensive alternative in patients receiving high-dose opioids for cancer pain, at dose ratios much lower than recommended in the literature. The incidence of serious toxicities suggests that methadone should only be initiated in an adequately monitored setting by pain management experts.

[Validity of photographical dietary assessment; a preliminary analysis].

We estimated nutritional intake from color photographs taken of meals with a 35-mm camera, and compared them with the values calculated from the menu. Among 21 meals examined, the coefficient of correlation between the values by the photo method and those from examining the menu was appreciably high; 0.842 in energy, 0.828-0.931 in three major nutrients, and 0.745-0.940 in vitamins and minerals. The differences between the photo method and menu observation were 0-14.8% on average, and the coefficient of variation of the differences was 9.1-32.3%. Estimation of salt was, however, very poor, and the agreement was lower due to the cooking method used. Some differences were found among the dietitians in estimated values of several nutrients. The running cost was approximately 87-yen per meal, which may pose a problem for large-scale dietary surveys. Compared with the use of record, recall, and frequency questionnaire methods, the photo method was easily used by participants, especially those not used to cooking, and could be applied to eating out or for take-out food. Moreover, this method may provide not only quantitative data but also qualitative including eating atmosphere. When estimation is difficult due to the ingredients or recipe, combined use with record or recall methods can facilitate estimation. This photo method is thus considered to be a valid and feasible means of dietary assessment.

[Assessment of the proliferative activity of hepatocellular carcinoma with the monoclonal antibody Ki-67 using flow cytometry].

This study examined whether the monoclonal antibody Ki-67 is an indicator of hepatocellular carcinoma proliferation and whether it represents a new parameter for determining the diagnosis and prognosis. The subjects were 22 patients who were not treated preoperatively among the patients undergoing hepatectomy at our department. Fresh specimens of the cancer tissue and the noncancerous regions were stained with PI after processing them with FITC-labeled Ki-67. Then 20,000 cells were analyzed by two-color flow cytometry. A significant difference was observed between the well differentiated group and the moderately and poorly differentiated groups. However, no significant difference was observed with respect to any other factor. The average Ki-67 labeling of the cancers in the patients with and without cirrhosis was 17.0 +/- 10.5% and 5.3 +/- 3.5%, respectively (p < 0.05). The cancers showed high Ki-67 labeling rates compared with the noncancerous areas and a positive correlation was observed between the two. These findings suggested that coexistent hepatic lesions have some influence on the proliferative activity of cancer. A significant correlation was confirmed by flow cytometry after immunostaining using the antibody MIB-1. Analysis by this method was considered to be useful for assessing the proliferating activity of hepatocellular carcinoma.

A rapid assessment of stimulus properties of morphine.

The difficulty in assessing stimulus properties of drugs becomes apparent when the test drug, like morphine, carries both aversive and reinforcing effects at certain doses. Mice (ICR Crj strain) were trained in a passive avoidance conditioning using a two-compartment shuttle-box. On alternate days, morphine (3.0 mg/kg) was paired with shock in one compartment and saline with shock in the other compartment. A total of 3 morphine/saline pairings were given. Animals were then tested 7 times, one test per day, with saline and different doses of morphine (0.75, 1.12, 1.32, 0.93, 1.50, 3.0 mg/kg) to reveal the stimulus properties of morphine. The preference for the morphine-conditioned safe compartment after morphine injections was used to indicate that the animals associated some "stimulus" or "motivational" properties of morphine with the cues of the safe compartment. The animals discriminated very well between saline and low doses of morphine on the one hand, and higher doses of morphine (close to that given during conditioning) on the other. The discontinuity between injections responded to as saline and those responded to as morphine was virtually complete between 1.12 and 1.32 mg/kg of morphine. These findings demonstrate that the present method can be used to establish an association between some stimulus properties of morphine and avoidance of shock. Accordingly, the successful discrimination of the animals between the two compartments revealed some stimulus properties of morphine.

Evaluation of cancer prevention strategies by computerized simulation model: methodological issues.

A computerized simulation model developed to evaluate the potential impact of primary and secondary prevention is discussed from methodologic perspectives. In the simulation model, named CANSAVE (Cancer Strategy Analysis and Validation of Effect), the natural history of cancer was modeled as a Markovian stochastic process from cancer-free state to death. The lung cancer death rate among Japanese males was projected for 50 years to the year 2041. The simulation showed that the age-adjusted death rate would increase and reach a peak of 166 per 100,000 in 1989 and then decrease to 148 in 2003. It then shows a tendency to increase again, up to 255 in 2028. This change may be attributed to a lower smoking initiation rate among those born in the 1930s. Promotion of mass screening programs exhibits a more prompt effect than antismoking efforts, but the reduction in annual deaths is expected to be only 11%, even if a 100% participation is realized by the year 2000. The reduction in smoking initiation rate, on the other hand, begins to show a visible effect very slowly. It was predicted that a 1% annual reduction in smoking initiation rate would result in a 20% decrease in the number of deaths in 2041. The smoking cessation program is in the middle with regard to promptness. The predicted reductions in lung cancer deaths in 2041 were 13, 47, and 66%, respectively, when the annual smoking cessation rate was increased from 0.46% (present status) to 1, 3, and 5%. The combined application of all three preventive measures seems essential to realize the most effective reduction in lung cancer deaths.

New developments in the assessment of pain in cancer patients.

Pain occurs in more than 80% of cancer patients before death. During recent years major progress has taken place in our techniques for the adequate assessment of cancer pain. Major prognostic factors associated with the pain syndrome have been recognized. In addition, other prognostic factors associated with the characteristics of the patient have been defined. Valid tools have been developed that allow for the assessment of most of the prognostic variables associated with analgesic response. During recent years a major effort has been made to integrate the pain syndrome within the other complex symptoms that are often present in patients with advanced cancer. The interaction of pain and analgesic treatment with other symptoms and their management is discussed. Finally, areas where future research should focus in the area of the diagnosis and assessment of pain are discussed.