Prostaglandin E2 is critical for the development of niacin-deficiency-induced photosensitivity via ROS production.

Pellagra is a photosensitivity syndrome characterized by three "D's": diarrhea, dermatitis, and dementia as a result of niacin deficiency. However, the molecular mechanisms of photosensitivity dermatitis, the hallmark abnormality of this syndrome, remain unclear. We prepared niacin deficient mice in order to develop a murine model of pellagra. Niacin deficiency induced photosensitivity and severe diarrhea with weight loss. In addition, niacin deficient mice exhibited elevated expressions of COX-2 and PGE syntheses (Ptges) mRNA. Consistently, photosensitivity was alleviated by a COX inhibitor, deficiency of Ptges, or blockade of EP4 receptor signaling. Moreover, enhanced PGE2 production in niacin deficiency was mediated via ROS production in keratinocytes. In line with the above murine findings, human skin lesions of pellagra patients confirmed the enhanced expression of Ptges. Niacin deficiency-induced photosensitivity was mediated through EP4 signaling in response to increased PGE2 production via induction of ROS formation.

Validity and reliability of the Japanese version of the Caregiver Reaction Assessment Scale (CRA-J) for community-dwelling cancer patients.

BACKGROUND: The aim of this study was to validate the Caregiver Reaction Assessment (CRA) among caregivers of community-dwelling advanced cancer patients in Japan. METHODS: A cross-sectional questionnaire was administered to advanced cancer patients and their caregivers who were cared for at day hospices and home palliative care services. We translated the CRA into Japanese, and then verified factor validity, reliability, construct validity, concurrent validity, and known groups' validity. To address construct and concurrent validity, we calculated Pearson's correlation coefficient between the Japanese version of the CRA and the Burden Index of Caregivers (BIC). To address known groups' validity, we used the t test or analysis of variance (ANOVA). RESULTS: A total of 57 caregivers participated in the study. Five factors were extracted (''impact on schedule,'' ''caregiver's self-esteem,'' ''lack of family support,'' ''impact on health,'' and ''impact on finances'') and reliability was good. Construct and concurrent validity among the subscales of the BIC were good. Regarding known groups validity, the subscale score of ''impact on schedule'' for the groups that cared 6 hours or more per day was higher than the other group (P = .04). CONCLUSION: The CRA-J is valid and reliable. This scale is useful for caregivers of cancer patients in Japan.

Quality of life, day hospice needs, and satisfaction of community-dwelling patients with advanced cancer and their caregivers in Japan.

BACKGROUND: The aims of this study were to clarify (1) the quality of life (QOL) of community-dwelling patients with advanced cancer and their caregivers in home palliative care and day hospice settings, (2) the need for day hospice of home palliative care patients and caregivers, and (3) the satisfaction with day hospice by day hospice patients and caregivers. METHODS: A cross-sectional questionnaire was administered to patients with advanced cancer and their caregivers who were cared for at day hospice and home palliative care. We measured the health-related quality of life using the SF-8, the need for day hospice of home palliative care patients and caregivers, and the satisfaction with day hospice by day hospice patients and caregivers. RESULTS: A total of 57 pairs of patients and caregivers participated in the study (day hospice, n = 23; home palliative care, n = 34). The physical and mental aspects of the patient QOL were significantly lower than national standard value. However, although physical aspect of caregivers QOL was significantly lower than national standard value, mental aspect of caregiver's QOL was not lower than national standard value. Forty-four percent of home palliative care patients and 67% of home palliative care caregivers preferred day hospice. The needs of patients and caregivers were wide ranging including medical treatment, distraction, information provision, and respite. Overall, the Japanese day hospice was evaluated highly. CONCLUSION: This is the first study of day hospice in Japan. Although there are several day hospices in Japan, the initiation of day hospice would probably be successful. The dissemination of day hospice is an important issue for patients with advanced cancer and their caregivers in Japan.