Anxiety, depression and psychosocial needs are the most frequent concerns reported by patients: preliminary results of a comparative explorative analysis of two hospital-based palliative care teams in Germany and Japan.

In the partnership between the medical departments of Würzburg University, Germany, and Nagasaki University, Japan, palliative care is a relevant topic. The aim of the study was to perform a comparative analysis of the hospital-based palliative care teams in Würzburg (PCT-W) and Nagasaki (PCT-N). Survey of staff composition and retrospective analysis of PCT patient charts in both PCTs were conducted. Patients self-assessed their symptoms in PCT-W and in Radiation Oncology Würzburg (RO-W). The (negative) quality indicator 'percentage of deceased hospitalised patients with PCT contact for less than 3 days before death' (Earle in Int J Qual Health Care 17(6):505-509, 2005) was analysed. Both PCTs follow a multidisciplinary team approach. PCT-N saw 410 cancer patients versus 853 patients for PCT-W (22.8% non-cancer patients). The Eastern Cooperative Oncology Group Performance Status at first contact with PCT-N was 3 or 4 in 39.3% of patients versus 79.0% for PCT-W. PCT-N was engaged in co-management longer than PCT-W (mean 20.7 days, range 1-102 versus mean 4.9 days, range 1-48). The most frequent patient-reported psychological symptom was anxiety (family anxiety: 98.3% PCT-W and 88.7% RO-W, anxiety 97.9% PCT-W and 85.9% RO-W), followed by depression (98.2% PCT-W and 80.3% RO-W). In 14 of the 148 deceased patients, PCT-N contact was initiated less than 3 days before death (9.4%) versus 121 of the 729 deceased PCT-W patients (16.6%). Psychological needs are highly relevant in both Germany and Japan, with more than 85% anxiety and depression in patients in the Japanese IPOS validation study (Sakurai in Jpn J Clin Oncol 49(3):257-262, 2019). This should be taken into account when implementing PCTs.

Association of resting energy expenditure with phase angle in hospitalized older patients: a cross-sectional analysis.

BACKGROUND/OBJECTIVES: Resting energy expenditure (REE) constitutes the largest component of total energy expenditure and undergoes an age-related decline that is unexplained by decreased fat-free mass. Phase angle (PhA) is a cellular health indicator that is possibly associated with REE. We investigated the association of REE and PhA in hospitalized older adults. SUBJECTS/METHODS: This single-center, cross-sectional analysis utilized the baseline data from a prospective longitudinal study and included 131 eligible patients aged ≥70 years. The REE was measured using indirect calorimetry, and PhA and body composition were assessed using bioelectrical impedance. The association between REE, PhA, and body composition was examined, and REE was compared using previously reported PhA cutoff values. RESULTS: In this cohort with a mean (±standard deviation) age of 87.4 (±7.0) years, 34.4% of the participants were men. REE and PhA correlated strongly (r: 0.562, p < 0.001) and significantly after adjusting for age and sex (r: 0.433, p < 0.001). Multivariate analysis showed a significant independent association between REE and PhA and skeletal muscle mass (standardized ß [95% CI]; 28.072 [2.188-53.956], p = 0.035) without any significant interaction between PhA and age on REE. The low PhA group had a significantly lower REE (kcal/day; 890 [856-925] vs. 1077 [1033-1122], p < 0.001), and this remained significant after adjusting for age, sex, and skeletal muscle mass index. CONCLUSIONS: PhA is associated with REE in older adults. Adjusting REE calculation algorithms based on PhA values and correcting predicted REE according to PhA may aid in determining more accurate energy requirements.

New prediction equations for resting energy expenditure in older hospitalized patients: Development and validation.

OBJECTIVES: Accurate resting energy expenditure (REE) prediction is needed to prevent over- or underfeeding in older hospitalized patients. However, few validated REE prediction Equations are known for such patients. Therefore, this study aimed to develop new REE prediction Equations and evaluate their validity. METHODS: This single-center, cross-sectional study enrolled 134 patients ages ≥70 y. For holdout validation, patients were randomized in a 3:1 ratio; for the development data set, a new Equation was developed according to the measured REE using indirect calorimetry. The new and existing Equations were compared using the validation data set. RESULTS: Mean patient age was 87.4 ± 6.9 y, and 34.3% were male. Two Equations were developed in multivariable regression models: Equation 1: REE (kcal/day) = 313.582 + Height (cm) × 3.973 + Body weight (kg) × 5.332 - Age (y) × 5.474 - (0 if male; 1 if female) × 20.012 + Calf circumference (cm) × 12.174; and Equation 2: REE (kcal/day) = 594.819 + Height (cm) × 3.760 + Body weight (kg) × 8.888 - Age (y) × 6.298 - (0 if male; 1 if female) × 16.396. The mean relative bias (95% CI) with measured REE as a reference had a small bias for Equations 1 and 2 (-0.1 [-4.1 to 3.9]% and -0.2 [-4.4 to 4.1]%, respectively); however, the Harris-Benedict, Food and Agriculture Organization of the United Nations/World Health Organization/United Nations University, Ganpule, and body weight × 20 Equations had larger biases (-6.2 [-10.3 to -2.0]%; 5.3 [1.3 to 9.3]%; -13.9 [-18.6 to -9.3]%; and -11.6 [-16.1 to -7.1]%, respectively). CONCLUSIONS: New prediction Equations using height, body weight, age, sex, and calf circumference improve REE prediction accuracy in older hospitalized patients.

Resting Energy Expenditure in Older Inpatients: A Comparison of Prediction Equations and Measurements.

Determining energy requirements are an important component of nutritional support for patients with malnutrition; however, the validity of prediction equations for resting energy expenditure (REE) is disputed in older hospitalized patients. We aimed to assess the validity of these equations in older hospitalized patients in Japan. This was a single-center, cross-sectional study of 100 patients aged ≥70 years, hospitalized between January 2020 and December 2021. REE was measured using an indirect calorimeter and was compared to the predicted values calculated from five REE prediction equations. The mean (95% confidence interval) measured REE was 968.1 (931.0, 1005.3) kcal/day, and the mean predicted REE was higher for the FAO/WHO/UNU (1014.3 [987.1, 1041.6] kcal/day, p = 0.164) and Schofield (1066.0 [1045.8, 1086.2] kcal/day, p < 0.001) equations and lower for the Harris-Benedict (898.6 [873.1, 924.1] kcal/day, p = 0.011), Ganpule (830.1 [790.3, 869.9] kcal/day, p < 0.001), and body weight (kg) × 20 (857.7 [821.9, 893.5] kcal/day, p < 0.001) equations. In the age group analysis, none of the predicted values were within a 10% error for more than 80% of patients aged 70−89 years and ≥90 years. The five REE prediction equations did not provide accurate estimates. Validated REE prediction equations need to be developed for older hospitalized patients.

Iris metastasis as the initial presentation of metastatic esophageal cancer diagnosed by fine needle aspiration biopsy: A case report.

RATIONALE: Metastasis of neoplasms to the eye is quite uncommon. In this case report, we describe a patient where primary esophageal cancer was diagnosed by fine needle aspiration biopsy (FNAB) of an iris tumor. PATIENT CONCERNS: A 70-year-old male complained of redness and discomfort in the right eye. DIAGNOSIS AND INTERVENTIONS: The patient's right eye was diagnosed as idiopathic uveitis, and a topical steroid was administered. As vitreous opacities were observed even after topical therapy, oral prednisolone was administered. On slit-lamp examination of the right eye, an iris mass with neovascularization was seen in the anterior chamber. A metastatic tumor was suspected, and FNAB was performed. Histology revealed squamous cell carcinoma. Systemic workup revealed esophageal cancer with several metastases. Best-corrected visual acuity decreased to 20/400, and intraocular pressure was 40 mmHg in the right eye. Two iris tumors with neovascularization were present extending into the anterior chamber with posterior iris synechiae and 360 degree peripheral anterior synechiae. Intraocular pressure in the right eye was medically managed with hypotensive eye drops and oral acetazolamide. Iris metastases were treated with 40 Gray of radiation therapy and concurrent chemotherapy. OUTCOMES: The tumor regressed, but intraocular pressure was refractory to treatment because of 360 degree goniosynechial closure. The right eye lost light perception six months after treatment commenced, and the patient died 9 months after the onset of therapy due to multiple systemic metastases. LESSONS: This is a rare case of masquerade syndrome without systemic symptoms in which FNAB of an iris tumor led to a diagnosis of metastatic esophageal squamous cell carcinoma. Although the patient lost his sight due to uncontrollable ocular hypertension, systemic chemotherapy, and radiation therapy were initially effective in the treatment of the metastatic iris tumor. As the prognosis of patients with metastatic iris tumors is poor, it is important for ophthalmologists to consider such diagnoses and conduct systemic investigations when necessary.

Ocular findings in Japanese patients with hydroxychloroquine retinopathy developing within 3 years of treatment.

PURPOSE: To describe the characteristics of Japanese patients with hydroxychloroquine (HCQ) retinopathy developing within 3 years of treatment outset. STUDY DESIGN: Retrospective case series METHODS: Three patients with HCQ retinopathy developing within 3 years of treatment outset have been identified in Japan since HCQ became available in 2015. Their medical charts, containing optical coherence tomography (OCT), fundus autofluorescence imaging, and visual field tests, were reviewed. RESULTS: The treatment durations and cumulative doses until onset were 29-36 months and 182-326 g, respectively. The first patient had possible pre-existing maculopathy, although the abnormalities were ambiguous. The second and third patients had impaired renal function. The patients did not complain of severe visual disturbance at diagnosis, but visual field loss and disruption of the outer retinal segments consisting of a parafoveal pattern in the first case and a pericentral pattern (localized, 8 or more degrees from the center of the fovea) in the second and third cases were clearly observed on OCT. Even after HCQ discontinuation, their retinopathy showed slight progression on the visual field tests and OCT images. A blood sample was obtained from 1 patient on the day after HCQ discontinuation, and the whole blood level of HCQ was measured using validated liquid chromatography-tandem mass spectrometry. The HCQ level 27 h after the last dose was high, at 2240 ng/mL (suggested threshold > 1733 ng/mL). CONCLUSION: Ophthalmologic screening from the initiation of HCQ treatment detected 3 cases of HCQ retinopathy developing within 3 years of treatment outset, including a patient with a high blood level of HCQ.

Axial Length and Prevalence of Myopia among Schoolchildren in the Equatorial Region of Brazil.

The prevalence of myopia is increasing globally, and the outdoor light environment is considered as a possible factor that can retard myopia. The aim of this study was to evaluate the prevalence of myopia and the light environment in Aracati, equatorial Brazil. We surveyed 421 children (421 right eyes; mean age, 10.6 years) and performed ocular examinations that included non-cycloplegic refraction and axial length (AL). Multiple regression analyses were performed to identify factors affecting myopia such as time spent outdoors and in near work. We measured illuminance and violet light irradiance in Aracati. The mean spherical equivalent (SE) and AL were -0.44 ± 1.38 diopters (D) and 22.98 ± 0.87 mm, respectively. The prevalence of myopia (SE ≤ -0.75 D) and high myopia (SE ≤ -6.0 D/AL ≥ 26.0 mm) was 20.4 and 1.4/0.48%, respectively. Multiple regression analyses showed that myopia was not associated with lifestyle factors. The average illuminance in Aracati was about 100,000 lux from morning to evening. The current results reflect the ALs and the prevalence of myopia among Brazilian schoolchildren. There is a possibility that the light environment in addition to other confounding factors including racial differences affects the ALs and refractive errors.

Efficient one-cycle affinity selection of binding proteins or peptides specific for a small-molecule using a T7 phage display pool.

Here, we report an efficient one-cycle affinity selection using a natural-protein or random-peptide T7 phage pool for identification of binding proteins or peptides specific for small-molecules. The screening procedure involved a cuvette type 27-MHz quartz-crystal microbalance (QCM) apparatus with introduction of self-assembled monolayer (SAM) for a specific small-molecule immobilization on the gold electrode surface of a sensor chip. Using this apparatus, we attempted an affinity selection of proteins or peptides against synthetic ligand for FK506-binding protein (SLF) or irinotecan (Iri, CPT-11). An affinity selection using SLF-SAM and a natural-protein T7 phage pool successfully detected FK506-binding protein 12 (FKBP12)-displaying T7 phage after an interaction time of only 10 min. Extensive exploration of time-consuming wash and/or elution conditions together with several rounds of selection was not required. Furthermore, in the selection using a 15-mer random-peptide T7 phage pool and subsequent analysis utilizing receptor ligand contact (RELIC) software, a subset of SLF-selected peptides clearly pinpointed several amino-acid residues within the binding site of FKBP12. Likewise, a subset of Iri-selected peptides pinpointed part of the positive amino-acid region of residues from the Iri-binding site of the well-known direct targets, acetylcholinesterase (AChE) and carboxylesterase (CE). Our findings demonstrate the effectiveness of this method and general applicability for a wide range of small-molecules.

Long-term surgical outcome of conventional trabeculotomy for childhood glaucoma.

PURPOSE: To investigate the long-term surgical outcomes of conventional trabeculotomy in eyes with childhood glaucoma in a Japanese population. METHODS: In this retrospective observational study, we enrolled Japanese patients with childhood glaucoma who underwent a conventional trabeculotomy at least once before age 3 years from 1986 to 2014 in our hospital. RESULTS: One hundred seven eyes of 64 patients (24 girls, 40 boys; mean age, 2.8 ± 5.1 months) were included. Sixty-eight (64%) eyes had primary childhood glaucoma (PCG) and 39 (36%) eyes had secondary childhood glaucoma (SCG). The average numbers of surgical operations performed to treat the two glaucoma types that resulted in significantly (p < 0.001) different surgical success rates were 1.4 ± 0.7 and 2.1 ± 0.8. Statistical analysis showed that eyes with PCG, compared with those with SCG, were successfully treated by one trabeculotomy and up to three trabeculotomies (hazard ratios 6.66 and 4.02, respectively). Age, gender, systemic complications, corneal diameter, corneal edema, and preoperative intraocular pressure did not significantly affect the surgical outcomes. CONCLUSIONS: Most eyes with PCG are treatable with a maximum of three trabeculotomies. However, SCG usually is refractory to trabeculotomy, and a more promising surgery must be designed.

Antifungal activities of the combination of tacrolimus and itraconazole against Trichophyton mentagrophytes.

Tacrolimus was reported to have no antifungal activity against dermatophytes, but it might show a synergistic fungicidal activity with azoles against dermatophytes as in the case of pathogenic yeasts. Therefore, we examined the antifungal activity of tacrolimus combined with itraconazole (ITZ) against five strains of Trichophyton mentagrophytes by measuring cell growth and performing MIC (minimum inhibitory concentration) testing. The mean colony diameter of T. mentagrophytes on 1/10 diluted Sabouraud dextrose agar (dSDA) with tacrolimus combined with ITZ was significantly shorter than that on dSDA with tacrolimus or ITZ. MICs of tacrolimus, ITZ, and tacrolimus combined with ITZ against T. mentagrophytes were determined, respectively. The results revealed a synergistic activity of tacrolimus in combination with ITZ against T. mentagrophytes.

Rapid identification of Candida tropicalis from canine cystitis.

The isolate from urine of a dog with cystitis was molecularly identified Candida tropicalis and its minimum inhibitory concentration (MIC) was determined by a microdilution method. The 25S ribosomal DNA sequence analysis indicated that the clinical isolate was essentially identical to that of C. tropicalis and distinct from other Candida species. The MIC(50) and the MIC(90) of fluconazole (FLZ) for the clinical isolate of C. tropicalis was 6.25 and 25 microg/ml, respectively, indicating that susceptibility of the clinical isolate of C. tropicalis to FLZ was less than for other strains of C. tropicalis as well as C. albicans. The molecular analysis as presented in this study assisted the diagnosis of candidiasis by identifying the yeasts in urine samples within 2 days. The patient dog, a 10-year-old male Shih Tzu dog (7.0 kg) referred for examination of cystitis was successfully treated with itraconazole.