Predicting factors in the last week of survival in elderly patients with terminal cancer: a prospective study in southern Taiwan.

BACKGROUND/PURPOSE: The proportion of elderly persons among terminal cancer patients is around 60% in Taiwan. Prediction of the last week of survival can be significant in palliative care units for planning patient management, fulfilling patients' wishes at the end of life, and meeting the needs of relatives. We aimed to find out the predictive factors for the last week of survival in elderly terminal cancer patients. METHODS: We prospectively observed items based on previous research that we anticipated might influence survival among 459 consecutive elderly patients. Within 24 hours of admission, we collected data including clinical symptoms and signs, demographic information, and biochemical test results. Multivariate logistic regression analysis was performed to identify factors associated with patient mortality within 7 days. RESULTS: Multivariate analysis indicated that the following factors were predictive of death: higher score of Eastern Cooperative Oncology Group (ECOG) performance status (OR, 2.018; p < 0.001), primary liver cancer (OR, 1.968; p = 0.024), male gender (OR, 2.885; p < 0.001), lower extremity muscle power (OR, 0.722; p = 0.0266), lower systolic blood pressure (OR, 0.985; p = 0.011), higher heart rate (OR, 1.017; p = 0.016), higher hemoglobin (OR, 1.216; p = 0.003), and higher blood urea nitrogen (BUN) (OR, 1.028; p < 0.001). CONCLUSION: We propose that the probability of survival of less than a week can be predicted by our formula. This formula, which includes factors of demographic information (male gender, and presence of liver cancer), clinical signs (lower systolic blood pressure, higher heart rate, and lower mean extremity muscle power), and biochemical tests (elevated BUN, and higher hemoglobin), may help improve survival prediction in terminal elderly cancer patients.

Growth strain in the trunk and branches of Chamaecyparis formosensis and its influence on tree form.

Distributions of growth strains in branches, straight trunks and basal sweeping trunks of Chamaecyparis formosensis Matsum. trees were measured with strain gauges. Microfibril angles (MFAs) of the S2 layer of the cell wall were measured by the iodine deposition method and their relationships with growth strain examined. The magnitude of the compressive stress on the lower side of trunks with a basal sweep was greater than that of the tensile stress at the surface of straight trunks. However, transverse compressive stress was similar around the trunk regardless of whether normal wood or compression wood was present. The released surface growth strains varied with MFA. At MFAs of 20-25 degrees , growth stress changed from tension to compression, and compressive stress increased dramatically in the compression wood region. Branches suffer bending stress due to self-loading. This stress is superimposed on the growth stress. Growth strains on the upper or lower sides of branches were larger than those in the trunks, suggesting that generation of growth stress on the lower sides of branches with extensive compression wood is affected by the gravitational bending stress due to self-loading. We conclude that branch form is affected by the interaction between the bending moment due to self-loading and that due to the asymmetric distribution of growth stress. Growth strain distribution in a branch differed depending on whether the branch was horizontal, upward bending or downward bending.