Intrafollicular classical Hodgkin lymphoma mimicking nodular lymphocyte predominant Hodgkin lymphoma: a report of two cases.

We here report on two rare cases of intrafollicular classical Hodgkin lymphoma (CHL). Case 1 was a 34-year-old man who underwent left supraclavicular lymph node biopsy. Case 2 was a 28-year-old woman who underwent surgical resection of an anterior mediastinal mass. The histology and microenvironment of both specimens resembled those of nodular lymphocyte predominant Hodgkin lymphoma. Nodular architecture was observed, which comprised normal-appearing small lymphocytes and scattered lymphocyte predominant (LP)-like cells. CD23(+) follicular dendritic cell meshworks were present in the nodules, surrounded by a mantle zone containing IgD(+) B cells. The LP-like cells were ringed by CD3(+) and PD-1(+) T cells, and numerous CD20(+) B cells were present in the background. However, the immunophenotypes of the LP-like cells resembled those of Hodgkin/Reed-Sternberg cells of CHL; they were positive for CD15, CD30, and PAX5, and negative for CD20, Bcl6, Oct2, and Bob1. These histopathological findings indicate that CHL can be derived from the germinal center.

Association of decreased frequency of conversation with depression, oral function and eating alone: A cross-sectional study of older adults during the COVID-19 pandemic.

AIM: This study examined the associations between geriatric factors and decreased opportunities for conversation among older adults amid a period of self-restraint during the COVID-19 pandemic. METHODS: A cross-sectional questionnaire-based survey was carried out in October 2020. The participants were 204 residents aged ≥65 years staying at a private care home in Kyoto city, Japan. Logistic regression analysis was carried out with the reduction of conversation opportunities as the dependent variable, and geriatric factors as independent variables after adjusting for age and sex. We compared the decreased frequency of opportunities between residents in the assisted living wing and in the nursing care wing of the private care home. RESULTS: The percentages of respondents who reported a decrease in the opportunities for conversation among themselves were 43.9% for residents in the assisted living wing and 19.7% for those in the nursing care wing. After adjusting for age and sex, the opportunities for conversation was significantly associated with the basic activities of daily living (OR 1.07, 95% CI 1.01-1.12), instrumental self-maintenance (OR 1.25, 95% CI 1.08-1.46), intellectual activity (OR 1.35, 95% CI 1.09-1.66), depression (OR 1.13, 95% CI 1.04-1.23), depressive mood (OR 3.83, 95% CI 1.98-7.42), decreased motivation (OR 3.11, 95% CI 1.58-6.12), appetite loss (OR 4.32, 95% CI 1.54-12.07), swallowing function (OR 1.05, 95% CI 1.00-1.10), chewing difficulty (OR 2.50, 95% CI 1.31-4.75) and eating alone (OR 2.5, 95% CI 1.35-4.62). CONCLUSION: Decreased opportunities for conversation was more perceived among older adults with higher daily functioning, suggesting that it is associated with depressed mood, oral function and solitary eating. Geriatr Gerontol Int 2024; 24: 385-391.

Association between glucose tolerance and mortality among Japanese community-dwelling older adults aged over 75 years: 12-year observation of the Tosa Longitudinal Aging Study.

AIM: Although the relationship between impaired glucose tolerance (IGT) and mortality has been investigated in diverse populations, few studies have focused on older populations. This study aimed to investigate the relationship between glucose tolerance and overall mortality among populations aged ≥75 years. METHODS: Data were obtained from the Tosa Longitudinal Aging Study, a community-based cohort survey conducted in Kochi, Japan. According to the results of a 75-g oral glucose tolerance test conducted in 2006, the participants were classified into four categories: normal glucose tolerance (NGT), impaired fasting glucose (IFG)/IGT, newly diagnosed diabetes mellitus (NDM), and known diabetes mellitus (KDM). The primary endpoint was overall mortality. Differences in overall mortality among the four categories were evaluated using the Cox proportional hazards model. RESULTS: During a median of 11.5 years of observation, 125 deaths of the 260 enrolled participants were recorded. The cumulative overall survival rate was 0.52, and the survival rates of NGT, IFG/IGT, NDM, and KDM were 0.48, 0.49, 0.49, and 0.25, respectively (log-rank test, P = 0.139). Adjusted hazard ratios (HRs) for mortality in the IFG/IGT and NDM groups compared with the NGT group were 1.02 (95% confidence interval [CI], 0.66-1.58) and 1.11 (95% CI, 0.56-2.22), while mortality in the KDM group was significantly higher than that in the NGT group (HR, 2.43; 95% CI, 1.35-4.37). CONCLUSION: Mortality did not differ significantly between the IFG/IGT, NDM, and NGT groups, but was higher in the KDM group than in the NGT group. Geriatr Gerontol Int 2023; 23: 341-347.

Competencies for on-call physicians for home medical care: A qualitative study of home care providers' experiences in Japan's super-aged society.

Background: In Japan, many older people hope to receive end-of-life care at home. In such situations, team-based home medical care with the support of on-call physicians is needed. However, to date, necessary competencies for the on-call physicians have yet to be clarified. We aim to reveal the competencies for on-call physicians in home medical care settings. Method: This was a qualitative study of semi-structured interviews concerning competencies for on-call physicians in home medical care. We evaluated digitally recorded interviews with eight home care professionals in seven home care facilities (three clinics, one hospital, and three nursing agencies) in A City, Japan. The transcribed data were analyzed by three researchers using thematic analysis. Results: The competencies for on-call physicians were divided into the following six categories: clinical skills for frequent complaints, collecting patients' information in advance, understanding purposes of home care, understanding general roles of home care health professionals, thoughtfulness toward patients' families, and an attitude of humility. Conclusion: These competencies were classified into disease-specific and interpersonal (collaborative) skills in home medical care. The competencies revealed by the study could contribute to the development of effective learning and preparation for on-call physicians who support home medical care.

Older adults' preferences for and actual situations of artificial hydration and nutrition in end-of-life care: An 11-year follow-up study in a care home.

AIM: To clarify older adults' preferences for and actual situations of artificial hydration and nutrition (AHN) in end-of-life care in a care home. METHODS: Participants were residents of a care home who had completed advance directives regarding preferred methods of AHN from 2009 to 2018. Advance directives alone were available from April 2009 to June 2016 (Wave 1), and advance care planning for AHN including advance directives was introduced in July 2016 (Wave 2). AHN preferences included (i) intensive methods (percutaneous endoscopic gastrostomy, nasogastric tube feeding and total parenteral nutrition), (ii) drip infusion, and (iii) oral intake only. Participants were followed until the end of 2020, and we checked whether decisions about AHN were based on older adults' preferences. RESULTS: In total, 272 participants had completed advance directives. Most participants preferred "oral intake only" (59.5%), followed by drip infusion (32.0%) and intensive methods (8.5%) in advance directives. Ninety of the 272 participants completed advance directives twice; 83.3% did not change their AHN preferences from Wave 1 to Wave 2. By the end of 2020, 93 of the 272 participants died in the care home. AHN was provided according to older adults' preferences in 48.9% (oral intake only), in 51.4% (drip infusion) and in 55.6% (intensive methods) of cases respectively. CONCLUSIONS: Most participants preferred oral intake only, and their preferences were reflected in decisions about actual situations of AHN in end-of-life care. To prepare for advanced dementia and senility, early advance care planning for AHN should be promoted. Geriatr Gerontol Int 2022; 22: 581-587.

Gynecological aspects as a component of comprehensive geriatric assessment: A study of self-rated symptoms of pelvic organ prolapse among community-dwelling elderly women in Japan.

OBJECTIVES: Despite the reported 'male-female health-survival paradox', no components of the comprehensive geriatric assessment (CGA) routinely used in the field of geriatrics focus on female-specific symptoms. To investigate the impact of gynecological factors among elderly women, we noted the gynecological history and examined the association between self-rated symptoms of pelvic organ prolapse (POP) and CGA. STUDY DESIGN: This community-based, cross-sectional study in Japan included 164 community-dwelling women aged ≥75 years. MAIN OUTCOME MEASURES: The main outcome measures were the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), activities of daily living (ADL), and Timed Up and Go (TUG) test. Self-rated symptoms of POP were assessed using POPDI-6, and the participants were dichotomized into POPDI-6 >0 (symptom group) and POPDI-6 = 0 (no-symptom group). Several components of the CGA were compared between the groups with and without symptoms of POP and the association with POPDI-6 score was analyzed by multiple logistic regression analysis. RESULTS: Compared with the no-symptom group, the symptom group had significantly longer TUG test time (≥13.5 s) (P = 0.024) and difficulty in basic ADL (score <21) (P = 0.02). In multiple logistic regression analysis, basic ADL <21 and TUG time ≥13.5 s were significantly associated with POPDI-6 >0 (odds ratio [OR] = 2.78; 95% confidence interval [CI] = 1.10-7.06 and OR = 3.45; 95% CI = 1.01-1.24). CONCLUSIONS: Self-rated POP symptoms were associated with CGA components among community-dwelling elderly women. Evaluating POP symptoms as part of the CGA could be meaningful for improving physical and psychological health in elderly women.

[A case of metastatic pulmonary cancer from urachal carcinoma that required differentiation from primary lung adenocarcinoma].

A 58-year-old man was given a diagnosis of urachal carcinoma and underwent a partial cystectomy with enbloc removal of the tumor and radical lymphadenectomy in 2006. In April 2009 he was admitted to our hospital because of hemoptysis and left chest pain. Chest CT showed a 4-cm mass shadow in the left S3 and nodular shadows in the right S1 and left S10. Flexible bronchoscopy demonstrated a tumorous lesion at the orifice of the left B3 bronchus. Although the cytological diagnosis suggested high-grade adenocarcinoma, the tumor was producing mucin and consisted of cells with anisonucleosis, which is not typical of primary lung adenocarcinoma. We then performed immunohistochemical and histological examination of a transbronchial lung biopsy specimen. The histological findings of the specimen were very similar to those of the previously resected urachal carcinoma. In addition, the tumor cells were negative for thyroid transcription factor-1 and surfactant precursor protein B, which are specific to primary lung adenocarcinoma. We therefore diagnosed metastatic pulmonary cancer from urachal carcinoma, which is a rare manifestation in bladder cancer. We report a rare case of metastatic pulmonary cancer from urachal carcinoma that required differentiation from primary lung adenocarcinoma in addition to a discussion of the literature.