The Relationship between Energy Expenditure and Type or Stage of Cancer

Malnutrition commonly occurs in patients with cancer. This situation can be associated with increased morbidity and mortality.The etiology is not clearly understood but decreased energy intake and increased energy expenditure may be involved. Weaimed to investigate the energy metabolic status including energy expenditure in patients with various cancers. The clinicalfeatures and energy metabolic status measured by indirect calorimetry of 74 patients with cancer (50 men and 24 women;mean age, 64.7 years) were obtained from the medical records. Hypermetabolism was more common and REE/kg (resting energyexpenditure / kg body weight) seems to be more reliable in estimating the true energy expenditure than %REE (measuredREE / predicted REE). The REE/kg and VO2 /kg (oxygen consumption per minute / kg body weight) varied among cancertypes, i.e., they were significantly higher in gastric cancer than in hepatocellular carcinoma. Moreover, REE/kg and VO2/kg wassignificantly higher in cancer stage IV than in stage I, or stages I and II. Patients with or at risk for malnutrition should receiveappropriate nutritional support, which has to be personalized according to tumor site, tumor stage, and the nutritional statusof the patient. This nutritional support should improve not only the patients\u27 quality of life but also their survival

Protein-Energy Malnutrition in Patients with Liver Cirrhosis

Protein-energy malnutrition (PEM) is frequently seen in patients with liver cirrhosis. This condition is associated with a poorprognosis and reduced survival. We investigated the protein and energy metabolic status, including serum albumin concentration,and resting energy expenditure (REE) and respiratory quotient (RQ) measured by indirect calorimetry in 23 patients withliver cirrhosis (8 men and 15 women; mean age, 60.3 years). The median value of %REE (measured REE / predicted REE)was highest in Child-Pugh grade A and lowest in grade C, and the range of RQ tended to be highest in Child-Pugh grade Aand lowest in grade C, although there were not statistically significant (p=0.871 and 0.664, respectively). Serum triglycerideconcentration was significantly lower in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 ormore, and free fatty acid tended to be higher in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85or more. Of the 23 patients, 78.3% were in a state of protein and/or energy malnutrition and 47.8% had PEM. Our results suggestthat %REE and RQ were not significantly associated with liver function, but the oxidation rate of fat was increased in advancedliver cirrhosis. A longitudinal study in a large population is needed to determine the efficacy of %REE and RQ measurementsfor adequate nutritional treatment and improvement of patient outcome

Analysis of T-cell alloantigen response via a direct pathway in kidney transplant recipients with donor-specific antibodies

Donor-specific antibodies (DSAs) are the main cause of graft loss over time. The direct pathway of alloantigen recognition is important in the pathogenesis of acute rejection. Recent studies have suggested that the direct pathway also contributes to the pathogenesis of chronic injury. Nevertheless, there are no reports on T-cell alloantigen response via the direct pathway in kidney recipients with DSAs. We analyzed the T-cell alloantigen response via the direct pathway in kidney recipients with DSAs (DSA+) or without DSAs (DSA−). A mixed lymphocyte reaction assay was implemented to assess the direct pathway response. DSA+ patients showed significantly higher CD8+ and CD4+ T cell responses to donor cells than DSA− patients. Furthermore, proliferating CD4+ T cells showed a marked increase in Th1 and Th17 responses in DSA+ patients than in DSA− patients. In a comparison between anti-donor and third-party responses, the anti-donor CD8+ and CD4+ T cell response was significantly lower than the anti-third-party response. In contrast, the donor-specific hyporesponsiveness was absent in DSA+ patients. Our study demonstrated that DSA+ recipients have a greater potential for developing immune responses against the donor tissues via the direct alloantigen recognition pathway. These data contribute to an understanding of DSAs pathogenicity during kidney transplantation

Laypersons’ Psychological Barriers Against Rescue Actions in Emergency Situations --A Questionnaire Survey--

BACKGROUND: Although bystanders' performance is important to improve outcomes of patients after cardiac arrests, few studies have investigated the barriers of bystanders, including those who could not perform cardiopulmonary resuscitation or any other rescue actions in emergency situations. This study aimed to assess the relationship between the psychological barriers of laypersons who encountered emergency situations and their rescue actions.Methods and Results:A questionnaire survey was conducted and this included laypersons who had encountered emergency situations during the last 5 years. Six questions were about the psychological barriers and 8 questions were about the laypersons' rescue actions. The primary outcome was any rescue actions performed by laypersons in an actual emergency situation. Overall, 7, 827 (92.8%) of 8, 430 laypersons responded; of them, 1, 361 (16.1%) had encountered emergency situations during the last 5 years, and 1, 220 (14.5%) were eligible for inclusion in the analyses. Of the 6 psychological barriers, "fear of approaching a collapsed person" (adjusted odds ratio [AOR] 0.50; 95% confidence interval [95% CI] 0.32-0.79) and "difficulties in judging whether to perform any rescue action" (AOR 0.63; 95% CI 0.40-0.99) were significantly associated with performing any rescue actions. CONCLUSIONS: The fear of approaching a collapsed person and difficulties in judging whether to take any actions were identified as the psychological barriers in performing any rescue actions by laypersons who encountered emergency situations

Effectiveness of a digital device providing real-time visualized tooth brushing instructions: A randomized controlled trial

Introduction: The aim of this trial was to investigate whether a digital device that provides real-time visualized brushing instructions would contribute to the removal of dental plaque over usual brushing instructions. Methods: We conducted a single-center, parallel-group, stratified permuted block randomized control trial with 1:1 allocation ratio. Eligibility criteria included people aged ≥ 18 years, and exclude people who met the following criteria: severely crowded teeth; using interdental cleaning implement; having external injury in the oral cavity, or stomatitis; having less than 20 teeth; using orthodontic apparatus; visited to a dental clinic; having the possibility of consulting a dental clinic; having a dental license; not owning a smartphone or tablet device; smoker; taken antibiotics; pregnant; an allergy to the staining fluid; and employee of Sunstar Inc. All participants received tooth brushing instructions using video materials and were randomly assigned to one of two groups for four weeks: (1) an intervention group who used the digital device, providing real-time visualized instructions by connection with a mobile application; and (2) a control group that used a digital device which only collected their brushing logs. The primary outcome was the change in 6-point method plaque control record (PCR) score of all teeth between baseline and week 4. The t-test was used to compare the two groups in accordance with intention-to-treat principles. Results: Among 118 enrolled individuals, 112 participants were eligible for our analyses. The mean of PCR score at week 4 was 45.05% in the intervention group and 49.65% in the control group, and the change of PCR score from baseline was −20.46% in the intervention group and −15.77% in the control group (p = 0.088, 95% confidence interval −0.70–10.07). Conclusions: A digital device providing real-time visualized brushing instructions may be effective for the removal of dental plaque

Prehospital cardiopulmonary resuscitation duration and neurological outcome after out-of-hospital cardiac arrest among children by location of arrest: a Nationwide cohort study

Background: Little is known about the associations between the duration of prehospital cardiopulmonary resuscitation (CPR) by emergency medical services (EMS) and outcomes among paediatric patients with out-of-hospital cardiac arrests (OHCAs). We investigated these associations and the optimal prehospital EMS CPR duration by the location of arrests. Methods: We included paediatric patients aged 0–17 years with OHCAs before EMS arrival who were transported to medical institutions after resuscitation by bystanders or EMS personnel. We excluded paediatric OHCA patients for whom CPR was not performed, who had cardiac arrest after EMS arrival, whose EMS CPR duration were  30 min) in both groups (1.4% [6/417] in residential locations and 0.6% [1/170] in public locations). Conclusions: A longer prehospital EMS CPR duration is independently associated with a lower proportion of patients with a favourable neurological outcome. The association between prehospital EMS CPR duration and neurological outcome differed significantly by location of arrests

GCV-resistant CMV treated by foscarnet

Cytomegalovirus (CMV) infection is themost common infectious complication following solid organ transplantation. Ganciclovir (GCV)-resistant CMV infection may be fatal, and is difficult to treat while avoiding allograft rejection. A 31-year-old woman received a second ABO-incompatible kidney transplant, from her father. Induction therapy consisted of basiliximab and rituximab followed by maintenance immunosuppression with tacrolimus, mycophenolate mofetil, and methylprednisolone. Her CMV serostatus was D+/R- at second transplant and she received prophylactic low-dose valganciclovir (VGCV). BK polyoma virus nephropathy (BKVN) developed 7 months after transplant concurrent with CMV hepatitis and retinitis. VGCV was increased to a therapeutic dose combined with reduced immunosuppression with minimal methylprednisolone (2mg/day) and everolimus (0.5mg/day). However, pp65 antigenaemia continued to increase for 6 weeks. Her CMV was defined as ganciclovir (GCV)-resistant. Foscarnet was therefore administered and her CMV disease resolved within 2 weeks. Kidney allograft dysfunction developed 9 months after transplant, and graft biopsy showed tubulointerstitial injury with crystal deposition suggesting foscarnet nephrotoxicity, with no findings of BKVN or rejection. Kidney function recovered after cessation of foscarnet and the patient had good graft function 18 months after transplant. This case demonstrates the successful use of foscarnet to treat GCV-resistant CMV infection after ABO-incompatible kidney transplant complicated with BKVN, without acute allograft rejection. This case further highlights the need to establish appropriate management for CMV D+/R- patients to avoid the acquisition of GCV-resistant gene mutations

Orosomucoid 1 is involved in the development of chronic allograft rejection after kidney transplantation

Chronic allograft rejection is the most common cause of long-term allograft failure. One reason is that current diagnostics and therapeutics for chronic allograft rejection are very limited. We here show that enhanced NF kappa B signaling in kidney grafts contributes to chronic active antibody-mediated rejection (CAAMR), which is a major pathology of chronic kidney allograft rejections. Moreover, we found that urinary orosomucoid 1 (ORM1) is a candidate marker molecule and therapeutic target for CAAMR. Indeed, urinary ORM1 concentration was significantly higher in kidney transplant recipients pathologically diagnosed with CAAMR than in kidney transplant recipients with normal histology, calcineurin inhibitor toxicity, or interstitial fibrosis and tubular atrophy. Additionally, we found that kidney biopsy samples with CAAMR expressed more ORM1 and had higher NF kappa B and STAT3 activation in tubular cells than samples from non-CAAMR samples. Consistently, ORM1 production was induced after cytokine-mediated NF kappa B and STAT3 activation in primary kidney tubular cells. The loss- and gain-of-function of ORM1 suppressed and promoted NF kappa B activation, respectively. Finally, ORM1-enhanced NF kappa B-mediated inflammation development in vivo. These results suggest that an enhanced NF kappa B-dependent pathway following NF kappa B and STAT3 activation in the grafts is involved in the development of chronic allograft rejection after kidney transplantation and that ORM1 is a non-invasive candidate biomarker and possible therapeutic target for chronic kidney allograft rejection

Protein-Energy Malnutrition in Patients with Liver Cirrhosis

Protein-energy malnutrition (PEM) is frequently seen in patients with liver cirrhosis. This condition is associated with a poor prognosis and reduced survival. We investigated the protein and energy metabolic status, including serum albumin concentration, and resting energy expenditure (REE) and respiratory quotient (RQ) measured by indirect calorimetry in 23 patients with liver cirrhosis (8 men and 15 women; mean age, 60.3 years). The median value of %REE (measured REE / predicted REE) was highest in Child-Pugh grade A and lowest in grade C, and the range of RQ tended to be highest in Child-Pugh grade A and lowest in grade C, although there were not statistically significant (p=0.871 and 0.664, respectively). Serum triglyceride concentration was significantly lower in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 or more, and free fatty acid tended to be higher in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 or more. Of the 23 patients, 78.3% were in a state of protein and/or energy malnutrition and 47.8% had PEM. Our results suggest that %REE and RQ were not significantly associated with liver function, but the oxidation rate of fat was increased in advanced liver cirrhosis. A longitudinal study in a large population is needed to determine the efficacy of %REE and RQ measurements for adequate nutritional treatment and improvement of patient outcome