A combination of routine laboratory findings and vital signs can predict survival of advanced cancer patients without physician evaluation: a fractional polynomial model

IntroductionThere have been no reports about predicting survival of patients with advanced cancer constructed entirely with objective variables. We aimed to develop a prognostic model based on laboratory findings and vital signs using a fractional polynomial (FP) model.MethodsA multicentre prospective cohort study was conducted at 58 specialist palliative care services in Japan from September 2012 to April 2014. Eligible patients were older than 20 years and had advanced cancer. We developed models for predicting 7-day, 14-day, 30-day, 56-day and 90-day survival by using the FP modelling method.ResultsData from 1039 patients were analysed to develop each prognostic model (Objective Prognostic Index for advanced cancer [OPI-AC]). All models included the heart rate, urea and albumin, while some models included the respiratory rate, creatinine, C-reactive protein, lymphocyte count, neutrophil count, total bilirubin, lactate dehydrogenase and platelet/lymphocyte ratio. The area under the curve was 0.77, 0.81, 0.90, 0.90 and 0.92 for the 7-day, 14-day, 30-day, 56-day and 90-day model, respectively. The accuracy of the OPI-AC predicting 30-day, 56-day and 90-day survival was significantly higher than that of the Palliative Prognostic Score or the Prognosis in Palliative Care Study model, which are based on a combination of symptoms and physician estimation.ConclusionWe developed highly accurate prognostic indexes for predicting the survival of patients with advanced cancer from objective variables alone, which may be useful for end-of-life management. The FP modelling method could be promising for developing other prognostic models in future research

Physical Activity and/or High Protein Intake Maintains Fat-Free Mass in Older People with Mild Disability; the Fukuoka Island City Study: A Cross-Sectional Study

Body composition changes with age, with fat mass (FM) increasing and fat-free mass (FFM) decreasing. Higher physical activity and high or adequate protein intake are thought to be beneficial in preventing the loss of skeletal muscle mass in the elderly. We aimed to investigate the relationships between physical activity, protein intake, and FFM in older people with mild disability. Total energy expenditure (TEE) under free-living conditions was assessed using the doubly-labelled water (DLW) method, and physical activity was measured using a triaxial accelerometer. Dietary intake was assessed using a self-recorded food intake diary during the DLW period. Percent FFM was significantly positively correlated with protein intake and physical activity level (PAL) after adjustment for age and sex (protein intake r = 0.652, p < 0.001, PAL r = 0.345, p = 0.011). In multiple linear regression analysis, when PAL, moderate-to-vigorous physical activity (MVPA), or protein intake were included, 31%, 32%, and 55%, respectively, of the variation in %FFM was explained. Moreover, the addition of both PAL/MVPA and protein intake explained 61%/60%, respectively, of the variation in %FFM. Either protein intake above the currently recommended level or higher levels of physical activity would be beneficial for the maintenance of high %FFM

Severe early-onset vitamin K deficiency bleeding in a boy born to a mother with Crohn’s disease in clinical remission: a case report

Vitamin K deficiency bleeding (VKDB) in neonates is a significant disorder that causes skin, gastrointestinal, and intracranial hemorrhaging. Early-onset VKDB occurs within 24 h of birth, and its prognosis is poor due to severe hemorrhage. The causes of early-onset VKDB include maternal intake of warfarin and anticoagulants, and maternal vitamin K deficiency. We report the case of a boy with early-onset VKDB born to a mother with Crohn’s disease. He developed severe cerebellar hemorrhage on the day of birth and subsequent non-communicating hydrocephalus requiring a ventriculoperitoneal shunt. The mother had a 14-year history of Crohn’s disease and short bowel owing to intestinal resection. She was in complete remission during pregnancy according to the Crohn’s Disease Activity Index. Endoscopic examination performed shortly before pregnancy revealed inflammatory findings in the residual small intestine. Her blood tests at delivery showed an elevated prothrombin induced by vitamin K deficiency or antagonist II (PIVKA-II) level of 26900 mAU/mL. A definitive protocol to prevent early-onset VKDB in mothers with Crohn’s disease complicated by a short bowel is lacking. Administering vitamin K to mothers with elevated PIVKA-II levels before delivery may help prevent early-onset VKDB

Skewed electronic band structure induced by electric polarization in ferroelectric BaTiO3

International audienceAbstract Skewed band structures have been empirically described in ferroelectric materials to explain the functioning of recently developed ferroelectric tunneling junction (FTJs). Nonvolatile ferroelectric random access memory (FeRAM) and the artificial neural network device based on the FTJ system are rapidly developing. However, because the actual ferroelectric band structure has not been elucidated, precise designing of devices has to be advanced through appropriate heuristics. Here, we perform angle-resolved hard X-ray photoemission spectroscopy of ferroelectric BaTiO 3 thin films for the direct observation of ferroelectric band skewing structure as the depth profiles of atomic orbitals. The depth-resolved electronic band structure consists of three depth regions: a potential slope along the electric polarization in the core, the surface and interface exhibiting slight changes. We also demonstrate that the direction of the energy shift is controlled by the polarization reversal. In the ferroelectric skewed band structure, we found that the difference in energy shifts of the atomic orbitals is correlated with the atomic configuration of the soft phonon mode reflecting the Born effective charges. These findings lead to a better understanding of the origin of electric polarization