ガン チリョウジ ノ エイヨウ カンリ

Weight loss, an indicator of malnutrition, is a common problem in cancer patients that is due to primary effect of abnormal metabolism by cancer cells, and to secondary effects of cancer therapy such as chemotherapy and radiation therapy. These therapies in cancer patients cause various symptoms including anorexia, nausea, vomiting, diarrhea, constipation, mucotitis, and alterations in taste and smell, etc. These symptoms are also reasons for weight loss. Weight loss has been recognized as an important component of adverse outcomes, including decreased response to chemotherapy, quality of life（QOL）, and increased morbidity and mortality. Therefore, early recognition and detection of risk for malnutrition through nutritional assessment and administration of appropriate nutritional care including parenteral nutrition should be required throughout cancer care. Good nutrition management can help cancer patients prevent weight loss, and improve therapeutic response, prognostic implication, and QOL

Maternal dietary intake of fish and child neurodevelopment at 3 years: a nationwide birth cohort—The Japan Environment and Children's Study

BackgroundResults on the association between fish intake during pregnancy and a reduction in neurodevelopmental delays in children have been inconsistent, with some reports finding an association and others finding none. Because neurodevelopmental delays are more pronounced at the age of 3 years, their association needs to be examined at this age.MethodsAfter exclusion and multiple imputation from a dataset comprising 104,057 records from the Japan Environment and Children's Study, logistic regression analysis was conducted in quintiles to evaluate the association between maternal fish intake during pregnancy and child neurodevelopment at age 3 years in 91,909 mother–child pairs. The Food Frequency Questionnaire (FFQ), validated in the Japan Public Health Center-Based Prospective Study for the Next Generation, was used to assess maternal fish intake during pregnancy. The Ages and Stages Questionnaires-3 was used to assess children's neurodevelopment in five domains: communication, gross motor, fine motor, problem-solving, and personal-social.ResultsConsistently lower odds were found for the highest vs. lowest quintile for the domains of communication, fine motor, problem-solving, and personal-social but not gross motor skills, with adjusted odd ratios (95% confidence intervals) of 0.89 (0.80–0.998), 0.90 (0.83–0.97), 0.86 (0.80–0.94), 0.87 (0.77–0.98), and 1.04 (0.94–1.16), respectively. The trend for lower odds of symptoms of neurodevelopmental delays across quintiles of higher maternal fish intake were significant for fine motor, problem-solving, and personal-social but not communication or gross motor.ConclusionsFish consumption during pregnancy may be associated with a reduced risk of neurodevelopmental delay in 3-year-olds, particularly in the fine motor, problem-solving, and personal-social domains. Continued investigation after the age of 3 could further clarify the association

テイGlycemic Indexショクヒン ワ 2ガタトウニョウビョウ ノ ハッショウ オ ヨボウシ チリョウ コウカ オ ユウスル

The incidence of type 2 diabetes should be reduced either by decreasing insulin demand or by improving insulin sensitivity. Jenkins et al . found that a low-glycemic-index diet containing mainly intact whole grains significantly reduced C-peptide concentrations compared with a high-glycemic-index diet containing primarily refined grain product. In this review, we examine evidence relating dietary glycemic index and glycemic load to type 2 diabetes incidence and the role of the form of dietary carbohydrate in the management of diabetes. Both metabolic and epidemiologic evidence suggests that replacing high-glycemic-index forms of carbohydrate with low-glycemic-index carbohydrate will reduce the risk of type 2 diabetes. Among patients with diabetes, the weight of evidence suggests that replacing high-glycemic-index with low-glycemic-index forms of carbohydrate will improve glycemic control and reduce hypoglycemic episodes among those treated with insulin

〈Case Reports〉HELLP syndrome at 22 weeks of gestation with resulting stillbirth and a favorable outcome in a subsequent pregnancy: A case report

[Abstract]HELLP syndrome, characterized by hemolysis,elevated liver enzymes, and low platelets,is one of the diseases related to hypertension in pregnancy. If the pregnancy is not terminated soon after HELLP is diagnosed, liver failure or disseminated intravascular coagulopathy (DIC)may occur. HELLP syndrome occurs in 0.2%–0.9% of all pregnancies; Onset before 24 weeks of gestation is extremely rare but is more likely to result in stillbirth. Women who have had a stillbirth often hope for another pregnancy soon after,but there is little information about the risks and outcomes for subsequent pregnancy in women who developed HELLP syndrome in early pregnancy.Thus, it is important to accumulate data on these outcomes in this population. Here, we report a case in which severe HELLP syndrome developed at 22 weeks of gestation, resulting in stillbirth, and was followed six months later by a pregnancy that with early intervention, produced a live birth

Impact of longer working hours on fathers’ parenting behavior when their infants are 6 months old: The Japan Environment and Children’s Study

ObjectiveLong working hours have been suggested to affect fathers’ parenting behavior, but previously reported findings have been inconsistent. This study examined the association between the working hours and parenting behavior of fathers while accounting for other factors related to their parenting behavior, using data from the Japan Environment and Children Study (JECS), a large cohort study in Japan.MethodsData from 43,159 father–mother pairs were analyzed. The mother assessed the father’s frequency of seven parenting behaviors at 6 months after delivery. Then, each behavior was classified into a high-engagement group (always and sometimes) or a low-engagement group (rarely and never). The father’s weekly working hours was obtained from his responses and was classified into six levels.ResultsLogistic regression analysis showed that after adjustment for covariates, fathers’ weekly working hours was inversely associated with the frequency of all parenting behaviors examined in this study (p for trend <0.0001). Compared with fathers working ≥0 to ≤40 h per week, those working >65 h per week showed the following adjusted odds ratios (95% confidence intervals) for low engagement in parenting behaviors: playing at home, 2.38 (2.08–2.72); changing diapers, 2.04 (1.89–2.20); and bathing the child, 2.01 (1.84–2.18).ConclusionThis study suggests that the greater time constraints imposed by longer working hours constitute a major factor that discourages fathers from engaging in childrearing behavior. Intervention targeting long working hours could contribute to measures aimed at promoting high-engagement parenting behaviors among fathers

Combining IVUS + OCT data, biomechanical models and machine learning method for accurate coronary plaque morphology quantification and cap thickness and stress/strain index predictions

Assessment and prediction of vulnerable plaque progression and rupture risk are of utmost importance for diagnosis, management and treatment of cardiovascular diseases and possible prevention of acute cardiovascular events such as heart attack and stroke. However, accurate assessment of plaque vulnerability assessment and prediction of its future changes require accurate plaque cap thickness, tissue component and structure quantifications and mechanical stress/strain calculations. Multi-modality intravascular ultrasound (IVUS), optical coherence tomography (OCT) and angiography image data with follow-up were acquired from ten patients to obtain accurate and reliable plaque morphology for model construction. Three-dimensional thin-slice finite element models were constructed for 228 matched IVUS + OCT slices to obtain plaque stress/strain data for analysis. Quantitative plaque cap thickness and stress/strain indices were introduced as substitute quantitative plaque vulnerability indices (PVIs) and a machine learning method (random forest) was employed to predict PVI changes with actual patient IVUS + OCT follow-up data as the gold standard. Our prediction results showed that optimal prediction accuracies for changes in cap-PVI (C-PVI), mean cap stress PVI (meanS-PVI) and mean cap strain PVI (meanSn-PVI) were 90.3% (AUC = 0.877), 85.6% (AUC = 0.867) and 83.3% (AUC = 0.809), respectively. The improvements in prediction accuracy by the best combination predictor over the best single predictor were 6.6% for C-PVI, 10.0% for mean S-PVI and 8.0% for mean Sn-PVI. Our results demonstrated the potential using multi-modality IVUS + OCT image to accurately and efficiently predict plaque cap thickness and stress/strain index changes. Combining mechanical and morphological predictors may lead to better prediction accuracies

ガンカンジャサン ノ エイヨウ カンリ オ ササエル エイヨウ サポート チーム

Several hospitals have recently established a nutrition support team（NST）for the nutritional management of inpatients. The NST includes medical doctors, nurses, dietitians, and pharmacists. The aims of the NST are to improve the nutritional condition and the quality of life（QOL）of patients. In Tokushima University Hospital, a NST was established in２００２. Our team comprises physicians, surgeons, dentists, nurses, dietitians, pharmacists, dental hygienists, and physical therapists. Overall, ７０％ of patients undergoing a NST intervention have cancer. Nutritional management in patients with cancer plays an important role in the supportive care during cancer treatment（surgery, chemotherapy, and radiotherapy）. It is focused on the improvement of undernutrition, return to oral feeding, and an improvement in QOL in palliative care. Recently, cancer cachexia has received a lot of attention, with various studies reporting on the nutritional care in patients with cancer. Malnutrition negatively impacts a patient’s response to therapy, leading to an increase in the incidence of treatment-related side effects, and impairment in muscle function, performance status, immune function, and QOL. Recently, it has been reported that NST improves the treatment outcome in patients with cancer because nutritional status is an important part of cancer treatment. Therefore, nutritional management by a NST in patients with cancer has played a crucial role in cancer therapy

A novel M cell–specific carbohydrate-targeted mucosal vaccine effectively induces antigen-specific immune responses

Mucosally ingested and inhaled antigens are taken up by membranous or microfold cells (M cells) in the follicle-associated epithelium of Peyer's patches or nasopharynx-associated lymphoid tissue. We established a novel M cell–specific monoclonal antibody (mAb NKM 16–2-4) as a carrier for M cell–targeted mucosal vaccine. mAb NKM 16–2-4 also reacted with the recently discovered villous M cells, but not with epithelial cells or goblet cells. Oral administration of tetanus toxoid (TT)– or botulinum toxoid (BT)–conjugated NKM 16–2-4, together with the mucosal adjuvant cholera toxin, induced high-level, antigen-specific serum immunoglobulin (Ig) G and mucosal IgA responses. In addition, an oral vaccine formulation of BT-conjugated NKM 16–2-4 induced protective immunity against lethal challenge with botulinum toxin. An epitope analysis of NKM 16–2-4 revealed specificity to an α(1,2)-fucose–containing carbohydrate moiety, and reactivity was enhanced under sialic acid–lacking conditions. This suggests that NKM 16–2-4 distinguishes α(1,2)-fucosylated M cells from goblet cells containing abundant sialic acids neighboring the α(1,2) fucose moiety and from non-α(1,2)-fucosylated epithelial cells. The use of NKM 16–2-4 to target vaccine antigens to the M cell–specific carbohydrate moiety is a new strategy for developing highly effective mucosal vaccines

Using optical coherence tomography and intravascular ultrasound imaging to quantify coronary plaque cap stress/strain and progression: A follow-up study using 3D thin-layer models

Accurate plaque cap thickness quantification and cap stress/strain calculations are of fundamental importance for vulnerable plaque research. To overcome uncertainties due to intravascular ultrasound (IVUS) resolution limitation, IVUS and optical coherence tomography (OCT) coronary plaque image data were combined together to obtain accurate and reliable cap thickness data, stress/strain calculations, and reliable plaque progression predictions. IVUS, OCT, and angiography baseline and follow-up data were collected from nine patients (mean age: 69; m: 5) at Cardiovascular Research Foundation with informed consent obtained. IVUS and OCT slices were coregistered and merged to form IVUS + OCT (IO) slices. A total of 114 matched slices (IVUS and OCT, baseline and follow-up) were obtained, and 3D thin-layer models were constructed to obtain stress and strain values. A generalized linear mixed model (GLMM) and least squares support vector machine (LSSVM) method were used to predict cap thickness change using nine morphological and mechanical risk factors. Prediction accuracies by all combinations (511) of those predictors with both IVUS and IO data were compared to identify optimal predictor(s) with their best accuracies. For the nine patients, the average of minimum cap thickness from IVUS was 0.17 mm, which was 26.08% lower than that from IO data (average = 0.23 mm). Patient variations of the individual errors ranged from ‒58.11 to 20.37%. For maximum cap stress between IO and IVUS, patient variations of the individual errors ranged from ‒30.40 to 46.17%. Patient variations of the individual errors of maximum cap strain values ranged from ‒19.90 to 17.65%. For the GLMM method, the optimal combination predictor using IO data had AUC (area under the ROC curve) = 0.926 and highest accuracy = 90.8%, vs. AUC = 0.783 and accuracy = 74.6% using IVUS data. For the LSSVM method, the best combination predictor using IO data had AUC = 0.838 and accuracy = 75.7%, vs. AUC = 0.780 and accuracy = 69.6% using IVUS data. This preliminary study demonstrated improved plaque cap progression prediction accuracy using accurate cap thickness data from IO slices and the differences in cap thickness, stress/strain values, and prediction results between IVUS and IO data. Large-scale studies are needed to verify our findings