Muscle mass, quality, and strength; physical function and activity; and metabolic status in cachectic patients with head and neck cancer

Background & aims: Cancer cachexia is commonly associated with poor prognosis in patients with head and neck cancer (HNC). However, its pathophysiology and treatment are not well established. The current study aimed to assess the muscle mass/quality/strength, physical function and activity, resting energy expenditure (REE), and respiratory quotient (RQ) in cachectic patients with HNC. Methods: This prospective cross-sectional study analyzed 64 patients with HNC. Body composition was measured via direct segmental multifrequency bioelectrical impedance analysis, and muscle quality was assessed using echo intensity on ultrasonography images. Muscle strength was investigated utilizing handgrip strength and isometric knee extension force (IKEF). Physical function was evaluated using the 10-mwalking speed test and the five times sit-to-stand (5-STS) test. Physical activity was examined using a wearable triaxial accelerometer. REE and RQ were measured via indirect calorimetry. These parameters were compared between the cachectic and noncachectic groups. Results: In total, 23 (36%) patients were diagnosed with cachexia. The cachectic group had a significantly lower muscle mass than the noncachectic group. Nevertheless, there was no significant difference in terms of fat between the two groups. The cachectic group had a higher quadriceps echo intensity and a lower handgrip strength and IKEF than the noncachectic group. Moreover, they had a significantly slower normal and maximum walking speed and 5 STS speed. The number of steps, total activity time, and time of activity (<3 Mets) did not significantly differ between the two groups. The cachectic group had a shorter time of activity (≥3 Mets) than the noncachectic group. Furthermore, the cachectic group had a significantly higher REE/body weight and REE/fat free mass and a significantly lower RQ than the noncachectic group. Conclusions: The cachectic group had a lower muscle mass/quality/strength and physical function and activity and a higher REE than the noncachectic group. Thus, REE and physical activity should be evaluated to determine energy requirements. The RQ was lower in the cachectic group than that in the noncachectic group, indicating changes in energy substrate. Further studies must be conducted to examine effective nutritional and exercise interventions for patients with cancer cachexia

Hematopoietic stem cell-derived Tregs are essential for maintaining favorable B cell lymphopoiesis following posttransplant cyclophosphamide

Posttransplant cyclophosphamide (PTCy) is associated with a low incidence of chronic graft -versus-host disease (cGVHD) following hematopoietic stem cell (HSC) transplantation. Previous studies have shown the important roles of B cell immunity in cGVHD development. Here, we investigated the long-term reconstitution of B lymphopoiesis after PTCy using murine models. We first demonstrated that the immune homeostatic abnormality leading to cGVHD is characterized by an initial increase in effector T cells in the bone marrow and subsequent B and Treg cytopenia. PTCy, but not cyclosporine A or rapamycin, inhibits the initial alloreactive T cell response, which restores intra-bone marrow B lymphogenesis with a concomitant vigorous increase in Tregs. This leads to profound changes in posttransplant B cell homeostasis, including decreased B cell activating factors, increased transitional and regulatory B cells, and decreased germinal center B cells. To identify the cells responsible for PTCy-induced B cell tolerance, we selectively depleted Treg populations that were graft or HSC derived using DEREG mice. Deletion of either Treg population without PTCy resulted in critical B cytopenia. PTCy rescued B lymphopoiesis from graft-derived Treg deletion. In contrast, the negative effect of HSC-derived Treg deletion could not be overcome by PTCy, indicating that HSC-derived Tregs are essential for maintaining favorable B lymphopoiesis following PTCy. These findings define the mechanisms by which PTCy restores homeostasis of the B cell lineage and reestablishes immune tolerance

A Study of Performance Appraisal of Nurses in North Kyusyu

The purpose of this study was to explain the actual circumstances and the recognition of the performance appraisal targeting the top nursing administrators in the hospitals. In this study, the participants were 203 nursing administrators (in 2000), 199 nursing administrators (in 2001), and 181 nursing administrators (in 2002) of hospitals that had beyond 100 beds in 3 prefectures of the northern part of Kyusyu. It was conducted by using a mailed self-reported questionnaire. Contents of the investigation were composed of ① the actual circumstances of the performance appraisal of nurses and ② the methods of and the necessity of the performance appraisal of nurses, and I have got the following results: 1) The survey was conducted for three consecutive years from 2000 to 2002, however, there was no obvious change in the results. 2) The hospitals where the performance appraisals were being carried out were 31.7％ (in 2000), 40.2％ (in 2001) and 37.6％ (in 2002). 3) The hospitals with the criteria of the performance appraisal were approximately 60％. Concerning the methods of the performance appraisal, the “relative evaluation” was 67.7％ (in 2000), 55.0％ (in 2001) and 33.9％ (in 2002), and the “absolute evaluation” was 30.8％ (in 2000), 36.3％ (in 2001) and 54.4％ (in 2002). 4) Although most nursing administrators recognized the need of the performance appraisal system, they answered “There is no performance appraisal system in the hospital.” And “I don’t know how to carry it out.” For the reason why it wasn’t being carried out. From the above, the need of the education of the nursing administrator was suggested to introduce a performance appraisal system with the purpose of the development of ability based on the will and the fitness of the individual nurse and the use of talented people

九州北部地方における看護職の人事考課に関する実態調査

The purpose of this study was to explain the actual circumstances and the recognition of the performance appraisal targeting the top nursing administrators in the hospitals. In this study, the participants were 203 nursing administrators (in 2000), 199 nursing administrators (in 2001), and 181 nursing administrators (in 2002) of hospitals that had beyond 100 beds in 3 prefectures of the northern part of Kyusyu. It was conducted by using a mailed self-reported questionnaire. Contents of the investigation were composed of ① the actual circumstances of the performance appraisal of nurses and ② the methods of and the necessity of the performance appraisal of nurses, and I have got the following results: 1) The survey was conducted for three consecutive years from 2000 to 2002, however, there was no obvious change in the results. 2) The hospitals where the performance appraisals were being carried out were 31.7％ (in 2000), 40.2％ (in 2001) and 37.6％ (in 2002). 3) The hospitals with the criteria of the performance appraisal were approximately 60％. Concerning the methods of the performance appraisal, the “relative evaluation” was 67.7％ (in 2000), 55.0％ (in 2001) and 33.9％ (in 2002), and the “absolute evaluation” was 30.8％ (in 2000), 36.3％ (in 2001) and 54.4％ (in 2002). 4) Although most nursing administrators recognized the need of the performance appraisal system, they answered “There is no performance appraisal system in the hospital.” And “I don’t know how to carry it out.” For the reason why it wasn’t being carried out. From the above, the need of the education of the nursing administrator was suggested to introduce a performance appraisal system with the purpose of the development of ability based on the will and the fitness of the individual nurse and the use of talented people

A Study on the Method of Catheter Insertion with Several Suggestions (I)

臨床検査が患者に与えるきまざまな苦痛を最小限にとどめる方法として，従来の教科書に採りあげられていない暗示効果に着目した。その実験例として，もっとも一般的に行われ，苦痛の大きいことで知られる十二指腸ゾンデ挿入を選定した。実験に当っては，従来の教科書通りに行う非暗示I群(坐位），非暗示II群（臥位）と筆者らが考案した暗示群の三例の比較を行った。結果は次の通りである。1．暗示群のゾンデ挿入成功者は，12例中11例，非暗示群の成功例は，I群，II群とも各12例中1例であった。2．暗示群，非暗示群を問わず，ゾンデを飲みはじめて，12〜15cmの部位（咽頭，食道入口部と推測される）が，もっとも苦痛の頻度が高く現われることが明らかになった。3．ゾンデ嚥下が10〜15cmに達した時，暗示効果は最大に発揮され，被験者と施行者との信頼関係の重要性が実証できた。4．ゾンデを45cmまで挿入するのに要する時間は，成功例（13例）の平均所要時間は1分52秒であった

Neutralizing Antibody Induction Associated with a Germline Immunoglobulin Gene Polymorphism in Neutralization-Resistant SIVsmE543-3 Infection

Antibody responses are crucial for the control of virus infection. Understanding of the mechanism of antibody induction is important for the development of a vaccine eliciting effective anti-virus antibodies. Virus-specific B cell receptor (BCR)/antibody repertoires are different among individuals, but determinants for this difference remain largely unclear. We have recently reported that a germline BCR immunoglobulin (IgG) gene polymorphism (VH3.33_ET or VH3.33_VI) in rhesus macaques is the determinant for induction of potent B404-class anti-simian immunodeficiency virus (SIV) neutralizing antibodies in neutralization-sensitive SIVsmH635FC infection. In the present study, we examined whether neutralization-resistant SIVsmE543-3 infection can induce the anti-SIV neutralizing antibodies associated with the germline VH3.33 polymorphism. Anti-SIVsmE543-3 neutralizing antibodies were induced in all the macaques possessing the VH3.33_ET allele, but not in those without VH3.33_ET, in the chronic phase of SIVsmE543-3 infection. Next generation sequencing analysis of BCR VH genes found B404-class antibody sequences only in those with VH3.33_ET. These results indicate that anti-SIVsmE543-3 neutralizing antibody induction associated with the germline BCR IgG gene polymorphism can be triggered by infection with neutralization-resistant SIVsmE543-3. This animal model would be useful for the elucidation of the mechanism of potent antibody induction against neutralization-resistant viruses

日本とカナダにおける肥満および糖尿病予防対策

Diabetes Mellitus Type 2 is currently a major health issue in both Japan and Canada. When diabetes is not properly managed, it is known to cause diabetes related neuropathy, blindness, and renal disease. Treatment of diabetes and related diseases is a huge financial burden in both countries. Obesity is a leading cause of diabetes. In order for diabetes prevention to occur, obesity must be prevented in the first place. Currently in Japan, approximately10% of children (1.2 million) are mildly obese and 5% of children are moderately or severely obese (600,000). The need for obesity prevention is a pressing matter. This report will examine the causes, various problems, and countermeasures in relation to childhood obesity in Japan, in comparison to The Kahnawake Schools Diabetes Prevention Project (KSDPP), a Canadian case study. Lifestyle-related causes of obesity in Japanese children include (1) over-eating, (2) high-fat diet, (3) lack of exercise, (4) irregular lifestyle, (5) stress. In order to promote health in children, the government, community, school system, medical and social services need to collaborate in making a cohesive program which a) nurtures proper daily habits, b) screens for obesity, c) establishes a health education system within schools, d) provides guidance and action in promoting nutritional balance focusing through school meals, e) encourages physical activity, especially walking, f) teaches the values of the family life, the enjoyment of nature by providing a wholesome and sound environment for children