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

Demonstration of a spherical plasma mirror for the counter-propagating kilojoule-class petawatt LFEX laser system

A counter-propagating laser-beam platform using a spherical plasma mirror was developed for the kilojoule-class petawatt LFEX laser. The temporal and spatial overlaps of the incoming and redirected beams were measured with an optical interferometer and an x-ray pinhole camera. The plasma mirror performance was evaluated by measuring fast electrons, ions, and neutrons generated in the counter-propagating laser interaction with a Cu-doped deuterated film on both sides. The reflectivity and peak intensity were estimated as ∼50% and ∼5 × 1018 W/cm2, respectively. The platform could enable studies of counter-streaming charged particles in high-energy-density plasmas for fundamental and inertial confinement fusion research.Kojima S., Abe Y., Miura E., et al. Demonstration of a spherical plasma mirror for the counter-propagating kilojoule-class petawatt LFEX laser system. Optics Express 30, 43491 (2022); https://doi.org/10.1364/oe.475945

Development and application of a ray-tracing code integrating with 3D equilibrium mapping in LHD ECH experiments

The central electron temperature has successfully reached up to 7.5 keV in large helical device(LHD) plasmas with a central high-ion temperature of 5 keV and a central electron density of1.3×1019 m−3. This result was obtained by heating with a newly-installed 154 GHz gyrotronand also the optimisation of injection geometry in electron cyclotron heating (ECH). Theoptimisation was carried out by using the ray-tracing code ‘LHDGauss’, which was upgradedto include the rapid post-processing three-dimensional (3D) equilibrium mapping obtainedfrom experiments. For ray-tracing calculations, LHDGauss can automatically read the relevantdata registered in the LHD database after a discharge, such as ECH injection settings (e.g.Gaussian beam parameters, target positions, polarisation and ECH power) and Thomsonscattering diagnostic data along with the 3D equilibrium mapping data. The equilibrium mapof the electron density and temperature profiles are then extrapolated into the region outsidethe last closed flux surface. Mode purity, or the ratio between the ordinary mode and theextraordinary mode, is obtained by calculating the 1D full-wave equation along the directionof the rays from the antenna to the absorption target point. Using the virtual magnetic fluxsurfaces, the effects of the modelled density profiles and the magnetic shear at the peripheralregion with a given polarisation are taken into account. Power deposition profiles calculatedfor each Thomson scattering measurement timing are registered in the LHD database. Theadjustment of the injection settings for the desired deposition profile from the feedbackprovided on a shot-by-shot basis resulted in an effective experimental procedure

Extension of operational regime in high-temperature plasmas and effect of ECRH on ion thermal transport in the LHD

A simultaneous high ion temperature (Ti) and high electron temperature (Te) regime was successfully extended due to an optimized heating scenario in the LHD. Such high-temperature plasmas were realized by the simultaneous formation of an electron internal transport barrier (ITB) and an ion ITB by the combination of high power NBI and ECRH. Although the ion thermal confinement was degraded in the plasma core with an increase of Te/Ti by the on-axis ECRH, it was found that the ion thermal confinement was improved at the plasma edge. The normalized ion thermal diffusivity ${{\chi}_{\text{i}}}/T_{\text{i}}^{1.5}$ at the plasma edge was reduced by 70%. The improvement of the ion thermal confinement at the edge led to an increase in Ti in the entire plasma region, even though the core transport was degraded

Relationship between serum iron level and physical function in heart failure patients is lost by presence of diabetes

Abstract Aims Iron deficiency (ID) is common in patients with heart failure (HF) and is reportedly associated with exercise intolerance and impaired quality of life. Iron supplementation therapy in HF patients with ID improves exercise capacity. Conversely, protective roles of iron depletion in the development of diabetes mellitus (DM) and its complications have been proposed. This study aimed to determine the impact of ID on physical function in HF patients with and without DM. Methods and results We enrolled consecutive patients who were admitted to our institute for HF diagnosis and management. The short physical performance battery (SPPB) was used to evaluate physical function, and low physical function was defined as an SPPB score of <10 points as individuals with SPPB scores of <10 points are most likely to be classified as frail and are at high risk for disability and future adverse events, including death. ID was defined as serum ferritin < 100 or 100–299 ng/mL when transferrin saturation (TSAT) was <20% according to the HF guidelines. Among the 562 HF patients (72 ± 14 years old; 56% male), 329 patients (58%) and 191 patients (34%) had ID and low physical function, respectively. Multivariate logistic regression analysis showed that TSAT as a continuous variable, but not ID, was a predictor of low physical function (odds ratio: 0.980, P = 0.024). Subgroup analysis showed that a significant association between low TSAT and low physical function was lost in HF patients with DM (P for interaction < 0.001). A spline dose–response curve for the relationship between TSAT and risk of low physical function with adjustments for covariates associated with low physical function in non‐DM patients was almost linear with an increase in the risk of low physical function as the TSAT increased, but such a relationship was not found in the analyses of DM patients. A lack of close TSAT–SPPB relationship in HF patients with DM was confirmed also in a propensity‐score‐matched cohort. Conclusions TSAT as a continuous variable, but not ID, was independently associated with physical function in HF patients, and a significant association was lost in patients with HF and DM, suggesting a limited impact of iron supplementation therapy in HF patients with DM