Incidence and associated factors of sudden unexpected death in advanced cancer patients: A multicenter prospective cohort study

[Purpose] A sudden unexpected death has significant negative impacts on patients, family caregivers, and medical staff in hospice/palliative care. This study aimed to clarify the incidence and associated factors of sudden unexpected death according to four definitions in advanced cancer patients. [Methods] We performed a prospective cohort study in 23 inpatient hospices/palliative care units in Japan. Advanced cancer patients aged ≥18 years who were admitted to inpatient hospices/palliative care units were included. The incidence and associated factors of sudden unexpected death were evaluated in all enrolled patients according to four definitions: (a) rapid decline death, defined as a sudden death preceded by functional decline over 1–2 days; (b) surprise death, defined if the primary responsible palliative care physician answered “yes” to the question, “Were you surprised by the timing of the death?”; (c) unexpected death, defined as a death that occurred earlier than the physicians had anticipated; and (d) performance status (PS)-defined sudden death, defined as a death that occurred within 1 week of functional status assessment with an Australia-modified Karnofsky PS ≥50. [Results] Among 1896 patients, the incidence of rapid decline death was the highest (30-day cumulative incidence: 16.8%, 95% CI: 14.8–19.0%), followed by surprise death (9.6%, 8.1–11.4%), unexpected death (9.0%, 7.5–10.8%), and PS-defined sudden death (6.4%, 5.2–8.0%). Male sex, liver metastasis, dyspnea, malignant skin lesion, and fluid retention were significantly associated with the occurrence of sudden unexpected death. [Conclusion] Sudden unexpected death is not uncommon even in inpatient hospices/palliative care units, with range of 6.4–16.8% according to the different definitions

Postmortem and helminthological examination of seabirds killed by oil spilled at Ishikari, Hokkaido, Japan, in November 2004

Postmortems and helminthological examinations were performed on beached seabirds killed by oil spilled from a grounded freighter at Ishikari, Hokkaido, Japan in November 13, 2004. The carcasses were covered with crude oil, but they had adequate subcutaneous fat levels. Gross pathological findings consisting of gastric ulcers, pulmonary edema, enlarged spleens and blackish liquid contents in the digestive tracts suggested that they had a rapid progression to death caused by a loss of ascending force, hypothermia and dehydration. Although the visceral organs had degenerated, no direct evidence of mortality caused by ingesting oil was observed. However, extensive acute inflammatory reactions caused by large numbers of mature and immature nematodes (Contracaecum rudolphii) deeply penetrating the gastric walls was observed in two of the birds. Helminthological investigations were conducted on 21 birds from six species, namely: Phalacrocorax capillatus, Aythya marila, Cerorhinca monocerata, Synthliboramphus antiquus, Aethia cristatella, and Brachyramphus perdix. Thirteen helminth species were obtained and identified, including eight nematodes (Eucoleus contortus, Baruscapillaria mergi, B. rudolphii, Amidostomum acutum, C. rudolphii, Tetrameres fissispina, Cosmocephalus obvelatus and Stegophorus stercorarii), three trematodes (Aporchis sp., Hyptiasmus sp. and Renicola sp.), one cestode (Diorchis nyrocae) and one acanthocephalan species (Andracantha phalacrocoracis). Of these, B. rudolphii from S. antiquus, C. rudolphii and Renicola sp. from A. cristatella, and C. obvelatus and Renicola sp. from B. perdix were first host records. Additionally, B. rudolphii was the first geographical record of this species in Japan

Development and validation of questionnaires for eating‐related distress among advanced cancer patients and families

Background: Eating‐related distress (ERD) is one type of psychosocial distress among advanced cancer patients and family caregivers. Its alleviation is a key issue in palliative care; however, there is no validated tool for measuring ERD. Methods: The purpose of this study was to validate tools for evaluating ERD among patients and family caregivers. The study consisted of a development and validation/retest phase. In the development phase, we made preliminary questionnaires for patients and family caregivers. After face validity and content validity, we performed an exploratory factor analysis and discussed the final adoption of items. In the validation/retest phase, we examined factor validity with an exploratory factor analysis. We calculated Pearson's correlation coefficients between the questionnaire for patients, the Functional Assessment of Anorexia/Cachexia Therapy Anorexia Cachexia Subscale (FAACT ACS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Cachexia 24 (EORTC QLQ‐CAX24) and Pearson's correlation coefficients between the questionnaire for family caregivers and the Caregiver Quality of Life Index‐Cancer (CQOLC) for concurrent validity. We calculated Cronbach's alpha coefficients (Cronbach's alpha) and intraclass correlation coefficients (ICCs) for internal consistency and test–retest reliability. We performed the Mann–Whitney U test between the questionnaires and cancer cachexia based on criteria from the international consensus for known‐group validity. Results: In the development phase, 162 pairs of patients and family caregivers were asked to participate, and 144 patients and 106 family caregivers responded. In the validation/retest phase, 333 pairs of patients and family caregivers were asked to participate, and 234 patients and 152 family caregivers responded. Overall, 183 patients and 112 family caregivers did the retest. Seven conceptual groups were extracted for the ERD among patients and family caregivers, respectively. Patient factors 1–7 correlated with FAACT ACS (r = −0.63, −0.43, −0.55, −0.40, −0.38, −0.54, −0.38, respectively) and EORTC QLQ‐CAX24 (r = 0.58, 0.40, 0.60, 0.49, 0.38, 0.59, 0.42, respectively). Family factors 1–7 correlated with CQOLC (r = −0.34, −0.30, −0.37, −0.37, −0.46, −0.42, −0.40, respectively). The values of Cronbach's alpha and ICC of each factor and all factors of patients ranged from 0.84 to 0.96 and 0.67 to 0.83, respectively. Those of each factor and all factors of family caregivers ranged from 0.84 to 0.96 and 0.63 to 0.84, respectively. The cachexia group of patients had significantly higher scores than the non‐cachexia group for each factor and all factors. Conclusions: Newly developed tools for measuring ERD experienced by advanced cancer patients and family caregivers have been validated

The Japanese Clinical Practice Guideline for acute kidney injury 2016

Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search

DIFFERENCE OF VIRULENCE IN CAUSING METRITIS IN HORSES BETWEEN HEAVILY ENCAPSULATED, LESS HEAVILY ENCAPSULATED AND NON-CAPSULATED STRAINS OF KLEBSIELLA PNEUMONIAE CAPSULAR TYPE 1

Heavily encapsulated strain of Klebsiella pneumoniae (K. pneumoniae) capsular type 1 inoculated into the uterus of a mare and filly caused severe and moderate metritis, respectively, while the less heavily encapsulated strain caused only very slight metritis in only 1 of 2 mares and nothing in a filly. Heavily encapsulated strain was recovered from uterine swabs of the mare and filly until the 25th and 21st post-inculation days (PIDs), respectively, and was recovered at autospy on the 23rd and 48th PIDs from the uterus and vagina, respectively. Less heavily encapsulated strain was recovered from uterine swabs of only 1 mare until the 8th PID only, but not from the remaining mare and filly, and the recovery of the organisms from the uterus and vagina at autopsy on the 20th and 27th PIDs was negative. Non-capsulated strain did not cause any metritis in a mare and a filly and the organisms were not recovered from uterine swabs from the 2nd PID nor at autospy on the 20th and 21st PIDs from the uterus and vagina

Virus-Related Diabetes in Cattle

Diabetes and Viruses (edit by Taylor, K., Hyöty, H., Toniolo, A., Zuckerman, A. (Eds.)