Integration of palliative, supportive, and nutritional care to alleviate eating-related distress among advanced cancer patients with cachexia and their family members

Advanced cancer patients with cachexia and their families can suffer from eating-related distress. This complex entity encompasses patients’ struggle to nourish themselves, emotional and social consequences of their inability to maintain food intake, and profound disturbance in family relationships. With evidence-based nutritional care, as well as symptom management to enable food intake, cachexia can be mitigated to some degree. In addition, patients and families require psychosocial support and education to understand and cope with this condition. Only by taking an integrated approach can health care teams alleviate eating-related distress, improve quality of life (QOL), reduce interpersonal conflicts, and alter perceptions of nutritional neglect for patients and families. However, few studies have investigated eating-related distress among patients and families. The aim of this narrative review is to describe what is known about eating-related distress and the roles of integrated palliative, supportive, and nutritional care in improving QOL of patients and families

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Hepatic Angiomyolipoma with Minimal Intratumoral Fat Content

We report a rare case of hepatic angiomyolipoma with minimal fat content. The low fat content led to an incorrect preoperative diagnosis. A 38-year-old man who was a carrier of hepatitis B virus infection incidentally presented with a hepatic tumor. His serum alpha-fetoprotein level was normal. Ultrasonography revealed a well-circumscribed, heterogeneous hypoechoic nonencapsulated liver tumor measuring 34 × 24 mm. Precontrast computed tomography (CT) did not reveal fatty attenuation in the lesion. Contrast-enhanced CT revealed a hypervascular nonencapsulated tumor in the arterial phase and moderate washing out of the contrast medium in the portal phase. A hypervascular tumor was observed on CT hepatic arteriography, and complete washing out of the contrast medium on CT during arterial portography. These findings are compatible with hepatocellular carcinoma. The tumor exhibited low signal intensity on T1-weighted images and high signal intensity on T2-weighted images; no hypointensity was observed on fat suppression images. The patient underwent left hemihepatectomy because of a preoperative diagnosis of hepatocellular carcinoma. The histopathological diagnosis was a hepatic angiomyolipoma with 5% fat content. Low fat content makes the diagnosis of this condition difficult. The absence of serum tumor markers and the presence of a nonencapsulated hypervascular tumor may facilitate the accurate preoperative diagnosis of hepatic angiomyolipomas that have a low fat content and mimic hepatocellular carcinoma

Holistic multimodal care for patients with cancer cachexia and their family caregivers

Patients with cancer cachexia frequently suffer from physical symptoms and psychological symptoms of illness, which can lead to emotional distress in patients and family caregivers. Although there is no standard care to manage cancer cachexia despite its high prevalence and negative impact on quality of life in patients and family caregivers, there is accumulating evidence showing the importance of holistic multimodal care for cancer cachexia. However, there is no agreement on the essential components of holistic multimodal care. Therefore, the aims of this review are to give an overview of what is known about the holistic multimodal care and to suggest the composition of a multidisciplinary team to achieve holistic interventions. Holistic multimodal care for cancer cachexia is defined as an approach that addresses physical health through medical, pharmacological, nutritional, and rehabilitative interventions as well as psychological, emotional, and social well-being issues according to the needs of patients and family caregivers. Moreover, an ideal multidisciplinary team is proposed to achieve holistic interventions based on patient- and family-centered care. However, the development of educational programs on cancer cachexia for both clinicians and patients and family caregivers is needed. Furthermore, measurements to assess the benefits of holistic multimodal care also need to be established

Impact of gas flow direction on the crystallographic texture evolution in laser beam powder bed fusion

This study demonstrated that the gas flow direction in the laser beam powder bed fusion (PBF-LB) significantly affects the crystallographic texture evolved in the products. The effect on texture is attributed to the difference in the melt pool depth, which depends on gas flow direction. The melt pool was shallower when the laser scanning and gas flow directions were parallel than when they were perpendicular. This phenomenon should be of particular concern when applying Scan Strategy_XY wherein the laser was scanned with a 90° rotation in each layer, which is often used in PBF-LB. The asymmetry in the melt pool depth generated by laser scanning in the x- and y-directions can lead to unintended variations in the crystallographic texture. The gas phase would interact with a part being manufactured immediately beneath the gas and affect the crystallographic feature of the product.Amano H., Ishimoto T., Hagihara K., et al. Impact of gas flow direction on the crystallographic texture evolution in laser beam powder bed fusion. Virtual and Physical Prototyping 18, e2169172 (2023); https://doi.org/10.1080/17452759.2023.2169172

Eating-related distress and need for nutritional support of families of advanced cancer patients: A nationwide survey of bereaved family members

Background: A number of advanced cancer patients are suffering from physical and psychosocial burdens because of cancer cachexia, and these burdens also greatly impact on their family members and relationships between patients and family members. It is necessary to consider the psychosocial impact of cancer cachexia on family members of advanced cancer patients. Methods: A cross-sectional anonymous nationwide survey was conducted involving 925 bereaved family members of cancer patients who had been admitted to 133 inpatient hospices throughout Japan. Results: A total of 702 bereaved family members returned the questionnaires (response rate, 75.9%). Concerning eating-related distress, 'I served what the patient wanted without consideration of calories and nutritional composition' was highest (75.1%), and 'I tried making many kinds of meals for the patient' and 'I was concerned about planning meals for the patient every day' followed (63.0% and 59.4%, respectively). The top 5 of the 19 items were categorized as 'fighting back'. Need for nutritional support was high (72.2%), and need for explanations about the reasons for anorexia and weight loss of patients was moderate (41.4%). Explanatory factor analysis of eating-related distress identified the following four domains: (factor 1) feeling that family members forced the patient to eat to avoid death, (factor 2) feeling that family members made great efforts to help the patient eat, (factor 3) feeling that eating was a cause of conflicts between the patient and family members, and (factor 4) feeling that correct information was insufficient. Results of multiple logistic regression analysis showed that spouse, fair/poor mental status, factors 1, and 4 were identified as independent determinants of major depression (odds ratio [OR] 3.27 [95% confidence interval (CI) 1.24-8.60], P=0.02; OR 4.50 [95% CI 2.46-8.25], P<0.001; OR 2.51 [95% CI 1.16-5.45], P=0.02; OR 2.33 [95% CI 1.13-4.80], P=0.02, respectively). Conclusions: A number of family members of advanced cancer patients experienced high levels of eating-related distress and had a need for nutritional support

Dog erythrocyte rosette-forming lymphocyte: blockage by OKT11 monoclonal antibody.

Human peripheral blood mononuclear cells (PBM) were separated into sheep erythrocyte rosette-forming (Es+) and non Es+ cells by the Ficoll-Hypaque gradient sedimentation method. Thirty-eight percent of the Es+ cells formed rosettes with dog erythrocytes and were designated as Es+Ed+ cells. The remaining Es+ cells were designated as Es+Ed- cells. Only a few non Es+ cells formed rosettes with dog erythrocytes. Among Es+Ed+ cells, T4 antigen-positive cells were observed approximately 1.7 times as often as T8 antigen-positive cells, when measured by staining with OKT4 or OKT8 monoclonal antibody. Among Es+Ed- cells, however, T4 and T8 antigen-positive cells were observed in almost equal proportion. Preincubation of PBM with OKT11 monoclonal antibody, but not with OKT4 monoclonal antibody, inhibited the rosette formation with dog as well as sheep erythrocytes. These results indicated that Es+Ed+ cells were a subpopulation of T-cells in which a majority of the cells were T4 antigen-positive, and that the binding sites of dog erythrocytes on human T-cells was closely linked with that of sheep erythrocytes.</p

動作を伴う視線計測に関する文献的考察

目　的：本研究の目的は，動作を伴う視線計測に関する先行研究から，視線の測定方法，分析方法，対象者数の妥当性を明らかにすることである。方　法：文献の選定には，CiNii Articles，医学中央雑誌Web 版（Ver.5），Medical Online を用い，キーワードは「視線計測」「アイマークレコーダ」「注視」とした。得られた文献のうち，選定基準に合致した文献23 件を分析対象とした。帰納的に内容を分析し，機器の条件設定，対象者数，分析指標等をマトリックスシートに整理し，視線の測定方法や分析方法の妥当性を検討した。結　果：視線計測機器の条件設定において，眼球運動の測定には瞳孔角膜反射法が多く用いられており，視野カメラレンズには水平角92°のレンズが最も多く用いられていた。対象者と分析処理方法について，対象者5 名以下では視線パターンを把握することを目的としており，統計的検定は行われていなかった。一方で，11 名以上を対象とした文献では，若齢者と比較した高齢者の視線，非熟練者と比較した熟練者の視線の特徴を統計学的検定から明らかにしていた。分析指標としては「注視時間」「注視回数」「注視項目変化表」「視線軌跡」が多く用いられていた。考　察：動作を伴う視線計測から熟練者の技の可視化，新人看護師や看護学生の技術習得，患者教育に繋げるためには，モバイル型視線計測機器を用い，動作環境に合わせた視野カメラレンズ，キャリブレーション方法を選択する必要がある。また，10 名以上を対象とした注視時間や注視回数の比較，注視項目変化表の分析より，動作中の思考や認知のプロセスを推定することが可能になると示された。資