Objective: Patients with terminal cancer experience malnutrition due to cachexia and other problems associated with the disease’s progression. Particularly, patients with gastrointestinal cancers often experience malnutrition because of gastrointestinal symptoms; however, there are few reports evaluating nutritional status based on cancer type up to the prediction of prognosis. In the present study, we examined nutritional evaluation and prognosis based on cancer type.

Methods: In 2019, 234 patients were admitted to Fujita Health University Nanakuri Memorial Hospital and subsequently died before being discharged. Of these patients, 210 were included in the study. Twenty-four patients who were determined to have refractory cachexia on admission were excluded. The 210 patients were divided into two groups, 94 and 116 patients with gastrointestinal cancers and non-gastrointestinal cancers, respectively. Subsequently, data, such as age, sex, presence or absence of metastasis, whether the cancer was initial or recurrent, serum albumin (Alb) and transthyretin (TTR) levels on admission, and survival time were examined. Moreover, for further analysis, the 94 patients with gastrointestinal cancers were classified into 51 and 43 with hepato-biliary-pancreas cancer and gastrointestinal tract cancers, respectively.

Results: Alb and TTR values were significantly lower in patients with gastrointestinal cancer than in patients with non-gastrointestinal cancer (p=0.015 and 0.002, respectively), and Alb values were significantly lower in patients with gastrointestinal tract cancer than in patients with hepato-biliary-pancreas cancer (p=0.049).

Conclusion: Patients with terminal cancer having poor nutritional status exhibit poor prognosis. Particularly, among patients with gastrointestinal tract cancer have exceptionally poor nutritional status. Therefore, providing nutritional management that combines intravenous nutrition with appropriate adjustments to each patient’s gastrointestinal and absorptive condition is important.

Objective: To elucidate the relationship between social participation and quality of life (QOL) in patients with traumatic brain injury.

Methods: This study included 128 community-dwelling patients with head injuries (average age: 41.8 years; average time since injury: 3126 days). We employed the Community Integration Questionnaire (CIQ; scoring range 0–29), a disease-specific scale for head injury patients, along with the Quality of Life after Brain Injury (QOLIBRI; scoring range 0–100%). An adjusted nonlinear regression analysis was used to explore the relationships between the CIQ (total score and subscales: home integration, social integration, productivity) and QOLIBRI (total score and subscales).

Results: A significant relationship was observed only between the Total CIQ and the Self subscale of the QOLIBRI (p=0.006). The Self subscale score of the QOLIBRI increased with the Total CIQ score up to 15, after which it plateaued. Additionally, a significant positive relationship was found between the Social Integration subscale of the CIQ and the Self subscale of the QOLIBRI (p=0.018). The QOLIBRI Self score increased with the CIQ Social Integration score up to 8, beyond which it remained stable. No associations were found between the CIQ’s Home Integration and Productivity subscales and the QOLIBRI scores.

Conclusion: The findings indicate that for individuals with traumatic brain injury, an increase in social participation, particularly in social integration, correlates with an enhanced sense of self-satisfaction up to a certain point. However, beyond this level, further advances in social participation do not yield additional gains, suggesting that factors other than social participation play a role in enhancing QOL. This underscores the multifaceted nature of QOL in this context.

Objectives: To develop a comprehensive machine learning model incorporating various clinical factors, including frailty and comorbidities, to predict 30-day readmission and mortality risk in patients with chronic obstructive pulmonary disease (COPD).

Methods: This retrospective cohort study used electronic health records (EHR) from Fujita Health University Hospital (2004–2019) for 1294 patients with COPD and 3499 hospitalization or death events. The EHR contained longitudinal patient data (demographics, diagnoses, test results, clinical records). We developed two eXtreme Gradient Boosting models, the comprehensive Top64 and practical 11-feature models. We compared these with the Comorbidity, Obstruction, Dyspnea, and Previous Exacerbations index (CODEX) model, a widely used tool for predicting hospital readmission or death in patients with COPD. The area under the receiver operating characteristic curve (AUC) with 95% confidence interval (CI), sensitivity, and specificity were used to evaluate the model performance.

Results: The Top64 (AUC: 0.769, 95% CI: 0.747–0.791) and practical 11-feature (AUC: 0.746, 95% CI: 0.730–0.762) models performed better than the CODEX model (AUC: 0.587, 95% CI: 0.563–0.611). The Top64 model showed 0.978 sensitivity and 0.341 specificity, and the practical 11-feature model achieved 0.955 sensitivity and 0.361 specificity. The calibration curves showed good agreement between the observed and predicted results for both models.

Conclusions: A machine learning approach based on clinical data readily available from the EHR performed better than existing models in predicting 30-day readmission and mortality risks in patients with COPD. A comprehensive risk prediction tool may enhance individualized care strategies and improve patient outcomes in COPD management.

Objectives: Sivelestat sodium hydrate (SSH) may be effective in the early stage of acute respiratory distress syndrome (ARDS) before the neutrophil extracellular trap scaffold structure is complete. Therefore, patients with suppression of fibrinolysis (SF) before the secondary fibrinolytic process might benefit from SSH administration. The primary aim of this study was to determine the effect of the SF state and combination therapy on the effect of SSH administration.

Methods: We retrospectively reviewed the data of patients diagnosed with ARDS at Fujita Health University Hospital between July 2005 and December 2016. Patients with ARDS were stratified into the SF and hyperfibrinolysis (HF) groups. Using the fibrin degradation product (FDP)/D-dimer ratio, cut-off values were set as follows: FDP/D-dimer >2 for the HF group and FDP/D-dimer ≤2 for the SF group. The 28-day mortality was the primary endpoint.

Results: In total, 168 patients (71 in the HF group and 97 in the SF group) were included in the analysis. The mortality within 28 days was not different based on SSH administration in either group (HF group: p=0.956, SF group: p=0.957). In the SF group, the mortality rate within 28 days in SSH-treated patients who received antithrombotic drugs was significantly higher than that in patients who received SSH only (p<0.05). However, this finding was not present in the HF group (p=0.786).

Conclusions: Concomitant use of SSH and antithrombotic drugs might worsen the treatment outcome of patients with ADRS in the SF state.

Objectives: Consistent hand hygiene practice is required to reduce the prevalence of healthcare-associated infections. However, frequent hand hygiene compromises the skin barrier, causing hand eczema. Consequently, compliance with this practice can be reduced. This study aimed to determine the safety of reducing the frequency of hand hygiene by nurses, focusing on the de-implementation of the current excessive hand hygiene protocol.

Methods: A single-group, pretest–post-test pilot study was conducted in three nurses at a growing care unit (level 2 neonatal intensive care unit) in a Japanese university hospital. The developed intervention was performed four times and the current hand hygiene protocol was performed six times in each nurse. The number of microbial contaminations on the hands at each time point was the primary outcome. Impairment of the skin barrier (changes in the stratum corneum water content, transepidermal water loss, and skin pH) was the secondary outcome.

Results: The pre- and post-test residual bacterial contamination at each time point was not significantly different (p=0.99). The amount of change in skin physiology was also not significantly different between the pre- and post-tests.

Conclusions: Hand hygiene effects, such as a reduction in bacterial contamination and impairment of skin physiology, were significantly different between before and after the intervention of reducing the frequency of hand hygiene by nurses. To confirm this finding, we will focus on resistant bacteria and test this intervention in randomized, controlled trials.

Background: “Nepic^®” (Japan Tissue Engineering Co., Ltd., Gamagori, Japan) is an autologous cultivated limbal epithelial sheet, approved in 2020 in Japan for the reconstruction of the corneal surface in cases of limbal stem cell deficiency (LSCD). Because the surgical procedure known as cultivated limbal epithelial cell sheet transplantation (CLET) has only recently been introduced and the number of cases remains limited, accumulating clinical experience is essential to ensure the safety and success of this procedure. Herein, we report the clinical course of a patient with unilateral LSCD who underwent CLET for a corneal surface reconstruction using Nepic^®.

Case presentation: A 50-year-old man sustained bilateral eye injuries from mortar during construction work. The patient’s right cornea exhibited LSCD. Initial treatment involved a 360° limbal transplantation with an allo-corneal graft at a university hospital. However, graft rejection occurred, and the corneal surface was subsequently covered by conjunctival tissue within 2 months. Because the patient’s left cornea and conjunctiva appeared healthy, we performed CLET with Nepic^® 3 years after the limbal transplantation.

Conclusions: When using Nepic^®, it is essential to become accustomed to handling the cultivated epithelial sheet on the ring-shaped holder; however, cultivated corneal epithelium transplantation can also be performed without the carrier material, but rather as a sheet. Though the corneal surface appeared smooth and shiny at 7 months postoperatively, we seek to determine whether the epithelial cells on the patient’s cornea are of corneal or conjunctival origin without resorting to invasive procedures, such as biopsy.

An 82-year-old man underwent distal gastrectomy for gastric cancer 6 months before admission to our hospital. His postoperative food intake was reduced to less than half of the preoperative amount. Two months postsurgery, he fell and fractured his leg and was bedridden. Furthermore, hypoalbuminemia and bilateral pleural effusions persisted. Despite repeated administration of an albumin preparation and pleural drainage, he showed no improvement for 3 months and was referred to our hospital. On admission, his height was 171 cm, weight 52.8 kg, and body mass index 18.1 kg/m². Moreover, he was clearly undernourished and had difficulty maintaining a standing position. In terms of nutritional enrichment, his diet was adjusted to meet the needs of an older adult patient postgastrectomy. A protein-enriched supplemental diet of approximately 1800 kcal was planned, and he could consume almost the entire amount. His refractory pleural effusion was resolved by performing concentrated pleural effusion reinfusion therapy, and he continued to receive aggressive nutritional support and rehabilitation. The patient’s general condition and activities of daily living improved markedly. Subsequently, he was discharged and could walk independently on day 64 of hospitalization. Summary: We experienced a successful case of refractory pleural effusion due to malnutrition treated with aggressive nutritional support combined with concentrated pleural fluid filtration reinfusion therapy.