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Objective: The method for assessing nutritional status of heart failure (HF) patients has not been fully established yet. Controlling nutritional status (CONUT) using two biochemical parameters (serum albumin and cholesterol level) and one immune indicator (total lymphocyte count) allows a daily assessment of nutritional status of all inpatients. This study aimed to clarify whether CONUT was useful for predicting short-term prognosis in acute HF patients.
Subjects and methods: This study was conducted on 38 patients with acute HF who were admitted to the St. Marianna University School of Medicine Yokohama City Seibu Hospital. Nutritional status was assessed using CONUT and blood samples were collected on admission. The relationships between CONUT scores and parameters associated with short-term prognosis were investigated.
Results: Of the study patients, 36 patients (95%) were identified as having mild to severe nutritional disturbances. The CONUT scores were significantly higher in the acute HF patients with infectious disease than those without infectious disease (p=0.02). The patients with higher CONUT scores tended to have longer hospital stay (p=0.02). Of note, the CONUT scores were significantly lower in the patients who could leave the hospital after alleviating HF symptoms (p=0.02).
Conclusions: This study result suggests that many acute HF patients might have some degree of nutritional disturbances. CONUT provides an early screening of nutritional disturbance and effectively predicts short-term prognosis in acute HF patients.

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Purpose: Serum albumin (Alb) levels are an indispensable marker for evaluating clinical nutrition status. The improved BCP (Bromcresol purple) method can measure the Alb levels more accurately than the conventional BCG (Bromcresol green) method. Therefore, this study aimed at investigating the influence of the two methods on clinical nutrition indices (CNI).
Materials and methods: A total of 7,891 blood samples from inpatients and outpatients were analyzed for serum Alb levels using both the BCG method and the improved BCP method simultaneously between Feb. 10 2009 and Mar. 31 2009. Based on the Alb levels from each method, Onodera's PNI (Prognostic Nutritional index) and COUNT (Controlling Nutritional status) values were calculated as nutrition index, and GPS (Glasgow Prognostic Score) and Miki's classification as cachexia evaluation.
Results: For Onodera's PNI value, the number of patients classified as nutritional deficiency was 7% higher by the improved BCP method than by the BCG method (P<0.001). For COUNT value, patients with moderate or higher nutritional deficiency was 5% more by the improved BCP (P<0.001). For GPS, the number of class 2 patients, highly suggestive of being cachexia was 5% more by the improved BCP (P<0.001). Moreover, for Miki's classification, patients with cachexia were 8% more by the improved BCP method (P<0.001).
Conclusions: CNI from the improved BCP method was able to identify more patients with moderate or severe nutrition deficiency precisely than that from the conventional BCG method. In the near future, further clinical examinations will be required to determine the new cut-off value for evaluating clinical nutrition status according to the improved BCP method.

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Purpose: In the terminal cancer stage, the discrepancies between the clinically appropriate treatment plans and the wishes of patients and family members sometimes occur. The purpose of this study was to clarify the causes and countermeasures of these problems.
Subjects and Methods: We surveyed 29 patients who were admitted to our hospital over the past one year.
Results: Causes: a) Lack of understanding about the disease was observed in 19 patients, and b) expectations for the treatment in 10 patients. Countermeasures: Appropriate modifications regarding the treatment were made after having discussions in 14 patients for a), and support was provided after showing sympathy in 6 patients for b). Since we could not obtain the patients' and family members' understanding in 5 patients for a) and in 4 patients for b), we tentatively performed the treatments based on the wishes of patients and family members and evaluated regularly the influences of these treatments to the patients (timelimited trial). Outcomes: Due to increased overflow of fluid and insufficient improvement of the nutritional conditions, the treatment regimens were changed in all patients 2 to 7 days after the initiation of this trial. Patients' burden caused by this trial was reduced by the subsequent treatments.
Conclusion: In order to provide appropriate parenteral nutritional treatment for terminally ill cancer patients, good communication between medical professionals and patients and family members, and consideration for patients' burden when performing a time-limited trial are essential.

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