Purpose: To elucidate the clinical features and treatment outcomes of patients with Burkitt lymphoma/leukemia (BL/L) who initially presented with extensive peripheral blood (PB) and/or bone marrow (BM) involvement. Patients and methods: We retrospectively reviewed the clinical records of patients with aggressive B-cell lymphoma between 2006 and 2017 for whom cytomorphological, immunophenotypic, and cytogenetic data were available. Results: Eleven patients matched the criteria of BL/L. Ages ranged between 16 and 78 years (median, 61 years). Seven patients presented with “B” symptoms and 3 with neurological signs or symptoms. White cell counts ranged between 4.0 and 73.0 × 10³/µL (median, 18.26 × 10³/µL), including 2.5 to 81.2% (median, 15.0%) leukemia cells. All patients showed high lactate dehydrogenase levels (median, 4,103 U/L). BM was infiltrated with 40.1 to 99.6% leukemia cells, showing the French-American-British L3 morphology. Leukemia cells were CD10⁺, CD19⁺, CD20⁺ except for one patient, CD22⁺, CD38⁺, and HLA-DR⁺, and expressed monoclonal surface immunoglobulins in 9 patients. MYC stained positive in leukemia cell nuclei in 6 out of 7 patients, BCL2 was negative, and Ki-67 positivity was higher than 90%. G-banding and/or fluorescence in situ hybridization revealed t(8;14)(q24;q32) in 10 patients and t(2;8)(p12;q32) in 1, and 2 showed unusual hybridization signal patterns. Ten patients were initially treated with dose-intensive chemotherapy in combination with or without rituximab and survival was better in 5 who completed the initial treatment schedule than in those who did not. Conclusion: The hematological assessment of PB/BM materials in combination with immunophenotypic and cytogenetic information and laboratory data led to the diagnosis of BL/L. Patients with BL/L may show a favorable response to dose-intensive chemotherapy; however, the development of optimal treatments for elderly patients that maintain high response rates and minimize toxicity remains challenging.

Purpose: To evaluate the effects of dietary intervention by registered dietitians (RDs) for patients admitted to the palliative care unit (PCU). Methods: We retrospectively reviewed the clinical records of patients who were admitted to the PCU between October 1, 2019 and March 31, 2020. For patients who were able to eat and express their will, RDs participated in the staff meeting at admission and visited the patients’ bedside to arrange their daily diet. Results: A total of 49 patients were examined. All patients were transferred to the PCU from acute care wards in our hospital and the median duration of PCU stay was 11 days (range, 1–48 days). Of the 49 patients, no RD visit was recorded for 23 whose median duration of PCU stay was 8 days (range, 11–32 days). Their dietary energy intake at admission ranged between 0 to 725 kilocalories per day (kcal/day), with a median value of 0 kcal/day. No patient had an increase in energy by 100 kcal/day or more during the PCU stay. On the other hand, the remaining 26 patients were visited by RDs on the day of admission (23 patients [88.4%]) or 4–11 days after admission (3 patients). The median duration of PCU stay was 16 days (range, 2–48 days) and the median dietary energy intake at admission was 365 kcal/day (range, 0–1,305 kcal). In total, they received dietary intervention by RDs 57 times: once for 14 (53.8%) patients, twice for 2, and 3 times or more for 10. Of note, 6 (20.7%) of the 26 patients had an increase in dietary energy intake by 100 kcal/day or more during the PCU stay and this effect was significant compared with the non-intervention group (Fisher’s exact test, P = 0.024). Conclusion: More than half of the PCU patients whose nutritional states were generally impaired received dietary intervention by RDs and a significant fraction had an increase in dietary energy intake during their PCU stay. Currently, dietary intervention by RDs in PCUs is not remunerated; however, we recommend that these activities be acknowledged and formally covered by the medical service fee system.

Febrile urinary tract infections require prompt diagnosis and treatment due to their rapidly progressive nature. Although Gram staining of the urine specimens is generally preferred for the initial assessment of causative organisms, this procedure is not often carried out in routine clinical practice because of restrictions in time, manpower, and materials. Our study focused on microscopic examination of unstained urinary sediments as an alternative and simple method to identify the morphology of bacteria in the urine compared with Gram staining. We evaluated 103 cases in which urine culture was carried out, and calculated the sensitivity and specificity of morphological assessment of bacteria in the urine by the urinary sediment microscopy test in comparison with the species of isolated bacteria (≥ 1 × 10⁵ CFU/mL) from urine culture as the standard. The sensitivity and specificity of the test were 54.5% (95% confidential interval [CI], 23.4–83.3%) and 95.7% (95% CI, 89.2–98.8%), respectively, for cocci, and 93.8% (95% CI, 79.2–99.2%) and 88.7% (95% CI, 79.0–95.0%), respectively, for bacilli. In 3 of 4 discordant cases between the urinary sediment microscopy test and the result of urine culture, cocci were misinterpreted as bacilli. This study was the first to evaluate the performance of the urinary sediment microscopy test. Our study suggests that this test is convenient and useful in the outpatient setting where time and manpower are limited.

Many of the structural variants of hemoglobin (Hb) are caused by a single amino acid substitution resulting from point mutations within the coding sequences of globin genes. Although the majority of Hb variants do not cause disease, the presence of variant Hb can affect the values of Hb A1c measured by high-performance liquid chromatography (HPLC), as variant Hb is variably charged, thus hindering chromatographic separation. In May 2015, we introduced a fully automated Hb A1c analyzer based on HPLC, HA-8180V (Arkray), mounting not only the standard Fast Mode, but also the Variant Mode software, enabling the detection of Hb S and Hb C, and flag-marking Hb D and Hb E. As the HPLC chromatograms of four patients suggested the presence of variant Hb, we performed nucleotide sequencing of the globin genes, confirming the corresponding missense mutations. These included Hb Q-Iran (α2 75[EF4] Asp>His HBA2:c.226G>C) in two patients, Hb St. Luke’s (α1 95[G2] Pro>Arg HBA1:c.287C>G) in one patient, and Hb Toranomon (β112[G14] Cys>Trp HBB:c.339T>G) in one patient. In four Southeast Asian patients, their chromatograms matched the pattern of Hb E, which is frequent on the Indian subcontinent and in Southeast Asia. Regarding the Hb A1c values, the Variant Mode was considered to yield true values in the Hb Q-Iran and Hb St. Luke’s cases, whereas both modes presented false low values in the Hb Toranomon case. For Hb E, the HA-8180V is designed to automatically output corrected Hb A1c values. When laboratory technologists observe a chromatogram pattern suggesting the presence of variant Hb, the physicians need to be provided with information regarding the effects of variant Hb on the values of Hb A1c, and offered other monitoring markers of diabetes to make an accurate diagnosis and enable appropriate treatment.

Maintenance of a satisfactory nutritional state is an important factor for cancer treatment, as management of nutrition in cancer patients supports chemotherapy, radiation therapy, and surgery, comprising the major modalities of cancer treatment. On the other hand, adverse events resulting from each treatment can negatively affect the patients by reducing their quality of life and potentially preventing cancer treatment. Thus, to perform cancer treatment effectively and safely, registered dietitians closely monitor the nutritional state of each patient and carefully arrange their daily oral diet, thereby preventing a decline in oral intake as much as possible. Among patients with hematological diseases, those who undergo hematopoietic stem cell transplantation (HSCT) become immunosuppressive and develop severe complications during the long-term inpatient treatment. Between November and December in 2016, among patients in the hematology ward whose disease conditions were stable, we interviewed a total of 22 with a history of difficulty in oral ingestion. Adverse events affecting oral ingestion frequently noted during inpatient treatment included anorexia, nausea, and mucositis, but the patients exhibited a wide range of symptoms. They often ate fruit and noodles that were brought by family members. We thus constructed an “interchangeable diet” table to inform that fruit and noodles, instead of rice, can be provided in the hospital diet. Furthermore, we developed a “recovery diet” program for patients who are unable to maintain an oral diet. Currently, we meet HSCT patients at their bedside to provide instruction for nutrition and diet on the day of admission to the hospital (usually to the clean room) and on the day of discharge. During inpatient treatment, we visit the patient once a week to arrange their oral diet according to their condition. In the future, we aim to not only promote instruction in the hematology ward, but also to provide all HSCT patients with instruction for nutrition and diet in the outpatient setting to resolve difficulties and distress, which they may experience after discharge, in order for them to not have to deal with problems alone.

In this study, we constructed and evaluated a training program for methotrexate (MTX) therapy to improve medication adherence by patients with rheumatoid arthritis (RA) who started therapy in the outpatient setting. Patients received instruction from pharmacists up to 3 times regarding the dosage of MTX, precautions when taking MTX, and when MTX is to be withheld. The instruction was provided using a pamphlet, focusing on areas the patient did not sufficiently understand. To obtain feedback on the training program, the patient’s level of understanding was assessed using a ‘comprehension test’ prepared by the multidisciplinary RA team at our hospital. The test was administered 3 times: before and after the initial instruction, and at the second visit to the hospital. To evaluate the educational effectiveness of this program, the percentage of correct answers on the 3 comprehension tests was compared for 57 RA patients who started MTX therapy between April 2017 and September 2018. The median percentage of correct answers increased significantly from 48.1% to 87.8% after the initial instruction (P < 0.001). Moreover, the percentage of correct answers at the second visit was 84.3%, a high percentage comparable with that after the initial instruction. This study revealed that the training program using the comprehension test promoted the patients’ understanding of MTX therapy. It is therefore expected to improve the medication adherence by RA patients receiving MTX.

Cancer treatments have markedly progressed and the prognosis of patients with cancers has improved. As long-term survival is often expected, when cancer treatment is completed as scheduled, supportive care is increasingly required for cancer patients to receive treatment without interruption. Supportive measures include not only those to relieve gastrointestinal symptoms, bone marrow suppression, and pain, but also those to detect and treat previously unexpected complications caused by newly developed molecular targeting agents and immune checkpoint inhibitors. To meet the requirement for the regional core hospital for cancers designated by the Ministry of Health, Labour, and Welfare, we established an onco-cardiology unit to facilitate supportive care in cancer treatment. Cardiotoxicity of anthracyclines is a well-known cardiovascular complication associated with chemotherapy. However, as the number of new drugs, which may cause cardiotoxicity, thrombosis, and hypertension, has rapidly increased in recent years, early detection and treatment of these cardiovascular complications are required. On the other hand, cancer survivors have a long-term risk of developing cardiovascular disease. In the setting of the progress in cancer treatment, the onco-cardiology unit was established nationwide in order to address cardiovascular complications that develop during and after cancer treatment. To clarify the details of cancer treatment and the state of cancer, we need to share information among all oncology departments. The author outlines the onco-cardiology unit at our hospital, and cancer therapeutic-related cardiac dysfunction (CTRCD) and cancer-associated venous thromboembolism (cancer VTE), which are currently attracting attention in the field of onco-cardiology.