Effects of Body Weight Reduction on Serum Irisin and Metabolic Parameters in Obese Subjects

BACKGROUND: Irisin is a myokine implicated in lipid and glucose metabolism. The objective of this study is to examine the effect of a body weight reduction on the serum irisin level and physical indicators in obese Japanese patients without diabetes. METHODS: The subjects were 22 patients (male/female, 5/17; age, 46.1±16.0 years; body mass index [BMI], 36.9±5.0 kg/m²) who completed a 6-month body weight reduction program at our clinic. The program included diet, exercise therapy and cognitive behavioral therapy. Blood parameters, body composition, exercise tolerance, homeostasis model assessment of insulin resistance (HOMA-IR), and serum irisin were determined before and after intervention, and relationships among changes in these data were examined. RESULTS: There were significant decreases in body weight and BMI after the intervention. Irisin before the intervention was significantly positively correlated with HOMA-IR (r=0.434, P<0.05). The mean irisin level showed no significant change after the intervention in all participants. However, improvements in % body fat, subcutaneous fat area, triglycerides, and fasting glucose were significantly greater in patients with an increase in irisin compared to those with a decrease in irisin after the intervention. Patients with an increase in irisin also had significantly lower fasting insulin (9.7±4.8 vs. 16.4±8.2, P<0.05) and HOMA-IR (2.2±1.1 vs. 3.7±1.6, P<0.05) after the intervention, compared to patients with a decrease in irisin. CONCLUSION: Body weight reduction did not alter irisin levels. However, irisin may play important roles in fat and glucose metabolism and insulin resistance, and the effects of body weight reduction on irisin kinetics may be a key for obesity treatment.

Outcome evaluation of introducing the Japanese version of the Liverpool Care Pathway for patients with cancer in a general ward

This study sought to determine whether the Japanese version of the Liverpool Care Pathway （LCP-J） could improve nurses’ practice in dying-phase and difficulties with palliative care in a general ward. Between July 2014 and June 2015, LCP-J intervention and educational program for nurse were introduced in a general ward. The primary aims of this study were to clarify the changes in self-reported practice and difficulties of nurse before and after the interventions. Self-reported practice and difficulties were measured using Palliative Care Self-Reported Practice Scale （PCPS） and Palliative Care Difficulty Scale （PCDS）, respectively. The secondary aim was to clarify the defference in treatment, care and examination within last 48 hours between LCP-J patients and non-LCP-J patients. We obtained 21 responses in pre-intervention and 22 responses in post-intervention surveys from eligible nurses. Significant improvements were noted on domain of dying-phase care in PCPS and domain of alleviation of symptom in PCDS （3.00±1.16 versus 3.52±0.61 [p=0.042], 3.56±0.78 versus 3.10±0.63 [p=0.015], respectively）. LCP-J was used for 9 dying cancer patients （40%）, and no significant difference in treatment and examination within last 48 hours between LCP-J patients and non-LCP-J patients. LCP-J in general ward may improve nurses’ practice in dying-phase and difficulties with alleviation of symptom. In addition, considering the burden of LCP-J, to develop a useful checklist and educational interventions for dying patients is promising.

The current state of patient education for opioids by doctors, nurses and pharmacists, and evaluation of a pamphlet

The first step of cancer medical treatment is to eliminate anxiety about opioids. It is recommended to use printed matter in the "Guideline for Cancer Pain Management" edited by Japanese Society of Palliative Medicine,but few medical professionals actually use it. We developed the Opioids' pamphlet designed by Aichi Prefectural Society of Hospital Pharmacists; abbreviated OPA. This pamphlet is little burdened for readers; focusing on eliminating anxiety about opioids. Evaluation of the utility of the OPA and the actual conditions of patient education about the use of opioids by medical professionals were investigated, since there have been no reports on these issues. A questionnaire survey was conducted in hospitals with more than 150 beds in Aichi Prefecture. It targeted doctors, pharmacists and nurses who were practicing palliative care using opioids. There were many pharmacists and nurses who had been consulted about opioids, and most of the consultations were about addiction. 60% of pharmacists and 30% of nurses voluntarily performed patient education. Awareness of the guideline for of cancer pain management was low. OPA, which was reviewed based on the guideline, was applicable to 99% of the cases where the nurses were consulted. Its size and contents were highly acclaimed. Therefore, OPA is extremely valuable in clinical practice. Palliat Care Res 2009; 4(1): 214-227

Evaluation of the effect of analgesics for cancer patients using their pain descriptions

<b>Purpose</b>: The present study aims to evaluate the effect of analgesics in cancer patients based on their pain descriptions. <b>Methods</b>: The relationship between the words that patients used to describe their pain due to cancer and the efficacy of treatment with analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioids was evaluated. <b>Results</b>: We recorded 529words that were used by 164patients to describe their pain and pain quality and classified them into 108types of pain.For patients who used the actual word 'dull' or one with a similar meaning, treatment with opioids was effective. However, treatment with opioids was less effective in patients who used words such as "numb" and "tingling". <b>Conclusion</b>: We were able to gain a good understanding of cancer pain by listening to the actual words that patients used when complaining of pain. These findings suggested that we could choose a suitable medication through evaluation of the actual words cancer patients used to describe their pain and successfully relieve their pain. Palliat Care Res 2009: 4(1): 207-213

Association of serum NO( x ) level with clustering of metabolic syndrome components in middle-aged and elderly general populations in Japan

<p><b>OBJECTIVES</b>The aim of this study was to determine whether the serum nitrite plus nitrate (NO( x )) level correlates with biomarkers that are known components of the metabolic syndrome (MetS).</p><p><b>METHODS</b>Serum NO( x ) levels were measured using a commercial kit in 608 Japanese men and women between the ages of 39 and 85 years. Multivariate adjustments for age, smoking status, alcohol consumption and exercise were made in the analysis of covariance (ANCOVA). The components of the metabolic syndrome were defined based on the following criteria: body mass index (BMI) >/=25.0 kg/m(2), glycated hemoglobin (HbA1c) >/=5.6%, systolic blood pressure >/=130 mmHg or diastolic blood pressure >/=85 mmHg, high-density lipoprotein-cholesterol (HDL-C) </=1.03 mmol/l for men and </=1.29 mmol/l for women and triglyceride >/=1.69 mmol/l.</p><p><b>RESULTS</b>The logarithmically transformed age-adjusted serum NO( x ) (lnNO( x )) value was significantly higher in the low HDL-C group (1.76 +/- 0.05 mumol/l; p < 0.05) than MetS component groups (1.65 +/- 0.01 mumol/l) in men, but no difference was found in women. The means of serum lnNO( x ) after multivariate adjustment were 1.64, 1.65, 1.64, 1.66, and 1.81 mumol/l for 0, 1, 2, 3, and 4-5 MetS components for all subjects, respectively. The results of ANCOVA confirmed that the serum lnNO( x ) level was significantly correlated with the clustering of MetS components in both men and women (p < 0.0001 for trend).</p><p><b>CONCLUSION</b>Our results suggest that an increase in the clustering of MetS components was associated with the increase in serum NO levels in our general population.</p>

Quality of life improvement in patients diagnosed with hormone refractory prostate cancer with bone metastasis as a result of chemotherapy and the administration of zoledronic acid

Bone metastases occur in patients who have developed prostate cancer, and severely compromise the patient's quality of life. Here, we evaluated the quality of life in our inpatients diagnosed with prostate cancer with multiple bone metastases and bone pain. In our study, we evaluated pain using a pain diary, investigated the palliative effects of opioid dose, and assessed the quality of life using SF-36. The administration of chemotherapy and zoledronic acid (ZA) resulted in pain palliation, an anti tumor effect and improvements in the quality of life. We suggest that the administration of ZA might be an effective clinical strategy for multimodality advanced solid cancer therapy. We conclude that a 'combined' examination, in which a pain diary evaluating pain is considered in association with an SF-36 assessment evaluating quality of life is crucial to patient care. Palliat Care Res 2008 ; 3(2) : 308-315