[Health-related Quality of Life in Patients with Mild-to-moderate Alzheimer's Disease: A Study Using the Five-level Version of European Quality of Life-5 Dimensions (EQ-5D-5L)].

OBJECTIVE: To investigate the relation between health-related quality of life (QOL) rated by proxy and various characteristics of patients with mild-to-moderate Alzheimer's disease (AD) using European Quality of Life-5 Dimensions (EQ-5D). PATIENTS: We recruited 128 AD patients with a Clinical Dementia Rating (CDR) of 0.5 (very mild) to 2 (moderate) who were cognitively assessed using the Mini-Mental State examination, Alzheimer's Disease Assessment Scale, and Frontal Assessment Battery, and whose family caregivers underwent an interview with CDR, Neuropsychiatric Inventory (NPI) and the five-level version of the EQ-5D for the proxy rating. METHODS: We obtained Pearson's correlation coefficients between the EQ-5D utility score and each demographic, clinical, and cognitive measure. All measures with moderate or large effect sizes (0.3 or more of absolute value of the correlation coefficient) were included in a multiple correlation analysis. RESULTS: The CDR sum of boxes (CDR-SOB), NPI total score, and educational attainment showed moderate effect sizes in the single correlation analyses. The effect sizes of the cognitive measures were small. The multiple correlation analysis showed that the CDR-SOB and NPI total score independently contributed to the EQ-5D utility score. CONCLUSION: Two independent factors, that is, overall severities of functional impairment and behavioral and psychological symptoms of dementia seemed to contribute to QOL in AD patients. (Received August 20, 2018; Accepted September 12, 2018; Published January 1, 2019).

A nationwide survey of hepatitis E virus infection in the general population of Japan.

To investigate nationwide the prevalence of hepatitis E virus (HEV) infection in the general population of Japan, serum samples were collected from 22,027 individuals (9,686 males and 12,341 females; age, mean +/- standard deviation: 56.8 +/- 16.7 years; range: 20-108 years) who lived in 30 prefectures located in Hokkaido, mainland Honshu, Shikoku, and Kyushu of Japan and underwent health check-ups during 2002-2007, and were tested for the presence of IgG, IgM, and IgA classes of antibodies to HEV (anti-HEV) by in-house ELISA and HEV RNA by nested RT-PCR. Overall, 1,167 individuals (5.3%) were positive for anti-HEV IgG, including 753 males (7.8%) and 414 females (3.4%), the difference being statistically significant (P < 0.0001). The prevalence of anti-HEV IgG generally increased with age and was significantly higher among individuals aged >or=50 years than among those aged <50 years (6.6% vs. 2.7%, P < 0.0001). Although 13 individuals with anti-HEV IgG also had anti-HEV IgM and/or anti-HEV IgA, none of them had detectable HEV RNA. The presence of HEV RNA was further tested in 50 or 49-sample minipools of sera from the remaining 22,014 individuals, and three individuals without anti-HEV antibodies tested positive for HEV RNA. The HEV isolates obtained from the three viremic individuals segregated into genotype 3 and were closest to Japan-indigenous HEV strains. When stratified by geographic region, the prevalence of anti-HEV IgG as well as the prevalence of HEV RNA or anti-HEV IgM and/or anti-HEV IgA was significantly higher in northern Japan than in southern Japan (6.7% vs. 3.2%, P < 0.0001; 0.11% vs. 0.01%, P = 0.0056; respectively).

[A case of non-small cell lung carcinoma successfully treated with carboplatin and weekly paclitaxel under renal dysfunction].

A 73-year-old man was admitted to our hospital with productive cough and dyspnea. His chest X-ray and CT scan showed a mass lesion on the lower lung field, pleural effusion on the left side, metastatic lesion in the right lung, and multiple metastases in the liver. The diagnosis was non-small cell carcinoma of the lung. Unfortunately, he had suffered from chronic nephritis; his creatinine level was 2.1, and his creatinine clearance was 29 ml/min. He received 4 courses of combined chemotherapy of carboplatin (AUC 5, day 1) and weekly paclitaxel (60 mg/ m2, day 1, 8, 15) every 4 weeks. His subjective symptoms as side effects were mild except for accidental melena due to colon diverticulum. Almost all lesions identified at admission were regressed by the chemotherapy. Although renal dysfunction often prevents patients with lung cancer from receiving systemic chemotherapies, in this case the combined chemotherapy of carboplatin and weekly paclitaxel proved to be a relatively safe and effective therapy for those patients with renal dysfunction.

Possible contribution of circulating transforming growth factor-beta1 to immunity and prognosis in unresectable hepatocellular carcinoma.

Transforming growth factor-beta1 (TGF-beta1) has been implicated in tumor progression. The relationship of this cytokine as measured in plasma to anti-tumor immunity and prognosis was investigated. This study consisted of 70 consecutive patients with unresectable hepatocellular carcinoma (HCC) (median age, 65 years). Forty-four healthy age-matched subjects and 32 patients with cirrhosis but no carcinoma served as controls. Patients with HCC were divided into those with plasma TGF-beta1 concentrations above (group A, n=21) or below (group B, n=49) 10 ng/ml (the mean concentration+2SD in the concentrations of the controls with cirrhosis was 8.7 ng/ml). Age, gender, Child-Pugh grade, and tumor stage distributions were similar in groups A and B. Considering all tumor stages together and individually, group A had a significantly shorter survival (median for all stages, 2 months) than group B (median for all stages, 10 months; P<0.01, generalized Wilcoxon's test). Groups A and B had significantly shorter survival than controls with cirrhosis (P<0.001 for each). Lymphokine-activated killer (LAK) activity in group A was significantly lower than that in group B (P<0.001). Natural killer (NK) activity in group A was also significantly lower than that in group B (P<0.05). Plasma TGF-beta1 concentration was a significant predictor of survival by Cox's proportional-hazards regression analysis (multivariate analysis, P<0.01). LAK and NK activities were also weak but significant predictors (P<0.05 and <0.05, respectively). These data suggest that plasma TGF-beta1 concentration is a predictor of outcome of patients with unresectable HCC. Circulating TGF-beta1 supposedly contributes to the suppression of anti-tumor immunity in the advanced disease.