Introduction: The importance of estimating the prognosis of advanced cancer patients is well known, but clinicians do not estimate survival time accurately. Since there is a need for an objective index to estimate survival time, the utility of the Prognostic Nutritional Index (PNI), which depends only on objective factors, was evaluated. Methods: The PNI was calculated using the following formula, PNI=10×serum albumin value (g/dL)+0.005×lymphocyte count in peripheral blood, at 3 months, 2 months, 1 month, 3 weeks, 2 weeks, 1 week, and within 3 days before death in 278 cancer patients (166 men, 112 women; age range, 33-99 years; mean age, 69.8 years) who died in a hospital surgical unit. Results: Sites of primary diseases included lung, breast, esophagus, stomach, colorectum, liver, biliary tract, and pancreas. The PNI values showed a gradual decrease over time. Changes in the PNI values were lower in non-gastrointestinal cancer patients than in gastrointestinal cancer patients. The mean PNI value was significantly higher in patients who lived >3 weeks (38.8) than in those who died within 3 weeks (32.4). When the PNI cut-off point was set at 35, and it was assumed that the life expectancy was within 3 weeks in cases with PNI <35, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 74.8%, 62.2%, 68.1%, and 69.6%, respectively. Discussion: The PNI appears to be a useful and simple parameter to predict clinical outcomes of patients with terminal stage cancer. Particularly, the PNI is considered feasible for gastrointestinal cancer patients.

OBJECTIVEClarify the relation between the complaints of wheelchair users and the vibration characteristics of the wheelchair, to improve wheelchair comfort and design.

METHODSThe question naires were distributed to 33 wheelchair users directly by the experimenter in order to identify the causes of complaints from wheelchair vibrations that they experienced. The vibration transmissibility of wheelchairs of ten subjects was measured to clarify the causes of complaints of wheelchair vibration according to the ISO 10326-1 standard in the laboratory using a broadband random vibration spectrum with a frequency-weighted vibration magnitude of 0.1 ms(-2) r.m.s. over the frequency range from 0.2 to 100 Hz. Each vibration exposure lasted 60 seconds.

RESULTSThe following findings were clear from the questionnaire results; (i) the vibration rom the wheelchair affected psychological comfort; (ii) the effects of different riding surfaces were important engineering issues affecting wheelchair ride comfort; (iii) the wheelchair users felt the vibration during wheelchair usage at locations on the neck, lower back and buttocks; (iv) vertical vibration was the most noticeable vibration from the wheelchair to each participant's body. The following findings were clear from the results of the transmissibility measurement of the wheelchair; (i) the resonance frequency-ranges of the transmissibility of the wheelchair showed significant differences between the subjects; (ii) intra-subject variability from three repeated transmissibility measurements was small; (iii) the first resonant frequency occurred approximately 5 to 7 Hz and the second resonant frequency occurred at around 8 Hz and the third resonant frequency occurred approximately 13 to 15 Hz; (iv) the magnitude of the peak transmissibility varied from 1.3 to 2.6.

CONCLUSIONFrom the comparison of the results of questionnaires and the transmissibility measurement of the wheelchair, the resonance frequency-ranges of the maximum vibration transmissibility of the manual wheelchairs were consistent with the frequency-ranges of the body parts of the causes of the complaints of wheelchair users. In addition, from these experimental results, it was suggested that the main point for improving a wheelchair user's comfort was to reduce the wheelchair seat vibration transmissibility at around 8 Hz and also to design wheelchair stiffness and damping characteristics to minimize vibration transmission at specific frequencies at body locations that caused the discomfort reported by wheelchair users.