Introduction: Among various predicting tools of survival developed for terminally ill cancer patients, Palliative Prognostic Score (PaP) is used very frequently. The target diseases of PaP are solid malignancies other than renal cancer; thus hematological malignancies are not included in them. Objective: To demonstrate that it is appropriate and useful to apply PaP to patients with terminally ill hematological malignancies. Methods: We used PaP to predict the survival of 18 patients with terminally ill hematological malignancies hospitalized in our hospice ward and compared the prediction accuracy with that of the previous studies. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 21-day survival probability were 91.7%, 83.3%, 91.7%, 83.3%, and 88.9%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 30-day survival probability were 72.7%, 85.7%, 88.9%, 66.7%, and 77.8%, respectively. Conclusion: Our results suggest that it may be possible to apply PaP to patients with terminally ill hematological malignancies.

OBJECTIVELead intake from possible exposure routes among children residing in the Tokyo Metropolitan Area was estimated.

METHODSLead concentrations in house dust samples collected from the houses of the children and those in 24-h duplicate diet samples of the children were determined. The daily lead intake was estimated by multiplying the lead concentrations in the house dust, diet, soil and ambient air (the latter two were from the literatures) by the corresponding intake and/or inhalation rates, and summing all of the products. Bioaccessibility tests were performed on the house dust, soil and diet samples to determine the lead uptake level.

RESULTSChildren residing in the Tokyo Metropolitan Area were estimated to be exposed to 21.5 μg of lead on a daily basis, with a maximum intake of up to 70.4 μg. The average weekly intake per kg body weight for a 5-year-old Japanese child was found to be 8.0 μg/kg bw/wk, which is below the Provisional Tolerable Weekly Intake (PTWI) of 25 μg/kg bw/wk. However, the maximum weekly intake was found to be 26 μg/kg bw/wk.

CONCLUSIONSHouse dust and soil ingestion can be the predominant routes of exposure to lead among children in Japan, and the source(s) of lead in such media must be specified to reduce the lead intake level of the children.

OBJECTIVESConcerns over dietary exposure to bisphenol A (BPA), an endocrine disruptor, have been raised because BPA is contained in resins and plastics commonly used for the preservation of food and beverages. The purpose of the present study was to assess daily intake levels of BPA in a group of male subjects by measuring total urinary BPA (free BPA plus BPA released by treatment with β-glucuronidase), as well as determining intra-individual variation in BPA excretion.

METHODSTwenty-four-hour urine was collected from 5 subjects for 5 consecutive days for the evaluation of between-day variation in urinary BPA excretion and from 36 male subjects for the estimation of the level of daily BPA intake. BPA in the urine samples was measured by GC/MS/MS following enzymatic hydrolysis of BPA glucuronate, solid phase extraction, and derivatization.

RESULTSA large between-day variation was found over 5 days for the daily excretion of urinary BPA in the 5 subjects. The daily excretion of urinary BPA was distributed log-normally in the 36 male subjects, with the median value being 1.2 μg/day (range: <0.21-14 μg/day), which was far below the Tolerable Daily Intake (0.01 mg/kg bw) recommended by a scientific committee in the European Commission in 2002. However, the maximum estimated intake per body weight (0.2 μg/kg/day) was only one order of magnitude lower than the reported lowest level for reproductive/behavioral effects in pregnant mice (2 μg/kg/day).

CONCLUSIONSMeasuring urinary BPA in urine is a suitable approach for estimating short-term BPA intake levels in individuals and/or estimating the average exposure level of populations. Urine analyses will be increasingly important in the human health risk assessment of BPA.

OBJECTIVESThe aim of this study is to assess preserved umbilical cords as chemical exposure media to investigatein utero chemical exposure. Furthermore, we aim to apply preserved umbilical cords to retrospective studies of the relationship betweenin utero chemical exposure and neurodevelopment disorders.

METHODSTwo sets of preserved umbilical cord samples were analyzed for exposure to polychlorinated biphenyls (PCBs): one composed of samples from 20 healthy Japanese subjects and the other set included samples from 17 autistic patients and 7 healthy sibling of theirs.

RESULTSThe possibility of external PCBs contamination during storage of preserved umbilical cord samples was found, and due to this problem, the study design should be limited to the comparison between PCBs concentration in preserved cord samples from autistic patients and that in those from their sibling. Total PCBs concentrations in preserved cords from autistic patients and their control siblings were compared and we found no statistically significant difference between them (Wilcoxon signed rank test, p>0.05).

CONCLUSIONSThe association between autism andin utero PCBs exposure was not clarified in this study; however, retrospective studies such as a case-control study of siblings using preserved umbilical cords can be a method of choice for examining the possible relationship betweenin utero chemical exposure and child hood disorders.

OBJECTIVESOur objectives were (1) to evaluate whether single spot urine is suitable media for longer-term phthalate esters exposure assessment, and (2) to estimate intake level of phthalate esters of Japanese pregnant women using urinary metabolites as an indicator of prenatal exposure level in their offspring.

METHODSWe analyzed nine metabolites (MMP, MEP, MnBP, MBzP, MEHP, MEOHP, MEHHP, MINP, MnOP) of seven phthalate esters in spot urine samples from 50 pregnant women by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Using four urine samples collected from each of 12 subjects from 50 pregnant women within 5-12 weeks, we compared intra- and interindividual variation in urinary metabolites by calculation of intraclass correlation coefficient (ICC). We estimated daily intakes of 50 pregnant women from their urinary metabolite concentrations.

RESULTSICCs for seven phthalate metabolite concentrations in single spot urine samples were: MMP (0.57), MEP (0.47), MnBP (0.69), MBzP (0.28), MEHP (0.51), MEHHP (0.43), and MEOHP (0.41) in 12 pregnant women. Phthalate ester metabolites had high detection rates in 50 subjects. The mean daily intake ranged from 0.01 to 2 mug/kg per day. The daily intake levels in all subjects were lower than corresponding tolerable daily intake (TDI) set by the European Food Safety Authority (EFSA), though maximum value for DnBP of 6.91 mug/kg per day accounted for 70% of TDI value.

CONCLUSIONSHigher ICCs indicated that phthalate metabolite levels in single spot urine could reflect longer-term exposure to the corresponding diesters of subjects. Although the current exposure level was less than TDIs, further studies and exposure monitoring are needed to reveal the toxicity of phthalate esters to sensitive subpopulation.

Objective: This study investigated prognostic factors of short survival in patients with malignant pleural mesothelioma (MPM) upon the time of their admission to the Palliative Care Unit (PCU). Method: We conducted a retrospective review of the medical records of 12 patients with MPM, who died at the PCU of our hospital from January 2016 to April 2018. According to the classification of survival period by previous predictor model, these patients were classified into three Groups, Group A: less than 13 days, Group B: between 14 and 55 days, and Group C: more than 56 days. Results: The number of patients was 5 in Group A, 5 in Group B, and 2 in Group C, respectively. Hemoptysis was seen in 40% of patients of Group A only and oxygen inhalation was necessary for all the patients of Group A. Dysphagia and bilateral pleural involvement were seen in 80% of Group A and in 60% of Group B. Pneumonia was seen in 60% of Group A and in 20% of Group B. The above four factors were not seen in Group C. Conclusion: This preliminary study suggests that hemoptysis, dysphagia, bilateral pleural involvement, pneumonia, and oxygen inhalation are possibly prognostic factors of short survival of patients with MPM upon their admission to PCU.