Early Palliative Care Improves Overall Survival in Patients With Lymphoma: A Single-institution Retrospective Study

BACKGROUND/AIM

Early palliative care (EPC) intervention in patients with solid tumors can provide many benefits. However, studies on patients with hematological malignancies are limited, and there is no data on patients with lymphoma. We conducted a preliminary retrospective survey of palliative care (PC) intervention in patients with lymphoma to clarify the effect of EPC on overall survival (OS).

PATIENTS AND METHODS

The first palliative care consultation (PC1) was retrospectively reviewed from medical records in Japan. Patients with lymphoma requiring inpatient PC at our institution from January 2012 to December 2018 were recruited. We conducted receiver operating characteristic (ROC) analysis; patients were divided into two groups (early and delayed), and the survival periods and palliative care team (PCT) referral details were compared.

RESULTS

The analysis included 77 patients with lymphoma [median age, 71 (64-79)] years. The median period to PC1 from the initial diagnosis was 395 (180-1,086) days. ROC analysis revealed an optimal PC intervention timing of 140 days. OS was significantly longer in the early group than that in the delayed group. The most common counseling details for the PCT were symptom relief and palliative care transfer (36.8% and 35.2%, respectively).

CONCLUSION

This real-world evaluation of PC intervention for inpatients with lymphoma revealed that PC intervention was provided at approximately 13 months following initial diagnosis. EPC intervention from diagnosis to 140 days may improve OS in patients with lymphoma; however further large-scale studies are required to verify this finding.

An improved method for clearing and staining free-hand sections and whole-mount samples

BACKGROUND AND AIMS

Free-hand sectioning of living plant tissues allows fast microscopic observation of internal structures. The aim of this study was to improve the quality of preparations from roots with suberized cell walls. A whole-mount procedure that enables visualization of exo- and endodermal cells along the root axis was also established.

METHODS

Free-hand sections were cleared with lactic acid saturated with chloral hydrate, and observed with or without post-staining in toluidine blue O or aniline blue. Both white light and UV light were used for observation. Lactic acid was also used as a solvent for berberine, and fluorol yellow for clearing and staining the samples used for suberin observation. This procedure was also applied to whole-mount roots with suberized celllayers.

KEY RESULTS

Clearing of sections results in good image quality to observe the tissue structure and cell walls compared with non-cleared sections. The use of lactic acid as a solvent for fluorol yellow proved superior to previously used solvents such as polyethylene glycol-glycerol. Clearing and fluorescence staining of thin roots such as those of Arabidopsis thaliana were successful for suberin visualization in endodermal cells within whole-mount roots. For thicker roots, such as those of maize, sorghum or tea, this procedure could be used for visualizing the exodermis in a longitudinal view. Clearing and staining of peeled maize root segments enabled observation of endodermal cell walls.

CONCLUSIONS

The clearing procedure using lactic acid improves the quality of images from free-hand sections and clearings. This method enhances the study of plant root anatomy, in particular the histological development and changes of cell walls, when used in combination with fluorescence microscopy.