Health-related quality of life evaluated by tumor node metastasis staging system in patients with hepatocellular carcinoma

AIM: To investigate and evaluate the change in healthrelated quality of life (HRQoL) by tumor node metastasis (TNM) staging system in patients with hepatocellular carcinoma (HCC). METHODS: A total of 140 patients diagnosed with HCC between June 2008 and April 2009 in our department were enrolled to this study. One hundred and thirty-five (96.5%) patients had liver cirrhosis secondary to hepatitis B virus (HBV) infection, 73 (54.07%) of them being HBV DNA positive; the other etiologies of liver cirrhosis were alcoholic liver disease (1.4%), hepatitis C (1.4%) or cryptogenic (0.7%). All subjects were fully aware of their diagnosis and provided informed consent. HRQoL was assessed before treatment using the functional assessment of cancer therapy-hepatobiliary (FACT-Hep) questionnaire. Descriptive statistics were used to evaluate demographics and disease-specific characteristics of the patients. One-way analysis of variance and independent samples t tests were used to compare the overall FACT-Hep scores and clinically distinct TNM stages. Scores for all FACT-Hep items were analyzed by frequency analyses. The mean scores obtained from the FACT-Hep in different Child-Pugh classes were also evaluated. RESULTS: The mean FACT-Hep scores were reduced significantly from TNM StageⅠto Stage Ⅱ, Stage ⅢA, Stage ⅢB group (687 ± 39.69 vs 547 ± 42.57 vs 387 ± 51.24 vs 177 ± 71.44, P = 0.001). Regarding the physical and emotional well-being subscales, scores decreased gradually from Stage Ⅰ to Stage ⅢB (P = 0.002 vs Stage Ⅰ; P = 0.032 vs Stage Ⅱ; P = 0.033 vs Stage ⅢA). Mean FACT-Hep scores varied by Child-Pugh class, especially in the subscales of physical well-being, functional well-being and the hepatobiliary cancer (P = 0.001 vs Stage I; P = 0.036 vs Stage Ⅱ; P = 0.032 vs Stage ⅢA). For the social and family well-being subscale, only Stage ⅢB scores were significantly lower as compared with Stage Ⅰ scores (P = 0.035). For the subscales of functional well-being and hepatobiliary cancer, there were significant differences for Stages ⅡΙ, ⅢA and ⅢB (P = 0.002vs StageⅠ). CONCLUSION: HRQoL of patients with HCC worsens gradually with progression of TNM stages. The most impaired subscales of HRQoL, as measured by FACT-Hep, were physical and emotional well-being.

The Income Security System in Japanese Traditional Performing Arts： A Strategy for Utilizing the Nation＇s Traditional Arts Resources

The objective of this paper is to examine an effective strategy for maintaining and utilizing the traditional arts resources of Japan. The authors explore two pillars of the strategy. One is to improve the quality of Japanese traditional performing arts by securing incomes for artists. The other is to utilize the traditional arts as a medium to expand Japanese cultural influence in foreign countries and to improve Japan＇s branding as a nation. First, the authors focus on the income security system practiced in traditional Japanese music and describe the discrepancy between short- and long-run optimality. The authors prove that the reputation of this art form affects its popularity and that it is optimal for the Iemoto （the head of the music school） to restrict the number of pupils in onstage performances in order to maintain stage quality. Second, the authors provide evidence that effective methods for a country to expand its cultural influence across the world differ among nations. The authors conduct willingness-to-pay （WTP） experiments and find that while German audiences largely prefer traditional Japanese music, those in the USA are slightly partial to its mixed fusion form. Therefore, the effective ways to expand Japanese cultural influence in foreign countries differ from one country to another.