Beliefs held by breast surgeons that impact the treatment decision process for advanced breast cancer patients : a qualitative study

Introduction: Although guidelines do not recommend chemotherapy for patients with advanced cancer when death is imminent, many reports suggest the tendency to continue this treatment has been increasing every year. This study aimed to construct a model to clarify the beliefs and communication of doctors who administer chemotherapy to patients with recurrent or metastatic (hereafter, “recurrent/metastatic”) breast cancer, and determine how these beliefs are related to the process of treating patients. Materials and methods: Semi-structured interviews were conducted with 21 breast surgeons, and interview contents were analyzed using the grounded theory approach in order to conceptualize the treatment process. Results: The process of chemotherapy for patients with recurrent/metastatic breast cancer differed based on two beliefs held by doctors. One was a “belief that the patient is an entity who cannot accept death,” and throughout the treatment process, these doctors consistently avoided sharing bad news that might hurt patients, and always discussed aggressive chemotherapy. They proposed treatments as long as options remained, and when they ultimately judged that the physical condition of patients could not withstand further treatment, treatment was terminated despite the patient hoping for continuation. The other was a “belief that the patient is an entity who can accept death.” From early on after recurrence/metastasis, these doctors repeatedly gave patients information including bad news about prognosis, and when they judged that further treatment would hinder a patient’s ability to have a good death, they proposed terminating treatment. Conclusion: We demonstrated that breast surgeons treating recurrent/metastatic breast cancer patients have two beliefs and constructed a model of the treatment process based on those beliefs. This offered breast surgeons, who make decisions regarding treatment without clearly-defined guidelines, a chance to reflect on their own care style, which we believe will contribute to optimal patient care

Superheavy element nuclear chemistry at RIKEN

金沢大学理工研究域物質化学系A gas-jet transport system has been coupled to the RIKEN gas-filled recoil ion separator GARIS to startup superheavy element (SHE) chemistry at RIKEN. The performance of the system was appraised using an isotope of element 104, 261Rf, produced in the 248Cm(18O,5n) 261Rf reaction. Alpha-particles of 261Rf separated with GARIS and extracted to a chemistry laboratory were successfully identified with a rotating wheel apparatus for α spectrometry. The setting parameters such as the magnetic field of the separator and the gas-jet conditions were optimized. The present results suggest that the GARIS/gas-jet system is a promising approach for exploring new frontiers in SHE chemistry: (i) the background radioactivities of unwanted reaction products are strongly suppressed, (ii) the intense beam is absent in the gas-jet chamber and hence high gas-jet efficiency is achieved, and (iii) the beam-free condition also allows for investigations of new chemical systems. © 2010 American Institute of Physics

Genetic polymorphysms of circadian and its related genes in psychiatric disorders.

科学研究費補助金研究成果報告書研究種目: 基盤研究(C)研究期間: 1998～2000課題番号: 10670896研究代表者: 山田 尚登（滋賀医科大学・医学部・助教授）研究分担者: 柏 淳（滋賀医科大学・医学部・助手）研究分担者: 尾関 祐二（滋賀医科大学・医学部・助手）研究分担者: 野口, 俊文（滋賀医科大学・医学部・非常勤講師

Success of Crizotinib Combined with Whole-Brain Radiotherapy for Brain Metastases in a Patient with Anaplastic Lymphoma Kinase Rearrangement-Positive Non-Small-Cell Lung Cancer

Although crizotinib shows marked antitumor activity in anaplastic lymphoma kinase (ALK) rearrangement-positive non-small-cell lung cancer (NSCLC) patients, all treated patients ultimately develop resistance to this drug. Isolated central nervous system failure without progression at extracranial sites is a common progression pattern in ALK rearrangement-positive NSCLC patients treated with crizotinib. Here, we report the success of crizotinib combined with whole-brain radiotherapy in an ALK rearrangement-positive NSCLC patient who developed leptomeningeal carcinomatosis and progression of multiple brain metastases. Additionally, we focused on the mechanism involved by examining the plasma and cerebrospinal fluid concentrations of crizotinib in the present case

Phamacogenomics of Clozapine-Induced Agranulocytosis

Background: Clozapine-induced agranulocytosis (CIA)/clozapine-induced granulocytopenia (CIG) (CIAG) is a life-threatening event for schizophrenic subjects treated with clozapine. Methods: To examine the genetic factor for CIAG, a genome-wide pharmacogenomic analysis was conducted using 50 subjects with CIAG and 2905 control subjects. Results: We identified a significant association in the human leukocyte antigen (HLA) region (rs1800625, p = 3.46 × 10−9, odds ratio [OR] = 3.8); therefore, subsequent HLA typing was performed. We detected a significant association of HLA-B*59:01 with CIAG (p = 3.81 × 10−8, OR = 10.7) and confirmed this association by comparing with an independent clozapine-tolerant control group (n = 380, p = 2.97 × 10−5, OR = 6.3). As we observed that the OR of CIA (OR: 9.3~15.8) was approximately double that in CIG (OR: 4.4~7.4), we hypothesized that the CIG subjects were a mixed population of those who potentially would develop CIA and those who would not develop CIA (non-CIA). This hypothesis allowed the proportion of the CIG who were non-CIA to be calculated, enabling us to estimate the positive predictive value of the nonrisk allele on non-CIA in CIG subjects. Assuming this model, we estimated that 1) ~50% of CIG subjects would be non-CIA; and 2) ~60% of the CIG subjects without the risk allele would be non-CIA and therefore not expected to develop CIA. Conclusions: Our results suggest that HLA-B*59:01 is a risk factor for CIAG in the Japanese population. Furthermore, if our model is true, the results suggest that rechallenging certain CIG subjects with clozapine may not be always contraindicated

Predicting the amount of carbon in carbon nanotubes grown by CH4 rf plasmas

Carbon nanotubes (CNTs) were grown on Si substrates by rf CH4 plasma-enhanced chemical vapor deposition in a pressure range of 1–10 Torr, and then characterized by scanning electron microscopy. At 1 Torr, the CNTs continued growing up to 60 min, while their height at 4 Torr had leveled off at 20 min. CNTs hardly grew at 10 Torr and amorphous carbon was deposited instead. CH4 plasma was simulated using a one-dimensional fluid model to evaluate the production and transport of radicals, ions, and nonradical neutrals. The amount of simulated carbon supplied to the electrode surface via the flux of radicals and ions such as CH3, C2H5, and C2H was consistent with estimations from experimental results

Fully protonated B-type hexamolybdoplatinate [H6PtMo6O24]2− and its adduct formation with [Pt(OH)6]2−

The crystral structure of tris(tetra-n-butylammonium) hydrogen hexahydroxidoplatinate(IV) [hexahydrogen α-hexamolybdoplatinate(IV)] pentadecahydrate, (C16H36N)3H[Pt(OH)6][H6PtMo6O24]·15H2O, was determined. The structural analysis revealed that all six triply-bridging O atoms of the hexamolybdoplatinate(IV) anion are protonated, making it formally the B-type Anderson anion [H6PtMo6O24]2−. The [H6PtMo6O24]2− anions connect with the [Pt(OH)6]2− anions through strong hydrogen bonds (O...O = 2.45–2.62 Å) to form a linear polymer in the crystal