80 research outputs found

    Ethical issues in autologous stem cell transplantation (ASCT) in advanced breast cancer: A systematic literature review

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    BACKGROUND: An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. METHODS: We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included articles, and were assessed and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. RESULTS: Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. CONCLUSIONS: The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature

    Effect of the Al Siting on the Structure of Co(II) and Cu(II) Cationic Sites in Ferrierite. A Periodic DFT Molecular Dynamics and FTIR Study

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    Periodic DFT molecular dynamics and FTIR spectroscopy were used to investigate the cationic sites of ferrierite exchanged with Co­(II) and Cu­(II) and their complexes with NO. Particular attention was paid to the effect of the Al siting in six-membered rings forming the cationic sites on the structure of these sites and the corresponding binding energies of Me­(II) (Me = Co and Cu). Our calculations show that both the cations upon binding to cationic sites induce a rearrangement of the local structure of the zeolite framework. The rearrangement is significant for the α and β-2 sites while it is minor for the β-1 site. Comparison of the observed and theoretical NO stretching frequencies of ferrierite Co­(II) and Cu­(II) complexes with a NO molecule permitted the assignment of IR bands to the individual types of cationic sites. For NO-Co-ferrierite, the IR bands found at 1956, 1941, and 1935 cm<sup>–1</sup> can be assigned to NO-Co complexes with Co­(II) located in the α, β-1, and β-2 sites, respectively. Similarly for NO-Cu-ferrierite, the frequencies of 1864, 1912, 1904, and 1892 cm<sup>–1</sup> belong to NO-Cu complexes having Cu­(II) accommodated in the α, β-1, β-2 (conformer 1), and β-2 (conformer 2) sites, respectively. The calculated adsorption energies are systematically higher for Co­(II) than for Cu­(II) for all the three sites and are in the order α > β-2 > β-1 for both the cations. Our computational results further reveal that upon binding Me­(II) both the local structure of the zeolite framework as well as the binding energies of Me­(II) strongly depend on the Al siting in the rings forming the cationic sites. The calculated relative binding energies of Me­(II) are in the order β-1 > β-2 > α for both the cations. The general tendency of Me­(II) accommodated in a cationic site to react is inversely proportional to the corresponding binding energies. We also showed that FTIR spectroscopy of complexes of NO and Me­(II)-exchanged ferrierite can serve to identify the Al siting in the six-membered rings forming cationic sites
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