Role of patient-reported symptoms and functioning in the care of patients with metastatic colorectal cancer

Introduction: Regular assessment of patients’ health related quality of life (HRQoL) with feedback to clinicians can play an important role in patient-doctor communication, problem detection and monitoring. Many cancer specific HRQoL instruments are available but their clinical utility in routine practice has not been systematically evaluated. The aim was to develop a HRQoL questionnaire for patients with advanced colorectal cancer (CRC) for use in routine practice and to explore ways to increase its’ clinical utility. Methods and results: A comprehensive development strategy was used to create CRC specific questionnaire for clinical practice. The strategy involved exploration of issues discussed in consultations of 17 CRC patients (68 consultations), review of literature, interviews with 7 oncologists and 10 patients, validation of the questionnaire in a sample of 155 CRC patients and validation in 448 patients as part of a wider study. A 55 item questionnaire, QuEST-Cr was created. Exploratory work was performed to examine the longitudinal impact of patient reported HRQoL collection with feedback using data from 198 patients’ oncology consultations over 4 consecutive visits. Impact of intervention on consultation content and communication preferences of patients and doctors were examined. Findings highlight lack of discussions about psychosocial issues even when patients reported poor functioning. Repeated assessment helped to maintain discussions of patients’ symptoms over time but not psychosocial issues. Training oncologists was considered a way of increasing the impact of patient reported HRQoL intervention. Review of literature identified barriers that needed to overcome. Conceptual models of adult learning guided the choice of teaching methods. Development of trigger DVDs provided valuable experiential learning opportunity. Conclusion: I developed and evaluated an instrument for screening and identifying the needs of CRC patients in routine clinical practice. I developed a training programme for oncologists which may help increase the clinical utility of patient reported HRQoL data

Role of patient-reported symptoms and functioning in the care of patients with metastatic colorectal cancer

Introduction: Regular assessment of patients’ health related quality of life (HRQoL) with feedback to clinicians can play an important role in patient-doctor communication, problem detection and monitoring. Many cancer specific HRQoL instruments are available but their clinical utility in routine practice has not been systematically evaluated. The aim was to develop a HRQoL questionnaire for patients with advanced colorectal cancer (CRC) for use in routine practice and to explore ways to increase its’ clinical utility. Methods and results: A comprehensive development strategy was used to create CRC specific questionnaire for clinical practice. The strategy involved exploration of issues discussed in consultations of 17 CRC patients (68 consultations), review of literature, interviews with 7 oncologists and 10 patients, validation of the questionnaire in a sample of 155 CRC patients and validation in 448 patients as part of a wider study. A 55 item questionnaire, QuEST-Cr was created. Exploratory work was performed to examine the longitudinal impact of patient reported HRQoL collection with feedback using data from 198 patients’ oncology consultations over 4 consecutive visits. Impact of intervention on consultation content and communication preferences of patients and doctors were examined. Findings highlight lack of discussions about psychosocial issues even when patients reported poor functioning. Repeated assessment helped to maintain discussions of patients’ symptoms over time but not psychosocial issues. Training oncologists was considered a way of increasing the impact of patient reported HRQoL intervention. Review of literature identified barriers that needed to overcome. Conceptual models of adult learning guided the choice of teaching methods. Development of trigger DVDs provided valuable experiential learning opportunity. Conclusion: I developed and evaluated an instrument for screening and identifying the needs of CRC patients in routine clinical practice. I developed a training programme for oncologists which may help increase the clinical utility of patient reported HRQoL data

Improvement of Cycling Capability of Li2S-FeS Composite Positive Electrode Materials by Surface Coating With Titanium Oxide

High-energy-density batteries are actively sought after for next-generation electric vehicle (EV) applications, triggering the search for sulfur-based positive electrode materials with high capacity for extended driving range. One of the primary issues of sulfur cathodes is the rapid capacity decay caused by the dissolution of sulfur in the electrolyte and the resulting parasitic reactions. This can be prevented by incorporating a suitable amount of carbon material into the sulfur electrodes, because of its inherent properties; however, introducing a large amount of low-density carbon materials will lead to a decrease in the energy density of the battery. Therefore, an alternative method to suppress sulfur dissolution is required for commercial applications. Recently, we developed a Fe-containing Li2S-based material (Li8FeS5) as the sulfur cathode; it has a relatively high initial discharge capacity (>700 mAh·g−1) and electric conductivity. However, rapid capacity degradation was observed during the initial several cycles, due to some unknown reactions between the electrolyte and Li8FeS5. In this study we demonstrate an effective method to improve the cycle performance of Li8FeS5 by coating its surface with a stabilizing material. We selected titanium oxide as the coating material, based on its high stability toward liquid electrolytes and its strong interaction with sulfur. Hence, we obtained TiOx-coated Li8FeS5 particles (Li8FeS5-TiOx) by a liquid-phase reaction. The transmission electron microscopy observation revealed that the Li8FeS5 particles were coated with several tens of nanometers of TiOx layers. The Li8FeS5-TiOx cells exhibited improved cycling performance with a carbonate electrolyte. We also observed that the capacity originating from an iron redox was not affected by coating during the cycling test; in contrast, the degradation of the cell capacity corresponding to the sulfur redox was suppressed significantly after coating with the TiOx layer. Thus, the surface reaction of Li8FeS5 with the electrolyte, which could be the main reason for the cycling degradation, was effectively suppressed by coating with the TiOx layer

マウス胸腺の脂肪細胞分化過程の速度論による解析

The differential process of adipocytes was investigated in the thymus and spleen of BALB/c mice by the real time PCR method. The transcriptions of PPARγ (PP) ,adiponectin (Ad) and resistin (Re) were considered as indications of differential stages of adipocytes and the transcription ratios, log Ad/PP and log Re/PP , were measured. These logarithmic ratios increased rapidly, at the border between fetal stage and neonatal, from negative value to positive in the thymus and to nearly 0 in the spleen. Subsequently, they were remained virtually constant throughout the experimental period. Kinetics was applied to the differential model of adipocytes in which the quantity of each transcription was assumed to be proportional to the cell number, and the changes of log Ad/PP and log Re/PP with age were interpreted successfullyBALB/cマウスの胸腺および脾臓での脂肪細胞の分化過程を,PPARγ(PP)に対するアディポネクチン(Ad),およびレジスチン(Re)の転写量を指標として,リアルタイムPCR法により検討した。加齢に伴い成熟脂肪細胞が増加してくる胸腺においては,アディポネクチンおよびレジスチンの転写量は,胎生期にはPPARγ の転写量より少なかったが,出生を境に急激に増大し,PPARγ の転写量の数十倍となり,その後ほぼ一定となった。成熟した脂肪細胞が認められない脾臓では,アディポネクチンおよびレジスチンの転写量は,出生を境に増大し,PPARyの転写量とほぼ等しくなった。各遺伝子の転写量は細胞数に比例すると仮定し,脂肪細胞系列の幹細胞を考えることにより,これらの結果を,速度論により説明することができた

Introduction of Air-Segmentation Approach to Flow Titration by Feedback-based and Subsequent Fixed Triangular Wave-controlled Flow Ratiometry

An air-segmentation approach has been introduced to a feedback-based and subsequent fixed triangular wave-controlled flow ratiometry to suppress axial dispersion in flow titration. The flow rate of a base solution containing an indicator is linearly varied with a control signal, Vc, supplied by a computer. The solution is merged with an acid solution under a constant total flow rate. Air is introduced to the merged solution in order to segment the solution with air bubbles. Both phases are led to a UV/Vis detector without phase separation. Air signals are removed by signal processing. The effect of the lag time between the merging of solutions upstream and the sensing of the corresponding signal downstream is offset by feedback-based upward and downward Vc scans, and thus the Vc that gives the equivalence composition is determined. Subsequently, fixed triangular wave control is applied to a narrower Vc range with a higher scan rate to enhance the throughput rate (maximally 11.8 titrations/min). Air-segmentation has been found to be effective to reduce axial dispersion and to preserve the titrand/titrant composition upon their just being merged. Consequently, the applicable range is extended especially to lower titrand concentration. The proposed method has been successfully applied to various acid-base titrations, including the nonaqueous titration of the Japanese Pharmacopoeia drug

Triangular-wave controlled amplitude-modulated flow analysis for extending dynamic range to saturated signals

We have applied our amplitude-modulated flow analysis concept to extend the dynamic range to saturated analytical signals. Sample solution, the flow rate FS of which is periodically varied with a triangular control signal Vc, is merged with a reagent solution delivered at a constant flow rate FR. While the total flow rate FT is kept constant, a diluent with FT – (FS + FR) flow rate is aspirated from the third channel. The analytical signal Vd obtained downstream is processed by fast Fourier transform to obtain the amplitudes of the wave components in Vd. When the sample concentration CS is low, Vd shows a triangular profile like Vc; the sum of the amplitudes ΣA is proportional to CS. When CS is high, Vd shows a trapezoidal profile because of the Vd saturation. A linear calibration curve can also be obtained for such saturated signals by plotting CSΣA against CS. The proof of the concept is validated by applying it to spectrophotometric determinations of a dye (Methylene Blue) and colored complexes of Fe2+−phenanthroline and Fe3+−Tiron