Background: In order to improve physicians' competence of palliative care, the PEACE project, a palliative care education program for physicians based on the Cancer Control Act, has been conducted throughout the country since 2008. The effectiveness and limitations of the current project management techniques and learning materials have not been determined. This study aimed to explore current problems with the PEACE project and to seek corrective strategies. Method: A workshop was held with 36 participants who had finished PEACE faculty-development programs, and involved brain-storming with physicians. The results of brain-storming sessions were qualitatively analyzed. Results: Most problems identified related to the burden, to the host, of holding the faculty-development program workshop. In addition, some problems related specifically to the individual host site or community involved. Conclusion: One strategy to improve these problems is to incorporate e-Learning to both expand the program and reduce the burden on the host site. In addition, workshop materials could be improved to include additional modules and revised guidelines. Palliat Care Res 2011; 6(2): 143-149

Purpose: The Palliative Care Education Program based on the Cancer Control Act has been held throughout Japan since 2008. The aim of this study is to identify changes attained through the program from the trainers' perspective. Method: The contents of the brain-storming sessions with the twelve trainers were qualitatively analyzed. Results: Six main categories of improvement were identified. These include: Reinforced cooperation; improved palliative care skills and knowledge; improved awareness of palliative care; improved understanding of the local palliative care resources; behavior modification of the participants; and development of in-hospital palliative care systems. Conclusion: Trainers recognized that holding the Palliative Care Education Program provides not only direct results such as greater knowledge and improved delivery of palliative care by physicians, but also indirect results such as enhanced cooperation and improved awareness of local palliative care resources.

Background：A palliative care education program based on the Cancer Control Act, namely the Palliative care Emphasis Program on symptom management and Assessment for Continuous medical Education（PEACE）, has been run in Japan since 2008. Purpose：The aim of this study was to evaluate the usefulness of PEACE for clinicalpractice. Method：Focus group interviews were conducted with 12 physicians who attended the program and were chosen by theoretical sampling. Two investigators independently performed thematic content analysis. Results：Qualitative analysis identified five main categories of usefulness of the program：（1）acquiring knowledge of palliative care；（2）acquiring skills to provide palliative care；（3）mastering an attitude of focusing on suffering；（4）acquiring knowledge about home palliative care；and（5）standardizing knowledge of basic palliative care in the community. Three main categories for program improvement were identified, namely the content and structure of the program, as well as the method of running the program. Conclusion：PEACE may be useful in providing systematic education in basic palliative care through the acquisition of basic knowledge and skills, discussion of cases with colleagues, observing good communication by other physicians, and networking in the community.

Porcelain aorta entails a high risk of cerebral as well as systemic embolism. We describe a case of aortic arch aneurysm with a circumferentially calcified aorta. The patient was a 61-year-old man on chronic hemodialysis who received aortic arch replacement. However, since chest CT scan revealed a totally calcified porcelain aorta and heavily calcified axillary artery, axillary artery cannulation was deemed to be contraindicated. On the other hand, possible complications caused by femoral artery cannulation are also well known, such as cerebral embolization. Therefore, transapical aortic cannula was used and aortic arch replacement was performed under deep hypothermic circulatory arrest. The patient was weaned from cardiopulmonary bypass without difficulty and had an uneventful recovery without any neurologic complications.

　　Serious aggravation of de novo hepatitis B caused by revitalization of the hepatitis B virus in HBs antigen negative, HBs antibody or HBc antibody positive patients has recently been reported. The incidence of de novo hepatitis B infection which occurs in patients undergoing immunosuppression or chemotherapy develops at times into a medical lawsuit. To cope with the situation, the Ministry of Health, Labour and Welfare (MHLW) issued the guideline for the management of hepatitis B infective occurring in patients treated with immunosuppressive therapy or chemotherapy (the revised edition). In our institution, the Chemotherapy Committee discussed our measures against de novo hepatitis B, and determined to carry out the in-hospital examination of the HBc antibody to provide reliable safe and speed medicine.　　During the investigation period, HBc antibody was examined for confirmation of anamnesis of Hepatitis B in patients receiving chemotherapy, immunosuppressive medicine, examination of infectious disease before blood transfusion and examination of viral hepatitis. In our institution, the number of cases which are adapted for the MHLW guideline (the revised edition) was 15 of 218 examples, and as a result HBs antigen negative, HBs antibody or HBc antibody positive patients, who could not be found in the routine screening for HB infection turned out to be not a few.　　Since it was expected that the number of patients undergoing immunosuppression and chemotherapy would continue to increase in the future, the necessity for observance of guideline was suggested to provide relief, safety in medical treatment.

Secretory immunoglobulin A (s-IgA) in saliva constitutes the first-line barrier to the entry of pathogens into the body, implying its critical role in mucosal immunity.To examine the effect of a shark liver oil (SLO)-containing diet on salivary s-IgA concentration in healthy male and female adults, 42 subjects were assigned to either placebo or 6 weeks of a 2,400 mg SLO-containing diet (1,500 mg as SLO) and assessed in a randomized, double-blind, placebo-controlled, parallel group trial.Salivary s-IgA concentration significantly increased at week 6 in the SLO group (P = 0.033), but not in the placebo group.Moreover, there was a significant difference between groups in the magnitude of change from baseline to week 6.No intervention-related adverse event or abnormal changes of laboratory test parameters were observed throughout the study period.In conclusion, an SLO-containing diet increases salivary s-IgA in healthy adults.

Purpose: Maintenance therapy after oxaliplatin withdrawal is useful in patients with metastatic colorectal cancer (mCRC). This study aimed to investigate the timing of discontinuation or reintroduction of oxaliplatin and the optimal maintenance therapy regimen for survival. Materials and Methods: PubMed and conference abstracts were searched to select phase II and III trials of first-line oxaliplatin-containing therapy with or without bevacizumab using maintenance therapy for mCRC. Correlations of median overall survival (OS) with induction therapy regimens, induction therapy duration, maintenance therapy regimens (fluoropyrimidine plus bevacizumab [FP+Bev], FP/Bev alone, and no treatment), and oxaliplatin reintroduction were investigated using correlation and weighted multivariate regression analyses. Results: Twenty-two treatment arms were analyzed, including 2,581 patients. The maintenance therapy regimen FP+Bev showed the strongest correlation with a prolonged OS (Spearman’s partial correlation coefficient=0.42), and the other three variables correlated weakly with the OS. The maintenance therapy regimen significantly interacted with the induction chemotherapy duration (p=0.019). The predicted OS for FP+Bev crossed the lines of FP/Bev alone at 18 weeks of induction therapy, and of no treatment at 23 weeks. The corresponding OS at 12 and 27 weeks of induction therapies were 28.6 and 24.2 months for FP+Bev, 25.9 and 28.8 months for FP/Bev alone, and 20.5 and 27.5 months for no treatment. Conclusion The optimal maintenance therapy regimen for the OS is a continuous induction therapy as long as possible followed by FP/Bev alone and switching to FP+Bev within approximately 4 months if induction therapy is discontinued.

Purpose: Maintenance therapy after oxaliplatin withdrawal is useful in patients with metastatic colorectal cancer (mCRC). This study aimed to investigate the timing of discontinuation or reintroduction of oxaliplatin and the optimal maintenance therapy regimen for survival. Materials and Methods: PubMed and conference abstracts were searched to select phase II and III trials of first-line oxaliplatin-containing therapy with or without bevacizumab using maintenance therapy for mCRC. Correlations of median overall survival (OS) with induction therapy regimens, induction therapy duration, maintenance therapy regimens (fluoropyrimidine plus bevacizumab [FP+Bev], FP/Bev alone, and no treatment), and oxaliplatin reintroduction were investigated using correlation and weighted multivariate regression analyses. Results: Twenty-two treatment arms were analyzed, including 2,581 patients. The maintenance therapy regimen FP+Bev showed the strongest correlation with a prolonged OS (Spearman’s partial correlation coefficient=0.42), and the other three variables correlated weakly with the OS. The maintenance therapy regimen significantly interacted with the induction chemotherapy duration (p=0.019). The predicted OS for FP+Bev crossed the lines of FP/Bev alone at 18 weeks of induction therapy, and of no treatment at 23 weeks. The corresponding OS at 12 and 27 weeks of induction therapies were 28.6 and 24.2 months for FP+Bev, 25.9 and 28.8 months for FP/Bev alone, and 20.5 and 27.5 months for no treatment. Conclusion The optimal maintenance therapy regimen for the OS is a continuous induction therapy as long as possible followed by FP/Bev alone and switching to FP+Bev within approximately 4 months if induction therapy is discontinued.

A 42 year-old woman with Marfan syndrome, who had replacement of the ascending aorta for acute aortic dissection several years ago, was found to have distal aortic arch aneurysm. The aneurysm had small entries at cervical arterial branches and large re-entry at the left external iliac artery. It was necessary to perform two-staged operation Bentall procedure with total arch replacement and abdominal aortic replacement with re-entry closure. It was usually performed with a primary entry closure for chronic aortic dissection, but massive invasion was expected. We performed catheter angiography for entry and re-entry, and decided to perform preceding re-entry closure. First, we underwent replacement of the abdominal aorta, and then successfully performed the Bentall procedure with total aortic arch replacement. The catheter angiography was useful for decision-making for medical treatment.

OBJECTIVE: The purpose of the present study was to clarify the relationship between white matter tracts and cognitive symptoms in children with high-functioning autism spectrum disorder (ASD). METHODS: We examined the cognitive functions of 17 children with high-functioning ASD and 18 typically developing (TD) controls and performed diffusion tensor imaging (DTI) tractography. We compared the results between the groups and investigated the correlations between the cognitive scores and DTI parameters within each group. RESULTS: The Comprehension scores in the ASD group exhibited a positive correlation with mean diffusivity (MD) in the forceps minor (F minor). In the TD group, the Comprehension scores were positively correlated with fractional anisotropy (FA) in the right inferior fronto-occipital fasciculus (IFO) and left anterior thalamic radiation (ATR), and negatively correlated with MD in the left ATR, radial diffusivity (RD) in the right IFO, and RD in the left ATR. Additionally, a positive correlation was observed between the Matching Numbers scores and MD in the left uncinate fasciculus and F minor, and RD in the F minor. Furthermore, the Sentence Questions scores exhibited a positive correlation with RD in the right inferior longitudinal fasciculus. Relative to TD controls, the specific tract showing a strong correlation with the cognitive scores was reduced in the ASD group. CONCLUSION: Our findings indicate that white matter tracts connecting specific brain areas may exhibit a weaker relationship with cognitive functions in children with ASD, resulting in less efficient cognitive pathways than those observed in TD children.
Anisotropy ; Autism Spectrum Disorder ; Autistic Disorder ; Brain ; Child ; Cognition ; Comprehension ; Diffusion Tensor Imaging ; Humans ; Neurobehavioral Manifestations ; Surgical Instruments ; White Matter