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In today's world, where clinical options are ever increasing and patients' needs are more diverse, it is not possible to conclude that simply practicing medical care based on pathophysiological data and medical evidence is sufficient for patients, particularly in terms of seeing each patient as an individual. Medical professionals must maintain a close relationship with their patients and seek treatment and care methods that reflect the patient's values and views on life and death, based on their own ethics in medical care. Ethics education should be provided on a continuing basis from the beginning of medical/pharmacy school. However, ethics education in pharmacy departments is often delivered in a lecture format attended by many students and/or as group training using case studies and hypothetical situations, i.e., "paper" patients. With these teaching methods, there are limited opportunities for the students to foster a sense of ethics or to think deeply about their values and views on life and death with respect to the patients they care for. Therefore, in this study, we conducted ethics exercises for pharmacy students in a group study format using a documentary film of real patients who were facing death. By retrospectively analyzing the results of the questionnaires collected before and after the assignments and exercises, we verified the educational effects and changes in the students' sense of ethics from participating in the group learning exercise; moreover, our results revealed the insight gained by the students in examining the experiences and challenges faced by terminally ill patients.

The questionnaire survey was conducted in 2020 to investigate the working conditions of qualified medical physicists in Japan. We developed a web-based system for administering the questionnaire and surveyed 1,228 qualified medical physicists. The number of received responses was 405. We summarized the results of the survey by job category. The obtained results showed that most of the people working as certified medical physicists met the following conditions: (1) position of healthcare occupation, (2) direct supervisor is a medical doctor or a medical physicist, (3) licensed or passed an examination for a Class I Radiation Protection Supervisor, (4) without the license of professional radiotherapy technologist, (5) master's or doctor's degree, (6) being assigned to the section that is different from the radiological technologist section. The average annual salary was approximately 600,000 yen higher for those employed as medical physicists than for those employed as radiotherapy technologists. The percentage of work performed by a certified medical physicist in radiation therapy greatly varies depending on whether the physicist is dedicated to treatment planning and equipment quality control. Alternatively, the proportion of the true duties of medical physicists in charge of radiation therapy, as considered by qualified medical physicists in radiation therapy, was the same regardless of whether they were working full-time or not. The results of this survey updated the working status of certified medical physicists in Japan. We will continue to conduct the survey periodically and update the information to contribute to the improvement of the working conditions of medical physicists and policy recommendations.

We report a case of pulmonary metastasis from hilar cholangiocarcinoma successfully treated by stereotactic body radiotherapy. The patient was a 70-year-old woman who underwent extended left hemi-hepatectomy with bile duct reconstruction for hilar cholangiocarcinoma at the age of 67. Pathological diagnosis indicated a well-differentiated adenocarcinoma. We followed up the patient without adjuvant chemotherapy. Nineteen months after the initial resection, a solitary pulmonary metastasis was detected in the right upper lobe. The patient received gemcitabine plus cisplatin(GC)therapy. After 4 courses of GC therapy, the size of the pulmonary metastasis was unchanged. Therefore, we performed a thoracoscopic wedge resection. Pathological diagnosis indicated that the pulmonary metastasis originated from the cholangiocarcinoma. Fifteen months after the pulmonary resection, another solitary pulmonary metastasis was detected in the left lower lobe. As the patient refused further chemotherapy, we performed stereotactic body radiotherapy(SBRT)(50 Gy/4 Fr). An adverse event of Grade 1 radiation pneumonitis was observed. The metastasis disappeared after SBRT. Twenty-eight months after SBRT and 70 months after the initial surgery, the patient is alive without recurrence.

A 24-year-old man with acute lymphoblasticleukemia underwent allogeneicperipheral blood stem cell transplantation (allo-PBSCT)from a human leukocyte antigen-matched sibling after myeloablative conditioning, with a regimen including total body irradiation(TBI)(12 Gy/6 fractions), 6 years ago. The patient developed extensive chronic graft-versus-host disease(cGVHD)of the skin, mouth, liver, and gut four months after allo-PBSCT. Treatment with cyclosporine and prednisolone was necessary to control the cGVHD. Six years after allo-PBSCT, the patient experienced odynophagia and was diagnosed with cervical esophageal squamous cell carcinoma(cT1bN1M0, cStage II B). Because we considered laryngeal preservation, risk of anastomotic leakage, and infection related to the operation, the patient was planned to receive chemoradio- therapy with 5-fluorouracil and cisplatin. Regarding irradiation, the patient received radiotherapy(50.4 Gy/28 fractions)for a primary tumor and lymph node without an elective nodal area. The patient achieved complete response and remained disease- free without any treatment-related complications for 3 years.

Iodine-131 (I-131) has been used for the ablation of residual thyroid remnants and cancer cells in well-differentiated thyroid cancers. It has also been used for metastatic well-differentiated thyroid cancers, especially lung and bone metastases. For small lung metastases, I-131 treatment has curative potential, particularly in young patients. Suppression of the thyroid stimulating hormone is also important for prolonging the survival of thyroid cancer patients. Strontium-89 (Sr-89) chloride has a mechanism similar to calcium, and it has been used for the treatment of bone metastases, especially osteoblastic metastases. It has been reported to have analgesic effects in an average of 76% of cases, and it is more effective if used in the early bone metastatic phase. Ibritumomab tiuxetan (Zevalin) is an anti-CD20 mouse monoclonal antibody labeled with Yttrium-90 (Y-90). It is used for treatment-resistant low grade or follicular B-cell non-Hodgkin's lymphomas and mantle lymphomas. Recently, radium-223 (Ra-223) has been used for bone metastases from castration resistant prostate cancers, and in a phase III trial, it has been proven to prolong survival of these patients. Cancer therapy using unsealed radioisotopes has been thought to be promising because it exhibits more targeted therapy than external beam irradiation. Therefore, if many more ideal targeting agents are developed in the future, this treatment might be used more commonly. As many agents such as I-131, Sr-89, and Ra-223 are available for treating bone metastasis, the combined use of other treatments such as high precision radiotherapy, bisphosphonates, hormonal agents, and molecular targeted agents should be investigated.

Cardiac scintigraphy accounted for 2.5 % of all 3,884 patients based on a survey ques- tionnaire of pediatric nuclear medicine examinations performed at 14 Japanese institutes in 2011. Myocardial perfusion imaging, classified as cardiac scintigraphy, is essential to detect myocardial ischemia in patients after Kawasaki disease (KD), although its less frequent performance is reported. Adenosine is widely noticed as a medication for pharma- cological stress testing in coronary arterial lesions after KD. We describe characteristics of adenosine including newly-devised administration protocol and pathway making of intravenous injection for stress testing. We comment on optimal radiopharmaceutical administered doses proposed in Japanese consensus guidelines for pediatric nuclear medi- cine. Their proposal doses approximate that calculated by Pediatric Dosage Card of Euro- pean Association of Nuclear Medicine. We hope myocardial perfusion imaging is performed under appropriate management of pediatric radiopharmaceutical administration.

To evaluate the effectiveness of the new victim participation systems, we examined whether the use of these systems had an effect on the confidence of the families of victims about the criminal justice system. The results of a questionnaire survey revealed that victims who participated in their criminal court cases had more confidence in the criminal justice system and were more accepting of the court decisions. Moreover, the present study examined the process of victims' confidence in criminal justice based on the value-expressive theory of procedural justice. In particular, the assumption was confirmed that the victims' feelings of expressing opinions resulted in their increased confidence in criminal justice through their confidence in the judges and their acceptance of court decisions.

The rate of severe late adverse effects has decreased with the highly accurate administration of radiation therapy; however, the total number of patients who suffer from late effects has not decreased because of the increased total number of patients and better survival rates. Late adverse effects, occurring more than a few months after irradiation, include the extension and collapse of capillaries, thickening of the basement membrane, and scarring of tissue due to loss of peripheral vessels. The main causes of these late effects are the loss of stromal cells and vascular injury. This is in contrast to early reactions, which occur mainly due to the reorganization of slow-growing non-stem cell renewal systems such as the lung, kidney, heart, and central nervous system. In addition, the patient's quality of life is impaired if acute reactions such as mouth or skin dryness are not alleviated. Most adverse effects are radiation dose dependent, and the thresholds differ according to the radiosensitivity of each organ. These reactions occur with a latency period of a few months to more than 10 years. Understanding the clinical and pathological status, through discussion with radiation oncologists, is the essential first step. Some of the late effects have no effective treatment, but others can be treated by steroids or hyperbaric oxygen therapy. An appropriate decision is important.

In Japan, preoperative chemoradiotherapy has not been routinely used for operable locally-advanced rectal cancer, mainly because of the chronic toxicities for intestines and the anal functions. Recently, by the use of intensity-modulated radiation therapy (IMRT), one can concentrate radiation doses to the target volume whereas minimizing the unnecessary doses to the surrounded normal tissues. Especially, IMRT seems promising in reducing the acute and late toxicities to intestines. With the use of IMRT as a part of the preoperative chemoradiotherapy would be promising by increasing the intensity of the treatment. Besides IMRT, particle therapies such as carbon ions are also considered promising. Furthermore, stereotactic body radiation therapy, intraoperative radiation therapy, combined use of molecular targeted agents and hypoxic cell radiosensitizers, might be promising.

We report multidisciplinary treatment of 3 patients with lymph node recurrence after curative gastrectomy. Case 1: A 71- year-old woman had a history of distal gastrectomy with D2 lymphadenectomy for the treatment of advanced gastric cancer. Para-aortic lymph node metastasis was observed 36 months after surgery. Complete response( CR) was achieved after concurrent chemoradiotherapy with S-1 plus radiation. Case 2: A 51-year-old man had a history of total gastrectomy with D2 lymphadenectomy for the treatment of advanced gastric cancer. Right cervical lymph node metastasis was observed 48 months after surgery. CR was achieved after concurrent chemoradiotherapy with S-1 plus radiation. Case 3: A 68-year-old man had a history of distal gastrectomy with D2 lymphadenectomy followed by neoadjuvant chemotherapy for the treatment of advanced gastric cancer. CR was achieved after sequential treatment with irinotecan( CPT-11) plus cisplatin( CDDP), radiation, and 5-fluorouraci(l 5-FU) plus Leucovorin therapy for lymph node recurrence near the head of the pancreas. These cases suggest that the combination of systemic chemotherapy and local radiation therapy might be effective for the treatment of lymph node recurrence in patients with gastric cancer.

Under the auspices of the Japanese Society of Pediatric Nuclear Medicine, an annual aggregate from a 5-year period, 2007 to 2011, of a survey questionnaire of pediatric nuclear medicine examinations performed at 14 institutes in the Kanto region was conducted. The subjects were pediatric patients 15 years old or younger. The survey questions included the determination method for administered dose of radiopharmaceuticals, the items examined and number of examinations. Of 14 institutes, 11 determined administered doses using the formula: adult dose X (age +1) / (age+7), while the remaining 3 used the adult dose as the maximum dose and used a conversion formula based on age and physical condition. In 2011, in a total of 3,884 pediatric patients, renoscintigraphy accounted for 41.5%, brain 14.4%, pulmonary scintigraphy 12.9%, oncology 9.0%, hepatobiliary scintigraphy 6.3%, gastrointestinal scintigraphy 4.8%, musculoskeletal scintigraphy 4.3%, cardiology 2.5%, and other 4.9% of all nuclear medicine examinations. Pediatric nuclear medicine examinations in general hospitals accounted for only 3.4% of all examinations. A similar trend was observed in previous years. Since pediatric patients have a longer reproductive term and higher sensitivity to radiation exposure, pediatric nuclear medicine requires a strict selection of appropriate studies and administered dose. These results show the current practice and would warrant further consideration.

This article examines the effects of language use on explicit and implicit attitudes. We employed the matched-guise technique to measure participants' impressions of standard-Japanese and Osaka-dialect speakers. Implicit attitudes were assessed by the Implicit Association Test (IAT). The Osaka-dialect speaker was evaluated as warmer than the standard-Japanese speaker, suggesting that explicit attitudes toward the Osaka dialect have changed positively. On the other hand, the results for the impression of intelligence were consistent with the previous literature that the standard-Japanese speaker was seen as more intelligent than the Osaka-dialect speaker. Compared with explicit attitudes, the analyses of implicit attitudes revealed that participants showed a consistent implicit bias favoring standard-Japanese language use. The changing processes and relationships of explicit and implicit attitudes were discussed.

Our first report mentioned the analysis results of the safety and efficacy of trigger point (TP) therapy by Neovitacain® injection (NV) in the daily clinical treatment of myofascial pain in cancer patients. This time, we report additional considerations regarding the following points; (1) Injection sites: they were concentrated on both sides of the spine, indicating that TPs could be easily formed on the points and near them to support the body's weight when patients were supine. (2) Correlation between VAS and FS: VAS and FS were positively correlated in every measurement period. (3) Patient satisfaction: many patients made several comments expressing feelings of satisfaction from this treatment. The comments were considered to reflect the patients' candid feelings. Therefore, all comments were classified according to the degree of patients' feeling of satisfaction. It may be possible to obtain much higher patient satisfaction by hearing out the voice of the patients. Judging from this study, TP therapy by NV for myofascial pain in cancer patients relieved the total pain of cancer patients. TP therapy has potential for obtaining high patient satisfaction.

Four studies were conducted to investigate the relationship between valences of self-evaluation and approach-avoidance tendencies. Based on regulatory focus theory (Higgins, 1997, 1998), we predicted that positivity of self-evaluation is related to the tendency to approach gains, while negativity of self-evaluation is related to the tendency to avoid losses. In Study 1, a self-report measure of behavioral tendencies for approaching gains and avoiding losses was developed. In Studies 2 to 4, correlations between these approach/avoidance tendencies and various kinds of self-evaluations were examined. Overall, the authors' predictions were supported. The results suggest that the self-evaluation system and the self-regulation system work in close cooperation with each other in controlling human behavior.

Special use-results surveillance was conducted to examine the safety and efficacy of trigger point (TP) therapy by Neovitacain ®injection (NV) in the daily clinical treatment of myofascial pain in cancer patients. The case report forms of 175 patients were collected from 43 nationwide facilities and all of them were analyzed in terms of safety and efficacy. This treatment deeply impressed both patients and physicians; 75.4% and 78.3% respectively, over "the good". In addition, as the results of Wilcoxon's signed rank sum test for pain assessment (VAS, FS), both "Cumulative effect before and after treatment" and "Immediate effect before and after each administration" were confirmed to show a highly significant difference (p<0. 0001). Side effects were observed in five of 175 cases (2. 9%) but none of them were serious. Judging from the results of this study, TP therapy with NV was considered to be very useful for the treatment of myofascial pain in cancer patients.

This study examined whether false memories, as revealed by the Deese-Roediger-McDermott (DRM) paradigm, can arise from indirect stereotype associations, as proposed by Lenton, Blair, and Hastie (2001). We found significant indications of stereotype-evoked false memories. The participants in our experiment reported that they were unaware of the gender theme of the studied list, suggesting that the false memories were due to implicit associative processes. Although we could not replicate an increase in the false recognition of stereotypically gender-congruent occupations, we detected a gender-congruent effect partially by the analyses of the "Remember" responses and the participants' egalitarian attitudes against the gender role. Moreover, analyses of the "Know" responses indicated that participants' attitudes toward gender roles potentially moderate the degree that they form occupational gender stereotypes. Implications of the results for basic/applied research on the interactions between stereotype and memory are discussed.

We have previously reported the efficacy of the Patient Oriented Clerkship (POC) in the clinical clerkship in Showa University Hospitals, by a trial with old four-year pharmacy program students. In the unique clerkship, each student has a patient in charge, and follows his/her clinical conditions throughout the rotation. The aim of the POC is that having the students learn spontaneously (Active Learning) and actively (Adult Learning) promoted by student's commitment and responsibility by communicating with patients and health professionals in a team. As the POC requires students both Active Learning and Adult Learning, we define the POC as Active Adult Learning (AAL). Having a patient in charge for each student gives them many opportunities to participate in the medical team and foster their problem solving skills. Our previous study eventually showed positive results of the POC in the one-month short clerkship in the four-year program. On the other hand, the effect of the unique hospital clerkship in the new six-year program is not known. We conducted a student survey to clarify the learning effect in the new six-year education system which was revised and 2.5 month clinical clerkship was scheduled according to the model core clerkship curriculum. This report is the first report to show a challenge of the AAL/POC clerkship in the new six-year pharmacy education program.

Among various altered fractionation regimens, hyperfractionated radiotherapy (HFRT) has been considered effective to raise survival rate(SR)as well as local control rate(LCR)in head and neck cancers. We reviewed our results of HFRT (117 cases) treated between 1995 and 2004 and compared with those of conventionally fractionated radiotherapy (CFRT; 80 cases) treated during the same period. By disease site, naso-/oro-/hypopharynx/larynx were 5/23/44/45 vs. 10/6/10/54. There were more advanced-stage cases in HFRT group (stage I/II/III/IV = 19/36/23/35 vs. 42/16/8/ 14). Median RT dose were 72 Gy vs. 66 Gy. In 71 cases, chemotherapy was added (HF/CF = 54/17). In stage III and IV cases, there was a borderline significant difference in LCR (at 5 years; 44.3% for HFRT group vs. 24.5% for CFRT group; p = 0.0502), and a tendency in SR(at 5 years; 50.7% for HFRT group vs. 16.7% for CFRT group; p = 0.1210). By disease site, LCR of HFRT group was higher in hypopharynx(p = 0.0005)and oropharynx(p = 0.0003), and SR of HFRT group was higher in hypopharynx(p = 0.0023). Acute toxicity was heavy but in most cases it was tolerable and there were no severe late toxicities. From our data, it was suggested that HFRT might be effective in certain kinds of head and neck cancers.

Guided by regulatory focus theory, this study examined the effects of goal framing on the subjective experience of affect and the accessibility of affective representations. Study I examined lay persons' beliefs concerning the relationship between goal framing and certain kinds of affective experiences. The results indicated that a promotion focus was associated with happiness and disappointment, whereas a prevention focus was associated with relaxation and tension. Study 2 examined the effect of goal framing on the activation of affective representations, and found that a promotion focus activated both gain-related representations (happy and disappointment) and loss-related representations (relaxation and tension), whereas a prevention focus activated only loss-related representations. These results suggest that goal framing activates particular affective representations, and the activated affective representations may influence the interpretation of positive or negative experiences. The discussion considered the function of the activation of affective representations as a mediator between goal framing and its cognitive and behavioral consequences.

Objectives: Novel multislice spiral computed tomography (MSCT) findings were identified in patients after Kawasaki disease that could not be detected by coronary angiography (CAG)., Methods: Eighteen patients had suffered from serious coronary arterial lesions after Kawasaki disease (mean age 21.7 years, range 13-34 years). Seventeen patients had stenotic lesions, and all of them had coronary aneurysms. MSCT was performed using a Siemens SOMATOM Volume Zoom (4-detector row) or a Toshiba Aquillion 16 (16-detector row). Findings of coronary calcification, stenotic lesion, and intimal hypertrophy in all coronary arteries were compared to those of CAG., Results: Eleven of the 18 patients (61%) had novel findings detected by MSCT. Coronary calcifications were found in 11 of the 18 patients (61%). Five patients had concentric calcified aneurysms, four had eccentric calcified aneurysms, and two had mixed calcified aneurysms. Coronary stenotic lesions were present in 6 of the 18 patients (33%) with calcified aneurysms. Two patients had intimal hypertrophy (11%). One patient had intimal hypertrophy along the left main trunk with a giant calcified aneurysm along the left anterior descending artery. Two patients had severe stenoses just distal to giant calcified aneurysms that were regarded as false positive findings, and were identified as mild stenoses by CAG., Conclusions: MSCT offers advantages over CAG in the evaluation of calcified aneurysms and intimal hypertrophy, and is a potential diagnostic modality for coronary intervention in patients after Kawasaki disease.

Radiation therapy (RT) for prostate cancer has been developing dramatically during the past 10 years in Japan as well as in USA. There are several ways to treat prostate cancer by RT. As for external-beam RT (EBRT), a more sophisticated technique beyond 3-dimensional conformal RT called intensity modulated RT was developed and has been in use in many Japanese RT centers. It can raise the total radiation dose and is expected to increase the biochemical control rate. As for brachytherapy, a low-dose-rate seed implant using iodine-125 was initiated in 2003 and has become widespread throughout Japan in only a few years. High-dose-rate brachytherapy using iridium-19 2 has also been used in more advanced cases combined with EBRT. Brachytherapy offers an ideal RT dose concentration and can avoid rectal complications. As for particle therapy, we have carbon and proton in several institutions in Japan. Particles have the merit of good dose distributions and for carbons, relative biological effectiveness. Furthermore, some centers are considering the stereotactic hypofractionated RT due to the relatively low alfa-beta ratio of prostate cancer. Recent reports showed that after a certain period of followup, the biochemical control rate was similar either with external beam high-quality RT, brachytherapy, heavy ion RT and surgery. Therefore, the choice of treatment should depend on the adverse effects, quality of life, medical costs, and the lifestyle of the patient. The merits and demerits of each treatment modality were discussed. Longer follow-up is still necessary and informed consent is mandatory when choosing a treatment modality.

Radiotherapy has been widely used in breast cancer in many situations. These are breast irradiation of breast conserving therapy,post mastectomy regional irradiation,irradiation for regional lymph nodes recurrence,breast irradiation of inoperable locally advanced cases,palliative irradiation of brain metastasis,bone metastasis and so on. The relationship among radiotherapy,surgery and systemic therapy has to be considered in those situations. In breast conserving therapy, the usefulness of breast irradiation is well established. Otherwise, a local controllability depend on a grade of residual tumor cell has not been understand. The authors conducted the survey of 941 cases of positive surgical margins and found that doses more than 60 Gy has a tendency for better local control in post menopausal cases. To reduce patient's burden,3 weeks short course irradiation (Canadian protocol) or accelerated partial breast irradiation have been introduced in breast irradiation. A subgroup which has no need to irradiate to conserving breast had not been identified. The timing between postoperative chemotherapy and irradiation is another point that has to be considered. To reduce distant metastasis,chemotherapy first has been considered better. As for post mastectomy regional irradiation, improvement of local and systemic control has been widely known these days. A timing of systemic therapy and irradiation is a point has to consider. In inoperable or far advanced T 4 tumors, breast irradiation with concurrent chemotherapy must be considered in stead of surgery. We have to know a big shortage in Japanese cancer treatment situation that we have few radiation oncologists or medical physicists in Japan. We have to educate those specialists to catch up with increasing cancer patients.

Tracheo-innominate artery fistula (TIF) is one of the most important complications of tracheostomy in that it is often life threatening. We experienced two cases with TIF and tracheo-innominate artery allovascularity, in which three-dimensional helical CT (3DCT) was useful in making the diagnosis of TIF and tracheo-innominate artery allovascularity. In one case, acute hemorrhage occurred during the procedure of routine tube exchange, and hemostasis was achieved by inflating the cuff of the tracheostomy tube. After TIF was confirmed by 3DCT, surgical ligation of the innominate artery was performed. In the other case, the recognition of a pulsating movement of the tracheostomy tube prompted us to perform 3DCT, which demonstrated a collateral branch from the innominate artery to the trachea. Laryngotracheal separation was performed to prevent hemorrhagic events in the future. For patients with severe neurological disorders, 3DCT has the advantage that only a short time is required to produce a digital image demonstrating the structure surrounding the trachea, which is necessary for the management of the patients' airway.

We present two cases of liver metastases from breast cancer treated by radiofrequency ablation (RFA) for elongation of life. Case 1: A 50-year-old woman was treated by left mastectomy (stage IIIa) in December 2002. In April 2004, she was treated with a combination therapy of weekly paclitaxel and trastuzumab for multiple liver metastases, left supraclavicular lymph node metastases, and multiple bone metastases. After 16 courses of weekly paclitaxel and trastuzumab, liver metastases decreased significantly in size. Because liver metastases recurred during a continuation of weekly paclitaxel and trastuzumab, we performed RFA and chemotherapy using a hepatic artery infusion of docetaxel for liver metastasis. The aggravation spread to the liver lesion and she died after 20 months from liver metastases. Case 2: A 65-year-old woman was treated by left mastectomy (stage IIA) in 1984, and the distant metastasis was not found through the course after an operation. She was noted with a liver function aberration in another hospital in March 2005. We scanned it, and it was diagnosed as multiple liver and bone metastases from breast cancer. Because she did not hope for an anticancer drug treatment for multiple liver metastases, we performed RFA in May 2005. After the second RFA was performed, she does not show any new lesion to the liver for 10 months.

We evaluated the efficacy and feasibility of low-dose gemcitabine concurrent with radiation as adjuvant therapy. Nine cases of locally far advanced unresectable pancreatic cancer were enrolled in this study. Intraoperative radiation was carried out in every case using eight or ten centimeter cones with a radiation dose of twenty to twenty five Gy. Postoperative radiation was two Gy per day on weekdays for five weeks. Low-dose gemcitabine (40 mg/m2) once a week was administered prior to radiation. A grade 3 adverse event occurred in three cases. CA19-9 decreased 60.1% and DUPAN-2, 52.6%. CT scan confirmed a necrotic change and a decrease of the tumor size. Average survival time was ten months. Peritoneal dissemination was the recurrence pattern. In conclusion, low-dose gemcitabine concurrent with radiation therapy may contribute to local control of the disease. However, peritoneal dissemination must be overcome to prolong survival.

Two studies were conducted to examine the effect of affects on self-control behavior in delayed cost dilemma. Results of Study 1 suggested that long term negative affects such as regret and self-disgust might have facilitating effects on motivation of self-control if they were anticipated before delayed-cost dilemma situations, but inhibiting effects on self-efficacy of control when experienced after dilemma situations. Study 2 examined the effect of affect priming on self-control in eating behavior, as well as an interaction effect of anticipated affect and regulatory resource on it. Results indicated that participants who had enough regulatory resource succeeded in self-control, i.e. they ate less, regardless of the type of affect priming, but those who did not have sufficient resource and were not primed with long-term negative affects failed to control their behavior. It was argued that regulatory resource explanation of self-control should be expanded to the theory including anticipated affects.

Gemcitabine (GEM) concurrent with radiation is clinically not well defined. We herein report four cases of chemo-radiotherapy against locally advanced pancreatic cancer using low-dose GEM concurrent with extra-beam radiation. A total of eight cases entered the study. Three were resected and five were non-resected cases. Intraoperative radiation was carried out in every case using an 8 or 10 centimeter cone with a radiation dose of 25 Gy. Postoperative radiation was 2 Gy per day on weekdays for 5 weeks. Four cases were concurrent with low-dose GEM (40 mg/m2) twice a week, whereas the other four were radiation only. With the use of GEM concurrent with radiation, tumor markers decreased more than 80 percent regardless of the tumor resection. CT scan confirmed a necrotic change and the decrease of the tumor size. In conclusion, low dose GEM concurrent with radiation therapy may be a promising therapeutic choice for the local control of advanced pancreatic cancers.

Appraisal theories of emotions assume that the emotions are elicited by the appraisals of events or circumstances along with the several dimensions. However, there are some inconsistencies among the dimensions proposed by various appraisal theories. The purpose of this study was to integrate the appraisal dimensions that were proposed by Scherer, Roseman, and Smith & Ellsworth's theories by empirically investigating the appraisals associated with each emotion. Three hundred seventy-six Japanese participants recalled a past experience associated with one of 13 emotions, and rated the nature of the emotional event along the appraisal dimensions proposed by them. A factor analysis identified eight factors: pleasantness, self/other control, certainty, anticipated effort and attention, novelty, human/situation control, motivational state, and coping potentials. These dimensions were consistently proposed by the appraisal theorists. Moreover the associations between each emotion and its appraisal profiles were mostly consistent with the previous theories except for a few dimensions. Discussion argued that the appraisal dimensions identified in this study adequately capture the important features of major emotions.

This study examined the effect of orthography (kanji, kana, and alphabet) on the usage of recognition heuristic, in the context of ecological rationality research. Forty-five students participated and performed the task consisted of randomly drawn two-alternative questions about population sizes of the 20 largest Chinese cities, except Beijing and Shanghai. It was found that kanji and kana tasks led to the usage of recognition heuristic more than alphabet task. Furthermore, judgments in kanji and kana tasks were more accurate than in alphabet task. These results suggested that the usage of recognition heuristic was facilitated when it increased judgment accuracy, and that recognition heuristic had ecological rationality.

With the development of MRI and MRA, many unruptured aneurysms have been detected and treated. Nevertheless, not a few false-positive and false-negative cases are found. We investigate aneurysms that were suspected after screening MRA at the neurosurgical outpatient clinic and the features of aneurysms detected not with MRA but with DSA were studied. Seventy-six patients (85 aneurysms) were suspected due to screening MRA and DSA was performed in 64 (71 aneurysms) of them. Correct diagnosis of cerebral aneurysms with MRA was obtained in 44 patients (45 aneurysms, 63.4%), while false-negative cases were found in 17 patients (plus 20 aneurysms) and false-positive cases in 7 patients (10 aneurysms). The accuracy was 97.2% in ACA, 93% in MCA, 94.4% in VA-BA, and 78.9% in IC, while the sensitivity 100%, 88.2%, 81.8%, 64.7% and the specificity 96.5%, 94.4%, 96.7%, 91.9%, respectively. The features of aneurysms correctly diagnosed with MRA were relatively large ACA, including AcoA, MCA and VA-BA aneurysms, whereas the features of aneurysms undetected with MRA were small IC aneurysms (1-3mm in diameter), especially at the C2-3 portion. These aneurysms at the C2-3 portion or at unusual portions tended to be difficult to detect even with 3D-CTA. Though most of the aneurysms detected with DSA but not with MRA tended to be small and not interventionally treated in the present study, we should pay attention to the fact that these aneurysms are overlooked despite the possibility that they may become enlarged or rupture. Though ruptured aneurysms were surgically treated with only MRA or 3D-CTA without conventional angiography in these days, we recommend the examination of the unruptured cases, which are usually asymptomatic and not hasty, with precise inspection by target MIP, high-performance 3D-CTA or DSA.

At the present time, surgery and standard radiotherapy are considered equally effective to control prostate cancer (PC) though previous randomized controlled trials (RCTs) this failed to show this. Therefore, it is important to inform patients of the treatment toxicity as well as treatment effect in selecting treatment options. Dose escalation studies have been done to enhance the biochemical control rate of PC. RCTS are necessary to evaluate the optimal doses in each risk group. Long-term follow-up is necessary both for biochemical control and normal tissue toxicity. Hormone manipulation has been considered standard treatment for high risk groups. Combined with radiotherapy, it is used neoadjuvantly and/or adjuvantly and has been shown to raise the biochemical control rate compared with radiotherapy alone and even overall survival in some RCTs. The timing and length of hormone therapy and the total dose of radiotherapy need to be determined. Brachytherapy is a promising modality in concentrating the dose to the target volume. The treatment results for the present time depend largely on the skills of the operators. But in future, it will be considered a standard treatment. The treatment results for prostate cancer have been improving owing to the continuing efforts to enhance the therapeutic ratio.

Purpose: The purpose of the current study was to evaluate the impact of fractionation on the treatment outcome of radiation therapy for hypopharyngeal carcinoma., Patients and Methods: Thirty-six inoperable or operation-refused hypopharyngeal patients were treated with curative-intended radiation therapy between 1976 and May 2001. Seventeen patients were treated with conventional radiation therapy, 1.8-2.0 Gy per fraction, totaling 64.0 Gy (CF group), and 19 were treated with hyperfractionated radiation therapy, 1.2 Gy per fraction, totaling 74.4 Gy (HF group)., Results: The radiation response of the two groups at the end of radiation therapy was almost the same. However, the 2-year local control rates of the HF and CF groups were 59.0% and 26.1% (p = 0.012), respectively, a statistically significant difference. Moreover, multivariate analysis showed that HF was an independent prognostic factor for local control., Conclusion: Hyperfractionated radiation therapy was superior to conventional radiation therapy for local control. Local control of hypopharyngeal carcinoma correlated with laryngeal preservation, suggesting that hyperfractionated radiation therapy for hypopharyngeal carcinoma could be beneficial for patient QOL.

We report a case of recurrent breast cancer with chronic renal failure in a 58-year-old female. She could be treated on an outpatient basis under good general condition for most of her remaining life by chemoradiotherapy in combination with hemodialysis. Modification of the chemoradiotherapy procedures and collaboration of medical staff including the doctor in charge of home medical care and her family was indispensable in keeping her hospital stay as short as possible.

This study examined the determinants of attitudes toward intergroup support. The data was collected from the participants of a simulated society game (SIMINSOC; Hirose, 1997). The global society in the game includes rich and poor regions, and the poor regions need to obtain support from rich regions for survival. One hundred and thirty-two participants were randomly assigned to either rich or poor regions and were engaged in various activities in the game. The level of ingroup identity was manipulated by facilitating group activities in some groups but no in others. Then they answered questions regarding the identification, attributions of responsibility, and attitude toward support provision. The results indicated that the identification toward the ingroup increased attribution bias. Furthermore, the identification toward the global society increased the intent to provide support among those from the rich regions. The discussion considered the importance of including intergroup variables in the attributional approach to support provision.

A 36-year-old woman admitted to our hospital because of numbness in the left limbs and weakness in the right arm, and was subsequently given a diagnosis of intramedullary spinal cord metastases from lung cancer. The patient had lung adenocarcinoma with metastases to the brain, spine and lymph nodes. Occipital craniotomy, radiation therapy and chemotherapy were performed on the lesions in the year following June 1994. In June 1995, however, she complained of numbness in the left limbs and weakness in the right arm. Compatible with her neurological manifestation, MRI demonstrated tumors in the right side of the cord at the spinal level of C3-4 and C7-Th1, both of which were of high density in T2-enhanced conditions with enhancement by gadolinium-diethylenetriamine pentaacetic acid. No invasion from spinal metastasis was detected by CT, scintigraphy or MRI. We therefore diagnosed her manifestation as Brown-Séquard syndrome caused by intramedullary spinal cord metastatic tumors of lung adenocarcinoma. In order to avoid paraplegia and dysfunction of the bladder and bowel, radiation therapy of the cord lesions with total dose of 44 Gy was performed. Her neurologic manifestation was improved, restoring her quality of life, as the tumor size estimated by MRI decreased. Four months later, however, she died of lung adenocarcinoma that developed accompanied with severe peritonitis carcinomatosa and multiple metastases.

Objectives: Cardiac sympathetic nerve activity in children with chronic heart failure was examined by quantitative iodine-123 metaiodobenzylguanidine (MIBG) myocardial imaging in 33 patients aged 7.5 +/- 6.1 years (range 0-18 years), including 8 with cardiomyopathy, 15 with congenital heart disease, 3 with anthracycrine cardiotoxicity, 3 with myocarditis, 3 with primary pulmonary hypertension and 1 with Pompe's disease., Methods: Anterior planar images were obtained 15 min and 3 hr after the injection of iodine-123 MIBG. The cardiac iodine-123 MIBG uptake was assessed as the heart to upper mediastinum uptake activity ratio of the delayed image (H/M) and the cardiac percentage washout rate (%WR)., Results: The severity of chronic heart failure was class I (no medication) in 8 patients, class II (no symptom with medication) in 9, class III (symptom even with medication) in 10 and class IV (late cardiac death) in 6. H/M was 2.33 +/- 0.22 in chronic heart failure class I, 2.50 +/- 0.34 in class II, 1.95 +/- 0.61 in class III, and 1.39 +/- 0.29 in class IV (p < 0.05). %WR was 24.8 +/- 12.8% in chronic heart failure class I, 23.3 +/- 10.2% in class II, 49.2 +/- 24.5% in class III, and 66.3 +/- 26.5% in class IV (p < 0.05). The low H/M and high %WR were proportionate to the severity of chronic heart failure., Conclusions: Cardiac iodine-123 MIBG showed cardiac adrenergic neuronal dysfunction in children with severe chronic heart failure. Quantitative iodine-123 MIBG myocardial imaging is clinically useful as a predictor of therapeutic outcome and mortality in children with chronic heart failure.

Radiotherapy can be done on an outpatient basis depending on the patient's cancer stage, radiation method, concurrent therapy, treatment purpose and general condition. Daily treatment time takes only about 1 minute, but the patient has to come 5 times a week for about 6 weeks for radical treatment and about 3 weeks for palliative treatment. If treated with radiotherapy alone, most patients suffer no severe adverse effects in their daily life. Therefore, radiotherapy can be done on an outpatient basis only if the patient is able to come frequently to the clinic for several weeks. Breast cancer patients commonly undergo radiotherapy in the outpatient clinic, such as breast conserving therapy, postoperative therapy and radiotherapy for local recurrence after mastectomy. Prostate cancer is also commonly treated with radical radiotherapy, postoperative therapy and radiotherapy for local recurrence after prostatectomy. Usually, postoperative irradiation for other cancers and radiotherapy for bone metastases are also undergone on an outpatient basis. During outpatient treatment, it is important to predict and avoid severe normal tissue reactions to radiotherapy, such as myelosuppression and/or pneumonitis, before they are apparent by watching the patient carefully.

We analyzed 58 cases of advanced or recurrent cervical cancer treated with intra-arterial infusion chemotherapy (IAIC) with or without radiotherapy. Two separate IAIC regimens were administered since 1985: group I consisted of 5-FU + MMC +/- ADR (30 patients) and group II consisted of CDDP + MMC +/- 5-FU (28 patients). The tip of a catheter was placed in the bifurcation of the abdominal aorta (1 way method: 45 patients regimen II: 15) between 1977-1984. We have used selective catheterization (2 ways method: 9) since 1995 in order to get good drug distribution. However we experienced grade 4 toxic effect of cutaneous and pain with this method, so we have used a 3 ways method (4 patients) since 1998. The two-year survival rete was 60% with the 1 way method, and 67% with the 2 ways method and regimen II. Severe adverse effects (grade 3 + 4) were found in 53, 56, 0%, respectively, by each of the three methods (1, 2, 3 ways) hematologically, 13, 22, 0% in gastrointestinally, 0, 44, 0% in cutaneously and 0, 56, 0% in pain or neurotoxicity. These data suggest that IAIC by the 3 ways method is a useful treatment for advanced or recurrent cervical cancer. However, one should check the blood flow distribution periodically, and control concentration of drugs.

The conventional treatment for patients with locally advanced esophageal cancer has been surgery or radiotherapy. The indication of the treatment depends on the location of the primary tumor, tumor stage, resectability of the lesion and operability of the patient. Radiotherapy is used in a case refusing surgery, medical contraindications to surgery, extensive locoregional disease or poor general condition. The survival rate by surgery alone or radiotherapy alone is poor. Thus, single modality therapy is not a standard treatment, but combined multimodal therapy including chemotherapy is a standard approach for locally advanced esophageal cancer. Further studies of optimization of multimodal therapies which are surgery and/or radiotherapy combined with chemotherapy are needed to improve the results in the treatment of esophageal cancer.