[Our Experience of Providing Home End-of-Life Care for a Child with a Brain Tumor - Overview of Issues Including Environmental Adjustment and Family Care].

INTRODUCTION: We provided home end-of-life care to a child with a brain tumor. As cases of children with malignancies who receive such care have rarely been described in Japan, we report our experience with this patient. CASE REPORT: An 11-year-old previously healthy boy was found to have a brainstem glioma in December X. The tumor was reduced by radiotherapy and chemotherapy, but relapse was noted in August X plus 1. Best supportive care alone was selected for this patient. Before the initiation of home care, we consulted a designated hospital for pediatric cancer treatment in the area and requested a case- worker from the child/home section in his resident area. As the patient was too young for long-term care insurance, we immediately applied for a physical disability certificate to augment welfare support. After the initiation of home care, swallowing function diminished markedly, but we provided guidance on dietary contents and suction, allowing continued oral ingestion by prioritizing his and his family's wishes. In January X plus 2 of the following year, his respiratory condition worsened after the development of aspiration pneumonitis, and he died at home. SUMMARY: We advocate the establishment of a regional network so that children with brain tumors can receive end-of-life care at home.

Adsorption of sulfonamides to marine diatoms and arthropods.

Sulfonamides are frequently detected in the environment, where these compounds adsorb to soil particles and are retained in the environment. However, adsorption of sulfonamides to planktonic particles in the sea is not known. Here we demonstrate that sulfonamides adsorb to a diatom (Chaetoceros) and an arthropod (Artemia), albeit at low levels, under laboratory conditions. In both plankton, sulfamethazine (SMT) was more readily adsorbed than was sulfamethoxazole (SMX). The adsorption occurred quickly and the concentration on the plankton was stable for at least 24 h (Chaetoceros) or 5 h (Artemia). These data suggest that marine plankton may retain sulfonamides, although the adsorbed concentration per cell or individual is not high.

Crucial transcription factors in endoderm and embryonic gut development are expressed in gut-like structures from mouse ES cells.

Mouse embryonic stem (ES) cells are pluripotent and retain the potential to form an organ similar to the gut showing spontaneous contractions in vitro. The morphological features of these structures and their formation, as assessed using the hanging drop method to produce embryoid bodies (EBs), seem to be similar to those in vivo. To determine whether the same molecular mechanisms are involved in the formation process, the expression pattern of transcription factors regulating endoderm and gut development in the mouse embryo was examined by in situ hybridization and compared with in vivo expression. Expression of gene products was also examined by immunohistochemistry, and expression colocalization was analyzed with double staining. The results showed that all factors examined, that is, Sox17, Id2, HNF3beta/Foxa2, and GATA4, were expressed in both EBs and gut-like structures. Moreover, their expression patterns were similar to those in the mouse embryo. EBs after the hanging drop period and before outgrowth already expressed all factors that were colocalized with each other in EB epithelial structures. These findings suggest that the origin of the gut-like structure is determined during the hanging drop period and that the gut-like structure is formed as the epithelial structure in EBs during the hanging drop period. They also indicate that the in vitro system using mouse ES cells mimics in vivo development and should prove useful in the study of molecular mechanisms for endoderm and gut development.