Prostaglandin (PG) D2 and PGE2 are positional isomers; however, they sometimes exhibit opposite physiological functions, such as in cancer development. Because DP receptors are considered to be a duplicated copy of EP2 receptors, PGD2 and PGE2 cross‐react with both receptors. These prostanoids may act as biased agonists for each receptor. In reviewing this field, a hypothesis was proposed to explain the opposed effects of these prostanoids from the viewpoints of the evolution of, mutations in, and biased activities of their receptors. (...) Previous findings showing more mutations/variations in DP receptors than EP2 receptors among individuals worldwide indicate that DP receptors are still in a rapid evolutionary stage. The opposing effects of these prostanoids on cancer development may be attributed to the biased activity of PGE2 for DP receptors, which may incidentally develop during the process of the old ligand, PGE2 gaining selectivity to newly diverged DP receptors. (shrink)

A one-dimensional scattering problem off a δ-shaped potential is solved analytically and the time development of a wave packet is derived from the time-dependent Schrödinger equation. The exact and explicit expression of the scattered wave packet supplies us with interesting information about the “time delay” by potential scattering in the asymptotic region. It is demonstrated that a wave packet scattered by a spin-flipping potential can give us quite a different value for the delay times from that obtained without spin-degrees of (...) freedom. (shrink)

BackgroundEach individual’s unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient’s preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship.Case presentationA 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. (...) We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient’s life due to concerns about the validity of her report.ConclusionsVariations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives. (shrink)

The aim of this study was to review the typical factors related to physician’s liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain.

BackgroundA physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability.MethodsWe analysed legal decisions of medical malpractice cases between (...) 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed.ResultsWhen the physician's explanation was given before treatment or surgery (p = 0.006), when it was relevant or specific (p = 0.000), and when the patient's consent was obtained (p = 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment.ConclusionThese findings may be useful in improving physician-patient communication in the medical setting. (shrink)

The philosopher and author of How Should We Live? presents “a clear and provocative discussion of issues such as boredom, hypocrisy, evil, and innocence”. In this book, John Kekes draws on anthropology, history, and literature to offer practical insights into the common predicaments we all face in our daily lives. Each chapter offers new ways of thinking about a common, fundamental problem, such as facing difficult choices, uncontrollable contingencies, complex evaluations, the failures of justice, the miasma of boredom, and the (...) inescapable hypocrisies of social life. In each case, Kekes discusses how others in different times and cultures have approached similar issues. Kekes examines what is good, bad, instructive, and dangerous in the Hindu caste system, Balinese role-morality, the sexually charged politics of the Shilluk, the religious passion of Cortes and Simone Weil, the fate of Colonel Hiromichi Yahara during and after the battle for Okinawa, the ritual human sacrifices of the Aztecs, and the tragedies to which innocence may lead. In doing so, he enlarges our understanding of the possibilities available to us as we struggle with the common obstacles of modern life. (shrink)