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Thiamine deficiency (TD) presents with various physical and psychiatric symptoms, but no cases with depression-like symptoms have been reported.
We report a patient with cancer who appeared to attempt suicide as a consequence of depressive mood likely related to TD.
The patient was a 58-year-old woman diagnosed with recurrent endometrial cancer, with lung metastasis and pelvic dissemination. The patient apparently attempted suicide was referred to the psycho-oncology department.
At the time of the examination, major depressive disorder was suspected based on her mental symptoms, but when thiamine was administered intravenously in response to her poor dietary intake, her palpitations, dyspnea, anorexia, and insomnia improved, and her suicidal ideation disappeared at her reexamination 1 hour later after thiamine administration.
Significance of results
It is likely that the observed palpitations, dyspnea, anorexia, and insomnia, as well as the severe depression and the attempted suicide, which were thought to be physical symptoms associated with depression, were actually related to TD. Suicidal ideation and attempted suicide are conspicuous as psychiatric symptoms. However, in such cases, rather than simply starting treatment for depression, it is necessary to consider reversible TD as a cause of these symptoms and perform differential diagnosis to confirm the physical illness.
Despite increasing reports of thiamine deficiency (TD) among cancer patients, there remain some patients with borderline thiamine concentrations (BTC). However, it is unclear whether such patients subsequently develop TD.
Here, we report cases of cancer patients progressing to TD within a short time period after presentation with BTC (24–28 ng/ml).
A 49-year-old female with lung cancer. During treatment for depression, the patient showed a decreased appetite, and a blood sample revealed BTC (25 ng/ml). Fourteen days later, she reported a continued loss of appetite, and despite the absence of the 3 classical signs of Wernicke encephalopathy (WE), additional testing showed a thiamine level of 23 ng/ml, leading to a diagnosis of TD.
A 65-year-old female developed depression during chemotherapy for angiosarcoma. Her blood sample revealed BTC (25 ng/ml). Seven days later, despite the absence of the classical signs of WE, a further testing revealed a thiamine level of 20 ng/ml.
A 41-year-old female developed depression during chemotherapy for ovarian cancer. No loss of appetite was observed, but a blood sample revealed BTC (25 ng/ml). Seven days later, despite the absence of the classical signs of WE or decreased appetite, further testing revealed a thiamine level of 19 ng/ml.
Significance of results
Depressed cancer patients with BTC may develop TD within a short time frame. To prevent TD, health-care professionals should maintain an awareness of its potential and the need for regular testing of thiamine level or prophylactic replacement therapy.
It is well known that the burden on the families of cancer patient extends across many aspects, but there have been no reports of family members developing delirium due to the burden of caring for a cancer patient.
We reported a caregiver who developed Wernicke encephalopathy (WE) while caring for a family member with advanced cancer.
The subject was a 71-year-old woman who had been caring for her husband, diagnosed with gastric cancer and liver metastases, for 5 months. She visited the “caregivers’ clinic” after referral by an oncologist who was worried about a deterioration in her mental condition that had appeared several weeks previously. The woman had a history of diabetes mellitus. Some giddiness was observed and, based on her inability to answer questions, her level of consciousness was checked and some disorientation was observed. She was diagnosed with delirium. A blood sample was collected to investigate the cause of the delirium, but the test data showed no hypoglycemia. Her appetite had declined since her husband was diagnosed with cancer. Thiamine deficiency was suspected as thiamine stores in the body are depleted within about 18 days and her loss of appetite had continued for 5 months. On intravenous injection of 100 mg of thiamine, her consciousness level was returned to normal in 1 h. A diagnosis of WE was supported by the patient's abnormally low serum thiamine level.
Significance of the results
The family members of cancer patients may develop a loss of appetite due to the burden of caring, resulting in WE. When providing care for signs of distress in family members, it is necessary to pay attention not only to the psychological aspects but also to their level of consciousness and physical aspects, particularly the possibility of serious illness resulting from reduced nutritional status.
Cancer patients often want to spend their final days at home, and it is essential that general practitioners have knowledge of and technical skills related to cancer medicine and symptom relief. Recent clinical studies have revealed that Wernicke encephalopathy (WE) is quite common in cancer patients. However, there have been no reports to date on WE in cancer patients undergoing home medical care.
From a series of cancer patient undergoing home medical care, we reported a patient with lung cancer who developed WE.
An 84-year-old female with lung cancer undergoing home medical care developed an impaired mental state and an attention deficit. Her symptoms fulfilled the diagnostic criteria for delirium. WE was suspected as the patient's food intake had fallen from normal a month previously to somewhere between 50% or just a few mouthfuls. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after thiamine administration.
Significance of the results
When delirium occurs in cancer patients undergoing home treatment, it is necessary to suspect thiamine deficiency as a potential cause, as appropriate diagnosis and treatment can prevent irreversible brain-related sequelae.
Cognitive dysfunction has a negative effect on cancer treatment; however, in a cancer setting, specific treatments can restore cognitive function. Such conditions are known as reversible dementia, with one of these being vitamin B12 (VB12) deficiency. However, there have been no reports of VB12 deficiency identified by preoperative evaluation in cancer patients.
We studied a patient who was referred to the Department of Psycho-oncology on suspicion of cognitive decline prior to lung cancer surgery. Preoperative evaluation revealed VB12 deficiency.
The patient was an 82-year-old woman diagnosed with lung cancer. She also presented with cognitive decline and, therefore, was referred to the Department of Psycho-oncology for preoperative evaluation. The patient scored 19 points on a Mini-Mental State Examination (MMSE), which is indicative of cognitive decline. As the onset of symptoms occurred several months previously and they were subacute, the possibility of reversible dementia was considered. Extensive examination revealed VB12 deficiency, and VB12 replacement therapy normalized the MMSE score to 25 points before surgery.
Significance of the results
When cognitive decline is observed in cancer patients, it is necessary to actively evaluate the serum levels of some B vitamins, including VB12.
Rapid progresses are achieved in catalytic CVD (Cat-CVD), often called hot-wire CVD, in the past 3-years NEDO national project in Japan. Cat-CVD technology presents many advantages in thin-film formation processes; high-efficiency of gas use, large-area deposition, no ion bombardment and low-temperature deposition even below 200°C. All of the elemental techniques for the industrially applicable Cat-CVD apparatuses, such as the suppression of the metal contamination, the precise control of the substrate temperature, the life extension of the catalyzer, 1-m size uniform deposition and the chamber cleaning, have been completely developed. Sophisticatedly designed substrate holder with electrostatic chuck and showerhead equipped with catalyzers are both key technologies for these achievements. High reproducibility for film properties is also obtained by controlling the reaction between high-density radicals and chamber walls. Prototype mass-production apparatus for SiNx passivation films in GaAs devices has been already developed and this will be probably the first application of Cat-CVD in industry. These recent movements appear to promise the drastic revolution in semiconductor and flat-panel display industries by introducing Cat-CVD in very near future.
Large grain-size polycrystalline Si (poly-Si) films are obtained on glass substrate by newly developed catalytic chemical sputtering method at low temperatures around 400 C. Si films are also epitaxially grown on (100) single-crystalline Si substrates. In the method Si films are deposited by the chemical transport of SiH4 species generated by the reaction between solid Si target and catalytically generated H atoms. Efficient deposition is realized using the remarkable difference in the etch rate depending on Si target temperatures. That is, SiH4 species are efficiently generated on cooled Si target by atomic-H etching and deposited on substrates with suppressed etching phenomena by heating. Full-width at half maximum of transverse-optical Raman signals originating from crystalline phase for the obtained poly-Si films is narrower than that for poly-Si prepared by excimer-laser annealing. It was noticeable that the grain size exceeds 1 m for the films with a thickness of about 1 m. Growth mode of poly-Si films especially in the initial stage is remarkably changed with a difference in the substrate material. It was found that formation of seed layer enhances the growth of poly-Si films on glass substrate.
This paper reports structural and electrical properties of catalytic-nitrided silicon dioxide (SiO2) films. The surface of SiO2/Si(100) was nitrided at temperatures below 573 K. It was found that the incorporated N atoms are bound to Si atoms and O atoms and located on the top-surface of SiO2. Catalytic-nitrided SiO2 films have small amounts of Si-OH bonds and adequate resistance to boron (B) penetration.
This paper reports a procedure for low-temperature nitridation of silicon dioxide (SiO2) surfaces using species produced by catalytic decomposition of NH3 on heated tungsten in catalytic chemical vapor deposition (Cat-CVD) system. The surface of SiO2/Si(100) was nitrided at temperatures as low as 200°C. X-ray photoelectron spectroscopy measurements revealed that incorporated N atoms are bound to Si atoms and O atoms and located top-surface of SiO2.
This is to review the present understanding on Cat-CVD (catalytic chemical vapor deposition) or hot wire CVD. Firstly, the deposition mechanism in Cat-CVD process is briefly mentioned along with key issues such as the effect of heat radiation and a method to avoid contamination from the catalyzer. Secondly, the properties of Cat-CVD Si-based thin films such as amorphous silicon (a-Si), polycrystalline silicon (poly-Si) and silicon nitride (SiNx) films are demonstrated, and finally, the feasibility of such films for industrial application is discussed.
This is to report the feasibility of ultra-thin silicon nitride (SiNx) films, prepared by catalytic chemical vapor deposition (Cat-CVD) method, as an ultra-thin gate insulator. In the Cat-CVD method, the deposition gases such as a gaseous mixture of silane (SiH4) and ammonia (NH 3) are decomposed by catalytic cracking reactions with a heated tungsten catalyzer placed near substrates, and SiNx films are formed at substrate temperatures around 300°C without using plasma. In the paper, additionally the effect of post-deposited treatments by using NH3-decomposed species or hydrogen (H2)-decomposed species formed by catalytic cracking of NH3 and H2 are also studied. It is found that a small hysteresis loop is seen in the C-V curve of as-deposited Cat-CVD SiNx films and that the leakage currents with thickness of 3nm equivalent oxide thickness (EOT) is slightly larger than that in the conventional thermal SiO2 of similar EOT. However, it is also found that the properties of Cat-CVD SiNx films are drastically improved by the post-deposited H2 or NH3 treatments, that is, the hysteresis loop disappears and the leakage current decreases by three orders of magnitude.
Ultra-thin silicon dioxide films can be formed at temperatures as low as 220°C by direct oxidation of Si, using active oxygen species generated by tungsten catalytic reaction in a catalytic chemical vapor deposition (Cat-CVD) system. The structural and electrical properties of such a films are investigated. It is found that the density of Si atoms in intermediate oxidation states and the density of films determined from etch rate in dilute HF solution were comparable to those of the films by a conventional thermal oxidation at 900°C. The electrical properties, breakdown electric field and leakage current were also comparable to those of thermally oxidized films.
Polycrystalline silicon (poly-Si) films are obtained at temperatures lower than 400°C by catalytic chemical vapor deposition (Catalytic CVD = Cat-CVD) method, often called hot-wire CVD method. Structural properties of the Cat-CVD poly-Si films, deposited with various gas pressures, are studied by Raman scattering spectroscopy and X-ray diffraction technique. It is found that there are two recipes for obtaining device quality poly-Si films, that is, such poly-Si films are obtained at low gas pressure around 1 mTorr or less as already reported, and also at high gas pressure around 0.1 to 1 Torr. It is also found that, in addition to catalyzer temperature, the gas pressure is a key factors to obtain device quality poly-Si films at high deposition rates.
We proposed use of a new CdF2/CaF2 heterointerface for the formation of large conduction band discontinuities to apply quantum effect devices fabricated on Si substrates. Resonant tunneling diodes using this heterointerface on Si were fabricated and negative differential resistance whose P/V current ratio of 24 at highest was observed at room temperature.
Polycrystalline silicon (poly-Si) films are deposited at temperatures lower than 300–400°C by the cat-CVD method. In the method, a SiH4 and H2 gas-mixture is decomposed by catalytic cracking reactions with a heated tungsten catalyzer placed near substrates. Carrier transport, optical and structural properties are investigated for this cat-CVD poly-Si. The films show both large carrier mobility and large optical absorption for particular deposition conditions. The cat-CVD poly-Si films are found to be one of the useful materials for thin film transistors and thin film solar cells.
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