Objective: Antiplatelet therapy is useful for infraction prevention.  But, in elderly patients, adverse events are easily observed, owing to the decrease in metabolism and excretion of drugs.  Furthermore, applying guidelines for medical care of each disease does not necessarily result in good conclusions.  Therefore, we used Japanese Adverse Drug Event Report database and assessed safety signals with signal detection about adverse events developed by the antiplatelet therapy in the elderly patients.
Methods: We analyzed all adverse events reported on ticlopidine hydrochloride that should be carefully administered, and clopidogrel, bisulfate and aspirin that are recommended as the alternative drugs.  We used the proportional reporting ratio for a safety index of drugs.
Results: While some adverse events were expressed in only ticlopidine hydrochloride, bleeding signal was detected in all the subject agents.  In addition, onset risk of ticlopidine hydrochloride was found to be the lowest value.  Moreover, adverse events expressed in clopidogrel bisulfate and aspirin were of a wide-variety compared with ticlopidine hydrochloride.
Conclusion: It is necessary to carefully administer not only ticlopidine hydrochloride but also the alternative drugs to the elderly patients as indicated, and there is a need to pay careful attention to administration of the alternative drugs.

Objective: Medical education was initiated in 2012 as part of health and physical education (HPE) in junior high schools.  This new measure was a result of a revision of school curriculum guidelines.  In this study, we aimed to clarify the implementation status of medical education in schools.
Methods: A questionnaire survey targeting junior high school teachers in Gifu (from 184 junior high schools) was conducted by mail.
Results: 60.9% of schools responded (112/184).  HPE teachers and school pharmacists were found to be in charge of providing medical education in 94.6% and 10.7% of schools, respectively.  The average duration of classes was 50 min and the average frequency was 1.2 times a week.  On average, 0.9% of schools stated that implementing medical education was “under contemplation,” 2.7% held “occasional” classes, and 2.7% only held “drug abuse-related” classes.  It was also found that the most commonly used educational material was the school textbook (91.1% of schools).  Additionally, 87.5% of schools responded “yes” to “lectures are delivered by outside lecturers,” and 69.6% responded “yes” to “we hope to introduce workshop participation.”
Conclusion: The results of the survey indicated that many junior high schools have provided medical education classes and that HPE teachers were in charge of teaching these classes.  However, some schools have not provided these classes.  It is considered necessary to enhance medical education activities in the pharmaceutical field by involving specialists from different areas.

In order to examine the personal space perception, measurements were conducted on both elbows in 14 men and 46 women. Each subject, with his (or her) eyes closed and with his upper arm fixed horizontally, was instructed to stop the vertical and horizontal swing motion of his lower arm at the point he considered to be the middle of the range of possible motion on the front and side of plane at his shoulder, and this was repeated ten times. In various conditions, similar measurements were also done to study factors affecting the personal space perception in 14 men.
Mean values of bisected angles in percentage against range of motion were deviated from the middle points in the direction of the elbow extension, although there were large differences between the individuals. The deviation was smallest in the vertical. side of plane, and was larger in the horizontal plane than that in the vertical plane. The deviation was not so much affected by the various conditions.
It was suggested that the gain of the personal space perception is higher in the elbow extension than in the elbow flexion and its difference is larger in the horizontal plane than in vertical plane of the human elbow joint.

Objective: Many of the elderly patients are suffering from constipation, are using the oral laxative.  However the risk assessment of the oral laxative is not performed.  Therefore, we used Japanese Adverse Drug Event Report database (JADER) and examined for the safety of the oral laxative in the elderly patients.
Methods: Since the analysis target medicines; 12 oral laxatives and target ADEs; “digestive disorders” and “electrolyte abnormality,” the JADER database for April 2004 to January 2015 were analyzed in adults of age exceeds 60.  We used the reporting odds ratio for a safety index of drugs, using reporting odds ratio, when the Lower bound of the 95% two-sided confidence interval exceeds 1, it is the signal detection of ADE.
Results: The oral laxatives detected the signal of “digestive disorders” were three medicines, and “electrolyte abnormality” were five medicines.  Especially, for electrolyte abnormalities not only increases the blood magnesium values as magnesium oxide, that there is also affect other electrolyte revealed.
Conclusion: Some oral laxatives were also intended to signal detections of the adverse events that are not listed in the attached document, it is necessary to pay attention to the use of them for the elderly patients.

Objective: Elderly patients commonly experience adverse drug events (ADEs) owing to their poor drug metabolizing and excretion ability, and these often cause multiple organ dysfunction syndrome.  Therefore, it is important that we identify the adverse drug events early on during prognosis.  We searched for oral medicines that might exacerbate the prognosis of ADEs in elderly patients.
Methods: The objects under analysis were oral medicines that were registered in the Japanese Adverse Drug Event Report database (JADER).  The associations between the elderly/non-elderly patients and exacerbation risk/non-exacerbation risk were analyzed by risk ratios (RR).  The signal detection of exacerbation risk was defined as 95% confidence interval of lower limit of risk ratio>1 and χ²≥4.
Results: The oral medicines that might markedly exacerbate the prognosis of ADEs in the elderly patients in comparison with the ADEs of young patients included 84 items, of which 63 have not been described as potentially inappropriate medicines in all guidelines for medical treatment of the elderly patients.
Conclusion: In this study, while we could not search for oral medicines having a high risk of ADEs, we were able to search for oral medicines that might exacerbate the prognosis of ADEs in elderly patients.  This result could contribute to the proper use of medicines in the elderly patients.

Background/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP. Methods: This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses. Results: Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS. Conclusions Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

  In 2008, Japanese Society of Drug Informatics (JASDI) organized the Future Vision Committee (the Committee) to propose the essential focus of drug informatics.  To explore a future vision about the drug information sciences, it was necessary to collect a variety of opinions widely from researchers.  Therefore, at the 11^th annual meeting of JASDI in July 5-6, 2008, the Committee convened a workshop to extract problems in the researches of drug informatics by using KJ method and evaluated the contents.  The major problems raised were “the field of drug informatics is too broad” and “there is no definition and/or no system of the drug informatics”.  Related problems raised are the shortness of the history and lack of originality in the study.  From different viewpoints, it was also pointed out that the methodology of the research is not well established and no systematic education is provided.  Taken together, major problems in drug informatics are concluded to be the lack of definition and the lack of systematizations, and will be solved to a certain extent by defining the outcome of the researches in drug informatics.

Background/Aims: This study aimed to examine the synergistic effect of independent risk factors on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: This multicenter retrospective study included 1,273 patients with native papillae who underwent ERCP for bile duct stones in Japan. Independent PEP risk factors were identified using univariate and multivariate analyses. Significant risk factors for PEP in the multivariate analysis were included in the final analysis to examine the synergistic effect of independent risk factors for PEP. Results: PEP occurred in 45 of 1,273 patients (3.5%). Three factors including difficult cannulation ≥10 minutes, pancreatic injection, and normal serum bilirubin level were included in the final analysis. The incidences of PEP in patients with zero, one, two, and three factors were 0.5% (2/388), 1.9% (9/465), 6.0% (17/285), and 12.6% (17/135), respectively. With increasing risk factors for PEP, the incidence of PEP significantly increased (1 factor vs. 2 factors, p=0.006; 2 factors vs. 3 factors, p=0.033). Conclusions As the number of risk factors for PEP increases, the risk of PEP may not be additive; however, it may multiply. Thus, aggressive prophylaxis for PEP is strongly recommended in patients with multiple risk factors.

OBJECTIVETeeth can serve as records of environmental exposure to heavy metals during their formation. We applied a new technology - synchrotron radiation microbeams (SRXRF) - for analysis of heavy metals in human permanent teeth in modern and historical samples.

METHODSEach tooth was cut in half. A longitudinal section 200 mum in thickness was subjected to the determination of the heavy metal content by SRXRF or conventional analytical methods (ICP-MS analysis or reduction-aeration atomic absorption spectrometry). The relative concentrations of Pb, Hg, Cu and Zn measured by SRXRF were translated in concentrations (in g of heavy metal/g of enamel) using calibration curves by the two analytical methods.

RESULTSConcentrations in teeth in the modern females (n = 5) were 1.2 +/- 0.5 mug/g (n = 5) for Pb; 1.7 +/- 0.2 ng/g for Hg; 0.9 +/- 1.1 mug/g for Cu; 150 +/- 24.6 mug/g for Zn. The levels of Pb were highest in the teeth samples obtained from the humans of the Edo era (1603-1868 AD: ) (0.5-4.0 mug/g, n = 4). No trend was observed in this study in the Hg content in teeth during 3,000 years. The concentrations of Cu were highest in teeth of two medieval craftsmen (57.0 and 220 mug/g). The levels of Zn were higher in modern subjects (P < 0.05) than those in the Jomon (~1000 BC: ) to Edo periods [113.2 +/- 27.4 (mug/g, n = 11)]. Reconstruction of developmental exposure history to lead in a famous court painter of the Edo period (18th century) revealed high levels of Pb (7.1-22.0 mug/g) in his childhood.

CONCLUSIONSSRXRF is useful a method for reconstructing human exposures in very long trends.