Today, well over 160, 000 patients undergo dialysis throughout Japan. The number of patients who are newly required to receive it is increasing year by year. Given that situation, our hospital has annually held a seminar since October 1994 for patients with renal diseases. The purpose is to slow the deterioration of renal function and to delay the introduction of dialysis by encouraging the patients to acquire a habit of taking high calory, low protein food.
This seminar must have help the patients get more knowledgeable about morbidity and learn the benefit of low protein rice-based diet. Now that three years have passed since the opening of the course, we reviewed the outcome, comparing the effects of old and new restrict diets.
A difference began to appear 9-2 months after the lst seminar between the seminar participants and the non-participants (control group) who received guidance only at the outpatient ward. The average rate of decrease in the serum creatine level of those participants who eated lowprotein rice was 0.029 and that of those participants who did not eat the restricted food was 0.166 (p<0.05), compared with 0.262 in the control group. We concluded that the difference is ascribable to the effect of the seminar. We would like to contribute to the well-being of the patients by enriching the content of the seminar and continuing to hold it.

BACKGROUND/AIMS: Recent genome-wide analyses have provided strong evidence concerning adverse events caused by thiopurine drugs such as azathioprine (AZA) and 6-mercaptopurine. The strong associations identified between NUDT15 p.Arg139Cys and thiopurine-induced leukopenia and severe hair loss have been studied and confirmed over the last 2 years. However, other coding variants, including NUDT15 p.Val18_Val19insGlyVal, NUDT15 p.Val18Ile, and FTO p.Ala134Thr, and a noncoding variation in RUNX1 (rs2834826) remain to be examined in detail in this respect. Therefore, we investigated the correlation between these adverse events and the 5 recently identified variants mentioned above among Japanese patients with inflammatory bowel diseases (IBD). METHODS: One hundred sixty thiopurine-treated patients with IBD were enrolled. Genotyping was performed using TaqMan SNP Genotyping Assays or Sanger sequencing. RESULTS: None of the 5 variants were associated with gastrointestinal intolerance to AZA. However, NUDT15 p.Arg139Cys was significantly associated with the interval between initiation and discontinuation of AZA among patients with gastrointestinal intolerance. This variant was strongly associated with early (<8 weeks) and late (≥8 weeks) leukopenia and severe hair loss. Moreover, it correlated with the interval between initiation of thiopurine therapy and leukopenia occurrence, and average thiopurine dose. NUDT15 p.Val18_Val19insGlyVal, NUDT15 p.Val18Ile, FTO p.Ala134Thr, and RUNX1 rs2834826 exhibited no significant relationship with the adverse events examined. CONCLUSIONS: Of the 5 variants investigated, NUDT15 p.Arg139Cys had the strongest impact on thiopurine-induced leukopenia and severe hair loss; therefore, its genotyping should be prioritized over that of other variants in efforts to predict these adverse events in Japanese patients with IBD.
6-Mercaptopurine ; Asian Continental Ancestry Group* ; Azathioprine ; Clinical Coding ; Hair ; Humans ; Inflammatory Bowel Diseases* ; Leukopenia

Objectives: A refill-prescription system startedin April, 2022 in Japan. Refill-prescriptions can be usedrepeatedly, but pharmacists are required to check patients' medication and determine whether refills are appropriate. This study aimed to clarify the actual status of community pharmacies' treatment of prescription refills and pharmacists’ concerns about them.Design: Questionnaire survey.Methods: A self-administered questionnaire survey was conducted for pharmacists at community pharmacies from June to July, 2022, shortly after the refill-prescription system was launched, focusing on handling of prescription refills in community pharmacies, and concerns and challenges about refill-prescriptions.Results: Responses were obtainedfrom 377 pharmacists in 34 prefectures throughout Japan. Among them, 30.8% had received refill-prescriptions. Many pharmacists checked medical histories, changes in patients' symptoms, and medication and medical examination status when determining the appropriateness of refills, but few reviewed past laboratory values or laboratory values measuredby patients themselves at the time of their pharmacy visit. Moreover, 34.8% of the pharmacies had internal rules for dealing with refills, and 39.8% had equipment to measure laboratory values. Many pharmacists were concerned about how to share patients’ information with other pharmacies. Challenges that were identified included “Determining whether the refill is appropriate for the patient” and “Establishment of a pharmacy system to receive refill-prescriptions”.Conclusion: This study clarified the actual status of community pharmacies handling of prescription refills, and pharmacists' concerns or challenges about them. Potential improvements include increasing the number of devices that can measure laboratory values at pharmacies, improving home-use measuring devices, creating guidelines to determine the appropriateness of prescription refills and improving pharmacists' skills.

  Using healthy volunteers, we examined the influence of emulsified oil and a low concentration of CO2 gas on cutaneous blood flow in the forearm. The forearm of each subject was immersed in 25 liters of warm water containing either 10 ppm emulsified oil or 60 ppm CO2 gas or both. Forearm cutaneous blood flow was measured for 20 minutes. Emulsified oil had no effect on cutaneous blood flow, whereas CO2 gas caused a gradual and significant increase. When CO2 gas was used with emulsified oil, cutaneous blood flow was significantly increased in comparison to CO2 alone, suggesting that emulsified oil enhances the vasodilation caused by CO2. We then prepared bath salts releasing CO2 and emulsified oil, and tested for their influence on sweating function in sixteen healthy adults. Each subject bathed daily 10 minutes either in tap water (control group) or in tap water dissolving bath salts releasing CO2 and emulsified oil (bath-salts group) at 40°C for successive 14 days. A sweating test was performed before and after the session of bathing. In the bath-salts group, the baseline tympanic temperature after successive bathing tended to be lower than that before successive bathing. Although the rise of body temperature during the heat exposure was not different between the groups, sweating rate was significantly greater after successive bathing. The analysis of the rate of sweat expulsion suggested that the greater sweat rate after the successive bathing is mediated by the central mechanism for sweating. Such changes were not observed in the control group. Thus, successive bathing using bath salts that release CO2 and emulsified oil may have a beneficial effect on sweating function.