Nagara Medical Center introduced two computer systems that utilized data imputed into electronic medical records.  The first system was used to check cancer chemotherapy prescriptions, whereas the second system was a preparation support system that facilitates precise mixing of anticancer drugs.
  The prescription checking system made it possible to easily monitor the dose of anticancer drugs and dosing intervals utilizing data imputed into electronic medical records.  Using this system, the time required for checking was reduced significantly compared to without using the system.
  The preparation support system enables converting the dose of anticancer drugs that imputed into electronic medical records to the prepared amount automatically and checking of the amounts of drugs for drug preparations.  Drugs are checked by reading a bar code attached to a vial or ampule in order to check prepared drugs are correct.  The prepared amount of drug is checked by measuring the weight of a syringe used in preparation before and after preparation.  Using the preparation support system, the preparation time required was prolonged significantly compared to that without using the system.  However, questionnaire survey revealed that prolonged time was in the allowable range to ensure safety.
  In conclusion, it is considered that the prescription checking system introduced efficient checking of prescriptions, and that the preparation support system introduced an improvement in the accuracy of preparation.

Objective: We have used therapeutic drug monitoring (TDM) analysis software to set the initial dose of vancomycin in our hospital.  In contrast, the TDM guideline, in which the initial dose of vancomycin per body weight was set, was published in 2012.  We looked forward with utilizing the TDM guideline in the clinical setting, after which we conducted multiple surveys to determine the important points of the TDM guideline.
Methods: We surveyed patients treated with vancomycin, in whom the initial dose was set using the TDM analysis software and the concordance rate between the vancomycin dose set with the software and that set with the TDM guideline.
Results: The concordance rate of vancomycin dose was 42.1%.  The mean age of the high-dose group (vancomycin dose higher than that recommended by the TDM guideline), was younger than that of the recommended-dose group.  Additionally, the mean body weight of the high-dose group was significantly lower than that of the recommended-dose group.  The corrected creatinine clearance of the low-dose group was significantly lower than that of the recommended-dose group.
Conclusion: Our results suggest that when the initial dose is set after referring the TDM guideline in patients who are not very high age, and having low body weight and decreased renal function, the dose may differ from the dose set by using TDM analysis software.  In addition, since the recommended dose per body weight is a range and not a single value, setting the dose appropriate to target trough concentration is necessary.

This report presents the case of a patient treated with epiglottoplasty (Biller's laryngoplasty technique) for the pseudobulbar type of dysphagia associated with herpes simplex encephalitis (HSE). A 67-year-old man developed acute HSE with disturbance of consciousness and intractable aspiration. Oral intake was tried, but resulted in aspiration pneumonia and was therefore canceled at the patient's former institution. At 12 months following onset, the patient consulted our hospital and we judged that aspiration could not be controlled, and that surgical management would be needed. In order to both prevent aspiration and preserve phonation, epiglottoplasty was performed at 15 months following onset. Postoperatively, the patient was able to resume an unrestricted diet except for clear liquids. He also underwent voice rehabilitation with the support of his family and rehabilitation staff. These efforts finally enabled him to speak clearly. Epiglottoplasty is an effective treatment for intractable aspiration, but this procedure is not widely known to Japanese physiatrists. Careful patient screening and selection by the attending physiatrist is essential, as is providing adequate postoperative swallowing and voice rehabilitation.

We tested the hypothesis that a force reduction in soleus muscles from hyperthyroid rats would be associated with oxidative modification of myofibrillar proteins. Daily injection of thyroid hormone [3, 5, 3’-triiodo-_L-thyronine (T₃)] for 21 days depressed isometric forces in whole soleus muscle across a range of stimulus frequencies (1, 10, 20, 40, 75 and 100 Hz) (P<0.05). In fiber bundles, hyperthyroidism also led to pronounced reductions (P<0.05) in both K⁺- and 4-chloro-m-cresol-induced contracture forces. The degrees of the reductions were similar between these two contractures. These reductions in force production were accompanied by a remarkable increment (103% ; P<0.05) in carbonyl groups comprised in myofibrillar proteins. In additional experiments, we have also tested the efficacy of carvedilol, a non-selective β₁-β₂-blocker that possesses anti-oxidative properties. Treatment with carvedilol prevented T₃-induced oxidation of myofibrillar proteins. However, carvedilol did not improve the hyperthyroid-induced reductions in force production. These data suggest that oxidative modification of myofibrillar proteins may not account for the reductions in force production of hyperthyroid rat soleus muscle.

Purpose: We conducted a group seminar for lung cancer patients. The purpose of the group seminar was to eliminate the negative notions about opioids and to impart the right knowledge about these drugs. Further, we investigated the notions about opioids and the effectiveness of the group seminar. Methods: A pharmacist conducted a group seminar on opioids for lung cancer inpatients who agreed to participate in the group seminar. Moreover, we performed a questionnaire survey before and after the delivery of the group seminar. Results: Sixty patients answered the questionnaire. After completion of the group seminar, the understanding and knowledge about opioids increased, as indicated by the responses of the patients to all of the questions. Conclusion: Complete elimination of the negative notion about opioids could not be achieved through the group seminar. However, the group seminar was thought to be one of the useful methods of educating patients. If a patient resists treatment with opioids, control of pain may be delayed. This in turn would hamper improvement of the quality of life. Therefore, we consider that it is necessary that a patient has the right knowledge about opioids beforehand. Palliat Care Res 2011; 6(1):109-118

PREAVOID is pharmaceutical intervention that is utilized to illustrate pharmacists’ contributions to medical care.  Currently, there is a great need for pharmacists to provide good medical services to inpatients; as a result, many pharmacists conduct pharmaceutical management in hospital wards.  However, pharmacists who have limited experience in working in the ward do not know exactly what they should check with respect to pharmaceutical management.  To resolve this problem, we determined 16 pharmaceutical-management items based on PREAVOID that was conducted at Nagara Medical Center.  Moreover, we conducted a pre-questionnaire survey assessing whether pharmacists who had worked in the ward for fewer than 4 years attended to these 16 check items in their daily work prior to our introducing the list to them.  The results indicated that pharmacists who had fewer than 2 years of experience working in wards attended to the 16 check items less than those who had more than 2 years of experience, and approximately half of the pharmacists had not received adequate guidance before beginning work at the ward.  In addition, most pharmacists indicated that clear check points were useful for conducting pharmaceutical management and the 16 check items were useful for their daily work.  These results indicate that the 16 check items are a useful educational tool for enabling pharmacists to conduct high quality pharmaceutical management from the initial stage and that using the 16 check items is superior to pharmacists only gaining this ability via prolonged experience working in the ward.

In order to determine the precise mechanism of the interactions between different types of cells, which are common phenomena in tissues and organs, the importance of coculture techniques are becoming increasingly important. In the area of cardiology, artificial arteries have been developed, based on the understanding of physiological communication of the arterial smooth muscle cells (SMC), endothelial cells (EC), and the extracellular matrix (ECM). In the study of atherosclerosis, the modification of low-density lipoprotein (LDL), which result in the recruitment and accumulation of white blood cells, especially, monocytes/macrophages, and foam cell formation, are hypothesized. Although there are well known animal models, an in vitro model of atherogenesis with a precisely known atherogenesis mechanism has not yet been developed. In this paper, an arterial wall reconstruction model using rabbit primary cultivated aortic SMCs and ECs, was shown. In addition, human peripheral monocytes were used and the transmigration of monocytes was observed by scanning electron and laser confocal microscopy. Monocyte differentiation into macrophages was shown by immunohistochemistry and comprehensive gene expression analysis. With the modified form of LDL, the macrophages were observed to accumulate lipids with a foamy appearance and differentiate into the foam cells in the ECM between the ECs and SMCs in the area of our coculture model.
Animal ; Aorta/physiology* ; Aorta/cytology* ; Arteriosclerosis/etiology* ; Cell Differentiation/physiology ; Cell Movement ; Coculture ; Endothelium, Vascular/physiology ; Endothelium, Vascular/cytology ; Extracellular Matrix/metabolism ; Foam Cells/ultrastructure ; Foam Cells/cytology ; Macrophages/physiology* ; Macrophages/cytology ; Male ; Microscopy, Confocal ; Microscopy, Electron ; Microscopy, Electron, Scanning ; Monocytes/ultrastructure ; Monocytes/physiology ; Muscle, Smooth, Vascular/physiology ; Muscle, Smooth, Vascular/cytology ; Myosin/metabolism ; Protein Isoforms/metabolism ; Rabbits

PURPOSE: New alternative bait rabies vaccines applicable to pet dogs and wild animals are needed to eradicate rabies in Korea. In this study, recombinant rabies virus, ERAG3G strain was constructed using reverse genetic system and the safety, efficacy and immunogenicity of the ERAG3G strain was evaluated in mice and dogs. MATERIALS AND METHODS: Using the full-length genome mutated amino acid at position 333 of glycoprotein of rabies virus (RABV) and helper plasmids, the ERAG3G strain was rescued in BHK/T7-9 cells successfully. Mice were inoculated with the ERAG3G strain for safety and efficacy. Safety and immunogenicity of the dog inoculated with the ERAG3G strain (1 mL, 10(8.0) FAID50/mL) via intramuscular route was evaluated for 28 days after inoculation. RESULTS: The ERAG3G strain rescued by reverse genetic system was propagated well in the mouse neuroblastoma cells revealing titer of 10(8.5) FAID50/mL and was not pathogenic to 4- or 6-week-old mice that received by intramuscular or intracranical route. Immunization with the ERAG3G strain conferred complete protection from lethal RABV in mice. Dogs inoculated with the vaccine candidate via intramuscular route showed high neutralizing antibody titer ranging from 2.62 to 23.9 IU/mL at 28 days postinoculation. CONCLUSION: Our findings suggest that the ERAG3G strain plays an important role in inducing protective efficacy in mice and causes to arise anti-rabies neutralizing antibody in dogs.
Animals ; Animals, Wild ; Antibodies, Neutralizing ; Dogs ; Genome ; Glycoproteins ; Immunization* ; Korea ; Mice* ; Neuroblastoma ; Plasmids ; Rabies Vaccines ; Rabies virus* ; Rabies*