1.Analysis of the Drug Monitoring Information by Using the CYP-Database for Predicting Drug-Drug Interactions
Katsunori Yamaura ; Maki Shimada ; Noriyuki Nakayama ; Masanori Ogawa ; Tadashi Nomoto ; Eiji Nakano ; Takao Namiki ; Koichi Ueno
Japanese Journal of Drug Informatics 2011;12(3):111-116
Objective: In the previous study, the CYP database was constructed in order to relate drug-drug interactions to the CYP metabolic information of the package inserts. In this study, we evaluated the clinical usefulness of the CYP database by using the Pharmaceutical and Medical Devices Agency (PMDA) Drug Monitoring Information.
Methods: We examined the drugs in CYP isoform responsible for drug metabolism. The age, sex, suspect drugs and co-administered drugs were extracted from 6,236 cases of the PMDA database of drug monitoring from January till November of 2008.
Results: Twenty-three percent of all cases had co-administered drugs. Forty-five percent of these cases were metabolized both suspect and co-administered drugs by the same CYP isoform, and three fourths of these cases were able to be detected only by the CYP database. In addition, the administration of substrate medicines in combination with substrate medicines was the largest (57%), followed by cases of substrate medicines in combination with inhibitor medicines (28%). Seventy-seven percent of the suspect drugs that had a large number of reported cases of side effects were substrate medicines, and the frequency of co-administration with substrate medicines was very high.
Conclusion: These data suggest that the CYP database, being used together with package inserts, might be a clinically useful tool to avoid adverse events caused by drug-drug interactions.
2.Impact of Serum Triglyceride and High Density Lipoprotein Cholesterol Levels on Early-Phase Insulin Secretion in Normoglycemic and Prediabetic Subjects.
Masanori SHIMODAIRA ; Tomohiro NIWA ; Koji NAKAJIMA ; Mutsuhiro KOBAYASHI ; Norinao HANYU ; Tomohiro NAKAYAMA
Diabetes & Metabolism Journal 2014;38(4):294-301
BACKGROUND: Increased triglycerides (TGs) and decreased high density lipoprotein cholesterol (HDL-C) levels are established as diabetic risks for nondiabetic subjects. The aim of this study was to investigate the relationship among TG, HDL-C, TG/HDL-C ratio, and early-phase insulin secretion in normoglycemic and prediabetic subjects. METHODS: We evaluated 663 Japanese subjects who underwent the 75-g oral glucose tolerance test. On the basis of these results, the subjects were divided into four groups: those with normal glucose tolerance (NGT; n=341), isolated impaired fasting glucose (i-IFG; n=211), isolated impaired glucose tolerance (i-IGT; n=71), and combined IFG and IGT (IFG+IGT; n=40). Insulin secretion was estimated by the insulinogenic index (IGI) (Deltainsulin/Deltaglucose [30 to 0 minutes]) and disposition index (DI) (IGI/homeostasis model assessment of insulin resistance). RESULTS: In prediabetic subjects (i-IFG, i-IGT, and IFG+IGT), linear regression analyses revealed that IGI and DI were positively correlated with HDL-C levels. Moreover, in subjects with i-IGT and (IFG+IGT), but not with i-IFG, the indices of insulin secretion were negatively correlated with the log-transformed TG and TG/HDL-C ratio. In both the subjects with i-IGT, multivariate linear regression analyses revealed that DI was positively correlated with HDL-C and negatively with log-transformed TG and TG/HDL-C ratio. On the other hand, in subjects with NGT, there was no association between insulin secretion and lipid profiles. CONCLUSION: These results revealed that serum TG and HDL-C levels have different impacts on early-phase insulin secretion on the basis of their glucose tolerance status.
Asian Continental Ancestry Group
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Cholesterol, HDL*
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Fasting
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Glucose
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Glucose Tolerance Test
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Hand
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Humans
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Insulin*
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Linear Models
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Triglycerides*
3.Muscle mechanoreflex of lower-extremity antigravity muscles is small during upright standing in young females with orthostatic hypotension who have not undergone exercise training
Takafumi NAKAYAMA ; Masanori SAKAMOTO ; Hirotoshi IFUKU
Japanese Journal of Physical Fitness and Sports Medicine 2022;71(6):479-492
Lower-extremity antigravity muscle contraction (the static muscle pump and muscle mechanoreflex) and the baroreflex are involved in regulating blood pressure (BP) during upright standing. We hypothesized that in females with orthostatic hypotension (showing a decrease > 20/10 mmHg within 3 min upon standing from supine), the muscle pump and mechanoreflex of the antigravity muscles is small during upright standing in those who have not undergone exercise training. To test this hypothesis, we compared the cardiovascular responses to head-up tilt, head-up suspension, head-up tilt + venous occlusion (which stops venous return from the lower extremities by static muscle pump), and head-up suspension + venous occlusion of 14 young females with orthostatic hypotension, of which seven had undergone exercise training (tOH) and seven had not (uOH), with those of eight females with orthostatic normotension (control) who had not undergone exercise training. Changes in BP, heart rate (HR), and stroke volume (SV) during both head-up tilt and suspension were measured. Although the increase in HR was larger and the decrease in SV tended to be smaller during head-up tilt than during suspension in the tOH, the response patterns of both were the same in the uOH. In occlusion trials, the increase in HR was larger during head-up tilt than during suspension in the tOH, whereas the increases in HR in both scenarios were the same in the uOH. These findings suggest a small muscle mechanoreflex of the antigravity muscles during upright standing in females with orthostatic hypotension who have not undergone exercise training.
4.The Physicians’ Barriers to Practice of Advance Care Planning:A Single Facility Questionnaire Survey
Tomohiro NAKAYAMA ; Takeshi YOSHIDA ; Masanori MORI
Palliative Care Research 2021;16(1):19-25
Background: Although practicing advanced care planning (ACP) has recently been recommended, little is known about physicians’ practice of ACP, and barriers to ACP in Japan. We aimed to clarify the proportion of physicians practicing ACP and explore barriers to ACP. Methods: We conducted a cross-sectional survey among physicians at a tertiary hospital (934 beds) in 2019, and asked them about their practice and awareness of ACP as well as beliefs regarding end-of-life discussions. A multivariate logistic regression analysis was conducted to explore barriers to their practice of ACP. Results: In total, 90 of 186 physicians responded (response rate, 48%). Forty-two (46%; 95% confidence interval=37-57%) reported that they practiced ACP. In multivariate analysis, determinants of “not” practicing ACP included the lack of awareness of ACP and physicians’ greater beliefs regarding the lack of resources as well as the lack of time and perception of burden. Conclusion: Even at the tertiary hospital, only less than a half of physicians practiced ACP, and the lack of their awareness of ACP and various beliefs served as barriers to their practice. Initiatives to raise awareness of ACP and optimize the management to ensure sufficient time and resources for physicians may be promising to promote ACP.
5.Contraindication of Minimally Invasive Lateral Interbody Fusion for Percutaneous Reduction of Degenerative Spondylolisthesis: A New Radiographic Indicator of Bony Lateral Recess Stenosis Using I Line
Ken ISHII ; Norihiro ISOGAI ; Yuta SHIONO ; Kodai YOSHIDA ; Yoshiyuki TAKAHASHI ; Kenichiro TAKESHIMA ; Masanori NAKAYAMA ; Haruki FUNAO
Asian Spine Journal 2021;15(4):455-463
Retrospective cohort study. This study aimed to evaluate aggravated lateral recess stenosis and clarify the indirect decompression threshold by combined lateral interbody fusion and percutaneous pedicle screw fixation (LIF/PPS). No previous reports have described an effective radiographic indicator for determining the surgical indication for LIF/PPS. A retrospective review of 185 consecutive patients, who underwent 1- or 2-level lumbar fusion surgery for degenerative spondylolisthesis (DS). According to their symptomatic improvement, they were placed into either the “recovery” or “no-recovery” group. Preoperative computed tomography (CT) images were evaluated for the position of the superior articular processes at the slipping level, followed by a graded classification (grades 0–3) using the impingement line (I line), a new radiographic indicator. All 432 superior articular facets in 216 slipped levels were classified, and both groups’ characteristics were compared. There were 171 patients (92.4%) in the recovery group and 14 patients in the no-recovery group (7.6%). All patients in the no-recovery group were diagnosed with symptoms associated with deteriorated bony lateral recess stenosis. All superior articular processes of the lower vertebral body in affected levels reached and exceeded the I line (I line-; grade 2 and 3) on preoperative sagittal CT images. In the recovery group, most superior articular processes did not reach the I line (I line+; grade 0 and 1; In DS cases that are classified as grade 2 or greater, the risk of aggravated bony lateral recess stenosis due to corrective surgery is high; therefore, indirect decompression by LIF/PPS is, in principle, contraindicated.
6.Contraindication of Minimally Invasive Lateral Interbody Fusion for Percutaneous Reduction of Degenerative Spondylolisthesis: A New Radiographic Indicator of Bony Lateral Recess Stenosis Using I Line
Ken ISHII ; Norihiro ISOGAI ; Yuta SHIONO ; Kodai YOSHIDA ; Yoshiyuki TAKAHASHI ; Kenichiro TAKESHIMA ; Masanori NAKAYAMA ; Haruki FUNAO
Asian Spine Journal 2021;15(4):455-463
Retrospective cohort study. This study aimed to evaluate aggravated lateral recess stenosis and clarify the indirect decompression threshold by combined lateral interbody fusion and percutaneous pedicle screw fixation (LIF/PPS). No previous reports have described an effective radiographic indicator for determining the surgical indication for LIF/PPS. A retrospective review of 185 consecutive patients, who underwent 1- or 2-level lumbar fusion surgery for degenerative spondylolisthesis (DS). According to their symptomatic improvement, they were placed into either the “recovery” or “no-recovery” group. Preoperative computed tomography (CT) images were evaluated for the position of the superior articular processes at the slipping level, followed by a graded classification (grades 0–3) using the impingement line (I line), a new radiographic indicator. All 432 superior articular facets in 216 slipped levels were classified, and both groups’ characteristics were compared. There were 171 patients (92.4%) in the recovery group and 14 patients in the no-recovery group (7.6%). All patients in the no-recovery group were diagnosed with symptoms associated with deteriorated bony lateral recess stenosis. All superior articular processes of the lower vertebral body in affected levels reached and exceeded the I line (I line-; grade 2 and 3) on preoperative sagittal CT images. In the recovery group, most superior articular processes did not reach the I line (I line+; grade 0 and 1; In DS cases that are classified as grade 2 or greater, the risk of aggravated bony lateral recess stenosis due to corrective surgery is high; therefore, indirect decompression by LIF/PPS is, in principle, contraindicated.
7.The Effect of High-flow Nasal Cannula Oxygen for Dyspnea in Patients with Advanced Disease: Systematic Review
Sho GOYA ; Yasushi NAKANO ; Hiroaki TSUKUURA ; Yusuke TAKAGI ; Hiroaki WATANABE ; Yoshinobu MATSUDA ; Jun KAKO ; Yoko KASAHARA ; Hiroyuki KOHARA ; Masanori MORI ; Takeo NAKAYAMA ; Takashi YAMAGUCHI
Palliative Care Research 2023;18(4):261-269
Objective: To evaluate the efficacy of high-flow nasal cannula oxygen (HFNC) for dyspnea in patients with advanced disease. Methods: A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Ichu-shi Web. Inclusion criteria were: 1) randomized controlled trials evaluating the effect of HFNC on dyspnea; 2) aged 18 years or older with advanced disease with hypoxemia; 3) control group was conventional oxygen therapy or noninvasive positive pressure ventilation. Exclusion criteria were: 1) patients in intensive care unit, 2) weaning from ventilator. Results: Six studies (4 from database searches, and 2 from hand searches) were included. In the 2 studies evaluating short-term intervention, one showed HFNC was more efficacious, and the other conventional oxygen was more efficacious. In the 2 studies evaluating long-term interventions: one showed HFNC was more efficacious, and the other showed no significant difference. In the 2 studies evaluating the intervention during exercise, one showed HFNC was more efficacious, and the other showed no significant difference. Conclusion: HFNC may be effective for dyspnea in patients with advanced disease associated with hypoxemia.