BACKGROUND/AIMS: Infliximab (IFX), an antibody to tumor necrosis factor, (TNF)-alpha has efficacy in treating Crohn's disease (CD). However, knowledge of the potential effects of IFX on patients' immune profiles is lacking. The purpose of this study was to reveal the immunological effects of IFX. METHODS: Twenty-two patients with a CD activity index (CDAI) of 194.2+/-92.9 and an average duration of disease of 3.26 months and 21 healthy controls were included. Patients were to have their first IFX remission induction therapy with 3 infusions (5 mg/kg) at weeks 0, 2, and 6. Oral 5-aminosalicylic acid was the only ongoing medication in the patient population. Blood samples at baseline, 12 hours after the first infusion and at week 14 were labeled with anti-CD4/CD25 antibodies for immunohistochemical measurement of regulatory T-cells (Treg). Serum cytokines and chemokines were measured by suspension array and ELISA. RESULTS: CDAI significantly decreased prior to the second IFX infusion (p<0.001). Clinical remission rates were 77.3% and 91% by the second and third infusions, respectively. At baseline, interleukin (IL)-6 (p<0.03), IL-8 (p<0.03), IL-10 (p=0.050), IL-13 (p<0.01), transforming growth factor-beta1 (p<0.01), and 'regulated on activation, normal T cell expressed and secreted' (RANTES) (p<0.01) were elevated in patients. After the initial IFX infusion, TNF-alpha (p<0.04), IL-6 (p<0.03), interferon (IFN)-gamma (p<0.04), IFN-gamma-inducible protein-10 (p<0.01), monocyte chemoattractant protein-1 (p<0.01), macrophage inflammatory protein-1beta (p<0.01), and RANTES (p<0.01) were decreased. IFX infusion was associated with an increase in Treg (p<0.01) and a decrease in the Th1 (IFN-gamma)/Th2 (IL-4) ratio (p<0.03). CONCLUSIONS: IFX use was associated with restoration of the Th1/Th2 balance after a single infusion and seemed to promote induction of naive Th0 lymphocytes to Treg. This knowledge should have clinical relevance.
Antibodies ; Antibodies, Monoclonal ; Chemokine CCL2 ; Chemokine CCL5 ; Chemokines ; Crohn Disease ; Cytokines ; Humans ; Immune System ; Interferons ; Interleukin-10 ; Interleukin-13 ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Lymphocytes ; Macrophages ; Mesalamine ; Remission Induction ; T-Lymphocytes, Regulatory ; Tumor Necrosis Factor-alpha ; Infliximab

Objective: This study aimed to determine if the discrepancy between depression severity rated by clinicians and that reported by patients depends on key behavioral/psychological features in patients with mood disorders. Methods: Participants included 100 patients with mood disorders. First, we examined correlations and regressions between scores on the Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI). Second, we divided the participants into those who provided 1) greater ratings for the BDI compared with the HAMD (BDI relative-overrating, BO) group, 2) comparable ratings for the BDI and HAMD (BDI relatively concordant, BC) group, or 3) less ratings for the BDI (BDI relative-underrating, BU) group. Adverse childhood experiences, autistic-like traits, and coping styles were evaluated with a six-item short version of the Childhood Trauma Questionnaire (CTQ-6), the Social Responsiveness Scale for Adults (SRS-A), and the Ways of Coping Checklist (WCCL), respectively. Results: A significant correlation was found between HAMD and BDI scores. Total and emotional abuse subscale scores from the CTQ-6, and the self-blame subscale scores from the WCCL were significantly higher for the BO group compared with the BU group. The BO group also elicited significantly higher SRS-A total scores than did the other groups. Conclusion These findings suggest that patients with adverse emotional experiences, autistic-like traits, and self-blame coping styles perceive greater distress than that evaluated objectively by clinicians. The results indicate the need for inclusion of subjective assessments to effectively evaluate depressive symptoms in patients deemed to have these psycho-behavioral concerns.

Hospital A has 12 dedicated beds for patients with intractable neurological diseases, which are chronic conditions that increase dependence on medical care as they progress. Disease progression also varies by disease and by patient. Patients and their family become more anxious about discharge when they think about how much the patient’s condition has changed since admission. Caregivers must acquire specialized skills due to the patient’s increased dependence on medical care and the increased number of care tasks, and it takes time to master those skills. Discharge is associated with many financial, physical, and mental stressors, and in some cases discharge coordination is difficult and the timing for discharge is missed. We sought to investigate how to provide more efficient discharge support and conducted a case study of 3 patients with intractable neurological diseases. Here we discuss our findings and our creation of a discharge support manual that clarifies when to start discharge coordination, necessary preparations, and topics for counseling patients and caregivers.

Introduction: Recently, doping among athletes has been on the rise, and pharmacists have an important role in both the promotion of anti-doping (AD) and in providing accurate information and effective support. In this study, we examined various fact-finding surveys that targeted physical education university (PEU) students, and we focused on their use of pharmacies/drugstores, their involvement with pharmacists, and knowledge about AD. We also examined the necessary AD-related professional competencies of pharmacists. Method: Questionnaire surveys were prepared, and the responses of 1,249 students were analyzed. Results : From a survey on what students buy at pharmacies/drug stores it showed that medicines for flu common colds sell the most. Most of the students did not receive any drug consultations at pharmacies/drug stores before purchasing, because they preferred to make their own decisions about drug use. Also, many students were wary of doping with supplements. Although the students who participated in international sports competitions and events possessed a wealth of doping-related knowledge and awareness, PEU students lacked them. Discussion : We determined that it was necessary to gather relevant patient information and explore methods so that intentions could be discussed when purchasing medications from pharmacies/drug stores. We also recognized the need for early doping education programs in light of the inadequate AD-related knowledge and awareness among university student-athletes. Therefore, all pharmacists should strive to acquire a wide range of knowledge to support athletes in this effort. Furthermore, we believe that expanding the professional functions of pharmacists would increase the awareness of AD among athletes.