Before the introduction of high density barium for contrast studies of the upper gastrointestinal tract, we conducted a survey concerning the adverse reactions to a swallow of barium and barium concentration.
The incidence of side effects rose as the density of barium increased but the effects were transient. There were no cases requiring medical treatment.
Furthermore, the constipation group and the normal group were examined separately.
The ratio of adverse reactions was high in the constipation group even when the barium density was low. In this group stool hardening and delayed excertion were also noticed.
The constancy of barium stool excretion was basically normal, and the barium density had little effect.
The effects of a laxative on the excretion consistency were investigated. The administration of a laxative did not always have a positive affect on excretion. The timing of the administration of the laxative and the amount of water intake should be examined in the future.
We also investigated how the patients feel when they are swallowing barium. We found that whether feel uncomfortable or not depended on the properties of barium rather than its density.
From these results it appears that appropriate guidance is necessary about the use of high density barium, in order to supress the occurrence of side effects, especially in the constipation group.

Objective: The revised Pharmaceutical Affairs Act that came into force in June 2009 prohibits the sale of nonprescription drugs via mail.  However, as a provisional measure, regular users and inhabitants of remote islands who do not have access to pharmacies or drug stores are allowed to purchase nonprescription drugs via mail until the end of May 2013.  This study involves a survey on the purchasing of nonprescription drugs by Internet-illiterate inhabitants of the remote Goto Islands, Nagasaki Prefecture, Japan.
Methods: Our process began with the distribution of questionnaires via mail to inhabitants of the remote Goto Islands, of whom 3,819 were randomly selected.  The responses were sent between January 22 and February 26, 2011.  We analyzed problems presented by 522 inhabitants who were Internet-illiterate.
Results: The results revealed that 57.3% of the respondents living on large islands—with pharmacies, drug stores, and pharmacists— (e.g., Fukueshima) and 85.3% of respondents living on small islands scattered around large islands—with none of the abovementioned amenities— (e.g., Maeshima) were Internet-illiterate.  Additionally, a majority of the respondents (more than 80%) felt no need to purchase nonprescription drugs over the Internet.  However, considering that a handful of these inhabitants do, or will at some time need to purchase nonprescription drugs over the Internet, we strive to establish an optimal system for supplying medications to these Internet-illiterate inhabitants.
Conclusion: Community pharmacists need to establish close relationships with the Internet illiterate (particularly those living on small islands) and promote the overall appropriate use of medicinal products.

Although numerous studies have shown that each neuropsychological test is effective for diagnosing mild cognitive impairment (MCI) or Alzheimer’s disease (AD), studies comparing diagnostic accuracies of various neuropsychological tests are relatively rare and practical cutoff values are not available. The present study aimed to investigate the validity of neuropsychological tests and develop cutoff values for each in differentiating healthy control (HC), MCI and AD groups. A total of 84 HC, 187 with MCI and 195 with AD were evaluated by the selected seven neuropsychological tests using receiver operating characteristic (ROC) curve analysis. Logical Memory (LM) delayed recall (cutoff, 7) and Rey Auditory Verbal Learning Test (RAVLT) delayed recall (cutoff, 6) were effective for differentiating HC from MCI. To distinguish MCI and AD, Rey Osterrieth Complex Figure Test (ROCFT) 3 mindelayed recall (cutoff, 6) and LM immediate recall (cutoff, 4) were excellent. Delayed recall of verbal materials, as indexed by LM and RAVLT was sensitive for discriminating MCI from HC. Handling visual memory traces, as indexed by ROCFT and immediate verbal information by LM were sensitive for differentiating MCI and AD.
Alzheimer Disease ; Dementia ; Neuropsychological Tests

AIMTo evaluate the occurrence and prevalence of microdeletions in the gamma chromosome of patients with azoospermia.

METHODSDNA from 29 men with idiopathic azoospermia was screened by polymerase chain reaction (PCR) analysis with a set of gamma chromosome specific sequence-tagged sites (STSs) to determine microdeletions in the gamma chromosome.

RESULTSDeletions in the DAZ (deleted in azoospermia) loci sgamma254 and sgamma255 were found in three patients with idiopathic azoospermia, resulting in an estimated frequency of deletions of 10.7% in idiopathic azoospermia men.

CONCLUSIONWe conclude that PCR analysis is useful for the diagnosis of microdeletions in the Y chromosome, which is important when deciding the suitability of a patient for assisted reproductive technology such as testicular sperm extracion-intracytoplasmic sperm injection (TESE-ICSI).

Adult ; Base Sequence ; Chromosomes, Human, Y ; DNA Primers ; Euchromatin ; genetics ; Follicle Stimulating Hormone ; blood ; Heterochromatin ; genetics ; Humans ; Luteinizing Hormone ; blood ; Male ; Oligospermia ; blood ; etiology ; genetics ; Polymerase Chain Reaction ; Prolactin ; blood ; Sequence Deletion ; genetics ; Sequence Tagged Sites ; Testosterone ; blood

OBJECTIVE: To analyze whether sufficient energy intake (EI) improves performance of activities of daily living (ADL) in patients with hip fracture admitted to rehabilitation hospitals. The adequate amount of EI for improving performance of ADL in patients with hip fracture remains unknown. METHODS: This retrospective cohort study included all patients with hip fracture (n=234) admitted to rehabilitation hospitals in Japan. The inclusion criteria for this study were age >65 years and body mass index <30.0 kg/m². Patients who were transferred to an acute hospital and those with missing case data were excluded. According to the amount of EI, the patients were classified into energy sufficiency and shortage groups (EI/total energy expenditure ≥1.0 and <1.0, respectively). The Functional Independence Measure (FIM) and FIM gain were used to evaluate the patient disability level and change in patient status in response to rehabilitation. Finally, FIM gain was calculated as the discharge FIM score minus the admission FIM score. RESULTS: The final analysis targeted 202 patients—53 (26.2%) were in the energy shortage group and 149 (73.8%) were in the energy sufficiency group. The energy sufficiency group had a greater FIM gain than the energy shortage group (mean, 25.1±14.2 vs. 19.7±16.4; p=0.024). Furthermore, sufficient EI in the first week since admission (β=0.165; 95% confidence interval, 0.392–5.230; p=0.023) was an independent factor of FIM gain. CONCLUSION: Among elderly patients with hip fracture admitted to rehabilitation hospitals in Japan, the amount of EI during the first week after admission was an independent factor of FIM gain.
Activities of Daily Living ; Aged ; Body Mass Index ; Cohort Studies ; Energy Intake ; Energy Metabolism ; Femoral Fractures ; Hip ; Humans ; Japan ; Nutritional Support ; Recovery of Function ; Rehabilitation ; Retrospective Studies

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.

Objective: Adverse reactions are sometimes induced by contrast media used for medical imaging and can be life-threatening. Thus, appropriate management is important for patient safety. The purpose of this study was to clarify the actual management of adverse reactions induced by contrast media in hospitals, the opportunities for intervention by hospital pharmacy departments and the attitudes of hospital pharmacists regarding the risk of adverse reactions.Methods: A self-administered questionnaire survey was conducted in the pharmacy departments of 16 hospitals (approximately 200 to 1,000 beds) located in the Tokyo metropolitan area of Japan. The survey asked about the presence or absence of internal rules or manuals regarding contrast media administration at each hospital, the management status of patients with risk factors for adverse reactions, the opportunities for interventions by pharmacists, and the opportunities for discussion regarding contrast media administration among pharmacists and other professionals.Results: Of the 16 hospitals, 10 responded to the questionnaires, and 7 of them had internal rules or manuals. These rules or manuals stipulated actions such as “do not administer contrast media” to patients with risk factor(s) for adverse reactions. For inpatients, there were opportunities for pharmacist interventions, such as drug management and guidance services and initial interviews upon hospital admission. However, for outpatients the opportunities for interventions were limited. At 5 of the 10 hospitals, pharmacists discussed contrast administration with physicians, radiologists, and other healthcare professionals.Conclusion: The present study reveal that many hospitals take great care in deciding on the administration of contrast media to patients at risk of adverse drug reactions. Our results indicate that the limited opportunities for “outpatient intervention" is an issue in the hospital pharmacy department's participation for proper use of contrast media.

Objective: Contrast media side effects range from minor ones such as itching and vomiting to life-threatening ones such as hypotension and loss of consciousness. The purpose of this study was to determine how contrast media side effects are actually managed in hospitals nationwide, as well as to identify opportunities for the pharmacy department to be involved in contrast media administration, and pharmacists’ awareness of the risk of contrast media side effects. Methods: A self-administered, unmarked questionnaire survey was conducted in the pharmacy departments of 2,000 hospitals nationwide. The survey asked about the existence of internal rules and manuals regarding contrast media at each facility, how to deal with patients at risk for side effects, opportunities for intervention with patients by the pharmacy department, and opportunities for discussion among pharmacists and other professionals regarding the administration of contrast media. Results: Of the 2,000 facilities, 96 responded to the questionnaire, among which 69 had internal regulations or manuals. In those with manuals, the manuals stipulated measures such as not administering contrast media or administering premedication in the case of patients with a history of contrast media side effects. In facilities where the manual recommended premedication, it was found that premedication was administered in both inpatient and outpatient settings. Regarding the role of the pharmacy department, it was found that intervention in all items related to risk factors for adverse drug reactions was achieved for only about 10% of the outpatients. Conclusion: This study revealed that many facilities are involved in the management of contrast media side effects. The results indicate that there is scope for pharmacy departments to intervene more proactively in outpatient settings to ensure appropriate contrast media use in the future.

Prolonged cough in coronavirus disease 2019 (COVID-19) is not only uncomfortable for patients, but also prolongs the length of stay in an isolation facility. This results in delays in patients' return to their daily life. Therefore, the prompt treatment of cough is important. In this report, we used Japanese traditional (Kampo) medicine, chikujountanto for the treatment of cases with residual cough, airway secretions, slight fever, anxiety, and insomnia, several days after the onset of coronavirus. From October 2020 to September 2021, we prescribed chikujountanto for thirty-three COVID-19 patients with prolonged cough in an isolation facility. Seven patients (6 women and 1 man with ages ranging 37-70 years) were treated with no other medication. Comorbid symptoms included slight fever, sputum, sore throat, nasal discharge, headache, anxiety/insomnia, and taste/olfactory disorders. The start date of treatment ranged from 9 to 21 days after the onset of COVID-19, and the time until cough and comorbid symptoms improved to values less than NRS 2 or less, was 2 to 6 days after treatment. Three patients had persistent cough and needed to switch to other medication. In COVID-19, chikujountanto may be useful for coughing during the period when the peak of the viral proliferative phase has passed but airway inflammation is still present.