At Anjo Kosei Hospital, patients receive injectable medication for diabetes treatment and devices for self-monitoring of blood glucose as in-hospital prescriptions. Pharmacists manage prescriptions according to established protocols when there is over- or under-prescribing. In this study, we retrospectively examined outpatient prescriptions for patients attending endocrinology and diabetology from January 2014 to June 2015 (before protocol implementation) and from July 2015 to December 2020 (after protocol implementation) to evaluate the usefulness of protocol-based supporting prescription by pharmacists. Changing prescriptions based on the protocol simplified prescription queries in 661 of 721 cases (91.7%), and significantly decreased the rate of unplanned doctor visits after the introduction of the protocol (p<0.05). Optimization of prescriptions through protocol-based assistance in prescribing is expected to reduce the burden on physicians, patients, and pharmacists by reducing the number of formal inquiries for questionable prescriptions and the number of unplanned doctor visits.

Purpose: To investigate the clinical significance of adaptive radiotherapy (ART) in locally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT). Materials and Methods: Eligible patients were treated with concurrent chemoradiotherapy using IMRT. Planning computed tomography in ART was performed during radiotherapy, and replanning was performed. Since ART was started in May 2011 (ART group), patients who were treated without ART up to April 2011 (non-ART group) were used as the historical control. The Kaplan-Meier method was used to calculate overall survival (OS), locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). LRFS for the primary tumor (LRFS_P) and regional lymph node (LRFS_LN) were also studied for more detailed analysis. Statistical significance was evaluated using the log-rank test for survival. Results: The ART group tended to have higher radiation doses. The median follow-up period was 127 months (range, 10 to 211 months) in the non-ART group and 61.5 months (range, 5 to 129 months) in the ART group. Compared to the non-ART group, the ART group showed significantly higher 5-year PFS (53.8% vs. 81.3%, p = 0.015) and LRFS (61.2% vs. 85.3%, p = 0.024), but not OS (80.7% vs. 80.8%, p = 0.941) and DMFS (84.6% vs. 92.7%, p = 0.255). Five-year LRFS_P was higher in the ART group (61.3% vs. 90.6%, p = 0.005), but LRFS_LN did not show a significant difference (91.9% vs. 96.2%, p = 0.541). Conclusion Although there were differences in the patient backgrounds between the two groups, this study suggests the potential effectiveness of ART in improving locoregional control, especially in the primary tumor.

Objective: This study aimed to investigate the accuracy and precision of continuous, non-invasive blood pressure obtained using the ClearSight system by comparing it with invasive arterial blood pressure, and to assess the hemodynamic changes using invasive methods and the ClearSight system in patients undergoing cesarean section. Methods: Arterial pressure was measured invasively with an intra-arterial catheter and non-invasively using the ClearSight system during cesarean section in patients with placenta previa or placenta accreta. Blood pressure measurements obtained using these two means were then compared. Results: Total 1,277 blood pressure measurement pairs were collected from 21 patients. Under Bland-Altman analysis, the ClearSight system demonstrated an acceptable accuracy with a bias and standard deviation of 8.8±13.4 mmHg for systolic blood pressure, -6.3±7.1 mmHg for diastolic blood pressure, and -2.7±8.0 mmHg for median blood pressure. Cardiac index levels were significantly elevated during fetal delivery and 5 minutes after placental removal, and systemic vascular resistance index levels were significantly decreased during fetal delivery and 40 minutes after placental removal. Conclusion In patients undergoing cesarean section, the ClearSight system showed excellent accuracy and precision compared to that of the currently used invasive monitoring system.

BACKGROUND: We investigated whether family histories of herpes zoster (HZ) are associated with the risk of incident HZ in a Japanese population. METHODS: A total of 12,522 Japanese residents aged ≥50 years in Shozu County participated in the baseline survey between December 2008 and November 2009 (the participation rate = 72.3%). They were interviewed at baseline by research physicians regarding the registrants' history of HZ. A self-administered questionnaire survey was conducted to evaluate the potential confounding factors. 10,530 participants without a history of HZ were followed up to ascertain the incidence of HZ during 3-years follow-up until the end of November 2012 with Japanese nationals. We estimated hazard ratios (HRs) of incident HZ according to first-degree family histories using the Cox proportional hazard regression after adjusting for age, sex, and other potential confounding factors. RESULTS: Compared to no HZ history of each family member, a history of brother or sister was associated with a higher risk of incident HZ while histories of father and mother were not. The multivariable HR (95%CI) of incident HZ for a history of brother or sister was 1.67 (1.04-2.69). When comparing to no family histories of all first-degree relatives, the multivariable HRs (95%CIs) were 1.34 (0.77-2.34) for a history of brother or sister alone, but 4.81 (1.78-13.00) for a history of mother plus brother or sister. As for the number of family histories, the multivariable HRs (95%CIs) were 1.08 (0.76-1.54) for one relative (father, mother, or brother or sister) and 2.75 (1.13-6.70) for two or more relatives. CONCLUSION Family histories of mother plus brother or sister and two or more first-degree relatives were associated with a higher risk of incident HZ.
Female ; Herpes Zoster/epidemiology* ; Humans ; Incidence ; Male ; Mothers ; Proportional Hazards Models

Objective: The aim of this study is to elaborate on the nutritional intervention in a multimodal intervention (the NEXTAC-ONE program) for the elderly with advanced cancer and to evaluate its tolerability Methods: We prospectively recruited patients aged ≥70 years scheduled to receive first-line chemotherapy for advanced pancreatic or non-small-cell lung cancer. Three nutritional intervention were planned in 8-week study period. The nutritional counseling consists of standard nutritional advice, evaluation and support for nutrition impact symptom, and evaluation and support for eating-related distress and food environment problems. We also provide the oral nutritional supplements rich in Branched Chain Amino Acids (BCAA). Results: 29 patients (96%) of a total of 30 study registrants participated in all three nutrition interventions. Median proportion of days in which patients recorded a nutritional diary was 90%. Median consumption of supplements was 99 %. There was no adverse event associated with nutritional intervention. Conclusions: Our nutritional intervention program showed an excellent compliance in the elderly with advanced cancer patients, and our data indicated a potential protective effect on nutritional deterioration.

Vitamin D (VD) is essential for bone health, and VD or its analogues are widely used in clinics to ameliorate bone loss. The targets and mode of VD anti-osteoporotic actions appear to be different from those of other classes of drugs modulating bone remodeling. VD exerts its biological activities through the nuclear VD receptor (VDR)-mediated transcriptional regulation of target mRNA and non-coding RNA genes. VD-induced gene regulation involves epigenetic modifications of chromatin conformation at the target loci as well as reconfiguration of higher-order chromosomal organization through VDR-mediated recruitment of various regulatory factors. Enhancer RNAs (eRNA), a class of non-coding enhancer-derived RNAs, have recently emerged as VDR target gene candidates that act through reorganization of chromatin looping to induce enhancer-promoter interaction in activation of mRNA-encoding genes. This review outlines the molecular mechanisms of VD actions mediated by the VDR and suggests novel function of eRNAs in VDR transactivation.
Bone Remodeling ; Chromatin ; Epigenomics ; Metabolism ; Receptors, Calcitriol ; RNA ; RNA, Messenger ; RNA, Untranslated ; Transcriptional Activation ; Vitamin D ; Vitamins

Objectives: We developed the multimodal program Nutrition and Exercise Treatment for Advanced Cancer (NEXTAC program). The aim of our study is to show algorithm of the home-based resistance training prescription and its compliance. Methods: We recruited 30 patients aged≥70 years scheduled to receive first-line chemotherapy for advanced pancreatic or non-small-cell lung cancer. Three educational sessions were planned in 8-week study period. Our resistance training consists of 3 or 5 of following 5 exercises components: (1) sit-to-stand, (2) calf raise, (3) knee extension, (4) knee raise, (5) side leg raise. Physiotherapist chose optimal prescription according to the modified Borg-scale. We assessed patient compliance, and safety. Results: Median proportion of days in which patients performed full or modified exercise program was 91%. Adverse events possibly related to the NEXTAC program were observed in 5 patients and included muscle pain (grade 1 in 2 patients), arthralgia (grade 1 in one patient), dyspnea on exertion (grade 1 in one patient), and plantar aponeurositis (grade 1 in one patient). Patient physical function and physical activity were maintained during the study period. Conclusion: Our resistance training showed excellent compliance and safety in elderly patients with newly diagnosed pancreatic and non-small-cell lung cancer receiving concurrent chemotherapy. Although this study was not designed to show the efficacy of the resistance training, our data indicate a potential protective effect on physical function and physical activity.

Aggressive anticoagulation therapy is necessary when Toyobo-LVAS is used for long-term treatment of severe heart failure. However, it is necessary to regulate it carefully if there is a hemorrhagic complication due to thromboembolism, but repeated blood testing is painful. We compared simple measurement with the CoaguChek XS^® with the conventional blood testing method. The correlation coefficient was 0.916, and the regression line was Y=0.8027X+0.3399. In addition, drawing blood using the CoaguChek XS^® was very effective in the reported pain reduction in patients.

Although the patent ductus venosus is congenital, the symptoms due to hyperammonemia vary, possibly depending on the shunt ratio and individual tolerance to ammonia. We have experienced two adult patients with large caliber patent ductus venosus and compensated liver cirrhosis. In one case, the ductus venosus simply communicated to the portal vein, but in the other case there were multiple short communicating vessels between the ductus venosus and left portal vein. Both cases were successfully treated by the transvenous embolization with steel coils and ethanolamine oleate, which has an expansive nature.
Adult ; Cases ; Transvenous approach ; Two ; Open

We report a case of a ruptured aneurysm in a patient in her 90's who was treated by coil embolization and returned to her independent life after discharge. A 95-year-old woman with a diagnosis of subarachnoid hemorrhage (SAH) of Hunt & Kosnik Grade II was treated by coil embolization, ventricular drainage, and a ventriculo-peritoneal shunt. The ventricular drainage was assembled as a closed system using a newly developed one-way ball valve to regulate the cerebrospinal fluid (CSF) outflow. With this system the patient was able to assume any posture and perform any movement she wished. The patient was freed from the physical constraint involved in conventional ventricular drainage. Early rehabilitation during the ventricular drainage would be useful to prevent pneumonia and muscle atrophy.