薬剤師と「食」を通じたプライマリ・ケア

1996年に米国科学アカデミー（NAS）により提唱された医療概念であるプライマリ・ケアは、幅広く国民の健康や福祉に関わる問題を総合的そして継続的に解決していく地域での実践活動であり、医療人として薬剤師も積極的に関わっていくべき課題である。この『継続的・統合的に解決していく実践活動』という概念において、「薬食同源」（ヒトが健康を維持することや病気から快復するために、薬と食品が同様な効果を持つ）という考え方は密接な関係があると筆者らは考えた。これより本論文では、プライマリ・ケアの概念に則り、毎日我々が摂取する「栄養」や「食」という習慣を通じて、薬剤師がどのように具体的な形で患者に医療を提供できるか、予防医学の流れ（一次予防、二次予防、三次予防）に沿って検討することとした。その結果、食や栄養を摂取する行為に薬剤師が介入し改善することで、各々のステージの予防に繋がり、医療費の増大や患者の心身の負担を減らし、プライマリ・ケアの普及にも貢献できることが明らかとなった

Personalized Nutritional Therapy Based on Blood Data Analysis for Malaise Patients

As medical doctors, we routinely check patient blood chemistry and CBC data to diagnose disease. However, these data and methods of analysis are very rarely used to find pre-disease conditions or treat undiagnosed malaise. Masatoshi Kaneko Ph.D. found that many pre-disease conditions and types of malaise could be detected using his unique method of blood data analysis, and could also be treated using personalized nutritional therapy as an alternative to using drugs. The authors of this article introduce personalized nutritional therapy based on blood data analysis (Kaneko’s method), and present and discuss some clinical cases. In total, 253 pre-disease or undiagnosed patients were treated using this nutritional therapy approach, and most of them recovered from their chronic symptoms and pre-disease conditions. This novel nutritional therapy has the potential to help many presymptomatic and undiagnosed patients suffering from malaise

A multi-institution phase II study of gemcitabine/S-1 combination chemotherapy for patients with advanced biliary tract cancer.

Purpose：We aimed to evaluate the efficacy and safety of gemcitabine/S-1 combination chemotherapy for the treatment of patients with advanced biliary tract cancer. 　Methods：Patients with histologically or cytologically confirmed unresectable or recurrent biliary tract cancer were eligible for inclusion. The primary endpoint was overall survival. Gemcitabine was administered intravenously at a dose of 1, 000 mg/m2 over 30 min on days 1 and 8, and oral S-1 was administered daily at a dose of 60 mg/m2 on days 1–14. This schedule was repeated every 3 weeks until disease progression or patient refusal. 　Results：Twenty-five patients were enrolled between October 2007 and January 2009. Eleven patients (44%) had extrahepatic bile duct cancer, 5 (20%) had intrahepatic bile duct cancer, 8 had gallbladder cancer (32%), and 1 (4%) had ampulla of Vater cancer. The median overall survival time was 12.7 months (95% CI, 8.4–23.5 months), and the 1-year survival rate was 52.0% (95% CI, 31.2–69.2%). Of the 23 patients with evaluable target regions, seven patients experienced a partial response, and an overall response rate was 30.4%. The following grade 3–4 hematological toxicities occurred: neutropenia (56%), leukopenia (24%), anemia (8%) and thrombocytopenia (4%). In spite of the high incidence of grade 3–4 neutropenia, no patients developed febrile neutropenia in the present study. The major grade 3–4 non-hematological toxicities were fatigue (8%), anorexia (8%) and diarrhea (4%). 　Conclusions：Gemcitabine/S-1 combination chemotherapy offered a promising survival benefit with acceptable toxicity in patients with advanced biliary tract cancer