Clinical Evaluation and Metabolism of Sevoflurane in Patients

Sevoflurane was submitted to Phase II studies in patients following Phase I studies. Sevoflurane, 2% inspired during maintenance, was administered with 50% N2O in oxygen to produce surgical anesthesia in 9 orthopedic patients of ASA Physical Status I. Under controlled ventilation, endotracheal concentration of sevoflurane was recorded. The blood concentration of sevoflurane was measured during and after the inhalation. Serum, urinary inorganic fluoride, and glucuronide of hexafluoroisopropanol were analysed with ion chromatographic analyzer. The patient inhaled sevoflurane for 3.5 ± 1.6 hr. All the patients were anesthetized and operated uneventfully. Postoperative laboratory findings showed no unexplainable abnormality. The end expiratory concentration of sevoflurane reached a plateau in 4.0 ± 0.8 min and fell rapidly after discontinuation of sevoflurane. Blood concentration of sevoflurane was about 500 μM during inhalation. It decreased promptly after termination of sevoflurane and was not correlated with anesthetic time. The time for verbal response after discontinuation was 11.8 ± 4.2 min. The serum concentration of inorganic fluoride increased after inhalation and reached a plateau (13.7 ± 8.2 μM) in 120 min. The level lasted for 120 min after anesthesia and fell by half at 12 hr after anesthesia. Urinary fluoride concentration varied from 20 to 3,000 μM during the first 12 hr urine, and showed its maximum in the first postoperative 12 or 24 hr urine. The findings that sevoflurane with nitrous oxide and oxygen produced surgical anesthesia without any sequelae and that the serum fluoride level did not exceed the nephrotoxic level warrent the further clinical evaluation in a wider range of subjects.A part of this work was supported by a Research Grant from the Japanese Ministry of Education, Science and Culture and presented at the 8th European Congress of Anaesthesiology, Vienna, Austria, in September, 1986

Chorea as the First Sign in a Patient with Elderly-Onset Systemic Lupus Erythematosus

The case of an elderly patient who had chorea as an initial symptom of systemic lupus erythematosus (SLE) accompanied by antiphospholipid syndrome (APS) is reported. A 68-year-old woman suddenly developed chorea of her left arm and leg. Magnetic resonance imaging (MRI) of the brain demonstrated a focal lesion in the right caudate head, which showed hyperintensity on fluid-attenuated inversion recovery and diffusion-weighted imaging. This condition was thought to be a common form of vascular chorea, which is likely to occur in elderly individuals; however, the laboratory data of this patient finally fulfilled the diagnostic criteria of SLE and APS. Physicians should be careful in diagnosing elderly individuals simply as having a vascular chorea because this symptom can be the initial manifestation of SLE or APS

PSmad3+/Olig2− expression defines a subpopulation of gfap-GFP+/Sox9+ neural progenitors and radial glia-like cells in mouse dentate gyrus through embryonic and postnatal development

In mouse dentate gyrus, radial glia-like cells (RGLs) persist throughout life and play a critical role in the generation of granule neurons. A large body of evidence has shown that the combinatorial expression of transcription factors (TFs) defines cell types in the developing central nervous system (CNS). As yet, the identification of specific TFs that exclusively define RGLs in the developing mouse dentate gyrus (DG) remains elusive. Here we show that phospho-Smad3 (PSmad3) is expressed in a subpopulation of neural progenitors in the DG. During embryonic stage (E14-15), PSmad3 was predominantly expressed in gfap-GFP-positive (GFP+)/Sox2+ progenitors located at the lower dentate notch (LDN). As the development proceeds (E16-17), the vast majority of PSmad3+ cells were GFP+/Sox2+/Prox1low+/Ki67+ proliferative progenitors that eventually differentiated into granule neurons. During postnatal stage (P1–P6) PSmad3 expression was observed in GFP+ progenitors and astrocytes. Subsequently, at P14–P60, PSmad3 expression was found both in GFP+ RGLs in the subgranular zone (SGZ) and astrocytes in the molecular layer (ML) and hilus. Notably, PSmad3+ SGZ cells did not express proliferation markers such as PCNA and phospho-vimentin, suggesting that they are predominantly quiescent from P14 onwards. Significantly PSmad3+/GFP+ astrocytes, but not SGZ cells, co-expressed Olig2 and S100β. Together, PSmad3+/Olig2− expression serves as an exclusive marker for a specific subpopulation of GFP+ neural progenitors and RGLs in the mouse DG during both embryonic and postnatal period

Association of breast feeding with early childhood dental caries: Japanese population-based study

Objectives: We investigated the association between breastfeeding duration during the first half year of life and the risk of early childhood caries from the age of 30 to 66 months in Japan. Design: Observational study of a longitudinal survey. Setting: A secondary data analysis of the Japanese Longitudinal Survey of Babies in the 21st Century. Participants: 43 383 infants at the age of 6 months. Outcome measures Early childhood caries—defined as a child's visit to a dentist for treatment of dental caries during the past 12 months—was ascertained from the caregiver from the age of 30 months in the survey. We estimated the risk of dental caries each year according to duration of breast feeding using logistic regression analyses. We controlled for a set of biological factors (birth weight, sex, parity and maternal age at delivery) and socioeconomic factors (maternal educational attainment and smoking status, marital status at delivery, family income and region of birth and residence). Results: We found that infants who had been breast fed for at least 6 or 7 months, both exclusively and partially, were at elevated risk of dental caries at the age of 30 months compared with those who had been exclusively formula fed. Adjusted ORs were 1.78 (95% CI, (1.45 to 2.17)) for the exclusively breastfed group and 1.39 (1.14 to 1.70) for the partially breastfed group. However, the associations became attenuated through the follow-up period and were no longer statistically significant beyond the age of 42 months for the partially breastfed group and beyond the age of 54 months for the exclusively breastfed group. Conclusions: We found an association between breast feeding for at least 6 or 7 months and elevated risk of dental caries at age 30 months. However, the association became attenuated as children grew older

健康への配慮とﾒﾀﾎﾞﾘｯｸｼﾝﾄﾞﾛｰﾑ対策状況について -佐世保市民の健康に関する実態調査報告-

本研究では､健康への意識の有無とﾒﾀﾎﾞﾘｯｸｼﾝﾄﾞﾛｰﾑ(以下､MetS)予防および改善行動の実践の有無から分析を行い､意識や行動の違いが健康に関する項目にどのような影響を与えるのか検討を行った｡その結果､健康への意識を持つことにより日常的に健康の維持増進に向けた生活習慣を送り､健康診断やがん検診の受診など健康に向けた望ましい行動や､共食日数の増加や余暇活動の増加など QOL の向上にもつながることが示唆された｡また､健康を意識することに加えて MetS 予防を行っているものでは､さらに望ましい生活習慣状況となっており､MetS 予防といった明確な目的およびその対策を実践しているという自覚によってより一層健康的な日常生活の実践に結びついていることが考えられた｡In the present study, we analyzed the data from the presence or absence of the awareness of health and from the presence or absence of the practice for prevention of metabolic syndrome(hereinafter called“MetS”)and the behavior for improvement, and examined what effect the differences in the awareness and behavior might influence on the items on health. As a result, it was suggested that, by having an awareness of health, it would be possible to establish a life-style enabling the maintenance and promotion of health, and to be linked to the desirable behavior for health such as having regularly a health check-up and a cancer examination, and to go far towards the advancement of QOL such as the increased number of days of‘eating in company\u27and the increased level of activity for leisure. In addition to having an awareness of health, those who were conducting the preventive measure against MetS were found to lead a more, desirable life-style, and to be related to the practice of a healthier daily life by becoming self-conscious of having a definite objective of preventing MetS and practicing its measure

スイッチOTC候補成分に関する模擬添付文書作成演習の実施とその効果

A training program was conducted at our pharmacy school concerning the necessity of over-thecounter (OTC) drug sales and counselling tasks undertaken by community pharmacists. In this study, we evaluated the changes in their awareness of pharmacy studies regarding self-medication and the professional practice of community pharmacists, as well as their satisfaction with the training. The training program involved the preparation of simulated OTC package inserts for potential prescription (Rx)-to-OTC switch candidates and a presentation about the details of these inserts. A questionnaire was distributed to 67 students who participated in the program in 2011, and responses from completed questionnaires were analysed (n = 61). Before training, 75.4% and 65.5% of the respondents selected `agree\u27 or `slightly agree\u27 respectively, as their responses to the statements `increase in Rx-to-OTC switch is useful for self-medication\u27 and `increase in Rx-to-OTC switch widens pharmacists\u27 appeal\u27. After training, the response rates were 96.7% and 85.2%, respectively. Furthermore, 98.3% of the respondents indicated that they were satisfied with the training. These findings suggest that the training program was useful for increasing students\u27 awareness about the importance of OTC sales, patient counselling and the professional practice of community pharmacists under the current sales system for OTC medicines

Prognostic impact of clinical factors for immune checkpoint inhibitor with or without chemotherapy in older patients with non-small cell lung cancer and PD-L1 TPS ≥ 50%

IntroductionThe proportion of older patients diagnosed with advanced-stage non-small cell lung cancer (NSCLC) has been increasing. Immune checkpoint inhibitor (ICI) monotherapy (MONO) and combination therapy of ICI and chemotherapy (COMBO) are standard treatments for patients with NSCLC and programmed cell death ligand-1 (PD-L1) tumor proportion scores (TPS) ≥ 50%. However, evidence from the clinical trials specifically for older patients is limited. Thus, it is unclear which older patients benefit more from COMBO than MONO.MethodsWe retrospectively analyzed 199 older NSCLC patients of Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 and PD-L1 TPS ≥ 50% who were treated with MONO or COMBO. We analyzed the association between treatment outcomes and baseline patient characteristics in each group, using propensity score matching.ResultsOf the 199 patients, 131 received MONO, and 68 received COMBO. The median overall survival (OS; MONO: 25.2 vs. COMBO: 42.2 months, P = 0.116) and median progression-free survival (PFS; 10.9 vs. 11.8 months, P = 0.231) did not significantly differ between MONO and COMBO group. In the MONO group, OS was significantly shorter in patients without smoking history compared to those with smoking history [HR for smoking history against non-smoking history: 0.36 (95% CI: 0.16-0.78), P = 0.010]. In the COMBO group, OS was significantly shorter in patients with PS 1 than those with PS 0 [HR for PS 0 against PS 1: 3.84 (95% CI: 1.44-10.20), P = 0.007] and for patients with squamous cell carcinoma (SQ) compared to non-squamous cell carcinoma (non-SQ) [HR for SQ against non-SQ: 0.17 (95% CI: 0.06-0.44), P < 0.001]. For patients with ECOG PS 0 (OS: 26.1 months vs. not reached, P = 0.0031, PFS: 6.5 vs. 21.7 months, P = 0.0436) or non-SQ (OS: 23.8 months vs. not reached, P = 0.0038, PFS: 10.9 vs. 17.3 months, P = 0.0383), PFS and OS were significantly longer in the COMBO group.ConclusionsECOG PS and histological type should be considered when choosing MONO or COMBO treatment in older patients with NSCLC and PD-L1 TPS ≥ 50%