The estrogen content and relative performance of Japanese and British sewage treatment plants and their potential impact on endocrine disruption

Both the UK and Japan are densely populated islands with relatively short rivers. Therefore, both countries are likely to be highly exposed to contaminants emanating from their human populations. This review considered how effective the different sewage treatment facilities of the two countries are at removing steroid estrogens from the effluent. The methods of estrogen analysis in sewage effluent, the number and importance of different sewage treatment types, and their apparent effectiveness at removing estrogens were all considered. In both countries the activated sludge treatment was dominant in terms of people served and water discharged. The analytical techniques used by those studying estrogen concentrations in effluents in both countries were broadly similar. Activated sludge plant (ASP) effluent in the UK typically contained around 2 ng/L E2 and 8 ng/L E1, whilst Japanese ASPs typically reported E2 as below detection, and 10 ng/L E1 in their effluents. When estrogenic bioassays were used in Japan they typically record an estrogenic potency of 10 ng/L E2 equivalents. Even taking into account EE2 (not found in Japanese effluents), the overall estrogenicity of British sewage effluents would appear to be the same as that of Japanese (around 10 ng/L E2 equivalents). This suggests that the ASPs serving the large urban communities would have effluent of similar estrogenic potencies in Japan and the UK. Less information is available about the more numerous biological (trickling) filter plants (BFP) in the UK and oxygen ditches (OD) in Japan which tend to serve smaller, more rural communities. The available data would suggest that the BFPs are significantly less efficient than the ODs at removing E1. This would suggest that in similar circumstances, British headwaters (where this STP type is often found) might be more at risk from endocrine disruption than their Japanese counterparts. Overall, the higher apparent incidence of endocrine disruption in British wild fish compared to Japanese cannot be attributed to differences in the efficiency of their respective STPs

Use of corticosteroids for remission induction therapy in patients with new-onset ulcerative colitis in real-world settings

Background: Corticosteroids may be temporarily effective for ulcerative colitis (UC), but long-term use increases the risk of adverse drug reactions. Objective: The goal of the study was to examine steroid use in remission induction therapy after diagnosis of UC. Study Design: A retrospective observational study using the Japan Medical Data Center (JMDC) Claims Database from January 2008 to December 2014. Setting: Clinics, university hospitals, and national/public hospitals. Intervention: Initiation of steroids after diagnosis of UC. Main outcome measures: Start time and annual rate of steroid use, and use during the first 6 months of remission induction therapy. Results: The subjects were 399 patients were newly diagnosed with UC in the study period. The rate of steroid use after diagnosis was 58.4% in 2009, and showed a significant decreasing trend yearly after 2010 (p ≤ 0.0001). Regarding the start time, 52.2% of patients began steroids within 60 days after diagnosis of UC. At 6 months after initiation, 23.7% continued to use steroids and 73.9% of these patients used high-dose steroids. Conclusion: In treatment of UC after diagnosis, many patients continue to use steroids for >6 months after initiation. Reduced use of steroids based on clinical practice guidelines for UC should be promoted

Slower titration of lamotrigine reduces the risk of rash.

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QT is longer in drug-free patients with schizophrenia compared with age-matched healthy subjects.

The potassium voltage-gated channel KCNH2 is a well-known gene in which mutations induce familial QT interval prolongation. KCNH2 is suggested to be a risk gene for schizophrenia. Additionally, the disturbance of autonomic control, which affects the QT interval, is known in schizophrenia. Therefore, we speculate that schizophrenic patients have characteristic features in terms of the QT interval in addition to the effect of antipsychotic medication. The QT interval of patients with schizophrenia not receiving antipsychotics (n = 85) was compared with that of patients with schizophrenia receiving relatively large doses of antipsychotics (n = 85) and healthy volunteers (n = 85). The QT interval was corrected using four methods (Bazett, Fridericia, Framingham or Hodges method). In ANCOVA with age and heart rate as covariates, patients not receiving antipsychotic treatment had longer QT intervals than did the healthy volunteers, but antipsychotics prolonged the QT interval regardless of the correction method used (P<0.01). Schizophrenic patients with and without medication had a significantly higher mean heart rate than did the healthy volunteers, with no obvious sex-related differences in the QT interval. The QT interval prolongation may be manifestation of a certain biological feature of schizophrenia