Investigation on safety climate for preventing dispensing errors in community pharmacies

We investigated consciousness of the prevention of dispensing errors with the pharmacists and clerical staffs which work in community pharmacies and analyzed the structure of those subconscious to examine preventive measures of dispensing errors. Questionnaire survey was performed for all pharmacists and clerical staffs working in community pharmacies where each is affiliated with four pharmacy groups. The questionnaire consisted of 38 questions about "atmospheres for the prevention of dispensing errors" in the pharmacy along their attributions. And data were analyzed by occupation to confirm the difference. As a result of factor analysis, five factors such as "the posture of the boss", "information exchange", "the order of the pharmacy" were extracted from the pharmacists. Moreover, in the case of the clerical staffs, five similar factors have been extracted besides "a sense of responsibility to duties" replaced "the order of the pharmacy". As a result of structural equation modeling, the pass model with high goodness of fit to which "measures for dispensing error prevention" and "consciousness to the dispensing error of a pharmacy" were assumed to be a subordinate concept respectively by each occupational category. It became clear that a suggestion of the concrete preventive measures drafting was provided even from the investigation of the consciousness level.     

Preservation of tubal function following methotrexate treatment for ectopic pregnancy

To evaluate methotrexate (MTX) administration as a conservative treatment for ectopic pregnancy, we reviewed the medical records of 248 cases (210 patients) of MTX treatment for tubal pregnancies at our department between December 1985 and December 2003, and compared its pregnancy prognosis with that of laparoscopic salpigotomy (59 patients). With the MTX treatment, 185 patients were successfully treated, and the subsequent pregnancy rate and ectopic pregnancy rate were 48.4 % and 18.4 %, respectively, while those rates were 49.2 % and 18.6 %, respectively, after the salpigotomy. These results suggest that MTX treatment is comparable to the more conservative operation. To clarify the (dys/) function of the ectopic implantation tubes and MTX-treated tube (s), we excluded patients who had a contra-lateral healthy tube, and extracted 40 patients as "the affected tube group", where the pregnancy-related parameters were not adversely affected. The findings suggest that MTX is not necessary to preserve tubal function.     

Highly potent and selective histone deacetylase 6 inhibitors designed based on a small-molecular substrate

To find novel histone deacetylase 6 (HDAC6)-selective inhibitors and clarify the structural requirements for HDAC6-selective inhibition, we prepared thiolate analogues designed based on the structure of an HDAC6-selective substrate and evaluated the histone/alpha-tubulin acetylation selectivity by Western blot analysis. Aliphatic compounds 17b-20b selectively caused alpha-tubulin acetylation over histone H4 acetylation. In enzyme assays using HDAC1, HDAC4, and HDAC6, compounds 17a-19a exhibited HDAC6-selective inhibition over HDAC1 and HDAC4.     

Dietary phospholipids ameliorate fructose-induced hepatic lipid and metabolic abnormalities in rats

Overconsumption of fructose results in hepatic dyslipidemia, which has a documented correlation with metabolic syndrome. We examined whether the ingestion of phospholipids (PL) from soybeans prevents fructose-induced metabolic abnormalities. Rats were fed either a fructose-free diet (C), a 60% fructose diet (F), or a 60% fructose plus 3% PL diet (F-PL) for 10 wk. At wk 8, plasma glucose concentrations after glucose loading were significantly higher in rats fed the F diet than in rats fed the C and F-PL diets, which did not differ from one another. The concentrations of hepatic TG, diglycerides, ceramides, and oleates in rats fed the F diet for 10 wk was significantly higher than those in rats fed the C diet. The increases were prevented by concurrent PL ingestion; concentrations did not differ between the F-PL and C groups. Dietary fructose increased the mRNA expression of SREBP1, ChREBP, and genes related to lipogenesis. PL completely inhibited these increases. Furthermore, reflecting the difference at the mRNA level, lipogenic enzyme activities were greater in rats fed the F diet than in rats fed the C diet, and PL ingestion suppressed the increased activities by fructose feeding. Treatment of cultured Hep-G2 cells with fructose for 24 h increased the levels of SREBP1 and ChREBP nuclear proteins, which were suppressed by culture with purified PL components, especially phosphatidylethanolamine and phosphatidylinositol. These findings indicate that PL prevents fructose-induced metabolic abnormalities in association with alterations of the hepatic lipid profile by inhibiting de novo lipogenesis.     

Cord blood transplantation from unrelated donors: a preliminary report from the Japanese Cord Blood Bank Network

As a source for hematopoietic stem cell transplantation (HSCT), cord blood transplantation from unrelated donors (UCBT) is now considered as an acceptable alternative to patients who need unrelated HSCT. To confirm the findings that mismatched UCBT is feasible, we discussed here the results for 477 patients with hematologic malignancies and non-malignancies who were subjected to UCBT coordinated by the Japanese Cord Blood Bank Network (JCBBN). From February 1997 to October 2001, 411 patients with malignancies and 66 with non-malignancies had UCBT through the cord blood bank in the JCBBN; 311 patients had HLA 0-1 mismatched UCBT; 165, had a 2-4 HLA mismatch. The Kaplan-Meier estimates for 3-year disease-free survival rate (DFS) were 35.2 ±2.8% in malignant diseases, and 33.6 ±7.2% in patients with non-malignant diseases. The HLA disparity had no effect on DFS, incidence of acute graft-versus-host disease, or engraftment. As reported previously, we also noted the importance of graft cell dose in determining survival in UCBT. Major advantages of UCBT include its rapid availability compared with unrelated donor bone marrow, and tolerance of an HLA mismatch at 2 loci, which will enable extension of the donor pool. This review outlines the latest UCBT progress, with emphasis on practical considerations in HLA-mismatched umbilical cord blood selection.     

Chronic cytopenia associated with T8 lymphocytosis successfully treated with glucocorticoids

We reported a prednisolone effective case of T 8 lymphocytosis. The patient was 83 years old male, who had suffered from hypoplastic anemia for more than 5 years before he admitted to our hospital. His blood picture was peculiar because adding to granulocytopenia, CD8 (+) large granular lymphocytes were dominant among his lymphocytes. A few days after administration of bolus methylprednisolone, prominent reticulocytosis and rapid improvement of anemia occurred and the latter continued for more than 1 year. We performed in vitro study on the mechanism of his cytopenias. The result of Southern blot analysis showed that his blood lymphocytes had a unique rearranged pattern of T cell receptor beta chain gene. Mononuclear cells had an inhibitory effect on autologous and allogenic CFU-E colony formation of bone marrow cells. These facts suggest that colony proliferating CD8 (+) lymphocytes had an inhibitory effect on erythropoiesis in vivo, and prednisolone blocked this inhibitory pathway in this patient.     

Rupture of the flexor pollicis longus in von Recklinghausen''s disease

An unusual cause of inability to flex the interphalangeal joint of the thumb in a patient with von Recklinghausen's disease is reported. A tumor in the cubital fossa and the basic characteristics of this disease led to a preoperative misdiagnosis of anterior interosseous nerve paralysis. However, surgical exploration and histological examination showed that the correct diagnosis was rupture of the flexor pollicis longus tendon caused by intratendinous proliferation of a neurofibroma. This is the first report in the English-language literature of a flexor tendon rupture caused by intratendinous tumor proliferation.     

Off‐Pump Coronary Artery Bypass Grafting in Patients with End‐Stage Renal Disease on Hemodialysis

Abstract Background: Coronary artery bypass grafting (CABG) for hemodialysis patients is high risk compared with other patient groups. The aim of this study was to analyze the potential benefits of off‐pump CABG for hemodialysis patients. Methods: From April 1994 through December 2000, 26 hemodialysis patients underwent CABG. The off‐pump group consisted of 15 patients operated on without a pump and the on‐pump group consisted of 11 patients operated on with a pump. Results: There was no difference between the two groups with regard to mean age, mean number of diseased vessels and mean number of anastomoses per patient. No patient died in either group during hospitalization. The postoperative complication rate was low in both groups. The postoperative ventilation time was shorter in the off‐pump group (8.5 vs 26.1 hours, p < 0.001, respectively [off‐pump group vs on‐pump group]). The length of ICU stay was shorter in the off‐pump group (1.7 vs 3.5 days, p # 0.01, respectively [off‐pump group vs on‐pump group]). The medial cost was lower in the off‐pump group ($26,200.80 versus $44,024.10 p # 0.0001 respectively [off‐pump group vs on‐pump group]). Conclusions: Off‐pump CABG provided excellent less‐invasive cardiac surgical results for dialysis patients.     

Variations in long- and middle-wavelength-sensitive opsin gene loci in crab-eating monkeys.

We analyzed variations in long (L)- and middle (M)-wavelength-sensitive opsin gene loci in crab-eating monkeys. Unlike humans, most monkeys have a single L and a single M gene. Two variant genotypes, one with only one opsin gene (dichromatic) and one with tandemly arrayed multiple genes, were also found in the monkeys. However, the frequency of the former was 0.47%, and that of the latter was 5% in the monkeys, while 2% and 66%, respectively, in Caucasian males. The two variants were found only in Java Island, Indonesia, and South Thailand, respectively. The data suggest that the frequency of each genotype is different among Old World primates.