Rehabilitation pharmacotherapy: A scoping review

Many patients in rehabilitation facilities are affected by polypharmacy. Polypharmacy is associated with rehabilitation outcomes and functional recovery. Consequently, a combination of rehabilitation and pharmacotherapy may improve the outcomes of older people undergoing rehabilitation. A recent report described the concept of rehabilitation pharmacotherapy. The concept envisages helping frail older people and people with disabilities to achieve the highest possible body function, activity level and quality of life. There are two key tenets of rehabilitation pharmacotherapy: “pharmacotherapy in consideration of rehabilitation” and “rehabilitation in consideration of pharmacotherapy.” “Pharmacotherapy in consideration of rehabilitation” includes use of drugs to treat impairment, activity limitation and participation restriction based on the International Classification of Functioning, Disability, and Health. “Rehabilitation in consideration of pharmacotherapy” refers to tailoring of rehabilitation considering the content of pharmacotherapy. With respect to drugs and motor dysfunction, anticholinergic drugs are associated with dysphagia and fractures. Increased use of potentially inappropriate medications may adversely affect the nutritional status. With respect to activities of daily living, polypharmacy and use of potentially inappropriate medications negatively affect the improvement in motor function during rehabilitation. Potent anticholinergic drugs are more likely to impede the improvement in cognitive function. In this review, we address the concept of rehabilitation pharmacotherapy and discuss its importance from the perspective of polypharmacy, the effect of drugs on disability and disease, nutritional status and activities of daily living. Geriatr Gerontol Int 2020; 20: – .     

Receptor interacting protein kinase mediates necrotic cone but not rod cell death in a mouse model of inherited degeneration

Retinitis pigmentosa comprises a group of inherited retinal photoreceptor degenerations that lead to progressive loss of vision. Although in most cases rods, but not cones, harbor the deleterious gene mutations, cones do die in this disease, usually after the main phase of rod cell loss. Rod photoreceptor death is characterized by apoptotic features. In contrast, the mechanisms and features of subsequent nonautonomous cone cell death remain largely unknown. In this study, we show that receptor-interacting protein (RIP) kinase mediates necrotic cone cell death in rd10 mice, a mouse model of retinitis pigmentosa caused by a mutation in a rod-specific gene. The expression of RIP3, a key regulator of programmed necrosis, was elevated in rd10 mouse retinas in the phase of cone but not rod degeneration. Although rd10 mice lacking Rip3 developed comparable rod degeneration to control rd10 mice, they displayed a significant preservation of cone cells. Ultrastructural analysis of rd10 mouse retinas revealed that a substantial fraction of dying cones exhibited necrotic morphology, which was rescued by Rip3 deficiency. Additionally, pharmacologic treatment with a RIP kinase inhibitor attenuated histological and functional deficits of cones in rd10 mice. Thus, necrotic mechanisms involving RIP kinase are crucial in cone cell death in inherited retinal degeneration, suggesting the RIP kinase pathway as a potential target to protect cone-mediated central and peripheral vision loss in patients with retinitis pigementosa.     

Evaluation of transferability of R-plasmid in bacteriocin-producing donors to bacteriocin-resistant recipients

Bacteriocin-producing Escherichia coli (donors) rapidly kill conventional recipient E. coli DH5α in conjugation experiments. To evaluate plasmid transferability of bacteriocin-producing donors, we established 2 different bacteriocin-resistant mutants derived from E. coli DH5α and used them as recipients. When the bacteriocin-resistant mutants were used in conjugation experiments, the transconjugant recovery from 20 bacteriocin-producing donors increased from 5% (1/20) to 65% (13/20), and the transfer frequencies increased. These results showed that bacteriocins inhibited the transfer of the R-plasmid from bacteriocin-producing donors. Thus, application of bacteriocin-resistant recipients might aid the evaluation of the potential transferability of plasmids from bacteriocin-producing donors.     

The rapid efficacy of abatacept in a patient with rheumatoid vasculitis

We report a case of rheumatoid vasculitis (RV) that responded well to abatacept, a cytotoxic T lymphocyte-associated antigen 4 (CTLA4)-immunoglobulin fusion protein. A 38-year-old woman developed RV despite treatment with methotrexate and tumor necrosis factor (TNF) inhibitors. The effects of steroid therapy, immunoabsorption plasmapheresis, and interleukin-6 inhibitor were insufficient, however, administration of abatacept rapidly improved her clinical symptoms with almost normalization of the immunological findings. This is the first published case report of the successful treatment of RV with abatacept.     

Effect of individual proton pump inhibitors on cardiovascular events in patients treated with clopidogrel following coronary stenting:: Results From the Ibaraki Cardiac Assessment Study Registry

Objectives : The aim of this study was to evaluate whether combination therapy of clopidogrel and proton pump inhibitors (PPIs) causes higher numbers of cardiovascular events than clopidogrel alone in Japanese patients. Background : PPIs are often prescribed in combination with clopidogrel following coronary stenting. PPIs are reported to diminish the effect of clopidogrel because both are metabolized by CYP2C19. However, no reports address the effects of PPIs on cardiovascular events following coronary stenting in the Japanese population. Methods : A total of 1,887 patients treated with clopidogrel following coronary stenting were enrolled in the Ibaraki Cardiac Assessment Study (ICAS) registry. All subjects were classified into two groups according to treatment without (n = 819) or with (n = 1,068) PPI. Propensity score analysis matched 1:1 according to treatment without PPI (n = 500) or with PPI (n = 500). Primary endpoint was the composite of all‐cause death or myocardial infarction. Results : No significant difference was observed in the primary endpoint between the group without PPI and the group with PPI (4.6% vs. 4.6%, P = 0.77). In contrast, a significant difference was found between the group without PPI and with PPI in regard to the incidence of gastrointestinal bleeding at the end of the follow‐up period and the specific PPI prescribed (2.4% vs. 0.8%, adjusted HR = 0.30, 95% Confidence interval 0.08‐0.87, P = 0.026) after propensity score matching. Conclusions : No significant association between PPI use and primary endpoint was observed in the Japanese population, whereas PPI use resulted in a significant reduction in the rate of gastrointestinal bleeding. © 2012 Wiley Periodicals, Inc.     

经睫状体平坦部行颞上或鼻下Baerveldt青光眼植入术的短期临床疗效比较

目的:研究并探讨Baerveldt青光眼植入术(BGI)的不同植入部位对眼压(IOP)的影响。方法:对日本Toho大学Sakura医疗中心接受BGI治疗的新生血管性青光眼的病例进行回顾性分析。所有患者分为两组:颞上植入组(16例患者18眼,其中男性13例,女性3例;平均年龄62.9±14.4岁)和鼻下植入组(15例患者17眼,其中男性11例,女性4例;平均年龄56.9±10.7岁)。术后12mo随访复查。比较两组术后12mo与术前相比的眼压降低率。结果:颞上植入组:术前平均IOP为31.1±10.0 mmHg,术后平均IOP为14.4±4.5 mmHg;鼻下植入组:术前平均IOP为34.9±9.7 mmHg,术后平均IOP为15.9±3.7 mmHg。颞上植入组IOP降低率为(50.0±19.0)%,鼻下植入组降低率为(51.2±16.3)%。两组间无显著统计学差异(t-test,P=0.590)。结论:经睫状体平坦部行颞上或鼻下BGI的短期临床疗效无差异。     

Assessment of the differences in the short-term clinical outcomes of superotemporal and inferonasal Baerveldt glaucoma implantation surgeries performed via the pars plana route

AIM: To investigate and discover whether different insertion areas for Baerveldt glaucoma implant (BGI) surgery produce different outcomes in terms of the reduction of intraocular pressure (IOP). METHODS: This retrospective study involved the review of cases of patients admitted at Toho University Sakura Medical Center, who underwent BGI surgery via the pars plana route for the treatment of neovascular glaucoma. The patients were divided into two groups: the superotemporal insertion group [18 eyes in 16 subjects (13 males, 3 females; mean age 62.9±14.4y)] and the inferonasal insertion group [17 eyes in 15 subjects (11 males, 4 females; mean age 56.9±10.7y)]. The patients were followed up and re-evaluated at 12mo. The IOP reduction rate 12mo after surgery relative to preoperative IOP was compared between the two groups. RESULTS: The mean preoperative IOP was 31.1±10.0 mm Hg and postoperative IOP was 14.4±4.5 mm Hg in the superotemporal group, whereas for the inferonasal group, the mean preoperative IOP was 34.9±9.7 mm Hg and postoperative IOP was 15.9±3.7 mm Hg. The IOP reduction rate of the superotemporal group was 50.0%±19.0% and that of the inferonasal group was 51.2%±16.3%. There was no significant correlation between the two groups (Student’s t-test, P=0.590). CONCLUSION: There was no difference in the short-term clinical outcomes between superotemporal and inferonasal BGI performed via the pars plana route.     

Effect of alcohol addition on the structure and corrosion resistance of plasma electrolytic oxidation films formed on AZ31B magnesium alloy

The effect of the addition of alcohol to a Na₃PO₄-based electrolyte on plasma electrolytic oxidation (PEO) of AZ31B magnesium alloy was investigated. Anodization with spark discharge was conducted in Na₃PO₄-based electrolyte containing various alcohols (e.g., ethanol, ethylene glycol, and glycerol) at a constant current density of 200 A m⁻² and a constant temperature of 25 °C. Voltage–time curves during the PEO process, the film structure, surface roughness, crystallographic structure, composition, corrosion resistance, and withstand voltage were investigated using various analytical equipment and electrochemical measurements. When the electrolyte containing alcohol was used, the initial bending voltage was higher than that observed using the basic electrolyte without alcohol addition, as was the oscillation voltage during the PEO process. For a given amount of electricity supplied, the addition of alcohol into the basic electrolyte tended to increase the thickness and corrosion resistance of PEO films formed while effectively reducing surface roughness. In particular, the addition of a polyhydric alcohol (i.e., ethylene glycol and glycerol) could act not only as a leveler for the formation of compact film but also as an enhancer for film qualities, such as corrosion resistance and withstand voltage. The patterns observed for Na₃PO₄-based electrolyte containing alcohol also hold for Na₂SiO₃-based electrolyte containing alcohol.

Alcohol used as an additive could act not only as a leveler for the formation of compact film but also as an enhancer for film qualities, such as corrosion resistance and withstand voltage.