A Case of Acute Withdrawal Symptoms Due to Unplanned Interruption of Buprenorphine Transdermal Patch: With a Discussion Including Social Aspects of Home Medical Care Patients

Introduction: Since the commercial availability of buprenorphine extended-release transdermal patches (BTDP) from the early 2010’s, the therapeutic indications for opioids have widely expanded to include chronic benign diseases. We report a case of a home health care patient with acute opioid withdrawal symptoms due to self-interruption of BTDP. Case: An 84-year-old man using home health care services due to worsening of lumbar spinal canal stenosis had been receiving analgesia with a BTDP, a mixed opioid agonist/antagonist analgesic, for the preceding five months. Since the patient's spouse thought that his pain and symptoms were gradually improving, she secretly replaced the BTDP with an NSAID patch without informing the patient. About 50 hours later, the patient experienced a variety of symptoms, including frequent urination with incontinence every five minutes, watery diarrhea, sweating, decreased blood pressure, discomfort in the feet, and insomnia. Evaluation of the Clinical Opiate Withdrawal Score (COWS) by the home health care physician indicated a score of 12, corresponding to mild withdrawal symptoms. About 12 hours after symptom onset, the severe abnormalities were barely noticeable and completely disappeared after two days. Conclusion: Few previous case reports have described withdrawal symptoms due to rapid discontinuation of BTDP. In addition to the medical considerations, we report the social issues associated with onset of the condition in a home environment. Opioid use for non-cancer pain requires medication management from a different perspective than that for cancer pain.

Importance of Extracting Intergroup Differences by Treatment Purpose and Content of Free-Response Answers That Should Be Considered when Screening for Pain by Administering the “Ease of Living Questionnaire” to Patients Undergoing Initial Radiotherapy

Background: We began conducting pain screenings using an in-house version of the “Ease of Living Questionnaire” for patients undergoing initial radiotherapy. Purpose: The purpose of this study was to classify patients undergoing radiotherapy for different medical purposes and to verify the differences in the responses between the groups identified. Methods: The “Ease of Living Questionnaire” was administered to all adult patients with cancer undergoing initial radiotherapy , and the responses were analyzed together with data concerning the patients’ background characteristics that were extracted from medical records. Results: A total of 543 responses to the questionnaire were collected, and the patients were divided into a palliative group (177), curative group (189), preoperative group (19), and postoperative group (158); statistical differences were observed with respect to patient gender, age, and target disease. Mental and physical distresses were more pronounced in the palliative group compared to the other three groups. Although psychosocial need was high with respect to the questionnaire items concerning symptoms and treatments/activities of daily living, the independent sensitivity values of the check fields were 0.29-0.65 and 0.08-0.38, respectively. Intergroup differences were observed with respect to symptoms and treatment/economic need as well as social security/occupational need. Conclusion: In order to gain an understanding of patient needs, we believe that it is necessary to take sufficient action in consideration of the content of free-response answers based on differences in background by treatment purpose.

Computed Diffusion-Weighted Imaging in Prostate Cancer: Basics, Advantages, Cautions, and Future Prospects

Computed diffusion-weighted MRI is a recently proposed post-processing technique that produces b-value images from diffusion-weighted imaging (DWI), acquired using at least two different b-values. This article presents an argument for computed DWI for prostate cancer by viewing four aspects of DWI: fundamentals, image quality and diagnostic performance, computing procedures, and future uses.

Factors Predicting Late Rectal Disorders after Radiation Therapy for Prostate Cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although various studies have been conducted on the effects of radiation therapy for prostate cancer, rectal toxicity after radiation therapy for prostate cancer, which is an important late adverse event associated with radiation therapy, has not been sufficiently examined. This study aimed to assess the associations of late rectal disorder (LRD) with dosimetric, anatomic, and clinical factors in patients with prostate cancer who underwent three-dimensional conformal radiation therapy (3D-CRT).</p><p><b>METHODS</b>We retrospectively analyzed 104 patients undergoing 3D-CRT between January 2009 and October 2011. Thirty patients were administered anticoagulation/antiplatelet (AC/AP) agents. The standard dose was 74 Gy. Uni- and multi-variate analyses were performed to identify factors predictive of LRD after 3D-CRT.</p><p><b>RESULTS</b>The median follow-up period was 66 (range: 14-87) months. LRD occurred in 10.6% (11/104) of patients. The median time from RT to LRD was 15 months (range: 7-41 months). Sixty-four percent of those with LRD (7/11 patients) had been given AC/AP agents. Fifty-five (6/11) patients had severe internal iliac artery calcification. By univariate analysis, significant predictors of LRD were internal iliac artery calcification, administration of AC/AP agents, and age. Being very elderly was the significant predictor identified by multivariate analysis (P = 0.0276). For patients receiving AC/AP agents and those with severe internal iliac artery calcification, the LRD incidences were 23.3% (7/30 patients) and 23.1% (6/26 patients), respectively, and being 75 years of age or older was a significant predictor in these subsets.</p><p><b>CONCLUSIONS</b>Our results suggest advanced age, administration of AC/AP agents, and severe internal iliac artery calcification to be risk factors for LRD in patients undergoing standard RT. Therefore, it is necessary to administer radiation with particular caution in the very elderly, especially those receiving AC/AP agents and/or with severe internal iliac artery calcification.</p>

Efficacy of Using Three-Tesla Magnetic Resonance Imaging Diagnosis of Capsule Invasion for Decision-Making About Neurovascular Bundle Preservation in Robotic-Assisted Radical Prostatectomy

PURPOSE: To evaluate the efficacy of using 3-tesla (T) magnetic resonance imaging (MRI) diagnosis of extracapsular extension (ECE) for decision-making about neurovascular bundle (NVB) preservation in robot-assisted radical prostatectomy (RARP) for prostate cancer (PC). MATERIALS AND METHODS: We prospectively collected data on PC patients (n=67) who underwent preoperative 3-T MRI before RARP. The choice between nerve sparing or resection was based on 3-T MRI findings of ECE. We compared the MRI findings with the pathological data on surgical margins. Our clinical staging in this study was defined only by MRI. RESULTS: When the data were divided by prostate lobe (right lobe or left lobe, n=134), 3-T MRI showed 28 positive cases of ECE in 134 prostate lobes, allowing NVB preservation in 42 cases (31.3%). Nerve-sparing surgery was achieved in 38.7% of cases in which clinical T2 staging by MRI was reported. The pathological data revealed that 10 of 134 prostate lobes had positive ECE. The overall sensitivity, specificity, positive predictive value, and negative predictive value for predicting stage T3 (positive ECE) by side were 60.0% (12 of 20 sides), 86.0% (98 of 114 sides), 42.9% (12 of 28 sides), and 92.5% (98 of 106 sides), respectively. CONCLUSIONS: Three-T MRI prior to RARP enables the use of ECE diagnosis to guide decision-making about NVB preservation, with comparatively high specificity and negative predictive value. Further prospective studies are underway to reach more definitive conclusions.

Role of MafA gene in insulin production-Analysis of heterozygous knockout mice / 中华内分泌代谢杂志

Objective To clarify the role of MafA gene in development of MODY (maturity onset diabetes of the young) by studying insulin production,gene expression,and serum glucose level in heterozygous MafA gene knockout mice.Methods C57BL/6J mice were used as control animals,MafA gene heterozygous mice were analyzed.The distribution curve of blood sugar levels over time and serum insulin of heterozygous mice were determined by using IPGTT.The sensitivity of the mice to insulin was examined by injecting insulin assay.The expression levels of genes of MafA,insulin,pdX1,Beta2,and other genes of heterozygous mice were analyzed by semi-quantitative RT-PCR.Morphological changes in pancreatic tissue and α-and β-cell counts were obtained by using immunofluorescence/histological examination.Results (1) Two weeks after birth,MafA gene heterozygous mice began to show that the blood glucose level was increased,weight was reduced,and the amount of insulin secretion was clearly decreased (P＜0.05 or P＜0.01) while the insulin sensitivity did not change significantly.(2)The islet volume in MafA gene heterozygous mice was increased significantly as compared with the control group.However there were no significant changes in the number of pancreatic cells,distribution patterns,and the ratio of α and β cell.(3) Semi-quantitative RT-PCR detection showed that,compared with the control group,MafA gene level,the amount of insulin and Beta2 gene in MafA gene heterozygous mice were significantly reduced(all P＜0.05),while no changes in the amount of glucagons and level of Pdx1 were found.Conclusions The blood glucose level of MafA gene heterozygous mice was raised early after birth.MafA gene is likely to be a new disease ralated gene of MODY.

Survey of Attitudes toward Work among Pharmacists Working in Large Group Hospitals / General Medicine

<b>Background:</b> In Japan, although many new pharmacy graduates are keen to find work, the number of new job openings for hospital pharmacists is limited. In this survey, we explored the attitudes toward work among hospital pharmacists working in large group hospitals in order to help pharmacy students make informed career decisions.<br><b>Methods:</b> A cross-sectional, self-administered survey of 614 hospital pharmacists working in 66 institutions of the Tokushukai Hospital Group across Japan was conducted.<br><b>Results:</b> The proportion of usable data from surveyed pharmacists was 71.7%. Approximately 80% of the respondents desired to commit to careers in the healthcare field and were keen to gain opportunities for personal development. Personal development was the key item among reasons given for decisions about workplace and turnover. About 95% of the pharmacists surveyed were satisfied with their jobs. Compared to the job satisfaction level of other workers, that of pharmacists was considerably higher, although only 5.5% of pharmacists saw themselves staying in their current job until retirement. Job satisfaction data demonstrated significant differences among cohorts of age and years employed, although some specific items associated with job satisfaction could not be identified. Future work plans were influenced by age and job satisfaction.<br><b>Conclusion:</b> This study suggests that pharmacists working in group hospitals nurture positive expectations for their careers. Management needs to make greater efforts to understand the professional characteristics of hospital pharmacists in order to better utilize their professional abilities and skills for patient care and for the benefit of other healthcare professionals.