Acquired Forms of Fibroblast Growth Factor 23-Related Hypophosphatemic Osteomalacia

Fibroblast growth factor 23 (FGF23) is a pivotal humoral factor for the regulation of serum phosphate levels and was first identified in patients with autosomal dominant hypophosphatemic rickets and tumor-induced osteomalacia (TIO), the most common form of acquired FGF23-related hypophosphatemic rickets/osteomalacia (FGF23rHR). After the identification of FGF23, many other inherited and acquired forms of FGF23rHR were reported. In this review article, the detailed features of each acquired FGF23rHR are discussed, including TIO, ectopic FGF23 syndrome with malignancy, fibrous dysplasia/McCune-Albright syndrome, Schimmelpenning-Feuerstein-Mims syndrome/cutaneous skeletal hypophosphatemia syndrome, intravenous iron preparation-induced FGF23rHR, alcohol consumption-induced FGF23rHR, and post-kidney transplantation hypophosphatemia. Then, an approach for the differential diagnosis and therapeutic options for each disorder are concisely introduced. Currently, the majority of endocrinologists might only consider TIO when encountering patients with acquired FGF23rHR; an adequate differential diagnosis can reduce medical costs and invasive procedures such as positron emission tomography/computed tomography and venous sampling to identify FGF23-producing tumors. Furthermore, some acquired FGF23rHRs, such as intravenous iron preparation/alcohol consumption-induced FGF23rHR, require only cessation of drugs or alcohol to achieve full recovery from osteomalacia.

Development of a Training Program on the Proper Use of Over-the-Counter Drugs for Pharmacy Pharmacists / 社会薬学

The importance of promoting self-medication is increasing, and the active participation of pharmacies is required to support this. We developed a training program based on the Attention, Relevance, Confidence, and Satisfaction (ARCS) model, which is a motivational design process to train pharmacists who support the proper use of OTC drugs, and for insurance pharmacists who usually perform dispensing work. In the six months of training, we conducted six sessions for insurance pharmacists on the subject of colds and constipation. In addition to conducting lectures and exercises on OTC drugs, we provided pharmacists with an opportunity to practice the training content during their daily work, and discuss solutions to the problems that they encountered. Of the eight participants who attended all workshops and were part of the final evaluation, seven provided OTC drugs after considering whether it was necessary to provide them. A total of six advised patients who came to the pharmacy to have their prescription medications dispensed that there were OTC medications that they should be careful about taking. These results suggest the usefulness of this training program based on the ARCS motivational design model.

Management of Leftover Medicine Associated with the Change of Prescription Form through Collaboration between General Practitioners and Community Pharmacists : A Research Survey / 社会薬学

The purpose of this study was to explore issues arising from the promotion of collaboration between general practitioners (GPs) and community pharmacists in the management of leftover medicine. The 2016 Revision of Medical Fee newly added the check boxes in the prescription form in which a physician requests the correspondence of a pharmacy when confirming leftover medicine. In this study, we conducted a questionnaire survey among GPs in three wards of Tokyo in the month of November 2016. Of the 1,256 clinics queried, 283 responded to the survey. Among those GPs responding, 86.6% were concerned about leftover medicine of their patients, while 29.3% used the check boxes. GPs who received an explanation about the change of the prescription form demonstrated a significant increase in the use of the check boxes, compared to GPs who did not (p<0.01). Of the GPs surveyed, 71.0% thought that the check boxes were an advantage in recognizing medicines that the patients did not take. An overall 67.5% of the GPs who used the check boxes revised prescriptions based on the information from pharmacists. The study suggests that by increasing collaboration between GPs and pharmacists, the information from pharmacists could be utilized to revise prescriptions and lead optimization of drug treatment.

Effect of knee flexion angles during maximum isometric hip extension / 体力科学

The purpose of this study was to examine the effects of knee flexion angles during maximum isometric hip extension. Ten healthy men performed maximum isometric hip extension in prone position at 15° and 90° knee flexion. Then, the hip extension torque was measured, and electromyographic (EMG) data were obtained from the biceps femoris long head, semitendinosus, semimembranosus, adductor magnus, and gluteus maximus muscles. The EMG data were full-wave rectified and integrated (IEMG). The IEMG values obtained during the measurement of isometric hip extension were normalized with the values collected at 90° knee flexion (normalized IEMG [NIEMG]). The hip extension torque at 15° knee flexion was significantly greater than that at 90° knee flexion. The NIEMG values from the hamstrings at 15° knee flexion significantly increased compared with those at 90° knee flexion. Meanwhile, the NIEMG values from the gluteus maximus at 90° knee flexion were significantly greater than those at 15° knee flexion. However, the NIEMG values from the adductor magnus did not significantly differ between 15° and 90° knee flexion. These results indicate that the hamstrings effectively generate contracting force during isometric hip extension and at knee extended position because its fiber length was close to the optimal length.