Tokushima University Hospital

In the field of team-based care, pharmacists are vital for optimizing medication therapy. However, many medical professionals lack the opportunity to learn how to propose prescription changes with precision. This study aimed to address this knowledge gap by developing and assessing a new educational program for pharmacy students focused on prescription support and interprofessional collaboration. We recruited 191 fifth-year pharmaceutical students during the 2022-2024 academic years. The program featured a 7-day intensive curriculum that included learning how to assist with prescriptions, analyzing clinical data, and engaging in role-playing exercises. A web-based questionnaire and a paper test were used to evaluate students' awareness and knowledge both before and after the program. Statistical analyses were performed to verify the significance of changes; we utilized the Wilcoxon signed-rank test for the ordinal data derived from the specific behavioral objectives and 2-tailed paired t tests for the interval data from the knowledge tests. The magnitude of change was quantified using r for Wilcoxon tests and Cohen dz for 2-tailed t tests, with 95% CI calculated to ensure the stability and reliability of the observed results. Analysis of the primary outcome specific behavioral objectives revealed statistically significant effects across all items (Wilcoxon signed-rank test; P<.001). Effect sizes (r=0.505-0.835) ranged from moderate to large, with particularly large effects observed in identifying contents issue (r=0.835, 95% CI 0.126-0.330; P<.001). Knowledge test scores showed significant improvement in the following 3 subjects: pharmacology (r=-0.504, 95% CI -0.215 to 0.127; P<.001), organic chemistry (r=0.254, 95% CI -0.148 to -0.193; P=.004), and communication (r=0.221, 95% CI -0.151 to -0.190; P=.01). No significant changes were observed in pathology or pharmacokinetics. This program provides strong evidence that practical, hands-on learning with hospital pharmacists helps improve pharmacy students' professional skills and optimize pharmaceutical therapies in interprofessional care. By teaching pharmacists to effectively propose prescription changes, the program equips them to become integral members of interprofessional care, ultimately leading to optimized pharmaceutical care for patients.

PIM kinases (PIM1, PIM2, PIM3) are serine/threonine kinases implicated in infection and reactivation of various viruses, but their roles in HIV-1 gene expression and particle production remain unclear. We examined their impact on HIV-1 and related viruses using co-transfection systems. PIM1 and PIM3, but not PIM2, markedly suppressed HIV-1 virion production without affecting infectivity. This inhibitory effect extended to transmitted/founder HIV-1 clones and SIV, indicating broad activity across lentiviruses. Kinase-dead mutants failed to reduce virion production, confirming the requirement for catalytic activity. Our data suggest that PIM1 and PIM3 act at distinct steps of HIV-1 gene expression: PIM1 reduces transcription, whereas PIM3 acts post-transcriptionally to diminish viral protein expression. Co-expression of PIM1 and PIM3 further enhanced suppression, suggesting complementary functions. Both kinases also inhibited expression from non-LTR promoters, implying involvement of general cellular factors. These findings reveal distinct and cooperative actions of PIM1 and PIM3 in limiting HIV-1 particle production, providing new insights into host kinase-mediated regulation of viral gene expression.

Chemotherapy-induced nausea and vomiting (CINV) is a distressing adverse effect of chemotherapy that requires aggressive prevention. This study aimed to evaluate the antiemetic efficacy of a 4-day dexamethasone (DEX) regimen compared with the guideline-recommended 1-day DEX regimen against delayed CINV in patients receiving low-emetic-risk chemotherapy (LEC). Pooled patient-level data from a multicenter, prospective, observational study, including 132 patients receiving LEC, divided into 1-day and 4-day DEX groups, were analyzed. An inverse probability of treatment weighting (IPTW) model was applied to balance patient characteristics. The primary endpoint was the incidence of delayed CINV, with secondary endpoints including symptom severity, food intake, and daily incidence patterns. After IPTW adjustment, the incidence of delayed nausea was significantly lower in the 4-day DEX group (3.19%) than in the 1-day group (22.78%, p = 0.001), with no significant difference in acute nausea between the groups (14.49% vs. 5.83%, p = 0.167). In a multivariate model, both female sex and the 1-day DEX regimen were independently associated with a higher risk of delayed CINV. The 4-day DEX group showed favorable trends in nausea incidence, severity, and food intake regardless of the presence of acute CINV. Although 1-day DEX remains the standard approach recommended by antiemetic guidelines, a 4-day DEX regimen shows promise as an alternative strategy for managing delayed nausea, especially in patients who experience acute CINV or have inadequate symptom control.

Cisplatin is a widely used chemotherapeutic agent; however, its clinical utility is limited by dose-dependent nephrotoxicity. Although hydration and diuretics are commonly employed to mitigate renal injury, their protective efficacy remains suboptimal. Correspondingly, Eucommia ulmoides Oliv. leaf extract (ELE) is a functional food ingredient with diuretic, antioxidant, and anti-inflammatory properties. Therefore, this study investigated the protective effects of ELE against cisplatin-induced nephrotoxicity (CIN) in mice and elucidated the underlying mechanisms. Mice were administered cisplatin (15 mg/kg) with or without ELE or furosemide (potent diuretic). Cisplatin administration markedly elevated blood plasma urea nitrogen levels and reduced creatinine clearance, thereby indicating renal dysfunction. Co-administration of ELE substantially ameliorated renal function markers and attenuated histological tubular damage. In contrast, furosemide failed to improve renal dysfunction despite increasing urine output. This suggests that diuresis alone is insufficient for renal protection. Furthermore, ELE markedly suppressed cisplatin-induced upregulation of proinflammatory cytokines (tumor necrosis factor-alpha and interleukin-1 beta) and renal injury markers (kidney injury molecule-1 and lipocalin-2) in kidney tissues. These findings indicate that ELE exerts renoprotective effects against CIN through diuretic, anti-inflammatory, and antioxidant mechanisms. These mechanisms most likely involve modulation of inflammatory signaling pathways in the kidneys. Overall, ELE shows promising potential as an adjunctive therapeutic agent for patients undergoing chemotherapy.

Acquired hemophilia A (AHA) is a rare autoimmune disorder characterized by coagulation factor VIII inhibitors, leading to severe bleeding. Patients often present with bleeding after invasive procedures, necessitating prompt diagnosis and management. Here, we report the case of an 83-year-old man diagnosed with AHA after experiencing persistent bleeding from a hemodialysis catheter insertion site. The catheter was placed for acute kidney injury (AKI) associated with nephrotic syndrome. Despite prednisolone therapy for nephrotic syndrome, he developed factor VIII inhibitors and significant bleeding, suggesting insufficient immunosuppression. Given his advanced age, renal failure, and recurrent pneumonia, intensified immunosuppressive therapy posed a high risk of infection. Therefore, a hemostasis-centered approach was prioritized. Recombinant activated factor VII (rFVIIa, eptacog alfa) failed to control the bleeding; however, recombinant porcine sequence factor VIII (rpFVIII, susoctocog alfa) proved effective, enabling the safe placement of a long-term indwelling catheter for hemodialysis. To maintain hemostasis, emicizumab was introduced, allowing outpatient hemodialysis without further bleeding. Reports of AHA in hemodialysis patients are scarce. To the best of our knowledge, there have been no prior reports of AHA cases requiring hemodialysis that were successfully treated with susoctocog alfa and emicizumab. This case highlights the potential role of these agents in optimizing hemostatic strategies for AHA patients undergoing hemodialysis.

We present a case of nephritis wherein quantitative indices derived from Gallium-67 ( 67 Ga) citrate scintigraphy (Ga-S) were used for the initial diagnosis and longitudinal monitoring of inflammatory activity over 2.5 years. Quantitative indices, including the maximum standardized uptake value (SUV max ), active nephritis volume (ANV), and total nephritis uptake (TNU), were calculated from baseline and follow-up SPECT/CT scans. Laboratory and clinical data were simultaneously assessed. The Baseline SUV max , ANV, and TNU were 13.8, 316, and 2553, respectively. Follow-up imaging demonstrated significant reductions (SUV max =4.5; ANV=147 cm 3 ; TNU=401) without pharmacological intervention, correlating with improvement in creatinine, CRP, and resolution of proteinuria. Quantitative Ga-S indices may serve as objective and reproducible biomarkers for monitoring renal inflammation, particularly in patients who cannot undergo biopsy.

Abstract Background A fully automated echocardiographic analysis system utilizing artificial intelligence was provided. It enables to generate diagnostic reports based on guidelines through zero-click measurements. While the system is expected to shorten examination time, the accuracy of both measurements and diagnoses remains to be verified. In particular, left ventricular wall thickness and the four classifications of left ventricular hypertrophy (normal, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy) are prone to variation in real-world clinical practice. In this study, we aimed to investigate the diagnostic accuracy of the four classifications of left ventricular hypertrophy by automated measurement using this system. Methods A total of 100 patients with hypertension, observed during echocardiographic examination, were included to the study. The average measurements by a total of eight experts from four centers were used as the gold standard, and the same left ventricular long-axis cross-sectional moving images were compared for agreement between the fully automated measurements and the four classifications of left ventricular hypertrophy. For expert measurements of left ventricular wall thickness, after learning in a preliminary meeting using guidelines published by the Association for Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI), experts at each institution paired up and performed measurements engaging in discussion. For statistical analysis, we used the Student's t-test to compare continuous variables and the weighted kappa coefficients to assess diagnostic agreement. Results The fully automated echocardiographic analysis system was able to measure 89 of 100 cases. Automatic measurements of ventricular septal wall thickness and left ventricular posterior wall thickness were significantly higher than the average of four-center (10.7±2.2mm vs. 9.1±1.8mm, p&amp;lt; 0.05, and 10.1±2.3 mm vs. 8.9±1.7mm, p&amp;lt; 0.05, respectively). The weighted kappa coefficient for the four categories of left ventricular hypertrophy was 0.84. Analysis of the agreement rate by classification revealed that concentric hypertrophy showed the highest agreement rate (89.3%), followed by concentric remodeling (88.9%). In contrast, eccentric hypertrophy (40.5%) and normal (26.7%) showed lower concordance rates (Figure). Conclusions Although the fully automated echocardiographic analysis system tended to overestimate wall thickness, the agreement rate for left ventricular hypertrophy classification was high.