Our hospital opened a PET Center on April 1,2005 and since then FDG has been used for PET clinical examinations.For FDG manufactured in hospitals,quality control has to be rapid and ensure safety of an equivalent level to that of clinical pharmaceuticals because it is administered to patients from a few minutes to a few hours after manufacture.With this in mind,we studied the utility of endotoxin removal filters in the FDG manufacturing process,and found that the endotoxin removal rates of all filters studied was high.The PALL infusion filter ELD NEO 96 made by PALL Co.Ltd .was particularly good in this respect and the residual RI rate was extremely low.
Human blood is apt to be contaminated by endotoxins because there are so many of them in the environment and they exhibit pyrogeneous activity when present in the blood.Therefore,endotoxin removal filters are considered to be very useful in the FDG manufacturing process from the aspects of safety,efficiency improvement in FDG synthesis,and quality control.

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It is well known that salt excess accelerates organ injury when the renin-angiotensin system is activated.In the present study,we investigated the mechanisms by which salt excess causes glomerular injury using AT_1A receptor overexpression mice,and evaluated the preventive effect of indapamide,a thiazide-like diuretic.Young AT_1A receptor overexpression mice and C57BL/6 mice (wild type normal control) were salt-loaded from 8 to 14 weeks old using 1.5% NaCl in drinking water,and kidney specimens were collected.In the indapamide treatment group,10 mg/kg body weight of indapamide was administered concomitantly in the drinking water,and the dose adjusted weekly according to body weight measurements.
Although neither strain of mice exhibited a significant increase in blood pressure after such salt loading during the specified period,increased urinary protein excretion was observed in the AT_1A receptor overexpression mice,and indapamide blocked this influence of salt loading.There was a slight increase in the number of glomerular cells due to salt loading in the wild type and a marked increase in the AT_1A receptor overexpression mice,which was suppressed by indapamide.Immunostaining of angiotensin II receptors revealed a strong reaction in the glomerular mesangial cells in the latter as opposed to a mild reaction in the former.Furthermore,salt loading induced an increase in collagen IV,a major component of the extracellular matrix (ECM),which was suppressed by indapamide.The present findings suggest that blood pressure and glomerular hypertrophy/ECM deposition are not necessarily connected in young AT_1A receptor overexpression mice,and that glomerular injury is accelerated by salt loading.Also indapamide appears to be a promising therapy in the case of a salt excess and an activated renin-angiotensin system.

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Sulbactam sodium-ampicillin sodium (hereinafter referred to as SBT/ABPC) injections are widely used for the treatment of infection and in view of this,we conducted a study to examine the therapeutic equivalence of original and generic preparations of SBT/ABPC.In it,we compared efficacy and safety in patients diagnosed with pneumonia,acute bronchitis,or acute bronchiolitis who received the original or a generic SBT/ABPC injection at the National Organization Kanazawa Medical Center from May 2007 to March 2008.
We analyzed the efficacy endpoints of body temperature,white blood cell count,and CRP level and the safety endpoints of AST (GOT),ALT (GPT),and BUN in 121 subjects receiving the original preparation and 112 receiving the generic one.Our results suggest therapeutic equivalence for both efficacy and safety,and we conclude that the generic version can definitely be used as an alternative to the original preparation.

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We have developed a systematic communication training program for preclinical training using a dialog simulator,as a new teaching approach for pharmacy students.The communication training consisted of 3 processes for the clinical case scenarios that were devised (e.g.anamnesis at pharmacy,instructing patients in compliance,prescription questions,instruction in self-injection).In the first,students checked interview items using a dialog simulator as the introductory phase of the training (process 1).In the second,students used this to prepare role-plays consisting of interviews with simulated patients (SP) in small groups (process 2).Students took turns at being the patient,pharmacist and observer in small groups and then students received feedback from SPs on their performance as pharmacists in the role-plays (process 3).Faculty participated in the communication training with regard to its scheduling and in the role-playing as patients.
Afterwards,we conducted a questionnaire survey of the students’impressions of such training using a dialog simulator and subjected the results to CS analysis in order to evaluate the areas for improvement in the communication-training program.Students’evaluations with regard to the effectiveness of self-learning were both significant and interesting.While there was a little dissatisfaction with the speech recognition function of the simulator and it was considered to require the most improvement (rating of 18.78),our findings indicate that our original program using such a device in systematic communication training is useful in helping students to acquire communication skills.

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In this study,we developed a reversed-phase high-performance liquid chromatographic method using a fluorescence derivatizing agent for the determination of topiramate (TPM) in infant plasma.The method used 100μL plasma samples,and the HPLC separation was carried out on a Discovery HS-C 18 column (3μm,4.6 mm×150 mm) with phosphate buffer (pH 2.5 ; 25 mM)-methanol-acetonitrile (50 : 40 : 10 (v/v/v)) as the mobile phase at a 1.0 mL/min flow rate.TPM was detected using a fluorescence detector (λex/em : 470/537 nm).The quantification limit was 0.1μg/mL,and the intra- and interassay coefficients of variation were 0.8-7.1% and 1.3-9.3%,respectively.A specificity and selectivity study showed that there were no interfering peaks.Furthermore,correlation analysis of TPM concentrations measured by HPLC and LC/MS produced a correlation coefficient (γ) of 0.9825.

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At Kanazawa Medical University Hospital,all patients with advanced non-small-cell lung cancer (NSCLC) are treated with a standardized regimen including carboplatin (CBDCA) plus paclitaxel (PTX) chemotherapy.However,the initial dosage setting is left to the judgment of each doctor,and a standardized protocol for dosage reduction has not been established.In this study,therefore,we examined initial dosage settings and adverse effect frequencies in 34 NSCLC patients treated with CBDCA/PTX chemotherapy,to see whether standardization of dose reduction would be possible.The initial dosage setting of CBDCA and/or PTX had been reduced in 20 NSCLC patients (58.8%).Since the difference between the standard and actual dose of PTX increases with age (y=0.56 x-22.75,r²=0.23,p<0.01),each doctor had reduced the dosage according to the patient’s age.When the incidence of hematologic toxicities was compared between patients under and over the age of 70,the incidence of neutropenia was significantly higher in the latter (p=0.035).The incidence of grade 3 or 4 neutropenia was significantly higher in the patients treated with the standard PTX dose than in those treated with a reduced PTX dose (p=0.034).In this study,we noted that there was not only a need to validate the initial dosage setting in CBDCA/PTX chemotherapy,but also a need to improve certain points.Our findings suggest that a standardized method for calculating initial dosage settings should be established through discussion of the data we obtained.

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In pacemaker-related infections,as for all foreign body related infections,it is usually desirable to remove the infected device.However,we report the case of a patient undergoing treatment with a Cardiac Resynchronization TherapyDefibrillator (CRT-D) for severe arrhythmia in whom removal of the defibrillator was difficult and infection control was achieved only with antimicrobial chemotherapy.
The patient,in whom a CRT-D had been implanted for ventricular tachycardia,was hospitalized for catheter infection disease.She was diagnosed with infective endocarditis as methicillin-resistant Staphylococcus aureus (MRSA) was detected in a blood culture,and vegetation on the CRT-D lead by TTE.Owing to her severe arrhythmia,the lead was not removed,and a doctor requested a pharmacist’s advice on drug selection for antimicrobial chemotherapy and planning its administration.
We conducted administration planning for vancomycin,gentamycin,linezolid and arbekacin,achieved success in controlling vancomycin-intermediate resistant Staphylococcus aureus,and the vegetation disappeared.However,we encountered drug interactions and the adverse effects of hematologic abnormalities and renal dysfunction.
It has been suggested that treatment of infections associated with cardiac devices is possible using only antimicrobial chemotherapy if appropriate,effective antimicrobials are selected.However,it is generally necessary to continue such therapy for a long period of time in a patient like this and it is therefore important to be aware of the incidence of antimicrobial resistance,the adverse effects of antimicrobial agents,and drug interactions when selecting antimicrobials for treatment.

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We conducted a survey on the current use of our hospital formulary (HF) and analyzed the results using customer satisfaction (CS) analysis in order to pinpoint areas for improvement in the formulary and the content of the items in it.Results concerning the frequency of HF usage revealed it’s high-level of popularity among healthcare professionals.Among the respondents,59.9% of physicians,88.3% of nurses,50.0% of pharmacists,and 74.2% of others selected“I often use it”or “I use it”from the five-grade evaluation scale concerning this item.Concerning the necessity of the HF,the results indicated a high degree of demand with 75.0% of physicians,82.0% of nurses,76.0% of pharmacists,and 80.6% of others answering“It is essential”or“I need it”.However,regarding satisfaction with the HF,the results suggested that the content of the items in it needed improvement,with only about 55.6% of all respondents (broken down to 54.1% of physicians,53.2% of nurses,64.6% of pharmacists,and 58.1% of others) selecting the“Very satisfied”or“Satisfied”responses.The CS analysis indicated“usability of appendices”,“adequacy of main text”,and“visually appealing nature of appendices” as items requiring improvement.

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The changes in theophylline clearance in 115 Japanese pediatric patients (72 males and 43 females) aged from 0.5 to 4 years undergoing a constant rate aminophylline infusion were investigated during the asthmatic acute phase.Plasma theophylline concentration data,which were retrospectively obtained from routine therapeutic drug monitoring,were divided into 2 groups according to the time from initiation of aminophylline infusion (up to 48 hours or more than 60 hours) in order to estimate theophylline clearance.
In male patients,the theophylline clearance estimated for more than 60 hours was 27% higher than that for up to 48 hours (p<0.01)for ages 2-<5 years.In female patients,the theophylline clearance estimated for more than 60 hours was 35% higher than that for up to 48 hours (p<0.05)for ages 2-<5 years.
Our findings suggested that the theophylline clearance estimated for more than 60 hours from the initiation of a constant aminophylline infusion could not be safely used in setting the next initial dose of aminophylline in the asthmatic acute phase in pediatric patients.

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Since the six-year education system for pharmacy students was established in 2006,educational programs to cultivate humanism in pharmacists have been an important part of the curriculum in each year.In Fukuyama University,a program providing contact with elderly people in day-care centers and children in nursery schools was introduced for second-year under graduate pharmacy students in 2007,in order to cultivate students’ability to communicate and empathize with them.
Analysis of the results of a questionnaire survey on the effects of the exchange education program that we conducted for 3 years revealed the following.On the first visit,many students could not communicate well with either the elderly people or the children but from the 2nd visit onwards,almost all students were able to communicate and control the level of their voice better,and have more eye contact.As the communication program went on,students were able to build close relationships with their partners.The results of the questionnaire also showed that almost all students were satisfied with the communication education program at both facilities and their partners were also satisfied with it.In addition,good cooperation with the facilities produced a stepwise increase in student satisfaction rates over the three years.These results suggest that communication education plays an important role by cultivating hospitality skills and having students think about their behavior as medical professionals.

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