Chemotherapy-induced gastrointestinal symptoms are one of the most distressing adverse side effects. To address this, serotonin (5-HT) 5-HT₃ receptor antagonists are recommended before chemotherapy and indicated when breakthrough chemotherapy-induced gastrointestinal symptoms occur. However, not all patients obtain sufficient effects with serotonin receptor antagonists. To provide precision medicine, we examined the relationship between the frequency or intensity of chemotherapy-induced gastrointestinal symptoms and polymorphisms of serotonin-related genes. We examined the association between gene polymorphisms and gastrointestinal symptoms in 55 patients with cancer who were undergoing chemotherapy at Nagoya University Hospital. Anorexia, nausea, and vomiting were graded based on the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. We found that the frequency and intensity of chemotherapy-induced gastrointestinal symptoms were associated with the gene polymorphisms of 5HTTLPR [serotonin transporter gene (SLC6A4)] and haplotype of VNTR [monoamine oxidase A gene (MAOA)]-rs1799836 [monoamine oxidase B gene (MAOB)]. Frequency was also associated with the gene polymorphism of VNTR (MAOA). Our study showed that certain gene polymorphisms were associated with the frequency and intensity of chemotherapy-induced gastrointestinal symptoms. These findings can help in the development of precision medicine for chemotherapy-induced side effects.

In this study, we investigated whether a combination of 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer with commercially available diquafosol sodium (DIQ eye-drops) or sodium hyaluronate eye drops (HYA eye-drops) enhances the therapeutic effect for dry eyes. An N-acetylcysteine-treated rabbit model was used to evaluate the therapeutic effect for dry eyes in this study. The instillation of eye-drops containing DIQ and HYA enhanced mucin levels, and promoted the improvement in the tear film breakup in the N-acetylcysteine-treated rabbit model. In addition, the combination of MPC polymer increased the dry eye therapy in DIQ eye-drops and HYA eye-drops. Although the mucin levels in the N-acetylcysteine-treated rabbit model were also enhanced by the combination of DIQ eye-drops and MPC polymer, the mucin levels were similar between HYA eye-drops co-instillated with or without MPC polymer. These results show that the combination of MPC polymer may enhance the therapeutic effect for dry eyes in commercially available eye-drops.

Patients with chronic obstructive pulmonary disease (COPD) have difficulty inhaling bronchodilator medication due to dyspnea. We investigated whether collaboration between community pharmacists and physical therapists at a respiratory clinic (COLLAB) that provides breathing exercises and inhalation instructions to COPD patients resulted in improved breathing techniques and respiratory indices.

Indices including the breathing technique scores of exhalation, inhalation, inspiratory length, and breath hold (poor 0, good 8); forced expiratory volume in one second (FEV₁); COPD assessment test (CAT) score (good 0, poor 40); and six-minute walk test (6MWT) were measured at 0 and 3 months after COLLAB.

Thirty-nine patients participated in the study. The median breathing technique score improved significantly in patients with stages Ⅰ and Ⅱ COPD (0-month 6.0 vs 3-month 8.0, P < 0.001) and patients with stages Ⅲ and Ⅳ COPD (0-month 3.0 vs 3-month 7.0, P < 0.001). The median 6MWT increased to a greater extent in patients with stages Ⅰ and Ⅱ COPD and improved the breathing techniques score (4 - 8 points) more than in patients with a slightly improved score (0 - 3 points) (48 m vs 0 m, P = 0.005). Patients with stages Ⅲ and Ⅳ COPD also had a greater increase in the median FEV₁ (0.02 L vs -0.10 L, P = 0.013) and decrease in the median CAT score (-3.0 vs 1.0, P = 0.024).

COLLAB improved the breathing technique scores, with patients achieving significant improvement in techniques having improved clinical indices. Therefore, COLLAB is important to achieve the full effect of inhalation medication in COPD patients.

In intensive care settings, there are very few reports of direct cooperation between pharmacists (Ph) and clinical engineers (CE) in Japan. Since extracorporeal circulation devices such as continuous hemodiafiltration, which affect pharmacokinetics, are widely used in these fields, cooperation between Ph and CE is important. Therefore, we evaluated the direct cooperation between Ph and CE for sharing information related to extracorporeal circulation devices. In order to evaluate the efficacy of this cooperation, the total numbers of pharmacist prescription interventions involving extracorporeal circulation devices before and after the cooperation, as well as the time required for these interventions, were compared. The total numbers of interventions before and after the cooperation were 303 and 430, respectively. Of these, the number of prescription interventions related to extracorporeal circulation devices increased significantly from 30 cases (9.9％) before to 85 cases (19.8％) after the cooperation (P < 0.001). The percentage of interventions within one 24-hour period also increased significantly from 66.7％ to 96.5％ (P < 0.001). After the cooperation, there were 44 cases that received intervention by direct sharing of information with the CE; most of these were related to the antimicrobial drug dosage. The results suggest that cooperation between Ph and CE related to extracorporeal circulation devices can contribute to early intervention with and the proper use of antimicrobial drugs.

Clostridioides difficile infection (CDI) is the major cause of nosocomial infectious diarrhea. Previous studies reported that the use of gastric acid suppressors increases the risk of CDI. In the present study, we compared the risk of CDI due to the use of proton pump inhibitors (PPI) and potassium-competitive acid blockers (P-CAB). Inclusion criteria were patients who were hospitalized, at least 65 years old, and received antimicrobial treatment.

The use of PPI or P-CAB increases the risk of CDI (P < 0.05, odds ratio (OR): 1.92, 95％ confidence interval (95％CI): 1.071 - 3.456). We also extracted 560 cases each from the PPI and P-CAB groups using propensity score matching. There was no significant difference in the onset of CDI between the two groups (P = 0.194, OR: 2.02, 95％CI: 0.685 - 5.943).

Our findings suggest that the increase in the risk of CDI by gastric acid suppressors is caused by the maintenance of intragastric pH ≥ 5 although the effect of the gastric acid suppression strength is expected to be small.