Stress has been well documented to bring about various clinical disorders, ranging from neurodegeneration, as seen in such conditions as Parkinson disease and Alzheimer disease, to metabolic disorders, including diabetes mellitus. It is also known that dysregulation of immune responses in the brain is closely linked to clinical disorders. In fact, it is accepted that stress associated with daily activities, be it good or not, can affect immunity as well as general health. However, the effects of stress on immune functions, especially brain immune cells, are not fully understood. As for immune cells, three types of glial cells contribute mainly to brain immunity: astrocytes, oligodendrocytes, and microglia. Microglia differ from the others in several aspects: first, they have a monocyte lineage; and second, they originate from the mesoderm, while astrocytes and oligodendrocytes, like neuronal cells, originate from the ectoderm. Thus, microglia are considered to be the central player in exerting immune functions in the brain. In this review, we describe the microglial responses induced by various kinds of stress and propose a possible mechanism by which stress induces microglial activation.
Hepatitis C virus (HCV) infection is one of the most prevalent infectious diseases in the world, with approximately 170 million people infected. Persistent HCV infection induces liver inflammation and fibrosis, increasing the risks of liver cirrhosis and hepatocellular carcinoma. The sustained virologic response rate of genotype 1 chronic hepatitis C patients on a previously used treatment regime (pegylated interferon and ribavirin therapy) was only 40%-60%. This combination therapy causes various adverse events and cannot be tolerated by or is contraindicated for some patients. The use of ribavirin in patients with an estimated glomerular filtration rate of <50 mL/min/1.73 m2 is particularly problematic, because ribavirin and its metabolites are excreted by the kidneys. Recently, remarkable advances have been made in the treatment of patients with chronic hepatitis C, and interferon-free, direct-acting antivirals have become the primary treatment strategy instead of interferon-based treatments. Direct-acting antiviral treatments comprise combinations of NS3/4 protease inhibitors, NS5A inhibitors, and NS5B polymerase inhibitors. The combination of asunaprevir (NS3/4 protease inhibitor) and daclatasvir (NS5A inhibitor) was the first interferon-free treatment to be approved in Japan. Thereafter, several combination treatments have been approved, including ledipasvir (NS5A inhibitor)/sofosbuvir (NS5B polymerase inhibitor), ombitasvir (NS3/4 protease inhibitor)/paritaprevir (NS5A inhibitor)/ritonavir, ombitasvir/paritaprevir/ritonavir/dasabuvir (NS5B polymerase inhibitor), grazoprevir (NS3/4 protease inhibitor)/elbasvir (NS5A inhibitor) and glecaprevir (NS3/4 protease inhibitor)/pibrentasvir (NS5A inhibitor). All these treatments have demonstrated high efficacy and safety, with over 90% of the patients achieving a sustained virologic response. Thus, HCV has become easy to eliminate in most patients with hepatitis C. However, there may still be some patients who are currently infected with HCV, and identifying those who have not received treatment may be a problem. Lastly, considerable numbers of patients attending institutions without hepatologists or hemodialysis facilities are not receiving anti-HCV treatment, so cooperation is required between hepatologists and physicians working in other fields.
Extending the role of pharmacists beyond the dispensing room to the ward bedside is essential for the advancement of medical care, and clinical pharmacists now provide pharmacological care-based drug therapy to patients through drug management guidance and hospital medical services. At hospitals, pharmacists support doctors by checking the dosage and content of prescriptions, monitoring efficacy and side effects, and providing information on drug interactions, thereby ensuring that advanced drug treatment is efficient and safe. We analyzed the records of interventions in drug therapy by clinical pharmacists working in the wards at our hospital and found that they contributed to the efficacy and safety of treatment. The clinical pharmacists made over 300 pharmaceutical interventions each month. Most of these interventions involved such important elements as treatment proposals and dosages, and more than 80% of them helped eliminate potential problems for patients, such as the necessity of additional treatment.
Although S-1+cisplatin therapy is used as first-line therapy for unresectable progressive/recurrent gastric cancer, the incidence of adverse events is not low. Renal dysfunction, especially, is an important side effect of dose-limiting toxicity and requires caution. Conversely, outpatient chemotherapy is becoming popular nationwide, but at the time of cisplatin administration, it is burdensome for patients to be infused for hospitalization to prevent renal dysfunction. It is possible that there is no difference between the incidence of renal dysfunction in patients to whom cisplatin is administered during hospitalization and that in outpatients treated with a short hydration regimen. Furthermore, currently, because of the increase in the infusion speed and use of magnesium, data on renal dysfunction associated with cisplatin administration in outpatient settings have not been reported. Here we report a case of the onset of renal dysfunction.