Aim: Deterioration of cognition, worsening of frailty, and pneumonia may be exacerbated by long-term treatment with medications having anticholinergic activity. The potency of anticholinergic activity in antipsychotics is reported in the literature, but potency or the order of potency was not found to coincide with each other. Therefore, we evaluated anticholinergic activity in antipsychotics by radio-receptor assay using a M1WT3 cell line expressing muscarinic-1 receptor.

Methods: We established an eco-friendly method of changing the scintillator in a radio-receptor assay system from liquid to solid using a M1WT3 cell membrane. With this method, we evaluated the anticholinergic activity of chlorpromazine, clozapine, perphenazine, pimozide, fluphenazine, and olanzapine, which show differences in anticholinergic potency as per the available literature, and aripiprazole and risperidone, which are frequently prescribed in psychiatry nowadays. To evaluate the potential appearance of anticholinergic side effects, anticholinergic activity in this report and the serum concentration range reported in a manufacturer's interview form were compared. We created a classification model of the potential appearance of anticholinergic side effects with reference to a report by Salahudeen et al. and later added one report each by Ohara et al., Nagai et al., and Huhn et al.

Results: The IC₅₀ (50% inhibition of quinuclidinyl benzylate binding) value of clozapine was the most potent among the evaluated compounds at 0.028±0.007 μM, followed by chlorpromazine 0.149±0.001 μM ＞ olanzapine 0.382±0.195 μM ＞ perphenazine 6.78±1.31 μM ＞ pimozide 7.25±3.51 μM ＞ fluphenazine 8.95±3.15 μM ＞ risperidone 10.638±7.054 μM ＞ aripiprazole 28.44±4.52 μM. Our results are very close to those reported by Huhn et al., which involved 50,000 patients prescribed with antipsychotics possessing anticholinergic activity.

Discussion: Among the evaluated antipsychotics, aripiprazole showed the lowest anticholinergic activity and is possibly free of side effects causing cognitive worsening. The radio-receptor binding assay we developed using the M1WT3 cell line can potentially be useful in monitoring side effects of deterioration of cognition in patients treated with antipsychotics.

We investigated anti-SARS-CoV-2 IgG and IgM in 9 subjects who were selected as with shadows on the lungs in chest computed tomography from 17 symptomatic subjects from 213 SARS-CoV-2-PCR-negative subjects in total of 266 subjects for the investigation of an in-hospital COVID-19 cluster in St. Marianna University Yokohama Seibu Hospital. Anti-SARS-CoV-2 IgM and IgG antibodies were investigated in the 5th, 7th, 11th, and 19th weeks after the exposure to SARS-CoV-2. Anti-SARS-CoV-2 IgM were positive in 2 out of the 9 cases from the 5th week but were negative in all the 9 cases in the 11th and 19th weeks. Anti-SARS-CoV-2 IgG were positive in 5 out of the 9 cases from the 5th week, being elevated to the largest values in the 5th or 7th weeks in all the 5 cases. Analyses for anti-SARS-CoV-2 antibodies may be valuable as an adjunct in the diagnosis of COVID-19 specifically for the detection of the symptomatic but SARS-CoV-2-PCR-negative patients in an in-hospital COVID-19 cluster.

We report a case of high-level femoral artery bifurcation resulting in puncture-site pseudoaneurysm following neuroendovascular intervention. An 80-year-old man with symptomatic right intracranial carotid artery stenosis underwent successful percutaneous angioplasty by transfemoral approach. Postoperative femoral arteriography showed the level of the femoral artery bifurcation to be at the center of the femoral head and that the superficial femoral artery was punctured. The access site was treated with a vascular closure device and manual compression. Two days post-procedure, ultrasound examination showed a femoral pseudoaneurysm of 26-mm diameter at the puncture site. Six days post-procedure, the femoral artery was surgically reconstructed after failure of echo-guided compression. High femoral artery bifurcation is reported to be a rare and high-risk factor for pseudoaneurysms. The ideal puncture site is the main trunk of the femoral artery. During preprocedural fluoroscopy, determination of the puncture level, which should be between the superior border and center of the femoral head, could be essential in avoiding injury to other arteries. Moreover, confirmation of the punctured artery with postprocedural femoral arteriography may help in predicting the occurrence of pseudoaneurysms. Because the parallel course of the superficial and deep femoral arteries at the level of femoral head makes them difficult to differentiate through palpation, accurate compression under ultrasound guidance may avoid enlargement or bleeding of a pseudoaneurysm.