This review summarizes one portion of the research for which the author received the Pharmaceutical Society of Japan Award. The complete title of the awarded research is “Pharmacological Studies on Metabolism and Functions of Biomembrane Lipids”. Because the awarded research is a very broad study, this review describes the discovery, physiological functions, and congenital defects of α-tocopherol transfer protein (α-TTP), a critical factor in determining the transport of vitamin E in the body, which has been the focus of the author's work throughout his research career.

Under the current Model Core Curriculum for Pharmaceutical Education, competencies and program-level learning outcomes are not differentiated; furthermore, how competencies are developed by specific behavioral objectives, which are subdivided by specialty, needs to be clarified. A clear vision for ensuring academic as well as clinical competencies in Japanese pharmaceutical education, which emphasizes research and education in basic fields, is needed. Standardization is necessary to ensure improvement in quality over time. Thus, it is necessary to establish a model core curriculum as a standard. First, we assigned students a task designed for them to pursue outcome-based education from the perspective of developing competencies. Second, students learned about the importance of “conceptual understanding”, which enables them to form generalizations and principles that enable them to deal with new situations. Finally, we discussed the specifics of how to transfer understanding in the cognitive domain and proposed a “concept-based curriculum” that considers a hierarchy of competencies that includes the non-cognitive domain. In addition, we created a draft of a form that had check items for incorporating it into a real curriculum with an eye to practical use. The method used in the present study of organizing a curriculum corresponding to qualitatively different cognitive, metacognitive, and action systems may be applicable to other professions in the medical field.

The model core curriculum for pharmacy education (core curriculum) specifies the basics of 6-year pharmacy education. Pharmacy education is currently being provided based on the revised version of the core curriculum created in 2013 (revised core curriculum), with the aim of training pharmacists with the ability to fulfill social needs. The revised core curriculum also defines the “fundamental capacities to become a pharmacist” that should be acquired by the time of graduation. As education based on the revised core curriculum has been progressing, various challenges of this version, which may also be related to the basis of 6-year pharmacy education, have been identified. Measures to address these challenges, including: clearly indicating the number of goals in each area and the relationship between basic and clinical pharmacy; demonstrating the basic ideas of 2 areas differing from those for knowledge acquisition, 〈basic items〉 and 〈pharmacological research〉; and defining 〈clinical pharmacy〉 and the 〈fundamental capacities to become a pharmacist〉 in the context of pharmacy education, should be discussed in the future. Students educated based on a new version of the core curriculum, which will be created during the next term, are supposed to be active in society as pharmacists 20 or 30 years later. With this taken into account, this paper discusses the revised core curriculum currently in use, and proposes improvement plans for the new version, such as specifying parameters to evaluate learning achievements and the hierarchical relationships among areas.

Thesis research and clinical training are comprehensive areas of learning for cultivating the major abilities indicated in the professional competencies of the Model Core Curriculum for Pharmacy Education. They are also important subjects that can effectively reflect the educational philosophy and the human resource development policies of each university. In the School of Pharmacy and the School of Pharmaceutical Sciences at Kanazawa University, we have established a human resource development policy of “fostering leaders who are active in a variety of professions in the field of pharmaceutical sciences”. We have been implementing various initiatives in line with this objective. In this symposium, we will present an analysis of the current situation in pharmaceutical education that led us to adopt such a human resource development policy. We will also introduce specific reforms that our university has promoted in response to this situation.

The first-phase third-party accreditation conducted by the Japan Accreditation Board for Pharmaceutical Education between FY 2013 and 2019 revealed various issues regarding current pharmacy education programs. In addition, the report of the Ministry of Health, Labour and Welfare's Study Group on the Training and Quality Improvement of Pharmacists, which was published in 2021, identified a broad range of issues in pharmaceutical education related to pharmacist training and quality improvement. Many of these issues are concerned with university curricula; thus, in order to ensure and enhance the quality of pharmaceutical education and develop pharmaceutical human resources that society demands, it is extremely important for each university to improve its curricula. Since revision of the model core curriculum for pharmaceutical education is currently underway, in this symposium, we held a discussion to identify points that need to be improved regarding the current model core curriculum to ensure and enhance the quality of pharmaceutical education in light of the above-mentioned issues, and incorporate the corresponding measures into the basic policy for revision of the model core curriculum.

Myelin is a multilamellar membrane structure formed by oligodendrocytes in the central nervous system (CNS) and Schwann cells in the peripheral nervous system (PNS). It has been recognized as an insulator that is essential for the rapid and efficient propagation of action potentials by saltatory conduction. However, recently many studies have shown that myelin and myelin-forming cells interact with axons and regulate the nervous system far more actively than previously thought. For example, myelination changes axons dynamically and divides them into four distinct functional domains: node of Ranvier, paranode, juxtaparanode, and internode. Voltage-gated Na⁺ channels are clustered at the node, while K⁺ channels are at the juxtaparanode, and segregation of these channels by paranodal axoglial junction is necessary for proper axonal function. My research experience began at the neurology ward of the Niigata University Medical Hospital, where I saw a patient with peripheral neuropathy of unknown etiology more than 37 years ago. In the patient's serum, we found an autoantibody against a glycolipid enriched in the PNS. Since then, I have been interested in myelin because of its beautiful structure and unique roles in the nervous system. In this review, our recent studies related to CNS and PNS myelin are presented.

The basal levels of intracellular Zn²⁺ and extracellular Zn²⁺ are in the range of ～100 pM and ～10 nM, respectively, in the brain. Extracellular Zn²⁺ dynamics is involved in both cognitive performance and neurodegeneration. The bidirectional actions are linked with extracellular glutamate and amyloid-β_1-42 (Aβ_1-42). Intracellular Zn²⁺ signaling via extracellular glutamate is required for learning and memory, while intracellular Zn²⁺ dysregulation induces cognitive decline. Furthermore, human Aβ_1-42, a causative peptide in Alzheimer's disease pathogenesis captures extracellular Zn²⁺ and readily taken up into hippocampal neurons followed by intracellular Zn²⁺ dysregulation. Aβ_1-42-mediated intracellular Zn²⁺ dysregulation is accelerated with aging, because extracellular Zn²⁺ is age-relatedly increased, resulting in Aβ_1-42-induced cognitive decline and neurodegeneration with aging. On the other hand, metallothioneins, zinc-binding proteins can capture Zn²⁺ released from intracellular Zn-Aβ_1-42 complexes and serve for intracellular Zn²⁺-buffering to maintain intracellular Zn²⁺ homeostasis. This review summarizes Zn²⁺ function and its neurotoxicity in the brain, and also the potential defense strategy via metallothioneins against Aβ_1-42-induced pathogenesis.

Particular batches of Moderna mRNA Coronavirus Disease 2019 (COVID-19) vaccine were recalled after foreign particles were found in some vaccine vials at the vaccination site in Japan in August 2021. We investigated the foreign particles at the request of the Ministry of Health, Labour and Welfare. Energy dispersive X-ray spectroscopy analysis suggested that the foreign particles found in the vials recalled from the vaccination sites were from stainless steel SUS 316L, which was in line with the findings of the root cause investigation by the manufacturer. The sizes of the observed particles ranged from <50 μm to 548 μm in the major axis. Similar foreign particles were also detected in 2 of the 5 vaccine vials of the same lot stored by the manufacturer, indicating that the foreign particles have already been administered to some people via vaccine. Observation of the vials of the same lot by digital microscope found smaller particles those were not detected by visual inspection, suggesting that more vials were affected. Contrarily, visual inspection and subvisible particulate matter test indicated no foreign particles in the vials of normal lots. Possible root cause and strategies to prevent such a deviation were discussed from technical and regulatory aspects.

We investigated a situation of passive smoking and its damaging effects among high school students. Urine cotinine concentration was measured and quantified. Additionally, we evaluated the awareness of passive smoking and smoking regulations in high school students, and the educational effect on passive smoking using a questionnaire survey and educational videos produced by high school students. We conducted a self-reporting questionnaire survey with high school students before and after watching the video produced by the high school students. We gathered the scores of the Kano Social Nicotine Dependence Questionnaire (KTSND) and awareness of smoking restrictions. Consent was obtained through the questionnaire before watching the video and collecting urine samples. Urine cotinine concentrations from 54 samples were evaluated and indicated within the low value. The KTSND score significantly decreased for those who responded to both questionnaires, after watching the video. Furthermore, analysis of the KTSND questionnaire items showed a significant decrease in scores for lifestyle, stress, and smoking location. This suggests that the video produced in this study has a certain amount of educational effect on passive smoking and that the student-led educational method is effective. The survey using the KTSND revealed that there were some students who were not exposed to passive smoking, but instead had high smoking tolerance. Going forward, it will be necessary to promote education on passive smoking and smoking prevention by incorporating the video lecture and urine cotinine concentration was measured, as in this study, to encourage behavior that decreases passive smoking among high school students.

Topical Medicine No. 37-① is one of the in-pharmacy formulation that specifies a confirmation test (referred hereafter as the conventional method) to identify its ingredient diphenhydramine (DH) by colorimetric test. However, the conventional method is environmentally unfriendly due to the large amount of sample and organic solvent used, and the extraction process is complicated. We therefore developed three methods in view of improving the currently confirmation testing process: a simplified version of the conventional method, a TLC method, and an LC/photodiode array detector (PDA) method. The LC/PDA method was also examined for the quantitation of DH in order to determine its content in the medicine when needed. The LC/PDA method also demonstrated sufficient linearity in the calibration curve and recovery rate. We also evaluated whether the three methods developed in this study could be applied to Topical Medicine No. 37-①, which is made of absorptive cream containing different parabens.

“Leukerin^® powder 10%” containing mercaptopurine (6-MP) is an oral anticancer drug that requires careful handling. As a powder formulation, there are risks of exposure due to scattering during dispensing and possible 6-MP contamination to other drugs due to adhesion to the packaging machine. We previously reported that wiping with an alcohol-containing towel is useful for removing scattered powder after dispensing. However, it is recommended to wipe disk-type powder-packaging machines with water instead of cleaning with the alcohol-containing towel. Hence, we scattered 6-MP powder 100 mg (total amount of 6-MP: 10 mg), and then wiped with water three times using different types of cloth each time. We confirmed that third time wiping cloth did not have any 6-MP. Furthermore, we confirmed that the adhering 6-MP could be removed by wipe-cleaning (water-wiping twice and dry-wiping once) after dispensing 6-MP powder at two pharmacies that routinely dispensed 6-MP powder using a disk-type powder-packaging machine. In addition, we confirmed the adhesion of 6-MP in parts of the machine not cleaned by wipe-cleaning and also in parts that were washed only with water, in both the pharmacies. Based on the above observations, we recommend the following steps for cleaning disk-type powder-packaging machines after dispensing 6-MP powder: (1) wipe-cleaning that includes water-wiping twice and then dry-wiping once, (2) cleaning all areas of the packaging machine, and (3) wipe-cleaning with water before washing with water.

Non-medical use of prescription medications is a serious public health crisis. The black market for prescription medications should be routinely surveyed to encourage their appropriate use. Herein, we focused on Twitter to investigate the possibility of illicit drug trading in Japan. From March 1 to 8, 2021, we examined the characteristics of Twitter posts, identified using the search term “Okusuri Mogu Mogu”, a Japanese argot used for trading of medications. The captured data included the date of the posts, whether with a hashtag was used, an indication of the trades type (buy, sell, self-administration, and unknown), and the name of the mentioned pharmaceutical products. The number of named medications in the posts was counted and further categorized according to the Anatomical Therapeutic Chemical (ATC) classification. Two hundred and thirty-eight posts were identified with the searching term “Okusuri Mogu Mogu”, of which 154 (64.7%) named specific medications. Of note, 73 posts (30.7%) were associated with buying or selling medications. We examined the 73 posts. These posts included 118 medications (26 types), of which 107 (88.4%) were classified as nervous system drugs. Hypnotics and sedatives were the most frequently mentioned medications. The present study sheds light on pharmaceutical medication trading via Twitter. Reinforcing the surveillance practices or cracking down on traders by authorities may be insufficient. We consider the possible effectiveness of socially supportive approaches to help those who lack support to access the appropriate psychiatric care.

The management of syncope is clinically important for heart failure (HF) patients. We herein describe a case on the efficacy of disopyramide for refractory syncope in HF with preserved ejection fraction (HFpEF). An 82-year-old man was hospitalized for respiratory distress and lower limb edema and was subsequently diagnosed with HFpEF. The use of diuretics improved HF symptoms; however, on day 10 after hospitalization, a rapid decrease in blood pressure and transient loss of consciousness developed. After neurologic examination, he was diagnosed with pure autonomic failure. Although he was administered midodrine 8 mg/d, fludrocortisone 0.1 mg/d, and droxidopa 300 mg/d, syncope was observed once a day on average. According to the Holter electrocardiogram, the patient's heart rate and coefficient of variation of R-R intervals (CVRR) during the day were unstable. In addition, high frequency power (parasympathetic nerve activity) was significantly higher than low frequency power (both sympathetic and parasympathetic nerves activity), suggesting that the parasympathetic nerves may have been highly active while the sympathetic nerves would have been blocked. On day 29, a pharmacist proposed disopyramide 300 mg/d, which blocks parasympathetic nerves and improves neural-mediated syncope, to the attending doctor. After the initiation of disopyramide, transient loss of consciousness was not observed. Furthermore, the diurnal variation in the heart rate and CVRR completely disappeared. In conclusion, disopyramide would be effective for refractory syncope in patients with HFpEF, and the Holter electrocardiogram may be a useful tool for the assessment of drug efficacy by pharmacists.