Assessment of "look-alike" packaging designs related to medication errors using information technology.

This study aimed to assess the similarity among press-through pack (PTP) sheets of pharmaceutical products in Japan. The appearance of PTPs was assessed using a pharmaceutical design database (PDD) of 2,750 pharmaceutical tablets comprising approximately 40 % of the 6,840 products marketed in Japan. Package sheet color (Sc), tablet color (Tc), character color (Cc), sheet line color (SLc), and upper color (Uc) were used to evaluate the uniformity of PTP sheet design. To assess the risk of misidentification, 1,000 prescriptions for 82,273 cancer patients were retrieved from 21,026,742 records in the claims database of the Japan Medical Data Center Co. Ltd., Tokyo, Japan. The most frequent PTP sheet colors for 143 drugs were Sc (silver), Tc (white), Cc (blue), SLc (none), and Uc (silver). The prescribing pattern of 1000 randomly chosen prescriptions was analyzed. Database records of prescriptions without tablets (n = 69), including only one PTP tablet (n = 292), and those with lack of PDD prescription data (n = 388) were excluded. Eventually, 236 prescriptions were evaluated. Fourteen prescriptions (5.9%) had PTP sheets with five matching elements and 29 had with four matching elements (12.3%). This novel PDD database for information technology concept easily identified similar PTP sheets involved in prescriptions dispensed in 18 % of evaluated cancer patients. The concept seems to be applicable for preventing look-alike dispensing errors.

Dermoscopic features of nonpigmented eccrine poromas in association with their histopathological features.

BACKGROUND: Nonpigmented eccrine poromas (EPs) occasionally mimic various skin tumours, but their dermoscopic features have not been clarified. OBJECTIVES: To evaluate the dermoscopic features of nonpigmented EPs in association with their histopathological features. METHODS: Retrospective analysis of the dermoscopic features of 10 histopathologically proven cases of nonpigmented EP at the Department of Dermatology, Shinshu University Hospital (Matsumoto, Japan). RESULTS: Specific features in vascular structures were observed in five of 10 nonpigmented EPs. Three cases showed a polymorphous vascular pattern: two cases of a combination of hairpin and dotted vessels, and one case of a combination of hairpin, dotted and linear-irregular vessels. In addition, there were two cases of monomorphous vascular pattern: one case of linear-irregular vessels, and one case of hairpin vessels. We did not observe arborizing, crown or comma vessels. Comedo-like openings, milia-like cysts, cerebriform pattern and ulceration were observed in one case each. Furthermore, nine of 10 cases showed the characteristic feature, described as well-circumscribed reddish globule/lacuna-like structures with separation of mesh bands, which were reminiscent of frog eggs aggregation. This characteristic feature on dermoscopy was explained by the histopathological features of horizontal sections at a depth of 300-400 µm from the surface. Island-shaped oedematous stroma with numerous microvessels, which were surrounded by poroid cells in mesh-like forms, were seen. CONCLUSIONS: Vascular structures and 'frog eggs-like appearance' are important features on dermoscopic examination of nonpigmented EP. Further studies are required to evaluate their diagnostic accuracy to differentiate nonpigmented EP from other tumours.

The citrus flavonoid, nobiletin, inhibits peritoneal dissemination of human gastric carcinoma in SCID mice.

The flavonoid nobiletin (5,6,7,8,3',4'-hexamethoxyflavone), found in Citrus depressa Rutaceae, a popular citrus fruit in Okinawa, Japan, reportedly inhibits the production of pro-matrix metalloproteinase (proMMP)-1, 3, and 9 in rabbit synovial fibroblasts in vitro. In the present study, we demonstrated the inhibitory effects of nobiletin on the proliferation of the cancer cell line, TMK- 1, and its production of MMPs. In the SCID mouse model, we found that nobiletin inhibited the formation of peritoneal dissemination nodules from TMK-1. The enzymatic activity of MMP-9 expressed in culture medium obtained from a co-culture of TMK-1 and mouse fibroblastic cells was inhibited by nobiletin in a concentration-dependent manner. In the SCID mouse model, total weight of dissemination nodules was significantly lower in the treated group compared with the vehicle control group (0.07 g vs. 0.78 g, P = 0.0059). The total number of dissemination nodules was also significantly lower than in the vehicle control group (7.5 vs. 69.3 / body, P = 0.0001). These results suggest that nobiletin may be a candidate anti-metastatic drug for prevention of peritoneal dissemination of gastric cancer.

A patient of hypogonadotropic hypogonadism accompanied by growth hormone deficiency and decreased bone mineral density who attained normal growth.

We present here a rare case of hypopituitarism accompanied by growth hormone (GH) deficiency and hypogonadotropic hypogonadism, in which the patient attained normal height but was of eunuchoid appearance. A 23-year-old man who had not reached puberty was referred to Saitama Medical School for hormonal evaluation. Basal hormonal data and hormone-stimulating tests revealed impaired secretion of GH, gonadotropins and adrenocorticotropic hormone (ACTH). Serum levels of testosterone, estrone, estradiol and estriol were all below the detectable ranges. The patient's plasma ACTH responded to corticotropin releasing hormone, but not to insulin-induced hypoglycemia. Serum GH showed a minimal response to GH-releasing hormone, but was unresponsive to insulin-induced hypoglycemia. Serum luteinizing hormone and follicle stimulating hormone did not respond to luteinizing hormone-releasing hormone. The results were compatible with a diagnosis of hypothalamic hypopituitarism. Magnetic resonance images of the brain showed a small anterior pituitary, an ectopic posterior lobe and transection of the pituitary stalk. Although the patient showed signs of hypopituitarism, he finally attained normal height, possibly because of failed epiphyseal maturation. His bone mineral density was markedly reduced to 0.647 g/cm2 in the lumbar spine; this level was 61.7% of the average level of healthy young males. Our findings were compatible with a recently advocated view that estrogen is important in promoting epiphyseal fusion and in determining bone density in males as well as females.

[The effects of exercise training on metabolic phases. With special reference to intraorganic fat and amino acids in Sprague-Dawley rats with streptozotocin diabetes].

We attempted to clarify the effects of aging and the difference between heavy and mild exercise training on the fat and amino acid (AA) systems of streptozotocin diabetic Sprague-Dawley rats in vivo. We exercised two groups of rats, both composed of juvenile and aged rats. The first group, however, consisted of diabetic rats only, the second of normal rats only. Both groups underwent mild training, 20 cm/s, or heavy training, 33 cm/s, for an hour a day, five times a week for four weeks. We looked for fat and amino acids in the serum, liver, red skeletal muscles and heart muscles at the pre- and post-training stages. The results were as follows: Although we observed decreased triglyceride (TG) levels in the serum, liver and intraskeletal muscles in the normal control group, similar decreases were also observed in the diabetic group undergoing insulin treatment with mild exercise training. On the other hand, we observed a clear increase in the rats subjected to heavy exercise training. This increase was particularly significant in the aged rats. There was, however, no significant change in the TG levels in the intraheart muscles of either the juvenile or aged rats, including the diabetic ones. Exercise training in the normal control group produced decreases in total AA, glycogenic AA, branched chain AA and ketogenic AA. Although there was no significant decrease in the TG levels in the serum, we could see clear signs of a decrease in the liver and the intraskeletal muscles. By contrast, the more the rats undergoing insulin treatment for diabetes were exercised, the greater the increase in the amount of AA in the livers and intraskeletal muscles. These changes were especially significant in the aged group. Consistent with previous reports, the diabetic groups produced different results for fat and AA in proportion to the intensity of exercise training and age of the rats. We also demonstrated that the differences were very small in the serum, but significant in the organs, livers and skeletal muscles. From the above findings, we have concluded that exercise training should play a major role in the treatment of diabetes in consideration not only of serum, but also transitions of the whole body's metabolic phases, including the intraorganic systems.

Higher excretion of urinary bound amino acids in infants: probably related to protein-anabolic effect of growth hormone.

Concentrations of bound amino acids in urine were found to be markedly higher in infants than in children over 4 years of age. And it was also found that bound amino acid levels in plasma were increased in infants and young children than in adults. Urinary excretion of bound amino acids was increased in hypopituitary dwarf after one day of intramuscular injection of human growth hormone. A possibility was advanced that an increased excretion of bound amino acids of the overflow type observed in infants was due to active protein biosynthesis stimulated by growth hormone of which plasma levels have been reported to be high in infancy.

Hypoglycemia during prolonged exercise in normal men.

Hypoglycemia (blood glucose less than 45 mg per deciliter [less than 2.5 mmol per liter]) occurred in seven of 19 healthy men who exercised to exhaustion on a cycle ergometer at 60 to 65 per cent of maximal aerobic power. The hypoglycemic subjects exercised for 15 to 70 minutes despite blood glucose levels of 25 to 48 mg per deciliter (1.4 to 2.7 mmol per liter), and their exhaustion time (mean +/- S.E.M., 142 +/- 15 minutes) was not significantly different from that of the euglycemic group (165 +/- 11). Plasma epinephrine was inversely related to blood glucose (P less than 0.01) and was three times higher in the hypoglycemic subjects (P less than 0.05). Glucose ingestion (40 or 80 g per hour) prevented the hypoglycemia and resulted in a smaller rise in plasma epinephrine but did not alter perceived exertion or consistently delay exhaustion. We conclude that hypoglycemia occurs in normal subjects during prolonged exercise and results in an exaggerated rise in plasma epinephrine. However, hypoglycemia fails to effect endurance, and its prevention does not consistently delay exhaustion.

[Study of weight-bearing changes of normal and abnormal feet by frontal tomography (author's transl)].

Roentogenographic examination with emphasis upon frontal tomography was applied to clarify the positional relationship between the calcaneus and talus, and to measure weight-bearing changes of these bones on normal and abnormal feet in frontal plane. studied were conducted on 30 left feet of normal adults, 18 left feet of normal children, and 37 feet of 19 children affected with cerebral palsy, and 19 feet with unilateral or bilateral foot disorders other than cerebral palsy. Statistical analysis of the in patients with diseases results gave the following results. The 30 feet of normal adults were without definite trend for internal or external rotation, medical or lateral shift, though the calcaneus in the sinus tarsi was found to lower to an average extent of 1.68 +/- 0.68mm. The 8 feet of normal children were also without definite trend of rotation or shift. The calcanei of some of children's flat feet with cerbral palsy were found to fluctuate markedly up and down and also medialy and laterally. But the weightbearing change was in most cases with cerebral palsy stayed within normal ranges. The 19 feet with disorders other than cerebral palsy were found to lie within the normal ranges of lowering, rotation and shift. The author's modification of Méary's method was able to be used quantitatively and qualitatively. This method showed that feet with calcaneus varus of calcaneus valgus deviate markedly from the normal feet based in the evidence of average precentage. The analysis by this quantitative method was found to agree well with that by frontal tomography.