Rescheduling of combination hydrocodone products: problems for long-term care practitioners.

The Drug Enforcement Administration recently announced the final rule to reschedule hydrocodone combinations from schedule III of the Controlled Substances Act to the more restrictive schedule II category. This regulatory change will have broad operational implications for practitioners serving the health care needs of long-term care residents. Stakeholders will need to work collectively to identify possible efficiencies to counter some of the anticipated costs as well as its effect on patient care.

AACP faculty affairs standing committee report of strategies for faculty self-advocacy and promotion.

OBJECTIVES: The 2020-2021 American Association of Colleges of Pharmacy Faculty Affairs Standing Committee (FASC) was charged with identifying how faculty can self-advocate and promote themselves in a social influence context. FINDINGS: The FASC identified social influence and persuasion theories and strategies that can be used by faculty to initiate self-advocacy discussions and collaborations. Social influence and persuasion theories can provide a framework for research and scholarship or for beginning discussions regarding self-advocacy. SUMMARY: This FASC report describes the Committee charge, background information, and an overview of social influence theories and how these theories can be applied in academic pharmacy. The report concludes with a summary of issues for follow-up to the Committee's work.

Ion and electron heating characteristics of magnetic reconnection in a two flux loop merging experiment.

Characteristics of the high-power reconnection heating were measured for the first time directly by two-dimensional measurements of ion and electron temperatures. While electrons are heated mainly inside the current sheet by the Ohmic heating power, ions are heated mainly by fast shock or viscosity damping of the reconnection outflow in the two downstream areas. The magnetic reconnection converts the energy of reconnecting magnetic field B(p) mostly to the ion thermal energy, indicating that the reconnection heating energy is proportional to B(p)(2).

Exploring the Case for Eminent Domain of Hepatitis C Virus Treatment Patents.

Hepatitis C virus (HCV) is a silent epidemic affecting millions of patients and represents the leading indication for liver transplantation in the United States and worldwide. New direct-acting antiviral agents offer the potential to cure patients infected with HCV but it comes at a staggering cost. Given the recent attention to these high-priced HCV therapies and the impact treating individuals with HCV is having on drug expenditures in the United States, there may be a need to revisit drug patent laws and the options the federal government has to ensure patient access to care.

Fear of Fear and Broad Dimensions of Psychopathology over the Course of Cognitive Behavioural Therapy for Panic Disorder with Agoraphobia in Japan.

OBJECTIVE: To examine the relationship of fear of fear and broad dimensions of psychopathology in panic disorder with agoraphobia over the course of cognitive behavioural therapy in Japan. METHODS: A total of 177 Japanese patients with panic disorder with agoraphobia were treated with group cognitive behavioural therapy between 2001 and 2015. We examined associations between the change scores in Agoraphobic Cognitions Questionnaire or Body Sensations Questionnaire and the changes in subscales of Symptom Checklist-90 Revised during cognitive behavioural therapy controlling the change in panic disorder severity using multiple regression analysis. RESULTS: Reduction in Agoraphobic Cognitions Questionnaire score was related to a decrease in all Symptom Checklist-90 Revised (SCL-90-R) subscale scores. Reduction in Body Sensations Questionnaire score was associated with a decrease in anxiety. Reduction in Panic Disorder Severity Scale score was not related to any SCL-90-R subscale changes. CONCLUSIONS: Changes in fear of fear, especially maladaptive cognitions, may predict broad dimensions of psychopathology reductions in patients of panic disorder with agoraphobia over the course of cognitive behavioural therapy. For the sake of improving a broader range of psychiatric symptoms in patients of panic disorder with agoraphobia, more attention to maladaptive cognition changes during cognitive behavioural therapy is warranted.

Spatiotemporal treadmill gait measurements using a laser range scanner: feasibility study of the healthy young adults.

OBJECTIVE: Spatio-temporal parameters are typically used for gait analysis. Although these parameters are measured by sophisticated systems such as 3D motion capture system or optoelectronic bars, these systems cannot be deployed easily because of their high costs, large space requirements and elaborate set-up. The purpose of this study is to develope a system for measuring spatiotemporal gait parameters using a laser range scanner during treadmill gait. APPROACH: To calculate accurate spatiotemporal parameters, the differences between the laser range scanner measured values and the reference values obtained from a 3D motion capture system were investigated in thirty subjects. From measurements in time and position at foot contact/off, adjustments to compensate for the differences in time and position were derived. Then, to determine the validity of the proposed system, values from the proposed system and the reference system were compared in four additional subjects. MAIN RESULTS: The results indicate that the data from the laser range scanner demonstrate certain differences in time and position compared with reference values. However, when compensation values were introduced, each spatiotemporal parameter correlated well with the reference values. SIGNIFICANCE: This newer system is smaller, is easier to deploy and requires less training than the 3D motion capture system.

Design of polarizers for a mega-watt long-pulse millimeter-wave transmission line on the large helical device.

The polarizer is one of the critical components in a high-power millimeter-wave transmission line. It requires full and highly efficient coverage of any polarization states, high-power tolerance, and low-loss feature. Polarizers with rounded shape at the edge of the periodic groove surface are designed and fabricated by the machining process for a mega-watt long-pulse millimeter-wave transmission line of the electron cyclotron resonance heating system in the large helical device. The groove shape of λ/8- and λ/4-type polarizers for an 82.7 GHz transmission line is optimally designed in an integral method developed in the vector theories of diffraction gratings so that the efficiency to realize any polarization state can be maximized. The dependence of the polarization states on the combination of the two polarizer rotation angles (Φλ/8, Φλ/4) is examined experimentally in a low-power test with the newly developed polarization monitor. The results show that the measured polarization characteristics are in good agreement with the calculated ones.

Development of oligonucleotide lateral-flow immunoassay for multi-parameter detection.

We have developed a highly sensitive and rapid oligonucleotide lateral-flow immunoassay (OLFIA), using a colloidal gold as an indicator, for the simultaneous detection of antigens and/or antibodies in specimen. This system can detect more than two types of antigens and/or antibodies in a single assay device at the same time. The device is basically composed of colloidal gold-labeled antibodies and oligonucleotide-labeled antibodies fixed in a conjugate pad, and the complementary oligonucleotide-labeled proteins are immobilized on a nitrocellulose membrane. If the target antigen is present in a specimen, the colloidal gold-labeled antibody and oligonucleotide-labeled antibody will make a complex with the antigen. Subsequently, the formed complex migrates to the place where complementary oligonucleotide is immobilized and is bound to the solid phase via the DNA-DNA interaction. As a result, more than two types of reactions can be detected on a single assay device by the combination of colloidal gold-labeled antibodies, different oligonucleotide-labeled antibodies and complementary oligonucleotide-labeled proteins immobilized at different places on a nitrocellulose membrane.

Fast atom bombardment and electrospray ionization tandem mass spectrometry of sulfated Lewis(x) trisaccharides.

Structural characterization of mono-, di-, and trisulfated trisaccharides by fast atom bombardment (FAB) and electrospray ionization (ESI) mass spectrometry is described. Both FAB and ESI collision-induced dissociation tandem mass spectrometry (CID-MS/MS) of sulfated trisaccharides allowed identification of the sulfated sugar and provided information on the saccharide chain sequence. The ESI CID-MS/MS of multiple-charged ions provided even more structural information, and some of the useful daughter ions appeared in the higher mass region than the precursor owing to a lower charge-state. These methodologies can be applied to the structural analyses of glycoconjugates with much larger molecular masses and higher polarity, such as the poly-sulfated analogs.

Determination of D-sorbitol in human erythrocytes by an enzymatic fluorometric method with an improved deproteinization procedure.

We developed an improved enzymatic assay of D-sorbitol in human erythrocytes by employing highly specific D-sorbitol dehydrogenase from Pseudomonas sp. (EC 1.1.1.14) and replacing perchloric acid (HClO4) and potassium carbonate (K2CO3), generally used for deproteinization, with sodium hydroxide (NaOH) and zinc sulphate (ZnSO4). In this assay, erythrocytes were separated from plasma by centrifugation and washed once with physiological saline. Subsequently, the erythrocytes were lysed with distilled water and proteins precipitated with NaOH and ZnSO4. After centrifugation, the resulting colourless supernatant was mixed with a glycine buffer (pH 9.0) containing NAD+ and D-sorbitol dehydrogenase. After incubation for 30 min at 37 degrees C, the NADH produced was measured fluorimetrically. The fluorescence intensities were corrected for sample blanks, and the values of D-sorbitol were normalized for haemoglobin content. The method had an analytical range of 1-180 micromol/L. The intra- and inter-assay precisions were < 3.3% and < 5.8%, respectively. The detection limit was 0.65 micromol/L. In terms of the linearity, precision and sensitivity, the improved method using NaOH and ZnSO4 was superior to the conventional method using HClO4 and K2CO3.

Structural elucidation of underivatized gangliosides by electrospray-ionization tandem mass spectrometry (ESIMS/MS).

The structural characterization of intact polysialogangliosides by electrospray-ionization mass spectrometry (ESIMS) and tandem mass spectrometry (MS/MS) is described. The negative-ion ESI mass spectra of gangliosides, such as a tetrasialoganglioside GQ1b, showed molecularly related ions with high sensitivity and accuracy. Collision-induced dissociation (CID) MS/MS provided adequate information to characterize the number and positions of sialic acids. ESIMS and CIDMS/MS techniques were applied successfully also in the positive-ion mode for characterization of intact gangliosides. Two isomeric disialogangliosides, GD1a and GD1b, are distinguishable from one another by CIDMS/MS in both negative- and positive-ion modes. The technique is readily applicable to structural analyses such as determining the positional isomers of glycoconjugates.

Technetium-99m serum albumin measurement of gastrointestinal protein loss in a subtotal gastrectomy patient with giant hypertrophic gastritis.

Gastrointestinal protein loss was measured using Tc-99m labeled human serum albumin in a patient with giant hypertrophic gastritis. Gastric secretion was aspirated via a nasogastric tube and measured for radioactivity after intravenous injection of Tc-99m albumin. Assessment of radioactivity of the collected gastric secretion yielded a total radiocount of 98.7 kilocounts per minute within 6 hours, which is equivalent to 1.1% of the total dose. Therefore, at least 1.1% of the circulating albumin was excreted into the gastric cavity within 6 hours, and, since simultaneous abdominal imaging did not demonstrate obvious accumulation of tracer in the gastrointestinal tract, protein loss was thought to be due to giant gastric rugae of the resected stomach. It was concluded that Tc-99m albumin is a valuable means for detection of the site of protein loss in patients with protein-losing gastroenteropathy. This method has several advantages in the clinical setting; it is less time consuming, easy to perform, and provides quantitative and qualitative assessment of protein loss.

[A case of 19th year pulmonary metastasis after radical mastectomy for breast cancer].

A 72-year-old woman was admitted to our hospital for further evaluation of a abnormal shadow in left middle lung field. The patient had undergone right mastectomy for infiltrating ductal carcinoma 19 years ago. She had no symptom, but had a time of mass X-ray screening this year. Chest CT finding showed a nodule 2 cm in diameter with slight irregular margin in S6 of left lung. We couldn't determine preoperatively that this tumor was a metastatic lesion or a primary lung cancer. And first, tumor was taken out for intraoperative frozen section diagnosis. Pathologist didn't diagnose whether this tumor was a metastatic or primary. So, we performed left lower lobectomy and mediastinal lymphadenectomy. On postoperative histopathologic finding lung cancer resembled well previous breast cancer. In immunohistochemical study cancer cells from lung and breast of the patient were respectively positive for anti Estrogen Receptor (ER) and anti Gross Cystic Disease Fluid Protein-15 (GCDFP-15). In conclusion lung cancer was diagnosed as a metastatic lesion from breast cancer 19 years ago. The patient has been well 2 years postoperatively without recurrence. In this case immunohistochemical examination was very useful for differentiation metastatic lesion and primary one.

[Adenoid cystic carcinoma of lower lobe of right lung: report of a case].

A 69-year-old male was admitted to the hospital for further examination of an abnormal shadow in the right lower lung fields. He was previously under medical treatment for right thoracic empyema. Chest computed tomography (CT) showed a solitary mass, 4.5 cm in diameter and broncofiberscopy evidenced a tumor in the right lower bronchus. The biopsy was performed and the tumor was diagnosed as a pleomorphic adenoma. Intraoperativefinding showed the tumor was 6 cm in gross, extended to the left atrium, and a daughter tumor was palpable in the middle lobe. The middle and lower lobe were resected. The tumor was located in S9, S10, 6 x 4 x 3.5 cm in size, 2 daughter tumor was found in the middle lobe, the pulmonary vein was thickened by tumor invasion. Pathohistologically, main tumor and daughter tumor showed malignant feature, were compatible with adenoid cystic cancer. Four years after operation, he is still now alive with home oxygen therapy.

[A case of pulmonary dirofilariasis].

A 58-year-old man was admitted to our hospital for detailed examination of continuous cough. On a chest X-ray film, abnormal shadow was detected in the right lower lung field. Preoperative examination findings didn't lead to a definitive diagnosis. Under thoracoscopy partial resection of the lung was performed to rule out a malignant lesion. Intraoperative pathologic finding revealed a granulomatous lesion. And, final pathological diagnosis showed to be a pulmonary dirofilariasis. His postoperative course was not eventful. On 20 th day he discharged postoperatively. Now, under the Pet-boom the disease has been reported increasingly. But it is difficult to find the disease preoperatively. So, it is real to be operated for differentiate from a malignant lesion. Recently in many cases open lung biopsy, has been undergone with less invasive procedure such as thoracoscopy and VATS. It will be mainstream in future.

[Prevention of postoperative recurrence of hepatocellular carcinoma by adjuvant locoregional chemotherapy].

Postoperative adjuvant locoregional chemotherapy was performed on patients who underwent hepatic resection for hepatocellular carcinoma with permeation of tumor into portal vein and/or into hepatic vein and/or intrahepatic metastasis to prevent recurrence. Twenty patients received intra-hepato-arterial infusion of chemotherapeutic drugs or Lipiodol, or transcatheter arterial embolization as adjuvant therapy, and 25 patients did not receive the therapy. There was no significant difference in the recurrence rate between the two groups, and disease-free-survival would not be improved significantly by adjuvant therapy. But the disease-free-survival was improved in patients who underwent relative noncurative hepatectomies. Median duration from the hepatic resection to the recurrence was prolonged by adjuvant therapy, but no significant difference was noted between the two groups. Serious hepatic injury was a side effect of adjuvant therapy in one patient. Therefore great care was necessary when performing the therapy. Further study on choice of the drugs and methods was considered necessary to obtain more effective therapy.

[Surgical treatment of advanced hepatocellular carcinoma].

One hundred and thirty-two patients with hepatocellular carcinoma in stages III and IV were studied. Seventy-six patients who underwent hepatectomy were divided into three groups: relative curative resection (RC: n = 30), relative noncurative resection (RNC: n = 30) and absolute noncurative resection (ANC: n = 16). Fifty-six patients were treated by non surgical procedures such as hepatic arterial infusion, transcatheter arterial embolization, ethanol injection and hyperthermia. The cumulative survival rate of hepatectomy patients was significantly better than that of non-surgically treated patients. The most significant prognostic factor was the presence of the portal venous invasion. In the patients without tumor thrombi or with tumor thrombi found microscopically, the cumulative survival rates of both RC and RNC were significantly better than those of ANC and non-surgically treated patients, but in the patients with tumor thrombi found grossly, there was no difference between hepatectomy patients and non-surgically treated patients. These results indicate that surgical treatment for advanced hepatocellular carcinoma improve the prognosis of the patients without tumor thrombi found grossly.