Effect of Thickening Agents on the In Vitro Antibacterial Activity of Vancomycin Hydrochloride Powder.

When vancomycin hydrochloride (VCM) powder mixes with xanthan gum-based thickening agents in food, lumps or other property-related changes may occur. Previous studies have reported delayed disintegration and elution of the drug and its adsorption on to xanthan gum, which is the main ingredient of thickened food products. If the addition of thickening agents can affect the antimicrobial activity of VCM powder as previously reported, it might interfere with the treatment of Clostridioides difficile infection (CDI). In this study, we investigated the effect of the addition of xanthan gum-based thickening agents on the antibacterial activity of VCM against Clostridioides difficile in vitro. The VCM concentration at 0 min after adding 3% Tsururinko Quickly (Clinico, Tokyo) to VCM powders (Shionogi, Osaka and Meiji Seika Pharma, Tokyo) was lower than that of the control [Shionogi: 65.15±35.57%, Meiji Seika Pharma: 77.00±15.81% (mean±standard deviation), ** p<0.01, Dunnet's test]. However, the VCM concentration at 30 min after the addition recovered to the control level. The drug susceptibility tests for C. difficile and Staphylococcus aureus using the disk diffusion method showed no effect of addition of 3% Tsururinko Quickly. Our in vitro evaluations showed that the addition of xanthan gum-based thickeners to VCM powders had a negligible effect on the treatment of CDI.

[Steroid pulse therapy was effective against anti-muscle-specific kinase antibody-positive myasthenia gravis crisis: a case report].

A 50-year-old woman experienced cardiopulmonary arrest. Although the arrest lasted for 4 min, she could not be withdrawn from the mechanical ventilator because of low tidal volume, despite being awake and alert after admission. The results of the anti-acetylcholine receptor antibody and repetitive nerve stimulation tests were negative, and the anti-muscle-specific kinase antibody levels revealed myasthenia gravis. We recommended therapeutic plasma exchange; however, the patient refused the treatment as she did not want to use blood products. Consequently, we initially attempted steroid pulse therapy, which enabled the patient to be withdrawn from the mechanical ventilator. Thus, steroid pulse therapy was beneficial for the crisis associated with the anti-muscle-specific kinase antibody in the absence of therapeutic plasma exchange.

Optimal Administration of Phosphorus Adsorbents When Using Medical Nutritional Supplements for Tube-fed Patients.

All medical enteral nutrition products contain phosphorus and when administered to patients with chronic kidney disease (CKD) and on dialysis, they lead to the risk of elevated serum phosphorus levels. Thus, serum phosphorus levels should be monitored, and phosphorus adsorbents should be used in cases of high serum phosphorus levels. In this study, we investigated the effect of phosphorus adsorbents on enteral nutrition, using Ensure Liquid®, a medical nutritional formula, for patients with CKD and those on dialysis. Additionally, we compared the effects of the simple suspension method, in which various phosphorus-adsorbing agents are suspended and mixed directly with the nutritional formula for tube administration (hereafter referred to as the "pre-mix method"), and the conventional method, in which only the phosphorus-adsorbing agents are administered separately from the nutritional formula for tube administration (hereafter referred to as the "normal administration method"). The administration of various phosphorus adsorbents using the pre-mix technique resulted in a phosphorus removal rate of 8-15% (approximately 12% on average). Therefore, through the pre-mix method, maintaining the phosphorus content of Ensure Liquid® below the daily phosphorus intake standard was possible for patients on dialysis. The pre-mix method via the simple suspension method of administering phosphorus adsorbent with Ensure Liquid® resulted in less drug adsorption to the injector and tube and a higher phosphorus removal rate than the normal administration method.

[Comparison of the Pharmaceutical Characteristics of Brand-name and Generic Pramipexole Extended-release Tablets and Their PTP Usability].

The pramipexole extended-release (long acting) tablet, a D2 receptor agonist commonly used for the treatment of Parkinson's disease, has increasingly demonstrated usability for patients with long acting performance and patient adherence improvements. As a generic drug it is sold by six companies while a brand name drug is also marketed. As these formulations are hygroscopic it is described as such in package inserts so that tablets will only be removed from the press-through package (PTP) immediately before ingestion. It is often dispensed in one-dose packaging (ODP) as determined by a patient's physical functions and symptom characteristics. With ODP, quality control and ease of removal from the PTP are important factors. In this study we examined the stability of tablets in the ODP (25℃ RH75%) while also comparing the ease of handling of the seven products currently marketed in Japan. In the tablets' ODP, changes such as swelling and decreases in tablets hardness were observed in six formulations. Differences were found among the products in comparison of packaging material, required tablet extrusion strength, and ease of removal. Given the differences in PTP materials and hygroscopicity it is suggested that pharmacists must not only consider the drug formulations of products but also contribute to improvements in medication adherence for patients with poor hand-finger function.

Glucagon-like peptide-1 stimulates type 3 iodothyronine deiodinase expression in a mouse insulinoma cell line.

AIMS: The pathophysiological roles of thyroid hormones in glucose metabolism remain uncertain. Type 3 iodothyronine deiodinase (D3) converts thyroxine (T4) and 3,5,3'-triiodothyronine (T3) to 3,3',5'-triiodothyronine (rT3) and 3,3'-diiodothyronine (T2), respectively, inactivating thyroid hormones in a cell-specific fashion. In the present study, we identified D3 expression in MIN6 cells derived from a mouse insulinoma cell line and examined the mechanisms regulating D3 expression in these cells. MAIN METHODS: We characterized D3 activity using HPLC analysis, and examined the effect of GLP-1 or exendin-4 on D3 expression and cAMP accumulation in MIN6 cells. We also measured insulin secretion from MIN6 cells exposed to GLP-1 and T3. KEY FINDINGS: We identified enzyme activity that catalyzes the conversion of T3 to T2 in MIN6 cells, which showed characteristics compatible with those for D3. D3 mRNA was identified in these cells using RT-PCR analysis. Forskolin rapidly stimulated D3 mRNA and D3 activity. Glucagon-like peptide-1 (GLP-1) increased D3 expression in a dose-dependent manner, and this effect was inhibited by the protein kinase A (PKA) inhibitor H-89. Exendin-4, a GLP-1 receptor agonist, also stimulated D3 expression in MIN6 cells. These results suggest that a cAMP-PKA-mediated pathway participates in GLP-1-stimulated D3 expression in MIN6 cells. Furthermore, GLP-1 stimulated insulin secretion was suppressed by the addition of T3 in MIN6 cells. SIGNIFICANCE: Our findings indicate that GLP-1 regulates intracellular T3 concentration in pancreatic ß cells via a cAMP-PKA-D3-mediated pathway that may also regulate ß-cell function.

Rituximab used successfully in the treatment of anti-NMDA receptor encephalitis.

We report the case of a young woman with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, without tumor, who was successfully treated with rituximab. Because conventional immunotherapy, including corticosteroids, immunoglobulin (IVIg), and plasma exchange showed little improvement in our patient, we introduced another treatment using rituximab. A week after the first administration of rituximab, her symptoms improved gradually and significantly. This case provides in vivo evidence that rituximab is an effective agent for treating anti-NMDAR encephalitis, even in those cases where conventional immunotherapies have been ineffective. Rituximab should be regarded as a beneficial therapeutic agent for this disease.

[Case report of HTLV-1 associated myelopathy (HAM) manifested after renal transplantation].

We report a 51-year-old man with human T lymphotropic virus type-1 (HTLV-1) associated myelopathy (HAM) manifested 10 months after renal transplantation. He had progressive spastic paralysis and neurogenic bladder for 10 years. HTLV-1 antibody are positive both serum and cerebral spinal fluid (CSF). Althoght HTLV-1 was not examined in the donor, it was suspected that the patient was infected by renal transplantation. After treatment of interferon-alpha (IFN-alpha), his motor function had improved and neopterin in CSF was decreased from 158 pmol/ml to 89 pmol/ml. This is a rare case of HAM after living renal transplantation. Cyclosporin and methylpredonisolone are used as immunosuppressants for preventing graft rejection. Time for developing HAM after renal transplantation was shorter than patients after cadaveric renal transplantation. More investigations are needed to clarify the mechanisms in the development of HAM associated with renal transplantation.