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Tacrolimus is a calcineurin inhibitor that has been used to prevent allograft rejection after organ transplantation. We report the case of a living-donor liver transplant recipient with breast cancer who received adjuvant chemotherapy at an appropriate relative dose intensity in spite of a decrease in the trough blood concentration of tacrolimus. The patient was a woman in her 50s who had undergone living-donor liver transplantation because of primary biliary cirrhosis and received maintenance therapy consisting of tacrolimus. She was diagnosed as having locally advanced breast cancer(ER and HER2 positive). After surgery, we administered 4 courses of EC followed by weekly administration of paclitaxel plus trastuzumab. During chemotherapy, although the trough blood concentration of tacrolimus was slightly decreased, neither severe adverse event nor allograft rejection was observed. Recently, organ transplantation outcomes have significantly improved as a result of the progress of immunosuppressive agents. However, the development of malignancies after transplantation is a serious problem.

The issue of drug lag in Japan has been rapidly reduced in recent years, and newly approved drugs now become available on Japanese and international markets at the same time. In this context, the risk management plan (RMP) system was introduced in 2012. RMPs describe important safety concerns recognized by Japan's Pharmaceuticals and Medical Devices Agency (PMDA) and marketing authorization holders (MAHs), as well as safety measures that MAHs request healthcare professionals (HCPs) to follow. The publication of RMPs is expected to support the sharing of drug risk management among HCPs during the postmarketing phase. In addition, to encourage risk communication between HCPs and patients, the PMDA website provides drug guides for patients and other information to promote proper understanding of drugs by patients and their families and enable them to identify serious adverse drug reactions at an early stage. However, the results of surveys conducted by the PMDA in FY2014 and FY2015 revealed low levels of awareness of RMPs and drug guides for patients in hospitals and other healthcare institutions. The surveys also showed that information regarding the proper use of drugs from MAHs and the PMDA was not incorporated into practice at healthcare institutions, resulting in the repeated release of identical safety alerts. To facilitate the increased utilization of risk communication tools, the PMDA has been providing and disseminating these tools through its website. This study addresses those efforts and the associated challenges.

Moxifloxacin, a recent, new quinolone agent, has superior pharmacokinetics and appears to be safe for patients with renal failure, as it is mainly excreted in the bile. The case of a hemodialysis patient with Legionella pneumonia who was successfully treated with moxifloxacin is reported. A 76-year-old woman, who had been on hemodialysis for chronic renal failure secondary to diabetic nephropathy, visited her hospital with a cough and fever. Pneumonia was diagnosed, and intravenous administration of cefotiam hydrochloride was begun, but her respiratory condition deteriorated. She was transferred to our hospital with dyspnea. A chest radiograph showed consolidation in both lung fields and cardiomegaly. A urinary antigen test for Legionella was positive. Legionella pneumonia with heart failure was diagnosed and she was started on 400 mg a day moxifloxacin. Her clinical condition improved. Moxifloxacin appears to be useful in the treatment of Legionella pneumonia in patients with renal failure.

A 55-year-old man, who had not suffered from any severe or recurrent bacterial infections previously, visited our hospital because of symptoms of fever, cough, sputum, and otorrhea. Chest X-ray and computed tomography demonstrated infiltrates in the right middle lobe and lingula. Pneumococcal pneumonia and tympanitis were diagnosed based on the isolation of Streptococcus pneumoniae from sputum and otorrhea specimens. A peripheral blood analysis showed a remarkable reduction in serum IgG level and the flow cytometric analysis of his peripheral monocytes indicated a significant reduction in Bruton's tyrosine kinase expression. Thus, we diagnosed his illness as X-linked agammaglobulinemia (XLA). Although immunoglobulin replacement therapy was performed, he developed recurrent lower respiratory tract infections. Low-dose long-term erythromycin treatment resulted in decreased frequency of respiratory tract infections. These results suggest that erythromycin therapy may be useful for the control of lower respiratory tract infections in patients with XLA. Even in adults with recurrent bacterial respiratory tract infections, the presence of XLA as an underlying disease should be considered. The effect of macrolide therapy for chronic lower respiratory tract infection associated with humoral immunodeficiency has rarely been reported. This case study may provide valuable information about macrolide therapy for such an infection in patients with humoral immunodeficiency.

A 62-year-old woman was admitted with fever and bloody sputum. A mass shadow in the left S3 and obstruction of the left B3 were seen on a chest radiograph and CT. Obstructive pneumonia was suspected, and cefotiam and imipenem/cilastatin were administered. However, this treatment did not show adequate efficacy. Bronchoscopy demonstrated a yellowish-white polypoid lesion in the left B3, but histopathological findings with HE staining yielded no definite diagnosis. Subsequently, Nocardia asteroides was detected in sputum test. A sulfamethoxazole-trimethoprim combination and minocycline were administered, and the clinical findings improved. Gram-positive microfilaments were confirmed retrospectively in the pathologic specimen, and a diagnosis of pulmonary nocardiosis was made.

Influenza virus is highly infectious and transmitted from human to human by droplet infection. Therefore, once the virus is brought into a hospital, this can lead to a severe outbreak of influenza among medical workers and inpatients, resulting in the failure of hospital functions. The fundamental protective measures against in-hospital infection include stopping the outbreak of influenza and minimizing the spread of infection when mass infection of influenza occurs in a hospital. Thus, it is vital that the infection control committee in each hospital prepares specific countermeasures against influenza infection reflecting the realities. As one such countermeasure, it is recommended is to give influenza vaccination to medical workers and patients before the illness becomes epidemic. Further, once an outbreak of influenza occurs in a hospital, administration of anti-influenza drugs to high-risk patients also needs to be considered.

Influenza infection is a serious problem in institutions for the elderly and those with increased risk factors because of the high pneumonia complication rate and a significant increase in mortality. An outbreak of influenza is mainly caused by contact from the staff to residents, therefore the health care of the staffs and prevention of influenza should be a high priority in institutions such as nursing homes. To prevent influenza epidemics, institutionalised elderly and high risk groups should be vaccinated more actively. The rapid test for diagnosis of influenza viral infection permits the timely administration of antiviral agents and infection control among institutionalised elderly and high risk groups. Amantadine and neuraminidase inhibitors could be used for treatment and prophylaxis of influenza among institutionalised elderly and high risk group patients.

A 76-year-old male with multiple myeloma, who was born and had lived in Ehime Prefecture was admitted to our hospital because of high fever. The chest X-p film showed right middle lobal pneumonia. Eosinophilia was detected and a stool smear examination revealed rhabditis form larvae of the nematode. The filaria form larvae of Strongyloides stercoralis were detected by stool culture. Antibiotics and pyruvinium pamoate were administered to bacterial pneumonia and hyperinfection of the strongyloides, respectively. Consequently, pneumonia and strongyloidiasis were promptly improved. It was considered that he was infected with strongyloides in south-east Asia during World-War II and a little autoinfection of this nematode had continued about 50 years. In addition, it was suggested that hyperinfection of strongyloides resulted from the immunosuppressive state induced by the chemotherapy for multiple myeloma.

We investigated the seasonal variation of sweating response during exercise. Four adult healthy men repeated a moderate bicycle exercise (60 watts) in a climatic chamber of an ambient temperature of 30 degrees C (relative humidity, 45%) in winter, spring, summer, and fall. In summer, sweat rate immediately increased as soon as the exercise started, whereas in winter in a few minutes. The mean sweat rate during exercise was significantly different between winter and summer. The transient reduction of the Tsk was observed at the beginning of the exercise in winter. The Tsk decreased in proportion to increasing of sweat rate in each season. Significantly negative correlations were found between sweat rate and the rate of change of Tsk during exercise in each season. The slope and intercept of regression line were significantly different between winter and summer. The index of sweating was made available for the relative value, changing rate against annual mean value of total sweat loss (delta SR, %). The relative value rather than the absolute value (i.e., expressed as g.m-2.h-1) corrected well with skin temperature. It is suggested that the present results may reflect adapted changes in the thermoregulatory mechanisms to seasonal acclimatization. Moreover, the fall in skin temperature during exercise may be not due to increased evaporative cooling, but may be the result of vasoconstriction probably caused by non-thermal factors.

The effect of the eluate from amalgam on glucan synthesis was investigated in this study in order to elucidate the mechanisms by which plaque accumulation is inhibited on amalgam but not on enamel or composite. Glucosyltransferase (GTase) was prepared from a cultured supernatant of Streptococcus mutans B 13 by the ammonium sulfate precipitation method. Five commercial amalgams were tested. The eluate from amalgams was prepared by immersing the amalgam discs (10 mm dia. x2 mm thick.) into distilled water for 2 weeks. A glucan synthesizing system was compounded using GTase (50 microliters), [14C]-sucrose (100 microliters), distilled water, and the eluate (350 microliters). After 18 h incubation at 37 degrees C, the formed water insoluble glucan was collected on glass fiber filters and its radioactivity was counted. Moreover, concentrations of zinc (Zn) and copper (Cu) in the eluates were determined by atomic absorption spectrophotometry. The eluates from Dispersalloy and Fluor alloy, which eluted Zn, were the most inhibitory for glucan synthesis. Sybraloy, which released Cu to a much greater degree than the other amalgams and its eluate showed intermediate antienzymatic activity. The other amalgams, Hi-atomic M and Spherical-D, did not effect GTase at all. The results indicated that various amalgams strongly impact inhibition rates of glucan formation.