藤村 昭太

Community pharmacies play a pivotal role in community healthcare. Recent technological advances, particularly the application of telemedicine in line with telepharmacy, are changing daily practice and creating new opportunities for pharmacies. We present a novel telemedicine-based sick child care system in Japan in which community pharmacies participate. In this system, when caregivers bring their child to a sick child care facility, on-site staff conduct teleconsultations with pediatricians. Childcare can be initiated immediately after the initial medical assessment. When medication is required, prescriptions are electronically transmitted to the family's preferred community pharmacy. The pharmacy prepares and delivers medications directly to the childcare facility, where they are administered by on-site staff. Pharmacists can also provide teleconsultation as a type of telepharmacy to caregivers and on-site staff. Using this system, community pharmacies could contribute to the reduction in the time from medical assessment to the initiation of sick child care. This system also provides safe and improved care efficiency by sharing medication-related healthcare information with all staff involved. We present a novel approach with the possible involvement of community pharmacies in supporting sick child care domains that have not yet been widely introduced in the field. This system highlights the importance of close collaboration between pediatricians, childcare staff, and community pharmacists in digitally enabled community healthcare.

Cancer cachexia causes anorexia and metabolic disorders, eventually leading to sarcopenia, which in turn contributes to the development of functional disabilities. Although anamorelin hydrochloride tablets are marketed to treat cancer cachexia, their efficacy varies significantly among patients. Here, we investigated the efficacy of anamorelin and the factors associated with weight gain. The factors that contributed to weight gain in patients before starting anamorelin were as follows: the patients' disease stage had not progressed to refractory cachexia based on the cancer cachexia classification of the European Palliative Care Research Collaborative; the patients had received fewer lines of anticancer treatment at the start of oral administration of anamorelin; and the patients had not met all the criteria for starting treatment with anamorelin, namely, C-reactive protein level >0.5 mg/dL, hemoglobin level <12 g/dL, and albumin level <3.2 g/dL. These results suggest that early administration of anamorelin hydrochloride tablets may increase the response rate when cancer cachexia is diagnosed.

The precise mechanisms of the reproductive physiological processes, such as labor initiation, are poorly understood. Oxytocin (OT) is one of the well-known uterotonics and is clinically adopted as a medication to facilitate childbirth. Vasopressin (VP), a posterior pituitary hormone similar to OT, has also been proposed to be involved in the reproductive physiology. In this study, we found that a total deficiency of V1a receptor subtype (V1aR) in mice resulted in a reduced number of pups, delayed labor initiation, and increased post-delivery hemorrhage compared with those in wild-type mice. Among the VP receptor subtypes, only V1aR was found to be expressed in the murine uterus, and its distribution pattern was different from that of the oxytocin receptor (OTR); V1aR expression was mainly distributed in the circular myometrium, whereas OTR was strongly expressed in both the circular and longitudinal myometrium. The maximum contractile force of the circular myometrium, induced by VP or OT, was attenuated in the pregnant uterus of Avpr1a-deficient mice. Contrarily, while OT expression was decreased in the Avpr1a-deficient uterus, OTR expression was significantly increased. These results suggest that V1aR deficiency not only reduces the uterine contractile force but also perturbs the expression of genes responsible for the reproductive physiology. Therefore, V1aR is necessary to exert the maximum contraction of the circular myometrium to deliver pups. This study revealed an important role of V1aR in physiological contraction and term parturition in mice.