Aim: Traditional Japanese medicine (Kampo medicine; KM) is widely used together with modern medicine in clinical settings. However, KM prescription trends during hospitalization has never been reported for Japanese university hospitals. This study aimed to investigate the KM prescription trends for hospitalized patients at a university hospital in Japan. The present study was conducted in a 'Problem-based Learning' workshop in a second-grade class at the Tohoku University School of Medicine. Methods: Using the drug prescription data of Tohoku University Hospital between October 2017 and September 2018, we identified hospitalized patients who were prescribed KM, which included 17 formulations. We investigated the prescription trends, sex, and age distribution of patients, and diseases for which KMs were prescribed. Results: Of the 19 249 patients, 1229 patients (6.4%) were newly prescribed KM during admission. The average age was 60.2 AE 18.8 years, and female patients accounted for 51.4%. The most prescribed KM was daikenchuto (485 patients), mainly for post-operative patients in the surgical departments and psychosomatic patients with gastrointestinal symptoms in the psychiatric departments. Yokukansan was used for dementia patients in the geriatric medicine department and for delirium patients in the intensive care unit. Rikkunshito was administered to patients after gastric cancer surgery and to patients with anorexia nervosa. Daikenchuto and shakuyakukanzoto were more frequently prescribed to men, and goreisan and goshajinkigan were more frequently prescribed to women. Conclusion: Kampo Medicines were prescribed for specific diseases or conditions at various inpatient departments in the university hospital.
Gene variants that encode pancreatic enzymes with impaired secretion can induce pancreatic acinar endoplasmic reticulum (ER) stress, cellular injury and pancreatitis. The role of such variants in pancreatic cancer risk has received little attention. We compared the prevalence of ER stress‐inducing variants in CPA1 and CPB1 in patients with pancreatic ductal adenocarcinoma (PDAC cases), enrolled in the National Familial Pancreas Tumor Registry, to their prevalence in noncancer controls in the Genome Aggregation Database (gnomAD). Variants of unknown significance were expressed and variants with reduced secretion assessed for ER stress induction. In vitro assessments were compared with software predictions of variant function. Protein variant software was used to assess variants found in only one gnomAD control (“n‐of‐one” variants). A meta‐analysis of prior PDAC case/control studies was also performed. Of the 1385 patients with PDAC, 0.65% were found to harbor an ER stress‐inducing variant in CPA1 or CPB1, compared to 0.17% of the 64 026 controls (odds ratio [OR]: 3.80 [1.92‐7.51], P = .0001). ER stress‐inducing variants in the CPA1 gene were identified in 4 of 1385 PDAC cases vs 77 of 64 026 gnomAD controls (OR: 2.4 [0.88‐6.58], P = .087), and variants in CPB1 were detected in 5 of 1385 cases vs 33 of 64 026 controls (OR: 7.02 [2.74‐18.01], P = .0001). Meta‐analysis demonstrated strong associations for pancreatic cancer and ER‐stress inducing variants for both CPA1 (OR: 3.65 [1.58‐8.39], P < .023) and CPB1 (OR: 9.51 [3.46‐26.15], P < .001). Rare variants in CPB1 and CPA1 that induce ER stress are associated with increased odds of developing pancreatic cancer.
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