A multi-institutional collaborative study was conducted concerning the course of pregnancy and delivery and the incidence of abnormal infants delivered of epileptic women. Of 657 women receiving antiepileptic drugs, 73% delivered live infants, 14% had miscarriage or stillbirth, and 13% underwent induced abortion. In contrast to the above findings, 80% of 162 patients not receiving antiepileptic drugs delivered live infants and 4% had miscarriage or stillbirth. The latter outcome was significantly increased in the medicated patients. In this series, 63 (9.9%) of 638 live births were malformed, 55 (11.5%) being from medicated mothers and 3 (2.3%) from nonmedicated mothers. The incidence of fetal malformation in medicated mothers was thus five times as high as that in nonmedicated mothers. Cleft lip and/or palate and malformations involving the cardiovascular system were found frequently in the infants from medicated mothers. General background factors that might exert teratogenic effects on pregnant patients with epilepsy were studied, and the potential toxicity of antiepileptic drugs to the fetus was also analyzed. In this regard, consideration should be given to whether the patient has partial epileptic seizures, whether the patient herself exhibits any malformation, or whether her previous pregnancy resulted in an abnormal outcome. The incidence of fetal malformation was the highest (12.7%) in the medicated patients who had epileptic seizures during the pregnancy. It is presumed on the basis of the results of analysis of the data that a combination of more than three drugs and a daily dose greater than a certain minimal level is likely to produce malformed infants.

Glutamine : fructose-6-phosphate amidotransferase 1 (GFAT1) was identified as a protein phosphorylated in glucose-deprived cells by immunoprecipitation using the anti-phospho Akt substrates (PAS) antibody, which recognizes the phosphorylation motif site by AMP-activated protein kinase (AMPK), followed by mass fingerprinting analysis. Glucose depletion-induced phosphorylation of endogenous GFAT was potentiated by 2-deoxyglucose (2-DG), an AMPK activator, and the 2-DG-stimulated phosphorylation of FLAG-tagged GFAT1 in transfected cells was suppressed by Compound C, an AMPK inhibitor. The 2-DG induced phosphorylation of GFAT1 was attenuated by the introduction of the kinase-negative mutant of AMPK, and the phosphorylation was observed in the cells expressing the constitutively active mutant of AMPK even in the absence of 2-DG. Subsequent analysis revealed that the PAS antibody recognized GFAT1 phosphorylated at Ser243, which is conserved among different species. The assay of the GFAT enzymatic activity in the cell lysates indicated that the 2-DG-treatment inhibited the enzymatic activity, and Compound C-preincubation partially prevented the 2-DG-induced decrease of the activity. Furthermore, the mutant replacing Ser243 by alanine partially prevented the decrease of GFAT activity by 2-DG treatment. These results indicate that the phosphorylation of GFAT1 at Ser243 by AMPK has an important role in the regulation of the GFAT1 enzymatic activity.

In Japan, hepatitis B or C virus infection has been a major health issue. For the prevention of liver‐related deaths, multifaceted strategies have been taken against hepatitis virus. In fiscal year (FY) 2002, nationwide screening for hepatitis was started as a part of health examinations provided by municipal governments. From FY2007, the hepatitis treatment network has been strengthened by the nationwide establishment of regional government‐based hepatitis treatment systems, comprising linked regional core centers, specialized institutions for hepatitis treatment, primary care physicians, and regional governments. Special subsidy program for patients with viral hepatitis was started at FY2008. The range of coverage has been expanding from patients treated with interferon to those on nucleotide analogs or interferon‐free therapies, including drug prices and examination expenses. The Basic Act on Hepatitis Measures was established in 2009. The Basic Guidelines for Promotion of Control Measures for hepatitis was issued in 2011, comprising nine principles in order to promote measures for hepatitis B and C. The Hepatitis Information Center was established in 2008. Its mission is to provide up‐to‐date hepatitis‐related information, supporting collaboration between regional core centers, and training medical personnel. The revision of the above‐mentioned Basic Guidelines in 2016 set the target as the reduction of patients progressing to cirrhosis and/or liver cancer. Achieving this goal definitely requires active collaboration among the national and local governments, regional core centers, and the Hepatitis Information Center, and participation by medical personnel, patients, and people with awareness.

No abstract

To determine the primary factors responsible for the increased incidence of malformation in the off-spring of antiepileptic drug (AED)-treated epileptic mothers, special attention was paid to drug combinations in a prospective study of 172 deliveries. Variables used for analysis were eight antiepileptic drugs (AEDs) and total daily dosages (drug score), and seven background factors consisting of maternal age at delivery, gravida, outcome of previous pregnancy, etiology and type of epilepsy, occurrence of seizures in the first trimester of pregnancy, and seizure frequency during pregnancy. The overall rate of malformation was 14.0%. Thirty-one patients were administered a single drug, and the rate of malformation was 6.5%. The remaining 141 patients were treated with multiple AEDs, and the rate of malformation was 15.6%. The drug score of the latter group was significantly higher than the former (p = 0.01). There was no definite dose-dependent increase in the incidence of malformations associated with any individual AEDs. There was no relationship between the type of defect and individual AEDs. Wilcoxon rank-sum test revealed significant association between the drug score, valproate (VPA), and congenital malformation. Carbamazepine (CBZ) also reached an almost significant level. Furthermore, VPA polypharmacy produced the highest incidence of malformation, higher than that produced by any other AED or drug combination. There was no significant association between the presence of malformations and the other putative risk factors. These results suggest that high dose of AEDs reflecting polypharmacy, VPA polypharmacy in particular, are primary factors responsible for the increased incidence of congenital malformation in the offspring of treated epileptic mothers.