The optimal dosing strategy for valganciclovir (VGCV) prophylaxis against cytomegalovirus (CMV) infection in pediatric patients after kidney transplantation (KT) remains uncertain because of the narrow therapeutic window between antiviral efficacy and safety. This study included pediatric patients who received VGCV prophylaxis after KT at a single center between December 2023 and December 2024. VGCV was administered once daily for 200 days using a reduced-dose regimen. Approximately 50
BackgroundThe Japanese Society for Helicobacter Research (JSHR) published the fifth edition of the guidelines for the management of Helicobacter pylori (H. pylori) infection in 2024 in Japanese language.MethodsThis edition of JSHR guidelines was first developed in accordance with the Minds Clinical Practice Guideline and Grading of Recommendations Assessment, Development, and Evaluation system. This was published after inviting public comments and external evaluations. Consensus on clinical questions (CQs) was achieved using the modified Delphi method.ResultsThere was no change in the basic policy that all H. pylori infectious diseases are indications for eradication. Nucleic acid amplification was added to the diagnostic methods. Effects of proton-pump inhibitors (PPIs) on diagnostic tests were updated. The superiority of potassium-competitive acid blockers to PPIs in 1-week triple therapy with amoxicillin and clarithromycin has been shown. A flowchart for eradication therapy was provided for use in real-world settings. For gastric cancer prevention, eradication in earlier age is recommended. The most appropriate test and treatment strategies for adolescents are also described. Some CQs concerning gastric cancer prevention were identified, although evidence level was insufficient to make recommendations based on clinical importance.ConclusionThe revised guidelines facilitate the appropriate management of H. pylori infection and gastric cancer prevention.
The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of December 2020 was searched in PubMed, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution Service (Minds) technique. A total of 38 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, pathological diagnosis deciding the diagnosis, and causal genes of vascular anomalies. Thus, the Japanese clinical practice guidelines for vascular tumors, vascular malformations, lymphatic malformations, and lymphangiomatosis 2022 have been prepared as the evidence-based guidelines for the management of vascular anomalies.
BACKGROUND:We aimed at estimating trends in 5-year net survival for myeloid and lymphoid malignancies, by age group and morphological subtype, using data on patients diagnosed during 2000-2014 and registered by 16 Japanese population-based cancer registries participating in the CONCORD-3 study. METHODS:We analyzed data on adult patients (15-99 years) diagnosed with a myeloid or lymphoid malignancy during 2000-2014 and followed up to December 31, 2014. We estimated 5-year net survival by age group and morphological subtype with the Pohar Perme estimator, and age-standardized the estimates using International Cancer Survival Standard weights. RESULTS:Significant improvements were observed in five-year net survival for myeloid malignancies among patients aged 15-44 years (from 57.3% in 2000-2004 to 72.3% in 2010-2014) and 45-54 years (from 41.9% to 61.3% over the same period). For lymphoid malignancies, 5-year net survival improved for all ages, but the improvement was less pronounced for older patients. Five-year net survival improved by 10% or more for myeloproliferative neoplasms, classic Hodgkin's lymphoma, and follicular lymphoma. Moderate improvement was observed for diffuse B-cell lymphoma and acute myeloid leukemia. CONCLUSIONS:Five-year net survival for patients with hematological malignancies improved throughout 2000-2014 in Japan. The improvement was more pronounced in younger than older patients. Continuous and detailed monitoring of cancer survival trends is crucial for devising effective control strategies for hematological malignancies. [221/250 words].
ABSTRACT Nirmatrelvir/ritonavir is an antiviral agent used against severe acute respiratory syndrome coronavirus 2 infection and inhibits cytochrome P450 3A and P‐glycoprotein. The concomitant use of nirmatrelvir/ritonavir markedly increases tacrolimus blood concentrations. Although temporary discontinuation or dose reduction of tacrolimus at the start of nirmatrelvir/ritonavir therapy is recommended in the package insert of this drug, little information is available on tacrolimus dosage adjustment when restarting. In this study, tacrolimus blood concentrations before and after nirmatrelvir/ritonavir co‐administration were collected from national university hospitals across Japan, and population pharmacokinetic analysis was performed to develop an optimal dosing strategy for tacrolimus. In total, 83 tacrolimus blood concentrations from 15 patients were used in the analysis. First, the individual pharmacokinetic parameters of tacrolimus before the intake of nirmatrelvir/ritonavir were estimated by post hoc Bayesian analysis using previously reported population pharmacokinetic parameters based on a two‐compartment model. The change in the relative bioavailability and clearance of tacrolimus after nirmatrelvir/ritonavir administration was estimated by population pharmacokinetic modeling. Consequently, tacrolimus clearance was considered almost completely inhibited, and relative bioavailability increased 7.99‐fold with the co‐administration of nirmatrelvir/ritonavir. The optimal dosing strategy based on the simulation was to withhold tacrolimus during nirmatrelvir/ritonavir therapy and to restart tacrolimus at 10% of the baseline dose on day 1, followed by 20% on day 3% and 50% on day 6, and increased to 100% on day 9 after discontinuation of nirmatrelvir/ritonavir, respectively. The proposed strategy will contribute to a safe and effective tacrolimus therapy when used in combination with nirmatrelvir/ritonavir.
