It is suggested that the ITPA gene mutation is closely related to the adverse reactions of AZA/6-MP in Japanese patients, and screening for the mutant allele is useful for predicting the most serious adverse reactions, agranulocytosis and acute bone marrow suppression.

Background: Usual clinical practice for arterial blood gas analysis (BGA) in conscious patients involves a one-time arterial puncture to be performed after a resting period of 20-30 min. The aim of this study was to evaluate the use of transcutaneous BGA for estimating this gold standard arterial BGA. Methods: Spontaneously breathing Asian adults (healthy volunteers and respiratory patients) were enrolled (n = 295). Transcutaneous PO 2 (PtcO 2) and PCO 2 (PtcCO 2) were monitored using a transcutaneous monitor (TCM4, Radiometer Medical AsP, Denmark) with sensors placed on the chest, forearm, earlobe or forehead. Transcutaneous BGA at 1-min intervals was compared with arterial BGA at 30 min. Reasonable steps to find severe hypercapnia with PaCO 2 > 50 mmHg were evaluated. Results: Sensors on the chest and forearm were equally preferred and used because of small biases (n = 272). The average PCO 2 bias was close to 0 mmHg at 4 min, and was almost constant (4-5 mmHg) with PtcCO 2 being higher than PaCO 2 at ≥8 min. The limit of agreement for PCO 2 narrowed over time: ± 13.6 mmHg at 4 min, ± 7.5 mmHg at 12-13 min, and ± 6.3 mmHg at 30 min. The limit of agreement for PO 2 also narrowed over time (± 23.1 mmHg at 30 min). Subgroup analyses showed that the PaCO 2 and PaO 2 levels, gender, and younger age significantly affected the biases. All hypercapnia subjects with PaCO 2 > 50 mmHg (n = 13) showed PtcCO 2 ≥ 50 mmHg for until 12 min.

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ObjectivesA meta-analysis suggested that the use of varenicline, which is a partial agonist of nicotinic acetylcholine receptors and is effective in smoking cessation, increases the risk of cardiovascular events within 52 weeks of starting treatment. Defining these events as occurring during drug treatment (usually for 12 weeks) or within 30 days of discontinuation, another meta-analysis showed that the risk was statistically insignificant. In the present study, we aimed to clarify the effect of varenicline-assisted smoking cessation on vascular endothelial function assessed by flow-mediated vasodilation (FMD).DesignBefore–after and time-series.SettingTochigi Prefecture, Japan.ParticipantsData of 85 participants who visited nicotine-dependent outpatient services were reviewed. FMD was repeatedly measured in 33 of the 85 participants. Inclusion criteria: 20 years and older, Brinkman index ≥200, Tobacco Dependence Screener ≥5 and stated motivation to quit smoking.InterventionsEach participant was treated with varenicline titrated up to 1.0 mg twice daily (for 12 weeks in total).Primary and secondary outcome measuresParticipants were evaluated by FMD prior to, and 3 months after, complete smoking cessation. Follow-up FMD measurements were carried out every 3 months if possible. Changes in FMD during varenicline use were also evaluated.ResultsFMD was significantly increased from 4.0±1.8% to 5.5±2.2% (p<0.01, n=22) 3 months after complete cessation. Although the timecourse of FMD in most of the cases showed an increase with fluctuations, there was an exceptional case where FMD decreased over the 9 months following complete cessation. Although statistically insignificant, FMD also increased during varenicline use (from 3.7±2.7% to 4.3±2.8%, n=11).ConclusionsOur observations suggest that in ceasing smokers, varenicline and smoking cessation do not lead to a worsening of the vascular endothelial function.Trial registrationFK-79 (International University of Health and Welfare).