The first case of COVID-19 in Japan was reported on 16 January 2020. The total number of the infected has reached 313,844 and the number of deaths has reached 4,379 as of 16 January 2021. This article reviews the characteristics of and responses to the three waves of COVID-19 in Japan during 2020-2021 in order to provide a reference for the next step in epidemic prevention and control. The Japanese Government declared a state of emergency on 7 April 2020, which suppressed the increase in the number of the infected by curtailing economic activity. The first wave peaked at 701 new cases a day and it decreased to 21 new cases on May 25 when the state of emergency was lifted. However, the number of the infected increased again due to the resumption of economic activity, with a peak of 1,762 new cases a day during the second wave. Although the situation was worse than that during the first wave, the government succeeded in limiting the increase without declaring a state of emergency again, and that may be attributed to a decrease in crowd activities and an increase in the number of inspections. During the third wave, the number of the infected continued to exceed the peak during previous waves for two months. Major factors for this rise include the government’s implementation of further policies to encourage certain activities, relaxed immigration restrictions, and people not reducing their level of activity. An even more serious problem is the bed usage for patients with COVID-19; bed usage exceeds 50% not only in major cities but also in various areas. On 7 January 2021, 5,953 new cases were reported a day; this greatly exceeded the previous peak, and the state of emergency was declared again. Although Japan has been preparing its medical system since the first wave, maintaining that system has imposed a large economic burden on medical facilities, hence stronger measures and additional support are urgently needed to combat COVID-19 in the coming few months.
Gallbladder carcinoma (GBC) is one of the most common malignant tumors in the biliary system, ranking sixth among gastrointestinal malignancies. In addition, the incidence of GBC has recently increased in China. GBC metastasizes early and invades adjacent organs such as the liver, making patients with GBC ineligible for radical surgery and giving them a poor prognosis. What is more, GBC is more inclined to develop chemo-resistance, which requires new strategies for clinical intervention. Cancer immunotherapy has made great advances over the past few years, with improved clinical efficacy against multiple malignancies, including GBC. This review summarizes the immunological characteristics of GBC as well as current advances in immunotherapies for GBC in order to provide new insights into future treatment and prevention of GBC.
Newcastle disease (ND), caused by the Newcastle disease virus (NDV), is transmitted by poultry with severe infectivity and a high fatality rate. The fusion (F) protein on the NDV envelope facilitates the merger of the viral and host cell membranes with the help of the homologous hemagglutinin-neuraminidase protein (HN). The transmembrane (TM) domains of viral fusion proteins are typically required for fusion, but the key amino acids in NDV F TM domains have not been identified. Site-directed mutagenesis was utilized to change the conserved amino acids at 500, 501, 502, 505, 510, 513, 516, 519, and 520 to alanine. It was found that mutants L519 and V520 had an interrupted protein expression, decreased to below 10%, and mutants A500, I505, V513, and V516 had a hypoactive impact on fusion activity, decreased to 85.38%, 67.05%, 55.38% and 51.13% of wt F, respectively. The results indicated that the TM domain plays a vital part in the fusion activity of the NDV F protein.
This study aims to compare the value of contrast-enhanced ultrasound (CEUS) and contrast-enhanced CT (CECT) in the differential diagnosis of benign and malignant renal masses. Included in this retrospective study were 143 renal masses in 141 patients using histopathological findings as the gold standard. A comparison was made of the two modalities in image characteristics for their accuracy in the differential diagnosis of renal masses. CEUS and CECT were both used for 39 masses in 37 patients, with 31 (79.5%) being malignant and 8 (20.5%) benign. The differences between the benign and malignant groups in perfusion intensity, perfusion uniformity and entry and exit of the contrast agent were not statistically significant (P > 0.05). However, CEUS could better display the circular perfusion of renal cell carcinoma than CECT (P < 0.05). CECT alone detected 109 masses in 107 patients, with 93 (85.3%) being malignant and 16 (14.7%) benign. CEUS detected 73 masses in 71 patients, with 56 (76.7%) being malignant and 17 (23.3%) benign. No statistically significant differences were observed between CEUS and CECT in the diagnosis of renal cell carcinoma (92.8% vs. 90.3%), with a specificity of 52.9% vs. 31.2%, an accuracy of 83.5% vs. 81.6%, and a positive predictive value of 86.7% vs. 88.4% or a negative predictive value of 69.2% vs. 35.7% (P > 0.05 for all). These results suggested both CEUS and CECT are highly valuable in the differential diagnosis of renal masses, and CEUS can be used as an important supplement for CECT in diagnosis of renal cancer.
There is little information on the impact of aging on liver resection of hepatocellular carcinoma (HCC). The aim of study was to evaluate the prognostic impact of the patient's age on the long-term survival after resection of HCC. The postoperative outcomes of the 291 elderly (≥ 70 years) and 340 younger (< 70 years) patients underwent curative liver resection for HCC were analyzed using multivariate and propensity-score matching. Risk score were calculated from the results of Cox regression analysis. The overall survival rate was significantly lower in the elderly group than that in the younger group (p = 0.01). Factors related to overall survival were vascular invasion (absent vs. present, HR 2.25; 95% CI 1.52-3.33, p = 0.0001), albumin level (< 3.0 vs. ≥ 3.0 g/dl, HR 2.23; 95% CI 1.31-3.79, p = 0.003), and number of tumors (solitary vs. multiple, HR 1.68; 95% CI 1.24-2.27, p = 0.001). The results of risk-score analysis with a Cox proportional-hazards model indicated that the proportion of poor-risk patients was significantly higher in the elderly than in the younger group. Propensity-score matching analysis yielded 234 pairs of patients. There were no significant differences in baseline profiles or risk scores between the two groups (p = 0.43). There were also no significant differences in the overall survival between the two groups (p = 0.23). Advanced age does not have a significant impact on the outcomes of patients after resection of HCC.
There is little information concerning whether incorporating clinically significant portal hypertension (CSPH) into albumin-bilirubin (ALBI) grading could improve its predictive capacity. In this study, we investigated the predictive ability of ALBI grade plus CSPH (ALBI-P score) for patients with hepatocellular carcinoma (HCC) after liver resection. Data from 1,679 patients were retrospectively reviewed. The ALBI-P score was calculated from the ALBI grade and a point for CSPH (0 for absence of CSPH and 1 for presence of CSPH). Independent risk factors for recurrence-free survival (RFS) and overall survival (OS) were analyzed. Multivariate analysis suggested that the ALBI-P score was an independent risk factor for both postoperative recurrence (HR = 1.441, 95% CI = 1.328-1.563, P < 0.001) and mortality (HR = 1.332, 95% CI = 1.156-1.535, P < 0.001). Both the RFS and OS of patients with an ALBI-P score of 1 were significantly better than those of patients with ALBI-P scores of 2 and 3 (5-year RFS of 38.9%, 26.1%, and 14.7%, respectively, P < 0.001; 5-year OS of 52.7%, 42.6%, and 29.3%, P < 0.001). When the ALBI-P score and BCLC stage were combined, the ALBI-P-BCLC score showed the highest area under the receiver operating characteristic curve to predict both postoperative recurrence and mortality compared with BCLC stage alone, BCLC stage combined with ALBI grade, or platelet-albumin-bilirubin grade. These results suggested incorporating CSPH into the ALBI grade could strengthen its prognostic power. The ALBI-P score may serve as a surrogate marker to predict HCC patient outcomes after liver resection.
Acute respiratory distress syndrome (ARDS) is a life-threatening form of acute lung injury (ALI) associated with hypoxemic lung damage and inflammation. Matrix metalloproteinase protein-3 (MMP3 or Stromelysin-1) is known to promote vascular injury in ALI/ARDS. Cisatracurium, a nicotinic neuromuscular blocker, is used in ARDS patients to decrease mechanical ventilator dyssynchrony, increase oxygenation, and improve mortality. However, the magnitude and the underlying mechanisms of these potential benefits of cisatracurium remains unclear. We investigated the effect of cisatracurium on lipopolysaccharide-induced MMP3 expression in human microvascular endothelial cells. In our results, cisatracurium treatment significantly decreased LPS-induced MMP3 expression and increased expression of cell junction proteins such as vascular endothelial cadherin (VE-cadherin) and claudin-5.
Transitional care is indispensable in successfully transitioning patients from hospital to home and preventing adverse events during this process. There were restricted services in several hospitals for minimizing the spread of COVID-19. Therefore, hospitals could not provide adequate transitional care that possibly resulted in poor post-discharge outcomes in patients. Some hospitals have now combined infection prevention with face-to-face opportunities, i.e., requiring reservations for transitional care consultation and restricting pre-discharge conferences. Several hospitals started providing pre-discharge conferences using apps, where patients/family caregivers and care teams could have face-to-face discussions about medical and nursing care plans, goals, and preferences. However, building a relationship between patient/family and medical/nursing staff and providing decision-making, psychological support, and risk assessment generally performed in person are still in demand. New hybrid strategies should be developed and evaluated to provide transitional care while using online systems and minimal face-to-face support during the pandemic.
Bone morphogenetic protein 4 (BMP4) was recently reported to confer reprogramming capability to embryonic stem cells (ESCs) by reactivating naïve pluripotency genes via Zbtb7a and Zbtb7b. A visual reporting system was developed to first identify BMP4 as a driver for the primed-to-naïve transition (PNT). In addition, two specific inhibitors were identified as significantly improving the efficiency of PNT (~80% transition) within 8 days. The Zbtb7 family members were first introduced in the context of PNT and stem cell fate decision-making. These findings provide valuable information on acquiring naïve pluripotent stem cells for regenerative medicine.
With the implementation of the two-child policy in China, an increased number of women of advanced maternal age (AMA) have been giving birth. Formulating evidence-based guidance for the clinical management of this population is crucial. This retrospective study aimed to explore factors influencing the mode of delivery in women of AMA. Data on 350 women of AMA who delivered at Shanghai Putuo Maternity & Infant Health Hospital from January to June of 2016 were collected. Results indicated that most (114/134, 85%) of the multiparae chose delivery via cesarean section (CS) because of uterine scarring. There were significant differences in the body mass index (BMI) before pregnancy, BMI at delivery, gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), and placenta previa between the CS and vaginal delivery groups (P < 0.05 for all). The current results suggest that vaginal delivery is recommended for the first delivery whenever reasonable. Moreover, management of metabolic disorders during pregnancy is essential to effectively reduce the rate of CS among women of AMA.