With approximately 296 million individuals estimated worldwide, the chronic infection of hepatitis B virus (HBV) is one of the most common risk factors for hepatocellular carcinoma (HCC). HBV-encoded X protein (HBx), which is multifunctional regulatory protein, has been considered to play an important role in the development of HBV-induced HCC because it interferes with various cellular signaling pathways and mechanisms that promote hepatocarcinogenesis such as transcription factors, cell cycle regulators, apoptosis, and DNA repair epigenetic mechanisms. However, despite its significance, the detailed molecular mechanisms underlying HBx remain unclear. In this review, we summarize the role of HBx in hepatocarcinogenesis. A better understanding on HBx-mediated hepatocarcinogenesis could provide a solid foundation for future research and lead to the development of therapeutics targeting HBx.

Background: The aim of this phase II single-arm clinical trial was to evaluate the safety and efficacy of a total neoadjuvant therapy (TNT) regimen consisting of systemic SOX chemotherapy (S-1 and oxaliplatin) during the waiting period after modified short course chemoradiation therapy (mSCCRT) for preoperative treatment of patients with cStage II/III rectal cancer. Materials and Methods: The study targeted 34 patients with lower rectal cancer cStage II/III treated with TNT between April 2021 and April 2024. The TNT protocol consisted of mSCCRT, radiation therapy 30 Gy (3 Gy × 10 fractions) concurrently with S-1 (80 mg/day, administered on days 1-5 and days 7-11), followed by two cycles of consolidation chemotherapy using SOX (S-1: 80 mg/body, oxaliplatin: 130 mg/body). A total mesorectal excision with lymph node dissection was performed 8-10 weeks after radiation therapy. The safety and efficacy of this treatment were evaluated. Results: The patients were 27 men and 7 women. A total of 30 patients (88.2%) completed the entire treatment regimen. The most common adverse event was diarrhea, observed in 23 cases (67.6%). Among these, 3 cases (8.8%) were classified as CTCAE Grade 3, with the remainder being Grade 1. Postoperative complications included one case (3.3%) of intra-abdominal abscess classified as Clavien-Dindo Grade IIIa. The pathological complete response (pCR) rate was 31.3%. Conclusion: The TNT regimen combining mSCCRT and consolidation chemotherapy was feasible and safe, with minimal severe adverse effects and postoperative complications, and was oncologically effective.

The reclassification of COVID-19 as a Category V infectious disease in Japan on May 8, 2023, shortened isolation periods for healthcare workers (HCP). Although early return-to-work (RTW) is crucial to maintaining hospital operations, it must be balanced against the risk of nosocomial transmission. In this study, we retrospectively analyzed 121 HCP diagnosed with COVID-19 between January 2022 and April 2023, measuring their SARS-CoV-2 antigen levels quantitatively using the Lumipulse^® SARS-CoV-2 Ag assay. Based on antigen kinetics, we estimated a Day 6 antigen threshold of 1183 pg/mL and set a conservative cutoff at <1200 pg/mL for safe RTW. From May 8, 2023, asymptomatic HCP with antigen levels <1200 pg/mL on Day 6 were allowed to return to work under close monitoring. Between May 8, 2023, and February 23, 2024, 108 of 145 HCP (74.5%) met the RTW criteria and resumed duties without nosocomial transmission. The remaining 37 staff, who either exceeded the threshold or were untested, returned on Day 11, also without incident. Our findings suggest that quantitative antigen testing offers an objective method for determining RTW eligibility and that a threshold of <1200 pg/mL on Day 6 is safe and operationally feasible. This strategy provides a practical balance between minimizing infection risk and sustaining hospital function. Periodic reevaluation of the antigen threshold will be necessary as viral characteristics and vaccination coverage evolve.

Aims: The current study was designed to evaluate the effect of switching from subcutaneous dulaglutide 0.75 mg weekly to oral semaglutide 7 mg daily on glycemic control, as reflected by hemoglobin A1c (HbA1c), occasional plasma glucose (PG) and glycoalbumin (GA) in real-world clinical practice in our hospital.

Patients and Methods: A search of electronic medical records from January to September 2023 was performed for patients who had received dulaglutide for type 2 diabetes and were switched to oral semaglutide because of a chronic shortage of the supply of dulaglutide. A total of 19 patients were enrolled and data for these patients were evaluated until the end of March 2024.

Results: All patients continued to take oral semaglutide during the observational period after the switch. After the change to oral semaglutide, there were no significant differences in HbA1c, PG and GA among time points of the final visit before baseline, at baseline (the time of the switch), and after 3 and 6 months. Low-density lipoprotein cholesterol (LDL-C), estimated glomerular filtration rate (eGFR), and body weight (BW) also did not differ significantly among all of these time points.

Conclusion: A switch from subcutaneous dulaglutide 0.75 mg weekly to oral semaglutide 7 mg daily did not influence glycemic control, as reflected by HbA1c, PG and GA levels, or LDL-C, eGFR, and BW over a 6-month observational period. The tolerability to this change was basically satisfactory.

X-linked adrenoleukodystrophy (X-ALD) is an extremely rare genetic disorder characterized by progressive demyelination of the central nervous system and adrenal insufficiency. Airway management in patients with X-ALD is often challenging due to rigidity/spasticity, cervicothoracic scoliosis, reduced respiratory reserve and gastroesophageal reflux disease. Standardized airway management strategy has not been established for these patients. A 26-year-old male patient with X-ALD underwent laparoscopic-assisted gastrostomy under general anesthesia. He was at risk of difficult airways and rapid desaturation during intubation due to severe cervicothoracic scoliosis, thoracic cage deformity, leftward tracheal deviation, and a history of recurrent aspiration pneumonia. Peri-intubation oxygenation at a flow rate of 45L/min via high flow nasal cannula (HFNC) during induction of anesthesia, which combines preoxygenation and apneic oxygenation during intubation, was administered. Tracheal intubation using a Glidescope^® was successfully performed without complications such as hypoxia or aspiration. We believe that peri-intubation oxygenation during airway management may be beneficial for patients with X-ALD who are at risk of hypoxia and aspiration pneumonia.

There are no reports, until now, of cases of Alport syndrome with the new coronavirus infection. We encountered two cases of Alport syndrome with chronic renal failure who developed pneumonia caused by SARS-CoV-2 while undergoing chronic maintenance hemodialysis. One of the patients received steroid pulse therapy, in addition to favipiravir, ciclesonide and nafamostat administered during hemodialysis. The other patient was treated without steroids. Although it took a long time before the PCR test for SARS-CoV-2 returned negative results, both patients improved.

Aesthetically and functionally desirable reconstruction of upper eyelid defects is a challenging problem, as defects exceeding 25% in width cannot be closed by primary closure and generally require reconstruction using a lower eyelid flap. The sacrifice of the lower eyelids cannot be disregarded. We hereby report our case of upper eyelid repair for a full-thickness defect of nearly the entire upper eyelid following the excision of Merkel cell carcinoma, which was performed without the need for a lower eyelid flap. Instead, we performed reconstruction using auricular cartilage grafting and the advancement of an orbicularis oculi musculocutaneous flap. The appearance of the upper eyelid, levator, and eyelid closure function was successfully restored.

The use of video laryngoscopes has significantly reduced the incidence of difficult intubation in the operating room to less than 1%. However, double-lumen tube (DLT) insertion remains challenging due to its longer, larger, and more rigid structure compared to single-lumen tube (SLT), even when using video laryngoscopes. A 73-year-old man was scheduled for thoracoscopic partial resection of the right upper lobe due to lung cancer. After induction of anesthesia, the tip of DLT repeatedly collided with the anterior tracheal wall even using McGRATH™ MAC videolaryngoscope or stylet, and the DLT could not be advanced into the trachea. In this situation, we inserted a 6.0 mm endotracheal tube with a U-shaped stylet to facilitate tracheal intubation. After confirming successful tracheal intubation, we removed the stylet, and a Frova intubating introducer was passed through the endotracheal tube. We removed only the endotracheal tube, and the DLT was successfully advanced into the trachea using the introducer as a guide to the trachea. Even in the era of videolaryngoscopes, introducers such as a Frova intubation introducer remain valuable tools in difficult airway management. This case highlights the importance of being familiar with introducers in managing unexpected difficult intubation of a DLT using a videolaryngoscope.

Aplastic anemia (AA) is characterized by pancytopenia and hypocellularity in bone marrow. Subacute thyroiditis (SAT) is characterized by clinical symptoms such as fever, thyroid pain, fatigue and those due to thyrotoxicosis, such as palpitation and finger tremor. Here, we report a patient who developed SAT with possible chronic thyroiditis. The patient had developed AA about 4 years ago, and had received immunosuppressive therapy with antithymocyte globulin and cyclosporin A (CyA). The association between AA and SAT in this case is uncertain, but it is interesting to consider the possibility of onset of SAT due to CyA.

This study reports on the initial outcomes of the newly established Reproductive Medicine Center at Dokkyo Medical University Hospital, which began operations in January 2024. A total of 152 female and 77 male patients were evaluated in the first year. Assisted reproductive technology (ART) was performed in 64 cycles, with a clinical pregnancy rate of 47.4% and no cases of ovarian hyperstimulation syndrome (OHSS). Advanced technologies including sperm DNA fragmentation index (DFI), oxidative-reduction potential (ORP) testing, endometrial microbiota analysis, AI-based embryo evaluation, and hysteroscopic morcellation were introduced. The pregnancy rate exceeded the national average reported by the Japan Society of Obstetrics and Gynecology (JSOG) in 2022; however, the miscarriage rate remained relatively high. Evaluation of male infertility and fertility preservation for cancer patients of both sexes, including those in the adolescent and young adult (AYA) generation, were also initiated. These results highlight the feasibility of launching a multidisciplinary reproductive care system within a university hospital and underscore the need for further refinement in outcome prediction and support systems.