In Japan, HIV testing has been offered anonymously and free-of-charge at local public health centers, together with pre- and post-test counseling since 1993. Since then, the number of HIV tests increased steadily to reach a peak in 2008 but has since decreased by 30% during the last decade. The number of tests further decreased in 2020 during the COVID-19 pandemic and steeply by 50% this year compared with the previous year, mostly due to a shift in the workload at these centers to COVID-19-related services. To deal with this decline and thinking beyond the current pandemic, more options for HIV testing are needed, such as self-testing/postal delivery of dried blood spot specimen, a method that is yet to be approved in Japan, in addition to the conventional plasma/serum-based HIV testing.
Japan ranks the highest globally, in terms of longevity. The average life expectancy was 81.4 years for men and 87.5 years for women in 2019. Such success in health is attributable to the substantial reduction in age-standardized mortality from cardiovascular diseases, especially stroke (136 per 105 in 1980 and 24 per 105 in 2015), when stroke mortality was the highest in the world between the 1960s and the 1990s. On the other hand, ischemic heart disease mortality was the lowest in the world between the 1960s and the 1980s and has continued to decline (40 per 105 in 1980 and 17 per 105 in 2015). Such a disease profile (larger burden of stroke compared to ischemic heart disease) was observed not only in Japan but also in some countries in central Asia and Africa, where small vessel disease (arteriolosclerosis) is assumed to be more common than large vessel disease (atherosclerosis). Between 1970 and 2015, a large decline in the population with high blood pressure levels was observed for both men and women. Meanwhile, there was a moderate decline in the smoking rate among men, and an increasing trend in serum cholesterol levels in both men and women. The sharp and extensive socioeconomic development between the 1960s and 1990s contributed to these health outcomes, while preventive measures and improved emergency medical care also contributed to the reduction of risk factors, disease incidence, case-fatality, and mortality. However, there is a threat of increasing incidence of ischemic heart disease in urban male employees and middle-aged male residents. Japan, with a super-aging society, needs to develop a new model for the prevention and control of cardiovascular disease and related health issues, with emphasis on efforts towards the early (primordial) prevention of cardiovascular disease as well as the attenuation of their progress towards chronic heart failure, chronic kidney disease, and vascular dementia.
Endoscopic resection (ER) techniques such as polypectomy, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely accepted as a less invasive treatment for gastrointestinal (GI) tumors. Since there is a limit to the size that can be resected by EMR and it is often divided, it is not possible to accurately evaluate the degree of cancer progression, and the cancer remains or causes recurrence. ESD is a technology that overcomes these weaknesses. ER techniques are considered for tumors that have a very low possibility of lymph node metastasis and are suitable for en-bloc resection. As ESD became more widespread, the difficulty of treating ESD was gradually resolved by the development of technology and equipment, the curative resection rate increased, and the complication rate decreased. ER techniques have become the standard treatment for early cancer and precancerous lesions in Japan, and the therapeutic indications are expanding day by day. The indications for whether endoscopic treatment can be performed are defined by the guidelines for each organ such as the esophagus, stomach, and colorectum. In the coming aging society, it is also necessary to evaluate the indications for endoscopic treatment and invasive treatment. In addition, recent advances in endoscopic technology are making it possible to remove submucosal tumors that previously required surgery. In this review, we summarize the recent Japanese standard indications of ER for each GI location and future prospects of ER.
Definitive chemoradiation (dCRT) is the mainstay treatment for cStage IVa esophageal squamous cell carcinoma (ESCC) with good performance status (PS), according to standard practice guidelines. Salvage surgery may incur operation complications and risk of mortality. According to the esophageal cancer practice guidelines outlined by the Japan Esophageal Society, when a tumor is residual and recurrent, chemotherapy and palliative symptomatic treatment is continued. However, salvage operation has been selected as a therapeutic option for recurrent or residual tumors after dCRT. There is weak evidence for not recommending surgery for cStage IVa ESCC exhibiting residual disease following dCRT. It has been reported that during salvage surgery the only prognostic factor that is thought to be performed is complete resection (R0), but at the same time, salvage esophagectomy increases the incidence of postoperative complications and mortality. The phase II chemoselection study by Yokota T et al. in Japan showed that multidisciplinary treatment initiated by induction therapy, in which docetaxel is added to cisplatin and 5-fluorouracil, resulted in a good prognosis in the short term. In this review, we discuss the surgical strategy and future of unresectable clinical T4 (cT4) ESCC.
Esophageal cancer is the seventh most common cancer, with an estimated 572,000 new cases, and the sixth most common cause of cancer-related deaths in 2018 with 509,000 annual worldwide deaths. Advanced esophageal squamous cell carcinoma (ESCC) is one of devastating tumors with a 5-year survival rate of less than 5% in patients with metastatic disease. Treatment options for patients with advanced ESCC are limited. Current guidelines recommend chemotherapy containing a platinum and a fluoropyrimidine agent as a first-line treatment. Recently, immune checkpoint inhibitors (ICIs), including nivolumab and pembrolizumab, have demonstrated antitumor activity and clinical efficacy in patients with advanced ESCC that is refractory or intolerant to first-line chemotherapy. ICIs are game-changers that not only transformed oncological strategy but also have a wide range of clinical potential in combination with conventional cytotoxic chemotherapy and radiotherapy. There is still an urgent, unmet need for reliable treatment options to conquer this intractable disease.
The primary tumor location (PTL) has attracted increasing attention in recent years for colorectal cancer (CRC) patients. Although the underlying mechanisms for differences caused by PTL remain still unclear, right-sided colon (RCC) and left-sided colon (LCC) are now considered as distinct entities because of their different molecular profile and clinical response to surgery and chemotherapy. In this article, we review the influence of PTL particularly on surgical management of primary and metastatic CRC settings. For nonmetastatic CRC, RCC could be a slightly superior prognostic factor after curative resection in stage I-II CRC, while RCC could be an inferior prognostic factor in stage III CRC with worse survival after recurrence, suggesting the oncological aggressiveness of recurrent RCC. For metastatic CRC, RCC could be a predictor of worse survival after hepatectomy of liver metastases from CRC with aggressive recurrence pattern and lower chance of re-resection. In lung metastases from CRC, the role of PTL still remains uncertain because of the limited number of studies. As to the impact of PTL on survival outcome after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for peritoneal metastases from CRC, a discrepancy exists among studies and further investigation will be needed. The very simple clinical factor of PTL could provide important information for the prediction of the survival outcome after surgery in CRC. Further clinical and basic research will facilitate the clinical application of PTL in a more specified and personalized manner.
The demand for HIV testing using dried blood spots (DBS) has increased recently. However, DBS is not an approved sample for HIV testing in Japan. This study examined the validation of HIV testing with DBS, prepared at the laboratory or remotely and mailed via postal service to the laboratory. DBS were punched out from a 5.5 mm diameter circle on filter paper, then eluted with 600 μL of phosphate buffered saline overnight at 4℃, and analyzed by Lumipulse S HIVAg/Ab (LUM). The mean LUM count of DBS was 237.4-times diluted compared to titrated plasma. Repeated sample testing showed that although LUM count of DBS decreased slightly with increase in sample storage time (up to one month), it did not affect the result of HIV testing with DBS. Based on testing of 50 HIV+ confirmed cases and 50 HIV- persons, the estimated sensitivity was 98% (49/50) with a specificity of 100% when the cut-off value is 0.5. The single false negative case was a patient with undetectable viral load over the last 10 years, resulting in a decrease of antibody titer below the cut-off level. In conclusion, although DBS cannot completely replace plasma in HIV testing because the sensitivity was a little lower than that of plasma, it can be potentially useful for a screening test by self-finger-prick and postal service use. This will allow people to receive HIV testing without visiting public health centers.
Medical Excellence JAPAN (MEJ) is a general incorporated association established in 2011 in Japan. It aims to serve as a central hub and a platform to promote international health business jointly with governments, medical communities, academic organizations, and healthcare industries. This article introduces the works of MEJ in the broader context of Japan Revitalization Strategy. The Act on Promotion of Healthcare Policy (2014 Act No. 48) established the Headquarters for Healthcare Policy, chaired by the Prime Minister and supported by dedicated secretariats in the Cabinet Office. The Headquarters aimed at policy coordination across ministries but learned hard lessons from COVID-19, such as delay of domestic vaccine production. This highlights our systematic weakness of the trajectory from R&D to public availability, and this is the field in which MEJ can play further roles. The value and feasibility of developing MEJ-like mechanisms in Asia with a rapidly growing healthcare sector is discussed.
Indocyanine green (ICG) is a fluorescent dye that selectively accumulates in primary hepatocellular carcinoma (HCC) as well as in extrahepatic metastases of HCC. Reported here is a case of metachronous lymph node (LN) metastases from HCC that were resected using ICG fluorescence navigation. A man in his 70s was referred to this department for suspected LN metastasis from HCC. Computed tomography revealed an enlarged suprapancreatic LN. After a laparotomy, an ICG fluorescence imaging system intraoperatively revealed strong fluorescence of this LN, which was then easily resected. An examination after the removal of the LN revealed fluorescence from the adjacent lymphatic tissue as well, so an additional resection was performed. Pathologically, both LNs were confirmed to be metastases from HCC. In this case, some lymphatic tissue metastases from HCC could not be identified prior to surgery, but intraoperative use of ICG fluorescence navigation facilitated their complete removal.
This crossover study investigated effects of physical therapy (PT) on motor function in patients with hemophilia infected with human immunodeficiency virus (HIV) due to treatment with non-heat-treated blood products. Patients were randomly divided into a PT-first group (PT once monthly for 6 months, then only home exercise (HE) for 6 months) and an HE-first group (HE for 6 months, then PT once monthly for 6 months). Carryover, period, and treatment effects were examined. Carryover effect was observed for flexion muscle strength of the right hip joint and fast walking cadence. Period effect was observed for extension Range of motion (ROM) of the left hip joint, dorsiflexion of the right ankle joint, and fast walking cadence. PT tended to be effective for abduction of the left shoulder joint and fast walking cadence. Compared with HE, PT tended to contribute to improving ROM of the shoulder joints and fast walking.
The world has been confronting a health crisis for two years because of the COVID-19 pandemic. The context of the crisis has the form of the first wave and subsequent waves that varied depending on the country. Undoubtedly, Algeria is one of the countries that have suffered severely from this pandemic. The recent wave has been marked with the huge number of casualties given the poor preparation. The country's preparation issue will be more complicated. In other words, in the context of an expected 4th wave that is characterized with the appearance of the new Omicron variant B.1.1.529. Thus, this news will consider the situation comprehensively and will provide recommendations to minimize the potential damage that will result from the fourth wave, and to attempt to limit the spread of the virus. The updated measures aim at rising the opportunities of improving the health situation in the country in the near future.