The Japanese government established the Children and Family Agency in April 2023 and is trying to promote evidence-based policymaking (EBPM). However, the current state of child and adolescent psychiatry in Japan demonstrated some difficulties. School refusal and suicide problems are increasing after the coronavirus disease-2019 (COVID-19) pandemic. These issues need to be addressed, thereby warranting various policies to be developed and implemented. Increasing the number of inpatient medical institutions and establishing a community-based data accumulation system that enables data and knowledge sharing among professionals is essential to improve child and adolescent psychiatric care. Furthermore, EBPM is needed to effectively develop a policy, and specialized experts are necessary to organize data and critically review evidence.

Preservation of renal function is an important goal of partial nephrectomy (PN) for renal tumors. Several attempts to preserve postoperative renal function, including hilar control surgery and omission of renal cortical renorrhaphy, have been reported, but the influence of each procedure remains controversial. We conducted a literature review based on PubMed to summarize the current situation and clarify the influence of each procedure on postoperative renal function. Effects of hilar control, omitting renorrhaphy, and a combination of both on post-PN renal function were reviewed. While hilar clamping does not influence postoperative renal function, cortical renorrhaphy tends to deteriorate. Parenchymal ischemia/reperfusion by hilar clamping leads to acute kidney injury through production of radical oxygen species. Recent randomized controlled studies, however, showed no differences in the postoperative renal function between on- and off-clamp laparoscopic PN. Finally, the effects of soft coagulation on renal parenchymal denaturation and postoperative renal function were reviewed. Although soft coagulation can lead to denaturation and necrosis of the renal parenchyma, the shortened warm ischemic time might positively affect postoperative renal function. In conclusion, off-clamp, non-renorrhaphy PN is feasible and safe for small renal tumors. Renorrhaphy, but not hilar clamping, tends to worsen postoperative renal function.

Responding to high disease burden of Hypertension (HTN), the Ministry of Health in Zambia, considers improving services related to HTN a national priority. Therefore, this study evaluated the interventions for HTN pharmaceutical treatment by training of health staffs and procurement of necessary medical devices. .We investigated service provision in the outpatient department (OPD) visits among patients aged 40 years and above in randomly selected health facilities in Chongwe district, between May and December 2017, before and after the interventions. The proportion of OPD visits that included standard clinical practices for HTN services significantly increased post-intervention: 45.8% to 71.9% for blood pressure screening, 26.8% to 31.8% for HTN diagnosis, and 14.2% to 20.9% for HTN medication. The proportion of OPD visits at which HTN medication was prescribed increased significantly post-intervention among patients with Grade 2 HTN or above, from 68.3% to 86.0%. The estimated district-wide monthly cost for HTN services in USD was $1,905 at baseline and increased to $2,643 post-intervention. These results suggest that improving HTN service provision is feasible and affordable at the district level. However, because a large number of individuals in need of HTN medication did not access a health facility, further investigation is required to estimate the expected effects and costs under improved access in the future.

Anomalous systemic arterial blood supply to the basal lung (ABLL) is a rare congenital malformation. Although surgical resection is the standard treatment, the surgical techniques for aberrant arteries remain poorly discussed. Herein, we evaluated the efficacy of our direct suture closure technique in preventing aneurysmal changes in aberrant artery stumps through a retrospective review of the medical records of patients who underwent surgical resection of ABLL at our institution between January 2013 and January 2023. The diagnosis of ABLL was based on enhanced computed tomography (CT) findings. To treat ABLL, we performed lateral thoracotomy through the 5^th intercostal space via a ~10 cm skin incision. After anatomical pulmonary resection, the aortic stump of the aberrant artery was sutured directly with a felted non-absorbable thread. In one patient, we further examined the postoperative blood flow using 4D-flow magnetic resonance imaging. Overall, 5 consecutive patients, including four (80%) females with a median age at operation of 59-year-old, were assessed. The median operative time was 166 min, and the median blood loss was 34 ml. There were no cases of perioperative mortality or morbidity, and the median hospital stay was 8 days. No vortex flow was observed in 4D-flow evaluation of blood flow. Histological changes were observed in the aberrant artery, including fibrous intimal thickening, atherosclerosis, intramural thrombus, and collection of foam cells and lymphocytes. Thus, we present this technique as a safe treatment for ABLL that allows for the preservation of blood flow and complete resection of abnormal vessels.

To evaluate the impact of the COVID-19 pandemic on the epidemiology of respiratory viral infections, we examined the prevalence of respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) infections for pediatric patients admitted to our hospital before and after the COVID-19 pandemic from January 2015 to June 2023. During the COVID-19 pandemic, no outbreaks of RSV infections were seen in 2020, and no outbreaks of hMPV infections were seen in 2020 and 2021. Before the pandemic, the two epidemics did not overlap, but after the pandemic, the two epidemics almost overlapped for the second year in a row. The average age of patients with both RSV and hMPV infection after the pandemic was significantly older than before the pandemic by approximately one year.

Infantile hemangiomas (IHs) are the most common benign tumors of infancy, occurring in approximately 5-10% of the population. Among what appear to be typical IHs with proliferative and involuting phases, we noticed that there are also IHs that are already present at birth and regress without proliferating. We therefore aimed to determine the frequency and clinical characteristics of this type of IH. A retrospective study was conducted on 176 lesions of 137 Japanese patients with IH. As a result, six lesions (3.4%) in three patients with IH (2.1%) were already present at birth and lacked subsequent proliferation. Analysis of the clinical characteristics of IHs without proliferation revealed that they are significantly less common in the head and neck region, which is the preferred site of the tumor, than typical IHs with proliferation (0% vs. 42.9%, p < 0.05 by Fisher's exact test). This suggests that when the clinical course of IH is uncommon, their distribution can also be atypical. Furthermore, all of the IHs without proliferation were superficial types, and there were no deep types in this cohort. This study demonstrates that the clinical course of IH can be diverse, and that very rarely there can be a type of IH that does not grow after birth. It may be necessary to consider conducting a detailed interview for the growth history at the first visit for the possibility of such a type of IH without proliferation, as it is likely that they can be followed up without the need for treatment.

Abstract: Although the initial triggers of Parkinson's disease (PD) remain largely unknown, viral infections have been implicated in some cases. In this study, we investigated the neurological sequelae and explored the potential association between post COVID-19 conditions and the development of Parkinson's disease-like symptoms by conducting a questionnaire survey on patients with COVID-19. We surveyed patients who had recovered from COVID-19 and visited the outpatient service of the institution from February 2020 to November 2021. Demographic and clinical data and data regarding the presence and duration of post COVID-19 conditions were obtained. The most common symptom was insomnia, experienced by 141 participants (27.9%). Bradykinesia was the next most common symptom, experienced by 66 participants (13.1%). Moreover, 18 (3.6%) participants reported persistence for > 180 days. Notably, the median duration of bradykinesia was 90 days. The proportions of patients with dysbasia, resting tremor, not previously noted constipation, and somniloquy were 9.1%, 5.0%, 4.8%, and 2.8%, respectively. Few participants had any of these symptoms lasting for more than 180 days. None of the participants was first diagnosed with PD, other neurological diseases, or dementia after COVID-19. Longitudinal follow-up surveys are needed to better understand the relationship between COVID-19 and PD.

We assessed trends in glycemic control among individuals with diabetes before and during the coronavirus disease 2019 pandemic. We used two databases to investigate changes in prescription days and the interval between physician visits and their impact on glycemic control among individuals with diabetes in Japan between 2017 and 2020. The analysis using the JMDC database indicated that prescription days were extended by approximately 20 days in 2020 compared to other years. The analysis using the Japan diabetes comprehensive database project based on an advanced electronic medical record system database revealed that intervals between physician visits were extended by approximately 7 days in 2020 compared to other years and glycemic control did not materially change in 2020. These results suggest that the prescription days increased with the spread of coronavirus disease 2019 in patients with diabetes, but the impact of the coronavirus disease 2019 pandemic on glycemic control appeared to be small.

Despite the lower rate of severe illness associated with the omicron variant than the delta variant, more deaths have occurred among patients with mild-to-moderate COVID-19 in Japan since the omicron variant surge during the sixth wave. This study aimed to elucidate the background, clinical course, and causes of death in patients with COVID-19. We conducted a retrospective observational study on patients with COVID-19 admitted to the National Center for Global Health and Medicine who subsequently died during the delta (July–September 2021) and omicron variant outbreaks (December 2021–August 2022). Among the 20 patients who died during the delta variant epidemic, the main causes of death were pneumonia (n = 16, 80%), preadmission complications (n = 3, 15%), and complications occurring during hospitalization (n = 1, 5%). However, during the omicron variant epidemic, 7/24 patients (29%) died of pneumonia, 11 (46%) died of complications before admission, and 6 (25%) died of complications during admission. During the omicron variant outbreak, two-thirds of the COVID-19 deaths during hospitalization were not primarily caused by pneumonia, unlike the delta variant outbreak, during which pneumonia had a greater impact on mortality. As patient demographics and clinical pictures change, the establishment of medical infrastructure for patients with life-threatening comorbidities and careful monitoring of acute COVID-related complications are essential.

We examined the association between antibody titer levels and risk of coronavirus disease 2019 (COVID-19) infection in the general Japanese population, including a total of 1,972 participants between June and September 2022. Specifically, we ascertained participants’ IgG antibody titers targeting the spike protein and infection status, and subsequently examined the association between antibody titer categories (< 2,500, 2,500–5,000, 5,000–10,000 and > 10,000 AU/mL) and COVID-19 infection to estimate risk ratios (RR) and their 95% confidence intervals (CI). Compared to the lowest category, the adjusted RR for participants with antibody titers ≥ 10,000 AU/mL was 0.38 (95% CI: 0.20–0.71). The observed non-linear relationship between the titers and the risk of infection showed that the risk decreased as the participant's antibody titer increased, but the slope became milder when the antibody titer reached approximately 10,000 AU/mL. These findings may contribute to the use of an individual's antibody titer to consider appropriate timing of vaccination.

Towards the WHO goal for hepatitis elimination, understanding the prevalence and management of hepatitis B and C viruses (HBV, HCV) among drug abusers is crucial. However, in Japan, where drug abuse is less prevalent than in other countries, there is a dearth of epidemiological studies on this topic. This study aimed to fill this gap by investigating virus prevalence and the testing and treatment landscape for drug abusers in Japan. We conducted a cross-sectional sero-epidemiological study at a psychiatric hospital in Hiroshima where approaching drug abusers was feasible. Blood samples and questionnaire on HBV/HCV testing and treatment were collected from drug abusers (n = 35, 85.7% male, mean age 55.4 years) and control group (n = 45, 71.1%, 48.2 years). Prevalence of HCV-Ab and HCV RNA in drug abusers was 60.0% (95% CI: 43.8–76.2%) and 28.6% (13.6–43.5%), respectively, which was significantly higher than in the control group (2.2%, 0.0%, respectively). All HCV-Ab positive drug abusers had undergone prior hepatitis virus testing, but only 42.9% of those eligible for HCV treatment were connected to it. For HBV, while prevalence of HBsAg was similar between groups (2.9% vs. 2.2%), prevalence of HBc-Ab was higher in drug abusers (34.3% vs. 17.8%), indicating a greater likelihood of exposure to HBV infection. In conclusion, HCV prevalence among drug abusers in psychiatric care is notably high. Although testing is accessible, a recognized challenge is the insufficient connection to treatment. Enhancing collaboration between psychiatric hospitals and hepatologists is crucial. Disregarding this issue is not an option for hepatitis elimination.

In steroidogenic tissues, a novel class of angiogenic molecules known as endocrine gland-derived vascular endothelial growth factors (EG-VEGF)/prokineticins are primarily produced. Here, we investigated how EG-VEGF/PROK1, a member of PROKs family, and its receptor are able to affect cellular motility in both non-neoplastic and cancerous human prostate cells. Using Western blot and motility test studies, EPN cells, a non-transformed cell line and Cancer Epithelial Prostatic Cells (CEPC) were employed as cellular models in the current investigation. Western blot examination of EPN normal prostate cells treated with EG-VEGF/PROK1 revealed that ERK1/2 was rapidly phosphorylated within 5, 10, and 20 minutes, while CEPC had high and sustained ERK1/2 activity at the same periods. Then, compared to normal EPN prostate cells, CEPC treated with EG-VEGF/PROK1 for up to 72 hours demonstrated enhanced cell motility. Based on our findings, EG-VEGF/PROK1 may play a role in prostate cancer progression by controlling angiogenesis and the motility of metastatic cells in CEPC cells, likely as a consequence of ERK1/2 activation, as contrasted to EPN normal prostate cells.

Highlighted by the G7 Hiroshima Summit and evident in Japan's complex vaccination program, the issue of novel coronavirus disease 2019 (COVID-19) vaccine allocation and utilization, particularly the dilemma of minimizing vaccine wastage, extends beyond national concerns. Various global strategies, such as using behavioral science principles like 'nudges', have been implemented to tackle the problem. However, scientific evaluation and international collaboration are insufficient; thus, analyzing successful case studies and innovative methods is crucial to pave the way for future preparedness and resilient responses to emerging pandemics.

To ensure good outcomes in patients presenting with vertigo, accurate prediction ruling out central vertigo is crucial during initial assessment. This study was conducted to develop a clinical decision rule (CDR) using objectively measurable predictors to exclude central vertigo, while maintaining 100% sensitivity. This was a multicenter, prospective, cohort study analyzing patients presenting to the emergency departments of six hospitals in Japan from April 2011 to March 2014. Eligible patients were 3,001 patients aged > 15 years. Patients were excluded if they presented with trauma, intoxication, heatstroke, anaphylaxis, or unconsciousness. The main outcome measure, definitive diagnosis of central vertigo, was based on confirmation of intracranial bleeding on head computed tomography (CT) or cerebral or cerebellar infarction or tumor on brain magnetic resonance imaging (MRI). Univariate analysis and multivariate recursive partitioning analysis were performed. A total of 1,938 patients were enrolled. Of 1,133 cases, 60 were diagnosed with central vertigo. The CDR diagnosed central vertigo if any of the following were present: headache or neck pain, vomiting, sBP > 150 mmHg, BS > 140 mg/dL, or LDH > 230 IU/L, providing sensitivity of 100% (95% CI 94.0–100%) and specificity of 21.2% (95% CI: 18.9–23.7%) to exclude central vertigo. The rule was validated in 805 eligible patients, of whom 87 had central vertigo, demonstrating sensitivity of 100% (95% CI: 95.8–100%) and specificity of 20.0% (95% CI: 17.4–22.9%). A highly sensitive CDR to exclude central vertigo was developed for patients presenting with vertigo to emergency departments. Further verification is needed to generalize this CDR.