Acute amebic appendicitis, a rare presentation of Entamoeba histolytica infection, is challenging to distinguish from non-amebic appendicitis because of similarities in symptoms and laboratory data. Here, we describe the case of a 42-year-old Japanese male with amebic appendicitis diagnosed by histopathological examination of the removed appendiceal specimens. In this case, blood eosinophilia was not observed, and amebic trophozoites were histologically distributed not only in surface exudates but also in appendiceal submucosa and muscularis propria. In addition, a thorough interview and additional colonoscopy after the diagnosis revealed a history of amebic colitis and persistent amebic colitis. We believe that physicians should be aware of the possible presence of amebic appendicitis because of its higher mortality rate compared to non-amebic appendicitis.

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Objectives: The ELF scores, a non-invasive serum marker for liver fibrosis, has primarily been utilized in Western countries as an alternative to liver biopsy. In this study, we assessed its diagnostic efficacy in Japanese patients by comparing it with other biomarkers.
Methods: We included 122 patients with chronic liver disease or cirrhosis who underwent liver biopsy. ELF scores, calculated for each fibrosis stage（F0-F4）based on the New Inuyama Classification, were compared with platelet count, aspartate aminotransferase-to-platelet ratio index（APRI）, fibrosis-4 index, Mac-2-binding protein glycan isomer（M2BPGi）levels, and autotaxin（ATX）levels.
Results: ELF scores exhibited the highest correlation with fibrosis stages determined by liver biopsy（ρ=0.741, P < 0.001）compared to other biomarkers. ELF scores increased with the development of fibrosis, and were higher in F1 than in F0（P=0.0062）and in F2 than in F1（P=0.0223）. The area under the curve（AUC）values for the ELF scores were 0.913, 0.890, 0.870, and 0.850 for ≥ F1, ≥ F2, ≥ F3, and ≥ F4, respectively. The AUC values of ELF scores were comparable to those of M2BPGi levels across all stages, surpassing ATX levels for ≥ F1, and outperforming other markers for both ≥ F1 and F2 stages. ELF scores exhibited high specificity（94.44%）for ≥ F1. For ≥ F2, sensitivity was 83.82%, specificity 81.48%. Both ≥ F3 and ≥ F4 demonstrated high sensitivity （86.96% and 90.00%, respectively）.
Conclusions: The ELF score, which strongly correlated with liver fibrosis, is particularly useful for diagnosing mild and moderate chronic hepatitis in Japanese patients and has the potential to rule out advanced liver fibrosis.

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  Rapid qualitative antigen tests are essential for the management of COVID-19, but their sensitivity and specificity vary. This study prospectively evaluated the diagnostic performance of a newly developed product, the SARS-CoV-2 Rapid antigen test 2.0 （Roche Diagnostics GmbH, Mannheim, Germany） in anterior nasal and nasopharyngeal samples, comparing results with reverse transcription polymerase chain reaction（RT-PCR）in nasopharyngeal samples. The symptomatic participants or asymptomatic participants with a history of close contact with COVID-19 patients were consecutively enrolled. The study also evaluated the sensitivities across different viral loads in pooled samples with known viral RNA levels and compared them with those of a previous product. Among 287 participants, 283 were symptomatic and 187 tested positive for SARS-CoV-2; 179 nasopharyngeal samples had viral loads ≥ 1,000 copies/test. The antigen test had a sensitivity of 92.5%（ 95% confidence interval ［CI］: 87.8%-95.8%） and specificity of 100%（ 95% CI: 96.4%-100%） in anterior nasal samples. When stratified by viral loads in the corresponding nasopharyngeal samples（≥ 10⁵ , ≥ 10⁴ to < 10⁵ , ≥ 10³ to < 10⁴ , ≥ 10² to < 10 ³ , and < 10² viral copies/test）, the sensitivities were 95.9%, 91.3%, 70.0%, 100%, and 40%, respectively. For nasopharyngeal samples, the sensitivity and specificity of the antigen test were 97.3%（95% CI: 93.9%-99.1%）and 99.0%（95% CI: 94.6%-100%）, respectively. In the evaluation of pooled samples, the SARS-CoV-2 Rapid antigen test 2.0 demonstrated a lower limit of detection for SARS-CoV-2 compared to the previous product. The SARS-CoV-2 Rapid antigen test 2.0 exhibited sufficient diagnostic performance, with improved detection performance over the previous products.

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Objective: During pregnancy, lipid metabolism is characterized by accumulation of fats during the first half of pregnancy and an increase in catabolism during the later stages. However, the underlying mechanisms for this shift are not well understood. We attempted to clarify the involvement of glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1（ GPIHBP-1）, an anchor protein for lipoprotein lipase（ LPL）, which is a major lipid metabolism enzyme, by measuring its blood levels during pregnancy.
Methods: Blood samples were collected from non-pregnant women and from pregnant women at different stages: early pregnancy （up to 20 weeks of gestation）, mid-pregnancy （21–33 weeks of gestation）, late pregnancy （34–41 weeks of gestation）, and puerperium（ 4–8 weeks after delivery）. The levels of LPL and GPIHBP-1 were measured in each sample. In addition, these values were adjusted for albumin concentration to account for the effects of physiological blood dilution due to pregnancy.
Results: During pregnancy, GPIHBP-1 and LPL blood concentrations decreased transiently but returned to nonpregnant levels after delivery. When adjusted for albumin concentration, the decrease in GPIHBP-1 levels was negated, while the decrease of LPL levels was preserved.
Conclusions: During the course of normal pregnancy, the levels of GPIHBP-1 showed a transient decrease, which was thought to be due to physiological dilution. The levels of blood LPL also showed transient decrease probably due to inhibition of lipolysis.

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  Gelatinous transformation（GT）is morphological change of fat tissue that reflects malnutrition. In bone marrow with GT, gelatinous deposits occupying hematopoietic space result in hypocellularity. Therefore, GT is presumed to be a cause of secondary anaemia. To characterise clinical feature, laboratory data and histology in patients with bone marrow GT, we enrolled 104 patients who were autopsied at Tokushima University Hospital and Tokushima Red Cross Hospital between August 2015 and July 2020. The patients were aged 71.7±11.4 years（69.2% male individuals）. Fifty-eight patients（55.8%）had malignant disease. Bone marrow and liver steatosis and medical records were retrospectively studied. Clinical data and basic blood and urine parameters prior to 3 weeks before death were analysed. Eighteen（17%）patients were assigned to the GT group. In this group, two（11.1%）cases were complicated by bone marrow fibrosis. Immunohistochemically, C-X-C motif chemokine ligand 12（CXCL12）-positive stromal cells were present in the GT marrow area; however, the number of stellate-shaped reticular cells with projections strongly positive for CXCL12 was reduced. Statistically, GT was not associated with malignant disease, liver fibrosis, or steatosis. In the GT group, serum creatinine was significantly lower than that in the non-GT group（median 0.75 mg/dL, IQR 0.61–1.17, p=0.047）. The body mass index and geriatric nutritional risk index were also significantly lower in the GT group（median 18.6, IQR 17.3–19.9, p < 0.001; median 66.8, IQR 61.9–70.6, p=0.002, respectively）. These results suggest that bone marrow GT indicates protein-energy malnutrition with muscle loss, but not with anaemia.

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