Background: Inflammatory markers, especially C-reactive protein (CRP), have been reported to be associated with all-cause mortality. In addition, α1-antitrypsin and white blood cell (WBC)-based inflammatory markers were suggested to represent mortality risk. We aimed to investigate whether simultaneous assessment of these markers was more useful for evaluating mortality risk than compared to individual assessment.
Methods: This longitudinal study included 5,970 Japanese community residents (mean age 62.9 years). Circulating levels of inflammatory markers were measured from baseline blood samples. All-cause mortality was ascertained by referring to the residential records.
Results: During a mean follow-up duration of 13.5 years, 550 deaths occurred. Kaplan–Meier curves for mortality showed significant differences across the quintiles of each marker (log-rank test: P < 0.05). Results of the Cox proportional hazard model adjusted for potential covariates indicated that α 1-antitrypsin (fifth quintile: hazard ratio 1.73, P < 0.001) and CRP (fourth quintile: hazard ratio 1.49, P = 0.001; fifth quintile: hazard ratio 1.33, P = 0.068) were significantly associated with mortality. Among the WBC-based markers, platelet-to-lymphocyte ratio (hazard ratio 1.38, P = 0.002), systemic immune–inflammation index (hazard ratio 1.27, P = 0.014), and lymphocyte-to-monocyte ratio (hazard ratio 1.39, P = 0.035) showed significant associations. When these markers were included in the same model, α1-antitrypsin, but not CRP, showed pronounced association, whereas the WBC-based markers showed significan αt but weak associations.
Conclusions: α1-antitrypsin was identified as a good marker for long-term mortality risk assessment in the general population. Combining these markers might help identify high risk populations.

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Objective: To investigate the quality management status of standard 12-lead electrocardiography at ISO 15189 accredited institutes in Japan and to support to develop appropriate operational guidelines.
Methods: We conducted a questionnaire survey on the status of quality management at each of the institutes certified in the field of electrocardiography, and then conducted an external quality assessment for eight automatic measurement items by distributing waveform simulators and recording control electrocardiograms to those institutes that wished to participate. The target institutes were selected to include various environments to the extent possible (e.g., vendors used, regular maintenance, regions, etc.), and the factors affecting the results were evaluated. In addition, in order to determine the status of internal quality management, all target electrocardiographs were recorded three times a day for at least 10 days at each institute.
Results: Thirty institutes were selected, and we were able to conduct the actual survey at 27 institutes between April 2023 and December 2024. The total number of electrocardiographs was 131, and the total number of records was 4052 records. The results revealed that there were inter-instrument and inter-institutional differences in seven automatic measurement items. The vendor used, the filter used during recording, and the presence or absence of vendor maintenance were significant factors influencing the measured values. The X-R control chart for each electrocardiograph showed that when the control limit was set at three times the standard deviation of the measured value, more than one-fourth of the instruments showed fluctuations exceeding this limit for some measurement items.
Discussion: Regarding the accuracy control of standard 12-lead electrocardiogram examinations, it has become clear that there are multiple facilities that cannot be evaluated as appropriate in terms of both internal and external accuracy control, and that it is necessary to conduct a more extensive survey and establish appropriate operational guidelines.

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Objective: Effective management of medical treatment information, particularly critical values, is essential in every clinical laboratory. A proposal for the management of critical values was issued by the Japanese Society of Laboratory Medicine in 2021. Our laboratory began implementing the revised proposal in December 2024, which recommends appointing a medical technologist as a risk manager. The risk manager is responsible for monitoring the occurrence of critical values, and acting as a liaison between the Clinical Laboratory and the Medical Safety Department.
Methods: We evaluated the impact of sharing and reviewing critical values, by a risk manager, with the Medical Safety Department by analyzing the number and content of critical value reports and tracking telephone communications from laboratory physician to attending physicians. Data from the fiscal year 2018 through June 2025 were included in the analysis.
Results: In our hospital, the total number of tests increased from 2,301,813 in 2018 to 3,235,049 in 2024. Between April 2018 and November 2024, there were 10 telephone calls from laboratory physician to attending physicians regarding 28,980 critical values. In contrast, from December 2024 onward, there were 13 such calls for just 2,495 critical values––a statistically significant increase (z = –8.65, p < 0.0001) following the appointment of a risk manager.
Conclusions: The introduction of a risk manager to facilitate the sharing and review of critical values with the Medical Safety Department led to a significant increase in follow-up telephone communication from laboratory physician. This may reflect improved professional oversight and laboratory management.

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  Individual immune responses to SARS-CoV-2 vaccination vary considerably; however, the genetic factors influencing antibody production remain incompletely understood. This study investigated the association between genetic polymorphisms and anti-SARS-CoV-2 antibody levels in 405 healthy Japanese individuals three weeks after their first dose of an mRNA vaccine. We focused on three genetic polymorphisms previously associated with antibody responses in humans. The GG genotype of rs3824949 in TRIM5 was significantly associated with higher antibody titers (P = 0.0009), whereas rs4792800 in TNFRSF13B and rs1611350 in HLAF- AS1 showed no significant associations. Stepwise regression analysis confirmed that rs3824949 remained an independent predictor after adjusting for age, lymphocyte count, and platelet count. Given the role of TRIM5 in innate immunity, our findings suggest that rs3824949 may enhance immune responses to SARS-CoV-2 mRNA vaccination, highlighting the role of host genetics in individual variability in vaccine responses. By identifying a genetic factor that significantly influences antibody responses, this study lays the groundwork for personalized vaccine strategies tailored to individual genetic backgrounds. Moreover, these findings may have broader implications beyond SARS-CoV-2, informing the design and optimization of future mRNA vaccines targeting other infectious diseases or cancers. Our work highlights the potential of precision vaccinology and emphasizes the need to include ethnically diverse populations in immunogenetic research. These insights contribute to a more equitable and effective global vaccination strategy, particularly in the era of rapidly advancing mRNA vaccine technologies.

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