Cervical cancer is caused by high-risk human papillomavirus (HPV) and is the fourth most common femalemalignancy in the world. HPV vaccination has recently been implemented worldwide. The World Health Organization (WHO) is implementing prevention strategies on a global scale with the aim of eliminating cervical cancer.It is expected that the morbidity and mortality rates of cervical cancer will decrease in the future. On the otherhand, cervical cancer is on the increase in Japan, and the age group of cervical cancer cases is becoming younger.One of the reasons for this is the decrease in vaccination opportunities due to the temporary suspension of proactive recommendations for HPV vaccination. This article describes the clinical characteristics, prevention and treatment methods of cervical cancer and the current status of HPV vaccination in Japan.

Among malignant skin tumors, malignant melanoma (hereinafter referred to as melanoma) is well known forits strong metastatic potency and poor prognosis. Moreover, it is safe to say that it is the most famous malignanttumor of the skin. The field of melanoma is at a stage where new findings are emerging one after another, and thespeed of progress is remarkable. Clark’s classification has been used for a long time to classify melanoma, butproblems have arisen in that there are certain tumor types that do not fit into this classification and that the relationship between tumor types and desirable treatment methods and prognosis is unclear. As a result, new taxonomies have been developed. In addition, what used to be common sense, contraindication for skin biopsy and thesignificance of lymph node dissection, for example, are no longer valid. Treatment methods have also advanceddramatically. The new drugs are already being used in clinical practice, and their effectiveness is already well recognized. In addition, therapeutic methods from new perspectives are now being developed.We have come to an era where we are always required to update our knowledge. This review is primarily forphysicians who wish to start learning malignant skin tumors and those other than dermatologists. We mainly focuson changes in attitudes toward managing melanoma.

The greatest advantage of working at a university or research institution is that a researcher can receive a Grantin-Aid for Scientific Research (KAKENHI) from the Japan Society for the Promotion of Science (JSPS). Sincea researcher does not necessarily have to be a full-time faculty member to be eligible to apply for KAKENHI,he/she can receive it as an adjunct lecturer, visiting researcher, or visiting professor while working at a city hospital or in private practice. The greatest feature of the Grants-in-Aid for Scientific Research is that it can be obtainedby researchers themselves on their initiative. However, as is the case with competitive research funds, sufficientpreparation and research achievements are needed. Of course, it is not possible to obtain funding by techniquealone. Nevertheless, it is necessary to have sufficient discussions with experienced supervisors for the reviewers tounderstand the importance of the study proposal. It must be written in a plain style, with a clear research objective,high originality, feasibility, and how the research results can contribute to human health. The story and logicalflow of the research are keys that determine the value of the application and must be understood by the reviewers,who are not necessarily specialists in the field.

The coronavirus disease 2019 (COVID-19) epidemic has had a major impact on stroke treatment. The acuteischemic stroke (AIS) treatment protocol at our hospital now requires a rapid antigen test on arrival to prevent thespread of COVID-19 infection, so the initiation of treatment may be delayed. We compared AIS treatment before(October 2018 to March 2020) and after the epidemic started (April 2020 to September 2021) to investigate theeffect of COVID-19. The number of AIS emergency transports was 73 before and 102 after the epidemic. Thetime from door to image time was significantly extended (p < 0.05). However, door-to-puncture time and puncture-to-recanalization time showed no significant changes. Possibly our revision of the protocol, such as omittingsome imaging examinations, including magnetic resonance imaging, enabled more rapid interventions.

Background: High mobility group box 1 (HMGB1) is a chromatin structural protein expressed ubiquitously inthe nuclei of mammalian cells. Increasing evidence suggests that inflammatory responses are involved in the progression of systemic injuries induced by a diverse range of insults, including stroke, trauma, tumors, and degenerative diseases. Whether HMGB1 expression in systemic organs is associated with transient ischemic attack (TIA)remains unclear. We hypothesized that HMGB1 expression after TIA would exacerbate systemic symptoms due toacute inflammation.Material and Methods: We performed transient bilateral and unilateral common carotid artery occlusion (2VOand 1VO) on Sprague‒Dawley (SD) male rats. Rats were randomized to the sham, 1VO, and 2VO groups. Thesham group underwent no procedure that involved common carotid artery occlusion. Common carotid arterieswere clamped for 30 minutes and, subsequently, reperfused for 24 hours. Brain, heart, liver, lung, spleen, kidneyand intestine tissue samples were collected for biochemical and histopathological analysis. Protein and mRNA expression were determined by western blot analysis and polymerase chain reaction (PCR).Results: HMGB1 expression increased in the brain, liver, spleen and intestine of the rat 1VO and 2VO models.In vivo results indicated high expression of HMGB1 in TIA, and the expression of MMP-9 and PKCδ in the cerebral cortex and hippocampus was regulated by HMGB1. In the 2VO model, the expression of CD11b and GFAPin the cerebral cortex was significantly increased compared with that in the control group (P < 0.001). HMGB1was translocated from the nucleus to the cytoplasm at early stages after TIA and then localized to the cytoplasm ofphagocytic microglia at later stages.Conclusion: HMGB1 expression increased in the systemic organs after TIA. HMGB1 promotes systemic inflammation, which mediates the immune response and tissue damage in the brain after TIA. Targeting HMGB1signaling may be a promising therapeutic approach for the treatment of TIA.

The first epidermal growth factor 1 (EGF-1) domain of coagulation factor IX (FIX) contains a CXDXXXXYXCXC consensus amino acid sequence, which reportedly induces endocytosis and clustering of lipid rafts in adhesive cells. Endocytosis and lipid rafts regulate signaling via receptors on the plasma membrane. In this study, weinvestigated the effect of FIX EGF-1 domains on intracellular signaling by thrombin (FIIa) in endothelial cells.Recombinant EGF-1 protein of FIX (EGF-FIX) alone did not induce ROCK-dependent phosphorylation ofmyosin light chain (MLC) in human umbilical vein endothelial cells (HUVECs). On the other hand, a high concentration (100 ng/ml) of FIIa increased phosphorylated MLC, and EGF-FIX enhanced it by 1.3-fold. Interestingly, low concentrations (0.3 ng/ml) of FIIa suppressed the phosphorylation of MLC, and the combination oflow-concentration FIIa and EGF-FIX promoted MLC phosphorylation. Methyl-beta-cyclodextrin (MβCD), whichinhibits the formation of lipid rafts, suppressed the phosphorylation of MLC regardless of the FIIa concentration,whereas EGF-FIX attenuated the effects of MβCD. EGF-FIX increased the distribution of the FIIa receptor(PAR1) in the lipid raft fraction. Active FIX could modulate intracellular signaling by other molecules in endothelial cells via its EGF domain.

Respiratory syncytial (RS) virus infection is a causative agent of respiratory tract infection that affects most infants by the age of 2 years. Neurological sequelae, however, are rarely seen with RS virus infection. We reportedhere a healthy 3-year-old boy with acute encephalopathy who developed the most severe neurological sequelaetriggered by RS virus infection.

The patient was a 3-year-old boy. He was admitted to our hospital because of unconsciousness, ataxic gait, dysarthria, and a cut wound on his left finger. A brain computed tomography scan on admission showed no abnormalfindings. Blood tests showed hypoglycemia and elevated ketone levels. Blood glucose levels were normalized bythe infusion treatment; however, he still had ataxic gait and dysarthria. Through interviews with the medical socialworker and the family physician, we found that his mother was on medication for psychiatric illness. A urine drugtest kit (Triage®DOA) detected benzodiazepine. Based on this result, he was diagnosed with acute drug intoxication. If there is a family history of psychiatric illness, a urine drug test kit should be used for the diagnosis of drugintoxication as a differential for unexplained unconsciousness.

Petersen’s hernia often develops early after Roux-en-Y (RY) reconstruction. We experienced Petersen’s herniathat developed 7 years and 6 months after laparotomic gastrectomy. A 77-year-old man was transferred to ourhospital presenting with abdominal pain. He had a history of gastric cancer at 7 years and 6 months previouslyand underwent distal gastrectomy with RY reconstruction. He was diagnosed with internal hernia and underwentemergency surgery. The operative findings revealed an internal jejunal hernia through the space between the mesentery of the Roux limb and the transverse mesocolon (Petersen’s defect). We repaired the incarcerated intestinaltract and closed Petersen’s defect. Petersen’s hernia often occurs in the first or second year due to weight loss aftergastrectomy. However, it can occur even after 5 years postoperatively, when gastric cancer surveillance has beencompleted. Thus, Petersen’s defect should be properly closed at the initial surgery.