Global health & medicine最新文献

Current anti-HIV drugs have significantly improved the prognosis of HIV infected patients so much so that it is now considered a chronic disease, and adherence to medications keeps non-detectable amounts of the virus in the body. However, HIV is still able to generate drug resistance substitutions. Protease inhibitors (PIs) in combination with other classes of anti-HIV drugs constitute an important part of the anti-HIV drug regimen. This article discusses some of the common resistance substitutions against PIs, mechanistic insight on resistance, and potential new inhibitors that can show efficacy against current resistant variants.

Japan has seen an increase in female physicians recently, yet it still lags behind other Organization for Economic Cooperation and Development (OECD) countries. A major barrier has been the historical discrimination against women in medical school admissions. In recent years, female enrolment in medical schools has risen, surpassing 40% in 2024, reflecting a broader societal shift. However, structural problems persist in the Japanese healthcare system. Although the number of doctors per capita is lower in Japan than in other countries, the number of patients is higher than in other countries, leading to overwork for doctors. As a result, only about one-third of female doctors in Japan are able to return to work after interrupting their careers to give birth or raise children. The maldistribution of physicians, both regionally and by specialty, exacerbates this issue. To sustain the rising number of female physicians, Japan must reform its medical system.

Frailty is a geriatric syndrome characterized by a multisystem physiological decline, increased vulnerability to stressors, and adverse clinical outcomes. However, there is a knowledge gap regarding the association between frailty and its influencing factors. This study aimed to understand the current status of preoperative frailty in elderly patients with hepatobiliary pancreatic disease (HBP) and analyze debilitation-related factors. We enrolled 220 participants aged ≥ 65 years who underwent HBP surgery at two hospitals in China between December 2023 and February 2024. The physical frailty of elderly participants in communities with different characteristics was compared using Kruskal-Wallis and chi-square tests. Ordinal logistic regression analysis was used to analyze the factors influencing preoperative frailty. A total of 212 patients were included in the analysis based on the inclusion and exclusion criteria, with an overall prevalence of frailty at 53 (25%). Ordinal logistic regression analysis results showed that current smoking (odds ratio [OR] = 2.584, p = 0.006) was an independent risk factor for preoperative frailty in elderly participants with HBP. In contrast, exercise habits (OR = 0.323, p < 0.001), two or more multimorbidity statuses (OR = 0.495, p = 0.033), and independent status (OR = 0.216, p < 0.001) were protective factors. Our results suggest that having good exercise habits, not smoking, and independent status can prevent frailty progression in older adults who require HBP surgery. Interventions for frail elderly patients should be supported preoperatively by strengthening exercises to improve tolerance to surgery.

mRNA vaccines emerged as a new therapeutic modality during the COVID-19 pandemic. Individuals with allergies often experience anxiety about potential adverse reactions to these vaccines. This study aims to elucidate the relationship between adverse reactions and various allergies, asthma, or atopic disorders. Data from approximately 20,000 Japanese healthcare workers participating in a prospective cohort study were analyzed. The number of vaccinated individuals was 19,792 (first dose), with systemic reactions occurring in 35.8% after the first dose and 75.3% after the second dose. Participants with allergies were categorized into groups: food and/or drug allergies (n = 806), asthma and/or atopic disorders (n = 2,370), asthma (both past medical history [PMH] and present illness [PI]) (n = 1,983), and atopic disorders (PI) (n = 567). Most systemic reactions in those with food and/or drug allergies occurred within the first three days of vaccination. Logistic regression analysis showed that food and/or drug allergies, asthma (PMH and PI), and asthma and/or atopic disorders were significantly associated with systemic reactions (odds ratios [95% confidence interval]: 1.65 [1.43-1.91], 1.36 [1.23-1.49], and 1.32 [1.21-1.45], respectively, for the first dose). These findings suggest the risk of systemic reactions after COVID-19 vaccination in individuals with the specified allergies, potentially contributing to vaccine hesitancy. Medical professionals should clearly communicate the risks and benefits of vaccination to those with allergies to alleviate their concerns. Additionally, our study's data may be useful for making decisions whether or not to get vaccinated in those with allergies and inform the development of future mRNA vaccines.

Patient-specific brain fluorodeoxyglucose-positron emission tomography (FDG PET) can detect areas with abnormal FDG uptake in patients with human immunodeficiency virus (HIV) before and after combination antiretroviral therapy (cART). There were few reports about the same patients before and shortly after cART in FDG PET. It is well known that HIV-RNA levels decrease and cognitive impairments in patients with HIV tend to improve on neurocognitive performance tests 6 months after starting cART. We conducted a quantitative imaging analysis (FDG PET and voxel-based morphometry (VBM)) of eight patients at pre- and 6 months post- cART with neurocognitive performance tests. In terms of participant-specific changes between pre- and post-cART imaging, some area showed that the size of area with abnormal FDG uptake shrunk and became a nearly physiological level at 6 months post-cART. No apparent changes in VBM were observed in this short period. FDG PET might detect the first effect of cART.

Recurrent spontaneous abortion (RSA), defined as two or more clinically confirmed pregnancies that end before 20-24 weeks of gestation, encompasses both embryonic and fetal losses and is a significant clinical challenge. The aim of this study was to compare the efficacy of allylestrenol (AT) and progesterone in improving pregnancy outcomes in RSA. From June 2021 to June 2024, 480 participants were randomly assigned to an AT, Progesterone, or Control group. Key outcomes included early pregnancy rates, ongoing pregnancies with fetal heart activity, live birth rates after 24 weeks, and pregnancy loss before 24 weeks. Results indicated significantly higher pregnancy rates at 6-8 weeks in both the Allylestrenol (71.8%) and Progesterone groups (76.2%) compared to the Control group (57.5%). At 12 weeks, ongoing pregnancies with fetal heart activity were higher in the Allylestrenol (65%) and Progesterone groups (64%) versus the Control group (52.5%). Both treatment groups had higher live birth rates (60% and 60.6%) compared to the Control group (45%). Pregnancy loss before 24 weeks was lower in both treatment groups (31.8% and 33.1%) compared to the Control group (38.7%). No significant adverse reactions were observed, indicating good safety profiles for both treatments. These findings suggest that both treatments effectively improve pregnancy outcomes in cases of RSA with satisfactory safety, supporting their potential clinical use. However, further research is needed to explore their long-term effects and broader applicability in clinical settings.

This study aims to delineate the characteristics and clinical trajectories of suicide attempts and self-harm, and its gender and age differences among children. This nationwide retrospective cross-sectional study utilized data extracted from the Japanese Diagnosis Procedure Combination inpatient database spanning 2016 to 2017. Children aged 7-17 years admitted to acute care hospitals for suicide attempts and self-harm, were identified. Patient characteristics included age, gender, suicide method, and comorbid psychiatric disorders. Trajectory information included the duration of hospital stay, admission ward, psychiatric/psychological interventions, in-hospital mortality, and healthcare expenditure. Data analysis encompassed 1,704 children hospitalized for suicide attempts and self-harm. Among these, 49.4% were junior high school age, 69.0% for female, and 28.4% for underweight. Overdose emerged as the most prevalent method for suicide attempts and self-harm (49.9%). Notably, 66.0% did not receive a diagnosis of any mental illness, and 56.3% did not undergo psychiatric/psychological care during their hospitalization. Boys were more likely to use high-lethality suicide methods, such as hanging (p < 0.001), and die during hospitalization (p < 0.001). Conversely, girls were more likely to use low-lethality suicide methods, such as drug overdose (p < 0.001), and receive psychiatric/psychological intervention during hospitalization (p = 0.015). Children aged 7-12 years were more likely to use high-lethality suicide methods, such as hanging (p < 0.001), and be diagnosed with attention-deficit/hyperactivity disorder (p < 0.001) and less likely to receive psychiatric/psychological intervention (p = 0.005) compared with other age groups. These findings suggest the importance of developing gender and age sensitive health policies, systems, and interventions to prevent child suicide.

The hyaline-vascular variant of Castleman disease (HVCD) is relatively uncommon and demonstrates no specific clinical or laboratory findings; therefore, its preoperative diagnosis warrants a radiological evaluation. This study aimed to review imaging findings of HVCD, focusing on perilesional fat stranding and fatty proliferation. Patients with a pathologically confirmed HVCD diagnosis who had undergone CT were recruited from five hospitals from January 2000 to March 2023. Three experienced radiologists assessed CT findings, including lesion location, lesion size, calcification, enhanced pattern, feeding vessel visualization, and arterial enhancement. Perilesional fat stranding, fatty proliferation, neighboring fascial thickening, and surrounding lymphadenopathy were the primary targets of analysis. Moreover, the intensities and apparent diffusion coefficient (ADC) values on MRI and the maximum standardized uptake value (SUVmax) on ¹⁸F-fluorodeoxyglucose positron emission tomography (PET) were evaluated. This study enrolled 43 patients (mean age 41.3 years ± 14.6 [standard deviation], 23 women). All lesions were well-defined round masses. Calcification and feeding vessels were detected in 21% (9/43) and 86% (36/43) of the patients, respectively. Perilesional fat stranding and fatty proliferation were observed in 44% (19/43) and 19% (8/43), respectively, with fatty proliferation detected only in retroperitoneal HVCD. Neighboring fascial thickening and surrounding lymphadenopathy were identified in 21% and 60%, respectively. The mean ADC value and SUVmax were 0.884 × 10^-3 mm²/s and 5.0, respectively. Retroperitoneal HVCD cases with perilesional fatty proliferation demonstrated a higher visceral fat ratio than those without (p = 0.046). Perilesional fat stranding and fatty proliferation were new characteristics of HVCD, especially in retroperitoneal cases.

Hepatitis B and C (HBV and HCV) testing has been performed in Japan since 2002 and is subsidized by central and prefectural governments. A follow-up program for HBV- or HCV-infected persons was started at that time in Ishikawa Prefecture. This study analyzed the long-term follow-up data from this program. In total, 1029 participants in the Ishikawa Hepatitis Follow-up Program (HBV-infected, n = 535; HCV-infected, n = 494) were enrolled. Clinical data between the first visit and the most recent visit by March 2019 were collected. In the HBV-infected group, 384 persons (71.8%) were asymptomatic carriers, 133 (24.9%) developed chronic hepatitis, 15 (2.8%) developed compensated liver cirrhosis, and 3 (0.6%) developed decompensated liver cirrhosis. Ninety (16.8%) were treated with nucleotide/nucleoside analogs. Sixteen (3.0%) developed liver cancer. In the HCV-infected group, 427 persons (86.4%) developed chronic hepatitis, 46 (9.3%) developed compensated liver cirrhosis, and 21 (4.3%) developed decompensated liver cirrhosis. Forty-eight (9.7%) developed liver cancer. Three hundred and seventy-eight (76.5%) received antiviral therapy (a direct-acting antiviral in 166, interferon-based treatment followed by a direct-acting antiviral in 73, and interferon-based treatment in 139). The subsidy system was used by 270 persons (71.4%). Sustained virological response was confirmed in 340 persons (68.8%). A higher FIB-4 index at the first visit was a significant risk factor for liver cancer in HBV-infected and HCV-infected persons. The Ishikawa Hepatitis Follow-up Program has revealed the clinical course of HBV and HCV infection in community-dwelling individuals. The results will be used for micro-elimination at a prefectural level.

In 2011, the Ministry of Health, Labour and Welfare started providing data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) for research purposes. The NDB is an exhaustive and valuable database for health policymaking and research. It provides an accurate and most recent visualization of the burden of hepatocellular carcinoma (HCC) in Japan. In this study, we analyzed the trend in HCC treatments using data from the NDB. The NDB data were retrospectively analyzed to calculate the number of patients who were diagnosed with HCC (International Classification of Diseases, version 10 code of C22.0) and underwent treatment from fiscal year (FY) 2016 to 2020. We observed the following trends in HCC treatments during the past 5 years: a slight increase in the number of liver resection (LR) cases (+5.4%), a decrease in the number of radiofrequency ablation cases (-15.2%), and a considerable decrease in the number of transarterial chemoembolization/transarterial embolization cases (-38.2%). However, the number of patients who received systemic therapy dramatically increased from 471 in FY 2016 to 1,584 in FY 2020 (+236%). Among LR cases, there was a remarkable increase in the number of laparoscopic procedures from 1,227 in FY 2016 to 2,057 in FY 2020 (+67.6%). This analysis of a national highly comprehensive database revealed a very recent visualization of HCC management in Japan, wherein the impact of recent advances in systemic therapy and minimally invasive surgery was prominent.