Global health & medicine最新文献

Hepatitis B core-related antigen (HBcrAg) is a vital marker for monitoring chronic hepatitis B (CHB) as it correlates with hepatitis B (HBV) DNA and covalently closed circular DNA (cccDNA). The iTACT-HBcrAg assay, approved in Japan, provides highly sensitive and automated testing, reducing patient burden by requiring smaller specimen volumes and offering shorter processing times. Crucial for managing HBV reactivation and predicting hepatocellular carcinoma, it delivers consistent and reliable results. In resource-limited regions, the HBcrAg-rapid diagnostic test (HBcrAg-RDT) facilitates early HBV detection and management. This point-of-care testing (POCT) tool requires no specialized equipment and provides results within 30 minutes, making it invaluable in areas lacking HBV DNA quantification. Trials in West Africa, Asia, and other developing regions demonstrate its sensitivity and specificity. Together, these advancements in iTACT-HBcrAg and HBcrAg-RDT assays enhance CHB patient care and contribute significantly to the global effort to eliminate HBV as a public health threat.

Psychological support is necessary for people with hemophilia and HIV (PHH) who suffer from cancers. Most PHH are infected with not only HIV but also hepatitis C virus due to non-heat-treated blood coagulation factor products. PHH have a high risk of carcinogenesis, including liver cancer. Furthermore, many PHH present psychological problems, due to the great stress resulting from carcinogenesis and which impedes their cancer treatment. This study aimed to assess the psychological support system through a nationwide survey of healthcare workers caring for PHH at HIV care hospitals in Japan. The response rate was 49.1% (194/395), with a coverage rate of 74% (516/697) for PHH. Our findings indicated that psychologists were the most likely to be "coordinated" or "expected to coordinate" when PHH suffered from cancer (74%, multiple responses allowed). The most common reason for rating the adequacy of psychological support as "very good" or "good" was "easy collaboration with various professionals and medical teams". The number of HIV coordinator nurses and clinical psychologists per facility was 1.06 and 2.56, respectively. Our findings indicated more psychological support systems should be established in Japan, including reimbursement for psychological support for PHH.

The nationwide registry of the Japanese Gastric Cancer Association contains data related to the efficacy of adjuvant chemotherapy and prognostic factors across this patient population; elderly patients with advanced resectable gastric cancer are especially prevalent. Here, we analyzed data from 34,931 patients, who were treated between 2011 and 2013 at 421 hospitals in Japan. Although adjuvant chemotherapy was effective overall, 75 years or older elderly patients had a worse prognosis compared to younger patients. The most administered adjuvant chemotherapy was S-1 monotherapy. Adjuvant S-1 monotherapy was also effective for patients with pT1N2, pT1N3, and pT3N0 stage II tumors, as well as patients with other stage II and III malignancies. Independent prognostic factors for poor overall and relapse-free survival in patients at both stage II and stage III were age 75 or older, male, preoperative Eastern Cooperative Oncology Group performance status (ECOG-PS) 1 or more, preoperative renal dysfunction, undifferentiated adenocarcinoma, undergoing total gastrectomy, open laparotomy, no adjuvant chemotherapy, D1 lymphadenectomy, residual tumor R1 or R2, and Clavien-Dindo classification grade II or higher. Age 75 or older, renal dysfunction, ECOG-PS 1 and total gastrectomy were also significant risk factors for postoperative complications and lower compliance with adjuvant chemotherapy. Our analysis also revealed that adjuvant chemotherapy after resection of cancer of gastric remnant and postoperative chemotherapy against CY1 gastric cancer were also effective. We conclude that adjuvant chemotherapy is effective for all stage II and III patients including age 75 or older gastric cancer patients, in addition to distal gastrectomy, proximal gastrectomy, and pylorus-preserving surgery to avoid total gastrectomy may improve surgical outcomes and quality of life for elderly patients.

In the post-COVID-19 era, inbound medical care in Japan adapted to the growing demand for high-quality and precise healthcare. One form of this care is a complete medical examination, which has gained significant popularity among foreign residents of Japan and foreign visitors to Japan. From 2021 to 2024, 787 individuals from 27 countries underwent a complete medical examination at our facility. The annual growth rate in foreign residents undergoing a complete medical examination was 64% (2022 vs. 2021), 22% (2023 vs. 2022), and 10% (2024 vs. 2023); a notable proportion of those individuals were originally from China. These findings underscore the need for Japan's medical care to evolve in response to the diverse needs of an international clientele, highlighting the importance of tailored healthcare solutions in a globalized context.

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.