Assessment of HIV prevalence among MSM in Tokyo using self-collected dried blood spots delivered through the postal service.

BACKGROUND: Men who have sex with men (MSM) are at high risk of HIV infection. However, there are only few data on HIV prevalence in MSM in Japan. The objective of this study was to explore the HIV prevalence in MSM at Shinjuku 2-chome, a well known gay quarter in Tokyo. METHODS: MSM directly collected the dried blood spot (DBS) self-collection HIV test kit from a drop-in center in Shinjuku 2-chome between August 2015 and December 2016. The participants collected their own blood by finger-prick and anonymously posted the kit to the laboratory. The participants accessed the study website and checked the results of their tests using unique ID and password. DBS was soaked in phosphate buffered saline overnight and the eluted sample was examined by the fourth generation HIV Ag/Ab test of LUMIPULSE (FUJIREBIO INC.), and followed by HISCL (Sysmex Corp.) when the first assay was positive. The result was defined provisionally positive if both were positive. RESULTS: A total of 1702 HIV test kits were distributed and 1403 DBS were returned (return rate: 82.4%). Since 20.2% of participants collected the test kit more than once, the estimated number of actual test kit users was 1120. Based on the results of the test kit, 34 cases were provisionally diagnosed with HIV. The estimated prevalence was 3.04% (95% confidence interval: 2.03-4.04). Of these 34, 24 (70.6%) were later confirmed to be HIV-positive in the hospital, while the remaining 10 were lost to follow-up. Among the participants, 34.5% received HIV test for the first time. Especially in those aged 20-29, 46.0% were first time HIV testers. CONCLUSIONS: The prevalence of HIV infection in the study population was 3.04%. The high collection suggested a demand for this type of testing in MSM. The test should be expanded further to difficult-to-reach or hidden populations. TRIAL REGISTRATION: This study was registered with the University Hospital Medical Information Network Clinical Trial Registry in August 20th, 2015 (Registry number: UMIN000018699 ).

Laparoscopic resection of liver PEComa associated with Li­Fraumeni syndrome: A case report.

Li-Fraumeni syndrome (LFS) is a hereditary cancer predisposition syndrome associated with germline mutations in tumor suppressor gene TP53. Perivascular epithelioid cell tumors (PEComas) are a group of tumors by the World Health Organization Classification as mesenchymal tumors composed of histologically and immunohistochemically distinctive PECs. The present study reports a rare case of PEComa associated with LFS. A 32-year-old female patient was referred to Tokyo Metropolitan Tama Medical Center (Tokyo, Japan) in March 2022 for a detailed examination of a liver mass. The patient had received a diagnosis of LFS based on a history of sarcoma and germline variants of TP53 7 years previously. Magnetic resonance imaging revealed a ring-enhanced mass in the liver segment 8 (S8). This was observed in the arterial phase, followed by washout of contrast media in the venous phase. Owing to the possibility of malignancy (such as metastatic liver tumor or hepatocellular carcinoma), the patient was referred for diagnostic surgery. In August 2022, a laparoscopic partial hepatectomy of S8 was performed without complications and she was discharged on postoperative day 7. The pathological findings led to the diagnosis of PEComa. The patient is currently under follow-up at 1 year and 4 months postoperative. Laparoscopic hepatectomy was useful as a diagnostic treatment because it was relatively non-invasive. Mutations in TP53 are involved in the development of PEComa. Further cases and studies are required to clarify the relationship between LFS and PEComa.

Bochdalek Hernia Causing Sigmoid Colon Strangulation in an Elderly Patient.

Diaphragmatic hernia with bowel strangulation is a fatal condition requiring a prompt diagnosis. Bochdalek hernia is a common type of diaphragmatic hernia that rarely but occasionally occurs in adults. We herein report a case of Bochdalek hernia causing sigmoid colon strangulation in an elderly patient whose condition was initially misdiagnosed as empyema. The early diagnosis of strangulated bowel stemming from diaphragmatic hernia can be challenging because of its rarity and the nonspecificity of its symptoms. However, tracing the mesenteric arteries on computed tomography can enable a quick diagnosis.

Persistent disturbance of consciousness with bilateral globus pallidus and substantia nigra lesions in 2 patients with severe COVID-19 pneumonia.

With an increasing number of cases of Coronavirus disease 2019 (COVID-19), various neurological complications have been reported; however, some of these have not been fully elucidated. We herein report on 2 cases in which lesions at the bilateral globus pallidus and substantia nigra were observed. The patients were a 27-year-old male and a 61-year-old female. They underwent ventilation management due to COVID-19 pneumonia with hypoxemia. However, even after the sedative had weakened, the state of consciousness disturbance was found to have continued. Brain magnetic resonance imaging was performed for both patients. From the bilateral globus pallidus to the substantia nigra of both, the fluid attenuated inversion recovery images and T2-weighted images indicated high intensity, while the diffusion-weighted image resulted in high intensity and low apparent diffusion coefficient. Regarding the 61-year-old female patient, head computed tomography also indicated low density at the bilateral globus pallidus. The patients did not show any improvement in their neurological findings while hospitalized. Although COVID-19 associated with bilateral globus pallidus and substantia nigra lesions are rare, the neurological prognosis may be poor. We believe that attention should be paid to these imaging findings at the onset of consciousness disturbance.

Radiologically Undetectable Latent Pulmonary Lymphocyte Infiltration Suggesting the Need for Early Glucocorticoid Therapy: An Autopsy Case of Rapidly Progressive COVID-19 Pneumonia with Lymphopenia.

We herein report a fatal case of coronavirus disease 2019 (COVID-19) pneumonia with rapid progression of respiratory failure and lymphopenia. Excessive recruitment and sequestration of lymphocytes in the lung were suggested as the pathophysiology underlying COVID-19-associated lymphopenia. Interestingly, the autopsy in this case revealed lymphocytic infiltration in the lungs even at sites that appeared normal on autopsy imaging. These findings suggest that in COVID-19 cases with risk factors of severe exacerbation, early glucocorticoid administration should be considered, especially if lymphopenia is present, even if the imaging findings show only mild abnormalities.

A modified technique to minimize filter tilting during deployment of the Günther Tulip filter: in vitro study.

With an in vitro model of the inferior vena cava, it was demonstrated that slight tension on the introducer during quick release of the jugular Günther Tulip filter led to less tilting of the filter compared with the technique recommended by the manufacturer. This technique may be useful to minimize significant filter tilting that may be associated with decreased filtration efficiency, and difficulty or impossibility of future filter retrieval.