Vasovagal reactions after COVID-19 vaccination in Japan.

Coronavirus disease 2019 (COVID-19) vaccine administration started in February 2021 in Japan. As of December 2021, approximately 75% of the population aged ≥12 years had received two doses of vaccine. We conducted a study to investigate vasovagal reactions (VVR) after COVID-19 vaccination using data on adverse events following immunization. The crude reporting rate of VVR (cases/1,000,000 doses) after vaccination was 9.6 in all age groups combined, and was more frequent in the younger age groups: 28.6 and 37.2 in individuals aged 10-19 years and 20-29 years, respectively. In individuals aged 10-29 years, the rate was similar in males and females (33.0 and 34.2, respectively, p = 0.53); but was higher after dose 1 than after dose 2 (57.4 and 8.8, respectively, p < 0.001). Based on these results, caution needs to be exercised when vaccinating adolescents and young adults, especially with dose 1 of COVID-19 vaccines.

Severe encephalopathy associated with SARS-CoV-2 Omicron BA.1 variant infection in a neonate.

INTRODUCTION: The coronavirus disease 2019 (COVID-19), including the Omicron variant, is less severe in children than in adults. To date, there has been no detailed description of COVID-19-associated severe encephalopathy due to the Omicron variant during the neonatal and early infantile periods. CASE PRESENTATION: During the outbreak of the Omicron variant, a 29-day-old male presented with a pale and ill appearance. The patient was intubated for mechanical ventilation owing to recurrent apnea, which subsequently turned out to be a breath-holding that may have been caused by seizure. In addition, nonconvulsive status epilepticus was observed. Total duration of repetitive seizure activities was approximately 30 min per hour when seizures were most severe. Brain magnetic resonance imaging (MRI) on day 14 revealed extensive hyperintensity in the T2 sequence, hypointensity in the fluid-attenuated inversion recovery (FLAIR) sequence in the deep and subcortical white matter, and diffusion restriction in the corpus callosum. The Omicron BA.1 variant of the severe acute respiratory syndrome coronavirus 2 was detected in his respiratory sample. Follow-up MRI on day 45 revealed multiple cystic cavitations. CONCLUSION: Although COVID-19 is not severe in most children, life-threatening conditions such as COVID-19-associated severe encephalopathy can occur during the neonatal and early infantile periods.

Medicine at mass gatherings: current progress of preparedness of emergency medical services and disaster medical response during 2020 Tokyo Olympic and Paralympic Games from the perspective of the Academic Consortium (AC2020).

Mass gatherings are events characterized by "the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community." Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health-care system, it can provide the opportunity for long-term benefits of public health-care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID-19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.

Association of Magnetic Resonance Imaging Features with Angioleiomyoma Histologic Subtype.

BACKGROUND: Angioleiomyomas typically present as small, painful, soft-tissue tumors less than 2 cm in diameter. The features of angioleiomyomas on magnetic resonance (MR) imaging are not well understood, and the association of MR findings with histologic subtype is unclear. In the present study, the MR features of angioleiomyomas of average size were compared in relation to histologic subtype. METHODS: This retrospective review of medical records analyzed MR imaging data and histologic specimens from 18 consecutive patients with angioleiomyomas that were resected at our hospital during the period from January 2006 through December 2013. RESULTS: On T1-weighted images, lesions exhibited homogeneous areas that were isointense with skeletal muscle. However, T2-weighted images of solid and venous angioleiomyomas showed heterogeneous areas that were isointense or slightly hyperintense, while cavernous angioleiomyomas exhibited hyperintensity. Most lesions had a hypointense rim, and two thirds had adjacent vessels. CONCLUSIONS: Our results suggest that MR findings for angioleiomyoma vary in relation to histologic subtype. T2-weighted images of solid and venous angioleiomyomas yielded specific MR findings that allowed for differentiation from other soft-tissue tumors, such as soft-tissue sarcomas. Most of these tumors exhibited isointense to slightly hyperintense regions, as compared with skeletal muscle, while findings for cavernous angioleiomyomas were nonspecific. Thus, clinical findings and MR imaging were almost sufficient for preoperative diagnosis of solid and venous angioleiomyomas.

MR Imaging of Mushroom-like Skin Adnexal Tumors in the Scalp: A Report of Two Cases.

Few studies had been published regarding imaging findings of skin adnexal tumors. We experienced two giant cases of them with a characteristic mushroom-like growth pattern. MRI showed a circumscribed mushroom-like shaped mass extruding from the subcutaneous tissue with microcystic lesions. Although differentiation between benignancy and malignancy may be difficult by radiological examinations, MRI may be helpful to identify its origin and differentiate soft tissue tumors with skin adnexal tumors in having these imaging findings.

Combined Use of Magnetic Resonance Imaging and Fine-Needle Aspiration Cytology for Diagnosis of Soft-Tissue Tumors.

BACKGROUND: Magnetic resonance imaging (MRI) and fine-needle aspiration cytology (FNAC) are useful in the diagnosis of soft-tissue tumors and can be performed on outpatients. These modalities are complementary: MRI examines a large area, while FNAC assesses a highly specific region; MRI displays only signal intensities, while FNAC visualizes actual tumor cells. We investigated the combined use of these methods for differentiating malignant and benign tumors. METHODS: 148 patients (153 lesions: 137 benign, 16 malignant) underwent preoperative MRI and FNAC. A diagnosis was judged to be correct if one or both diagnoses were correct, incorrect if at least one diagnosis was incorrect, and indeterminate if both diagnoses were indeterminate or if MRI was indeterminate and the FNAC sample was insufficient. RESULTS: The diagnostic yields for MRI only, FNAC only, and their combination were 81.7%, 84.3%, and 92.2%, respectively, indicating that the diagnostic performance of MRI and FNAC was significantly improved when the methods were combined. CONCLUSIONS: As compared with either modality used alone, combined preoperative use of MRI and FNAC improved diagnosis of soft-tissue tumors.

Recurrent YAP1-MAML2 and YAP1-NUTM1 fusions in poroma and porocarcinoma.

Poroma is a benign skin tumor exhibiting terminal sweat gland duct differentiation. The present study aimed to explore the potential role of gene fusions in the tumorigenesis of poromas. RNA sequencing and reverse transcription PCR identified highly recurrent YAP1-MAML2 and YAP1-NUTM1 fusions in poromas (92/104 lesions, 88.5%) and their rare malignant counterpart, porocarcinomas (7/11 lesions, 63.6%). A WWTR1-NUTM1 fusion was identified in a single lesion of poroma. Fluorescent in-situ hybridization confirmed genomic rearrangements involving these genetic loci. Immunohistochemical staining could readily identify the YAP1 fusion products as nuclear expression of the N-terminal portion of YAP1 with a lack of the C-terminal portion. YAP1 and WWTR1, also known as YAP and TAZ, respectively, encode paralogous transcriptional activators of TEAD, which are negatively regulated by the Hippo signaling pathway. The YAP1 and WWTR1 fusions strongly transactivated a TEAD reporter and promoted anchorage-independent growth, confirming their tumorigenic roles. Our results demonstrate the frequent presence of transforming YAP1 fusions in poromas and porocarcinomas and suggest YAP1/TEAD-dependent transcription as a candidate therapeutic target against porocarcinoma.

Damage to sebaceous gland and the efficacy of moisturizer after whole breast radiotherapy: a randomized controlled trial.

BACKGROUND: We conducted a randomized trial to evaluate the efficacy of heparinoid moisturization for radiation dermatitis. We report the time-course of sebum content after whole breast radiotherapy (WBRT) and the efficacy of heparinoid moisturizer. METHODS: Patients receiving adjuvant breast RT were randomly assigned into three groups; prophylaxis, post-WBRT and control groups. Patients used moisturizer on the irradiated breast from the beginning of RT in the prophylaxis group, 2 weeks post-RT in the post-WBRT group, and no moisturizer in the control group. Sebum content of the irradiated and non-irradiated breast was measured to assess sebaceous gland damage. Sebum composition was also analyzed. RESULTS: A total of 76 patients were analyzed; 30 in the post-WBRT group, 32 in the control group, 14 in the prophylaxis group. The sebum content in the irradiated breast significantly decreased after WBRT in the post-WBRT and control groups. The decrease was sustained in the control group. In the non-irradiated breast, sebum content also decreased after WBRT in the post-WBRT and control groups. After moisturizer application, sebum content by sebumeter returned to pre-RT level in the post-WBRT group, while the decrease was sustained in the control group. Sebum content measured by evaporative light scattering detector and sebumeter was similar in the control group, but the dissociation was observed after moisturizer application in the post-WBRT group. The proportion of wax esters decreased in the irradiated breast after WBRT. CONCLUSIONS: Radiotherapy significantly reduced sebum content in both irradiated and non-irradiated breast, indicating that RT caused quantifiably persistent sebaceous gland damage in irradiated sites and the surrounding tissue. Combined with the results from our previous study, heparinoid moisturizer treatment effectively prevents water loss by retaining oil contents on the skin surface. TRIAL REGISTRATION: UMIN, UMIN000005532 . Registered 1 April 2011.

Adalimumab treatment in Japanese patients with generalized pustular psoriasis: Results of an open-label phase 3 study.

A phase 3, multicenter, open-label, 52-week study investigated the efficacy and safety of adalimumab 80 mg at week 0 followed by adalimumab 40 mg every other week (option to escalate to 80 mg when necessary) in Japanese patients with generalized pustular psoriasis (GPP). Adults (aged 15-75 years) with GPP, total skin score (overall erythema area, erythema area with pustules, and edema area) of 3 or more, and erythema with pustules (skin score, ≥1) based on the 2014 Japanese Dermatological Association severity index of GPP were enrolled. The primary efficacy end-point was clinical response at week 16 (non-responder imputation), defined as achieving remission (total skin score, 0) or improvement from baseline (reduction of ≥1 point from a baseline total skin score of 3 or ≥2 points from a baseline total skin score of ≥4). Of 10 enrolled patients (mean disease duration, 10.6 years), seven patients, including three with the dose escalated to 80 mg every other week before week 15, achieved clinical response at week 16, and five achieved clinical response at week 52. Mean change from baseline total GPP score was -4.6 at week 16 (n = 8) and -6.0 at week 52 (n = 5); change in total skin score was -3.1 (n = 8) and -4.2 (n = 5), respectively. Nine patients experienced one or more adverse events and three experienced serious adverse events. The most common adverse events were nasopharyngitis, pruritus and hypoalbuminemia. In conclusion, adalimumab was effective and well tolerated for up to 52 weeks in the treatment of Japanese patients with GPP.

[Papillary Fibroelastoma of the Left Ventricular Outflow Tract;Report of a Case].

Papillary fibroelastoma(PFE) is a rare and benign primary cardiac neoplasm. The incidence of PFE in the left ventricle is lower than that in other parts of the heart. A 67-year-old female was referred to our cardiology department for treatment of severe cardiac failure due to mitral regurgitation. Transthoracic and transesophageal echocardiography coincidently revealed a 1.0 cm highly mobile mass attached by a stalk to the outflow tract wall of the left ventricle. The mass was easily detected using endoscope and successfully removed without any postoperative complications and was pathologically diagnosed as a PFE. In this report, we discuss the echocardiographic character of PFE and the usefulness of endoscope for the identification and resection of a PFE in the left ventricle.

Efficacy of heparinoid moisturizer as a prophylactic agent for radiation dermatitis following radiotherapy after breast-conserving surgery: a randomized controlled trial.

BACKGROUND: The application of heparinoid moisturizer for 2 weeks following whole-breast radiotherapy (WBRT) was previously reported to significantly increase skin water content (WC) and help improve skin dryness and desquamation. The prospective open-label, randomized trial included an exploratory arm to investigate the preventive efficacy of heparinoid moisturizer for acute radiation dermatitis (ARD). METHODS: Between April 2011 and April 2013, patients receiving WBRT were assigned (1:2:2) to receive either: moisturizer for prophylaxis (group P), moisturizer starting 2 weeks after WBRT for treatment (group M), and no moisturizer (group C). This paper presents the results of comparison between the exploratory arm and no moisturizer group. Skin WC was measured prior to WBRT, on the last day of WBRT, and 2 weeks, 4 weeks and 3 months following WBRT. Signs and symptoms were also assessed. RESULTS: Comparing two groups, WC values were significantly higher in group P until 4 weeks following WBRT. At 2 weeks following WBRT, mean WC values in group P and C were 38.5 ± 6.1 arbitrary units (a.u.) and 30.2 ± 7.8 a.u., respectively (P < 0.001). In group C, dryness was more severe at 2 and 4 weeks following WBRT and desquamation more severe until 3 months following WBRT. However, the erythema score showed no difference between the two groups. Regarding symptoms, group C pain scores on the last day of WBRT were significantly higher than in group P (P < 0.030). CONCLUSIONS: The preventive application of heparinoid moisturizer has the potential of reducing skin desquamation and dryness in patients receiving WBRT.

Nail findings in patients with psoriatic arthritis: A cross-sectional study with special reference to transverse grooves.

BACKGROUND: Patients with psoriatic arthritis (PsA) commonly present with nail manifestations; however, little is known about these manifestations. OBJECTIVE: This study investigated whether nail findings can be used to discriminate between PsA and psoriasis without arthritis. METHODS: We performed a retrospective analysis of 118 patients with PsA and 974 patients with psoriasis without arthritis who visited St. Luke's International Hospital (Tokyo, Japan) between July 2003 and February 2015. Patients with PsA were classified according to the Classification of Psoriatic Arthritis criteria. Skin lesion severity was assessed by using the Psoriasis Area and Severity Index, and 9 types of nail findings were investigated. RESULTS: The incidence of nail involvement in patients with PsA was 67.6%. Female sex, presence of transverse grooves, onycholysis, and splinter hemorrhages were significantly related to PsA, with transverse grooves demonstrating the strongest association (odds ratio, 5.01; 95% confidence interval, 2.31-10.8; P < .01). Furthermore, the presence of transverse grooves was strongly related to both distal interphalangeal arthritis and enthesitis. LIMITATIONS: The PsA population was relatively small. CONCLUSIONS: Nail findings enabled us to distinguish patients with PsA from those without arthritis. The presence of transverse grooves is significantly associated with PsA and may be associated with distal interphalangeal arthritis and enthesitis.

Overlap of IgG4-related Disease and Multicentric Castleman's Disease in a Patient with Skin Lesions.

A 59-year-old man presented with multiple dark red erythemas with induration, anemia, and polyclonal hypergammaglobulinemia. A skin biopsy revealed the infiltration of lymphocytes and plasma cells and he was initially diagnosed with multicentric Castleman's disease (MCD). Glucocorticoid treatment was only partially effective. Four years later, the patient's bilateral lacrimal glands gradually became enlarged and a biopsy revealed dense lymphocyte and plasma cell infiltration with an IgG4+/IgG+ plasma cell ratio of 70%. The patient was diagnosed with IgG4-related disease (RD). Rituximab only had a slight effect. This case demonstrates that overlapping features of IgG4-RD and MCD may present in a single patient, which suggests a shared pathogenesis.

Hypertrophic Herpes Simplex Virus Type 1 Infection in a Patient With Acute Myeloid Leukemia.

A 64-year-old woman had a transformation from polycythemia vera to acute myeloid leukemia. While she was treated with azacitidine and prednisolone, a nodule at the left angle of the mouth developed, which was biopsied and diagnosed with hypertrophic herpes simplex virus type 1 (HSV-1) infection. The nodule resolved completely with aciclovir. While HSV type 2 virus occasionally forms mass or tumoral lesions in immunocompromised, especially acquired immunodeficiency syndrome, patients, it is extremely rare that HSV-1 infection leads to similar lesions. The hematological conditions and the therapies given may have contributed to the rare manifestation of HSV-1 infection.

Randomized, prospective assessment of moisturizer efficacy for the treatment of radiation dermatitis following radiotherapy after breast-conserving surgery.

OBJECTIVE: The effect of heparinoid moisturizer use after acute skin damage for patients receiving whole-breast radiotherapy after lumpectomy is understudied. METHODS: A total of 30 patients were randomly assigned to receive heparinoid moisturizer (Group M), and 32 patients comprised the control group (Group C). Patients in Group M were instructed to apply heparinoid moisturizer from 2 weeks following whole-breast radiotherapy, and to continue to use the moisturizer until 3 months after completion of whole-breast radiotherapy. Group C patients were instructed to not apply any topical moisturizer during the study period. The relative ratio of skin water content ratio (RWCR(t) = (It /Nt)/(I0/N0)) between irradiated and non-irradiated field was calculated. Signs and symptoms were also assessed. The primary endpoint was the difference in relative ratio of skin water content ratio between 2 and 4 weeks following whole-breast radiotherapy. RESULTS: In Group C, relative ratio of skin water content ratio dropped to 0.80 ± 0.15 at 2 weeks and maintained the low level at 4 weeks following whole-breast radiotherapy. Similarly, in Group M, relative ratio of skin water content ratio dropped to 0.81 ± 0.19 at 2 weeks (prior to application), however, it returned to baseline level (1.05 ± 0.23) at 4 weeks (2 weeks after application). The arithmetic difference of relative ratio of skin water content ratio in Group M was 0.24 ± 0.23 and was significantly larger than in Group C (0.06 ± 0.15; P < 0.01). Skin dryness and desquamation were less severe in Group M. CONCLUSIONS: The application of heparinoid moisturizer for 2 weeks following whole-breast radiotherapy significantly increased water content and helped improve skin dryness and desquamation compared with no use of moisturizer.

Reduced expression of dermcidin, a peptide active against propionibacterium acnes, in sweat of patients with acne vulgaris.

Dermcidin (DCD), an antimicrobial peptide with a broad spectrum of activity against bacteria such as Propionibacterum acnes, is expressed constitutively in sweat in the absence of stimulation due to injury or inflammation. The aim of this study was to determine the relationship between DCD expression and acne vulgaris associated with P. acnes. The antimicrobial activity of recombinant full-length DCD (50 µg/ml) was 97% against Escherichia coli and 100% against Staphylococcus aureus. Antimicrobial activity against P. acnes ranged from 68% at 50 µg/ml DCD to 83% at 270 µg/ml DCD. DCD concentration in sweat from patients with acne vulgaris (median 9.8 µg/ml, range 6.9-95.3 µg/ml) was significantly lower than in healthy subjects (median 136.7 µg/ml, range 45.4-201.6 µg/ml) (p = 0.001). DCD demonstrated concentration-dependent, but partial, microbicidal activity against P. acnes. These results suggest that reduced DCD concentration in sweat in patients with inflammatory acne may permit proliferation of P. acnes in pilosebaceous units, resulting in progression of inflammatory acne.

Mycostatic effect of recombinant dermcidin against Trichophyton rubrum and reduced dermcidin expression in the sweat of tinea pedis patients.

Trichophytosis, a common dermatophytosis, affects nearly 20-25% of the world's population. However, little is known about mechanisms for preventing colonization of Trichophyton on the skin. Dermcidin, an antimicrobial peptide that provides innate immunity to the skin and is constitutively secreted even in the absence of inflammatory stimulation, was studied to elucidate its antimycotic activity against Trichophyton. Recombinant dermcidin was determined to have antimycotic activity against Trichophyton rubrum, as evaluated by colony-forming unit (CFU) assays. The killing rate of dermcidin was 40.5% and 93.4% at 50 µg/mL (the average dermcidin concentration in healthy subjects) and 270 µg/mL, respectively. An effect of dermcidin treatment was found to be a reduction of the metabolic activity of Trichophyton as determined by nicotinamide adenine dinucleotide assay. Further, dermcidin concentrations in sweat of tinea pedis patients were found to be lower than those of healthy subjects. These findings suggest a mycostatic role for dermcidin, at normal sweat concentrations. Accordingly, we suspect that dermcidin, at normal sweat concentrations, inhibits growth of Trichophyton, where Trichophyton is subsequently eliminated in conjunction with epidermis turnover. Dermcidin, therefore, appears to play a role in the skin protection mechanism that prevents colonization of tinea pedis.

[Successful management of aorto-esophageal fistula, using staged 3 times operation].

A 66-year-old man, presented with hematemesis and hemorrhagic shock, was transported to our institution. Computed tomographic examination suggested a pseudo-aneurysm formed by bleeding from aorto-esophageal fistula( AEF). We planned staged operations. At first, in an emergent operation, graft replacement of descending aorta, was performed under partial cardiopulmonary bypass, by left thoracotomy approach. AEF was 5 mm in diameter, and existed inside of normal-diameter and non-aneurysmal aortic intima. AEF orifice into pseudo-aneurysm was closed with aortic wall and was sutured tightly. Next day, gastrointestinal fiberscopy was performed, and penetrating ulcer was found at lower esophagus.To prevent infective complications, the 2nd operation, subtotal esophagectomy, cervical esophagostomy, gastrostomy and tube ileostomy were performed by right thoracotomy approach. Post- operative course was uneventful. Two months later, 3rd operation, cervical esophago-gastric anastomosis was performed, uneventfully. Two years and four months elapsed, and no evidences of infection and formation of pseudo-aneurysm were observed.

Response to hydroxychloroquine in Japanese patients with lupus-related skin disease using the cutaneous lupus erythematosus disease area and severity index (CLASI).

BACKGROUND: Hydroxychloroquine (HCQ) is not available in Japan. To design a clinical trial of HCQ, we evaluated the response to HCQ in Japanese patients with lupus-related skin disease using the cutaneous lupus erythematosus disease area and severity index (CLASI). METHODS: Twenty-seven patients with lupus-related skin disease who started HCQ at four hospitals were included. Patients were categorized into responders by the CLASI response criteria. The points and the rate of improvement in the CLASI activity score after 16 weeks of treatment were analyzed, focusing on six parameters: systemic lupus erythematosus (SLE), skin manifestations, disease duration, prednisolone, smoking, and severity. RESULTS: Twenty-seven patients, including 17 with SLE (6 with SLE/Sjögren's syndrome), were analyzed retrospectively. Twenty-three patients (85 %) were categorized as responders. The mean CLASI activity score improved from 10.1 to 4.5 (p < 0.0001). The improvement rate did not differ in these parameters except for that of annular erythema (81.6 versus 34.3 %, p = 0.036). On multivariate analysis, the baseline CLASI activity score (CLASI ≥9) correlated with the greatest decrease in CLASI activity score (F = 69.7, p < 0.0001). CONCLUSIONS: CLASI is a reliable indicator to evaluate the efficacy of the drug, and HCQ is an effective treatment for Japanese patients with lupus-related skin disease.