This study aims to examine whether the parenterally administered mRNA-based COVID-19 vaccines can induce sufficient mucosal-type IgA responses to prevent SARS-CoV-2 transmission.
We examined the ...longitudinal kinetics of SARS-CoV-2 spike RBD-specific IgA and IgG responses in sera of Japanese healthcare workers (HCWs) after receiving two doses and the third dose of BNT162b2 mRNA vaccines. During the prospective cohort study, Omicron breakthrough infections occurred in 62 participants among 370 HCWs who had received triple doses of the vaccine. Pre-breakthrough sera of infected HCWs and non-infected HCWs were examined for the levels of anti-RBD IgA and IgG titers.
The seropositivity of anti-RBD IgA at 1 M after the second vaccine (2D-1M) and after the third dose (3D-1M) was 65.4% and 87.4%, respectively, and wanes quickly. The boosting effect on anti-RBD Ab titers following breakthrough infections was more notable for anti-RBD IgA than for IgG. There were partial cause-relationships between the lower anti-RBD IgA or IgG at pre-breakthrough sera and the breakthrough infection.
Parenterally administered COVID-19 vaccines do not generate sufficient mucosal-type IgA responses despite strong systemic IgG responses to SARS-CoV-2. These results demonstrate the necessity and importance of reevaluating vaccine design and scheduling to efficiently increase oral or respiratory mucosal immunity against SARS-CoV-2.
An 81-year-old woman with hematochezia was referred to our hospital. Although iron-deficiency anemia was observed, we did not detect any bleeding source on contrast computed tomography, ...esophagogastroduodenoscopy, and colonoscopy. Capsule endoscopy revealed active bleeding at the ileum. Double-balloon endoscopy revealed an 8-mm torose lesion on the ileum. Clinical follow-up was done without resection of the polyp as the patient was taking two antiplatelet agents at the time of diagnosis. Since hematochezia and anemia had not improved at the follow-up visit, we decided to resect the polyp by cold snare polypectomy as the procedure is associated with less post-procedural bleeding when combined with local saline injection. Microscopic findings of the resected specimen confirmed the presence of an inflammatory polyp. Eighteen months after the polypectomy, there was no recurrence of anemia or rebleeding. These observations suggest that cold snare polypectomy combined with local saline injection may be useful in the management of small benign intestinal polyps.
A 69-year-old male patient underwent endoscopic submucosal dissection (ESD) of gastric adenoma in May 2012. The pathological diagnosis was tubular adenoma, and curative resection was performed. After ...ESD, it was thought that Helicobacter pylori was spontaneously eradicated. In April 2014, a 40mm hyperplastic polyp was detected at the resection site. The polyp grew to 50mm in September 2015, at which time we performed ESD of the polyp. However, one year later a similar hyperplastic polyp developed again. We performed ESD of the recurrent polyp and injected 80mg of triamcinolone acetonide locally at the site of the post-ESD ulcer. Thereafter, we have not observed recurrence of polyp. It was considered that local steroid injection prevented the development of hyperplastic polyp at the resection site after ESD.
Background
Poorly differentiated thyroid carcinoma (PDTC) was recognized as an independent clinicohistological entity of thyroid cancer in the 2004 World Health Organization (WHO) classifications, ...separated from papillary (PTC) and follicular carcinoma (FTC). The Turin proposal provides more specific criteria for the diagnosis of PDTC. However, in an iodine-sufficient country such as Japan, PDTC comprises <1% of all thyroid cancers. In 1983, Sakamoto analyzed pathological characteristics of PTC and FTC that recurred within 5 years after initial surgery and identified solid, trabecular, insular (STI) and scirrhous growth patterns as important predictors of poor prognosis. We re-evaluated the impact of histopathological findings on the clinical course of PTC and FTC.
Materials and methods
Specimens from 376 consecutive cases diagnosed as PTC (
n
= 351) or FTC (
n
= 25) between 1994 and 2001 were reviewed.
Results
Nine (2%) patients were diagnosed with PDTC according to WHO criteria. Only 1 case (0.3%) met the Turin criteria. In addition, STI components were seen in various specimens as follows: ≥50%, ≥10% but <50%, >0% but <10%, and 0% of specimens for 9 (2%), 31 (8%), 19 (5%), and 317 cases (85%), respectively. As for cause-specific survival, a significant difference was apparent between the ≥50% and ≥10% but <50% groups. Disease-free survival was identical between these groups and was significantly worse than in the >0% but <10% and 0% groups. According to multivariate analysis, histological features of STI ≥10% and squamous metaplasia were significantly related to cause-specific survival, but scirrhous infiltration, necrosis, nuclear atypia, and vascular invasion were not. The presence of STI at a level ≥10% was also a significant risk factor, together with clinical risk factors including large tumor size, large nodal metastasis, and distant metastasis. According to AMES risk-group definition, clinically high-risk patients with STI ≥10% showed the worst 10-year cause-specific survival, at 57%, irrespective of total thyroidectomy with radioactive iodine (RAI) treatment. Ten of 25 PTC patients (40%) with STI ≥10% developed cervical recurrence, whereas 9 of 15 FTC patients (60%) with STI ≥10% showed distant metastasis.
Conclusions
The measurement of STI ≥10% represents a distinctly important risk factor for patient survival. In particular, clinically high-risk patients with STI ≥10% need further therapy beyond RAI. Original histological pattern, as papillary or follicular, affects the site of recurrence.
Thirty-nine patients with endometrioid adenocarcinoma (EA) and atypical hyperplasia (AH) of the endometrium who received conservative treatment to preserve fertility were collected from member ...institutions of the Japan Gynecologic Oncology Study Group. Twenty-nine and ten were originally diagnosed with EA without myometrial invasion and AH, respectively. We performed a central pathological review to make definite diagnoses, and the diagnosis of EA in 29 cases was changed to AH in ten, complex hyperplasia in three and atypical polypoid adenomyoma in three, and AH in ten was changed to EA in one and simple hyperplasia in one. Nine of 12 women (75%) with EA and 15 of 18 women (83%) with AH had an initial response to medroxyprogesterone acetate (MPA) treatment. Two of nine responders with EA later developed relapse, and one of them had metastasis to the left obturator lymph node. Two became pregnant, and one delivered one full-term infant. One of the responders with AH had a relapse in the endometrium. Five became pregnant, and four delivered four normal infants. The young women with endometrial carcinoma localized in the endometrium who wish to preserve fertility may be treated as successfully with MPA as those with AH.
Abstract Background Aortic aneurysms including dissection are uncommon complications of systemic lupus erythematosus, but the incidence has been increasing with an improved prognosis for this ...disease. However, the mechanisms contributing to aneurysm formation in systemic lupus erythematosus have not been fully clarified. Methods A meta-analysis of published cases was conducted to clarify the patient characteristics that may contribute to aneurysm formation in systemic lupus erythematosus. A search of relevant studies published over the past 40 years (1969–2008) was carried out in the publications on aortic aneurysms with systemic lupus erythematosus, and 35 cases were identified. The contributing factors to aneurysm formation as well as the patient prognosis were searched for sex, age, duration of corticosteroid treatment, aneurysm site (thoracic and/or abdominal), mortality, evidence of atherosclerotic involvement, and presence or absence of an operation, rupture, dissection, cystic medial degeneration, vasculitis, and hypertension. Each of these factors was assigned to each point score. Based on the point scores, a statistical analysis of rank correlation was thereafter performed. Results The factors correlating with the presence of thoracic or abdominal lesions differed significantly. The presence of thoracic aneurysms correlated with dissection and cystic medial degeneration, whereas abdominal lesions correlated with the finding of atherosclerosis. Thoracic lesions showed a high rate of death, while abdominal lesions were associated with a relatively favorable prognosis. Abdominal lesions were related to the duration of steroid therapy. The other correlations among the various factors were also evaluated, with the finding of cystic medial degeneration associated with vasculitis. Conclusion Two principal patterns emerged from this analysis. One was the fatal nonatherosclerotic thoracic aneurysm which was associated with cystic medial degeneration and probably due to vasculitis. The other was atherosclerotic abdominal aneurysm which was complicated by long-term steroid treatment and it showed a relatively favorable prognosis.
Summary L-type amino acid transporter 1 (LAT1) is a Na+ –independent neutral amino acid transporter that has an essential role in cell proliferation. Although LAT1 expression is observed in various ...tumor cell lines and immunohistochemical expression of LAT1 has been investigated in carcinomas of various organs, LAT1 expression in uterine cervical neoplasm has not been reported. Therefore, in the present study, we immunohistochemically analyzed LAT1 expression along with the well-known markers of cervical carcinogenesis Ki-67 and p16 in normal uterine cervical mucosa (49 specimens) as well as cervical intraepithelial neoplasia (17 mild or moderate dysplasias and 19 severe dysplasias or carcinomas in situ) and invasive carcinomas (17 squamous cell carcinomas and 9 adenocarcinomas). LAT1 expression was limited to the basal layer of normal squamous epithelium, and it was significantly decreased in cervical intraepithelial neoplasia ( P < .001), generally paralleled by increased expression of Ki-67 and p16. Interestingly, in invasive squamous cell carcinoma, LAT1 expression again increased especially at the invasive fronts ( P < .001), whereas Ki-67 and p16 expressions were almost unchanged relative to noninvasive neoplasia. Although virtually no LAT1 expression was demonstrated in normal uterine cervical glands, LAT1 expression was observed in some adenocarcinomas ( P < .001). The present study suggests that LAT1 expression decreases because of human papillomavirus infection as reflected by p16 overexpression in cervical intraepithelial neoplasia, whereas LAT1 expression in invasive carcinoma is associated with acquired malignant potential.
To evaluate the sensitivity and specificity of endometrial cytology obtained by intrauterine sample using a descriptive reporting format for endometrial cytological diagnosis.
10,152 consecutive ...endometrial scrapings obtained in 13 different Japanese hospitals were analyzed. Cytological results were classified as 'negative for malignancy', 'atypical endometrial cells' (ATEC), 'endometrial hyperplasia', 'atypical endometrial hyperplasia' or 'malignant tumor'. ATEC was subclassified as 'ATEC, of undetermined significance' (ATEC-US) and 'ATEC, cannot exclude atypical endometrial hyperplasia or more' (ATEC-A). Cytological results were compared with the histological diagnosis as a gold standard. When the cytological result was 'negative for malignancy' and there was no subsequent histological examination, the case was considered a true negative when the endometrium was assessed as normal on transvaginal ultrasonography and there was no abnormal uterine bleeding.
1,083 cases in which histology was not performed, 557 cases of 'unsatisfactory specimen' and 76 cases of ATEC-US were excluded. In the remaining 8,436 cases, the sensitivity and specificity, positive predictive value and negative predictive value for detecting atypical endometrial hyperplasia or malignant tumors were 79.0 and 99.7, 92.9 and 98.9%, respectively.
The current diagnostic standards for endometrial cytology in Japan were established. Specificity is satisfactory for excluding cancer or precancerous diseases.
The purpose of this study was to determine the optimal diagnostic criteria for lateral pelvic lymph node metastasis in patients with rectal carcinoma.
From July 1997 to June 2005, fifty-one patients ...with locally advanced middle or lower rectal carcinoma underwent preoperative MRI examination, followed by total mesorectal excision with lateral pelvic node dissection. Factors of lateral pelvic lymph nodes evaluated were size, shape and internal structure. The size of lymph nodes was measured in both long and short axis diameters. The shape of lymph nodes was categorized into ovoid or irregular. The internal structure of lymph nodes was categorized into homogeneous or non-homogeneous. Optimal preoperative criteria on MRI were clarified by area under receiver operating characteristic curves (AUC). To clarify the optimal diagnostic criteria for diagnosing lateral pelvic lymph node metastasis, these basic four categories were analyzed. Subsequently, combined criteria comprising 11 categories were also evaluated to clarify optimal criteria.
Detection of lateral pelvic lymph node on MRI was significantly higher in the metastatic group. The basic four categories were evaluated to define each optimal criterion for metastasis. In category 1, the optimal criteria for long axis diameter of 10 mm or larger showed the largest AUC of 0.711. In category 2 (short axis diameter), the criterion of 5 mm or larger showed the largest AUC of 0.736. In category 3, an ovoid shape showed an AUC of 0.722. In category 4, heterogeneity of the internal structure gave the largest AUC of 0.708. Based on these results, fifteen categories (category 1-15) were defined. Among them, category 8 (an ovoid shape with a short axis diameter) showed the largest AUC of 0.75, representing 67% sensitivity, 83% specificity, and 78% overall accuracy.
An ovoid shape with a transverse axis diameter of 5 mm or larger on MRI was considered as the optimal criterion for diagnosing lateral lymph node metastasis in patients with rectal carcinoma.
