COVID‐19治療後患者に対する廃用リハの重要性

This study examined the effects of rehabilitation on patients after coronavirus disease ２０１９ recovery. ４５ patients（male１８, female ２７, aged ４９‐９７, median：７９ years old）were evaluated for physical and cognitive functions using eight assessment items. We compared and analyzed these data at the time of admission with at the time of discharge, as well as outcome assessment using a performance index. Among the evaluated items, significant improvements were observed in FIM motor（p<０．００１）, cognitive（p<０．００１）, MMSE（p<０．００１）, right hand grip strength（p<０．０１）, left hand grip strength（p<０．００１）, skeletal muscle mass（p<０．０５）, and ６‐minute walk test（p<０．０５）. In addition, the performance index of the subjects was １００．６, which was much higher than the facility standard requirement. Furthermore, it was suggested that the establishment of exercise habits and lifestyle rhythms through rehabilitation may have contributed to the cessation of oxygen administration, insulin and psychotropic medication, it was clarified that the implementation of rehabilitation is effective

Effectiveness of Messenger RNA Coronavirus Disease 2019 Vaccines Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infections During the Delta Variant Epidemic in Japan: Vaccine Effectiveness Real-time Surveillance for SARS-CoV-2 (VERSUS)

Background. Although high vaccine effectiveness of messenger RNA (mRNA) coronavirus disease 2019 (COVID-19) vaccines has been reported in studies in several countries, data are limited from Asian countries, especially against the Delta (B.1.617.2) variant.Methods. We conducted a multicenter test-negative case-control study in patients aged ≥16 years visiting hospitals or clinics with signs or symptoms consistent with COVID-19 from 1 July to 30 September 2021, when the Delta variant was dominant (≥90% of SARS-CoV-2 infections) nationwide in Japan. Vaccine effectiveness of BNT162b2 or mRNA-1273 against symptomatic SARS-CoV-2 infections was evaluated. Waning immunity among patients aged 16–64 years was also assessed.Results. We enrolled 1936 patients, including 396 test-positive cases and 1540 test-negative controls for SARS-CoV-2. The median age was 49 years, 53.4% were male, and 34.0% had underlying medical conditions. Full vaccination (receiving 2 doses ≥14 days before symptom onset) was received by 6.6% of cases and 38.8% of controls. Vaccine effectiveness of full vaccination against symptomatic SARS-CoV-2 infections was 88.7% (95% confidence interval [CI], 78.8%–93.9%) among patients aged 16–64 years and 90.3% (95% CI, 73.6%–96.4%) among patients aged ≥65 years. Among patients aged 16–64 years, vaccine effectiveness was 91.8% (95% CI, 80.3%–96.6%) within 1–3 months after full vaccination, and 86.4% (95% CI, 56.9%–95.7%) within 4–6 months.Conclusions. mRNA COVID-19 vaccines had high effectiveness against symptomatic SARS-CoV-2 infections in Japan during July–September 2021, when the Delta variant was dominant nationwide

Effectiveness of mRNA COVID-19 vaccines against symptomatic SARS-CoV-2 infections during the SARS-CoV-2 Omicron BA.1 and BA.2 epidemic in Japan: vaccine effectiveness real-time surveillance for SARS-CoV-2 (VERSUS)

Background: Evaluating COVID-19 vaccine effectiveness (VE) domestically is crucial for assessing and determining national vaccination policy. This study aimed to evaluate VE of mRNA COVID-19 vaccines in Japan. Methods: We conducted a multicenter test-negative case-control study. The study comprised indivi-duals aged ≥16 visiting medical facilities with COVID-19-related signs or symptoms from 1 January to 26 June 2022, when Omicron BA.1 and BA.2 were dominant nationwide. We evaluated VE of primary and booster vaccination against symptomatic SARS-CoV-2 infections and relative VE of booster compared with primary.Results: We enrolled 7,931 episodes, including 3,055 test positive. The median age was 39, 48.0% were male, and 20.5% had underlying medical conditions. In individuals aged 16 to 64, VE of primary vaccination within 90 days was 35.6% (95% CI, 19.0–48.8%). After booster, VE increased to 68.7% (60.6–75.1%). In individuals aged ≥65, VE of primary and booster was 31.2% (−44.0–67.1%) and 76.5% (46.7–89.7%), respectively. Relative VE of booster compared with primary vaccination was 52.9% (41.0– 62.5%) in individuals aged 16 to 64 and 65.9% (35.7–81.9%) in individuals aged ≥65.Conclusions: During BA.1 and BA.2 epidemic in Japan, mRNA COVID-19 primary vaccination provided modest protection. Booster vaccination was necessary to protect against symptomatic infections

Routine varicella vaccination program and hospitalization for herpes zoster in Japan

Whether reducing exposure to varicella by the implementation of the routine varicella vaccination program for children leads to increased incidence of herpes zoster (HZ) remains controversial. The aim of the present study was to identify the trend in the hospitalization associated with HZ before and after the introduction of routine varicella vaccination by using nationally representative data from an inpatient database in Japan. Data were obtained on the number of inpatients hospitalized for HZ from the “Survey on the effect of the introduction of Diagnosis Procedure Combination (DPC) database” and the total population in Japan from the Population Estimates created by the former Statistics Bureau between fiscal years 2013 and 2018. The data from the DPC hospitals only and all hospitals in the survey were analyzed separately. The trends in the annual incidence of HZ hospitalization were identified. The trends in the annual hospitalization for HZ per 100,000 persons were then analyzed by age group (0–20, 21–40, 41–60, 61–79, and ≥80 years of age). The annual number of hospitalizations for HZ was approximately 20,000 in the DPC hospitals and 25,000 in all hospitals, showing no upward trend. The age-specific annual hospitalization rate for HZ did not increase in all the age groups. As age increased, the hospitalization rate also increased. This study presents no upward trend in the hospitalizations for HZ after the implementation of the routine varicella vaccination program in Japan

Bromide supplementation exacerbated the renal dysfunction, injury and fibrosis in a mouse model of Alport syndrome

<div><p>A seminal study recently demonstrated that bromide (Br^-) has a critical function in the assembly of type IV collagen in basement membrane (BM), and suggested that Br^- supplementation has therapeutic potential for BM diseases. Because salts of bromide (KBr and NaBr) have been used as antiepileptic drugs for several decades, repositioning of Br^- for BM diseases is probable. However, the effects of Br^- on glomerular basement membrane (GBM) disease such as Alport syndrome (AS) and its impact on the kidney are still unknown. In this study, we administered daily for 16 weeks 75 mg/kg or 250 mg/kg (within clinical dosage) NaBr or NaCl (control) via drinking water to 6-week-old AS mice (mouse model of X-linked AS). Treatment with 75 mg/kg NaBr had no effect on AS progression. Surprisingly, compared with 250 mg/kg NaCl, 250 mg/kg NaBr exacerbated the progressive proteinuria and increased the serum creatinine and blood urea nitrogen in AS mice. Histological analysis revealed that glomerular injury, renal inflammation and fibrosis were exacerbated in mice treated with 250 mg/kg NaBr compared with NaCl. The expressions of renal injury markers (<i>Lcn2</i>, <i>Lysozyme</i>), matrix metalloproteinase (<i>Mmp-12</i>), pro-inflammatory cytokines (<i>Il-6</i>, <i>Il-8</i>, <i>Tnf-α</i>, <i>Il-1β</i>) and pro-fibrotic genes (<i>Tgf-β</i>, <i>Col1a1</i>, <i>α-Sma</i>) were also exacerbated by 250 mg/kg NaBr treatment. Notably, the exacerbating effects of Br^- were not observed in wild-type mice. These findings suggest that Br^- supplementation needs to be carefully evaluated for real positive health benefits and for the absence of adverse side effects especially in GBM diseases such as AS.</p></div

Long-term NaBr treatment does not affect the renal function in WT mice.

<p>(A) Schematic diagram of the experimental design for NaCl (250 mg/kg) or NaBr (75 mg/kg, 250 mg/kg) treatment in WT mice. (B) Body weight was measured every two weeks until mice were 32 weeks old. (C) Serum creatinine in 32-week-old mice was measured. (D) Total RNA was isolated from renal tissues of 32-week-old mice. Quantitative RT-PCR was performed to evaluate the expression of the indicated genes. Bars indicate the mean ± S.D. (n = 4). P values were assessed by Tukey-Kramer test. n.s., not significant.</p

NaBr exacerbates the renal fibrosis in AS mice.

<p>(A) Representative images of Masson-Trichrome (MT)-stained renal sections from 22-week-old AS mice are shown. Scale bar, 50 μm. (B) Tubulointerstitial fibrosis score was evaluated by measuring the fibrotic region in MT-stained section. (C-E) Total RNA was isolated from renal tissues of 22-week-old mice. Quantitative RT-PCR was performed to analyze the expression of the indicated pro-fibrotic genes (C), matrix metalloproteinase (D) and anti-fibrotic genes (E). The data were normalized to <i>Gapdh</i>. Bar graphs indicate the mean ± S.D. (n = 4–6). *P<0.05; **P<0.01 vs NaCl (250 mg/kg)-treated AS, #P<0.05; ##P<0.01 versus NaBr (75 mg/kg)-treated AS mice. P values were assessed by Tukey-Kramer test. n.s., not significant.</p

Bromide ion concentration.

<p>Bromide ion concentration.</p