Infection prevention measures for patients on hemodialysis during COVID-19 pandemic in Japan: a nationwide questionnaire follow-up survey in 2022

Abstract Background Coronavirus disease (COVID-19) continues to be prevalent in 2023, and infection control measures against it remain important in medical practice. In 2020, we conducted a questionnaire survey mainly on the implementation of infection prevention measures for patients on hemodialysis under COVID-19 pandemic in Japan. Since then, vaccination for COVID-19 has been initiated and the outbreak of new variants had occurred. Infection prevention measures at dialysis facilities have possibly changed; therefore, we conducted a follow-up survey. Methods Between October 11 and November 14, 2022, we distributed a questionnaire survey to 4,198 dialysis facilities in Japan. The survey investigated (i) the characteristics of the facilities, (ii) infection prevention measures in routine dialysis practice, (iii) experience in treating COVID-19-positive/suspected dialysis patients, (iv) feasibility of various isolation measures, (v) nosocomial transmission, (vi) COVID-19 vaccination status, and (vii) impact on medical practice and economic aspects. We then compared the answers from the previous survey conducted in 2020 with those of the current survey. Results Responses were obtained from 1956 facilities (response rate: 46.6%). Overall, 83.5% of the facilities have examined and treated patients with COVID-19. While the compliance rate improved since the previous survey, it remained low for some factors such as linen exchange. More than 60% of the facilities reported that they were coping with a lack of manpower and space for isolation. Most patients at the surveyed facilities were vaccinated for COVID-19; only 2.8% were unvaccinated. Compared with unvaccinated patients, vaccinated patients had a lower infection rate (vaccinated 9.2% vs. unvaccinated 41.2%; crude risk ratio [RR] 0.22; 95% confidence interval [CI] 0.22–0.23; p < 0.001) and mortality rates (vaccinated 0.3% vs. unvaccinated 6.6%; crude RR 0.05; 95% CI 0.04–0.06; p < 0.001). Conclusion The implementation rates of most of the infection prevention measures improved compared to those in the previous survey. However, labor shortages, lack of space, and problems coordinating with other medical facilities remain a challenge. COVID-19 vaccination was significantly associated with reduced infection and mortality in Japanese patients on hemodialysis, which should be confirmed by further studies with confounding adjustment

Pulmonary Function Analysis of Japanese Athletes: Possibly Even More Asthmatics in the Field

Background: The prevalence of bronchial asthma (BA) in youth is increasing in Japan, but very few athletes are reported to be affected with BA. The aim of this study is to analyze pulmonary function test (PFT) in athletes from the aspect of BA retrospectively. Methods: Medical history questionnaires of 2111 athletes (male: 1549, female: 562) were reviewed. All athletes participated in the institute’s athletic test for the first time, from April 2003 through March 2006. Athletes were categorized into three groups; current-BA confirmed and treated by the physician, possible-BA according to the allergic history and/or BA symptoms, and non-BA that is neither of the above two groups. The PFT data were then analyzed. Results: There were 24 current-BA (1.1%), 137 possible-BA (6.5%), and 183 cases with a past history of BA (PH; 8.7%). Percent of predicted forced expiratory volume in 1 second (%FEV1) and of predicted peak expiratory flow rate (%PEF) in current-BA (86.2 ± 17.7% and 81.6 ± 19.1%, respectively) and possible-BA (84.7 ± 14.6% and 81.2 ± 17.3%, respectively) were significantly lower than those in non-BA (93.9 ± 13.7% and 93.8 ± 19.8%, respectively), without any significant difference between current-BA and possible-BA. Athletes with PH show impaired obstructive indices; even in non-BA with PH showed lower %FEV1 (91.3 ± 13.9%, p < 0.05) and %PEF (86.8 ± 17.8%, p < 0.001) than non-BA without PH (94.0 ± 13.7% and 94.2 ± 19.9%, respectively). Conclusions: The incidence of BA in Japanese athletes may be higher than currently recognized. More intervention is encouraged for the diagnosis of BA, to avoid any fatal asthma during sports by initiating preventive therapy

De Novo Emergence of Mesenchymal Stem-Like CD105+ Cancer Cells by Cytotoxic Agents in Human Hepatocellular Carcinoma

BACKGROUND: Cancer stem cells (CSCs) are considered a pivotal target for the eradication of hepatocellular carcinoma (HCC). Recently, we reported that the CSC markers epithelial cell adhesion molecule (EpCAM) and CD90 are expressed independently in primary HCCs and cell lines, and CD90+ cells share features of metastatic vascular endothelial cells and express the vascular endothelial marker CD105, a co-receptor of transforming growth factor-beta. METHODS: The EpCAM+ cell lines HuH1 and HuH7 were treated with 5-fluorouracil (5-FU) or epirubicin in vitro. Gene and protein expression levels were evaluated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and fluorescence-activated cell sorting, respectively. The expression of CD105 in primary HCC was evaluated by immunohistochemistry. The relationship of CD105 expression status and HCC prognosis was evaluated using 85 surgically resected HCC tissues by Kaplan–Meier survival analysis. RESULTS: 5-FU or epirubicin treatment resulted in the generation of CD90+ and CD105+ cells in vitro in HuH1 and HuH7 cells, which originally contain no CD90+ or CD105+ cells. This phenomenon was validated by qRT-PCR analysis with activation of the epithelial-mesenchymal transition (EMT) program regulators Snail family zinc finger 1 (SNAI1) and SNAI2. Immunohistochemical analysis indicated that CD105+ cells were morphologically identical to vascular endothelial cells in untreated primary HCCs. However, surgically resected specimens after transcatheter arterial chemoembolization clearly indicated that CD105+ cancer cells survived at the peripheral edge of the tumor. Kaplan–Meier survival analysis indicated that HCCs expressing CD105 showed poor prognosis after surgery with statistical significance. CONCLUSIONS: Taken together, our data highlight the role of CD105+ HCC cells with activation of the EMT program generated de novo after cytotoxic therapy on the prognosis of HCC patients