Predictive Model for Adverse Events and Immune Response Based on the Production of Antibodies After the Second-Dose of the BNT162b2 mRNA Vaccine

Background: The BNT162b mRNA vaccine for coronavirus disease 2019, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mimics the immune response to natural infection. Few studies have predicted the adverse effects (AEs) after the second-dose vaccination. We present a predictive model for AEs and immune response after the second-dose of the BNT162b mRNA vaccine. Methods: To predict AEs, 282 healthcare workers (HCWs) were enrolled in this prospective observational study. The classification and regression tree (CART) model was established, and its predictive efficacy was assessed. To predict immune response, 282 HCWs were included in the analysis. Moreover, the factors affected by anti-SARS-CoV-2 spike protein RBD antibody (s-IgG) were evaluated using serum samples collected 2 months after the second-dose vaccination. The s-IgG level was assessed using Lumipulse G1200. Multiple regression analyses were conducted to evaluate variables associated with anti-s-IgG titer levels. Results: The most common AEs after the second-dose vaccination were pain (87.6%), redness (17.0%) at the injection site, fatigue (68.8%), headache (53.5%), and fever (37.5%). Based on the CART model, headache after the first-dose vaccination and age < 30 years were identified as the first and second discriminators for predicting the headache after the second-dose vaccination, respectively. In the multiple linear regression model, anti-s-IgG titer levels were associated with age, female sex, and AEs including headache and induration at the injection site after the second-dose vaccination. Conclusion: Headache after the first-dose vaccination can be a predictor of headache after the second-dose vaccination, and AEs are indicators of immune response

Physical Characteristics of Injection Site Pain After COVID-19 mRNA BNT162b2 Vaccination

Background: BNT162b2, an mRNA COVID-19 vaccine, was launched in many countries as an intramuscular vaccination for COVID-19 infection. Few studies have assessed the physical indications of pain at the immunization site. This study aimed to characterize pain at the injection site and investigate morphological attributes using ultrasound. Methods: Forty-three of 211 healthcare workers who received a second dose of BNT162b2 between February 2021 and March 2021 were enrolled in the study. The mean age of the subjects was 40 years. We evaluated patients’ pain at the injection site using the Numerical Rating Pain Scale (NRPS). We also assessed the thickness of the deltoid muscle fascia at the injection site by ultrasound. Bayesian robust correlation was employed to explore the relationship between the pain intensity scores and ultrasound measurements. Results: All eligible subjects complained of pain at the injection site. A median pain onset of 8 hours post-vaccination and a median peak intensity score of 4 were reported. Onset of relief occurred after 2 days. Ultrasound images demonstrated a 2.5-fold increase in fascia thickness at the injection site without intramuscular echogenicity change in all subjects. A correlation was established between the NRPS score and the non-injection-to-injection-side ratio of fascia thickness at the injection site (rho = 0.66). Conclusion: A sore arm was the most prevalent side effect of BNT162b2 vaccination and could be attributed to temporal fasciitis

シュウガクテキ チリョウ ガ ソウコウ シタ シンコウ チョウカンマク アクセイ リンパシュ ノ 1レイ

Mesenteric malignant lymphoma is comparative rare and has a poor prognosis in anadvanced case.Here, we report a patient with intestinal obstruction due to mesenteric malignantlymphoma treated successfully by gastrointestinal bypass operation, chemo-and radiotherapy.A 67-year-old man was admitted to our hospital because of abdominal pain andnausea. An abdominal CT scan revealed a huge tumorous lesion with a soft tissue density,which involved descending colon. Since the symptoms was persisted after conservativetreatment, gastrointestinal bypass procedures were surgically formed. During the laparotomy,an open incisional biopsy was performed. Histological examination showed non-Hodgkinlymphoma with diffuse, large-sized and B-cell type. This case was classified into high-risk groupacccording to International Prognostic Index (IPI). After the operation, 5 courses of combinedchemotherapy (THP-COP) and 30 Gy radiation were performed. These multidisciplinarytreatment is considered to be very effective. Since then complete response and goodpatient’s QOL has been attained for these 3.5 years

A case of thoracic esophageal cancer undergone esophagectomy after induction chemotherapy in a Jehovah’s Witness

We report the case of a 50-year-old female Jehovah’s Witness with advanced esophageal cancer who underwent esophagectomy following induction chemotherapy. She visited our hospital complaining of dysphagia and was diagnosed of advanced esophageal cancer by upper endoscopy. She refused allogeneic transfusion. Induction chemotherapy was performed. Severe anemia occurred as an adverse event. A subtotal esophagectomy was performed after her anemia improved. During the surgery, a large volume of replacement fluid was injected, the blood was diluted, and intraoperative bleeding was relatively reduced. Intraoperative blood salvage was made using Cell Saver. The postoperative course were stable by using autologous blood and albumin infusion. The patient was discharged on postoperative day 27. Jehovah’s Witnesses with gastrointestinal malignancies can be treated safely by performing surgical therapy based on blood replacement therapy and autologous blood transfusion

Emission spectroscopy of a microhollow cathode discharge plasma in helium-water gas mixtures

A dc microhollow cathode discharge (MHCD) plasma was generated inflowing helium gas containing water vapor. The cathode hole diameters were 0.3, 0.7, 1.0, and 2.0 mm, each with a length of 2.0 mm. Emission spectroscopy was carried out to investigate the discharge mode and to determine the plasma parameters. For the 0.3-mm cathode, stable MHCDs in an abnormal glow mode existed at pressures up to 100 kPa, whereas for larger diameters, a plasma was not generated at atmospheric pressure. An analysis of the lineshapes relevant to He at 667.8 nm and to Hα at 656.3 nm implied an electron density and gas temperature of 2 × 1014 cm-3 and 1100 K, respectively, for a 100-kPa discharge in the negative glow region. The dependence of the OH band, and Hα intensities on the discharge current exhibited different behaviors. Specifically, the OH spectrum had a maximum intensity at a certain current, while the H atom intensity kept increasing with the discharge current. This observation implies that a high concentration of OH radicals results in quenching, leading to the production of H atoms via the reaction OH + e- → O + H + e-

Training in VANS using human cadavers

Endoscopic surgery has been introduced in various surgical fields. Endoscopic surgery requires different skills from open surgery due to the restricted surgical field and difficulty in identifying anatomical structures from certain viewpoints. Therefore, surgeons need to undergo sufficient surgical training before performing such surgery in the clinical setting. We examined the utility of fresh frozen human cadavers for surgical training aimed at introducing video-assisted neck surgery (VANS) at our department. First, we performed surgical training using fresh human cadavers four times. Next, we performed hemi-thyroidectomy with VANS in 5 clinical patients. After the cadaver training and the actual surgery, the surgeons evaluated each step of the surgical procedure using a 3-point scale. In the cadaver training, the scores for steps : creation of a subcutaneous tunnel and lifting up the skin flap and pre-thyroid muscles were higher than other steps. And a tracheal injury occurred as a complication. However, we were able to recognize anatomical structures under the endoscopic view. And it was also useful for confirming the role of surgical staff and simulating the placement of surgical equipment. Surgical training using fresh frozen human cadavers was effective at introducing a new surgical method

A case of the gastric metastasis from invasive lobular carcinoma of the breast

A 45-year-old woman underwent total mastectomy with axillary lymph node dissection for right breast cancer in 2015. Histopathological examination of the resected specimen showed triple-negative invasive lobular carcinoma and advanced lymph node metastasis. The patient underwent postoperative adjuvant therapy consisting of a dose-dense epirubicin-cyclophosphamide regimen and weekly paclitaxel and radiotherapy. However, multiple bone metastases were detected, 18 months postoperatively. The patient developed upper abdominal discomfort, 21 months postoperatively, and gastroscopy revealed multiple, irregular depressed lesions in the stomach. Histopathological examination of stomach biopsy specimens revealed tumor cells that showed diffuse invasion of the lamina propria of mucous membrane. Immunohistochemical evaluation of biopsy specimens obtained from the stomach and the excised breast tissue showed cells that were immunopositive for CK7 and GCDFP-15 and immunonegative for CK20. The gastric lesion was therefore diagnosed as metastases from invasive lobular carcinoma of the breast. Although the patient received chemotherapy, she died of meningeal carcinomatosis from breast cancer, 7 month after the diagnosis of stomach metastasis. Immunohistochemical evaluation for CK20, which is expressed in gastric cancer and GCDFP-15, which originates from breast tissue, is useful to distinguish between breast cancer metastases and signet ring cell carcinoma of the stomach

Alternative mRNA Splicing in Three Venom Families Underlying a Possible Production of Divergent Venom Proteins of the Habu Snake, Protobothrops flavoviridis

Snake venoms are complex mixtures of toxic proteins encoded by various gene families that function synergistically to incapacitate prey. A huge repertoire of snake venom genes and proteins have been reported, and alternative splicing is suggested to be involved in the production of divergent gene transcripts. However, a genome-wide survey of the transcript repertoire and the extent of alternative splicing still remains to be determined. In this study, the comprehensive analysis of transcriptomes in the venom gland was achieved by using PacBio sequencing. Extensive alternative splicing was observed in three venom protein gene families, metalloproteinase (MP), serine protease (SP), and vascular endothelial growth factors (VEGF). Eleven MP and SP genes and a VEGF gene are expressed as a total of 81, 61, and 8 transcript variants, respectively. In the MP gene family, individual genes are transcribed into different classes of MPs by alternative splicing. We also observed trans-splicing among the clustered SP genes. No other venom genes as well as non-venom counterpart genes exhibited alternative splicing. Our results thus indicate a potential contribution of mRNA alternative and trans-splicing in the production of highly variable transcripts of venom genes in the habu snake

カン ノウホウセイ シュヨウノ 2セツジョレイ

We report two cases of cystadenoma and cystadenocarcinoma of the liver. Case 1 : A 38-yearold woman, complaining of discomfort of upper abdomen, was detected a cystic tumor in segment 5of the liver by abdominal CT scan. A part of the tumor had an enhanced lesion the angiographyshowed an enhanced peripheral staining of the cystic lesion. S 5-6 segmentectomy was performed.The resected material showed that the tumor was a multilocular and cystic lesion, histopathologicallywas diagnosed as hepatobiliary cystadenoma. Case 2 : A 72-year old man was incidentallypointed out a liver tumor in the left lobe at an examination of pneumonia. Abdominal CT scanshowed a papillary enhanced solid lesion in cystic tumor with invasion to the caudate lobe. ERCPshowed a filling defect in the common bile duct. Extended left hepatic lobectomy, caudate lobectomyand extrahepatic bile duct resection were performed. The final diagnosis was hepatobiliarycystadenocarcinoma.Cystadenoma is known to have a carcinogenic potential. In the case with suspition of neoplasticcyst, resection must be perfomed

イ ゲンパツ ジュウモウガン ノ 1レイ

A 79-year-old man, complaining of right hypochondralgia, was admitted to our hospital. Gastrointestinalendoscopy revealed a elevated lesion on the anterior wall of the gastric antrum. Adistal gastrectomy was performed. Histological findings confirmed the diagnosis of gastric choriocarcinoma,and there was coexistence of adenocarcinoma. The patient left the hospital in uneventfulpostoperative course. He had recurrence on remnant stomach on the third postoperativemonth. Also chemotherapy with TS-1 and paclitaxel was performed, was no effective, resulting inpatient death on the fourth postoperative month. The patient died of recurrence complicatedpneumonia. We reported on this case with some bibliographical comments