日本红十字会

Japan has seen a dramatic shift in liver cancer epidemiology, with hepatocellular carcinoma (HCC) declining after decades of comprehensive viral hepatitis control, illustrating the impact of sustained public health intervention. This review examines trends in liver cancer epidemiology in Japan in the context of long-term viral hepatitis control. National data indicate a substantial reduction in disease burden, with liver cancer mortality declining from 34,637 deaths in 2002 to fewer than 30,000 in 2014. The incidence of newly acquired infections is low, with HCV estimated at approximately 0.4 per 100,000 person-years and HBV at 2.38 per 100,000 person-years. These trends likely reflect population-based screening, universal health coverage, and expanded access to antiviral therapy. However, the aetiology of HCC is evolving, with non-viral causes increasing from 6.8% in 1991 to 41.1% in 2015 and accounting for 56.0% of HCC deaths in 2019. Overall, Japan's experience suggests progress in viral hepatitis control, while highlighting the need to address metabolic and lifestyle-related risk factors to sustain future prevention of liver cancer.

BACKGROUND AND OBJECTIVES:Immunoglobulin A (IgA) deficiency occurs in approximately 1 in 14,000 individuals in Japan. Approximately 32% harbour anti-IgA, most of which are naturally occurring and rarely cause anaphylaxis, although high-titre anti-IgA from alloimmunization can cause severe reactions. A stable supply of IgA-deficient plasma is essential for minimizing this risk. We therefore developed a novel reagent for large-scale identification of IgA-deficient donors. MATERIALS AND METHODS:Four mouse monoclonal anti-IgA-producing cell lines were established using the hybridoma method after immunizing mice with IgA protein. Purified antibodies were conjugated to carboxylate-modified polystyrene latex beads for IgA measurement using the latex agglutination method on an automated analyser. Samples with low IgA concentrations were re-tested by enzyme-linked immunosorbent assay (ELISA) for confirmation. RESULTS:Adoption of a dual antibody assay design achieved a detection limit of 0.4 mg/dL, suitable for high-throughput screening. Screening of 24,977 randomly selected donor samples between February 2022 and April 2023 yielded 4 low IgA cases. IgA deficiency was verified by supplemental ELISA, which was required solely for these four samples. Three of four had IgA levels <0.05 mg/dL, which is the most common threshold for identifying IgA-deficient donors. CONCLUSION:We have developed a new reagent for detecting IgA deficiency. The assay is automatable and appears useful for large-scale screening of blood donors.

Shared decision making in renal replacement therapy should reflect patient values. However, the quantitative impact of family involvement—particularly in Asian contexts—on decision-making quality remains underexplored. This nationwide, multicenter cross-sectional study (October 2022–February 2025) involved 475 adults with stage 5 chronic kidney disease across 49 facilities in Japan. Following the selection of renal replacement therapy, participants were surveyed regarding the final decision-makers and their specific roles. Shared decision-making quality was evaluated using the three-item CollaboRATE scale, assessing information exchange and preference integration. Compared with “physician-only” decisions, CollaboRATE scores (points; 95% confidence interval) were significantly higher in the “patient and physician” (+ 12.3; 1.5–23.2) and “patient, physician, and key person” groups (+ 13.7; 0.8–26.7). Role-based analyses showed that shared decision-making with the physician or key person was associated with a + 10.0 point increase (3.2–16.8) versus decisions without patient involvement. Among patients having family, scores were significantly higher for patient only (+ 9.5), patient-led with input from physician or key person (+ 10.4), and shared decision-making (+ 12.1) categories, compared with no patient involvement. Family involvement enhances shared decision-making quality when selecting renal replacement therapy, particularly when the process remains collaborative and guided by patient preferences.

Background Accurate preoperative staging of upper tract urothelial carcinoma (UTUC) remains challenging. This study aimed to develop site-specific scoring systems for predicting muscle-invasive UTUC without ureteroscopic findings. Methods This retrospective multicenter study initially included 386 patients who underwent radical nephroureterectomy for UTUC at Tottori University Hospital and affiliated hospitals between January 2015 and December 2021. Patients with clinically node-positive disease or those who received neoadjuvant chemotherapy were excluded. Preoperative variables included age, sex, body mass index, hydronephrosis, urinary cytology, clinical T stage, tumor size, and multifocality. Univariable and multivariable logistic regression analyses were performed separately for ureteral and renal pelvic tumors to identify the predictors of muscle-invasive disease. Results Among 356 eligible patients, 157 (44.1%) had muscle-invasive UTUC. Multivariable analysis identified positive urinary cytology and clinical T stage as independent predictors of muscle-invasive disease in both ureteral and renal pelvic tumors, whereas hydronephrosis was an additional independent predictor in ureteral tumors. Scoring systems incorporating these variables achieved areas under the curve of 0.865 for ureteral cancer and 0.745 for renal pelvic cancer. Optimal cutoff scores based on the Youden index were ≥ 3 for ureteral tumors and ≥ 2 for renal pelvic tumors, with sensitivity rates of 85.4% and 68.0% and specificity rates of 77.4% and 73.6%, respectively. Conclusion Site-specific scoring systems based on routinely available preoperative variables accurately predicted muscle-invasive UTUC without requiring ureteroscopic findings. These models may facilitate preoperative risk stratification, although external validation is required.

Background In Japan, remote areas have limited access to medical care due to geographical constraints. Additionally, some regions, although not classified as remote areas, have limited transfusion capacity because of their distance from blood centers. These are referred to as transfusion-access remote areas (t-remote areas). This study aimed to clarify transfusion practices in these regions. Materials and methods A questionnaire was distributed in November 2024 to clinics located in remote areas and to clinics and hospitals in t-remote areas. Results The questionnaire response rate was 35 % (290/823 clinics) in remote areas and 49 % (211/427 facilities) in t-remote areas. The median emergency transport time from blood centers to t-remote facilities was 70 min. Red blood cells were used in 3.1 % of remote area clinics, 87 % of t-remote area clinics, and 99 % of t-remote area hospitals. Emergency transfusions were performed in 0.3 %, 17 %, and 55 % of these facilities, respectively. Clinics generally transferred patients to other hospitals, whereas 67 % of t-remote area hospitals managed emergencies on-site. Blood products were not stored in clinics, whereas 36 % of t-remote area hospitals maintained red cell inventories, and 22 % requested blood rotation systems. Interfacility transfers were reported in 0.3 % of remote area clinics and approximately 6 % of t-remote area facilities, with about 20 % expressing a need for such a system. Fresh whole-blood transfusion was rare. Conclusion Overall, transfusion practices in remote area clinics were limited. In contrast, some t-remote area medical facilities require improved infrastructure to meet emergency transfusion demands.