Japanese public healthcare insurance claims are a promising population-scale dataset to offer tangible evidence for healthcare policy making. The dataset has employed a nested-tuple form, which no known techniques can efficiently transform to the standard relational data model. This paper explores the technical benefit of allowing vector attributes in the relational database for managing public healthcare insurance claims. The experiment with the commercial implementation and Japanese population-scale dataset confirms that the proposed approach performs much (up to 3.4 times) faster for analytical queries having compositive predicates, while it only needs 10% penalty time for data preprocessing and database import.
The inaugural hybrid virtual and in-person meeting of the Global Outbreak Alert and Response Network partners in the WHO Western Pacific Region convened on 20–21 November 2024 in Tokyo, Japan. Hosted by the National Centre for Global Health and Medicine and Japan's Ministry of Health, Labour and Welfare, the meeting aimed to enhance regional preparedness and response capabilities for emerging health threats, aligning with the Asia Pacific Health Security Action Framework. The meeting concluded with a consensus on the necessity for sustained engagement, expanded training programs, and strengthened research initiatives to fortify health security across the Western Pacific Region.
Background Atezolizumab plus bevacizumab therapy was recently introduced as the first line for unresectable advanced hepatocellular carcinoma (HCC), but immune-related adverse events (IrAEs) due to atezolizumab are a great concern. Here, we report the case of a patient who developed fatal acquired coagulation factor deficiency after hepatectomy for HCC, treated with atezolizumab and bevacizumab before surgery. Case presentation A 70-year-old man received right trisegmentectomy of the liver with hepaticojejunostomy for advanced HCC with bile duct invasion, after atezolizumab and bevacizumab therapy. The patient suffered the sudden onset of severe multiple coagulation factor deficiency (II, V, VII, VIII, IX, X, XI and XII) immediately following reoperation for anastomotic leakage of hepaticojejunostomy, 7 days after hepatectomy. The coagulation factor deficiency did not reverse even with intensive treatment, and the patient died of uncontrollable bleeding 32 days after hepatectomy. An IrAE due to atezolizumab was suspected because the patient had developed the possible IrAE of enthesitis of the right gastrocnemius muscle before surgery, and specific inhibitors against factor V and anti-factor V autoantibodies were detected, leading to an ultimate diagnosis of autoimmune FV/5 deficiency (AiF5D). Conclusion Severe acquired coagulopathy should be recognized as a possible life-threatening IrAE when using atezolizumab and bevacizumab for HCC.
