Cases Of WHO Research Articles

The Shortcomings of International Organizations in Addressing the Challenge of COVID-19 - The Cases of WHO and WTO

Under the influence of COVID-19, the shortcomings of some international organizations were exposed. This paper focused on the problems of the WHO and WTO in responding to COVID-19 and made suggestions. Lack of power and funding was a major reason for the WHOs failure in responding to COVID-19. Accordingly, we believed that the WHO should establish powerful authority and reform its funding mechanism as soon as possible. In the case of the WTO, although the WTO took some action in response to COVID-19, the shortcomings of the existing treaties, the Trade Policy Review Mechanism, and the Agreement on Trade-related Aspects of Intellectual Property limited the role of it. In addition, Looseness among members was also an issue that the WTO needed to address. Therefore, the WTO needed to do the following: first, clarify the ambiguous concepts in the existing treaties; second, develop new treaties; third, reform the TPRM; and fourth, solve the problems in the TRIPS agreement.

2 Cases of Vestibular Dysfunction Who Improved with Yanggumhwa Pharmacopuncture Treatment

2 Cases of Vestibular Dysfunction Who Improved with Yanggumhwa Pharmacopuncture Treatment

3 Cases of Trigeminal Neuralgia Patient Who Improved with Acupotomy and Oriental Medicine Combination Treatment

3 Cases of Trigeminal Neuralgia Patient Who Improved with Acupotomy and Oriental Medicine Combination Treatment

Patterns of local failure in patients with high-grade glioma after postoperative radiotherapy with or without chemotherapy

BackgroundTo retrospectively analyze the failure patterns of postoperative adjuvant chemoradiotherapy for high-grade glioma (HGG) under the new WHO classification, particularly focusing on relationship of recurrence pattern and molecular subtypes.MethodsThis retrospective study was conducted in Ruijin Hospital of Shanghai Jiaotong University from April 2014 to April 2018. A total of 56 patients diagnosed as WHO III–IV were included. Patients, who underwent pathological typing according to the 2016 WHO Classification of Tumors of the Central Nervous (CNCS), including tumor grade and IDH status. We collected the basic data. The initial relapsed T1 enhancement MRI imaging was transferred and fused to the original treatment planning CT. The tumors were classified as in-field, marginal, or out-field if greater than 80%, 20–80%, or less than 20% of the recurrent volume fell within the 95% isodose line, respectively.ResultsThe median overall survive was 22.0 months (95% CI: 16.7–27.2). The 1-, 2-, and 3-year survival rates were 85.8%, 43.9%, and 28.8%, respectively. Thirty-three (58.9%) patients progressed with a median progression survival of 15.9 (95% CI: 12.9–19.0) months. Of 33 patients experienced recurrence, 22 (66.7%) had in-field recurrence within a 9.3-month median period (range, 3–32.7 months), and 3 patients (9.1%) were respectively marginal recurrence occurred at 5.9, 6.4, and 15 months, and 6 patients (18.2%) developed out-field progression at a median of 16.1 (4.5–27.1) months, and 2 patients developed both in- and out-field recurrence (6.1%) at 3.2, 4.7 months, respectively. There were16 cases of WHO III, 40 cases of WHO IV, 13 cases of IDH mutation (IDHmt), 30 cases of wildtype (wt) and 13 cases of NOS. The incidence of recurrence of IDHmt (4 cases, 30%) was significantly lower than that of IDHwt (19 cases, 63.3%) and IDH NOS (10 cases, 76.9%) (P=0.001). Local recurrence (in the field and margin) of radiotherapy was 16 cases (84.2%) of IDHwt and 2 cases (50%) of IDHmt type (P=0.05).ConclusionsIn this study, we highlighted the importance of genomic research on identifying local failure patterns and providing recommendations of target delineation for HGG treatment. IDHwt HGG had a higher probability of in-field recurrence after radiotherapy, and RTOG target delineation guide was appropriate, while EORTC guidelines were recommended to IDHmt HGG. Further investigations in prospective randomized clinical trials were warranted to confirm our results.

Is rapid diagnostic test (malaria Pv/Pf Ag card test) reliable in diagnosing malaria

Background: Malaria is a protozoan disease transmitted by the bite of infected female anopheles mosquitoes is one of the most important parasitic diseases of human with transmission in 109 countries, affecting more than one billion people worldwide. This study was planned to compare the gold standard i.e. peripheral blood smear examination and the newer rapid diagnostic test (malaria plasmodium falciparum/ plasmodium vivax antigen card) to know the diagnostic accuracy of Rapid Diagnostic Test (RDT) kits. Methods: All the suspected cases of WHO defined malaria between 1month to 18 years of age were enrolled in the study.Results: Out of 96 clinically suspected cases of malaria 63 were confirmed by peripheral smear. The age range of participants ranged from 4 months to 17 years. On peripheral smear examination, out of 96 clinically suspected cases, 37 (38.5%) cases were positive for P. vivax, 23 (23.9%) were positive for P. falciparum and 3 (3.1%) were positive for both parasites by microscopy. Sensitivity and specificity of RDT for Plasmodium Vivax is 92.5% and 96.4% respectively. Sensitivity and specificity of RDT for Plasmodium Falciparum is 96.2% and 90%.Conclusions: The rational use of RDTs as a complement to microscopy might give substantial health benefits through earlier treatment, reduction in morbidity and mortality and more rationalized approach for choosing anti-malarial drugs, which in terms may prevent drug resistance.

Electroencephalographic Finds - EEG According To 13 Cases of Patients Who Are Cocaine Chronic Users In Comparison To A Healthy Control Group of 10 Patients With Similar Characteristics

Electroencephalographic Finds - EEG According To 13 Cases of Patients Who Are Cocaine Chronic Users In Comparison To A Healthy Control Group of 10 Patients With Similar Characteristics

2週間の監視下運動療法後に自己申告チェックリストを用いた非監視運動療法にて3カ月間の歩行距離維持が可能であった間歇性跛行の2例

2週間の監視下運動療法後に自己申告チェックリストを用いた非監視運動療法にて3カ月間の歩行距離維持が可能であった間歇性跛行の2例

Molecular-genetic and clinical characteristics of gliomas with astrocytic appearance and total 1p19q loss in a single institutional consecutive cohort.

The prognostic significance of 1p19q loss in astrocytic gliomas has been inconclusive.We collected 57 gliomas with total 1p19q loss from among 218 cases of WHO grade-II/III gliomas operated at Keio University Hospital between 1990 and 2010. These tumors were classified as oligodendroglial or "astrocytic" by a WHO-criteria-based institutional diagnosis. Chromosomal copy number aberrations (CNAs), IDH 1/2 mutations, MGMT promoter methylation, and expression of p53 and ATRX were assessed. Survival outcome was compared between the two histological groups.Of the 57 codeleted gliomas, 37, 16, and four were classified as oligodendroglial, "astrocytic", and unclassified, respectively. Comparative genomic hybridization revealed that although chromosome 7q/7 gain was more frequent in "astrocytic" gliomas, other CNAs occurred at a similar frequency in both groups. None of the "astrocytic" gliomas showed p53 accumulation, and ATRX loss was found in three of the 15 "astrocytic" gliomas. The estimated overall survival (OS) curves in the patients with codeleted oligodendroglial and "astrocytic" gliomas overlapped, and the median OS was 187 and 184 months, respectively. Histopathological re-assessment by a single pathologist showed consistent results.Gliomas with total 1p19q loss with "astrocytic" features have molecular and biological characteristics comparable to those of oligodendroglial tumors.

Diagnostic and prognostic value of IDH1 mutation in gliomas

Objective To discuss the significance of IDH1 mutation for diagnosis and prognosis of gliomas through detecting of IDH1 mutation in supratentorial glioma cells. Methods IDH1 genes of postoperative pathological samples obtained from 315 patients with supratentorial gliomas (3 cases of WHO Ⅰ, 95 cases of WHO Ⅱ, 37 cases of WHO Ⅲ and 180 cases of WHO Ⅳ) were collected for DNA extraction, on which PCR amplification and direct sequencing were done. At the same time, multiple⁃factor analysis was used on those patients' age, sex, tumor location, excision extension, Karnofsky Performance Status (KPS) and progression⁃free survival time or median survival time, to investigate the influence of IDH1 mutation on the prognosis of patients. Results A total of 112 gene mutations among 315 cases (35.56%) were found and they were all R132H type of mutations. Mutation rates in WHOⅡ, Ⅲ and Ⅳ gliomas were 72.63% (69/95), 24.32% (9/37) and 18.89% (34/180) respectively, which were significantly different (P = 0.000, for all). Among patients with IDH1 mutations in WHOⅣ gliomas, there were 18 cases of primary glioblastoma and 16 cases of secondary glioblastoma, the mutation rates of which were 11.39% (18/158) and 72.73% (16/22), respectively. The latter was much higher than the former and the difference was statistically significant ( χ 2 = 23.654，P = 0.001). Survival analysis revealed that IDH1 mutation presented notable effect on the prognosis of patients with gliomas. Conclusion IDH1 mutation can happen in WHO Ⅱ, Ⅲ and Ⅳ gliomas, and the mutation rates of WHOⅡ gliomas and secondary glioblastomas of WHO Ⅳ are higher than others. The survival time of patients are remarkably influenced by IDH1 mutation, and the prognosis of patient with IDH1 mutation is good, which may suggest that IDH1 mutation is an important diagnostic and prognostic biomarker in different grades of gliomas． DOI：10.3969/j.issn.1672⁃6731.2012.06.015

RhG-CSF療法によって完全寛解, 部分寛解を得た再生不良性貧血の2例

rhG-CSF療法によって完全寛解, 部分寛解を得た再生不良性貧血の2例

Expression of Zonulin, c-kit, and Glial Fibrillary Acidic Protein in Human Gliomas

The hallmarks of human malignant gliomas are their marked invasiveness and vascularity. Because angiogenesis and tumor invasion have been associated with extracellular matrix degradation and intercellular tight junctions, the involvement of zonulin in glioma biology is in the focus. We selected for histological examination five cases of glioblastoma WHO IV (nomenclature of the World Health Organization) and one case each from astrocytoma WHO III, meningioma WHO III, and meningioma WHO I as control samples. The meningioma WHO I is regarded as benign, whereas the meningioma WHO III is recognized as the transition form of malignant tumors in humans. The visualization of a newly designed antibody against human zonulin was studied in triple-labeling studies using fluorescence immunocytochemistry and compared with the expression of c-kit and glial fibrillary acidic protein in differently developed human gliomas. We found that increasing the expression of c-kit is accompanied by an increase of zonulin expression. Both are correlated to the degree of malignancy of human brain tumors. The expression of zonulin is correlated to the degradation of the blood-brain barrier as revealed by Griffonia simplicifolia lectin. In differently graded tumors, we found differently graded involvement of blood vessels in the tumor development, explaining patients' survival.

Two Cases of Congenital Myotonic Dystrophy Who Complained Delayed Development

Two Cases of Congenital Myotonic Dystrophy Who Complained Delayed Development

救命しえた壊死型虚血性大腸炎の３例

虚血性腸炎は，一般に保存的に軽快するが，壊死型は不可逆的で緊急手術適応である．原因は，動脈硬化など血管因子と便秘·細菌など腸管因子が関与するとされるが，特定し難い．我々は，救命しえた3例の壊死型虚血性大腸炎を経験し，非閉塞性腸管虚血症(NOMI）との関連を検討した．3例の虚血部位は，いずれも下腸間膜動脈領域に限局し，30, 70, 60時間後に全身状態の改善を待って壊死腸管切除を施行した．術後，3例それぞれ腸管内圧上昇·外傷性ショック·腸内細菌，糖尿病による動脈内膜肥厚·狭小化と便秘·腸内細菌，動脈硬化の進行による狭義の腸管虚血症の悪化と便秘が推定された． 一方，NOMIは，心疾患など高危険群を原因に血管攣縮の結果，再灌流障害から広範に壊死に至る疾患で，診断·治療には血管造影も有効とされる．治療法，生存率，術後Quality of life(QOL）を評価するために，二者の定義を明確にする必要があると思われた．

Study of correlation between expression of bradykinin B2 receptor and pathological grade in human gliomas

In clinical practice there is a difference in response of the blood-tumour barrier (BTB) permeability induced by bradykinin in brain tumours with the same pathology. The variability in response of tumours to bradykinin is likely to be related to the expression level of bradykinin B2 receptor. This study used fresh human glioma samples to determine the expression level of bradykinin B2 receptor on gliomas with different pathological grades. The grade of tumour was classified using the WHO classification. To determine the bradykinin B2 receptor expression level in gliomas, Immunohistochemistry and Western blot methods were used. In 24 cases of gliomas there were eight cases of WHO I glioma, eight cases of WHO II glioma and eight cases of WHO III glioma. Both Western blot and immunohistochemistry showed bradykinin B2 receptors localized on tumour cells, whilst brain cells at the edge of the glioma hardly expressed B2 receptor. There were significant differences of bradykinin B2 receptor expression level among different pathological grades of glioma. The expression of B2 receptor in the three grades of glioma was in the order of WHO I < WHO II < WHO III. Determination of bradykinin B2 receptor expression level in human glioma may be useful in screening glioma patients to predict whether they will be suitable for opening of the blood – tumour barrier with bradykinin or its analogue.

Two Cases of Kawasaki-Disease Who Showed Coronary Arterial Dilatation Even after Good Response to a Single High-dose Intravenous Immunoglobulin Infusion

It is now clear that a high-dose intravenous immunoglobulin therapy (IVIG) in patients with Kawasaki disease (KD) is effective for reducing the incidence of coronary arterial lesions (CAL). But both the total dose and the dose regimens of IVIG are still controversial.In this study, we report two cases with CAL in KD. These two cases were treated with aspirin (30mg/kg/day) and a single high-dose IVIG (1g/kg/day) on 5th day of illness. IVIG reduced their body temperature immediately to less than 37.5°C on 6th day of illness, so we did not add IVIG. Although they did not get high fever, and both the counts of white blood cells and the levels of C-reactive protein decreased after IVIG, their coronary arteries dilated gradually. In one case, the diameter of anterior descending branch of left coronary dilated to 4.0mm. In the other case, that of left main coronary artery dilated to 5.8mm. We confirmed these changes regressed to normal by either 2DE or selective coronary angiography after three months of onset. These cases suggest that a single high-dose IVIG (1g/kg/day) can not prevent CAL in KD, even after good response to IVIG.

Deletion mapping of chromosome 19 in human gliomas.

There is evidence that a putative glioma tumor suppressor locus resides on the long arm of chromosome 19. We present data on 161 gliomas from 156 patients, which were studied by microsatellite analysis for loss of heterozygosity (LOH) on chromosome 19. Eight loci on the long arm and 2 loci on the short arm of chromosome 19 were examined. LOH on 19q was observed in 3/19 astrocytomas (WHO grade II), 12/27 anaplastic astrocytomas (WHO grade III), 16/76 cases of glioblastoma multiforme WHO (grade IV), 4/9 oligodendrogliomas (WHO grade II), 3/5 anaplastic oligodendrogliomas (WHO grade III), 5/9 mixed oligo-astrocytomas (WHO grade II) and 8/10 anaplastic oligo-astrocytomas (WHO grade III). While 31 of the tumors with LOH on chromosomal arm 19q exhibited allelic loss at every informative locus, 20 tumors showed terminal or interstitial deletions. In contrast to astrocytomas and glioblastomas, tumors with an oligodendroglial component had predominantly lost the entire long arm of chromosome 19. The common region of overlap in gliomas was located on 19q13.2-q13.4 between the markers D19S178 and D19S180. Our data confirm the involvement of a putative tumor suppressor gene on chromosomal arm 19q in gliomas and assign this gene to 19q13.2-q13.4.

中心静脈栄養カテーテルによる乳児真菌性心内膜血栓症の 2 症例

中心静脈栄養カテーテルによる乳児真菌性心内膜血栓症の 2 症例

Histopathological subgrouping of WHO II urothelial neoplasms by cytophotometric measurements of nuclear atypia.

The grade of nuclear atypia was objectively assessed in 21 cases of non-invasive WHO II transitional cell bladder neoplasm. Measurements were performed by stage scanning absorbance cytophotometry, registering nuclear optical density, nuclear area, and the variability of these two factors, in 5 microns thick Feulgen-stained paraffin sections. The material was subgrouped into a 2- and a 2+ group according to the degree of histopathological atypia. Cytophotometrically determined atypia showed close correlation to the subjectively judged atypia, and there was no overlap between 2- and 2+. A difference in tumour ploidy level between different WHO II tumours is the most likely explanation of the grouping recorded.

World malaria situation.

In 99 countries or areas of the world, more than 40% of the population is at risk of acquiring malaria. Falciparum malaria does not exist or is not a problem in just 13 countries or areas. 9% of the population live in areas, chiefly in sub-Saharan Africa, where no national malaria program operates and malaria incidence is still high. Global incidence is about 120 million cases (80% in sub-Saharan Africa) and almost 300 million people (90% in sub-Saharan Africa) have the parasite. Reporting of malaria cases of WHO is improving, but is still variable. In north Africa, Libya and Tunisia appear to be free from malaria transmission. Number of cases in Egypt is falling and tend to be in El Faiyum Governorate. 53% of all cases in the Americas are in Brazil (almost 99% in Amazonia), 25% from Andean countries (especially Columbia and Ecuador), and 14% from Central America. Malaria transmission in the Caribbean is limited to Hispaniola. Even though most malaria cases are in Brazil, French Guiana and Guyana have the highest incidence (52 and 40 cases per 1000 people, respectively). Bahrain, Cyprus, Israel, Jordan, Kuwait, Qatar, and Lebanon are free of endemic malaria. Yet malaria transmission did occur in the Kerak Lowlands of Jordan in 1990, but remedial measures quickly eliminated the focus. Malaria cases still occur in Afghanistan, Pakistan, Iran, Oman, Saudi Arabia, Yemen, the United Arab Emirates, and Syria. India has more than 33% of the malaria cases outside of Africa. Except for the Maldives, the other south Asian countries continue to have malaria transmission. In east Asia and Oceania, the countries which continue to have malaria transmission are Thailand, Indonesia, Viet Nam, some areas of China, Cambodia, Laos, Myanmar, Papua New Guinea, Vanuatu, Solomon Islands, Malaysia, and Philippines. In Turkey, endemic malaria occurs in the southeast (Adana and southeast Anatolia) and at limited other foci. There are also small foci of endemic malaria in Azerbaijan and Tajikistan.