PurposeTo evaluate the efficacy and safety of self‐injections of the prefilled recombinant human chorionic gonadotropin (r‐hCG) in a syringe in assisted reproductive technology (ART) treatment for the maturation trigger (MT), as compared to self‐injections of conventional hCG and intranasal administration of gonadotropin‐releasing hormone agonist (GnRH‐a).MethodsBetween January and April, 2017, 396 patients who underwent oocyte retrieval were recruited. Of these, 396 patients were classified into three groups, according to the types of MT: (1) the urinary human chorionic gonadotropin (u‐hCG) group that consisted of patients who had a self‐injection of u‐hCG (n = 127); (2) the GnRH‐a group that received nasal administration of GnRH‐a (n = 159); and (3) the r‐hCG group that had a self‐injection of r‐hCG (n = 110). Several ART outcomes were evaluated.ResultsThe mature oocyte retrieval rate was not different between the u‐hCG, r‐hCG, and GnRH‐a groups and the fertilization and cleavage rates were similar between the three groups. The clinical pregnancy rates did not significantly differ between the GnRH‐a group and the u‐hCG group; however, it was significantly lower in the GnRH‐a group, compared to the r‐hCG group. No difference was observed in the incidence of moderate or more severe ovarian hyperstimulation syndrome among the three groups.ConclusionThe self‐injection of the prefilled r‐hCG is a favorable MT for ART patients.

Rationale: Coronavirus disease (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 virus, was reported in Wuhan of China in December 2019. The world is still in a state of pandemic owing to COVID-19. COVID-19 vaccines help our bodies develop immunity against the virus that causes COVID-19 without having to get the illness. Herein, we describe a rare case of a critical disorder, hemophagocytic lymphohistiocytosis (HLH), in a patient with nephritic sclerosis associated with hypertension, following mRNA COVID-19 vaccination. HLH is a life-threatening hyperinflammatory syndrome caused by aberrantly activated macrophages and cytotoxic T cells that may rapidly progress to terminal multiple organ failure.Patient concerns: An 85-year-old Japanese woman with chronic renal failure and hypertension was included in this study. Routine laboratory investigations provided the following results: white blood cell (WBC) count, 4.6 × 10 9 /L; hemoglobin (Hb), 8.1 g/ dL; platelet count, 27 × 10 9 /L; blood urea nitrogen 48.9 mg/dL, and serum creatinine 3.95 mg/dL. The patient developed malaise, vomiting, and persistent high fever (up to 39.7°C) on the 12 th day after receiving the second dose of the vaccine. Initial evaluation revealed neutropenia. The total WBC count was 0.40 × 10 9 /L (Neutrophils 0, Lymphocytes 240/μ, blast 0%); Hb 9.0 g/dL, platelet count 27 × 10 9 /L; and, C Reactive Protein 9.64 mg/dL.Diagnosis: Further tests showed hyperferritinemia (serum ferritin 2284.4 μg/L). Bone marrow examination revealed haemophagocytosis. A provisional diagnosis of HLH associated with the Comirnaty ® vaccination was made based on the HLH-2004 diagnostic criteria. Interventions:The patient was treated with granulocyte colony-stimulating factor and 500 mg methylprednisolone.Outcomes: A significant improvement was observed in the patient's condition; the abnormal laboratory results resolved gradually, and the patient was discharged.Lessons: This case serves to create awareness among clinicians that HLH is a rare complication of COVID-19 vaccination and should be considered, especially in patients with a history of chronic renal failure and hypertension.

Poorly differentiated adenocarcinoma of colorectal carcinoma (CRC) is a rare condition with poor prognosis. Here, we describe the case of a 69-year-old man who underwent laparoscopic low anterior resection and was pathologically diagnosed with stage IIIA CRC. At 10 months post-operation, he developed fever and loss of appetite. Laboratory examination revealed fibrin degradation products > 120.0 µg/dL and D-dimer > 60.0 µg/dL. Bone marrow (BM) examination showed malignant epithelioid infiltrate with CK20 and CDX2 expression, leading to a diagnosis of disseminated carcinomatosis of bone marrow, which is rare in CRC and indicates widespread disease is throughout the body. Furthermore, immunohistochemistry indicated the predominant expression of receptor activator of nuclear factor κB ligand (RANKL) in CRC and BM tissues. Thus, RANKL expression, which is known to indicate metastatic behavior of cancer cells, in CRC may play a critical role in promoting osteoclast formation, which has been associated with the pathogenesis of BM lesions.

Poorly differentiated adenocarcinoma of colorectal carcinoma (CRC) is a rare condition with poor prognosis. Here, we describe the case of a 69-year-old man who underwent laparoscopic low anterior resection and was pathologically diagnosed with stage IIIA CRC. At 10 months post-operation, he developed fever and loss of appetite. Laboratory examination revealed brin degradation products > 120.0 µg/dL and D-dimer > 60.0 µg/dL. Bone marrow (BM) examination showed malignant epithelioid in ltrate with CK20 and CDX2 expression, leading to a diagnosis of disseminated carcinomatosis of bone marrow, which is rare in CRC and indicates widespread disease is throughout the body. Furthermore, immunohistochemistry indicated the predominant expression of receptor activator of nuclear factor κB ligand (RANKL) in CRC and BM tissues. Thus, RANKL expression, which is known to indicate metastatic behavior of cancer cells, in CRC may play a critical role in promoting osteoclast formation, which has been associated with the pathogenesis of BM lesions.

A 71-year-old man with an 18-year history of hemodialysis was admitted to our hospital because of lumbar spinal stenosis and underwent L3-L5 posterior laminectomy. On the 9th day after the operation, 30 minutes after hemodialysis was started, he noted right upper abdominal pain that suddenly worsened. He had a slight bulge in the abdomen and strong tenderness, and hemorrhaging in the abdominal wall was suspected because Carnett's sign was positive. Abdominal ultrasonography (Picture 1) and computed tomography (Picture 2) were performed. He was diagnosed with rectus sheath hematoma (RSH), a spindle-shaped hematoma centered on the right rectus abdominis muscle. As his hemodynamics were stable and no rapid progression of anemia was observed, we performed conservative treatment, after which the hematoma shrank without rebleeding. Risk factors of RSH, including anticoagulants, aging, cough, trauma, and obesity, have been reported (1, 2). In our case, heparin use and compression by a corset were believed to be involved in the development.