Cancer patients are considered highly susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, it is not well known when chemotherapy can be safely restarted in cancer patients after coronavirus disease 2019 . Here, we describe the case of an 18-year-old man diagnosed with primary mediastinal nonseminomatous germ cell tumor (PMNSGCT) in which chemotherapy could be safely restarted after COVID-19. On day 11 of the third cycle of bleomycin, etoposide, plus cisplatin (BEP), he was diagnosed with mild COVID-19. On day 16 after the onset of COVID-19 (day 26 of third cycle of BEP), chemotherapy for his PMNSGCT was restarted. He received surgery after the fourth cycle of BEP without recurrence of COVID-19. Chemotherapy could be restarted and followed by surgery in this post-COVID-19 patient who had experienced mild illness after the discharge criteria were met and all symptoms had disappeared. We report this case with a review of the literature on restarting chemotherapy after SARS-CoV2 infection.

Summary Triglyceride deposit cardiomyovasculopathy (TGCV) is an intractable disease characterized by massive triglyceride (TG) accumulation in the myocardium and coronary arteries caused by genetic or acquired dysfunction of adipose TG lipase (ATGL). A phase IIa trial has been conducted involving patients with idiopathic TGCV using CNT-01 (tricaprin/trisedecanion) by the Japan TGCV study group, which showed that CNT-01 improved myocardial lipolysis as demonstrated by iodine-123-beta-methyl iodophenyl-pentadecanoic acid (BMIPP) scintigraphy. We evaluated changes in myocardial TG content using proton magnetic resonance spectroscopy (1H-MRS) before/after CNT-01. This report describes a male patient with hypertension, diabetes, angina pectoris, repeated percutaneous coronary intervention, chest pain, and exertional dyspnea that persisted despite standard medications and nitroglycerin. Idiopathic TGCV was diagnosed based on a remarkably reduced washout rate (WR) for BMIPP scintigraphy, high myocardial TG content on 1H-MRS, and no ATGL mutation. After an 8-week, 1.5 g/day CNT-01 administration, the WR of BMIPP increased from 5.1 to 13.3% and the myocardial TG content decreased from 8.4 to 5.9%, with no adverse effects. CNT-01 corrected myocardial lipolysis and subsequently reduced TG content in idiopathic TGCV as evaluated using 1H-MRS, which may be a useful, noninvasive evaluation of therapeutic efficacy. Learning points Triglyceride deposit cardiomyovasculopathy (TGCV) is an intractable disease characterized by massive triglyceride accumulation in the myocardium and coronary arteries, caused by genetic or acquired dysfunction of adipose triglyceride lipase. Japan TGCV Study Group developed a specific treatment for idiopathic TGCV using CNT-01 (tricaprin/trisedecanion), a type of medium-chain fatty acid. CNT-01 corrected myocardial lipolysis and reduced TG content in idiopathic TGCV using proton magnetic resonance spectroscopy, which may be a useful noninvasive evaluation of therapeutic efficacy.

Asymmetric septal hypertrophy (ASH) is the most common phenotype of hypertrophic cardiomyopathy (HCM). However, the difference between myocardial metabolism and myocardial features such as myocardial fibrosis and myofiber disarray in HCM remains unclear. Cardiac magnetic resonance (CMR) and proton magnetic resonance spectroscopy (1H-MRS) were performed on 16 patients diagnosed as HCM with ASH to assess the differences in myocardial features and morphology. There were 7 patients who had LGE in ASH localized with the voxel of 1H-MRS. The LV ejection fraction was significantly lower in the LGE (+) group than in the LGE (−) group (64.8% ± 4.9% vs. 72.1% ± 3.8%, P = 0.004). LV end-systolic volume was significantly greater in the LGE (+) group than in the LGE (−) group (51 ± 11 ml vs. 33 ± 12 ml, P = 0.007). A significant difference in MTG content was observed between patients in the LGE (+) group and in the LGE (−) group (0.58% ± 0.22% vs 1.29% ± 0.73%, P = 0.03). MTG content was significantly associated with LV ejection fraction, LV end systolic volume, and LV mass. In multivariate analyses, LV ejection fraction had an independent association with MTG content (P = 0.01) Our data suggest that the metabolism of the septum in HCM with ASH may be different based on the absence or presence of LGE and that measurement of MTG content by 1H-MRS may be useful to evaluate the characteristics of myocardial metabolic changes caused by the LV remodeling process in HCM. (248 words)

Background: Although lung ultrasound has been reported to be a portable, cost-effective, and accurate method to detect pneumonia, it has not been widely used because of the difficulty in its interpretation. Here, we aimed to investigate the effectiveness of a novel artificial intelligence-based automated pneumonia detection method using point-of-care lung ultrasound (AI-POCUS) for the coronavirus disease 2019 (COVID-19).Methods: We enrolled consecutive patients admitted with COVID-19 who underwent computed tomography (CT) in August and September 2021. A 12-zone AI-POCUS was performed by a novice observer using a pocket-size device within 24 h of the CT scan. Fifteen control subjects were also scanned. Additionally, the accuracy of the simplified 8-zone scan excluding the dorsal chest, was assessed. More than three B-lines detected in one lung zone were considered zone-level positive, and the presence of positive AI-POCUS in any lung zone was considered patient-level positive.Results: A total of 577 lung zones from 56 subjects (59.4 ± 14.8 years, 23% female) were evaluated using AI-POCUS. The mean number of days from disease onset was 9, and 14% of patients were under mechanical ventilation. The patient-level accuracy of 12-zone AI-POCUS for detecting CT-validated pneumonia was 94.5%, sensitivity was 92.3%, and specificity was 100%. When simplified with 8-zone scan, the accuracy, sensitivity, and sensitivity were 83.9%, 77.5%, and 100%, respectively. The zone-level accuracy, sensitivity, and specificity of AI-POCUS were 65.3 %, 37.2%, and 97.8 %, respectively.Interpretation: AI-POCUS using the novel pocket-size ultrasound system showed excellent agreement with CT-validated COVID-19 pneumonia, even when used by a novice observer.

Background: The aim of this study was to evaluate the clinical performance of a newly developed automated immunoassay HISCL SARS-CoV-2 Antigen assay kit designed to detect the nucleocapsid (N) protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: The HISCL SARS-CoV-2 Antigen assay kit is composed of automated chemiluminescence detection systems. Western blot analysis confirmed that anti-SARS-CoV antibodies detected SARS-CoV-2 N proteins. The best cut-off index (COI) was determined using human serum samples obtained from coronavirus disease-2019 (COVID-19) patients and patients without COVID-19. To test the clinical performance, 115 samples obtained from 46 patients with COVID-19 and 69 individuals who tested negative for COD-19 using reverse transcription quantitative polymerase chain reaction (RT-qPCR) were used. Results: The HISCL antigen assay kit showed a sensitivity of 95.4 % in the samples with copy numbers of >100, and a sensitivity of 16.6 % in the samples with copy numbers of <99. The kit did not cross-react with other human corona viruses causing seasonal common cold (HCoV 229E, OC43, NL63, and HKU1) and influenza (H1N1, H3N2, and B), and none of the 69 individuals with negative RT-qPCR results were diagnosed as positive. Importantly, 81.8 % of the samples with low virus load (<50 copy numbers) were diagnosed as negative. Thus, use of the HISCL antigen assay kit may reduce overdiagnosis compared with RT-qPCR tests. Conclusion: The rapid and high-throughput HISCL SARS-CoV-2 Antigen assay kit developed in this study can be used as a suitable screening test for infectious COVID-19, and may play a role in controlling the pandemic.