Single-incision laparoscopic cholecystectomy:Single institution experience and literature review

Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery.We report one of the initial clinical experiences in Japan with this new technique.Four cases of gallbladder diseases were selected for this new technique.A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus.A 12-mm trocar was placed through an open approach,and the abdominal cavity was explored with a 10-mm semiflexible laparoscope.Two 5-mm ports were inserted laterally from the laparoscope port.A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder.Dissection was performed using an electric cautery hook and an Endograsper roticulator.There were two women and two men with a mean age of 50.5 years(range:40-61 years).All procedures were completed successfully without any perioperative complications.In all cases,there was no need to extend the skin incision.Average operative time was 88.8 min.Postoperative follow-up didnot reveal any umbili-cal wound complication.Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.

Classifying genotype F of hepatitis B virus into F1 and F2 subtypes

AIM： To explore the propriety of providing hepatitis B virus （HBV） genotypes F and H with two distinct genotypes. METHODS： Eleven HBV isolates of genotype F （HBV/F） were recovered from patients living in San Francisco, Japan, Panama, and Venezuela, and their full-length sequences were determined. Phylogenetic analysis was carded out among them along with HBV isolates previously reported. RESULTS： Seven of them clustered with reported HBV/F Isolates in the phylogenetic tree constructed on the entire genomic sequence. The remaining four flocked on another branch along with three HBV isolates formerly reported as genotype H. These seven HBV isolates, including the four in this study and the three reported, had a sequence divergence of 7.3-9.5% from the other HBV/F isolates, and differed by 〉13.7% from HBV isolates of the other six genotypes （A-E and G）. Based on a marked genomic divergence, falling just short of 〉8% separating the seven genotypes, these seven HBV/F isolates were classified into F2 subtype and the former seven into F1 subtype provisionally. In a pairwise comparison of the S-gene sequences among the 7 HBV/F2 isolates and against 47 HBV/F1 isolates as well as 136 representing the other six genotypes （A-E and G）, two clusters separated by distinct genetic distances emerged.CONCLUSION： Based on these analyses, dassifying HBV/ F isolates into two subtypes （F1 and F2） would be more appropriate than providing them with two distinct genotypes （F and H）.

Acute Exacerbation of Liver Disease Induced by Pegylated Interferon Alpha2a Treatment for Chronic Hepatitis C

A 66yearold female was referred to a local clinic for the treatment of chronic hepatitis C. Her family physician started the administration of PegIFN alpha2a in combination with ribavirin in September, 2008. Three months after the commencement of the therapy, alopecia was noted, and it gradually worsened. She also complained of general fatigue. Since her alopecia and general fatigue continued to worsen, her family physician decided to discontinue the PegIFN plus ribavirin therapy in February, 2009. On April 5, the patient complained of severe general fatigue as well as fever, and she was referred to the local clinic again. Blood chemistry tests demonstrated that her AST level increased from 200 IU on April 5 to 1000 IU on April 9 but her HCV RNA level stayed at 4.1 logIU/mL. Based on the findings of an elevated IgG level (2244 mg), AST/ALT > 1.5, and weak positivity for antismooth muscle antibody (1:40), an autoimmune mechanism was considered as the etiology of her liver damage. Despite treatment with 60 ml of glycyrrhizin, 1 g of gabexate mesylate, and 500 mg of methylprednisolone, she died on April 23. PegIFN induced acute liver failure is quite rare, but clinicians should aware of this lifethreatening side effect during and after interferon therapy.

Rapid detection of neutralizing antibodies to SARS-CoV-2 variants in post-vaccination sera

The uncontrolled spread of the coronavirus disease 2019(COVID-19)pandemic has led to the emergence of different severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)variants across the globe.The ongoing global vaccination strategy to curtail the COVID-19 juggernaut is threatened by the rapidly spreading variants of concern(VOC)and other regional mutants,which are less responsive to neutralization by infection-or vaccine-derived antibodies(Gomez et al.,2021;Wang et al.,2021).