BACKGROUND: Icaridin and DEET are common insect repellents widely used on human skin and clothing (skin-insect repellents [skin-IR]) to repel common pests, such as mosquitoes and biting flies. Novel analytical methods for urinary skin-IR exposure biomarkers that can be effectively applied in epidemiological studies and provide strong evidence related to risk assessment associated with daily exposure are required. In this study, we aimed to develop a method for analyzing the concentrations of icaridin, DEET, and two DEET metabolites N,N-diethyl-3-(hydroxymethyl) benzamide and 3-(diethylcarbamoyl) benzoic acid in human urine. METHODS: In this analysis, after formic acid-induced acidification of the urine sample, exposure biomarkers were extracted using solid-phase extraction composed of a modified polystyrenedivinylbenzene polymer for reversed phase (hydrophobic) retention. Subsequently, high-performance liquid chromatography-tandem mass spectrometry was performed within 10 min for a separation analysis. The present method was applied to five Japanese adults (aged 20-43 years) who used icaridin or DEET-containing products within a week. RESULTS: Limits of detection were 0.06-0.11 µg/L. Extraction recoveries were 74%-88%. The intraday and interday variations were 1.5-17.5 and 0.9-15.8% relative standard deviation, respectively. All exposure biomarkers were successfully detected in all five adults. Urinary concentrations of exposure biomarkers reached their maximum values within 15 h after starting to use skin-IR. CONCLUSIONS This method was successful in measuring urinary exposure biomarkers of skin-IR, including icaridin and DEET. Moreover, this study presents the first application of biomonitoring of urinary icaridin concentrations after using a commercial product.
Humans ; Solid Phase Extraction/methods* ; Tandem Mass Spectrometry/methods* ; Adult ; Insect Repellents/urine* ; DEET/urine* ; Young Adult ; Male ; Japan ; Female ; Chromatography, Liquid ; Biomarkers/urine* ; Chromatography, High Pressure Liquid ; East Asian People

Background: The COVID-19 pandemic disrupted healthcare delivery worldwide, including dental services. In Japan, the burden and age-specific patterns of dental anesthesia use have not been quantified. We aimed to describe national trends in dental sedation and general anesthesia (GA) in Japan from fiscal year (FY) 2019 (pre-pandemic baseline) through FY 2023 using aggregated claim-level data from the National Database Open Data Japan and interpret these trends in the context of COVID-19-related healthcare constraints. We compared the age distributions of patients who underwent GA in dentistry and medicine. Methods: This analysis used aggregated claim counts from the National Database Open Data (FY 2019–FY 2023). Sedation and GA categories were defined using reimbursement codes: inhalation sedation (K002), intravenous sedation interpreted as conscious or moderate sedation (K003), intravenous anesthesia interpreted as deep sedation (L001–2), and GA (L008). Outcomes were annual claim counts, relative indices standardized to FY 2019 (=100), and age-stratified distributions in 5-year groups (0–4 years to ≥90 years). Age distributions for GA were visualized as mirrored pyramids in dentistry and medicine. No inferential tests were performed. Results: Inhalation sedation increased by approximately 7% in FY 2023. Intravenous sedation increased substantially by 68%. Intravenous anesthesia declined sharply in FY 2020, the first pandemic year, and then plateaued. Dental GA decreased in FY 2020, recovered, and expanded to 110,000 claims by FY 2023 (relative index: 122.3).Dental GA showed a bimodal age distribution (peaking at 5–9 years and 15–29 years), whereas medical GA were concentrated at 70–85 years, indicating distinct modality- and sector-specific demand structures. Conclusion Using claims tabulations spanning the pre-pandemic, pandemic, and “with-COVID” phases, we found heterogeneous trajectories in dental sedation and GA in Japan, characterized by robust growth in conscious or moderate sedation and recovery and expansion of dental GA after an initial 2020 decline. The divergent GA age distributions between dentistry and medicine underscore fundamentally different demand profiles.Interpreted within the context of COVID-19, these modality- and age-specific patterns highlight the adaptive and resilient responses of Japan’s dental anesthesia services under pandemic-related constraints and provide a foundation for future policy and workforce planning.

Purpose: To describe a patient receiving maintenance hemodialysis complicated with calcific uremic arteriolopathy (calciphylaxis) in whom ulcer pain control was successfully achieved by buprenorphine. Case: A 75-year-old man was admitted due to intractable, extreme pain, which was accompanied by skin ulcers of the lower extremities. By a series of examinations including skin biopsy, the lesion was diagnosed to be calcific uremic arteriolopathy. The pain was not controllable with non-steroidal anti-inflammatory drugs and even by the nerve block. Buprenorphine, a partial agonist for the opioid receptor, markedly alleviated the mixed pain which was attenuated from Numerical Rating Scale (NRS) 10/10 to 0-2/10. Conclusion: Buprenorphine was very effective for the refractory pain control in a patient with skin ulcer due to calcific uremic arteriolopathy.