Objective: Monitoring the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants is important due to concerns regarding infectivity, transmissibility, immune evasion and disease severity. We evaluated the temporal and regional replacement of previous SARS-CoV-2 variants by the emergent strains, Alpha and Delta. Methods: We obtained the results of polymerase chain reaction screening tests for variants conducted in multiple commercial laboratories. Assuming that all previous strains would be replaced by one variant, the new variant detection rate was estimated by fitting a logistic growth model. We estimated the transmission advantage of each new variant over the pre-existing virus strains. Results: The variant with the N501Y mutation was first identified in the Kinki region in early February 2021, and by early May, it had replaced more than 90% of the previous strains. The variant with the L452R mutation was first detected in the Kanto-Koshin region in mid-May, and by early August, it comprised more than 90% of the circulating strains. Compared with pre-existing strains, the variant with the N501Y mutation showed transmission advantages of 48.2% and 40.3% in the Kanto-Koshin and Kinki regions, respectively, while the variant with the L452R mutation showed transmission advantages of 60.1% and 71.9%, respectively. Discussion In Japan, Alpha and Delta variants displayed regional differences in the replacement timing and their relative transmission advantages. Our method is efficient in monitoring and estimating changes in the proportion of variant strains in a timely manner in each region.

A 2-month-old female Holstein calf and a 5-month-old female Japanese black calf presented with gingival vascular hamartoma located in the interdental space between the second and third mandibular incisors in the right and left mandibles, respectively. On radiographic or computed tomographic images, osteolytic changes appeared within the mandibular bones adjacent to the masses. The masses were removed along with affected mandibular bone by using unilateral rostral mandibulectomy. After surgery, both cases exhibited a normal appetite and grew normally, with no cosmetic changes or recurrences. Unilateral rostral mandibulectomy can be applied for invasive gingival vascular hamartomas associated with osteolytic changes.
Animals ; Appetite ; Asian Continental Ancestry Group ; Cattle ; Female ; Hamartoma ; Humans ; Incisor ; Infant ; Mandible ; Mandibular Osteotomy ; Radiography ; Recurrence

Vertebral fractures occur with only slight trauma in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, a lumbar vertebra fracture, due to an intraoperative body position has not been previously reported. An 87-year-old woman with kyphosis sustained a left trochanteric fracture of her femur. The patient was placed in a supine position during the operation. Postoperatively, the patient experienced severe right thigh pain. Magnetic resonance imaging revealed an L4 vertebral fracture. Computed tomography revealed ankylosis from the upper thoracic spine to the sacrum. While in a supine position under general anesthesia, the contact of the patient's lower back with operating table likely created a fulcrum at her lumbosacral spine acting as a long lever arm, bearing the mass of her upper body. We performed L1-S2 posterior stabilization. DISH patients with kyphosis placed in a supine position have an increased risk for lumbar vertebral fracture.
Aged, 80 and over ; Anesthesia, General ; Ankylosis ; Arm ; Female ; Femur* ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal* ; Kyphosis ; Magnetic Resonance Imaging ; Operating Tables ; Sacrum ; Spine ; Supine Position ; Thigh

No abstract available.
Burkitt Lymphoma ; Fungemia ; Humans ; Trichosporon

Dengue is an emerging disease in Nepal and was first observed as an outbreak in nine lowland districts in 2006. In 2010, however, a large epidemic of dengue occurred with 4,529 suspected and 917 serologically-confirmed cases and five deaths reported in government hospitals in Nepal. The collection of demographic information was performed along with an entomological survey and clinical evaluation of the patients. A total of 280 serum samples were collected from suspected dengue patients. These samples were subjected to routine laboratory investigations and IgM-capture ELISA for dengue serological identification, and 160 acute serum samples were used for virus isolation, RT-PCR, sequencing and phylogenetic analysis. The results showed that affected patients were predominately adults, and that 10% of the cases were classified as dengue haemorrhagic fever/ dengue shock syndrome. The genetic characterization of dengue viruses isolated from patients in four major outbreak areas of Nepal suggests that the DENV-1 strain was responsible for the 2010 epidemic. Entomological studies identified Aedes aegypti in all epidemic areas. All viruses belonged to a monophyletic single clade which is phylogenetically close to Indian viruses. The dengue epidemic started in the lowlands and expanded to the highland areas. To our knowledge, this is the first dengue isolation and genetic characterization reported from Nepal.

Traumatic retropharyngeal hematoma is a rare condition and may be lethal in some cases. In patients with this condition, the absence of a vertebral fracture or a major vascular injury is extremely rare. We present the case of a 92-year-old man who hit his forehead by slipping on the floor in his house. He had no symptoms at the time; however, he experienced throat pain and dyspnea at 6 hours after the injury. On arrival, he complained of severe dyspnea; therefore, an emergency endotracheal intubation was performed. A lateral neck roentgenogram after intubation showed dilatation of the retropharyngeal and retrotracheal space and no evidence of a cervical vertebral fracture. Cervical computed tomography (CT) with contrast medium revealed a massive hematoma extending from the retropharyngeal to the superior mediastinal space but no evidence of contrast medium extravasation or a vertebral fracture. However, sagittal magnetic resonance imaging (MRI) revealed an anterior longitudinal ligament (C4-5 levels) injury. We determined that the cause of the hematoma was an anterior longitudinal ligament injury and a minor vascular injury around the injured ligament. Therefore, we recommend that patients with retropharyngeal hematoma undergo sagittal cervical MRI when roentgenography and CT reveal no evidence of injury.
Aged ; Aged, 80 and over ; Hematoma ; diagnosis ; etiology ; Humans ; Longitudinal Ligaments ; injuries ; Magnetic Resonance Imaging ; Male ; Pharyngeal Diseases ; diagnosis ; etiology ; Tomography, X-Ray Computed

Abdominal Injuries ; complications ; Abdominal Wall ; pathology ; Aged ; Embolization, Therapeutic ; Female ; Hematoma ; therapy ; Humans ; Liver Cirrhosis ; complications

Aerobic exercise is known to reduce pulse wave velocity (PWV), which reflects arterial stiffness. However, aerobic exercise has a depressor effect, and PWV strongly depends on blood pressure (BP). Therefore, improvement of PWV with aerobic exercise may have an indirect effect on reducing BP. In this study, the relationship between changes in BP and regional PWV measured by oscillometric and tonometry sensors before and after exercise therapy emphasizing aerobic exercise was evaluated in 46 elderly people receiving outpatient treatment for lifestyle-related diseases (7 males and 39 females, mean age : 68 years). In all subjects, BP and PWV measurements were performed before and after exercise therapy. PWV was measured between the brachium and ankle (baPWV), between the heart and femoral artery (hfPWV), and between the femoral artery and ankle (faPWV). During 6 months of exercise therapy, BP, baPWV, hfPWV and faPWV decreased significantly. By multiple regression analysis, the changes in systolic BP were extracted as factors correlated with changes in baPWV and faPWV. The changes in baPWV (r=0.639, p<0.01) and faPWV (r=0.649, p<0.01) correlated significantly with changes in systolic BP. However, changes in hfPWV were not extracted as a factor correlated with changes in systolic BP (r=0.228, p=n. s). In conclusion, exercise therapy emphasizing aerobic exercise was suggested to reduce the stiffness of both the lower limb artery (peripheral artery) and the aorta (central artery). Peripheral arterial stiffness improved concurrently with a reduction in BP as a result of exercise therapy ; but there is a possibility that the improvement of central arterial stiffness is not dependent on reducing BP.

The clinical competence needed by every beginning resident and the present status of such competencewere examined in August 1998 through questionnaires distributed to clinical educators and the nursing staff of university hospitals and clinical training hospitals designated by the Ministry of Health and Welfare. Completed questionnaires were returned by 576 (65.9%) of clinical educators and nursing staff. With a cluster analysis of the necessity and the present status of clinical competence, 21 items for clinical competence were identified as those most requiring evaluation by the national examination. These 21 items included 11 items for clinical competence in the cognitive domain, 8 items in the psychomotor domain, and 2 in the affective domain. In about half of the direct answers obtained from clinical educators, evaluations were considered necessary for 15 items of clinical competence, of which 13 belonged to the cognitive domain. These results were consistent with the present status. However, practical examinations have also attracted increasing attention, as the results included strong demands that the national examination evaluate some basic clinical skills, such as physical examination and measurement of vital signs. However, about 30 % of authorities governing the national examination thought no changes are needed in the national examination.

X type questions have been used for the national medical licensing examination since 1997. At Tsukuba University, X type questions have been used since 1996. We compared X typeand K type questions on the basis of the percentage of correct answers and discrimination power. The average percentage of correct answers was 68.2% for K type questions and 53.1% for X type questions. However, the average discrimination power was +0.227 for K type questions and +0.257 for X type questions. These results indicate that X type questions are more difficult and are suitable for achievement tests. The estimated knowledge quantity was 2.04 for K type questions and 2.32 for X type questions. This suggests that the person writing the questions decreased the essential difficulty of X type questions.