Objective: In 2018, the Shinjuku City Department of Health detected excess cases of hepatitis A virus (HAV) infection. The objectives of this investigation were to characterize the outbreak, identify transmission routes among inpatient cases and make recommendations to control and prevent HAV infection among men who have sex with men. Methods: Information about cases of HAV infection was collected from the National Epidemiological Surveillance for Infectious Diseases system and inpatient interviews conducted by public health nurses in 2018. Results: There were 131 HAV cases in 2018. Of these, 98% (129/131) were male, of whom 81% (105/129) were men who have sex with men. Hospitalization was required for 40 cases (31%). The age groups with the highest proportion of cases were 30–39 and 40–49 years (each 34%; 44/131). Two cases (2%) had received the second dose of the HAV vaccine, but only 10 days before symptom onset; all others had received no doses. The sequence type subgroup 13, an RIVM-HAV-16–090-like strain, was seen in 51 cases (39%). Of the 40 hospitalized cases, 21 (53%) participated in an interview conducted using a semistructured questionnaire. Altogether, of 21 cases, 12 (57%) had coinfection with HIV, 13 (62%) had casual sexual contact within the preceding 2 months and 10 (48%) had used social networking services (SNS) to find a sexual partner. Discussion: In Shinjuku, this outbreak almost exclusively affected the population of men who have sex with men. The detected outbreak strain has previously been reported in outbreaks among men who have sex with men in Taiwan (China) and Europe. For HAV prevention, the most important measures are raising awareness of the risk of HAV as a sexually transmitted infection via SNS and promoting immunization at the appropriate time.

Background/Aims: Unsedated transnasal esophagogastroduodenoscopy (EGD) is affected by a poor scope lens-cleaning function. We have previously reported good, albeit limited, effects of an oolong tea washing solution; here, we evaluated the effectiveness of a 5% lens cleaning solution for cleaning an EGD lens. Methods: Five percent lens cleaning solution (C), 5% dimethicone solution (D), and distilled water (W) were prepared. Study I: Lenses were soiled with pork grease, washed with each washing solution, and their image quality was judged. Study II: Patients (n=996) scheduled for transnasal EGD were randomly assigned to the C- or W-group. Lens cleanliness level, washing solution volume used, and endoscopist stress due to lens contamination were determined. Results: Study I: The image quality of the lenses washed with (C) was significantly superior. (D) was clinically unsuitable because of spray nozzle clogging. Study II: Lens cleaning in the C-group was significantly superior (p<0.0001) and the solution volume required was significantly reduced (p<0.0001), while endoscopist stress was also lower (p<0.0001). Conclusions For transnasal small-caliber EGD, the present 5% lens cleaning solution provided good visibility. It features a high detergency level and is simple to formulate for therapeutic endoscopy applications, such as endoscopic submucosal dissection.

Secondary neurulation (SN) is a critical process to form the neural tube in the posterior region of the body including the tail. SN is distinct from the anteriorly occurring primary neurulation (PN); whereas the PN proceeds by folding an epithelial neural plate, SN precursors arise from a specified epiblast by epithelial-to-mesenchymal transition (EMT), and undergo self-renewal in the tail bud. They finally differentiate into the neural tube through mesenchymal-to-epithelial transition (MET). We here overview recent progresses in the studies of SN with a particular focus on the regulation of cell lineage, self-renewal, and EMT/MET. Cellular mechanisms underlying SN help to understand the functional diversity of the tail in vertebrates.

The conventional crushing method for administration of drugs to patients with feeding tubes has been commonly used at the Hyogo College of Medicine College Hospital. Compared with this conventional method, the simple suspension method can reduce drug degradation due to light and moisture absorption as well as avoid drug loss and contamination. We conducted a workshop to introduce this method to pharmacists. We asked the participants to fill a questionnaire-based survey both before and after the workshop to determine the effects of the workshop on the change in the degree of awareness among participants about these methods. The awareness of participants about the simple suspension method was approximately 80% before the workshop. Approximately 60% of participants answered that they had questions about simple suspension method from individuals from other occupations, suggesting a high awareness of this method. After the workshop, approximately 98% of participants answered that they were “satisfied” or “slightly satisfied,” suggesting that they were in favor of introducing the suspension method. The results of text mining indicated a requirement for participants to consider incompatibilities and to educate the nursing department. Participants who actively considered the proposal of simple suspension method had an altered perception toward the introduction and utilization of this method. Therefore, this survey suggested that workshops could alter the perception and behavior of pharmacists about the methods of drug administration via feeding tube.

Secondary neurulation (SN) is a critical process to form the neural tube in the posterior region of the body including the tail. SN is distinct from the anteriorly occurring primary neurulation (PN); whereas the PN proceeds by folding an epithelial neural plate, SN precursors arise from a specified epiblast by epithelial-to-mesenchymal transition (EMT), and undergo self-renewal in the tail bud. They finally differentiate into the neural tube through mesenchymal-to-epithelial transition (MET). We here overview recent progresses in the studies of SN with a particular focus on the regulation of cell lineage, self-renewal, and EMT/MET. Cellular mechanisms underlying SN help to understand the functional diversity of the tail in vertebrates.

Background/Aims: Unsedated transnasal esophagogastroduodenoscopy (EGD) is affected by a poor scope lens-cleaning function. We have previously reported good, albeit limited, effects of an oolong tea washing solution; here, we evaluated the effectiveness of a 5% lens cleaning solution for cleaning an EGD lens. Methods: Five percent lens cleaning solution (C), 5% dimethicone solution (D), and distilled water (W) were prepared. Study I: Lenses were soiled with pork grease, washed with each washing solution, and their image quality was judged. Study II: Patients (n=996) scheduled for transnasal EGD were randomly assigned to the C- or W-group. Lens cleanliness level, washing solution volume used, and endoscopist stress due to lens contamination were determined. Results: Study I: The image quality of the lenses washed with (C) was significantly superior. (D) was clinically unsuitable because of spray nozzle clogging. Study II: Lens cleaning in the C-group was significantly superior (p<0.0001) and the solution volume required was significantly reduced (p<0.0001), while endoscopist stress was also lower (p<0.0001). Conclusions For transnasal small-caliber EGD, the present 5% lens cleaning solution provided good visibility. It features a high detergency level and is simple to formulate for therapeutic endoscopy applications, such as endoscopic submucosal dissection.

Background: Acetaminophen, an antipyretic analgesic, is one of the main pain relief medications for cancer according to the World Health Organization guidelines. Design: A case report of a 75-year-old woman who had been taking acetaminophen to relieve cancer pain caused by recurrence after surgery for left upper-lobe cancer and multiple bone metastases. Following a formulation change, the participant experienced allergy-like symptoms. Results: After switching to a different formulation, the allergic symptoms disappeared. Conclusion: The results obtained from this case report suggest that pharmaceutical additives in the acetaminophen formulation caused the allergic reaction, and not the acetaminophen itself. The woman’s pain was successfully controlled by changing to a different type of formulation. If allergic reaction symptoms appear after taking acetaminophen, switching to a different formulation of the drug may enable the continued use of acetaminophen to treat the patient’s pain.

Guidelines recommend that clinical laboratories perform phenotypic tests (nitrocefin-based test and penicillin 10-U [P10] or 1-U [P1] zone edge tests) to detect penicillinase in Staphylococcus aureus isolates. This study aimed to assess the prevalence of blaZ encoding penicillinase and perform various phenotypic tests in S. aureus isolates from Japan. We prospectively collected 200 methicillin-susceptible S. aureus isolates from June 2015 to January 2016 and performed six phenotypic tests (nitrocefin-based test, P10 zone edge test/P10 diffusion test, penicillin 2-U [P2] zone edge test/P2 diffusion test, and cloverleaf test) on each sample. We confirmed the presence of blaZ (two blaZ-positive isolates) using PCR. Using blaZ PCR as a standard, we observed a low sensitivity (50%) and positive predictive value (PPV, 50%) of the nitrocefin-based test, low PPV (18.2%) of the P10 zone edge test, low sensitivity (50%) of the P10 diffusion test, low PPV (50% and 22.2%) of the P2 zone edge test and P2 diffusion test, respectively, and low sensitivity (50%) of the cloverleaf test. These data suggest a low performance (sensitivity and PPV) of these six phenotypic tests because of the low prevalence (1%) of blaZ in S. aureus isolates from Japan.
Diffusion ; Japan* ; Penicillinase* ; Penicillins ; Polymerase Chain Reaction ; Prevalence* ; Prospective Studies ; Staphylococcus aureus* ; Staphylococcus*

Computed diffusion-weighted MRI is a recently proposed post-processing technique that produces b-value images from diffusion-weighted imaging (DWI), acquired using at least two different b-values. This article presents an argument for computed DWI for prostate cancer by viewing four aspects of DWI: fundamentals, image quality and diagnostic performance, computing procedures, and future uses.
Magnetic Resonance Imaging ; Prostate* ; Prostatic Neoplasms*