Multidrug-Resistant Tuberculosis Outbreak among Immigrants in Tokyo, Japan, 2019-2021.

In mid-September 2019, a teenage Chinese male student and part-time waiter in Tokyo was diagnosed with multidrug-resistant (MDR) sputum smear-positive pulmonary tuberculosis (TB). This study describes the outbreak investigation of his friends and colleagues at the restaurant. We investigated 6 friends and 15 colleagues; 5 friends and 13 colleagues underwent interferon-γ release assay (IGRA). Of these, 3 friends (60.0%) and 4 colleagues (30.8%) were IGRA-positive. Each of the friends and colleagues was found to have MDR-TB (20% and 7.7%, respectively). Challenges during the investigation were the unavailability of regimens for latent TB infection (LTBI) for contacts with MDR-TB, budgetary constraints concerning implementing computed tomography (CT) scans for the contacts, frequent address changes of foreign-born patients and contacts, investigation during the coronavirus disease pandemic, and variations of alphabetical expression of the names of the patients and contacts, particularly for those from China. It is recommended that the national government officially adopt prophylaxis regimens for LTBI with MDR-TB, address the budgetary constraints regarding CT scans, and deploy liaison officers for coordinating investigations involving many foreign-born patients and contacts scattered in multiple municipalities. The names of foreign-born persons could more accurately be identified using both the alphabet and Chinese characters.

Aqueous Extract from Leaves of Citrus unshiu Attenuates Lipopolysaccharide-Induced Inflammatory Responses in a Mouse Model of Systemic Inflammation.

Inflammation is related to various life-threatening diseases including cancer, neurodegenerative diseases, and metabolic syndrome. Because macrophages are prominent inflammatory cells, regulation of macrophage activation is a key issue to control the onset of inflammation-associated diseases. In this study, we aimed to evaluate the potential anti-inflammatory activity of Citrus unshiu leaf extract (CLE) and to elucidate the mechanism underlying its anti-inflammatory effect. We found the inhibitory activity of CLE on the secretion of proinflammatory cytokines and a chemokine from mouse macrophage-like RAW 264.7 cells and mouse peritoneal macrophages. The inhibitory activity of CLE was attributed to downregulated JNK, p38 MAPK, and NF-κB signaling pathways, leading to suppressed gene expression of inflammation-associated proteins. Oral administration of CLE significantly decreased the serum level of proinflammatory cytokines IL-6 and TNFα and increased that of anti-inflammatory cytokine IL-10 in lipopolysaccharide-induced systemic inflammation mice. In addition, oral administration of CLE decreased secretion and gene expression of several proinflammatory proteins in the liver and spleen of the model mice. Overall results revealed that C. unshiu leaf is effective to attenuate inflammatory responses in vitro and in vivo.

A multidrug-resistant tuberculosis outbreak in a language school: Tokyo, Japan, 2019-2020.

Background: Japan has successfully reduced the burden of tuberculosis (TB) in the past seven decades; however, there are still some issues in eliminating TB. Its presence in immigrants, particularly multidrug-resistant (MDR) TB, is one of them. In mid-September 2019, a teenage Chinese male student in a morning class of a Japanese language school in Tokyo, Japan, was diagnosed with sputum smear-positive pulmonary MDR-TB. Method: The outbreak cases were analyzed in a cohort study. Results: We investigated 138 students and 18 teachers, of whom 81 (51.9%) were male, 115 (73.7%) were aged from 20 to 29 years, and 124 (76.9%) were from China. Four other students in the same classroom and another in a different classroom from the index patient in the morning classes were also diagnosed with MDR-TB disease by the end of November 2020. In addition, 31 cases of latent TB infection (LTBI) were detected among the students and teachers. Students in the same classroom had the highest risk of TB infection (78.9%, 95% confidence interval [CI]: 54.4%-93.9%) with a relative risk of 8.6 (95% CI: 3.9-19.0), followed by students in the other classrooms of the morning classes (25.9%, 95% CI: 15.0%-39.7%) with a relative risk of 2.8 (95% CI: 1.2-6.8), compared with the afternoon class students (9.2%, 95% CI: 3.5-19.0) who had minimal contact with the index patient. Conclusion: National TB programs should adopt prophylaxis regimens for MDR-TB LTBI cases and provide prophylaxis to them, particularly if related to an outbreak. The Japanese government should screen immigrants for TB, particularly those from TB-endemic areas.

Breast metastasis from rectal cancer with BRAF V600E mutation: a case report with a review of the literature.

Metastasis of rectal cancer to the breast is an extremely rare clinical event. We report the case of a 67-year-old woman with a metastatic breast tumor derived from a BRAF V600E mutant rectal carcinoma that was diagnosed and resected curatively 1 year previously. Computed tomography showed a left breast mass and multiple lung nodules suspected to be indicative of recurrent rectal cancer. The ultrasonography examination demonstrated a 10 × 10-mm hypoechoic solid lesion in the left breast with an elevation in the serum carcinoembryonic antigen level and serum carbohydrate antigen 19-9 level. Core needle biopsy was performed, and histopathologic examination showed Cytokeratin 20 and CDX-2 positivity, compatible with rectal cancer. To our knowledge, this is the first case of a metastatic breast tumor arising from rectal carcinoma with BRAF mutation. Although breast metastasis is very rare event, the possibility of breast metastasis from extra mammary sites should be considered when the breast tumor is found in cancer treatment.

Citrus kawachiensis Peel Powder Reduces Intestinal Barrier Defects and Inflammation in Colitic Mice.

The anti-inflammatory effect of Citrus kawachiensis peel powder was examined in a murine model of dextran sodium sulfate (DSS)-induced colitic mice. In addition to the whole powder, its ethanol extract rich in polyphenolic compounds and ethanol extraction residue rich in dietary fibers were used. The whole powder ameliorated the DSS-induced body weight loss (body weight changes on day 9, Control 108 ± 2, DSS 91 ± 4, DSS+whole peel powder 106 ± 1%, p < 0.05), colon shortening (colon length, Control 5.0 ± 0.1, DSS 3.9 ± 0.1, DSS+whole peel powder 4.7 ± 0.1 cm, p < 0.05), increased expression of pro-inflammatory cytokines (e.g., TNF-α, Control 1.0 ± 0.1, DSS 22.2 ± 5.8, DSS+whole peel powder 4.3 ± 1.5 arbitrary unit, p < 0.05), and decreased expression of colonic tight junctions (TJs) (e.g., occludin, Control 1.00 ± 0.07, DSS 0.21 ± 0.07, DSS+whole peel powder 0.70 ± 0.06 arbitrary unit, p < 0.05). The resolution of abnormalities barring the decreased expression of zonula occludens-2, junctional adhesion molecule-A, and claudin-7 by the extraction residue was comparable to that achieved using the powder (body weight change 107 ± 1%; colon length 4.7 ± 0.1 cm; TNF-α 4.1 ± 0.7; occludin 0.58 ± 0.06 arbitrary unit, p < 0.05). The ethanol extract alone did not have any influence on these abnormalities (body weight change 94 ± 2%; colon length 4.1 ± 0.1 cm; TNF-α 40.5 ± 9.0 arbitrary unit; occludin 0.18 ± 0.02 arbitrary unit, p < 0.05). The powder and ethanol extraction residue, but not ethanol extract, increased fecal acetic acid concentration (Control 4.9 ± 0.6, DSS 5.0 ± 0.9, DSS+whole peel powder 8.8 ± 1.8, DSS+ethanol extract 5.3 ± 0.8, DSS+ethanol extraction residue 12.5 ± 1.1 mmol/L, p < 0.05). Taken together, DFs in the ethanol extraction residue largely contributed to the peel powder-mediated reduction of TJ barrier defect and inflammation in colitic mice.

Involvement of C-terminal amino acids of a hyperthermophilic serine racemase in its thermostability.

Pyrobaculum islandicum is a hyperthermophilic archaeon that grows optimally at 95-100 °C. In the previous study, we extensively purified a serine racemase from this organism and cloned the gene for overexpression in Escherichia coli (Ohnishi et al. 2008). This enzyme also exhibits highly thermostable L-serine/L-threonine dehydratase activity. In the present study, we aimed to elucidate the molecular mechanisms underlying the high thermostability of this enzyme. A recombinant variant of this enzyme, PiSRvt, constructed by truncating the C-terminal 72 amino acids, was compared with the native enzyme, PiSR. The dehydratase activity of PiSR and PiSRvt was found to owe to a homotrimer and a monomer, respectively, that demonstrated high and moderate thermostability, respectively. These observations reveal that the C-terminal region contributes to monomer trimerization that provides the extreme thermostability.

[RISK OF TUBERCULOSIS INFECTION AND DISEASE AMONG JAPANESE FEMALE NURSES AND MALE DOCTORS IN RECENT YEARS].

[Objectives and Materials] Based on the tuber- culosis (TB) surveillance database, the incidence rates of TB infection and active disease among healthcare workers were observed for female nurses and male doctors in 2010 in comparison with those of the general population. [Results] The relative risk (RR) of active TB among female nurses aged 20-69 years was 4.86 (95% confidence interval: 4.31-5.45) for 2010, which has increased from 2.30 observed in 1987-1997. The RR was highest for nurses aged 20-29 years at 8.84 and declined with age until 3.60 for those aged 50-59 years that was still significantly higher than 1. For male doctors the RR was significantly higher than 1 only for those aged 39 years or younger. The rates of those who were -indicated for treatment of latent TB infection (LTBI) were clearly higher among healthcare workers; for female nurses the RR was 32.7 (95% CI: 30.5-35.0), ranging from the highest level of 62.8 among those aged 20-29 years down to 11.6 for those aged 60-69 years. For male doctors also, the RR was high at 9.7 (7.9- 11.7) for 20-69 years, ranging from 14.5 for those aged 20- 29 years down to 5.3 for those aged 60-69 years. [Discussion] TB cases of nurses and doctors were more likely to be detected by the active case finding measures such as periodic screening and contact investigations than cases in the general population, which indicates the current effort of addressing the occupational exposure in the healthcare set- tings. The high level of risk of TB disease as Iwell as LTBI among healthcare professions and its possibly increasing trend as. seen in female nurses warrants further strengthening of monitoring of the problem and overall countermeasures in their workplaces.

Participation of D-serine in the development and reproduction of the silkworm Bombyx mori.

The silkworm Bombyx mori contains high concentrations of free D-serine, an optical isomer of L-serine. To elucidate its function, we first investigated the localization of D-serine in various organs of silkworm larvae, pupae, and adult moths. Using immunohistochemical analysis with an anti-D-serine antibody, we found D-serine in the microvilli of midgut goblet and cylindrical cells and in peripheral matrix components of testicular and ovarian cells. By spectrophotometric analysis, D-serine was also found in the hemolymph and fat body. D-Alanine was not detected in the various organs by immunohistochemistry. Serine racemase, which catalyzes the inter-conversion of L- and D-serine, was found to co-localize with D-serine, and D-serine production from L-serine by intrinsic serine racemase was suggested. O-Phospho-L-serine is an inhibitor of serine racemase, and it was administered to the larvae to reduce the D-serine level. This reagent decreased the midgut caspase-3 level and caused a delay in spermatogenesis and oogenesis. The reagent also decreased mature sperm and egg numbers, suggesting D-serine participation in these processes. D-Serine administration induced an increase in pyruvate levels in testis, midgut, and fat body, indicating conversion of D-serine to pyruvate. On the basis of these results, together with our previous investigation of ATP biosynthesis in testis, we consider the possible involvement of D-serine in ATP synthesis for metamorphosis and reproduction.

Methemoglobin reduction mediated by D-amino acid dehydrogenase in Propsilocerus akamusi (Tokunaga) larvae.

A methemoglobin (metHb) reduction system is required for aerobic respiration. In humans, Fe(III)-heme-bearing metHb (the oxidized form of hemoglobin), which cannot bind oxygen, is converted to Fe(II)-heme-bearing oxyhemoglobin (oxyHb, the reduced form), which can bind oxygen, in a system comprising NADH, NADH-cytochrome b5 reductase, and cytochrome b5. However, the mechanism of metHb reduction in organisms that inhabit oxygen-deficient environments is unknown. In the coelomic fluid of the larvae of Propsilocerus akamusi, which inhabit a microaerobic environment, we found that metHb was reduced by D-alanine. We purified an FAD-containing enzyme, D-amino acid dehydrogenase (DAD), and component V hemoglobin from the larvae. Using the purified components and spectrophotometric analyses, we showed a novel function of DAD: DAD-mediation of P. akamusi component V metHb reduction with using D-alanine as an electron donor. P. akamusi larvae possess this D-alanine-DAD metHb reduction system in addition to a previously discovered NADH-NADH-cytochrome b5 reductase system. This is the first report of the presence of DAD in a multicellular organism. The molecular mass of DAD was estimated to be 45 kDa. The optimal pH and temperature of the enzyme were 7.4 and 20 °C, respectively, and the optimal substrate was D-alanine. The enzyme activity was inhibited by benzoate and sulfhydryl-binding reagents.

Methemoglobin reduction by NADH-cytochrome b(5) reductase in Propsilocerus akamusi larvae.

For oxygen respiration, a methemoglobin (metHb) reduction system is needed in the cell because metHb cannot bind oxygen. We examined the insect Propsilocerus akamusi larvae to elucidate the metHb reduction system in an organism that inhabits an oxygen-deficient environment. NADH-dependent reduction of metHb in coelomic fluid suggested the coexistence of cytochrome b5 reductase (b5R) and cytochrome b5 with hemoglobin in the fluid and that these proteins were involved in physiological metHb reduction in the larvae. The presence of b5R was revealed by purifying b5R to homogeneity from the midge larvae. Using purified components, we showed that larval metHb was reduced via the NADH-b5R (FAD)-cytochrome b5-metHb pathway, a finding consistent with that in aerobic vertebrates, specifically humans and rabbits, and b5R function between mammal and insect was conserved. b5R was identified as a monomeric FAD-containing enzyme; it had a molecular mass of 33.2 kDa in gel-filtration chromatography and approximately 37 kDa in SDS-PAGE analysis. The enzyme's optimal pH and temperature were 6.4 and 25 °C, respectively. The apparent Km and Vmax values were 345 µM and 160 µmol min(-1) mg(-1), respectively, for ferricyanide and 328 µM and 500 µmol min(-1) mg(-1), respectively, for 2,6-dichlorophenolindophenol. The enzyme reaction was inhibited by benzoate, p-hydroxymercuribenzoate, iodoacetamide, and iodoacetate, and was not inhibited by metal ions or EDTA.

[Analysis on workload for hospital DOTS service].

BACKGROUND AND OBJECTIVE: A directly observed treatment short course (DOTS) trial was launched in Japan in the late 1990s and targeted patients with social depression at urban areas. Based on these findings, the Ministry of Health, Labour and Welfare established the Japanese DOTS Strategy in 2003, which is a comprehensive support service ensuring the adherence of tuberculosis patients to drug administration. DOTS services are initially provided at the hospital to patients with infectious tuberculosis who are hospitalized according to the Infectious Diseases Control Law. After being discharged from the hospital, the patients are referred to a public health center. However, a survey conducted in 2008 indicated that all the patients do not receive appropriate DOTS services at some hospitals. In the present study, we aimed to evaluate the protocols and workload of DOTS at hospitals that are actively involved in tuberculosis medical practice, including DOTS, to assess whether the hospital DOTS services were adequate. METHOD: We reviewed a series of articles on hospital DOTS from a Japanese journal on nursing for tuberculosis patients and identified 25 activities regarding the hospital DOTS service. These 25 items were then classified into 3 categories: health education to patients, support for adherence, and coordination with the health center. In total, 20 hospitals that had > 20 authorized tuberculosis beds were selected--while considering the geographical balance, schedule of this survey, etc.--from 33 hospitals where an ex-trainee of the tuberculosis control expert training program in the Research Institute of Tuberculosis (RIT) was working and 20 hospitals that had collaborated with our previous survey on tuberculosis medical facilities. All the staff associated with the DOTS service were asked to record the total working time as well as the time spent for each activity. The data were collected and analyzed at the RIT. RESULT: The working times for each activity of the DOTS service for nurses, pharmacists, ward clerks, head nurses, and doctors were 100, 90, 87, 86, and 63 min, respectively. For other professions, including medical social workers, nursing aids, nutritionists, and physical therapists, the working times for each activity of the DOTS service were 31, 18, 10, and 8 min, respectively. The professionals who spent a longer time on health education, support for patient adherence, and coordination with the health center were pharmacists, doctors, and head nurses; nurses, pharmacists, and doctors; and head nurses, doctors, and ward clerks, respectively. DISCUSSION: Aging of tuberculosis patients was associated with problems on adherence in many patients, including patients who were not suited for a standard regimen, patients whose activity of daily life had deteriorated due to senile dementia, patients with diabetes mellitus, etc. Smoking cessation and mental care for cases of multi-drug resistant disease are new challenges in tuberculosis patient care. The present study clearly indicated that activities including patient education, support for patient adherence, and coordination with the health center--essential components of the hospital DOTS service according to the Japanese DOTS Strategy--were performed by a team of professionals including doctors, nurses, pharmacists, medical social workers, etc., depending on the features and roles that they serve and the needs of each patient. For good practice of hospital DOTS, it is essential to not only provide DOTS, but also effectively provide individual or group health education and coordinate with health centers, thus aiming towards a better community DOTS service after patient discharge.

Effect of D-serine on spermatogenesis and extracellular signal-regulated protein kinase (ERK) phosphorylation in the testis of the silkworm, Bombyx mori.

Although the pupae and larvae of Bombyx mori possess especially large amounts of free d-serine, the physiological role of the amino acid in the silkworm is unknown. We investigated the effect of d-serine on spermatogenesis. A lowered d-serine level throughout larval development caused a delay in spermatogenesis and resulted in reduced numbers of eupyrene sperm. Administration of d-serine transiently increased the activation of extracellular signal-regulated protein kinase1/2 (ERK1/2; hereafter, ERK) by approximately 25% in the testis of day 3 fifth instar larvae. l-Serine had no effect on ERK activation, and other organs did not respond to d-serine. The effect of d-serine on ERK activation was confirmed by administering d-serine dehydratase, an enzyme that specifically degrades d-serine, and the enzyme's inhibitor, hydroxylamine. ERK phosphorylation in the testis was significantly inhibited by Go6983 and U0126, inhibitors of protein kinase C (PKC) and mitogen-associated protein kinase kinase 1/2 (MEK), respectively, but not by H-89, a protein kinase A (PKA) inhibitor, indicating that ERK was activated in the testis via PKC and MEK but not via PKA. The inhibition of ERK phosphorylation by Go6983 or U0126 was reduced by 20-30% by d-serine. Roughly 30% of c-Raf phosphorylation at an inhibitory site (Ser259) was decreased by the addition of d-serine. These results suggest that d-serine activates ERK in the testis of silkworms through a pathway including c-Raf but not PKC or MEK. Immunohistochemistry confirmed d-serine-induced ERK phosphorylation in the testis and revealed the presence of phospho-ERK in the nuclei of spermatocytes and spermatids.

D-Amino acid oxidase and presence of D-proline in Xenopus laevis.

We purified D-amino acid oxidase (EC 1.4.3.3, DAO) from Xenopus laevis tadpoles. The optimal temperature and pH for enzyme activity were 35-40 °C and 8.3-9.0, respectively, depending on the substrate amino acids available to the enzyme; the highest activity was observed with D-proline followed by D-phenylalanine. Activity was significantly inhibited by p-hydroxymercuribenzoate, but only moderately by p-chloromercuribenzoate or benzoate. Enzyme activity was increased until the final tadpole stage, but was reduced to one-third in the adult and was localized primarily in the kidney. The tadpoles contained high concentrations of D-proline close to the final developmental stage and nearly no D-amino acids were detected in the adult frog, indicating that D-amino acid oxidase functions in metamorphosis.

MEG measures of covert orienting and gaze processing in children.

We investigated developmental differences in the cortical attention processing network using magnetoencephalography (MEG) and a spatial cueing task in 7-8 and 12-13 year old children. The cueing paradigm consisted of a centrally presented face with left or right averted eye-gaze in the gaze cue condition, and a central face with straight gaze presented with a cue stimulus to the left or right of the face in the peripheral cue condition. Cue congruency was 50 %. MEG was recorded during the two conditions and event-related beamforming was used to determine the timing and location of the brain activity related to target detection with the two types of cueing. The MEG data showed no age differences in the eye-gaze condition, but a developmental difference characterised by slower and more diffuse activations for peripheral cues in the younger versus the older age group. In the 7-8 year olds activation peaked around 300 ms, and was localised to left inferior frontal gyrus as well as posterior areas related to visuo-spatial processing. The 12-13 year olds showed a temporoparietal pattern of activation characteristic of spatial reorientation which resembled that seen for adult participants using the same paradigm (Nagata et al. 2012). The activation peaked around 200 ms and was localised to the left superior frontal gyrus, middle frontal gyrus but bilaterally near the temporoparietal junction. The data indicate maturational changes in brain activity for peripheral cueing.

[Expanding the role of the nursing profession in tuberculosis medical services].

Implications of changes in the law regarding the payment system for medical services in 2012 for TB medicine and care include mandatory hospital DOTS, planning and implementing adherence support for patients, patient education, and close cooperation with public-health centers. Nurses are expected to contribute to early diagnosis of TB and treatment completion among high-risk populations by coordinating with the community and relevant organizations. It is also important to clarify roles and establish a network through which necessary information and advice may be sought from specialists. Expanding the role of nursing professions in TB care and medicine is hoped to improve the level of awareness and knowledge among persons involved in TB prevention, care, and medicine.

[Nationwide survey of suitability of tuberculosis wards for in-hospital care of tuberculosis patients].

PURPOSE: To clarify the situation and suitability of tuberculosis wards for in-hospital tuberculosis care, with a view toward establishing a national standard for tuberculosis wards. METHODS: Data were obtained by sending questionnaires to all 321 tuberculosis wards in Japan. RESULTS: Of the hospitals to which questionnaires were sent, 69.3% returned their responses. In most of these hospitals, the total number of beds in one tuberculosis ward was either less than 20 or more than 40. In approximately two-thirds of the hospitals, tuberculosis wards were incorporated into another (non-tuberculosis) ward. In more than 70% of the hospitals, the mean hospital stay of tuberculosis patients exceeded 40 days. This relatively long hospital stay implies that amenities are a very important issue in tuberculosis wards; however, amenities were generally far from sufficient in most of the hospitals. Of all the tuberculosis beds, 18.2% were in single-occupant rooms and 19.4% had a sufficient floor area (more than 15 m2). Beds in single-occupant rooms with sufficient floor area, equipped with a toilet, bath or shower, washstand, negative-pressure control, and HEPA filter in an air exhaust duct, comprised 2.4% of all tuberculosis beds. CONCLUSION: In spite of the relatively long hospital stays, amenities were generally less than adequate. The conditions in most tuberculosis wards were far below the presumptive recommended standards. When national standards for tuberculosis wards are established, these findings should be taken into consideration.

Simple and low-cost high-performance liquid chromatographic method for determination of D- and L-amino acids.

In this article, a simple and low-cost method for the analysis of amino acid enantiomers by using high-performance liquid chromatography (HPLC) is described. In this method, the amino acids are modified to diastereomers in order to be separated into enantiomers on a usual C(18) reversed-phase column. Methanol instead of acetonitrile is used as an elution solvent; the results of HPLC with methanol elution are comparable with those of HPLC with acetonitrile elution. Sub-nanomolar sensitivity is attained by measuring the absorbance at 340 nm in analysis of 15 amino-acid enantiomers.

Spatio-temporal localisation of attentional orienting to gaze and peripheral cues.

Another person's eye gaze often triggers our attention such that we follow their direction of gaze. We investigated how the neural mechanisms for processing eye-gaze and spatial attention interact using magnetoencephalography (MEG) in young adults. In a cueing paradigm, a face was presented centrally with left or right averted eye-gaze serving as the directional cue in the eye-gaze condition. In the peripheral cue condition, the face with a straight gaze was presented with a cue stimulus appearing on the left or right of the face. Cue validity was 50%. MEG was recorded during the two conditions and event-related beamforming was used to determine the timing and location of the brain activity related to the two types of cueing. The MEG data indicated that generally the network of activation in response to our two cue types was similar. In contrast, MEG responses to the targets demonstrated one main peak at 286-306 ms for the eye-gaze cue condition while two peaks were found at 238-258 ms and 286-306 ms for the peripheral cue condition. Activation was also consistently larger for the invalid than valid trials. Source images for the invalid minus valid contrasts for the 238-258 ms window showed significant activation only in the peripheral cueing condition, in the left temporoparietal junction and left inferior frontal gyrus. In the 286-306 ms window, both conditions showed left medial frontal activations. Thus, peripheral cues showed more rapid neural processing than the eye-gaze cues, with the second component being common to both, reflecting in part common processing. We suggest that attentional processing was maximal in the left hemisphere, as the right hemisphere was likely engaged in processing the face information.