Isolation of azole-resistant Aspergillus spp. from food products.

The prevalence of azole-resistant Aspergillus fumigatus is increasing worldwide and is speculated to be related to the use of azole pesticides. Aspergillus spp., the causative agent of aspergillosis, could be brought into domestic dwellings through food. However, studies on azole-resistant Aspergillus spp. in food products are limited. Therefore, we aimed to isolate Aspergillus spp. from processed foods and commercial agricultural products and performed drug susceptibility tests for azoles. Among 692 food samples, we isolated 99 strains of Aspergillus spp. from 50 food samples, including vegetables (22.9%), citrus fruits (26.3%), cereals (25.5%), and processed foods (1.8%). The isolates belonged to 18 species across eight sections: Aspergillus, Candidi, Clavati, Flavi, Fumigati, Nidulantes, Nigri, and Terrei. The most frequently isolated section was Fumigati with 39 strains, followed by Nigri with 28 strains. Aspergillus fumigatus and A. welwitschiae were the predominant species. Ten A. fumigatus and four cryptic strains, four A. niger cryptic strains, two A. flavus, and four A. terreus strains exceeded epidemiological cutoff values for azoles. Aspergillus tubingensis, A. pseudoviridinutans, A. lentulus, A. terreus, and N. hiratsukae showed low susceptibility to multi-azoles. Foods containing agricultural products were found to be contaminated with Aspergillus spp., with 65.3% of isolates having minimal inhibitory concentrations below epidemiological cutoff values. Additionally, some samples harbored azole-resistant strains of Aspergillus spp. Our study serves as a basis for elucidating the relationship between food, environment, and clinically important Aspergillus spp.

Cooperativity of the Activated CH/π Interaction Probed through CH Stretching Vibrations in Phenol-(Acetylene)n (∼16 ≤ n ≤ ∼30) and (Acetylene)n+ (10 ≤ n ≤ 70) Clusters.

The acidity of acetylene CH is stronger than that of alkane CH, and the attractive interaction between an acetylene CH with π-electrons, which shows a clear hydrogen bond property, is called activated CH/π interaction. In this study, cooperative enhancement of the activated CH/π interaction has been probed through the cluster size dependence of the red shift of the acetylene CH stretching vibrational band in neutral phenol-(acetylene)n (∼16 ≤ n ≤ ∼30) and (acetylene)n+ (10 ≤ n ≤ 70). In both the clusters, the characteristic asymmetric (red-shaded) shape of the CH stretch band has been observed. This band shape means that the magnitude of the activated CH/π interaction is enhanced by its cooperativity in the interior moiety of the cluster. The red-shifted component of the band extends with increasing cluster size, and the edge of this component seems to reach to the CH stretch band position of crystalline acetylene at the size of n = 20-30, indicating that dozens of molecules need to interact each other to maximize cooperativity in the activated CH/π interaction of acetylene. On the other hand, the peak position of the band does not converge to that of crystalline acetylene in the observed size range. The present result suggests that the spectral convergence of acetylene clusters to the bulk may occur in the cluster size range of hundreds or larger.

Development of Drone-Mounted Multiple Sensing System with Advanced Mobility for In Situ Atmospheric Measurement: A Case Study Focusing on PM2.5 Local Distribution.

This study was conducted using a drone with advanced mobility to develop a unified sensor and communication system as a new platform for in situ atmospheric measurements. As a major cause of air pollution, particulate matter (PM) has been attracting attention globally. We developed a small, lightweight, simple, and cost-effective multi-sensor system for multiple measurements of atmospheric phenomena and related environmental information. For in situ local area measurements, we used a long-range wireless communication module with real-time monitoring and visualizing software applications. Moreover, we developed four prototype brackets with optimal assignment of sensors, devices, and a camera for mounting on a drone as a unified system platform. Results of calibration experiments, when compared to data from two upper-grade PM2.5 sensors, demonstrated that our sensor system followed the overall tendencies and changes. We obtained original datasets after conducting flight measurement experiments at three sites with differing surrounding environments. The experimentally obtained prediction results matched regional PM2.5 trends obtained using long short-term memory (LSTM) networks trained using the respective datasets.

Enterovirus D68 respiratory infection in a children's hospital in Japan in 2015.

BACKGROUND: Outbreaks of enterovirus D68 (EV-D68) respiratory infections in children were reported globally in 2014. In Japan, there was an EV-D68 outbreak in the autumn of 2015 (September-October). The aim of this study was to compare EV-D68-specific polymerase chain reaction (PCR)-positive and EV-D68-specific PCR-negative patients. METHODS: Pediatric patients admitted for any respiratory symptoms between September and October 2015 were enrolled. Nasopharyngeal swabs were tested for multiplex respiratory virus PCR and EV-D68-specific reverse transcription-PCR. EV-D68-specific PCR-positive and -negative patients were compared regarding demographic data and clinical information. RESULTS: A nasopharyngeal swab was obtained from 76 of 165 patients admitted with respiratory symptoms during the study period. EV-D68 was detected in 40 samples (52.6%). Median age in the EV-D68-specific PCR-positive and -negative groups was 3.0 years (IQR, 5.5 years) and 3.0 years (IQR, 4.0 years), respectively. The rates of coinfection in the two groups were 32.5% and 47.2%, respectively. There was no significant difference in the history of asthma or recurrent wheezing, length of hospitalization, or pediatric intensive care unit admission rate between the groups. The median days between symptom onset and admission was significantly lower for the EV-D68-positive group (3.0 days vs 5.0 days, P = 0.001). EV-D68 was identified as clade B on phylogenetic analysis. No cases of acute flaccid myelitis were encountered. CONCLUSIONS: More than half of the samples from the children admitted with respiratory symptoms were positive for EV-D68-specific PCR during the outbreak. Asthma history was not associated with the risk of developing severe respiratory infection.

Influences of Salinity and Organic Compounds on Embryo Development in Three Medaka Oryzias Congeners with Habitats Ranging from Freshwater to Marine.

To clarify whether Oryzias congeners, including freshwater, brackish water, and marine medaka, would be useful models for evaluating environmental chemical effects in various aquatic ecosystems, we examined the influence of salinity on their embryo development. We also compared the toxicity values of the organotin compounds triphenyltin and tributyltin, which remain pollutants of marine and freshwater ecosystems, between Oryzias latipes (freshwater), Oryzias melastigma (brackish water), and Oryzias javanicus (saltwater). Hatching and survival rates of O. latipes were significantly decreased at a salinity of 34, whereas O. melastigma and O. javanicus were adaptable to various salinities from freshwater to seawater. The lowest observed effect concentrations of organotin compounds for survival and embryo development were the similar in the three species. The similarity of the species' responses to organotin compounds indicated that Oryzias congeners are useful for ecological risk assessment of chemicals in a range of aquatic ecosystems, from freshwater to marine.

A combined theoretical and experimental study of phenol-(acetylene)n (n ≤ 7) clusters.

Structures and vibrational spectra of phenol-(acetylene)n (Ph(Ac)n) clusters are studied by a combination of theoretical calculations and infrared (IR) spectroscopy. The molecular electrostatic potential features are utilized for generating trial geometries of the medium-sized Ph(Ac)n (n = 1, 2, 4, 6, and 7) clusters. These initial geometries are subjected to geometry optimization within the second-order Møller-Plesset (MP2) theory, employing correlation consistent aug-cc-pVDZ (aVDZ) basis set. Minimal nature of the reported structures is confirmed by doing vibrational frequency run at MP2/aVDZ level of theory using full calculations for n = 1 and 2 and employing grafting based molecular tailoring approach for the n = 4, 6, and 7. Several isomers for n ≥ 4 are found to lie in an energy window of 1 kcal mol-1 of each other. Considering the formidability of MP2 level investigation for the large number of isomers for n = 6 and 7, B97-D level theory is used for studying their energetics and IR spectra. It is seen that the number of energetically close isomers increases with increasing n. Moderately size-selected IR spectra of Ph(Ac)n (n = 4 and 7), prepared by a supersonic jet expansion, are measured for the acetylenic C-H and phenolic O-H stretch regions by infrared-ultraviolet (IR-UV) double resonance spectroscopy combined with time-of-flight mass spectrometry. Asymmetric line shape of the C-H stretch band and remarkable line broadening and weakening of the O-H stretch band are noteworthy features of the observed spectra. These findings of the experimental spectra are explained by the theoretical studies. The averaging of the vibrational spectrum of low-lying isomers of the Ph(Ac)n clusters lying in a narrow energy range is found to be responsible for the broadening and weakening of the O-H band.

Perioperative Management of Patients With End-Stage Renal Disease.

End-stage renal disease (ESRD) is associated with significant alterations in cardiovascular function; homeostasis of body fluid, electrolytes, and acid-base equilibrium; bone metabolism, erythropoiesis; and blood coagulation. The prevalence of ESRD is increasing rapidly worldwide, as is the number of patients requiring surgery under general anesthesia. Patients with ESRD have significantly higher risks of perioperative morbidity and mortality due to multiple comorbidities. The perioperative management of patients with ESRD under general anesthesia therefore requires special considerations and a careful multidisciplinary approach. In this review, the authors summarize the available literature to address common issues related to patients with ESRD and discuss the best perioperative approach for this patient subgroup.

Observation of Evidence for the π*-σ* Hyperconjugation in the S1 State of o-, m-, and p-Fluorotoluenes by Double-Resonance Infrared Spectroscopy.

Drastic changes of the methyl internal rotation potential energy functions upon the electronic excitation have been reported for o- and m-fluorotolunes [ Okuyama , K. , Mikami , N. , and Ito , M. J. Phys. Chem. 1985 , 89 , 5617 - 5625 ], and their physical origin has been attributed to the π*-σ* hyperconjugation. To observe direct evidence of the π*-σ* hyperconjugation, double-resonance infrared spectroscopy was carried out in the CH stretching vibrational region in both the S0 and S1 states of jet-cooled o-, m-, and p-fluorotoluenes. In the spectra of both o- and m-fluorotoluenes, some of the methyl CH bands were red-shifted upon the electronic excitation while the residual CH bands stayed in the same frequency region. The normal-mode analysis demonstrated that the shift behavior correlates to the relative conformation between the methyl CH bond and the phenyl ring plane. This conformation-dependent methyl CH bond weakening clearly supports the presence of the π*-σ* hyperconjugation in o- and m-fluorotoluenes. The similar red-shift of the methyl CH bands upon the electronic excitation was seen also in p-fluorotoluene though the magnitude of the shift was much smaller. The mechanism of its internal rotation potential energy behavior, however, can be different from those of the o- and m-isomers.

Clinicopathological features of gastric adenocarcinoma of the fundic gland (chief cell predominant type) by retrospective and prospective analyses of endoscopic findings.

BACKGROUND AND AIM: Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) is a variant of gastric adenocarcinoma with chief cell differentiation. GA-FG-CCP is rare and not well understood. The present study aimed to investigate the clinicopathological features of GA-FG-CCP using retrospective and prospective analyses of endoscopic findings. METHODS: A total of 20 patients including nine cases treated with endoscopic submucosal dissection (ESD) were diagnosed with GA-FG-CCP. Morphological changes were analyzed by retrospectively retracing past endoscopic records and following up after definitive diagnoses, including the status of Helicobacter pylori (H. pylori) infection. RESULTS: GA-FG-CCP were small and whitish lesions accompanied by atypical vascular growth and their macroscopic types were classified as 0-IIa (60%), 0-IIb (25%), and 0-IIc (15%), respectively. The lesions were found in the non-atrophic gastric mucosa of the upper (70%) or middle portion (30%), although gastric mucosal atrophy associated with current or past H. pylori infection was identified in 75% of cases. In the nine cases treated with ESD, submucosal invasion was identified in 80% of the resected lesions, but no lymphovenous infiltration was detected. Ki-67 labeling index of GA-FG-CCP was low at 3.2% and visible morphological changes were rarely detected during long-term endoscopic observation for 58.9 ± 13.1 months. CONCLUSIONS: These data indicate that GA-FG-CCP, even when submucosal invasion occurs easily, might be of low-grade malignancy as long as it is the chief cell predominant type without other epithelial abnormalities. In addition, GA-FG-CCP might develop despite H. pylori infection or gastric mucosal atrophy.

Genetic Polymorphism in Alcohol Metabolism and Drinking Behavior are Associated with Gastric Cancer Risk in Men.

Objective In recent years, there has been a growing focus on health risks associated with alcohol consumption. The present study investigated whether or not the genetic variant of aldehyde dehydrogenase 2 (ALDH2) influences the risk of gastric cancer among individuals identified as hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT), which provides a comprehensive assessment of hazardous drinking behavior. Patients We enrolled men with hazardous drinking behavior (AUDIT score ≥ 8) who had undergone gastric cancer screening (either endoscopy or a barium X-ray examination of the upper gastrointestinal tract) between April 2013 and March 2020 within 1 year from entry and who had subsequently undergone at least one more gastric cancer screening up to March 2021. Functional single-nucleotide polymorphisms of ALDH2 (rs671) were measured using a direct TaqMan PCR method with unprocessed saliva. Results A total of 246 men were enrolled, comprising 193 individuals with active ALDH2 (ALDH2*1/*1) and 53 with less-active ALDH2 (ALDH2*1/*2). The cumulative incidence of gastric cancer in the less-active group was higher than in the active ALDH2 group (p=0.01, hazard ratio: 4.6, 95% confidence interval: 1.2-16.7). Alcohol consumption was lower in the less-active ALDH2 group than in the active ALDH2 group, although no marked difference was observed in the AUDIT score. Conclusion In individuals with hazardous drinking behavior, a heightened risk of gastric cancer was observed among those with less-active ALDH2 variants, even when their alcohol consumption was comparatively lower than in those with active ALDH2 variants.

Occurrence and ecological risk assessment of 16 plasticizers in the rivers and estuaries in Japan.

Owing to growing concerns about the adverse effects of phthalate plasticizers, non-phthalate plasticizers are being increasingly used as their replacement. However, information on the residual environmental concentrations and ecological risks posed by these plasticizers is limited. In this study, we analyzed the environmental contamination of 11 phthalates and 5 non-phthalate plasticizers in Class A and B rivers in Japan. In the considered river water samples, phthalates and non-phthalates were detected in the following order of detection frequency: phthalates (DEHP > DMP > DMEP > BBP > DNPP > DNP > DEEP > DBEP = DNOP) and non-phthalates (ATBC > DEHS > DEHA > TOTM = DIBA). Phthalate plasticizers were the most abundant and included DEHP (157-859 ng/L), DMP (

Origin of surface motor unit potentials in hypothenar motor unit number estimation.

INTRODUCTION: Far-field potentials (FFPs) from muscles other than the abductor digiti minimi (ADM) may interfere with motor unit number estimation (MUNE) from that muscle. METHODS: We identified the origin of each surface motor unit potential (SMUP) during hypothenar MUNE using the multiple point stimulation method in 20 control subjects by recording from individual ulnar-innervated muscles with a common proximal reference (pref). RESULTS: ADM SMUPs comprised 39.0% of the accepted SMUPs, followed by those from the fourth dorsal interosseous muscle (14.0%), the fourth lumbrical muscle (9.2%), and the second and third palmar interosseous muscles (8.8% each). The percentage of ADM SMUPs varied from 18% to 73% of accepted SMUPs among individual subjects. Accepted non-ADM SMUPs were usually much smaller than ADM SMUPs, and many more non-ADM SMUPs were excluded due to their small size. CONCLUSIONS: A large contribution from non-ADM or non-hypothenar SMUPs obscures the meaning of the MUNE value.

Collagenous gastritis.

In the present paper, we report a case of rare collagenous gastritis. The patient was a 25-year-old man who had experienced nausea, abdominal distention and epigastralgia since 2005. Esophagogastroduodenoscopy (EGD) carried out at initial examination by the patient's local doctor revealed an extensively discolored depression from the upper gastric body to the lower gastric body, mainly including the greater curvature, accompanied by residual mucosa with multiple islands and nodularity with a cobblestone appearance. Initial biopsies sampled from the nodules and accompanying atrophic mucosa were diagnosed as chronic gastritis. In August, 2011, the patient was referred to Tohoku University Hospital for observation and treatment. EGD at our hospital showed the same findings as those by the patient's local doctor. Pathological findings included a membranous collagen band in the superficial layer area of the gastric mucosa, which led to a diagnosis of collagenous gastritis. Collagenous gastritis is an extremely rare disease, but it is important to recognize its characteristic endoscopic findings to make a diagnosis.

Influence of Bisphenol A and 17ß-Trenbolone Exposure in Oryzias Congeners.

Japanese medaka is specified as a model fish in the test guidelines of the Organisation for Economic Co-operation and Development. Recently, populations of Japanese medaka in Japan were divided into two species, the northern Oryzias sakaizumii and the southern O. latipes. Previously, we reported that induction concentrations for sex reversal by exposure to 17α-methyltestosterone differed significantly between these two species, indicating that they respond differently to endocrine-disrupting chemica. In the present study, we examined the effects of exposure to two more endocrine-disrupting chemicals (bisphenol A and 17ß-trenbolone) in O. sakaizumii, and compared the results with those previously reported for O. latipes. Exposure to both bisphenol A and 17ß-trenbolone induced testis-ova formation or sex reversal in O. sakaizumii. Exposure to 17ß-trenbolone also increased expression of gonadal soma-derived factor (gsdf). Least-observed-effect concentrations for gonadal sex differentiation and gsdf expression were lower for O. latipes than for O. sakaizumii after exposure to bisphenol A, and were lower for O. sakaizumii than for O. latipes after exposure to 17ß-trenbolone. These results demonstrate that O. sakaizumii and O. latipes respond differently to androgenic and estrogenic endocrine-disrupting chemicals. Environ Toxicol Chem 2023;42:673-678. © 2022 SETAC.

Seven Epithemia taxa (Bacillariophyta) from Lake Akan (Japan) and their salinity tolerances.

The ecologies (salinity tolerance) of many diatoms are largely unknown, despite their potential to contribute to more detailed paleoenvironmental reconstructions. This study therefore aimed to investigate the relationship between diatom species and salinity. We cultured seven cosmopolitan benthic diatom species obtained from Lake Akan, a freshwater inland lake in Japan: Epithemiaadnata, E.frickei, E.gibba, E.operculata, E.sorex, E. sp. and E.turgida. Each species was cultured at eleven salinities between 0‰ and 50‰. Epithemiaadnata, E.frickei and E.sorex had the highest growth rate at a salinity of 3‰, with no further increase observed above 25‰. However, E.gibba had the highest growth rate at a salinity of 5‰, with no increase at salinities ≥ 30‰. These results suggest that E.adnata, E.frickei, E.gibba, and E.sorex grow in freshwater to brackish-water environments. Epithemiaoperculata and E. sp. proliferated at all salinities, indicating that they can adapt to hypersaline environments. However, E.turgida did not survive in salinities >10‰, making it the species with the narrowest salinity tolerance range. These results provide new knowledge that improves the understanding of the ecology of these species in modern environments and offer insights into paleoenvironmental reconstructions through diatom analysis.

[A case of acute bilateral blindness presumably caused by reversible cerebral vasoconstriction syndrome after traumatic brain injury].

A 62-year-old man was admitted to our hospital for acute bilateral blindness two days after a head injury. Hemorrhagic cerebellar infarction was found on the initial MRI, and peripheral arteries were poorly visualized on MRA. On the follow-up MRA nine days later, peripheral arteries were clearly depicted. These imaging findings suggested reversible cerebral vasoconstriction syndrome (RCVS). We started steroid pulse therapy for suspected optic neuritis with no clear response. The initial fundoscopic examination revealed no abnormalities in the optic disc, but optic nerve atrophy developed one month later. Based on the course of events, we diagnosed the patient with posterior ischemic optic neuropathy triggered by RCVS.

Adverse effects of thyroid-hormone-disrupting chemicals 6-propyl-2-thiouracil and tetrabromobisphenol A on Japanese medaka (Oryzias latipes).

Thyroid-hormone-disrupting chemicals are increasingly attracting attention because of their potential harmful effects on animal health, including on fishes. Here, we investigated the effects of exposure to the thyroid-hormone-disrupting chemicals 6-propyl-2-thiouracil (PTU) and tetrabromobisphenol A (TBBPA) on swim bladder inflation, eye development, growth, swimming performance, and the expression of thyroid-related genes in Japanese medaka (Oryzias latipes). PTU exposure resulted in reductions in eye size, growth, and swim bladder inflation, and these effects led to poorer swimming performance. These phenotypic effects were accompanied by increased expression of the thyroid-stimulating hormone subunit beta (tshß) paralog tshß-like, but there were no significant changes in expression for tshß, deiodinase 1 (dio1), deiodinase 2 (dio2), and thyroid hormone receptor alpha (trα) and beta (trß). For PTU exposure, we identified the key event (swim bladder inflation reduction) and an adverse outcome (swimming performance reduction). No significant effects from TBBPA exposure were seen on swim bladder inflation, eye development, growth, or swimming performance. However, expression of tshß-like and tshß (significantly enhanced) and trα and trß (significantly reduced) were affected by TBBPA exposure albeit not in dose-dependent manners. There were no effects of TBBPA on the expression of dio1 and dio2. We thus show that the two thyroid-hormone-disrupting chemicals PTU and TBBPA differ in their effect profiles with comparable effects on the studied phenotypes and thyroid-related gene expression to those reported in zebrafish.

Utility of nerve ultrasound in the management of primary neurolymphomatosis: Case report and review of the literature.

Introduction: Primary neurolymphomatosis (NL) is a critical differential diagnosis of asymmetric multiple mononeuropathy and radiculoplexopathy. Its diagnosis is often challenging due to the lack of typical clinical signs of systemic lymphoma. We report a case of primary NL where nerve ultrasound (NUS) played an important role in the diagnosis and follow-up of the disease. Case presentation: A 52-year-old man developed asymmetric painful multiple mononeuropathy in the right upper limb with cranial nerve involvement. After being referred to our department, the patient underwent NUS, which revealed marked enlargement and increased vascularity in the right upper limb nerves, brachial plexus, and cervical nerve roots. Furthermore, an epineural hypoechoic mass, a characteristic finding of NL, was seen in the right median nerve. These NUS findings prompted us to perform 18F-fluorodeoxyglucose positron emission tomography/computed tomography and a subsequent biopsy on the right axillary lymph node, confirming NL. Notably, the NUS abnormalities dramatically subsided, demonstrating the effectiveness of chemotherapy. Discussion: The diagnostic utility of NUS for NL has been documented by many recent reports. Additionally, NUS can work as a quick follow-up tool for NL, as seen in our case.

Transmission of COVID-19 in Nightlife, Household, and Health Care Settings in Tokyo, Japan, in 2020.

Importance: There have been few studies on the heterogeneous interconnection of COVID-19 outbreaks occurring in different social settings using robust, surveillance epidemiological data. Objectives: To describe the characteristics of COVID-19 transmission within different social settings and to evaluate settings associated with onward transmission to other settings. Design, Setting, and Participants: This is a case series study of laboratory-confirmed COVID-19 cases in Tokyo between January 23 and December 5, 2020, when vaccination was not yet implemented. Using epidemiological investigation data collected by public health centers, epidemiological links were identified and classified into 7 transmission settings: imported, nightlife, dining, workplace, household, health care, and other. Main Outcomes and Measures: The number of cases per setting and the likelihood of generating onward transmissions were compared between different transmission settings. Results: Of the 44 054 confirmed COVID-19 cases in this study, 25 241 (57.3%) were among male patients, and the median (IQR) age of patients was 36 (26-52) years. Transmission settings were identified in 13 122 cases, including 6768 household, 2733 health care, and 1174 nightlife cases. More than 6600 transmission settings were detected, and nightlife (72 of 380 [18.9%]; P < .001) and health care (119 [36.2%]; P < .001) settings were more likely to involve 5 or more cases than dining, workplace, household, and other settings. Nightlife cases appeared in the earlier phase of the epidemic, while household and health care cases appeared later. After adjustment for transmission setting, sex, age group, presence of symptoms, and wave, household and health care cases were less likely to generate onward transmission compared with nightlife cases (household: adjusted odds ratio, 0.03; 95% CI, 0.02-0.05; health care: adjusted odds ratio, 0.57; 95% CI, 0.41-0.79). Household settings were associated with intergenerational transmission, while nonhousehold settings mainly comprised transmission between the same age group. Among 30 932 cases without identified transmission settings, cases with a history of visiting nightlife establishments were more likely to generate onward transmission to nonhousehold settings (adjusted odds ratio, 5.30 [95% CI, 4.64-6.05]; P < .001) than those without such history. Conclusions and Relevance: In this case series study, COVID-19 cases identified in nightlife settings were associated with a higher likelihood of spreading COVID-19 than household and health care cases. Surveillance and interventions targeting nightlife settings should be prioritized to disrupt COVID-19 transmission, especially in the early stage of an epidemic.