National Surveillance of Pediatric Acute Hepatitis of Unknown Etiology, Japan, October 2021-December 2022.

Pediatric acute hepatitis of unknown etiology has been reported globally since April 2022. In Japan, 139 possible cases with onset dates after October 2021 were reported as of December 2022. Three patients required liver transplants, but none died. Rates of adenovirus positivity (11/125, 9%) were lower than those for other countries.

Gastric cancer complicated by paraneoplastic neurological syndrome which presented with extremity numbness: a case report.

BACKGROUND: Paraneoplastic neurological syndromes refer to a group of neurological disorders, which occur as distant effects of malignant tumors and are not caused by metastasis, nutritional disorders, or side effects of antitumor drugs. CASE PRESENTATION: A 70-year-old woman complained of a 1-month history of extremity numbness. Upon presentation to our hospital, she had worsening numbness, and experienced staggering and falling. Physical examination revealed diminished tendon reflexes in both lower limbs, stocking and glove-type abnormal sensation, and left-sided dominant high-steppage gait due to weakness of the bilateral tibialis anterior muscles. Blood tests indicated anemia, and upper gastrointestinal endoscopy revealed gastric cancer, leading to laparoscopic distal gastrectomy. A nerve conduction velocity test showed demyelinating peripheral neuropathy. Further blood tests and imaging studies ruled out nutritional disorders, such as vitamin deficiency, diabetes-related diseases, connective tissue diseases, and central nervous system metastasis, leading to the suspicion of paraneoplastic neurological syndrome. After laparoscopic distal gastrectomy, the progression of symptoms stopped, and with intravenous high-dose immunoglobulin and steroid therapy, the symptoms improved to only minor numbness in the peripheral limbs as of the 18-month follow-up. As of the 2-year follow-up, there has been no cancer recurrence or metastasis. CONCLUSIONS: When paraneoplastic neurological syndrome is suspected, early diagnosis and a multidisciplinary approach, including surgical treatment, are important before irreversible neurological damage occurs.

Pancreatic morphological abnormality that was challenging to differentiate from an ectopic pancreas: a case report.

BACKGROUND: Protrusion of the lateral contour of the pancreatic head is a pancreatic morphological abnormality, which is known as rare shape atypia. We present a rare case of protrusion of the lateral contour of the pancreatic head, which was challenging to distinguish from an ectopic pancreas. CASE PRESENTATION: The patient was a 40-year-old man with a history of acute pancreatitis that occurred twice in the past. He complained of epigastric pain since the day before the visit; his blood workup showed high serum amylase level and a CT scan revealed a 25-mm-large mass with contrast effect from the anterior wall of the gastric pylorus to the duodenum and increased surrounding fatty tissue density. Endoscopic ultrasonography revealed a mass lesion in the gastric pylorus with continuity with the gastric wall and suspected partial continuity with the pancreatic head. Thus, the possibility of pancreatic morphological abnormality or an ectopic pancreas was considered. Following which, resection was attempted and intraoperative findings showed a wide extension of the pancreatic parenchyma from the pancreatic head to the anterior wall of the gastric pylorus to the duodenal bulb. Since the patient only had mild pancreatitis, the resection was judged to be too invasive and was completed by exploratory laparoscopy. CONCLUSIONS: Even if the findings on preoperative CT are suspicious for an ectopic pancreas or tumor, a pancreatic morphological abnormality, such as a protrusion of the lateral contour of the pancreatic head, should be included in the differential diagnosis.

SARS-CoV-2 detection by fluorescence loop-mediated isothermal amplification with and without RNA extraction.

Rapid and simple point-of-care detection of SARS-CoV-2 is an urgent need to prevent pandemic. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) can detect SARS-CoV-2 more rapidly than RT-PCR. Saliva is non-invasive specimen suitable for mass-screening, but data comparing utility of nasopharyngeal swab (NPS) and saliva in RT-LAMP test are lacking and it remains unclear whether SARS-CoV-2 could be detected by direct processing of samples without the need for prior RNA extraction saliva. In this study, we compared utility of saliva and NPS samples for the detection of SARS-CoV-2 by a novel RT-fluorescence LAMP (RT-fLAMP). The sensitivity and specificity of the RT-fLAMP with RNA extraction were 97% and 100%, respectively, with equivalent utility of NPS and saliva. However, sensitivity was decreased to 71% and 47% in NPS and saliva samples without RNA extraction, respectively, suggesting that RNA extraction process may be critical for the virus detection by RT-fLAMP.

The Impact of Oral Health on Work Performance of Japanese Workers.

OBJECTIVE: The aim of this study was to investigate the association between oral health and work performance measured as absenteeism and presenteeism. METHODS: Study participants were employees (mean age: 42.7 ±â€Š11.4 years) of 11 companies in Japan. Oral examination and self-administered questionnaires provided information on industrial category, work schedule, work performance (absenteeism and presenteeism), and smoking status. RESULTS: The proportion of absenteeism (2.7%) or presenteeism (6.8%) of workers caused by oral health problems was low. Logistic regression analysis showed that the risk of absenteeism due to oral health problems was not significantly related to occupation or oral health status. However, the risk of presenteeism caused by oral health problems was 2.01 (95% confidence interval, 1.03 to 3.92) times higher among participants with periodontitis. CONCLUSIONS: Periodontal disease is associated with presenteeism of workers. It is considered that the periodontal disease countermeasure in the workplace should be provided.

Comparison of the histopathological characteristics of large colorectal laterally spreading tumors according to growth pattern.

OBJECTIVES: Colorectal laterally spreading tumors (LSTs) are widely recognized owing to their structural characteristics. This study aims to clarify the histopathological characteristics of large colorectal LSTs according to growth pattern. METHODS: We studied 297 colorectal LSTs measuring ≥20 mm in diameter. The LSTs were classified into four types: granular homogenous type (LST-G-H), granular nodular mixed type (LST-G-M), non-granular flat elevated type (LST-NG-F), and non-granular pseudo-depressed type (LST-NG-PD). Retrospectively collected data were examined to compare the histopathological characteristics of LSTs according to the growth pattern. RESULTS: LST-G-M lesions (142 lesions) were most common, followed by LST-NG-F (74 lesions), LST-G-H (61 lesions), and LST-NG-PD (20 lesions). The mean tumor diameter of LST-G lesions (38.5 ± 17.2 mm) was significantly greater than that of LST-NG lesions (26.3 ± 7.0 mm, P < 0.001). In particular, 45% of LST-G-M lesions were ≥40 mm in diameter. Adenomas accounted for 54% of LST-G-H lesions compared with only 10% of LST-NG-PD lesions. Pathological T1 carcinomas accounted for 55% of LST-NG-PD lesions and were not found among LST-G-H lesions. CONCLUSIONS: The biological malignancy of colorectal LSTs differs considerably depending on the growth pattern even among large lesions and therefore should be considered when selecting treatment regimens.

The Oral Healthcare System in Japan.

This paper describes the present Japanese oral healthcare system and outlines the future challenges and perspectives for Japan. Japan has developed a system for providing high-quality and appropriate health care efficiently through a universal health insurance system which has been in operation since 1961. This health insurance covers most restorative, prosthetic and oral surgery treatment. Therefore, all people can receive dental treatment at a relatively low cost, with the same fees applying throughout the nation. In Japan, public oral health services are provided by the local governments according to the life stage of their populations. These services are mainly conducted by private dental practitioners under contracts with local governments. National oral health data shows that the oral health of the Japanese population has improved over the last several decades. Future challenges and perspectives for Japanese dentistry include: tackling the regional differences in oral health, decreasing the cost of health expenditure, establishment of sustainable emergency oral healthcare services in times of disaster, and the development a new tele-dental system for remote areas without access to dental professionals.

Preparation of Fluoroalkyl End-Capped Vinyltrimethoxysilane Oligomeric Silica Nanocomposites Containing Gluconamide Units Possessing Highly Oleophobic/Superhydrophobic, Highly Oleophobic/Superhydrophilic, and Superoleophilic/Superhydrophobic Characteristics on the Modified Surfaces.

Fluoroalkyl end-capped vinyltrimethoxysilane oligomer [RF-(CH2-CHSi(OMe)3)n-RF (RF-(VM)n-RF)] undergoes the sol-gel reaction in the presence of N-(3-triethoxysilylpropyl)gluconamide [Glu-Si(OEt)3] under alkaline conditions to afford the corresponding fluorinated oligomeric silica nanocomposites containing gluconamide units [RF-(VM-SiO3/2)n-RF/Glu-SiO3/2]. These obtained nanocomposites were applied to the surface modification of glass to provide the unique wettability characteristics such as highly oleophobic/superhydrophobic and highly oleophobic/superhydrophilic on the modified surfaces under a variety of conditions. Such a highly oleophobic/superhydrophobic characteristic was also observed on the modified PET (polyethylene terephthalate) fabric swatch, which was prepared under similar conditions, and this modified PET fabric swatch was applied to the separation membrane for the separation of the mixture of fluorocarbon oil and hydrocarbon oil. The RF-(VM-SiO3/2)n-RF/Glu-SiO3/2 nanocomposites, which were prepared under lower feed amounts of basic catalyst (ammonia), were found to cause gelation in water. Interestingly, it was demonstrated that these gelling nanocomposites are also applied to the surface modification of the PET fabric swatch to give a highly oleophobic/superhydrophobic characteristic on the surface. On the other hand, the modified glass surfaces treated with the corresponding nanocomposite possessing no gelling ability were found to supply the usual hydrophobic characteristic with a highly oleophobic property. More interestingly, the wettability change on the modified PET fabric swatch from highly oleophobic to superoleophilic was observed, and remained superhydrophobic after immersing the modified PET fabric swatch into water.

Preparation and Surface Property of Fluoroalkyl End-Capped Vinyltrimethoxysilane Oligomer/Talc Composite-Encapsulated Organic Compounds: Application for the Separation of Oil and Water.

Fluoroalkyl end-capped vinyltrimethoxysilane oligomer [R(F)-(CH2-CHSi(OMe)3)n-R(F); n = 2, 3; R(F) = CF(CF3)OC3F7 (R(F)-VM oligomer)] can undergo the sol-gel reaction in the presence of talc particles under alkaline conditions at room temperature to provide the corresponding fluorinated oligomeric silica/talc nanocomposites (RF-VM-SiO2/Talc). A variety of guest molecules such as 2-hydroxy-4-methoxybenzophenone (HMB), bisphenol A (BPA), bisphenol AF, 3-(hydroxysilyl)-1-propanesulfonic acid (THSP), and perfluoro-2-methyl-3-oxahexanoic acid (R(F)-COOH) are effectively encapsulated into the R(F)-VM-SiO2/Talc composite cores to afford the corresponding fluorinated nanocomposites-encapsulated these guest molecules. The R(F)-VM-SiO2/Talc composites encapsulated low molecular weight aromatic compounds such as HMB and BPA can exhibit a superoleophilic-superhydrophobic characteristic on the surfaces; however, the R(F)-VM-SiO2/Talc composite-encapsulated THSP and R(F)-COOH exhibit a superoleophobic-superhydrophilic characteristic on the modified surfaces. In these nanocomposites, the R(F)-VM-SiO2/Talc/THSP composites are applicable to the surface modification of polyester fabric, and the modified polyester fabric possessing a superoleophobic-superhydrophilic characteristic on the surface can be used for the membrane for oil (dodecane)/water separation. In addition, the R(F)-VM-SiO2/Talc composites-encapsulated micrometer-size controlled cross-linked polystyrene particles can be also prepared under similar conditions, and the obtained composite white-colored particle powders are applied to the packing material for the column chromatography to separate water-in-oil (W/O) emulsion.

[Evaluation of a nested-pCR to detect 18S rDNA for the diagnosis of toxoplasmic meningoencephalitis].

To detect an 18S ribosomal DNA fragment of Toxoplasma gondii Nested-PCR was used to detect an 18S ribosomal DNA fragment of Toxoplasma gondii in the CSF of 13 patients at 6 facilities in whom Toxoplasma meningoencephalitis had been suspected between January 2001 and Feburary 2005. Based on the diagnostic criteria of the CDC, all patients were treated with the anti-toxoplasmic chemotherapy based on the clinical diagnosis. Clinical improvement was observed in 11 patients, and the final diagnosis was toxoplasmosis, but the conditions of 2 patients deteriorated, and they were ultimately diagnosed with malignant lymphoma. Based on the results of the clinical diagnosis, we assessed the effectiveness of the nested-PCR method of examining the CSF for making the diagnosis of Toxoplasma meningoenephalitis. The results of the nested-PCR were positive in 8 of the 13 cases, and all 8 cases had been diagnosed with Toxoplasma encephalitis clinically. The results were negative in 5 of the 13 cases, but 3 of the 5 negative cases had been clinically diagnosed as toxoplasmosis, indicating that the test was false-negative in some cases (27.3%; 3/11). Toxoplasma meningoencephalitis is so difficult to diagnose that the development of the new, high-specificity diagnostic methods is being eagerly awaited.

Characterisation of hexokinase in Toxoplasma gondii tachyzoites.

We have cloned the hexokinase [E.C. 2.7.1.1] gene of Toxoplasma gondii tachyzoite and obtained an active recombinant enzyme with a calculated molecular mass of 51,465Da and an isoelectric point of 5.82. Southern blot analysis indicated that the hexokinase gene existed as a single copy in the tachyzoites of T. gondii. The sequence of T. gondii hexokinase exhibited the highest identity (44%) to that of Plasmodium falciparum hexokinase and lower identity of less than 35% to those of hexokinases from other organisms. The specific activity of the homogeneously purified recombinant enzyme was 4.04 micromol/mg protein/min at 37 degrees C under optimal conditions. The enzyme could use glucose, fructose, and mannose as substrates, though it preferred glucose. Adenosine triphosphate was exclusively the most effective phosphorus donor, and pyrophosphate did not serve as a substrate. K(m) values for glucose and adenosine triphosphate were 8.0+/-0.8 microM and 1.05+/-0.25mM, respectively. No allosteric effect of substrates was observed, and the products, glucose 6-phosphate and adenosine diphosphate, had no inhibitory effect on T. gondii hexokinase activity. Other phosphorylated hexoses, fructose 6-phosphate, trehalose 6-phosphate which is an inhibitor of yeast hexokinase, and pyrophosphate, also did not affect T. gondii hexokinase activity. Native hexokinase activity was recovered in both the cytosol and membrane fractions of the whole lysate of T. gondii tachyzoites. This result suggests that T. gondii hexokinase weakly associates with the membrane or particulate fraction of the tachyzoite cell.