Non-tuberculous mycobacterial disease associated with Mycobacterium montefiorense in salamanders.

Introduction: Mycobacterium montefiorense is one of the causes of non-tuberculous mycobacterial infections in moray eels and salamanders. Although M. montefiorense infection could be a threat to salamanders, little information is available regarding this pathogen and associated infection. This study aimed to provide fundamental information regarding M. montefiorense and its infection in salamanders. Methods: Nine M. montefiorense strains isolated from three species of salamanders, namely, Japanese black salamander (Hynobius nigrescens), Hakuba salamander (H. hidamontanus), and Tohoku hynobiid salamander (H. lichenatus), between 2010 and 2018, were characterized based on phenotypic and genetic examination. We also pathologically observed salamanders infected with the M. montefiorense strains, including Hakuba salamanders and Tohoku hynobiid salamanders. Results: The microbiological and chemical characteristics of the M. montefiorense salamander and an eel strain (reference strain) matched. Susceptibility testing for antimicrobials suggested that clarithromycin may be effective. Regarding disinfectants, phtharal, peracetic acid, glutaral, sodium hypochlorite, and benzalkonium chloride may be effective. Phylogenetic analyses revealed that the strains isolated from salamanders in 2014 and 2018 were genetically closely related, which could indicate an outbreak. The main gross findings in infected salamanders include skin ulcerative lesions or nodules in the enlarged liver. Microscopically, multifocal to coalescent granulomatous lesions composed of massive macrophages containing numerous acid-fast bacilli were prominently observed in the liver. Conclusion: This study contributes to our understanding of the genetic diversity and phenotypic characteristics of M. montefiorense, as well as the pathology of the infection.

A conventional PCR-based method to detect the E2 gene of the rubella virus for epidemiological analysis.

To eliminate the rubella virus (RV), genetic characterization is vital for its detection, identification of endemic transmission, and diagnosis of imported cases. The 739-nucleotide region in the E1 gene has primarily been used for genotyping for epidemiological analysis. However, in the 2018-2019 RV outbreak, identical sequences were observed in patients who were not epidemiologically linked. Additionally, the 739 nt sequences from the outbreak in Tokyo in 2018-2019 were identical to RV identified in China in 2019. This suggests that this region may be insufficient to identify the detected RV strains as endemic or imported. In 62.4% of the specimens, the E1 gene sequences of the 1E RV genotype were identical. Additionally, the observed discordance of sequences from the mainly detected identical sequence in the 739-nt sequence of the E1 gene were one (31.0%), two (3.5%), three (2.6%), and four (0.23%). Moreover, a comparison of the complete structural protein-coding region suggests that the E2 gene is more diverse than the E1 and the capsid gene. Thus, conventional polymerase chain reaction (PCR) primers were developed to detect the E2 gene and improve epidemiological analysis. A comparison of the sequences identified during the RV outbreak in Tokyo revealed genetic differences in the sequences (15 of the 18 specimens). These results suggest that additional information could be obtained by simultaneously analyzing the E2 and the E1 region. The identified sequences can potentially aid in evaluating the RV strains detected during epidemiological analysis.

Genetic Characteristics of the Virus Detected in the First Mpox Imported Case in Tokyo, Japan.

Mpox, caused by the mpox virus (MPXV), produces symptoms similar to those of smallpox when transmitted to humans. Since 1970, this disease has been endemic, particularly in Africa. However, since May 2022, the number of patients without a history of travel to endemic areas has increased rapidly globally. Under these circumstances, in July 2022, two different real-time PCR methods were used on specimens brought to the Tokyo Metropolitan Institute of Public Health. MPXV was detected in the skin samples, and it was inferred that the virus was a West African strain. Furthermore, a more detailed analysis of the genetic characteristics of the detected MPXV using next-generation sequencing revealed that the MPXV detected in Tokyo was strain B.1, which corresponds to the same strain that is prevalent in Europe and the USA. This suggests that mpox reported for the first time in Japan was imported and related to outbreaks in Europe and the USA. Therefore, it is necessary to continue monitoring outbreaks in Japan in conjunction with global epidemics.

Molecular and Epidemiological Analysis of Respiratory Syncytial Virus Detected in Tokyo, Japan in 2021 Season.

During the COVID-19 pandemic in 2021, Japan experienced an outbreak of respiratory syncytial virus (RSV) infection. A total of 51 RSV cases were detected in infant specimens, including 38 rhinorrhea and 13 nasopharyngeal swabs, collected at the Tokyo Metropolitan Institute of Public Health. Of the 51 cases, 12 were RSV-A and 39 were RSV-B. The G protein gene sequence of RSV-A belonged to the ON1 genotype, whereas RSV-B belonged to the BA9 genotype; thus, different types of RSV were detected during the same period, suggesting that the unusual 2021 RSV season was not due to a single strain or genotype. Of all RSV-positive cases, the proportion of patients aged ≥2 years was 56.8% in 2021, higher than the 31.2% reported in the past 5 years. This indicates that infants aged <1 year who were originally susceptible to RSV infection were less likely to be infected with RSV because of the COVID-19 control measures. The 2021 epidemic peaked in the 28th week, 9 weeks earlier than the average from 2016 to 2020. Therefore, it seems necessary to accumulate and analyze further data, such as factors that led to the outbreak and the characteristics of the detected viruses in 2021.

[Survey of the Efficacy of Long-term and Successive Pharmaceutical Care in Outpatient Chemotherapy by Oncology Pharmacy Specialists].

It is important that pharmacists ensure safe chemotherapy implementation. In addition to inspecting chemotherapeutic prescriptions according to patient condition and drug-drug interactions, the management of chemotherapy-induced adverse effects and associated pharmaceutical intervention is one of the most important responsibilities of pharmacists in medical care teams. In May 2016, an oncology pharmacist was set responsible for the specialized, long-term, and successive pharmaceutical care, including instructions about appropriate use of medication at an outpatient chemotherapy center. We evaluated the effectiveness of the continuous pharmaceutical care. The number of medication counseling and associated pharmaceutical interventions increased with time. Specifically, the number of pharmaceutical interventions (prescription questions and pharmaceutical proposals) was 745 (459 and 286, respectively) in the surveillance period, which significantly increased compared to that observed within the same duration before posting an oncology pharmacist. The adoption rate was approximately 70% for prescription questions and 98% for pharmaceutical proposals. We also found that approximately 70% of the proposals attenuated the painful symptoms. Furthermore, approximately 60% of all pharmaceutical interventions were established after the third visit; in particular, approximately 20% of the pharmaceutical proposals were suggested after the sixth visit, indicating that continuous medication counseling results in an increase in pharmaceutical proposals. In conclusion, long-term and successive pharmaceutical care by oncology pharmacy specialists in outpatient chemotherapy contributes to a safe and less onerous chemotherapy implementation, as it has been highly adopted, is effective in many cases, and has been proven to be important for risk management in chemotherapy.

[Evaluation of the Stability of Indomethacin Oral Spray in Two Different Formulation Conditions].

　Indomethacin (IM) oral spray is a hospital preparation that is used to reduce pain from oral mucositis induced by radiotherapy and chemotherapy. IM oral spray consists of IM (0.25%) dissolved in KH2PO4-NaOH buffer (Formulation A) or Formulation A containing xylitol (Xyl) and glycerin (Gly) (Formulation B). To clarify the stability of IM oral spray in two different formulation conditions, we evaluated the residual rates of IM in these formulations to determine the optimal storage temperature and shelf-life. IM oral spray was stored at freezer temperature (-20°C), refrigerator temperature (4°C) and room temperature (25°C) for up to 16 weeks after preparation. The residual rate of IM was determined by using HPLC. The residual rates of IM in Formulation A and Formulation B after storage for 16 weeks at freezer temperature were ≥95%. When stored at refrigerator temperature, the residual rate of IM in Formulation A was 96.1% after 12 weeks, and the residual rates of IM in Formulation B were 95.8% after 2 weeks, 90.1% after 4 weeks and 72.7% after 12 weeks. These results suggested that Formulation A is stable for at least 12 weeks when stored at 4°C. However, degradation of IM seemed to be accelerated in the formulation containing Xyl and Gly, suggesting that the expiration date should be shortened to 2 weeks at 4°C. In addition, both formulations were stable for at least 16 weeks in a freezer, indicating that long-term preservation is possible.

Comparison between patients with norovirus-related gastroenteritis and asymptomatic carriers with respect to distribution of antibody-complexed viral particles and intestinal flora.

Asymptomatic carriers have a major influence on the spreading of norovirus infections. The objective of this study was to examine the characteristics of patients and asymptomatic carriers affected by norovirus-related community gastroenteritis outbreaks. No significant difference between the two groups was observed in terms of the number of norovirus-antibody complexes with respect to total numbers. Principal coordinates analysis of the intestinal flora based on ß-diversity analysis, revealed a different bacterial composition between patients and asymptomatic carriers, particularly regarding the genera Pseudomonas, Bacteroides, and Erwinia, as well as the Ruminococcaceae family. Although the proportional changes between these intestinal microorganisms were not sufficient to explain gastroenteritis symptoms, they represent possible markers shared by asymptomatic norovirus carriers.

Chemical constituents of Morinda citrifolia roots exhibit hypoglycemic effects in streptozotocin-induced diabetic mice.

The hypoglycemic effects of the chemical constituents of Morinda citrifolia roots was evaluated in streptozotocin (STZ)-induced diabetic mice. The CHCl3, EtOAc, n-BuOH and H2O soluble phases of the MeOH extract of M. citrifolia roots were administrated orally to STZ-induced diabetic mice. Only the n-BuOH soluble phase showed a significant reduction of the blood glucose levels. From the biologically active n-BuOH soluble phase, two iridoids and three anthraquinones were isolated as main constituents. These compounds were identified by spectroscopic analysis to be deacetylasperulosidic acid (1), asperulosidic acid (2), damnacanthol-3-O-beta-D-primeveroside (3), lucidin 3-O-beta-D-primeveroside (4) and morindone-6-O-beta-D-primeveroside (5). 3 and 4 exhibited the hypoglycemic effects, which were anthraquinones with no substituents in one aromatic ring.

Genetic and morphological differences among populations of the Bonin Islands White-eye in Japan.

The Bonin Islands White-eye, Apalopteron familiare , is the sole endemic avian species surviving on the Bonin Islands. The current distribution of this species is limited to only three islands of the Hahajima Island group: Hahajima, Imotojima, and Mukohjima. Imotojima and Mukohjima, which are small satellite islands of Hahajima, are about 3.6 km and 5.5 km, respectively, from the larger island. To investigate genetic and morphological differences among A. familiare populations on these islands, we assayed 634 bp of mitochondrial control region sequence for 132 birds from five locations among the three islands. We detected five haplotypes: two endemic haplotypes each on Hahajima and Imotojima and one on Mukohjima. Principal component analysis based on eight morphological characters of 162 birds from the three island populations revealed that birds from the small satellite islands had significantly different beak morphological characters. Our findings indicate that over-sea dispersal is rare in A. familiare , even when islands are separated by only a few kilometers, and suggest that little movement occurs on Hahajima. Thus, each population on each island should be conserved as an evolutionarily significant unit. The low dispersal ability of this species suggests that it is vulnerable to habitat fragmentation. Although the populations are currently stable and do not require rapid countermeasures, they should be monitored, especially those on the smaller islands.

Early manifestation of vogt-koyanagi-harada disease as unilateral posterior scleritis.

PURPOSE: To describe a patient with an initial diagnosis of unilateral posterior scleritis who developed bilateral Vogt-Koyanagi-Harada (VKH) disease 12 months later. CASE: A 38-year-old woman was diagnosed with posterior scleritis in her right eye at successive examinations. The left eye showed no signs of ocular inflammation. OBSERVATIONS: Her right eye developed a second attack of posterior scleritis 3 months after the initial diagnosis. Twelve months after the first incident, granulomatous uveitis and sunset glow fundus were observed in both eyes. At the same time, lymphocytosis was found in the cerebrospinal fluid, and she was HLA DR-4-positive. In addition, poliosis was noted. CONCLUSIONS: The final diagnosis was primarily VKH disease with presenting signs and symptoms of unilateral posterior scleritis. We therefore recommend that when following a patient with posterior scleritis include VKH disease in the differential diagnosis.

Predicting postoperative anterior chamber depth in cataract patients using Scheimpflug slit photography.

PURPOSE: To predict the postoperative anterior chamber (AC) depth from the preoperative in situ position of the lens central clear zone (CCZ) using Scheimpflug slit photography. METHODS: 111 eyes of 78 cases that underwent phacoemulsification and intraocular lens (IOL) implantation were examined. 748 eyes of 383 healthy subjects with transparent lenses were used as the control. Scheimpflug slit photography was done under maximal mydriasis, and biometry was performed on the photographs. Two types of acrylic IOLs (MA30BA and MA60BM, both from Alcon) were used in this study. The preoperative AC depth (L1), the distance between the anterior lens capsule and lens CCZ (L2) and the postoperative AC depth (I1) were determined. I2, the predicted postoperative AC depth, was then determined from a linear regression of L1 + L2 and I1. RESULTS: L2 thickened by 0.014 mm/year, and L1 decreased by 0.016 mm/year in the transparent lenses. L1 + L2 changed little with aging in both cataractous and transparent lenses. L1 + L2 and I1 showed a linear correlation with r = 0.80 in the MA30BA and r = 0.77 in the MA60BM groups. The mean error values between I1 and I2 were 0.095 +/- 0.096 and 0.123 +/- 0.114 mm in MA30BA and MA60BM, respectively. The error between I1 and I2 was within +/- 0.17 and +/- 0.33 mm or less in 72.9 and 91.5% of MA30BA and in 82.7 and 96.2% of MA60BM. In contrast, the error between I2 and I1 when calculated using the SRK/T formula was much larger - in excess of +/- 0.33 mm in 38.7% of the eyes. CONCLUSIONS: L1 + L2 changes little with aging and is considered a useful marker of the position of the crystalline lens in situ. There was a high correlation between I1 and L1 + L2. These allow a far more accurate prediction of I1 than previous methods. In combination with the conventional regression formula and ray tracing, a highly accurate IOL power calculation can be attained.