Methods of Cleaning Taps to Prevent Hospital-Associated Infections: An Environmental Survey-Based Study.

In hospitals, outbreaks can occur due to pathogens accumulating in the areas around the wards' washbasins. Carbapenem-resistant Enterobacterales (CRE) was detected in an environmental survey in the high-care unit of a university hospital in Isehara, Japan, and effective cleaning methods were investigated. This study investigated methods of cleaning taps using commonly used detergents and disinfectants, and it assessed their effectiveness in removing hard scale and pathogens, including CRE. The taps were cleaned using various methods and cleaning agents, including environmentally neutral detergent, citric acid, baking soda, cleanser, 80% ethanol, 0.1% sodium hypochlorite, and a phosphoric acid-based environmental detergent (Space Shot). The cleaning effect was assessed based on the agent's effectiveness at removing hard scale from taps. Biofilms and scale were identified on taps, and several bacterial species were cultured. Only phosphoric acid-based detergent was effective at removing hard scale. After cleaning with the phosphoric acid-based detergent, the bacterial count decreased, and no CRE or other pathogens were detected. These results provide a reference for other facilities considering introducing this cleaning method.

[Restructuring Torso CT Protocol for Radiation Dose Management].

PURPOSE: There are problems with dose management in X-ray computed tomography (CT) because the protocol used for any examination is not always in the same scan range. The purpose of this study was to investigate the usefulness of setting the CT protocol based on the scan range. METHODS: We evaluated the examination data of patients who underwent plain CT based on a scan range of chest to pelvis and abdomen to pelvis. The previous protocol [Chest-Abdomen Routine] was changed to the current protocols [Chest_Abdomen] and [Chest_Pelvis], and the previous protocol of [Abdomen Routine] was changed to the current protocols [Abdomen] and [Abdomen_Pelvis]. Examination data of height, scan length, volume CT dose index (CTDIvol), and dose length product (DLP) were obtained from digital imaging and communications in medicine, and radiation dose structured report using Radimetrics. The relationship between patient height and scan range, and CTDIvol and DLP was indicated in a scatter plot. Standard deviation (SD) of scan length and DLP were compared between current and previous protocols. Outliers were defined as the data exceeding average ±2SD. RESULTS: The SD of scan length decreased by 77.1% on abdomen to pelvis, and the SD of DLP decreased by 65.2% on abdomen to pelvis. The causes of the outliers were CT scan range, scan parameter, arm position, metal implants, and body thickness of patients. CONCLUSION: Setting CT protocols based on the scan range reduced SD of scan length and DLP. It was helpful for reducing the number of scan range outliers and analyzing the cause of outliers.

Species Diversity based on Revised Systematics of Xerophilic Aspergillus section Restricti Isolated from Storage Rooms and Houses in Japan.

Eighty-seven strains of Aspergillus section Restricti were isolated from five storage rooms (50 strains) and 21 houses (37 strains) between 2014 and 2020. Eleven species were identified based on their morphological characteristics and molecular phylogeny using the rRNA internal transcribed spacer (ITS) region, calmodulin (CaM), ß-tubulin (benA), and RNA polymerase II second largest subunit (RPB2) sequences. A. penicillioides, which was known to cause the deterioration of cultural assets, was isolated at high frequency (73%) from the surfaces of 11 cultural assets in the storage rooms; A. clavatophorus and A. magnivesiculatus, which are closely related to A. penicillioides, were also isolated frequently (45 and 64%, respectively). Five species [A. clavatophorus (42.8%), A. penicillioides (42.8%), A. magnivesiculatus (14.3%), A. reticulatus (28.6%), and A. vitricola (28.6%)] were isolated from dust on the carpets in seven houses. Five species [A. clavatophorus (33.3%), A. penicillioides (55.5%), A. magnivesiculatus (44.4%), A. restrictus (44.4%), and A. gracilis (11.1%)] were isolated from dust on the bedding in nine houses. Using the taxonomic system described by Sklenár et al. (2017), five species (A. clavatophorus, A. magnivesiculatus, A. hordei, A. reticulatus, and A. glabripes) previously identified as A. penicillioides were confirmed as new to Japan.

Distribution of Aspergillus section Nigri at shochu fermenting places in Japan.

Koji mold, which belongs to the Aspergillus section Nigri, is used in the production of shochu. The section Nigri is composed of very morphologically similar members that in some cases produce mycotoxins, which rises concerns as to whether the presence of mycotoxin-producing fungi in shochu producing sites can compromise consumer safety. Thus, we examined the presence of mycotoxin-producing sec. Nigri fungi in six shochu factories (named A-F) in Japan. Airborne fungal levels in the factories were determined, and a traditional koji called "kona-koji" made from the mold naturally present in factory C (Aogashima village) was analyzed. Isolates of sec. Nigri fungi were identified morphologically and confirmed via cytochrome b gene analysis. In factory A (Nago city), airborne fungal levels of sec. Nigri were 4,000 and 100 cfu/m3 in the koji-making and fermentation rooms, respectively. In factories B, C, and D, the levels were 40, >104 cfu/m3, and 100 cfu/m3, respectively. In factory F (Iki city), there were high levels of airborne white-koji mold (a white mutant of Asp. luchuensis). The most dominant fungal species of sec. Nigri was isolated and identified as Asp. luchuensis via genetic analysis. This is likely to have originated from the commercial fermentation culture used. Asp. niger and Asp. luchuensis were isolated from kona-koji. Mycotoxin production (ochratoxin and fumonisin B2) by Asp. luchuensis (eight strains) and Asp. niger (three strains) was virtually inexistent; only one strain of Asp. niger was positive for fumonisin B2. This study clearly shows that mycotoxin-producing fungi are not dominant in the fungal flora present in the shochu factories examined and therefore, that the liquor can be safely fermented.Implications: In this study, we examined the presence of mycotoxin-producing Aspergillus sec. Nigri fungi in six shochu (Japanese distilled beverage) factories. The most dominant fungal species of sec. Nigri was isolated and identified as Aspergillus luchuensis (black-koji mold). The proportion of mycotoxin-producing Aspergillus niger and Aspergillus carbonarius was very small. In addition, the Asp. niger isolated from koji mold did not have the ability to produce ochratoxins or fumonisin B. This study clearly shows that shochu can be safely fermented.

Isolation of Simplicillium sympodiophorum and Toxicocladosporium irritans from the Blowout Air of Household Air Conditioners.

Household air conditioners are known to be contaminated with dematiaceous fungi such as genus Toxicocladosporium and genus Cladosporium. We frequently encounter cases in which a large amount of fungi, which are presumed to belong to the family Cordycipitaceae, are isolated from the blowout air of the household air conditioners. Therefore, the Cordycipitaceae isolated in the survey of four cases of the air conditioners were identified by genetic analyses. As a result, all of them were found to be Simplicillium sympodiophorum. The concentration of airborne fungi, S. sympodiophorum in the blowout air was high (> 104 cfu/m3) as exceeding the upper limit of quantification in three of four cases, and 5,000 cfu/m3 in one case. This study revealed that S. sympodiophorum contaminated multiple air conditioners. Genus Toxicocladosporium was also isolated from the two air conditioners, and it was found to be Toxicocladosporium irritans by the genetic analysis.

The setting of heartbeat acceptance windows on gated myocardial perfusion single-photon emission computed tomography using CZT camera: effect of left ventricular functional parameters in patients with arrhythmia.

OBJECTIVES: Consistently variable with several peaks in heart rate histogram (e.g. bigeminy and trigeminy) is one of the arrhythmia types. We investigated the effects of gating error by consistently variable patients on left ventricular (LV) functional with cadmium zinc telluride (CZT) camera. The purpose of this study is to evaluate LV functional parameters by setting different heartbeat acceptance windows on gated myocardial perfusion single-photon emission computed tomography (SPECT) (MPS) in consistently variable patients, using echocardiography (echo) as a reference. MATERIALS AND METHODS: Sixteen consistently variable patients underwent the gated MPS using a D-SPECT. The MPS images were obtained by setting two different types of heartbeat acceptance windows. The heartbeat acceptance windows were set to include only one peak and two peaks of the maximum count peaks, respectively. RESULTS: Mean end-diastolic volume, end-systolic volume and left ventricular ejection fraction (LVEF) were 112.7 mL, 62.2 mL and 51.3% for one peak, 114.5 mL, 66.1 mL and 47.1% for two peak, and 113.0 mL, 54.2 mL and 54.1% for echo, respectively. The mean differences between two peaks and echo in LVEF were larger than those of between one peak and echo. CONCLUSION: Our study suggests that setting the heartbeat acceptance window of one peak was suitable for accurate measurement of LV function in consistently variable patients.

Respiratory sensitization to insect allergens: Species, components and clinical symptoms.

Airborne insect particles have been identified as an important cause of respiratory allergies, including allergic asthma and rhinitis. In the literature, the significance of respiratory exposure to insect particles as a cause of occupational allergy has been well-documented. Indeed, many cases of occupational allergy have been reported including allergy to the larvae of flies and moths in anglers and occupationally exposed workers, to grain pests in bakers or other workers handling grains, and to crickets and/or locusts in researchers and workers in aquaculture companies. Furthermore, the prevalence of sensitization to insect allergens is considerably high among patients with asthma and/or rhinitis who are not occupationally exposed to insects, suggesting the clinical relevance of exposure to insects in indoor and outdoor environmental non-occupational settings. Exposure to cockroaches, a well-studied indoor insect, is associated with cockroach sensitization and the development and exacerbation of asthma. Booklice, another common indoor insect, were recently identified as a significant sensitizer of asthmatic patients in Japan and India, and potentially of asthma patients living in warm and humid climates around the world. Lip b 1 was identified as an allergenic protein contributing to the species-specific sensitization to booklice. Moths are considered a significant seasonal outdoor allergen and their allergens are considered to have the highest sensitization rate among Japanese patients. However, other than cockroaches, allergenic insect proteins contributing to sensitization have not been fully characterized to date.

Comparison of DNA sequencing and morphological identification techniques to characterize environmental fungal communities.

Culture-independent DNA sequencing of fungal internal transcribed spacer 2 (ITS2) region was compared to a culture-dependent morphological identification technique to characterize house dust-borne fungal communities. The abundant genera were Aspergillus, Wallemia, Cladosporium, and Penicillium. Statistically significant between-method correlations were observed for Wallemia and Cladosporium (Spearman's ρ = 0.75 and 0.72, respectively; p < 0.001). Penicillium tended to be detected with much higher (averaged 26-times) relative abundances by the culture-based method than by the DNA-based method, although statistically significant inter-method correlation was observed with Spearman's ρ = 0.61 (p = 0.002). Large DNA sequencing-based relative abundances observed for Alternaria and Aureobasidium were likely due to multicellularity of their spores with large number of per-spore ITS2 copies. The failure of the culture-based method in detectiing Toxicocladosporium, Verrucocladosporium, and Sterigmatomyces was likely due to their fastidiousness growth on our nutrient medium. Comparing between the two different techniques clarified the causes of biases in identifying environmental fungal communities, which should be amended and/or taken into consideration when the methods are used for future fungal ecological studies.

Analysis of Fungal Flora in the Dust of Bedding in Japanese Houses and Genetic Identification of Yeasts Isolated from the Dust.

This study examined the fungal flora contained in the dust of bedding used in 50 houses in Japan. The result showed that the mycoflora having the largest isolation rate was yeasts, which were isolated by 42 out of 50 houses (84%), and exceeded the isolation rate of Cladosporium spp. (80%) and Aspergillus spp. (66%). In addition, the isolation rate of Alternaria, which was an important fungus causing asthma, 66% was being considered as a high isolation rate, and this result was very interesting. The isolation rate of xerophilic fungi such as Aspergillus restrictus and Wallemia often found in house dust on the floor, was not very high. Forty-one strains of yeasts isolated from each dust sample were identified, and Naganishia diffluens species complex and Filobasidium magnum had a larger number of 13 strains, respectively. Since N. diffluens was the yeasts often isolated from human skin, it was thought to be an association between the fungal skin flora and fungal flora of bed dust. Meanwhile, there was no report of isolation of F. magnum from house dust previously. To the best of our knowledge, this is the first study showing its isolation from bedding with relatively high frequency.

Genetic Identification of Dematiaceous Fungi Isolated from Washing Machine in Japan, and Considering of Fungal Removal Methods.

In 2017, 2 household washing machines which were used at a house in Saitama prefecture were tested for fungal flora sampling. The fungi were identified in detail via genetic analysis of the ITS region. The number of fungi which were isolated were 8.7×106～6.1×107 cfu/100cm2 and dematiaceous fungi such as Ochroconis musae, Exophiala, Cyphellophora, Knufia epidermidis were dominant. As for Knufia epidermidis, this is the first report for identification from a Japanese household. The number of isolated Cladosporium, which is common in the environment, was fewer compared with the above 4 genera. The identified fungi were Cladosporium halatolerans, which is recently being recognized as the main species of Cladosporium. In our research, we have cleaned the 2 washing machines with different bleaches. Residual fungi was detected in washing machine A, which was cleaned with an oxygen bleach. On the other hand, no fungi was detected in washing machine B, which was cleaned with a chlorine bleach.

Rare presentation of anaphylaxis: pancake syndrome.

A 43-year-old woman presented with oral discomfort, sneezing, urticaria, eyelid angioedema, abdominal pain, diarrhoea, dyspnoea and wheeze soon after eating a Japanese flour pancake (okonomiyaki, containing wheat, egg, yam, pork, prawn and squid). Subsequent analysis of the flour used in the pancake revealed the presence of Dermatophagoides farinae (4500 mites/g). The patient tested positive for specific IgE to D. farinae (15.2 kU/L) and D. pteronyssinus (14.0 kU/L) with negative responses to other ingredients in the pancake. Oral ingestion of dust mite in poorly stored foods can cause anaphylactic reactions in patients with allergy.

Effectiveness of Airborne Fungi Removal by using a HEPA Air Purifier Fan in Houses.

Few studies have evaluated the performance of air purifiers in removing airborne fungi in houses. Here, we evaluated the ability of a HEPA air purifier fan to remove airborne fungi in six houses in Japan. In each house, the number of airborne fungi decreased more rapidly when the air purifier fan was on (test measurement) than when it was off (control) , demonstrating its ability to decrease the fungal concentration. The number of airborne fungi decreased between 1.5 and 6 times faster when the air purifier fan was on than when it was off (spontaneous decrease) . Clean air change rates, calculated from measurements taken 15 min after the test equipment operation began, ranged from 2.9 to 5.4 (h-1) , indicating adequate air cleaning. One of the six test houses contained a much greater concentration of airborne fungi than the standard set by the Architectural Institute of Japan. When the air purifier fan was operated in the house, the indoor/outdoor (I/O) ratio decreased from 77.5, equating to a fungal concentration of 53,000 cfu/m3 at 0 min to 0.72 or 620 cfu/m3 after 45 min, which is below the standard. This reduction clearly demonstrated the antifungal effect of the air purifier fan.

Fungal levels in houses in the Fukushima Daiichi Nuclear Power Plant evacuation zone after the Great East Japan Earthquake.

Residences located within 20 km of the damaged Fukushima Daiichi Nuclear Power Plant were evacuated shortly after the Great East Japan Earthquake. The levels of airborne and surface fungi were measured in six houses in the evacuation zone in August 2012 and February 2013. Airborne fungal levels in all of the houses in the summer were higher than the environmental standard levels for residential houses published in Architectural Institute of Japan (>1000 colony-forming units [CFU]/m3). In two houses whose residents rarely returned to visit, fungal levels were extremely high (>52,000 CFU/m3). Although fungal levels in the winter were much lower than those in the summer, they were still higher than environmental standard levels in several houses. Indoor fungal levels were significantly inversely related to the frequency with which residents returned, but they were not correlated with the air exchange rates, temperature, humidity, or radiation levels. Cladosporium spp. and Penicillium spp. were detected in every house. Aspergillus section Circumdati (Aspergillus ochraceus group) was also detected in several houses. These fungi produced ochratoxin A and ochratoxin B, which have nephrotoxic and carcinogenic potential. The present study suggests that further monitoring of fungal levels is necessary in houses in the Fukushima Daiichi Nuclear Power Plant evacuation zone, and that some houses may require fungal disinfection. IMPLICATIONS: The results suggest that residents' health could be at risk owing to the high levels of airborne fungi and toxic fungi Aspergillus section Circumdati. Therefore, monitoring and decontamination/disinfection of fungi are strongly recommended before residents are allowed to return permanently to their homes. In addition, returning to home with a certain frequency and adequate ventilation are necessary during similar situations, e.g., when residents cannot stay in their homes for a long period, because fungal levels in houses in the Fukushima Daiichi Nuclear Power Plant evacuation zone were inversely correlated with the frequency with which residents returned to visit their houses.

Immobilization of immunoglobulin-G-binding domain of Protein A on a gold surface modified with biotin ligase.

Protein A from Staphylococcus aureus specifically binds to the Fc region of immunoglobulin G (IgG) and is widely used as a scaffold for the immobilization of IgG antibodies on solid supports. It is known that the oriented immobilization of Protein A on solid supports enhances its antibody-binding capability in comparison with immobilization in a random manner. In the current work, we developed a novel method for the oriented immobilization of the IgG-binding domain of Protein A based on the biotinylation reaction from archaeon Sulfolobus tokodaii. Biotinylation from S. tokodaii has a unique property in that the enzyme, biotin protein ligase (BPL), forms a stable complex with its biotinylated substrate protein, biotin carboxyl carrier protein (BCCP). Here, BCCP was fused to the IgG-binding domain of Protein A, and the resulting fusion protein was immobilized on the BPL-modified gold surface of the sensor chip for quartz crystal microbalance through complexation between BCCP and BPL. The layer of the IgG-binding domain prepared in this way successfully captured the antibody, and the captured antibody retained high antigen-binding capability.

Allergenicity and cross-reactivity of booklice (Liposcelis bostrichophila): a common household insect pest in Japan.

BACKGROUND: Booklice (Liposcelis bostrichophila) are a common household insect pest distributed worldwide. Particularly in Japan, they infest 'tatami' mats and are the most frequently detected insect among all detectable insects, present at a frequency of about 90% in dust samples. Although it has been hypothesized that they are an important indoor allergen, studies on their allergenicity have been limited. METHODS: To clarify the allergenicity of booklice and the cross-reactivity of this insect allergen with allergens of other insects, patients sensitized to booklice were identified from 185 Japanese adults with allergic asthma using skin tests and IgE-ELISA. IgE-inhibition analysis, immunoblotting and immunoblotting-inhibition analysis were performed using sera from these patients. Allergenic proteins contributing to specific sensitization to booklice were identified by two-dimensional electrophoresis and two-dimensional immunoblotting. RESULTS: The booklouse-specific IgE antibody was detected in sera from 41 patients (22% of studied patients). IgE inhibition analysis revealed that IgE reactivity to the booklouse allergen in the sera from one third of booklouse-sensitized patients was not inhibited by preincubation with extracts from any other environmental insects in this study. Immunoblotting identified a 26-kD protein from booklouse extract as the allergenic protein contributing to specific sensitization to booklice. The amino acid sequence of peptide fragments of this protein showed no homology to those of previously described allergenic proteins, indicating that this protein is a new allergen. CONCLUSIONS: Sensitization to booklice was relatively common and specific sensitization to this insect not related to insect panallergy was indicated in this population.

Dose-response effects of an aqueous formulation of calcitriol and evaluation of renal function in nonpregnant cows.

Dose responses of plasma calcitriol, calcium (Ca), bone metabolic markers and glomerular filtration rate (GFR) were evaluated in four nonpregnant Holstein cows treated subcutaneously with an aqueous formulation of calcitriol at four doses in a 4 × 4 Latin-square design. Calcitriol, Ca, and markers of bone metabolism were analyzed in plasma samples. GFR was measured in predose and day 5 samples. Plasma calcitriol and Ca concentrations increased dose-dependently. The calcitriol dose was positively correlated with the area under the concentration-time curve of plasma calcitriol. Bone formation markers tended to increase from day 3 onward for all doses. No significant changes in GFR were noted. Thus, exogenous calcitriol administered between 0.0625 and 0.5 µg/kg body weight elicited dose-dependent increases in both plasma calcitriol and Ca and elevated bone formation markers without affecting renal function in nonpregnant cows.

Response of plasma bone markers to a single intramuscular administration of calcitriol in dairy cows.

To elucidate the effects of an exogenous calcitriol (1,25-dihydroxyvitamin D(3)) on plasma bone markers, the formation item osteocalcin (OC), undercarboxylated OC (ucOC) and bone-specific alkaline phosphatase (BALP), and the resorption parameter tartrate-resistant acid phosphatase isoform 5b (TRAP5b) and hydroxyproline (HYP) were measured in conjunction with plasma calcitriol and calcium (Ca) concentrations in dairy cows receiving calcitriol or its vehicle according to a 2×2 crossover design. Calcitriol (0.5 µg/kg, i.m.) increased significantly its plasma level during 6 h to day 2 and plasma Ca concentration during 12 h to day 7 compared to the vehicle. Also, plasma OC and ucOC started to rise from day 3 and 1, respectively, and remained elevated until day 7. No change in plasma BALP, TRAP5b or HYP associated with calcitriol treatment was noted. These results demonstrate that exogenous calcitriol stimulates osteoblasts to biosynthesise OC, a determinant of the bone formation in cows.