The relationship between MMP-2 rs243865, MMP-9 rs398242 and CXCL-12 rs1801157 gene polymorphisms with Japanese encephalitis disease and disease outcome in North Indian population

Background & objectives: Japanese encephalitis virus (JEV) is one of the most important causes of acute and uncontrolled inflammatory disease in Asia. Matrix metalloproteinases (MMPs) and chemokines play a detrimental role in the host response to JE disease, aetiology, and disease outcome. Evidently, MMPs are widely circulated in the brain and regulate various process including microglial activation, inflammation, blood-brain barrier disruption as well as affects central nervous system (CNS). The present study was to assess the association of single nucleotide polymorphisms of MMP-2, MMP-9 and chemokine (CXCL-12/SDF1-3’) in the north Indian population. Methods: We performed case-control study comprising of 125 patients and 125 healthy controls in north Indian population. Genomic DNA was extracted from whole blood and gene polymorphism have been determined by PCR-RFLP method. Results: MMP-2, MMP-9 and CXCL-12 gene was not significantly associated with JE disease, but homozygous (T/T) genotype of MMP-2 was statically associated with disease outcome (p=0.05, OR=0.110). A/G and G/G genotype of CXCL-12 was significantly associated with severity of disease. (p=0.032, OR=5.500, p=0.037, OR= 9.167). The serum level of MMP-2 was observed significantly increased in JE patients with homozygous (T/T) genotype whereas increased MMP-9 level was associated with heterozygous genotype. Interpretation & conclusion: MMP-2, MMP-9 and CXCL-12 gene polymorphism were not associated with JE susceptibility, but MMP-2 may be contributed to disease protection. CXCL-12 was associated with disease severity. In our concern this is the first report from northern India.

Clinical and epidemiological analysis of 18 cases of Japanese spotted fever in Zigui County / 中华检验医学杂志

Objective:The epidemiological and clinical characteristics of 18 cases of Japanese spotted fever (JSF) in Zigui County were analyzed in order to improve the prevention and treatment of JSF.Methods:This is a case series analysis. The epidemiological and clinical data, laboratory tests and imaging characteristics of 18 JSF cases with median age of 60 years (54, 68) identified by The People′s Hospital of Zigui from April 2021 to August 2022 were collected and analyzed retrospectively.Results:Most (17/18) of the patients were farmers and all had a field exposure history. The patient′s onset was from April to October. Spring and autumn were the seasons with the highest incidence of JSF. The first symptoms of patients were high fever, headache, and fatigue. Of the 18 cases, 15 had a rash and 12 presented an eschar and 3 had neither rash nor eschar. In addition, 10 of 18 cases experienced edema of both lower extremities, and 3 got disturbance of consciousness. Laboratory tests found that 15 patients had abnormal white blood cells and 11 patients had decreased platelets. C-reactive protein, procalcitonin, D-dimer, lactate dehydrogenase, and alpha-hydroxybutyrate dehydrogenase were elevated in all patients; 13 patients with elevated alanine aminotransferase, 14 patients with elevated aspartate transamination. Kidney damage caused by Rickettsia japonica infection showed by abnormal proteinuria in 11 of the patients. Conclusions:The most common clinical manifestations of JSF are non-specific indications such as high fever, chills, fatigue, headache. The eschar and rash, which are the main features of Rickettsia infection, are not present in all patients, resulting delay of diagnosis or misdiagnosis. Medical workers should be more alert to rickettsial infections in patients with fever of unknown origin, especially in seasons of high incidence of spotted fever. Early diagnosis and correct antibiotic treatment shall be given according to the patient′s clinical manifestations, laboratory results and imaging test to control disease progression.

The Application and Pitfalls for Registering New Japanese Board of Cardiovascular Surgery / 日本心臓血管外科学会雑誌

The first examination of the new board of the Japanese cardiovascular surgery took place in 2022. As it is a transitional period for the new system, many doctors are not familiar with the changes and details of the new system, and some have their concerns. Here, we held a round-table discussion with doctors who actually took the new board of the Japanese cardiovascular surgery under the new system, and we summarized their opinion.

Research on Issues Preventing Japanese Global Health Personnel from Working at International Organizations / 国際保健医療

Objective  There is a growing need to develop human resources with diverse experience, expertise, and a global perspective who can contribute to global rule-making in health. One of the government’s goals is to increase the number of Japanese personnel working for international organizations, but it has not reached the desired level. This study identified the barriers that medical and non-medical professionals have when applying for or working at international organizations, as well as the support measures they expect from the government, to highlight issues and examine employment support measures.Methods  A qualitative and descriptive research was conducted based on semi-structured interviews with 20 physicians, nursing professionals, graduates of public health graduate schools, non-medical professionals, students, etc., who were (1) seeking employment with international organizations, (2) currently employed, and (3) previously employed but left.Results  The following seven themes were highlighted as barriers to applying for or working at an international organization: 〈issues specific to Japanese society and people〉, 〈concerns about a career in global health〉, 〈discrepancy between a career as a healthcare professional and a career in global health〉, 〈need to strengthen skills〉, 〈preparation for competitive examinations〉, 〈importance of WLB〉, 〈issues inherent in international organizations〉. Conclusion  Possible support measures include individual career counseling, seminars on how to survive in international organizations, and seminars for female applicants of child-rearing age, based on the knowledge and experience of current/former employees of international organizations. As for the issues that hinder the dispatch of medical personnel overseas, the first step would be to compare and verify the positive effects that strengthening the overseas dispatch would have on their skills, the workplace environment, and the acceptance of foreign patients. The development and introduction of systems, such as sabbatical and long-term leave, and reinstatement of employment is especially required of global companies and international hospitals.

Nursing students’ knowledge, rewriting skills and perception about communicating with non-native Japanese people to transmit health information / 国際保健医療

Objective  Everyone has the right to obtain information through understandable language. Nevertheless, it has been pointed out that in Japan, a language barrier prevents it. Plain Japanese (easy Japanese) has been proposed as a solution. Plain Japanese is a language form simplified to be suitable for non-native Japanese peoples’ Japanese abilities. However, there are limited studies on healthcare professionals’ use of plain Japanese. The objectives of this study were to examine changes, moreover associations between knowledge and rephrasing skills among nursing students.Method  Eighty nursing students were subjected to this study. We conducted a lesson on “plain Japanese”. Data were collected before and after the lesson using questionnaires. We compared the number of knowledge items and rephrasing scores before and after the lesson. After the lesson, we also compared the number of knowledge items between the high rephrasing score group and the low rephrasing score group. We compared perceptions about communication with non-native Japanese people before and after the lesson.Results  Seventy-two nursing students participated in this study. There was a significant difference in the number of knowledge items before and after the lessons（from 2 to 8) (p<0.05). Rephrasing skills scores were increased as well (from 3 to 4) (p<0.05). The positive answers about “plain Japanese” increased after the lesson. However, the median number of knowledge items among the high rephrasing score group was 10 and the median number among the low rephrasing score group was 8 after the lesson. There was no significant difference between the two groups (p>0.05). Conclusions  Overall, both the number of knowledge items and rephrasing skills scores were increased. However, it is unknown whether the increase in rephrasing skills were improved based on increased knowledge. Students will more specific knowledge and repetitive practice to improve skills in using plain Japanese.

Past Activities and Prospects of Japanese Association of Family Physician Trainees / 日本プライマリ・ケア連合学会誌

A certain period of time has passed since the transition to the General Medicine residency system under the Japanese Medical Specialty Board and Family Medicine specialist training system by the Japan Primary Care Association. We have summarized the needs of residents identified in the survey, and detailed the activities to date and prospects of the Japanese Association of Family Physician Trainees, a self-help support organization, which is an official subcommittee of the Japan Primary Care Association, from the viewpoint of the residents. We believe that this paper will serve as a resource for the training of residents, help guide them under the new system, and help to improve the training system, considering evidence suggesting that information may not be reaching residents who need support.

A novel lateral classification of osteonecrosis of femoral head based on CT recons-truction of necrotic area and its clinical verification / 中国修复重建外科杂志

OBJECTIVE@#To analyze the femoral head collapse and the operation of osteonecrosis of the femoral head (ONFH) in different Japanese Investigation Commitee (JIC) types, in order to summarize the prognostic rules of each type of ONFH, and explore the clinical significance of CT lateral subtypes based on reconstruction of necrotic area of C1 type and verify their clinical effect.@*METHODS@#A total of 119 patients (155 hips) with ONFH between May 2004 and December 2016 were enrolled in the study. The total hips consisted of 34 hips in type A, 33 in type B, 57 in type C1, and 31 in type C2, respectively. There was no significant difference in age, gender, affected side, or type of ONFH of the patients with differenct JIC types ( P>0.05). The 1-, 2-, and 5-year femoral head collapse and operation of different JIC types were analyzed, as well as the survival rate (with femoral head collapse as the end point) of hip joint between different JIC types, hormonal/non-hormonal ONFH, asymptomatic and symptomatic (pain duration >6 months or ≤6 months), and combined preserved angle (CPA) ≥118.725° and CPA<118.725°. JIC types with significant differences in subgroup surgery and collapse and with research value were selected. According to the location of the necrotic area on the surface of the femoral head, the JIC classification was divided into 5 subtypes in the lateral CT reconstruction, and the contour line of the necrotic area was extracted and matched to the standard femoral head model, and the necrosis of the five subtypes was presented by thermography. The 1-, 2-, and 5-year outcomes of femoral head collapse and operation in different lateral subtypes were analyzed, and the survival rates (with collapse of the femoral head as the end point) between CPA≥118.725° and CPA<118.725° hip in patients with this subtype were compared, as well as the survival rates of different lateral subtypes (with collapse and surgery as the end points, respectively).@*RESULTS@#The femoral head collapse rate and operation rate in the 1-, 2-, and 5-year were significantly higher in patients with JIC C2 type than in patients with other hip types ( P<0.05), while in patients with JIC C1 type than in patients with JIC types A and B ( P<0.05). The survival rate of patients with different JIC types was significantly different ( P<0.05), and the survival rate of patients with JIC types A, B, C1, and C2 decreased gradually. The survival rate of asymptomatic hip was significantly higher than that of symptomatic hip, and the survival rate of CPA≥118.725° was significantly higher than that of CPA<118.725° ( P<0.05). The lateral CT reconstruction of type C1 hip necrosis area was selected for further classification, including type 1 in 12 hips, type 2 in 20 hips, type 3 in 9 hips, type 4 in 9 hips, and type 5 in 7 hips. There were significant differences in the femoral head collapse rate and the operation rate among the subtypes after 5 years of follow-up ( P<0.05). The collapse rate and operation rate of types 4 and 5 were 0; the collapse rate and operation rate of type 3 were the highest; the collapse rate of type 2 was high, but the operation rate was lower than that of type 3; the collapse rate of type 1 was high, but the operation rate was 0. In JIC type C1 patients, the survival rate of the hip joint with CPA≥118.725° was significantly higher than that with CPA<118.725° ( P<0.05). In the follow-up with femoral head collapse as the end point, the survival rates of types 4 and 5 were all 100%, while the survival rates of types 1, 2, and 3 were all 0, and the difference was significant ( P<0.05). The survival rate of types 1, 4, and 5 was 100%, of type 3 was 0, and of type 2 was 60%, showing significant difference ( P<0.05).@*CONCLUSION@#JIC types A and B can be treated by non-surgical treatment, while type C2 can be treated by surgical treatment with hip preservation. Type C1 was classified into 5 subtypes by CT lateral classification, type 3 has the highest risk of femoral head collapse, types 4 and 5 have low risk of femoral head collapse and operation, type 1 has high femoral head collapse rate but low risk of operation; type 2 has high collapse rate, but the operation rate is close to the average of JIC type C1, which still needs to be further studied.

Clinicopathological Features of Buccal Squamous Cell Carcinoma with Focus on Patients Who Never Smoke and Never Drink

Abstract Introduction Oral carcinoma has been reported at a substantial proportion in patients who never smoke and never drink. However, the proportion may vary by subsite and ethnicity. Objective We aimed to determine the clinicopathological features of buccal squamous cell carcinoma (SCC) in a Japanese population. Methods We retrospectively analyzed the records of patients diagnosed with buccal SCC at our institution from September 2002 to November 2015. We reviewed the gender, age, tumor status, treatment, smoking, alcohol drinking, multiple primary cancers, and prognosis of the patients. The overall and cause-specific survival rates were calculated, and the effects of clinicopathological variables were assessed by univariate analysis. Furthermore, the cause of death was evaluated. Results Among the 63 patients (men: 38; women: 25) included in the present study, 29 (46.0%) never smoked or drank. Women were almost 5 years older than men (p = 0.014). The number of women in the group who never smoked or drank was disproportionately higher than that of those in the smoker or drinker groups (p < 0.001). In total, 29 patients (46.0%) had 59 multiple primary cancers, including 26 oral cancers. Surgeries and radiotherapy were performed in 57 (90.5%) and 6 (9.5%) cases, respectively. The 5-year overall survival and disease-specific survival rates were 74.6 and 78.8%, respectively. Conclusion Our study confirms that buccal SCC may develop in older adult Japanese patients, especially in women who have never smoked or drank. These patients could be at risk for second primary malignancy.

Japanese encephalitis virus in India: An update on virus genotypes

Japanese encephalitis (JE) is a leading cause of viral encephalitis in Southeast Asia. It is a serious public health issue in India, and cases have been emerging in newer areas of the country. Although vaccination efforts have already been initiated in the country since 2006 and later through the Universal Immunization Programme in 2011, still a significant reduction in the number of cases has to be achieved since an escalating trend of JE incidence has been reported in certain States such as Assam, Uttar Pradesh and West Bengal. Moreover, fresh cases of JE have been reported from certain pockets in Odisha as well. Despite the mass JE vaccination programme implemented in prioritized endemic zones in the country in 2011, a shift in the age group of JE virus (JEV) infection was noticed affecting the adult population in West Bengal. The recent detection of the circulation of genotype I (GI) in Gorakhpur, Uttar Pradesh and the co-circulation of GI and genotype III (GIII) in West Bengal are probably a warning signal for the public health personnel to strengthen the surveillance system in all endemic hotspots in the country. The abrupt emergence of JEV genotype V (GV) in China and Korea in 2009, after its first detection in Malaya in 1952, endemic countries have been cautioned to strengthen their surveillance, because GV has been suspected of getting dispersed efficiently in other parts of Asia. Moreover, the reduced protection efficiency of the JEV GIII-based vaccine against the JEV genotype V further warrants careful evaluation of the ongoing vaccination strategies in the endemic countries, anticipating the possible incursion of GV and its impact on future control strategies. In view of the above facts, the present communication reviews the current knowledge on the molecular epidemiology of JEV in India vis-a-vis the global scenario and discusses the future priorities in JEV research in India for effectively designing control strategies.

Molecular epidemiology of Japanese encephalitis in pigs and risk factors associated with causing Japanese encephalitis in pigs of Lakhimpur, the first case reported in the district of North East India

Background & objectives: Japanese encephalitis (JE) is a major public health problem in India. The first outbreaks of JE have been reported from the North-eastern regions of Assam, particularly from the Lakhimpur district of Assam between July–August 1989. In Assam every year many people died due to JE. This study was performed to investigate the molecular epidemiology of JE in pigs in Lakhimpur district of Assam and the risk factors associated with causing Japanese encephalitis in pigs. This study will help to map out the endemic regions and to know where and when to apply the most control strategies towards the prevention and control of the disease. Methods: A total of 342 serum samples from pigs were collected from 10 organized and 20 unorganized farms from 9 blocks and recorded to age, sex and breed and tested by RT-PCR. Pig farms and the surrounding environment were studied for assessment of farm-level risk factors responsible for JEV infection in pigs. Results: Out of 342 samples tested for detection of the E gene of JEV, 14 samples were found to be positive with a prevalence rate of 4.09%. Age, sex and breed-wise higher cases were found in at the age group above 12 months, sex wise female and breed-wise local pigs. Pig farms less than 500 meters from risk factors like rice field, stagnant water source, wild bird exposure to farm and mosquito exposure at farm/ bite to pigs, found to be more numbers of JE cases. Interpretation & conclusion: Molecular epidemiology of JE in pigs, and humans; positive at Lakhimpur recommend the need for uninterrupted surveillance of this virus in pigs specially those areas where pig population is more and all risk factors are present.

Japanese encephalitis presenting as transverse myelitis: An uncommon presentation

Japanese Encephalitis Virus (JEV) is the main cause of viral encephalitis in South East Asia. Commonly, it presents as an acute encephalitic syndrome with fever, headache, seizures, and altered sensorium as clinical manifestations. However, there can be atypical presentations such as acute transverse myelitis (ATM) as the initial manifestation. Clinicians should be aware of such possibilities and myelitis due to the JE virus should be considered as a differential in children presenting with encephalomyelitis

Outbreaks and Sporadic Cases of Japanese Encephalitis in the State of Odisha, India: Outcome of 7 Years of Laboratory Surveillance

Acute encephalitis syndrome (AES) is a major public health challenge in India. We report here the epidemiology of sporadics and outbreaks of Japanese Encephalitis (JE) in Odisha state during 2012–2018. A total of 4235 AES cases (sporadics – 3394, outbreak cases – 841) recorded including 42 outbreaks; majority (n = 18) of which were during 2016. Overall JE virus (JEV) positivity was 11.78% (outbreak cases – 24.5%, sporadic cases – 8.6%). Age ≤15 years were largely affected during outbreaks, while 16–60 years population was dominant among sporadics. The major outbreak (2016) involved 336 patients from a tribal dominated district, spread over 173 villages. JEV seropositivity was high (43.45%) with 28.57% mortality. Epidemiological linkage with pig rearing was documented through JEV neutralizing antibodies in 50% of pig serum samples. Although the postvaccination period (2017–18) showed increase in AES case reporting but low JE proportion. Ongoing surveillance and preparedness of the health system would be of importance, especially in tribal‑dominated districts.

ACUTE ENCEPHALITIS SYNDROME IN A TERTIARY CARE SETTING WITH SPECIAL REFERENCE TO JAPANESE ENCEPHALITIS: AN OBSERVATIONAL STUDY IN ASSAM, INDIA

Acute Encephalitis Syndrome (AES) is a major public health problem and Japanese Encephalitis (JE) is one of the most important causes of AES. Therefore, it is crucial to know the etiology of AES for patient management and decision making. The present study aimed to assess the morbidity and mortality profile of AES/JE patients admitted in tertiary care setting. An observational prospective cross-sectional study was conducted among 140 hospitalized AES patients admitted in Pediatric and Medicine ward of Jorhat Medical College and Hospital (JMCH), Jorhat over a period from August, 2017 to July 2018. Blood serum and cerebrospinal fiuids (CSF) were tested for presence of JE specific IgM antibody by Mac ELISA during acute illness of AES. The data were compiled and analyzed using the IBM SPSS, V23.0. Of the total 140 AES cases, majority (60%) were below 15 years age (p-value 0.180). Significantly higher proportion of AES cases were from rural areas (94.3%) (p-value <0.0001). The male and female ratio was 1.3:1. The most common presenting symptoms in AES patients were fever (100%), change in mental status (100%), seizure (56.4%) and headache (42.9%). Signs of meningeal irritation were present in 69.3% of cases. Around 22.9% AES patients had GCS ? 8. A total 49 (35%) cases were found to be laboratory confirmed JE following detection of JE specific IgM antibody. Among the JE patients, only 4.1% were immunized with SA 14-14-2 vaccine and 14% died before discharge. The complete recoveries were observed in 78% of cases. JE is one of the major causes of AES which is highly prevalent in this part of India. The significant findings in the present study calls for policy decision to combat JE.

First report on the detection of Japanese encephalitis virus in fruit bats from India

Japanese encephalitis (JE) is a mosquito borne viral zoonotic disease and JE virus (JEV) is responsible for causing several children deaths every year in India. Since 1978, cases of JE have been reported from Gorakhpur district of Uttar Pradesh state annually. The knowledge on the role played by wildlife reservoirs in the sylvatic transmission and maintenance of JE virus remains limited. Bats are reservoir hosts for several emerging and re-emerging viral pathogens but their role in zoonotic cycle of JEV has not been elucidated yet. In Gorakhpur district of Uttar Pradesh, 52 fruit bats were found dead on 26 May 2020. The post-mortem report of the bat samples conducted at the Indian Veterinary Research Institute stated that the bats died due to brain hemorrhage, caused by excessive heat. The brain tissue samples of the bats were subjected to investigation using molecular techniques to determine the presence of JEV. The present work reports for the first time the detection of JEV in brain samples of bats from India. The viral load ranging from 8 to 18 copies/reaction was detected in brain samples by TaqMan real Time RT-PCR. The low viral load might be the reason for the absence of apparent clinical signs in bats and suggests the probable role of fruit bats in maintaining the JEV in nature.

Spatiotemporal Epidemiology of Japanese Encephalitis Cases of Dibrugarh district from 2014 to 2018: A Hospital Record-Based Descriptive Study

Background: Since 1976, several JE outbreaks have been reported from most of the districts of Assam. Objectives: The present study aims to conduct a descriptive and spatial analysis to understand the spatiotemporal distribution of JE cases of Dibrugarh district. Methods: Spatiotemporal distribution of JE cases from 2014 to 2018 at village level was described in maps using Geographical Information System. Spatial association between JE reporting places in the study area has been analyzed using spatial statistics analytical techniques. Temporal distribution of JE cases from 2014 to 2018 for different variable were described in tables. Results: During the period 2014–2018, incidence rate of JE cases ranged between 2.7/100,000 and 5.9/100,000 population and highest case fatality rate was 18.3% in 2014. Highest numbers of JE cases were reported in the age group 0–10 years. Most of the JE cases were from rural areas (84.2%). There was a seasonal pattern of JE which peaked in July. There were hotspots around Dibrugarh Municipality area, Duliajan oil town, Hatiali gaon, Naharkatiya chah bagicha, Nagaon Dhadumia gaon, and Nahortoli Tea Estate. Conclusion: On the basis of the study, JE hotspots can be identified that would help health authorities to further investigate and identify the factors responsible for its occurrence.

Undokai: encontro esportivo dos nipo-brasileiros em Ivoti/Rio Grande do Sul / Undokai: japanese-brazilians sports meeting in Rio Grande do Sul / Undokai: encuentro deportivo de japoneses-brasileños en Rio Grande do Sul

O objetivo deste estudo é compreender como se constituiu o encontro esportivo Undokai dos nipo-brasileiros em Ivoti/Rio Grande do Sul, Brasil, no início do século XXI. Realizou-se uma coleta de informações, principalmente em jornais, os quais foram submetidos à técnica da análise documental. Evidenciou-se que o Undokai foi instituído como uma das formas de preservar a cultura do grupo de nipo-brasileiros residentes na cidade de Ivoti. A despeito das dificuldades enfrentadas nos primeiros tempos, tais tradições não foram submergidas com o movimento migratório. Por meio de encontros esportivos, este grupo também buscou distinguir-se diante de diferentes grupos étnicos que compunham a sociedade em que estavam inseridos.

The aim of this study is to understand how the Japanese Undokai sporting event was instituted in Ivoti/Rio Grande do Sul, Brazil, in the early 21st century. A collection of information was carried out mainly in documentary sources, which were submitted to the technique of documentary analysis. It was evidenced that the Undokai was instituted as one of the ways to preserve the culture of the group of Japanese-Brazilians residing in the city of Ivoti. Despite the difficulties encountered in the early days, such traditions were not submerged by the migratory movement. Therefore, through sporting meetings, this group also sought to distinguish itself from different ethnic groups that made up the society in which they were inserted.

El objetivo de este estudio es comprender cómo se instituyó el encuentro deportivo Undokai de japoneses-brasileños en Ivoti/Rio Grande do Sul, Brasil, a principios del siglo XXI. Se recopiló información, principalmente de periódicos, que fueron sometidos a la técnica de análisis documental. Era evidente que el Undokai se estableció como una de las formas de preservar la cultura del grupo japonés-brasileño residente en la ciudad de Ivoti. A pesar de las dificultades enfrentadas en los primeros días, estas tradiciones no fueron sumergidas con el movimiento migratorio. A través de encuentros deportivos, este grupo también buscó distinguirse frente a las diferentes etnias que conformaban la sociedad en la que se insertaba.

Dengue Encephalopathy or Japanese Encephalitis? Co-Infection or Serologic Cross- Reactivity?

@#Dengue infection has a wide clinical spectrum ranging from asymptomatic presentation to life-threatening severe dengue with multiorgan failure, and increasingly recognized neurological presentation in the past decade. Japanese encephalitis on the other hand is another common mosquitoes-borne flavivirus infection endemic in Southeast Asia, which share some similar clinical features. We report a case of a 38-year-old male patient who presented to us with complaints of fever and acute encephalitis syndrome with positive dengue NS1 antigen, and positive cerebrospinal fluid serologies for both dengue and JE immunoglobulins. Magnetic Resonance Imaging findings were suggestive of encephalitic changes. Co-infection and serology cross-reactivity of these two flaviviruses is not uncommon in countries where both dengue and Japanese encephalitis are endemic, and thus, the treating clinician should have a high index of suspicion if clinical and serological evidence are present whilst treating the patient.

Experience of Midwives in communicating non-Japanese speaking women during the perinatal care / 国際保健医療

Introduction  In Japan, midwives have difficulty communicating non-Japanese speaking women. The study aims to explore the midwives’ experience in communicating with them during the perinatal period. Methods  The semi-structured interviews were conducted for five midwives who have had experienced perinatal care for non-Japanese women.Results  Four categories were emerged during the pregnancy of the women: «Midwives desire to provide accurate information when giving medical and health related explanations», «Means and methods of health guidance depend on the contents», «It is much easier to interact with clients if verbal communication means are available during the prenatal check-ups» and «It is difficult to communicate by telephone about signs of onset of labor without having verbal communication means». Five categories have emerged in the intrapartum period including «Appropriate means and continuous involvement make communication smoother during delivery», «Non-verbal communication measures are useful in providing intrapartum care and «In case of an emergency of mother and fetus, ability of mother’s understanding and selection of appropriate means of communication are critical». Four categories have emerged in the postpartum period including «Midwives can communicate with non-verbal means for the health guidance» and «Midwives feel helpless when they cannot communicate verbally during the postpartum follow-ups». One thematic category «Midwives genuinely desire to provide quality communication despite the differences in language and culture»has emerged from over all period.Conclusions  It is important to prepare linguistic communication measures which help midwives to accurately communicate with their clients during the perinatal periods.

Alleviating Japanese encephalitis virus infection with multiple receptor tyrosine kinase inhibitor sunitinib / 中国热带医学

@#Abstract: Objective　To evaluate the effects of sunitinib on Japanese encephalitis virus (JEV) infection in vitro and vivo. Methods　The 4-week-old BALB/c mice infected with JEV by intraperitoneal injection. The infected mice were treated with sunitinib for 5 days and 10 days respectively. After that, the change of weight and survival rate were evaluated continuously. The viral load variation in mice brain were detected by qRT-PCR. Indirect immunohistochemical staining assay (IFA) was used to detect the number and distribution of CD4+/CD8+T cells in mouse brain. IFA was also used to observe the expression of virus E protein in the brain of mice. Vero cells were infected with JEV in vitro and given a certain concentration of sunitinib to observe the cell survival status. The expression of virus E protein in cells was detected by IFA. Results　Continuous administration of sunitinib significantly improved the survival rate of infected mice. Survival rate and body weight changes showed that the 5-day's administration strategy was significantly better than the 10-day's administration strategy. The treatment of sunitinib decreased the infiltration of CD4+/CD8+T cells in the brain and reduced the changes of vascular sleeve. However, the variation of viral load and E protein expression in brain were not obvious. The cytopathic effect (CPE) of infected Vero cells were slightly relieved after giving sunitinib, and the expression of E protein was also slightly changed. Conclusion　Sunitinib can significantly reduce the mortality of infected mice, and the 5-day's administration strategy is significantly better than the 10-day's administration strategy. Sunitinib decrease T lymphocyte infiltration in brain of mice, relieve the encephalitis symptoms ,and prolonged the life of mice.

Reflecting on activities over the past decade and considering future developments / 全日本鍼灸学会雑誌

The safety committee has been undertaking activities, such as conducting regular workshops at the annual congresses, managing the "Safety Measures Website for Acupuncture and Moxibustion," researching the literature, conducting multicenter prospective studies on acupuncture and moxibustion-related adverse events, collecting information about medical accidents involving acupuncture and moxibustion in Japan, addressing the media pertaining to false information regarding the safety of acupuncture and moxibustion, and formulating the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice. At the 71st annual Tokyo congress workshop, activities conducted over the past decade were summarized.　Regarding the studies on acupuncture and moxibustion-related adverse events, a literature review of reports concerning acupuncture- and moxibustion-associated adverse events published globally from 2004 to 2019 was introduced. Furthermore, the results of a multicenter prospective study conducted by the safety committee were also introduced. Additionally, the Safety Guidelines for Japanese Acupuncture and Moxibustion Practice were introduced, and the results of a questionnaire survey determining the degree of recognition of these guidelines were simultaneously reported. Moreover, regarding future developments, plans to create and publish a safety manual for acupuncture and moxibustion (provisional name) were reported.　In the second half of the workshop, reports on the past cases of needle breakage and retained needles were introduced under the topic "precautions and preventive measures regarding needle breakage and retained needles." Furthermore, the number of needle breakage claims filed under the liability insurance of acupuncture and moxibustion practitioners was reported. These details demonstrate that despite the common use of single-use acupuncture needles, accidents involving needle breakage still exist. Lastly, measures for reducing the difficulty in needle removal and preventing needle breakage were summarized, and opinions on the same were exchanged with the participants.