Variations in Editions of Fukushokiran and Contributory Factors / 日本東洋医学雑誌

Fukushin, or abdominal diagnosis, is one of the characteristics of the Kampo medical examination. During the Edo period, “Fukushokiran (腹証奇覧)” became popular due to its explanations of illustrations of abdominal diagnosis and findings, focusing on the prescriptions in “Shanghanlun (傷寒論)” and “Jinguiyaolue (金匱要略).” In this study, we examined various existing editions of “Fukushokiran” and highlighted the differences in abdominal diagnosis illustrations and findings among them. According to the year indicated at the beginning and end of the volume, “Fukushokiran” is divided into pre-Kyowa and Bunka editions. Although the currently facsimile edition is based on the Bunka edition, significant differences were observed in abdominal diagnosis illustrations and other findings, which were revised from the pre-Kyowa edition. “Fukushokiran” has two parts including the first and second parts; however, differences between the pre-Kyowa and Bunka editions are particularly noticeable in the second part. Inaba Bunrei, the author of “Fukushokiran,” died in Bunka 2 (1805) ; therefore, it is unlikely that he was involved in the revision of the Bunka edition. Instead, it is assumed that the views of Wakuta Shukuko, a disciple of Bunrei, are reflected in the Bunka edition.

Cholera outbreak in 2022 among children in Karachi: Study of cases attending to a Tertiary Care Hospital.

Objective & Background: Repeated outbreaks of cholera have occurred in Karachi. Changing patterns in seasonality, serotypes and antibiotic resistance have been observed in these outbreaks. Recently, in the year 2022, a surge of cholera cases has been reported from Karachi during the months of April-June. This study aimed to identify clinical features, antibiotic susceptibility, complications, and response to treatment of V. cholerae infection among children attending Indus hospital, Karachi. Methods: A retrospective chart review of pediatric patients was conducted for children aged 0-16 years. All children treated for culture-proven cholera infection at Indus Hospital from March to June 2022 were included. Details of clinical features, complications, antibiotic susceptibility, and response to treatment were retrieved from the health management information system (HMIS) of the hospital. Results: Twenty children were included. The median age was 01 (0.50-3.75) years. There were 9 (45%) males and 11 (55%) females. All the culture isolates belonged to serogroup O1 Ogawa of the Vibrio cholerae. Vomiting and diarrhea were the most common symptoms. Dehydration, acute kidney injury, and shock were seen in 19 (95%), 6 (30%), and 2 (10%) children respectively. Eleven children were admitted with an average hospital stay of 5 (Median-IQR 3-6) days. The isolates were completely susceptible to tetracycline, ciprofloxacin, and azithromycin. Different antibiotics were given which included cefotaxime, ceftriaxone, doxycycline, and ciprofloxacin. All children responded completely to the antibiotics. Conclusion: In present study all V. cholerae isolates belonged to the O1 Ogawa serotype that showed complete susceptibility to tetracycline, ciprofloxacin, and azithromycin. Dehydration, electrolyte imbalance, and renal impairment were the most common complications observed. Drinking unboiled water was identified as a potential source of cholera in most children. Therefore, advocacy of hygienic practices and disinfection of water supplies is recommended to prevent future cholera outbreaks.

Molecular Basis of the Toxigenic Vibrio cholerae O1 Serotype Switch from Ogawa to Inaba in Haiti.

Toxigenic Vibrio cholerae O1 serotype Ogawa was introduced involuntarily into Haiti in October 2010, and virtually all of the clinical strains isolated during the first 5 years of the epidemic were Ogawa. Inaba strains were identified intermittently prior to 2015, with diverse mutations resulting in a common phenotype. In 2015, the percentage of clinical infections due to the Inaba serotype began to rapidly increase, with Inaba supplanting Ogawa as the dominant serotype during the subsequent 4 years. We investigated the molecular basis of the serotype switch and confirmed that all Inaba strains had the same level of mRNA expression of the wbeT genes, as well as the same translation levels for the truncated WbeT proteins in the V. cholerae Inaba isolates. Neither wbeT gene expression levels, differential mutations, or truncation size of the WbeT proteins appeared to be responsible for the successful Inaba switch in 2015. Our phylodynamic analysis demonstrated that the V. cholerae Inaba strains in Haiti evolved directly from Ogawa strains and that a significant increase of diversifying selection at the population level occurred at the time of the Ogawa-Inaba switch. We conclude that the emergence of the Inaba serotype was driven by diversifying selection, independent of the mutational pattern in the wbeT gene. IMPORTANCE Our phylodynamic analysis demonstrated that Vibrio cholerae Inaba strains in Haiti evolved directly from Ogawa strains. Our results support the hypothesis that after an initial Ogawa-dominated epidemic wave, V. cholerae Inaba was able to become the dominant strain thanks to a selective advantage driven by ongoing diversifying selection, independently from the mutational pattern in the wbeT gene.

Antigenicidad e inmunogenicidad de una cepa inactivada de Vibrio cholerae O1 El Tor Inaba / Antigenicity and immunogenicity of inactivated Vibrio cholerae 01 El Tor Inaba

INTRODUCCIÓN: el cólera continúa siendo problema de salud, principalmente en las zonas más pobres. La mayoría de los aislamientos que se realizan al nivel mundial pertenecen a Vibrio cholerae O1 biotipo El Tor serotipo Ogawa, aunque se han reportado brotes causados por el serotipo Inaba, por lo que se aconseja que una vacuna efectiva contra la enfermedad deberá contener células o antígenos de ambos serotipos. OBJETIVO: describir las características de la cepa de V. cholerae O1 El Tor Inaba C6706 como posible cepa para la obtención de vacunas inactivadas contra el cólera. MÉTODOS: se elaboró un lote de siembra de trabajo crioconservado a - 70 ºC, se evaluó su identidad, pureza y viabilidad. La cepa fue cultivada en caldo triptona soya y su inactivación se realizó a 56 ºC durante 20 min. Se evaluó la capacidad antigénica del producto obtenido mediante western blot y ELISA de inhibición de lipopolisacárido. La inmunogenicidad en conejos, inoculados por vía intraduodenal, se determinó mediante la cinética de anticuerpos vibriocidas. RESULTADOS: el lote de siembra de trabajo mantuvo su identidad, pureza y viabilidad durante 18 meses de estudio. Se observó la presencia de los antígenos lipopolisacárido, hemaglutinina sensible a manosa y proteína de membrana externa U, en las suspensiones de células inactivadas de V. cholerae O1, no así de las subunidades A y B de la toxina colérica (CTA y CTB, respectivamente) o pilli corregulado con la toxina (TCP). Por otra parte, se obtuvieron títulos vibriocidas en los sueros de conejos, similares a la respuesta inducida por la cepa viva atenuada 638 de V. cholerae O1, candidata a vacuna oral. CONCLUSIONES: la cepa de V. cholerae O1 El Tor Inaba C6706 mostró características culturales, antigénicas e inmunogénicas que permiten considerarla como posible cepa para la obtención de vacunas inactivadas contra el cólera(AU)

INTRODUCTION: cholera continues being a serius health problem, mainly in the poorest areas. Most of the isolations worldwide belong to Vibrio cholerae O1 biotype El Tor serotype Ogawa, although there have been reported outbreaks caused by serotype Inaba, that is why it is recommended that an effective vaccine against the illness should contain cells or antigens of both serotypes. OBJECTIVE: to describe the characteristics of the strain C6706 of V. cholerae O1 El Tor Inaba as a likely strain for the obtaining of inactivated vaccines for cholera. METHODS: a criopreserved working culture batch was made up at - 70 ºC to evaluate identity, purity and viability. The strain was cultured in tryptone soy broth and was inactivated at 56º C for 20 minutes. Antigenicity of this preparation was tested by Western Blot and ELISA inhibition test. Immunogenicity in adult rabbits, inoculated intraduodenally, was determined by means of kinetics of vibriocidal antibodies. RESULTS: the working culture batch kept their identity, purity and viability during 18 months of study. The results confirmed the presence of relevant antigens as lipopolysaccharide (LPS), mannose-sensitive hemagglutinin (MSHA) and outer membrane protein U (OmpU) in the suspension of inactivated V. cholerae O1 cells, but not cholera toxin subunits (CTA, CTB) or toxin-coregulated pili (TCP).On the other hand, vibriocidal titers were found in rabbit sera, which were similar to those previously reported for the live V. cholerae O1 strain 638, an attenuated oral vaccinal candidate CONCLUSIONS: the V. cholerae O1 El Tor Inaba C6706 strain showed cultural, antigenic and immunogenic characteristics that allow us to consider it as a possible strain for the obtaining of inactivated vaccines for cholera(AU)

Antigenicidad e inmunogenicidad de una cepa inactivada de Vibrio cholerae O1 El Tor Inaba / Antigenicity and immunogenicity of inactivated Vibrio cholerae 01 El Tor Inaba

INTRODUCCIÓN: el cólera continúa siendo problema de salud, principalmente en las zonas más pobres. La mayoría de los aislamientos que se realizan al nivel mundial pertenecen a Vibrio cholerae O1 biotipo El Tor serotipo Ogawa, aunque se han reportado brotes causados por el serotipo Inaba, por lo que se aconseja que una vacuna efectiva contra la enfermedad deberá contener células o antígenos de ambos serotipos. OBJETIVO: describir las características de la cepa de V. cholerae O1 El Tor Inaba C6706 como posible cepa para la obtención de vacunas inactivadas contra el cólera. MÉTODOS: se elaboró un lote de siembra de trabajo crioconservado a - 70 ºC, se evaluó su identidad, pureza y viabilidad. La cepa fue cultivada en caldo triptona soya y su inactivación se realizó a 56 ºC durante 20 min. Se evaluó la capacidad antigénica del producto obtenido mediante western blot y ELISA de inhibición de lipopolisacárido. La inmunogenicidad en conejos, inoculados por vía intraduodenal, se determinó mediante la cinética de anticuerpos vibriocidas. RESULTADOS: el lote de siembra de trabajo mantuvo su identidad, pureza y viabilidad durante 18 meses de estudio. Se observó la presencia de los antígenos lipopolisacárido, hemaglutinina sensible a manosa y proteína de membrana externa U, en las suspensiones de células inactivadas de V. cholerae O1, no así de las subunidades A y B de la toxina colérica (CTA y CTB, respectivamente) o pilli corregulado con la toxina (TCP). Por otra parte, se obtuvieron títulos vibriocidas en los sueros de conejos, similares a la respuesta inducida por la cepa viva atenuada 638 de V. cholerae O1, candidata a vacuna oral. CONCLUSIONES: la cepa de V. cholerae O1 El Tor Inaba C6706 mostró características culturales, antigénicas e inmunogénicas que permiten considerarla como posible cepa para la obtención de vacunas inactivadas contra el cólera.

INTRODUCTION: cholera continues being a serius health problem, mainly in the poorest areas. Most of the isolations worldwide belong to Vibrio cholerae O1 biotype El Tor serotype Ogawa, although there have been reported outbreaks caused by serotype Inaba, that is why it is recommended that an effective vaccine against the illness should contain cells or antigens of both serotypes. OBJECTIVE: to describe the characteristics of the strain C6706 of V. cholerae O1 El Tor Inaba as a likely strain for the obtaining of inactivated vaccines for cholera. METHODS: a criopreserved working culture batch was made up at - 70 ºC to evaluate identity, purity and viability. The strain was cultured in tryptone soy broth and was inactivated at 56º C for 20 minutes. Antigenicity of this preparation was tested by Western Blot and ELISA inhibition test. Immunogenicity in adult rabbits, inoculated intraduodenally, was determined by means of kinetics of vibriocidal antibodies. RESULTS: the working culture batch kept their identity, purity and viability during 18 months of study. The results confirmed the presence of relevant antigens as lipopolysaccharide (LPS), mannose-sensitive hemagglutinin (MSHA) and outer membrane protein U (OmpU) in the suspension of inactivated V. cholerae O1 cells, but not cholera toxin subunits (CTA, CTB) or toxin-coregulated pili (TCP).On the other hand, vibriocidal titers were found in rabbit sera, which were similar to those previously reported for the live V. cholerae O1 strain 638, an attenuated oral vaccinal candidate CONCLUSIONS: the V. cholerae O1 El Tor Inaba C6706 strain showed cultural, antigenic and immunogenic characteristics that allow us to consider it as a possible strain for the obtaining of inactivated vaccines for cholera.

Comparative Study Between Inaba's Procedure and Modified Inaba's Procedure with Delayed Suture in the Treatment of Osmidrosis Axillae

PURPOSE: The Inaba's procedure, the treatment of osmidrosis axillae, has the advantages of low recurrent rate and easiness in learning, yet it produces early postoperative discomfort and scar formation by tie-over dressing. The authors modified the Inaba's procedure by using delayed suture of the incision wound and omitting tie-over dressing. The comparative study of Inaba's procedure and its modification was performed to confirm the advantages of modified procedure. METHODS: The study contains the retrospective analysis of the medical records of 296 patients with osmidrosis who were treated using the Inaba's procedure from December, 1996 to February, 2007. The study also contains the prospective analysis of 20 patients, from March, 2007 to July, 2008, who were treated by the modified Inaba's procedure with delayed suture of the incision wound and gentle pressure dressing instead of tie-over dressing. The operative results of two groups were compared and verified by Mann-Whitney U test (SPSS 12.0). RESULTS: The incidence of complications was 14.5% in the Inaba's procedure, whereas 6.2% in the modified Inaba's procedure. Both procedures have the same basic surgical procedure in terms of the location of incision site and subdermal shaving of the sweat glands, and therefore similar good results were obtained in the aspect of postoperative axillary odor, recurrent rate and postoperative condition of axillary hair. Certainly, the modified Inaba's procedure had better outcome in each element of PSS (Patient Scar Self-Rating Scale), compared to the Inaba's procedure. In addition, the modified Inaba's procedure showed a statistical significance in dressing-related pain reduction and overall satisfaction. CONCLUSION: The modified Inaba's procedure had advantages of decreasing early postoperative complications such as hematoma, discomfort and pain caused by tie-over dressing, and decreased scar formation. However, the drawback was delayed suture of the incision wound after 48 hours.