Orthogonal antibody testing for COVID-19 among healthcare workers in a non-epidemic place and time: Japan's Iwate Prefecture, May 18-31, 2020

Of the 47 prefectures in Japan, Iwate had the fewest cases of coronavirus disease 2019 (COVID-19), with the first diagnosis officially confirmed on July 28, 2020. A baseline serological survey of COVID-19 antibodies is essential to accurately evaluate an epidemic outbreak. The primary purpose of this study was to determine pre-epidemic prevalence of COVID-19 antibodies among healthcare workers, using two laboratory-based quantitative tests. In addition, a point-of-care (POC) qualitative test, rapid, simple, and convenient for primary care clinics, was compared with the laboratory-based tests. All antibody tests were performed on serum from 1,000 healthcare workers (mean age, 40 ± 11 years) in Iwate Prefectural Central Hospital, May 29-31, 2020. A COVID-19 case was defined as showing positive results in both laboratory-based quantitative tests. None of 1,000 samples had positive results in both of the laboratory immunoassays. The POC test showed positive results in 33 of 1,000 samples (3.3%) (95% confidence interval:2.19-4.41), but no samples were simultaneously positive in both laboratory-based tests. In conclusion, COVID-19 cases were not serologically confirmed by a baseline control study of healthcare workers at our hospital in late May, 2020. Moreover, the POC qualitative test may offer no advantage in areas with very low prevalence of COVID-19, due to higher false-positive reactions compared with laboratory-based quantitative immunoassays

Prevalence and safety of robotic surgery for gastrointestinal malignant tumors in Japan

[Aim] The National Health Insurance system has reimbursed robotic gastrointestinal surgery since April 2018 in Japan. Additionally, strict facility and surgeon standards were established by the government and the academic society. This study aimed to evaluate the prevalence and safety of robotic surgery using a Japanese nationwide web-based database. [Methods] Patients who underwent the following robotic surgeries for malignant tumors in 2018 were included: esophagectomy (RE), total gastrectomy (RTG), distal gastrectomy (RDG), proximal gastrectomy (RPG), low anterior resection (RLAR), and rectal resections other than RLAR (RRR). The number of cases and surgical mortality rates each month were calculated to evaluate the prevalence and safety of robotic procedures. [Results] A total of 3281 patients underwent robotic gastrointestinal surgery. The monthly number of robotic surgeries nearly doubled in April 2018 when they were initially reimbursed by the National Health Insurance system. Operative mortality rates were 0.9%, 0.4%, 0.2%, and 2.8% for RE (n = 330), RTG (n = 239), RDG (n = 1167), and RPG (n = 109), respectively. No mortality was observed in RLAR (n = 1062) or RRR (n = 374). [Conclusion] Robotic surgery for gastrointestinal malignant tumors was safely introduced into daily clinical practice along with rigorous surgeon and facility standards in Japan

Laparoscopic Surgery for Acute Diffuse Peritonitis Due to Gastrointestinal Perforation: A Nationwide Epidemiologic Study Using the National Clinical Database

[Background] Elective laparoscopic surgery is now widely accepted in the treatment of abdominal diseases because of its minimal invasiveness and rapid postoperative recovery. It is also used in the emergency setting for the diagnosis and treatment of acute diffuse peritonitis regardless of the causative disease. However, the value of laparoscopy in acute diffuse peritonitis remains unclear. In this study we aimed to show trends in the use of laparoscopy over time and compare the real-world performance of laparoscopic surgery with that of open surgery for acute diffuse peritonitis due to gastrointestinal perforation. [Methods] We extracted data from the National Clinical Database, a nationwide surgery registration system in Japan, for patients with a diagnosis of acute diffuse peritonitis due to gastroduodenal or colorectal perforation between 2016 and 2019. Trends in the use of laparoscopy over time were identified. Patient characteristics, laboratory findings, surgical findings, and postoperative complications were compared between laparoscopic surgery and open surgery. [Results] Patients in poor condition and those with abnormal laboratory findings tended to undergo open surgery. Anesthesia time and operating time were longer for laparoscopic surgery in patients with gastroduodenal perforation but shorter in those with colorectal perforation. Fewer complications occurred in patients who underwent laparoscopic surgery. The number of institutions where laparoscopic surgery was performed and the proportion of the use of laparoscopy at each institution increased over time. [Conclusion] The use of laparoscopy is becoming common in surgery for acute diffuse peritonitis due to gastrointestinal perforation. This approach may be a useful option for acute diffuse peritonitis

ADAMTS13 gene deletion enhances plasma high-mobility group box1 elevation and neuroinflammation in brain ischemia-reperfusion injury

Highly adhesive glycoprotein von Willebrand factor (VWF) multimer induces platelet aggregation and leukocyte tethering or extravasation on the injured vascular wall, contributing to microvascular plugging and inflammation in brain ischemia-reperfusion. A disintegrin and metalloproteinase with thrombospondin type-1 motifs 13 (ADAMTS13) cleaves the VWF multimer strand and reduces its prothrombotic and proinflammatory functions. Although ADAMTS13 deficiency is known to amplify post-ischemic cerebral hypoperfusion, there is no report available on the effect of ADAMTS13 on inflammation after brain ischemia. We investigated if ADAMTS13 deficiency intensifies the increase of extracellular HMGB1, a hallmark of post-stroke inflammation, and exacerbates brain injury after ischemia-reperfusion. ADAMTS13 gene knockout (KO) and wild-type (WT) mice were subjected to 30-min middle cerebral artery occlusion (MCAO) and 23.5-h reperfusion under continuous monitoring of regional cerebral blood flow (rCBF). The infarct volume, plasma high-mobility group box1 (HMGB1) level, and immunoreactivity of the ischemic cerebral cortical tissue (double immunofluorescent labeling) against HMGB1/NeuN (neuron-specific nuclear protein) or HMGB1/MPO (myeloperoxidase) were estimated 24h after MCAO. ADAMTS13KO mice had larger brain infarcts compared with WT 24h after MCAO (p<0.05). The rCBF during reperfusion decreased more in ADAMTS13KO mice. The plasma HMGB1 increased more in ADAMTS13KO mice than in WT after ischemia-reperfusion (p<0.05). Brain ischemia induced more prominent activation of inflammatory cells co-expressing HMGB1 and MPO and more marked neuronal death in the cortical ischemic penumbra of ADAMTS13KO mice. ADAMTS13 deficiency may enhance systemic and brain inflammation associated with HMGB1 neurotoxicity, and aggravate brain damage in mice after brief focal ischemia. We hypothesize that ADAMTS13 protects brain from ischemia-reperfusion injury by regulating VWF-dependent inflammation as well as microvascular pluggin

Loss of Deacetylation Activity of Hdac6 Affects Emotional Behavior in Mice

Acetylation is mediated by acetyltransferases and deacetylases, and occurs not only on histones but also on diverse proteins. Although histone acetylation in chromatin structure and transcription has been well studied, the biological roles of non-histone acetylation remain elusive. Histone deacetylase 6 (Hdac6), a member of the histone deacetylase (HDAC) family, is a unique deacetylase that localizes to cytoplasm and functions in many cellular events by deacetylating non-histone proteins including α-tubulin, Hsp90, and cortactin. Since robust expression of Hdac6 is observed in brain, it would be expected that Hdac6-mediated reversible acetylation plays essential roles in CNS. Here we demonstrate the crucial roles of Hdac6 deacetylase activity in the expression of emotional behavior in mice. We found that Hdac6-deficient mice exhibit hyperactivity, less anxiety, and antidepressant-like behavior in behavioral tests. Moreover, administration of Hdac6-specific inhibitor replicated antidepressant-like behavior in mice. In good agreement with behavioral phenotypes of Hdac6-deficient mice, Hdac6 dominantly localizes to the dorsal and median raphe nuclei, which are involved in emotional behaviors. These findings suggest that HDAC6-mediated reversible acetylation might contribute to maintain proper neuronal activity in serotonergic neurons, and also provide a new therapeutic target for depression

<English Paper Original Paper>Nocturnal Sleep at a Predetermined Time in Healthy Undergraduate Students

本研究では, 翌朝ある時刻に起床しなければならないと言う覚醒企図を就寝前に課した場合, それがその後の終夜睡眠経過にどの様な影響を及ぼすかを検討した.心身共に健康な大学生8名(男子6名, 女子2名)を対象に, 連続4夜の終夜睡眠ポリグラフ記録を実施した.1,2夜目を順応夜, 3夜目を基準夜, 4夜目を実験夜に割り当てた.実験夜では, 被験者に対して, 翌朝必ず5時に起床するよう就寝前に教示した.被験者はまた, 睡眠中に覚醒したと気づいた時にはいつでも, ボタン押しを4回行うよう教示された(行動的覚醒;BSA).実験夜では, 5時に起床したと判断した時は, ボタン押しを行いその旨を実験者に伝えるよう要請した.その結果, (1)睡眠段階2までの潜時が実験夜でやや延長する傾向が認められた, (2)第1睡眠周期における各睡眠段階の出現率を基準夜と実験夜で比較したが, 有意な差は認められなかった, (3)一夜全体の行動的覚醒(BSA)の総出現数は, 基準液に比べ実験夜で有意に増加した.この結果から, 就寝前の時間に関連した心理的ストレス状態が, 入眼を遅らせ, 中途覚醒を増加させることが示唆された.This study examind the effect of trying to wake up at predetermined time without any aids on subsequent nocturnal sleep. Polysomnograms were recorded from six male and two female undergraduate students for four consecutive nights. The third night was assigned as the baseline night. In the fourth night, subjects were instructed to wake up at five o\u27clock the next morning without any aid. Each night subjects were also instructed to press a button four times whenever they perceived their own awakenings from sleep (behaviorally signaled awakening; BSA). Comparing the baseline night with the experimental night showed that there were no significant differences on any sleep variables during the first sleep cycle, but the latency to stage 2 was slightly delayed and BSAs were significantly more frequent during the experimental night. It is suggested that psychological stress related to time pressure might influence sleep onset and could have induced spontaneous awakenigs from sleep

Downslope soil detachment–transport on steep slopes via rain splash

This study developed a one-dimensional model of downslope rain splash transport based on field experiments and previous studies. The developed model considers soil detachment processes, ground cover, probability densities, and the effect of overland run-off in preventing detachment. Field monitoring was conducted to observe precipitation run-off, ground cover, and sediment production on steep hillslopes. Field-observed data were used to develop the splash detachment rate equation, probability densities for splash transport, and the maximum splash transport distance. Observed and estimated splash transport showed overall agreement, with some differences for small storm events or events with relatively low intensity, probably caused by variation of overland run-off depth and connectivity as well as differences in soil surface cohesion at various degrees of wetness. Our model can provide insights on the interactions among rainfall intensity, soil surface condition, soil wetness, and splash transport on forested hillslopes

Effect of ground cover on splash and sheetwash erosion over a steep forested hillslope: a plot-scale study

The contributions and relationships of erosion by splash and overland flow over a steep slope in a Japanese beech forest in plots with different percentages of ground cover were examined. Three erosion plots (2 m wide × 5 m long) with average understory coverage of 1%, 45%, and 94% were installed. Sediment transported by rain splash and by overland flow was sampled separately. For the plots with sparse, moderate, and high understory coverage, the average proportions of splash soil to total soil erosion during the monitoring period were 16%, 32%, and 18%, respectively. A significant correlation between the amount of splash soil and precipitation was found in the plots with 1% and 45% understory coverage, whereas no statistical relationship was identified for the plot with high understory coverage. At the sparse ground cover plot showing the largest sediment movement, the contribution of splash transport decreased with increasing precipitation. The amount of sheetwash erosion was significantly correlated with the amount of splash soil under the condition of sparse ground cover. This relationship was more pronounced during high precipitation events and the rainy season. Splash contribution to the sediment transport was in the range of 0.8%–76.7%, 2.8%–81% and 2.1%–60.8% for plot with high, moderate and low ground cover, respectively. The sparse ground cover showed the largest variation of splash and sheetwash contribution in soil erosion. This variability was due to variation in ground cover and soil surface wetness condition which led to a variation of detachment and non-linear relationship of sheetwash splash