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This family case suggests that the clinical features of COVID-19 pneumonia might differ between younger and older children.This study aimed at evaluating performance of Xpert MTB/RIF (Xpert) regarding detection of pulmonary tuberculosis compared to acid-fast bacilli (AFB) smear and culture, and concordance of rifampin resistance with drug susceptibility test. Specimens simultaneously referred for AFB smear, culture, and Xpert during April 2015 to March 2018 were retrospectively reviewed. Sensitivity, specificity, and mean cycle-threshold (Ct) values of Xpert and rifampin resistance results were analyzed. Results of Xpert for pulmonary tuberculosis were evaluated by AFB smear grade. Among the total of 3,840 specimens, 491 were positive in Xpert and 626 were positive in culture. Sensitivity and specificity of Xpert was 75.6% and 99.4%, respectively. Sensitivity of Xpert in smear-positive/culture-positive specimens was 98.6% and those of smear-negative and trace/culture-positive was 63.1%. Positivity of Xpert in culture-positive specimens were 89.9%/98.6%/95.7%/100.0%/100.0% in smear grade trace/1+/2+/3+/4+. Ct values of 491 specimens significantly lowered as AFB smear grade increased (p less then 0.0001). Ct of smear-positive/smear-trace/smear-negative specimens were 21.7 ± 4.2/26.5 ± 3.9/27.4 ± 3.6, respectively. Rifampin resistance tested by Xpert and culture was 98.3% concordant. Region covered by probe E was the most frequently mutated (50.0%). Xpert showed reliable performance in detecting pulmonary tuberculosis in smear-positive/culture-positive specimens and further improvements are needed for smear negative/culture positive specimens.Genes conferring carbapenem resistance have spread worldwide among gram-negative bacteria. Subtyping of these genes has epidemiological value due to the global cross-border movement of people. Subtyping of blaIMP genes that frequently detected in Japan appears to be important in public health settings; however, there are few useful tools for this purpose. We developed a subtyping screening tool based on PCR direct sequencing, which targets the internal sequences of almost all blaIMP genes. The tool used bipartite multiplex primers with M13 universal sequences at the 5'-end. According to in silico analysis, among the 78 known IMP-type genes, except for blaIMP-81, 77 detected genes were estimated to be differentiated. In vitro evaluation indicated that sequences of amplicons of IMP-1, IMP-6, IMP-7, and IMP-20 templates were identical to their respective subtypes. Even if the amplicons were small or undetectable through the first PCR, sufficient amplicons for DNA sequencing were obtained through a second PCR using the M13 universal primers. In conclusion, our tool can be possibly used for subtype screening of blaIMP, which is useful for the surveillance of bacteria with blaIMP in clinical and public health settings or environmental fields.Sputum microscopy and Xpert MTB/RIF are the primary rapid diagnostic methods for tuberculosis (TB) in Nepal. Disagreements among Xpert, microscopy, and culture, for example, cases with Xpert positive and microscopy negative, were frequently observed in Nepal including in our reference laboratory. The objective of this study was to compare the effectiveness of Xpert with culture and microscopy for TB diagnosis in Nepal. A total of 125 TB suspected sputum samples were processed for Xpert, microscopy, and culture. The Xpert results when compared with culture showed 100% sensitivity and 97.4% specificity with an excellent agreement (kappa = 0.96), whereas microscopy showed the sensitivity and specificity of 43.2% and 98.7%, respectively, with a moderate agreement (kappa = 0.4). The sensitivity and specificity of microscopy, when compared with Xpert, were 43.5% and 100%, respectively. The majority of Xpert positive samples of a medium MTB detection and all samples of low and very low MTB detection were missed by microscopy. Our study showed that Xpert MTB/RIF is a reliable tool for the diagnosis and management of TB in Nepal. Because of its high cost and sustainability, alternative simple and rapid diagnostic methods with a similar efficiency would be helpful for TB control in Nepal.Neonatal pertussis has the potential for severe complications, even death. Mothers have been identified as the most frequent source of neonatal pertussis. Almost a dozen countries have implemented pertussis vaccination programs for pregnant women to protect neonates, but Japan has not yet done so. The aim of this questionnaire-based study was to ascertain the willingness of women to be vaccinated during pregnancy and the factors associated with willingness. Subjects were 977 pregnant women who visited either of two selected hospitals for maternity health checks. Most of the women were in their first pregnancy (96%) and about half considered a physician to be the most reliable source of information about vaccination (481/977, 49%). "Willingness to receive pertussis vaccination" was significantly associated with the factors "no fear of receiving vaccination" (odds ratio [OR]=3.10, 95% confidence interval [CI] 2.21-4.34), "necessary to prevent pertussis" (OR=8.70, 95% CI 6.17-12.28), "effective in pregnancy"(OR=5.46, 95% CI 3.94-7.56), and "no concern about side effects after vaccination"(OR=3.03, 95% CI 1.66-5.55). Pregnant women are likely to consider vaccination if they have a good understanding of the disease and its outcomes. Physicians are well positioned to improve knowledge and attitudes toward pertussis vaccination during pregnancy.Public health interventions have served an important role in controlling coronavirus disease 2019 (COVID-19), a rapidly spreading infectious disease. To contribute to future COVID-19 countermeasures, we aimed at verifying the results of countermeasures achieved by public health centers (PHCs) against the first wave of COVID-19 in Yamagata Prefecture, Japan. During January-May 2020, 1,253 patients suspected of SARS-CoV-2 infection were invited for testing. Simultaneously, based on retrospective contact tracings, PHCs investigated the infection sources and transmission routes of laboratory-confirmed COVID-19 cases and tested 928 contacts. Consequently, 69 cases were confirmed during March 31 - May 4, 58 (84.1%; 95% confidence interval 75.5-92.7) of whom were found from contacts. The spread of infection was triggered by cases harboring epidemiological links outside of Yamagata. Then, the number of cases increased rapidly. However, PHCs identified epidemiological links in 61 (88.4%; 95% confidence interval 80.8-96.0) of the 69 cases and transmission chains up to the fifth generation. Finally, the spread of infection ended after approximately one month. Our results indicate that the identification of infection sources and active case finding from contacts based on retrospective contact tracing was likely to be an effective strategy to end the first wave of COVID-19 in Yamagata.To understand the clinical course of human adenoviral (HAdV) conjunctivitis for establishing a better treatment regimen, thirty-eight eyes of 19 patients with HAdV-54 conjunctivitis for less than one week from onset were evaluated for clinical signs and symptoms and DNA copy numbers. It is observed that a viral load of 104-105 is required to develop symptoms of HAdV conjunctivitis, as symptoms were present in all the eyes whose viral load was ≥104 at least once during the course. Next, it is observed that asymptomatic infections in contralateral eyes are common as the virus was detected in most eyes that did not develop conjunctivitis. Furthermore, there was no rapid decrease of the viral load in healed eyes, on the contrary, the viral load in healed eyes on day 15 was significantly higher than in unhealed eyes. This was likely due to corticosteroid instillation that rapidly alleviated symptoms but prolonged the duration of viral shedding. Recently, combination treatment with iodine and corticosteroids has been recommended for HAdV conjunctivitis. Assessing changes in viral load as well as clinical symptoms would be helpful to better understand the clinical course of this disease.This descriptive cross-sectional study collected data of the prevalence of diabetes mellitus (DM) among tuberculosis (TB) at the Urban DOTS (Directly observed treatment, short-course) Centers in the Kathmandu, Bhaktapur, and Lalitpur districts of Nepal. The prevalence of DM was assessed in 67 previously treated TB cases (PTTB) and 214 new TB cases. DM was diagnosed in 8 PTTB and 20 new TB patients. Clinical interviews identified 14 cases of DM, the rapid blood glucose test diagnosed 4 cases, and the oral glucose tolerance test (OGTT) diagnosed 4 cases. Impaired glucose tolerance and impaired fasting glycemia were found in 8 and 5 cases, respectively. The 18-24 age group had the largest number of new TB cases (82; 38.3%). However, the comorbidity of DM and TB was higher in the 35 years and older age group and was found in 24.2% of PTTB and in 23.1% of new TB cases. To provide the evidence of impacts of DM screening for TB cases, larger number of samples should be analyzed. The DM screening for TB patients is expected to start in developing countries. It should be initiated by clinical interview about DM and glucose tests by rapid kits.Bilateral inferior petrosal sinus sampling (BIPSS) is the current gold standard test for differentially diagnosing ACTH-dependent Cushing's syndrome (CS). However, BIPSS is an invasive procedure, and its availability is limited. We retrospectively analysed the 24-hour urinary free cortisol (UFC) level during the high-dose dexamethasone suppression test (HDDST) and plasma ACTH/cortisol levels after the desmopressin stimulation test (DDAVP test) in subjects with confirmed Cushing's disease (CD) (n = 92) and ectopic ACTH-dependent CS (EAS) (n = 16), and evaluated the positive predictive value (PPV) of the two combined-tests in the aetiological diagnosis of ACTH-dependent CS. The percent changes in UFC levels after the HDDST and in ACTH/cortisol levels after DDAVP administration relative to the corresponding basal levels and the area under the receiver operating characteristic (ROC) curve (AUC) were analysed. Pluripotin UFC suppression below 62.7% suggested a pituitary origin with a sensitivity (SE) of 80% (95% CI 70-88) and a specificity (SP) of 80% (95% CI 52-96). A threshold increase in the ACTH level after DDAVP stimulation of 44.6% identified CD with an SE of 91% (95% CI 83-97) and an SP of 75% (95% CI 48-93). The combination of both tests yielded an SE of 95.5% and PPV of 98.4% for CD, and significantly improved the efficiency of the differential diagnosis between CD and EAS. These dual non-invasive endocrine tests may substantially reduce the need for BIPSS in the etiological investigation of ACTH-dependent CS.Rosiglitazone (RSG) is widely used to reduce the amount of sugar in the blood of patients with diabetes mellitus. Diabetic nephropathy is the most common microvascular complication of diabetes. The role of RSG in diabetic nephropathy is not fully understood. Diabetic nephropathy model was constructed in high glucose (HG)-treated mouse mesangial cells. The effects of RSG on cell viability and cell cycle were investigated using cell counting kit-8 (CCK-8) assay and flow cytometry assay. Oxidative stress was assessed according to ROS production and SOD activity in cells. Inflammatory responses were assessed according to the releases of inflammatory cytokines. Extracellular matrix (ECM) accumulation was determined by the levels of fibronectin and collagen IV using western blot. The expression of Gm26917 and microRNA-185-5p (miR-185-5p) was detected by quantitative real-time polymerase chain reaction (qPCR). The interaction between Gm26917 and miR-185-5p was validated by dual-luciferase reporter assay, RNA immunoprecipitation (RIP) assay and pull-down assay.