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Objective Rapid cycling (RC) presents a risk of greater severity in bipolar disorder (BD), whereas patients with one-year euthymia (OYE) have better prognosis. The purpose of this study was to identify the clinical background and prescription characteristics of patients in the two opposing states of current RC and OYE from a large sample (N = 2609) in a multicenter treatment survey on BD in psychiatric clinics (MUSUBI). Methods MUSIBI was a cross-sectional study wherein questionnaires, based on a retrospective medical record survey of consecutive cases of BD, were distributed to 176 outpatient clinics. The questionnaire collected information on patient background, current episode, and clinical and prescription characteristics. OYE was defined as the presence of a euthymic state for at least 12 months. Results In this study, current RC (9.7% frequency) was significantly higher in females, had a younger age of onset, functional impairments, and a higher rate of neurodevelopmental disorder and physical comorbidity compared to non-RC patients. OYE (19.4% frequency) was associated with a lower proportion of females, older age, higher occupational status, and lower rate of suicide ideation, psychotic symptoms, personality disorder, and alcohol or substance abuse. Mood stabilizers were prescribed in ≥80% of cases, while antipsychotics were prescribed in half of the cases (more in RC and less in OYE). Antidepressant prescription rates were lower in OYE than in RC. Conclusions RC and OYE generally show opposing characteristics, but the details of the opposite parameters are distinctive. Clinicians can help predict the progression of BD by understanding the clinical background and characteristics of these opposing clinical features.

Background To provide updates on clinical practice of acute pancreatitis (AP) in Japan, we conducted a nationwide epidemiological survey. Methods This study consisted of a two-staged survey; the number of AP patients was estimated by the first-stage survey and their clinical features were examined by the second-stage survey. We surveyed AP patients who had visited hospitals in 2016. Results The estimated number of AP patients in 2016 was 78,450, with an overall incidence of 61.8 per 100,000 persons. We obtained detailed clinical information of 2994 AP patients, including 706 (23.6%) severe cases classified according to the Japanese severity criteria. The male-to-female sex ratio was 2.0, and the mean age at onset was 59.9 years in males and 66.5 years in females. Alcohol was the most common etiology (42.8%) in males and gallstones in females (37.7%). The AP-associated mortality was 6.1% in severe AP cases, which was decreased by 40% compared to the 2011 survey. Antibiotics were administered to most cases, with carbapenem being frequently used. Enteral nutrition was given in 31.8% of severe cases, but majority cases received after 48 h. Among the 107 patients who received intervention for walled-off necrosis, five patients received surgery-first approach, 66 received endoscopic ultrasound-guided transluminal drainage, and 19 underwent step-up approach. Conclusions We clarified the current status of AP in Japan including the significant reduction of mortality in severe cases, shift to endoscopic approaches for walled-off necrosis, and poor compliance of the recommendations in the guidelines including management of enteral nutrition and antibiotic administration.

OBJECTIVE There is limited information available on the prescription of psychotropic agents to patients with bipolar I (BD-I) and bipolar II disorder (BD-II). The purpose of this study was to investigate the characteristics of drug therapy in BD-I and BD-II outpatients, particularly with regard to antidepressants. METHODS In 2017, the MUlticenter treatment SUrvey for BIpolar disorder in Japanese psychiatric clinics (MUSUBI) study collected data on current mental status, medications, and other factors from 2774 outpatients with BD-I or BD-II. RESULTS There were significant differences in the rates of prescriptions for mood stabilizers, antipsychotics and antidepressants. Mood stabilizers and antipsychotics were prescribed at higher rates to patients with BD-I (mood stabilizers; BD-I 86.0%, BD-II 80.8%, p

SummaryMeasles among healthcare workers (HCWs) is associated with a significant risk of nosocomial transmission to susceptible patients. When a measles case occurs in the healthcare setting, most guidelines recommend exhaustive measures. To evaluate the effects of measures against measles transmission in the healthcare setting precisely, it is essential to determine whether secondary transmission generally occurs. This study describes, for the first time, the actual secondary transmission rate for a measles-infected HCW in a ward with no special air ventilation capacity. The routine treatment of a number of immunocompromised patients occurs in this ward, and thus patients as well as HCWs have a thorough understanding and practice of standard and extended precautions. Our paired serum sample study revealed that none of the people in the ward exposed to the HCW at the catarrhal stage over a period of 4 days exhibited elevated levels of antibodies against measles. We suggest that strict adherence to standard and expanded precautions among patients and HCWs may be effective for preventing the transmission of a highly airborne disease, such as measles.

Seven hexon hypervariable regions (HVRs) of adenoviruses (Ads) were identified by comparing the regions among different serotypes; however, no one has compared HVR sequences among the identical serotypes, except for adenovirus type 3 (Ad3). To examine a variability between the HVRs for each serotype, we compared the sequences of Ad1-6 isolates, respectively, isolated between 1988 and 2007 in Yamagata, Japan. We selected 23-43 isolates randomly and sequenced 894-987 bp regions. Except for strains with insertions and deletions, the sequence identities among Ad1-6 were 99-100%, excluding that between the two Ad5 groups (approx. 94%). Even the insertions and deletions were likely to be established, as these changes were repeatedly observed. The obtained phylogenetic tree indicated that Ad isolates and reference strains branched depending on serotype. The Yamagata isolates had similar sequences or amino acid arrangements to the reference strains as well as to other strains isolated in different areas. HVRs have been stably conserved as serotype-specific regions for a long period with only minor genomic variations. Therefore, we herein recommend that these regions be hereafter referred to as "serotype-specific regions", which might be a more appropriate title with which to characterize the epidemiological nature of these sites than the current "HVRs".

Influenza A/H3N2 viruses have increased the number of glycosylation sites on the head of the hemagglutinin (HA) protein since their appearance in 1968. Here, the effect of the addition of oligosaccharide chains to the HA of the H3N2 virus on its biological activities was investigated. We constructed wild-type HA and six mutant HAs of A/Aichi/2/68 virus with two or one to six glycosylation sites on the head, respectively. The glycosylation sites of mutated HAs correspond to representative H3N2 isolates (A/Victoria/3/75, A/Memphis/6/86 and A/Sydney/5/97). We analyzed their intracellular transport, receptor-binding and cell fusion activities. The results showed that all the mutated HAs were transported to the cell surface, as well as wild-type HA, but some of them decreased in the receptor-binding activity. By contrast, the cell-fusion activity was not affected. Reactivity of mutated HAs, having four or five oligosaccharides with human serum collected in 1976, was much lower than that of the wild-type HA. These observations raised the possibility that the addition of new oligosaccharides to the head of the HA of the H3N2 virus may have provided the virus with an ability to evade antibody pressures.

The hemagglutinin-esterase (HE) glycoprotein of the influenza C virus causes cell fusion under acidic conditions. Because the influenza C virus grows more efficiently at 34 °C than at 37 °C, we examined whether the cell fusion activity of HE synthesized at 34 °C was higher than that at 37 °C. COS-1 cells, transfected with HE cDNA of C/Ann Arbor/1/50 virus, were incubated at 34 or 37 °C, and the cell fusion activity was analyzed after incubation for 24 h at each temperature. The results showed that cell fusion was observed with HE synthesized at 34 °C but not at 37 °C, although both HEs were transported to the cell surface. The fusion pore formation process did not proceed sufficiently when HE was synthesized at 37 °C. Comparison of the acetylesterase activities and antigenic structures between the HE synthesized at 34 °C and that at 37 °C showed that there were little or no differences in their properties. In contrast, the hemadsorption test with human erythrocytes suggested that the cell surface expression of HE synthesized at 37 °C was less efficient than that at 34 °C.

We have succeeded in generating virus-like particles (VLPs) of influenza C virus from cloned cDNAs. A cDNA of green fluorescent protein (GFP) gene flanked by the 5' and 3' noncoding regions of the segment 5 of influenza C virus was inserted between an RNA polymerase I promoter and terminator of the Pol I vector in antisense orientation. This plasmid DNA was transfected into 293T cells together with plasmids encoding the viral proteins of C/Ann Arbor/1/50 (AA/50) or C/Yamagata/1/88 (YA/88). Transfer of the supernatants of the 293T cells to HMV-II cells with helper virus resulted in the GFP expression in the HMV-II cells, and the quantification of the GFP-positive HMV-II cells indicated the presence of 106 VLPs/ml supernatant. Cords with 50−300 μm in length were observed on the transfected 293T cells, though they were not observed when the plasmid for M1 protein of AA/50 was replaced with that of C/Taylor/1233/47 (TAY/47). This finding provided direct evidence for the previous hypothesis by Nishimura et al. (1994) that M1 protein is involved in the formation of cord-like structures protruded from the YA/88-infected cells.

The hemagglutinin-esterase (HE) glycoprotein of influenza C virus is composed of three domains: a stem domain active in membrane fusion (F), an acetylesterase domain (E), and a receptor-binding domain (R). The protein contains eight N-linked glycosylation sites, four (positions 26, 395, 552, and 603) in the F domain, three (positions 61, 131, and 144) in the E domain, and one (position 189) in the R domain. Here, we investigated the role of the individual oligosaccharide chains in antigenic properties, intracellular transport, and biological activities of the HE protein by eliminating each of the glycosylation sites by site-specific mutagenesis. Comparison of electrophoretic mobility between the wild-type and the mutant proteins showed that while seven of the glycosylation sites are used, one (position 131) is not. Analysis of reactivity of the mutants with anti-HE monoclonal antibodies demonstrated that glycosylation at position 144 is essential for the formation of conformation-dependent epitopes. It was also evident that glycosylation at the two sites in the F domain (positions 26 and 603), in addition to that in the E domain (position 144), is required for the HE molecule to be transported from the endoplasmic reticulum and that mutant HEs lacking one of these three sites failed to undergo the trimer assembly. Removal of an oligosaccharide chain at position 144 or 189 resulted in a decrease in the esterase activity. By contrast, two mutants lacking an oligosaccharide chain at position 26 or 603, which were defective not only in cell surface expression but in trimerization, possessed full-enzyme activity, suggesting that the HE monomers present within the cell have acetylesterase activity. Fusion activity of cells expressing each of mutant HEs was found to be comparable with the ability of the protein to be transported to the cell surface, suggesting that there is no specific oligosaccharide chain that plays a critical role in promoting membrane fusion.

We reported previously that monoclonal antibody S16, which had been raised against the hemagglutinin-esterase (HE) glycoprotein of influenza C/Ann Arbor/1/50 (AA/50) virus, recognizes a linear epitope present on the HE molecules of all influenza C viruses examined except for viruses belonging to a lineage represented by Aichi/1/81 (AI/81). Comparison of the deduced amino acid sequence of HE between viruses on the AI/81-related lineage and those on the others suggests that the epitope recognized by S16 is located in a region containing amino acid residue 403 and that a change from Glu to Lys at this position causes the loss of reactivity with the antibody. To prove it, the wild type (WT) HEs of AA/50 and AI/81 as well as their mutants with an amino acid substitution at residue 403 were expressed in CV-1 cells from the recombinant simian virus 40 (SV40) and tested for reactivity with S16 by immunoprecipitation. The results showed that the AA/50 virus WT and AI/81 virus mutant HEs (both having Glu at residue 403) were reactive with S16 whereas the AI/81 virus WT and AA/50 virus mutant HEs (both having Lys at residue 403) were not. Furthermore, we examined the reactivity of S16 with two synthetic peptides (corresponding to residues 397–409) that possess Glu and Lys at position 403, respectively, by enzyme-linked immunosorbent assays. The results demonstrated that the former peptide but not the latter was reactive with S16. These observations support strongly the notion described above. During this study it was also found that S16 cross-reacts with large T antigen of SV40.

Labeling of influenza C virus-infected HMV-II cells with [32P]orthophosphate showed that the CM2 protein is posttranslationally modified by phosphorylation. The unglycosylated form of CM2 synthesized in the presence of tunicamycin was found to be highly phosphorylated. This result, together with the finding that digestion of CM2 with peptide-N-glycosidase F failed to remove the 32P label from the glycosylated form of CM2, indicated that phosphorylation occurs in the polypeptide backbone and not in the oligosaccharide chain. Furthermore, phosphoamino acid analysis revealed that phosphorylation occurs exclusively on serine residues. Treatment of infected cells with brefeldin A resulted in a complete inhibition of phosphorylation, showing that phosphorylation of CM2 occurs after its migration from the endoplasmic reticulum to the Golgi apparatus. Phosphorylation of CM2 was also inhibited strongly, although not completely, by monensin treatment, suggesting that CM2 is phosphorylated predominantly after its movement from medial to trans Golgi cisternae. Finally, we found that the CM2 protein incorporated into the progeny virion is phosphorylated, which indicates that there is no strictly selective incorporation of the unphosphorylated form of CM2 into the virion.

The antigenic and genetic characteristics of the 18 human strains of influenza C virus isolated in Yamagata and Sendai Cities, Japan between January 1991 and February 1993 were investigated. Antigenic analysis with monoclonal antibodies to the hemagglutinin-esterase glycoprotein showed that the isolates could be divided into three distinct groups closely related to C/Yamagata/26/81, C/Aichi/1/81 and C/Mississippi/80, respectively. T1-oligonucleotide fingerprinting of total vRNA revealed that the six isolates belonging to the C.Yamagata/26/81 virus group had the genomes greatly similar to one another but considerably different from those of the 1988/1990 isolates (except C/Yamagata/10/89) of the same antigenic group. Comparison of total or partial nucleotide sequences of the seven RNA segments of the three strains (C/Miyagi/3/91, C/Miyagi/9/91 and C/Miyagi/2/92) representative of the 1991/1993 strains of the C/Yamagata/26/81 virus group with those of the previous influenza C isolates obtained from humans and pigs during 1980/1989 showed that the 1991/1993 strains, like C/Yamagata/10/89, are more closely related to viruses isolated from pigs in Beijing, China in 1981/1982 than to any of the isolates from humans. This observation suggests strongly that interspecies transmission of influenza C virus between humans and pigs has occurred in nature, although it is not known whether the virus has been transmitted from pigs to humans or from humans to pigs.

A total of 10 influenza C virus strains isolated recently in Yamagata City, Japan and shown to belong to the same lineage was compared for the ability to agglutinate chicken and mouse erythrocytes under various conditions. C/Yamagata/10/89 was unique in lacking the ability to agglutinate chicken erythrocytes at a temperatureor = 4 degrees C. This isolate also agglutinated native mouse erythrocytes only very inefficiently, although the high agglutination titer was obtained with the glutaraldehyde-fixed cells. Furthermore, it was found that C/Yamagata/4/88, unlike the other isolates, agglutinated erythrocytes from chickens to lower titers than those from mice, even when assayed at 0 degree C. Comparison of the deduced amino acid sequence of hemagglutinin-esterase among the 6 representative strains including two older isolates, C/Yamagata/26/81 and C/Nara/2/85, suggested that the failures of C/Yamagata/10/89 to agglutinate chicken erythrocytes ator = 4 degrees C and unfixed mouse erythrocytes to high titers may be due to amino acid changes at residues 337 (Glu--Lys) and 340 (Thr--Tyr), respectively, and that a change at residue 347 (Leu--Ser) may be responsible for the decreased ability of C/Yamagata/4/88 to agglutinate chicken erythrocytes.

The antigenic and genetic relationships among 15 strains of influenza C virus isolated between August, 1988, and May, 1990, in Yamagata City, Japan, were investigated. Based on the results of antigenic analysis with monoclonal antibodies to the hemagglutinin-esterase (HE) glycoproteins and oligonucleotide mapping of total vRNA, the isolates were divided into two distinct groups closely related to either C/Yamagata/26/81 or C/Aichi/1/81. Antigenic differences between two groups could be detected clearly with heterogeneous antiviral sera. Comparison of the HE gene sequences between the representative Yamagata isolates and the previous isolates from other countries showed that C/Yamagata/26/81-like and C/Aichi/1/81-like viruses had high degrees of nucleotide sequence homology with C/pig/Beijing/115/81 and C/Johannesburg/1/66, respectively. These observations suggest that two lineages of influenza C virus, markedly different from each other in both antigenic and genetic structures, were simultaneously present in Yamagata City during 1988-1990 and that viruses belonging to each of the two lineages may also be prevalent in other areas of Japan and even in other countries.

We observed previously that cord-like structures which had lengths up to 500 μm or greater were protruding from the surface of HMV-II cells infected with influenza C/Yamagata/1/88 virus (Nishimura et al., 1990, Virology 179, 179-188). Comparison of the cord-forming ability among a number of influenza C isolates revealed that the C/Taylor/1233/47 strain was unique in lacking the ability. It was also found that the major structural proteins, hemagglutinin-esterase (HE), nucleoprotein (NP), and matrix (M), could each be distinguished between C/Yamagata/1/88 and C/Taylor/1233/47 viruses by SDS-polyacrylamide gel electrophoresis. To determine the genes involved in the cord formation, a series of reassortant viruses were prepared between C/Yamagata/1/88 and C/Taylor/1233/47, and parental derivation of genes coding for HE, NP, and M was determined by gel electrophoresis. All reassortants which derived M gene from C/Yamagata/1/88, irrespective of derivation of genes coding for HE and NP, had the ability to generate cords, whereas none of reassortants which derived M gene from C/Taylor/1233/47 were capable of producing cords. With respect to several representative reassortants, the origins of genes encoding the polymerase proteins (PB2, PB1, P3) and the nonstructural proteins (NS1, NS2) were determined by T1-oligonucleotide fingerprinting of the isolated RNA segments. The results suggested that none of genes coding for these proteins are exclusively associated with the cord formation. Thus, it is likely that the M gene is the key determinant of the cord-forming ability of influenza C viruses. Nucleotide sequence analysis of the M genes revealed that compared to C/Yamagata/1/88, C/Taylor/1233/47 had two amino acid substitutions in the M molecule at positions 24 (Ala → Thr) and 133 (Asp → Asn).

Neutralization-resistant variants of influenza C/Ann Arbor/1/50 virus were selected with monoclonal antibodies against four different antigenic sites on the hemagglutinin-esterase (HE) glycoprotein, and their HE genes were sequenced to identify amino acid residues important for the integrity of each site. Twelve different amino acid substitutions in a total of 18 antigenic variants were all located on the HE1 subunit. Although variants for antigenic site A-2 had a change at position 367, all substitutions in the variants for sites A-1, A-3, and A-4 occurred in the central region of the HE1 spanning amino acid positions 178 to 283. Furthermore, it was found that many of the substitutions in the variants selected with antibodies to sites A-1 and A-3 were clustered within or near one of the three variable regions revealed previously by comparing amino acid sequences of the HEs among various influenza C isolates (Buonagurio, D. A., Nakada, S., Fitch, W. M., and Palese, P., Virology 146, 221–232, 1985). The antigenic variants were also examined for their ability to agglutinate chicken and human erythrocytes in order to obtain information concerning the receptor-binding site on the HE molecule. The results suggested that the amino acid changes at residues 178, 186, 187, 190, 206, 212, and 226 decreased the hemagglutinating activity whereas those at residues 245, 266, and 283 produced an opposite effect.

Most Drosophila mRNAs are actively translated in the early embryo, with the exception of the poorly translated ribosomal protein (r-protein) mRNAs. Two possible mechanisms for this translational discrimination were tested: (1) Translation of r-protein mRNAs is discriminated against by the limited activity of translational initiation factors in the early embryo and (2) translation of r-protein mRNAs is repressed by trans-acting factors that reversibly bind these mRNAs. Exogenously provided initiation factors promoted partial recruitment of r-protein mRNAs into polysomes, suggesting that modulation of initiation factor activity may play a role in the translational discrimination of r-protein mRNAs during embryogenesis. No evidence for involvement of reversibly binding trans-acting factors was obtained, although there are limitations in the interpretation of the latter experiments.