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Objectives　On-site inspections of hospitals were conducted in Osaka City during fiscal years 2018 and 2019, whereas document-based inspections were performed during the COVID-19 pandemic in fiscal year 2021. This case report aimed to compare the outcomes of these two methods and provide a good indication of the method that should be selected in case of a pandemic.Methods　For on-site inspections, documents, including checklists, were sent to 351 hospitals from the Osaka City Public Health Office, and responses from each hospital were returned. On-site inspections were conducted, and the written instructions that indicated inadequate aspects and guidance were mailed to hospitals.For document-based inspections, documents were sent to 176 hospitals, and responses were returned. For hospitals that answered "incomplete" regarding the categories of medical safety management systems and hospital-acquired infection control, public health physicians called to confirm and instruct their inadequate responses, and the same step as the on-site inspection was executed. We compared and examined the outcomes of the on-site and document-based inspections.Results　In the on-site inspections, 12 of the 351 hospitals (3.4%) were recognized as inadequate because of a shortage of healthcare workers. In the document-based inspections, eight out of 176 hospitals (4.5%) were identified, and there was no significant difference.Regarding the medical safety management system, 95 of the 351 hospitals (27.1%) on on-site inspection and 21 of the 176 hospitals (11.9%) on document-based inspection received written instructions. The proportion of hospitals that received written instructions was significantly higher for on-site inspections than for document-based inspections (P < 0.001).For hospital-acquired infection control, 65 of 351 hospitals (18.6%) on on-site inspection and 17 of 176 hospitals (9.7%) on document-based inspection got written instructions. The proportion of hospitals that received written instructions was significantly higher for on-site inspections than document-based inspections (P = 0.007).Conclusion　Document-based inspection can easily unify the guiding criteria with fewer public health physicians. However, because of the limited amount of information available without checking the documents retained in hospitals, it is difficult to monitor the matters that need instructions. Thus, on-site inspection is preferable. However, if onsite inspection is difficult, inspection combined with online methods should be considered.

Purpose: To determine the efficacy of A-5021, a new analogue of acyclovir, on murine herpetic keratitis., Methods: Herpes simplex virus type 1 (strain CHR3) was inoculated onto bilateral scarified BALB/c corneas. Clinical scores on the corneas treated with A-5021 eyedrops were compared with those obtained from the treatment with 3% acyclovir eye ointment by slit lamp microscopy. Virus titers of the trigeminal ganglia and eyeballs were quantitated on Vero cell monolayers. Mice treated with saline or a white petroleum jelly were used as controls., Results: A-5021 eyedrops significantly suppressed both corneal epithelial and stromal lesions at all concentrations used. Clinical scores on the epithelium and stroma treated with 0.1% A-5021 were equivalent to those with 3% acyclovir treatment. When compared with the non-drug-treated control mice, virus titers in the eyeballs and trigeminal ganglia in A-5021- and acyclovir-treated mice were significantly less than those in controls., Conclusions: A-5021 eyedrops, which are easily applied onto the affected cornea, ameliorated clinical scores and suppressed virus growth. It is a promising alternative treatment of herpetic keratitis.

Purpose: To determine alterations in expression of genes in herpes simples virus (HSV)-1 latently infected mouse trigeminal ganglia (TGs), after treatment with cyclophosphamide and dexamethasone., Methods: Scarified corneas of female BALB/c mice were inoculated with HSV-1 strain McKrae. Four weeks after inoculation, cyclophosphamide and dexamethasone were intravenously injected to induce HSV-1 reactivation. Uninfected mice were also treated with the immunosuppressants. Four groups of animals were studied: uninfected, not treated; uninfected, drug treated; latently infected, not treated; and latently infected, drug treated. PolyA+ mRNA from the TGs of each group was reverse transcribed, labeled with 32P, incubated on a 1185-gene array membrane, and analyzed by phosphorimaging. As a comparison and to confirm microarray results, semiquantitative RT-PCR was also performed for selected genes., Results: The immunosuppressive drugs significantly increased expression of two genes (calpactin 1 light chain and guanine nucleotide-binding protein alpha-stimulating polypeptide [GNAS]) in the ganglia of uninfected mice compared with those in untreated uninfected mice. Ten genes were shown to be significantly increased in the latent TGs of mice treated with immunosuppressants compared with latently infected untreated mice. These genes were prostaglandin E2 receptor EP4 subtype (PTGER4), insulin promoter factor 1 (IPF1), glutathione S-transferase mu2, cyclin D2, peripherin, plasma glutathione peroxidase, methyl CpG-binding protein 2, retinal S-antigen, ErbB2 proto-oncogene, and GNAS. Eight genes were shown to be significantly decreased in the HSV-1 latent TGs treated with the drugs, compared with untreated latently infected mice. These genes were peripheral myelin protein 22, decorin, transcription factor AP-1, dystroglycan 1, myelin protein zero, mitogen-activated protein kinase 3, prothymosin beta 4, and brain lipid-binding protein. The results obtained by semiquantitative RT-PCR were similar to those obtained by microarray analysis., Conclusions: Those genes with expression altered by immunosuppressive drug treatment may play an important role in ocular HSV-1 recurrence. Changes in expression of genes in the prostaglandin pathway, a transcription factor, and an enzyme in the cell cycle are considered especially important in HSV-1 reactivation by immunosuppression and are reviewed.