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A 36-year-old Japanese female had a 10-day history of a painful red nodule on the left index finger. Histologically, there were intraepidermal blisters containing degenerated keratinocytes and multinucleated giant cells and a focal infiltrate of lymphocytes with degenerated peripheral nerves in the dermis. The epidermal cells were positively stained with antivaricella zoster virus monoclonal antibody but not antiherpes simplex virus type 1 or 2 antibody. A polymerase chain reaction analysis of DNA extracted from the skin specimen exhibited a positive band.

Background: Japan lacks an established framework for routine seasonal influenza vaccine effectiveness (SIVE) assessment at the national and municipal levels. This study aimed to estimate SIVE among older adults using an innovative population-based administrative database linking medical fee claims data with vaccination records, while also exploring its potential bias., Methods: In this retrospective population-based cohort study, we assessed SIVE against medically attended influenza during the 2017/18 season among older adults aged ≥65 years in a Japanese city. A Cox proportional hazards model was used to estimate hazard rate ratios, treating vaccination status as time-dependent. To explore potential biases, multivariate logistic regression analysis was used to investigate the association between vaccination status and acute respiratory infection (ARI) diagnosis and trauma/injury during the non-influenza season., Results: This study included 82 % (n = 110,892) of the city's older adult population, with 39.7 % vaccination coverage. The estimated SIVE was 2.9 % (95 % confidence interval: -6.2-11.2), showing no statistical significance. Similarly, subgroup analyses by age and comorbidities revealed no significant protective effect of SIVE. In the non-season analysis, adjusted odds ratios of vaccination were significantly higher for ARI [1.3 (1.3-1.4)] and trauma/injury [1.2 (1.1-1.2)]. However, no significance was observed for hospitalizations with these diagnoses, which include severe conditions less associated with healthcare-seeking behaviors [0.9 (0.8-1.1) and 0.8 (0.6-1.0), respectively]., Conclusions: No significant SIVE was observed during the 2017/18 season. Our real-world observational study, based on medical fee claims data, indicates a potential underestimation of SIVE owing to bias related to healthcare-seeking behaviors., Competing Interests: Declaration of competing interest The authors declare no competing financial interests or personal relationships that may have influenced the work reported in this study., (Copyright © 2024. Published by Elsevier Ltd.)

Reverse osmosis membranes of aromatic polyamide (PA) reinforced with a crystalline cellulose nanofiber (CNF) were synthesized and their desalination performance was studied. Comparison with plain PA membranes shows that the addition of CNF reduced the matrix mobility resulting in a molecularly stiffer membrane because of the attractive forces between the surface of the CNFs and the PA matrix. Fourier transform-infrared spectroscopy and X-ray photoelectron spectroscopy results showed complex formation between the carboxy groups of the CNF surface and the m- phenylenediamine monomer in the CNF-PA composite. Molecular dynamics simulations showed that the CNF-PA had higher hydrophilicity which was key for the higher water permeability of the synthesized nanocomposite membrane. The CNF-PA reverse osmosis nanocomposite membranes also showed enhanced antifouling performance and improved chlorine resistance. Therefore, CNF shows great potential as a nanoreinforcing material towards the preparation of nanocomposite aromatic PA membranes with longer operation lifetime due to its antifouling and chlorine resistance properties.

Approximately 50% of patients with adult T-cell leukemia/lymphoma (ATLL) have skin involvement, and the smoldering, skin lesion-bearing cases are often treated with various skin-directed therapies, such as phototherapy and radiation therapy. Daily oral administration of etoposide plus prednisolone (EP) is also used for smoldering-type ATLL. However, it remains unclear whether these therapies improve patients' survival. We retrospectively analyzed the prognosis of patients with smoldering, skin lesion-bearing ATLL (n = 62), who were treated, as first therapy, with one skin-directed therapy (n = 29), oral EP alone (n = 14) or a combination of skin-directed therapy and oral EP (n = 19). Multivariate analysis revealed that the hazard ratios (HRs) for the overall survival (OS) and progression-free survival (PFS) with the combination therapy were significantly lower than those with the skin-directed therapy (HR 0.1, p = 0.001; HR 0.2, p = 0.002, respectively). These results suggest that the combination of skin-directed therapy and oral EP improves the clinical outcome of patients with smoldering, skin lesion-bearing ATLL.

We report a case of dyshydrosiform pemphigoid. Multiple small bullae were noticed in the bilateral hands and feet of an 85 year old Japanese male about 1 month before admission to hospital, and these lesions gradually worsened and expanded generally. Clinical appearance on the initial examination showed a collection of erosions, bullae, and pustules with haemorrhagic pompholyx. Serum anti-BP180 antibody index was more than 150. Histopathologic appearance of the bullous leision revealed a subepidermal bulla with an inflammatory infiltrate and fibrinous exudate, with aggregated eosinophils, neutrophils, and lymphocytes in the upper dermis. In direct immunofluorescence, the epidermal basement membrane was stained strongly for complement C3 and weakly for IgG. Based on these features, especially from the particular clinical aspects, we finally diagnosed one subtype of bullous pemphigoid, namely dyshidrosiform pemphigoid. Although he got better by orally taking steroids, the eruptions recurred just after tapering off. Thereafter, he died due to worsened general condition partly complicated by pancreatitis.

Cutaneous involvement is seen in ~ 50% of adult T-cell leukemia/lymphoma (ATLL) patients. We investigated the association between skin eruption type and prognosis in 119 ATLL patients. ATLL eruptions were categorized into patch (6.7%), plaque (26.9%), multipapular (19.3%), nodulotumoral (38.7%), erythrodermic (4.2%), and purpuric (4.2%) types. When the T stage of the tumor-node-metastasis-blood (TNMB) classification of mycosis fungoides/Sézary syndrome was applied to ATLL staging, 16.0% were T1, 17.7% T2, 38.7% T3, and 4.2% T4, and the remaining 23.5% were of the multipapular and purpuric types. For the patch type, the mean survival time (median survival time could not be estimated) was 188.4 months. The median survival times (in months) for the remaining types were as follows: plaque, 114.9; multipapular, 17.3; nodulotumoral, 17.3; erythrodermic, 3.0; and purpuric, 4.4. Kaplan-Meier curves of overall survival showed that the erythrodermic type had the poorest prognosis, followed by the nodulotumoral and multipapular types. The patch and plaque types were associated with better survival rates. Multivariate analysis demonstrated that the hazard ratios of the erythrodermic and nodulotumoral types were significantly higher than that of the patch type, and that the eruption type is an independent prognostic factor for ATLL. The overall survival was worse as the T stage became more advanced: the multipapular type and T2 were comparable, and the purpuric type had a significantly poorer prognosis than T1.

Dyskeratosis congenita (DC) is an inherited disorder that is characterized by the triad of skin pigmentation, nail dystrophy, and mucosal leukoplakia. Individuals with DC suffer from premature mortality because of bone marrow failure, pulmonary disease, or malignant transformation within the areas of mucosal leukoplakia, caused by telomerase dysfunction. We present a case of a 31-year-old Japanese man with DC who developed laryngeal cancer (supraglottic T4aN0M0). To avoid the serious risks of accelerating the DC-associated complications by DNA-damaging therapies, he was treated with a total laryngectomy plus right modified neck dissection (levels IB, IIA, III, and IV). A contralateral nodal metastasis appeared 4 months after initial surgery and was salvaged by a left radical neck dissection. Our strategy to spare DNA-damaging therapies has proven effective so far. This is the first reported case of laryngeal cancer in a patient with DC in the English-language medical literature.

A 74-year-old Japanese man developed erythema multiforme on the inner aspect of his left elbow where ketoprofen-containing tape was applied and exposed to sunlight, and the eruption subsequently spread to the four limbs and trunk. The lesions were successfully treated with systemic corticosteroids without recurrence. Lymphocyte stimulation tests with ketoprofen-photomodified peripheral blood mononuclear cells revealed that the patient had circulating lymphocytes reactive with a photohaptenic moiety of ketoprofen. To our knowledge, this is the first case of erythema multiforme induced by photocontact dermatitis. The presence of circulating photoantigen-reactive T cells seemed to induce erythema multiforme as an unusual manifestation in this patient.

Background: In the non-immediate type of drug eruptions, the populations of circulating T cells may be altered as a consequence of T cell responses to a culprit drug., Objective: The aim of this study was to investigate differences among the types of drug eruptions in propagating T cell populations of the patients' peripheral blood., Methods: The type of eruptions were divided into three categories: (1) generalized maculopapular eruption (MPE), (2) erythema multiforme (EM)/Stevens-Johnson syndrome (SJS), and (3) drug-induced hypersensitivity syndrome (DIHS) or drug rash with eosinophilia and systemic symptoms (DRESS). T cell populations were phenotypically analyzed by flow cytometry in the percentage of T helper (Th) 1 (CXCR3+CD4+), Th2 (CCR4+CD4+), Tc1 (CXCR3+CD8+), and Tc2 (CCR4+CD8+) subsets and their activation states as assessed by CD69, CD25 or HLA-DR positivity., Results: Upon occurrence of both MPE and EM/SJS, Th2 cells outnumbered Th1 cells, whereas Tc1 and Tc2 cells differentially predominated in EM/SJS and MPE, respectively. An increase of HLA-DR+CD8+ cells in EM/SJS type provided another supportive evidence for Tc1 stimulation. In DIHS, during the development of the second wave of eruption and/or liver dysfunction associated with anti-HHV6 antibody elevation, CD4+ cells were gradually decreased, but CD8+ cells were inversely increased. Tc1 cells were increased as well as Th1 cells. Finally, in all the three groups, there existed a considerable number of CD25+CTLA-4-CD4+ T cells., Conclusion: Our study suggests that Th2/Tc2 and Th2/Tc1 cells mediate MPE and EM/SJS, respectively, and Tc1 cells are involved in the pathogenesis of DIHS at the late stage.

Antiallergic drugs have various actions against allergy-associated cells and molecules as well as antihistamic properties. We studied the effects of antiallergics on the serum levels of substance P. Patients with atopic dermatitis were treated with one of four oral H1-antagonists for 14 days, and the serum level of substance P was measured before and after treatment in parallel with several atopic severity markers. Olopatadine significantly decreased the substance P level. This is in accordance with its known downmodulatory effect on tachykinin release. In contrast, cetiridine and fexofenadine unexpectedly increased the substance P level. In patients administered cetiridine, the blood severity markers for atopic dermatitis, including lactate dehydrogenase, eosinophil number, and the soluble forms of IL-2R, E-selectin, VCAM-1 and ICAM-1 were reduced after the treatment. Therefore, the elevation of SP was unrelated to the deterioration of atopic dermatitis but rather associated with improvement. Our study suggests that antiallergics can be divided into substance P-increasing and -decreasing types and raises the possibility that the increment of substance P by the former type is caused by the competitive occupation of substance P receptors.

We report four cases of non-clostridial gas gangrene. All cases were associated with diabetes mellitus as the underlying disease. Case 1: a 60-year-old male developed an ulcerative lesion on the dorsum of his left foot. Peptostreptococcus asaccharolyticus, Citrobacter freundii and Staphyrococcus epidermidis were identified in culture from odoriferous pus. Case 2: a 81-year-old female developed a lesion on her vulva spreading to the right lower abdomen. Bacteroides bivius, Peptostreptococcus asaccharolyticus and Streptococcus faecalis were identified in culture of the odoriferous pus. Case 3: a 80-year-old male developed a swollen area with ulcer on the right foot. Bacteroides fragiris, Enterococcus faecalis, Proteus mirabilis, Enterococcus avium and Enterococcus faecalis were identified by culture. Case 4: a 52-year-old female developed swelling of her left groin. Enterococcus faecalis and Streptococcus anginosus were identified in culture from the odoriferous pus. In all patients, a radiological examination revealed the presence of subcutaneous gas in the lesion. Prognosis of non-clostridial gas gangrene is usually poor. These four patients, however, all survived. Once an infectious sign is seen in the diabetic patient, it is important to discover a gas figure by using the radiological examination (plain film or computed tomography). Earlier diagnosis and debridement are the most important for a better prognosis. Because workers with diabetes mellitus are now increasing in number, occupational physicians should always keep in mind that a serious infectious disease like non-clostridial gas gangrene can develop even from minor accidental trauma, and they should control the working environment in the workplace where accidents often happen.

A 41-year-old Japanese woman came to our clinic complaining of multiple edematous erythemas on the trunk and legs. The eruptions recurred periodically in association with the menstrual cycle. She had received oral progesterone therapy between 24 and 34 years of age. There were no abnormal values found in the routine and hormonal examinations, including progesterone and estrogen levels in serum and urine. After an intradermal skin test with progesterone, she had no reaction after 20 minutes but a positive reaction after 48 hours.

Effects of aeration on purple nonsulfur bacteria (PnSB) were studied in photobioreactors. Bacterial community changes were analyzed by denaturing gradient gel electrophoresis (DGGE) and fluorescence in situ hybridization (FISH). DGGE band pattern change was small and only few prominent bands were obtained at non-aeration condition. Sequencing results of the prominent DGGE bands obtained at this condition revealed that they represented mainly the PnSB, Rhodobacter sphaeroides and Rhodopseudomonas palustris. On the other hand, under aerated condition, some prominent bands originated from heterotrophs appeared but no proliferation of PnSB was observed. FISH was applied to detect PnSB and their population was quantified. Maximum PnSB ratio (up to 80%) was obtained both at non-aeration condition and at constant ORPs less than -200 mV. In the presence of DO, Rps. palustris was more competitive to chemoheterotrophs than Rb. sphaeroides.

Herpetic whitlow is one of the herpes simplex virus (HSV) infections, and is known as an occupational disease. In Japan, however, there have been only a few reports of this disease. Recently, we experienced three cases of herpetic whitlow in health care workers. They presented painful vesicles on the right ring finger, the left thumb and the left index finger, respectively. All of them were considered to have been infected by HSV when they were engaged in mouth care of inpatients. We reviewed these three cases from the aspect of occupational medicine, and propose the following three points for preventing this serious nosocominal infection to health care workers: 1) re-education and enlightenment for the workers regarding hazardous behavior of HSV, 2) keeping the hands and fingers free from skin impairments, and 3) early diagnosis and treatment for herpetic whitlow of health care professionals to prevent further nosocominal infection.

A 50-year-old Japanese woman visited our clinic, complaining of generalized erythema with painful erosions and bullae. The histopathological findings of the skin lesion suggested development of impetigo. Gentamycin-resistant Staphylococcus aureus was detected by the bacterial culture examination from the impetiginous bullae. A direct immunofluorescence study of the lesion showed an intercellular deposition of IgG and C3 in the upper epidermis. We diagnosed this case as pemphigus foliaceus associated with bullous impetigo. A combined oral administration of tetracycline (200 mg/day) and nicotinamide (1200 mg/day) for 3 weeks was successful. In Japan, patients with moderate to severe symptoms of pemphigus foliaceus are usually treated with oral steroid therapy. To our knowledge, however, there is no reported pemphigus case which has been successfully treated only with tetracycline and nicotinamide.

A 36-year-old man, working in a chemical industry, had a generalized pruritic eruption. A forty-eight hour patch test revealed positivity for 1% hydroxylamine. Prevention of exposure to this chemical resulted in a dramatic improvement of the symptoms. Based on these findings, we diagnosed this case as occupational contact dermatitis due to hydroxylamine. There has been few case reports of contact dermatitis due to hydroxylamine. Histopathological examination revealed a marked spongiosis and a spongiotic bulla formation in the epidermis and follicular infundibulum, suggesting an allergic reaction.

We report here 9 patients suffering from hydrofluoric acid burn who visited our clinic from July, 1979 to February, 2000. These 9 cases occupied 25% of all chemical burn cases experienced in our clinic. All the patients were men ranging in age from 20 to 53 (mean age 35 years; average 36.8 years). At the time of accidental exposures, 6 patients had been engaged in washing or cleaning work, and 2 had been changing the parts of instruments containing hydrofluoric acid. Eight patients received burns on the hands and/or fingers. During the work, 2 patients had used vinyl chloride or rubber gloves, but three patients employed no protection for the hands. After the symptoms began to develop, it was found that the glove of one patient had a pin hole. Coupled with the occasions described in previous reports, the causal factors of hydrofluoric acid burn could be divided as follows: 1) negligence or carelessness of workers, in particular skilled persons, in handling hydrofluoric acid, 2) ignorance of the dangerousness of hydrofluoric acid, 3) the presence of pin hole (s) in protection gloves, and 4) unexpected accident. Hydrofluoric acid is one of the most corrosive inorganic acids, and can produce progressive and serious tissue necrosis with severe pain. To prevent burns due to this chemical, enlightenment and reeducation of the workers regarding the hazard of hydrofluoric acid are necessary.

Hydrogen peroxide is widely used in products such as rocket fuel, bleaching preparations and topical disinfectants. Contact of hydrogen peroxide with the skin can cause severe skin damage. In this report, we describe a case of skin injury induced by hydrogen peroxide. The patient was a 34-year-old man working in a dry cleaning shop. While he was pouring 35% hydrogen peroxide, some of it accidentally splashed over his left shoulder and back, and then an erythema, purpura and vacuolar eruption, similar to bubble wrap, appeared on his left shoulder and down the left side of his back. Histologically, numerous vacuolar structures were observed in the epidermis, dermis and subcutaneous tissue. Coupled with the clinical features, these vacuolar structures were considered as 'oxygen bubbles'. Subcutaneous emphysema was detected by chest X-ray examination. All skin eruptions rapidly healed without scarring by using a steroid ointment. As far as we know, this is the first time such clinical and histological features have been described, (Copyright 2000 S. Karger AG, Basel.)

20 Reference strains of Legionella species, isolated from human, were classified according to their ability to grow within thioglycolate-induced peritoneal macrophages of mice and guinea pigs. Inbred and congenic mice were used to study the effect of the natural resistance genes Lgn1 and Bcg that are expressed phenotypically in the mouse macrophages. The Lgn1 gene controlled the intracellular growth of Legionella pneumophila Philadelphia-1 and Legionella jordanis GIFU 12657, but the Bcg gene did not affect the intracellular growth of any organism examined. Based on these results and the growth ability in guinea pig macrophages, the 20 reference strains were divided into four groups. This grouping will help us to understand a variety of modes of interaction between Legionella species and macrophages.

Organisms of some Legionella species are known to internalize and multiply within epithelial cell lines. During the study on interaction between Legionella spp. and Vero cells, we found that L. dumoffii Tex-KL (ATCC 33343) can enter into Vero cells approximately four to 20 times more often than five other strains of four species of legionella. The mode of entry between L. dumoffii Tex-KL and L. pneumophila Philadelphia-1 was compared and studied by treating Vero cells with reagents which inhibit phagocytosis and endocytosis. Monodansylcadaverine, cytochalasin D and nocodazol were used as inhibitors of receptor-mediated endocytosis, microfilament-dependent phagocytosis and polymerization of microtubules, respectively. The uptake of L. dumoffii Tex-KL required receptor-mediated endocytosis by Vero cells, while the uptake of L. pneumophila Philadelphia-1 used mainly microfilament-dependent phagocytosis. Polymerization of microtubules was necessary for Vero cells for the uptake of both strains of legionella. An electron microscopic examination revealed that some organisms of the L. dumoffii strain Tex-KL escaped from endosomal vacuoles into cytoplasm in the early stage of infection, and proliferated in the cytoplasm. At that period, most of the bacteria were surrounded by rough endoplasmic reticula. In contrast, L. pneumophila Philadelphia-1 proliferated only within ribosome-lined endosome. We suggest that L. dumoffii Tex-KL internalize and proliferate in Vero cells in a different way to L. pneumophila Philadelphia-1, and that there is a variety of the mode of interaction between Legionella spp. and epithelial cells., (Copyright 1998 Academic Press Limited.)