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Owing to the extensive use of antibiotics in hospitals, animal husbandry, and various human activities, antibiotic contamination is becoming an increasing global concern, including in Bangladesh. In Bangladesh, the Buriganga River is heavily polluted with multiple antibiotics, which can lead to antibiotic resistance in bacteria. In this study, we performed the first investigation of seasonal variations in the occurrence and spatial distribution of 29 antibiotics in the Buriganga River, Bangladesh, from wet season (August 2019) and dry season (February 2020). We also evaluate the potential environmental and resistance risks related to antibiotic contamination. The concentrations of metronidazole (9.1-970 ng L -1 ), sulfadiazine (below the limit of detection (-1 ), and levofloxacin (-1 ) were the highest, and metronidazole, amoxicillin, and doxycycline were detected in all samples during both seasons. The number of antibiotics detected, and their overall concentrations were higher during the dry season (February) than during the wet season (August). Ecological risk assessment using risk quotients (RQs) indicated that levofloxacin (maximum RQ = 90), amoxicillin (58), and ciprofloxacin (21) could pose a high risk to aquatic organisms, whereas sulfamethazine, trimethoprim, doxycycline, and lincomycin pose a medium risk. The levels of seven antibiotics, trimethoprim, ciprofloxacin, levofloxacin, amoxicillin, ampicillin, cefotaxime, and metronidazole exceeded the antibiotic resistance thresholds. In conclusion, this study highlights the urgent need for further research with improved wastewater management practices and implement stricter regulations on antibiotic use to protect aquatic ecosystems and public health in Bangladesh., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Masahiro Tokumura reports financial support was provided by Ministry of the Environment. Masahiro Tokumura reports financial support was provided by Kurita Water and Environment Foundation. Masahiro Tokumura reports financial support was provided by Steel Foundation for Environmental Protection Technology. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

We present a 43-year-old female who presented with left chest pain on exhalation after falling in her room five days ago. CT scan of the chest also revealed a suspected complicated diaphragmatic injury in the posterolateral hernia orifice measuring 34 × 27 mm with pneumothorax. Laparoscopy was performed in the lithotomy position with the left hand raised during thoracoscopy, followed by a thoracoscopic approach. Operative findings were as follows: 1) a left posterolateral diaphragmatic hernia (DH) was diagnosed, 2) the transverse colon was herniated into the thoracic cavity and appeared difficult to reduce laparoscopically due to visceral adhesion to the left lung, 3) thoracoscopy was added to release the fibrous adhesion of the colon to the lung, and 4) the diaphragmatic repair was performed with the running suture. In addition, we performed a literature review, which identified nine cases of DH treated with a minimally invasive abdominal and thoracic approach (MATA), including our case. From this experience, MATA is proposed as the first choice to treat DH when there is strong adhesion of herniated contents to the thoracic cavity viscera., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Toyoda et al.)

Background: On 1 January 2024, a 7.6 magnitude earthquake struck the Noto Peninsula. We entered the disaster area to provide relief and set up a makeshift clinic in an evacuation center to evaluate the quality and quantity of food provided there., Methods: This cross-sectional study, of mainly older adults, was conducted to analyze the amino acid and fatty acid composition of evacuation shelter meals in comparison with the results of the Japan National Survey, mainly focused on older adults. (1) We analyzed 11 evacuation foods using the "Duplicated Combination" Model and the digestible amino acid score (DIAAS) in relation to the half-life determined by the N-terminal amino acid proteins. (2) Linoleic acid (LA) and alpha-linolenic acid (ALA) levels were compared with European Food Safety Authority (EFSA) recommendations (3). The national survey of emergency food stocks in 198 hospitals and 189 social care institutions conducted in Jan 2024 was analyzed., Results: (1) DIAAS was less than 1.00 for all 11 foods provided and was considered inadequate, (2) the half-life of the protein, whose N -terminal valine has a half-life of 100 h, must be considered a possible deficiency when living in a shelter for more than a week, (3) LA and ALA levels were less than 40% of EFSA recommended, (4) the nationwide survey found that 80% of people have a three-day supply and data on amino acids and fatty acids were not available due to a lack of questionnaires., Conclusion: Analysis of food in evacuation shelters after the Noto Peninsula earthquake revealed the quality of amino acids involved in shelter meals using DIAAS and the lack of LA and ALA for older adults. The "Duplicated Combination" model used in this analysis could be beneficial for developing improved nutrition plans in similar future scenarios, mainly for older adults., Competing Interests: The authors declare no conflicts of interest.

Background: The relationship between protein intake and the long-term prognosis of elderly patients with heart failure remains poorly understood. We investigated the association between predischarge protein intake and long-term prognosis in hospitalized elderly patients with heart failure., Methods and Results: A single-center, retrospective analysis of hospitalized patients aged ≥65 years with heart failure and reduced ejection fraction was conducted. Protein intake was evaluated by nutritionists based on visual measurements of the percentage of dietary intake obtained for 7 days before discharge by a nurse. A cutoff of 1.2 g/kg/day protein intake was used to compare the incidence of a composite endpoint, including all-cause mortality and heart failure rehospitalization within 1 year. Among the 100 patients (median age 79 years; 47% male), 56% had low protein intake (<1.2 g/kg/day). Patients with low protein intake had a significantly higher rate of composite endpoints than those with high protein intake (50% vs. 20%; log-rank test P=0.03). Multivariable Cox proportional hazards model revealed that low protein intake was independently associated with long-term prognosis with a hazard ratio of 2.73 and a 95% confidence interval of 1.10-6.80 (P=0.03)., Conclusions: Low protein intake in the predischarge phase was associated with long-term prognosis in hospitalized elderly patients with heart failure and reduced ejection fraction., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2025, THE JAPANESE CIRCULATION SOCIETY.)

Isocyanates are used as raw materials for polyurethane foams, paints, and building materials. The isocyanates can cause acute adverse health effects such as irritation of the respiratory tract, skin, and eyes, and induce asthma and sick house syndrome. However, investigations into the potential sources and risk assessments of indoor isocyanates are limited. Thus, this study aimed to determine the sources and exposure routes of isocyanates and to assess their risk in indoor environments. The results showed that household products, such as infant chairs, mattresses, and polyurethane foam spray, used in indoor environments are potential sources of atmospheric isocyanic acids (ICA). Toluene diisocyanate and methyl isocyanate pose relatively high risks to indoor environments. Total concentrations of isocyanates ranged from 38.2 to 1570 ng g -1 in infant chairs, mattresses, and spray polyurethane foams. The indoor products can be indoor sources of ICA because emission rates of ICA from household products were observed in all products (0.0536-1.37 ng g -1 d -1 ). Field observations showed that isocyanate concentrations in house-dust samples ranged from 0.194±0.126 (ethyl isocyanate) to 70.1±67.8 (ICA) ng g -1 . Atmospheric isocyanate concentrations ranged from 0.0030±0.020 (propyl isocyanate) to 26.0±14.3 (ICA) ng m -3 . An estimation of human exposure demonstrated that air inhalation was the major route of isocyanate exposure. The minimum margin of exposure values of methyl isocyanate and toluene diisocyanate were 523 and 655, respectively, for children, indicating that they may pose a relatively high risk., Competing Interests: Declarations. Competing interest: Authors have declared that no competing interests exist. Ethical Approval: This article does not contain any studies involving human and animal participants performed by any of the authors. The manuscript in part or in full has not been published anywhere. Consent to Participate: Not applicable. Consent to Publish: All of the authors have read and approved the paper for submission of publication., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

BACKGROUND Median arcuate ligament syndrome (MALS) poses a considerable challenge in terms of diagnosis due to its manifestation of diverse symptoms linked to constriction of the median arcuate ligament surrounding the celiac artery. The present study introduces an earlier diagnostic modality using ultrasound measurements of the flow velocity of the celiac artery during the inspiratory and expiratory phases, with the latter being higher than the former, to avoid prolonged follow-up of postprandial symptomatology. CASE REPORT A 46-year-old female patient presented with acute postprandial abdominal pain, which was alleviated by analgesic medication. The findings from the physical examination and laboratory tests were within normal limits. Further investigations were conducted due to persistent symptoms, revealing an elevation in celiac artery flow velocity during expiration on ultrasound. The diagnosis of median arcuate ligament syndrome (MALS) was confirmed through contrast-enhanced CT and angiography. Subsequently, the patient underwent laparoscopic release of the median arcuate ligament, leading to alleviation of symptoms at the 1-year follow-up assessment. CONCLUSIONS Our case report highlights the importance of a dynamic imaging diagnostic strategy for MALS. When encountering challenging postprandial abdominal pain that is hard to diagnose, it could be crucial to utilize abdominal ultrasound to measure the flow velocity of the celiac artery. This approach may serve as a valuable screening method for identifying MALS and, subsequently, prompt the need for further diagnostic tests.

Polar organic chemical integrative samplers (POCIS) are promising devices for measuring the time-weighted average concentrations of hydrophilic compounds in aquatic environments. However, the mechanisms underlying compound uptake by POCIS remain unclear. We investigated the permeation kinetics of polyethersulfone and polytetrafluoroethylene membrane filters, and the sorption kinetics of Oasis HLB (Waters), Envi-Carb (Supelco), and Oasis WAX (Waters) sorbents. The log octanol-water partition coefficient (K OW ) values of the 19 targeted compounds ranged from -0.55 to 6.0. The overall mass-transfer coefficients were negatively correlated with K OW , indicating that interactions between hydrophobic compounds and the membrane inhibit permeation. The sorption rate coefficient showed no correlation with K OW and depended on the type of sorbent used. These results imply that the uptake of highly hydrophilic compounds by POCIS is determined by both the membrane and the sorbent kinetics; however, membrane kinetics dominate the uptake of hydrophobic compounds. Environ Toxicol Chem 2024;43:2115-2121. © 2024 SETAC., (© 2024 SETAC.)

Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.

Background: Humankind has faced unexperienced pandemic events since 2020. Since the COVID-19 pandemic has calmed down, we felt the need to verify whether in-hospital mortality had worsened compared to pre-pandemic conditions due to the COVID-19 pandemic., Objective: To test the hypothesis that daily food consumption is associated with in-hospital mortality during hospitalization and to provide baseline data to examine whether the effects of COVID-19 exist or not in post-pandemic period., Methods: All hospitalized patients staying in a single institution on the third Thursday of May, August, November, and the following February were included. Compared data: (1) among four seasons, (2) between age < 75 vs. ≥75 years, (3) between <75% vs. ≥75% of in-hospital food, and (4) logistic regression analysis to identify factors associated with in-hospital mortality., Results: In 365 inpatients, the following results were obtained: (1) no seasonality or age effect in in-hospital mortality, (2) the novel cutoff value of 75% of the hospital food requirement was used to identify poor in-hospital survivors, (3) logistic regression analysis showed low food consumption, with <75% of the hospital food requirement as the predictor of high in-hospital mortality., Conclusions: A small eater of in-hospital food < 75% during hospitalization was associated with significantly higher in-hospital mortality in patients with scheduled hospitalization in the pre-pandemic period. Then, a study protocol is proposed to test the existence of the effects of COVID-19 in the same study in the post-COVID-19 period. This study protocol is, to our knowledge, the first proposal to test the effects of food consumption in the post-COVID-19 period on in-hospital mortality in the clinical nutritional areas.

Background: Japan is a country often subject to natural disasters, influenced by a rapidly increasing aging demographic. The current research aims to analyze the food distribution for elderly evacuees who were relocated to a care facility in Wajima City, administered by the non-profit organization Tokushukai Medical Assistant Team (TMAT), post the Noto Peninsula Earthquake on 1 January 2024. A significant portion of the shelter's inhabitants were elderly individuals., Methods: TMAT's operations began immediately after the calamity, concentrating on evaluating the nutritional content of meals provided during the initial and subsequent phases, along with a thorough nutritional assessment. During this process, researchers examined the meal conditions for evacuees, including the elderly and those with disabilities, observed the actual meal distribution at welfare centers, and discussed the challenges and potential solutions., Result: Throughout the TMAT mission, a total of 700 evacuees received assistance, with 65% being 65 years old or above. An analysis of the nutritional content of the 10 meal varieties served at the shelter revealed inadequate energy and protein levels for elderly individuals, particularly men, indicating the need for future enhancements., Conclusions: Following a detailed evaluation of TMAT's response to the Noto Peninsula earthquake, it was determined that the food provided in the shelters in the affected areas did not meet the nutritional needs of elderly individuals, especially men, based on nutritional analysis. To stress the importance of establishing an effective framework, it is recommended to promptly revise the emergency food provisions for the elderly population, considering they constitute the majority of the affected individuals.

The consumption of arsenic and trace-metal-contaminated rice is a human health concern worldwide, particularly in Bangladesh. In this study, the effects of rice varieties and water management practices on the concentrations of arsenic and trace metals in rice grains were investigated to reduce human health risks related to rice consumption. In addition, the performance of risk reduction using the optimum combination of rice variety and water management practices was quantitatively assessed using Monte Carlo simulation, in which non-carcinogenic and carcinogenic risk distributions under the status quo and the optimum combination were compared. The experimental results revealed that Dular and BRRI dhan45 (rice varieties) cultivated under alternate wetting and drying (AWD) and continuous flooding (CF) conditions showed the lowest hazard quotient (HQ) values for copper, cadmium, and arsenic and the lowest target cancer risk (TR) for arsenic. In Dular and BRRI dhan45 (AWD and CF) varieties, the proportion of the population for which HQs exceeded 1.0 (the reference value) tended to decrease (except for arsenic), compared with populations for which the rice varieties and water management practices were not specified. These results suggest that the use of optimum combinations of rice varieties and water management practices could reduce non-carcinogenic and carcinogenic risks associated with arsenic and trace metals uptake via rice grain consumption by the Bangladeshi people., Competing Interests: Declaration of competing interest This study was supported by the Mitsui Bussan Environmental Fund (grant number: R18-2009), Japan. The authors declare no competing financial interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: Live two-way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real-world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large-scale pragmatic, randomized controlled trial to determine the effectiveness of long-term treatment for multiple psychiatric disorders via two-way video using smartphones and other devices, which are currently the primary means of telecommunication., Methods: This randomized controlled trial compared two-way video versus face-to-face treatment for depressive disorder, anxiety disorder, and obsessive-compulsive disorder in the subacute/maintenance phase during a 24-week period. Adult patients with the above-mentioned disorders were allocated to either a two-way video group (≥50% video sessions) or a face-to-face group (100% in-person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS) score. Secondary outcomes included all-cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder., Results: A total of 199 patients participated in this study. After 24 weeks of treatment, two-way video treatment was found to be noninferior to face-to-face treatment regarding SF-36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all-cause discontinuation, treatment efficacy, and satisfaction., Conclusion: Two-way video treatment using smartphones and other devices, was noninferior to face-to-face treatment in real-world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care., (© 2023 The Authors. Psychiatry and Clinical Neurosciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Dermal exposure to phosphorus flame retardants (PFRs) has received much attention as a major alternative exposure route in recent years. However, the information regarding dermal exposure via direct contact with a product is limited. In addition, in the commonly used dermal permeability test, the target substance is dissolved in a solvent, which is unrealistic. In this study, a dermal permeability test of PFRs in three car seats was performed using artificial skin. The PFR concentrations in the car seats are 0.12 wt% tris(2-chloroethyl) phosphate (TCEP), 0.030-0.25 wt% tris(2-chloroisopropyl) phosphate (TCPP), 0.15 wt% triphenyl phosphate (TPhP), 0.89 wt% cresyl diphenyl phosphate (CsDPhP), 0.074 wt% tricresyl phosphate (TCsP), and 0.46-4.7 wt% diethylene glycol bis [di (2-chloroisopropyl) phosphate (DEG-BDCIPP). The mean skin permeation rates for a contact time of 24 h are 14 (TCEP), 5.4-160 (TCPP), 0.67 (CsDPhP), 0.38 (TPhP), and 3.3-58 ng cm -2  h -1 (DEG-BDCIPP). The concentrations of TCsP in receptor liquid were lower than the limit of quantification at the contact time of 24 h. The skin permeation rates were significantly affected by the type of car seat (e.g., fabric or non-fabric). The potential dermal TCPP exposure rate for an adult via direct contact with the car seat during the average daily contact time (1.3 h), which was the highest value assessed in this study, was estimated to be 16,000 ng kg -1 day -1 , which is higher than that related to inhalation and dust ingestion reported as significant exposure route of PFRs in previous studies. These facts reveal that dermal exposure associated with direct contact with the product might be an important exposure pathway for PFRs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Anisakiosis, also known as Anisakis larvae infestation, is an increasing parasitic infestation due to the worldwide spread of raw fish and shellfish consumption habits. We present a rare presentation of intestinal intussusception as a preoperative diagnosis and noticed it postoperatively due to Anisakis larvae. A 43-year-old man presented to the emergency department with abdominal pain around the umbilicus and vomiting for several hours. On physical examination at presentation, he had tenderness in the lower abdomen. His radiological studies showed a right-sided pseudo-kidney sign and ileo-colonic intussusception on ultrasound echography. His computed tomography images added findings of submucosal edema and wall thickening in the terminal ileum, swollen regional lymph nodes, and ascites. An urgent laparotomy was performed for ileo-colonic intussusception of an unknown cause. During the laparotomy, the ileocecal intussusception was manually reduced after dissecting the adhesion due to the previous appendectomy, and a partial ileotomy was undertaken using the Endo-GIA automatic anastomosis device. At the resected ileal wall surface, the presence of Anisakis larvae was noticed, and anisakidosis was diagnosed. The dietary history taken post-operatively revealed that he had eaten salmon, bonito, and squid sashimi four days prior to his emergency department visit. His postoperative course was uneventful, and he was discharged from the hospital on the fifth day postoperatively. Anisakiosis must be in the differential diagnosis of intussusception, and eating history seems like a cue to diagnose, and it might be meaningful to clinicians., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Umemoto et al.)

Indoor volatile organic compounds (VOCs) are usually sampled using active carbon samplers and subsequently analyzed using gas chromatography-mass spectrometry (GC-MS) to assess the exposure risk to workers. Therefore, selection of a suitable solvent for VOC extraction is crucial. However, reports on the use of 2-phenoxyethanol-known for its low vapor pressure and low toxicity-as a solvent for extracting VOCs from activated carbon are lacking. Here, we show that 2-phenoxyethanol is a suitable alternative solvent with low toxicity and can extract a wide variety of VOCs without overlapping with target VOCs on the gas chromatogram. The recoveries of 2-phenoxyethanol were 57% (styrene) to 83% (methyl n-butyl ketone), which were higher than those of CS 2 , acetone, and n-hexane at room temperature. The recoveries improved to 67% (styrene) to 102% (isopentyl acetate) under 50 °C. Optimization of the GC conditions showed that a viscosity delay time of 3 s was required to avoid producing bubbles in the injection syringes. We selected DB-HeavyWAX as a column because it could be heated above the boiling point of 2-phenoxyethanol (247 °C), allowing the removal of 2-phenoxyethanol from the column. This study contributes to the development of analysis methods for VOCs under safe operating conditions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Yuichi Miyake reports financial support was provided by Environmental Restoration and Conservation Agency of Japan. Yuichi Miyake reports financial support was provided by Japan Society for the Promotion of Science. Qi Wang reports financial support was provided by Japan Society for the Promotion of Science., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of Competing Interest The authors states that they have no conflict of interest.

Background: Tokunoshima is a remote island in the Amami Islands, 470 km southwest of the Kagoshima mainland. It has a population of 23,000 and consists of three towns: Tokunoshima, Isen, and Amagi. Three medical institutions on the island are responsible for blood transfusion medicine, but there is no blood stockpiling station on the island, and blood is stockpiled in each of the hospitals. Although Tokunoshima Tokushukai Hospital is responsible for 70% of transfusion medicine on Tokunoshima, it is difficult to maintain a sufficient amount of blood in stock considering disposal., Aim: To determine whether changing the distribution of blood types in a hospital's stockpile would reduce the transfusion disposal rate., Methods: This was a retrospective survey. By changing the in-house stock of blood products for transfusions delivered to our hospital over 10 years from January 2013 to December 2017 (preintervention) and from January 2018 to December 2022 (postintervention), we compared the cost-saving effects of these two intervention strategies on disposal rates and blood inventories, as well as the survival rates of case profiles requiring transfusion interventions in hospital-donated transfusion and ABO-incompatible transfusion between two periods. The hospital's stock of RBC had changes that storage of type (A, B, O, AB) RBC from (4, 4, 4, 2) units in the pre-interventon to (2, 2, 6, 0) units in the postintervention., Results: The annual blood product waste rate decreased from 23.4% in the preintervention period to 17.9% in the post-intervention period., Conclusion: By changing the blood products stockpiled for transfusion medicine in Tokunoshima, the transfusion disposal rate can be reduced., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 Takamitsu Sakamoto et al.)

Polycyclic aromatic hydrocarbons (PAHs) and their halogenated derivatives (XPAHs) have been a concern because of their high toxicity. Monitoring indoor PAHs and XPAHs concentrations is important for risk assessment because humans typically spend >90 % of their time indoors. However, the background levels of indoor PAHs and XPAHs concentrations are unknown because of the low sensitivity of conventional analytical methods. In this study, we developed a highly sensitive analytical method using a thermal separation probe (TSP) coupled to a gas chromatograph with a triple quadrupole mass spectrometer method for 26 PAHs and 40 XPAHs. The method quantification limit (MQL) values of the TSP method were 1.1 (3,8-dichlorofluoranthene)-906 (dibenzo[a,e]pyrene) times lower than those of the conventional method. The regression line comparing the TSP and conventional methods was y = (0.944 ± 0.0401)x, which was in good agreement. These results demonstrate that the TSP method can be applied to indoor air analysis. The total concentrations of PAHs and XPAHs were 944 and 73.5 pg m -3 for the house and 735 and 0.924 pg m -3 in the office, respectively. Among the detected compounds, 13 PAHs and XPAHs could not be detected using conventional methods because of their high MQL values. The composition of total toxicity equivalency values in the house was dominated by dibenzo[a,i]pyrene (DBaiP: 43.2 %) and dibenzo[a,h]pyrene (DBahP: 27.1 %), which could not be detected using the conventional method. Therefore, the TSP method can improve the risk assessment of indoor PAHs and XPAHs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Streptococcus dysgalactiae subsp. equisimillis (SDSE) is classified as a group G streptococcus (GGS). In systemic SDSE infection, septic shock is easily induced and has a high mortality of 44%. The case was a 78-year-old man presented with fever and chills of 20 hours duration. He was in shock at the presentation and developed melena on day nine. CT images showed bowel wall thickening with emphysema and bedside colonoscopy showed active bleeding in the descending colon and rectum. Blood cultures were positive for Streptococcus dysgalactiae and a diagnosis of streptococcal toxic shock syndrome (STSS) due to SDSE was made. Urgent Hartmann procedure with laparotomy for removal of descending and rectal colon was performed to relieve his shock status. His shock status was reversed after surgery. Surgical specimens confirmed the presence of SDSE on the intestinal mucosa. This is the first case of STSS due to SDSE infection of the intestinal wall. Resection of infected tissue in the setting of multiple organ dysfunction syndrome and necrotizing enterocolitis is indicated in such cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Matsuoka et al.)

Symptomatic isolated celiac artery (CA) dissection (SICAD) is an extremely rare form of visceral artery dissection. It is diagnosed by a contrast abdominal computed tomography (CT) scan showing a CA dissection (CAD). There are 4 types of CAD: Type I-IV. Type I has entry and re-entry and no true luminal narrowing. All types other than type I have entry and re-entry. They have true lumen compression and true lumen constriction due to false lumen. We report a case with the longest follow-up, 120 months after symptom onset, without evidence of CAD exacerbation. A 56-year-old man presented with a sudden onset of abdominal and back pain. He had a past medical history of left pneumothorax, pulmonary tuberculosis at the age of 23, and hypertension on medication since the age of 46. On physical examination, he had mild muscle rebound tenderness in the epigastric region. The curved multiplanar reconstruction (MPR) of the urgent 3-dimensional contrast-enhanced abdominal computed tomography angiography (CTA) showed an isolated celiac artery dissection type I. Given the risk of emergency surgery for total occlusion of the CA, conservative management with analgesics during hospitalization resolved the abdominal pain, and the patient was discharged 3 days later. Subsequently, a total of 5 CTAs were performed over 120 months, but no worsening of CA arterial dissection and CA occlusion findings were observed. In type I SICAD cases, arterial dissection, and CA occlusion may progress, in which case emergency stenting or endovascular treatment may be indicated, and close follow-up such as CTA is required., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

The photodegradation of plastic waste produces microplastics (MPs) in marine environments. Plastics can adsorb hydrophobic organic pollutants such as polycyclic aromatic hydrocarbons (PAHs) and can be transported over long distances. However, the impact of adsorbed pollutants on the photodegradation remains unknown. Here, we show that adsorbed PAHs act as photocatalysts that promote the photodegradation of polyethylene. Upon light irradiation, coloration and surface degradation of the PAH-adsorbed polyethylene sheets were observed, indicating that the PAH-adsorbed polyethylene sheets are less resistant to light. Furthermore, fluorene, phenanthrene, anthracene, benzo[a]anthracene, benzo[a]pyrene, and indeno[1,2,3-cd]perylene adsorbed on polyethylene MP exhibited lower photodegradation rates than the aqueous phase. These results indicate that these PAHs can act as photocatalysts; their role of PAHs may have two adverse effects on marine environment. First, enhanced photodegradation of plastic waste increased the production of MPs. Second, the lifetime of PAHs is extended, thereby enhancing PAHs pollution in marine environments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The prevalence of hepatic cyst (HC) ranges from 2.5 to 4.7%. Among them, HCs with with symptoms occur in 15%. Extrahepatic rupture of HCs with hemorrhagic shock and death may occur. Early detection of intracystic hemorrhage is necessary to prevent lifethreatening complications. In this case, a 77-year-old woman underwent regular checkups. Her ultrasound (US) showed multiple hepatic cysts (HCs). The largest HC was 80 mm in diameter and located in segment 8 of the right lobe. Her prognostic nutritional index (PNI) was 41.7, indicating high surgical morbidity and mortality after surgery. Multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) were added to identify intra- and extra-cystic anatomy. Compared to MDCT, MRI was able to identify intra-cystic heterogeneous low and high intensity. These findings were interpreted to indicate acute to chronic intra-cystic hemorrhage. As a complication of the rupture and death, an anterior segmentectomy with segmentectomy with cholecystectomy was planned and performed. Her postoperative course was uneventful and she was discharged on day 16. The life-threatening complex HCs include intra-cystic hemorrhage, rupture, hemorrhagic shock and death. To prevent these, we would like to emphasize that MRI appears to be superior to US or CT in providing accurate information on the time course of intra-cystic hemorrhage from hemoglobin to hemosiderin changes to guide urgent surgical intervention of hepatectomy to prevent HC rupture and prevent HC rupture and death., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

The Buriganga River plays a key role in the socioeconomic structure of Dhaka, the capital of Bangladesh. However, this river is severely polluted and is considered one of the most polluted in the world. Therefore, this study aimed to assess the concentrations of various metals in the Buriganga River. A study was conducted from August 2019 to February 2020 to determine the concentrations of 16 metals in water samples (n = 210) collected from 10 distinct sites in the Buriganga River. The mean values for the concentrations of Cr, Mn, Ni, Zn, As, Se, Cd, Sb, and Pb in river water were above the guideline values prescribed by the WHO, Japan, and Bangladesh. Moreover, the fraction ratios of Be, Cr, Co, Ni, Cu, Zn, Se, Mo, Ag, Cd, Sb, and Pb were high (>0.85); consequently, these metals could accumulate at high concentrations in river sediments. Assessment using the single-factor pollution index allowed the classification of the pollution level as 'serious pollution' for Sb and 'heavy pollution' for Cd, Ni, and Pb. The trace metal concentrations in this river imply that crops cultivated along the river using river water may also be contaminated with trace metals.

A 31-year-pld female patient, presented to the emergency room with vaginal bleedingand a three day history of left sided lower abdominal pain. he showed shock status and an'' as ``She came in with a hypovuoluminc shock and an enhanced 3-dimensional multidetector-computed tomography (3D-MDCT) images showed a specific teardropping owl's eye appearance consistent with an active bleeding around fetal sac and from ruptured tubal ectopic pregnancy (EP) spreading into peritoneum at the 9th gestational week. According to accurate radiological diagnosis, she has been able to receive a successful urgent transportation via helicopter to the consultee obstetricians and received an urgent salpingectomy with the diagnosis of tubal rupture in EP. Her post-surgical course was uneventful and discharged hospital on 8th day. From this case experience, an urgent diagnosis of a ruptured tubal EP in shocked female using not US but MDCT is accurately diagnosed because MDCT has radiological advantage to visualize active hemorrhage using contrast-medium., (© 2023 Published by Elsevier Inc. on behalf of University of Washington.)

In rural areas, the medical resources are extremely limited not only pandemic but non-pandemic period. Tele-healthcare system using digital technology-based telemedicine is widely used across various medical specialties. To solve limitation of medical resources in hospital located in remote isolated areas, telehealthcare system using smart application has been applied to access expert opinions in pre-coronavirus disease (COVID-19) era since 2017. The COVID-19 has spread also in this island during COVID-19 period. We have experienced three consecutive neuroemergency patients. Their ages and final diagnoses were: 98 years with subdural hematoma (case 1), 76 years with post-traumatic subarachnoid hemorrhage (case 2), and 65 years with cerebral infarction (case 3), respectively. The tele-counseling could save two of three transportations to tertiary hospital and also save 6,000 US dollars per case for transportation by helicopter. From these three cases counseled through smart app which has been started to use 2 years before COVID-19 emerged in 2020, what this case series would report are the following two viewpoints: (1) medicoeconomic benefits exist in tele-healthcare system in COVID-19 era and (2) developing telehealthcare systems must be prepared that is available even when the electricity system has been shut down, for instance solar system that could. This system must be developed when non-disaster period for disaster days of natural disasters and human-related disasters including wars and terrorisms., Competing Interests: There are no conflicts of interest., (© 2023 Published by Scientific Scholar on behalf of Journal of Neurosciences in Rural Practice.)

Competing Interests: There are no conflicts of interest.

Background: On February 6, 2023, a series of mega-earthquakes (MEs) struck the southern parts of Turkey and northern Syria. In the first 16 days after the Turkey MEs (TMEs), the Tokushukai Medical Assistant Team (TMAT) backed by its infrastructure visited Turkey to support a local hospital. With the goal of helping local communities and working with local supporters and authorities, Turkey is on a mission to positively impact people's lives., Methods: Data collected covered the TMAT support period in February 2023. All patients admitted to a hospital were registered through the Minimum Data Set (MDS) of the Emergency Medical Team (EMT) Coordination Cell (EMTCC)., Results: A total of 561 patients were hospitalized during the 16-day mission. A review of the MDS data showed a de-crease in the number of inpatients. The number of diseases directly related to the disaster was confirmed to be due to a gradual decrease in TME aftershock. However, the number of patients with nondisaster-related disease remained stable., Conclusion: The experience of EMT in the initial relief of MEs that struck Turkey and Syria on February 6, 2023 showed that a mobile type 1 EMT in the early stage while rebuilding the infrastructure is essential. From the analysis of patient profiles, it is clear that knowledge and experience of skin diseases is needed in the first minutes of MEs. In addi-tion, it has become clear that to ensure the quality of MDS for further analysis and to improve the efficiency and effec-tiveness of EMS, it is essential to have recorders in the EMS. These MDS recorders, called descriptors, must be isolated from the treating medical staff to eliminate subjectivity and ensure data accuracy.

A 67-year old male with intussusception due to sigmoid colonic caner was treated. For making correct classification of antegrade or retrograde type, multidetector-computed tomography in longitudinal views seemed optimal to demonstrate anatomical type. This radiological modality made to identify this instead of ultrasound sonography (US) could reveal details of surrounding information. Under intestinal obstruction due to intussusception, cancer-related information such as lymph nodal involvement could be visible using not US but MDCT because of air collection around lesions. His preoperative MDCT revealed antegrade type intussusception with cancerous mass at the leading point and no nodal involvements. Under general anesthesia, he has undertaken laparotomy to resect intussuscepted sigmoid colonic lesion successfully without delaying of surgical procedure. For correct preoperative identification of antero-retrograde type of intussusception using MDCT, safer surgical procedure could be provided. For these purposes, the authors classified these into 2 types, type M and W from longitudinal views of intussuscepted lesions using 3D-MDCT. This classification might be helpful for clinicians to diagnose type of intussusception and provide preoperative information of cancerous involvements with vessels and lymph nodal involvements to consider surgical option., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Cases with iliopsoas abscess (IPA) in a single hospital-based cases were reviewed and compared with clinical profiles of published hospital-based IPA series. To verify usefulness of prognostic nutritional index (PNI) used to predict outcome and severity of IPA, this study was performed. This study consists of 2 parts: Study 1 - Case review of IPA series in a single hospital: 7 cases with IPA treated in a single hospital in sequential 5 years were collected (series 1) and their clinical profiles compared. Study 2 - Review of hospital-based literature: A search of the PubMed database from 1990 to the present was performed, using the Boolean expression ([Psoas OR iliopsoas] AND [abscess] AND [hospital-based]). Two hospital-based case series were collected. The clinical profiles of 2 series were compared with series 1 to draw predictive factors of outcome and deciding treatment modality, medical or surgical. Study 1 - Analyzing 7 IPA cases, average age was 76.7 years old (varying from 64 to 91) and the lifesaving rate was 86%. PNI < 45, calculated with serum albumin (Alb) and total lymphocyte count, and larger cumulative abscess volume (CAV) measured by computed tomography seem outcome predictors. Study 2 - Analyzing 2 hospital-based IPA series (series 2 and 3), series 2 reviewed isolated IPA cases without any comorbidities and series 3 reviewed IPA cases with cardiovascular disorders. Among 3 series including ours, series 1 showed oldest case and longer length of hospitalization. Series 3 showed the highest mortality among 3 because it collected IPA with cardiovascular comorbidities. PNI seems predictors of outcome and disease activity in patients with IPA and might indicate treated with surgical intervention., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

The hepatocellular carcinoma (HCC) with intrahepatic and bone metastasis shows poor survival of averagely 3 months. The bone metastasis and HCC itself might cause cancer-associated pain. An intrathecal (IT) analgesia might contribute to improve QOL and prolong surviving time (ST). A 71-year-old male presented with temperature and appetite loss continuing for 2 months. He looked pale and malaise. Computed tomography and tumor markers elevation confirmed diagnosis of HCC stage IV. To treat him, molecularly targeted therapy was started but abandoned because of side effects of life-threatening convulsions and loss of consciousness. Since this time, pain control strategy was planned as advance care plan. After dermal and oral opioids were administered, IT analgesia was introduced to conquer uncontrollable pelvic pain due to metastatic osteolytic lesions. Owing to IT analgesia against severe cancer-related pain, he had lived for 46 months. Comparing with reviews in which average ST is 3 months, this is the case with the longer ST in bone-metastatic HCC. From our experience, it must be emphasized that relieving cancer-related pain strategy for patients with progressive bone-metastatic HCC might contribute to prolong ST longer when adjuvant therapy has been failed., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 by S. Karger AG, Basel.)

A 72-year-old female diagnosed with rectal cancer treated with a surgical procedure was reported. As 3 liver metastases (LMs) appeared in multidetector CT, adjuvant chemotherapy using Bevacizumab combined with modified FOLFOX-6 was completed. LMs were changed to cystic lesions during the follow-up period, consistent with liquefactive necrosis. These cystic lesions that appeared in the course of disappearing LMs (DLMs) were identified by CT as homogeneous low signal intensity in hepatocyte specific Gd-enhanced MRI. This might be pathognomonic radiological footprint equivalent to liquefactive necrosis observed in the process of DLM and must be carefully followed in the course of radiological complete response. The radiological changing findings of LMs to cystic changes, high sensitivity of detecting DLM, and limitations of Gd-MRI might be meaningful to clinicians., (© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Groupers are widely distributed in tropical and subtropical areas worldwide, are key species to coastal ecosystems, and valuable fishery targets. To facilitate artificial seed production technology for grouper aquaculture, the mechanisms of reproduction and gonad development are being elucidated for these important species. In addition, since groupers are sexually dimorphic fish with female-first maturity (protogynous hermaphrodite fish), research is being conducted to clarify the ecological mechanism of sex change and their reproductive physiology, focusing on the endocrine system. In recent years, research on groupers has also been conducted to understand changes in the coastal environment caused by ocean warming and man-made chemicals. However, due to difficulties associated with conducting research using wild populations for breeding experiments, knowledge of the physiology and ecology of these fish is lacking, especially their reproductive physiology. In this review, we present information on the reproductive physiology and endocrinology of groupers obtained to date, together with the characteristics of their life history.

Antimicrobial peptides (AMPs) are found widespread in nature and possess antimicrobial and immunomodulatory activities. Due to their multifunctional properties, these peptides are a focus of growing body of interest and have been characterized in several fish species. Due to their similarities in amino-acid composition and amphipathic design, it has been suggested that neuropeptides may be directly involved in the innate immune response against pathogen intruders. In this review, we report the molecular characterization of the fish-specific AMP piscidin1, the production of an antibody raised against this peptide and the immunohistochemical identification of this peptide and enkephalins in the neuroepithelial cells (NECs) in the gill of several teleost fish species living in different habitats. In spite of the abundant literature on Piscidin1, the biological role of this peptide in fish visceral organs remains poorly explored, as well as the role of the neuropeptides in neuroimmune interaction in fish. The NECs, by their role as sensors of hypoxia changes in the external environments, in combination with their endocrine nature and secretion of immunomodulatory substances would influence various types of immune cells that contain piscidin, such as mast cells and eosinophils, both showing interaction with the nervous system. The discovery of piscidins in the gill and skin, their diversity and their role in the regulation of immune response will lead to better selection of these immunomodulatory molecules as drug targets to retain antimicrobial barrier function and for aquaculture therapy in the future.

This study characterizes the spawning phenomena of the honeycomb grouper ( Epinephelus merra ), which is a lunar-synchronized spawner that spawns a few days after full moon. To elucidate the aggregation characteristics of wild honeycomb groupers, the numbers of males and females at the spawning grounds were counted before and after the full moon. Approximately 20 males were consistently observed at the spawning grounds throughout the study period. Females appeared several days after full moon and rapidly increased in number, peaking four days after full moon (41 individuals). The maturation status of the females aggregating at the spawning grounds was investigated. The gonadosomatic index increased rapidly three days after full moon, and ovulation was confirmed. Individuals with ovulatory eggs were present for three days, after which the number of females at the spawning grounds decreased. Additionally, the role of males in final oocyte maturation (FOM) and ovulation in females during the spawning phase was investigated in captivity. FOM was induced in females reared in water with mature males, suggesting that male pheromones in the water induced FOM via activation of the hypothalamic-pituitary-gonadal axis. This suggests that spawning at the natural spawning grounds was the result of male-female interactions via pheromones.

A 79 years male with fishbone-induced acute appendicitis was treated surgically with laparoscopic procedure. In preoperative diagnostic study, 3-dimensional multidetector-computed tomography (3D-MDCT) demonstrated the foreign body in the appendix and 3D-reconstructed images seemed fishbone with sharp-pointed dorsal fin directing to the tip of the appendix. With these findings, surgical indication of appendectomy was confirmed and laparoscopic appendectomy was performed. He made a full recovery and was discharged in a satisfactory condition following 7 days of post-operative treatment. From this case experience, 3D-MDCT seems helpful to visualize details of foreign bodies in the appendix, and valuable to confirm surgical indication of complicated acute appendicitis., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: The COVID-19 pandemic has had a profound impact on the mental health of people around the world. Anxiety related to infection, stress and stigma caused by the forced changes in daily life have reportedly increased the incidence and symptoms of depression, anxiety disorder and obsessive-compulsive disorder. Under such circumstances, telepsychiatry is gaining importance and attracting a great deal of attention. However, few large pragmatic clinical trials on the use of telepsychiatry targeting multiple psychiatric disorders have been conducted to date., Methods: The targeted study cohort will consist of adults (>18 years) who meet the DSM-5 diagnostic criteria for either (1) depressive disorders, (2) anxiety disorders, or (3) obsessive-compulsive and related disorders. Patients will be assigned in a 1:1 ratio to either a "telepsychiatry group" (at least 50% of treatments to be conducted using telemedicine, with at least one face-to-face treatment [FTF] within six months) or an "FTF group" (all treatments to be conducted FTF, with no telemedicine). Both groups will receive the usual treatment covered by public medical insurance. The study will utilize a master protocol design in that there will be primary and secondary outcomes for the entire group regardless of diagnosis, as well as the outcomes for each individual disorder group., Discussion: This study will be a non-inferiority trial to test that the treatment effect of telepsychiatry is not inferior to that of FTF alone. This study will provide useful insights into the effect of the COVID-19 pandemic on the practice of psychiatry., Trial Registration: jRCT1030210037, Japan Registry of Clinical Trials (jRCT)., (Copyright © 2021. Published by Elsevier Inc.)

An invasive aspergillosis (IA) primarily occurs among immunocompromised patients. Recently with an influenzae infection prevalently spreading, influenzae-associated invasive aspergillosis (IAIA) has been reported occasionally. By contrast, neuroleptic malignant syndrome (NMS) occurs rarely in psychiatric patients who are treated with Olanzapine. We report a 43 years old male with psychiatric disorder who had developed IAIA followed by NMS and cerebral hemorrhage as the result of aspergillus invasion to cerebral vessels. He had also super-infection of COVID-19, 13 months later to be saved completely after invasive mechanical respiratory supports. From clinical aspects, we would emphasize that it is of importance to find earlier co-occurrence of IAIA patients with cerebral hemorrhage due to secondary infectious vasculopathy of IA., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

An isolated superior mesenteric artery (SMA) dissection (ISMAD) is extremely rare among visceral artery dissections. Its diagnosis is made by abdominal contrast CT scan which shows SMA occlusion partially or completely. The ISMAD is classified into 6 types: type I-V has partial occlusion and treated medically using antiplatelets or anticoagulants. On the other hand, type VI has complete occlusion and must be treated by urgent surgical operation. We present a 67-year-old female who presented with sudden onset abdominal pain and melena. An urgent contrast CT revealed type VI ISMAD. She underwent 3 staged operations as follows: (1) first, as laparotomy showed pale color in almost the extensive length of the small intestine, arterial bypassing of SMA was undertaken using SMA to the right common iliac artery bypass; (2) as the second-look operation on the next day, the terminal ileum was resected, and the remaining small intestine was able to be preserved. However, when the abdomen was tried to be closed, systemic blood pressure decreased to pre-shock condition, so the abdominal wall was closed at skin level with silastic sheet. (3) As the third-look operation on the 7th day, ileostomy was created, and the abdominal wall was safely closed. The postoperative course was uneventful. This case study shows that SMA grafting and staged operations might be an option to preserve the length of the small intestine when ISMAD is diagnosed as type VI., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 by S. Karger AG, Basel.)

The subtypes of zona pellucida (zp), primarily expressed in female gonads, are considered novel molecular markers for testis-ova (or intersex), a type of gonadal abnormality caused by environmental estrogens (EEs) in Japanese medaka (Oryzias latipes). However, the association between testis-ova and the expression of gonadal zp subtypes is unclear in other teleost species, particularly in species studied in field surveys. In this study, 17α-ethinylestradiol (EE2) was orally administrated at 4-4000 ng/g body weight (BW)/day for 28 days to gray mullets (Mugil cephalus), and gonadal abnormalities were studied using histological analysis. The expression profiles of gonadal zp subtypes (zpb and zpc5) were analyzed to evaluate their suitability as gonadal abnormality markers by comparing with a hepatic vitellogenin (vtg) subtype (vtgAb). The oral administration of EE2 40 and 400 ng/g BW/day for 28 days induced significant gonadal zpb expression, and the gonads showed moderate abnormality (testis-ova). Conversely, the gonadal zpc5 levels decreased significantly in response to the oral administration of EE2 at 4000 ng/g BW/day for 28 days, and the gonads exhibited severe abnormalities. The hepatic vtgAb levels increased upon EE2 treatment regardless of gonadal abnormality. Therefore, the gonadal zpb levels and hepatic vtgAb levels served as appropriate markers for testis-ova and EE2 presence, respectively. However, the diagnosis of severe gonadal abnormality using gonadal zpc5 was moderately accurate. The findings suggest that the combination of vtgAb, zpb, and zpc5 is a potential marker for gonadal abnormality caused by EE contamination in gray mullet. That said, the potential of zpc5 should be reconsidered to determine if it shows greater accuracy in a larger or more diverse population., (Copyright © 2021. Published by Elsevier B.V.)

An emphysematous cystitis s a rare urinary tract infectious disease and fatal unless any treatments. The case was a 97-year-old female presented with knee pain after falling with co-existence of macroscopic hematuria and pyuria. The ultrasonography examined on the same day showed a hyperechoic bladder-ring appearance bordering bladder wall which was re-was re-confirmed by computed tomography by air bubble collection on the circumferential bladder wall. We conclude and emphasize as the leaning point that emphysematous cystitis is raised as a differential diagnosis when ultrasonography showed the pathognomonic as hyperechoic bladder-ring appearance bordering bladder wall., Competing Interests: All authors have no conflicts of interest to disclose., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Vertebrates usually exhibit gonochorism, whereby their sex is fixed throughout their lifetime. However, approximately 500 species (~ 2%) of extant teleost fishes change sex during their lifetime. Although phylogenetic and evolutionary ecological studies have recently revealed that the extant sequential hermaphroditism in teleost fish is derived from gonochorism, the evolution of this transsexual ability remains unclear. We revealed in a previous study that the tunica of the ovaries of several protogynous hermaphrodite groupers contain functional androgen-producing cells, which were previously unknown structures in the ovaries of gonochoristic fishes. Additionally, we demonstrated that these androgen-producing cells play critical roles in initiating female-to-male sex change in several grouper species. In the present study, we widened the investigation to include 7 genera and 18 species of groupers and revealed that representatives from most major clades of extant groupers commonly contain these androgen-producing cells, termed testicular-inducing steroidogenic (TIS) cells. Our findings suggest that groupers acquired TIS cells in the tunica of the gonads for successful sex change during their evolution. Thus, TIS cells trigger the evolution of sex change in groupers.

Polycyclic aromatic hydrocarbons (PAHs) and their halogenated derivatives (XPAHs) are ubiquitous in various environmental media. Analytical problems, however, make it difficult to accurately determine their concentrations. To develop a satisfactory analytical method suitable for a diversity of PAHs and XPAHs in multiple environmental samples, we evaluated three commercial analytical columns (DB-5MS, Select PAH, and Rxi-PAH) for better chromatographic separation and optimized the analytical conditions for gas chromatography-triple quadrupole mass spectrometry (GC-MS/MS). Comparison of the abilities of the columns to separate peaks revealed that the Rxi-PAH was the best column for both PAH and XPAH analyses. Optimization of analytical conditions for GC-MS/MS resulted in sensitivities for PAHs and XPAHs that were 4.2-fold-2600-fold higher than the sensitivities of GC-high-resolution MS (GC-HRMS) (an example of a traditional analytical method). Although there were no statistically significant differences between the instrumental detection limits (IDLs) of PAHs and XPAHs measured by GC-HRMS, the IDLs of XPAHs were significantly lower than those of PAHs when measured by GC-MS/MS. This difference could be attributed to the unique ionization patterns of XPAHs in the GC-MS/MS analysis, which suppressed background noise and increased the analytical sensitivity. Analyses of PAHs and XPAHs in grilled chicken, vehicle exhaust, sea sediment, ambient air, and indoor dust via the analytical method optimized in this study revealed that the proposed method was sufficiently sensitive, comprehensive, and versatile for risk assessment purposes, and could eliminate interferences associated with the co-elution of target PAHs and XPAHs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Because of their unintentional formation and low vapor pressure, polycyclic aromatic hydrocarbons (PAHs) and their halogenated derivatives (XPAHs) in the atmosphere are distributed primarily to aerosolized particles with an aerodynamic diameter less than 2.5 μm (PM 2.5 ). However, no information is available regarding the occurrence of PM 2.5 -bound PAHs and XPAHs in Bangladesh, one of the most highly PM 2.5 -polluted regions worldwide. In this study, we investigated the occurrence of PM 2.5 -bound PAHs and XPAHs in the atmospheres of Dhaka in Bangladesh and Shizuoka in Japan (as a reference) and estimated their incremental lifetime cancer risks (ILCRs). In addition, we statistically estimated the potential sources of PM 2.5 -bound PAHs and XPAHs by using principal component analysis and positive matrix factorization. The median concentration of total PM 2.5 -bound PAHs and XPAHs in Bangladesh was 24.2 times that in Japan. The estimated potential sources of PAHs clearly differed between Japan and Bangladesh, whereas those of XPAHs were largely (>80%) unknown in both countries. The median ILCR in Bangladesh was 2.81 × 10 -3 , which greatly exceeded the upper limit of acceptable risk (10 -4 ). These results indicate that comprehensive monitoring and control of atmospheric PM 2.5 -bound PAHs and XPAHs are needed urgently, especially in highly polluted countries., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective., (© 2021 American Society for Parenteral and Enteral Nutrition.)

A recombinant giant grouper Luteinizing Hormone (LH) consisting of tethered beta and alpha subunits was produced in a yeast expression system. The giant grouper LH β-subunit was also produced and administered to rabbits for antibody development. The recombinant LH and its antibody were used to develop an Enzyme Linked Immunosorbent Assay (ELISA). This ELISA enabled detection of plasma LH levels in groupers at a sensitivity between 391 pg/ml and 200 ng/ml. Different species of grouper were assayed with this ELISA in conjunction with gonadal histology and body condition data to identify links between circulating LH levels and sexual development. We found that circulating levels of LH decreased when oocytes began to degenerate, and sex-transition gonadal characteristics were apparent when LH levels decreased further. When circulating LH levels were related to body condition (body weight/ body length), transitioning-stage fish had relatively high body condition but low plasma LH levels. This observation was similar across multiple grouper species and indicates that plasma LH levels combined with body condition may be a marker for early male identification in the protogynous hermaphrodite groupers., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)