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Close observation of the local transmission of influenza A(H1N1) viruses enabled an estimate of the length of time the virus was transmitted without a mutation. Of 4,448 isolates from 11 consecutive years, 237 isolates could be categorized into 57 strain groups with identical hemagglutinin genes, which were monitored for the entire duration of an epidemic season. In addition, 35 isolates with identical sequences were identified at the study site and in other countries within 147 days. Consequently, it can be postulated that once an influenza virus enters a temperate region, the strain rarely mutates before the end of the season.

The correlation of viral growth capability (n = 156) with the viral load in nasopharyngeal swabs (n = 76) was assessed. Epidemic influenza A/H1N1, A/H3N2, and B viruses showed a wide range of growth capability (104–1011 copies/mL) in Madin-Darby canine kidney cells. The growth was correlated with the nasopharyngeal viral load (r = 0.53). Six selected strains showed growth-dependent cell death (r = 0.96) in a growth kinetics assay. Epidemic influenza viruses exhibit a wide range of growth capability. Growth capability should be considered one of the key factors in disease prognosis.

To investigate the prevalence and background of children with medical complexity (CMC) and its secular trend in Japan.CMC were defined as patients under the age of 20 years requiring medical care and devices. The patients were enrolled using the national health insurance claims data of three hospitals and two rehabilitation centers in Tottori Prefecture. The study period was divided into three periods: Period 1, 2007-2010; Period 2, 2011-2014; and Period 3, 2015-2018.A total of 378 CMC were enrolled. The prevalence of CMC was 1.88 per 1000 population among subjects aged20 years in 2018, and it increased by approximately 1.9 times during the study period. The number of CMC who presented with severe motor and intellectual disabilities did not change from Period 1 to Period 3. Meanwhile, the number of CMC who had relatively preserved motor and intellectual abilities increased from 58 to 98. The proportion of CMC who required respiratory management and oxygen therapy increased by 1.3 and 1.8 times, respectively. By contrast, the proportion of CMC who need tube feeding decreased significantly between periods 1 and 3 (P 0.05).The prevalence of CMC increased almost twice during the 12-year study period; however, the increase in the number of patients with relatively preserved motor and intellectual abilities was pronounced. This study showed that the need for medical care and devices differed based on the underlying disorders and severity of CMC; therefore, individualized medical, welfare, and administrative services and education about the various types of CMC must be provided.

三叉神経痛に対しては carbamazepine が特効薬として使用され, 根治的には Jannetta の手術が行われる。しかし手術を望まず carbamazepine も無効となって, 激痛に悩まされる例もある。今回, 漢方薬が有効であった症例について検討した。漢方薬により carbamazepine が不要となったものを著効例, 半減できたものを有効例としてまとめると, 著効例7例, 有効例7例であった。処方は呉茱萸湯が2例, 五苓散を含む処方が9例, 柴胡桂枝湯・当帰四逆加呉茱萸湯生姜湯・麻黄附子細辛湯が各1例となった。三叉神経痛は上小脳動脈やその周辺血管の三叉神経への癒着・圧迫があり, 三叉神経の浮腫が生じていると考えられている。限局した領域における浮腫であっても五苓散や呉茱萸湯などはその利水効果によって効果を発現できるのではないかと思われた。14例の検討から三叉神経痛は水毒・表寒証が多いと考えられた。

The production of leukemia inhibitory factor (LIF) is suggested to be critical for the successful implantation of blastocysts into decidua, because LIF expression is essential for the implantation of mouse blastocytes. We investigated the regulation of LIF production by decidual cytokines and steroid hormones. Stimulation of decidual cells by interleukin-1, tumor necrosis factor alpha, or transforming growth factor beta augmented LIF production in a dose-dependent manner. Moreover, estradiol, a steroid hormone that increases during ovulation and early pregnancy, also enhanced LIF production in a dose-dependent manner. These responses were blocked by protein kinase C (PKC) inhibitor but not by other kinase inhibitors, suggesting an important role of PKC in decidual LIF production mediated by cytokines and estradiol. We also showed that stimulating decidual cells with LIF failed to stimulate DNA synthesis and prolactin production in these cells. In summary, LIF was mainly localized in the decidual glands and stroma, and its production was increased by cytokines and estradiol in a dose-dependent fashion; but stimulation of decidual cells by LIF did not influence their proliferation or their prolactin production.

HBe抗体陽性HBVキャリア妊婦から出生し,慢性肝障害をきたした姉弟例を経験した.姉は生後2カ月からB型肝炎ウイルスによると考えられる重症肝炎を発症したが,HBs抗体出現後も中等度の肝機能障害が1年間持続した.分娩時に母親からB型肝炎ウイルスと非A非B型肝炎ウイルスの重複垂直感染を受けた可能性が示唆された.弟はB型肝炎の垂直感染防止のため生直後にHBIGを投与されたが,生後2カ月から11カ月間,肝機能障害が持続した.生後8カ月からHBs抗体の上昇およびHBc抗体の再上昇がみられた.非A非B型肝炎ウイルスがB型肝炎の潜伏期を延長した可能性も考えられた.