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Purpose To investigate the clinical characteristics of central serous chorioretinopathy (CSC) with age. Study design Retrospective, cross-sectional study. Methods One-hundred and forty-seven CSC patients were classified into three age groups (aged <50 years (younger group; n=53), 50–70 years (middle group; n=68), and >70 years (senior group; n=26)) and the characteristics were compared. Bilateral ophthalmic evaluation included the best corrected visual acuity (BCVA), spherical equivalents, fundus examination, fundus autofluorescence, optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography. Results The male/female ratio became lower at more advanced ages (P=0.011). Bilateral macular abnormalities were observed more frequently in the senior group than the other groups (p=0.018) and multiple drusen were characteristic in the senior group (p<0.0001). The more advanced age groups displayed a worse BCVA (P=0.002). The rate of eyes with flat retinal pigment epithelium (RPE) elevation on OCT was significantly higher in the middle group than the other groups (P=0.024). The mean subfoveal choroidal thickness (SCT) was thickest in the younger group (P<0.0001). Unifocal leakage on FA and choroidal vascular hyperpermeability were mostly found in eyes of the younger group (P<0.001,P=0.020). Conclusion CSC cases in those aged >70 years were associated with an increased proportion of women and having bilateral macular abnormalities, multiple drusen, and multifocal leakage sites. The BCVA and the SCT decreased with age. Patients with CSC aged 50–70 years had the highest rate of flat RPE elevation on OCT. These characteristics need to be considered to make an accurate diagnosis, particularly in elderly patients.

To counter the global health threat of antimicrobial resistance, effective antimicrobial stewardship programs are needed to improve antimicrobial use (AMU) among dentists in addition to physicians. This study aimed to investigate the nationwide epidemiology of AMU among Japanese dentists to facilitate the development of dentist-centered programs. We conducted a retrospective population-based study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan to analyze the AMU among Japanese dentists between 2015 and 2017. AMU was quantified as the defined daily doses per 1,000 inhabitants per day (DID). The trends in dentist-prescribed AMU were examined according to antimicrobial category and administration route. We also compared outpatient oral AMU between dentists and physicians as well as between on-site and off-site dispensing. The DID values of dentist-prescribed AMU were 1.23 in 2015, 1.22 in 2016, and 1.21 in 2017. During this study period, outpatient oral antimicrobials comprised the majority (approximately 99%) of dentist-prescribed AMU, and cephalosporins were the most frequently prescribed antimicrobials (>60% of all antimicrobials). The DID values of outpatient oral AMU were 1.21 for dentists and 12.11 for physicians. The DID value for on-site dispensing was 0.89 in 2017, in which cephalosporins were the predominantly used antimicrobials (DID: 0.60). Interventions that target dentists in Japan should focus on on-site dispensing of oral antimicrobials (especially cephalosporins) for outpatients. Further studies are needed to ascertain the underlying factors of oral cephalosporin prescriptions to guide the development of effective antimicrobial stewardship programs.

Background Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP’s own experiences of being stigmatised in the Philippines. Methods A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well. Results The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP’s mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual’s reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God’s will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma. Conclusions The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.

Two ways of anodizing 3D-printed AlSi10Mg alloy were characterized, and then their fatigue properties were evaluated. Test specimens were fabricated via a laser-powder bed fusion (L-PBF) process followed by machining. Normal and hard anodizing were both conducted in a sulfuric acid bath. The anodized layer was observed using FE-SEM/EDS. Fine Si particles dispersed in the matrix showing web-like patterns were incorporated in the anodized layer. By etching the Si particles away with Keller’s reagent, a characteristic maze-like 3D structure of anodized Al was observed. Then, rotating bending fatigue tests were carried out to evaluate the fatigue strength at 107 cycles. The fatigue strength of the as-machined, normal-anodized and hard-anodized specimens was 106, 100 and 95 MPa, respectively. The fatigue limits were proportional to the surface roughness with higher linearity. By reducing the surface roughness, the fatigue strength of the hard-anodized specimen was improved. This result demonstrates the possibility of improving the fatigue properties of anodized components by reducing their surface roughness. Lastly, a CASS (copper-accelerated acetic acid salt spray) test was conducted, and superior corrosion resistance of the normal- and hard-anodized layers was verified.

Antimicrobial use (AMU) is estimated at the national level by using sales data (S-AMU) or insurance claims data (C-AMU). However, these data might be biased by generic drugs that are not sold through wholesalers (direct sales) and therefore not recorded in sales databases, or by claims that are not submitted electronically and therefore not stored in claims databases. We evaluated these effects by comparing S-AMU and C-AMU to ascertain the characteristics and limitations of each kind of data. We also evaluated the interchangeability of these data by assessing their relationship. We calculated monthly defined daily doses per 1,000 inhabitants per day (DID) using sales and claims data from 2013 to 2017. To assess the effects of non-electronic claim submissions on C-AMU, we evaluated trends in the S-AMU/C-AMU ratio (SCR). To assess the effects of direct sales of S-AMU, we divided AMU into generic and branded drugs and evaluated each SCR in terms of oral versus parenteral drugs. To assess the relationship between S-AMU and C-AMU, we created a linear regression and evaluated its coefficient. Median annual SCRs from 2013 to 2017 were 1.046, 0.993, 0.980, 0.987, and 0.967, respectively. SCRs dropped from 2013 to 2015, and then stabilized. Differences in SCRs between branded and generic drugs were significant for oral drugs (0.820 vs 1.079) but not parenteral drugs (1.200 vs 1.165), suggesting that direct sales of oral generic drugs were omitted in S-AMU. Coefficients of DID between S-AMU and C-AMU were high (generic, 0.90; branded, 0.84) in oral drugs but relatively low (generic, 0.32; branded, 0.52) in parenteral drugs. The omission of direct sales information and non-electronically submitted claims have influenced S-AMU and C-AMU information, respectively. However, these data were well-correlated, and it is considered that both kinds of data are useful depending on the situation.

The four serotypes of dengue virus (DENV), types 1 to 4 (DENV-1 to DENV-4), exhibit approximately 60% identity in the encoded amino acid residues of viral proteins. Reverse transcription of RNA extracted from patient serum specimens followed by PCR amplification with serotype-specific probes is the current standard technique for DENV serotyping. However, this method is time- and cost-consuming, and rapid detection systems with low cost are desirable. Previously, we developed a prototype serotype-specific immunochromatography system. That system was composed of four strips with four corresponding distinct sample buffers, each specifically detecting a single DENV serotype. In the present study, we improved this system by combining pairs of strips into one lateral-flow cassette each, providing DENV-1 and DENV-2 detection in one device and DENV-3 and DENV-4 detection in a second device; this strategy successfully reduced the required sample volume. Furthermore, we were able to adjust the composition of the sample buffers such that a single sample buffer sufficed for all four DENV serotype detection reactions, allowing much easier handling of the devices. Evaluation of this new device against laboratory and clinical DENV isolates and clinical specimens from DENV-infected individuals showed sensitivity that was comparable to that of our previous version, yielding serotype specificity of 100%. These new devices are expected to be of use in the clinical setting, accelerating both prospective and retrospective epidemiological studies.

Introduction: Early detection and intervention are important to prevent dementia. Gait parameters have been recognized as a potentially easy screening tool for mild cognitive impairment (MCI); however, differences in gait parameters between cognitive healthy individuals (CHI) and MCI are small. Daily life gait change may be used to detect cognitive decline earlier. In the present study, we aimed to clarify the relationship between cognitive decline and daily life gait. Methods: We performed 5-Cog function tests and daily life and laboratory-based gait assessments on 155 community-dwelling elderly people (75.5 ± 5.4 years old). Daily life gait was measured for 6 days using an iPod-touch with an accelerometer. Laboratory-based 10-m gait (fast pace) was measured using an electronic portable walkway. Results: The subjects consisted of 98 CHI (63.2%) and 57 cognitive decline individuals (CDI; 36.8%). Daily life maximum gait velocity in the CDI group (113.7 [97.0–128.5] cm/s) was significantly slower than that in the CHI group (121.2 [105.8–134.3] cm/s) (p = 0.032). In the laboratory-based gait, the stride length variability in the CDI group (2.6 [1.8–4.1]) was significantly higher than that in the CHI group (1.8 [1.2–2.7]) (p < 0.001). The maximum gait velocity in daily life gait was weakly but significantly correlated with stride length variability in laboratory-based gait (ρ = −0.260, p = 0.001). Conclusion: We found an association between cognitive decline and slower daily life gait velocity among community-dwelling elderly people.

This study aimed to identify the factors associated with the use of penicillins as the first-choice antimicrobial in Japan's dental clinics. Cross-sectional questionnaire-based survey. Dental clinics throughout Japan. Dentists at the participating clinics. Questionnaires were sent to 1,700 dental care facilities in July 2020, and responses were collected until September 2020. The survey gathered data on clinic characteristics, provision of on-site antimicrobial dispensing, choice of antimicrobials, and knowledge regarding antimicrobial resistance (AMR) and infective endocarditis (IE). Descriptive epidemiology and logistic regression analyses were performed to identify the factors associated with on-site dispensing of penicillins and their use as the first-choice antimicrobial. Responses were obtained from 342 (response rate: 20.1 %) dentists from dental clinics. While 93.9% of respondents were aware of the term \"AMR,\" only 20.8% were familiar with Japan's National Action Plan on AMR. AMR countermeasures were implemented in 79.4% of clinics, but 58.4% of respondents lacked awareness of IE guidelines. In the multivariable logistic regression analyses, \"adherence to IE guidelines\" (odds ratio: 2.56, = .001) and \"clinic stocks ≥2 antimicrobials\" (5.02, = .002) were positively associated with on-site dispensing of penicillins. In contrast, \"clinic with ≥2 full-time dentists\" (odds ratio: .45, = .033) was negatively associated with the use of penicillins as the first-choice antimicrobial. There was a low awareness of the National Action Plan and IE guidelines among dentists. Enhancing educational activities and fostering environments that facilitate collaborative decision-making regarding antimicrobial use may help to improve antimicrobial stewardship in Japan's dental clinics.

The Front Cover is inspired by the diversity in the ocean also in cyberspace. In the present research, we can synthesize diverse heterocyclic molecules having a trifluoromethyl group in a single step by changing the N‐substitution. You can see more variations of trifluoromethyl heterocycles in several papers by our group. More information can be found in the Communication by Hiroto Uno et al.

Efficient synthesis of N,O‐heterocyclic tetra‐substituted trifluoromethyl‐3,1‐benzoxazines via a transition‐metal‐catalyzed decarboxylative intramolecular cyclization was achieved. The decarboxylation of N‐benzoyl trifluoromethyl‐benzoxazinones generated the amide oxygen nucleophile, allowing a selective internal C1‐attack on Pd‐ or Cu‐coordinated zwitterions, affording medicinally attractive tetra‐substituted vinyl‐ or ethynyl‐trifluoromethyl‐3,1‐benzoxazines. This protocol can be applied to the synthesis of perfluoroalkyl‐ and non‐fluorinated 3,1‐benzoxazines. Efficient synthesis of N,O‐heterocyclic tetra‐substituted trifluoromethyl‐3,1‐benzoxazines via a transition‐metal‐catalyzed decarboxylative intramolecular cyclization was achieved. The decarboxylation of N‐benzoyl trifluoromethyl‐benzoxazinones generated the amide oxygen nucleophile, allowing a selective internal C1‐attack on Pd‐ or Cu‐coordinated zwitterions, affording medicinally attractive tetra‐substituted vinyl‐ or ethynyl‐trifluoromethyl‐3,1‐benzoxazines. This protocol can be applied to the synthesis of perfluoroalkyl‐ and non‐fluorinated 3,1‐benzoxazines.