Providencia is a genus of Gram-negative and non-spore forming bacteria belonging to the family Morganellaceae, which causes opportunistic infections in humans. Of the 10 Providencia species identified to date, three, P. alcalifaciens, P. rettgeri and P. stuartii, are clinically important. P. alcalifaciens causes diarrhea, including outbreaks arising from food-borne infections, and P. stuartii and P. rettgeri have been found to cause hospital acquired urinary tract infections. Four isolates of P. rettgeri and one isolate of P. stuartii were obtained from urine samples of five patients in Japan in 2018. All five isolates were highly resistant to carbapenems. Three isolates harbored bla_IMP-70, encoding a variant of IMP-1 metallo-β-lactamase, with two amino acid substitutions (Val67Phe and Phe87Val), one isolate harbored two copies of bla_IMP-1 and one isolate harbored bla_IMP-11. Expression of bla_IMP-70 conferred carbapenem resistance in Escherichia coli. Recombinant IMP-10, an IMP-1 variant with Val67Phe but without Phe87Val, had significant higher hydrolytic activities against meropenem than recombinant IMP-1, indicating that the Val67Phe amino acid substitution alters activities against meropenem in IMP-70. These results suggest that Providencia species. become more highly resistant to carbapenems by acquisition of two copies of bla_IMP-1 or by mutations in bla_IMP that result in amino acid substitutions, such as bla_IMP-70.

Footcare awareness and practice are limited in Japan, which is attributable to unavailability of specialized podiatry services, in contrast to the Western healthcare system. Japan does not have national educational courses in podiatry and footcare, and daily foot care is not routinely practiced owing to the cultural background. Moreover, medical insurance covers only diabetic footcare, which contributes to the limited popularity of footcare in Japan. Footcare in Japan is provided by qualified nurses (foot care nurses) who are certified by various organizations and societies. Footcare nurses render the following services: (a) Provision of professional footcare after evaluation and patient education for foot self-care. (b) Multidisciplinary coordination between the footcare team. Owing to lack of podiatry services in Japan, a multidisciplinary therapeutic approach to foot lesions is necessary. The footcare nurse coordinates communication of patient information across team members and interdepartmental referrals for effective multidisciplinary therapy. (c) Patient education to improve awareness of footcare. Footcare is not currently widely established as a component of medical and nursing care and patient welfare, and greater awareness regarding its role is necessary. The importance of footcare to maintain healthy walking needs to be emphasized among individuals with foot lesions. In view of the high life expectancy and rapid population aging in Japan, maintaining a healthy gait is essential to improve healthy life expectancy, and foot care nurses can play an active role in the future.

Objective This study aimed to assess the accuracy of previously developed height prediction models in male Japanese football players and create new height prediction models.

Materials The participants were elite academy male football players. We collected current height, parent’s height, calendar age and bone age in 6^th grade of primary school and obtained actual final height at 20 to 28 years old.

Methods We compared the accuracy of two conventional models for predicting final height. These used current height, calendar age and either bone age (Model 1) or parental height (Model 2). We then developed a new model to optimize the coefficients of Model 1 (Model 3). The final model added parental height to Model 3 and optimized the coefficients (Model 4).

Results Prediction accuracy was higher for Model 2 (R = 0.52, P < 0.001) than Model 1 (p = 0.33, P < 0.001). The equation of Model 3 was final height = 0.63229313×actual measured height-8.2541327×calendar age-2.3009853×bone age (TW2)+206.627184. The R-square was 0.49 (P < 0.0001). The equation of Model 4 was final height = 0.32156081×actual measured height-
4.6652063×calendar age+0.41903909×father’s height+0.34952508×mother’s height-0.740469×bone age(TW2)+62.1007751. The R-square was 0.61 (P < 0.0001).

Conclusions In the two previous conventional models, a formula using parental height had better predictive accuracy. We developed a new height prediction model using current height, calendar age, father’s and mother’s height and bone age.

Objectives This study aimed to investigate the effects of drinking oxygenated water on oxygen saturation during exercise under normobaric hypoxic conditions.

Materials A randomized placebo-controlled single-blinded trial was performed. Twenty-two healthy adults (16 men and 6 women), with a mean age (standard deviation) of 22.4 (2.73) years, participated in the study. The participants were randomly assigned to one of two groups: an OX group (drinking oxygenated mineral water) and a control group (drinking normal mineral water). Both groups performed walking exercises under normobaric hypoxic conditions. Blood oxygen saturation (SpO₂), pulse rate (PR), and walking distance were measured during exercise.

Results SpO₂ decreased and PR increased during exercise in both groups. The decrease in SpO₂ was smaller and the increase in PR was greater in the OX group compared with those in the control group. No significant difference was found in walking distance between the two groups.

Conclusions Drinking oxygenated water before exercise may inhibit SpO₂ reduction under normobaric hypoxic conditions.

Objectives This study aimed to investigate the protective effects of hydrogen-rich water (HW) intake on renal injury in neonatal rats with high oxygen loading.

Materials We used pregnant and newborn Sprague-Dawley rats.

Methods Four groups were set up, with mother and newborn rats immediately after delivery as one group: RA-PW (room air and purified water), RA-HW (room air and HW), O₂-PW (80% oxygen and purified water), and O₂-HW (80% oxygen and HW). The newborn rats were maintained in either a normoxic (room air, 21% oxygen) or controlled hyperoxic (80% oxygen) environment from birth. Then, HW (O₂-HW and RA-HW groups) or PW (O₂-PW and RA-PW groups) was administered to parents of each group.

Results The number of immature glomeruli significantly increased in the O₂-PW group (exposed to hyperoxia). Conversely, the O₂-HW group had significantly fewer immature glomeruli than O₂-PW group. In the RT-PCR analysis of kidney tissue, α-SMA, TGF-β, and TNF-α levels were significantly higher in the O₂-PW group than in the RA-PW group and significantly lower in the O₂-HW group than in the O₂-PW group.

Conclusions HW intake can potentially reduce oxidative stress and prevent renal injury in neonates with high oxygen loading.

Objective The concept of self-endangering work behavior (SEWB) was recently proposed to describe problematic behaviors to cope with heavy workloads and self-management. Although SEWB may enable workers to achieve immediate goals, it risks health and long-term work capacity. In this study, we developed a Japanese version of the SEWB (J-SEWB) scale, which was originally in German, and verified its validity and reliability.

Materials The original SEWB scale consisted of 21 items, constituting five subscales: “Intensification of working hours,” “Prolongation/extension of working hours,” “Refraining from recovery/leisure activities,” “Working despite illness,” and “Use of stimulating substances.” We translated the scale into Japanese, then checked the wording using back-translation.

Methods The J-SEWB scale and questions for working conditions and sociodemographic variables was administered via an online survey with 600 participants registered with an internet survey company in Japan. Cronbach’s α coefficients were calculated for each subscale to assess internal consistency. Construct validity was examined using principal factor analysis with equamax rotation. An analysis of variance evaluated the relationships of J-SEWB scores with working conditions and sociodemographic variables.

Results Cronbach’s α coefficients ranged from 0.846 to 0.964 for five subscales, and 0.957 for all 21 items (total J-SEWB score) in 600 participants. The factor analysis identified five factors, classifying 21 items into corresponding subscales. Total J-SEWB scores were significantly higher for flexible work as well as longer working hours.

Conclusions The J-SEWB scale appears to be an effective tool for assessing SEWB in Japanese employees, with satisfactory reliability and construct validity.

Objectives There are many reports on the effects of trace elements on human anthropometric characteristics. Among these elements, cobalt has consistently shown an inverse relationship with obesity risk. In the present study, we aimed to investigate the relationship between urinary levels of trace elements, focusing on cobalt, and childhood obesity, as indicated by the body mass index (BMI) in early adolescents, focusing on the participants’ gender.

Design A cross-sectional study was conducted in the Tokyo Teen Cohort study. Based on urinary samples, we obtained the anthropometric characteristics (weight and height) and potential covariates associated with childhood BMI for 1542 children (mean age=12 years; 860 boys and 682 girls).

Methods Concentrations of urinary cobalt and 17 other trace elements were measured using inductively coupled plasma-mass spectrometry or inductively coupled plasma-atomic emission spectrometry.

Results Pearson’s correlation coefficient revealed an inverse relationship between the log of cobalt concentrations in the urine and the BMI for the boys (r=-0.125, p<0.001) and girls (r=-0.082, p=0.033). Multivariate analysis, adjusted for various covariates, reconfirmed the correlation between urine cobalt and the childhood BMI, only in the boys (beta=-0.14, p<0.001).

Conclusions Among the 18 elements measured in the children’s urine, cobalt may exhibit sufficient potency to decrease the risk of childhood obesity, particularly in boys. Future studies are required to clearly determine the magnitude of the effect and the underlying mechanism(s).

Objective This study retrospectively explores the objective signs of imminent suicide risk in psychiatric in-patients.

Design The study analysed the diagnostic and nursing records of a psychiatric hospital that covered the last 14 days before the suicide attempts of 18 people, who, between March 2008 and July 2019, were found to have died by suicide during their hospital stay.

Methods Three professionals used a fishbone diagram to separately identify the factors that led to each person’s suicide, the objective signs that indicated imminent suicide risk, possible preventive strategies, and other observations. They compared their findings and used the KJ method (Kawakita Jiro Method) to categorise the items on which they all agreed.

Results Objective signs of imminent suicide risk were condensed into five categories: ‘signs emanating from the patient’, ‘signs gleaned through engagement’, ‘signs from response to treatment’, ‘signs associated with reports from the family’, and ‘signs inferred from multiple sources of information’. Five categories describing issues with the way in which the hospital staff handled information were extracted, namely ‘omission in diagnostic records during admission’, ‘omission in conference records’, ‘communication lapse during transfer’, ‘need for integrated information’, and ‘systemic issues’.

Conclusions The findings offer insights on assessing suicide risk and preventing suicide.

Objectives The correlation between altered small intestinal motility and irritable bowel syndrome is not well evaluated. This study aimed to assess the small intestinal and colonic transits in an adolescent irritable bowel syndrome rat model with restraint stress and determine the role of small intestinal motility in the irritable bowel syndrome pathophysiology.

Materials Restraint stress was utilized to prepare adolescent irritable bowel syndrome rat models that were evaluated for clinical signs, including stool frequency and diarrhea. The small intestinal motility and transit rate were also evaluated.

Methods The amounts of mRNA encoding corticotropin-releasing hormone, mast cell, and serotonin (5-Hydroxytryptamine) receptor 3a were quantified using real-time polymerase chain reaction; the 5-Hydroxytryptamine expression was evaluated using immunostaining.

Results Restraint stress significantly increased the number of fecal pellet outputs, stool water content, and small intestinal motility in the adolescent irritable bowel syndrome rat models. There was no difference in real-time polymerase chain reaction results; however, immunostaining analysis revealed that 5-Hydroxytryptamine expression in the small intestine was significantly increased in the adolescent irritable bowel syndrome rat models.

Conclusions In the rat model of adolescent irritable bowel syndrome with restraint stress, we observed an increase in small intestinal and colonic motility. In the small intestine, enhanced 5-Hydroxytryptamine secretion in the distal portion may be involved in increasing the small intestinal motility. Although the present study focused on 5-Hydroxytryptamine, further investigation of other factors that regulate intestinal peristalsis may lead to the establishment of more effective treatment methods for adolescent irritable bowel syndrome.

Background Escherichia coli is thought to cause xanthogranulomatous cholecystitis (XGC). However, it is unclear whether other pathogens are associated with the cause and progression of XGC.

Case presentation Patient 1 was a 55-year-old man with a previous surgical history of right lung cancer. He presented with abdominal pain and was diagnosed with acute cholecystitis. He underwent endoscopic nasogallbladder drainage (ENGBD), antimicrobial therapy, and endoscopic sphincterotomy (EST). He underwent cholecystectomy on day 59. The patient was pathologically diagnosed with chronic phase XGC. Acinetobacter baumannii was isolated from the bile sample during the operation. Patient 2 was a 58-year-old man with no previous medical history. He presented with abdominal pain and was diagnosed with acute cholecystitis. He underwent endoscopic retrograde biliary drainage (ERGBD) and antimicrobial therapy. His symptoms improved, but acute cholecystitis became exacerbated on day 53. The patient was treated with antimicrobial therapy. He underwent cholecystectomy on day 88. The patient was pathologically diagnosed with focal acute inflammatory phase XGC. Staphylococcus capitis was isolated from the bile during the operation. This study describes two patients with XGC, one infected with A. baumannii and the other with S. capitis, in their gallbladders, which was identified by bacterial culture. Metagenomic analysis revealed that the genera Acinetobacter and Staphylococcus predominated and that other genera, including Delftia and Anaerobacillus, were also present, suggesting that these bacteria play a significant role in the pathological changes associated with XGC.

Conclusions This is the first report of A. baumannii and S. capitis infections in patients with XGC.