Stress responses are part of an important system in maintaining the homeostasis of a living organism. After acute inflammation, if tissue repair is incomplete or stress is not completely removed with an excessive and prolonged inflammatory response, damage is accumulated in living organs and chronic inflammation persists. Thus, irreversible tissue and organ damage occurs, which is accompanied by fibrosis. Further, inflammatory diseases, such as fibrotic diseases, autoimmune diseases, allergies, and arteriosclerosis, account for most causes of deaths in humans; therefore, it is extremely important to understand mechanisms of inflammation and to establish a control method. Inflammation is caused by a complex influence of various molecules and cells that form networks through inflammatory cytokines. Since various factors influence each other, the onset time, degree, and duration of inflammation may differ. This article explains the mechanism of inflammation, presents findings on its regulatory factors and methods, and enumerates the innate immune system receptors (pattern recognition receptors) and responsible cells (neutrophils, innate lymphoid cells, natural killer T cells) that cause inflammation. This article thus aims to understand the complex networks involved in inflammation.

The role of respiratory viruses in pediatric patients with severe lower respiratory tract infection (LRTI) is unclear in Japan. The purpose of this study was to investigate the prevalence of respiratory viruses in children with LRTI managed at the pediatric intensive care unit (PICU) in a single center in Chiba, Japan. We examined 153 patients with LRTI who needed ventilatory support including high-flow nasal cannula oxygen therapy between April 2012 and March 2017; 116 by immunochromatography and 37 by PCR. Nasal swab samples were then examined using immunochromatography assay kits for respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and influenza virus (flu). For PCR, viral antigen nucleic acids were obtained from nasal swabs. Each sample was examined by (RT-) PCR for RSV, enterovirus (EV), hMPV, human bocavirus (HBoV), parainfluenza virus (PIV), and adenovirus (AdV). Clinical characteristics, disease course, and prognosis were investigated. Of 153 patients with a median age of 13 months (0 months-13 years), 73 were male, and 59% had previously had an underlying disease and/or disability. We detected at least 1 virus in 147 patients (96%); 10 patients (6.5%) had co-infection with different viruses. RSV (53%) was the most common, followed by hMPV (20%), EV (5.2%), flu (4.6%), HBoV (4.6%), and PIV (2.6%). Infants were frequently positive for RSV or EV, whereas children over 1 year old were frequently positive for hMPV or HBoV. Seasonal variation was seen in each virus. Over half of the patients positive for RSV or flu were previously heathy children, but many patients positive for other viruses had some other disease or disability. Duration of PICU stay depended on patients' backgrounds rather than the causative virus. After LRTI, 1 patient dead, 2 patients received tracheotomy, and 1 started home oxygen therapy. In conclusion, RSV was the most common in LRTI pediatric patients in the PICU. Except for RSV and flu, patients frequently had some other disease/disability. Duration of PICU stay and prognosis often depends on the patient's background.

Salt restriction is important in the management of hypertension with or without diabetes. We conducted a cross-sectional study to examine the association between dietary salt intake and dietary behavior, knowledge about salt restriction, and social background in Japanese adult patients with type 2 diabetes (T2D) and hypertension. We studied 200 hypertension patients with T2D (122 men and 78 women) who visited the outpatient clinic of Diabetes Center, Tokyo Women's Medical University Hospital from April 2014 to March 2016. A self-administered questionnaire on eating behaviors was distributed. Random urine samples were collected at three consecutive visits and daily salt intake was calculated using the equation by Uechi et al. Multivariable regression analysis showed that low salt intake was significantly associated with "dietary support other than self (i.e. family)" and "not overeating under stress" in men and "not eating fast" in women (p-values <0.05). There was no difference in salt intake between correct and incorrect responders to questions about salt-related knowledge. In conclusion, knowledge about food/health related to salt intake was not associated with salt intake in patients with T2D and hypertension. Nutritional guidance and interventions aimed at reducing salt intake are urgently needed.

A survey was performed among members of the Japan Surgical Society who were parenting surgeons, including working mothers (female surgeons) and working fathers (male surgeons), regarding daily hustle and big life event at work and in private life. A total of 3,068 members responded. Among them, 1,322 had child (ren) under age 18. After excluding responses with omissions or errors, a total of 1,078 (926 males, 152 females) were analyzed. Stress was scored on a scale of 1 to 100. The rate of stress experience was calculated and compared to those in a previous "Working mother's stress survey report." In males, the reasons for high stress level were finding temporary day care, cannot find someone to do his work, and no free time for himself. In females, the reasons for high stress level were bullying/harassment in the workplace, finding temporary day care, and complaint from patients and patients' families. Fathers and mothers working in surgery had different basic problems regarding parenting. However, results of stress level and stress experience rate suggest that the important stress was related to time. In conclusion, in order for parenting surgeons to maintain motivation at work, it is necessary to reform working style in surgery and resolve the causes that generate stress at work and in private life.