Displaying publications 1 - 20 of 29 in total

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  1. Sahabudin E, Kubo S, Yuzir MAM, Othman N, Nadia Md Akhir F, Suzuki K, et al.
    Bioengineered, 2024 Dec;15(1):2314888.
    PMID: 38375815 DOI: 10.1080/21655979.2024.2314888
    Cadmium (Cd) has become a severe issue in relatively low concentration and attracts expert attention due to its toxicity, accumulation, and biomagnification in living organisms. Cd does not have a biological role and causes serious health issues. Therefore, Cd pollutants should be reduced and removed from the environment. Microalgae have great potential for Cd absorption for waste treatment since they are more environmentally friendly than existing treatment methods and have strong metal sorption selectivity. This study evaluated the tolerance and ability of the microalga Tetratostichococcus sp. P1 to remove Cd ions under acidic conditions and reveal mechanisms based on transcriptomics analysis. The results showed that Tetratostichococcus sp. P1 had a high Cd tolerance that survived under the presence of Cd up to 100 µM, and IC50, the half-maximal inhibitory concentration value, was 57.0 μM, calculated from the change in growth rate based on the chlorophyll content. Long-term Cd exposure affected the algal morphology and photosynthetic pigments of the alga. Tetratostichococcus sp. P1 removed Cd with a maximum uptake of 1.55 mg g-1 dry weight. Transcriptomic analysis revealed the upregulation of the expression of genes related to metal binding, such as metallothionein. Group A, Group B transporters and glutathione, were also found upregulated. While the downregulation of the genes were related to photosynthesis, mitochondria electron transport, ABC-2 transporter, polysaccharide metabolic process, and cell division. This research is the first study on heavy metal bioremediation using Tetratostichococcus sp. P1 and provides a new potential microalga strain for heavy metal removal in wastewater.[Figure: see text]Abbreviations:BP: Biological process; bZIP: Basic Leucine Zipper; CC: Cellular component; ccc1: Ca (II)-sensitive cross complementary 1; Cd: Cadmium; CDF: Cation diffusion facilitator; Chl: Chlorophyll; CTR: Cu TRansporter families; DAGs: Directed acyclic graphs; DEGs: Differentially expressed genes; DVR: Divinyl chlorophyllide, an 8-vinyl-reductase; FPN: FerroportinN; FTIR: Fourier transform infrared; FTR: Fe TRansporter; GO: Gene Ontology; IC50: Growth half maximal inhibitory concentration; ICP: Inductively coupled plasma; MF: molecular function; NRAMPs: Natural resistance-associated aacrophage proteins; OD: Optical density; RPKM: Reads Per Kilobase of Exon Per Million Reads Mapped; VIT1: Vacuolar iron transporter 1 families; ZIPs: Zrt-, Irt-like proteins.
  2. Maeda Y, Hirakawa T, Suzuki S, Suhaimi N, Shamsol Anuar NS, Yoneda K, et al.
    Microbiol Resour Announc, 2024 Feb 15;13(2):e0081623.
    PMID: 38179908 DOI: 10.1128/MRA.00816-23
    Tetratostichococcus sp. P1 shows an acidophilic phenotype which could allow mass-scale monoculture of this green microalga without severe contamination by environmental microorganisms. In this study, we report a chromosome-scale genome assembly for Tetratostichococcus sp. P1.
  3. Uni S, Fukuda M, Uga S, Agatsuma T, Nakatani J, Suzuki K, et al.
    Parasitol Int, 2021 Aug;83:102313.
    PMID: 33662527 DOI: 10.1016/j.parint.2021.102313
    Reports of zoonotic infections with Onchocerca japonica (Nematoda: Filarioidea), which parasitizes the Japanese wild boar, Sus scrofa leucomystax, have recently increased in Japan. To predict the occurrence of infection in humans, it is necessary to determine the prevalence of O. japonica infection in the natural host animals. We investigated the presence of adult worms in the footpads, and of microfilariae in skin snips, taken from the host animals, between 2000 and 2018. Onchocerca japonica was found in 165 of 223 (74%) Japanese wild boars in Honshu and Kyushu. Among the nine regions studied, the highest prevalence of O. japonica infection was found in Oita, Kyushu, where 47 of 52 (90.4%) animals were infected. The ears were the predilection sites for O. japonica microfilariae. Adult worms of O. japonica were found more frequently in the hindlimbs than in the forelimbs of the host animals. Onchocerca takaokai was found in 14 of 52 (26.9%) Japanese wild boars in Oita. In Kakeroma Island among the Nansei Islands, both O. japonica and O. takaokai were isolated from the Ryukyu wild boar, S. s. riukiuanus. These observations could help predict future occurrences of human zoonotic onchocercosis in Japan.
  4. Widiastuti N, Widyanto AR, Caralin IS, Gunawan T, Wijiyanti R, Wan Salleh WN, et al.
    ACS Omega, 2021 Jun 22;6(24):15637-15650.
    PMID: 34179608 DOI: 10.1021/acsomega.1c00512
    Hydrogen (H2) has become one of the promising alternative clean energy resources. Membrane technology is a potential method for hydrogen separation or production. This study aims to develop a new carbon membrane for hydrogen separation or production. Moreover, the permeation behavior of H2, CO2, and CH4 through a hollow fiber composite carbon membrane derived from P84 co-polyimide and with incorporation of zeolite composite carbon (ZCC) was also examined. ZCC was synthesized via the impregnation method of sucrose into zeolite-Y pores, followed by carbonization at 800 °C. Thus, this filler has a high surface area, high microporosity, ordered pore structure, and low hydrophilicity. The presence of zeolites in ZCC is predicted to increase certain gases' affinity for the membrane. Various heating rates (1-5 °C/min) were applied during pyrolysis to understand the effect of the heating rate on the pore structure and H2/CO2 and H2/CH4 gas separation performance. Moreover, gas permeation was evaluated at various temperatures (298-373 K) to study the thermodynamic aspect of the process. A characteristic graphite peak was detected at 2θ ∼ 44° in all carbon samples. Scanning electron microscopy (SEM) observations revealed the void-free surface and the asymmetric structure of the carbon membranes. During the permeation test, it was found that gas permeation through the membrane was significantly affected by the temperature of the separation process. The highest permeability of H2, CO2, and CH4 was detected on the composite carbon membrane at a 3 °C/min heating rate with a permeation temperature of 373 K. The thermodynamic study shows that CO2 and H2 have lower activation energies compared to CH4. The transport mechanism of the membrane involved adsorption and activated surface diffusion. The permeation temperature has a large impact on the transport of small penetrants in the carbon matrix.
  5. Kaha M, Iwamoto K, Yahya NA, Suhaimi N, Sugiura N, Hara H, et al.
    Sci Rep, 2021 06 03;11(1):11708.
    PMID: 34083633 DOI: 10.1038/s41598-021-91128-z
    Microalgae are important microorganisms which produce potentially valuable compounds. Astaxanthin, a group of xanthophyll carotenoids, is one of the most powerful antioxidants mainly found in microalgae, yeasts, and crustaceans. Environmental stresses such as intense light, drought, high salinity, nutrient depletion, and high temperature can induce the accumulation of astaxanthin. Thus, this research aims to investigate the effect of black light, also known as long-wave ultraviolet radiation or UV-A, as a stressor on the accumulation of astaxanthin as well as to screen the antioxidant property in two tropical green algal strains isolated from Malaysia, Coelastrum sp. and Monoraphidium sp. SP03. Monoraphidium sp. SP03 showed a higher growth rate (0.66 day-1) compared to that of Coelastrum sp. (0.22 day-1). Coelastrum sp. showed significantly higher accumulation of astaxanthin in black light (0.999 g mL culture-1) compared to that in control condition (0.185 g mL-1). Similarly, Monoraphidium sp. SP03 showed higher astaxanthin content in black light (0.476 g mL culture-1) compared to that in control condition (0.363 g mL culture-1). Coelastrum sp. showed higher scavenging activity (30.19%) when cultured in black light condition, indicating a correlation between the antioxidant activity and accumulation of astaxanthin. In this study, black light was shown to possess great potential to enhance the production of astaxanthin in microalgae.
  6. Hui SS, Zhang R, Suzuki K, Naito H, Balasekaran G, Song JK, et al.
    Scand J Med Sci Sports, 2021 Mar;31(3):763-771.
    PMID: 33249648 DOI: 10.1111/sms.13893
    Less is known about how compliance with 24-hour movement guidelines for physical activity (PA), sedentary behavior, and sleep affects adiposity in young people. The purposes of this study were to compare compliance with 24-hour movement guidelines in Asian adolescents and to examine the associations between compliance with 24-hour movement guidelines and body fat percentage. A sample of 12 590 adolescents aged 13.63 (± 1.01) years from eight Asian metropolitan cities including Bangkok (Thailand), Hong Kong SAR, Kuala Lumpur (Malaysia), Seoul (South Korea), Shanghai (China), Singapore, Taipei (Taiwan), and Tokyo (Japan) completed interviewer-administered questionnaires to assess moderate-to-vigorous PA, recreational screen time, sleep duration, and covariates. Body fat percentage was measured using bioelectrical impedance analysis. We found that compliance with 24-hour movement guidelines differed in Asian adolescents across the eight cities. Adjusting for covariates, there was a negative association between number of the guidelines being met and body fat percentage in Asian adolescents. In addition, meeting only the sleep guideline and both the PA and sleep guidelines had negative associations with body fat percentage compared with no guidelines being met. Our findings improve the understanding about how compliance with 24-hour movement guidelines benefit a healthy body weight in adolescents, as well as contribute to development of evidence-based 24-hour movement guidelines for Asian young people. Future research is needed to gain better insights into the directionality of the associations between compliance with 24-hour movement guidelines and adiposity, as well as the mechanisms underlying the associations in Asian adolescents.
  7. Abdul Aziz FA, Suzuki K, Honjo M, Amano K, Mohd Din ARJB, Tashiro Y, et al.
    J Biosci Bioeng, 2021 Jan;131(1):77-83.
    PMID: 33268319 DOI: 10.1016/j.jbiosc.2020.09.009
    The coexisting mechanism of a synthetic bacterial community (SBC) was investigated to better understand how to manage microbial communities. The SBC was constructed with three kinds of phenol-utilizing bacteria, Pseudomonas sp. LAB-08, Comamonas testosteroni R2, and Cupriavidus sp. P-10, under chemostat conditions supplied with phenol as a sole carbon and energy source. Population densities of all strains were monitored by real-time quantitative PCR (qPCR) targeting the gene encoding the large subunit of phenol hydroxylase. Although the supply of phenol was stopped to allow perturbation in the SBC, all of the strains coexisted and the degradation of phenol was maintained for more than 800 days. The qPCR analyses showed that strains LAB-08 and R2 became dominant simultaneously, whereas strain P-10 was a minor population. This phenomenon was observed before and after the phenol-supply stoppage. The kinetic parameters for phenol of the SBC changed before and after the phenol-supply stoppage, which suggests a change in functional roles of strains in the SBC. Transcriptional levels of phenol hydroxylase and catechol dioxygenases of three strains were monitored by reverse-transcription qPCR (RT-qPCR). The RT-qPCR analyses revealed that all strains shared phenol and survived independently before the phenol-supply stoppage. After the stoppage, strain P-10 would incur the cost for degradation of phenol and catechol, whereas strains LAB-08 and R2 seemed to be cheaters using metabolites, indicating the development of the metabolic network. These results indicated that it is important for the management and redesign of microbial communities to understand the metabolism of bacterial communities.
  8. Lee GLY, Zakaria NN, Convey P, Futamata H, Zulkharnain A, Suzuki K, et al.
    Int J Mol Sci, 2020 Dec 09;21(24).
    PMID: 33316871 DOI: 10.3390/ijms21249363
    Study of the potential of Antarctic microorganisms for use in bioremediation is of increasing interest due to their adaptations to harsh environmental conditions and their metabolic potential in removing a wide variety of organic pollutants at low temperature. In this study, the psychrotolerant bacterium Rhodococcus sp. strain AQ5-07, originally isolated from soil from King George Island (South Shetland Islands, maritime Antarctic), was found to be capable of utilizing phenol as sole carbon and energy source. The bacterium achieved 92.91% degradation of 0.5 g/L phenol under conditions predicted by response surface methodology (RSM) within 84 h at 14.8 °C, pH 7.05, and 0.41 g/L ammonium sulphate. The assembled draft genome sequence (6.75 Mbp) of strain AQ5-07 was obtained through whole genome sequencing (WGS) using the Illumina Hiseq platform. The genome analysis identified a complete gene cluster containing catA, catB, catC, catR, pheR, pheA2, and pheA1. The genome harbours the complete enzyme systems required for phenol and catechol degradation while suggesting phenol degradation occurs via the β-ketoadipate pathway. Enzymatic assay using cell-free crude extract revealed catechol 1,2-dioxygenase activity while no catechol 2,3-dioxygenase activity was detected, supporting this suggestion. The genomic sequence data provide information on gene candidates responsible for phenol and catechol degradation by indigenous Antarctic bacteria and contribute to knowledge of microbial aromatic metabolism and genetic biodiversity in Antarctica.
  9. Abdul Aziz FA, Suzuki K, Amano K, Moriuchi R, Dohra H, Tashiro Y, et al.
    Microbiol Resour Announc, 2020 Sep 10;9(37).
    PMID: 32912906 DOI: 10.1128/MRA.00597-20
    We report the draft genome sequence of Variovorax boronicumulans strain c24, which was isolated from a soil-inoculated chemostat culture amended with phenol as a sole carbon and energy source. The genome data will provide insights into phenol and other xenobiotic compound degradation mechanisms for bioremediation applications.
  10. Sakaue S, Hirata J, Kanai M, Suzuki K, Akiyama M, Lai Too C, et al.
    Nat Commun, 2020 03 26;11(1):1569.
    PMID: 32218440 DOI: 10.1038/s41467-020-15194-z
    The diversity in our genome is crucial to understanding the demographic history of worldwide populations. However, we have yet to know whether subtle genetic differences within a population can be disentangled, or whether they have an impact on complex traits. Here we apply dimensionality reduction methods (PCA, t-SNE, PCA-t-SNE, UMAP, and PCA-UMAP) to biobank-derived genomic data of a Japanese population (n = 169,719). Dimensionality reduction reveals fine-scale population structure, conspicuously differentiating adjacent insular subpopulations. We further enluciate the demographic landscape of these Japanese subpopulations using population genetics analyses. Finally, we perform phenome-wide polygenic risk score (PRS) analyses on 67 complex traits. Differences in PRS between the deconvoluted subpopulations are not always concordant with those in the observed phenotypes, suggesting that the PRS differences might reflect biases from the uncorrected structure, in a trait-dependent manner. This study suggests that such an uncorrected structure can be a potential pitfall in the clinical application of PRS.
  11. Aziz FAA, Suzuki K, Moriuchi R, Dohra H, Tashiro Y, Futamata H
    Microbiol Resour Announc, 2020 Feb 13;9(7).
    PMID: 32054711 DOI: 10.1128/MRA.01478-19
    We report the draft genome sequence of Variovorax boronicumulans strain HAB-30, which was isolated from a phenol-degrading chemostat culture. This strain contains genes encoding a multicomponent type of phenol hydroxylase, with degradation pathways for catechol and other aromatic compounds. The genome sequence will be useful for understanding the metabolic pathways involved in phenol degradation.
  12. Hui SS, Zhang R, Suzuki K, Naito H, Balasekaran G, Song JK, et al.
    J Sports Sci, 2020 Feb;38(3):273-279.
    PMID: 31774367 DOI: 10.1080/02640414.2019.1695334
    Purpose: The present study aimed to investigate and compare physical activity (PA) and health-related fitness in Asian adolescents, and to examine the associations between meeting PA guidelines and attaining fitness standards. Methods: A sample of 12,590 adolescents (Mage = 13.63 years, SD = 1.01) from eight Asian metropolitan cities completed measurements of PA, five field-based fitness tests, and covariates. The fitness test scores were further classified into Healthy Fitness Zone (HFZ) or Needs Improvement Zone (NIZ). Results: Findings showed that adolescents' levels of PA and fitness components differed by cities. City differences were also found in proportions of meeting PA guidelines and achieving the HFZs of aerobic capacity, muscular fitness, and body composition. After controlling covariates, meeting PA guidelines positively associated with being in the HFZs of aerobic and muscular fitness, but the association was not significant with being in the body composition HFZ. Conclusion: There was a large variation in PA and health-related fitness in adolescents across the eight Asian cities. Asian adolescents achieving PA guidelines were more likely to be in the HFZ of aerobic and muscular fitness. Prospective follow-up studies are warranted to gain better insights into the relationships between objectively-measured PA and fitness.
  13. Kidokoro T, Suzuki K, Naito H, Balasekaran G, Song JK, Park SY, et al.
    BMC Public Health, 2019 Dec 27;19(1):1737.
    PMID: 31881869 DOI: 10.1186/s12889-019-8079-0
    BACKGROUND: Moderate-to-vigorous physical activity (MVPA) and television viewing are independently associated with cardiorespiratory fitness. However, limited evidence is available on their combined effects, specifically of MVPA and watching television, on cardiorespiratory fitness in the young Asian population. Therefore, the present study examined whether MVPA can attenuate the detrimental effects of prolonged television viewing on the cardiorespiratory fitness of Asian adolescents.

    METHODS: This is a cross-sectional study on 9553 adolescents (aged 12-15 years) from 8 Asian metropolitan cities (Tokyo, Hong Kong, Shanghai, Taipei, Bangkok, Kuala Lumpur, Seoul, and Singapore). Cardiorespiratory fitness was assessed by using a 15-m progressive aerobic capacity endurance run (PACER) test. The time spent on MVPA and watching television was assessed using the International Physical Activity Questionnaire-Short Form.

    RESULTS: MVPA was more closely associated with the PACER score than the duration of watching television. Compared with the reference group (i.e. those with the lowest levels of MVPA [

  14. Guan Y, Vossen A, Adachi I, Adamczyk K, Ahn JK, Aihara H, et al.
    Phys Rev Lett, 2019 Feb 01;122(4):042001.
    PMID: 30768311 DOI: 10.1103/PhysRevLett.122.042001
    We report the first observation of the spontaneous polarization of Λ and Λ[over ¯] hyperons transverse to the production plane in e^{+}e^{-} annihilation, which is attributed to the effect arising from a polarizing fragmentation function. For inclusive Λ/Λ[over ¯] production, we also report results with subtracted feed-down contributions from Σ^{0} and charm. This measurement uses a dataset of 800.4  fb^{-1} collected by the Belle experiment at or near a center-of-mass energy of 10.58 GeV. We observe a significant polarization that rises with the fractional energy carried by the Λ/Λ[over ¯] hyperon.
  15. Suzuki K, Aziz FAA, Honjo M, Nishimura T, Masuda K, Minoura A, et al.
    Microbiol Resour Announc, 2018 Nov;7(18).
    PMID: 30533775 DOI: 10.1128/MRA.01009-18
    A batch culture was enriched on phenol with trichloroethene-contaminated aquifer soil as an inoculum. Cupriavidus sp. strain P-10 was isolated from the culture using a diluted plating method. Here, we report the draft genome sequence and annotation of strain P-10, which provides insights into the metabolic processes of phenol degradation.
  16. Jin RR, Sutcliffe A, Vento M, Miles C, Travadi J, Kishore K, et al.
    Acta Paediatr, 2018 10;107(10):1733-1738.
    PMID: 29385272 DOI: 10.1111/apa.14242
    AIM: The diagnosis of tongue-tie (or ankyloglossia) has increased more than 10-fold in some countries. Whether this is a global phenomenon or related to cultural and professional differences is uncertain.

    METHODS: An online survey in English, Japanese, Chinese and Spanish was disseminated between May and November 2016 via 27 international professional bodies to >30 clinical professions chosen a priori to represent occupations involved in the management of neonatal ankyloglossia.

    RESULTS: A total of 1721 responses came from nursing (51%), medical (40%), dental (6%) and allied health (4%) clinicians. Nurses (40%) and allied health (34%) professionals were more likely than doctors (8%) to consider ankyloglossia as important for lactation problems, as were western (83%) compared to Asian (52%) clinicians. Referrals to clinicians for ankyloglossia management originated mainly from parents (38%). Interprofessional referrals were not clearly defined. Frenectomies were most likely to be performed by surgeons (65%) and dentists (35%), who were also less likely to be involved in lactation support. Clinicians performing frenectomies were more likely to consider analgesia as important compared to those not performing frenectomies.

    CONCLUSION: The diagnosis and treatment of ankyloglossia vary considerably around the world and between professions. Efforts to standardise management are required.

  17. Mayumi T, Okamoto K, Takada T, Strasberg SM, Solomkin JS, Schlossberg D, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):96-100.
    PMID: 29090868 DOI: 10.1002/jhbp.519
    Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
  18. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):41-54.
    PMID: 29032636 DOI: 10.1002/jhbp.515
    The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30-day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
  19. Mori Y, Itoi T, Baron TH, Takada T, Strasberg SM, Pitt HA, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):87-95.
    PMID: 28888080 DOI: 10.1002/jhbp.504
    Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
  20. Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, et al.
    J Hepatobiliary Pancreat Sci, 2018 Jan;25(1):31-40.
    PMID: 28941329 DOI: 10.1002/jhbp.509
    The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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