Economic losses associated with mastitis due to bovine leukemia virus infection.

Bovine leukemia virus (BLV), which causes enzootic bovine leukosis and immunosuppression, is widely prevalent on Japanese dairy farms. However, in the absence of a national eradication scheme with compensation programs, it is important to estimate BLV-associated economic losses to raise farmers' awareness. Mastitis (includes both clinical and subclinical) is a common disease in the dairy industry and the most common reason for culling. We hypothesized that immunosuppression due to BLV predisposes subclinical mastitis. A retrospective cohort study was conducted to trace Holstein cows at 9 commercial dairy farms in the Nemuro and Kushiro regions of Hokkaido Prefecture, Japan, where monitoring of BLV proviral load is routine. Information regarding Dairy Herd Improvement data, parity number, and delivery day was collected at each farm. Cows with no confirmed infection with BLV during lactation were defined as non-infected. Low-proviral-load and high-proviral-load (H-PVL) cows were defined as those in which proviral load was below and over 2,465 copies/50 ng of DNA, respectively, or 56,765 copies/105 cells, respectively, throughout the lactation period. Survival analysis was performed using the frailty model to estimate the hazard ratio of subclinical mastitis for BLV infection status using data from 1,034 dairy cows after adjusting for parity number and delivery season as confounding factors. Kaplan-Meier survivor curves demonstrated that half of the H-PVL cows developed subclinical mastitis within 52 d after calving. The hazard ratio of subclinical mastitis for H-PVL cows was 2.61 times higher than that of non-infected cows. In 2017, there were 264,443 clinical mastitis cases in Hokkaido. Using field and published data, annual economic losses were estimated using Monte Carlo simulation. The economic loss due to mastitis associated with BLV infection per H-PVL cow was $418.59 (¥43,952), with the annual economic loss in Hokkaido Prefecture due to mastitis caused by BLV infection estimated at $6,097,225 (¥640,208,633). In summary, H-PVL cows were more susceptible to subclinical mastitis than non-infected and low-proviral-load cows, and mastitis due to BLV infection was projected to cause significant economic losses.

Healthy Aging: Comparative Analysis of Local Perception and Diet in Two Health Districts of Côte d'Ivoire and Japan.

Context: Good health and longevity depend on dynamic interactions between biological, social, psychological, and environmental factors. Aging is globally a big challenge, particularly with the demographic transition, including population growth, and an emerging burden to society. Knowledge, behavior, diet, and consumption of animal source food were related to aging and emerged as the key factors modulating healthy aging. Objective: The study was designed to understand the main healthy aging factors, such as knowledge, social network, and diet of elders, and to derive mutual learning from it for healthy aging. Methods: A qualitative approach has been applied to explore health-related knowledge, attitude, and diet of elders from Ebetsu (Japan) and Tiassalé (Côte d'Ivoire) health districts, using focus group discussions and comparative context analysis between high- and low-income countries. Results: The study shows that living longer is a common feature of people in Japan compared to Côte d'Ivoire, where the life expectancy is still low. Both groups of elders have social networks that support them, and both offer their gained experience to society. While Japanese elders depend on pension and insurance for income and medical treatments, Ivorians depend mostly on their children and social network in old age. The worries of elders differ between the two regions. In Ebetsu, elder members of the community are concerned about the future burden they pose for the younger generation if they develop ill-health, making them more resilient to aging. In Taabo, elders are considered to be culturally and socially useful to the society. Elders in Ebetsu pointed out that for healthy aging, education on diet at a younger age, physical activities, and access to basic social services are the key aspects. This was not observed in Taabo's context. Being inactive and dependent on others were described as the most worrying situations for elders in Ebetsu, as it is perceived to increase the risk of non-communicable diseases and anxiety. Elders in Ebetsu have good knowledge on what constitutes a healthy diet, and they believe that diversifying their diet, reducing portions, and substituting red meat with good animal and vegetable proteins are best eating practices to maintain good health. In Côte d'Ivoire, the diet is imbalanced and the whole family consumes the same meal made mainly with high-energy staples and little protein. However, it is observed in both societies that adopting a good diet is very expensive. Conclusion: The consciousness of aging is universal, but healthy aging varies according to the social systems, education, and knowledge on diet transition. Physical activities, protein-energy balance in diet, and social networks are the key for healthy aging in both contexts. The challenge is to find ways to increase knowledge regarding healthy aging and to strengthen the support system so that healthy aging becomes affordable.

Rabies outbreak in black-backed jackals (Canis mesomelas), South Africa, 2016.

Rabies, a fatal and vaccine-preventable disease, is endemic throughout Africa. In 2016, a rabies outbreak occurred in black-backed jackals (Canis mesomelas) along the western boundary of Gauteng Province, South Africa. We investigated the possible drivers of the 2016 outbreak and established its origin. Using spatio-temporal locations of cases, we applied logistic regression and Geographic Information System techniques to investigate environmental covariates driving occurrences of emerging rabies cases in Gauteng Province. About 53.8% of laboratory-confirmed lyssaviruses in Gauteng Province in 2016 originated from jackals. Phylogenetic trees reconstructed from a partial region of the glycoprotein gene of these and historical rabies viruses (RABVs) demonstrated the lyssaviruses to be of canid origin with 97.7% nucleotide sequence similarity. The major cluster comprised jackal RABVs from the 2012 KwaZulu/Natal outbreak and the 2016 outbreak in Gauteng Province. The second cluster was composed of both jackal and dog RABVs. Both clusters correlated with independent RABV introductions into Gauteng by dogs and jackals, respectively. This study demonstrated an expansion of a jackal rabies cycle from north-west Province into Gauteng Province during the 2016 dry period, as jackals ranged widely in search for food resources leading to increased jackal-dog interactions, reminiscent of the intricate links of domestic and wildlife rabies cycles in South Africa.

Usefulness and accuracy of segmental adrenal venous sampling on localisation and functional diagnosis of various adrenal lesions in primary aldosteronism.

AIM: To clarify the usefulness and accuracy of segmental adrenal venous sampling (sAVS) on localisation and functional diagnosis of various adrenal lesions in primary aldosteronism. MATERIALS AND METHODS: Consecutive patients (n=162) who underwent adrenalectomy and 138 patients indicated for medication following sAVS were analysed retrospectively. Based on immunohistopathological diagnosis, the positive predictive value (PPV) of computed tomography (CT)-detectable aldosterone-producing adenoma (APA) was calculated. Moreover, endocrinological and sAVS characteristics were analysed quantitatively and qualitatively among APA, CT-undetectable aldosterone-producing nodules (APNs), multiple aldosterone-producing micronodules (MAPM), and medication groups. RESULTS: The PPV of APA by sAVS was 137/141 (97.1%; 95% confidence interval, 92.9-99.2%). Compared to the medication cases, the APA group showed stronger disease activity clinically and significant differences in adrenal hormones, such as a higher aldosterone level and aldosterone-to-cortisol ratio, and lower cortisol levels in the adrenal central vein and aldosterone maximum tributaries on the dominant side after cosyntropin stimulation. The APA group shows focal aldosterone hypersecretion, such as mean number of aldosterone elevated segments (1.7 ± 0.7 versus 2 ± 0.9, p=0.003) and presence of aldosterone-not-elevated segments (93% versus 41%, p<0.001). Clinically and in terms of sAVS, APN and MAPM showed similar characteristics to APA and to the medication cases, respectively. CONCLUSION: sAVS can localise functionally active tissues of CT-detectable and CT-undetectable lesions enabling decisions on surgical or medical treatment.

Animal health and food safety risk assessments.

Animal health risk assessment is one of the key tasks of Veterinary Services. There are well-established protocols created by the World Organisation for Animal Health and Codex Alimentarius Commission for assessing risk. They cover terrestrial and aquatic animals and zoonotic infectious diseases, food safety, and the environment, taking into consideration the connections between them. Significant effort has been made in developing methods to estimate the probability, and consequences, of infectious disease incursion in diseasefree countries through legal or illegal trade or via the movements of insects and wildlife. Additional efforts have been made in the design of prevention strategies and contingency plans. Concerns about possible pandemics of avian influenza continue to be important motivation for monitoring viruses for selection of vaccine candidate strains. The recent COVID-19 pandemic was zoonotic in nature and caused extensive disruption throughout the world. Tools are becoming available for quantitative food safety risk assessments for bacteria, toxins, viruses, and antimicrobial resistance genes, including tools that allow simulations for the selection of effective control options. Applying participatory techniques facilitates the conduct of risk analysis in low- and middle-income countries. In internationally established frameworks, risk assessment is the first step towards elimination of important infectious diseases in endemic countries and it is an important contributor to the reduction of disease risks. Quantitative and qualitative socio-economic and behavioural studies have been developed to design risk management options that are acceptable and sustainable for actors throughout value chains.

L'évaluation des risques pour la santé animale constitue l'une des tâches centrales des Services vétérinaires. L'Organisation mondiale de la santé animale et la Commission du Codex Alimentarius ont élaboré à cet effet des protocoles d'évaluation des risques désormais bien établis. Ces protocoles recouvrent les stratégies de gestion du risque qui soient à la fois acceptables et applicables durablement par les acteurs intervenant à chaque point des chaînes de valeur.

La determinación del riesgo zoosanitario es uno de los principales cometidos de los Servicios Veterinarios. Ya existen arraigados protocolos de determinación del riesgo, elaborados por la Organización Mundial de Sanidad Animal y la Comisión del Codex Alimentarius, que abarcan desde los animales terrestres y acuáticos hasta las enfermedades infecciosas zoonóticas, pasando por las cuestiones ambientales y de inocuidad de los alimentos, y tienen en cuenta las conexiones existentes entre todos estos factores. Se ha dedicado un gran esfuerzo a dar con métodos para calcular la probabilidad y las consecuencias de que una enfermedad infecciosa penetre en un país exento de ella a resultas del comercio, ya sea legal o ilegal, o del desplazamiento de.

Estimation of circulating bovine leukemia virus levels using conventional blood cell counts.

Bovine leukemia virus (BLV) is widely prevalent in Japanese dairy farms. To control BLV infections in Japan, segregating or managing cows according to their proviral load (PVL) is a rational strategy. This study was conducted to establish a quantitative procedure for estimating blood PVL per microliter using a statistical model to offer a cost-effective alternative to the conventional quantitative real-time PCR method. In total, 250 Holstein cows infected with BLV were identified from 10 commercial dairy farms. Information on age was collected and blood samples were tested for white blood cell and lymphocyte counts and PVL using PCR. Generalized linear models with quasi-Poisson errors were used to estimate PVL by selecting age, logarithm of lymphocyte count, and their interaction term as explanatory variables. To evaluate the model, blood samples of 92 BLV-infected Holstein cows from 2 other commercial dairy farms were tested, and measured PVL values were compared with estimated PVL values by the model. The logPVL per microliter was modeled by positive associations with log lymphocyte count and age and a negative association with the interaction term. In the evaluation, measured PVL values had a strong correlation with estimated PVL values (Spearman's ρ = 0.87). In conclusion, our model provides a cost-effective and more rapid alternative to the conventional method to facilitate test and segregation or management of BLV-suspected cows.

The risk of rabies spread in Japan: a mathematical modelling assessment.

Rabies was eliminated from Japan in 1957. In the 60 years since elimination, vaccination coverage has declined and dog ownership habits have changed. The purpose of this study was to assess the current risk of rabies spread in Japan. A spatially explicit transmission model was developed at the 1 km2 grid scale for Hokkaido and Ibaraki Prefectures. Parameters associated with dog movement and bite injuries were estimated using historical records from Japan, and were used with previously published epidemiological parameters. The final epidemic size, efficacy of rabies contingency plans and the influence of dog owner responses to incursions were assessed by the model. Average outbreak sizes for dog rabies were 3.1 and 4.7 dogs in Hokkaido and Ibaraki Prefectures, respectively. Average number of bite injury cases were 4.4 and 6.7 persons in Hokkaido and Ibaraki Prefectures, respectively. Discontinuation of mandatory vaccination increased outbreak sizes in these prefectures. Sensitivity analyses showed that higher chance of unintentional release of rabid dogs by their owners (from 0.5 to 0.9 probability) increased outbreak size twofolds. Our model outputs suggested that at present, incursions of rabies into Japan are very unlikely to cause large outbreaks. Critically, the reaction of dog owners to their dogs developing rabies considerably impacts the course of outbreaks. Contingency measures should therefore include sensitisation of dog owners.

Inhibiting NADPH oxidase protects against long-term memory impairment induced by neonatal sevoflurane exposure in mice.

BACKGROUND: Neonatal exposure to anaesthetics such as sevoflurane has been reported to result in behavioural deficits in rodents. However, while oxidative injury is thought to play an underlying pathological role, the mechanisms of neurotoxicity remain unclear. In the present study, we investigated whether the NADPH oxidase inhibitor apocynin protects against long-term memory impairment produced by neonatal sevoflurane exposure in mice. METHODS: Postnatal day six mice were divided into four groups; (1) non-anaesthesia, (2) intraperitoneal apocynin (50 mg kg(-1)) treatment, (3) 3% sevoflurane exposure for 6 h, and (4) apocynin treatment combined with sevoflurane exposure. Superoxide concentrations and NADPH oxidase expression in the brain were determined using dihydroethidium fluorescence and immunoblotting, respectively. Cleaved caspase-3 immunoblotting was used for the detection of apoptosis, and cytochrome c immunoblotting was performed to evaluate mitochondrial function. Long-term cognitive impairment was evaluated using the fear conditioning test in adulthood. RESULTS: Sevoflurane exposure increased concentrations of superoxide (109%) and the NADPH oxidase subunit p22phox (39%) in the brain, and apocynin abolished these increases. Neonatal sevoflurane exposure caused learning deficits in adulthood. Apocynin also maintained long-term memory function in mice given neonatal sevoflurane exposure, and it reduced apoptosis and decreased cytochrome c concentrations in the brains of these mice. CONCLUSIONS: Apocynin reduces neuronal apoptosis and protects against long-term memory impairment in mice, neonatally exposed to sevoflurane by reducing superoxide concentrations. These findings suggest that NADPH oxidase inhibitors may protect against cognitive dysfunction resulting from neonatal anaesthesia.

Fluency-dependent cortical activation associated with speech production and comprehension in second language learners.

This functional magnetic resonance imaging (fMRI) study investigated the brain regions underlying language task performance in adult second language (L2) learners. Specifically, we identified brain regions where the level of activation was associated with L2 fluency levels. Thirty Japanese-speaking adults participated in the study. All participants were L2 learners of English and had achieved varying levels of fluency, as determined by a standardized L2 English proficiency test, the Versant English Test (Pearson Education Inc., 2011). When participants performed the oral sentence building task from the production tasks administered, the dorsal part of the left inferior frontal gyrus (dIFG) showed activation patterns that differed depending on the L2 fluency levels: The more fluent the participants were, the more dIFG activation decreased. This decreased activation of the dIFG might reflect the increased automaticity of a syntactic building process. In contrast, when participants performed an oral story comprehension task, the left posterior superior temporal gyrus (pSTG) showed increased activation with higher fluency levels. This suggests that the learners with higher L2 fluency were actively engaged in post-syntactic integration processing supported by the left pSTG. These data imply that L2 fluency predicts neural resource allocation during language comprehension tasks as well as in production tasks. This study sheds light on the neural underpinnings of L2 learning by identifying the brain regions recruited during different language tasks across different modalities (production vs. comprehension).

Mental and physical distress of field veterinarians during and soon after the 2010 foot and mouth disease outbreak in Miyazaki, Japan.

An outbreak of foot and mouth disease occurred in Miyazaki, Japan, in April 2010, and nearly 290,000 animals were culled to control the disease. This study was conducted to demonstrate the causes and intensity of mental distress felt by the field veterinarians participating in the control programme. A focus group discussion was conducted with ten veterinarians to understand their distress during the outbreak, and a questionnaire to quantify the degree of distress experienced each week was administered to 16 veterinarians. A detailed questionnaire was separately administered to 70 veterinarians six months after the outbreak was controlled, to assess mental distress status and to identify the risk factors for serious mental illness (SMI) using the six-item Kessler scale (K6). Overall, mental distress (mean 3.1) was significantly greater than physical distress (mean 1.9, p < 0.001). The risk factors for mental distress were categorised into three groups: culling, communication with farmers, and gender; each category was qualitatively described. Only two respondents (2.9%) had high K6 scores suggesting SMI. In the final generalised linear models with quasi-Poisson errors, the riskfactorsfor SMI that remained were: disinfecting vehicles (p = 0.01), distress (p <0.001), and increased alcohol consumption (p = 0.057), and a protective factor: participation in culling (p = 0.07), which suggested healthy worker bias. Sensitive individuals had been allocated to non-culling activities during disease control. In conclusion, human resource management was adequate during the outbreak from a public-health perspective. However, monitoring delayed symptoms of post-traumatic stress disorder is recommended.

Associations of antimicrobial use with antimicrobial resistance in Campylobacter coli from grow-finish pigs in Japan.

To determine associations between antimicrobial use and antimicrobial resistance in Campylobacter coli, 155 isolates were obtained from the feces of apparently healthy grow-finish pigs in Japan. In addition, data on the use of antibiotics collected through the national antimicrobial resistance monitoring system in Japan were used for the analysis. Logistic regression was used to identify risk factors to antimicrobial resistance in C. coli in pigs for the following antimicrobials: ampicillin, dihydrostreptomycin, erythromycin, oxytetracycline, chloramphenicol, and enrofloxacin. The data suggested the involvement of several different mechanisms of resistance selection. The statistical relationships were suggestive of co-selection; use of macrolides was associated with enrofloxacin resistance (OR=2.94; CI(95%): 0.997, 8.68) and use of tetracyclines was associated with chloramphenicol resistance (OR=2.37; CI(95%): 1.08, 5.19). The statistical relationships were suggestive of cross-resistance: use of macrolides was associated with erythromycin resistance (OR=9.36; CI(95%): 2.96, 29.62) and the use of phenicols was associated with chloramphenicol resistance (OR=11.83; CI(95%): 1.41, 99.44). These data showed that the use of antimicrobials in pigs selects for resistance in C. coli within and between classes of antimicrobials.

Effects of climatic elements on Campylobacter-contaminated chicken products in Japan.

Japanese weather data for areas that produced Campylobacter spp.-positive chicken products were compared with those for areas producing negative samples. Regarding samples produced during the period of rising temperature (spring and summer), the mean weekly air temperatures for Campylobacter-positive samples were higher than those for negative samples for the period of the week in which the samples were purchased (18.7 °C vs. 13.1 °C, P = 0.006) to a 12-week lag (12 weeks before purchasing samples; 7.9 °C vs. 3.4 °C, P = 0.009). Significant differences in weekly mean minimum humidity and sunshine duration per day were also observed for 1- and 2-week lag periods. We postulated that the high air temperature, high humidity and short duration of sunshine for the chicken-rearing period increased Campylobacter colonization in chickens during the period of rising temperature. Consequently, the number of Campylobacter-contaminated chicken products on the market in Japan may fluctuate because of the climatic conditions to which reared chickens are exposed.

Alendronate is more effective than elcatonin in improving pain and quality of life in postmenopausal women with osteoporosis.

UNLABELLED: A randomized controlled trial was performed to compare the short-term effects of alendronate (ALN) and ECT on pain and quality of life (QOL) in postmenopausal women with osteoporosis. Back pain and QOL [Short-Form Health Survey (SF-8)] significantly improved at 1, 3, and 6 months in both groups, with greater improvements in the ALN group than in the ECT group. These results suggested that ALN reduced back pain and improved QOL more markedly than ECT in postmenopausal osteoporotic women with back pain. INTRODUCTION: Intramuscular ECT is known to reduce pain via the central nervous system. A multicenter randomized controlled trial was performed to compare the short-term effects of ALN and ECT on pain and QOL in postmenopausal women with osteoporosis. METHODS: One hundred and 94 postmenopausal osteoporotic women with back pain (mean age 79.8 years, range 60-96 years) were randomly divided into two groups: the ALN group (35 mg weekly) and the ECT group (intramuscular 20 units a week). The duration of the study was 6 months. The trial was completed in 97 (100%) women of the ALN group and 96 (99.0%) women of the ECT group. Urinary levels of cross-linked N-terminal telopeptide of type I collagen (NTX), serum alkaline phosphatase (ALP), face scale score (FSS, back pain), and SF-8 (QOL) were monitored. RESULTS: Urinary NTX levels significantly decreased at 3 months in the ALN group, but not in the ECT group. Serum ALP levels significantly decreased at 6 months in the both groups, with a greater reduction in the ALN group. The FSS and SF-8 significantly improved at 1, 3, and 6 months in both groups, with greater improvements in the ALN group than in the ECT group. CONCLUSIONS: ALN suppressed bone turnover, reduced back pain, and improved QOL more markedly than ECT in postmenopausal osteoporotic women with back pain.

Population-dynamics focussed rapid rural mapping and characterisation of the peri-urban interface of Kampala, Uganda.

In developing countries, cities are rapidly expanding and urban and peri-urban agriculture (UPA) has an important role in feeding these growing urban populations; however such agriculture also carries public health risks such as zoonotic disease transmission. It is important to assess the role of UPA in food security and public health risks to make evidence-based decisions on policies. Describing and mapping the peri-urban interface (PUI) are the essential first steps for such an assessment. Kampala, the capital city of Uganda is a rapidly expanding city where the PUI has not previously been mapped or properly described. In this paper we provide a spatial representation of the entire PUI of Kampala economic zone and determine the socio-economic factors related with peri-urbanicity using a population-dynamics focussed rapid rural mapping. This fills a technical gap of rapid rural mapping and offers a simple and rapid methodology for describing the PUI which can be applied in any city in developing countries for wide range of studies.

Serum lipoprotein(a) dynamics before/after menopause and long-term effects of hormone replacement therapy on lipoprotein(a) levels in middle-aged and older Japanese women.

AIM: To assess lipoprotein(a) Lp(a) dynamics before and after menopause and to examine long-term changes during hormone replacement therapy (HRT) in middle-aged and older Japanese women. METHODS: (1) Serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and Lp(a) concentrations of 526 patients were compared. The patients were divided into 3 groups on the basis of menopausal status (premenopause, perimenopause, postmenopause). (2) Serum markers of lipid metabolism were measured at baseline and at 6-month intervals in 161 postmenopausal women who continuously received HRT with conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) for 4 years. (3) Changes in serum concentrations of markers were compared among 120 women with hypercholesterolemia who were randomly assigned to receive HRT (CEE plus MPA, or transdermal estradiol plus MPA) or pravastatin. RESULTS: (1) Lp(a) concentrations were significantly higher in the postmenopausal women than in the premenopausal or perimenopausal women. (2) The mean Lp(a) concentration after 6 months of HRT decreased by about 19%, and similar levels were maintained for 4 years (3). The mean Lp(a) concentration after 6 months of HRT decreased by 19.9% in the CEE plus MPA group, but did not change significantly in the transdermal estradiol plus MPA group or the pravastatin group. CONCLUSION: Our results suggest that HRT with CEE plus MPA is useful for the management of elevated serum Lp(a) concentrations in middle-aged and older women. However, follow-up studies are needed to determine whether this finding is related to the future prevention of coronary heart disease events.

Late preconditioning with isoflurane in cultured rat cortical neurones.

BACKGROUND: We tested the hypothesis that isoflurane induces late preconditioning in cultured rat cortical neurones and preconditioning elicits changes in expression of Kir6.2 (the ion-conducting subunit of the metabolically responsive ATP-sensitive potassium (K(ATP)) channel) and EAAC1 (neuronal glutamate transporter). METHODS: Primary cultures of rat cortical neurones were exposed to non-lethal oxygen-glucose deprivation (OGD), i.e. ischaemic preconditioning, for 30 min, 100 microM of diazoxide, a potent opener of the mitochondrial K(ATP) (mitoK(ATP)) channels, for 60 min or 1.4% isoflurane for 3 h. Lethal OGD was performed for 120 min 24 h after preconditioning stimuli. Neuronal injury was assessed by measurement of lactate dehydrogenase (LDH) efflux into the medium 24 h after lethal OGD, and neural viability was determined by proliferation assay. Gene and protein expression was confirmed by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) and western blot analysis 24 h after preconditioning stimuli. RESULTS: All preconditioning stimuli resulted in a significant decrease in LDH activity and maintained neuronal viability. These effects were abolished by 5-hydroxydecanoate, a selective inhibitor of the mitoK(ATP) channel. Quantitative RT-PCR and Western blot analysis demonstrated that there was no significant difference between Kir6.2 mRNA and protein levels. All preconditioning stimuli resulted in > or =2-fold increases in EAAC1 mRNA and protein compared with control. CONCLUSIONS: Isoflurane induced late preconditioning in cultured rat cortical neurones. Ischaemic and pharmacological preconditioning with diazoxide and isoflurane induced ischaemic tolerance in the cultured neurones via mitoK(ATP) channels without an increase in Kir6.2 expression, and induced upregulation of EAAC1 expression.

Unilateral recurrent laryngeal nerve neuropraxia following placement of a ProSeal laryngeal mask airway in a patient with CREST syndrome.

We report a severe unilateral recurrent laryngeal nerve neuropraxia following use of the ProSeal laryngeal mask airway (PLMA) in a 71-year-old female patient with CREST syndrome. She required amputation of the 5th phalanx of foot because of gangrene due to Raynaud's syndrome. Anesthesia was induced with propofol, and a size 3 PLMA was inserted. Anesthesia was maintained with sevoflurane and nitrous oxide for 2 h and the operation was performed uneventfully. On removal of PLMA, the cuff volume was measured to 40 ml. The patient did not complain of respiratory discomfort shortly after PLMA removal. However, the next day she developed dysphagia and hoarseness. Laryngoscopic examination revealed unilateral vocal cord paralysis. Cricothyrotomy was required because of suspected silent aspiration pneumonia. The pharyngolaryngeal complications improved with a mobile vocal cord but slight hoarseness after 2 months. We considered the patient's CREST syndrome with a potential of tissue ischemia, and the high intracuff pressure of the PLMA due to nitrous oxide influx, to be the cause of severe recurrent laryngeal nerve neuropraxia in this case.

Effect of prostaglandin E1 on inflammatory responses and gas exchange in patients undergoing surgery for oesophageal cancer.

BACKGROUND: Oesophageal surgery causes morbidity and mortality from respiratory complications. We tested the possibility that prostaglandin E1 (PGE1) could reduce inflammatory cytokine responses and improve gas exchange after oesophagectomy. METHODS: We randomized 14 patients into two groups. One group received PGE1 20 ng kg(-1) min(-1) i.v. during anaesthesia (PGE1 group) and the other group did not (control group). Anaesthesia was maintained with sevoflurane and epidural anaesthesia. During oesophagectomy, ventilation of one lung was carried out with a double-lumen bronchial tube. The patients were extubated on or after the first postoperative day. Blood samples were taken at induction of anaesthesia, at the end of thoracotomy, at the end of the operation, 2 h after surgery and on the first day after surgery. RESULTS: The groups were similar for ASA physical status, age, FEV1%, operation time, duration of thoracotomy, intraoperative fluid volume and blood loss. The arterial blood gas and arterial pressure during surgery were also similar in the PGE1 and control groups. However, the PaO2/FiO2 ratio on the first day after surgery was significantly greater in the PGE1 group compared with the control group. Serum concentrations of IL-6 and IL-8 increased after surgery in both groups. IL-6 was significantly less in the PGE1 group at the end of the operation and 2 h after the operation. CONCLUSIONS: Intraoperative PGE1 reduced IL-6 production in patients undergoing oesophagectomy and oxygenation was better in the postoperative period.

Acute myelogenous leukemia in a donor after granulocyte colony-stimulating factor-primed peripheral blood stem cell harvest.

This article describes the first case of acute myeloid leukemia (AML) in a healthy donor at 14 months after granulocyte colony-stimulating factor (G-CSF)-primed peripheral blood stem cell (PBSC) harvest. In September 2001, a healthy 61-year-old female was given G-CSF prior to PBSC harvest for her brother with multiple myeloma. In spite of successful engraftment, the recipient died from a disease relapse. In November 2002, the donor, admitted with high fever and leukocytosis with 98.5% blastoid cells, was diagnosed as having AML (M1). Her leukemia cells were positive for CD13, CD33, and G-CSF receptor without chromosomal abnormality and responded to G-CSF in vitro. During chemotherapy, she died of progressive pneumonia. If our case is truly the first, the incidence of leukemia in donors may not be higher than that of naturally occurring leukemia. However, efforts towards an international long-term study, or at least to report every case similar to ours, would be required to be conclusive.