Interchanges and movements of humpback whales in Japanese waters: Okinawa, Ogasawara, Amami, and Hokkaido, using an automated matching system.

Humpback whales in the western North Pacific are considered endangered due to their small population size and lack of information. Although previous studies have reported interchanges between regions within a population, the relationship between the geographic regions of a population in Japan is poorly understood. Using 3,532 fluke photo IDs of unique individuals obtained from four areas in Japan: Hokkaido, six IDs (2009-2019); Ogasawara, 1,477 IDs, from two organizations (1) Everlasting nature of Asia (1987-2020) and (2) Ogasawara Whale Watching Association, (1990-2020); Amami, 373 IDs (1992-1994, 2005-2016); Okinawa, 1,676 IDs (1990-2018), interchanges were analyzed. The ID matchings were conducted using an automated system with an 80.9% matching accuracy. Interchange and within-region return indices were also calculated. As a result, number of matches and interchange indices follow locations, Hokkaido-Okinawa (3, 0.31), Amami-Ogasawara (36, 0.06), Amami-Okinawa (222, 0.37), and Okinawa-Ogasawara (225, 0.08), respectively. Interchange indices among Japanese areas were much higher than the indices between Ogasawara/Okinawa and Hawaii (0.01) and Mexico (0.00) reported in previous studies, indicating that the Japanese regions are utilized by the same population. At the same time, the frequency of interchanges among the three breeding areas vary, and the high within-region return indices in respective breeding areas suggest the site fidelity of the whales in each area at some level. These results indicate the existence of several groups within the population which are possibly be divided into at least two groups based on geographical features: one tend to utilize Ogasawara and the Mariana Archipelago; the other utilize Amami, Okinawa, and the Philippines, migrating along the Ryukyu and Philippine Trench. The matching results also suggest that Hokkaido is possibly be utilized as a corridor between northern feeding areas and southern breeding areas at least by individuals migrating to Okinawa area.

aMAP score prediction of hepatocellular carcinoma occurrence and incidence-free rate after a sustained virologic response in chronic hepatitis C.

AIMS: Hepatocellular carcinoma (HCC) can still occur in hepatitis C virus (HCV) patients who have achieved a sustained virologic response (SVR), which remains an important clinical issue in the direct-acting antivirals era. The current study investigated the clinical utility of the aMAP score (consisting of age, male, albumin-bilirubin, and platelets) for predicting HCC occurrence in HCV patients achieving an SVR by direct-acting antivirals. METHODS: A total of 1113 HCV patients without HCC history, all of whom achieved an SVR, were enrolled for clinical comparisons. RESULTS: Hepatocellular carcinoma was recorded in 50 patients during a median follow-up period of 3.7 years. The aMAP score was significantly higher in the HCC occurrence group than in the HCC-free group (53 vs. 47, p < 0.001). According to risk stratification based on aMAP score, the cumulative incidence of HCC occurrence for the low-, medium-, and high-risk groups was 0.14%, 4.49%, and 9.89%, respectively, at 1 year and 1.56%, 6.87%, and 16.17%, respectively, at 3 years (low vs. medium, low vs. high, and medium vs. high: all p < 0.01). Cox proportional hazard analysis confirmed aMAP ≥ 50 (hazard ratio [HR]: 2.78, p = 0.014), age≥ 70 years (HR: 2.41, p = 0.028), ALT ≥ 17 U/L (HR: 2.14, p < 0.001), and AFP ≥ 10 ng/mL (HR: 2.89, p = 0.005) as independent risk factors of HCC occurrence. Interestingly, all but one patient (99.5%) with aMAP less than 40 was HCC-free following an SVR. CONCLUSION: The aMAP score could have clinical utility for predicting HCC occurrence in HCV patients achieving an SVR.

Elevation of a periosteal flap with irrigation of the bone for minor oral surgery reduces the duration of action of infiltration anesthesia.

The aim of this study is to assess the difference in duration of action after infiltration anesthesia when elevation of a periosteal flap (EPF) was accomplished with water or saline irrigation versus nonelevation of a periosteal flap (NEPF). The 57 patients in this study were under conscious sedation. A long treatment time of more than 1 hour was used. Instances where peripheral nerve block or opioids were administered and infiltration anesthesia over 2 fields were excluded before the study. Patients were included in either an EPF group (n = 29) or an NEPF group (n = 28). Statistically significant differences were detected in the initial dose of anesthetic (EPF: 4.3 +/- 1.4 mL, NEPF: 1.8 +/- 0.9 mL), the time until initial supplemental anesthesia (EPF: 38 +/- 26 minutes, NEPF: 65 +/- 27 minutes), and the frequency of anesthesia administration (EPF: 2.5 +/- 1.2 times, NEPF: 1.3 +/- 0.7 times). These results suggest that the duration of anesthesia action in EPF decreases to half compared with NEPF, even if the anesthetic was infiltrated in double the amount. Although supplemental anesthesia is required frequently in EPF, it is not efficacious. We speculated that the residual anesthetics in tissue were washed out by irrigation and hemorrhage and that supplemental anesthesia became ineffective because of leakage from the opened flap. Elevation of a periosteal flap reduces the effect of infiltration anesthetics.

A survey of combined epidural-propofol anesthesia with noninvasive positive pressure ventilation as a minimally invasive anesthetic protocol.

BACKGROUND: Combined epidural-propofol anesthesia with use of noninvasive positive pressure ventilation (NPPV) via the nose has been used routinely in our operating theaters. The purpose of this report was to present a survey of this anesthesia. MATERIAL/METHODS: 265 adult patients undergoing lower extremity or lower abdominal gynecological surgery during 1999 were examined. After epidural anesthesia, patients were given propofol infusion. NPPV was applied with an inspiratory/expiratory positive airway pressure of 14/8 cm H2O, a respiratory rate of 10 breaths/min, and oxygen delivery into the nasal mask resulting in a concentration of 40% or an inspiratory oxygen fraction of 0.35. Epidural anesthesia was continuously applied after surgery for postoperative pain relief. Various data related to the surgery or anesthesia were evaluated both on the day of surgery and on postoperative day 1. RESULTS: Of 265 patients, 3 patients could not receive our anesthetic protocol. Of the residual 262 patients, no patients showed serious clinical problems during anesthesia, excluding for hypotension, which was observed in 31-56% patients and was treated with ephedrine injection. Patients informed us of good analgesia (98%), feelings (78%) and dreams (47%). On postoperative day 1, postoperative analgesia and mood conditions were satisfactory. There were no patients complaining of intraoperative awareness. CONCLUSIONS: The principle of our anesthesia consists of epidural anesthesia, sole propofol infusion and noninvasive airway management, so as to provide an anesthetic technique with minimal invasiveness. Although airway maintenance by NPPV is not always suitable, our anesthesia is practicable for certain kinds of operations.