Functional outcomes of rehabilitation in patients with subacute stroke on haemodialysis.

OBJECTIVE: To examine functional outcomes in patients with subacute stroke who are on haemodialysis. DESIGN: Observational cohort study. SUBJECTS: Patients with stroke who were admitted to rehabilitation wards between April 2011 and August 2016 were retrospectively enrolled. METHODS: Data on the Functional Independence Measure (FIM) and discharge destination were collected from medical records as outcomes. Outcomes were compared for patients who received haemodialysis and those who did not. Multiple regression analyses were carried out to explore the impact of haemodialysis on functional outcomes. RESULTS: Among 859 patients, 34 (mean age 63.6 years (standard deviation (SD) 11.7)) required haemodialysis while staying in rehabilitation wards. One hundred patients not receiving haemodialysis (mean age 70.7 years (SD 13.8) ) were randomly selected as controls. The total FIM score at discharge, FIM gain, FIM efficiency, FIM effectiveness, and discharge destination were not significantly different between the 2 groups (p > 0.05). Multiple regression analysis, adjusted for other confounding factors, found no significant difference in total FIM score between groups at discharge (p = 0.427). CONCLUSION: Dialysis was not an inhibitory factor affecting outcomes during subacute rehabilitation in patients with stroke. Rehabilitation should be considered for patients with subacute stroke requiring haemodialysis, in order to provide every opportunity to achieve adequate functional outcomes.

PCR-based identification of Culex pipiens complex collected in Japan.

The Culex pipiens complex consists of vector mosquitoes that transmit important human pathogens. In this study we established a simplified method to distinguish three members of the Cx. pipiens complex, Cx. p. pallens Coquillet, Cx. p. form molestus Forskal, and Cx. quinquefasciatus Say, collected in Japan. Sequence analysis of the Drosophila Ace-orthologous acetylcholinesterase (Ace) gene (668 to 680 bp) revealed that a single polymorphic region characterizes each species. Based on this region, specific primers that distinguish Cx. p. form molestus (ACEpip2) and Cx. p. pallens (ACEpall2) were newly designed. Polymerase chain reactions were performed with the genomic DNA of Culex mosquitoes as the template, and these primers clearly distinguished two Culex spp. The accuracy of the designed primers was evaluated with 38 colonies of mosquito samples collected from 9 prefectures of Japan. The testing revealed that the distribution of anautogenous Cx. p. pipiens has not been confirmed in Japan. It also revealed that the male of Cx. p. pallens possesses an Ace gene haplotype that is highly similar to the sequence of Cx. quinquefasciatus. This improved method allows the evaluation of vector competence of Cx. p.molestus, which is the suspected vector of West Nile virus.

Insecticide resistance in potential vector mosquitoes for West Nile virus in Japan.

Culex pipiens complex is the significant vector mosquito of West Nile virus. To take stock of the current situation of insecticide susceptibilities and design an ideal mosquito control strategy, we collected Culex pipiens pallens Coquillet, Culex pipiens form molestus Forskal, and Culex quinquefasciatus Say from fields in Japan and conducted bioassays for five larvicides (fenitrothion, temephos, etofenprox, diflubenzuron, and pyriproxyfen) by using a larval dipping method. Among five insecticides tested, obvious reduced susceptibilities were observed for etofenprox, which is the only pyrethroid compound registered as a larvicide in Japan. Twenty-two of 56 colonies exhibited a >10% survival rate at the etofenprox concentration of 5.7 microg/ml, which is a 10 times higher concentration of the working solution. The LC50 of a colony collected from Fukuoka prefecture for etofenprox exceeded 60 microg/ml (resistance ratio >2,307), and this colony also exhibited cross-resistance to other pyrethroids, permethrin (299-fold) and phenothrin (1,200-fold). The insect growth regulators diflubenzuron and pyriproxyfen were found to be sufficiently effective enough to control Culex larvae present, but decreased sensitivities to these insecticides were slightly detected in some colonies of Cx. p. form molestus collected from urban areas. Several etofenprox-resistant colonies of Cx. p. form molestus exhibited simultaneously decreased susceptibilities to other insecticides, including temephos, diflubenzuron, and pyriproxyfen.