The emergence of oseltamivir-resistant pandemic influenza A (H1N1) 2009 virus amongst hospitalised immunocompromised patients in Scotland, November-December, 2009.

To investigate the frequency of oseltamivir resistance in circulating strains of the 2009 influenza A(H1N1) pandemic virus in Scotland, 1,802 samples from 1,608 infected hospitalised patients were screened by the H275Y discriminatory RT-PCR. Among these, we identified 10 patients who developed the H275Y mutation. All of them were immunocompromised and were under treatment or had been treated previously with oseltamivir.

The effect of nitrous oxide on cerebral blood flow velocity in children anaesthetised with sevoflurane.

To determine the effects of nitrous oxide on middle cerebral artery blood flow velocity (CBFV) during sevoflurane anaesthesia in children, CBFV was measured using transcranial Doppler sonography in 16 ASA I or II children. Anaesthesia consisted of 1.0 MAC sevoflurane in 30% oxygen with intermittent positive pressure ventilation maintaining FEco2 at 38 mmHg (5.0 kPa) and a caudal epidural block using 0.25% bupivacaine 1.0 ml.kg-1. The remainder of the inspired gas was varied in one of two sequences either air/nitrous oxide/air or nitrous oxide/air/nitrous oxide. The results showed that CBFV decreased when nitrous oxide was replaced by air (p = 0.03) and returned to its initial value when nitrous oxide was reintroduced. CBFV increased when air was replaced by nitrous oxide (p = 0.04) and returned to its initial value when air was reintroduced. Mean heart rate and blood pressure remained constant. We conclude that nitrous oxide increases cerebral blood flow velocity in healthy children anaesthetised with 1.0 MAC sevoflurane.

The effect of sevoflurane on cerebral blood flow velocity in children.

BACKGROUND: Sevoflurane is a suitable agent for neuroanesthesia in adult patients. In children, cerebrovascular carbon dioxide reactivity is maintained during hypo- and normocapnia under sevoflurane anesthesia. To determine the effects of sevoflurane on middle cerebral artery blood flow velocity (Vmca) in neurologically normal children, Vmca was measured both at different MAC values and at one MAC over a specified time period, using transcranial Doppler sonography. METHODS: Twenty-six healthy children undergoing elective urological surgery were enrolled (16 patients in part I and 10 in part II). In part I of the study anesthesia comprised sevoflurane 0.5, 1.0 and 1.5 MAC in 30% oxygen and a caudal epidural block. Once steady state had been reached at each sevoflurane MAC level, three measurements of Vmca, mean arterial pressure (MAP) and heart rate (HR) were recorded. In part II of the study patients received sevoflurane 1.0 MAC over a 90-min period, with the same variables being recorded at 15-min intervals. RESULTS: Vmca did not vary significantly at 0.5, 1.0 and 1.5 MAC sevoflurane. There was a significant decrease in MAP between 0.5 MAC and 1.0 MAC sevoflurane (P < 0.005) and also between 1.0 MAC and 1.5 MAC (P < 0.01). There was no significant change in Vmca over 90 min at 1.0 MAC sevoflurane. CONCLUSION: Sevoflurane does not significantly affect cerebral blood flow velocity in healthy children at working concentrations.

Cerebrovascular carbon dioxide reactivity in children anaesthetized with sevoflurane.

BACKGROUND: To determine the effects of sevoflurane on cerebrovascular carbon dioxide reactivity (CCO2R), middle cerebral artery blood flow velocity (CBFV) was measured at different levels of PE'CO2 by transcranial Doppler sonography in 16 ASA I or II children, aged 18 months to 7 yr undergoing elective urological surgery. METHODS: Anaesthesia comprised 1.0 MAC sevoflurane and air in 30% oxygen delivered through an Ayre's T piece by intermittent positive-pressure ventilation, and a caudal epidural block with 0.25% bupivacaine 1.0 ml kg(-1) without epinephrine. PE'CO2 was randomly adjusted to 25, 35, 45 and 55 mm Hg (3.3, 4.6, 5.9 and 7.2 kPa) with an exogenous source of CO2, while maintaining ventilation variables constant. RESULTS: CBFV increased as PE'CO2 increased from 25 to 35, and to 45 mm Hg (P<0.001), but did not increase significantly with an increase in PE'CO2 from 45 to 55 mm Hg. Mean heart rate and arterial pressure remained constant. CONCLUSION: CCO2R is preserved in healthy children anaesthetized with 1.0 MAC sevoflurane.

Laparoscopic fundoplication in children: anaesthetic experience of 51 cases.

We report the anaesthetic management and outcomes of our first 51 laparoscopic fundoplications. Case records of the 50 patients (one redo), median age 6 years (5 months to 20 years), were reviewed. Median duration of anaesthesia was 120 (60-300) min. During the procedure, the heart rate and blood pressure increased by more than 20% over baseline in 18% and 12% cases, respectively. Median increase in PECO2 was 1.0 (0.3-2.3) kPa [7.6 (2.3-18) mmHg]. After surgery, all but one of the patients were managed on a normal surgical ward. Postoperative analgesia requirement was oral or rectal analgesics in 89% of patients and ceased within 48 h of surgery in 95% patients. Median time to discharge home from day of operation was 2 (1-9) days. We conclude that laparoscopic fundoplication in children is well tolerated, there is no requirement for routine postoperative high dependency care and analgesic requirements are minimal.

Effects of oxidant air pollutants on western pine beetle (Coleoptera: Scolytidae) populations in southern California.

The attack rates, brood survival, and emergence rates of the western pine beetle, Dendroctonus brevicomis LeConte, and incidence of entomophagus associates, were compared between photochemical oxidant damaged, and apparently healthy, ponderosa pine trees, Pinus ponderosa Dougl. ex Laws in the San Bernardino Forest in Southern California. The results from this study suggest that oxidant-damaged trees attacked by western pine beetle produced about the same total brood with lower initial attacks when compared with healthier trees, whereas the numbers of predators and parasitoids were higher in the healthier trees. This higher productivity trend for western pine beetle is most evident in trees attacked by the first beetle generation. Trees attacked by the second generation, both damaged and healthy, produced much less western pine beetle brood than generation 1 attacked trees, regardless of oxidant damage. The implication of these results is that, in stands with a higher proportion of oxidant damaged trees, a given population of western pine beetle could kill more trees, and increase at a greater rate, than in a stand with a lower proportion of damaged trees.

Partial purification and characterisation of the human skin fibroblast androgen receptor: detection of abnormal receptor complexes in cells from patients with androgen insensitivity syndromes.

After incubation of hGSF with [3H]5 alpha-dihydrotestosterone, 17 beta-hydroxy-7 alpha, 17 alpha-dimethyl-4-estrene-3-one, or 17 beta-hydroxy-17 alpha-methyl-4,9,11-estrien-3-one, androgen-receptor complexes were extracted with 0.5 M KCl and precipitated by 35% ammonium sulphate. Receptor complexes from control hGSF sedimented at approximately 4S on linear 5-20% sucrose gradients. The 4S peak was diminished or absent in cells from androgen insensitive patients exhibiting absent, deficient or unstable binding of androgens in intact hGSF. This procedure may be a useful means of distinguishing quantitative and qualitative defects in androgen binding to receptor, since one cell line found to have normal levels of androgen receptor complexes in whole cell assays had a profile resembling that of receptor negative cells on sucrose gradients. The complexes from one patient with complete androgen insensitivity having normal androgen binding in intact hGSF were indistinguishable from control complexes after sucrose gradient analysis and ADP-Sepharose chromatography. Receptor complexes were eluted from the ADP-Sepharose between 0.5-1.0 M KCl. HPLC-gel filtration of androgen receptor complexes at 22 degrees C revealed two peaks, the larger had a Mr of 60-65K, Stokes radius of 3.16 nm and a frictional ratio between 1.21 and 1.43. The second peak, Mr of 15K, was believed to represent a fragment of the receptor containing the steroid binding domain. On gel filtration at 22 degrees C the complexes from a patient with partial androgen insensitivity, who showed a diminished 4S receptor peak on sucrose gradients, revealed only the small "meroreceptor" fragment, suggesting that the mutation in this individual might render the androgen receptor more susceptible to proteolysis in vitro.