Pandemic influenza virus surveillance, Izu-Oshima Island, Japan.

A population-based influenza surveillance study (using PCR virus subtyping) on Izu-Oshima Island, Japan, found that the cumulative incidence of influenza A(H1N1)pdm09 virus infections 2 seasons after the pandemic was highest for those 10-14 years of age (43.1%). No postpandemic A(H1N1)pdm09 case-patients had been infected with A(H1N1)pdm09 virus during the pandemic season.

Improving the Accuracy of Diagnosis for Multiple-System Atrophy Using Deep Learning-Based Method.

Multiple-system atrophy (MSA) is primarily an autonomic disorder with parkinsonism or cerebellar ataxia. Clinical diagnosis of MSA at an early stage is challenging because the symptoms change over the course of the disease. Recently, various artificial intelligence-based programs have been developed to improve the diagnostic accuracy of neurodegenerative diseases, but most are limited to the evaluation of diagnostic imaging. In this study, we examined the validity of diagnosis of MSA using a pointwise linear model (deep learning-based method). The goal of the study was to identify features associated with disease differentiation that were found to be important in deep learning. A total of 3377 registered MSA cases from FY2004 to FY2008 were used to train the model. The diagnostic probabilities of SND (striatonigral degeneration), SDS (Shy-Drager syndrome), and OPCA (olivopontocerebellar atrophy) were estimated to be 0.852 ± 0.107, 0.650 ± 0.235, and 0.858 ± 0.270, respectively. In the pointwise linear model used to identify and visualize features involved in individual subtypes, autonomic dysfunction was found to be a more prominent component of SDS compared to SND and OPCA. Similarly, respiratory failure was identified as a characteristic of SDS, dysphagia was identified as a characteristic of SND, and brain-stem atrophy was identified as a characteristic of OPCA.

Spatial statistical analysis of regional disparities in suicide among policy units in Japan: Using the Bayesian hierarchical model.

Suicide prevention is a crucial policy issue in Japan to be addressed nationally. Nevertheless, if there are regional differences in suicide, even in adjacent sub-regions, measures may need to be taken at the sub-regional level. Previous studies have not compared regional differences in suicide based on the size of policy units, such as prefectures, secondary medical areas, and municipalities. This study used the number of suicides from open data for 10 years from 2009 to 2018 to obtain shrinkage estimates of the standardized mortality ratio (SMR) using the Bayesian hierarchical model. We visualized and compared the regional disparities in suicide for each policy unit. For each gender and policy unit, adjacent regions had similar clusters of SMRs and positive spatial autocorrelation of global Moran's I (p < 0.001 for each). Comparisons between each policy unit showed that even if the SMR was low for the prefectural units, there were regions with high SMRs in municipalities and secondary medical areas, and vice versa. It was found that assessing suicide solely on a prefecture-by-prefecture basis may overlook regional disparities in suicide. This research emphasizes the need to establish suicide indicators at the secondary medical or municipal level and execute individual suicide prevention interventions in neighboring communities. Prefectures can also play a role in developing collaborative cooperation between neighboring regions by acting as actors.

[Mobitz type II block during one-lung ventilation].

We present a case of Mobitz type II atrioventricular block during one-lung ventilation in a 74-year-old man with lung cancer under anesthesia. Premedication with atropine 0.5 mg and midazolam 2 mg intramuscularly were given 30 min before entering the operating room. Before anesthesia, his heart rate was 72 beats x min(-1) with normal sinus rhythm and blood pressure was 120/70 mmHg. An epidural catheter was placed at T4-5 interspace and 1.5% mepivacaine was infused (7 ml bolus and 5 ml x hr(-1) thereafter). After placing external pacemaker paddle, general anesthesia was induced with propofol 3 microg x ml(-1) and fentanyl 0.1 mg, and tracheal intubation was facilitated with vecuronium 6 mg. Anesthesia was maintained with propofol and fentanyl. After initiating one-lung ventilation, the patient developed Mobitz type II block with a heart rate of 30 beats x min(-1). External pacing was started (rate: 80 beats x min(-1), output: 150 mA). However, body movement associated with external pacing interrupted operative procedure, and blood pressure was not restored effectively. Therefore, external pacing was stopped and atropine and dopamine were administered. Mobitz type II block continued, but blood pressure and heart rate were maintained during the operation. Cardiac rhythm was restored the next morning without any treatment. Propofol, fentanyl, and thoracic epidural anesthesia could caused Mobitz type II block. External pacing should not be used for thoracic surgeries.

[Grand mal convulsion after an interscalene block with ropivacaine].

We report a case of grand mal convulsion due to inadvertent intravascular injection of ropivacaine. An 83-year-old woman was scheduled for upper limb surgery. The interscalene block was performed with neurostimulator and 0.5% ropivacaine 30 ml was injected after careful negative aspiration. Approximately 3 min after the injection, the patient lost consciousness and developed generalized convulsion, which was repeated 7 times. The seizures stopped after administration of diazepam 10 mg and thiamylal 250 mg i.v. Trachea was intubated and lungs were mechanically ventilated. During the seizure, arterial blood pressure increased from 180/110 mmHg to 190/120 mmHg and heart rate changed from 90 beats x min(-1) to 88 beats x min(-1). Ventricular premature beats were observed sporadically but stopped spontaneously. After the episode, the operation was performed under general anesthesia (nitrous oxide 50% and sevoflurane 1.5-2% in oxygen 50%). The patient recovered uneventfully after the operation. Although careful aspiration was done before the injection of ropivacaine, inadvertent intravenous injection could have occurred during the administration. Intermittent aspiration should be indispensable during the administration, because a large dose of local anesthetic is necessary for interscalene block. In this case, the only cardiovascular manifestation was ventricular premature beats indicating that ropivacaine has less cardiotoxicity.

[Combined spinal-epidural anesthesia for abdominal surgery in a patient with chronic obstructive pulmonary disease].

A 69-year-old man (150 cm, 57 kg)who had been diagnosed as having COPD, was admitted to our hospital because of abdominal pain and drowsiness. He was diagnosed as CO2 narcosis and perforation of appendix. When he recovered from CO2 narcosis, he was scheduled for elective ilectomy. Because his pulmonary function was impaired, combined spinal and epidural anesthesia was selected. With the patient in the right lateral position, an epidural catheter was inserted at T12-L1 interspace, and spinal anesthesia was performed at L3-4 interspace with 0.5% isobaric bupivacaine 4 ml. When the patient was positioned laterally, SpO2 decreased from 82% to 77%. After completion of injection, the patient was returned to the supine position, and SpO2 immediately recovered. Spinal block level was not satisfactory, and fentanyl 0.1 mg and 2% mepivacaine 4 ml were administered through epidural catheter to achieve a T4 level of block. Because severe intraperitoneal inflammation was observed, ilectomy was changed to drainage of intra-abdominal abscess. The patient did not complain of dyspnea, pain, or nausea, intraoperatively. SpO2 was 85-93% with O2 inhalation at 1l x min(-1) during the operation. Post-operative course was uneventful. Although lateral position is popular in performing epidural and spinal anesthesia, sitting position could be suitable for this patient. Decrease in SpO2 may have occurred due to ventilation-perfusion mismatch. Since combined spinal and epidural anesthesia can preserve spontaneous respiration and it is possible to titrate anesthetic level, it would be preferable for abdominal surgery in patients with COPD.

Expression analysis for inverted effects of serotonin transporter inactivation.

Inactivation of serotonin transporter (HTT) by pharmacologically in the neonate or genetically increases risk for depression in adulthood, whereas pharmacological inhibition of HTT ameliorates symptoms in depressed patients. The differing role of HTT function during early development and in adult brain plasticity in causing or reversing depression remains an unexplained paradox. To address this we profiled the gene expression of adult Htt knockout (Htt KO) mice and HTT inhibitor-treated mice. Inverted profile changes between the two experimental conditions were seen in 30 genes. Consistent results of the upstream regulatory element search and the co-localization search of these genes indicated that the regulation may be executed by Pax5, Pax7 and Gata3, known to be involved in the survival, proliferation, and migration of serotonergic neurons in the developing brain, and these factors are supposed to keep functioning to regulate downstream genes related to serotonin system in the adult brain.

Cerebral pial vascular changes under propofol or sevoflurane anesthesia during global cerebral ischemia and reperfusion in rabbits.

BACKGROUND: Propofol and sevoflurane are commonly used anesthetics for neurosurgery. The aim of the study was to compare the effects of propofol with sevoflurane on cerebral pial arteriolar and venular diameters during global brain ischemia and reperfusion. METHODS: Japanese white rabbits were anesthetized with propofol (n=11), sevoflurane (n=9), or the combination of sevoflurane and intralipid (n=10). Global brain ischemia was induced by clamping the brachiocephalic, left common carotid, and left subclavian arteries for 15 minutes. Pial microcirculation was observed microscopically through closed cranial windows and measured using a digital-video analyzer. Measurements were recorded before clamping and afterward for 120 minutes. RESULTS: Plasma glucose and mean arterial blood pressure increased significantly during ischemia in the propofol-anesthetized rabbits. During ischemia, pial arteriolar and venular diameters decreased significantly in all groups. After unclamping, large and small, pial arteriolar and venular diameters increased temporarily and significant dilation was observed in both sevoflurane groups. From 10 minutes after unclamping until the end of the study, large and small arterioles returned to baseline diameters in the sevoflurane groups, but decreased significantly by 10% to 20% in the propofol rabbits. Ischemia-induced adverse effects such as pulmonary edema and acute brain swelling were observed primarily in propofol-anesthetized rabbits. CONCLUSION: Propofol and sevoflurane acted differently on pial vessels during reperfusion after ischemic insult. Pial arterioles and venules did not dilate immediately after reperfusion, and subsequently constricted throughout the reperfusion period in propofol-anesthetized rabbits. In contrast, pial arterioles and venules dilated temporarily and returned to baseline in sevoflurane-anesthetized rabbits.

The direct effects of propofol on pial microvessels in rabbits.

Propofol is widely used for neurosurgical anesthesia; however, its effects on the pial microvasculature are unknown. We therefore evaluated the direct effects of propofol on pial microvessels in rabbits. Pial microcirculation was visualized using a closed cranial window technique in 20 Japanese white rabbits. In the first experiment (n=14), after baseline hemodynamic measurements, the cranial window was superfused with 5 increasing concentrations of propofol (10, 10, 10, 10, 10 mol/L; n=8) or intralipid (at comparable concentrations; n=6) dissolved in artificial cerebrospinal fluid for 7 minutes each. A typical anesthetic concentration of 5 microg/mL corresponds to 10 mol/L. In the second experiment (n=6), phenylephrine 10 mol/L and nitroglycerin 10 mol/L were applied topically for 7 minutes under pentobarbital anesthesia. In the third experiment (n=3), electroencephalogram and bispectral index were measured under pentobarbital anesthesia. Diameters of selected pial arterioles and venules were visualized with a microscope-video capture unit combination and subsequently measured with a digital video analyzer. Topical application of propofol at 10, 10, 10, or 10 mol/L did not alter the diameters of the pial microvessels; however, at 10 mol/L propofol induced dilation in large and small arterioles, along with venular dilation. Intralipid alone did not have any significant effect on vessel diameters. Phenylephrine and nitroglycerin produced pial arteriolar and venular constriction and dilation, respectively. Phenylephrine constricted and nitroglycerin dilated pial arterioles and venules. Pentobarbital did not produce either burst suppression or an isoelectric electroencephalogram. The results confirm our hypothesis: clinically relevant concentrations of propofol, that is, approximately 10 mol/L, do not dilate pial arterioles or venules.

Expression analysis of genes responsible for serotonin signaling in the brain.

To thoroughly understand the function and regulation of neurotransmitter systems in the brain, as well as the underlying disease mechanisms, it is important to comprehensively analyze the expression patterns of genes participating in such systems. Using functional annotated cDNA clones (FANTOM), we examined the gene expression patterns of the serotonin neurotransmitter system, which is involved in psychiatric diseases such as depression. We chose 24 gene products and visualized their endogenous localizations using in situ hybridization (ISH). We were able to fine-tune an automated ISH method to obtain high-resolution cell-based figures within 24 h. We also measured the amounts of mRNAs with quantitative RT-PCR. The outline of the in situ gene expression pattern viewed under low magnification agreed with the results of the RT-PCR. In the high-resolution view obtained with ISH, we could document novel localizations of the several genes critically related to serotonin activity.