Geriatric nutritional risk index as the prognostic factor in older patients with fragility hip fractures.

This study investigated the long-term survival and incidence of secondary fractures after fragility hip fractures. The 5-year survival rate was 62%, and the mortality risk was seen in patients with GNRI < 92. The 5-year incidence of secondary fracture was 22%, which was significantly higher in patients with a BMI < 20. BACKGROUND: Malnutrition negatively influences the postoperative survival of patients with fragility hip fractures (FHFs); however, little is known about their association over the long term. OBJECTIVE: This study evaluated the ability of the geriatric nutritional risk index (GNRI) as a risk factor for long-term mortality after FHFs. METHODS: This study included 623 Japanese patients with FHFs over the age of 60 years. We prospectively collected data on admission and during hospitalization and assessed the patients' conditions after discharge through a questionnaire. We examined the long-term mortality and the incidence of secondary FHFs and assessed the prognostic factors. RESULTS: The mean observation period was 4.0 years (range 0-7 years). The average age at the time of admission was 82 years (range 60-101 years). The overall survival after FHFs (1 year, 91%; 5 years, 62%) and the incidence of secondary FHFs were high (1 year, 4%; 5 years, 22%). The multivariate Cox proportional hazard analysis revealed the risk factors for mortality as older age (hazard ratio [HR] 1.04), male sex (HR 1.96), lower GNRI score (HR 0.96), comorbidities (malignancy, HR 2.51; ischemic heart disease, HR 2.24; revised Hasegawa dementia scale ≤ 20, HR 1.64), no use of active vitamin D3 on admission (HR 0.46), and a lower Barthel index (BI) (on admission, HR 1.00; at discharge, HR 0.99). The GNRI scores were divided into four risk categories: major risk (GNRI, < 82), moderate risk (82-91), low risk (92-98), and no risk (> 98). Patients at major and moderate risks of GNRI had a significantly lower overall survival rate (p < 0.001). Lower body mass index (BMI) was also identified as a prognostic factor for secondary FHFs (HR 0.88 [p = 0.004]). CONCLUSIONS: We showed that older age, male sex, a lower GNRI score, comorbidities, and a lower BI are risk factors for mortality following FHFs. GNRI is a novel and simple predictor of long-term survival after FHFs.

Transition of Akabane virus genogroups and its association with changes in the nature of disease in Japan.

Akabane virus (AKAV) is teratogenic to the foetus of domestic ruminants and causes a significant reproduction loss in cattle in Japan. In several past epizootics in cattle, AKAV was also associated with post-natal encephalomyelitis, mainly in calves and young stock. Previously analysed AKAV isolates in East Asia form two major clusters, genogroups I and II, with isolates involved in encephalomyelitis belonging mainly to the former. Between 2007 and 2013, AKAV epizootics were regularly observed in Japan during the summer/autumn season, and abnormal deliveries and post-natal encephalomyelitis caused by the virus in cattle were reported. During this period, 30 AKAV isolates were obtained from diseased and sentinel cattle, a piglet and Culicoides biting midges throughout Japan and were subjected to genetic comparison and phylogenetic analysis with previous isolates. In 2007, 2011 and 2013, AKAV belonging to genogroup I was identified in the central nervous systems of calves showing neurological disorders. Notably, a total of 165 cases of bovine encephalomyelitis were reported in 2011 and the isolated viruses from affected animals shared high genetic identities with a South Korean isolate that was associated with a large outbreak in 2010, suggesting some epidemiological linkage between these epizootics. Epizootics of genogroup II were observed in 2008 and 2010, but bovine post-natal encephalomyelitis cases rarely occurred. Our findings suggest that the frequent incursion of genogroup I isolates has increased the frequency of post-natal encephalomyelitis cases in Japan in recent years. Infection by genogroup I virus was also identified in piglets with neurological disorders or congenital malformations in 2011 and 2013. The aetiological role of AKAV in pigs should be elucidated in the future.

An economic assessment of foot and mouth disease in Japan.

A large-scale foot and mouth disease (FMD) epidemic in Japan in 2010 caused severe economic losses for livestock and related industries. In this paper, the authors develop a clear and usable framework to estimate the economic impact of this FMD outbreak. An economic analysis is then conducted by combining this framework with an epidemiological model. The framework estimates the direct and indirect costs to livestock and related industries by applying an input-output model, as well as by addressing expenditure on disease control. The direct cost to the livestock industry was estimated at 51.2 billion Japanese yen (JPY), engendering an indirect cost to related industries of JPY 25.5 billion. The expenditure for disease control activities was estimated at JPY 8.2 billion. The total impact of the 2010 FMD epidemic was estimated at almost JPY 85 billion. Within the economic analysis, the authors evaluate several control measure scenarios: a baseline scenario, which assumes that the rapid disease spread observed in the early phase of the 2010 FMD epidemic would continue; prompt culling within 24 hours; early detection of the first case; and emergency vaccination within a radius of 10 km around the affected farms in either seven or 28 days. Prompt culling and early detection were superior from an economic point of view, reducing the total economic impact to 30% and 2% of that in the baseline scenario, respectively. Compared with these scenarios, vaccination was less cost effective. However, vaccination suppressed the speed of disease spread and shortened the duration of the epidemic, suggesting its potential effectiveness in curbing rapid disease spread in a densely populated area.

Une épizootie de fièvre aphteuse de grande envergure survenue au Japon en 2010 a entraîné de graves pertes économiques pour la filière de l'élevage et les secteurs connexes. Les auteurs proposent un cadre d'évaluation clair pour estimer l'impact économique de ce foyer de fièvre aphteuse. Ils effectuent ensuite une analyse économique dans laquelle ce cadre d'évaluation est relié à un modèle épidémiologique. Les coûts directs et indirects subis par la filière de l'élevage et par les secteurs connexes sont évalués dans ce cadre en appliquant un modèle entrées­sorties (input­output) et en prenant en compte les dépenses liées à la lutte contre la maladie. Le coût direct de la maladie pour la filière de l'élevage a été estimé à 51,2 milliards de yens japonais, auxquels s'ajoute le coût indirect pour les secteurs connexes estimé à 25,5 milliards de yens japonais. Les dépenses induites par la lutte contre la maladie s'élèvent à 8,2 milliards de yens japonais. L'impact total de l'épizootie de fièvre aphteuse de 2010 est estimé à près de 85 milliards de yens japonais. Dans leur analyse économique, les auteurs ont évalué plusieurs scénarios relatifs aux mesures de lutte appliquées : un scénario de base, qui suppose une propagation de la maladie au même rythme que durant la phase initiale de l'épidémie de 2010 ; l'abattage rapide des animaux en 24 heures ; la détection précoce du premier cas ; l'application de la vaccination d'urgence dans un périmètre de 10 km autour des exploitations affectées et dans un délai de sept ou de 28 jours. Par rapport au scénario de base, l'abattage rapide et la détection précoce sont les meilleurs scénarios du point de vue économique, réduisant l'impact économique total respectivement à 30 % et 2 % de celui du scénario de base. Comparativement à ces scénarios, la vaccination est la solution la moins efficiente économiquement. Néanmoins, la vaccination a freiné la propagation de la maladie et limité la durée de l'épidémie, ce qui laisse penser qu'elle permettrait d'infléchir la courbe de propagation de la maladie dans les zones à forte densité de bétail.

En 2010 se produjo en el Japón una epidemia de fiebre aftosa de grandes proporciones, que causó graves pérdidas económicas a la industria ganadera y demás sectores conexos. Los autores describen un método claro para estimar el impacto económico de dicho brote. Acto seguido, llevan a cabo un análisis económico combinando este método con un modelo epidemiológico. El método permite estimar los costos directos e indirectos que soportan la industria ganadera y demás sectores conexos aplicando un modelo de «insumoproducto ¼ (input­output) y teniendo también en cuenta los gastos ligados al control de la enfermedad. Según los cálculos, el costo directo para la industria ganadera fue de 51 200 millones de yenes japoneses y el costo indirecto para los sectores conexos fue de 25 500 millones de yenes. Se estimó que las actividades de lucha contra la enfermedad supusieron gastos por valor de 8 200 millones. En total, pues, según estas estimaciones, el impacto económico de la epidemia de fiebre aftosa de 2010 se cifra en casi 85 000 millones de yenes. Como parte del análisis económico, los autores evalúan varias hipótesis relativas a las medidas de control: una hipótesis básica, en la cual prosigue sin trabas la veloz propagación de la enfermedad observada en la primera fase de la epidemia de 2010; la rápida implantación, en un plazo de 24 horas, de medidas de sacrificio sanitario; la pronta detección del primer caso; y la vacunación de emergencia dentro de un radio de 10 km alrededor de las explotaciones afectadas, en un plazo de siete días o en un plazo de 28 días. Desde un punto de vista económico, el rápido sacrificio sanitario y la pronta detección ofrecían mejores resultados, pues reducían el impacto económico total hasta un 30% y un 2%, respectivamente, del registrado en la hipótesis básica. En comparación con esas dos hipótesis, la vacunación ofrecía menos eficacia en relación con el costo, aunque frenaba la rápida propagación de la enfermedad y abreviaba la epidemia, de donde se infiere que puede resultar eficaz para contener la rápida dispersión de la enfermedad en áreas densamente pobladas.

Comparison of the computed tomography values of the bone fragment gap after sagittal split ramus osteotomy in mandibular prognathism with and without asymmetry.

The purpose of this study was to compare computed tomography (CT) Hounsfield unit values of bone fragment gaps after sagittal split ramus osteotomy (SSRO) in patients with and without asymmetry, and to evaluate differences between the deviated and non-deviated sides in asymmetric patients. Thirty-two patients who underwent a bilateral SSRO were included in this retrospective study. Patients were divided into symmetric and asymmetric groups by cephalometric analysis. CT values of the bone fragment gap were measured at 1 week and at 1 year after surgery. There were significant differences between CT values obtained at 1 week and at 1 year after surgery for all measurement points. However, there were no significant differences in CT values between symmetric and asymmetric patients at either 1 week or 1 year after surgery. Among asymmetric patients, there were no significant differences between the deviated and non-deviated sides at 1 week or 1 year after surgery. This study showed ossification of the bone fragments and adaptation to change the mandible form in patients with and without asymmetry following SSRO.

Bone morphogenetic protein 7 induces cementogenic differentiation of human periodontal ligament-derived mesenchymal stem cells.

Bone morphogenetic protein 7 (BMP-7) is a multifunctional differentiation factor that belongs to the transforming growth factor superfamily. BMP-7 induces gene expression of protein tyrosine phosphatase-like, member A/cementum attachment protein (PTPLA/CAP) and cementum protein 1 (CEMP1), both of which are markers of cementoblasts and cementocytes. In the previous study, we reported that BMP-7 treatment enhanced PTPLA/CAP and CEMP1 expression in both normal and immortal human periodontal ligament (PDL) cells. To elucidate the molecular mechanisms of the gene expression of these molecules, in this study, we identified a functional transcription activator binding region in the promoter region of PTPLA/CAP and CEMP1 that is responsive to BMP signals. Here, we report that some short motifs termed GC-rich Smad-binding elements (GC-SBEs) that are located in the human PTPLA/CAP promoter and CEMP1 promoter are BMP-7 responsive as analyzed with luciferase promoter assays. On the other hand, we found that transcription of Sp7/Osterix and PTPLA/CAP was up-regulated after 1 week of BMP-7 treatment on purified normal human PDL cells as a result of gene expression microarray analysis. Furthermore, transcription of Sp7/Osterix, runt-related transcription factor 2 (RUNX2), and alkaline phosphatase (ALP) was up-regulated after 2 weeks of BMP-7 treatment, whereas gene expression of osteo/odontogenic markers such as integrin-binding sialoprotein (IBSP), collagen, type I, alpha 1 (COL1A1), dentin matrix acidic phosphoprotein 1 (DMP1), and dentin sialophosphoprotein (DSPP) was not up-regulated in purified normal or immortal human PDL cells as a result of qRT-PCR. The results suggest that BMP-7 mediates cementogenesis via GC-SBEs in human PDL cells and that its molecular mechanism is different from that for osteo/odontogenesis.

Injuries to staff engaged in foot-and-mouth disease eradication in Japan.

BACKGROUND: In April 2010, a large-scale outbreak of foot-and-mouth disease, a highly infectious disease affecting cloven-hoofed animals, was reported in Miyazaki prefecture in Japan. Many staff were dispatched to the epidemic area to undertake containment measures. Various injuries were reported among the dispatched staff. AIMS: To study the characteristics of injuries that occurred during containment measures and to identify the characteristics of those injured. METHODS: We analysed records of injuries that occurred among staff dispatched from national organizations and prefectures other than Miyazaki prefecture. Based on these records, a qualitative analysis was conducted for veterinarians and non-veterinarian support staff as each group played a different role during the outbreak. RESULTS: Forty-seven veterinarians and 183 support staff were injured. The injury risk was significantly higher for support staff (13%) than for veterinarians (5%; P < 0.001). The most frequently reported injury resulted from exposure to disinfectant and the next was abrasions caused by friction from protective clothing and rubber boots. Among veterinarians, needlestick accidents were also frequently reported. CONCLUSIONS: Applying a less hazardous disinfectant and improving protective equipment to prevent skin abrasion may be effective in reducing the risk of these injuries among staff conducting containment measures. Reducing injuries among staff in such circumstances will assist effective control measures.

Analysis of risk factors associated with bovine leukemia virus seropositivity within dairy and beef breeding farms in Japan: a nationwide survey.

This cross-sectional study evaluated risk factors associated with farm-level bovine leukemia virus (BLV) seropositivity in 563 dairy and 490 beef farms throughout Japan. Twenty randomly selected cattle on each farm were serologically tested, and farm epidemiologiocal information was obtained through face-to-face interviews. Due to the large number of zero-prevalence dairy and beef farms, data analysis was performed using a zero-inflated negative binomial model, which revealed that the common risk factors associated with higher within-farm seroprevalence were past detection of clinical leukemia and presence of blood-sucking insects. Loose housing on dairy farms and direct contact between calves and adult cattle on beef farms were also identified as risk factors. With regard to farm-level presence of BLV, the presence of purchased cattle was found to be a risk factor in both sectors. Sending heifers to a common ranch was identified as an additional risk factor for dairy farms.

Mathematical model of the 2010 foot-and-mouth disease epidemic in Japan and evaluation of control measures.

A large-scale foot-and-mouth disease (FMD) epidemic occurred in Japan in 2010. The epidemic arose in an area densely populated with cattle and pigs, continued for 3 months, and was contained by emergency vaccination. In this study, a mathematical simulation model of FMD transmission between farms was developed to generate the disease spread in the affected area. First, a farm-distance-based transmission kernel was estimated using the epidemic data. The estimated transmission kernel was then incorporated into the transmission model to evaluate the effectiveness of several control measures. The baseline model provided a good fit to the observed data during the period from imposition of movement restrictions until the implementation of vaccination. Our simulation results demonstrated that prompt culling on infected farms after detection could contribute to reducing the disease spread. The number of infected farms decreased to 30% of the baseline model by applying the 24-h prompt culling scenario. The early detection scenario resulted in a smaller-sized epidemic. However, the results of this scenario included a 35% chance of large-scale epidemic (more than 500 infected farms), even when the disease was detected 14 days earlier than in the baseline model. As additional options, preemptive culling could halt the epidemic more effectively. However, the preemptive culling scenario required substantial resources for culling operations. The 1-km preemptive scenario involved more than 50 farms remaining to be culled per day. Therefore, preemptive culling scenarios accompanied some difficulties in maintaining a sufficient capacity for culling in the affected area. A 10-km vaccination 7 days after the first detection of the disease demonstrated the potential to contain the epidemic to a small scale, while implementation of a 3-km vaccination on the same day could not effectively reduce epidemic size. In vaccination scenarios, the total number of farms that were either culled or vaccinated exceeded that of the baseline model. Vaccination scenarios therefore posed a problem of appropriate management of many vaccinated animals, whether these vaccinated animals would be culled or not. The present FMD transmission model developed using the 2010 FMD epidemic data in Japan provides useful information for consideration of suitable control strategies against FMD.

Utility of risk-weighted surgical-pathological factors in early-stage cervical cancer.

BACKGROUND: Surgical-pathological risk factors were evaluated by weighting the magnitude of significance of multiple risk factors correlating to survival and treatment response in cervical cancer. METHODS: Multivariate analysis was performed for survival outcomes entering seven pathological factors obtained from 540 radical hysterectomy specimens in stage IA2-IIB cervical cancer cases. Hazard ratio (HR) in each risk factor was determined, and the sum of HR scores for the corresponding risk factors was determined per case. Survival curves and postoperative treatment response (concurrent chemoradiotherapy (CCRT) vs radiotherapy alone) were evaluated based on the extent of HR-weighted scores. RESULTS: Hazard ratios for risk factors relating to disease-free survival (DFS) was: lympho-vascular space invasion 3.95, nodal metastasis 3.88, adenocarcinoma 3.40, large tumour 2.36, positive margin 1.99, deep stromal invasion 1.29, and parametria invasion 1.21. The HR-weighted scoring method showed a high predictive value for recurrence (area-under-curve 0.836, P<0.001). Hazard ratio-weighted scores were negatively correlated to DFS, and the cases with score 12.5 showed 5-year DFS rate of 23.8%. Tumours with larger score offset the benefits of CCRT over radiotherapy alone for postoperative adjuvant treatment (P<0.001). CONCLUSION: Surgical-pathological risk factors provide valuable information for survival and management of early-stage cervical cancer when number and significance of risks are weighted.

Risk factors for local spread of foot-and-mouth disease, 2010 epidemic in Japan.

To provide a basis for effective foot-and-mouth disease (FMD) prevention measures, factors associated with local spread were investigated in this study using data of the 2010 FMD epidemic in Japan. Thirty-eight local clusters within a 500-m radius from source farms were selected. In the clusters with pig source farms, more neighboring farms were infected in a short time compared with the clusters with cattle source farms. The influence of distance and wind upon local spread did not show a significant difference between infected and noninfected neighboring farms. Large-size pig farms posed a greater risk of inducing local spread; the odds ratio with reference to small-size cattle farms was 16.73. Middle-size and large-size cattle farms had a greater risk of infection; odds ratios with reference to small-size cattle farms were 15.65 and 25.52, respectively. The present results are useful for understanding features of local spread and prioritizing farms for control measures.

Ovulation compensatory function after unilateral ovariectomy in dogs.

As a step towards elucidation of the timing and mechanism of the determination of the number of ovulated ova in dogs, we excised one ovary 2, 5 and 8 days after the beginning of vulval bleeding and examined whether the lost ovulation function, assessed by estimating the number of ovulated oocytes, would be compensated for by the remaining ovary. The number of ovulated ova was maintained by the remaining ovary in the group that underwent unilateral ovariectomy 2 days after the beginning of vulval bleeding. However, in the groups ovariectomized 5 or 8 days after the beginning of vulval bleeding, no compensation for the number of ova that would have been ovulated from the lost ovary was observed; ova were ovulated only from the follicles 3 mm or greater in diameter observed in the remaining ovary at unilateral ovariectomy. Thus, in dogs, the number of ovulated ova is considered to be determined within 5 days after the beginning of vulval bleeding.

Ovulation day after onset of vulval bleeding in a beagle colony.

This study investigated the duration of the interval between the onset of vulval bleeding at pro-oestrus and ovulation estimated from the plasma progesterone concentration in a large number of beagle bitches. The influence and association of individual variation, ageing and duration of the oestrous cycle were also investigated. The mean time of ovulation after the onset of vulval bleeding was 11.1 ± 0.2 days, but it widely ranged from 3 to 31 days. This timing was not influenced by age or duration of the oestrous cycle, and within-individual variation was small. As there has been no previous report in which the ovulation day was investigated by the age, these data may be very valuable.

Spermatogenic function in cats.

There are limited data on feline sperm production. We exhausted epididymal spermatozoa (i.e. the number of ejaculated spermatozoa <5 × 10(6)) by frequent semen collections using the artificial vagina method in five tomcats and determined the number of spermatozoa stored in the epididymis. We investigated the time (days) required for the number of epididymal spermatozoa to return to the pre-exhaustion level and determined the number of spermatozoa produced per day. After spermatozoa were exhausted by frequent semen collection, 6 or more days were required to return to the pre-exhaustion level. Based on the duration of resting (days) and total number of spermatozoa, the mean number of spermatozoa produced per day was 30 × 10(6).

Prevalence and growth kinetics of Shiga toxin-producing Escherichia coli (STEC) in bovine offal products in Japan.

Recent epidemiological data suggest a link between the consumption of bovine offal products and Shiga toxin-producing Escherichia coli (STEC) infection in Japan. This study thus examined the prevalence of STEC in various types of these foods. PCR screened 229 bovine offal products for the presence of Shiga toxin (stx) gene. Thirty-eight (16·6%) samples were stx positive, of which eight were positive for rfbE(O157) and three were positive for wzy(O26). Four O157 and one O26 STEC isolates were finally obtained from small-intestine and omasum products. Notably, homogenates of bovine intestinal products significantly reduced the extent of growth of O157 in the enrichment process compared to homogenates of beef carcass. As co-incubation of O157 with background microbiota complex from bovine intestinal products in buffered peptone water, in the absence of meat samples, tended to reduce the extent of growth of O157, we reasoned that certain microbiota present in offal products played a role. In support of this, inoculation of generic E. coli from bovine intestinal products into the homogenates significantly reduced the extent of growth of O157 in the homogenates of bovine intestinal and loin-beef products, and this effect was markedly increased when these homogenates were heat-treated prior to inoculation. Together, this report provides first evidence of the prevalence of STEC in a variety of bovine offal products in Japan. The prevalence data herein may be useful for risk assessment of those products as a potential source of human STEC infection beyond the epidemiological background. The growth characteristic of STEC O157 in offal products also indicates the importance of being aware when to test these food products.

Simulating the bovine spongiform encephalopathy situation in Japan.

Despite various measures taken by the Japanese government to protect the cattle population from exposure to the bovine spongiform encephalopathy (BSE) agent, the first case of BSE was detected in September 2001. Subsequently, BSE surveillance was enhanced, involving mandatory reporting and investigation of all clinical BSE suspects, and testing of fallen stock and all cattle slaughtered for human consumption. Tests on over nine million cattle led to the detection of 35 additional cases by the end of May 2009. Using the surveillance data and other information as input variables, models were developed to explore the possible source of introduction of BSE into Japan, evaluate the effectiveness of control measures, estimate the prevalence of BSE in different birth cohorts, predict a future BSE epidemic, and simulate the impact of changes in surveillance strategies. Despite difficulties associated with the availability and uncertainty of some of the input variables, these models provided an objective insight into the BSE situation in Japan.

Independently driven four-probe method for local electrical characteristics in organic thin-film transistors under controlled channel potential.

We describe an independently driven four-probe method to investigate local channel mobility in organic field-effect transistors (OFETs). In OFET devices, probe-organic contact resistance affects device characteristics even in four-probe measurement because a change in contact resistance at the source probe induces a change in channel potential, resulting in different local carrier density. To overcome this problem, we introduced a feedback circuit between the source probe and a channel voltage probe to keep the channel potential constant. We demonstrate four-probe I-V measurement on a pentacene thin film (50 nm thick) under controlled channel potential. The feedback successfully enables us to separate contact resistance and channel resistance even under different contact conditions. We also measured four-probe resistance as a function of gate bias and channel probe position. The present results were in good agreement with two-dimensional model calculation by arranging four probes in a defect-free area; the mobility of the pentacene single grain was evaluated to be 0.25 cm(2)/(V s).

Simulation model for Campylobacter cross-contamination during poultry processing at slaughterhouses.

Broiler meat is regarded as the most common source of Campylobacter infection and risk management measures are required to reduce broiler meat contamination. Among the quantitative risk assessments for Campylobacter in broiler meat, evaluation of the poultry processing stage is particularly important for predicting the contamination level of broiler meat and the effects of control measures. In this study, we built a simulation model for cross-contamination during poultry processing focusing on Campylobacter contamination at the individual carcass level. Using this model, we examined changes in the prevalence of contaminated carcasses and the number of Campylobacter per carcass after processing. As a result, it was found that the prevalence and number of Campylobacter after processing were largely influenced by the number of Campylobacter on the contaminated carcasses before processing. In the baseline model, where it was assumed that the mean number of Campylobacter on contaminated carcasses before processing was 4.7 log10 cfu per carcass, the prevalence after processing was less than that before processing. Although the median value of Campylobacter on contaminated carcasses was reduced after processing, the distributions after processing became wider and the upper limit of the 95% credible interval of Campylobacter on contaminated carcasses remained elevated. The individual-based simulation model can trace individual level changes considering discrete interactions, while models tracing mean values cannot handle these interactions in detail. The individual-based approach is considered useful for modelling cross-contamination among individual carcasses during poultry processing.

Development of a semi-quantitative evaluation system for surveillance of bovine spongiform encephalopathy, using the analytic hierarchy process.

Evaluating surveillance results is important in estimating the risk of bovine spongiform encephalopathy (BSE) cases in a particular country, or in countries from which products are imported. Although various methods have been proposed for quantitative evaluation of surveillance results, no methods focusing on surveillance from a qualitative perspective have yet been established. The authors have developed an objective method for evaluating the qualitative aspects of BSE surveillance, based on the analytic hierarchy process. Factors related to surveillance credibility were selected through expert meetings and arranged in a hierarchical structure. These evaluation factors were also weighted, so that a points system could be used for evaluation. As a result, 13 evaluation factors comprising three-layer hierarchies were generated. When surveillance in Japan before and after a BSE case was evaluated using this evaluation system, an improvement in the quality of the surveillance was observed after the outbreak. Although this study suggests that the selection of the experts had a significant effect on the outcome, the authors believe that this method will also be applicable for establishing qualitative evaluation systems for other diseases.

Spinal subarachnoid hematoma following spinal anesthesia in a patient with HELLP syndrome.

A case of subarachnoid hematoma following spinal anesthesia for cesarean section in a patient with HELLP syndrome is reported. A 39-year-old woman underwent cesarean section under spinal anesthesia for worsening preeclampsia with HELLP syndrome. Despite full recovery from the spinal anesthetic, on the second postoperative day she felt numbness on the posterior aspect of her right leg, noticed she was insensitive to bladder fullness and had mild flaccid paraparesis. Magnetic resonance imaging revealed a spinal subarachnoid hematoma with cauda equina compression. With conservative management she made an almost complete recovery within three months. Serial magnetic resonance imaging showed spontaneous regression of the hematoma. The risk of spinal subarachnoid hematoma following obstetric regional anesthesia is exceedingly small even in a patient with coagulopathy and, to our knowledge, this is only the second reported case following obstetric regional anesthesia. Anesthesia for HELLP syndrome in patients with an adequate platelet count but without disseminated intravascular coagulation is controversial. It is therefore important for clinicians to recognize the symptoms and signs of spinal subarachnoid hematoma to avoid delay in treatment that might result in severe neurological deficit.

Plasma LH, ovulation and conception rates in cats mated once or three times on different days of oestrus.

Although cats are induced ovulators, the relationship between the day of breeding, the number of matings and the likelihood of ovulation and conception have not been extensively investigated. In this experiment, cats were mated either once or three times on day 1 or day 5 of oestrus to study the incidence of the LH surge, ovulation and conception rates. The percentage ovulating and the conception rates after a single mating on day 1 of oestrus were 60% (6/10) and 33.3% (2/6), respectively, and for cats mated once on day 5 of oestrus were 83.3% (10/12) and 40% (4/10), respectively. When cats were mated three times on day 1 of oestrus, the ovulation rates and conception rates were 70% (7/10) and 85.7% (6/7), respectively, and for those mated three times on day 5 of oestrus were 100% (10/10) and 100% (10/10), respectively. The concentration of LH did not increase in non-ovulating cats, and cats that were mated three times had LH concentrations that were numerically higher than those that were mated once. Litter size was neither related to the day of mating nor to the number of matings. Although an increase in the number of matings on day 1 of oestrus produced a numerically larger LH surge, it did not increase the ovulation rate, suggesting that plasma oestradiol concentrations were not sufficiently elevated to induce a high pituitary response to mating stimulation. The conception rate after a single mating was low, suggesting that the number of sperm per mating was not sufficient. These results suggest that mating more than once in the middle of oestrus is required to improve ovulation rates and conception rates in cats.