Application of the World Café method to discuss the efficiency of African swine fever control strategies in European wild boar (Sus scrofa) populations.

In the current epidemic of African swine fever (ASF) in Europe, the maintenance and spread of the disease among wild boar populations remains the most important epidemiological challenge. Affected and at-risk countries have addressed this situation using a diversity of wild boar management methods with varying levels of success. The methods applied range from conventional animal disease intervention measures (zoning, stakeholder awareness campaigns, increased surveillance and biosecurity measures) to measures aimed at reducing wild boar population movements (fencing and baiting/feeding) or population numbers (intensive hunting). To assess the perceived efficiency and acceptance of such measures in the context of a focal introduction of ASF, the authors organised a participatory workshop inviting experts from the fields of wildlife management, wild boar ecology, sociology, epidemiology and animal disease management to discuss the advantages and disadvantages of various control approaches. The discussions between professionals from different countries took place using the World Café method. This paper documents the World Café method as a tool for increasing the level of participation in multi-stakeholder group discussions, and describes the outputs of the workshop pertaining to the control measures. In summary, the World Café method was perceived as an efficient tool for quickly grasping comprehensive perspectives from the professionals involved in managing ASF and wild boar populations, while promoting engagement in multi-disciplinary discussions. The exercise achieved a good overview of the perceived efficiency and applicability of the different control methods and generated useful recommendations for ASF control in wild boar populations in Europe.

DNA damage and apoptosis in the aged canine brain: relationship to Abeta deposition in the absence of neuritic pathology.

1. In addition to beta-amyloid (Abeta) deposition and cytoskeletal neuropathology, both the Alzheimer's disease (AD) and Down's syndrome (DS) human brain exhibit marked evidence of DNA damage, however, it is difficult to separate events that occur in conjunction with neurofibrillary pathology versus Abeta pathology in these systems. 2. In contrast, the aged canine brain exhibits the accumulation of Abeta into diffuse deposits similar to those found in early AD and DS in the absence of neurofibrillary pathology. Furthermore, Abeta deposition in canine brain is correlated with cognitive deficits. 3. In order to test the hypothesis that TUNEL labeling for DNA damage in AD is not simply a consequence of agonal artifacts, postmortem artifacts, or neurofibrillary pathology, and may be directly related to Abeta deposition, we examined Abeta immunoreactivity, PHF-1 immunoreactivity, and TUNEL labeling in this animal model. 4. These experiments reveal a relationship between the amount of DNA damage detected by TUNEL labeling and levels of Abeta deposition. Further, in animals with no TUNEL labeling, we detected no Abeta immunoreactivity. 5. These data support the hypothesis that TUNEL labeling in AD ans DS is not a consequence of agonal artifact, postmortem artifact, or tau pathology, and may be directly related to Abeta deposition and perhaps AD pathogenesis.

Mineral excretion following furosemide compared with bumetanide therapy in premature infants.

Mineral excretion following single doses of furosemide were compared with bumetanide in a random cross-over trial in 17 premature infants. The mean birthweight and gestational age were 889 +/- 85 g and 27 +/- 2 weeks. Following furosemide therapy, significantly higher chloride losses and urine volumes were noted in the first 8-h period compared with the second or third 8-h periods. Following bumetanide therapy, sodium, calcium, and chloride losses and urine volumes were significantly higher in the first 8 h compared with the second or third 8-h periods. Hourly sodium and chloride losses were significantly lower following bumetanide than furosemide during the first two 8-h periods. During the final 8-h period sodium, potassium, chloride, and calcium losses were significantly lower following bumetanide than following furosemide. Sodium loss per urine volume was lower with bumetanide than furosemide but calcium loss tended to be higher. Hence, bumetanide does not appear to be a calcium-sparing diuretic following single-dose therapy.

Renal cortical and renal medullary necrosis in the first 3 months of life.

Renal cortical necrosis, renal medullary necrosis, and combined renal cortical-medullary necrosis result from renal ischemia without vascular occlusion. Renal hypoperfusion and ischemic injury in infants have been ascribed to massive blood loss, hemolytic disease, septicemia, and severe hypoxemia. In a postmortem study we identified 82 cases among 1,638 autopsies during the 20 years between 1970 and 1989 in infants 3 months old or less at the time of death. The frequency of renal necrosis in autopsy cases increased significantly during the last 6 years of the study. The distribution of the renal lesion was cortical in 28, medullary in 23, and combined in 31. Forty infants carried diagnoses of congenital heart disease, 17 of asphyxial shock, 9 of sepsis, 3 of infectious myocarditis, 9 of major malformations, 4 of anemic shock, 1 of vascular malformation, and 1 of gastroenteritis and dehydration. A significantly higher proportion of babies with congenital heart disease had cortical involvement. Comparison of clinical characteristics revealed a significantly higher frequency of prematurity, respiratory distress syndrome, bleeding diathesis, and possibly sepsis in the children with congenital heart disease, suggesting that these factors are important in the pathogenesis of the renal lesion. Fourteen infants underwent cardiac catheterization; there was no demonstrable association between the renal lesions and the use of radiographic contrast medium. We conclude that severe congenital heart disease itself is a risk factor for life-threatening renal cortical and medullary necrosis.

Real-time US guidance during renal biopsy in children: a different approach. Technical note.

To minimize procedural failures and complications, a real-time ultrasound (US) approach was developed for percutaneous renal biopsy in the pediatric population. With use of a 3- or 5-MHz transducer, the medial border of the kidney is localized and a line, which parallels the renal axis, is drawn on the skin. The lower pole and renal hilum are identified, and lines are drawn perpendicular to the long axis. After the patient is sedated, the entry site is selected above the lower pole. The transducer is placed on the child's side in an oblique transverse plane parallel to the axis of the kidney, the needle is guided into the renal cortex, and a specimen is obtained. Sixty-five biopsies were performed in 63 children. Fifty-five specimens were obtained from native kidneys. Success was achieved in all cases with only three minor complications. This approach appears to be an easy, safe, and accurate guide for renal biopsy in the pediatric population.

Effects of prenatal ethanol exposure on postnatal renal function and structure in the rat.

Effects of prenatal ethanol exposure on postnatal renal function and structure in the rat. Renal function and morphology were studied in 90-day-old offspring of ethanol-fed (E) rats and were compared to pair-fed control (C) animals. Compared to C rats, E rats were smaller at birth, had higher fractional sodium excretion (p less than 0.01) and lower fractional potassium excretion (p less than 0.01). In E rats, sodium (Na) restriction resulted in a significant increase in urine flow and Na wastage, whereas C rats remained in Na balance. E rats developed hyperkalemia, when potassium (K) intake was increased from 2.8 to 14 mEq/day. Baseline creatinine clearance, urine and blood osmolalities and pH, plasma electrolytes and aldosterone concentrations were similar in both groups. There was no significant difference in wet or dry kidney weight, renal water content, or renal tissue concentrations of Na or K between the two groups. No difference was found in gross morphology or light microscopic appearances of the kidneys between E and C rats. Thus rats exposed to ethanol during fetal life have a defect in urine concentration and Na conservation when fed a low Na diet and a defect in K excretion when given a K load without evidence of any gross or light microscopic renal structural abnormalities at 90 days of age.

Management of hyponatremic seizures in children with hypertonic saline: a safe and effective strategy.

OBJECTIVE: To study efficacy and safety of hypertonic saline administration in the management of hyponatremic seizures. DESIGN: Retrospective, observational, cross-sectional study with factorial design. SETTING: In-patient population in a university hospital. PATIENTS: All children admitted with serum sodium concentrations less than 125 mmol/L. Sixty-nine episodes of severe hyponatremia in 60 children were reviewed. Forty-one of these children presented with seizures. INTERVENTIONS: Twenty-five of 41 seizure patients received an iv bolus of 4 to 6 mL/kg body weight of 3% saline. Twenty-eight patients were treated with a benzodiazepine and/or phenobarbital with or without the subsequent administration of hypertonic saline. MEASUREMENTS AND MAIN RESULTS: Thirteen treatment failures and ten instances of apnea occurred among the 28 patients treated with benzodiazepine/phenobarbital. Administration of hypertonic saline resulted in resolution of seizures and apnea in all cases. Those patients receiving 3% saline had a higher serum sodium increase rate from 0 to 4 hrs than the remaining patients (3.1 +/- 1.3 vs. 1.7 +/- 1.2 mmol/L.hr, p less than .01). None developed subsequent neurologic deterioration or clinical manifestations of osmotic demyelination syndrome. CONCLUSION: Treatment of hyponatremic seizures with routine anticonvulsants may be ineffective and is associated with a considerable incidence of apnea. A rapid increase in the serum sodium concentration by 3 to 5 mmol/L with the use of hypertonic saline is safe and efficacious in managing acute symptomatic hyponatremia.

The effect of aggressive nutrition on infection rates in patients maintained on peritoneal dialysis.

Aggressive nutrition has been reported to improve growth parameters in children undergoing peritoneal dialysis. The current study reports the effect of a program of aggressive nutrition, started in 1/1988, on catheter-related infection rates in children undergoing chronic peritoneal dialysis. A combination of high calorie foods, supplements, "candy bar diets", and, when necessary, modular gastrostomy feedings, to provide 3-4 gm/kg/d and 100-120 kcal/kg/d was used. Peritonitis and catheter infection rates were assessed. A total of 37 pediatric patients underwent peritoneal dialysis from 1/1986-7/1990, with a total cumulative experience of 596 patient months. The peritonitis rate decreased from 1 episode/5.53 patient-month in 1987 to 1 episode per 46 patient-month in 1990. There was no significant effect on the catheter infections or the number of admissions/patient month. However, there was a 55% decline in the number of hospitalization days/patient month (p less than 0.01). The decrease in the peritonitis rate was independent of the modality of peritoneal dialysis or the usage of ultraviolet connecting devices. In 10 patients followed sequentially, the peritonitis rate was less (1 episode/23.5 patient months) after gastrostomy tube placement and feedings than before gastrostomy tube placement (1 episode/8.28 patient months) (p less than 0.01). There were no significant differences in serum albumin or total protein levels between the two observation periods. We conclude that adequate nutrition may play a role in decreasing the peritonitis rate in children maintained on peritoneal dialysis and speculate improved white cell function as a possible underlying mechanism.

Escherichia coli cellulitis in children with idiopathic nephrotic syndrome.

Although Streptococcus pneumoniae is traditionally considered the preponderant bacterial pathogen in children with nephrotic syndrome, recent data suggest an increase of infections with encapsulated gram-negative organisms. We report two children with idiopathic nephrotic syndrome in relapse who developed spontaneous Escherichia coli cellulitis. The organism was recovered from the cellulitis tissue aspirate of one, and from the blood of the other. Both patients responded to appropriate antibiotic therapy. Initial treatment of sepsis, peritonitis or spontaneous cellulitis in nephrotic patients should include broad spectrum antibiotic coverage pending results of appropriate cultures.

Reflux nephropathy.

This article reviews current concepts of reflux nephropathy, including the pathophysiology, diagnosis, relationship to infection, role in causing end-stage renal disease, and appropriate treatment and management. The condition is defined from a epidemiologic point of view herein, and attention also is given to possible progressions this condition can take.

Metabolism and pharmacokinetics of acetaminophen in a severely poisoned young child.

A 1-year-old child with severe acetaminophen (APAP) poisoning after ingestion of 10 gm APAP demonstrated central nervous system depression, shock, hypothermia, and metabolic acidosis. There was dramatic improvement during treatment with intravenously administered N-acetylcysteine (NAC) and hemodialysis, and the patient recovered without sequelae. A detailed study of APAP metabolism was carried out during the initial 72 hours after ingestion. APAP-sulfate and APAP-glucuronide accounted for 29% and 33%, respectively, of total drug in urine, whereas cysteine and NAC conjugates accounted for only 12%. The low incidence of severe toxicity in children after overdoses of APAP may be related to greater capacity to metabolize APAP via a nontoxic pathway.

HgCl2-induced acute renal failure in the developing rat.

The present investigation was undertaken to find the differences, if any, in the pattern of nephrotoxic acute renal failure (HgCl2, 4.7 mg/kg body weight SC), in the developing rat and its relationship to the renin angiotensin system. No differences in renal cortical renin content were found between 2, 4, and 8 week olds, but plasma renin concentration was highest at 2 weeks and declined with age. Plasma renin was significantly increased in all groups 6 hr after HgCl2 injection, and the percentage of increase was highest in the 4 week olds. Despite these differences in initial plasma renin and in changes in plasma renin after HgCl2, the pattern of acute renal failure (as assessed by changes in blood urea nitrogen) was similar in the three groups for the first three days. Subsequently, the 4 and 8 week olds exhibited recovery (blood urea nitrogen began to decline), whereas blood urea nitrogen continued to increase to the fifth day in the 2 week olds. The mortality was highest in this group. No simple correlation was observed between basal renal renin, plasma renin, the increase in plasma renin following HgCl2 injection, and the pattern or severity of acute renal failure.

Pharmacokinetics of severe theophylline intoxication managed by peritoneal dialysis.

In a patient severely poisoned with theophylline, saturation kinetics were demonstrated at serum concentrations > 35 micrograms/ml with subsequent conversion to first order kinetics (t 1/2 = 5.4 h). Peritoneal dialysis was used to enhance the drug's removal. The mean theophylline clearance was greater for dialysate (5.11 ml/min) than for urine (1.98 ml/min) or gastric fluid (0.32 ml/min). Urinary elimination occurred as a constant first order process (t 1/2 = 4.3 h). Peritoneal dialysis is a valuable early adjunct in the management of severe theophylline intoxication.

Glycerol-induced myohemoglobinuric acute renal failure in the pregnant rat.

These studies examined the effects of the volume expansion and the enhanced activity of the renin-angiotensin system during pregnancy on the severity of glycerol-induced myoglobinuric acute renal failure (ARF) in the rat. Renal cortical renin content (RCRC) and plasma renin concentration (PRC) were measured during the first, second, and third weeks of pregnancy. There were no significant changes in RCRC during pregnancy, but PRC was significantly elevated by the third week (22 +/- 2 vs. 12 +/- 2 ng angiotensin I/ml/k, p less than 0.001), despite plasma volume expansion as assessed by changes in the hemotocrit (37.7 +/- 0.5 vs. 46.4 +/- 0.6%, p less than 0.001). Despite the elevated PRC, a significant reduction in the severity of ARF was seen during the third week of pregnancy, as assessed by both blood urea nitrogen and inulin clearance measurements. When a sustained natriuresis was superimposed earlier in pregnancy by saline drinking, significantly more protection against ARF was seen, but with less plasma volume expansion. These results suggest that the mechanism by which saline drinking confers protection may be independent of the degree of volume expansion but may be dependent upon the associated sustained natriuresis.

[Metabolic aspects of parsalmide in the cat (author's transl)]. / Untersuchungen uber den Stoffwechsel von Parsalmid bei der Katze.

2-Proparglyoxy-5-amino-N-(n-butyl)-benzamide(parsalmide, My 41-6) given s.c. to the cat and excreted in the urine, was present partly as unchanged parsalmide (25-62% of total excreted compounds), partly as unstably conjugated compounds (17-36%, mainly N-glucuronilparsalmide), and partly as stably conjugated compounds (11-36%, mainly N-acetylparsalmide). Urinary excretion of parsalmide and its metabolites continued for some days, indicating a slow excretion from the body, contrasting with other species, man included, previously examined. Summarizing, there are some 5-6 metabolites of parsalmide in the urine of treated cats, apart from unchanged parsalmide.