Rapidly Expanding Range of Highly Pathogenic Avian Influenza Viruses

The movement of highly pathogenic avian influenza (H5N8) virus across Eurasia and into North America and the virus’ propensity to reassort with co-circulating low pathogenicity viruses raise concerns among poultry producers, wildlife biologists, aviculturists, and public health personnel worldwide. Surveillance, modeling, and experimental research will provide the knowledge required for intelligent policy and management decisions.     

Effects of stimulus frequency and duration on somatosensory discrimination responses

Somatosensory processing of duration and frequency changes was investigated using event-related potentials to vibrotactile stimuli. Intermittent vibration to the fingertips of either hand was presented using a two-stimulus odd-ball paradigm (deviant P = 0.10). One group (N = 12, 18–38 years) was presented with stimulus pairs of 20/70, 50/150 and 170/250 ms. A second group (N = 10, 19–34 years) was tested using frequency pairs of 200/70 Hz. A psychophysical study examined the subjects’ ability to discriminate between different stimulus pairs. A clear negative shift in the response to the deviant stimulus was recorded with all the stimulus conditions used in both experiments. Both frequency changes and duration increments/decrements revealed an initial negativity in the subtraction waveform with a mean onset of 90–170 ms and a following positivity, both of which were dependent on the duration of the stimulus used. A significant decrease in the amplitude of both components was observed with the 170/250 ms pairing, coinciding with a positive correlation between individual discrimination performance and amplitude. These results support the existence of a somatosensory mismatch response with features similar to those of the aMMN and highlight the relevance of the somatosensory-specific positivity. Results from the duration experiment also resolve some of the discrepancies between previous studies.     

Antibody-producing cells: virus-induced alteration of response to antigen.

Spleen antibody-forming cells of mice yield a 3- to 10-fold increase in their response to sheep erythrocyte antigen if they are acutely infected by lactate dehydrogenase-elevating virus. This early stimulation is replaced by a long-term inhibition of the antibody-forming cells as the viremia goes into its persisting chronic stage. These contrasting immunological phenomena are examined as contributing factors responsible for the enhancement by this virus of asparaginase (EC 3.5.1.1; L-asparagine amidolydrolase) therapy against leukemia in mice, and for the alteration of the susceptibility of mice to various neoplastic processes.     

Cost‐effectiveness analysis of preoperative transfusion in patients with sickle cell disease using evidence from the TAPS trial

The study's objective was to assess the cost‐effectiveness of preoperative transfusion compared with no preoperative transfusion in patients with sickle cell disease undergoing low‐ or medium‐risk surgery. Seventy patients with sickle cell disease (HbSS/Sß⁰thal genotypes) undergoing elective surgery participated in a multicentre randomised trial, Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS). Here, a cost‐effectiveness analysis based on evidence from that trial is presented. A decision‐analytic model is used to incorporate long‐term consequences of transfusions and acute chest syndrome. Costs and health benefits, expressed as quality‐adjusted life years (QALYs), are reported from the ‘within‐trial’ analysis and for the decision‐analytic model. The probability of cost‐effectiveness for each form of management is calculated taking into account the small sample size and other sources of uncertainty. In the range of scenarios considered in the analysis, preoperative transfusion was more effective, with the mean improvement in QALYs ranging from 0.018 to 0.206 per patient, and also less costly in all but one scenario, with the mean cost difference ranging from ?£813 to £26. All scenarios suggested preoperative transfusion had a probability of cost‐effectiveness >0.79 at a cost‐effectiveness threshold of £20 000 per QALY.     

Twelve-lead high-frequency QRS electrocardiography during anesthesia in healthy subjects

Analysis of the high-frequency (HF) components of the QRS complex has been shown to be a more sensitive indicator of myocardial ischemia and infarction than conventional ST segment analysis in settings outside of the operating room. In this study, we documented the effect of general anesthesia on HF QRS analysis in healthy patients as the first step in determining the potential of this technique for monitoring anesthetized patients. HF QRS electrocardiograms (ECGs) were obtained from all 12 ECG leads in 30 healthy subjects before and after the induction of anesthesia. When compared with preinduction values, there were significant postinduction changes in multiple variables of the HF QRS in many leads studied that were within previously described normal limits. Additional study is needed to understand the potential of this monitoring technique for enhancing detection of myocardial ischemia in the anesthetized population.     

Domestic poultry and SARS coronavirus, southern China

SARS coronavirus injected intratracheally into chickens, turkeys, geese, ducks, and quail, or into the allantoic sac of their embryonating eggs, failed to cause disease or replicate. This finding suggests that domestic poultry were unlikely to have been the reservoir, or associated with dissemination, of SARS coronavirus in the animal markets of southern China.     

Factors determining the duration of tracheal intubation in cardiac surgery: a single-centre sequential patient audit

BACKGROUND AND OBJECTIVE: The study was designed to identify those factors associated with early tracheal extubation following cardiac surgery. Previous studies have tended to concentrate on surgery for coronary artery bypass or on other selected cohorts. METHODS: Sequential cohort analysis of 296 unselected adult cardiac surgery patients was performed over 3 months. RESULTS: In total, 39% of all patients were extubated within 6 h, 89% within 24 h and 95% within 48 h. Delayed extubation (>6 h after surgery) appeared unrelated to age, gender, body mass index, a previous pattern of angina or myocardial infarction, diabetes, preoperative atrial fibrillation, and preoperative cardiovascular assessment, as well as other factors. Delayed tracheal extubation was associated with poor left ventricular, renal and pulmonary function, a high Euroscore, as well as the type, duration and urgency of surgery. Early extubation (<6 h) was not associated with a reduced length of stay in either the intensive care unit or in hospital compared with patients who were extubated between 6 and 24 h. In these groups, it is presumed that organizational and not clinical factors appear to be responsible for a delay in discharge from intensive care. Patients who were extubated after 24 h had a longer duration of hospital stay and a greater incidence of postoperative complications. Postoperative complications were not adversely affected by early tracheal extubation. CONCLUSIONS: In an unselected sequential cohort, both patient- and surgery-specific factors may be influential in determining the duration of postoperative ventilation of the lungs following cardiac surgery. In view of the changing nature of the surgical population, regular re-evaluation is useful in reassessing performance.