Feasibility study of immediate pharyngeal cooling initiation in cardiac arrest patients after arrival at the emergency room

AIM: Cooling the pharynx and upper oesophagus would be more advantageous for rapid induction of therapeutic hypothermia since the carotid arteries run in their vicinity. The aim of this study was to determine the effects of pharyngeal cooling on brain temperature and the safety and feasibility for patients under resuscitation. METHODS: Witnessed non-traumatic cardiac arrest patients (n=108) were randomized to receive standard care with (n=53) or without pharyngeal cooling (n=55). In the emergency room, pharyngeal cooling was initiated before or shortly after return of spontaneous circulation by perfusing physiological saline (5 °C) into a pharyngeal cuff for 120 min. RESULTS: There was a significant decrease in tympanic temperature at 40 min after arrival (P=0.02) with a maximum difference between the groups at 120 min (32.9 ± 1.2°C, pharyngeal cooling group vs. 34.1 ± 1.3°C, control group; P<0.001). The return of spontaneous circulation (70% vs. 65%, P=0.63) and rearrest (38% vs. 47%, P=0.45) rates were not significantly different based on the initiation of pharyngeal cooling. No post-treatment mechanical or cold-related injury was observed on the pharyngeal epithelium by macroscopic observation. The thrombocytopaenia incidence was lower in the pharyngeal cooling group (P=0.001) during the 3-day period after arrival. The cumulative survival rate at 1 month was not significantly different between the two groups. CONCLUSIONS: Initiation of pharyngeal cooling before or immediately after the return of spontaneous circulation is safe and feasible. Pharyngeal cooling can rapidly decrease tympanic temperature without adverse effects on circulation or the pharyngeal epithelium

Species identification, antifungal susceptibility, and clinical feature association of Aspergillus section Nigri isolates from the lower respiratory tract

Species of Aspergillus section Nigri are generally identified by molecular genetics approaches, whereas in clinical practice, they are classified as A. niger by their morphological characteristics. This study aimed to investigate whether the species of Aspergillus section Nigri isolated from the respiratory tract vary depending on clinical diagnosis. Forty-four Aspergillus section Nigri isolates isolated from the lower respiratory tracts of 43 patients were collected from February 2012 to January 2017 at the National Hospital Organization (NHO) Tokyo National Hospital. Species identification was carried out based on β-tubulin gene analysis. Drug susceptibility tests were performed according to the Clinical and Laboratory Standards Institute (CLSI) M38 3rd edition, and the clinical characteristics were retrospectively reviewed. A. welwitschiae was isolated most frequently, followed by A. tubingensis. More than half of the A. tubingensis isolates exhibited low susceptibility to azoles in contrast to only one A. welwitschiae isolate. Approximately three quarters of the patients from whom A. welwitschiae was isolated were diagnosed with colonization, whereas more than half the patients from whom A. tubingensis was isolated were diagnosed with chronic pulmonary aspergillosis (CPA). More attention needs to be given to the drug choice for patients with CPA with Aspergillus section Nigri infection because A. tubingensis, which was found to be frequently azole-resistant, was the most prevalent in these patients

Dietary Lactoferrin Alleviates Age-Related Lacrimal Gland Dysfunction in Mice

BACKGROUND: Decrease in lacrimal gland secretory function is related to age-induced dry eye disease. Lactoferrin, the main glycoprotein component of tears, has multiple functions, including anti-inflammatory effects and the promotion of cell growth. We investigated how oral administration of lactoferrin affects age-related lacrimal dysfunction. METHODS AND FINDINGS: Twelve-month-old male C57BL/6Cr Slc mice were randomly divided into a control fed group and an oral lactoferrin treatment group. Tear function was measured at a 6-month time-point. After euthanasia, the lacrimal glands were subjected to histological examination with 8-hydroxy-2'-deoxyguanosine (8-OHdG) antibodies, and serum concentrations of 8-OHdG and hexanoyl-lysine adduct (HEL) were evaluated. Additionally, monocyte chemotactic protein-1(MCP-1) and tumor necrosis factor-α (TNF-α) gene expression levels were determined by real-time PCR. The volume of tear secretion was significantly larger in the treated group than in the control. Lactoferrin administration reduced inflammatory cell infiltration and the MCP-1 and TNF-α expression levels. Serum concentrations of 8-OHdG and HEL in the lactoferrin group were lower than those in the control group and were associated with attenuated 8-OHdG immunostaining of the lacrimal glands. CONCLUSION: Oral lactoferrin administration preserves lacrimal gland function in aged mice by attenuating oxidative damage and suppressing subsequent gland inflammation

Effectiveness of cyclic irrigation in reducing suspended solids load from a paddy-field district

The reduction of suspended solids, nutrients, and organic matter loads in drainage water from paddy fields is an important issue for water quality management in closed water areas in Japan. We evaluated the ability of cyclic irrigation to reduce the suspended solids load from paddy fields. In 2006 and 2007, we investigated water and mass balances during the irrigation period in a low-lying paddy-field district neighboring Lake Biwa, which is the largest lake in Japan. We confirmed that cyclic irrigation reduced effluent loads during the puddling season. With cyclic irrigation, 118 kg ha−1 of suspended solids was returned to the paddy fields in 2006 and 199 kg ha−1 in 2007. The effect of cyclic irrigation on the net suspended solids load can be represented by three ratios: the concentration ratio, which represents the ratio of the suspended solids concentration in drainage water to that in lake water; the cyclic irrigation ratio, which represents the ratio of the volume of reused water to that of irrigation water in cyclic irrigation; and the surplus irrigation water ratio, which represents the ratio of the volume of surplus irrigation water to that of irrigation water. The cyclic irrigation ratio and the surplus irrigation water ratio interact to determine the effect of cyclic irrigation on the net suspended solids load. Simultaneously increasing the cyclic irrigation ratio and decreasing the surplus irrigation water ratio will maximize the purification effect on drainage water from paddy fields

Assessment of factors influencing groundwater-level change using groundwater flow simulation, considering vertical infiltration from rice-planted and crop-rotated paddy fields in Japan

Assessing factors that influence groundwater levels such as land use and pumping strategy, is essential to adequately manage groundwater resources. A transient numerical model for groundwater flow with infiltration was developed for the Tedori River alluvial fan (140 km2), Japan. The main water input into the groundwater body in this area is irrigation water, which is significantly influenced by land use, namely paddy and upland fields. The proposed model consists of two models, a one-dimensional (1-D) unsaturated-zone water flow model (HYDRUS-1D) for estimating groundwater recharge and a 3-D groundwater flow model (MODFLOW). Numerical simulation of groundwater flow from October 1975 to November 2009 was performed to validate the model. Simulation revealed seasonal groundwater level fluctuations, affected by paddy irrigation management. However, computational accuracy was limited by the spatiotemporal data resolution of the groundwater use. Both annual groundwater levels and recharge during the irrigation periods from 1975 to 2009 showed long-term decreasing trends. With the decline in rice-planted paddy field area, groundwater recharge cumulatively decreased to 61 % of the peak in 1977. A paddy-upland crop-rotation system could decrease groundwater recharge to 73–98 % relative to no crop rotation

Effects of cyclic irrigation on water and nitrogen mass balances in a paddy field

Cyclic irrigation is considered an effective water management practice for reducing pollutant loads from a paddy-field district. The objective of this study was to clarify the effects of cyclic irrigation on mass balance in paddy plots. At the study site, cyclic irrigation with a high cyclic irrigation ratio (% reused water in irrigation water) was conducted from late April to late June. We found a complementary relationship between the volume of irrigation water and rainfall, which together totaled about 1400–1600 mm during the irrigation period each year. We concluded that a cyclic irrigation system that enables the paddy-field district to use a high cyclic irrigation ratio may lead to more efficient use of rainfall for crop irrigation. Nitrogen concentrations in both irrigation water and ponded water tended to be higher during the cyclic irrigation period than during the lake water irrigation period. Nitrogen input from irrigated water accounted for about 8–16% of the total input of nitrogen. It is suggested that fertilizer application of nitrogen can be reduced by its return through cyclic irrigation

Relationship between increment of groundwater level at the beginning of irrigation period and paddy filed area in the Tedori River Alluvial Fan Area, Japan

There are many paddy fields and large amounts of groundwater in the Tedori River Alluvial Fan in Ishikawa Prefecture, Japan. Water infiltration from paddy fields during irrigation may significantly contribute to groundwater recharge. Groundwater recharge is known to be one outcome of paddy farming, and in general is usually related to land use. However, a decreased area of paddy fields because of socioeconomic factors such as urbanization and increasing area of fallow fields has possibly affected the groundwater environment. Evaluation of the quantitative effect of paddy fields on groundwater is necessary for groundwater conservation. This study examined the relationship between differences in the depth of groundwater from just before the irrigation period to just after the first irrigation of paddy fields (increments of groundwater levels) in observation wells and the area of paddy fields around each well. The paddy areas within circular buffer zones, which were delineated at 0.2 km intervals between 0.2 and 2.0 km centered on each observation well, were calculated. A positive relationship was found between the rise in groundwater and the area of paddy field within different buffer zones at most wells. In addition, in the middle or upper part of the fan, the effect of changes in the area of paddy fields surrounding the well on the groundwater level rise was greater than that on the lower part of the fan