Facial trauma with life-threatening bleeding treated by andexanet alfa administration: A case report

Recently, anticoagulant reversal has become a treatment option for life-threatening bleeding, especially in intracranial hemorrhage. Although evidence of the beneficial efficacy of andexanet alfa accumulates in cases of intracranial hemorrhage, little is known about its effectiveness in head injuries without intracranial hemorrhage. We present the case of an 87-year-old man who suffered a stroke 1 year previously and had been taking apixaban since then, who was brought to the emergency department with facial trauma due to a fall. Upon arrival at the hospital, the patient was conscious, and his vital signs were normal; however, physical examination revealed epistaxis, and plain head computed tomography (CT) showed multiple facial fractures without intracranial hemorrhage. As epistaxis was challenging to control, upper airway obstruction developed. His percutaneous oxygen saturation (SpO₂) decreased rapidly, and he underwent tracheal intubation. Contrast-enhanced head CT revealed at least two extravasations, near the anterior wall of the right maxillary sinus and from the nasal canal to the nasopharynx area. However, embolization using interventional radiology was deemed difficult. Because the bleeding did not stop, we determined the bleeding was life-threatening and uncontrollable. Therefore, we infused andexanet alfa to stop the bleeding. After infusion, hemostasis was confirmed. This case suggests the effectiveness of andexanet alfa in cases of facial trauma and extracranial bleeding difficult to stop, resulting in favorable outcomes and hemostatic effects

Verification of a simplified disk diffusion method for antimicrobial susceptibility testing of bovine mastitis isolates

Bovine mastitis is mainly treated with antimicrobials. Determination of antimicrobial treatments based on the results of an antimicrobial susceptibility test is important to reduce the risk of emergence of antimicrobial resistance and to provide effective treatment. In Japan, not only the standardized agar disk diffusion method (standardized-ADD) based on Clinical and Laboratory Standards Institute guidelines, but also the agar disk diffusion method further simplified (simplified-ADD) are widely used as antimicrobial susceptibility tests for bovine mastitis isolates in the clinical laboratory. However, whether the simplified-ADD is a useful alternative to the standardized-ADD has not yet been sufficiently verified. Therefore, to verify the usefulness of the simplified-ADD, we compared the results of the standardized-ADD and the simplified-ADD using clinical isolates of bovine mastitis. Following testing of 83 isolates from 11 bacterial species, the correlation coefficient of the disk zone diameters in both methods was 0.92, indicating that the simplified-ADD is effective as an alternative method to the standardized-ADD. However, because the disk zone diameter tended to be smaller in the simplified-ADD than in the standardized-ADD, sufficient attention should be paid to this point when determining the treatment for clinical cases of mastitis from the results of the simplified-ADD. The fact that a difference in the results between the two methods was present means that the results cannot be interpreted based on the same criteria. Therefore, determination of the criteria appropriate for the simplified-ADD is needed

Sequence type and primary structure of the vru gene upstream region of Streptococcus uberis isolated from bovine clinical mastitis in Japan

In the present study, we investigated the variability of bovine clinical mastitis isolates of Streptococcus uberis in Japan by multilocus sequence typing. We also investigated the variations in the primary structure of the vru gene upstream region of the isolates to elucidate the association of this region with the occurrence of clinical mastitis. Eighty-two isolates were recovered from 62 dairy farms in Japan; these isolates were associated with 57 sequence types (STs), including 54 novel STs to which 78 isolates belonged. Thirty isolates with ST1003 (one of the novel STs) and related STs at the triple-locus variant level accounted for 37% of the isolates examined. A total 16 (20%) isolates were assigned to clonal complexes (CC143 and CC86) that are major in New Zealand and Australia. Seventy-one of the 82 isolates had 1, 3, 4 or 5 bp deletions in the vru gene upstream region in comparison with the corresponding region in the S. uberis virulent strain 0140J and the remaining 11 isolates had no deletions. These results suggest that S. uberis is a diverse mastitis-causing pathogen, and the integrity of the vru gene upstream region is not necessarily conclusive for the occurrence of bovine clinical mastitis

Effects of Intramammary Antimicrobial Treatment on the Milk Microbiota Composition in Mild Clinical Bovine Mastitis Caused by Gram-Positive Bacteria

The purpose of this study was to clarify the effects of antimicrobial treatment for mild mastitis caused by Gram-positive bacteria on the milk microbiota in dairy cattle. Sixteen quarters of sixteen cows with mild clinical mastitis from the same herd were included in the study. On the day of onset (day 0), the cows were randomly allocated to a no-treatment (NT; n = 10) group or an intramammary antimicrobial treatment (AMT) group that received AMT starting on day 0 (AMT-AMT group; n = 6). The next day (day 1), the cows in the NT group were randomly allocated into an NT group (NT-NT group; n = 3) that received no treatment or an AMT group that received AMT starting on day 1 (NT-AMT group; n = 7). Milk samples were collected on days 0, 1, 3 and 7, and the milk microbiota of each sample was comprehensively analyzed via 16S rRNA gene amplicon sequencing of the milk DNA. During the treatment period, the milk microbiota of the NT-NT group did not change, but those of the NT-AMT and AMT-AMT groups changed significantly on days three and seven. Thus, the use of antimicrobials for mild mastitis caused by Gram-positive bacteria changes the milk microbiota composition

Transrectal guidance of the ovaries reduces operative time during bovine laparoscopic ovariectomy.

The main objective of this study was to evaluate the effects of transrectal guidance of the ovaries by an assistant on operative time during bovine laparoscopic ovariectomy. Twenty four clinically healthy Holstein dairy cows were divided randomly into two groups. In the transrectal guidance group, an assistant grasped the ovaries via the transrectal route and pulled them to a position where they could be visualized with a camera. On the other hand, the control group was operated without guidance. The time required to remove both ovaries in the guidance group was shorter than that in the control group (P<0.01). We concluded that laparoscopic ovariectomy with transrectal guidance of the ovaries can substantially shorten operative time, thereby greatly contributing to animal welfare and to reducing the burden on the operator