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Summary Difficult decisions often require evaluation of samples of evidence acquired sequentially. A sensible strategy is to accumulate evidence, weighted by its reliability, until sufficient support is attained. An optimal statistical approach would accumulate evidence in units of logarithms of likelihood ratios (logLR) to a desired level. Studies of perceptual decisions suggest that the brain approximates an analogous procedure, but a direct test of accumulation, in units of logLR, to a threshold in units of cumulative logLR is lacking. We trained rhesus monkeys to make decisions based on a sequence of evanescent, visual cues assigned different logLR, hence different reliability. Firing rates of neurons in the lateral intraparietal area (LIP) reflected the accumulation of logLR and reached a stereotyped level before the monkeys committed to a decision. The monkeys’ choices and reaction times, including their variability, were explained by LIP activity in the context of accumulation of logLR to a threshold. [ABSTRACT FROM AUTHOR]

Reexpansion pulmonary edema ( RPE) is an increased permeability pulmonary edema that usually occurs in the reexpanded lung after several days of lung collapse. This condition is recognized to occur more frequently in patients under the age of 40 years, but there has been no detailed analysis of reported pediatric cases of RPE to date. For this review, Pub Med literature searches were performed using the following terms: 're(-)expansion pulmonary (o)edema' AND ('child' OR 'children' OR 'infant' OR 'boy' OR 'girl' OR 'adolescent'). The 22 pediatric cases of RPE identified were included in this review. RPE was reported in almost the entire pediatric age range, and as in adult cases, the severity ranged from subclinical to lethal. No specific treatment for RPE was identified, and treatment was administered according to the clinical features of each patient. Of the 22 reported cases, 10 occurred during the perioperative period, but were not related to any specific surgical procedures or anesthetic techniques, or to the duration of lung collapse. Pediatric anesthesiologists should be aware that pediatric RPE can occur after reexpansion of any collapsed lung and that some invasive therapies can be useful in severe cases. [ABSTRACT FROM AUTHOR]

The diaphragm is one of the organs directly affected by abdominal sepsis. Evidence suggests that sepsis induces diaphragmatic fatigability and that activated neutrophils play a crucial role in the development of diaphragmatic fatigability. In the present study, we investigated whether olprinone, a phosphodiesterase inhibitor, influenced the kinetics of cytokine-induced neutrophil chemoattractant-1 (CINC-1) in the diaphragm under abdominal septic conditions. Male Wistar rats were randomly assigned to a sham group, a cecal ligation and perforation group, and a phosphodiesterase inhibitor-pretreated group. To measure serial changes in CINC-1 concentrations, the right hemidiaphragm was removed at 4, 8, and 16 h after the surgical procedure in each group. In the cecal ligation and perforation group, CINC-1 concentrations in the diaphragm were significantly elevated compared with those in the sham group at both 4 and 8 h after the cecal ligation and perforation procedure. In the phosphodiesterase inhibitor-pretreated group, olprinone significantly attenuated the elevated CINC-1 concentrations at both 4 and 8 h after the surgical procedure. However, we observed no statistically significant differences in CINC-1 concentrations between the cecal ligation and perforation group and the phosphodiesterase inhibitor-pretreated groups at 16 h after the surgical procedure. Olprinone decreases elevated CINC-1 concentration in the diaphragm under septic conditions. This suggests that olprinone may inhibit neutrophil recruitment to the diaphragm. [ABSTRACT FROM AUTHOR]

Laparoscopic adjustable gastric banding (LAGB) is a common type of bariatric surgery worldwide, though not so in Japan. Here we report the anesthetic management of LAGB in ten Japanese patients with morbid obesity. General anesthesia was induced with propofol, fentanyl, and vecuronium bromide and maintained with sevoflurane in oxygen and air (or nitrous oxide in some cases). In a limited number of patients, perioperative epidural analgesia was performed, with fentanyl injected intravenously for analgesia in the remaining patients. Although some special considerations were needed, in perioperative management, including thromboprophylaxis, there were no severe complications in any of the patients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the medical case of a two-year-old girl with bilateral developmental dysplasia of the hip (DDH) and suspected reexpansion pulmonary edema (RPE).

The article presents a case study of a five years old girl child with pervasive developmental disorder and who is also born small for gestational age(SGA). She was receiving growth harmone (GH) therapy and laboratory findings revealed no chromosomal anomalies, endocrine abnormalities, and none of congenital anomaly syndromes. SGA short stature is not involved in the predictive factors of difficult intubation. It mentions SGA children receiving GH therapy, might have difficult airway.

A letter to the editor is presented in response to the article by Alan R. Tait on the study of children with attention deficit/hyperactivity disorders who underwent anesthesia.

Abstract We aimed to clarify prophylactic antimicrobial effects of single-dose piperacillin (PIPC) for perioperative infections in the transurethral resection of bladder tumor (TURBT) in comparison with those of single-dose tazobactam/piperacillin (TAZ/PIPC) through a retrospective analysis. We analyzed data from 192 TURBT patients treated with single-dose (4 g) intravenous PIPC (P group) between April 2015 and April 2017. For comparison, we analyzed data from 50 TURBT patients treated with single-dose (4.5 g) intravenous TAZ/PIPC (T/P group) between June 2013 and April 2014. We compared the perioperative incidences of fever (≥38 °C) and bacteriuria in the two groups. The number of febrile patients was four (2.1%) in the P group and one (2.0%) in the T/P group, without significant difference (p = 0.970). Among these febrile patients, urine and blood samples of two patients in the P group tested positive for bacterial cultures of Citrobacter koseri and Enterococcus faecalis , respectively. None of the patients in the T/P group tested positive for urine culture, postoperatively. However, 22 patients (18.2%) in the P group tested positive for urine culture, and Staphylococcus epidermidis (six patients), E. faecalis (three patients), Escherichia coli (three patients), Streptococcus agalactiae (two patients), Staphylococcus aureus (two patients), and C. koseri (one patient) were isolated. There was no significant difference in the incidence of bacteriuria in these two groups (p = 0.055). Based on these results, single-dose PIPC administration for the prevention of perioperative infections in TURBT was as effective as TAZ/PIPC. [ABSTRACT FROM AUTHOR]

A correction to the article "Occurrence of infection following prostate biopsy procedures in Japan: Japanese Research Group for Urinary Tract Infection (JRGU): A multi-center retrospective study," published in an issue of the journal is presented.