Cattle are major reservoirs of the provisionally named influenza D virus, which is potentially involved in the bovine respiratory disease complex. Here, we conducted a serological survey for the influenza D virus in Japan, using archived bovine serum samples collected during 2010–2016 from several herds of apparently healthy cattle in various regions of the country. We found sero-positive cattle across all years and in all the prefectural regions tested, with a total positivity rate of 30.5%, although the positivity rates varied among regions (13.5–50.0%). There was no significant difference in positivity rates for Holstein and Japanese Black cattle. Positivity rates tended to increase with cattle age. The herds were clearly divided into two groups: those with a high positive rate and those with a low (or no) positive rate, indicating that horizontal transmission of the virus occurs readily within a herd. These data demonstrate that bovine influenza D viruses have been in circulation for at least 5 years countrywide, emphasizing its ubiquitous distribution in the cattle population of Japan.

A risk assessment was conducted to assess the risk of ASFV entry into Japan through pork products illegally brought in by air passengers from China and fed to pigs in Japan. Scenario tree modelling was used with the following entry and exposure pathway considered to be the most likely route of ASF entry: an ASFV infected pork product is illegally brought into Japan by air travellers from China; this pork product is then used in a restaurant where scrap waste is recycled for animal feed and subsequently fed to pigs without being heattreated. Input parameter values were based on surveys conducted by the authors, scientific data gathered from the literature and official data published by government agencies. The annual probability of ASFV entry into Japan via this pathway was predicted to be 0.20 (90% prediction interval: 0.00-0.90). The wide prediction interval was mainly caused by the uncertainty regarding the dose response relation of ASFV, followed by the probability of an ASF infected pig dying on affected farms, the loading of ASFV in an infected pig and the probability of an illegally imported pork product being heat-treated in China and used in restaurants. The results of scenario analysis revealed that the annual probability of ASFV entry into Japan will increase with an increase in the number of ASF affected farms in China. The probability of ASFV entry will increase substantially even if only a small proportion of Ecofeed is not heat-treated during the production process. The probability will decrease if an increased proportion of farms that feed swill apply heat-treatment before feeding swill to their pigs. These findings indicate that stringent application of heat-treatment of Ecofeed and swill is key to protecting the Japanese pig industry from the introduction of ASFV.

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Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis for acute ischaemic stroke in China. Regional emergency systems have been proven a successful approach to improve access to thrombolysis. Shenzhen is a high population density city with great geographical disparity of healthcare resources, leading to limited access to rt-PA thrombolysis for most patients with acute ischaemic stroke. To improve rapid access to rt-PA thrombolysis in Shenzhen, a Shenzhen stroke emergency map was implemented by Shenzhen healthcare administrations. This map comprised certification of qualified local hospitals, identification of patients with stroke, acute stroke transport protocol and maintenance of the map. We conducted a retrospective observational study to compare consecutive patients with acute stroke arriving at qualified local hospitals before and after implementation of the Shenzhen stroke emergency map. After implementation of the map, the rate of patients receiving rt-PA thrombolysis increased from 8.3% to 9.7% (p=0.003), and the rate of patients treated with endovascular thrombectomy increased from 0.9% to 1.6% (p<0.001). Sixteen of 20 hospitals have an increase in the number of patients with stroke treated with rt-PA thrombolysis. The median time between receipt of the call and arrival on the scene reduced significantly (17.0 min vs 9.0 min, p<0.001). In Shenzhen Second People’s Hospital, the median onset-to-needle time and door-to-needle time were reduced (175.5 min vs 149.5 min, p=0.039; 71.5 min vs 51.5 min, p<0.001). No statistically significant differences were found in the proportion of rt-PA-treated patients within various geographical distances. Currently, there are more than 40 cities in China implementing a stroke emergency map. The Shenzhen stroke emergency map improves access to rt-PA thrombolysis for acute ischaemic stroke, and the novel model has been expanded to multiple areas in China. Future efforts should be conducted to optimise the stroke emergency map.

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Background: The issue of whether serum uric acid (SUA) is associated with the outcome of acute ischemic stroke is controversial. This study aimed to evaluate the correlation between the SUA level and outcome of patients with ischemic stroke by performing a meta-analysis. Materials and Methods: Studies were included by a systematic search of several databases through December 01, 2018, followed by reviewing reference lists of obtained articles. Studies that included odds ratios (ORs) for ischemic stroke outcome per unit SUA level with 95% confidence intervals (95% CIs) were eligible for the meta-analysis. A random-effects model was used to calculate the pooled risk estimate. Publication bias was detected by Begg’s test. Results: Fifteen studies with a total of 12,739 cases of stroke were included. Overall, higher SUA levels were associated with a significantly better outcome of ischemic stroke (OR, 1.13; 95% CI, 1.07-1.18; P<0.00001). For patients receiving thrombolytic therapy, a subgroup meta-analysis showed a positive association between SUA level and patient outcome (OR, 1.26; 95% CI, 1.14-1.40; P<0.00001). In addition, the pooled estimate of patients with a modified Rankin Scale score ≤2 at 90 days also showed a positive association (OR, 1.07; 95% CI, 1.01-1.133; P<0.00001). Furthermore, we found that the average SUA level in patients with a good outcome was higher than in those with a poor outcome (mean difference, 0.24 µmol/L; 95% CI, 0.16-0.32; P<0.00001). Conclusions: This meta-analysis suggested that there was a significant positive association between SUA level and the outcome of ischemic stroke.

Background Existing data suggest that cerebral autoregulation (CA) varies among different subtypes of ischaemic stroke. CA is globally impaired in patients with small artery occlusion (SAO). However, the factors influencing CA impairment in patients remains to be elucidated. Methods Stroke patients with SAO who underwent brain magnetic resonance imaging (MRI) were prospectively studied. Within 7 days after stroke onset, CA was recorded from the middle cerebral artery blood flow velocity and arterial blood pressure was simultaneously measured. Transfer function analysis was used to derive CA parameters, including gain and phase. Clinical characteristics, mean arterial pressure (MAP), biochemical findings, and cerebral small vessel disease (CSVD) markers on MRI were assessed in each patient. Factors associated with CA parameters were investigated. Univariate and multivariate linear regression analyses were conducted to determine the relationship between clinical factors and CA parameters. Results Sixty-three SAO patients (age, 56.3 ± 9.9 years; 55 men) were enrolled in the study. In the multiple linear regression analysis, after controlling for relevant clinical factors, MAP on admission (ipsilateral OR = 0.99 and contralateral OR = 0.99, both P < 0.005) was a significant independent predictor of bilateral gain. MAP > 105 mmHg on admission (OR = 0.77, P = 0.019) was significantly associated with ipsilateral gain. Diabetes mellitus was a significant predictive factor for bilateral gain (ipsilateral OR = 1.32 and contralateral OR = 1.22, both P < 0.005). No correlations were found between CA parameters and CSVD characteristics. Conclusion In SAO-related ischaemic stroke, patients with MAP > 105 mmHg on admission tended to have better ipsilateral CA. Diabetes mellitus appears to be an independent risk factor for CA impairment in patients with SAO-related stroke. CSVD may not be the main factor affecting bilateral CA in patients with SAO.

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