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The risk of transmissible spongiform encephalopathy (TSE) infection from endoscopic procedures has been discussed recently in this journal.1,2 Subclinical carriers of variant Creutzfeldt–Jakob disease (vCJD), the numbers of whom are unknown, may present a risk of iatrogenic infection to susceptible patients participating in endoscopy. We report a pilot study, undertaken here on sheep, describing a non-invasive assessment of autonomic function based on heart rate variability (HRV) which may provide a useful screening method for subclinical carriers of certain TSE diseases.
Detection of disease associated prion protein (PrPd) in the brain stem is used in confirmatory postmortem tests for bovine spongiform encephalopathy (BSE) and sheep scrapie; this protein is also present in humans with vCJD.3–5 In scrapie, the timing of PrPd accumulation in the dorsal motor nucleus of the vagus nerve (DMNX) indicates that this is a likely site of initial neuroinvasion.4 Non-myelinated vagal fibres from the DMNX and faster myelinated vagal fibres from the nucleus ambiguus are involved in the control of HRV, which is the millisecond beat to beat change that is …
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