bluuebunny/crossref_metadata_2025 huggingface dataset:
A MODIFIED COTTON‐WOOL COLUMN METHOD FOR THE RAPID RECOVERY OF DNA FROM AGAROSE GEL SLICE
Authors: LIU BAOYI , XU WEICHEN , LUO ZHIYAO , LIU QIUYUN
Published: February 2008

A previous report has described a simple and inexpensive cotton‐wool column method for the recovery of DNA from agarose gel slice. However, it takes 2 h from start to finish. Here we present a simplified version of the technique which can cut hands‐on time to within 20 min while retaining a fair DNA yield. Agarose gel slice was mashed before conducting centrifugation of the cotton‐wool column tube, which enhanced DNA yield by at least 50%. Only one spin was required with a 30–35% DNA recovery rate, a second spin after treatment of agarose sediment in the tube with microwave would add another several percent. DNA obtained can be efficiently amplified by polymerase chain reaction (PCR) or subcloned. This provides a simple, rapid and cheap alternative to commercial kits.

PRACTICAL APPLICATIONS

The mashed agarose gel slice alone or with water is used for centrifugation with the best efficiency. The flowthrough can be directly used for polymerase chain reaction (PCR) amplifications, which would only take less than 10 min to obtain. The flowthrough must be ethanol precipitated if other molecular manipulations such as cloning are to be conducted, which will require another 10 min. One sample costs around 1 US cent to process with the cotton‐wool column method in developing countries. It will be a rapid and reliable alternative to expensive commercial kits.
EPITOPE ANALYSIS OF STREPTOCOCCAL M3 ANTIGEN‐SPECIFIC MONOCLONAL ANTIBODY
Authors: HONG KYONGSU
Published: February 2008

The binding domains of four monoclonal antibodies (mAbs) (4E10, 2C11, 1E10 and 3H9) specific for M3, the major protein surface antigen of Streptococcus pyogenes, were determined by Western blot analysis using truncated M3 polypeptides. The data indicate that epitopes for four mAbs are located within the B repeat block in M3 protein. A sandwich enzyme‐linked immunosorbent assay for detecting of M3 protein was established using these mAbs and polyclonal anti‐M3 antibody. The technique would be beneficial to our understanding of the epidemiology and to better control of streptococcal diseases.

PRACTICAL APPLICATIONS

Severe invasive diseases such as streptococcal toxic shock‐syndrome and necrotizing fasciitis have been mainly caused by M1 and M3 serotypes. The M types are also associated with acute rheumatic fever (ARF). Importantly, serotype M3 strains cause a higher rate of lethal infections than other group A streptococcus (GAS) M types. Since epitopes for four monoclonal antibodies (mAbs) are located within the B repeat block in M3 protein, assays for detecting of the epitopes using the mAbs could be helpful for the detection of severe invasive diseases or ARF.
“Congratulations, You Have Been Randomized Into the Control Group!(?)”: Issues to Consider When Recruiting Schools for Matched‐Pair Randomized Control Trials of Prevention Programs
Authors: Ji Peter , DuBois David L. , Flay Brian R. , Brechling Vanessa
Published: February 2008

Background:  Recruiting schools into a matched‐pair randomized control trial (MP‐RCT) to evaluate the efficacy of a school‐level prevention program presents challenges for researchers. We considered which of 2 procedures would be most effective for recruiting schools into the study and assigning them to conditions. In 1 procedure (recruit and match/randomize), we would recruit schools and match them prior to randomization, and in the other (match/randomize and recruitment), we would match schools and randomize them prior to recruitment.

Method:  We considered how each procedure impacted the randomization process and our ability to recruit schools into the study. After implementing the selected procedure, the equivalence of both treatment and control group schools and the participating and nonparticipating schools on school demographic variables was evaluated.

Results:  We decided on the recruit and match/randomize procedure because we thought it would provide the opportunity to build rapport with the schools and prepare them for the randomization process, thereby increasing the likelihood that they would accept their randomly assigned conditions. Neither the treatment and control group schools nor the participating and nonparticipating schools exhibited statistically significant differences from each other on any of the school demographic variables.

Conclusions:  Recruitment of schools prior to matching and randomization in an MP‐RCT may facilitate the recruitment of schools and thus enhance both the statistical power and the representativeness of study findings. Future research would benefit from the consideration of a broader range of variables (eg, readiness to implement a comprehensive prevention program) both in matching schools and in evaluating their representativeness to nonparticipating schools.
The Relationship Between School Absence, Academic Performance, and Asthma Status
Authors: Moonie Sheniz , Sterling David A. , Figgs Larry W. , Castro Mario
Published: February 2008

Background:  Children with asthma experience more absenteeism from school compared with their nonasthma peers. Excessive absenteeism is related to lower student grades, psychological, social, and educational adjustment. Less is known about the relationship between the presence of asthma and the academic achievement in school‐aged children. Since students with asthma miss more days from school, this may negatively impact their academic achievement. The goal of this study was to investigate the relationships between absenteeism, presence of asthma, and asthma severity level with standardized test level performance in a predominantly African American urban school district.

Methods:  A cross‐sectional analysis was conducted of 3812 students (aged 8‐17 years) who took the Missouri Assessment Program (MAP) standardized test during the 2002‐2003 academic year.

Results:  After adjustment for covariates, a significant inverse relationship was found between absenteeism and test level performance on the MAP standardized test in all children (F = 203.9, p < .001). There was no overall difference in test level achievement between those with and without asthma (p = .12). Though not statistically different, those with persistent asthma showed a modestly increased likelihood of scoring below Nearing Proficient compared with those with mild intermittent asthma (adjusted odds ratio = 1.93, 95% confidence intervals = 0.93‐4.01, p = .08).

Conclusions:  A negative impact of absenteeism on standardized test level achievement was demonstrated in children from an urban African American school district. Children with asthma perform the same academically as their nonasthma peers. However, those with persistent asthma show a trend of performing worse on MAP standardized test scores and have more absence days compared with other students. More research is warranted on the effects of persistent asthma on academic achievement.
The principles of rapid response for amphibian conservation, using the programmes in Panama as an example
Authors: GAGLIARDO R. , CRUMP P. , GRIFFITH E. , MENDELSON J. , ROSS H. , ZIPPEL K.
Published: February 2008

As a direct response to many threats facing seriously threatened amphibian species, including habitat loss, pollution and, more recently, emerging infectious disease, ex situ captive‐breeding programmes have proven valuable tools in species preservation. Uniting scientific research and conservation initiatives, here the growth of ex situ conservation for nearly a decade in central Panama is discussed. Looking at three specific projects, it can be demonstrated that collaborative efforts and multiple‐response methods yield positive results in amphibian conservation and species preservation. At the same time, the lessons learned will be examined in each of these projects to allow for future amphibian conservation programmes to consider.
Quality of and Mold Growth on White Enriched Bread for Military Rations Following Directional Microwave Treatment
Authors: Lakins D.G. , Echeverry A. , Alvarado C.Z. , Brooks J.C. , Brashears M.T. , Brashears M.M.
Published: February 2008

ABSTRACT:  Meals ready‐to‐eat (MRE) are self‐contained and flexible packages used by military personnel while in the field to store food for an extended period of time; however, inclusion of white bread is not a common practice because of short shelf life stability and spoilage. The objective of this study was to determine mold inhibition and quality attributes over a 60‐d period after applying directional microwaves. Different bread loaves were used for quality and for microbiological experiments. For microbiological analysis, bread was exposed to 0‐, 5‐, 6‐, 7‐, 8‐, 9‐, and 10‐s directional microwave treatments after inoculation with a 3 strain cocktail of common bread mold, stored at 25 °C for 60 d, and monitored for mold growth. For quality analysis, bread was exposed to 0‐ and 10‐s treatments, stored at 25 °C, and moisture, water activity (aw), softness, and sensory analysis were analyzed on 0, 7, 14, 28, 45, and 60 d. There was no quantifiable mold present at day 0 when treated for 10 s (P < 0.05). By day 60, the 10‐s treatment had significantly lower counts (< 3 CFU/g) than the remaining treatments. Directional microwave treatment significantly decreased the moisture content of the bread but was not detectable by consumers. There was no difference in aw through day 45 but differences were detected at day 60. There were no differences in softness (mm) of the treated and untreated bread through day 60. No differences were detected by sensory analysis. Directional microwaves can be used to extend the shelf life of white enriched bread up 2 mo with minimal mold growth and without detrimental effect to quality.
A Soybean Cultivar Lacking Lipoxygenase 2 and 3 Has Similar Calcium Bioavailability to a Commercial Variety Despite Higher Calcium Absorption Inhibitors
Authors: Martino H.S.D. , Martin B.R. , Weaver C.M. , Bressan J. , Moreira M.A. , Costa N.M.B.
Published: February 2008

ABSTRACT:  The aim of this study was to evaluate calcium bioavailability of a new soybean variety without 2 lipoxygenases with better taste and flavor than a commercial variety containing all 3 isozymes. Using the femur 45Ca uptake method, calcium absorption from a new Brazilian variety, UFV‐116, was compared to a common Brazilian variety, OCEPAR 19. Male Sprague–Dawley growing rats weighing 150 to 170 g (10/group) received test meals of whole fat soy flour prepared from UFV‐116 or OCEPAR‐19 seeds labeled with 10 μCi of 45Ca. Femurs were removed after 48 h for determination of 45Ca uptake. Calcium fractional absorption was equivalent between the 2 varieties. The higher oxalate:calcium molar ratio and the higher content of oxalate and phytate (P < 0.05) found in the UFV‐116 variety did not affect calcium absorption. Therefore, the new variety is a comparable source of high bioavailable calcium.
Internal and External Time Conflicts in Adolescents: Sleep Characteristics and Interventions
Authors: Fischer F. M. , Radosevic‐Vidacek B. , Koscec A. , Teixeira L. R. , Moreno C. R. C. , Lowden A.
Published: February 2008

ABSTRACT— Daytime fatigue and lack of sleep seem to increase throughout adolescent years. Several environmental, psychological, and biological factors have been associated with the development of sleep across adolescence. The aim of the present article is to summarize these factors and to give examples of various outcomes in sleep patterns among adolescents studied in different cultural settings. It is obvious from earlier work that many adolescents have displaced circadian rhythms and lack of adaptation to school hours due to an early school start or additional burdens for work. Several interventions have aimed to help the adaptation process by supporting sleep processes and changing scheduling, in this way promoting classroom alertness. In summary, adolescents worldwide shorten their sleep due to schoolwork hours and additional work, especially by disturbing their sleep due to circadian misalignment.
Transforming growth factor‐β in cutaneous melanoma
Authors: Javelaud Delphine , Alexaki Vasileia‐Ismini , Mauviel Alain
Published: February 2008

Transforming growth factor‐β (TGF‐β) plays a complex role during carcinogenesis. It may either act as a tumor suppressor through its broad antiproliferative potential or as a tumor promoter either via direct effects on tumor cell aggressiveness or indirectly by modulating stromal responses, angiogenesis and immune surveillance. Increased production of TGF‐β by cancer cells is often associated with tumor grade. Melanoma cells largely escape cell cycle arrest normally induced by TGF‐β in normal melanocytes, yet produce active TGF‐β and are capable of efficient transcriptional responses to the growth factor. In this review, we summarize the current knowledge about the role played by TGF‐β in melanoma progression and hypothesize about the appropriateness of targeting TGF‐β signaling for therapeutic intervention.
Acute Normovolemic Hemodilution
Authors: Goodnough Lawrence T.
Published: February 2008

I Acute normovolemic hemodilution is a point of care method of autologous blood procurement. Acute hemodilution has several inherent advantages over preoperative autologous blood donation: it is inexpensive, does not require testing, and has none of the risks of administrative error or bacterial contamination related to stored blood. The clinical efficacy of acute hemodilution is increasingly apparent. This technique will also serve as a foundation for the use of emerging oxygen carrying solutions.
Transfusion Alternatives in Trauma
Authors: Biffl Walter L. , Moore Ernest E.
Published: February 2008

Restoration of oxygen‐carrying capacity plays an essential role in the management of trauma patients. The potential risks associated with allogeneic blood, as well as the immunosuppressive potential of transfusions, have stimulated interest in alternatives to allogeneic blood transfusion. In the setting of trauma, the feasible alternatives are limited to autotransfusion and blood substitutes. Autotransfusion avoids infectious risks and obviates compatibility testing. However, coagulopathy remains a significant problem associated with autotransfusion. Hemoglobin substitutes offer many theoretical advantages over allogeneic transfusion. Several formulations have been investigated in clinical trials. Our experience has been exclusively with a polymerized, pyridoxylated stroma‐free human hemoglobin‐based solution (PolyHeme). In infusions up to 10 units (5 liters) PolyHeme has proved an adequate oxygen carrier without serious adverse effects, and has reduced the need for allogeneic blood. Given its safety, efficacy, and favorable immunomodulatory profile, PolyHeme appears to have tremendous potential as an alternative to transfusion.
Transfusion Alternatives in Orthopedic Surgery
Authors: Earnshaw Peter H.
Published: February 2008

The volume of orthopedic surgery is large and growing ‐ over 200,000 hip and knee arthroplasties were performed in the USA alone last year ‐ and these patients are at particularly high risk of requiring a blood transfusion. Orthopedic surgeons can significantly reduce the amount of allogeneic blood transfused by following simple guidelines. Accurate data gathering has allowed us to better target those most at risk. A wide range of strategies is available including, but not limited to, review of transfusion triggers, autologous predonation, hemodilution techniques, blood salvage and the use of perioperative erythropoietin. Some techniques are particularly suited to orthopedic surgery and the use of an algorithm can help us to select the best approach for the individual patient.
Anemia and Cardiovascular Disease
Authors: Wahr Joyce A.
Published: February 2008

Cardiovascular disease accounts for the majority of deaths each year in Westernized countries. Anemia, with its obligatory increase in cardiac output, may present a special risk in these patients. A review of the physiology of acute and chronic anemia as well as the physiology of myocardial ischemia is presented, as is also a review of the literature regarding the risks and recommendations for therapy in this group of high‐risk patients.
Acute Normovolemic Hemodilution (ANH). A practical approach.
Authors: Shander Aryeh
Published: February 2008

As one of the modalities available for perioperative blood conservation, ANH presents a dilemma to the clinician for various reasons. First, the efficacy of ANH as a technique for blood conservation has been challenged by some investigators. Others suggest that ANH is only effective with ranges of blood collection and severity of anemia that make most anesthesiologists uncomfortable14. In addition, performance of ANH requires experienced clinicians, and additional work and vigilance by the anesthesiology staff. The combination of skepticism, increased work, and training requirements without the benefit of reimbursement make this simple and valuable procedure one of the most underutilized forms of intraoperative blood conservation techniques. The gain in popularity of all blood conservation techniques in the last decade has resulted in the reexamination of the efficacy of ANH and the need to increase utilization of this technique. Although ANH has been a known modality for quite some time5 6, it has never gained full acceptance among anesthesiologists, surgeons, and others involved in blood conservation. Table 1 raises a number of issues
Crystalloids or Colloids for the Treatment of Hypovolemia?
Authors: Baron Jean‐François
Published: February 2008

Blood volume is a critical factor in maintaining hemodynamic equilibrium and tissue oxygenation. Intravascular volume is regulated very closely by means of several complex mechanisms, for which the onset of action varies widely. In some situations, such as acute bleeding, sepsis or with the use of certain drugs, the body must withstand absolute or relative changes in blood volume that cannot be immediately compensated for by the regulatory mechanisms. In these situations, the main goal of volume therapy is to temporarily increase plasma volume until the body's own mechanisms can correct the hypovolemia.

Treatment of hypovolemia has changed significantly in recent years. In the past, fresh frozen plasma (FFP) or its equivalent was long the volume expander most commonly used. Now, indications for FFP are limited to the correction of some hemostatic disorders. A by‐product of this legitimate change in practice was increased use of human albumin. Because of the financial consequences of this strategy, several consensus conferences have issued recommendations on the best indications for the use of various plasma volume expanders.

Despite these recommendations, the choice of the appropriate agent in the treatment of hypovolemia has not yet been settled. The debate on crystalloids versus colloids continues, along with a debate on the choice of colloid.
Oxygen Carriers ‐ What is Behind Us? What is Ahead?
Authors: Spiess Bruce D.
Published: February 2008

Is there a need for blood substitutes? Five years ago, that question would have met with a nearly universal answer of “yes” as the HIV crisis was front‐page news in every major news publication in the developed world. Today, a number of advances in blood banking have given us the safest blood supply that has ever existed. Therefore, some clinicians have taken that claim (the safest blood supply) and have questioned the need for a “blood substitute”. Although the incidence of viral disease transmission by blood products has drastically declined in the last 10 years and HIV and hepatitis C transmission are now almost vanishingly rare, the other risks of blood transfusion remain. Allergic reaction occurs in approximately 1/100 units transfused and although sometimes dismissed as minor in certain cases, an allergic reaction may be life threatening (e.g. immediately after cardiopulmonary bypass). Graft‐versus‐host reaction, sepsis, transfusion‐related acute lung injury, and incompatibility are now coming more into focus as the viral transmission issues fade.
A New Hydroxyethyl Starch: HES 130/0.4 Voluven®
Authors: Baron Jean François
Published: February 2008

Blood volume is a critical factor in ma in taining hemody namic equilibrium and tissue oxyge nation. In travascular volume is regulated very closely by means of several complex mechanisms, for which the onset of action varies widely. Insome situations, such as acute bleeding, sepsis or with the use of certain drugs, the body must withstand absolute or relative changes in blood volume that cannot be immediately compensated for by the regulatory mechanisms. In these situations, the main goal of volume therapy is to temporarily increase plasma volume until the body's own mechanisms can correct the hypovolemia.

Treatment of hypovolemia has changed significantly in recent years. In the past, fresh frozen plasma (FFP) or its equivalent was long the volume expander most commonly used. Now, indications for FFP are limited to the correction of some hemostatic disorders. A by‐product of this legitimate change in practice was increased use of human albumin. Because of the financial consequences of this strategy, several consensus conferences have issued recommendations on the best indications for the use of various plasma volume expanders.

Despite these recommendations, the choice of the appropriate agent in the treatment of hypovolemia has not yet been settled. The debate on crystalloid s versus colloids continues, besides a debate on the choice of colloid.
Risks Associated with Under‐Transfusion
Authors: Wahr Joyce A.
Published: February 2008

Cardiovascular disease accounts for a majority of the deaths each year in westernized countries. Anemia, with its obligatory increase in cardiac output, may present a special risk in these patients. A review of the physiology of acute and chronic anemia as well as the physiology of myocardial ischemia is presented. A review of the literature regarding the risks and recommendations for therapy in this group of high‐risk patients is presented.
Transfusion Morbidity and Mortality in the ICU
Authors: Hébert Paul C
Published: February 2008

Transfusion of red blood cells (RBC) continues to be an important therapy for treatment of anemia in intensive care settings. The critically ill are a heterogeneous population affected by a variety of pathophysiological processes and are, therefore, predisposed to the – adverse outcomes of anemia. As such, the risks imposed on this population when transfusion therapy is prescribed are of great interest. Over the past decade there has been a shift in transfusion practice with guidelines being developed that promote more conservative and safer use of blood. The Transfusion Requirements in Critical Care (TRICC) trial clearly established the safety of a restrictive transfusion strategy, thereby suggesting that physicians could easily minimize exposure to allogeneic RBCs by lowering their transfusion threshold. Further research will add to the generalizability of this study as well as explore the possible mechanism to explain why red cell transfusions did not improve outcomes in the critically ill.
Lessons from Meta‐analysis: The Case of Albumin
Authors: Soni Neil
Published: February 2008

Evidence has long been the mainstay of medical practice. The introduction of meta‐analysis as a method coupled with stylized review, the systematic review, has produced a supposedly quantifiable and scientific means of collating evidence. While this has been used to good effect in some areas of medical practice where adequate data exist, it has also been applied in situations where there are woefully inadequate data. An example of this is the issue of the use of albumin. It is the author's contention that the methods used and the conclusions subsequently drawn were inappropriate and heavily flawed. This has given reason to review the validity of meta‐analysis in such circumstances and to challenge the method of systematic review.

The lessons learned from meta‐analysis do not relate to the subject of albumin, but to the potential for abuse of statistical method.
Efficacy of Preoperative Autologous Blood Donation
Authors: Mercuriali Francesco , Inghilleri Giovanni
Published: February 2008

Preoperative autologous blood donation (PABD) is the most widely utilized autotransfusion technique. However, improvements in allogeneic blood safety and increased pressure on cost‐containment command a review of its role by analyzing the need, feasibility, efficacy and cost‐effectiveness of the procedure. Residual risks and shortages of donor blood still support the need for PABD. Experiences worldwide show that the technique has a good feasibility profile when hospital resources are appropriately organized and support its safety in the majority of the patients scheduled for elective surgery. Studies in the United States and Europe demonstrate that PABD is effective in reducing exposure to allogeneic blood. However, the cost‐effectiveness of PABD has been claimed to be poor. Thus, strategies should be adopted to reduce the direct costs of PABD, to optimize its efficacy, and to reduce the collection of unnecessary blood units. PABD should be appropriately planned in order to derive the greatest physiologic benefits from blood collections. For example, it is necessary to start PABD at least 20 days before the operation, to collect at least two units of AB (autologous blood), and to monitor the patient's iron status. A personalized approach to define the patient's transfusion requirements can facilitate the decision about enrollment in a PABD program and define the number of units to be collected from a given patient.
The Changing Transfusion Practice of Neonatal and Pediatric Surgery
Authors: Kling Pamela J.
Published: February 2008

The use of erythrocyte transfusions to treat anemia in neonatal and pediatric surgery patients has changed dramatically over the last decade. Recombinant human erythropoietin (rHuEPO) has been shown to decrease transfusion exposure in many disease states in both adults and children. rHuEPO has also been used perioperatively in children. This paper discusses perioperative anemia, the current status of rHuEPO therapy, surgical and non‐surgical strategies that minimize blood loss, and transfusion therapy in the pediatric surgical patient.
Management of the Anemia of Prematurity Using Human Recombinant Erythropoietin
Authors: Ohls Robin K.
Published: February 2008

The evolution of clinical practice in the care of extremely low birth weight infants continues to affect their number of transfusions. Advancements such as improved ventilation and treatment of preterm lung disease, the development of pediatric laboratory equipment and microsampling techniques, and the use of alternatives to blood products such as human recombinant erythropoietin (rHuEPO) have all improved transfusion practices in neonatology. EPO has been studied extensively as treatment for a variety of anemias in adults and children. Following in vitro studies of the anemia of prematurity that showed the primary etiology to be decreased EPO concentrations, clinical trials evaluated the administration of EPO to preterm infants to treat the anemia of prematurity. Recent studies have focused on the administration of EPO in the first weeks of life to alleviate the anemia caused by excessive phlebotomy losses, and to prevent the anemia of prematurity. It is likely that EPO administration in combination with instituting rigorous transfusion guidelines and decreasing phlebotomy losses will have the greatest impact in decreasing transfusion requirements in all preterm and term neonates, regardless of the etiology of their anemia.
Using Small‐Volume Resuscitation in Sweden: Observations From Initial Experiences
Authors: Svensén Christer H.
Published: February 2008

One of the most striking features of infusing hypertonic solutions is the rapid onset of plasma volume expansion. Following a renewed interest raised by Brazilian researchers in 1980, various hyperosmotic solutions ‐ hypertonic saline alone or in combination with dextran or hetastarch ‐ have been developed for prehospital resuscitation of severe hemorrhagic shock. They have also been used in burns, sepsis, nontraumatic hemorrhages, and vascular and cerebral injuries. While clinical trials have not provided definitive data as to their efficacy, the available studies show that they might be beneficial in improving survival in patients with hypotension associated with traumatic injury. Furthermore, there is much clinical evidence that hypertonic solutions alone or in combination with colloids are the fluid of choice for head‐trauma patients. Numerous studies have already established their safety.
Volume Kinetics – Pharmacokinetics for Fluids
Authors: Svensén Christer H.
Published: February 2008

Fluid therapy is a main component in the management of critically ill patients. Unfortunately, a considerable number of patients receive excessive fluid therapy that results in volume overload and organ dysfunction. There is an obvious need for a more refined scientific method to replace the more or less precise “rules‐of‐thumb.” A new approach to fluid therapy‐volume kinetics‐is the first adaptation of pharmacokinetic theory that allows the behavior of fluid volumes administered during intravenous therapy to be analyzed and simulated.
Volume Kinetics and Hypertonic‐Hyperoncotic Solutions*
Authors: Hahn Robert G.
Published: February 2008

Kinetic analysis may be used to compare the potencies of infusion fluids to dilute venous plasma, which can be used as an index of plasma volume expansion. In male volunteers, Ringer's acetate and Ringer's lactate were between 5% and 15% less potent than 0.9% saline, while 7.5% saline was approximately 4 times and 7.5% saline in 6% dextran 70 approximately 6.5 times more potent than normal saline. Slightly different results were obtained depending on whether only the infusion period or both the infusion and postinfusion periods were studied.
The Dilemma Between Cost‐Effectiveness and Quality of Care in Transfusion Medicine: The Fiduciary Responsibility of the Physician to the Patient With Regard to Blood Transfusion and Transfusion Alternatives
Authors: Ziman Alyssa , Goldfinger Dennis
Published: February 2008

Cost‐effectiveness analysis (CEA) figures prominently in medical decision‐making and, therefore, must be easily applicable and correctly used. Unfortunately, CEA has the potential to be misleading and in many analyses, including those of transfusion safety initiatives, inappropriate benchmarks have been utilized. Consequently, many transfusion safety initiatives have been incorrectly deemed not cost‐effective and subsequently underutilized, allowing cost to dictate practice. This trend in transfusion medicine creates a dilemma for transfusion medicine professionals, who are torn between their roles as patient advocates and providers of quality patient care and as cost‐conscious laboratory administrators. Given patient demand always for the safest, most effective transfusion therapy regardless of cost and the current medical climate dictated by CEA, who should choose which transfusion safety initiative should be implemented or which transfusion product or alternative should be available? We believe that transfusion medicine professionals must first and foremost uphold their fiduciary responsibility to patients by delivering the safest, most effective therapy.
Perioperative Disorders of Primary Hemostasis: Determination and Treatment
Authors: Kretschmer Volker , Darakchtiev Anton , Bade Sascha , Weippert‐Kretschmer Monka
Published: February 2008

Primary hemostasis, the first phase of hemostasis after vessel injury, is a complex process involving the platelets and resulting in the formation of the platelet plug that forms the basis for further coagulation (secondary hemostasis). Perioperative bleeding complications are often due to disorders of primary hemostasis. With respect to detection and treatment, functional platelet disorders are a greater problem than thrombocytopenia. Therefore, routine screening tests for primary hemostasis appear to be more important than those usually performed on plasmatic coagulation. Among the various diagnosis tools for the evaluation of primary hemostasis, platelet count and the Platelet Function Analyser (PFA‐100) with epinephrine are sensitive and specific for the detection of primary hemostasis disorders, whereas TEG is only appropriate to detect those caused by thrombocytopenia. Screening tests for primary hemostasis should at least be performed before major or complicated operations. The administration of platelet‐inhibiting drugs before and shortly after surgery should be avoided or stopped in time. Most disorders of primary hemostasis caused by impairment of platelet function can be successfully treated with desmopressin alone or in combination with antifibrinolytics. Platelet count and the PFA‐100 with epinephrine are well‐suited to document therapeutic effect and guide the use of these agents that can considerably reduce the need for platelet transfusion and prevent bleeding complications.
Disseminated Intravascular Coagulation
Authors: Levi Marcel
Published: February 2008

Disseminated intravascular coagulation (DIC) is a syndrome characterized by systemic intravascular activation of coagulation, leading to widespread deposition of fibrin in the circulation. There is compelling evidence from clinical and experimental studies that DIC is involved in the pathogenesis of microvascular dysfunction and contributes to organ failure. In addition, the massive and ongoing activation of coagulation may result in depletion of platelets and coagulation factors, thereby causing bleeding. Recent insight into important pathogenetic mechanisms that may lead to DIC has resulted in novel preventive and therapeutic approaches to patients with sepsis and a derangement of coagulation. Thrombin generation proceeds via the (extrinsic) tissue factor/factor VIIa route and simultaneously occurring depression of inhibitory mechanisms, such as antithrombin III and the protein C system. Also, impaired fibrin degradation, due to high circulating levels of type 1 plasminogen activator inhibitor (PAI‐1), contributes to enhanced intravascular fibrin deposition. Supportive strategies aimed at the inhibition of coagulation activation may theoretically be justified and have been found to be beneficial in experimental and initial clinical studies. These strategies include inhibition of tissue factor‐mediated activation of coagulation or restoration of physiological anticoagulant pathways via the administration of antithrombin concentrate or recombinant human activated protein C.
Management of Anemia: Erythropoietin Therapy or Red Blood Cell Transfusion?
Authors: Goodnough Lawrence Tim
Published: February 2008

Erythropoietin therapy was approved for use as a blood conservation intervention beginning in 1989 for patients with medical anemia and in 1997 for surgical patients. The adoption of this strategy has been rapid in some settings (e.g., renal failure patients), progressive in others (e.g., cancer patients), and slow in others (e.g., surgery patients). At the same time, the risks of blood transfusion have declined substantially whereas the costs of blood transfusion have increased significantly. Issues regarding the risks and costs associated with blood transfusion have led to a reevaluation of clinical transfusion practices. The evolution of new techniques such as acute normovolemic hemodilution (ANH) and the novel erythropoiesis‐stimulating protein (NESP) bring new options to allogeneic blood transfusion. Erythropoietin therapy, with or without autologous blood procurement, is undergoing new scrutiny as an alternative to blood transfusion. This is not only because of traditional concerns regarding blood risks but because of new blood inventory and cost considerations.
The Emerging Dutch Hemovigilance System: Voluntary and State‐of‐the‐Art
Authors: Poel Cees L. van der , Schipperus Martin R.
Published: February 2008

SUMMARy

In 1996 the Dutch Inspectorate of Health enquired whether a national surveillance system for hemovigilance could be developed for the Netherlands. This request was inspired by the Untied Kingdom's initiative to install a reporting system for serious hazards of transfusion (SHOT).

An independent foundation named TRIP (Transfusion Reactions in Patients) was established, owned by the professional medical societies engaged in blood transfusion. TRIP was formally launched at the 5th European Hemovigilance Seminar in Amsterdam on February 6–7, 2003.The TRIP office has the aim to anonymously collate, register, analyze and report on the safety of blood transfusion. In addition, TRIP aims to enhance the safety of blood transfusion by educational programs on blood transfusion safety.

The TRIP program closely resembles the British SHOT system, in being a voluntary system supporting professionals and in its focus on serious adverse events. It is recognized that underreporting may exist, but it is felt that in The Netherlands a voluntary system would be more productive than a compulsory system.

TRIP holds the view that the correct and optimal use of blood is as important for blood transfusion safety as is the prevention of adverse events. In the future, it is envisaged that TRIP will participate in the education of nurses, doctors and technicians in blood transfusion safety.
Assessment of the Risk of Transfusion‐Transmitted Viral Infections
Authors: Kleinman Steven , Vamvakas Eleftherios c.
Published: February 2008

SUMMARy

The risk of transfusion‐transmitted viral infections is presently exceedingly low, and mathematical modeling is necessary to estimate the magnitude of the residual risk. Direct calculation of the risk from prospective studies of transfusion recipients is either not possible or prohibitively expensive. The accumulated experience with the incidence/window‐period model indicates that this approach can predict (1) the approximate residual risk of transfusion‐transmitted infections that are characterized by an infectious window period before appearance of infectious disease markers in peripheral blood; and (2) the approximate risk reduction that can be expected with implementation of new tests.
Intravenous Fluids and Renal Failure
Authors: O'Malley Catherine M.N.
Published: February 2008

Numerous intravenous fluid preparations are available for administration to patients in the clinical setting. These fluids have traditionally been described as either crystalloid or colloid but they may be further classified according to the nature of the solution itself, i.e. 0.9% NaCl (normal saline) or balanced salt‐based fluids (e.g., lactated Ringer's solution).

Until recently, little attention has been paid to the potential systemic effects of intravenous fluids that occur independently of their efficacy as agents for intravascular volume replacement. This article explores the available data regarding the impact of intravenous fluids on the kidney to determine whether there is any evidence linking intravenous fluid administration and the pathogenesis of renal dysfunction or renal failure. Particular reference is made to 0.9% NaCl and the hydroxyethylstarch solutions but other fluids such as gelatin and dextran are also considered. In addition, the metabolic effects of intravenous fluids are discussed as these may influence the choice of fluid type in patients with impaired renal function and renal failure.
Hyperchloremic Acidosis: Pathophysiology and Clinical Impact
Authors: Burdett Edward , Roche Antony M. , Mythen Michael G.
Published: February 2008

Hyperchloremic acidosis is a predictable consequence of normal saline‐based fluid administration. The theoretical basis for this is easily understood using Stewart's model of acid‐base homeostasis. Data are emerging which describe the consequences of hyperchloremic acidosis in the surgical population.
Cell Salvage in Cardiothoracic Surgery: Cost Issues
Authors: Morgan Cliff , Cooper Mary
Published: February 2008

The benefits of cell salvage in cardiothoracic surgery are generally accepted from a quality perspective and in terms of reducing the need for transfusion of allogeneic blood. The authors attempt to place this clinical quality driver in the context of financial issues such as the relative costs of using or, indeed, not using cell salvage. Recent developments in the United Kingdom make the case for widespread use of cell salvage very compelling but differences in the prevalence of transfusion‐related complications and different cost models in various health economies have to be considered.
Approaches to the Engineering of Hemoglobin‐Based Oxygen Carriers
Authors: Fronticelli Clara , Bellelli Andrea , Brinigar William S.
Published: February 2008

Molecular biology offers the opportunity to construct hemoglobin molecules as blood substitutes tailored to specific therapeutic applications. Oxygen affinity can be manipulated by amino acid substitutions in the heme pocket or on the protein surface. A response to the concentration of plasma‐Cl‐ that mimics the effect of 2,3‐DPG was also introduced in human Hb. Polymerization of tetrameric Hb prevents the vasoconstriction associated with infusion of Hb solutions. Polymers have been obtained through the formation of intermolecular S‐S bonds between cysteine residues introduced on the Hb surface. In a mouse model, transfusion of polymeric hemoglobins reduced the volume of cerebral infarction. This effect was particularly evident with polymers having a high oxygen affinity (P50≤˜2.0 Torr) and no cooperativity (n = 1). These are the same functional characteristics of myoglobin. Polymers of myoglobin have been constructed and could be a viable alternative to the use of polymeric hemoglobins in some pathological conditions.
Acute Normovolemic Hemodilution: A Critical Evaluation of Its Safety and Utility in Pediatric Patients
Authors: Wong Edward C. C.
Published: February 2008

The use of blood conservation techniques has gained importance since the 1980s when hazards of blood transfusion, especially transfusion of infectious agents, became well recognized. In adult medicine, predonation autologous blood donation (PABD) and techniques of intraoperative and postoperative collection and reinfusion, initially perfected during the Vietnam era, were used with increased frequency. Methods to limit homologous transfusion in pediatrics were slow to develop, at least in part due to limitations of venous access, operational complexity and the unique and ever changing physiology of the infant and toddler. Blood conservation techniques include PABD, intraoperative hemodilution, intraoperative blood recovery and postoperative scavenging. The history and physiology of hemodilution and its application in pediatric surgery patients with and without additional conservation methods in different clinical conditions will be discussed. In particular, the use of acute normovolemic hemodilution in pediatrics will be the focus of this review.
Aprotinin Versus Synthetic Antifibrinolytics in Cardiac Surgery
Authors: Dietrich Wulf
Published: February 2008

The prophylactic perioperative use of antifibrinolytics in open‐heart surgery substantially reduces hemorrhage and allogeneic blood requirements. This has been proven for open‐heart surgery, but is not as evident for other surgical procedures. In general, the higher the degree of intraoperative hemostatic activation, the more effective in terms of decreased bleeding tendency a pharmacological antifibrinolytic intervention will be. It should be emphasized that aprotinin, in contrast to tranexamic acid or epsilon aminocaproic acid, does not act as a pure antifibrinolytic, but also has thrombin‐reducing properties. Promising results for aprotinin as an antiinflammatory agent are under discussion. Both drugs are recommended for the reduction of bleeding tendency during and after open‐heart surgery. Review of the literature suggests the routine use of antifibrinolytics during open‐heart surgery.
Resuscitation Endpoints in Trauma
Authors: Napolitano Lena M.
Published: February 2008

Fluid and blood resuscitation is the mainstay of therapy for the treatment of hemorrhagic shock, whether due to trauma or other etiology. Cessation of hemorrhage with rapid hemostatic techniques is the first priority in the treatment of traumatic hemorrhagic shock, with concomitant fluid resuscitation with blood and crystalloids to maintain perfusion and organ function. “Hypotensive” or “low‐volume” resuscitation has become increasingly accepted in the prehospital resuscitation phase of trauma, prior to definitive hemorrhage control, since aggressive fluid resuscitation may increase bleeding. Resuscitation after hemorrhage control is focused on restoration of tissue oxygenation. Efforts to optimize resuscitation have used “resuscitation endpoints” as markers of adequacy of resuscitation. The resuscitation endpoints that have been evaluated include both global (restoration of blood pressure, heart rate and urine output, lactate, base deficit, mixed venous oxygen saturation, ventricular end‐diastolic volume) and regional (gastric tonometry, near‐infrared spectroscopy for measurement of muscle tissue oxygen saturation) measures. This review critically evaluates the evidence regarding the use of resuscitation endpoints in trauma.
Overview of Transfusion Practices in Perioperative and Critical Care*
Authors: Hébert Paul C. , McDonald Bernard J. , Tinmouth Alan
Published: February 2008

Decisions concerning the use of allogeneic red blood cell (RBC) transfusion in the treatment of anemia and hemorrhage require a clear understanding of the risks and benefits of both the condition and its treatment. Although we have developed a much clearer appreciation for the infectious and immunomodulatory risks of RBC transfusion over the past two decades, the risks of anemia in many clinical settings and the benefits of RBC transfusion are still inadequately characterized. Only one large randomized controlled trial has examined red cell administration in the perioperative and in the critical care setting, and high‐quality clinical evidence is not yet available for many decisions related to red cell transfusions. Several studies and initiatives to evaluate alternatives to RBC transfusions and to improve current understanding of transfusion practices are underway. It is anticipated that risks and benefits of red cells and alternatives will be elucidated in the coming years.
Thoughts on the Mechanism of Action of Aprotinin
Authors: Royston David
Published: February 2008

Currently there is no unifying theory that fully explains the hemostatic action of aprotinin. The majority of data related to the potential mechanism(s) of action of aprotinin can be broadly divided into the three topics of preservation of platelet function, reduced fibrinolysis and inhibition of thrombin generation. These three themes are not mutually exclusive and have evidence that either supports or refutes their importance in the process. What is clear when all of the scientific evidence is evaluated is that aprotinin is not simply an antifibrinolytic. The agent has multiple direct and indirect effects to inhibit platelet and coagulation functions in addition to inhibition of free plasmin. Despite the incomplete knowledge of its mechanism of action, aprotinin given in a sufficient dose remains the most potent agent currently available to prevent the need for transfusions of blood and hemostatic components in multiple surgical environments.
Stylus Flight in Surface Profiling
Authors: Song J. F. , Vorburger T. V.
Published: February 2008

In this paper, theoretical and experimental work on stylus flight is described. Experiments on the surfaces of different roughness specimens with sinusoidal, rectangular, triangular and random waveforms support the theoretical model, which predicts stylus flight from the traversing speed, stylus force, stylus radius and parameters of the surface.