bluuebunny/crossref_metadata_2025 huggingface dataset:
Behaviour is not really at risk after surviving meningitis in childhood
Authors: Ritchi Lieneke , Jennekens‐Schinkel Aag , Van Schooneveld Monique , Koomen Irene , Geenen Rinie
Published: February 2008

Aim: To examine behaviour problems, personality, self‐perceived competence and academic deficits in children who had recovered from non‐Haemophilus influenzae type b (Hib) bacterial meningitis (BM) without obvious medical sequelae.

Methods: Assessments in 182 children, mean age 10 (range 5–14) years, 4–10 years after surviving meningitis, were compared to scores of norm reference groups.

Results: More children were estimated to have academic deficits (27%) than behaviour problems as perceived by the parents (9%). The mean deviation from normal was absent to moderate on behaviour problems, personality variables and self‐perceived competence.

Conclusion: Children who survived non‐Hib BM without severe medical sequelae hardly differ from normal children with respect to personality and self‐perceived competence. A small proportion deviates from normal in behaviour problems.
The role of candidal histolytic enzymes on denture‐induced stomatitis in patients living in retirement homes
Authors: Thiele Magna Carvalho de Menezes , Carvalho Alessandra de Paula e , Gursky Lauren Christine , Rosa Rosimeire Takaki , Samaranayake Lakshman Perera , Rosa Edvaldo Antonio Ribeiro
Published: February 2008

Material and methods:  Fifty nine elders wearing complete dentures and living in retirement homes in Curitiba (southern Brazil), were divided into two groups: group #1, 26 patients with denture‐induced stomatitis and group #2, 33 patients without denture‐induced stomatitis. The two groups were evaluated in relation to the degree of denture‐induced stomatitis, salivary fungal loads, and secretion of some histolytic enzymes.

Results:  Patients from group #1 showed higher degrees of colonisation by Candida albicans (p = 0.031). Candida krusei, Candida tropicalis, and Candida parapsilosis were also isolated, but there were no differences between the groups (p > 0.05). Secretory aspartyl protease (Sap) and chondroitinase did not show significant differences among the isolated Candida spp. in the two groups. Phospholipase secretion rates were higher among the strains of C. albicans from group #2 (p = 0.036). The same behaviour was not detected for non‐albicans Candida species.

Conclusions:  The results could infer that differences in the secretion rates of candidal histolytic enzymes should not be imputed as imperative for the progress of denture‐induced stomatitis.
Pollen Morphology of Pedicularis sect. Cyathophora, a Group Endemic to the Eastern Himalaya‐Hengduan Mountains Region
Authors: Yu Wen‐Bin , Wang Hong
Published: February 2008

Pedicularis sect. Cyathophora is a distinctive group endemic to the eastern Himalaya‐Hengduan Mountains region. It was regarded as a ‘grex’ or section and included all four general corolla types of Pedicularis. A unique feature of it is that the leaf and bract bases are fused together to form a cup‐like structure around the stem at each node. Pollen morphology of seven species in sect. Cyathophora was investigated by scanning electron microscopy (SEM) and light microscopy (LM). Two different pollen apertures could be distinguished (i.e. trisyncolpate and bisyncolpate) using LM, while examination with SEM made it possible to recognize three types of exine ornamentation (i.e. microscabrate, microfoveolate and microreticulate). The microfoveolate exine ornamentation was found in trisyncolpate pollen grains for the first time. Possible relationships between pollen data and the corolla types were discussed. Comparisons of floral and phyllotaxy characters of the genus Pedicularis, together with the pollen characters of sect. Cyathophora, could help us to better understand the evolutionary trends in Pedicularis.
Characters of DNA Constitution in the Rye B Chromosome
Authors: Long Hong , Qi Zhong‐Xia , Sun Xiao‐Ming , Chen Cheng‐Bin , Li Xiu‐Lan , Song Wen‐Qin , Chen Rui‐Yang
Published: February 2008

We have
used chromosome microdissection and microcloning to construct a DNA library of the entire B chromosome (B) of rye. New rye B‐specific sequences have been screened from this pool, blasted with other sequences and analyzed to elucidate the characters of DNA constitution and the possible pathway of the origin of the rye B chromosome. We report the discovery of a new sequence that is specific to the rye B centromere.
Mapping and Quantitative Trait Loci Analysis of Verticillium Wilt Resistance Genes in Cotton
Authors: Wang Hong‐Mei , Lin Zhong‐Xu , Zhang Xian‐Long , Chen Wei , Guo Xiao‐Ping , Nie Yi‐Chun , Li Yun‐Hai
Published: February 2008

Verticillium wilt is one of the most serious constraints to cotton production in almost all of the cotton‐growing countries. In this study, “XinLuZao1” (XLZ1), a susceptible cultivar Gossypium hirsutum L. and “Hai7124” (H7124), a resistant line G. barbadense, and their F2:3 families were used to map and study the disease index induced by verticillium wilt. A total of 430 SSR loci were mapped into 41 linkage groups; the map spanned 3 745.9 cM and the average distance between adjacent loci was 8.71 cM. Four and five quantitative trait loci (QTLs) were detected based on the disease index investigated on July 22 and August 24 in 2004, respectively. These nine QTLs explained 10.63−28.83% of the phenotypic variance, six of them were located on the D sub‐genome. Two QTLs located in the same marker intervals may partly explain the significant correlation of the two traits. QTLs explaining large phenotypic variation were identified in this study, which may be quite useful in cotton anti‐disease breeding.
Afrotropical amphibians in zoos and aquariums: will they be on the ark?
Authors: LÖTTERS S.
Published: February 2008

The worldwide status of the amphibians is alarming and one of the most effective conservation measures will be breeding in zoos and aquariums. In this paper, the situation for Afrotropical amphibians is highlighted. According to the Global Amphibian Assessment (GAA), one‐quarter of the c. 1000 described Afrotropical species is threatened with extinction, as is one‐quarter of the c. 230 described Madagascan endemics alone. Habitat destruction is the most serious threat in the region, while the amphibian chytrid fungus Batrachochytrium dendrobatidis apparently plays a minor role. However, although known to be present on mainland Africa, this pathogen has not yet been recorded on Madagascar. It could therefore pose a serious threat to the Madagascan amphibian fauna in the future. The International Species Information System (ISIS) lists only about 5% of all Afrotropical amphibians maintained in zoos and aquariums, half of which are Madagascan, with a focus on Mantella frogs. Only 16 of these species are considered to be threatened under the GAA, including 11 Madagascan species. Conservation breeding is currently practiced in a single species only: the Critically Endangered Tanzanian Kihansi spray toad Nectophrynoides asperginis. Using both GAA and ISIS, the number of species identified as threatened is about 15 times higher than the number of species currently maintained in zoos and aquariums. The Madagscan situation is slightly better because one‐fifth of the 55 known threatened species is maintained in zoos and aquariums. Considerably more effort must be put into conservation breeding in the Afrotropical region.
Physicochemical Properties of Partially Oxidized Corn Starch from Bromide‐Free TEMPO‐Mediated Reaction
Authors: Chang P.S. , Park K.O. , Shin H.K. , Suh D.S. , Kim K.O.
Published: February 2008

ABSTRACT:  This study was conducted to determine the optimal temperature and time for the regiospecific oxidation of primary alcohol groups in corn starch with 2,2,6,6‐tetramethyl‐1‐piperidinyl oxoammonium ion (TEMPO) and sodium hyphochlorite (NaOCl). The study also elucidated the molecular structure of fully oxidized corn starch (FOCS) prepared at optimum temperature and physicochemical properties of the partially (10%, 20%, and 30%) oxidized corn starches (POCS). The reaction time rapidly decreased up to 30 °C, and then gradually decreased. Selectivity, yield, and viscosity were drastically reduced at temperatures higher than 35 to 40 °C. Optimal oxidation temperature for the production of FOCS was determined as 35 °C. Regiospecific oxidation of the primary alcohol group without oxidation of the secondary alcohol group was confirmed in 13C‐NMR and IR spectra. Water‐binding capacity, swelling power, solubility power, and transmittance of POCS increased as the degree of oxidation increased. Hardness, gumminess, and chewiness of corn starch gel containing POCS were not significantly different from those of native corn starch gel at 1‐d storage, but the values of the starch gel containing POCS were smaller than those of the native starch gel after 1‐d storage. However, springiness and cohesiveness did not differ significantly among the samples regardless of storage time.
Mind, Brain, Education, and Biological Timing
Authors: Golombek Diego A. , Cardinali Daniel P.
Published: February 2008

ABSTRACT— Circadian rhythms, in particular the sleep–wake cycle, modulate most, if not all, aspects of physiology and behavior. Their impact on education has recently begun to be understood, including a clear positive relationship between sleep and learning. In fact, sleep deprivation, common to adolescents throughout the world, has a deep effect on academic performance, and this fact is often increased by inadequate school schedules. This special issue of Mind, Brain, and Education deals with the relation between biological rhythms and learning, as discussed in an International Mind, Brain, and Education Society meeting that took place in Erice, Italy in May 2007. The articles (with contributors from Brazil, Croatia, Sweden, Spain, United Kingdom, United States, and Argentina) cover several aspects of this fundamental link between timing and education and suggest strategies to optimize school and sleep schedules for a better quality of life and improved academic performance of students.
Time Constraints in the School Environment: What Does a Sleepy Student Tell Us?
Authors: Menna‐Barreto Luiz , Wey Daniela
Published: February 2008

ABSTRACT— In this article, we discuss school schedules and their implications in the context of chronobiological contemporary knowledge, arguing for the need to reconsider time planning in the school setting. We present anecdotal observations regarding chronobiological challenges imposed by the school system throughout different ages and discuss the effects of these schedules in terms of sleepiness and its deleterious consequences on learning, memory, and attention. Different settings (including urban vs. rural habitats) influence timing, which also depends on self‐selected sleep schedules. Finally, we criticize the traditional view of a necessary strict stability of sleep–wake habits.
Intraoperative Autotransfusion of RBC and PRP
Authors: Gombotz Hans , Kulier Alexander
Published: February 2008

When IAT is used, the patient's shed blood is collected continuously from the wound site during surgery. The salvaged red cells are stored in a dedicated reservoir and subsequently processed by cell separation (continuous centrifugation), washed with saline, concentrated and retransfused to the patient. In the context of perioperative blood saving strategies, IAT has gained standard‐of‐care status in many surgical procedures as it is especially cost‐effective when the anticipated intraoperative blood loss is likely to exceed 1000 mL (major orthopedic, cardiac, vascular and emergency trauma surgery). IAT is not primarily recommended for cancer surgery or whenever the operative field is contaminated.

Intraoperative plasmapheresis (IP) is used in cardiac surgery to minimize coagulation deficiencies caused by the traumatizing effects of cardiopulmonary bypass (CPB) on platelets. A substantial amount of the patient's circulating platelets is withdrawn prior to heparinization and initiation of CPB. The collected autologous platelet‐rich plasma is then stored at room temperature, preserving platelet function and plasmatic coagulation factors, and retransfused to the patient after heparin reversal. There is controversy about the actual blood saving benefit of IP, but this method may be effective in complicated procedures precipitating high blood loss and long CPB times. In addition, IP may be used when other autologous whole blood harvesting techniques are not an option.
Hemorrhagic Shock and Early Resuscitation: the Cons
Authors: Bickell William H.
Published: February 2008

Although intravenous fluid administration is considered universally indicated for patients with post‐traumatic hypotension of presumed hemorrhagic origin, there are no prospective clinical trials which have adequately validated this practice. Moreover, recent hemorrhage models that incorporate a vascular injury, as well as recently completed clinical trials, have indicated that attempts to restore blood pressure before surgical hemostasis may have the undesirable effect of accentuating hemorrhage and mortality.
Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*
Authors: Levi Marcel , E.Cromheecke Manon , Jonge Evert de , Prins Martin H. , Mol Bas J. M. de , Briët Ernest , Büller Harry R.
Published: February 2008

Background:Excessive bleeding may complicate cardiac surgery, and is associated with increased morbidity and mortality. Pharmacological strategies to decrease perioperative bleeding have been investigated in a large number of controlled trials, most of which have shown a decrease in blood loss. However, most studies lacked sufficient power to detect a beneficial effect on clinically more relevant outcomes. We did a meta‐analysis of all randomized, controlled trials of the three most frequently used pharmacological strategies to decrease perioperative blood loss (aprotinin, lysine analogues [aminocaproic acid and tranexamic acid], and desmopressin).

Methods:Studies were included if they reported at least one clinically relevant outcome (mortality, rethoracotomy, proportion of patients receiving a transfusion, or perioperative myocardial infarction) in addition to perioperative blood loss. In addition, a separate meta‐analysis was done for studies concerning complicated cardiac surgery.

Findings:We identified 72 trials (8409 patients) that met the inclusion criteria. Treatment with aprotinin decreased mortality almost two‐fold (odds ratio 0.55 [95% CI 0.34‐0.90]) compared with placebo. Treatment with aprotinin and with lysine analogues decreased the frequency of surgical re‐exploration (0.37 [0.25‐0.55], and 0.44 [0.22‐0.90], respectively). These two treatments also significantly decreased the proportion of patients receiving any allogeneic blood transfusion. By contrast, the use of desmopressin resulted in a small decrease in perioperative blood loss, but was not associated with a beneficial effect on other clinical outcomes. Aprotinin and lysine analogues did not increase the risk of perioperative myocardial infarction; however, desmopressin was associated with a 2.4‐fold increase in the risk of this complication. Studies in patients undergoing complicated cardiac surgery showed similar results.

Interpretation:Pharmacological strategies that decrease perioperative blood loss in cardiac surgery, in particular aprotinin and lysine analogues, also decrease mortality, the need for rethoracotomy, and the proportion of patients receiving a blood transfusion.
Recombinant Activated Factor VII for Adjunctive Hemorrhage Control in Trauma*
Authors: Martinowitz Uri , Kenet Gili , Segal Eran , Luboshitz Jacob , Lubetsky Aharon , Ingerslev Jorgen , Lynn Mauricio
Published: February 2008

Background: Recombinant activated factor VII (rFVIIa) was approved for treatment of hemorrhages in patients with hemophilia who develop inhibitors to factors VIII or IX. Conditions with increased thromboembolic risk, including trauma with or without disseminated intravascular coagulation, were considered a contraindication for the drug. The mechanism of action of rFVIIa suggests enhancement of hemostasis limited to the site of injury without systemic activation of the coagulation cascade. Therefore, use of the drug in trauma patients suffering uncontrolled hemorrhage appears to be rational.

Methods: Seven massively bleeding, multitransfused (median, 40 units [range, 25–49 units] of packed cells), coagulopathic trauma patients were treated with rFVIIa (median, 120 μg/kg [range, 120–212 μg/kg]) after failure of conventional measures to achieve hemostasis.

Results: Administration of rFVIIa resulted in cessation of the diffuse bleed, with significant decrease of blood requirements to 2 units (range, 1–2 units) of packed cells (p < 0.05); shortening of prothrombin time and activated partial thromboplastin time from 24 seconds (range, 20–31.8 seconds) to 10.1 seconds (range, 8–12 seconds) (p < 0.005) and 79 seconds (range, 46–110 seconds) to 41 seconds (range, 28–46 seconds) (p < 0.05), respectively; and an increase of FVII level from 0.7 IU/mL (range,0.7‐0.92 IU/mL) to 23.7 IU/mL (range, 18–44 IU/mL) (p < 0.05). Three of the seven patients died of reasons other than bleeding or thromboembolism.

Conclusion: The results of this report suggest that in trauma patients rFVIIa may play a role as an adjunctive hemostatic measure, in addition to surgical hemostatic techniques, and provides the motivation for controlled animal and clinical trials.
A Recommended Blood Management Practices in Total Joint Replacement Surgery
Authors: Keating E. Michael , Meding John B.
Published: February 2008

Concern about the safety of allogeneic blood transfusion, including the risk of viral infection and immunosuppression, has led to the development of transfusion options in total joint replacement. These options include intraoperative and postoperative blood salvage, autologous donation, hemodilution, and the use of recombinant human erythropoietin (epoetin alfa). Blood salvage, either intraoperative or postoperative, has been shown not to be cost‐effective at our institution, other than in revision hip replacements, because not enough blood is collected. Autologous donation is not helpful in primary hip or knee surgery. One‐third of patients undergoing joint replacement surgery have hemoglobin (Hb) levels between 10 and 13 g/dL preoperatively. The most efficient way to decrease allogeneic risk in these patients is with epoetin alfa. The use of epoetin alfa decreases allogeneic risk to an acceptable 12.9%. Patients with preoperative hemoglobin above 15 g/dL undergoing single total knee or total hip replacement do not need anything since their allogeneic risk is minimal at our institution.
Erythropoietin Use in Pediatric Oncology
Authors: Porter Joanne C.
Published: February 2008

Anemia is commonly seen in patients with cancer, whether it is from the disease process itself or from treatment. Anemia can cause fatigue and diminished quality of life in adult cancer patients. Children tolerate anemia well; however, they frequently receive intensive chemotherapy schedules, which aggravate the anemia and require red cell transfusion. Recombinant human erythropoietin stimulates erythropoiesis in the bone marrow and has been shown to effectively eliminate the anemia seen in renal failure. Erythropoietin has also been shown to ameliorate anemia, decrease transfusion needs, and improve the quality of life in adult cancer patients receiving chemotherapy and radiation. In several pediatric oncology trials, children demonstrate similar effects of increased hemoglobin and decreased red cell transfusion needs in response to exogenous erythropoietin. This review will discuss the adult studies that laid the foundation for the pediatric oncology trials utilizing recombinant human erythropoietin in the treatment of anemia. It will also delineate some of the remaining controversial issues surrounding recombinant human erythropoietin use in pediatric patients.
Blood Conservation During Pediatric Cardiac Surgery
Authors: Gomez Daniel , Olshove Vincent , Weinstein Samuel , Davis J. Terrance
Published: February 2008

Eliminating blood product exposure in pediatric cardiac surgery is a challenging and difficult task. Avoidance of allogeneic blood products decreases the risk of a transfusion reaction and potential complications. Various strategies have been explored to decrease donor exposure from the preoperative through the postoperative period. In this paper, the authors review the current literature on blood conservation techniques and examine the changing practice of blood use and blood conservation in the field of pediatric cardiac surgery.
Transfusion‐Related Acute Lung Injury
Authors: Kokkini Garyfallia
Published: February 2008

Transfusion‐related acute lung injury (TRALI) is the adult respiratory distress syndrome arising from transfusion of a plasma‐containing blood product. It occurs within 1–6 hours of transfusion and is the third leading cause of transfusion‐related mortality in developed countries. TRALI patients present with dyspnea, hypotension, fever, and bilateral noncardiogenic pulmonary edema. Effective treatment includes stopping the transfusion and providing supportive care, whose intensity will depend on the clinical picture. Approximately 80% of TRALI patients recover within 96 hours. TRALI may result from multiple mechanisms. In most cases, pathogenesis appears to reflect the presence of granulocyte or HLA antibodies in donor blood. These react with and fix complement to antigens in the recipient, which leads to granulocyte aggregation, activation, and severe capillary leakage. Preventive measures should focus on limiting exposure to donors most likely to precipitate TRALI. Implicated donors are multiparous females and donors with previous multiple exposure to allogeneic transfusions. Clear recommendations and guidelines for preventing TRALI are needed.
The Effects of Fluid Optimization on Outcome Following Major Surgery
Authors: Levett Denny Z. H. , Grocott Michael P W. , Mythen Michael G.
Published: February 2008

The appropriate administration of intravenous fluid therapy to maintain an effective circulating volume and prevent inadequate tissue perfusion is a core element of the perioperative practice of anesthesia. The choice of fluid in a variety of different clinical situations can now be rationally guided by an understanding of the physicochemical and biological properties of the crystalloid and colloid solutions available. Deciding how much fluid to give has traditionally been more controversial. Fluid therapy should be titrated to rational physiological end‐points, directed by appropriate cardiovascular monitoring. Goal‐directed “optimization” of intravascular volume and organ blood flow aims to ensure adequate tissue perfusion and cellular oxygenation. There is a substantial body of literature demonstrating that mortality following major surgery can be significantly reduced by goal‐directed approaches to perioperative hemodynamic management. This literature will be reviewed and implications for current anesthetic practice discussed.
Use of Albumin in the Intensive Care Unit
Authors: Dubois Marc‐Jacques , Vincent A Jean‐Louis
Published: February 2008

The use of albumin in the critical care setting is a very controversial issue. Although not a new situation, we have seen a renewed interest in this question, especially after the publication of one particular meta‐analysis. Much has been said about its publication, but it merits a brief review. Hypoalbuminemia, no longer considered to be “acceptable” or even inevitable in critically ill patients, has also been revisited. We will examine the issue by reviewing studies that have tried to correct the condition, the mechanisms by which it appears and its prognostic value. Finally, a great deal of work has been done to gain a better understanding of albumin and its properties beyond the most commonly accepted, namely maintenance of plasma oncotic pressure. A review of the research will help us to recognize that more randomized controlled trials are warranted.
Hypertonic Solutions May Prevent Multiple Organ Failure in Humans: Myth or Reality?
Authors: Boldt Joachim
Published: February 2008

Hypertonic solutions have been proposed as an effective means of fluid resuscitation in the treatment of refractory hypovolemic shock. Due to the hypertonicity of these solutions, only a small volume of fluid is necessary to effectively restore cardiovascular functions. They seem to have positive effects on correcting perfusion due to various mechanisms. They may also prevent trauma‐induced immunosuppression. In various clinical settings, an improved blood flow may avoid the development of organ dysfunction and improve outcome. However, except for trauma patients, there are only few clinical studies available on the use of hypertonic solutions. Therefore, the question of whether a hypertonic volume replacement could positively influence organ perfusion and prevent the development of organ dysfunction in the critically ill deserves further investigations.
Hazards of Homologous Blood Transfusion
Authors: Isbister James P.
Published: February 2008

In the current era of evidence‐based medical practice, clinicians should ensure they have a good understanding of the potential benefits of and indications for potentially dangerous homologous blood component therapy. More attention is now being given to assessing the appropriateness of homologous transfusion therapy, with efforts to establish better evidence of improvements in patient outcomes. Such an approach allows for a more logical and realistic analysis of the risk/benefit equation in clinical management. In this summary of our current knowledge of the potential hazards of homologous blood transfusion, transfusion‐transmitted infections are not addressed in detail, as most of the major problems relating to HIV and viral hepatitis have been solved and good reviews are available in the literature. In this review of the potential hazards of homologous blood transfusion, the focus is on many of the other areas of concern regarding the risk/benefit equation for homologous transfusion. Transfusion‐related immunosuppression, the clinical significance of storage lesions, the potential adverse effects of leukocytes, error minimization, transfusion‐related lung injury and less well‐known immunological incompatibilities are addressed.
The Use of Recombinant Factor VIIa in Platelet Disorders: Thrombocytopenia and Thrombocytopathia
Authors: Hoffman Ron , Brenner Benjamin
Published: February 2008

Recombinant FVlla is considered nowadays an universal hemostatic agent while its primary role has been for treatment of hemophilic patients with inhibitors. Its unique mode of action makes FVlla a usefull tool to induce hemostasis in patients with defective thrombin generation with severe bleeding diathesis. The use of rFVlla in thrombocytopathic and thrombocytopenic associated bleeding disorders is discussed.
Recombinant Factor VIIa: The Possibilities for Monitoring
Authors: Escobar Miguel A.
Published: February 2008

Recombinant factor VIIa was developed for the treatment of bleeding in patients with hemophilia and inhibitors. Because of its unique mechanism of action, binding weakly to activated platelets independent of factors VIII or IX and enhancing factor X activation, systemic activation of the coagulation does not seem to occur. Thus, a local burst of thrombin induces hemostasis at the site of bleeding. The monitoring of this local event (thrombin generation) has not been developed. Assays that use non‐flow techniques, like the PT and aPTT, do not reflect physiological hemostatic conditions and have a limited application in the monitoring of rFVIIa. On the other hand, experimental models that use whole blood under shear force and that can indirectly measure thrombin generation may have a potential role in the monitoring of rFVIIa.
Overview of the French Hemovigilance
Authors: Wautier Jean‐Luc , Hossenlopp Claudine
Published: February 2008

SUMMARy

Hemovigilance began in France in 1993 and was reorganized in 1998.The Hemovigilance Unit is now part of the drug security agency (Agence Française de Sécurité Sanitaire des Produits de Santé, AFSSAPS) and has recently published its annual report. The number of deaths related to transfusion is decreasing but still significant (45 in 2001). Causes are most frequently undetermined (24) but when identified, are related to inadequate medical care (8) and to immunological incompatibility (3). Adverse reactions are frequently immunological (78%), and risks of viral transmission are significantly reduced. Progress in the safety of blood products is evident; however, their clinical use should still be improved.
Hemovigilance in Countries with Scarce Resources –A WHO Perspective
Authors: Dhingra Neelam , Hafner Valentina , Xueref Serge
Published: February 2008

SUMMARy

In many parts of the world, people continue to die due to shortage of blood and blood products. The safety of blood transfusion therapy remains a continuing concern, particularly where resources are scarce. The different stages of economic and social development are reflected in the existing status of the countries health care systems and that of their national blood transfusion services. The lack of quality systems, standardization and traceability of collected blood along the blood transfusion chain are the major contributing factors to the undesired outcomes of transfusion and increased risk of transfusion‐transmissible infections, namely HIV/AIDS and hepatitis. Hemovigilance as a concept and developed operational system, supports the continuous improvement of quality and safety of transfusion practices. Once the minimum safety requirements are in place, implementation of quality systems in the blood transfusion service throughout the entire blood transfusion chain has to be considered the first mandatory step for establishing hemovigilance systems. The challenge awaiting countries with scarce resources is the implementation of their own hemovigilance system in a sustainable way.

The integrated approach for a safer blood supply developed by WHO is aimed at building capacities at a national level, through advocacy, infrastructure development, technical support, training and documentation, and it creates the necessary grounds for establishment of hemovigilance systems. By further increasing its commitment in this area, WHO fulfils its leadership role in preventing risk factors for major disease burden and in organizing equitable health services, in line with its strategic directions.

Based on existing data and locally gained experience, joint programs and related expertise can be developed, strengthening inter‐country, regional and global collaboration for a safer, adequate blood supply.
Strength of the Evidence Generated From Reports of Clinical Research
Authors: Vamvakas Eleftherios C.
Published: February 2008

SUMMARy

Positive or negative findings in clinical research may represent true‐positive or true‐negative results, which reflect a relationship that does or does not exist in the reference population of interest. Alternatively, positive or negative findings in clinical research may represent false‐positive or false‐negative results, which are due to chance, bias, and/or confounding factors. If such alternative explanations for the results of a study have been ruled out, a valid statistical association is reported. A judgment of a cause‐and‐effect relationship is based on the totality of all available evidence, and it can also be made from a large, double‐blind, and correctly conducted and analyzed randomized controlled trial.
The Colloid Crystalloid Debate: Are We Asking the Right Question?
Authors: Moretti Eugene W. , Robertson Kerri M. , GAN Tong J.
Published: February 2008

Controversy remains over the best resuscitation fluid (colloid or crystalloid) to use in hypovolemic patients. Most randomized clinical trials done to address this issue were conducted in critically ill patients with mortality as their primary endpoint. Unfortunately these studies were insufficiently powered to detect a difference. Many recent meta‐analyses suffer from limitations that include: dated studies, poor blinding, marked heterogeneity, and disparate therapeutic goals. The type of resuscitation fluid may have little impact on mortality. A properly designed clinical trial that would detect a difference in mortality would be burdensome on limited resources. The effect of these differing fluid types on the quality of a patient's postoperative recovery, as it relates to nausea, vomiting, edema, and pain, may be a more meaningful endpoint for investigation.

This review presents the findings of recent meta‐analyses and addresses some common limitations of these reviews. Data on the quality of postoperative recovery with differing fluid regimens is presented, and their effect on renal function and coagulation profiles is examined.

The emphasis on the quality of postoperative recovery with the potential to reduce the length of stay shouldn't be minimized. Perhaps the time has come to design clinical trials that study the impact of IV fluids on patient recovery during their hospital stay, rather than mortality.
Introduction of a Cell Salvage Service
Authors: Thomas Dafydd
Published: February 2008

In the early 1990s it became apparent to a number of clinicians working at our institution that there was a need to develop a blood conservation program. At the time, the fear of viral transmission via blood transfusion had once more become a reality with the problems related to hepatitis C. This issue came close on the heels of the HIV epidemic, which had required enormous resource to minimize the risk of transfusion‐transmitted infection. The positive aspects of minimizing allogeneic transfusion and only resorting to this treatment when alternatives were not available seemed to be in keeping with the best ideals of preventative medicine. The formation of a hospital transfusion committee and the central use of cell salvage in the hospital's blood conservation policy has led to an atmosphere of awareness and improved knowledge about transfusion issues. The introduction of a cell salvage service has not only allowed better use of allogeneic supplies but in many cases prevented the need for allogeneic transfusion altogether. Other measures have led to improved transfusion practice but the presence in the main theater suite of a cell salvage service has acted as a catalyst to promote better blood transfusion within our institution.
Hyperoxic Ventilation in Critical Dilutional Anemia: Intestinal O2 Transport and Tissue Oxygenation
Authors: Kemming Gregor I. , Meisner Franz G. , Kleen Martin , Meier Jens M. , Tillmanns Jochen , Hutter Jörg W. , Wojtczyk Christoph J. , Packert Kristian B. , Bottino Daniel , Habler Oliver P.
Published: February 2008

Objective: The onset of hyperoxic ventilation after hemodilution to the critical hematocrit (Hctcrit) improves myocardial and peripheral tissue oxygenation. However, it is unknown whether at Hctcrit hyperoxemia is also beneficial to intestinal oxygenation, since intestinal tissue hypoxia might even worsen as a result of hyperoxic vasoconstriction. To study this, we investigated whether hyperoxic ventilation started at Hctcrit is beneficial in terms of intestinal oxygenation.

Method: 18 anesthetized pigs were hemodiluted to their individual Hctcrit (onset of myocardial ischemia; ECG) by 1:1 exchange of blood with 6% pentastarch (200,000/0.5). At Hctcrit hyperoxic ventilation was initiated. Nine complete datasets were obtained and analyzed at baseline, at Hctcrit and during hyperoxic ventilation. Analysis included intestinal O2 transport parameters (portal blood gases), intestinal mucosal O2 partial pressure (MDO‐Electrode) and regional intestinal blood flow (microsphere method).

Results: At Hctcrit (7.2 ±1.2%), intestinal O2 delivery was reduced. Despite increased O2 extraction, local tissue hypoxia was documented by markedly reduced portal venous (26 ± 2 Torr) and jejunal O2 (9 ± 3 Torr) partial pressures. Portal venous base excess (‐10 ± 3 mmol/L) and lactate concentration (4.3 ± 1.4 mmol/L) evidenced anaerobic intestinal metabolism (all p < 0.05). During hyperoxic ventilation, intestinal O2 delivery increased (p < 0.05) requiring a less intensive O2 extraction; physically dissolved O2 extracted from plasma was predominantly responsible for the restoration of portal and intestinal mucosal O2 partial pressure (49 ± 2 Torr and 17 ± 4 Torr; p < 0.05 vs. Hctcrit). Portal base excess (‐12 ± 6 mmol/L) and lactate concentration (4.3 ± 1.9 mmol/L) did not recover.

Conclusion: Hyperoxic ventilation at Hctcrit did improve intestinal O2 transport and mucosal oxygenation after 15 min. However, intestinal O2 debt persisted during the observation time.

Hyperoxic ventilation reverses manifest intestinal mucosal tissue hypoxia at Hctcrit due to the efficacious utilization of physically dissolved O2. There is no evidence that at Hctcrit hyperoxia‐induced vasoconstriction further does impair microvascular intestinal blood flow and O2 transport. It remains unclear, to which extent hyperoxic ventilation may induce relevant O2 shunts. Hence, the true value of this technique for a possible use in humans remains to be elucidated.
The European Network of Transfusion Medicine Societies, EuroNet‐TMS
Authors: Rouger Philippe
Published: February 2008

Europe is developing in a complex environment in which healthcare represents an important field of activities. Transfusion Medicine (TM) plays a major role in European healthcare developments, and as such requires the involvement of numerous actors. Professional medical/scientific societies have the responsibility of promoting their disciplines. In this way it has been considered both necessary and relevant to build up a federation of transfusion medicine societies throughout the European Union (EU); in this context, EuroNet‐TMS, the European Network of Transfusion Medicine Societies, was formed in early 2002 with the agreement of 15 EU countries. This network groups more than 6,000 professionals from blood transfusion centers. At present it has six major objectives: (1) to find coherent responses to issues at stake in TM; (2) to promote medical and scientific developments of blood transfusion in Europe; (3) to ensure the highest and most up‐to‐date scientific level in order to meet safety and quality standards; (4) to offer similar TM services to all EU citizens; (5) to share knowledge and data within Europe; (6) to develop numerous interfaces with decision‐makers taking into account the diversity of European countries.
The Impact of Aprotinin on Transfusion Requirements in Orthotopic Liver Transplantation
Authors: Molenaar I. Quintus , Porte Robert J.
Published: February 2008

Perioperative blood loss has been identified as an important cause of morbidity and mortality after orthotopic liver transplantation (OLT). Although rare, excessive blood loss is still a serious complication and risk factor for poor outcome after OLT. Besides the surgical skills, specific coagulation abnormalities and disturbances in the hemostatic system contribute to increased blood loss. Hyperfibrinolysis, frequently observed in the anhepatic and early postreperfusion period, may play a significant role. Antifibrinolytic drugs (epsilon aminocaproic acid, tranexamic acid, aprotinin) have the ability to reduce hyperfibrinolysis. This overview discusses the role of one of these antifibrinolytics, aprotinin, in reducing hyperfibrinolysis and thus blood loss during OLT. Several studies have been performed since the early 1990s. In particular, the results of the most recent randomized controlled trials are evaluated. In these studies, a significant reduction in blood loss (40–60%) and transfusion requirements (30–40%) is observed, depending on the administered regimens. Several dose regimens have been used: low‐dose, regular‐dose and high‐dose aprotinin. All three regimens seem to be effective when compared to placebo. At first sight, a low‐dose regimen would therefore be preferable. Other arguments, however, like a dose‐dependent anticoagulant effect, might count in favor of a higher dose. A definite conclusion on the most favorable dose regimen can therefore not be drawn at this moment.

The concern for thromboembolic complications associated with the use of aprotinin is discussed. We analyzed the thromboembolic complications in the most recent trials and also combined the data to see if there was any sign for a higher incidence of thromboembolic complications. Results showed no difference between the aprotinin and placebo groups. Moreover, a trend towards a lower incidence of thromboembolic complications was observed in the aprotinin groups, supporting its mild anticoagulant effect.

It is concluded that aprotinin is a safe prohemostatic drug which reduces blood loss and transfusion requirements. Despite the relatively low transfusion needs recently described by experienced centers, a positive effect of aprotinin can still be obtained as shown in the most recent studies.
Emerging Role of Hemoglobin Solutions in Trauma Care
Authors: Moore Ernest E.
Published: February 2008

Most authorities believe that the greatest need for blood substitutes is in patients with unanticipated acute blood loss, and trauma is the most likely scenario. The blood substitutes reaching advanced clinical trials today are red blood cell (RBC) substitutes, derived from hemoglobin. The hemoglobin‐based oxygen carriers (HBOCs) tested currently in FDA Phase III clinical trials are polymerized hemoglobin solutions. In the USA, the standard approach to restoring oxygen delivery in hemorrhagic shock has been crystalloid administration to expand intravascular volume, followed by stored RBCs for critical anemia. Allogeneic RBCs, however, may have adverse immunoinflammatory effects that increase the risk of postinjury multiple organ failure (MOF). Phase II clinical trials, as well as in vitro and in vivo work, suggest that resuscitation with a HBOC – in lieu of stored RBCs – attenuates the systemic inflammatory response invoked in the pathogenesis of MOF. Specifically, a HBOC has been shown to obviate stored RBC provoked neutrophil (PMN) priming, endothelial activation, and systemic release of interleukins 6,8, and 10. Based on this background and work by others, we have initiated a multicenter prehospital trial in which severely injured patients with major blood loss (SBP < 90 mm Hg) are randomized to initial field resuscitation with crystalloid versus HBOC. During the hospital phase the control group is further resuscitated with stored RBCs, whereas the study group receives HBOC (up to 6 units) in the first 12 hours. The primary study endpoint is 30‐day mortality, and secondary endpoints include reduction in allogeneic RBCs, hemoglobin levels < 5 g/dL, uncrossmatched RBCs, and MOF. The potential efficacy of HBOCs expands beyond the temporary replacement for stored RBCs. Hemoglobin solutions might ultimately prove superior in delivering oxygen to ischemic or injured tissue. The current generation of HBOCs can be lifesaving for acute blood loss today, but the next generation might be biochemically tailored for specific clinical indications.
Preoperative Autologous Blood Donation in Cardiac Surgery
Authors: Dietrich Wulf , Busley Raimund
Published: February 2008

Autologous blood donation is one of the oldest methods to avoid allogeneic blood tran‐fusion. This method has repeatedly shown to be an effective practice to reduce the exposure of patients to allogeneic blood in cardiac surgery. However, during recent years, this method has been criticized increasingly, mostly for economic reasons. The objective of this overview is to assess the role of autologous blood predonation in cardiac surgery. We evaluated our results in 8235 cardiac surgical patients, of which 18% (1512 of 8235) underwent autologous blood donation. To avoid a selection bias, patients were stratified for preoperative risk score. Of all patients undergoing autologous blood donation 16% received allogeneic blood while 57% of the patients without predonation received transfusion (p < 0.05). Patients without predonation received 1.67 ± 2.8 (mean ± SD) allogeneic units, patients in the autologous group 0.39 ± 1.25 (p < 0.05). Patients with predonation received a higher total number of any transfusion (autologous and allogeneic) compared to patients without predonation (2.39 ± 3.4 vs. 1.79 ± 3.7, p < 0.05). Elective cardiac surgery offers ideal conditions for autologous blood donation mainly because of the high probability of transfusion. In our hands, it was a cost‐effective method to reduce allogeneic blood transfusion. Based on our results, we conclude, that autologous predonation still remains a promising and cost‐effective alternative in the attempt to reduce allogeneic blood transfusion in elective cardiac surgery.
The Role of Recombinant, Activated Factor VII in Hemorrhage Following Cardiac Surgical Procedures
Authors: Murkin John M.
Published: February 2008

While the usage of aprotinin and other antifibrinolytics has significantly decreased bleeding and transfusion requirements in cardiac surgical patients in general, certain patients still experience massive hemorrhage despite such therapy. Reexploration for bleeding has been identified as a strong independent risk factor for operative mortality, renal failure, prolonged mechanical ventilation, adult respiratory distress syndrome, sepsis, and atrial arrhythmias. Consequently, therapies to effectively limit otherwise uncontrolled hemorrhage have an important role in the clinical management of cardiac surgical patients. The hemostatic efficacy of recombinant factor VIIa (rFVIIa) appears to lie in its ability to activate FX directly to produce thrombin, independent of the presence and/or activity of co‐factors FVIII, FIX or FXI. There is also some evidence for the efficacy of rFVIIa in patients with platelet dysfunction which may also be relevant to its usage in cardiac surgical patients. This review considers the most recent clinical reports of the usage of rFVIIa for the control of massive blood loss and potentially fatal hemorrhage following cardiac surgery, with a view to assessing efficacy and dosing strategies. In addition, concern has been raised that patients undergoing cardiac surgery may have vulnerable plaques in coronary arteries or aorta, thus the risk of intracoronary activation of hemostasis with consequent potential for ischemic and thrombotic events may exist. Controlled clinical trials of rFVIIa assessing dose‐ranging and with adequate power to detect the impact of therapy on morbidity and mortality are necessary before it can be recommended for routine use in patients who present excessive bleeding following cardiac surgery.
Analysis of Laser Evaporative and Fusion Cutting
Authors: Cai L. , Sheng P.
Published: February 2008

This paper presents an analytical description of the evaporative and fusion laser cutting process. The model incorporates the effects of heat conduction, phase change, beam divergence, surface absorption and plasma absorption (for fusion cutting of metals) to estimate the geometry of the cutting front for given process parameters, material properties and workpiece geometry. Model estimates for kerf shape were developed for continuous-wave CO2 laser cutting of polymethyl-methacrylate (PMMA), aluminum oxide and 304 stainless steel. Comparison of model estimates with experimental results showed good agreement for cutting front geometries for PMMA, good kerf width agreement for aluminum oxide and model underestimation of kerf profile for 304 stainless steel. Results for the comparison of predicted and measured profile and centerline angles of inclination are also presented.