bluuebunny/crossref_metadata_2025 huggingface dataset:
Secular trends in end‐stage kidney disease requiring renal replacement therapy in Japan: Japanese Society of Dialysis Therapy Registry data from 1983 to 2016
Authors: Wakasugi Minako , Kazama Junichiro J , Narita Ichiei
Published: April 2019

Aim

We aimed to describe secular trends in the incidence of end‐stage kidney disease (ESKD) requiring renal replacement therapy (RRT) in Japan, and to assess the effect of population aging on the incidence of ESKD.

Methods

The national incidence of ESKD requiring RRT was calculated using published data and Japan's population statistics. Age‐standardized incidence was calculated by direct standardization using the World Standard Population. The average annual percentage of change (APC) in rates and corresponding 95% confidence interval (CI) were computed for trends by joinpoint regression analysis. To assess the effect of population aging on the incidence of ESKD requiring RRT, we used the method proposed by Bashir and Estève, which splits the crude incidence into three components: population structure, population size, and age‐independent risk.

Results

Age‐standardized incidence trends (1983–1996) increased significantly in both men (APC 6.33, 95% CI: 5.39–7.29) and women (APC 5.25, 95% CI: 4.26–6.24). With a significant inflection point in 1996, the trend was stable for men (APC −0.16, 95% CI: −0.48 to 0.17) but significantly decreased for women (APC −1.98, 95% CI: −2.38 to −1.59) from 1996 to 2016. The main reason for the increase in those with ESKD requiring RRT has changed; before 1996, the change in age‐independent risk was the main contributor, but after 1996, the change in age structure with a higher proportion of older individuals was the main contributor.

Conclusion

The increase in number of ESKD patients requiring RRT dramatically changed in Japan during the 1983 to 2016 period.
Glycerol‐3‐phosphate acyltransferase 6 controls filamentous pathogen interactions and cell wall properties of the tomato and Nicotiana benthamiana leaf epidermis
Authors: Fawke Stuart , Torode Thomas A. , Gogleva Anna , Fich Eric A. , Sørensen Iben , Yunusov Temur , Rose Jocelyn K. C. , Schornack Sebastian
Published: April 2019

The leaf outer epidermal cell wall acts as a barrier against pathogen attack and desiccation, and as such is covered by a cuticle, composed of waxes and the polymer cutin. Cutin monomers are formed by the transfer of fatty acids to glycerol by glycerol‐3‐phosphate acyltransferases, which facilitate their transport to the surface.

The extent to which cutin monomers affect leaf cell wall architecture and barrier properties is not known. We report a dual functionality of pathogen‐inducible GLYCEROL‐3‐PHOSPHATE ACYLTRANSFERASE 6 (GPAT6) in controlling pathogen entry and cell wall properties affecting dehydration in leaves.

Silencing of Nicotiana benthamiana NbGPAT6a increased leaf susceptibility to infection by the oomycetes Phytophthora infestans and Phytophthora palmivora, whereas overexpression of NbGPAT6a‐GFP rendered leaves more resistant. A loss‐of‐function mutation in tomato SlGPAT6 similarly resulted in increased susceptibility of leaves to Phytophthora infection, concomitant with changes in haustoria morphology. Modulation of GPAT6 expression altered the outer wall diameter of leaf epidermal cells. Moreover, we observed that tomato gpat6‐a mutants had an impaired cell wall–cuticle continuum and fewer stomata, but showed increased water loss.

This study highlights a hitherto unknown role for GPAT6‐generated cutin monomers in influencing epidermal cell properties that are integral to leaf–microbe interactions and in limiting dehydration.
Febrile seizures with leukocytosis as a predictor for occult bacteremia
Authors: Ogawa Eiki , Shoji Kensuke , Kamidani Satoshi , Miyairi Isao
Published: April 2019

Background

Febrile children 3–36 months old, who had a body temperature >39°C and white blood cell (WBC) count >15 000/mm3 were known to be at risk for occult pneumococcal bacteremia (OPB) in the pre‐pneumococcal conjugate vaccine (PCV) era. The positive predictive value of these criteria, however, decreased dramatically after the introduction of PCV, indicating a need for alternative criteria. A high rate of febrile seizures has been noted in children with OPB, suggesting that screening may still be practical in this population. We performed a retrospective analysis to evaluate factors that predict OPB in patients visiting the emergency department (ED) with febrile seizures.

Methods

Children 3–36 months old who visited the ED for febrile seizures and had blood cultures taken were included. Patients with underlying diseases were excluded from analysis. We performed statistical analyses comparing patient demographics according to the presence or absence of OPB.

Results

One thousand and eighty‐two patients visited the ED with febrile seizure, and blood cultures were taken in 397, of whom 87% had received more than three doses of PCV. Of the nine patients with OPB, eight (89%) met the risk criteria. In contrast, only 12% (48/388) of those without OPB met the criteria. In this population, those who fulfilled the risk criteria were more likely to have OPB than those who did not (14.3% vs 0.3%; likelihood ratio, 7.17).

Conclusions

High WBC count and fever may effectively predict OPB in pediatric patients with febrile seizure in the post‐PCV era.
TALKING ABOUT WORLDS*
Authors: Mandelkern Matthew
Published: April 2019

I explore the logic of the conditional, using credence judgments to argue againstDualityand in favor ofConditional Excluded Middle. I then explore how to give a theory of the conditional which validates the latter and not the former, developing a variant on Kratzer (1981)'s restrictor theory, as well as a proposal which combines Stalnaker (1968)'s theory of the conditional with the theory of epistemic modals I develop in Mandelkern 2019a. I argue that the latter approach fits naturally with a conception of conditionals as referential devices which allow us to talk about particular worlds.
Supply Base Design for the Procurement of Multiple Items
Authors: Martínez‐de‐Albéniz Victor , Wang Jiao
Published: April 2019

Sourcing new products in advance entails significant risks for a buyer. To reduce the possibility of bringing a mediocre item to the market, buyers can build a large supply base and pick the best available products after uncertainties have materialized. Designing such a supply base is a challenging task: the buyer needs to decide how many suppliers to recruit, and how to split them across potential groups, such as product types or geographies. In this study, we propose a framework to design optimal supply bases when multiple items must be sourced from potential suppliers that are subject to uncertainties on the profitability of their supplies. We start with the case of independent supplier profits: we characterize the optimal supply base size and find that it is optimal to recruit a much larger number of suppliers compared to the number of products needed, which increases in the riskiness of supplier designs so as to better exploit the potential upside in profitability deviations. We then study the case where different supplier groups are correlated. While the exact solution can be obtained in simple cases, the general stochastic problem can only be solved numerically. Hence, we propose three approximations that provide excellent solutions, especially when the number of products to source is large. Our framework thus provides guidelines for buyers that want to control their sourcing risks through supply base design and to improve their profits by exploiting the option value of diversification.
Input‐Price Risk Management: Technology Improvement and Financial Hedging
Authors: Shantia Ali , Aflaki Sam , Ghoddusi Hamed
Published: April 2019

We study the merits and limitations of technology improvement (TI) initiatives for managing input–price risk. Such initiatives (e.g., energy efficiency projects) typically reduce the consumption of an input commodity and so result in lower production costs, more sustainable operations, and/or an improved competitive position. This study explores whether TI can also serve to hedge risks. Although TI clearly reduces both average cost and risk exposure, some firms may actually benefit from input–price uncertainty; the result, when combined with production flexibility, is an “option value” that firms may well be reluctant to forgo. We develop a stylized mathematical model to examine the incentives of different types of firms to adopt TI. Thus, we derive a closed‐form expression that quantifies a firm’s attitude toward input–price risk by considering the firm’s certainty premium, or what the firm would pay to “lock in” the unit input price, and then link that premium to various firm‐ and industry‐specific characteristics. We also compare the risk management advantages of technology improvement vs. financial hedging (FH) and give conditions under which these strategies are complements or substitutes. Our results show that, even when input‐price uncertainty is desirable for firms, they can still benefit from investing in risk reduction measures—such as TI and FH—because the uncertainty’s option value could thereby increase. A firm’s ability to adjust its price in response to both market competition and input‐price variation mediates the benefit of risk‐reducing measures and also affects the complementarity of these two strategies.
Integrative roles of nitric oxide and hydrogen sulfide in melatonin‐induced tolerance of pepper (Capsicum annuum L.) plants to iron deficiency and salt stress alone or in combination
Authors: Kaya Cengiz , Higgs David , Ashraf Muhammad , Alyemeni Mohammed N. , Ahmad Parvaiz
Published: April 2019

There seems to be no report in the literature on the effect of melatonin (MT) in relieving the detrimental effects of combined application of salt stress (SS) and iron deficiency (ID). Therefore, the effect of MT on the accumulation/synthesis of endogenous nitric oxide (NO) and hydrogen sulphide (H2S) and how far these molecules are involved in MT‐improved tolerance to the combined application of ID and SS in pepper (Capsicum annuum L) were tested. Hence, two individual trials were set up. The treatments in the first experiment comprised: Control, ID (0.1 mM FeSO4), SS (100 mM NaCl) and ID + SS. The detrimental effects of combined stresses were more prominent than those by either of the single stress, with respect to growth, oxidative stress and antioxidant defense attributes. Single stress or both in combination improved the endogenous H2S and NO, and foliar‐applied MT (100 µM) led to a further increase in NO and H2S levels. In the second experiment, 0.1 mM scavenger of NO, 2‐(4‐carboxyphenyl)‐4,4,5,5‐tetramethylimidazoline‐1‐oxyl‐3‐oxide potassium salt (cPTIO) and that of H2S, hypotuarine (HT) were applied along with MT to get further evidence whether NO and H2S are involved in MT‐induced tolerance to ID and SS. MT combined with cPTIO and HT under a single or combined stress showed that NO effect was reversed by the NO scavenger, cPTIO, alone but the H2S effect was inhibited by both scavengers. These findings suggested that tolerance to ID and SS induced by MT may be involved in downstream signal crosstalk between NO and H2S.
Application of lipidomics in bivalve aquaculture, a review
Authors: Laudicella Vincenzo A. , Whitfield Phillip D. , Carboni Stefano , Doherty Mary K. , Hughes Adam D.
Published: April 2019

Bivalve production is a relevant aquaculture activity in Europe; however, it is not developing with same extents of other aquaculture sectors due to causes connected with regulation stringency, labour cost, space availability, habitat loss as well as variability in recruitment events, climate change and diseases. Understanding the physiology and nutritional requirements of bivalves during aquaculture activities might result beneficial to fuel up the development of the sector. Lipids are important molecules as they are relevant components of cellular membranes acting in several physiological processes like reproduction, growth, immunological responses and energy reserve. Nevertheless, lipid diversity is still poorly understood despite the research efforts of the last decades. Technological advancements provide tools to unveil such diversity. Lipidomics, a branch of metabolomics, is the science targeting the lipidome (e.g. the totality of biological lipids in an organism). In this review, lipidomics, and its related concepts, are discussed providing an overview of recent lipidomics studies on bivalves. Lipidomics could result in several advantages if compared with traditional lipid profiling techniques; however, aims and scopes of future lipidomics studies should be expanded. Here, possible future applications of lipidomics in the context of bivalve production are presented and discussed. Unveiling the lipidome of marine bivalves could aid disclosing important information regarding nutrition, biology, physiology and epidemiology on bivalves. This knowledge, once applied, has the potential to improve bivalve production and the resilience of the sector to environmental changes.
Morphological indices for canine spermatozoa based on the World Health Organization laboratory manual for human semen
Authors: Morselli Maria Giorgia , Colombo Martina , Faustini Massimo , Luvoni Gaia Cecilia
Published: April 2019

Attempting to contribute to the development of a more objective morphological evaluation of dog spermatozoa, in this study the indices of multiple sperm defects (multiple abnormalities index [MAI]; teratozoospermic index [TZI]; sperm deformity index [SDI]) were calculated following the World Health Organization (WHO) guidelines. In Experiment I, the concordance of MAI, TZI and SDI with the proportions of morphologically normal spermatozoa (MNS) was evaluated in fresh ejaculated spermatozoa (dogs = 47). In Experiment II, the potential role of indices as prognostic values was assessed in spermatozoa of different origin and treatment (fresh ejaculated:n = 6; fresh epididymal:n = 6; frozen‐thawed ejaculated:n = 6) by their correlation with different semen parameters (motility, membrane integrity and acrosome status) and with an in vitro sperm function test. Samples with different proportions of MNS showed different values of SDI, the index that better represented the decline of sperm morphology in both fresh and frozen‐thawed samples (Exp. I and II;p < 0.05). No correlations between indices and semen parameters were observed (Exp. II), but when samples were evaluated collectively, negative correlations (SDI‐motility,p = 0.01; SDI‐acrosome integrity,p = 0.002) were found. Including all the defects of each spermatozoon, SDI might be a useful index during morphological analysis and better discriminates the increase in multiple defects. A more objective morphological evaluation for dog spermatozoa was achieved by the WHO method, and in vitro tests allowed to elucidate the validity of SDI as prognostic indicator of in vitro fertilizing potential.
Using webinars to extend the reach of soil learning in New South Wales: A first look
Authors: Jenkins Abigail , Beange Luke , Morris Stephen
Published: April 2019

Increasingly knowledge is shared using new web‐based channels. The use of these channels is relatively new in the realm of soil science. However, they may prove to be very useful for connecting time‐poor, geographically dispersed audiences in an efficient and cost‐effective way. There has been limited study of this form of knowledge sharing for natural science (let alone soil science). In New South Wales (NSW), Australia, the NSW Department of Primary Industries (NSW DPI) has coordinated the Soil Network of Knowledge (SNoK) monthly webinar over 3 years, with over 40 webinars targeting an audience of next users of soil information. Aggregated data collected from these webinars indicated that the majority of information is used for professional development by participants. Whether this will eventually lead to on‐ground practice change because of the improved professional and technical knowledge of participants is still a moot point and will require further investigation over time. The information collected on attendance and participation showed that webinars are a good way to connect with some target audiences such as other government bodies that have a historical relationship with NSW DPI. However, other target audiences that NSW DPI has always found difficulty in engaging, such as private advisers, require more active overtures to drive participation. The growing subscriber base is encouraging.
The novel HLA‐DRB1*04:01:10 allele detected in a Taiwanese individual
Authors: Yang Kuo‐Liang , Lin Py‐Yu
Published: April 2019

One nucleotide substitution at residue 261 of HLA‐DRB1*04:01:01:01 results in a new allele, HLA‐DRB1*04:01:10.
Detection of an HLA‐A*02 variant, HLA‐A*02:474, in a Taiwanese individual
Authors: Yang Kuo‐Liang , Lin Py‐Yu
Published: April 2019

One nucleotide replacement at residue 368 of HLA‐A*02:06:01:01 results in a novel allele, HLA‐A*02:474.
Changes in donor antibody titer levels over time in a military group O low‐titer whole blood program
Authors: Bailey Jonathan D. , Fisher Andrew D. , Yazer Mark H. , Howard Jeffrey T. , Corley Jason B. , Miles Ethan A. , Cap Andrew P.
Published: April 2019

BACKGROUND

The ability to rapidly administer whole blood (WB) at the point of injury is an important intervention to save lives. This can be accomplished using low titer group O WB donors. Titers of immunoglobulin M anti‐A and anti‐B might change over time. This study describes titer testing in a large series of donors.

STUDY DESIGN AND METHODS

Data were collected retrospectively from the Armed Services Blood Program and the Theater Medical Data Store. Soldiers assigned to the 75th Ranger Regiment were screened and titered upon completion of training or before deployment or during periodic unit readiness activities. A Ranger group O low‐titer (ROLO) donor was defined as having titers of both anti‐A and ‐B of less than 256 by immediate spin testing.

RESULTS

Between May 2015 and January 2017, of a total of 2237 participating soldiers, 1892 (84.5%) soldiers underwent antibody titering once, while 266 (11.9%) were titered twice, 62 (2.8%) were titered three times, and 17 (0.8%) were titered at least four times. The mean age was 26.5 ± 6.5, and 2197 (98.2%) were male. A total of 69.5% of donors met ROLO donor criteria on the first test. The percentage of donors meeting universal‐donor criteria increased to 83.5% on the second test, 91.1% on the third test, and 100% on the fourth and fifth tests.

CONCLUSIONS

With successive titer testing, it appears that individuals display a tendency toward lower titers. This may indicate that titer testing may not be required after the second test if donors have been identified initially as low titer.
Future of platelet formulations with improved clotting profile: a short review on human safety and efficacy data
Authors: Cancelas Jose A.
Published: April 2019

BACKGROUND

Platelet (PLT) transfusion is a widely used therapy in treating or preventing bleeding and hemorrhage in patients with thrombocytopenia or trauma. Compared to the relative ease of PLT transfusion, current practice for PLT storage at room temperature (RT) for up to 5 to 7 days is inefficient, costly, wasteful, and relatively unsafe.

STUDY DESIGN AND METHODS

This study was a review of major advances in PLT derivative products with improved hemostatic potential and safety feature.

RESULTS

Recent progress in understanding the PLT activation and host clearance mechanisms has led to reassessments of current and new storage conditions that employ refrigeration and/or cryopreservation to overcome storage lesions and significantly extend shelf life of PLTs with reduced risk of pathogen contamination.

DISCUSSION

It is anticipated that future PLT preservation involving cold, frozen, and/or pathogen reduction strategies in proper PLT additive solutions will enable longer term and safer PLT storage.
Optimizing whole blood storage: hemostatic function of 35‐day stored product in CPD, CP2D, and CPDA‐1 anticoagulants
Authors: Meledeo Michael Adam , Peltier Grantham C. , McIntosh Colby S. , Bynum James A. , Cap Andrew P.
Published: April 2019

BACKGROUND

Transitioning from whole blood (WB) to components developed from efforts to maximize donor yield. Components are advantageous for specific derangements, but treating hemorrhage with components requires significantly more volume to provide similar effects to WB. Because storage lesion and waste remain problematic, this study examined hemostatic function of refrigerated WB stored for 35 days in anticoagulants citrate–phosphate‐dextrose‐adenosine (CPDA‐1), citrate–phosphate‐dextrose (CPD), or citrate–phosphate‐double dextrose (CP2D).

METHODS

Refrigerated WB units from healthy donors were sampled over 35 days. Global hemostatic parameters were measured by thromboelastometry, thrombogram, platelet aggregometry, and platelet adhesion to collagen under shear conditions. The effects of transfusion filtration and mixing 35‐day stored product with fresh WB were evaluated.

RESULTS

Countable platelets declined as aggregation clusters appeared in microscopy. While gross platelet agonist‐induced aggregation declined over time, normalization revealed aggregation responses in remaining platelets. Peak thrombin generation increased over time. Clot strength diminished over storage in tissue factor–activated samples (normalized by filtration of aggregates). Functional fibrinogen responses remained consistent throughout. Filtration was necessary to maintain consistent platelet adhesion to collagen beyond collection day. Few differences were observed between anticoagulants, and stored/fresh mixing studies normalized coagulation parameters.

CONCLUSIONS

WB is easier to collect, store, and transfuse. WB provides platelets, an oft‐neglected, critical resuscitation component, but their individual numbers decline as aggregates appear, resulting in diminished coagulation response. WB has better performance in these assays when examined at earlier time points, but expirations designated to specific anticoagulants appear arbitrary for hemostatic functionality, as little changes beyond 21 days regardless of anticoagulant.
Lifeline for the front lines: blood products to support the warfighter
Authors: Taylor Audra L. , Corley Jason B. , Swingholm Matthew T. , Sloan Melanie A. , McDonald Harry , Quesada Jose F. , Evans Christopher L. , Ceballos William A.
Published: April 2019

BACKGROUND

Hemorrhage is the leading cause of death on the battlefield. Damage control resuscitation guidelines in the US military recommend whole blood as the preferred resuscitation product. The Armed Services Blood Program (ASBP) has initiated low‐titer group O whole blood (LTOWB) production and predeployment donor screening to make whole blood more available to military forces.

STUDY DESIGN AND METHODS

ASBP donor centers updated procedures and labeling for LTOWB production. Donors are screened according to US Food and Drug Administration regulations and standard operating procedures. Group O donors are tested for anti‐A and anti‐B titer levels. Additionally, military personnel notified for pending deployment coordinate with their local ASBP donor center to complete whole blood donor prescreening. The process consists of completing a donor history questionnaire, processing of blood samples for blood group and infectious disease testing, and titer determination for group O personnel.

RESULTS

Since March 2016, 7940 LTOWB units have been manufactured at ASBP donor centers and shipped in support of combat operations. Additionally, ASBP donor centers have screened several thousand service members before deployment. From these screenings, the donor low titer rate was 68% and infectious disease reactive test rate was extremely low (≤0.004).

CONCLUSION

Whole blood is now the preferred blood product for resuscitation of combat trauma patients. The ASBP partnered with combat forces to screen personnel before deployment. Additionally, LTOWB is manufactured and shipped in support of combat operations. These efforts are expanding the availability of LTOWB for the warfighter.
Evaluation of a lyophilized platelet‐derived hemostatic product
Authors: Bynum James A. , Meledeo Michael A. , Peltier Grantham C. , McIntosh Colby S. , Taylor Ashley S. , Montgomery Robbie K. , Reddoch–Cardenas Kristin M. , Getz Todd M. , Fitzpatrick Michael G. , Cap Andrew P.
Published: April 2019

BACKGROUND

Current limitations of platelet shelf life to 5 days have led to an increasingly greater demand for hemostatic agents with greater longevity. The objective of this study was to evaluate the function of a lyophilized platelet‐derived hemostatic product (thrombosome [TS]) as a potential alternative to fresh platelets.

METHODS

Platelets were collected from whole blood from healthy donors. TSs were reconstituted with water and added to various configurations of reassembled whole blood (platelets, plasma, and RBCs); measures included rotational thromboelastometry (ROTEM), optical aggregometry, mitochondrial function, calibrated automated thrombogram, collagen adhesion under flow (shear flow assay), and flow cytometry.

RESULTS

In ROTEM, no differences were observed between maximum clot formation values for contact pathway activation thromboelastometry tests with TSs or platelet samples. Significantly decreased aggregation was observed in the TSs versus platelets (p < 0.001 for all agonists). Flow cytometry measures demonstrated significant decreases in glycoprotein Ib expression and increases in phosphatidylserine expression in the TS group (p < 0.01). The calibrated automated thrombogram assay was suggestive (lag time and peak thrombin) that the TSs might have some thrombogenic properties. Measurements of mitochondrial function revealed that TSs had no functional mitochondria.

CONCLUSION

In this study, TSs were shown to have nonfunctional mitochondria. ROTEM measures revealed that the TSs had no impact on clot strength. Likewise, compared to platelets, the TSs displayed minimal aggregation, had significantly more phosphatidylserine (measure of activation status), but had the ability to adhere to a collagen surface under flow conditions and contribute to clot formation and induced greater thrombin generation.
Current state of transfusion in traumatic brain injury and associated coagulopathy
Authors: Stolla Moritz , Zhang Fangyi , Meyer Michael R. , Zhang Jianning , Dong Jing‐Fei
Published: April 2019

Traumatic brain injury (TBI)‐induced coagulopathy has long been recognized as a significant risk for poor outcomes in patients with TBI, but its pathogenesis remains poorly understood. As a result, current treatment options for the condition are limited and ineffective. The lack of information is most significant for the impact of blood transfusions on patients with isolated TBI and in the absence of confounding influences from trauma to the body and limbs and the resultant hemorrhagic shock. Here we discuss recent progress in understanding the pathogenesis of TBI‐induced coagulopathy and the current state of blood transfusions for patients with TBI and associated coagulopathy.
Management of moderate and severe traumatic brain injury
Authors: Abdelmalik Peter A. , Draghic Nicole , Ling Geoffrey S. F.
Published: April 2019

Traumatic brain injury (TBI) is a common disorder with high morbidity and mortality, accounting for one in every three deaths due to injury. Older adults are especially vulnerable. They have the highest rates of TBI‐related hospitalization and death. There are about 2.5 to 6.5 million US citizens living with TBI‐related disabilities. The cost of care is very high.

Aside from prevention, little can be done for the initial primary injury of neurotrauma. The tissue damage incurred directly from the inciting event, for example, a blow to the head or bullet penetration, is largely complete by the time medical care can be instituted. However, this event will give rise to secondary injury, which consists of a cascade of changes on a cellular and molecular level, including cellular swelling, loss of membrane gradients, influx of immune and inflammatory mediators, excitotoxic transmitter release, and changes in calcium dynamics. Clinicians can intercede with interventions to improve outcome in the mitigating secondary injury. The fundamental concepts in critical care management of moderate and severe TBI focus on alleviating intracranial pressure and avoiding hypotension and hypoxia. In addition to these important considerations, mechanical ventilation, appropriate transfusion of blood products, management of paroxysmal sympathetic hyperactivity, using nutrition as a therapy, and, of course, venous thromboembolism and seizure prevention are all essential in the management of moderate to severe TBI patients. These concepts will be reviewed using the recent 2016 Brain Trauma Foundation Guidelines to discuss best practices and identify future research priorities.
The use of cryopreserved platelets in the treatment of polytraumatic patients and patients with massive bleeding
Authors: Bohonek Milos , Kutac Dominik , Landova Ludmila , Koranova Michaela , Sladkova Eliska , Staskova Eva , Voldrich Martin , Tyll Tomas
Published: April 2019

BACKGROUND

The short shelf‐life of fresh platelets limits their efficient inventory management and availability during a massive transfusion protocol. Risk of insufficient availability can be mitigated by building an inventory of cryopreserved platelets (CPs).

METHODS

A comparative study of fresh apheresis platelets (FAPs) and CPs was performed. Type‐O CPs were processed with DMSO frozen at −80°C and reconstituted in thawed AB plasma. All patients enrolled in the study had the following parameters evaluated on admission: vital signs (body temperature, heart rate, mean arterial pressure), blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level, and, in trauma patients, international severity score. Several outcomes were evaluated: 30‐day survival, adverse events, quantity of administered blood products, fibrinogen concentrate and thromboxane (TXA), and laboratory parameters after transfusion (blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level).

RESULTS

Twenty‐five (25) patients in the study group received transfusions totaling 81 units of CPs. Twenty‐one (21) patients in the control group received a total of 67 units of FAPs. There were no significant differences in patient characteristics (p > 0.05) between groups. Both groups were comparable in clinical outcomes (30‐day survival, administered blood products, fibrinogen concentrate, TXA, and adverse events). Among posttransfusion laboratory parameters, platelet count was higher in the group transfused with FAPs (97.0 ×109/L) than in the group transfused with CPs (41.5 ×109/L), p = 0.02025. Other parameters were comparable in both groups.

CONCLUSION

The study suggests that CPs are tolerable and a feasible alternative to FAPs. However, larger randomized studies are needed to draw definitive conclusions.
Human primary fibroblasts perform similarly to MSCs in assays used to evaluate MSC safety and potency
Authors: Christy Barbara A. , Herzig Maryanne C. , Delavan Christopher , Cantu Carolina , Salgado Christi , Bynum James A. , Cap Andrew P.
Published: April 2019

BACKGROUND

Cellular therapeutic agents may benefit trauma patients by modulating the immune response to injury, and by reducing inflammation and vascular leakage. Administration of allogeneic mesenchymal stromal cells (MSCs) shows some benefit in preclinical and clinical trials, but less testing has been performed with other cell types. Human primary fibroblasts (FBs) were compared to MSCs in assays designed to evaluate MSCs to determine if these assays actually evaluate properties unique to MSCs or whether related cell types perform similarly.

STUDY DESIGN AND METHODS

MSC‐related surface marker expression, tissue factor, and human leukocyte antigen–D related were evaluated by flow cytometry, and in vitro adipogenic and osteogenic differentiation potential were determined. Procoagulant activity was determined by thromboelastography. Two potency assays correlated with immunomodulation potential were utilized: the mixed lymphocyte reaction and indoleamine 2,3‐dioxygenase enzyme activity assays.

RESULTS

Human primary FBs performed similarly to MSCs in assays designed to evaluate MSC characteristics and potency. Although similar for MSC‐positive cell surface marker expression, FBs did not show robust adipose differentiation and expressed some level of markers not expected on MSCs.

CONCLUSIONS

Human primary FBs are very similar to human MSCs, at least in assays currently used to evaluate MSC potency. Preclinical and clinical testing are required to determine if FBs show similar activity to MSCs in vivo. If FBs show inferior activity in vivo, development of new MSC‐specific potency assays will be necessary to evaluate properties relevant to their unique clinical benefits.
Aerial drones for blood delivery
Authors: Ling Geoffrey , Draghic Nicole
Published: April 2019

Aerial drone technology is now in use to improve medical care, especially blood delivery. The use of aerial drones is broader than just this and includes aerial photography, express shipping and delivery, disaster management, search and rescue operations, crop monitoring, weather tracking, law enforcement, and structural assessment. This wide use promises to accelerate and, ideally, reduce the cost of technological advances of drones. By doing so, drone use offers the opportunity of improving health care, particularly in remote and/or underserved environments by decreasing lab testing turnaround times, enabling just‐in‐time lifesaving medical supply/device delivery, and reducing costs of routine prescription care in rural areas.
Effect of plasma processing and storage on microparticle abundance, nitric oxide scavenging, and vasoactivity
Authors: Rogers Stephen C. , Moynihan Francis T. , McDonough Ryan , Timm David D. , Hovmand‐Warner Eyvind , Frazier Elfaridah , Thomas Kimberly A. , Spinella Philip C. , Doctor Allan
Published: April 2019

BACKGROUND

We set out to define the impact of collection, processing, and storage on plasma product microparticle (MP) abundance, potential for nitric oxide (NO) scavenging, and vasoactivity.

STUDY DESIGN AND METHODS

Three currently US licensed products were tested: liquid plasma (LP), fresh frozen plasma (FFP), and solvent detergent plasma (SDP), along with a product under development, spray‐dried solvent detergent plasma (SD‐SDP) with/without beads. Vasoactivity was assessed in vitro using rabbit aortic vascular rings; MP abundance was determined by flow cytometry; and NO scavenging capacity/rate was determined using a biochemical NO consumption assay. All samples were analyzed unprocessed and following centrifugation at two speeds (2,500× g to remove platelets, and 25,000× g to remove microparticles).

RESULTS

Significant differences in vasoactivity were observed, with SD‐SDP minus beads demonstrating the greatest constriction and FFP the lowest constriction response. All products exhibited the same total NO scavenging capacity; however, significant differences were observed in the maximal rate of scavenging, with SD‐SDP minus beads and FFP reacting fastest and SDP the slowest. Across all products, platelet and microparticle depletion had no effect on vasoactivity or NO scavenging (total or rate). Microparticles (RBC derived) were found only in FFP and LP, with relative abundance (LP > FFP). Additionally, storage had no effect on total or RBC‐derived MP abundance, NO scavenging, or vasoactivity.

CONCLUSION

Although vasoactivity differed between plasma products, we did not find similar differences in either total or RBC‐derived MP abundance or NO scavenging capacity/rate.
Plasma for burn shock resuscitation: is it time to go back to the future?
Authors: Gurney Jennifer M. , Kozar Rosemary A , Cancio Leopoldo C.
Published: April 2019

Patients with burn shock can be challenging to resuscitate. Burn shock produces a variety of physiologic derangements: Patients are hypovolemic from volume loss, have a increased systemic vascular resistance, and may have a depressed cardiac output depending on the extent of the thermal injury. Additionally, the burn wound produces a significant inflammatory cascade of events that contributes to the shock state. Fluid resuscitation is foundational for the initial treatment of burn shock. Typical resuscitation is with intravenous lactated Ringer's in accordance with well‐established formulas based on burn wound size.

In the past century, as therapies to treat thermal injuries were being developed, plasma was the fluid used for burn resuscitation; in fact, plasma was used in World War II and throughout the 1950s and 1960s. Plasma was abandoned because of infectious risks and complications. Despite huge strides in transfusion medicine and the increased safety of blood products, plasma has never been readopted for burn resuscitation.

Over the past 15 years, there has been a paradigm shift in trauma resuscitation: Less crystalloid and more blood products are used; this strategy has demonstrated improved outcomes. Plasma is a physiologic fluid that stabilizes the endothelium. The endotheliopathy of trauma has been described and is mitigated by transfusion strategies with a 1:1 ratio of RBCs to plasma. Thermal injury also results in endothelial dysfunction: the endotheliopathy of burns. Plasma is likely a better resuscitation fluid for patients with significant burn wounds because of its capability to restore intravascular volume status and treat the endotheliopathy of burns.
Platelet enhancement of bacterial growth during room temperature storage: mitigation through refrigeration
Authors: Ketter Patrick M. , Kamucheka Robin , Arulanandam Bernard , Akers Kevin , Cap Andrew P.
Published: April 2019

INTRODUCTION

Due to high risk of septic transfusion reactions arising from bacterial contamination, US Food and Drug Administration regulations currently limit platelet storage to 5 days at room temperature (RT). However, blood culturing methods can take up to 7 days to detect bacteria, allowing transfusion of potentially contaminated units. Thus, cold storage (CS) may be a viable means of extending shelf life and improving safety.

STUDY DESIGN AND METHODS

Platelets and fresh plasma (FP) were collected by apheresis from healthy donors, aliquoted, and challenged with Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, or Staphylococcus epidermidis. Aliquots were then stored at either RT or CS.

RESULTS

Significant (p < 0.05) bacterial growth was detected at RT for most bacteria as early as Day 1 after collection, with peak growth occurring between Days 3 and 4. Growth remained static during CS. Additionally, platelets appeared to enhance bacterial replication with growth significantly lower (p < 0.05) in FP relative to RT‐stored platelets. Lactic acid promoted bacterial growth when added to FP at RT. Bacterial challenge also resulted in significantly increased platelet activation (p < 0.05) and significantly reduced platelet function (p < 0.05) in RT storage relative to uninfected controls by Day 5 after collection. Conversely, CS ablated bacteria growth, limited platelet metabolism, and preserved platelet function throughout the study.

CONCLUSION

These data suggest that CS presents an attractive alternative to RT to both extend storage life and reduce the risk of transfusion‐related sepsis.
The need for dried plasma – a national issue
Authors: Pusateri Anthony E. , Butler Frank K. , Shackelford Stacy A. , Sperry Jason L. , Moore Ernest E. , Cap Andrew P. , Taylor Audra L. , Homer Mary J. , Hoots W. Keith , Weiskopf Richard B. , Davis Michael R.
Published: April 2019

Recent studies have demonstrated that early transfusion of plasma or RBCs improves survival in patients with severe trauma and hemorrhagic shock. Time to initiate transfusion is the critical factor. It is essential that transfusion begin in the prehospital environment when transport times are longer than approximately 15 to 20 minutes. Unfortunately, logistic constraints severely limit the use of blood products in the prehospital setting, especially in military, remote civilian, and mass disaster circumstances, where the need can be most acute. US military requirements for logistically supportable blood products are projected to increase dramatically in future conflicts. Although dried plasma products have been available and safely used in a number of countries for over 20 years, there is no dried plasma product commercially available in the United States. A US Food and Drug Administration–approved dried plasma is urgently needed. Considering the US military, disaster preparedness, and remote civilian trauma perspectives, this is an urgent national health care issue.
Independent origins of coastal colonization in the tribe Athetini (Coleoptera, Staphylinidae)
Authors: Song Jeong‐Hun , Lee Seung‐Gyu , Lee Jae‐Seok , Ahn Kee‐Jeong
Published: April 2019

Less than 1% of Staphylinidae are known to be confined to coastal habitats. To explore the origins of coastal colonization within the tribe Athetini Casey, we present a revised molecular phylogeny. The dataset comprised partial mitochondrial COI, COII, 16S rDNA, NADH1, partial nuclear 18S rDNA and 28S rDNA. We chose a total of 95 species in 51 genera, including 14 coastal species in eight genera and 21 outgroup species from other aleocharine tribes. The concatenated dataset was analysed simultaneously by both parsimony‐ and model‐based (Bayesian and maximum likelihood) methods. The tribe Athetini was not supported as a monophyletic group, but together with the tribes Tachyusini, Ecitocharini and Hygronomini did form a monophylum. The ecological association of species with a coastal habitat was mapped onto a phylogeny to assess the evolution of habitat specialization in the Athetini lineage. The results reveal that five independent origins of coastal colonization have occurred throughout the tribe Athetini: (a) Osakatheta + Adota minuta + coastal Atheta (Badura) (clade A); (b) Adota (clade B); (c) Pontomalota + Tarphiota + Thinusa (clade C); (d) Iotarphia (clade D); and (e) Psammostiba (clade E). The low species number of the coastal Athetini compared with the entire Athetini lineage indicates that coastal habitats are harsh environments and so only a few species were able to colonize this habitat. The following changes in classification are proposed: (a) Ad. minuta Lee and Ahn is removed from the genus Adota and tentatively included in Atheta (Badura); (b) The genus Saphocallus Sharp is transferred from Athetini to Geostibini.
Forensic Uncertainty Quantification for Experiments on the Explosively Driven Motion of Particles
Authors: Hughes Kyle , Balachandar S. , Kim Nam H. , Park Chanyoung , Haftka Raphael , Diggs Angela , Littrell Donald M. , Darr Jason
Published: April 2019

Six explosive experiments were performed in October 2014 and February of 2015 at the Munitions Directorate of the Air Force Research Laboratory with the goal of providing validation-quality data for particle drag models in the extreme regime of detonation. Three repeated single particle experiments and three particle array experiments were conducted. The time-varying position of the particles was captured within the explosive products by X-ray imaging. The contact front and shock locations were captured by high-speed photography to provide information on the early time gas behavior. Since these experiments were performed in the past and could not be repeated, we faced an interesting challenge of quantifying and reducing uncertainty through a detailed investigation of the experimental setup and operating conditions. This paper presents the results from these unique experiments, which can serve as benchmark for future modeling, and also our effort to reduce uncertainty, which we dub forensic uncertainty quantification (FUQ).
Numerical Investigation of Sediment Transport of Sandy Beaches by a Tsunami-Like Solitary Wave Based on Navier–Stokes Equations
Authors: Liu Cheng , Liu Xiaojian , Jiang Changbo , He Yong , Deng Bin , Duan Zihao , Wu Zhiyuan
Published: April 2019

To improve our current understanding of tsunami-like solitary waves interacting with sandy beach, a nonlinear three-dimensional numerical model based on the computational fluid dynamics (CFD) tool OpenFOAM® is first self-developed to better describe the wave propagation, sediment transport, and the morphological responses of seabed during wave runup and drawdown. The finite volume method (FVM) is employed to discretize the governing equations of Navier–Stokes equations, combining with an improved volume of fluid (VOF) method to track the free surface and a k–ε model to resolve the turbulence. The computational capability of the hydrodynamics and the sediment transport module is well calibrated by laboratory data from different published references. The results verify that the present numerical model can satisfactorily reproduce the flow characteristics, and sediment transport processes under a tsunami-like solitary wave. The water-sediment transport module is then applied to investigate the effects of prominent factors, such as wave height, water depth, and beach slope, in affecting the beach profile change. Finally, a dimensionless empirical equation is proposed to describe the transport volume of onshore sediment based on simulation results, and some proper parameters are recommended through the regression. The results can be significantly helpful to evaluate the process of transported sediment by a tsunami event.
Development and Reliability of an Athlete Introductory Movement Screen for Use in Emerging Junior Athletes
Authors: Rogers Simon A. , Hassmén Peter , Roberts Alexandra H. , Alcock Alison , Gilleard Wendy L. , Warmenhoven John S.
Published: April 2019

Purpose: A novel 4-task Athlete Introductory Movement Screen was developed and tested to provide an appropriate and reliable movement screening tool for youth sport practitioners. Methods: The overhead squat, lunge, push-up, and a prone brace with shoulder touches were selected based on previous assessments. A total of 28 mixed-sport junior athletes (18 boys and 10 girls; mean age = 15.7 [1.8] y) completed screening after viewing standardized demonstration videos. Athletes were filmed performing 8 repetitions of each task and assessed retrospectively by 2 independent raters using a 3-point scale. The primary rater reassessed the footage 3 weeks later. A subgroup (n = 11) repeated the screening 7 days later, and a further 8 athletes were reassessed 6 months later. Intraclass correlation coefficients (ICC), typical error (TE), coefficient of variation (CV%), and weighted kappa (k) were used in reliability analysis. Results: For the Athlete Introductory Movement Screen 4-task sum score, intrarater reliability was high (ICC = .97; CV = 2.8%), whereas interrater reliability was good (intraclass correlation coefficient = .88; CV = 5.6%). There was a range of agreement from fair to almost perfect (k = .31–.89) between raters across individual movements. A 7-day and 6-month test–retest held good reliability and acceptable CVs (≤ 10%) for sum scores. Conclusion: The 4-task Athlete Introductory Movement Screen appears to be a reliable tool for profiling emerging athletes. Reliability was strongest within the same rater; it was lower, yet acceptable, between 2 raters. Scores can provide an overview of appropriate movement competencies, helping practitioners assess training interventions in the athlete development pathway.
Complete Genome Sequence of Bacillus amyloliquefaciens Bacteriophage Ray17
Authors: Showalter Ryan , Adat Imraan , Raab Ronald , Temple Louise
Published: April 2019

Bacteria belonging to the genus
Bacillus
and their cognate viruses are easily found in the environment. Soil sampled from Rockingham County, VA, yielded the bacteriophage Ray17, which was isolated on
Bacillus amyloliquefaciens
.