bluuebunny/crossref_metadata_2025_split huggingface dataset:
ABC Study: The Results and Clinical Application
Authors: Vincent Jean‐Louis 
Published: February 2008

SUMMARyAnemia is one of the most commonly encountered abnormal laboratory findings in intensive care unit (ICU) patients, and many ICU patients will receive a blood transfusion during their ICU stay. However, the determinants of when and to whom transfusions should be given are not clear cut and have been the subject of considerable debate in recent years. Transfusion practice may vary considerably between institutions and across countries. The ABC (anemia and blood transfusion in critical care) study reported increased ICU and hospital mortality rates in patients who had received a transfusion. On the other hand, low hemoglobin levels are still associated with increased mortality and morbidity. The “traditional” transfusion trigger of 10 g/dL certainly no longer applies to all, but may well be relevant in certain groups, e.g., patients with cardiac disease. Transfusions should certainly be more restrictive than before, but applying this policy across the board cannot be recommended; each patient must be assessed individually on the basis of past and present clinical history, and in light of oxygenation and hemodynamic parameters. Clearly, further study is needed before we are able to determine the best transfusion strategies for our ICU patients.
Fluid Therapy and Coagulation
Authors: James Michael F.M. 
Published: February 2008

SUMMARYThis article reviews the influence of commonly used resuscitation solutions on both laboratory and clinical coagulation variables. Contrary to the common view, crystalloid solutions enhance coagulation over a range of hemodilution between 10–40%, and do not impair coagulation until hemodilution approaches 70%, provided that ionized calcium concentrations are maintained. By contrast, all of the colloid solutions exert some inhibitory effect on coagulation that appears to exceed the effects of simple hemodilution. The gelatin preparations appear to have the least adverse effect, while dextran preparations impair coagulation to the greatest extent. There is a range of effects exerted by the hydroxyethyl starches that is determined by the in vivo molecular weight of the starch product, with the medium‐to‐low molecular weight solutions (< 200 kD) with a low degree of substitution (< 0.5) exhibiting effects on coagulation that are not significantly different from those of either albumin or the gelatins.
The Therapeutic Potential of Ethyl Pyruvate for the Management of Ischemia/Reperfusion Syndromes, Sepsis and Sepsis‐Related Organ Dysfunction, and Other Conditions Associated With Excessive Inflammation
Authors: Fink Mitchell P. 
Published: February 2008

SUMMARYPyruvate, the final product of glycolysis and the starting substrate for the tricarboxylic acid cycle, plays a central role in intermediary metabolism. It is also an effective scavenger of reactive oxygen species. In order to take advantage of the beneficial effects of pyruvate while circumventing the problem of its poor stability in solution, our laboratory formulated the ester derived from pyruvic acid and ethanol, namely ethyl pyruvate, in a Ringer's‐type calcium‐ and potassium‐containing balanced salt solution. Ringer's ethyl pyruvate solution (REPS) has been evaluated in preclinical studies using animal models of mesenteric ischemia/reperfusion injury, hemorrhagic shock, acute endotoxemia, sepsis, and severe acute alcoholic hepatitis. Treatment with REPS, when compared with treatment with Ringer's lactate solution, has been shown to be able to improve survival and decrease expression of proinflammatory mediators. REPS warrants further evaluation for the resuscitation of patients with hemorrhagic shock and a variety of acute inflammatory conditions.
Cell Salvage in Cardiac Surgery
Authors: Sanjay Prabhu S. , Desmond Michael J. 
Published: February 2008

SUMMARYCardiac surgery is associated with significant amount of bleeding and has been identified as one of the major users of donor blood and blood products. There are increasing concerns about the risks of allogeneic blood transfusion. To minimize the complications associated with allogeneic transfusion there has been a strong trend towards promoting autologous blood transfusion. Cell salvage is a form of autologous transfusion that entails collection of one's own blood, processing of the shed blood and reinfusion into the patient. Its usage in cardiac surgery is related to the fact that these patients have a clean surgical wound intraoperatively and a closed sterile wound drainage system postoperatively, together with a propensity to bleed. Several studies have shown that cell salvage is a useful technique and has several advantages when used in cardiac surgery. A multidisciplinary approach to blood conservation is recommended and cell salvage is one technique that has shown to be effective and safe.
The Qualities of Blood Reinfused During Cell Salvage
Authors: Ridler Biddy M.F. , Thompson John F. 
Published: February 2008

SUMMARYThis article considers the end‐products of the different methods of intraoperative cell salvage. Variations in hematocrit, coagulation factors, and the way in which contaminants are processed are addressed. There are important differences between the techniques in use; it is vital for all those who operate the equipment and who supervise the reinfusion of salvaged blood to be aware of these issues.
Oxygen Transport Agents: A New Approach to Red Blood Cell Alternatives
Authors: Winslow Robert M. 
Published: February 2008

SUMMARYTraditional approaches to red cell substitutes, including perfluorocarbon emulsions, modified hemoglobins or encapsulated hemoglobins, have not fulfilled their early promise. However, the vast amount of research performed in pursuit of these products has allowed a new and deeper insight into the details of O2 transfer at the microscopic level and how red cells, hemoglobin and the vascular system interact to ensure tissue oxygenation. With this understanding in mind, it is now possible to design new O2 carrier molecules specifically aimed at providing O2 to hypoxic tissue. In one sense, these products are not “red cell substitutes” because many of their properties are different from those of red cells and simple measurement of hemoglobin concentration may not be the best indicator of their ability to effectively transport O2. More properly, these new molecules are “O2 transport agents” and, as such, can be used in many clinical applications where red cells are administered today.
An Effective Blood Replacement Fluid That Targets Oxygen Delivery, Increases Plasma Viscosity, and Has High Oxygen Affinity
Authors: Tsai Amy G. , Sakai Hiromi , Wettstein Reto , Kerger Heinz , Intaglietta Marcos 
Published: February 2008

SummaryTo the present the development of blood substitutes has had as a goal to reproduce the properties of blood. New information on how oxygen is transported in microcirculation allows the design of fluids that may be more efficacious than blood during transfusion/resuscitation. These fluids induce vasodilation and increase peripheral vascular resistance through increased blood viscosity, achieving the dual goal of lowering arteriolar oxygen consumption and delivering more oxygen to the tissues. Restoration of tissue function is ensured by reducing the possibility that tissue micro‐regions fall below the threshold of anaerobic metabolism. This goal is attained by using high‐affinity modified hemoglobins that act as a reservoir of oxygen only deployed when the circulating blood arrives at tissue regions where pO2 is very low, even though tissue pO2 may be appear to be below normal. A special feature of an oxygen carrying plasma expander designed according to this premise is that it requires comparatively small amounts of hemoglobin to be effective, a factor that is important since presently human hemoglobin appears to be the oxygen carrier of choice.
The Pharmacoeconomics of Alternatives to Allogeneic Blood Transfusion
Authors: Hulst Marinus van , Slappendel Robert , Postma Maarten J. 
Published: February 2008

SUMMARY Background and Objectives: Pharmacoeconomics provides a standardized methodology for valid comparisons of interventions in different fields of healthcare. The role of pharmacoeconomics in the safety of blood, blood products and alternatives has however been very limited up to today. This paper discusses the pharmacoeconomic evaluations of alternatives to blood transfusion that have been published in the scientific literature. Methods: We reviewed pharmacoeconomic methodology with special reference to cost‐effectiveness and cost‐utility analysis. We searched the literature for such cost‐effectiveness analyses related to alternatives to blood transfusion. Results: Net costs per quality‐adjusted life year (QALY) gained varied from cost‐saving for reduction of blood transfusions by antifibrinolytics and for analyses which included assumed complications caused by transfusion‐related immunomodulation to more than a hundred millions of US$ per QALY gained for preoperative autologous donation by transurethral prostatectomy patients and epoetin augmentation of preoperative autologous donation. Conclusions: Currently preoperative autologous blood donation with or without epoetin augmentation and epoetin in the absence of autologous transfusion cannot be regarded as cost‐effective healthcare interventions for the general population. Perioperative use of antifibrinolytics may be cost‐saving, but at present evidence is scarce. Cost‐effectiveness of alternatives to blood transfusion may improve if the impact of adverse effects of allogeneic transfusion, such as immunomodulation, bacterial infection and TRALI, can be further substantiated, if the costs of allogeneic blood transfusion continue to rise due to the introduction of (more) safety measures or if donor blood becomes scarce.
Red Blood Cell Transfusion Practices in Pediatric Critical Care
Authors: Lacroix Jacques , Tucci Marisa , Gauvin France 
Published: February 2008

SummaryIn this paper, we review all published papers on the practice patterns of pediatric intensivists with respect to the transfusion of red blood cells to critically ill children. In order to achieve this task, we address three questions: (1) What do pediatric intensivists think about RBC transfusion? (2) What do they do in practice? (3) What should be done? A review of the available evidence in the medical literature was undertaken, and the results reported. We concluded that there is a large variation in stated and observed practice patterns in pediatric intensive care. The hemoglobin concentration, as well as many other host‐specific factors, modulate the decision to prescribe a RBC transfusion in critically ill children. Hard data that support the prevalent practice pattern are scarce. Clearly, more clinical studies are required to better define the best red blood cell transfusion strategy in pediatric intensive care units.
Guidelines for Transfusion: A Way to Decrease Transfusion
Authors: Roseff Susan D. 
Published: February 2008

SUMMARYTransfusion practice must be audited to comply with regulatory and quality standards. The Joint Commission on the Accreditation of Healthcare Organizations requires evaluation of transfusion practice as a part of continuous quality improvement. Transfusion guidelines are written by each institution, usually by a blood utilization committee, and then reviewed by the committee, which is composed of transfusion medicine and peer members. These guidelines should contain criteria that would make a transfusion easily justified without further investigation. In addition, they should include clinical criteria that render transfusion appropriate, even if the proscribed triggers are not met. Guidelines serve as a means of evaluating transfusion practice, not as transfusion indications.In addition to concerns about transfusion transmitted disease, there are also growing numbers of reports of increased morbidity and mortality due to transfusion itself, which is known to mediate inflammatory cytokines. With new safety measures, regulatory requirements and changes in demographics, there are less eligible donors, resulting in concerns over the adequacy of the blood supply.With the long potential life span of pediatric patients, preventing adverse transfusion outcomes that could have long‐term consequences is important. There are a variety of pharmacologic agents and new technologies available to decrease the need for blood products, reducing risks from transfusion, while preserving the supply of banked blood. Transfusion guidelines are an integral component of any program to help an institution evaluate how well it adheres to acceptable, safe practice. There are many publications written by expert consensus panels that set down adult transfusion audit guidelines and a few that specifically address pediatric guidelines. Unfortunately, there is a paucity of evidence‐based data in the pediatric transfusion literature. This paper will look at data to support the use of conservative transfusion practice and then discuss the creation of guidelines and how they can help, in a comprehensive program, to decrease or even abrogate the use of blood products. Where specific data for pediatric transfusion exists, it will be presented.
Medical and Economic Impact of Aprotinin Use in Adult Cardiac Surgery
Authors: Meyerson Shari L. , Smith Peter K. 
Published: February 2008

SUMMARYAprotinin, a non‐specific serine protease inhibitor, has been conclusively shown to reduce bleeding and transfusion requirements in coronary artery bypass grafting patients supported by cardiopulmonary bypass during surgery. Aprotinin is approved for use in a full‐dose regimen which inhibits kallikrein, plasmin, and premature platelet activation by circulating thrombin. It is also approved for use in a half‐dose regimen which inhibits only plasmin while preserving platelet function as well. With the full‐dose regimen, aprotinin is more effective than the lysine analogues for bleeding endpoints. It also reduces the incidence of perioperative stroke, compared to placebo, while safety in relation to myocardial infarction and death is maintained. The half‐dose regimen is also effective in reducing bleeding and transfusion, but has been associated with increased rates of perioperative myocardial infarction and death, and appears to be less effective in stroke reduction than full‐dose, particularly in high‐risk patients. Full‐dose aprotinin is more effective than half‐dose aprotinin in reducing bleeding and blood transfusion.A comprehensive economic analysis of the randomized trial resource use data has been performed to evaluate the cost‐effectiveness of both aprotinin doses. In primary coronary artery bypass grafting, most of the cost of full‐dose aprotinin and all of the cost of half‐dose aprotinin is recovered by in‐hospital reduction of resource based costs. Further cost savings throughout the patient's lifetime are realized for full‐dose aprotinin due to stroke reduction, ultimately recovering the full cost of the drug. For half‐dose, additional lifetime savings related to stroke reduction are offset by increased lifetime cost of myocardial infarction. In reoperative coronary artery bypass grafting, the use of both full‐ and half‐dose aprotinin led to in‐hospital cost savings of approximately $2,000 per patient. When lifetime costs of complications were considered, an additional savings of $4,000 per patient for full‐dose and $2,000 per patient for half‐dose were realized, primarily through stroke reduction.
Blood Conservation in Pediatric Cardiac Surgery
Authors: Pouard Philippe 
Published: February 2008

SUMMARYThere are many blood conservation strategies available for children undergoing cardiac surgery. These strategies will vary depending on patient age and type of surgery. The goal of them all, however, is the same, namely to minimize exposure to allogeneic transfusion while maximizing the use of autologous red cells. Every participant in the process, including the cardiologist, anesthesiologist, perfusionist, surgeon, intensivist and laboratory technician, is committed to the overriding objective of blood conservation in pediatric cardiac surgery. Even if the effects and costs of al l these methods have not yet been completely assessed, many are available, accurate and need to be implemented.
Bovine Immune Response to Inoculation with
Neospora caninum
Surface Antigen SRS2 Lipopeptides Mimics Immune Response to Infection with Live Parasites
Authors: Baszler Timothy V. , Shkap Varda , Mwangi Waithaka , Davies Christopher J. , Mathison Bruce A. , Mazuz Monica , Resnikov Dror , Fish Lea , Leibovitch Benjamin , Staska Lauren M. , Savitsky Igor 
Published: February 2008

ABSTRACT

Infection of cattle with
Neospora caninum
protozoa, the causative agent of bovine protozoal abortion, results in robust cellular and humoral immune responses, particularly CD4
+
T-lymphocyte activation and gamma interferon (IFN-γ) secretion. In the present study,
N. caninum
SRS2 (NcSRS2) T-lymphocyte-epitope-bearing subunits were incorporated into DNA and peptide preparations to assess CD4
+
cell proliferation and IFN-γ T-lymphocyte-secretion immune responses in cattle with predetermined major histocompatibility complex (MHC) genotypes. In order to optimize dendritic-cell processing, NcSRS2 DNA vaccine was delivered with granulocyte macrophage-colony-stimulating factor and Flt3 ligand adjuvant. The synthesized NcSRS2 peptides were coupled with a palmitic acid molecule (lipopeptide) and delivered with Freund's adjuvant. Cattle vaccinated with NcSRS2 DNA vaccine alone did not induce T-lymphocyte activation or IFN-γ secretion, whereas subsequent booster inoculation with NcSRS2-lipopeptides induced robust NcSRS2-specific immune responses. Compared to the response in control animals, NcSRS2-lipopeptide-immunized cattle had significantly increased NcSRS2-specific T-lymphocyte proliferation, numbers of IFN-γ-secreting peripheral blood mononuclear cells, and immunoglobulin G1 (IgG1) and IgG2a antibody levels. The findings show that
N. caninum
NcSRS2 subunits bearing T-lymphocyte epitopes induced cell-mediated immune responses similar to the protective immune responses previously described against live parasite infection, namely T-lymphocyte activation and IFN-γ secretion. The findings support the investigation of NcSRS2 immunogens for protection against
N. caninum
-induced fetal infection and abortion in cattle.
Genetic Features of Clinical Isolates of
Streptococcus dysgalactiae
subsp.
equisimilis
Possessing Lancefield's Group A Antigen
Authors: Tanaka Daisuke , Isobe Junko , Watahiki Masanori , Nagai Yoshiyuki , Katsukawa Chihiro , Kawahara Ryuji , Endoh Miyoko , Okuno Rumi , Kumagai Nanako , Matsumoto Masakado , Morikawa Yoshiro , Ikebe Tadayoshi , Watanabe Haruo 
Published: February 2008

ABSTRACT

Thirteen
Streptococcus dysgalactiae
subsp.
equisimilis
isolates possessing Lancefield's group A antigen recovered from people in Japan during 2000 to 2004 were genotyped. The results indicate that a conserved clone has persisted and spread within Japan, and two different
emm
types were observed within members of this clone.
Characterization of New Staphylococcal Cassette Chromosome
mec
(SCC
mec
) and Topoisomerase Genes in Fluoroquinolone- and Methicillin-Resistant
Staphylococcus pseudintermedius
Authors: Descloux Sybill , Rossano Alexandra , Perreten Vincent 
Published: February 2008

ABSTRACT

Fluoroquinolone- and methicillin-resistant
Staphylococcus pseudintermedius
isolates harbor two new staphylococcal cassette chromosome
mec
(SCC
mec
) elements that belong to class A, allotype 3 (SCC
mec
II-III), and to the new allotype 5 (SCC
mec
VII). Analysis of the complete nucleotide sequences of the topoisomerase loci
gyrB
/
gyrA
and
grlB
/
grlA
revealed mutations involved in fluoroquinolone resistance.
Survey of Vaginal-Flora
Candida
Species Isolates from Women of Different Age Groups by Use of Species-Specific PCR Detection
Authors: Vermitsky John-Paul , Self Matthew J. , Chadwick Sean G. , Trama Jason P. , Adelson Martin E. , Mordechai Eli , Gygax Scott E. 
Published: February 2008

ABSTRACT

A retrospective survey of 93,775 samples testing positive in
Candida
species-specific PCR tests performed on cervicovaginal swabs over a 4-year period demonstrated consistent yearly distributions of
Candida albicans
(89%),
C. glabrata
(7.9%),
C. parapsilosis
(1.7%), and
C. tropicalis
(1.4%). However, the species distributions among different age groups revealed increases in the percentages of non-
albicans
species with increases in age.
Role of Sindbis Virus Capsid Protein Region II in Nucleocapsid Core Assembly and Encapsidation of Genomic RNA
Authors: Warrier Ranjit , Linger Benjamin R. , Golden Barbara L. , Kuhn Richard J. 
Published: February 2008

ABSTRACT
Sindbis virus is an enveloped positive-sense RNA virus in the alphavirus genus. The nucleocapsid core contains the genomic RNA surrounded by 240 copies of a single capsid protein. The capsid protein is multifunctional, and its roles include acting as a protease, controlling the specificity of RNA that is encapsidated into nucleocapsid cores, and interacting with viral glycoproteins to promote the budding of mature virus and the release of the genomic RNA into the newly infected cell. The region comprising amino acids 81 to 113 was previously implicated in two processes, the encapsidation of the viral genomic RNA and the stable accumulation of nucleocapsid cores in the cytoplasm of infected cells. In the present study, specific amino acids within this region responsible for the encapsidation of the genomic RNA have been identified. The region that is responsible for nucleocapsid core accumulation has considerable overlap with the region that controls encapsidation specificity.
Hydrophobic Inactivation of Influenza Viruses Confers Preservation of Viral Structure with Enhanced Immunogenicity
Authors: Raviv Yossef , Blumenthal Robert , Tompkins S. Mark , Humberd Jennifer , Hogan Robert J. , Viard Mathias 
Published: February 2008

ABSTRACTThe use of inactivated influenza virus for the development of vaccines with broad heterosubtypic protection requires selective inactivation techniques that eliminate viral infectivity while preserving structural integrity. Here we tested if a hydrophobic inactivation approach reported for retroviruses could be applied to the influenza virus. By this approach, the transmembrane domains of viral envelope proteins are selectively targeted by the hydrophobic photoactivatable compound 1,5-iodonaphthyl-azide (INA). This probe partitions into the lipid bilayer of the viral envelope and upon far UV irradiation reacts selectively with membrane-embedded domains of proteins and lipids while the protein domains that localize outside the bilayer remain unaffected. INA treatment of influenza virus blocked infection in a dose-dependent manner without disrupting the virion or affecting neuraminidase activity. Moreover, the virus maintained the full activity in inducing pH-dependent lipid mixing, but pH-dependent redistribution of viral envelope proteins into the target cell membrane was completely blocked. These results indicate that INA selectively blocks fusion of the virus with the target cell membrane at the pore formation and expansion step. Using a murine model of influenza virus infection, INA-inactivated influenza virus induced potent anti-influenza virus serum antibody and T-cell responses, similar to live virus immunization, and protected against heterosubtypic challenge. INA treatment of influenza A virus produced a virus that is noninfectious, intact, and fully maintains the functional activity associated with the ectodomains of its two major envelope proteins, neuraminidase and hemagglutinin. When used as a vaccine given intranasally (i.n.), INA-inactivated influenza virus induced immune responses similar to live virus infection.