AAGBI guidelines: the use of blood components and their alternatives 2016.

Blood transfusion can be life-saving. Anaesthetists regularly request and administer blood components to their patients. All anaesthetists must be familiar with indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematology specialists and their local blood sciences laboratory is encouraged. Considerable changes in approaches to optimal use of blood components, together with the use of alternative products, have become apparent over the past decade, leading to a need to update previous guidelines and adapt them for the use of anaesthetists working throughout the hospital system.

Operational anaesthesia for the management of traumatic brain injury.

The primary brain insult that occurs at the time of head injury, is determined by the degree of neuronal damage or death and so cannot be influenced by further treatment. The focus of immediate and ongoing care from the point of wounding to intensive care management at Role 4 should be to reduce or prevent any secondary brain injury. The interventions and triage decisions must be reassessed at every stage of the process, but should focus on appropriate airway management, maintenance of oxygenation and carbon dioxide levels and maintenance of adequate cerebral perfusion pressure. Early identification of raised intracranial pressure and appropriate surgical intervention are imperative. Concurrent injuries must also be managed appropriately. Attention to detail at every stage of the evacuation chain should allow the head-injured patient the best chance of recovery.

Noncollinear magnetic hyperfine fields in the Ag spacers of Fe/Ag multilayers.

Nearly perpendicular magnetic hyperfine fields have been observed for the first time in the Ag "spacers" of Fe/Ag multilayers using low temperature nuclear orientation of (110)Ag(m) at 6 mK. At the same time, vibrating sample magnetometry measurements at temperatures down to 4 K have shown the magnetic anisotropy of the Fe to be in plane. The direction of the Ag hyperfine field is thus noncollinear (nearly orthogonal) to the Fe anisotropy. These results are compared with full potential linearized augmented plane wave calculations using the wien97 code.

Pulsed-field gel electrophoresis used to investigate genetic diversity of Haemophilus influenzae type b isolates in Australia shows differences between Aboriginal and non-Aboriginal isolates.

We used pulsed-field gel electrophoresis to study the epidemiology and population structure of Haemophilus influenzae type b. DNAs from 187 isolates recovered between 1985 and 1993 from Aboriginal children (n = 76), non-Aboriginal children (n = 106), and non-Aboriginal adults (n = 5) in urban and rural regions across Australia were digested with the SmaI restriction endonuclease. Patterns of 13 to 17 well-resolved fragments (size range, approximately 8 to 500 kb) defining 67 restriction fragment length polymorphism (RFLP) types were found. Two types predominated. One type (n = 37) accounted for 35 (46%) of the isolates from Aboriginals and 2 (2%) of the isolates from non-Aboriginals, and the other type (n = 41) accounted for 2 (3%) of the isolates from Aboriginals and 39 (35%) of the isolates from non-Aboriginals. Clustering revealed seven groups at a genetic distance of approximately 50% similarity in a tree-like dendrogram. They included two highly divergent groups representing 50 (66%) isolates from Aboriginals and 6 (5%) isolates from non-Aboriginals and another genetically distinct group representing 7 (9%) isolates from Aboriginals and 81 (73%) isolates from non-Aboriginals. The results showed a heterogeneous clonal population structure, with the isolates of two types accounting for 42% of the sample. There was no association between RFLP type and the diagnosis of meningitis or epiglottitis, age, sex, date of collection, or geographic location, but there was a strong association between the origin of isolates from Aboriginal children and RFLP type F2a and the origin of isolates from non-Aboriginal children and RFLP type A8b. The methodology discriminated well among the isolates (D = 0.91) and will be useful for the monitoring of postvaccine isolates of H. influenzae type b.

[Homosexuality and psychoanalytic hypocrisy]. / Homosexualität und psychoanalytische Heuchelei.

The author criticizes the common practice in the national and international psychoanalytic associations of denying homosexual applicants admission to training even though all parties know full well that there are more than a few homosexual psychoanalysts within their ranks, some of whom enjoy the high professional esteem of their colleagues. The author refers to his earlier article "Homosexuality and psychoanalysis" (Psyche, 1985, 39, 750-759).

More familial leukaemia in ALL patients with both unexplained high transcortin levels and an HLA antigen Cw3.

In a group of 74 adult ALL patients 25 had a transcortin level greater than or equal to 3 SD above the normal mean, 15 expressed an HLA-Cw3 antigen and 11 combined both characteristics. In this subgroup of 11 ALL patients, five had familial leukaemia, i.e. at least one relative with acute leukaemia or lymphoma. On the other hand, only three examples of familial leukaemia were found in a series of 59 ALL patients with one or none of these two characteristics (relative risk: 15.6; P less than 0.001).

Evidence for an interaction of insulin and sex steroids in the regulation of vitamin D metabolism in the rat.

Vitamin D metabolites and vitamin D-binding protein (DBP) were measured in non-diabetic rats and in rats made diabetic with streptozotocin. The animals were studied in the intact state, after gonadectomy and during pregnancy. In male non-diabetic rats the serum concentrations of 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) and DBP decreased after orchidectomy and were restored by treatment with testosterone. In female non-diabetic rats, these parameters increased after ovariectomy. Increased 1,25-(OH)2D3 and decreased DBP concentrations were found during pregnancy in non-diabetic rats. After the induction of diabetes in intact rats of both sexes, the concentration of DBP decreased, but a significant decrease in the concentration of 1,25-(OH)2D3 was found in male animals only. After ovariectomy, however, 1,25-(OH)2D3 decreased also in female diabetic rats. Both orchidectomy and insulin deficiency depressed serum concentrations of 1,25-(OH)2D3 (-22 and -45% respectively) and DBP (-14 and -29% respectively), but the effects of insulin deficiency were greater than those of androgen withdrawal. Moreover, the testosterone concentration was twofold lower in intact male diabetic rats than in non-diabetic animals. Insulin, but not testosterone treatment, however, restored DBP and 1,25-(OH)2D3 concentrations in diabetic rats, and insulin was effective in intact as well as in gonadectomized animals. This study shows that insulin deficiency decreases the concentrations of DBP and 1,25-(OH)2D3 in the rat, and that these decreases are facilitated by androgens, but counteracted by oestrogens.

HLA antigen CW3 combined with unexplained high transcortin levels is found in patients with acute lymphoblastic leukemia but not in their parents, sibs and offspring.

ALL patients with an unexplained high transcortin level (greater than or equal to 3 SD above the normal mean) have a higher incidence of HLA antigen Cw3 than patients with a lower transcortin level. Although both factors are inheritable, their combination occurs only rarely in the family members of these patients.

Phylogenetic study of transcortin using monoclonal antibodies.

We produced monoclonal antibodies that recognise three distinct epitopes of human transcortin. These epitopes are present on transcortin of humans with normal and altered transcortin levels, as well as on a variant with lower affinity for cortisol. One epitope is present on transcortin of Old World Monkeys and apes, the others are only present on transcortin of apes. The epitopes are not present on transcortin of other species. These results indicate that human transcortin contains a highly evolved and a more conserved part.

Vitamin D metabolites and their binding protein in adult diabetic patients.

Vitamin D metabolites and vitamin D-binding protein were measured in the serum of nonketotic Bantu and Caucasian insulin-requiring diabetic subjects from Zaire and Belgium, respectively. In Caucasian diabetics, whether untreated (N = 18) or insulin treated (N = 26), no abnormalities were found. The Bantu diabetics (N = 20) were more insulin-deficient and had a poorer glucose control than the Caucasians. They presented, compared with Bantu controls, a significant decrease in the serum concentrations of 25-hydroxyvitamin D3 (26 +/- 10 vs. 35 +/- 14 micrograms/L, P less than .01), 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] (38 +/- 15 vs. 58 +/- 17 ng/L, P less than .001), and vitamin D-binding protein (303 +/- 55 vs. 356 +/- 41 mg/L, P less than .001). The decreased concentrations of vitamin D metabolites in the adult Bantu diabetic patients may be partly explained by a concomitant decrease in the concentration of vitamin D-binding protein, possibly due to insulin deficiency. The ratio between the molar concentrations of 1,25-(OH)2D3 and vitamin D-binding protein, used as an index of the free hormonal level, was also decreased, in association with a decreased serum calcium level. In conclusion, no abnormalities in vitamin D metabolism were found in Caucasian insulin-dependent diabetics, whereas low serum 1,25(OH)2D3 concentrations and hypocalcemia were found in poorly controlled Bantu diabetic subjects.