A Systematic Review of Donor Serum Sodium Level and Its Impact on Transplant Recipients.

BACKGROUND: An important aspect of donor management is the optimization of serum sodium levels. OBJECTIVE: To perform a systematic review to determine the effects of donor sodium levels on heart, lung, kidney, and pancreas graft function, recipient mortality, and to identify the optimal donor serum sodium target. METHODS: We searched MEDLINE, Cochrane, Guideline databases, and trial registries from 1946 to May 2019 for studies investigating the effects of donor serum sodium levels on transplant outcomes in all non-hepatic organs. A two-step independent review process was used to identify relevant articles based on inclusion/exclusion criteria. We describe the results narratively, assess the risk of bias, and apply GRADE methodology to evaluate the certainty in the evidence. RESULTS: We included 18 cohort studies in our final analysis (n=28,007). 3 of 4 studies demonstrated an association between donor serum sodium and successful organ transplantation. 5 studies reported no association with graft function, while 6 studies did. 5 studies reported on recipient survival, 3 of which suggested donor sodium is unlikely to be associated with recipient survival. The included studies had serious risk of bias, and the certainty in evidence was deemed to be very low. CONCLUSION: In low risk of bias studies, donor sodium dysregulation is unlikely to affect kidney graft function or mortality of heart and kidney recipients, but the certainty in the evidence is very low due to inconsistency and imprecision. Further research is required to refine the serum sodium target range, quantify the dose-response curve, and identify organs most vulnerable to sodium dysregulation.

Mass-mortality in green striped tree dragons (Japalura splendida) associated with multiple viral infections.

In spring 2011, high mortality in association with skin lesions, systemic haemorrhages and necrosis occurred in a group of green striped tree dragons (Japalura splendida) which were imported from southwestern China via Florida to Germany. Infections with various endoparasites were diagnosed in coprological examinations. Different antiparasitic and antibiotic treatments over a period of three months did not reduce the mortality rate. The remaining animals were therefore euthanased and submitted for additional testing. Predominant findings in pathological examination were granulomatous and necrotising inflammation of the skin, vacuolar tubulonephrosis of the distal renal tubules, hyperaemia and liver necrosis. Eosinophilic intranuclear and basophilic intracytoplasmic inclusion bodies were detected in the liver. Virological testing (PCR and virus isolation methods) demonstrated the presence of ranavirus, adenovirus and invertebrate iridovirus.

Detection of pathogens in Boidae and Pythonidae with and without respiratory disease.

Respiratory diseases in boid snakes are common in captivity, but little information is available on their aetiology. This study was carried out to determine the occurrence of lung associated pathogens in boid snakes with and without respiratory signs and/or pneumonia. In total, 80 boid snakes of the families Boidae (n = 30) and Pythonidae (n = 50) from 48 private and zoo collections were included in this survey. Husbandry conditions were evaluated using a detailed questionnaire. All snakes were examined clinically and grouped into snakes with or without respiratory signs. Tracheal wash samples from all snakes were examined bacteriologically as well as virologically. All snakes were euthanased, and a complete pathological examination was performed. Respiratory signs and pneumonia were detected more often in pythons than in boas. An acute catarrhal pneumonia was diagnosed more often in snakes without respiratory signs than in snakes with respiratory signs, which revealed fibrinous and fibrous pneumonia. Poor husbandry conditions are an important trigger for the development of respiratory signs and pneumonia. Different bacterial pathogens were isolated in almost all snakes with pneumonia, with Salmonella species being the most common. Ferlavirus (formerly known as ophidian paramyxovirus)-RNA was detected only in pythons. Inclusion body disease was rarely seen in pythons but often in boas. Adenovirus and Mycoplasma were other pathogens that were diagnosed in single snakes with pneumonia. In living boid snakes with respiratory signs, tracheal wash samples were found to be a useful diagnostic tool for the detection of viral and bacterial pathogens.

Allergic reactions to lignocaine.

True allergic reactions to local analgesics are extremely rare. This case report illustrates the procedures adopted to manage a patient with a history of suspected allergy. A young woman was found to have a true type I hypersensitivity to lignocaine. Another routinely used local analgesic agent, prilocaine, was tested by the same methods and found to give no allergic response. Dental treatment was successfully completed using the latter and the patient advised to wear a medical alert bracelet.

The provision of adult intensive care in Northern Ireland with reference to the role of high dependency care.

In 1991 an audit of Intensive Care Services was carried out by the Northern Ireland Intensive Care Group. In conjunction with this regional overview, all patients in the Regional Intensive Care Unit, (RICU) in the Royal Victoria Hospital were assessed daily, over a 10 month period in 1990-91 and classified as conforming to either intensive care or high dependency status. These data were then used to compare adult intensive care service in Northern Ireland with recent national and international recommendations on intensive care. Ten units in Northern Ireland were surveyed. In regard to national or international guidelines, all ten were deficient to some degree. Four units had significant deficiencies; small patient numbers, lack of 'dedicated' 24 hr medical cover and or deficiencies in the provision of appropriate monitoring and or equipment. There was a large diversity in casemix among the ten units surveyed which suggested differing admission criteria. The bed occupancy of RICU was 100%. Refused admissions constituted a further 13% of unresourced workload. The lack of physically separate, dedicated high dependency unit facilities meant that 26% of bed days were devoted to HDU care (usually for "improved" intensive care unit patients not yet ready for discharge to a general ward. Achieving nationally recommended intensive care standards (on a regional basis) is probably only possible if a number of the smaller intensive care units are redesignated as high dependency units, and patients requiring intensive care are concentrated in a smaller number of larger ICUs. This will increase the frequency of interhospital transfer of critically ill patients.

Balancing the extraction of primary teeth: a review.

Balancing the extraction of primary teeth is a procedure advocated to maintain symmetry of the developing dentition by encouraging symmetrical drift of teeth mesial and distal to the extraction sites on each side of the dental arch. Current opinion about this procedure expressed in standard reference works is confused and occasionally contradictory. Whilst some authorities cite specific situations where balancing extractions should be performed, others are less precise with their advice, and at least one considers that there is little justification for the procedure. Scientific evidence supporting the procedure is tenuous. The one study carried out specifically to compare dental centre line shift following unilateral or bilateral extraction of primary teeth showed greater shift in cases of unilateral (unbalanced) extractions. Other studies do not directly address the issue and such information as they offer is imprecise. Although the procedure of balancing extractions is strongly advocated by many clinicians, it is not based on definitive experimental evidence.

A clinical trial to evaluate the retention of a silver cermet-ionomer cement used as a fissure sealant.

A randomized clinical trial was under-taken to compare the retention of a silver cermet-ionomer cement, Ketac Silver, with a conventional, autopolymerizing BIS-GMA resin sealant, Delton, using matched pairs of fissure sites within each subject's mouth. One hundred twenty matched contralateral pairs of fissure sites in first and second permanent molars of 53 school children were sealed with the two materials. The choice of site and material was selected at random. The ages of the children ranged from five to 16 years; first permanent molars were sealed in the five- to 10-year age group, and second permanent molars in the 11- to 16-year age group. Sealants were assessed as present, partly present, or absent at 6, 12, and 24 months. The number of pairs of sites available for reassessment declined from 102 at six months to 59 at 24 months as patients were lost to the study. Retention rates were higher for the Ketac Silver sealants at all three inspection intervals (P < 0.01): 93% compared with 74% at six months, 81% compared with 65% at 12 months, and 83% compared with 58% at 24 months. When analyzed according to age range, the difference between the retention rates was statistically significant in the five- to 10-year-olds but not significant in the 11- to 16-year-olds. The conclusion reached in this study was that cermet cement was better retained than conventional resin sealants in younger children.

Root agenesis in developing canines as a complication of intranasal antrostomy.

A case is reported in which the roots of both maxillary canines failed to develop, a defect that could be traced to antral surgery when the patient was 8 years of age. The differential diagnosis of such a finding is proffered. The maxillary antrum is described, and aspects of the surgical procedure, the nasal antrostomy, used in this patient are discussed. A brief outline of current thought on the mechanisms of eruption of teeth is appropriate, and treatment of the symptomatic tooth is mentioned.

A method for the preparation of high-molecular-weight DNA from marine and freshwater triclads (Platyhelminthes, Turbellaria).

Although the last decade has seen much activity devoted to the phylogeny of the Platyhelminthes, such activity has relied in the main on traditional anatomical, ultrastructural, and developmental data. Extension of these studies to the molecular level has been impeded by the lack of a reliable method for the isolation of DNA from these organisms, especially marine triclads whose DNA is particularly difficult to isolate using methods currently used with other eukaryotic or prokaryotic organisms. We report here the details of a method that results in the rapid isolation of relatively pure DNA in good yields from small amounts of material. The method involves the treatment of the animals with high concentrations of NaDodSO4 followed by phenol extraction, resulting in a product that is an excellent substrate for restriction endonuclease digestion and Southern blotting.

Anti-inflammatory effects of synthetic retinoids may be related to their immunomodulatory action.

The effects of retinoids have been studied in a model of delayed-type hypersensitivity using the T-cell-dependent antigen, methylated bovine serum albumin to elicit inflammation in the hind paws of mice. A number of synthetic retinoids, including etretinate and arotinoids, showed a marked anti-inflammatory action in this model. Using differential dosing schedules, the anti-inflammatory effect of retinoids was clearly distinguished from conventional cyclooxygenase inhibitors. By screening a number of synthetic retinoids, structure-activity relationships for this effect can be deduced.