Management of bloodless surgery in a trauma setting. Balancing patient wishes with safety.

Many patients refuse blood or blood products because of religious beliefs or fear of complications. At Hennepin County Medical Center, a multidisciplinary team developed a Bloodless Surgery Medicine Guideline (BSMG) to help identify those who refuse blood products, guide medical decision-making, improve documentation of informed consent or refusal, and ensure continuity of care for patients. To our knowledge, this is the first documentation of a guideline for managing informed consent for or refusal of blood or blood products in trauma patients. This article discusses the development of and legal rationale for two key components of the BSMG: an informed consent/refusal algorithm and a blueprint for discussing the use of blood or blood components with patients and documenting their decisions.

The role of phytochrome C in gravitropism and phototropism in Arabidopsis thaliana.

The phytochrome (phy) photoreceptors, which consist of a small gene family PHYA-E in dicot plants, play important roles in regulating many light-induced responses in plants. Although the best characterised phytochromes are phytochrome A (phyA) and phytochrome (phyB), the functions of phyD and phyE have been increasingly studied. Phytochrome C (phy C) has been the most poorly understood member of the photoreceptor family, since isolation of phyC mutants only has been accomplished within the last few years. Recent reports show that phyC functions in hypocotyl elongation, rosette leaf morphology, and timing of flowering. In the present study, we show that phyC plays a role in tropisms in seedlings and inflorescence stems of light-grown Arabidopsis thaliana (L.) Heynh. (Wassilewskija ecotype). Phytochrome C has a positive effect on gravitropism in hypocotyls and stems, but it has a limited role in root gravitropism. In contrast, phyC attenuates the positive phototropic response to blue light in hypocotyls and the red-light-based positive phototropism in roots. Phytochrome D (phy D) also mediates gravitropism in hypocotyls and inflorescence stems and attenuates positive phototropism in response to blue in hypocotyls and stems. Thus, phyC can be added to the list of the other four phytochromes, which play various roles in both gravitropism and phototropism in plant organs. This report also supports the growing body of evidence demonstrating cross talk between phytochromes and blue-light photoreceptors.