Intensivist-led management of brain-dead donors is associated with an increase in organ recovery for transplantation.

The disparity between the number of patients in need of organ transplantation and the number of available organs is steadily rising. We hypothesized that intensivist-led management of brain dead donors would increase the number of organs recovered for transplantation. We retrospectively analyzed data from all consented adult brain dead patients in the year before (n = 35) and after (n = 43) implementation of an intensivist-led donor management program. Donor characteristics before and after implementation were similar. After implementation of the organ donor support team, the overall number of organs recovered for transplantation increased significantly (66 out of 210 potentially available organs vs. 113 out of 258 potentially available organs, p = 0.008). This was largely due to an increase in the number of lungs (8 out of 70 potentially available lungs vs. 21 out of 86 potentially available lungs; p = 0.039) and kidneys (31 out of 70 potentially available kidneys vs. 52 out of 86 potentially available kidneys; p = 0.044) recovered for transplantation. The number of hearts and livers recovered for transplantation did not change significantly. Institution of an intensivist-led organ donor support team may be a new and viable strategy to increase the number of organs available for transplantations.

Using the affective bias test to predict drug-induced negative affect: implications for drug safety.

BACKGROUND AND PURPOSE: Predicting the risk of drug-induced adverse psychiatric effects is important but currently not possible in non-human species. We investigated whether the affective bias test (ABT) could provide a preclinical method with translational and predictive validity. EXPERIMENTAL APPROACH: The ABT is a bowl-digging task, which quantifies biases associated with learning and memory. Rats encounter independent learning experiences, on separate days, under either acute manipulations (e.g. pro-depressant vs. control) or different absolute reward values (e.g. high vs. low). A bias is observed during a preference test when an animal's choices reflect their prior experience. We investigated the effects of putative pro-depressant drug treatments following acute or chronic administration on the formation of an affective bias or reward-induced positive bias respectively. KEY RESULTS: The immunomodulators LPS (10 µg·kg-1 ), corticosterone (10 and 30 mg·kg-1 ) and IFN-α (100 U·kg-1 ) induced a negative affective bias following acute treatment. Tetrabenazine (1 mg·kg-1 ) also induced a negative bias, but no effects were observed with varenicline, carbamazepine or montelukast. Chronic treatment with IFN-α (100 U·kg-1 ) and retinoic acid (10 mg·kg-1 ) impaired the formation of a reward-induced positive bias but did not alter sucrose preference test (SPT). CONCLUSIONS AND IMPLICATIONS: The ABT has the potential to provide a novel approach to predict pro-depressant risk in a non-human species. Negative biases induced by acute treatment in the standard version of the task may also predict longer-term effects on reward processing as shown by the deficit in reward-induced positive bias following chronic treatment, an effect distinct from anhedonia in the SPT. LINKED ARTICLES: This article is part of a themed section on Pharmacology of Cognition: a Panacea for Neuropsychiatric Disease? To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.19/issuetoc.

Routine intraoperative laparoscopic cholangiography.

BACKGROUND: Whether intraoperative laparoscopic cholangiography should be routine is debatable. METHODS: We reviewed the cholangiography experience in 669 consecutive laparoscopic cholecystectomies. RESULTS: Mean age of the patients was 39 years, 78% were female, and 29% had acute cholecystitis. Cholecystectomy was completed laparoscopically in 606 (91%). Laparoscopic cholangiography was completed in 562 (93%) and 348 (62%) were routine (no preoperative indication). The mean operating time in 1996 was 61 minutes. Out of the 348 routine cholangiograms, 17 demonstrated evidence of unsuspected choledocholithiasis. Five patients had choledocholithiasis documented by laparoscopic common bile duct exploration and/or endoscopic retrograde cholangiopancreatography. Two patients had normal postoperative cholangiopancreatography. One of 10 patients managed expectantly was readmitted postoperatively with obstructive jaundice. In 4 patients, routine cholangiography revealed unexpected anatomy, and in 2, this prevented misidentification and transection of the common bile duct. CONCLUSION: Laparoscopic cholangiography is safe, quick, detects unsuspected choledocholithiasis, and can prevent common bile duct transection. It should be routine.

Recommendations for mechanical ventilation during donor care.

The organ procurement coordinator usually directs adjustments to the mechanical ventilator during donor care. It is often difficult to achieve optimal oxygen uptake and carbon dioxide removal while avoiding barotrauma or undesirable effects on the cardiac output. Interrelationships among a variety of ventilator parameters must be understood in order to achieve the desired goal of providing the best organs possible. These recommendations review the key ventilator parameters of tidal volume; positive end-expiratory pressure; auto-positive end-expiratory pressure; fraction of inspired oxygen; and flowrate and frequency and their interactions in controlling peak, plateau, and mean and end-expiratory airway pressures.

The role of freezing in setting the latitudinal limits of mangrove forests.

Mangrove trees dominate coastal vegetation in tropical regions, but are completely replaced by herbaceous salt marshes at latitudes above 32 degrees N and 40 degrees S. Because water deficit can increase damage caused by freezing, we hypothesized that mangroves, which experience large deficits as a result of saline substrates, would suffer freeze-induced xylem failure. Vulnerability to freeze-induced xylem embolism was examined in the most poleward mangrove species in North America, in an area where freezing is rare but severe, and in Australia, in an area where freezing is frequent but mild. Percentage loss in hydraulic conductivity was measured following manipulations of xylem tension; xylem sap ion concentration was determined using X-ray microanalysis. Species with wider vessels suffered 60-100% loss of hydraulic conductivity after freezing and thawing under tension, while species with narrower vessels lost as little as 13-40% of conductivity. These results indicate that freeze-induced embolism may play a role in setting the latitudinal limits of distribution in mangroves, either through massive embolism following freezing, or through constraints on water transport as a result of vessel size.

Growth of heterotrophic bacteria and algal extracellular products in oligotrophic waters.

The unexpected observation of 200 to 400 coliform bacteria per 100 ml in an unpolluted pristine stream was studied within Grand Teton National Park, Wyo. The high numbers of waterborne bacteria occurred in mid- to late summer at a location where there was a coincidental bloom of an algal mat community. Periphyton samplers were used to measure the algal growth that coincided with the increase in number of bacteria. Laboratory studies followed the growth of various coliform bacteria in the supernatant obtained from a Chlorella culture isolated from the mat community. Mixed natural bacterial populations from the stream and pure cultures of water-isolated fecal and nonfecal coliforms increased by two to three orders of magnitude at 13 degrees C when grown in the algal supernatant. Radioactive algal products were obtained by feeding an axenic Chlorella culture C-labeled bicarbonate under laboratory cultivation at 13 degrees C with illumination. Radioactive organic material from the algae became incorporated into the particulate fraction of pure cultures of coliform bacteria as they reproduced and was later released as they died.

Aquatic indicator bacteria in the high alpine zone.

Selected waters from the high alpine zone within Grand Teton National Park, Wyoming, were analyzed for populations of indicator bacteria during the past three summers to determine the influence of various factors on the quality of these waters. In general the water quality was not significantly influenced by the presence or absence of human visitors but rather by the nature of the biological community through which the streams flowed. A minority of the coliforms that were recovered from all of the sites proved to be fecal coliforms. The fecal streptococci isolated were identified as the species that were found primarily in the fecal material of the native rodent and moose populations. It is concluded that management questions that relate to the carrying capacity of alpine areas should be approached with the aid of other biological parameters along with levels of indicator bacteria in the streams.

Approach to management of the heartbeating 'brain dead' organ donor.

In recent years, transplantation has assumed an important role in the treatment of patients with end-stage diseases of most major organ systems. However, the greatest limitation in organ transplantation today is organ supply. Among factors that can affect the organ supply favorably, donor management has received the least attention. This review addresses management of the multi-organ donor within the intensive care unit. With an increased awareness of donor management issues and the application of a rational physiological approach, the supply of functional organs for transplantation can be increased.

KIE: Clinical management of the brain dead, potential multi-organ donor within the intensive care unit is reviewed. The emphasis is on physiological maintenance until organ procurement. Among the topics discussed are donor recognition and evaluation, declaration of brain death, medical management, and organ procurement and coordination.