Effects of Grazing Management and Buffer Strips on Metal Runoff from Pastures Fertilized with Poultry Litter.

Metal runoff from fields fertilized with poultry litter may pose a threat to aquatic systems. Buffer strips located adjacent to fields may reduce nutrients and solids in runoff. However, scant information exists on the long-term effects of buffer strips combined with grazing management on metal runoff from pastures. The objective of this study was to assess the 12-yr impact of grazing management and buffer strips on metal runoff from pastures receiving poultry litter. The research was conducted using 15 watersheds (25 m wide and 57 m long) with five treatments: hayed (H), continuously grazed (CG), rotationally grazed (R), rotationally grazed with a buffer strip (RB), and rotationally grazed with a fenced riparian buffer strip (RBR). Poultry litter was applied annually in spring at 5.6 Mg ha. Runoff samples were collected after every rainfall event. Aluminum (Al) and iron (Fe) concentrations were strongly and positively correlated with total suspended solids, indicating soil erosion was the primary source. Soluble Al and Fe were not related to total Al and Fe. However, there was a strong positive correlation between soluble and total copper (Cu) concentrations. The majority of total Cu and zinc was in water-soluble form. The CG treatment had the highest metal concentrations and loads of all treatments. The RBR and H treatments resulted in lower concentrations of total Al, Cu, Fe, potassium, manganese, and total organic carbon in the runoff. Rotational grazing with a fenced riparian buffer and converting pastures to hayfields appear to be effective management systems for decreasing concentrations and loads of metals in surface runoff from pastures fertilized with poultry litter.

Potential for in situ chemical oxidation of acid extractable organics in oil sands process affected groundwater.

The process of bitumen extraction from oil sands in Alberta, Canada leads to an accumulation of toxic acid-extractable organics (AEOs) in oil sands process water (OSPW). Infiltration of OSPW from tailings ponds and from their retaining sand dykes and subsequent transport towards surface water has occurred. Given the apparent lack of significant natural attenuation of AEOs in groundwater, remediation may be required. This laboratory study evaluates the potential use of unactivated persulfate and permanganate as in situ oxidation agents for remediation of AEOs in groundwater. Naphthenic acids (NAs; CnH2n+zO2), which are a component of the acutely toxic AEOs, were degraded by both oxidants in OSPW samples. Permanganate oxidation yielded some residual dissolved organic carbon (DOC) whereas persulfate mineralized the AEO compounds with less residual DOC. Acid-extractable organics from oxidized OSPW had essentially no Microtox toxicity.

Identification of the primary collagen-binding surface on human glycoprotein VI by site-directed mutagenesis and by a blocking phage antibody.

Glycoprotein (GP) VI is the major receptor responsible for platelet activation by collagen, but the collagen-binding surface of GPVI is unknown. To address this issue we expressed, from insect cells, the immunoglobulin (Ig)-like ectodomains (residues 1-185) of human and murine GPVI, called hD1D2 and mD1D2, respectively. Both proteins bound specifically to collagen-related peptide (CRP), a GPVI-specific ligand, but hD1D2 bound CRP more strongly than did mD1D2. Molecular modeling and sequence comparison identified key differences between hD1D2 and mD1D2. Ten mutant hD1D2s were expressed, of which 4 had human residues replaced by their murine counterpart, and 6 had replacements by alanine. CRP binding studies with these mutants demonstrated that the exchange of lysine at position 59 for the corresponding murine glutamate substantially reduced binding to CRP. The position of lysine59 on the apical surface of GPVI suggests a mode of CRP binding analogous to that used by the related killer cell Ig-like receptors to bind HLA. This surface was confirmed as critical for collagen binding by epitope mapping of an inhibitory phage antibody against GPVI. This anti-GPVI, clone 10B12, gave dose-dependent inhibition of the hD1D2-collagen interaction. Clone 10B12 inhibited activation of platelets by CRP and collagen in aggregometry and thrombus formation by the latter in whole blood perfusion. Antibody 10B12 showed significantly reduced binding to the hD1D2-E59, and, on that basis, the GPVI:10B12 interface was modeled.

Predicting cancer development in oral leukoplakia: ten years of translational research.

Our 10-year translational study of the oral premalignant lesion (OPL) model has advanced the basic understanding of carcinogenesis. Although retinoids have established activity in this model, a substantial percentage of our OPL patients progress to cancer, especially after treatment is stopped. On the basis of our 10-year OPL study, we have developed the first comprehensive tool for assessing cancer risk of OPL patients. This cancer risk assessment tool incorporates medical/demographic variables, epidemiological factors, and cellular and molecular biomarkers. Between 1988 and 1991, 70 advanced OPL patients were enrolled in a chemoprevention trial of induction with high dose isotretinoin (1.5 mg/kg/day for 3 months) followed by 9 months of maintenance treatment with either low dose isotretinoin (0.5 mg/kg/day) or beta-carotene (30 mg/d; total treatment duration, 1 year). We assessed the relationship between cancer risk factors and time to cancer development by means of exploratory data analysis, logrank test, Cox proportional hazard model, and recursive partitioning. With a median follow-up of 7 years, 22 of our 70 patients (31.4%) developed cancers in the upper aerodigestive tract following treatment. The overall cancer incidence was 5.7% per year. The most predictive factors of cancer risk are OPL histology, cancer history, and three of the five biomarkers we assessed (chromosomal polysomy, p53 protein expression, and loss of heterozygosity at chromosome 3p or 9p). In the multivariable Cox model, histology (P = 0.0003) and the combined biomarker score of chromosomal polysomy, p53, and loss of heterozygosity (P = 0.0008) are the strongest predictors for cancer development. Retinoic acid receptor beta and micronuclei were not associated with increased cancer risk. We have demonstrated a successful strategy of comprehensive cancer risk assessment in OPL patients. Combining conventional medical/demographic variables and a panel of three biomarkers can identify high risk patients in our sample. This result will need to be validated by future studies. With the identification of high risk individuals, more efficient chemoprevention trials and molecular targeting studies can be designed.

Blood transfusion and blood conservation: cost and utilization issues.

Approximately 12 million red blood cell units are transfused to nearly 4 million patients annually in the United States (1). The conservation of blood has historically arisen from awareness that the inventory of this resource is limited (2), as well as the knowledge that blood transfusion carries a risk (3). Estimates of current blood transfusion risks (4-12), and the costs of transfusion complications (13-17), are summarized in Table 1. In addition, emphasis on the costs of health care has raised issues related to the costs of blood transfusion (18, 19). Finally, recent guidelines have emphasized that in the elective transfusion setting, no blood transfusion is a desirable outcome (20, 21). Furthermore, these guidelines along with consensus conference recommendations (22) have emphasized that if blood is to be transfused, autologous (the patient's own) blood is preferable to allogeneic (from an anonymous, volunteer donor) blood. Thus, the costs of blood conservation, for which an increasing array of technologic procedures and products have become available (Table 2), have also become an issue (23). The purpose of this review is to provide an overview of emerging data on the cost-effectiveness of blood and blood conservation interventions in order to help identify areas important for future investigation.

Reinfusion of whole blood following addition of tobramycin powder to the wound during total knee arthroplasty.

This study prospectively examined nine human volunteers who underwent unilateral cementless total knee arthroplasty and had 600 mg of tobramycin powder added to their wound just prior to fascial closure. Serum levels of tobramycin were measured at 30 minutes, 4 hours, 8 hours, and 12 hours after surgery. Tobramycin levels in the reinfused whole blood were measured with each reinfusion. Patients were reinfused up to 12 hours after surgery and then the reservoir was left to suction drainage. All patients had significant levels of serum tobramycin 30 minutes after surgery. The average serum level was 5.5 micrograms/ml (range, 3.0-10.6 micrograms/ml). This level was achieved prior to any reinfusion and represented systemic absorption of tobramycin from the bleeding surfaces of the muscle and bone. All patients received at least one reinfusion of 400 ml of whole blood in the first 8 hours after surgery. Two thirds of the patients received a second reinfusion within the same time frame. Serum tobramycin levels measured post-reinfusion indicated that the risk of attaining potential toxic levels of aminoglycoside was not dependent on reinfusion, but on absorption from the wound. The dose of tobramycin in the drain was measured and found to be excessive and potentially toxic (range, 27-312 mg; average, 132 mg). Despite this fact, reinfusion was not as likely to produce toxic serum levels as was local uptake of the antibiotic. Although no patient in this series had any complaints relating to the high dose of tobramycin (deafness or renal failure), caution should be exercised when using antibiotics in a reinfusion system.(ABSTRACT TRUNCATED AT 250 WORDS)

Reinfusion of whole blood after revision surgery for infected total hip and knee arthroplasties.

Because of its proven effectiveness in reducing the need for banked blood transfusions following total joint arthroplasty, the indications for postoperative blood retrieval were expanded to include seven cases of infected total knee or hip arthroplasties where a one-stage exchange procedure was performed. Each joint had been aspirated after surgery and had positive cultures but no gross pus at the time of revision surgery. Each of the operations included debridement with reimplantation of a cementless prosthesis under cover of intravenous antibiotics for 48 hours followed by oral treatment until discharge. Antibiotic-soaked morselized bone graft was used in all patients to restore deficient nonstructural bone. Wound drainage blood was retrieved and reinfused during the first 8 hours after surgery, averaging 958 cc. Banked blood usage averaged 2.4 U (88% homologous) with an average blood loss of 1,974 cc. One patient experienced shaking chills during a second reinfusion of 600 cc of blood without stoppage of the transfusion. Wound hematoma occurred in one patient but did not require surgical evacuation. No patient developed evidence of septicemia.

Comparison of low-dose isotretinoin with beta carotene to prevent oral carcinogenesis.

BACKGROUND: High-dose isotretinoin therapy has been determined to be an effective treatment for leukoplakia. However, a high rate of relapses and toxic reactions led us to conduct a trial of a much lower dose of isotretinoin in the hope of maintaining a response and limiting toxicity. METHODS: In the first phase of the study, 70 patients with leukoplakia underwent induction therapy with a high dose of isotretinoin (1.5 mg per kilogram of body weight per day) for three months; in the second phase, patients with responses or stable lesions were randomly assigned to maintenance therapy with either beta carotene (30 mg per day) or a low dose of isotretinoin (0.5 mg per kilogram per day) for nine months. RESULTS: In the first phase, the rate of response to high-dose induction therapy in the 66 patients who could be evaluated was 55 percent (36 patients). The lesions of seven patients progressed, and therefore they did not participate in the second phase of the trial. Of the 59 patients included in the second phase, 33 were assigned to beta carotene therapy and 26 to low-dose isotretinoin therapy; these two groups did not differ significantly in prognostic factors. Of the 53 patients who could be evaluated, 22 in the low-dose isotretinoin group and 13 in the beta carotene group responded to maintenance therapy or continued to have stable lesions (92 percent vs. 45 percent, P < 0.001). In situ carcinoma developed in one patient in each group, and invasive squamous-cell carcinoma in five patients in the beta carotene group. Toxicity was generally mild, though greater in the group given low-dose isotretinoin therapy. CONCLUSIONS: When preceded by high-dose induction therapy, low-dose isotretinoin therapy was significantly more active against leukoplakia than beta carotene and was easily tolerated.

Postoperative blood retrieval and transfusion in cementless total knee arthroplasty.

Postoperative wound drainage was aspirated, collected, and transfused in 197 patients undergoing unilateral or bilateral cementless knee arthroplasty using the Solcotrans or the Constavac Blood Conservation blood-retrieval devices. Operative technique, method of hemostasis, and postoperative management were identical in all patients. Drainage-tube suction pressure was minimized, and the duration of drainage collection was less than 8 hours in all patients. In the 153 patients who underwent unilateral total knee arthroplasty (TKA), the amount of blood retrieved and transfused averaged 829 cm3 (59% of total blood lost). For the 44 patients who underwent bilateral procedures, 1,131 cm3 of blood was salvaged (56% of total blood lost). Transfused banked blood averaged 1.7 units (25% homologous) in unilateral cases, while bilateral procedures required 3.0 units (35% homologous). Complications (4%) included wound hematomata in five patients and deep venous thrombosis in two. Transient chills, fever, or tachycardia were seen in four patients at the time of transfusion. Transfusion requirements of banked blood appeared to be significantly reduced, especially in simultaneous bilateral knee arthroplasty, when compared to previous experience in patients who did not undergo postoperative blood retrieval.

Electrotherapy and hyperbaric oxygen: promising treatments for postradiation complications.

Electrotherapy and hyperbaric oxygen therapy have been added to physical therapy to treat patients with postsurgery and radiation sequelae. Problems of reduced oral opening and range of head movement, soft tissue necrosis, osteoradionecrosis, and delayed wound healing were addressed in 37 patients over a 3-year period. Of this group, 16 irradiated maxillary resection patients were specifically followed up to determine the effectiveness of the new modalities on improving reduced oral opening. Although healing and the quality of the soft tissues showed marked improvement there was no significant improvement in oral opening.

Elite special forces: physiological description and ergogenic influence of blood reinfusion.

We measured the physical exercise capabilities of U.S. Army Special Forces soldiers (male) and determined the subsequent ergogenic influence of autologous blood reinfusion. Twelve subjects (Ss) completed maximal exercise treadmill testing in a comfortable (Ta = 20 degrees C, Tdp = 9 degrees C) environment. Six Ss were later transfused with a 600 ml autologous red blood cell (50% Hct) NaCl glucose-phosphate solution and completed identical maximal exercise tests 3 and 10 d posttransfusion. Pretransfusion, the 12 Ss had a maximal oxygen uptake (VO2max) of 4.36 +/- 0.56 L . min-1 and 55 +/- 4 ml . kg-1 . min-1 with a heart rate of 188 +/- 10 b . min-1 and ventilatory equivalent for oxygen of 37 +/- 3. For the 6 reinfused Ss, hemoglobin and red cell volume (RCV) increased by 10% (p less than 0.05) and 11% (p less than 0.05), respectively, posttransfusion. Reinfusion increased (p less than 0.05) VO2max from 4.28 +/- 0.22 L . min-1 (54 +/- 5 ml . kg-1 . min-1) to 4.75 +/- 0.42 L . min-1 (60 +/- 6 ml . kg-1 . min-1) and 4.63 +/- 0.21 L . min-1 (59 +/- 6 ml . kg-1 . min-1) at 3 and 10 d posttransfusion, respectively. No significant relationship was found between the individual change in RCV and VO2max values pre- to posttransfusion. We conclude that Special Forces soldiers have high levels of aerobic fitness that can be further increased by blood reinfusion for at least 10 d.