A prospective assessment of the medic autologous blood transfusion skills for field transfusion preparation.

BACKGROUND: Data demonstrate the benefit of blood product administration near point-of-injury (POI). Fresh whole blood transfusion from a pre-screened donor provides a source of blood at the POI when resources are constrained. We captured transfusion skills data for medics performing autologous blood transfusion training. METHODS: We conducted a prospective, observational study of medics with varying levels of experience. Inexperienced medics were those with minimal or no reported experience learning the autologous transfusion procedures, versus reported experience among special operations medics. When available, medics were debriefed after the procedure for qualitative feedback. We followed them for up to 7 days for adverse events. RESULTS: The median number of attempts for inexperienced and experienced medics was 1 versus 1 (interquartile range 1-1 for both, p = .260). The inexperienced medics had a slower median time to needle venipuncture access for the donation of 7.3 versus 1.5 min, needle removal after clamping time of 0.3 versus 0.2 min, time to bag preparation of 1.9 versus 1.0 min, time to IV access for reinfusion of 6.0 versus 3.0 min, time to transfusion completion of 17.3 versus 11.0 min, and time to IV removal of 0.9 versus 0.3 min (all p < .05). We noted one administrative safety event in which an allogeneic transfusion occurred. No major adverse events occurred. Qualitative data saturated around the need for quarterly training. CONCLUSIONS: Inexperienced medics have longer procedure times when training autologous whole blood transfusion skills. This data will help establish training measures of performance for skills optimization when learning this procedure.

Can calf age be estimated using a combination of serum gamma-glutamyl transferase, total protein and immunoglobulin G?

Our aim was to test a novel method for estimating the age of young calves, using serum γ-glutamyl transferase (GGT) activity, total protein concentration and immunoglobulin G (IgG) concentration. Blood samples were taken from 59 dairy calves at 2, 4, 6, 8, 10, 12, and 14 days of age, and serum GGT activity, total protein concentration, and IgG concentration were measured. Bayesian regression models were used to estimate the association of GGT, total protein, and IgG, with calf age. A multivariate hierarchical regression model was then created, and the model's reliability in estimating the age of simulated subjects was assessed. The univariate models showed a strong within-calf relationship between age and GGT (conditional R2 (cR2) = 0.93), and age and total protein (cR2 = 0.75), while the relationship between calf age and IgG was less consistent (cR2 = 0.63). There was a high degree of variation between calves for these parameters, particularly for the relationship between age and total protein (marginal R2 (mR2) 0.02), and age and IgG (mR2 0.01); somewhat less between-calf variation was seen for GGT (mR2 0.30). For the final multivariate model, we tested the model reliability by simulating new subjects. The credible intervals for estimates of calf age generated from the model were wide, indicating poor reliability. We concluded that single measurements of serum GGT activity, total protein concentrations and IgG concentrations cannot be used to reliably estimate the age of young calves to within 1-2 days.

Invited review: The welfare of young calves transported by road.

The transport of young calves is a welfare concern. Young calves aged ≤3 mo are particularly vulnerable to compromised welfare, and are at a relatively high risk of morbidity and mortality compared with adult cattle. Calves face several potential challenges to welfare during and after transport, including food and water deprivation, disease, injury, and stress from handling, social mixing, and new environments. The key risk factors identified for poor calf welfare associated with transport include long transport and fasting durations, young age at transport, poor colostral immunity, timing within the calving season, lack of bedding in trucks, and high stocking density. Maximizing calf welfare thus requires a multifaceted approach, such as minimizing transport and fasting durations, transporting at an appropriate stocking density with comfortable bedding, only transporting calves that are healthy and fit, and optimizing pre-transport calf management. More research is needed to understand the effect of transport on the mental or affective state of calves.

Trace element deficiency is highly prevalent and associated with infection and mortality in patients with alcoholic hepatitis.

BACKGROUND: Malnutrition is common in patients with alcohol-related liver disease and is associated with outcome in patients with alcoholic hepatitis. Trace elements (cobalt, copper, iron, selenium and zinc) are micronutrients essential for many cellular processes including antioxidant pathways. The prevalence and relevance of trace element deficiency is unknown in alcoholic hepatitis. AIM: To determine the prevalence of trace element deficiency and its association with clinical outcomes in patients with alcoholic hepatitis. METHODS: Serum was obtained from patients with alcoholic hepatitis, alcohol-related cirrhosis and healthy volunteers as part of clinical trials, cohort studies and a biobank. Trace element concentration was measured by inductively coupled plasma mass spectrometry. Association of trace element levels with development of infection within 90 days and mortality within 28 and 90 days was evaluated by multivariate logistic regression. RESULTS: Sera from 302 patients with alcoholic hepatitis, 46 with alcohol-related cirrhosis and 15 healthy controls were analysed for trace element concentration. The prevalence of zinc deficiency (85%) and selenium deficiency (67%) in alcoholic hepatitis was higher than in alcohol-related cirrhosis (72% [p=0.04] and 37% [p<0.001], respectively). Zinc, selenium, copper and chromium were significantly different between groups. Iron deficiency was a predictor of development of infection within 90 days. Zinc deficiency was a predictor of mortality within 28 and 90 days. CONCLUSION: Trace element deficiency in patients with alcoholic hepatitis is highly prevalent and associated with infection and mortality. Supplementation with selected trace elements may improve clinical outcomes in this patient group but further insight is required of their biological and clinical effects.

Risk Associated With Autologous Fresh Whole Blood Training.

Fresh whole blood (FWB) is increasingly being recognized as the ideal resuscitative fluid for hemorrhagic shock. Because of this, military units are working to establish the capability to give FWB from a walking blood bank donor in environments that are unsupported by conventional blood bank services. Therefore, many military units are performing autologous blood transfusion training. In this training, a volunteer has a unit of blood collected and then transfused back into the same donor. The authors report their experience performing an estimated 3408 autologous transfusions in training and report no instances of hemolytic transfusion reactions or other major complications. With appropriate control measures in place, autologous FWB training is low-risk training.

Detergentless ultrasound-assisted extraction of trace elements from edible oils using lipase as an extractant.

A new method for the extraction and preconcentration of trace elements (Al, Ba, Cd, Cu, Fe, Mn, Mo, Ni, Ti, V and Zn) from edible oils by producing detergentless micro-emulsions via an ultrasound-assisted extraction using a water phase containing Lipase at pH 3 as an extractant was developed. The trace elements in the water phase post-extraction were determined against matrix matched standards using ICP-MS. In the first step of the work, the parameters that affect extraction, such as pH, the volume of 1% lipase in the water phase and the ultrasonic and centrifugation times were optimized. Under the optimal conditions, the detection limits (µg kg(-1)) were 0.46, 0.03, 0.007, 0.028, 0.67, 0.038, 0.022, 0.14, 0.17, 0.05 and 0.07 for Al, Ba, Cd, Cu, Fe, Mn, Mo, Ni, Ti, V and Zn respectively for edible oils (3 Sb/m). A certified reference material (EnviroMAT HU-1 Used oil) was analysed to check the accuracy of the developed method. Results obtained were in agreement with certified values with a t-test showing that no significant differences at the 95% confidence levels were found. The proposed method was applied to different edible oils such as sunflower oil, rapeseed oil, olive oil and salmon oil.

Extraction of trace elements by ultrasound-assisted emulsification from edible oils producing detergentless microemulsions.

The aim of this study is to develop a new method for the extraction and preconcentration of trace elements from edible oils via an ultrasound-assisted extraction using ethylenediaminetetraacetic acid (EDTA) producing detergentless microemulsions. These were then analyzed using ICP-MS against matrix matched standards. Optimum experimental conditions were determined and the applicability of the proposed ultrasound-assisted extraction method was investigated. Under the optimal conditions, the detection limits (µg kg(-1)) were 2.47, 2.81, 0.013, 0.037, 1.37, 0.050, 0.049, 0.47, 0.032 and 0.087 for Al, Ca, Cd, Cu, Mg, Mn, Ni, Ti, V and Zn respectively for edible oils (3Sb/m). The accuracy of the developed method was checked by analyzing certified reference material. The proposed method was applied to different edible oils such as sunflower seed oil, rapeseed oil, olive oil and cod liver oil.

Interaction of curcumin with manganese may compromise metal and neurotransmitter homeostasis in the hippocampus of young mice.

Manganese (Mn) exposure is related to industrial activities, where absorption by inhalation has high relevance. Manganism, a syndrome caused as a result of excessive accumulation of Mn in the central nervous system, has numerous symptoms similar to those seen in idiopathic Parkinson disease (IPD). Some of these symptoms, such as learning, memory, sensorial, and neurochemical changes, appear before the onset of motor deficits in both manganism and IPD. The aim of this study was to evaluate the possible neuroprotective effects of curcumin against behavioral deficits induced by Mn toxicity in young (2 months old) Swiss mice. We evaluated the effect of chronic inhalation of a Mn mixture [Mn(OAc)3 and MnCl2 (20:40 mM)], 1 h/session, three times a week, over a 14-week period on behavioral and neurochemical parameters. Curcumin was supplemented in the diet (500 or 1,500 ppm in food pellets). The Mn disrupted the motor performance evaluated in the single-pellet reach task, as well as the short- and long-term spatial memory evaluated in the step-down inhibitory avoidance task. Surprisingly, curcumin also produced similar deleterious effects in such behavioral tests. Moreover, the association of Mn plus curcumin significantly increased the levels of Mn and iron, and decreased the levels of dopamine and serotonin in the hippocampus. These alterations were not observed in the striatum. In conclusion, the current Mn treatment protocol resulted in mild deficits in motor and memory functions, resembling the early phases of IPD. Additionally, curcumin showed no beneficial effects against Mn-induced disruption of hippocampal metal and neurotransmitter homeostasis.

A prospective evaluation of the contribution of ambient temperatures and transport times on infrared thermometry readings of intravenous fluids utilized in EMS patients.

BACKGROUND: During cold weather months in much of the country, the temperatures in which prehospital care is delivered creates the potential for inadvertently cool intravenous fluids to be administered to patients during their transport and care by emergency medical services (EMS). There is some potential for patient harm from unintentional infusion of cool intravenous fluids. Prehospital providers in these cold weather environments are likely using fluids that are well below room temperature when prehospital intravenous fluid (IVF) warming techniques are not being employed. It was hypothesized that cold ambient temperatures during winter months in the study location would lead to the inadvertent infusion of cold intravenous fluids during prehospital patient care. METHODS: Trained student research assistants obtained three sequential temperature measurements using an infrared thermometer in a convenience sample of intravenous fluid bags connected to patients arriving via EMS during two consecutive winter seasons (2011 to 2013) at our receiving hospital in Syracuse, New York. Intravenous fluids contained in anything other than a standard polyvinyl chloride bag were not measured and were not included in the study. Outdoor temperature was collected by referencing National Weather Service online data at the time of arrival. Official transport times from the scene to the emergency department (ED) and other demographic data was collected from the EMS provider or their patient care record at the time of EMS interaction. RESULTS: Twenty-three intravenous fluid bag temperatures were collected and analyzed. Outdoor temperature was significantly related to the temperature of the intravenous fluid being administered, b = 0.69, t(21) = 4.3, p < 0.001. Transport time did not predict the measured intravenous fluid temperatures, b = 0.12, t(20) = 0.55, p < 0.6. CONCLUSIONS: Use of unwarmed intravenous fluid in the prehospital environment during times of cold ambient temperatures can lead to the infusion of cool intravenous fluid and may result in harm to patients. Short transport times do not limit this risk. Emergency departments should not rely on EMS agencies' use of intravenous fluid warming techniques and should consider replacing EMS intravenous fluids upon ED arrival to ensure patient safety.

The effects on claw health of supplement feeding grazing dairy cows on feed pads.

The effects of feeding and management systems on the health and welfare of grazing dairy cows were investigated by comparing the claw health of cows fed grain during milking and pasture silage in the paddock (Control), with cows fed a grain-based partial mixed ration (PMR) on a concrete feed pad. Cows were assessed on three occasions during lactation: (1) early lactation (20-81 days in milk [DIM]) before allocation to feeding treatments; (2) mid-lactation (97-158 DIM) immediately following an intensive feeding experiment, and (3) late lactation (173-243 DIM) several months after return to initial management groups. At the final examination, claw puncture resistance was measured. The results showed that for the most prevalent lesions (white line disease, paintbrush haemorrhage and traumatic bruising), there was no effect of feeding system or amount of supplement on the presence of the moderate to severe forms in early lactation, but cows were more likely to have a particular lesion at the second assessment if it was present in early lactation. Puncture resistance of the claw was not related to presence of a lesion for any of the most prevalent lesion types. It was concluded for this herd that for most indicators of claw health, there was no overall effect of different feeding systems (supplement fed during milking or on a feed pad) or amount of supplement.

Acupuncture--help, harm, or placebo?

The most recent meta-analysis appearing in Fertility and Sterility on acupuncture was reevaluated in view of the marked heterogeneity of interventions, controls, data analysis, and timing of interventions in the trials that were included. After removing some of the trials and data based on more rigorous standards for a high quality meta-analysis, a significant benefit of the intervention could no longer be shown. When studies with and without placebo controls were analyzed separately, a placebo effect was suggested. Individual trials with a confidence limit below unity emphasized the potential for a detrimental impact on outcomes, which should be considered both in using acupuncture clinically as an adjunct for IVF and in design of future trials. Much more data that includes a placebo control will be required before a conclusion can be made that acupuncture has a true treatment effect on IVF outcomes. However, unless the timing and method of the acupuncture are standardized, practitioners will still have difficulty being sure that their particular method will help beyond the apparent benefit provided by a placebo.

Growth performance and starch utilization in common carp (Cyprinus carpio L.) in response to dietary chromium chloride supplementation.

A nutrition trial was conducted on juvenile common carp (Cyprinus carpio), initial mean body weight 15 ± 0.4 g within a controlled facility at 25 ± 0.5°C. Six diets containing various levels of supplementary Cr (0, 0.2, 0.5, 1.0, 1.5, and 2.0) mg Cr/kg of diet as Cr chloride hexahydrate were fed to carp for a period of 10 weeks. Lower growth performance was observed in fish fed on the control diet and the diet supplemented with the highest level of Cr (2.0mg Cr/kg). Although fish fed 0.5mg Cr/kg showed the best growth performance, this was not significantly different (P>0.05) from fish fed 1.0mg Cr/kg. The regression of plasma glucose concentration was linear (R(2)=0.97 and P value=0.001) as the Cr content of the diet increased (up to 1.5mg Cr/kg). Cr carcass content was elevated with an increasing level of dietary Cr supplementation up to 1.5mg Cr/kg; but fish fed on the diet supplemented with the highest level of Cr (2.0mg Cr/kg) showed a decrease in Cr carcass content. Histological examination to evaluate the impact of different Cr supplementation on liver and gut tissues showed notable changes. The higher level of Cr (2.0mg Cr/kg) in the diet gave rise to elevated hepatocyte vacuolization and changes in gut tissue morphology. It appeared that Cr chloride significantly improved growth within a defined range (0.2-1.5) mg Cr/kg without any negative impact, while 2.0mg Cr/kg in carp diet seems to be the threshold for the initiation of toxicity.

Selenium in water enhances antioxidant defenses and protects against copper-induced DNA damage in the blue mussel Mytilus edulis.

Selenium and copper are naturally occurring elements in the environment that have important roles in cellular function. Selenium is known for its role in antioxidant defense, whereas copper is a redox-active metal capable of acting as a pro-oxidant. We investigated the effects of short term selenium (Na(2)SeO(3)) supplementation (4 µg/L for 3 days) on antioxidant parameters of the blue mussel, Mytilus edulis, and its possible protective effects against a subsequent copper (CuSO(4)) exposure (56 µg/L for 3 days). Selenium supplementation caused a 4-fold increase in glutathione levels in gills. The activity of selenium-dependent glutathione peroxidase was modulated by selenium in gills (2-fold increase) and also in cell-free haemolymph (40% increase). Copper exposure produced decreases in protein thiol levels (35%) and in thioredoxin reductase activity (60%) in gills and induced an increase in DNA damage in haemocytes (70% increase in % tail DNA observed using the comet assay). The decrease in thioredoxin reductase activity may constitute a mechanism of copper toxicity in bivalves, warranting further investigation. Pre-treatment with selenium largely prevented these deleterious effects of copper on protein thiols, thioredoxin reductase activity and DNA damage. The results suggest that induction of key antioxidant defenses such as glutathione and selenium-dependent glutathione peroxidase, as a result of selenium supplementation, may play an important role in protection of aquatic organisms against oxidative stress.

Determination of gallium at trace levels using a spectrofluorimetric method in synthetic U-Ga and Ga-As solutions.

A simple, easy to use and selective spectrofluorimetric method for the determination of trace levels of gallium has been developed. A new Schiff base, N-o-vanillidine-2-amino-p-cresol (OVAC) was synthesized and its fluorescence activity with gallium investigated. Based on this chelation reaction, a spectrofluorimetric method has been developed for the determination of gallium in synthetically prepared Ga-U and Ga-As samples buffered at pH 4.0 using acetic acid-sodium acetate. The chelation reaction between Ga(III) and N-o-vanillidine-2-amino-p-cresol was very fast, requiring only 30min at room temperature to complex completely. The limit of detection (LOD) (3sigma) for Ga(III) was 7.17 nM (0.50 microgL(-1)), determined from the analysis of 11 different solutions of 20 microg L(-1) Ga(III).

Cloning, expression, characterization and crystallization of BRP39, a signalling glycoprotein expressed during mammary gland apoptosis.

Breast regression protein (BRP39) is a glycoprotein, which is expressed during mammary gland involution in mouse. The physiological function of BRP39 is not known. High levels of expression of BRP39 have also been associated with breast cancer development. In the present investigation a cDNA encoding rBRP39 (recombinant BRP39) was cloned by PCR techniques. It consists of 1,143 nucleotides and encodes an open reading frame of 381 amino acid residues including a signal sequence of 21 amino acids. Recombinant BRP39 was produced in E. coli in a soluble form at low temperature (15 degrees C). Expression and purification of rBRP39 was confirmed by western blot analysis. Purified rBRP39 showed high chitin-binding activity but no chitinase activity. The lack of chitinase activity may be attributed to the mutation of critical active site residue Glu120 to Leu120 and Asp118 to Ala118 in BRP39. However, a mutant in which the residue was reverted back to Glu, by site directed mutagenesis, displayed no chitinase activity. Purified recombinant BRP39 was crystallized and the crystals diffracted X-rays to 2.8A resolution. The crystals belonged to the space group C2 with unit cell parameters a=130.4A, b=81.3A, c=229.2A, beta=105.9 degrees. The structure refinement is in progress.