A comparison of the new ROTEM® sigma with its predecessor, the ROTEMdelta.

Thromboelastometry point-of-care coagulation testing facilitates optimised management of bleeding. Previous thromboelastometry systems required the blood sample and liquid reagents to be pipetted in several manual steps by trained personnel. The ROTEMsigma coagulation analyser is a fully automated point-of-care device. We aimed to assess the reference ranges of the new device and to compare the results with those of the predecessor device, the ROTEMdelta. We took blood from healthy volunteers and from hyper- or hypocoagulable patients; blood samples from healthy volunteers served to determine reference ranges for the most important parameters for the ROTEMsigma: CTEXTEM 48-61 s; A5EXTEM 30-51 mm; MCFEXTEM 54-70 mm; CTINTEM 138-174 s; MCFINTEM 51-67 mm and MCFFIBTEM 5-24 mm. We then used blood samples from patients to compare the results obtained between the old and the new device. We found a strong correlation between the same tests performed on two ROTEMsigma devices and between the ROTEMsigma and the ROTEMdelta with respect to the determination of thromboelastometry parameters of hyper- and hypocoagulable patients (all p < 0.001 and R > 0.8). Performance evaluation for the ROTEMsigma device showed very high precision (R > 0.99, p < 0.001). Our reference ranges can serve as an important aid for other hospitals using this new device.

Fibrinogen supplementation ex vivo increasesclot firmness comparable to platelet transfusion in thrombocytopenia.

BACKGROUND: Fibrinogen concentrate can improve clot firmness and offers a better safety profile than platelet concentrates. Reduction or avoidance of blood transfusions represents a strategy to reduce associated risks. We investigated whether supplementation of fibrinogen concentrate ex vivo can compensate for clot strength as compared with platelet transfusion in vivo METHODS: One hundred patients in need of platelet transfusion (PT) were enrolled. Blood samples were collected immediately before PT and at 1 h and 24 h after PT. Fibrinogen concentrate was added to these citrated whole blood samples at concentrations of 50, 100, 200 and 400 mg kg-1 and the maximum clot firmness (MCF) was analysed using ROTEM thromboelastometry. RESULTS: Fibrinogen supplementation increased MCF significantly and dose-dependently before and after PT. The effect of fibrinogen concentrate (equivalent to doses of 100 and 200 mg kg-1) ex vivo was comparable to that of PT in vivo, whereas 400 mg kg-1 fibrinogen significantly improved MCF compared with PT (P < 0.001). CONCLUSIONS: Fibrinogen concentrate can match the effect of PT on MCF in thrombocytopenia. This potential alternative haemostatic intervention should be evaluated in clinical trials.

Prevalence and impact of abnormal ROTEM(R) assays in severe blunt trauma: results of the 'Diagnosis and Treatment of Trauma-Induced Coagulopathy (DIA-TRE-TIC) study'.

BACKGROUND: ROTEM(®)/TEG(®) (rotational thromboelastometry) assays appear to be useful for the treatment of bleeding trauma patients. However, data on the prevalence and impact of abnormal ROTEM(®) assays are scarce. METHODS: This is a prospective cohort study of blunt trauma patients (Injury Severity Score ≥15 or Glasgow Coma Score ≤14) admitted to Innsbruck Medical University Hospital between July 2005 and July 2008. Standard coagulation tests, antithrombin (AT), prothrombin fragments (F1+2), thrombin-antithrombin complex (TAT), and ROTEM(®) assays were measured after admission. Data on 334 patients remained for final analysis. RESULTS: ROTEM(®) parameters correlated with standard coagulation tests (all Spearman r>0.5), and significant differences in mortality were detected for defined ROTEM(®) thresholds [FIBTEM 7 mm (21% vs 9%, P=0.006), EXTEM MCF (maximum clot firmness) 45 mm (25.4% vs 9.4%, P=0.001)]. EXTEM MCF was independently associated with early mortality [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.9-0.99] and MCF FIBTEM with need for red blood cell transfusion (OR 0.92, 95% CI 0.87-0.98). In polytrauma patients with or without head injury (n=274), the prevalence of low fibrinogen concentrations, impaired fibrin polymerization, and reduced clot firmness was 26%, 30%, and 22%, respectively, and thus higher than the prolonged international normalized ratio (14%). Hyperfibrinolysis increased fatality rates and occurred as frequently in isolated brain injury (n=60) as in polytrauma (n=274) (5%, 95% CI 1.04-13.92 vs 7.3%, 95% CI 4.52-11.05). All patients showed elevated F1+2 and TAT and low AT levels, indicating increased thrombin formation. CONCLUSIONS: Our data enlarge the body of evidence showing that ROTEM(®) assays are useful in trauma patients. Treatment concepts should focus on maintaining fibrin polymerization and treating hyperfibrinolysis.

In vivo and in vitro studies of major surface loop deletion mutants of the Escherichia coli K-12 maltoporin: contribution to maltose and maltooligosaccharide transport and binding.

The trimeric protein LamB of Escherichia coli K-12 (maltoporin) specifically facilitates the diffusion of maltose and maltooligosaccharides through the outer membrane. Each monomer consists of an 18-stranded antiparallel beta-barrel with nine surface loops (L1 to L9). The effects on transport and binding of the deletion of some of the surface loops or of combinations of several of them were studied in vivo and in vitro. In vivo, single-, DeltaL4, DeltaL5, DeltaL6, and double-loop deletions, DeltaL4 + DeltaL5 and DeltaL5 + DeltaL6, abolished maltoporin functions, but not the double deletion DeltaL4 + DeltaL6 and the triple deletion DeltaL4 + DeltaL5 + DeltaL6. While deletion of the central variable portion of loop L9 (DeltaL9v) affected maltoporin function only moderately, the combination of DeltaL9v with the double deletion of loops L4 and L6 (triple deletion DeltaL4 + DeltaL6 + DeltaL9v) strongly impaired maltoporin function and resulted in sensitivity to large hydrophilic antibiotics without change in channel size as measured in vitro. In vitro, the carbohydrate-binding properties of the different loop mutants were studied in titration experiments using the asymmetric and symmetric addition of the mutant porins and of the carbohydrates to one or both sides of the lipid bilayer membranes. The deletion of loop L9v alone (LamBDeltaL9v), of two loops L4 and L6 (LamBDeltaL4 + DeltaL6), of three loops L4, L5 and L6 (LamBDeltaL4 + DeltaL5 + DeltaL6) or of L4, L6 and L9v (LamBDeltaL4 + DeltaL6 + DeltaL9v) had relatively little influence on the carbohydrate-binding properties of the mutant channels, and they had approximately similar binding properties for carbohydrate addition to both sides compared with only one side. The deletion of one of the loops L4 (LamBDeltaL4) or L6 (LamBDeltaL6) resulted in an asymmetric carbohydrate binding. The in vivo and in vitro results, together with those of the purification across the starch column, suggest that maltooligosaccharides enter the LamB channel from the cell surface side with the non-reducing end in advance. The absence of some of the loops leads to obstruction of the channel from the outside, which results in a considerable difference in the on-rate of carbohydrate binding from the extracellular side compared with that from the periplasmic side.

Stable nitrogen isotope ratios of bone collagen reflect marine and terrestrial components of prehistoric human diet.

The delta 15N values of bone collagen from Eskimos and from Northwest Coast Indians dependent on salmon fishing are about 10 per mil more positive than those from agriculturalists in historic times. Among prehistoric humans, two groups dependent on marine food sources show bone collagen delta 15N values that are 4 to 6 per mil more positive than those from two agricultural groups. The nitrogen isotope ratios of bone collagen from prehistoric inhabitants of the Bahamas are anomalously low for reasons that relate to the biogeochemical cycle of nitrogen in coral reefs.

[Effect of diurnal distribution of food intake on 24-h profiles of plasma lipoproteins (author's transl)]. / Lipoproteine bei zeitlich unterschiedlicher Nahrungsaufnahme.

The lipid infiltration theory of atherogenesis accepted, 24 h lipoprotein profiles may be more relevant than preprandial morning samples. Such profiles were performed in 12 metabolically healthy volunteers during two dietetic regimes identical in total food content but differing in the distribution over the day: form A meant an evening meal of 15% of total caloric intake, form B of 40%. After one week of each form, 24 h lipoprotein profiles differed significantly in the time course of triglyceride rich lipoproteins and in the mean values over 24 h in VLDL and LDL phospholipids and HDL cholesterol. These findings are cautiously interpreted as possible signs of differences in the catabolism of triglyceride rich lipoproteins, remnants and intermediate lipoproteins. The difference in HDL cholesterol which was higher in form A is discussed in the context of recent epidemiologic evidence.

An unusual fracture of the base of the fifth metatarsal bone.

An unusual fracture of the base of the fifth metatarsal bone is described. The type of fracture and the displacement of the proximal fragment was unlike that of most other fractures of this region of the foot. It requires open reduction and internal fixation which was successfully carried out by means of tension wires.

Myelination in rabbit optic nerves is accelerated by artificial eye opening.

Artificial opening of the eyes of young rabbits on the 5th postnatal day led to accelerated myelination: the myelin-specific basic and proteolipid proteins nearly doubled between the 7th and the 10th postnatal days when compared to controls; 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNP) activity also increased by about 60%. Conversely, lowered AChE activities presumably reflected elevated myelin/axolemma ratios. Myelination in treated animals normalized during later ontogenetic stages (greater than 20th postnatal day).

[Observations during tonsillectomy in angiomatous phakomatoses of the head (author's transl)]. / Bemerkungen zur Tonsillektomie bei angiomatöser Phakomatose im Kopfbereich.

The problems encountered during tonsillectomy in a patient with a vascular malformation (flame nevus), mandibular hypertrophy, and extensive arteriovenous malformations involving the external carotid arteries are described. The inclusion of the patient in the Sturge-Weber or Klippel-Trenaunay Syndromes is discussed.

[Malignant melanoma of penis]. / Das maligne Melanom des Penis.

Two cases of malignant melanoma of the penis are reported. A further case report of a naevus caeruleus of the glans penis is presented with regard to the differential diagnosis of malignant melanoma of the penis. A comprehensive review of the literature has revealed 41 case reports of malignant melanoma of the penis. A brief characterisation of malignant melanoma of the penis is given.

Effect of inactivation by hydroxylamine on early functions of poliovirus.

Evidence is presented that poliovirus particles with a single lethal hit by hydroxylamine do not induce in host cells either inhibition of cellular protein synthesis or viral ribonucleic acid (RNA) replication. The RNA of these viruses is not replicated even if the cells are simultaneously infected with both active and inactivated viruses. The damaged viral RNA seems to have lost both its template function and its function in the translation of normal viral proteins.

Glacier oxygen-18 content and pleistocene ocean temperatures.

The mean oxygen-18 content of continental ice sheets during the last glacial maximum is estimated to deltaO(18)=-30 per mille or less, and the consequent change in the isotopic composition of the oceans at that time to 1.2 per mille or more. This means that at least 70 percent of the oxygen-18 variations found in shells of planktonic foraminifera from deep-sea cores between times of glacial maximums and minimums are due to isotopic changes in ocean water, and at most 30 percent to changes in ocean surface temperature. Hence, Emiliani's "paleotemperature" curve rather depicts the amount of ice on the continents in excess of that present today. In this sense it may be renamed a "paleoglaciation" curve.