Practice Algorithm of Rotational Thromboelastometry-Guided (ROTEM-Guided) Bleeding Management in Liver Transplantation.

Liver transplantation (LT) is frequently complicated by coagulopathy associated with end-stage liver disease, which is often multifactorial and associated with hemostatic disturbances affecting both the procoagulant and anticoagulant systems. This rebalanced coagulation system may lead to bleeding diathesis or increased clot formation. Conventional coagulation tests cannot reflect these complex changes because they can only illustrate deficiencies in the procoagulant system. Viscoelastic tests such as rotational thromboelastometry (ROTEM) have been used in LT and have shown useful for detecting coagulopathy and guiding transfusions. Implementation of ROTEM-guided bleeding management algorithms has proven effectiveness in reducing bleeding, transfusion needs, complication rates, and healthcare costs in LT. This document is intended to provide a practice algorithm for the management of major bleeding and coagulopathy during LT and to encourage adaptation of the guidelines to individual institutional circumstances and resources.

Investigation of the fall armyworm (Spodoptera frugiperda) gut microbiome and entomopathogenic fungus-induced pathobiome.

The gut microflora plays an important role in insect development and physiology. The gut bacterial microbiome of the fall armyworm (FAW), Spodoptera frugiperda, in both cornfield and laboratory-reared populations was investigated using a 16S metagenomic approach. The alpha- and beta-diversity of the cornfield FAW populations varied among sampling sites and were higher than those of the laboratory-reared FAW population, indicating that different diets and environments influence the gut bacterial composition. To better understand the interaction between the microbiome and entomopathogenic fungi (EPF), FAWs from organic and conventionally managed corn fields and from the laboratory-reared colony were inoculated with Beauveria bassiana NCHU-153 (Bb-NCHU-153). A longer median lethal time (LT50) was observed in the Bb-NCHU-153-infected cornfield FAW population than in the laboratory-reared FAWs. In terms of the microbiome, three Bb-NCHU-153-infected FAW groups showed different gut bacterial compositions compared to noninfected FAW. Further investigation of the cooccurrence network and linear discriminant analysis (LDA) of effect size (LEfSe) revealed that the enriched bacterial genera, such as Enterococcus, Serratia, Achromobacter, and Tsukamurella, in the gut might play the role of opportunistic pathogens after fungal infection; in contrast, some gut bacteria of Methylobacterium, Marinomonas, Paenochrobactrum, Pseudomonas, Acinetobacter, Delftia, Dietzia, Gordonia, Leucobacter, Paracoccus, and Stenotrophomonas might be probiotics against EPF infection. These results indicated that EPF infection can change the gut bacterial composition and lead to a pathobiome in the FAW and that some bacterial species might protect the FAW from EPF infection. These findings could be applied to the design of pathobiome-inducing biocontrol strategies.

Evaluation of microbiological safety, physicochemical and aromatic qualities of shiikuwasha (Citrus depressa Hayata) juice after high pressure processing.

This study evaluated high pressure processing (HPP) for achieving greater than 5-log reduction of Escherichia coli O157:H7 in shiikuwasha (Citrus depressa Hayata) juices and compare quality parameters, including microbiological safety, total phenolic content (TPC), total flavanones (TFC), and polymethoxylated flavones, browning, volatile aromatic, and physicochemical properties of HPP-treated juice with those of high-temperature short-time pasteurized juice. A HPP of 600 MPa for 150 s was identified capable of achieving greater than 5.15-log reductions of E. coli O157:H7 in shiikuwasha juice. The microbiological shelf life of the juices were at least 28 days when processed at HPP for 600 MPa/150 s or HTST for 90 °C/60 s. The color, aromatic, and antioxidant contents (TPC, TFC, Tangeletin, Nobiletin) were well preserved after HPP, however, HTST resulted in a significant (p < 0.05) loss of antioxidant content (TPC (8.8%), Tangeletin (6.8%)), and negatively impacted the juice color. By the end of storage, the amount of these aroma relevant volatiles appears to still be higher in HPP pasteurized juices compared to their conventional counterparts. This study demonstrated that under optimal conditions of HPP can attain the same level of microbiological safety as thermal pasteurization and preserved the acceptable quality of shiikuwasha juice.

Isolation and Selection of Entomopathogenic Fungi from Soil Samples and Evaluation of Fungal Virulence against Insect Pests.

Entomopathogenic fungi (EPF) are one of the microbial control agents for integrated pest management. To control local or invasive pests, it is important to isolate and select indigenous EPF. Therefore, the soil bait method combined with the insect bait (mealworm, Tenebrio molitor) system was used in this study with some modifications. The isolated EPF were then subjected to the virulence test against the agricultural pest Spodoptera litura. Furthermore, the potential EPF strains were subjected to morphological and molecular identifications. In addition, the conidia production and thermotolerance assay were performed for the promising EPF strains and compared; these data were further substituted into the formula of effective conidia number (ECN) for laboratory ranking. The soil bait-mealworm system and the ECN formula can be improved by replacing insect species and integrating more stress factors for the evaluation of commercialization and field application. This protocol provides a quick and efficient approach for EPF selection and will improve the research on biological control agents.

A modified tongue depressor facilitates the insertion of ProSeal laryngeal mask airway: Comparison with digital and introducer techniques.

BACKGROUND: The larger and softer cuff of the ProSeal laryngeal mask airway (LMA) may cause difficulty in insertion. We introduced a novel technique using a modified tongue depressor to aid the ProSeal LMA insertion. METHODS: A total of 150 patients were randomly allocated into three groups of 50 each, digital (D), introducer (I), and tongue depressor (TD). The ProSeal LMA was inserted by the aid of digit, introducer and a modified tongue depressor, respectively. The primary outcomes included insertion time, insertion frequency, pre- and post-insertion blood pressure/heart rate, presence of blood on the ProSeal LMA cuff after removal, and postoperative sore throat. RESULTS: The insertion time was significantly shorter in the TD group than in the D and I groups (23.3 ± 5.1 s vs. 26.8 ± 9.3 s and 27.8 ± 9.5 s; p = 0.025 and p = 0.004). The rate of successful intubation on the first attempt was significantly higher in the TD group than in the D and I groups (98% vs. 84% and 82%; p = 0.035 and p = 0.02). The incidence of blood staining on the LMA cuff after removal was significantly lower in the TD group than in the D and I groups (6% vs. 22% and 24%; p = 0.044 and p = 0.025). The incidence of sore throat in the post-anesthesia care unit was significantly lower in the TD group than in the D and I groups (8% vs. 26% and 28%; p = 0.033 and p = 0.019). CONCLUSION: The modified tongue depressor-aided technique is superior to the digital manipulation and introducer tool techniques for ProSeal LMA insertion.