Estimating personal solar ultraviolet radiation exposure through time spent outdoors, ambient levels and modelling approaches.

BACKGROUND: Evidence on validation of surrogates applied to evaluate the personal exposure levels of solar ultraviolet radiation (UVR) in epidemiological studies is scarce. OBJECTIVES: To determine and compare the validity of three approaches, including (i) ambient UVR levels, (ii) time spent outdoors and (iii) a modelling approach integrating the aforementioned parameters, to estimate personal UVR exposure over a period of 6 months among indoor and outdoor workers and in different seasons (summer/winter). METHODS: This validation study was part of the European Commission-funded ICEPURE project and was performed between July 2010 and January 2011 in a convenience sample of indoor and outdoor workers in Catalunya, Spain. We developed linear regression models to quantify the variation in the objectively measured personal UVR exposure that could be explained, separately, by the ambient UVR, time spent outdoors and modelled UVR levels. RESULTS: Our 39 participants - mostly male and with a median age of 35 years - presented a median daily objectively measured UVR of 0·37 standard erythemal doses. The UVR dose was statistically significantly higher in summer and for outdoor workers. The modelled personal UVR exposure and self-reported time spent outdoors could reasonably predict the variation in the objectively measured personal UVR levels (R2 range 0·75-0·79), whereas ambient UVR was a poor predictor (R2 = 0·21). No notable differences were found between seasons or occupation. CONCLUSIONS: Time outdoors and our modelling approach were reliable predictors and of value to be applied in epidemiological studies of the health effects of current exposure to UVR.

Postoperative analgesia with continuous wound infusion of local anaesthesia vs saline: a double-blind randomized, controlled trial in colorectal surgery.

AIM: The aim of this prospective double-blind randomized clinical trial was to determine whether preperitoneal continuous wound infusion (CWI) of the local anaesthetic ropivacaine after either laparotomy or video-assisted laparoscopy for colorectal surgery would reduce patient consumption of morphine. METHOD: Patients scheduled for colorectal surgery randomly received a 48-h preperitoneal CWI of either 0.38% ropivacaine or 0.9% saline at rates of 5 ml/h after laparotomy or 2 ml/h after laparoscopy. The primary end-point was total morphine consumption in surgery and afterwards through a patient-controlled analgesia device. Results in the laparotomy and laparoscopy subgroups were also compared. RESULTS: Sixty-seven patients were included, 33 in the ropivacaine CWI group and 34 in the saline group. Median [interquartile range (IQR)] morphine consumption was lower in the ropivacaine group [23.5 mg (11.25-42.75)] than in the saline group [52 mg (24.5-64)] (P = 0.010). Morphine consumption was also lower in the laparotomy subgroup receiving ropivacaine [21.5 (15.6-34.7)] than in the saline group [52.5 (22.5-65) ml] (P = 0.041). Consumption was statistically similar in laparoscopy patients on ropivacaine or saline. No side effects were observed. Sixteen patients had a surgical wound infection (23.9%); 11 (16.4%) presented wound infection and five (7.5%) organ space infection. Forty-six catheter cultures were obtained; 10 (21.7%) were positive, assessed to be due to contamination. CONCLUSION: Preperitoneal CWI of ropivacaine is a good, safe addition to a multimodal analgesia regimen for colorectal surgery. CWI can reduce morphine consumption without increasing adverse effects.

What do preweaned and weaned calves need in the diet: a high fiber content or a forage source?

The objective of this study was to determine whether the improvement of performance of young calves associated with the supplementation of chopped grass hay reported in some studies is due to an increase in the total neutral detergent fiber (NDF) content of the consumed diet or to the provision of chopped grass hay. Sixty-three Holstein calves [9±4.4 d old; mean ± standard deviation (SD)] were randomly distributed in 4 treatments resulting from the combination of 2 levels of NDF content of a pelleted starter and the supply or absence of forage provision: low-NDF starter (18%) with or without chopped oat hay, and high-NDF starter (27%) with or without chopped oat hay. All animals were fed the same milk replacer (21% crude protein and 19.2% fat) at the rate of 4 L/d at 15% dry matter from d 1 to 34, and 2 L/d at 15% dry matter from d 35 to 42 (weaning). The study finished 2 wk after weaning. Body weight was measured weekly and individual calf starter and hay intake was recorded daily. On d 50, blood samples were drawn 2h after the morning concentrate offer to determine serum glucose and insulin concentrations. On d 52, samples of ruminal fluid were obtained via an esophageal tube, and pH was measured immediately. During the preweaning period, pelleted starter intake was similar among treatments, but average daily gain tended to be greater in low- than in high-NDF treatments (0.69 vs. 0.63±0.020 kg/d, respectively; mean ± SD). However, during the 2 wk after weaning, supplementation of forage improved pelleted starter intake and average daily gain without affecting the gain-to-feed ratio. Probably, the greater pelleted starter intake observed in forage-supplemented calves was mainly due to the greater ruminal pH found in forage-supplemented calves compared with forage-deprived calves (5.81 vs. 5.05±0.063, respectively). Blood insulin-to-glucose ratio was greater in forage-supplemented compared with unsupplemented calves [mean ± SD; 6.53 vs. 4.24±0.125 insulin (ng/L)-to-glucose (mg/dL) ratio, respectively]. In conclusion, a low-NDF pelleted starter is recommended during the preweaning period, and the provision of chopped hay is necessary right after weaning to improve calf performance.

[Anesthesia in the patient with impaired liver function]. / Anestesia en el paciente con alteración de la función hepática.

We review information on impaired liver function, focusing on concepts relevant to anesthesia and postoperative recovery. The effects of impaired function are analyzed by systems of the body, with attention to the complications the patient with liver cirrhosis may develop according to type of surgery. Approaches to correcting coagulation disorders in the cirrhotic patient are particularly controversial because an increase in volume may be a factor in bleeding owing to increased portal venous pressure and imbalances in the factors that favor or inhibit coagulation. Perioperative morbidity and mortality correlate closely to Child-Pugh class and the score derived from the model for end-stage liver disease (MELD). Patients in Child class A are at moderate risk and surgery is therefore not contraindicated. Patients in Child class C or with a MELD score over 20, on the other hand, are at high risk and should not undergo elective surgical procedures. Abdominal surgery is generally considered to put patients with impaired liver function at high risk because it causes changes in hepatic blood flow and increases intraoperative bleeding because of high portal venous pressures.

The role of transmembrane protein 27 (TMEM27) in islet physiology and its potential use as a beta cell mass biomarker.

AIMS/HYPOTHESIS: Transmembrane protein 27 (TMEM27) is a membrane protein cleaved and shed by pancreatic beta cells that has been proposed as a beta cell mass biomarker. Despite reports of its possible role in insulin exocytosis and cell proliferation, its function in beta cells remains controversial. We aimed to characterise the function of TMEM27 in islets and its potential use as a beta cell mass biomarker. METHODS: To determine TMEM27 function, we studied TMEM27 gene expression and localisation in human healthy and diabetic islets, the correlation of its expression with cell cycle and insulin secretion genes in human islets, its expression in tungstate-treated rats, and the effects of its overproduction on insulin secretion and proliferation in a beta cell line and islets. To elucidate its utility as a beta cell mass biomarker, we studied TMEM27 cleavage in a beta cell line, islets and primary proximal tubular cells. RESULTS: TMEM27 mRNA levels in islets are lower in diabetic donors than in controls. Its gene expression correlates with that of insulin and SNAPIN in human islets. TMEM27 expression is downregulated in islets of tungstate-treated rats, which exhibit decreased insulin secretion and increased proliferation. TMEM27 overproduction in a beta cell line and islets significantly enhanced glucose-induced insulin secretion, with modest or no effects on proliferation. Finally, TMEM27 is cleaved and shed by renal proximal tubular cells and pancreatic islets. CONCLUSIONS/INTERPRETATION: Our data support a role for TMEM27 in glucose-induced insulin secretion but not in cell proliferation. The finding that its cleavage is not specific to beta cells challenges the current support for its use as a potential beta cell mass biomarker.

[ABO incompatible living donor kidney transplantation: a dream come true. Experience of Hospital Clínic of Barcelona]. / Trasplante renal ABO incompatible: de un sueño a una realidad. Experiencia del Hospital Clínic de Barcelona.

INTRODUCTION: During the last years the number of patients on waiting list for kidney transplantation has been stable. Living donor kidney transplantation is nowadays a chance to increase the pool of donors. However, there are a group of patients with ABO incompatibility, making impossible the transplant until now. The aim of the present study is to describe the experience of Hospital Clinic Barcelona on ABO incompatible living transplantation. METHODS: A retrospective- descriptive study was made based on 11 living donor kidney recipients with ABO incompatibility in Hospital Clinic of Barcelona from October'06 to January'09. Selective blood group, antibody removal with specific immunoadsortion, immunoglobulin and anti- CD 20 antibody were made until the immunoglobulin (IgG) and isoaglutinine (IgM) antibody titters were 1/8 or lower. Immunosuppressive protocol was adjusted to particular recipient characteristics. Isoaglutinine titters were set before, during and post desensitization treatment and two weeks after transplant. Immunological, medical and surgical evaluation was the standard in living donor kidney transplant program. RESULTS: Medium age of donors and recipients were 47.8 +/- 12.4 and 44.4 +/- 14.1 years, respectively. 90% of donors were females and 73% of recipients males. Follow-up time was 10.2 +/- 10.2 months. Siblings and spouses were the most frequent relation (n=4, 36.4%, respectively). Chronic glomerulonephritis, adult polycystic kidney disease and Alport syndrome, the most frequent cause of end-stage renal disease. All the patients acquire appropriate isoaglutinine titters pre transplant (< 1/8), requiring 5.54 +/- 2.6 immunoadsorption sessions pretransplant and 2.82 posttransplant. One patient didn t need any immunoadsorption session (incompatibility blood group B) and another patient plasma exchange instead of immunoadsorption for being hypersensitized with positive flow cytometry crossmatch. Posttransplant isoaglutinine titters remained low. Two patients had cellular acute rejection episode (type IA and IB of Banff classification) with good response to corticosteroid treatment. Patient and graft survival were 91% at first year and remain stable during the follow-up. A graft lost by death of patient in relation to haemorrhagic shock developed within the first 72 hours after transplantation. Renal graft function at first year was excellent with serum creatinine of 1.3 +/- 0.8 mg/dl, creatinine clearance of 62.6 ml/min/1.73 m2 and proteinuria of 244.9 mg/U-24h. CONCLUSION: ABO incompatible living donor kidney transplantation represent an effective and safe alternative in certain patients on waiting list for renal transplant, obtaining excellent results in patient and graft survival, with good renal graft function.

Tribological and wear behaviour of alumina toughened zirconia nanocomposites obtained by pressureless rapid microwave sintering.

Dense alumina toughened zirconia nanocomposites (ATZ, 3Y-TZP with 20 wt% Al2O3) were densified by non-conventional microwave sintering technology at relatively low temperatures (1200 and 1300 °C). The sintering method and its effect on densification, microstructure, mechanical properties and tribological behaviour were investigated. The outcomes demonstrated that the density rose as the sintering temperature was higher, and therefore the mechanical properties were enhanced, reaching a maximum hardness (18.4 ±â€¯0.4 GPa) and fracture toughness (5.7 ±â€¯0.3MPa·â€¯m1/2). In addition, the samples were subjected to a tribological test in dry and wet conditions, using artificial saliva. In both cases, the coefficient of friction and wear volume for samples obtained by microwave sintering are lower than conventional samples, with the wear volume being two times higher in dry conditions than in wet conditions.

Improvement of associated respiratory problems in morbidly obese patients after open Roux-en-Y gastric bypass.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is present in 44% of patients scheduled for bariatric surgery. Respiratory dysfunction associated with this syndrome is attributable to chronic obstructive pulmonary disease (COPD) and/or obesity hypoventilation syndrome (OHS). We studied the long-term effect of bariatric surgery on weight loss, on the respiratory comorbidities associated with obesity, and on the need for non-invasive positive pressure ventilation. METHODS: We followed a sample of patients with respiratory co-morbidity scheduled for open Capella Roux-en-Y gastric bypass (RYGBP) over 5-years. Patients who were positive for polysomnographic studies and required continous positive airway pressure (CPAP) before surgery were included. All patients were subjected to the same anesthetic and surgical protocols. At 1 year after surgery, polysomnographic studies were performed and arterial blood gases and pulmonary function were tested. RESULTS: Of the 209 patients scheduled for bariatric surgery during the study period, 105 had respiratory co-morbidity. Of these, 30 required CPAP-BiPAP treatment before surgery and were included in our study. Surgery took 128 minutes (range 70 to 210 minutes). Tracheal extubation in the operating theater was possible for 26 patients (86.7%). During the early postoperative period, 7 patients (23.3%) presented respiratory complications. Length of hospitalization was 6.87 days (range 4 to 11 days). At 1 year after RYGBP, patients presented significant weight loss and improvement of hypoxemia (from 73.3 +/- 10.6 to 90.5 +/- 11.5, P = 0.000), hypercarbia (from 44.5 +/- 5.7 to 40.6 +/- 4.9, P = 0.005), and in spirometric (P = 0.004) and polysomnographic results (P = 0.001). CPAP-BiPAP treatment after weight loss was necessary in only 14% of patients (P = 0.001). CONCLUSIONS: Weight loss after RYGBP improved arterial blood gases, respiratory tests and polysomnographic studies. CPAP treatment can be withdrawn in most patients.

Conversion from tacrolimus to cyclosporine could improve control of posttransplant diabetes mellitus after renal transplantation.

Posttransplant diabetes mellitus (PTDM) occurs in approximately 15% to 20% of renal transplant patients. It has important clinical implications for graft function and survival. Anticalcineurin drugs are associated with an increased risk of developing PTDM. There is a little evidence that conversion from tacrolimus to cyclosporine (CsA)-based immunosuppression improves glucose metabolism and reverses diabetes. This prospective study included nine renal transplant patients (mean age of 34 +/- 20) with PTDM under immunosuppression with tacrolimus. Five were switched directly to CsA and the other four (glycemia > 250 mg/dL) required insulin and were simultaneously switched to CsA. Basal blood levels of tacrolimus were 7.9 +/- 1.9 ng/dL. Conversion was associated with an early, significant improvement of glycemia and HbA1c blood levels (P < .01). At the end of the follow-up, the glycemia (105 +/- 20 mg/dL) and Hb1Ac (5.1 +/- 0.4 mg/dL) were normal. Insulin was discontinued between 3 and 6 months in all patients who required it at the beginning. Cholesterol did not change significantly and triglycerides decreased significantly (basal 210 +/- 85 mg/dL, at 12 months 125 +/- 29, P < .01). Graft function was stable with a mean serum creatinine of 1.7 +/- 0.2 mg/dL. CsA blood levels remained stable during all follow-up periods (P = NS). There were neither episodes of acute rejection nor secondary effects related to the medication. In summary, renal transplant patients receiving tacrolimus who develop PTDM may display better control of hyperglycemia by a switch to CsA.

[Imported malaria: clinical and epidemiological review of an emerging disease]. / Malaria importada: revisión epidemiológica y clínica de una enfermedad emergente cada vez más frecuente.

OBJECTIVE: To describe the epidemiology, clinical and laboratory features and outcome of children younger than 15 years with malaria in our hospital. MATERIAL AND METHODS: A retrospective case review of all children admitted to our hospital with malaria between 1997 and 2005 was performed. The following epidemiological data were analyzed: age, sex, nationality of the child and of the family, country and date of trip, chemoprophylaxis used, clinical features, laboratory parameters (hemogram and biochemistry), type of plasmodium and degree of parasitization, treatment, associated diseases, length of hospital stay, and outcome. RESULTS: A total of 24 children (16 boys) were diagnosed (median age, 6.5 years). All of the patients were immigrants or were the children of sub-Saharian immigrants. Thirteen patients had traveled to a malaria-endemic country during the summer holidays. Eleven children started chemoprophylaxis, but only two completed the whole course. The most common symptoms were fever (21 patients) and gastrointestinal symptoms (16 patients). Nineteen patients had anemia and six had thrombocytopenia. The most common species identified was Plasmodium falciparum (19 patients). After treatment, outcome was satisfactory in 21 patients. One patient had recurrence at 3 months, another showed sequelae, and one died after 30 days. CONCLUSIONS: Most children with imported malaria in our area were immigrants or the children of immigrants. Although treatment response is usually satisfactory, rapid diagnosis of this disease in the emergency room of any hospital capable of treating these patients is required.

Knowledge and opinions of veterinary students in Italy toward animal welfare science and law.

Animal welfare (AW) is a growing concern worldwide and veterinary students are expected to demonstrate a high degree of professional interest in the welfare of animals. However, previous studies have highlighted gaps in the teaching of AW teaching in different countries, possibly impairing veterinary competency in the area. This survey aimed to assess the opinions of Italian veterinary students towards AW, as well as their knowledge on the issue. Questions were divided into different sections, investigating the definition of, and information on, AW, knowledge about AW legislation, and the level of tolerance towards AW in regard to the use of animals for different purposes. Results showed that behaviour was the most frequently used word to define AW. Italian students considered their own level of knowledge on AW as good, relying on their university training, websites and television. They requested more AW legislation, but when questioned on specifics of the current legislation, there was a general lack of knowledge. Although poultry, pigs and rabbits were considered the species experiencing the worst management conditions, the species that raised the most AW concerns were companion animals and cattle. Results from this investigation may allow the development of tailored actions aimed at appropriately implementing educational strategies, at national and international levels, to improve the role of future veterinarians as leaders in AW.

[Factors related to renal dysfunction after liver transplantation in patients with normal preoperative function]. / Factores relacionados con la disfunción renal postoperatoria en pacientes trasplantados hepáticos con función preoperatoria normal.

OBJECTIVE: To determine perioperative factors related to postoperative renal dysfunction in patients receiving liver transplants who had normal renal function before surgery. PATIENTS AND METHODS: We analyzed the cases of 189 consecutive patients. Patients with hepatorenal syndrome and previously diagnosed renal insufficiency were excluded, as were patients undergoing a second transplant operation. Postoperative renal dysfunction was diagnosed when creatinine levels exceeded 1.5 mg x dL(-1) in the first postoperative week. Multivariate analysis of preoperative variables (patient characteristics; Child-Pugh score; status with the United Network for Organ Sharing; and sodium, coagulation, hemoglobin, and creatinine levels); intraoperative variables (blood product units required, duration of surgery, reperfusion syndrome, surgical technique, and crystalloids required); and postoperative variables (hemodialysis or filtration, reoperation, mortality, creatinine levels at 6 and 12 months). RESULTS: One hundred fifty patients with normal kidney function were included. Postoperative renal dysfunction developed in 45 (30%). Differences between patients with and without postoperative renal dysfunction were found for weight; sex; Child-Pugh score; blood transfusion requirements (mean [SD] of 2.36 [2.4] units of packed red cells in the group of patients with renal dysfunction vs 1.3 [1.8] in the patients with normal function); and reperfusion syndrome (26 [66.7%] patients with renal dysfunction and 35 [21.5%] without). The last 2 variables continued to be significantly correlated with renal dysfunction in the multivariate analysis with a relative risk of 1.25, (95% confidence interval [CI], 1.01-1.55) for units of blood transfusion and 2.41 (95% CI, 1.04-5.57) for reperfusion syndrome. Renal replacement therapy was used in 4 patients (2.7%). Mortality rates were similar. At 6 and 12 months, 26 (17.3%) and 18 (12%) patients had renal dysfunction. CONCLUSIONS: Acute renal dysfunction is a frequent complication following a liver transplant and it is associated with transfusion of more units of blood products even when the average transfusion amount is not large.

Can the monitoring of animal welfare parameters predict pork meat quality variation through the supply chain (from farm to slaughter)?

The objective of this study was to assess the relationship between the animal welfare conditions evaluated through the supply chain and pork quality variation. A total of 4,680 pigs from 12 farms-5 animal welfare improved raising system (AWIRS) and 7 conventional raising system (CON) farms-were assessed from farm to slaughter through a comprehensive audit protocol merging the European Welfare Quality, the Canadian Animal Care Assessment, and American Meat Institute audit guide criteria. At the abattoir, a subsample of 1,440 pigs (120 pigs/farm) was randomly chosen out of 24 loads (2 farms per wk) transported by 2 drivers (driver A and driver B) for the assessment of stunning effectiveness, carcass bruises, blood lactate levels, and meat quality traits. Meat quality was assessed in the longissimus lumborum (LL) muscle 24 h postmortem by measuring ultimate pH (pHu), color (L*, a*, and b*), and drip loss. Data were analyzed by the MIXED, GLIMMIX, and NAPAR1WAY procedures of SAS. Spearman correlations were calculated to determine the relationship between audit scores and meat quality traits. Better animal welfare conditions, as showed by greater final scores for good housing (GHo; = 0.001) and good health ( = 0.006) principles, were recorded at AWIRS farms. Pigs from AWIRS farms handled by driver B displayed a greater percentage of turning back ( = 0.01) and slips ( < 0.001) during unloading and a greater ( = 0.02) frequency of falls in the stunning chute. A greater ( = 0.02) reluctance to move at loading was found in CON pigs loaded by driver A compared with driver B, whereas a greater ( < 0.001) reluctance to move was found in these pigs at unloading when they were unloaded by driver B. Drip loss was higher ( = 0.003) and pale, soft, and exudative pork percentage was greater ( < 0.001) in the LL muscle of the heavier AWIRS pigs. The GHO principle was best correlated with pHu ( = -0.75, = 0.01) and Minolta L* value ( = 0.87, < 0.001) of the LL muscle. Overall, drip loss variation in the LL muscle was correlated with the frequency of slips at unloading ( = 0.63, = 0.001) and in the restrainer area ( = 0.74, < 0.001). The results of this study showed that the quality of the raising system and truck driver skills as assessed by animal welfare audit protocols are important sources of variation in the behavioral response of pigs to preslaughter handling and may affect pork quality variation. However, the different live weight between CON and AWIRS pigs may have biased the meat quality results in this study.

Comparison of meat quality parameters in surgical castrated versus vaccinated against gonadotrophin-releasing factor male and female Iberian pigs reared in free-ranging conditions.

This study compared carcass and meat quality traits between 16 vaccinated (VF), 19 castrated (CF) and 8 entire (EF) female Iberian pigs, and between 21 vaccinated (VM) and 19 castrated (CM) male Iberian pigs reared in free ranging conditions. Vaccination consisted in the application of Improvac® at the age of 11, 12 and 14 months in VF and VM. Pigs were slaughtered at 16 months. In females, carcass and meat quality were found to be very similar regardless of the treatment. In males, VM had a leaner carcass, lower (P < 0.05) percentage of intramuscular fat, higher shear force and more rancidity than CM(P < 0.05 in all cases). It could be concluded that vaccination or suitable for free-range conditions in terms of product qualities. Vaccination in females did not alter carcass and meat quality, and specific interests should consider reproductive behavior in free-range conditions.

Efficacy of conversion to sirolimus in posttransplantation Kaposi's sarcoma.

UNLABELLED: The increased incidence of Kaposi's sarcoma (KS) in organ transplantation has been related to the KS herpes virus and the permissive effect of immunosuppressive therapy. We postulated that conversion to SRL in renal recipients with KS favored regression of KS lesions without increasing the risk of graft rejection. METHODS: In this study we performed a retrospective chart review of 7 caucasian renal transplant recipients affected by KS to determine demographic data, etiology of ESRD, immunologic risk factors, immunosuppressive treatment, KS disease follow-up, and renal function before and after SRL conversion. RESULTS: All seven patients were under calcineurin inhibitor treatment at the onset of KS which was limited to the skin, without regression despite attempts to minimize immunosuppression. After conversion to SRL, six patients showed progressive regression of KS lesions, with only hyperpigmented atrophic cutaneous lesions remaining after a mean time of 8.1 months (2-18 months). The seventh patient has completed 9 months follow-up with a near complete regression of KS lesions. One patient returned to hemodialysis after 13 months following irreversible acute renal failure not directly related to SRL conversion; in the other six, renal function was stable. The mean serum creatinine was 1.87 +/- 0.64 versus 1.74 +/- 0.68 mg/dL, pre-conversion versus the end of follow up, respectively. Mean SRL blood level was 9.2 +/- 2.0 ng/mL. CONCLUSION: After SRL conversion, patients with KS showed progressive regression without an increased risk of acute rejection. SRL offers a promising approach to the management of posttransplantation KS and probably other malignancies in organ transplant recipients.

Fibrinogen: A Clinical Update on Liver Transplantation.

INTRODUCTION: Hemostatic and coagulation disorders related to severe liver disease may cause massive bleeding beyond what can be expected from surgical trauma in liver transplantation. Fluid resuscitation and fibrinolysis may aggravate the problem, as plasma fibrinogen decreases in all patients. The objective of this review was to update the criteria for fibrinogen replacement in liver transplantation. METHODS: A PubMed and Scopus search from 1990 to 2015 was made. The following key words were used: fibrinogen, liver transplantation, coagulation, and blood product replacement. Controlled trials and observational studies were selected on the basis of clinical relevance. RESULTS: There is a scarcity of published controlled studies on perioperative fibrinogen replacement. Most articles refer to expert opinion; therefore, criteria for the administration of fibrinogen have been empirically established. The response to cryoprecipitate or fibrinogen concentrate administration in liver transplantation has not been established. Viscoelastic platelets free tests have been reported to have a good correlation with Clauss-measured plasma fibrinogen concentration. In surgical patients, the median increase in fibrinogen plasma level per gram injected has been determined in 0.2375 g/L. Alternatively, fibrinogen replacement can be guided based on viscoelastic hemostatic assays. CONCLUSIONS: In liver transplantation, plasma fibrinogen levels are low in most patients during surgery. Fibrinogen administration to correct hypofibrinogenemia has a positive impact on surgical bleeding. However, there is a scarcity of literature about fibrinogen administration; therefore, administration should be adjusted to replace plasma fibrinogen levels in the range of normal and guided by thromboelastometry.

Electrical stunning effectiveness with current levels lower than 1 A in lambs and kid goats.

An experiment with 360 lambs grouped into three Spanish commercial categories, (Pascual, 13-16 kg; Recental, 9-13 kg and Lechal <7 kg carcass weight) and kid goats (7 kg) was performed to assess stunning effectiveness after head-only (HO) and head-to-body (HB) electrical stunning with intensity currents of 0.3, 0.5 and 0.7 Amperes (A) compared to 1.0 A. After stunning, all animals showed tonic-clonic muscular activity and epileptiform EEG, absence of rhythmic breathing, corneal reflex, spontaneous blinking and pain sensibility. The quiescent EEG occurred earlier (P < 0.05) in HB compared to HO in all categories. More animals recovered corneal reflex and rhythmic breathing before onset of the quiescent activity after HO (from 15 to 50%) compared to HB (from 0 to 15%) (P < 0.05). Concluding, HO and HB electrical stunning with 0.3, 0.5 and 0.7 A induce effective stunning similar to 1.0 A in lambs and kid goats. After stunning and sticking, brain failure occurs earlier in HB than HO system.

Tribocorrosion behavior of beta titanium biomedical alloys in phosphate buffer saline solution.

The tribo-electrochemical behavior of different ß titanium alloys for biomedical applications sintered by powder metallurgy has been investigated. Different mechanical, electrochemical and optical techniques were used to study the influence of the chemical composition, Sn content, and the electrochemical conditions on the tribocorrosion behavior of those alloys Ti30NbxSn alloys (where "x" is the weight percentage of Sn content, 2% and 4%). Sn content increases the active and passive dissolution rate of the titanium alloys, thus increasing the mechanically activated corrosion under tribocorrosion conditions. It also increases the mechanical wear of the alloy. Prevailing electrochemical conditions between -1 and 2V influences the wear accelerated corrosion by increasing it with the applied potential and slightly increases the mechanical wear of Ti30Nb4Sn. Wear accelerated corrosion can be predicted by existing models as a function of electrochemical and mechanical parameters of the titanium alloys.

Electrochemical behavior of near-beta titanium biomedical alloys in phosphate buffer saline solution.

The electrochemical behavior of three different near-ß titanium alloys (composed by Ti, Nb and Sn) obtained by powder metallurgy for biomedical applications has been investigated. Different electrochemical and microscopy techniques were used to study the influence of the chemical composition (Sn content) and the applied potential on the microstructure and the corrosion mechanisms of those titanium alloys. The addition of Sn below 4wt.% to the titanium powder improves the microstructural homogeneity and generates an alloy with high corrosion resistance with low elastic modulus, being more suitable as a biomaterial. When the Sn content is above 4%, the corrosion resistance considerably decreases by increasing the passive dissolution rate; this effect is enhanced with the applied potential.