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When in 2010 the world's governments pledged to increase protected area coverage to 17% of the world's land surface, several Central African countries had already set aside 25% of their northern savannas for conservation. To evaluate the effectiveness of this commitment, we analyzed the results of 68 multispecies surveys conducted in the seven main savanna national parks in Central Africa (1960-2017). We also assembled information on potential drivers of large herbivore population trends (rainfall and number of rangers) and on tourist numbers and revenues. In six out of the seven parks, wild large herbivore populations declined dramatically over time, livestock numbers increased severalfold, and tourism, the pillar under a once thriving local wildlife industry, collapsed. Zakouma National Park (Chad) stood out because its large herbivore populations increased, an increase that was positively correlated with rainfall and number of rangers (a proxy for management inputs). With increasing insecurity and declining revenues, governments find themselves confronted with too few resources to protect vast areas. To deal with this conversation overstretch, we propose to extend the repeatedly promoted solutions--scaled up funding, enhanced management--with a strategic retreat, focusing scarce resources on smaller areas to save wildlife in the Central African savannas.
Sobredimensionamiento de la Conservación y la Declinación a Largo Plazo de la Fauna y el Turismo en las Sabanas de África Central Resumen Cuando los gobiernos del mundo se comprometieron en 2010 a incrementar la cobertura de áreas protegidas al 17% de la superficie terrestre del planeta, varios países del centro de África ya habían dispuesto el 25% de sus sabanas ubicadas al norte de la región para la conservación. Para evaluar la efectividad de este compromiso, analizamos los resultados de 68 censos multiespecies realizados en los siete parques nacionales principales de la sabana en África Central (1960-2017). También ensamblamos información sobre los causantes principales de las tendencias poblacionales de los grandes herbívoros (lluvias, número de guardaparques) y sobre las cifras e ingresos del turismo. En seis de los siete parques, las poblaciones de los grandes herbívoros silvestres declinaron dramáticamente con el tiempo, el número de cabezas de ganado incrementó varias veces y el turismo, el pilar de una industria faunística próspera en su momento, colapsó. El Parque Nacional Zakouma en Chad resaltó debido a que las poblaciones de herbívoros grandes incrementaron en esta localidad, un incremento que estuvo relacionado positivamente con las lluvias y el número de guardabosques (un sustituto para las aportaciones de manejo). Con el incremento en la inseguridad y la declinación de los ingresos, los gobiernos se encuentran de frente con muy pocos recursos para proteger áreas extensas. Para afrontar este sobredimensionamiento de la conservación, proponemos ampliar las soluciones que se promueven repetidamente - incrementos al financiamiento, manejo mejorado - con un repliegue estratégico, el cual enfoque los recursos escasos en las áreas más pequeñas para rescatar a la fauna de las sabanas del centro de África.
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Animais Selvagens , Conservação dos Recursos Naturais , Animais , Conservação dos Recursos Naturais/métodos , Ecossistema , Pradaria , TurismoRESUMO
Current theoretical models of the commons assert that common-pool resources can only be managed sustainably with clearly defined boundaries around both communities and the resources that they use. In these theoretical models, open access inevitably leads to a tragedy of the commons. However, in many open-access systems, use of common-pool resources seems to be sustainable over the long term (i.e., current resource use does not threaten use of common-pool resources for future generations). Here, we outline the conditions that support sustainable resource use in open property regimes. We use the conceptual framework of complex adaptive systems to explain how processes within and couplings between human and natural systems can lead to the emergence of efficient, equitable, and sustainable resource use. We illustrate these dynamics in eight case studies of different social-ecological systems, including mobile pastoralism, marine and freshwater fisheries, swidden agriculture, and desert foraging. Our theoretical framework identifies eight conditions that are critical for the emergence of sustainable use of common-pool resources in open property regimes. In addition, we explain how changes in boundary conditions may push open property regimes to either common property regimes or a tragedy of the commons. Our theoretical model of emergent sustainability helps us to understand the diversity and dynamics of property regimes across a wide range of social-ecological systems and explains the enigma of open access without a tragedy. We recommend that policy interventions in such self-organizing systems should focus on managing the conditions that are critical for the emergence and persistence of sustainability.
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Modelos Teóricos , Alocação de Recursos , Agricultura , Conservação dos Recursos Naturais , Ecossistema , Pesqueiros , Humanos , PropriedadeRESUMO
The dynamics of infectious diseases are greatly influenced by the movement of both susceptible and infected hosts. To accurately represent disease dynamics among a mobile host population, detailed movement models have been coupled with disease transmission models. However, a number of different host movement models have been proposed, each with their own set of assumptions and results that differ from the other models. Here, we compare two movement models coupled to the same disease transmission model using network analyses. This application of network analysis allows us to evaluate the fit and accuracy of the movement model in a multilevel modeling framework with more detail than established statistical modeling fitting methods. We used data that detailed mobile pastoralists' movements as input for 100 stochastic simulations of a Spatio-Temporal Movement (STM) model and 100 stochastic simulations of an Individual Movement Model (IMM). Both models represent dynamic movement and subsequent contacts. We generated networks in which nodes represent camps and edges represent the distance between camps. We simulated pathogen transmission over these networks and tested five network metrics-strength, betweenness centrality, three-step reach, density, and transitivity-to determine which could predict disease simulation outcomes and thereby be used to correlate model simulation results with disease transmission simulations. We found that strength, network density, and three-step reach of movement model results correlated with the final epidemic size of outbreak simulations. Betweenness centrality only weakly correlated for the IMM model. Transitivity only weakly correlated for the STM model and time-varying IMM model metrics. We conclude that movement models coupled with disease transmission models can affect disease transmission results and should be carefully considered and vetted when modeling pathogen spread in mobile host populations. Strength, network density, and three-step reach can be used to evaluate movement models before disease simulations to predict final outbreak sizes. These findings can contribute to the analysis of multilevel models across systems.
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Febre Aftosa/transmissão , Modelos Biológicos , Migração Animal , Animais , Camarões/epidemiologia , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/transmissão , Biologia Computacional , Simulação por Computador , Epidemias/estatística & dados numéricos , Epidemias/veterinária , Febre Aftosa/epidemiologia , Interações entre Hospedeiro e Microrganismos , Humanos , Análise Espaço-Temporal , Processos EstocásticosRESUMO
This study examined the spatial variation of potential gastrointestinal pathogens within drinking water sources and home storage containers in four neighborhoods in Maroua, Cameroon. Samples were collected from source (n = 28) and home containers (n = 60) in each study neighborhood. Pathogen contamination was assessed using quantitative polymerase chain reaction, targeting Campylobacter spp., Shiga toxin producing Escherichia coli (virulence genes, stx1 and stx2), and Salmonella spp. Microbial source tracking (MST) targeted three different host-specific markers: HF183 (human), Rum2Bac (ruminant) and GFD (poultry) to identify contamination sources. Staphylococcus aureus and the tetracycline-resistance gene (tetQ) were assessed to measure human hand contact and presence of antibiotic-resistant bacteria. Pathogen/MST levels were compared statistically and spatially, and neighborhood variation was compared with previously collected demographic information. All the test fecal markers and pathogens (except Arcobacter) were detected in home and source samples. Two neighborhoods tested positive for most pathogens/MST while the others only tested positive for one or two. Spatial variation of pathogens/MST existed between sources, storage containers, and neighborhoods. Differing population density and ethno-economic characteristics could potentially explain variation. Future research should explore the influence of demographic and ethno-economic factors on water quality during microbial risk assessments in urban Africa.
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Bactérias , Água Potável/microbiologia , Microbiota , Camarões , Cidades , Fezes/microbiologia , Reação em Cadeia da PolimeraseRESUMO
In this article, we consider the implications of Murray Last's (1981)Knowing About Not Knowing for the study of ethnoveterinary knowledge of mobile pastoralists in the Far North Region of Cameroon. Specifically, we ask two interrelated questions: (1) what is the nature of this knowledge, and (2) what is the best way to study it? We conducted a study of pastoralists' knowledge of human and animal infectious diseases to evaluate the claim that mobile pastoralists in the Chad Basin do not have a concept for zoonotic diseases. We used a combination of free lists and semi-structured interviews to study pastoralists' knowledge. The results suggest that pastoralists do not have a concept for zoonotic diseases. Moreover, we found considerable variation in pastoralists' ethnoveterinary knowledge and examples of not knowing, which contrasts with previous studies that do not describe much variation in ethnoveterinary knowledge. In our discussion, we consider to what extent descriptions of ethnoveterinary knowledge are the product of researchers' conceptual framework and methodology.
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Lysis of deep venous thrombotic obstruction in the extremities has been shown to decrease the frequency and severity of symptoms of postthrombotic syndrome. However, for those lesions that contain organized thrombus, the use of conventional methods to lyse thrombus is less successful than for acute thrombus. The authors here present a novel method for treatment of older, organized thrombus using excimer laser. This technique can obviate some of the limitations of the other methods and allow effective treatment when other methods fail. It has been used successfully in 19 patients with excellent results and is recommended for those cases.
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Angioplastia com Balão , Terapia a Laser/instrumentação , Lasers de Excimer , Síndrome Pós-Trombótica/prevenção & controle , Procedimentos Cirúrgicos Vasculares/instrumentação , Trombose Venosa/terapia , Angioplastia com Balão/instrumentação , Doença Crônica , Constrição Patológica , Humanos , Flebografia , Síndrome Pós-Trombótica/diagnóstico por imagem , Síndrome Pós-Trombótica/etiologia , Stents , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/cirurgiaRESUMO
Foot-and-mouth disease (FMD) affects cloven-hoofed livestock and agricultural economies worldwide. Analyses of the 2001 FMD outbreak in the United Kingdom informed how livestock movement contributed to disease spread. However, livestock reared in other locations use different production systems that might also influence disease dynamics. Here, we investigate a livestock production system known as transhumance, which is the practice of moving livestock between seasonal grazing areas. We built mechanistic models using livestock movement data from the Far North Region of Cameroon. We represented these data as a dynamic network over which we simulated disease transmission and examined three questions. First, we asked what were characteristics of simulated FMDV transmission across a transhumant pastoralist system. Second, we asked how simulated FMDV transmission across a transhumant pastoralist system differed from transmission across this same population held artificially stationary, thereby revealing the effect of movement on disease dynamics. Third, we asked if disease simulations on well-studied theoretical networks are similar to disease simulations on this empirical dynamic network. The results show that the empirical dynamic network was sparsely connected except for an eight-week period in September and October when pastoralists move from rainy season to dry season grazing areas. The mean epidemic size across all 3,744 simulations was 99.9% and the mean epidemic duration was 1.45 years. Disease simulations across the static network showed a smaller mean epidemic size (27.6%) and a similar epidemic duration (1.5 years). Epidemics simulated on theoretical networks showed similar final epidemic sizes (100%) and different mean durations. Our simulations indicate that transhumant livestock systems have the potential to host FMDV outbreaks that affect almost all livestock and last longer than a year. Furthermore, our comparison of empirical and theoretical networks underscores the importance of using empirical data to understand the role of mobility in the transmission of infectious diseases.
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Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/transmissão , Epidemias , Febre Aftosa/epidemiologia , Febre Aftosa/transmissão , Gado , Animais , Camarões , Bovinos , Vírus da Febre Aftosa , Modelos Teóricos , Estações do AnoRESUMO
Foot and mouth disease virus (FMDV) is an RNA virus that infects cloven-hoofed animals, often produces either epidemic or endemic conditions, and negatively affects agricultural economies worldwide. FMDV epidemic dynamics have been extensively studied, but understanding of drivers of disease persistence in areas in which FMDV is endemic, such as most of sub-Saharan Africa, is lacking. We present a spatial stochastic model of disease dynamics that incorporates a spatial transmission kernel in a modified Gillespie algorithm, and use it to evaluate two hypothesized drivers of endemicity: asymptomatic carriers and the movement of mobile herds. The model is parameterized using data from the pastoral systems in the Far North Region of Cameroon. Our computational study provides evidence in support of the hypothesis that asymptomatic carriers, but not mobile herds, are a driver of endemicity.
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Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/transmissão , Vírus da Febre Aftosa , Febre Aftosa/epidemiologia , Febre Aftosa/transmissão , Animais , Camarões , Portador Sadio , Bovinos , Doenças Endêmicas , Epidemias , Cadeias de MarkovRESUMO
Transboundary movement of animals is an important mechanism for foot-and-mouth disease virus (FMDV) spread in endemic regions, such as Cameroon. Several transboundary animal trade routes cross the Far North Region of Cameroon, and cattle moved on foot along these routes often come in contact with native (sedentary and transhumant) herds. The purpose of this study was to investigate the role of transboundary trade cattle in the epidemiology of FMDV in the Far North Region of Cameroon. A total of 582 oropharyngeal fluid (OPF) samples were collected from asymptomatic transboundary trade cattle at official border check points and 57 vesicle epithelial tissues were collected from clinically affected native cattle in the Far North Region of Cameroon during 2010-2014. Viral protein 1 (VP1) coding sequences were obtained from 6 OPF samples from transboundary cattle (4 serotype O, 2 serotype SAT2) and 19 epithelial tissue samples from native cattle (7 serotype O, 3 serotype SAT2, 9 serotype A). FMDV serotype O viruses belonged to two topotypes (East Africa-3 and West Africa), and phylogenetic analyses suggested a pattern of continuous transmission in the region. Serotype SAT2 viruses belonged to a single topotype (VII), and phylogenetic analysis suggested a pattern of repeated introductions of different SAT2 lineages in the region. Serotype A viruses belonged to topotype AFRICA/G-IV, and the pattern of transmission was unclear. Spearman rank correlation analysis of VP1 coding sequences obtained in this study from transboundary and native cattle showed a positive correlation between genetic distance and time for serotype O (ρ = 0.71, p = 0.003) and between genetic distance and geographic distance for serotype SAT2 (ρ = 0.54, p = 0.1). These data suggest that transboundary trade cattle participate in the transmission of FMDV in the Far North Region of Cameroon, however the dynamics and direction of transmission could not be determined in this study. Results of this study contribute to the understanding of transboundary FMDV epidemiology in Central Africa and will help to inform control programs in Cameroon and in the region.
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OBJECTIVE To determine the extent of environmental exposure to heteroxenous coccidia from wild canid feces in southeastern Ohio. SAMPLE 285 presumed wild canid fecal samples collected across an ecological system in southeastern Ohio. PROCEDURES Morphological classification and molecular analysis were used to determine the canid genus for collected fecal samples. Microscopic and molecular analysis were used to detect coccidian oocysts and DNA. Several variables were analyzed for associations with coccidian DNA detection or prevalence. RESULTS Coccidian DNA was detected in 51 of 285 (17.9%) fecal samples. Of those positive samples, 1% (95% confidence interval, 0.4% to 3%) had positive results for Hammondia heydorni and none had positive results for Neospora caninum, for an estimated environmental N caninum prevalence of 0% (95% confidence interval, 0% to 7%)/1-km2 hexagonal area evaluated. Morphological classification revealed that 78.9% (225/285) of fecal samples were from coyotes and 17.2% (49/285) were from foxes. No difference in proportions of coccidian DNA-positive fecal samples was identified among canid species. Environmental temperature and fecal freshness were associated with coccidian DNA detection. Land use type, relative canid density, and cattle density were not associated with the prevalence of coccidian DNA-positive samples. CONCLUSIONS AND CLINICAL RELEVANCE The low prevalence of coccidia shed in wild canid feces in this study, including the estimated 0% environmental prevalence of N caninum, suggested that the role of the oocyst environmental phase in coccidia transmission to ruminants is likely minor in rural southeastern Ohio.
Assuntos
Coccídios/isolamento & purificação , Coccidiose/veterinária , Fezes/parasitologia , Raposas/parasitologia , Animais , Bovinos , Coccidiose/epidemiologia , Coccidiose/parasitologia , Exposição Ambiental , Ohio/epidemiologia , Oocistos , TemperaturaRESUMO
Pathogen transmission across species drives disease emergence; however, mechanisms by which multi-host pathogens cross species boundaries are not well identified. This knowledge gap prevents integrated and targeted control in an epidemiologically continuous ecosystem. Our goal is to describe the impact of host species heterogeneity on the epidemiology of Neospora caninum circulating between livestock and wildlife in southeastern Ohio. We collected biological samples from Père David's deer (Elaphurus davidianus) located at an outdoor wildlife conservation center; from cattle raised at farms adjacent to the center; and from wild white-tailed deer that roamed across farm and center boundaries. We designed nested infectious disease models of competing hypotheses about transmission and used collected data to fit the models, thereby estimating important immunological and transmission quantities which describe the species-specific contribution to the persistence of this pathogen in the community. We applied these data and models to suggest appropriate species-specific disease control methods. Results show that immunity in cattle and Pére David's deer wanes over time, while in white-tailed deer immunity appears to be lifelong. Transmission quantities for cattle were estimated at values below the threshold for an outbreak (Rt < 1), meaning that chains of transmission are not maintained within this population and infections must occur due to reintroduction from an outside source. Pére David's deer and white-tailed deer both could maintain continuous chains of transmission within their group (Rt > 1). Therefore, we propose that control of contact with outside sources will be useful for disease control in cattle; boosting immunity with vaccines might be an avenue to prevent infection in cattle and Père David's deer. White-tailed deer are a potential maintenance host for infection and require further study to determine optimal control methods. Community-level investigations like this allow us to better evaluate heterogeneities in transmission processes that ultimately guide targeted control.
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Coccidiose/veterinária , Especificidade de Hospedeiro , Animais , Animais Selvagens , Bovinos , Coccidiose/epidemiologia , Coccidiose/transmissão , Cervos , Surtos de Doenças , Neospora , Ohio/epidemiologiaRESUMO
Primary aortic tumors are rare; only 86 cases of primary aortic angiosarcoma have been reported since its first description in 1873. The diagnosis of aortic angiosarcoma is usually confirmed by postoperative pathologic examination or postmortem study. The authors present a case of primary aortic angiosarcoma with postresection recurrence.
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Aorta Abdominal , Hemangiossarcoma/diagnóstico por imagem , Recidiva Local de Neoplasia , Neoplasias Vasculares/diagnóstico por imagem , Aortografia , Implante de Prótese Vascular/métodos , Diagnóstico Diferencial , Seguimentos , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgiaRESUMO
Land use science has traditionally used case-study approaches for in-depth investigation of land use change processes and impacts. Meta-studies synthesize findings across case-study evidence to identify general patterns. In this paper, we provide a review of meta-studies in land use science. Various meta-studies have been conducted, which synthesize deforestation and agricultural land use change processes, while other important changes, such as urbanization, wetland conversion, and grassland dynamics have hardly been addressed. Meta-studies of land use change impacts focus mostly on biodiversity and biogeochemical cycles, while meta-studies of socioeconomic consequences are rare. Land use change processes and land use change impacts are generally addressed in isolation, while only few studies considered trajectories of drivers through changes to their impacts and their potential feedbacks. We provide a conceptual framework for linking meta-studies of land use change processes and impacts for the analysis of coupled human-environmental systems. Moreover, we provide suggestions for combining meta-studies of different land use change processes to develop a more integrated theory of land use change, and for combining meta-studies of land use change impacts to identify tradeoffs between different impacts. Land use science can benefit from an improved conceptualization of land use change processes and their impacts, and from new methods that combine meta-study findings to advance our understanding of human-environmental systems.
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Ecossistema , Agricultura , Biodiversidade , Mudança Climática , Conservação dos Recursos Naturais , Humanos , Urbanização , Áreas AlagadasRESUMO
Modeling the movements of humans and animals is critical to understanding the transmission of infectious diseases in complex social and ecological systems. In this paper, we focus on the movements of pastoralists in the Far North Region of Cameroon, who follow an annual transhumance by moving between rainy and dry season pastures. Describing, summarizing, and modeling the transhumance movements in the region are important steps for understanding the role these movements may play in the transmission of infectious diseases affecting humans and animals. We collected data on this transhumance system for four years using a combination of surveys and GPS mapping. An analysis on the spatial and temporal characteristics of pastoral mobility suggests four transhumance modes, each with its own properties. Modes M1 and M2 represent the type of transhumance movements where pastoralists settle in a campsite for a relatively long period of time (≥20 days) and then move around the area without specific directions within a seasonal grazing area. Modes M3 and M4 on the other hand are the situations when pastoralists stay in a campsite for a relatively short period of time (<20 days) when moving between seasonal grazing areas. These four modes are used to develop a spatial-temporal mobility (STM) model that can be used to estimate the probability of a mobile pastoralist residing at a location at any time. We compare the STM model with two reference models and the experiments suggest that the STM model can effectively capture and predict the space-time dynamics of pastoral mobility in our study area.
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Algoritmos , Modelos Teóricos , Chuva , Estações do Ano , Criação de Animais Domésticos/métodos , Animais , Camarões , Ecossistema , Humanos , Poaceae/crescimento & desenvolvimento , Dinâmica Populacional , MigrantesRESUMO
In urban Maroua, Cameroon, improved drinking water sources are available to a large majority of the population, yet this water is frequently distributed through informal distribution systems and stored in home containers (canaries), leaving it vulnerable to contamination. We assessed where contamination occurs within the distribution system, determined potential sources of environmental contamination, and investigated potential pathogens. Gastrointestinal health status (785 individuals) was collected via health surveys. Drinking water samples were collected from drinking water sources and canaries. Escherichia coli and total coliform levels were evaluated and molecular detection was performed to measure human-associated faecal marker, HF183; tetracycline-resistance gene, tetQ; Campylobacter spp.; and Staphylococcus aureus. Statistical analyses were performed to evaluate the relationship between microbial contamination and gastrointestinal illness. Canari samples had higher levels of contamination than source samples. HF183 and tetQ were detected in home and source samples. An inverse relationship was found between tetQ and E. coli. Presence of tetQ with lower E. coli levels increased the odds of reported diarrhoeal illness than E. coli levels alone. Further work is warranted to better assess the relationship between antimicrobial-resistant bacteria and other pathogens in micro-ecosystems within canaries and this relationship's impact on drinking water quality.
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Bactérias/efeitos dos fármacos , Fenômenos Fisiológicos Bacterianos , Água Potável/microbiologia , Gastroenteropatias/epidemiologia , Resistência a Tetraciclina , Qualidade da Água , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/genética , Bactérias/isolamento & purificação , Camarões , Criança , Pré-Escolar , Cidades , Feminino , Gastroenteropatias/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Inquéritos e Questionários , Abastecimento de Água , Adulto JovemRESUMO
While the goal of African pastoralists is health and longevity of herd and household, some of their management strategies appear to counter this long-term goal. Pastoralists in the far north region of Cameroon, for example, do not always remove chronically sick animals from their herds, even though chronic diseases, such as brucellosis, are contagious and have the potential to cause fertility problems in the herd. We used ethnographic and epidemiologic methods to understand why pastoralists do not remove chronically sick animals and whether their management strategies have an impact on herd fertility. We used semi-structured interviews to collect data on pastoralists' understandings of disease and its impacts on fertility as well as data on herd management. We compared these data with disease prevalence and herd fertility data to measure the effect of management strategies on herd fertility. We found that the percentage of chronically sick animals in a herd negatively correlated with herd fertility, but this was not true for the prevalence of brucellosis. Thus, preliminary examination of disease costs and benefits suggests that herders' decisions to keep sick animals in their herds may lower herd fertility, but this is not due to brucellosis alone. The results of this study underline the complexity of infectious disease ecology in pastoral systems and the need for holistic and comprehensive studies of the ecology of infectious diseases in pastoral systems.
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UNLABELLED: Hemoglobin-based oxygen carrier-201 (HBOC-201, hemoglobin glutamer-250 [bovine], Hemopure; Biopure Corporation, Cambridge, MA) is polymerized hemoglobin of bovine origin being developed as an oxygen therapeutic. In this study, we evaluated the tolerability of a single intraoperative dose of HBOC-201 in surgical patients. In a single-blinded, multicenter study, 81 patients were randomized to receive either a single infusion of HBOC-201 (55 patients) or an equivalent volume of lactated Ringer's solution (26 patients). Forty-two patients originally assigned to the HBOC-201 group received the entire planned treatment of only one of the following doses: 0.6, 0.9, 1.2, 1.5, 2.0, or 2.5 g/kg of body weight. Thirteen of the 55 patients in the HBOC-201-assigned group did not reach the trigger point for transfusion administration, and they were not included in the analysis. We studied clinical outcomes and compared hematologic findings, blood chemistry values, and blood use in the two treatment groups. There were no patient deaths in this study. No pattern of clinically significant laboratory abnormalities could be attributed to exposure to HBOC-201. In the HBOC-201 group, 2 patients had a transient increased concentration of serum transaminases and 6 had transient skin discoloration. One patient in the HBOC-201 group had mast cell degranulation with hypotension. Postoperatively, methemoglobin plasma concentrations increased in the HBOC-201 group in a dose-dependent manner, reaching maximal values of 3.7% +/- 3.2% (average of all doses given) on postoperative day 3. There was no difference in the mean number of allogeneic blood units transfused in the 2 groups (3.3 +/- 1.8 and 3.7 +/- 4.1 for the lactated Ringer's solution and HBOC-201 groups, respectively) over the course of hospitalization. The intraoperative administration of HBOC-201, up to a maximum of 245 g, was generally well tolerated. There was no relationship between HBOC-201 use and the number of allogeneic blood units transfused over the entire hospitalization course. The administration of HBOC-201 was associated with a delayed (third postoperative day) dose-dependent increase in the plasma methemoglobin concentration. We conclude that the intraoperative use of HBOC-201 was generally well tolerated. IMPLICATIONS: The intraoperative use of hemoglobin glutamer-250 (bovine) (HBOC-201, Hemopure was generally well tolerated. The administration of HBOC-201 was associated with a delayed increase in the plasma methemoglobin concentrations.
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Perda Sanguínea Cirúrgica , Substitutos Sanguíneos/administração & dosagem , Hemoglobinas , Complicações Intraoperatórias/terapia , Adolescente , Adulto , Idoso , Anticorpos/análise , Análise Química do Sangue , Pressão Sanguínea , Substitutos Sanguíneos/efeitos adversos , Transfusão de Sangue , Feminino , Frequência Cardíaca , Hemoglobinas/análise , Humanos , Imunoglobulina G/análise , Infusões Intravenosas , Período Intraoperatório , Soluções Isotônicas/administração & dosagem , Masculino , Metemoglobina/análise , Pessoa de Meia-Idade , Lactato de Ringer , Método Simples-CegoRESUMO
Some human brain areas are tonically active in a resting state when subjects are not engaged in any overt task. The activity of these areas decreases when subjects are engaged in a wide variety of laboratory tasks designed to study cognitive operations. It has been suggested that these areas, among them the medial parietal (precyneus) and the dorsomedial prefrontal cortices, may support a "default state" of the human brain. Passive visual observation of laboratory stimuli typically yields no change in activity in these default areas compared to rest. Here we report functional magnetic resonance imaging (fMRI) data on normal subjects watching realistic movie clips depicting everyday social interactions. In contrast with previous findings on default state brain areas, the observation of the relational segment of the movie clip, during which two persons interact, yielded increased activity in the medial parietal (precuneus) and dorsomedial prefrontal cortices, compared to rest and to observation of the segment of the movie clip depicting a single individual engaged in everyday activities. To the best of our knowledge, this is the first report of joint increased activity in medial parietal and dorsomedial prefrontal cortices. We suggest that the default state areas may participate in the processing of social relations in concert with regions previously identified as critical for social cognition that were also activated by our stimuli, including the inferior frontal cortex, the superior temporal cortex, and the fusiform gyrus.