Evaluation of "flat-line" thromboelastography after reperfusion during liver transplantation

BACKGROUND

"Flat-line" (no clot formation) thromboelastography (TEG) is frequently observed after graft reperfusion during liver transplantation (LT). We aimed to evaluate the incidence and causes of flat-line TEG after graft reperfusion during LT.

METHODS

With institutional review board approval, data of 208 consecutive recipients who underwent LT from May 2010 to May 2012 were retrospectively reviewed. We performed 3 different types of TEG measurements at 5 minutes after graft reperfusion: native TEG (nTEG), tranexamic acid-added TEG (tTEG), and protamine-added TEG (pTEG). The flat-line TEG was defined as having no trace at all at 60 minutes of TEG. We examined the incidence and causes of flat-line nTEG. We also compared recipients with flat-line nTEG (F group) and clot-forming nTEG (C group).

RESULTS

One hundred eighty-two recipients were included in the final analysis. The incidence of flat-line nTEG was 27% (49/182 cases). Among 49 recipients in the F group, 28 recipients showed clot formation in both tTEG and pTEG, 19 recipients in only tTEG, and 1 recipient in only pTEG; 1 recipient showed no clot formation in any TEGs. Graft from the deceased donor was more frequently observed in the F group than in the C group (P = .039). The F group showed decreased platelet count (P = .001), increased prothrombin time (P = .002), and decreased fibrinogen (P = .009) compared with the C group.

CONCLUSIONS

No clot formation was relatively common after reperfusion during LT, and the main causes were hyperfibrinolysis and heparin effect. Liver graft from deceased donors was associated more frequently with no clot formation after reperfusion during LT.

Do labetalol and methyldopa have different effects on pregnancy outcome? Analysis of data from the Control of Hypertension In Pregnancy Study (CHIPS) trial

OBJECTIVE

To compare pregnancy outcomes, accounting for allocated group, between methyldopa-treated and labetalol-treated women in the CHIPS Trial (ISRCTN 71416914) of 'less tight' versus 'tight' control of pregnancy hypertension.

DESIGN

Secondary analysis of CHIPS Trial cohort.

SETTING

International randomised controlled trial (94 sites, 15 countries).

POPULATION OR SAMPLE

Of 987 CHIPS recruits, 481/566 (85.0%) women treated with antihypertensive therapy at randomisation. Of 981 (99.4%) women followed to delivery, 656/745 (88.1%) treated postrandomisation.

METHODS

Logistic regression to compare outcomes among women who took methyldopa or labetalol, adjusted for the influence of baseline factors.

MAIN OUTCOME MEASURES

CHIPS primary (perinatal loss or high level neonatal care for >48 hours) and secondary (serious maternal complications) outcomes, birthweight <10th centile, severe maternal hypertension, pre-eclampsia and delivery at <34 or <37 weeks.

RESULTS

Methyldopa and labetalol were used commonly at randomisation (243/987, 24.6% and 238/987, 24.6%, respectively) and post-randomisation (224/981, 22.8% and 433/981, 44.1%, respectively). Following adjusted analyses, methyldopa (versus labetalol) at randomisation was associated with fewer babies with birthweight <10th centile [adjusted odds ratio (aOR) 0.48; 95% CI 0.20-0.87]. Methyldopa (versus labetalol) postrandomisation was associated with fewer CHIPS primary outcomes (aOR 0.64; 95% CI 0.40-1.00), birthweight <10th centile (aOR 0.54; 95% CI 0.32-0.92), severe hypertension (aOR 0.51; 95% CI 0.31-0.83), pre-eclampsia (aOR 0.55; 95% CI 0.36-0.85), and delivery at <34 weeks (aOR 0.53; 95% CI 0.29-0.96) or <37 weeks (aOR 0.55; 95% CI 0.35-0.85).

CONCLUSION

These nonrandomised comparisons are subject to residual confounding, but women treated with methyldopa (versus labetalol), particularly those with pre-existing hypertension, may have had better outcomes.

TWEETABLE ABSTRACT

There was no evidence that women treated with methyldopa versus labetalol had worse outcomes.

Association of unit size, resource utilization and occupancy with outcomes of preterm infants

OBJECTIVE

Assess association of NICU size, and occupancy rate and resource utilization at admission with neonatal outcome.

STUDY DESIGN

Retrospective cohort study of 9978 infants born at 23-32 weeks gestation and admitted to 23 tertiary-level Canadian NICUs during 2010-2012. Adjusted odds ratios (AOR) were estimated for a composite outcome of mortality/any major morbidity with respect to NICU size, occupancy rate and intensity of resource utilization at admission.

RESULTS

A total of 2889 (29%) infants developed the composite outcome, the odds of which were higher for 16-29, 30-36 and >36-bed NICUs compared with <16-bed NICUs (AOR (95% CI): 1.47 (1.25-1.73); 1.49 (1.25-1.78); 1.55 (1.29-1.87), respectively) and for NICUs with higher resource utilization at admission (AOR: 1.30 (1.08-1.56), Q4 vs Q1) but not different according to NICU occupancy.

CONCLUSION

Larger NICUs and more intense resource utilization at admission are associated with higher odds of a composite adverse outcome in very preterm infants.

HLA-B*15:327, a novel variant of HLA-B*15, discovered in a Taiwanese unrelated hematopoietic stem cell donor

One nucleotide substitution at residue 86 of HLA-B*15:27:01 results in a new allele, HLA-B*15:327.

A single nucleotide deletion in exon 3 of the HLA-C*07:02:01:01 allele produces a novel HLA-C*07 null allele, HLA-C*07:393N

A single nucleotide deletion in HLA-C*07:02:01:01 results in a novel null allele, HLA-C*07:393N.

Analysis of predictors for lactate elimination after reperfusion in recipients of living-donor liver transplantation

BACKGROUND

Graft-recipient weight ratio (GRWR) is the only documented predictor that influences the lactate elimination after reperfusion in living-donor liver transplantation (LDLT). This study was performed to investigate the predictors of lactate elimination after reperfusion in recipients of adult LDLT.

METHODS

The medical records of 159 patients who underwent LDLT were analyzed. Lactate level (mmol/L) was measured from just before the initiation of surgery (P0) and 5, 60, and 120 minutes after reperfusion of graft (R0, R1, and R2, respectively). The change of lactate level after reperfusion was defined as difference between lactate level measured at R0 and R2. Patients were divided into accumulation and elimination groups. Donor and recipient factors were compared between the 2 groups.

RESULTS

Lactate accumulation occurred in 80 of 159 recipients (50.3%), and elimination occurred in 79 (49.7%). GRWR and Model for End-Stage Liver Disease (MELD) score were higher in the elimination group. Lactate at R0 was lower in the elimination group.

CONCLUSIONS

Higher GRWR and MELD score and lower lactate level immediate after reperfusion of graft were predictors of lactate elimination after reperfusion during adult LDLT.

HLA-A*02:541, a novel variant of HLA-A*02, discovered in a Taiwanese unrelated hematopoietic stem cell donor

Two nucleotide changes at residue 524 and residue 527 of HLA-A*02:07:01 results in a novel allele, HLA-A*02:541.

Identification of a novel HLA-DRB1*04 null allele, HLA-DRB1*04:178N

A single nucleotide insertion in codon 77 of HLA-DRB*04:05:01 results in a null allele, HLA-DRB1*04:178N.

HLA-B*46:60, a novel variant of HLA-B*46:01:01, detected in a Taiwanese unrelated hematopoietic stem cell donor by sequence-based typing

One nucleotide replacement at residue 89 of HLA-B*46:01:01 results in a novel allele, HLA-B*46:60.

Protective role of quercetin against cisplatin-induced hair cell damage in zebrafish embryos

BACKGROUND AND OBJECTIVES

The aim of this study was to evaluate the protective effects of quercetin on cisplatin-induced hair cell damage in transgenic zebrafish embryos.

MATERIALS AND METHODS

Five days postfertilization zebrafish embryos were exposed to 1 mM cisplatin and quercetin at 10, 50, 100, or 200 μM for 4 h. Hair cells within neuromasts of the supraorbital, otic, and occipital lateral lines were analyzed by fluorescent microscopy (n = 10). Survival of hair cells was calculated as the average number of hair cells in the control group that were not exposed to cisplatin. Ultrastructural changes were evaluated using scanning electron microscopy.

RESULTS

Hair cell damage in neuromasts was decreased by co-treatment of quercetin and cisplatin (quercetin 100 μM: 8.6 ± 1.1 cells; 1 mM cisplatin only: 5.0 ± 0.5 cells; n = 10, p < 0.05); apoptosis of hair cells examined by special stain was also decreased by quercetin. The ultrastructure of hair cells within neuromasts was preserved in zebrafish by the combination of quercetin (100 μM) and cisplatin (1 mM).

CONCLUSION

In conclusion, quercetin showed protective effects against cisplatin-induced toxicity in a zebrafish model. The results of this study suggest the possibility of a protective role of quercetin against cisplatin-induced apoptotic cell death in zebrafish.

Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units

OBJECTIVE

To identify predictors of severe retinopathy of prematurity (ROP) in a large population-based cohort and to examine risk-adjusted variations across units.

STUDY DESIGN

Retrospective analysis of Canadian Neonatal Network data on neonates with birth weight <1500 g who were screened for ROP between 2003 and 2010. Characteristics of infants with and without ROP were compared and a risk-adjusted model for severe ROP was developed. Rates of severe ROP were compared between sites.

RESULTS

1163 of 9187 (12.7%) infants developed severe ROP. Lower gestational age, male sex, small for gestational age, patent ductus arteriosus, late onset sepsis, more than two blood transfusions, inotrope use, and outborn status were associated with an increased risk of severe ROP. Severe ROP rates varied significantly between units.

CONCLUSION

Younger, smaller and sicker male infants had higher adjusted risks of severe ROP and rates varied significantly among sites.

HLA-A*24:287, a novel variant of HLA-A*24:02:01:01, discovered in a Taiwanese hematopoietic stem cell donor

One nucleotide replacement in codon 182 of HLA-A*24:02:01:01 results in a novel allele, HLA-A*24:287.

HLA-A*02:510, a variant of HLA-A*02, discovered in a Taiwanese unrelated hematopoietic stem cell donor

Two nucleotide changes in codon 116 (TAC → TTA) of HLA-A*02:01:01:01 result in a novel allele, HLA-A*02:510.

HLA-C*07:375, a variant of HLA-C*07, detected in a Taiwanese unrelated hematopoietic stem cell donor

One nucleotide exchange in codon 20 of HLA-A*07:02:01:01 results in a novel allele, HLA-C*07:375.

First Report of Powdery Mildew Caused by Phyllactinia actinidiae on Hardy Kiwi in Korea

Actinidia arguta (Siebold & Zucc.) Planch. ex Miq., known as hardy kiwi, is a perennial vine native to Japan, Korea, northern China, and Russian Siberia. It produces a small fruit resembling the kiwifruit. The fruits, referred to as hardy kiwifruit, are edible and often sweeter than kiwifruit. Picking of wild hardy kiwifruits in autumn is a popular ecotourism activity in Korea. In 2000, a powdery mildew disease on the abaxial surface of hardy kiwi leaves was found in Korea. Additional findings of the powdery mildew between 2000 and 2013 showed that the disease of hardy kiwi commonly occurs in Korea. The infected leaves were frequently distorted when young, then becoming prematurely chlorotic and defoliated. Chasmothecia were abundantly formed by September. Voucher specimens (n = 21) were deposited in the Korea University Herbarium (KUS). Mycelia were hypophyllous, thinly effuse, initially forming patches, finally covering the whole abaxial leaf surface. Hyphal appressoria were hook-shaped or often branched, and single or opposite in pairs. Conidiophores were erect, cylindrical, 160 to 300 × 5 to 7.5 μm with straight foot-cells (65 to 115 μm long), basal septum elevated up to 15 μm, and produced conidia singly. Conidia were obpyriform to clavate, papillate at the apex, 55 to 75 × 20 to 32 μm, and devoid of fibrosin bodies. Germ tubes were produced at the terminal and lateral positions of conidia. Chasmothecia were blackish brown, depressed globose, and 190 to 250 μm in diameter. Appendages arising around the equatorial zone of chasmothecia were 9 to 15 in number, acicular with a bulbose base, 1 to 1.3 times as long as the chasmothecial diameter, hyaline throughout, and aseptate. Penicillate cells crowded on the upper part of the chasmothecia were ampulliform, numerous, 50 to 87.8 μm long, and 12.5 to 17.5 μm wide. Asci were 13 to 20 in a chasmothecium, olivaceous brown, 60 to 90 × 22.5 to 40 μm, and short stalked. Ascospores were 2 in an ascus, ellipsoid-ovoid, pale olivaceous, and 32.5 to 40 × 16.5 to 20 μm. On the basis of the morphological characteristics, this fungus was identified as Phyllactinia actinidiae (Jacz.) Bunkina (1). To confirm the identification, the complete internal transcribed spacer (ITS) regions of rDNA of three specimens (KUS-F23673, F26240, and F26308) were amplified using primers ITS5/P3 and sequenced (4). The resulting sequences were deposited in GenBank (Accession Nos. KJ703014, KJ703015, and KJ703016). GenBank BLAST search with the three isolates showed >99% similarity with the results for P. actinidiae on hardy kiwi from Japan (AB080489, AB080500, and AB080508). Actinidia-Phyllactinia associations were recorded in China, Japan, Taiwan, Korea, Russia, and Turkey (2,3). However, P. actinidiae on A. arguta was known only from Japan (3). To our knowledge, this is the first record of P. actinidiae on hardy kiwi in Korea. There has been no finding of powdery mildews on commercial varieties of golden kiwi (A. chinensis) and fuzzy kiwi (A. deliciosa) in Korea. Common occurrence of Phyllactinia powdery mildew on hardy kiwi in Korea can be a potential threat to the commercial kiwi industry. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No.11. CBS, Utrecht, 2012. (2) I. Erper et al. Scand. J. Forest Res. 27:432, 2012. (3) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication. ARS, USDA, March 10, 2014. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

Uncertain areas in the diagnosis of allergic bronchopulmonary aspergillosis in patients with asthma

BACKGROUND AND OBJECTIVE

The prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients with bronchial asthma remains unknown. We evaluated the roles of various laboratory tests in the diagnosis of ABPA, including, skin prick test (SPT) for Aspergillus fumigatus (Af), and serum Af specific IgE and IgG antibody measurement.

METHODS

A total of 50 asthma patients with more than 1000cell/μL of peripheral blood eosinophils were prospectively collected between January 2007 and September 2011. Evaluations using SPT for Af, serum total IgE and specific IgE antibody to Af by CAP system, IgG antibody to Af by enzyme immunoassay (EIA) or CAP system were performed according to the essential minimal criteria for the diagnosis of ABPA - asthma, immediate cutaneous reactivity to Af, elevated total IgE, and raised Af specific IgE and IgG.

RESULTS

Among 50 patients, three patients (6.0%) were diagnosed as ABPA, of whom each confirmed five items of the essential minimal diagnostic criteria for the diagnosis of ABPA. Six patients (12.0%) showed negative responses to Af in SPT, but positive responses in specific IgE by CAP system. Eight patients (16.0%) showed negative responses to IgG to Af by CAP system, but positive responses by enzyme immunoassay (EIA).

CONCLUSIONS

SPT and serum IgE to Af measurement by CAP system should be performed simultaneously. It is reasonable to set up cut-off values in Af specific IgE/IgG by CAP system for the differentiation of ABPA from Af sensitised asthma patients.

The relationship of trigger finger and flexor tendon volar migration after carpal tunnel release

It has been suggested that the increased frequency of trigger finger (TF) after carpal tunnel release (CTR) may be caused by the volar migration of the flexor tendons at the wrist altering the tendon biomechanics at the A1 pulley. This hypothesis has not been validated. We performed pre- and post-operative ultrasonography (USG) on the affected wrists of 92 patients who underwent CTR. Pre-operative USG was performed in neutral with no tendon loading; post-operative USG was performed in neutral unloaded and in various positions of wrist flexion whilst loading the flexor tendons with gripping. The mean volar migration of the flexor tendons after CTR was 2.2 (SD 0.4) mm in the unloaded neutral position. It was 1.8 (SD 0.4) mm in patients who did not develop TF and 2.5 (SD 0.5) mm in those who did (p = 0.0067). In loaded wrist flexion, the mean volar migration of flexor tendons after CTR in patients who did not develop TF and those who did was 2.1 and 3.0 mm in 0° flexion; 3.2 and 3.9 mm in 15° flexion; 4.3 and 5.1 mm in 30° flexion; and 4.9 and 5.8 mm in 45° flexion, respectively. There were significant differences between patients with and without TF at each flexion angle. Our data indicate that patients with greater volar migration of the flexor tendons after CTR are more likely to develop TF. This conclusion supports the hypothesis that the occurrence of TF after CTR may be caused by the bowstringing effects of the flexor tendons.

Growth performance and carcass characteristics of korean native ducks fed diets with varying levels of limiting amino acids

There are multiple experiments conducted with male Korean native ducks (KND) to evaluate the optimal levels of limiting amino acids (AA). In Exp. 1, a total of 450 one-d-old male KNDs were divided into five groups with six replicates and fed experimental diets with varying levels of lysine, total sulfur amino acids (TSAA) and threonine (T1, 0.90/0.74/0.70%; T2, 1.00/0.82/0.77%; T3, 1.10/0.90/0.85%; T4, 1.20/0.98/0.93%; T5, 1.30/1.07/1.01%) to 21 d of age. In Exp. 2, one-d-old male KND were received and fed commercial starter diet from hatching to 21 d of age, and then divided into five groups with six replicates and fed one of five diets varying levels of lysine, TSAA, and threonine (T1, 0.73/0.62/0.54%; T2, 0.80/0.68/0.60%; T3, 0.87/0.74/0.65%; T4, 0.94/0.80/0.70%; T5, 1.01/0.86/0.75%) during 22 to 56 d of age, respectively. The BW gain was linearly increased as dietary limiting AA levels increased to 1.20% lysine, 0.98% TSAA and 0.93% threonine. There were no significant differences in feed intake, gain:feed and uniformity among groups. In Exp. 2, the BW gain and gain:feed were not affected by dietary limiting AA levels. There were no significant differences in carcass characteristics and meat quality among groups. The growth performance and carcass characteristics did not show the significant response to increasing dietary limiting AA levels in KND during 22 to 56 d of age. In conclusion, the levels of lysine, TSAA and threonine necessary to maximize growth for starter phase were at least 1.20%, 0.98%, and 0.93%, respectively. On the other hands, KND require relatively low levels of limiting AA for late growth and carcass yield. The dietary levels of 0.73% lysine, 0.62% TSAA and 0.54% threonine appear to be adequate during growing phase.

Comparison of growth performance, carcass characteristics and meat quality of korean local chickens and silky fowl

This study was conducted to compare growth performance, carcass characteristics and meat quality of 4 breeds of local chicken. A total of 480 1-d-old chicks were distributed to 16 pens, with 4 treatments of breed, 4 replicates and 30 chicks per pen. Three Korean local breeds of white-mini broiler, Hanhyup-3-ho, and Woorimatdag, and a breed of silky fowl were raised under identical rearing and feeding conditions for 31-d, 37-d, 36-d, and 59-d, respectively. The BW and feed consumption on a pen basis were weekly measured for all pens, and ADFI, ADG and gain:feed were calculated for each pen. The ADFI and ADG of 3 breeds of Korean local chicken were greater than those of silky fowl (p<0.05). Within the Korean local breeds, ADFI of white-mini broiler was the highest (p<0.05), and ADG of Hanhyup-3-ho and white-mini broiler was the highest (p<0.05). Gain:feed of silky fowl was less than that of the 3 breeds of Korean local chicken. The carcass and breast yield of white-mini broiler were the greater than those of other breeds (p<0.05). The breast meat color (CIE L*, a*, and b*) of 3 breeds of Korean local chicken were higher than that of silky fowl (p<0.05). The breast meat of Hanhyup-3-ho had greater cooking loss (p<0.05), whereas water holding capacity and pH were less than those of other breeds (p<0.05). The color score of 3 breeds of Korean local chicken was higher than that of silky fowl (p<0.05). Woorimatdag had a higher score on tenderness (p<0.05), whereas flavor score was less than that of other breeds (p<0.05). In conclusion, 4 local breeds of chicken have some unique features and seem to have more advantages, and this information can help consumers who prefer healthy and premium chicken meat.

Discovery of HLA-A*11:167, a variant of HLA-A*11, in a Taiwanese unrelated hematopoietic stem cell donor

One nucleotide replacement in codon 57 of HLA-A*11:01:01 results in a novel allele, HLA-A*11:167.

An HLA-A*11 variant, A*11:166, revealed in a Taiwanese unrelated bone marrow hematopoietic stem cell donor

One nucleotide replacement in codon 35 of the human leukocyte antigen HLA-A*11:01:01 results in a new allele, HLA-A*11:166.