TEG-based transfusion protocol is associated with decreased blood product use without increased risk of hemoperitoneum

BACKGROUND

Thromboelastography (TEG) informs the need for blood product transfusions to prevent procedural bleeding complications in patients with cirrhosis. We aimed to evaluate the impact of using a TEG-based transfusion protocol on blood product utilization before paracentesis and the post-paracentesis hemoperitoneum (PPH) incidence.

METHODS

We conducted an ambispective analysis of patients with cirrhosis who underwent paracentesis from 2017 to 2021. In May 2019, we enacted a TEG-based transfusion protocol to guide pre-paracentesis blood product use. Patients with platelets < 20,000 or international normalized ratio ≥ 4 underwent TEG and received blood products if r value > 10 min or MA <30 mm. Patients were divided into pre-TEG and post-TEG protocol cohorts based on the date of paracentesis. Pre-paracentesis blood product transfusions in the form of platelets, fresh frozen plasma, and cryoprecipitates were recorded. PPH was defined as a decrease in hemoglobin of ≥1 g and the presence of blood on diagnostic imaging and/or the need for therapeutic intervention.

RESULTS

A total of 483 patients underwent 1281 paracenteses. The main etiologies of cirrhosis were alcohol (43%) and NASH (25%), and the mean MELD-sodium was 22±6. Pre-TEG and post-TEG protocol cohort sizes were similar: 253 patients and 607 paracenteses versus 230 patients and 674 paracenteses. After TEG-protocol implementation, blood product transfusions decreased significantly (228 vs. 49 products, p<0.001) with associated cost savings. One patient in each cohort developed PPH.

CONCLUSION

Implementation of a pre-paracentesis TEG-based transfusion protocol for patients with cirrhosis successfully resulted in decreased blood product use with no associated increase in incidence of PPH.

Activity profile in elite Polish soccer players

The aim of the present study was to determine and characterize the activity of male Polish Premier League soccer players during elite-level matches, depending on playing position, activity intensity range, and match period. The study sample comprised 1178 players. Amisco Pro® was used to track the match activity players. Statistical analysis of the total distance covered by players revealed that the greatest distance was covered by central midfielders (11894 ± 765 m) and external midfielders (11751 ± 686 m). In terms of velocity, the greatest distance was covered by players in the V1 range (0 ≤ V1 < 11 km · h^-1, standing, walking), (7028 ± 294 m). The difference between the match periods was statistically non-significant, amounting to only 0.5%. As such they could prove useful for present and future comparisons between positions and represent the scientific basis for developing position-specific conditioning/training regimes for both clubs and individuals.

Reversible pressure pre-amorphization of a piezochromic metal–organic framework

Reversible pressure amorphization of a piezochromic metal–organic framework.

Serum Leptin Is a Biomarker of Malnutrition in Decompensated Cirrhosis

Background and Aims

Malnutrition is a leading cause of morbidity and mortality in cirrhosis. There is no consensus as to the optimal approach for identifying malnutrition in end-stage liver disease. The aim of this study was to measure biochemical, serologic, hormonal, radiographic, and anthropometric features in a cohort of hospitalized cirrhotic patients to characterize biomarkers for identification of malnutrition.

Design

In this prospective observational cohort study, 52 hospitalized cirrhotic patients were classified as malnourished (42.3%) or nourished (57.7%) based on mid-arm muscle circumference < 23 cm and dominant handgrip strength < 30 kg. Anthropometric measurements were obtained. Appetite was assessed using the Simplified Nutrition Appetite Questionnaire (SNAQ) score. Fasting levels of serum adipokines, cytokines, and hormones were determined using Luminex assays. Logistic regression analysis was used to determine features independently associated with malnutrition.

Results

Subjects with and without malnutrition differed in several key features of metabolic phenotype including wet and dry BMI, skeletal muscle index, visceral fat index and HOMA-IR. Serum leptin levels were lower and INR was higher in malnourished subjects. Serum leptin was significantly correlated with HOMA-IR, wet and dry BMI, mid-arm muscle circumference, skeletal muscle index, and visceral fat index. Logistic regression analysis revealed that INR and log-transformed leptin were independently associated with malnutrition.

Conclusions

Low serum leptin and elevated INR are associated with malnutrition in hospitalized patients with end-stage liver disease.

Changes in the anaerobic threshold in an annual cycle of sport training of young soccer players

The aim of the study was to assess changes in the anaerobic threshold of young soccer players in an annual training cycle. A group of highly trained 15-18 year old players of KKS Lech Poznań were tested. The tests included an annual training macrocycle, and its individual stages resulted from the time structure of the sports training. In order to assess the level of exercise capacities of the players, a field exercise test of increasing intensity was carried out on a soccer pitch. The test made it possible to determine the 4 millimolar lactate threshold (T LA 4 mmol · l^-1) on the basis of the lactate concentration in blood [LA], to establish the threshold running speed and the threshold heart rate [HR]. The threshold running speed at the level of the 4 millimolar lactate threshold was established using the two-point form of the equation of a straight line. The obtained indicators of the threshold running speed allowed for precise establishment of effort intensity used in individual training in developing aerobic endurance. In order to test the significance of differences in mean values between four dates of tests, a non-parametric Friedman ANOVA test was used. The significance of differences between consecutive dates of tests was determined using a post-hoc Friedman ANOVA test. The tests showed significant differences in values of selected indicators determined at the anaerobic threshold in various stages of an annual training cycle of young soccer players. The most beneficial changes in terms of the threshold running speed were noted on the fourth date of tests, when the participants had the highest values of 4.01 m · s^-1 for older juniors, and 3.80 m · s^-1 for younger juniors. This may be indicative of effective application of an individualized programme of training loads and of good preparation of teams for competition in terms of players’ aerobic endurance.

The influence of methisoprinol administered in ovo on the morphological structure of the spleen in turkeys

This study analyzed the effect of a synthetic, low-toxic immunomodulator - methisoprinol - administered in ovo on the morphological structure of the spleen in turkeys. Experiments were conducted on three groups of 5-day-old BUT 9 turkeys (35 birds in each group) hatched from eggs which, on day 26 of incubation, had been administered methisoprinol (VetAgro, Lublin, Poland) in ovo in a dose of 5 mg (group I) or 20 mg per egg (group II). Poults hatched from eggs administered a physiological solution of NaCl in a dose of 0.1 ml per egg in ovo served as a control (group III). Samples of the spleen were collected from 5 birds selected at random from a group of decapitated 5-day-old poults and the prepared 7 fm-paraffin sections were stained with HE. A morphometric analysis of the germinal centres of the white pulp of the spleen was conducted by subjecting pictures taken with an optical microscope to a Digital Image Analysis using Axio Vision software (by Zeiss). The study demonstrated that in terms of the morphological structure, the spleen of the poults hatched from eggs administered 5 mg of methisoprinol (group I) did not differ considerably from the spleen of the control birds. In turn, spleens of the poults hatched from eggs administered 20 mg of methisoprinol per embryo were characterized by distinctively developed red pulp and within the area of the white pulp by distinct cortical section containing numerous lymphocytes. In spleens of the poults from this group, the morphometric examination also demonstrated a higher number of germinal centres of the white pulp as compared to their number in spleens of the birds from the other groups.

The influence of methisoprinol applied in ovo upon hatchability and health status of turkeys

A study was undertaken to determine the effect of a synthetic immunomodulator, i.e. methisoprinol applied in ovo, upon the hatchability of turkey poults under conditions of a standard hatchery as well as on their health status evaluated based on analyses of selected biochemical indices in their blood serum. Experiments were conducted on 5 groups of BUT 9 turkeys at the age of 5 days (35 birds in each group) hatched from eggs to which methisoprinol (VetAgro, Lublin, Poland) was applied in ovo at a dose of 5 mg (group I), 10 mg (group II) or 20 mg per egg (group III) on the 26th day of incubation. Turkeys hatched from eggs to which a physiological solution of NaCl was applied on the same day at a dose of 0.1 ml per egg (group IV) as well as those hatched from eggs without in ovo injection (group V) served as controls. Five hundreds eggs were used in each group. Hatchability was evaluated based on the number of hatched poults in respect of the number of eggs with live embryos transferred from the setting compartment to the hatching compartment, that were subjected to in ovo administration of the preparations according to the experimental design. Blood serum of the 5-day-old turkey poults was analyzed for activities of AST, ALP, LDH-L, CK, lysozyme and ceruloplasmine as well as for total protein and albumin contents. Analyses were also conducted for the immune system organ index - percentage contribution of organs of the immune system (spleen, thymus and the bursa of Fabricius) in the body weight of turkeys. The study demonstrated that methisoprinol administered to turkey embryos in ovo on day 26 of incubation at doses of 5, 10 or 20 mg per embryo did not induce any disturbances in the hatching process or affect its final result. In addition, it was shown not to exert any negative effect on the health status of the reared turkey poults.

Rhythms, synchrony and electrical coupling in the Locus coeruleus

Electrical coupling of neurones is believed to promote synchronized activity. It may, however, also be a requirement for the maintenance of endogenous rhythmic activity in some systems. In en bloc isolated brainstem-spinal cord of the neonatal rat simultaneous whole cell recordings from pairs of LC neurones (n = 47 pairs) disclosed for the most part strongly synchronized activity which could take the form of tonic spiking or phasic bursts. Simultaneous whole cell recording from LC neurones and glia also revealed synchronized waves of depolarization in 7 of 17 pairs. This synchrony was partly due to respiratory-phased synaptic input and partly due to mechanisms, which were not dependent on chemical synapses. The gap junction uncoupler carbenoxolone suppressed non-synaptic rhythmic activity in LC neurones, but did not suppress either respiratory-phased synaptic input to these neurones or their excitatory response to increased CO(2). We give preliminary direct evidence for the existence of a current pathway between LC neurones, which is inhibited by carbenoxolone. Within the LC nucleus carbenoxolone-sensitive electrical coupling, which may involve neurone-glia as well as neurone-neurone interactions, may be required not just for synchronization, but also for the maintenance of rhythm.

[Influence of prion protein gene polymorphisms on performance traits in German meat sheep breeds]

PrP polymorphisms influence the scrapie susceptiblility of sheep. The objective of this study was to analyse the association between performance traits and the PrP genotype in the sheep breeds German black-headed and German white-headed mutton, Bleu du Maine, German mutton merino, Leine, Texel and Suffolk from Lower Saxony and Westphalia. We analysed performance traits such as scores for muscle mass, type and wool quality and the calculated daily weight gain using linear animal models. In all seven breeds no statistically significant associations were found between performance traits and the occurrence of ARR alleles, and the ARR/ARR genotypes, respectively. All genotyped sheep of all breeds investigated showed significantly superior performance traits in comparison to the non-genotyped animals.

Synchronized rhythms in chemosensitive neurons of the locus coeruleus in the absence of chemical synaptic transmission

The activity of locus coeruleus (LC) neurons was examined in the en bloc isolated brainstem-spinal cord of the neonatal rat using paired whole cell or whole cell plus extracellular recording. In artificial cerebrospinal fluid (ACSF) LC neurons were synchronized by their respiratory innervation and in some neurons showing tonic or burst patterns of discharge these patterns of discharge could also be synchronized. Replacing ACSF with low Ca(2+)-high Mg(2+) generated synchronized rhythmic bursts which remained synchronized at high CO(2) (up to 20%). This rhythm was suppressed by TTX. Substitution of Ba(2+) for Ca(2+) in ACSF generated a synchronized rhythm which was TTX-insensitive. The frequency of this rhythm increased by 31+/-16% on raising CO(2) concentration from 2 to 10%. We conclude that the capacity of chemosensitive LC neurons to generate a synchronized rhythm depends on their electrical coupling, but not on chemical synaptic transmission.

Locus coeruleus neurones in vitro: pH-sensitive oscillations of membrane potential in an electrically coupled network

The response to hypercapnic acidosis (2-8% CO2, bath pH 7.8-7.2) was examined in whole cell recordings from neonatal (P1 to P5) rat Locus coeruleus (LC) neurones in the in vitro brainstem-spinal cord preparation exposed to low Ca2+ (0.2 mM)-high Mg2+ (5 mM). This medium suppressed chemical synaptic transmission and resulted in a pattern of subthreshold oscillations of membrane potential and rhythmic burst discharge which was synchronized throughout the network. The oscillation was suppressed, and the discharge of individual neurones desynchronized, by the gap junction uncoupler, carbenoxolone, indicating that in low Ca2+-high Mg2+ LC neurones form an electrically coupled network. Switching from 2 to 8% CO2 decreased the oscillation amplitude and increased its frequency. The oscillation was suppressed by external Cd2+ and by TTX. but persisted during injection into the cell soma of QX-314. We conclude that in LC neurones acidosis increases the frequency of a Ca2+- and Na+-dependent dendritic oscillator which is synchronized by gap junction coupling throughout the network. This coupling is retained during acidosis.