Antithrombin and hypercoagulability in sepsis: insights from thrombelastography?

Antithrombin (AT) has been used for over 25 years to successfully treat disseminated intravascular coagulation (DIC). A four-day AT therapy in patients with DIC in the KyberSept trial has been related to a clear survival benefit in patients not receiving concomitant heparin. Gonano and coworkers performed thrombelastography (TEG) measurements in patients with severe sepsis and clearly showed hypercoagulability, as defined by five TEG parameters, compared to healthy controls. In the AT group they found a trend towards normalization of TEG parameters after treatment, although this did not reach statistical significance. This first clinical evaluation of hypercoagulability during AT treatment could not provide evidence for an attenuation of coagulopathy, an effect that might be due to high inter-individual variability

Ansätze für eine muttergebundene Aufzucht von Milchschaflämmern in der Praxis

Ziel der Studie war die Erhebung von Erfahrungen aus der Praxis mit muttergebundener Aufzucht bei Milchschafen. Es wurden 11 Leitfadengestützte Experteninterviews geführt. Die Betriebe unterschieden sich in ihren Aufzuchtmethoden vor allem durch Beginn des Melkens (Spanne 1. - 56. Tag nach der Geburt), Anzahl Melkungen am Tag (1 oder 2), Dauer des Kontakts zwischen Mutterschafen und Lämmern (ganz- oder halbtags), sowie der Dauer der Säugeperiode (45 - 183 Tage), bei z.T. sehr unterschiedlichen Kombinationen. Die Betriebsleiter waren trotz der reduzierten Milchmenge zufrieden mit ihren Aufzuchtmethoden

Visible light is a better co-inducer of apoptosis for curcumin-treated human melanoma cells than UVA

Curcumin attracts worldwide scientific interest due to its anti-proliferative and apoptosis inducing effects on different tumor cells at concentrations ranging from 10 to 150 µM (3.7–55 µg/ml). Unfortunately, because of a low oral bioavailability, only low and pharmacologically ineffective serum levels are achievable. In this study, an alternative treatment concept consisting of low concentration curcumin (0.2–5 µg/ml) and irradiation with UVA or visible light (VL) has been tested. The experimental results show clearly that this treatment decreases the proliferation and the viability of human melanoma cells while the cell membrane integrity remains intact. We identified the onset of apoptosis characterized by typical markers such as active caspases 8, 9 and 3 as well as DNA fragmentation accompanied by the loss of cell adhesion. The mitochondrial apoptosis signaling pathway is predominant due to an early activation of caspase-9. The present data indicate a higher efficacy of a combination of curcumin and VL than curcumin and UVA. Reduced effects as a result of light absorption by heavily pigmented skin are unlikely if VL is used. These results indicate that a combination of curcumin and light irradiation may be a useful additional therapy in the treatment of malignant disease

infectious serum or culture-grown virus?

Schmallenberg virus (SBV), discovered in Europe in 2011, causes mild transient disease in adult ruminants, but fetal infection can lead to severe malformation in cattle, sheep and goats.To elucidate the pathogenesis of this novel orthobunyavirus, considerable efforts are required. A reliable and standardized infection model is essential for in vivo studies. In the present study, two groups of four cattle were inoculated with either serum passaged in cattle only or cell culture-grown virus. The replication of culture-grown SBV in cattle was reduced compared to virus inoculated via infectious serum. In a second experiment, the infectious serum was titrated in calves; the tested batch contained 102.83 infectious doses per mL. Hence, serum-borne virus that was only passaged in the natural host is a suitable option for a standardized SBV infection model

Detection and Typing of Highly Pathogenic Porcine Reproductive and Respiratory Syndrome Virus by Multiplex Real-Time RT-PCR

Porcine reproductive and respiratory syndrome (PRRS) causes economic losses in the pig industry worldwide, and PRRS viruses (PRRSV) are classified into the two distinct genotypes “North American (NA, type 2)” and “European (EU, type 1)”. In 2006, a highly pathogenic NA strain of PRRSV (HP-PRRSV), characterized by high fever as well as high morbidity and mortality, emerged in swine farms in China. Therefore, a real-time reverse transcription polymerase chain reaction (RT-qPCR) assay specific for HP-PRRSV was developed and combined with type 1- and type 2-specific RT-qPCR systems. Furthermore, an internal control, based on a heterologous RNA, was successfully introduced. This final multiplex PRRSV RT-qPCR, detecting and typing PRRSV, had an analytical sensitivity of less than 200 copies per µl for the type 1-assay and 20 copies per µl for the type 2- and HP assays and a high diagnostic sensitivity. A panel of reference strains and field isolates was reliably detected and samples from an animal trial with a Chinese HP-PRRS strain were used for test validation. The new multiplex PRRSV RT-qPCR system allows for the first time the highly sensitive detection and rapid differentiation of PRRSV of both genotypes as well as the direct detection of HP-PRRSV

Prothrombin complex concentrate in surgical patients: retrospective evaluation of vitamin K antagonist reversal and treatment of severe bleeding

Introduction Prothrombin complex concentrates are recommended for rapid reversal of vitamin K anticoagulants. As they normalize levels of vitamin K dependent clotting factors and re-establish hemostasis, they may also be used as adjunctive therapy in patients with major bleeding. The aim of this study was to retrospectively evaluate the efficacy of prothrombin complex concentrates in the surgical setting. Methods The case notes of 50 patients requiring urgent oral anticoagulation reversal (n = 12) or with severe perioperative coagulopathic bleeding (n = 38) who received an infusion of prothrombin complex concentrate (Beriplex P/N(R) 500) at the surgical department of the University of Munich Hospital, Germany were retrospectively reviewed. Efficacy of prothrombin complex concentrate application was evaluated using the Quick test, reported as an international normalized ratio, hemodynamic measurements and requirement for blood products. Safety assessments included whole blood hemoglobin levels and specific parameters of organ dysfunction. Results Baseline characteristics were comparable, except that mean baseline international normalized ratio and hemoglobin levels were significantly higher (P < 0.01) in anticoagulation reversal than in bleeding patients. In anticoagulation reversal, the international normalized ratio was significantly reduced (from 2.8 +/- 0.2 at baseline to 1.5 +/- 0.1, P < 0.001) after one prothrombin complex concentrate infusion (median dose 1500 IU; lower quartile 1,000, upper quartile 2,000). No major bleeding was observed during surgery after prothrombin complex concentrate administration. Only one patient received platelets and red blood cell transfusion after prothrombin complex concentrate administration. In bleeding patients, infusion of prothrombin complex concentrate (median dose 2,000 IU; lower quartile 2,000, upper quartile 3,000) significantly reduced the INR from 1.7 +/- 0.1 at baseline to 1.4 +/- 0.1 (P < 0.001). This decrease was unrelated to fresh frozen plasma or vitamin K administration. Bleeding stopped after prothrombin complex concentrate administration in 4/11 (36%) patients with surgical bleeding and 26/ 27 (96%) patients with diffuse bleeding. Hemoglobin levels increased significantly from baseline in bleeding patients (P < 0.05) and mean arterial pressure stabilized (P < 0.05). No thrombotic events or changes in organ function were reported in any patient. Conclusions Prothrombin complex concentrate application effectively reduced international normalized ratios in anticoagulation reversal, allowing surgical procedures and interventions without major bleeding. In bleeding patients, the improvement in coagulation after prothrombin complex concentrate administration was judged to be clinically significant

Longitudinal Changes in the Blood Supply and Demand in North-East-Germany 2005-2015

Background: Securing future blood supply is a major issue of transfusion safety. In this prospective 10-year longitudinal study we enrolled all blood donation services and hospitals of the federal state Mecklenburg-Western Pomerania. Methods and Results: From 2005 to 2015 (time period with major demographic effects), whole blood donation numbers declined by 18%. In male donors this paralleled the demographic change, while donation rates of females declined 12.4% more than expected from demography. In parallel, red cell transfusion rates/1,000 population decreased from 2005 to 2015 from 56 to 51 (-8.4%), primarily due to less transfusions in patients >60 years. However, the transfusion demand declined much less than blood donation numbers: -13.5% versus -18%, and the population >65 years (highest transfusion demand) will further increase. The key question is whether the decline in transfusion demand observed over the previous years will further continue, hereby compensating for reduced blood donation numbers due to the demographic change. The population structure of Mecklenburg-Western Pomerania reflects all Eastern German federal states, while the Western German federal states will reach similar ratios of age groups 18-64 years / ≥65 years about 10 years later. Conclusions: Regular monitoring of age- and sex-specific donation and transfusion data is urgently required to allow transfusion services strategic planning for securing future blood supply

Digitalisierung in Bildungseinrichtungen des Handels: Fallstudien als IST-Stands-Analyse im BMBF-Verbundprojekt VOM_Handel.

Der vorliegende Forschungsbericht spiegelt den Ist-Stand im BMBF geförderten Verbundvorhaben VOM_Handel wieder. Die Untersuchung, die in Form von Fallstudien angelegt wurde, dient dabei als eine Informations- bzw. Datenbasis mit Hilfe derer einerseits aktuelle Veränderungsprozesse identifiziert sowie notwendige Veränderungsprozesse abgeleitet werden können. Zielgruppen waren dabei alle MitarbeiterInnen der unterschiedlichen Hierarchieebenen (Geschäftsführung, mittlere Führen, Dozenten und Verwaltung) in den beteiligten Bildungseinrichtungen des Handels. Ausgehend von 18 Leitfadeninterviews wurden Thesen und Hypothesen gebildet, die weiterführend durch eine Dokumentenanalyse sowie einen Online-Fragebogen bearbeitet wurden. Grundsätzlich soll im Projekt VOM_Handel die Organisationsentwicklung auf allen Hierarchieebenen von Bildungseinrichtungen im Rahmen der Digitalisierung mit besonderem Fokus auf der Veränderung von Lehr- und Lernprozessen adressiert werden.:Inhaltsverzeichnis 2 Abbildungsverzeichnis 3 Tabellenverzeichnis 4 1. Ausgangssituation und Aufgabenstellung 5 2. Methodisches Vorgehen 5 3. Entwicklung der Instrumente 6 3.1. Interviewleitfaden 6 3.2. Online-Fragebogen 8 4. Ergebnisdarstellung der Interviews 9 4.1. Vision, Leitbild und Strategie 9 4.2. Einstellung zur Digitalisierung 10 4.3. Infrastruktur 11 4.4. Lehren und Lernen mit Digitalen Medien 11 4.5. Medienkompetenz der Lehrenden 12 4.6. Medienkompetenz der Zielgruppe(n) 13 4.7. Bewertung der Gesamtsituation 14 5. Ergebnisdarstellung der Dokumentenanalyse 15 6. Ergebnisdarstellung der Online-Umfrage 18 6.1. Deskriptive Statistik 18 6.1.1. Beschreibung der Stichprobe 18 6.1.2. Digitalisierung und Infrastruktur 20 6.2. Inferenzstatistische Auswertung 35 6.2.1. Computerbezogene Einstellungen und Computerängstlichkeit 35 6.2.2. Gruppenvergleiche und Regression 42 6.2.3. Weitere Zusammenhänge von Variablen 45 7. Zusammenführung der Daten 47 8. Zusammenfassung und Ausblick 49 Literatur 5