Plasma Transfusion and Procoagulant Product Administration in Extracorporeal Membrane Oxygenation:A Secondary Analysis of an International Observational Study on Current Practices

OBJECTIVES: To achieve optimal hemostatic balance in patients on extracorporeal membrane oxygenation (ECMO), a liberal transfusion practice is currently applied despite clear evidence. We aimed to give an overview of the current use of plasma, fibrinogen concentrate, tranexamic acid (TXA), and prothrombin complex concentrate (PCC) in patients on ECMO.DESIGN: A prespecified subanalysis of a multicenter retrospective study. Venovenous (VV)-ECMO and venoarterial (VA)-ECMO are analyzed as separate populations, comparing patients with and without bleeding and with and without thrombotic complications. SETTING: Sixteen international ICUs.PATIENTS: Adult patients on VA-ECMO or VV-ECMO.INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 420 VA-ECMO patients, 59% (n = 247) received plasma, 20% (n = 82) received fibrinogen concentrate, 17% (n = 70) received TXA, and 7% of patients (n = 28) received PCC. Fifty percent of patients (n = 208) suffered bleeding complications and 27% (n = 112) suffered thrombotic complications. More patients with bleeding complications than patients without bleeding complications received plasma (77% vs. 41%, p &lt; 0.001), fibrinogen concentrate (28% vs 11%, p &lt; 0.001), and TXA (23% vs 10%, p &lt; 0.001). More patients with than without thrombotic complications received TXA (24% vs 14%, p = 0.02, odds ratio 1.75) in VA-ECMO, where no difference was seen in VV-ECMO. Of 205 VV-ECMO patients, 40% (n = 81) received plasma, 6% (n = 12) fibrinogen concentrate, 7% (n = 14) TXA, and 5% (n = 10) PCC. Thirty-nine percent (n = 80) of VV-ECMO patients suffered bleeding complications and 23% (n = 48) of patients suffered thrombotic complications. More patients with than without bleeding complications received plasma (58% vs 28%, p &lt; 0.001), fibrinogen concentrate (13% vs 2%, p &lt; 0.01), and TXA (11% vs 2%, p &lt; 0.01). CONCLUSIONS: The majority of patients on ECMO receive transfusions of plasma, procoagulant products, or antifibrinolytics. In a significant part of the plasma transfused patients, this was in the absence of bleeding or prolonged international normalized ratio. This poses the question if these plasma transfusions were administered for another indication or could have been avoided.</p

Influence of dietary bulk agents (silica, cellulose and a natural zeolite) on protein digestibility, growth, feed intake and feed transit time in European seabass (Dicentrarchus labrax) juveniles

International audienc

Effect of dietary carbohydrate-to-lipid ratios on growth, lipid deposition and metabolic hepatic enzymes in juvenile Senegalese sole (<i>Solea senegalensis</i>, Kaup)

A study was undertaken to determine the effect of various dietary carbohydrate-to-lipid ratios on growth performance, whole-body composition and tissue lipid content in Senegalese sole (Solea senegalensis) juveniles. Data on the dietary regulation of key hepatic enzymes of the lipogenic and glycolytic pathways (glucose-6-phosphate dehydrogenase, G6PD; malic enzyme, ME; fatty acid synthetase, FAS; pyruvate kinase, PK and glucokinase, GK) were also generated. Four isonitrogenous (crude protein: 52% dry matter (DM)) diets were formulated to contain one of two lipid levels (11% and 21% DM). Within each dietary lipid level, the nature of the carbohydrate fraction (raw or extruded peas) was varied. Triplicate groups of 54 sole (initial body weight: 23.6+/-1.2 g) were grown in recirculated seawater over 67 days. Fish were fed using automated feeders. At the end of the study, whole-body, liver, viscera and muscle samples were withdrawn for analyses. During the experimental period, the mean fish weight about doubled in all treatments. No significant differences were found in growth performance (ranging from 1.1% to 1.4% body weight day-1) among dietary treatments. High-fat diets increased whole-body fat content. Similarly, daily fat gain ranged from 0.54 to 0.78 g kg-1 day-1 and highest values were found in fish fed high-lipid diets. Dietary treatments also affected tissue lipid content (liver, viscera and muscle), with highest values in fish fed high-fat diets. The nature of dietary carbohydrates had little influence on performance criteria, but affected tissue lipid deposition. The activities of G6PD, ME and FAS were depressed by elevated levels of dietary lipid, confirming the inhibitory effect of dietary fats on lipid biosynthesis. At both dietary lipid levels, ME and FAS activities were little affected by dietary carbohydrate. Activities of PK and GK were not affected by the starch level of the diets. In Senegalese sole juveniles, the lipogenic pathway is more susceptible to modulation by dietary means (particularly through lipid intake) than the glycolytic pathway

Histochemical aspects of the yol k-sac and digestive tract of larvae of the Senegal sole, Solea senegalensis (Kaup, 1858)

Histochemical distribution of glycoproteins, carbohydrates and proteins rich in different aminoacids were studied using histological and histochemical procedures, in Senegal sole, Solea senegalensis (Kaup, 1858) larvae from hatching until day 15. Glycogen, proteins and glycoproteins were detected in the yolk-sac of the larvae at hatching and during the yolk-resorption. The epithelia1 digestive system (brush border, enterocytes and goblet cells) contained neutral and acid mucins (carboxylated andlor sulphated). Glycogen was observed in the cytoplasm of the digestive absortive cells (enterocytes) and in the liver (hepatocytes) on day 3-4 posthatching. Protein reactions, and specially those that showed proteins rich in arginine, tyrosine and tryptophan, were very intense in the zymogen granules of the pancreatic cells. Oesophageal and intestinal goblet cells contained glucose N-acetyl and sialic acid residues, but the mucin content of these mucous cells did not show affinity towards Con-A, suggesting the absence of glycoproteins with Mannose andlor glucose residues. WGA showed a very intense positivity in the microvilli of the digestive epithelium of the larvae and positive granules for both lectins, specially for Con-A, were detected in the cytoplasm of the anterior intestinal enterocytes

Histochemical study of skin and gills of Senegal sole, Solea senegalensis larvae and adults

A battery of horseradish peroxidaseconjugated lectins (Con A, WGA and DBA), as well as conventional histochemical techniques (PAS, saponification, Alcian Blue pH 0.1, 1, 2.5, chlorhydric hydrolisis, neuraminidase, Bromophenol blue, Tioglycollate reduction and Ferric-ferricyanide-FeIII) were used to study the content and distribution of carbohydrates, proteins and glycoconjugate sugar residues on the skin and gills of Senegal sole, Solea senegalensis larvae and adults. During larval development of Solea senegalensis (from hatching until day 45 posthatching), epidermal sacciform, as well as branchial and epidermal chloride cells were unreactive with all cytochemical tests performed in this paper. Mucous or goblet cells of the corporal skin and gills containing strongly sulphated acid glycoproteins were evident on days 15-20 of larval development, as well as in epidermal and branchial mucous cells of adult specimens, which also contained GlcNAc andlor sialic acid. In adult specimen, the proteic content was higher in branchial mucous cells than in epidermal cells. In larvae, variable amounts of glycoproteins containing sialic acid, GlcNAc, GalNAc, Man andlor Glc residues were observed in epithelia1 cells and/or cuticle. GlcNAc andlor sialic acid sugar residues were only weakly detected in glycoproteins of some epidermal and branchial mucous cells of larvae by day 45, because from hatching until metamorphosis, lectin reactions (WGA, Con A and DBA) were negative in mucous cells

lmmunocytochemical distribution of cytochrome P4501A CYPlA in developing gilthead seabream, Sparus aurata

CYPlA is a major inducible enzyme in the metabolism of xenobiotic substrates. In this paper we investigate by means of immunohistochemistry, the tissue distribution of constitutive cytochrome P4501A (CYPlA) during the period of endogenous nutrition (from hatching until day 4) in developing gilthead seabream, Sparus aurata larvae. For this purpose, a polyclonal antiserum (BN- 1, Biosense Laboratories) directed against conserved piscine CYPlA sequences was used on paraffin-embedded sections from seabream larvae. From hatching onward, CYPlA immunoreactivity was observed in the following tissues and cells: syncytial, oil-globule envelopes and matrix of the yolk-sac, kidney (epithelia of renal tubules), cardiac muscle cells, skin epidermal cells, troncal musculature, enterocytes of different intestinal regions, goblet cells of the bucco-pharyngeal region, gill epithelia1 cells and the endothelia of the vascular system of various tissues (especially from liver and brain). Moreover, eye (retina), olfactory epithelium and some positive nerve fibers located in the proximity of the olfactory bulbs and running ventrally toward the posterior brain were strongly CYPlA immunoreactive. In general, the intensity of immunostaining increased with larval development

The role of early nutritional stimuli as modulators of metabolic pathways in seabream post-larvae : a nutritional programming approach

International audienc

A review of the culture potential of <i>Solea solea</i> and <i>S. senegalensis</i>

A number of scientific studies have investigated aspects of soles(Solea solea and S. senegalensis) ecology, population genetics and biology in their natural environment, and the species have been extensively studied in captivity during the last decade. Studies on the genetic population structure of sole indicate that several distinct breeding populations exist within its distributional range in European waters. Recent studies suggest a phylogenetic relatedness of S. solea and S. senegalensis, being found as closest sister lineages in most reconstructions. However, studies on molecular genetics and morphological traits give diagnostic differences that consistently lead to their taxonomic separation at the specific rank. Studies show that sole spawn readily in captivity, and the buoyant, fertilized eggs are easily collected. Stocking density during maturation should be 1-1.5kg/m2, and temperature should be kept above 16°C (S. senegalensis) or between 8 and 12°C (S. solea). In nature, the onset of spawning is related to a rise in temperature occurring during spring (March-June). Salinity should be kept constant around 33-35‰ and the fish reared under simulated natural photoperiod (LDN). In other cultured flatfish species, a change in the photoperiod is the key environmental signal used to manipulate and control maturation, but at present time there are no published work that verifies or contradicts this for either S. senegalensis or S. solea. Studies indicate that a mixture of inert and live food may increase the weaning success of sole fry, and this can be further enhanced by using attractants in the dry feed. Future experiments are needed to determine the ideal time to commence weaning and determine the minimum duration of this period. Studies on alternative feeding strategies are also required. The effect of temperature and photoperiod on juvenile growth has not been studied systematically in neither of the two species and the relative importance of a direct photoperiod effect on growth in sole therefore remains to be defined

Feed deprivation in Senegalese sole (Solea senegalensis Kaup, 1858) juveniles: effects on blood plasma metabolites and free amino acid levels.

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