Administration of centhaquin and crystalloid fluid in a pediatric swine model of hemorrhagic shock

Background: Hemorrhage is a frequent event in hospital and prehospital settings. The aim of the present study is to investigate whether centhaquin improves 24-hour survival and reduces the total volume of required fluids in an established model of swine hemorrhagic shock.Material and methods: Twenty-five pigs were instrumented and subjected to hemorrhagic shock. The animals were randomly allocated in two experimental groups, the control (vehicle) (n=10) and the centhaquin group (0.015 mg/kg), (n=10); all animals received Lactated Ringer's solution in the resuscitation phase until their mean arterial pressure reached 90% of the baseline. A sham group (n=5) was added a posteriori to mimic the hemodynamic profile of the centhaquin group.Results: A statistically significant difference was observed in the time required for the three groups to reach their target MAP, 36.88 ± 3.26 min for the control group versus 9.40±1.01 min for the sham group and 7.10 ± 0.97 min for the centhaquin group (p<0.001). The total amount of fluids in the control and the sham group was significantly higher when compared to that of the centhaquin treated animals (p<0.001). All ten animals in the centhaquin group survived for 24 hours, whereas only three animals survived in the control group and one animal in the sham group (p=0.002).Conclusions: Centhaquin 0.015 mg/kg, administered in the fluid resuscitation phase resulted in lower volume of fluids and better survival compared to control and sham operated animals.Εισαγωγή: Η αιμορραγική καταπληξία αποτελεί μείζον πρόβλημα με μεγάλη θνητότητα. Κύρια θεραπεία είναι η αποκατάσταση του κυκλοφορούντος όγκου αίματος με τη χορήγηση υγρών. Σκοπός της παρούσας μελέτης ήταν να διερευνηθεί εάν η σενθακίνη βελτιώνει την επιβίωση στις 24 ώρες καθώς και εάν δύναται να μειώσει την συνολική χορήγηση υγρών και τον απαιτούμενο χρόνο ανάνηψης σε χοίρειο μοντέλο αιμορραγικής καταπληξίας.Υλικό και Μέθοδοι: Τα χοίρεια μοντέλα που συμπεριελήφθησαν στην παρούσα μελέτη ήταν είκοσι πέντε. Οι φάσεις του ερευνητικού πρωτοκόλλου ήταν έξι: η σταθεροποίηση, η πρόκληση αιμορραγίας, η συντήρηση, η αναζωογόνηση, η ωριαία παρατήρηση και η 24ωρη παρακολούθηση. Σε όλα τα ζώα προκλήθηκε οξεία αιμορραγία έως ότου η μέση αορτική πίεση (ΜΑΠ) να μειωθεί στα 40-45 mmHg. Είκοσι από αυτά τυχαιοποιήθηκαν σε δύο επιμέρους ομάδες των δέκα, την ομάδα ελέγχου και την ομάδα σενθακίνης, η οποία έλαβε την σενθακίνη σε δόση 0,015 mg/kg. Σε όλα τα ζώα χορηγήθηκε ''Lactated Ringer's solution'' κατά την φάση της αναζωογόνησης έως ότου η ΜΑΠ επανέλθει στο 90% της αρχικής. Μία επιπλέον ομάδα πέντε ζώων, η ομάδα μίμησης, προστέθηκε μεταγενέστερα, προκειμένου να μιμηθεί την αιμοδυναμική εικόνα της ομάδας που έλαβε σενθακίνη.Αποτελέσματα: Στατιστικώς σημαντική διαφορά παρατηρήθηκε ανάμεσα στις τρεις ομάδες όσον αφορά τον χρόνο επίτευξης της ΜΑΠ, κατά τη φάση της αναζωογόνησης, 36,88 ± 3,26 λεπτά για την ομάδα ελέγχου έναντι 9,40 ± 1,01 της ομάδας μίμησης και 7,10 ± 0,97 για την ομάδα σενθακίνης (p<0,001). Ο συνολικός όγκος των υγρών στις ομάδες ελέγχου και μίμησης ήταν σημαντικά υψηλότερος από τον αντίστοιχο της σενθακίνης (2093 ± 196 ml, 1830 ± 173 και 342 ± 48 αντίστοιχα, p<0,001). Όλα τα ζώα που έλαβαν σενθακίνη επεβίωσαν τις επόμενες 24 ώρες ενώ, αντίθετα, μόνο 3 από την ομάδα ελέγχου και μόλις 1 από την ομάδα μίμησης (p=0,002).Συμπέρασμα: Η σενθακίνη χορηγούμενη στη φάση της αναζωογόνησης βελτιώνει σημαντικά την επιβίωση ενώ απαιτεί μικρότερο όγκο υγρών καθώς και λιγότερο χρόνο ανάνηψης

Measuring Integrated Market and Credit Risks in Bank Portfolios

The banking crises of the 1990s emphasize the need to model the connections between volatility and the potential losses faced by financial institutions due to correlated market and credit risks. We present a simulation model that explicitly links changes in the financial environment and the distribution of future bank capital ratios. This forward-looking quantitative risk assessment methodology allows banks and regulators to identify risks before they materialize and make appropriate adjustments to banks’ portfolios. This model was applied to the study of the risk profile of the largest South African banks in the context of the Financial System Stability Assessment (FSSA) (1999).Banking;Credit risk;Economic models;market risk, bank risk, credit ratings, banking sector, return on equity, bank capital, risk assessment, bank assets, bank portfolio, risk analysis, bank clients, banking system, mortgage lending, mortgage loan, arbitrage, banking crises, bankers, foreign exchange, bank failure, present value, bank portfolios, bank loan, banks ? loan, credit risk exposure, credit risks, equity securities, risk portfolio, off balance sheet, risk management, bank interest, bank securities, bank interest margins, probability of default, banks ? asset, bank deposits, bank client, dividend yield, emerging markets, interest rate arbitrage, bank structure, credit risk management, risk profile, bank failure rates

Effect of vacuum packaging on lipid oxidation of eel ( Anguilla anguilla) flesh during refrigerated storage

Recent trends towards extending the shelf-life of fresh eel during refrigerated storage have rendered the control of lipid oxidation increasingly important. Eel fat is very sensitive to oxidative deterioration because of its high content of polyunsaturated fatty acids. To delay or minimise oxidative deterioration of fresheel fat during refrigerated storage, the use of vacuum packaging was investigated. Lipid oxidation was assessed by monitoring malonaldehyde (MDA) formation in wild (n=10) and farmed (n=10) eel flesh samples at 0, 1, 2, 5 and 8 days of refrigerated storage in atmospheric air or under vacuum packaging, using a selective third-order derivative spectrophotometric method. The results clearly demonstrated the oxidative stability of vacuum packed eelflesh following storage for 8 days at 3±1oC and the significant oxidation of the atmospheric air stored eel flesh even after 1 day of refrigerated storage

A Successful Pregnancy Despite the Presence of an Intrauterine Fetal Bone Fragment.

OBJECTIVE: Intrauterine retention of fetal bones following a termination of a pregnancy is a rare complication. Among the few reported cases in literature, there has been no report describing the birth of a live fetus, despite the presence of an embryonic ossicle within the endometrial cavity. CASE REPORT: A 28-year-old woman, with an obstetrical history of a miscarriage at the 19(th) week of gestation, underwent a diagnostic hysteroscopy for evaluation of pelvic pain and infertility, which revealed an intrauterine embryonic ossicle. The patient did not comply with our recommendations to undergo a surgical hysteroscopy. The patient&apos;s next visit was during her 9(th) week of gestation. She was followed up regularly at our Obstetrics Department. Her gestation was uneventful, while an elective caesarean section at the 39(th) week of gestation was performed. CONCLUSION: The present clinical case has demonstrated that achieving childbearing is possible, despite the requirement of removing such bone fragments

N-Terminal Pro-B Type Natriuretic Peptide as a Predictive Biomarker of Bronchopulmonary Dysplasia or Death Due to Bronchopulmonary Dysplasia in Preterm Neonates: A Systematic Review and Meta-Analysis

Background: Emerging evidence suggests the clinical utility of N terminal pro B type natriuretic peptide (NT-proBNP) in multiple cardiac and pulmonary abnormalities both in adult and pediatric populations. To date, however, there is no consensus regarding its efficacy for the prediction and severity of bronchopulmonary dysplasia in premature neonates. The objective of the present meta-analysis was to determine differences in NT-proBNP among neonates that develop BPD or die from BPD and to evaluate if there is relative information on the diagnostic accuracy of the method. Methods: We conducted a systematic search according to the PRISMA guidelines and looked into Medline (1966–2023), Scopus (2004–2023), Clinicaltrials.gov (2008–2023), EMBASE (1980–2023), Cochrane Central Register of Controlled Trials CENTRAL (1999–2022) and Google Scholar (2004–2023) together with the reference lists from included studies. The potential risk of bias encountered in our study was evaluated using the QUADAS -2 tool. Finally, a total of 9 studies met the eligibility criteria, comprising 1319 newborns, from which 397 developed BPD and 922 were unaffected controls. Results: The results retrieved from our meta-analysis showed that newborns suffering from BPD had notably elevated NT-proBNP levels after birth when compared with healthy neonates (SMD 2.57, 95% CI 0.41, 4.72). The summary effect of the AUC meta-analysis showed that NT-proBNP was very accurate in detecting neonates at risk of developing severe BPD or dying from the disease (AUC −0.16, 95% CI −0.23, −0.08). No studies reported data relevant to the sensitivity and/or specificity of the method in diagnosing BPD. Conclusion: Serum NT-proBNP levels represent a potential future biomarker with great diagnostic validity for the prediction of BPD complicating preterm deliveries. The limited amount of studies included and the significant variations in cutoff values and timing of measurement still restrict the application of NT-proBNP as an established clinical biomarker for BPD. The design of larger prospective studies will provide a more representative number of participants and will address the discrepancies in existing literature

Temporal Trends and Associated Factors for Pre-Hospital and In-Hospital Delays of Stroke Patients over a 16-Year Period: The Athens Study

Background: The management and outcome of acute ischemic stroke changed dramatically after the introduction of intravenous thrombolysis. However, relatively few patients have received thrombolytic treatment, mainly due to pre-hospital and/or in-hospital delays. Although the causes of these delays have been adequately studied, their change over a long period has not. Methods: All acute first-ever stroke patients (n = 2,746) presenting to our academic center from 1993 to 2008 were prospectively documented in a computerized stroke data bank. The time from symptoms onset to presentation at the emergency room and to acquisition of a brain CT was calculated. Time trends over this period as well as the factors affecting them were analyzed. Results: The final study cohort consisted of 2,326 acute stroke patients after excluding 302 patients with an unknown time of stroke onset and 118 who suffered a stroke during hospitalization for another illness. Over the 16-year period, the median time from stroke onset to presentation at the emergency room decreased significantly from 3.15 h (interquartile range 1.30-10.30) to 2.00 h (range 1.00-4.00) (p &lt; 0.001). The median time from emergency room presentation to CT scan completion also decreased significantly (p &lt; 0.001) from 12.3 h (range 4.1-29.8) to 1.0 h (range 0.31-2.77). As a result, the proportion of patients having a CT scan within 4 h of stroke onset increased significantly from 8.6% in 1993-1994 to 53.6% in 2007-2008 (p &lt; 0.001). Thrombolytic treatment was applied in 4.15% of all ischemic stroke patients in the period from 2003 to 2008. Along with other significant factors, use of an emergency medical service was associated with a 57% greater chance of presenting within 3 h after symptoms onset. Conclusions: These results suggest a continued improvement in pre-hospital and in-hospital delays for stroke management. Public awareness and education regarding medical and paramedical services are necessary for the best early management of acute stroke patients. Copyright (C) 2010 S. Karger AG, Base

Middle colic vein draining to splenic vein: a rare anatomic variation encountered during a right hemicolectomy

Right or subtotal colectomy either open or laparoscopic may be a challenging operation owing to technical difficulties. One of these, is to identify a safe and adequate dissection plane, ligating and dissecting lymph nodes around middle colic vessels. The purpose of this study was to depict a rare anatomic variation of middle colic vein (MCV) draining to splenic vein. We report the case of a 55-year-old male patient, who was subjected to a right hemicolectomy for an adenocarcinoma in the ascending colon. During dissecting the transverse mesocolon from the greater omentum, for complete mesocolic excision (CME), we encountered that the MCV drained in the splenic vein. With respect of this rare anatomic variability, CME was completed without hemorrhage. Our aim is to depict that deep knowledge of MCV anatomy and its variations is of paramount importance to achieve CME and to avoid dangerous or massive bleeding

Vitrified human umbilical arteries as potential grafts for vascular tissue engineering

Background: The development of a biological based small diameter vascular graft (d < 6 mm), that can be properly stored over a long time period at − 196 °C, in order to directly be used to the patients, still remains a challenge. In this study the decellularized umbilical arteries (UAs) where vitrified, evaluated their composition and implanted to a porcine model, thus serving as vascular graft. Methods: Human UAs were decellularized using 3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS) and sodium dodecyl sulfate (SDS) detergents. Then, vitrified with vitrification solution 55 (VS55) solution, remained for 6 months in liquid nitrogen and their extracellular matrix composition was compared to conventionally cryopreserved UAs. Additionally, total hydroxyproline, sulphated glycosaminoglycan and DNA content were quantified in all samples. Finally, the vitrified umbilical arteries implanted as common carotid artery interposition graft to a porcine animal model. Results: Decellularized and vitrified UAs characterized by proper preservation of extracellular matrix proteins and tissue architecture, whereas conventionally cryopreserved samples exhibited a disorganized structure. Total hydroxyproline content was preserved, although sulphated glycosaminoglycan and DNA contents presented significantly alterations in all samples. Implanted UAs successfully recellularized and remodeled as indicated by the histological analysis. Conclusion: Decellularized and vitrified UAs retained their structure function properties and can be possible used as an alternative source for readily accessible small diameter vascular grafts

Financial Crises in Japan and Latin America

This book looks at the key issues and lessons that policymakers must consider in designing an adequate framework for dealing with financial crises. These include structural problems and their causes, policy actions, the role of market discipline, and preemptive strategies