Intraoperative blood transfusions in highly alloimmunized patients undergoing orthotopic liver transplantation.

Intraoperative blood requirements were analyzed in patients undergoing primary orthotopic liver transplantation and divided into two groups on the basis of panel reactive antibody of pretransplant serum measured by lymphocytotoxicity testing. One group of highly sensitized patients (n = 25) had PRA values of over 70% and the second group of patients (n = 26) had 0% PRA values and were considered nonsensitized. During the transplant procedure, the 70% PRA group received considerably greater quantities of blood products than the 0% PRA group--namely, red blood cells: 21.1 +/- 3.7 vs. 9.8 +/- 0.8 units (P = 0.002), and platelets: 17.7 +/- 3.2 vs. 7.5 +/- 1.5 units (P = 0.003). Similar differences were observed for fresh frozen plasma and cryoprecipitate. Despite the larger infusion of platelets, the blood platelet counts in the 70% PRA group were lower postoperatively than preoperatively. Twenty patients in the 70% PRA group received platelet transfusions, and their mean platelet count dropped from 95,050 +/- 11,537 preoperatively to 67,750 +/- 8,228 postoperatively (P = 0.028). In contrast, nearly identical preoperative (84,058 +/- 17,297) and postoperative (85,647 +/- 12,445) platelet counts were observed in the 17 0% PRA patients who were transfused intraoperatively with platelets. Prothrombin time, activated partial thromboplastin time, and fibrinogen levels showed no significant differences between both groups. These data demonstrate that lymphocytotoxic antibody screening of liver transplant candidates is useful in identifying patients with increased risk of bleeding problems and who will require large quantities of blood during the transplant operation

Chemical characterization of water-soluble organic carbon aerosols at a rural site in the Pearl River Delta, China, in the summer of 2006

Online measurements of water-soluble organic carbon (WSOC) aerosols were made using a particle-into-liquid sampler (PILS) combined with a total organic carbon (TOC) analyzer at a rural site in the Pearl River Delta region, China, in July 2006. A macroporous nonionic (DAX-8) resin was used to quantify hydrophilic and hydrophobic WSOC, which are defined as the fractions of WSOC that penetrated through and retained on the DAX-8 column, respectively. Laboratory calibrations showed that hydrophilic WSOC (WSOCHPI) included low-molecular aliphatic dicarboxylic acids and carbonyls, saccharides, and amines, while hydrophobic WSOC (WSOCHPO) included longer-chain aliphatic dicarboxylic acids and carbonyls, aromatic acids, phenols, organic nitrates, cyclic acids, and fulvic acids. On average, total WSOC (TWSOC) accounted for 60% of OC, and WSOCHPO accounted for 60% of TWSOC. Both WSOC HIP and WSOCHPO increased with photochemical aging determined from the NOx/NOy ratio. In particular, the average WSOCHPO mass was found to increase by a factor of five within a timescale of ∼10 hours, which was substantially larger than that of WSOCHPI (by a factor of 2-3). The total increase in OC mass with photochemical aging was associated with the large increase in WSOCHPO mass. These results, combined with the laboratory calibrations, suggest that significant amounts of hydrophobic organic compounds (likely containing large carbon numbers) were produced by photochemical processing. By contrast, water-insoluble OC (WIOC) mass did not exhibit significant changes with photochemical aging, suggesting that chemical transformation of WIOC to WSOC was not a dominant process for the production of WSOC during the study period. Copyright 2009 by the American Geophysical Union

Intraoperative blood transfusion requirements and deficient hemostasis in highly alloimmunized patients undergoing liver transplantation

During orthopic liver transplantation (OLT) a large transfusion of different blood components is frequently necessary. From 1981 to 1985 at the University Health Center in Pittsburgh, 4,318 units of RBCs and 4,788 units of platelets were administered during 366 OLT performed in adults. This results in a mean of 25 units of RBCs and 30 units of platelets per operation. The majority of adult liver transplant patients receive multiple transfusions of whole blood and/or blood components during their pretransplant course because of complications relating to their original disease. The exposure of these patients to different antigens from random donors facilitates the development of alloimmunization. The heightened alloimmune state can be identified by preoperative values of panel reacting antibodies (PRA). Since platelets possess the HLA antigens of donor specificity, platelets may function as the target of host antibodies, resulting in platelet alteration and subsequent dysfunction. Thus, the effect of alloimmunization on platelet function may be one of the factors responsible for significant blood loss after large transfusions of different blood components. In this retrospective study we compared blood loss and platelet transfusion during OLT with preoperative alloimmunization against random donor antigens, indicated by PRA values

The application of statistical network models in disease research

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Host social structure is fundamental to how infections spread and persist, and so the statistical modelling of static and dynamic social networks provides an invaluable tool to parameterise realistic epidemiological models. We present a practical guide to the application of network modelling frameworks for hypothesis testing related to social interactions and epidemiology, illustrating some approaches with worked examples using data from a population of wild European badgers Meles meles naturally infected with bovine tuberculosis. Different empirical network datasets generate particular statistical issues related to non-independence and sampling constraints. We therefore discuss the strengths and weaknesses of modelling approaches for different types of network data and for answering different questions relating to disease transmission. We argue that statistical modelling frameworks designed specifically for network analysis offer great potential in directly relating network structure to infection. They have the potential to be powerful tools in analysing empirical contact data used in epidemiological studies, but remain untested for use in networks of spatio-temporal associations. As a result, we argue that developments in the statistical analysis of empirical contact data are critical given the ready availability of dynamic network data from bio-logging studies. Furthermore, we encourage improved integration of statistical network approaches into epidemiological research to facilitate the generation of novel modelling frameworks and help extend our understanding of disease transmission in natural populations.M.J.S. is funded by a NERC standard grant (NE/M004546/1) awarded to R.A.M., D.P.C., D.J.H. and M.B., with the APHA team at Woodchester Park, UK (lead scientist is R.J.D.) as project partners

Contribution of particulate nitrate to airborne measurements of total reactive nitrogen

Simultaneous measurements of speciated, total reactive nitrogen (NOy) and particulate NO3 (particle diameter <1.3 μm) were made on board the NASA P-3B aircraft over the western Pacific in February-April 2001 during the Transport and Chemical Evolution over the Pacific (TRACE-P) experiment. Gas-phase and particulate NOy was measured using a gold tube catalytic converter. For the interpretation of particulate NOy, conversion efficiencies of particulate NH4NO3, KNO3, NaNO3, and Ca(NO3)2 were measured in the laboratory. Only NH4NO3 showed quantitative conversion, and its conversion efficiency was as high as that for HNO3. NOy measured on board the aircraft was found to be systematically higher by 10-30% than the sum of the individual NOy gas components (Σ(NOy)i) at 0-4 km. Particulate NO3- concentrations measured by a particle-into-liquid sampler (PILS) were nearly equal to NOy - Σ(NOy)i under low-dust-loading conditions. The PILS data showed that the majority of the particulate NO3- was in the form of NH4NO3 under these conditions, suggesting that NH4NO3 particles were quantitatively converted to detectable NO by the NOy converter, consistent with the laboratory experiments. The contribution of particulate NO3- to NOy was most important at 0-2 km, where NO3- constituted 10-30% of NOy during TRACE-P. On average, the amounts of particulate NO3- and gas-phase HNO3 were comparable in this region. Copyright 2005 by the American Geophysical Union

Social structure contains epidemics and regulates individual roles in disease transmission in a group-living mammal

This is the final version. Available from Wiley via the DOI in this record. Data accessibility: The original weighted adjacency matrix for the high‐density population of European badgers, as well as code used for simulating networks and disease simulations can be found online https://doi.org/10.5061/dryad.49n3878.Population structure is critical to infectious disease transmission. As a result, theoretical and empirical contact network models of infectious disease spread are increasingly providing valuable insights into wildlife epidemiology. Analyzing an exceptionally detailed dataset on contact structure within a high-density population of European badgers Meles meles, we show that a modular contact network produced by spatially structured stable social groups, lead to smaller epidemics, particularly for infections with intermediate transmissibility. The key advance is that we identify considerable variation among individuals in their role in disease spread, with these new insights made possible by the detail in the badger dataset. Furthermore, the important impacts on epidemiology are found even though the modularity of the Badger network is much lower than the threshold that previous work suggested was necessary. These findings reveal the importance of stable social group structure for disease dynamics with important management implications for socially structured populations.Natural Environment Research Council (NERC