Prevention and management of acute reactions to intravenous iron in surgical patients

Absolute or functional iron deficiency is the most prevalent cause of anaemia in surgical patients, and its correction is a fundamental strategy within "Patient Blood Management" programmes. Offering perioperative oral iron for treating iron deficiency anaemia is still recommended, but intravenous iron has been demonstrated to be superior in most cases. However, the long-standing prejudice against intravenous iron administration, which is thought to induce anaphylaxis, hypotension and shock, still persists. With currently available intravenous iron formulations, minor infusion reactions are not common. These self-limited reactions are due to labile iron and not hypersensitivity. Aggressively treating infusion reactions with H 1 -antihistamines or vasopressors should be avoided. Self-limited hypotension during intravenous iron infusion could be considered to be due to hypersensitivity or vascular reaction to labile iron. Acute hypersensitivity reactions to current intravenous iron formulation are believed to be caused by complement activation-related pseudo-allergy. However, though exceedingly rare (<1:250,000 administrations), they should not be ignored, and intravenous iron should be administered only at facilities where staff is trained to evaluate and manage these reactions. As preventive measures, prior to the infusion, staff should inform all patients about infusion reactions and identify those patients with increased risk of hypersensitivity or contraindications for intravenous iron. Infusion should be started at a low rate for a few minutes. In the event of a reaction, the very first intervention should be the immediate cessation of the infusion, followed by evaluation of severity and treatment. An algorithm to scale the intensity of treatment to the clinical picture and/or response to therapy is presented

Possible Patient Early Diagnosis by Ultrasonic Noninvasive Estimation of Thermal Gradients into Tissues Based on Spectral Changes Modeling

To achieve a precise noninvasive temperature estimation, inside patient tissues, would open promising research fields, because its clinic results would provide early-diagnosis tools. In fact, detecting changes of thermal origin in ultrasonic echo spectra could be useful as an early complementary indicator of infections, inflammations, or cancer. But the effective clinic applications to diagnosis of thermometry ultrasonic techniques, proposed previously, require additional research. Before their implementations with ultrasonic probes and real-time electronic and processing systems, rigorous analyses must be still made over transient echotraces acquired from well-controlled biological and computational phantoms, to improve resolutions and evaluate clinic limitations. It must be based on computing improved signal-processing algorithms emulating tissues responses. Some related parameters in echo-traces reflected by semiregular scattering tissues must be carefully quantified to get a precise processing protocols definition. In this paper, approaches for non-invasive spectral ultrasonic detection are analyzed. Extensions of author's innovations for ultrasonic thermometry are shown and applied to computationally modeled echotraces from scattered biological phantoms, attaining high resolution (better than 0.1°C). Computer methods are provided for viability evaluation of thermal estimation from echoes with distinct noise levels, difficult to be interpreted, and its effectiveness is evaluated as possible diagnosis tool in scattered tissues like liver

Analysing intermediary organisations and their influence on upgrading in emerging agricultural clusters

This paper analyses intermediary organisations in developing economy agricultural clusters. The paper critically engages with a growing narrative in studies of intermediaries that have stressed the ownership structure of intermediaries as a key driver for enabling knowledge transfer, inter-firm learning and upgrading of small producers in clusters. Two case studies of Latin American clusters are presented and discussed. The study suggests that in addition to ownership structure, cluster governance and the embeddedness of intermediaries in clusters are critical factors that need to be taken into account in understanding the influence of intermediaries in the upgrading of small producers in clusters

Femtosecond laser microstructuring of zirconia dental implants

This study evaluated the suitability of femtosecond laser for microtexturizing cylindrical zirconia dental implants surface. Sixty-six cylindrical zirconia implants were used and divided into three groups: Control group (with no laser modification), Group A (microgropored texture), and Group B (microgrooved texture). Scanning electron microscopy observation of microgeometries revealed minimal collateral damage of the original surface surrounding the treated areas. Optical interferometric profilometry showed that ultrafast laser ablation increased surface roughness (Ra, Rq, Rz, and Rt) significantly for both textured patterns from 1.2× to 6×-fold when compared with the control group (p Group B 8.4% ± 0.42% > Group A 1.6% ± 0.35%) and aluminum (Control 4.3% ± 0.9% > Group B 2.3% ± 0.3% > Group A 1.16% ± 0.2%) in the laser-treated surfaces (p Group A 1.94% > Group B 1.72%) as the surfaces were processed with ultrashort laser pulses. We concluded that femtosecond laser microstructuring offers an interesting alternative to conventional surface treatments of zirconia implants as a result of its precision and minimal damage of the surrounding areas

WadD, a New Brucella Lipopolysaccharide Core Glycosyltransferase Identified by Genomic Search and Phenotypic Characterization

Brucellosis, an infectious disease caused by Brucella, is one of the most extended bacterial zoonosis in the world and an important cause of economic losses and human suffering. The lipopolysaccharide (LPS) of Brucella plays a major role in virulence as it impairs normal recognition by the innate immune system and delays the immune response. The LPS core is a branched structure involved in resistance to complement and polycationic peptides, and mutants in glycosyltransferases required for the synthesis of the lateral branch not linked to the O-polysaccharide (O-PS) are attenuated and have been proposed as vaccine candidates. For this reason, the complete understanding of the genes involved in the synthesis of this LPS section is of particular interest. The chemical structure of the Brucella LPS core suggests that, in addition to the already identified WadB and WadC glycosyltransferases, others could be implicated in the synthesis of this lateral branch. To clarify this point, we identified and constructed mutants in 11 ORFs encoding putative glycosyltransferases in B. abortus. Four of these ORFs, regulated by the virulence regulator MucR (involved in LPS synthesis) or the ByrR/ByrS system (implicated in the synthesis of surface components), were not required for the synthesis of a complete LPS neither for virulence or interaction with polycationic peptides and/or complement. Among the other seven ORFs, six seemed not to be required for the synthesis of the core LPS since the corresponding mutants kept the O-PS and reacted as the wild type with polyclonal sera. Interestingly, mutant in ORF BAB1_0953 (renamed wadD) lost reactivity against antibodies that recognize the core section while kept the O-PS. This suggests that WadD is a new glycosyltransferase adding one or more sugars to the core lateral branch. WadD mutants were more sensitive than the parental strain to components of the innate immune system and played a role in chronic stages of infection. These results corroborate and extend previous work indicating that the Brucella LPS core is a branched structure that constitutes a steric impairment preventing the elements of the innate immune system to fight against Brucella

CMB Imprints of a Pre-Inflationary Climbing Phase

We discuss the implications for cosmic microwave background (CMB) observables, of a class of pre-inflationary dynamics suggested by string models where SUSY is broken due to the presence of D-branes and orientifolds preserving incompatible portions of it. In these models the would-be inflaton is forced to emerge from the initial singularity climbing up a mild exponential potential, until it bounces against a steep exponential potential of "brane SUSY breaking" scenarios, and as a result the ensuing descent gives rise to an inflationary epoch that begins when the system is still well off its eventual attractor. If a pre-inflationary climbing phase of this type had occurred within 6-7 e-folds of the horizon exit for the largest observable wavelengths, displacement off the attractor and initial-state effects would conspire to suppress power in the primordial scalar spectrum, enhancing it in the tensor spectrum and typically superposing oscillations on both. We investigate these imprints on CMB observables over a range of parameters, examine their statistical significance, and provide a semi-analytic rationale for our results. It is tempting to ascribe at least part of the large-angle anomalies in the CMB to pre-inflationary dynamics of this type.Comment: 38 pages, LaTeX, 11 eps figures, references added, matches version to appear in JCA

Identification and expression pattern of a new carotenoid cleavage dioxygenase gene member from Bixa orellana

Carotenoid cleavage dioxygenases (CCDs) are a class of enzymes involved in the biosynthesis of a broad diversity of secondary metabolites known as apocarotenoids. In plants, CCDs are part of a genetic family with members which cleave specific double bonds of carotenoid molecules. CCDs are involved in the production of diverse and important metabolites such as vitamin A and abscisic acid (ABA). Bixa orellana L. is the main source of the natural pigment annatto or bixin, an apocarotenoid accumulated in large quantities in its seeds. Bixin biosynthesis has been studied and the involvement of a CCD has been confirmed in vitro. However, the CCD genes involved in the biosynthesis of the wide variety of apocarotenoids found in this plant have not been well documented. In this study, a new CCD1 gene member (BoCCD1) was identified and its expression was charaterized in different plant tissues of B. orellana plantlets and adult plants. The BoCCD1 sequence showed high homology with plant CCD1s involved mainly in the cleavage of carotenoids in several sites to generate multiple apocarotenoid products. Here, the expression profiles of the BoCCD1 gene were analysed and discussed in relation to total carotenoids and other important apocarotenoids such as bixin

Genomic insertion of a heterologous acetyltransferase generates a new lipopolysaccharide antigenic structure in brucella abortus and brucella melitensis

Brucellosis is a bacterial zoonosis of worldwide distribution caused by bacteria of the genus Brucella. In Brucella abortus and Brucella melitensis, the major species infecting domestic ruminants, the smooth lipopolysaccharide (S-LPS) is a virulence factor. This S-LPS carries a N-formyl-perosamine homopolymer O-polysaccharide that is the major antigen in serodiagnostic tests and is required for virulence. We report that the Brucella O-PS can be structurally and antigenically modified using wbdR, the acetyl-transferase gene involved in N-acetyl-perosamine synthesis in Escherichia coli O157:H7. Brucella constructs carrying plasmidic wbdR expressed a modified O-polysaccharide but were unstable, a problem circumvented by inserting wbdR into a neutral site of chromosome II. As compared to wild-type bacteria, both kinds of wbdR constructs expressed shorter O-polysaccharides and NMR analyses showed that they contained both N-formyl and N-acetyl-perosamine. Moreover, deletion of the Brucella formyltransferase gene wbkC in wbdR constructs generated bacteria producing only N-acetyl-perosamine homopolymers, proving that wbdR can replace for wbkC. Absorption experiments with immune sera revealed that the wbdR constructs triggered antibodies to new immunogenic epitope(s) and the use of monoclonal antibodies proved that B. abortus and B. melitensis wbdR constructs respectively lacked the A or M epitopes, and the absence of the C epitope in both backgrounds. The wbdR constructs showed resistance to polycations similar to that of the wild-type strains but displayed increased sensitivity to normal serum similar to that of a per R mutant. In mice, the wbdR constructs produced chronic infections and triggered antibody responses that can be differentiated from those evoked by the wild-type strain in S-LPS ELISAs. These results open the possibilities of developing brucellosis vaccines that are both antigenically tagged and lack the diagnostic epitopes of virulent field strains, thereby solving the diagnostic interference created by current vaccines against Brucella