Predictors of perioperative blood loss in total joint arthroplasty.

UNLABELLED: UPDATE The print version of this article has errors that have been corrected in the online version of this article. In the Materials and Methods section, the sentence that reads as During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 mg/dL or a hematocrit level of at least 33%. in the print version now reads as During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 g/dL or a hematocrit level of at least 33%. in the online version. In Table III, the footnote that reads as The values are given as the estimate and the standard error in milligrams per deciliter. in the print version now reads as The values are given as the estimate and the standard error in grams per deciliter. in the online version. BACKGROUND: Despite advances in surgical and anesthetic techniques, lower-extremity total joint arthroplasty is associated with considerable perioperative blood loss. As predictors of perioperative blood loss and allogenic blood transfusion have not yet been well defined, the purpose of this study was to identify clinical predictors for perioperative blood loss and allogenic blood transfusion in patients undergoing total joint arthroplasty. METHODS: From 2000 to 2008, all patients undergoing unilateral primary total hip or knee arthroplasty who met the inclusion criteria were enrolled in the study. Perioperative blood loss was calculated with use of a previously validated formula. The predictors of perioperative blood loss and allogenic blood transfusion were identified in a multivariate analysis. RESULTS: Eleven thousand three hundred and seventy-three patients who underwent total joint arthroplasty, including 4769 patients who underwent total knee arthroplasty and 6604 patients who underwent total hip arthroplasty, were evaluated. Multivariate analysis indicated that an increase in blood loss was associated with being male (263.59 mL in male patients who had undergone total hip arthroplasty and 233.60 mL in male patients who had undergone total knee arthroplasty), a Charlson Comorbidity Index of \u3e3 (293.99 mL in patients who had undergone total hip arthroplasty and 167.96 mL in patients who had undergone total knee arthroplasty), and preoperative autologous blood donation (593.51 mL in patients who had undergone total hip arthroplasty and 592.30 mL in patients who had undergone total knee arthroplasty). In patients who underwent total hip arthroplasty, regional anesthesia compared with general anesthesia reduced the amount of blood loss. The risk of allogenic blood transfusion increased with the amount of blood loss in the patients who underwent total hip arthroplasty (odds ratio, 1.43 [95% confidence interval, 1.40 to 1.46]) and the patients who underwent total knee arthroplasty (odds ratio, 1.47 [95% confidence interval, 1.42 to 1.51]), but the risk of blood transfusion increased with the Charlson Comorbidity Index only in patients who underwent total knee arthroplasty (odds ratio, 3.2 [95% confidence interval, 1.99 to 5.15]). The risk of allogenic blood transfusion decreased with preoperative autologous blood donation in patients who underwent total hip arthroplasty (odds ratio, 0.01 [95% confidence interval, 0.01 to 0.02]) and patients who underwent total knee arthroplasty (odds ratio, 0.02 [95% confidence interval, 0.01 to 0.03]). CONCLUSIONS: This study identified some clinical predictors for blood loss in patients undergoing total joint arthroplasty that we believe can be used for implementing more effective blood conservation strategies. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence

Rôle et place du riz pluvial dans les exploitations du Vakinankaratra (Hauts Plateaux et Moyen Ouest)

International audienceDans la région des Hautes Terres, zone montagneuse dont les plaines et les bas fond irrigués sont dominés par de forts reliefs, l'accroissement de la pression démographique s'est traduit par la saturation des terres irriguées, destinées à la riziculture, et par une emprise agricole de plus en plus forte sur les terres de versant. La conduite des cultures de versant (Tanety), ou cultures pluviales, selon les techniques traditionnelles de travail du sol, combiné à l'abondance des pluies, accentue les phénomènes d'érosion et conduit donc à une forte perte de fertilité. De plus, la dégradation des sols en amont se traduit très souvent par l'ensablement et des dégâts sur les infrastructures et parcelles irriguées situées en aval. Ainsi, ces systèmes ne permettent pas, du fait de la fragilité de l'écosystème, de concilier les objectifs de production et de durabilité. Pour faire évoluer ces systèmes vers plus de durabilité, il convient d'améliorer les connaissances sur les pratiques des exploitants. Cette communication présente les résultats de deux diagnostics agraires réalisé en 2007 dans la commune d'Andranomanelatra, à la périphérie d'Antsirabe, sur les hauts plateaux de Madagascar et en 2008/2009 dans le reste du Vakinankaratra, hauts plateaux et moyen-ouest, ainsi que des résultats obtenus et sortis de la base de données parcelle (BDD) du projet BVPI SE/HP. Des typologies d'exploitations sont présentées pour mieux identifier les contraintes et opportunités de chaque type et la place du riz pluvial dans la formation du revenu ou la satisfaction des besoins alimentaires. On examinera l'opportunité que représente le riz pluvial pour les agriculteurs de la région sans oublier les autres opportunités ou alternatives présentes dans la zone qui semblent plus adaptées à des contextes très différenciés des hauts plateaux. La discussion portera sur les enjeux agricoles à venir et la place que peut y jouer le riz pluvial

The BSUIN project

Baltic Sea Underground Innovation Network (BSUIN) is an European Union funded project that extends capabilities of underground laboratories. The aim of the project is to join efforts in making the underground laboratories in the Baltic Sea Region’s more accessible for innovation, business development and science by improving the availability of information about the underground facilities, service offerings, user experience, safety and marketing.The development of standards for the characterization of underground laboratories will allow to compared them with each other. This will help you choose the best places for physical measurements such as neutrino physics or searching for dark matter. The project concerns laboratories where so far no measurements have been made, and even undergrounds where there are no organized laboratories yet.The description of the BSUIN project and the first results of characterization of natural radioactive background in underground laboratories will be presented ˙ The BSUIN Project is funded by Interreg Baltic Sea funding cooperation [2]

BCR and its mutants, the reciprocal t(9;22)-associated ABL/BCR fusion proteins, differentially regulate the cytoskeleton and cell motility

BACKGROUND: The reciprocal (9;22) translocation fuses the bcr (breakpoint cluster region) gene on chromosome 22 to the abl (Abelson-leukemia-virus) gene on chromosome 9. Depending on the breakpoint on chromosome 22 (the Philadelphia chromosome – Ph+) the derivative 9+ encodes either the p40((ABL/BCR) )fusion transcript, detectable in about 65% patients suffering from chronic myeloid leukemia, or the p96((ABL/BCR) )fusion transcript, detectable in 100% of Ph+ acute lymphatic leukemia patients. The ABL/BCRs are N-terminally truncated BCR mutants. The fact that BCR contains Rho-GEF and Rac-GAP functions strongly suggest an important role in cytoskeleton modeling by regulating the activity of Rho-like GTPases, such as Rho, Rac and cdc42. We, therefore, compared the function of the ABL/BCR proteins with that of wild-type BCR. METHODS: We investigated the effects of BCR and ABL/BCRs i.) on the activation status of Rho, Rac and cdc42 in GTPase-activation assays; ii.) on the actin cytoskeleton by direct immunofluorescence; and iii) on cell motility by studying migration into a three-dimensional stroma spheroid model, adhesion on an endothelial cell layer under shear stress in a flow chamber model, and chemotaxis and endothelial transmigration in a transwell model with an SDF-1α gradient. RESULTS: Here we show that both ABL/BCRs lost fundamental functional features of BCR regarding the regulation of small Rho-like GTPases with negative consequences on cell motility, in particular on the capacity to adhere to endothelial cells. CONCLUSION: Our data presented here describe for the first time an analysis of the biological function of the reciprocal t(9;22) ABL/BCR fusion proteins in comparison to their physiological counterpart BCR

P-loop mutations and novel therapeutic approaches for imatinib failures in chronic myeloid leukemia

Imatinib was the first BCR-ABL-targeted agent approved for the treatment of patients with chronic myeloid leukemia (CML) and confers significant benefit for most patients; however, a substantial number of patients are either initially refractory or develop resistance. Point mutations within the ABL kinase domain of the BCR-ABL fusion protein are a major underlying cause of resistance. Of the known imatinib-resistant mutations, the most frequently occurring involve the ATP-binding loop (P-loop). In vitro evidence has suggested that these mutations are more oncogenic with respect to other mutations and wild type BCR-ABL. Dasatinib and nilotinib have been approved for second-line treatment of patients with CML who demonstrate resistance (or intolerance) to imatinib. Both agents have marked activity in patients resistant to imatinib; however, they have differential activity against certain mutations, including those of the P-loop. Data from clinical trials suggest that dasatinib may be more effective vs. nilotinib for treating patients harboring P-loop mutations. Other mutations that are differentially sensitive to the second-line tyrosine kinase inhibitors (TKIs) include F317L and F359I/V, which are more sensitive to nilotinib and dasatinib, respectively. P-loop status in patients with CML and the potency of TKIs against P-loop mutations are key determinants for prognosis and response to treatment. This communication reviews the clinical importance of P-loop mutations and the efficacy of the currently available TKIs against them