Does point of care prothrombin time measurement reduce the transfusion of fresh frozen plasma in patients undergoing major surgery? The POC-OP randomized-controlled trial

BACKGROUND: Bleeding is a frequent complication during surgery. The intraoperative administration of blood products, including packed red blood cells, platelets and fresh frozen plasma (FFP), is often live saving. Complications of blood transfusions contribute considerably to perioperative costs and blood product resources are limited. Consequently, strategies to optimize the decision to transfuse are needed. Bleeding during surgery is a dynamic process and may result in major blood loss and coagulopathy due to dilution and consumption. The indication for transfusion should be based on reliable coagulation studies. While hemoglobin levels and platelet counts are available within 15 minutes, standard coagulation studies require one hour. Therefore, the decision to administer FFP has to be made in the absence of any data. Point of care testing of prothrombin time ensures that one major parameter of coagulation is available in the operation theatre within minutes. It is fast, easy to perform, inexpensive and may enable physicians to rationally determine the need for FFP. METHODS/DESIGN: The objective of the POC-OP trial is to determine the effectiveness of point of care prothrombin time testing to reduce the administration of FFP. It is a patient and assessor blind, single center randomized controlled parallel group trial in 220 patients aged between 18 and 90 years undergoing major surgery (any type, except cardiac surgery and liver transplantation) with an estimated blood loss during surgery exceeding 20% of the calculated total blood volume or a requirement of FFP according to the judgment of the physicians in charge. Patients are randomized to usual care plus point of care prothrombin time testing or usual care alone without point of care testing. The primary outcome is the relative risk to receive any FFP perioperatively. The inclusion of 110 patients per group will yield more than 80% power to detect a clinically relevant relative risk of 0.60 to receive FFP of the experimental as compared with the control group. DISCUSSION: Point of care prothrombin time testing in the operation theatre may reduce the administration of FFP considerably, which in turn may decrease costs and complications usually associated with the administration of blood products. TRIAL REGISTRATION: NCT00656396.

Intravaginal and intracervical application of seminal plasma in in vitro fertilization or intracytoplasmic sperm injection treatment cycles--a double-blind, placebo-controlled, randomized pilot study

OBJECTIVE: To evaluate whether intravaginal application of seminal plasma at the time of follicle aspiration in IVF or intracytoplasmic sperm injection treatment cycles has the potential to increase pregnancy rate. To calculate the number of patients needed to achieve significance in a multicenter trial. DESIGN: Double-blind, placebo-controlled randomized pilot study. SETTING: University department of gynecological endocrinology and reproductive medicine. PATIENT(S): One hundred sixty-eight patients undergoing IVF or intracytoplasmic sperm injection treatment. INTERVENTION(S): Cryopreserved seminal plasma from the patient's partner or sodium chloride (placebo) was injected into the cervix and the posterior fornix of the vagina just after follicle aspiration. MAIN OUTCOME MEASURE(S): Clinical-pregnancy rate. RESULT(S): One hundred sixty-eight patients agreed to participate in the study. Participation was limited to one treatment cycle. Thirty-one patients (18%) were excluded from the study, mainly as a result of canceled embryo transfers. Seventy patients received placebo, and 67 received seminal plasma. The clinical-pregnancy rate was 25.7% (18/70) in the placebo group. The clinical-pregnancy rate in the seminal plasma group reached 37.3% (25/67), corresponding to a relative increase of 45%. CONCLUSION(S): Even though significance was not reached in this pilot study, the data suggest that seminal plasma has the potential to improve pregnancy rate. It is estimated that around 450 patients need to be recruited to reach significance in a multicenter study.

Breakdown voltage of metal-oxide resistors in liquid argon

We characterized a sample of metal-oxide resistors and measured their breakdown voltage in liquid argon by applying high voltage (HV) pulses over a 3 second period. This test mimics the situation in a HV-divider chain when a breakdown occurs and the voltage across resistors rapidly rise from the static value to much higher values. All resistors had higher breakdown voltages in liquid argon than their vendor ratings in air at room temperature. Failure modes range from full destruction to coating damage. In cases where breakdown was not catastrophic, subsequent breakdown voltages were lower in subsequent measuring runs. One resistor type withstands 131 kV pulses, the limit of the test setup.

A method to suppress dielectric breakdowns in liquid argon ionization detectors for cathode to ground distances of several millimeters

We present a method to reach electric field intensity as high as 400 kV/cm in liquid argon for cathode-ground distances of several millimeters. This can be achieved by suppressing field emission from the cathode, overcoming limitations that we reported earlier.

Experimental study of electric breakdowns in liquid argon at centimeter scale

In this paper we present results on measurements of the dielectric strength of liquid argon near its boiling point and cathode-anode distances in the range of 0.1 mm to 40 mm with spherical cathode and plane anode. We show that at such distances the applied electric field at which breakdowns occur is as low as 40 kV/cm. Flash-overs across the ribbed dielectric of the high voltage feed-through are observed for a length of 300 mm starting from a voltage of 55 kV. These results contribute to set reference for the breakdown-free design of ionization detectors, such as Liquid Argon Time Projection Chambers (LAr TPC).

Comparison of the capacity of enamel matrix derivative gel and enamel matrix derivative in liquid formulation to adsorb to bone grafting materials.

BACKGROUND The use of an enamel matrix derivative (EMD) has been shown to enhance periodontal regeneration (e.g., formation of root cementum, periodontal ligament, and alveolar bone). However, in certain clinical situations, the use of EMD alone may not be sufficient to prevent flap collapse or provide sufficient stability of the blood clot. Data from clinical and preclinical studies have demonstrated controversial results after application of EMD combined with different types of bone grafting materials in periodontal regenerative procedures. The aim of the present study is to investigate the adsorption properties of enamel matrix proteins to bone grafts after surface coating with either EMD (as a liquid formulation) or EMD (as a gel formulation). METHODS Three different types of grafting materials, including a natural bone mineral (NBM), demineralized freeze-dried bone allograft (DFDBA), or a calcium phosphate (CaP), were coated with either EMD liquid or EMD gel. Samples were analyzed by scanning electron microscopy or transmission electron microscopy (TEM) using an immunostaining assay with gold-conjugated anti-EMD antibody. Total protein adsorption to bone grafting material was quantified using an enzyme-linked immunosorbent assay (ELISA) kit for amelogenin. RESULTS The adsorption of amelogenin to the surface of grafting material varied substantially based on the carrier system used. EMD gel adsorbed less protein to the surface of grafting particles, which easily dissociated from the graft surface after phosphate-buffered saline rinsing. Analyses by TEM revealed that adsorption of amelogenin proteins were significantly farther from the grafting material surface, likely a result of the thick polyglycolic acid gel carrier. ELISA protein quantification assay demonstrated that the combination of EMD liquid + NBM and EMD liquid + DFDBA adsorbed higher amounts of amelogenin than all other treatment modalities. Furthermore, amelogenin proteins delivered by EMD liquid were able to penetrate the porous surface structure of NBM and DFDBA and adsorb to the interior of bone grafting particles. Grafting materials coated with EMD gel adsorbed more frequently to the exterior of grafting particles with little interior penetration. CONCLUSIONS The present study demonstrates a large variability of adsorbed amelogenin to the surface of bone grafting materials when enamel matrix proteins were delivered in either a liquid formulation or gel carrier. Furthermore, differences in amelogenin adsorption were observed among NBM, DFDBA, and biphasic CaP particles. Thus, the potential for a liquid carrier system for EMD, used to coat EMD, may be advantageous for better surface coating.

Molecular Dynamics Simulations of Lead and Lithium in Liquid Phase

Pb17Li is today a reference breeder material in diverse fusion R&D programs worldwide. Extracting dynamic and structural properties of liquid LiPb mixtures via molecular dynamics simulations, represent a crucial step for multiscale modeling efforts in order to understand the suitability of this compound for future Nuclear Fusion technologies. At present a Li-Pb cross potential is not available in the literature. Here we present our first results on the validation of two semi-empirical potentials for Li and Pb in liquid phase. Our results represent the establishment of a solid base as a previous but crucial step to implement a LiPb cross potential. Structural and thermodynamical analyses confirm that the implemented potentials for Li and Pb are realistic to simulate both elements in the liquid phase.

Molecular dynamics simulations of lead and lithium in liquid phase

Pb17Li is today a reference breeder material in diverse fusion R&D programs worldwide. Extracting dynamic and structural properties of liquid LiPb mixtures via molecular dynamics simulations, represent a crucial step for multiscale modeling efforts in order to understand the suitability of this compound for future Nuclear Fusion technologies. At present a Li-Pb cross potential is not available in the literature. Here we present our first results on the validation of two semi-empirical potentials for Li and Pb in liquid phase. Our results represent the establishment of a solid base as a previous but crucial step to implement a LiPb cross potential. Structural and thermodynamical analyses confirm that the implemented potentials for Li and Pb are realistic to simulate both elements in the liquid phase.

Increasing the accuracy of positive displacement meters for the measurement of volume in liquid hydrocarbon logistics

Accuracy in the liquid hydrocarbons custody transfer is mandatory because it has a great economic impact. By far the most accurate meter is the positive displacement (PD) meter. Increasing such an accuracy may adversely affect the cost of the custody transfer, unless simple models are developed in order to lower the cost, which is the purpose of this work. PD meter consists of a fixed volume rotating chamber. For each turn a pulse is counted, hence, the measured volume is the number of pulses times the volume of the chamber. It does not coincide with the real volume, so corrections have to be made. All the corrections are grouped by a meter factor. Among corrections highlights the slippage flow. By solving the Navier-Stokes equations one can find an analytical expression for this flow. It is neither easy nor cheap to apply straightforward the slippage correction; therefore we have made a simple model where slippage is regarded as a single parameter with dimension of time. The model has been tested for several PD meters. In our careful experiments, the meter factor grows with temperature at a constant pace of 8?10?5?ºC?1. Be warned

Conductivity variations of multi-walled carbon nanotubes oriented in liquid crystal cells

The control of carbon nanotubes conductivity is generating interest in several fields since it may be relevant for a number of applications. The self-organizing properties of liquid crystals may be used to impose alignment on dispersed carbon nanotubes,thus control-ling their conductivity and its anisotropy. This leads to a number of possible applications in photonic and electronic devices such as electrically controlled carbon nanotube switch- es and crossboards. In this work, cells of liquid crystals doped with multi-walled nanotubes have been prepared in different configurations. Their conductivity variations upon switching have been investigated. It turns out that conductivity evolution depends on the initial configuration (either homogeneous, homeotropic or in-plane switching), the cell thickness and the switching record. The control of these manufacturing paramenters allows the modulation of the electrical behavior of carbon nanotubes.

Improving the pass-band return loss in liquid crystal dual-mode bandpass filters by microstrip patch reshaping

In this paper, the design and experimental characterization of a tunable microstrip bandpass filter based on liquid crystal technology are presented. A reshaped microstrip dual-mode filter structure has been used in order to improve the device performance. Specifically, the aim is to increase the pass-band return loss of the filter by narrowing the filter bandwidth. Simulations confirm the improvement of using this new structure, achieving a pass-band return loss increase of 1.5 dB at least. Because of the anisotropic properties of LC molecules, a filter central frequency shift from 4.688 GHz to 5.045 GHz, which means a relative tuning range of 7.3%, is measured when an external AC voltage from 0 Vrms to 15 Vrms is applied to the device.

On the Electric Breakdown in Liquid Argon at Centimeter Scale

We present a study on the dependence of electric breakdown discharge properties on electrode geometry and the breakdown field in liquid argon near its boiling point. The measurements were performed with a spherical cathode and a planar anode at distances ranging from 0.1 mm to 10.0 mm. A detailed study of the time evolution of the breakdown volt-ampere characteristics was performed for the first time. It revealed a slow streamer development phase in the discharge. The results of a spectroscopic study of the visible light emission of the breakdowns complement the measurements. The light emission from the initial phase of the discharge is attributed to electro-luminescence of liquid argon following a current of drifting electrons. These results contribute to set benchmarks for breakdown-safe design of ionization detectors, such as Liquid Argon Time Projection Chambers (LAr TPC).

Selected bibliography of physico-chemical properties in liquid ammonia and related solvents /

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