Improving recognition of potential tissue donors: a quality improvement project by a hospitalist in training in The Hague, The Netherlands.

The number of tissue donations decreased in The Netherlands over recent years. The aim of this project was to determine the number of missed tissue donors in the Haaglanden Medical Centre and to develop a strategy to improve the number of tissue donors. We retrospectively analyzed patient files of all deceased patients in 2014 for their potential as tissue donors. Our objectives were to determine the number of missed tissue donors and the percentage of correctly identified tissue donors among all physicians and hospitalists in training. In addition, a clinical audit and three focus group interviews were used to determine the level of knowledge about and adherence to local and national protocols. The findings enabled us to suggest national and local improvements to reduce the percentage of missed tissue donors. The number of missed tissue donors was 94 (17.2%) of 548 deceased patients in 2014. The percentage of correctly identified tissue donors was 65.7% among all physicians (Cohen's Kappa coefficient 0.557, p ≤ 0.001) and 57.1% among hospitalists in training (Cohen's Kappa coefficient 0.492, p ≤ 0.001). In 31 patients (32.4%), the reported contra-indication by physicians was not a contra-indication for tissue donation in The Netherlands. There was no statistical difference in correct identification between physicians and hospitalists in training (p = 0.321, Mann-Whitney). The most effective actions to increase the number of tissue donations include to better inform physicians about contra-indications and help them in the recognition of a tissue donor.

Effects of clopidogrel therapy on whole blood platelet aggregation, the Plateletworks® assay and coagulation parameters in cats with asymptomatic hypertrophic cardiomyopathy: a pilot study.

BACKGROUND: Although scientific evidence is limited, clopidogrel is frequently used as prophylaxis for arterial thromboembolism in cats with hypertrophic cardiomyopathy (HCM). OBJECTIVES: Evaluating effects of clopidogrel therapy in asymptomatic cats with HCM on (1) conventional whole blood aggregation (WBA), (2) alternative platelet aggregation assessed with tubes of the Plateletworks® assay and (3) standard coagulation parameters. ANIMALS AND METHODS: Prospective, randomized, double-blind, placebo-controlled pilot study. Fourteen asymptomatic HCM cats were randomly allocated to receive placebo (n = 5) or clopidogrel (18.75 mg/cat q24h, n = 9) as part of a larger study. Aggregation responses (to 20 µM adenosine diphosphate (ADP) and 10 µg/ml collagen) in WBA and the Plateletworks® assay and standard coagulation parameters were evaluated at baseline and after seven days of therapy. RESULTS: Clopidogrel therapy significantly reduced aggregation responses to ADP and collagen in the Plateletworks® agonists tubes (ADP and collagen: P < 0.001), but did not significantly reduce aggregation responses to ADP and collagen in the WBA technique (ADP: P = 0.07, collagen: P = 0.30). Clopidogrel therapy did not show a significant effect on prothrombin time, activated partial thromboplastin time, antithrombin, D-dimers and fibrinogen concentrations. CONCLUSION AND CLINICAL IMPORTANCE: Clopidogrel therapy at a dose of 18.75 mg/cat q24h for seven days causes a significant decrease in in vitro platelet aggregation evaluated with the Plateletworks® assay, without affecting standard coagulation parameters in cats with asymptomatic HCM.

Blocking CD40-TRAF6 interactions by small-molecule inhibitor 6860766 ameliorates the complications of diet-induced obesity in mice.

BACKGROUND: Immune processes contribute to the development of obesity and its complications, such as insulin resistance, type 2 diabetes mellitus and cardiovascular disease. Approaches that target the inflammatory response are promising therapeutic strategies for obesity. In this context, we recently demonstrated that the interaction between the costimulatory protein CD40 and its downstream adaptor protein tumor necrosis factor receptor-associated factor 6 (TRAF6) promotes adipose tissue inflammation, insulin resistance and hepatic steatosis in mice in the course of diet-induced obesity (DIO). METHODS: Here we evaluated the effects of a small-molecule inhibitor (SMI) of the CD40-TRAF6 interaction, SMI 6860766, on the development of obesity and its complications in mice that were subjected to DIO. RESULTS: Treatment with SMI 6860766 did not result in differences in weight gain, but improved glucose tolerance. Moreover, SMI 6860766 treatment reduced the amount of CD45(+) leucocytes in the epididymal adipose tissue by 69%. Especially, the number of adipose tissue CD4(+) and CD8(+) T cells, as well as macrophages, was significantly decreased. CONCLUSIONS: Our results indicate that small-molecule-mediated inhibition of the CD40-TRAF6 interaction is a promising therapeutic strategy for the treatment of metabolic complications of obesity by improving glucose tolerance, by reducing the accumulation of immune cells to the adipose tissue and by skewing of the immune response towards a more anti-inflammatory profile.

The Linköping-Lund surgical experience with the HeartMate left ventricular assist system.

Four transplant candidates fulfilling the Food and Drug Administration criteria for a permanent left ventricular assist device received a pneumatic HeartMate system as a bridge to heart transplantation. All patients survived and were fully rehabilitated at the time of transplantation, which was carried out 2 to 6 months after the initial operation. There were no major complications associated with the procedures. We are impressed by the effectiveness and safety of the device.

[The quantitative composition of the intestinal lactoflora before and after space flights of different lengths]. / Die quantitative Zusammensetzung der Lactoflora des Verdauungstrakts vor und nach kosmischen Flügen unterschiedlicher Dauer.

Due to the emotional stress before the take off the lactoflora of 24 cosmonouts shows distinct changes regarding the spectrum of different species of Lactobacilli. Compared to long-time flights after short-time flights even stronger alterations are observed. The reason is that the disturbances which take place before the take-off as to the short space of time cannot be balanced by the macroorganism. Additionally, after a certain adaptive period the factors of the space travel begin to act. There are characteristic individual particularities regarding the number of Lactobacilli in the saliva and the feces of the cosmonouts.

[Ability of lactobacilli in the human microflora to produce lysozyme]. / O sposobnosti laktobatsill mikroflory cheloveka produtsirovat' lizotsim

Lysozyme activity of 403 strains of lactobacilli were investigated; of these 26 were from foreign sets and 377 were isolated from the contents of the stomach, feces and vaginal discharge of healthy adults. The species reference of lactobacillae was confirmed by the results of study of their physiologo-biochemical properties with the aid of 45 tests. A method of agar plates was adapted to determination of lysozyme: the autoclaved suspension of Micrococcus lysodeikticus (strain No. 2665) was added to the agar medium MPC-I, and lactobacilli were cultivated for 4 days in the CO2 atmosphere at 37 degrees C. There was revealed the capacity of L. fermenti and L. brevis to produce lysozyme; in L. fermenti the lysozyme activity was much more frequent (p less than 0.001); strains of the rest of the species of lactobacilli differentiated by the Rogosa and Sharpe's classification proved to be lysozyme-negative. It was shown that the lactobacilli of the L. fermenti species, included into the microflora of the intestine and the vagina of healthy adults as a rule possessed lysozyme activity. L. fermenti strain 90T-S4 used in the production of dry lactobacterin also produced lysozyme. All this favours an important role of L. fermenti in the protective function of the microflora.