Impact of Transfused Citrate on Pathophysiology in Massive Transfusion.

This narrative review article seeks to highlight the effects of citrate on physiology during massive transfusion of the bleeding patient. DATA SOURCES: A limited library of curated articles was created using search terms including "citrate intoxication," "citrate massive transfusion," "citrate pharmacokinetics," "hypocalcemia of trauma," "citrate phosphate dextrose," and "hypocalcemia in massive transfusion." Review articles, as well as prospective and retrospective studies were selected based on their relevance for inclusion in this review. STUDY SELECTION: Given the limited number of relevant studies, studies were reviewed and included if they were written in English. This is not a systematic review nor a meta-analysis. DATA EXTRACTION AND SYNTHESIS: As this is not a meta-analysis, new statistical analyses were not performed. Relevant data were summarized in the body of the text. CONCLUSIONS: The physiologic effects of citrate independent of hypocalcemia are poorly understood. While a healthy individual can rapidly clear the citrate in a unit of blood (either through the citric acid cycle or direct excretion in urine), the physiology of hemorrhagic shock can lead to decreased clearance and prolonged circulation of citrate. The so-called "Diamond of Death" of bleeding-coagulopathy, acidemia, hypothermia, and hypocalcemia-has a dynamic interaction with citrate that can lead to a death spiral. Hypothermia and acidemia both decrease citrate clearance while circulating citrate decreases thrombin generation and platelet function, leading to ionized hypocalcemia, coagulopathy, and need for further transfusion resulting in a new citrate load. Whole blood transfusion typically requires lower volumes of transfused product than component therapy alone, resulting in a lower citrate burden. Efforts should be made to limit the amount of citrate infused into a patient in hemorrhagic shock while simultaneously addressing the induced hypocalcemia.

Impact of Coronavirus Outbreak on NO2 Pollution Assessed Using TROPOMI and OMI Observations.

Spaceborne NO2 column observations from two high-resolution instruments, Tropospheric Monitoring Instrument (TROPOMI) on board Sentinel-5 Precursor and Ozone Monitoring Instrument (OMI) on Aura, reveal unprecedented NO2 decreases over China, South Korea, western Europe, and the United States as a result of public health measures enforced to contain the coronavirus disease outbreak (Covid-19) in January-April 2020. The average NO2 column drop over all Chinese cities amounts to -40% relative to the same period in 2019 and reaches up to a factor of ~2 at heavily hit cities, for example, Wuhan, Jinan, while the decreases in western Europe and the United States are also significant (-20% to -38%). In contrast with this, although Iran is also strongly affected by the disease, the observations do not show evidence of lower emissions, reflecting more limited health measures.

Corresponding affections: emotional exchange among siblings in the Nassau family.

This article examines the nature of emotional exchange among the siblings who were the children of William the Silent, leader of the nascent Dutch Republic. Using evidence from extensive familial correspondence, it asks how the language of emotions could constitute forms of power within the family, by analyzing how actions and expressions of emotion were presented, discussed, and interpreted in epistolary form, to whom, and with what intention and impact. The article studies social, geographic, linguistic, and other distinctions between siblings in their use of affective discourses in correspondence and argues that attention to affective language can help to elucidate the agentive force of emotions in both reflecting and informing notions of power within the family.

Optimization of a chemooptical surface plasmon resonance based sensor.

A surface plasmon based chemooptical sensor has been optimized by the use of computer simulation programs. Calculated and experimentally measured performances are in good agreement, showing the value of the simulation tool.