Prehospital Massive Transfusion for Resuscitation of an Entrapped Patient in a Rural Setting: A Case Report.

Resuscitation of injured patients suffering from hemorrhagic shock with blood products in the prehospital environment is becoming more commonplace. However, blood product utilization is typically restricted and can be exhausted in the event of a prolonged entrapment. Delivery of large amounts of blood products to a scene is rare, particularly in rural settings. We present the case of a 26-year-old male who was entrapped in a motor vehicle for 144 min. First responders assessed the entrapped patient to be in hemorrhagic shock from lower extremities injuries. The Helicopter Emergency Medical Services team exhausted their supply of blood products shortly after arrival on scene. The local trauma center's Surgical Emergency Response Team (SERT) was requested to the scene. The preplanned response included seven units of blood components to provide massive transfusion at the point of injury and released directly to field responders by the blood bank. During extrication, the patient was given two units of packed red blood cells by initial responders with three more units of blood components from the SERT supply. During transfer to the hospital, the patient received an additional three units, and four units were transfused on initial trauma resuscitation in the hospital. He was found to have severe lower extremities injuries as the cause of his hemorrhage. The patient survived to hospital discharge. Delivery of large volumes of blood products to an entrapped patient with prolonged extrication time may be a lifesaving intervention. We advocate for integration of blood bank services and on scene physician guided resuscitation for prolonged extrications.

Heptamolybdate: a highly active sulfide oxygenation catalyst.

The sulfide oxygenation activities of both heptamolybdate ([Mo7O24]6-, [1]6-) and its peroxo adduct [Mo7O22(O2)2]6- ([2]6-) were examined in this contribution. [Mo7O22(O2)2]6- was prepared in a yield of 65% from (NH4)6[Mo7O24] (1a) upon treatment of 10 equiv. of H2O2 and structurally identified through single crystal X-ray diffraction study. (nBu4N)6[Mo7O22(O2)2] (2b) is an efficient catalyst for the sequential oxygenation of methyl phenyl sulfide (MPS) by H2O2 to the corresponding sulfoxide and subsequently sulfone with a 100% utility of H2O2. Surprisingly, (nBu4N)6[Mo7O24] (1b) is a significantly faster catalyst than 2b for MPS oxygenation under identical conditions. The pseudo-first order kcat constants from initial rate kinetics are 54 M-1 s-1 and 19 M-1 s-1 for 1b and 2b, respectively. Electrospray ionization mass spectrometry (ESI-MS) investigation of 1b under the catalytic reaction conditions revealed that [Mo2O11]2- is likely the main active species in sulfide oxygenation by H2O2.

The effects of age and muscle contraction on AMPK activity and heterotrimer composition.

Sarcopenia is characterized by increased skeletal muscle atrophy due in part to alterations in muscle metabolism. AMP-activated protein kinase (AMPK) is a master regulator of skeletal muscle metabolic pathways which regulate many cellular processes that are disrupted in old-age. Functional AMPK is a heterotrimer composed of α, ß and γ subunits, and each subunit can be represented in the heterotrimer by one of two (α1/α2, ß1/ß2) or three (γ1/γ2/γ3) isoforms. Altered isoform composition affects AMPK localization and function. Previous work has shown that overall AMPK activation with endurance-type exercise is blunted in old vs. young skeletal muscle. However, details regarding the activation of the specific isoforms of AMPK, as well as the heterotrimeric composition of AMPK in old skeletal muscle, are unknown. Our purpose here, therefore, was to determine the effect of old-age on 1) the activation of the α1 and α2 catalytic subunits of AMPK in skeletal muscle by a continuous contraction bout, and 2) the heterotrimeric composition of skeletal muscle AMPK. We studied gastrocnemius (GAST) and tibialis anterior (TA) muscles from young adult (YA; 8months old) and old (O; 30months old) male Fischer344×Brown Norway F1 hybrid rats after an in situ bout of endurance-type contractions produced via electrical stimulation of the sciatic nerve (STIM). AMPKα phosphorylation and AMPKα1 and α2 activities were unaffected by age at rest. However, AMPKα phosphorylation and AMPKα2 protein content and activity were lower in O vs. YA after STIM. Conversely, AMPKα1 content was greater in O vs. YA muscle, and α1 activity increased with STIM in O but not YA muscles. AMPKγ3 overall concentration and its association with AMPKα1 and α2 were lower in O vs. YA GAST. We conclude that activation of AMPKα1 is enhanced, while activation of α2 is suppressed immediately after repeated skeletal muscle contractions in O vs. YA skeletal muscle. These changes are associated with changes in the AMPK heterotrimer composition. Given the known roles of AMPK α1, α2 and γ3, this may contribute to sarcopenia and associated muscle metabolic dysfunction.

Recover, Recycle, and Reuse: Prove-Out of Pyrotechnic Illuminants Containing Demilitarized Magnesium.

The development and prove-out of yellow-light-emitting pyrotechnic illuminants based on recover, recycle, and reuse (R3 ) technology is described. Magnesium used in this investigation was recovered from four different illuminating pyrotechnic munitions by means of an environmentally friendly demilitarization process. Despite significant differences in the particle size and purity between the four lots of recovered magnesium, the performance of each lot-on evaluation in the M127A1 US Army yellow-light-emitting illuminant configuration-exceeded the military requirement and performance of the virgin magnesium-containing control. All formulations were found to have low sensitivities to various ignition stimuli and possessed high thermal onset temperatures. In addition to the military significance, this demonstrated "green" pyrotechnics technology of using recycled magnesium in illuminating pyrotechnics may also be of interest to the civilian fireworks community.