Fluid therapy for the traumatized patient     

Bernd Driessen  DVM  Dr. med. vet.  DACVA  ECVPT    Benjamin Brainard  VMD 《Journal of Veterinary Emergency and Critical Care》2006,16(4):276-299

Objective: To review the rationale behind and experiences with traditional and newly evolving concepts of fluid therapy in the traumatized patient, and to review conventional and novel fluid preparations for use in trauma resuscitation. Data sources: Human and veterinary clinical and research studies. Human data synthesis: Current treatment guidelines recommend aggressive fluid resuscitation with lactated ringers solution (LRS) or saline as optimum management of hemorrhagic shock in trauma, regardless of whether bleeding is controlled or not. The rationale behind this strategy is to restore intravascular volume as rapidly as possible to ensure adequate vital organ perfusion. Recently, this strategy has been challenged, especially in patients with uncontrolled hemorrhage, as neither laboratory evidence nor clinical trials support this practice. Current research indicates that vigorous fluid infusion may exacerbate bleeding and cause severe hemodilution, both impairing resuscitation outcome. As a result, a new line of thinking is emerging that balances the risks and benefits of intravenous volume infusion by offering the clinician alternative treatment strategies and emphasizes continuous endpoint‐oriented monitoring. ‘Hypotensive’ or ‘hypovolemic’ resuscitation techniques as well as initial volume replacement with fluids other than LRS or saline (e.g., hypertonic saline [HTS], HTS with dextran 70 [HTS‐D]) have been introduced in human medical practice as additional options for treatment of victims of trauma under certain circumstances. Clinical studies evaluating the use of hemoglobin‐based oxygen carriers (HBOCs) in the trauma setting are underway and may soon lead to an expansion of the fluid arsenal available to the clinician for treatment of trauma patients. Veterinary data synthesis: Based on available animal data, neither strict guidelines nor a clear fluid preference for resuscitation of traumatic shock have been defined. Although systematic clinical trials are missing, combinations of crystalloid and colloid (natural or artificial) appear to be as effective for resuscitation as crystalloid alone. Judicious use of an HBOC (e.g., Oxyglobin^®) as a substitute for blood/red blood cells may be recommended in situations where whole blood or pRBCs are not or not yet available. Conclusions: The search for optimal methods of fluid resuscitation in trauma is ongoing. At this point the best solution is a differentiated approach to fluid therapy, one that tailors type and volume of resuscitation solution(s) used to the type and severity of injury in an individual patient and uses monitoring of perfusion and oxygenation parameters to guide resuscitation. Crystalloid fluids are effective for resuscitation but may need to be combined with or replaced by colloidal fluids in certain clinical situations.  相似文献   

Oxygen saturation measurements in canine blood containing hemoglobin glutamer-200 (Bovine): in vitro validation of the NOVA CO-Oximeter     

Jahr JS  Driessen B  Lurie F  Tang Z  Louie RF  Kost G 《Veterinary clinical pathology / American Society for Veterinary Clinical Pathology》2001,30(1):39-45

Abstract: This study was designed to validate in vitro oxygen saturation (SO₂) measurements with the NOVA CO-Oximeter (Nova Biomedical Corp, Waltham, Mass, USA) in canine blood containing hemoglobin (Hb) glutamer-200 bovine (Hb-200; Oxyglobin, Biopure, Cambridge, Mass, USA) as a Hb-based oxygen carrier recently introduced into clinical practice. In the first set of experiments, stored blood from 6 mixed-breed canine blood donors was used. Target PO₂ levels were reached in aliquots of blood samples by tonometry. Oxygen saturation was then measured with the test device and calculated based on known PO₂ values. In the second set of experiments, total oxygen content was directly measured by means of an oxygen-specific electrode in aliquots of fresh whole arterial, venous, and mixed (arterial-venous) blood withdrawn from the same canine blood donors. Hb-200 was added to those blood samples to yield plasma Hb concentrations of 1.62, 3.25, 6.50, and 9.75 g/dL. Based on Hb content and SO₂ measured by the NOVA CO-Oximeter in these samples, total oxygen content was also calculated for each sample and compared with measured values. A strong correlation was found between SO₂ values measured with the co-oximeter in samples after tonometry, and calculated SO₂ based on known PO₂. Directly measured total blood O₂ content varied by ≤ 5% from values computed based on co-oximeter measurements of Hb content and SO₂. These results did not change with different levels of oxygenation of the samples or different plasma Hb-200 concentrations. In conclusion, the NOVA CO-Oximeter is an accurate analyzer for measurement of SO₂ after Hb-200 administration to canine blood.  相似文献   

Efficacy of alveolar recruitment in anesthetized horses ventilated with Heliox or 30% oxygen/70% nitrogen     

Kelley Varner  Klaus Hopster  Bernd Driessen 《Veterinary anaesthesia and analgesia》2018,45(6):885.e15

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Detection of classical swine fever vaccine virus in blood and tissue samples of pigs vaccinated either with a conventional C-strain vaccine or a modified live marker vaccine     

Koenig P  Hoffmann B  Depner KR  Reimann I  Teifke JP  Beer M 《Veterinary microbiology》2007,120(3-4):343-351

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Pradofloxacin in the treatment of canine deep pyoderma: a multicentred, blinded, randomized parallel trial   总被引：2，自引：0，他引：2  

Mueller RS  Stephan B 《Veterinary dermatology》2007,18(3):144-151

A multicentre, randomized, blinded study compared the efficacy of pradofloxacin with that of a combination of amoxycillin/clavulanic acid in the treatment of deep pyoderma in dogs. Dogs with clinical lesions of deep pyoderma and a positive bacterial culture were included in the study. At each visit, they were evaluated with lesion, pruritus and general condition scores. Dogs were treated either with pradofloxacin at 3 mg kg-1 once daily or with amoxycillin at 10 mg kg-1 and clavulanic acid at 2.5 mg kg-1 twice daily and evaluated weekly for 3 weeks and every 2 weeks thereafter until 2 weeks past clinical remission. Maximal treatment duration was 9 weeks, and maximal evaluation period was 11 weeks. Of the 56 dogs treated with pradofloxacin (group 1), 48 dogs (86%) achieved clinical remission, four dogs improved, four dogs did not respond and a recurrence of clinical signs was not seen in any patient after 11 weeks. Of the 51 dogs treated with amoxycillin/clavulanic acid (group 2), 37 dogs achieved clinical remission (73%), three dogs showed improvement, five dogs showed no response and in six dogs, clinical signs recurred within 2 weeks of cessation of therapy. These results indicate that pradofloxacin is an efficacious therapy comparable to amoxycillin/clavulanic acid for deep bacterial pyoderma in dogs.  相似文献   

A quantitative RT-PCR platform for high-throughput expression profiling of 2500 rice transcription factors     

Camila Caldana  Wolf-Rüdiger Scheible  Bernd Mueller-Roeber  Slobodan Ruzicic 《Plant methods》2007,3(1):1-9

Background

The diploid, Solanum caripense, a wild relative of potato and tomato, possesses valuable resistance to potato late blight and we are interested in the genetic base of this resistance. Due to extremely low levels of genetic variation within the S. caripense genome it proved impossible to generate a dense genetic map and to assign individual Solanum chromosomes through the use of conventional chromosome-specific SSR, RFLP, AFLP, as well as gene- or locus-specific markers. The ease of detection of DNA polymorphisms depends on both frequency and form of sequence variation. The narrow genetic background of close relatives and inbreds complicates the detection of persisting, reduced polymorphism and is a challenge to the development of reliable molecular markers. Nonetheless, monomorphic DNA fragments representing not directly usable conventional markers can contain considerable variation at the level of single nucleotide polymorphisms (SNPs). This can be used for the design of allele-specific molecular markers. The reproducible detection of allele-specific markers based on SNPs has been a technical challenge.

Results

We present a fast and cost-effective protocol for the detection of allele-specific SNPs by applying Sequence Polymorphism-Derived (SPD) markers. These markers proved highly efficient for fingerprinting of individuals possessing a homogeneous genetic background. SPD markers are obtained from within non-informative, conventional molecular marker fragments that are screened for SNPs to design allele-specific PCR primers. The method makes use of primers containing a single, 3'-terminal Locked Nucleic Acid (LNA) base. We demonstrate the applicability of the technique by successful genetic mapping of allele-specific SNP markers derived from monomorphic Conserved Ortholog Set II (COSII) markers mapped to Solanum chromosomes, in S. caripense. By using SPD markers it was possible for the first time to map the S. caripense alleles of 16 chromosome-specific COSII markers and to assign eight of the twelve linkage groups to consensus Solanum chromosomes.

Conclusion

The method based on individual allelic variants allows for a level-of-magnitude higher resolution of genetic variation than conventional marker techniques. We show that the majority of monomorphic molecular marker fragments from organisms with reduced heterozygosity levels still contain SNPs that are sufficient to trace individual alleles.  相似文献   

From explanation to application: introducing a practice-oriented ecosystem services evaluation (PRESET) model adapted to the context of landscape planning and management   总被引：1，自引：0，他引：1  

Christina von Haaren  Christian Albert  Jan Barkmann  Rudolf S. de Groot  Joachim H. Spangenberg  Christoph Schröter-Schlaack  Bernd Hansjürgens 《Landscape Ecology》2014,29(8):1335-1346

The development and use of the conceptual framework of ecosystem services (ES) has been very successful in supporting the broad diffusion and application of ES within science and policy communities. However, most of the currently proposed interpretations of the framework neither correlate to environmental planning nor to decision-making contexts at the local and regional scale, which is a potential reason for the slow adoption and practice of the ES conceptual framework. This paper proposes a practice-oriented ES evaluation (PRESET) model specifically adapted to the requirements of local and regional planning and decision-making contexts, and discusses its potential benefits and implications for practice. Through the usage of PRESET we suggest making a distinction between ‘offered ES’, ‘utilized ES’, ‘human input’, and ‘ES benefits’ as relevant information for decision-making. Furthermore, we consider it important to link these decision-support categories to different value dimensions relevant in planning and management practice. PRESET provides guidance to inject the ES concept into planning, but needs to be implemented together with concrete assessment methods, indicators and data. The planning strategic benefits of using PRESET include its reference to existing legislative objectives, avoiding the risk that monetized ES values might dominate decision-making, clarification of human contributions, and easier identification of land use conflicts and synergies. Examples are given for offered and utilized ES, as well as for respective evaluation approaches and instruments of implementation.  相似文献   

Organic Tracers from Wild Fire Residues in Soils and Rain/River Wash-Out     

Oros  Daniel R.  Mazurek  Monica A.  Baham  John E.  Simoneit  Bernd R. T. 《Water, air, and soil pollution》2002,137(1-4):203-233

The molecular compositions and alteration products of the major organic components in soils and litter subjected to controlled or wildfire burning, and subsequent erosion by rain and river transport have been determined by GC-MS. The major compound groups imparted to soils include n-alkanoic acids, n-alkanes, n-alkanols, phytosterols, and terpenoids. Biomarker tracer analysis indicates that organic compounds remain as internal lipid components of char and heavy particles and are deposited onto soil during wildfire and prescribed burning. The process of rain erosion and river transport releases some of these internal components into the surroundings where they are further subjected to biological alteration. The distributions and abundances ofhomologous compound series coupled with biomarker tracer analysis provides a chemical fingerprint which is useful for identifying the single or multiple plant species contributing organic matter by both thermal (burning) and biological processes. Such fingerprints are useful for tracking soils which are transported in the atmosphere by wind as suspended particles in dust storms and on land by rain erosion to rivers.  相似文献   

Land Application of Wastewater in Brazil - A scientific challenge: Chemical Characterization of Soil at Populina, S?o Paulo State (9 pp)     

Vania Rosolen  Uwe Herpin  Stefan Fränzle  Gerhard Breulmann  Plínio B. de Camargo  Wanderley S. Paganini  Carlos C. Cerri  Adolpho J. Melfi  Bernd Markert 《Journal of Soils and Sediments》2005,5(2):112-120

Background, Aims and Scope   The rapid increase of wastewater worldwide and the consequently urgently needed treatment measures towards disposal purposes has led to an expansion of alternative treatment methods. Besides conventional and cost intensive systems, domestic wastewater treatment by overland flow process represents an effective and low-cost alternative. However, in addition to beneficial elements in wastewaters, there is a release of other elements of the Periodic Table into the environment, which can be considered as potentially toxic. This requires a reliable chemical characterization of the wastewater element composition as well as the soils onto which it will be applied. This paper aims at presenting the chemical fingerprint methodology to characterize concentrations of a large set of elements in a tropical ferralsol in order to provide information concerning chemical modifications after long-term application of wastewater by overland flow process. The results are also used to estimate environmental implications according to guiding values for soils in São Paulo State.Methods   The wastewater treatment in Populina has been operating for 18 years. Composite soil samples were taken in a treated plot and a control plot. Wastewater was chemically characterized by using AAS. Total C and total N of soil samples were determined by Delta Plus Mass Spectrometer. The remaining elements (32) were analyzed using ICP-OES. Grain size analysis was carried out after oxidation by H2O2, and soil dispersion with NaOH and Na4P2O7 treatments. pH was measured in water. Quality control of all measurements was verified by corresponding reference materials. Fingerprint graphs were generated by standardizing the values of the control plot and by graphically displaying positive/negative percentage deviations of the element values at the treated plot from values of the control site. Results and Discussion   Chemical analyses of the wastewater used showed high BOD, COD, TOC and N values, while the majority of metals were below the detection limit that is attributed to the limitations in the instrumental techniques (AAS) utilized. The comparison of the two selected sites revealed substantial changes of the element contents associated with long-term application of domestic wastewater. Fingerprint graphs of the treated field indicated higher values for the vast majority of macro and micro-nutrients (C, N, P, K, Ca, Mg, Mo, Zn, Cu), as well as for other elements, e.g. Ba, Sr, Na, Li, or La. Enrichments of ecotoxic elements (e.g. As or Pb) occurred in the surface horizon despite the low contents of those elements in the wastewater. Other elements analyzed, i.e. Ag, Be, Bi, Cd, Sb, Sn, W or Sc, that are partially considered to be toxic, did not show considerable differences. Due to limitations in the analytical techniques applied, these results do not imply that there is no existence or no release of elements from wastewater at trace or ultra-trace levels. It is expected that more sophisticated techniques will be available in the future. Typical soil elements (Ti, Al, Fe, V, Zr) show higher values at the control site suggesting higher contents of mineralogical components. The highly positive deviation of C-contents linked with higher values of many other elements in the treated soil suggest element enrichments associated with organic matter. Concerning environmental implications, the comparison with guiding values for an enhanced monitoring showed partly an excess of acceptable metal concentration levels. Proposed intervention values were not exceeded, except for with Ba. Comparisons with phytotoxic element concentrations in soils indicate critical values for As, Cu and Cr. Conclusion   Using multi-element analysis, the study represents a first approach to access wastewater application by overland flow on the basis of a rather large range of chemical elements in Brazil. The comparison of the two selected areas revealed distinctly higher values for the majority of elements in the treated plot. The study also highlighted the importance of organic matter for element retention. The environmental implications of domestic wastewater application to soil surfaces can be grave. Since also toxic elements are enriched in these treated soils, the areas can partly be classified as polluted, and require long-term monitoring and detailed investigations.Recommendation and Outlook   The analytical data obtained may only allow for some conclusions concerning long-term feasibility and geochemical preconditions of wastewater irrigation. Therefore, not only the total concentrations of metals are of interest, but also element speciation must be analyzed in order to predict, for instance, how long the ion uptake capacity of the soil will last. Aside from the analytical procedures used in speciation, theoretical chemical (thermodynamic) concepts such as the principles of Pourbaix diagrams should also be used to predict solubility, immobilization and bioavailability of different element species.  相似文献   

Subject Area ´Soils´: The (Associate) Subject Editors and Advisors: Challenges and relevant literature in JSS and ESPR (the presentation of the Editors is not complete yet and will be continued)     

Gilbert Sigua  Pavol Bielek  Stefan Trapp  Stefan Norra  Jadwiga Gzyl  Galina Machulla  Jaakko Paasivirta  Bernd Markert  Willie JGM Peijnenburg  Kerstin Hund-Rinke 《Journal of Soils and Sediments》2006,6(4):192-199

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