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Introduction: Rotational thromboelastometry (ROTEM) records whole blood coagulation in vitro. Data on dynamic changes of clot patterns during intravenous thrombolysis (IVT) in acute ischemic stroke is scarce. We investigated the feasibility of ROTEM as a potential point-of-care assessment tool for IVT., Methods: In this prospective pilot study, patients with acute stroke symptoms received IVT. Whole blood coagulation was tracked on the ROTEM analyzer. Blood samples were analyzed before, and then 2, 15, 30 and 60 min after beginning IVT. In vitro clots (iCLs) were described by their maximum clot firmness (MCF), the time needed to reach MCF (MCF-t), as well as the area under the curve (AR10). National Institutes of Health Stroke Scale (NIHSS) was used as early clinical outcome parameter., Results: We analyzed 288 iCLs from 12 patients undergoing IVT. In all iCLs, an early fibrinolysis (91% within the first 10 min) was detected during IVT. Three different curve progression patterns were observed: a low-responder pattern with a continuous clot increase, a high-responder pattern with a sustained clot decrease or total clotting suppression and an intermediate-responder pattern with alternating clot characteristics. There was a difference among these groups in early clinical outcome (AR10 and MCF each p = 0.01, MCF-t p = 0.02, Kruskal-Wallis Test)., Conclusion: The fibrinolysis patterns determined using ROTEM allow for the monitoring of IVT in patients with acute ischemic stroke. This pilot study found a correlation between the in vitro fibrinolysis patterns and early clinical outcomes. These findings support a potential for individualization of IVT in the future., (© 2022. The Author(s).)

It is difficult to disentangle the many variables (e.g. internal or external cues and random events) that shape the microbiota in the gastrointestinal tract of any living species. Ecological assembly processes applied to microbial communities can elucidate these drivers. In our study, farmed Atlantic cod (Gadus morhua) were fed a diet of 10% macroalgae supplement (Ulva rigida [ULVA] or Ascophyllum nodosum [ASCO] or a non-supplemented control diet [CTRL]) over 12 weeks. We determined the influence of ecological assembly processes using a suite of null-modelling tools. We observed dissimilarity in the abundance of common OTUs over time, which was driven by deterministic assembly. The CTRL samples showed selection as a critical assembly process. While dispersal limitation was a driver of the gut microbiome for fish fed the macroalgae supplemented diet at Week 12 (i.e., ASCO and ULVA). Fish from the ASCO grouping diverged into ASCO_N (normal) and ASCO_LG (lower growth), where ASCO_LG individuals found the diet unpalatable. The recruitment of new taxa overtime was altered in the ASCO_LG fish, with the gut microbiome showing phylogenetic underdispersion (nepotistic species recruitment). Finally, the gut microbiome (CTRL and ULVA) showed increasing robustness to taxonomic disturbance over time and lower functional redundancy. This study advances our understanding of the ecological assembly and succession in the hindgut of juvenile Atlantic cod across dietary treatments. Understanding the processes driving ecological assembly in the gut microbiome, in fish research specifically, could allow us to manipulate the microbiome for improved health or resilience to disease for improved aquaculture welfare and production., (© 2022. The Author(s).)

Objectives: The increasing need for anesthetists has been coupled with a rising number of open training positions. Thus, there is an increased need to attract future anesthetists among students and graduates from medical universities. Using results from a questionnaire, we designed an information and training program to increase interest in anesthesia and intensive care., Materials and Methods: With the use of semistructured interviews, medical students were questioned about factors influencing their decision for a speciality. We used the results to design an information and practice program for students and young doctors. This program was held 12 times at different anesthesia departments in different hospitals. Evaluation was obtained through a feedback questionnaire at the end of each sessions and with another questionnaire 2 to 4 years after the program., Results: Feedback showed positive responses concerning utility for practical work, actuality, and relevance for daily practical work. There was a 22.7% response from participants for the follow-up questionnaire. Of these, 87% stated that interest in anesthesia was increased by the program, and 74% underwent practical training in an anesthesia department. Seventeen participants started a speciality training for anesthesia and intensive care medicine., Conclusions: The design of this practice-oriented program was effective in eliciting, spreading, and increasing interest and attracting students to a medical specialty.

Background: Aquaculture successfully meets global food demands for many fish species. However, aquaculture production of Atlantic cod (Gadus morhua) is just 2.5% of total market production. For cod farming to be a viable economic venture specific challenges on how to increase growth, health and farming productivity need to be addressed. Feed ingredients play a key role here. Macroalgae (seaweeds) have been suggested as a functional feed supplement with both health and economic benefits for terrestrial farmed animals and fish. The impact of such dietary supplements to cod gut integrity and microbiota, which contribute to overall fish robustness is unknown. The objective of this study was to supplement the diet of juvenile Atlantic cod with macroalgae and determine the impacts on fish condition and growth, gut morphology and hindgut microbiota composition (16S rRNA amplicon sequencing). Fish were fed one of three diets: control (no macroalgal inclusion), 10% inclusion of either egg wrack (Ascophyllum nodosum) or sea lettuce (Ulva rigida) macroalgae in a 12-week trial., Results: The results demonstrated there was no significant difference in fish condition, gut morphology or hindgut microbiota between the U. rigida supplemented fish group and the control group at any time-point. This trend was not observed with the A. nodosum treatment. Fish within this group were further categorised as either 'Normal' or 'Lower Growth'. 'Lower Growth' individuals found the diet unpalatable resulting in reduced weight and condition factor combined with an altered gut morphology and microbiome relative to the other treatments. Excluding this group, our results show that the hindgut microbiota was largely driven by temporal pressures with the microbial communities becoming more similar over time irrespective of dietary treatment. The core microbiome at the final time-point consisted of the orders Vibrionales (Vibrio and Photobacterium), Bacteroidales (Bacteroidetes and Macellibacteroides) and Clostridiales (Lachnoclostridium)., Conclusions: Our study indicates that U. rigida macroalgae can be supplemented at 10% inclusion levels in the diet of juvenile farmed Atlantic cod without any impact on fish condition or hindgut microbial community structure. We also conclude that 10% dietary inclusion of A. nodosum is not a suitable feed supplement in a farmed cod diet.

In the context of future aquaculture intensification, a longitudinal ten-year evaluation of the current traditional rainbow trout production in Ireland was performed. Publically available and independent data obtained from local authorities were gathered and analysed. Inlet and outlet concentrations of parameters such as BOD 5 , ammonium, nitrite, dissolved oxygen and pH for four consecutive flow-through fish farms covering the four seasons over a ten-year period (2005-2015) were analysed. The objectives of the study were (i) to characterize the impact of each fish farm on water quality in function of their respective production and identify any seasonal variability, (ii) to quantify the cumulative impact of the four farms on the river quality and to check if the self-purification capacity of the river was enough to allow the river to reach back its background levels for the analysed parameters, (iii) to build a baseline study for Ireland in order to extrapolate as a dataset for expected climate change and production intensification. For most of the parameter analysed, no significant impact of the fish farming activity on water quality/river quality was observed. These results, the first ones generated in Ireland so far, will have to be completed by a survey on biodiversity and ecotoxicology and compared after production intensification and the likely future introduction of water treatment systems on the different sites., Competing Interests: The authors declare there are no competing interests.

This study examines the potential of next-generation sequencing based 'genotyping-by-sequencing' (GBS) of microsatellite loci for rapid and cost-effective genotyping in large-scale population genetic studies. The recovery of individual genotypes from large sequence pools was achieved by PCR-incorporated combinatorial barcoding using universal primers. Three experimental conditions were employed to explore the possibility of using this approach with existing and novel multiplex marker panels and weighted amplicon mixture. The GBS approach was validated against microsatellite data generated by capillary electrophoresis. GBS allows access to the underlying nucleotide sequences that can reveal homoplasy, even in large datasets and facilitates cross laboratory transfer. GBS of microsatellites, using individual combinatorial barcoding, is potentially faster and cheaper than current microsatellite approaches and offers better and more data.

Background: The use of Palmaria palmata (PP) as a natural ingredient in farmed Atlantic salmon diets was investigated. The effect of salmon diet supplementation with P. palmata (0, 5, 10 and 15%) or synthetic astaxanthin (positive control, PC) for 16 weeks pre-slaughter on quality indices of fresh salmon fillets was examined. The susceptibility of salmon fillets/homogenates to oxidative stress conditions was also measured., Results: In salmon fillets stored in modified atmosphere packs (60% N2 /40% CO2 ) for up to 15 days at 4 °C, P. palmata increased surface -a* (greenness) and b* (yellowness) values in a dose-dependent manner, resulting in a final yellow/orange flesh colour. In general, the dietary addition of P. palmata had no effect on pH, lipid oxidation (fresh, cooked and fillet homogenates) and microbiological status. 'Eating quality' sensory descriptors (texture, odour and oxidation flavour) in cooked salmon fillets were not influenced by dietary P. palmata. Salmon fed 5% PP showed increased overall acceptability compared with those fed PC and 0% PP., Conclusion: Dietary P. palmata was ineffective at providing red coloration in salmon fillets, but pigment deposition enhanced fillets with a yellow/orange colour. Carotenoids from P. palmata may prove to be a natural pigment alternative to canthaxanthin in salmon feeds., (© 2014 Society of Chemical Industry.)

The next generation sequencing revolution has enabled rapid discovery of genetic markers, however, development of fully functioning new markers still requires a long and costly process of marker validation. This study reports a rapid and economical approach for the validation and deployment of polymorphic microsatellite markers obtained from a 454 pyrosequencing library of Atlantic cod, Gadus morhua, Linnaeus 1758. Primers were designed from raw reads to amplify specific amplicon size ranges, allowing effective PCR multiplexing. Multiplexing was combined with a three-primer PCR approach using four universal tails to label amplicons with separate fluorochromes. A total of 192 primer pairs were tested, resulting in 73 polymorphic markers. Of these, 55 loci were combined in six multiplex panels each containing between six and eleven markers. Variability of the loci was assessed on G. morhua from the Celtic Sea (n = 46) and the Scotian Shelf (n = 46), two locations that have shown genetic differentiation in previous studies. Multilocus F(ST) between the two samples was estimated at 0.067 (P = 0.001). After three loci potentially under selection were excluded, the global F(ST) was estimated at 0.043 (P = 0.001). Our technique combines three-primer and multiplex PCR techniques, allowing simultaneous screening and validation of relatively large numbers of microsatellite loci., (© 2014 The Authors.)

By combining next-generation sequencing technology (454) and reduced representation library (RRL) construction, the rapid and economical isolation of over 25 000 potential single-nucleotide polymorphisms (SNP) and >6000 putative microsatellite loci from c. 2% of the genome of the non-model teleost, Atlantic cod Gadus morhua from the Celtic Sea, south of Ireland, was demonstrated. A small-scale validation of markers indicated that 80% (11 of 14) of SNP loci and 40% (6 of 15) of the microsatellite loci could be amplified and showed variability. The results clearly show that small-scale next-generation sequencing of RRL genomes is an economical and rapid approach for simultaneous SNP and microsatellite discovery that is applicable to any species. The low cost and relatively small investment in time allows for positive exploitation of ascertainment bias to design markers applicable to specific populations and study questions., (© 2013 The Authors. Journal of Fish Biology © 2013 The Fisheries Society of the British Isles.)

Eight primary embryonic developmental stages were assigned to eggs of ballan wrasse Labrus bergylta using key morphological features following standardized nomenclature: Ia, Ib, II, III, IV, V, VI and VI+, reared from single family clutches under comparable environmental conditions in Ireland and Norway. Development in L. bergylta is typical of demersal marine finfish species with a short egg stage. Hatching occurred c. 123 h post-fertilization (hpf) equivalent to 62·5 degree days at 12·2 ± 1·10° C (mean ±S.D.), after which the larvae swam intermittently near the surface of the water column., (© 2012 The Authors. Journal of Fish Biology © 2012 The Fisheries Society of the British Isles.)

Atrial fibrillation (AF) following cardiac surgery is an important factor contributing to postoperative morbidity. Transvenous, intracardial cardioversion (TIC) has been shown to be effective in the treatment of chronic AF, but is an invasive and cost-intensive procedure. However, TIC would definitely be a beneficial approach if recurrence of AF following TIC is low and pharmacological treatment could be avoided. Thus, we hypothesised that TIC would be superior to conventional treatment with amiodarone with respect to the conversion rate and recurrence of AF. We compared TIC and conventional amiodarone therapy in a prospective, randomised and controlled trial in patients who developed AF following cardiac surgery. Twenty-three patients developed AF out of a total of 76 patients who gave written informed consent. Eighteen of these AF patients could be randomised into two equally sized groups to receive either an ALERT pulmonary artery catheter and TIC, or a standard pulmonary artery catheter and treatment with amiodarone. Haemodynamic parameters were registered before intervention to exclude pulmonary hypertension or fluid overload. Rates of cardioversion were compared by a Likelyhood ratio test. Out of the nine ALERT patients, AF in five cases converted to sinus rhythm (SR) with a median of two shocks (6 J). After 24 hours however, only two patients remained in sinus rhythm. On the other hand, six of the nine patients treated with amiodarone were still in SR after 24 hours. Whereas no difference was detectable in the conversion rate, persistence of SR following TIC was low. Thus, TIC without antiarrhythmic treatment is not recommendable for the treatment of postoperative AF.

Ethical controversies in transplantation medicine are frequent and are not only discussed in the medical societies, but also by the pubic at large. Recently, the shortage of donor organs has led to a discussion of the commonly accepted ethical principles applied in transplantation medicine. In this paper, we highlight some of the thoughts expressed in the literature and discuss them in the context of transplantation.

Introduction: We observed an oscillatory flow while ventilating critically ill patients with the Dräger Oxylog 3000 transport ventilator during interhospital transfer. The phenomenon occurred in paediatric patients or in adult patients with severe airway obstruction ventilated in the pressure-regulated or pressure-controlled mode. As this had not been described previously, we conducted a bench study to investigate the phenomenon., Methods: An Oxylog 3000 intensive care unit ventilator and a Dräger Medical Evita-4 NeoFlow intensive care unit ventilator were connected to a Dräger Medical LS800 lung simulator. Data were registered by a Datex-S5 Monitor with a D-fend flow and pressure sensor, and were analysed with a laptop using S5-Collect software. Clinical conditions were simulated using various ventilatory modes, using various ventilator settings, using different filters and endotracheal tubes, and by changing the resistance and compliance. Data were recorded for 258 combinations of patient factors and respirator settings to detect thresholds for the occurrence of the phenomenon and methods to overcome it., Results: Under conditions with high resistance in pressure-regulated ventilation with the Oxylog 3000, an oscillatory flow during inspiration produced rapid changes of the airway pressure. The phenomenon resulted in a jerky inspiration with high peak airway pressures, higher than those set on the ventilator. Reducing the inspiratory flow velocity was effective to terminate the phenomenon, but resulted in reduced tidal volumes., Conclusion: Oscillatory flow with potentially harmful effects may occur during ventilation with the Dräger Oxylog 3000, especially in conditions with high resistance such as small airways in children (endotracheal tube internal diameter <6 mm) or severe obstructive lung diseases or airway diseases in adult patients.

Brain natriuretic peptide is a neurohormone used for estimation of left ventricular wall tension and volume overload. We describe the use of this parameter in a postoperative cardiac surgery patient for detection and monitoring of left ventricular failure in a postoperative intensive care unit at a tertiary care center. Left ventricular failure was detected by brain natriuretic peptide levels, while x-ray and values obtained by the pulmonary artery catheter were inconclusive.

Context: Regarding the increasing gap between demand and supply of donor organs the question is increasingly discussed, if families of organ donors should receive a financial incentive for consenting to organ donation. However, little attention has been paid to the psychological consequences of such incentives., Objective: We discuss the question of financial incentives for families of presumed organ donors in the light of relevant psychological theories., Data Sources and Study Selection: Overview of the psychological literature. Only well established theories were included., Conclusions: We summarise, that financial benefits for consent to organ donoation could affect adversely the public opinion toward organ donation and the whole process of transplantation and thus could counterproductively influence the consent rates.

Objective: To evaluate the interaction of recruitment maneuvers and prone positioning on gas exchange and venous admixture in patients with early extrapulmonary acute respiratory distress syndrome ventilated with high levels of positive end-expiratory pressure. We hypothesized that a sustained inflation performed after 6 hrs of prone positioning would induce sustained improvement in oxygenation (Pao2/Fio2) and venous admixture., Design: Prospective, interventional study., Setting: Tertiary care, postoperative intensive care unit., Patients: Fifteen patients with early extrapulmonary acute respiratory distress syndrome., Interventions: After 6 hrs of prone positioning, a sustained inflation was performed with 50 cm H2O maintained for 30 secs. Data were recorded in supine position, after 6 hrs of prone positioning, at 3, 30, and 180 mins following the sustained inflation., Measurements and Main Results: A response to prone positioning was observed in nine of 15 patients leading to an improvement of Pao2/Fio2 (147 +/- 37 torr vs. 225 +/- 77 torr, p = .005) and venous admixture (35.4 +/- 8.3% vs. 28.9 +/- 9.8%, p = .001). Six patients did not respond to prone positioning. Following the sustained inflation, the responders to prone positioning showed a further increase of Pao2/Fio2 and decrease of venous admixture at 3 mins (Pao2/Fio2, 225 +/- 77 torr vs. 368 +/- 90 torr, p = .018; venous admixture, 28.9 +/- 9.8% vs. 18.9 +/- 6.7%, p = .05). In all six nonresponders to prone positioning, an improvement of Pao2/Fio2 and venous admixture occurred at 3 mins following the sustained inflation (128 +/- 18 torr vs. 277 +/- 59 torr, p = .03; venous admixture, 34.2 +/- 6.0% vs. 23.8 +/- 6.3%, p = .05). The beneficial effects of the sustained inflation remained significantly elevated over 3 hrs in responders and nonresponders to prone positioning., Conclusion: In patients with early extrapulmonary acute respiratory distress syndrome, a sustained inflation performed after 6 hrs of prone positioning induced further and sustained improvement of oxygenation and venous admixture in both responders and nonresponders to prone positioning.

First kidney transplantations were performed in Aden, Jemen in 2003. A difficult medical environment and unrehearsed decision-making process in a country of scant resources were the background of this undertaking. A brief report is given on the medical situation, training and preparedness of the Yemeni medical community for transplant procedures. Initial impressions of psychological aspects of first-ever organ transplantation in this Islamic country are presented.

In patients with acute respiratory distress syndrome (ARDS), recruitment maneuvers have been proposed as an adjunct to mechanical ventilation to open up atelectasis and to keep these alveoli open by the application of adequate high levels of positive end-expiratory pressure (PEEP). Though several studies reported that the responsiveness to recruitment maneuvers resulted in a marked improvement of oxygenation with a concomitant decrease in airway pressure and/or inspiratory fraction of oxygen, the performance of recruitment maneuvers still remains a matter of dispute, especially in patients ventilated with a lung protective ventilation strategy. In this review we discuss the pathophysiological background, factors affecting the responsiveness to recruitment maneuvers and their clinical impact in the light of recently published studies. Successful recruitment depends on several factors like the applied recruitment pressure, the level of PEEP set before and after the recruitment maneuver, the stage and the underlying disease of the ARDS, chest wall mechanics and the transpulmonary pressure as well as the positioning of the patient. Regarding the current literature, recruitment maneuvers may be considered as a rescue therapy in the early stage of severe hypoxemic lung failure, if a lung protective ventilation strategy and other additive adjuncts like prone positioning or the application of inhaled vasodilators failed to induce adequate gas exchange.

During the first Yemeni Congress of Uro-Nephrology in Aden, an international team performed the first kidney tranplantations in the region. We report the difficulties encountered and discuss the pros and cons for transplantations in developing countries.

As atelectasis occurs in most patients during general anaesthesia and may be one of the major causes for the development of hypoxaemia and nosocomial pneumonia, its prevention may be considered as an important objective in perioperative management. The major causative mechanisms are the loss of respiratory muscle tone, compression and gas absorption. Vital capacity manoeuvres have been proposed as a means to eliminate atelectasis in the vast majority of patients and restore normal pulmonary gas exchange during general anaesthesia. In this review we describe the pathogenesis of atelectasis in the perioperative period and discuss in the light of recent published investigations the suitability of the vital capacity manoeuvre as a tool during general anaesthesia. Reviewing the current literature, a vital capacity manoeuvre during general anaesthesia may only be useful under specific circumstances when mechanical ventilation with a high inspiratory fraction of oxygen is required or during cardiac surgery at the end of cardiopulmonary bypass to reduce the amount of atelectasis and to maintain adequate gas exchange.

Members of transplant teams are oft confronted with highly emotional situations. Inability to handle these situations leads to burn-out and impairs the performance of the team. We introduce and discuss first experiences with a training program--COPe--specifically concentrating on establishing and maintaining communication in such situations.

Background and Objective: Endogenous catecholamines are released in brain-dead organ donors following painful stimulation during retrieval surgery, and might be harmful to harvested organs. Our hypothesis was that inhibition of pain by fentanyl would inhibit such catecholamine release., Methods: We tested 17 brain-dead organ donors in a randomized, placebo-controlled, double-blinded study. Blood samples for determination of epinephrine and norepinephrine concentrations were obtained before and 10 min after in take of either fentanyl 7 microg kg(-1) or an equivalent volume of placebo. Further points of measurement were taken after skin incision and sternotomy. Mean arterial pressure and heart rate at these points were recorded., Results: Catecholamine concentrations rose following painful stimuli. No differences in haemodynamics, between the fentanyl and the placebo group were detectable. Epinephrine concentrations, but not those of norepinephrine, were higher in the fentanyl group, reaching significance following sternotomy., Conclusion: We conclude that the use of fentanyl (7 microg kg(-1)) was not effective in suppressing the catecholamine release, following painful surgical stimulation in brain-dead organ donors.

Unlabelled: We report the occurrence of an intraoperative left atrial hematoma during coronary artery bypass grafting surgery. Echocardiography proved to be of great help in diagnosis and monitoring of this patient. After severe hemodynamic impairment the patient recovered and could be transferred on postoperative day eight. Follow-up examination showed no signs of atrial pathologies. Differential diagnosis and echocardiographic findings are discussed., Implications: The authors report the utility of transesophageal echocardiography for diagnosis and management of an intramural left atrial hematoma during coronary artery surgery.