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PubMed2006

Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol.

BACKGROUND: Massive transfusion, the administration of 10 to more than 100 units of red blood cells (RBC) in less than 24 hours, can be a life saving therapy in the treatment of severe injury. The rapid administration of large numbers of RBC, along with sufficient plasma and platelets to treat or prevent coagulopathy, is frequently a disorderly process. Patient care and collaborative research might be aided with a common protocol. METHODS: The authors polled trauma organizations and trauma centers to find examples of massive transfusion protocols. The goals and ease of use of these protocols were evaluated. RESULTS: Massive transfusion protocols exist at a relatively small number of large and well-organized trauma centers. Most of these protocols are designed to treat pre-existing and/or ongoing coagulopathy. CONCLUSIONS: The evidence would suggest that prevention of coagulopathy is superior to its treatment. Simple ratios such as 1:1:1 RBC:plasma:platelets have the benefit of ease of use and the relatively higher plasma and platelet doses appear to be associated with improved outcome. Such a standard protocol can foster multicenter research on resuscitation and hemorrhage control. The fixed volume ratios might allow the number and rate of administered units of RBC to be used as surrogates for blood loss and primary treatment effect.

Australia↗

PubMed2006

A protocol to diagnose intimate partner violence in the emergency department.

BACKGROUND: To better identify women at risk for intimate partner violence (IPV), we developed a diagnostic protocol composed of injury location and response to a verbal questionnaire to identify women at high risk for reporting an IPV-related injury etiology. The purpose of this study was to test the external validity of the protocol when applied at two institutions that differ considerably in terms of geography and socioeconomic measures. METHODS: A cross-sectional design was used at two demographically and geographically different hospitals, designated H1 and H2. The sample was composed of adult females age >or=18 years presenting to the emergency department (ED) for evaluation and management of nonverifiable traumatic injuries. The predictor variable was risk for reporting an IPV-related injury. Risk was categorized per the protocol as high or low. High-risk subjects had visible head, neck, or face (HNF) injuries and positive responses to the questionnaires. Low-risk subject had non-HNF injuries or negative responses to the screening questionnaires. The outcome variable was self-reported injury etiology classified as IPV-related or other. Descriptive and bivariate statistics and standard measurements for a diagnostic test were computed. RESULTS: The sample was composed of 400 subjects, with 200 subjects enrolled at each institution. Self-reported IPV was 34% and 9.5% at H1 and H2, respectively. The protocol classified 33% (H1) and 18% (H2) of subjects as high risk. Sensitivities were 90% (H1) and 74% (H2). Specificities were 96% (H1) and 88% (H2). Subjects classified per protocol as high-risk had an 18-fold (p < 0.01, H1) and 13-fold (p < 0.01, H2) increased risk for reporting IPV-related injuries. CONCLUSIONS: Despite significant geographic and socioeconomic differences between the two hospitals, the results suggest that our protocol may be applicable in disparate clinical settings.

Adolescent↗

PubMed2000

Simple proof of security of the BB84 quantum key distribution protocol

We prove that the 1984 protocol of Bennett and Brassard (BB84) for quantum key distribution is secure. We first give a key distribution protocol based on entanglement purification, which can be proven secure using methods from Lo and Chau's proof of security for a similar protocol. We then show that the security of this protocol implies the security of BB84. The entanglement purification based protocol uses Calderbank-Shor-Steane codes, and properties of these codes are used to remove the use of quantum computation from the Lo-Chau protocol.

Journal Article↗

PubMed2004

A family of quantum protocols.

We introduce three new quantum protocols involving noisy quantum channels and entangled states, and relate them operationally and conceptually with four well-known old protocols. Two of the new protocols (the mother and father) can generate the other five "child" protocols by direct application of teleportation and superdense coding, and can be derived in turn by making the old protocols "coherent." This gives very simple proofs for two famous old protocols (the hashing inequality and quantum channel capacity) and provides the basis for optimal trade-off curves in several quantum information processing tasks.

Journal Article↗

PubMed2005

Unconditional security of a three state quantum key distribution protocol.

Quantum key distribution (QKD) protocols are cryptographic techniques with security based only on the laws of quantum mechanics. Two prominent QKD schemes are the Bennett-Brassard 1984 and Bennett 1992 protocols that use four and two quantum states, respectively. In 2000, Phoenix et al. proposed a new family of three-state protocols that offers advantages over the previous schemes. Until now, an error rate threshold for security of the symmetric trine spherical code QKD protocol has been shown only for the trivial intercept-resend eavesdropping strategy. In this Letter, we prove the unconditional security of the trine spherical code QKD protocol, demonstrating its security up to a bit error rate of 9.81%. We also discuss how this proof applies to a version of the trine spherical code QKD protocol where the error rate is evaluated from the number of inconclusive events.

Journal Article↗

PubMed1999

Feasibility in the inverse protein folding protocol.

Methods for protein structure (3D)-sequence (1D) compatibility evaluation (threading) have been developed during the past decade. The protocol in which a sequence can recognize its compatible structure in the structural library (i.e., the fold recognition or the forward-folding search) is available for the structure prediction of new proteins. However, the reverse protocol, in which a structure recognizes its homologous sequences among a sequence database, named the inverse-folding search, is a more difficult application. In this study, we have investigated the feasibility of the latter approach. A structural library, composed of about 400 well-resolved structures with mutually dissimilar sequences, was prepared, and 163 of them had remote homologs in the library. We examined whether they could correctly seek their homologs by both forward- and inverse-folding searches. The results showed that the inverse-folding protocol is more effective than the forward-folding protocol, once the reference states of the compatibility functions are appropriately adjusted. This adjustment only slightly affects the ability of the forward-folding search. We noticed that the scoring, in which a given sequence is re-mounted onto a structure according to the 3D-1D alignment determined by the dynamic programming method, is only effective in the forward-folding protocol and not in the inverse-folding protocol. Namely, the inverse-folding search works significantly better with the score given by the 3D-1D alignment per se, rather than that obtained by the re-mounting. The implications of these results are discussed.

Algorithms↗

PubMed2006

A unit-based protocol to enhance Jordanian nurses' autonomous decision making.

AIM: To develop a unit-based protocol to enhance Jordanian nurses' autonomous decision making. BACKGROUND: Many escalating changes are influencing health care organizations, which require the enhancement of nurses' autonomy to manage these frequent changes. Autonomy is addressed in the context of accountability, authority and responsibility. Nurses' involvement in patient care and unit operation decisions is a part of their autonomy. Autonomy will influence nurses' job satisfaction and retention, patients' satisfaction and the quality of nursing care. METHODS: This protocol was developed based on a personal experience, nurses and senior nursing students' feedback, a review of the literature, and consultation with a group of 26 nurses in a teaching hospital. The nurses were asked on the comprehensiveness and applicability of the protocol to health care settings. Nurses' suggestions regarding the protocol were taken into consideration during the development and revision stages. RESULTS AND CONCLUSIONS: A unit-based protocol was developed to enhance nurses' autonomous decision making through activities that support the process of autonomy and work environment. This protocol will have positive short, intermediate and long-term outcomes for patients, nurses and organizations.

Attitude of Health Personnel↗

PubMed1998

Limiting life support. Experiences with a special protocol.

BACKGROUND: Different aspects of withholding or withdrawal of life-sustaining treatment have been described in the literature. However, there are few descriptions of local policies or protocols regarding the limiting of life support. The present study describes the pattern of limiting life support in a Scandinavian intensive care unit (ICU) and the experience with a special protocol for such decisions. METHOD: Prospective study of decisions to limit life support in the ICU of a tertiary referral hospital during 1 year using a special protocol and medical records. RESULTS: A decision to limit life support was documented in the special protocol in 61/1008 (6%) of the patients and in 39/79 (49%) of the patients dying in the ICU. Poor prognosis and failure to respond to treatment were the most common reasons for foregoing life-sustaining treatment. Of the 61 patients with a special protocol, 7 survived more than 3 months. The decision was altered for 5 patients towards additional limitations and for 4 patients towards fewer or no limitations. CONCLUSION: Decisions to limit life support in the ICU are common. There is a substantial survival rate. A structured clinical protocol can be used for continuous follow-up of decisions and the decision-making process.

Adolescent↗

PubMed2006

Comparison of two freezing protocols in an open freezing system for cryopreservation of rat ovarian tissue.

AIM: To compare two freezing protocols in an automatic open-vessel freezing system for cryopreservation of rat ovarian tissue. METHODS: Ovarian tissue was transplanted heterotopically into the neck muscle, either without cryopreservation (group 1, n = 6) or with cryopreservation after equilibration with 1.5 mol/L dimethyl sulfoxide and propanediol (protocol A, group 2, n = 6) or 1.5 mol/L ethyl glycol (protocol B, group 3, n = 6). The ovarian tissue was examined with LIVE/DEAD fluorescent viability staining and histologically after isotransplantation. RESULTS: The healthy follicular loss (intact oocyte and >50% granulosa cells alive) due to cryopreservation was 15.5% with protocol A and 12.2% with protocol B. Histological examination showed follicles in all developmental phases in all groups: group 1, 35.5 +/- 5.7/mm(2) (mean +/- SD); group 2, 16.0 +/- 5.0/mm(2); group 3, 17.3 +/- 5.7/mm(2). The differences between groups 1 and 2 and between groups 1 and 3 were significant (P < 0.001). The difference between groups 2 and 3 was not significant (P = 0.33). CONCLUSIONS: These results demonstrate that the use of an open freezing system with both freezing protocols allows cryopreservation of rat ovarian tissue with equally good survival rates.

Animals↗

PubMed2006

Isolation of E. coli O157:H7 and non-O157 STEC in different matrices: review of the most commonly used enrichment protocols.

AIMS: To review and characterize the enrichment protocols used for detecting all Shiga-Toxin producing Escherichia coli (STEC) from different matrices. METHODS AND RESULTS: Firstly, the frequency distribution of the factors characterizing the enrichment protocols is described; secondly, a multiple correspondence analysis is performed to display profiles of association of these factors, and thirdly, published results concerning the relative performances of the protocols are summarized. Trypticase Soy Broth (TSB) is reported as the most frequently used enrichment broth. More often, one antibiotic is added in enrichment broths and these broths are incubated for a duration of 16-24 h at 35-37 degrees C. It also appears that the incubation temperature does not seem to be related to the type of serogroup looked for and that antibiotics are used regardless of the matrix analysed. Finally, results relating to the enrichment protocol efficacy are rare and differ from one study to another. CONCLUSIONS: Statistical studies must be conducted so as to assess the efficacy of the main enrichment protocols investigated in this study. SIGNIFICANCE AND IMPACT OF THE STUDY: This study reviews the most commonly used enrichment protocols and highlights the lack of results as to their relative efficacy.

Colony Count, Microbial↗

PubMed2005

Direct implant loading in the edentulous maxilla using a bone density-adapted surgical protocol and primary implant stability criteria for inclusion.

BACKGROUND: Long healing periods and submerged implant placement are commonly used in the maxilla. This extends the time of oral handicap and makes the use of immediate loading protocols an attractive option. The current clinical literature on direct loading of dental implants in the maxilla is limited. PURPOSE: The purpose of this prospective clinical study was to evaluate the clinical outcome and stability of directly loaded Brånemark System or Replace Select Tapered implants (Nobel Biocare AB, Göteborg, Sweden) after using a modified surgical protocol and inclusion by primary implant stability. In addition, a reference group treated according to a two-stage protocol was used for comparison. MATERIALS AND METHODS: Twenty patients planned for prosthetic rehabilitation with implant-supported bridges in the edentulous maxilla participated in the study group. The final decision on immediate loading was made after implant placement using insertion torque and resonance frequency analysis (RFA) as acceptance criteria. All patients were included, and 123 oxidized implants (TiUnite, Nobel Biocare AB) were placed using a surgical protocol for enhanced primary stability. A screw-retained temporary bridge was delivered within 12 hours and a final bridge within 3 months of implant placement. The patients were monitored through clinical and radiographic follow-up examinations from implant placement to at least 12 months. Marginal bone level was measured at bridge delivery and after 12 months of loading. Additional RFA measurements were made after 6 months of loading. A reference group comprising 20 patients with 120 implants treated according to a two-stage protocol was used for comparison. RESULTS: One (0.8%) of the 123 implants in the study group failed, and no implant was lost in the reference group. The cumulative survival rates after 12 months of loading were thus 99.2% and 100% for immediate and delayed loading protocols, respectively. The marginal bone resorption was 0.78 (SD 0.9) in the study group and 0.91 (SD 1.04) in the reference group. RFA showed a mean value of 62.9 (SD 4.9) implant stability quotient (ISQ) at placement and 64.5 (SD 4.8) ISQ after 6 months for immediately loaded implants (not significant). The corresponding figures for the reference groups were 61.3 (SD 8.8) ISQ and 62.6 (SD 7.0) ISQ (not significant). There were no statistically significant differences between the groups at any time point. CONCLUSION: The use of six to seven implants for immediate loading of a fixed provisional bridge is a viable option for implant treatment of the edentulous maxilla, at least when good primary implant stability can be ensured.

Aged↗

PubMed1996

Apoptosis or necrosis following Photofrin photosensitization: influence of the incubation protocol.

Photosensitization using the tumor-localizing porphyrin Photofrin induces cell death both in vitro and in vivo, but the mechanism of cell death is not well understood. Cell lysis (necrosis) and apoptosis have both been observed. The latter seems restricted mainly to lymphoma and epithelial cell lines. To check the influence of the incubation protocol on the cell death mechanism, CV-1 cells were loaded with Photofrin using two different protocols. In both protocols, photosensitized CV-1 cells underwent severe morphological changes before cell death. Many cells treated with protocol 1 (24 h with 1 microgram/mL of Photofrin in culture medium) underwent apoptosis, as demonstrated by plasma membrane blebbing and fragmentation into vesicles, condensation of the chromatin and fragmentation of the nucleus with oligonucleosomic degradation of the DNA. In contrast, cells treated with protocol 2 (1 h with 10 micrograms/mL of Photofrin in phosphate-buffered saline) lysed instead of fragmented, without oligonucleosomic degradation of the DNA. This type of cell death looks much like necrosis. However, early morphological changes suggest that it is, in fact, apoptosis stopped by plasma membrane leakage. It is concluded that apoptosis is primarily induced in CV-1 cells but may be arrested by membrane lysis, depending on the incubation protocol.

Animals↗

PubMedDate not supplied

A new method of computing spin-lattice relaxation maps in magnetic resonance imaging using fast scanning protocols.

A new algorithm to compute spin-lattice relaxation (T1) maps in magnetic resonance imaging (MRI) by using fast imaging protocols and monitoring the magnetization evolution towards a steady state is proposed. This algorithm uses a general least-squares fit to multiple point experimental data and is thus much more precise than the standard two-point fit. Since this imaging protocol is designed to consume time comparable to that of standard clinical protocols, it has an advantage in comparison to traditional multiple point protocols, which require considerably longer scanning times. In addition to T1 maps the protocol can generate final images suitable for clinical diagnosis. Thus it is possible to generate relaxation data without considerably lengthening the total required MRI study time. The results of phantom testing of this protocol are reported.

Algorithms↗

PubMed2001

Rapid pulsed-field gel electrophoresis protocol for subtyping of Campylobacter jejuni.

We developed a rapid pulsed-field gel electrophoresis (PFGE) protocol for subtyping Campylobacter isolates based on the standardized protocols used by PulseNet laboratories for the subtyping of other food-borne bacterial pathogens. Various combinations of buffers, reagents, reaction conditions (e.g., cell suspension concentration, lysis time, lysis temperature, and restriction enzyme concentration), and electrophoretic parameters were evaluated in an effort to devise a protocol that is simple, rapid, and robust. PFGE analysis of Campylobacter isolates can be completed in 24 to 30 h using this protocol, whereas the most widely used current protocols require 3 to 4 days to complete. Comparison of PFGE patterns obtained in six laboratories showed that subtyping results obtained using this protocol are highly reproducible.

Animals↗

PubMed2003

The detection of Simian virus 40 in mesotheliomas from New Zealand and England using real time FRET probe PCR protocols.

AIMS: To detect Simian virus 40 (SV40) DNA in mesotheliomas from New Zealand and from England using novel real time FRET probe polymerase chain reaction (PCR) protocols. METHODS: Twenty four mesotheliomas from New Zealand (Central North Island) and 32 mesotheliomas from England (Greater Manchester region) were examined. Two real time FRET probe PCR protocols were optimised and their analytical sensitivity compared using dilutions of SV40 DNA. A conventional SV40 large tumour antigen protocol with detection by probe hybridisation and chemiluminescent Southern blotting was also optimised. RESULTS: Both real time PCR protocols had the same analytical sensitivity, detecting down to 10(-6) pg of SV40 DNA for each reaction, approximately one SV40 copy. All of the 56 mesothelioma samples contained amplifiable beta globin DNA, but none contained amplifiable SV40 DNA with the conventional large T antigen PCR-Southern blotting protocol, or the two real time FRET probe PCR protocols. The positive and negative controls gave the expected results. There was no evidence of inhibition. CONCLUSIONS: There is abundant evidence in the literature for the presence of SV40 in mesotheliomas. However, this study found no evidence of SV40 in mesotheliomas from England and New Zealand. The extensive use of SV40 contaminated polio vaccine in New Zealand does not seem to have resulted in SV40 associated mesotheliomas.

DNA, Viral↗

PubMed2004

Large liver tumors: protocol for radiofrequency ablation and its clinical application in 110 patients--mathematic model, overlapping mode, and electrode placement process.

PURPOSE: To establish a preoperative protocol for ultrasonographically guided percutaneous radiofrequency (RF) ablation of large liver tumors that is based on mathematic models and clinical experience and to evaluate the role of this protocol in RF ablation. MATERIALS AND METHODS: A regular prism and a regular polyhedron model were used to develop a preoperative protocol for liver tumor ablation. This protocol enabled the authors to minimize the number of ablation spheres, optimize the overlapping mode, and determine the electrode placement process. One hundred ten patients with 121 liver tumors were treated by using this protocol. Sixty-nine patients had 74 hepatocellular carcinomas (HCCs), and 41 had 47 metastases to the liver (ie, metastatic liver carcinomas [MLCs]). Patients underwent follow-up helical computed tomography (CT) 1 month and every 2-3 months after RF ablation. Ablation was considered a success if no contrast enhancement was detected in the treated area on the CT scan obtained at 1 month. RESULTS: A total of 536 ablations were performed in the 121 tumors. The ablation success rate was 87.6% (106 of 121 tumors); the local recurrence rate, 24.0% (29 of 121 tumors); and the estimated mean recurrence-free survival, 17.1 months. Twenty-five patients underwent 38 re-treatments for local tumor recurrence. Major complications occurred in seven patients. Of these patients, only one, who had a tumor close to the colon, had a colon perforation 1 week after RF and required surgical intervention. CONCLUSION: The described protocol for treatment of large tumors had a success rate of 87.6% and a local recurrence rate of 24.0%.

Adult↗

PubMed1992

Dependence of muscle fatigue on stimulation protocol: effect of hypocaloric diet.

This study tested the hypothesis that the decreased resistance of skeletal muscles to fatigue after a period of inadequate nutrition is a consequence of the type of fatigue test employed. Rats (n = 8) were fed hypocalorically for 10 days, resulting in a 33.5 +/- 3.0% (SE) reduction in body weight. The fatigue resistance of muscles was assessed with use of isolated soleus muscles at a temperature of 25 degrees C. Fatigue resistance was determined from the decline in isometric force during a series of tetanic contractions. Two contrasting contraction protocols were devised to test the susceptibility of muscles to fatigue. One protocol was designed to require high rates of energy supply and hence force a dependence on glycolytic energy supply pathways. The second protocol required much lower rates of energy supply that could be entirely met by oxidative energy supply processes. During the high energy demand (glycolytic) protocol, the force produced by muscles from a control group of rats decreased to 78.7 +/- 0.8% (n = 12 muscles) of the initial value. Hypocaloric feeding significantly reduced the resistance of muscles to fatigue: force declined to 61.3 +/- 3.5% (n = 16 muscles) during the contraction protocol. In contrast, when fatigue was quantified using the low energy demand (oxidative) contraction protocol, the effect of nutritional status on fatigue resistance was entirely abolished. This result supports the hypothesis that resistance to fatigue is critically dependent on the fatigue test employed.

Animals↗

PubMed1999

Comparison of different double immunostaining protocols for paraffin embedded liver tissue.

Most of the double immunostaining protocols that have been introduced so far have been developed for application on fresh frozen material or based on different species antibodies. In liver tissue, general problems of double immunostaining techniques are further complicated by tissue-specific difficulties, such as necrosis or high intracellular protein content. To assess a reliable double immunostaining protocol for archived, paraffin embedded liver tissue, different protocols based on the use of same species primary antibodies were evaluated in terms of sensitivity, specificity and non-specific background staining in pathological liver specimens. We compared peroxidase-anti-peroxidase, alkaline phosphatase-anti-alkaline phosphatase (PAP/APAP), labelled-avidin-biotin (LAB/LAB) and digoxigenin-anti-digoxigenin (dig-a-dig/PAP) techniques using different cytokeratin antibodies and an antibody against PCNA. Comparison of the double immunostaining techniques revealed a high sensitivity and specificity in all procedures. Sections, which were stained employing PAP/APAP-technique, displayed a higher background staining compared to sections which were treated with the LAB/LAB or dig-a-dig/PAP protocol. In contrast to the dig-a-dig/PAP protocol, the LAB/LAB technique provides a better time/cost relationship. Therefore, we would like to recommend a modified LAB/LAB protocol for simultaneous detection of different antigens in archived liver tissue.

Animals↗