However, primary renal diseases for ESRD are different by race an

However, primary renal diseases for ESRD are different by race and area and the incidence, prevalence and mortality of CKD vary accordingly.14 Consequently, the CKD screening and prevention programs requires different approaches depending on the patient’s race, habitual and socioeconomic status and be modified in response check details to the situations where they would be conducted. The authors thank Dr Hung-Chun Chen and the organizing committee for providing this opportunity to share experience on prevention and management of CKD. Dr Nan Chen’s work was supported in part by grants from the Leading Academic Discipline Project of Shanghai Health

Bureau (05III001), the Shanghai Leading Academic Discipline Project (T0201) and the Science and Technology Commission of Shanghai Municipality (08dz1900502). The Authors state that there is no conflict of interest regarding the material discussed in the manuscript. “
“Date written: July 2008 Final submission: October 2008 No recommendations possible based on Level I or II evidence (Suggestions

are based on Level III and IV evidence) C646 price As dialysis is an accepted and available mode of treatment for end-stage kidney disease (ESKD) in Australia and New Zealand, the decision concerning acceptance onto a dialysis programme should be made on the basis of the patient’s need. The cardinal factor for acceptance onto dialysis or continuation Methocarbamol of dialysis is whether dialysis is likely to be of benefit to the patient.* *Additional notes: 1 Lack of certainty about whether the treatment will be of benefit to the patient may suggest the use of temporary dialysis or a ‘trial’ so

that dialysis as a treatment option can be evaluated. Survey individual unit documentation of implementation of the above ‘Suggestions for Clinical Care’ and rates of insertion and completion of the checklist titled ‘Approaching ESKD’ (Appendix) in patient notes. These draft guidelines do not refer to temporary dialysis, but expressly consider acceptance onto long-term dialysis, which would be terminated only by the death of the patient, successful renal transplantation, inability to maintain successful dialysis or elective withdrawal of dialysis by the patient. There is broad consensus in Australia and New Zealand that people in our society regardless of age, race, gender, religion and underlying disease have equal rights to access health facilities. Unless the patient has chosen to accept only supportive treatment, individuals and society at large expect that ESKD should not, except in unusual circumstances, be the primary cause of death.

brasiliensis model The CCR3 receptor would be a logical target f

brasiliensis model. The CCR3 receptor would be a logical target for blockade or deletion, because this is the only known receptor for the murine eotaxins. This might be performed in conjunction with inhibition of the C5a receptor, and as previously (75,76), with co-expression of the IL-5 transgene. The cytokines IL-4 and IL-13 and the STAT6 selleck chemicals signalling pathway through which they work are important for eosinophil recruitment into the skin following N. brasiliensis infection and most importantly, deletion of these genes or the IL-4Rα chain gene, results in higher lung larval burdens during secondary infections (76). IL-4, IL-13 and STAT6 had previously been shown to be important for resistance

at the level of the gut, with gene deletion delaying the clearance of intestinal larvae and adult worms in primary infections (72,85). Our recent findings have now highlighted the importance of these cytokines SAHA HDAC for early resistance to larvae and this may be a critical result when developing vaccines for helminths such as the hookworms, S. stercoralis and Schistosoma, which enter the host via the skin. In addition to facilitating the recruitment of eosinophils, complement also mediates attachment to N. brasiliensis larvae in vitro and in vivo (78,79). C3 can be detected on infectious-stage larvae incubated with sera from WT, C1qa−/−

and C4−/− mice and these sera facilitate the adherence Carbachol of eosinophil-rich leucocyte populations (78). In contrast, C3 cannot be detected on L3 incubated with sera from factor B−/− and C3−/− mice, and leucocyte adherence is inhibited in this context. Infective-stage larvae activate murine complement via the alternative pathway, but lung-stage (L4) larvae also activate complement via the lectin pathway (78). Endogenously derived C3 products are readily detectable on larvae recovered from the skin within 30 min of injection, but are found at much lower levels by 150 min pi. Leucocyte adherence to 24- and 48-h lung larvae is also minimal, even when an exogenous source of complement is provided (78). Collectively, these data suggest that late-stage skin and lung-stage larvae upregulate expression of an

inhibitor of complement deposition or a factor capable of rapidly degrading C3, and this may inhibit leucocyte recruitment and adherence to larvae in the lungs up to 48 h pi. Within 30–150 min of injection into skin air pouches, larvae aggregate into very large clumps, and this is largely dependent on the alternative pathway of complement activation (75). Whilst it is difficult to mechanically dissociate these clumps in vitro (75), clearly 80-90% of larvae can escape from the skin during the first few hours of infection in a susceptible WT host (65). In contrast, in IL-5 Tg hosts larvae can be trapped in the skin for up to 24 h and are usually surrounded by a strong inflammatory infiltrate in which eosinophils predominate (65).

1B) Next, plexA1 expression was siRNA

ablated in T cells

1B). Next, plexA1 expression was siRNA

ablated in T cells to evaluate its importance for their expansion driven by allogeneic mDC. Though the scrambled RNA also reduced to some extent the efficiency of proliferation, this was much more pronounced upon plexA1 silencing (Fig. 1C, and inset for RNA silencing control). Similarly, ectopic selleck kinase inhibitor expression of dominant negative, but not full length plexA1 (nor that of an unrelated eGFP-expression plasmid), efficiently abrogated allogeneic T-cell expansion though transfection efficiencies were around 25% only as detected by flow cytometry for the VSV-G-tag of the respective constructs (Fig. 1D, and inset for expression control). To relate their functional requirement to subcellular localization, we Belnacasan analyzed redistribution of plexA1/NP-1 in fixed allogeneic DC/T-cell

conjugates (Fig. 2). CD3 and plexA1 inefficiently translocated towards interfaces in the rarely detectable iDC/T-cell conjugates (Fig. 2A, exemplified in the upper row). In about 80% of mDC/T-cell conjugates, however, interface recruitment of plexA1, and there, co-localization with CD3 were observed (Fig. 2A, exemplified in the bottom row, and in Fig. 2B, fourth panel). PlexA1 interface accumulation was similarly efficient in autologous conjugates involving superantigen(SA)-loaded mDC (not shown). As reported earlier 32, a fraction of NP-1 was also detected within allogeneic mDC/T-cell interfaces (an example is shown in Fig. 2B). Collectively, these data indicate that plexA1 and, to a more limited extent, NP-1 are components of the IS. The instability of MV-DC/T-cell conjugates prevented direct analyses of potential alteration of plexA1/NP-1 redistribution 10. Since IS recruitment of plexA1 specifically in T cells was not yet reported, we confirmed redistribution of this molecule and NP-1 towards stimulatory interfaces

by replacement of mDC by αCD3/CD28-coated beads (Fig. 2C). In line with our flow cytometry data, especially plexA1 was mainly detected in intracellular PDK4 compartments from where it was effciently recruited towards the bead interfaces in about 50% of conjugating T cells (Fig. 2C, upper row and right graph), and this also referred to NP-1 (Fig. 2C, bottom row and right graph). Pre-exposure to MV dramatically decreased the percentage of T cells that are able to polarize these molecules towards the interface (Fig. 2C graphs). This was dependent on the interaction of T cells with the MV gp complex since translocation was recovered in the presence of antibodies directed against the MV H protein. Moreover, plexA1/NP-1 efficiently translocated towards the interfaces in T cells exposed to a recombinant MV expressing VSV-G protein instead of the MV gps (MGV) (Fig. 2C).

Whether vascular calcification can be prevented or reversed with

Whether vascular calcification can be prevented or reversed with strategies BI 2536 nmr aimed at maintaining phosphate homeostasis is as yet unknown. One recent study also determined an association between serum phosphate within the normal range and vascular and valvular calcification.21 This study of 439 young and middle-age participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with both normal renal function and CKD, and no known CVD, reported that after adjustment for eGFR, each 1 mg/dL increase in serum phosphate concentration was significantly associated with a 21%, 33%,

25% and 62% greater prevalence of coronary artery, thoracic, aortic valve and mitral valve calcification respectively. The CARDIA study, described earlier, also showed that phosphate levels within the reference range were significantly associated with coronary artery calcium levels in a young healthy adult population.19 Elevations in serum phosphate have been associated with structural changes and renal decline in animal models.68 In human observational studies, hyperphosphataemia is associated with progression of established CKD and the development of ESKD (end-stage C646 purchase kidney

disease)23,69–71 and studies of renal transplant recipients describe an association between higher serum phosphate and renal allograft loss.27,28 Serum phosphate levels in the upper-normal range have also recently been reported to be associated with an increased risk of developing incident CKD and ESKD.6,24 One study involving 2269 participants from the Framingham Heart Study showed that those in the highest phosphate category had an increased risk of CKD with OR 2.14 (95% CI 1.07–4.28) Suplatast tosilate when compared with the reference group with serum phosphate 2.5–3.49 mg/dL.6 The same study also analysed 13 372 participants

from the Third National Health and Nutrition Examination Survey (NHANES III) and reported that phosphate ≥4 mg/dL was associated with an increased risk of incident ESKD (RR 1.90 (95% CI 1.03–3.53)). Zoccali et al. recently evaluated the relationship between baseline serum phosphate, disease progression and response to angiotensin-converting enzyme (ACE) inhibition in 331 patients with proteinuric CKD in the prospective Ramipril Efficacy In Nephropathy (REIN) trial.72 Phosphate levels in the highest two quartiles were significantly associated with faster progression to both ESKD and to a composite end-point of doubling of serum creatinine or ESKD compared with patients with phosphate levels below the median. Therefore, with higher serum phosphate levels the renoprotective effect of ramipril decreased, despite adjustment for potential confounders such as GFR and urinary protein. This suggests that phosphate may potentially modify the protective effect of the only real therapeutic class of agents used in CKD. FGF-23 is the most potent hormone regulating phosphate homeostasis.73 In health, FGF-23 is secreted by osteocytes and osteoblasts in response to dietary phosphate intake.

2 mM each dNTP, 2 5 U Taq, 2 5 μL of BSA (0 1 g/10 mL) and 1 μM f

2 mM each dNTP, 2.5 U Taq, 2.5 μL of BSA (0.1 g/10 mL) and 1 μM for each forward and reverse primer in a total of 50 μL reaction volume was used. A total of 35 cycles, each consisting of 94°C for 45 s, 59°C for 45 s, and 72°C for 1 min, were performed; RG7420 datasheet an initial hot start at 94°C for 3 mins and a final extension step at 72°C for 7 mins were also included. For the secondary PCR step, the PCR mixture was identical except that a concentration of 1.5 mM MgCl2 was used. A total of 40 cycles, each consisting of 94°C for 30 s, 58°C for 90 s, and 72°C for 2 mins, were performed; an initial hot start at 94°C for 3 mins and a final extension step at 72°C for 7 mins were also included.

PCR products were analyzed on 1% agarose gel and visualized by ethidium bromide

staining. The PCR products were purified using the terminator V3.1 cycle sequencing kit (Applied Biosystems, Foster, CA, USA). Sequences were assembled using the SeqMan program (DNASTAR, USA). The characteristics of study participants are presented as mean and percentage. As appropriate, Student’s t-test was used to compare the means of continuous variables, whereas categorical variables were compared using Fisher’s exact test or Pearson’s BI 2536 solubility dmso X2 test. A logistic model was used to assess any association between potential risk factors and Cryptosporidium spp. infection; P < 0.02 according to univariate analysis was considered significant and is presented with the OR. Wald's test was used to assess the significance of variable associations. Correlations between exposure and outcome that considered possible confounding variables were evaluated by multivariate analysis by means of a logistic regression model. Only variables with P < 0.05 on Wald's test were included in the multivariate model; a backward deletion process was used. Analyses were carried out using computer software SPSS ver.12 (SPSS, USA). For both univariate and multivariate

analyses, associations were considered significant at P < 0.05. We studied 183 immunocompromised patients. Megestrol Acetate Their medical conditions were HIV infection in 47 (25.7%), ALL 43 (23.5%), AML 13 (7.1%), CLL 18 (9.8%), various solid cancers 22 (12%), NHL 11 (6%), post-bone marrow transplant 13 (7.1%) and post-renal transplant 16 (8.7%). One hundred and fifty one patients (82.5%) were male and 32 (17.5%) female. The majority of patients (72.7%) were over 30 years old, non-diarrheic (87%), had CD4 + T-cells counts > 100 cells/mm3 (93.4%) and were urban dwellers (76%). We considered patients had Cryptosporidium infection if their fecal samples contained typical oocysts of 4–6 μm when examined after using a modified acid-fast staining technique. We identified oocysts of Cryptosporidium in the feces of 11 of the 183 patients (6%). Demographic, environmental and clinical characteristics of the studied patients are shown in Table 1. We identified two genotypes, C.parvum and C.hominis, by 18s rRNA gene amplification, sequencing and analysis. We identified C.

After euthanasia, pancreas were removed and fixed in phosphate-bu

After euthanasia, pancreas were removed and fixed in phosphate-buffered formalin 10% (phosphate buffer pH = 7·2) for 24 h. The organs were conserved in alcohol 70% until histological processing and paraffin inclusion. Five-μm sections were cut and stained with haematoxylin and eosin (H&E). All islets on the slides were analysed and the following criteria

were employed to determine insulitis score: 0 = intact islet; 1 = peri-insulitis; 2 = moderate insulitis (< 50% mononuclear infiltration); and 3 = severe insulitis (more than 50% mononuclear infiltration). Spleen cells were cultured in RPMI-1640 medium supplemented Ferroptosis mutation with 10% fetal bovine serum, 2 mM L-glutamine and 40 mg/l of gentamicin and then plated at 5 × 106 cells/ml in 48-well flat-bottomed culture plates (Nunc, Sigma-Aldrich) and stimulated with 10 μg/ml of recombinant heat shock protein 65-kDa (rhsp65). Cytokine levels were evaluated 48 h later by enzyme-linked immunosorbent assay (ELISA) in culture supernatants using interferon (IFN)-γ, interleukin (IL)-5 and IL-10 BD OptEIA Sets (Becton Dickinson, San Jose, CA, USA) and tumour necrosis factor (TNF)-α

Duoset (R&D Systems, Minneapolis, selleck screening library MN, USA). The assays were performed according to the manufacturer’s instructions. Spleen cells were collected, the red blood cells were lysed with Hanks’s buffer containing NH4Cl and the remaining cells were adjusted to 2·5 × 106 cells/100 μl. These cells were incubated with 0·5 μg of fluorescein isothiocianate (FITC) anti-mouse CD4 (clone GK1·5) and 0·25 μg of allophycocyanin (APC) anti-mouse Molecular motor CD25 (clone PC61·5) for 20 min at room temperature. Staining for FoxP3 was then performed utilizing the phycoerythrin (PE) anti-mouse/rat FoxP3 Staining Set (eBioscience, San Diego, CA,

USA), according to the manufacturer’s instructions. After incubation, the cells were fixed in paraformaldehyde 1%. The cells were analysed by flow cytometry using FACSCalibur (Becton Dickinson) and BD CellQuest Pro software (Becton Dickinson, San Jose, CA). Results are presented as mean ± standard error of the mean (s.e.m.). For diabetes incidence, the χ2 test was used. In all other cases, one-way analysis of variance (anova) was used for parameters with normal distribution and the Kruskal–Wallis test for parameters with non-normal distribution. Dunn’s test was used when necessary. Significance level was P < 0·05. Statistical analysis was accomplished with SigmaStat for Windows version 3·5 (Systat Software Inc., Chicago, IL, USA). Weight variation, glycaemia and the score of mononuclear infiltration in the pancreas were analysed in mice immunized with BCG alone or with prime-boost (BCG followed by pVAXhsp65) before diabetes induction with STZ. As shown in Fig. 1a, although all the groups gained weight, BCG–STZ and BCG/DNAhsp65–STZ exhibited a smaller variation (3 and 1%, respectively) in comparison to the control group (9%).

This process ensures the preservation of the benefits of randomiz

This process ensures the preservation of the benefits of randomization and avoids the introduction of bias during analysis. As-treated analysis may sometimes be used to test the robustness of findings but should rarely be used to replace the

use of intention-to-treat analysis. In the study by MG-132 nmr Suki et al.,1 as almost half of the study participants discontinued the study for a range of reasons such as non-compliance, loss to follow-up and adverse events, it was particularly important to include this proportion in the analyses so as to prevent overestimation of the treatment effect. Based on the results presented in the article, you are confident that the study has undertaken analyses according to the original randomization of participants, this website that is, by intention-to-treat. Questions: What were the results? What was the size and precision of the effect? When considering the results of a study, an assessment of the precision is essential. The exact ‘true’ effect of an intervention is never known. However, it is possible to estimate this effect.

When we consider the precision of a study, we are considering the proximity of an estimate to the ‘true’ effect. The interval, enclosed by the extremes at which the estimate may possibly lie, is known as the 95% confidence intervals (CIs). By accepting the 95% CI, one is accepting that the true effect lies within that range 95% of the time, in other words, the estimate will lie outside the interval 5% of the time. The precision of a study ultimately depends on the number of events, and therefore its sample size. As a general rule of thumb, the larger the proportion of participants who experience the outcome, the greater the precision, that is, total number of events drives the power of the study whilst the sample size and event rate determines Fenbendazole the total number of events. A larger sample size will produce more outcomes

and therefore narrower CIs, allowing one to be more confident that the estimate is closer to the true effect. The results of a study can be expressed in a number of different ways and it is important to understand and interpret the significance of such results. Some examples include differences in a continuous factor (e.g. effects of sevelamer on serum phosphate levels), a dichotomous outcome (e.g. relative risk of hyperphosphataemia or risk of cardiovascular events) or as time-to-event analyses, comparing the length of time taken for a particular event of interest to occur between the two groups, thus providing additional information and statistical power.8 The results of time-to-event analyses are often expressed by hazard ratios.9 Perhaps the most important method for presenting the results of dichotomous outcomes is the absolute risk difference, which describes the proportion of individuals prevented from having an event, and can be used to calculate numbers needed to treat.

Local protein expression of angiotensin II and its type 2 recepto

Local protein expression of angiotensin II and its type 2 receptor was dramatically upregulated in tibia of UUO mice. Conclusion:  Together, it is concluded that the obstructive nephropathy

has defective effects on bone, and the underlying mechanisms are the reduction of bone formation MG-132 molecular weight and the increase of bone resorption, which is mediated, at least partially through local angiotensin II signalling. “
“Intravenous immunoglobulin (IVIg) therapy for antibody-mediated rejection (AMR) is increasing and is associated with a small but significant incidence of thrombosis. We determined thrombosis rates in patients treated with high-dose IVIg for AMR before and after alteration of an infusion protocol. The newer protocol introduced routine administration of aspirin 300 mg, enoxaparin 1 mg/kg, intravenous hydration and a maximum infusion NVP-AUY922 mouse rate of 100 mg/kg per hour (previously 200 mg/kg per hour). Nine thromboses in 275 infusions occurred before the protocol alteration (event rate 3.3%). Two were arterial thromboses including an acute myocardial infarct and a renal transplant artery thrombosis, which resulted in infarction of 2/3 of the graft. Seven venous thromboses occurred, six in arteriovenous fistulae and one case with bilateral above knee deep venous thromboses. Significant associations with thromboses were seen with higher IVIg dose and male sex. In the 6 months since the introduction

of the new infusion protocol, 74 infusions have been administered with no thrombotic events. There have been no significant bleeding or fluid overload side-effects.

Infusion times, however, have been doubled. A slower rate of infusion combined with antiplatelet and anticoagulation has thus far eliminated the small but significant IVIg-related thrombosis rate previously observed in our patients treated for AMR without resulting in significant side-effects. Further study is now required to define which elements Methane monooxygenase of this protocol are essential. “
“Chronic kidney disease (CKD) is a common and serious problem that adversely affects human health, limits longevity and increases costs to health-care systems worldwide. Its increasing incidence cannot be fully explained by traditional risk factors. Oxidative stress is prevalent in CKD patients and is considered to be an important pathogenic mechanism. Oxidative stress develops from an imbalance between free radical production often increased through dysfunctional mitochondria formed with increasing age, type 2 diabetes mellitus, inflammation, and reduced anti-oxidant defences. Perturbations in cellular oxidant handling influence downstream cellular signalling and, in the kidney, promote renal cell apoptosis and senescence, decreased regenerative ability of cells, and fibrosis. These factors have a stochastic deleterious effect on kidney function. The majority of studies investigating anti-oxidant treatments in CKD patients show a reduction in oxidative stress and many show improved renal function.

We confirmed that residual catalytic activity of dnRAG1 could not

We confirmed that residual catalytic activity of dnRAG1 could not account for this accumulation as dnRAG1 mice bred to a RAG1-deficient background Selleckchem C59 wnt show no

evidence of B-cell or T-cell development beyond what is observed in RAG1−/− mice (see Supplementary material, Fig. S1). Follow-up studies on one of these lines, no. 15, show that in 12-week-old mice, the percentage and absolute number of B220lo CD19+ B cells is significantly higher in dnRAG1 mice than in wild-type (WT) mice in spleen, bone marrow (BM), lymph node (LN), peritoneal cavity (PC), and peripheral blood (PB), but the relative abundance of these cells compared with more conventional B220hi CD19+ B cells varies depending on tissue origin (Fig. 1c; see Supplementary material, Fig. S2a). The abundance and distribution of T-cell

subsets is not significantly different between WT and dnRAG1 animals in the thymus or spleen (see Supplementary material, Carfilzomib order Fig. S2b,c). In lymph nodes, CD4+ T cells show a modest, but statistically significant increase in dnRAG1 mice compared with WT mice (see Supplementary material, Fig. S2b,c). As the B220lo CD19+ B-cell phenotype in dnRAG1 mice was so striking, we focused our efforts to characterize the accumulation of these cells and did not investigate T-cell subsets further. Examining the ontogeny of these cells demonstrated that the frequency of B220lo CD19+ B cells steadily increases with age, with significant differences detected in the spleen by 4 weeks of age, eventually comprising ∼ 35% of splenic lymphocytes by about 12 months SPTLC1 of age (Fig. 1d). Other than a mild splenic hyperplasia, older dnRAG1 exhibited no obvious indications of disease that would distinguish them from their normal littermates, suggesting that B220lo CD19+ B-cell accumulation has no significant impact on the health of the animals. Because

peritoneal B1 B cells display a B220lo CD19+ phenotype,27 we speculated that splenic B220lo CD19+ B cells in dnRAG1 mice may express other surface markers indicative of a B1 B cell. A hallmark of the B1a B cell is the expression of CD5.27 Extensive flow cytometric analysis revealed that splenic B220lo CD19+ cells in dnRAG1 mice also express CD5, and have a surface phenotype characterized as sIgMhi sIgDint CD21− CD23− CD24−CD43lo AA4.1− CD11b− (Fig. 1e, and data not shown). This immunophenotype is quite similar to peritoneal B1a B cells, except that the peritoneal subset expresses slightly lower levels of sIgD and also expresses CD11b (Fig. 1e). The lack of CD11b expression is also consistent with the reported phenotype of splenic B1 cells from wild-type BALB/cByJ mice reported by others.28 To determine whether dnRAG1 mice exhibit defects in B-cell maturation, we stained bone marrow and spleen with antibodies to differentiate the various stages of B-cell development.

The anastomoses are performed at more proximal levels to keep the

The anastomoses are performed at more proximal levels to keep them away from the trauma zone. This reasonable maneuver causes the distal of the flap to cover the most critical part of the defect. Trichostatin A manufacturer Any marginal necrosis, then, ends in exposure of the bone or implant. Reported here is the use of a perforator flap derived from a previously transferred free MCF as a backup tissue.

Distal marginal necrosis exposing vital structures were encountered after six free MCF transfers during the last 6 years. These were highly complicated cases in which no regional flap options were available and a second free flap was unfeasible due to recipient vessel problems. A perforator flap was elevated on the perforator vessel(s) penetrating the underlying muscle of the previous MCF and either advanced or transposed to cover the defect. Donor sites on MCF were closed primarily. Wound dehiscence that healed secondarily was observed in two cases. The knee prosthesis was removed in one case due to uncontrolled osteomyelitis. No complications were detected in other three cases. The described flap can be a leg saver whenever a previously transferred free MCF fails to cover the distal site of the defect. The flap can be advanced for 3–5 cm

and allows more than 90 degrees of rotation. © 2010 Wiley-Liss, Inc. Microsurgery 30:457–461, 2010. “
“The treatment of facial palsy is a complex and challenging area of plastic surgery. Microsurgical innovation has introduced the modern see more age of dynamic reconstruction for facial palsy. This review will focus Sorafenib chemical structure on microsurgical reconstruction for smile restoration in patients with long-standing facial palsy. The most common donor muscles and nerves will be presented. The advantages and disadvantages of single-stage versus multi-stage

reconstruction will be discussed. Contemporary trends will be highlighted and the authors’ preferred practice outlined. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013 “
“Background: Microvascular free tissue transfer in head and neck surgery has become an indispensable tool. Anastomotic thrombosis is one of the leading causes of flap failure; however, there are no validated methods to accurately identify and quantify those patients most at risk of thrombotic complications. The aim of this study was to determine if functional fibrinogen to platelet ratio using thrombelastography could preoperatively identify patients at risk of thrombotic complications. Materials and Methods: Twenty nine patients undergoing free tissue transfer surgery for head and neck pathology underwent routine TEG® analysis, with calculation of functional fibrinogen to platelet ratio at induction of anesthesia. All perioperative thrombotic complications were recorded and crossreferenced with preoperative ratios.