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MitraClip implantation is an option in managing selected high surgical risk patients with severe MR. The current evidence suggests that MitraClip can be implanted with reproducible safety and feasibility profile in this subgroup of patients. Further prospective trials with mid- to long-term follow-up are required.

A previously unreported pancreatic duct was found by Liu (1989) in Pekin ducks. This duct has now been consistently found in six breeds of domestic ducks and six species of wild ducks in China. For purposes of Nomina Anatomica Avium it is hereby called the 'first pancreatic duct' (Ductus pancreaticus primus) since it enters the duodenum at or near the flexure where the descending duodenum becomes the ascending duodenum. All other pancreatic ducts enter the duodenum later, closer to where it joins the jejunum. This first pancreatic duct drains the caudal extremity of the dorsal lobe of the pancreas and can be easily exteriorized for experimental purposes. Within the parenchyma of the dorsal lobe of the pancreas this duct communicates with the dorsal pancreatic duct. In the present study of the gross anatomy of the pancreatic lobes of domestic and wild Chinese ducks we describe and illustrate variations in position and number of all biliary and pancreatic ducts.

Introduction: Platelets have a short shelf life (5 days). Smaller Australian hospitals often cannot justify keeping many (or even any) platelet units on-site. Paradoxically, up to 30% of platelet units are discarded. The provision of platelets in military field hospitals is similarly challenging. In response, the Netherlands Military Blood Bank modified US protocols to freeze, store and reconstitute platelets. First employed in Bosnia in 2001, thawed frozen platelets were used from 2006-10 to treat Australian soldiers in the Dutch-led NATO hospital in Afghanistan. Platelets are reconstituted in thawed plasma within seven minutes, requiring minimal equipment and skill. The single controlled clinical trial of this technology randomised 73 cardiac surgery patients to cryopreserved or liquidstored platelets for treatment of bleeding [1]. Cryopreserved platelets were associated with less bleeding and fewer red cell transfusions. No adverse effects were observed. However, this study was almost certainly underpowered to ensure safety. Before cryopreserved platelets can be approved by the Australian TGA, more information about their comparative effectiveness, cost-effectiveness, and safety is required. Methods: CLIP is a 90-patient, 4-hospital pilot blinded randomised controlled effectiveness trial of cryopreserved platelets in comparison to apheresis platelets. Outcomes that will be assessed for possible use in a subsequent definitive trial include 28 day mortality, blood loss, transfusion requirement, and incidence of venous thromboembolism. Cardiac surgery patients at high risk of bleeding in the perioperative period will be identified using a validated score. Consented patients will be randomised to receive either cryopreserved or conventional platelets if the treating clinician decides a platelet transfusion is indicated. Patients will receive up to three units of study platelets. Should more be required, these will be conventional open-label platelets. The ARCBS has optimised a method for manufacturing cryopreserved apheresis platelets [2] and compared various in vitro characteristics to conventional liquid platelets. Results: Cryopreserved and conventional platelet units contain similar platelet numbers (approximately 300 x 10 9 /unit). GPIba and GPIIb receptor expression is reduced by cryopreservation, compared to conventional platelets, but activation markers CD62P and CD63 are similar. Cryopreserved platelet units contained significantly more phosphatidylserine-and tissue factor-positive microparticles, which were associated with a reduction in the time to clot formation and increased thrombin generation. Discussion: Cryopreserved platelets prepared using this method are of sufficient quality for clinical trials. The CLIP pilot study, planned to commence in November 2014, is a prelude to a definitive multicentre trial in Australian cardiac surgery patients aimed at providing sufficient evidence to inform regulatory evaluation and potential widespread use in Australian civilian and military practice.