Cloning and functional characterization of a superfamily of microbial inwardly rectifying potassium channels.

Background: Liver transplantation is associated with massive blood loss due to a combination of coagulopathy, portal hypertension, and multiple vascular transection and anastomoses. Multiple blood transfusions over a short time frame may result in significant blood and component wastage due to over-ordering of blood products and component time expiry. Blood wastage in the setting of liver transplantation is yet to be reviewed. We reviewed transfusion practices during liver transplantation and audited blood component and product wastage. Methods: We performed a single-center retrospective review of all adult patients aged >16 years over a period of a year. A total of 181 cases were included in the review. Results: Eighty-seven percent of liver transplants were first transplants and were mainly due to chronic liver failure. Our cohort had a median blood loss of 4249 mL (IQR 2830, 6576) per transplant. Patients having redo procedures or have acute liver failure as a presenting aetiology bled significantly more. Nearly all our patients received blood products during the perioperative period. Fresh frozen plasma (FFP) was transfused in 91.2% of our cohort, followed by packed red cells (PRC, 64.2%), platelets (52.5%) and cryoprecipitates (32.0%). A total of 142 units of blood and blood product were wasted. This equates to a wastage rate of 4.6%. This is higher than the target of 3% set by our institution. Highest wastage rates were seen in FFP (8.6%), followed by PRC (2.2%), cryoprecipitates (1.0%) and platelets (0.9%). The commonest cause of wastage was "time expired". The total cost of wastage is £9800, which represents 3.3% of the total cost of blood products transfused. Conclusion: Changing blood component ordering habits, staff training, and awareness may help reduce wastage of this precious commodity.

Road traffic accidents are one of the commonest causes of death in children. Child safety car seats have played a pivotal role in reducing the mortality and morbidity associated with road traffic accidents. However, there have been some concerns about the about the design of front facing car seats versus their rear facing counterparts. Legislation governing the use of rear facing car seats is variable, with some Scandinavian countries recommending their use up to the age of four, while others mandate their use only until one year of age. We present three case narratives of patients aged under 3 years who sustained catastrophic injuries after being involved in a road traffic accident despite being placed in an appropriately sized forward facing car seat. We reviewed the literature for evidence comparing the safety and efficacy of front versus rear facing car seats. Accident registry and crash test results support the increased safety of rear facing child seats. Frontal sled test have demonstrated that forward facing car seats expose children to much higher neck loads and chest displacement resulting in higher injury scores. Epidemiological data from registries and observational studies support the experimental data and demonstrate a clear injury-reducing effect of rear facing child seats compared to their forward facing counterpart. We recommend keeping children in rear facing car seats until the age of four, which is common practice in Sweden.

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