title: Subject-Based versus Population-Based Care after Radiation Exposure.
abstract: In a mass casualty radiation event situation, individualized therapy may overwhelm available resources and feasibility issues suggest a need for the development of population-based strategies. To investigate the efficacy of a population-based strategy, Chinese macaques (n = 46) underwent total-body irradiation and received preemptive antibiotics, IV hydration on predetermined postirradiation days and were then compared to macaques (n = 48) that received subject-based care in which blood transfusions, IV hydration, nutritional supplementation and antibiotic supportive measures were provided. Estimated radiation doses for LD30/60, LD50/60 and LD70/60 of animals with subject-based care: 6.83 Gy (6.21, 7.59), 7.44 Gy (6.99, 7.88) and 8.05 Gy (7.46, 8.64), respectively, and for population-based care: 5.61 Gy (5.28, 6.17), 6.62 Gy (6.13, 7.18) and 7.63 Gy (7.21, 8.20), respectively. Analysis of four time periods, 0-9, 10-15, 16-25 and 26-60 days postirradiation, identified significant mortality differences during the period of 10-15 days. A subset analysis of higher radiation doses (6.75-7.20 Gy, n = 32) indicated hydration, nutrition and septic status were not significantly different between treatments. Whole blood transfusion treatment, administered only in subject-supportive care, was associated with significantly higher platelet and absolute neutrophil counts. Median platelet counts greater than 5,670 cells/μl and absolute neutrophil counts greater than 26 cells/μl during this period correlated with survival. We observed that the population-based treatment increased the LD50/60 compared to nontreatment (6.62 Gy vs. 4.92 Gy) and may be further optimized during days 10-15, where strategic blood transfusions or other strategies to achieve increases in neutrophil and platelet counts may further increase survival rates in subjects exposed to high doses of radiation.
authors.affiliation: a  Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612;
authors.forename: Jiang-Zhou
authors.initials: JZ
authors.lastname: Yu
authors.affiliation: b  Department of harmacology, University of Illinois at Chicago, Chicago, Illinois 60612;
authors.forename: Matt
authors.initials: M
authors.lastname: Lindeblad
authors.affiliation: b  Department of harmacology, University of Illinois at Chicago, Chicago, Illinois 60612;
authors.forename: Alex
authors.initials: A
authors.lastname: Lyubimov
authors.affiliation: a  Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612;
authors.forename: Flavia
authors.initials: F
authors.lastname: Neri
authors.affiliation: c  Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois 60612;
authors.forename: Brett
authors.initials: B
authors.lastname: Smith
authors.affiliation: a  Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612;
authors.forename: Erzsebet
authors.initials: E
authors.lastname: Szilagyi
authors.affiliation: d  Department of Veterinary Medicine, University of Illinois at Chicago, Chicago, Illinois 60612;
authors.forename: Lisa
authors.initials: L
authors.lastname: Halliday
authors.affiliation: e  Department of Radiation Oncology at University of Maryland School of Medicine, Baltimore, Maryland 21702; and.
authors.forename: Tom
authors.initials: T
authors.lastname: MacVittie
authors.affiliation: f  Johns Hopkins School of Public Health, Baltimore, Maryland 21206.
authors.forename: Joy
authors.initials: J
authors.lastname: Nanda
authors.affiliation: a  Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612;|g  Department of UIC Cancer Center, University of Illinois at Chicago, Chicago, Illinois 60612;|h  Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois 60612;
authors.forename: Amelia
authors.initials: A
authors.lastname: Bartholomew
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D008253:Macaca mulatta; D008297:Male; D009503:Neutropenia / Q000628:therapy; D018529:Nutritional Support; D011833:Radiation Injuries, Experimental / Q000628:therapy*; D013921:Thrombocytopenia / Q000628:therapy; D014916:Whole-Body Irradiation
chemical_list: D000900:Anti-Bacterial Agents