The best strategy for red blood cell transfusion in severe burn patients,restrictive or liberal: A randomized controlled trial

IntroductionAlthough blood transfusion is common in burns, data are lacking in appropriate transfusion thresholds. It has been reported that a restrictive blood transfusion policy decreases blood utilization and improves outcomes in critically ill adults, but the impact of a restrictive blood transfusion policy in burn patients is unclear. We decided to investigate the outcome of decreasing the blood transfusion threshold.Material and methodsEighty patients with TBSA > 20% who met our inclusion criteria were included. They were randomly divided into control and intervention groups. The intervention group received packed cells only when Hemoglobin declined to less than 8 g/dL at routine laboratory evaluations. While the control group received packed-cell when hemoglobin was declined to less than 10 g/dl. The total number of the received packed cell before, during and after any surgical procedure was recorded. The outcome was measured by the evaluation of the infection rate and other complications.ResultThe mean hemoglobin level before transfusion was 7.7 ± 0.4 g/dL in the restrictive group and 8.8 ± 0.7 g/dL in the liberal group. The mean number of RBC unit transfusion per patient in the restrictive group was significantly lower than the traditional group (3.28 ± 2.2 units vs. 5.9 ± 3.7 units) (p-value = 0.006). The total number of RBC transfused units varied significantly between the two groups (p-value = 0.014). The number of transfused RBC units outside the operation room showed a significant difference between groups (restrictive: 2.8 ± 1.4 units vs. liberal: 4.4 ± 2.6 units) (p = 0.004). We did not find any significant difference in mortality rate or other outcome measures between groups.ConclusionApplying the restrictive transfusion strategy in thermal burn patients who are highly prone to all kinds of infection, does not adversely impact the patient outcome, and results in significant cost savings to the institution and lower rate of infection. We conclude that the restrictive transfusion practice during burn excision and grafting is well tolerated and effective in reducing the number of transfusions without increasing complications.Clinical Trial Registration ReferenceIRCT20190209042660N1.     

Isolated noncompaction of the ventricular myocardium

Isolated noncompaction of the ventricular myocardium is a recently described anomaly. We report the first case of this anomaly presenting as a restrictive cardiomyopathy, and the first association of this entity with endocardial fibrosis.     

结核病临床分离株及痰标本中embB基因型的快速测定

目的建立快速测定结核病耐乙胺丁醇(EMB)分离株和痰标本中结核分枝杆菌EMB耐药基因型的方法，以期为患者提供及时、有效地化验结果。方法应用16S rDNA聚合酶链反应(PCR)-单链构象多态性(SSCP)和PCR-限制性片段长度多态性(RFLP)对11株耐EMB分离株和46例结核病痰标本进行分子菌种鉴定和embB基因突变的部位与性质分析。结果以结核分枝杆菌H37Rv标准株为对照，11株耐EMB分离株和46例临床痰标本经16S rDNA PCR-SSCP分析电泳图谱均与结核分枝杆菌标准株相同；限制性内切酶NlaⅢ消化embB基因扩增产物显示，11株耐EMB分离株中4株(36．4％)不被NlaⅡ消化；46例结核病痰标本中10例(21．7％)不被NlaⅡ消化。结论部分结核分枝杆菌耐EMB是由于embB基因突变所致。采用PCR-SSCP和PCR-RFLP方法可直接快速测定结核病耐EMB分离株和痰标本中结核分枝杆菌耐EMB基因型。     

Laparoscopic greater curvature plication: Surgical techniques and early outcomes of a Chinese experience

BackgroundLaparoscopic greater curvature plication (LGCP) is a novel restrictive bariatric procedure that can reduce the gastric volume by infolding the gastric greater curvature without gastrectomy. The objective of this study was to describe the surgical technique of LGCP and validate the efficacy and safety of LGCP for the treatment of obesity in obese Chinese patients with a relatively low body mass index (BMI).MethodsTwenty-two obese patients (mean age 33.8±6.0 years; mean BMI 37.0±7.0 kg/m²) underwent LGCP between September 2011 and September 2012. After dissecting the greater omentum and short gastric vessels, the gastric greater curvature plication with 2 rows of nonabsorbable suture was performed under the guidance of a 32-F bougie. The data were collected during follow-up examinations performed at 1, 3, 6, and 12 months postoperatively.ResultsAll procedures were performed laparoscopically. The mean operative time was 84.1 minutes (50–120 min), and the mean length of hospital stay was 3.8 days (2–10 d). There were no deaths or postoperative major complications that needed reoperation. The mean percentage of excess weight loss (%EWL) was 22.9%±6.9%, 38.6%±9.8%, 51.5%±13.5%, and 61.1%±15.9% at 1, 3, 6, and 12 months postoperatively. At 6 months, type 2 diabetes was in remission in 2 (50%) patients, hypertension in 1 (33.3%) patient, and dyslipidemia in 11 (78.6%) patients. Decreases in the index for homeostasis model assessment of insulin resistance (HOMA-IR) and in insulin and glucose concentrations were observed.ConclusionsThe early outcomes of LGCP as a novel treatment for obese Chinese with a relatively low BMI are satisfactory with respect to the effectiveness and low incidence of major complications. Additional long-term follow-up and prospective, comparative trials are still needed.     

Effects of cinnamon on perineal pain and healing of episiotomy: a randomized placebo-controlled trial

BACKGROUND: Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area.OBJECTIVE: The aim of this study was to assess the effect of cinnamon on perineal pain and healing of episiotomy incision.DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: In this double-blind, randomized, placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratifi ed block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo ointment, 2 mL every 12 h for 10 d.MAIN OUTCOME MEASURES: Perineal pain and wound healing were assessed using visual analogue scale(0-10) and Redness, Edema, Ecchymosis, Discharge, Approximation scale(0-15), respectively. General linear model was used to compare the groups on the outcomes adjusted for baseline values and stratifi ed factors.RESULTS: Follow-up rate was 100% up to the 8 h time point in both groups, and 86%(62 of 72) in the cinnamon group and 85%(61 of 72) in the placebo group at day 10-11 after delivery. Pain score in the cinnamon group was signifi cantly lower than that in the placebo group at(4±1) h(adjusted difference:-0.6, 95% confi dence interval:-1.0 to-0.2) and(8±1) h(-0.9,-1.4 to-0.3) after intervention, and on the 10-11 th day after delivery(-1.4,-2.0 to-0.7). Also the cinnamon group showed signifi cantly more improvement than the control group in healing score at(8±1) h(-0.2,-0.4 to-0.04) and the 10-11 th day after delivery(-1.6,-2.0 to-1.1). CONCLUSION: Cinnamon can be used for reducing perineal pain and improving healing of episiotomy incision.