半边旗5F注射液的溶血性和过敏性实验研究

目的观察半边旗5F注射液的制剂安全性。方法采用家兔红细胞体外孵育进行溶血性试验;采用豚鼠经胫静脉给药进行全身过敏性试验。结果半边旗5F注射液在体外对家兔红细胞无溶血作用,对豚鼠不引起全身过敏性反应。结论半边旗5F注射液是一种安全的注射用制剂。     

茵栀黄口服液与金银花提取物对葡萄糖-6-磷酸脱氢酶缺乏大鼠的溶血影响及退黄疗效分析

目的 研究不同剂量茵栀黄口服液与不同浓度金银花提取物对葡萄糖-6-磷酸脱氢酶（G6PD）缺乏大鼠的溶血影响和退黄疗效比较。方法 将实验用雄性Wistar大鼠随机分为10组,每组10只,分别为正常组（不予任何处理）、阴性对照组（给予生理盐水）、阳性对照组（给予伯氨喹啉）、2倍剂量茵栀黄组（给予13.4 mL/kg茵栀黄口服液）、4倍剂量茵栀黄组（给予26.8 mL/kg茵栀黄口服液）、8倍剂量茵栀黄组（给予53.6 mL/kg茵栀黄口服液）、正常浓度金银花组（给予剂量为6.7 mL/kg,浓度为8 mg/mL金银花提取物）、中浓度金银花组（给予剂量为6.7 mL/kg,浓度为40 mg/mL金银花提取物）、高浓度金银花组（给予剂量为6.7 mL/kg,浓度为80 mg/mL金银花提取物）、极高浓度金银花组（给予剂量为6.7 mL/kg,浓度为160 mg/mL金银花提取物）。除正常组外,其余各组通过乙酰苯肼制造G6PD缺乏大鼠模型,通过瑞氏染色观察造模前后大鼠红细胞形态变化;造模后各组给予相应药物进行处理,用血常规及血生化检测仪检测相关溶血指标,以及血总胆红素和间接胆红素水平。结果 G6PD缺乏大鼠红细胞形态不规则,中央区染色变浅。与造模前相比,阳性对照组给药后红细胞计数下降,游离血红蛋白水平和网织红细胞百分比均上升（P < 0.05）;不同剂量茵栀黄组和不同浓度金银花组只有网织红细胞百分比均高于造模前水平（P < 0.05）。不同剂量茵栀黄组总胆红素和间接胆红素水平均较阳性对照组下降（P < 0.05）,不同浓度金银花组间接胆红素水平低于阳性对照组（P < 0.05）,但总胆红素水平高于各剂量茵栀黄组（P < 0.05）。与4倍剂量和8倍剂量茵栀黄组相比,2倍剂量茵栀黄组给药后大鼠总胆红素水平下降百分比最高（P < 0.05）。结论 大剂量茵栀黄口服液与不同浓度金银花提取物均不会引起G6PD缺乏大鼠发生溶血;茵栀黄口服液退黄疗效比金银花提取物好,且其疗效可能并不随剂量增大而提高。     

CD59 deficiency presenting as polyneuropathy and Moyamoya syndrome with endothelial abnormalities of small brain vessels

CD59 is involved in lymphocyte signal transduction and regulates complement-mediated cell lysis by inhibiting the membrane attack complex. In the cases reported so far, congenital isolated CD59 deficiency was associated with recurrent episodes of hemolytic anemia, peripheral neuropathy, and strokes. Here, we report on a patient from a consanguineous Turkish family, who had a first episode of hemolytic anemia at one month of age and presented at 14 months with acute Guillain-Barré syndrome (GBS). The child suffered repeated infection-triggered relapses leading to the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Although partly steroid-responsive, the polyneuropathy failed to be stabilized by a number of immunosuppressive agents. At the age of 6 years, he developed acute hemiparesis and showed progressive stenosis of proximal cerebral arteries, evolving into Moyamoya syndrome (MMS) with recurrent infarctions leading to death at 8 years of age. Post-mortem genetic analysis revealed a pathogenic p.(Asp49Valfs*31) mutation in CD59. Re-analysis of brain biopsy specimens showed absent CD59 expression and severe endothelial damage. Whereas strokes are a known feature of CD59 deficiency, MMS has not previously been described in this condition. Therefore, we conclude that in MMS combined with hemolysis or neuropathy CD59 deficiency should be considered. Establishing the diagnosis and targeted therapy with eculizumab might have prevented the lethal course in our patient.     

Effects of Pulsatile Control Algorithms for Diagonal Pump on Hemodynamic Performance and Hemolysis

The objective of this study is to compare hemodynamic performances under different pulsatile control algorithms between Medos DeltaStream DP3 and i‐cor diagonal pumps in simulated pediatric and adult ECLS systems. An additional pilot study was designed to test hemolysis using two pumps during 12h‐ECLS. The experimental circuit consisted of parallel combined pediatric and adult ECLS circuits using an i‐cor pump head and either an i‐cor console or Medos DeltaStream MDC console, a Medos Hilite 2400 LT oxygenator for the pediatric ECLS circuit, and a Medos Hilite 7000 LT oxygenator for the adult ECLS circuit. The circuit was primed with lactated Ringer's solution and human packed red blood cells (hematocrit 40%). Trials were conducted at various flow rates (pediatric circuit: 0.5 and 1L/min; adult circuit: 2 and 4L/min) under nonpulsatile and pulsatile modes (pulsatile amplitude: 1000–5000rpm [1000 rpm increments] for i‐cor pump, 500–2500rpm [500 rpm increments] for Medos pump) at 36°C. In an additional protocol, fresh whole blood was used to test hemolysis under nonpulsatile and pulsatile modes using the two pump systems in adult ECLS circuits. Under pulsatile mode, energy equivalent pressures (EEP) were always greater than mean pressures for the two systems. Total hemodynamic energy (THE) and surplus hemodynamic energy (SHE) levels delivered to the patient increased with increasing pulsatile amplitude and decreased with increasing flow rate. The i‐cor pump outperformed at low flow rates, but the Medos pump performed superiorly at high flow rates. There was no significant difference between two pumps in percentage of THE loss. The plasma free hemoglobin level was always higher in the Medos DP3 pulsatile group at 4 L/min compared to others. Pulsatile control algorithms of Medos and i‐cor consoles had great effects on pulsatility. Although high pulsatile amplitudes delivered higher levels of hemodynamic energy to the patient, the high rotational speeds increased the risk of hemolysis. Use of proper pulsatile amplitude settings and intermittent pulsatile mode are suggested to achieve better pulsatility and decrease the risk of hemolysis. Further optimized pulsatile control algorithms are needed.     

Exchange Transfusion for Severe Neonatal Hyperbilirubinemia: 17 Years’ Experience from Vojvodina,Serbia

This study aimed to evaluate the frequency of the main risk factors for severe neonatal hyperbilirubinemia, to determine the incidence of exchange transfusion (ET) in the Autonomous Province of Vojvodina (the northern part of Serbia) and to describe the experience with ET performed in premature and term infants during the past 17 years. We performed a retrospective data analysis of 398 newborn infants who underwent a double volume ET from 1997 to 2013. During the 17 year study period, a decreasing incidence of ET, expressed per thousand newborns, was observed. A total of 468 double volume ET were performed: 328 (82.4 %) infants had one treatment and 70 (17.6 %) had repeated treatments. A total of 262,830 mLs of blood were transfused, an average of 660 mLs per child. There were 221 male and 177 female infants, with a sex ratio 1.25:1. The frequencies of risk factors for developing hyperbilirubinemia were as follows: (1) 38 % RhD incompatibility; (2) 38 % ABO incompatibility (26 % group A infant of group O mother, 12 % group B infant of group O mother); (3) 7 % low birth weight/preterm birth; (4) 17 % other factors. Risk factors for neurotoxicity were identified in 56.3 % of infants. No deaths or complications were reported arising from the treatment. ABO and Rh incompatibilities were found to be the main risk factors for severe neonatal hyperbilirubinemia in Vojvodina. Exchange transfusion, used as therapy for severe hyperbilirubinemia, trended downwards over the period of this study.     

Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient

We experienced a case of liver abscess due to Clostridium perfringens(CP) complicated with massive hemolysis and rapid death in an adequately controlled type2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgica drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae(K. pneumoniae) and Escherichia coli(E. coli). Although CP is relatively rare,the survival rate is very poor compared with those of K. pneumoniae and E. coli. Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important.     

Acute dapsone poisoning in a 3-year-old child: Case report with review of literature

Dapsone(DDS-diamino diphenyl sulphone) is a sulfone antibiotic being used for a variety of clinical conditions. Poisoning in children by DDS is rarely reported. Poisoning in acute cases will be frequently unrecognized due to relative lack of severe signs and symptoms. Methemoglobinemia is the major life-threatening situation associated with poisoning of DDS. Hence, any delay for medical attention can lead to increased rate of mortality. In this case, we describe acute DDS poisoning in a 3-year-old child and the successful management using intravenous methylene blue.     

吉祥草总皂苷溶血、止咳、化痰、抗炎作用的研究

 目的观察吉祥草提取物总皂苷抗溶血及止咳、化痰、抗炎的作用.方法采用兔血红细胞溶血实验法;采用小鼠氨水引咳法及气管酚红排泌法观察吉祥草总皂苷(TSRC)的镇咳及祛痰作用;采用小鼠耳壳二甲苯致肿法、小鼠腹腔毛细血管通透法观察TSRC的抗炎作用.结果采用兔血红细胞溶血实验法证明TSRC不溶血.给小鼠(灌胃给药)TSRC100,200mg/kg小鼠咳嗽潜伏期明显延长,咳嗽次数减少(P＜0.01);气管酚红排泌量明显增多(P＜0.01);但对小鼠耳壳二甲苯致肿的抑制率及小鼠腹腔毛细血管通透性无明显效果(P＞0.05).给小鼠(皮下注射给药)TSRC100,200 mg/kg,对小鼠耳壳二苯致肿的抑制率及小鼠腹腔毛细血管通透性与生理盐水比有明显效果(P＜0.05,P＜0.01).结论吉祥草总皂苷(TSRC)不溶血.吉祥草总皂苷(TSRC)灌胃给药能抑制氨水引起的小鼠咳嗽;能促进小鼠气管酚红排泌;灌胃给药抗炎作用不明显.吉祥草总皂苷(TSRC)皮下注射给药抗炎作用明显.     

-80℃低温保藏对结直肠癌血浆miRNA标志物的影响

目的探讨在非溶血和溶血状态下，低温保藏时间对结直肠癌患者血浆miRNA标志物质量的影响。 方法随机抽取中山大学附属第三医院生物样本资源库2014年至2021年间在-80℃低温环境下保藏不同时间的结直肠癌血浆标本，采用分光光度计检测评估血浆溶血程度，并分为溶血组和非溶血组。miRNA提取后采用实时荧光定量PCR对潜在的结直肠癌miRNA标志物miR-92a-3p和miR-378a-5p进行丰度分析和比较。 结果在-80℃低温储存环境下，非溶血组保藏8年以及溶血组保藏3年的血浆中miR-92a-3p和miR-378a-5p丰度无明显变化，溶血组保藏1、3年的血浆中miR-92a-3p的丰度显著高于同期非溶血组（均P<0.01），而两组同期保藏1、3年miR-378a-5p的丰度差异无统计学意义（P=0.931、0.339）。 结论血浆初始溶血状态会影响循环miRNA的丰度，但低温保藏时间不影响血浆中miRNA的丰度，能较好地保持血浆样本中miRNA的稳定，用于后续研究。     

Association of crystalloid fluid infusion with intravascular hemolysis and organ dysfunction in hematopoietic stem cell transplant patients

Endothelial cell activation and injury is common after hematopoietic stem cell transplant (HSCT) and is associated with many post-transplant complications. An underexplored mechanism of endothelial cell damage in this population is the infusion of normal saline (NS, 0.9 % sodium chloride) and other crystalloids, as NS use is associated with adverse outcomes in other patient populations. We hypothesized that the infusion of unbalanced crystalloids during HSCT may lead to changes in biomarkers commonly associated with red blood cell (RBC) hemolysis in patients before and after infusion, and that markers of endothelial and end-organ damage during admission may be associated with markers of hemolysis and total crystalloid use. Samples were collected from 97 patients. From pre-fluid infusion to post-fluid infusion, mean haptoglobin decreased (11.7 ug/ml vs 8.4 ug/ml; p < 0.0001), hemopexin decreased (549 vs 512 μg/ml; p = 0.005), and red cell distribution width (RDW) decreased (15.7 vs 15.6; p = 0.0009). During admission (mean 19.4 days, SD 9.9), all markers of tissue and organ damage, including mean creatinine, lactate dehydrogenase (LDH), blood urea nitrogen (BUN), total bilirubin, AST, and ALT, increased from admission to peak levels (p < 0.0001). On linear regression, fluid volume (ml/kg) of crystalloid infusion positively predicted post-fluid infusion cell-free hemoglobin (r(96) = 0.34, p < 0.0001), free heme (r(96) = 0.36, p < 0.0001), and peak LDH during admission (r(75) = 0.23, p = 0.041), and negatively predicted post-fluid infusion hemopexin (r(96) = − 0.34, p < 0.0001). Unbalanced crystalloids may contribute to hemolysis and endothelial damage in HSCT patients. Alternatives such as buffered crystalloid solutions (PlasmaLyte, Lactated Ringer’s) may be worth investigating in this population.