加味温经汤联合阿仑膦酸钠片治疗肾阳亏虚型绝经后骨质疏松症临床研究

目的:观察加味温经汤联合阿仑膦酸钠片治疗肾阳亏虚型绝经后骨质疏松症(PMOP)的临床疗效。方法:选取150例肾阳亏虚型PMOP患者,按随机数字表法分为对照组和观察组各75例。对照组给予口服阿仑膦酸钠片治疗,观察组在对照组基础上加服加味温经汤,2组均治疗6个月。对比2组总体疗效、治疗前后碱性磷酸酶(ALP),血钙(Ca)、磷(P),雌二醇(E2),促卵泡雌素(FSH),促黄体生成素(LH)水平,记录治疗过程中不良反应发生情况。结果:观察组总有效率96.0%,对照组总有效率80.0%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组ALP水平均较治疗前降低(P<0.05),血Ca含量均较治疗前增加(P<0.05);观察组ALP水平低于对照组(P<0.05),血Ca含量高于对照组(P<0.05)。治疗后,2组E2水平均较治疗前升高,FSH及LH水平均较治疗前降低,差异均有统计学意义(P<0.05);观察组E2水平高于对照组,差异有统计学意义(P<0.05)。2组血常规异常、肝肾功能异常、消化道症状、皮肤过敏发生率比较,差异均无统计学意义(P>0.05)。结论:加味温经汤治疗肾阳亏虚型PMOP,能有效改善患者的临床症状和性激素水平,用药安全性高。     

Physiological changes in the hemolymph of juvenile shrimp Litopenaeus vannamei to sublethal nitrite and nitrate stress in low-salinity waters

Juveniles of the shrimp Litopenaeus vannamei (3.3 ± 0.4 g) were exposed separately to nitrite (0.0, 1.1, 2.6, and 5.3 mg/L nitrogen as nitrite [NO₂⁻-N]) and nitrate (0, 90, 225 and 400 mg/L nitrogen as nitrate [NO₃⁻-N]) concentrations equivalent to 0, 10, 25, and 50% of the LC₅₀-96 h value of NO₂⁻-N and NO₃⁻-N in low salinity water (3 g/L). Shrimps responded to nitrite and nitrate according to changes in oxyhemocyanin, glucose, lactate and ion levels in the hemolymph after 6, 12, 24, and 48 h of exposure. Oxyhemocyanin levels decreased with increasing nitrite and nitrate levels and were higher at 50% exposure to the contaminants. Compared to the control, glucose and lactate increased significantly at 50% exposure to nitrite and nitrate, particularly at 12 and 24 h. Na⁺ in the hemolymph changed with nitrite and nitrate, while K⁺ only changed ˜with nitrite.     

Using droplet digital PCR to screen for rare blood donors: Proof of principle

BackgroundDigital droplet PCR (ddPCR) is a very sensitive high throughput genotyping methodology. To date, the use of ddPCR in immunohematology is restricted to fetal genotyping of red blood cell antigens. Our hypothesis is that this technology could be applied to screen for rare red blood cell genotypes, such as Di(b-).MethodsNucleic acid of 3168 donors was extracted for viral screening routine in pools of 6, which were converted into three types of 48-donor pools: control pools (only DI*B/*B samples), pools with varying amount of DI*A/*B samples (n = 1–5) and a pool with one rare DI*A/*A sample. Pools were genotyped using ddPCR to detect and quantify DI*A and DI*B alleles.ResultsDI*A allele was accurately detected in all pools containing Di(a + b+) samples and in the pool containing one Di(a + b-) sample. No copies were detected in the control pools (n = 60). The ratio between the number of DI*A and DI*B copies varied significantly between the pools and the triplicates.ConclusionThe proposed ddPCR assay was accurate in identifying the rare DI*A allele in large pools of donors and can be applied to screen for Di(b-) phenotype. The strategy can potentially be extended to search for other rare RBC phenotypes.     

Update on patient blood management 2019

Preoperative anaemia is common and is associated with adverse outcomes. Furthermore, it puts patients at risk for allogeneic blood transfusions which in turn may be associated with adverse outcomes. Diagnosis and treatment of anaemia is one of the tenets of patient blood management (PBM), along with reduction in unnecessary transfusions and use of hemostatic agents to reduce bleeding among multiple others. Effective PBM is multi‐disciplinary, multi‐modal, timely, personalized and patient‐centred. I will discuss recent updates in PBM with emphasis on treatment of preoperative anaemia, restrictive transfusion triggers and use of tranexamic acid. I will also briefly discuss the barriers to PBM implementation and start conversation about how to improve patient engagement.     

Relationship between biological variation and delta check rules performance

ObjectivesThe performance of delta check rules has been considered to be dependent on the biological variation characteristics of the analyte of interest. The assumed relationships have not been formally studied. The mathematical relationship between biological variation and delta check rules is explored in this study.Design and methodsFrom the mathematical model for absolute difference delta check, the threshold for specificity and sensitivity are observed to be normalized differently. For specificity, the threshold is normalized by the within-subject biological variation (expressed as a coefficient of variation, ${\mathit{CV}}_i$), whereas for sensitivity the threshold is normalized by the between-subject biological variation (expressed as a coefficient of variation, ${\mathit{CV}}_g$). This highlights the different roles the two biological variations play in affecting the absolute difference distribution for correct and switched patient samples. Analogous to absolute difference delta checks, for relative difference delta checks, the expressions for specificity and sensitivity are scaled by ${\mathit{CV}}_i$ and ${\mathit{CV}}_g,$ respectively. However, the expressions are independent of ${\mu }_g$(the average of the population).ResultsA comparison between the mathematical model and empirical/ historical laboratory data obtained from patients was conducted for both absolute and relative difference delta checks. In general it was found that the specificity obtained from the historical laboratory data was less than the model predicted values, while on the other hand, good correspondence was obtained between the experimental sensitivity and predicted sensitivity.ConclusionsThe difference in within-subject biological variation in different patients may contribute to the observed discrepancy in predicted and empirical delta check performance.     

Blood Transfusion can be Avoided in Single-Anesthetic Bilateral Total Knee Arthroplasty

BackgroundFemale gender and surgical drain use have been associated with an increased transfusion risk following single-anesthetic bilateral total knee arthroplasty (SBTKA). This study evaluated allogenic blood transfusion rates among female and male patients undergoing SBTKA with intraoperative tourniquet, tranexamic acid and contemporary blood transfusion thresholds but without surgical drain use.MethodsWe performed a retrospective electronic medical record review for 125 consecutive patients undergoing SBTKA (250 knees) between May 1, 2015 and July 10, 2021. Patient demographic characteristics (age, gender, body mass index, American Society of Anesthesiologists), preoperative and postoperative hemoglobin levels, perioperative transfusions, operative time, and hospital length of stay were compared between 76 female (60.8%) and 49 male (39.2%) patient cohorts using paired Student’s t-test or Fisher’s exact test with a P value <.05 for significance.ResultsNo patient in either gender-based cohort received a perioperative allogeneic or autologous blood transfusion (P = 1). There were no significant differences in patient demographic features or medical comorbidities. Male patients had significantly higher mean preoperative (14.7 versus 13.7 g/dL, P < .01) and postoperative (12.7 versus 11.8 g/dL, P < .01) hemoglobin levels and a shorter mean hospital length of stay (2.5 versus 3.0 days, P < .01). There was no difference in the mean operative time (154.7 versus 150.7 minutes, P = .34) or change in the hemoglobin level (2.1 versus 1.9 g/dL, P = .27).ConclusionSBTKA can be performed with a limited risk of perioperative transfusion with a combination of intraoperative tourniquet, tranexamic acid, conservative blood transfusion criteria, and avoidance of postoperative drain use. Study results were not influenced by patient gender.Level of evidenceThis is a level III, retrospective cohort study.