Oxygen delivery-guided perfusion for the prevention of acute kidney injury: A randomized controlled trial

ObjectivesThe reduction of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery using an oxygen delivery-guided perfusion strategy (oxygen delivery strategy) for cardiopulmonary bypass management compared with a fixed flow perfusion (conventional strategy) remains controversial. The purpose of this study was to determine whether a oxygen delivery strategy would reduce the incidence of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery.MethodsWe randomly enrolled 300 patients undergoing cardiopulmonary bypass surgery. Patients were randomly assigned to a oxygen delivery strategy (maintaining a oxygen delivery index value >300 mL/min/m² through pump flow adjustments during cardiopulmonary bypass) or a conventional strategy (a target pump flow was determined on the basis of the body surface area). The primary end point was the development of acute kidney injury. Secondary end points were the red blood cell transfusion rate and number of red blood cell units, intubation time, postoperative length of stay in the intensive care unit and the hospital, predischarge estimated glomerular filtration rate, and hospital mortality.ResultsAcute kidney injury occurred in 20 patients (14.6%) receiving the oxygen delivery strategy and in 42 patients (30.4%) receiving the conventional strategy (relative risk, 0.48; 95% confidence interval, 0.30-0.77; P = .002). The secondary end points were not significantly different between strategies. In a prespecified subgroup analysis of patients who had nadir hematocrit less than 23% or body surface area less than 1.40 m², the oxygen delivery strategy seemed to be superior to the conventional strategy and the existence of quantitative interactions was suggested.ConclusionsAn oxygen delivery strategy for cardiopulmonary bypass management was superior to a conventional strategy with respect to preventing the development of acute kidney injury.     

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目的探讨血液流变学与复发性口腔溃疡(recurrent oral ulcertion,ROU)发病机制的关系及观察银杏叶提取物(extyact ginkgo biloba,EGb)对ROU血液流变学的影响。方法2004—2005年,在遵义医学院中心实验室用大鼠口腔黏膜匀浆组织加弗氏免疫佐剂注射方法建立大鼠ROU模型,将成功模型动物随机分为阳性对照组、阴性对照组、EGb糊剂组、EGb片剂组、EGb糊剂+片剂组,每组各8只。应用生化分析法和微量毛细管法检测成模前后及用药前后各组大鼠纤维蛋白原、红细胞压积的变化,NEX-2型板式黏度计测定其血浆黏度。结果大鼠成模后的血液纤维蛋白原、红细胞压积、血浆黏度均较成模前增高(P<0.01);治疗后,EGb糊剂组、EGb片剂组、EGb片剂+糊剂组的纤维蛋白原、红细胞压积、血浆黏度均有不同程度的下降,尤其EGb片剂组、EGb片剂+糊剂组更为明显,与对照组比较差异均有统计学意义(P<0.01),而EGb片剂组和EGb片剂+糊剂组之间差异无统计学意义(P>0.05)。结论ROU的发生与微循环障碍有关,EGb能改善ROU模型大鼠的微循环,尤以EGb片剂、EGb糊剂+片剂效果最好。     

Immunoglobulin administration to fetuses with anemia due to alloimmunization to D

BACKGROUND: The purpose of this study was to examine fetal tolerance of high-dose intravenous immunoglobulin (IVIG), given directly at the time of intravascular transfusion, and its effects on fetal hemolysis and pregnancy outcome in the setting of alloimmunization to D. STUDY DESIGN AND METHODS: Thirteen consecutive D+ fetuses requiring transfusion for maternal alloimmunization received high-dose IVIG (1.0 g/kg) and red cell transfusions. Twenty-four previous, consecutive fetuses with maternal anti-D served as controls. The schedules for subsequent transfusions were the same in the two groups. RESULTS: High-dose IVIG was well tolerated by all fetuses. In the IVIG group, daily decreases in hematocrit were smaller than those in controls after the second administration of IVIG (mean hematocrit decrease, 0.72 percent/day vs. 1.45 percent/day; p = 0.007). No significant difference was found in the total number of fetal transfusions, the gestational age at delivery, the duration of neonatal intensive care, the number of neonates requiring postnatal transfusion therapy, and perinatal mortality. CONCLUSION: In this small pilot study, direct administration to fetuses of IVIG with red cell transfusions was well tolerated and appeared to have a beneficial effect on fetal hemolysis.     

Dependency of R2 and R2* relaxation on Gd-DTPA concentration in arterial blood: Influence of hematocrit and magnetic field strength

Dynamic susceptibility contrast (DSC) MRI is clinically used to measure brain perfusion by monitoring the dynamic passage of a bolus of contrast agent through the brain. For quantitative analysis of the DSC images, the arterial input function is required. It is known that the original assumption of a linear relation between the R₂^(*) relaxation and the arterial contrast agent concentration is invalid, although the exact relation is as of yet unknown. Studying this relation in vitro is time-consuming, because of the widespread variations in field strengths, MRI sequences, contrast agents, and physiological conditions. This study aims to simulate the R₂^(*) versus contrast concentration relation under varying physiological and technical conditions using an adapted version of an open-source simulation tool. The approach was validated with previously acquired data in human whole blood at 1.5 T by means of a gradient-echo sequence (proof-of-concept). Subsequently, the impact of hematocrit, field strength, and oxygen saturation on this relation was studied for both gradient-echo and spin-echo sequences. The results show that for both gradient-echo and spin-echo sequences, the relaxivity increases with hematocrit and field strength, while the hematocrit dependency was nonlinear for both types of MRI sequences. By contrast, oxygen saturation has only a minor effect. In conclusion, the simulation setup has proven to be an efficient method to rapidly calibrate and estimate the relation between R₂^(*) and gadolinium concentration in whole blood. This knowledge will be useful in future clinical work to more accurately retrieve quantitative information on brain perfusion.     

Toxicology of 3-epi-deoxynivalenol,a deoxynivalenol-transformation product by Devosia mutans 17-2-E-8

Microbial detoxification of deoxynivalenol (DON) represents a new approach to treating DON-contaminated grains. A bacterium Devosia mutans 17-2-E-8 was capable of completely transforming DON into a major product 3-epi-DON and a minor product 3-keto-DON. Evaluation of toxicities of these DON-transformation products is an important part of hazard characterization prior to commercialization of the biotransformation application. Cytotoxicities of the products were demonstrated by two assays: a MTT bioassay assessing cell viability and a BrdU assay assessing DNA synthesis. Compared with DON, the IC₅₀ values of 3-epi-DON and 3-keto-DON were respectively 357 and 3.03 times higher in the MTT bioassay, and were respectively 1181 and 4.54 times higher in the BrdU bioassay. Toxicological effects of 14-day oral exposure of the B6C3F₁ mouse to DON and 3-epi-DON were also investigated. Overall, there were no differences between the control (free of toxin) and the 25 mg/kg bw/day or 100 mg/kg bw/day 3-epi-DON treatments in body and organ weights, hematology and organ histopathology. However, in mice exposed to DON (2 mg/kg bw/day), white blood cell numbers and serum immunoglobulin levels were altered relative to controls, and lesions were observed in adrenals, thymus, stomach, spleen and colon. Taken together, in vitro and in vivo studies indicate that 3-epi-DON is substantially less toxic than DON.     

便携式血糖仪系统准确性评价及血细胞比容对其检测结果的影响

目的评价便携式血糖仪系统准确性及血细胞比容对其检测结果准确性的影响。方法参照GB/T19634-2005的要求选择50例临床标本,选择当前应用广泛的5种型号血糖仪各2台,分别进行双份测定,与己糖激酶法结果比较,评价血糖仪的系统准确性。制备高、中、低血糖浓度各5个血细胞比容水平的标本,分别用5款血糖仪测定血糖浓度,与己糖激酶法结果比较,评价不同血糖浓度水平下血细胞比容对血糖仪检测结果准确性的影响。结果按照ISO 15197:2003的准确性判断标准,StatStrip Xpress、Accu-Check、Optium Xceed、Contour TS、Rightest GM300在准确限内的结果分别为100%、99%、97%、100%、75%;按照新版ISO 15197:2013的标准,StatStrip Xpress、Accu-Check、Optium Xceed、Contour TS、Rightest GM300在准确限内的结果分别为100%、99%、92%、98%、72%。在高、中、低3种血糖浓度、5个血细胞比容水平下,StatStrip Xpress的结果符合ISO15197:2003和ISO15197:2013的准确性要求;Accu-Check的结果满足ISO 15197:2003的准确性要求;Optium Xceed、Contour TS、Rightest GM300的检测结果超出了ISO15197:2003的最低允许限或无检测结果。结论血糖仪检测体系之间的准确性差异较大,部分血糖仪符合新版ISO15197:2013标准,大部分符合ISO15197:2003的要求,个别血糖仪达不到ISO15197:2003的准确性最低标准。在使用前需要对其进行评价或验证,同一医院不同血糖仪之间需要进行比对以确保血糖结果的准确可比。     

促红细胞生成素对胃癌相关性贫血患者的疗效

目的:观察促红细胞生成素对胃癌相关性贫血患者疗效及预后的影响。方法:将60例胃癌晚期肿瘤相关性贫血患者按照随机分组的方法分为治疗组(30例)和对照组(30例),对照组采用常规化疗以及常规抗贫血治疗,治疗组采用常规化疗加重组人促红细胞生成素治疗,每次150U/kg,皮下注射3次/周,疗程8周,比较两组血红蛋白、红细胞和红细胞比容,评价疗效。结果:治疗组在使用重组人促红细胞生成素后的第4周和第8周,有效率为33%(10/30)和67%(20/30),对照组效率为10%(3/30)和17%(5/30);血红蛋白、红细胞和红细胞比容治疗组治疗前和治疗后4周相比较有极显著差异(P<0.01),治疗组治疗前和治疗后8周相比较有极显著差异(P<0.01),对照组治疗前和治疗后4周以及治疗后8周相比较没有差异。治疗组和对照组同期比较有极显著差异(P<0.01)。与治疗前比较,治疗组KPS评分较高,与对照组比较有显著差异(P<0.05)。结论:应用重组人EPO可以有效的治疗胃癌相关性贫血,改善患者贫血状态,临床效果良好,且无明显不良反应。