Effectiveness of a prospective physician self-audit transfusion- monitoring system

BACKGROUND: The purpose of this study was to search for a more effective transfusion-monitoring system than the existing system of retrospective peer review. STUDY DESIGN AND METHODS: This research used a study-control, preintervention and postintervention design, to evaluate the effectiveness of a prospective physician self-audit transfusion-monitoring system that functioned without the direct involvement of transfusion service physicians. This research also evaluated the effectiveness of issuing to physicians a memo with transfusion guidelines. Three process indicators were used to assess physician behavior at various stages of the blood-ordering process: 1) the number of crossmatches ordered per admission, 2) the transfusion-to- crossmatch ratio, and 3) the number of blood units returned to the laboratory after physician self-auditing. The study used two outcome indicators to reflect overall blood utilization: 1) the percentage of patients who received red cell transfusions and 2) the number of blood units transfused per recipient each month. RESULTS: The prospective physician self-audit system implemented at the study hospital did not reverse physician transfusion decisions, and the process of issuing to physicians a memo with transfusion guidelines at the control hospital failed to reduce blood usage. However, a transient reduction in blood utilization was observed at the study hospital. CONCLUSION: The reduction was hypothesized to be due to a Hawthorne effect, in which observed behavior is affected by the subject's awareness of the research study.     

通过基因芯片筛选创伤修复差异表达基因

目的通过基因芯片筛选同真皮间充质干细胞相关的创伤修复差异表达基因。方法利用贴壁生长的特性分离大鼠真皮间充质干细胞，用Hpure提取伤口液刺激前后dMSCs和创伤前后大鼠皮肤组织中总RNA。PCR扩增已构建抑制消减杂交差异表达文库中485个克隆的插入片断，送北京博奥制作基因芯片。提取的RNA反转录后分别同芯片杂交，找出在细胞水平和组织水平同时高表达的克隆。将这些克隆测序，进行生物信息学分析。结果分离的大鼠真皮间充质干细胞呈纺锤形，在体外显示多向分化潜能。抽提伤口液刺激前后dMSCs和创伤前后大鼠皮肤组织中总RNA，反转录后和基因芯片杂交，发现可能同创伤愈合相关的13条基因，其中热休克蛋白70（HSP70），基质金属蛋白酶3（MMP3），白细胞蛋白酶抑制因子（SLPI）等可能在创伤愈合中有重要意义。结论抑制消减杂交和基因芯片结合是筛选差异表达基因的一种有效方法。伤口液刺激前后dMSCs中差异表达基因的发现能为从基因水平探讨dMSCs参与创伤愈合的分子机制提供新的研究靶点。     

The routine use of Rh-negative reagent red cells for the identification of anti-D and the detection of non-D red cell antibodies

BACKGROUND: Before 1987, fewer than 50 patients per year at the authors' laboratory had a positive antibody detection test due to antepartum Rhesus immunoprophylaxis. However, after 1987, a marked increase was observed in the number of patients who had received Rh immune globulin (RhIG) during pregnancy as part of routine antepartum Rh immunoprophylaxis. In anticipation that an increased use of RhIG during pregnancy would increase the number of patients in whom anti-D was detected by this laboratory, a protocol was developed to abbreviate the process required to identify anti-D. Although this protocol was adopted primarily to address an anticipated increase in antenatal RhIG usage in women, it was also applied to alloimmunized Rh-negative males. STUDY DESIGN AND METHODS: When an Rh-negative patient (male or female) had a reactive screening test for unexpected antibodies and met certain other criteria, the patient's serum was tested with a three-vial set of Rh-negative reagent red cells (Rh-negative screening RBCs), instead of with panels of typed RBCs (panel RBCs), for the identification of anti- D or the detection of non-D antibodies. If the serum under test did not agglutinate or hemolyze Rh-negative screening RBCs, anti-D was identified and no further testing was performed. If the serum agglutinated or hemolyzed Rh-negative screening RBCs, conventional testing with panel RBCs was done to determine the antibody specificity. RESULTS: Rh-negative patients (n = 1174) who had reactive screening tests for unexpected antibodies were tested with Rh-negative screening RBCs; 1079 were found to have anti-D as a single antibody. Seven of these patients subsequently developed a non-D alloantibody, after transfusion or pregnancy, and one patient had anti-C that escaped detection at the time of initial testing with Rh-negative RBCs (a false- negative result). Ninety-two patients had anti-D in combination with a non-D antibody, and three patients had a non-D antibody but not anti-D. Use of the anti-D identification protocol actually reduced the laboratory workload by 176 College of American Pathologists workload units per month, in spite of a marked increase in the number of patients in whom anti-D was detected. No hemolytic transfusion reaction was attributed to the abbreviation of anti-D identification. CONCLUSION: The identification of anti-D may be abbreviated without jeopardizing patient safety. Such a protocol can reduce laboratory workload and might be particularly appealing to health care facilities that perform antibody detection testing on large numbers of Rh-negative pregnant women, especially if antepartum RhIG is administered routinely.     

分级检验在血脂检验中的应用价值

目的：对分级检验在血脂检验中的应用价值进行评价分析,为今后临床检验工作提供可靠的参考依据。方法选取2012年8月~2014年8月在本院接受血脂检验患者109例,均采集血液标本6 ml,平均分成2份,分别采取拉网式检验和分级检验2种不同的检验方法对血脂水平进行检验,对比分析检验结果。结果2种方法在检测低密度脂蛋白胆固醇、载脂蛋白A值和B值方面的结果有显著性差异(P<0.05),三酰甘油、总胆固醇、高密度脂蛋白胆固醇的检验结果则无明显差异(P>0.05)。结论分级检验能够对高血脂进行直接准确检测,临床价值显著,值得关注并推广。     

白芷近缘野生种兴安白芷的生药学研究

目的 对兴安白芷进行系统的生药学研究以区别于其他白芷类药材.方法 按照常规生药学方法进行来源、性状、显微鉴定,按<中国药典>2005年版白芷项下方法进行薄层鉴别与含量测定.结果 找出了兴安白芷在生药性状、组织构造及化学成分上的主要特征.结论 为白芷种质资源的评价提供了参考依据.     

Diagnostic Splenectomy for Visceral Leishmaniasis

A 57-year-old-man with a history of malaise, fever,night sweats and shortness of breath presented a diagnostic challenge to his medical team. He was pancytopaenic and had splenomegaly on admission but other investigations, including bone marrow aspiration, proved inconclusive. After the patient deteriorated clinically, the general surgical team was requested to perform a diagnostic splenectomy. The histology of this showed infection with visceral leishmaniasis. He recovered completely with Amphotericin treatment. Although this is a rare condition, particularly for the general surgeon, this case highlights the difficult position surgeons are often put in when performing major surgery diagnostically.     

多聚（ADP-核糖）聚合酶抑制剂对大鼠缺血再灌注肾脏损伤的保护作用

目的探讨多聚（ADP-核糖）聚合酶（PARP）抑制剂3-氨基苯甲酰胺（3-AB）在大鼠-肾脏缺血再灌注损伤中的保护作用及对肾组织血管内皮生长因子A（VEGF-A）和中性粒细胞明胶酶相关脂质运载蛋白（NGAL）mRNA表达的影响。方法将54只大鼠随机分为假手术组（S组）、再灌注后模型组（M组）和PARP抑制剂组（P组）,每组8只。比较各组大鼠右侧肾动脉缺血再灌注后2、6、12h后的血肌酐和尿素氮水平、肾脏组织病理学变化、肾组织PARP蛋白表达及肾组织VEGF-A和NGAI．mRNA表达。结果（1）M组各时间点的血肌酐、尿素氮水平均高于S组,P组各时间点血肌酐、尿素氮明显低于M组,差异均有统计学意义（P〈0．01）;（2）P组肾组织病理学表现较M组改善;（3）P组各时间点肾组织PARP表达明显低于M组,差异有统计学意义（P〈0．05）;（4）与M组相比,P组肾组织的VEGF-AmRNA的表达升高,NGALmRNA表达降低,有统计学差异（P〈0．05）。结论PARP抑制剂3AB对大鼠肾脏缺血再灌注损伤具有保护作用,可下调NGAL及上调VEGF-AmRNA表达。