The cost-effectiveness of preoperative autologous blood donation for total hip and knee replacement

Although the frequency of preoperative autologous blood donation is increasing dramatically, the economic implications of its use remain largely unexplored. Decision analysis was used to calculate the cost- effectiveness of autologous blood donation for hip and knee replacement. Cost-effectiveness, expressed as cost per quality-adjusted year of life saved, was based on observed red cell use in 629 patients undergoing surgery at two tertiary-care centers. Autologous blood donation for bilateral and revision joint replacement cost $40,000 per quality-adjusted year of life saved at Center 1 and $241,000 at Center 2. Autologous blood donation for primary unilateral hip replacement cost $373,000 per quality-adjusted year of life saved at Center 1 and $740,000 at Center 2. Autologous blood donation was least cost- effective for primary unilateral knee replacement ($1,147,000/quality- adjusted year of life saved at Center 1 and $1,467,000/year at Center 2). Differences between autologous blood collections and transfusion requirements explained variations among procedures in the cost- effectiveness of autologous blood donation. Higher transfusion rates in autologous blood donors than in nondonors accounted for the poorer cost- effectiveness of autologous blood donation at Center 2 than at Center 1. Autologous blood donation is not as cost-effective as most accepted medical practices. Its cost-effectiveness can be improved substantially by the avoidance of overcollection and overtransfusion of autologous blood.     

新型无机微粒栓塞材料BaFe12O19的血液相容性实验

目的:评价BaFe12O19微粒作为一种新开发的具有潜在应用前景的新型血管内栓塞材料的血液相容性,并观察其对机体的出血时间、凝血时间及凝血酶原时间、纤维蛋白原测定、活化部分凝血活酶时间、凝血酶时间的影响。方法:BaFe12O19微粒材料于2005-07/2006-05在武汉理工大学生物材料与工程研究中心实验室完成,血液相容性实验于2006-05/09在解放军广州军区武汉总医院中心实验室完成。①溶血实验:取人新鲜全血,分别加入生理盐水(阴性对照组)、蒸馏水(阳性对照组)、无机微粒浸提液(实验组),观察溶血情况,计算溶血率。②出血、凝血时间测定:健康NIH小鼠随机分为实验组和对照组,分别腹腔注射无机微粒混悬液或生理盐水1 mL,7 d后测定出血、凝血时间。③凝血功能实验:取健康Wistar大鼠静脉血,随机分为实验组及对照组,分别注入1 g/L微粒混悬液或生理盐水1 mL,30 min后测量凝血功能。结果:①溶血实验结果:实验组和阴性对照组均无溶血现象,阳性对照组全部溶血,实验组的溶血率为2.08%,符合ISO规定的不大于5%的标准。②出血、凝血时间测定结果:实验组和对照组小鼠的出血、凝血时间比较差异无显著性意义(P>0.05)。③凝血功能实验结果:实验组和对照组凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间、凝血酶时间比较均无显著差别(P>0.05)。结论:BaFe12O19微粒符合血液相容性标准,具有良好的血液相容性能。     

Characterization of novel Mycobacterium tuberculosis pncA gene mutations in clinical isolates from the Ukraine

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Mycobacterium tuberculosis cases in the Ukraine are increasing. Pyrazinamide (PZA) is critically important for first- and second-line tuberculosis (TB) treatment regimes. However, PZA drug susceptibility testing is time consuming and technically challenging. The present study utilized Next-generation sequencing (NGS) to identify mutations in the pncA gene from clinical isolates and to assess the prevalence of pncA gene mutations in MDR/XDR-TB patients. Clinical isolates were inactivated in molecular transport media and shipped from Kharkiv, Ukraine, to San Antonio, TX. Whole-genome and targeted pncA gene sequencing was carried out using Illumina MiSeq instrumentation. Mutations were noted in 67 of 91 (74%) clinical isolates comprising substitutions, insertions, and deletions in the pncA coding and upstream promoter region. Of 45 mutation types, there were 11 novel, i.e., to date unknown, pncA mutations identified of which 3 were confirmed PZA resistant. Seven isolates contained mixed base mutations, whereas 4 harbored doubled mutations. Data reported here further support use of NGS for pncA gene characterization and may contribute in significant fashion to PZA therapy, especially in MDR- and XDR-TB patients.     

Fatal Airway Injuries during Operation Enduring Freedom and Operation Iraqi Freedom

Objective. To determine if a single mailing from the local volunteer fire department can increase the number of homes with proper, visible address numbering. Proper numbering is essential in rapidly locating a house during an emergency response. Methods. The study was conducted at a suburban/rural fire department providing EMS andfire suppression services to a 22 square mile area with residential mailboxes located at the street. During a hazard identification pre-plan tour, each house was examined andassigned a classification: (A) No number visible on the house or mailbox (improper); (B) Number on only one side of the mailbox (improper); (C) Number on both sides or the end of the mailbox, or visible on the house (proper). The homeowners of all residences with improper numbering (A or B) were sent a one-page letter, discussing the need for proper numbering. The tour was repeated six weeks later to determine whether deficiencies had been corrected. It was prospectively determined that a 25% improvement was sought. Results. During the pre-plan tour, 73 houses were classified as type A, 454 as type B, and1706 as type C. At the re-visit, 135 (26%) of the type A andB homes had been properly numbered. Correction of deficiencies was better at type A homes (37, or 51%) than at type B homes (98, or 22%) (p < 0.001 by Chi-square). Conclusion. For houses with improper numbering, a single mailing from the fire department can be effective in encouraging residents to post proper numbers.     

Final height gain by GH therapy in children with idiopathic short stature is dose dependent

Recombinant human GH therapy to children with idiopathic short stature (ISS) increases growth velocity, but its effect on final height (FH) is still uncertain. The aim of this study was to investigate the effect of recombinant human GH on FH of patients with ISS who were treated according to two protocols in comparison to untreated historical controls. In study 1 (n = 24), all patients were treated with 14 IU (4.6 mg)/m(2) body surface x wk in the first year; thereafter the dosage was doubled if the growth response was insufficient. In study 2 (n = 34), patients were randomized into three arms: 18 IU (6 mg)/m(2) x wk; 27 IU (9 mg)/m(2) x wk; and 18 IU/m(2) x wk in the first year, followed by 27 IU/m(2) x wk thereafter. Observed or estimated FH was available for 53 patients. Thirty-four untreated controls from the same centers were available for comparison. Mean FH SD score in GH-treated children was -2.1, vs. -2.4 in controls (-2.4) (NS), but height SD score gain (1.3 vs. 0.7) and the difference between FH and predicted adult height (4.0 vs. 0.8 cm) were significantly greater. The growth response on an initial dosage of 27 IU/m(2) x wk (6.9 cm) was significantly better than on other regimens (2.8 cm). We conclude that a GH dosage of 27 IU (9 mg)/m(2) x wk to prepubertal children with ISS leads to a mean FH gain of approximately 7 cm, whereas regimens starting on lower dosages are less efficacious.     

马缨丹根的化学成分研究

从马缨丹(Lantana camara L.)根的乙醇提取物中分离鉴定出六个寡糖(Ⅰ～Ⅵ)和六个环稀醚萜葡萄糖甙(Ⅶ～Ⅻ),即水苏糖(Ⅰ),毛蕊花糖(Ⅱ),筋骨草糖(Ⅲ),毛蕊花四糖(Ⅳ),α-D-半乳糖-(1[→6-)α-D-半乳糖-(1]₃→6-)D-葡萄糖(Ⅴ),α-D-半乳糖-(1[→6-)α-D-半乳糖-(1]₄→6-)D-葡萄糖(Ⅵ),黄夹子苦甙(Ⅶ),8-表马钱素(Ⅷ),山栀子甙甲酯(Ⅸ),黄夹苦甙(Ⅹ),lamiridoside(Ⅺ)和京尼平甙(Ⅻ)。Ⅴ和Ⅵ是新化合物,分别命名为马缨丹糖A(lantanose A)和马缨丹糖B(lantanose B),其余均首次从该植物中分离得到。     

Hemorrhagic intracranial malignant neoplasms: spin-echo MR imaging

Twelve patients with 15 separate, spontaneously hemorrhagic, intracranial malignant lesions (seven primary gliomas, eight metastatic lesions) were examined with spin-echo magnetic resonance imaging at 1.5 T, and with computed tomography. The signal intensity patterns of these lesions, as seen on both short repetition time (TR)/short echo time (TE) and long-TR/long-TE spin-echo pulse sequences, were compared with the previously described appearance at 1.5 T of non-neoplastic intracerebral hematomas. The images of hemorrhagic intracranial malignancies showed notable signal heterogeneity, often with identifiable nonhemorrhagic tissue corresponding to tumor; diminished, irregular, or absent hemosiderin deposition; delayed hematoma evolution; and pronounced or persistent edema, compared with non-neoplastic hematomas. The demonstration of these characteristics in the appropriate clinical setting may suggest malignancy as the cause of an intracranial hematoma.