Transfusion patterns in pediatric open heart surgery

BACKGROUND: Transfusions in pediatric open heart surgery were analyzed to determine the percentage of patients transfused, the types and volumes of blood components used, and the relationships among transfusions, patient characteristics, surgeon, and surgical procedure. STUDY DESIGN and METHODS: In a 9-month period, 122 patients, aged 12 or less (median, 1 year; 31% <4 months old), underwent 126 procedures (37 routine, 60 complex, 29 repeat operations). Bypass circuit size and priming solution, target intraoperative hematocrit, heparinization, protamine reversal, and transfusion indications and doses were standardized. The number of full "adult" units of packed red cells (RBCs), units of fresh-frozen plasma (FFP), and platelet concentrates (PCs) transfused in the operating room through postoperative Day 3 were tabulated. RESULTS: RBCs, FFPs, and PCs were transfused in 98, 54, and 58 percent of cases, respectively. Twenty-two percent of components were transfused postoperatively. The average numbers of components transfused for complex procedures (3.4 RBCs, 6.1 total) and repeat operations (4.0 RBCs, 8.1 total) were greater than those for routine procedures (1.8 RBCs, 2.1 total) (p<0.01). The average total number of components transfused did not correlate with surgeon or patient age; patients <4 months old used the largest mean numbers of RBCs and total components of all types. For four procedures, preoperative crossmatch and directed-donation collection orders that would be expected to produce acceptable utilization rates and a <15-percent chance of needing additional components were determined. CONCLUSION: Blood order protocols for pediatric open heart surgery can be procedure-specific, should address the use of non-red cell components, and should cover early postoperative transfusions.     

生长期运动性骨量增加对延缓增龄骨量丢失的作用

目的:探讨生长期,尤其是青春期进行体育运动所获得骨量的增加能否减缓增龄性骨量丢失,预防骨质疏松发生。资料来源:应用计算机检索Medline,EBSCO全文数据库1980-01/2006-06关于运动与生长期骨量的研究文献,检索词"exercise,growing,bone",限定语言种类为English。资料选择:对资料进行初审,选取包含对生长期进行运动干预的研究文献。纳入标准:①生长期人体和动物运动对骨的干预研究。②研究目的为停训和运动量减少后的骨量或骨密度变化的研究。③全文。排除综述文献。资料提炼:共检索到62篇关于运动与生长期骨量的研究文献,最终纳入符合标准的文献30篇。资料综合:关于停训后和运动量减少后骨密度的变化,一些人体研究和动物研究结果存在一定的差异,但两种研究方法均揭示,停训后坚持一定量运动可以使生长期运动所获得的增加骨量得以维持。而且由于生长期运动所增加骨量的部位和增龄性骨吸收的部位是不同的,因此认为生长期进行运动所获得骨量的增加可以维持至老年期。本文拟就运动与生长期骨量的关系作一综述。结论:生长期运动所获得骨量的增加可以维持至老年期,以对抗增龄性的骨量丢失,在预防骨质疏松发生中具有一定意义。     

Damage occurs early in systemic vasculitis and is an index of outcome

Because death after acute systemic vasculitis is now uncommon, alternative measures of outcome are required. A significant component of patient morbidity is disease-related damage, which can be quantified by the Vasculitis Damage Index (64 items in 11 organ-based systems). We investigated serially the time-course of damage in 120 patients with systemic vasculitis, to determine the earliest indicators of outcome. High damage scores at 2 years after presentation were characteristic of fatal disease (OR 8.1-12.4). Significant damage occurred within 6 months of presentation, and was a feature of fatal disease. More damage occurred after presentation than after relapse. Lung and multi-system damage were early indicators of poor outcome in severe non-fatal disease. Damage occurs early in systemic vasculitis, and is an indicator of poor outcome. This novel observation, together with evidence of persistent subclinical disease activity and the high frequency of relapse, suggests a need for new treatment strategies. Analogy with the management of acute leukaemia suggests a strategy of early diagnosis and intensive induction of remission, with early escalation of treatment for resistant disease.      

Changing patterns of blood transfusions in four sets of United States hospitals, 1980 to 1985

Annual transfusion activity between 1980 and 1985 was surveyed in four sets of United States (US) hospitals, which together accounted for 4.8 percent of the red cell (RBC) transfusions in the US in 1980. Total RBC transfusion rates (total RBCs transfused/1000 hospital admissions) increased between 1980 and 1982 but remained nearly constant between 1982 and 1985. Plasma transfusion dynamics followed a similar pattern, whereas the preoperative deposit of autologous blood by patients accelerated rapidly after 1982. These changes appear to reflect responses to the acquired immune deficiency syndrome epidemic. In contrast, total platelet transfusion rates grew by 76 percent during the 6-year period, approaching total RBC rates by 1985. This is the first reported evidence in such a large sample of transfusions that total RBC transfusion rates have moderated.     

Assessment of non-heart-beating donor (NHBD) kidneys for viability on machine perfusion.

The shortage of organs has resulted in renewed interest in organs from non-heart-beating donors (NHBD). Viability assessment of such organs may reduce the incidence of delayed graft function and primary non-function. In Phase III of the NHBD programme, introduction of machine perfusion enabled the assessment of these marginal donors. Since then the graft survival has been 88.4% compared with the previous phase where machine perfusion or viability assessment was not done (45.5%). The parameters used were total glutathione S-transferase (GST) in the perfusate, the intrarenal vascular resistance (IRVR) and flow characteristics over time. METHODS: All NHBD kidneys were machine perfused through a locally developed perfusion system. The viability was assessed by serial measurements of the above-mentioned parameters. RESULTS: Forty-two local NHBD kidneys were retrieved and one kidney was imported, of which 19 donors (i.e. 38 kidneys) were of the uncontrolled (category II) donors. After viability assessment on machine perfusion; two kidneys were discarded due to positive tests for syphilis, four kidneys had high total GST levels, five kidneys due to high IRVR and poor flow characteristics and one did not flush on retrieval. Three kidneys were exported after viability tests. In 28 NHBD kidney recipients, immediate graft function was seen in two kidneys, 22 (84.6%) developed delayed graft function. One kidney had primary non-function, and two recipients lost their grafts, due to chronic rejection and renal vein thrombosis. There were two deaths, unrelated to transplantation. Graft survival was achieved in 88.4% (23/26 graft survival in phase III) of cases. CONCLUSION: Machine perfusion and assessment of NHBD kidneys has been successfully introduced to the Newcastle NHBD programme. This approach, using renal transplants from largely category II donors produced a success rate of 88.4% which was significantly better than the phase II period (45.5%) of the program (p=0.023, Fisher 2 tail test).     

Bifidobacterium breve M‐16V as a Probiotic for Preterm Infants: A Strain‐Specific Systematic Review

Introduction: Bifidobacterium breve M‐16V has been used as a probiotic in preterm infants. Probiotic strain‐specific data are essential to guide clinical practice. Objective : To assess effects of B breve M‐16V in preterm neonates. Design : A systematic review of randomized controlled trials (RCTs) and non‐RCTs of B breve M‐16V in preterm infants was conducted. Multiple databases, proceedings of Pediatric Academy Society, and other relevant conferences were searched in September 2016 and on January 5, 2017. Results : Five RCTs (n = 482) and 4 non‐RCTs (n = 2496) were included. Of the 5 RCTs, 4 carried high/unclear risk of bias in many domains. Meta‐analysis (fixed effects model) of RCTs showed no significant benefits on stage ≥2 necrotizing enterocolitis, late‐onset sepsis, mortality, and postnatal age at full feeds. Meta‐analysis of non‐RCTs showed significant benefits on (1) late‐onset sepsis—3 studies (n = 2452), odds ratio = 0.56 (95% CI, 0.45–0.71), P < .0001; (2) mortality—2 studies (n = 2319), odds ratio = 0.61 (95% CI, 0.44–0.84), P = .002; and (3) postnatal age at full feeds (days)—2 studies (n = 361), mean difference, ?2.42 (95% CI, ?2.55 to ?2.3), P < .00001. There were no adverse effects from B breve M‐16V. On Grading of Recommendations, Assessment, Development, and Evaluation analysis, the overall quality of evidence was deemed very low. Conclusions : Current evidence is limited regarding the potential of B breve M‐16V in preterm neonates. Adequately powered, preferably cluster RCTs are needed to confirm these findings.