The effect of an intraoperative treatment algorithm on physicians' transfusion practice in cardiac surgery

Background : Inappropriate transfusion in cardiac surgery may, in part, be due to empiric transfusion therapy instituted in the absence of timely laboratory data. Therefore, the effect of a transfusion decision algorithm based on intraoperative coagulation monitoring of physicians' transfusion practice and the transfusion outcome was evaluated. Study Design and Methods : In a randomized, controlled trial, cardiac surgical patients determined to have microvascular bleeding at the cessation of cardiopulmonary bypass were assigned to algorithm (A) or standard (S) therapy. Group A was treated with plasma and platelet therapy according to a transfusion algorithm based on on-site coagulation data available within 4 minutes. For Group S, the use of laboratory-based data and the decision to transfuse blood components were at physician discretion. Results : Sixty-six patients were entered into the study (Group A, n = 30; Group S, n = 36). Other than the fact that there were significantly more female patients in Group S than in Group A, no differences between cohorts in regard to perioperative risk factors for blood transfusion needs were identified. Therefore, gender was factored in as a covariate in the statistical analysis. Group A patients received fewer hemostatic blood component units (p = 0.008) and had fewer total donor exposures (p = 0.007) during the entire hospitalization period. Linear regression analysis of the differences in slopes in Groups A and S for the relationships between the red cell volume lost and the red cell volume transfused (p < 0.03), non-red cell units transfused (p < 0.0001), and total number of blood components transfused (p < 0.0001) demonstrated that physicians' transfusion practice was significantly altered by the use of a transfusion algorithm with on-site coagulation data, independent of surgical blood losses. Conclusion : The use of algorithms by transfusion decision makers can serve as an effective physician education intervention.     

Rapid freezing of whole blood or buffy coat samples for polymerase chain reaction and cell culture analysis: application to detection of human immunodeficiency virus in blood donor and recipient repositories. The Transfusion Safety Study Group

Storage of lymphocytes for later use in prospective epidemiologic studies of blood donors and transfusion recipients has been limited by the cost of separating peripheral blood mononuclear cells (PBMCs). When the Transfusion Safety Study began in 1985, it was decided to establish a cell repository of cryopreserved buffy coat (BC) samples, and thus far over 20,000 samples have been accumulated from enrolled subjects. To determine if these specimens could be used for polymerase chain reaction, a simple thawing and pelleting technique for recovering hemoglobin-free total white cells (WBCs) was developed. To validate the technique, parallel analysis was conducted of BCs, whole blood (WB), and PBMC samples from human immunodeficiency virus type 1 (HIV-1)- seropositive subjects. Immediate postthaw cell courts of 29 frozen- thawed (F-T) WB and BC samples averaged 90 percent of the prefreeze (input) values. Representative WBC populations were obtained by immediate pelleting. Amplification of HIV-1 gag sequences from F-T BCs and F-T WB was 94 and 75 percent, respectively, which is as sensitive as that obtained with freshly separated PBMC lysates. Quantitative HIV- 1 proviral load analysis by serial dilution of 23 F-T BCs and 8 WB lysates showed results comparable to those obtained with lysates of fresh PBMCs. Values for WBC differential and immunophenotyping could be applied to express viral load relative to total WBCs, PBMCs, or CD4+ cells. These results establish the basis for simplified virologic analysis of cryopreserved BC or WB specimens.     

石斛类叶鞘的显微鉴定研究

商品石斛的植物来源复杂,规格繁多,外形鉴定较困难。为了准确鉴定石斛的品种,对常作为药用的16种石斛属(Dendrobium Sw)植物的叶鞘进行了显微观察,发现其表皮细胞的形状,大小,所含草酸钙结晶的形状、大小、分布等种间区别较明显,可作为鉴别石斛种类的科学依据之一。本文对金钗石斛D.nobile Lindl。等16种石斛的叶鞘表面特征加以描述,并附主要特征图和检索表。     

盐酸普鲁卡因经皮离子导入的研究

目的：考察盐酸普鲁卡因的离子导入与电流强度、药物浓度的关系。方法：测定不同的电流强度、不同的药物浓度的离子导入增渗倍数（ＥＲ）。结果：固定药物浓度,电流强度为０．１,０．２和０．３ｍＡ时的ＥＲ值分别为６８．９９和１２７。固定电流强度０．２ｍＡ,药物浓度为０．０１５１,０．０３０４和０．０６０５ｇ／１００ｍｌ时的ＥＲ值分别为９５,９９和９８,结论：离子导入可以显著提高药物渗透速率,增渗倍数（ＥＲ）随     

L -粘附素单抗在缺血再灌注损伤中的作用

目的中性粒细胞粘附在缺血再灌注损伤中有非常重要的作用.本文用SD大鼠趾长屈肌缺血再灌注损伤模型,观察L-粘附素单抗LAM1-116在缺血再灌注损伤中的作用.方法30只SD大鼠被均分为2组LAM1-116组和生理盐水对照组.每只大鼠的一侧趾长屈肌作为正常对照,另外一侧进行3 h缺血4 h再灌注.结果LAM1-116组实验侧的髓过氧化物酶为正常的2倍(2.3±2.2),生理盐水对照组则为正常的28倍(27.5±11.7)(P＜0.001);LAM1-116组的湿重比(1.10±0.10)、疲劳肌力(77.1%±12.1%)与对照组相比(分别为1.23±0.10和49.7%±9.3%)明显改善(P＜0.05);组织学上,LAM 1-116组的中性粒细胞局部浸润显著减少,水肿减轻.结论通过L-粘附索单克隆抗体LAM1-116阻断L-粘附素的功能,可以有效地降低中性粒细胞在再灌注肌肉中的浸润,防止组织水肿,从而改善肌肉的功能.