Can the reading for serologic reactivity following 37 degrees C incubation be omitted?

The need to detect antibodies that agglutinate and/or hemolyze red cells (RBCs) directly at 37 degrees C, but do not react in subsequently performed indirect antiglobulin tests (IATs), is of concern relative to the streamlining and automation of antibody detection methods. To determine incidence and significance of such reactions, data from 87,480 tests, which used low-ionic-strength saline, 10-minute incubation at 37 degrees C, and anti-IgG, were analyzed for unexpected antibodies. There were 3590 positive tests, of which 475 showed reactions at 37 degrees C but not in subsequently performed IATs (37 + IAT-). Of these, 196 reactions were due to autoantibodies or other factors usually considered insignificant with respect to the survival of transfused incompatible RBCs, 176 were due to alloantibodies of questionable clinical significance (M, Lea, P1, etc.), and 103 were associated with alloantibodies of potential clinical significance (63 E, 27 K, 5 Jka, 4 D, 3 cE, and 1 C). This latter reaction was seen in 72 patients, with two 37 + IAT-antibodies occurring in each of 3 patients. Of the 75 potentially significant 37 + IAT-antibodies, 57 were seen in patients recently exposed to homologous RBCs, 13 in patients with a history of transfusion and/or pregnancy, and 5 in patients with no known exposure to homologous RBCs. IAT reactivity was observed in subsequent samples with 27 of these antibodies. The predictive value of a 37 + IAT-test was 21.7 percent for a potentially significant antibody. The incidence was 0.12 percent of all tests for unexpected antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous umbilical blood sampling and umbilical vein transfusions. Rapid serologic differentiation of fetal blood from maternal blood

Percutaneous umbilical blood samples (PUBS), obtained under ultrasound guidance, are used for prenatal diagnosis and management of hemolytic disease of the newborn (HDN) and other fetal disorders. Rapid testing at the time of sampling is vital to distinguish fetal from maternal blood. Blood typing was performed by slide technique in the treatment room during 38 procedures on 25 patients. Anti-I was used to test 50 presumed PUBS; venous I-positive maternal blood was tested in parallel. Because anti-I cannot detect fetal blood after umbilical vein transfusion (UVT) of I-positive donor blood, ABO and Rh blood typing reagents were used to test 29 samples when maternal and fetal or donor blood groups differed. Monoclonal reagents were used for optimal detection of weak AB antigens in fetal blood. Avid, chemically modified anti-D was used for Rh typing. Blood typing showed 27 (34%) of 79 samples to be maternal blood. Fetal blood was obtained in 8 of 10 cases investigated for fetal disorder and in 16 cases of potential HDN (anti-D, 5; -CD, 5; -cE, 2; -K, 2; -c; -E). The absence of HDN (antigen-negative fetus) was determined in 4 cases. UVT afforded live birth of 9 of 10 infants with HDN and was not indicated in two cases.     

Nationwide survey of home transfusion practices

BACKGROUND: Limited information exists on home transfusion practices. STUDY DESIGN AND METHODS: In 1995, a survey requesting data for 1994 was sent to 1273 American Association of Blood Banks (AABB) institutional members and 113 non-AABB home health care agencies that provide out-of-hospital transfusions. RESULTS: Of 943 respondents, 102 provide blood to a home transfusion program, 37 provide blood and run a home transfusion program, and 13 run a home transfusion program only, for a total of 152 (16%) with some involvement in home blood transfusions. Most of the 50 respondents with a home transfusion program are licensed by their state and accredited by the Joint Commission on Accreditation of Healthcare Organizations. All respondents have written policies for home transfusion, and 90 percent require a signed informed-consent document before initiating transfusions in the home. Most have policies requiring that there be a second adult and a telephone in the home, that the home be deemed safe for transfusion, that the patient's physician be readily available, and that the patient have had prior transfusions. The most common component issued by the blood providers was red cells, followed by platelets. White cell-reduced components were always provided by 36 percent of respondents. The most common patient diagnosis was cancer. Home transfusions were provided primarily by registered nurses. Only 14 percent of respondents indicated that the medical director of the blood bank is responsible for approving a patient for home transfusion. A posttransfusion visit is performed by 46 percent of respondents. CONCLUSION: Although most facilities have policies for the administration of home transfusions, there remains marked heterogeneity among blood providers and transfusionists regarding home transfusion practices.     

Performance of a Radiation Protection Cabin During Implantation of Pacemakers or Cardioverter Defibrillators

Radioprotection for Cardiac Device Implant . Introduction: Pacemaker implants are associated with a high cumulative exposure of the operators to radiation. Standard radiation protection with lead aprons is incomplete and the cause of spine disorders. A radiation protection cabin offers complete protection by surrounding the operator, without requiring a lead apron. Methods: We randomly and evenly assigned 60 patients undergoing implantations of permanent pacemakers or cardioverter defibrillators (ICD) with (a) a radiation protection cabin (cabin group, n = 30) versus (b) standard protection with a 0.5 mm lead‐equivalent apron (control group, n = 30). Radiation exposure was measured using personal electronic dosimeters placed on the thorax, back, and head of the operator. Results: The patient, procedural, and device characteristics of the 2 study groups were similar. All procedures in the cabin group were performed as planned without increase in duration or complication rate compared with the control group. The mean radiation dose to the head, normalized for fluoroscopy duration, was significantly lower in the cabin (0.040 ± 0.032 μSv/min) than in the control (1.138 ± 0.560 μSv/min) group (p < 0.0001). The radiation doses to the thorax (0.043 ± 0.027 vs 0.041 ± 0.040 μSv/min) and back (0.038 ± 0.029 vs 0.033 ± 0.018 μSv/min) in the cabin versus control group (under the apron) were similar. Conclusions: The use of a radiation protection cabin markedly decreased the exposure of the operator to radiation, and eliminated the need to wear a lead apron, without increasing the procedural time or complication rate during implantation of pacemaker and ICD. (J Cardiovasc Electrophysiol, Vol. 21, pp. 428–430, April 2010)     

大鼠慢性牙周炎与慢性肾衰竭模型的建立及相关性研究

目的 用SD大鼠建立慢性牙周炎（CP）和慢性肾衰竭（CRF）动物模型,探讨两种疾病是否相关。 方法 将40只健康雄性SD大鼠随机分为4组,每组10只：正常对照组、CP组、CRF组和CP＋CRF组。于8周末处死动物,检查记录牙周指标,检测血清中血肌酐（Scr）、尿素氮（BUN）、白细胞介素（IL）1β、肿瘤坏死因子（TNF）α的含量,观察牙周和肾脏组织病理学改变,进行统计学分析。 结果 成功建立了CP和CRF动物模型。CP＋CRF组Scr（120.54±21.29） μmol/L, BUN（34.20±14.44） mmol/L;CRF组Scr（93.63±18.82） μmol/L,BUN（17.77±4.15） mmol/L,两组间差异有统计学意义（P < 0.05）。肾脏病理显示,CP组肾组织出现炎性改变,CP＋CRF组肾脏炎细胞浸润,PAS、Masson染色评分与CRF组差异有统计学意义。牙周病理显示,CP组、CP＋CRF组出现明显牙周炎,CP＋CRF组附着丧失（AL）（173.60±16.75）μm,CP组AL（124.00±23.87） μm,两组差异有统计学意义（P < 0.05）。CP组、CRF组、CP＋CRF组血清IL-1β、TNF-α水平显著高于正常对照组 （P < 0.05）,CP＋CRF组IL-1β显著高于CP组、CRF组（P < 0.05）,CP＋CRF组TNF-α水平高于CP组、CRF组,且与CP组差异有统计学意义（P < 0.05）。2×2析因设计方差分析结果显示,CP与CRF对Scr、BUN、AL的数值具有交互作用（P < 0.05）,且两因素各自对上述指标的主效应显著（P < 0.05）;CP与CRF对IL-1β、TNF-α的数值不具有交互作用（P > 0.05）,但两因素各自对IL-1β、TNF-α的主效应显著（P < 0.05）。 结论 本模型可在SD大鼠同时显现牙周炎和慢性肾衰竭,CP可加重肾衰竭,两者间有相关性,CP可能通过炎性机制加重肾脏的损害。     

Levels of (1→3)-β-D-glucan, <Emphasis Type="Italic">Candida</Emphasis> mannan and <Emphasis Type="Italic">Candida</Emphasis> DNA in serum samples of pediatric cancer patients colonized with <Emphasis Type="Italic">Candida</Emphasis>species

Background  

Surveillance cultures may be helpful in identifying patients at increased risk of developing invasive candidiasis. However, only scant information exists on the effect of Candida colonization on serum levels of diagnostic biomarkers. This prospective surveillance study determined the extent of Candida colonization among pediatric cancer patients and its possible impact on serum levels of (1-3)-β-D-glucan (BDG), Candida mannan and Candida DNA.     

大蒜素对人胃癌细胞系MGC-803增殖的影响及其作用机制

目的通过大蒜素作用于人胃癌细胞系MGC-803,探讨其对胃癌细胞增殖的影响及机制。方法通过细胞培养技术检测大蒜素作用胃癌细胞后细胞增殖抑制率;免疫组化及RT-PCR法检测胃癌细胞中p16INK4因子表达变化。结果大蒜素作用于MGC-803细胞后,对其增殖表现出了明显的抑制作用,且呈浓度依赖性：大蒜素处理的MCC-803细胞p16蛋白及p16INK4 mRNA表达明显强于未应用大蒜素处理组（P〈0．05）。结论大蒜素可以抑制MGC-803细胞的增殖,其机制之一可能为上调了细胞抑癌基因p16INK4的表达。     

3种正畸粘接剂临床粘接效果对比分析

目的:比较3种临床常用的不同类型的正畸粘接剂托槽脱落率.方法:将新诊正畸患者75例分成3组,分别用3种粘接剂(A-Transband XT光固化粘接剂,B-京津釉质粘接剂,C-TF非调和型粘接剂)粘接后比较即刻加载后、加力1个月、3个月复诊后的托槽累计脱落率.结果:3种粘接剂即刻粘接后脱落率差异有统计学意义.结论:3种粘接剂远期粘接效果相同,即刻粘接效果TF非调和型粘接剂在3者中为最好.     

中医大学生传统医德教育创新对策思考

文章通过阐述中国传统医德的基本原则——＂医乃仁术＂,指出：面对市场经济和医学技术飞速发展的挑战,人们呼唤＂医乃仁术＂传统的复归,中国传统医德仍然具有现代价值。在此基础上,通过分析我国医疗服务工作和高等中医教育面临的新形势和新任务,阐明中国传统医德教育在中医大学生人才培养中的现实意义,提出加强中国传统医德教育的创新对策。     

术后硬膜外自控镇痛注药速度对镇痛效果的影响

【目的】观察硬膜外术后自控镇痛不同注药速度的镇痛效果和副作用的差异。【方法】选择2008年5月-2009年2月60例择期妇科下腹部开腹手术患者随机分为两组,两组各30例,A组布比卡因5.0mg/kg和芬太尼10.0μg/kg,加盐水至100ml,B组布比卡因5.0mg/kg和芬太尼10.0μg/kg,加盐水至200ml,分别于术毕硬膜外腔给予负荷量后接镇痛泵,观察术后4、8、16、24、36、48h的ECG、sPO2、RR、BP疼痛及镇静评分并记录恶心呕吐瘙痒等不良反应。【结果】两组患者单位时间实际用药量、镇静评分无显著性差异,疼痛评分（VAS）B组明显低于A组,有显著性差异（P〈0.05）,两组恶心呕吐等副反应的发生率无显著性差异（P〉0.05）。【结论】在不增加镇痛液的药物剂量的情况下,加大容量、提高注药速度能取得更好的术后镇痛效果。