在接受心脏手术的住院患者中,总血红蛋白的测定减少红细胞输注量:一项回顾性数据库分析

目的一直以来,围手术期血红蛋白监测依赖于测量血浆红细胞比容(Hct)的血气分析设备计算饱和度。测量总血红蛋白量(t Hb)的碳氧-血氧定量法,可获得对血液稀释更全面的评估。本研究旨在评估施行大心脏手术的住院患者中用碳氧-血氧定量法检测的t Hb和用电导率检测的Hct,与红细胞(red blood cell,RBC)输注、住院时间(length of stay,LOS)和住院费用的相关性。方法回顾性分析2014年1月至2016年6月行冠状动脉旁路移植术(CABG)和/或瓣膜置换(VR)术患者的临床资料,使用Med Assets出院数据。患者按照检测方式(t Hb和Hct)进行分组,采用详细的账单记录和当代操作术语编码。根据医院特定的成本费用比来计算住院费用。采用多变量logistic回归法来确定RBC输注和资源利用的重要驱动因素。结果本研究纳入18 169例心血管手术患者。其中Hct监测患者占66%,并更有可能进行CABG+VR双重手术(10.4%vs.8.9%,P=0.006 9)。在控制了患者和医院特征及患者合并症后,Hct组较t Hb组有明显更高的RBC输注风险(OR=1.26,95%CI 1.15~1.38,P0.000 1),更长的LOS(IRR=1.08,P0.000 1)和更高的费用(IRR=1.15,P0.000 1)。结论与Hct监测相比,在心血管手术期间进行t Hb监测可以显著减少RBC输注和住院费用、缩短住院时间。     

Evaluation of Factors Associated With Response to Hepatitis B Vaccination in Patients With Inflammatory Bowel Disease

It is recommended to investigate the serology of hepatitis B virus (HBV) and vaccinate seronegative patients at the time of diagnosis in inflammatory bowel diseases (IBD). This study aimed to investigate the efficacy of HBV vaccine and factors affecting the response.In this retrospective, observational study, HBV-seronegative IBD patients were administered 3 doses (at months 0, 1, and 6) recombinant 20 μg HbsAg. Patients’ demographics, IBD attributes, and treatment methods were investigated as the factors with potential impacts on vaccination outcomes.One hundred twenty-five patients with IBD were evaluated. The number of patients with Anti-HBs >10 IU/L was 71 (56.8%), and the number of patients with anti-HBs >100 IU/L was 50 (40%). Age, disease activity, Crohn disease subtype, and immunosuppressive treatment (IST) were found to have significant effects on immune response (P = 0.011, P < 0.001, P = 0.003, and P < 0.001, respectively). With multivariate analysis, age < 45 years (OR 3.1, 95% CI 1.2–8.3, P = 0.020), vaccination during remission (OR 5.6, 95% CI 2.3–14, P < 0.001), and non-IST (OR 11.1, 95% CI 2.9–43.2, P = 0.001) had favorable effects on the occurrence of adequate vaccine response.The likelihood of achieving adequate immune response with standard HBV vaccination protocol in IBD is low. Selecting vaccination protocols with more potent immunogenicity is a better approach to achieve effective vaccine response in patients with multiple unfavorable factors.     

Severe atrioventricular decoupling, uncoupling, and ventriculoatrial coupling during enhanced atrial pacing: incidence, mechanisms, and implications for minimizing right ventricular pacing in ICD patients

Background: Enhanced AAI/R pacing minimizes right ventricular pacing but may permit or induce AV decoupling (AV‐DC) due to unrestricted AV intervals (AVIs). The purpose of this study was to characterize and quantify AVI behavior in a randomized trial of enhanced AAI/R pacing in ICD patients. Methods: One hundred twenty‐one patients in the Marquis ICD MVP? Study, a randomized 1‐month crossover comparison of cumulative% ventricular pacing (Cum%VP) in enhanced AAIR (MVP) vs DDD/R, were analyzed. AV‐DC was defined as ≥40% AVIs >300 ms; VA coupling (VA‐C) was defined as%V‐atrial pace (AP) intervals <300 ms. Dynamic AVI behavior and increases in Cum%VP due to AV block (AV uncoupling, AV‐UC) were characterized using Holters with real‐time ICD telemetry. Results: AV‐DC occurred in 17 (14%) of patients. Baseline PR, amiodarone, nighttime, lower rate >60 beats/min, rate response, and Cum%AP were associated with longer AVIs. Logistic regression identified baseline PR (odds ratio [OR]= 1.024, 95% confidence interval [CI] 1.007–1.042; P = 0.005), and Cum%AP (OR = 1.089, 95% CI 1.027–1.154; P = 0.004) as predictors of AV‐DC. AV‐DC was associated with ≈10‐fold increases in both Cum%VP (13.6 ± 28.3% vs 1.2 ± 3.9%; P = 0.023) due to transient AV‐UC) and VA‐C (6.0 ± 17.5% vs 0.5 ± 1.2%, P = 0.028). AV coupling (<40% AVIs >300 ms) was preserved in 104 (86%) patients. Conclusions: AV‐DC, VA‐C, and AV‐UC may be worsened or induced by enhanced AAI/R pacing. Conservative programming of lower rate and rate response should reduce the risk of AV‐DC by reducing Cum%AP.     

Improved defibrillation efficacy with an ascending ramp waveform in humans

OBJECTIVES: The purpose of this study was to compare an ascending ramp waveform (RAMP) with a standard, clinically available biphasic truncated exponential waveform (BTE) for defibrillation in humans. BACKGROUND: In animal studies, RAMP had a lower defibrillation threshold (DFT) than BTE. METHODS: We studied 63 patients at implantable cardioverter-defibrillator placement using a dual-coil lead and left pectoral active can. The subjects were divided into two groups, one with a 12-ms ascending first phase and one with a 7-ms ascending first phase. Phase 2 of RAMP for both groups was a truncated exponential decay with 65% tilt and reversed polarity. The BTE had a 50% tilt in each phase. DFT and upper limit of vulnerability (ULV) were measured for both waveforms using a binary search protocol. RESULTS: The patient population was 77% male, with a mean age of 63 +/- 10 years and ejection fraction of 33 +/- 13%. Delivered energy at DFT was lower with the 7-ms RAMP vs BTE (5.4 +/- 2.6 J vs 6.5 +/- 3.4 J; P < .01) but unchanged with the 12-ms RAMP (7.4 +/- 4.5 J vs 7.1 +/- 4.9 J). Maximal voltage at DFT was significantly lower with either RAMP compared to BTE (P < .01). There was a strong correlation between ULV and DFT for both RAMP and BTE (P < .01). CONCLUSIONS: The 7-ms ascending ramp waveform significantly reduced delivered energy (18%) and voltage (24%) at DFT, whereas the 12-ms RAMP reduced only DFT voltage. This is the first report of a waveform that is superior to a BTE for defibrillation in humans. ULV correlates with DFT for RAMP, supporting the use of ULV testing for implantation of devices.     

Cytotoxic activities of new iron(III) and nickel(II) chelates of some <Emphasis Type="Italic">S</Emphasis>-methyl-thiosemicarbazones on K562 and ECV304 cells

The S-methyl-thiosemicarbazones of the 2-hydroxy-R-benzaldehyde (R= H, 3-OH 3-OCH₃ or 4-OCH₃) reacted with the corresponding aldehydes in the presence of FeCl₃ and NiCl₂. New ONNO chelates of iron(III) and nickel(II) with hydroxy- or methoxy-substitued N ¹,N ⁴-diarylidene-S-methyl-thiosemicarbazones were characterized by means of elemental analysis, conductivity and magnetic measurements, UV-Vis, IR and ¹H-NMR spectroscopies. Cytotoxic activities of the compounds were determined using K562 chronic myeloid leukemia and ECV304 human endothelial cell lines by MTT assay. It was determined that monochloro N ¹-4-methoxysalicylidene-N ⁴-4-methoxysalicylidene-S-methyl-thiosemicarbazidato-iron(III) complex showed selective anti-leukemic effects in K562 cells while has no effect in ECV304 cells in the 0.53 μg/ml (IC₅₀) concentrations. Also, some methoxy-substitued nickel(II) chelates exhibit high cytotoxic activitiy against both of these cell lines in low concentrations. Cytotoxicity data were evaluated depending on cell lines origin and position of the substituents on aromatic rings.     

A protective glycosylphosphatidylinositol-anchored membrane protein of Plasmodium yoelii trophozoites and merozoites contains two epidermal growth factor-like domains

Using sera from mice immunized and protected against Plasmodium yoelii malaria, we identified a novel blood-stage antigen gene, pypag-2. The 2.1-kb pypag-2 cDNA contains a single open reading frame that encodes a 409-amino-acid protein with a predicted molecular mass of 46.8 kDa. Unlike many characterized plasmodial antigens, blocks of tandemly repeated amino acids are lacking in the pypAg-2 protein sequence. Recombinant pypAg-2, comprising the full-length protein minus the predicted N-terminal signal and C-terminal anchor sequences, was produced and used to raise a high-titer polyclonal rabbit antiserum. This antiserum was used to identify and characterize the native protein through immunoblotting, immunoprecipitation and immunofluorescence assays. Consistent with the presence of a glycosylphosphatidylinositol anchor, pypAg-2 fractionated with the detergent phase of Triton X-114-solubilized proteins and could be metabolically labeled with [(3)H]palmitic acid. By immunofluorescence, pypAg-2 expression was localized to both the trophozoite and merozoite membranes. Similar to Plasmodium falciparum merozoite surface protein 1, pypAg-2 contains two C-terminal epidermal growth factor (EGF)-like domains. Most importantly, immunization with recombinant pypAg-2 protected mice against lethal P. yoelii malaria. Thus, pypAg-2 is a target of protective immune responses and represents a novel addition to the family of merozoite surface proteins that contain one or more EGF-like domains.