Assessment of the urgency and deferability of transfusion to inform emergency blood planning and triage: the Bloodhound prospective audit of red blood cell use

BACKGROUND: Careful planning is essential to ensure blood availability during shortages. Triaging supply is one proposed strategy; however, few data concerning the urgency of transfusion are available to inform planning. This study sought to determine the proportion of red blood cells (RBCs) used for clinically urgent indications.
STUDY DESIGN AND METHODS: A total of 5132 RBC units were randomly selected at point of production and distributed into general statewide inventory over a 9-month period. These selected units carried case report forms, for completion at the point of hospital issue for transfusion. Completed forms were returned to the blood service for collation and analysis, capturing information on indication and clinical urgency of supply, including use for potentially deferrable elective surgery.
RESULTS: Data from 5052 RBC units indicated that 95.6% were transfused. Approximately one-third of transfused units were used to support surgery, one-third for hematology/oncology, and one-third for other medical and miscellaneous indications. Where used for surgery, 25.7% (95% confidence interval [CI], 23.4%-28.0%) were for elective procedures, although urgency of surgery was unknown in 17.1% (95% CI, 15.2%-19.2%) of cases. Supply for nonurgent medical indications and elective surgery only accounted for 9.8% (95% CI, 9.0%-10.6%) of use, with 53.4% (95% CI, 52.0%-54.8%) of RBCs required within 24 hours.
CONCLUSIONS: The majority of RBCs are transfused with a high degree of clinical urgency, with only a minor proportion required to support elective surgery.     

Absent intracranial translucency--new ultrasound marker for spina bifida at 11-13+6 weeks of gestation

Spina bifida is the most common abnormality of the fetal central nervous system. Prenatal diagnosis is usually made by ultrasound in the second or third trimester of pregnancy. However, first trimester detection of spina bifida is still a challenge. A new indirect ultrasound sign of open spina bifida between 11-13 6 weeks of gestation (w.g.) has been recently described. The marker is associated with an absence of intracranial translucency (IT) in the mid-sagittal plane. We present a case report of an open spina bifida detected at 13+2 weeks of gestation with an absent IT. The main ultrasound characteristics of normal and absent IT are described. In addition, the diagnostic role of three-dimensional (3D) transvaginal ultrasound is also discussed.     

Are COX‐2 inhibitors preferable to combined NSAID and PPI in countries with moderate health service expenditures?

Rationale In developed countries, cyclooxygenase 2 (COX‐2) inhibitors were shown to be less costly than the combination of non‐steroidal anti‐inflammatory drugs (NSAIDs) and proton pump inhibitors (PPIs) in treatment of patients with high risk of serious gastrointestinal (GI) adverse effects. It is questionable if such results apply to developing countries where health service costs are lower and there is high discrepancy between generic and patent protected drug prices. We analysed the direct cost of treatment with generic NSAIDs in combination with PPIs versus branded COX‐2 inhibitors in patients with high risk of serious GI adverse effects from the perspective of the public health service in Serbia. Methods Total cost of treatment of serious GI complications and the use of NSAID+PPI versus COX‐2 inhibitors were calculated. A model for estimation of cost of treatment of NSAID+PPI versus COX‐2 inhibitors which included the probability of developing serious GI adverse effects was developed. Results Total cost of treatment of serious GI adverse effects resulted in an average of $814/patient. Considering the relative risk of such adverse effects for patients with four or more risk factors, the least costly treatment over 6 months was the use of celecoxib ($487). Compared with diclofenac+omeprazole, cost savings were estimated at $59 and $22 per patient with celecoxib and etoricoxib, respectively. Conclusion Cost savings may be achieved by using COX‐2 inhibitors in patients at high risk of GI adverse effects even in countries with moderate health care service expenditures. Such possibility requires further investigation.     

Mortality among the Chernobyl emergency workers: estimation of radiation risks (preliminary analysis).

This paper presents results of the analysis of mortality among Chernobyl accident emergency workers who are resident in Russia. The analysis is based on information for the cohort of emergency workers (males) from six regions of Russia including 65,905 persons with documented external doses in the range 0.005-03 Sv. These data were gathered during the period 1991 to 1998 and cover a total of 426,304 follow-up person-y. In this period, 4,995 deaths occurred in the cohort under study. The mortality analysis was performed for four groups of causes of death (ICD-9 codes): (1) malignant neoplasms (140-239); (2) cardiovascular diseases (390-459); (3) injuries, poisoning and violent deaths, (800-999); and (4) the remainder (other than the above). The standardized mortality rate for groups 1, 3, and 4 is less than unity and varies from 0.6 to 0.9. For group 2 (death from cardiovascular diseases) the standardized mortality rate conforms with the control within 95% confidence intervals. The control was the mortality rate (males) for the corresponding ages in Russia in general and the internal control, the spontaneous mortality among emergency workers, derived from the equation of the observed and expected number of cases in the followed up cohort. Dose response of mortality was studied. Statistically significant radiation risks were obtained for mortality from malignant neoplasms (515 cases) and cardiovascular diseases (1,728 cases). The values of the excess relative risk per unit dose (ERR Sv(-1)) for malignant neoplasms and cardiovascular diseases are estimated as 2.11 (1.31, 2.92 95% CI) and 0.54 (0.18,0.91 95% CI) (for external control), 2.04 (0.45, 4.31 95% CI) and 0.79 (0.07, 1.64 95% CI) (for internal control), respectively. The risk of death from all noncancer causes is close to zero and not statistically significant.     

Genomic events associated with progression of pleural malignant mesothelioma

Pleural malignant mesothelioma (MM) is an aggressive cancer with a very long latency and a very short median survival. Little is known about the genetic events that trigger MM and their relation to poor outcome. The goal of our study was to characterize major genomic gains and losses associated with MM origin and progression and assess their clinical significance. We performed Representative Oligonucleotide Microarray Analysis (ROMA) on DNA isolated from tumors of 22 patients who recurred at variable interval with the disease after surgery. The total number of copy number alterations (CNA) and frequent imbalances for patients with short time (<12 months from surgery) and long time to recurrence were recorded and mapped using the Analysis of Copy Errors algorithm. We report a profound increase in CNA in the short-time recurrence group with most chromosomes affected, which can be explained by chromosomal instability associated with MM. Deletions in chromosomes 22q12.2, 19q13.32 and 17p13.1 appeared to be the most frequent events (55-74%) shared between MM patients followed by deletions in 1p, 9p, 9q, 4p, 3p and gains in 5p, 18q, 8q and 17q (23-55%). Deletions in 9p21.3 encompassing CDKN2A/ARF and CDKN2B were characterized as specific for the short-term recurrence group. Analysis of the minimal common areas of frequent gains and losses identified candidate genes that may be involved in different stages of MM: OSM (22q12.2), FUS1 and PL6 (3p21.3), DNAJA1 (9p21.1) and CDH2 (18q11.2-q12.3). Imbalances seen by ROMA were confirmed by Affymetrix genome analysis in a subset of samples.     

原发性开角型青光眼视盘形态变化分析33例(英文)

目的:分析原发性开角型青光眼(POAG)视盘损害的进展和进展频率。方法:33例(66眼)POAG患者,男14例,女19例,年龄14 ～79岁,在随访的6a间(2000/2006),3次或更多次进行海德堡视网膜断层扫描仪Ⅱ(HRT Ⅱ)检查。对整体和节段的视盘参数进行回归分析判断视盘损害的进展。患者每年进行Octopus G1计算机视野分析检查一次。激光扫描视盘图像参数包括:盘沿面积(ra),杯盘比(C/D),盘沿体积(rv),平均视神经纤维层厚度(mRNFL)。扫描视神经的节段包括总体(G),颞侧(T),颞上(TS),颞下(TI),鼻侧(N),鼻上方(NS)和鼻下(NI)。结果:根据杯盘比C/D,总体上有34眼(51%)视盘损害进展,32眼(48%)没有进展。12眼(18%)颞侧(T),7眼(10.6%)颞上,14眼(21%)颞下,8眼(12%)鼻侧,7眼(10,6%)鼻上,13眼(20%)鼻下,视盘损害进展。5眼(8%)没有进展。结论:在鼻侧(N)及颞下方(TI)视盘损害进展最多,进展频率最高在颞下方(TI)和鼻下方(NI),频率最低在鼻上方(NI)。杯盘比C/D最敏感。节段扫描对POAG进展分析有重要意义。