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151.
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154.
We have used the techniques of radioimmunoprecipitation (RIP) and Western blot to identify the membrane proteins that bind certain alloantibodies. Anti-PlA1 sera precipitated two bands, corresponding to platelet glycoproteins IIb and III, whether or not calcium was present during the procedure. By Western blot, this antibody bound only glycoprotein III. Anti-PlA1 serum does not precipitate proteins from the platelets of a patient with Glanzmann's thrombasthenia. Two monoclonal antibodies reacting with lymphocyte HLA antigens, as well as sera from highly allosensitized patients, precipitated bands of 38,500 and 13,500 daltons. These bands correspond to the molecular weights of the two subunits of the HLA antigen, as it has been described for other cell types. The patients' sera also precipitated a protein of 72,000 daltons from some platelets. The sera of two patients with quinidine- induced thrombocytopenia precipitated a 138,000-dalton band (glycoprotein Ib-alpha) in the presence of quinidine. The purified IgG antibody from one patient did not require other plasma factors to bind to platelets in the presence of quinidine, while purified antibody from a second patient required plasma factors other than, or in addition to von Willebrand factor. Although several sera from patients with idiopathic thrombocytopenic purpura (ITP) were tested, only one precipitated membrane proteins by the RIP method; this serum identified binding proteins corresponding to glycoproteins IIb and III. 相似文献
155.
Transfusion and alloimmunization in sickle cell disease. The Cooperative Study of Sickle Cell Disease 总被引:2,自引:0,他引:2
Rosse WF; Gallagher D; Kinney TR; Castro O; Dosik H; Moohr J; Wang W; Levy PS 《Blood》1990,76(7):1431-1437
In 1,814 patients with sickle cell disease who had been transfused, the overall rate of alloimmunization to erythrocyte antigens was 18.6%. The rate of alloimmunization in this group appears to be an explicit function of the number of transfusions received because it increases exponentially with increasing numbers of transfusions. Alloimmunization usually occurred with less than 15 transfusions, although the rate of alloimmunization continued to increase when more transfusions were given. The rate of alloimmunization was less in patients with hemoglobin SC disease and sickle-beta+ thalassemia because these patients had received fewer transfusions. Children less than 10 years old had a slightly lower rate of alloimmunization than patients in other age groups even after correction for the number of transfusions given. Women were more frequently alloimmunized than men; this was largely due to the fact that women received more transfusions than men, but in the age group 16 to 20 years the increase may have been due in part to alloimmunization owing to pregnancy. Forty-five percent of those alloimmunized made antibodies of only one specificity; 17% made four or more antibodies reacting with different antigens. Antibodies to the C and E antigens of the Rh group, the Kell antigen, and the Lewis antigens were most commonly made. These findings may be important in formulating a rational transfusion policy in sickle cell disease. 相似文献
156.
Peacock WF IV Emerman CL McErlean ES Deluca SA van Lente F Rao JS Nissen SE 《Annals of emergency medicine》2000,35(3):213-220
STUDY OBJECTIVE: Recent reports suggest a short series of cardiac troponin (cTnT) testing effectively identifies patients at risk for cardiac events. However, there are few studies validating this strategy. The purpose of this study was to determine the ability of cTnT levels to predict short- and long-term outcomes in low-risk patients with suspected acute coronary syndromes. METHODS: This prospective longitudinal study was conducted in a 20-bed emergency department observation unit. Patients at low risk for acute coronary ischemia, with a normal creatine kinase-isoenzyme subunit MB (CKMB) index, were admitted to an observation unit for chest pain evaluation. Serum cTnT levels were measured at baseline and at 4, 8, and 16 hours after admission. The main outcome measures were adverse cardiac events (death, acute myocardial infarction, unstable angina, revascularization) during the index visit and within 6 months after discharge. Using manufacturer's recommendations, the cTnT level was considered abnormal if it exceeded 0.2 microg/L. RESULTS: Two hundred sixty-six patients were evaluated. Twenty-one (7.9%) had an adverse event during their index hospitalization. Troponin testing identified only 2 (9.5%) of these patients. Twenty (7.5%) had a cardiac event within 6 months; none were identified by cTnT testing. The sensitivity and specificity were 9.5% and 99.2%, respectively, at the index visit, and 0% and 98.4% at 6 months. The positive and negative predictive values were 50% and 93%, respectively, at the index visit; and 0% and 92% at 6 months. CONCLUSION: Determination of troponin T levels has a low sensitivity and high specificity for predicting outcomes in low-risk patients evaluated for suspected acute coronary syndromes. This study does not support a strategy of relying solely on troponin testing for disposition decisions. 相似文献
157.
Sander Ovaere Isabelle Boscart Isabelle Parmentier Pieter Jan Steelant Tino Gabriel Junior Allewaert Hans Pottel Franky Vansteenkiste Mathieu D’Hondt 《Journal of gastrointestinal surgery》2018,22(4):684-694
Background
In the field of liver surgery, evidence on the effectiveness of clinical pathways based on ERAS principles is limited.Methods
This is a single-center observational study from a prospectively maintained database. Two cohorts were formed of all patients undergoing liver surgery during a defined period before (traditional management) and after introduction of a clinical pathway. Additionally, a case-match analysis—based on approach, tumor location, and Brisbane classification of resection—was performed. A cost analysis and patient satisfaction questionnaire were carried out.Results
In both the overall analysis (n?=?229) as well as the case-match analysis (n?=?100), hospital stay was significantly reduced from 8 to 4 days and from 6.5 to 4 days, respectively (p?<?0.05). Postoperative morbidity (traditional management 11/50 vs clinical pathway 5/50; p?=?1.00) and readmission rate did not increase. Cost analysis showed a significant decrease in postoperative costs in favor of the clinical pathway (traditional management €3666.7 vs clinical pathway €1912.2; p?<?0.001). Overall, 92.3% of the survey questions were answered with satisfied (86.0%) or very satisfied (6.3%).Discussion
Implementation of clinical pathway for liver surgery is feasible and safe. A clinical pathway significantly reduces hospital stay without increasing postoperative morbidity and readmission rates. Postoperative costs are significantly reduced. Patient satisfaction is high.158.
Psychiatric aspects of Cushing's syndrome 总被引:1,自引:0,他引:1
Patients with Cushing's syndrome were studied (n=209, 78% females). Control
patients had pituitary adenomas secreting growth hormone or prolactin. Age
at diagnosis of Cushing's syndrome was 8-74 (mean 39) years. Duration of
symptoms was 0.2-9 (median 2.0) years. Adverse life events within the 2
years preceding the onset of Cushing's syndrome were not significantly
commoner than in controls. Depressive illnesses were associated with the
presence of adverse life events (p<0.001). Depressive illness was
more common in females (p<0.01). There were no significant
differences in the severity of depression in the different types of
Cushing's syndrome. Pathological anxiety had been diagnosed in 26 patients
(12%), mania or hypomania in six patients (3%) and confusion in three
patients (1%). Psychotic illness had been diagnosed in 16 patients (8%) and
was more common in adrenal carcinomas (p<0.01). Significant
psychiatric illness, usually depressive preceded the onset of all symptoms
and signs of Cushing's syndrome in 25 patients (12%); 23 of these developed
pituitary Cushing's disease, and two adrenal adenomas. When Cushing's
syndrome was diagnosed, significant psychiatric illness, usually
depression, was present or had been a feature of Cushing's syndrome in 120
(57%) patients.
相似文献
159.
This article introduces a new method of component preparation that is capable of producing white cell (WBC)-reduced platelet concentrates (PCs) from whole blood. Whole blood is separated into packed red cells (RBCs) and platelet-rich plasma (PRP) by centrifugation, and the PRP is expressed through a newly designed WBC removal filter into the platelet storage bag. The filtered PRP is then centrifuged and yields WBC-reduced PCs and plasma for freezing as fresh-frozen plasma (FFP). The method uses standard triple-pack blood bags and centrifugation protocols. Fifteen WBC-reduced PCs prepared with this technique had an average volume of 56.7 mL, an average Day 5 platelet content of 8.6 x 10(10) per unit, and an average Day 5 WBC content of 0.83 +/- 0.7 x 10(4) per unit (0.14 WBCs/microL). This represents WBC removal equal to at least 99.9 percent (3 log10) of the WBCs found in standard PCs prepared in our laboratory by an identical centrifugation protocol. Paired studies documented a 4.5-percent platelet loss by filtration. Filtration had no effect on the plasma prepared for FFP as measured by prothrombin time; activated partial thromboplastin time; factors I, V, VIII:C, and VIII:von Willebrand factor; antithrombin-III; albumin; globulin; or total protein. This method holds promise as a simple and highly effective technique for the production of WBC-reduced PCs by filtration during component preparation. 相似文献
160.
The role of residual donor white cells (WBCs) in producing the storage lesion of platelets used for transfusion was studied. The effect of prestorage WBC reduction on in vitro and in vivo measurements of the quality of stored platelet concentrates (PCs) was examined by using a newly developed WBC-reduction filter capable of preparing PCs with a mean residual WBC concentration of less than 1 per microL. For in vitro studies, a triplet study design was used, in which WBC-reduced PCs were matched to standard PCs and to WBC-enriched PCs obtained from the same donor at the same phlebotomy. Twelve donors were studied. Prestorage WBC reduction resulted in a higher pH and pO2 and a lower pCO2 than in standard PCs. In accord with previous in vitro studies, a significant rise in plasma glycocalicin and lactate dehydrogenase was measured during storage, but the levels were not significantly different in WBC-reduced PCs and standard PCs. Platelet aggregation and ATP release in response to graded doses of thrombin was similar in WBC-reduced and standard PCs. In vivo recovery and survival studies were comparable in WBC-reduced and standard PCs. Although the residual donor WBC content of PCs has a significant impact on storage pH, pO2, and pCO2, prestorage WBC reduction does not affect platelet structure, function, or viability as assessed by in vitro or in vivo measurements. 相似文献