Use of plasma: Clinical indications and types of plasma components in Sweden

The use of plasma in Sweden is relatively high compared to other countries in the European Union. An analysis of all transfusion recipients in Orebro county during the whole year 2000 was performed. There were 3159 transfusion recipients of whom 96% had a registered diagnosis and 50% had undergone a "true" operation. Seven hundred and eleven patients (23%) had received plasma. Significantly more operated than nonoperated and more men than women received plasma. The typical plasma recipient was a man undergoing cardiovascular surgery. In Sweden there are two main types of plasma components: fresh frozen (FFP) and nonfrozen liquid plasma stored for up to 14 days, both considered to be clinically equal for most indications. The quality of these components as well as stored thawed FFP has been studied. The major storage effect was cold-induced contact activation and thereby consumption of C1 esterase inhibitor (C1INH) by day 14 in 22%. The citrate content in plasma sustained the overall coagulation function over 14 days. Other studies have shown that the levels of FV and ADAMTS 13 after 14 days remain at 70% or more compared to those for FFP. Since it is immediately available, liquid, nonfrozen or thawed, plasma is of great value in emergencies. Quality criteria for plasma components need to be assessed against evidence based indications and published in guidelines.     

Diagnosis of chronic endometritis in biopsies with stromal breakdown

Plasma cells are the hallmark of chronic endometritis but are not specific for upper tract infection. Plasma cells have also been noted in hormonally mediated endometrial disorders in association with gland architectural changes ("disordered proliferative" and "anovulatory" patterns), and stromal breakdown. We reviewed benign endometrial biopsies diagnosed at Beth Israel Deaconess Medical Center over a 2-year period described as disordered/anovulatory patterns +/- stromal breakdown. Cases were excluded if tissue was not available; women were younger than 50 years where most diagnoses were atrophic or cancer; or diagnoses were secretory, menstrual endometrium, or polyps. The remaining 61 cases were compared to 33 samples of unremarkable proliferative endometrium. Plasma cells were quantified on hematoxylin and eosin-stained sections and using a histochemical stain methyl green pyronin. The indication for biopsy was an abnormal pattern of bleeding in 34 cases, infertility workup in 7, incidental part of workup for pain, or other findings in 5. The majority of disordered proliferative endometrium had plasma cells (61% grade 1, 17% grade 2) all seen on methyl green pyronin staining only. Two thirds of proliferative endometrium with breakdown showed plasma cells (19% grade 1, 39% grade 2, 10 % grade 3). Plasma cells were rare in inactive endometrium and noted in only 18% of unremarkable proliferative endometrium, all grade 1. Plasma cells are commonly present in the endometrium of women with dysfunctional uterine bleeding and focal stromal breakdown. Given the lack of clinical evidence for infection, the inflammation likely represents a physiologic process.     

Tribological behavior of plasma-sprayed carbon nanotube-reinforced hydroxyapatite coating in physiological solution

Wear behavior of plasma-sprayed carbon nanotube (CNT)-reinforced hydroxyapatite (HA) coating is evaluated in the simulated body fluid environment. Apart from enhancing the fracture toughness and providing biocompatibility, CNT-reinforced HA coating demonstrated superior wear resistance compared with that of hydroxyapatite coating without CNT. Initiation and propagation of microcracks during abrasive wear of plasma-sprayed hydroxyapatite coatings was suppressed by CNT reinforcement. Surface characterization and wear studies have shown that in addition to acting as underprop lubricant, CNTs provide reinforcement via stretching and splat-bridging for enhanced abrasion resistance in vitro.     

Relationship between dietary folate intakes,maternal plasma total homocysteine and B-vitamins during pregnancy and fetal growth in Japan

Background Adequate folate status in pregnancy is important for satisfactory pregnancy outcome. Aim of the Study The objective of the present study was to evaluate folate status in healthy pregnant women by assessing dietary folate intakes and measuring changes in folate-related biomarkers including plasma tHcy, serum vitamin B₁₂ (B₁₂), and serum and RBC folate concentrations in each trimester and to examine their relation to fetal growth. Methods From 94 pregnant women, 3-day-dietary records were obtained and blood was collected for plasma total homocysteine (tHcy), serum B₁₂, and serum and red-blood cell (RBC) folate measurements. Infant anthropometric measurements were made immediately after birth. Results Average folate intake was less than 300 μg/day with a mean energy intake of about 1800 kcal. Mean serum and RBC folate concentrations declined significantly during gestation (p < 0.05). Mean serum B₁₂ also significantly decreased (p < 0.01), whereas plasma tHcy increased from 5.1 in the first trimester to 5.9 μmol/l in the third trimester (p < 0.01). Multiple regression analyses, after controlling for maternal age, parity and pre-pregnancy body-mass index indicated that a 1.0 μmol/l increase in plasma tHcy in the third trimester corresponded to a 151 g decrease in birth weight (p < 0.01). Neither B₁₂ nor folate concentrations in all three trimesters showed any significant associations with birthweight. Plasma pyridoxal-5′-phosphate concentrations were markedly low, and were consistent with low intake of vitamin B₆ in our population. Conclusion Our data suggest that higher plasma tHcy in the third trimester is a predictor of lower birth weight. In general, the dietary intake of B-vitamins and energy may be inadequate in our population, suggesting intervention is necessary.     

肿瘤患者同型半胱氨酸与静脉血栓及凝血功能的相关性研究

目的:研究血浆同型半胱氨酸(Hcy)水平与肿瘤患者静脉血栓(VTE)及凝血功能的相关性,同时探讨肿瘤患者发生静脉血栓的相关危险因素,为临床治疗提供参考。方法:检测182例发生VTE的肿瘤患者和200名普通肿瘤患者及200名健康体检者（对照组）血浆Hcy、D-二聚体(D-Dimer,D-D)、纤维蛋白原(FIB)、凝血因子VIII(FVIII)、组织纤维溶酶原激活物(t-PA)等指标。结果:VTE患者Hcy、D-D、FVIII、FIB及t-PA检测水平均高于普通肿瘤患者及健康体检者（P＜0.05）;而普通肿瘤患者组D-D、FIB水平高于健康体检者（P＜0.05）;Hcy、D-D检测VTE的ROC曲线下面积分别为0.72（95%CI:0.68~0.79）和0.77（95%CI:0.72~0.83）;VTE肿瘤患者组中,Hcy、D-D血液含量存在明显的相关性（P=0.003 3,r=0.622）;高Hcy水平、D-D高水平以及t-PA血浆含量高是肿瘤患者发生VTE的危险因素。结论:Hcy水平能有效反映治疗患者的凝血状态,监测Hcy及D-D水平可以提高VTE的诊断效率,对肿瘤患者的预后有重要的临床参考价值。     

结外NK/T细胞淋巴瘤鼻型患者B症状与EBV‐DNA及细胞因子预后价值分析

目的 探讨结外NK/T细胞淋巴瘤鼻型（ENKTL）患者治疗前B症状与血浆EBV‐DNA拷贝数和血清细胞因子水平的相关关系,并分析其机制和预后价值。方法 回顾性分析资料齐全的173例患者,其中男性116例,女性57例,中位年龄43岁（4~71岁）。Ann Arbor分期Ⅰ‐Ⅱ期126例,Ⅲ‐Ⅳ期47例。肿瘤原发部位包括鼻腔（100例）、非鼻腔上呼吸消化道（34例）和上呼吸消化道以外（39例）。治疗前有和无B症状者分别为91例和82例。按照血浆EBV‐DNA拷贝数的高低分为阴性组36例、低载量（<10⁴ copies/ml）组73例和高载量（≥10⁴ copies/ml）组64例。检测的血清细胞因子包括IFN‐γ、IL‐2、IL‐4、IL‐6、IL‐10和TNF‐α。相关性分析采用Cochran‐Armitage趋势检验和Spearman相关性分析,采用Cox回归风险模型进行单因素分析评估预后影响因素并用Kaplan‐Meier法绘制生存曲线。结果 B症状及发热的发生与血浆EBV‐DNA拷贝水平的增加呈显著一致的趋势,发生B症状的患者其血清IFN‐γ、IL‐6和IL‐10的水平均高于无B症状组（P均<0.001）。血清IFN‐γ、IL‐6和IL‐10水平也均与血浆EBV‐DNA拷贝数呈正相关。B症状的发生与ENKTL患者的高危临床特征相关,包括晚期、原发肿瘤局部侵犯、区域淋巴结累及和治疗前LDH升高。单因素生存分析显示,Ann Arbor分期、B症状、血浆EBV‐DNA及上述血清细胞因子均为OS和PFS的影响因素（P均<0.05）。然而,多因素分析并未显示B症状对生存的独立预后价值。结论 ENKTL患者B症状的发生与EBV‐DNA拷贝水平和细胞因子的增高有关,这些指标也是影响ENKTL患者预后的重要因素。     

The pattern of plasma insulin response to glucose in patients with a previous myocardial infarction--the respective effects of age and disease

Plasma insulin and blood sugar variations were investigated during oral (OGTT) and intravenous (IVGTT) glucose tolerance tests in 10 patients aged 32 to 41 and 10 Patients aged 48 to 60 who had suffered a myocardial infarction at least three months previously. The results obtained in each group of patients were compared with those of ten normal subjects of corresponding age. The respective influences of age and cardio-vascular disease on the pattern of the plasma insulin and blood sugar responses to the glucose load were dissociated on the basis of analysis of variance.—Advancing age was associated with a rise in the mean blood sugar level during OGTT and a lowering of the glucose assimilation coefficient during IVGTT, but it was not accompanied by a significant change in the plasma insulin levels during either of the two tests.—Cardiovascular disease was associated with an augmentation of the mean blood sugar level during OGTT, but also with a prolonged and excessive response in plasma insulin. During IVGTT the glucose assimilation coefficient and the plasma insulin variations were not statistically different in the patients with a previous myocardial infarction and in the normal subjects.—The previous occurrence of a myocardial infarction is thus associated with a hyperinsulinism during OGTT, but not after a rapid stimulation as realized during IVGTT. The nature of the gastrointestinal factors involved in the genesis of this hyperinsulinism remains a matter of conjecture.     

血CTCs和cfDNA联合检测与传统肿瘤标志物检测在辅助诊断乳腺癌中的应用价值比较

目的比较血循环肿瘤细胞(CTCs)、循环游离DNA(cf DNA)联合检测与传统肿瘤标志物糖蛋白抗原153(CA153)检测在辅助诊断乳腺癌中的应用价值。方法回顾性选择2017年1月到2019年6月在安徽省第二人民医院收治的82例被确诊的乳腺癌患者为乳腺癌组,选取同期收治的50例乳腺良性疾病患者为乳腺良性疾病组,50例于该院体检的健康女性为对照组。采用ROCHE化学发光仪检测血清CA153水平;采用qPCR检测血浆cf DNA基因水平(241 bp hTERT和100 bp hTERT)和完整性(241 bp hTERT/100 bp hTERT);采用Ce1l Search系统检测血CTCs;受试者工作曲线(ROC)分析血CA153、cf DNA与CTCs诊断乳腺癌的诊断价值。结果乳腺癌组患者的血CTCs阳性表达率为37. 80%,明显高于乳腺良性疾病组的16. 00%(P <0. 05),明显高于对照组的12. 00%(P <0. 05);乳腺癌组的血CA153、241 bp hTERT、100 bp hTERT、241 bp hTERT/100 bp hTERT水平均明显高于乳腺良性疾病组(P <0. 05),乳腺良性疾病组的血CA153、241 bp hTERT、100 bp hTERT、241 bp hTERT/100 bp h TERT水平均明显高于对照组(P <0. 05);ROC分析显示,血cf DNA 241 bp hTERT、100 bp hTERT、241 bp hTERT/100 bp hTERT以及三者联合诊断乳腺癌的曲线下面积(AUC)依次为0. 865、0. 725、0. 870和0. 950;血CTCs和CA153诊断乳腺癌的AUC为0. 609和0. 733,明显低于cf DNA诊断的0. 950。结论血cf DNA对乳腺癌具有较高的诊断价值,有望应用于乳腺癌患者的临床辅助诊断。     

Cardiovascular and thrombophilic risk factors for idiopathic sudden sensorineural hearing loss

BACKGROUND: In recent years there has been a significant increase in the diagnosis of sudden sensorineural hearing loss (SSHL) in western, countries with an incidence of 20 of 100,000 people affected every year. No clear causes for this disease have been found thus far, but cochlear ischemia has been hypothesized in patients in whom an infectious episode or acoustic neurinoma have been excluded. OBJECTIVES: The aim of this case-control study was to investigate a number of acquired and inherited thrombophilic risk factors [antithrombin, protein C and S; factor V (FV) Leiden, FII polymorphism; lupus anticoagulant (LA); anticardiolipin (aCL) antibodies; fasting homocysteine (Hcy); lipoprotein(a) (Lp(a)); plasminogen activator inhibitor-1 (PAI-1)] in addition to cardiovascular risk factors in patients with idiopathic SSHL (ISSHL). PATIENTS AND METHODS: We investigated 155 patients (67 male/88 female; age: 55 (range 19-79 years) with a diagnosis of ISSHL within 30 days from the onset of symptoms, and 155 controls (67 male/88 female; age 54 (range 19-78 years). Fasting Hcy levels were significantly higher in patients than in controls [11.6 (6.7-60) micromol/L vs. 8.7 (5.0-24) micromol/L] as well as PAI-1 levels [19 (2-95) mg/dL vs. 14.5 (4.0-87) mg/dL]. Lupus anticoagulant was present in 13 of 155 (8.4%) patients; 20 patients (12.9%) had positivity of aCL (four IgM and 16 IgG). In no patient was a deficiency of physiological clotting inhibitors antithrombin, protein C and protein S found. No significant differences between patients and controls were observed for Lp(a) plasma levels [111 (1-1146) mg/L vs. 103 (11-695) mg/L] and for the presence of FV Leiden (4.5% vs. 4.5%) and FII variant G20210A (3.8% vs. 3.2%). RESULTS AND CONCLUSIONS: Independent risk factors for ISSHL at the multivariate analysis (adjusted for age, sex and the traditional cardiovascular risk factors) were the positivity of aCL: OR 5.6 (95% CI 2.0-15.3); cholesterol levels within the second and third tertiles (with respect to the first tertile): T2 = OR 4.8 (95% CI 1.9-12.6)/T3 = OR 19 (95% CI 7-50.1); PAI-1 and Hcy levels within the third tertile (with respect to the first tertile): OR 20 (95% CI 7.8-78) and OR 4.0 (95% CI 2.0-8.1), respectively. These preliminary data suggest that hypercholesterolemia, hyperhomocysteinemia, elevated PAI-1 levels and anticardiolipin antibodies are associated with ISSHL, so indirectly supporting the hypothesis of a vascular occlusion in the pathogenesis of the disease.