An in vitro method for predicting the efficacy of WBC separation using different starch preparations and anticoagulant ratios

BACKGROUND: Separation of blood components depends on a number of factors, including the viscosity of the plasma and the number and size of the various cellular elements. To enhance granulocyte collection, it is common practice to alter the plasma environment by the addition of sedimenting agents such as hydroxyethyl starch. Recently, because of its prolonged persistence in the circulation, the higher-molecular-weight form of hydroxyethyl starch, Hespan (HP), has been replaced by the lower-molecular-weight form, pentastarch (PS). However, the yield appears to be lower. A rapid in vitro approach was used to permit comparison of the efficiency of separation of WBCs by the use of PS and HP and different ratios of anticoagulants that also alter the sedimenting characteristics of blood. STUDY DESIGN AND METHOD: Blood from individual persons was collected into sodium citrate at ratios of 1:8, 1:12, and 1:16. Samples were evaluated either before or after the addition of PS or HP and after centrifugation. RESULTS: The addition of HP increased the sedimentation rate to at least four times that of plasma (10.9 vs. 47.9 mm); PS approximately doubled the rate. Viscosity was altered by the introduction of either starch. These changes (ranging from a rate of 4.2 in HP with a 1:16 anticoagulant to 3.6 in PS with a 1:8 ratio of anticoagulant) reflected the anticipated effects of anticoagulant dilution and carbohydrate addition. Granulocyte recovery was highest, with a 1:12 anticoagulant ratio in all tests with HP producing the greatest yield (HP, 101%; PS, 89%; control, 78%). CONCLUSION: HP is far more effective than its lower-molecular-weight substitute PS in the generation of granulocytes in the buffy coat of whole blood. This method provides a simple, rapid, in vitro approach to evaluating the separating efficiency of solutions.     

羟乙基淀粉对失血性休克血管反应性的影响

目的 观察羟乙基淀粉（HEs）对失血性休克血管反应性的影响，并探讨其机制。方法 40只SD大鼠，雌雄不限，按照随机数字表法分为正常组、休克组、复方氯化钠（即林格液，SC）组、HES130／0．4组和HES200／0．5组，每组8只。股动脉放血至大鼠平均动脉压（MAP）为40mmHg（1mmHg=0．133kPa），维持30min后分别输注溶液，使MAP升至70mmHg，并维持60min；观察各用药组在60min内维持MAP70mmHg所需补液量。分别在休克前及休克30、60和90min静脉注射去甲肾上腺素（NE）2μg／kg，观察液体对NE升压反应的影响；取动脉血测定血浆一氧化氮（NO）和一氧化氮合酶（NOS）含量。结果各用药组之间维持MAP70mmHg所需补液量比较差异均有显著性（P均〈0．01），其中HES200／0．5组所需补液量最少，HES130／0．4组次之，SC组最多。休克90min时，HES130／0．4组、HES200／0．5组MAP升高幅度均明显高于SC组（P均〈0．05），血浆NO和NOS含量均明显低于SC组（P〈0．05或P〈0．01）。结论 HES130／0．4和HES200／0．5可通过降低血浆NO和NOS含量，从而改善休克大鼠的血管反应性。     

急性高容量血液稀释对全髋关节置换术患者血浆杀菌/通透性增加蛋白表达的影响

Objective To study the effect of acute hypervolemic hemodilution on expression of plasma bac-tericidaL/permeability-increasing protein (BPI) in patients undergoing total hip replacement. Methods Twenty ASA Ⅰ-Ⅱ patients undergoing elective total hip replacement were randomly divided into two groups (n=10 for thesia. The blood loss,blood transfusion and the time of operation were recorded. Venous blood samples were taken before anesthesia (T0) ,at the begining of operation (T1) ,30 min after operation (T2) ,and at the end of operation (T3) for determination of plasma bactericidal/permeability-increasing protein. Results The blood loss and the blood transfusion in HES group were significantly lower than that of LR group[blood loss: (560±90)ml vs (810±110) ml and blood transfusion: (200±100) ml vs (600±200) ml,t=5.562 and 5.657,P<0.001]. The plasma BPI concentrations in HES group were significantly increased at T2～T3 as compared to baseline value at T0 [(8.9±1.6)μg/L,(13.4±1.2)μg/L and (4.9±1.2)μg/L,P<0.05]. The plasma BPI concentrations in LR group were significantly increased at T2～T3 as compared to baseline value at T0 [(7.3±1.2)μg/L,(9.9±0.8) μg/L and (5.0±1.1)μg/L,P<0.05],but were lower than those in HES group (t=2.530 and 7.674,P=0.021 and 0.001 ). Conclusion Acute hypervolemic hemodilution with 200/0.5 hydroxyethyl starch can reduce blood transfusion during total hip replacement operation and also can increase the BPI level which would beneficial for the immunological function.     

Improving pulse crops as a source of protein,starch and micronutrients

Pulse crops have been known for a long time to have beneficial nutritional profiles for human diets but have been neglected in terms of cultivation, consumption and scientific research in many parts of the world. Broad dietary shifts will be required if anthropogenic climate change is to be mitigated in the future, and pulse crops should be an important component of this change by providing an environmentally sustainable source of protein, resistant starch and micronutrients. Further enhancement of the nutritional composition of pulse crops could benefit human health, helping to alleviate micronutrient deficiencies and reduce risk of chronic diseases such as type 2 diabetes. This paper reviews current knowledge regarding the nutritional content of pea (Pisum sativum L.) and faba bean (Vicia faba L.), two major UK pulse crops, and discusses the potential for their genetic improvement.     

Dietary protein source and butyrylated high-amylose maize starch included in a high-protein diet determines the urinary metabolome of rats

Intake of red and processed meat increases the risk of colorectal cancer (CRC), whereas dairy product consumption and the intake of dietary fibre are negatively associated with this risk. We investigated the effect of (i) low-protein diets with either whey or cooked meat (beef) as the protein source and (ii) high-protein diets with cooked meat (beef) either without or with the inclusion of 10% butyrylated high-amylose maize starch (HAMSB), on the urinary metabolome of rats. Urine samples from rats were analysed using untargeted LC-MS metabolomics. The level and source of the dietary protein affected the urinary excretion of numerous metabolites indicating that several metabolic pathways were changed. The inclusion of HAMSB in a high-protein diet caused significant alterations in the excretion of several metabolites. HAMSB reduced urinary excretion of potentially harmful metabolites resulting from a high level of meat consumption.     

羟乙基淀粉联合呋塞米治疗小儿肾病综合征合并重度水肿的临床研究

目的探讨使用羟乙基淀粉联合呋塞米治疗小儿肾病综合征的临床效果与护理要点。方法将肾内科2015年3月至2016年3月收治的50例肾病综合征出现重度水肿的患儿,按照治疗先后顺序将其分为试验组(25例)与对照组(25例),试验组使用羟乙基淀粉联合呋塞米治疗,对照组采用右旋糖酐治疗。观察两组临床疗效,并总结护理要点。结果对照组有效率为48.0%,试验组有效率为80.0%,试验组明显高于对照组,差异有统计学意义(P0.05);对照组在知识宣传、用药、皮肤清洁、饮食指导及并发症预防等方面评分较试验组低,差异有统计学意义(P0.05)。结论对出现肾病综合征合并严重水肿的患儿,临床用药选择羟乙基淀粉联合使用呋塞米加速排尿,并对患儿进行多方面护理,大部分患儿家属对临床服务感到满意且患儿临床治疗效果较好。     

霍姆溶液对老年前列腺电切术中血浆胶体渗透压和电解质的影响

目的观察霍姆溶液（高渗羟乙基淀粉40溶液）对前列腺电切术（transurethral resection of prostates,TURP）中老年患者血浆胶体渗透压（colloid osmotic pressure,COP）和血电解质（Na＋、K＋）的影响。方法择期在硬膜外麻醉下行TURP术的老年男性患者45例,ASA分级Ⅰ-Ⅱ级,随机分为高渗组（H组,n=15）,羟乙基淀粉溶液组（HS组,n=15）,林格氏液组（R组,n=15）。于硬膜外麻醉开始用药同时分别给予高渗液、羟乙基淀粉溶液、林格氏液,按4mYmin输注1h,记录术前（T1）、输注完毕即刻（T2）、术毕即刻（T3）血浆胶体渗透压,血Na＋、K＋值及各项血流动力学指标（Map、HR、SpO2,CVP）。结果H组与HS组间血浆COP的变化无显著性差异,与R组相比,血浆COP变化较小,差异有统计学意义（P〈0．01）。三组血K＋值变化均无明显差异,H组与HS组、R组相比,血Na＋变化差异均具有统计学意义（P〈0．01）;H纽、HS组的各项血流动力学指标较R组平稳。结论老年前列腺电切术患者术中应用高渗羟乙基淀粉40溶液有利于维持血浆COP和机体内环境稳定．减少前列腺电切综合征（transurethral resection of prostate syndrome,TURS）的发生。     

低张羟乙基淀粉130／0．4对失血并腹腔海水浸泡伤犬的救治作用

目的观察低张羟乙基淀粉130／0．4对失血并腹腔海水浸泡伤的救治效果。方法制作30％失血并腹腔海水浸泡伤动物模型,15只犬随机分为对照组、0．9％氯化钠治疗组、低张羟乙基淀粉治疗组,观察每组动物失血并腹腔海水浸泡后平均动脉压（meanarterypressure,MAP）、心排血量（cardiacoutput,CO）、尿量、血浆渗透压及存活时间。结果低张羟乙基淀粉130／0．4可显著改善MAP及CO,增加尿量,降低血浆渗透压,延长存活时间。结论低张羟乙基淀粉对失血并腹腔海水浸泡伤具有较好的救治效果。     

羟乙基淀粉急性扩容性血液稀释对凝血功能的影响

目的比较6%羟乙基淀粉130/0.4和6%羟乙基淀粉200/0.5急性扩容性血液稀释时对神经外科手术患者凝血功能的影响。方法选择行择期神经外科手术的患者40例,随机分为6%羟乙基淀粉200/0.5组（H组,n=20）和6%羟乙基淀粉130/0.4组（V组,n=20）,于麻醉诱导后以500ml/30min的速度输注6%羟乙基淀粉130/0.4或6%羟乙基淀粉200/0.51500ml行急性扩容性血液稀释。于血液稀释前（T0）、输液1000m（lT1）、1500m（lT2）和血液稀释后30-60min（T3）时,取股静脉血监测凝血功能变化,包括激活凝血活酶时间（ACT）、凝血速（CR）、凝血达峰时间（TP）和血小板功能（PF）。结果在血液稀释过程中,两组血液稀释后ACT较稀释前显著缩短（P〈0.05）,H组在输液T1、T2和T3缩短幅度分别为18%、27%和20%,V组分别为16%、25%和21%,组间比较,差异无统计学意义（P〉0.05）。两组CR均下降,和稀释前比较,差异有统计学意义P〈0.05）,H组各时间点分别下降17%、37%和33%,V组分别下降18%、30%和27%。组间比较,差异无统计学意义（P〉0.05）。PF在稀释过程中V组下降幅度明显小于H组（P〈0.05）。TP在两组之间比较,V组延长幅度较小,两组之间在T2比较,差异有统计学意义（P〈0.05）。结论神经外科患者应用羟乙基淀粉溶液行急性扩容性血液稀释时,6%羟乙基淀粉130/0.4对于凝血功能的影响明显小于6%羟乙基淀粉200/0.5,临床使用更为安全。