Sysmex XN-9000血液分析仪检测有核红细胞的临床应用评价

目的 评价Sysmex XN-9000血液分析仪检测外周血有核红细胞（NRBC）的临床应用价值。方法 收集16 273份外周血标本,分别应用Sysmex XN-9000血液分析仪和显微镜下人工检测两种方法检测NRBC,以显微镜下人工检测结果为金标准计算仪器检测的灵敏度、特异度、阳性预测值和阴性预测值。以两种方法检测均为阳性的248例标本作为研究对象,分析两种方法检测NRBC百分比的相关性。对277例显微镜下人工检测NRBC阳性患者的疾病谱进行分析。结果 Sysmex XN-9000血液分析仪检测NRBC的灵敏度为89.5%,特异度为99.6%,阳性预测值为80.5%,阴性预测值为99.8%。两种方法检测的NRBC百分比呈正相关（r_s=0.813,P<0.001）。分析277例显微镜下人工检测NRBC阳性患者的疾病谱,结果显示血液病患者173例,非血液病患者104例,经仪器检测的NRBC计数在两组之间差异有统计学意义（非血液病组中位数为0.38×10⁹/L,血液病组中位数为0.16×10⁹/L,P<0.05）,而NRBC百分比差异无统计学意义（非血液病组中位数为2.95%,血液病组中位数为3.60%,P=0.835 1）。NRBC阳性血液病主要包括急性淋巴细胞白血病（31例）、急性粒细胞白血病（55例）、淋巴瘤（39例）、多发性骨髓瘤（18例）,NRBC阳性非血液病主要包括实体肿瘤（24例）和肝硬化上消化道出血（36例）等。结论 Sysmex XN-9000血液分析仪检测NRBC准确度较高,具有较好的临床应用价值。     

郑州地区183例临床输血不良反应回顾性分析

目的分析本地区不同血液制品的输血不良反应发生率的情况,为血站采用血液制品精细化管理来有效预防输血不良反应提供理论依据。方法统计2017年1～12月河南省红十字血液中心发放至郑州市签订供血合同医院的各类血液制品,收集并查阅同期医院反馈的183例临床输血反应反馈单,记录血液制品种类和输血不良反应类型,比较不同血液制品不良反应的发生率,统计分析不同血液制品引起输血不良反应类型的差异。结果 2017年1～12月共发放血液制品751 490袋,发生输血反应183例,输血不良反应总发生率0. 024%(183/751 490),其中全血、悬浮红细胞、去白悬浮红细胞、普通冰冻血浆和病毒灭活血浆的不良反应发生率分别为1. 869%(2/107)、0. 052%(89/172 366)、0. 024%(15/62 247)、0. 030%(47/155 337)和0. 005%(7/147 460)。输血不良反应以过敏和发热为主,过敏的患者中,由普通冰冻血浆引起的输血反应38例(40. 43%)高于病毒灭活血浆6例(6. 38%),差异有统计学意义(P <0. 05);发热的患者中,由悬浮红细胞引起的输血反应54例(75. 00%)高于去白悬浮红细胞6例(8. 33%),差异有统计学意义(P <0. 05)。结论全血的输血不良反应发生率最高,其次为悬浮红细胞和普通冰冻血浆;去白悬浮红细胞和病毒灭活血浆可以显著减少输血不良反应的发生率。     

Oxygen delivery-guided perfusion for the prevention of acute kidney injury: A randomized controlled trial

ObjectivesThe reduction of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery using an oxygen delivery-guided perfusion strategy (oxygen delivery strategy) for cardiopulmonary bypass management compared with a fixed flow perfusion (conventional strategy) remains controversial. The purpose of this study was to determine whether a oxygen delivery strategy would reduce the incidence of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery.MethodsWe randomly enrolled 300 patients undergoing cardiopulmonary bypass surgery. Patients were randomly assigned to a oxygen delivery strategy (maintaining a oxygen delivery index value >300 mL/min/m² through pump flow adjustments during cardiopulmonary bypass) or a conventional strategy (a target pump flow was determined on the basis of the body surface area). The primary end point was the development of acute kidney injury. Secondary end points were the red blood cell transfusion rate and number of red blood cell units, intubation time, postoperative length of stay in the intensive care unit and the hospital, predischarge estimated glomerular filtration rate, and hospital mortality.ResultsAcute kidney injury occurred in 20 patients (14.6%) receiving the oxygen delivery strategy and in 42 patients (30.4%) receiving the conventional strategy (relative risk, 0.48; 95% confidence interval, 0.30-0.77; P = .002). The secondary end points were not significantly different between strategies. In a prespecified subgroup analysis of patients who had nadir hematocrit less than 23% or body surface area less than 1.40 m², the oxygen delivery strategy seemed to be superior to the conventional strategy and the existence of quantitative interactions was suggested.ConclusionsAn oxygen delivery strategy for cardiopulmonary bypass management was superior to a conventional strategy with respect to preventing the development of acute kidney injury.     

Coronary Vascular Bed Perfusion with a Polyethylene Glycol-Modified Hemoglobin-Encapsulated Liposome, Neo Red Cell, in Rats

Whether hemoglobin (Hb) encapsulated liposomes have vasoconstrictive activity remains controversial. We therefore examined the vascular activity of a liposome Hb, Neo red cell (NRC), in a simple in vitro model of Langendorff perfusion of the rat heart using Krebs-Henseleit (KH) solution as the perfusate. In the KH solution, NRC (Hb at 1 mg/ml), however, induced an immediate and abnormal increase in perfusion pressure. Histological examinations revealed that embolisms were the likely cause of this disturbance. Inorganic crystals formed by the mixing of NRC with the perfusate were a possible source of the embolisms. We found that the addition of bovine serum albumin to the perfusate was effective in avoiding embolic events. This protocol was used to compare the vasoconstrictive properties of unmodified bovine Hb and NRC. Unmodified bovine Hb (1 mg/ml) caused an increase in perfusion pressure and a decrease in the duration of bradykinin-induced relaxation. In contrast, NRC (Hb at 1 mg/ml) had no such vasoconstrictive effects. These results provide the first information regarding perfusion of the circulatory vascular bed by NRC and further evidence that the encapsulation of Hb into liposomes is an effective approach to modulate Hb-related vasoconstrictive activity.     

2单位冰冻红细胞自动化洗涤程序研究

目的：对透析式冰冻红细胞（ RBC）洗涤机的处理程序进行改进,使之适用于2 U冰冻RBC的洗涤处理。方法深低温保存2 U冰冻RBC解冻复温后,采用透析式冰冻RBC洗涤机进行洗涤处理,对洗涤程序进行了提高泵速和加液速度、调整溶液渗透压等方面的改进,大幅缩短2 U冰冻RBC洗涤处理时间。对洗涤后的RBC进行血红蛋白（ Hb）含量、Hb回收率、甘油残留量（上清渗透压）、游离Hb含量、变形性以及凋亡率等指标的检测,并据此判断洗涤效果。结果改进前后的透析式洗涤程序处理得到的RBC的Hb含量分别为（35．03±4．20）和（53．82±2．08）g;Hb回收率分别为（61．10±8．46）％和（80．22±3．73）％;上清渗透压分别为（307．00±14．50）和（322．00± 29．00）mOsm;游离Hb分别为（0．74±0．04）和（0．80±0．08）g／L;程序改进前后的洗涤时间分别为（1．64±0．31）和（1．04±0．16）h;改进前后的洗涤程序处理得到的RBC在Hb含量、Hb回收率、RBC变形性、洗涤时间等指标上有明显改善。而在甘油残留量、游离Hb含量、细胞凋亡等方面无显著变化。结论经过程序改进,2 U冰冻RBC洗涤时间缩短、洗涤后RBC和Hb含量显著升高,提高了洗涤效率及冰冻RBC的利用效率。     

Altered ATP-dependent mitochondrial Ca2+ uptake in cold ischemia is attenuated by ruthenium red

BACKGROUND: Graft dysfunction as a result of preservation injury remains a major clinical problem in liver transplantation. This is related in part to accumulation of mitochondrial calcium (Ca(2+)), which has been linked to activation of proapoptotic factors. We hypothesized that cold ischemia increases mitochondrial Ca(2+) uptake in a concentration dependent fashion and that ruthenium red (RR) will attenuate these changes by inhibiting the mitochondrial Ca(2+) uniporter. METHODS: Rat livers perfused with cold University of Wisconsin (UW) solution (4 degrees C) with or without RR (10 microM) via the portal vein (n = 3 per group) were processed immediately (no ischemia) or after 24 h cold-storage (24 h cold ischemia). Mitochondria were separated by differential centrifugation, and adenosine triphosphate (ATP)-dependent (45)Ca(2+) uptake was determined in the presence of ATP (5 mM), adenosine diphosphate (ADP), or adenosine 5'-beta,gamma-imidotriphosphate (AMP-PNP); variable concentrations of extramitochondrial (45)Ca(2+) were used. All measurements were performed in triplicate. Student's t test with P < 0.05 was taken as significant. RESULTS: Our data demonstrate the following: 1) ATP-dependent (45)Ca(2+) uptake in mitochondria separated from livers following 24 h of cold ischemia in UW alone was higher than in mitochondria isolated from non-ischemic livers; the increased uptake was dependent on the concentration of (45)Ca(2+) in the incubation buffer. 2) There was no difference in ATP-dependent (45)Ca(2+) uptake between nonischemic mitochondria and those separated from livers stored in UW-RR for 24 h. 3) (45)Ca(2+) uptake in mitochondria from livers subjected to 24 h of cold ischemia in UW-RR was significantly lower compared to those from livers stored in UW alone when (45)Ca(2+) concentrations were greater than 1 microM. CONCLUSION: 1) Cold ischemia affects mitochondrial Ca(2+) handling, especially when it is challenged by high extramitochondrial Ca(2+) concentrations. 2) The addition of RR in preservation solution attenuates the effects of cold ischemia on mitochondrial Ca(2+) handling. 3) Inhibition of mitochondrial Ca(2+) uniporter with RR protects mitochondria from Ca(2+) overload at high Ca(2+) concentrations. These findings may offer a potentially effective strategy for prevention of ischemia-reperfusion injury in liver transplantation.     

肺癌患者红细胞促外周血淋巴细胞增殖能力的实验研究

目的探讨肺癌患者红细胞(RBC)促外周血淋巴细胞(PBL)增殖能力,了解肺癌患者RBC免疫调控功能状况.方法肺癌患者(检测组)和正常人(对照组))的RBC为效应细胞,正常人淋巴细胞为靶细胞,采用四甲基偶氮唑蓝(MTT)比色法,检测红细胞调控淋巴细胞增殖反应的能力.结果健康人RBC促PBL增殖作用明显,其增殖率为(57.3±10.2)%;而肺癌患者RBC促PBL增殖作用较健康人明显低下,增殖率为(38.4±8.6)%(P＜0.01);肺癌患者手术后RBC促PBL增殖作用有明显改善,增殖率为(43.9±11.4)%,仍低于健康人.结论肺癌患者红细胞免疫调控功能低下.     

红参发酵产物对高糖下大鼠肾小球系膜细胞增殖和细胞外基质降解的影响

目的：探讨红参发酵产物（FRGE）对高糖刺激下大鼠肾小球系膜细胞（GMCs）增殖和细胞外基质（ECM）降解的影响,阐明FRGE对糖尿病肾病（DN）的防治作用及可能机制。方法：将GMCs分为正常对照（NG）组、高糖（HG）组、高糖＋不同浓度（3.75、7.50和15.00 mg·L^-1）FRGE组。四甲基偶氮唑盐（MTT）光吸收法观察各组GMCs的增殖率,酶联免疫吸附法（ELISA）检测培养细胞上清中Ⅳ型胶原蛋白（Col Ⅳ）的水平,蛋白免疫印迹技术（Western blotting）检测基质金属蛋白酶2（MMP-2）和基质金属蛋白酶组织抑制物2（TIMP-2）蛋白表达水平。结果：与NG组比较,HG组GMCs增殖率升高（P<0.01）,Col Ⅳ水平升高（P<0.01）,TIMP-2蛋白表达水平上调（P<0.01）,MMP-2蛋白表达水平下调（P<0.01）;与HG组比较,高糖＋不同浓度FRGE组GMCs增殖率均降低（P<0.01）,Col Ⅳ水平降低（P<0.01）,TIMP-2蛋白表达水平下调（P<0.01）,MMP-2蛋白表达水平上调（P<0.01）。结论：FRGE可通过抑制高糖诱导的大鼠GMCs增殖,促进ECM的降解,延缓DN的发生发展。     

红蓝光治疗痤疮临床疗效观察

目的:探讨红蓝光照射治疗痤疮的临床疗效和安全性。方法:将113例轻、中度痤疮患者分为两组,实验组采用本院自制的克林霉素醇溶液联合红蓝光照射治疗,对照组仅外用本院自制的克林霉素醇溶液治疗。采用痤疮综合分级系统(GAGS)评价治疗前、后疗效。结果:实验组和对照组有效率分别为82.8%和43.6%,两组的治疗有效率存在显著性差异(P<0.01)。GAGS综合分值均较治疗前明显下降(P<0.01),但实验组下降更显著。结论:红蓝光治疗面部轻、中度痤疮安全有效。     

Blood utilization in children managed non-operatively for blunt solid organ injury

BACKGROUND: Blood product utilization is an important issue in health care, given the frequent shortages in hospitals and the societal burden required to maintain the supply. Therefore, we retrospectively audited our blunt spleen/liver trauma experience to determine the percentage of cross-matched blood that was transfused to see whether more stringent typing criteria should be applied. METHODS: A retrospective analysis of a recent 7-year experience with nonoperative management in patients with blunt spleen or liver injury was performed. Demographics, packed red blood cells prepared by cross-match, and transfusions were measured. Unmatched, O-type blood given in the trauma bay was excluded. Patients undergoing laparotomy for solid organ injury were excluded. Data are expressed as mean +/- standard deviation. RESULTS: During the study period, 130 patients were nonoperatively managed for spleen and/or liver injury. Mean age was 8.7 +/- 4.6 years, and 62% were male. The mean grade of injury was 2.4 +/- 0.9. A total of 187 units of packed red blood cells was ordered in 60 patients. A total of 46.5 units was administered to 22 patients, revealing a 24.9% transfusion rate for the units ordered in 36.7% of the patients for whom it was ordered. When patients with other major injuries and those with ongoing bleeding requiring an operation or who clinically required blood on presentation were excluded, there were 80 patients. In this stable population, 104 units of PRBCs were ordered for 29 patients. A total of 18 units was then transfused in 5 patients, for a 17.3% transfusion rate for the units orders in 17.2% of the patients for whom it was ordered. None of the 5 patients received transfusion the day of admission. CONCLUSION: Hemodynamically stable patients with blunt spleen/liver injury triaged to conservative management should have their blood typed and be monitored closely for signs or laboratory values that would mandate a cross-match. According to our data, this strategy would safely improve utilization of blood bank resources.