BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodefi...BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV)-I/II,malaria,and syphilis is mandatory before blood transfusions.Worldwide,HCV,HBV,and HIV are the leading viruses causing mortality,affecting millions of people globally,including those with co-infections of HIV/HCV and HIV/HBV.Studies highlight the impact of TTIs on life expectancy and health risks,such as liver cirrhosis,cancer,and other diseases in individuals with chronic HBV.Globally,millions of blood donations take place annually,emphasizing the importance of maintaining blood safety.AIM To study the prevalence of TTIs,viz.,HBV,HCV,HIV I/II,syphilis,and malaria parasite(MP),among different blood donor groups.METHODS The study assessed the prevalence of TTIs among different blood donor groups in Delhi,India.Groups included total donors,in-house donors,total camp donors,institutional camp donors,and community camp donors.Tests for HIV,HBV,and HCV were done using enzyme-linked immunosorbent assay,while syphilis was tested with rapid plasma reagins and MP rapid card methods.The prevalence of HBV,HCV,HIV,and syphilis,expressed as percentages.Differences in infection rates between the groups were analyzed usingχ²tests and P-values(less than 0.05).RESULTS The study evaluated TTIs among 42158 blood donors in Delhi.The overall cumulative frequency of TTIs in total blood donors was 2.071%,and the frequencies of HBV,HCV,HIV-I/II,venereal disease research laboratory,and MP were 1.048%,0.425%,0.221%,0.377%,and 0.0024%,respectively.In-house donors,representing 37656 donors,had the highest transfusion transmissible infection(TTI)prevalence at 2.167%.Among total camp donors(4502 donors),TTIs were identified in 1.266%of donors,while community camp donors(2439 donors)exhibited a prevalence of 1.558%.Institutional camp donors(2063 donors)had the lowest TTI prevalence at 0.921%.Statistical analysis revealed significant differences in overall TTI prevalence,with total and in-house donors exhibiting higher rates compared to camp donors.CONCLUSION Ongoing monitoring and effective screening programs are essential for minimizing TTIs.Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.展开更多
Beta thalassemia(β-thalassemia)syndromes are a heterogeneous group of inherited hemoglobinopathies caused by molecular defects in the beta-globin gene that lead to the impaired synthesis of beta-globin chains of the ...Beta thalassemia(β-thalassemia)syndromes are a heterogeneous group of inherited hemoglobinopathies caused by molecular defects in the beta-globin gene that lead to the impaired synthesis of beta-globin chains of the hemoglobin.The hallmarks of the disease include ineffective erythropoiesis,chronic hemolytic anemia,and iron overload.Clinical presentation ranges from asymptomatic carriers to severe anemia requiring lifelong blood transfusions with subsequent devastating complications.The management of patients with severeβ-thalassemia represents a global health problem,particularly in low-income countries.Until recently,management strategies were limited to regular transfusions and iron chelation therapy,with allogeneic hematopoietic stem cell transplantation available only for a subset of patients.Better understanding of the underlying pathophysiological mechanisms ofβ-thalassemia syndromes and associated clinical phenotypes has paved the way for novel therapeutic options,including pharmacologic enhancers of effective erythropoiesis and gene therapy.展开更多
Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(...Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(tetracosactide;TCS10)targeting melanocortin receptors(MCRs)in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.Methods:Sensitivity analysis was based on a randomized,two-arm,multicenter,double-blind,controlled trial.The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs outputs in 100 consecutive cases(from August to September 2013 from Emilia Romagna region,Italy).Patients included an agent-based TCS10 group(10 mg,single intravenous bolus before surgery;n=56)and control group(n=44)and the association with cytokines,lactate,and bleeding-blood transfusion episodes with the prior-risk log odds for mortality rate in time-to-event was analyzed.Results:Thirty-day mortality was significantly improved in the TCS10 group vs.control group(0 vs.8 deaths,P<0.0001).Baseline levels of interleukin(IL)-6,IL-10,and lactate were associated with bleeding episodes,independent of TCS10 treatment[odds ratio(OR)=1.90,95%confidence interval(CI)1.39-2.79;OR=1.53,95%CI 1.17-2.12;and OR=2.92,95%CI 1.40-6.66,respectively],while baseline level of Fms-like tyrosine kinase 3 ligand(Flt3L)was associated with lower bleeding rates in TCS10-treated patients(OR=0.31,95%CI 0.11-0.90,P=0.03).For every 8 TCS10-treated patients,1 bleeding case was avoided.Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group(OR=0.32,95%CI 0.14-0.73,P=0.01).For every 4 TCS10-treated patients,1 transfusion case was avoided.Conclusions:Sensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care.To introduce the technology readiness level in real-life critically ill patients,further large-scale studies are required.Trial registration:European Union Drug Regulating Authorities Clinical Trials Database(EudraCT Number:2007-006445-41).展开更多
BACKGROUND Hypertriglyceridemia thalassemia syndrome is a rare condition that occurs in patients with thalassemia.It typically presents with a combination of profound anemia and milky serum.Although previous case seri...BACKGROUND Hypertriglyceridemia thalassemia syndrome is a rare condition that occurs in patients with thalassemia.It typically presents with a combination of profound anemia and milky serum.Although previous case series have demonstrated the benefit of blood transfusions in reducing serum triglycerides,information regar-ding clinical outcomes and standard management in this setting remains limited.AIM To identify the clinical course,treatment strategies,and outcomes of patients with hypertriglyceridemia thalassemia syndrome.METHODS We performed a comprehensive search of the Scopus,PubMed,and Embase databases.We included only English-language articles and did not apply any publication date limits.The databases were last accessed on September 1,2024.This study was registered under number CRD420250587918 and included studies involving children and adults with thalassemia,hypertriglyceridemia,and available data on clinical course.RESULTS A total of 14 publications were included in the analysis,all of which were case reports or case series.No higher-quality evidence was available.Among 28 children with hypertriglyceridemia thalassemia syndrome,there were 22 cases ofβ-thalassemia major and 6 cases of hemoglobin E/β-thalassemia,including our illustrative case.The median age of onset was 11 months,and 92.3%of cases presented prior to the first blood transfusion.The common clinical manifestations included pallor(100%)and hepatosplenomegaly(67.9%).For hypertriglyceridemia-related symptoms,lipemia retinalis and xanthomas were observed in 25.0%and 10.7%of cases,respectively.The median hemoglobin level was 5.5 g/dL,while the median triglyceride level was 935 mg/dL.For management,92.9%of cases received blood transfusions with or without other interventions.At a median of 12 months’follow-up,all patients responded to the treatment without lipid-lowering agents,and 85.7%of cases were alive.CONCLUSION Hypertriglyceridemia thalassemia syndrome occurs exclusively in young children and usually presents with anemia and severe hypertriglyceridemia prior to the first transfusion.Management with blood transfusions provides a favorable response.However,long-term regular monitoring is warranted.展开更多
BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as...BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.展开更多
Introduction: Human pegivirus (HPgV), initially identified as hepatitis G virus in the 1990s, predominantly causes acute hepatitis and may persist particularly in individuals with compromised immune systems or those c...Introduction: Human pegivirus (HPgV), initially identified as hepatitis G virus in the 1990s, predominantly causes acute hepatitis and may persist particularly in individuals with compromised immune systems or those co-infected with HIV, HBV, or HCV. Despite its potential public health implications, particularly in transfusion contexts, comprehensive epidemiological data on HPgV in Burkina Faso remains scarce. Objectives: This study aimed to determine 1) the prevalence of human pegivirus infection among blood donors at the Regional Blood Transfusion Centre (Koudougou, Burkina Faso), and 2) the rates of co-infection between human pegivirus with HIV, HBV, HCV and Treponema pallidum. Material and Methods: Between 9 and 27 August 2022, 100 blood samples were collected and analyzed at the Regional Blood Transfusion Centre. Screening for HIV, HBV, HCV, and Treponema pallidum was conducted using the Cobas e 601 system (Roche Diagnostics). A 100 μL volume of each donor’s plasma was utilized for viral RNA extraction with the DNA/RNA Prep Kit (Sacace Biotechnologies) following the manufacturer’s instructions. HPgV RNA detection was conducted using the HGV Real-TM amplification kit (Sacace Biotechnologies). Results: The study was comprised of 100 blood donors, identifying HPgV RNA in 14 individuals (14% prevalence), with one noted co-infection with HBV. None of the participants were HIV positive. The prevalence rates for HBV and HCV were each found to be 5%, and syphilis also presented a prevalence of 5%. Conclusion: Our findings indicate a significant prevalence of HPgV among blood donors in Burkina Faso, underscoring the need for heightened surveillance and preventive measures in blood transfusion services and the broader population to enhance transfusion safety and public health.展开更多
Background: Blood transfusion (BT) is crucial to the provision of modern health care. However, blood is scarce and costly, and its use is associated with risks. Therefore, the medical professionals who handle it shoul...Background: Blood transfusion (BT) is crucial to the provision of modern health care. However, blood is scarce and costly, and its use is associated with risks. Therefore, the medical professionals who handle it should have adequate knowledge to ensure rational and safe utilization. The objective of the study was to determine the level of BT knowledge among junior medical doctors in Kenya. Methodology: A cross-sectional study was conducted among junior medical doctors working in Western Kenya. Data was collected using questionnaires from August 2021 to March 2022, and analysis was done by way of descriptive and inferential statistics. A p Results: A total of 150 medical doctors participated in the study. Males comprised 60% (n = 90), and the mean age of the participants was 29.9 (SD 3.6) with a range of 25 - 45 years. The mean knowledge score was 54.1% ± 16.4% and was associated with orientation (AOR = 3.157, 95% CI = 1.194 - 8.337). Conclusion: Blood transfusion knowledge among the doctors was suboptimal and was associated with pre-internship induction. There is a need for additional education in BT during all phases of medical training and practice, including orientation for medical interns.展开更多
BACKGROUND There is an ongoing debate regarding the relationship between intraoperative blood transfusions and patient outcomes.Unifying the results is difficult because of differences in surgery type,target populatio...BACKGROUND There is an ongoing debate regarding the relationship between intraoperative blood transfusions and patient outcomes.Unifying the results is difficult because of differences in surgery type,target population and postoperative observation indicators.AIM To evaluate the risk factors for intraoperative blood transfusion and its impact on postoperative outcomes in elderly gastrointestinal cancer patients.METHODS This was a retrospective single-center study of elderly patients(≥65 years old)who underwent elective abdominal surgery for gastrointestinal cancer with general anesthesia.Patients with chronic kidney disease and missing related data were excluded.The primary outcomes included acute kidney injury(AKI),myocardial injury,and respiratory complications during hospitalization.Multivariate logistic regression was performed to explore the exposure-outcome relationship.RESULTS A total of 967 patients were included in this study.A lower preoperative hematocrit level,longer operative time(>300 minutes)and greater amount of blood loss were observed in 145(15.0%)patients who received blood transfusions during surgery(P<0.0005).Among these patients,the incidences of AKI,myocardial injury and respiratory complications were 8.3%(n=12),5.5%(n=8),and 15.9%(n=23),respectively,and these values were significantly greater.Multivariate analysis revealed that receiving a transfusion was an independent risk factor for AKI,myocardial injury and respiratory complications(all P<0.05).CONCLUSION These results demonstrate that intraoperative blood transfusion increases the risk of poorer outcomes in elderly patients receiving gastrointestinal cancer surgery.These findings provide new ideas for improving the prognosis of elderly cancer patients.展开更多
The Rh blood group system,especially the D antigen,is crucial in transfusion medicine and obstetrics.Weak D phenotypes,caused by mutations in the Rhesus D antigen(RhD)blood group(RHD)gene,result in reduced antigen exp...The Rh blood group system,especially the D antigen,is crucial in transfusion medicine and obstetrics.Weak D phenotypes,caused by mutations in the Rhesus D antigen(RhD)blood group(RHD)gene,result in reduced antigen expression,posing challenges in serological testing and clinical management.Variability in detection methods leads to inconsistent results,making accurate classification difficult.Molecular techniques like polymerase chain reaction and DNA sequencing have significantly improved the identification of weak D variants,offering more reliable transfusion strategies and reducing the risk of alloimmunization.However,challenges such as lack of standardized protocols,cost constraints,and population-specific variations remain.In obstetrics,proper management of pregnant women with weak D is essential to prevent hemolytic disease of the fetus and newborn.Non-invasive prenatal testing using cell-free fetal DNA shows promise in predicting RhD incompatibility and minimizing unnecessary Rh immune globulin administration.Future advancements in highthroughput genotyping and discovery of novel RHD alleles could enhance RhD testing accuracy and efficiency.Standardizing RHD genotyping and adopting genotype-based management strategies for Rh immune globulin therapy and red blood cell transfusions will improve patient safety and clinical outcomes.This review examines the molecular basis,challenges,and future prospects in weak D phenotype management.展开更多
BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention...BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.展开更多
Background:Exercise training promotes brain plasticity and is associated with protection against cognitive impairment and Alzheimer’s disease(AD).These beneficial effects may be partly mediated by blood-borne factors...Background:Exercise training promotes brain plasticity and is associated with protection against cognitive impairment and Alzheimer’s disease(AD).These beneficial effects may be partly mediated by blood-borne factors.Here we used an in vitro model of AD to investigate effects of blood plasma from exercise-trained donors on neuronal viability,and an in vivo rat model of AD to test whether such plasma impacts cognitive function,amyloid pathology,and neurogenesis.Methods:Mouse hippocampal neuronal cells were exposed to AD-like stress using amyloid-βand treated with plasma collected from human male donors 3 h after a single bout of high-intensity exercise.For in vivo studies,blood was collected from exercise-trained young male Wistar rats(high-intensity intervals 5 days/week for 6 weeks).Transgenic AD rats(McGill-R-Thyl-APP)were inj ected 5 times/fortnight for 6 weeks at2 months or 5 months of age with either(a)plasma from the exercise-trained rats,(b)plasma from sedentary rats,or(c)saline.Cognitive function,amyloid plaque pathology,and neurogenesis were assessed.The plasma used for the treatment was analyzed for 23 cytokines.Results:Plasma from exercised donors enhanced cell viability by 44.1%(p=0.032)and reduced atrophy by 50.0%(p<0.001)in amyloid-β-treated cells.In vivo exercised plasma treatment did not alter cognitive function or amyloid plaque pathology but did increase hippocampal neurogenesis by~3 fold,regardless of pathological stage,when compared to saline-treated rats.Concentrations of 7 cytokines were significantly reduced in exercised plasma compared to sedentary plasma.Conclusion:Our proof-of-concept study demonstrates that plasma from exercise-trained donors can protect neuronal cells in culture and promote adult hippocampal neurogenesis in the AD rat brain.This effect may be partly due to reduced pro-inflammatory signaling molecules in exercised plasma.展开更多
BACKGROUND Occult hepatitis B infection(OBI)is a globally prevalent infection,with its frequency being influenced by the prevalence of hepatitis B virus(HBV)infection in a particular geographic region,including Africa...BACKGROUND Occult hepatitis B infection(OBI)is a globally prevalent infection,with its frequency being influenced by the prevalence of hepatitis B virus(HBV)infection in a particular geographic region,including Africa.OBI can be transmitted th-rough blood transfusions and organ transplants and has been linked to the development of hepatocellular carcinoma(HCC).The associated HBV genotype influences the infection.AIM To highlight the genetic diversity and prevalence of OBI in Africa.METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search on PubMed,Google Scholar,Science Direct,and African Journals Online for published studies on the prevalence and genetic diversity of OBI in Africa.RESULTS The synthesis included 83 articles,revealing that the prevalence of OBI varied between countries and population groups,with the highest prevalence being 90.9%in patients with hepatitis C virus infection and 38%in blood donors,indicating an increased risk of HBV transmission through blood transfusions.Cases of OBI reactivation have been reported following chemotherapy.Genotype D is the predominant,followed by genotypes A and E.CONCLUSION This review highlights the prevalence of OBI in Africa,which varies across countries and population groups.The study also demonstrates that genotype D is the most prevalent.展开更多
We read with interest the recent systematic reviewaArtificial intelligence and machine learning for hemorrhagic trauma careoby Peng et al.[1],which evaluated literature on machine learning(ML)in the management of trau...We read with interest the recent systematic reviewaArtificial intelligence and machine learning for hemorrhagic trauma careoby Peng et al.[1],which evaluated literature on machine learning(ML)in the management of traumatic haemorrhage.We thank the authors for their contribution to the role of ML in trauma.展开更多
Dr.Atefe R.Tari is a researcher at the Cardiac Exercise Research Group(CERG),at the Norwegian University of Science and Technology,and at the Department of Neurology and Clinical Neurophysiology,St.Olavs Hospital,Norw...Dr.Atefe R.Tari is a researcher at the Cardiac Exercise Research Group(CERG),at the Norwegian University of Science and Technology,and at the Department of Neurology and Clinical Neurophysiology,St.Olavs Hospital,Norway.Before defending her PhD in medicine in 2022,she had published 12 papers,several in high-ranking journals.Dr.Tari is heading her dedicated research group within CERG,focusing on the effects of exercise training on Alzheimer's disease.She is also co-principle investigator of the ExPlas trial examining the effect of plasma transfusions from young fit individuals on cognitive function in patients with Alzheimer’s disease.Mainly her research focuses on exploring the molecular secrets underlying the beneficial effects of exercise training on cognitive function—aiming to unravel in detail the molecular choreography of exercise training to discover molecular markers linked to various disease models.展开更多
Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Method...Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.展开更多
Background:Normal bile is sterile.Studies have shown that cholangitis after liver transplantation(LT)was associated with a relatively poor prognosis.It remains unclear whether the bacteriobilia or fungibilia impact th...Background:Normal bile is sterile.Studies have shown that cholangitis after liver transplantation(LT)was associated with a relatively poor prognosis.It remains unclear whether the bacteriobilia or fungibilia impact the patient outcomes in LT recipients,especially with donation after circulatory death(DCD)allografts,which was correlated with a higher risk of allograft failure.Methods:This retrospective study included 139 LT recipients of DCD grafts from 2019 to 2021.All patients were divided into two groups according to the presence or absence of bacteriobilia or fungibilia.The prevalence and microbial spectrum of postoperative bacteriobilia or fungibilia and its possible association with outcomes,especially hospital stay were analyzed.Results:Totally 135 and 171 organisms were isolated at weeks 1 and 2,respectively.Among all patients included in this analysis,83(59.7%)developed bacteriobilia or fungibilia within 2 weeks posttransplantation.The occurrence of bacteriobilia or fungibilia[β=7.43,95%CI(confidence interval):0.02 to 14.82,P=0.049],particularly the detection of Pseudomonas(β=18.84,95%CI:6.51 to 31.07,P=0.003)within 2 weeks post-transplantation was associated with a longer hospital stay.However,it did not affect the graft and patient survival.Conclusions:The occurrence of bacteriobilia or fungibilia,particularly Pseudomonas within 2 weeks posttransplantation,could influence the recovery of liver function and was associated with prolonged hospital stay but not the graft and patient survival.展开更多
The late-breaking science presented at the 2023 scientific session of the American Heart Association paves the way for future pragmatic trials and provides meaningful information to guide management strategies in coro...The late-breaking science presented at the 2023 scientific session of the American Heart Association paves the way for future pragmatic trials and provides meaningful information to guide management strategies in coronary artery disease and heart failure(HF).The dapagliflozin in patient with acute myocardial infarction(DAPA-MI)trial showed that dapagliflozin use among patients with acute MI without a history of diabetes mellitus or chronic HF has better cardiometabolic outcomes compared with placebo,with no difference in cardiovascular outcomes.The MINT trial showed that in patients with acute MI and anemia(Hgb<10 g/dL),a liberal transfusion goal(Hgb≥10 g/dL)was not superior to a restrictive strategy(Hgb 7-8 g/dL)with respect to 30-day all-cause death and recurrent MI.The ORBITA-2 trial showed that among patients with stable angina and coronary stenoses causing ischemia on little or no antianginal therapy,percutaneous coronary intervention results in greater improvements in anginal frequency and exercise times compared with a sham procedure.The ARIES-HM3 trial showed that in patients with advanced HF who received a HeartMate 3 levitated left ventricular assist device and were anticoagulated with a vitamin K antagonist,placebo was noninferior to daily aspirin with respect to the composite endpoint of bleeding and thrombotic events at 1 year.The TEAMMATE trial showed that everolimus with low-dose tacrolimus is safe in children and young adults when given≥6 months after cardiac transplantation.Providing patients being treated for HF with reduced ejection fraction(HFrEF)with specific out-of-pocket(OOP)costs for multiple medication options at the time of the clinical encounter may reduce‘contingency planning’and increase the extent to which patients are taking the medications decided upon.The primary outcome,which was cost-informed decisionmaking,defined as the clinician or patient mentioning costs of HFrEF medication,occurred in 49%of encounters with the checklist only control group compared with 68%of encounters in the OOP cost group.展开更多
BACKGROUND The advent of coronavirus disease 2019(COVID-19)unveiled the worst national blood crisis that the United States had witnessed in over a decade.With the pandemic influencing the different stages of the acqui...BACKGROUND The advent of coronavirus disease 2019(COVID-19)unveiled the worst national blood crisis that the United States had witnessed in over a decade.With the pandemic influencing the different stages of the acquisition of blood products outside the hospital setting,we aimed to explore the possible barriers contributing to the shortage of blood products within the medical community.the COVID era and pre-COVID era.METHODS We conducted a retrospective cross-sectional study on hospitalized patients distinguishing the pattern of blood transfusion during the COVID and pre-COVID era in a community hospital.Data was tabulated to include the number of red blood cell(RBC)transfusions and if transfusions met restrictive blood transfusion criteria as per institutional guidelines.Chi-square was applied to test the statistical association between qualitative variables.Unpaired t test and Mann Whitney U test were applied respectively to test the mean difference of quantitative variables.RESULTS A total of 208 patients were included in the study,of which 108 were during COVID era and 100 were during pre-COVID era.The leading reason for admission in both the COVID era and pre-COVID era transfused patients was shortness of breath(53.7%and 36%P=0.001),followed by gastrointestinal bleeding(25.9%and 21%P=0.001).There was a higher percentage of RBC transfusions in the intensive care unit in the COVID-era group than in the pre-COVID era group(38.9%vs 22%,P=0.008).The restrictive transfusion criteria were met in 62%vs 79%in the COVID and pre-COVID eras,respectively(P=0.008).CONCLUSION The COVID-era group received RBC transfusions with less stringent adherence to restrictive blood transfusion practices in comparison to pre-COVID era group.展开更多
文摘BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV)-I/II,malaria,and syphilis is mandatory before blood transfusions.Worldwide,HCV,HBV,and HIV are the leading viruses causing mortality,affecting millions of people globally,including those with co-infections of HIV/HCV and HIV/HBV.Studies highlight the impact of TTIs on life expectancy and health risks,such as liver cirrhosis,cancer,and other diseases in individuals with chronic HBV.Globally,millions of blood donations take place annually,emphasizing the importance of maintaining blood safety.AIM To study the prevalence of TTIs,viz.,HBV,HCV,HIV I/II,syphilis,and malaria parasite(MP),among different blood donor groups.METHODS The study assessed the prevalence of TTIs among different blood donor groups in Delhi,India.Groups included total donors,in-house donors,total camp donors,institutional camp donors,and community camp donors.Tests for HIV,HBV,and HCV were done using enzyme-linked immunosorbent assay,while syphilis was tested with rapid plasma reagins and MP rapid card methods.The prevalence of HBV,HCV,HIV,and syphilis,expressed as percentages.Differences in infection rates between the groups were analyzed usingχ²tests and P-values(less than 0.05).RESULTS The study evaluated TTIs among 42158 blood donors in Delhi.The overall cumulative frequency of TTIs in total blood donors was 2.071%,and the frequencies of HBV,HCV,HIV-I/II,venereal disease research laboratory,and MP were 1.048%,0.425%,0.221%,0.377%,and 0.0024%,respectively.In-house donors,representing 37656 donors,had the highest transfusion transmissible infection(TTI)prevalence at 2.167%.Among total camp donors(4502 donors),TTIs were identified in 1.266%of donors,while community camp donors(2439 donors)exhibited a prevalence of 1.558%.Institutional camp donors(2063 donors)had the lowest TTI prevalence at 0.921%.Statistical analysis revealed significant differences in overall TTI prevalence,with total and in-house donors exhibiting higher rates compared to camp donors.CONCLUSION Ongoing monitoring and effective screening programs are essential for minimizing TTIs.Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.
文摘Beta thalassemia(β-thalassemia)syndromes are a heterogeneous group of inherited hemoglobinopathies caused by molecular defects in the beta-globin gene that lead to the impaired synthesis of beta-globin chains of the hemoglobin.The hallmarks of the disease include ineffective erythropoiesis,chronic hemolytic anemia,and iron overload.Clinical presentation ranges from asymptomatic carriers to severe anemia requiring lifelong blood transfusions with subsequent devastating complications.The management of patients with severeβ-thalassemia represents a global health problem,particularly in low-income countries.Until recently,management strategies were limited to regular transfusions and iron chelation therapy,with allogeneic hematopoietic stem cell transplantation available only for a subset of patients.Better understanding of the underlying pathophysiological mechanisms ofβ-thalassemia syndromes and associated clinical phenotypes has paved the way for novel therapeutic options,including pharmacologic enhancers of effective erythropoiesis and gene therapy.
基金funded by the National Plan Military Research (EF a2011.188)
文摘Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(tetracosactide;TCS10)targeting melanocortin receptors(MCRs)in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.Methods:Sensitivity analysis was based on a randomized,two-arm,multicenter,double-blind,controlled trial.The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs outputs in 100 consecutive cases(from August to September 2013 from Emilia Romagna region,Italy).Patients included an agent-based TCS10 group(10 mg,single intravenous bolus before surgery;n=56)and control group(n=44)and the association with cytokines,lactate,and bleeding-blood transfusion episodes with the prior-risk log odds for mortality rate in time-to-event was analyzed.Results:Thirty-day mortality was significantly improved in the TCS10 group vs.control group(0 vs.8 deaths,P<0.0001).Baseline levels of interleukin(IL)-6,IL-10,and lactate were associated with bleeding episodes,independent of TCS10 treatment[odds ratio(OR)=1.90,95%confidence interval(CI)1.39-2.79;OR=1.53,95%CI 1.17-2.12;and OR=2.92,95%CI 1.40-6.66,respectively],while baseline level of Fms-like tyrosine kinase 3 ligand(Flt3L)was associated with lower bleeding rates in TCS10-treated patients(OR=0.31,95%CI 0.11-0.90,P=0.03).For every 8 TCS10-treated patients,1 bleeding case was avoided.Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group(OR=0.32,95%CI 0.14-0.73,P=0.01).For every 4 TCS10-treated patients,1 transfusion case was avoided.Conclusions:Sensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care.To introduce the technology readiness level in real-life critically ill patients,further large-scale studies are required.Trial registration:European Union Drug Regulating Authorities Clinical Trials Database(EudraCT Number:2007-006445-41).
文摘BACKGROUND Hypertriglyceridemia thalassemia syndrome is a rare condition that occurs in patients with thalassemia.It typically presents with a combination of profound anemia and milky serum.Although previous case series have demonstrated the benefit of blood transfusions in reducing serum triglycerides,information regar-ding clinical outcomes and standard management in this setting remains limited.AIM To identify the clinical course,treatment strategies,and outcomes of patients with hypertriglyceridemia thalassemia syndrome.METHODS We performed a comprehensive search of the Scopus,PubMed,and Embase databases.We included only English-language articles and did not apply any publication date limits.The databases were last accessed on September 1,2024.This study was registered under number CRD420250587918 and included studies involving children and adults with thalassemia,hypertriglyceridemia,and available data on clinical course.RESULTS A total of 14 publications were included in the analysis,all of which were case reports or case series.No higher-quality evidence was available.Among 28 children with hypertriglyceridemia thalassemia syndrome,there were 22 cases ofβ-thalassemia major and 6 cases of hemoglobin E/β-thalassemia,including our illustrative case.The median age of onset was 11 months,and 92.3%of cases presented prior to the first blood transfusion.The common clinical manifestations included pallor(100%)and hepatosplenomegaly(67.9%).For hypertriglyceridemia-related symptoms,lipemia retinalis and xanthomas were observed in 25.0%and 10.7%of cases,respectively.The median hemoglobin level was 5.5 g/dL,while the median triglyceride level was 935 mg/dL.For management,92.9%of cases received blood transfusions with or without other interventions.At a median of 12 months’follow-up,all patients responded to the treatment without lipid-lowering agents,and 85.7%of cases were alive.CONCLUSION Hypertriglyceridemia thalassemia syndrome occurs exclusively in young children and usually presents with anemia and severe hypertriglyceridemia prior to the first transfusion.Management with blood transfusions provides a favorable response.However,long-term regular monitoring is warranted.
文摘BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.
文摘Introduction: Human pegivirus (HPgV), initially identified as hepatitis G virus in the 1990s, predominantly causes acute hepatitis and may persist particularly in individuals with compromised immune systems or those co-infected with HIV, HBV, or HCV. Despite its potential public health implications, particularly in transfusion contexts, comprehensive epidemiological data on HPgV in Burkina Faso remains scarce. Objectives: This study aimed to determine 1) the prevalence of human pegivirus infection among blood donors at the Regional Blood Transfusion Centre (Koudougou, Burkina Faso), and 2) the rates of co-infection between human pegivirus with HIV, HBV, HCV and Treponema pallidum. Material and Methods: Between 9 and 27 August 2022, 100 blood samples were collected and analyzed at the Regional Blood Transfusion Centre. Screening for HIV, HBV, HCV, and Treponema pallidum was conducted using the Cobas e 601 system (Roche Diagnostics). A 100 μL volume of each donor’s plasma was utilized for viral RNA extraction with the DNA/RNA Prep Kit (Sacace Biotechnologies) following the manufacturer’s instructions. HPgV RNA detection was conducted using the HGV Real-TM amplification kit (Sacace Biotechnologies). Results: The study was comprised of 100 blood donors, identifying HPgV RNA in 14 individuals (14% prevalence), with one noted co-infection with HBV. None of the participants were HIV positive. The prevalence rates for HBV and HCV were each found to be 5%, and syphilis also presented a prevalence of 5%. Conclusion: Our findings indicate a significant prevalence of HPgV among blood donors in Burkina Faso, underscoring the need for heightened surveillance and preventive measures in blood transfusion services and the broader population to enhance transfusion safety and public health.
文摘Background: Blood transfusion (BT) is crucial to the provision of modern health care. However, blood is scarce and costly, and its use is associated with risks. Therefore, the medical professionals who handle it should have adequate knowledge to ensure rational and safe utilization. The objective of the study was to determine the level of BT knowledge among junior medical doctors in Kenya. Methodology: A cross-sectional study was conducted among junior medical doctors working in Western Kenya. Data was collected using questionnaires from August 2021 to March 2022, and analysis was done by way of descriptive and inferential statistics. A p Results: A total of 150 medical doctors participated in the study. Males comprised 60% (n = 90), and the mean age of the participants was 29.9 (SD 3.6) with a range of 25 - 45 years. The mean knowledge score was 54.1% ± 16.4% and was associated with orientation (AOR = 3.157, 95% CI = 1.194 - 8.337). Conclusion: Blood transfusion knowledge among the doctors was suboptimal and was associated with pre-internship induction. There is a need for additional education in BT during all phases of medical training and practice, including orientation for medical interns.
基金Supported by the National Natural Science Foundation of China,No.81901999the Natural Science Foundation of Shanghai Municipality,No.23ZR1410900Wu Jieping Medical Foundation,No.320.6750.2024-05-47.
文摘BACKGROUND There is an ongoing debate regarding the relationship between intraoperative blood transfusions and patient outcomes.Unifying the results is difficult because of differences in surgery type,target population and postoperative observation indicators.AIM To evaluate the risk factors for intraoperative blood transfusion and its impact on postoperative outcomes in elderly gastrointestinal cancer patients.METHODS This was a retrospective single-center study of elderly patients(≥65 years old)who underwent elective abdominal surgery for gastrointestinal cancer with general anesthesia.Patients with chronic kidney disease and missing related data were excluded.The primary outcomes included acute kidney injury(AKI),myocardial injury,and respiratory complications during hospitalization.Multivariate logistic regression was performed to explore the exposure-outcome relationship.RESULTS A total of 967 patients were included in this study.A lower preoperative hematocrit level,longer operative time(>300 minutes)and greater amount of blood loss were observed in 145(15.0%)patients who received blood transfusions during surgery(P<0.0005).Among these patients,the incidences of AKI,myocardial injury and respiratory complications were 8.3%(n=12),5.5%(n=8),and 15.9%(n=23),respectively,and these values were significantly greater.Multivariate analysis revealed that receiving a transfusion was an independent risk factor for AKI,myocardial injury and respiratory complications(all P<0.05).CONCLUSION These results demonstrate that intraoperative blood transfusion increases the risk of poorer outcomes in elderly patients receiving gastrointestinal cancer surgery.These findings provide new ideas for improving the prognosis of elderly cancer patients.
文摘The Rh blood group system,especially the D antigen,is crucial in transfusion medicine and obstetrics.Weak D phenotypes,caused by mutations in the Rhesus D antigen(RhD)blood group(RHD)gene,result in reduced antigen expression,posing challenges in serological testing and clinical management.Variability in detection methods leads to inconsistent results,making accurate classification difficult.Molecular techniques like polymerase chain reaction and DNA sequencing have significantly improved the identification of weak D variants,offering more reliable transfusion strategies and reducing the risk of alloimmunization.However,challenges such as lack of standardized protocols,cost constraints,and population-specific variations remain.In obstetrics,proper management of pregnant women with weak D is essential to prevent hemolytic disease of the fetus and newborn.Non-invasive prenatal testing using cell-free fetal DNA shows promise in predicting RhD incompatibility and minimizing unnecessary Rh immune globulin administration.Future advancements in highthroughput genotyping and discovery of novel RHD alleles could enhance RhD testing accuracy and efficiency.Standardizing RHD genotyping and adopting genotype-based management strategies for Rh immune globulin therapy and red blood cell transfusions will improve patient safety and clinical outcomes.This review examines the molecular basis,challenges,and future prospects in weak D phenotype management.
文摘BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.
基金funded by The Norwegian Research Council,the Liaison Committee between the Central Norway Regional Health Authorityfunded by the Coordination for the Improvement of Higher Education PersonnelBrazil(Capes)。
文摘Background:Exercise training promotes brain plasticity and is associated with protection against cognitive impairment and Alzheimer’s disease(AD).These beneficial effects may be partly mediated by blood-borne factors.Here we used an in vitro model of AD to investigate effects of blood plasma from exercise-trained donors on neuronal viability,and an in vivo rat model of AD to test whether such plasma impacts cognitive function,amyloid pathology,and neurogenesis.Methods:Mouse hippocampal neuronal cells were exposed to AD-like stress using amyloid-βand treated with plasma collected from human male donors 3 h after a single bout of high-intensity exercise.For in vivo studies,blood was collected from exercise-trained young male Wistar rats(high-intensity intervals 5 days/week for 6 weeks).Transgenic AD rats(McGill-R-Thyl-APP)were inj ected 5 times/fortnight for 6 weeks at2 months or 5 months of age with either(a)plasma from the exercise-trained rats,(b)plasma from sedentary rats,or(c)saline.Cognitive function,amyloid plaque pathology,and neurogenesis were assessed.The plasma used for the treatment was analyzed for 23 cytokines.Results:Plasma from exercised donors enhanced cell viability by 44.1%(p=0.032)and reduced atrophy by 50.0%(p<0.001)in amyloid-β-treated cells.In vivo exercised plasma treatment did not alter cognitive function or amyloid plaque pathology but did increase hippocampal neurogenesis by~3 fold,regardless of pathological stage,when compared to saline-treated rats.Concentrations of 7 cytokines were significantly reduced in exercised plasma compared to sedentary plasma.Conclusion:Our proof-of-concept study demonstrates that plasma from exercise-trained donors can protect neuronal cells in culture and promote adult hippocampal neurogenesis in the AD rat brain.This effect may be partly due to reduced pro-inflammatory signaling molecules in exercised plasma.
文摘BACKGROUND Occult hepatitis B infection(OBI)is a globally prevalent infection,with its frequency being influenced by the prevalence of hepatitis B virus(HBV)infection in a particular geographic region,including Africa.OBI can be transmitted th-rough blood transfusions and organ transplants and has been linked to the development of hepatocellular carcinoma(HCC).The associated HBV genotype influences the infection.AIM To highlight the genetic diversity and prevalence of OBI in Africa.METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search on PubMed,Google Scholar,Science Direct,and African Journals Online for published studies on the prevalence and genetic diversity of OBI in Africa.RESULTS The synthesis included 83 articles,revealing that the prevalence of OBI varied between countries and population groups,with the highest prevalence being 90.9%in patients with hepatitis C virus infection and 38%in blood donors,indicating an increased risk of HBV transmission through blood transfusions.Cases of OBI reactivation have been reported following chemotherapy.Genotype D is the predominant,followed by genotypes A and E.CONCLUSION This review highlights the prevalence of OBI in Africa,which varies across countries and population groups.The study also demonstrates that genotype D is the most prevalent.
基金JMW,RSS,EP,EK,WM,ZBP,and NRMT have received research funding from a precision trauma care research award from the Combat Casualty Care Research Program of the US Army Medical Research and Materiel Command(DM180044).
文摘We read with interest the recent systematic reviewaArtificial intelligence and machine learning for hemorrhagic trauma careoby Peng et al.[1],which evaluated literature on machine learning(ML)in the management of traumatic haemorrhage.We thank the authors for their contribution to the role of ML in trauma.
文摘Dr.Atefe R.Tari is a researcher at the Cardiac Exercise Research Group(CERG),at the Norwegian University of Science and Technology,and at the Department of Neurology and Clinical Neurophysiology,St.Olavs Hospital,Norway.Before defending her PhD in medicine in 2022,she had published 12 papers,several in high-ranking journals.Dr.Tari is heading her dedicated research group within CERG,focusing on the effects of exercise training on Alzheimer's disease.She is also co-principle investigator of the ExPlas trial examining the effect of plasma transfusions from young fit individuals on cognitive function in patients with Alzheimer’s disease.Mainly her research focuses on exploring the molecular secrets underlying the beneficial effects of exercise training on cognitive function—aiming to unravel in detail the molecular choreography of exercise training to discover molecular markers linked to various disease models.
文摘Objective: To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors.Methods: Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis.Results: In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03;two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram.Conclusion: A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.
基金supported by grants from Shanghai Municipal Health Commission(201940032)National Key Research and Development Program of China(2023YFC2505900).
文摘Background:Normal bile is sterile.Studies have shown that cholangitis after liver transplantation(LT)was associated with a relatively poor prognosis.It remains unclear whether the bacteriobilia or fungibilia impact the patient outcomes in LT recipients,especially with donation after circulatory death(DCD)allografts,which was correlated with a higher risk of allograft failure.Methods:This retrospective study included 139 LT recipients of DCD grafts from 2019 to 2021.All patients were divided into two groups according to the presence or absence of bacteriobilia or fungibilia.The prevalence and microbial spectrum of postoperative bacteriobilia or fungibilia and its possible association with outcomes,especially hospital stay were analyzed.Results:Totally 135 and 171 organisms were isolated at weeks 1 and 2,respectively.Among all patients included in this analysis,83(59.7%)developed bacteriobilia or fungibilia within 2 weeks posttransplantation.The occurrence of bacteriobilia or fungibilia[β=7.43,95%CI(confidence interval):0.02 to 14.82,P=0.049],particularly the detection of Pseudomonas(β=18.84,95%CI:6.51 to 31.07,P=0.003)within 2 weeks post-transplantation was associated with a longer hospital stay.However,it did not affect the graft and patient survival.Conclusions:The occurrence of bacteriobilia or fungibilia,particularly Pseudomonas within 2 weeks posttransplantation,could influence the recovery of liver function and was associated with prolonged hospital stay but not the graft and patient survival.
文摘The late-breaking science presented at the 2023 scientific session of the American Heart Association paves the way for future pragmatic trials and provides meaningful information to guide management strategies in coronary artery disease and heart failure(HF).The dapagliflozin in patient with acute myocardial infarction(DAPA-MI)trial showed that dapagliflozin use among patients with acute MI without a history of diabetes mellitus or chronic HF has better cardiometabolic outcomes compared with placebo,with no difference in cardiovascular outcomes.The MINT trial showed that in patients with acute MI and anemia(Hgb<10 g/dL),a liberal transfusion goal(Hgb≥10 g/dL)was not superior to a restrictive strategy(Hgb 7-8 g/dL)with respect to 30-day all-cause death and recurrent MI.The ORBITA-2 trial showed that among patients with stable angina and coronary stenoses causing ischemia on little or no antianginal therapy,percutaneous coronary intervention results in greater improvements in anginal frequency and exercise times compared with a sham procedure.The ARIES-HM3 trial showed that in patients with advanced HF who received a HeartMate 3 levitated left ventricular assist device and were anticoagulated with a vitamin K antagonist,placebo was noninferior to daily aspirin with respect to the composite endpoint of bleeding and thrombotic events at 1 year.The TEAMMATE trial showed that everolimus with low-dose tacrolimus is safe in children and young adults when given≥6 months after cardiac transplantation.Providing patients being treated for HF with reduced ejection fraction(HFrEF)with specific out-of-pocket(OOP)costs for multiple medication options at the time of the clinical encounter may reduce‘contingency planning’and increase the extent to which patients are taking the medications decided upon.The primary outcome,which was cost-informed decisionmaking,defined as the clinician or patient mentioning costs of HFrEF medication,occurred in 49%of encounters with the checklist only control group compared with 68%of encounters in the OOP cost group.
文摘BACKGROUND The advent of coronavirus disease 2019(COVID-19)unveiled the worst national blood crisis that the United States had witnessed in over a decade.With the pandemic influencing the different stages of the acquisition of blood products outside the hospital setting,we aimed to explore the possible barriers contributing to the shortage of blood products within the medical community.the COVID era and pre-COVID era.METHODS We conducted a retrospective cross-sectional study on hospitalized patients distinguishing the pattern of blood transfusion during the COVID and pre-COVID era in a community hospital.Data was tabulated to include the number of red blood cell(RBC)transfusions and if transfusions met restrictive blood transfusion criteria as per institutional guidelines.Chi-square was applied to test the statistical association between qualitative variables.Unpaired t test and Mann Whitney U test were applied respectively to test the mean difference of quantitative variables.RESULTS A total of 208 patients were included in the study,of which 108 were during COVID era and 100 were during pre-COVID era.The leading reason for admission in both the COVID era and pre-COVID era transfused patients was shortness of breath(53.7%and 36%P=0.001),followed by gastrointestinal bleeding(25.9%and 21%P=0.001).There was a higher percentage of RBC transfusions in the intensive care unit in the COVID-era group than in the pre-COVID era group(38.9%vs 22%,P=0.008).The restrictive transfusion criteria were met in 62%vs 79%in the COVID and pre-COVID eras,respectively(P=0.008).CONCLUSION The COVID-era group received RBC transfusions with less stringent adherence to restrictive blood transfusion practices in comparison to pre-COVID era group.
