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Objective: To describe the use of non-erythrocyte blood products transfusion in very preterm and extremely preterm infants in the neonatal intensive care units (NICU) of the Chinese Neonatal Network (CHNN) in 2019, to explore the disparity between different centers, and to further investigate the rationality and standardability of non-erythrocyte blood products transfusion. Methods: This was a cross-sectional study based on the CHNN cohort of very preterm and extremely preterm infants. All 6 598 infants with gestational age (GA)<32 weeks and admitted to the 57 NICU of CHNN within 24 h of life in 2019 were enrolled. Non-erythrocyte blood products included platelet, plasma, albumin, immunoglobulin, cryoprecipitate and prothrombin complex. Infants who received at least one type of non-erythrocyte blood products were defined in transfusion group. The comparison between infants with and without transfusion was done by t-test, rank-sum test or χ2 test as appropriate. Linear regression model was used to generate adjusted transfusion rate of each center, and to investigate the correlation between adjusted rate and center-level characteristics. Results: A total of 6 598 infants were enrolled in the study, with gestational age of 30.0 (28.7, 31.0) weeks and birth weight of (1 353±312) g, and 43.6 % (2 877) of them were female. Among them, 42.7% (2 816) infants were enrolled in transfusion group, with the times of transfusion as 3 (1, 6) times. Compared to the infants without any transfusion of non-erythrocyte blood products, those infants received transfusion had lower gestational age (Z=17.62, P<0.01), lower birth weight (t=18.64, P<0.01), higher proportion of small-for-gestation age (χ2=31.06, P<0.01), multiple birth (χ²=12.82, P<0.01) and intensive resuscitation in delivery room (χ²=287.52, P<0.01), as well as lower proportion of females (χ²=10.68, P<0.01) and even lower proportion of infants born in this hospital (χ²=78.23, P<0.01). Among the entire study population, albumin (25.4%, 1 674 cases), immunoglobulin (21.5%, 1 417 cases) and plasma (18.9%, 1 245 cases) were the most commonly used non-erythrocyte blood products. Overall, 60.4% (544/901) infants with gestational age <28 weeks received transfusion 4 (2, 8) times. A total of 39.9% (2 272/5 697) infants between 28-31weeks received non-erythrocyte blood products 3 (1, 6) times. The non-erythrocyte blood products transfusion rates of critically-ill and non-critically-ill infants were 62.2% (1 693/2 723) and 29.0% (1 123/3 875) respectively, and the transfusion times were 4 (2,7) and 2 (1,4) times. The transfusion rates varied significantly among different NICU, and the disparities remained obvious after adjustment (adjusted χ²=153.48, P<0.01). Conclusion: Near half of very preterm and extremely preterm infants admitted to Chinese NICU in 2019 receive non-erythrocyte blood products during hospitalization with significant disparities among different hospitals.
Subject(s)
Female , Humans , Infant , Infant, Newborn , China , Cross-Sectional Studies , Infant, Extremely Premature , Infant, Premature, Diseases , Intensive Care Units, NeonatalABSTRACT
@#AIM: To assess the clinical efficacy of phacoemulsification, intraocular lens implantation with goniosynechialysis(PEI+GSL)for acute angle closure glaucoma(AACG)and cataract with extensive angle closure synechiae.<p>METHODS: A retrospective study, we studied 35 eyes of 32 patients with AACG and cataract in our hospital. The extent of anterior chamber angle-closure synechiae was defined as an eye with >180°. All patients underwent PEI+GSL and completed an ophthalmologic examination including vision, intraocular pressure(IOP), anterior chamber depth(ACD), angle-opening distance(AOD500), trabecular-iris space area(TISA500)were observed at 1d, 1wk, 1mo and 3mo after cataract surgery. The angle closure range and retinal nerve fiber layer(RNFL)thickness changes at postoperative 1mo and 3mo were observed, and recorded complications.<p>RESULTS: Postoperative 3mo BCVA(0.334±0.154)and IOP(14.63±3.59mmHg)were improved compared with preoperative(0.914±0.290, 42.54±8.06mmHg)(<i>P</i><0.05). ACD(3.203±0.214mm), OCT angle parameters AOD500 and TISA500(0.308±0.014, 0.315±0.015mm, 0.134±0.013, 0.139±0.018mm2)were significantly increased compared with preoperation. The extent of angle closure with gonioscopy(72.32±28.33°)decreased compared preoperation(215.29°±30.66°), and RNFL thickness thinner than preoperation(<i>P</i><0.001). Changes in AOD500 and TISA500 for both nasal and temporal were negatively correlated with IOP, but not with changes in ACD, and no significant complications occurred in the 3mo after surgery.<p>CONCLUSION: The treatment of PEI+GSL can improve vision, deeper ACD and effectively open ACA in the early stage, thus controlling IOP.
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Objective: To evaluate the effects of captopril on Klotho protein and related inflammatory factors in the model of hypertensive SD rats. Methods: Eighteen SD rats were randomly divided into normal group, hypertensive model group and captopril experimental group, respectively. N'-nitro-L-arginine (L-NNA) was used by gavage in SD rats to make the hypertensive model. After successful establishment of the model, the experimental group was given captopril for treatment of hypertension, and the normal group and hypertension group were given an equal volume of normal saline by gavage in the SD rats. Blood pressure changes were measured by tail arteries of the SD rats. Enzyme-linked immunosorbent assay (ELISA) was used to measure plasma levels of Klotho protein, thromboxane (TXA2), and endothelin (ET). The level of nitric oxide (NO) was measured by nitrate reductase method. The content of malondialdehyde (MDA) was measured by TBA method, and the activity of superoxide dismutase (SOD) was measured by WST-1 method. The pathological changes of HE stained vascular wall in thoracic aorta of each group were observed. The vascular endothelial cell injury was evaluated by measuring the expression of CD31 by immunohistochemistry (IHC). Results: Compared with those in the normal group, the contents of TXA2, ET and MDA in the model group were significantly higher (P<0.05), while the content of Klothoprotein and NO and SOD activities were lower (P<0.05). Compared with those in the model group, the contents of TXA2, ET and MDA in the captopril group were significantly decreased (P<0.05), and the Klotho protein content, NO content and SOD activity were higher (P<0.05). The results of HE staining showed that the aortic vascular fibrosis and disorder in the model group and the aorticl wall were thicker than those in the normal group. The vessel wall was significantly thinner in the treatment group than in the model group. The results of IHC showed that the aortic endothelial cells in the model group were damaged and shedding. The vascular endothelial cells in the controlled group were increased and gradually repaired. Conclusion: Captopril can reduce the stress response of endothelial cells and repair the vascular endothelium, which can improve vascular endothelial function and increase Klotho protein level.