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【Objective】 To develop a quick and accurate crossmatching test technology without the power equipment and additional reagents before blood transfusion, so as to improve the timeliness and safety of blood transfusion treatment in sudden situations as war or natural disasters. 【Methods】 The irregular antibodies quickly promote coagulants (QPC) were used as the reaction medium reagent. The 200 μL QPC were wrapped in the bursts bead and preset within different recess of the detection tubes. The bursts beads were squeezed with the reagent left in the well, then the blood samples were dropped in the main(recipient plasma: 200 μL, donor 3%—5% RBC: 100 μL) and secondary(donor plasma: 200 μL, recipient 3%—5% RBC: 100 μL)reaction grooves. The result interpretated by hand wrestling or 1 500 g centrifugation of 15 seconds. Meanwhile, the comparing experiments with the prior methods were implemented to evaluate the method’s reliability. 【Results】 The results of the bursting reagent, being stored at 37℃ for one week, were consistent with those of the freshly prepared cross-matching reagent, indicating that the bursting reagent was practical in the field and had good stability at normal temperature. No statistical difference between the sensitivity and the results of the microcolumn gel method was noticed by paired data t test (P>0.05). The parallel cross matching tests of 50 clinical samples were performed by microcolumn gel method and coagulant-bursting technique; the Kappa value was 0.973 2, and irregular antibodies were detected in 2 cases, with concordance rate at 100%, showing good consistency. 【Conclusion】 The improved method is simple and fast, and also safe and reliable for compatibility testing before blood transfusion, which is especially suitable for the field rescue of the wounded in wartime and sudden natural disasters, and is worthy of popularization.
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【Objective】 To analyze the causes of a case of hemolytic disease of the fetus and newborn (HDFN),and investigate the genetic background of maternal Rh deletion D--formation. 【Methods】 Blood samples of maternal and fetus were collected, and ABO blood typing, Rh blood typing, antibody screening and identification test were performed to explore the blood group serological characteristics of Rh deletion type D--, and Rh gene sequence was performed on parturient. 【Results】 The maternal blood group was identified to be O type, D--, and the anti-Hr0 antibody against Rh high-frequency antigen was suspected to be caused by multiple pregnancies which passes through the placental barrier and enable fetus to obtain anti Hr0 antibody, leading to HDFN, with genetic testing result as RH RHCE* Ce/RHCE* Ce. 【Conclusion】 In-depth research on the formation mechanism of Rh D-- in parturient should be conducted to provide clinical value for HDFN blood exchange treatment and blood transfusion in special blood group population.
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【Objective】 To evaluate the efficacy and safety of early interventions by traditional Chinese medicine oral liquid combined with plasma exchange in the treatment of pregnant women with high titer of ABO/Rh antibodies. 【Methods】 156 pregnant women with serum antibodies presenting high titer (ABO ≥512, Rh ≥ 64) in our hospital from May 2018 to April 2021 were randomly divided into traditional Chinese medicine group(group Ⅰ, n=68), traditional Chinese medicine combined with plasma exchange group(group Ⅱ, n=57) and control group (n=31). The control group were given VC, VEand oxygen uptake. Group Ⅰ were further given oral administration of traditional Chinese medicine liquid on the basis of treatment of the controls. GroupⅡwas further treated with plasma exchange on the basis of group I treatment(for 20 days every month). The biochemistry, serum antibody titer and foetus intrauterine growth were monitored. The the efficacy of treatment, as well as pregnancy and neonatal conditions in the three groups were observed. 【Results】 The decrease time of antibody titer and IgG subtype titer in groupⅠ and Ⅱ, relative to the controls, were significantly better(P<0.05). The effective rate of group Ⅰ(72.59%, 49/68) and group Ⅱ(92.98%, 53 /57) were significantly higher than the controls(18.52%, 5/27, with 4 cases excluded). No HDN occurred in group II, indicating superior treatment outcome to group I and the controls. 【Conclusion】 The oral administration of traditional Chinese medicine liquid combined with plasma exchange, with good therapeutic efficacy and maternal-fetal safety, was effective for the early interventions of ABO/Rh incompatible HDN and worthy of clinical application.
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Objective:To assess the differences of the 2016 and 2009 edtion guidelines on diastolic dysfunction in sepsis patients.Methods:A single-center, prospective study was conducted. The relevant information of sepsis patients in Intensive Care Unit (ICU) were analyzed from October 2016 to January 2019. Patients’ transthoracic echocardiography at the first 24 h and 3rd day of their admission and left ventricular diastolic dysfunction were stratified according to the 2009 and 2016 edition guidelines. Patients’ characteristics, arterial blood gas analysis, and blood biochemical indexes were recorded at the first 24 h of the ICU admission. Additionally, the following information were retrieved during ICU stay: site of infection, frequency of adrenaline and dobutamine, maximal dose of norepinephrine, use of hydrocortisone, invasive mechanical ventilation and renal replacement therapy. The rank-sum test of two independent samples was used to compare the differences in the diagnosis of left ventricular diastolic dysfunction.Results:A total of 196 patients with sepsis or septic shock were screened, and 86 patients were excluded. Finally, clinical data of 110 patients were included in the analysis.The median time of the first ultrasound examination in ICU was 17 h. Among the patients with different diastolic function severity in baseline data analysis, only age was significantly different. According to the 2016 edition guidelines, 43 (39%) of 110 patients had diastolic dysfunction and another 30 (27%) had indeterminate diastolic dysfunction within 24 h of ICU admission. According to the 2009 edition guidelines, 40 (36%) patients had diastolic dysfunction and 58 (53%) patients had indeterminate diastolic dysfunction. The diagnosis of left ventricular diastolic dysfunction of different grades was significantly different between the 2016 and 2009 edition guidelines ( Z=4.92, P<0.01). According to the 2016 edition guidelines at the 3rd day of ICU admission, 52 (47%) patients were diagnosed with diastolic dysfunction and 18 (18%) were diagnosed with indeterminate diastolic dysfunction; According to the 2009 edition guidelines, 50 (46%) of these patients were diagnosed with diastolic dysfunction and 45 (41%) had indeterminate diastolic function. Similarly, there was a large difference in diagnosis ( Z=4.60, P<0.01). Subgroup analysis of patients with normal systolic function (ejection fraction > 50%) showed that the diagnosis of left ventricular diastolic dysfunction were significantly different at the first 24 h and the 3rd day of ICU admission ( Z=4.34, P<0.01 and Z=5.71, P<0.01). Conclusions:The 2016 edition guidelines identify a significantly higher incidence of dysfunction in patients with severe sepsis and septic shock compared to the 2009 edition guidelines. Although the 2016 edition guidelines seem to be an improvement, issues remain with the application of guidelines using traditional measures of diastolic dysfunction in this cohort.
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OBJECTIVE@#To investigate the clinical and immunological characteristics, treatment and prognosis of common variable immune deficiency (CVID) in adult patients.@*METHODS@#We retrospectively analyzed the clinical data of 13 adult patients hospitalized in our hospital for CVID diagnosed according to the criteria in International Consensus Document (2016), and analyzed their clinical manifestations, laboratory test results, imaging findings, pathological examinations and treatments.@*RESULTS@#The mean age of onset was 24.46±16.82 years in these patients, who had a mean age of 32.54±14.86 years at diagnosis with a median diagnostic delay of 5 years (IQR: 2-15 years). The main manifestation of the patients was repeated infections, including repeated respiratory tract infection (10 cases; 76.9%) and repeated diarrhea (3 cases; 23.1%). Three (23.1%) of the patients had autoimmune disease and 10 (76.9%) had chronic pulmonary disease. IgG, IgA and IgM were decreased in all the patients. The proportion of CD4+T cells decreased in 10 patients (76.9%), CD8+T cells increased in 11 patients (84.6%), and CD4/ CD8 decreased in 10 patients (76.9%). Complement C3 decreased in 58.3% (7/12) and C4 decreased in 33.3% (4/12) of the patients. Twelve patients (92.3%) were treated with intravenous infusion of gamma globulin with symptomatic treatments. One patient died due to massive gastrointestinal hemorrhage, and the other patients showed improve ments after the treatments and were discharged.@*CONCLUSIONS@#The clinical manifestations of CVID are diverse, and recurrent respiratory tract infection is the most common manifestation. Decreased IgG often accompanied by lowered IgA and IgM levels is a common finding in laboratory tests. The treatment of CVID currently relies on gamma globulin with symptomatic treatments for the complications.
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Adolescent , Adult , Child , Humans , Middle Aged , Young Adult , Autoimmune Diseases , Common Variable Immunodeficiency , Delayed Diagnosis , Immunoglobulins, Intravenous , Retrospective StudiesABSTRACT
Objective To investigate the prognostic impact of left ventricular diastolic dysfunction in septic shock patients in intensive care unit (ICU). Methods A single-center, prospective tudy was conducted. The relevant information of septic shock patients who underwent an echocardiographic assessment during the initial management were analyzed in ICU of Harrison International Peace Hospital Affiliated to Hebei Medical University from June 2016 to October 2017. Hemodynamics were evaluated using transthoracic echocardiography within the first 24 h of shock, and LV diastolic dysfunction is present if the available parameters meet the cutoff values. Patients' characteristics, arterial blood gas analysis, and blood biochemical indexes were recorded in the first 24h at ICU admission. Additionally, the following information were retrieved during ICU stay: site of infection, frequency of adrenaline and dobutamine, maximal dose of norepinephrine, use of hydrocortisone, invasive mechanical ventilation and renal replacement therapy. A multivariate analysis was performed to determine independent risk factors associated with septic shock mortality, and the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of all risk factors on the outcome of patients. Results Among the 138 patients with septic shock hospitalized in the ICU during the study period, 102 patients were enrolled [76 men (75％); aged 64 ± 12 years] and 92 of them (90％) were mechanically ventilated. Thirty patients died in ICU with a mortality rate of 29％. LV diastolic dysfunction was observed in 32 patients (31％). No significant inter-group difference in infection characteristics was found. The death group had significantly higher APACHE Ⅱ score, SOFA score, lactate and creatinine levels than the survival group. Similarly, the death group received a greater dose of vasopressors and required more frequent administration of epinephrine than the survivors. While the dead group exhibited slightly yet significantly larger RV cavity, which was reflected by a significant greater RVEDA/LVEDA ratio (0.77 ± 0.43 vs 0.59 ± 0.17) with no association with paradoxical septal motion. Mean value of lateral e′ maximal velocity was significantly lower in the death group compared with the survival group(10.50 ± 3.80)cm/s vs (12.9 ± 4.6)cm/s. The proportion of LV diastolic dysfunction tended to be higher in the death group than in the survival group (14/30 vs 18/72). In the multivariate analysis, the maximal dose of norepinephrine (OR=1.69, 95％CI:1.05-2.79), the SOFA score(OR=2. 24,95％CI:1.32-3.35) ,e′ lateral maximal velocity (OR=2.23, 95 ％ CI:1.01-5.57), lactate(OR=2.36, 95％CI:1.25-5.43) and LV diastolic dysfunction(OR=1.32,95％CI:1.11-3.15) were significantly associated with septic shock mortality. The area under ROC curve of lateral e′ maximal velocity for predicting death of septic shock patients was 0.63 (95％CI: 0.54-0.78) and the cut-off value was 8.9 cm/s, with a sensitivity and specificity of 76％ and 54％, respectively. Conclusions The present study suggests that LV diastolic function might be associated with ICU mortality in patients with septic shock. A multicenter prospective study assessing a large cohort of patients using serial echocardiographic examinations remains to confirm the prognostic value of LV diastolic dysfunction in septic shock patients.
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BACKGROUND:The homing ability of mesenchymal stem cells is closely associated with the effects of celltransplantation. Clarifying the mechanism of chemotaxis and migration wil contribute to enhance the clinical application of mesenchymal stem cells. OBJECTIVE:To investigate the effect of Cdc42 in the homing of human umbilical cord mesenchymal stem cells. METHODS:First, mesenchymal stem cells were isolated from human umbilical cord, and co-cultured with tumor necrosis factorα, interleukin-1β, and transforming growth factorβ. Western blot assay was used to test the level of Cdc42. Besides, Cdc42 siRNA was synthesized by chemical method to transfect the cells, and cellmigration and adhesion were measured by Transwel and Matrigel separately. Meanwhile, the activity of signal molecule, extracellular regulated protein kinase 1/2, was evaluated by western blot. RESULTS AND CONCLUSION:The results indicated that the inflammation factors induced the highly expression of Cdc42 in human umbilical cord mesenchymal stem cells, almost double level to controls. siRNA notably inhibited the migration and adhesion of human umbilical cord mesenchymal stem cells through Cdc42 down-regulation, and the extracellular regulated protein kinase 1/2 and phosphorylation form were also decreased simultaneously. In a word, we speculate Cdc42 plays a role in the chemotaxis of human umbilical cord mesenchymal stem cells in vitro.
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AIM:To investigate the type of chloride channel activated by cisplatin in poorly differentiated na -sopharyngeal carcinoma cells (CNE-2Z cells).METHODS:The technique of whole-cell patch-clamp was used to investi-gate the role of Ca 2+in the activation of cisplatin-activated chloride currents and to analyze the effect of hypertonic stress on these currents in CNE-2Z cells.RESULTS:Chloride currents were induced when the cells were exposed to the calcium -free cisplatin solution , showing the similar density to the currents induced by cisplatin with the presence of extracellular cal -cium.However , the latency and the peak time of cisplatin-activated currents in the absence of extracellular calcium were prolonged.The activation of cisplatin-activated chloride currents was insensitive to the depletion of intra-and extracellular calcium.Calcium channel antagonist nifedipine had no effect on the cisplatin -activated chloride currents , while hypertonic solution completely inhibited those currents .CONCLUSION:The cisplatin-activated chloride currents are independent on intra/extracellular calcium .The chloride channels activated by cisplatin are not calcium-activated chloride channels , but are probably volume-sensitive chloride channels .
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Mesenchymal stem cells (MSC) possess an innate ability for self-renewal and can differentiate into multiple cell types.MSC have been used in cell-based therapy in various disease conditions including tumors.However,as MSC therapy gained popularity among practitioners and rescarchers,there have been reports on thre adverse effects of MSC especially in the context of tumor modulation and malignant transformation.Recent studies have shown that MSC also play an important role in the resistance to various anti-cancer drugs.This review provides an overview of the functional properties of MSC in cancer drug resistance.
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Objective To investigate the effects of the low-dose ketamine on the minimum alveolar concentration (MAC) of sevoflurane in patients undergoing gynecological abdominal surgery.Methods Fifty-one ASA Ⅰ or Ⅱ patients aged 36-49 yr with body mass index ≤ 30 kg/m2 scheduled for gynecological abdominal surgery were randomly divided into control group (group C, n = 29) and ketamine group (group K, n = 22) . The paitents were unpremedicated. In group K, a loading dose of ketamine 0.2 mg/kg was injected intravenously followed by infusion at a rate of 14 μg·kg-1 ·min-1 , while equal volume of normal saline was given in group C. Anesthesia was induced with inhalation of sevoflurane (end-tidal concentration 4%-5%, maintaining for 5 min) in both groups. Endotracheal intubation was performed. The patients breathed sevoflurane until the predetermined target end-tidal sevoflurane concentration was reached for at least 15 min before skin incision. Occurrence of body movement was determined by any visible contraction of the muscle bundle of trunk, limbs, head and neck during skin incision and/or within 60 s after skin incision. The initial end-tidal concentration of sevoflurane was set at 1.8 % .If body movement occurred, the end-tidal concentration of sevoflurane was increased by 0.2% , while if not, decreased by 0.2% . MACs of sevoflurane were calculated. Results The MAC of sevoflurane was 1.51% (95% confidence interval 1.45%-1.58%) in group K, and 2.49% (95% confidence interval 2.40%-2.57%) in group C, and there was significant difference between the two groups ( P < 0.05) . Conclusion Intravenous infusion of the low-dose ketamine can enhance the anesthetic effect of sevoflurane in patients undergoing gynecological abdominal surgery.
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n of IL-6 and TNF-alpha,alleviate the inflammation of ANP.
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To study whether the late-acting co-stimulatory molecules ICOS can suppress the apoptosis and sustain the survival and proliferation of T cells through the survivin pathway, ICOS signals deficient T-cells were infected with adenovirus carried survivin gene, other T-cells were given ICOS co-stimulatory signals, then infected with adenovirus carried dominant-negative mutant survivin gene. Apoptosis and proliferation were determined by TUNEL and CCK-8 respectively. The results show that engagement of ICOS signal increased the expression level of survivin significantly. Survivin can sustain co-stimulatory deficient T cells survival and suppress the apoptosis. Mutant survivin inhibits ICOS signal positive T cells survival and increase its apoptosis. Late-acting co-stimulatory molecules ICOS can suppress the apoptosis and sustain the survival of T cells through the survivin pathway.
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These six aspects are discussed,including perfect management institutions,the development of management measures,strict quality control,the different management and update optimization,and the establishment of the reward and punishment systems. It aims to strengthen management,improve the management of field medical equipment and maintain in good condition. Update optimization in practice and quality improvement of field medical equipment are required for suitable rescue,treatment needs in peacetime and wartime.
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Objective To construct the bicistronic retroviral vectors containing GFP gene and human survivin gene(wildtype and T34A mutant). Methods Survivin fragments were amplified from eukaryotic expression vectors by PCR, then cloned into pMIG retroviral vectors. The constructed recombinant was identified by double digestion with restriction enzymes. The constructed retroviral vectors was transfected into Phoenix E package cells under mediation of liposome. The expression of mRNA was examined by RT-PCR and the transcription of gene was determined by FACS analysis of GFP. Results The target fragments were successfully bound to pMIG vector. After the vectors were transfected into NIH3T3 cells, the expression of mRNA was confirmed by RT-PCR and the expression of GFP was confirmed by FACS analysis. Conclusion Human survivin gene wildtype and T34A mutant retroviral vectors have been constructed successfully, which can provide strong molecular tools for further studies and a novel approach for selective cancer gene therapy.
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As an important part in hospital quality management,medical metrology management is a technical support and necessary means for medical quality.Four aspects such as reinforcement of organization,rules,basic construction and exertion of function are discussed.It is impsrtant and esstntial to strengthen medical metrology.[Chinese Medical Equipment Journal,2008,29(2):107,109]