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Resumen Introducción: El SARS-CoV-2 se desconocía hasta el brote en Wuhan, China en diciembre de 2019, las características ultraestructurales de este virus con predisposición a receptores expresados en los neumocitos tipo II (CD209L y ECA2) resultan en daño alveolar difuso y un tercio de los pacientes con SARS-CoV-2 cumplen criterios de SIRA con hipoxemia severa. Tras el curso severo de la enfermedad y alta mortalidad se reportó en estudios la asociación del dímero D (DD) con casos graves y atribuyéndose al estado protrombótico de la enfermedad, contribuyendo directamente en ventilación mecánica prolongada y muerte. Objetivo principal: Determinar los diferentes niveles de dímero D ante la presencia de hipoxemia severa en pacientes con neumonía por SARS-CoV-2 ingresados en la terapia intensiva. Material y métodos: Estudio transversal comparativo retrospectivo unicéntrico, se revisaron expedientes de pacientes mayores de 18 años que ingresaron a la Unidad de Cuidados Intensivos con diagnóstico de neumonía por SARS-CoV-2; se tomaron en cuenta los valores de DD al ingreso, al séptimo día y la relación PaO2/FiO2 de gasometrías arteriales. Definimos hipoxemia severa PaO2/FiO2 menor de 150 mmHg y tras prueba U de Mann-Whitney se evaluaron niveles de DD, curva de ROC y AUC para punto de cohorte de DD y la asociación con terapia de aporte de oxígeno y su desenlace con OR e IC95%. Resultados: Se estudiaron expedientes de 82 pacientes, 81.7% presentó hipoxemia severa al ingreso, y 74.4% al séptimo día; se reportó una mediana de DD de 1,410 ng/mL con hipoxemia severa y al séptimo día 2,238 ng/mL (p = 0.001). Curva ROC encontró DD 1,500 ng/mL como punto de cohorte asociado a hipoxemia severa (AUC: 0.808, IC al 95% 0.706-0.910). En escalas pronósticas reportó mayor puntuación, APACHE II (24 pts, p = 0.036), SOFA (12 pts, p = 0.012), y SAPS II (67 pts, p ≤ 0.0001); así como en defunciones (81.6%, p ≤ 0.0001, OR 16.50 IC al 95% 5.472-49.80). Conclusión: Dímero D mayor y/o igual a 1,500 ng/mL se asocia con hipoxemia severa y con mayor mortalidad al séptimo día de estancia en UCI, indicándonos que el DD es un potencial marcador temprano y útil para guiar la terapéutica y evaluar el pronóstico del paciente.
Abstract Introduction: SARS-CoV-2 was unknown until the outbreak in Wuhan, China in December 2019, the ultra-structural characteristics of this virus with predisposition to receptors expressed in type II pneumocytes (CD209L and ECA2), results in diffuse alveolar damage and a third of the patients with SARS-CoV-2 meet criteria for SIRA with severe hypoxemia. After the severe course of the disease and high mortality, the association of DD with severe cases was reported in studies and attributed to the prothrombotic state of the disease, directly contributing to prolonged mechanical ventilation and death. Main objective: To determine the different levels of DD in the presence of severe hypoxemia in patients with SARS-CoV-2 pneumonia admitted to intensive care. Material and methods: Cross-sectional retrospective single-center study, records of patients older than 18 years who were admitted to the intensive care unit with a diagnosis of SARS-CoV-2 pneumonia were reviewed; DD values on admission, on the seventh day and the PaO2/FiO2 ratio of arterial blood gases were considered. We defined severe hypoxemia PaO2/FiO2 less than 150 mmHg and after the Mann-Whitney U test, DD levels, ROC curve and AUC were evaluated for the DD cohort point and the association with oxygen supply therapy and its outcome with OR and HF 95%. Results: Records of 82 patients were studied, 81.7% presented severe hypoxemia on admission, and 74.4% on the seventh day; A median DD of 1,410 ng/mL was reported with severe hypoxemia and 2,238 ng/mL on the seventh day (p = 0.001). ROC curve found DD 1,500 ng/mL as a cohort point associated with severe hypoxemia (AUC: 0.808, 95% CI 0.706-0.910). On prognostic scales I report a higher score, APACHE II (24 pts, p = 0.036), SOFA (12 pts, p = 0.012), and SAPS II (67 pts, p ≤ 0.0001); as well as in deaths (81.6%, p ≤ 0.0001, OR 16.50 95% CI 5.472-49.80). Conclusion: DD greater than and/or equal to 1,500 ng/mL is associated with severe hypoxemia and higher mortality on the seventh day of stay in the ICU, indicating that DD is a potential early and useful marker to guide the therapy and evaluate the prognosis of the patient.
Resumo Introdução: O SARS-CoV-2 era desconhecido até o surto em Wuhan, China, em dezembro de 2019, as características ultraestruturais desse vírus com predisposição a receptores expressos em pneumócitos tipo II (CD209L e ACE2), resultando em dano alveolar difuso e um terço dos pacientes com SARS-Cov-2 atendem aos critérios para SDRA com hipoxemia grave. Após o curso grave da doença e alta mortalidade, estudos relataram a associação do D-Di com casos graves e atribuindo-se ao estado pró-trombótico da doença, contribuindo diretamente para ventilação mecânica prolongada e óbito. Objetivo principal: Determinar os diferentes níveis de dímero-D na presença de hipoxemia grave em pacientes com pneumonia por SARS-CoV-2 internados em terapia intensiva. Material e métodos: Estudo transversal comparativo retrospectivo unicêntrico, foram revisados prontuários de pacientes maiores de 18 anos admitidos na unidade de terapia intensiva com diagnóstico de pneumonia por SARS-CoV-2; foram considerados os valores de D-Di na admissão, no sétimo dia e a relação PaO2/FiO2 da gasometria arterial. Definimos hipoxemia grave PaO2/FiO2 menor que 150 mmHg e após o teste U de Mann-Whitney, os níveis de D-Di, curva ROC e AUC foram avaliados para o ponto de coorte D-Di e a associação com oxigenoterapia e seu desfecho com OR e IC 95%. Resultados: Foram estudados prontuários de 82 pacientes, 81.7% com hipoxemia grave na admissão e 74.4% no sétimo dia; relatou-se um D-Di médio de 1,410 ng/mL com hipoxemia grave e 2,238 ng/mL no sétimo dia (p = 0.001). A curva ROC encontrou D-Di 1,500 ng/mL como um ponto de coorte associado à hipoxemia grave (AUC: 0.808, IC 95% 0.706-0.910). Em escalas de prognóstico, APACHE II (24 pontos, p = 0.036), SOFA (12 pts, p = 0.012) e SAPS II (67 pts, p ≤ 0.0001); bem como em óbitos (81.6%, p ≤ 0.0001, OR 16.50, IC 95% 5.472-49.80). Conclusão: O D-Di maior e/ou igual a 1,500 ng/ml está associada à hipoxemia grave e maior mortalidade no sétimo dia de internação na UTI, indicando que o D-Di é um potencial marcador precoce e útil para orientar a terapia e avaliar o prognóstico do paciente.
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Objective The epidemiological characteristics of high-altitude pulmonary thromboembolism (PTE) were investigated, and to enhance people's cognitive level of high-altitude PTE. Methods A tatal of 286 patients with PTE admitted to our hospital from May 2017 to October 2019 were selected and divided into study group (n = 143) living at high altitude of 2500 ~ 4500 m and control group (n=143) living at low altitude of 1500~2450m according to altitude.The clinical data, D-D, FIB levels, and laboratory routine examinations were compared between the two groups, and the risk factors were analyzed using univariate analysis and the independent risk factors were analyzed by multivariate logistic regression. Results The levels of D-D and FIB in the control group were significantly increased (P 0.05). Conclusion Those were independent risk factors affecting the incidence of PTE at high altitude，including multivariate logistic regression analysis indicated that red blood cell level, HGB level, DVT, D-D, and FIB. The higher the plasma D-D and FIB levels, the recurrence interval, especially the related diseases of patients at high altitude need regular monitoring.
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BACKGROUND: To improve Rh-related antigen negative blood supply effectively, the Korean Red Cross (KRC) blood centers have performed Rh phenotype screening tests of C, c, E and e antigens for all donors since April, 2013. Especially for rare ‘-D-/-D-’ blood supply and donor recruitment, we have implemented Rh phenotype confirmation test for all C, c, E and e antigen negative donors. In this study, we report the test results of 7 donors with ‘-D-/-D-’ phenotype. METHODS: All three KRC Blood Laboratory Centers performed Rh phenotype screening tests using the automatic machine, PK7300 (Beckman Coulter, Japan), for all 876,920 donors from January 1, 2018 to April 30, 2018. We then performed the Rh phenotype confirmation test using the tube method manually, at room temperature, 37℃ and antihuman globulin phase. RESULTS: Among 876,920 donors, 14 were Rh antigen C, c, E, e negative as results of Rh phenotype screening test. The results of Rh phenotype confirmation test of these 14 donors showed that 7 donors were Rh antigen C, c, E, e negative. The ratio of -D-/-D- phenotype for all donors was 0.000798%. CONCLUSION: Our data suggests that -D-/-D- phenotype is one of the rare blood groups among Koreans. Although ‘-D-/-D-’ phenotype was confirmed by serologic tests, it is necessary to re-confirm it by molecular genetic techniques.
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Humans , Blood Group Antigens , Hepatitis B e Antigens , Mass Screening , Methods , Molecular Biology , Phenotype , Red Cross , Serologic Tests , Tissue DonorsABSTRACT
AIM To investigate the effects of Tongmai Decoction on PLT,PAgR,D-D and TEG in elderly patients with intertrochanteric fracture in perioperative period.METHODS One hundred and fifteen recruited patient subjects were randomly divided into two groups.Fifty-seven cases in the control group were treated with Low Molecular Weight Heparins Calcium Injection,and 58 cases in the treatment group were intervened with both Low Molecular Weight Heparins Calcium Injection and Tongmai Decoction.The preoperative and postoperative dynamic changes of PLT,PAgR,D-D and TEG (R value,K value,alpha angle,MA),and adverse drug reactions in the two groups were detected 1,3,7 d prior to,and after the treatments,respectively.RESULTS No statistically significant difference between the two groups' PLT,PAgR and D-D contents were observed before the operation (P ＞ 0.05).The levels of PLT,PAgR and D-D in both groups increased one day after the operation with similar change degree (P ＞ 0.05).On the 3rd and 7th days after the surgery,the PLT,PAgR and D-D contents in the two groups began to drop,and the decline in the treatment group was more significant (P ＜ 0.05).No significantly different TEG (R value,K value,alpha angle,MA) between the two groups was noticed before the operation (P ＞ 0.05).Patients of both groups displayed their R value,K value decrease,and alpha Angle,MA increase (P ＞ 0.05) one day after the operation with similar change degree.Their R value,K value increased,and alpha angle,MA decreased,and as well as the statistically significant change between the two groups were discovered on the 3rd and 7th postoperative days (P ＜ 0.05).CONCLUSION Tongmai Decoction can effectively reduce blood hypercoagulability and prevent deep venous thrombosis in terms of PLT,PAgR,D-D and TEG (R value,K value,alpha angle,MA) improvement in elderly patients with intertrochanteric fracture in perioperative period.
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Objective To investigate FIB and D-D with GRACE risk score to predict the risk of acute coronary syndrome (ACS)during hospitalization.Methods Plasma FIB,D-D and GRACE risk score were measured in 90 patients with ACS and 23 healthy controls,the number of coronary artery lesions of ACS patients also was obtained.Results The results of FIB,D-D levels and GRACE risk score in ACS group were 2.77±0.79 g/L,1.67±2.13 mg/L,147.19±32.50,respective-ly.Compared to controls,FIB,D-D and GRACE risk score in ACS group were significantly increased (t=6.256,6.465, 10.317,all P<0.001).There were significant differences in plasma D-D and FIB levels in different risk stratification (F=18.475,9.426,all P<0.001).FIB (r=0.485,P<0.000 1)and D-D (r=0.357,P<0.000 6)levels were found positively related with GRACE risk score.Conclusion Pasma FIB ,D-D levels and GRACE risk score were increased in ACS group. FIB and D-D can be used as indicators to predict the risk stratification for ACS patients,and D-D was better than FIB.
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AIM To investigate the effects of Sanqi Huayu Oral Liquid (Notoginseng Radix et Rhizoma,Corydalis Rhizoma) on femoral shaft comminuted fracture caused by trauma in perioperative period of high-risk groups.METHODS One hundred and twenty patients meeting the inclusion criteria were randomly and equally divided into treatment group and control group.The control group was treated by low molecular weight heparin calcium injection,while the treatment group was additionally given Sanqi Huayu Oral Liquid.Two groups' levels of serum IL-6,TNF-α and D-D were detected on pre-operation and the 1 st,3rd,7th after operation,respectively.Additionally,the adverse drug reactions were also observed.RESULTS There were no statistically significant differences in the levels of serum IL-6,TNF-α and D-D between the two groups before operation.The first day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups showed increasing trends,which had similar elevated levels without statistically significant differences.The third day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups presented downward trends,but those in the treatment group were decreased more markedly with statistically significant differences.Furthermore,the seventh day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups were lower than those before the operation,and these indices in the treatment group were lower than those in the control group with statistically significant differences.CONCLUSION Sanqi Huayu Oral Liquid can not only effectively reduce the levels of serum IL-6,TNF-α and D-D in perioperative period of high-risk groups,but also prevent the formation of deep vein thrombosis.
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Objective To investigate the diagnostic value of D‐D and coagulation indices detection in cerebral apoplexy to provide the diagnostic basis for clinic .Methods Sixty patients with cerebral apoplexy in our hospital were selected and divided into the is‐chemic cerebral apoplexy group(observation group 1 ,40 cases) and hemorrhagic cerebral apoplexy group(observation group 2 ,20 cases) ,at the same time 60 individuals undergoing the physical examination in our hospital were selected as the control group .The blood coagulation instrument was adopted to detect D‐D ,PT ,APTT ,FIB and AT‐Ⅲ .Results Compared with the control group , the D‐D and FIB levels in the observation group 1 and 2 were obviously increased ,APTT was obviously extended and the AT‐Ⅲlevel was obviously reduced ,the differences between them had statistical significance(P0 .05) .D‐D ,APTT and FIB were positively correlated with cerebral ap‐oplexy(r=0 .422 ,0 .138 ,0 .171 ,P<0 .05) .Conclusion The detection of D‐D ,APTT and FIB has the diagnostic value in diagno‐sing cerebral apoplexy ,especially the clinical significance of D‐D is more significant .
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Objective To investigate the assessment value of serum Lp-PLA2 ,hs-CRP and D-D dimer on the severity of cor-onary artery lesion .Methods A total of 136 patients with coronary heart disease acute myocardial infarction (AMI) group 46 ca-ses ,stable angina pectoris (SAP) group 38 cases and unstable angina pectoris (UAP) group 52 cases from the inpatient of cardiolo-gy department in our hospital were selected as observation group ,and 135 healthy subjects were selected as control group ,serum Lp-PLA2 was detected by enzyme kinetic method ,Serum hs-CRP and plasma D-D dimer were detected by immune turbidimetric method ,of the severity of coronary artery lesion was evaluated by the Gensini integrations .Results Serum Lp-PLA2 ,hs-CRP ,D-D dimer level and Gensini score of observation group were significantly higher than those of control group ,above indexes of AMI group were higher than those of SAP group and UAP group ,UAP group were significantly higher than SAP group ,with statistical significance between the two groups(P<0 .05) .Serum Lp-PLA2 ,hs-CRP ,D-D dimer level and Gensini score of patients with heart functional class Ⅱwere significantly lower than those of Ⅲ and Ⅳ patients ,above indexes of patients with heart functional class Ⅲwere significantly lower than Ⅳ patients ,the difference between two groups was significant(P<0 .05) .Compared with severity of coronary artery lesion ,serum Lp-PLA2 hs-CRP and D-D dimer levels of mild coronary artery lesions were significantly lower than those of moderate and high coronary artery lesions ,and moderate coronary artery lesions was obviously lower than high coronary artery lesions (P<0 .05) ,Pearson correlation analysis also found that ,Lp-PLA2 ,hs-CRP ,D-D dimer levels had positive correlation with Gensini score (r=0 .642 ,0 .651 ,0 .608 ,P<0 .05) .Conclusion The assessment of serum Lp-PLA2 ,hs-CRP and D-D dimer level in the severity of coronary artery lesion has important significance .
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Objective To investigate the relationship between hypertensive disorder complicating pregnancy(HDCP)with homo-cysteine,D-D and high sensitive C-reactive protein(hs-CRP).Methods 80 HDCP women included 38 cases of gestational hyperten-sion,26 cases of mild preeclampsia and 16 cases of severe preeclampsias,and at the same time 36 normal late-term pregnant women and 30 non-pregnant normal women were selected as the control group.The plasma Hcy was determined by the enzymatic cycling assay,D-D was determined by the latex immune turbidimetry and hs-CRP was determined by the nephelometry immuno assay,re-spectively.Results The plasma Hcy,D-D and hs-CRP levels in the HDCP group were significantly increased compared with the normal non-pregnancy women group and the normal late-term pregnancy women group controls and showed the increasing trend with the aggravation of disease condition,the differences had the statistical significance(P <0.01).Conclusion Timely monitoring the plasma Hcy,D-D and hs-CRP levels can effective conduct the adverse pregnancy prediction,thus timely takes the medication in-tervention for correcting the occurrence and development of the disease condition,and provides the significant reference indexes for evaluating the change and prognosis of the disease condition in clinic.
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The very rare D--/D-- phenotype lacks C, c, E, e antigens with strong expression of the D antigen. A 31-year-old woman delivered her second baby, 3.6 kg girl at 38+4 weeks' gestation through repeat-Cesarean section. Her parents were not consanguineous. She had one artificial abortion, one Cesarean section with red blood cell transfusion and two spontaneous abortions. Her red cells were typed as O, D+C-c-E-e- and did not react with anti-Hr(o) (Rh 17). Her serum reacted with all of the screening cells and identification panel cells with strength of (++)~(+++). The baby was mildly jaundiced 12 hours after delivery. At 1 day after delivery, total bilirubin was 17.7 mg/dL, and direct and indirect antiglobulin tests were both positive. Phototherapy was immediately given for the baby but jaundice and anemia were worsened. Twenty six milliliter of the mother's whole blood was given twice to the baby after plasma depletion and leukocyte reduction. The baby showed improvement of jaundice and anemia, and discharged at hospital day 14. As far as we know, this is the third reported case of hemolytic disease of the newborn occurred in the D--/D-- mother with anti-Hr(o) in Korea, and the first case that was neither fatal nor treated with intensive medical care.
Subject(s)
Adult , Female , Humans , Infant, Newborn , Pregnancy , Abortion, Spontaneous , Anemia , Bilirubin , Cesarean Section , Coombs Test , Erythrocyte Transfusion , Hepatitis B e Antigens , Jaundice , Korea , Leukocytes , Mass Screening , Mothers , Parents , Phenotype , Phototherapy , PlasmaABSTRACT
Blood types are very important because they are associated with blood transfusion, the diagnosis of hematological diseases and the related diseases. Rh system is a major blood group system as ABO system. Major Rh antigen is Rh (D) antigen. Minor Rh antigens are Rh (C), (c), (E), (e) antigen. Most of people have Rh (C), (c), (E), (e) antigen but some people don't have these antigens. The hematologists call this blood type -D-/-D- blood phenotype. -D-/-D- phenotype is blood group that have (D) antigen without (C), (c), (E), (e) Antigen. This blood type is rare throughout the world. Especially, fetal hydops associated with anti-C,-c,-E,-e antibody is very rare. We experienced a case of fetal hydrops associated with anti-C,-c,-E,-e antibodies and report it with a brief of literatures.
Subject(s)
Antibodies , Blood Transfusion , Diagnosis , Hematologic Diseases , Hydrops Fetalis , PhenotypeABSTRACT
D-D4FC (?-D-2′,3′-didehydro-2′,3′-dideoxy-5-fluorocytidine),a new anti-HIV drug,is on its PhaseⅡ clinical trials in America,France and Germany. Our lab has synthesized D-D4FC successfully using N-deoxyribosyltransferase from Lactobacillus helveticto catalyzing the ribose transfer from D4T (?-D-2′,3′-unsaturated thymidine) to 5-FC (5-fluorocytidine).The yield of D-D4FC reached 25%.We discovered the reaction could also be done by using intact cells.The yield could increase to 50% in 12.5 hours and more convenient to industrial continuous process.In this paper,the conditions including pH,buffer,substrates concentration,cells amount,reaction time and a possible catalytic mechanism were studied and discussed.
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Objective To study the dynamic changes and clinical significance of D-D, t-PA and PAI in patients with acute renal failure during the process of different methods of blood purification. Methods Thirty-seven ARF patients were divided into three groups: HD group, HDF group and HF group. Plasma D-D level, t-PA and PAI activity were determined 1 hour, 4 hours before and after treatment. Normal control group consisted of fourteen healthy people. Results ① Plasma D-D level and PAI activity in ARF patients were obviously higher than those in control group, while t-PA activity was lower(P0.05). ③ After 4 hours of the treatment, compared with HD group, HDF and HF groups had significant difference in plasma D-D level, t-PA and PAI activity(P