ABSTRACT
【Objective】 To investigate the factors influencing the production of platelet antibody and its effect on clinical platelet transfusion. 【Methods】 This is a single-center prospective observational study. The research subjects were patients with hematological diseases in West China Hospital of Sichuan University from October 1, 2018 to September 30, 2019, and their plasma were collected before platelet transfusion to detect platelet antibodies using solid-phase agglutination method. According to the results of platelet antibody screening, the patients were divided into platelet antibody positive group and negative group. The t test and nonparametric Mann-Whitney U test were used to compare the transfusion efficacy of two groups. Patients’ demographic and clinical information, including age, gender, diagnosis, the units of platelets and RBC transfused, were collected via HIS6.2.0 and whole process management system of blood in clinical (version 3.0) to analyze the influence of age, gender and the disease on the positive rate of platelet antibodies, as well as the profile of platelet antibodies in patients with different diseases, the correlation between the positive rate of platelet antibodies and the history of blood/platelets transfusion. In additional, the platelet transfusion process was observed on site. 【Results】 A total of 316 patients with hematologic diseases were included in this study, mainly with acute myeloid leukemia(188/316, 59.5%). All patients were transfused 1671 U platelet [1~17(5.3±3.1)U each person] and 1896 U RBC products [0~38(7.8±4.6)U each person] during the treatment. Out of the 316 patients, platelet antibodies were found in 85 (26.9%) of them. No significant differences in the positive rates of platelet antibody after transfusion were notice by genders or ages(P>0.05). The incidence of platelet antibody was related to diseases (P<0.05), with MDS as the highest (57.1%), followed by aplastic anemia (36.4%) and myeloid leukemia (27.7%). In additional, the positive rate of platelet antibody increased with the number of previous platelet transfusions(P<0.05). The 316 patients were divided into positive group and negative group according to the results of platelet antibody screening. The corrected count of increment (5.2×109/L vs 11.5×109/L, P<0.01) and absolute platelet increase(8×109/L vs 17×109/L, P<0.01)in positive group were lower than those in negative group. The positive group were transfused more units of platelets(1.7 U vs 1.2 U, P<0.01)and red blood cells(1.5 U vs 1.1 U, P<0.05)per week than negative group. The platelet transfusion interval was shorter in positive group than negative group (3.1 days vs 3.6 days, P<0.05), but there was no significant difference in red blood cell transfusion interval (3.1 days vs 3.8 days, P>0.05) between two groups. The minimum PLT count(5×109/L vs 9×109/L, P<0.01), average PLT count(27×109/L vs 40×109/L, P<0.01)and average Hb(71 g/L vs 77 g/L, P<0.05)in positive group were lower than those in negative group during hospitalization, but there was no significant difference in the minimum Hb(56 g/L vs 59 g/L, P>0.05)between two groups. According to transfusion events on site, the incidence of acute adverse reactions to transfusion was 13% (169/1 291). 【Conclusions】 The positive rates of platelet antibodies in patients with hematologic diseases were relatively high. In addition, the efficacy of platelet transfusion in positive group were worse than that in the negative group. It is recommended that platelet antibody testing should be routinely performed before transfusion in hematologic disease patients to select crossmatch-compatible platelets in order to improve the effectiveness of platelet transfusion.
ABSTRACT
Resumen La familia es considera como una institución en constante cambio. A pesar de ello el legislador pretende mantener su estructura desde una posición religiosa, tradicional, conservadora, matrimonial y basada en relaciones de pareja monogámica y heterosexual. No obstante, las manifestaciones sociales y culturales han logrado el reconocimiento de estructuras familiares diferentes a las normativizadas, en aplicación de los principios de igualdad y equidad, y en garantía de derechos patrimoniales y personales, como en el caso del concubinato. Objetivo: Establecer el desarrollo y evolución jurisprudencial en Colombia de la Corte Suprema de Justicia y la Corte Constitucional que llevaron al concubinato de la ilegalidad a su reconocimiento como estructura familiar con protección jurídica. Materiales y métodos: Se revisó la jurisprudencia sobre el concubinato de ambas Cortes y se clasificaron en tres categorías: las que comenzaron a reconocerla como familia y establecieron requisitos para ello; las que cambiaron estos requisitos y las que establecieron diferencias con la unión marital de hecho. Resultados: Se demuestra cómo se cambió de una situación ilícita a una estructura familiar con reconocimiento jurídico, aunque no legal y, una vez más que, el derecho de familia en Colombia es ineficaz para reconocer los derechos personales y patrimoniales que se derivan de las relaciones familiares emergentes. Conclusión: Los resultados se enmarcan en las discusiones actuales de las ciencias sociales sobre la familia como una institución en permanente cambio, sin que ello implique que se encuentre en crisis, debido a que se trata de una comprensión desde los fines, roles y funciones que aquella cumple en la sociedad y no desde su estructura.
Abstract Introduction: The family is considered as an institution in constant change. In spite of this, the legislator intends to maintain its structure from a religious, traditional, conservative, matrimonial perspective and based on monogamous and heterosexual couple relationships. However, social and cultural manifestations have achieved the recognition of family structures different from those regulated, in application of the principles of equality and equity, and in guarantee of patrimonial and personal rights, as in the case of concubinage. Objective: Establish the development and jurisprudential evolution in Colombia of the Supreme Court of Justice and the Constitutional Court that led to the concubinage from illegality to its recognition as a family structure with legal protection. Materials and methods: The jurisprudence on the concubinage of both Courts was reviewed and classified into three categories: those that began to recognize it as a family and established requirements for it, those that changed these requirements and those that established differences with the marital union in fact. Research Result: It demonstrates how to change from an illegal situation to a family structure with legal recognition, although not legal and, once again, how family law in Colombia is ineffective when recognizing the personal and patrimonial rights that derive from emerging family relationships. Conclusion: The results are framed in the current discussions of the social sciences on the family as an institution in permanent change, without implying that it is in crisis, because it is an understanding from the ends, roles and functions that the family fulfills in society and not from its structure.
Resumo Introdução: A família é considerada como uma instituição em constante mudança. Apesar disso, o legislador pretende manter sua estrutura a partir de uma posição religiosa, tradicional, conservadora, matrimonial e baseada em relacionamentos monogâmicos e heterossexuais nos casais. No entanto, as manifestações sociais e culturais tem conseguido o reconhecimento de estruturas familiares diferentes às normalizadas na aplicação dos princípios de igualdade e equidade e, na garantia dos direitos patrimoniais e pessoais, como é o caso do concubinato. Objetivo: Estabelecer o desenvolvimento e evolução jurisprudencial na Colômbia do Tribunal Supremo da Justiça e do Tribunal Constitucional que levaram ao concubinato da ilegalidade ao seu reconhecimento como estrutura familiar com proteção jurídica. Materiais e métodos: Revisou-se a jurisprudencia sob o concubinato de ambos os Tribunais e classificaram-se em três categorias: aqueles que começaram a reconhecer-lo como família e estabeleceram requisitos para isso; aqueles que mudaram estes requisitos e aqueles que estabeleceram diferenças com a união conjugal de fato. Resultados: demonstra-se como mudar de uma situação ilegal para uma estrutura familiar com reconhecimento jurídico, embora não seja legal e, mais uma vez, o direito de família na Colômbia é ineficaz para reconhecer os direitos pessoais e patrimoniais que derivam das relações familiares emergentes. Conclusão: Os resultados são enquadrados nas discussões atuais das ciências sociais sob a família como uma instituição em constante transformação, sem implicar que está em crise, pois trata-se de uma compreensão dos propósitos, papéis e funções que a sociedade cumpre e não de sua estrutura.
ABSTRACT
Antecedentes: El sentimiento de ineficacia personal es una de las características clínicas nucleares en los trastornos de la conducta alimentaria (TCA). Objetivo: Describir la evidencia acerca del sentimiento de ineficacia personal en pacientes portadoras de anorexia nerviosa y/o bulimia nerviosa. Método: Se realizó una búsqueda bibliográfica mediante las bases de datos Medline/PubMed de evidencia sobre la ineficacia en los TCA. Resultados: El "paralizante sentimiento de ineficacia personal", descrito por Bruch (1973) en pacientes anorécticas, relacionado con un déficit en el sentido del self debido a distorsiones tempranas en el vínculo madre-hija, aún es un concepto válido en la práctica clínica cotidiana. Aunque la ineficacia es también característica del trastorno depresivo, en los TCA se relaciona principalmente, con motivación por la delgadez, perfeccionismo, timidez, falta de asertividad y consciencia interoceptiva (alexitimia), abuso de laxantes y sustancias, dieta, ejercicio físico, sintomatología obsesivo-compulsiva, baja autoestima, insatisfacción corporal, estrés y con la severidad del TCA. Conclusiones: Existe una fuerte evidencia que apoya la existencia de un sentimiento de ineficacia personal, tanto en poblaciones no clínicas en riesgo para desarrollar TCA, como también en pacientes anorécticas y/o bulímicas. Puede considerarse un factor predisponente, perpetuante y pronóstico de un TCA. Sin embargo, su presencia en trastornos depresivos cuestiona su especificidad en los TCA.
Background: The sense of personal ineffectiveness is one of the core clinical characteristics in eating disorders (ED). Objective: To describe the evidence on the sense of personal ineffectiveness in patients suffering from anorexia nervosa and/or bulimia nervosa. Method: Medline/Pubmed databases were used to look for evidence on ineffectiveness in ED. Results: The "paralyzing sense of personal ineffectiveness" described by Bruch (1973) in anorexic patients, related to a deficit in the sense of self, due to early distortions in mother-child attachment, is still a valid concept in everyday clinical practice. Although ineffectiveness is also a characteristic of a depressive disorder, in ED it is related mainly to drive for thinness, perfectionism, shyness, lack of assertiveness and interoceptive awareness (alexythimia), laxative and substance abuse, diet, physical exercise, obsessive-compulsive symptomatology, low self-esteem, body dissatisfaction, stress and severity of ED. Conclusions: There is strong evidence supporting the sense of ineffectiveness, both in non clinical populations at risk to develop ED and also in anorexic and/or bulimic patients. It may be considered as a predisposing, perpetuating and prognosis factor of an ED. Nevertheless, ineffectiveness as a feature of depressive disorder questions its exclusiveness to ED.