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Abstract Understanding the physiological concepts of oxygen delivery is essential to discern the mechanisms that influence its increase, reduction or maintenance in the body. This text explores the different mechanisms that help maintain oxygen delivery even in the face of reduced hemoglobin levels. Adequate oxygen delivery ensures tissue and metabolic balance, which is crucial to avoid harmful consequences such as metabolic acidosis and cellular dysoxia. The complex interaction between variables such as cardiac output, hemoglobin and heart rate (HR) plays a fundamental role in maintaining oxygen delivery, allowing the body to temporarily adjust to situations of anemia or high metabolic demand. It is important to emphasize that blood transfusions should not be based on fixed values, but rather on individual metabolic needs. Strategies to reduce myocardial consumption and monitor macro and micro hemodynamics help in making rational decisions. Individualizing treatment and considering factors such as blood viscosity in relation to the benefits of transfusion are increasingly relevant to optimize therapy and minimize risks, especially in complex clinical scenarios, such as neurocritical patients and trauma victims.
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Acidosis , Cardiac OutputABSTRACT
Background: Blood gas analysis is critical in managing children in intensive care unit primarily in respiratory disorders. This study aimed to ascertain agreement between the arterial and peripheral venous measurement of pH, pCO2, pO2 and bicarbonate levels along with SpO2 in acute asthma. Methods: Hospital based cross sectional analytical study was conducted at Pushpagiri Institute of Medical Sciences in 50 children within the age group of 5-15 years who presented with symptoms suggestive of acute asthma with a modified PSI>6 after informed consent from parents and assent from child. SpO2 monitoring and ABG simultaneously with VBG were done immediately after admission. Statistical analysis was done to find out any correlation using Pearson correlation coefficient and Bland Altman plots were drawn to assess agreement. Results: 50 children in the age group 5 years to 15 years were included in the study. Arterial pH and venous pH were found to be correlated significantly, Pearson correlation coefficient r=0.438. There was a good correlation between the arterial and venous pCO2 with r= 0.610, bicarbonate values r=0.608. There was poor correlation between arterial PO2 and venous PO2 values (r=0.030). The bias plot for pH and pCO2 showed moderate agreement in with 95% limits of agreement being in acceptably narrow range. The mean bias in pH was 0.0242 (SD=0.04912, 95% limits of agreement = -0.0721 to 0.12045); bias in pCO2 was -4.04400 (SD=5.53616, 95% limits of agreement = -14.8949 to 6.8069), and in bicarbonate levels -0.0940 (SD=2.09, 95% limits of agreement = -4.1998 to 4.0119). Conclusions: Even though there was a good correlation and a moderate agreement between ABG and VBG parameters like pH, pCO2 and bicarbonate, VBG cannot be replaced for ABG in acute asthma. Pulse oximetry also has limitations in children with acute severe asthma as compared to ABG value.
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Objective:To establish the normal reference range of the ratio of fetal umbilical venous flow rate to umbilical artery pulsatility index (VAI).Methods:A total of 816 normal fetuses underwent prenatal examination and delivery were randomly selected from October 2018 to December 2020 in Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Fetal weight was obtained by measuring fetal biparietal diameter, head circumference, abdominal circumference, and femoral length.Umbilical venous flow (Quv) was measured. Umbilical artery pulsatility index (UA-PI) was obtained in the free segment of amniotic fluid. Quv was standardized according to fetal size to calculate the umbilical venous flow rate (nQuv) and VAI. The association between Quv, nQuv, UA-PI, VAI and the fetal gestational week were analyzed using correlation analysis. VAI was presented as ± s, the upper limit of 95% reference value and the lower limit of 5% reference value were taken as the standards of VAI increase and decrease, respectively. Twenty-six fetuses whose VAI were lower than limit of 5% and 20 fetuse whose VAI were than limit of 95% were chosed as the case group. Results:①Fetal Quv was positively correlated with gestational week ( r=0.893, P<0.001), nQuv and UA-PI were negatively correlated with gestational week ( r=-0.552, -0.827; all P<0.001), and VAI had no significant correlation with gestational week ( r=0.000, P=0.758); ②The mean, standard deviation, lower 5% reference value, and upper 95% reference value of VAI were 195.81, 55.61, 105.95, and 293.33, respectively; ③In the cases with abnormal VAI, 26 fetuses with reduced VAI, of whom there were 16 cases of maternal hypertension, and 13 cases complicated by severe preeclampsia; 1 case with 40 turns of umbilical cord torsion, 3 cases of stillbirth, 16 cases of preterm delivery, 19 cases of low neonatal birth body weight, 4 cases of 1-min Apgar score ≤7, 6 cases of umbilical artery blood pH<7.2, and 1 case without abnormalities in fetus during pregnancy and follow-up newborn. Among the 20 fetuses with increased VAI, there were 10 cases of fetal severe thalassemia, 2 cases of thalassemia, 1 case of sacrococcygeal teratoma, 1 case of portal venous shunt, 3 cases of placental chorioangioma, and 3 cases without abnormalities in fetus during pregnancy and follow-up newborn. Conclusions:The measurement and calculation of fetal VAI is simple and easy to perform. As a comprehensive index, fetal VAI remains constant in mid and late pregnancy, facilitates the follow-up of abnormal fetuses, and has potential clinical application.
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Ankle exercises are useful for preventing deep vein thrombosis, as they increase venous blood flow velocity. The cause for the increased venous blood flow velocity during ankle exercises may be the skeletal-muscle pump, but the mechanism is not clearly understood. The purpose of this study was to investigate the effects of the dorsiflexion angle and gastrocnemius muscle contraction on venous blood flow velocity during ankle exercises and to investigate the mechanism of the increase in venous blood flow velocity. The blood flow velocity in the popliteal vein, ankle joint angle, and surface electromyographic activity of the gastrocnemius muscle were measured at rest and during ankle exercises in the prone position in young healthy volunteers. The significant increase in venous blood flow velocity was observed during dorsiflexion phase, max dorsiflexion and during planter flexion phase. The peak venous blood flow velocity was different in each subject and classified into four types. The correlations of venous blood velocity to ankle joint angle and with the surface electromyographic activity of the gastrocnemius muscle were not statistically significant. These findings suggest that venous blood flow velocity increases not only during plantar flexion and dorsiflexion.
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Background and Purpose: Hie-symptom is more common in women, with complains of strong cold sensation of fingers and lower limbs during cold weather. From the cyanotic findings of hands and thighs and dark venous blood, blood stasis due to excessive peripheral vein contraction was suspected. Then we studied the changes of sublingual and body surface temperature, venous gas partial pressure in the warm and cold conditions. To examine the role of thermo-dilating effects of nitric oxide (NO), the effects oral administration PDE 5 inhibitor Tadarafil (TDF) were also studied. Subjects and Methods: The subjects were 10 women (31 +- 8.8 yrs) with Hie-symptom and 7 women (26+-3.7 yrs) without Hie-symptom, BMI, blood pressure, heart rate,sublingual and peripheral body surface temperature (hand and lower limb), venous and arterial blood gas partial pressure, and fingertip arterial oxygen saturation were measured. The measurement was carried out at warm indoors (about 23°C) and cold outdoors (about 12°C). Then 10 mg TDF tablet was taken and all measurements were repeated again at the same time on the next day. Results: There was no difference in fingertip arterial blood oxygen saturation in both groups either at indoor or outdoor conditions, and even after taking TDF. In the cold outdoor, the subjects with Hie-symptom, compared to without Hie-symptom, showed significantly lower body surface temperature and venous blood pO2, and increased pCO2. After taking TDF, although sublingual temperature and the decrease in body surface temperature outside the room improved in both groups, the improvement was greater in Hie-symptom. Consideration and Conclusion: Because of normal fingertip arterial blood oxygen saturation, Hie-symptom is not considered to be a disorder of the cardiopulmonary/arterial system. From a significant decrease in peripheral body surface temperature, and peripheral venous blood pO2, and an increase in pCO2 of Hie-symptom in cold outdoors, it is considered that blood stasis by excessive constriction of peripheral veins or arteriovenous anastomosis (AVA) by the cold. The better effects of oral TDF, in Hie-symptom seems to predict the involvement of NO or cGMP in blood stasis.
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@#Peripheral venous blood gas (VBG) analysis is increasingly used as an alternative to arterial sampling in Emergency Departments throughout the world.[1] There are multiple advantages using peripheral venous samples for blood gas analysis - technical ease, reduced pain and fewer complications. The difference in sample site chosen for blood gas analysis between European and Australian centres has been notable for members of our author group, prompting discussion and review of the literature.
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Background and Purpose: Hie-symptom is more common in women, with complains of strong cold sensation of fingers and lower limbs during cold weather. From the cyanotic findings of hands and thighs and dark venous blood, blood stasis due to excessive peripheral vein contraction was suspected. Then we studied the changes of sublingual and body surface temperature, venous gas partial pressure in the warm and cold conditions. To examine the role of thermo-dilating effects of nitric oxide (NO), the effects oral administration PDE 5 inhibitor Tadarafil (TDF) were also studied. Subjects and Methods: The subjects were 10 women (31 +- 8.8 yrs) with Hie-symptom and 7 women (26+-3.7 yrs) without Hie-symptom, BMI, blood pressure, heart rate,sublingual and peripheral body surface temperature (hand and lower limb), venous and arterial blood gas partial pressure, and fingertip arterial oxygen saturation were measured. The measurement was carried out at warm indoors (about 23°C) and cold outdoors (about 12°C). Then 10 mg TDF tablet was taken and all measurements were repeated again at the same time on the next day. Results: There was no difference in fingertip arterial blood oxygen saturation in both groups either at indoor or outdoor conditions, and even after taking TDF. In the cold outdoor, the subjects with Hie-symptom, compared to without Hie-symptom, showed significantly lower body surface temperature and venous blood pO2, and increased pCO2. After taking TDF, although sublingual temperature and the decrease in body surface temperature outside the room improved in both groups, the improvement was greater in Hie-symptom. Consideration and Conclusion: Because of normal fingertip arterial blood oxygen saturation, Hie-symptom is not considered to be a disorder of the cardiopulmonary/arterial system. From a significant decrease in peripheral body surface temperature, and peripheral venous blood pO2, and an increase in pCO2 of Hie-symptom in cold outdoors, it is considered that blood stasis by excessive constriction of peripheral veins or arteriovenous anastomosis (AVA) by the cold. The better effects of oral TDF, in Hie-symptom seems to predict the involvement of NO or cGMP in blood stasis.
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Background: It is clearly mentioned in the medicine books that blood gas analysis from arterial puncture is the gold standard. But in the past few years it is commonly seen that clinicians have started trusting on venous blood gas analysis as well as started advising VBG (Venous blood gas) in the initial diagnosis of critical patients in emergency setting. Keeping this fact in mind, we designed a study to determine whether VBG could be a better replacement of ABG (Arterial blood gas) in the emergency where diverse pathological conditions are encountered.Methods: This prospective cross-sectional study comprised of 50 patients of 20-60 yrs age with a variety of diagnoses admitted in the emergency department. 50 paired samples (ABG+VBG) were obtained from them under strict aseptic precautions after obtaining their verbal consent. With a minimum delay of less than 2 min blood gas analysis was performed on blood gas analyzer. Parameters (pH, PCO2, PO2, HCO3, Base Excess and O2 saturation) from ABG and VBG were recorded and compared using Student’s Unpaired ‘t’ test.Results: pH and HCO3 showed statistical significant (p value <0.05) differences between ABG and VBG, while BE showed statistical non-significant (p value >0.05) difference between them. Contrary to this, PCO2, PO2 and O2 saturation from ABG and VBG showed statistical highly significant (p value <0.0001) differences.Conclusions: VBG should not be interchangeably considered in place of ABG with regard to pH, HCO3, PCO2, PO2 and O2 saturation in conditions where actual oxygenation status of patient is required (e.g.; hypovolemic shock, respiratory disorders, mechanically ventilated patients, etc.)
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Background: DKA is the most common serious and life-threatening acute complication of diabetes. The mortality rate is currently estimated at 2% to 10% for patients hospitalized with DKA. Mortality is predominantly due to underlying morbidities, such as sepsis or acute myocardial infarction, but deaths also occur as a result of hypokalemia induced arrhythmias and cerebral edema. Aim of the study: To compare arterial and venous blood gas values in the initial evaluation of patients with Diabetic Ketoacidosis (DKA). Materials and methods: The study was conducted in the division of emergency medicine at Rajah Muthiah Medical College and Hospital, Chidambaram in the year 2017 August to February 2018. Totally 61 patients were included in the study. Both sex in the age group of 14 to 70 years whose Capillary Blood Glucose equal to or greater than 250 mg/dl, Urine ketonuria (+) were included in the study. Results: 37% of patients had >12 urine ketone levels of the patients of patients were 2+ (15 mg/dl) which was 41.0%. 39.3% of patients were 1+ (5 mg/dl) and 19.7% of patients were 3+ (40 mg/dl). All G. Balaji, R. Devi. Comparative study on arterial and venous blood gas values in the initial evaluation of patients with diabetic ketoacidosis who are visiting the Emergency Department of Rajamutaiah Medical College and Hospital. IAIM, 2019; 6(5): 160-165. Page 161 patients were ketone positive. ABG pH valune in which 60.7% of patients were between the level of 7.01 – 7.4, 39.3% of them were from 6.7 – 7.0. ABG PCO2 value in which 44.3% of patients had values from 16-25, 21.3% of patients had values between 5-15 as well as 26-35 and 13.1% of patients had values from 36-45. In which about 65.7% of patients had HCO3 levels between 12.01-17, 15.2% of patients had HCO3 levels between 7.01-12 14.1 % of patients had levels between 17.01 – 18 and 5% of them between 2-7. VBG pH in DKA, in which, 57.4% were in between 7.01 – 7.41. 41% of patients had a pH from 6.7 – 7.0 and 1.6% were between 6.03 - 6.6. VBG HCO3 in which, 62.3% of patients had HCO3 levels from 12.01-17, 24.6% had from 7.01 – 12, 11.5% were in between 2-7 and 1.6% were showing levels in between 17.01-18. Conclusion: Venous blood gas measurements accurately and fairly demonstrate the degree of acidosis in the initial evaluation of patients with Diabetic Ketoacidosis in the Emergency Department in comparison with Arterial blood gas values.
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objective To explore the effect of Standard Operating Procedure on the management of venous blood specimens before laboratory. Methods Blood collection SOP was established and applied on the management of venous blood specimens before laboratory.Nursing capacity,complication rate,rate of unqualified blood specimens were compared between before and after the SOP applying. Results Before and after the applying of SOP, the blood collection capacity of nurses were 85.43 ± 5.07,91.28 ± 4.78,the differences were statistically significant(t=-8.104, P=0.024). Before the applying of SOP, amounts of complication about venous blood collection, unqualified blood specimens and unqualified blood specimens which lead by nursing factors were 21, 95, 51, while after the applying, the amounts were 9, 63, 21, the differences were statistically significant (χ2=4.887, 6.052, 6.325, P﹤0.05). Conclusion Application of Blood collection SOP can promote nursing capacity of blood collection and reduce the incidence of unqualified venous blood specimens,improve the quality of venous blood specimens.
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objective@#To explore the effect of Standard Operating Procedure on the management of venous blood specimens before laboratory.@*Methods@#Blood collection SOP was established and applied on the management of venous blood specimens before laboratory.Nursing capacity,complication rate,rate of unqualified blood specimens were compared between before and after the SOP applying.@*Results@#Before and after the applying of SOP, the blood collection capacity of nurses were 85.43±5.07,91.28±4.78,the differences were statistically significant(t=-8.104, P=0.024). Before the applying of SOP, amounts of complication about venous blood collection, unqualified blood specimens and unqualified blood specimens which lead by nursing factors were 21, 95, 51, while after the applying, the amounts were 9, 63, 21, the differences were statistically significant (χ2=4.887, 6.052, 6.325, P<0.05).@*Conclusion@#Application of Blood collection SOP can promote nursing capacity of blood collection and reduce the incidence of unqualified venous blood specimens,improve the quality of venous blood specimens.
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Objective To investigate the value of the difference between peripheral arterial and venous blood gas analysis for the prognosis of patients with septic shock after resuscitation.Methods Patients with septic shock aged 18 to 80 years admitted to intensive care unit (ICU) of Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine from May 2016 to December 2017 were enrolled. The peripheral arterial blood and peripheral venous blood gas analysis were measured simultaneously after the early 6 hours resuscitation, including pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), base excess (BE), bicarbonate (HCO3-) and lactate (Lac) level, and the difference values between peripheral arterial and venous blood were calculated. According to the 28-day survival, the patients were divided into survival group and death group. Multiple Logistic regression analysis was used to analyze the risk factors of death, and the receiver operating characteristic curve (ROC) was used to analyze the prognostic value of blood gas analysis parameters for prognosis.Results A total of 65 patients with septic shock resuscitation were enrolled in the study, 35 survived while 30 died during the 28-day period. ① There was no significant difference in gender, age, and mean arterial pressure (MAP), central venous pressure (CVP), central venous oxygen saturation (ScvO2) and norepinephrine (NE) dose between the two groups.② The arterial and venous Lac, the difference of Lac (ΔLac) and PCO2 (ΔPCO2) between arterial and venous blood in death group were significantly higher than those in survival group [arterial Lac (mmol/L): 7.40±3.10 vs. 4.82±2.91, venous Lac (mmol/L): 9.17±3.27 vs. 5.81±3.29, ΔLac (mmol/L): 1.77±0.54 vs. 0.99±0.60, ΔPCO2 (mmHg, 1 mmHg =0.133 kPa): 9.64±5.08 vs. 6.70±3.71, allP < 0.01], and there was no significant difference in the other arterial and venous blood gas analysis index and its corresponding differential difference between two groups. ③ Multiple Logistic regression analysis showed that ΔPCO2 [β = 0.247, odd ratio (OR) = 1.280, 95% confidential interval (95%CI) = 1.057-1.550,P = 0.011], and ΔLac (β = 2.696,OR = 14.820, 95%CI = 2.916-75.324,P = 0.001) were the independent risk factors for the prognosis of septic shock. ④ It was shown by ROC curve analysis that arterial blood Lac, ΔLac andΔPCO2 had predictive value on prognosis of septic shock, the area under ROC curve (AUC) was 0.792, 0.857, 0.680, respectively (allP < 0.05). When the best cut-off value of arterial Lac was 4.00 mmol/L, the sensitivity was 100%, and the specificity was 62.86% for predictor of death in 28-day; when the best cut-off value of ΔLac was 1.25 mmol/L, the sensitivity was 93.33%, and the specificity was 68.57% for predictor of death in 28-day; when the best cut-off value of ΔPCO2 was 4.35 mmHg, the sensitivity was 83.33%, and the specificity was 37.14% for predictor of death in 28-day.Conclusions Compared to other parameters, the difference between peripheral arterial and venous blood gas analysis, ΔPCO2 and ΔLac had the best correlation with the prognosis of septic shock. The ΔPCO2 and ΔLac are the independent prognostic predictors for 28-day survival.
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Objective To investigate whether there are differences in the detection of biochemical items such as electrolytes , total protein and urea between arterial plasma and venous plasma .Methods Self paired design was used to compare and study the biochemical results of different samples .70 samples ( 36 samples from male patients and 34 from female patients ) that were performed with both arterial blood gas analysis and biochemical item test of venous blood in Clinical Laboratory of Peking Union Medical College Hospital during the period from June to September of 2017 were collected.18 biochemical items like electrolytes in arterial blood and venous blood were synchronously detected by automatic biochemical analyzer.Statistic analyses were carried out by SPSS 18.00.Whether the deviation was of clinic significance was determined by National Health Standards ( WS/T 403-2012 ) and the total error admitted by Royal Society of Pathology of Australia .Regression analysis of Passing-Bablok was performed by MedCalc software . The difference between the results of different samples was investigated by drawing Bland -Altman diagram.Results The results of Ca, Cl, K, Na, P, TP, ALB, ALT, AST, LDH, Glu, Cr, Urea, TG, CHO, UA, CHE, TBA in the samples of arterial blood plasma were 2.46(2.25-2.56) mmol/L,(105.68 ±7.29)mmol/L, 3.81(3.54-4.03) mmol/L, 140.45(137.08-144.20) mmol/L, 0.97(0.77-1.11) mmol/L,(60.39 ±9.40)g/L,(31.23 ±6.81)g/L, 17.4(11.95 -30.05)U/L, 20.85(14.9 -34.03) U/L, 210.1(163.15-342.60) U/L, 7.58(5.95-10.04) mmol/L, 76.35(51.05-110.7) μmol/L, 6.94(3.98-11.08) mmol/L, 1.15(0.84-1.89) mmol/L, 3.31(2.73-4.35) mmol/L, 271.55(187.78-423.30) μmol/L,(4.71 ±2.17)KU/L, 2.19(1.09 -4.19) μmol/L,respectively, and 2.24(2.05-2.35) mmol/L,(103.98 ±7.32)mmol/L, 3.84(3.58 -4.19) mmol/L, 139.30(136.08 -142.33) mmol/L, 0.99(0.78-1.14) mmol/L,(60.37 ±9.67) g/L,(32.62 ±6.89) g/L, 17.6(12.75-31.2) U/L, 20.6(15.28-36.6) U/L, 233.95(176.48-363.75) U/L, 7.55(5.62-9.52) mmol/L, 77.15 (56.08-111.98) μmol/L, 6.94(3.97 -10.53) mmol/L, 1.13(0.83 -1.93) mmol/L, 3.23(2.71-4.37) mmol/L, 273.4(187.30-401.55) μmol/L,(4.74 ±2.21) KU/L, 2.29(1.02 -4.23) μmol/L respectively in the samples of venous blood plasma .The difference of results of TP、Glu、Cr、TG、CHE、TBA between two types of samples were of no statistic significance ( the values of t or Z were 0.121,-0.054,-0.269,-0.480,-1.730 and -1.843 respectively, P>0.05), among these items the difference of Glu was of notable clinical significance (>1/2 TE percentage:50%).The difference of results of Ca , Cl, K, Na, P, ALB, ALT, AST, LDH, Urea, CHO, UA between two types of samples were of statistic significance (the values of t or Z were -7.115,6.794,-2.119,-4.996,-3.483,-8.839,-2.419,-2.742,-3.833,-5.010,-2.060 and -2.467 respectively, P<0.05), among these items the difference of Urea, CHO, UA, Na, P and ALT was of no notable clinical significance ( >total TE percentage: 0%, 2.86%, 0%, 2.9%, 4.3%, 1.43% respectively), while the difference of Ca, Cl, K, ALB, AST and LDH was of clinical significance (>total TE percentage:90%, 10%, 14.3%, 32.9%, 10.00%, 32.9%respectively).Conclusions The differences in the detected data of some biochemical items between venous plasma and arterial plasma demonstrated clinical significance .When detecting those biochemical items , clinicians should pay attention to the selection of arterial blood sample .It should be considered to establish a reference interval for related biochemical items of arterial blood when necessary .
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Objective To investigate the effect of SVV guided fluid therapy on blood gas and lipopolysaccharide (LPS),procalcitonin (PCT) in patients undergoing resection of gastrointestinal tumor.Methods Sixty patients aged 60 85 years from Jan,2016 to Feb,2017 falling into ASA physical status Ⅱ or Ⅲ,scheduled for elective radical operations for gastrointestinal cancers,were includ ed and randomly divided into two groups (n =30 each) using a random number table:ScvO2 guided fluid therapy (group C),SVV guided fluid therapy (group G).MAP,HR and CVP of patients were recorded at the same time before anesthesia (T0),tumor removal (T1) and the end of surgery (T2)respectively.PH,BE,HCO3-and Lac of venous blood samples and artery blood samples at T0-T2,6 hours after surgery(T3) were recorded.Venous blood samples were collected at T0,T3 to detect LPS and PCT.Crystalloid requirements,colloid requirements,total volume,bleeding volume,peritoneal fluid volume and the use of dopamine were recorded.The time of PACU,time when the patients first exhausted and was fed after operation,length of hospital stay after operation were recorded.Results Compared with group C,BE of artery blood was obviously increased at T2,T3 in group G (P<0.05);the Lac of artery at T2 and the Lac of artery and venous blood at T3 in group G was obvi ously decreased.LPS and PCT were decreased at T3 in group G (P<0.05).Compared with group C,the needed colloid was increased in group G,the needed crystalloid and total volume of fluid infused were decreased in group G (P<0.05).Compared with group C,the time of PACU starting to exhaust and feed,length of hospital was shortened in group G (P<0.05).Conclusion SW guided goal directed fluid therapy is more conductive to maintain the acid base and reduce the incidence of in fection for the patients with gastrointestinal tumor operation,promote the recovery of gastrointestinal function and decrease the length of hopital after operations.
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Abstract Although the biological properties of mesenchymal stem cells (MSC) are well-characterized in vitro, MSC clinical application is still far away to be achieved, mainly due to the need of xenogeneic substances for cell expansion, such as fetal bovine serum (FBS). FBS presents risks regarding pathogens transmissions and internalization of animal's proteins, which can unleash antigenic responses in patients after MSC implantation. A wide range of venous blood derivatives (VBD) has been reported as FBS substitutes showing promising results. Thus, the aim of this study was to conduct a systematic scoping review to analyze whether VBD are effective FBS substitutes for MSC ex vivo expansion. The search was performed in SciVerse ScopusTM, PubMed, Web of ScienceTM, BIREME, Cochrane library up to January 2016. The keywords were selected using MeSH and entry terms. Two independent reviewers scrutinized the records obtained considering specific inclusion criteria. The included studies were evaluated in accordance with a modified Arksey and O' Malley's framework. From 184 found studies, 90 were included. Bone marrow mesenchymal stem cells (BMMSC) were presented in most of these studies. Overall, VBD allowed for either, maintenance of MCS's fibroblast-like morphology, high proliferation, high colony-formation ability and maintenance of multipotency. Besides. MSC expanded in VBD supplements presented higher mitogen activity than FBS. VBD seems to be excellent xeno-free serum for ex vivo expansion of mesenchymal stem cells. However, an accentuated heterogeneity was observed between the carried out protocols for VBD isolation did not allowing for direct comparisons between the included studies.
Resumo Embora as propriedades biológicas das células-tronco mesenquimais (MSC) sejam bem caracterizadas in vitro, a aplicação clínica das MSC ainda está longe de ser alcançada, principalmente devido à necessidade de substâncias xenogênicas para expansão celular, como o soro fetal bovino (FBS). O FBS apresenta riscos quanto às transmissões de patógenos e à internalização de proteínas animais, o que pode desencadear respostas antigênicas em pacientes após a implantação das MSC. Uma vasta gama de derivados do sangue venoso (VBD) têm sido relatada como substitutos do FBS mostrando resultados promissores. Assim, o objetivo deste estudo foi conduzir uma revisão de escopo sistemática para analisar se VBD poderiam ser substitutos do FBS eficazes para expansão das MSC em condições ex vivo. A pesquisa foi realizada no SciVerse Scopus, PubMed, Web of Science, BIREME e biblioteca Cochrane até janeiro de 2016. As palavras-chave foram selecionadas usando MeSH e entre termos. Dois revisores independentes examinaram os registros obtidos considerando critérios de inclusão específicos. Os estudos incluídos foram avaliados de acordo com uma estrutura modificada de Arksey e O 'Malley. Dos 184 estudos encontrados, 90 foram incluídos. As células-tronco da medula óssea (BMMSC) foram utilizadas na maior parte destes estudos. Em geral, o VBD permitiu tanto a manutenção da morfologia semelhante a fibroblastos das MCS, alta proliferação, alta capacidade de formação de colônias e manutenção de multipotêncialidade. Além disso, as MSC expandidas em suplementos derivados do sangue venoso apresentaram uma maior atividade mitogênica do que as expandidas em FBS. Os VBD parecem ser excelentes soro livres de agentes xenogênicos para expansão ex vivo de MSC. Entretanto, observou-se uma heterogeneidade acentuada entre os protocolos realizados para o isolamento VBD, não permitindo assim comparações diretas entre os estudos incluídos.
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Humans , Animals , Cattle , Veins , Blood Substitutes , Mesenchymal Stem Cells/cytology , Culture MediaABSTRACT
Objective:To explore the application effect of root cause analysis (RCA) and nursing ethics theory on improving the success rate of venipuncture blood collection in infants.Methods:In January 2016,150 infantswho were punctured for venous blood collection in the out-patient blood collection room in our hospital were selected as the control group.The root cause analysis was used to determine the root cause of the success rate of infant venipuncture blood collection,and the feasible measures were formulated.And 150 infants after 6 months of the implementation of RCA were selected as the observation group.The success rate of puncture and the satisfaction of the families were compared in both two groups.Results:The success rate of venipuncture blood collection in observation group (93.3%) was significantly higher than the control group(76.7%),and the families' satisfaction of the observation group (95%) was also significantly higher than those in the control group (70%).Conclusions:The application of root cause analysis and nursing ethics theory,effective nursing measures and psychological care can improve the success rate of infant venipuncture blood collection.
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Objective To investigate the difference and correlation between venous blood of pregnant women and neonatal um-bilical cord blood .Methods A total of 319 pregnant women and their newborns in People′s Hospital of Longhua District from Jan-uary 2013 to August 2016 were selected as the objects in this research ,fasting venous blood samples of all the pregnant women were collected at the labor day ,umbilical cord blood samples of the infants were collected at the end of delivery .Serum alkaline phospha-tase(ALP) ,pseudocholine esterase(PCHE) ,prealbumin(PA) ,retinol binding protein(RBP) ,urea nitrogen(BUN) ,creatinine(CR) , uric acid(UA) ,total cholesterol(TC) ,triglyceride(TG) and other indicators were detected in all the blood samples .Results ALP , PCHE ,PA ,RBP ,TC and TG of venous blood samples from pregnant women were significantly higher than those of newborn um-bilical cord blood samples ,the differences were statistically significant (P<0 .05) ,but there were no significant differences on BUN , CR ,UA(P>0 .05) .There were positive correlations between venous blood from pregnant women and umbilical cord blood samples on serum PCHE ,PA ,RBP ,BUN ,CR ,UA(P<0 .05) ,while there was no correlation on serum ALP ,TC ,TG(P>0 .05) .Conclusion There are different constituent in venous blood from pregnant women and newborn umbilical cord blood ,and indicators in new-born umbilical cord blood such as PCHE could be effected by the pregnant women .
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Objective To investigate the difference and correlation between venous blood of pregnant women and neonatal um-bilical cord blood .Methods A total of 319 pregnant women and their newborns in People′s Hospital of Longhua District from Jan-uary 2013 to August 2016 were selected as the objects in this research ,fasting venous blood samples of all the pregnant women were collected at the labor day ,umbilical cord blood samples of the infants were collected at the end of delivery .Serum alkaline phospha-tase(ALP) ,pseudocholine esterase(PCHE) ,prealbumin(PA) ,retinol binding protein(RBP) ,urea nitrogen(BUN) ,creatinine(CR) , uric acid(UA) ,total cholesterol(TC) ,triglyceride(TG) and other indicators were detected in all the blood samples .Results ALP , PCHE ,PA ,RBP ,TC and TG of venous blood samples from pregnant women were significantly higher than those of newborn um-bilical cord blood samples ,the differences were statistically significant (P<0 .05) ,but there were no significant differences on BUN , CR ,UA(P>0 .05) .There were positive correlations between venous blood from pregnant women and umbilical cord blood samples on serum PCHE ,PA ,RBP ,BUN ,CR ,UA(P<0 .05) ,while there was no correlation on serum ALP ,TC ,TG(P>0 .05) .Conclusion There are different constituent in venous blood from pregnant women and newborn umbilical cord blood ,and indicators in new-born umbilical cord blood such as PCHE could be effected by the pregnant women .
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Objective To investigate the significance of circulating tumor cells in tumor reflux venous blood in colorectal cancer patients with liver metastasis.Methods Seventy-four patients with colorectal cancer treated in Liaoning Cancer Hospital & Institute from January 2015 to January 2017 were enrolled in this study.The circulating tumor cells were detected by CellSearch system in patients with tumor reflux venous blood to analyze the results of circulating tumor cells and their clinical significance.Results Among the 74 patients with colorectal cancer,there were 24 patients with synchronous liver metastasis and 9 patients with metachronous liver metastasis.The sensitivity of CEA and CA19-9 positive in the detection of colorectal cancer synchronous liver metastasis was 67.9% and 58.6%,respectively.The sensitivity of circulating tumor cells positive detection in tumor reflux venous blood in the diagnosis of synchronous liver metastasis was 60.6%.n patients with metachronous liver metastases,CEA and CA19-9 positive patients were 33.3% and 55.6%,respectively,while CTCs positive patients were 77.8%.Conclusion The detection of circulating tumor cells in tumor reflux venous blood of colorectal cancer not only improves the detection rate,but also may become a predictive factor for metachronous liver metastasis.
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Objective To investigate the current status of nurses'' needlestick injuries during venous blood sampling, evaluate effective prevention strategies.Methods A stratified cluster sampling method was used to investigate clinical nurses in China by questionnaire, contents of questionnaire included the general information of nurses, training and management on venous blood sampling among nursing staff, adherence to wearing gloves before blood sampling, the occurrence of needlestick injuries during the process of venous blood sampling in the past year and so on.Results A total of 2 861 questionnaires were distributed, and 2 575 valid questionnaires were recovered.93.17% of the investigated nurses had participated in the training of venous blood sampling regularly;87.15% received regular check of venous blood sampling;before venous blood sampling, only 72.74% knew whether the patient had bloodborne infectious disease;only 61.01% wore gloves during blood sampling.Incidence of needlestick injuries during venous blood sampling was 20.78% in the past year.There was no significant differences in the incidence of needlestick injuries when using 3 different types of needles(Pearson x2=1.649, P=0.438).48.21% of needlestick injuries occurred during disposing medical waste.Conclusion The training and management on nurses'' venous blood sampling is better in China, but incidence of needlestick injuries is still high.It is necessary to formulate safety operation regulations of venous blood sampling, standardize the operation procedures and specify the contents of training, so as to correct nurses'' unsafe behavior during venous blood sampling.