Perioperative transfusion analysis and blood ordering schedule update for total knee arthroplasty / 中国输血杂志

【Objective】 To investigate the perioperative rate of allogeneic red blood cell (RBC) transfusion in patients who underwent total knee arthroplasty (TKA) and its risk factors, and to identify its cross-match to transfusion ratio (C∶T ratio). 【Methods】 Anesthetic data of patients who underwent TKA from January 2014 to October 2019 in Peking Union Medical College Hospital were collected and analyzed retrospectively. Perioperative allogeneic RBC transfusion rate was calculated, and binary Logistic regression analysis was performed to identify its risk factors in these patients. The overall C∶T ratio was calculated and divided into subgroups based on surgery type and age group. 【Results】 The study enrolled 2 903 patients. The perioperative rate of allogeneic RBC transfusion in TKA patients was 10.9% (95% CI 9.8%~12.0%) and overall C∶T ratio was 5.6∶1. The independent risk factors leading to perioperative allogeneic RBC transfusion included advanced age(OR=1.025, 95% CI 1.009~1.042, P<0.01), preoperative hemoglobin level(OR=0.966, 95% CI 0.954~0.978, P<0.001), preoperative anemia(OR=3.543, 95% CI 2.052~6.119, P<0.001), hematological diseases(OR=6.462, 95% CI 2.479~16.841, P<0.001), bilateral surgery(OR=7.681, 95% CI 5.759~10.245, P<0.01) and revision surgery(OR=9.584, 95% CI 4.360~21.065, P<0.001). 【Conclusion】 The risk factors for perioperative allogeneic RBC transfusion in TKA patients included advanced age, preoperative low hemoglobin level, preoperative anemia, hematological diseases, bilateral surgery and revision surgery. Only type and screen tests are recommended if patients receiving unilateral primary TKA surgery are less than 75 years old without anemia and hematological diseases, while at least one to four units of blood should be cross-matched if patients are with preoperative anemia and hematological diseases or will receive bilateral and revision arthroplasty.

Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial / 中华医学杂志(英文版)

BACKGROUND@#Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.@*METHODS@#Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).@*RESULTS@#We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.@*CONCLUSION@#The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT01597232.

Risk factors of acute kidney injury after primary total knee arthroplasty in patients with ASA physi-cal status Ⅰ or Ⅱ / 临床麻醉学杂志

Objective To determine the incidence of acute kidney injury in patients undergoing primary total knee arthroplasty with ASA physical status Ⅰ or Ⅱ.Methods A total of 2 623 patients from January 2014 to December 2019,513 males and 2 110 females,aged ≥ 18 years,ASA physical status Ⅰor Ⅱ,who underwent primary total knee arthroplasty were included.Demographic characteristics and perio-perative data were collected.AKI was diagnosed according to the criteria from Kidney Disease Improving Global Outcomes(KDIGO)and the patients were divided into two groups:AKI group and non-AKI group.Independent risk factors of acute kidney injury were evaluated by binary logistic regression.Results Forty-one patients(1.9％)developed acute kidney injury postoperatively.Binary logistic regression showed perio-perative transfusion(OR=3.979,95％CI 2.243-7.056,P＜0.001),the duration of operation(OR=1.007,95％CI 1.001-1.013,P=0.031)and perioperative combined use of antibiotics(vancomycin+cefuroxime/clindamycin)(OR=4.053,95％CI 1.350-12.165,P=0.013)were independent predic-tive factors of acute kidney injury.Conclusion Perioperative transfusion,longer duration of operation,and combined use of antibiotics(vancomycin+cefuroxime/clindamycin)were risk factors for postoperative AKI in patients with ASA physical status Ⅰ or Ⅱ.

A retrospective analysis based on the investigation and handling results of 310 medical research integrity cases / 中华医学科研管理杂志

Objective:to understand the current situation of academic research misconduct by analyzing the investigation results of a number of medical scientific research integrity cases, to strengthen the construction of scientific research integrity in medical institutions.Methods:Select the investigation and handling results of 310 medical scientific research integrity cases disclosed by the National Health Commission in 2021, and analyze the basic information of the case papers, the types and characteristics of misconduct behaviors involved, and the handling results of each institution.Results:This batch of problematic papers was widely distributed, including particular hospitals from a certain region or city level hospitals. Identified misconduct included fabrication of the research process, falsification of research data, purchasing, ghost-writing, third-party submission, and inappropriate authorship. Responsible persons were severely punished.Conclusions:Long-term mechanism for the prevention of academic misconduct should be established with collaboration among administrative department, medical institutions and research personnel, to deal with academic misconduct more systematically.

Effects of different doses of gabapentin on streptozotocin-induced diabetic neuropathic pain / 中华麻醉学杂志

Objective To investigate the effects of different doses of gabapentin on streptozotocin (STZ)-induced diabetic neuropathic pain in rats.Methods Male SD rats aged 6 weeks weighing 180-200 g were used in this study. Diabetes ntellitus ( DM) was induced by intraperitoneal STZ 60 mg/kg and confirmed one week later by blood glucose =16.7 mmol/L before breakfast. The DM rats were randomly divided into 4 groups ( n = 6 each) : gabapentin groups received intraperitoneal gabapentin 30, 60 and 120 mg/kg twice a day (at 9:00 am and 3:00 pm) for 3 weeks respectively and control group received intraperitoneal normal saline 0.6 ml instead of gabapentin. The paw withdrawal threshold to von Frey filament stimulation was measured before and at 30, 60, 120, 180, 240 min after first gabapentin injection and once a week for 3 weeks. Results After gabapentin 60 and 120 mg/kg, the paw withdrawal threshold to mechanical stimuli was significantly increased and lasted for about 4 h. The analgesic effect peaked at 60 min after IP gabapentin injection. Normal saline and gabapentin 30 mg/kg had no significant analgesic effect. The degree of analgesia was significantly decreased at day 14 and 21 of treatment with gabapentin 60 and 120 mg/kg as compared with that at 60 min after gabapentin injection. Conclusion The hyperalgesia and allodynia in rats with diabetes mellitus can be effectively reversed by gabapentin 60 and 120 mg/kg,while long-term use of gabapentin can induce drug tolerance.