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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.
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Humanos , Adulto , Complicações Pós-Operatórias , Transfusão de Eritrócitos/efeitos adversos , Transfusão de Sangue , Hospitais , Hemoglobinas/análiseRESUMO
Objective To observe the correlation of intrapulmonary TREM-1 with endoplasmic reticulum stress in mice with acute lung injury (ALI).Methods Balb/c mice were tracheally injected with lipopolysaccharide(LPS,5 mg/kg) to induce ALI.Real-time PCR and Western blot were used to detect the expressions of TREM-1,CHOP and GRP78.The correlation of TREM-1 with endoplasmic reticulum-related proteins was analyzed.LPS (100 ng/mL) was used to induce inflammation in mouse primary peritoneal macrophages,and expressions of TREM -1,CHOP and GRP78 mRNA were detected by real-time PCR.The effect of TREM-1 activation on the expressions of CHOP and GRP78 was observed in macrophages.Results The expressions of TREM-1,CHOP and GRP78 mRNA were increased in ALI mice.TREM-1 mRNA expression was positively correlated with CHOP and GRP78 mRNA expression.In vitro,LPS up-regulated the expressions of TREM-1,CHOP and GRP78,and TREM-1 was positively correlated with CHOP and GRP78.Activation of TREM-1 increased CHOP and GRP78 mRNA expressions.Conclusions TREM-1 is positively related to the endoplasmic reticulum stress.The activation of TREM-1 enhances endoplasmic reticulum in mouse macrophages.
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Objective To observe the effects of isoflurane (ISO) inhale anesthesia on the expression of brain-derived neurotrophic factor (BDNF) and Bcl-2 of hippocampal in rats.Methods A total of 54 SD rats were divided into 3 groups:control group (n=6),O2 group (n=24) and ISO group (n=24).All rats were given 1 week to adapt the environment.Then,rats in the control group were directly sacrificed to collect hippocampi specimens;rats in the O2 group inhaled mixed gas containing 40％ O2 and air for 1 hour;rats in the ISO group anesthetized with 3 ％ ISO and maintained for 1 h with 1.8 ％ ISO after righting reflex disappeared,inhaling 40％ O2 in the whole process of anesthesia.Respiratory rate and percutaneous oxygen saturation (SpO2) of the rats were observed before anesthesia,after induction,30 min after anesthesia,60 min after anesthesia and at the moment of analepsia,respectively.Rats in the O2 group and ISO group were sacrificed to extract hippocampi specimens at 6,12,24 and 72 h after treatment,respectively.The BDNF and Bcl-2 mRNA expression levels in hippocampus of rats were detected using the semi-quantitative reverse transcription PCR (RT-PCR).Results Compared to that before anesthesia,the respiratory rates after induction,30 min after anesthesia and 60 min after anesthesia were decreased (P＜0.05),while no apparent changes was found in the SpO2 (P＞0.05).Compared to the O2 group,the relative expressions of BDNF mRNA in hippocampi of rats in the ISO group were obviously decreased at 12 and 24 h after the treatment (P＜0.05).After anesthesia,the relative expression of BDNF mRNA in rat hippocampus in the ISO group was decreased as time goes on,and the expression levels at 12 and 24 h after the treatment were lower than those in the control group (P＜0.05).Compared to the O2 group and control group,the relative expression levels of Bcl-2 mRNA in hippocampi of the rats in the ISO group were lower at all time points for detection (P＜0.05).Conclnsion ISO can generate transient inhibition effect on expressions of BDNF and Bcl-2 in hippocampus of rat.
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Objective To observe the effects of isoflurane (ISO) inhale anesthesia on the expression of brain-derived neurotrophic factor (BDNF) and Bcl-2 of hippocampal in rats.Methods A total of 54 SD rats were divided into 3 groups:control group (n=6),O2 group (n=24) and ISO group (n=24).All rats were given 1 week to adapt the environment.Then,rats in the control group were directly sacrificed to collect hippocampi specimens;rats in the O2 group inhaled mixed gas containing 40％ O2 and air for 1 hour;rats in the ISO group anesthetized with 3 ％ ISO and maintained for 1 h with 1.8 ％ ISO after righting reflex disappeared,inhaling 40％ O2 in the whole process of anesthesia.Respiratory rate and percutaneous oxygen saturation (SpO2) of the rats were observed before anesthesia,after induction,30 min after anesthesia,60 min after anesthesia and at the moment of analepsia,respectively.Rats in the O2 group and ISO group were sacrificed to extract hippocampi specimens at 6,12,24 and 72 h after treatment,respectively.The BDNF and Bcl-2 mRNA expression levels in hippocampus of rats were detected using the semi-quantitative reverse transcription PCR (RT-PCR).Results Compared to that before anesthesia,the respiratory rates after induction,30 min after anesthesia and 60 min after anesthesia were decreased (P＜0.05),while no apparent changes was found in the SpO2 (P＞0.05).Compared to the O2 group,the relative expressions of BDNF mRNA in hippocampi of rats in the ISO group were obviously decreased at 12 and 24 h after the treatment (P＜0.05).After anesthesia,the relative expression of BDNF mRNA in rat hippocampus in the ISO group was decreased as time goes on,and the expression levels at 12 and 24 h after the treatment were lower than those in the control group (P＜0.05).Compared to the O2 group and control group,the relative expression levels of Bcl-2 mRNA in hippocampi of the rats in the ISO group were lower at all time points for detection (P＜0.05).Conclnsion ISO can generate transient inhibition effect on expressions of BDNF and Bcl-2 in hippocampus of rat.
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Objective To observe the anesthesia and recovery results of sevoflrane and remifentanil combined anesthesia in open or laparoscopic surgeries. Methods 60 cases of ordinary surgeries from the department of gynecology and general surgeries were included in this study with 30 cases in each group. (1)recording total sevoflurane inhalation time, muscular relaxant amount, end tidal sevoflurane concentration;(2)recording BP,HR at 10 min after induction,operation staring and ending,ventilation recovery, opening eye and extubation period;also sevoflurane concentration 5 min after stopping medicine and ventilation recovery;recording time period between surgery ending and autonomous respiration recovery , eye opening and extubation. Results No any adverse events happen in each patient.the sevoflurane inhalation time in open surgery group was (157.20 ± 47.28) min, longer than that of laparoscopic surgeries group (73.50 ± 11.23)min(P0.05). Conclusion Sevoflurane combined remifentanil anesthesia can achieve stable intra-operative maintenance and rapid postoperative recovery quality , we suggest the widespread usage of it in clinic.
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OBJECTIVE:To observe the efficacy and safety of topiramate in treatment of epilepsy METHODS:15 patients with refractory epilepsy treated with topiramate as additive drug and 61 newly-diagnosed epileptic patients with topiramate as monotherapeutic agent entered the open-label trial and were followed-up RESULTS:Among 15 patients with refractory epilepsy, the frequency of seizure decreased by 50% or greater in 10 cases with an effective rate of 66 7%, and 2 patients were free from seizure;among 61 newly-diagnosed cases, the frequency of seizure reduced by 50% or more in 45 cases(73 8%), and 16 cases were free from seizure(26 2%) The ARDs were lower in incidence and mild in severity CONCLUSION:Topiramate was safe and effective as additive or monotherapeutic agent for multiple types of seizure