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【Objective】 To explore the laboratory monitoring procedure and its clinical significance in patients with passenger lymphocyte syndrome after liver transplantation. 【Methods】 The Hb and bilirubin levels were monitored in one AB blood type patient post-liver transplantation. The ABO blood group type, unexpected antibody screening test, direct anti-globulin test and acid elution test were performed respectively in blood samples of the patient to identify the serum antibodies and erythrocyte membrane sensitized antibodies. 【Results】 The patent’s Hb level showed a decreasing trend on the day 11 post-operation, reaching the lowest level of 62 g/L on day 17, and his serum bilirubin increased. The patient’s ABO blood type was determined as AB while anti-B antibody was detected in the patient’s serum. The direct anti-globulin test was weakly positive, while the unexpected antibody screening test was negative. Anti-B antibody was detected in the elution and the patient’s serum. The patient′s serum was incompatible with type AB and type B erythrocytes in the cross-matching test, while it was compatible with type A and type O erythrocytes. 【Conclusion】 Through monitoring serum anti-A, anti-B and direct anti-human globulin test, the patients with passenger lymphocyte syndrome after liver transplantation can be early diagnosed and the prognosis can be improved.
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Platelets are important components of the blood system. There are many kinds of concentrated platelets and their derivatives, among which platelet-rich plasma (PRP ), growth factors (GFs) and platelet-rich fibrin (PRF) have been widely used in clinical practice. Lyophilized platelets (Lyo-P) or freeze-dried platelets (FDP) are prepared from concentrated platelets by freeze-drying and have the advantages of long storage time at room temperature, light weight, convenient transportation, inactivation of pathogens, etc. Lyo-P contain high concentration of GFs, fibrin, white blood cells and various cytokines. In addition to their hemostatic and coagulative functions, Lyo-P and their products are increasingly used in wound healing, tissue repair, cosmetology, reproductive medicine and other fields.
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Cutaneous chronic wounds are a major global health burden in continuous growth due to population aging and the higher incidence of chronic diseases, such as diabetes. In the process of spontaneous wound healing, growth factors play a vital role. Thanks to the high content of growth factors in platelet rich plasma(PRP), more and more PRP has been used to treat chronic refractory wounds, including diabetic ulcer, pressure ulcer, venous ulcer, and burns, etc., and has achieved significant results. Given the short duration of local growth factor release in the wound when PRP is applied alone, some studies have combined PRP with different tissue biology materials, such as hyaluronic acid, chitosan, and chitosan derivatives, to achieve better therapeutic results. In this paper, the preparation method of PRP, the mechanism of growth factors, the effect of PRP on wound repair, the combined application of PRP with repair materials and the advantages and disadvantages of PRP are reviewed.
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【Objective】 To explore the effect of intelligent closed-loop mobile nursing management system in quality management of blood transfusion. 【Methods】 The mobile nursing system and the cold chain management system of our hospital were integrated to realize intelligent closed-loop management of blood transfusion. After consulting medical records, 789 blood recipients, admitted to the Department of Hematology of our hospital from January to December 2017 (before the implementation of closed-loop management), were selected as the control group, and 836 blood recipients, admitted during January to December 2018 (after the implementation of closed-loop management), were selected as the observation group. A self-designed blood transfusion standard management checklist was adopted, with the number of standard execution items as the numerator and the total number of checked items as the denominator to obtain the standard implementation rate. The checking rate of blood sample collection, blood transfusion rate within 30 min after blood issuing, the execution rate of double check specification and inspection specification, the completion rate of RBCs transfusion within 4 h and qualified rate of blood transfusion nursing record before and after the implementation of closed-loop management were compared by chi-square test or Fisher's exact probability method to evaluate the efficacy of blood quality management improvement. A total of 8 head nurses from clinical departments (Hematology Department, Cardiac Surgery Department, Operating Room, Comprehensive ICU) involved in blood transfusion were selected for semi-structured interviews. The interviews focused on the effect of intelligent closed-loop mobile nursing information system in quality management of clinical blood use, and the results of the interviews were analyzed. 【Results】 The double check execution rate of blood transfusion, the checking rate of blood sample collection specification, the transfusion rate within 30 min after blood issuing, the execution rate of blood transfusion inspection, the completion rate of RBCs transfusion within 4 h, the qualified rate of blood transfusion nursing record in the observation group and the control group after and before the implication of the intelligent closed-loop mobile nursing management system were 100%(836/836) vs 97.72%(771/789), 99.04%(828/836) vs 97.34%(768/789), 97.97%(819/836) vs 95.06%(750/789), 99.28%(830/836) vs 94.93%(712/789), 99.16%(829/836) vs 97.47%(769/789) and 100%(836/836) vs 89.73%(708/789), respectively, showing significant improvement (P < 0.05). The time spend on the record, summary and feedback of quality control results was significantly shortened. 【Conclusion】 The application of intelligent closed-loop mobile nursing management system in the quality management of clinical blood use can effectively improve the efficiency of blood transfusion, nursing quality and the safety of clinical blood use.
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Objective:The expression of endothelial growth factor-A (VEGF-A), chemokine [monocyte chemoattractant protein-1(MCP-1) and RANTES] in stenosis of autologous arteriovenous fistula (AVF) in hemodialysis patients and their correlation with basic fibroblast growth factor (b-FGF).Methods:From March 2018 to April 2019, 90 patients with end-stage renal disease were enrolled in this study. All patients were given the first autologous AVF surgery, and 45 patients with AVF loss were in group Ⅰ, 45 patients with normal AVF were in group Ⅱ. The thickness and area of intima and media were measured. The expression of growth factors was detected by immunohistochemistry. The correlation between serum b-FGF and the expression of growth factors was analyzed.Results:The thickness ratio and area ratio of intima to media in group Ⅰ were larger than those in group Ⅱ ( P<0.05). VEGF-A, MCP-1 and RANTES were strongly positive in group Ⅰ and weakly positive in group Ⅱ. The expression levels of serum b-FGF, serum and tissue VEGF-A, MCP-1 and RANTES in group Ⅰ were significantly higher than those in group Ⅱ ( P<0.05). Serum b-FGF levels in group Ⅰ were positively correlated with serum levels of VEGF-A, MCP-1 and RANTES ( r=0.794, 0.523, 0.576, P<0.05), while serum b-FGF levels in group Ⅱ were not significantly correlated with serum levels of VEGF-A, MCP-1 and RANTES ( P>0.05). Conclusions:Serum b-FGF may play an important role in venous intimal hyperplasia by mediating the over expression of VEGF-A, MCP-1 and RANTES.
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OBJECTIVE@#To evaluate the efficacy of ultrasound or fluoroscopic-guided percutaneous transluminal angioplasty (PTA) combined with thrombolysis for the treatment of acutely thrombosed arteriovenous fistula (AVF) or grafts (AVG).@*METHODS@#One hundred and ninety-two hemodialysed patients, in whom the thrombosed arterio-venous AVF or AVG developed less than 72 h and there were no contraindications for thrombolysis and PTA, underwent PTA combined with thrombolysis therapy in Sir Run Run Shaw Hospital of Zhejiang University from October 2014 to October 2017. Under ultrasound and/or fluoroscopic guidance, balloon catheter was introduced to thrombosis sites along a guide wire. Then the balloon was inflated and normal saline mixed with urokinase and heparin was injected for thrombolysis. After blood flow was restored, angioplasty was performed on vascular stenosed sites.@*RESULTS@#A total of 274 endovascular interventional operations were performed for 192 patients. The procedure success rate was 98.2%, clinical success rate was 93.8%and complication rate was 1.46%. The post-intervention primary patency rates for AVF group were 87.4%, 76.7%and 63.9%at 3, 6 and 12 months, respectively; while the post-intervention secondary patency rates were 93.7%, 91.6%and 83.0%, respectively. The post-intervention primary patency rates for AVG group were 60.7%, 51.5%and 43.1%at 3, 6 and 12 months, while the post-intervention secondary patency rates were 82.7%, 77.1%and 70.8%, respectively.@*CONCLUSIONS@#PTA combined with thrombolysis is an effective and safe therapeutic option for AVF and AVG thrombosis, which would prolong hemodialysis access and save vascular resources for hemodialyzed patients.
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Humanos , Angioplastia , Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Diálise Renal , Estudos Retrospectivos , Terapia Trombolítica , Trombose , Cirurgia Geral , Resultado do Tratamento , UltrassonografiaRESUMO
Objective To apply real-time transperineal ultrasound ( TPUS) to monitor the intra-fractional prostate motion,collect and analyze the data of the prostate motion,aiming to provide evidence for the optimization of the target area and plan of radiotherapy for prostate cancer. Methods TPUS is a non-invasive monitoring technique that utilizes an automatic scanning ultrasound probe to dynamically monitor and correct the motion of organs during radiotherapy. In this study, TPUS was utilized to collect 1588 intra-fractional data of 70 patients with prostate cancer. Prior to each cycle of radiotherapy,CBCT was adopted to correct the errors between intra-factional data by using VMAT. During radiotherapy, real-time ( once per second) ultrasound images were acquired to monitor the 3D motion of the prostate on the x (left+,right-),y (cranial+, caudal-), and z ( abdominal+, dorsal-) axes, emphasizing the analysis of 4D motion of the prostate. Results All patients successfully completed the treatment and data collection. The median time of effective monitoring per faction was 179 seconds (132-286 seconds). During 95% of the monitoring time,the distance of prostate motion was 2. 22 mm in the left direction,2. 17 mm in the right,2. 08 mm in the cranial, 1. 98 mm in the caudal,2. 44 mm in the abdominal and 2. 97 mm in the dorsal direction,respectively. In the x,y and z axes,the percentage of time in which the distance of prostate motion less than 1 mm among the total time was 83. 07%,85. 46% and 78. 27%,respectively,whereas 97. 70%,97. 87% and 96. 45% for＜3 mm, respectively. Conclusions TPUS is a non-invasive real-time monitoring technique,which can detect the 4D motion of the prostate during radiotherapy. By using VMAT,the range of prostate motion is relatively small, and the motion range is less than 3 mm in each direction within 95% of the time.