Transfusion rates and disease spectrum in neonates treated with blood transfusion in China.

This study aimed to investigate blood transfusion rates and spectrum of diseases in hospitalized neonates treated with blood transfusion in China to provide supporting data for future studies on neonatal blood transfusion.Data on hospitalized neonates were obtained from more than 100 experts from the Department of Neonatology of 55 hospitals in China between January 1, 2012 and December 31, 2016, using a standardized survey. A statistical analysis was conducted to evaluate the data collected, including the blood transfusion rates, blood component transfused, spectrum of diseases, and spectrum of major diseases.Between 2012 and 2016, 541,128 neonates were hospitalized in the 55 hospitals surveyed. There were 70,433 neonates who received blood transfusion, with an average transfusion rate of 13.02%. The rates of red blood cell transfusion, platelet transfusion, and plasma transfusion were 9.44%, 0.66%, and 4.77%, respectively. The neonatal blood transfusion rate was 17.99% in Northeast China, 9.74% in Northwest China, and between 10.60% and 16.22% in other regions. The neonatal blood transfusion rate was 12.3% in general hospitals and 13.8% in women and children's hospitals. The top 10 diseases identified in hospitalized neonates treated by blood transfusion were, in rank order, as follows:prematurity,pneumonia, hyperbilirubinemia, bacterial sepsis, respiratory distress syndrome, anemia, hemolytic disease, asphyxia, hemorrhage, and necrotizing enterocolitis.The neonatal blood transfusion rate in China is 13.03%.The rank order in the disease spectrum of the hospitalized neonates and that in hospitalized neonates treated with blood transfusion are different.

Erythema papulatum centrifugum and new diagnostic criteria.

Erythema papulatum centrifugum (EPC), also known as erythema papulosa semicircularis recidivans (EPSR), is distinct from eczema and other well-described figurate erythemas characterised by annular erythematous lesions. We report 7 cases of EPC and propose new diagnostic criteria including the following: (i) EPC is characterised by single or multiple recurrent expanding annular or semi annular erythema with central regression, surrounded by tiny red papules; (ii) the lesions regularly relapse and resolve; (iii) the histopathologic feature shows superficial perivascular inflammation with or without mild inflammation around sweat glands in the mid dermis and (iv) patients lack other associated cutaneous or internal abnormalities.

Good hemostatic effect of platelets stored at 4°C in an in vitro model of massive blood loss and thrombocytopenia.

This study compared the corrective effects of storage of platelets at 4°C and at 22°C in an in vitro model of massive blood loss and thrombocytopenia to provide an experimental basis for the storage of platelets for clinical applications.In vitro model of massive blood loss and thrombocytopenia were constructed by the in vitro hemodilution method and cell washing method. Using storage of platelets at 4°C (1, 3, 5, 7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the coagulation condition of the different models, by thromboelastography and by routine blood indices.①Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of massive blood loss. Platelet count results improved from 17 to 27 × 10/L to greater than 120 × 10/L for 4°C storage, and 20 to 27 × 10/L to greater than 120 × 10/L for 22°C storage. Thromboelastography maximum amplitude (TEG-MA) results improved from 8.8 to 15.4 mm to greater than 43 mm for 4°C storage, and 12.2 to 14.4 mm to greater than 44.8 mm for 22°C storage. Thromboelastography reaction time values decreased from 9.9-24.9 minutes to 3.8-5.5 minutes for 4°C storage, and 9.9-22.7 minutes to 4.3-4.5 minutes for 22°C storage. ②Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of thrombocytopenia. Platelet count results improved from 12 to 34 × 10/L to greater than 99 × 10/L for 4°C storage, and 12 to 34 × 10/L to greater than 120 × 10/L for 22°C storage. TEG-MA results improved from 21.4 to 32.1 mm to greater than 49.1 mm for 4°C storage, and 21.4 to 31.6 mm to greater than 50.5 mm for 22°C storage.Platelets stored at 4°C and 22°C have the same correcting effect for 1, 3, and 5 days. Platelets stored at 4°C for 7 to 14 days have similarly hemostatic effect on the in vitro model of massive blood loss and thrombocytopenia.

Postoperative local incision analgesia for acute pain treatment in patients with hepatocellular carcinoma.

OBJECTIVE: The present study aimed to investigate the analgesic effect and safety of using local incision analgesia to treat acute postoperative pain in patients with hepatocellular carcinoma (HCC). METHOD: A cohort of 60 patients undergoing liver cancer resection was randomly divided into three groups (n=20 per group): local incision analgesia (LIA) group, which received local infiltration with ropivacaine combined with a postoperative analgesia pump; intravenous patient-controlled analgesia (PCA) group, which received fentanyl intravenous analgesia postoperatively; and the control group, which received tramadol hydrochloride injection postoperatively according to the NRS scoring system. The postoperative analgesic effect in each group was compared and tumor recurrence (survival) was analyzed using the Kaplan-Meier method. RESULTS: NRS scores, rate of analgesic usage, ambulation time (h) and intestinal function recovery time (h) were significantly reduced in LIA group compared with the control group at each postoperative time point (6, 12, 24 and 48 hours; p<0.05). Additionally, the NRS scores of LIA patients at 12 hours post-surgery was significantly reduced compared with PCA group (p<0.05), and the occurrence of postoperative adverse events in LIA group was significantly lower than that in PCA group (p<0.05). Survival analysis demonstrated that the mean survival time (tumor recurrence) was significantly increased in LIA group compared with the control group (χ2=4.749; p=0.029). CONCLUSION: Local incision analgesia improves the analgesic effect, causes fewer adverse reactions and increases postoperative survival time. Our study demonstrated that local incision analgesia is a safe and effective method of postoperative pain management following hepatectomy.

Postoperative local incision analgesia for acute pain treatment in patients with hepatocellular carcinoma

Summary Objective: The present study aimed to investigate the analgesic effect and safety of using local incision analgesia to treat acute postoperative pain in patients with hepatocellular carcinoma (HCC). Method: A cohort of 60 patients undergoing liver cancer resection was randomly divided into three groups (n=20 per group): local incision analgesia (LIA) group, which received local infiltration with ropivacaine combined with a postoperative analgesia pump; intravenous patient-controlled analgesia (PCA) group, which received fentanyl intravenous analgesia postoperatively; and the control group, which received tramadol hydrochloride injection postoperatively according to the NRS scoring system. The postoperative analgesic effect in each group was compared and tumor recurrence (survival) was analyzed using the Kaplan-Meier method. Results: NRS scores, rate of analgesic usage, ambulation time (h) and intestinal function recovery time (h) were significantly reduced in LIA group compared with the control group at each postoperative time point (6, 12, 24 and 48 hours; p<0.05). Additionally, the NRS scores of LIA patients at 12 hours post-surgery was significantly reduced compared with PCA group (p<0.05), and the occurrence of postoperative adverse events in LIA group was significantly lower than that in PCA group (p<0.05). Survival analysis demonstrated that the mean survival time (tumor recurrence) was significantly increased in LIA group compared with the control group (χ2=4.749; p=0.029). Conclusion: Local incision analgesia improves the analgesic effect, causes fewer adverse reactions and increases postoperative survival time. Our study demonstrated that local incision analgesia is a safe and effective method of postoperative pain management following hepatectomy.

[Transurethral resection of the prostate for BPH in native Tibetans with different prostate volumes: A single-center retrospective analysis].

OBJECTIVE: To investigate the perioperative parameters and postoperative sexual function and complications in native Tibetans undergoing transurethral resection of the prostate (TURP) for BPH with different prostate volumes. METHODS: From June 2015 to February 2017, 325 native Tibetans with BPH underwent TURP in the People's Hospital of Tibet Autonomous Region. The patients were aged 59－88 years, with a median oxygen saturation level of 84% in the normal status, 24% with hydronephrosis, 40.3% with the history of acute urinary retention, 61.8% with pulmonary hypertension, and 19.1% taking regular medication preoperatively. According to the preoperative prostate volume (PV), the patients were divided into a large PV (LPV) group (PV ≥80 ml, n = 124) and a small PV (SPV) group (<80 ml, n = 201). Perioperative parameters and postoperative sexual function and complications were analyzed and compared between the two groups of patients. RESULTS: The operation time was significantly longer in the LPV than in the SPV group (ï¼»92.36 ± 26.35ï¼½ vs ï¼»56.28 ± 24.61ï¼½ min, P < 0.05) and the intraoperative blood loss was higher in the former than in the latter (ï¼»401.12 ± 50.12ï¼½ vs ï¼»385.15 ± 51.62ï¼½ ml, P < 0.05). Compared with the baseline, at 6 months after operation, the IPSS was significantly decreased in all the patients (22.13 ± 6.23 vs 5.29 ± 1.14 in the LPV group, P < 0.05; 23.04 ± 6.82 vs 5.12 ± 1.28 in the SPV group, P < 0.05), and the maximum urinary flow rate (Qmax) remarkably improved (ï¼»17.46 ± 5.82ï¼½ vs ï¼»5.91 ± 1.86ï¼½ ml/s in the LPV group, P < 0.05; ï¼»17.99 ± 5.86ï¼½ vs ï¼»6.01 ± 1.92ï¼½ ml/s in the SPV group, P < 0.05). The incidence rate of retrograde ejaculation was markedly higher in the LPV than in the SPV group postoperatively (48.4% vs 20.9%, P < 0.05). No statistically significant differences were observed between the two groups of patients in the incidence of postoperative complications (13.71% vs 9.45%, P > 0.05). CONCLUSIONS: TURP is effective and safe for the treatment of BPH native Tibetans with different prostate volumes.

Development and Application of A Close-loop Blood Information System / 现代检验医学杂志

Objective To establish of a close loop blood information system forreal time monitoring in the entire process of clinical blood transfusion.Methods In accordance with files and laws in clinical blood transfusion and combining the work in blood transfusion department with the actual needs of clinical blood transfusion,the blood transfusion department in Shaanxi Provinical People's Hospital developed the close-loop blood information system with Skynet Software Co.Ltd.Results The close-loop blood information system was achieved informational management patternthat was detailed information from blood products arrival to departure and whole process of evaluation transfusion effect.The link of Hospital Information Manage System (HIS),Laboratory Information System (LIS) and blood information system was completed with the system.The system realized real-time and accurate data collection and monitoring.The system achieved a closed-loop management of the entire process of clinical blood transfusion.Conclusion By using theclose loop blood information system,the quality of medical services can be improved,the work productivity can be increased,and the clinical blood transfusion can be rationalized.

Investigation of the status quo of massive blood transfusion in China and a synopsis of the proposed guidelines for massive blood transfusion.

The aim of this study was to provide an overview of massive transfusion in Chinese hospitals, identify the important indications for massive transfusion and corrective therapies based on clinical evidence and supporting experimental studies, and propose guidelines for the management of massive transfusion. This multiregion, multicenter retrospective study involved a Massive Blood Transfusion Coordination Group composed of 50 clinical experts specializing in blood transfusion, cardiac surgery, anesthesiology, obstetrics, general surgery, and medical statistics from 20 tertiary general hospitals across 5 regions in China. Data were collected for all patients who received ≥10 U red blood cell transfusion within 24 hours in the participating hospitals from January 1 2009 to December 31 2010, including patient demographics, pre-, peri-, and post-operative clinical characteristics, laboratory test results before, during, and after transfusion, and patient mortality at post-transfusion and discharge. We also designed an in vitro hemodilution model to investigate the changes of blood coagulation indices during massive transfusion and the correction of coagulopathy through supplement blood components under different hemodilutions. The experimental data in combination with the clinical evidence were used to determine the optimal proportion and timing for blood component supplementation during massive transfusion. Based on the findings from the present study, together with an extensive review of domestic and international transfusion-related literature and consensus feedback from the 50 experts, we drafted the guidelines on massive blood transfusion that will help Chinese hospitals to develop standardized protocols for massive blood transfusion.

[FTIR Spectroscopic Characterization of Material Composition in Functional Leaf of Cotton under Stress of Potassium and Boron].

Potassium (K) and boron (B) are essential nutrient elements for plants, and the elements play an important role for plant growth, development and physiological metabolism. Cotton has a higher demand for K and B; K deficiency or B deficiency often occurs in cotton though. To reveal the component changes in functional leaf of cotton under K and B stress and investigate effects on material composition from K and B. A pot experiment was conducted at Huazhong Agricultural University. (1) the characteristic peaks at 1 546.86, 1 438.85, 1 153.39 and 1 024.17 cm(-1) disappeared due to B deficiency, and relative absorbance of other characteristic peaks was decreased compared with normal, which suggested that the structures of protein, fiber, soluble sugar and ribosome in cotton functional leaf changed and decreased in cotent when lack of K. (2) the relative absorbance of all characteristic peaks was increased in the B-deficient cotton leaves compared with normal, suggesting B deficiency leads to the accumulation in leaves of protein, and fiber, soluble sugar and other carbohydrates because of the hindered transportation. (3) lack of both potassium and boron, induced significant changes to both the locations and relative absorbance of characteristic peaks, and the content of protein, and soluble sugar and other carbohydrates increased, while the content of nucleic acids and polysaccharides dropped. K deficiency led to the structures of protein, fiber, soluble sugar and ribosome in cotton functional leaf changed and decreased in content; B deficiency gave rise to the accumulation in leaves of protein, and fiber, soluble sugar and other carbohydrates; the content of protein and soluble sugar and other carbohydrates increased, while the content of nucleic acids and polysaccharides dropped when K and B were all in short supply.

[FTIR Study of Leaf of Different Cotton Genotypes under Potassium Substitution with Sodium.]

Potassium (K) deficiency affects cotton growth. The substitution effects of sodium (Na) and potassium research have been the focus of attention at home and abroad. The aim of this paper was to study the substitution effects of Na and K on material composition in leaf of two kinds of K-efficiency cotton genotypes (HG103 and LG122) using Fourier to transform infrared (FTIR) spectroscopy. The results showed that: (1) the increment of the relative absorbance of HG103 at peaks 2 960, 2 855 and 2 926 cm-1 were the same with LG122 with addition of Na in deficient K, while at peaks 1 078 and 1 103 cm-1, the increment of HG103 was higher than LG122, indicating that in deficient K, Na could promote the synthesis of carbohydrate, protein and esters, wherein the promoting effect on carbohydrate of HG103 was greater than LG122, while for protein and esters, there has no difference. However, the decrement of the relative absorbance at these five peaks of HG103 was higher than LG122 with addition of Na in adequate K, suggesting that in adequate K, the inhibitory effect of Na on carbohydrate, protein and esters of HG103 was less LG122. (2) the peaks at 1 734 and 1 437 cm-1 disappeared due to K dificiency, when added Na, these peaks did not appear, implying that the structure of amideⅠband and cellulose was broken when lack of K when added Na has no changes.

Smart polymeric particle encapsulated gadolinium oxide and europium: theranostic probes for magnetic resonance/optical imaging and antitumor drug delivery.

Smart polymeric particles possessing the advantages of paramagnetism, luminescence, and controlled drug delivery in a single entity are reported. Gadolinium oxide and europium-encapsulated temperature/pH-responsive polymeric particles (PLTPPs) synthesized by emulsifier-free emulsion polymerization show good biocompatibility with C6 cells and anticancer drug (doxorubicin, DOX) loading capability. In vitro drug release assessment discloses release abatement under acidic conditions or at high temperature, and the DOX-loaded PLTPPs have obvious antitumor properties for C6 and H22 cells. Cellular uptake tests confirm that the materials can be taken up by C6 cells thereby facilitating optical imaging. The T1-weighted relaxivity value at 3 T is 6.13 mM-1 s-1 which is 39% higher than that of the clinical Magnevist®. In vivo MR and optical imaging reveal that the PLTPPs are effective dual probes. The results indicate that the PLTPPs have great potential in tumor diagnosis and treatment.

Investigation of the current situation of massive blood transfusion in different surgical departments: a large multicenter study in China.

OBJECTIVE: This study aims to learn about the current situation of surgical massive blood transfusion of different surgical departments in China's Tertiary hospitals, which could provide the basis for the formulation of guidelines on massive blood transfusion. METHOD: A multicenter retrospective research on the application status of blood constituents during massive blood transfusion was conducted and a comparative analyses of survival and length of hospitalization in patients from different departments (trauma, cardiac surgery, obstetric conditions, or other common surgeries), were performed. RESULT: In China, during massive blood transfusion the ratio of the dosage of fresh frozen plasma to the dosage of red blood cell suspension reached 1:1-2, while the dosage of platelet and cryoprecipitate appeared to be very small. The risk of in-hospital death were associated with the primary disease in patients receiving massive blood transfusion (Log-Rank P = 0.000), cardiac surgery and trauma patients who received massive blood transfusion have a higher risk of death rate. CONCLUSIONS: Patients undergoing massive blood transfusion among different surgical departments have a certain difference in use of blood transfusion, mortality rate and the time of death. Our findings suggested that we should set up an independent transfusion program in cardiac surgery and trauma patients of massive blood transfusion.

Hemostatic function of packed red blood cells: an in-vitro study.

Clinical observations suggest that red blood cells (RBCs) participate directly in hemostasis. We designed an in-vitro system aimed at evaluating the hemostatic function of RBCs. Blood samples were collected from 20 healthy volunteers and packed RBCs (PRBCs) were supplied by the Shaanxi Province Blood Center. We investigated the effect of RBCs and hemoglobin concentration on the hemostatic function in vitro by thromboelastography. The activation of platelets was evaluated by detecting their active markers through flow cytometry. PRBCs ameliorated the coagulation disorders induced by dilution of the blood in vitro. However, addition of hemoglobin did not increase the blood coagulation, as the level of hemoglobin was negatively correlated to the clot index. Furthermore, washing PRBCs to remove contaminating residual clotting factors and platelets excluded that the coagulation effect of the PRBCs transfusion was because of the RBCs itself. Platelet activity in PRBCs exposed to storage greater than 3 weeks was not significantly reduced consistent with it being a possible contributor. Therefore, we postulate that the suspected coagulation effects ascribed to the PRBCs at transfusion may simply be because of residual clotting factors and active platelets incompletely removed in the preparation of PRBCs rather than because of the red cell membrane or its contents.

Balanced ratio of plasma to packed red blood cells improves outcomes in massive transfusion: A large multicenter study.

Resuscitation with the early administration of plasma can improve the survival of patients undergoing surgery or trauma patients who require massive transfusion. To ascertain the optimal ratio of fresh frozen plasma (FFP) to packed red blood cells (pRBCs) in massive transfusions, the records of 1,048 patients who received a massive transfusion at 20 hospitals were retrospectively reviewed. The patients were stratified into three groups according to the ratio of FFP to pRBCs. These were the low (<1:2.3), middle (1:2.3-0.75) and high (≥1:0.75) ratio groups. For 24-h treatment, the middle FFP:pRBC ratio led to a lower mortality rate (9.31%) compared with that in the low (11.83%) and high (11.44%) ratio groups (P=0.477). For 72-h treatment, the middle FFP:pRBC ratio also lead to the lowest mortality rate (7.25%), which was significantly lower than the ratios in the low (10.39%) and high (13.65%) ratio groups (P=0.007). The length of hospital stay, ICU stay, and FFP:pRBC ratio in 72 h were found to be significant associated with mortality. The optimal ratio of FFP to pRBCs of 1:2.3-0.75 in 72 h can improve the survival of patients undergoing massive transfusions.

Association between frequency of blood tests and mortality rate in patients undergoing massive blood transfusion: a multicenter study in five regions of China.

In order to provide Chinese clinicians with guidelines for the management of massive blood loss, we investigated the correlation between the frequency of blood tests and the mortality rate in patients undergoing massive blood transfusion (MBT). The aim of this study is to provide Chinese clinicians with guidelines for the management of massive blood loss. We retrospectively reviewed the medical records of patients who underwent massive blood transfusion (MBT) from 20 tertiary hospitals in 5 regions of China. The frequency of blood tests performed within 24 or 72 hours was compared between patients infused with < 10 and ≥ 10 U of red blood cells (RBC). The correlation between the frequency of blood tests and the mortality rate was determined. A high frequency of blood tests was associated with a low mortality rate in MBT cases. The frequency of all blood tests performed within 24 hours was negatively correlated with the mortality rate in patients infused with ≥ 10 U of RBC, while the frequency of blood coagulation tests performed within 72 hours was negatively correlated with the mortality rate in both patients infused with ≥ 10 and < 10 U of RBC. In conclusions: Measuring the blood indices frequently within the first 24 hours of MBT links to lower mortality rate. Coagulation indices in MBT patients should be closely monitored in the long term to help improve survival.

Coagulation defects associated with massive blood transfusion: A large multicenter study.

The variations in the coagulation indices of patients receiving massive blood transfusion were investigated across 20 large­scale general hospitals in China. The data of 1,601 surgical inpatients receiving massive transfusion were retrospectively collected and the trends in the platelet counts and coagulation indices prior to and at 16 different time points during packed red blood cell (pRBC; after 2­40 units of pRBC) transfusion were evaluated by linear regression analysis. Temporal variations in the means of prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT) and fibrinogen (FIB) concentration were also assessed and the theoretical estimates and actual measurements of the platelet count were compared. The results demonstrated that the platelet count decreased linearly with an increase in the number of pRBC units transfused (Y=150.460­3.041X; R2 linear=0.775). Following transfusion of 18 units of pRBC (0.3 units of pRBC transfused per kilogram of body weight), the average platelet count decreased to 71x10(9)/l (<75x10(9)/l). Furthermore, variations in the means of PT, INR, APTT and FIB did not demonstrate any pronounced trends and actual platelet counts were markedly higher than the theoretical estimates. In conclusion, no variations in the means of traditional coagulation indices were identified, however, the platelet count demonstrated a significant linear decrease with an increase in the number of pRBC units transfused. Furthermore, actual platelet counts were higher than theoretical estimates, indicating the requirement for close monitoring of actual platelet counts during massive pRBC transfusion.

The plasma and platelet are important in reducing the mortality in surgical massive blood transfusion: a large multicenter study in China.

OBJECTIVE: The aim of this study was to learn the current situation of surgical massive transfusion of death and survival groups in China, which could provide the basis for the formulation of guidelines on massive transfusion. METHODS: A multicenter retrospective research for the application status of blood constituents during massive blood transfusion was conducted, the differences of fresh frozen plasma and platelet application between death group and survival group were compared, and the transfusion volume and the distribution of other blood constituents were analyses at different periods of time when red blood cells are infused between death group and survival group. RESULTS: The patients with fresh frozen plasma compare the patients with red blood cell was 1:1-2 during massive transfusion, while the dosage of platelet and cryocepitate were transfused very small. Results showed that the average amount of platelet and plasma in death group was significantly lower than those in survival group. CONCLUSION: During massive transfusion, clinicians in 20 Chinese hospitals paid more attention to the infusion of fresh frozen plasma while making the infusion of red blood cells. However, they paid little attention to the supplement of platelet and cryocepitate. The average quantity of plasma and platelet in survival group were also higher than those in death group.