Clinical efficacy of implementing a Patient Blood Management (PBM) Protocol in joint replacement surgery: a retrospective cohort study in a national referral center.

OBJECTIVE: The aging of population has dramatically broadened the total number of Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) performed worldwide. To optimize the number of blood transfusions performed, a multimodal and multidisciplinary approach was introduced, called Patient Blood Management (PBM). The aim of the present retrospective study is to evaluate the feasibility and clinical outcomes of a PBM protocol applied in a national referral center for joint replacement surgery. PATIENTS AND METHODS: Clinical reports of 9,635 patients undergoing primary THA or TKA, from 2014 to 2019, were screened. The trends of hemoglobin value at admission and at day 4 after surgery were analyzed. Furthermore, the trend of blood bags' requests and blood transfusions was longitudinally evaluated to assess the efficacy of our PBM protocol and its potential impact in reducing the length of stay in the hospital. RESULTS: In 2014, mean hemoglobin (Hb) levels at postoperative day 4 were 10.3 g/dl and 10.2 g/dl for TKA (unilateral and bilateral, respectively), and in 2019 were 11.3 g/dl and 11.6 g/dl (unilateral and bilateral, respectively, p=0.001). Total requested red blood cell (RBC) transfusions by each surgery over time have decreased for THA (277 in 2014 vs. 120 in 2019, p=0.001).  A correlation matrix analysis between Hb level, body mass index (BMI), age, days spent in orthopedic (OR) ward and number of requested transfusions showed that RBC bags transfusions were related to the length of the hospital stay. CONCLUSIONS: A timely application of a PBM protocol in the perioperative period of TKA and THA was significantly associated to the reduction of blood transfusions and total length of hospital stay, with clear benefits for both the patients and the hospital.

Molecular epidemiology of Enterococcus faecium isolates from an Italian hospital.

BACKGROUND: Outbreaks of vancomycin-resistant Enterococcus faecium (VRE) strains is an emerging problem worldwide. Even if still relatively uncommon in European hospitals, infections caused by VRE have also been increasing recently in this continent. METHODS: In this study, we characterized 50 consecutive VRE and 23 vancomycin-sensitive E. faecium (VSE) isolates collected in an Italian hospital. The presence of the esp gene and that of genes encoding resistance to glycopeptides was investigated by polymerase chain reaction (PCR). All of the isolates were typed by multi-locus sequence typing (MLST), and a selection of them also by pulsed-field gel electrophoresis (PFGE). RESULTS: We found that all of the VRE and 18 (78%) of the VSE strains belonged to the single clonal complex-17 (CC17). The most represented sequence type (ST) was ST78 (34% of the isolates). When further analyzed by PFGE, ST78 isolates were subdivided into five pulsotypes, four of them closely related. The strong association between the esp gene and CC17 was confirmed. Interestingly, such an association was higher among vancomycin-resistant isolates. Most of the esp-positive isolates (34/46, 74%) encoded Esp4, a rare variant of this protein characterized by the absence of A repeats. CONCLUSIONS: Our findings underscore the role of the CC17 lineage in the nosocomial spread of VRE and VSE, and its rapid local evolution, underscoring the need for programs designed to provide early detection in order to prevent its spreading among the nosocomial population.

PCR ribotyping for characterizing Salmonella isolates of different serotypes.

The 16S-23S intergenic spacer region in 218 strains of Salmonella isolated from four Italian hospitals during the period from 1977 to 1994 was analyzed by PCR ribotyping. This molecular typing technique allowed for the identification of seven different and specific electrophoretic profiles for the seven serovars S: enteritidis, S. london, S. anatum, S. panama, S. heidelberg, S. agona, and S. goldcoast. Otherwise, the spacer region appears to be polymorphic in S. typhimurium S. infantis, and S. derby since we could identify eight, six, and four different ribotypes, respectively.

[Behavior of some acute phase reactant proteins during phlogosis and neoplasms and their correlation with erythrocyte sedimentation rate]. / Comportamento di alcune proteine della fase acuta in corso di flogosi e di neoplasie, e loro correlazione con la V.E.S.

Alpha 2 macroglobulin, haptoglobin and fibrinogen plasma levels were simultaneously determined, as well as E.S.R., to test if a significant difference could be found among cancer, inflammatory diseases and control subjects. Haptoglobin was higher in the cancer group and fibrinogen in inflammatory diseases, but these selective increases are not believed to be enough to suggest the widespread determinations of these proteins. A significant correlation was found between alpha 2 macroglobulin and E.S.R., as well as between fibrinogen and E.S.R.

[Local synthesis of immunoglobulins in pleural effusions. II]. / Sintesi locale di immunoglobuline nei versamenti pleurici. Nota II.

A report is given about the synthesis of IgG immunoglobulins in the pleural infiltrations. The quantity of immunoglobulins locally yielded is estimated through the ratio IgG/Albumin in the blood and in the infiltration. Evidence is given that the mechanic and neoplastic transudates are easily detectable on account of the failed local synthesis of immunoglobulins of IgG type. A short account is given of the local synthesis of IgA.

[Advantages of the combination of the technics of double arc precipitation analysis and of scaled dilutions in the study of asymptomatic monoclonal gammopathies]. / Vantaggi dell'associazione delle tecniche di analisi del doppio arco di precipitazione e delle diluizioni scalari nello studio delle gammopatie monoclonali asintomatiche.

A report is given about the opportunity and the advantages of combining the traditional scheme for the study of the pathological immunoglobulins with the analysis of the uncoupling of the bow of precipitation against IgG and the isolation of the pathological immunoglobulin through a diluition of the serum such as to bring the fraction electrophoretically dispersed to not detectable levels and make it detectable the monoclonae portion electrophoretically homogeneous.

[Proposal for an organic scheme for the survey of the proteins in the spinal fluid (author's transl)]. / Proposta di uno schema organico per lo studio delle proteine del liquido cefalo - rachidiano.

A simple technique of electroimmunodiffusion is described, which is fit for identifying the variations in the ratio IgG/Albumin in the spinal fluid (liquor). Furthermore a general scheme for the survey of the proteic situation in the spinal fluid is also proposed.

[The secretory IgA. The local secretory immunitary system (author's transl)]. / Le IgA secretorie. Il sistema immunitario secretorio locale (S.I.S.L.)

The Authors take into examine the local secretory immunitary system (L.S.I.S.) starting from the presence of antibody-molecules in secretions: they study origin, characteristics, action and excitement procedures of this class of molecules, also compared with the immunitary central system.