Blood utilization in five Chinese hospitals shows low hemoglobin thresholds in medical patients.

BACKGROUND: The number of red blood cell units transfused per capita in China is lower than in western countries and the reason(s) for the difference is unknown. STUDY DESIGN AND METHODS: We randomly chose 5050 transfused patients from five Chinese hospitals. We compared transfused cases to nontransfused controls matched for the same underlying diagnosis. We assessed the pretransfusion hemoglobin (Hb) trigger and other clinical characteristics associated with transfusion. After stratifying by underlying disease, we compared pretransfusion Hb level in Chinese hospitals to 12 US hospitals. RESULTS: In 5050 patients who received transfusion, the pretransfusion Hb levels were lower in medical (6.3 g/dL) compared to surgical patients receiving transfusion postoperatively (8.1 g/dL). In patients with nonsurgical diagnoses, the pretransfusion Hb was much lower than that in the United States; the difference in mean Hb level varied by underlying diagnosis from 0.4 to 1.8 g/dL. In case-control analysis of cases (n = 1356) compared to controls (n = 1201), the pretransfusion Hb showed the strongest association with transfusion. Compared to 10 g/dL, the odds ratio (95% confidence interval) for pretransfusion Hb of 7 to 7.9 g/dL was 37.7 (24.8-57.4). CONCLUSION: Transfusion triggers in five Chinese hospitals appear comparable to those in the United States for surgical patients; however, medical patients have lower pretransfusion Hb levels (approx. 6 g/dL). Of the factors assessed, the pretransfusion Hb was most strongly associated with transfusion. The clinical impact of lower transfusion thresholds used in China is unknown.

Is the evidence strong enough for acupuncture ameliorates clinical symptoms in patients with amyotrophic lateral sclerosis: A protocol for a systematic review and meta-analysis.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron diseases. Until now, it lacks effective drugs for its treatment, and the median survival time of ALS is reported as only 20 to 48 months after the onset of symptoms. Acupuncture served as part of traditional Chinese therapy, has been widely applied to clinical practice for patients with ALS but lacks studies to verify its efficacy. This study provides a protocol of systematic review, with which we will comprehensively verify the effects of acupuncture on ALS with evidence-based studies. METHODS: The eligible studies will be collected from 4 English databases (the MEDLINE via PubMed, the Cochrane Library, EMBASE, the Web of Science, and Ovid database), and 4 Chinese databases (China Science and Technology Journal Database, Chinese Biomedical Literature Database, Wan-fang Database, China National Knowledge Infrastructure) from October 2000 to October 2022. The primary outcome measure is the change in amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) scores. We will use RevMan V.5.3 software to calculate the data synthesis and will conduct meta-analysis based on the collected data. RESULTS: The primary outcome measure is the change in ALSFRS-R scores, and secondary outcome measures included changes in forced vital capacity, grasping power, pinch strength, modified Norris Scale, ALS assessment questionnaire-40, and time to activity of daily living-independent will be measured and comprehensively assessed to evaluate the effect of acupuncture on ALS from this systematic review and meta-analysis. CONCLUSION: The systematic review and meta-analysis will assess the effect of acupuncture in the treatment of ALS with up-to-date clinical evidence. PROSPERO REGISTRATION NUMBER: PROSPERO CRD 42019124785.

[Analysis of Clinical Blood Use in Emergency Blood Loss Patients].

OBJECTIVE: To explore the blood transfusion data of emergency hemorrhage patients, so as to provide the basis for improving the quality of emergency blood transfusion and guiding clinic rational blood transfusion. METHODS: one thousand emergency blood loss patients once transfused RBC suspension were collected by Recipient Epidemiology and Donor Evaluation Study-III internationals Site range from November 2012 to November 2015. The clinical data including age, sex, clinical diagnosis etc were analyzed retrospectively. According to the quantity of blood transfusion the 1 000 patients were divided into 3 groups: low transfusion volume group(834),moderate transfusion volume group(116) and high transfusion volume group(50), difference was compared among the 3 groups，the transfusion predicting index and risk factor were analyzed by unvariate and multivoriate analyses using SPSS 23.0 software. RESULTS: High volume transfusion group was different from moderate and low volume transfusion in sex, pathogenesis, systolic pressure, hemoglobin level, with or without surgical operation, infusion volume of blood products, the retention time of ICU, total hospitalzed stay and mortality(P＜0.05), but there were no differences in age, respiration frequency, temperature before transfusion and creatinine level. The multivarate analysis showed that with or without surgical operation(OR=7.515，95% CI: 3.289-17.174, P=0.000), bleeding volume in surgery(OR=2.626, 95% CI: 1.428-4.828, P=0.043), the amount of transfused red blood cells(OR=2.574, 95% CI: 1.306-5.073, P=0.015), plasma transfusion or no(OR=2.118, 95% CI: 1.184-3.789, P=0.011), cryoprecipitate transfusion or no(OR=5.296, 95% CI: 2.164-12.960, P=0.000) were the independent risk factors for death resulted from emergency blood loss. CONCLUSION: The probability of massive transfusion in the trauma patients is higher，and the massive transfusion associates with increased mortality in the emergency blood loss patients. Surgery operation, bleeding volume in operation, amount of transfused red blood cells, plasma transfusion and cryoprecipitate transfusion may predict the mortality of patients with blood transfusion.

Surgery-free video-oculography in mouse models: enabling quantitative and short-interval longitudinal assessment of vestibular function.

Vestibulo-ocular reflex (VOR) responding to acceleration stimuli is originated from the vestibular apparatuses and thus widely used as an in vivo indicator of the vestibular function. We have developed a vestibular function testing (VFT) system that allows to evaluate VOR response with improved efficiency. The previously required surgical procedure has been avoided by using a newly designed animal-immobility setup. The efficacy of our VFT system was demonstrated on the mice with vestibular abnormalities caused by either genetic mutations (Lhfpl5-/- or Cdh23-/-) or applied vestibulotoxicant (3,3'-iminodipropionitrile, IDPN). Daily longitudinal inspection of the VOR response in the IDPN-administered mice gives the first VOR-based daily-progression profile of the vestibular impairment. The capability of VOR in quantifying the severity of toxicant-induced vestibular deficits has been also demonstrated. The acquired VOR-measurement results were validated against the corresponding behavioral-test results. Further validation against immunofluorescence microscopy was applied to the VOR data obtained from the IDPN-administered mice. We conclude that the improved efficiency of our surgery-free VFT system, firstly, enables the characterization of VOR temporal dynamics and quantification of vestibular-impairment severity that may reveal useful information in toxicological and/or pharmaceutical studies; and, secondly, confers our system promising potential to serve as a high-throughput screener for identifying genes and drugs that affect vestibular function.