[Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement].

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Sanz-Reig, J; Parra Ruiz, B; Ferrández Martínez, J; Martínez López, J F

2016-01-01

To evaluate the effectiveness and safety of a single intravenous dose of tranexamic acid in order to reduce blood loss in total knee replacement. Prospective observational study of the administration of tranexamic acid in patients undergoing primary total knee arthroplasty from November 2013 to February 2015, in which an autologous blood recovery system was used. The study included 98 patients, distributed into two groups of 49 patients according to whether or not they received intravenous tranexamic acid. The primary endpoint was the number of patients requiring autologous transfusion from the recovery system autologous blood recovery system. No drop-outs were recorded during follow-up. There were no significant differences between groups as regards the preoperative and hospital variables. The mean preoperative haemoglobin and haematocrit at 24 and 48 hours postoperatively were similar in both groups. The average volume of bleeding in the autologous blood recovery system and estimated average blood loss was lower in patients who had been administered tranexamic acid, with significant differences. No patients in the group that was administered tranexamic acid required blood autotransfusion. The transfusion rate was zero in the two groups. No adverse events related to the administration of tranexamic acid were recorded. Intravenous administration of tranexamic acid, according to the described protocol, has presented a non-autotransfusion or allo-transfusion rate of 100%, with no increased incidence of thrombotic events. Thus, its use in this group of patients is recommended. The indication should be individualized, its use justified in the patient medical records, and informed consent is mandatory. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population

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Abhishek Shinde

2015-01-01

Full Text Available Introduction: For quite a few years, tranexamic acid (TEA has been used during total knee arthroplasty (TKA to reduce blood loss. However, no consensus exits regarding its timing and doses. Materials and Methods: We conducted a prospective, randomized double-blinded study of 56 patients in the Indian population undergoing TKA from 2011 to 2012. A dose of 10 mg/kg body weight of TEA (three doses was given in one group and normal saline was administered in the other. Results: The mean blood loss in the TEA unilateral group was 295 mL ± 218 mL and in the placebo group was 482 mL ± 186 mL (P < 0.005. In the bilateral TEA group, the mean blood loss was 596 mL ± 235 mL and in the placebo group was 1349 mL ± 41 mL (P < 0.005. Conclusion: The number of patients requiring blood transfusion reduced substantially. There was no increase in the risk of deep vein thrombosis (DVT and pulmonary embolism. TEA reduces intraoperative and postoperative blood loss and thus reduces the need of allogenic blood transfusion.

Autologous blood transfusion in total knee replacement surgery.

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Sarkanović, Mirka Lukić; Gvozdenović, Ljiljana; Savić, Dragan; Ilić, Miroslav P; Jovanović, Gordana

2013-03-01

Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people's (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

Remifentanil Reduces Blood Loss During Orthognathic Surgery.

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Matsuura, Nobuyuki; Okamura, Taiki; Ide, Satoko; Ichinohe, Tatsuya

2017-01-01

Remifentanil is reported to reduce oral tissue blood flow. We performed a retrospective investigation using logistic regression analysis of anesthesia records to investigate whether the use of remifentanil infusion in a balanced anesthesia technique was useful as a primary technique to reduce blood loss during orthognathic surgery. Subjects were 80 patients who underwent Le Fort I osteotomy and sagittal split ramus osteotomy of the mandible. The variables included gender, age, weight, type of maintenance anesthetic, type and dose or infusion rate of opioid, mean systolic blood pressure (SBP-mean), coefficient of variation of systolic blood pressure (CVSBP) during surgery, mean heart rate (HR-mean), duration of surgery, total blood loss, volume of infusion used, amount of local anesthetic used, body temperature, and urine output. Gender, type of maintenance anesthetic, type of opioid, SBP-mean, CVSBP, HR-mean, and duration of surgery were used as candidates for independent variables. Logistic regression analysis was performed for the selected independent variables with the total blood loss as the dependent variable. The factors associated with the reduction of blood loss were the use of remifentanil (odds ratio, 3.112; 95% CI, 1.166-8.307; P = .023) and smaller CVSBP (odds ratio, 2.747; 95% CI, 1.07-7.053; P = .036). Use of remifentanil and smaller CVSBP were associated with a reduction of blood loss during orthognathic surgery.

Comparative study of topical vs. intravenous tranexamic acid regarding blood loss in total knee arthroplasty

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Ari Zekcer

Full Text Available ABSTRACT Objective: To compare topical vs. intravenous tranexamic acid (TA in total knee arthroplasty regarding blood loss and transfusion., Methods: Ninety patients were randomized to receive TA intravenously (20 mg/kg in 100 mL of saline; group IV, topically (1.5 g in 50 mL of saline, sprayed over the operated site, before release of the tourniquet; topical group, or intravenous saline (100 mL with anesthesia; control group. The volume of drained blood in 48, h, the amount of transfused blood, and the serum levels of hemoglobin and hematocrit before and after surgery were evaluated., Results: The groups were similar for gender, age, weight, laterality, and preoperative hemoglobin and hematocrit levels (p> 0.2. The hemoglobin level dropped in all groups when comparing the preoperative and the 48-h evaluations: the control group decreased 3.8 mg/dL on average, while the IV, group had a decrease of 3.0, and the topical group, of 3.2 (p= 0.019. The difference between the control and IV, groups was confirmed by Bonferroni test (p= 0.020. The difference between the control group and the topical group was not significant (p= 0.130, although there was less reduction in hemoglobin in the topical group; the comparison between the IV, group and the topical group was also not significant (p= 1.000. Conclusion: Using topic and IV, tranexamic acid decreased blood loss and the need for transfusion in total knee arthroplasty. Topical application showed results similar to IV use regarding the need for blood transfusion, but without the possible side effects of IV, administration.

Topical fibrin sealant versus intravenous tranexamic acid for reducing blood loss following total knee arthroplasty: A systematic review and meta-analysis.

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Gao, Fuqiang; Ma, Jinhui; Sun, Wei; Guo, Wanshou; Li, Zirong; Wang, Weiguo

2016-08-01

Efficacy and safety of topical application of a fibrin sealant (FS) compared with intravenous administration of tranexamic acid (TXA) for reducing blood loss after total knee arthroplasty (TKA) is controversial. We undertook a meta-analysis to compare the effects of topical application of FS or intravenous administration of TXA on blood loss after TKA. PubMed, Medline, Embase, Web of Science and the Cochrane Library were searched to identify studies comparing FS with TXA for TKA patients. The mean difference (MD) of blood loss, hemoglobin value, and odds ratios (ORs) of transfusion requirements and adverse events in FS and TXA groups were pooled throughout the study. Relevant data were analyzed using RevMan v5.3. Five studies involving 359 patients were included (181 FS vs. 178 TXA). TXA use had a significantly lower prevalence of blood transfusion (OR = 3.14; 95% confidence interval (CI), 1.67 to 5.90, P = 0.0004) and higher hemoglobin level (MD = -1.23; 95% CI, -2.19 to -0.27, P = 0.01) than FS in the early postoperative period. No significant difference was seen in total blood loss between the two groups (MD = 198.06; 95% CI, -267.45 to 663.57; P = 0.40). There were no significant differences in adverse events, superficial infections, or deep-vein thrombosis among study groups. Our meta-analysis suggests that intravenous administration of TXA for patients undergoing TKA may reduce blood-transfusion requirements and maintain higher hemoglobin levels compared with topical application of FS in the early postoperative period. There were no significant differences in total calculated blood loss and prevalence of complications between the two groups. However, owing to the variation of included studies, no firm conclusions can be drawn. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Comparision of blood loss between computer assisted and conventional total knee arthroplasty

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Paras Kumar Mohanlal

2013-01-01

Conclusion: These results suggest that there is no significant difference in blood loss in CAS TKA and conventional TKA. This study also highlights the heterogeneity of methods used in studies related to CAS TKA. We believe that there is a need for a large multicenter prospective randomized controlled trial to be performed before a consensus can be reached on the influence of CAS techniques on blood loss during primary TKA.

Predicting Factors for Allogeneic Blood Transfusion and Excessive Postoperative Blood Loss after Single Low-Dosage Intra-Articular Tranexamic Acid Application in Total Knee Replacement

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Paphon Sa-ngasoongsong

2017-01-01

Full Text Available Background. Recently, intra-articular tranexamic acid (IA-TXA application has become a popular method for perioperative blood loss (PBL reduction in total knee replacement (TKR. Nevertheless, through our knowledge, no previous studies had shown the correlation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT after IA-TXA. Materials and Methods. A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period (2013-2014. Patient’s characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss (THL, estimated total blood loss (ETBL, and drainage volume per kg (DV/kg. Excessive PBL was defined as PBL that exceeded 90th percentile. Results. From multivariate analysis, low preoperative hemoglobin (Hb level and body mass index (BMI were the significant predictors of postoperative BT (p<0.0001 and 0.003, resp.. Excessive THL significant associated with preoperative Hb (p<0.0001. Excessive ETBL significantly associated with preoperative Hb, height, preoperative range-of-motion, and creatinine clearance (p<0.05 all. Low BMI and large prosthesis size were the significant predictors of excessive DV/kg (p=0.0001 and 0.002, resp.. Conclusions. Low preoperative Hb and BMI were the significant risks of postoperative transfusion after TKR with IA-TXA. Moreover, multiple perioperative factors could result in higher PBL.

A randomized trial of the effect of low dose epinephrine infusion in addition to tranexamic acid on blood loss during total hip arthroplasty

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Jans, Ø.; Grevstad, U.; Mandoe, H.

2016-01-01

procedure. Intraoperative tranexamic acid (TXA) was administered to all subjects. The primary outcome was intraoperative blood loss directly measured by drains and weighing swabs. Secondary outcome was total blood loss at 24 h postoperatively calculated using the Gross formula. Results: Of 106 subjects...

Comparison of Two Methods of Bolus and Infusion of Tranexamic Acid in Reduction of Blood Loss in Total Knee Arthroplasty

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Mohammadreza Moshari

2018-01-01

Full Text Available AbstractBackground: So far, many studies have been performed to determine the optimal dose and regimen of tranexamic acid to reduce preoperative and postoperative blood loss in primary total knee arthroplasty. In the present study, two different methods of administration (bolus and infusion, were compared.Materials and Methods: Forty patients were randomized in the two groups (A and B of 20 patients each. All patients received 500 mg tranexamic acid before inflation of tourniquet. Group A (mean age, 64± 6.1 years received 500 mg tranexamic acid 10 minutes before loosening of tourniquet and group B (mean age, 63.5 ± 7.7 years received 500 mg tranexamic acid through IV infusion during 6 hours from the time of tourniquet loosening (total dose of TA, 1 g in both groups. Intraoperative blood loss,postoperative drainage (in 6 and 12 hours, blood transfusion (in 48 hours, and decrease in hematocrit and hemoglobin (6 and 12 hours later, were compared between the two groups.Results: The patients in group B had lower intra- and postoperative blood loss in 6 and 12 hours and also had lower decrease in hemoglobin, and their packed cell transfusion rate was significantly lower compared to the group A.Conclusion: The findings of this study indicated that infusion administration of tranexamic acid in primary total knee arthroplasty, was more effective in the reduction of perioperative blood loss as well as need for blood transfusion in 48 hours.

No Effect of a Bipolar Sealer on Total Blood Loss or Blood Transfusion in Nonseptic Revision Knee Arthroplasty-A Prospective Study With Matched Retrospective Controls.

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Nielsen, Christian Skovgaard; Gromov, Kirill; Jans, Øivind; Troelsen, Anders; Husted, Henrik

2017-01-01

Postoperative anemia is frequent after revision of total knee arthroplasty (TKA) with reported transfusion rates up to 83%. Despite increased efforts of reducing blood loss and enhancing fast recovery within the fast-track setup, a considerable transfusion rate is still evident. The aim of this study was therefore to evaluate the effect of a bipolar sealer on blood loss and transfusion in revision TKA. In this single-center prospective cohort study with retrospective controls, 51 patients were enrolled in a fast-track setup for revision TKA without the use of a tourniquet. Twenty-five prospectively enrolled patients received treatment with both a bipolar sealer and electrocautery, whereas 26 patients had received treatment with a conventional electrocautery only in the retrospective group. No significant differences were found neither for calculated blood loss, with 1397 (standard deviation, ± 452) mL in the bipolar sealer group vs 1452 (SD, ± 530) mL in the control group (P = .66), nor for blood transfusion rates of 53% and 46% (P = .89), respectively. Four controls were readmitted within 90 days follow-up. The use of a bipolar sealer in a TKA revision setting without the use of a tourniquet did not reduce blood loss or blood transfusion rates. Copyright © 2016 Elsevier Inc. All rights reserved.

Tranexamic acid reduces intraoperative occult blood loss and tourniquet time in obese knee osteoarthritis patients undergoing total knee arthroplasty: a prospective cohort study.

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Meng, Yutong; Li, Zhirui; Gong, Ke; An, Xiao; Dong, Jiyuan; Tang, Peifu

2018-01-01

Obesity can result in increased blood loss, which is correlated with poor prognosis in total knee arthroplasty (TKA). Clinical application of tranexamic acid is effective in reducing blood loss in TKA. However, most previous studies focused on the effect of tranexamic acid in the whole population, neglecting patients with specific health conditions, such as obesity. We hypothesized that tranexamic acid would reduce blood loss to a greater extent in obese patients than in those of normal weight. A total of 304 patients with knee osteoarthritis treated with TKA from October 2013 to March 2015 were separated into tranexamic, non-tranexamic, obese, and non-obese groups. The demographic characteristics, surgical indices, and hematological indices were all recorded. We first investigated the ability of intravenous tranexamic acid to reduce intraoperative blood loss in knee osteoarthritis patients undergoing unilateral TKA. Second, we performed subgroup analysis to compare the effects of tranexamic acid between obese and non-obese patients separately. Of the 304 patients, 146 (52.0%) received tranexamic acid and 130 (42.8%) were obese. In the analysis of the whole group, both the actual and occult blood loss volume were lower in the tranexamic acid group (both P tranexamic acid group ( P tranexamic acid was shown to reduce theoretical and actual blood loss in both the obese and non-obese groups ( P Tranexamic acid reduced occult blood loss and tourniquet time in the obese group ( P 0.05). Tranexamic acid can reduce occult blood loss and tourniquet time in obese patients to a greater extent than in patients of normal weight. Therefore, obese knee osteoarthritis patients undergoing TKA can benefit more from tranexamic acid.

Perioperative blood saving measures in total hip and knee arthroplasty

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Horstmann, W.G.

2011-01-01

This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty. Background: Worldwide, approximately 1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total

Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

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Georgi P. Georgiev

2018-04-01

Full Text Available Purpose: Many randomised controlled trials and meta-analysis studies have presented the efficacy of tranexamic acid (TXA without an increase of complications. However, questions still remain about the type of administration, optimal dose and secondary outcomes of TXA in total hip arthroplasty and total knee arthroplasty. The aim of this review is to summarise the existing information in literature concerning the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use. Methods: A literature review containing 63 articles from the PubMed data starting from the first description of tranexamic acid until now was made in trying to present the existing information in a simple and effective way. Results: TXA leads to statistically significant reduction of peri and postoperative bleeding and in that way decreases blood transfusion rates and the infection risk. Topical and intravenous (IV use of TXA revealed similar results, with no increase of deep venous thrombosis. Therefore, topical TXA could be a reasonable alternative in patients with contraindications for IV application of TXA. Conclusions: Blood loss control with TXA, a synthetic analogue of the amino acid lysine, may be an excellent and safe alternative to allogeneic blood transfusion after total hip arthroplasty and total knee arthroplasty. Further studies are needed to establish the efficacy of combined IV and topical administration of TXA with regard to diminishing blood loss and reducing hospital stay. The Translational Potential of this Article: This review briefly presents the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use with regard to diminishing blood loss and reducing hospital stay for better therapeutic strategies in orthopaedics. Keywords: Arthroplasty, Review, Tranexamic acid

Quantitative determination of blood losses by a whole-body counter

International Nuclear Information System (INIS)

Rochna Viola, E.M.; Garreta, A.C. de; Soria, N.; Blanco, E.

1976-01-01

A method to quantitate blood losses by determination of the 51 Cr whole body retention (WBR) was developed. Autologous red cells labelled with Na 2 O 4 51 Cr were given intravenously. Blood losses were simulated by withdrawing blood samples. Percent relative variation (PRV) between real blood losses (blood withdrawal) and blood losses calculated by determining the WBR, were found. Withdrawal of 60 ml blood gave a PRV lower than 10.0%. 51 Cr body loss due to elution and red cell death was found to be 0.017 day -1 . The method allows the accurate detection of total blood losses of 60 ml or more, and it can be used to quantitate gastrointestinal or gynecological hemorrhages, avoiding the inconveniences involved by the complete recolection of faeces or of towels and tampons. (author) [es

The efficiency and safety of fibrin sealant for reducing blood loss in primary total hip arthroplasty: A systematic review and meta-analysis.

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Wang, Zhiyuan; Xiao, Lin; Guo, Hao; Zhao, Guanghui; Ma, Jianbing

2017-01-01

Total hip arthroplasty (THA) is associated with substantial blood loss. The objective of present systematic review and meta-analysis is to provide evidence from randomized controlled trials (RCTs) on the efficiency and safety of administration of fibrin sealant (FS) for reducing blood loss in patients undergoing primary THA. Potential relevant studies were identified from electronic databases including Medline, PubMed, Embase, ScienceDirect, web of science and Cochrane Library. Gray academic studies were also identified from the reference list of included studies. There was no language restriction. Pooling of data was carried out by using RevMan 5.1. Six randomized controlled trials (RCTs) met the inclusion criteria. Current meta-analysis indicated that there were significant differences in terms of total blood loss (MD = -153.77, 95% CI: -287.21 to -20.34, P = 0.02), postoperative hemoglobin level (MD = -0.25, 95% CI: -0.46 to -0.05, P = 0.02) and transfusion rate (RD = -0.12, 95% CI: -0.22 to -0.03, P = 0.01) between groups. No significant differences were found regarding the incidence of deep venous thrombosis (DVT) (RD = 0.00, 95% CI: -0.01to 0.01, P = 0.51) or other side effects. Administration of fibrin sealant in total hip arthroplasty may reduce total blood loss, postoperative hemoglobin decline and transfusion requirements. Moreover, no adverse effect was related to FS. Due to the limited quality of the evidence currently available, higher quality RCTs are required. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Quantification of surgical blood loss.

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Lee, Marcel H; Ingvertsen, Britt T; Kirpensteijn, Jolle; Jensen, Asger L; Kristensen, Annemarie T

2006-06-01

To compare gravimetric and colorimetric methods of quantifying surgical blood loss, and to determine if there is a correlation between preoperative hemostatic tests (buccal mucosa bleeding time [BMBT] and intraoperative blood loss). Prospective clinical study. Dogs (n=15) admitted for cutaneous tumor excision, orthopedic procedure, or exploratory laparotomy. Intraoperative blood loss was quantified by measuring irrigation fluid and weighing surgical sponges used for blood and fluid collection during surgery. Results of gravimetric measurements were then correlated to blood loss quantified using spectrophotometric analysis of hemoglobin (Hb) content. Hemostatic variables including BMBT were measured before surgery and compared with the calculated amount of blood loss. Blood loss quantified by gravimetric measurement showed a significant correlation with colorimetric determination of Hb content in surgical sponges and collected irrigation fluid (r=0.93, P<.0001). BMBT correlated weakly but significantly with intraoperative blood loss (r=0.56, P<.05). Quantifying intraoperative blood loss using spectrophotometric Hb analysis accurately assessed the amount of blood loss; however, it is a time-consuming procedure, primarily applicable as a research tool. Gravimetric evaluation of intraoperative blood loss was found to be an accurate method, which can be recommended for use in a clinical setting. Estimation of blood loss using a gravimetric method is accurate and applicable in the clinical setting and provides surgeons with a simple and objective tool to evaluate intraoperative blood loss.

No Effect of a Bipolar Sealer on Total Blood Loss or Blood Transfusion in Nonseptic Revision Knee Arthroplasty-A Prospective Study With Matched Retrospective Controls

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Nielsen, Christian Skovgaard; Gromov, Kirill; Jans, Øivind

2017-01-01

deviation, ± 452) mL in the bipolar sealer group vs 1452 (SD, ± 530) mL in the control group (P = .66), nor for blood transfusion rates of 53% and 46% (P = .89), respectively. Four controls were readmitted within 90 days follow-up. CONCLUSION: The use of a bipolar sealer in a TKA revision setting without......BACKGROUND: Postoperative anemia is frequent after revision of total knee arthroplasty (TKA) with reported transfusion rates up to 83%. Despite increased efforts of reducing blood loss and enhancing fast recovery within the fast-track setup, a considerable transfusion rate is still evident. The aim......-five prospectively enrolled patients received treatment with both a bipolar sealer and electrocautery, whereas 26 patients had received treatment with a conventional electrocautery only in the retrospective group. RESULTS: No significant differences were found neither for calculated blood loss, with 1397 (standard...

Tourniquets do not increase the total blood loss or re-amputation risk in transtibial amputations

DEFF Research Database (Denmark)

Wied, Christian; Tengberg, Peter T; Holm, Gitte

2017-01-01

AIM: To investigate the total blood loss (TBL) and the safety with respect to the re-amputation rate after transtibial amputation (TTA) conducted with and without a tourniquet. METHODS: The study was a single-centre retrospective cohort study of patients with a primary TTA admitted between January...... 2013 and April 2015. All patients with a primary TTA were assessed for inclusion if the amputation was performed because of arteriosclerosis or diabetic complications. All patients underwent a standardized TTA procedure that was performed approximately 10 cm below the knee joint and performed...... portion, which equals 55 g/L of haemoglobin. The TBL during the first four postoperative days was calculated based on the haemoglobin level and the estimated blood volume. The re-amputation rate was evaluated within 30 d. RESULTS: Seventy-four out of 86 consecutive patients who underwent TTA within...

Blood Conservation Strategies in Total Hip and Knee Arthroplasty

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David Liu

2015-01-01

Full Text Available Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

Blood lead levels and chronic blood loss

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Manci, E.A.; Cabaniss, M.L.; Boerth, R.C.; Blackburn, W.R.

1986-03-01

Over 90% of lead in blood is bound to the erythrocytes. This high affinity of lead for red cells may mean that chronic blood loss is a significant means for excretion of lead. This study sought correlations between blood lead levels and clinical conditions involving chronic blood loss. During May, June and July, 146 patients with normal hematocrits and red cell indices were identified from the hospital and clinic populations. For each patient, age, race, sex and medical history were noted, and a whole blood sample was analyzed by flameless atomic absorption spectrophotometry. Age-and race-matched pairs showed a significant correlation of chronic blood loss with lead levels. Patients with the longest history of blood loss (menstruating women) had the lowest level (mean 6.13 ..mu..g/dl, range 3.6-10.3 ..mu..g/dl). Post-menopausal women had levels (7.29 ..mu..g/dl, 1.2-14 ..mu..g/dl) comparable to men with peptic ulcer disease, or colon carcinoma (7.31 ..mu..g/dl, 5.3-8.6 ..mu..g/dl). The highest levels were among men who had no history of bleeding problems (12.39 ..mu..g/dl, 2.08-39.35 ..mu..g/dl). Chronic blood loss may be a major factor responsible for sexual differences in blood lead levels. Since tissue deposition of environmental pollutants is implicated in diseases, menstruation may represent a survival advantage for women.

Perioperative blood loss and diclofenac in major arthroplastic surgery

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Ljiljana Gvozdenović

2011-04-01

Full Text Available Introduction: Contemporary literature indicates precaution over the perioperative use of non-steroidal anti-inflammatory drugs, since they can potentially increase perioperative blood loss related to their mechanism of action. The aim of this study was to assess the influence of non-steroidal anti-inflammatory drugs on perioperative blood loss undergoing hip arthroplasty and its correlation with general and regional anesthesia.Methods: This prospective study included 120 patients who had undergone elective unilateral total hip arthroplasty. Patients were allocated into four groups. Groups 1 and 2 were pretreated with diclofenac and operated in general and regional anesthesia. Group 3 and 4 weren’t pretreated with any non-steroidal anti-inflammatory drug and were, as well, operated in general and regional anesthesia. Diclofenac was administered orally two times a day 75 mg (total 150 mg and also as intramuscular injection (75 mg preoperatively and 12 hours later on a day of surgery.Results: The perioperative blood loss in the rst 24 hours showed an increase of 29.4% in the diclofenac group operated in general anesthesia and increase of 26.8% in patients operated in regional anesthesia (P < 0.05 compared to control group. Statistical data evaluation of patients operated in general anesthesia compared to regional anesthesia, the overall blood loss in the rst 24 h after surgery, showed an increase of 6.4% in the diclofenac group and increase of 3.6% in placebo group. This was not statistically significant.Conclusion: Pretreatment with non-steroidal anti-inflammatory drugs (diclofenac before elective unilateral total hip arthroplasty increases the perioperative blood loss signficantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.

Quantitative assessment of gastrointestinal blood loss with anti-inflammatory drugs

International Nuclear Information System (INIS)

Dahanukar, S.A.; Sheth, U.K.; Bhiwankar, N.T.; Ramnath, S.R.; Mehta, B.C.; Katoch, D.S.

1980-01-01

A comparative study of gastrointestinal blood loss caused by aspirin, flurbiprofen and RH-8 was carried out in 24 normal volunteers in whom erythrocytes were labelled with radioactive chromium i.e. Cr 51 . Blood loss was estimated by counting radio-activity in vitro taking total amount of faeces. The method used was independent of distribution of radio-activity in the faeces, which does not require homogenization. Significant increase in blood loss occurred with aspirin, flurbiprofen and RH-8; only the difference between RH-8 and flurbiprofen group is significant. (auth.)

Avaliação da perda sanguínea na artroplastia total do joelho com e sem soltura do torniquete Blood loss in total knee arthroplasty with and without tourniquet release

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José Wanderley Vasconcelos

2011-01-01

Full Text Available OBJETIVO: Avaliar a perda sanguínea em pacientes submetidos à artroplastia total cimentada do joelho com e sem soltura trans-operatória do torniquete pneumático para a hemostasia. MÉTODOS: Foram estudados 72 pacientes submetidos à artroplastia total, num total de 80 joelhos, divididos em dois grupos: Grupo 1 onde se manteve o torniquete pneumático até a sutura e curativo da ferida operatória, e Grupo 2 onde foi realizada a soltura do torniquete pneumático após a cimentação da prótese, com realização de hemostasia direta, antes da sutura e curativo. Os pacientes foram avaliados quanto ao sangramento pelo dreno de sucção e à contagem de hemoglobina e hematócrito, considerando os intervalos de duas, 24 e 48 horas de pós-operatório. RESULTADOS: Não houve diferença significante entre os dois grupos quanto ao sangramento pós-operatório e decréscimo dos parâmetros hematimétricos. Somente um paciente do Grupo 2 necessitou transfusão de concentrado de hemáceas no pós-operatório. CONCLUSÃO: O sangramento pós-operatório na ATJ mostrou-se igual com e sem a soltura do torniquete pneumático para a realização da hemostasia.OBJECTIVE: To evaluate blood loss in patients submitted to cemented total knee arthroplasty with and without perioperative tourniquet release for hemostasis. METHODS: Seventy-two patients (eighty knees were submitted to total knee arthroplasty, allocated into two groups: in Group 1, in which the pneumatic tourniquet was maintained until suture and dressing of the operated wound, and Group 2, in which the pneumatic tourniquet was released intraoperatively after cementing the prosthesis, with direct hemostasis, before the suture and dressing. The patients were evaluated for blood loss by the suction drain, and hemoglobin and hematocrit counts, at intervals of 2, 24 and 48 hours in the postoperative period tube. RESULTS: There was no significant difference between the groups in terms of postoperative blood

Reduced Operating Time but Not Blood Loss With Cruciate Retaining Total Knee Arthroplasty

Science.gov (United States)

Vermesan, Dinu; Trocan, Ilie; Prejbeanu, Radu; Poenaru, Dan V; Haragus, Horia; Gratian, Damian; Marrelli, Massimo; Inchingolo, Francesco; Caprio, Monica; Cagiano, Raffaele; Tatullo, Marco

2015-01-01

Background There is no consensus regarding the use of retaining or replacing cruciate implants for patients with limited deformity who undergo a total knee replacement. Scope of this paper is to evaluate whether a cruciate sparing total knee replacement could have a reduced operating time compared to a posterior stabilized implant. Methods For this purpose, we performed a randomized study on 50 subjects. All procedures were performed by a single surgeon in the same conditions to minimize bias and only knees with a less than 20 varus deviation and/or maximum 15° fixed flexion contracture were included. Results Surgery time was significantly shorter with the cruciate retaining implant (P = 0.0037). The mean duration for the Vanguard implant was 68.9 (14.7) and for the NexGen II Legacy was 80.2 (11.3). A higher range of motion, but no significant Knee Society Scores at 6 months follow-up, was used as controls. Conclusions In conclusion, both implants had the potential to assure great outcomes. However, if a decision has to be made, choosing a cruciate retaining procedure could significantly reduce the surgical time. When performed under tourniquet, this gain does not lead to reduced blood loss. PMID:25584102

Tranexamic Acid Reduced the Percent of Total Blood Volume Lost During Adolescent Idiopathic Scoliosis Surgery.

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Jones, Kristen E; Butler, Elissa K; Barrack, Tara; Ledonio, Charles T; Forte, Mary L; Cohn, Claudia S; Polly, David W

2017-01-01

Multilevel posterior spine fusion is associated with significant intraoperative blood loss. Tranexamic acid is an antifibrinolytic agent that reduces intraoperative blood loss. The goal of this study was to compare the percent of total blood volume lost during posterior spinal fusion (PSF) with or without tranexamic acid in patients with adolescent idiopathic scoliosis (AIS). Thirty-six AIS patients underwent PSF in 2011-2014; the last half (n=18) received intraoperative tranexamic acid. We retrieved relevant demographic, hematologic, intraoperative and outcomes information from medical records. The primary outcome was the percent of total blood volume lost, calculated from estimates of intraoperative blood loss (numerator) and estimated total blood volume per patient (denominator, via Nadler's equations). Unadjusted outcomes were compared using standard statistical tests. Tranexamic acid and no-tranexamic acid groups were similar (all p>0.05) in mean age (16.1 vs. 15.2 years), sex (89% vs. 83% female), body mass index (22.2 vs. 20.2 kg/m2), preoperative hemoglobin (13.9 vs. 13.9 g/dl), mean spinal levels fused (10.5 vs. 9.6), osteotomies (1.6 vs. 0.9) and operative duration (6.1 hours, both). The percent of total blood volume lost (TBVL) was significantly lower in the tranexamic acid-treated vs. no-tranexamic acid group (median 8.23% vs. 14.30%, p = 0.032); percent TBVL per level fused was significantly lower with tranexamic acid than without it (1.1% vs. 1.8%, p=0.048). Estimated blood loss (milliliters) was similar across groups. Tranexamic acid significantly reduced the percentage of total blood volume lost versus no tranexamic acid in AIS patients who underwent PSF using a standardized blood loss measure.Level of Evidence: 3. Institutional Review Board status: This medical record chart review (minimal risk) study was approved by the University of Minnesota Institutional Review Board.

The comparison of placental removal methods on operative blood loss

International Nuclear Information System (INIS)

Waqar, F.; Fawad, A.

2008-01-01

On an average 1 litre of blood is lost during Caesarean Section. Many variable techniques have been tried to reduce this blood loss. Many study trials have shown the spontaneous delivery of placenta method to be superior over manual method because of reduced intra operative blood loss and reduced incidence of post operative endometritis. The main objective of our study was to compare the risk of blood loss associated with spontaneous and manual removal of the placenta during caesarean section. This study was conducted at Department of Obstetrics and Gynaecology, Islamic International Medical Complex, Islamabad from September 2004 to September 2005. All Women undergoing elective or emergency caesarean section were included in the study. Exclusion criteria were pregnancy below 37 weeks, severe maternal anaemia, and prolonged rupture of the membranes with fever, placenta praevia, placenta accreta and clotting disorders. Patients were allocated to the two groups randomly. Group A comprised of women in whom the obstetrician waited a maximum of 5 minutes till the placenta delivered spontaneously. In group B the obstetrician manually cleaved out the placenta as soon as the infant was delivered. The primary outcome measures noted were difference in haemoglobin of >2 gm/dl (preoperatively and postoperatively), time interval between delivery of baby and placenta, significant blood loss (>1000 cc), additional use of oxytocics, total operating time and blood transfusions. Data was analysed by SPSS. Statistical tests used for specific comparison were chi square-test and Student's t-test. One hundred and forty-five patients were allocated to two groups randomly. Seventy-eight patients were allocated to group A and 67 patients allocated to group B. Mean maternal age, birth weight, and total operating time were the same in two groups, but blood loss as measured by a difference in haemoglobin of greater then 2 grams/dl was statistically significant. Significant blood loss (>1000 cc

Tranexamic acid versus aminocaproic acid for blood management after total knee and total hip arthroplasty: A systematic review and meta-analysis.

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Liu, Qiuliang; Geng, Peishuo; Shi, Longyan; Wang, Qi; Wang, Pengliang

2018-06-01

To compare the efficacy and safety of tranexamic acid and aminocaproic acid for reducing blood loss and transfusion requirements after total knee and total hip arthroplasty. We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11) and the Cochrane Library (1900-2017.11). The primary outcomes, including total blood loss, hemoglobin decline and transfusion requirements. Secondary outcomes include length of hospital stay and postoperative complications such as the incidence of deep vein thrombosis and pulmonary embolism. Each outcome is combined and calculated using the statistical software STATA 12.0. Fixed/random effect model is adopted based on the heterogeneity tested by I 2 statistic. A total of 1714 patients are analyzed across three randomized controlled trials (RCTs) and one non-RCT. The present meta-analysis reveals that TXA is associated with a significantly reduction of total blood loss and postoperative hemoglobin drop compared with EACA. No significant differences are identified in terms of transfusion rates, length of hospital stay, and the incidence of postoperative complications. Although total blood loss and postoperative hemoglobin drop are significant greater in EACA groups, there is no significant difference between TXA and EACA groups in terms of transfusion rates. Based on the current evidence available, higher quality RCTs are still required for further research. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty.

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Demos, Harry A; Lin, Zilan X; Barfield, William R; Wilson, Sylvia H; Robertson, Dawn C; Pellegrini, Vincent D

2017-08-01

Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA. After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation. TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed. Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Tranexamic Acid Safely Reduced Blood Loss in Hemi- and Total Hip Arthroplasty for Acute Femoral Neck Fracture: A Randomized Clinical Trial.

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Watts, Chad D; Houdek, Matthew T; Sems, S Andrew; Cross, William W; Pagnano, Mark W

2017-07-01

We aimed to determine whether (1) tranexamic acid (TXA) reduces the incidence of transfusion (2) TXA reduces the calculated blood loss, and (3) there are any observable differences in 30- and 90-day complications with TXA administration during arthroplasty for femoral neck fracture (FNF). Prospective, double-blinded, randomized controlled trial. Level 1 Academic Trauma Center. One hundred thirty-eight patients who presented with a low-energy, isolated, FNF (AO 31B) treated with either hemi- or total hip arthroplasty within 72 hours of injury were randomized to either the TXA group (69 patients) or placebo group (69 patients). In the TXA group, patients received 2 doses of 15 mg/kg intravenous TXA dissolved in 100 mL of saline, each administered over 10 minutes; 1 dose just before incision, and the second at wound closure. In the placebo group, 100 mL of saline solution was administered in a similar fashion. Perioperative care was otherwise standardized including conservative transfusion criteria. Our primary outcome was to determine the proportion of patients who underwent blood transfusion during hospitalization. Secondary outcomes were calculated blood loss, number of units transfused during hospitalization, and incidence of adverse events at 30 and 90 days including thromboembolic event, wound complications, reoperation, hospital readmission, and all-cause mortality. TXA reduced mean incidence of transfusion by 305 mL (P = 0.0005). There was a trend toward decreased transfusion rate in the TXA group (17% vs. 26%, P = 0.22). TXA was safe with no differences in adverse events at 30 and 90 days. This randomized clinical trial found that TXA administration safely reduced blood loss with a tendency for decreased transfusion rate and total blood product consumption for patients undergoing hip arthroplasty for acute FNF. More studies are needed to further ascertain the role of TXA in the management of patients with FNF. Therapeutic Level I. See Instructions for Authors

Blood management and transfusion strategies in 600 patients undergoing total joint arthroplasty: an analysis of pre-operative autologous blood donation.

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Perazzo, Paolo; Viganò, Marco; De Girolamo, Laura; Verde, Francesco; Vinci, Anna; Banfi, Giuseppe; Romagnoli, Sergio

2013-07-01

Blood loss during total joint arthroplasty strongly influences the time to recover after surgery and the quality of the recovery. Blood conservation strategies such as pre-operative autologous blood donation and post-operative cell salvage are intended to avoid allogeneic blood transfusions and their associated risks. Although widely investigated, the real effectiveness of these alternative transfusion practices remains controversial. The surgery reports of 600 patients undergoing total joint arthroplasty (312 hip and 288 knee replacements) were retrospectively reviewed to assess transfusion needs and related blood management at our institute. Evaluation parameters included post-operative blood loss, haemoglobin concentration measured at different time points, ASA score, and blood transfusion strategies. Autologous blood donation increased the odds of receiving a red blood cell transfusion. Reinfusion by a cell salvage system of post-operative shed blood was found to limit adverse effects in cases of severe post-operative blood loss. The peri-operative net decrease in haemoglobin concentration was higher in patients who had predeposited autologous blood than in those who had not. The strengths of this study are the high number of cases and the standardised procedures, all operations having been performed by a single orthopaedic surgeon and a single anaesthesiologist. Our data suggest that a pre-operative autologous donation programme may often be useless, if not harmful. Conversely, the use of a cell salvage system may be effective in reducing the impact of blood transfusion on a patient's physiological status. Basal haemoglobin concentration emerged as a useful indicator of transfusion probability in total joint replacement procedures.

Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery.

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Salma, Ra'ed Ghaleb; Al-Shammari, Fahad Mohammed; Al-Garni, Bishi Abdullah; Al-Qarzaee, Mohammed Abdullah

2017-06-01

This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery. A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included. The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night. In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.

Microdebrider tonsillectomy associated with more intraoperative blood loss than electrocautery.

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Stansifer, Kyle J; Szramowski, Molly G; Barazsu, Lindsay; Buchinsky, Farrel J

2012-10-01

To describe and compare the intraoperative blood loss in children who underwent tonsillectomy and/or adenoidectomy during a transition from using electrocautery to a microdebrider. Retrospective case series of a single pediatric otolaryngologist at an urban general hospital. Patients aged 2-20 years who had tonsillectomy, adenoidectomy, or adenotonsillectomy over a 12 month period were included. Tonsillectomy was performed by microdebrider or electrocautery and adenoidectomy was performed by microdebrider, curette, or suction electrocautery. Total intraoperative blood loss was measured and compared between surgical techniques. Of the 148 patients, 109 had tonsillectomy with or without adenoidectomy and 39 had adenoidectomy alone. The mean blood loss was 47 ml or 1.8 ± 1.6 ml/kg and the maximum blood loss was 11 ml/kg. Adenoid curette and adenoid microdebrider yielded similar blood loss but were associated with more bleeding than suction electrocautery (Pelectrocautery tonsillectomy (mean of 2.6 ± 2.2 ml/kg versus 1.2 ± 1.2 ml/kg, P=0.0002). Eighteen percent of adenotonsillectomy patients lost greater than 5% of calculated circulating blood volume (95% CI, 9.8-26). Linear regression models did not show an association between the amount of blood loss and patient age, clinical indication, or the surgeon's experience with the microdebrider (P>0.05). Microdebrider tonsillectomy is associated with more intraoperative bleeding than electrocautery tonsillectomy. Approximately twice as much blood was lost with the microdebrider, but the absolute increase was insignificant from a hemodynamic perspective. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Tranexamic acid reduces blood loss in patients with extracapsular fractures of the hip

DEFF Research Database (Denmark)

Tengberg, P T; Foss, N B; Palm, H

2016-01-01

AIMS: We chose unstable extra-capsular hip fractures as our study group because these types of fractures suffer the largest blood loss. We hypothesised that tranexamic acid (TXA) would reduce total blood loss (TBL) in extra-capsular fractures of the hip. PATIENTS AND METHODS: A single...

Blood-loss Management in Spine Surgery.

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Bible, Jesse E; Mirza, Muhammad; Knaub, Mark A

2018-01-15

Substantial blood loss during spine surgery can result in increased patient morbidity and mortality. Proper preoperative planning and communication with the patient, anesthesia team, and operating room staff can lessen perioperative blood loss. Advances in intraoperative antifibrinolytic agents and modified anesthesia techniques have shown promising results in safely reducing blood loss. The surgeon's attention to intraoperative hemostasis and the concurrent use of local hemostatic agents also can lessen intraoperative bleeding. Conversely, the use of intraoperative blood salvage has come into question, both for its potential inability to reduce the need for allogeneic transfusions as well as its cost-effectiveness. Allogeneic blood transfusion is associated with elevated risks, including surgical site infection. Thus, desirable transfusion thresholds should remain restrictive.

An evaluation of intra-operative and post-operative blood loss in ...

African Journals Online (AJOL)

Background: Total knee replacement is a rewarding and reliable procedure, producing a lasting relief to severe knee pains. However, significant blood loss usually in the post-operative period may be a challenge, necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this ...

Tranexamic acid administration to older patients undergoing primary total hip arthroplasty conserves hemoglobin and reduces blood loss.

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El Beheiry, Hossam; Lubberdink, Ashley; Clements, Nigel; Dihllon, Kiran; Sharma, Vicky

2018-06-01

Tranexamic acid effects in older people are difficult to predict. This study investigated the following research questions: 1) Is tranexamic acid effective in older patients undergoing primary total hip arthroplasty (THA)? and 2) Is there a difference in the effect of tranexamic acid between younger and older patients? This was a 2-phase retrospective matched-pair study of patients who underwent THA in 2007-2013. All procedures were performed by surgeons with at least 10 years' experience as senior consultant. In the first phase, 58 patients aged 65 years or more who received tranexamic acid were matched 1:1 with patients who did not receive tranexamic acid for age, sex, American Society of Anesthesiologists (ASA) classification and body mass index. In the second phase, 58 patients aged 65 years or more who received tranexamic acid were matched 1:1 with patients less than 65 years of age who received tranexamic acid for sex, ASA classification and body mass index. The primary outcome measures were percent maximum decrease in hemoglobin level and estimated blood loss after surgery. In the first phase, patients who received tranexamic acid conserved postoperative hemoglobin by a mean of 10.26 g/L (standard deviation [SD] 9.89 g/L) compared to the control group ( p Tranexamic acid reduced the postoperative decrease in hemoglobin level and blood loss in older patients. Moreover, the significant hemoglobin-sparing effect of tranexamic acid in older patients was similar to that observed in younger patients.

Real Time Intraoperative Monitoring of Blood Loss with a Novel Tablet Application

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Sharareh, Behnam; Woolwine, Spencer; Satish, Siddarth; Abraham, Peter; Schwarzkopf, Ran

2015-01-01

Introduction : Real-time monitoring of blood loss is critical in fluid management. Visual estimation remains the standard of care in estimating blood loss, yet is demonstrably inaccurate. Photometric analysis, which is the referenced “gold-standard” for measuring blood loss, is both time-consuming and costly. The purpose of this study was to evaluate the efficacy of a novel tablet-monitoring device for measurement of Hb loss during orthopaedic procedures. Methods : This is a prospective study of 50 patients in a consecutive series of joint arthroplasty cases. The novel System with Feature Extraction Technology was used to measure the amount of Hb contained within surgical sponges intra-operatively. The system’s measures were then compared with those obtained via gravimetric method and photometric analysis. Accuracy was evaluated using linear regression and Bland-Altman analysis. Results : Our results showed a significant positive correlation between Triton tablet system and photometric analysis with respect to intra-operative hemoglobin and blood loss at 0.92 and 0.91, respectively. Discussion : This novel system can accurately determine Hb loss contained within surgical sponges. We believe that this user-friendly software can be used for measurement of total intraoperative blood loss and thus aid in a more accurate fluid management protocols during orthopaedic surgical procedures. PMID:26401167

DOES INTRAVENOUS TRANEXAMIC ACID REDUCE BLOOD LOSS DURING SURGICALLY ASSISTED RAPID PALATAL EXPANSION?

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Emine AKBAŞ

2017-10-01

Full Text Available Purpose: The purpose of this study was to evaluate the efficacy of tranexamic acid (TXA in reducing blood loss during surgically assisted rapid palatal expansion (SARPE procedure. Subjects and Methods: A total of 34 patients (12 male, 22 female who had been treated surgically under general anesthesia with SARPE including pterygoid disjunction for transverse maxillary deficiency (TMD were included in this study. The study group (n=17 received intravenous (IV TXA 10 mg/kg as a preoperative bolus; the control group (n=17 received normal saline solution. Preoperative and postoperative haemoglobin and haematocrit values, intraoperative blood loss, and any blood product transfusion were recorded. Results: Blood loss during SARPE was statistically significantly less in the study group than the control group (p=0.0001. Conclusion: Preoperative IV administration of TXA can effectively control blood loss during when SARPE with pterygoid disjunction is performed.

The optimal protocol to reduce blood loss and blood transfusion after unilateral total knee replacement: Low-dose IA-TXA plus 30-min drain clamping versus drainage clamping for the first 3 h without IA-TXA.

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Park, Joo Hyun; Choi, Sung Wook; Shin, Eun Ho; Park, Myung Hoon; Kim, Myung Ku

2017-01-01

Although intraarticular tranexamic acid (IA-TXA) administration or drainage clamping are popular methods used to reduce blood loss after total knee replacement (TKR), the protocol remains controversial. We aimed (1) to establish new protocols through investigating whether two methods, that is, low-dose (500 mg) IA-TXA plus 30-min drain clamping and drainage clamping for the first 3 h without IA-TXA, can reduce blood loss and blood transfusion after unilateral TKR and (2) to make recommendations related to clinical application. This study, conducted from September 2014 to June 2016 related to enrolled 95 patients with primary osteoarthritis who were to have a unilateral cemented TKR, was nonrandomized and retrospective. In group A, the drain was released following tourniquet deflation. In group B, 500-mg TXA was injected into the knee joint via a drain tube after fascia closure and the drain was clamped for the first 30 min to prevent leakage. In group C, the drain was clamped for the first 3-h postoperation. Demographic characteristics and clinical data were collected, including the levels of hematocrit (Hct), the total blood loss (TBL), drained blood volume (BV), the amount of blood transfused, and any complications that developed. We found a significantly lower postoperative TBL, drained BV, decreasing Hct level, and less transfused BV in the IA-TXA injection group (group B) and the 3-h drainage clamping group (group C) compared to the conventional negative drainage group (group A; p optimal than drainage clamping in patients with high bleeding tendency or lateral retinacular release during TKR, who would be concerned about postoperative wound complication.

[Quantitative analysis of blood loss in liposuction].

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Schor, N; Zatz, R M; Mendonça, A R; Takatu, P M; Patto, G S

1989-01-01

This study was performed in 15 female patients submitted to suction lipectomy as an isolated procedure, to establish blood loss in the procedure. A wide variation of blood-to-fat ratios was observed (17 to 59%) with a mean blood loss in lipoaspirates of 34 +/- 3%. Internal blood losses occurring in the first 72 post-operative hours were as important as or more important than external losses, and responsible for a mean 7% fall in the level of hemoglobin. Internal blood losses occurred between 72 hours and the 7th to the 10th post-operative days and were responsible for a mean 3% fall in the level of hemoglobin. Blood losses occurring in this study were demonstrated to be greater than usually assumed. Some prophylactic measures are recommended to provide for a safer treatment of these patients: an iron supplementation during the pre-operative period; careful clinical and laboratorial screening for bleeding disorders and for the intake of drugs that can interfere with coagulation; use of smaller-diameter cannulas for aspiration, auto-transfusion when aspirating in excess of 1,000 ml, and limiting the aspiration to 1,500 ml.

Comparison of Two Methods of Bolus and Infusion of Tranexamic Acid in Reduction of Blood Loss in Total Knee Arthroplasty

OpenAIRE

Mohammadreza Moshari; Bahman Malek; Mohammadreza Minator-Sajjadi; Maryam Vosoghian; Mastaneh Dahi; Mahshid Ghasemi; Razieh Shekari

2018-01-01

AbstractBackground: So far, many studies have been performed to determine the optimal dose and regimen of tranexamic acid to reduce preoperative and postoperative blood loss in primary total knee arthroplasty. In the present study, two different methods of administration (bolus and infusion), were compared.Materials and Methods: Forty patients were randomized in the two groups (A and B) of 20 patients each. All patients received 500 mg tranexamic acid before inflation of tourniquet. Group A (...

Visual estimation versus gravimetric measurement of postpartum blood loss: a prospective cohort study.

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Al Kadri, Hanan M F; Al Anazi, Bedayah K; Tamim, Hani M

2011-06-01

One of the major problems in international literature is how to measure postpartum blood loss with accuracy. We aimed in this research to assess the accuracy of visual estimation of postpartum blood loss (by each of two main health-care providers) compared with the gravimetric calculation method. We carried out a prospective cohort study at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1 November 2009 and 31 December 2009. All women who were admitted to labor and delivery suite and delivered vaginally were included in the study. Postpartum blood loss was visually estimated by the attending physician and obstetrics nurse and then objectively calculated by a gravimetric machine. Comparison between the three methods of blood loss calculation was carried out. A total of 150 patients were included in this study. There was a significant difference between the gravimetric calculated blood loss and both health-care providers' estimation with a tendency to underestimate the loss by about 30%. The background and seniority of the assessing health-care provider did not affect the accuracy of the estimation. The corrected incidence of postpartum hemorrhage in Saudi Arabia was found to be 1.47%. Health-care providers tend to underestimate the volume of postpartum blood loss by about 30%. Training and continuous auditing of the diagnosis of postpartum hemorrhage is needed to avoid missing cases and thus preventing associated morbidity and mortality.

Role of Tranexamic Acid in Reducing Blood Loss in Vaginal Delivery.

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Roy, Priyankur; Sujatha, M S; Bhandiwad, Ambarisha; Biswas, Bivas

2016-10-01

Anti-fibrinolytic agents are used to reduce obstetric blood loss as the fibrinolytic system is known to get activated after placental delivery. To evaluate the efficacy of parenteral tranexamic acid in reducing blood loss during normal labour and to compare it with the amount of blood loss in patients who received placebo in the third stage of labour. Patients with spontaneous labour or planned for induction of labour and fulfilling the inclusion criteria were recruited for the study. In each patient, the pre-delivery pulse rate, blood pressure, Hb gm% and PCV% were noted. Labour was monitored carefully using a partogram. The study group received Inj. Oxytocin and Inj. Tranexamic acid. The control group received Inj. Oxytocin and Placebo injection. Immediately after delivery of the baby, when all the liquor was drained, the patient was placed over a blood drape-a disposable conical, graduated plastic collection bag. The amount of blood collected in the blood drape was measured. Then the patient was given pre-weighed pads, which were weighed 2 h post-partum. The blood loss was measured by measuring the blood collected in the drape and by weighing the swabs before and after delivery. The total number of patients studied was 100-equally distributed in both the groups. The age group of the patients and BMI were comparable. There was a significant increase in the pulse rate and decrease in blood pressure in the control group as compared with the study group. The post-delivery haemoglobin and haematocrit were significantly reduced in the control group as compared to the study group. The mean blood loss at the end of 2 h was 105 ml in the study group and 252 ml in the control group. There was a significant increase in the usage of uterotonics and also in the need for blood transfusion in the control group; 12 % of the patients in the control group had to stay for more than 3 days compared to 2 % in the study group. Tranexamic acid injection, an antifibrinolytic

Low-Dose Epinephrine Plus Tranexamic Acid Reduces Early Postoperative Blood Loss and Inflammatory Response: A Randomized Controlled Trial.

Science.gov (United States)

Zeng, Wei-Nan; Liu, Jun-Li; Wang, Fu-You; Chen, Cheng; Zhou, Qiang; Yang, Liu

2018-02-21

The reductions of perioperative blood loss and inflammatory response are important in total knee arthroplasty. Tranexamic acid reduced blood loss and the inflammatory response in several studies. However, the effect of epinephrine administration plus tranexamic acid has not been intensively investigated, to our knowledge. In this study, we evaluated whether the combined administration of low-dose epinephrine plus tranexamic acid reduced perioperative blood loss or inflammatory response further compared with tranexamic acid alone. This randomized placebo-controlled trial consisted of 179 consecutive patients who underwent primary total knee arthroplasty. Patients were randomized into 3 interventions: Group IV received intravenous low-dose epinephrine plus tranexamic acid, Group TP received topical diluted epinephrine plus tranexamic acid, and Group CT received tranexamic acid alone. The primary outcome was perioperative blood loss on postoperative day 1. Secondary outcomes included perioperative blood loss on postoperative day 3, coagulation and fibrinolysis parameters (measured by thromboelastography), inflammatory cytokine levels, transfusion values (rate and volume), thromboembolic complications, length of hospital stay, wound score, range of motion, and Hospital for Special Surgery (HSS) score. The mean calculated total blood loss (and standard deviation) in Group IV was 348.1 ± 158.2 mL on postoperative day 1 and 458.0 ± 183.4 mL on postoperative day 3, which were significantly reduced (p 0.05). The combined administration of low-dose epinephrine and tranexamic acid demonstrated an increased effect in reducing perioperative blood loss and the inflammatory response compared with tranexamic acid alone, with no apparent increased incidence of thromboembolic and other complications. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Radiochromium (chromium-51) evaluation of gastrointestinal blood loss associated with placebo, aspirin, and nabumetone

International Nuclear Information System (INIS)

Lussier, A.; LeBel, E.

1987-01-01

Gastrointestinal blood loss is one of the most serious clinical events induced by drugs. To date, almost no nonsteroidal anti-inflammatory drug has been shown to be devoid of that side effect in a strictly controlled study. The objective of this study was to assess quantitatively, by use of radioactive chromium (chromium-51)-labeled red blood cells, gastrointestinal blood loss associated with nabumetone (1000 mg daily), aspirin (3.6 g daily), and placebo. A total of 37 normal subjects, divided among the three treatment groups and a fourth group that received no treatment, were assessed clinically and quantitatively for gastrointestinal blood loss over a period of 28 days of active treatment. The results with chromium-51, analyzed on a logarithmic scale, revealed no statistically significant differences between the nabumetone, placebo, and control groups. Gastrointestinal blood loss in the aspirin group, however, was elevated when compared with all other groups at a high level of statistical significance (p less than 0.001). It is concluded that, under conditions in which aspirin causes substantial gastrointestinal microbleeding, nabumetone is not significantly different from placebo

Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery.

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Faverani, Leonardo Perez; Ramalho-Ferreira, Gabriel; Fabris, André Luis Silva; Polo, Tárik Ocon Braga; Poli, Guilherme Henrique Souza; Pastori, Cláudio Maldonado; Marzola, Clóvis; Assunção, Wirley Gonçalves; Garcia-Júnior, Idelmo Rangel

2014-09-01

Procedures for the surgical correction of dentofacial deformities may produce important complications, whether due to the potential for vascular injury or to prolonged surgery, both of which may lead to severe blood loss. Fluid replacement with crystalloid, colloid, or even blood products may be required. The aim of this study was to assess blood loss and transfusion requirements in 45 patients (18 males and 27 females; mean age 29.29 years, range 16-52 years) undergoing orthognathic surgery, assigned to one of two groups according to procedure type-rapid maxillary expansion or double-jaw orthognathic surgery. Preoperative hemoglobin and hematocrit levels and intraoperative blood loss were measured. There was a substantial individual variation in pre- and postoperative hemoglobin values (10.3-17 and 8.8-15.4 g/dL, respectively; p surgery and follow meticulous protocols to minimize the risks.

Accuracy of Blood Loss Measurement during Cesarean Delivery

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Doctorvaladan, Sahar V.; Jelks, Andrea T.; Hsieh, Eric W.; Thurer, Robert L.; Zakowski, Mark I.; Lagrew, David C.

2017-01-01

Objective?This study aims to compare the accuracy of visual, quantitative gravimetric, and colorimetric methods used to determine blood loss during cesarean delivery procedures employing a hemoglobin extraction assay as the reference standard. Study Design?In 50 patients having cesarean deliveries blood loss determined by assays of hemoglobin content on surgical sponges and in suction canisters was compared with obstetricians' visual estimates, a quantitative gravimetric method, and the blood...

Global Landslide Total Economic Loss Risk Deciles

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National Aeronautics and Space Administration — Global Landslide Total Economic Loss Risk Deciles is a 2.5 minute grid of global landslide total economic loss risks. A process of spatially allocating Gross...

Antioxidants Attenuate Oxidative Stress-Induced Hidden Blood Loss in Rats

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Hong Qian

2017-12-01

Full Text Available Objective: Hidden blood loss (HBL, commonly seen after total knee or hip arthroplasty, causes postoperative anemia even after reinfusion or blood transfusion based on the visible blood loss volume. Recent studies demonstrated that oxidative stress might be involved in HBL. However, whether the antioxidants proanthocyanidin (PA or hydrogen water (HW can ameliorate HBL remains poorly understood. The aim of this study was to evaluate the effects of PA and HW on HBL. Materials and Methods: A rat HBL model was established through administration of linoleic acid with or without treatment with PA or HW. The levels of hemoglobin (Hb, red blood cell (RBC count, superoxide dismutase (SOD activity, glutathione peroxidase (GSH-PX activity, malondialdehyde (MDA, and ferryl Hb were measured. Results: RBC and Hb values as well as the activity of SOD and GSH-PX were reduced after administration of linoleic acid, which was ameliorated by treatment with PA or HW. In addition, the quantity of MDA was significantly decreased with the administration of PA or HW. Conclusion: PA and HW could ameliorate HBL in a rat model by reducing oxidative stress, suggesting that they might be used as a novel therapeutic approach in the prophylaxis or treatment of HBL in clinics.

Global Drought Total Economic Loss Risk Deciles

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National Aeronautics and Space Administration — Global Drought Total Economic Loss Risk Deciles is a 2.5 minute grid of global drought total economic loss risks. A process of spatially allocating Gross Domestic...

Factors contributing to postpartum blood-loss in low-risk mothers through expectant management in Japanese birth centres.

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Eto, Hiromi; Hasegawa, Ayako; Kataoka, Yaeko; Porter, Sarah E

2017-08-01

To describe aspects of expectant midwifery care for low-risk women conducted in midwifery-managed birth centres during the first two critical hours after delivery and to compare differences between midwifery care, client factors and postpartum blood loss volume. As a secondary analysis from a larger study, this descriptive retrospective study examined data from birth records of 4051 women who birthed from 2001 to 2006 at nine (21%) of the 43 midwifery centres in Tokyo. Nonparametric and parametric analyses identified factors related to increased blood loss. Interviews to establish sequence of midwifery care were conducted. The midwifery centres provided care based on expectant management principles from birth to after expulsion of the placenta. Approximately 63.3% of women were within the normal limits of blood loss volume under 500g. A minority of women (12.9%) experienced blood loss between 500 and 800g and 4% had blood loss exceeding 1000g. Blood loss volume tended to increase with infant birth weight and duration of delivery. The total blood loss volume was significantly higher for primiparas than for multiparas during the critical two hours after delivery and for immediately after delivery, yet blood loss volume was significantly higher for multiparas than for primiparas during the first hour after delivery. Preventive uterine massage and umbilical cord clamping after placenta expulsion resulted in statistically significant less blood loss. Identified were two patterns of midwifery care based on expectant management principles from birth to after expulsion of the placenta. The practice of expectant management was not a significant factor for increased postpartum blood loss. These results detail specific midwifery practices and highlight the clinical significance of expectant management with low risk pregnant women experiencing a normal delivery. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Safe surgery: how accurate are we at predicting intra-operative blood loss?

LENUS (Irish Health Repository)

2012-02-01

Introduction Preoperative estimation of intra-operative blood loss by both anaesthetist and operating surgeon is a criterion of the World Health Organization\\'s surgical safety checklist. The checklist requires specific preoperative planning when anticipated blood loss is greater than 500 mL. The aim of this study was to assess the accuracy of surgeons and anaesthetists at predicting intra-operative blood loss. Methods A 6-week prospective study of intermediate and major operations in an academic medical centre was performed. An independent observer interviewed surgical and anaesthetic consultants and registrars, preoperatively asking each to predict expected blood loss in millilitre. Intra-operative blood loss was measured and compared with these predictions. Parameters including the use of anticoagulation and anti-platelet therapy as well as intra-operative hypothermia and hypotension were recorded. Results One hundred sixty-eight operations were included in the study, including 142 elective and 26 emergency operations. Blood loss was predicted to within 500 mL of measured blood loss in 89% of cases. Consultant surgeons tended to underestimate blood loss, doing so in 43% of all cases, while consultant anaesthetists were more likely to overestimate (60% of all operations). Twelve patients (7%) had underestimation of blood loss of more than 500 mL by both surgeon and anaesthetist. Thirty per cent (n = 6\\/20) of patients requiring transfusion of a blood product within 24 hours of surgery had blood loss underestimated by more than 500 mL by both surgeon and anaesthetist. There was no significant difference in prediction between patients on anti-platelet or anticoagulation therapy preoperatively and those not on the said therapies. Conclusion Predicted intra-operative blood loss was within 500 mL of measured blood loss in 89% of operations. In 30% of patients who ultimately receive a blood transfusion, both the surgeon and anaesthetist significantly underestimate

Acute normovolaemic haemodilution decreases postoperative allogeneic blood transfusion after total knee replacement.

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Olsfanger, D; Fredman, B; Goldstein, B; Shapiro, A; Jedeikin, R

1997-09-01

We hypothesized that the success of postoperative blood conservation after acute normovolaemic haemodilution (NVHD) is influenced by the extent of intraoperative bleeding and surgical trauma, and the timing of autologous blood transfusion. As total knee replacement is associated with minimal intraoperative but extensive postoperative blood loss, this procedure is ideally suited to acute NVHD. Therefore, to test our hypothesis, 30 patients undergoing elective total knee replacement were enrolled in a prospective, randomized, controlled study. In groups NVHD-2 and NVHD-6, before induction of anaesthesia patients were bled to a target packed cell volume (PCV) of 28-30%, and in the post-anaesthesia care unit autologous blood was transfused over a 2-h period terminating after operation at 2 and 6 h, respectively. In the control group, NVHD was not performed. After operation, platelets, fibrinogen, prothrombin and partial thromboplastin time, and liver function, urea and electrolytes were measured and compared with preoperative baseline values. Significantly (P conservation strategy. However, there was no difference in allogeneic blood administration between the two NVHD groups. Coagulation and liver function, and urea and electrolyte concentrations were unaffected by treatment.

Predicting operative blood loss during spinal fusion for adolescent idiopathic scoliosis.

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Ialenti, Marc N; Lonner, Baron S; Verma, Kushagra; Dean, Laura; Valdevit, Antonio; Errico, Thomas

2013-06-01

Patient and surgical factors are known to influence operative blood loss in spinal fusion for adolescent idiopathic scoliosis (AIS), but have only been loosely identified. To date, there are no established recommendations to guide decisions to predonate autologous blood, and the current practice is based primarily on surgeon preference. This study is designed to determine which patient and surgical factors are correlated with, and predictive of, blood loss during spinal fusion for AIS. Retrospective analysis of 340 (81 males, 259 females; mean age, 15.2 y) consecutive AIS patients treated by a single surgeon from 2000 to 2008. Demographic (sex, age, height, weight, and associated comorbidities), laboratory (hematocrit, platelet, PT/PTT/INR), standard radiographic, and perioperative data including complications were analyzed with a linear stepwise regression to develop a predictive model of blood loss. Estimated blood loss was 907±775 mL for posterior spinal fusion (PSF, n=188), 323±171 mL for anterior spinal fusion (ASF, n=124), and 1277±821 mL for combined procedures (n=28). For patients undergoing PSF, stepwise analysis identified sex, preoperative kyphosis, and operative time to be the most important predictors of increased blood loss (Ploss in PSF: blood loss (mL)=C+Op-time (min)×(6.4)-pre-op T2-T12 kyphosis (degrees)×(8.7), C=233 if male and -270 if female. We find sex, operative time, and preoperative kyphosis to be the most important predictors of increased blood loss in PSF for AIS. Mean arterial pressure and operative time were predictive of estimated blood loss in ASF. For posterior fusions, we also present a model that estimates blood loss preoperatively and can be used to guide decisions regarding predonation of blood and the use of antifibrinolytic agents. Retrospective study: Level II.

Decay in blood loss estimation skills after web-based didactic training.

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Toledo, Paloma; Eosakul, Stanley T; Goetz, Kristopher; Wong, Cynthia A; Grobman, William A

2012-02-01

Accuracy in blood loss estimation has been shown to improve immediately after didactic training. The objective of this study was to evaluate retention of blood loss estimation skills 9 months after a didactic web-based training. Forty-four participants were recruited from a cohort that had undergone web-based training and testing in blood loss estimation. The web-based posttraining test, consisting of pictures of simulated blood loss, was repeated 9 months after the initial training and testing. The primary outcome was the difference in accuracy of estimated blood loss (percent error) at 9 months compared with immediately posttraining. At the 9-month follow-up, the median error in estimation worsened to -34.6%. Although better than the pretraining error of -47.8% (P = 0.003), the 9-month error was significantly less accurate than the immediate posttraining error of -13.5% (P = 0.01). Decay in blood loss estimation skills occurs by 9 months after didactic training.

ROLE OF 400 MCG INTRAOPERATIVE SUBLINGUAL MISOPROSTOL FOR REDUCTION OF CAESAREAN BLOOD LOSS

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Lalmohan Nayak

2017-02-01

Full Text Available BACKGROUND Lower segment caesarean section is a common surgical procedure. Postpartum haemorrhage incidence after LSCS is 4%. Misoprostol is a prostaglandin E1 analogue with good uterotonic properties, easy availability, low cost, thermostability, long shelf life, easy administration and few adverse effects at therapeutic dose. It is readily absorbed by oral, sublingual, buccal, vaginal or rectal route. Sublingual route attains quickest concentration. Dose of 400 mcg was chosen in this study to minimise adverse effects with optimal therapeutic benefit. The aim of the study is to determine the efficacy of sublingual misoprostol in reducing caesarean blood loss. MATERIALS AND METHODS It is a prospective experimental study done in VSSIMSAR, Burla. Women undergoing LSCS were randomly assigned to study and control groups of equal strength of 100 each. In all cases, preoperative Hb%, haematocrit, pulse, BP was noted. Study group were given 400 mcg misoprostol at the time of cord clamping. In control group, nothing was given. In all patients, active management of third stage of labour was done by using oxytocin 10 IU (IV along with uterine massage. Blood loss soaked by tetra was calculated using formula, blood loss = wet weight-dry weight/1.05 (1.05 is constant. Amount of blood loss, postoperative Hb%, haematocrit, pulse rate, BP was noted in both groups and compared. BP and pulse were noted after 1 hour and Hb%, haematocrit were noted after 24 hours. RESULTS Study group showed significant decrease in total blood loss (around 117.9 mL as compared to control group. There was significant decrease in the postoperative fall in Hb in the study group as compared to control, the mean difference being 0.631 gm%. Study group also showed decrease in postoperative fall in haematocrit as compared to control, the mean difference being 0.055. CONCLUSION Misoprostol significantly reduced caesarean blood loss and doesn’t affect foetal outcome without significant

Effectiveness of tranexamic acid in reducing blood loss during cytoreductive surgery for advanced ovarian cancer.

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Kietpeerakool, Chumnan; Supoken, Amornrat; Laopaiboon, Malinee; Lumbiganon, Pisake

2016-01-23

placebo, given immediately before surgery for reducing blood loss and the need for red blood cell transfusion. The mean total estimated blood loss was 668.34 mL and 916.93 mL for participants assigned to tranexamic acid and placebo groups, respectively. The mean difference (MD) of total estimated blood loss between the groups did not show a clinically important effect (MD - 248.59 mL; 95% confidence interval (CI) - 550.9 to 53.79; one study, 100 participants; moderate quality evidence). The mean number of transfused units of blood components was not different between the two groups (low quality evidence). There were no noted differences in the incidence of reoperation, readmission or thromboembolic events (very low quality evidence). We considered the methodology of the included study to be at low risk of selection, detection, and reporting biases. However, we were concerned about an imbalance of some baseline characteristics between the groups, and as there was no protocol for blood transfusion, the rate of blood transfusion may vary depending on the practice of each participating hospital. Currently, there is insufficient evidence to recommend the routine use of tranexamic acid for reducing blood loss in women undergoing cytoreductive surgery for advanced EOC, as only limited data are available from a single, low quality RCT at low overall risk of bias.

Gastrointestinal blood loss induced by three different non-steroidal anti-inflammatory drugs.

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Bidlingmaier, A; Hammermaier, A; Nagyiványi, P; Pabst, G; Waitzinger, J

1995-04-01

A clinical study was performed on 18 healthy volunteers to compare the gastrointestinal daily blood loss induced by oral intake of three different non-steroidal anti-inflammatory drugs, lysine clonixinate (CAS 55837-30-4), ibuprofen (CAS 15687-27-1) and acetylsalicylic acid (CAS 50-78-2 ASA). For quantitative determination of gastrointestinal blood loss, autologous erythrocytes were radiolabelled in vitro with 51Cr and reinfused at study start. The amount of radioactivity excreted in faeces was measured during a placebo baseline phase of three days, a treatment phase of five days with thrice daily dosing of ASA, ibuprofen or lysine clonixinate and a subsequent wash-out phase of five days. The highest increase of mean daily blood loss over baseline was observed after treatment with ASA (+ 1.66 ml/d versus baseline). Treatment with ibuprofen led to an increase of mean daily blood loss by + 0.52 ml/d. During treatment with lysine clonixinate the mean increase of daily blood loss was +0.32 ml/d versus baseline. In the ibuprofen and lysine clonixinate treatment groups the values of mean daily blood loss decreased during the wash-out phase with respect to the verum phase, whereas the mean daily blood loss during the wash-out phase after treatment with ASA even increased in comparison to the verum phase (mean daily blood loss: +2.07 ml/d versus baseline.

[New non-volumetric method for estimating peroperative blood loss].

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Tachoires, D; Mourot, F; Gillardeau, G

1979-01-01

The authors have developed a new method for the estimation of peroperative blood loss by measurement of the haematocrit of a fluid obtained by diluting the blood from swabs in a known volume of isotonic saline solution. This value, referred to a monogram, may be used to assess the volume of blood impregnating the compresses, in relation to the pre-operative or present haematocrit of the patient, by direct reading. The precision of the method is discussed. The results obtained justified its routine application in surgery in children, patients with cardiac failure and in all cases requiring precise compensation of per-operative blood loss.

Evaluation of the use of shock index in identifying acute blood loss in healthy blood donor dogs.

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McGowan, Erin E; Marryott, Kimberly; Drobatz, Kenneth J; Reineke, Erica L

2017-09-01

To determine if shock index (SI) would increase following blood donation and if it would be a more sensitive assessment of acute blood loss as compared with heart rate (HR), blood pressure, and plasma lactate. Prospective study. University teaching hospital. Twenty client-owned clinically normal dogs. Peripheral venous blood measurements and blood donation. Data were collected at 3 time points: prior to donation (T pre ), immediately after donation (T 0 ), and 10 minutes following completion of donation (T 10 ). HR and systolic blood pressure (SBP) were recorded and used to calculate SI at time points T pre , T 0 , and T 10 . Packed cell volume (PCV), total plasma protein (TPP), and plasma lactate were evaluated from a peripheral venous blood sample at T pre and T 10. The mean SI was significantly increased at both time points following blood donation as compared to baseline (SI pre = 0.88 ± 0.19 vs SI 0 = 1.17 ± 0.21 vs SI 10 = 1.12 ± 0.25 (P = 0.0002 and 0.0003, respectively). Following blood donation, the mean SBP was significantly lower (SBP pre = 149 ± 24 mm Hg, SBP 0 = 118 ± 20 mm Hg; P = 0.0001, SBP 10 = 133 ± 21 mm Hg; P = 0.011). The mean HR was not significantly different at T 0 but was significantly increased at T 10 (HR pre = 128 ± 21/min, HR 0 = 136 ± 25/min, P = 0.193; HR 10 = 146 ± 29/min, P = 0.003). There was no significant difference in mean PCV (PCV pre = 50 ± 4%, PCV 10 = 48 ± 4%, P = 0.08). The mean TPP and plasma lactate were significantly different following donation but still within the reference interval (TPP pre = 6.8 ± 0.4 g/dL, TPP 10 = 6.4 ± 0.4 g/dL, P = 0.0014; Lac pre = 1.7 ± 0.7mmol/L, Lac 10 = 1.9 ± 0.8 mmol/L, P = 0.04). A receiver operating characteristic (ROC) analysis comparing area under the curve (AUC) for SI, HR, and SBP at T 0 and T 10 compared to T pre found that SI (AUC at T 0 : 0.858, CI: 0.730, 0.984 AUC at T 10 : 0.769 CI: 0.617, 0.921) was a better indicator of blood loss

The efficacy of bipolar sealer on blood loss in spine surgery: a meta-analysis.

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Lan, Tao; Hu, Shi-Yu; Yang, Xin-Jian; Chen, Yang; Qiu, Yi-Yan; Guo, Wei-Zhuang; Lin, Jian-Ze; Ren, Kai

2017-07-01

The purpose of this meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to gather data to evaluate the efficacy and safety of bipolar sealer versus standard electrocautery in the management of spinal disease. The electronic databases including Embase, PubMed and Cochrane library were searched to identify relevant studies published from the time of the establishment of these databases up to January 2017. The primary outcomes were total blood loss, requirement of transfusion (rate and amount), and operation time. The secondary outcomes were length of hospital stay and postoperative wound infection. Data analysis was conducted with RevMan 5.3 software. A total of five studies involving 500 patients (261 patients in the BS group and 239 in the control group) were included in the meta-analysis. The pooled results revealed that application of bipolar sealer could decrease the total blood loss in spine surgery [WMD = -467.49, 95% CI (685.47 to -249.51); p SMD = -0.36, 95% CI (-0.60 to -0.13), p infection [OR = 0.88, 95% CI (0.31-2.48), p = 0.81; I 2  = 0.0%] between both groups. The available evidence suggests that bipolar sealer is superior to standard electrocautery with less blood loss, shorter operation time and less transfusion requirement. There is no significant difference between both groups regarding length of hospitalization and wound infection. Hence, bipolar sealer is recommended in spine surgery. Because of the limitation of our study, more well-designed RCTs with large sample are required to provide further evidence of safety and efficacy between bipolar sealer and standard electrocautery in the treatment of spinal disease.

Postpartum Vaginal Blood Loss following Two Different Methods of Cervical Ripening

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Okon Asuquo Okon

2017-01-01

Full Text Available Eighty women undergoing induction of labor at the University of Calabar Teaching Hospital were recruited and randomly allocated into two treatment groups (40 each, to receive either serial 50 µg doses of misoprostol or intracervical Foley catheter. Vaginal blood loss was collected and measured using an under buttocks plastic collection bag and by perineal pad weighing up to 6 hours postpartum. There were no significant differences between the two groups with respect to sociodemographic and obstetric characteristics. Comparison of blood loss in vaginal deliveries between the two groups revealed that subjects in the misoprostol group had significantly higher blood loss than subjects in the Foley catheter group (488 ± 222 versus 326 ± 106, p<0.05. In both groups, there was strong and statistically significant positive correlation between postpartum blood loss and induction delivery interval (r=0.75, p<0.0001; r=0.77, p<0.0001. There were no significant differences in maternal outcomes. In view of this, further study is required to ascertain if lower doses of misoprostol for induction of labor may result in lesser blood loss. This trial is registered with ISRCTN14479515.

A phylogenetic approach to total evaporative water loss in mammals.

Science.gov (United States)

Van Sant, Matthew J; Oufiero, Christopher E; Muñoz-Garcia, Agustí; Hammond, Kimberly A; Williams, Joseph B

2012-01-01

Maintaining appropriate water balance is a constant challenge for terrestrial mammals, and this problem can be exacerbated in desiccating environments. It has been proposed that natural selection has provided desert-dwelling mammals physiological mechanisms to reduce rates of total evaporative water loss. In this study, we evaluated the relationship between total evaporative water loss and body mass in mammals by using a recent phylogenetic hypothesis. We compared total evaporative water loss in 80 species of arid-zone mammals to that in 56 species that inhabit mesic regions, ranging in size from 4 g to 3,500 kg, to test the hypothesis that mammals from arid environments have lower rates of total evaporative water loss than mammals from mesic environments once phylogeny is taken into account. We found that arid species had lower rates of total evaporative water loss than mesic species when using a dichotomous variable to describe habitat (arid or mesic). We also found that total evaporative water loss was negatively correlated with the average maximum and minimum environmental temperature as well as the maximum vapor pressure deficit of the environment. Annual precipitation and the variable Q (a measure of habitat aridity) were positively correlated with total evaporative water loss. These results support the hypothesis that desert-dwelling mammals have lower rates of total evaporative water loss than mesic species after controlling for body mass and evolutionary relatedness regardless of whether categorical or continuous variables are used to describe habitat.

Bipolar sealer device reduces blood loss and transfusion requirements in posterior spinal fusion for adolescent idiopathic scoliosis.

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Gordon, Zachary L; Son-Hing, Jochen P; Poe-Kochert, Connie; Thompson, George H

2013-01-01

Reducing perioperative blood loss and transfusion requirements is important in the operative treatment of idiopathic scoliosis. This can be achieved with special frames, cell saver systems, pharmacologic aspects, and other techniques. Recently there has been interest in bipolar sealer devices as an adjunct to traditional monopolar electrocautery. However, there is limited information on this device in pediatric spinal deformity surgery. We reviewed our experience with this device in a setting of a standard institutional operative carepath. Perioperative blood loss and transfusion requirements of 50 consecutive patients with adolescent idiopathic scoliosis undergoing a posterior spinal fusion and segmental spinal instrumentation and who had a bipolar sealer device used during their surgery was compared with a control group of the 50 preceding consecutive patients who did not. Anesthesia, surgical technique, use of intraoperative epsilon aminocaproic acid (Amicar), postoperative protocol, and indications for transfusions (hemoglobin≤7.0 g/dL) were identical in both groups. The preoperative demographics for the patients in both groups were statistically the same. The bipolar sealer group demonstrated a significant reduction in intraoperative estimated blood loss, total perioperative blood loss, volume of blood products transfused, and overall transfusion rate when compared with the control group. When subgroups consisting of only hybrid or all-pedicle screw constructs were considered individually, these findings remained consistent. There were no complications associated with the use of this device. Using the bipolar sealer device is a significant adjunct in decreasing perioperative blood loss and transfusion requirements in patients undergoing surgery for adolescent idiopathic scoliosis. Level III-retrospective comparative study.

Protein Losses and Urea Nitrogen Underestimate Total Nitrogen Losses in Peritoneal Dialysis and Hemodialysis Patients.

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Salame, Clara; Eaton, Simon; Grimble, George; Davenport, Andrew

2018-04-28

Muscle wasting is associated with increased mortality and is commonly reported in dialysis patients. Hemodialysis (HD) and peritoneal dialysis (PD) treatments lead to protein losses in effluent dialysate. We wished to determine whether changes in current dialysis practice had increased therapy-associated nitrogen losses. Cross-sectional cohort study. Measurement of total protein, urea and total nitrogen in effluent dialysate from 24-hour collections from PD patients, and during haemodiafiltration (HDF) and haemodialysis (HD) sessions. One hundred eight adult dialysis patients. Peritoneal dialysis, high-flux haemodialysis and haemodiafiltration. Total nitrogen and protein losses. Dialysate protein losses were measured in 68 PD and 40 HD patients. Sessional losses of urea (13.9 [9.2-21.1] vs. 4.8 [2.8-7.8] g); protein (8.6 [7.2-11.1] vs. 6.7 [3.9-11.1] g); and nitrogen (11.5 [8.7-17.7] vs. 4.9 [2.6-9.5] g) were all greater for HD than PD, P losses were lower with HD 25.9 (21.5-33.4) versus 46.6 (27-77.6) g/week, but nitrogen losses were similar. We found no difference between high-flux HD and HDF: urea (13.5 [8.8-20.6] vs. 15.3 [10.5-25.5] g); protein (8.8 [7.3-12.2] vs. 7.6 [5.8-9.0] g); and total nitrogen (11.6 [8.3-17.3] vs. 10.8 [8.9-22.5] g). Urea nitrogen (UN) only accounted for 45.1 (38.3-51.0)% PD and 63.0 (55.3-62.4)% HD of total nitrogen losses. Although sessional losses of protein and UN were greater with HD, weekly losses were similar between modalities. We found no differences between HD and HDF. However, total nitrogen losses were much greater than the combination of protein and UN, suggesting greater nutritional losses with dialysis than previously reported. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Do autologous blood transfusion systems reduce allogeneic blood transfusion in total knee arthroplasty?

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Pawaskar, Aditya; Salunke, Abhijeet Ashok; Kekatpure, Aashay; Chen, Yongsheng; Nambi, G I; Tan, Junhao; Sonawane, Dhiraj; Pathak, Subodhkumar

2017-09-01

To study whether autologus blood transfusion systems reduce the requirement of allogneic blood transfusion in patients undergoing total knee arthroplasty. A comprehensive search of the published literature with PubMed, Scopus and Science direct database was performed. The following search terms were used: (total knee replacement) OR (total knee arthroplasty) OR (TKA) AND (blood transfusion) OR (autologous transfusion) OR (autologous transfusion system). Using search syntax, a total of 748 search results were obtained (79 from PubMed, 586 from Science direct and 83 from Scopus). Twenty-one randomized control trials were included for this meta-analysis. The allogenic transfusion rate in autologus blood transfusion (study) group was significantly lower than the control group (28.4 and 53.5 %, respectively) (p value 0.0001, Relative risk: 0.5). The median units of allogenic blood transfused in study control group and control group were 0.1 (0.1-3.0) and 1.3 (0.3-2.6), respectively. The median hospital stay in study group was 9 (6.7-15.6) days and control group was 8.7 (6.6-16.7) days. The median cost incurred for blood transfusion per patient in study and control groups was 175 (85.7-260) and 254.7 (235-300) euros, respectively. This meta-analysis demonstrates that the use of auto-transfusion systems is a cost-effective method to reduce the need for and quantity of allogenic transfusion in elective total knee arthroplasty. Level I.

PREVENTION OF BLOOD LOSS IN THIRD STAGE OF LABOUR BY PLACENTAL BLOOD DRAINAGE- A CLINICAL STUDY

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B. K. Dutta

2017-12-01

Full Text Available BACKGROUND Placental cord drainage is a simple, safe and non-invasive method which reduces the duration and blood loss in the third stage of labour thereby preventing PPH. This method is of great use in day to day obstetric practices not requiring any extra effort, cost or equipment, so this type of practice is more relevant in rural areas. The objectives of the study were1. To evaluate the effectiveness of placental blood drainage via umbilical cord in reducing duration and blood loss in third stage of labour. 2. Reducing the incidence of postpartum haemorrhage. 3. Decreasing the complications in third stage of labour and reduce maternal mortality. MATERIALS AND METHODS This study was carried out in 100 full term pregnant women admitted in the labour room in Gauhati medical college and hospital in the department of obstetrics and gynaecology since 1st August 2007 to 30th August 2008. Cases were divided into two. Study group and control group. RESULTS In control group the average duration of third stage was 7.41 minutes and in study group 5.57 minutes and p value was <0.001 which is very highly significant. The blood loss in third stage of labour was more in case of control group, the mean blood loss in control was 169.48 ml and study group was 110.38 ml after delivery of placenta. The post-partum haemorrhage was present in 2% of cases in control group while in study group it was present in 0% case. CONCLUSION Placental blood drainage is one of the additional components in active management of third stage of labour, which is safe, simple and non-invasive method. It reduces the duration of third stage of labour, amount of blood loss and decreases the duration of placental separation time.

The effect of tranexamic acid on blood coagulation in total hip replacement arthroplasty: rotational thromboelastographic (ROTEM®) analysis.

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Na, H S; Shin, H J; Lee, Y J; Kim, J H; Koo, K H; Do, S H

2016-01-01

We evaluated changes in rotational thromboelastometry (ROTEM(®) ) parameters and clinical outcomes in patients undergoing total hip replacement arthroplasty, with concomitant infusions of tranexamic acid and of 6% hydroxyethyl starch 130/0.4. Fifty-five patients were randomly assigned to either the tranexamic acid (n = 29) or the control (n = 26) group. Hydroxyethyl starch was administered in the range of 10-15 ml.kg(-1) during the operation in both groups. In the control group, the clot formation time and maximum clot firmness of APTEM showed significant differences when compared with those of EXTEM at one hour postoperatively, suggestive of fibrinolysis. In the tranexamic acid group, there was no significant difference between each postoperative EXTEM and APTEM parameter. In the tranexamic acid and control group, postoperative blood loss was 308 ml (210-420 [106-745]) and 488 ml (375-620 [170-910], p = 0.002), respectively, and total blood loss was 1168 ml (922-1470 [663-2107]) and 1563 ml (1276-1708 [887-1494], p = 0.003). Haemoglobin concentration was higher in the tranexamic acid group on the second postoperative day (10.5 (9.4-12.1 [7.9-14.0]) vs. 9.6 (8.9-10.5[7.3-16.0]) g.dl(-1) , p = 0.027). In patients undergoing total hip replacement arthroplasty, postoperative fibrinolysis aggravated by hydroxyethyl starch was attenuated by co-administration of 10 mg.kg(-1) tranexamic acid, which may have led to less postoperative blood loss. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

A systematic review of the relationship between blood loss and clinical signs.

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Rodolfo Carvalho Pacagnella

Full Text Available INTRODUCTION: This systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage. METHODS: A systematic review of the literature was carried out using a comprehensive search strategy to identify studies presenting data on the relationship of clinical signs & symptoms and blood loss. Methodological quality was assessed using the STROBE checklist and the general guidelines of MOOSE. RESULTS: 30 studies were included and five were performed in women with pregnancy-related haemorrhage (other studies were carried in non-obstetric populations. Heart rate (HR, systolic blood pressure (SBP and shock index were the parameters most frequently studied. An association between blood loss and HR changes was observed in 22 out of 24 studies, and between blood loss and SBP was observed in 17 out of 23 studies. An association was found in all papers reporting on the relationship of shock index and blood loss. Seven studies have used Receiver Operating Characteristic Curves to determine the accuracy of clinical signs in predicting blood loss. In those studies the AUC ranged from 0.56 to 0.74 for HR, from 0.56 to 0.79 for SBP and from 0.77 to 0.84 for shock index. In some studies, HR, SBP and shock index were associated with increased mortality. CONCLUSION: We found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed.

Role of tranexamic acid in reducing blood loss during and after caesarean section

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Simran Kaur Bhatia

2015-01-01

Full Text Available Introduction: Association between caesarean section and intra operative and post operative bleeding is known. Post-partum hemorrhage is still a leading cause for maternal morbidity and mortality. This study will evaluate the efficacy and safety of tranexamic acid in reducing the blood loss after placental delivery following lower segment caesarean section (LSCS and note any adverse effects. Materials and Methods: A total of 100 women, who underwent elective or emergency primary caesarean section at term between 37 and 41 weeks have been studied prospectively. They were divided into two groups. In the study group of 50, tranexamic acid 1 gm IV was given 20 minutes before making incision for caesarean section and the control group of 50 did not receive tranexamic acid. Statistical Analysis: For quantitative outcomes, the t-test was used to test for difference in the two groups. For categorical outcomes, chi square and odds ratio with 95% confidence interval were used as applicable. Results: The patient characteristics, namely age, height, weight, gestational age and gravidity in two groups were similar which was statistically insignificant. Hemoglobin decreased slightly after birth in both groups but no statistical difference between two groups was noticed. There was no episode of thrombosis in the study. Tranexamic acid significantly reduced the quantity of the blood loss from time of placental delivery to 2 hours postpartum (P < 0.001 and from end of LSCS to 2 hours postpartum (P < 0.001. However, there was no statistical difference in quantity of blood loss from time of placental delivery to end of LSCS in both groups (P < 0.001. Conclusion: A safe dose of tranexamic acid has an effective role in reducing blood loss during LSCS without causing adverse reaction. Thus, drug can be used effectively in reducing maternal morbidity and mortality during LSCS.

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

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Umer Chaudhry Muhammad

2011-05-01

Full Text Available Abstract Background & Purpose Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery. Methodology This was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5% knees (group-I had received tranexamic acid (by surgeon preference while the remaining fifty-two patients with 66 (51.5% knees (group-II had did not received any tranexamic acid either pre- or post-operatively. Results The mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral and 2695 ml (bilateral. In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral and 1.94 gm/dl (bilateral, with a mean drainage of 826 ml (unilateral and 1288 ml (bilateral (p-value Interpretation Tranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.

The effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32 degrees C).

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Karski, J M; Dowd, N P; Joiner, R; Carroll, J; Peniston, C; Bailey, K; Glynn, M F; Teasdale, S J; Cheng, D C

1998-12-01

Prophylactic administration of tranexamic acid (TA), an antifibrinolytic agent, decreases bleeding after cardiac surgery with systemic hypothermia (25 degrees C to 29 degrees C). Warmer systemic temperatures during cardiopulmonary bypass (CPB) may reduce bleeding and thus alter the requirement for TA. The effect of three different doses of TA on bleeding after cardiac surgery with mild systemic hypothermia (32 degrees C) is evaluated. Double-blind, prospective, randomized study. University hospital. One hundred fifty adult patients undergoing aortocoronary bypass or valvular cardiac surgery. Patients received TA, 50 (n = 50), 100 (n = 50), or 150 (n = 50) mg/kg intravenously before CPB with mild systemic hypothermia. Blood loss through chest drains over 6, 12, and 24 hours after surgery and total hemoglobin loss were measured. Autotransfused blood, transfused banked blood and blood products, and coagulation profiles were measured. Analysis of variance on log-transformed data for blood loss and confidence intervals (CIs) of 0.95 were calculated and transformed to milliliters of blood. No patient was re-explored for bleeding. Blood loss at 6 hours was statistically greater in the 50-mg/kg group compared with the other two groups (p = 0.03; p = 0.02). Total hemoglobin loss was statistically greater in the 50-mg/kg group compared with the 150-mg/kg group (p = 0.04). There was no statistical difference in blood tranfusion rate or coagulation profiles among the three groups. However, preoperative hemoglobin level was statistically lower in the 150-mg/kg group compared with the other two groups (p = 0.01). Of the three doses of TA studied, the most efficacious and cost-effective dose to reduce bleeding after cardiac surgery with mild hypothermic systemic perfusion is 100 mg/kg.

Intraoperative blood loss in bimaxillary orthognathic surgery with multisegmental Le Fort I osteotomies and additional procedures.

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Kretschmer, W B; Baciut, G; Bacuit, Mihaela; Zoder, W; Wangerin, K

2010-06-01

Autologous blood donation is not currently recommended by most authors for routine bimaxillary osteotomies. There are few data about bimaxillary procedures with multisegmental maxillary osteotomies. Our aim was to investigate the effect of additional osteotomies and iliac crest grafts on operative blood loss. A total of 225 consecutive patients having bimaxillary multisegmental osteotomies during a three-year period (January 2006-January 2009) were examined to see if their haemoglobin concentration and packed cell volume were reduced. The influence of iliac crest grafts, additional osteotomies (genioplasty, malar osteotomy, iliac crest graft, anterior mandibular segmental osteotomy), operating time, age, and sex were assessed. Neither age nor sex influenced blood loss, whereas operating time correlated significantly with reductions in haemoglobin concentration and packed cell volume. Blood loss was significantly higher in the group who had additional procedures (p 0.001 for haemoglobin concentration and packed cell volume) than in the group who had no additional procedures, whereas there were no significant differences among the three subgroups who had additional procedures (additional osteotomies, iliac crest grafts, or both procedures). Four patients who had additional procedures required transfusion, whereas no blood was given in the group who had no additional procedures. Because the transfusion rate was so low, we could make no general recommendation for preoperative blood donation in such cases. Copyright 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Efficacy of drainage blood reinfusion in early postoperative period after total hip arthroplasty in patients with rheumatoid arthritis

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N B Shelokova

2008-01-01

Full Text Available To study effect of drainage blood reinfusion in early postoperative period (EPP after total hip arthroplasty (THA in patients with rheumatoid arthritis (RA. Material and methods. Primary THA was performed in 51 RA pts with hip damage (49 female, 2 male aged from 26 to 68 years. 42 THA were performed with “Endosystems and Implants” (ESI endoprosthesis, and 21 — with “Mathys” endoprosthesis. The pts were divided into two groups. Standard infusion-transfusion therapy with donor blood components was performed in group 1 pts (n=26 to compensate blood loss in EPP. In group 2 pts (n=25 drainage blood reinfusion was done with active aspiration system Handy Vac TM ATS (Unomedical. Group 1 pts had more prominent circulatory and neurologic disturbances in EPP: hypodynamic variant of circulation with elevation of peripheral vascular resistance till 5-7 day of postoperative period, prominent hypersympathicotonia and a large number of posttransfusion reactions. Evaluation of hemodynamic and vegetative disturbances showed advantage of blood loss compensation and vegetative disturbances normalization with drainage blood reinfusion in EPP after THA in comparison with standard pts management.

Total and antigen-specific Ige levels in umbilical cord blood

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Sybilski AJ

2009-12-01

Full Text Available Abstract The present study was conducted to learn whether the perinatal and environmental factors could influence the total and antigen-specific IgE levels in umbilical cord blood. Retrospective data were obtained from 173 mother-infant pairs. Total and specific (for children's food, wheat/grass and house dust mite-HDM cord blood IgE levels were determined using the immunoassay test. The total cord blood IgE was between 0.0-23.08 IU/ml (mean 0.55 ± 2.07 IU/ml; median 0.16 IU/ml. Total IgE levels were significantly higher in boys compared with girls (OR = 2.2; P = 0.007, and in newborns with complicated pregnancy (OR = 2.7; P = 0.003. A greater number of siblings correlated with increases in the total cord blood IgE (P

The use of torniquet to reduce blood loss at myomectomy.

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Ikechebelu, J I; Ezeama, C O; Obiechina, N J A

2010-06-01

Fibroids remain the commonest pelvic tumour seen in women with myomectomy being the major form of treatment in our environment. Techniques to minimize blood loss will reduce patient morbidity and the need for blood transfusions. One such technique is the use of a tourniquet during myomectomy operation. This study examines the effectiveness and safety this tourniquet technique. A comparative analysis of the blood loss, transfusion rate and the morbidities associated with the use and non-use of a tourniquet during myomectomy operation at Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria was undertaken. The Foley's urethral catheter was adapted as a uterine tourniquet and applied as low as possible at the base of the uterus before enucleating the fibroid masses. The patients who had their myomectomy performed with application of a tourniquet [tourniquet group] and those without [no-tourniquet group] were evenly matched for age, parity and presenting symptoms. The overall mean age of patients was 35.7 +/- 6.1 years and parity was 0.40 +/- 1.25. The main presenting symptoms of the patients were lower abdominal mass 65.6%, menorrhagia 38.7%, infertility 33.3%, abdominal pain 19.4% and dysmenorrhoea 14.0%. There was a statistically significant difference [P < 0.001] in mean blood loss for the no-tourniquet group [756.4 +/- 285.7] and the tourniquet group [515.7 +/- 292.8] as well as the mean blood transfusion rate in no-tourniquet group [1.0 units +/- 1.14] and the tourniquet group [0.24 units +/- 0.51]. However there was no significant difference between the two groups with respect to complication profile. The Foley's catheter form of tourniquet is cheap, safe, effectively reduces blood loss during myomectomy and significantly reduces transfusion rate while not adding to the complications due to the operation.

Occupational Noise Exposure, Bilateral High-Frequency Hearing Loss, and Blood Pressure.

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Gan, Wen Qi; Mannino, David M

2017-11-13

The aim of this study was to investigate the relationships between occupational noise exposure and blood pressure using self-reported occupational exposure and bilateral high-frequency hearing loss. This study included 4548 participants aged 20 to 69 years from the National Health and Nutrition Examination Survey 1999 to 2004. On the basis of self-reported exposure status, participants were divided into the current, former, or never exposed groups. Bilateral high-frequency hearing loss was defined as the average high-frequency hearing threshold at least 25 dB in both ears. The currently exposed participants had slightly increased diastolic blood pressure compared with those never exposed. Among previously exposed participants, those with bilateral high-frequency hearing loss had increased systolic blood pressure, heart rate, and the prevalence of hypertension compared with those with normal high-frequency hearing. Although there were some significant results, the evidence was not consistent to support the associations between occupational noise exposure and blood pressure.

Fibrin sealants or cell saver eliminate the need for autologous blood donation in anemic patients undergoing primary total knee arthroplasty.

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Bou Monsef, Jad; Buckup, Johannes; Waldstein, Wenzel; Cornell, Charles; Boettner, Friedrich

2014-01-01

Reducing allogeneic blood transfusions remains a challenge in total knee arthroplasty. Patients with preoperative anemia have a particularly high risk for perioperative blood transfusions. 176 anemic patients (Hb < 13.5 g/dl) undergoing total knee replacement were prospectively evaluated to compare the effect of a perioperative cell saver (26 patients), intraoperative fibrin sealants (5 ml Evicel, Johnson & Johnson Wound Management, Ethicon, Somerville, NJ) (45 patients), preoperative autologous blood donation (PABD) (21 patients), the combination of fibrin sealants and preoperative autologous blood donation (44) and no intervention (40 patients) on perioperative blood loss and transfusion requirements. All protocols resulted in significant reduction of allogeneic blood transfusions. Transfusion rates were similar with the use of PABD (19%), Evicel (18%), and cell saver (19%), all significantly lower than the control group (38 %, p < 0.05). Combining Evicel with PABD resulted in significantly higher wastage of autologous units (p < 0.05) with no significant reduction in allogeneic transfusion rate (14%). The use of fibrin sealant resulted in a significant reduction of blood loss compared to the PABD group (603 vs. 810 ml, p < 0.005) as well as the control group (603 vs. 822 ml, p < 0.005). While PABD proved to be the most cost-effective treatment option in anemic patients, fibrin sealants and cell saver show similar reduction in allogeneic transfusion rates compared to controls. The combination of fibrin sealants and PABD is not cost-effective and increases the number of wasted units.

Use of Tranexamic Acid during Total Endoprosthetic Replacement of the Hip Joint

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D. D. Selivanov

2010-01-01

Full Text Available Objective: to evaluate the blood-saving activity, efficacy, and safety of tranexamic acid. Subjects and methods. Thirty-seven patients allocated into two groups were enrolled in the study of the efficacy of tranexamic acid as an agent in reducing blood loss during hip joint replacement. Group 2 patients were injected tranexamic acid, 10 mg/kg body weight, 20—30 minutes before and 3 hours after surgery in the same dosage. This resulted in a significant (48.5% reduction in total blood loss (from 1089.6 to 560.8 ml (p<0.05. No tranexamic acid-induced complications were found. The administration of tranexamic acid during total endoprosthetic replacement of the hip joint could reduce blood loss by 35 and 59.4% in the intraoperative and postoperative periods, respectively, and total blood loss by 48.4%. The use of tranexamic acid allows one to refuse transfusion of blood components during total endoprosthetic replacement of the hip joint. Key words: hip joint replacement, blood loss, tranexamic acid.

Human local and total heat losses in different temperature.

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Wang, Lijuan; Yin, Hui; Di, Yuhui; Liu, Yanfeng; Liu, Jiaping

2016-04-01

This study investigates the effects of operative temperature on the local and total heat losses, and the relationship between the heat loss and thermal sensation. 10 local parts of head, neck, chest, abdomen, upper arm, forearm, hand, thigh, leg and foot are selected. In all these parts, convection, radiation, evaporation, respiration, conduction and diffusion heat losses are analyzed when operative temperature is 23, 28, 33 and 37 °C. The local heat losses show that the radiation and convection heat losses are mainly affected by the area of local body, and the heat loss of the thigh is the most in the ten parts. The evaporation heat loss is mainly affected by the distribution of sweat gland, and the heat loss of the chest is the most. The total heat loss of the local body shows that in low temperature, the thigh, leg and chest have much heat loss, while in high temperature, the chest, abdomen, thigh and head have great heat loss, which are useful for clothing design. The heat losses of the whole body show that as the operative temperature increases, the radiation and convection heat losses decrease, the heat losses of conduction, respiration, and diffusion are almost constant, and the evaporation heat loss increases. By comparison, the heat loss ratios of the radiation, convection and sweat evaporation, are in agreement with the previous researches. At last, the formula about the heat loss ratio of convection and radiation is derived. It's useful for thermal comfort evaluation and HVAC (heating, ventilation and air conditioning) design. Copyright © 2016 Elsevier Inc. All rights reserved.

Fecal blood loss in patients with colonic polyps: a comparison of measurements with 51chromium-labeled erythrocytes and with the Haemoccult test

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Herzog, P.; Holtermueller, K.H.; Preiss, J.; Fischer, J.; Ewe, K.; Schreiber, H.J.; Berres, M.

1982-01-01

The quantitative determinations of fecal daily blood loss after intravenous administration of 51 Cr-labeled erythrocytes in 44 patients with colonic polyps and in 11 controls were compared with the results of the daily performed Haemoccult test without dietary restrictions. A total of 642 stool specimens was analyzed for 51 Cr loss and the Haemoccult test. The mean fecal daily blood loss in the 34 patients with adenomatous polyps of the descending colon and rectosigmoid was 1.36 +/- 0.14 ml/day (mean +/- SEM), in the 10 patients with polyps of the ascending and transverse colon it was 1.28 +/- 0.31 ml/day, and in the 11 controls 0.62 +/- 0.07 ml/day. There was no positive Haemoccult test in the controls. In fecal specimens from patients with polyps in the descending colon and rectosigmoid containing 2.0-3.99 ml blood/day, the Haemoccult-test was positive in 86%. Fecal specimens from patients with polyps in the ascending colon and transverse colon containing equal blood loss yielded a positive Haemoccult test result in 26%. Thus, the positivity of the Haemoccult test is determined by the fecal daily blood loss and the anatomic location of colonic bleeding sites

Exploring the relationship of peripheral total bilirubin, red blood cell, and hemoglobin with blood pressure during childhood and adolescence.

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Chen, Xiao-Tian; Yang, Song; Yang, Ya-Ming; Zhao, Hai-Long; Chen, Yan-Chun; Zhao, Xiang-Hai; Wen, Jin-Bo; Tian, Yuan-Rui; Yan, Wei-Li; Shen, Chong

2017-11-04

Total bilirubin is beneficial for protecting cardiovascular diseases in adults. The authors aimed to investigate the association of total bilirubin, red blood cell, and hemoglobin levels with the prevalence of high blood pressure in children and adolescents. A total of 3776 students (aged from 6 to 16 years old) were examined using cluster sampling. Pre-high blood pressure and high blood pressure were respectively defined as the point of 90th and 95th percentiles based on the Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Both systolic and diastolic blood pressure were standardized into z-scores. Peripheral total bilirubin, red blood cell and hemoglobin levels were significantly correlated with age, and also varied with gender. Peripheral total bilirubin was negatively correlated with systolic blood pressure in 6- and 9-year-old boys, whilst positively correlated with diastolic blood pressure in the 12-year-old boys and 13- to 15-year-old girls (p0.05). Total bilirubin could be weakly correlated with both systolic and diastolic blood pressure, as correlations varied with age and gender in children and adolescents; in turn, the increased levels of red blood cell and hemoglobin are proposed to be positively associated with the prevalence of high blood pressure. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

[Case-control study on effect of rivaroxaban on the risk of hidden bleeding after total hip arthroplasty].

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Li, Jun; Jing, Jue-Hua; Shi, Zhan-Jun; Zhou, Yun

2014-01-01

To investigate the risk of hidden blood loss about applying rivaroxaban after total hip arthroplasty. From October 2009 to May 2012,88 patients with femoral head necrosis were treated with primary total hip arthroplasty. All the patients were divided into Rivaroxaban group(44 cases)and control group(44 cases). There were 25 males and 19 females in the Rivaroxaban group, with an average age of (58.48 +/- 15.19) years old; in the control group,24 patients were male and 20 patients were female, with an average age of (61.11 +/- 13.54) years old. The patients in the Rivaroxaban group took Rivaroxaban orally from the first day after operation with a dose of 10 mg each day, and treatment course was 14 days. The patients in the control group took placebo orally at the same time. Dominant blood loss and transfusion were recorded, blood routine examinations were taken before operation and at 3 days after operation. The total blood loss and hidden blood loss were calculated according to the formula. The mean total blood loss was (1509.56 +/- 325.23) ml and the hidden blood loss was(581.47 +/- 215.01) ml, accounting for (37.88 +/- 10.42)% in the Rivaroxaban group. The mean total blood loss was (1262.30 +/- 397.95) ml and the hidden blood loss was (395.59 +/- 97.33) ml, accounting for (30.62 +/- 0.20)% in the control group. The total blood loss, hidden blood loss and transfusion in the Rivaroxaban group was significantly more than those in control group,b ut there was no significant difference on dominant blood loss between two groups. Rivaroxaban increased the overall bleeding risk of total hip arthroplasty, especially hidden bleeding risk, which should be careful used.

Role of Local Infiltration of Tranexamic Acid in Reducing Blood Loss in Peritrochanteric Fracture Surgery in the Elderly Population

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Virani SR

2016-11-01

Full Text Available Introduction: Peritrochanteric fractures are common injuries occurring in elderly patients. Surgeries for these fractures are associated with significant blood loss. Intravenous tranexamic acid has a proven track record in many orthopaedic surgeries including trauma, arthroplasty and spine surgeries. Objective: To study the effect of local subfascial and intramuscular infiltration of tranexamic acid in reducing blood loss and the requirement for blood transfusion in intertrochanteric fracture surgery. Study Design: Single centre prospective analytical study. Materials and Methods: One hundred and thirty seven patients above 65 years of age were included in the study, divided into two groups: the intervention group received subfascial and intramuscular infiltration of 2g tranexamic acid before wound closure and the control group of alternate patients did not receive any tranexamic acid infiltration. The postoperative drain output was recorded, as well as the haemoglobin level and the patients needing blood transfusion. Results and Conclusions: The preoperative and postoperative haemoglobin values were recorded. The mean preoperative haemoglobin was 10.9% and 10.8% (p=0.79 in the trial and control groups respectively. The mean postoperative haemoglobin was 9.5gm% and 9.2gm% (p=0.36 in the two groups. The total postoperative blood loss in the tranexamic acid group and the control group was 190.3ml and 204.3ml respectively (p=0.25. Ten patients (14.9% in the intervention group and 12 patients (17.1% in the control group required blood transfusion. We conclude that tranexamic acid does not play a significant role in reducing postoperative blood loss and blood transfusion when used locally in peritochanteric fracture surgery. However a larger double blinded study comparing various modalities of use of tranexamic acid is needed to conclusively establish its role.

Measuring Post-Partum Haemorrhage in Low-Resource Settings: The Diagnostic Validity of Weighed Blood Loss versus Quantitative Changes in Hemoglobin.

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Esther Cathyln Atukunda

Full Text Available Accurate estimation of blood loss is central to prompt diagnosis and management of post-partum hemorrhage (PPH, which remains a leading cause of maternal mortality in low-resource countries. In such settings, blood loss is often estimated visually and subjectively by attending health workers, due to inconsistent availability of laboratory infrastructure. We evaluated the diagnostic accuracy of weighed blood loss (WBL versus changes in peri-partum hemoglobin to detect PPH.Data from this analysis were collected as part of a randomized controlled trial comparing oxytocin with misoprostol for PPH (NCT01866241. Blood samples for complete blood count were drawn on admission and again prior to hospital discharge or before blood transfusion. During delivery, women were placed on drapes and had pre-weighed sanitary towels placed around their perineum. Blood was then drained into a calibrated container and the sanitary towels were added to estimate WBL, where each gram of blood was estimated as a milliliter. Sensitivity, specificity, negative and positive predictive values (PPVs were calculated at various blood volume loss and time combinations, and we fit receiver-operator curves using blood loss at 1, 2, and 24 hours compared to a reference standard of haemoglobin decrease of >10%.A total of 1,140 women were enrolled in the study, of whom 258 (22.6% developed PPH, defined as a haemoglobin drop >10%, and 262 (23.0% had WBL ≥500mL. WBL generally had a poor sensitivity for detection of PPH (85% in high prevalence settings when WBL exceeds 750mL.WBL has poor sensitivity but high specificity compared to laboratory-based methods of PPH diagnosis. These characteristics correspond to a high PPV in areas with high PPH prevalence. Although WBL is not useful for excluding PPH, this low-cost, simple and reproducible method is promising as a reasonable method to identify significant PPH in such settings where quantifiable red cell indices are unavailable.

The effect of prophylactic intravenous tranexamic acid on blood loss after vaginal delivery in women at low risk of postpartum haemorrhage: a double-blind randomised controlled trial.

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Mirghafourvand, Mojgan; Mohammad-Alizadeh, Sakineh; Abbasalizadeh, Fatemeh; Shirdel, Mina

2015-02-01

To determine the effect of prophylactic tranexamic acid (TA) on calculated and measured blood loss after vaginal delivery in women at low risk of postpartum haemorrhage. In this double-blind randomised controlled trial, 120 women with a singleton pregnancy were randomly allocated to receive either one gram intravenous TA or placebo in addition to 10 IU oxytocin after delivery of the fetus. Calculated blood loss was determined based on haematocrit before delivery and 12-24 h postdelivery. The quantity of blood loss was measured during two time periods: from delivery of the fetus to placental expulsion and from placental expulsion to the end of the second hour after childbirth. The mean (SD) calculated total blood loss (519 (320) vs 659 (402) mL, P = 0.036) and measured blood loss from placental delivery to 2 h postpartum (69 (39) vs 108 (53) mL, P  1000 mL was lower in the TA group (7% vs 18%, P = 0.048). Prophylactic TA reduces blood loss after vaginal delivery in women with a low risk of postpartum haemorrhage. The prophylactic use of TA may reduce blood loss complications and enhance maternal health. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Blood Loss in Surgery for Aggressive Vertebral Haemangioma with and without Embolisation

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Robinson, Yohan; Sheta, Reda; Salci, Konstantin; Willander, Johan

2015-01-01

Despite their benign nature some symptomatic aggressive vertebral haemangiomas (AVH) require surgery to decompress spinal cord and/or stabilise pathological fractures. Preoperative embolisation may reduce the considerable blood loss during surgical decompression. This systematic review investigated whether preoperative embolisation reduced surgical blood loss during treatment of symptomatic AVH. PubMed Medline, Web of Science, and Ovid Medline were searched for case reports and clinical studi...

Total hepatofugal portal blood flow in cirrhosis demonstrated by transhepatic portography

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Burcharth, F; Aagaard, J

1988-01-01

We investigated 108 patients with cirrhosis of the liver and portal hypertension by percutaneous transhepatic portography to demonstrate the occurrence and frequency of total hepatofugal portal blood flow. Sixteen patients (14.8%) had a total hepatofugal portal blood flow. The aetiology of portal hypertension and the portal pressure did not differ from that in the group of patients with hepatopetal portal blood flow. A significantly higher percentage of patients in the group with hepatofugal flow had gastro-oesophageal varices (P < 0.025). All patients with varices had bled. Half of the patients in the group with hepatofugal blood flow had a false splenoportographic diagnosis of portal vein thrombosis. In conclusion, total hepatofugal postal blood flow exists more often than hitherto assumed. Hepatofugal blood flow does not relieve portal hypertension nor prevent development of gastro-oesophageal varices or bleeding.

Comparative Aspects of the Regulation of Cutaneous and Cerebral Microcirculation During Acute Blood Loss

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I. A. Ryzhkov

2017-01-01

Full Text Available Objective. Using laser Doppler flowmetry (LDF and wavelet-analysis of microvascular blood flow oscillations to determine the features of regulation of cutaneous and cerebral microhemocirculation at early stages of acute fixed volume blood loss.Materials and methods.Experiments were carried out on 31 male outbred rats weighing 300 g to 400 g. The animals were anesthetized by intraperitoneal injection of pentobarbital (45 mg/kg. The tail artery was catheterized for invasive measurement of mean blood pressure (BP and blood withdrawal. The LDF method (ЛАКК-02 device, LAZMA, Russia was used to record microvascular blood flow simultaneously in the right ear and the pial vessels of the left parietal region. An acute fixed-volume hemorrhage model was used. The target blood loss volume was 30% of the total blood volume (TBV. Within 10 minutes after the end of hemorrhage (posthemorrhagic period, the blood pressure and the LDF-gram were recorded. The following LDF-gram parameters were analyzed: the mean value of IP; the maximum amplitude of blood flow oscillations (Amax and the corresponding frequency (Fmax in the frequency band 0.01—0.4 Hz. Statistical processing of the data was performed using Statistica 7.0.Results. At baseline, the values of IP, Аmax and Fmax in the brain were higher than in the skin. At posthemorrhagic period, BP decreased, on average, from 105 to 41 mm Hg. Against this background, IP in the skin decreased by 65%, while in the brain it reduced only by 17%, as compared with the baseline values (P0,0001. In the same time these organs were characterized by a unidirectional dynamics of patterns of fluxmotion. In both investigated organs, Amax increased sharply, and Fmax decreased. In posthemorrhagic period, fluxmotion not only «slowed down», but was also synchronized in a relatively narrow frequency band: for the skin Fmax was about 0.04 Hz (at the border of the endothelial and neurogenic band, for the brain about 0.09 Hz

Coagulation competence and fluid recruitment after moderate blood loss in young men

DEFF Research Database (Denmark)

Zaar, Morten; Mørkeberg, Jakob; Pott, Frank C

2014-01-01

The coagulation system is activated by a reduction of the central blood volume during orthostatic stress and lower body negative pressure suggesting that also a blood loss enhances coagulation. During bleeding, however, the central blood volume is supported by fluid recruitment to the circulation...

Influence of sibutramine in addition to diet and exercise on the relationship between weight loss and blood glucose changes

DEFF Research Database (Denmark)

Kamil, S; Finer, N; James, W P T

2017-01-01

on glycemic control. METHODS AND RESULTS: 8192 obese patients with diabetes were randomized to sibutramine or placebo plus diet and exercise after a preliminary 6 weeks in which all patients received sibutramine. Patients were classified into four groups of weight change. A total of 1582 patients had a weight...... loss induced by sibutramine, diet, and exercise attenuates falls in blood glucose levels and HbA1c compared with similar weight loss with placebo, diet and exercise....

Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial.

Science.gov (United States)

Romanò, Carlo L; Monti, Lorenzo; Logoluso, Nicola; Romanò, Delia; Drago, Lorenzo

2015-11-01

The aim of the present study was to assess the efficacy of a thrombin-based topical haemostatic in reducing blood requirements after total knee replacement (TKR) revision surgery. This prospective, randomized, controlled study was designed to evaluate the haemostatic efficacy and safety of a thrombin-based topical haemostatic (Floseal) versus standard treatment in patients receiving total knee revision arthroplasty. The decrease in haemoglobin values postsurgery and the blood units transfused were recorded. The decision to transfuse was made by a surgeon blinded to the patient's group allocation. Forty-eight patients were enroled in the study; twenty-four patients each were randomized to the treatment and control groups, respectively. The median decrease in haemoglobin concentration on the first postoperative day was 2.2 g/dL in the treatment group and 2.7 g/dL in the control group. A significant reduction in units of blood transfused was also observed in the treatment group compared with the control group [1.1 ± 1.13 (range 0-4) vs. 1.9 ± 1.41 (range 0-5) blood units; P = 0.04]. No major treatment-related adverse events were recorded in the study. This study shows that a thrombin-based topical haemostatic reduces the need for blood transfusion in TKR revision surgery. A thrombin-based topical haemostatic agent can be an appropriate solution to enhance haemostasis and vessel sealing at the operative site in TKR revision surgery, in order to reduce the need for blood transfusion after surgery. II.

FACTORS AFFECTING BLOOD LOSS DURING OpEN REDUCTION ...

African Journals Online (AJOL)

The use of diathermy and positioning of the patient in a way that encourages free venous drainage at the operative site (1) is a practical and inexpensive way of minimising blood loss during surgery. The operative site should be a little above the level of the heart (1). Good anaesthetic technique reduces episodes of.

Intrathoracic Pressure Regulator for Blood Loss

Science.gov (United States)

2016-05-24

hepatitis A antibody, and human immunodeficiency virus antibody), urine tests (drug screen I-abuse, marijuana, and a pregnancy test), and a 12-lead... sodium chloride; 250 mL over 2.5 minutes) were administered if systolic BP < 85 mmHg. Blood pressure, other hemodynamics, UO, and total amount of

Comparative changes in monthly blood urea nitrogen, total protein ...

African Journals Online (AJOL)

The objective of this study was to determine the comparative changes in the monthly blood urea nitrogen (BUN) concentration, total protein (TP) concentration in blood serum and the body condition score of Nguni cows and heifers raised on sweetveld. Twenty-four clinically healthy animals in different parities, namely Parity ...

Can Tranexamic Acid Reduce Blood Loss during Major Cardiac Surgery? A Pilot Study.

Science.gov (United States)

Compton, Frances; Wahed, Amer; Gregoric, Igor; Kar, Biswajit; Dasgupta, Amitava; Tint, Hlaing

2017-09-01

We examined the effectiveness of tranexamic acid in preventing intraoperative blood loss during major cardiac surgery. Out of initial 81 patients undergoing major cardiac surgery (both coronary artery bypass and valve repair procedures) at our teaching hospital, sixty-seven patients were selected for this study. We compared estimated blood loss, decrease in percent hemoglobin and hematocrit following surgery between two groups of patients (none of them received any blood product during surgery), one group receiving no tranexamic acid (n=17) and another group receiving tranexamic acid (n=25). In the second study, we combined these patients with patients receiving modest amounts of blood products (1-2 unit) and compared these parameters between two groups of patients (25 patients received no tranexamic acid, 42 patients received tranexamic acid). In patients who received no blood product during surgery, those who received no tranexamic acid showed statistically significant (independent t-test two tailed at p tranexamic acid (mean: 987.2 mL, SD: 459.9, n=25). We observed similar results when the patients receiving no blood products and patients receiving modest amount of blood products were combined based on the use of tranexamic acid or not. No statistically significant difference was observed in percent reduced hemoglobin or hematocrit following surgery in any group of patients. We conclude that intraoperative antifibrinolytic therapy with tranexamic acid does not reduce intraoperative blood loss during major cardiac surgery which contradicts popular belief. © 2017 by the Association of Clinical Scientists, Inc.

Prothrombin complex concentrate in the reduction of blood loss during orthotopic liver transplantation: PROTON-trial

NARCIS (Netherlands)

F. Arshad (Freeha); B. Ickx (Brigitte); R.T. van Beem (Rachel); W.G. Polak (Wojciech); F. Grüne (Frank); F. Nevens (Frederik); M. Ilmakunnas (Minna); A.M. Koivusalo (Anna-Maria); H. Isoniemi (Helena); P.F.W. Strengers; H.J.M. Groen (Henk); H.G.D. Hendriks (Herman); T. Lisman (Ton); J. Pirenne (Jacques); R.J. Porte (Robert)

2013-01-01

textabstractBackground: In patients with cirrhosis, the synthesis of coagulation factors can fall short, reflected by a prolonged prothrombin time. Although anticoagulants factors are decreased as well, blood loss during orthotopic liver transplantation can still be excessive. Blood loss during

Prothrombin complex concentrate in the reduction of blood loss during orthotopic liver transplantation : PROTON-trial

NARCIS (Netherlands)

Arshad, Freeha; Ickx, Brigitte; van Beem, Rachel T.; Polak, Wojciech; Grune, Frank; Nevens, Frederik; Ilmakunnas, Minna; Koivusalo, Anna-Maria; Isoniemi, Helena; Strengers, Paul F. W.; Groen, Henk; Hendriks, Herman G. D.; Lisman, Ton; Pirenne, Jacques; Porte, Robert J.

2013-01-01

Background: In patients with cirrhosis, the synthesis of coagulation factors can fall short, reflected by a prolonged prothrombin time. Although anticoagulants factors are decreased as well, blood loss during orthotopic liver transplantation can still be excessive. Blood loss during orthotopic liver

Hydroxyethyl Starch Reduces Coagulation Competence and Increases Blood Loss During Major Surgery

DEFF Research Database (Denmark)

Rasmussen, Kirsten C; Johansson, Pär I; Højskov, Michael

2014-01-01

OBJECTIVE: This study evaluated whether administration of hydroxyethyl starch (HES) 130/0.4 affects coagulation competence and influences the perioperative blood loss. BACKGROUND: Artificial colloids substitute blood volume during surgery; with the administration of HES 130/0.4 (Voluven, Fresenius...

Total hepatofugal portal blood flow in cirrhosis demonstrated by transhepatic portography

International Nuclear Information System (INIS)

Burcharth, F.; Aagaard, J.; Herlev Hospital

1988-01-01

We investigated 108 patients with cirrhosis of the liver and portal hypertension by percutaneous transhepatic portography to demonstrate the occurrence and frequency of total hepatofugal portal blood flow. Sixteen patients (14.8%) had a total hepatofugal portal blood flow. The aetiology of portal hypertension and the portal pressure did not differ from that in the group of patients with hepatopetal portal blood flow. A significantly higher percentage of patients in the group with hepatofugal flow had gastro-oesophageal varices (P [de

Effect of antifibrinolytic drugs on transfusion requirement and blood loss during orthotopic liver transplantation: Results from a single center

Directory of Open Access Journals (Sweden)

Devi A

2008-01-01

Full Text Available Background: During orthotopic liver transplantation (OLT, activation of the fibrinolytic system can contribute significantly to perioperative bleeding. Prophylactic administration of antifibrinolytic agents has been shown to reduce blood loss and the need for allogenic transfusion. Objective: To study the effect of antifibrinolytics on requirement of blood components, blood loss and operative time during OLT in patients with end stage liver disease, reporting to a single centre. Materials and Methods: Consecutive patients who underwent OLT at this centre during the period February 2003-October 2007 were the subjects of this study. Based on the individual anesthesiologist′s preference, patients were assigned to receive either two million units of aprotinin (AP as a bolus followed by 5,00,000 units/hour or 10 mg/kg tranexamic acid (TAas a bolus followed by 10 mg/kg every six to eight hours, administered from the induction till the end of the surgery. Transfusion policy was standardized in all patients. Intraoperative red cell salvage was done wherever possible. The effect of these two antifibrinolytic drugs on transfusion requirement was evaluated as a whole and in a sub group of patients from each treatment group and compared with a concurrent control group that did not receive antifibrinolytic drugs. Results: Fifty patients (40 M / 10 F, 44 adults, 6 pediatric patients underwent OLT in the study period. Fourteen patients were given AP, 25 patients were given TA and 11 patients did not receive any of the agents(control group. The median volume of total blood components transfused in antifibrinolytic group (n=39 was 4540 ml(0-19,200ml, blood loss 5 l(0.7-35l and operative time 9h (4.5-17h and that of control group(n=11 was 5700 ml(0-15,500ml, 10 l(0.6-25 l and 9h (6.4-15.8h respectively. The median volume of blood transfusions, blood loss and operative time was lesser in AP group(n=14 than that of TA group(n=25. Conclusion: There is definite

Calibrated delivery drape versus indirect gravimetric technique for the measurement of blood loss after delivery: a randomized trial.

Science.gov (United States)

Ambardekar, Shubha; Shochet, Tara; Bracken, Hillary; Coyaji, Kurus; Winikoff, Beverly

2014-08-15

Trials of interventions for PPH prevention and treatment rely on different measurement methods for the quantification of blood loss and identification of PPH. This study's objective was to compare measures of blood loss obtained from two different measurement protocols frequently used in studies. Nine hundred women presenting for vaginal delivery were randomized to a direct method (a calibrated delivery drape) or an indirect method (a shallow bedpan placed below the buttocks and weighing the collected blood and blood-soaked gauze/pads). Blood loss was measured from immediately after delivery for at least one hour or until active bleeding stopped. Significantly greater mean blood loss was recorded by the direct than by the indirect measurement technique (253.9 mL and 195.3 mL, respectively; difference = 58.6 mL (95% CI: 31-86); p 500 mL (8.7% vs. 4.7%, p = 0.02). The study suggests a real and significant difference in blood loss measurement between these methods. Research using blood loss measurement as an endpoint needs to be interpreted taking measurement technique into consideration. This study has been registered at clinicaltrials.gov as NCT01885845.

Animal board invited review: Dairy cow lameness expenditures, losses and total cost.

Science.gov (United States)

Dolecheck, K; Bewley, J

2018-03-20

Lameness is one of the most costly dairy cow diseases, yet adoption of lameness prevention strategies remains low. Low lameness prevention adoption might be attributable to a lack of understanding regarding total lameness costs. In this review, we evaluated the contribution of different expenditures and losses to total lameness costs. Evaluated expenditures included labor for treatment, therapeutic supplies, lameness detection and lameness control and prevention. Evaluated losses included non-saleable milk, reduced milk production, reduced reproductive performance, increased animal death, increased animal culling, disease interrelationships, lameness recurrence and reduced animal welfare. The previous literature on total lameness cost estimates was also summarized. The reviewed studies indicated that previous estimates of total lameness costs are variable and inconsistent in the expenditures and losses they include. Many of the identified expenditure and loss categories require further research to accurately include in total lameness cost estimates. Future research should focus on identifying costs associated with specific lameness conditions, differing lameness severity levels, and differing stages of lactation at onset of lameness to provide better total lameness cost estimates that can be useful for decision making at both the herd and individual cow level.

DOES TRANEXAMIC ACID REDUCE BLOOD LOSS IN OFF-PUMP CORONARY ARTERY BYPASS?

Directory of Open Access Journals (Sweden)

A. Mehr-Aein

2006-09-01

Full Text Available Tranexamic acid is now used on a routine basis for on-pump coronary artery bypass grafting (CABG. We assessed the hemostatic effects of tranexamic acid to decrease bleeding tendency and transfusion requirements in patients undergoing off-pump coronary artery bypass surgery (OPCAB. A total of 66 patients were enrolled to elective OPCAB in a double-blind, prospective randomized study. Of these, 33 patients received tranexamic acid (15 mg/kg before the infusion of heparin and 15 mg/kg after protamin infusion, and 33 patients received only saline. Preoperative hematologic variables, postoperative bleeding and allogeneic transfusions were considered. D-dimer plasma levels were also evaluated to monitor the activation of fibrinolysis. Postoperative bleeding was significantly lower in the tranexamic acid group compared with the control group (320 ± 38 mL vs. 480 ± 75 mL at 12 hour, P < 0.001. The tranexamic acid group had significantly lesser need for allogeneic blood products (0.46 units/patients vs. 0.94 units/patients, P < 0.001. They had also lower post-operative D-dimer plasma levels. No postoperative thrombotic complications were observed in either group. The defective hemostasis occurs even in the OPCABG. Tranexamic acid effectively reduces postoperative blood loss and the need for allogeneic blood products after OPCAB is decreased.

The physiology of blood loss and shock: New insights from a human laboratory model of hemorrhage.

Science.gov (United States)

Schiller, Alicia M; Howard, Jeffrey T; Convertino, Victor A

2017-04-01

The ability to quickly diagnose hemorrhagic shock is critical for favorable patient outcomes. Therefore, it is important to understand the time course and involvement of the various physiological mechanisms that are active during volume loss and that have the ability to stave off hemodynamic collapse. This review provides new insights about the physiology that underlies blood loss and shock in humans through the development of a simulated model of hemorrhage using lower body negative pressure. In this review, we present controlled experimental results through utilization of the lower body negative pressure human hemorrhage model that provide novel insights on the integration of physiological mechanisms critical to the compensation for volume loss. We provide data obtained from more than 250 human experiments to classify human subjects into two distinct groups: those who have a high tolerance and can compensate well for reduced central blood volume (e.g. hemorrhage) and those with low tolerance with poor capacity to compensate.We include the conceptual introduction of arterial pressure and cerebral blood flow oscillations, reflex-mediated autonomic and neuroendocrine responses, and respiration that function to protect adequate tissue oxygenation through adjustments in cardiac output and peripheral vascular resistance. Finally, unique time course data are presented that describe mechanistic events associated with the rapid onset of hemodynamic failure (i.e. decompensatory shock). Impact Statement Hemorrhage is the leading cause of death in both civilian and military trauma. The work submitted in this review is important because it advances the understanding of mechanisms that contribute to the total integrated physiological compensations for inadequate tissue oxygenation (i.e. shock) that arise from hemorrhage. Unlike an animal model, we introduce the utilization of lower body negative pressure as a noninvasive model that allows for the study of progressive

The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures.

LENUS (Irish Health Repository)

Manning, Brian J

2012-02-03

Although it is widely accepted that aspirin will increase the risk of intra- and post-operative bleeding, clinical studies have not consistently supported this assumption. We aimed to assess the effect of pre-operative aspirin on blood loss and transfusion requirements in patients undergoing emergency fixation of femoral neck fractures. A prospective case-control study was undertaken in patients presenting with femoral neck fractures. Parameters recorded included intra-operative blood loss, post-operative blood loss, transfusion requirements and peri-operative reduction in haemoglobin concentration. Of 89 patients presenting with femoral neck fractures 32 were on long-term aspirin therapy. Pre-operative aspirin ingestion did not significantly affect peri-operative blood loss, or change in haemoglobin concentration or haematocrit. However those patients taking aspirin pre-operatively had a significantly lower haemoglobin concentration and haematocrit and were more likely to be anaemic at presentation than those who were not receiving aspirin. Patients taking aspirin were also more likely to receive blood transfusion post-operatively.

Blood transfusion in primary total shoulder arthroplasty: incidence, trends, and risk factors in the United States from 2000 to 2009.

Science.gov (United States)

Ryan, Devon J; Yoshihara, Hiroyuki; Yoneoka, Daisuke; Zuckerman, Joseph D

2015-05-01

Total shoulder arthroplasty (TSA) may be associated with substantial blood loss, and some patients require perioperative blood transfusion. Possible blood transfusion methods include predonated autologous blood transfusion, perioperative autologous blood transfusion, and allogeneic blood transfusion (ALBT). The purposes of the present study were to assess the incidence and recent trends over time of blood transfusion in TSA and analyze patient and hospital characteristics that affect the risk of ALBT. This study used national hospital discharge data from the National Inpatient Sample between 2000 and 2009. The data were used to generate the overall blood transfusion rate, and linear regression was used to assess trends in transfusion patterns over time. Logistic regression analysis was performed to analyze which patient and hospital characteristics independently influence the likelihood that a given patient undergoes ALBT. The overall blood transfusion rate (ie, the proportion of patients who received at least 1 transfusion of any kind) was 6.7%. This rate increased over time, from 4.9% in 2000 to 7.1% in 2009 (P blood transfusion rate in TSA found in the present study may be related to factors specific to TSA, such as the introduction of reverse total shoulder arthroplasty during the study period. A variety of patient and hospital characteristics contribute to the risk of undergoing ALBT. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

[Evaluation of hearing loss parameters in workers and its relationship with fasting blood glucose levels].

Science.gov (United States)

Vicente-Herrero, M Teofila; Lladosa Marco, Silvia; Ramírez-Iñiguez de La Torre, M Victoria; Terradillos-García, M Jesús; López-González, Ángel Arturo

2014-05-01

Hearing loss due to noise is considered within the prevention plans of the most common occupational diseases. In addition to evaluation of working conditions, other personal factors increasing the risk of hypoacusis, such as diabetes, should be taken into account. To explore hearing loss in the workplace and its relationship to impaired fasting baseline blood glucose levels. An observational, cross-sectional study enrolling 1636 workers from service companies was conducted. Full audiometric evaluation was performed at different frequencies: high frequency (HF), early loss index (ELI), speech average loss (SAL), and monaural and binaural loss. Results were categorized by baseline blood glucose levels: G1 (125mg/dl). Based on both HF and ELI, 11% of workers had clear indication of deafness. Women with G3 levels showed significant differences in the results of HF and ELI indexes as compared to the G1 group (P=.038 and .046, respectively). A positive association was found between hearing loss and G3 blood glucose levels in HF (OR: .338; p=.002), ELI (OR: .407; p=.007), and the monaural test in the left ear (OR: 4.77×10-5; p=.006). Despite the methodological limitations of this study, there is evidence for an increased risk of high frequency hearing loss in workers with high baseline blood glucose levels. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Polysaccharides from astragali radix restore chemical-induced blood vessel loss in zebrafish

Science.gov (United States)

2012-01-01

Background Astragali Radix has been used widely for the treatment of cardiovascular and cerebrovascular diseases, and to enhance endurance and stamina in traditional Chinese medicine (TCM) for over 2000 years. The polysaccharide constituents of Astragali Radix (ARP) are considered as one of the major constituents contributing to the multiple pharmacological effects of this medicinal plant. The purpose of the study is to evaluate the vascular regenerative activities of ARPs in a chemically-induced blood vessel loss model in zebrafish. Methods Blood vessel loss was induced in both Tg(fli-1a:EGFP)y1 and Tg(fli-1a:nEGFP)y7 embryos by administration of 300 nM VEGFR tyrosine kinase inhibitor II (VRI) for 3 h at 24 hpf (hour post-fertilization). Then, the blood vessel damaged zebrafish were treated with ARPs for 21 h and 45 h after VRI withdrawal. Morphological changes in intersegmental vessels (ISVs) of zebrafish larvae were observed under the fluorescence microscope and measured quantitatively. The rescue effect of ARPs in the zebrafish models was validated by measuring the relative mRNA expressions of Kdrl, Kdr and Flt-1 using real-time PCR. Results Two polysaccharide fractions, P4 (50000 D 0.1 μm), isolated from Astragali Radix by ultrafiltration, produced a significant and dose-dependent recovery in VRI-induced blood vessel loss in zebrafish. Furthermore, the down-regulation of Flk-1 and Flt-1 mRNA expression induced by VRI was reversed by treatment with P4. Conclusion The present study demonstrates that P4 isolated from Astragali Radix reduces VRI-induced blood vessel loss in zebrafish. These findings support the hypothesis that polysaccharides are one of the active constituents in Astragali Radix, contributing to its beneficial effect on treatment of diseases associated with a deficiency in angiogenesis. PMID:22357377

Comparison of blood loss between using non central part cutting knee prosthesis and distal central part cutting.

Science.gov (United States)

Malairungsakul, Anan

2014-12-01

Patients who undergo knee replacement surgery may need to receive a blood transfusion due to blood loss during the operation. Therefore it was important to improve the design of knee implant operative procedures in an attempt to reduce the rate of blood loss. The present study aimed to compare the blood loss between two types of knee replacement surgery. This is a retrospective study in which 78 patients received cemented knee replacements in Phayao Hospital between October 2010 and March 2012. There were two types of surgical procedure: 1) using an implant position covering the end of the femoral bone without cutting into the central part of the distal femoral, 2) using an implant position covering the end of the femoral bone cutting the central part of the distal femoral. Blood loss, blood transfusion, hemoglobin and hematocrit were recorded preoperatively, immediately postsurgery and 48 hours after surgery. Findings revealed that the knee replacement surgery using the implant position covering the end of the femoral bone without cutting the central part of the distal femoral significantly lowered the rate of blood loss when compared to using the implant position covering the end of the femoral bone with central cutting of the distal femor. The average blood loss during the operation without cutting at the central part of distal femoral was 49.50 ± 11.11 mL; whereas the operation cutting the central part of the distal femoral was 58.50 ± 11.69 mL. As regards blood loss, the knee replacement surgery using the implant position covering the end ofthefemoral bone without cutting the central part of distal femor was better than using the implant position covering the end of the femoral bone cutting at the central part of the distal femor.

Total reflection x-ray analysis of metals in blood samples

International Nuclear Information System (INIS)

Nakamura, Takuya; Matsui, Hiroshi; Kawamata, Masaya

2009-01-01

The sample preparation for TXRF (total reflection X-ray fluorescence) quantitative analysis of trace elements in human blood samples was investigated. In the TXRF analysis, a solution sample is dropped and dried on a flat substrate, and then the dried residue is measured. In this case, the dried residue should be flat not to disturb X-ray total reflection on the substrate. In addition, it is required to simply measure the whole blood sample by TXRF method, although a serum is analyzed in many cases. Thus, we studied the optimum conditions of the sample preparation of the whole blood by adding the pure water to apply Hemolysis phenomenon, where blood cells are destroyed due to different of the osmotic pressure, leading to flat residue. It was found that the best S/B ratio was obtained when the whole blood was diluted 8 times with pure water. Moreover, it was investigated the influence of the surface chemical condition of the glass substrate on the shape of the dried reside of the blood sample. When the surface of the glass substrate was hydrophilic, the shape of the dried residues was not uniform, as a result, the quantitative data of TXRF analysis gave a large deviation. On the other hand, when the surface of the glass was hydrophobic, the shape of the residue was almost uniform, as a result, a good reproducibility was obtained. Another problem was an outer ring of the dried residue of the blood. This uneven ring absorbs the primary X-rays, caused to low determined quantitative data. Thus, we tried the heating way of the dropped blood sample at a high temperature of 200 degrees. In this case, the blood sample was dried immediately, and a flat homogeneous dried residue was obtained without the outer ring. Using the optimized conditions for sample preparation, human blood sample was quantitatively measured by TXRF and ICP-AES. A good agreement was obtained in TXRF and ICP-AES determinations; however, the measurement of Cl and Br will be an advantage of TXRF, because

Tranexamic acid reduces blood loss during and after cesarean section: A double blinded, randomized, controlled trial

Directory of Open Access Journals (Sweden)

Amr H. Yehia

2014-03-01

Conclusions: Tranexamic acid can be used safely to reduce blood loss during cesarean section. Reduced blood loss after tranexamic acid was associated with improvement of post-operative hemoglobin, hematocrit and with reduction of post-partum need for iron replacement.

Decisions with Uncertain Consequences-A Total Ordering on Loss-Distributions.

Science.gov (United States)

Rass, Stefan; König, Sandra; Schauer, Stefan

2016-01-01

Decisions are often based on imprecise, uncertain or vague information. Likewise, the consequences of an action are often equally unpredictable, thus putting the decision maker into a twofold jeopardy. Assuming that the effects of an action can be modeled by a random variable, then the decision problem boils down to comparing different effects (random variables) by comparing their distribution functions. Although the full space of probability distributions cannot be ordered, a properly restricted subset of distributions can be totally ordered in a practically meaningful way. We call these loss-distributions, since they provide a substitute for the concept of loss-functions in decision theory. This article introduces the theory behind the necessary restrictions and the hereby constructible total ordering on random loss variables, which enables decisions under uncertainty of consequences. Using data obtained from simulations, we demonstrate the practical applicability of our approach.

Donation frequency, iron loss, and risk of cancer among blood donors

DEFF Research Database (Denmark)

Edgren, Gustaf; Reilly, Marie; Hjalgrim, Henrik

2008-01-01

BACKGROUND: Long-term deleterious effects of repeated blood donations may be masked by the donors' healthy lifestyle. To investigate possible effects of blood donation and iron loss through blood donation on cancer incidence while minimizing "healthy donor effects," we made dose......-response comparisons within a cohort of Swedish and Danish blood donors. METHODS: We used a nested case-control study design, in which case patients were defined as all donors who were diagnosed with a malignancy between their first recorded blood donation and study termination (n = 10866). Control subjects (n...... plasma donors (> 25 vs 0 donations, OR = 2.14, 95% CI = 1.22 to 3.74). CONCLUSIONS: Repeated blood donation was not associated with increased or decreased risk of cancer overall. The lack of consistency across latency periods casts doubt on an apparent association between reduced cancer risk and iron...

Decisions with Uncertain Consequences-A Total Ordering on Loss-Distributions.

Directory of Open Access Journals (Sweden)

Stefan Rass

Full Text Available Decisions are often based on imprecise, uncertain or vague information. Likewise, the consequences of an action are often equally unpredictable, thus putting the decision maker into a twofold jeopardy. Assuming that the effects of an action can be modeled by a random variable, then the decision problem boils down to comparing different effects (random variables by comparing their distribution functions. Although the full space of probability distributions cannot be ordered, a properly restricted subset of distributions can be totally ordered in a practically meaningful way. We call these loss-distributions, since they provide a substitute for the concept of loss-functions in decision theory. This article introduces the theory behind the necessary restrictions and the hereby constructible total ordering on random loss variables, which enables decisions under uncertainty of consequences. Using data obtained from simulations, we demonstrate the practical applicability of our approach.

Minimizing blood loss in liver transplantation : Progress through research and evolution of techniques

NARCIS (Netherlands)

de Boer, MT; Molenaar, IQ; Hendriks, HGD; Slooff, MJH; Porte, RJ

2005-01-01

Blood loss during liver transplantation has long been recognized as an important cause of morbidity and, especially in the early days, also mortality. It is well known that blood transfusions are associated with an increased risk of postoperative complications, such as infections, pulmonary

Blood trihalomethane levels and the risk of total cancer mortality in US adults

International Nuclear Information System (INIS)

Min, Jin-Young; Min, Kyoung-Bok

2016-01-01

Background: Although animal data have suggested the carcinogenic activity of trihalomethanes (THMs), there is inconsistent evidence supporting the link between THM exposure and cancers in humans. Objectives: We investigated the association between specific and total blood THM levels with the risk of total cancer mortality in adults. Methods: We analyzed data from the 1999–2004 Third National Health and Nutrition Examination Survey and the Linked Mortality File of the United States. A total of 933 adults (20–59 years of age) with available blood THM levels and no missing data for other variables were included. Four different THM species (chloroform, bromodichloromethane (BDCM), dibromochloromethane (DBCM) and bromoform) were included, and the codes associated with cancer (malignant neoplasm) were C00 through C97, based on the underlying causes of death listed in the International Classification of Disease 10the Revision. Results: Compared with adults in the lowest DBCM, bromoform, and total brominated THM tertiles, those in the highest DBCM, bromoform, and total brominated THM tertiles exhibited adjusted hazard ratios (HR) of total cancer mortality of 4.97 (95% confidence interval (CI) = 1.59–15.50), 4.94 (95% CI = 1.56–15.61), and 3.42 (95% CI = 1.21–15.43) respectively. The risk of total cancer mortality was not associated with increases in blood chloroform and total THM levels. Conclusions: We found that the baseline blood THM species, particularly brominated THMs, were significantly associated with total cancer mortality in adults. Although this study should be confirm by other studies, our findings suggest a possible link between THM exposures and cancer. - Highlights: • Trihalomethanes (THM) are classified as either probable or possible carcinogens. • Limited evidence on the link between THM and the incidence of cancer in humans. • We investigated the association between blood THM levels and the risk of total cancer mortality. • High

Plasmalemma Vesicle-Associated Protein Has a Key Role in Blood-Retinal Barrier Loss

NARCIS (Netherlands)

Wisniewska-Kruk, Joanna; van der Wijk, Anne-Eva; van Veen, Henk A.; Gorgels, Theo G. M. F.; Vogels, Ilse M. C.; Versteeg, Danielle; van Noorden, Cornelis J. F.; Schlingemann, Reinier O.; Klaassen, Ingeborg

2016-01-01

Loss of blood-retinal barrier (BRB) properties induced by vascular endothelial growth factor (VEGF) and other factors is an important cause of diabetic macular edema. Previously, we found that the presence of plasmalemma vesicle-associated protein (PLVAP) in retinal capillaries associates with loss

Relative blood loss and operative time can predict length of stay following orthognathic surgery.

Science.gov (United States)

Andersen, K; Thastum, M; Nørholt, S E; Blomlöf, J

2016-10-01

The aim of this study was to investigate the length of stay (LOS) following orthognathic surgery and thereby to establish a benchmark. The secondary aim was to identify predictors of postoperative LOS following orthognathic surgery. Patients were treated consecutively during the period 2010 to 2012. Inclusion criteria were (1) patient age ≥18 years, and (2) surgery involving a three-piece Le Fort I osteotomy, or a bilateral sagittal split osteotomy (BSSO), or bimaxillary surgery. A total of 335 patients were included. The following data were recorded: height, weight, body mass index (BMI), age, sex, operative time, intraoperative blood loss, and type of surgery. LOS was defined as the duration of time from date of surgery to date of discharge. The average LOS was 1.3 days following Le Fort I osteotomy, 1.3 days following BSSO, and 1.8 days following bimaxillary surgery. In the multivariate regression model (R(2)=0.11), predictors of a prolonged LOS were operative time (P<0.001) and relative blood loss (P=0.002). No significant effect of age, BMI, sex, or treatment on LOS was observed. The short duration of LOS found in this study supports the possibility of increasing outpatient pathways for selected patients. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Blood management in total hip replacement: an analysis of factors associated with allogenic blood transfusion.

Science.gov (United States)

Wong, Samuel; Tang, Howard; de Steiger, Richard

2015-06-01

The aim of this study was to audit the blood transfusion practice throughout the Epworth Healthcare Hospitals for patients undergoing primary total hip replacement (THR). We determined if blood-saving techniques were having an impact on the risk of allogenic blood transfusion and which patients were at risk of receiving allogenic blood transfusion. This study uses a retrospective audit of 787 patients who had undergone primary THR surgery at three Melbourne hospitals: Epworth Richmond, Epworth Eastern and Epworth Freemasons in 2010. Patient demographics, transfusion requirements and blood-conserving techniques were recorded. One hundred and eighty (23%) patients received allogenic blood transfusion and 18 (2.3%) patients received autologous blood transfusion. On multivariate analysis, preoperative anaemia (odds ratio (OR) 4.7, P blood transfusion. Use of spinal anaesthetic was found to be associated with lower risk of transfusion (OR 0.6, P = 0.0180) compared with general anaesthetic alone. Cell saver, acute normovolaemic haemodilution and re-infusion drain tube usage did not have a significant impact on reducing the risk of allogenic blood transfusion. Identification of patients at risk of blood transfusion, correction of preoperative anaemia and a restrictive transfusion policy are important factors to consider in effective perioperative blood management. © 2015 Royal Australasian College of Surgeons.

Duration of works, flight hours, and blood pressure related to noise-induced hearing loss among Indonesian Air Force helicopter pilots

Directory of Open Access Journals (Sweden)

Kholidah Hanum

2006-09-01

Full Text Available Helicopter pilots exposed to high intensity noise and other risk factors had increased risk to be noise-induced hearing loss (NIHL. Therefore, it is beneficial to study several risk factors related to NIHL. This study was a nested case-control. Data was extracted from available medical records among helicopter pilots who performed routine aerophysiology training indoctrination (ILA during 1980 through March 2004 at Saryanto Institute for Aviation and Aerospace Medicine (Lakespra, Jakarta. Case was those who had audiogram with a notch of 40 dB or more and of 4000 Hertz on one site or bilateral ears. A case was matched by two controls who free from NIHL up to 2004. All risk factors for cases and controls were counted as of reference date of cases diagnosed. There were 187 medical records available for this study. A number of 32 cases and 64 controls were identified. The final model reveals that NIHL was related to total duration of works, flight hours, and blood pressure. Those who had 500 hours or more than less 500 hours had a moderate increased risk for 2.5 to be NIHL [Adjusted odds ratio (ORa= 2.50; 95% confidence intervals (CI = 0.66-9.29; p = 0.180]. Those who had total duration works 11-24 years had a moderate increased to be NIHL for 2.7 times (ORa = 2.71; 95% CI=0.90-8.10; p = 0.075. Furthermore, prehypertension and hypertension stage 1 subjects than normal blood pressure had moderate trend increased risk to be NIHL. In conclusion total flight hours for 500 hours or more, total duration works 11-24 years, or prehypertension and hypertension stage 1 increased risk NIHL. (Med J Indones 2006; 15:185-90 Keywords: noise induced hearing loss, flight hours, working duration, blood pressure

Aortic blood flow subtraction: an alternative method for measuring total renal blood flow in conscious dogs

DEFF Research Database (Denmark)

Sandgaard, N C F; Andersen, J L; Holstein-Rathlou, N-H

2002-01-01

We have measured total renal blood flow (TRBF) as the difference between signals from ultrasound flow probes implanted around the aorta above and below the renal arteries. The repeatability of the method was investigated by repeated, continuous infusions of angiotensin II and endothelin-1 seven...... arterial blood pressure by 49% and decreased TRBF by 12%, providing an increase in renal vascular resistance of 69%. Dynamic analysis showed autoregulation of renal blood flow in the frequency range ... of TRBF by aortic blood flow subtraction is a practical and reliable method that allows direct comparison of excretory function and renal blood flow from two kidneys. The method also allows direct comparison between TRBF and flow in the caudal aorta....

Segmental blood pressure after total hip replacement

DEFF Research Database (Denmark)

Gebuhr, Peter Henrik; Soelberg, M; Henriksen, Jens Henrik Sahl

1992-01-01

Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant...... drop was found in all pressures 1 week postoperatively. The decrease followed the systemic pressure and was restored to normal after 6 weeks. In a group of six patients with preoperatively decreased ankle pressure, a significant transient further decrease in the ankle-toe gradient pressure was found...... on the operated side. None of the patients had symptoms from the lowered pressure. We conclude that in patients without signs of ischemia, the postoperative segmental pressure decrease is reversible and therefore not dangerous....

Free Amino Acids in the Blood Plasma of Pigs during Total Starvation

Energy Technology Data Exchange (ETDEWEB)

Cuperlovic, M.; Jovanovic, M.; Stosic, D. [Institute for the Application of Nuclear Energy in Agriculture, Veterinary Medicine and Forestry, Belgrade, Yugoslavia (Serbia)

1968-07-01

From the nutritional point of view it is interesting to establish whether the level of free amino acids in the blood plasma can be used as an indicator of protein anabolism and catabolism. Investigations to date have given no answer to this question. It is known that numerous exogenous and endogenous factors affect protein metabolism. These effects also vary with the level of protein intake and make the relationship between the quantitative and qualitative composition of the free amino acids pool and the total protein metabolism even more complicated. To reduce some of these factors, these investigations were done under the conditions of complete exclusion of exogenous nutrition. Piglets, aged 8-10 weeks, were subjected to total starvation in the course of 28 d. During this period, the body weight, serum protein content, plasma amino acid concentration and plasma urea concentration were followed. During the whole experimental period the body weight decreased, rapidly at the beginning and more slowly towards the end. The mean total body weight loss was 44.6 % of the first day's weight. The serum protein content increased slightly at the beginning of starvation and then, towards the end of the experiment, decreased, reaching a value that was only a little lower than the protein content determined before the onset of starvation. Changes of the quantitative composition.of the free amino acid pool did not follow the changes of the serum protein content. At the beginning of starvation, concentrations of a great number of amino acids increased in accordance with some earlier results. After long periods of starvation, however, differences between individual amino acids become more clear. Concentrations of some amino acids, e.g. lysine, increased continually during the whole period, while concentrations of most of the other amino acids remained for some time at high levels and only in the last week of starvation decreased to the values similar to those observed at the

Tolerance to bovine clinical mastitis: Total, direct, and indirect milk losses.

Science.gov (United States)

Detilleux, J

2018-04-01

The objectives of this paper were to estimate direct and indirect milk losses associated with mastitis. Indirect losses, linked to indirect tolerance, are mediated by the increase in milk somatic cell count (SCC) in response to bacterial infection. Direct losses, linked to weak direct tolerance, are not mediated by the increase in SCC. So far, studies have evaluated milk loss associated with clinical mastitis without considering both components, which may lead to biased estimates of their sum; that is, the total loss in milk. A total of 43,903 test-day records on milk and SCC from 3,716 cows and 5,858 lactations were analyzed with mediation mixed models and health trajectories to estimate the amount of direct, indirect, and total milk losses after adjustment for known and potentially unmeasured (sensitivity analyses) confounding factors. Estimates were formalized under the counterfactual causal theory of causation. In this study, milk losses were mostly mediated by an increase in SCC. They were highest in the first month of lactation, when SCC were highest. Milk losses were estimated at 0.5, 0.8, and 1.1 kg/d in first, second, and third and greater parity, respectively. Two phases described how changes in milk were associated with changes in SCC: on average, one occurred before and one after the day preceding the clinical diagnosis. In both phases, changes in milk were estimated at 1 mg/d per 10 3 cells/mL. After adjusting for known confounders, cow effect accounted for 20.7 and 64.2% of the variation in milk in the first and second phases, respectively. This suggests that deviations from the resilient path were highest during the second phase of inflammation and that selection for cows more tolerant to mastitis is feasible. As discussed herein, epigenetic regulation of macrophage polarization may contribute to the variation in milk observed in the second phase. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Whole blood coagulation time, haematocrit, haemoglobin and total ...

African Journals Online (AJOL)

The study was carried out to determine the values of whole blood coagulation time (WBCT), haematocrit (HM), haemaglobin (HB) and total protein (TP) of one hundred and eighteen apparently healthy turkeys reared under an extensive management system in Zaria. The mean values for WBCT, HM, HB and TP were 1.12 ...

The safety of peri-articular local anaesthetic injection for patients undergoing total knee replacement with autologous blood transfusion: a randomised trial.

Science.gov (United States)

Wallace, D F; Emmett, S R; Kang, K K; Chahal, G S; Hiskens, R; Balasubramanian, S; McGuinness, K; Parsons, H; Achten, J; Costa, M L

2012-12-01

Intra-operative, peri-articular injection of local anaesthesia is an increasingly popular way of controlling pain following total knee replacement. At the same time, the problems associated with allogenic blood transfusion have led to interest in alternative methods for managing blood loss after total knee replacement, including the use of auto-transfusion of fluid from the patient's surgical drain. It is safe to combine peri-articular infiltration with auto-transfusion from the drain. We performed a randomised clinical trial to compare the concentration of local anaesthetic in the blood and in the fluid collected in the knee drain in patients having either a peri-articular injection or a femoral nerve block. Clinically relevant concentrations of local anaesthetic were found in the fluid from the drains of patients having peri-articular injections (4.92 μg/ml (sd 3.151)). However, none of the patients having femoral nerve blockade had detectable levels. None of the patients in either group had clinically relevant concentrations of local anaesthetic in their blood after re-transfusion. The evidence from this study suggests that it is safe to use peri-articular injection in combination with auto-transfusion of blood from peri-articular drains during knee replacement surgery.

Significant reduction in blood loss in patients undergoing minimal extracorporeal circulation

NARCIS (Netherlands)

Gerritsen, W. B.; van Boven, W. J.; Smelt, M.; Morshuis, W. J.; van Dongen, H. P.; Haas, F. J.; Aarts, L. P.

2006-01-01

Several recent studies have shown differences in blood loss and allogeneic transfusion requirements between on-pump and off-pump coronary artery bypass grafting (CABG). Recently a new concept, the mini-extracorporeal circulation, was introduced to minimize the side effects of extracorporeal

Reducing blood loss during laparoscopic myomectomy by temporary uterine artery clamping using bulldog clamp

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Kai-Jo Chiang

2014-01-01

Full Text Available Uterine myoma is the most common benign gynecologic tumor worldwide. Mini-invasive surgery has become popular for myomectomy, with advantages over laparotomy. However, reducing blood loss during laparoscopic myomectomy is a major concern for the surgeon because of the limitation in making a quick control bleeding during the operation. Several methods have proved to decrease blood flow, but are not always effective or available. We present a case of uterine myoma with the uterine arteries clamped by bulldog clamps during laparoscopic myomectomy. The myoma was removed successfully with minimal blood loss (<50 ml during the operation. This is an effective, safe, and reliable method for reducing bleeding during laparoscopic myomectomy that does not require ligation of the uterine artery.

Effect of tranexamic acid on intraoperative blood loss and transfusion requirements in patients undergoing excision of intracranial meningioma.

Science.gov (United States)

Hooda, Bhavna; Chouhan, Rajendra Singh; Rath, Girija Prasad; Bithal, Parmod Kumar; Suri, Ashish; Lamsal, Ritesh

2017-07-01

Surgical excision of meningioma is often complicated by significant blood loss requiring blood transfusion with its attendant risks. Although tranexamic acid is used to reduce perioperative blood loss, its blood conservation effect is uncertain in neurosurgery. Sixty adults undergoing elective craniotomy for meningioma excision were randomized to receive either tranexamic acid or placebo, initiated prior to skin incision. Patients in the tranexamic acid group received intravenous bolus of 20mg/kg over 20min followed by an infusion of 1mg/kg/h till the conclusion of surgery. Intraoperative blood loss, transfusion requirements and estimation of surgical hemostasis using a 5-grade scale were noted. Postoperatively, the extent of tumor excision on CT scan and complications were observed. Demographics, tumor characteristics, amount of fluid infusion, and duration of surgery and anesthesia were comparable between the two groups. The amount of blood loss was significantly less in tranexamic acid group compared to placebo (830mlvs 1124ml; p=0.03). The transfusion requirement was less in tranexamic acid group (p>0.05). The patients in tranexamic acid group fared better on a 5-grade surgical hemostasis scale with more patients showing good hemostasis (p=0.007). There were no significant differences between the groups with regards to extent of tumor removal, perioperative complications, hospital stay or neurologic outcome. To conclude, administration of tranexamic acid significantly reduced blood loss in patients undergoing excision of meningioma. Fewer patients in the tranexamic acid group received blood transfusions. Surgical field hemostasis was better achieved in patients who received tranexamic acid. Copyright © 2017 Elsevier Ltd. All rights reserved.

Leukocytic Response and Peripheral Venous Blood Lymphocyte Apoptosis as a Marker of Tissue Ischemia in Acute Massive Blood Loss

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N. V. Borovkova

2013-01-01

Full Text Available Objective: to estimate the level of peripheral venous blood lymphocyte apoptosis and intraoperative hypoxia in victims with acute massive blood loss. Subjects and methods. Twenty-two patients with open and close chest and abdominal traumas complicated by acute massive blood loss were examined. All the patients were emergently operated on to stop bleeding. Tissue metabolism was evaluated from gases, acid-base parameters, and plasma lactate, glucose, potassium, and sodium levels. Apoptosis of mononuclear cells was studied and dead leukocytes were counted using flow cytometry. Results. Preoperatively, the victims were found to have venous hypoxemia, hyperlactatemia, hyperglycemia, moderate leukocytosis, and higher dead leukocyte counts. There were also raised counts of lymphocytes coming into the process of apoptosis. A significant relationship was found between monocyte counts and hypoxia values. At the end of surgery, oxygen balance values became stable and exerted an effect on the count of leukocytes, the relative level of granulocytes, the relative and absolute counts of dead and damaged leukocytes, and the concentration of lymphocytes in the victims’ venous blood during the early stages of apoptosis, as evidenced by nonlinear regression models. Conclusion. The indicators of immunocompetent cell apoptosis and the count of venous blood dead leukocytes along with lactate levels and venous hypoxemia parameters reflect the degree of tissue hypoxia and may be used as specific markers.

Effect of early release of tourniquet in total knee arthroplasty

International Nuclear Information System (INIS)

Abbas, K.; Raza, H.; Umer, M.; Hafiz, K.

2013-01-01

To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Study Design: Comparative study. Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007. Methodology: One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss (determined by Gross method) and other study variables were noted as per objective and computed. Results: There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 L and 1.108 L in group-A and B respectively (p = 0.27). Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Conclusion: Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay. (author)

Impact of preoperative antithrombotic therapy on blood management after implantation of primary total knee arthroplasty.

Science.gov (United States)

Leitner, Lukas; Musser, Ewald; Kastner, Norbert; Friesenbichler, Jörg; Hirzberger, Daniela; Radl, Roman; Leithner, Andreas; Sadoghi, Patrick

2016-08-04

Red blood cell concentrates (RCC) substitution after total knee arthroplasty (TKA) is correlated with multifold of complications and an independent predictor for higher postoperative mortality. TKA is mainly performed in elderly patients with pre-existing polymorbidity, often requiring permanent preoperative antithrombotic therapy (PAT). The aim of this retrospective analysis was to investigate the impact of demand for PAT on inpatient blood management in patients undergoing TKA. In this study 200 patients were retrospectively evaluated after TKA for differences between PAT and non-PAT regarding demographic parameters, preoperative ASA score > 2, duration of operation, pre-, and intraoperative hemoglobin level, and postoperative parameters including amount of wound drainage, RCC requirement, and inpatient time. In a multivariate logistic regression analysis the independent influences of PAT, demographic parameters, ASA score > 2, and duration of the operation on RCC demand following TKA were analyzed. Patients with PAT were significantly older, more often had an ASA > 2 at surgery, needed a higher number of RCCs units and more frequently and had lower perioperative hemoglobin levels. Multivariate logistic regression revealed PAT was an independent predictor for RCC requirement. PAT patients are more likely to require RCC following TKA and should be accurately monitored with respect to postoperative blood loss.

Reconciliation of Halogen-Induced Ozone Loss with the Total-Column Ozone Record

Science.gov (United States)

Shepherd, T. G.; Plummer, D. A.; Scinocca, J. F.; Hegglin, M. I.; Fioletov, V. E.; Reader, M. C.; Remsberg, E.; von Clarmann, T.; Wang, H. J.

2014-01-01

The observed depletion of the ozone layer from the 1980s onwards is attributed to halogen source gases emitted by human activities. However, the precision of this attribution is complicated by year-to-year variations in meteorology, that is, dynamical variability, and by changes in tropospheric ozone concentrations. As such, key aspects of the total-column ozone record, which combines changes in both tropospheric and stratospheric ozone, remain unexplained, such as the apparent absence of a decline in total-column ozone levels before 1980, and of any long-term decline in total-column ozone levels in the tropics. Here we use a chemistry-climate model to estimate changes in halogen-induced ozone loss between 1960 and 2010; the model is constrained by observed meteorology to remove the eects of dynamical variability, and driven by emissions of tropospheric ozone precursors to separate out changes in tropospheric ozone. We show that halogen-induced ozone loss closely followed stratospheric halogen loading over the studied period. Pronounced enhancements in ozone loss were apparent in both hemispheres following the volcanic eruptions of El Chichon and, in particular, Mount Pinatubo, which significantly enhanced stratospheric aerosol loads. We further show that approximately 40% of the long-term non-volcanic ozone loss occurred before 1980, and that long-term ozone loss also occurred in the tropical stratosphere. Finally, we show that halogeninduced ozone loss has declined by over 10% since stratospheric halogen loading peaked in the late 1990s, indicating that the recovery of the ozone layer is well underway.

ATLS Hypovolemic Shock Classification by Prediction of Blood Loss in Rats Using Regression Models.

Science.gov (United States)

Choi, Soo Beom; Choi, Joon Yul; Park, Jee Soo; Kim, Deok Won

2016-07-01

In our previous study, our input data set consisted of 78 rats, the blood loss in percent as a dependent variable, and 11 independent variables (heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, respiration rate, temperature, perfusion index, lactate concentration, shock index, and new index (lactate concentration/perfusion)). The machine learning methods for multicategory classification were applied to a rat model in acute hemorrhage to predict the four Advanced Trauma Life Support (ATLS) hypovolemic shock classes for triage in our previous study. However, multicategory classification is much more difficult and complicated than binary classification. We introduce a simple approach for classifying ATLS hypovolaemic shock class by predicting blood loss in percent using support vector regression and multivariate linear regression (MLR). We also compared the performance of the classification models using absolute and relative vital signs. The accuracies of support vector regression and MLR models with relative values by predicting blood loss in percent were 88.5% and 84.6%, respectively. These were better than the best accuracy of 80.8% of the direct multicategory classification using the support vector machine one-versus-one model in our previous study for the same validation data set. Moreover, the simple MLR models with both absolute and relative values could provide possibility of the future clinical decision support system for ATLS classification. The perfusion index and new index were more appropriate with relative changes than absolute values.

High-throughput sequencing of microRNAs in peripheral blood mononuclear cells: identification of potential weight loss biomarkers.

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Fermín I Milagro

Full Text Available INTRODUCTION: MicroRNAs (miRNAs are being increasingly studied in relation to energy metabolism and body composition homeostasis. Indeed, the quantitative analysis of miRNAs expression in different adiposity conditions may contribute to understand the intimate mechanisms participating in body weight control and to find new biomarkers with diagnostic or prognostic value in obesity management. OBJECTIVE: The aim of this study was the search for miRNAs in blood cells whose expression could be used as prognostic biomarkers of weight loss. METHODS: Ten Caucasian obese women were selected among the participants in a weight-loss trial that consisted in following an energy-restricted treatment. Weight loss was considered unsuccessful when 5% (responders. At baseline, total miRNA isolated from peripheral blood mononuclear cells (PBMC was sequenced with SOLiD v4. The miRNA sequencing data were validated by RT-PCR. RESULTS: Differential baseline expression of several miRNAs was found between responders and non-responders. Two miRNAs were up-regulated in the non-responder group (mir-935 and mir-4772 and three others were down-regulated (mir-223, mir-224 and mir-376b. Both mir-935 and mir-4772 showed relevant associations with the magnitude of weight loss, although the expression of other transcripts (mir-874, mir-199b, mir-766, mir-589 and mir-148b also correlated with weight loss. CONCLUSIONS: This research addresses the use of high-throughput sequencing technologies in the search for miRNA expression biomarkers in obesity, by determining the miRNA transcriptome of PBMC. Basal expression of different miRNAs, particularly mir-935 and mir-4772, could be prognostic biomarkers and may forecast the response to a hypocaloric diet.

Total and regional blood flows in vascularized skeletal muscle grafts in rabbits

International Nuclear Information System (INIS)

Burton, H.W.; Stevenson, T.R.; Dysko, R.C.; Gallagher, K.P.; Faulkner, J.A.

1988-01-01

The transplantation of whole skeletal muscles is a common clinical procedure. Although atypical blood flows have been reported in small free muscle grafts, the blood flow of large neurovascular-intact (NVI) and neurovascular-anastomosed (NVA) grafts have not been measured. Because the maximum specific force (N/cm 2 ) of NVI and NVA grafts is 65% that of control muscles, we hypothesized that total and regional blood flows of NVI and NVA grafts at rest and during twitch contractions are significantly lower than lower flows of control muscles. In rabbits, blood flows of control rectus femoris (RFM) muscles and NVI and NVA grafts of RFM muscles were measured by the radioactive-microsphere technique. Total blood flows in grafts were not different from the control RFM muscle values, except for a higher resting flow in NVA grafts and a lower flow at 3 Hz in NVI grafts. Minor variations in regional flows were observed. We conclude that the operative procedures of grating and repair of blood vessels affect the vascular bed of muscles minimally, and the deficits observed in grafts do not arise from inadequate perfusion

Synergistic effects of intravenous and intra-articular tranexamic acid on reducing hemoglobin loss in revision total knee arthroplasty: a prospective, randomized, controlled study.

Science.gov (United States)

Yuan, Xiangwei; Wang, Jiaxing; Wang, Qiaojie; Zhang, Xianlong

2018-04-01

Tranexamic acid decreases blood loss in primary total knee arthroplasty, and no related prospective randomized clinical trials have been conducted to evaluate the effectiveness and safety of tranexamic acid in revision total knee arthroplasty. Thus, we conducted this work to evaluate the synergistic effects of intravenous plus intra-articular tranexamic acid on reducing hemoglobin loss compared with intra-articular tranexamic acid alone in revision total knee arthroplasty. This prospective, controlled study randomized 96 patients undergoing revision total knee arthroplasty into two groups: an intravenous plus intra-articular tranexamic acid group (48 patients who received 20 mg/kg intravenous tranexamic acid and 3.0 g intra-articular tranexamic acid); and an intra-articular tranexamic acid alone group (48 patients who received the same intravenous volume of normal saline and 3.0 g intra-articular tranexamic acid). The primary outcome was hemoglobin loss. Secondary outcomes included the volume of drain output, the percentage of patients who received transfusions, the number of units transfused, and thromboembolic events. The baseline data, preoperative hemoglobin, and tourniquet time were similar in both groups. There was significantly less hemoglobin loss in the intravenous plus intra-articular tranexamic acid group compared with the intra-articular tranexamic acid alone group (2.7 ± 0.6 g/dL and 3.7 ± 0.7 g/dL; p tranexamic acid alone group, the intravenous plus intra-articular tranexamic acid group also had significantly less drain output, fewer patients who received transfusions, and fewer units transfused (all p tranexamic acid alone, combined intravenous plus intra-articular tranexamic acid significantly reduced hemoglobin loss and the need for transfusion without an apparent increase in thromboembolic events in patients who underwent revision total knee arthroplasty. © 2018 AABB.

Matched cohort study of topical tranexamic acid in cementless primary total hip replacement.

Science.gov (United States)

Sanz-Reig, Javier; Mas Martinez, Jesus; Verdu Román, Carmen; Morales Santias, Manuel; Martínez Gimenez, Enrique; Bustamante Suarez de Puga, David

2018-03-29

Tranexamic acid has been shown to be effective in reducing blood loss after total hip replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use to reduce blood loss after primary total hip replacement and to compare these outcomes with those of a matched control group from a similar cohort that did not have received tranexamic acid. This is a prospective matched control study to assess the effect of a 2 g topical tranexamic acid in 50 mL physiological saline solution in total hip replacement. Primary outcomes were hemoglobin and hematocrit drop, and total blood loss. Secondary outcomes were transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events. We could match 100 patients to a control group. There were no statistical significantly differences between the two groups. The hemoglobin and hematocrit postoperative values were significantly higher in topical tranexamic acid group than in control group (P tranexamic acid group and 1163 in control group with significant differences (P = 0.001), which meant 34% reduction in total blood loss. Length of stay was lower in topical tranexamic acid group. The risk of deep vein thrombosis and pulmonary events did not increase. A single dose of 2 g tranexamic acid in 50 mL physiological saline solution topical administration was effective and safe in reducing bleeding in patients undergoing unilateral primary non-cemented total hip replacement compared to a matched control group.

Continuous Postoperative Pericardial Flushing: A Pilot Study on Safety, Feasibility, and Effect on Blood Loss

NARCIS (Netherlands)

Manshanden, Johan S. J.; Gielen, Chantal L. I.; de Borgie, Corianne A. J. M.; Klautz, Robert J. M.; de Mol, Bas A. J. M.; Koolbergen, David R.

2015-01-01

Background: Prolonged or excessive blood loss is a common complication after cardiac surgery. Blood remnants and clots, remaining in the pericardial space in spite of chest tube drainage, induce high fibrinolytic activity that may contribute to bleeding complications. Continuous postoperative

Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery.

Science.gov (United States)

Shim, Jae Kwang; Choi, Yong Seon; Oh, Young Jun; Bang, Sou Ouk; Yoo, Kyung Jong; Kwak, Young Lan

2007-07-01

Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting. One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively. Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups. Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.

First Trimester Pregnancy Loss and the Expression of alternatively spliced NKp30 isoforms in Maternal Blood and Placental Tissue

Directory of Open Access Journals (Sweden)

Avishai eShemesh

2015-06-01

Full Text Available In this study, we aimed to investigate whether first trimester pregnancy loss is associated with differences in expression of NKp30 splice variants (isoforms in maternal peripheral blood or placental tissue. We conducted a prospective case-control study; a total of 33 women undergoing dilation and curettage due to first trimester pregnancy loss were further subdivided into groups with sporadic or recurrent pregnancy loss. The control group was comprised of women undergoing elective termination of pregnancy. The qPCR approach was employed to assess the relative expression of NKp30 isoforms as well as the total expression of NKp30 and NKp46 receptors between the selected groups. Results show that in both PBMC and placental tissue, NKp46 and NKp30 expression was mildly elevated in the pregnancy loss groups compared with the elective group. In particular, NKp46 elevation was significant. Moreover, expression analysis of NKp30 isoforms manifested a different profile between PBMC and the placenta. NKp30-a and NKp30-b isoforms in the placental tissue, but not in PBMC, showed a significant increase in the pregnancy loss groups compared with the elective group. Placental expression of NKp30 activating isoforms -a and -b in the pregnancy loss groups was negatively correlated with PLGF expression. In contrast, placental expression of these isoforms in the elective group was positively correlated with TNFα, IL-10 and VEGF-A expression. The altered expression of NKp30 activating isoforms in placental tissue from patients with pregnancy loss compared to the elective group and the different correlations with cytokine expression point to the involvement of NKp30-mediated function in pregnancy loss.

Audit on the Efficient Use of Cross-Matched Blood in Elective Total Hip and Total Knee Replacement

Science.gov (United States)

Rogers, BA; Johnstone, DJ

2006-01-01

INTRODUCTION This prospective audit studies the use of cross-matched blood in 301 patients over a 1-year period undergoing total knee (TKR) and total hip replacement (THR) surgery in an orthopaedic unit. PATIENTS AND METHODS Analysis over the first 6 months revealed a high level of unnecessary cross-matched blood. The following interventions were introduced: (i) to cease routine cross-matching for THR; (ii) all patients to have a check full blood count on day 2 after surgery; and (iii) Hb < 8 g/dl to be considered as the trigger for transfusion in patients over 65 years and free from significant co-morbidity. These changes are in accordance with published national guidelines [Anon. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113: 24–31]. RESULTS In the next 6 months, the number of units cross-matched but not transfused fell by 96% for THR, and the cross-match transfusion (C:T) ratio reduced from 3.21 to 1.62. Reductions were also observed for the TKR cohort. These results provide evidence of a substantial risk and cost benefit in the use of this limited resource. A telephone survey of 44 hospitals revealed that 20 hospitals routinely cross-matched blood for THR and 11 do so for TKR. CONCLUSIONS Changes can be made to the Maximum Surgical Blood Ordering Schedules (MSBOS) in other orthopaedic units according to national guidelines. PMID:16551419

Reduction of aspirin-induced fecal blood loss with low-dose misoprostol tablets in man

International Nuclear Information System (INIS)

Cohen, M.M.; Clark, L.; Armstrong, L.; D'Souza, J.

1985-01-01

Misoprostol (SC-29333), a synthetic prostaglandin E1 methyl ester analog, was given simultaneously with acetylsalicylic acid in a double-blind, placebo-controlled randomized prospective study of 32 healthy human male subjects. Fecal blood loss was measured for eight days using the 51 Cr-labeled red blood cell technique. Aspirin (650 mg qid) and misoprostol (25 micrograms qid) or placebo were given during days 3, 4, and 5. There was a significant (P less than 0.05) increase in median blood loss (modified Friedman test) from 0.81 to 6.05 ml/day in the aspirin with placebo group (N = 16). Median blood loss was increased (from 0.75 to 3.75 ml/day) in the aspirin with misoprostol group (N = 16), but this was significantly less (Mann-Whitney U test, P less than 0.01) than the placebo group. Mean serum salicylate concentrations in the placebo and misoprostol groups were similar (7.8 and 6.8 micrograms/ml, respectively). There were no significant changes in laboratory values in any of the subjects studied, nor were any major side-effects encountered. This study demonstrates that oral misoprostol reduces aspirin-induced gastrointestinal bleeding even when administered simultaneously and at a dose level below its threshold for significant acid inhibition. This indicates a potential role for misoprostol in the prevention of gastric mucosal damage in selected patients

Allogeneic blood transfusion and prognosis following total hip replacement: a population-based follow up study

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Overgaard Soren

2009-12-01

Full Text Available Abstract Background Allogeneic red blood cell transfusion is frequently used in total hip replacement surgery (THR. However, data on the prognosis of transfused patients are sparse. In this study we compared the risk of complications following THR in transfused and non-transfused patients. Methods A population-based follow-up study was performed using data from medical databases in Denmark. We identified 28,087 primary THR procedures performed from 1999 to 2007, from which we computed a propensity score for red blood cell transfusion based on detailed data on patient-, procedure-, and hospital-related characteristics. We were able to match 2,254 transfused with 2,254 non-transfused THR patients using the propensity score. Results Of the 28,087 THR patients, 9,063 (32.3% received at least one red blood cell transfusion within 8 days of surgery. Transfused patients had higher 90-day mortality compared with matched non-transfused patients: the adjusted OR was 2.2 (95% confidence interval (CI: 1.2-3.8. Blood transfusion was also associated with increased odds of pneumonia (OR 2.1; CI: 1.2-3.8, whereas the associations with cardiovascular or cerebrovascular events (OR 1.4; CI: 0.9-2.2 and venous thromboembolism (OR 1.2; CI: 0.7-2.1 did not reach statistical significance. The adjusted OR of reoperation due to infection was 0.6 (CI: 0.1-2.9. Conclusions Red blood cell transfusion was associated with an adverse prognosis following primary THR, in particular with increased odds of death and pneumonia. Although the odds estimates may partly reflect unmeasured bias due to blood loss, they indicate the need for careful assessment of the risk versus benefit of transfusion even in relation to routine THR procedures.

The effect of blood volume loss on cardiovascular response to lower body negative pressure using a mathematical model

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Karam, E. H.; Srinivasan, R. S.; Charles, J. B.; Fortney, S. M.

1994-01-01

Different mathematical models of varying complexity have been proposed in recent years to study the cardiovascular (CV) system. However, only a few of them specifically address the response to lower body negative pressure (LBNP), a stress that can be applied in weightlessness to predict changes in orthostatic tolerance. Also, the simulated results produced by these models agree only partially with experimental observations. In contrast, the model proposed by Melchior et al., and modified by Karam et al. is a simple representation of the CV system capable of accurately reproducing observed LBNP responses up to presyncopal levels. There are significant changes in LBNP response due to a loss of blood volume and other alterations that occur in weightlessness and related one-g conditions such as bedrest. A few days of bedrest can cause up to 15% blood volume loss (BVL), with consequent decreases in both stroke volume and cardiac output, and increases in heart rate, mean arterial pressure, and total peripheral resistance. These changes are more pronounced at higher levels of LBNP. This paper presents the results of a simulation study using our CV model to examine the effect of BVL on LBNP response.

"Hidden" Preoperative Blood Loss With Extracapsular Versus Intracapsular Hip Fractures: What Is the Difference?

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Harper, Katharine D; Navo, Paul; Ramsey, Frederick; Jallow, Sainabou; Rehman, Saqib

2017-12-01

Excessive blood loss with hip fracture management has been shown to result in increased rates of complications. Our goal is to compare blood loss and transfusion rates between patients with intracapsular and extracapsular (both intertrochanteric (IT) and subtrochanteric (ST)) hip fractures. 472 patients were evaluated over a five-year period. Those who presented to the hospital with a proximal femur fracture (femoral neck, IT or ST) were considered for the study. Exclusion criteria included polytrauma, gunshot injuries, periprosthetic fractures, and non-operative management. Primary endpoint was hemoglobin (Hgb) drop from admission to day of surgery (DOS); secondary endpoint was need for pre-op transfusion and discharge location. 304 patients were analyzed who sustained a proximal femur fracture. Median IC Hgb drop was 0.6g/dL; median EC Hgb drop was 1.1g/dL from admission to DOS ( p = 0.0272). Rate of pre-operative transfusions was higher in EC (36/194 = 18.6%) than IC fractures (5/105 = 4.5%) ( p = 0.0006), and overall transfusion rates remained higher throughout hospital stay (55.7% EC vs. 32.7% IC; p = 0.0001). Breakdown of bleeding rate and tranfusion rates between IT and ST fractures were not significant ( p = 0.07; p = 0.4483). Extracapsular hip fractures were more likely to be discharged to a skilled nursing facility (SNF) (84.4% EC vs. 73.8% IC; p = 0.027). Intracapsular hip fractures have significantly less pre-operative blood loss and fewer pre-operative transfusions than their extracapsular counterparts. These findings can be used to establish appropriate pre-operative resuscitative efforts, ensuring that hip fracture protocols account for the increased likelihood of blood loss in extracapsular fractures.

Quantification of total hexose on dry blood spot by tandem mass spectrometry.

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Gong, Zhenhua; Tian, Guoli; Huang, Qiwei; Wang, Yanmin; Ge, Qingwei

2012-12-01

Because hypoglycemia and hyperglycemia are harmful and not always associated with overt clinical signs, it is necessary to have methods available to screen for glucose levels to detect hypoglycemia and diabetes as early as possible. A new method for such screening and the clinical determination of blood total hexose on a dry blood spot (DBS) using tandem mass spectrometry (MS/MS) was developed. The serum glucose controls and blood were prepared as DBS and then extracted into a methanol solution containing isotope-labeled internal standards. The methanolic extraction was subjected to HPLC, followed by MS/MS in positive ion mode. Multiple-reaction monitoring of m/z 203.1→23 was used to detect hexose, and m/z 209.0→23 was used for 13C6-D-glucose. The recoveries of blood glucose by MS/MS were 90%-102% with an R(2) value of 0.999 after linear regression (pblood total hexose in neonates aged 3-7 days (6.41±1.46 mmol/L) was lower than that in neonates aged 8-30 days (6.66±1.38 mmol/L), and it was lower in neonates than in children aged 1-72 months (7.19±1.87 mmol/L). Quantification of total hexose on a dry blood spot by MS/MS is accurate, reliable and feasible for screening and clinical tests. Copyright © 2012 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Ciclosporine A asxay: RIA or HPLC, plasma or total blood

International Nuclear Information System (INIS)

Lapalus, P.; Garraffo, R.; Krebs, B.; Lapalus, F.

1985-01-01

The two methods now in force for ciclosporine A assay are radioimmunoassay (RIA) and high pressure liquid chromatography (HPLC) in various biological media (plasma, serum, total blood). The advantages and disadvantages of the two methods are presented [fr

A double-blind, placebo-controlled randomized clinical trial to evaluate the efficacy of tranexamic acid in irrigant solution on blood loss during percutaneous nephrolithotomy: a pilot study from tertiary care center of North India.

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Bansal, Ankur; Arora, Aditi

2017-08-01

To evaluate the efficacy and safety of 0.1% tranexamic acid in irrigant fluid in reducing blood loss during PCNL. The study involved 400 patients who were planned for PCNL and were prospectively randomized into two equal groups. In tranexamic group, 0.1% tranexamic acid was given in irrigant fluid, while in placebo group, distilled water was added to irrigant fluid during surgery. Operative data were recorded which included fall in hemoglobin, total blood loss, operative time, irrigation fluid, length of stay in hospital, requirement of blood transfusion, complications related to PCNL and adverse events of tranexamic acid. Baseline parameters were comparable between two groups. The fall in hemoglobin and total blood loss in the tranexamic group was significantly lower than placebo group (1.71 vs. 2.67 gm/dL, 154.55 vs. 212.61 mL, respectively, p tranexamic group were significantly less compared to placebo (p tranexamic group versus 82% in placebo (p = 0.12). The blood transfusion requirement was significantly lower in the tranexamic group versus placebo (5 vs. 12.5%, p = 0.012), as was the complication rate (19 vs. 28%, p = 0.044). The requirement of angioembolization in the tranexamic group was significantly less as compared to placebo (0.5 vs. 4%, p = 0.03). No adverse events related to administration of tranexamic acid were noted. 0.1% tranexamic acid in irrigant fluid is safe and significantly reduces perioperative blood loss and requirement of blood transfusion during percutaneous nephrolithotomy. It is associated with lower perioperative complication rates.

Estimation and comparison of intra operative blood loss in patients with and without venous thromboembolism prophylaxis

International Nuclear Information System (INIS)

Ahsin, S.; Bashir, A.; Faiz, S.A.; Tahir, J.; Ijaz, A.

2014-01-01

To estimate and compare intraoperative blood loss in surgical patients with and without deep vein thrombosis (DVT) prophylaxis using unfractionated heparin Study Design: Clinical Trial Place and Duration: Surgery Department of Fauji Foundation Hospital and Physiology Department Foundation University Medical College from October 2011 to August 2012 Patients and Methodology: Patients were selected by non probability purposive sampling. Patients fulfilling the inclusion criteria were divided into 2 groups 25 each on the basis of order of presentation at Fauji Foundation Hospital until cohort numbers were reached. Group I received no heparin whereas group II received heparin. Written informed consent was taken from the patient after explaining the procedure of the study. Coagulation profile was done for both groups before the planned surgery. Heparin in a dose of 5000 units was administered subcutaneously to group II on the morning of the planned surgery and it was stopped 24 hours post operatively. Blood loss was estimated in both groups by weighing cotton swabs pre and post operatively. Data was analyzed by SPSS version 17. Results: Demographic data and surgical procedure time between the two groups did not differ. Blood loss between the two groups did not show any statistically significant difference. Conclusion: DVT prophylaxis using unfractionated heparin did not lead to any significant overt blood loss when compared with those without it. (author)

Detection of Salmonella sp., Vibrio sp. and total plate count bacteria on blood cockle (Anadara granosa)

Science.gov (United States)

Ekawati, ER; Yusmiati, S. N. H.

2018-01-01

Blood cockle (Anadara granosa) has high level of zinc and protein, which is beneficial for therapeutic function for malnourished particularly stunting case in children. Zinc in animal foods is more absorbable than that from vegetable food. Blood cockle (Anadara granosa) is rich in nutrient and an excellent environment for the growth of microorganisms. This research aimed to identify the contamination of Salmonella sp., Vibrio sp. and total plate count bacteria on blood cockle (Anadara granosa). This was observation research with laboratory analysis. Salmonella sp. and Vibrio sp. were detected from blood cockle. Total plate count was determine of the total amount of the bacteria. Results detected from 20 samples of blood cockle showed that all samples were negative of Salmonella sp. and 1 sample positive Vibrio sp. The result of total plate count bacteria was < 5 x 105 colony/g sample.

Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study [version 1; referees: 1 approved, 2 approved with reservations

Directory of Open Access Journals (Sweden)

Firtantyo Adi Syahputra

2016-06-01

Full Text Available Objectives Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL. Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice.   Methods A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL.   Results Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037. Our results revealed that TBL (mL = -153.379 + 0.229 × stone burden (mm2 + 0.203 x baseline serum hematocrit (%; thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL.

Use of tranexamic acid in total knee arthroplasty

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MARRA, FRANCESCO; ROSSO, FEDERICA; BRUZZONE, MATTEO; BONASIA, DAVIDE EDOARDO; DETTONI, FEDERICO; ROSSI, ROBERTO

2016-01-01

Purpose different strategies have been developed to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. Methods we enrolled all patients submitted to a primary TKA in our department between November 2014 and August 2015. They were divided into three groups corresponding to the method of TXA administration used: intravenous (IV), intra-articular (IA), and a combination of the two. Demographic data, as well as preoperative hemoglobin and platelet levels, were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions; postoperative pain was also assessed. Student’s t-test or a χ2 test was used to evaluate between-group differences, using p<0.05 as the cut-off for statistically significant differences. Results the sample comprised 34 patients: IV, 10 cases; IA, 15 cases, and combined (IV + IA), 9 cases. The average age of the patients was 71.1±6.4 years. No significant differences in the outcome measures were found between the groups, with the exception of a significantly lower maximum hemoglobin loss in the combined versus the IV group (p=0.02). There were no differences between the groups in the amount of blood in the drain or the rate of transfusions. Conclusions the data from this preliminary study, as well as data from the literature, confirm that TXA administration is safe and effective in reducing total blood loss in TKA, and no administration protocol seems to be superior to the others. Level of evidence Level II, prospective comparative study. PMID:28217656

Triggers of blood transfusion in percutaneous nephrolithotomy

International Nuclear Information System (INIS)

Zehri, A.K.; Biyabani, S.R.; Siddiqui, K.M.; Memon, A.

2011-01-01

To determine the triggers of blood transfusion in patients undergoing percutaneous nephrolithotomy (PCNL). The percutaneous surgery database was retrospectively reviewed to identify patients with postoperative haemorrhage and need for blood transfusion. Blood loss was estimated by the postoperative drop in haemoglobin factored by the quantity of any blood transfusion. Various patients and procedure-related factors were assessed for association with total blood loss or blood transfusion requirement using stepwise univariate, forward multivariate regression analysis. A total of 326 procedures were performed in 316 patients. Two hundred and thirty two procedures were included in the study. There were 167 males and 65 females. The mean age was 41+14 years. The mean haemoglobin drop was 1.68 +1.3 gm/dL. The overall blood transfusion rate was 14.2%. Stepwise multivariate regression analysis showed that female gender (p = 0.003), staghorn stone (p = 0.023), stone fragmentation with ultrasound (p = 0.054) and chronic renal failure (p = 0.001) were significantly predictive of the need for blood transfusion. Chronic renal failure, female gender, presence of staghorn calculi and stone fragmentation using ultrasonic device were predictive of blood transfusion in this cohort of patients. (author)

Blood Management Strategies to Reduce Transfusions After Elective Lower-Extremity Joint Arthroplasty Surgeries: One Tertiary Care Hospital's Early Experience With an Alternative Payment Model-a Total Joint "Bundle".

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Kansagra, Ankit; Andrzejewski, Chester; Krushell, Robert; Lehman, Andrew; Greenbaum, Jordan; Visintainer, Paul; McGirr, Joan; Mahoney, Kathleen; Cloutier, Darlene; Ehresman, Alice; Stefan, Mihaela S

Blood loss associated with lower-extremity total joint arthroplasty (TJA) often results in anemia and the need for red blood cell transfusions (RBCTs). This article reports on a quality improvement initiative aimed at improving blood management strategies in patients undergoing TJA. A multifaceted intervention (preoperative anemia assessment, use of tranexamic acid, discouragement of autologous preoperative blood collection, restrictive RBCT protocols) was implemented. The results were stratified into 3 intervention periods: 1, pre; 2, peri; and 3, post. Fractional logistic regression was used to describe differences between various intervention periods. During the study period, 2511 patients underwent TJA. Compared with the preintervention period, there was 81.8% decrease in total units of RBCT during the postintervention period. Using activity-based costing (~$1000/unit), the annualized saving in RBC expenditure was $480 000. A multidisciplinary approach can be successful and sustainable in reducing RBCT and its associated costs for patients undergoing TJA.

A new strategy for umbilical cord blood collection developed at the first Colombian public cord blood bank increases total nucleated cell content.

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Vanegas, Diana; Triviño, Lady; Galindo, Cristian; Franco, Leidy; Salguero, Gustavo; Camacho, Bernardo; Perdomo-Arciniegas, Ana-María

2017-09-01

The total nucleated cell dosage of umbilical cord blood (UCB) is an important factor in determining successful allogeneic hematopoietic stem cell transplantation after a minimum human leukocyte antigen donor-recipient match. The northern South American population is in need of a new-generation cord blood bank that cryopreserves only units with high total nucleated cell content, thereby increasing the likelihood of use. Colombia set up a public cord blood bank in 2014; and, as a result of its research for improving high total nucleated cell content, a new strategy for UCB collection was developed. Data from 2933 collected and 759 cryopreserved cord blood units between 2014 and 2015 were analyzed. The correlation of donor and collection variables with cellularity was evaluated. Moreover, blood volume, cell content, CD34+ count, clonogenic capacity, and microbial contamination were assessed comparing the new method, which combines in utero and ex utero techniques, with the conventional strategies. Multivariate analysis confirmed a correlation between neonatal birth weight and cell content. The new collection method increased total nucleated cell content in approximately 26% and did not alter pre-cryopreservation and post-thaw cell recovery, viability, or clonogenic ability. Furthermore, it showed a remarkably low microbial contamination rate (1.2%). The strategy for UCB collection developed at the first Colombian public cord blood bank increases total nucleated cell content and does not affect unit quality. The existence of this bank is a remarkable breakthrough for Latin-American patients in need of this kind of transplantation. © 2017 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

Early Removal of Drainage Tube after Fast-Track Primary Total Knee Arthroplasty.

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Zhang, Shaoyun; Xu, Bin; Huang, Qiang; Yao, Huan; Xie, Jinwei; Pei, Fuxing

2017-07-01

There is no consensus as to whether drainage tube should be used and how long it should remain in use after primary total knee arthroplasty (TKA). As fast-track (FT) program has been implemented in TKA, whether drainage tube could be removed early, and the ideal timing for removal after FT primary TKA has been a new topic. The purpose of this prospective cohort study was to evaluate the safety and feasibility of early removal of drainage tube when FT program was implemented in primary TKA. A total of 101 patients undergoing FT primary TKA were prospectively allocated into three groups. Patients in group A (31 patients) indwelled wound drainage tube for 6 hours after surgery while group B (34 patients) for 12 hours and group C (36 patients) for 18 hours. The knee circumference, resting and moving visual analogue score (VAS), hemoglobin (Hb), hematocrit, white blood count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), the volume of blood loss and drainage, and postoperative length of stay (LOS) among three groups were recorded and compared. There was no statistically significant difference in the volume of total and hidden blood loss among three groups ( p  > 0.05), but as the time of drainage prolonged, total volume of drainage and dominant blood loss increased gradually ( p   0.05), the decrease of Hb in the perioperative period and postoperative LOS as well. Early removal of wound drainage tube could drain the hematocele and reduce the risk of infection, and it doesn't increase the sense of pain, inflammatory reaction, limb swelling, and total blood loss. It's safe and feasible to remove the drainage tube within 6 to 12 hours after FT primary TKA. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A randomised controlled trial of oxytocin 5IU and placebo infusion versus oxytocin 5IU and 30IU infusion for the control of blood loss at elective caesarean section--pilot study. ISRCTN 40302163.

LENUS (Irish Health Repository)

Murphy, Deirdre J

2012-02-01

OBJECTIVE: To compare the blood loss at elective lower segment caesarean section with administration of oxytocin 5IU bolus versus oxytocin 5IU bolus and oxytocin 30IU infusion and to establish whether a large multi-centre trial is feasible. STUDY DESIGN: Women booked for an elective caesarean section were recruited to a pilot randomised controlled trial and randomised to either oxytocin 5IU bolus and placebo infusion or oxytocin 5IU bolus and oxytocin 30IU infusion. We wished to establish whether the study design was feasible and acceptable and to establish sample size estimates for a definitive multi-centre trial. The outcome measures were total estimated blood loss at caesarean section and in the immediate postpartum period and the need for an additional uterotonic agent. RESULTS: A total of 115 women were randomised and 110 were suitable for analysis (5 protocol violations). Despite strict exclusion criteria 84% of the target population were considered eligible for study participation and of those approached only 15% declined to participate and 11% delivered prior to the planned date. The total mean estimated blood loss was lower in the oxytocin infusion arm compared to placebo (567 ml versus 624 ml) and fewer women had a major haemorrhage (>1000 ml, 14% versus 17%) or required an additional uterotonic agent (5% versus 11%). A sample size of 1500 in each arm would be required to demonstrate a 3% absolute reduction in major haemorrhage (from baseline 10%) with >80% power. CONCLUSION: An additional oxytocin infusion at elective caesarean section may reduce blood loss and warrants evaluation in a large multi-centre trial.

The efficacy of topical tranexamic acid in total hip arthroplasty: a meta-analysis.

Science.gov (United States)

Chen, Shubiao; Wu, Kezhou; Kong, Gengbin; Feng, Weili; Deng, Zhihua; Wang, Hu

2016-02-16

Topical tranexamic acid (TXA) has been shown to be effective in reducing blood loss and the need for transfusion after total knee arthroplasty. However, the effectiveness of topical TXA use in total hip arthroplasty (THA) still remains unclear. The purpose of this meta-analysis is to examine the safety and efficacy of topical use of TXA following THA. Topical TXA reduces blood loss and transfusion rates without increasing risk of deep vein thrombosis in patients with THA. An electronic literature search of PubMed, Embase, the Cochrane Library, Web of Science and Chinese Biomedical Database was performed, to identify studies published before February 2015. All randomized controlled trials and cohort studies evaluating the efficacy of topical TXA during THA were included. Two independent authors identified the eligible studies, assessed their methodological quality, and extracted data. The data were using fixed-effects or random-effects models with (standard) mean differences and risk ratios for continuous and dichotomous variables, respectively. Data were analysed using RevMan 5.3 software. Fourteen studies encompassing 2594 patients met the inclusion criteria for our meta-analysis. Our meta-analysis indicated that when compared with the placebo group, topical use of TXA significantly reduced total blood loss (MD = -297.65 ml, 95 % CI -371.68 ml, 116.08 ml; P level (SMD = -0.66, 95 % CI -0.91, -0.41; P Topical TXA could significantly reduce total blood loss, drainage loss, transfusion rates and decrease haemoglobin level following THA, without increasing risk of venous thromboembolisms.

Vaccination with recombinant aspartic hemoglobinase reduces parasite load and blood loss after hookworm infection in dogs.

Directory of Open Access Journals (Sweden)

Alex Loukas

2005-10-01

Full Text Available Hookworms infect 730 million people in developing countries where they are a leading cause of intestinal blood loss and iron-deficiency anemia. At the site of attachment to the host, adult hookworms ingest blood and lyse the erythrocytes to release hemoglobin. The parasites subsequently digest hemoglobin in their intestines using a cascade of proteolysis that begins with the Ancylostoma caninum aspartic protease 1, APR-1.We show that vaccination of dogs with recombinant Ac-APR-1 induced antibody and cellular responses and resulted in significantly reduced hookworm burdens (p = 0.056 and fecal egg counts (p = 0.018 in vaccinated dogs compared to control dogs after challenge with infective larvae of A. caninum. Most importantly, vaccinated dogs were protected against blood loss (p = 0.049 and most did not develop anemia, the major pathologic sequela of hookworm disease. IgG from vaccinated animals decreased the catalytic activity of the recombinant enzyme in vitro and the antibody bound in situ to the intestines of worms recovered from vaccinated dogs, implying that the vaccine interferes with the parasite's ability to digest blood.To the best of our knowledge, this is the first report of a recombinant vaccine from a hematophagous parasite that significantly reduces both parasite load and blood loss, and it supports the development of APR-1 as a human hookworm vaccine.

[Clinical signification of a modified dilution method (MDM) for blood loss assessment in the cases of nonvariceal upper gastrointestinal bleeding].

Science.gov (United States)

Geogiev, G; Shishenkov, M; Ninov, B; Dosheva, I

2006-01-01

The aim of this study was to compare the modified dilution method (MDM) for in vivo bloodless assessment with the accepted in the clinical practice methods. We measured 148 blood samples from 134 patients with nonvariceal upper gastrointestinal bleeding (NUGB) and 21 blood samples from healthy persons as a negative control. In the randomized group of 53 patients with NUGB we compared accuracy of the blood loss determination by means of erythrocyte mass loss (estimated with MDM), Allgower-Burri index and American College of Surgeon Index (ACSI). The obtained results give us a reason to recommend a combination between American College of Surgeon classification for blood loss in patients with NUGB and a parallel measurement of the MDM values.

Influence of curve magnitude and other variables on operative time, blood loss and transfusion requirements in adolescent idiopathic scoliosis.

LENUS (Irish Health Repository)

Nugent, M

2015-05-03

Posterior spinal instrumentation and fusion for correction of adolescent idiopathic scoliosis (AIS) typically requires lengthy operating time and may be associated with significant blood loss and subsequent transfusion. This study aimed to identify factors predictive of duration of surgery, intraoperative blood loss and transfusion requirements in an Irish AIS cohort.

The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery : A meta-analysis

NARCIS (Netherlands)

Schouten, Esther S.; van de Pol, Alma C.; Schouten, Anton N. J.; Turner, Nigel M.; Jansen, Nicolaas J. G.; Bollen, Casper W.

Objective: Aprotinin reduces the blood loss and transfusion of blood products in children undergoing major surgery. Aprotinin has been associated with severe side effects in adults, and tranexamic acid and aminocaproic acid have been found to be safer alternatives in adults. This systematic review

Postoperative blood salvage versus allogeneic blood transfusion in total knee and hip arthroplasty: a literature review.

Science.gov (United States)

Leigheb, Massimiliano; Pogliacomi, Francesco; Bosetti, Michela; Boccafoschi, Francesca; Sabbatini, Maurizio; Cannas, Mario; Grassi, Federico

2016-04-15

We aimed to compare Postoperative Blood Salvage (PBS) with Allogeneic Blood Transfusion (ABT) in patients undergoing Total Hip and Knee Arthroplasty (THA, TKA).  A bibliographic research was carried out in order to review the literature dedicated to postoperative blood salvage in major orthopaedic surgery, excluding papers dealing exclusively with preoperative autologous donation, intraoperative blood salvage and ABT. PBS and ABT were compared according to complications, costs and duration of hospitalization. PBS effectiveness in reducing ABT was also assessed. PBS system is useful for reducing the complication rate and the length of hospital stay if compared to ABT. Costs for the reinfusion of unwashed shed blood, washed blood, and allogeneic transfusion are controversial among the different authors. Several papers demonstrate that PBS significantly reduces the need of postoperative ABT in both THA and TKA, while there is low evidence that PBS does not affect the risk of surgical wound complications. To reduce potential risks related to PBS, including non-hemolytic febrile reaction, the reinfusion of saved blood should begin within 4-6 hours after the start of collection through the wound drainage. According to literature, PBS appears to be a valid alternative to ABT, which is the standard treatment for postoperative anemia in THA and TKA. Contraindications to PBS must be ruled out before recommending it to patients undergoing major orthopaedic procedures.

Blood volume, blood pressure and total body sodium: internal signalling and output control

DEFF Research Database (Denmark)

Bie, P

2009-01-01

Total body sodium and arterial blood pressure (ABP) are mutually dependent variables regulated by complex control systems. This review addresses the role of ABP in the normal control of sodium excretion (NaEx), and the physiological control of renin secretion. NaEx is a pivotal determinant of ABP......, and under experimental conditions, ABP is a powerful, independent controller of NaEx. Blood volume is a function of dietary salt intake; however, ABP is not, at least not in steady states. A transient increase in ABP after a step-up in sodium intake could provide a causal relationship between ABP...... and the regulation of NaEx via a hypothetical integrative control system. However, recent data show that subtle sodium loading (simulating salty meals) causes robust natriuresis without changes in ABP. Changes in ABP are not necessary for natriuresis. Normal sodium excretion is not regulated by pressure. Plasma...

The effect of total blood exchange with PHP solution on cardiac xenotransplantation.

Science.gov (United States)

Liu, H; Agishi, T; Suga, H; Hayasaka, Y; Teraoka, S; Ota, K

1995-04-01

Prevention of hyperacute rejection is a difficult and unsolved problem in xenotransplantation. Natural antibodies and complement activation have been known to play an important role in the xenotransplantation between discordant species pairs. In the present study, total blood exchange (TBE) was performed with pyridoxalated-hemoglobin-polyoxyethylene conjugate (PHP) solution (Ajinomoto Co., Inc., Kawasaki, Japan) before cardiac xenotransplantation in order to remove the immunoglobulins and prolong xenograft survival time. Guinea pigs and rats were used as the discordant species combination for donor and recipient. Two groups were established: Group 1, untreated control (n = 8) and Group 2, TBT with PHP solution (n = 8). The exchange blood transfusion was carried out at the rate of 15-20 ml/h utilizing PHP solution using a blood pump. After the blood exchange was processed, hematocrit (Ht) levels dropped to 4 or 5%, and a cardiac xenotransplantation was performed within 24 h. The levels of serum IgA, IgM, and IgG were decreased to less than 25, 25, and 10% of the base line, respectively, after blood exchange. A mean xenograft survival time in Group 2 was prolonged to 472 +/- 74 min and to 10.4 +/- 1.8 min in Group 1 (p < 0.01). A titer of the anti-guinea pig lymphocytotoxic antibody in rat serum was decreased to almost nil. The data from this study suggest that total blood exchange with PHP solution may be useful in preoperative removal of xenograft antibodies in xenotransplantation.

Blood Density Is Nearly Equal to Water Density: A Validation Study of the Gravimetric Method of Measuring Intraoperative Blood Loss.

Science.gov (United States)

Vitello, Dominic J; Ripper, Richard M; Fettiplace, Michael R; Weinberg, Guy L; Vitello, Joseph M

2015-01-01

Purpose. The gravimetric method of weighing surgical sponges is used to quantify intraoperative blood loss. The dry mass minus the wet mass of the gauze equals the volume of blood lost. This method assumes that the density of blood is equivalent to water (1 gm/mL). This study's purpose was to validate the assumption that the density of blood is equivalent to water and to correlate density with hematocrit. Methods. 50 µL of whole blood was weighed from eighteen rats. A distilled water control was weighed for each blood sample. The averages of the blood and water were compared utilizing a Student's unpaired, one-tailed t-test. The masses of the blood samples and the hematocrits were compared using a linear regression. Results. The average mass of the eighteen blood samples was 0.0489 g and that of the distilled water controls was 0.0492 g. The t-test showed P = 0.2269 and R (2) = 0.03154. The hematocrit values ranged from 24% to 48%. The linear regression R (2) value was 0.1767. Conclusions. The R (2) value comparing the blood and distilled water masses suggests high correlation between the two populations. Linear regression showed the hematocrit was not proportional to the mass of the blood. The study confirmed that the measured density of blood is similar to water.

Maternal blood total oxypurines and erythrocyte 2,3-diphosphoglycerate levels during normal pregnancy.

Science.gov (United States)

Mizutani, S; Akiyama, H; Kurauchi, O; Taira, H; Yamada, R; Narita, O; Tomoda, Y

1985-01-01

The effects of pregnancy on the levels of maternal plasma total oxypurines (hypoxanthine, xanthine and uric acid) and erythrocyte 2,3-diphosphoglycerate (2,3-DPG) was investigated. With advancing gestation there was a slight increasing tendency in plasma total oxypurines as well as erythrocyte 2,3-DPG in pregnant women. When the ratio of 2,3-DPG to total oxypurines was calculated, the ratio was almost unchanged until week 34. After week 35, the ratio decreased to week 37; the ratios between week 37 and 40 had similar values to cord blood. The above data suggest that the changes of these metabolites in maternal peripheral blood may be indicative for hypoxia with fetoplacental tissue.

Comparative effectiveness of a portion-controlled meal replacement program for weight loss in adults with and without diabetes/high blood sugar.

Science.gov (United States)

Coleman, C D; Kiel, J R; Mitola, A H; Arterburn, L M

2017-07-10

Individuals with type 2 diabetes (DM2) may be less successful at achieving therapeutic weight loss than their counterparts without diabetes. This study compares weight loss in a cohort of adults with DM2 or high blood sugar (D/HBS) to a cohort of adults without D/HBS. All were overweight/obese and following a reduced or low-calorie commercial weight-loss program incorporating meal replacements (MRs) and one-on-one behavioral support. Demographic, weight, body composition, anthropometric, pulse and blood pressure data were collected as part of systematic retrospective chart review studies. Differences between cohorts by D/HBS status were analyzed using Mann-Whitney U-tests and mixed model regression. A total of 816 charts were included (125 with self-reported D/HBS). The cohort with D/HBS had more males (40.8 vs 25.6%), higher BMI (39.0 vs 36.3 kg m - 2 ) and was older (56 vs 48 years). Among clients continuing on program, the cohorts with and without D/HBS lost, on average, 5.6 vs 5.8 kg (NS) (5.0 vs 5.6%; P=0.005) of baseline weight at 4 weeks, 11.0 vs 11.6 kg (NS) (9.9 vs 11.1%; P=0.027) at 12 weeks and 16.3 vs 17.1 kg (13.9 vs 15.7%; NS) at 24 weeks, respectively. In a mixed model regression controlling for baseline weight, gender and meal plan, and an intention-to-treat analysis, there was no significant difference in weight loss between the cohorts at any time point. Over 70% in both cohorts lost ⩾5% of their baseline weight by the final visit on their originally assigned meal plan. Both cohorts had significant reductions from baseline in body fat, blood pressure, pulse and abdominal circumference. Adults who were overweight/obese and with D/HBS following a commercial weight-loss program incorporating MRs and one-on-one behavioral support achieved therapeutic weight loss. The program was equally effective for weight loss and reductions in cardiometabolic risk factors among adults with and without D/HBS.

A comparison of total amount of blood needed in patients taking autologous or homologous blood transfusion in coronary artery bypass grafting a clinical randomized case control trial

International Nuclear Information System (INIS)

Akhlagh, S.H.; Chohedri, A.H.; Bazojoo, A.; Nemati, M.H.

2007-01-01

The aim of this clinical case-control trial was to compare the total amount of blood needed in patients taking autologous or homologous blood transfusion in coronary artery bypass grafting (CABG) surgery. Sixty patients scheduled for CABG were randomly allocated to ANH (Acute Normovulemic Hemodynamic) group (A group) or control group (B group). Hematocrit before operation and 24 hours after the operation were checked. The amount of the total blood needed in each group was measured at the end of the operation. There was no significant difference between the two groups as regards post operational hematocrit. The mean total blood infused to the control and ANH group was 2010 ml and 1815 ml respectively. However there was significant difference between the two groups as regards the total amount of the blood needed during operation. Our randomized, double blinded case control study demonstrated that autologous blood, beside carrying lower risks for hemolytic and nonhemolytic transfusion reactions decrease the total amount of blood needed for CABG. However larger studies with more patients are needed to confirm the results. (author)

Intravenous dexmedetomidine infusion in adult patients undergoing open nephrolithotomy: Effects on intraoperative hemodynamics and blood loss; a random

Directory of Open Access Journals (Sweden)

Doaa A. Rashwan

2015-10-01

Conclusion: Dexmedetomidine infusion in patients undergoing open nephrolithotomy under general anesthesia was associated with intraoperative hemodynamic stability, which decreases intraoperative blood loss and the need for intraoperative blood transfusion.

Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis.

Science.gov (United States)

Shin, Young-Soo; Yoon, Jung-Ro; Lee, Hoon-Nyun; Park, Se-Hwan; Lee, Dae-Hee

2017-11-01

This meta-analysis was designed to compare the effectiveness and safety of intravenous (IV) versus topical administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty (TKA) by evaluating the need for allogenic blood transfusion, incidence of postoperative complications, volume of postoperative blood loss, and change in haemoglobin levels. Studies were included in this meta-analysis to check whether they assessed the allogenic blood transfusion rate, postoperative complications including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT), volume of postoperative blood loss via drainage, estimated blood loss, total blood loss, and change in haemoglobin levels before and after surgery in primary TKA with TXA administered through both the IV and topical routes. Ten studies were included in this meta-analysis. The proportion of patients requiring allogenic blood transfusion (OR 1.34, 95 % CI 0.63-2.81; n.s.) and the proportion of patients who developed postoperative complications including PTE or DVT (OR 0.85, 95 % CI 0.41 to 1.77; n.s.) did not significantly differ between the two groups. There was 52.3 mL less blood loss via drainage (95 % CI -50.74 to 185.66 mL; n.s.), 52.1 mL greater estimated blood loss (95 % CI -155.27 to 51.03 mL; n.s.), and 51.4 mL greater total blood loss (95 % CI -208.16 to 105.31 mL; n.s.) in the topical TXA group as compared to the IV TXA group. The two groups were also similar in terms of the change in haemoglobin levels (0.02 g/dL, 95 % CI -0.36 to 0.39 g/dL; n.s.). In primary TKA, there are no significant differences in the transfusion requirement, postoperative complications, blood loss, and change in haemoglobin levels between the IV and topical administration of TXA. In addition, results from subgroup analysis evaluating the effect of the times of TXA administration through the IV route suggested that double IV dose of TXA is more effective than single dose in terms of the

The beneficial effect of Batroxobin on blood loss reduction in spinal fusion surgery

DEFF Research Database (Denmark)

Hu, Hui-Min; Chen, Li; Frary, Charles Edward

2015-01-01

Objective Our objective was to evaluate the efficacy and safety of Batroxobin on blood loss during spinal operations. Methods After obtaining approval from the ethics committee at the hospital along with informed written consent, we performed a double-blind, randomized, placebo-controlled study w...

Evaluation of the carotid artery stenosis based on minimization of mechanical energy loss of the blood flow.

Science.gov (United States)

Sia, Sheau Fung; Zhao, Xihai; Li, Rui; Zhang, Yu; Chong, Winston; He, Le; Chen, Yu

2016-11-01

Internal carotid artery stenosis requires an accurate risk assessment for the prevention of stroke. Although the internal carotid artery area stenosis ratio at the common carotid artery bifurcation can be used as one of the diagnostic methods of internal carotid artery stenosis, the accuracy of results would still depend on the measurement techniques. The purpose of this study is to propose a novel method to estimate the effect of internal carotid artery stenosis on the blood flow based on the concept of minimization of energy loss. Eight internal carotid arteries from different medical centers were diagnosed as stenosed internal carotid arteries, as plaques were found at different locations on the vessel. A computational fluid dynamics solver was developed based on an open-source code (OpenFOAM) to test the flow ratio and energy loss of those stenosed internal carotid arteries. For comparison, a healthy internal carotid artery and an idealized internal carotid artery model have also been tested and compared with stenosed internal carotid artery in terms of flow ratio and energy loss. We found that at a given common carotid artery bifurcation, there must be a certain flow distribution in the internal carotid artery and external carotid artery, for which the total energy loss at the bifurcation is at a minimum; for a given common carotid artery flow rate, an irregular shaped plaque at the bifurcation constantly resulted in a large value of minimization of energy loss. Thus, minimization of energy loss can be used as an indicator for the estimation of internal carotid artery stenosis.

Influence of sibutramine in addition to diet and exercise on the relationship between weight loss and blood glucose changes.

Science.gov (United States)

Kamil, Sadaf; Finer, Nicholas; James, William Philip T; Caterson, Ian D; Andersson, Charlotte; Torp-Pedersen, Christian

2017-07-01

Weight loss is expected to improve glycaemic control in patients with diabetes or at high risk hereof. Sibutramine causes weight loss and is associated with an increased risk of myocardial infarction and stroke in high-risk patients. We examined the impact of sibutramine-induced weight loss on glycaemic control. In total, 8192 obese patients with diabetes were randomized to sibutramine or placebo plus diet and exercise after a preliminary 6 weeks in which all patients received sibutramine. Patients were classified into four groups of weight change. A total of 1582 patients had a weight loss >5.7 kg; 2047 patients lost 3.7-5.7 kg; 2432 patients lost sibutramine lost slightly more weight than those on placebo (-0.2 kg on average, P sibutramine-treated patients were -0.4 mmol/L (±3.2, P = 0.0002), +0.1 mmol/L (±3.0, P = 0.04), +0.4 mmol/L (±2.8, P = 0.01), and +0.2 mmol/L (±3.4, P = 0.003). Mean values of HbA1c followed the same pattern though the HbA1c changes were smaller with weight loss and greater with weight gain in the sibutramine group. All results were statistically significant (P sibutramine, diet, and exercise attenuates falls in blood glucose levels and HbA1c compared with similar weight loss with placebo, diet, and exercise. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.

Assessment of Corrosion, Fretting, and Material Loss of Retrieved Modular Total Knee Arthroplasties.

Science.gov (United States)

Martin, Audrey J; Seagers, Kirsten A; Van Citters, Douglas W

2017-07-01

Modular junctions in total hip arthroplasties have been associated with fretting, corrosion, and debris release. The purpose of this study is to analyze damage severity in total knee arthroplasties of a single design by qualitative visual assessment and quantitative material loss measurements to evaluate implant performance and patient impact via material loss. Twenty-two modular knee retrievals of the same manufacturer were identified from an institutional review board-approved database. Junction designs included tapers with an axial screw and tapers with a radial screw. Constructs consisted of 2 metal alloys: CoCr and Ti6Al4V. Components were qualitatively scored and quantitatively measured for corrosion and fretting. Negative values represent adhered material. Statistical differences were analyzed using sign tests. Correlations were tested with a Spearman rank order test (P corrosion than other components, suggesting preferential corrosion when interfacing with Ti6Al4V. Overall, although corrosion was noted in this series, material loss was low, and none were revised for clinical metal-related reaction. This suggests the clinical impact from corrosion in total knee arthroplasty is low. Copyright © 2017 Elsevier Inc. All rights reserved.

'Shrink' losses in commercially sized corn silage piles: Quantifying total losses and where they occur.

Science.gov (United States)

Robinson, P H; Swanepoel, N; Heguy, J M; Price, T; Meyer, D M

2016-01-15

Silage 'shrink' (i.e., loss of fresh chopped crop between ensiling and feedout) represents a nutrient loss which can degrade air quality as volatile carbon compounds, degrade surface waterways due to seepage, or degrade aquifers due to seepage. Virtually no research has documented shrink in large silage piles. The term 'shrink' is often ill defined, but can be expressed as losses of wet weight (WW), oven dry matter (oDM), and oDM corrected for volatiles lost in the drying oven (vcoDM). Corn silage piles (4 wedge, 2 rollover/wedge, 1 bunker) from 950 to 12,204 tonnes as built, on concrete (4), soil (2) and a combination (1) in California's San Joaquin Valley, using a bacterial inoculant, covered within 24 h with an oxygen barrier inner film and black/white outer plastic, fed out using large front end loaders through an electronic feed tracking system, and from the 2013 crop year, were used. Shrink as WW, oDM and vcoDM were 90±17, 68±18 and 28±21 g/kg, suggesting that much WW shrink is water and much oDM shrink is volatiles lost during analytical oven drying. Most shrink occurred in the silage mass with losses from exposed silage faces, as well as between exposed face silage removal and the total mixed ration mixer, being low. Silage bulk density, exposed silage face management and face use rate did not have obvious impacts on any shrink measure, but age of the silage pile during silage feedout impacted shrink losses ('older' silage piles being higher), but most strongly for WW shrink. Real shrink losses (i.e., vcoDM) of large well managed corn silage piles are low, the exposed silage face is a small portion of losses, and many proposed shrink mitigations appeared ineffective, possibly because shrink was low overall and they are largely directed at the exposed silage face. Copyright © 2015 Elsevier B.V. All rights reserved.

Uptake and Loss Kinetics of 57Co, 85Sr and 134Cs on Blood Cockle Anadara granosa

International Nuclear Information System (INIS)

Srisuksawad, K; Prasertchiewchan, N.; Tungkitjanukij, S.; Pakkong, P.

2005-02-01

Adult blood cockle (A. granosa) were exposed in the laboratory to 57 Co, 85 Sr, and 134 Cs in seawater at average +- s.e. stable activities of 0.725+-0.010 Bq/ml, 0.917+-0.066 Bq/ml and 1.37+-0.105 Bq/ml, respectively. The study aims to determine key contaminant bioaccumulation, retention and loss parameters for bio-indicator organisms used in assessment of the impact of the effluent discharge from nuclear and non-nuclear facilities on coastal area. Natural coastal water conditions in dry season with a salinity of 30 ppt, at 30οC and p H 8.1+-0.1 of the study area (Bang Pa Kong river basin) were simulated as far as practicable. 19 d uptake of radiotracers showed that blood cockle did not accumulate 134 Cs and 85 Sr but considerably accumulated 57 Co. Non-linear regression model fitting of a 1-compartment exponential uptake model derived overall weight concentration factors for the whole cockle at saturation of 687.6+-6.23 ml/g for 57 Co. 22 d loss experiment showed that 57 Co is tightly bounded in blood cockle and 63.2+-15.2% retained in the whole body. Loss of 57 Co displayed 2-compartment loss kinetic. The calculated half time for the short and long components of loss model was estimated 1.4 dand 41 d, respectively

Patient pain and blood management in total hip and knee arthroplasty

NARCIS (Netherlands)

Thomassen, Bregje J.W.

2014-01-01

What is already known on this topic: Local infiltration analgesia in combination with a multimodal pain approach helps for adequate postoperative pain control. Blood saving alternatives should be implemented in the process of primary total hip and knee arthroplasties. The endpoint in patient

Use of intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials

Directory of Open Access Journals (Sweden)

FU De-jie

2013-04-01

Full Text Available 【Abstract】 Objective: The effect of tranexamic acid (TA on patients receiving total knee arthroplasty (TKA has been reported in many small clinical trials. But single trials are not sufficient enough to clarify the effectiveness and safety of TA. So, we carried out a meta-analysis of randomized controlled trials to investigate the efficacy and safety of the intravenous use of TA in TKA. Methods: Literatures were retrieved in Cochrane Library, OVID, PubMed, EMBASE, CNKI and Wanfang Data. All the related literatures were checked by two independent investigators and only the high quality randomized con-trolled trials were enrolled. Relevant data were analyzed using RevMan 5.1 to compare the difference of blood loss, transfusion and complications between TA group and con-trol group. Results: There were 353 related literatures and only 22 randomized controlled trials met the inclusion criteria. The use of TA in TKA significantly reduced total blood loss by a mean of 435.41 ml (95% CI 300.62-570.21, P<0.01, post-operative blood loss by a mean of 406.69 ml (95% CI 333.16-480.22, P<0.01. TA also significantly lowered the transfu-sion rate (risk difference 0.30, 95% CI 0.21-0.39, P<0.01 and transfusion volume (mean difference 0.95 unit, 95% CI 0.53-1.37, P<0.01. The risks between TA group and control group in developing deep vein thrombosis and pulmonary embo-lism were not statistically significant. Conclusion: TA is beneficial for patients undergoing TKA, which can significantly reduce total blood loss, post-operative blood loss, transfusion rate, and transfusion volume. Meanwhile TA is recommended to reduce deep vein thrombosis and pulmonary embolism following TKA. Key words: Tranexamic acid; Arthroplasty; Knee; Blood loss, surgical; Meta-analysis

Extracellular space, blood volume, and the early dumping syndrome after total gastrectomy

Energy Technology Data Exchange (ETDEWEB)

Miholic, J.; Reilmann, L.; Meyer, H.J.; Koerber, H.K.; Kotzerke, J.; Hecker, H. (Medzinische Hochschule Hannover (Germany, F.R.))

1990-10-01

Extracellular space and blood volume were measured using 82Br dilution and 51Cr-tagged erythrocytes in 24 tumor-free patients after total gastrectomy. Eleven of the patients suffered from early dumping. Age, blood volume, and extracellular space were significantly smaller in dumpers (P less than 0.05). The dumping score could be predicted by a multiple regression model considering blood volume per lean body mass and extracellular space (r = 0.637; P = 0.0039). Rapid (t1/2 less than 360 seconds) emptying of the gastric substitute, assessed using a 99Tc-labeled solid test meal, was significantly associated with dumping in addition to extracellular space and blood volume (r = 0.876; P = 0.0018). Both rapid emptying and a narrow extracellular space seem to contribute to the early dumping syndrome.

Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Mi, Bobin; Liu, Guohui; Zhou, Wu; Lv, Huijuan; Liu, Yi; Zha, Kun; Wu, Qipeng; Liu, Jing

2017-07-01

The purpose of this meta-analysis was to compare the blood loss and complications of intra-articular (IA) with intravenous (IV) tranexamic acid (TXA) for total knee arthroplasty (TKA). A comprehensive search of studies was conducted to identify related articles in Pubmed, Embase, Cochrane central Register of Controlled Trials, springerLink, OVID and the Research published from January 1980 to September 2016. All studies that compared IA TXA with IV TXA application on TKA were included. Main outcomes of the two methods were collected and analyzed by using Review Manager 5.3. There were 16 randomized controlled trials with 1308 cases met the criteria. Compared with IV TXA, IA TXA had similar blood volume of drainage, hidden blood loss, transfusion rate and complications (P > 0.05). IA TXA had lower total blood loss than IV TXA, and there was significant difference (P  0.05) when compared with IA TXA. Both IA TXA and single dose of IV TXA are effective in reducing total blood loss and postoperative hemoglobin drop without increasing complications of DVT or PE. The current meta-analysis suggests that 1.5 g TXA by IA administration or 1 g TXA by IV administration 10 min before tourniquet deflation is effective and safe in patients undergoing TKA.

Quantitative measurement of total cerebral blood flow using 2D phase-contrast MRI and doppler ultrasound

Energy Technology Data Exchange (ETDEWEB)

Seo, Keum Soo; Choi, Sun Seob; Lee, Young Il [Dong-A Univ., College of Medicine, Busan (Korea, Republic of)

2001-12-01

To compare of quantitative measurement of the total cerebral blood flow using two-dimensional phase-contrast MR imaging and Doppler ultrasound. In 16 volunteers (mean age, 26 years; mean body weight, 66 kg) without abnormal medical histories, two-dimensional phase-contrast MR imaging was performed at the level of the C2-3 inter vertebral disc for flow measurement of the internal carotid arteries and the vertebral arteries. Volume flow measurements using Doppler ultrasound were also performed at the internal carotid arteries 2cm above the carotid bifurcation, and at the vertebral arteries at the level of the upper pole of the thyroid gland. Flows in the four vessels measured by the two methods were compared using Wilcoxon's correlation analysis and the median score. Total cerebral blood flows were calculated by summing these four vessel flows, and mean values for the 16 volunteers were calculated. Cerebral blood flows measured by 2-D phase-contrast MR imaging and Doppler ultrasounds were 233 and 239 ml/min in the right internal carotid artery, 250 and 248 ml/min in the left internal carotid artery, 62 and 56 ml/min in the right vertebral artery, and 83 and 68 ml/min in the left vertebral artery. Correlation coefficients of the blood flows determined by the two methods were 0.48, 0.54, 0.49, and 0.62 in each vessel, while total cerebral blood flows were 628{+-}68 (range, 517 to 779) ml/min and 612{+-}79 (range, 482 to 804)ml/min, respectively. Total cerebral blood flow was easily measured using 2-D phase-contrast MR imaging and Doppler ultrasound, and the two noninvasive methods can therefore be used clinically for the measurement of total cerebral blood flow.

Tranexamic acid: optimal blood loss management in surface replacement arthroplasty.

Science.gov (United States)

Sassoon, A; Nam, D; Jackups, R; Johnson, S R; Nunley, R M; Barrack, R L

2016-02-01

This study investigated whether the use of tranexamic acid (TXA) decreased blood loss and transfusion related cost following surface replacement arthroplasty (SRA). A retrospective review of patients treated with TXA during a SRA, who did not receive autologous blood (TXA group) was performed. Two comparison groups were established; the first group comprised of patients who donated their own blood pre-operatively (auto group) and the second of patients who did not donate blood pre-operatively (control). Outcomes included transfusions, post-operative haemoglobin (Hgb), complications, and length of post-operative stay. Between 2009 and 2013, 150 patients undergoing SRA were identified for inclusion: 51 in the auto, 49 in the control, and 50 in the TXA group. There were no differences in the pre-operative Hgb concentrations between groups. The mean post-operative Hgb was 11.3 g/dL (9.1 to 13.6) in the auto and TXA groups, and 10.6 g/dL (8.1 to 12.1)in the control group (p = 0.001). Accounting for cost of transfusions, administration of TXA, and length of stay, the cost per patient was $1731, $339, and $185 for the auto, control and TXA groups, respectively. TXA use demonstrated higher post-operative Hgb concentrations when compared with controls and decreased peri-operative costs. Tranexamic acid safely limits allogeneic transfusion, maintains post-operative haemoglobin, and decreases direct and indirect transfusion related costs in surface replacement arthroplasty. ©2016 The British Editorial Society of Bone & Joint Surgery.

Continuous Postoperative Pericardial Flushing: A Pilot Study on Safety, Feasibility, and Effect on Blood Loss

Directory of Open Access Journals (Sweden)

Johan S.J. Manshanden

2015-09-01

Conclusions: CPPF after cardiac surgery was found to be safe and feasible in this experimental setting. The clinically relevant effect on blood loss needs to be confirmed in a randomized clinical trial.

Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial

Directory of Open Access Journals (Sweden)

Latter David

2009-06-01

Full Text Available Abstract Background Diffuse microvascular bleeding remains a common problem after cardiac procedures. Systemic use of antifibrinolytic reduces the postoperative blood loss. The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting (CABG. Methods Thirty eight patients scheduled for primary isolated coronary artery bypass grafting were included in this double blind, prospective, randomized, placebo controlled study. Tranexamic acid (TA group (19 patients received 1 gram of TA diluted in 100 ml normal saline. Placebo group (19 patients received 100 ml of normal saline only. The solution was purred in the pericardial and mediastinal cavities. Results Both groups were comparable in their baseline demographic and surgical characteristics. During the first 24 hours post-operatively, cumulative blood loss was significantly less in TA group (median of 626 ml compared to Placebo group (median of 1040 ml (P = 0.04. There was no significant difference in the post-op Packed RBCs transfusion between both groups (median of one unit in each (P = 0.82. Significant less platelets transfusion required in TA group (median zero unit than in placebo group (median 2 units (P = 0.03. Apart from re-exploration for excessive surgical bleeding in one patient in TA group, no difference was found in morbidity or mortality between both groups. Conclusion Topical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient.

Impact of blood sampling in very preterm infants

DEFF Research Database (Denmark)

Madsen, L P; Rasmussen, M K; Bjerregaard, L L

2000-01-01

; the groups were then subdivided into critically ill or not. Diagnostic blood sampling and blood transfusion events were recorded. In total, 1905 blood samples (5,253 analysis) were performed, corresponding to 0.7 samples (1.9 analysis) per day per infant. The highest frequencies were found during the first....../kg. For the extremely preterm infants a significant correlation between sampled and transfused blood volume was found (mean 37.1 and 33.3 ml/kg, respectively, r = + 0.71, p = 0.0003). The most frequently requested analyses were glucose, sodium and potassium. Few blood gas analyses were requested (1.9/ infant). No blood...... losses attributable to excessive generous sampling were detected. The results show an acceptable low frequency of sampling and transfusion events for infants of GA 28-32 weeks. The study emphasizes the necessity of thorough reflection and monitoring of blood losses when ordering blood sampling...

Transfusion of blood and blood component therapy for postpartum haemorrhage at a tertiary referral center

International Nuclear Information System (INIS)

Hussain, N.; Shah, T.; Shah, N.; Khan, N.H.

2011-01-01

Objective: To determine the practice of transfusion of blood and blood products in cases of postpartum haemorrhage, at a tertiary referral center. Methods: A retrospective study was conducted where medical records were reviewed for women, who either delivered or were admitted in labour suite with diagnosis of postpartum haemorrhage. The study period extended from Jan 2008 to Oct 2009. During a period of 22 months, records were reviewed for transfusion of blood and blood products in above group of women. Data were analyzed for descriptive statistics. Results: During the study period, a total of 4744 patients were admitted in the labour suite. A total of 113 (2.36%) women were diagnosed with Post partum haemorrhage. Uterine atony was the commonest cause of PPH, followed by genital tract trauma. A total of 81(71%) women received transfusion of blood and blood components (1.6%). The mean blood loss was 1088 ml (+- 584ml). Transfusion of blood and blood component therapy was significantly more in women who underwent caesarean section, compared to those women who delivered vaginally. There was one case of acute tubular necrosis due to PPH, and seven maternal deaths. The mean hospital stay was of +- 3 days. Conclusion: In this hospital based study, the prevalence of PPH was 2.36 +- %, and the rate of transfusion of blood and blood products was 1.6%.

Operative blood loss and the frequency of haemorrhage associated with adenotonsillectomy in children: a double-blind trial of ethamsylate.

Science.gov (United States)

Arora, Y R; Manford, M L

1979-06-01

One hundred children were allocated randomly to receive either ethamsylate (Dicynene) or a placebo before undergoing adenotonsillectomy. Blood loss at operation was estimated from the haemoglobin content of swabs and aspirated fluid. Mean blood loss in the ethamsylate-treated group was not significantly less than in the controls. The frequency of secondary haemorrhage was significantly less in children treated with ethamsylate (P less than 0.01). No side-effects were reported in either group.

Detection of Low-volume Blood Loss: Compensatory Reserve Versus Traditional Vital Signs

Science.gov (United States)

2014-01-01

follows: heart rate (HR), blood pressure (BP), respiratory rate, and oxygen saturation. These vital signs are, however, notoriously unreliable.2,3 As...additional tests using specific equipment.22 Base deficit (BD) is a rapidly and widely available serum laboratory marker of systemic acidosis that...and mortality.23,24 BD can increase, however, because of any derangement causing metabolic acidosis and is not limited to intravascular volume loss

The association between low levels of lead in blood and occupational noise-induced hearing loss in steel workers

Energy Technology Data Exchange (ETDEWEB)

Hwang, Yaw-Huei [Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC Rm. 735, 17, Xu-Zhou Rd., Taipei, Taiwan, ROC (China); Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC Rm. 735, 17, Xu-Zhou Rd., Taipei, Taiwan, ROC (China); Chiang, Han-Yueh [Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC Rm. 735, 17, Xu-Zhou Rd., Taipei, Taiwan, ROC (China); Yen-Jean, Mei-Chu [Division of Family Medicine, E-Da Hospital, Taiwan, ROC 1, E-Da Rd., Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, Taiwan, ROC (China); I-Shou University, Kaohsiung County, Taiwan, ROC 1, Sec. 1, Syuecheng Rd., Da-Shu Shiang, Kaohsiung County, Taiwan, ROC (China); Wang, Jung-Der, E-mail: jdwang@ntu.edu.tw [Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC Rm. 735, 17, Xu-Zhou Rd., Taipei, Taiwan, ROC (China); Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC Rm. 735, 17, Xu-Zhou Rd., Taipei, Taiwan, ROC (China); Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC No. 1, Chang-Teh St., Taipei, Taiwan, ROC (China)

2009-12-15

As the use of leaded gasoline has ceased in the last decade, background lead exposure has generally been reduced. The aim of this study was to examine the effect of low-level lead exposure on human hearing loss. This study was conducted in a steel plant and 412 workers were recruited from all over the plant. Personal information such as demographics and work history was obtained through a questionnaire. All subjects took part in an audiometric examination of hearing thresholds, for both ears, with air-conducted pure tones at frequencies of 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz. Subjects' blood samples were collected and analyzed for levels of manganese, copper, zinc, arsenic, cadmium and lead with inductive couple plasma-mass spectrometry. Meanwhile, noise levels in different working zones were determined using a sound level meter with A-weighting network. Only subjects with hearing loss difference of no more than 15 dB between both ears and had no congenital abnormalities were included in further data analysis. Lead was the only metal in blood found significantly correlated with hearing loss for most tested sound frequencies (p < 0.05 to p < 0.0001). After adjustment for age and noise level, the logistic regression model analysis indicated that elevated blood lead over 7 {mu}g/dL was significantly associated with hearing loss at the sound frequencies of 3000 through 8000 Hz with odds ratios raging from 3.06 to 6.26 (p < 0.05 {approx} p < 0.005). We concluded that elevated blood lead at level below 10 {mu}g/dL might enhance the noise-induced hearing loss. Future research needs to further explore the detailed mechanism.

The association between low levels of lead in blood and occupational noise-induced hearing loss in steel workers

International Nuclear Information System (INIS)

Hwang, Yaw-Huei; Chiang, Han-Yueh; Yen-Jean, Mei-Chu; Wang, Jung-Der

2009-01-01

As the use of leaded gasoline has ceased in the last decade, background lead exposure has generally been reduced. The aim of this study was to examine the effect of low-level lead exposure on human hearing loss. This study was conducted in a steel plant and 412 workers were recruited from all over the plant. Personal information such as demographics and work history was obtained through a questionnaire. All subjects took part in an audiometric examination of hearing thresholds, for both ears, with air-conducted pure tones at frequencies of 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz. Subjects' blood samples were collected and analyzed for levels of manganese, copper, zinc, arsenic, cadmium and lead with inductive couple plasma-mass spectrometry. Meanwhile, noise levels in different working zones were determined using a sound level meter with A-weighting network. Only subjects with hearing loss difference of no more than 15 dB between both ears and had no congenital abnormalities were included in further data analysis. Lead was the only metal in blood found significantly correlated with hearing loss for most tested sound frequencies (p < 0.05 to p < 0.0001). After adjustment for age and noise level, the logistic regression model analysis indicated that elevated blood lead over 7 μg/dL was significantly associated with hearing loss at the sound frequencies of 3000 through 8000 Hz with odds ratios raging from 3.06 to 6.26 (p < 0.05 ∼ p < 0.005). We concluded that elevated blood lead at level below 10 μg/dL might enhance the noise-induced hearing loss. Future research needs to further explore the detailed mechanism.

EFFICACY OF TRANEXAMIC ACID IN DECREASING BLOOD LOSS DURING AND AFTER CAESAREAN SECTION IN MULTIGRAVIDA PARTURIENTS: A CASE CONTROLLED PROSPECTIVE STUDY

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Gunavathi Kandappan

2016-06-01

Full Text Available OBJECTIVES To study the efficacy of Tranexamic acid in reducing blood loss during and after the lower segment caesarean section in Multigravida parturients. METHODOLOGY A case controlled prospective study was conducted in 50 multigravida parturient women undergoing elective lower segment caesarean section in our hospital after getting Institutional Ethical Committee approval, over a period of two months. 25 of them were given Tranexamic acid 15 mg/kg immediately before caesarean section. Blood loss was collected and measured during two periods. The first period was from placental delivery to end of LSCS and the second from the end LSCS to 2 hours postpartum. RESULTS Tranexamic acid significantly reduces the quantity of blood loss from the end of LSCS to 2 hours post-partum in multigravida parturients. No complications or side effects are noted in both the groups. CONCLUSION Tranexamic acid significantly reduces the amount of blood loss during and after the lower segment caesarean section in multigravida parturients and its use was not associated with any side effects or complications.

Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy.

Science.gov (United States)

Yun, Sung Il; Lee, Yoon Hyung; Kim, Jae Soo; Cho, Sung Ryong; Kim, Bum Soo; Kwon, Joon Beom

2012-11-01

Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. From March 2008 to February 2012, 57 selected patients underwent standard or totally tubeless PNL. Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PNL group. We compared patient and stone characteristics, operation time, length of hospitalization, analgesia requirements, stone-free rate, blood loss, change in creatinine, and perioperative complications between the standard and totally tubeless PNL groups. There were no significant differences in preoperative patient characteristics, postoperative complications, or the stone-free rate between the two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with the standard PNL group. Blood loss and change in creatinine were not significantly different between the two groups. Totally tubeless PNL appears to be a safe and effective alternative for the management of renal stone patients and is associated with a decrease in length of hospital stay.

Productivity loss due to premature mortality caused by blood cancer: a study based on patients undergoing stem cell transplantation.

Science.gov (United States)

Ortega-Ortega, Marta; Oliva-Moreno, Juan; Jiménez-Aguilera, Juan de Dios; Romero-Aguilar, Antonio; Espigado-Tocino, Ildefonso

2015-01-01

Stem cell transplantation has been used for many years to treat haematological malignancies that could not be cured by other treatments. Despite this medical breakthrough, mortality rates remain high. Our purpose was to evaluate labour productivity losses associated with premature mortality due to blood cancer in recipients of stem cell transplantations. We collected primary data from the clinical histories of blood cancer patients who had undergone stem cell transplantation between 2006 and 2011 in two Spanish hospitals. We carried out a descriptive analysis and calculated the years of potential life lost and years of potential productive life lost. Labour productivity losses due to premature mortality were estimated using the Human Capital method. An alternative approach, the Friction Cost method, was used as part of the sensitivity analysis. Our findings suggest that, in a population of 179 transplanted and deceased patients, males and people who die between the ages of 30 and 49 years generate higher labour productivity losses. The estimated loss amounts to over €31.4 million using the Human Capital method (€480,152 using the Friction Cost method), which means an average of €185,855 per death. The highest labour productivity losses are produced by leukaemia. However, lymphoma generates the highest loss per death. Further efforts are needed to reduce premature mortality in blood cancer patients undergoing transplantations and reduce economic losses. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

Blood profile of proteins and steroid hormones predicts weight change after weight loss with interactions of dietary protein level and glycemic index.

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Ping Wang

2011-02-01

Full Text Available Weight regain after weight loss is common. In the Diogenes dietary intervention study, high protein and low glycemic index (GI diet improved weight maintenance.To identify blood predictors for weight change after weight loss following the dietary intervention within the Diogenes study.Blood samples were collected at baseline and after 8-week low caloric diet-induced weight loss from 48 women who continued to lose weight and 48 women who regained weight during subsequent 6-month dietary intervention period with 4 diets varying in protein and GI levels. Thirty-one proteins and 3 steroid hormones were measured.Angiotensin I converting enzyme (ACE was the most important predictor. Its greater reduction during the 8-week weight loss was related to continued weight loss during the subsequent 6 months, identified by both Logistic Regression and Random Forests analyses. The prediction power of ACE was influenced by immunoproteins, particularly fibrinogen. Leptin, luteinizing hormone and some immunoproteins showed interactions with dietary protein level, while interleukin 8 showed interaction with GI level on the prediction of weight maintenance. A predictor panel of 15 variables enabled an optimal classification by Random Forests with an error rate of 24±1%. A logistic regression model with independent variables from 9 blood analytes had a prediction accuracy of 92%.A selected panel of blood proteins/steroids can predict the weight change after weight loss. ACE may play an important role in weight maintenance. The interactions of blood factors with dietary components are important for personalized dietary advice after weight loss.ClinicalTrials.gov NCT00390637.

Total Artificial Heart Implantation Blood Pressure Management as Resolving Treatment for Massive Hemolysis following Total Artificial Heart Implantation.

Science.gov (United States)

Ghodsizad, Ali; Koerner, Michael M; El-Banayosy, A; Zeriouh, Mohamed; Ruhparwar, Arjang; Loebe, Matthias

2016-10-21

The SynCardia Total Artificial Heart (TAH) has been used for patients with biventricular failure, who cannot be managed with implantation of a left ventricular (LV) assist device. Following TAH implantation, our patient developed severe hemolysis, which could only be managed successfully by aggressive blood pressure control [Ohashi 2003; Nakata 1998].

Isolation of Microarray-Grade Total RNA, MicroRNA, and DNA from a Single PAXgene Blood RNA Tube

DEFF Research Database (Denmark)

Kruhøffer, Mogens; Andersen, Lars Dyrskjøt; Voss, Thorsten

2007-01-01

We have developed a procedure for isolation of microRNA and genomic DNA in addition to total RNA from whole blood stabilized in PAXgene Blood RNA tubes. The procedure is based on automatic extraction on a BioRobot MDx and includes isolation of DNA from a fraction of the stabilized blood...... and recovery of small RNA species that are otherwise lost. The procedure presented here is suitable for large-scale experiments and is amenable to further automation. Procured total RNA and DNA was tested using Affymetrix Expression and single-nucleotide polymorphism GeneChips, respectively, and isolated micro......RNA was tested using spotted locked nucleic acid-based microarrays. We conclude that the yield and quality of total RNA, microRNA, and DNA from a single PAXgene blood RNA tube is sufficient for downstream microarray analysis....

STEAM GENERATOR TUBE INTEGRITY ANALYSIS OF A TOTAL LOSS OF ALL HEAT SINKS ACCIDENT FOR WOLSONG NPP UNIT 1

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HEOK-SOON LIM

2014-02-01

Full Text Available A total loss of all heat sinks is considered a severe accident with a low probability of occurrence. Following a total loss of all heat sinks, the degasser/condenser relief valves (DCRV become the sole means available for the depressurization of the primary heat transport system. If a nuclear power plant has a total loss of heat sinks accident, high-temperature steam and differential pressure between the primary heat transport system (PHTS and the steam generator (SG secondary side can cause a SG tube creep rupture. To protect the PHTS during a total loss of all heat sinks accident, a sufficient depressurization capability of the degasser/condenser relief valve and the SG tube integrity is very important. Therefore, an accurate estimation of the discharge through these valves is necessary to assess the impact of the PHTS overprotection and the SG tube integrity of the primary circuit. This paper describes the analysis of DCRV discharge capacity and the SG tube integrity under a total loss of all heat sink using the CATHENA code. It was found that the DCRV's discharge capacity is enough to protect the overpressure in the PHTS, and the SG tube integrity is maintained in a total loss of all heat accident.

Steam Generator Tube Integrity Analysis of A Total Loss of all Heat Sinks Accident for Wolsong NPP Unit 1

Energy Technology Data Exchange (ETDEWEB)

Lim, Heoksoon; Song, Taeyoung; Chi, Moongoo [Korea Htydro and Nuclear Power Co., Ltd., Daejeon (Korea, Republic of); Kim, Seoungrae [Nuclear Engineering Service and Solution, Daejeon (Korea, Republic of)

2014-02-15

A total loss of all heat sinks is considered a severe accident with a low probability of occurrence. Following a total loss of all heat sinks, the degasser/condenser relief valves (DCRV) become the sole means available for the depressurization of the primary heat transport system. If a nuclear power plant has a total loss of heat sinks accident, high-temperature steam and differential pressure between the primary heat transport system (PHTS) and the steam generator (SG) secondary side can cause a SG tube creep rupture. To protect the PHTS during a total loss of all heat sinks accident, a sufficient depressurization capability of the degasser/condenser relief valve and the SG tube integrity is very important. Therefore, an accurate estimation of the discharge through these valves is necessary to assess the impact of the PHTS overprotection and the SG tube integrity of the primary circuit. This paper describes the analysis of DCRV discharge capacity and the SG tube integrity under a total loss of all heat sink using the CATHENA code. It was found that the DCRV's discharge capacity is enough to protect the overpressure in the PHTS, and the SG tube integrity is maintained in a total loss of all heat accident.

Steam Generator Tube Integrity Analysis of A Total Loss of all Heat Sinks Accident for Wolsong NPP Unit 1

International Nuclear Information System (INIS)

Lim, Heoksoon; Song, Taeyoung; Chi, Moongoo; Kim, Seoungrae

2014-01-01

A total loss of all heat sinks is considered a severe accident with a low probability of occurrence. Following a total loss of all heat sinks, the degasser/condenser relief valves (DCRV) become the sole means available for the depressurization of the primary heat transport system. If a nuclear power plant has a total loss of heat sinks accident, high-temperature steam and differential pressure between the primary heat transport system (PHTS) and the steam generator (SG) secondary side can cause a SG tube creep rupture. To protect the PHTS during a total loss of all heat sinks accident, a sufficient depressurization capability of the degasser/condenser relief valve and the SG tube integrity is very important. Therefore, an accurate estimation of the discharge through these valves is necessary to assess the impact of the PHTS overprotection and the SG tube integrity of the primary circuit. This paper describes the analysis of DCRV discharge capacity and the SG tube integrity under a total loss of all heat sink using the CATHENA code. It was found that the DCRV's discharge capacity is enough to protect the overpressure in the PHTS, and the SG tube integrity is maintained in a total loss of all heat accident

Evaluation of Blood Hemodynamics in Vascular Grafts after Total Arterial Coronary Revascularization

Directory of Open Access Journals (Sweden)

Ahmad Ali Amirghofran

2016-07-01

Full Text Available Arterial grafting has increasingly been advocated for the treatment of coronary artery disease in an attempt to improve the long-term results. In the quest to perform routine total arterial revascularization, composite Y graft methods are gaining popularity. The aim of our study was to evaluate whether blood flow in the left internal thoracic artery can provide sufficient perfusion to the entire cardiac muscle per se. Twenty patients with severe coronary artery stenosis who underwent complete arterial coronary revascularization using a composite graft entered our study. Blood flow in thoracic trunk was evaluated in three phases: cross-clamp on, cross-clamp off, and after weaning the patient from cardiopulmonary bypass. Mean arterial blood pressure in the thoracic trunk in these various positions was 62.7±3.7. left internal thora cic artery can provide sufficient blood flow to the cardiac muscles for both rest and exercise conditions.

Total lymphoid irradiation in multiple sclerosis: blood lymphocytes and clinical course

International Nuclear Information System (INIS)

Cook, S.D.; Devereux, C.; Troiano, R.; Zito, G.; Hafstein, M.; Lavenhar, M.; Hernandez, E.; Dowling, P.C.

1987-01-01

We have found a significant relationship between blood lymphocyte count and prognosis in 45 patients receiving either total lymphoid irradiation or sham irradiation for chronic progressive multiple sclerosis. Patients with sustained lymphocyte counts less than 900 mm-3 for prolonged periods after treatment showed less rapid progression over the ensuing 3 years than did patients with multiple sclerosis who had lymphocyte counts above this level (p less than 0.01). Our results suggest that a simple laboratory test, the absolute blood lymphocyte count, may serve as a valuable barometer for monitoring the amount of immunosuppressive therapy needed to prevent progression in patients with multiple sclerosis, and possibly other autoimmune diseases

Thromboprophylaxis after minimally invasive total knee arthroplasty: A comparison of rivaroxaban and enoxaparin

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Shih-Hsiang Yen

2014-08-01

Full Text Available Background: Total knee arthroplasty (TKA carries a substantial rate of venous thromboembolism (VTE. The blood-saving of effect of tranexamic acid (TEA in TKA using enoxaparin for thromboprophylaxis has been well known. However, the routine use of chemoprophylaxis in TKA remains controversial because of postoperative bleeding complications. Therefore, the purpose of this study was to retrospectively compare the incidence of VTE, and postoperative blood loss and wound-related complications in minimally invasive (MIS-TKA patients who received rivaroxaban or enoxaparin prophylaxis. Methods: A total of 113 patients who underwent primary unilateral MIS-TKA between 2009 and 2012 were studied. Of these, 61 patients (study group received rivaroxaban prophylaxis between 2011 and 2012 and a control group of 52 patients received enoxaparin prophylaxis between 2009 and 2010. All patients received one intraoperative injection of TEA (10 mg/kg. We compared the changes in hemoglobin (Hb level, postoperative drainage amount, total blood loss, transfusion rate, and incidence of postoperative wound complications and VTE between the two groups. Results: No differences in postoperative Hb levels, blood drainage amount, total blood loss, and transfusion rate were observed between the two groups. No deep-vein thrombosis of the leg or pulmonary embolism was noted in both groups. There were no major wound complications including hematoma and infection requiring surgical intervention for open irrigation or debridement. Conclusions: Our retrospective study demonstrated a low rate of VTE in MIS-TKA patients who received rivaroxaban or enoxaparin when TEA was used for bleeding prophylaxis. No increased perioperative bleeding or postoperative wound-related complications were observed in the rivaroxaban group compared with the enoxaparin group

Desmopressin use for minimising perioperative blood transfusion

Science.gov (United States)

Desborough, Michael J; Oakland, Kathryn; Brierley, Charlotte; Bennett, Sean; Doree, Carolyn; Trivella, Marialena; Hopewell, Sally; Stanworth, Simon J; Estcourt, Lise J

2017-01-01

Background Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. Objectives To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (2017, issue 3) in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the Transfusion Evidence Library (from 1980), and ongoing trial databases (all searches to 3 April 2017). Selection criteria We included randomised controlled trials comparing DDAVP to placebo or an active comparator (e.g. tranexamic acid, aprotinin) before, during, or immediately after surgery or after invasive procedures in adults or children. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We identified 65 completed trials (3874 participants) and four ongoing trials. Of the 65 completed trials, 39 focused on adult cardiac surgery, three on paediatric cardiac surgery, 12 on orthopaedic surgery, two on plastic surgery, and two on vascular surgery; seven studies were conducted in surgery for other conditions. These trials were conducted between 1986 and 2016, and 11 were funded by pharmaceutical companies or by a party with a commercial interest in the outcome of the trial. The GRADE quality of evidence was very low to moderate across all outcomes. No trial reported quality of life. DDAVP versus placebo or no treatment Trial results showed considerable heterogeneity between surgical settings for total volume of red cells transfused (low

Combined effects of resistance training and carbohydrate-restrictive or conventional diets on weight loss, blood variables and endothelium function

Directory of Open Access Journals (Sweden)

Claudia Mello MEIRELLES

Full Text Available ABSTRACT Objective: To compare the effects of either a carbohydrate-restrictive diets or a conventional hypoenergetic diet combined with resistance training. Methods: Twenty-one overweight and obese adults participated in an eight-week program consisting of progressive resistance training combined with carbohydrate-restrictive diets (initially set at <30 g carbohydrate; n=12 or conventional hypoenergetic diet (30% energetic restriction; carbohydrate/protein/lipid: 51/18/31% of total energy consumption; n=9. It was hypothesized that the carbohydrate-restrictive diets would induce greater weight loss but that both diets would elicit similar effects on selected health markers. Body mass, and body composition, blood variables and flow-mediated brachial artery dilation (flow-mediated brachial artery dilation; by ultrasound were used to assess changes due to the interventions. Results: Significant within-group reductions in body mass (-5.4±3.5%; p=0.001 versus -3.7±3.0%; p=0.015 and body fat (body fat; -10.2±7.0%; p=0.005 versus -9.6±8.8%; p=0.017 were identified for carbohydrate-restrictive diets and conventional hypoenergetic diet, respectively, but there were no significant differences between groups as the result of the interventions. Fat free mass, blood variables and flow-mediated brachial artery dilation did not significantly change, except for the total cholesterol/high-density lipoprotein ratio, which was reduced 10.4±16.9% in carbohydrate-restrictive diets (p=0.037 and 0.5±11.3% in conventional hypoenergetic diet (p=0.398. Conclusion: Carbohydrate-restrictive diets associated with resistance training was as effective as conventional hypoenergetic diet in decreasing body mass and body fat, as well as maintaining fat free mass, blood variables and flow-mediated brachial artery dilation, however it was more effective at lowering the total cholesterol/low density lipoprotein ratio.

‘Shrink’ losses in commercially sized corn silage piles: Quantifying total losses and where they occur

Energy Technology Data Exchange (ETDEWEB)

Robinson, P.H.; Swanepoel, N.; Heguy, J.M.; Price, T.; Meyer, D.M., E-mail: phrobinson@ucdavis.edu [Department of Animal Science, UCCE Stanislaus, San Joaquin & Merced Counties, University of California, Davis, CA 95616 (United States)

2016-01-15

Silage ‘shrink’ (i.e., loss of fresh chopped crop between ensiling and feedout) represents a nutrient loss which can degrade air quality as volatile carbon compounds, degrade surface waterways due to seepage, or degrade aquifers due to seepage. Virtually no research has documented shrink in large silage piles. The term ‘shrink’ is often ill defined, but can be expressed as losses of wet weight (WW), oven dry matter (oDM), and oDM corrected for volatiles lost in the drying oven (vcoDM). Corn silage piles (4 wedge, 2 rollover/wedge, 1 bunker) from 950 to 12,204 tonnes as built, on concrete (4), soil (2) and a combination (1) in California's San Joaquin Valley, using a bacterial inoculant, covered within 24 h with an oxygen barrier inner film and black/white outer plastic, fed out using large front end loaders through an electronic feed tracking system, and from the 2013 crop year, were used. Shrink as WW, oDM and vcoDM were 90 ± 17, 68 ± 18 and 28 ± 21 g/kg, suggesting that much WW shrink is water and much oDM shrink is volatiles lost during analytical oven drying. Most shrink occurred in the silage mass with losses from exposed silage faces, as well as between exposed face silage removal and the total mixed ration mixer, being low. Silage bulk density, exposed silage face management and face use rate did not have obvious impacts on any shrink measure, but age of the silage pile during silage feedout impacted shrink losses (‘older’ silage piles being higher), but most strongly for WW shrink. Real shrink losses (i.e., vcoDM) of large well managed corn silage piles are low, the exposed silage face is a small portion of losses, and many proposed shrink mitigations appeared ineffective, possibly because shrink was low overall and they are largely directed at the exposed silage face. - Highlights: • Corn silage piles were used to measure ‘shrink’ from construction to feedout • Shrink was wet weight, dry weight (oDM) and oDM volatiles corrected

Effect of Tranexamic Acid on Blood Loss, D-Dimer, and Fibrinogen Kinetics in Adult Spinal Deformity Surgery.

Science.gov (United States)

Pong, Ryan P; Leveque, Jean-Christophe A; Edwards, Alicia; Yanamadala, Vijay; Wright, Anna K; Herodes, Megan; Sethi, Rajiv K

2018-05-02

Antifibrinolytics such as tranexamic acid reduce operative blood loss and blood product transfusion requirements in patients undergoing surgical correction of scoliosis. The factors involved in the unrelenting coagulopathy seen in scoliosis surgery are not well understood. One potential contributor is activation of the fibrinolytic system during a surgical procedure, likely related to clot dissolution and consumption of fibrinogen. The addition of tranexamic acid during a surgical procedure may mitigate the coagulopathy by impeding the derangement in D-dimer and fibrinogen kinetics. We retrospectively studied consecutive patients who had undergone surgical correction of adult spinal deformity between January 2010 and July 2016 at our institution. Intraoperative hemostatic data, surgical time, estimated blood loss, and transfusion records were analyzed for patients before and after the addition of tranexamic acid to our protocol. Each patient who received tranexamic acid and met inclusion criteria was cohort-matched with a patient who underwent a surgical procedure without tranexamic acid administration. There were 17 patients in the tranexamic acid cohort, with a mean age of 60.7 years, and 17 patients in the control cohort, with a mean age of 60.9 years. Estimated blood loss (932 ± 539 mL compared with 1,800 ± 1,029 mL; p = 0.005) and packed red blood-cell transfusions (1.5 ± 1.6 units compared with 4.0 ± 2.1 units; p = 0.001) were significantly lower in the tranexamic acid cohort. In all single-stage surgical procedures that met inclusion criteria, the rise of D-dimer was attenuated from 8.3 ± 5.0 μg/mL in the control cohort to 3.3 ± 3.2 μg/mL for the tranexamic acid cohort (p tranexamic acid cohort to 60.6 ± 35.1 mg/dL (p = 0.004). In patients undergoing spinal surgery, intravenous administration of tranexamic acid is effective at reducing intraoperative blood loss. Monitoring of D-dimer and fibrinogen during spinal surgery suggests that tranexamic acid

Volume-dependent hemodynamic effects of blood collection in canine donors - evaluation of 13% and 15% of total blood volume depletion

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RUI R.F. FERREIRA

2015-03-01

Full Text Available Background: There is no consensus regarding the blood volume that could be safely donated by dogs, ranging from 11 to 25% of its total blood volume (TBV. No previous studies evaluated sedated donors.Aim: To evaluate the hemodynamic effects of blood collection from sedated and non-sedated dogs and to understand if such effects were volume-dependent.Materials and Methods: Fifty three donations of 13% of TBV and 20 donations of 15% TBV were performed in dogs sedated with diazepam and ketamine. Additionally, a total of 30 collections of 13% TBV and 20 collections of 15% TBV were performed in non-sedated dogs. Non-invasive arterial blood pressures and pulse rates were registered before and 15 min after donation. Results: Post-donation pulse rates increased significantly in both sedated groups, with higher differences in the 15% TBV collections. Systolic arterial pressures decreased significantly in these groups, while diastolic pressures increased significantly in 13% TBV donations. Non-sedated groups revealed a slight, but significant, SBP decrease. No clinical signs related to donations were registered.Conclusion: These results suggest that the collection of 15% TBV in sedated donors induces hemodynamic variations that may compromise the harmlessness of the procedure, while it seems to be a safe procedure in non-sedated dogs.

Experimental studies on the blood loss and intake of 51Cr labelled red cells by Clonorchis sinensis in rabbits

International Nuclear Information System (INIS)

Lee, M.J.; Kim, J.R.; Rim, H.J.

1982-01-01

Experimental study was carried out to observe the blood loss due to the ingestion of host blood by Colonorchis sinensis in the rabbits by using chromium radioisotope 51 Cr. On the other hand, in order to confirm the blood intake activity by the worms, the radioactivity was measured on blood, bile juice and flukes removed from the bile ducts of the rabbits experimentally infected with C. sinensis. (Author)

Comparison of oral versus intravenous application of tranexamic acid in total knee and hip arthroplasty: A systematic review and meta-analysis.

Science.gov (United States)

Zhang, Lu-Kai; Ma, Jian-Xiong; Kuang, Ming-Jie; Zhao, Jie; Wang, Ying; Lu, Bin; Sun, Lei; Ma, Xin-Long

2017-09-01

Tranexamic acid (TXA) is regarded as one of the most important drugs in reducing blood loss and hemoglobin (Hb) drop after total knee arthroplasty (TKA) or total hip arthroplasty (THA). Treatment with tranexamic acid (TXA) by intravenous application has been discussed extensively. Recently, several studies have reported that oral administration has an effect on blood sparing. Therefore, we performed a meta-analysis to investigate the efficacy and safety between oral TXA and intravenous TXA (IV-TXA) for blood sparing in total knee and hip arthroplasty. Randomized controlled trials (RCTs) or retrospective cohort studies (RCSs) about relevant research were searched for by using PubMed (1996-April 2017), Embase (1980-April 2017), and the Cochrane Library (CENTRAL, April 2017). Five studies that compared oral with IV administration of TXA were included in our meta-analysis. Meta-analysis results were collected and analyzed by the software Review Manager 5.3 (Copenhagen: The Nordic Cochrane Center, The Collaboration, 2014). Five studies containing 3474 patients met the inclusion criteria. Our pooled data analysis indicated that oral TXA was as effective as the IV-TXA in terms of the average Hb drop (P = 0.88), total Hb loss (P = 0.57), total blood loss (P = 0.42), transfusion rate (P = 0.16), complications (P = 0.61), and length of hospital stay (P = 1.00). Compared with the IV-TXA method, oral TXA shows similar blood-sparing efficacy for preventing hemoglobin drop, total hemoglobin loss, and total blood loss following TKA or THA. In addition, no significant differences of transfusion rate, complications, or length of hospital stay were found between the 2 groups. However, because of the limited number of included studies, more studies of high quality are needed to further identify the optimal administration time for oral TXA. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Relationship Between Changes in Fat and Lean Depots Following Weight Loss and Changes in Cardiovascular Disease Risk Markers.

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Clifton, Peter M

2018-04-04

Gluteofemoral fat mass has been associated with improved cardiovascular disease risk factors. It is not clear if loss of this protective fat during weight loss partially negates the effect of loss of visceral fat. The aim of this study was to examine regional fat loss in a large weight-loss cohort from one center and to determine if fat loss in the leg and total lean tissue loss is harmful. We combined the data from 7 of our previously published 3-month weight-loss studies and examined the relationship between regional fat and lean tissue loss and changes in cardiovascular disease risk factors in 399 participants. At baseline, leg fat was positively associated with high-density lipoprotein cholesterol in women and inversely with fasting triglyceride level in both sexes. Abdominal lean tissue was also related to systolic blood pressure in men. Changes in regional fat and lean tissue were positively associated with changes in glucose, insulin, total cholesterol, triglycerides, low-density lipoprotein cholesterol and systolic and diastolic blood pressure ( r =0.11-0.22, P lean tissue dominating in multivariate regression. After adjustment for total weight or total fat change, these relationships disappeared except for a positive relationship between arm and lean leg mass loss and changes in triglycerides and systolic blood pressure. Loss of leg fat and leg lean tissue was directly associated with beneficial changes in cardiovascular disease risk markers. Loss of lean tissue may not have an adverse effect on cardiovascular disease risk, and measures to retain lean tissue during weight loss may not be necessary. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Evaluation of blood loss after early or late release of ischemia in patients undergoing total knee replacement Avaliação da perda sanguínea após a liberação precoce ou tardia da isquemia em pacientes submetidos à artroplastia total do joelho

Directory of Open Access Journals (Sweden)

Marcos George de Souza Leão

2013-04-01

Full Text Available OBJECTIVE: compare blood loss in 40 patients underwent to unilateral total knee replacement with the release of ischemia before and after skin closure and compressive dressing. METHODS: in a prospective randomized study, in 40 patients underwent to total knee replacement, dividing then into two groups: group A in which the ischemia was released before skin closure, allowing bleeding control and group B where the ischemia was released after skin suture and pressure dressing. We compared the results of laboratory tests of serum hemoglobin before surgery and 48 hours postoperatively, the blood volume contained in vacuum suction drain and the transfusions that was necessary. RESULTS: As a result, the post operative serum hemoglobin levels had a mean decrease of 3.57 g/dL in group A and 4.24 g/dL in group B with an average of 0.67g/dL difference between them, statistically insignificant.The observed mean drainage, in the vacuum drain, were 705 mL in group A and 700 mL in group B. The 5ml difference between medians was considered statistically insignificant. The number of patients who received transfusions was four patients in both groups and all received two units of red blood cells. CONCLUSION: the post operative serum hemoglobin levels, as well as the need of blood transfusion, in the patient underwent to total knee replacement, where the ischemia was released before wound closure, has no statistical effect in comparison with patients where the sutures and bandages were done after the ischemia release. Level of Evidence IB - Individual randomized controlled trial with narrow confidence interval. OBJETIVO: Avaliar comparativamente a perda sanguínea em pacientes submetidos à artroplastia total do joelho, com liberação da isquemia antes e após suturas e curativo compressivo. MÉTODOS: Fez-se um estudo prospectivo randomizado em 40 pacientes submetidos à artroplastia total do joelho divididos em dois grupos. No primeiro grupo a isquemia foi

Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study

Directory of Open Access Journals (Sweden)

Endres Stefan

2011-11-01

Full Text Available Abstract Background Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery. Methods This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments. Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed. Results The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39. The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the platelet concentration Allogenic blood transfusion (two red cell units was needed for eight patients

Onlay bone augmentation on mouse calvarial bone using a hydroxyapatite/collagen composite material with total blood or platelet-rich plasma.

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Ohba, Seigo; Sumita, Yoshinori; Umebayashi, Mayumi; Yoshimura, Hitoshi; Yoshida, Hisato; Matsuda, Shinpei; Kimura, Hideki; Asahina, Izumi; Sano, Kazuo

2016-01-01

The aim of this study was to assess newly formed onlay bone on mouse calvarial bone using a new artificial bone material, a hydroxyapatite/collagen composite, with total blood or platelet-rich plasma. The hydroxyapatite/collagen composite material with normal saline, total blood or platelet-rich plasma was transplanted on mouse calvarial bone. The mice were sacrificed and the specimens were harvested four weeks after surgery. The newly formed bone area was measured on hematoxylin and eosin stained specimens using Image J software. The hydroxyapatite/collagen composite materials with total blood or platelet-rich plasma induced a significantly greater amount of newly formed bone than that with normal saline. Moreover, bone marrow was observed four weeks after surgery in the transplanted materials with total blood or platelet-rich plasma but not with normal saline. However, there were no significant differences in the amount of newly formed bone between materials used with total blood versus platelet-rich plasma. The hydroxyapatite/collagen composite material was valid for onlay bone augmentation and this material should be soaked in total blood or platelet-rich plasma prior to transplantation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Biomonitoring of Lead, Cadmium, Total Mercury, and Methylmercury Levels in Maternal Blood and in Umbilical Cord Blood at Birth in South Korea

Science.gov (United States)

Kim, Yu-Mi; Chung, Jin-Young; An, Hyun Sook; Park, Sung Yong; Kim, Byoung-Gwon; Bae, Jong Woon; Han, Myoungseok; Cho, Yeon Jean; Hong, Young-Seoub

2015-01-01

With rising concerns of heavy metal exposure in pregnancy and early childhood, this study was conducted to assess the relationship between the lead, cadmium, mercury, and methylmercury blood levels in pregnancy and neonatal period. The study population included 104 mothers and their children pairs who completed both baseline maternal blood sampling at the second trimester and umbilical cord blood sampling at birth. The geometric mean maternal blood levels of lead, cadmium, total mercury, and methylmercury at the second trimester were 1.02 ± 1.39 µg/dL, 0.61 ± 1.51 µg/L, 2.97 ± 1.45 µg/L, and 2.39 ± 1.45 µg/L, respectively, and in the newborns, these levels at birth were 0.71 ± 1.42 µg/dL, 0.01 ± 5.31 µg/L, 4.44 ± 1.49 µg/L, and 3.67 ± 1.51 µg/L, respectively. The mean ratios of lead, cadmium, total mercury, and methylmercury levels in the newborns to those in the mothers were 0.72, 0.04, 1.76, and 1.81, respectively. The levels of most heavy metals in pregnant women and infants were higher in this study than in studies from industrialized western countries. The placenta appears to protect fetuses from cadmium; however, total mercury and methylmercury were able to cross the placenta and accumulate in fetuses. PMID:26516876

Allogenic blood transfusion following total hip arthroplasty: results from the nationwide inpatient sample, 2000 to 2009.

Science.gov (United States)

Saleh, Anas; Small, Travis; Chandran Pillai, Aiswarya Lekshmi Pillai; Schiltz, Nicholas K; Klika, Alison K; Barsoum, Wael K

2014-09-17

The large-scale utilization of allogenic blood transfusion and its associated outcomes have been described in critically ill patients and those undergoing high-risk cardiac surgery but not in patients undergoing elective total hip arthroplasty. The objective of this study was to determine the trends in utilization and outcomes of allogenic blood transfusion in patients undergoing primary total hip arthroplasty in the United States from 2000 to 2009. An observational cohort of 2,087,423 patients who underwent primary total hip arthroplasty from 2000 to 2009 was identified in the Nationwide Inpatient Sample. International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes 99.03 and 99.04 were used to identify patients who received allogenic blood products during their hospital stay. Risk factors for allogenic transfusions were identified with use of multivariable logistic regression models. We used propensity score matching to estimate the adjusted association between transfusion and surgical outcomes. The rate of allogenic blood transfusion increased from 11.8% in 2000 to 19.0% in 2009. Patient-related risk factors for receiving an allogenic blood transfusion include an older age, female sex, black race, and Medicaid insurance. Hospital-related risk factors include rural location, smaller size, and non-academic status. After adjusting for confounders, allogenic blood transfusion was associated with a longer hospital stay (0.58 ± 0.02 day; p conservation methods. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

The reversible P2Y12 antagonist ACT-246475 causes significantly less blood loss than ticagrelor at equivalent antithrombotic efficacy in rat.

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Rey, Markus; Kramberg, Markus; Hess, Patrick; Morrison, Keith; Ernst, Roland; Haag, Franck; Weber, Edgar; Clozel, Martine; Baumann, Martine; Caroff, Eva; Hubler, Francis; Riederer, Markus A; Steiner, Beat

2017-10-01

The P2Y 12 receptor is a validated target for prevention of major adverse cardiovascular events in patients with acute coronary syndrome. The aim of this study was to compare two direct-acting, reversible P2Y 12 antagonists, ACT-246475 and ticagrelor, in a rat thrombosis model by simultaneous quantification of their antithrombotic efficacy and surgery-induced blood loss. Blood flow velocity was assessed in the carotid artery after FeCl 3 -induced thrombus formation using a Doppler flow probe. At the same time, blood loss after surgical wounding of the spleen was quantified. Continuous infusions of ACT-246475 and ticagrelor prevented the injury-induced reduction of blood flow in a dose-dependent manner. High doses of both antagonists normalized blood flow and completely abolished thrombus formation as confirmed by histology. Intermediate doses restored baseline blood flow to ≥65%. However, ACT-246475 caused significantly less increase of blood loss than ticagrelor; the difference in blood loss was 2.6-fold (P ACT-246475 and ticagrelor on vascular tone. At concentrations needed to achieve maximal antithrombotic efficacy, ticagrelor compared with ACT-246475 significantly increased carotid blood flow velocity in vivo (P = 0.003), induced vasorelaxation of precontracted rat femoral arteries, and inhibited contraction of femoral artery induced by electrical field stimulation or by phenylephrine. Overall, ACT-246475 showed a significantly wider therapeutic window than ticagrelor. The absence of vasodilatory effects due to high selectivity of ACT-246475 for P2Y 12 provides potential arguments for the observed safety advantage of ACT-246475 over ticagrelor. © 2017 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.

Evaluation of the contribution of smoking to total blood polonium-210 in Saudi population

Energy Technology Data Exchange (ETDEWEB)

Shabana, E.I. E-mail: eshabana@kacst.edu.sa; Elaziz, M.A. Abd; Al-Arifi, M.N.; Al-Dhawailie, A.A.; Al-Bokari, M.M-A

2000-01-01

A preliminary study of {sup 210}Po concentrations in the blood of some smokers and nonsmokers is presented in order to evaluate the contribution of smoking to total blood {sup 210}Po in Saudi population. Blood samples were collected from 30 volunteers and analyzed by high resolution {alpha}-spectrometry using a radiochemical technique. The technique is based on the separation of polonium from other components of the sample by wet ashing with an HNO{sub 3}/H{sub 2}O{sub 2} oxidizing mixture and spontaneous deposition on a silver disc under the relevant conditions for {alpha}-particle counting. The results indicated that a significant fraction (about 30%) of blood {sup 210}Po is related to smoking.

Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life.

Science.gov (United States)

Huang, Ze-Ning; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Tu, Ru-Hong; Lin, Ju-Li

2017-10-21

To evaluate the short-term outcomes and quality of life (QoL) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-later-cut overlap method (IJOM) after totally laparoscopic total gastrectomy (TLTG). A total of 507 patients who underwent laparoscopic gastrectomy (D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG (group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy (LATG) (group A, n = 456). The short-term outcomes and QoL were compared between the two groups after 1:2 propensity-score matching (PSM). We used a questionnaire to assess QoL. Before matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups ( P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A ( P < 0.05). After matching, group T reported better QoL in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better QoL ("Have you felt pain" and "Have you had difficulty eating solid food") ( P < 0.05). The IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving QoL after laparoscopic gastrectomy.

Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty.

Science.gov (United States)

Bilgili, Mustafa Gökhan; Erçin, Ersin; Peker, Gökhan; Kural, Cemal; Başaran, Serdar Hakan; Duramaz, Altuğ; Avkan, Cevdet

2014-06-01

Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Retrospective comparative study. Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (pblood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.

Experimental studies on the blood loss and intake of /sup 51/Cr labelled red cells by Clonorchis sinensis in rabbits

Energy Technology Data Exchange (ETDEWEB)

Lee, M.J.; Kim, J.R.; Rim, H.J. (Korea Univ, Seoul (Republic of Korea). Coll. of Medicine)

1982-03-01

Experimental study was carried out to observe the blood loss due to the ingestion of host blood by Colonorchis sinensis in the rabbits by using chromium radioisotope /sup 51/Cr. On the other hand, in order to confirm the blood intake activity by the worms, the radioactivity was measured on blood, bile juice and flukes removed from the bile ducts of the rabbits experimentally infected with C. sinensis.

Effects of Clonidine Premedication on Intraoperative Blood Loss in Patients With and Without Opium Addiction During Elective Femoral Fracture Surgeries.

Science.gov (United States)

Ommi, Davood; Teymourian, Houman; Zali, Alireza; Ashrafi, Farzad; Jabbary Moghaddam, Morteza; Mirkheshti, Alireza

2015-08-01

Opium is an addictive agent and one of the most common narcotics With great challenges of intraoperative hemodynamic instabilities. The current study aimed to assess the effects of clonidine on intraoperative blood loss in patients with and without opium addiction in femoral fracture surgeries. In a randomized clinical trial, 160 candidates for elective femoral fracture operations under general anesthesia were divided into four groups of 40 subjects: group 1 (placebo 1), subjects without addiction received placebo 90 minutes before the operation; group 2 (placebo 2), patients with opium addiction received placebo as group 1; group 3 (Clonidine 1), patients without addiction received clonidine 90 minutes before the operation and group 4 (Clonidine 2), patients with opium addiction received clonidine as premedication. Intraoperative blood loss in clonidine recipient groups, patients with and without addiction, was less than that of the placebos (both P values opium addiction. Premedication with clonidine to decrease intraoperative blood loss can be more effective in patients with opium addiction than the ones without addiction.

Effects of exercise and respiration on blood flow in total cavopulmonary connection

DEFF Research Database (Denmark)

Hjortdal, V E; Emmertsen, K; Stenbøg, E

2003-01-01

BACKGROUND: Little is known about blood flow and its relationship to respiration during exercise in patients with total cavopulmonary connection (TCPC). METHODS AND RESULTS: We studied 11 patients 12.4+/-4.6 years (mean+/-SD) of age 5.9+/-2.8 years (mean+/-SD) after TCPC operation. Real-time MRI...

Safety of retransfusing shed blood after local infiltration analgesia in total knee arthroplasty

NARCIS (Netherlands)

Thomassen, B.J.; Pool, L.; Van Der Flier, R.; Stienstra, R.; in 't Veld, B.A.

2012-01-01

We investigated the safety of LIA (local infiltration analgesia) combined with retransfusion of drained blood. Total knee arthroplasty patients received two peri-articular injections during surgery followed by continuous infusion, both with ropivacaine (567 mg). Ropivacaine plasma concentrations

Predictive Value of Intraoperative Thromboelastometry for the Risk of Perioperative Excessive Blood Loss in Infants and Children Undergoing Congenital Cardiac Surgery: A Retrospective Analysis.

Science.gov (United States)

Kim, Eunhee; Shim, Haeng Seon; Kim, Won Ho; Lee, Sue-Young; Park, Sun-Kyung; Yang, Ji-Hyuk; Jun, Tae-Gook; Kim, Chung Su

2016-10-01

Laboratory hemostatic variables and parameters of rotational thromboelastometry (ROTEM) were evaluated for their ability to predict perioperative excessive blood loss (PEBL) after congenital cardiac surgery. Retrospective and observational. Single, large university hospital. The study comprised 119 children younger than 10 years old undergoing congenital cardiac surgery with cardiopulmonary bypass (CPB). Intraoperative excessive blood loss was defined as estimated blood loss≥50% of estimated blood volume (EBV). Postoperative excessive blood loss was defined as measured postoperative chest tube and Jackson-Pratt drainage≥30% of EBV over 12 hours or≥50% of EBV over 24 hours in the intensive care unit. PEBL was defined as either intraoperative or postoperative excessive blood loss. External temogram (EXTEM) and fibrinogen temogram (FIBTEM) were analyzed before and after CPB with ROTEM and laboratory hemostatic variables. Multivariate logistic regression was performed. Incidence of PEBL was 19.3% (n = 23). Independent risk factors for PEBL were CPB time>120 minutes, post-CPB FIBTEM alpha-angle, clot firmness after 10 minutes20%. Laboratory hemostatic variables were not significant in multivariate analysis. The risk prediction model was developed from the results of multivariate analysis. The area under the receiver operating characteristic curve was 0.94 (95% confidence interval: 0.90-0.99). Post-CPB ROTEM may be useful for predicting both intraoperative and postoperative excessive blood loss in congenital cardiac surgery. This study provided an accurate prediction model for PEBL and supported intraoperative transfusion guidance using post-CPB FIBTEM-A10 and EXTEM-A10. Copyright © 2016 Elsevier Inc. All rights reserved.

Tranexamic Acid in Total Joint Arthroplasty: Efficacy and Safety

Directory of Open Access Journals (Sweden)

Mohammad Reza Rasouli

2015-01-01

Full Text Available Despite improvements in surgical and anesthetic techniques, total joint arthroplasty (TJA is still associated with substantial blood loss and postoperative anemia (1. A considerable portion of patients with postoperative anemia require blood transfusion, which has been shown to negatively affect the outcome of TJA and predisposes patients to development of surgical site infection and periprosthetic joint infection (2,3.   Various blood conservation strategies have been developed to reduce the need for allogeneic blood transfusion in patients undergoing TJA (3. Administration of tranexamic acid (TA is one of the most effective (4. TA is a synthetic lysine derivative drug that binds to plasminogen and prevents the interaction of plasminogen and fibrin, eventually leading to dissolution of fibrin clots (5.   There is level I evidence supporting the need for allogeneic transfusion in primary total hip and total knee arthroplasties, and the efficacy of TA in particular for reducing blood loss (6,7. TA is also effective in reducing the need for blood transfusion in bilateral TJA and revision surgeries (4. Moreover, when TA is used, other blood conservation strategies are rendered unnecessary (4.   The drug can be used intravenously in a weight-based manner (10-20 mg/kg, or administered 1gm intravenously at the start of surgery and 1gm intravenously at the end of surgery, or up to 3 hours after the first dose. TA can also be applied topically to the surgical site to provide hemostasis, or it can be injected intra-articularly (1g in 50 cc saline. Although oral administration of TA (25 mg/kg, maximum 2g, two hours preoperatively has also been reported to be effective, it is not routinely used in TJA patients and intravenous and topical methods are preferred (4.   Despite the proven efficacy of the use of TA in TJA, there are still some concerns about the development of venous thromboembolism (VTE after TA is used. Since VTE following TJA is

Measures of total stress-induced blood pressure responses are associated with vascular damage.

Science.gov (United States)

Nazzaro, Pietro; Seccia, Teresa; Vulpis, Vito; Schirosi, Gabriella; Serio, Gabriella; Battista, Loredana; Pirrelli, Anna

2005-09-01

The role of cardiovascular reactivity to study hypertension, and the assessment methods, are still controversial. We aimed to verify the association of hypertension and vascular damage with several measures of cardiovascular response. We studied 40 patients with normal-high (132 +/- 1/87 +/- 1 mm Hg) blood pressure (Group 1) and 80 untreated hypertensive subjects. Postischemic forearm vascular resistance (mFVR) served to differentiate hypertensive subjects (142 +/- 2/92 +/- 1 mm Hg v 143 +/- 2/94 +/- 2 mm Hg, P = NS) with a lower (Group 2) and higher (Group 3) hemodynamic index of vascular damage (4.8 +/- .05 v 6.3 +/- .09, P blood pressure, heart rate, forearm blood flow, and vascular resistance. Reactivity measures included: a) change from baseline, b) residualized score, c) cumulative change from baseline and residualized score, and d) total reactivity as area-under-the-curve (AUC), including changes occurring during baseline and recovery phases. The AUC of systolic blood pressure, diastolic blood pressure, and mFVR progressively increased in the groups (P AUC of SBP, DBP, and forearm blood flow and resistance demonstrated the highest (P AUC of SBP (beta = 0.634) and forearm blood flow (beta = -0.337) were predictive (P blood pressure stress response, as AUC, including baseline and recovery phases, was significantly better associated with hypertension and vascular damage than the other reactivity measures studied.

A Mobile Phone-Based Health Coaching Intervention for Weight Loss and Blood Pressure Reduction in a National Payer Population: A Retrospective Study.

Science.gov (United States)

Mao, Alice Yuqing; Chen, Connie; Magana, Candy; Caballero Barajas, Karla; Olayiwola, J Nwando

2017-06-08

The prevalence of obesity and associated metabolic conditions continue to be challenging and costly to address for health care systems; 71% of American adults were overweight, with 35% of men and 40% of women diagnosed with obesity in 2014. Digital health coaching is an innovative approach to decreasing the barriers of cost and accessibility of receiving health coaching for the prevention and management of chronic disease in overweight or obese individuals. To evaluate the early impact of a mobile phone-based health coaching service on weight loss and blood pressure management in a commercially insured population. This was a retrospective study using existing registry data from a pilot commercial collaboration between Vida Health and a large national insurance provider, which enrolled adult members who were overweight (body mass index >25 kg/m2) and able to engage in a mobile phone-based coaching intervention. Participants received 4 months of intensive health coaching via live video, phone, and text message through the Vida Health app. Participants were also provided with a wireless scale, pedometer, and blood pressure cuff. Of the 1012 enrolled, 763 (75.40%) participants had an initial weight upon enrollment and final weight between 3 and 5 months from enrollment; they served as our intervention group. There were 73 participants out of the 1012 (7.21%) who had weight data 4 months prior to and after Vida coaching, who served as the matched-pair control group. Participants in the intervention group lost an average of 3.23% total body weight (TBW) at 4 months of coaching and 28.6% (218/763) intervention participants achieved a clinically significant weight loss of 5% or more of TBW, with an average of 9.46% weight loss in this cohort. In the matched-pair control group, participants gained on average 1.81% TBW in 4 months without Vida coaching and lost, on average, 2.47% TBW after 4 months of Vida coaching, demonstrating a statistically significant difference of 4

Effectiveness of autologous transfusion system in primary total hip and knee arthroplasty.

LENUS (Irish Health Repository)

Schneider, Marco M

2014-01-01

Autologous transfusion has become a cost-efficient and useful option in the treatment of patients with high blood loss following major orthopaedic surgery. However, the effectiveness of autologous transfusion in total joint replacement remains controversial.

Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty

DEFF Research Database (Denmark)

Harsten, A; Kehlet, H; Toksvig-Larsen, S

2013-01-01

BACKGROUND: /st>This study was undertaken to compare the effects of general anaesthesia (GA) and spinal anaesthesia (SA) on the need for postoperative hospitalization and early postoperative comfort in patients undergoing fast-track total knee arthroplasty (TKA). METHODS: /st>One hundred and twenty....... Secondary outcome parameters included actual time of discharge, postoperative pain, intraoperative blood loss, length of stay in the Post Anaesthesia Care Unit, dizziness, postoperative nausea and vomiting, need for urinary catheterization and subject satisfaction. RESULTS: /st>GA resulted in shorter LOS...

The relationship between blood lead levels and periodontal bone loss in the United States, 1988-1994.

OpenAIRE

Dye, Bruce A; Hirsch, Rosemarie; Brody, Debra J

2002-01-01

An association between bone disease and bone lead has been reported. Studies have suggested that lead stored in bone may adversely affect bone mineral metabolism and blood lead (PbB) levels. However, the relationship between PbB levels and bone loss attributed to periodontal disease has never been reported. In this study we examined the relationship between clinical parameters that characterize bone loss due to periodontal disease and PbB levels in the U.S. population. We used data from the T...

Evaluation of the impact of density gradient centrifugation on fetal cell loss during enrichment from maternal peripheral blood.

Science.gov (United States)

Emad, Ahmed; Drouin, Régen

2014-09-01

Physical separation by density gradient centrifugation (DGC) is usually used as an initial step of multistep enrichment protocols for purification of fetal cells (FCs) from maternal blood. Many protocols were designed but no single approach was efficient enough to provide noninvasive prenatal diagnosis. Procedures and methods were difficult to compare because of the nonuniformity of protocols among different groups. Recovery of FCs is jeopardized by their loss during the process of enrichment. Any loss of FCs must be minimized because of the multiplicative effect of each step of the enrichment process. The main objective of this study was to evaluate FC loss caused by DGC. Fetal cells were quantified in peripheral blood samples obtained from both euploid and aneuploid pregnancies before and after enrichment by buoyant DGC using Histopaque 1.119 g/mL. Density gradient centrifugation results in major loss of 60% to 80% of rare FCs, which may further complicate subsequent enrichment procedures. Eliminating aggressive manipulations can significantly minimize FC loss. Data obtained raise questions about the appropriateness of the DGC step for the enrichment of rare FCs and argues for the use of the alternative nonaggressive version of the procedure presented here or prioritizing other methods of enrichments. © 2014 John Wiley & Sons, Ltd.

Preoperative methylprednisolone does not reduce loss of knee-extension strength after total knee arthroplasty

DEFF Research Database (Denmark)

Lindberg-Larsen, Viktoria; Bandholm, Thomas Q; Zilmer, Camilla K

2017-01-01

tests, rescue analgesic requirements, and plasma C-reactive protein (CRP) changes. Results - 61 patients completed the follow-up. The loss in quadriceps muscle strength was similar between groups; group MP 1.04 (0.22-1.91) Nm/kg (-89%) vs. group C 1.02 (0.22-1.57) Nm/kg (-88%). Also between......-265) mg/L (p loss of knee-extension strength or other functional outcomes at discharge after fast-track TKA despite a reduced systemic inflammatory response.......Background and purpose - Patients undergoing total knee arthroplasty (TKA) face challenges related to postoperative reduction in knee-extension strength. We evaluated whether inhibition of the inflammatory response by a single preoperative dose of methylprednisolone (MP) reduces the pronounced loss...

The effect of tranexamic acid in unilateral and bilateral total knee arthroplasty in the South Asian population: A retrospective cohort study.

Science.gov (United States)

Mufarrih, Syed Hamza; Malik, Azeem Tariq; Qureshi, Nada Qaisar; Lakdawala, Riaz Hussain; Rabbani, Muhammad Umar; Ali, Arif; Noordin, Shahryar

2018-04-01

Together with evidence of higher bleeding tendencies, the vulnerability of the South-Asian population to anemia secondary to a higher prevalence of hemoglobinopathies and micronutrient deficiencies merits further exploration of the effects of tranexamic acid on this population. Additionally, limited access to self-care facilities and certain sociocultural beliefs and practices may not be conducive to a speedy recovery from surgical complications. The aim of this study is to investigate the effects of intraoperative administration of tranexamic acid during total knee arthroplasty when considering the South-Asian population. Medical record files of 355 patients who underwent total knee arthroplasty (2007-2015) were reviewed to collect data regarding patient characteristics, surgical variables and post-operative complications. Unilateral and Bilateral total knee arthroplasty were studied separately. Analysis was done using t-test, Mann-Whitney U test, chi-square and Fisher's exact square where appropriate. The threshold for significance was p tranexamic acid caused a significant reduction in estimated blood loss (p-value=0.011), total operative time, calculated blood loss, and hemoglobin change (p-valuetranexamic acid only caused a significant reduction in calculated blood loss (p-value tranexamic acid vs. those who did not, there was a significant increase in length of hospital stay (ptranexamic acid effectively reduces intraoperative blood loss, it does not have an effect on the need for post-operative blood transfusions. The increased length of stay and special care unit admissions associated with tranexamic acid use should be explored further to reveal the complete safety profile of tranexamic acid administration in the South-Asian population during total knee arthroplasty. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Total contribution of airborne lead to blood lead.

OpenAIRE

Manton, W I

1985-01-01

A nine year study of blood lead concentrations and isotope ratios carried out on a married couple shows that pulmonary deposition cannot account for all the airborne lead in blood; that lead from bone may comprise 70% of blood lead; and that during pregnancy blood lead may double due to mobilisation of lead from bone.

Open Craniosynostosis Surgery: Effect of Early Intraoperative Blood Transfusion on Postoperative Course.

Science.gov (United States)

Kurnik, Nicole M; Bristol, Ruth; Maneri, Celia; Singhal, Raj; Singh, Davinder J

2017-07-01

Correction of craniosynostosis can result in blood loss when the patient already has physiologic anemia. The aim of this study was to determine whether patients benefit from early blood transfusion and whether the timing of blood transfusion affects metabolic disturbances and the postoperative course. In this retrospective review, 71 patients who underwent open calvarial vault remodeling for correction of craniosynostosis were separated into 2 groups according to whether they received blood transfusions early (within the first 30 minutes of surgery) or later (after the first 30 minutes of surgery). Patients were further separated into nonsyndromic and syndromic cohorts. Tracked variables included hemoglobin, hematocrit, arterial blood gas values, lactate level, length of stay, estimated blood loss, and amount of blood transfused in the operating room, amount transfused postoperatively, and total amount transfused.Among all patients, the early transfusion group had a higher hemoglobin nadir overall and received less postoperative blood. Within the nonsyndromic cohort, the early transfusion group had a higher estimated blood loss and received more transfused blood. In the syndromic cohort, the early transfusion group had a hemoglobin nadir that was significantly higher than in the late transfusion group and a lower estimated blood loss, shorter pediatric intensive care unit stay, and less postoperative blood transfused. Syndromic patients also received significantly more blood overall. For syndromic patients undergoing open calvarial vault remodeling, transfusion within the first 30 minutes of surgery should be considered.

Total contribution of airborne lead to blood lead.

Science.gov (United States)

Manton, W I

1985-01-01

A nine year study of blood lead concentrations and isotope ratios carried out on a married couple shows that pulmonary deposition cannot account for all the airborne lead in blood; that lead from bone may comprise 70% of blood lead; and that during pregnancy blood lead may double due to mobilisation of lead from bone. PMID:3970881

Effect of total lymphoid irradiation and pretransplant blood transfusion on pancreatic islet allograft survival

International Nuclear Information System (INIS)

Mendez-Picon, G.; McGeorge, M.

1983-01-01

Total lymphoid irradiation (TLI) has been shown to have a strong immunosuppressive effect both experimentally and clinically. Pretransplant blood transfusions have also been shown to have a strong beneficial effect in the outcome of organ transplantation. A study was made of the effect of TLI and pretransplant blood transfusions, alone and in combination, as an immunosuppressive modality in the isolated pancreatic islet transplant in the rat model. Donor rats (Fischer RT1v1) were kept on a 50% DL-ethionine supplemented diet for 4-6 weeks prior to pancreas removal. Recipient rats (Lewis RT1) were made diabetics prior to transplantation by iv injection of streptozotocin (45 mg/kg). Transfusion protocol consisted of a biweekly transfusion of 2 ml of either donor specific or third party transfusions. Total lymphoid irradiation was carried out by daily administration of 200 rads during one week prior to transplantation. Transplantation of the isolated islets was performed by intraportal injection. Syngeneic transplant of one and a half donor pancreata in each recipient reverted the diabetic condition indefinitely (greater than 100 days). Untreated allogenic grafts had a mean survival time (MST) of 5.2 days. Total lymphoid irradiation in dosages of 800, 1000, and 1200 rads, as the only immunosuppressive regimen, prolonged the MST of allografts to 15.3, 16.5, and 21.8 days, respectively (P less than .05). Pretransplant third party blood transfusion had no effect on allograft survival (MST 6.0). When donor specific blood transfusions were given, the MST was prolonged to 25.3 days (P less than .05). When TLI was administered to recipients of donor specific transfusions, the MST of the allografts did not show any statistical significant difference when compared with untreated animals. This abrogation of the beneficial effect of specific blood transfusion was observed in all dosages of TLI employed: 800 rad (MST 3.0), 1000 rad (MST 8.0), 1200 rad (MST 5.18)

Eddy current and total power loss separation in the iron-phosphate-polyepoxy soft magnetic composites

International Nuclear Information System (INIS)

Taghvaei, A.H.; Shokrollahi, H.; Janghorban, K.; Abiri, H.

2009-01-01

This work investigates the magnetic properties of iron-phosphate-polyepoxy soft magnetic composite materials. FTIR spectra, EDX analysis, distribution maps, X-ray diffraction pattern and density measurements show that the particles surface layer contains a thin layer of nanocrystalline/amorphous phosphate with high coverage of powders surface. In this paper, a formula for calculating the eddy current loss and total loss components by loss separation method is presented and finally the different parts of power losses are calculated. The results show that, the contribution of eddy current in the bulk material for single coating layer (k b = 0.18) is higher in comparison with double coating layer (k b = 0.09). Moreover, iron-phosphate-polyepoxy composites (P = 0.000004f 2 ) have lower power loss in comparison with iron-phosphate composites (P = 0.00002f 2 ).

Functional Response of Tumor Vasculature to PaCO2: Determination of Total and Microvascular Blood Volume by MRI

Directory of Open Access Journals (Sweden)

Scott D. Packard

2003-07-01

Full Text Available In order to identify differences in functional activity, we compared the reactivity of glioma vasculature and the native cerebral vasculature to both dilate and constrict in response to altered PaCO2. Gliomas were generated by unilateral implantation of U87MGdEGFR human glioma tumor cells into the striatum of adult female athymic rats. Relative changes in total and microvascular cerebral blood volume were determined by steady state contrast agent-enhanced magnetic resonance imaging for transitions from normocarbia to hypercarbia and hypocarbia. Although hypercarbia induced a significant increase in both total and microvascular blood volume in normal brain and glioma, reactivity of glioma vasculature was significantly blunted in comparison to normal striatum; glioma total CBV increased by 0.6±0.1%/mm Hg CO2 whereas normal striatum increased by 1.5±0.2%/mm Hg CO2, (P < .0001, group t-test. Reactivity of microvascular blood volume was also significantly blunted. In contrast, hypocarbia decreased both total and microvascular blood volumes more in glioma than in normal striatum. These results indicate that cerebral blood vessels derived by tumor-directed angiogenesis do retain reactivity to CO2. Furthermore, reduced reactivity of tumor vessels to a single physiological perturbation, such as hypercarbia, should not be construed as a generalized reduction of functional activity of the tumor vascular bed.

Variation in Use of Blood Transfusion in Primary Total Hip and Knee Arthroplasties.

Science.gov (United States)

Menendez, Mariano E; Lu, Na; Huybrechts, Krista F; Ring, David; Barnes, C Lowry; Ladha, Karim; Bateman, Brian T

2016-12-01

There is growing clinical and policy emphasis on minimizing transfusion use in elective joint arthroplasty, but little is known about the degree to which transfusion rates vary across US hospitals. This study aimed to assess hospital-level variation in use of allogeneic blood transfusion in patients undergoing elective joint arthroplasty and to characterize the extent to which variability is attributable to differences in patient and hospital characteristics. The study population included 228,316 patients undergoing total knee arthroplasty (TKA) at 922 hospitals and 88,081 patients undergoing total hip arthroplasty (THA) at 606 hospitals from January 1, 2009 to December 31, 2011 in the Nationwide Inpatient Sample database, a 20% stratified sample of US community hospitals. The median hospital transfusion rates were 11.0% (interquartile range, 3.5%-18.5%) in TKA and 15.9% (interquartile range, 5.4%-26.2%) in THA. After fully adjusting for patient- and hospital-related factors using mixed-effects logistic regression models, the average predicted probability of blood transfusion use in TKA was 6.3%, with 95% of the hospitals having a predicted probability between 0.37% and 55%. For THA, the average predicted probability of blood transfusion use was 9.5%, with 95% of the hospitals having a predicted probability between 0.57% and 66%. Hospital transfusion rates were inversely associated with hospital procedure volume and directly associated with length of stay. The use of blood transfusion in elective joint arthroplasty varied widely across US hospitals, largely independent of patient case-mix and hospital characteristics. Copyright © 2016 Elsevier Inc. All rights reserved.

Concentration of total proteins in blood plasma of chickens hatched from irradiated eggs with low dose gamma radiation

International Nuclear Information System (INIS)

Vilic, M.; Kraljevic, P.; Miljanic, S.; Simpraga, M.

2005-01-01

It is known that low-dose ionising radiation may have stimulating effects on chickens. Low doses may also cause changes in the concentration of blood plasma total proteins, glucose and cholesterol in chickens. This study investigates the effects of low dose gamma-radiation on the concentration of total proteins in the blood plasma of chickens hatched from eggs irradiated with a dose of 0.15 Gy on incubation days 7 and 19. Results were compared with the control group (chickens hatched from non-irradiated eggs). After hatching, all other conditions were the same for both groups. Blood samples were drawn from the heart, and later from the wing vein on days 1, 3, 5, 7,10, 20, 30 and 42. The concentration of total proteins was determined spectrophotometrically using Boehringer Mannheim GmbH optimised kits. The concentration of total proteins in blood plasma in chickens hatched from eggs irradiated with 0.15 Gy on incubation day 7 showed a statistically significant decrease on the sampling day 3 (P less than 0.05) and 7 (P less than 0.01). The concentration of total proteins in blood plasma in chickens hatched from eggs irradiated with 0.15 Gy on incubation day 19 showed a statistically significant increase only on sampling day 1 (P less than 0.05). These results suggest that exposure of eggs to 0.15 Gy of gamma-radiation on the 7th and 19th day of incubation could produce different effects on the protein metabolism in chickens.(author)

Neural, Endocrine and Local Mechanisms in the Effects of Environmental Stressors on the Cardiovascular Response to Blood Loss

National Research Council Canada - National Science Library

Schadt, James C

2006-01-01

Our studies have provided important, new information about the role of neurohumoral systems as well as the interaction of these systems with local mechanisms in cardiovascular control during blood loss...

Varicose vein surgery using a pneumatic tourniquet: reduced blood loss and improved cosmesis.

OpenAIRE

Thompson, J. F.; Royle, G. T.; Farrands, P. A.; Najmaldin, A.; Clifford, P. C.; Webster, J. H.

1990-01-01

A prospective controlled randomised study has been performed of 100 consecutive patients undergoing varicose vein surgery. One group underwent saphenofemoral flush ligation and multiple lower leg avulsions with the leg exsanguinated with a Rhys-Davies cuff, and ischaemia maintained with a pneumatic tourniquet. The other group underwent identical surgery but with a 30 degree head down tilt only. Blood loss was significantly less (13.5 +/- 12 ml vs 133 +/- 78 ml; P less than 0.01) and postopera...

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

Directory of Open Access Journals (Sweden)

Mustafa Gökhan Bilgili

2014-06-01

Full Text Available Background: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results: No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05 and cost was higher in Group 1 (p<0.05. Conclusion: Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.

Increased protein intake reduces lean body mass loss during weight loss in athletes.

Science.gov (United States)

Mettler, Samuel; Mitchell, Nigel; Tipton, Kevin D

2010-02-01

To examine the influence of dietary protein on lean body mass loss and performance during short-term hypoenergetic weight loss in athletes. In a parallel design, 20 young healthy resistance-trained athletes were examined for energy expenditure for 1 wk and fed a mixed diet (15% protein, 100% energy) in the second week followed by a hypoenergetic diet (60% of the habitual energy intake), containing either 15% (approximately 1.0 g x kg(-1)) protein (control group, n = 10; CP) or 35% (approximately 2.3 g x kg(-1)) protein (high-protein group, n = 10; HP) for 2 wk. Subjects continued their habitual training throughout the study. Total, lean body, and fat mass, performance (squat jump, maximal isometric leg extension, one-repetition maximum (1RM) bench press, muscle endurance bench press, and 30-s Wingate test) and fasting blood samples (glucose, nonesterified fatty acids (NEFA), glycerol, urea, cortisol, free testosterone, free Insulin-like growth factor-1 (IGF-1), and growth hormone), and psychologic measures were examined at the end of each of the 4 wk. Total (-3.0 +/- 0.4 and -1.5 +/- 0.3 kg for the CP and HP, respectively, P = 0.036) and lean body mass loss (-1.6 +/- 0.3 and -0.3 +/- 0.3 kg, P = 0.006) were significantly larger in the CP compared with those in the HP. Fat loss, performance, and most blood parameters were not influenced by the diet. Urea was higher in HP, and NEFA and urea showed a group x time interaction. Fatigue ratings and "worse than normal" scores on the Daily Analysis of Life Demands for Athletes were higher in HP. These results indicate that approximately 2.3 g x kg(-1) or approximately 35% protein was significantly superior to approximately 1.0 g x kg(-1) or approximately 15% energy protein for maintenance of lean body mass in young healthy athletes during short-term hypoenergetic weight loss.

Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210 cases.

Science.gov (United States)

Ohrt-Nissen, Søren; Bukhari, Naeem; Dragsted, Casper; Gehrchen, Martin; Johansson, Pär I; Dirks, Jesper; Stensballe, Jakob; Dahl, Benny

2017-07-01

The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including avoidance of synthetic colloids), restrictive RBC trigger according to institutional standardized protocol, the use of cell savage, and goal-directed therapy according to thrombelastography. In total, 210 patients were included. 64 patients (31%) received RBC transfusions. A decline in the intraoperative rate of RBC transfusion was observed, from 77% in 2011 to 13% in 2016 (p transfusion group had a significantly larger major curve, lower preoperative hemoglobin, higher estimated blood loss, and an increased use of crystalloid volume resuscitation. Multiple logistic regression showed that significant predictors for RBC transfusion were preoperative hemoglobin level (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.27-0.57), estimated blood loss (OR, 1.26; 95% CI, 1.15-1.42), and year of surgery (indicating the effect of patient blood management) (OR per year, 0.76; 95% CI, 0.58-0.99). A perioperative patient blood management program substantially reduced the need for RBC transfusion. A preoperative evaluation of anemia is essential to further minimize transfusion rates. © 2017 AABB.

Progressive sensorineural hearing loss, subjective tinnitus and vertigo caused by elevated blood lipids.

Science.gov (United States)

Pulec, J L; Pulec, M B; Mendoza, I

1997-10-01

The otologist frequently sees patients with progressive sensorineural hearing loss, subjective aural tinnitus and vertigo with no apparent cause. Elevated blood lipids may be a cause of inner ear malfunction on a biochemical basis. To establish the true incidence of this condition, all new patients (4,251) seen during an eight-year period were evaluated; of these, 2,332 patients had complaints of inner ear disease. All had a complete neurotologic examination, appropriate audiometric and vestibular studies and imaging, and blood tests including lipid phenotype studies. Hyperlipoproteinemia was found in 120 patients (5.1%). Most patients were found to be overweight and had additional coexisting conditions such as diabetes mellitus. Treatment with vasodilators and a 500-calorie, high-protein, low-carbohydrate diet yielded improvement of symptoms in 83% of patients within five months of initiation of treatment.

Plateletpheresis before redo CABG diminishes excessive blood transfusion.

Science.gov (United States)

Christenson, J T; Reuse, J; Badel, P; Simonet, F; Schmuziger, M

1996-11-01

Blood conservation remains an important element for patients undergoing cardiac operations with cardiopulmonary bypass. Preoperative platelet-rich plasma (PRP) harvest is an autologous blood conservation method. The efficacy of preoperative PRP harvest and post-cardiopulmonary bypass reinfusion on postoperative bleeding and need for postoperative blood transfusion was evaluated in patients undergoing redo coronary artery bypass grafting in a prospective, randomized manner. All adult patients admitted for redo coronary artery bypass grafting entered into the study. The PRP harvest aim was 20% or more of the total estimated circulating platelets. Immediately preoperatively three sequestration cycles were performed. The PRP was reinfused after weaning from cardiopulmonary bypass. One hundred seven parameters/patient were recorded. There were 20 patients in the RPR group and 20 controls (without PRP harvest). Patient characteristics, operative data, and preoperative hematologic parameters did not differ between the groups. In the PRP group, the mean platelet count in the PRP was 864 +/- 139 x 10(3)/microL, and the platelet yield was 27% +/- 5% (range, 20% to 37%). The average total chest tube blood loss was 423 mL (PRP) compared with 1,462 mL (controls; p platelets and reinfusion of the PRP after cardiopulmonary bypass resulted in significantly less postoperative blood loss and decreased fluid and blood transfusion requirements compared with controls. Postextubation gas exchange, ventilation time, and time required in the intensive care unit were also better, and the method was found cost-effective.

No effect of fibrin sealant on drain output or functional recovery following simultaneous bilateral total knee arthroplasty

DEFF Research Database (Denmark)

Skovgaard, Christian; Holm, Bente; Troelsen, Anders

2013-01-01

Background and purpose Blood loss after total knee arthroplasty (TKA) may lead to anemia, blood transfusions, and increased total costs. Also, bleeding into the periarticular tissue may cause swelling and a reduction in quadriceps strength, thus impairing early functional recovery. In this random...... in TKA showed no benefit in reducing drain output or in facilitating early functional recovery when used with a tourniquet, tranexamic acid, and a femoral bone plug....

10B-NMR determination of 10B-BPA, 10B-BPA–fructose complex and total 10B in blood for BNCT

International Nuclear Information System (INIS)

Yoshino, K.; Yabe, T.; Hattori, T.; Saito, K.; Ishikawa, A.; Ohki, H.

2014-01-01

First spontaneous, noninvasive determination method of 10 B-BPA, 10 B-BPA–fructose complex, and total 10 B in blood is described. 10 B-NMR measurement with 100,000 FT accumulation enables us to obtain the result within 100 min/sample. The detection limits for the simultaneous analysis were 3 ppm, 3 ppm and 6 ppm for 10 B-BPA, 10 B-BPA–fructose complex and total 10 B respectively in this study. By this method, we can actually discuss behavior of the 10 B-BPA–fructose complex in blood. - Highlights: • First 10 B-NMR determination of 10 B-BPA and 10 B-BPA–fructose complex in blood. • Total 10 B concentration in blood could be obtained by this method • The detection limit was 3 ppm for total 10 B

A Common Allele in FGF21 Associated with Sugar Intake Is Associated with Body Shape, Lower Total Body-Fat Percentage, and Higher Blood Pressure

Directory of Open Access Journals (Sweden)

Timothy M. Frayling

2018-04-01

Full Text Available Summary: Fibroblast growth factor 21 (FGF21 is a hormone that has insulin-sensitizing properties. Some trials of FGF21 analogs show weight loss and lipid-lowering effects. Recent studies have shown that a common allele in the FGF21 gene alters the balance of macronutrients consumed, but there was little evidence of an effect on metabolic traits. We studied a common FGF21 allele (A:rs838133 in 451,099 people from the UK Biobank study, aiming to use the human allele to inform potential adverse and beneficial effects of targeting FGF21. We replicated the association between the A allele and higher percentage carbohydrate intake. We then showed that this allele is more strongly associated with higher blood pressure and waist-hip ratio, despite an association with lower total body-fat percentage, than it is with BMI or type 2 diabetes. These human phenotypes of variation in the FGF21 gene will inform research into FGF21’s mechanisms and therapeutic potential. : Drugs targeting the hormone FGF21 may have beneficial health effects. Variations in human DNA in the FGF21 gene provide an indication of what those effects may be. Here, we show that variation in the FGF21 gene is associated with higher blood pressure and altered body shape, despite lower total body-fat percentage. Keywords: FGF21, BMI, waist-hip ratio, blood pressure, body fat, allele, genetic variant, UK Biobank

Behaviour of perioperative values of haemoglobin, haematocrit and red blood cells in elderly patients undergoing lower limb arthroplasty: a retrospective cohort study on non-transfused patients.

Science.gov (United States)

Drago, L; De Vecchi, E; Romano', C L; Vassena, C; Banfi, G

2013-01-01

Little is known on how elderly patients recover pre-operative haemoglobin, haematocrit and red blood cell levels after total hip and knee arthroplasties. In this study we aimed to evaluate blood loss and recovery blood levels in relation to gender, type of surgery and preoperative haemoglobin values. We conducted a retrospective cohort study on 187 patients over 65 years of age who underwent total knee or total hip arthroplasty between January 2008 and December 2009. Preoperative blood analysis was carried out within 40 days prior to intervention followed by a 15-day postoperative follow-up. Haemoglobin recovery values in anaemic patients versus healthy patients was also estimated. All tested values decreased significantly during the first 3-5 postoperative days. Haemoglobin levels decreased statistically significantly more in males than in females, while no significant differences were observed for haematocrit and erythrocytes. Recovery of haemoglobin values did not differ significantly between healthy patients and patients with preoperative haemoglobin below 120 g/L. Furthermore, our data showed a higher blood loss in total hip arthroplasty, whilst recovery rates showed to be higher after a total knee arthroplasty procedure. In conclusion, the type of intervention and gender played an important role in blood loss and recovery rates in total joint arthroplasty.

Tandem mass spectrometric identification of dextrose markers in dried-blood spots from infants receiving total parenteral nutrition.

Science.gov (United States)

Chace, Donald H; De Jesús, Víctor R; Lim, Timothy H; Hannon, W Harry; Spitzer, Alan R

2010-11-11

The false positive rate for the newborn screening of disorders of amino acid metabolism for premature infants is higher than full term infants. This may be due to very low birth weight infants receiving high concentrations of amino acids from total parenteral nutrition (TPN) administration and/or immature metabolism. An investigation of the possible influence of TPN on screening of premature infants resulted in the detection of three unusual peaks in the tandem mass spectrometry (MS/MS) acylcarnitine profile. These markers were closely correlated with the detection of very high multiple amino acid increases in the profiles of newborns administered with TPN and who were ultimately found to be normal and free of inherited metabolic disorders. TPN solutions contain a concentrated mixture of amino acids and dextrose and other nutrients in saline. Due to its high concentration and suggestion of a carbohydrate, it was hypothesized that dextrose (D-glucose) was the contaminant and source of the markers detected. Dextrose, stable isotope-labeled 13C6-dextrose and various TPN solutions were analyzed directly or after enrichment in whole blood by multiple MS/MS acquisition modes including MS-only, product and precursor ion and neutral loss scans. Analysis of dried-blood spots (DBS) prepared from whole blood spiked with TPN solutions containing 12.5% dextrose and amino acid formulations designed to deliver 2.5 gm/kg/day of an amino acid mixture had moderate increases of all 3 dextrose markers detected at m/z 325, 399 and 473 as compared to controls. MS-only scans, product and precursor ion scans of dextrose and 13C6-dextrose in positive ion mode confirmed that these 3 peaks are derived from dextrose. Mass spectral analysis of labeled and unlabeled dextrose suggested that these peaks were dimers derived from dextrose. The identification of dextrose markers in DBS indicates that high concentrations of dextrose were present in blood and the likely source was contamination by TPN

No positive effect of autologous platelet gel after total knee arthroplasty

NARCIS (Netherlands)

Peerbooms, Joost C.; de Wolf, Gideon S.; Colaris, Joost W.; Bruijn, Daniël J.; Verhaar, Jan A. N.

2009-01-01

Activated platelets release a cocktail of growth factors, some of which are thought to stimulate repair. We investigated whether the use of autologous platelet gel (PG) in total knee arthroplasty (TKA) would improve wound healing and knee function, and reduce blood loss and the use of analgesics.

Study on the Measurement of 51Cr-tagged Red Cell Survival: Reevaluation of its method and the effect of Blood loss on red cell survival with 51Cr

International Nuclear Information System (INIS)

Choi, Hak Yong; Koh, Chang Soon; Lee, Moon Ho

1970-01-01

Reappraisal measurement of apparent half survival time of red cell by 51 Cr method was made and effects of blood-letting over red cell survival were observed. The study was performed on 53 normal male subjects under three different experimental conditions. 1) Group 1: Mean 51 Cr red cell half survival by ACD wash method was 29.7 days. T 1 /2 of Ascorbic acid method was 29.0 days in group with 100 mg dose and 29.1 days in group with 50 mg dose respectively. There was no difference between these two methods in regards to red cell half survival. No difference were noted in amount of ascorbic acid administered. 2) Group 2: As daily amount of blood loss in increased the shortening of red cell half survival was noted. Rapid phase was seen when blood loss ranged 10 to 25 ml per day, while slow phase noted when more loss amounted 25 ml more daily. Thus, it was clear that there was more than an exponential relation between T 1 /2 and the amount of blood loss. 3) Group 3: T 1 /2 measured cpm per whole blood was within normal range and T 1 /2 measured by cpm per red mass showed shortening tendency when compared with the former in the group measured after blood loss (from 25 ml daily up to 100 ml daily in 10 days). In the group with rather constant blood loss of 100 ml daily for 10 consecutive days revealed the significant difference in two measurement (P 1 /2 in non-steady state. When red cell production is increased compared with red cell destruction, T 1 /2 measured by cpm per red cell mass shorter than that by cpm per whole blood. Shortening of T 1 /2 measured by cpm per whole blood is more prominent, if red destruction is enhanced and exceeds production. 5) It is clear that when expressing red cell destruction rate, T 1 /2 measured by cpm per whole blood is more adequate and production more consistent with cpm red cell mass. 6) T 1 /2 measured during blood-letting, when corrected by amount of blood loss, it remains normal. It is erroneous to use conventional equational

Mosaic Loss of Chromosome Y in Blood Is Associated with Alzheimer Disease.

Science.gov (United States)

Dumanski, Jan P; Lambert, Jean-Charles; Rasi, Chiara; Giedraitis, Vilmantas; Davies, Hanna; Grenier-Boley, Benjamin; Lindgren, Cecilia M; Campion, Dominique; Dufouil, Carole; Pasquier, Florence; Amouyel, Philippe; Lannfelt, Lars; Ingelsson, Martin; Kilander, Lena; Lind, Lars; Forsberg, Lars A

2016-06-02

Men have a shorter life expectancy compared with women but the underlying factor(s) are not clear. Late-onset, sporadic Alzheimer disease (AD) is a common and lethal neurodegenerative disorder and many germline inherited variants have been found to influence the risk of developing AD. Our previous results show that a fundamentally different genetic variant, i.e., lifetime-acquired loss of chromosome Y (LOY) in blood cells, is associated with all-cause mortality and an increased risk of non-hematological tumors and that LOY could be induced by tobacco smoking. We tested here a hypothesis that men with LOY are more susceptible to AD and show that LOY is associated with AD in three independent studies of different types. In a case-control study, males with AD diagnosis had higher degree of LOY mosaicism (adjusted odds ratio = 2.80, p = 0.0184, AD events = 606). Furthermore, in two prospective studies, men with LOY at blood sampling had greater risk for incident AD diagnosis during follow-up time (hazard ratio [HR] = 6.80, 95% confidence interval [95% CI] = 2.16-21.43, AD events = 140, p = 0.0011). Thus, LOY in blood is associated with risks of both AD and cancer, suggesting a role of LOY in blood cells on disease processes in other tissues, possibly via defective immunosurveillance. As a male-specific risk factor, LOY might explain why males on average live shorter lives than females. Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.

Total glucosides of paeony prevents juxta-articular bone loss in experimental arthritis

OpenAIRE

Wei, Chen Chao; You, Fan Tian; Mei, Li Yu; Jian, Sun; Qiang, Chen Yong

2013-01-01

Background Total glucosides of paeony (TGP) is a biologically active compound extracted from Paeony root. TGP has been used in rheumatoid arthritis therapy for many years. However, the mechanism by which TGP prevents bone loss has been less explored. Methods TGP was orally administered for 3?months to New Zealand rabbits with antigen-induced arthritis (AIA). Digital x-ray knee images and bone mineral density (BMD) measurements of the subchondral knee bone were performed before sacrifice. Chon...

The relationship between total arterial revascularization and blood transfusion following coronary artery bypass grafting.

Science.gov (United States)

Djordjevic, Jasmina; Ngaage, Dumbor L

2015-05-01

Blood transfusion adversely affects the outcome of coronary artery bypass grafting (CABG), yet blood transfusion after CABG is still common. Total arterial revascularisation (TAR) is increasingly used in current practice but its impact on postoperative blood transfusion is not known. We reviewed the cardiothoracic and blood bank databases and collected data for isolated primary CABG patients from July 2007 to June 2012, excluding patients who had a single graft (n = 148). Perioperative variables of TAR patients (n = 745) were compared with patients who had one or more venous grafts (SVG, n = 1,761) for first-time isolated CABG. The conduits used in TAR patients were predominantly left internal thoracic and radial arteries. Matched group comparison of TAR and SVG patients was performed. The association of TAR with blood transfusion was investigated using multivariate and matched analysis. Of 2,506 patients, the 745 (29.7 %) that had TAR were generally younger, with less complex coronary artery disease and less often diabetic. After correcting for these by 1:1 matching, the mean chest tube drainage and rates of blood transfusion remained significantly lower (p transfused in TAR patients. By multivariate analysis, TAR had an independent effect on reducing blood transfusion after CABG [odds ratio (OR) 0.67, 95 % confidence interval (CI) 0.47-0.97, p = .03]. TAR achieved predominantly with left internal thoracic and radial arteries substantially reduced blood transfusion rates after primary CABG. Further studies are warranted.

Blood Transfusion During Total Ankle Arthroplasty Is Associated With Increased In-Hospital Complications and Costs.

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Ewing, Michael A; Huntley, Samuel R; Baker, Dustin K; Smith, Kenneth S; Hudson, Parke W; McGwin, Gerald; Ponce, Brent A; Johnson, Michael D

2018-04-01

Total ankle arthroplasty (TAA) is an increasingly used, effective treatment for end-stage ankle arthritis. Although numerous studies have associated blood transfusion with complications following hip and knee arthroplasty, its effects following TAA are largely unknown. This study uses data from a large, nationally representative database to estimate the association between blood transfusion and inpatient complications and hospital costs following TAA. Using the Nationwide Inpatient Sample (NIS) database from 2004 to 2014, 25 412 patients who underwent TAA were identified, with 286 (1.1%) receiving a blood transfusion. Univariate analysis assessed patient and hospital factors associated with blood transfusion following TAA. Patients requiring blood transfusion were more likely to be female, African American, Medicare recipients, and treated in nonteaching hospitals. Average length of stay for patients following transfusion was 3.0 days longer, while average inpatient cost was increased by approximately 50%. Patients who received blood transfusion were significantly more likely to suffer from congestive heart failure, peripheral vascular disease, hypothyroidism, coagulation disorder, or anemia. Acute renal failure was significantly more common among patients receiving blood transfusion ( P < .001). Blood transfusions following TAA are infrequent and are associated with multiple medical comorbidities, increased complications, longer hospital stays, and increased overall cost. Level III: Retrospective, comparative study.

Neither pre-operative education or a minimally invasive procedure have any influence on the recovery time after total hip replacement.

Science.gov (United States)

Biau, David Jean; Porcher, Raphael; Roren, Alexandra; Babinet, Antoine; Rosencher, Nadia; Chevret, Sylvie; Poiraudeau, Serge; Anract, Philippe

2015-08-01

The purpose of this study was to evaluate pre-operative education versus no education and mini-invasive surgery versus standard surgery to reach complete independence. We conducted a four-arm randomized controlled trial of 209 patients. The primary outcome criterion was the time to reach complete functional independence. Secondary outcomes included the operative time, the estimated total blood loss, the pain level, the dose of morphine, and the time to discharge. There was no significant effect of either education (HR: 1.1; P = 0.77) or mini-invasive surgery (HR: 1.0; 95 %; P = 0.96) on the time to reach complete independence. The mini-invasive surgery group significantly reduced the total estimated blood loss (P = 0.0035) and decreased the dose of morphine necessary for titration in the recovery (P = 0.035). Neither pre-operative education nor mini-invasive surgery reduces the time to reach complete functional independence. Mini-invasive surgery significantly reduces blood loss and the need for morphine consumption.

Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled and prospective cohort trials.

Science.gov (United States)

Wang, Hao; Shen, Bin; Zeng, Yi

2014-12-01

There has been much debate and controversy about the optimal regimen of tranexamic acid in primary total knee arthroplasty. The purpose of this study was to undertake a meta-analysis to compare the efficacy of topical and intravenous regimen of tranexamic acid in primary total knee arthroplasty. A systematic review of the electronic databases PubMed, CENTRAL, Web of Science, and Embase was undertaken. All randomized controlled trials and prospective cohort studies evaluating the effectiveness of topical and intravenous tranexamic acid during primary total knee arthroplasty were included. The focus of the analysis was on the outcomes of blood loss, transfusion rate, and thromboembolic complications. Subgroup analysis was performed when possible. Of 328 papers identified, six trials were eligible for data extraction and meta-analysis comprising 679 patients (739 knees). We found no statistically significant difference between topical and intravenous administration of tranexamic acid in terms of blood loss, transfusion requirements and thromboembolic complications. Topical tranexamic acid has a similar efficacy to intravenous tranexamic acid in reducing both blood loss and transfusion rate without sacrificing safety in primary total knee arthroplasty. II. Copyright © 2014 Elsevier B.V. All rights reserved.

Exact and Heuristic Solutions to Minimize Total Waiting Time in the Blood Products Distribution Problem

Directory of Open Access Journals (Sweden)

Amir Salehipour

2012-01-01

Full Text Available This paper presents a novel application of operations research to support decision making in blood distribution management. The rapid and dynamic increasing demand, criticality of the product, storage, handling, and distribution requirements, and the different geographical locations of hospitals and medical centers have made blood distribution a complex and important problem. In this study, a real blood distribution problem containing 24 hospitals was tackled by the authors, and an exact approach was presented. The objective of the problem is to distribute blood and its products among hospitals and medical centers such that the total waiting time of those requiring the product is minimized. Following the exact solution, a hybrid heuristic algorithm is proposed. Computational experiments showed the optimal solutions could be obtained for medium size instances, while for larger instances the proposed hybrid heuristic is very competitive.

How Acute Total Sleep Loss Affects the Attending Brain: A Meta-Analysis of Neuroimaging Studies

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Ma, Ning; Dinges, David F.; Basner, Mathias; Rao, Hengyi

2015-01-01

Study Objectives: Attention is a cognitive domain that can be severely affected by sleep deprivation. Previous neuroimaging studies have used different attention paradigms and reported both increased and reduced brain activation after sleep deprivation. However, due to large variability in sleep deprivation protocols, task paradigms, experimental designs, characteristics of subject populations, and imaging techniques, there is no consensus regarding the effects of sleep loss on the attending brain. The aim of this meta-analysis was to identify brain activations that are commonly altered by acute total sleep deprivation across different attention tasks. Design: Coordinate-based meta-analysis of neuroimaging studies of performance on attention tasks during experimental sleep deprivation. Methods: The current version of the activation likelihood estimation (ALE) approach was used for meta-analysis. The authors searched published articles and identified 11 sleep deprivation neuroimaging studies using different attention tasks with a total of 185 participants, equaling 81 foci for ALE analysis. Results: The meta-analysis revealed significantly reduced brain activation in multiple regions following sleep deprivation compared to rested wakefulness, including bilateral intraparietal sulcus, bilateral insula, right prefrontal cortex, medial frontal cortex, and right parahippocampal gyrus. Increased activation was found only in bilateral thalamus after sleep deprivation compared to rested wakefulness. Conclusion: Acute total sleep deprivation decreases brain activation in the fronto-parietal attention network (prefrontal cortex and intraparietal sulcus) and in the salience network (insula and medial frontal cortex). Increased thalamic activation after sleep deprivation may reflect a complex interaction between the de-arousing effects of sleep loss and the arousing effects of task performance on thalamic activity. Citation: Ma N, Dinges DF, Basner M, Rao H. How acute total

Analysis of blood transfusion predictors in patients undergoing elective oesophagectomy for cancer

Directory of Open Access Journals (Sweden)

Welch Neil T

2008-01-01

Full Text Available Abstract Background Oesophagectomy for cancers is a major operation with significant blood loss and usage. Concerns exist about the side effects of blood transfusion, cost and availability of donated blood. We are not aware of any previous study that has evaluated predictive factors for perioperative blood transfusion in patients undergoing elective oesophagectomy for cancer. This study aimed to audit the pattern of blood crossmatch and to evaluate factors predictive of transfusion requirements in oesophagectomy patients. Methods Data was collected from the database of all patients who underwent oesophagectomy for cancer over a 2-year period. Clinico-pathological data collected included patients demographics, clinical factors, tumour histopathological data, preoperative and discharge haemoglobin levels, total blood loss, number of units of blood crossmatched pre-, intra- and postoperatively, number of blood units transfused, crossmatched units reused for another patient and number of blood units wasted. Clinico-pathological variables were evaluated and logistic regression analysis was performed to determine which factors were predictive of blood transfusion. Results A total of 145 patients with a male to female ratio of 2.5:1 and median age of 68 (40–85 years were audited. The mean preoperative haemoglobin (Hb was 13.0 g/dl. 37% of males (Hb 70 years, Hb level Conclusion The cohort of patients audited was over-crossmatched. The identified independent predictors of blood transfusion should be considered in preoperative blood ordering for oesophagectomy patients. This study has directly led to a reduction in the maximum surgical blood-ordering schedule for oesophagectomy to 2 units and a reaudit is underway.

Perioperative Allogeneic Red Blood-Cell Transfusion Associated with Surgical Site Infection After Total Hip and Knee Arthroplasty.

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Everhart, Joshua S; Sojka, John H; Mayerson, Joel L; Glassman, Andrew H; Scharschmidt, Thomas J

2018-02-21

Perioperative allogeneic red blood-cell transfusion is a suspected risk factor for surgical site infection (SSI) after total joint arthroplasty (TJA), but the interrelationships among SSI risk, transfusion dose, preoperative anemia, and the presence of coagulopathies have not been well described. Data on SSI within 1 year after surgery as well as on transfusion with blood products within 30 days after surgery were obtained for 6,788 patients who had undergone primary or revision total hip or knee arthroplasty from 2000 to 2011 in a single hospital system. Multivariate logistic regression modeling was used to determine the independent association between allogeneic red blood-cell transfusion and SSI. There was a dose-dependent association between allogeneic red blood-cell transfusion and SSI, with the infection rate increasing as the transfusion dose increased from 1 unit (odds ratio [OR] = 1.97; 95% confidence interval [CI] = 1.38, 2.79; p 3 units (OR = 7.40; CI = 4.91, 11.03; p conservation strategies. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Relationship Between Total and Biaccessible Lead on Children's Blood Lead Levles in Urban Residential Philadelphia Soils.

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U.S. Environmental Protection Agency — Relationship Between Total and Biaccessible Lead on Children's Blood Lead Levles in Urban Residential Philadelphia Soils. This dataset is not publicly accessible...

Cerebral blood flow studied by 133Xe inhalation technique in parkinsonism: loss of hyperfrontal pattern

International Nuclear Information System (INIS)

Bes, A.; Gueell, A.; Fabre, N.; Dupui, P.; Victor, G.; Geraud, G.

1983-01-01

Cerebral blood flow (grey matter flow) in parkinsonism requires further investigation. The noninvasive method of 133 Xe inhalation permits study of larger numbers of subjects than previously used invasive techniques such as the intracarotid 133 Xe injection method. Measurements were made in this laboratory in 30 subjects having Parkinson's disease. Mean hemispheric blood flow (F1) values were 70.4 +/- 9.3 ml/100 g/min, compared to 76.3 for a group of age-matched normal subjects, which is a decrease of -7.8%. The most striking difference was the loss of the hyperfrontal distribution in parkinsonism. The prefrontal F1 values were only 1.8% greater than the hemisphere grey matter flow, compared with 8.5% in controls of a similar age group

Menstrual blood loss measurement: validation of the alkaline hematin technique for feminine hygiene products containing superabsorbent polymers.

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Magnay, Julia L; Nevatte, Tracy M; Dhingra, Vandana; O'Brien, Shaughn

2010-12-01

To validate the alkaline hematin technique for measurement of menstrual blood loss using ultra-thin sanitary towels that contain superabsorbent polymer granules as the absorptive agent. Laboratory study using simulated menstrual fluid (SMF) and Always Ultra Normal, Long, and Night "with wings" sanitary towels. Keele Menstrual Disorders Laboratory. None. None. Recovery of blood, linearity, and interassay variation over a range of SMF volumes applied to towels. Because of the variable percentage of blood in menstrual fluid, blood recovery was assessed from SMF constituted as 10%, 25%, 50%, and 100% blood. The lower limit of reliable detection and the effect of storing soiled towels for up to 4 weeks at 15°C-20°C, 4°C, and -20°C before analysis were determined. Ninety percent recovery was reproducibly achieved up to 30 mL applied volume at all tested SMF compositions, except at low volume or high dilution equivalent to sanitary towels that contain superabsorbent polymers. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Effect of a high-protein diet on maintenance of blood pressure levels achieved after initial weight loss : the DiOGenes randomized study

NARCIS (Netherlands)

Engberink, M. F.; Geleijnse, J. M.; Bakker, S. J. L.; Larsen, T. M.; Handjieva-Darlesnka, T.; Kafatos, A.; Martinez, J. A.; Pfeiffer, A. F. H.; Kunesova, M.; Jebb, S. A.; Holst, C.; Astrup, A.; Saris, W. H. M.; Brink, E. J.; van Baak, M. A.

Randomized trials have shown significant blood pressure (BP) reductions after increased protein compared with carbohydrate intake, but the effect on BP maintenance after initial weight loss is unclear. We examined the effect of a high-protein diet on the maintenance of reduced BP after weight loss

Effect of a high-protein diet on maintenance of blood pressure levels achieved after initial weight loss: the DiOGenes randomized study

NARCIS (Netherlands)

Engberink, M.F.; Geleijnse, J.M.; Bakker, S.J.L.; Larsen, T.

2015-01-01

Randomized trials have shown significant blood pressure (BP) reductions after increased protein compared with carbohydrate intake, but the effect on BP maintenance after initial weight loss is unclear. We examined the effect of a high-protein diet on the maintenance of reduced BP after weight loss

The cost of post-operative shed blood salvage after total knee arthroplasty: an analysis of 1,093 consecutive procedures

Science.gov (United States)

Muñoz, Manuel; Ariza, Daniel; Campos, Arturo; Martín-Montañez, Elisa; Pavía, José

2013-01-01

Background Requirements for allogeneic red cell transfusion after total knee arthroplasty are still high (20–50%), and salvage and reinfusion of unwashed, filtered post-operative shed blood is an established method for reducing transfusion requirements following this operation. We performed a cost analysis to ascertain whether this alternative is likely to be cost-effective. Materials and methods Data from 1,093 consecutive primary total knee arthroplasties, managed with (reinfusion group, n=763) or without reinfusion of unwashed salvaged blood (control group, n=330), were retrospectively reviewed. The costs of low-vacuum drains, shed blood collection canisters (Bellovac ABT®, Wellspect HealthCare and ConstaVac CBC II®, Stryker), shed blood reinfusion, acquisition and transfusion of allogeneic red cell concentrate, haemoglobin measurements, and prolonged length of hospital stay were used for the blood management cost analysis. Results Patients in the reinfusion group received 152±64 mL of red blood cells from postoperatively salvaged blood, without clinically relevant incidents, and showed a lower allogeneic transfusion rate (24.5% vs 8.5%, for the control and reinfusion groups, respectively; p =0.001). There were no differences in post-operative infection rates. Patients receiving allogeneic transfusions stayed in hospital longer (+1.9 days [95% CI: 1.2 to 2.6]). As reinfusion of unwashed salvaged blood reduced the allogeneic transfusion rate, both reinfusion systems may provide net savings in different cost scenarios (€ 4.6 to € 106/patient for Bellovac ABT, and € −51.9 to € 49.9/patient for ConstaVac CBCII). Discussion Return of unwashed salvaged blood after total knee arthroplasty seems to save costs in patients with pre-operative haemoglobin between 12 and 15 g/dL. It is not cost-saving in patients with a pre-operative haemoglobin >15 g/dL, whereas in those with a pre-operative haemoglobin cost-saving, its efficacy could be increased by

Association of Automatically Quantified Total Blood Volume after Aneurysmal Subarachnoid Hemorrhage with Delayed Cerebral Ischemia

NARCIS (Netherlands)

Zijlstra, I. A.; Gathier, C. S.; Boers, A. M.; Marquering, H. A.; Slooter, A. J.; Velthuis, B. K.; Coert, B. A.; Verbaan, D.; van den Berg, R.; Rinkel, G. J.; Majoie, C. B.

2016-01-01

The total amount of extravasated blood after aneurysmal subarachnoid hemorrhage, assessed with semiquantitative methods such as the modified Fisher and Hijdra scales, is known to be a predictor of delayed cerebral ischemia. However, prediction rates of delayed cerebral ischemia are moderate, which

The impact of allogenic blood transfusion on the outcomes of total pancreatectomy with islet autotransplantation.

Science.gov (United States)

Yoshimatsu, Gumpei; Shahbazov, Rauf; Saracino, Giovanna; Lawrence, Michael C; Kim, Peter T; Onaca, Nicholas; Beecherl, Ernest E; Naziruddin, Bashoo; Levy, Marlon F

2017-11-01

Allogenic blood transfusion (ABT) may be needed for severe bleeding during total pancreatectomy with autotransplantation (TPIAT), but may induce inflammation. This study investigated the impact of ABT. With a population of 83 patients who underwent TPIAT from 2006 to 2014, this study compared cytokine levels, patient characteristics, islet characteristics, metabolic outcomes, insulin requirements, and hemoglobin A1c for those who received a blood transfusion (BT) versus no blood transfusion (NBT). Initially, proinflammatory cytokines were moderately higher in the BT group than the NBT group. Despite longer procedures and more severe bleeding, the BT group had similar values to the NBT group for insulin requirements, serum C-peptide, hemoglobin A1c, and insulin independence rate. The probability of insulin independence was slightly higher in patients receiving ≥3 units of blood. ABT induced elevation of proinflammatory cytokines during the perioperative period in TPIAT, but these changes did not significantly change posttransplant islet function. Copyright © 2017 Elsevier Inc. All rights reserved.

Statistical analysis of dose heterogeneity in circulating blood: Implications for sequential methods of total body irradiation

International Nuclear Information System (INIS)

Molloy, Janelle A.

2010-01-01

Purpose: Improvements in delivery techniques for total body irradiation (TBI) using Tomotherapy and intensity modulated radiation therapy have been proven feasible. Despite the promise of improved dose conformality, the application of these ''sequential'' techniques has been hampered by concerns over dose heterogeneity to circulating blood. The present study was conducted to provide quantitative evidence regarding the potential clinical impact of this heterogeneity. Methods: Blood perfusion was modeled analytically as possessing linear, sinusoidal motion in the craniocaudal dimension. The average perfusion period for human circulation was estimated to be approximately 78 s. Sequential treatment delivery was modeled as a Gaussian-shaped dose cloud with a 10 cm length that traversed a 183 cm patient length at a uniform speed. Total dose to circulating blood voxels was calculated via numerical integration and normalized to 2 Gy per fraction. Dose statistics and equivalent uniform dose (EUD) were calculated for relevant treatment times, radiobiological parameters, blood perfusion rates, and fractionation schemes. The model was then refined to account for random dispersion superimposed onto the underlying periodic blood flow. Finally, a fully stochastic model was developed using binomial and trinomial probability distributions. These models allowed for the analysis of nonlinear sequential treatment modalities and treatment designs that incorporate deliberate organ sparing. Results: The dose received by individual blood voxels exhibited asymmetric behavior that depended on the coherence among the blood velocity, circulation phase, and the spatiotemporal characteristics of the irradiation beam. Heterogeneity increased with the perfusion period and decreased with the treatment time. Notwithstanding, heterogeneity was less than ±10% for perfusion periods less than 150 s. The EUD was compromised for radiosensitive cells, long perfusion periods, and short treatment times

Statistical analysis of dose heterogeneity in circulating blood: implications for sequential methods of total body irradiation.

Science.gov (United States)

Molloy, Janelle A

2010-11-01

Improvements in delivery techniques for total body irradiation (TBI) using Tomotherapy and intensity modulated radiation therapy have been proven feasible. Despite the promise of improved dose conformality, the application of these "sequential" techniques has been hampered by concerns over dose heterogeneity to circulating blood. The present study was conducted to provide quantitative evidence regarding the potential clinical impact of this heterogeneity. Blood perfusion was modeled analytically as possessing linear, sinusoidal motion in the craniocaudal dimension. The average perfusion period for human circulation was estimated to be approximately 78 s. Sequential treatment delivery was modeled as a Gaussian-shaped dose cloud with a 10 cm length that traversed a 183 cm patient length at a uniform speed. Total dose to circulating blood voxels was calculated via numerical integration and normalized to 2 Gy per fraction. Dose statistics and equivalent uniform dose (EUD) were calculated for relevant treatment times, radiobiological parameters, blood perfusion rates, and fractionation schemes. The model was then refined to account for random dispersion superimposed onto the underlying periodic blood flow. Finally, a fully stochastic model was developed using binomial and trinomial probability distributions. These models allowed for the analysis of nonlinear sequential treatment modalities and treatment designs that incorporate deliberate organ sparing. The dose received by individual blood voxels exhibited asymmetric behavior that depended on the coherence among the blood velocity, circulation phase, and the spatiotemporal characteristics of the irradiation beam. Heterogeneity increased with the perfusion period and decreased with the treatment time. Notwithstanding, heterogeneity was less than +/- 10% for perfusion periods less than 150 s. The EUD was compromised for radiosensitive cells, long perfusion periods, and short treatment times. However, the EUD was

Rectal red blood loss in a healthy toddler is not always a juvenile polyp.

Science.gov (United States)

Rousseff, T; Matthyssens, L; Van Renterghem, K; Van de Putte, D; De Wulf, D; Van Winckel, M; Van de Velde, S; De Bruyne, R; Van Biervliet, S

2017-01-01

Aim Heterotopic gastric mucosa is a well-known congenital anomaly in Meckel's diverticula and duplication cysts. Solitary heterotopic gastric mucosa in the rectum is a rare and frequently overlooked abnormality. Starting from a patient history, the literature is searched and all cases reported over the past 20 years are reviewed and compared to a summary of the older cases. Differences between adult and childhood presentation are outlined and our patient is compared with prior reported cases. Case A 3-year-old girl presented with recurrent rectal blood loss caused by heterotopic gastric mucosa without duplication cyst. She was endoscopically treated with two-stage endoscopic surgical dissection (ESD). Up to now, rectal heterotopic gastric mucosa has been reported in 34 adults and 24 children, including this patient. There is an overall male dominance (69%). Presenting complaints in children were recurrent fresh blood loss per anum (96%), pain (46%), perineal ulcers (25%), diarrhoea (8%) and one patient had an ano-cutaneous fistula. Endoscopy revealed a mucosal elevation with a slightly different aspect (33%), a polyp (42%) and a solitary ulcer (25%). Endoscopy in adults reveals more frequently polyps compared to children. Treatment in childhood is mainly surgical where adults are more frequently treated with endoscopic techniques. Conclusion In a child with recurrent rectal bleeding in good general health, it is important to withhold heterotopic gastric mucosa in the differential diagnosis and take sufficient biopsies during endoscopy. © Acta Gastro-Enterologica Belgica.

Loss of Brain Aerobic Glycolysis in Normal Human Aging.

Science.gov (United States)

Goyal, Manu S; Vlassenko, Andrei G; Blazey, Tyler M; Su, Yi; Couture, Lars E; Durbin, Tony J; Bateman, Randall J; Benzinger, Tammie L-S; Morris, John C; Raichle, Marcus E

2017-08-01

The normal aging human brain experiences global decreases in metabolism, but whether this affects the topography of brain metabolism is unknown. Here we describe PET-based measurements of brain glucose uptake, oxygen utilization, and blood flow in cognitively normal adults from 20 to 82 years of age. Age-related decreases in brain glucose uptake exceed that of oxygen use, resulting in loss of brain aerobic glycolysis (AG). Whereas the topographies of total brain glucose uptake, oxygen utilization, and blood flow remain largely stable with age, brain AG topography changes significantly. Brain regions with high AG in young adults show the greatest change, as do regions with prolonged developmental transcriptional features (i.e., neoteny). The normal aging human brain thus undergoes characteristic metabolic changes, largely driven by global loss and topographic changes in brain AG. Copyright © 2017 Elsevier Inc. All rights reserved.

The Nordic Obstetric Surveillance Study: a study of complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery.

Science.gov (United States)

Colmorn, Lotte B; Petersen, Kathrine B; Jakobsson, Maija; Lindqvist, Pelle G; Klungsoyr, Kari; Källen, Karin; Bjarnadottir, Ragnheidur I; Tapper, Anna-Maija; Børdahl, Per E; Gottvall, Karin; Thurn, Lars; Gissler, Mika; Krebs, Lone; Langhoff-Roos, Jens

2015-07-01

To assess the rates and characteristics of women with complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery in the Nordic countries. Prospective, Nordic collaboration. The Nordic Obstetric Surveillance Study (NOSS) collected cases of severe obstetric complications in the Nordic countries from April 2009 to August 2012. Cases were reported by clinicians at the Nordic maternity units and retrieved from medical birth registers, hospital discharge registers, and transfusion databases by using International Classification of Diseases, 10th revision codes on diagnoses and the Nordic Medico-Statistical Committee Classification of Surgical Procedure codes. Rates of the studied complications and possible risk factors among parturients in the Nordic countries. The studied complications were reported in 1019 instances among 605 362 deliveries during the study period. The reported rate of severe blood loss at delivery was 11.6/10 000 deliveries, complete uterine rupture was 5.6/10 000 deliveries, abnormally invasive placenta was 4.6/10 000 deliveries, and peripartum hysterectomy was 3.5/10 000 deliveries. Of the women, 25% had two or more complications. Women with complications were more often >35 years old, overweight, with a higher parity, and a history of cesarean delivery compared with the total population. The studied obstetric complications are rare. Uniform definitions and valid reporting are essential for international comparisons. The main risk factors include previous cesarean section. The detailed information collected in the NOSS database provides a basis for epidemiologic studies, audits, and educational activities. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Management of major blood loss: an update

DEFF Research Database (Denmark)

Johansson, P I; Ostrowski, S R; Secher, N H

2010-01-01

the early control of the cause of bleeding by non-definitive means, while haemostatic control resuscitation seeks early control of coagulopathy. Haemostatic resuscitation provides transfusions with plasma and platelets in addition to red blood cells (RBCs) in an immediate and sustained manner as part...... of the transfusion protocol for massively bleeding patients. Transfusion of RBCs, plasma and platelets in a similar proportion as in whole blood prevents both hypovolaemia and coagulopathy. Although an early and effective reversal of coagulopathy is documented, the most effective means of preventing coagulopathy....... Furthermore, viscoelastic whole blood assays, such as thrombelastography (TEG)/rotation thromboelastometry (ROTEM), appear advantageous for identifying coagulopathy in patients with severe haemorrhage, as opposed to conventional coagulation assays. In our view, patients with uncontrolled bleeding, regardless...

Economic burden of malignant blood disorders across Europe: a population-based cost analysis.

Science.gov (United States)

Burns, Richeal; Leal, Jose; Sullivan, Richard; Luengo-Fernandez, Ramon

2016-08-01

Malignant blood disorders are a leading contributor to cancer incidence and mortality across Europe. Despite their burden, no study has assessed the economic effect of blood cancers in Europe. We aimed to assess the economic burden of malignant blood disorders across the 28 countries in the European Union (EU), Iceland, Norway, and Switzerland. Malignant blood disorder-related costs were estimated for 28 EU countries, Iceland, Norway, and Switzerland for 2012. Country-specific costs were estimated with aggregate data on morbidity, mortality, and health-care resource use obtained from international and national sources. Health-care costs were estimated from expenditure on primary, outpatient, emergency, inpatient care, and drugs. Costs of informal care and productivity losses due to morbidity and early death were also included. For countries in the EU, malignant blood disorders were compared with the economic burden of overall cancer. Malignant blood disorders cost the 31 European countries €12 billion in 2012. Health-care cost €7·3 billion (62% of total costs), productivity losses cost €3·6 billion (30%), and informal care cost €1 billion (8%). For the EU countries, malignant blood disorders cost €6·8 billion (12%) of the total health-care expenditure on cancer (€57 billion), with this proportion being second only to breast cancer. In terms of total cancer costs in the EU (€143 billion), malignant blood disorders cost €12 billion (8%). Malignant blood disorders represent a leading cause of death, health-care service use, and costs, not only to European health-care systems, but to society overall. Our results add to essential public health knowledge needed for effective national cancer-control planning and priorities for public research funding. European Hematology Association. Copyright © 2016 Elsevier Ltd. All rights reserved.

Staged Custom, Intramedullary Antibiotic Spacers for Severe Segmental Bone Loss in Infected Total Hip Arthroplasty

Directory of Open Access Journals (Sweden)

Atul F. Kamath

2011-01-01

Full Text Available Introduction. Total hip arthroplasty (THA infections with severe bone loss pose significant reconstructive challenges. We present our experience with two-stage hip reimplantation using an intramedullary, antibiotic-impregnated nail. Methods. Three patients with infected THA with severe proximal femoral bone loss (Mallory type IIIB or greater were treated using a custom antibiotic spacer. Clinical outcomes and any complications were recorded. Average followup was 49 months from final reimplantation. Results. Mean age at spacer placement (stage 1 was 53 years. The mean Harris Hip Score at final followup was 80. Two patients had asymptomatic heterotopic ossification, and one patient had a 2 cm leg-length discrepancy. Conclusions. A custom intramedullary nail antibiotic spacer is a reliable option in the staged management of the infected THA with severe proximal femoral bone loss. Benefits of this technique include limb salvage with maintenance of leg length, soft tissue tension, and functional status.

Effects of Hypotensive Anesthesia on Reducing Intraoperative Blood Loss, Duration of Operation, and Quality of Surgical Field During Orthognathic Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Science.gov (United States)

Lin, Susie; McKenna, Samuel J; Yao, Chuan-Fong; Chen, Yu-Ray; Chen, Chit

2017-01-01

The objective of this study was to evaluate the efficacy of hypotensive anesthesia in reducing intraoperative blood loss, decreasing operation time, and improving the quality of the surgical field during orthognathic surgery. A systematic review and meta-analysis of randomized controlled trials addressing these issues were carried out. An electronic database search was performed. The risk of bias was evaluated with the Jadad Scale and Delphi List. The inverse variance statistical method and a random-effects model were used. Ten randomized controlled trials were included for analysis. Our meta-analysis indicated that hypotensive anesthesia reduced intraoperative blood loss by a mean of about 169 mL. Hypotensive anesthesia was not shown to reduce the operation time for orthognathic surgery, but it did improve the quality of the surgical field. Subgroup analysis indicated that for blood loss in double-jaw surgery, the weighted mean difference favored the hypotensive group, with a reduction in blood loss of 175 mL, but no statistically significant reduction in blood loss was found for anterior maxillary osteotomy. If local anesthesia with epinephrine was used in conjunction with hypotensive anesthesia, the reduction in intraoperative blood loss was increased to 254.93 mL. Hypotensive anesthesia was effective in reducing blood loss and improving the quality of the surgical field, but it did not reduce the operation time for orthognathic surgery. The use of local anesthesia in conjunction with hypotensive general anesthesia further reduced the amount of intraoperative blood loss for orthognathic surgery. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Effect of a high-protein diet on maintenance of blood pressure levels achieved after initial weight loss

DEFF Research Database (Denmark)

Engberink, M F; Geleijnse, J M; Bakker, S J L

2015-01-01

Randomized trials have shown significant blood pressure (BP) reductions after increased protein compared with carbohydrate intake, but the effect on BP maintenance after initial weight loss is unclear. We examined the effect of a high-protein diet on the maintenance of reduced BP after weight loss......(-2), BP was 118/73 mm Hg and 28 subjects (6.5%) used antihypertensive agents. Systolic BP during 26 weeks of weight maintenance dietary intervention increased in both treatment groups, but it was 2.2 mm Hg less (95% CI: -4.6 to 0.2 mm Hg, P=0.08) in the high-protein group than in the lower...

Large animal evaluation of riboflavin and ultraviolet light-treated whole blood transfusion in a diffuse, nonsurgical bleeding porcine model.

Science.gov (United States)

Okoye, Obi T; Reddy, Heather; Wong, Monica D; Doane, Suzann; Resnick, Shelby; Karamanos, Efstathios; Skiada, Dimitra; Goodrich, Raymond; Inaba, Kenji

2015-03-01

The Mirasol system has been demonstrated to effectively inactivate white blood cells (WBCs) and reduce pathogens in whole blood in vitro. The purpose of this study was to compare the safety and efficacy of Mirasol-treated fresh whole blood (FWB) to untreated FWB in an in vivo model of surgical bleeding. A total of 18 anesthetized pigs (40 kg) underwent a 35% total blood volume bleed, cooling to 33°C, and a standardized liver injury. Animals were then randomly assigned to resuscitation with either Mirasol-treated or untreated FWB, and intraoperative blood loss was measured. After abdominal closure, the animals were observed for 14 days, after which the animals were euthanized and tissues were obtained for histopathologic examination. Mortality, tissue near-infrared spectroscopy, red blood cell (RBC) variables, platelets (PLTs), WBCs, and coagulation indices were analyzed. Total intraoperative blood loss was similar in test and control arms (8.3 ± 3.2 mL/kg vs. 7.7 ± 3.9 mL/kg, p = 0.720). All animals survived to Day 14. Trended values over time did not show significant differences-tissue oxygenation (p = 0.605), hemoglobin (p = 0.461), PLTs (p = 0.807), WBCs (p = 0.435), prothrombin time (p = 0.655), activated partial thromboplastin time (p = 0.416), thromboelastography (TEG)-reaction time (p = 0.265), or TEG-clot formation time (p = 0.081). Histopathology did not show significant differences between arms. Mirasol-treated FWB did not impact survival, blood loss, tissue oxygen delivery, RBC indices, or coagulation variables in a standardized liver injury model. These data suggest that Mirasol-treated FWB is both safe and efficacious in vivo. © 2015 AABB.

Temporary Intraoperative Porto-Caval Shunts in Piggy-Back Liver Transplantation Reduce Intraoperative Blood Loss and Improve Postoperative Transaminases and Renal Function: A Meta-Analysis.

Science.gov (United States)

Pratschke, Sebastian; Rauch, Alexandra; Albertsmeier, Markus; Rentsch, Markus; Kirschneck, Michaela; Andrassy, Joachim; Thomas, Michael; Hartwig, Werner; Figueras, Joan; Del Rio Martin, Juan; De Ruvo, Nicola; Werner, Jens; Guba, Markus; Weniger, Maximilian; Angele, Martin K

2016-12-01

The value of temporary intraoperative porto-caval shunts (TPCS) in cava-sparing liver transplantation is discussed controversially. Aim of this meta-analysis was to analyze the impact of temporary intraoperative porto-caval shunts on liver injury, primary non-function, time of surgery, transfusion of blood products and length of hospital stay in cava-sparing liver transplantation. A systematic search of MEDLINE/PubMed, EMBASE and PsycINFO retrieved a total of 909 articles, of which six articles were included. The combined effect size and 95 % confidence interval were calculated for each outcome by applying the inverse variance weighting method. Tests for heterogeneity (I 2 ) were also utilized. Usage of a TPCS was associated with significantly decreased AST values, significantly fewer transfusions of packed red blood cells and improved postoperative renal function. There were no statistically significant differences in primary graft non-function, length of hospital stay or duration of surgery. This meta-analysis found that temporary intraoperative porto-caval shunts in cava-sparing liver transplantation reduce blood loss as well as hepatic injury and enhance postoperative renal function without prolonging operative time. Randomized controlled trials investigating the use of temporary intraoperative porto-caval shunts are needed to confirm these findings.

Defining clinically important perioperative blood loss and transfusion for the Standardised Endpoints for Perioperative Medicine (StEP) collaborative: a protocol for a scoping review.

Science.gov (United States)

Bartoszko, Justyna; Vorobeichik, Leon; Jayarajah, Mohandas; Karkouti, Keyvan; Klein, Andrew A; Lamy, Andre; Mazer, C David; Murphy, Mike; Richards, Toby; Englesakis, Marina; Myles, Paul S; Wijeysundera, Duminda N

2017-06-30

'Standardised Endpoints for Perioperative Medicine' (StEP) is an international collaboration undertaking development of consensus-based consistent definitions for endpoints in perioperative clinical trials. Inconsistency in endpoint definitions can make interpretation of trial results more difficult, especially if conflicting evidence is present. Furthermore, this inconsistency impedes evidence synthesis and meta-analyses. The goals of StEP are to harmonise definitions for clinically meaningful endpoints and specify standards for endpoint reporting in clinical trials. To help inform this endeavour, we aim to conduct a scoping review to systematically characterise the definitions of clinically important endpoints in the existing published literature on perioperative blood loss and transfusion. The scoping review will be conducted using the widely adopted framework developed by Arksey and O'Malley, with modifications from Levac. We refined our methods with guidance from research librarians as well as researchers and clinicians with content expertise. The electronic literature search will involve several databases including Medline, PubMed-not-Medline and Embase. Our review has three objectives, namely to (1) identify definitions of significant blood loss and transfusion used in previously published large perioperative randomised trials; (2) identify previously developed consensus-based definitions for significant blood loss and transfusion in perioperative medicine and related fields; and (3) describe the association between different magnitudes of blood loss and transfusion with postoperative outcomes. The multistage review process for each question will involve two reviewers screening abstracts, reading full-text articles and performing data extraction. The abstracted data will be organised and subsequently analysed in an iterative process. This scoping review of the previously published literature does not require research ethics approval. The results will be used

ATWS analysis for total loss of feedwater sequence in UCN 3 and 4

International Nuclear Information System (INIS)

Park, S. H.; Song, Y. M.; Kim, D. H.; Kim, S. D.; Park, S. Y.

1999-01-01

ATWS is a trip-failed severe accident initiated from the transients like a turbine trip, a control bank withdrawal, and a loss of feedwater which are expected to occur comparatively often (one or two occurrences / year). In this study, an ATWS sequence in Ulchin 3 and 4 is analyzed and the effects of the important systems are studied for accident management purpose using a MIDAS/PK computer code. The MIDAS/PK code has been developed via coupling a point kinetics module with the MELCOR code. The code calculates a primary peak pressure of about 24MPa at 240 seconds for the ATWS initiated by a TLOF (Total Loss of Feedwater) transient. Along with the basic ATWS analysis, several sensitivity runs are performed. From these, the turbines and the safety depressurization system (SDS) are judged to be important. The turbine trip resulting in a loss of offsite power and a RCP trip, degrades primary heat transfer to the secondary sides, and in turn, increases primary coolant temperature which reduces the reactor power due to the negative moderator temperature coefficient. Manual operation of SDS has an effect to lower the primary peak pressure considerably via supplementary depressurization in addition to the PORVs

Laparoscopic total pancreatectomy

Science.gov (United States)

Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

2017-01-01

Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344

The effect of different dosage regimens of tranexamic acid on blood loss in bimaxillary osteotomy: a randomized, double-blind, placebo-controlled study.

Science.gov (United States)

Apipan, B; Rummasak, D; Narainthonsaenee, T

2018-05-01

The purpose of this study was to compare the effects of three dosage regimens of intravenous tranexamic acid and normal saline placebo on blood loss and the requirement for transfusion during bimaxillary osteotomy. A prospective, randomized, double-blind, placebo-controlled study was performed. Eighty patients scheduled for elective bimaxillary osteotomy were divided into four groups: a placebo group and three groups receiving a single dose of tranexamic acid 10, 15, or 20mg/kg body weight after the induction of anaesthesia. Demographic data, the anaesthetic time, the operative time, and the experience of the surgical team were similar in the four groups. Patients receiving placebo had increased blood loss compared to those receiving tranexamic acid. No significant difference in blood loss was found among those who received 10, 15, or 20mg/kg body weight of tranexamic acid. There was no significant difference in transfusion requirement, amount of 24-h postoperative vacuum drainage, length of hospital stay, or complications among the four groups. Prophylactic tranexamic acid decreased bleeding during bimaxillary osteotomy. Of the three dosages of tranexamic acid studied, the most efficacious and cost-effective dose to reduce bleeding was 10mg/kg body weight. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Allogeneic blood transfusion and prognosis following total hip replacement: a population-based follow up study

DEFF Research Database (Denmark)

Pedersen, Alma B; Mehnert, Frank; Overgaard, Søren

2009-01-01

BACKGROUND: Allogeneic red blood cell transfusion is frequently used in total hip replacement surgery (THR). However, data on the prognosis of transfused patients are sparse. In this study we compared the risk of complications following THR in transfused and non-transfused patients. METHODS......: A population-based follow-up study was performed using data from medical databases in Denmark. We identified 28,087 primary THR procedures performed from 1999 to 2007, from which we computed a propensity score for red blood cell transfusion based on detailed data on patient-, procedure-, and hospital......-related characteristics. We were able to match 2,254 transfused with 2,254 non-transfused THR patients using the propensity score. RESULTS: Of the 28,087 THR patients, 9,063 (32.3%) received at least one red blood cell transfusion within 8 days of surgery. Transfused patients had higher 90-day mortality compared...

Hypotensive anesthesia: Comparing the effects of different drug combinations on mean arterial pressure, estimated blood loss, and surgery time in orthognathic surgery.

Science.gov (United States)

Jeong, James; Portnof, Jason E; Kalayeh, Mona; Hardigan, Patrick

2016-07-01

Sevoflurane, an inhalational hypotensive anesthetic agent with a vasodilatory property, has been commonly used as a single agent to induce hypotension and effectively decrease blood loss in orthognathic surgery. However, it is common for patients to receive other hypotensive anesthetic agents in combination with sevoflurane. The purpose of our retrospective cohort study is to investigate whether administering an additional hypotensive agent has greater effect at reducing mean arterial pressure (MAP), estimated blood loss (EBL) and surgery time during orthognathic surgery. 57 subjects, aged 0-89 of both genders, who underwent orthognathic surgery were investigated in this study. Each patient's anesthesia records were reviewed to record the following variables of interest: EBL, duration of surgery, and MAP reduction in %. 41 subjects were placed in Group I and they received sevoflurane alone. 16 subjects were placed in Group II and they received sevoflurane plus a "supportive" agent. These "supportive" agents were esmolol, labetalol, metoprolol, nicardipine, and dexmedetomidine. The significant differences between two groups were assessed by using ANCOVA and p surgery time. Subjects in Group II experienced a greater reduction in MAP during surgery than subjects in Group I, 27.30% and 20.44%, respectively (p = 0.027). There was no significant difference for sex (p = 0.417) or age group (p = 0.113) in estimated blood loss, however. The mean surgery time in Group I was 1.93, 2.77, and 4.54 h with respect to LeFort, BSSO/IVRO, and double jaw surgery. Patients in Group II had a mean surgery time of 1.73, 2.07, and 5.64 h with respect to LeFort, BSSO/IVRO, and double jaw surgery. No statistically significant difference was demonstrated in surgery time between Group I vs. Group II (p > 0.05). Subjects in Group II experienced, on average, more blood loss than subjects in Group I, 355.50 ml and 238.90 ml, respectively. The use of multi-drug combination may offer

Usefulness of gram staining of blood collected from total parenteral nutrition catheter for rapid diagnosis of catheter-related sepsis.

Science.gov (United States)

Moonens, F; el Alami, S; Van Gossum, A; Struelens, M J; Serruys, E

1994-01-01

The accuracy of Gram staining of blood drawn from catheters used to administer total parenteral nutrition was compared with paired quantitative blood cultures for the diagnosis of catheter-related sepsis. Gram staining was positive in 11 of 18 episodes of catheter-related sepsis documented by quantitative culture (sensitivity, 61%) but in none of the 5 episodes of fever unrelated to catheter infection. Thus, this procedure enabled the rapid presumptive diagnosis and guidance of antimicrobial therapy for total parenteral nutrition catheter sepsis, with a positive predictive value of 100% and a negative predictive value of 42%. PMID:7521359

Combined versus single application of tranexamic acid in total knee and hip arthroplasty: A meta-analysis of randomized controlled trials.

Science.gov (United States)

Peng Zhang, M M; Jifeng Li, M M; Xiao Wang, M M

2017-07-01

To compare the efficacy and safety of the combined application of both intravenous and topical tranexamic acid versus the single use of either application in patients with total knee and hip arthroplasty. Potentially relevant studies were identified from electronic databases including Medline, PubMed, Embase, ScienceDirect and the Cochrane Library. Patients undergoing primary total knee and hip arthroplasty were included in our studies, with an experimental group that received combined intravenous and topical application of tranexamic acid and a control group that received a single application of tranexamic acid or normal saline. The primary outcomes were total blood loss, hemoglobin decline and transfusion requirements. The secondary outcomes were length of stay, operation time and tranexamic acid-related adverse effects, such as superficial infection, deep vein thrombosis or pulmonary embolism. Modified Jadad scores were used to assess the quality of the included randomized controlled trials (RCTs). The data was pooled using RevMan 5.3. After testing for heterogeneity across studies, the data were aggregated using random-effects modeling when appropriate. We have registered the trial at http://www.researchregistry.com. Six RCTs that included 704 patients met the inclusion criteria. The present meta-analysis indicated significant differences existed in the total blood loss (MD = -134.65, 95% CI: -191.66 to -77.64, P tranexamic acid in total knee and hip arthroplasty was associated with significantly reduced total blood loss, postoperative hemoglobin decline, drainage volume, and transfusion requirements. Based on the limitations of current meta-analysis, well-designed, high-quality RCTs with long-term follow-up are still required. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Vascular calcifications on the preoperative radiograph: harbinger of tourniquet failure in patients undergoing total knee arthroplasty?

Energy Technology Data Exchange (ETDEWEB)

Woelfle-Roos, Julia Verena; Dautel, Laura; Bieger, Ralf; Reichel, Heiko [University of Ulm, Department of Orthopaedic Surgery, Ulm (Germany); Mayer, Benjamin [University of Ulm, Institute of Epidemiology and Medical Biometrics, Ulm (Germany); Woelfle, Klaus-Dieter [Klinikum Augsburg, Vascular Surgery Division, Surgical Center, Augsburg (Germany)

2017-09-15

Vascular calcifications on the preoperative radiograph of patients scheduled for total knee arthroplasty (TKA) often give rise to concern, as their clinical relevance remains uncertain. The aim of this study was to investigate whether these vascular calcifications - especially medial artery calcifications (MACs), which increase arterial stiffness - were associated with tourniquet failure and thus with increased intraoperative blood loss. A total of 765 patients who underwent primary TKA with a tourniquet (cuff pressure 350 mmHg) between 2009 and 2011 were screened for vascular calcifications on the preoperative radiograph. Vascular calcifications were classified into intimal and medial artery calcifications. Intraoperative blood loss of patients with and without MAC was compared, and a mixed linear regression model was used to adjust for the presence of several confounding factors (e.g., obesity, operating time). None of the 50 (6.5%) patients with MAC showed signs of tourniquet failure. Intraoperative blood loss of patients with MAC was not significantly elevated compared to the overall study group (p = 0.592) even when corrected for the presence of several confounding factors. We found no evidence that vascular calcifications seen on the preoperative radiograph might be associated with tourniquet failure. However, surgeons should be aware of this possibility as tourniquet failure might become more common considering the ongoing trend toward minimizing cuff pressures. (orig.)

Effect of a Modest Weight Loss in Normalizing Blood Pressure in Obese Subjects on Antihypertensive Drugs

Directory of Open Access Journals (Sweden)

Luisa Gilardini

2016-07-01

Full Text Available Objective: To assess the effect of a lifestyle intervention in lowering/normalizing blood pressure (BP levels in hypertensive (controlled or not obese patients. Methods: In this prospective observational study, 490 obese hypertensive patients, 389 controlled (BP Results: 18.9% of CH and 20.0% of UH were on ≥ 3 antihypertensive drugs. Weight change (average -4.9 ± 2.7% was independent of the antihypertensive drugs employed. Systolic BP (SBP decreased by 23 mm Hg and diastolic BP (DBP by 9 mm Hg, in patients with UH most of whom (89% normalized BP levels (in 49% after a weight loss Conclusion: Lifestyle interventions are useful for all obese hypertensive patients in most of whom a modest weight loss is sufficient to normalize BP levels avoiding the aggressive use of multiple antihypertensive drugs.

Relative blood volume changes underestimate total blood volume changes during hemodialysis

NARCIS (Netherlands)

Dasselaar, Judith J.; Lub-de Hooge, Marjolijn N.; Pruim, Jan; Nijnuis, Hugo; Wiersum, Anneke; de Jong, Paul E.; Huisman, Roel M.; Franssen, Casper F. M.

Background: Measurements of relative blood volume changes (ARBV) during hemodialysis (HD) are based on hemoconcentration and assume uniform mixing of erythrocytes and plasma throughout the circulation. However, whole-body hematocrit (Ht) is lower than systemic Ht. During HD, a change in the ratio

Relationship Between Total and Bioaccessible Lead on Children’s Blood Lead Levels in Urban Residential Philadelphia Soils

Science.gov (United States)

Relationships between total soil or bioaccessible lead (Pb), measured using an in vitro bioaccessibility assay, and children’s blood lead levels (BLL) were investigated in an urban neighborhood in Philadelphia, Pennsylvania, USA, with a history of soil Pb contamination....

Change in fat-free mass assessed by bioelectrical impedance, total body potassium and dual energy X-ray absorptiometry during prolonged weight loss

DEFF Research Database (Denmark)

Hendel, H W; Gotfredsen, A; Højgaard, L

1996-01-01

A total of 16 obese women (body mass index (BMI) 30-43 kg m(-2)) participated in a weight reduction study. Before and after a weight loss of 11.7 +/- 7.4 kg (mean +/- SD), body composition was assessed by dual energy X-ray absorptiometry (DXA), and total body potassium counting (TBK). These measu......A total of 16 obese women (body mass index (BMI) 30-43 kg m(-2)) participated in a weight reduction study. Before and after a weight loss of 11.7 +/- 7.4 kg (mean +/- SD), body composition was assessed by dual energy X-ray absorptiometry (DXA), and total body potassium counting (TBK......). These measurements were compared with bioimpedance analysis (BIA) by applying 11 predictive BIA equations published in the literature. Predictive equations for the present study population were developed, with the use of fat-free mass (FFM) as assessed by TBK and DXA as references in multiple regression analysis....... The results of the BIA equations varied widely; FFM was generally overestimated by BIA as compared with DXA and TBK before and after weight loss. During weight loss, the FFM did not change, as estimated by DXA (1.3 +/- 2.3 kg, p > 0.05) and TBK (0.9 +/- 2.9 kg, p > 0.05). The recorded change in impedance (R...

Effect of oral drenching with zinc oxide or synthetic zeolite A on total blood calcium in dairy cows

DEFF Research Database (Denmark)

Jørgensen, R. J.; Hansen, T.; Jensen, M. L.

2001-01-01

Danish Holstein dairy cows in late lactation and milked in the morning only were used as a model for dry pregnant cows to determine the effect of oral drenching with zeolite A and zinc oxide, respectively, on total serum calcium. Ten cows were assigned randomly to two groups of five cows each......, given either synthetic zeolite A (group A) or zinc oxide (group B). Blood samples were drawn daily at 10 a.m. and 10 p.m. during the whole experiment, and total serum calcium was determined. Daily fluctuations in blood calcium were recorded, with morning values being consistently lower than evening...... values. Oral drenching with a single dose of zinc oxide of 100 mg/kg of body weight as well as with zeolite in doses of 500 g of zeolite/cow twice a day for 2.5 d was reflected in serum calcium levels. In the group given zeolite A, there was a depression in evening values of total serum calcium although...

Stop of loss of cognitive performance during rehabilitation after total hip arthroplasty-prospective controlled study.

Science.gov (United States)

Brem, Matthias H; Lehrl, Siegfried; Rein, Anna K; Massute, Sylvia; Schulz-Drost, Stefan; Gelse, Kolja; Schlechtweg, Phillip M; Hennig, Friedrich F; Olk, Alexander; Jacob, Harald J; Gusinde, Johannes

2010-01-01

Prolonged hospitalization is known to be associated with a loss of cognitive performance. Does playing video games (VGs) developed to improve cognitive properties delay this loss or even lead to an increase in cognitive performance? We performed a 10-day longitudinal study of patients who received total hip arthroplasty. We compared 16 patients (6 male) aged 66 ± 9 years (mean ± standard deviation) who played Dr. Kawashima's Brain Training: How Old Is Your Brain? (Nintendo; Redmond, Washington) on a Nintendo DS handheld console with 16 control patients (6 male) aged 69 ± 14 years. We measured cognitive performance 1 day preoperation, as well as on days 2 and 9 postoperation. With the daily exercise of a specific VG by the play group, the patients' fluid intelligence (median intelligence quotient 99-106), working memory capacity, and rate of information processing significantly improved over the course of 7 postoperative days. The cognitive performance of the control group did not increase. However, the memory spans of both groups did not systematically change. Exercise with VGs can prevent the loss of cognitive performance during prolonged hospitalization.

Relationship between Serum Iron Profile and Blood Groups among the Voluntary Blood Donors of Bangladesh.

Science.gov (United States)

Hoque, M M; Adnan, S D; Karim, S; Al-Mamun, M A; Faruki, M A; Islam, K; Nandy, S

2016-04-01

Blood donation results in a substantial iron loss and subsequent mobilization from body stores. Chronic iron deficiency is a well-recognized complication of regular blood donation. The present study conducted to compare the level of serum ferritin, serum iron, total iron binding capacity (TIBC) and percentage transferrin saturation in different ABO and Rhesus type blood groups among the voluntary blood donors of Bangladesh. The present prospective study included 100 healthy voluntary donors attending at Department of Blood Transfusion, Dhaka Medical College, Dhaka between the periods of July 2013 to Jun 2014. From each donor 10mL venous blood sample was taken and divided into heparinized and non-heparinized tubes for determination of hemoglobin (Hb), hematocrit (Hct), serum iron (SI), total iron binding capacity (TIBC) and serum ferritin by standard laboratory methods. Percentage of transferrin saturation (TS) calculated from serum iron and TIBC. Data were analyzed with SPSS (version 16) software and comparisons between groups were made using student's t-test and one way ANOVA. In the present study mean±SD of age of the respondents was 27.2±6.5 years with a range of 18 to 49 years and 81.0% were male and 19.0% were female. Among the donors 18.0% had blood group A, 35.0% had blood group B, 14.0% had blood group AB and 33.0% had blood group O. Among the donors 91.0% had rhesus positive and 9.0% had rhesus negative. Donors with blood group O had lowest haemoglobin, serum iron and transferring saturation levels. Donors with blood group A had highest TIBC level. Donors with blood group B had lowest serum ferritin level. An independent samples 't' test showed statistically significant difference in serum ferritin and percentage transferrin saturation between blood group AB and blood group O and in percentage transferrin saturation between blood group B and blood group O. One way ANOVA showed that there is no significant difference in haemoglobin, serum iron, serum

Does the suction drain diameter matter? Bleeding analysis after total knee replacement comparing different suction drain gauges

Directory of Open Access Journals (Sweden)

Marcos George de Souza Leao

Full Text Available ABSTRACT OBJECTIVES: To evaluate bleeding and the estimated blood loss in patients who underwent total knee replacement (TKR with different closed suction drains (3.2-mm and 4.8-mm gauge. METHODS: This was a randomized controlled trial with 22 patients who underwent TKR and were divided into two groups: Group I, with 11 patients in whom the 3.2-mm suction drain was used, and Group II, with 11 patients in whom the 4.8-mm suction drain was used. The hematocrit was measured after 24, 48 and 72 h after surgery in order to calculate the estimated blood loss. The drained volume was measured 3, 6, 12, 24, and 48 h after TKR, and thereafter both groups were compared. RESULTS: Regarding the hematocrit, there were no differences between groups in measured periods (24, 48, and 72 h after surgery. The total bleeding measured at the suction drains within 48 h was higher in Group II, with a statistically significant difference (p = 0.005; in the first 24 h, there was major bleeding in Group II (mean 893 mL, with a significant difference (p = 0.004. Between 24 and 48 h, there was no statistically significant difference in both groups (p = 0.710. The total estimated bleeding was higher in Group I, with mean of 463 mL, versus 409 mL in Group II, with no statistical significance (p = 0.394. CONCLUSIONS: Bleeding was higher in the group that used the 4.8 mm gauge suction drain, with no differences in hematocrit and estimated blood loss.

Preventing Excessive Blood Loss During Percutaneous Nephrolithotomy by Using Tranexamic Acid: A Double Blinded Prospective Randomized Controlled Trial

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Adnan Siddiq

2017-12-01

Full Text Available Objective: Percutaneous nephrolithotomy (PCNL is most frequently performed procedure for renal stones 2 cm and larger. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive and safe drug like tranexamic acid (TA would ultimately turn out to be cornerstone for establishing future guidelines. Aim of this study is to evaluate whether TA is efficacious in preventing blood loss during PCNL. Materials and Methods: Ethical review board approval taken. Sample size calculation yielded 240 patients, comprising 120 in each group. Group A receiving TA and group B receiving placebo. Age, gender, body mass index (BMI, stone size, volume and location, preoperative blood count, creatinine, urine analysis, coagulation profile and necessary radiological investigations done. Randomization through lottery method. Both patient and investigator were blinded. Hemoglobin (Hb and hematocrit (Hct levels done at 24 hours postoperatively and fall in values recorded. Results: Both groups were equal in characteristics like age, gender, BMI, stone size, volume and location (p>0.05. Operative variables like calyx punctured, position of puncture and operative time were also found to be similar in both groups. Median change in Hb in placebo group was 1.6 interquartile range (IQR 4, while in TA group was 1.3 (IQR 7.8 (p=0.001. Similarly, median change in Hct level in placebo group was 3.6 (IQR 11.8 and in TA group was 2.4 (IQR 13 (p<0.001. Sixteen patients were transfused after surgery; 12 (75% belonged to placebo group while 4 (25% belonged to TA group (p=0.038. Hospital stay was not significantly different in both groups (p=0.177 with median of 4.0 and IQR of 0 in both groups. Conclusion: TA during PCNL reduces blood loss and minimizes blood transfusion rate.

Can a mathematical model predict an individual's trait-like response to both total and partial sleep loss?

Science.gov (United States)

Ramakrishnan, Sridhar; Lu, Wei; Laxminarayan, Srinivas; Wesensten, Nancy J; Rupp, Tracy L; Balkin, Thomas J; Reifman, Jaques

2015-06-01

Humans display a trait-like response to sleep loss. However, it is not known whether this trait-like response can be captured by a mathematical model from only one sleep-loss condition to facilitate neurobehavioural performance prediction of the same individual during a different sleep-loss condition. In this paper, we investigated the extent to which the recently developed unified mathematical model of performance (UMP) captured such trait-like features for different sleep-loss conditions. We used the UMP to develop two sets of individual-specific models for 15 healthy adults who underwent two different sleep-loss challenges (order counterbalanced; separated by 2-4 weeks): (i) 64 h of total sleep deprivation (TSD) and (ii) chronic sleep restriction (CSR) of 7 days of 3 h nightly time in bed. We then quantified the extent to which models developed using psychomotor vigilance task data under TSD predicted performance data under CSR, and vice versa. The results showed that the models customized to an individual under one sleep-loss condition accurately predicted performance of the same individual under the other condition, yielding, on average, up to 50% improvement over non-individualized, group-average model predictions. This finding supports the notion that the UMP captures an individual's trait-like response to different sleep-loss conditions. © 2014 European Sleep Research Society.

Splitting blood and blood product packaging reduces donor exposure for patients undergoing cardiopulmonary bypass.

Science.gov (United States)

Nuszkowski, M M; Jonas, R A; Zurakowski, D; Deutsch, N

2015-11-01

Cardiopulmonary bypass for congenital heart surgery requires packed red cells (PRBC) and fresh frozen plasma (FFP) to be available, both for priming of the circuit as well as to replace blood loss. This study examines the hypothesis that splitting one unit of packed red blood cells and one unit of fresh frozen plasma into two half units reduces blood product exposure and wastage in the Operating Room. Beginning August 2013, the blood bank at Children's National Medical Center began splitting one unit of packed red blood cells (PRBC) and one unit of fresh frozen plasma (FFP) for patients undergoing cardiopulmonary bypass (CPB). The 283 patients who utilized CPB during calendar year 2013 were divided into 2 study groups: before the split and after the split. The principal endpoints were blood product usage and donor exposure intra-operatively and within 72 hours post-operatively. There was a significant decrease in median total donor exposures for FFP and cryoprecipitate from 5 to 4 per case (p = 0.007, Mann-Whitney U-test). However, there was no difference in the volume of blood and blood products used; in fact, there was a significant increase in the amount of FFP that was wasted with the switch to splitting the unit of FFP. We found that modification of blood product packaging can decrease donor exposure. Future investigation is needed as to how to modify packaging to minimize wastage. © The Author(s) 2015.

GLUCOSE AND TOTAL PROTEIN LEVEL IN LABORATORY RATS UNDER CONDITIONS OF SHORT-TERM FASTING

Directory of Open Access Journals (Sweden)

Damir Suljević

2013-09-01

Full Text Available Glucose level (UV enzymatic method and total protein level (Biuret method were measured in the blood samples of the rats exposed to short-term starvation. We found a statistically significant increase in the glucose level in experimental animals during starvation, which is also evident in males and females in the experimental group (p <0.05, while decrease in the total protein level was not statistically significant. During starvation, more significant weight loss was observed in females compared to males.Key words: glucose, total protein, serum, Rattus

Cytokine-Mediated Loss of Blood Dendritic Cells During Epstein-Barr Virus-Associated Acute Infectious Mononucleosis: Implication for Immune Dysregulation.

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Panikkar, Archana; Smith, Corey; Hislop, Andrew; Tellam, Nick; Dasari, Vijayendra; Hogquist, Kristin A; Wykes, Michelle; Moss, Denis J; Rickinson, Alan; Balfour, Henry H; Khanna, Rajiv

2015-12-15

Acute infectious mononucleosis (IM) is associated with altered expression of inflammatory cytokines and disturbed T-cell homeostasis, however, the precise mechanism of this immune dysregulation remains unresolved. In the current study we demonstrated a significant loss of circulating myeloid and plasmacytoid dendritic cells (DCs) during acute IM, a loss correlated with the severity of clinical symptoms. In vitro exposure of blood DCs to acute IM plasma resulted in loss of plasmacytoid DCs, and further studies with individual cytokines showed that exposure to interleukin 10 could replicate this effect. Our data provide important mechanistic insight into dysregulated immune homeostasis during acute IM. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

A Weight-Loss Diet Including Coffee-Derived Mannooligosaccharides Enhances Adipose Tissue Loss in Overweight Men but Not Women

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St-Onge, Marie-Pierre; Salinardi, Taylor; Herron-Rubin, Kristin; Black, Richard M.

2013-01-01

Mannooligosaccharides (MOS), extracted from coffee, have been shown to promote a decrease in body fat when consumed as part of free-living, weight-maintaining diets. Our objective was to determine if MOS consumption (4 g/day), in conjunction with a weight-loss diet, would lead to greater reductions in adipose tissue compartments than placebo. We conducted a double-blind, placebo-controlled weight-loss study in which 60 overweight men and women consumed study beverages and received weekly group counseling for 12 weeks. Weight and blood pressure were measured weekly, and adipose tissue distribution was assessed at baseline and at end point using magnetic resonance imaging. A total of 54 subjects completed the study. Men consuming the MOS beverage had greater loss of body weight than men consuming the Placebo beverage (−6.0 ± 0.6% vs. −2.3 ± 0.5%, respectively, P coffee-derived MOS to a weight-loss diet enhanced both weight and adipose tissue losses in men, suggesting a potential functional use of MOS for weight management and improvement in adipose tissue distribution. More studies are needed to investigate the apparent gender difference in response to MOS consumption. PMID:21938072

Changes in glucose-elicited blood metabolite responses following weight loss and long term weight maintenance in obese individuals with impaired glucose tolerance.

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Geidenstam, Nina; Danielsson, Anders P H; Spégel, Peter; Ridderstråle, Martin

2016-03-01

Weight loss improves insulin sensitivity and glucose tolerance in obese subjects with impaired glucose tolerance (IGT), but the long term dynamic effects on blood metabolites other than glucose during an oral glucose tolerance test (OGTT), are largely unknown. Here, we studied changes in OGTT-elicited metabolite patterns in obese subjects during a diet-induced weight loss study. Blood samples from 14 obese individuals with IGT were collected at 0, 30 and 120 min during a standard 75 g OGTT at baseline (BMI 44 ± 2 kg/m(2)), after weight loss (BMI 36 ± 2 kg/m(2)) and after weight maintenance (BMI 35 ± 2 kg/m(2)). Serum metabolite levels were analyzed by gas chromatography/mass spectrometry and compared to a lean glucose tolerant group. Changes in the OGTT-elicited metabolite patterns occurred differentially during weight loss and weight maintenance. Enhanced suppression of aromatic amino acids were associated with decreased insulinogenic index observed after weight loss (tyrosine: r=0.72, p=0.013; phenylalanine: r=0.63, p=0.039). The OGTT-elicited suppression and/or lack of increase in levels of glutamate, glutamine, isoleucine, leucine, and the fatty acids laurate, oleate and palmitate, improved towards the lean profile after weight maintenance, paralleling an improvement in glucose tolerance. The greater heterogeneity in the response before and after weight loss in the obese, compared to lean subjects, was markedly reduced after weight maintenance. Diet-induced weight loss followed by weight maintenance results in changes in metabolite profiles associated with either hepatic insulin sensitivity or peripheral glucose tolerance. Our results highlight the importance of evaluating the effects of weight loss and weight maintenance separately. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Pregnancy Loss and Miscarriage

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... D linked to miscarriage among women with prior pregnancy loss Release: Anti-HIV drug combination does not increase preterm birth risk, study suggests Release: Elevated blood pressure before pregnancy may increase chance of pregnancy loss All related ...

IFCC reference measurement procedure for substance concentration determination of total carbon dioxide in blood, plasma or serum

NARCIS (Netherlands)

Burnett, RW; Covington, AK; Fogh-Andersen, N; Kulpmann, WR; Lewenstam, A; Mas, AHJ; VanKessel, AL; Zijlstra, WG

A reference measurement procedure for substance concentration determination of total CO, in blood, plasma (the anticoagulant is usually heparin) or serum is described. The document covers the principle of the method, the materials and equipment needed and essential aspects of the procedure. The

Effects of blood transfusion and cyclophosphamide before total lymphoid irradiation on survival of rats with bone marrow transplantation

International Nuclear Information System (INIS)

Ran Xinze; Yan Yongtang

1994-01-01

The effects of blood transfusion at various intervals before and after bone marrow transplantation (BMT) and with different donors on the survival of rats with BMT were investigated. Cyclophosphamide was administered before total lymphoid irradiation (TLI) with 10 Gy γ-rays from a 60 Co source. All the rats in control groups and in the group with blood transfusion alone died within 4-12 days after TLI. The 60-day survival rate after TLI in the group of donor-specific blood transfusion given one day after BMT was not significantly different from that in the group with BMT alone (the 60-day survival rate was 10%). The survival rates in the groups with transfusion of both donor specific and non-specific blood one day before BMT were 20% and 40% (P<0.05) respectively. All the rats given blood transfusion three days before BMT died within 4-10 days after TLI. The survival rate in the group with both donor-specific blood transfusion and cyclophosphamide given in divided dose one day before BMT increased to 80% (P<0.01). The results show that the therapeutic effect of blood transfusion on rats with BMT is related to the time of blood transfusion

How acute total sleep loss affects the attending brain: a meta-analysis of neuroimaging studies.

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Ma, Ning; Dinges, David F; Basner, Mathias; Rao, Hengyi

2015-02-01

Attention is a cognitive domain that can be severely affected by sleep deprivation. Previous neuroimaging studies have used different attention paradigms and reported both increased and reduced brain activation after sleep deprivation. However, due to large variability in sleep deprivation protocols, task paradigms, experimental designs, characteristics of subject populations, and imaging techniques, there is no consensus regarding the effects of sleep loss on the attending brain. The aim of this meta-analysis was to identify brain activations that are commonly altered by acute total sleep deprivation across different attention tasks. Coordinate-based meta-analysis of neuroimaging studies of performance on attention tasks during experimental sleep deprivation. The current version of the activation likelihood estimation (ALE) approach was used for meta-analysis. The authors searched published articles and identified 11 sleep deprivation neuroimaging studies using different attention tasks with a total of 185 participants, equaling 81 foci for ALE analysis. The meta-analysis revealed significantly reduced brain activation in multiple regions following sleep deprivation compared to rested wakefulness, including bilateral intraparietal sulcus, bilateral insula, right prefrontal cortex, medial frontal cortex, and right parahippocampal gyrus. Increased activation was found only in bilateral thalamus after sleep deprivation compared to rested wakefulness. Acute total sleep deprivation decreases brain activation in the fronto-parietal attention network (prefrontal cortex and intraparietal sulcus) and in the salience network (insula and medial frontal cortex). Increased thalamic activation after sleep deprivation may reflect a complex interaction between the de-arousing effects of sleep loss and the arousing effects of task performance on thalamic activity. © 2015 Associated Professional Sleep Societies, LLC.

Appropriateness of Intra-Operative Blood Transfusion In Children at ...

African Journals Online (AJOL)

Background: The decision to transfuse intra-operatively is based on preoperative haemoglobin (Hb), estimated blood loss and physiological variables. The visual estimate of blood loss is notoriously unreliable especially with small volumes of blood losses in children. Objectives :We sought therefore to determine the ...

Total flying hours and risk of high systolic blood pressure in the civilian pilot in Indonesia

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Ferdi Afian

2016-07-01

Full Text Available Abstrak Latar belakang: Tekanan darah sistolik tinggi di antara pilot sipil antara lain akan menyebabkan gangguan kardiovaskular sehingga akan mengganggu kelancaran penerbangan. Tujuan penelitian ini ialah untuk mengetahui faktor-faktor dominan terhadap tekanan darah sistolik tinggi pada pilot sipil. Metode: Penelitian potong lintang dengan metode sampling purposif pada pilot yang melakukan pemeriksaan kesehatan berkala di Balai Kesehatan Penerbangan pada tanggal 18-29 Mei 2015. Data yang dikumpulkan adalah karakteristik demografi dan pekerjaan, klinis, kebiasaan olahraga, kebiasaan makan, indeks massa tubuh dan riwayat penyakit. Tekanan darah sistolik tinggi ialah tekanan darah sistolik140 mmHg atau lebih. Hasil: Dari 690 pilot yang melakukan pemeriksaan kesehatan berkala, 428 pilot laki-laki bersedia berpartisipasi mengikuti penelitian ini. Usia dan riwayat penyakit hipertensi merupakan faktor risiko dominan yang berhubungan dengan tekanan darah sistolik tinggi. Jika dibandingkan dengan pilot usia 19-39 tahun, yang berusia 40-65 tahun mempunyai 15,1 kali lipat lebih besar risiko terkena tekanan darah sistolik tinggi [rasio odds suaian (ORa= 15,12; p= 0,001]. Pilot dengan riwayat penyakit hipertensi dibandingkan dengan yang tidak ada riwayat memiliki risiko tekanan darah sistolik tinggi 93,2 kali lipat lebih besar (ORa= 93,21; p= 0,001 Kesimpulan: Usia 40-65 tahun dan memiliki riwayat hipertensi meningkatkan risiko tekanan darah sistolik tinggi di antara pilot sipil di Indonesia. Kata kunci: tekanan darah sistolik, total jam terbang, pilot sipil, Indonesia.  Abstract Background: Systolic high blood pressure among civilian pilots among others will cause cardiovascular disease and this condition will disrupt the flight.The purpose of this study was to identified the dominant factors related to high systolic blood pressure in the civilian pilots. Methods: A cross-sectional study with a purposive sampling method on a pilot who performed periodic

Oral tranexamic acid is equivalent to topical tranexamic acid without drainage in primary total hip arthroplasty: A double-blind randomized clinical trial.

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Luo, Ze-Yu; Wang, Duan; Meng, Wei-Kun; Wang, Hao-Yang; Pan, Hui; Pei, Fu-Xing; Zhou, Zong-Ke

2018-05-01

To compare the efficacy of multiple doses of oral tranexamic acid (TXA) with topical TXA administration in reducing blood loss following total hip arthroplasty (THA). In this double-blinded trial, 117 patients undergoing primary THA were randomized to receive 2 g TXA orally 2 h preoperatively, and two doses of 1 g TXA postoperatively (oral group) or 3 g of TXA topical administration in the operating room (topical group). The primary outcome was a reduction in hemoglobin concentration. Other outcomes-such as blood loss, TXA-related cost (¥), length of hospital stay (days), complications such as pulmonary thromboembolism (PE), deep vein thrombosis (DVT), and infection, blood coagulation and fibrinolysis, and hip function-were recorded. The mean reduction in hemoglobin level was similar between the oral and topical groups (3.07 g/dL compared with 3.12 g/dL; p = 0.85). Similarly, there was no significant difference in the mean total blood loss between oral and topical administration (863 mL compared with 902 mL; p = 0.62). Three patients received an allogeneic blood transfusion, including one patient in the oral group and two patients in the topical group (p = 0.55). The oral group had a significantly lower TXA-related cost than the topical group: ¥944 and ¥4359, respectively (p = 0.01). No PE, DVT, cardiac infarction or renal failure occurred during the 90-day follow-up. The coagulation and fibrinolysis parameters were similar between the two groups. Oral TXA is equivalent to topical TXA administration in the reduction of blood loss in the setting of primary THA without drainage. Copyright © 2018. Published by Elsevier Ltd.

Economic burden of non-malignant blood disorders across Europe: a population-based cost study.

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Luengo-Fernandez, Ramon; Burns, Richeal; Leal, Jose

2016-08-01

Blood disorders comprise a wide range of diseases including anaemia, malignant blood disorders, and haemorrhagic disorders. Although they are a common cause of disease, no systematic cost-of-illness studies have been done to assess the economic effect of non-malignant blood disorders in Europe. We aimed to assess the economic burden of non-malignant blood disorders across the 28 countries of the European Union (EU), Iceland, Norway, and Switzerland. Non-malignant blood disorder-related costs (WHO International Classification of Diseases, 10th revision [ICD] D50-89) were estimated for 28 EU countries, Iceland, Norway, and Switzerland for 2012. Country-specific costs were estimated with aggregate data on morbidity, mortality, and health-care resource use obtained from international and national sources. Health-care costs were estimated from expenditure on primary care, outpatient care, emergency care, hospital inpatient care, and drugs. Costs of informal care and productivity losses due to morbidity and early death were also included. To these costs we added those due to malignant blood disorders (ICD-10 C81-96 and D47) as estimated in a Burns and colleagues' companion Article to obtain the total costs of blood disorders. Non-malignant disorders of the blood cost the 31 European countries €11 billion in 2012. Health-care costs accounted for €8 billion (75% of total costs), productivity losses for €2 billion (19%), and informal care for less than €1 billion (6%). Averaged across the European population studied, non-malignant disorders of the blood represented an annual health-care cost of €159 per ten citizens. Combining malignant and non-malignant blood disorders, the total cost of blood disorders was €23 billion in 2012. Our study highlights the economic burden that non-malignant blood disorders place on European health-care systems and societies. Our study also shows that blood disorder costs were evenly distributed between malignant and non

Total Blood Mercury Levels and Depression among Adults in the United States: National Health and Nutrition Examination Survey 2005–2008

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Ng, Tsz Hin H.; Mossey, Jana M.; Lee, Brian K.

2013-01-01

Background Mercury is a neurotoxicant linked with psychiatric symptoms at high levels of exposure. However, it is unclear whether an association is present at the low exposure levels in the US adult population. Materials and Methods Cross-sectional associations of total blood mercury and depression were assessed in 6,911 adults age ≥20 in the National Health and Nutrition Examination Survey (NHANES), 2005–2008. The Patient Health Questionnaire-9 was used to assess depression (high likelihood of a depressive spectrum disorder diagnosis; score 5–27). Results Unadjusted survey weighted logistic regression suggested that higher total blood mercury was associated with lower odds of depression (Odds Ratio  = 0.49, 95% Confidence Interval: 0.36–0.65, comparing the highest and lowest mercury quintiles). This association largely disappeared after adjustment for sociodemographic variables (income-poverty ratio, education, marital status). However, in age-stratified analyses, this inverse relationship remained in older adults (age ≥40) even after adjustment for sociodemographic variables. Simulation analyses adjusting for expected confounding effects of fish intake suggested that the inverse relationship among older adults may be plausibly attributed to residual confounding (Odds Ratio  = 0.75, 95% Confidence Interval: 0.50–1.12, comparing the highest and lowest mercury quintiles). Conclusions Higher total blood mercury was not associated with increased odds of depression. The lower odds of depression in older adults with higher total blood mercury may be due to residual confounding. PMID:24244482

Geographic and temporal patterns of variation in total mercury concentrations in blood of harlequin ducks and blue mussels from Alaska.

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Savoy, Lucas; Flint, Paul; Zwiefelhofer, Denny; Brant, Heather; Perkins, Christopher; Taylor, Robert; Lane, Oksana; Hall, Jeff; Evers, David; Schamber, Jason

2017-04-15

We compared total mercury (Hg) concentrations in whole blood of harlequin ducks (Histrionicus histrionicus) sampled within and among two geographically distinct locations and across three years in southwest Alaska. Blue mussels were collected to assess correlation between Hg concentrations in locally available forage and birds. Mercury concentrations in harlequin duck blood were significantly higher at Unalaska Island (0.31±0.19 mean±SD, μg/g blood) than Kodiak Island (0.04±0.02 mean±SD, μg/g blood). We found no evidence for annual variation in blood Hg concentration between years at Unalaska Island. However, blood Hg concentration did vary among specific sampling locations (i.e., bays) at Unalaska Island. Findings from this study demonstrate harlequin ducks are exposed to environmental sources of Hg, and whole blood Hg concentrations are associated with their local food source. Copyright © 2017 Elsevier Ltd. All rights reserved.

What is the role of autologous blood transfusion in major spine surgery?

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Kumar, Naresh; Chen, Yongsheng; Nath, Chinmoy; Liu, Eugene Hern Choon

2012-06-01

Major spine surgery is associated with significant blood loss, which has numerous complications. Blood loss is therefore an important concern when undertaking any major spine surgery. Blood loss can be addressed by reducing intraoperative blood loss and replenishing perioperative blood loss. Reducing intraoperative blood loss helps maintain hemodynamic equilibrium and provides a clearer operative field during surgery. Homologous blood transfusion is still the mainstay for replenishing blood loss in major spine surgery across the world, despite its known adverse effects. These significant adverse effects can be seen in up to 20% of patients. Autologous blood transfusion avoids the risks associated with homologous blood transfusion and has been shown to be cost-effective. This article reviews the different methods of autologous transfusion and focuses on the use of intraoperative cell salvage in major spine surgery. Autologous blood transfusion is a proven alternative to homologous transfusion in major spine surgery, avoiding most, if not all of these adverse effects. However, autologous blood transfusion rates in major spine surgery remain low across the world. Autologous blood transfusion may obviate the need for homologous transfusion completely. We encourage spine surgeons to consider autologous blood transfusion wherever feasible.

A prospective randomized comparison of continuous hemihepatic with intermittent total hepatic inflow occlusion in hepatectomy for liver tumors.

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Liang, Guanlin; Wen, Tianfu; Yan, Lunan; Li, B O; Wu, Guochang; Yang, Jian; Lu, Bo; Chen, Zheyu; Liao, Zhixue; Ran, Shun; Yu, Zhang

2009-01-01

To evaluate whether continuous hemihepatic inflow occlusion (HHO) during hepatectomy can be safer than and be as effective as intermittent total hepatic inflow occlusion (THO) in reducing blood loss. Eighty patients undergoing liver resections were included in a prospective randomized study comparing the intra- and postoperative course under THO (n=40) or HHO (n=40). THO was performed with periods of 20 minutes of occlusion and 5 minutes of releasing, while HHO was performed with continuous occlusion. The surface area of liver transection, amount of blood loss, measurements of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and postoperative evolution were recorded. The two groups were similar at entry in terms of preoperative liver function and in the proportion of patients experiencing major hepatectomy. The total ischemic time of the two groups was similar (p=0.37), but the operative time in the THO group was longer than in the HHO group (p=0.02). No significant difference was found between the HHO and THO group in blood loss during liver parenchyma transection (p=0.14), the elevations of ALT and AST on the first postoperative day (ALT: p=0.12; AST: p=0.66) and postoperative morbidity (p=0.35). On the basis of our findings, if it is feasible, continuous HHO is recommended for complex liver resection.

Effects of total flavonoids from Drynariae Rhizoma prevent bone loss in vivo and in vitro

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Shuang-hong Song

2016-12-01

Full Text Available Estrogen deficiency is one of the major causes of osteoporosis in postmenopausal women. Drynariae Rhizoma is a widely used traditional Chinese medicine for the treatment of bone diseases. In this study, we investigated the therapeutic effects of the total Drynariae Rhizoma flavonoids (DRTF on estrogen deficiency-induced bone loss using an ovariectomized rat model and osteoblast-like MC3T3-E1 cells. Our results indicated that DRTF produced osteo-protective effects on the ovariectomized rats in terms of bone loss reduction, including decreased levels of bone turnover markers, enhanced biomechanical femur strength and trabecular bone microarchitecture deterioration prevention. In vitro experiments revealed that the actions of DRTF on regulating osteoblastic activities were mediated by the estrogen receptor (ER dependent pathway. Our data also demonstrated that DRTF inhibited osteoclastogenesis via up-regulating osteoprotegrin (OPG, as well as down-regulating receptor activator of NF–κB ligand (RANKL expression. In conclusion, this study indicated that DRTF treatment effectively suppressed bone mass loss in an ovariectomized rat model, and in vitro evidence suggested that the effects were exerted through actions on both osteoblasts and osteoclasts. Keywords: Osteoporosis, Osteoblast, Osteoclast, Ovariectomy, Drynariae Rhizoma

Measurements of total lead concentrations and of lead isotope ratios in whole blood by use of inductively coupled plasma source mass spectrometry

International Nuclear Information System (INIS)

Delves, H.T.; Campbell, M.J.

1988-01-01

Methods are described for the accurate and precise determination of total lead and its isotopic composition in whole blood using inductively coupled plasma source mass spectrometry (ICP-MS). Sensitivities of up to 3 x 10 6 counts s -1 for 208 Pb at a total lead concentration of 5 μmol l -1 (1 μg ml -1 ) enabled total blood lead levels to be measured in 4 min per sample, with a detection limit of 0.072 μmol l -1 (15 μg l -1 ). The agreement between ICP-MS and atomic absorption spectrometry (AAS) for this analysis was excellent: ICP-MS 0.996 x AAS -0.0165 μmol l -1 ; r 0.994. Isotope ratio measurements required 15 min to achieve the required accuracy and precision both of which were generally better than 0.5% for 206 Pb: 207 Pb and 208 Pb: 206 Pb isotopic lead ratios. The ICP-MS data for these ratios in ten quality control blood specimens has a mean bias relative to isotope dilution mass spectrometry of -0.412% for 206 Pb: 207 Pb ratios and of +0.055% for the 208 Pb: 206 Pb ratios. This level of accuracy and that of the total blood lead measurements is sufficient to permit application of these ICP-MS methods to environmental studies. (author)

Total hip and knee joint replacement: perioperative clinical aspects

Directory of Open Access Journals (Sweden)

Luciana Pereira Almeida de Piano

2010-09-01

Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

Bipolar sealer not superior to standard electrocautery in primary total hip arthroplasty: a meta-analysis.

Science.gov (United States)

Yang, Yang; Zhang, Li-Chao; Xu, Fei; Li, Jia; Lv, Yong-Ming

2014-10-10

To assess whether bipolar sealer has advantages over standard electrocautery in primary total hip arthroplasty (THA). All studies published through November 2013 were systematically searched in PubMed, Embase, ScienceDirect, The Cochrane Library, and other databases. Relevant journals or conference proceedings were searched manually. Only randomized controlled trials were included. Two independent reviewers identified and assessed the literature. Mean difference in blood loss and risk ratios of transfusion rates and of complication rates in the bipolar sealer group versus the standard electrocautery group were calculated. The meta-analysis was conducted using RevMan 5.1 software. Five studies were included, with a total sample size of 559 patients. The use of bipolar sealer did not significantly reduce intraoperative blood loss, hemoglobin drop, hospital stay, and operative time. There were no significant differences in need for transfusion and the incidence of infection between the study groups. The available evidence suggests that the use of bipolar sealer was not superior to standard electrocautery in patients undergoing primary THA. The use of bipolar sealer is not recommended in primary THA.

Multi-Targeted Antithrombotic Therapy for Total Artificial Heart Device Patients.

Science.gov (United States)

Ramirez, Angeleah; Riley, Jeffrey B; Joyce, Lyle D

2016-03-01

To prevent thrombotic or bleeding events in patients receiving a total artificial heart (TAH), agents have been used to avoid adverse events. The purpose of this article is to outline the adoption and results of a multi-targeted antithrombotic clinical procedure guideline (CPG) for TAH patients. Based on literature review of TAH anticoagulation and multiple case series, a CPG was designed to prescribe the use of multiple pharmacological agents. Total blood loss, Thromboelastograph(®) (TEG), and platelet light-transmission aggregometry (LTA) measurements were conducted on 13 TAH patients during the first 2 weeks of support in our institution. Target values and actual medians for postimplant days 1, 3, 7, and 14 were calculated for kaolinheparinase TEG, kaolin TEG, LTA, and estimated blood loss. Protocol guidelines were followed and anticoagulation management reduced bleeding and prevented thrombus formation as well as thromboembolic events in TAH patients postimplantation. The patients in this study were susceptible to a variety of possible complications such as mechanical device issues, thrombotic events, infection, and bleeding. Among them all it was clear that patients were at most risk for bleeding, particularly on postoperative days 1 through 3. However, bleeding was reduced into postoperative days 3 and 7, indicating that acceptable hemostasis was achieved with the anticoagulation protocol. The multidisciplinary, multi-targeted anticoagulation clinical procedure guideline was successful to maintain adequate antithrombotic therapy for TAH patients.

Advantages and Challenges of Dried Blood Spot Analysis by Mass Spectrometry Across the Total Testing Process

Science.gov (United States)

Zakaria, Rosita; Allen, Katrina J.; Koplin, Jennifer J.; Roche, Peter

2016-01-01

Introduction Through the introduction of advanced analytical techniques and improved throughput, the scope of dried blood spot testing utilising mass spectrometric methods, has broadly expanded. Clinicians and researchers have become very enthusiastic about the potential applications of dried blood spot based mass spectrometric applications. Analysts on the other hand face challenges of sensitivity, reproducibility and overall accuracy of dried blood spot quantification. In this review, we aim to bring together these two facets to discuss the advantages and current challenges of non-newborn screening applications of dried blood spot quantification by mass spectrometry. Methods To address these aims we performed a key word search of the PubMed and MEDLINE online databases in conjunction with individual manual searches to gather information. Keywords for the initial search included; “blood spot” and “mass spectrometry”; while excluding “newborn”; and “neonate”. In addition, databases were restricted to English language and human specific. There was no time period limit applied. Results As a result of these selection criteria, 194 references were identified for review. For presentation, this information is divided into: 1) clinical applications; and 2) analytical considerations across the total testing process; being pre-analytical, analytical and post-analytical considerations. Conclusions DBS analysis using MS applications is now broadly applied, with drug monitoring for both therapeutic and toxicological analysis being the most extensively reported. Several parameters can affect the accuracy of DBS measurement and further bridge experiments are required to develop adjustment rules for comparability between dried blood spot measures and the equivalent serum/plasma values. Likewise, the establishment of independent reference intervals for dried blood spot sample matrix is required. PMID:28149263

Associations between change in sedentary behavior and outcome in standard behavioral weight loss treatment.

Science.gov (United States)

Kerrigan, Stephanie G; Call, Christine; Schaumberg, Katherine; Forman, Evan; Butryn, Meghan L

2018-03-01

Sedentary behavior, particularly in prolonged periods, is an important determinant of health. Little research exploring changes in sedentary behavior during behavioral weight loss programs exists. This study evaluated the magnitude of changes in total and prolonged sedentary behavior and how these changes related to changes in weight and cardiovascular outcomes during a behavioral weight loss program. Participants (n = 450) in two lifestyle modification programs underwent assessments of sedentary behavior (by accelerometry), weight, waist circumference, blood pressure, and resting heart rate at baseline and after 6 months of treatment. Sedentary behavior was defined as both total and prolonged (≥30 continuous minutes) sedentary minutes/day. Reductions in total and prolonged sedentary time were significant and were accounted for by increases in moderate-to-vigorous physical activity (MVPA). Only changes in MVPA significantly predicted change in weight when entered into a model simultaneously with changes in sedentary behavior. Changes in total and prolonged sedentary time were not associated with changes in waist circumference, heart rate, or blood pressure. Change in sedentary time was not independently associated with change in health outcomes during a behavioral weight loss treatment. High variability in changes in sedentary time indicate that individual differences may be important to examine. Reducing sedentary time may not be powerful enough to impact these health outcomes above the effects of other changes made during these programs; alternatively, it may be that increasing focus in treatment on reducing sedentary time may engender greater decreases in sedentariness, which could lead to better health outcomes.

Effect of bariatric surgery-induced weight loss on renal and systemic inflammation and blood pressure: a 12-month prospective study.

Science.gov (United States)

Fenske, Wiebke K; Dubb, Sukhpreet; Bueter, Marco; Seyfried, Florian; Patel, Karishma; Tam, Frederick W K; Frankel, Andrew H; le Roux, Carel W

2013-01-01

Bariatric surgery improves arterial hypertension and renal function; however, the underlying mechanisms and effect of different surgical procedures are unknown. In the present prospective study, we compared the 12-month follow-up results after Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy on weight loss, hypertension, renal function, and inflammatory status. A total of 34 morbidly obese patients were investigated before, one and 12 months after Roux-en-Y gastric bypass (n = 10), laparoscopic adjustable gastric banding (n = 13), and laparoscopic sleeve gastrectomy (n = 11) for hypertension, kidney function, urinary and serum cytokine levels of macrophage migration inhibitory factor, monocyte chemotactic protein-1, and chemokine ligand-18. At 12 months after surgery, the patients in all 3 treatment arms showed a significant decrease in the mean body mass index, mean arterial pressure, and urinary and serum inflammatory markers (all P .8 mg/L) had a marked improvement in renal function 12 months after surgery (P < .05). Surgically induced weight loss is associated with a marked decrease in renal and systemic inflammation and arterial hypertension and improvement in renal function in patients with pre-existing renal impairment. These effects appear to be independent of surgical procedure. The improvement in renal inflammation could be 1 of the mechanisms contributing to the beneficial effects of bariatric surgery on arterial blood pressure, proteinuria, and renal function. Copyright © 2013 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

The effect of tranexamic acid on blood loss and maternal outcome in the treatment of persistent postpartum hemorrhage: A nationwide retrospective cohort study.

Directory of Open Access Journals (Sweden)

Ada Gillissen

Full Text Available Recent results show a protective effect of tranexamic acid on death due to bleeding in patients with postpartum hemorrhage in low- and middle-resource countries. We quantify the association between early administration of tranexamic acid compared to late or no administration and severe acute maternal morbidity and blood loss among women suffering from persistent severe postpartum hemorrhage in a high-income country.We performed a nationwide retrospective cohort study in 61 hospitals in the Netherlands. The study population consisted of 1260 women with persistent postpartum hemorrhage who had received at least four units of red cells, or fresh frozen plasma or platelets in addition to red cells. A review of medical records was performed and cross-referenced with blood bank data. The composite endpoint comprised maternal morbidity (hysterectomy, ligation of the uterine arteries, emergency B-Lynch suture, arterial embolization or admission into an intensive care unit and mortality.247 women received early tranexamic acid treatment. After adjustment for confounding, odds ratio for the composite endpoint for early tranexamic acid (n = 247 versus no/late tranexamic acid (n = 984 was 0.92 (95% confidence interval (CI 0.66 to 1.27. Propensity matched analysis confirmed the absence of a difference between women with and without tranexamic acid. Blood loss after administration of first line therapy did not differ significantly between the two groups (adjusted difference -177 mL, CI -509.4 to +155.0.Our findings suggest that in a high-resource country the effect of tranexamic acid on both blood loss and the combined endpoint of maternal mortality and morbidity may be disappointing.

The effect of tranexamic acid on blood loss and maternal outcome in the treatment of persistent postpartum hemorrhage: A nationwide retrospective cohort study

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Henriquez, Dacia D. C. A.; van den Akker, Thomas; Wind, Merlijn; Zwart, Joost J.; van Roosmalen, Jos; Eikenboom, Jeroen; Bloemenkamp, Kitty W. M.; van der Bom, Johanna G.

2017-01-01

Background Recent results show a protective effect of tranexamic acid on death due to bleeding in patients with postpartum hemorrhage in low- and middle-resource countries. We quantify the association between early administration of tranexamic acid compared to late or no administration and severe acute maternal morbidity and blood loss among women suffering from persistent severe postpartum hemorrhage in a high-income country. Methods and findings We performed a nationwide retrospective cohort study in 61 hospitals in the Netherlands. The study population consisted of 1260 women with persistent postpartum hemorrhage who had received at least four units of red cells, or fresh frozen plasma or platelets in addition to red cells. A review of medical records was performed and cross-referenced with blood bank data. The composite endpoint comprised maternal morbidity (hysterectomy, ligation of the uterine arteries, emergency B-Lynch suture, arterial embolization or admission into an intensive care unit) and mortality. Results 247 women received early tranexamic acid treatment. After adjustment for confounding, odds ratio for the composite endpoint for early tranexamic acid (n = 247) versus no/late tranexamic acid (n = 984) was 0.92 (95% confidence interval (CI) 0.66 to 1.27). Propensity matched analysis confirmed the absence of a difference between women with and without tranexamic acid. Blood loss after administration of first line therapy did not differ significantly between the two groups (adjusted difference -177 mL, CI -509.4 to +155.0). Conclusions Our findings suggest that in a high-resource country the effect of tranexamic acid on both blood loss and the combined endpoint of maternal mortality and morbidity may be disappointing. PMID:29107951

Estimating the total TEQ in human blood from naturally-occurring vs. anthropogenic dioxins. A dietary study

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Connor, K [Exponent, Natick, MA (United States); Harris, M [Exponent, Houston, TX (United States); Edwards, M [Exponent, Bellevue, WA (United States); Chu, A; Clark, G [XDS, Inc., Durham, NC (United States); Finley, B [Exponent, Santa Rosa, CA (United States)

2004-09-15

Numerous naturally-occurring compounds in the human diet can bind to the aryl hydrocarbon, or dioxin receptor (AhR) and activate the AhR signaling pathway. These compounds include certain indole carbinols and their derivatives, heterocyclic aromatic amines, flavonoids, carotinoids, vitamin A derivatives (retinoids), and tryptophan metabolites. Several researchers have suggested that the daily dietary intake of these ''endodioxins'', in terms of a TCDD-equivalency (TEQ) is likely to be far greater than that associated with daily background intake of anthropogenic dioxins. The purpose of this study was to provide preliminary data for evaluating whether dietary endodioxins may in fact be significant contributors to the non-PCDD/F and PCB fraction of the blood TEQ. This was accomplished by measuring the total bioassay (CALUX {sup registered}) TEQ in the blood of several volunteers under various dietary regimens. Specifically, blood samples were collected from volunteers who maintained a baseline diet, which was relatively free of vegetables, followed by a diet enriched in endodioxin-containing vegetables. The background blood levels of PCDD/Fs and PCBs were measured for each volunteer at the beginning of the study in order to establish a baseline TEQ for each participant. To provide a measure of study sensitivity, CALUX {sup registered} analysis was also performed on blood samples from volunteers who took an off-the-shelf indole-3-carbinole (I3C) supplement. I3C is the main dietary ICZ precursor and could be expected to increase the levels of this endodioxin in blood.

Estimating the total TEQ in human blood from naturally-occurring vs. anthropogenic dioxins. A dietary study

Energy Technology Data Exchange (ETDEWEB)

Connor, K. [Exponent, Natick, MA (United States); Harris, M. [Exponent, Houston, TX (United States); Edwards, M. [Exponent, Bellevue, WA (United States); Chu, A.; Clark, G. [XDS, Inc., Durham, NC (United States); Finley, B. [Exponent, Santa Rosa, CA (United States)

2004-09-15

Numerous naturally-occurring compounds in the human diet can bind to the aryl hydrocarbon, or dioxin receptor (AhR) and activate the AhR signaling pathway. These compounds include certain indole carbinols and their derivatives, heterocyclic aromatic amines, flavonoids, carotinoids, vitamin A derivatives (retinoids), and tryptophan metabolites. Several researchers have suggested that the daily dietary intake of these ''endodioxins'', in terms of a TCDD-equivalency (TEQ) is likely to be far greater than that associated with daily background intake of anthropogenic dioxins. The purpose of this study was to provide preliminary data for evaluating whether dietary endodioxins may in fact be significant contributors to the non-PCDD/F and PCB fraction of the blood TEQ. This was accomplished by measuring the total bioassay (CALUX {sup registered}) TEQ in the blood of several volunteers under various dietary regimens. Specifically, blood samples were collected from volunteers who maintained a baseline diet, which was relatively free of vegetables, followed by a diet enriched in endodioxin-containing vegetables. The background blood levels of PCDD/Fs and PCBs were measured for each volunteer at the beginning of the study in order to establish a baseline TEQ for each participant. To provide a measure of study sensitivity, CALUX {sup registered} analysis was also performed on blood samples from volunteers who took an off-the-shelf indole-3-carbinole (I3C) supplement. I3C is the main dietary ICZ precursor and could be expected to increase the levels of this endodioxin in blood.

Total knee replacement induces peripheral blood lymphocytes apoptosis and it is not prevented by regional anesthesia - a randomized study.

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Kosel, Juliusz; Rusak, Małgorzata; Gołembiewski, Łukasz; Dąbrowska, Milena; Siemiątkowski, Andrzej

2016-01-01

Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis. 34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal-epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy. Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery. Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Total knee replacement induces peripheral blood lymphocytes apoptosis and it is not prevented by regional anesthesia - a randomized study

Directory of Open Access Journals (Sweden)

Juliusz Kosel

2016-04-01

Full Text Available ABSTRACT BACKGROUND: Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis. METHODS: 34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal-epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy. RESULTS: Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery. CONCLUSION: Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique.

Spectral Mining for Discriminating Blood Origins in the Presence of Substrate Interference via Attenuated Total Reflection Fourier Transform Infrared Spectroscopy: Postmortem or Antemortem Blood?

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Takamura, Ayari; Watanabe, Ken; Akutsu, Tomoko; Ikegaya, Hiroshi; Ozawa, Takeaki

2017-09-19

Often in criminal investigations, discrimination of types of body fluid evidence is crucially important to ascertain how a crime was committed. Compared to current methods using biochemical techniques, vibrational spectroscopic approaches can provide versatile applicability to identify various body fluid types without sample invasion. However, their applicability is limited to pure body fluid samples because important signals from body fluids incorporated in a substrate are affected strongly by interference from substrate signals. Herein, we describe a novel approach to recover body fluid signals that are embedded in strong substrate interferences using attenuated total reflection Fourier transform infrared (ATR FT-IR) spectroscopy and an innovative multivariate spectral processing. This technique supported detection of covert features of body fluid signals, and then identified origins of body fluid stains on substrates. We discriminated between ATR FT-IR spectra of postmortem blood (PB) and those of antemortem blood (AB) by creating a multivariate statistics model. From ATR FT-IR spectra of PB and AB stains on interfering substrates (polyester, cotton, and denim), blood-originated signals were extracted by a weighted linear regression approach we developed originally using principal components of both blood and substrate spectra. The blood-originated signals were finally classified by the discriminant model, demonstrating high discriminant accuracy. The present method can identify body fluid evidence independently of the substrate type, which is expected to promote the application of vibrational spectroscopic techniques in forensic body fluid analysis.

Incidence and Risk Factors for Blood Transfusion in Total Joint Arthroplasty: Analysis of a Statewide Database.

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Slover, James; Lavery, Jessica A; Schwarzkopf, Ran; Iorio, Richard; Bosco, Joseph; Gold, Heather T

2017-09-01

Significant attempts have been made to adopt practices to minimize blood transfusion after total joint arthroplasty (TJA) because of transfusion cost and potential negative clinical consequences including allergic reactions, transfusion-related lung injuries, and immunomodulatory effects. We aimed to evaluate risk factors for blood transfusion in a large cohort of TJA patients. We used the all-payer California Healthcare Cost and Utilization Project data from 2006 to 2011 to examine the trends in utilization of blood transfusion among arthroplasty patients (n = 320,746). We performed descriptive analyses and multivariate logistic regression clustered by hospital, controlling for Deyo-Charlson comorbidity index, age, insurance type (Medicaid vs others), gender, procedure year, and race/ethnicity. Eighteen percent (n = 59,038) of TJA patients underwent blood transfusion during their surgery, from 15% with single knee to 45% for bilateral hip arthroplasty. Multivariate analysis indicated that compared with the referent category of single knee arthroplasty, single hip had a significantly higher odds of blood transfusion (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.68-1.83), as did bilateral knee (OR, 3.57; 95% CI, 3.20-3.98) and bilateral hip arthroplasty (OR, 6.17; 95% CI, 4.85-7.85). Increasing age (eg, age ≥80 years; OR, 2.99; 95% CI, 2.82-3.17), Medicaid insurance (OR, 1.36; 95% CI, 1.27-1.45), higher comorbidity index (eg, score of ≥3; OR, 2.33; 95% CI, 2.22-2.45), and females (OR, 1.75; 95% CI, 1.70-1.80) all had significantly higher odds of blood transfusion after TJA. Primary hip arthroplasties have significantly greater risk of transfusion than knee arthroplasties, and bilateral procedures have even greater risk, especially for hips. These factors should be considered when evaluating the risk for blood transfusions. Copyright © 2017 Elsevier Inc. All rights reserved.

Combined application versus topical and intravenous application of tranexamic acid following primary total hip arthroplasty: a meta-analysis.

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Zhang, Pei; Liang, Yuan; Chen, Pengtao; Fang, Yongchao; He, Jinshan; Wang, Jingcheng

2017-02-21

The use of intravenous (IV) or topical tranexamic acid (TXA) in total hip arthroplasty has been proven to be effective and safe in total hip arthroplasty. However, which of these two administration routes is better has not been determined. The combined administration of TXA has been used in total knee arthroplasty with satisfactory results. We hypothesized that combined application of TXA may be the most effective way without increased rate of thrombotic events such as deep vein thrombosis (DVT) and pulmonary embolisms (PE) in patients subjected to primary total hip replacement (THA). A meta-analysis was conducted to compare the efficacy and safety of the combined use of tranexamic acid (TXA) relative to topical or intravenous (IV) use alone for treatment of primary THA. The outcomes included total blood loss, postoperative hemoglobin decline, transfusion rates, and the incidence rates of deep vein thrombosis (DVT) and pulmonary embolisms (PE). We searched electronic databases including PubMed, EMBASE, the Cochrane Library, Web of Science, the Chinese Biomedical Literature database, the CNKI database, and Wanfang Data until September 2016. The references of the included articles were also checked for additional potentially relevant studies. There were no language restrictions for the search. The data of the included studies were analyzed using RevMan 5.3 software. Seven studies met the inclusion criteria, encompassing a total of 1762 patients. Our meta-analysis demonstrated that total blood loss, postoperative hemoglobin decline, and transfusion rates were significantly lower for patients that received the combined treatment compared to patients that received either topical or intravenous administration of TXA. No statistical differences were found in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE). The group that received the combined treatment had lower total blood loss, postoperative hemoglobin decline, and transfusion rates without an

TNF, IL-1 and IL-6 in circulating blood after total-body and localized irradiation in rats

NARCIS (Netherlands)

Haveman, J.; Geerdink, A. G.; Rodermond, H. M.

1998-01-01

The levels of TNF, IL-1 and IL-6 in circulating blood of female WAG/Rij rats were assessed both after total-body irradiation (TBI) and localized irradiation of the right hind leg. The results show that enhanced levels of IL-1 in the circulation reflect a stress situation presumably resulting from

Operative and Immediate Postoperative Differences Between Traditional Multiport and Reduced Port Laparoscopic Total Splenectomy in Pediatric Patients.

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Seims, Aaron D; VanHouwelingen, Lisa; Mead, Jessica; Mao, Shenghua; Loh, Amos; Sandoval, John A; Davidoff, Andrew M; Wu, Jianrong; Wang, Winfred C; Fernandez-Pineda, Israel

2017-02-01

Laparoscopy offers many benefits to splenectomy, such as reduced incisional pain and shortened hospital duration. The purpose of this study is to evaluate procedural and outcome differences between multiport (MP) and reduced port (RP) splenectomy when utilized to treat children. An institutional review board approved retrospective analysis of all consecutive laparoscopic total splenectomies performed at a single institution between January 2010 and October 2015 was conducted. We evaluated demographics, surgical technique, instance of conversion, operative duration, estimated blood loss, need for intraoperative blood transfusion, postoperative length of stay, time to full feeds, complications, and follow-up duration. Over a 5-year period, 66 patients less than 20 years of age underwent laparoscopic total splenectomy. RP splenectomy was attempted in 14 patients. The remaining 52 were MP operations. Populations were comparable with regard to demographics. Preoperative splenic volumes (mL) were greater in the RP population (median [IQR]: 1377 [747-1508] versus 452 [242-710], P = .039). RP splenectomy demonstrated no difference compared to MP splenectomy in operative time (153 versus 138 minutes, P = .360), estimated blood loss (120 versus 154 mL, P = .634), or percent of cases requiring intraoperative blood transfusion (14 versus 23, P = .716). By the first postoperative day, 57% of RP and 17% of MP patients could be discharged (P = .005). Thirty-day readmission rates were similar, at 7% for RP and 8% for MP operations. Fever was the indication for all readmissions. Mean duration of follow-up is 28 months for MP and 13 months for RP cases. A reduced number of ports can be safely utilized for total splenectomy in pediatric patients without increasing procedural duration or need for intraoperative blood transfusion. In addition, rate of discharge on the first postoperative day was significantly higher in the RP splenectomy group.