Angioedema after rt-PA infusion led to airway emergency: a case report of rescue treatment with fresh frozen plasma

Abstract The authors report the case of a 71-year-old woman presented to the Emergency Department with acute ischemic stroke. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Angioedema after rt-PA infusion could be a life-threatening emergency that requires quick airway management by skilled professionals. As this condition is triggered by several factors, such as unregulated histamine and bradykinin production, the traditional treatment recommended by the guidelines may not be sufficient and the use of FFP can be considered as a safe and valuable aid.

Blasting the myth of predictive INR changes related to plasma transfusion: an academic institution's experience

Abstract Introduction Plasma transfusion is a common therapeutic strategy used to lower international normalized ratio (INR) values in the non-emergent setting. However, due to lack of evidence of its efficacy, standardized guidelines for this practice have not been well established. Methods This retrospective observational cohort study analyzed 276 inpatient encounters that involved plasma transfusions focusing on change in INR values from pre- to post-transfusion, with respect to the following predictor variables: vitamin K co-administration, number of plasma units transfused, order indication and body mass index (BMI). Results The overall average change in the INR was 1.35. Patients who received vitamin K showed an average change of 2.51, while patients that did not receive vitamin K demonstrated an average change of 0.70. Increased numbers of plasma units transfused showed benefit up to three-unit orders. Greater decreases in the INR were observed for patients requiring plasma for anticoagulation reversal or active bleeding. There was no significant difference in the change in INR based on the BMI. By multivariate and regression analyses, the stepwise addition of each successive predictor variable demonstrated an increase in the shared variance in the outcome of the post-transfusion INR: the pre-transfusion INR and vitamin K co-administration alone was not significant (p= 0.45); the additional number of plasma units transfused was significant (R² = 0.13, p < 0.001), and; the subsequent additional plasma order indications (R² = 0.19, p < 0.001) and BMI (R² = 0.18, p < 0.001) were increasingly significant. Conclusion Taking into consideration the combination of multiple predictive factors may aid in a more efficient use of plasma products.

HPLC-MS/MS method for determination of betamethasone in human plasma with application to a dichorionic twin pregnancy pharmacokinetic and placental transfers studies

Abstract Betamethasone (BET) is a synthetic glucocorticoid recommended for pregnant women at imminent risk of preterm birth before 34 weeks to reduce neonatal complications. There are different techniques to describe BET plasma quantification. However, none quantified the plasmatic concentration of BET in dichorionic (DC) twin pregnancies using LC-MS. Our objectives were to develop and validate a method for quantifying BET by LC-MS for pharmacokinetic (PK) and placental transfer studies in DC twin pregnancies. Blood samples were collected after intramuscular administration of a single BET dose containing 6 mg disodium phosphate + 6 mg acetate. BET was determined in plasma by liquid-liquid extraction. The method showed linearity in the range of 2-250 ng/mL, as well as precision and accuracy with a coefficient of variation and relative standard errors ≤ 15%. Additionally, the method presented selectivity and did not present matrix or carry-over effect. Stability tests also presented coefficient of variation and relative standard errors ≤ 15%. This is the first study which describe maternal and fetal plasma concentrations of BET in a DC twin pregnancy. The BET PK parameters were AUC0-∞, CL/F, Vd/F, Cmax, Tmax of 292.20 h*ng/mL, 39.08 L/h, 278.72 L, 25.55 ng/mL and 0.58 h, respectively. The placental transfer ratios of umbilical vein/maternal vein and intervillous space/maternal vein were 0.14 and 0.19 and 0.40 and 0.27 for both twins, respectively. However, a clinical study with more subjects is imperative to confirm this higher concentration of BET in the intervillous space

Implementación de tromboelastografia para evitar la transfusión de plasmas fresco congelado en neonatos / Implementation of thrombelastography to avoid transfusion of fresh frozen plasma in neonates

Introducción: actualmente, la indicación principal para la transfusión de FFP es corregir la deficiencia de los factores de coagulación en pacientes con hemorragia activa o sugestión de esta, sin embargo, la práctica clínica ha demostrado que un porcentaje grande de las transfusiones de FFP en neonatología no siguen las recomendaciones de las guías actuales y, en su mayoría, son innecesarias. Objetivo: ampliar el conocimiento que se tiene sobre la transfusión de FFP en neonatología y la implementación de la tromboelastografía para evitar realizar estas intervenciones. Metodología: se realizó una revisión de la literatura en la base de datos PubMed y Elsevier, usando palabras clave como tromboelastografía, transfusión de plasma en neonatos, hemostasia neonatal. Conclusión: se evidenció que los tiempos de coagulación de los neonatos y prematuros sanos son más prolongados en comparación a los adultos, por ello facilita su errada cuando se habla de transfusión de FFP, de ahí que la TEG sea una buena herramienta para evaluar el estado coagulante de los neonatos de manera integral, sin abrir paso a errores de interpretación y facilitando la decisión de tratamientos en los pacientes en UCIN, antes de requerir transfusiones de FFP.

Introduction: Currently the main indication for FFP transfusion is to correct coagulation factor deficiency in patients with active bleeding or its suggestion, however, clinical practice has shown that a large percentage of FFP transfusions in neonatology do not they follow current guideline recommendations and are mostly unnecessary. Objective: To expand the knowledge about these transfusions in neonatology and the implementation of thrombelastography to avoid performing these interventions. Methodology: A review of the literature was carried out in the PubMed and Elsevier databases, using keywords such as "thrombelastography", "plasma transfusion in neonates", "neonatal hemostasis". Conclusion: It was evidenced that the coagulation times of healthy neonates and premature infants are longer compared to adults, thus facilitating their misinterpretation and limiting their use when talking about FFP transfusion, therefore TEG is a good tool. to evaluate the coagulation interpretación y limita su utilización status of neonates in a comprehensive manner, without giving way to interpretation errors and facilitating treatment decisions in patients in the NICU before requiring FFP transfusions.

Plasma Acylcarnitine and Urinary Organic Acid Profiling for the diagnosis of Fatty Acid Oxidation Disorder and Organic Acidurias using tandem mass spectrometry (MS/MS) and gas chromatography tandem with mass spectrometry (GC-MS): a retrospective study

INTRODUCTION@#Acylcarnitines in plasma and urinary organic acids are essential diagnostic markers for some Inborn Errors of Metabolism (IEM) such as fatty acid oxidation disorders, and disorders related to organic acids metabolism. By virtue of R. A. 9288, Filipino newborn babies are screened for inherited metabolic disorders via the analysis of dried blood spots (DBS) using MS/MS. @*OBJECTIVE@#This study aimed to establish the plasma acylcarnitine (PLAC) and urinary organic acid (UOA) profiles of Filipino newborn babies screened at high risk for IEMS using MS/MS and single quadrupole GC-MS analytical techniques. Further, this study describes the process of determining the true positive cases of fatty acid oxidation disorders and some organic acidurias among screened Filipino newborn babies using different sample types such as plasma and urine via flow injection analysis with tandem mass spectrometry (FIA-MS/MS) and another technique such as gas chromatography in tandem with mass spectrometry (GC-MS).@*METHODOLOGY@#Plasma acylcarnitine and urinary organic acid analyses were performed using Waters® MS/MS and Agilent® single quadrupole GC-MS, respectively. Results obtained from PLAC and UOA databases and IEM registry of the Biochemical Genetics Laboratory (BGL) covering the period 2015-2021 were utilized to account for the number of confirmed cases out of the total number screened positive for IEMs. Descriptive statistics was also used to evaluate the detection rates of FAODs and Organic Acidurias in Filipino newborn babies screened to be high risk.@*RESULTS@#Plasma acylcarnitine analysis was introduced by BGL only in 2015. Data from 2015-2021, indicated 176 true positives out of 1642 babies screened at high risk for FAODs and organic acidurias. The use of plasma and urine samples for measurements in MS/MS and GC-MS yielded a detection rate of 10.7% with 104 Filipino newborn babies afflicted with fatty acid oxidation disorders (FAOD) while 72 were found to be confirmed cases of organic acidurias. Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency was reported to be the most common FAOD with 67 cases. Organic acidurias such as glutaric aciduria type 1 and 3-Methylcrotonyl-CoA carboxylase (3-MCC) deficiency were found to be common with 34 and 26 true positives, respectively. @*CONCLUSION@#The plasma acylcarnitine and urinary organic acid profiles of Filipino newborn babies with fatty acid oxidation disorders and organic acidurias obtained via MS/MS and GC/MS, respectively, were presented in this paper. This study emphasizes the importance of conducting confirmatory testing to establish the true positives from among those Filipino newborns flagged to be at high risk for FAODs or organic aciduria. The confirmatory tests are based on the use of different samples such as urine and plasma in order to detect and quantify biomarkers for FAODs and organic acidurias using two different analytical techniques such as MS/MS and GC-MS. This study warrants further studies directed towards the validation of analytical methodologies for targeted measurements of biomarkers of IEMS in urine and plasma of newborn babies to increase the efficiency of establishing true positives and to determine the efficiency of administration of interventions on Filipino children with genetic disabilities, that is, for monitoring purposes.

Impact of the COVID-19 pandemic on blood supply: A comparative cross-sectional study of the pre-pandemic and pandemic era

Objective@#The study aimed to determine the impact of the COVID-19 pandemic on local blood supply management in the Davao Region, Philippines from 2019 to 2021 through the analysis of trends in blood supply in Davao Region, Philippines.@*Methodology@#Secondary data from two blood centers in the Davao Region for the years 2019 to 2021 were used to determine the trends on blood donation supply. To evaluate trends, the overall number of blood donors and the quantities of various types of blood components in whole blood, packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelet concentrate have been compared between pre-pandemic, pandemic periods and as restrictions eased.@*Results@#A substantial decrease of 51.6% in the number of blood donors was seen during 2021 in comparison with 2019. The trend in collection by blood components also showed a significant trend from 2019 to 2021, whole blood (200.8%), packed RBCs (37.1%), fresh frozen plasma (113.6%). While the platelet concentrate supply declined by 34.9% from 2019 to 2020, an increase of 10.7% was noted onwards to 2021.@*Conclusion@#The results demonstrate that during the COVID-19 pandemic, there was a major reduction in donation and supply of blood. The challenges faced by blood banks in ensuring a stable and sufficient blood supply are highlighted by the decrease in the number of donors and by the different trends in the supply of blood components. The targeted efforts to promote blood donation and enhance the resilience of the blood supply during and after the pandemic is important.

Clinical diagnosis and treatment of hereditary thrombocytopenia and purpura: a report of five cases and literature review / 中华血液学杂志

Objective: To report the clinical manifestations and laboratory features of five patients with congenital thrombotic thrombocytopenic purpura (cTTP) and explore its standardized clinical diagnosis and treatment along with a review of literature. Methods: Clinical data of patients, such as age of onset, disease manifestation, personal history, family history, and misdiagnosed disease, were collected. Treatment outcomes, therapeutic effects of plasma infusion, and organ function evaluation were observed. The relationship among the clinical manifestations, treatment outcomes, and ADAMTS13 gene mutation of patients with cTTP was analyzed. Additionally, detection of ADAMTS13 activity and analysis of ADAMTS13 gene mutation were explored. Results: The age of onset of cTTP was either in childhood or adulthood except in one case, which was at the age of 1. The primary manifestations were obvious thrombocytopenia, anemia, and different degrees of nervous system involvement. Most of the patients were initially suspected of having immune thrombocytopenia. Acute cTTP was induced by pregnancy and infection in two and one case, respectively. ADAMTS13 gene mutation was detected in all cases, and there was an inherent relationship between the mutation site, clinical manifestations, and degree of organ injury. Therapeutic or prophylactic plasma transfusion was effective for treating cTTP. Conclusions: The clinical manifestations of cTTP vary among individuals, resulting in frequent misdiagnosis that delays treatment. ADAMTS13 activity detection in plasma and ADAMTS13 gene mutation analysis are important bases to diagnose cTTP. Prophylactic plasma transfusion is vital to prevent the onset of the disease.

Value for combination of T1WI star -VIBE with TWIST -VIBE dynamic contrast -enhanced MRI in distinguishing lung nodules / 中南大学学报(医学版)

OBJECTIVES@#With the increasing detection rate of lung nodules, the qualitative problem of lung nodules has become one of the key clinical issues. This study aims to evaluate the value of combining dynamic contrast-enhanced (DCE) MRI based on time-resolved imaging with interleaved stochastic trajectories-volume interpolated breath hold examination (TWIST-VIBE) with T1 weighted free-breathing star-volumetric interpolated breath hold examination (T1WI star-VIBE) in identifying benign and malignant lung nodules.@*METHODS@#We retrospectively analyzed 79 adults with undetermined lung nodules before the operation. All nodules of patients included were classified into malignant nodules (n=58) and benign nodules (n=26) based on final diagnosis. The unenhanced T1WI-VIBE, the contrast-enhanced T1WI star-VIBE, and the DCE curve based on TWIST-VIBE were performed. The corresponding qualitative [wash-in time, wash-out time, time to peak (TTP), arrival time (AT), positive enhancement integral (PEI)] and quantitative parameters [volume transfer constant (Ktrans), interstitium-to-plasma rate constant (Kep), and fractional extracellular space volume (Ve)] were evaluated. Besides, the diagnostic efficacy (sensitivity and specificity) of enhanced CT and MRI were compared.@*RESULTS@#There were significant differences in unenhanced T1WI-VIBE hypo-intensity, and type of A, B, C DCE curve type between benign and malignant lung nodules (all P<0.001). Pulmonary malignant nodules had a shorter wash-out time than benign nodules (P=0.001), and the differences of the remaining parameters were not statistically significant (all P>0.05). After T1WI star-VIBE contrast-enhanced MRI, the image quality was further improved. Compared with enhanced CT scan, the sensitivity (82.76% vs 80.50%) and the specificity (69.23% vs 57.10%) based on MRI were higher than that of CT (both P<0.001).@*CONCLUSIONS@#T1WI star-VIBE and dynamic contrast-enhanced MRI based on TWIST-VIBE were helpful to improve the image resolution and provide more information for clinical differentiation between benign and malignant lung nodules.

Development and validation of liquid chromatography-tandem mass spectrometry method to quantify dasatinib in plasma and its application to a pharmacokinetic study

Abstract Dasatinib, a potent oral multi-targeted kinase inhibitor against Src and Bcr-Abl, can decrease inflammatory response in sepsis. A simple and cost-effective method for determination of an effective dose dasatinib was established. This method was validated in human plasma, with the aim of reducing the number of animals used, thus, avoiding ethical problems. Dasatinib and internal standard lopinavir were extracted from 180 uL of plasma using liquid-liquid extraction with methyl tert-butil ether, followed by liquid chromatography coupled to triple quadrupole mass spectrometry in multiple reaction monitoring mode. For the pharmacokinetic study, 1 mg/kg of dasatinib was administered to mice with and without sepsis. The method was linear over the concentration range of 1-98 ng/mL for DAS in mice and human plasma, with r2>0.99 and presented intra- and interday precision within the range of 2.3 - 6.2 and 4.3 - 7.0%, respectively. Further intra- and interday accuracy was within the range of 88.2 - 105.8 and 90.6 - 101.7%, respectively. The mice with sepsis showed AUC0-t = 2076.06 h*ng/mL and Cmax =102.73 ng/mL and mice without sepsis presented AUC0-t = 2128.46 h*ng/mL. Cmax = 164.5 ng/mL. The described analytical method was successfully employed in pharmacokinetic study of DAS in mice.

Liquid chromatography-mass spectrometry for simultaneous determination of spironolactone and canrenone in plasma samples

Abstract n our study, we aimed to validate a method based on liquid chromatography-mass spectrometry (LC-MS) to quantify spironolactone (SPI) and its active metabolite canrenone (CAN) simultaneously in plasma samples to support in vivo experiments. Compounds were separated by using a C18 column with the isocratic elution of a mobile phase composed of 0.1% (v/v) formic acid in methanol-water (60:40 v/v) at a flow rate of 0.4 mL min−1. SPI and CAN were detected in na electrospray interface operating in a positive ionization mode and quantified using the selective ion mode monitoring of mass-charge ratios (m/z) of 439.0 for SPI and 363.1 for CAN. After calculating the matrix effect using theoretical equations, we observed the strong interference of plasma in the equipment-generated signal, which required creating analytical curves using the matrix as a solvent. The method was nevertheless linear (r 2 > 0.999) in a concentration range of 0.4-5.0 µg mL−1, as well as precise, with a coefficient of variation less than 5%. SPI's and CAN's recovery rates from the plasma ranged from 87.4% to 112.1%, while their limits of detection (i.e., 0.07 µg mL−1 and 0.03 µg mL−1, respectively) and quantification (i.e., 0.20 µg mL−1 and 0.08 µg mL−1, respectively) in the presence of plasma contaminants were low. Therefore, the bioanalytical method seems to be feasible for quantifying SPI and CAN in plasma

Therapeutics and COVID-19: living guideline - 16 September 2022

The WHO Therapeutics and COVID-19: living guideline contains the Organization's most up-to-date recommendations for the use of therapeutics in the treatment of COVID-19. The latest version of this living guideline is available in pdf format (via the 'Download' button) and via an online platform, and is updated regularly as new evidence emerges. This twelfth version of the WHO living guideline now contains 19 recommendations. This latest update provides updated recommendations for remdesivir, addresses the use of combination therapy with corticosteroids, interleukin-6 (IL-6) receptor blockers and Janus kinase (JAK) inhibitors in patients with severe or critical COVID-19, and modifies previous recommendations for the neutralizing monoclonal antibodies sotrovimab and casirivimab-imdevimab in patients with non-severe COVID-19.

Reflections on the fundamental nature of homeopathic potencies: Plasma, Langmuir Adsorption and Vitalism

There is a pressing need to develop methods and approaches that will identify the fundamental nature of homeopathic potencies. Aims: To bring together recent basic research on potencies, especially that using solvatochromic dyes, and to supplement these results with reliable observations made by Hahnemann and his contemporaries from the very beginnings of homeopathy, together with a detailed examination of the process of trituration and succussion coupled to dilution, in order to significantly limit the number of possible explanations as to the identity of potencies. Methodology: A mixture of lab based and literature studies such that as far as possible all verified and substantiated observations about homeopathic potencies have been examined. Results and Discussion: An understanding of the fundamental nature of homeopathic potencies that includes all known and accepted observations (in vitro, in vivoand clinical) is not realistic without embracing hypotheses involving the emergent properties of complex systems and in particular, vitalistic concepts. Using a vitalistic model it is possible to explain a wide range of seemingly unrelated phenomena -such as the polarising effect of potencies on solvatochromic dyes, the ability to use a range of materials such as water, lactose and cellulose as carriers of potencies, the administering of potencies by olfaction, the antidoting effect of camphor on potency action, the non-linear dependence of potency strength on volume as well as succussion level, the oscillatory behaviour of potencies and experimenter/observer/practitioner effects. Conclusion: A hypothesis in which homeopathic potencies can be seen as self-actuating and autonomous plasma generated by trituration and/or succussion and carried according to Langmuir adsorption models fits the known observations about potencies.

Development and implementation of a COVID-19 convalescent plasma program in a middle-income economy

Abstract Introduction Convalescent Plasma therapy is one of the therapeutic strategies that has been used for patients with the Covid-19 disease. Implementing a program with national extension to supply hospitals with this blood component is a great challenge mainly in a middle-income economy. Objectives Our objective was to develop and implement a Covid-19 Convalescent Plasma Program which met established quality standards and was adapted to a reality of limited resources. Methods A multicentric convalescent plasma collection program was developed and implemented, based on four main sequential procedures: selective donor recruitment, pre-donation antibody screening (Anti-SARS-CoV-2- Chemiluminescence IgG Abbott), convalescent plasma collection by apheresis or whole-blood processing and distribution to the hospitals according to local demand. Results From the 572 candidates submitted to the pre-donation antibody screening, only 270 (47%) were considered eligible for plasma donation according to the established criteria. Higher levels of total antibody were associated with the donor age being above 45 years old (p= 0.002), hospital admission (p= 0.018), and a shorter interval between the diagnosis of the SARS-CoV-2 infection and plasma donation (p < 0.001). There was no association between the ABO and Rh blood groups and their antibody levels. Of the 468 donations made, 61% were from the collection of whole-blood and 39%, from apheresis. The Covid-19 Convalescent Plasma units obtained were distributed to 21 different cities throughout the country by air or ground transportation. Conclusion The implementation of a Covid-19 Convalescent Plasma program in a continental country with relatively scarce resources is feasible with alternative strategies to promote lower cost procedures, while complying with local regulations and meeting quality standards.

Antibody response against SARS-CoV-2 in convalescent plasma donors: Can we predict subjects' eligibility?

Abstract Introduction As the Coronavirus Disease 2019 (COVID-19) pandemic unfolds around the world; answers related to the antibody response against the virus are necessary to develop treatment and prophylactic strategies. We attempted to understand part of the immune response of convalescent plasma donation candidates. Method We carried out a cross-sectional, observational, non-intervention study, testing 102 convalescent plasma donation candidates for antibodies against the virus, relating these data to the time interval between symptom onset and sample collection, age, disease severity, and gender. Results In our sample, the individuals who developed a greater antibody response were the ones who had a longer time interval between symptom onset and sample collection, the ones who had been hospitalized and the subjects above 35 years old. Moreover, 17 individuals did not present any reactive antibodies. Conclusion These results are important in that they raise questions about the role of the humoral response against the virus, as some individuals do not develop antibodies to fight it. In addition, they help develop recruitment strategies for convalescent plasma donors, who should be asymptomatic for at least 21 days and are possibly more likely to have reactive antibodies after 35 days without symptoms.

Comparison of plasma lipid profiles and atherogenic indices among hypertensives with or without type 2 diabetes

Background: Several atherogenic indices derived from the lipid profiles are postulated to better detect dyslipidemias and predict the risk of having cardiovascular events even in the presence of insignificant changes in individual lipid parameters. Objective: To compare the lipid ratios and atherogenic index of plasma (AIP) to conventional atherogenic indices among hypertensive type 2 diabetics to hypertensive nondiabetes (HND) controls. Materials and Methods: A case­control study in which 210 participants with type 2 diabetes mellitus with hypertension (hypertensive­diabetic [HD]) compared with 150 (n = 155) hypertensive without diabetes (HND) with similar ages were enrolled. Blood samples for fasting lipid profile were collected and analyzed, and the following indices and ratios were calculated: (TC/high­density lipoprotein­cholesterol [HDL­C]), (low­density lipoprotein­cholesterol [LDL­C]/HDL­C), (HDL­C/ LDL­C), and AIP. The indices were compared in both the participants and control group. Results: There was no significant difference in the clinical characteristics of HD compared to the HND except the systolic blood pressure, weight, and HDL­C which were lower in the HND group. The frequency of dyslipidemia was found to be significantly higher in the HD group except elevated LDL­C in males (25.8% vs. 17.4%, χ2 = 0.055, respectively). Furthermore, all the lipid ratios, except (Castelli risk index II [CRI­ II] were found to be significantly different among HD as compared to HND group (P = 0.002, P = 0.045, respectively). Conclusions: This study concludes that Nigerians with both type 2 diabetes and hypertension have worse dyslipidemia and abnormal lipid ratios compared to those with only hypertension.

Effects of plasma lipopolysaccharide changes on platelet release of vascular endothelial growth factor and thromobospondin-1 in patients with cirrhotic portal hypertension after TIPS procedure / 中华肝脏病杂志

Objective: To investigate the effects of plasma lipopolysaccharide (LPS) concentration changes on platelet release of vascular endothelial growth factor (VEGF) and thrombospondin (TSP)-1 in patients with decompensated cirrhotic portal hypertension after transjugular intrahepatic portosystemic shunt (TIPS) procedure. Methods: 169 cases with cirrhotic portal hypertension were enrolled, of which 81 cases received TIPS treatment. LPS, VEGF, and TSP-1 concentrations with different Child-Pugh class in peripheral blood plasma of patients were measured. After pre-incubation of normal human platelets with different concentrations of LPS and stimulated by collagen in vitro, platelet PAC-1 expression rate, VEGF, and TSP-1 concentrations were detected. PAC-1 expression rate and the concentrations of LPS, VEGF and TSP-1 in peripheral blood plasma of patients before and after TIPS procedure were detected. The relationship between plasma LPS, VEGF and TSP-1 concentrations and Child-Pugh score changes in patients after TIPS procedure was analyzed. Statistical analysis was performed by t-test, one-way ANOVA or Pearson's rho according to different data. Results: Plasma LPS and TSP-1 concentrations were significantly higher in Child-Pugh class C patients than class A and B, but the concentration of plasma VEGF was significantly lower than class A and B (P < 0.01). In vitro experiments showed that concentration of LPS, TSP-1, and platelet PAC-1 expression rate was higher in the supernatant, but the difference in the concentration of VEGF in the supernatant was not statistically significant. Portal vein pressure and platelet activation were significantly decreased (P < 0.01) in patients after TIPS procedure. Portal venous pressure, platelet activation, plasma LPS, and TSP-1 levels were significantly decreased continuously, while VEGF levels were significantly increased continuously after TIPS procedure. Plasma LPS concentration was positively correlated with TSP-1 concentration (r = 0.506, P < 0.001), and negatively correlated with VEGF concentration (r = -0.167, P = 0.010). Child-Pugh score change range was negatively correlated with change range of plasma VEGF concentration (r = -0.297, P = 0.016), and positively correlated with change range of plasma TSP-1 concentration (r = 0.145, P = 0.031) after TIPS. Conclusion: Portal venous pressure gradient, plasma LPS concentration and corresponding platelet activation was decreased in cirrhotic portal hypertension after TIPS procedure, and with TSP-1 reduction and VEGF elevation it is possible to reduce the liver function injury caused by portal venous shunt.

Congenital factor X deficiency: a retrospective analysis of 11 cases / 中华血液学杂志

Objective: To analyze the clinical characteristics, laboratory examination, diagnosis, treatment, and outcome of hereditary factor Ⅹ (FⅩ) deficiency. Methods: Clinical data of 11 patients with congenital FⅩ deficiency were retrospectively analyzed from July 2009 to February 2021. Results: There were 3 males and 8 females. Median age was 39 (5-55) years. The media duration of follow-up was 81.67 (1.87-142.73) months. Of the 11 patients, 10 had bleeding symptoms, 7 had ecchymosis or hemorrhage after skin bump, 7 had nosebleed, 6 had gingival hemorrhage, and 1 had muscle hematoma. Among the female patients, 6 had menorrhagia and 1 experienced bleeding after vaginal delivery. Family history of FⅩ deficiency was found in one case. Eight patients had a history of surgery, and four had postoperative bleeding. Laboratory findings were characterized by significantly prolonged activated partial thromboplastin time, prothrombin time, and decreased FⅩ activity (FⅩ∶C) . Four cases underwent gene mutation analysis and five new mutations were found. Four cases were treated with prothrombin complex concentrates (PCC) and seven cases with fresh frozen plasma (FFP) . One female patient had significantly reduced menstrual volume after PCC prophylactic therapy. One patient received FFP for prophylactic infusion with no bleeding during and after the operation. Conclusion: Most patients with congenital FⅩ deficiency had bleeding symptoms and there was no significant correlation between severity of bleeding symptoms and FⅩ∶C. Prophylaxis should be applied in patients with severe bleeding tendencies. Gene mutation test is significant for screening, diagnosis, and prognosis prediction of congenital FX deficiency.

Aplicação do plasma de baixa temperatura sob pressão atmosférica no controle de biofilmes cariogênicos / Application of low temperature plasma under atmospheric pressure in the control cariogenic biofilms

O objetivo geral do presente estudo foi avaliar a aplicação dos jatos de plasma de baixa temperatura sob pressão atmosférica (PBTPA) produzidos por gás de argônio e hélio como gases de trabalho, no controle de biofilmes cariogênicos. Para tanto, foram estabelecidos os parâmetros físicos dos PBTPA gerados com argônio e hélio que se mostraram efetivos frente a biofilmes mono, dual e polimicrobianos compostos por combinações das espécies Streptococcus mutans, Streptococcus gordonii, Streptococcus sanguinis, Lactobacillus casei, Lactobacillus acidophilus, Candida albicans e Actinomyces naeslundii. Os biofilmes mono, dual e multi-espécies foram submetidos ao tratamento com PBTPA produzidos por dois dispositivos diferentes, um obtido comercialmente (kINPen09®) que usou argônio como gás de trabalho, e outro protótipo desenvolvido pela FEG-UNESP (Faculdade de Engenharia de Guaratinguetá) que usou hélio. Análises quantitativas e microscópicas (confocal, microscopia eletrônica de varredura) foram realizadas. Foi incluído controle negativo (sem tratamento), positivo (clorexidina 0,12%) e controle de gás, utilizando apenas fluxo de gás, sem produzir plasma. Além disso, os efeitos celulares do PBTPAargônio e hélio sobre biofilme dual e multi-espécies também foram analisados em microscopia eletrônica de varredura e microscopia de varredura a laser confocal. Todos os ensaios foram realizados em triplicata em três experimentos independentes. Os resultados foram tabulados e analisados quanto à distribuição. A seguir, os testes estatísticos mais adequados foram selecionados. O nível de significância foi de 5%. Os resultados obtidos para os tratamentos dos biofilmes mono, dual ou multi-espécies com PBTPA-argônio e hélio foram todos significativos em comparação ao controle negativo em todos os tempos analisados. Para PBTPA-argônio, não houve recuperação de S. gordonii e S. sanguinis em todos tempos analisados. Para PBTPA-hélio, os melhores resultados foram obtidos em 5 e 7 minutos de exposição dos biofilmes ao PBTPA. Finalmente, tanto o dispositivo gerador de PBTPA que trabalhou com gás argônio quanto o dispositivo que trabalhou com gás hélio, demonstraram resultados promissores e poderão contribuir para o desenvolvimento de novos protocolos de Odontologia de Intervenção Mínima. (AU) The general objective of this study was to evaluate the application of lowtemperature plasma under atmospheric pressure (PBTPA) of argon and helium flow, in the control of cariogenic biofilms. For this, the effective physical parameters of PBTPA-argon and helium in mono, dual and polymicrobial biofilms composed of combinations of the species Streptococcus mutans, Streptococcus gordonii, Streptococcus sanguinis, Lactobacillus casei, Lactobacillus acidophilus, Candida albicans and Actinomyces naeslundii were established. The multi-species biofilms were treated by different PBTPA generating devices, one obtained commercially (kINPen09®) that used argon as working gas, and another prototype developed by FEG-UNESP (Faculdade de Engenharia de Guaratinguetá) that used helium as working gas. Quantitative and microscopic analyzes (confocal, scanning electron microscopy) were performed. Negative control (no treatment), positive control (chlorhexidine 2%) and gas control (argon) were included. Besides that, cellular effects of PBTPA-argon and helium on dual and multi-species biofilms were analyzed by scanning electron microscopy (SEM) and confocal laser scanning microscopy. The results obtained for the treatments of mono, dual or multispecies biofilms with both PBTPA-argon and helium were all significant when compared to the negative control at all times analyzed. For PBTPA-argon, there was no recovery of S. gordonii and S. sanguinis at all analyzed times. For PBTPA-helium, the best results were obtained at 5 and 7 min of exposure of biofilms to PBTPA. All the tests were carried out in triplicate in three independent experiments. The results are tabulated and analyzed in terms of distribution. Next, the most suitable statistical tests were selected. The level of significance was 5%. The results obtained for the treatments of mono, dual or multi-species biofilms with PBTPA-argon and helium were all significant compared to the negative control at all analyzed times. Finally, both PBTPA generating could contribute to the development of new protocols for Minimal Intervention Dentistry (AU)

O objetivo geral do presente estudo foi avaliar a aplicação dos jatos de plasma de baixa temperatura sob pressão atmosférica (PBTPA) produzidos por gás de argônio e hélio como gases de trabalho, no controle de biofilmes cariogênicos. Para tanto, foram estabelecidos os parâmetros físicos dos PBTPA gerados com argônio e hélio que se mostraram efetivos frente a biofilmes mono, dual e polimicrobianos compostos por combinações das espécies Streptococcus mutans, Streptococcus gordonii, Streptococcus sanguinis, Lactobacillus casei, Lactobacillus acidophilus, Candida albicans e Actinomyces naeslundii. Os biofilmes mono, dual e multi-espécies foram submetidos ao tratamento com PBTPA produzidos por dois dispositivos diferentes, um obtido comercialmente (kINPen09®) que usou argônio como gás de trabalho, e outro protótipo desenvolvido pela FEG-UNESP (Faculdade de Engenharia de Guaratinguetá) que usou hélio. Análises quantitativas e microscópicas (confocal, microscopia eletrônica de varredura) foram realizadas. Foi incluído controle negativo (sem tratamento), positivo (clorexidina 0,12%) e controle de gás, utilizando apenas fluxo de gás, sem produzir plasma. Além disso, os efeitos celulares do PBTPAargônio e hélio sobre biofilme dual e multi-espécies também foram analisados em microscopia eletrônica de varredura e microscopia de varredura a laser confocal. Todos os ensaios foram realizados em triplicata em três experimentos independentes. Os resultados foram tabulados e analisados quanto à distribuição. A seguir, os testes estatísticos mais adequados foram selecionados. O nível de significância foi de 5%. Os resultados obtidos para os tratamentos dos biofilmes mono, dual ou multi-espécies com PBTPA-argônio e hélio foram todos significativos em comparação ao controle negativo em todos os tempos analisados. Para PBTPA-argônio, não houve recuperação de S. gordonii e S. sanguinis em todos tempos analisados. Para PBTPA-hélio, os melhores resultados foram obtidos em 5 e 7 minutos de exposição dos biofilmes ao PBTPA. Finalmente, tanto o dispositivo gerador de PBTPA que trabalhou com gás argônio quanto o dispositivo que trabalhou com gás hélio, demonstraram resultados promissores e poderão contribuir para o desenvolvimento de novos protocolos de Odontologia de Intervenção Mínima. (AU)

Blood components use at two private hospitals in Belo Horizonte, Minas Gerais between July 2017 and June 2019

ABSTRACT Introduction: A retrospective ecological longitudinal study was carried out with data on blood components use from two private hospital units that belong to the same organization located in Belo Horizonte between July 2017 and June 2019. Objectives: To describe the monthly series of red blood cells, platelets and plasma use and the rate of blood components use for general hospitalizations in the health network, from the perspective of time series. Methods: A total of 15 time series were created with monthly data related to the use of blood components. The stationarity of the series was verified by the unit root test, the trend, by the Cox-Stuart test and seasonality, by the Fisher test (significance levels of 10% for the first test and 5% for the last two). Results: All series tested positive for the trend component and showed an increasing trend for the use of blood components. Ten series showed statistically significant seasonality and eight series were identified as non-stationary. The percentage of transfusions of blood components due to hospitalization at hospitals 1 and 2 was 29% (22% at hospital 1 and 38.9% at hospital 2). Conclusion: This study was able to describe the components of blood components use dynamics, from the perspective of time series at hospitals. Due to the growing trend in demand for blood components and their high cost, we propose the reduction of blood components use and the expanded use of alternative blood transfusion strategies.