Analysis of the estimation of bleeding using several proposed haematometric equations.

PURPOSE: Among various methods for estimating blood loss, the gravimetric method is the most accurate; however, its use in routine practice is complicated. Although several equations have been proposed for this purpose, there is no consensus on the most suitable. METHODS: A cross-sectional study was conducted in seven secondary and tertiary hospitals between March and July 2018 including all patients undergoing total hip arthroplasty or hip prosthesis replacement under general or regional anaesthesia. We compared blood loss estimates obtained using the gravimetric method (weighing gauzes and pads and measuring volumes of blood collected by suction during surgery) and using three different equations, two of which considered intravenous fluids (CRYS 3.5 and 1.5) and a third which did not (the traditional equation). Additionally, intraclass correlation coefficients (ICCs) and Bland-Altman plots were used. RESULTS: The mean blood loss estimated using the gravimetric method was 513.7 ± 421.7 mL, while estimates calculated using the CRYS 3.5, CRYS 1.5 and traditional equations were 737.2 ± 627.4, 420.8 ± 636.2 and 603.4 ± 386.3 mL, respectively. Comparing these results, we found low levels of agreement (based on ICCs), except when using the traditional equation (ICC: 0.517). The limits of agreement comparing external blood loss with the estimates from the equations ranged from - 1655.6 to 1459.2 in the case of the CRYS 1.5 equation to - 839.6 to 1008.4 in the case of the traditional equation. CONCLUSIONS: For use in clinical practice, haematological index-based equations, regardless of whether they consider fluids administered, do not show sufficiently strong correlations with gravimetric estimates of intraoperative blood loss.

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: a WSES observational study.

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality.

Seat Belt Syndrome and the Submarine Effect: A Case Report.

The seatbelt sign is indicative of severe internal lesions in as many as 30% of cases. In the "submarine effect" the body slides below the belt, acting like hinge. "Seatbelt syndrome" describes the presence of the seat belt sign plus an intra-abdominal or spinal injury. We present the case of a driver in a car accident in whom severe soft tissue and visceral lesions were caused by a two-point seat-belt reproducing a complete "seatbelt syndrome".

Potential Application of Plant-derived Bioengineered Human VEGF for Tissue Regeneration.

The design and development of novel biological drugs are among the most exciting new areas of biotechnology which are gaining the attention of scientists. In the last few decades several fabrication processes have been proposed and developed for the production of recombinant growth factors. However, traditional production processes have several limitations in terms of scale- up, cost-efficiency and purity grade of the proteins. In the present study, we propose for the first time the proof-of-concept of large-scale production of growth factors in plants as a new alternative to other production processes. We have decided to select vascular endothelial growth factor (VEGF) as model assuming its key role in cell survival and regenerative medicine. Results show that the present protocol is efficient to scale up a purification procedure of rh VEGF isoform 165 in Nicotiana benthamiana plants. Our procedure resulted in dimeric VEGF protein with high purity degree and yield, which showed full biological activity over endothelial and epithelial cells, suggesting great potential for its use in regenerative medicine. This protein could be exploited not only in tissue repair and regeneration but also as a biologically active ingredient in dermocosmetics.