Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.875
Filtrar
1.
Medicine (Baltimore) ; 100(3): e24139, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546027

RESUMO

ABSTRACT: To evaluate the efficacy and safety of plasma rich in growth factors (PRGF) in photorefractive keratectomy (PRK) versus Mitomycin C (MMC).This is a comparative, longitudinal and retrospective case-control study (MMC vs PRGF), in patients with a spherical correction from -0.25 to -8.00 D and cylinder correction from -0.25 to -3.00. The uncorrected distance visual acuity (UDVA), refractive efficacy and safety indices, and changes in endothelial cell density were evaluated. The predictability was assessed with the postoperative manifest spherical equivalent.Forty-four patients (72 eyes) were treated with MMC and twenty-five patients (45 eyes) with PRGF. The final UDVA (LogMar) in MMC was 0.029 ±â€Š0.065 and in PRGF it was 0.028 ±â€Š0.048 (p = 0.383). The efficacy index for MMC was 0.98 ±â€Š0.10 and 1.10 ±â€Š0.46 for patients treated with PRGF (p = 0.062). The safety index for MMC was 1.03 ±â€Š0.11 and 1.12 ±â€Š0.46 (p = 0.158) for PRGF group. The change percentage of endothelial cell density was 0.9 ±â€Š11.6 for MMC and 4.3 ±â€Š13.1 for PRGF (p = 0.593). The predictability for MMC was 92.1% and for the PRGF was 91.9% (p = 0.976). Hyperemia, eye pain and superficial keratitis were observed in 11.1% of the MMC group; no adverse events were observed with the PRGF.The use of PRGF in PRK surgery is as effective as MMC. The PRGF shows a better safety profile than MMC for its intraoperative use in PRK.


Assuntos
Transfusão de Sangue Autóloga/métodos , Opacidade da Córnea/prevenção & controle , Peptídeos e Proteínas de Sinalização Intercelular/administração & dosagem , Ceratectomia Fotorrefrativa , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Antibióticos Antineoplásicos/uso terapêutico , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mitomicina/uso terapêutico , Soluções Oftálmicas , Estudos Retrospectivos , Adulto Jovem
2.
World Neurosurg ; 148: e209-e217, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33385596

RESUMO

BACKGROUND: The occurrence of coronavirus disease 2019 (COVID-19) has overwhelmed the blood supply chain worldwide and severely influenced clinical procedures with potential massive blood loss, such as clipping surgery for aneurysmal subarachnoid hemorrhage (aSAH). Whether acute normovolemic hemodilution (ANH) is safe and effective in aneurysm clipping remains largely unknown. METHODS: Patients with aSAH who underwent clipping surgery within 72 hours from bleeding were included. The patients in the ANH group received 400 mL autologous blood collection, and the blood was returned as needed during surgery. The relationships between ANH and perioperative allogeneic blood transfusion, postoperative outcome, and complications were analyzed. RESULTS: Sixty-two patients with aSAH were included between December 2019 and June 2020 (20 in the ANH group and 42 in the non-ANH group). ANH did not reduce the need of perioperative blood transfusion (3 [15%] vs. 5 [11.9%]; P = 0.734). However, ANH significantly increased serum hemoglobin levels on postoperative day 1 (11.5 ± 2.5 g/dL vs. 10.3 ± 2.0 g/dL; P = 0.045) and day 3 (12.1 ± 2.0 g/dL vs. 10.7 ± 1.3 g/dL; P = 0.002). Multivariable analysis indicated that serum hemoglobin level on postoperative day 1 (odds ratio, 0.895; 95% confidence interval, 0.822-0.973; P = 0.010) was an independent risk factor for unfavorable outcome, and receiver operating characteristic curve analysis showed that it had a comparable predictive power to World Federation of Neurosurgical Societies grade (Z = 0.275; P > 0.05). CONCLUSIONS: ANH significantly increased postoperative hemoglobin levels, and it may hold the potential to improve patients' outcomes. Routine use of ANH should be considered in aneurysm clipping surgery.


Assuntos
Aneurisma Roto/cirurgia , Transfusão de Sangue Autóloga/métodos , Procedimentos Médicos e Cirúrgicos de Sangue/métodos , Hemodiluição/métodos , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Transfusão de Sangue/estatística & dados numéricos , Feminino , Hemoglobinas/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Instrumentos Cirúrgicos
3.
Medicine (Baltimore) ; 99(51): e23842, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371166

RESUMO

BACKGROUND: There is limited evidence to assess the evaluation of the safety and effectiveness of autologous blood injections in the treatment of lateral epicondylitis patients. For this study, the aim was to compare the efficiency of corticosteroid and autologous blood injections for the treatment of lateral epicondylitis in a retrospective cohort trial in our single center. METHODS: After being approved by the institutional review committee of Chongqing General Hospital (IRB# 2018.417.C, November 9, 2018), we performed a single-center, retrospective study between November 2018 and January 2020. All participants provided written informed consent. The criteria for inclusion in our experiment are as follows: over 18 years old; with the history of at least 6 months of lateral epicondylitis; and the palpation of lateral epicondyle tenderness; visual analog scale (≥4). In the group A, the patient were injected the autologous blood. In group B, the patients were immersed with 0.5% of bupivacaine (1 ml) and local corticosteroids (2 ml) at lateral epicondyle. The outcomes were composed of a visual analog scores of subjective pain severity over the past 24 hours as the primary result; and limb function in various tasks of daily activity measured with disabilities of the arm, shoulder, and hand quick questionnaire scores, the maximum grip strength and the modified scores of Nirschl, as secondary results. All the results were assessed before the injection and at 4 weeks and 8 weeks after the injection. For all examination, when the P value was less than .05, it would be defined to be a statistically significant difference. RESULTS: The results of this study would provide new information about the influence of autologous blood injections in treating the lateral epicondylitis. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6263).


Assuntos
Corticosteroides/normas , Transfusão de Sangue Autóloga/normas , Protocolos Clínicos , Cotovelo de Tenista/tratamento farmacológico , Adolescente , Corticosteroides/uso terapêutico , Adulto , Transfusão de Sangue Autóloga/métodos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Estudos Retrospectivos , Inquéritos e Questionários , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento
5.
Anaesthesia ; 75(4): 479-486, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32037522

RESUMO

Cell salvage is an important component of blood management in patients undergoing revision hip arthroplasty surgery. However concerns regarding efficacy and patient selection remain. The aims of this study were to describe intra-operative blood loss, cell salvage re-infusion volumes and red blood cell transfusion rates for revision hip procedures and to identify factors associated with the ability to salvage sufficient blood intra-operatively to permit processing and re-infusion. Data were collected from a prospective cohort of 664 consecutive patients undergoing revision hip surgery at a single tertiary centre from 31 March 2015 to 1 April 2018. Indications for revision surgery were aseptic (n = 393 (59%)) fracture (n = 160 (24%)) and infection (n = 111 (17%)). Salvaged blood was processed and re-infused when blood loss exceeded 500 ml. Mean (SD) intra-operative blood loss was 1038 (778) ml across all procedures. Salvaged blood was re-infused in 505 of 664 (76%) patients. Mean (SD) re-infusion volume was 253 (169) ml. In total, 246 of 664 (37%) patients received an allogeneic red blood cell transfusion within 72 h of surgery. Patients undergoing femoral component revision only (OR (95%CI) 0.41 (0.23-0.73)) or acetabular component revision only (0.53 (0.32-0.87)) were less likely to generate sufficient blood salvage volume for re-infusion compared with revision of both components. Compared with aseptic indications, patients undergoing revision surgery for infection (1.87 (1.04-3.36)) or fracture (4.43 (2.30-8.55)) were more likely to generate sufficient blood salvage volume for re-infusion. Our data suggest that cell salvage is efficacious in this population. Cases where the indication is infection or fracture and where both femoral and acetabular components are to be revised should be prioritised.


Assuntos
Artroplastia de Quadril/métodos , Transfusão de Sangue Autóloga/métodos , Cuidados Intraoperatórios/métodos , Recuperação de Sangue Operatório/métodos , Reoperação/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
6.
Anesth Analg ; 130(5): 1389-1395, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058448

RESUMO

BACKGROUND: Cardiothoracic surgery is associated with major blood loss and allogeneic transfusion of red blood cell concentrates. To minimize allogeneic red blood cell (RBC) transfusion, intraoperative cell salvage has been effectively used for years. The objective of this study was to evaluate the impact of cell salvage on blood coagulation factors. METHODS: We enrolled 30 patients scheduled for cardiac surgery in a prospective single-center observational cohort study at an academic hospital. Blood samples from the cell salvage system were obtained from both the reservoir and the processed red blood cell concentrate. Coagulation factors, fibrinogen, antithrombin and von Willebrand activity, and antigen were assessed before and after cell salvage. Statistical analysis was performed using Wilcoxon matched-pairs signed rank test. RESULTS: Our results revealed a significant decrease of fibrinogen (P < .001), coagulation factors II (P = .004), factors VII, X, and XIII (P < .001), and all other measured coagulation factor concentrations/activities in the processed red blood cell concentrate, when compared to the concentrations/activities of the reservoir. CONCLUSIONS: The results of the present study revealed a significant reduction of coagulation factor concentrations/activities by the washing process. Therefore, physicians need to consider adequate management of coagulation in patients with major blood loss and the need of large volumes of RBC transfusion.


Assuntos
Fatores de Coagulação Sanguínea/metabolismo , Coagulação Sanguínea/fisiologia , Transfusão de Sangue Autóloga/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Cuidados Intraoperatórios/métodos , Recuperação de Sangue Operatório/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
Medicine (Baltimore) ; 99(2): e18577, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914036

RESUMO

BACKGROUND: Autologous blood transfusion helps to avoid or reduce the need for allogenic blood transfusion in patients undergoing major surgery. We examined the value of erythropoietin therapy to support preoperative autologous blood donation (PABD) in patients undergoing orthopedic surgery. METHODS: For this systematic review and meta-analysis, Medline, Cochrane, EMBASE, and Google Scholar databases were searched from October 26th, 1989 until September 30th, 2017. Primary outcomes were percentages of patients able to donate ≥4 units of blood for autologous transfusion, amount of allogeneic blood transfused, changes in hematocrit and hemoglobin levels from before PABD to immediately before surgery, and adverse events. RESULTS: Of 256 studies identified, 18 studies met the inclusion criteria with a total of 1914 patients (mean age 51-69 years), of whom 1153 were treated with erythropoietin. Erythropoietin was associated with a greater percentage of patients able to donate ≥4 units of blood for autologous use compared to controls (OR = 6.00, 95% CI = 3.97 to 9.09, P < .001). Patients receiving preoperative erythropoietin had significantly less of a reduction in hematocrit and hemoglobin levels from before PABD to immediately before surgery compared with controls (hematocrit: mean differences = -1.438, 95% CI = -2.14 to -0.73, P < .001; hemoglobin: mean differences = -1.426, 95% CI = -1.78 to -1.07, P < .001). No significant differences were observed in the amount of allogenic blood transfused between patients receiving erythropoietin and controls (difference in means = -0.220, 95% CI = -0.536 to 0.097, P = .174). Patients who received erythropoietin were less likely to experience dizziness than controls, but the incidence of nausea or fatigue were similar between groups. CONCLUSION: Erythropoietin therapy during the PABD period results in less of a reduction in hematocrit and hemoglobin levels and an increase in the percentage of patients able to donate blood preoperatively.


Assuntos
Transfusão de Sangue Autóloga/métodos , Eritropoetina/uso terapêutico , Procedimentos Ortopédicos/métodos , Período Pré-Operatório , Idoso , Eritropoetina/administração & dosagem , Eritropoetina/efeitos adversos , Feminino , Hematócrito , Hemoglobinas , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Andrologia ; 52(3): e13510, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31965580

RESUMO

Partial priapism is a rare disorder in literature and generally described as a contusion or thrombosis of the cavernous body of the penis secondary to blunt trauma. Because of the rarity of disease, there is not much information about the treatment. Conservative management with nonsteroidal anti-inflammatory drug is often applied treatment. Here, we presented a proximal partial priapism treated successfully with autologous clot embolisation secondary to pelvic trauma.


Assuntos
Transfusão de Sangue Autóloga/métodos , Embolização Terapêutica/métodos , Priapismo/terapia , Angiografia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Masculino , Pênis/irrigação sanguínea , Pênis/diagnóstico por imagem , Priapismo/diagnóstico , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Adulto Jovem
9.
J Surg Res ; 247: 271-279, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31706541

RESUMO

BACKGROUND: The aim of this study was to evaluate the efficacy of autologous platelet-rich gel (APG) in the treatment of deep sinus tract wounds from diabetic ulcers. METHODS: Forty-eight patients with diabetic ulcers were randomly classified into two groups: an APG treatment group (25 patients) and a conventional wound dressing control group (23 patients). The sinus tract closure times, ulcer healing rates, hospitalization times, and hospitalization expenses of the two groups were compared. RESULTS: There were no significant differences in the basic data and wound conditions between the two groups. The cure (healed wound) rates were 96% and 87% for the APG group and control group, respectively. During the first 4 wk, the sinus tract closure rate for the APG group was significantly higher than that for the control group. However, there was no significant difference in the sinus tract healing between the two groups at the end of the 8th wk. For the APG group and the control group, the average hospital stays were 19.36 ± 7.239 d and 48.13 ± 11.721 d, respectively, and the total hospitalization expenses were 2.48 ± 0.45 ten thousand yuan and 5.63 ± 1.35 ten thousand yuan (P < 0.05), respectively. These differences were statistically significant. CONCLUSIONS: When compared with conventional wound dressings, APG can accelerate the healing of deep sinus tract wounds associated with diabetic ulcers.


Assuntos
Transfusão de Sangue Autóloga/métodos , Pé Diabético/terapia , Plasma Rico em Plaquetas , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Bandagens , Pé Diabético/complicações , Géis , Humanos , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
10.
Urology ; 135: 106-110, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31626857

RESUMO

OBJECTIVE: To examine long- and short-term outcomes using cell salvage with a commercially available leukocyte depletion filter following radical cystectomy in an oncologic population. MATERIALS AND METHODS: One hundred and fifty-seven patients, 87 of whom received a cell salvage transfusion, were retrospectively identified from chart review. Ninety-day outcomes as well as long-term mortality and cancer recurrence data were collected. Chi-square, Student's t, or Mann-Whitney U tests were used as appropriate. Multivariable regressions of survival were performed with a Cox proportional-hazards model. RESULTS: Those who received a cell salvage transfusion did not show any differences in rate of cancer recurrence (23%) vs those who did not receive a cell salvage transfusion (24%; P = .85). There were also no differences noted in mortality rates between the 2 populations (12% vs 17%; P = .36). Furthermore, no differences were noted in postoperative complication rates, length of hospital stay, 90-day culture positive infections or readmissions (P >.05). CONCLUSION: There are no significant differences in short-term or long-term patient outcomes between those who did and did not receive an intraoperative cell salvage transfusion. Cell salvage transfusions with a leukocyte depletion filter are safe and effective methods to reduce the need for allogeneic blood transfusions while controlling for the theoretical risk of metastatic spread.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue Autóloga/efeitos adversos , Cistectomia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Recuperação de Sangue Operatório/efeitos adversos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue Autóloga/métodos , Feminino , Filtração/instrumentação , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Procedimentos de Redução de Leucócitos/instrumentação , Leucócitos/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Inoculação de Neoplasia , Recuperação de Sangue Operatório/instrumentação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
11.
Spine (Phila Pa 1976) ; 45(6): E336-E341, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31574059

RESUMO

STUDY DESIGN: Observational cohort study with propensity score matching. OBJECTIVE: Determine whether antifibrinolytic drug use is associated with decreased allogeneic blood transfusion in multilevel pediatric spine surgery. SUMMARY OF BACKGROUND DATA: Antifibrinolytic drugs are commonly used in adult multilevel spine surgery to reduce blood loss and allogeneic transfusion; however, only small studies have examined their efficacy in pediatric patients having multilevel spine surgery. METHODS: Pediatric patients who had posterior multilevel spine surgery between 2016 and 2017 were identified in the national surgery quality improvement program participant use file. Propensity score matching was used to reduce bias from confounding and the rate of intraoperative allogeneic transfusion was compared between patients who received antifibrinolytic drugs and those who did not. Secondary outcomes included intraoperative cell saver volume, postoperative allogeneic transfusion, massive intraoperative transfusion, and adverse events including venous thromboembolism and seizure. RESULTS: A total of 6904 patients underwent posterior multilevel spine surgery during the study period and 83% received antifibrinolytics. The matched cohort included 604 patients. Antifibrinolytic use had no association with reduced intraoperative allogeneic transfusion: odds ratio (OR) = 0.71 (99% confidence interval [CI] = 0.40-1.26, P = 0.12) or cell saver volume, median volume = 114 mL (0, 250 mL) in antifibrinolytic group versus 100 mL (0, 246 mL) in control group, P = 0.04. There was also no association with reduced postoperative allogeneic transfusion OR = 1.23 (99% CI = 0.54-2.81, P = 0.52) or massive transfusion OR = 1.0 (99% CI = 0.34-2.92, P = 1.0). No patient in the matched cohort had a venous thromboembolism or seizure. CONCLUSION: Antifibrinolytic drugs are commonly used in pediatric multilevel spine surgery in the United States, but no efficacy was demonstrated in our study. There were no venous thromboembolisms or seizures implying an excellent safety profile in pediatric patients. LEVEL OF EVIDENCE: 3.


Assuntos
Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue Autóloga/métodos , Pontuação de Propensão , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Criança , Estudos de Coortes , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/tendências , Doenças da Coluna Vertebral/diagnóstico , Fusão Vertebral/tendências
12.
J Cosmet Dermatol ; 19(1): 185-189, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31674154

RESUMO

BACKGROUND: Autologous blood concentrates are increasingly being applied in esthetic medicine and dentistry due to their safety and their potential beneficial properties. Platelet-rich fibrin based on the low speed centrifugation, a newly described blood product, seems to convey additional properties in several in vitro and ex vivo studies. Its clinical significance however in relation to facial regeneration remains anecdotal. OBJECTIVE: The aim of this study was to assess a specific combination of PRF liquid matrices utilized for lower facial regeneration (Cleopatra technique). PATIENTS/METHODS: Cleopatra technique was applied in 32 patients. In addition to recording of all patients' complaints and adverse events, a photographical study was performed. Possible positive effects were assessed by asking twenty-three independent reviewers to distinguish initial and later photographs of each patient. RESULTS: A statistically significant percentage of true answers by the reviewers was noted upon completion of the treatment (U = 110.5, P < .001), which indicates a clinically significant effect of Cleopatra technique. Moreover, only few minor, self-limited adverse events were recorded. CONCLUSIONS: Cleopatra technique is a well-tolerated and effective method of lower facial rejuvenation that deserves further attention from dentists and other health professional who utilize conservative methods in facial esthetics.


Assuntos
Transfusão de Sangue Autóloga/métodos , Técnicas Cosméticas , Face , Fibrina Rica em Plaquetas , Rejuvenescimento , Adulto , Idoso , Centrifugação/métodos , Feminino , Humanos , Injeções Subcutâneas , Pessoa de Meia-Idade , Resultado do Tratamento
14.
J Cosmet Dermatol ; 19(2): 456-461, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31241854

RESUMO

BACKGROUND: Multiple therapeutic approaches are usually required when treating atrophic acne scars. Subcision was reported to be of value in improving rolling scars. Autologous platelet-rich plasma (PRP) has recently been proposed as an adjuvant treatment option for atrophic acne scars with few reports evaluating its efficacy. OBJECTIVE: Our objective was to compare the effect of intradermal injection of PRP vs combined PRP and subcision in the treatment of atrophic acne scars. METHODS: Thirty patients with bilateral atrophic acne scars were enrolled. Each patient received three monthly sessions. Each side of the face was randomly treated either with intradermal PRP alone or with combined treatment with subcision followed by PRP injection. Patients were assessed at 3 and 6 months following the last treatment session. Evaluation of serial photographs was performed by two blinded investigators. RESULTS: Platelet-rich plasma alone showed a better response, fewer side effects, and shorter downtime compared to combined subcision and PRP. CONCLUSION: Autologous PRP injection can be a therapeutic option in the treatment of atrophic acne scars, with fewer complications and better tolerability than combined subcision and autologous PRP.


Assuntos
Acne Vulgar/terapia , Transfusão de Sangue Autóloga/métodos , Cicatriz/terapia , Técnicas Cosméticas/instrumentação , Plasma Rico em Plaquetas , Acne Vulgar/complicações , Adolescente , Adulto , Atrofia/etiologia , Atrofia/terapia , Cicatriz/etiologia , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Injeções Intradérmicas , Masculino , Agulhas , Satisfação do Paciente , Resultado do Tratamento , Adulto Jovem
15.
Anesth Analg ; 131(2): 483-493, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31880628

RESUMO

BACKGROUND: The relationships between the ratios of transfused allogeneic blood products and clinical outcomes in patients with acute intraoperative hemorrhage are poorly defined. METHODS: To better define these ratios, we undertook a single-center, observational cohort study of all surgical patients (≥18 years) who received rapid transfusion defined by a critical administration threshold of 3 or more units of red blood cells (RBCs) intraoperatively within 1 hour between January 1, 2011 and December 31, 2015. Multivariable regression analyses were used to assess relationships between ratios of plasma to RBCs and platelets to RBCs at 3, 12, and 24 hours and clinical outcomes. The primary outcome was hospital mortality, with secondary outcomes of intensive care unit and hospital-free days. RESULTS: The study included 2385 patients, of whom 14.9% had a plasma-to-RBC ratio of 1.0+, and 47.6% had a platelet-to-RBC ratio of 1.0+. Higher plasma-to-RBC and platelet-to-RBC ratios were observed for patients who underwent cardiac, transplant, and vascular surgery and in patients with greater derangements in hemostatic laboratory values. Ratios did not differ by patient age or severity of illness. Higher ratios were not associated with improved clinical outcomes. Mortality differed by platelet-to-RBC but not plasma-to-RBC ratio, with the highest mortality observed with a platelet-to-RBC ratio of 0.1-0.9 at 24 hours (odds ratio, 3.34 [1.62-6.88]) versus no platelets (P= .001). Higher plasma-to-RBC ratios were associated with decreased hospital-free days, although differences in clinical outcomes were not significant after exclusion of patients receiving only RBCs without component therapies. CONCLUSIONS: Transfusion ratios in surgical patients with critical intraoperative hemorrhage were largely related to surgical and hemostatic features rather than baseline patient characteristics. Higher ratios were not associated with improved outcomes.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Plaquetas/metabolismo , Transfusão de Sangue Autóloga/métodos , Complicações Intraoperatórias/sangue , Complicações Intraoperatórias/terapia , Plasma/metabolismo , Idoso , Estudos de Coortes , Transfusão de Eritrócitos/métodos , Feminino , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Arthroscopy ; 35(11): 3117-3131.e2, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31699265

RESUMO

PURPOSE: To investigate the functional improvement and pain reduction of different nonsurgical treatments for patellar tendinopathy (PT), a systematic review with network meta-analysis was performed. METHODS: Studies were comprehensively searched for without language restrictions in the CENTRAL, MEDLINE, EMBASE, Web of Science, Physiotherapy Evidence Database, and SPORTDiscus databases from inception to May 2018. Randomized controlled trials about nonsurgical treatments for PT were included. The outcome measurements were the Victorian Institute of Sports Assessment (VISA) scale and pain scores (such as the visual analog scale or Numerical Rating Scale). Study quality was evaluated using the Physiotherapy Evidence Database score. Direct comparisons were performed using pairwise meta-analysis, whereas network meta-analysis was performed using a frequentist method in a multivariate random-effects model. RESULTS: Eleven studies with 430 affected patellar tendons were included in the systematic review. The summary mean difference of improvement in the VISA scale versus the control group for corticosteroid injection was -23.00 (95% confidence interval [CI] -36.73 to -9.27), for leukocyte-rich platelet-rich plasma (LR-PRP) was 13.22 (95% CI 2.37-24.07), for focused extracorporeal shockwave therapy (ESWT) was -1.28 (95% CI -6.25 to 3.68), for radial ESWT was -6.68 (95% CI -20.20 to 6.84), for ultrasound was -0.70 (95% CI -11.23 to 9.83), for autologous blood injection was -0.60 (95% CI -9.30 to 8.10), for dry needling was 17.51 (95% CI -2.57 to 37.60), for topical glyceryl trinitrate was -0.90 (95% CI -13.07 to 11.27), and for skin-derived tendon-like cells was 10.40 (95% CI -1.59 to 22.39). LR-PRP (Surface Under the Cumulative Ranking curve [SUCRA] = 87.5%) or dry needling (SUCRA = 90.5%) was most likely to be ranked the best in terms of improvement on the VISA scale. Compared with the control group, the summary mean difference of the change in pain score for corticosteroid injection was 0.80 (95% CI -3.48 to 5.08), for LR-PRP was -1.87 (95% CI -3.28 to -0.46), for focused ESWT was 0.13 (95% CI -0.68 to 0.93), for radial ESWT was 0.03 (95% CI -1.92 to 1.98), for ultrasound was -0.20 (95% CI -1.49 to 1.09), for autologous blood injection was 0.60 (95% CI -0.73 to 1.93), for dry needling was -0.37 (95% CI -2.71 to 1.97), and for topical glyceryl trinitrate was -0.50 (95% CI -2.55 to 1.55). The treatment most likely to be ranked the best in terms of change in pain score was LR-PRP (SUCRA = 94.9%). CONCLUSIONS: The network meta-analysis demonstrated that LR-PRP has the greatest functional improvement and pain reduction for PT compared with other treatment options. However, the treatment effect estimates can be biased by the possible intransitivity and should not be overestimated. LEVEL OF EVIDENCE: Level I, meta-analysis of Level I studies.


Assuntos
Transfusão de Sangue Autóloga/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Glucocorticoides/administração & dosagem , Metanálise em Rede , Plasma Rico em Plaquetas , Tendinopatia/terapia , Humanos , Injeções Intralesionais , Ligamento Patelar , Resultado do Tratamento
17.
Medicine (Baltimore) ; 98(38): e17291, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568014

RESUMO

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a clinically common chronic disease with the characteristic of recurrent attacks, difficulty of cure and high morbidity, disability, death rates. COPD exerts a great burden on patients, families and society. Acupoint Autohemotherapy (AA) is a traditional Chinese medicine (TCM) treatment by taking the patient's own venous blood and injecting them at acupoints, combined with the continuous stimulation of blood and the specific efficacy of the acupoint itself. It has been proved to be useful in pulmonary treatment and rehabilitation of COPD patients. However, the efficacy of AA on COPD patients has not been fully statistically evaluated. In this study, we aim to systematically examine the efficacy and safety of AA for COPD patients. METHODS: Data from all English and Chinese databases, including Medline, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Biomedical Literature Database and Chongqing VIP information, will be used to conduct a systematic and comprehensive literature search. The range of date is from inception to July 2019. Randomized controlled trials (RCTs) related to AA and western medicine in the treatment of COPD will be included. Quality of included trials will be assessed according to the risk of bias tool of Cochrane Handbook 5.1.0. The GRADE approach will be used to rate the certainty of the evidence of estimates derived from meta-analysis. RevMan 5.3 will be used for data synthesis, sensitivity analysis, meta-regression analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias, and Begg and Egger tests will be used to assess funnel plot symmetries. Grading of recommendations assessment, development and evaluation system will be utilized to assess the quality of evidence. RESULTS: This systematic review and meta-analysis aims to summarize the direct and indirect outcomes for AA and western medicine on COPD patients and evaluate its efficacy and safety. The results will be submitted to a peer-reviewed journal once completed. CONCLUSION: The systematic review will provide evidence to assess the efficacy and safety of AA and western medicine in the treatment of COPD patients. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019137189.


Assuntos
Pontos de Acupuntura , Transfusão de Sangue Autóloga/métodos , Medicina Tradicional Chinesa/métodos , Doença Pulmonar Obstrutiva Crônica/terapia , Transfusão de Sangue Autóloga/efeitos adversos , Humanos , Medicina Tradicional Chinesa/efeitos adversos , Resultado do Tratamento
18.
Paediatr Anaesth ; 29(11): 1136-1145, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31532041

RESUMO

BACKGROUND: Posterior spinal fusion for adolescent idiopathic scoliosis is a complex surgery often associated with clinically significant blood loss leading to perioperative blood transfusion. Knowledge of risk factors for blood loss and transfusion stems mostly from retrospective studies. AIM: We sought to prospectively investigate putative prognostic factors for intraoperative blood loss and perioperative blood transfusion in adolescent idiopathic scoliosis patients undergoing posterior spine fusion, including clinical characteristics, surgical factors, and preoperative assessment of overall coagulative and fibrinolytic functions in plasma using the clot formation and lysis (CloFAL) assay. METHODS: Following Internal Review Board approval, adolescents 10 to <21 years old with idiopathic scoliosis undergoing posterior spine fusion were enrolled preoperatively in a single-institutional prospective cohort and biobanking study. Clinical data were collected on patient characteristics, surgical approach, perioperative management, intraoperative estimated blood loss, and blood transfusion through hospital discharge. Coagulative and fibrinolytic functions in plasma were measured on preoperative samples by CloFAL assay (Coagulation Index and modified Fibrinolytic Index). Univariate linear regression and multivariable linear regression were performed to identify predictors of weight-indexed intraoperative estimated blood loss EBL (EBL/kg). RESULTS: The final study population included 74 patients. Median age was 14.8 years (SD = 2.2). After adjustment for other putative prognostic factors via multivariable linear regression, coagulative function as determined preoperatively by CloFAL Coagulation Index was an independent predictor of intraoperative (EBL)/kg. Specifically, each 10% increase in CloFAL CI was associated with 3% decrease in the geometric mean of EBL/kg (OR 0.97, 95%CI 0.94-0.99, P = .01). CONCLUSION: In adolescents undergoing posterior spinal fusion for idiopathic scoliosis, increased coagulative function measured preoperatively using the CloFAL assay is independently associated with decreased intraoperative blood loss. Future studies should expand upon these investigations of plasma coagulative and fibrinolytic capacities in combination with clinical factors, to guide precise preventive strategies against blood loss and blood transfusion in this patient population.


Assuntos
Testes de Coagulação Sanguínea/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Escoliose/sangue , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Bancos de Espécimes Biológicos , Coagulação Sanguínea/fisiologia , Transfusão de Sangue Autóloga/métodos , Feminino , Humanos , Masculino , Cuidados Pré-Operatórios/métodos , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
19.
Ophthalmologica ; 242(4): 214-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31509827

RESUMO

PURPOSE: To identify the predictors for anatomical and functional outcome after re-vitrectomy with application of autologous platelet concentrate (APC) in eyes with persistent idiopathic macular hole (MH). METHODS: Retrospective study of 103 eyes with persistent MHs after vitrectomy with peeling of internal limiting membrane (ILM) and expansive gas. All patients underwent re-vitrectomy with APC and endotamponade. The anatomical MH closure rate and postoperative best-corrected visual acuity (BCVA) were evaluated. Further, predictive factors influencing the success of the surgery were analyzed. RESULTS: Median BCVA (logMAR) before the surgery was 1.00 (interquartile range [IQR] 0.80-1.30) and the median of minimum diameter between hole edges was 508 µm (IQR 387-631). The final closure rate after re-vitrectomy with APC was 60.2% (62 of 103 eyes). The following predictors were identified to significantly influence the closure rate: tractional hole index (THI), axial length, time between first and second surgery, and the experience of the surgeon (p < 0.05). CONCLUSIONS: Re-vitrectomy with APC led to the closure of 60.2% of the persistent MHs. The closure rate negatively correlates with increasing axial length, time between the first and second surgery, and the decreased THI. Further, experienced surgeons (with a history of >100 pars plana vitrectomies with ILM peeling) had significantly higher closure rates.


Assuntos
Plaquetas , Transfusão de Sangue Autóloga/métodos , Tamponamento Interno/métodos , Macula Lutea/patologia , Perfurações Retinianas/terapia , Acuidade Visual , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Reoperação , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
20.
Ann Thorac Surg ; 108(6): 1738-1744, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31445910

RESUMO

BACKGROUND: Blood conservation with antifibrinolytics, topical hemostatics, and strict transfusion triggers are becoming commonplace in cardiac surgery. The aim of this study was to evaluate the effect of a blood conservation protocol centering on standardized intraoperative autologous blood donation (IAD) use in cardiac surgery. METHODS: We reviewed charts of patients who underwent cardiac surgery at our hospital over an 8-year period to analyze transfusion tendencies before and after a new blood conservation policy was implemented. Propensity score matching was used to account for population differences in preoperative and perioperative covariates. RESULTS: Over an 8-year period (January 2009 to December 2017) 1002 patients were studied. Three hundred fifty-two patients before the new blood conservation policy (group 1) were compared with 650 patients after the change (group 2). Fewer group 2 patients required blood transfusions during their hospital stay (78% vs 61%, P < .001), were transfused fewer units (2.8 vs 1.81 units, P < .001), and experienced a shorter length of stay (8.02 vs 7.28 days, P = .012). Propensity score-matched cohorts revealed reductions in any complication (29.5% vs 18.8%, P = .007), fewer postoperative transfusions (70.1% vs 50.9%, P < .001), and a lower transfusion volume (1.82 vs 1.21 units, P = .002) associated with IAD without any associated change in mortality. CONCLUSIONS: IAD use is associated with reduced transfusions in cardiac surgery and may be considered a complementary aspect of blood conservation. Our experience suggests it may be applied with few limitations. A causal relationship between IAD and outcomes should be established with prospective studies.


Assuntos
Doadores de Sangue/provisão & distribução , Transfusão de Sangue Autóloga/métodos , Procedimentos Cirúrgicos Cardíacos , Cuidados Intraoperatórios/métodos , Hemorragia Pós-Operatória/prevenção & controle , Idoso , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Médicos e Cirúrgicos de Sangue/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...