Red blood cell (RBC) transfusions are common in intensive care unit, trauma, and surgical patients. However, the hematocrit that should be maintained in any particular patient because the risks of ...further transfusion of RBC outweigh the benefits remains unclear.
A systematic review of the literature to determine the association between red blood cell transfusion, and morbidity and mortality in high-risk hospitalized patients.
MEDLINE, Embase, Cochrane Register of Controlled Trials, and citation review of relevant primary and review articles.
Cohort studies that assessed the independent effect of RBC transfusion on patient outcomes. From 571 articles screened, 45 met inclusion criteria and were included for data extraction.
Forty-five studies including 272,596 were identified (the outcomes from one study were reported in four separate publications). The outcome measures were mortality, infections, multiorgan dysfunction syndrome, and acute respiratory distress syndrome. The overall risks vs. benefits of RBC transfusion on patient outcome in each study was classified as (i) risks outweigh benefits, (ii) neutral risk, and (iii) benefits outweigh risks. The odds ratio and 95% confidence interval for each outcome measure was recorded if available. The pooled odds ratios were determined using meta-analytic techniques.
Forty-five observational studies with a median of 687 patients/study (range, 63-78,974) were analyzed. In 42 of the 45 studies the risks of RBC transfusion outweighed the benefits; the risk was neutral in two studies with the benefits outweighing the risks in a subgroup of a single study (elderly patients with an acute myocardial infarction and a hematocrit <30%). Seventeen of 18 studies, demonstrated that RBC transfusions were an independent predictor of death; the pooled odds ratio (12 studies) was 1.7 (95% confidence interval, 1.4-1.9). Twenty-two studies examined the association between RBC transfusion and nosocomial infection; in all these studies blood transfusion was an independent risk factor for infection. The pooled odds ratio (nine studies) for developing an infectious complication was 1.8 (95% confidence interval, 1.5-2.2). RBC transfusions similarly increased the risk of developing multi-organ dysfunction syndrome (three studies) and acute respiratory distress syndrome (six studies). The pooled odds ratio for developing acute respiratory distress syndrome was 2.5 (95% confidence interval, 1.6-3.3).
Despite the inherent limitations in the analysis of cohort studies, our analysis suggests that in adult, intensive care unit, trauma, and surgical patients, RBC transfusions are associated with increased morbidity and mortality and therefore, current transfusion practices may require reevaluation. The risks and benefits of RBC transfusion should be assessed in every patient before transfusion.
This study was designed to determine if a limited access feeding protocol would induce binge-type eating when energy intake on the day before the binge was not reduced. Rats were assigned to four ...groups; all groups had continuous access to chow and water throughout the 4 wk study. In addition, access to optional shortening was provided as follows: (1) Control (C): no access to shortening, (2) Regular Shortening Access-7 (RSA7): 2-h access everyday, (3) Regular Shortening Access-3 (RSA3): 2-h access every Monday, Wednesday, and Friday, (4) Irregular Shortening Access (ISA): 2-h access on various days, such that the number of shortening access (binge) sessions equaled that of RSA3, but the last three sessions were each separated by 4 days. On the days prior to the last two binge sessions, RSA3 consumed significantly less energy than any other group (
p<0.05), but ISA intakes equaled those of Control and RSA7. During the last two binge sessions, intakes of RSA3 and ISA did not differ, and both groups consumed significantly more than RSA7 or Control (
p<0.05). These results demonstrate that binge-type eating can be induced by limiting access to an optional fatty food, and does not depend upon undereating on the previous day.
Hospital-acquired anemia (HAA) is a prevalent condition that is independently associated with worse clinical outcomes including prolongation of hospital stay and increased morbidity and mortality. ...While multifactorial in general, iatrogenic blood loss has been long recognized as one of the key contributing factors to development and worsening of HAA during hospital stay. Patients can be losing over 50 mL of blood per day to diagnostic blood draws. Strategies such as elimination of unnecessary laboratory tests that are not likely to alter the course of management, use of pediatric-size or small-volume tubes for blood collection to reduce phlebotomy volumes and avoid blood wastage, use of closed blood sampling devices, and substituting invasive tests with point-of-care testing alone or bundled together have generally been shown to be effective in reducing the volume of iatrogenic blood loss, hemoglobin decline, and blood transfusions, with no negative impact on the availability of test results for the clinical team. These strategies are important components of Patient Blood Management programs and their adoption can lead to improved clinical outcomes for patients.
•Hospital-acquired anemia is a prevalent risk factor for worse outcomes.•Diagnostic blood draws are one of the key contributing factors•Blood draws can cost patients as much as 50 mL of blood lost per day.•Unnecessary laboratory tests should be eliminated.•Reducing the phlebotomy volumes is effective in reducing blood wastage.
The difficulty of fusion splicing hollow-core photonic bandgap fiber (PBGF) to conventional step index single mode fiber (SMF) has severely limited the implementation of PBGFs. To make PBGFs more ...functional we have developed a method for splicing a hollow-core PBGF to a SMF using a commercial arc splicer. A repeatable, robust, low-loss splice between the PBGF and SMF is demonstrated. By filling one end of the PBGF spliced to SMF with acetylene gas and performing saturation spectroscopy, we determine that this splice is useful for a PBGF cell.
Anemia is common in critically ill patients and results in a large number of red blood cell (RBC) transfusions. Recent data have raised the concern that RBC transfusions may be associated with worse ...clinical outcomes in some patients.
To assess the efficacy in critically ill patients of a weekly dosing schedule of recombinant human erythropoietin (rHuEPO) to decrease the occurrence of RBC transfusion.
A prospective, randomized, double-blind, placebo-controlled, multicenter trial conducted between December 1998 and June 2001.
A medical, surgical, or a medical/surgical intensive care unit (ICU) in each of 65 participating institutions in the United States.
A total of 1302 patients who had been in the ICU for 2 days and were expected to be in the ICU at least 2 more days and who met eligibility criteria were enrolled in the study; 650 patients were randomized to rHuEPO and 652 to placebo.
Study drug (40 000 units of rHuEPO) or placebo was administered by subcutaneous injection on ICU day 3 and continued weekly for patients who remained in the hospital, for a total of 3 doses. Patients in the ICU on study day 21 received a fourth dose.
The primary efficacy end point was transfusion independence, assessed by comparing the percentage of patients in each treatment group who received any RBC transfusion between study days 1 and 28. Secondary efficacy end points identified prospectively included cumulative RBC units transfused per patient through study day 28; cumulative mortality through study day 28; change in hemoglobin from baseline; and time to first transfusion or death.
Patients receiving rHuEPO were less likely to undergo transfusion (60.4% placebo vs 50.5% rHuEPO; P<.001; odds ratio, 0.67; 95% confidence interval CI, 0.54-0.83). There was a 19% reduction in the total units of RBCs transfused in the rHuEPO group (1963 units for placebo vs 1590 units for rHuEPO) and reduction in RBC units transfused per day alive (ratio of transfusion rates, 0.81; 95% CI, 0.79-0.83; P =.04). Increase in hemoglobin from baseline to study end was greater in the rHuEPO group (mean SD, 1.32 2 g/dL vs 0.94 1.9 g/dL; P<.001). Mortality (14% for rHuEPO and 15% for placebo) and adverse clinical events were not significantly different.
In critically ill patients, weekly administration of 40 000 units of rHuEPO reduces allogeneic RBC transfusion and increases hemoglobin. Further study is needed to determine whether this reduction in RBC transfusion results in improved clinical outcomes.
Objective
The objective of this study was to describe oral health literacy (OHL) among periodontal patients and to examine its association with periodontal health status.
Methods
This cross‐sectional ...study included new and referred patients presenting to the University of North Carolina Graduate Periodontology Clinic. Sociodemographic and dental history information were collected. OHL was measured using a dental word recognition instrument, Rapid Estimate of Adult Literacy‐30 (REALD‐30). Clinical periodontal examinations were completed.
Results
One hundred and twenty‐eight participants enrolled and 121 completed all study examinations and instruments. Despite a high level of education among participants in our study, low levels of OHL were found in one‐third (33 percent) of the study population. Thirty‐one percent had moderate OHL (score of 22‐25), 37 percent had high OHL (score ≥ 26). The mean REALD‐30 score was 23. Fifty‐three percent of participants had severe periodontitis, 29 percent had moderate periodontitis, and 18 percent had mild or no periodontitis. Bivariate analysis showed a significant association between OHL and periodontal status (P < 0.05). The effect of OHL on periodontal health status remained statistically significant (P < 0.002) even after controlling for smoking, race, and dental insurance.
Conclusion
Lower OHL was associated with more severe periodontal disease among new and referred patients presenting to the University of North Carolina Graduate Periodontology Clinics.
Neoepitopes are the only truly tumor-specific antigens. Although potential neoepitopes can be readily identified using genomics, the neoepitopes that mediate tumor rejection constitute a small ...minority, and there is little consensus on how to identify them. Here, for the first time, we use a combination of genomics, unbiased discovery MS immunopeptidomics and targeted MS to directly identify neoepitopes that elicit actual tumor rejection in mice. We report that MS-identified neoepitopes are an astonishingly rich source of tumor rejection mediating neoepitopes. MS has also demonstrated unambiguously the presentation by MHC I, of confirmed tumor rejection neoepitopes which bind weakly to MHC I; this was done using DCs exogenously loaded with long peptides containing the weakly binding neoepitopes. Such weakly MHC I-binding neoepitopes are routinely excluded from analysis, and our demonstration of their presentation, and their activity in tumor rejection, reveals a broader universe of tumor-rejection neoepitopes than presently imagined. Modeling studies show that a mutation in the active neoepitope alters its conformation such that its T cell receptor-facing surface is significantly altered, increasing its exposed hydrophobicity. No such changes are observed in the inactive neoepitope. These results broaden our understanding of antigen presentation and help prioritize neoepitopes for personalized cancer immunotherapy.
Laser-driven high-order harmonic generation1,2 provides spatially3 and temporally4 coherent tabletop sources of broadband extreme-ultraviolet (XUV) light. These sources typically operate at low ...repetition rates, frep ≲ 100 kHz, where phase-matched HHG is readily achieved5,6. However, many applications demand the improved counting statistics or frequency-comb precision afforded by high repetition rates, frep > 10 MHz. Unfortunately, at such high frep, phase matching is prevented by steady-state plasma accumulated in the generation volume7–11, strongly limiting the XUV average power. Here, we use high-temperature gas mixtures as the generation medium to increase the gas translational velocity, thereby reducing the steady-state plasma in the laser focus. This allows phase-matched XUV emission inside a femtosecond enhancement cavity at frep = 77 MHz, enabling a record generated power of ~ 2 mW in a single harmonic order. This power scaling opens up many demanding applications, including XUV frequency-comb spectroscopy12,13 of few-electron atoms and ions for precision tests of fundamental physical laws and constants14–20.
The development of hollow core photonic crystal fibers with low losses over a broad spectral region in the near IR enabled the demonstration of a novel laser type - Hollow-core Optical Fiber Gas ...Laser (HOFGLAS). The laser combines attractive features of fiber lasers such as compactness and long interaction length of pump and laser radiation with those of gas lasers such as the potential for high output power and narrow line width. This paper summarizes recent developments and describes the demonstration of C sub(2)H sub(2) and HCN prototype lasers. Avenues to extend laser emission further into the IR are discussed.
Children and adolescents in foster care include many of the most severely traumatized victims of child abuse and neglect. They deserve the best possible care and treatment, yet their outcomes remain ...poor. The persistence of poor outcomes for youth in foster care reflects challenges of psychiatric diagnostic formulation and of service system design/access, both areas in which child and adolescent psychiatrists have a key role to improve care and outcomes.
PDF
