Blood Infusion Research Articles

Hyperbaric oxygen therapy ameliorates acute brain injury after porcine intracerebral hemorrhage at high altitude.

IntroductionIntracerebral hemorrhage (ICH) at high altitude is not well understood to date. This study investigates the effects of high altitude on ICH, and examines the acute neuroprotection of hyperbaric oxygen (HBO) therapy against high-altitude ICH.MethodsMinipigs were placed in a hypobaric chamber for 72 h before the operation. ICH was induced by an infusion of autologous arterial blood (3 ml) into the right basal ganglia. Animals in the high-altitude ICH group received HBO therapy (2.5 ATA for 60 min) 30 min after ICH. Blood gas, blood glucose and brain tissue oxygen partial pressure (PbtO2) were monitored continuously for animals from all groups, as were microdialysis products including glucose, lactate, pyruvate and glutamate in perihematomal tissue from 3 to 12 h post-ICH.ResultsHigh-altitude ICH animals showed significantly lower PbtO2, higher lactate/pyruvate ratio (LPR) and glutamate levels than low-altitude ICH animals. More severe neurological deficits, brain edema and neuronal damage were also observed in high-altitude ICH. After HBO therapy, PbtO2 was significantly increased and LPR and glutamate levels were significantly decreased. Brain edema, neurological deficits and neuronal damage were also ameliorated.ConclusionsThe data suggested a more serious disturbance of tissue oxygenation and cerebral metabolism in the acute stage after ICH at high altitude. Early HBO treatment reduced acute brain injury, perhaps through a mechanism involving the amelioration of the derangement of cerebral oxygenation and metabolism following high-altitude ICH.

Intraoperative nursing cooperation for micro-surgical clipping of middle cerebral artery aneurysms

Objective To investigate the importance of nursing cooperation in the operation of middle cerebral artery aneurysm (MCAA) microsurgical clipping. Methods We retrospectively analyzed 202 cases (male 103 cases, female 99 cases) of MCAA patients who were underwent microsurgical clipping surgery (from January 1997 to December 2013), and the importance of nursing cooperation in the process were analyzed. A total of 242 aneurysms were found during surgery of 212 cases underwent craniotomy clipping, in which 215 cases were MCAA, and 2 cases underwent autologous dura wrapping, except one unbroken MCAA case was embolism. Results All patients in this group underwent Yasargil′s pterional trans-sylvian approach, 212 MCAA surgery were successfully clipped. 174 cases were clipped without rupture (81.3%), while rupture (18.7%) occurred in 40 patients during surgery. All patients had been treated with controlled hypotension and intracranial hypotension, through timely blood transfusion, infusion and other response measures to ensure the successful completion of surgery. Conclusions It can help will the operation completed smoothly and improve surgical effects by personalized utilizing of controlled hypotension, brain tissue relaxation techniques and other measures in microsurgical clipping of MCAA, as well as good nursing cooperation during the process of aneurysms rupture. Key words: Middle cerebral artery aneurysms; Microsurgical clipping; Intraoperative nursing

Autologous Bone Marrow Mononuclear Cells Exert Broad Effects on Short- and Long-Term Biological and Functional Outcomes in Rodents with Intracerebral Hemorrhage.

Autologous bone marrow-derived mononuclear cells (MNCs) are a potential therapy for ischemic stroke. However, the effect of MNCs in intracerebral hemorrhage (ICH) has not been fully studied. In this study, we investigated the effects of autologous MNCs in experimental ICH. ICH was induced by infusion of autologous blood into the left striatum in young and aged male Long Evans rats. Twenty-four hours after ICH, rats were randomized to receive an intravenous administration of autologous MNCs (1 × 10(7) cells/kg) or saline. We examined brain water content, various markers related to the integrity of the neurovascular unit and inflammation, neurological deficit, neuroregeneration, and brain atrophy. We found that MNC-treated young rats showed a reduction in the neurotrophil infiltration, the number of inducible nitric oxide synthase-positive cells, and the expression of inflammatory-related signalings such as the high-mobility group protein box-1, S100 calcium binding protein B, matrix metalloproteinase-9, and aquaporin 4. Ultimately, MNCs reduced brain edema in the perihematomal area compared with saline-treated animals at 3 days after ICH. Moreover, MNCs increased vessel density and migration of doublecortin-positive cells, improved motor functional recovery, spatial learning, and memory impairment, and reduced brain atrophy compared with saline-treated animals at 28 days after ICH. We also found that MNCs reduced brain edema and brain atrophy and improved spatial learning and memory in aged rats after ICH. We conclude that autologous MNCs can be safely harvested and intravenously reinfused in rodent ICH and may improve long-term structural and functional recovery after ICH. The results of this study may be applicable when considering future clinical trials testing MNCs for ICH.

Evaluation of hemolysis in microcatheter directed blood infusion at different flow rates for transarterial salvage reperfusion: In-vitro study.

Microcatheter directed blood reperfusion is an endovascular salvage option for acute cerebral artery occlusions. It has not been investigated whether this technique may be associated with hemolysis. Analysis of hemolysis during blood infusion through different microcatheters and infusion rates to assess related risks. Four microcatheters with different inner diameters were perfused with blood samples at three infusion rates. Hemolytic markers including lactate-dehydrogenase (LDH) and haptoglobin were analyzed. Samples before and after blood infusion were compared using Student's t-test. Flow-related degree of hemolysis was analyzed with regression analysis. Resulting shear stress was calculated and correlated with LDH and haptoglobin. Significant increase of LDH and decrease of haptoglobin was found after blood reperfusion through small microcatheters at progressive flow rates (p<0.05). No hemolysis was found with larger diameter microcatheters at all flow rates (p>0.05). Correlation between shear stress, LDH and haptoglobin was r=0.86 and r=0.75, respectively. Progressive hemolysis occurs during blood perfusion of small lumen microcatheters at increasing flow rates. This phenomenon may be related to turbulent flow, exposure time and increased shear stress. Larger microcatheters did not induce hemolysis and may be the preferred choice for stroke reperfusion.

Study on tubeless mini-percutaneous nephrolithotomy in treatment of the upper ureteral calculi

Objective To investigate the feasibility and clinical effect of the tubeless mini-percutaneous nephrolithotomy (PCNL) in treatment of upper ureteral calculi. Methods From March 2014 to March 2015, all the patients with upper ureteral calculi except for those with severe infection, pyonephrosis or renal cortex less than 5 mm were randomized into two groups, the standard PCNL group (24 F nephrostomy tube) and the mini-PCNL group (18 F nephrostomy tube). After PCNL, all the patients received ultrasound examination to check residual stones, perforation and urine leakage. DJ tube was placed and the channel of PCNL was packed with hemostatic sponge without nephrostomy tube. There were 26 patients in standard group and 28 in mini-group. The operation time, postoperative hemoglobin change, postoperative visual analogue pain score (VAS), the time when urine turned clean, postoperative urinary extravasation, hydrothorax, fever and the stone-free rate were compared between two groups. Particularly, these data were compared in those aged>65 years. Results The operation time in the standard PCNL and the mini-PCNL group was (58.3±21.8) and (86.4±23.3) minutes respectively, and had a significant difference (t=10.836, P 0.05). No significant difference were found between two groups (all P>0.05). There was one patient who got fever more than 38.5℃ in the standard group and 2 cases in the mini-group. Each group had 1 slight hydrothorax, and no blood infusion and perinephric urinary extravasation were found. The application of packing hemostatic sponge in the nephrostomy channel was feasible and suitable for both the standard and tubeless mini-PCNL groups. Conclusions The application of packing hemostatic sponge in the nephrostomy channel is feasible and suitable in both the standard and tubeless mini-PCNL. It is safe for the treatment of renal and ureteral calculi, and it can decrease the hemorrhage and urine leakage, which works for the elderly patients too. Key words: Percutaneous nephrolithotomy; Ureteral calculi

Assessment of bone marrow-derived Cellular Therapy in progressive Multiple Sclerosis (ACTiMuS): study protocol for a randomised controlled trial.

BackgroundWe have recently completed an evaluation of the safety and feasibility of intravenous delivery of autologous bone marrow in patients with progressive multiple sclerosis (MS). The possibility of repair was suggested by improvement in the neurophysiological secondary outcome measure seen in all participants. The current study will examine the efficacy of intravenous delivery of autologous marrow in progressive MS. Laboratory studies performed in parallel with the clinical trial will further investigate the biology of bone marrow-derived stem cell infusion in MS, including mechanisms underlying repair.Methods/designA prospective, randomised, double-blind, placebo-controlled, stepped wedge design will be employed at a single centre (Bristol, UK). Eighty patients with progressive MS will be recruited; 60 will have secondary progressive disease (SPMS) but a subset (n = 20) will have primary progressive disease (PPMS). Participants will be randomised to either early or late (1 year) intravenous infusion of autologous, unfractionated bone marrow. The placebo intervention is infusion of autologous blood. The primary outcome measure is global evoked potential derived from multimodal evoked potentials. Secondary outcome measures include adverse event reporting, clinical (EDSS and MSFC) and self-assessment (MSIS-29) rating scales, optical coherence tomography (OCT) as well as brain and spine MRI. Participants will be followed up for a further year following the final intervention. Outcomes will be analysed on an intention-to-treat basis.DiscussionAssessment of bone marrow-derived Cellular Therapy in progressive Multiple Sclerosis (ACTiMuS) is the first randomised, placebo-controlled trial of non-myeloablative autologous bone marrow-derived stem cell therapy in MS. It will determine whether bone marrow cell therapy can, as was suggested by the phase I safety study, improve conduction in multiple central nervous system pathways affected in progressive MS. Furthermore, laboratory studies performed in parallel with the clinical trial will inform our understanding of the cellular pharmacodynamics of bone marrow infusion in MS patients and the mechanisms underlying cell therapy.Trial RegistrationISRCTN27232902 Registration date 11/09/2012. NCT01815632 Registration date 19/03/2013

Repeated autologous umbilical cord blood infusions are feasible and had no acute safety issues in young babies with congenital hydrocephalus.

Babies with congenital hydrocephalus often experience developmental disabilities due to brain injury associated with prolonged increased pressure on the developing brain parenchyma. Umbilical cord blood (CB) infusion has favorable effects in animal models of brain hypoxia and stroke and is being investigated in clinical trials of brain injury in both children and adults. We sought to establish the safety and feasibility of repeated intravenous infusions of autologous CB in young babies with congenital hydrocephalus. Infants with severe congenital hydrocephalus and an available qualified autologous CB unit traveled to Duke for evaluation and CB infusion. When possible, the CB unit was utilized for multiple infusions. Patient and CB data were obtained at the time of infusion and analyzed retrospectively. From October 2006 to August 2014, 76 patients with congenital hydrocephalus received 143 autologous CB infusions. Most babies received repeated doses, for a total of two (n = 45), three (n = 18), or four (n = 4) infusions. There were no infusion-related adverse events. As expected, all babies experienced developmental delays. Cryopreserved CB products may be effectively manipulated to provide multiple CB doses. Repeated intravenous infusion of autologous CB is safe and feasible in young babies with congenital hydrocephalus.

Activation of Dopamine D2 Receptor Suppresses Neuroinflammation Through αB-Crystalline by Inhibition of NF-κB Nuclear Translocation in Experimental ICH Mice Model.

Inflammatory injury plays a critical role in intracerebral hemorrhage (ICH)-induced secondary brain injury. Recently, dopamine D2 receptor (DRD2) is identified as an important component controlling innate immunity and inflammatory response in central nervous system, and αB-crystallin (CRYAB) is a potent negative regulator on inflammatory pathways. Here, we sought to investigate the role of DRD2 on neuroinflammation after experimental ICH and the potential mechanism mediated by CRYAB. Two hundred and twenty-four (224) male CD-1 mice were subjected to intrastriatal infusion of bacterial collagenase or autologous blood. Two DRD2 agonists quinpirole and ropinirole were administrated by daily intraperitoneal injection starting at 1 hour after ICH. DRD2 and CRYAB in vivo knockdown was performed 48 hours before ICH insult. Behavioral deficits and brain water content, Western blots, immunofluorescence staining, coimmunoprecipitation (Co-IP) assay, and proteome cytokine array were evaluated. Endogenous DRD2 and CRYAB expressions were increased after ICH. DRD2 knockdown aggravated the neurobehavioral deficits and the pronounced cytokine expressions. DRD2 activation by quinpirole and ropinirole ameliorated neurological outcome, brain edema, interleukin-1β, and monocyte chemoattractant protein-1 expression, as well as microglia/macrophages activation, in the perihematomal region. These effects were abolished by pretreatment with CRYAB siRNAs. Quinpirole enhanced cytoplasmic binding activity between CRYAB and NF-κB and decreased nuclear NF-κB expression. Similar therapeutic benefits were observed using autologous blood injection model and intranasal delivery of quinpirole. DRD2 may have anti-inflammatory effects after ICH. DRD2 agonists inhibited neuroinflammation and attenuated brain injury after ICH, which is probably mediated by CRYAB and enhanced cytoplasmic binding activity with NF-κB.

Recombinant ADAMTS 13 Attenuates Brain Injury After Intracerebral Hemorrhage.

Inflammatory responses and blood-brain barrier (BBB) dysfunction play important roles in brain injury after intracerebral hemorrhage (ICH). The metalloprotease ADAMTS 13 (a disintegrin and metalloprotease with thrombospondin type I motif, member 13) was shown to limit inflammatory responses through its proteolytic effects on von Willebrand factor. In the present study, we addressed the role of ADAMTS 13 after experimental ICH. ICH was induced in mice by intracerebral infusion of autologous blood. The peri-hematomal inflammatory responses, levels of matrix metalloproteinase-9 and intercellular adhesion molecule-1, pericyte coverage on brain capillaries, and BBB permeability were quantified at 24 hours. Functional outcomes, cerebral edema, and hemorrhagic lesion volume were quantified at day 3. Treatment with recombinant ADAMTS 13 (rADAMTS 13) reduced the levels of chemokines and cytokines, myeloperoxidase activity, and microglia activation and neutrophil recruitment after ICH. rADAMTS 13 also decreased interleukin-6 expression in brain endothelial cells stimulated by lipopolysaccharide, whereas recombinant von Willebrand factor reversed this effect. The anti-inflammatory effect of rADAMTS 13 was accompanied by reduced expression of intercellular adhesion molecule-1 and less activation of matrix metalloproteinase, enhanced pericyte coverage of brain microvessels, and attenuated BBB disruption. Furthermore, neutrophil depletion protected against BBB damage, and rADAMTS 13 treatment had no further beneficial effect. Finally, treatment of mice with rADAMTS 13 reduced cerebral edema and hemorrhagic lesion volume and improved neurological functions. Our findings reveal the importance of rADAMTS 13 in regulating pathological inflammation and BBB function and suggest that rADAMTS 13 may provide a new therapeutic strategy for ICH.

Simultaneous determination of polyvinylchloride plasticizers di(2-ethylhexyl) phthalate and tri(2-ethylhexyl) trimellitate and its degradation products in blood by liquid chromatography-tandem mass spectrometry

Di(2-ethylhexyl) phthalate (DEHP) and tri(2-ethylhexyl) trimellitate (TEHTM or TOTM) are common plasticizers that are also largely used for PVC medical devices, e.g. bags and tubing for blood transfusions and infusions. The leachability of medical devices is a well-known situation of increasing toxicological concern. To assess the migration of plasticizers from PVC medical devices into human blood we developed and validated an analytical method for the determination of DEHP and TOTM in combination with the determination of their primary degradation products mono(2-ethylhexyl) phthalate (MEHP), 1,2-di(2-ethylhexyl) trimellitate (1,2-DEHTM) and 2-mono(2-ethylhexyl) trimellitate (2-MEHTM). The presented method involves liquid–liquid extraction of the analytes from the blood followed by the subsequent analytical separation and detection using LC–MS/MS analysis. The validation of the procedure showed a good precision in the range of 1.8 to 5.3%. Mean accuracy ranged from 86% for 1,2-DEHTM to 109% for MEHP. LOQ was found to be 2 to 5μg/L for each of the analytes. Additionally, the method is characterised by its wide linear range up to 2mg/L each for the degradation products of TOTM to 100mg/L for the parent plasticizer DEHP. The presented method promises to be of major advantage for further studies as it allows for the first time the simultaneous determination of DEHP and TOTM in human blood in combination with the analysis of their degradation products that render possible to investigate the leachability of a broad range of PVC medical devices in human blood using only one analytical method.

Measuring the influence of blood component infusion rate on recipient vital signs.

One of the challenges surrounding blood component administration is the determination of an appropriate rate of infusion. There are very few evidence-based guidelines available to guide healthcare providers looking for a 'standard' infusion rate for red blood cells (RBCs), plasma or platelets (PLTs). Our objective was to determine the extent to which blood component infusion rates were associated with changes in transfusion recipient vital signs. We retrospectively examined records of 3496 component infusions (RBCs, n = 2359; PLTs, n = 478; plasma, n = 659) over a 1-year period at a 362-bed multispecialty hospital. The following data were collected for each transfusion: blood product volume and infusion time, recipient pre- and post-transfusion temperature, blood pressure and pulse rate, and hospital ward where transfusion occurred. Plasma (median 10.4 ml/min) was infused faster than PLTs (median 7.2 ml/min, P < 0.0001) or RBCs (median 2.3 ml/min, P < 0.0001). For all blood components, infusion rates varied based on the hospital unit performing the infusion. No association was found between relatively fast RBC, plasma or PLT infusion rates (>20 ml/min) and clinically significant reported changes in vital signs. There does not appear to be a strong correlation between infusion rate and significant changes in recipient temperature, blood pressure or pulse rate. Based on these data, a reasonable rate for routine transfusion is 2-3 ml/min for RBCs and 7-10 ml/min for plasma and PLTs. Faster infusion rates (>20 ml/min) likely can be applied with close patient monitoring if there is a more urgent need for transfusion.

Dimethyl fumarate confers neuroprotection by casein kinase 2 phosphorylation of Nrf2 in murine intracerebral hemorrhage

Background and purposeEdema formation, inflammation and increased blood–brain barrier permeability contribute to poor outcomes after intracerebral hemorrhage (ICH). This study examined the therapeutic effect of dimethyl fumarate (DMF), a fumaric acid ester that activates nuclear factor erythroid-2 related factor 2 (Nrf2) and Nrf2 heterodimerization effector protein musculo-aponeurotic fibrosarcoma-G (MAFG) in a murine ICH model. MethodsMale CD-1 mice (n=176) were subjected to intrastriatal infusion of bacterial collagenase (n=126), autologous blood (n=18) or sham surgery (n=32). Four (4) animals not subjected to ICH (naive) were also included in the study. After ICH, animals either received vehicle, dimethyl fumarate (10mg or 100mg/kg) or casein kinase 2 inhibitor (E)-3-(2,3,4,5-tetrabromophenyl)acrylic acid (TBCA). Thirty-two mice also received scrambled siRNA or MAFG siRNA 24h before ICH. Brain water content and neurological function were evaluated. ResultsDimethyl fumarate reduced Evans blue dye extravasation, decreased brain water content, and improved neurological deficits at 24 and 72h after ICH. Casein kinase 2 inhibitor TBCA and MAFG siRNA prevented the effect of dimethyl fumarate on brain edema and neurological function. After ICH, ICAM-1 levels increased and casein kinase 2 levels decreased. Dimethyl fumarate reduced ICAM-1 but enhanced casein kinase 2 levels. Again, casein kinase 2 inhibitor TBCA and MAFG siRNA abolished the effect of dimethyl fumarate on ICAM-1 and casein kinase 2. Dimethyl fumarate preserved pNrf2 and MAFG expression in the nuclear lysate after ICH and the effect of dimethyl fumarate was abolished by casein kinase 2 inhibitor TBCA and MAFG siRNA. Dimethyl fumarate reduced microglia activation in peri-hematoma areas after ICH. The protective effect of dimethyl fumarate on brain edema and neurological function was also observed in a blood injection mouse model. ConclusionDimethyl fumarate ameliorated inflammation, reduced blood-brain barrier permeability, and improved neurological outcomes by casein kinase 2 and Nrf2 signaling pathways after experimental ICH in mice.

Curcumin attenuates brain edema in mice with intracerebral hemorrhage through inhibition of AQP4 and AQP9 expression.

Aquaporins (AQPs) are the water-channels that play important roles in brain water homeostasis and in cerebral edema induced by brain injury. In this study we investigated the relationship between AQPs and a neuroprotective agent curcumin that was effective in the treatment of brain edema in mice with intracerebral hemorrhage (ICH). ICH was induced in mice by autologous blood infusion. The mice immediately received curcumin (75, 150, 300 mg/kg, ip). The Rotarod test scores, brain water content and brain expression of AQPs were measured post ICH. Cultured primary mouse astrocytes were used for in vitro experiments. The expression of AQP1, AQP4 and AQP9 and NF-κB p65 were detected using Western blotting or immunochemistry staining. Curcumin administration dose-dependently reduced the cerebral edema at d 3 post ICH, and significantly attenuated the neurological deficits at d 5 post ICH. Furthermore, curcumin dose-dependently decreased the gene and protein expression of AQP4 and AQP9, but not AQP1 post ICH. Treatment of the cultured astrocytes with Fe(2+) (10-100 μmol/L) dose-dependently increased the expression and nuclear translocation of NF-κB p65 and the expression of AQP4 and AQP9, which were partly blocked by co-treatment with curcumin (20 μmol/L) or the NF-κB inhibitor PDTC (10 μmol/L). Curcumin effectively attenuates brain edema in mice with ICH through inhibition of the NF-κB pathway and subsequently the expression of AQP4 and AQP9. Curcumin may serve as a potential therapeutic agent for ICH.

Serum and urinary biomarkers for predicting acute kidney injury after partial nephrectomy.

The purpose of this study was to evaluate the ability of specific biomarkers to predict acute kidney injury (AKI) after partial nephrectomy. A prospective study of 89 patients undergoing partial nephrectomy was conducted in the First Affiliated Hospital of Fujian Medical University. The patients were divided into two groups according to AKI status: an AKI group and non-AKI group. Receiver operator characteristic (ROC) curves were generated and the areas under the curve (AUCs) were compared. Twenty-eight subjects (31.5%) developed AKI while sixty-one subjects (68.5%) did not. Vascular clamping time in the AKI group was longer than that in the non-AKI group (29 ± 17 min vs. 24 ± 9 min, P = 0.042). Eight patients (28.6%) received blood infusion in the AKI group compared with five patients (8.2%) in the non-AKI group (P = 0.021). The area under ROC curve for AKI prediction was 0.792 [95% confidence interval (CI) 0.697 to 0.888, P < 0.000] for serum cystatin C 24 hours after surgery and 0.756 (95% CI 0.656 to 0.857, P < 0.000) for serum cystatin C 48 hours after surgery. Multivariate regression analysis showed transfusion [Hazard ratio (HR) 3.712, P = 0.044] and 24 hours serum cystatin C (HR 41.594, P = 0.001) correlated with AKI. Postoperative serum cystatin C may be an early predictor for AKI after partial nephrectomy. Transfusion may be an independent risk factor for AKI after partial nephrectomy.

Effects of ulinastatin on hemorrhagic shock and resuscitation-induced acute lung injury in rats

Objective To evaluate the effects of ulinastatin on hemorrhagic shock and resuscitation (HS/R) -induced acute lung injury in rats. Methods Fifteen SPF adult Sprague-Dawley rats, aged 2-3 months, weighing 300-400 g, were divided into 3 groups (n=5 each) using a random number table: sham operation group (group S) , HS/R group and ulinastatin group (group U) . Carotid arteries were cannulated for blood pressure monitoring and blood-letting.HS/R was induced by blood-letting and maintained for 1 h, followed by resuscitation with autologous blood transfusion and infusion of normal saline.After cannulation of carotid arteries (T0) , at 5 min after hemorrhagic shock (T1) , before resuscitation (T2) , at 5 min after the expected blood pressure was achieved following resuscitation (T3) , and at 30 min, 1.5 h and 2.5 h after resuscitation (T4-6) , arterial blood samples were collected for determination of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations (by enzyme-linked immunosorbent assay) . Arterial blood samples were collected at T0, T2 and T6 for blood gas analysis.The pH value, partial pressure of arterial carbon dioxide (PaCO2) , and base excess (BE) value were recorded, and oxygenation index (PaO2/FiO2) was calculated.Lungs were removed at T6, and pulmonary specimens were obtained for examination of pathological changes which were scored, and nucleus was extracted for determination of nuclear factor-kappa B (NF-κB) p65 expression by enzyme-linked immunosorbent assay. Results Compared with group S, the pH values, , BE values and OI were significantly decreased, and PaCO2, plasma IL-6 and TNF-α concentrations, expression of NF-κB p65 in lung tissues, and pathological scores were increased in U and HS/R groups.Compared with group HS/R, the plasma concentrations of IL-6 and TNF-α, expression of NF-κB p65 in lung tissues, and pathological scores were significantly decreased, and no significant changes were found in parameters of blood gas analysis in group U. Conclusion Although ulinastatin can alleviate HS/R-induced acute lung injury, it is insufficient to improve lung oxygenation in rats. Key words: Trypsin inhibitors; Shock, hemorrhagic; Cardiopulmonary resuscitation; Respiratory distress syndrome, adult

Cause analysis and preventive measures for blood sample errors

Objective To study the reason and preventive measures of inconformity of the extraction appeared in the process of transfusion blood specimens with the patient's blood type. Methods The reasons of transfusion errors why extracting required blood type was not consistent with the patient's blood type examplesa in Zhengzhou transfusion of hospital from 2008 to 2012 were retrospectively analyzed. Results The experimental results showed that blood specimen inconformity was 49.60%, the error rate of blood extraction and blood infusion was 31.20%, infusion error only was 15.20%, blood type change after stem cell transfusion was 4.00%. Reasons of blood type change after stem cell transplantation to extract blood samples mainly included the blood center or blood did not accord with logo type blood stations provided(16.13%), blood use application form to fill in error(20.97%), check the wrong blood type (6.45%),blood samples taken(29.03%), the blood sample tag(27.42%). Conclusion In order to ensure the safety for clinical use must adopt measures to prevent resolutely put an end to a blood transfusion errors. Key words: Blood sample errors; Blood transfusions; Bloodtype

Novel Method for Investigating Impaired Blood Pressure Regulation Following Subarachnoid Hemorrhage in Conscious Rats

Despite 30,000 annual incidences in the US, treatment for subarachnoid hemorrhage (SAH) is limited. Several negative outcomes associated with SAH lead to high morbidity and mortality, including disrupted cardiac function and blood pressure (BP) regulation. Intervention during the acute phase of SAH is most crucial for longterm outcome; however, the mechanisms of cardiovascular dysfunction are unclear, as are the optimal methods to restore normal function. Current in vivo models are not suited to study the acute phase of SAH due to autonomic suppression by anesthesia. Therefore, we developed a novel model system to study acute and chronic cardiovascular effects of SAH in conscious animals. Rats are outfitted with radiotelemetry transmitters (DSI) for BP and heart rate (HR) recording. Guide cannulas are implanted to target the lateral ventricle and cisterna magna (CM) for intracranial pressure (ICP) recording and blood infusion, respectively. Following post-op recovery, baseline BP and HR are measured for one week, and on testing day 0.4 ml of arterial blood from a donor rat is infused directly into the CM. ICP and BP are recorded continuously for 2 hours following SAH via DSI calibrated output adapter and Powerlab 8.0 software (ADInstruments). BP is then recorded for 4 more weeks using telemetry. During blood infusion ICP rises by ~70-100 mmHg, BP increases ~30 mmHg and HR increases ~130 bpm. SAH rats then exhibit a sustained 15 mmHg increase in BP for 7 days. Control rats infused with saline exhibit similar acute changes but no longterm rise in BP. This model system will enable better testing of therapeutic strategies to improve cardiovascular control and longterm outcome following SAH. Supported by University of Vermont startup funds.

Intrarenal Blockade of Angiotensin II AT1 Receptor Abolishes Renal Cortical Hypoxia in Salt Restricted Animals

Low salt (LS) diet results in activation of the renin‐angiotensin system (RAS) to maintain volemia and arterial blood pressure. We hypothesized that LS‐induced RAS activation increases Na+ transport in the kidney contributing to hypoxia also in the otherwise healthy kidney since renal blood flow (RBF) is not under metabolic control.Male Sprague Dawley rats were fed normal (NS, 0.4%) or low (LS, 0.01%) salt diet during two weeks. Thereafter, catheters were placed in the carotid artery and femoral vein for blood pressure measurement and infusion of saline containing 3H‐inulin, respectively, in anesthetized (thiobutabarbital) animals. The left kidney was immobilized and a catheter was placed in the renal artery. Measurements were obtained during a baseline and after infusion of the angiotensin II AT1‐receptor blocker candesartan (4.2 µg/kg) directly into the renal artery. Oxygen consumption (QO2) was estimated from the arterio‐venous difference in O2 content multiplied by RBF (Transonic flow probe). Renal cortical and medullary partial pressures of oxygen (PO2) were measured using Clark‐type electrodes. Mean arterial blood pressure, glomerular filtration rate and RBF were similar in both groups. The LS rats had less efficient Na+ transport along with higher QO2 compared to NS. LS reduced cortical PO2 whereas medullary PO2 was increased compared to NS. Importantly, acute AT1‐receptor inhibition by candesartan normalized cortical PO2 and restored the cortico‐medullary oxygen gradient in the animal receiving LS.These results indicate that LS‐induced cortical hypoxia is associated with angiotensin II AT1 receptor activation, which induces hypoxia in the kidney cortex.

Effects of bronchoscopic lung volume reduction using transbronchial infusion of autologous blood and thrombin in patients with severe chronic obstructive pulmonary disease.

Existing medical treatments have limitations in the management of very severe chronic obstructive pulmonary disease (COPD). We performed bronchoscopic lung volume reduction (BLVR) using transbronchial infusion of autologous blood and thrombin (BLVR with blood) in three patients with very severe COPD whose dyspnea could not be relieved by maximum medical management. Two patients underwent BLVR with blood in the left and right lungs at intervals of a half-year or a year, and one patient underwent this procedure in only the right lung. We assessed the changes in pulmonary function, exercise capacity and quality of life before and after BLVR with blood in a total of five procedures. The subjects were 58- to 74-year-old males. Their forced expiratory volume in one second (FEV1) percent predicted ranged from 14.8% to 23.4%. BLVR with blood achieved significant improvements as follows (values before → after the procedure, mean ± standard deviation): FEV1 0.45r the L → 0.76r the L (P=0.004), inspiratory capacity 1.50cityo L → 2.05±.05c L (P=0.015), 3-minute walk test 46.8nuteo m → 89.6±34.5 m (P=0.004). Lung function peaked several months after BLVR with blood and returned to nearly the baseline level in 6 months, but exercise capacity was better than that at baseline for at least 12 months. St. George's Respiratory Questionnaire (SGRQ), measured in two patients before and 12 months after the procedure, showed remarkable improvements (-15.6 and -11.9 units). BLVR with blood is an effective palliative treatment for very severe COPD.

IJIREEICE - Electrical, Electronics, Instrumentation and Control

In this new era of machines replacing human, the latter are prone to various kinds of health hazards. This has a direct relevance to the health of a human being and functioning of the heart. Thus, it is of utmost importance to check and maintain the pulse rate under control. This has been achieved by obtaining the heart rate using a PPG (Photo- plethysmography) sensor called TCRT 1000. This paper primarily intends to observe pulse rate using NI myRIO and display the pulse rate graphically using LabVIEW programming. Abiding to the principles of photo-plethysmograph technique, this paper provides a solution to the acquire real time signal from the fingertip of the human. The finger tips are highly receptive and responsive to blood infusions. For every systolic and diastolic pulse changes in the heart, there is a continuous inflow and outflow of blood in the finger tip. The real time signal that has been obtained from the sensor is sent to the virtual environment using the analog input port of NI myRIO. This paper helps in obtaining the output of sensor in digital and graphical format.