Changes In Hematocrit Research Articles

Comparative study between the roles of intrauterine misoprostol versus the sublingual route for prevention of postpartum blood loss in elective cesarean sections: a randomized controlled trial

BackgroundThe prostaglandin E1 analog “misoprostol” is a drug that has powerful ecbolic effects and can be beneficial in the prevention and treatment of postpartum hemorrhage, which is the leading cause of maternal mortality worldwide.ObjectivesTo assess the value of adding intrauterine misoprostol together with intravenous oxytocin injection compared with sublingual misoprostol together with intravenous oxytocin injection during elective cesarean section to reduce blood loss intraoperatively and prevent postpartum hemorrhage.MethodsA total of 192 pregnant women were counseled and recruited from the labor and delivery unit at Kasr Al Aini Hospital, Cairo University, and equally randomized into two groups. Group (A) included 96 women who received intrauterine misoprostol (400 mg) + oxytocin. Group (B) included 96 women who received sublingual misoprostol (400 mg) + oxytocin. The primary outcome of our study was estimation of the amount of blood loss during and after cesarean delivery. The secondary outcomes were the incidence of PPH within the first 6 h after labor, the need for blood transfusion, the need for any supplementary ecbolic drugs, the need for additional surgical intervention for PPH, changes in hematocrit and hemoglobin in both groups after delivery, and the incidence of side effects of the study medications.ResultsWe observed a significant discrepancy between the two groups in terms of postoperative Hb and Hct, postoperative differences (pre- and post-Hb and post-Hct) and EBL favoring the intrauterine group. However, no significant difference was observed between the groups with respect to excessive blood loss > 1000 ml in the 1st six hours, the need for supplementary ecbolics, the necessity for blood or blood prod, the need for additional surgical intervention (for PPH) or side effects.ConclusionIntrauterine misoprostol combined with oxytocin intravenous infusion is more effective than sublingual misoprostol combined with oxytocin intravenous infusion in lowering intraoperative blood loss and preventing postpartum hemorrhage in elective cesarean section.Trial registrationThis trial was retrospectively registered with the ClinicalTrials.gov Registry on 12-April-2024 (registration number: NCT06364098).

Hematocrits of red blood cell units increase during storage due to changes in mean corpuscular volume, impacting outcomes of red cell exchange procedures

Abstract Introduction Hematocrits of red blood cell (RBC) units are generally not measured by blood centers or transfusion services. Red blood cell exchange (RCE) is commonly used to treat sickle cell disease, and a key parameter needed in RCE is the average hematocrit of RBC units. However, there is no consensus on the average hematocrit to use or how it is affected by storage. The goal of our study is to determine the average hematocrit of RBC units by measuring hematologic parameters RBC units during storage and performing statistical modeling of hematocrit changes over time. Methods We sampled aliquots of leukoreduced RBC units in AS-1 (n=10) using the Terumo TSCD-II Sterile Tubing Welder to sterilely collect ~15mL of RBCs in transfer-pack containers. Aliquots were collected weekly from Day 7 to Day 42 of storage. Complete blood counts were performed using the Sysmex XN-3100 Hematology Analyzer. We statistically modeled changes in RBC units during storage by utilizing Bayesian multilevel linear regression models, allowing for capturing effects at the individual RBC-unit level. Posterior distributions of model parameters were estimated and processed using Stan and the rethinking and rstan packages in R. Posterior distributions are summarized with posterior means and 95%-credible intervals in parentheses. Model selection was done by calculating Akaike weights using the widely applicable information criterion (WAIC) to signify statistical support for each model. Results Multilevel linear regression models of hematologic parameters as a function of storage time were developed. Hematocrits increased with a posterior mean of 1.4% (0.98–1.75%) per week of storage, with posterior mean hematocrits of: 61.9% (60.2–63.6%) on Day 7, 63.9% (61.5–66.4%) on Day 21, and 66.0% (62.8–69.7%) on Day 42. These results indicate that a single average cannot be used for RBC units since hematocrits dramatically increase during storage. Mean corpuscular volume (MCV) increased with a posterior mean of 2.31 fL (1.4–3.71) per week whereas hemoglobin remained stable with a posterior mean increase of 0.008 g/dL (-0.016–0.031) per week. Using these results, we subsequently developed a multilevel regression model of hematocrit as a function of MCV. The model using MCV (WAIC=100.2, weight=100%) was favored over the model using time (WAIC=120.0, weight=0%), suggesting that changes in MCV are driving the increasing hematocrits. Conclusion Our study is the first to leverage Bayesian statistics to carefully quantify the average hematocrits of RBC units during storage time and to demonstrate that increasing hematocrits are caused by changes in MCV. These results indicate that transfusion protocols must consider the age of RBC units for RCE calculations, and provisions (e.g., requiring use of fresh units for RCE) may help minimize the variability in post-exchange testing. Moreover, our findings suggest that transfusion services should regularly measure hematocrits of RBC units in their inventory.

Sodium and Hematocrit Levels' Correlation and Clinical Impacts in Jordanian Hemodialysis Patients.

Given cofounders, this retrospective study investigates the correlation between hyponatremia status and hematocrit (Hct) changes, as well as the clinical utility of these two prognosticators in relation to overall health status. The study was retrospectively conducted on adult hemodialysis (HD) patients at the King Hussein Medical Center in Amman, Jordan, from 2015 to 2022. It looked at how sodium (Na) levels, the hematocrit-to-hemoglobin ratio (HHR), and outcomes of interest were related. The study examined acute myocardial infarction, stroke, refractory hypertension, dialysis graft thrombosis, and all-cause mortality as the composite outcomes of interest (cOI). We conducted a series of receiver operating characteristics, binary logistic regression (BLgR), and sensitivity analyses between each tested prognosticator and the cOI. We constructed and illustrated a multiple logistic regression(MLgR) model to investigate the adjusted association of each prognosticator against the tested composite outcome probability. The majority of HD patients were hemolyzed for a period of four to seven years. The constructed binary regressionmodeling for each prognosticator was [e (109.36 - 0.849 × Na)/[1 + e (109.36 - 0.849 × Na)] and [e (16.033 - 6.388 × HHR)/[1 + e (16.033 - 6.388×HHR)], with a 35.57% probability of cOI at the optimal Na of 129.51 mEq/l and a 42.8% at optimal HHR of 2.555:1. When the length of hemodialysis (LOD) was introduced into theMLgRmodeling all the investigated independent variables were significant except the HHR (p-value = 0.908). A higher LOD, lower Na, and lower HHR all support a positive cOI probability status. Regular inspection of Na and HHR and ensuring their closet to their optimal thresholds are mandatory to mitigate the risk of higher cOI probability.

Iron supplementation post-blood donation in Vietnam: Impact on hemoglobin, red cell indices, and iron reserves

Background. Regular blood donation plays a pivotal role in mitigating the formation of free radicals by regulating iron accumulation. However, frequent blood donation can lead to chronic iron deficiency. In this study, we aimed to evaluate the effectiveness of daily iron supplementation as an intervention to expedite hemoglobin (Hb) recovery among frequent blood donors at a hospital in Vietnam. Methodology. Conducted longitudinally within the Hematology Department of a Hanoi hospital from February to July 2023, our study involved 104 eligible participants. They received a daily iron supplement comprising 100 mg of elemental iron, 0.75 mg of folic acid, and 5 mg of zinc sulfate for a minimum of 8 weeks. Blood samples were collected at three key time points: before blood donation during recruitment, immediately after donation, and at least 8 weeks post-donation. Results. Our findings revealed moderate, statistically significant positive correlations between elemental iron administration and changes in platelet count (PLT), hematocrit (HCT), and mean corpuscular hemoglobin (MCH) (r = 0.753, p <0.001; r = 0.887, p <0.001; and r = 0.703, p <0.001, respectively). Additionally, weak but significant correlations were observed between elemental iron administration and red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width coefficient of variation (RDWC), and red cell distribution width standard deviation (RDWS) (r = 0.260, p = 0.002; r = 0.302, p = 0.005; r = 0.160, p = 0.010; r = 0.120, p = 0.020; and r = 0.400, p <0.001, respectively). Conclusion. Over an eight-week duration, the regimen of daily iron supplementation yielded significant improvements in both red cell variables, red cell indices, and iron study variables, demonstrating its potential clinical impact.

Second-Line Uterotonics for Uterine Atony: A Randomized Controlled Trial.

To evaluate the comparative efficacy of two of the most commonly used second-line uterotonics-methylergonovine maleate and carboprost tromethamine. We conducted a double-blind randomized trial at two large academic perinatal centers in patients undergoing nonemergency cesarean delivery with uterine atony refractory to oxytocin, as diagnosed by the operating obstetrician. The intervention included administration of a single dose of intramuscular methylergonovine or carboprost intraoperatively at diagnosis. The primary outcome, uterine tone on a 0-10 numeric rating scale 10 minutes after study drug administration, was rated by operating obstetricians blinded to the drug administered. Secondary outcomes included uterine tone score at 5 minutes, administration of additional uterotonic agents, other interventions for uterine atony or hemorrhage, quantitative blood loss, urine output, postpartum change in serum hematocrit, transfusion, length of hospital stay, adverse drug or transfusion reactions, and postpartum hemorrhage complications. A sample size of 50 participants per group was planned to detect a 1-point difference (with estimated within-group SD of 1.5) in the mean primary outcome with 80% power at a two-sided α level of 0.05 while accounting for potential protocol violations. A total of 1,040 participants were enrolled, with 100 randomized to receive one of the study interventions. Mean±SD 10-minute uterine tone scores were 7.3±1.7 after methylergonovine and 7.6±2.1 after carboprost, with an adjusted difference in means of -0.1 (95% CI, -0.8 to 0.6, P=.76). Additional second-line uterotonics were required in 30.0% of the methylergonovine arm and 34.0% in the carboprost arm (adjusted odds ratio 0.72, 95% CI, 0.27-1.89, P=.505), and geometric mean quantitative blood loss was 756 mL (95% CI, 636-898) and 708 mL (95% CI, 619-810) (adjusted ratio of geometric means 1.06, 95% CI, 0.86-1.31, P=.588), respectively. No differences were detected in the occurrence of other interventions for uterine atony or postpartum hemorrhage. No difference was detected in uterine tone scores 10 minutes after administration of either methylergonovine or carboprost for refractory uterine atony, indicating that either agent is acceptable. ClinicalTrials.gov, NCT03584854.

Acute Effects of Breath-Hold Conditions on Aerobic Fitness in Elite Rugby Players.

The effects of face immersion and concurrent exercise on the diving reflex evoked by breath-hold (BH) differ, yet little is known about the combined effects of different BH conditions on aerobic fitness in elite athletes. This study aimed to assess the acute effects of various BH conditions on 18 male elite rugby players (age: 23.5 ± 1.8 years; height: 183.3 ± 3.4 cm; body mass: 84.8 ± 8.5 kg) and identify the BH condition eliciting the greatest aerobic fitness activation. Participants underwent five warm-up conditions: baseline regular breathing, dynamic dry BH (DD), static dry BH (SD), wet dynamic BH (WD), and wet static BH (WS). Significant differences (p < 0.05) were found in red blood cells (RBCs), red blood cell volume (RGB), and hematocrit (HCT) pre- and post-warm-up. Peak oxygen uptake (VO2peak) and relative oxygen uptake (VO2/kgpeak) varied significantly across conditions, with BH groups showing notably higher values than the regular breathing group (p < 0.05). Interaction effects of facial immersion and movement conditions were significant for VO2peak, VO2/kgpeak, and the cardiopulmonary optimal point (p < 0.05). Specifically, VO2peak and peak stroke volume (SVpeak) were significantly higher in the DD group compared to that in other conditions. Increases in VO2peak were strongly correlated with changes in RBCs and HCT induced by DD warm-up (r∆RBC = 0.84, r∆HCT = 0.77, p < 0.01). In conclusion, DD BH warm-up appears to optimize subsequent aerobic performance in elite athletes.

Early-phase factors associated with pediatric severe dengue in the Thai–Myanmar cross-border region

BackgroundDengue disease is caused by dengue virus, which is transmitted by Aedes mosquitoes in tropical and subtropical regions worldwide. Although most infected individuals have benign febrile illness or no apparent symptoms, a small percentage develop severe dengue, a potentially fatal condition that occurs after a febrile stage. Many studies have identified factors predicting dengue severity among different populations and time courses. To help find practical approaches applicable in remote settings, we focused on the investigation of early factors associated with severe dengue in Thai–Myanmar cross-border region.MethodsThis retrospective case-control study was performed to determine factors contributing to severe dengue in the pediatric population. We reviewed the hospital records of patients with dengue infection aged 0–19 years who were admitted to Maesot General Hospital, situated near the Thai–Myanmar cross-border region, between 2017 and 2022. Medical data during the first 5 days of illness and outcomes were collected and analyzed.ResultsThis study included 144 patients with a serologically confirmed diagnosis of dengue infection, with 43 severe and 101 non-severe cases. Among biological factors, being an infant and belonging to an ethnic group in Myanmar showed a significant association with severe dengue in the univariable analysis. Multivariable logistic regression revealed that the presence of mucosal bleeding (adjusted OR 5.39, 95% CI 1.06–27.52, P = 0.043), a change in hematocrit ≥ 10% (adjusted OR 3.68, 95% CI 1.15–11.74, P = 0.028), and serum albumin < 35 g/L (adjusted OR 8.10, 95% CI 2.55–25.72, P < 0.001) during the first 5 days of illness were significantly associated with developing severe dengue.ConclusionsThis study supports the use of certain WHO warning signs and hematocrit change during febrile phase to predict pediatric severe dengue in low-resource settings. Potential factors such as very young age and ethnic groups warrant further exploration to identify risks contributing to severe dengue infection.

Acute effects of apnea bouts on hemoglobin concentration and hematocrit: a systematic review and meta-analysis.

ABSTRACT López-Rebenaque O, Solís-Ferrer, Fierro-Marrero J, Asís-Fernández F. Acute effects of apnea bouts on hemoglobin concentration and hematocrit: a systematic review and meta-analysis. Undersea Hyperb Med. 2024 Second Quarter; 51(2):173-184. Objective: This study aimed to systematically analyze the existing literature and conduct a meta-analysis on the acute effects of apnea on the hematological response by assessing changes in hemoglobin (Hb) concentration and hematocrit (Hct) values. Methods: Searches in Pubmed, The Cochrane Library, and Web of Science were carried out for studies in which the main intervention was voluntary hypoventilation, and Hb and Hct values were measured. Risk of bias and quality assessments were performed. Results: Nine studies with data from 160 participants were included, involving both subjects experienced in breath-hold sports and physically active subjects unrelated to breath-holding activities. The GRADE scale showed a “high” confidence for Hb concentration, with a mean absolute effect of 0.57 g/dL over control interventions. “Moderate” confidence appeared for Hct, where the mean absolute effect was 2.45% higher over control interventions. Hb concentration increased to a greater extent in the apnea group compared to the control group (MD = 0.57 g/dL [95% CI 0.28, 0.86], Z = 3.81, p = 0.0001) as occurred with Hct (MD = 2.45% [95% CI 0.98, 3.93], Z = 3.26, p = 0.001). Conclusions: Apnea bouts lead to a significant increase in the concentration of Hb and Hct with a high and moderate quality of evidence, respectively. Further trials on apnea and its application to different settings are needed.

Conversion Total Hip Arthroplasty After Pedicled Peri-Hip Bone Flap Grafting: The Chinese Experience

BackgroundThis study investigated the perioperative outcomes of patients undergoing conversion total hip arthroplasty (THA) after failed peri-hip bone flap grafting (PBFG) and compared them with those patients undergoing primary THA for osteonecrosis of the femoral head (ONFH). MethodsFrom January 2010 to December 2021, 163 Chinese patients (163 hips) were treated by conversion THA after failed PBFG (containing 94 patients who had pedicled vascularized iliac bone flap grafting and 69 patients who had pedicled vascularized greater trochanter bone flap grafting), and 178 Chinese patients were treated by primary THA. The preoperative baseline data and perioperative indicators in both groups were compared. ResultsIn the conversion group, patients had significantly greater blood loss, a longer length of stay, and greater changes in serum hemoglobin than those in the primary THA group (P < 0.05). The operative room time, transfusion volume, calculated blood loss, changes in serum hematocrit, and increased superficial infection (P > 0.05) in the conversion group were greater compared with the primary cohort; however, the difference was not statistically significant. The mean postoperative Harris Hip Scoring system (HHS) of the PBFG group at the 1-month follow-up was 81, and the control group had a score of 82. Importantly, subgroup analysis of the PBFG group indicated that there was no significant difference between patients who had prior pedicled vascularized iliac bone flap grafting and pedicled vascularized greater trochanter bone flap grafting (P > 0.05), except for the operative room time (P = 0.032). ConclusionsHip-sparing surgery of ONFH did not make THA more difficult or lead to more perioperative complications, but increased blood loss and extended hospital stay from a prior PBFG are still notable problems in clinical practice. Thus, it is necessary for surgeons to focus attention on the improvement of the preoperative condition and prepare for any specific intraoperative challenges.

The necessity of suction drainage when intra-articular injection of tranexamic acid is used during primary total knee arthroplasty: a retrospective study

BackgroundSuction drainages are commonly used after total knee arthroplasty (TKA) procedures; however, their use is somewhat controversial. Recently, some reports have claimed that the administration of tranexamic acid (TXA) may prevent postoperative bleeding following TKAs. Although numerous studies have reported regarding different dosages, timings of administration, or drain clamping times for intravenous and intra-articular TXA injections (IA-TXAs), few have examined whether suction drainage is necessary when TXA is administered. In this study, we compared using suction drainage without TXA administration and IA-TXA without suction drainage and aimed to examine the need for suction drainage during IA-TXA.MethodsThis retrospective study was conducted on 217 patients who had received TKA for osteoarthritis; 104 were placed on suction drainage after TKA without TXA (Group A), whereas the remaining 113 received IA-TXA immediately after surgery without suction drainage (Group B). Our clinical evaluation included assessments of the need for transfusion, presence of postoperative complications, incidence of deep vein thrombosis (DVT), and changes in hemoglobin (Hb), hematocrit (Hct), and D-dimer levels.ResultsNo significant differences were observed in terms of postoperative complications and preoperative Hb, Hct, or D-dimer levels between the two groups. Although the prevalence of DVT was significantly higher in Group B (p < 0.05), all cases were asymptomatic. Hb and Hct levels were significantly lower in Group A than in Group B at 1, 3, 7, and 14 days postoperatively (p < 0.05), although none of the cases required blood transfusions. D-dimer levels were significantly higher in Group A than in Group B at 1 and 3 days postoperatively (p < 0.05).ConclusionSuction drainage might not be necessary when IA-TXA is administered after TKA procedures.

926-P: Early Sodium–Glucose Cotransporter 2 Inhibitors–Induced Change in Haematocrit as a Predictor of Mortality and Cardiovascular Risk—A Real-World Study

926-P: Early Sodium–Glucose Cotransporter 2 Inhibitors–Induced Change in Haematocrit as a Predictor of Mortality and Cardiovascular Risk—A Real-World Study

#1806 Cycling is safe – effect of intradialytic cycle ergometry on cerebral oxygenation and cognitive function – a pilot study

Abstract Background and Aims Patients on chronic hemodialysis benefit from intradialytic exercise with improvements in endurance, muscle strength and health-related quality of life. It is not known whether the increased oxygen demand during intradialytic exercise negatively affects cerebral oxygenation and cerebral function. The aim of the study was to assess the risk of cerebral undersupply by measuring cerebral oxygenation, perfusion and cognitive function during and after intradialytic ergometer training. Method Twelve patience on maintenance hemodialysis (HD) trice weekly were included in the study. In an initial ramp test, using bed cycle ergometer, we first determined the maximum physical strength (Pmax) at the level of exhaustion (HD A). Then, one hour after start of a second HD (HD B), patients performed 40%, 50% and 60% of Pmax for 6 min. Pulmonary function tests, blood volume (BVM), cardiac output (by electrical cardiometry), regional cerebral oxygen saturation (rSO2) (by near-infrared spectroscopy) and cerebral blood flow (CBF, by Doppler sonography) were measured. The relative changes in rSO2, CBF and hematocrit were used to calculate cerebral oxygen supply (DO2). Cognitive tests (Stroop, Trail Making and Mini Addenbrookes Cognitive Examination Test) were performed before and after HD sessions with and, as controls, without ergometry (HD-C). Results Median age was 68 (42-85) years, 9/12 were male, complete data set was obtained in 10 patients. During step test exercise (HD B), at the highest exercise level (according to Borg (1-10) 6.75 ± 2.9), rSO2 increased (+6 ± 9%, p=0.034) without a significant change in CBF. In the meantime, relative blood volume decreased during ergometry (-5.8 ± 2.73%; p=0.002), causing a temporary increase of hematocrit. Despite a small decrease in CBF in 3 patients, the mean change of rSO2, CBF and hematocrit always had a positive trend in all patients, as a surrogate of stable cerebral oxygen supply (Table 1). In comparative cognitive tests (B vs. C), we observed no significant changes in cognitive functions. Conclusion In this pilot study, intradialytic bed-cycle ergometry during the first hour of HD for &amp;lt;20 min at 40-60% of patients’ individual maximum intensity had no negative effects on cerebral oxygenation and function. Specific studies testing the safety intradialytic exercise with different conditions, such as increasing intensity or duration, are needed.

Efficacy of recombinant erythropoietin for the late treatment of anemia of prematurity in a level IV neonatal intensive care unit: a retrospective single-center cohort study.

To describe the population to which we administered recombinant erythropoietin and to determine the effectiveness of this treatment as quantified by the change in hematocrit. This retrospective chart review study included infants who received erythropoietin for the treatment of anemia of prematurity. There were 132 infants representing 162 unique treatment courses included in the study. The average duration of therapy was 9 days (±7) and 6 doses (±2). The average change in hematocrit (Hct) was 6.2% (SD 3.9%, p < 0.001). Rise in Hct was associated with a higher number of rEPO doses (p < 0.001) and higher postmenstrual age (p < 0.001). In our small cohort we did not find an association between the number of rEPO doses and retinopathy of prematurity (ROP) requiring treatment. Erythropoietin is safe and effective at treating anemia of prematurity as evidenced by a clinically and statistically significant increase in Hct from baseline.

Abstract PO2-27-03: Clinical Results of Subjects Remaining in the Phase 3 ARTEST Study Enobosarm Therapy in AR+ER+HER2- Metastatic Breast Cancer with 3 or Greater Prior Lines of Therapy

Abstract Background: Targeting the androgen receptor (AR) with an oral selective AR agonist, enobosarm, is a novel approach to overcome ER and CDK4/6 inhibitor resistance to suppress AR+ER+HER2- metastatic breast cancer (mBC). Preclinical studies in CDK4/6 inhibitor and estrogen blocking agent resistant PDX mBC models demonstrated that enobosarm alone suppressed tumor growth. In a small subgroup analysis of patients with ER+HER2- mBC who progressed on estrogen blocking agent and a CDK 4/6 inhibitor from the Phase 2 802 study, enobosarm treatment resulted in a best overall response rate of 30% (2 CRs and 1 PR) and a 6-month clinical benefit rate (CBR) of 50%. Methods: The clinical activity of enobosarm 9mg alone was evaluated compared to standard of care (SOC) in the Phase 3 ARTEST, open-label, randomized, multicenter study in AR+ER+HER2-mBC who have progressed on 2 or greater lines of prior therapies, including estrogen blocking agents and CDK4/6 inhibitors. The study was discontinued for administrative reasons not related to efficacy or safety. Results: At the time study was discontinued, 34 patients with confirmed AR positivity were randomized to either enobosarm (n=16) or SOC control (n=18). SOC control treatment group received an average of 2.6 (range 1-5) and enobosarm 9mg monotherapy an average of 2.9 (range 1-5) prior lines of treatment. On average, enobosarm or the SOC control was given in the 4th line treatment for AR+ER+HER2- metastatic breast cancer. In the evaluable population, two partial responses were observed in the enobosarm treatment arm versus no responses in the SOC control arm. In patients with ≤3 lines of prior endocrine therapy, the best objective response rate (ORR) was 18.8% for enobosarm and 0% for control. In patients with ≤3 lines of prior endocrine therapy with ≤1 prior treatment with CDK 4/6 inhibitor, best ORR was 33% in the enobosarm group versus no responses in the SOC control (Table 1). CBR on day 180 was 33.3% (4/12) in the enobosarm group vs 0% (0/11) in the control group. Enobosarm treatment was well tolerated without masculinizing adverse events and no increases in hematocrit changes. Conclusions: Activity of enobosarm in this heavily pretreated patient population is encouraging and supports further clinical investigation. The Phase 3 ENABLAR-2 study is underway to further evaluate enobosarm alone or in combination with abemaciclib for the second-line treatment of AR+ER+HER2- metastatic breast cancer in patients who have received a prior estrogen blocking agent and a CDK 4/6 inhibitor. Clinical trial information: NCT04869943. Research Sponsor: Veru Inc. Table 1. Responses in patients with enobosarm versus SOC treatment. Citation Format: Kristine Rinn, Elisa Krill Jackson, Gary Barnette, Domingo Rodriguez, Itay Shalev, Mitchell Steiner, Joyce O'Shaughnessy, Hope Rugo, Adam Brufsky. Clinical Results of Subjects Remaining in the Phase 3 ARTEST Study Enobosarm Therapy in AR+ER+HER2- Metastatic Breast Cancer with 3 or Greater Prior Lines of Therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-27-03.

Comparative effectiveness of combined peri-articular and intra-articular injection versus intravenous and intra-articular injection of tranexamic acid in total knee arthroplasty: a randomized controlled trial study.

Tranexamic acid (TXA) administration is supported by numerous evidence in reducing blood loss after total knee arthroplasty (TKA). The combination of intravenous (IV) and intra-articular (IA) TXA administration revealed good result in blood loss reduction with less evidence of venous thromboembolism event (VTE). Several literature reviews portray that peri-articular (PA) administration yields similar hemostasis in comparison to IV route. However, there is no report on the clinical effect of combining PA + IA TXA in blood loss reduction and its complications, compared to combining IV + IA TXA after TKA. We conducted a double-blind, randomized controlled trial comparing the use of PA + IA TXA administration and IV + IA TXA administration in 70 patients who were scheduled for unilateral primary TKA. Thirty-five patients were assigned for PA + IA injection (Group 1) and anoter 35 patients were assigned for IV + IA injection (Group 2). Primary outcomes included total blood loss at 48h, and the need for blood transfusion. Secondary outcomes included thigh and leg circumference, degree of knee flexion, and postoperative complications. The calculated blood loss at 48h showed no difference between Groups 1 and 2 (617ml vs. 632ml, p = 0.425). The total hemoglobin and hematocrit changes were not different (1.89g/dL vs. 1.97g/dL, p = 0.371 and 5.66% vs. 5.87%, p = 0.391). There was no need for blood transfusion in either group. However, lower thigh swelling was significant in Group 1 (2.15cm vs. 2.79cm, p = 0.04). Leg circumferences at 48h was also lower in Group 1(42.12cm vs. 42.77cm, p = 0.04). There was no significant difference in knee flexion decrease between the two groups (38° vs. 37°, p = 0.425). There were no VTE complications or infections found in either group. Combined PA + IA TXA administration had similar efficacy in blood loss reduction and blood transfusion when compared to combined IV + IA TXA. The first group displayed less soft tissue swelling. The combination of PA + IA TXA administration can be used as an alternative regimen to avoid IV TXA administration.

Impact of cell salvage on hematocrit and post-partum anemia in low hemorrhage risk elective cesarean delivery

BackgroundPostpartum anemia is a significant contributor to peripartum morbidity. The utilization of cell salvage in low risk cases and its impact on postpartum anemia has not been investigated. We therefore aimed to examine the impact of autologous blood transfusion/cell salvage in routine cesarean delivery on postoperative hematocrit and anemia. Study design and methodsRetrospective cohort study from a perfusion database from a large academic center where cell salvage is performed at the discretion of the obstetrical team. Data from 99 patients was obtained. All patients were scheduled elective cesarean deliveries that took place on the labor and delivery floor. Thirty patients in the cohort had access to cell salvage where autologous blood was transfused after surgery. Pre-procedural hemoglobin/hematocrit measurements were obtained along will postpartum samples that were collected on post-partum day one. ResultsThe median amount of blood returned to cell salvage patients was 250 mL [206–250]. Hematocrit changes in cell salvage patients was significantly smaller than controls (−1.85 [−3.87, −0.925] vs −6.4 [−8.3, −4.75]; p < 0.001). The odds of developing new anemia following surgery were cut by 74% for the cell salvage treatment group, compared to the odds for the control group (OR = 0.26 (0.07–0.78); p = 0.028) DiscussionDespite losing more blood on average, patients with access to cell salvage had higher postoperative HCT, less postpartum anemia, and no difference in complications related to transfusion. The utilization of cell salvage for routine cesarean delivery warrants further research.

Revision Extension of Fusion Surgery in Thoracolumbar Spine Using a Newly Designed Revision Rod - Comparative Matched Cohort Study Versus Implant-Replacement Surgery.

Retrospective cohort study. To compare the results of revision extension of fusion surgery using the newly designed revision rod and implant-replacement surgery in thoracolumbar spine. Thirty-one patients who underwent extension of fusion surgery using the revision rod for adjacent segment disease were included in this study. Thirty-one patients who underwent implant-replacement revision surgery were selected as a control group by matching age, sex, preoperative diagnosis, and number of revision segments. The mean age was 70.7 ± 8.0years in the revision rod (RR) group and 69.0 ± 8.4years in the control group. Preoperative diagnoses, underlying diseases, and mean number of revision segments (2.2 ± 1.1) were similar in both groups. The change of hemoglobin (1.0 ± 1.9 vs 2.5 ± 1.5g/dl; P < .01), hematocrit (4.1 ± 4.9 vs 7.2 ± 4.4 % P < .01) and albumin (.8 ± .9 vs 1.3 ± .4g/dl; P < .01) levels before and after surgery showed significant differences between the two groups. Hemovac drainage was significantly less in the RR group (P = .01). The mean operative time was shorter in the RR group (203.5 ± 9.5min vs 233.5 ± 8.7min; P = .12) with no statistical difference. Radiological results showed that the average lumbar lordosis 2years after surgery was lower in the RR group compared to the control group (25.1 ± 9.9° vs 32.9 ± 9.8°; P = .02). Union rates and clinical outcomes were not different between the two groups. Revision extension of fusion surgery using a newly designed revision rod had less hemovac drainage and superior laboratory findings compared to implant-replacement revision surgery.

Differential approach to preoperative preparations for diffuse purulent peritonitis in children

BACKGROUND: Diffuse purulent peritonitis is the most severe complication of abdominal surgical pathology accompanied by the development of serious metabolic disorders, and its elimination is a preoperative task.&#x0D; AIM: This study aimed to compare traditional preoperative preparations using a new scheme that provides a differential approach considering the stage of peritonitis, degree of endotoxicosis, child’s age, and succinate administration.&#x0D; MATERIALS AND METHODS: An analysis of the results of treatment of patients aged 1–14 years (average age 7.9 ± 3.9 years) with diffuse purulent peritonitis of various etiologies who were treated from 2006 to 2022 in the children’s surgical department of the V.D. Seredavin Samara Regional Hospital, Samara. The patients were divided into two groups. The main group included 237 patients who underwent preoperative preparation according to the proposed scheme (depending on age, peritonitis stage, and degree of endotoxemia) lasting at least 4–6 h. In addition, for intracorporeal detoxification, the antihypoxant meglumine sodium succinate was used. The control group comprised 102 children who received traditional therapy according to generally accepted approaches and national guidelines for pediatric surgery lasting 2–3 h. Changes in hemodynamic parameters, electrolytes, hematocrit, platelets, and blood gases were comprehensively examined.&#x0D; RESULTS: After preoperative preparation, a statistically significant improvement in hemodynamic parameters was observed in the main group compared with that in the control group; the indicators were close to normal values. The dynamics of hematological parameters indicated more pronounced hemodilution in patients of the main group of all ages, which proves a significant improvement in the rheological properties of blood. Electrolyte and blood gas indicators did not reach the indicators of healthy children in any groups; however, in the main group, they were closer to normal. Complications of varying severity in the main group occurred in 21 children (8.8% ± 1.4%; p 0.001), whereas in the control group, they were diagnosed in 47 patients (46.0% ± 4.6%). A statistically significant reduction in the length of stay of patients in the intensive care unit after surgery was noted in 80% of children in the main group.&#x0D; CONCLUSIONS: The proposed scheme of preoperative preparation based on a differential approach using the antihypoxant meglumine sodium demonstrated greater effectiveness than traditional treatment. The composition, volume, and duration of preoperative preparation are dependent on the state of homeostasis and the age of the patient.

Effect of Empagliflozin with or without the Addition of Evolocumab on HDL Subspecies in Individuals with Type 2 Diabetes Mellitus: A Post Hoc Analysis of the EXCEED-BHS3 Trial.

Evolocumab and empagliflozin yield a modest rise in plasma high-density lipoprotein cholesterol (HDL-C) through unknown mechanisms. This study aims to assess the effect of evolocumab plus empagliflozin vs. empagliflozin alone on HDL subspecies isolated from individuals with type 2 diabetes mellitus (T2D). This post hoc prespecified analysis of the EXCEED-BHS3 trial compared the effects of a 16-week therapy with empagliflozin (E) alone or in combination with evolocumab (EE) on the lipid profile and cholesterol content in HDL subspecies in individuals with T2D divided equally into two groups of 55 patients. Both treatments modestly increased HDL-C. The cholesterol content in HDL subspecies 2a (7.3%), 3a (7.2%) and 3c (15%) increased from baseline in the E group, while the EE group presented an increase from baseline in 3a (9.3%), 3b (16%) and 3c (25%). The increase in HDL 3b and 3c was higher in the EE group when compared to the E group (p < 0.05). No significant interactive association was observed between changes in hematocrit and HDL-C levels after treatment. Over a 16-week period, empagliflozin with or without the addition of evolocumab led to a modest but significant increase in HDL-C. The rise in smaller-sized HDL particles was heterogeneous amongst the treatment combinations.

Sex Differences in Hydration Biomarkers and Test-Retest Reliability Following Passive Dehydration.

This study investigated (a)differences between males and females for changes in serum, tear, and urine osmolality, hematocrit, and urine specific gravity following acute passive dehydration and (b)assessed the reliability of these biomarkers separately for each sex. Fifteen males (age: 26.3 ± 3.5years, body mass: 76 ± 7kg) and 15 females (age: 28.8 ± 6.4years, body mass: 63 ± 7kg) completed a sauna protocol twice (5-28days apart), aiming for 4% body mass loss (BML). Urine, blood, and tear markers were collected pre- and postdehydration, and change scores were calculated. Male BML was significantly greater than that of females in Trial 1 (3.53% ± 0.55% vs. 2.53% ± 0.43%, p < .001) and Trial 2 (3.36% ± 0.66% vs. 2.53% ± 0.44%, p = .01). Despite significant differences in BML, change in hematocrit was the only change marker that displayed a significant difference in Trial 1 (males: 3% ± 1%, females: 2% ± 1%, p = .004) and Trial 2 (males: 3% ± 1%, females: 1% ± 1%, p = .008). Regression analysis showed a significant effect for sex (male) predicting change in hematocrit (β = 0.8, p = .032) and change in serum osmolality (β = -3.3, p = .005) when controlling for BML but not for urinary or tear measures. The intraclass correlation coefficients for females (ICC 2, 1) were highest for change in urine specific gravity (ICC = .62, p = .006) and lowest for change in tear osmolarity (ICC = -.14, p = .689), whereas for males, it was posthematocrit (ICC = .65, p = .003) and post tear osmolarity (ICC = .18, p = .256). Generally, biomarkers showed lower test-retest reliability in males compared with females but, overall, were classified as poor-moderate in both sexes. These findings suggest that the response and reliability of hydration biomarkers are sex specific and highlight the importance of accounting for BML differences.