CT Ratio Research Articles

Improving RBC inventory by optimizing preoperative ordering and eliminating crossmatch and hold.

Blood product constraints have increased the focus on inventory management as blood banks have faced challenges that impact supply chains and donor availability. Solutions often include a reduction in transfusion volumes through multidisciplinary improvements, but this is often coupled with a reduction in blood bank inventory to match reduced demand. We sought to improve inventory availability within the blood bank without modification of transfusion rates through solutions that prevented unnecessary RBC orders and crossmatching. Improvements were focused on reduction of duplicate orders, preoperative blood orders, excess volume of blood orders, and crossmatching in advance of perioperative needs. The study monitored the improvement of the crossmatch to transfusion ratio as the primary outcome and days of shelf life until expiration as a secondary outcome. The CT ratio of RBCs decreased from 2.03 (16,044/7922) pre-implementation to 1.67 (12,321/7375) post-implementation (p < 0.05). Our inventory was managed more efficiently following our interventions as demonstrated through the day of shelf life of RBCs issued. Pre-implementation, RBCs were issued an average of 17.5 days before expiration, which increased to 20.4 days post-implementation (p < 0.05). Modification of preoperative order sets and education of clinical staff to ensure appropriate blood product ordering can significantly impact available inventory. Although this was also identified within our study, we found that the largest impact comes from a change in crossmatching workflow to reduce unnecessary reserving of RBCs. These changes can be implemented without significant impact to turnaround time.

An evaluation model of hepatic steatosis based on CT value and serum uric acid/HDL cholesterol ratio can predict intrahepatic recurrence of colorectal cancer liver metastasis.

Intrahepatic recurrence is one of the main causes of treatment failure in patients with colorectal cancer liver metastasis (CRLM). Hepatic steatosis was reported to provide fertile soil for metastasis. The effect of irinotecan-inducted hepatic steatosis on the progression of liver metastasis remains to be verified. Therefore, we aim to clarify the effect of hepatic steatosis on postoperative intrahepatic recurrence in CRLM and whether it is relevant to irinotecan-based chemotherapy. Data for a total of 284 patients undergoing curative surgical treatment for CRLMs were retrospectively reviewed between March 2007 and June 2018. Hepatic steatosis score (HSS) was established by combining Liver to Spleen CT ratio (LSR) and Uric acid to HDL-cholesterol ratio (UHR) to detect the presence of hepatic steatosis. The evaluation model is consistent with pathological results and has high prediction ability and clinical application value. Patients with HSS high risk (HSS-HR) had significantly worse prognosis than those with HSS low risk (HSS-LR) (3-year intrahepatic RFS: 42.7% vs. 29.4%, P = 0.003; 5-year OS: 45.7% vs. 26.5%, P = 0.002). Univariate and multivariate analysis confirmed its essential role in the prediction of intrahepatic RFS. Besides, patients treated with preoperative irinotecan chemotherapy were more likely to end up with HSS-HR than those with non-irinotecan chemotherapy (63.3% vs. 21.8%, P < 0.001). Furthermore, irinotecan chemotherapy is relevant to worse prognosis in baseline HSS-HR patients. In summary, patients with HSS-HR had significantly worse 5-year OS and 3-year intrahepatic RFS. Irinotecan chemotherapy is more likely to lead to HSS-HR and pre-existing hepatic steatosis may be a worse prognostic factor limiting patients underwent IRI-based chemotherapy.

Maximum surgical blood ordering schedule for elective surgical procedures in Omdurman teaching hospital, Sudan

BackgroundThe need for blood during a surgical procedure is greater than what blood banks are able to provide. There is an excessive amount of blood being ordered for elective surgeries, surpassing the actual requirements. Only 30% of the cross matched blood is actually used in these surgeries. The accuracy of estimating the transfusion needs before a surgical procedure can be determined by looking at the cross match to transfusion ratio and the transfusion index. “These indicators play a crucial role in developing the maximum surgical blood ordering schedule; in this study, these indicators were tested.”Aim of studyIs to determine the efficiency of blood ordering and transfusion practices for patients undergoing elective surgeries.MethodsThis study is a prospective cross-sectional hospital-based study done at Omdurman Teaching Hospital-Sudan. Conducted for the duration of 6 months period from July to December 2019.The study participants were patients who underwent elective surgical procedures in general surgery and Urology departments as total coverage sample over a period of study duration. Ethical clearance obtained from ethical committee of Sudan Medical Specialization Board.ResultsTwo hundreds seven patients included in this study, the amount of blood units requested were 443-unit, cross matching for 98.6% (n 437) of units were done. Only 100 unit were Transfused (22,8%). The calculated CT ratio was 4.4, transfusion index was 1.6 and transfusion probability was 29.9%.ConclusionTransfusion probability and transfusion index of the present study were optimal but comparatively higher than the standard guidelines as most of the cross matched blood was not utilized.

215 The effect of a Lactobacillus fermentation postbiotic on nursery pig growth performance after experimental inoculation with F18 Escherichia coli.

Abstract This study evaluated a Lactobacillus fermentation postbiotic (LFP) in nursery pigs challenged with F18 ETEC. A total of 119 three-week-old barrows and gilts were used in this study. Pigs were acclimated for a period of 7 d upon arrival at the facility before inoculation. Pigs were stocked in mixed-sex pens of 6 pigs in each pen. Four rooms were used and each room had 5 pens. One room of pigs was not challenged with F18 ETEC (NCH). Ninety pigs in the other 3 rooms were intraorally challenged for three consecutive days with F18 ETEC isolate at a concentration of ~1x109 cfu/ml (CH) Pigs in the non-challenge groups were housed in separate airspaces than those receiving ETEC inoculum to avoid contamination. All pigs, regardless of health challenge, were fed a standard two-phase dietary nursery program. Five dietary treatments were evaluated: T1) negative dietary control without feed additives (Carabox, zinc oxide, and added copper), T2) 750 ppm LFP, T3) 1,500 ppm LFP, T4) 2,250 ppm LFP, and T5) positive control (PC) with feed additives. Feces were collected at 0 and 4 d post inoculation (dpi) to evaluate fecal shedding by real time polymerase chain reaction (rtPCR). Pig body weights were collected at -7, 0, 7, 14, 21, and 42 dpi to calculate performance. Feed intake was measured at the completion of the two dietary phases at 7 and 42 dpi for calculation of average daily feed intake (ADFI) and gain to feed ratio (G:F). All pigs were negative for F18 ETEC on 0 dpi and the non-challenge pigs remained negative by 4 dpi. At 4 dpi, the pigs fed 1,500 and 2,500 ppm LFP had significantly less Cts than pigs fed the positive control (rtPCR &amp;lt; 0.819, P = 0.03). Pigs fed the negative control had significantly greater fecal bacterial load than those fed the positive control averaged across challenge treatments and dpi (Ct ratio = 0.84, P = 0.03). Total E. coli and overall bacterial load were increased at 0 dpi compared with 4 dpi (Ct ratio= 0.90, P &amp;lt; 0.02). Pigs fed the positive control grew significantly faster than those fed the other diets during the acclimation phase (P &amp;lt; 0.01). Pigs in T5 were heavier than those on T1 at 14 and 21 dpi P &amp;lt; 0.02; table 1). End weights, average daily gain (ADG), and ADFI were similar between T1 and T2-4 across dietary phases (P = 0.13) with a tendency for the pigs feed 1,500 ppm to be heavier at d 21 (linear effect, P = 0.15) Pigs fed the positive control were heavier and grew faster at the end of each phase compared with pigs fed the other diets. The F18 challenge was effective in decreasing pig performance. Preliminary evidence suggests lactobacillus fermentation postbiotic may improve nursery performance in the face of an F18 challenge, but further investigation is necessary.

Training stress, neuromuscular fatigue and well-being in volleyball: a systematic review

BackgroundVolleyball, with its unique calendar structure, presents distinct challenges in training and competition scheduling. Like many team sports, volleyball features an unconventional schedule with brief off-season and pre-season phases, juxtaposed against an extensive in-season phase characterized by a high density of matches and training. This compact calendar necessitates careful management of training loads and recovery periods. The effectiveness of this management is a critical factor, influencing the overall performance and success of volleyball teams. In this review, we explore the associations between training stress measures, fatigue, and well-being assessments within this context, to better inform future research and practice.MethodsA systematic literature search was conducted in databases including PsycINFO, MEDLINE/PubMed, SPORTDiscus, Web of Science, and Scopus. Inclusion criteria were original research papers published in peer-reviewed journals involving volleyball athletes.ResultsOf the 2535 studies identified, 31 were thoroughly analysed. From these 31 articles, 22 included professional athletes, seven included collegiate-level volleyball athletes, and two included young athletes. Nine studies had female volleyball players, while the remaining 22 had male volleyball athletes.ConclusionsInternal training load should be collected daily after training sessions and matches with the session rating of perceived exertion method. External training load should also be measured daily according to the methods based on jump height, jump count, and kinetic energy. If force platforms are available, neuromuscular fatigue can be assessed weekly using the FT:CT ratio of a countermovement jump or, in cases where force platforms are not available, the average jump height can also be used. Finally, the Hooper Index has been shown to be a measure of overall wellness, fatigue, stress, muscle soreness, mood, and sleep quality in volleyball when used daily.

Machine learning assessment of dental age classification based on cone-beam CT images: a different approach.

Machine learning (ML) algorithms are a portion of artificial intelligence that may be used to create more accurate algorithmic procedures for estimating an individual's dental age or defining an age classification. This study aims to use ML algorithms to evaluate the efficacy of pulp/tooth area ratio (PTR) in cone-beam CT (CBCT) images to predict dental age classification in adults. CBCT images of 236 Turkish individuals (121 males and 115 females) from 18 to 70 years of age were included. PTRs were calculated for six teeth in each individual, and a total of 1416 PTRs encompassed the study dataset. Support vector machine, classification and regression tree, and random forest (RF) models for dental age classification were employed. The accuracy of these techniques was compared. To facilitate this evaluation process, the available data were partitioned into training and test datasets, maintaining a proportion of 70% for training and 30% for testing across the spectrum of ML algorithms employed. The correct classification performances of the trained models were evaluated. The models' performances were found to be low. The models' highest accuracy and confidence intervals were found to belong to the RF algorithm. According to our results, models were found to be low in performance but were considered as a different approach. We suggest examining the different parameters derived from different measuring techniques in the data obtained from CBCT images in order to develop ML algorithms for age classification in forensic situations.

Miscibility and crystallization behavior of Poly(butylene terephthalate)/Poly(ethylene terephthalate-co-1,4-cyclohexylene dimethylene terephthalate) blends

The miscibility and crystallization behavior of a series of polymer blends containing different content of poly(butylene terephthalate) (PBT) and poly(ethylene terephthalate-co-1,4-cyclohexylene dimethylene terephthalate) (P(ET/CT)) have been studied. It is confirmed through DSC, SAXS and SEM that PBT is miscible with P(ET/CT) with different CT content. When the mole content of CT is 37 %, P(ET/CT) (abbreviated as P(ET/CT37 %)) is fully amorphous. But, as the mole ratio of CT is 66 %, P(ET/CT) (abbreviated as P(ET/CT66 %)) possesses crystallizability. Compared to the extremely fast crystallization of PBT, the crystallizability of P(ET/CT66 %) is so weak that non-isothermal crystallization (at a cooling rate of 10 °C/min) can hardly occur. Upon blending, however, it is interesting to find that the P(ET/CT66 %) could be involved in the crystallization of the blends within the entire composition range. In the DSC cooling curves, a double-peak crystallization could be observed, in which the Tc1 is attributed to the crystallization of PBT and the Tc2 to that of P(ET/CT66 %). Further, the two glass transition temperatures of the blends after crystallization confirm the occurrence of crystallization-induced phase separation at higher P(ET/CT) content. Therefore, the excluded P(ET/CT66 %) local domain or aggregation is regarded as the prerequisite of the P(ET/CT66 %) crystallization, and the previously formed PBT crystals act as its nucleating agent.

Novel scoring system using contrast-enhanced mammography to differentiate benign and malignant architectural distortion

BackgroundIncidence of malignancy in architectural distortion (AD) is variable, and as a standard of care, all the architectural distortions are biopsied. It is important to identify benign and malignant characteristics of ADs on imaging to predict the probability of malignancies as well as to establish radiological–pathological concordance. The aim of our study was to analyse the utility of contrast-enhanced mammography (CEM) in primary AD, to describe and evaluate the accuracy of CEM parameters and derive a novel scoring system to differentiate benign and malignant AD.ResultsForty-six patients with 49 ADs were evaluated with a median age, 51 years (age range—34–72 years) and all were women. Of the 49 ADs, 65.3% (32/49) were benign, and 34.69% (17/49) were malignant. The CEM parameters which predicted malignancy were moderate or marked density, size > 0.95 cm, CT ratio > 1.31, mass morphology and washout kinetics. The absence of enhancement and enhancing AD with AD score of 0 had a 100% NPV for malignancy. Enhancing architectural distortion with a score of 3 or more had 100% PPV for malignancy. A score of 1 or 2 was indeterminate, and an individualised decision was recommended.ConclusionsIn primary AD, several CEM features have significantly predicted malignancy when the score is 3 and above. A biopsy may be avoided in non-enhancing AD and enhancing AD with a score of 0 due to high NPV.

Novel approach to prenatal predictors of outcomes for fetuses with severe Ebstein anomaly

Objective Ebstein anomaly (EA) is a cardiac malformation with highly variable presentation and severity with limited perinatal management options. We present incorporation of fetal lung measurements into a multidisciplinary evaluation for counseling and predicting postnatal outcomes in patients with severe EA. Methods Five fetuses with severe fetal EA were reviewed. Third trimester sonographic observed/expected total lung area (O/E TLA) and lung to head ratio (O/E LHR), fetal MRI total fetal lung volume ratio (O/E-TFLV), echocardiographic cardio-thoracic ratio (CT ratio), sonographic estimated fetal weight (EFW) by Hadlock formula and presence of hydrops, were used to guide perinatal management. Results Three of five had appropriate fetal growth, were delivered at term in a cardiac operative suite, and underwent immediate intervention with good neonatal outcomes. Two had severe fetal growth restriction (FGR), CT ratios > 0.8 and O/E LHR and TLA < 25%. One of which delivered prematurely with neonatal demise and one suffered in utero demise at 34 weeks. Conclusions FGR, hydrops, increased CT ratio and reduced O/E LHR and TFLV are potential prognosticators of poor outcomes in severe EA, and should be validated in larger cohorts that would allow for a statistical analysis of the predictive utility of these measurements.

Pathophysiological Mechanisms Underlying Unilateral Vocal Fold Paralysis in Female Patients: An Ultrasonographic Study.

Laryngeal ultrasonography (LUS) has been suggested as an alternative diagnostic tool for unilateral vocal fold paralysis (UVFP). The present study applied LUS and quantitative laryngeal electromyography (LEMG) in female UVFP patients to investigate the pathophysiologic mechanisms of UVFP. In this cross-sectional study, vocal fold (VF) length parameters included resting and phonating VF length measured using B-mode LUS, and color Doppler vibrating length (CDVL) measured using the color Doppler mode. Forty female patients with UVFP were enrolled, among whom 11 and 29 were assigned to the thyroarytenoid (TA) muscle+cricothyroid (CT) muscle group (with CT involvement) and the TA (without CT involvement) group, respectively. In the TA group, the turn frequency in thyroarytenoid-lateral cricoarytenoid (TA-LCA) on the paralyzed side, as observed through LEMG, correlated with the VF length during the resting phase (R=0.368, P=0.050) and CDVL values (R=0.627, P=0.000) on the paralyzed side. In the TA+CT group, the turn ratio in the CT muscle correlated with the normalized phonatory vocal length change (nPLC; R=0.621, P=0.041) on the paralyzed side. CDVL and nPLC are two parameters that can be utilized to predict the turn frequencies of TA-LCA in UVFP cases without CT involvement, and the turn ratio of CT in cases of UVFP with CT involvement, respectively. The findings suggest that LUS, as a noninvasive tool, can serve as an alternative method for assessing the severity of laryngeal nerve injury and offer valuable insights into the pathophysiology of UVFP.

Measurement of thalamus and cortical damages in hypoxic ischemic encephalopathy

BackgroundThe thalamic gray-white matter ratios (GWRs) on CT and quantitative suppression ratios (SRs) of background activities on EEG may reflect damages in the thalamus and cerebral hemispheres in patients with hypoxic-ischemic encephalopathy (HIE). MethodsThe inclusion criteria were (1) cardiac arrest patients over the age of 20 years from March 2010 to March 2020, and (2) patients who had both EEG and brain CT within 7 days after cardiac arrest. The thalamic GWRs were semi-quantitatively measured by using the region of interest (ROI). SRs of background were analyzed with the installed software (Persyst® v13) in EEG machine. Results175 patients were included among 686 patients with HIE and the thalamic GWRs of 168 patients were successfully measured. 155 patients (89 %) showed poor outcomes. The poor outcome group revealed not only higher SRs, but also lower thalamic GWRs. The thalamic GWRs showed a negative correlation to the SRs (ρ (rho) = −0.36, p < 0.0001 for right side, ρ (rho) = −0.31, p < 0.0001 for left side). The good outcome group showed neither beyond the cut-off values of thalamic GWRs nor SRs [40 % (59/148) VS 0 % (0/20) in right side, p = 0.0005 %, and 28 % (42/148) VS 0 % (0/20) in left side, p = 0.0061]. ConclusionThe thalamic GWRs and SRs may reflect the damage in the thalamus and cerebral hemispheres in patients with HIE. Insults in the thalamocortical circuit (TCC) or the thalamus might be responsible for the poor outcome.

Application of intergenic sequence between ND5 and ND6 as novel target for authentication and quantification of Oviductus Ranae

Oviductus Ranae (OR), dried oviducts from Rana dybowskii (RD), is a valuable food and medicine included by Chinese pharmacopeia, mainly produced in Changbai Mountain area of China. Economically motivated adulteration with oviducts from unclear species has become one of the most concerned food safety issues. Existing methods based on DNA sequencing are cost and time consuming, making them unfit for rapid authentication and quantification. Here, we developed a PCR/RT-PCR method targeting a RD specific intergenic sequence region termed IGS56 in mtDNA (Genbank NC_023528.1, 17059–17154 bp). Common primers in RD close species (F1-ND5/R1-ND6), RD specific primers (F2-IGS56/R2-ND6) and universal primers (F0–18 s/R0–18 s) were used for authentication by PCR, while RD specific primers (F3-IGS56-RT/R3-ND6-RT) and reference primers (F0–18 s-RT/R0–18 s-RT) were used for quantification by RT-PCR. For authentication, standard OR sample together with 19 batches OR samples obtained from different sites of Changbai mountain area were all identified to be RD. For RT-PCR based quantification, calibration curve with a good linear correlation (R2 =0.9915), was plotted with Ct ratio (Specificity Ct /Reference Ct) and OR percentage mixed by oviducts of R.nigromaculata. The accuracy of RT-PCR method established was verified to be high, with an average recovery rate of 106.744%.

Applications of rotational thromboelastometry in heparin monitoring in critical COVID-19 disease: Observations in the Maastricht Intensive Care COVID cohort

BackgroundCritically ill COVID-19 patients are at risk for venous thromboembolism (VTE). Therefore, they receive thromboprophylaxis and, when appropriate, therapeutic unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). To monitor heparins in COVID-19 disease, whole-blood rotational thromboelastometry (ROTEM) may be a promising alternative to the aPTT and anti-Xa assays. ObjectiveTo evaluate the ROTEM INTEM/HEPTEM ratios in mechanically ventilated COVID-19 patients treated with UFH and therapeutic LMWH. Material and methodsA subcohort of mechanically ventilated COVID-19 patients of the prospective Maastricht Intensive Care Covid (MaastrICCht) cohort was studied. Anti-Xa, aPTT, and ROTEM measurements following treatment with UFH or therapeutic dose of LMWH (nadroparin) were evaluated using uni- and multivariable linear regression analysis and receiver operating characteristics. ResultsA total of 98 patients were included, of which 82 were treated with UFH and 16 with therapeutic LMWH. ROTEM-measured INTEM/HEPTEM CT ratio was higher in patients using UFH (1.4 [1.3–1.4]) compared to patients treated with LMWH (1.0 [1.0–1.1], p < 0.001). Both the aPTT and anti-Xa were associated with the CT ratio. However, the β-regression coefficient (95%CI) was significantly higher in patients on UFH (0.31 (0.001–0.62)) compared to therapeutic LMWH (0.09 (0.05–0.13)) for comparison with the anti-Xa assay. Furthermore, ROC analysis demonstrated an area under the curve for detecting UFH of 0.936(0.849–1.00), 0.851(0.702–1.000), and 0.645(0.465–0.826) for the CT ratio, aPTT, and anti-Xa, respectively. ConclusionThe ROTEM INTEM/HEPTEM CT ratio appears a promising tool to guide anticoagulant therapy in ICU patients with COVID-19 disease, but associations with clinical endpoints are currently lacking.

Detection and quantification of perioperative heparin-like effects by rotational thromboelastometry in living-donor liver transplant recipients: A prospective observational study.

Heparin-like effects (HLEs) can affect hemostasis during liver transplantation. The aim of this study was to assess the perioperative incidence and severity of HLE with rotational thromboelastometry (ROTEM) and activated partial thromboplastin time (aPTT). ROTEM and aPTT were measured intraoperatively and on postoperative days (POD) 1, 3, and 7. HLE was identified if ROTEM INTEM/HEPTEM CT-ratio was >1.25 and severe forms of HLE when ratio was ≥2. Based on aPTT, HLE was defined when aPTT ratio was >1.25 (patient aPTT/control aPTT). Thirty-eight recipients were included. Variable degrees of HLE were detected by aPTT-ratio and INTEM/HEPTEM CT ratio. No significant correlation existed between both ratios. Based on INTEM/HEPTEM CT ratio, HLE was detected in 7/38 during anhepatic phase, 19/38 post-reperfusion, 10/38 on POD1, 4/38 on POD3, and 0/38 on POD7. Four cases of severe HLE were identified by INTEM/HEPTEM CT ratio only in the anhepatic phase. Postoperative infusion of unfractionated heparin led to mild-moderate HLE on POD1 and 3 as evident by both tests. Red blood cell and plasma transfusion were higher with severe HLE (1350 ± 191 ml and 3558 ± 1407 ml). Composite adverse outcome of any complication or death within 3 months for patients without HLE, mild-moderate HLE, and severe HLE as detected by ROTEM was 27.8%, 42.9%, and 66.7%, respectively. INTEM/HEPTEM CT ratio was able to detect and quantify HLE as aPTT ratio. The ability of the INTEM/HEPTEM CT ratio to identify severe HLE earlier in the anhepatic phase needs to be studied in a larger population. HLE is self-limiting, but when identified in a severe form, it is associated with worse outcome.

An Immune-metabolic signature (IMMETCOLS) identifies three clusters in mCRC with different immune-phenotype distribution and potential clinical implications.

e15534 Background: The overall response rate following immune check-point blockade (ICB) is &lt; 5% in microsatellite stable (MSS) advanced colorectal cancer (mCRC), and between 30-35% in MSI mCRC. We here evaluate the relationship between our immune-metabolic signature (IMMETCOLS) distribution (cluster (IMC) 1; mesenchymal glycolytic, IMC 2; epithelial-non glycolytic and IMC 3; epithelial mitochondrial oxidative) with immune phenotypes (inflamed (IF), immune-excluded (IE) and immune-desert (ID)) in MSS and MSI mCRC patients (pts). Methods: We have analyzed IMMETCOLS in a retrospective cohort of 128 mCRC pts enriched with MSI-H and BRAF genotype using the nCounter platform (Nanostring Technologies, US). Immune phenotypes were evaluated by immunohistochemistry using 7 immune markers (CD68, CD163, CD8, CD3, FOXP3, PD-L1 and PD1) in a subset of 47 mCRC pts (27 MSS and 20 MSI), in TMAs containing 4 cores from the center of the tumor (CT) and invasive front (IF). The number of stained immune cells was counted using a computerized image analysis system, and PD-L1 was evaluated using CPS score (&lt; 1 vs &gt; 1). Patients having a CD3 cell count below 572 cells/mm2 and a CD8 density below 175 cells/mm2 in IF or CT were considered as ID. (Halama Nils, 2011). CD3 density was also semi-quantitatively estimated in peritumoral stroma and intra-tumoral (range 1-4), defining as IE those cases with a difference &gt; 1 between the two regions in both IF and CT (Brooks JM, 2019). Results: Cluster distribution was similar between MSI (IMC1-40%, IMC2-20% and IMC-40%) and MSS (IMC1-34%, IMC2-24%, IMC3-43%) pts. Patients with high LDH levels (&gt; 1.5ULN) were enriched with IMC3 phenotype (p &lt; 0.0001). MSI have increased CD3 (p = 0.002), CD68 (p = 0.002) and CD163 (p = 0.001) in CT than MSS patients. IMC1 pts had increased CD163/CD68 ratio in CT (p = 0.004). 75% of MSI pts were IE and 25% IF. 55% of MSS pts were IE, 38% ID and 7% IF. IMMETCOLS/ immune-phenotype distribution was: IMC1 (16% ID/ 84% IE), IMC2 (12% ID/ 63% IE/ 25% IF) and IMC3 (35%ID/ 47% IE/ 18% IF). PD1 immuno-expression &gt; 1% (IF and CT) and PD-L1 positivity was observed in 38%, 30% and 28% of pts respectively. There were no differences in PD-L1 (CPS) and PD1 expression between MSS and MSI tumors. Inflamed tumors show higher PD-L1 expression compared with IE and ID immune-phenotypes (p = 0.014). PD1 &gt; 1% expression at IF was significatively lower in IMC1 vs IMC2 and IMC3 tumors (p = 0.032). Conclusions: IMC1 subtype is associated with low PD1 expression, high CD163/CD68 ratio and IE phenotype even in MSI-H mCRC patients. Therefore, IMMETCOLS testing would be of value to identify MSI mCRC pts that do not benefit to ICB therapy.

Detection of Ovine or Bovine Milk Components in Commercial Camel Milk Powder Using a PCR-Based Method.

Food ingredient adulteration, especially the adulteration of milk and dairy products, is one of the important issues of food safety. The large price difference between camel milk powder, ovine, and bovine milk powder may be an incentive for the incorporation of ovine and bovine derived foods in camel milk products. This study evaluated the use of ordinary PCR and real-time PCR for the detection of camel milk powder adulteration based on the presence of ovine and bovine milk components. DNA was extracted from camel, ovine, and bovine milk powder using a deep-processed product column DNA extraction kit. The quality of the extracted DNA was detected by amplifying the target sequence from the mitochondrial Cytb gene, and the extracted DNA was used for the identification of milk powder based on PCR analysis. In addition, PCR-based methods (both ordinary PCR and real-time PCR) were used to detect laboratory adulteration models of milk powder using primers targeting mitochondrial genes. The results show that the ordinary PCR method had better sensitivity and could qualitatively detect ovine and bovine milk components in the range of 1% to 100% in camel milk powder. The commercial camel milk powder was used to verify the practicability of this method. The real-time PCR normalization system has a good exponential correlation (R2 = 0.9822 and 0.9923) between ovine or bovine content and Ct ratio (specific/internal reference gene) and allows for the quantitative determination of ovine or bovine milk contents in adulterated camel milk powder samples. Accuracy was effectively validated using simulated adulterated samples, with recoveries ranging from 80% to 110% with a coefficient of variation of less than 7%, exhibiting sufficient parameters of trueness. The ordinary PCR qualitative detection and real-time PCR quantitative detection method established in this study proved to be a specific, sensitive, and effective technology, which is expected to be used for market detection.

Blood use in elective surgical procedures in a “type A” base hospital

IntroductionBlood orders for surgical patients make up a considerable portion of total blood requests but the majority doesn’t lead to a transfusion. Routine crossmatching and reserving blood for all surgeries can be reduced by establishing a Maximum Surgical Blood Ordering Schedule [MSBOS]. We have analyzed blood utilization in Base Hospital Puttalam and formulated an MSBOS with this study. Material and methodsA total of 2145 surgeries from surgical and gynaecology &amp; obstetric units in the year 2019 was analyzed. Patients who underwent massive transfusions and patients having a pre-operative haemoglobin concentration less than 8.3g/dl or obtained a pre-operative transfusion were excluded considering transfusions to correct preoperative anaemia. The crossmatch to transfusion ratio [C: T], transfusion probability [T%] and transfusion index [TI] was calculated for each surgical procedure. The procedures having a C: T of &gt;3:1 was recommended for group and screen [G&amp;S]. ResultsOf a total of 2145 patients, 90% were females. A total of 1565 units were requested and 1521 units were crossmatched for 2034 patients while only 193 were transfused. Overall indices for the study population are CT ratio of 7.8:1, %T of 10.4% and TI of 0.15. Indices for surgical unit patients are CT ratio of 5:1, %T of 15.2% and TI of 0.29. By using the MSBOS total of 1403 cross matches could have been avoided. ConclusionsBy implementing the MSBOS 92% of cross matches for elective surgeries could have been avoided. The results are on par with the previous studies done at tertiary health care centres.

Blood Ordering and Transfusion Practices: An Insight Toward Better Utility of Blood Products.

BackgroundAn adequate supply of quality blood products is the backbone of any hospital. To maintain it, the utilization and wastage of the products should be closely monitored.ObjectiveTo determine the crossmatch to transfusion (C/T) ratio, transfusion probability (%T), and transfusion index (Ti) of packed red blood cells and to review the use of platelets.Materials and methodsA total of 6,326 hematological patients receiving packed red blood cells were included in the study. The random donor platelets that were prepared during this period were also included to know the actual utilization of platelets.ResultsA total of 26,146 crossmatches were requested for these 6,326 patients in three years. Out of these, 26,024 units were issued and transfused to the patients. The CT ratio of our data was calculated to be 1.00, the transfusion probability was found to be 98.1%, and the transfusion index was computed to be 0.99. For random donor platelets, 37,162 were prepared from whole blood during this period, while 30,971 platelets were transfused to the patients.ConclusionThe overall results of our analysis showed proper utilization of blood products at our institution. The wastage was considered to be minimal.

The relationship between INTEM/HEPTEM coagulation time ratio and heparin plasma concentration in obstetric patients: an exploratory in vitro investigation.

Unfractionated heparin continues to be one of the main agents used for thromboprophylaxis in obstetrics, which can complicate the placement of neuraxial anesthetics. In this study, we explored the relationship between a point-of-care coagulation test (thromboelastometry) and plasma heparin concentrations in vitro. We obtained blood from consenting obstetric patients with uncomplicated pregnancies in their third trimester who were not in labour and had a specific hematocrit range. Blood was processed and analyzed. We added increasing amounts of unfractionated heparin to samples from 0 to 0.3 U·mL-1 in 0.05 U·mL-1 increments to simulate increasing doses of unfractionated heparin. We performed INTEM and HEPTEM testing in parallel with activated partial thromboplastin time (aPTT) testing. We created a model of the relationship between heparin concentration and the INTEM/HEPTEM coagulation time (IH CT) ratio using nonlinear regression. A similar model for aPTT was also created. Seventy-seven patients were included in the study. Only one concentration of heparin was added to blood samples of each patient. At a concentration of 0.05 U·mL-1, the IH CT ratio was less than or equal to 1.1 in 9/11 (82%) samples. Activated partial thromboplastin time was not prolonged (> 35 sec) until a concentration of 0.1 U·mL-1 heparin was added. In all samples, the IH CT ratio was prolonged at a concentration ≥ 0.2 U·mL-1 as measured by thromboelastometry; however, at no concentration of heparin was aPTT prolonged in all samples. The point-of-care IH CT ratio may be useful in identifying the presence of little to no heparin activity. Further research is needed to determine if this ratio can predict heparin activity in vivo.

Optimized Reconstruction Algorithm-Processed CT Image in the Diagnosis of Correlation between Epicardial Fat Volume and Coronary Heart Disease

This study was to analyze the application value of a reconstruction algorithm in CT images of patients with coronary heart disease and analyze the correlation between epicardial fat volume and coronary heart disease. An optimized reconstruction algorithm was constructed based on compressed sensing theory in this study. Then, the optimized algorithm was applied to the image reconstruction of multislice spiral CT image data after testing its sensitivity, accuracy, and specificity. 60 patients with suspected angina pectoris were divided into lesion group (40 cases) and normal group (20 cases) according to whether there were coronary atherosclerotic plaques in cardiac vessels. The results showed that the sensitivity, specificity, and accuracy of the optimized reconstruction algorithm were 91.78%, 84.27%, and 95.32%, and the running time was (12.18 ± 2.49) s. The CT value of the liver and the CT ratio of the liver and spleen in the lesion group were (53.81 ± 5.91) and (3.88 ± 0.67), respectively. There was no significant difference between the two groups ( P &gt; 0.05 ). The body mass index and epicardial fat volume in the lesion group were (31.93 ± 4.54) kg/m2 and (120.09 ± 22.01) cm3, respectively. The body mass index and fat volume in the lesion group were significantly higher than those in the normal group ( P &lt; 0.05 ). The epicardial fat constitution increased with the increase of the number of coronary arteries involved, and there was a positive correlation between them. Among patients with different coronary atherosclerotic plaques, the epicardial fat volume in patients with mixed plaques was the largest ( P &lt; 0.05 ). In summary, optimizing CT images under compressed a sensing reconstruction algorithm could effectively improve the diagnostic accuracy of doctors. Epicardial fat volume was positively correlated with coronary heart disease. Epicardial fat volume could be used as one of the important indexes to predict coronary heart disease.