Hematocrit Measurements Research Articles

Prevalence and predictive factors of testosterone-induced erythrocytosis: a retrospective single center study.

This study analyzes the prevalence and predictive factors of testosterone-induced erythrocytosis (TIE) in patients receiving testosterone replacement therapy (TRT). Retrospective single-center observational study. 247 patients were included; median age was 47.0 years (interquartile range (IQR) 32-60) and median follow-up years 2.9 (1.0-5.5). The most common indication for TRT was central hypogonadism (51%) followed by primary hypogonadism (26%). TRT was carried out with testosterone undecanoate (TU) n=194, testosterone enanthate (TE) n=18 and testosterone gel (n=35). Compared to baseline, hematocrit (HCT) values at last follow-up (LFU) increased significantly by +0.04 (95% confidence interval (CI) [0.027, 0.050], p=<0.0001) in all patients (n=92) and +0.06 (95%CI [0.031, 0.057], p<0.0001) in the TU group (n=71). 57% of the patients reached an HCT value>0.46, 23% >0.5 and 5%>0.54. 46% of the patients who have reached an HCT value >0.46 have had their highest HCT measurement within the first year of TRT application. Logistic regression analysis indicated that body mass index (BMI) was significantly associated with the development of an HCT ≥0.5 (p=0.013) and HCT ≥0.46 (p=0.008). There was an association between the baseline HCT measurement and the outcome of a HCT measurement ≥0.46 (p=0.025), patients with high starting values were more likely to develop TIE. TIE appears to be frequent and does not only present within the first year of therapy which indicates a close follow-up of laboratory values within the first year followed by annual controls. Baseline BMI and baseline HCT measurement should be considered in risk stratification of TIE development.

Dynamic fluidic manipulation in microfluidic chips with dead-end channels through spinning: the Spinochip technology for hematocrit measurement, white blood cell counting and plasma separation.

Centrifugation is crucial for size and density-based sample separation, but low-volume or delicate samples suffer from loss and impurity issues during repeated spins. We introduce the "Spinochip", a novel microfluidic system utilizing centrifugal forces for efficient filling of dead-end microfluidic channels. The Spinochip enables versatile fluid manipulation with a single reservoir for both inlet and outlet functions. It expels compressed air, facilitating fluid flow, and offers programmable filling mechanisms based on the hydraulic resistance of microfluidic channels. Compatible with a basic centrifuge, it allows sequential filling, internal mixing, and collection in straight microfluidic channels by simply adjusting the spinning speed, eliminating the need for complex valving. We demonstrated the Spinochip's efficacy in blood testing, where it successfully separated blood components, such as plasma, buffy coat, and red blood cells, from a single drop using centrifugation alone. This system enabled simultaneous hematocrit (R2 >0.99) and total white blood cell (R2 >0.93) quantification within a single microfluidic channel without the need for staining or special reagents. Remarkably, the Spinochip can perform hematocrit measurements on as little as 100 nL of blood, potentially paving the way for less invasive blood analysis. This innovative approach unlocks new possibilities in microfluidics, providing precise fluidic control and centrifugation for sample volumes as small as a few nanoliters.

Measurement of pulmonary hematocrit using oscillation of hyperpolarized 129Xe MR signals in blood.

To demonstrate the feasibility of measuring pulmonary hematocrit (Hct) in blood in vivo using oscillation of hyperpolarized 129Xe MR signals and its potential for disease assessment in animal models. Hyperpolarized 129Xe dynamic MR spectroscopy was performed on 10 anemia model rats and 10 control rats. A concise model based on hyperpolarized 129Xe MR signal oscillations was built for calculating pulmonary Hct. Blood tests and chemical shift saturation recovery were conducted on each rat to obtain Hct. Correlations of Hct obtained from different methods were analyzed using SPSS 22.0. Hct measurements were strongly correlated with blood test (Spearman correlation coefficient r = 0.871, p < 0.001) and chemical shift saturation recovery measurements (r = 0.956, p < 0.001). Hct was 0.198 ± 0.054 for the anemic cohort and 0.457 ± 0.039 for the control group (p < 0.001). We developed an approach that provided a way to quantify changes in pulmonary Hct using oscillations of hyperpolarized 129Xe signals. This method shows promise for noninvasive pulmonary Hct assessment and disease evaluation.

The thromboelastogram is confounded by hematocrit in clinical samples tested on both mechanical and acoustic platforms.

Red blood cells are critical participants in normal hemostasis, but in vitro experiments have shown that the thromboelastogram (TEG) maximum amplitude has a paradoxical inverse relationship with hematocrit. This study reviewed all samples at a single academic institution where any mechanical (TEG 5000) or acoustic (TEG 6s) TEG was drawn within 5 min of hematocrit measurement. A total of 7,176 samples were identified using complete TEG and conventional coagulation test data (6,384 mechanical, 744 acoustic, and 48 both). In the primary analysis, hematocrit was negatively associated with the maximum amplitude on both mechanical and acoustic platforms after adjusting for relevant confounders. This suggests that the thromboelastogram may misrepresent the contribution of red blood cells in normal hemostasis.

Elevated Interleukin-6 Levels as a Potential Marker of Neonatal Morbidity in Full-term Infants With Polycythemia: A Prospective Study.

To research and show that interleukin-6 (IL-6) and c-reactive protein (CRP), which can be used as infection markers, are also higher among newborns with polycythemia. The study took place in the neonatal intensive care unit of Zekai Tahir Burak Maternity Teaching and Research Hospital. Infants with a gestational age of >37 weeks were included in the study. Infants with chorioamnionitis, perinatal asphyxia, and positive blood culture were excluded from the study. Blood samples were obtained six hours after the delivery from the peripheral vein of the infants for measurements of central hematocrit, blood culture, IL-6, and CRP. Infants with a venous hematocrit value of >65% were grouped as the "polycythemia group," and the ones with a venous hematocrit value of <65% were designated as the "control group." Observation of significantly higher levels of CRP and IL-6 among newborns admitted to the neonatal intensive care unit due to different causes (such as respiratory distress, hypoglycemia, and feeding intolerance), but significantly higher IL-6 levels in newborns with polycythemia. Thirty-five newborns (18 infants in the polycythemia group and 17 infants in the control group) were enrolled in the study. The IL-6 values for the polycythemia group were higher than the upper normal limits (mean ± 2SD, 37.6 ± 55 vs 12 ± 5pg/dL, respectively; P = 0.00). The IL-6 values of the polycythemia group were found to be higher than the IL-6 values of the control group, with a mean ± 2SD of 37.6 ± 55 vs 6.3 ± 3.4pg/dL, respectively; this was significant (P = 0.00). Although the CRP values of the polycythemia group were found to be slightly higher than those of the control group (a mean ± 2SD of 3.06 ± 4.07 vs 1.54 ± 2.21mg/dL, respectively, P > 0.05), this was not significant. This study found a significant and robust statistical correlation between IL-6 and v. Hct values (P = 0.01, rs = 0.641). Contrary to IL-6 levels, however, a meaningful relationship was not found between CRP and v.htc values (P = 0.286; rs = 0.184).

Detection of Internal Hemorrhage via Sequential Inference: An In Silico Feasibility Study.

This paper investigates the feasibility of detecting and estimating the rate of internal hemorrhage based on continuous noninvasive hematocrit measurement. A unique challenge in hematocrit-based hemorrhage detection is that hematocrit decreases in response to hemorrhage and resuscitation with fluids, which makes hemorrhage detection during resuscitation challenging. We developed two sequential inference algorithms for detection of internal hemorrhage based on the Luenberger observer and the extended Kalman filter. The sequential inference algorithms use fluid resuscitation dose and hematocrit measurement as inputs to generate signatures to enable detection of internal hemorrhage. In the case of the extended Kalman filter, the signature is nothing but inferred hemorrhage rate, which allows it to also estimate internal hemorrhage rate. We evaluated the proof-of-concept of these algorithms based on in silico evaluation in 100 virtual patients subject to diverse hemorrhage and resuscitation rates. The results showed that the sequential inference algorithms outperformed naïve internal hemorrhage detection based on the decrease in hematocrit when hematocrit noise level was 1% (average F1 score: Luenberger observer 0.80; extended Kalman filter 0.76; hematocrit 0.59). Relative to the Luenberger observer, the extended Kalman filter demonstrated comparable internal hemorrhage detection performance and superior accuracy in estimating the hemorrhage rate. The analysis of the dependence of the sequential inference algorithms on measurement noise and plant parametric uncertainty showed that small (≤1%) hematocrit noise level and personalization of sequential inference algorithms may enable continuous noninvasive detection of internal hemorrhage and estimation of its rate.

Automatic characterization of capillary flow profile of liquid samples on μTADs based on capacitance measurement

Capillary flow profile of liquid samples in porous media is closely related to the important properties of liquid samples, including the viscosity and the surface energy. Therefore, capillary flow profile can be used as an index to differentiate liquid samples with different properties. Fast and automatic characterization of capillary flow profile of liquid samples is necessary. In this work, we develop a portable and economical capacitance acquisition system (CASY) to easily obtain the capillary flow profile of liquid samples on microfluidic thread-based analytical devices (μTADs) by measuring the capacitance during the capillary flow. At first, we validate the accuracy of this method by comparing with the traditional method by video analysis in obtaining the capillary flow profiles in μTADs of cotton threads or glass fiber threads. Then we use it to differentiate liquid samples with different viscosity (mixture of water and glycerol). In addition, capillary flow profile on μTADs with chemical valves (chitosan or sucrose) can also be obtained on this device. Lastly, we show the potential of this device in measurement of hematocrit (HCT) of whole blood samples. This device can be used to catalog liquid biological samples with different properties in point-of-care diagnostics in the near future.

On the mechanisms of stress-induced human spleen contraction: training for a higher blood oxygen-carrying capacity.

Despite its comparatively limited size in humans, spleen has been shown able to expel red-blood cells in the circulation and thus augment blood oxygen-carrying capacity under certain physiologic conditions. In the present state-of-the-art review, the short- and long-term regulation of spleen volume will be discussed. With regards to the physiological mechanism underlying spleen contraction, sympathetic activation stands as the prime contributor to the response. A dose-dependent relationship between specific interventions of apnea, exercise and hypoxia (imposed separately or in combination) and spleen contraction alleges to the trainability of the spleen organ. The trainability of the spleen is further substantiated by virtue of cross-sectional and longitudinal studies reporting robust increases in both organ volume at rest and subsequent spleen contraction. Alternative ways to assess the relationship between hematologic gains and the magnitude of spleen contraction (i.e., the reduction of spleen volume) will be presented herein. In extension of changes in the conventional measures of hemoglobin concentration and hematocrit, assessment of hemoglobin mass and total blood volume using the (safe, low-cost and time-efficient) CO-rebreathing technique could deepen scientific knowledge on the efficiency of human spleen contraction.

(067) EFFECTS OF ORAL TESTOSTERONE UNDECANOATE ON SEMEN PARAMETERS IN HYPOGONADAL MEN: AN INTERIM ANALYSIS OF A PROSPECTIVE PILOT STUDY

Abstract Introduction Testosterone replacement therapy (TRT) is commonly prescribed for men with hypogonadism. While injectable testosterone preparations are widely used, oral testosterone formulations have become an increasingly popular treatment option due to their ease of administration and avoidance of repeated intramuscular injections. However, the effects of oral testosterone on semen analysis (SA) parameters and male fertility potential remain understudied. Objective To evaluate changes in semen analysis parameters, including sperm concentration, motility, and morphology, among hypogonadal men receiving oral testosterone undecanoate therapy. Methods A pilot prospective study was conducted enrolling hypogonadal men. Exclusion criteria included prior TRT, use of clomiphene citrate or human chorionic gonadotropin, and azoospermia. Participants received oral testosterone undecanoate for 3 months. SA evaluating sperm concentration, motility, and volume were performed at baseline and 3 months. Concurrent biochemical assessment included measurement of reproductive hormone levels and hematocrit. An interim blood draw was made for drug titration to the therapeutic testosterone range. Baseline and follow-up semen parameters and hormonal values were compared using paired statistical tests. The primary outcome was a change in semen parameters after 3 months of oral testosterone therapy. Results At the interim analysis with 5 patients enrolled thus far, the mean age was 39.6 years (SD: 5.36). Overall, only one patient became azoospermic. When excluding him, a statistically significant increase in total testosterone levels was observed between baseline and follow-up (220.60 ± 42.54 ng/dL vs. 704.67 ± 188.83 ng/dL, p = 0.02), as well as for free testosterone (62.64 ± 9.78 ng/dL vs. 221.98 ± 43.78 ng/dL, p = 0.01). No significant differences were detected between baseline and follow-up values for estradiol, follicle-stimulating hormone, luteinizing hormone, or hematocrit levels. Semen analysis parameters, including sperm concentration, motility, and volume, did not demonstrate statistically significant changes from baseline to 3-month follow-up. These preliminary findings are summarized in Table 1. Conclusions In this pilot study expected increases in total and free testosterone levels were achieved, confirming adequate treatment. No significant changes in semen parameters or other reproductive hormones were observed after 3 months of treatment. Larger scale studies are needed to fully evaluate the effects of oral testosterone formulations on semen quality and male fertility potential. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast, Halozyme Investor: Sprout.

Overuse of Hematocrit Testing After Elective General Surgery at a Veterans Affairs Medical Center.

To evaluate the clinical usefulness and costs of routine postoperative hematocrit testing after elective general surgery. We reviewed charts of all patients who had elective general surgery at New Mexico Veterans Affairs Health Care System, Albuquerque hospital from 2011 through 2014. Demographic data and patient characteristics (eg, comorbidities, smoking/drinking history), estimated blood loss (EBL), pre- and postoperative hematocrit levels, and signs and symptoms of anemia were compared in patients who did or did not receive a blood transfusion within 72 hours of the operation. Of 1531 patients who had an elective general surgery between 2011 and 2014, ≥ 1 postoperative hematocrit levels were measured in 288 individual patients. There were 1312 postoperative hematocrit measurements before discharge (mean, 8.7; range, 1-44). There were 12 transfusions (0.8%) for patients without moderate to severe pre-existing anemia (hematocrit < 30%). Five of 12 transfused patients received intraoperative transfusions and 7 patients were transfused within 72 hours postoperation. No patients were transfused preoperatively. Of 12 patients receiving transfusion, 11 had EBL > 199 mL and/or signs of anemia. Risk factors for postoperative transfusion included lower preoperative hematocrit, increased EBL, and having either abdominoperineal resection or a total proctocolectomy. Routine postoperative hematocrit measurements after elective general surgery at US Department of Veterans Affairs medical centers are of negligible clinical value and should be reconsidered. Clinical judgment, laboratory-documented pre-existing anemia, a high-risk operation, or symptoms of anemia should prompt monitoring of patient postoperative hematocrit testing. This strategy could have eliminated 206 initial hematocrit checks over the 4 years of the study.

#2956 Hemodynamic evaluation of different replacement fluids during therapeutic plasmapheresis with Crit-line™

Abstract Background and Aims Therapeutic plasmapheresis (TP) is an extracorporeal technique used to remove pathogenic macromolecules from the plasma. Human serum Albumin (HSA) or fresh frozen plasma can be used as replacement fluid, alone or in combination, and with or without the addition of a crystalloid such as saline. There is wide practice variation in the type of replacement fluid and according the procedure of TP such as single plasma exchange (SPE) or double plasmafiltration (DFPP). Replacing plasma with crystalloid carries a risk of hypotension if the proportion of replacement with crystalloid exceeds 30%. CRIT-LINE™ monitor estimate RBV changes during HD based on measurements of hematocrit and could be used in hemodialysis to prevent hypotensive episodes. Method We conducted a retrospective case series study in a tertiary center to evaluate RBV changes during TP (SPE &amp; DFPP) in three patients with PIDC treated with chronic TP using SPE or DFPP according to guidelines. For each patient and procedure (SPE or DFPP) we compare different substitution fluid infusion protocol between 2021 and 2023. We evaluated each patient's sessions with CRITLINE™ continuous RBV monitoring during either SPE or DFPP with comparison of different replacement fluid protocols. For DFPP with plasmafractionator EC30 (Asahi Kasei Medical Co., Japan) or medopen30 (Infomed, Switzerland), we compare protocols as follows (1) continuous infusion of 500 ml of HSA 4% throughout the session and (2) 500 ml HSA 4% at the last 20 min of the session. For SPE, we compare protocols as follows (1) 100% volume of HSA 4% supplementation (2) a combination of 70% HSA 4% and 30% of saline started at the last part of the session (3) a combination of 70% HSA 4% and 30% of saline started at the first part of the of the session. Results BVM decreased by 15% ± 5% in DFPP session with 500 ml HSA 4% at the last 20 min of the session and by 12% ± 3 in DFPP session with continuous infusion of 500 ml of HSA 4% throughout the session . In SPE, BVM decreased by 18% ± 2 in session with a combination of 70% HSA 4% and 30% of saline and by 10% in session with 100% albumin substitution. Hypotensive episodes occurred in session with a combination of 70% albumin 4% and 30% of saline at the end of session. Conclusion CRITLINE IV continuous RBV monitoring is an interesting tool that can be used to evaluate the optimal substitution fluid in TP and for prevention of hypotension. Randomized control trial are needed to confirm the results.

#861 Intradialytic oxygen saturation in chronic hemodialysis patients—results from a large U.S. population

Abstract Background and Aims The study of intradialytic oxygen saturation (SO2) in hemodialysis (HD) patients is a significant yet under-explored area. This study's objective was to evaluate the epidemiological aspects of SO2 during HD. Method SO2 levels during HD were measured using the Crit-Line Monitor (CLM; Fresenius Medical Care North America, Waltham, MA), a device certified by the US Food and Drug Administration (FDA) for the measurement of hematocrit and SO2 in the extracorporeal circuit. CLM measurements were recorded at 10-second intervals and transmitted into Amazon Web Services (AWS) via Apache KAFKA, a real time streaming software. Apache KAFKA was rolled out in phased approach, started early 2021. We extracted CLM data between January 14, 2021, and July 30, 2023. CLM values with the following characteristics were deemed implausible and hence, excluded: SO2 ≤ 0 or ≥99.9; hematocrit &amp;lt; 15% or &amp;gt;60%. We computed basic statistics of SO2 for every HD session. We then excluded the sessions with the standard deviation of SO2 &amp;lt; 0.1%, an interquartile range of zero, and sessions with less than 360 SO2 measurements (i.e., less than 60 minutes of recording). Results We collected data from over 5.6 million HD sessions. After data cleaning, we retained 4.9 million HD sessions from 72,656 patients treated in 727 dialysis clinics across the US. The average duration of a session was 204.5 (±42.8) minutes. Per HD session, on average 1,227 (±257) SO2 measurements were recorded. The distribution of the number of SO2 measurements per HD session is shown in Fig. 1A. The mean of the session-level average SO2 was 88% (±15%). The distribution of session-level average SO2 is shown in Fig. 1B. The bimodal distribution of SO2 is attributed to the use of arterio-venous and central venous vascular accesses, respectively. Conclusion We collected and analysed a substantial dataset of intradialytic SO2 in a large US HD population. These data provide a rich source for future research into SO2 and its clinical correlates. Exploring intradialytic SO2 in depth will offer valuable insights to improve patient care and optimize treatment procedures.

Linking red blood cell functional phenotypes to environmental tolerance in high-altitude adapted deer mice

Oxygen (O2) is essential for vertebrate life, and complex cardio-respiratory systems have evolved to transport the gas from the environment to each individual cell. Even short disruptions of this O2 flux can have deleterious effects that are linked to numerous disease states. Animals that have adapted to hypoxic environments, such as deer mice ( Peromyscus maniculatus) native to high altitude, can provide valuable insight into naturally evolved solutions to O2 deprivation. Previous work has shown that high-altitude deer mice have evolved a higher hemoglobin O2 affnity and other coordinated changes across the O2 transport cascade that enable higher metabolic rates in hypoxia. Red blood cells (RBC) are the functional unit of O2 and carbon dioxide transport in the blood and play central roles in matching O2 supply and demand in the microcirculation by releasing signaling molecules such as ATP and gasotransmitters; but how these cellular mechanisms respond to hypoxic environments has not been studied. We hypothesized that high-altitude adaptation in deer mice has improved the function of RBCs for cardiovascular gas transport in hypoxia. Lab-raised breeding colonies of deer-mice were established from wild mice caught at low altitude (~400 m in the Great Plains of Nebraska) and at high altitude (~4300 m in the Rocky Mountains of Colorado). Using a common-garden experimental design, third-generation deer mice from high- and low-altitude populations were acclimated to warm normoxia (21°C, 21 kPa O2) or cold hypobaric hypoxia (5°C, 12 kPa O2) for 8 weeks. Blood samples were collected for measurements of hematocrit, hemoglobin concentration, RBC volume, plasma erythropoietin concentration, RBC contents of membrane transport and channel proteins (anion exchanger, aquaporin 1 and rhesus associated glycoprotein) by immunocytochemistry and western blotting, and carbonic anhydrase activity using biochemical techniques. The release of ATP from RBCs was measured in tonometers at decreasing levels of O2 by luminometry, and the vascular sensitivity to ATP was determined by wire myography on second-order mesenteric arteries. Finally, bone marrow samples were collected from the femurs to measure gene expression levels in the erythropoietic tissue. Our experimental design allowed us to examine the interactive effects of cold hypoxic environments on RBC phenotype, by untangling environmentally-induced plasticity from the signatures of adaptation that are unique to high-altitude natives. This work is providing a better understanding of how RBC function participates in matching cardiovascular O2 supply and demand in extreme hypoxia, which has important applications in animal and human health. This work was supported by a NSERC Canada Banting Postdoctoral Fellowship to TSH and a Discovery Grant to GRS. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Cotton threads encapsulated by thermal contraction tube for point-of-care diagnostics

Passive microfluidic devices based on capillary force are popular choices for point-of-care diagnostics. Paper, threads and cloth have been used to fabricate these microfluidic devices. Here, we introduced a novel method for packaging microfluidic thread-based analytical devices (μTADs) by encapsulating cotton threads in thermal contraction tubes. This package method can help to increase convenience during practice. At first, we investigate the influence of this package method on the capillary flow behavior and water absorption capacity of cotton threads. Then, we show the possibility of this package method in preparing μTADs with complex shapes. Lastly, we successfully use μTADs based on this package method for applications in point-of-care diagnostics including glucose detection in urine, fibrinogen detection in blood plasma, and plasma separation from whole blood samples and hematocrit (HCT) measurement. The package method is promising in expanding the applications of μTADs in point-of-care diagnostics.

Correlation of cerebral blood flow velocity with haematocrit in neonates at risk of polycythaemia: a COHORT study

Background: The incidence of polycythemia is 1.5-4% of all live births. To diagnose polycythemia, a venous hematocrit is necessary, and polycythaemia is linked to changes in cerebral blood flow. The primary objective is to compare cerebral blood flow velocity (CBFV) and resistance index (RI) between polycythemia and normocythemia groups. The secondary objective is to correlate the peak systolic velocity (PSV) of anterior and middle cerebral arteries (ACA and MCA) with hematocrit in neonates at risk for polycythemia. Methods: In a prospective observational study, babies with a gestational age of &gt;35 weeks and a risk factor for polycythaemia were enrolled in the study. Free-flowing venous blood was sent for haematocrit measurement between 2 and 6 hours of life. Repeat PCV is sent to babies with a prior value of PCV &gt;65% at 36 hours of life or before discharge. PSV, end diastolic velocity (EDV), RI of ACA and MCA were measured using Mindray portable ultrasound machine with a mini- curved ultrasound transducer (8-13 mhz). Data is entered in excel and analysed. Results: Out of 75 enrolled babies, 19 had polycythaemia. The mean PSV±SD of MCA was 27.84±6.04 cm/s and 27.27±5.74 cm/s in the normocythemia and polycythemia groups, respectively, at 6 hours of life, which is statistically insignificant. The mean PSV±SD of MCA was 31.41±6.92 cm/s and 29.61±6.57 cm/s in normocythemia and polycythaemia groups, respectively, at 36 hours of life, which is statistically insignificant too. Conclusions: Cerebral Doppler values did not correlate with haematocrit between the normocythemia and polycythemia groups in the neonates at risk of polycythemia.

Safety and Efficacy of a Novel Hemostatic Powder in Total Knee Arthroplasty.

This retrospective study evaluated the safety and efficacy of SURGICEL® Powder-Absorbable Hemostatic Powder (SP) made from oxidized regenerated cellulose (ORC) in total knee arthroplasty (TKA). Ninety-one patients who underwent TKA at Peking University Third Hospital between January 2024 and July 2024 were retrospectively analyzed. Hemostatic effectiveness was evaluated by comparing perioperative blood loss, hemoglobin (Hb) levels, hematocrit (HCT), and transfusion rates. Clinical safety was assessed by comparing complication rates, operation time, visual analog scale (VAS) scores, and postoperative fever. Finally, 85 patients were included: 43 in the SP group (using SP) and 42 in the control group (not using SP). There were no significant differences in age, sex, height, weight, preoperative HCT, or Hb levels. The volume of perioperative blood loss within 3 days in the SP group was reduced by approximately 154 ml compared with that in the control group. The Hb and HCT levels in the SP group were higher on the first, second, and third days after surgery, and there were significant differences between the two groups in terms of repeated measurements of HCT and Hb levels within 3 days postoperatively. There were no statistically significant differences in the operation time, postoperative VAS scores, complications, transfusion rates, or postoperative fever. In conclusion, this study confirmed that SP can significantly reduce perioperative blood loss in TKA without negatively affecting clinical outcomes.

Alteration in Haematological Parameters of Heteropneustes fossilis Exposed to Sodium Fluoride

This Study examines how sodium fluoride influences the hematological characteristics of Heteropneustes fossilis when subjected to sub-lethal doses. The fish were treated with sodium fluoride concentrations of 2.20 ppm (equivalent to 1/6 of the 96-hour LC50) and 4.40 ppm (corresponding to 1/3 of the 96-hour LC50) over periods of 15 and 30 days, respectively. The outcomes revealed noteworthy changes in various parameters, including total erythrocyte count, haemoglobin concentration, haematocrit measurements, mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV), among others. These results indicate that extended exposure to sodium fluoride adversely affects the haematological well-being of H. fossilis.

Standardized viscosity as a source of error in computational fluid dynamic simulations of cerebral aneurysms.

Computational fluid dynamics (CFD) simulations are a powerful tool for studying cerebral aneurysms, capable of evaluating hemodynamics in a way that is infeasible with imaging alone. However, the difficulty of incorporating patient-specific information and inherent obstacles of in vivo validation have limited the clinical usefulness of CFD of cerebral aneurysms. In this work we investigate the effect of using standardized blood viscosity values in CFD simulations of cerebral aneurysms when compared to simulations of the same aneurysms using patient-specific viscosity values derived from hematocrit measurements. The objective of this work is to determine the level of error, on average, that is, caused by using standardized values of viscosity in CFD simulations of cerebral aneurysms. By quantifying this error, we demonstrate the need for incorporating patient-specific viscosity in future CFD investigations of cerebral aneurysms. CFD simulations of forty-one cerebral aneurysms were conducted using patient-specific boundary conditions. For each aneurysm two simulations were conducted, one utilizing patient-specific blood viscosity derived from hematocrit measurements and another using a standardized value for blood viscosity. Hemodynamic parameters such as wall shear stress (WSS), wall shear stress gradient (WSSG), and the oscillatory shear index (OSI) were calculated for each of the simulations for each aneurysm. Paired t-tests for differences in the time-averaged maps of these hemodynamic parameters between standardized and patient-specific viscosity simulations were conducted for each aneurysm. Bland-Altman analysis was used to examine the cohort-wide changes in the hemodynamic parameters. Subjects were broken into two groups, those with higher than standard viscosity and those with lower than standard viscosity. An unpaired t-test was used to compare the percent change in WSS, WSSG, and OSI between patient-specific and standardized viscosity simulations for the two cohorts. The percent changes in hemodynamic parameters were correlated against the direction and magnitude of percent change in viscosity, aneurysm size, and aneurysm location. For all t-tests, a Bonferroni-corrected significance level of 0.0167 was used. 63.2%, 41.5%, and 48.7% of aneurysms showed statistically significant differences between patient-specific and standardized viscosity simulations for WSS, WSSG, and OSI respectively. No statistically significant difference was found in the percent changes in WSS, WSSG, and OSI between the group with higher than standard viscosity and those with lower than standard viscosity, indicating an increase in viscosity can cause either an increase or decrease in each of the hemodynamic parameters. On a study-wide level no significant bias was found in either direction for WSS, WSSG, or OSI between the simulation groups due to the bidirectional effect of changing viscosity. No correlation was found between percent change of viscosity and percent change of WSS, WSSG, or OSI, meaning an after-the-fact correction for patient-specific viscosity is not feasible. Standardizing viscosity values in CFD of cerebral aneurysms has a large and unpredictable impact on the calculated WSS, WSSG, and OSI when compared to CFD simulations of the same aneurysms using a patient-specific viscosity. We recommend implementing hematocrit-based patient-specific blood viscosity values for all CFD simulations of cerebral aneurysms.

Evaluation of blood type as a potential risk factor for hemorrhage during vaginal hysterectomy

ObjectiveTo examine the association between the O blood type and bleeding tendency in patient undergoing vaginal hysterectomy. MethodsThis was a retrospective cohort study including all women who had undergone vaginal hysterectomy at our institution between January 2015 and September 2020. All women underwent blood type and complete blood count testing pre- and post-operatively. The estimated intraoperative blood loss, the need for blood transfusion, pre- and postoperative hemoglobin and hematocrit measurements and surgical data were recorded for all patients. Patients with known coagulopathies or those taking antithrombotic medications were excluded from the study. Statistical analysis was performed using student t, χ2, Fischer exact, and ANOVA tests as well as a stepwise logistic regression model. ResultsThe study included 106 patients (35.2 %) with O and 195 patients (64.8 %) with non-O (i.e., A, B or AB) blood types. The O blood type was significantly associated with a higher risk for moderate blood loss (defined as a pre- to postoperative Hb or HCT drop >2gr or >6 %, respectively) (p = 0.012), but not with severe (defined as a Hb or HCT drop of >3gr or >9 %, respectively) perioperative bleeding, nor with the need for blood transfusion. ConclusionThe O blood type was found to be significantly associated with moderate but not with severe intraoperative bleeding during and following vaginal hysterectomy.

EMAS position statement: Testosterone replacement therapy in older men.

Late-onset hypogonadism is the clinical entity characterised by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in ageing men. It has been associated with metabolic syndrome, reduced bone mineral density, and increased cardiovascular morbidity and mortality risk. Although testosterone replacement therapy (TRT) reverses most of these conditions in young hypogonadal men, the risk/benefit ratio of TRT in older men is debatable. To update the 2015 EMAS statement on TRT in older men with new research on late-onset hypogonadism and TRT. Literature review and consensus of expert opinion. TRT should be offered only to symptomatic older men with confirmed low testosterone concentrations after explaining the uncertainties regarding the long-term safety of this treatment. TRT may be offered to men with severe hypogonadism and erectile dysfunction to improve sexual desire, erectile, and orgasmic function. It should also be considered in hypogonadal men with severe insulin resistance or pre-diabetes mellitus. TRT may also be considered, in combination with proven treatment strategies, for osteoporosis, or for selected patients with persistent mild depressive symptoms and/or low self-perceived quality of life, combined with standard medical care for each condition. TRT is contraindicated in hypogonadal men actively seeking fertility treatment. Due to a lack of data, TRT should not be routinely used in older men to improve exercise capacity/physical function, improve cognitive function, or prevent cognitive decline. TRT must be avoided in older, frail men with known breast cancer or untreated prostate cancer and all men who have had myocardial infarction or stroke within the last four months, and those with severe or decompensated heart failure. The quality of evidence regarding patients with previous prostate cancer or cardiovascular disease is too low to draw definitive conclusions. Any limits on duration of use are arbitrary, and treatment should continue for as long as the man feels the benefits outweigh the risks for him, and decisions must be made on an individual basis. Withdrawal should be considered when hypogonadism is reversed after the resolution of underlying disorder. Short-acting transdermal preparations should be preferred for TRT initiation in older men, but injectable forms may be considered subsequently. Older men on TRT should be monitored at 3, 6, and 12months after initiation and at least yearly thereafter, or earlier and more frequently if indicated. Evaluation should include assessment of the clinical response, and measurement of total testosterone, haematocrit, and prostate-specific antigen (PSA) concentrations. Bone density and/or quality should also be assessed. Obese and overweight patients should be encouraged to undergo lifestyle modifications, including exercise and weight loss, to increase endogenous testosterone.