Hemoglobin Loss Research Articles

A tale of two genes: divergent evolutionary fate of haptoglobin and hemopexin in hemoglobinless Antarctic icefishes.

The evolution of Antarctic notothenioid fishes in the isolated freezing Southern Ocean has led to remarkable trait gains and losses. One of the most extraordinary was the loss of the major oxygen carrier hemoglobin (Hb) in the icefishes (family Channichthyidae). Although the mechanisms of this loss and the resulting compensatory changes have been well studied, the impact of Hb loss on the network of genes that once supported its recycling and disposal has remained unexplored. Here, we report the functional fate and underlying molecular changes of two such key Hb-supporting proteins across the icefish family - haptoglobin (Hp) and hemopexin (Hx), crucial in removing cytotoxic free Hb and heme, respectively. Hp plays a critical role in binding free Hb for intracellular recycling and absent its primary client, icefish Hp transcription is now vanishingly little, and translation into a functional protein is nearly silenced. Hp genotype degeneration has manifested in separate lineages of the icefish phylogeny with three distinct nonsense mutations and a deletion frame shift, as well as mutated polyadenylation signal sequences. Thus, Hb loss appears to have diminished selective constraint on Hp maintenance, resulting in its stochastic, co-evolutionary drift towards extinction. Hx binds free heme for iron recycling in hepatocytes. In contrast to Hp, Hx genotype integrity is preserved in the icefishes and transcription occurs at levels comparable to those in the red-blooded notothenioids. The persistence of Hx likely owes to continued selective pressure for its function from mitochondrial and non-Hb cellular hemoproteins.

Self-prescribed nutrition supplements for hair loss following laparoscopic sleeve gastrectomy bariatric surgery: extent of the problem in a cohort of Chinese patients

Introductions: Hair loss is common after bariatric surgery. This study analyzes the extent and risk factors of hair loss following laparoscopic sleeve gastrectomy (LSG), and satisfaction of self-prescribed supplements.
 Methods: All patients of LSG bariatric surgery during June 2013 to August 2016 at Shanghai East Hospital affiliated to Tongji University, Shanghai, China were included in the study. Study variables were- age, gender, preoperative body mass index, hemoglobin, albumin, total cholesterol, iron, zinc, copper, folic acid, vitamin B12, vitamin D, and postoperative excess weight loss (% EWL), time and degree of hair loss, satisfaction of using supplements. Logistic regression was used to analyze risk factors for hair loss.
 Results: Total of 86 patients underwent LSG. After exclusion data on 54 patients (M=11, F=43) were analyzed. Hair loss was reported by 42/54 (77.8%, M=6, F=36), starting at 3.43±1.36 months and ending at 8.59±3.38. All of 11 severe hair losses were in female. The female gender, preoperative serum folic acid, and %EWL were significant risk factors for hair loss. Hair regrowth was reported by 39/42 (92.86%). The 15 patients who used various self-prescribed iron and zinc supplements reported no satisfactory benefit.
 Conclusions: Hair loss was seen in 3/4th of patents after LSG bariatric surgery. Self-prescribed nutrition supplements were used by 1/3 of patients without satisfaction. Female gender, preoperative serum folic acid, and %EWL were significant risk factors for hair loss.

Preliminary analysis of the effect of different administration routes of tranexamic acid on blood loss after total hip arthroplasty for female femur neck fractures

To study curative effect of different administration routes of tranexamic acid (TXA) on blood loss of elderly female patients with femoral neck fracture in total hip arthroplasty. From December 2015 to January 2018, 77 elderly women with femoral neck fractures undergoing total hip replacement were divided into four groups: group A, group B, group C, and group D. The group A (intravenous medication group) included 21 patients with an average age of (77.10±7.02) years old. The patients in group A received 15 mg/kg TXA intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The group B(local medication group) included 18 cases, with an average age of (73.83±6.56) years old. The patients in group B received saline intravenously 5 minutes before skin incision and intraoperative infusion of 3 g TXA into the joint cavity. The group C (combined medication group) included 19 cases, with an average age of (74.26±6.04) year old. The patients in group C received 15 mg/kg TXA intravenously before operation and intraoperative infusion of 1.5 g TXA into the joint cavity. The group D (control group) included 19 cases, with an average age of (76.69±9.27) years old. The patients in group D received saline intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The postoperative wound drainage volume, hemoglobin value, and the total blood loss calculated according to the height and weight and the hematocrit (HCT) before and after operation were observed and compared. In group A, the postoperative drainage was(111.91±35.02)ml; the change of hemoglobin was(26.86±12.99) g/L; and total blood loss was(628.60±306.78) ml. In group B, postoperative drainage was(108.89±36.61) ml; change of hemoglobin was(26.28±8.59) g/L; and the total blood loss was (584.41±250.86) ml. In group C, postoperative drainage was(102.63±47.36) ml; change of hemoglobin was (26.89±12.47) g/L; and total blood loss was(634.78±384.89) ml. In group D, postoperative drainage was(107.37±40.53) ml; change of hemoglobin was(40.95±12.48) g/L; and total blood loss was(1 005.24±483.37) ml. There were no significant differences among 4 groups in postoperative drainage volume (P>0.05). The hemoglobin and total blood loss in group A, B, and C were less than those in the group D(P<0.05), however, there were no significant differences among three groups(P>0.05). Application of TXA can effectively reduce blood loss during perioperative period of total hip arthroplasty for elderly women with femoral neck fracture. The best administration route and dosage should be further studied.

Bilateral unicompartmental knee arthroplasty: one stage or two stages?

Bilateral unicompartmental knee arthroplasty (UKA) may be performed as one- or two-stage procedure. Previous reports suggest that UKA provides a more rapid functional recovery than total knee arthroplasty. However, little data exist on whether bilateral UKA can be performed without increasing the perioperative risk compared with unilateral cases. We retrospectively compared 51 patients treated between January 2014 and March 2017 with single-stage UKA (group A) with 51 patients who underwent unilateral procedure (group B) to evaluate perioperative complications. We noted no statistically significant difference between the two groups in terms of gender, age and body mass index. Patients who underwent single-stage bilateral UKA had longer operating room time with respect to single procedure (93.2min vs. 50.7min). However, the bilateral group had a shorter cumulative operating room time (93.2min) compared to the unilateral group (101.5min) with a statistically significant difference (p < 0.05). Average hemoglobin loss at discharge was 3.1 points for group A and 2.4 for group B, with a statistically significant difference (p < 0.05). Our results demonstrated that bilateral simultaneous UKA does not increase the risk for perioperative complications. Total blood loss at discharge is statistically higher in bilateral UKA rather than unilateral UKA; however, cumulative hemoglobin loss is statistically lower in bilateral group. Patients can benefit from a single hospital admission and anesthetic time, while the shorter total inpatient stay and lower blood loss can reduce hospital costs in cases of bilateral surgery. Retrospective study.

Postoperative weight loss followed by radical cystectomy predicts poor prognosis in patients with muscle-invasive bladder cancer.

We aimed to investigate the impact of postoperative weight loss following radical cystectomy (RC) on patients' prognoses. RC and urinary diversion were performed in 512 consecutive patients with muscle-invasive bladder cancer at our hospitals between May 1996 and July 2018. Demographic clinical information, pre- and postoperative serum albumin, hemoglobin, and weight were evaluated retrospectively at 1month. We also evaluated the association of weight loss with complications and overall survival (OS) as estimated using the Kaplan-Meier method and compared using the log-rank test. Risk factors for poor OS were determined by Inverse Probability of Treatment Weighted (IPTW)-adjusted Cox regression analysis. In 385 patients who met the study search criteria, median postoperative weight loss from baseline at 1week and 1month was 1.1 (- 1.8%) and 3.2 (- 5.4%) kg, respectively. Patients with significant weight loss (defined as ≥ 7.5% at 1month) had higher-grade complications within 1month and had significantly shorter OS than those with weight loss of < 7.5%. Type of urinary diversion, loss of serum albumin, and loss of hemoglobin were not significantly associated with weight loss. IPTW-adjusted Cox regression analysis showed that such significant weight loss was an independent risk factor for poor OS. Weight loss followed by radical cystectomy was significantly associated with poor prognosis in patients with muscle-invasive bladder cancer.

Intravenous Tranexamic Acid Versus Topical Aminocaproic Acid: Which Method Has the Least Blood Loss and Transfusion Rates?

Introduction:Since the advent of antifibrinolytics, blood transfusions and their associated complications in total joint arthroplasty have decreased. Few studies have compared different antifibrinolytic types with respect to blood loss and transfusion rates. We sought to compare the blood loss and transfusion rates between epsilon-aminocaproic acid (EACA), tranexamic acid (TXA), and control.Methods:A total of 564 patients underwent primary total hip or total knee arthroplasty at our institution. Patients were divided into 3 groups: 183 EACA, 204 TXA, and 177 control. Patient demographics, hemoglobin, transfusion rates, and blood loss were collected.Results:Patient preoperative variables were similar. The control group had a mean estimated blood loss (EBL) of 1.48 L, with 51 units of packed red blood cells (pRBCs) given and 14.7% of patients receiving a blood transfusion. The EACA group had an EBL of 1.33 L, with 20 pRBCs given and 10.9% of patients receiving a transfusion. The TXA group had an EBL of 1.05 L, with 3 pRBCs transfused in 0.98% of patients. Compared with the control group, blood loss (P = 0.0014; P < 0.0001), number of pRBCs given (P = 0.007; P < 0.0001), and number of patients transfused (P = 0.012; P < 0.0001) were significantly lower in the EACA and TXA groups, respectively. TXA had significantly lower blood loss (P < 0.0001), lower number of tranfusions (P = 0.005), and less patients transfused (P = 0.003) compared with EACA.Conclusion:Our study reports lower blood loss, transfusion rates, and number of patients needing transfusion with both EACA and TXA in the setting of total joint arthroplasty. When comparing between EACA and TXA, TXA had lower blood loss, transfusion rates, and number of patients requiring transfusion.

Temporary simultaneous two-arterial occlusion for reducing operative blood loss during laparoscopic myomectomy: a randomized controlled trial

To evaluate the efficacy and safety of temporary simultaneous two-arterial occlusions (TESTO) in terms of operative blood loss during laparoscopic myomectomy. A total of 62 patients with symptomatic myomas were randomly assigned to either the experimental group or the control group. In the experimental group, the uterine arteries and utero-ovarian arteries were temporarily occluded with laparoscopic bulldog clamps. The primary outcome measures were operative blood loss and change in hemoglobin. There were no differences in baseline demographics between the two groups. The amounts of operative blood loss (56.3 ± 42.8mL vs. 138.2 ± 48.8mL, p < 0.001) and change in hemoglobin (1.0 ± 0.5g/dL vs. 1.7 ± 1.1g/dL, p = 0.002) were significantly lower in the experimental group than that in the control group. The total operative time was not significantly different between the two groups. However, it took less time for myoma enucleation (13.1 ± 14.6min vs. 17.6 ± 10.4min, p = 0.006) and for uterine suturing (19.5 ± 10.7min vs. 24.6 ± 8.8min, p = 0.006) in the experimental group than that in the control group. None of patients in both groups developed operative complications. The use of the TESTO procedure is effective in reducing operative blood loss and hemoglobin loss without causing morbidity during laparoscopic myomectomy.

Determination of hemoglobin mass in humans by measurement of CO uptake during inhalation of a CO-air mixture: a proof of concept study.

Measuring hemoglobin mass (Hbmass) using the carbon monoxide (CO) bolus rebreathing method is frequently used in research but has yet to be widely used in the clinical practice. The estimation of an adequate CO bolus may be difficult in patients with unknown Hbmass. In the present pilot study, a progressive inhalation technique for CO that leads to a linear individual adjusted COHb increase was evaluated. Sixteen healthy test subjects participated in the study (preliminary investigation: six; main study: ten). The reliability and validity of the new method were evaluated using multiple measurements of Hbmass with and without a defined blood donation and compared to a CO bolus method. The participants inhaled a CO‐air mixture (CO concentration: 1500 ppm) for a specific breathing duration. The CO uptake and COHb change were determined simultaneously. The typical error (reliability) in the repeated measurements was 2.4% (CI ± 4.7). The mean difference between the new method and the bolus method was 34 g (±41; P = 0.026). The measured hemoglobin loss in 490 mL of blood was 74 g (±35), and the calculated hemoglobin loss was 77 g (±4) (mean difference 3 g ± 34; P = 0.820). The new method was reliable and valid in a proof of concept study with healthy subjects. The total amount of CO and as a result the COHb increase is individually adjustable. Future studies in clinical settings are needed to determine if the method could be used in disease‐specific pathologies associated with changes in Hbmass.

Hidden blood loss and its risk factors after hip hemiarthroplasty for displaced femoral neck fractures: a cross-sectional study.

PurposeSeveral authors have reported the degree of total blood loss (TBL) following hemiarthroplasty for displaced femoral neck fracture; however, the research specifically investigating on hidden blood loss (HBL) after hip hemiarthroplasty is still lacking. The purpose of this study is to evaluate the HBL in patients who underwent hip hemiarthroplasty for displaced femoral neck fractures and to analyze its risk factors.Patients and methodsFrom January 2015 to December 2016, 212 patients (57 males and 155 females) with displaced femoral neck fracture undergoing hip hemiarthroplasty were included in this study. The demographic and relevant clinical information of the patients were collected. According to the Gross’s formula, each patient’s height, weight, and preoperative and postoperative hematocrit were recorded and used for calculating the total perioperative blood loss and HBL. Risk factors were further analyzed by multivariate linear regression.ResultsThe HBL was 525±217 mL, with 61.0%±13.6% in the total perioperative blood loss (859±289 mL), and the perioperative hemoglobin (Hb) loss was 23.8±7.4 g/L. Multivariate linear regression analysis revealed that HBL was positively associated with higher American Society of Anesthesiologists (ASA) classification (regression coefficient=62.169, 95% CI=15.616–108.722; P=0.009), perioperative gastrointestinal bleeding/ulcer (regression coefficient=155.589, 95% CI=38.095–273.083; P=0.010), and transfusion (regression coefficient=192.118, 95% CI=135.578–248.659; P<0.001). Compared with females, males had a risk of increased HBL (regression coefficient=87.414, 95% CI=28.547–146.280; P=0.004), and general anesthesia had an increased HBL compared with spinal anesthesia (regression coefficient=68.920, 95% CI=11.707–126.134; P=0.018).ConclusionHBL should not be ignored in patients who underwent hip hemiarthroplasty for displaced femoral neck fractures in the perioperative period, because it is a significant portion of TBL. Female patients, patients with higher ASA classification and perioperative gastrointestinal bleeding/ulcer, patients who were administered general anesthesia, or patients who underwent transfusion had a greater amount of HBL after hip hemiarthroplasty was performed. Having a correct understanding of HBL may help surgeons improve clinical assessment capabilities and ensure patients’ safety.

The effect of a fibrin sealant on knee function after total knee replacement surgery. Results from the FIRST trial. A multicenter randomized controlled trial.

BackgroundTotal knee replacement (TKR) is increasingly performed in short term hospital stay, making same day mobilization an important issue is after surgery. This implies little joint effusion by reducing intra-articular blood loss, which will enhance knee range of motion. The application of a topical fibrin sealant on the intraoperative bare bone and synovial tissue may contribute to better early full mobilization and thus improved functional outcomes. Since ambulation with a fully extended knee is less strenuous, we hypothesized that patients who received fibrin sealant would demonstrate improved early knee extension after six weeks compared to patients who received standard care.MethodsA multicenter randomized controlled trial in a consecutive series of osteoarthritis patients scheduled for TKR surgery. Participants were randomized to receive fibrin sealant or not before closing the knee joint capsule. Primary outcome was change in knee extension angle(°) at short term (2 weeks) follow-up (cExt). Secondary outcomes were 6-week extension angle, knee flexion angle, hemoglobin loss, blood transfusion rates, complication rates, the Knee Society Score, and the KOOS and EQ5D questionnaires.ResultsWhen data on primary outcome became available from 250 patients, an interim analysis was performed by an independent Data Safety Monitoring Board for safety and effectivity assessment. This analysis showed that sufficient patients were included to detect a cExt of 10° between both groups. Inclusion was stopped however, all in the meantime included patients were treated according to their randomization. A total of 466 were available for analysis. Both groups were comparable in terms of baseline characteristics. The estimated mean cExt difference was 0.2° (95%CI -0.5 to 0.9). No differences in secondary outcomes were found.ConclusionsNo beneficial effects or side effects were found of a topically applied fibrin sealant during TKR surgery. These results discourage the clinical use of a fibrin sealant in TKR.Trial registrationDutch Trial Register, NTR2500.

Bilateral Single-session vs Staged Mini-percutaneous Nephrolithotomy for Renal Stones: A Comparative Study

ObjectiveTo compare safety and efficacy of bilateral single-session mini-percutaneous nephrolithotomy (BSS-Mini-PNL) vs staged-Mini-PNL. Patients and MethodsAdult patients with bilateral renal stones indicated for PNL were managed with BSS-Mini-PNL (45 patients and 90 renal units) and prospectively compared vs staged-Mini-PNL (55 patients and 110 renal units) between July 2014 and December 2017. Mini-PNL was done through 18-Fr tract in prone position under regional anesthesia and fluoroscopy using pneumatic lithotripsy. A semirigid ureteroscope (8.5/11.5 Fr) was used. Mann-Whitney, Student t, chi-square, or Fisher's exact tests were used as appropriate. ResultsBoth groups were comparable in characteristics of stones and patients. Stone burden was 3.36 ± 1.61 vs 3.38 ± 1.18 cm2 in BSS-Mini-PNL vs staged-Mini-PNL, respectively. Staghorn stones were present in 13.3% vs 8.2% in BSS-Mini-PNL vs staged-Mini-PNL, respectively. There was no significant difference in the number of required tracts (1.34 ± 0.6 vs 1.25 ± 0.51 tract/renal unit) as well as the rate of tubeless Mini-PNL (81.1% vs 85.5%) or stone-free rate (90% vs 92.7%) in BSS-Mini-PNL vs staged-Mini-PNL, respectively. BSS-Mini-PNL had significantly shorter operative time (126.22 ± 37.2 vs 169.63 ± 61.28 minutes), shorter hospital stay (2 [1-8] vs 4 [2-16] days) and higher hemoglobin loss (1.1 [0.1-2.8] vs 0.5 [0.1-2.17] gm/d) than staged-Mini-PNL. The complications profile (17.8% vs 13.6%) and rate of blood transfusion (4.4% vs 3.6%) were comparable in BSS-Mini-PNL vs staged-Mini-PNL, respectively, without significant difference. ConclusionBSS-Mini-PNL is comparable to staged-PNL as regard stone-free rate and complications according to the selection criteria of the present study. However, BSS-Mini-PNL is associated with significant reduction in the cumulative operative time and hospital stay, which are reflected on the overall cost.

Prospective study to compare efficacy of systemic, local and combined administration of tranexamic acid in reducing blood loss in total knee arthroplasty

Perioperative blood loss is a major challenge to surgeon in TKA. There are different methods to reduce blood loss in total knee arthroplasty (TKA). The efficacy of both systemic and local tranexamic acid (TXA) administration is demonstrated in the literature. The aim of the present study was to compare the efficacy of systemic, local and combined (systemic + local) administration of TXA in reducing blood loss after TKA. 47 patients undergoing TKA were divided into three groups (IV 18 cases; IA 20 cases, and combined (IV + IA) 9 cases) corresponding to the method of TXA administration. Demographic data, preoperative hemoglobin and platelet levels were collected. The primary outcome was the maximum hemoglobin loss, while the secondary outcomes were the amount of blood in the drain (cc/hour) and the rate of transfusions. Student’s t-test or a χ2 test was used to evaluate between-group differences, using p

Sa1226 USE OF HEMOSTATIC POWDER (TC-325) IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING AT A TERTIARY CENTER: A CASE SERIES

Upper gastrointestinal bleeding remains an important medical problem nowadays. Despite recent advances in endoscopic treatment, up to 30% of the patients will present treatment failure or recurrence of bleeding, with up to 10% of mortality. The hemostatic powder TC-325 is a novel hemostatic method with good efficacy in previous studies. However, few patients have been treated with TC-325 and the best clinical scenarios for its use are still to be determined. Evaluate the effectiveness of TC-325 by determining the immediate hemostasis rate (IHR) and the early and late rebleeding rates, and associated adverse events in patients with upper gastrointestinal bleeding. This is prospective observational case series. All patients with upper gastrointestinal bleeding treated with TC-325 from December 2015 to September 2017 were included in this study. Immediate hemostasis was defined as complete cessation of the bleeding by the end of the endoscopic procedure. Rebleeding was defined as hematemesis or melena with a hemoglobin loss of at least 3 g/dL compared to the post procedure hemoglobin level. Rebleeding was classified in early (3 days after the procedure) and late (after 3 days). The TC-325 was used as first-line or salvage therapy at the discretion of the endoscopist. The follow-up period was 30 days. Thirty patients werncluded (mean age 55,7 years), including 3 pediatric patients. TC-325 was used as first-line therapy in 17 patients (56,7%) and as salvage therapy in thirteen (43,3%). In twenty-three patients (76,7%) the procedure was performed in the ICU. Twenty-five (83,3%) had bleeding from benign lesions; while five (16,7%) had bleeding tumors. The benign bleeding lesions included 6 duodenal ulcers, 3 gastric ulcers, 2 anastomosis, 2 esophageal ulcers, 1 GAVE, 1 jejunal ulcer in a patient with altered anatomy and 5 post stem cell transplantation patients with graft-versus-host disease (GVHD). The malignant bleeding lesions included 1 gastric adenocarcinoma, 1 duodenal neuroendocrine tumor, 1 metastatic colon adenocarcinoma, 1 duodenal invasion by pancreatic cancer and 1 esophageal squamous cell carcinoma. The immediate hemostasis rate was 100%. The early rebleeding rate was 23,3 %. The late rebleeding rate was 16,7 %. There were no adverse events related to the use of TC-325 hemostatic powder. One patient died due to massive rebleeding (3,3%). TC-325 hemostatic powder achieved primary hemostasis in all patients. Early and late rebleeding rates were 23,3% and 16,7% respectively. This reveals an overall high rebleeding rate. There were no adverse events directly associated with the use of TC-325. Hemostatic powders may play an important role in patients with diffuse, malignant or GVHD associated bleeding.Large duodenal ulcer caused by CMV infection. A - Persistent bleeding after epinephrine injection, electrocoagulation and hemoclip deployment. B- Hemostasis after use of TC-325 .View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Mo1108 CAN THE ORBIT SCORE PREDICT DELAYED BLEEDING AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION IN PATIENTS RECEIVING ORAL ANTICOAGULATION THERAPY?

Oral anticoagulation therapy increases the risk of delayed bleeding after colorectal endoscopic dissection (ESD). The Outcomes Registry for Better Informed Treatment (ORBIT) score was recently proposed as a simple predictive model for major bleeding in patients with atrial fibrillation receiving warfarin or direct oral anticoagulants (DOACs). This study aimed to investigate the usefulness of the ORBIT score for predicting delayed bleeding after colorectal ESD in patients receiving oral anticoagulation therapy. This was a retrospective, single-center study. Colorectal ESD was performed on 581 consecutive patients with 635 lesions at our hospital between April 2005 and August 2017. Of these, we enrolled 23 patients receiving oral anticoagulation therapy. In patients with multiple lesions, the first treated or submucosal invasive lesion was considered the representative lesion. The ORBIT score was calculated from the total score of the following five factors: reduced hemoglobin/hematocrit and bleeding history (2 points each); and insufficient kidney function, antiplatelet treatment, and age >74 years (1 point each). In the original report, the high-risk group was defined as patients with a score of ≥4 points. Delayed bleeding was defined as bleeding requiring endoscopic intervention after ESD. Major delayed bleeding was defined as a hemoglobin loss of >2 g/dL or a transfusion requirement. The primary outcome was the incidence of delayed/major delayed bleeding associated with a high risk based on the ORBIT score. The secondary outcomes were predictive factors and diagnostic accuracy of the ORBIT score for delayed/major delayed bleeding. Of 23 patients, 9 were categorized as high-risk patients. The incidence of delayed bleeding and major delayed bleeding were 39.1% (warfarin, 3/8; DOAC, 6/15) and 17.4% (warfarin, 1/8; DOAC, 3/15), respectively. Delayed bleeding occurred more frequently in the high-risk group than in the non-high-risk group (66.7% vs. 21.4%, p=0.077). Major delayed bleeding was significantly more frequent in the high-risk group than in the non-high-risk group (44.4% vs. 0.0%, p=0.014). ORBIT score ≥4 was the only predictive factor for delayed bleeding in logistic regression analysis including age, sex, diabetes mellitus, hypertension, warfarin/DOAC, ORBIT score ≥4, location, macroscopic type, tumor diameter, procedure time, submucosal fibrosis, and histologic type (odds ratio, 7.33; 95% confidence interval, 1.11-48.26; p=0.038). The sensitivity and specificity of ORBIT score 4 for delayed/major delayed bleeding were 78.6%/73.7% and 66.7%/100.0%, respectively. All delayed bleeding cases were managed without surgery. ORBIT score might be useful for predicting delayed bleeding, especially major delayed bleeding, in colorectal ESD for patients receiving oral anticoagulation therapy.

Patient-Specific Instrumentation Affects Perioperative Blood Loss in Total Knee Arthroplasty.

Patient-specific instrumentation (PSI) may contribute to reduced blood loss related to total knee arthroplasty (TKA). The purpose of this study was to compare the estimated hemoglobin (Hb) and red blood cell volume (RBC) losses in two groups of patients undergoing TKA with PSI and conventional instrumentation. Pre- and postoperative blood samples were collected from 22 patients randomly assigned to receive a PSI-assisted or conventional TKA. Post- to preoperative Hb difference was calculated and RBC loss was estimated according to Sehat et al. A significant difference in Hb reduction in favor of the PSI group was registered on the last day of stay (p = 0.0084) and significant treatment effect (p = 0.027) on Hb reduction after intervention was found with a regression model for longitudinal measurements. This study demonstrated that PSI leads to a significant trend in earlier Hb regain. These promising results suggest a beneficial effect of PSI in blood loss reduction.

Complications and risk management in the use of the reaming-irrigator-aspirator (RIA) system: RIA is a safe and reliable method in harvesting autologous bone graft.

BackgroundAutologous bone grafting (ABG) remains the gold standard for augmentation of bone defects. The RIA system has become more prevalent, but evidence regarding risk management and complications remain scarce. This study presents the risk management and complications associated with RIA in the largest single-center case series to date.MethodsAll records, operative notes, lab data and radiographs of patients receiving a RIA procedure at Heidelberg´s University Hospital between 01/01/2010 and 31/12/2016 were reviewed. Multivariate logistic regression models adjusting for clinically relevant covariates were used to examine the respective relevance regarding the presence and absence of prolonged postoperative pain (PPP).ResultsA total of 341 RIA procedures on 306 patients were performed at our level-1 trauma center. The femur was the main donor site (98.53%; N = 336) whereas only in 1.47% (N = 5) the tibia was utilized. A total of 11 patients showed a relevant loss of hemoglobin requiring blood transfusion. A total of 22 patients suffered from PPP directly associated with the RIA procedure resulting in prevalence of 6.45%. The 6 major complications in our study were of diverse origin and all intraoperative complications took place in the early phase of the RIA procedure in our center (2010–2013). Our data revealed influence of sex (p = 0.0459) and age (p = 0.0596) on the criterion PPP. The favored model including sex and age resulted in an AUC of 66.2% (CI: 55.5%-76.9%).ConclusionPerioperative blood loss remains a prevalent complication during RIA reaming. In addition, PPP occurs with a prevalence of 6.45%. This study showed a complication rate of 1.76%, emphasizing RIA´s overall safety and furthermore highlighting the need for vigilance in its application and prior extensive hands-on training of surgeons. Level of Evidence: II.

Shape-Shifted Red Blood Cells: A Novel Red Blood Cell Stage?

Primitive nucleated erythroid cells in the bloodstream have long been suggested to be more similar to nucleated red cells of fish, amphibians, and birds than the red cells of fetal and adult mammals. Rainbow trout Ficoll-purified red blood cells (RBCs) cultured in vitro undergo morphological changes, especially when exposed to stress, and enter a new cell stage that we have coined shape-shifted RBCs (shRBCs). We have characterized these shRBCs using transmission electron microscopy (TEM) micrographs, Wright–Giemsa staining, cell marker immunostaining, and transcriptomic and proteomic evaluation. shRBCs showed reduced density of the cytoplasm, hemoglobin loss, decondensed chromatin in the nucleus, and striking expression of the B lymphocyte molecular marker IgM. In addition, shRBCs shared some features of mammalian primitive pyrenocytes (extruded nucleus surrounded by a thin rim of cytoplasm and phosphatidylserine (PS) exposure on cell surface). These shRBCs were transiently observed in heat-stressed rainbow trout bloodstream for three days. Functional network analysis of combined transcriptomic and proteomic studies resulted in the identification of proteins involved in pathways related to the regulation of cell morphogenesis involved in differentiation, cellular response to stress, and immune system process. In addition, shRBCs increased interleukin 8 (IL8), interleukin 1 β (IL1β), interferon ɣ (IFNɣ), and natural killer enhancing factor (NKEF) protein production in response to viral hemorrhagic septicemia virus (VHSV). In conclusion, shRBCs may represent a novel cell stage that participates in roles related to immune response mediation, homeostasis, and the differentiation and development of blood cells.

Oxidized Regenerated Cellulose Can Reduce Hidden Blood Loss after Total Hip Arthroplasty: A Retrospective Study

ABSTRACTBackground: There is a large amount of hidden blood loss (HBL) after total hip arthroplasty (THA), but the effective and safe methods to reduce HBL are still controversial. Methods: Sixty-nine consecutive patients who underwent THA in our hospital from January 2015 to December 2015 were analyzed retrospectively. The patients were divided into two groups, Group A (THA without oxidized regenerated cellulose) and Group B (THA with oxidized regenerated cellulose). Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, and surgical complications were collected and analyzed. Results: A total of 37 (54%) patients used oxidized regenerated cellulose (ORC) in operation. The total blood loss (TBL), postoperative blood loss (PBL), hemoglobin (Hb) loss, and hidden blood loss (HBL) in group B were significantly lower than in group A. Conclusions: The use of ORC to fill the bone surface and soft tissue gap before incision closure can effectively reduce HBL and may be a potential treatment for blood prevention after THA.

MP62-11 HOLMIUM LASER ENUCLEATION VERSUS BIPOLAR RESECTION FOR LARGE PROSTATE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2018MP62-11 HOLMIUM LASER ENUCLEATION VERSUS BIPOLAR RESECTION FOR LARGE PROSTATE Ahmed Yehia, Enmar Habib, Mohammed ElSheemy, Hussein Aly, Samir Morsy, A Hossam, and M Abdelazeem Ahmed YehiaAhmed Yehia More articles by this author , Enmar HabibEnmar Habib More articles by this author , Mohammed ElSheemyMohammed ElSheemy More articles by this author , Hussein AlyHussein Aly More articles by this author , Samir MorsySamir Morsy More articles by this author , A HossamA Hossam More articles by this author , and M AbdelazeemM Abdelazeem More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To compare safety and efficacy of bipolar resection (BPR) vs holmium laser enucleation (HOLEP) for large prostate. METHODS 141 patients with BPH (larger or equal to 75 gm) indicated for surgical intervention were included in this prospective cohort study. Patients were classified into 2 groups. Group A (71 cases) treated by HOLEP (Versa pulse 100 W; Lumenis; Germany) using 550 micron laser fibers (2 J - 50 Hz for enucleation and 1.5 J - 30 Hz for hemostasis). Enucleation was followed by use of morcellator (Versa cut). Group B (70 cases) was treated by BPR using bipolar resectoscope (Karl Storz) and its generator (AUTOCON® II 400 ESU). Power output was set at 5 for resection and 6 for coagulation. Preoperative criteria, operative and postoperatiove findings were compared between both groups using Mann-Whitney test, Chi-Square test, Student-t test or Fisher-Exact test as appropriate. Preoperative vs postoperative findings were compared in each group using Wilcoxon-signed rank test. RESULTS Perioperative and follow-up findings are presented in Table 1. Adenoma size and patients on anticoagulants were significantly higher in HOLEP group. Hospital stay, catheterization time and hemoglobin loss were significantly better in HOLEP group. Follow up was done for 6 months in all patients. There was significant postoperative improvement in IPSS score and Qmax in each group. Qmax improvement was significantly better in Group A. There was no significant difference in postoperative complications between both groups but blood transfusion was clinically higher in group B (and near significance, p = 0.058). CONCLUSIONS HOLEP and bipolar resection are safe and effective for treatment of large prostate. Although patients on anticoagulants or with larger adenoma sizes were significantly present in a higher rate in HOLEP group, HOLEP provided a better voiding pattern, hemoglobin loss, hospital stay and catheterization time. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e836 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ahmed Yehia More articles by this author Enmar Habib More articles by this author Mohammed ElSheemy More articles by this author Hussein Aly More articles by this author Samir Morsy More articles by this author A Hossam More articles by this author M Abdelazeem More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Tranexamic acid reduces blood loss after primary shoulder arthroplasty: a double-blind, placebo-controlled, prospective, randomized controlled trial

BackgroundTranexamic acid (TXA) is an antifibrinolytic that has been shown to decrease blood loss and transfusion rates after hip and knee arthroplasty, with only limited evidence to support its use in shoulder arthroplasty. This study was conducted to determine whether intravenous (IV) TXA is more effective than placebo in reducing blood loss after primary total shoulder arthroplasty (TSA).MethodsIn this prospective, double-blind, placebo-controlled, randomized clinical trial, patients undergoing primary anatomic and reverse TSA were randomized to receive 1 g of intravenous TXA or a placebo of an equivalent volume of intravenous normal saline administered 10 minutes before the incision. The primary outcome measurement was calculated postoperative blood loss. Secondary outcomes included transfusion rates, weight of hemoglobin loss, hospital length of stay, and thromboembolic events.ResultsThe study enrolled 110 patients, 2 of whom were excluded because they did not have a postoperative hemoglobin measurement, and the remaining 108 patients (52 for TXA, 56 for placebo) were analyzed. There were no significant differences between TXA and placebo groups in preoperative characteristics. For the primary outcome, the TXA group had significantly lower postoperative blood loss of 1100.9 ± 367.4 mL compared with 1274.5 ± 460.0 mL for the placebo group (P = .03). For secondary outcomes, TXA had lower weight of hemoglobin loss compared with placebo (152.2 ± 57.3 g vs. 178.0 ± 65.8 g; P = .03). No patients in the TXA or placebo groups required a transfusion.ConclusionsIntravenous TXA reduced blood loss after primary TSA compared with placebo.