Reduction In Hemoglobin Research Articles

Alkyl Benzene Sulfonate Induced Acute Toxicity and Potential Alteration of Growth, Hematological, Biochemical, Enzymological and Stress Biomarkers in Oreochromis mossambicus (Peters, 1852)

The present study was intended to determine the toxic effect of Alkyl benzene sulfonate (ABS) on Oreochromis mosambicus. Probit analysis was employed to determine the 96h LC50 of surfactants for O. mossambicus. Moreover, the survivability of surfactant exposed was calibrated and validated using general threshold survival models (GUTS) in terms of required data sets and fit performance. Subsequently, fish were assigned to experimental groups exposed to 10% and 20% of 96h LC50 of surfactants for the period of 45 d to assess the changes in growth, hematological, plasma biochemical, and enzymological as well as stress enzyme parameters in gills and liver by employing standard protocol. The 24h, 48h, 72h and 96h LC 50 values of ABS to O. mossambicus are 0.55mg/l, 0.28 mg/l, 0.09 mg/l and 0.06 mg/l respectively. Moreover, the GUTS- IT model better projected the survivability in O. mossambicus for ABS exposure. During sublethal exposure, a consequential reduction in specific growth rate (SGR), RBC, hemoglobin (Hb), hematocrit (Ht) value, plasma protein, albumin, and acetylcholinesterase (AChE) activities in gills and liver, as well as significant induction in gastrosomatic index (GSI), feed conversion ratio (FCR), plasma glucose, creatinine, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels and catalase (CAT), superoxide dismutase (SOD), malondialdehyde (MDA) in gills and liver were observed in exposed fish. Moreover, in both gills and the liver, GST and glutathione peroxidase (GPx) exhibited a significant initial increase followed by a subsequent decrease in exposed fish. The effects of ABS on fish were identified using the correlation matrix, integrated biomarker response (IBR) and biomarker response index (BRI). These findings show that exposure to surfactant affects multiple biomarkers in O. mossambicus.

Combinations of cypermethrin and dimethoate alter behavior, hematology and histology of African Catfish, Clarias gariepinus.

Cypermethrin and dimethoate are pesticides frequently used in agriculture to eliminate pests. Contemporaneity of these and other pesticides in commercial preparations and several aquatic ecosystems is well known, though poorly studied. This study aims to evaluate the effect of sublethal concentrations of combinations of cypermethrin and dimethoate on juvenile catfish, Clarias gariepinus, given that the pesticides concomitantly occur in the floodplains were the fish breed. Behavioral, hematological and histopathological changes in juvenile fish exposed to sublethal concentrations were monitored for 96 hours. Pesticide exposed fish exhibited abnormal behaviors such as erratic swimming, frequent air gulping, sudden jerk movement and rapid opercula movement and these were more pronounced in higher concentrations. Significant reductions in erythrocytes (0.83-20.94%), hemoglobin (4.12-29.23%) and PVC (7.14-28.57%) and increase in leucocytes (4.84-9.32%) were observed (p<0.05). Mean corpuscular hemoglobin concentration (MCHC), mean corpuscular hemoglobin (MCH) and mean cell volume (MCV) reduced significantly in the exposed groups compared to the control. Infiltration of inflammatory cells, distortion of cell architecture, hemorrhage and necrosis were the observed histopathological damages in the heart, brain, gill, liver, kidney and fin of exposed fish. These pathological damages were more severe than previously reported for either chemical. Therefore, the use of these chemicals in agriculture should be regulated, especially near fish breeding sites.

Predicting the level of anemia among Ethiopian pregnant women using homogeneous ensemble machine learning algorithm

BackgroundMore than 115,000 maternal deaths and 591,000 prenatal deaths occurred in the world per year with anemia, the reduction of red blood cells or hemoglobin in the blood. The world health organization divides anemia in pregnancy into mild anemia (Hb 10–10.9 g/dl), moderate anemia (Hb 7.0–9.9 g/dl), and severe anemia (Hb < 7 g/dl). This study aims to predict the level of anemia among pregnant women in the case of Ethiopia using homogeneous ensemble machine learning algorithms.MethodsThis study was conducted following a design science approach. The data were gathered from the Ethiopian demographic health survey and preprocessed to get quality data that are suitable for the machine learning algorithm to develop a model that predicts the levels of anemia among pregnant. Decision tree, random forest, cat boost, and extreme gradient boosting with class decomposition (one versus one and one versus rest) and without class decomposition were employed to build the predictive model. For constructing the proposed model, twelve experiments were conducted with a total of 29,104 instances with 23 features, and a training and testing dataset split ratio of 80/20.ResultsThe overall accuracy of random forest, extreme gradient boosting, and cat boost without class decompositions is 91.34%, 94.26%, and 97.08.90%, respectively. The overall accuracy of random forest, extreme gradient boosting, and cat boost with one versus one is 94.4%, 95.21%, and 97.44%, respectively. The overall accuracy of random forest, extreme gradient boosting, and cat boost with one versus the rest are 94.4%, 94.54%, and 97.6%, respectively.ConclusionFinally, the researcher decided to use cat boost algorithms with one versus the rest for further use in the development of artifacts, model deployment, risk factor analysis, and generating rules because it has registered better performance with 97.6% accuracy. The most determinant risk factors of anemia among pregnant women were identified using feature importance. Some of them are the duration of the current pregnancy, age, source of drinking water, respondent’s (pregnant women) occupation, number of household members, wealth index, husband/partner's education level, and birth history.

Precision Medicine: Determination of Ribavirin Urinary Metabolites in Relation to Drug Adverse Effects in HCV Patients.

The most commonly used antiviral treatment against hepatitis C virus is a combination of direct-acting antivirals (DAAs) and ribavirin (RBV), which leads to a shortened duration of therapy and a sustained virologic response until 98%. Nonetheless, several dose-related side effects of RBV could limit its applications. This study aims to measure the urinary concentration of RBV and its main metabolites in order to evaluate the drug metabolism ability of HCV patients and to evaluate the adverse effects, such as anemia, with respect to RBV metabolite levels. RBV and its proactive and inactive metabolites were identified and quantified in the urine of 17 HCV males with severe liver fibrosis using proton nuclear magnetic resonance (1H-NMR) at the fourth week (TW4) and at the twelfth week of treatment (EOT). Four prodrug urinary metabolites, including RBV, were identified and three of them were quantified. At both the TW4 and EOT stages, six HCV patients were found to maintain high concentrations of RBV, while another six patients maintained a high level of RBV proactive metabolites, likely due to nucleosidase activity. Furthermore, a negative correlation between the reduction in hemoglobin (Hb) and proactive forms was observed, according to RBV-triphosphate accumulation causing the hemolysis. These findings represent a proof of concept regarding tailoring the drug dose in relation to the specific metabolic ability of the individual, as expected by the precision medicine approach.

Association of In-Hospital Hemoglobin Drop With Decreased Myocardial Salvage and Increased Long-Term Mortality in Patients With Acute ST-Segment-Elevation Myocardial Infarction.

BackgroundAnemia and blood loss occur often in patients with ST‐segment–elevation myocardial infarction (STEMI). In‐hospital hemoglobin drop is associated with 1‐year mortality in patients with acute coronary syndrome. However, data on the effect of hemoglobin reduction on myocardial salvage and long‐term outcomes are scarce. We investigated the impact of in‐hospital hemoglobin drop on myocardial salvage and 5‐year mortality in patients with STEMI treated with primary percutaneous coronary intervention.Methods and ResultsIn‐hospital hemoglobin drop was defined as a decrease in hemoglobin levels from admission and nadir hemoglobin values. Patients were categorized as having the following: no drop, minimal drop (<3 g/dL), minor drop (≥3 to <5 g/dL), and major drop (≥5 g/dL). Myocardial area at risk and infarct size were measured using serial single‐photon emission computerized tomography imaging. The co‐primary outcomes were myocardial salvage and 5‐year all‐cause mortality. Of 1204 patients, 1169 (97.1%) showed a hemoglobin drop during hospitalization: minimal, minor, and major drop occurred in 894 (74.3%), 214 (17.8%), and 61 (5.1%) patients, respectively. Myocardial salvage was reduced in patients with minimal (median, 0.53 [interquartile range, 0.27–0.83]), minor (median, 0.40 [interquartile range, 0.18–0.62]), and major (median, 0.40 [interquartile range, 0.14–0.77]) drop compared with patients without drop (median, 0.70 [interquartile range, 0.44–1.0], P<0.001). After adjusting for covariates, hemoglobin drop remained an independent correlate of poor myocardial salvage. A drop of ≥3 g/dL was associated with reduced left ventricular function at 6 months and with increased mortality at 5‐year follow‐up after STEMI.ConclusionsIn patients with STEMI undergoing primary percutaneous coronary intervention, in‐hospital hemoglobin drop was associated with reduced myocardial salvage, left ventricular function, and increased long‐term mortality.

Spectrophotometric analysis of post-mortem lividity: A new objective measure to define time of death

The correct definition of time of death often represents a key to solving judicial cases. One of the methods for determination of the time interval since death is at present the quantitative and qualitative characteristics of hypostases. However, the simple observation of the degree and fixation of hypostases is based on nonobjective parameters, and is therefore characterized by an intrinsic variability that can compromise their reliability. The purpose of the present study was to define an objective and standardizable method that allows estimation of time since death with good approximation. To achieve this, the instrument used was based on spectrophotometry, to analyze only the hemoglobin contribution to skin color, while excluding the role of melanin. This made it possible to analyze a hypostatic area, with a numerical value defined as a measure of the hemoglobin content before and after application of standardized pressure for a defined time interval. The study was conducted on 100 cadavers in various wards. The variables considered in the study were: Hb-pre (mean hemoglobin measure before weight force application); Hb-post (mean hemoglobin measure after weight force application), ΔHb (change in mean hemoglobin measures from before to after weight force application); and red% Hb (percentage reduction in hemoglobin after weight force application, compared to the mean measure of hemoglobin before weight force application). The analysis showed statistically significant correlations between red% Hb in the skin area analyzed and time from death to examination. This provided a mathematical formula to estimate time since death with good reliability ( ± 4 h, 50 min).

Risk of hemolysis in Plasmodium vivax malaria patients receiving standard primaquine treatment in a population with high prevalence of G6PD deficiency.

Primaquine is essential for the radical cure of Plasmodium vivax malaria, but it poses a potential danger of severe hemolysis in G6PD-deficient (G6PDd) patients. This study aimed to determine whether primaquine is safe in a population with high G6PD prevalence but lacking G6PD diagnosis capacity. In Myanmar, 152 vivax patients were gender- and age-matched at 1:3 for G6PDd versus G6PD-normal (G6PDn). Their risk of acute hemolysis was followed for 28days after treatment with the standard chloroquine and 14-day primaquine (0.25mg/kg/day) regimen. Patients anemic and non-anemic at enrollment showed a rising and declining trend in the mean hemoglobin level, respectively. In males, the G6PDd group showed substantially larger magnitudes of hemoglobin reduction and lower hemoglobin nadir levels than the G6PDn group, but this trend was not evident in females. Almost 1/3 of the patients experienced clinically concerning declines in hemoglobin, with five requiring blood transfusion. The standard 14-day primaquine regimen carries a significant risk of acute hemolytic anemia (AHA) in vivax patients without G6PD testing in a population with a high prevalence of G6PD deficiency and anemia. G6PD testing would avoid most of the clinically significant Hb reductions and AHA in male patients.

Association between bariatric surgery and anemia

ObjectivesSeveral studies have recently conducted to investigate the link between anemia and bariatric surgery (BS). The results from these studies, however, were inconsistent. Therefore, a meta-analysis was conducted to determine whether BS for weight loss is a risk factor for anemia. MethodsStudies were identified relevant papers published a cutoff date of May 2022 for meta-analysis by searching four electronic databases (PubMed, EMBASE, Web of Science and Cochrane Library). Pairs of authors conducted title and abstract, full-text assessment, data extraction and risk of bias assessment, and quality of articles. Random-effects models were used to estimate the pooled effect size and evaluated the overall quality of evidence. The sources of heterogeneity were assessed with I2. The Newcastle-Ottawa scale (NOS) was used to assess the methodologic quality of selected studies. The publication bias was assessed using funnel plots and Egger's test statistics. ResultsIn all, eight studies comprising 3150 patients were finally included in the final study analysis. Of these, pooled analysis of eight studies detecting association between anemia and BS for weight loss yield a statistically significant correlation (SMD −1.12 (−1.46—−0.78, I2=93%). Subgroup analyses were performed according to postoperative follow-up time and operation method. Before 24 months postoperatively, no patient had a significant decrease in hemoglobin. More than 24 months after BS, patients show a significant reduction in hemoglobin. In addition, the hemoglobin level was not changed after sleeve gastrectomy (SG) and adjustable gastric banding (AGB) (SMD −0.19 (−1.04—0.67, I2=0% for SG; SMD −0.30 (−0.82—0.22 for AGB), but the hemoglobin level was significantly reduced after Roux-en-Y gastric bypass (RYGB) (SMD −1.19 (−1.52—−0.87, I2=94.2%). ConclusionThis current meta-analysis found that at 24 months after RYGB, the patient's hemoglobin level was significantly reduced, increasing the risk of anemia. Therefore, attention should be paid to the occurrence of anemia after BS. A large, placebo-controlled, multi-center study is needed to clarify the role of BS for weight loss in this patient anemia.

A Comparative Study of Blood Loss With and Without Infusion of Tranexamic Acid in Total Knee Replacement

Introduction: Total knee replacement (TKR) is associated with significant blood loss in intra- and postoperative periods. This trial was designed to determine the efficacy of tranexamic acid (TXA) in the reduction of perioperative blood loss and the need for blood transfusion in patients undergoing primary TKR.Materials and methods: This study was performed at a tertiary care institute with 30 cases of primary unilateral TKR. The patients were randomly divided into two groups comprising 15 patients each. Group A comprised patients who received TXA by intravenous route and locally. Group B served as control, which comprised patients who had not received TXA. Patients were assessed in terms of intraoperative and postoperative blood loss, reduction in haemoglobin, the requirement of blood transfusion, and any untoward effects of TXA at 24 and 72 hours after surgery.Results: In group A, the mean number of swabs used intraoperatively was 2.3 ± 0.5 swabs while in group B, the mean number was 4.3 ± 0.7 swabs (p = 0.0000). The mean drop in the postoperative haemoglobin concentration in group A was 0.6 gm/dl (24 hours) and 1.3 gm/dl (72 hours), with a mean postoperative drain collection of 247.3 ± 50.6 ml (24 hours) and 316.7 ± 55.6 ml (72 hours). In comparison, the mean drop in the postoperative haemoglobin in group B was 1.5 gm/dl (24 hours) and 2.3 gm/dl (72 hours), with a mean drain collection of 474 ± 30.7 ml (24 hours) and 453.3 ± 37.7 ml (72 hours) (p < 0.001). In group A, significantly fewer patients (four) required blood transfusion while 13 patients required blood transfusion in group B (p = 0.0004).Conclusion: The data from this study conclude that the use of TXA in TKR significantly reduces perioperative blood loss and the need for postoperative blood transfusion without significantly altering the liver and renal functions and coagulation profile of patients.

COVID-19 pandemic and care of transfusion-dependent patients of thalassaemia: Experience from a paediatric centre in North India.

AimCovid‐19 has presented an unprecedented challenge to health services and has significantly affected the management of non‐Covid illnesses, like thalassemia. The present study documents the impact of Covid‐associated restrictions and disruptions on working of the pediatric thalassemia day care centre (TDCC), and measures taken by TDCC and blood transfusion services to adapt to and mitigate the negative impact of Covid pandemic and associated lockdown on patient care.MethodsPre‐transfusion haemoglobin and packed cell transfusion requirement were compared across three time periods, namely pre‐lockdown, lockdown and post‐lockdown in paediatric transfusion‐dependent thalassaemia (TDT) patients. Caregivers were interviewed to document any problems faced by them.ResultsThe study involved 181 TDT patients. There was a significant reduction in mean pre‐transfusion haemoglobin and red cells transfused during lockdown phase as compared to pre‐lockdown phase. Regular care was interrupted in 45% of patients and 76% of patients getting blood from outside could not get leukoreduced red cells. Investigations, monitoring and continuity of iron chelation were also affected. Blood centre faced 30.5% reduction in blood supply during lockdown. TDCC and blood centre took several steps, including prolongation of service hours and staggering of transfusions to ensure maximum transfusions while ensuring social distancing.ConclusionThe Covid‐19 pandemic imposed many unprecedented challenges to the routine care of thalassaemic patients; however, some of them could be dealt with by a proactive approach and micro‐planning at the institution level. Other similar resource‐limited settings could learn from experiences for continued quality care for chronic medical conditions during pandemic like situations.

Serum protein and electrolyte imbalances are associated with chemotherapy induced neutropenia

IntroductionCancer and its treatment using various chemotherapeutic agents can have many adverse side effects. These side effects often result in significant changes in haematological and biochemical composition of blood. As a result, the regular monitoring of serum biochemical and haematological changes plays an important role in management of disease. The present study aimed to determine the relationship between haematological and biochemical changes in neutropenic cancer patients following chemotherapy. Specifically we evaluated the association between neutrophil count and serum proteins and electrolytes. MethodsFor this purpose we analysed retrospectively collected laboratory results from two independent patient cohorts. Each cohort was divided into a control group consisting of patients with normal haematological parameters and a study group which included patients with reduced neutrophil counts. Neutropenic patients (study group) were cancer patients on chemotherapy. Results and conclusionBlood samples of cancer patients in study group showed reduction in haemoglobin, neutrophils and platelets. Neutropenic group showed a significant reduction in serum albumin, total protein, calcium, and potassium. Our results show that patients with severe neutropenia had pronounced changes in serum protein and electrolytes and increased incidence of abnormal serum protein and electrolyte level. The changes in the neutrophil counts showed a positive correlation with the changes in serum protein and electrolyte levels. A similar trend was seen in both the patient cohorts: the discovery set (176 patients) and the validation set (200 patients). Taken together our results suggest that chemotherapy-induced neutropenia is associated with dysregulation in haemoglobin, platelets, serum proteins and electrolytes.

Glucagon-like peptide-1 receptor agonist (GLP1-RA) therapy in type 2 diabetes.

Type 2 diabetes (T2D) is a national health priority. Its rising prevalence isaccompanied by a high burden of diabetes-related complications, many ofwhich are preventable. Numerous glucose-lowering medications have beendeveloped in recent years with growing evidence relating to their efficacy and safety. These advances haveincreased the complexity of prescribing decisions inT2D. This review provides clinicians with relevant evidence and practical advice concerning glucagon-like peptide-1 receptor agonists (GLP1-RAs) in T2D. The Royal Australian College of General Practitioners recommends GLP1-RAs as an option for second-line therapy in T2D. GLP1-RAs contribute to weight loss and glycated haemoglobin reduction. GLP1-RAs also reduce incidence of cardiovascular events in selected populations, and available evidence suggests renoprotective effects. Common adverse effects include gastrointestinal symptoms, especially in the weeks following treatment initiation. GLP1-RAs should be considered for people with T2D at high cardiovascular risk or where weight loss is a priority.

Effect of Organophosphate, Monocrotophos on Behavioural, Haematological, Histological and Biochemical Indices in the Subtropical Catfish Heteropneustes fossilis (Bloch, 1794)

A study was conducted to evaluate the impact of acute sub-lethal toxicity of monocrotophos on behavioural, biochemical, haematological and histopathological changes in Heteropneustes fossilis (49.53±0.71 g). Probit analysis showed the 96 h LC50 of monocrotophos for H. fossilis was 20 ppm. Followed by the LC50 value, sub-lethal concentrations for acute exposure of monocrotophos were 3 ppm in T1, 6 ppm in T2 and 8 ppm in T3 for 72 h of the experimental period. The behavioural responses observed in treated fish were: erratic movement, imbalance in swimming, surfacing, and hyperactivities. A gradual reduction in total RBC count, haemoglobin, monocyte, and basophil contents were observed with an increased concentration of monocrotophos. On other hand, the total WBC count, neutrophil, basophil and blood ESR showed reversed trend (p&lt;0.05). Total tissue protein content of gill, liver and kidney was altered and decreased significantly (p&lt;0.05) in monocrotophos-treated fish. Tissue lipid peroxidation (LPO) and catalase activities in gill, liver and kidney were also altered after 24 h, 72 h and followed an increasing trend in exposed fish which differed significantly (p&lt;0.05) from the control group. Compared to the control, significant changes were observed in the histopathological architecture of blood cells and gill tissue. The overall result showed that exposure to monocrotophos severely affects fish behaviour and physiology. Therefore the misuse of the chemical may be avoided to reduce the negative impact on aquatic animals.

P-762 Intraabdominal Hemorrhage Following Ultrasound-guided Transvaginal Oocyte Retrieval: Retrospective Analysis of 25 Cases

Abstract Study question Intraabdominal hemorrhage is a rare but serious complication following (oocyte pick up, OPU), it is very important for clinicians to know the risk factors. Summary answer Intraabdominal hemorrhage is mild in most cases, laparoscopy or laparotomy is the most effective approach to stop bleeding quickly in severe intraabdominal hemorrhage cases. What is known already During the OPU procedure, intraabdominal hemorrhage is not visible without the assistance of ultrasound, even minor bleeding, if persists, may lead to life-threatening consequences. Previous publications had limited sample size and the analysis of serial cases was scarce, most studies focused on severe hemorrhage that necessitated surgical interventions and somehow neglected those with mild hemorrhage. The reported incidence of severe intraabdominal hemorrhage varied from 0.06% to 0.27%, while 0.08%-0.1% of patients required surgery. Study design, size, duration Retrospective study, 25 cases that underwent post-OPU intraabdominal hemorrhage and required hospitalization in our center since 2003 to January 2021. Participants/materials, setting, methods Patients underwent intraabdominal hemorrhage following OPU in a University-affiliated center needed to be hospitalized. We aimed to discuss the clinical characteristics, risk factors, and precautionary measures of intraabdominal hemorrhage following OPU procedures. Main results and the role of chance The incidence of intraabdominal hemorrhage following OPU procedures was 0.044%. In all 25 cases, 17 received conservative treatment while emergency surgical exploration was performed to stop bleeding quickly for the remaining patients. Primary symptoms included the following: abdominal distention and/or pain, chest distress, dizziness, syncope, tenesmus, palpitations, etc.48% and 92% of patients had obvious symptoms within the first hour and 12 hours following OPU, respectively. Pelvic hematoma and/or effusion were found under ultrasonic scan in all but three patients. Overall, the reduction in hemoglobin(ΔHb) and hematocrit (ΔHct) were 26.50±13.32 g/L and 7.70%±3.66%, respectively. The mean interval between OPU and surgical procedure was 29.88±18.80 hours. And the main intra-operative findings were laceration and/or active bleeding on the ovary and satisfied hemostasis was achieved through suture or electrocoagulation. The blood aspirated during the procedure was 1 563±548 ml on average. Before they got discharged, these patients stayed at hospital for 5.04 days on average. In addition, our data shows that intraabdominal hemorrhage following OPU does not affect the final pregnancy outcomes, the cumulative live birth rate per woman was 48% (12/25). Limitations, reasons for caution This study is limited by its retrospective nature. In addition, patients who underwent mild hemorrhage and received effective therapy in an outpatient clinic rather than hospitalization or elsewhere were not included, which might lead to underestimation of the incidence concerned. Wider implications of the findings Intraabdominal hemorrhage is a rare but serious complication following OPU, which might be life-threatening. Nonetheless, hemorrhage is mild in most cases and conservative treatment is the first-line choice. Laparoscopy or laparotomy is the most effective approach to stop bleeding quickly in severe intraabdominal hemorrhage cases. Trial registration number not applicable

Does the intramedullary femoral canal plug reduce blood loss during total knee arthroplasty?

IntroductionThe benefit of the femoral canal bone plug during total knee arthroplasty (TKA) in reducing blood loss has never been proven. The aim of this meta-analysis was to determine whether the femoral canal bone plug significantly reduces blood loss in primary TKA.MethodAll studies published before December 2021 were searched. The inclusion criteria were randomized controlled trials comparing blood loss between TKA with plugged and unplugged femoral intramedullary canal, respectively. The primary outcome was postoperative hemoglobin reduction.ResultsFive studies with a total of 717 patients (361 in the plugged group, 356 in the unplugged group) met the criteria for inclusion in the meta-analysis. The mean difference in hemoglobin level between the two groups was 0.92 g/dL, with significantly less hemoglobin reduction in the plugged group (95% confidence interval [CI] − 1.64 to − 0.21, p = 0.01). The patients in the plugged group also had a significantly lower risk of receiving a blood transfusion (risk ratio 0.58, 95% CI 0.47–0.73, p < 0.00001).ConclusionsThis meta-analysis demonstrates that using a femoral canal bone plug can significantly reduce blood loss and lower the risk ratio of blood transfusion in patients undergoing TKA.

Treatment-Interval Changes in Serum Levels of Albumin and Histidine Correlated with Treatment Interruption in Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma Completing Chemoradiotherapy under Recommended Calorie and Protein Provision.

Simple SummaryTreatment interruption during concurrent chemoradiotherapy (CCRT) jeopardizes the outcomes of patients with locally advanced head and neck squamous-cell carcinoma (LAHNSCC), which is associated with increased toxicity during CCRT. Nonetheless, we found that under the provision of recommended calories (25 kcal/kg/day) and protein (1 g/kg/day) throughout the treatment course, treatment-interval changes in serum albumin and histidine levels—not treatment toxicity—greatly contributed to the interruption of treatment in patients with LAHNSCC. We believe that serum levels of albumin and histidine should be integrated into the routine nutritional assessment of patients undergoing CCRT.We investigated risk factors for treatment interruption (TI) in patients with locally advanced head and neck squamous-cell carcinoma (LAHNSCC) following concurrent chemoradiotherapy (CCRT), under the provision of recommended calorie and protein intake; we also evaluated the associations between clinicopathological variables, calorie and protein supply, nutrition–inflammation biomarkers (NIBs), total body composition change (TBC), and a four-serum-amino-acid metabolite panel (histidine, leucine, ornithine, and phenylalanine) among these patients. Patients with LAHNSCC who completed the entire planned CCRT course and received at least 25 kcal/kg/day and 1 g of protein/kg/day during CCRT were prospectively recruited. Clinicopathological variables, anthropometric data, blood NIBs, CCRT-related factors, TBC data, and metabolite panels before and after treatment were collected; 44 patients with LAHNSCC were enrolled. Nine patients (20.4%) experienced TIs. Patients with TIs experienced greater reductions in hemoglobin, serum levels of albumin, uric acid, histidine, and appendicular skeletal mass, and suffered from more grade 3/4 toxicities than those with no TI. Neither increased daily calorie supply (≥30 kcal/kg/day) nor feeding tube placement was correlated with TI. Multivariate analysis showed that treatment-interval changes in serum albumin and histidine levels, but not treatment toxicity, were independently associated with TI. Thus, changes in serum levels of albumin and histidine over the treatment course could cause TI in patients with LAHNSCC following CCRT.

P840: A MATCHING-ADJUSTED INDIRECT COMPARISON OF THE EFFICACY OF PEGCETACOPLAN USING PRINCE TRIAL DATA VERSUS RAVULIZUMAB AND ECULIZUMAB IN COMPLEMENT-NAÏVE PATIENTS WITH PAROXYSMAL NOCTURNAL HEMOGLOBINURIA

Background: Pegcetacoplan (PEG) is a PEGylated peptide targeting proximal complement protein C3 that has been shown to control both intravascular and extravascular hemolysis and recently approved by the FDA and EMA for the treatment of paroxysmal nocturnal hemoglobinuria (PNH). PRINCE (NCT04085601), was a phase-3, randomized, open-label trial assessing the efficacy and safety of PEG compared to control (CTL) treatment, excluding complement inhibitors among treatment naïve patients with PNH. PEG demonstrated superior efficacy to CTL by improving hemoglobin (Hb) levels and reductions in lactate dehydrogenase (LDH) levels in patients with PNH. To date, no head-to-head clinical trials exist comparing PEG to complement inhibitors in treatment naïve patients. Aims: To assess the comparative effectiveness of PEG for complement-naïve patients with PNH against ravulizumab (RAV) and eculizumab (ECU) using matching-adjusted indirect comparison (MAIC) methodology to conduct cross-trial comparisons. Methods: Individual patient data from PRINCE as well as aggregated published results of RAV and ECU in the ALXN1210-PNH-301 (“301”) study (Lee et al. 2019) were used. To adjust for cross-study differences, propensity score weighting was developed using logistic regression analyses and used to balance demographic and clinical characteristics between the PEG arm and RAV and ECU arms from 301. Outcomes were compared at 26 weeks using unanchored MAIC between PEG versus RAV and PEG versus ECU and included mean and percent change in LDH levels from baseline, LDH normalization (defined as LDH levels dropping <1xULN [246 U/L] in the absence of transfusions during the randomized controlled period), Hb stabilization (defined as the avoidance of a ≥2 g/dL decrease in hemoglobin level in the absence of transfusions during the randomized controlled period), and transfusion avoidance. Weighted Wald tests and 95% confidence intervals were computed for comparisons of categorical and continuous outcomes. Results: A total of 34 patients were included in the PEG arm, 125 patients in the RAV arm, and 121 patients in the ECU arm. Prior to matching, significant differences existed between arms in the proportion of patients with White and American Indian or Alaska Native race, and mean LDH (all p<0.001). After matching the PEG to the RAV and ECU arms, separately, most patient characteristics were well balanced with a mean age of 43.8 years, 44.8 years, 46.2 years, respectively, 43.0-50.0% females, and a mean Hb of 9.4-9.6g/dL across arms; however, there were significant differences in Asian race and baseline LDH (all p<0.01). At week 26, patients in the PEG arm showed a significantly greater improvement in their LDH levels from baseline, with a mean of -523 U/L (-11.2%) compared to RAV and -578 U/L (-12.0%) compared to ECU (all p<0.001; Figure 1). Patients receiving PEG also showed significant improvements in LDH normalization (35.6% compared to RAV, p<0.001; 39.6% compared to ECU, p<0.001), Hb stabilization (28.2% compared to RAV, p<0.001; 31.7% compared to ECU, p<0.001), and transfusion avoidance (22.6% compared to RAV, p<0.001; 30.1% compared to ECU, p<0.001; Figure 1). Image:Summary/Conclusion: In the absence of head-to-head comparisons, this unanchored MAIC study shows that PEG is more efficacious versus RAV and ECU in complement inhibitors treatment naïve PNH patients in terms of significant improvements across all evaluated endpoints, Hb stabilization, LDH improvement, LDH normalization and transfusion avoidance.

Presence of a Novel Anatomical Structure May Cause Bleeding When Using the Calyx Access in Mini-Percutaneous Nephrolithotomy.

BackgroundFused renal pyramid (FRP) is a kidney anatomical structure which was first identified by us. The vascular anatomy of FRP exhibits different from that of the normal renal pyramid (NRP), manifested by the distribution of the ectopic interlobar arteries in FRP. In this study, we analyzed the effect of FRPs on bleeding when using calyx access in mini-percutaneous nephrolithotomy (PCNL).Patients and MethodsOverall, 633 patients who underwent ultrasound-guided single-tract mini-PCNL were divided into two groups according to the puncture method used: in group A, puncture was performed through the axial direction of the renal calyx, the line from the apex of the fornix to the center of the neck plane under B-mode ultrasound guidance; and in group B, Doppler ultrasound-guided axillary puncture through calyces corresponding to NRPs when the plane of renal column blood vessels on both sides was selected or calyx puncture through the hypovascular area of the FRPs. Relevant demographic and clinical data were retrospectively analyzed.ResultsThe two groups exhibited similar baseline characteristics. No significant differences were found in hemoglobin reduction, puncture site, tract size, postoperative creatinine level, or stone-free rate between the two groups (P > 0.05). Blood transfusion and embolization rates in group B were significantly lower than those in group A (P = 0.03 and 0.045, respectively). No differences were found between the two groups in terms of persistent pain, hydrothorax, fever, subcapsular hematoma, and urosepsis (P > 0.05). The overall complication rate was not significantly different between the two groups (P = 0.505).ConclusionsFRP is a non-negligible anatomical structure that may cause hemorrhage when using calyx access. Doppler ultrasound can identify ectopic blood vessels in FRPs to reduce bleeding during calyx access in mini-PCNL procedures.

Chemotherapy with a TP Regimen in Combination with Stereotactic Radiotherapy Could Significantly Optimize the Clinical Efficacy of NSCLC Treatment.

The changes in lifestyle and bad living habits have a significant impact on the health of people, resulting in an increasing prevalence of lung cancer. The most prevalent kind of lung cancer is nonsmall cell lung cancer (NSCLC), which accounts for around 80% of all cases. Chemotherapy is a common treatment method in clinical practice with certain negative effects. The primary goal of this study is to investigate the clinical efficacy of stereotactic radiotherapy in combination with a docetaxel plus cisplatin (TP) chemotherapy regimen in patients with nonsmall cell lung cancer (NSCLC) and their impact on the levels of cytokeratin fragment 21-1 (CYFRA21-1) and metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in NSCLC patients. Eighty patients who were admitted to the hospital between November 2016 and November 2019 were recruited and assigned to receive either chemotherapy with a TP regimen (the control group) or chemotherapy with a TP regimen plus stereotactic radiotherapy (the observation group). The WHO response evaluation criteria (REC) for solid tumors were adopted to analyze short-term efficacy, and the Karnofsky performance status (KPS) score was used to assess the quality of life by recording adverse reactions in the blood system, kidney, gastrointestinal tract, bladder, nervous system, and heart. The levels of CYFRA21-1 and MALAT1 in serum before and after the treatment were determined and compared. As a result, the observation group showed higher total efficacy and MALAT1 level, better quality of life, and lower CYFRA21-1 level than the control group (P < 0.05). Stereotactic radiotherapy plus TP regimen chemotherapy resulted in significantly better progression-free survival, overall survival, survival rate, and long-term prognosis versus chemotherapy alone. Moreover, combined therapy was associated with a lower incidence of hemoglobin reduction, gastrointestinal reaction, and renal impairment versus TP regimen chemotherapy (P < 0.05). Therefore, we concluded that stereotactic radiotherapy plus chemotherapy with a TP regimen significantly optimizes the clinical efficacy of the NSCLC treatment.

TPF induction chemotherapy versus PF adjuvant chemotherapy plus concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma: A multicenter, randomized controlled, III trial.

6069 Background: To investigate the efficacy and safety of the two modes of concurrent chemoradiotherapy combined with induction or adjuvant chronotherapy for the treatment of locoregionally advanced nasopharyngeal carcinoma. Methods: A total of 266 patients with locoregionally advanced NPC were enrolled from May 2018 to July 2021 and randomly divided into a test (n = 133) and a control (n = 133) group. In the test group, the docetaxel and cisplatin plus fluorouracil (TPF) regimen was used to induce chronological chemotherapy for 3 cycles (docetaxel 75mg / m2, D1, cisplatin 75mg / m2, d1-d5, fluorouracil 750mg / m2 / D, d1-d5) + 3 cycles of concurrent chemoradiotherapy (cisplatin 100mg / m2; The control group was treated with three cycles of concurrent chemoradiotherapy (cisplatin 100mg / m2) + cisplatin plus fluorouracil (PF) regimen with adjuvant schedule chemotherapy for three cycles (cisplatin 80mg / m2 on days d1-d5, fluorouracil 800mg / m2 / d on days d1-d5). In both groups, intensity-modulated radiation therapy was used with a total dose of 69.96 Gy to the primary tumor at T1 and T2, 72.6 Gy to the primary tumor at T3 and T4, and 69.96 Gy to the positive lymph nodes. Acute adverse effects and survival were compared between the two groups. Results: A median follow-up of 19 months, 129 patients in the test group and 124 in the control group were evaluable for efficacy and adverse effects.Compliance was 96.99% and 90.22%, respectively. The 2-year overall survival rates were 91.7% and 90.5%, and the 2-year progression free survival rates were 92.4% and 90.4% in the test and control groups, respectively, with no significant difference ( P &gt; 0.05). The test group had a lower incidence of radiation mucositis, dry mouth, and dysphagia than the control group ( P &lt; 0.05), whereas the test group had a higher incidence of leukopenia, neutropenia, hemoglobin loss, vomiting ( P &lt; 0.05), decreased radiation dermatitis, platelets There were no significant differences in the categories of creatinine elevation and transaminase elevation (P &gt; 0.05). Conclusions: The patients' compliance was good and the toxic effects such as radiation mucositis, dry mouth and dysphagia were reduced under the treatment mode in which the TPF induced chemotherapy combined with concurrent chemoradiotherapy.Although the toxic effects such as leukopenia, neutropenia, hemoglobin reduction and vomiting were increased, the efficacy was comparable with that of the PF in which the adjuvant schedule chemotherapy combined with concurrent chemoradiotherapy. Clinical trial information: NCT-03574324.