Small Amount Of Blood Research Articles

Thermal Ablation of Pulmonary Nodules by Electromagnetic Navigation Bronchoscopy Combined With Real-Time CT-Based 3D Fusion Navigation:Report of One Case.

A nodule in the right middle lobe of the lung was treated by a combination of cone-beam CT,three-dimensional registration for fusion imaging,and electromagnetic navigation bronchoscopy-guided thermal ablation.The procedure lasted for 90 min,with no significant bleeding observed under the bronchoscope.The total radiation dose during the operation was 384 mGy.The patient recovered well postoperatively,with only a small amount of blood in the sputum and no pneumothorax or other complications.A follow-up chest CT on the first day post operation showed that the ablation area completely covered the lesion,and the patient was discharged successfully.

Comparison of Novel and Traditional Bleeding Techniques in Neonatal and Juvenile Mice.

Blood collection is frequently used for neonatal and juvenile mice in toxicology, developmental, and immunology studies and is often a terminal procedure. However, the use of nonterminal blood collection techniques, including the submandibular and the submental collection techniques described for adult mice, may offer opportunities to reduce animal numbers and refine current methods. The use of the submental technique has not been described for neonatal or juvenile mice. In this study, we compared the submental and submandibular blood collection techniques to determine their suitability for use in neonatal and juvenile mice. Male and female CD1 mice, ages 7, 14, 21, and 28 d, were randomized by sex into submental (n = 16), submandibular (n = 16), or control (n = 8) groups. Each mouse was weighed, bled per its assigned group (or only restrained in the case of control mice), and then decapitated without anesthesia for terminal blood collection. Blood collection volume and corticosterone concentrations were measured. The 2 methods showed significant differences in the volume of blood collected at ages 14 and 28, with the submandibular technique yielding significantly higher volumes. No significant differences were detected in corticosterone levels between the 2 techniques based on age or sex. A subset of mice (n = 8, 2 per age group) were bled via submental or submandibular technique and were evaluated 48 h later for gross and histopathologic evidence of trauma. Seven of the 8 mice showed expected inflammation and healing at the collection sites, with 4 mice having embedded strands of fur in the tissue. These data indicate that the submental blood collection is a viable method for nonterminal blood collection method in neonatal and juvenile mice, especially when smaller amounts of blood are needed.

Prolonged holding time and sampling protocol affects viscoelastic coagulation parameters as measured by the VCM-Vet™ using fresh equine native whole blood.

Determine the effect of sample holding time and single sample reuse on viscoelastic coagulation parameters when using fresh equine native whole blood. 8 healthy adult horses from a university teaching herd. Blood collected by direct jugular venipuncture (18 ga needle, 3 mL syringe) was held at 37 °C for 2, 4, 6, or 8 minutes according to 1 of 2 protocols. Syringes were gently inverted twice, a small amount of blood was expressed, testing cartridges were filled, and placed within the VCM-Vet™ device (Entegrion Inc). Protocol A: samples were processed from a single syringe. Protocol B: 4 syringes were drawn through a single needle. VCM-Vet™ measures assessed included clot time (CT), clot formation time (CFT), alpha angle (AA), amplitude at 10/20 minutes (A10/A20), maximal clot firmness (MCF), and lysis index at 30/45 minutes (LI30/LI45). Differences over time were examined using the Friedman test and post hoc Wilcoxon Rank Sum Test with Bonferroni correction, P ≤ .05. Following Protocol A, there was a significant effect of holding time for CT (P = .02), CFT (P = .04), and AA (P = .05). CT and AA decreased over time, while CFT increased. Samples handled by Protocol B showed no significant difference over time for any of the VCM-Vet™ parameters. Sample holding time and handling protocol impact VCM-Vet™ testing results of fresh equine native whole blood. Viscoelastic coagulation samples tested using the VCM-Vet™ may be held unagitated for up to 8 minutes after collection while warm, but should not be reused.

Evaluation and establishment of reference intervals using the i-STAT1 blood chemistry analyzer in turkeys

In veterinary medicine, point-of-care testing techniques have become popular, since they provide immediate results and only small amounts of blood are needed. The handheld i-STAT1 blood analyzer is used by poultry researchers and veterinarians; however, no studies have evaluated the accuracy of this analyzer determined reference intervals in turkey blood. The objectives of this study were to 1) investigate the effect of storage time on turkey blood analytes, 2) compare the results obtained by the i-STAT1 analyzer to those obtained by the GEM Premier 3000, a conventional laboratory analyzer, and 3) establish reference intervals for blood gases and chemistry analytes in growing turkeys using the i-Stat. For the first and second objectives, we used the CG8+ i-STAT1 cartridges to test blood from 30 healthy turkeys in triplicate and once with the conventional analyzer. To establish the reference intervals, we tested a total 330 blood samples from healthy turkeys from 6 independent flocks during a 3-yr period. Blood samples were then divided into brooder (<1 wk) and growing (1-12 wk of age). Friedman's test demonstrated significant time-dependent changes in blood gas analytes, but not for electrolytes. Bland-Altman analysis revealed that there was agreement between the i-STAT1 and the GEM Premier 300 for most of the analytes. However, Passing-Bablok regression analysis identified constant and proportional biases in the measurement of multiple analytes. Tukey's test revealed significant differences in the whole blood analytes between the means of brooding and growing birds. The data presented in the present study provide a basis for measuring and interpreting blood analytes in the brooding and growing stages of the turkey lifecycle, offering a new approach to health monitoring in growing turkeys.

Acquired hemophilia A developing in the perioperative period of pancreatoduodenectomy: a report of two cases

BackgroundAcquired hemophilia A (AHA) is a rare disease characterized by a prolonged activated partial thromboplastin time (aPTT) and the production of coagulation factor VIII inhibitors. We encountered two cases of AHA in the perioperative period of pancreatoduodenectomy (PD).Case presentationCase 1: A 76-year-old woman with intraductal papillary mucinous carcinoma developed acute cholecystitis 5 days before PD. Despite immediate improvement in her acute cholecystitis with biliary drainage and antibiotics, her aPTT level was prolonged (55.9 s). PD was performed as scheduled. On postoperative day (POD) 2, she developed intra-abdominal hemorrhaging that required reoperation. However, intra-abdominal bleeding and concomitant anemia persisted after reoperation. On POD 13, she was diagnosed with AHA based on the detection of an inhibitor of coagulation factor VIII. Despite hemostatic and immunosuppressive treatment, including massive blood transfusion, her general condition gradually worsened due to continuous bleeding and secondary infections. She ultimately died of multiple organ failure on POD 71. Case 2: An 82-year-old man received PD for distal cholangiocarcinoma. On POD 3, a small amount of blood via abdominal drainage was observed. On POD 4, his aPTT level was prolonged (61.5 s). On POD 8, subcutaneous hemorrhaging of the median wound was observed, and corticosteroids were administered under suspicion of AHA on POD 9. On POD 15, an inhibitor of FVIII was detected, and he was diagnosed with AHA. On POD 17, the aPTT level had normalized, and an inhibitor of FVIII was undetectable. On POD 41, he was discharged without any serious hemorrhagic events.ConclusionsAHA may be more frequent than previously reported. When unexplained prolonged aPTT or bleeding symptoms are observed, it is important to keep AHA in mind during the perioperative period of invasive surgery.

Quantification of nine psychotropic drugs in postmortem dried blood spot samples by liquid chromatography–tandem mass spectrometry for simple toxicological analysis

Dried blood spot (DBS) sampling has evolved to become the method of choice for collecting samples for newborn screening and therapeutic drug monitoring worldwide. The major advantage of this approach is that it requires only a small amount of blood. In addition, the collection of DBSs on filter paper is simple, sample storage costs are small, and the process deactivates microorganisms and viruses. However, despite these advantages, DBS sampling is seldom used in forensic toxicological analyses. Here, we developed and validated an approach that uses liquid chromatography coupled with electrospray ionization−tandem mass spectrometry for quantifying nine psychotropic drugs (citalopram, duloxetine, mirtazapine, olanzapine, paroxetine, quetiapine, sertraline, zolpidem and zopiclone) in cadaveric DBS samples. Most of them are frequently used by self-harm but are not already targeted by an existing drug screening kit. Our method use only one 3-mm disk excised from each DBS and does not require the troublesome purification process. The linearities of the calibration curves were good in the concentration range of 0.05–1.0 μg/mL. Our method allows for repeatable and accurate quantification with intra- and inter-assay coefficients of variation of below 11.9% and below 12.5%, respectively, for each of the target drugs. In addition, the target drug concentrations in the DBSs remained stable for at least one month when stored at − 80 °C. Compared with our institute’s routine method for cadaveric blood sampling, the QuEChERS method, quantifiable concentrations showed a good positive correlation for each of the target drugs. In addition, the concentrations of almost all the target drugs obtained with DBS sampling method were comparable with those obtained with the QuEChERS sampling method. Thus, the present findings extend the possible uses of DBS sampling to the quantification of multiple psychotropic drugs in the field of forensic toxicological testing.

Biodegradable Polycaprolactone Fibers with Silica Aerogel and Nanosilver Particles Produce a Coagulation Effect.

Poly-ε-caprolactone (PCL) is a biodegradable aliphatic polyester that can be used in the field of biomaterials. Electrospinning is the name given to the process of producing micro and nanoscale fibers using electrostatically charged polymeric solutions under certain conditions. Almost all synthetic and naturally occurring polymers can undergo electrospinning using suitable solvents or mixtures prepared in certain proportions. In this study, silica aerogels were obtained by the sol-gel method. PCL-silica aerogel fibers were synthesized by adding 0.5, 1, 2, and 4% ratios in the PCL solution. Blood contact analysis was performed on the produced fibers with UV-VIS. According to the results obtained, 0.5, 1, 2, and 4% nano-silver were added to the fiber-containing 4% aerogel. Then, SEM-EDS and FTIR analyses were performed on all fibers produced. Antimicrobial tests were performed on fibers containing nano-silver. As a result, high-performance blood coagulation fibers were developed using PCL with aerogel, and an antimicrobial effect was achieved with nano-silver particles. It is thought that the designed surface will be preferred in wound dressing and biomaterial in tissue engineering, as it provides a high amount of cell adhesion with a small amount of blood and contains antimicrobial properties.

Gastrointestinal: Small bowel hemangioma with unusual endoscopic findings and complicated with obscure gastrointestinal bleeding.

A 68-year-old woman was referred to our hospital for evaluation of severe anemia. Although she had an upper endoscopy and colonoscopy that failed to show the cause of her anemia, there was a small amount of blood in the terminal ileum, which suggested small bowel bleeding. In our hospital, video capsule endoscopy identified a spherically raised lesion in the jejunum, with central erosion of the surface mucosa, which was similar in morphology to a submucosal tumor (Fig. 1a). Balloon-assisted enteroscopy revealed a dark reddish, elevated lesion in the jejunum, the surface of which was extensively peeled off and thickly covered by blood clots (Fig. 1b). Malignant tumors such as angiosarcoma, gastrointestinal stromal tumor, and malignant lymphoma were suspected. A definitive preoperative diagnosis was difficult because of the unusual endoscopic findings. The patient underwent laparoscopic small bowel resection. The lesion was 17 mm in diameter (Fig. 2a). Histological findings revealed that the elevated lesion consisted of exposed vascular components, surrounded by normal small bowel mucosa, and numerous dilatated vessels without atypia were observed from the lamina propria to the muscularis propria. These findings were consistent with cavernous hemangioma (Fig. 2b,c). After surgery, the anemia improved within 6 months. Hemangiomas occur rarely in the small bowel. Thirteen cases of small bowel hemangiomas, observed preoperatively by enteroscopy, have been reported in adults. To the best of our knowledge, a submucosal tumor-like hemangioma with exposed vascular components is extremely rare and has been described in only one case. It was hypothesized that this uncommon morphology was formed by collapse of the tumor due to external stimuli such as small bowel peristalsis and food residue. This case highlights the unusual endoscopic appearance of small bowel hemangioma as a rare cause of obscure gastrointestinal bleeding.

OP52 Health Technology Assessment Of Pain-Free Blood Draw Devices In Pediatrics

IntroductionBlood collection in a pediatric population is a time-consuming activity and an unpleasant experience. Moreover, many laboratory tests require only small amounts of blood while larger quantity of blood is usually drawn, generating excess waste that must be properly disposed of. To solve patient concerns and workflow inefficiencies biomedical companies developed Pain-Free Blood Draw (PFBD) devices. The aim of this health technology assessment (HTA) study is to compare the performances of PFBD devices with the standard venipuncture to evaluate the potential benefits of introducing PFBD devices into clinical practice.MethodsPFBD devices use microneedles that breach the stratum corneum, significantly reducing the pain perception due to the superficial skin penetration. Decision-oriented HTA method, was applied to conduct the HTA process. It is an analytical instrument that integrates the EunetHTA CoreModel with the analytic hierarchy process, to choose the best technology solution by identifying the main evaluation criteria and defining the weightsof system and performance values. Eight professionals have been involved to define the evaluation criteria and to measure the two technologies’ performance. As the method requires, a literature review was conducted to define the evaluation scheme represented by a multilevel decision tree composed of evaluation areas (domains) and key performance indicators (KPI).ResultsFive evaluation domains were included in the analysis (clinical effectiveness, safety, costs, organizational aspects, and technical characteristics), described by 35 KPIs. Preliminary clinical effectiveness results showed diagnostic concordance between blood samples obtained with PFBD and venipuncture. Even if the additional costs of PFBD, these devices seem to improve the safety by reducing the biological risks for operators. Moreover, considering pediatric patients, organizational aspects would benefit by the use of PFBD in terms of ease of use, compliance of patients, and time reduction for blood collection.ConclusionsResults showed that PFBD not only have great repercussions in terms of clinical benefits, especially for pediatric patients, but also a significant impact in terms of organizational aspects.

Effectiveness of transarterial embolisation for intractable postpartum haemorrhage in a disseminated intravascular coagulation state, despite emergency hysterectomy

We evaluated the effectiveness of transarterial embolization (TAE) for intractable postpartum hemorrhage in patients with disseminated intravascular coagulation (DIC) despite emergency hysterectomy. We retrospectively assessed TAE performed after emergency hysterectomy in 15 patients between July 2008 and January 2022. Underlying condition, technical success, clinical success, angiographic findings, laboratory findings, pregnancy-modified DIC score (The International Society on Thrombosis and Haemostasis), blood transfusion, ICU (Intensive care unit) admission day, hospital day, in-hospital mortality, and long-term sequelae were evaluated. All patients were diagnosed with DIC before embolization, with a 43.9 mean DIC score. All patients showed positive angiographic findings for active bleeding. Thirty-eight bleeding arteries were confirmed. The remnant uterine artery (n=25) was the most common focus of persistent bleeding, followed by the cervicovaginal artery (n=6), pudendal artery (n=3), obturator artery (n=2), vesical artery (n=1), and unspecified artery from the internal iliac artery (n=1). Technical and clinical success rates were 100% (15/15) and 93.3% (14/15), respectively. Mean nadir hemoglobin (Hb) level before embolization was 4.9 g/dL. All patients underwent massive transfusion before embolization (mean 33.2 packs of RBC). Postoperatively, a smaller amount of blood was transfused than before the procedure (mean 10.6 packs of RBC). Mean nadir Hb level after embolization was 8.2 g/dL. There was one instance each of in-hospital death, hypoxic brain damage, and ischemic acute kidney injury. Despite hysterectomy for postpartum bleeding, there could be multiple residual or uncontrolled bleeding foci, especially in case of DIC, for which TAE could be an effective treatment.

SUPERIOR SAGITTAL SINUS THROMBOSIS PRESENTING AS DETERIORATING RESIDUAL WEAKNESS

SUPERIOR SAGITTAL SINUS THROMBOSIS PRESENTING AS DETERIORATING RESIDUAL WEAKNESS

Head Lice: What You Need to Know

Head Lice: What You Need to Know

Simple and simultaneous quantification of cyanide, ethanol, and 1-propanol in blood by headspace GC–MS/NPD with a Deans switch

This study aimed to develop a method to simultaneously quantify cyanide, ethanol, and 1-propanol in blood using headspace gas chromatography–mass spectrometry/nitrogen-phosphorus detection (HS–GC–MS/NPD) with a Deans switch. Cyanide is a powerful and rapidly acting poison. However, routine cyanide testing can be costly and time-consuming, given that cyanide poisoning rarely occurs in Japan. Therefore, we attempted to combine cyanide and routine alcohol (ethanol and 1-propanol) testing using HS–GC–MS/NPD with a Deans switch. 1-Propanol can be used as an indicator of putrefaction. NPD is advantageous over MS in terms of sensitivity for cyanide detection, and the Deans switch allows for switching between two detectors in a single run. Three analytical columns with different characteristics were investigated to achieve adequate separation. In addition, we verified whether 18 other volatile compounds could be simultaneously detected using this system. The following instruments were used: 7697A headspace sampler, 7890A GC, 5975 C MS, and NPD via a Deans switch (Agilent Technologies); Columns: PoraBOND Q (25 m × 0.25 mm × 3 μm), CP-Sil 5 CB (25 m × 0.25 mm × 1.2 μm), and HP-INNOWax (30 m × 0.25 mm × 0.5 μm). For sample preparation, whole blood (0.1 mL) was placed into a 10-mL headspace vial, and 50 μL of internal standard (IS) mixture (4 μg/mL propionitrile for cyanide, and 1 mg/mL ethanol-d6 for ethanol and 1-propanol) and 20 μL of 0.5-M ascorbic acid were added. After capping, 21.25% phosphoric acid (0.1 mL) was added to the vial using a syringe. The vial was incubated at 60 °C for 20 min, and 1 mL of the headspace was automatically injected into the GC–MS/NPD system. The target compounds were cyanide, ethanol, 1-propanol, sulfide, azide, 1,1-difluoroethane, methanol, acetaldehyde, acetone, butane, isobutane, pentane, hexane, heptane, octane, nonane, chloroform, benzene, toluene, ρ-xylene, and styrene. Among the three columns investigated, PoraBOND Q achieved the most effective separation, and its sensitivity was equal to or greater than that of the other columns for all compounds, except hydrogen azide; therefore, PoraBOND Q was selected. After selecting the analytical column, the switching times of the Deans switch were determined. All 23 compounds, including the IS, were successfully detected. The calibration curves for cyanide, ethanol, and 1-propanol were linear, and their R2 values were >0.999. The intra- and inter-day accuracy and precision were <15%. Forensic laboratories must conduct several blood examinations, including biochemical test, alcohol test, and drug screening. However, obtaining a sufficient amount of blood during an autopsy can be occasionally challenging. This method allows simultaneous quantification of cyanide, ethanol, and 1-propanol in a single run with a small amount of blood (0.1 mL). In this method, a chief feature is that only the part where hydrogen cyanide or propionitrile (IS) appeared was cut into NPD, improving sensitivity to cyanide. Although the Deans switch chooses one of two detectors, sufficient separation achieved using the PoraBOND Q column enabled the detection of all target compounds in this system. A simple and simultaneous quantification method for cyanide, ethanol, and 1-propanol in blood was developed using headspace GC–MS/NPD with a Deans Switch. This method could also detect 18 other volatile compounds. Therefore, this method could be valuable for the routine analysis of volatile compounds in forensic practice.

Analysis of Single Blood Entities Using an Ultramicroelectrode through Single-Entity Electrochemistry

The research was conducted with the aim of analyzing individual human blood cells in the presence of redox species based on single-entity electrochemistry. Various blood cells (e.g., red blood cell, white blood cell, and platelets) perform a role directly related to survival, such as oxygen transport, hemostasis, and immune response, as they move through the whole body’s blood vessels. However, with the current lab-on-a-chip typed biosensor technology, the factors that can be measured using a small amount of blood are limited to uric acid, cholesterol, glucose, or hemoglobin in the blood. In clinical laboratories, common methods for measuring individual blood counts are automated hematology analyzers based on the automated Coulter cell counting method or flow cytometry, which produce a huge amount of blood count results, but are limited. For this reason, it is proposed a method for detecting individual blood cells that can be applied to a biosensor simply and quickly.References Ran, An. et al. (2021) ‘Emerging point-of-care technologies for anemia detection’, Lab on a Chip, 21(10), pp. 1843-1865.J-H, Lin. et al. (2020) ‘A Multifunctional Microfluidic Device for Blood Typing and Primary Screening of Blood Diseases’ ACS Sensors, 5(10), pp. 3082-3090.J, Lee. et al. (2020) ‘Determination of Serotonin Concentration in Single Human Platelets through Single-Entity Electrochemistry’, ACS Sensors, 5(7), pp. 1943-1948.T.L.T, Ho. et al. (2018) ‘Determining mean corpuscular volume and red blood cell count using electrochemical collision events’, Biosensors and Bioelectronics. 110, pp. 155-159.A-C, Villani. et al. (2017) ‘Single-cell RNA-seq reveals new types of human blood dendritic cells, monocytes, and progenitors’, Science. 356, No.6335.

Over-transfusion with blood for suspected hemorrhagic shock is not associated with worse clinical outcomes.

We evaluated patient outcomes after early, small volume red blood cell (RBC) transfusion in the setting of presumed hemorrhagic shock. We hypothesized that transfusion with even small amounts of blood would be associated with more complications. Retrospective review of trauma patients admitted to a Level 1 trauma center between 2016-2021. Patients predicted to require massive transfusion who survived ≥72 h were categorized according to units of RBCs transfused in the first 24 h. A Cox regression model stratified by dichotomized ISS and adjusted for SBP <90 mm Hg and pulse >120 bpm on arrival was used to estimate hazard ratios (HRs) for outcomes of interest. A total of 3121 (24%) received RBC transfusion within the first 24 h. Massive transfusion protocol (MTP) was activated in 38% (1188/3121): 17% received no RBCs, 27.4% 1-3units, 32.4% 4-9units, and 22.7% ≥10units. Mean ISS increased with each category of RBC transfusion. There was no difference in the risk of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), infection, cardiac arrest, venous thromboembolism or stroke for patients receiving 1-3units compared to the non-transfused group or 4-9units group (p > 0.05). Compared to those receiving ≥10units, the 1-3units group had a significantly lower risk of AKI, ARDS, and cardiac arrest. Early empiric RBC transfusion for presumed hemorrhagic shock may subject patients to potential over-transfusion and end-organ damage. Among patients meeting clinical triggers for MTP, 1-3units of allogeneic RBCs is not associated with worse outcomes.

Prenatal Diagnosis and Management of Thrombocytopenia-Absent Radius Syndrome.

Prenatal Diagnosis and Management of Thrombocytopenia-Absent Radius Syndrome.

Hospital Seroprevalence of Dengue Virus Infection among Adults of Urban Dhaka

Background: Global incidence of dengue has increased dramatically over the last few decades. In Bangladesh, there is a high transmission of Dengue in urban and peri-urban areas of Dhaka and other major cities. Seasonal variation, improper surveillance, underreporting of dengue infection have made difficult to estimate disease burden of dengue. Objective: This study was aimed to observe the rate of seropositivity by ELISA for Dengue IgG patients presenting to hospital. Methods: This is a cross-sectional study done in seven medical college hospital in urban Dhaka from January 2018 to March 2018. A small amount of blood was taken obtaining informed written consent in patients selected by purposive sampling during presenting to hospitals and a pre-tested questionnaire was fill to gather socio-demographic and relevant epidemiological data. Results: A total of 695 patients were included in this study with a mean age 34.9±16.49. Dengue IgG was positive in 349 (51.2%), positivity was found highest (70%) in Shahabuddin Medical College Hospital and lowest (25%) in Uttara Adhunik Medical College. Dengue IgG positive patients were more literate (82% vs 74.2%), more from urban setting (51.2% vs 41.8%), had more monthly income, had more garden (26.8% vs 23.3%) and stagnant water (25.5% vs 23%) in comparison to IgG negative patients. Conclusion: This study revealed that high seroprevalence posing risk to develop severe dengue and indicating high disease burden which warranted large scale well design population-based study. Bangladesh Med Res Counc Bull 2021; 47(1): 17-22

Biomarker-Based Models for Preoperative Assessment of Adnexal Mass: A Multicenter Validation Study.

Simple SummaryOvarian cancer (OC) is the deadliest genital tumor in women. In this multicenter study, we developed three new diagnostic models based on serum proteins and patient age. All models were then validated using data from centers other than those used for the model development. We also compared the performance of these models with common singular markers (CA125, HE4) and algorithms (ROMA-50 and the Copenhagen Index). We used modern technology (Luminex®, Austin, TX, USA) that enables the simultaneous determination of several biomarkers in a small amount of blood. A combination of patient age with four to six markers performed best: CA125, osteopontin, prolactin, macrophage migration inhibitory factor, and, eventually, HE4 and leptin. Our models were better than the ROMA-50 index but did not outperform the Copenhagen Index. In postmenopausal patients, all the newly developed models performed excellently. Unfortunately, none of the models tested improved the diagnosis in premenopausal patients and those missed due to normal CA125 levels.Ovarian cancer (OC) is the most lethal genital malignancy in women. We aimed to develop and validate new proteomic-based models for non-invasive diagnosis of OC. We also compared them to the modified Risk of Ovarian Malignancy Algorithm (ROMA-50), the Copenhagen Index (CPH-I) and our earlier Proteomic Model 2017. Biomarkers were assessed using bead-based multiplex technology (Luminex®) in 356 women (250 with malignant and 106 with benign ovarian tumors) from five European centers. The training cohort included 279 women from three centers, and the validation cohort 77 women from two other centers. Of six previously studied serum proteins (CA125, HE4, osteopontin [OPN], prolactin, leptin, and macrophage migration inhibitory factor [MIF]), four contributed significantly to the Proteomic Model 2021 (CA125, OPN, prolactin, MIF), while leptin and HE4 were omitted by the algorithm. The Proteomic Model 2021 revealed a c-index of 0.98 (95% CI 0.96, 0.99) in the training cohort; however, in the validation cohort it only achieved a c-index of 0.82 (95% CI 0.72, 0.91). Adding patient age to the Proteomic Model 2021 constituted the Combined Model 2021, with a c-index of 0.99 (95% CI 0.97, 1) in the training cohort and a c-index of 0.86 (95% CI 0.78, 0.95) in the validation cohort. The Full Combined Model 2021 (all six proteins with age) yielded a c-index of 0.98 (95% CI 0.97, 0.99) in the training cohort and a c-index of 0.89 (95% CI 0.81, 0.97) in the validation cohort. The validation of our previous Proteomic Model 2017, as well as the ROMA-50 and CPH-I revealed a c-index of 0.9 (95% CI 0.82, 0.97), 0.54 (95% CI 0.38, 0.69) and 0.92 (95% CI 0.85, 0.98), respectively. In postmenopausal women, the three newly developed models all achieved a specificity of 1.00, a positive predictive value (PPV) of 1.00, and a sensitivity of >0.9. Performance in women under 50 years of age (c-index below 0.6) or with normal CA125 (c-index close to 0.5) was poor. CA125 and OPN had the best discriminating power as single markers. In summary, the CPH-I, the two combined 2021 Models, and the Proteomic Model 2017 showed satisfactory diagnostic accuracies, with no clear superiority of either model. Notably, although combining values of only four proteins with age, the Combined Model 2021 performed comparably to the Full Combined Model 2021. The models confirmed their exceptional diagnostic performance in women aged ≥50. All models outperformed the ROMA-50.

Anesthesiological Possibilities of Intraoperative Bleeding Control During Endoscopic Rhinosinusurgical Interventions

The safety and effectiveness of endoscopic rhinological operations in the treatment of chronic inflammatory diseases, as well as neoplasms of the paranasal sinuses, are largely achieved by reducing bleeding in the area of the surgical field. Even a small amount of blood can disrupt the view during endoscopy and prevent the intervention from being performed, thereby increasing the risk of complications.The review presents modern methods of reducing the risk of intraoperative bleeding under general anesthesia. Each approach has its own characteristics, therefore, the benefit-risk ratio should be assessed for each patient before choosing a specific method for controlling intraoperative bleeding.

Polymethyl Methacrylate-Based Smart Microfluidic Point-of-Care Testing of Prothrombin Time and International Normalized Ratio through Optical Detection.

The mechanical heart valve is a crucial solution for many patients. However, it cannot function on the state of blood as human tissue valves. Thus, people with mechanical valves are put under anticoagulant therapy. A good measurement of the state of blood and how long it takes blood to form clots is the prothrombin time (PT); moreover, it is an indicator of how well the anticoagulant therapy is, and of whether the response of the patient to the drug is as needed. For a more specific standardized measurement of coagulation time, an international normalized ratio (INR) is established. Clinical testing of INR and PT is relatively easy. However, it requires the patient to visit the clinic for evaluation purposes. Many techniques are therefore being developed to provide PT and INR self-testing devices. Unfortunately, those solutions are either inaccurate, complex, or expensive. The present work approaches the design of an anticoagulation self-monitoring device that is easy to use, accurate, and relatively inexpensive. Hence, a two-channel polymethyl methacrylate-based microfluidic point-of-care (POC) smart device has been developed. The Arduino based lab-on-a-chip device applies optical properties to a small amount of blood. The achieved accuracy is 96.7%.