This prospective descriptive study aimed to document the use and the quality of delivery of blood products in paediatric patients at the Port Moresby General Hospital. Paediatric patients transfused in the Paediatric Ward, the Special Care Nursery, the general Intensive Care Unit, the full Nursing Care Ward and the Children's Outpatient Department were included. 555 transfusion requests were dispensed from the blood bank to paediatric patients during the six months from the end of February to August 2012. Detailed information about age, sex, diagnosis, indication for transfusion and whether or not this followed standard indications, timeliness of transfusion and the quality of the transfusion procedure was recorded for a convenience sample of 64 patients, 37 males and 27 females, with a median age of 33 months and an interquartile range of 9-72 months. The most common indication for transfusion was infection-related anaemia. 50% of patients transfused did not meet standard indications for this intervention. In 86% of cases there was a delay in blood transfusion, blood shortage being an important contributing factor. Adequate monitoring of transfusion occurred in only 20% of the patients. No major adverse reactions were reported. It is highly recommended that a blood transfusion checklist be designed to improve the quality of blood transfusion practices and monitoring. Clinicians need to improve their prescribing of blood in accordance with established guidelines.
Paediatric ; Blood - transfusion ; Blood products - Therapeutic use

OBJECTIVE: To observe the changes of plasminogen activator inhibitor-1 and D-dimer during continuous blood purification (CBP) and related factors. METHODS: Sixteen patients who were diagnosed with multiple organ dysfunction syndrome (MODS) were randomly divided into 2 groups: 8 patients received standard continuous blood purification with heparin anticoagulation, and the other 8 received CBP without anticoagulation. Ten normal blood samples were collected from healthy volunteers as controls. All patients underwent CBP for 8 h. Blood was taken from those patients at 0, 15, 60, 120 and 480 min during the CBP. Plasma plasminogen activator inhibitor-1, D-dimer and serum TNF-α and IL-1β were measured by ELISA. RESULTS: Plasma levels of PAI-1 and D-dimer were increased significantly compared with those in the control group (P<0.05). Plasma level of PAI-1 was reduced (P<0.05) and D-dimer was increased (P<0.05) after the CBP. The level of plasma PAI-1 in the heparin group was significant reduced compared with the group of CBP without anticoagulation (P<0.05). There was negative correlation between the level of PAI-1 and the dosage of heparin used during a CBP session in the heparin group (r=-0.746, P<0.001). CONCLUSION The level of PAI-1 and D-dimer is higher in patients with MODS than that in the normal controls. After the CBP treatment, there is significant decrease in PAI-1 and increase in D-dimer in both groups. Heparin used during CBP can reduce PAI-1 which intensifies its function of anticoagulation.
Anticoagulants ; therapeutic use ; Fibrin Fibrinogen Degradation Products ; analysis ; Heparin ; therapeutic use ; Humans ; Interleukin-1beta ; blood ; Plasminogen Activator Inhibitor 1 ; blood ; Renal Dialysis ; Tumor Necrosis Factor-alpha ; blood

Alanine Transaminase ; blood ; DNA, Viral ; analysis ; Gene Products, pol ; genetics ; Hepatitis B ; drug therapy ; Humans ; Lamivudine ; therapeutic use ; Mutation

OBJECTIVETo explore the clinical efficacy of the principle of activating blood circulation to break stasis (ABCBS) and its influence on platelet membranous protein particle (GMP-140) and D(2) dimer (D-dimer) before and after treatment.

METHODSEighty-eight patients with blood stasis syndrome (BSS) of acute cerebral infarction (ACI) were randomly divided into two groups, both of which were treated with conventional treatment, i.e. with western medicine (WM), with Salvia injection added through intravenously dripping. One of the two groups was used as the control and the other group as the treated group who had ABCBS herbs orally taken in addition. The duration of treatment course for both groups was 3 weeks.

RESULTSThere were changes in both groups over clinical symptoms, nerve function deficit scoring and GMP-140, D-dimer, but the treated group showed significantly better than that of the control group, (P < 0.05).

CONCLUSIONABCBS principle could serve as an important auxiliary treating method for BSS of ACI, as it can effectively alter the blood of ACI patients which was viscous, condense, coagulant and aggregating.

Acute Disease ; Aged ; Aspirin ; therapeutic use ; Blood Circulation ; drug effects ; Blood Platelets ; metabolism ; Cerebral Infarction ; blood ; physiopathology ; therapy ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Nervous System ; physiopathology ; Nimodipine ; therapeutic use ; P-Selectin ; blood ; Phytotherapy ; Plant Preparations ; therapeutic use ; Platelet Aggregation Inhibitors ; therapeutic use ; Salvia ; Vasodilator Agents ; therapeutic use

OBJECTIVETo study the clinical features of chronic hepatitis B (CHB) patients with tyrosine-methionine-aspartate-aspartate (YMDD) mutation after lamivudine therapy.

METHODSThis investigation was a retrospective study of 63 CHB patients with YMDD mutation during lamivudine therapy. Clinical data, including period and types of YMDD mutation; hepatitis B virus (HBV) DNA levels and alanine aminotransferase (ALT) levels before and after YMDD mutation were measured. YMDD mutation in the HBV DNA polymerase gene was determined using polymerase chain reaction (PCR) and direct sequencing. HBV DNA quantification was determined using real-time PCR. Relevant serum markers of HBV were measured. The follow-up period was 12 months after YMDD mutation.

RESULTSYMDD mutation occurred 7-44 months (median, 21.5 months) after the start of lamivudine therapy. The majority of the cases (42/63, 66.6%) had YMDD mutants detected between 12 and 24 months. Four types of YMDD mutation were observed in this study, rtL180M/M204V mutation was the predominant type (26/63, 41.3%). A proportion of patients (16/63, 25.4%; 12/63, 19.1%) had higher HBV DNA levels and ALT levels (after mutation vs before mutation), respectively.

CONCLUSIONThe majority of patients with YMDD mutants had similar or lower HBV DNA levels and ALT levels compared with baseline values. This subset of patients might have benefited from the continued lamivudine therapy. The patients with increased ALT and HBV DNA levels (breakthrough hepatitis) should benefit from the addition of a newer nucleotide analogue (e.g. adefovir).

Adolescent ; Adult ; Aged ; Anti-HIV Agents ; therapeutic use ; Child ; DNA Mutational Analysis ; Female ; Gene Products, pol ; blood ; genetics ; Hepatitis B, Chronic ; blood ; diagnosis ; drug therapy ; genetics ; Humans ; Lamivudine ; therapeutic use ; Male ; Middle Aged ; Mutation ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo establish a rapid specific method to identify the single-nucleotide polymorphisms (SNPs) of HBV polymerase gene region which are the methionine residue of the conserved YMDD motif.

METHODSTwo specific primers were designed to amplify interested gene region involved in SNPs which were also used as HBV DNA identification. Specific primers of SNaPshot were designed to detect 741A-G (YVDD), 743G-T (YIDD). The different fluorescent dye labeled ddNTP was used to further extend the strand of PCR product and was detected by ABI PRISM 310 Genetic Analyzer. Sera from 13 patients with chronic hepatitis B after lamivudine treatment were analyzed.

RESULTSAside from mutation of YMDD, there were mutations of 514C-A, 523C-A, 562T-A, 667C-A. The 13 samples were simultaneously tested with SNaPshot and DNA sequencing, the same results were obtained. The method of SNaPshot showed high specificity.

CONCLUSIONMutation of YMDD results in the changes of ATG codon, and there are new ATG codon in the upper strand of YMDD. SNaPshot technique is rapid, specific and accurate for the SNPs monitoring of HBV DNA mutation during lamivudine therapy. Two samples were determined by SnaPshot technique, identifying the co-existence of the mixed wild type and mutant type HBV infection.

Antiviral Agents ; therapeutic use ; Base Sequence ; DNA, Viral ; blood ; genetics ; Drug Resistance, Viral ; Gene Products, pol ; genetics ; Hepatitis B ; blood ; drug therapy ; virology ; Humans ; Lamivudine ; therapeutic use ; Polymorphism, Single Nucleotide ; Sequence Analysis, DNA

OBJECTIVETo evaluate the clinical efficacy and safety of sequential treatment with alprostadil and beraprost sodium for chronic renal failure caused by chronic glomerulonephritis.

METHODSSixty-three patients with chronic renal failure due to chronic glomerulonephritis, after receiving a 2-week-long conventional treatment, were randomly divided into alprostadil group (n=20, with alprostadil injection at 10 µg/d for 2 weeks), sequential treatment group (n=21, with alprostadil injection at 10 µg/d for 2 weeks and oral beraprost sodium at 20 µg three times a day for 12 weeks), and strengthened sequential treatment group (n=22, with alprostadil injection at 20 µg/d for 2 weeks and a double dose of oral beraprost sodium for 12 weeks). Urinary albumin excretion rate (UAER), cystatin C (Cys C), blood urea nitrogen, creatinine, fibrinogen, D-dimer, prothrombin time (PT), and platelets were tested before and after the treatment, and the changes in urinary albumin discharge rate, serum creatinine, and glomerular filtration rate were determined.

RESULTSThe patients in strengthened sequential treatment group showed a significantly decreased change rate of urinary albumin discharge rate (P<0.01) than those in the other two groups. In the two sequential treatment groups, especially the strengthened treatment group, the change rate of glomerular filtration rate increased significantly compared with that in alprostadil group (P<0.01). Strengthened sequential treatment resulted also in significantly decreased increment of serum creatinine compared that in the other 2 groups (P<0.01). After 14 weeks of treatment, fibrinogen and D-dimer were decreased in all the 3 groups (P<0.05) to a comparable level between the 3 groups (P>0.05), and prothrombin time (PT) or platelet showed no significant changes (P>0.05).

CONCLUSIONSequential treatment with alprostadil and beraprost sodium can improve the glomerular filtration rate and decrease urine albumin excretion rate, serum creatinine increase rate, and lower blood fibrinogen and D-dimer levels, thus delaying the progression of chronic renal failure caused by chronic glomerulonephritis. This therapy shows a dose-related effect with good clinical safety.

Adolescent ; Adult ; Aged ; Alprostadil ; therapeutic use ; Blood Urea Nitrogen ; Chronic Disease ; Creatinine ; blood ; Drug Therapy, Combination ; Epoprostenol ; analogs & derivatives ; therapeutic use ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Fibrinogen ; metabolism ; Glomerular Filtration Rate ; Glomerulonephritis ; complications ; Humans ; Kidney Failure, Chronic ; blood ; drug therapy ; etiology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors ; therapeutic use ; Platelet Count ; Prothrombin Time ; Urological Agents ; therapeutic use ; Young Adult

OBJECTIVETo examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.

METHODSIn the present study, eighteen patients with acute myocardial infarction (AMI) received 1.5 or 2.0 million U nonspecific urokinase (UK), or 70 approximately 80 mg fibrin-specific recombinant tissue plasminogen activator (rt-PA) and did not use heparin until 8 hours after intravenous injection of the above agents. Eight patients with AMI and without thrombolytic therapy were enrolled as controls. Coagulant and thrombolytic activity markers included thrombin-antithrombin III complex (TAT), D-dimer, fibrinogen (Fg), FMPV/Amax. All markers were determined before, immediately, 1, 2, 4 and 8 hours after the administration of thrombolytic agents respectively.

RESULTSMolecular marker of thrombin generation--TAT showed an activated coagulant state immediately after thrombolytic therapy. Level of TAT showed no significant changes between every two observed phases in controls. However, level of TAT increased significantly from 4.95 +/- 1.75 microg/L ( 4.63 +/- 1.37 microg/L) to 14.71 +/- 3.31 microg/L (14.25 +/- 2.53 microg/L) before and immediately after administration of thrombolytic agents UK (or rt-PA). There was significant difference between level of serum TAT of patients with and without thrombolytic therapy (P < 0.05). Patients achieving clinical reperfusion had lower TAT level than those failing in thrombolytic therapy, and higher FMPV/Amax level than controls. D-dimer, a surrogate of thrombolytic activity increased markedly and Fg significantly declined after thrombolytic therapy (P < 0.05).

CONCLUSIONSThrombin generation occurred in plasma in response to excess fibrinolysis induced by thrombolytic therapy. Both urokinase and rt-PA had procoagulant action. This transient activation of the coagulant system might contribute to early reocclusion. These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents. These results also suggested that TAT might be useful in predicting clinical outcomes of patients treated with thrombolytic therapy for AMI.

Aged ; Antithrombin III ; Biomarkers ; blood ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Fibrinogen ; metabolism ; Fibrinolytic Agents ; therapeutic use ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; blood ; drug therapy ; Peptide Hydrolases ; blood ; Recombinant Proteins ; therapeutic use ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; therapeutic use ; Urokinase-Type Plasminogen Activator ; therapeutic use

BACKGROUNDDiabetic macrovascular complications are important causes of cardiovascular and cerebrovascular diseases and also one of the major causes of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Phlorizin has been reported to be effective in reducing the blood glucose level in diabetic mellitus, while little is known about its effects on vascular complications. This study aimed to observe the effects of phlorizin on the aorta of diabetes db/db mice and explore its mechanism.

METHODSDiabetic db/db mice (n = 16) and age-matched db/m mice (n = 8) were divided into three groups: normal control group (CC group, db/m mice, n = 8), untreated diabetic group (DM group, db/db mice, n = 8) and diabetic group treated by phlorizin (DMT group, db/db mice, n = 8). Phlorizin (20 mg/kg body weight) was given in normal saline solution intragastrically for 10 weeks. Animals were weighed weekly. At the 10th weekend, all mice were fasted overnight and then sacrificed. Fasting blood was collected, and the aortas were dissected. The blood samples were analyzed for fasting blood glucose (FBG), serum advanced glycation end products (AGEs), malondialdehyde (MDA) and superoxide dismutase (SOD) activity, the aortic ultrastructure was studied.

RESULTSThe weight and serum concentration of FBG, AGEs, and MDA in the DM group were higher than that in the CC group (P < 0.01), and they were significantly lower in the DMT group (P < 0.05). Serum SOD activity was lower than that in the CC group (P < 0.01), and it is significantly higher in the DMT group (P < 0.05). The severity of aorta damage in the DMT group was less than that in the DM group.

CONCLUSIONSPhlorizin protected the db/db mice from diabetic macrovascular complications, attributed to the decreasing of blood glucose and AGEs level, and its antioxidant potential. This study may provide a new natural medicine for treating diabetic macrovascular complications.

Animals ; Aorta, Thoracic ; pathology ; Blood Glucose ; analysis ; Diabetic Angiopathies ; drug therapy ; pathology ; Glycation End Products, Advanced ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Phlorhizin ; therapeutic use ; Superoxide Dismutase ; metabolism

OBJECTIVETo observe the intervention of Xuezhikang (XZK) on patients of acute coronary syndrome (ACS) with different levels of blood lipids.

METHODSAdopting the double blind randomized controlled method, 105 patients of ACS were divided into two groups. The 53 patients in the treated group, 26 with normal blood lipids (NBL) and 27 with hyperlipemia (HL) were treated with conventional western medicine plus XZK 1.2 g per day for 12 weeks. The 52 patients in the control group, 25 with NBL and 27 with HL, were treated with conventional western medicine alone. Besides, a healthy control group consisted of 40 subjects was set up. The changes of brachial arterial endothelium-dependent diastolic function (FMD) before and after treatment was observed, the changes of blood levels of nitric oxide (NO), endothelin-1 (ET-1), C-reactive protein (CRP) and lipids were also recorded.

RESULTSBefore treatment, FMD value and serum NO level were lower and ET-1 and CRP levels in ACS patients were higher than those in the healthy subjects, and a significant correlation existed between CRP, NO and FMD with LDL-C. After treated for 12 weeks, FMD value and serum NO level increased, levels of ET-1 and CRP decreased significantly in the treated group, showing significant difference to those in the control group (P < 0.05, P < 0.01). Serum levels of TC, TG and LDL-C in the treated group lowered significantly. HDL-C level in patients with HL increased significantly while in those with NBL, it showed a trend of increasing but with no statistical significance.

CONCLUSIONApplying XZK in ACS patients in early stage, either with NBL or with HL, could improve the endothelial function, antagonize inflammatory response to stabilize the atheromatous plaque.

Adult ; Aged ; Angina, Unstable ; blood ; complications ; drug therapy ; Biological Products ; Cholesterol ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Hyperlipidemias ; blood ; complications ; drug therapy ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; Myocardial Infarction ; blood ; complications ; drug therapy ; Phytotherapy