BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*

Objective To investigate the synergistic protective effects of WR-2721 combined with lentinan and cytokines against radiation damage in mice, and to provide a new treatment for acute radiation injury. Methods Seventy Institute of Cancer Research mice were divided into seven groups: a control group, a model group, WR-2721 group, Lentinan & cytokine group, WR-2721 & Lentinan group, WR-2721 & cytokine group and WR-2721 & Lentinan & cytokine group. All groups except the control group were irradiated with ⁶⁰Co γ-rays at a dose rate of 0.8 Gy/min and a cumulative dose of 5.0 Gy. The mice were sacrificed by cervical dislocation 14 d after irradiation to measure their spleen index, thymus index, and serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin-11 (IL-11), and tumor necrosis factor-alpha (TNF-α). Results For the mice treated with WR-2721, lentinan, and cytokines, the spleen index was 7.33 ± 2.84, the thymus index was 1.70 ± 0.30, the serum SOD level was 114.0 ± 8.3, the MDA level was 7.33 ± 1.16, the IL-11 level was 155.8 ± 49.4, and the TNF-α level was 174.0 ± 37.8. All these indicators except the spleen index in the combination group significantly differed from those of the model group (P < 0.05 or 0.01), indicating the combined treatment promoted recovery from radiation damage. Conclusion WR-2721 combined with lentinan and cytokines has significant synergistic protective effects, which is a promising treatment for acute radiation injury.

Objective:To establish a scientific and standardized routine for perioperative nursing in pediatric otolaryngology, reduce the incidence of postoperative delirium, and improve the quality of postoperative recovery by implementing the best practice of evaluation and intervention of postoperative delirium in pediatric otolaryngology.Methods:By reviewing literature related to evaluation, prevention, intervention and management of postoperative delirium in pediatric otolaryngology from March 2018 to September 2019, fourteen best practice were concluded. By combining the best evidence and the clinical circumstances, the evidenced-based criteria were established and then applied in the Otolaryngology and Head and Neck Surgery Department, the Children ′s Hospital of Zhejiang University School of Medicine. Results:After three rounds of reviews, the results showed that the criteria 2, 3, 6, and 8 had 100.0% complacence. Comparison of before and after applying the evidence, there was no statistically significant difference for the occurrence of postoperative delirium or pain ( P>0.05); there was a statistically significant reduction of pain score at 60 minutes after returning to the ward ( χ2=9.93, P<0.05); there was a statistically significant reduction of preoperative anxiety score of children ′s family members from (33.36 ± 6.84) points to (29.54 ± 6.94) points ( F=6.33, P<0.05); there was a statistically significant increase of doctors ′ score of delirium knowledge based on evidence from (23.00 ± 3.94) points to (33.43 ± 8.25) points ( t=-3.02, P<0.05); and there was a statistically significant increase of nurses ′ score of delirium knowledge based on evidence from (33.11 ± 8.46) points to (57.79 ± 6.58) points ( t=-10.35, P<0.05) when the evidence was applied. Conclusion:The evidence-based practice didn ′t significantly relieve the postoperative delirium in pediatric otolaryngology, but it was helpful to relieve the postoperative pain level of children and the anxiety level of their families. The management of postoperative delirium in pediatric otolaryngology needs to be further explored.

OBJECTIVE： To study the effects of cimetidine on low dose rate irradiation-induced liver cell apoptosis in Beagle dogs. METHODS： Healthy male Beagle dogs were randomly divided into normal control group， model control group， positive drug group （lentinan， 21.33 mg/kg） and cimetidine low-dose， medium-dose and high-dose groups （5.33， 10.67， 21.33 mg/kg）， with 4 Beagle dogs each. Except for normal control group， other groups were given 60Co-γ accumulative irradiation （dosage rate： 0.040 8 mGy/min） for 23 d； the medication groups were given relevant medicine orally before irradiation， once a day. Twenty-four hours after stopping irradiation， TUNEL method was used to detect the apoptosis of liver cells in Beagle dogs. The percentage of apoptotic cells was calculated. The expression level of apoptosis-related proteins （Bax， Bcl-2， Caspase-3， p53） in liver tissue was detected by immunohistochemistry. RESULTS： Compared with normal control group， apoptotic cells and Bax， Caspase-3， p53 positive cells were increased significantly in liver tissue of Beagle dogs in model control group； the percentage of apoptotic cells， protein expression levels of Bax， Caspase-3 and p53 were increased significantly； Bcl-2 positive cells were decreased significantly， and its protein expression level was decreased significantly （P＜0.05 or P＜0.01）. Compared with model control group， above positive cells of liver tissue in Beagle dogs were changed to different extents in medication groups； the percentage of apoptotic cells and protein expression levels of p53 in medication groups， protein expression levels of Bax in positive drug group， cimetidine low-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were decreased significantly； protein expression levels of Bcl-2 were increased significantly in cimetidine groups. The percentage of apoptotic cells in cimetidine medium-dose and high-dose groups as well as protein expression levels of Caspase-3 in cimetidine groups were all lower than positive control group. Protein expression level of p53 in cimetidine low-dose group was significantly higher than positive drug group （P＜0.05 or P＜0.01）. CONCLUSIONS： Cimetidine can inhibit the low dose rate irradiation-induced apoptosis of liver cells in Beagle dogs， and certainly protect liver cells against irradiation. The mechanism of it may be associated with up-regulating the protein expression of Bcl-2 and down-regulating the protein expression of Bax， Caspase-3 and p53 in liver cells.

Objective To investigate the effects of prolonged deloyment at sea on the serum hormone levels of the ship crew with different age and length of sea service before and after deployment at sea.Methods Serum levels of thyroxine (T4),T3 (triiodothyronine),thyroid stlmulating (TSH),adreno-cortico-tropichormone (ACTH),corticotropin-re-leasing hormone (CRH),COR (cortisol),testosterone (T) and neuropeptide Y (NPY) were detected by ELISA,and the obtained results were analyzed and compared according to age and length of service.Results When the low-age (age range between 24 and 29) group was compared with the senior age (over 30 years) group,there were 2 serum hormones in the low-age group that displayed significant changes (P ＜0.05),while there were 6 hormones in the senior age group that displayed significant changes (P ＜ 0.05).When comparisons were made between the short length of service group (from 2 to 8 years) and the long length of service group (≥9 years),there were 2 serum hormones in the shorter length of service group that displayed significant changes (P ＜ 0.05),as compared with 4 serum hormones that showed obvious changes in the longer length of service group (P ＜ 0.05).Conclusions Results indicated that the effects of prolonged deployment at sea on serum hormone levels on the low-age and shorter length of service group were lower than those in the senior-age and longer leigth of service group.

Objective To investigate the effects of prolonged deloyment at sea on the serum hormone levels of the ship crew with different age and length of sea service before and after deployment at sea.Methods Serum levels of thyroxine (T4),T3 (triiodothyronine),thyroid stlmulating (TSH),adreno-cortico-tropichormone (ACTH),corticotropin-re-leasing hormone (CRH),COR (cortisol),testosterone (T) and neuropeptide Y (NPY) were detected by ELISA,and the obtained results were analyzed and compared according to age and length of service.Results When the low-age (age range between 24 and 29) group was compared with the senior age (over 30 years) group,there were 2 serum hormones in the low-age group that displayed significant changes (P ＜0.05),while there were 6 hormones in the senior age group that displayed significant changes (P ＜ 0.05).When comparisons were made between the short length of service group (from 2 to 8 years) and the long length of service group (≥9 years),there were 2 serum hormones in the shorter length of service group that displayed significant changes (P ＜ 0.05),as compared with 4 serum hormones that showed obvious changes in the longer length of service group (P ＜ 0.05).Conclusions Results indicated that the effects of prolonged deployment at sea on serum hormone levels on the low-age and shorter length of service group were lower than those in the senior-age and longer leigth of service group.

Objective To investigate the radioprotective effect of cimetidine on survival rate and hematopoietic system in acutely irradiated mice.Methods The total body irradiation doses were 6.0Gy and 8.0Gy respectively at 1.01Gy/min rate. Sixty healthy male C57BL/6 mice were randomly divided into control group, model group, positive-drug (523) group and cimetidine groups (33.3mg/kg, 100mg/kg and 300mg/kg). Each group had ten mice. The mice were given intragastric administration of cimetidine for 6d before the irradiation in cimetidine groups, and 523 was administered before irradiation once a day for one day in 523 group, and at 5h after irradiation, was given again. The 30d survival rate after 8.0Gy irradiation was recorded. The peripheral blood cells, bone marrow DNA content and frequency of micronucleated polychromatic erythrocytes (fMNPCE) were determined 30d after 6.0Gy irradiation.Results After 8.0Gy irradiation, all the mice died on 21th day in model control group. The survival rates in cimetidine groups were 50%, 20% and 30%, respectively. After 6.0Gy irradiation on 30th day, compared with control group, the peripheral white blood cells (WBC) and bone marrow DNA content were decreased significantly (P<0.01,P<0.05) in model group, and fMNPCE was increased significantly (P<0.05). Compared with model group, WBC was significantly increased in 300mg/kg cimetidine group (P<0.01). In cimetidine groups, the bone marrow DNA content was increased significantly after irradiation (P<0.01 orP<0.05), and the fMNPCE was decreased significantly (P<0.01 orP<0.05) and tended towards normal.Conclusion Cimetidine could improve 30d survival rate of acutely irradiated mice and has good protective effect on hematopoietic system.

Objective To investigate the effects of prolonged deployment at sea on the levels of blood routine in submariners.Methods Two milliliters of venal blood were collected from 57 submariners before, during and after prolonged deployment at sea , and the levels of white blood cell ( WBC), red blood cell (RBC), hemoglobin (Hb) and platelet (PLT) were detected.Results The levels of WBC [(7.43 ±1.26) ×109 /L、(7.55 ±1.62) ×109 /L ], RBC [(5.33 ±0.33) ×1012 /L、 (5.22 ±0.36) ×1012 /L], Hb [(151.97 ±9.44) g/L、(159.44 ±11.64) g/L] and PLT [(215.30 ±38.90) ×109 /L、(211.70 ± 39.99) ×109 /L] during and after deployment were all higher than those before deployment [(5.90 ±1.29) × 109 /L、(4.41 ±0.29) ×1012 /L、(142.84 ±10.06)g/L、(175.37 ±40.98) ×109 /L].Statistical significance could be noted when comparisons were made between them (P <0.05).The levels of RBC and Hb during and after deployment were higher than the norms , and statistical significance could also be seen , as compared with those before deployment (P <0.05).Conclusions Prolonged deployment at sea might exert effects on the levels of blood routine in submariners due to various reasons .Effects should be made on the monitoring of blood routine in submariners.

Objective To investigate the effects of prolonged deployment at sea on the levels of blood routine in submariners.Methods Two milliliters of venal blood were collected from 57 submariners before, during and after prolonged deployment at sea , and the levels of white blood cell ( WBC), red blood cell (RBC), hemoglobin (Hb) and platelet (PLT) were detected.Results The levels of WBC [(7.43 ±1.26) ×109 /L、(7.55 ±1.62) ×109 /L ], RBC [(5.33 ±0.33) ×1012 /L、 (5.22 ±0.36) ×1012 /L], Hb [(151.97 ±9.44) g/L、(159.44 ±11.64) g/L] and PLT [(215.30 ±38.90) ×109 /L、(211.70 ± 39.99) ×109 /L] during and after deployment were all higher than those before deployment [(5.90 ±1.29) × 109 /L、(4.41 ±0.29) ×1012 /L、(142.84 ±10.06)g/L、(175.37 ±40.98) ×109 /L].Statistical significance could be noted when comparisons were made between them (P <0.05).The levels of RBC and Hb during and after deployment were higher than the norms , and statistical significance could also be seen , as compared with those before deployment (P <0.05).Conclusions Prolonged deployment at sea might exert effects on the levels of blood routine in submariners due to various reasons .Effects should be made on the monitoring of blood routine in submariners.

Objective:To observe the temperature vaxiation in the pulp chamber during Nd-YAG laser irradiation at tooth cervical portion.Methods:60 extracted permanent teeth were divided into 3 groups (anterior teeth,premolars and molars,n =20).The teeth in each group were further divided into 4 subgroups according to the laser power setting (0.4 W,0.8 W)and interval time(1 0 s,20 s)(n =5).After canal preparation the teeth were fixed and filmed using the parallel projection technique.the thickness of the buccal pulp chamber wall was measured by graphic analyzing software.The buccal cervical portion of the teeth was irradiated through 200 μm optical fiber,Temperature in the pulp was measured by K type thermo-electric couples fixed to the pulp chamber wall.Re-sults:The temperature inside the chamber increased with the higher power setting(P <0.01 ),under the same power setting,longer irradiation duration caused higher temperature rise(P <0.01 ).Greater chamber wall thickness was associated with lower temperature rise.Conclusion:The temperature rise in the pulp chamber during laser irradiation is correlated with laser power setting and the thickness of the irradiated tooth tissue.