BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources.Most protocols recommend type and cross of...BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources.Most protocols recommend type and cross of 2 red blood cell(RBC)units for patients undergoing surgery for treatment of hip fracture.Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion,but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.AIM To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion(C:T)ratio in hip fracture surgery patients.METHODS In 2015 a patient blood management(PBM)program was implemented at our institution mandating a single unit-per-occurrence transfusion policy and a restrictive transfusion threshold of<7 g/dL hemoglobin in asymptomatic patients and<8 g/dL in those with refractory symptomatic anemia or history of coronary artery disease.We identified all hip fracture patients between 2013 and 2017 and compared the preoperative hemoglobin which would predict a 2:1 C:T ratio in the pre PBM and post PBM cohorts.Prediction profiling and sensitivity analysis were performed with statistical significance set at P<0.05.RESULTS Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified,291 in the post PBM cohort.Transfusion requirements in the post PBM cohort were lower(51%vs 33%,P<0.0001)than in the pre PBM cohort.The mean RBC units transfused per patient was 1.15 in the pre PBM cohort,compared to 0.66 in the post PBM cohort(P<0.001).The 2:1 C:T ratio(inpatient transfusion probability of 50%)was predicted by a preoperative hemoglobin of 12.3 g/dL[area under the curve(AUC)0.78(95%confidence interval(CI),0.72-0.83),Sensitivity 0.66]in the pre PBM cohort and 10.7 g/dL[AUC 0.78(95%CI,0.73-0.83),Sensitivity 0.88]in the post PBM cohort.A 50%probability of requiring>1 RBC unit was predicted by 11.2g/dL[AUC 0.80(95%CI,0.74-0.85),Sensitivity 0.87]in the pre PBM cohort and 8.7g/dL[AUC 0.78(95%CI,0.73-0.83),Sensitivity 0.84]in the post-PBM cohort.CONCLUSION The hip fracture maximum surgical blood order schedule should consider preoperative hemoglobin in determining the number of units to type and cross prior to surgery.展开更多
An in situ method has been used to load Cu_(2)O nanoparticles on the surface of a hydroxyl group rich TiO_(2)precursor.Cu_(2)O nanoparticles are formed by in situ reduction of Cu(OH)_(2) with Sn^(2+)ions linked to the...An in situ method has been used to load Cu_(2)O nanoparticles on the surface of a hydroxyl group rich TiO_(2)precursor.Cu_(2)O nanoparticles are formed by in situ reduction of Cu(OH)_(2) with Sn^(2+)ions linked to the surface of the TiO_(2)precursor.The initial Cu_(2)O nanoparticles serve as seeds for subsequent particle growth.The resulting Cu_(2)O nanoparticles are evenly dispersed on the surface of the TiO_(2)precursor,and are heat and air stable.The as-prepared composite is an excellent catalyst for Ullmann type cross coupling reactions of aryl halides with phenol.The composite catalyst also showed good stability,remaining highly active after five consecutive runs.展开更多
文摘BACKGROUND Maximum surgical blood order schedules were designed to eliminate unnecessary preoperative crossmatching prior to surgery in order to conserve blood bank resources.Most protocols recommend type and cross of 2 red blood cell(RBC)units for patients undergoing surgery for treatment of hip fracture.Preoperative hemoglobin has been identified as the strongest predictor of inpatient transfusion,but current maximum surgical blood order schedules do not consider preoperative hemoglobin values to determine the number of RBC units to prepare prior to surgery.AIM To determine the preoperative hemoglobin level resulting in the optimal 2:1 crossmatch-to-transfusion(C:T)ratio in hip fracture surgery patients.METHODS In 2015 a patient blood management(PBM)program was implemented at our institution mandating a single unit-per-occurrence transfusion policy and a restrictive transfusion threshold of<7 g/dL hemoglobin in asymptomatic patients and<8 g/dL in those with refractory symptomatic anemia or history of coronary artery disease.We identified all hip fracture patients between 2013 and 2017 and compared the preoperative hemoglobin which would predict a 2:1 C:T ratio in the pre PBM and post PBM cohorts.Prediction profiling and sensitivity analysis were performed with statistical significance set at P<0.05.RESULTS Four hundred and ninety-eight patients who underwent hip fracture surgery between 2013 and 2017 were identified,291 in the post PBM cohort.Transfusion requirements in the post PBM cohort were lower(51%vs 33%,P<0.0001)than in the pre PBM cohort.The mean RBC units transfused per patient was 1.15 in the pre PBM cohort,compared to 0.66 in the post PBM cohort(P<0.001).The 2:1 C:T ratio(inpatient transfusion probability of 50%)was predicted by a preoperative hemoglobin of 12.3 g/dL[area under the curve(AUC)0.78(95%confidence interval(CI),0.72-0.83),Sensitivity 0.66]in the pre PBM cohort and 10.7 g/dL[AUC 0.78(95%CI,0.73-0.83),Sensitivity 0.88]in the post PBM cohort.A 50%probability of requiring>1 RBC unit was predicted by 11.2g/dL[AUC 0.80(95%CI,0.74-0.85),Sensitivity 0.87]in the pre PBM cohort and 8.7g/dL[AUC 0.78(95%CI,0.73-0.83),Sensitivity 0.84]in the post-PBM cohort.CONCLUSION The hip fracture maximum surgical blood order schedule should consider preoperative hemoglobin in determining the number of units to type and cross prior to surgery.
基金We gratefully thank the National Natural Science Foundation of China(NSFC)(Nos.50725207,20873156,and 20821003)the National Basic Research Program of China(MOST)(Nos.2007CB-936400 and 2009CB930400)the Chinese Academy of Sciences for financial supports.
文摘An in situ method has been used to load Cu_(2)O nanoparticles on the surface of a hydroxyl group rich TiO_(2)precursor.Cu_(2)O nanoparticles are formed by in situ reduction of Cu(OH)_(2) with Sn^(2+)ions linked to the surface of the TiO_(2)precursor.The initial Cu_(2)O nanoparticles serve as seeds for subsequent particle growth.The resulting Cu_(2)O nanoparticles are evenly dispersed on the surface of the TiO_(2)precursor,and are heat and air stable.The as-prepared composite is an excellent catalyst for Ullmann type cross coupling reactions of aryl halides with phenol.The composite catalyst also showed good stability,remaining highly active after five consecutive runs.