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Blood utilization in a surgical intensive care unit: cause analysis and solutions to reduce inappropriate red blood cell transfusions

Objectives: Despite the fact that many published guidelines for optimal usage of blood products are available, RBC transfusions are frequently guided by personal preference and tradition. The purpose of the study was to examine the appropriateness of RBC transfusions for surgical patients admitted to the SICU and how it might affect the clinical outcomes. Methods: We retrospectively reviewed all RBC transfusions that occurred in a general SICU between July 1, 2015 and June 30, 2016. Each RBC transfusion was critically appraised using four criteria to determine whether or not the transfusion was indicated. Demographic data and clinical outcome measures of transfused and non-transfused patients as well as patients with indicated or non-indicated RBC transfusions were compared. Results: There were 617 patients admitted to the SICU and 245 (39.7%) of them required RBC transfusions. Transfused patients were more likely to have had operations prior to ICU admission (87.3% vs. 75.8%) and have higher APACHE II scores (22.1 ± 8.5 vs. 15.5 ± 7.4). They also had longer ICU stays (8.0 ± 9.1 vs. 3.0 ± 3.7 days) and higher ICU mortality rates (14.3% vs. 6.2%). Among 651 transfusions, 38.4% of them fulfilled at least one criterion for transfusion and 61.6% were not considered appropriate. Patients who had non-indicated postoperative RBC transfusion were more likely to have had intraoperative blood loss ≥ 500 mL (p ＜ 0.05). Conclusions: Our efforts to reduce unnecessary RBC transfusion in the SICU appear inadequate. Educating medical personnel is important, but additional measures should also be taken in order to improve compliance.

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Comparison of the postural assessment scale for stroke and the berg balance scale among ambulatory patients with chronic stroke

Background and purpose: We examined the correlation between the scores of the Postural Assessment Scale for Stroke Patients (PASS) and those of the Berg Balance Scale (BBS) among ambulatory patients with chronic stroke. If the PASS scores are strongly correlated with the BBS scores, the PASS would be a superior alternative for evaluation because it can be administered faster and is more comprehensive. Methods: The PASS and BBS scores of 23 independently ambulatory patients with chronic stroke were collected and analyzed using Spearman's rank correlation. Because the BBS includes more items for assessing dynamic balance function, we also analyzed the correlation between the scores of the changing posture subscale of the PASS and the scores of the BBS. Results: The Spearman rank correlation coefficient (r) between the BBS and PASS scores was .93 (P＜0.05), that between the changing posture scores and BBS scores was .87 (P ＜0.05). Conclusions: Our study indicated that among ambulatory patients with stroke, the PASS and BBS scores were strongly correlated. Thus, the PASS is a superior alternative for evaluating patients with stroke because it is faster to administer and more comprehensive. Contrary to our hypothesis, the degree of the correlation between the changing posture scores and the BBS scores was not higher than that of the correlation between the PASS and BBS scores. Nevertheless, we believe that the PASS is still a more effective test for evaluating balance function among ambulatory patients with stroke.

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Sesamol, a phenolic antioxidant, acts as regulator of NF-kB and MAPKs-mediated antiplatelet effects

Antiplatelet therapy plays a crucial role in medical treatment for patients with acute coronary syndrome. Since percutaneous coronary interventions increase in number and complication, more patients must be treated with antiplatelet therapy for cardiovascular diseases in which arterial thrombosis plays a key role. Present antiplatelet therapy is greatly effective in preventing atherothrombotic complications. However, the increased number of patients remain to experience persistent complications although being correctly treated, because of pharmacokinetics and interactions of drugs, genetic background and increased thrombus formation. Therefore, several massive research efforts have taken to offer new antiplatelet drugs with better defensive properties without any bleeding risk. Sesamol, a dietary compound derived from sesame lignans, has free radical scavenging and antioxidant properties. Sesamol is effective for hyperlipidemia, antihypertension and lipid peroxidation due to its antioxidant and cytoprotective properties. We found that sesamol has potent antiplatelet activity via activation of cyclic adenosine monophosphate (cAMP)- endothelial nitric oxide synthase (eNOS)/ nitric oxide (NO)-cGMP pathway and inhibition of phospholipase C (PLC)γ2, protein kinase C (PKC) -p38 MAPK-thromboxane A2 (TxA2). Our another study also found that this compound inhibits nuclear factor-kappa B (NF-κB) signaling events to exert its antiplatelet activity. In this review, we summarize the sesamol's antiplatelet effect through NF-κB/MAPK and PLC signaling pathways.

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Improving executive functions in two children with high-functioning autism spectrum disorder through figure skating experiences: focusing on inhibiting repetitive behaviors

Background and Purpose: This study is the first to examine whether the executive functions (EFs) of children with high-functioning autism spectrum disorder (CWHFA) can be improved through figure skating (FS) experiences. Methods: In this single-case experimental study, a qualified FS coach trained two CWHFA by following the training system developed by the Ice Skating Institute. Multiple baselines of the two CWHFA were formed on several target indices, including EF subcomponents (Taiwanese Traditional-Chinese Childhood Executive Functioning Inventory) and repetition behaviors (Repetitive Behavior Scale-Revised). Social validation was also conducted via interviewing their mothers. Results: The results indicated that both of the CWHFA made progress on FS techniques during their 12 sessions of lessons in 6 weeks. The improved inhibitory control and repetitive behaviors were correlated with and might have probably been modiated by the FS experiences. The positive effects might have transferred to their daily lives. Conclusion: The results suggested that FS experiences helped the two CWHFA on their FS skills and bettered their inhibitory control as well as lowered their repetitive behaviors. Future randomised controlled trials further examining this effect are warranted.

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Intraocular fixation with Gore-Tex® sling for dislocated intraocular lens with plate loop haptic

Intraocular lens (IOL) dislocation is always a nightmare to even an experienced ophthalmic surgeon. The scleral fixation of the IOL is commonly adopted in cases of IOL dislocation, but suture erosion and breakage remain significant concerns. Besides, surgical induced astigmatism and longer recovery time are associated with the relatively large corneal wound during the explantation and implantation of the IOL. Therefore, we described a modified scleral fixation technique for dislocated IOL with plate loop haptic. First, trocar assistant 25-gauge sclerotomies were done, and the dislocated IOL was grasped from the vitreous cavity into the anterior chamber. The CV-8 polytetrafluoroethylene (PFTE; Gore-Tex® ) suture was inserted through the small corneal wound, and was then threaded through and the haptic eyelet of the IOL. All four ends of the Gore-Tex® suture were pulled through the sclerotomies once the suture end passed through the both eyelets of the IOL, and the sutures were carefully adjusted and tied. By using this modified technique, we successfully decreased the surgical induced astigmatism and the possibility of suture breakage in the future.