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Critical Care (London, England) Feb 2020Spontaneous intracerebral hemorrhage is a devastating disease, accounting for 10 to 15% of all types of stroke; however, it is associated with disproportionally higher... (Review)
Review
Spontaneous intracerebral hemorrhage is a devastating disease, accounting for 10 to 15% of all types of stroke; however, it is associated with disproportionally higher rates of mortality and disability. Despite significant progress in the acute management of these patients, the ideal surgical management is still to be determined. Surgical hematoma drainage has many theoretical benefits, such as the prevention of mass effect and cerebral herniation, reduction in intracranial pressure, and the decrease of excitotoxicity and neurotoxicity of blood products.Several surgical techniques have been considered, such as open craniotomy, decompressive craniectomy, neuroendoscopy, and minimally invasive catheter evacuation followed by thrombolysis. Open craniotomy is the most studied approach in this clinical scenario, the first randomized controlled trial dating from the early 1960s. Since then, a large number of studies have been published, which included two large, well-designed, well-powered, multicenter, multinational, randomized clinical trials. These studies, The International Surgical Trial in Intracerebral Hemorrhage (STICH), and the STICH II have shown no clinical benefit for early surgical evacuation of intraparenchymal hematoma in patients with spontaneous supratentorial hemorrhage when compared with best medical management plus delayed surgery if necessary. However, the results of STICH trials may not be generalizable, because of the high rates of patients' crossover from medical management to the surgical group. Without these high crossover percentages, the rates of unfavorable outcome and death with conservative management would have been higher. Additionally, comatose patients and patients at risk of cerebral herniation were not included. In these cases, surgery may be lifesaving, which prevented those patients of being enrolled in such trials. This article reviews the clinical evidence of surgical hematoma evacuation, and its role to decrease mortality and improve long-term functional outcome after spontaneous intracerebral hemorrhage.
Topics: Cerebral Hemorrhage; Craniotomy; Hematoma; Humans; Treatment Outcome
PubMed: 32033578
DOI: 10.1186/s13054-020-2749-2 -
Platelets 2019Inherited or acquired disorders of platelet production and function can result in thrombocytopenia and bleeding. Mouse models have proven useful for investigating the...
Inherited or acquired disorders of platelet production and function can result in thrombocytopenia and bleeding. Mouse models have proven useful for investigating the mechanisms that underlie these defects in humans. Precise methods for blood withdrawal, platelet isolation and measurement of platelet parameters are key for the generation of reproducible and conclusive data. Here, we provide three different protocols for mouse platelet isolation to encourage research knowledge transfer between experienced laboratories, while at the same time enabling less experienced researchers to implement a protocol that best suits their local expertise and equipment. We also address the issue that reported mouse platelet count and size vary considerably in the literature by investigating different factors that influence these important platelet parameters, namely: 1) genetic background and gender, 2) choice of analysis method (hematological analyzer or flow cytometry), 3) dilution of the blood sample and 4) choice of anticoagulant. The herein presented results and considerations may serve as a practical guide for both experienced and new researchers in the platelet field.
Topics: Animals; Blood Platelets; Hematology; Male; Mice; Platelet Count
PubMed: 30346859
DOI: 10.1080/09537104.2018.1528345 -
Journal of Thrombosis and Haemostasis :... Apr 2005Summary. A variety of definitions of major bleeding have been used in published clinical studies, and this diversity adds to the difficulty in comparing data between...
Summary. A variety of definitions of major bleeding have been used in published clinical studies, and this diversity adds to the difficulty in comparing data between trials and in performing meta-analyses. In the first step towards unified definitions of bleeding complications, the definition of major bleeding in non-surgical patients was discussed at the Control of Anticoagulation Subcommittee of the International Society on Thrombosis and Haemostasis. Arising from that discussion, a definition was developed that should be applicable to studies with all agents that interfere with hemostasis, including anticoagulants, platelet function inhibitors and fibrinolytic drugs. The definition and the text that follows have been reviewed and approved by the cochairs of the subcommittee and the revised version is published here. The intention is to also seek approval of this definition from the regulatory authorities.
Topics: Anticoagulants; Fibrinolytic Agents; Hematology; Hemorrhage; Hemostasis; Humans; Platelet Aggregation Inhibitors; Postoperative Complications
PubMed: 15842354
DOI: 10.1111/j.1538-7836.2005.01204.x -
Vox Sanguinis Oct 2021Wastage of blood products can be a significant cost to blood banks. However, the cause of wastage is often complex and makes it difficult to determine wastage-associated...
BACKGROUND
Wastage of blood products can be a significant cost to blood banks. However, the cause of wastage is often complex and makes it difficult to determine wastage-associated factors. Machine learning techniques may be useful tools to investigate these complex associations. We investigated whether unsupervised machine learning can identify patterns associated with wastage in our blood bank.
MATERIALS AND METHODS
Data on red blood cells, platelets and frozen products were obtained from the laboratory information system of the Central Zone Blood Transfusion Services at Nova Scotia Health Authority. A total of 879 532 transactions were analysed by association rule mining, a type of machine learning algorithm. Associations with lift scores greater than 25 and with clinical relevance were flagged for further examination.
RESULTS
Association rule mining returned a total of 3355 associations related to wastage. Several notable associations were identified. For example, certain wards were associated with wastage due to thawing unused frozen products. Other examples included association between smaller blood banks and evening work shifts with product wastage due to excess time outside the laboratory or returning products with high temperatures.
CONCLUSION
This paper demonstrates the effective use of unsupervised machine learning for the purpose of investigating wastage in a large blood bank. The use of association rule mining was able to identify wastage factors, which can help guide quality improvement initiatives. This technique can be automated to provide rapid analysis of complex associations contributing to wastage and could be utilized in modern blood banks.
Topics: Blood Banks; Blood Platelets; Erythrocytes; Transfusion Medicine; Unsupervised Machine Learning
PubMed: 33634887
DOI: 10.1111/vox.13089 -
The Orthopedic Clinics of North America Jan 2022Symptomatic postoperative epidural hematomas are rare, with an incidence of 0.10% to 0.69%. Risk factors have varied in the literature, but multiple studies have... (Review)
Review
Symptomatic postoperative epidural hematomas are rare, with an incidence of 0.10% to 0.69%. Risk factors have varied in the literature, but multiple studies have reported advanced age, preoperative or postoperative coagulopathy, and multilevel laminectomy as risk factors for hematoma. The role of pharmacologic anticoagulation after spine surgery remains unclear, but multiple studies suggest it can be done safely with a low risk of epidural hematoma. Prophylactic suction drains have not been found to lower hematoma incidence. Most symptomatic postoperative epidural hematomas present within the first 24 to 48 hours after surgery but can present later. Diagnosis of a symptomatic hematoma requires correlation of clinical signs and symptoms with a compressive hematoma on MRI. Patients will usually first complain of a marked increase in axial pain, followed by radicular symptoms in the extremities, followed by motor weakness and sphincter dysfunction. An MRI should be obtained emergently, and if it confirms a compressive hematoma, surgical evacuation should be carried out as quickly as possible. The prognosis for neurologic improvement after evacuation depends on the time delay and the degree of neurologic impairment before evacuation.
Topics: Hematoma, Epidural, Spinal; Humans; Incidence; Postoperative Complications; Risk Factors; Spinal Diseases
PubMed: 34799017
DOI: 10.1016/j.ocl.2021.08.006 -
Oncology Research and Treatment 2015
Topics: Congresses as Topic; Health Care Costs; Hematology; Humans; Medical Oncology
PubMed: 25676571
DOI: 10.1159/000369567 -
IEEE Reviews in Biomedical Engineering 2021Segmentation of white blood cells in digital haematology microscope images represents one of the major tools in the diagnosis and evaluation of blood disorders.... (Review)
Review
Segmentation of white blood cells in digital haematology microscope images represents one of the major tools in the diagnosis and evaluation of blood disorders. Pathological examinations are being the gold standard in many haematology and histophathology, and also play a key role in the diagnosis of diseases. In clinical diagnosis, white blood cells are analysed by pathologists from peripheral blood smears samples of patients. This analysis is mainly based on morphological features and characteristics of the white blood cells and their nuclei and cytoplasm, including, shapes, sizes, colours, textures, maturity stages and staining processes. Recently, Computer Aided Diagnosis techniques have been rapidly growing in the digital haematology area related to white blood cells, and their nuclei and cytoplasm detection, as well as their segmentation and classification techniques. In digital haematology image analysis, these techniques have played and will continue to play, a vital role for providing traceable clinical information, consolidating pertinent second opinions, and minimizing human intervention. This study outlines, discusses, and introduces the major trends from a particular review of detection and segmentation methods for white blood cells and their nuclei and cytoplasm from digital haematology microscope images. Performance of existing methods have been comprehensively compared, taking into account databases used, number of images and limitations. This study can also help us to identify the challenges that remain, in achieving a robust analysis of white blood cell microscope images, which could support the diagnosis of blood disorders and assist researchers and pathologists in the future. The impact of this work is to enhance the accuracy of pathologists' decisions and their efficiency, and overall benefit the patients for faster and more accurate diagnosis. The significant of the paper on intelligent system is that provides future potential techniques for solving overlapping white blood cell identification and other problems microscopic images. The accurate segmentation and detection of white blood cells can increase the accuracy of cell counting system for diagnosing diseases in the future.
Topics: Algorithms; Cell Nucleus; Cytoplasm; Hematology; Humans; Image Processing, Computer-Assisted; Leukocytes; Microscopy; Support Vector Machine
PubMed: 32746365
DOI: 10.1109/RBME.2020.3004639 -
Health Technology Assessment... Sep 2015While it is accepted practice to remove extradural (EDH) and subdural haematomas (SDH) following traumatic brain injury, the role of surgery in parenchymal traumatic... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
While it is accepted practice to remove extradural (EDH) and subdural haematomas (SDH) following traumatic brain injury, the role of surgery in parenchymal traumatic intracerebral haemorrhage (TICH) is controversial. There is no evidence to support Early Surgery in this condition.
OBJECTIVES
There have been a number of trials investigating surgery for spontaneous intracerebral haemorrhage but none for TICH. This study aimed to establish whether or not a policy of Early Surgery for TICH improves outcome compared with a policy of Initial Conservative Treatment.
DESIGN
This was an international multicentre pragmatic parallel group trial. Patients were randomised via an independent telephone/web-based randomisation service.
SETTING
Neurosurgical units in 59 hospitals in 20 countries registered to take part in the study.
PARTICIPANTS
The study planned to recruit 840 adult patients. Patients had to be within 48 hours of head injury with no more than two intracerebral haematomas greater than 10 ml. They did not have a SDH or EDH that required evacuation or any severe comorbidity that would mean they could not achieve a favourable outcome if they made a complete recovery from their head injury.
INTERVENTIONS
Patients were randomised to Early Surgery within 12 hours or to Initial Conservative Treatment with delayed evacuation if it became clinically appropriate.
MAIN OUTCOME MEASURES
The Extended Glasgow Outcome Scale (GOSE) was measured at 6 months via a postal questionnaire. The primary outcome was the traditional dichotomised split into favourable outcome (good recovery or moderate disability) and unfavourable outcome (severe disability, vegetative, dead). Secondary outcomes included mortality and an ordinal assessment of Glasgow Outcome Scale and Rankin Scale.
RESULTS
Patient recruitment began in December 2009 but was halted by the funding body because of low UK recruitment in September 2012. In total, 170 patients were randomised from 31 centres in 13 countries: 83 to Early Surgery and 87 to Initial Conservative Treatment. Six-month outcomes were obtained for 99% of 168 eligible patients (82 Early Surgery and 85 Initial Conservative Treatment patients). Patients in the Early Surgery group were 10.5% more likely to have a favourable outcome (absolute benefit), but this difference did not quite reach statistical significance because of the reduced sample size. Fifty-two (63%) had a favourable outcome with Early Surgery, compared with 45 (53%) with Initial Conservative Treatment [odds ratio 0.65; 95% confidence interval (CI) 0.35 to 1.21; p = 0.17]. Mortality was significantly higher in the Initial Conservative Treatment group (33% vs. 15%; absolute difference 18.3%; 95% CI 5.7% to 30.9%; p = 0.006). The Rankin Scale and GOSE were significantly improved with Early Surgery using a trend analysis (p = 0.047 and p = 0.043 respectively).
CONCLUSIONS
This is the first ever trial of surgery for TICH and indicates that Early Surgery may be a valuable tool in the treatment of TICH, especially if the Glasgow Coma Score is between 9 and 12, as was also found in Surgical Trial In spontaneous intraCerebral Haemorrhage (STICH) and Surgical Trial In spontaneous lobar intraCerebral Haemorrhage (STICH II). Further research is clearly warranted.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN 19321911.
FUNDING
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 70. See the NIHR Journals Library website for further project information.
Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Cerebral Hemorrhage, Traumatic; Female; Hematoma; Humans; Male; Middle Aged; Patient Selection; Sample Size; Time-to-Treatment; Treatment Outcome; Young Adult
PubMed: 26346805
DOI: 10.3310/hta19700 -
Journal of Thrombosis and Haemostasis :... Jul 2017Advances in the management of patients with suspected pulmonary embolism (PE) have improved diagnostic accuracy and made management algorithms safer, easier to use, and... (Review)
Review
Advances in the management of patients with suspected pulmonary embolism (PE) have improved diagnostic accuracy and made management algorithms safer, easier to use, and well standardized. These diagnostic algorithms are mainly based on the assessment of clinical pretest probability, D-dimer measurement, and imaging tests-predominantly computed tomography pulmonary angiography. These diagnostic algorithms allow safe and cost-effective diagnosis for most patients with suspected PE. In this review, we summarize signs and symptoms of PE, current existing evidence for PE diagnosis, and focus on the challenge of diagnosing PE in special patient populations, such as pregnant women, or patients with a prior VTE. We also discuss novel imaging tests for PE diagnosis and highlight some of the additional challenges that might require adjustments to current diagnostic strategies, such as the reduced clinical suspicion threshold, resulting in a lower proportion of PE among suspected patients as well as the overdiagnosis of subsegmental PE.
Topics: Acute Disease; Algorithms; Computed Tomography Angiography; Cost-Benefit Analysis; Dyspnea; Female; Fibrin Fibrinogen Degradation Products; Hematology; Hemorrhage; Humans; Lung; Magnetic Resonance Angiography; Male; Pregnancy; Probability; Pulmonary Alveoli; Pulmonary Embolism; Radionuclide Imaging; Reproducibility of Results; Tomography, X-Ray Computed
PubMed: 28671347
DOI: 10.1111/jth.13694 -
Journal of Neurointerventional Surgery Dec 2017Intracerebral hemorrhage and, more specifically, intraparenchymal hemorrhage, are devastating disease processes with poor clinical outcomes. Primary injury to the brain... (Review)
Review
Intracerebral hemorrhage and, more specifically, intraparenchymal hemorrhage, are devastating disease processes with poor clinical outcomes. Primary injury to the brain results from initial hematoma expansion while secondary hemorrhagic injury occurs from blood-derived products such as hemoglobin, heme, iron, and coagulation factors that overwhelm the brains natural defenses. Novel neuroprotective treatments have emerged that target primary and secondary mechanisms of injury. Nonetheless, translational application of neuroprotectants from preclinical to clinical studies has yet to show beneficial clinical outcomes. This review summarizes therapeutic agents and neuroprotectants in ongoing clinical trials aimed at targeting primary and secondary mechanisms of injury after intraparenchymal hemorrhage.
Topics: Brain; Cerebral Hemorrhage; Clinical Trials as Topic; Hematoma; Humans; Neuroprotective Agents
PubMed: 28710084
DOI: 10.1136/neurintsurg-2017-013197