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BJA: British Journal of Anaesthesia (1)
Patient Safety in Surgery (1)
The Journal of investigative dermatology (1)
Atoyan, Ruzanna (1)
Botchkarev, Vladimir A. (1)
Botchkarev, Vladimir V. (1)
Colomina, M. J. (1)
Efimova, Tatiana (1)
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Patient blood management in Europe
Van Aken, H.
Colomina, M. J.
Spahn, D. R.
BJA: British Journal of Anaesthesia
Preoperative anaemia is common in patients undergoing orthopaedic and other major surgery. Anaemia is associated with increased risks of postoperative mortality and morbidity, infectious complications, prolonged hospitalization, and a greater likelihood of allogeneic red blood cell (RBC) transfusion. Evidence of the clinical and economic disadvantages of RBC transfusion in treating perioperative anaemia has prompted recommendations for its restriction and a growing interest in approaches that rely on patients' own (rather than donor) blood. These approaches are collectively termed ‘patient blood management’ (PBM). PBM involves the use of multidisciplinary, multimodal, individualized strategies to minimize RBC transfusion with the ultimate goal of improving patient outcomes. PBM relies on approaches (pillars) that detect and treat perioperative anaemia and reduce surgical blood loss and perioperative coagulopathy to harness and optimize physiological tolerance of anaemia. After the recent resolution 63.12 of the World Health Assembly, the implementation of PBM is encouraged in all WHO member states. This new standard of care is now established in some centres in the USA and Austria, in Western Australia, and nationally in the Netherlands. However, there is a pressing need for European healthcare providers to integrate PBM strategies into routine care for patients undergoing orthopaedic and other types of surgery in order to reduce the use of unnecessary transfusions and improve the quality of care. After reviewing current PBM practices in Europe, this article offers recommendations supporting its wider implementation, focusing on anaemia management, the first of the three pillars of PBM.
anaemia; outcome; patient blood management; transfusion
BMP signalling induces cell-type specific changes in gene expression programs of human keratinocytes and fibroblasts
Fessing, Michael Y.
Mardaryev, Andrei N.
Botchkarev, Vladimir V.
Botchkarev, Vladimir A.
The Journal of investigative dermatology
BMP signalling plays a crucial role in skin development and homeostasis, whereas molecular mechanisms underlying its involvement in regulating gene expression programs in keratinocytes and fibroblasts remain largely unknown. We demonstrate here that several BMP ligands, all BMP receptors and BMP-associated Smad1/5/8 are expressed in human primary epidermal keratinocytes and dermal fibroblasts. Treatment of both cell types by BMP-4 resulted in the activation of the BMP-Smad, but not BMP-MAPK pathways. Global microarray analysis revealed that BMP-4 treatment induces distinct and cell-type specific changes in gene expression programmes in keratinocytes and fibroblasts, which are far more complex versus the effects of BMPs on cell proliferation/differentiation described previously. Furthermore, our data suggest that potential modulation of cell adhesion, extracellular matrix remodelling, motility, metabolism, signalling and transcription by BMP-4 in keratinocytes and fibroblasts is likely to be achieved by the distinct and cell type-specific sets of molecules. Thus, these data provide an important basis for delineating mechanisms that underlie the distinct effects of the BMP pathway on different cell populations in the skin and will be helpful in further establishing molecular signalling networks regulating skin homeostasis in health and disease.
The unresolved safety concerns of bovine thrombin
Patient Safety in Surgery
A recent review has suggested that bovine thrombin is not associated with an increased risk of bleeding in surgical populations. In spite of extremely limited evidence available, many valuable resources (e.g. safety surveillance and post-marketing programs, case reports) were excluded in reaching this conclusion. While waiting for the adequately powered, controlled clinical trials to address the effects of bovine thrombin on bleeding and thrombotic events, the potential risk cannot be simply ignored. Rather, continued vigilance in the post-surgical setting for bleeding events that may be associated with the development of acquired coagulation factor inhibitors following bovine thrombin administration is warranted.
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