scholarly journals Establishment and Evaluation of Gvhd Mouse Model for Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5681-5681
Author(s):  
Mei Xie ◽  
Weihong Chen ◽  
Qiaoxia Zhang ◽  
Xin Du
Keyword(s):  
Bone Marrow ◽  
Conditioning Regimen ◽  
Group Iv ◽  
Spleen Cells ◽  
Hematopoietic Stem ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Leukocyte Counts ◽  
Group Ii

Abstract Objective: To study the feasibility of using cyclophosphamide alone without total body irradiation (TBI) as conditioning regimen for allogeneic hematopoietic stem cell transplantation (allo-HSCT) and establish a graft-versus-host disease (GVHD) mouse model. Methods: Single cell suspension of spleen and bone marrow were prepared from donor C57/BL/6 mice (B6 mice) . The recipient B6D2F1 mice (F1 mice) were signed into 4 groups with 12 mice per each group. Groups I~III mice were conditioned with peritoneal injection of cyclophosphamide (300 mg/m 2/d) on day -5, -4 and -3 of allo-HSCT, and group IV mice were used as control with saline injection. On day 0, group I mice were injected through tail vein with a mixture of 2×107 spleen cells, 5×106 bone marrow cells and 1×104 P815 cells; group II with 5×106 bone marrow cells and 1×104 P815 cells; group III with 1×104 P815 cells and group IV with RPMI1640 culture medium. The blood leukocyte counts were analyzed, GVHD score and the pathological leukemia infiltration of skin, liver and colon were evaluated and compared on day 30 after allo-HSCT. Results: (1) The GVHD scores of group I mice were 2 to 4 on day 14 post allo-HSCT, and mice started to die on day 15, eight (8) mice survived and the GVHD scores of them were 1 to 6 with a survival rate of 66.7% on day 30. Group II mice began to die on day 6 and only one survived on day 30 with a survival rate of 8.3%. All of group III mice died on day 18. Group IV mice survived (Figure 1). (2) The leukocyte counts in group I and group II were significantly increased on day 7 post allo-HSCT(p<0.05). There was also a significant difference in total leukocyte counts between groups I/II and group IV (p<0.05). The leukocyte counts in mice of groups I~III were significantly decreased, and there were a significant difference between group I and groups II/III/IV respectively (p<0.05) on day 14 post allo-HSCT. On day 21 after allo-HSCT, the leukocyte count of Group I and II mice were ≥1×109/L, which means that allo-HSCT were successful. The leukocyte counts in group I mice were again increased on day 28 post allo-HSCT. There was no significant difference between Group I and Group IV (p>0.05). (3) Pathological observation: The cell atrophy and necrosis in the hepatic portal area and slight infiltration of the leukemia cells in central vein were observed in group I recipient mice. The number of hepatocytes of the mice decreased, and the infiltration of the leukemia cells in the liver sinus were observed in group II. The liver was heavily infiltrated by leukemic cells in group III mice. The mouse livers were normal in group IV mice. Conclusion: It is feasible to establish GVHD model of the leukemia mice with cyclophosphamide conditioning regimen of allo-HSCT, and simple to operate. This is less harmful to people, animals and the environment. Discussion: The traditional animal model of GVHD is based on TBI conditioning regimen prior to allo-HSCT. However, the process can lead to systemic adverse reactions such as myelosuppression, radiation gastroenteritis, endocrine disorders and systemic function disorders, etc. in both the operators and animals. Therefore, the radiotherapy doses have to be low. At the same time, it is difficult to establish animal models of GVHD due to the uneven distribution of the doses. Cyclophosphamide was selected for the conditioning regimen of allo-HSCT in the study. Cyclophosphamide had the effect direct on killing tumor cells, induced recipients to tolerate the immune of donors, enabled to implant donor cells into recipients smoothly. The stable chimeras were obtained. There are a large number of T and B lymphocytes in donor's spleen cells. By injecting donor spleen cells and active immune cells derived from proliferation and differentiation of hematopoietic stem cells, the effects of graft-anti-leukemia are availably activated in recipients. Acknowledgments We thank Dr Zhifu Xiang very much for his great helpful revisions. Disclosures No relevant conflicts of interest to declare.

scholarly journals Assessment of Outcome of Intrathecal Analgesia in Multiparous Women Undergoing Vaginal Delivery

2020 ◽  
Vol 5 (1) ◽  
pp. 153-155
Author(s):  
Sanjay Melville Masih ◽  
Rakesh Kumar Gupta
Keyword(s):  
Vaginal Delivery ◽  
Group Iv ◽  
Normal Vaginal Delivery ◽  
Secondary Outcome ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Multiparous Women ◽  
Group Ii ◽  
Intrathecal Analgesia

Background: The present study was conducted to assess the outcome of intrathecal analgesia in multiparous women undergoing vaginal delivery. Subjects and Methods: The present study was conducted among 80 multiparous women ages ranged 18- 40 years. All patients received 0.5 ml of intrathecal injection of 2.5 mg bupivacaine 0.5% and 1 ml dexamethasone 4 mg plus a 0.5 ml adjuvant. The adjuvants in group I patients were 100 μg morphine, 25 μg fentanyl in group II, 5 μg dexmedetomidine in group III and normal saline in group IV (control group). The primary and secondary outcome was the duration of pain relief, the analgesia onset time, the maximum level of sensory block, the visual analogue scale (VAS) was recorded. Results: The mean duration of analgesia in group I was 182.4 minutes, in group II was 170.5 minutes, in group III was 200.4 minutes and in group, IV was 140.2 minutes. The onset of analgesia was 3.9 minutes, 2.8 minutes, 2.7 minutes and 4.5 minutes in group I, II, III and IV respectively. S1 sensory regression time (minutes) was 181.4, 157.4, 185.3 and 130.6 in group I, II, III and IV respectively. Modified Bromage scale 5 minutes, 15 minutes and 30 minutes after IT in all groups was 0.0. VAS was 1.3, 1.6, 1.6 and 3.1 with significant differences in all groups (P< 0.05). There was non- significant difference in mean age, weight, height and gestational age between all groups (P> 0.05). There was a non- significant difference in APGAR 1, 5, umbilical pH immediately after delivery, neonatal HR after 5minute, 15 minutes and 30 minutes in all groups (P> 0.05). Conclusion: The authors found that dexmedetomidine is a safe and effective adjuvant to intrathecal bupivacaine-dexamethasone in multiparous women undergoing normal vaginal delivery.

Is there a difference in prevalence of anxiety and depression symptoms among patients with different stages of hypertension?

2017 ◽  
Vol 41 (S1) ◽  
pp. S414-S414 ◽  
Author(s):  
A. Mermerelis ◽  
S.M. Kyvelou ◽  
V. Akke ◽  
C. Papageorgiou ◽  
C. Stefanadis ◽  
...  
Keyword(s):  
Depression Scale ◽  
Group Iv ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Study Cohort ◽  
Hypertensive Patients ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

IntroductionWhether anxiety and depression are associated with hypertension and to what extent is not clear.AimsThe aim of the present study was to assess any differences in the prevalence of anxiety and depression among different groups of hypertensive patients.MethodsThe study cohort comprised of 127 patients (75 male, mean age 54 ± 14) who underwent assessment of their blood pressure levels and were divided in four groups: group I (normotensives, n = 34), group II (stage 1 HTN, n = 33), group III (stage 2 HTN, n = 30) and group IV (stage 3 HTN, n = 30). The evaluation of anxiety disorder was made by means of Hospital Anxiety Depression Scale (HADS), while the evaluation of depression was made with the Beck Depression Inventory (BDI). Statistical analysis was done with SPSS for windows. P-value was set at 0.05 for differences to be considered significant.ResultsComparing the four groups of patients there was a significant difference both in BDI (8.6 ± 7.0 vs. 11.6 ± 10.4 vs. 27.1 ± 5.8 vs. 32.4 ± 3.9, P < 0.0001) and HADS (10.2 ± 7.2 vs. 9.7 ± 7.0 vs. 16 ± 4.7 vs. 27 ± 5.1, P < 0.0001). We proceeded to comparison among the 4 groups and there was a significant rise in the BDI and HADS in three of the four groups group II > group III > group IV, P < 0.0001.ConclusionThese data suggest that there is a clear burden of anxiety and depression as the levels of BP increase. This finding is of important clinical significance as it could contribute to a different approach of hypertensive patients. A larger cohort study could enlightened the mechanisms involved.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals An in vitro comparative Evaluation of Fracture Strength of Roots Instrumentated with Self-adjusting File and Reciproc Reciprocating File, with and without Obturation

2017 ◽  
Vol 1 (1) ◽  
pp. 20-25
Author(s):  
Pooja Kabra
Keyword(s):  
Fracture Strength ◽  
Comparative Evaluation ◽  
Group Iv ◽  
Control Group ◽  
Group V ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

ABSTRACT Aim The purpose of this study was to evaluate the fracture strength of roots instrumented with the self-adjusting file (SAF; ReDent-Nova, Ra'anana, Israel) and the Reciproc reciprocating file and that were and were not obturated using the warm vertical lateral compaction technique. Materials and methods In total, 75 mandibular premolar teeth were sectioned at or below the cementoenamel junction to obtain roots 13 mm in length. The roots were balanced with respect to buccolingual and mesiodistal diameters and weight. They were distributed into four experimental groups and one control group (n = 15): No instrumentation (group I), instrumentation with SAF files but no obturation (group II), instrumentation with SAF files and obturated with warm vertical lateral compaction (group III), instrumentation with Reciproc File but no obturation (group IV), and instrumentation with Reciproc File and obturated with warm vertical lateral compaction (group V). AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) was used along with gutta-percha points. One week later, a vertical load was applied to the specimen's canal until fracture occurred. Data were statistically analyzed using one-way analysis of variance (p = 0.05). Results The mean fracture load was 312.83 N for group I, 297.35 N for group II, 359.15 N for group III, 231.51 N for group IV, and 275.81 N for group V. Conclusion The fracture resistances exhibited a statistically significant difference between all the groups. Teeth instrumented by SAF exhibited a better fracture resistance. How to cite this article Tyagi S, Choudhary E, Kabra P, Chauhan R. An in vitro comparative Evaluation of Fracture Strength of Roots Instrumentated with Self-adjusting File and Reciproc Reciprocating File, with and without Obturation. Int J Clin Dent Res 2017;1(1):20-25.

scholarly journals Microshear bond strength evaluation of surface pretreated zirconia ceramics bonded to dentin

2015 ◽  
Vol 09 (02) ◽  
pp. 224-227 ◽  
Author(s):  
Shenbagakuttalam Anand ◽  
Ambrose Vedamanickam Rajesh Ebenezar ◽  
Nirupa Anand ◽  
Kothandaraman Rajkumar ◽  
Sekar Mahalaxmi ◽  
...  
Keyword(s):  
Bond Strength ◽  
Testing Machine ◽  
Group Iv ◽  
Zirconia Ceramics ◽  
Group V ◽  
Statistical Significant Difference ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

ABSTRACT Objectives: To comparatively assess the micro shear bond strength (MSBS) of dentin bonded surface pre-treated zirconia ceramics. Materials and Methods: Zirconia blocks were sectioned into 50 cubical blocks. The blocks were further categorized into five groups (n = 10 each). Group I: No treatment was performed on zirconia samples; Group II: The zirconia samples were sand-blasted; Group III: Group II + etched with 9.8% of hydrofluoric (HF) acid for 60 s; Group IV: The sandblasted zirconia samples were selectively infiltrated with low fusing porcelain; and Group V: Group IV + etched using 9.8% HF acid gel. The zirconia specimens were then bonded to dentin samples, and the samples were tested for MSBS evaluation using universal testing machine. Results: The MSBS of all the four experimental groups shows greater value than group I. Among the experimental groups, group V and group IV do not show any statistical significant difference, whereas the mean MSBS of groups IV and V were statistically greater than group III and group II. However, groups I, II, and III do not show any statistical significant difference in mean MSBS values between them. Conclusion: Selective infiltration etching of zirconia ceramics provides the highest bond strength with resin cement.

scholarly journals Effect of different irrigation porotocols on root dentine micro-hardness-An invitro study

2021 ◽  
Vol 6 (4) ◽  
pp. 217-221
Author(s):  
Ashish Choudhary ◽  
Sukhbir Kour ◽  
Azhar Malik
Keyword(s):  
Functional Performance ◽  
Test Group ◽  
Direct Consequence ◽  
Group Iv ◽  
Micro Hardness ◽  
Group Iii ◽  
Percentage Decrease ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

IIrrigation solutions used and time of use has a definite effect on the micro hardness & other physical properties of dentin which in turn have direct consequence on the longevity functional performance of root canal treated teeth. To evaluate the effect of different irrigation solutions on micro hardness of root dentin.Forty extracted single rooted lower premolars were used. After instrumentation all the root halves were randomly assigned into 4groups (n=10) and brought in contact with one of the following irrigants for 5 minutes. Group I: 10 ml of 5% Sodium Hypochlorite (NaOCl).Group II: 10 ml of 17% ethylene diamine tetra-acetic acid (EDTA) followed by 10 ml of 5% NaOCl.Group III: 10 ml of 5% NaOCl followed by 10 ml of 2% chlorhexidine digluconate (CHX).Group IV: 10 ml of 5% NaOCL followed by flush of 10 ml distilled water then by 10ml of 2% CHX. Dentin micro hardness was measured at baseline and after treatment to determine the change in micro hardness, using Vickers tester.Data was analyzed using following parametric tests t-test, ANOVA test and Post Hoc test. Group II ie final irrigation with EDTA showed the highest percentage decrease in micro hardness values, followed by group III, then group IV and the lowest was group I. All groups showed a significant difference between each other (P &#60; 0.05), except group III and IV. The coronal third showed the highest percentage decrease with significant difference between apical and middle thirds (P &#60; 0.05).EDTA with NaOCl causes greatest changes in dentine micro hardness, an intermediate flush with normal saline should be given for prevention of precipitation with NaOCl & CHX.

scholarly journals Analysis of GABRB3 gene mRNA expression and motor coordination after administration of valerian extracts (Valeriana officinalis) in BALB/c mice

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 670
Author(s):  
Erwin Mulyawan ◽  
Muhammad Ramli Ahmad ◽  
Andi Asadul Islam ◽  
Muh. Nasrum Massi ◽  
Mochammad Hatta ◽  
...  
Keyword(s):  
Mrna Expression ◽  
Motor Coordination ◽  
Group Iv ◽  
Valeriana Officinalis ◽  
Rotarod Test ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Gene Mrna

Background: Valeriana officinalis has often been used to treat sleep disorders as a traditional medicine for 2000 years. The sedative effect of valerian extract is facilitated by the GABAA receptor β3 subunit. The aim of this study is to determine the effect of valerian extract on GABRB3 gene mRNA expression and sedative effect in BALB/c mice. Methods: This is an experimental preclinical study using a posttest-only control group design. A total of 20 BALB/c mice were randomly allocated into four groups consisting of five mice each. Group I was given 5 ml of Aqua Dest (distilled water), group II was given 0.025 mg/10 g of diazepam, group III was given 2.5 mg/10 g of valerian extract, and group IV was given 5 mg/10 g of valerian extract. The drugs were administrated for seven days through a gastric gavage. The rotarod test was performed on the seventh day. A blood sample was taken on the first day before drug administration and after the rotarod test on the seventh day to be analyzed using quantitative real-time PCR. Results: GABRB3 gene mRNA expression showed a significant increase in groups II, III, and IV (p <0.0001). There was significant difference between group III and IV. The examination of motor coordination (rotarod test) showed a significant difference (p <0.05) between group I and group II, between group I and group III, and between group I and group IV. There was no significant difference between group II and both groups III and IV. Conclusions: GABRB3 gene mRNA expression was significantly increased after the administration of valerian extract. Based on the rotarod test, valerian extract and diazepam had a clinically similar sedation effect. A higher dose of valerian extract does not yield a higher level of GABRB3 gene mRNA expression nor sedative effects.

Comparison of the Craniofacial Characteristics of Two Syndromes Associated with the Pierre Robin Sequence

1992 ◽  
Vol 29 (3) ◽  
pp. 210-219 ◽  
Author(s):  
Karl Glander ◽  
George J. Cisneros
Keyword(s):  
Group Iv ◽  
Craniofacial Morphology ◽  
Group Iii ◽  
Robin Sequence ◽  
Group I ◽  
Lateral Cephalograms ◽  
Significant Difference ◽  
Group Ii ◽  
Mandibular Retrognathia ◽  
Craniofacial Characteristics

The craniofacial characteristics of two syndromes commonly associated with Robin sequence were compared for 49 subjects. Lateral cephalograms were analyzed for four groupings: Group I—Stickler syndrome with versus without Robin, Group II—velocardlofacial (VCF) syndrome with versus without Robin, Group III—Stickler without Robin compared to VCF without Robin, and Group IV—Stickler with Robin compared to VCF with Robin. Thirty-two skeletal and 18 soft tissue measurements were compared. In Group I, three skeletal measurements were significantly different (SNA, SNB, and SNPg). In Group II, no significant difference was found for any of the 50 measurements. In Group III, a significant difference was demonstrated for seven parameters (one skeletal, six pharyngeal and airway). In Group IV, two skeletal and eight airway measures were significantly different. The findings Indicate that the relative maxillary and mandibular retrognathia observed in Stickler/Robin patients may predispose them to the Robin sequence and vice versa; the Robin features In VCF may be caused by hypotonia rather than any craniofacial or physical obstruction of the airway; Stickler and VCF are similar in craniofacial morphology but show marked differences in pharyngeal and airway morphology; and cephalometrics should not be the sole prognosticator of the Robin sequence and Its association with Stickler and VCF.

scholarly journals Resistance to fracture of intraradicular posts made of biological materials

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Karine Taís Aguiar Tavano ◽  
Adriana Maria Botelho ◽  
Dhelfeson Willya Douglas-de-Oliveira ◽  
Antonio Ferreira Avila ◽  
Rudolf Huebner
Keyword(s):  
Glass Fiber ◽  
Fracture Pattern ◽  
Group Iv ◽  
Group Iii ◽  
Fiber Posts ◽  
Group I ◽  
Significant Difference ◽  
Human Dentin ◽  
Glass Fiber Posts ◽  
Group Ii

Abstract Background The aim was to analyze the fracture resistance of human teeth treated endodontically and restored with posts made of bovine dentin, human dentin, or glass fiber, and to evaluate the fracture pattern. Methods Cylindrical posts of 1.5 mm in diameter cemented to the roots of human maxillary canines presented a length of 15 mm, cervical diameter of 5–5.5 mm in the mesiodistal direction, and 7–7.5 mm in the vestibule-palatal direction. The groups studied were: Group I—10 glass fiber posts; Group II—10 human dentin posts; Group III—10 bovine dentin posts (self-adhesive resin cement); and Group IV—10 bovine dentin posts (resin-modified glass-ionomer cements). The coronal part of tooth was restored with a standardized core build-up using composite. All of the groups were submitted to a compression force test and the resistance to fracture was verified using a universal testing machine. The fracture pattern was likewise evaluated. Results The values of resistance to fracture were: 723.3N in group I, 561.5N in group II, 556.6N in group III, and, 613.27N in group IV. However, no statistically significant difference was observed among the groups. The fractures in groups I and II were most commonly found in the middle/apical third and were considered irreparable. For restored teeth in group III, half of the fractures appeared in the cervical third and were reparable. In group IV, all of the fractures were reparable, with the majority in the cervical thirds. Conclusion Bovine dentin can be used as intraradicular post to substitute human dentin and glass fiber posts. The greater the malleability of the post, the greater the chances of survival of the teeth when subjected to fracture testing.

A Clinical Evaluation of Deproteinization and Different Cavity Designs on Resin Restoration Performance in MIH-Affected Molars: Two-Year Results

2017 ◽  
Vol 41 (5) ◽  
pp. 336-342 ◽  
Author(s):  
Hayriye Sönmez ◽  
Sinem Saat
Keyword(s):  
Group Iv ◽  
Retention Rates ◽  
Control Group ◽  
Clinical Effects ◽  
Success Rates ◽  
Group Iii ◽  
Group I ◽  
Molar Incisor Hypomineralization ◽  
Significant Difference ◽  
Group Ii

Background: The aim of this study was to evaluate the clinical effects of deproteinization of the hypomineralized enamel and different cavity designs on the performance of the composite resin restorations(CRRs) placed into the cavities of MIH (molar incisor hypomineralization)-affected molars. Study design: 95 MIH-affected permanent first molars (PFMs) and 31 caries but not MIH-affected PFMs (126 teeth in total) were included in the study. The MIH-affected molars were divided into three groups. In Group I, all hypomineralized tissue was removed until healthy enamel was reached. In Group II, carious and cheesy hypomineralized tissue was removed until a reasonable resistance was detected in the hypomineralized tissue. In Group III, cavities designed as Group II, differently from this group deproteinization of the left hypomineralized tissue was performed prior to the placement of CRRs. Group IV served as the control group consisting of unaffected carious PFMs. Restorations were evaluated according to modified USPHS criteria for 24 months. Results: The retention rates were 93.7% for Group I, 80.7% for Group II, 93.5% for Group III and 100% for Group IV. The success rate for the restorations in Group II proved significantly lower (p&lt;0.05) than that of the other three groups. No significant difference in success rates was observed between Group I, Group III and Group IV (p&gt;0.05) at the end of 24 months. Conclusions: Failure of the restorations was predominant in the group that the hypomineralized tissue was left surrounding the cavities. Deproteinization of the hypomineralized enamel was found to enhance the retention rates of CRRs.

scholarly journals Perbedaan Kadar Hemoglobin Metode Sianmethemoglobin dengan dan Tanpa Sentrifugasi pada Sampel Leukositosis

2015 ◽  
Vol 1 (2) ◽  
pp. 72
Author(s):  
Wahdah Norsiah
Keyword(s):  
Total Sample ◽  
Group Iv ◽  
Hemoglobin Level ◽  
Observational Research ◽  
Cross Sectional ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
The Difference

Examination of hemoglobin levels influenced leukocytosis sianmethemoglobin method that causes increased absorbance measurements of hemoglobin levels increased significantly and the false blood sample that has been diluted with a solution Drabkins in centrifugation at 3000 rpm for 10 minutes and then the absorbance of the supernatant was measured with a photometer at λ 546 nm. This study aimed to analyze the differences in hemoglobin level examination siamethemoglobin method with and without centrifugation at sample leukocytosis. This type of research is observational research laboratory. The study design was cross-sectional study. Samples were taken from the remaining blood samples of patients who have been examined leukositnya number more than 20,000 / uL with Hematology Analyzer (CEL-DYN Ruby) February-April 2014, and were divided into 4 groups based on criteria that group 1. leukocyte count of 20,000 / uL-29 999 / mL, group II. 30,000 / uL-39 999 / uL, the group III. 40,000 / uL-49,999 / uL, the group IV. More than 50,000 / uL. The number of samples taken were 20 samples of each group, a total sample of 80 samples. The analysis showed no significant difference in hemoglobin levels siamethemoglobin method with and without centrifugation at sample leukocytosis with a value of p = 0.000 less than 0.05 α. Leukocytosis Turbidity affects the difference in hemoglobin levels with and without centrifugation, the higher the number the greater the difference in leukocyte levels of hemoglobin, hemoglobin level examination results of the study based on the criteria of the number of leukocytes obtained by the difference in hemoglobin levels with and without centrifugation in group I. 0.22 ± 0.07 g / dL, group II 0.40 ± 0.22 g / dL, a group III. 0.44 ± 0.14 g / dL, Group IV. 0.85 ± 0.41 g / dL. The level of hemoglobin in the sample sianmethemoglobin method leukocytosis with more than 20,000 / uL need a centrifuge so that appropriate hemoglobin levels over the patient's clinical condition.

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