Combined Coagulation Research Articles

Pathophysiology of Coagulopathy in Hematological Malignancies and in COVID-19

Many severe illnesses with a systemic impact may cause activation of coagulation. While systemic activation of coagulation leads to a coagulopathy that follows many common activation pathways and failure of endogenous regulatory anticoagulant systems, underlying conditions may utilize distinctive pathogenetic routes and may vary in clinical manifestations of the coagulopathy. The coagulation derangement associated with hematological malignancies and the coagulopathy of coronavirus disease 2019 (COVID-19) clearly demonstrate such differences. Malignancies are associated with venous thromboembolism due to the biological effect of malignant cells, frequent medical interventions, or the presence of indwelling vascular catheters. The underlying pathogenesis of cancer-associated coagulopathy relies on tissue factor-mediated activation of coagulation, cytokine-controlled defective anticoagulant pathways, fibrinolytic changes, and dysfunctional endothelium. There is an additional risk caused by anti-cancer agents including chemotherapy and immunotherapy. The underlying pathogenetic factor that contributes to the thrombotic risk associated with chemotherapy is endothelial cell injury (or loss of protection of endothelial integrity, for example, by vascular endothelial growth factor inhibition). In addition, individual anti-cancer agents may have specific prothrombotic effects. One of the remarkable features of severe COVID-19 infections is a coagulopathy that mimics but is not identical to the disseminated intravascular coagulation and thrombotic microangiopathy and has been identified as a strong marker for an adverse outcome. Severe COVID-19 infections cause inflammation-induced changes in coagulation in combination with severe endothelial cell injury. This coagulopathy likely contributes to pulmonary microvascular thrombosis, bronchoalveolar fibrin deposition (which is a hallmark of acute respiratory distress syndrome) and venous thromboembolic complications.

A sustainable solution to treat textile effluent by employing combined coagulation, oxidation and ultrafiltration techniques

Presently, Pakistan is the 8th largest exporter of textile products in the world andthis sector is considered the backbone of Pakistan’s economy. Due to intensifieduse of dyes, chemicals, and water, the textile sector is also listed as the highestcontributor to environmental pollution. Therefore, to approach the demand of newglobal trend towards sustainability, the textile industry along with others need tofocus on resource recovery and reuse. The present study was therefore plannedfor the treatment of textile effluent composed from 04 textile mill samples. Thetextile effluent is treated by employing coagulation, ozone oxidation, andultrafiltration techniques. All the samples exceeded the standard limits as given inSindh Environmental Quality Standard (SEQS 2016). Each individual treatmentprovided promising results in terms of reduction in pollution load. Overall findingsrevealed a remarkable decrease in total suspended solid (TSS) (96 %), totaldissolved solid (TDS) (78 %), chemical oxygen demand (COD) (93 %), BiologicalOxygen Demand-BOD (93 %), oil & grease (96 %) and heavy metals (HM) (98 %).It is suggested that combined techniques are the best option for textile effluenttreatment.

The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

AimsPeriprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation.MethodBetween January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation.ResultsThe levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively.ConclusionThe coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed.Level of evidenceLevel III, diagnostic study.

Diagnosis and choice of haemostatic therapy during surgery in patients with combined coagulation factor V and VIII defi ciency

Introduction. Among the most common congenital coagulopathies are haemophilia and Von Willebrand disease. These illnesses are often mimicked by orphan hereditary coagulopathies, including combined coagulation factor V and VIII deficiency.Aim — description of a clinical presentation, hampered diagnosis and choice of haemostatic therapy in a surgical patient with combined blood coagulation factor V and VIII deficiency.Main findings. We describe a clinical case of congenital combined factor V and VIII deficiency and detail the aetiology, frequency, localisation and intensity of haemorrhages. Comorbidity and surgical indications are demonstrated to require an inter-specialty medical involvement.

Combined coagulation and intermittent sand filtration for on-site treatment of greywater

Performance of coagulation followed by intermittent saturated sand filtration system was evaluated for greywater treatment using real greywater. Filters with two different grain sizes were used to study the effect of media size on the removal. Filters were charged daily with 20 L of greywater coagulated with polyaluminium chloride (PACl). Performance of the filters were evaluated based on physicochemical and microbial parameters. Results showed that coagulation followed by sand filtration resulted in 94, 76 and 80% reduction in turbidity, BOD and COD respectively. Also, more than 99% of total and faecal coliform removal was observed. Sand filter with smaller grain size performed significantly better than the sand filter with coarser grain size. Coagulation followed by filtration showed stable and reliable performance as the effluent quality was insensitive to fluctuations in influent quality. Combined coagulation and sand filtration produced effluent conforming to different reuse standards.

Treatment of pesticide intermediate industrial wastewater using hybrid methodologies

Abatement of water pollution is being a major concern to be dealt with, as the scarcity of water for basic needs of human beings is increasing drastically. As a part of diminishing water pollution, treatment of industrial wastewater prior to disposal plays a paramount role. Due to the typical characteristics of pesticide, intermediate industrial waste water the treatment is also challenging issue. In this study three different sequential methodologies (Methodology-I: combined rotavapour distillation, fenton and anaerobic biological process, Methodology-II: combined rotavapour distillation, photo fenton and anaerobic biological process, Methodology-III combined coagulation, fenton, electro oxidation and anaerobic biological process) has been evaluated for the treatment of pesticide intermediate industrial wastewater. Among the three sequential methodologies opted in this study for the treatment of pesticide intermediate industrial wastewater, percentage removal of COD was 95% in methodology-1 (i.e. combined rotavapor distillation, fenton and anaerobic biological treatment).

The feasibility of combined coagulation flocculation and constructed wetland as green technology for sustainable leachate treatment

This study aims to determine the feasibility of coagulation flocculation processing using Moringa oleífera seed powder (MOSP) and vertical sub surface flow constructed wetlands (VSSFCW) to process leachate landfill (LL). The method used is to do a jar test to determine the optimum conditions and then proceed with VSSFCW processing. In the coagulation flocculation process, the optimum conditions were obtained with a dose of 175 mg/L, pH 6.5 and a speed of rapid mixing of 100 rpm for 10 minutes. This optimum condition is able to reach the percentage of COD, turbidity and Mn removal of 35.27%, 69.48%, and 94.83%, respectively. However, the effluent value is still above the Minister of Environment regulation standard No. 5/2014 regarding the standard quality of wastewater for the parameters of COD and Mn that is equal to 584.19 mg/L for COD and 6.98 mg/L for Mn, while for turbidity meets the standard of 69.83 mg/L. Further processing with VSSFCWs can improve the quality of LL effluent resulting from coagulation flocculation 66.36 mg/L; 4.97 mg/L for turbidity and 0.12 mg/L for Mn or with efficiencies of 88.64%, 92.88% and 98.22%. These results were obtained at the optimum HRT conditions for 10 days.

Лазерное лечение осложненной ретинальной артериальной макроаневризмы

The article presents different approaches to laser treatment of retinal arterial macroaneurysm, complicated by exudation and hemorrhage in the macula. The treatment included barrier and direct coagulation of retinal arterial macroaneurysm with 532 and 577 nm lasers, laser hyaloidotomy of premacular hemorrhage using a 1064 nm. YAG laser. Dynamic observation was performed using fluorescence angiography and OCT angiography. Positive and stable functional results were achieved. A conclusion has been drawn on the effectiveness of laser coagulation in combination with hyaloidotomy in the treatment of complicated retinal arterial macroaneurysm.

Low-cost biomass for the treatment of landfill leachate from Fez City: application of a combined coagulation–adsorption process

In this work, the efficiency of a novel treatment of solid-waste landfill leachate based on coagulation and then adsorption onto a natural bioadsorbent was examined. The reduction in the chemical oxygen demand (COD), biological oxygen demand (BOD5), turbidity, and color of the leachate from the urban sanitary landfill in Fez City (Morocco) following treatment was evaluated. Ferric chloride was used as the coagulant in the coagulation–flocculation pretreatment of the leachate, and Cupressus sempervirens cones were employed to adsorb the contaminants in the coagulated leachate. The optimum dose of ferric chloride was found to be 20 g per liter. The resulting coagulation process reduced the COD by 69%, the BOD5 by 60%, and the color of the leachate by 88%. Following the adsorption of the pretreated landfill leachate on Cupressus sempervirens cones, the COD, BOD5, and color of the leachate were found to be 86%, 96%, and 93% lower than their original values, respectively. The adsorption capacity of the treatment qe was calculated as 385 $${\text{mg}}_{{{\text{O}}_{ 2} }} \;{\text{g}}^{ - 1}$$ for 1 g of Cupressus sempervirens cones per liter under optimal adsorption conditions (including pH 7, 25 °C, and 8 h of contact time). A study of the adsorption kinetics for the COD revealed that a pseudo-second-order model provided the best fit to the experimental kinetic data, and the equilibrium data were well described by the Langmuir isotherm model. These results of the study indicate that the novel combined coagulation–adsorption treatment of landfill leachate is an inexpensive alternative to current landfill leachate treatments, and is suitable for application to industrial-scale sanitary landfills.

Treatment of wood industry wastewater by combined coagulation-flocculation-decantation and fenton process.

In the present research, the efficiency of turbidity and chemical oxygen demand (COD) reduction from the wood industry wastewater (WIW) by the use of a combined coagulation-flocculation-decantation (CFD) - Fenton process was studied. Firstly, the performance of three coagulants such as ferric chloride (FeCl3 ), aluminum sulphate (alum), and polyaluminum chloride (PACl) was evaluated. The polyacrylamide (PAM) was used as a flocculant. The results showed that the polyaluminum chloride had a high removal efficiency. The COD reduction of 84.1% and turbidity removal of 82.0% of were obtained in coagulation-flocculation-decantation (CFD). Secondly, Fenton process was optimized, by the use of a response surface methodology (RSM), with application of a central composite design (CCD). The maximum turbidity and COD removal obtained by this process were 94.1% and 72.5% respectively, under optimal conditions ([Fe2+ ]=250mg/L, [H2 O2 ]=500mg/L, pH 3.5, time 60min). The kinetics of COD and turbidity removal were determined by the model of first order. In conclusion, the combination of coagulation-flocculation-decantation (CFD) - Fenton process presented as a remarkable method for wood wastewater treatment. PRACTITIONER POINTS: A combination of coagulation-flocculation-decantation and Fenton process was introduced for the wood industry wastewater treatment. A designed experimental approach for treatment of wood industry wastewater using a Fenton process was studied. The yields of COD, BOD5 , N-NO3 , P-PO4 , and dye removal were obtained according to the standard limits in Iran.

Degradation of recalcitrant organic matter in SAARB leachate by a combined process of coagulation and catalytic ozonation.

A combined coagulation and γ-Al2O3 catalytic ozonation process was used to treat semi-aerobic aged refuse biofilter (SAARB) effluent from treating mature landfill leachate. First, the coagulant providing the best pretreatment performance was selected. Then, the coagulated SAARB leachate was further treated in an optimized γ-Al2O3-catalyzed ozonation process. Characteristics of the γ-Al2O3-catalyzed ozonation process were determined, and a reaction mechanism was proposed. FeCl3 provided the best treatment efficiency (chemical oxygen demand (COD) removal of 65.8%, absorbance at 254nm (UV254) removal of 68.55%, and color number (CN) removal of 79.4%). Under optimized O3 dosage (18.92mg/min) and γ-Al2O3 dosage (10g/L), efficiencies of removing COD, UV254, and CN were 54.3%, 82.9%, and 95.9%, respectively, at 30min. In addition, spectral analysis indicated that fulvic-like substances in ultraviolet and visible regions were effectively degraded in the γ-Al2O3-O3 process and some smaller organic products were produced. Characterization of γ-Al2O3 showed that γ-Al2O3 was relative stable; its morphology and constituent elements did not change much after reaction. In addition, ozonation capacity was enhanced by heterogeneous catalytic effects of γ-Al2O3. The combined coagulation and γ-Al2O3 catalytic ozonation process was proven to be an efficient treatment method for removing bio-refractory organic matter contained in SAARB leachate.

COVID-19 coagulopathy vs disseminated intravascular coagulation

Patients with severe COVID-19 infections frequently manifest coagulation abnormalities that are associated with respiratory deterioration and death. In addition, many patients with severe COVID-19 infections develop thromboembolic complications, which seem to be related to the coagulopathy. It has been suggested that undiagnosed pulmonary embolism contributes to a sudden deterioration of pulmonary oxygen exchange that is sometimes seen in patients with COVID-19 infections. The coagulation changes associated with COVID-19 mimic other systemic coagulopathies that are regularly seen during severe infections, such as disseminated intravascular coagulation or thrombotic microangiopathy. However, at the same time, the clinical and laboratory characteristics of the coagulation changes in COVID are distinctly different from those in the common presentation of these conditions. Severe COVID-19 infections seem to cause a profound coagulation abnormality caused by inflammation-induced changes in coagulation in combination with severe endothelial cell injury, with consequent massive release of von Willebrand factor and plasminogen activators. This coagulopathy likely contributes to pulmonary microvascular thrombosis, bronchoalveolar fibrin deposition (which is a hallmark of adult respiratory distress syndrome), and thromboembolic complications.

A combined ultrasonic and chemical conditioning process for upgrading the sludge dewaterability

ABSTRACT Dewatering is of paramount step in sludge management, and conditioning with coagulant is considered as the commonest way to improve the sludge dewaterability. Sludge disintegration process was examined through Ultrasound (US) to strip the water from the sludge flocs and accordingly four coagulants: aluminium sulphate (Alum), iron (III) chloride (FeCl3), cationic polyacrylamide (CPAM) and combined ferric chloride and lime (CC) with optimum dosages were employed to improve the sludge dewaterability in terms of capillary suction time (CST), specific resistance to filtration (SRF) and moisture content (MC). The ultrasonic sludge disintegration with 1 min exposure with an energy dosage of 700 kJ/kg TS realises the best sludge dewatering efficiency. In addition, the effects of CPAM and CC conditioning on sludge dewaterability were higher compared with two other conditioners. The combined US-CPAM and US-CC with optimum dosages 8 and 101 mg/kg DS significantly improved sludge dewaterability parameters (MC: 68.50%, SRF: 1.03 × 1010 m/kg and CST: 31.82 s) and (MC: 72%, SRF: 1.08 × 1010 m/kg and CST: 31.82 s) compared with when conditioning experiments were performed alone. Scanning electron microscopy (SEM) images showed that the combined US-CPAM and US-CC conditioning formed a more porous structure and low compressible sludge filter cake which are desired to sludge dewatering. Therefore, the ultrasonic-assisted conditioning with CPAM and combined coagulant (lime + Ferric chloride) could significantly improve the sludge dewaterability indices.

Antifungal mechanisms of ε-poly-L-Lysine with different molecular weights on Saccharomyces cerevisiae

The effect of various surfactants used in textile dyeing processes on coagulation treatment of dying wastewater was investigated. When alum was used as a coagulant, the color removal rate of milling-type acid dyes was significantly decreased by the presence of nonionic surfactants. The combined use of inorganic and organic coagulants achieved an excellent color removal rate of more than 95% for the most of acid dyes tested in this study. In the combined coagulants treatment, nonylphenol ether nonionic surfactants and anionic surfactants had no significant effect on the color removal efficiency. However, poly(oxyethylene) alkylamine nonionic surfactants decreased remarkably the color removal rate. The decrease of the color removal rate was more severe by the surfactant having smaller number of ethylene oxide group.

Treatment of Petroleum and Flowstation Wastewater Using Combined Coagulants

Performance and effectiveness of single and combined coagulants in the treatment of petroleum and flow station wastewater has been studied. In this study, samples of petroleum and flowsation were treated separated with Barium Chloride, Iron (ii) sulphate, Magnesium Oxide and then with mixtures of different chemicals. Standard methods for examination of water and wastewater was used in the analysis of some important physico-chemical parameters. The results of the analysis of all the parameters in the petroleum and flow station wastewater samples treated with six different types of coagulants shows significant changes and variations in the level of virtually all the parameters in the treated samples when compared with that of the blank.The combined chemical coagulants exhibited a high capacity to reduce the pollutants to recommended effluent limits with the mixture of Magnesium Hydroxide and Iron (ii) Sulphate been the most effective coagulants. The result revealed that average value of all selected parameters showed variation from points A to F. However, these variations are not statistically significant with F (0.068019) being less than Fcritical Keywords : Petroleum, Flow station, Wastewater, Coagulants, ANOVA DOI : 10.7176/CPER/62-04 Publication date: January 31 st 2020

Elevated thrombin generation in patients with congenital disorder of glycosylation and combined coagulation factor deficiencies

BackgroundCongenital disorders of glycosylation are rare inherited diseases affecting many different proteins. The lack of glycosylation notably affects the hemostatic system and leads to deficiencies of both procoagulant and anticoagulant factors. ObjectiveTo assess the hemostatic balance in patients with multiple coagulation disorders by using a thrombin generation assay. MethodWe performed conventional coagulation assays and a thrombin generation assay on samples from patients with congenital disorder of glycosylation. The thrombin generation assay was performed before and after activation of the protein C system by the addition of soluble thrombomodulin. ResultsA total of 35 patients were included: 71% and 57% had low antithrombin and factor XI levels, respectively. Protein C and protein S levels were abnormally low in 29% and 26% of the patients, respectively, whereas only 11% displayed low factor IX levels. Under baseline conditions, the thrombin generation assay revealed a significantly higher endogenous thrombin potential and thrombin peak in patients, relative to controls. After spiking with thrombomodulin, we observed impaired involvement of the protein C system. Hence, 54% of patients displayed a hypercoagulant phenotype in vitro. All the patients with a history of stroke‐like episodes or thrombosis displayed this hypercoagulant phenotype. ConclusionA thrombin generation assay revealed a hypercoagulant in vitro phenotype under baseline condition; this was accentuated by impaired involvement of the protein C system. This procoagulant phenotype may thus reflect the risk of severe vascular complications. Further research will have to determine whether the thrombin generation assay is predictive of vascular events.

Açaí waste beneficing by gasification process and its employment in the treatment of synthetic and raw textile wastewater

Abstract Aiming to add value to the waste from acai processing industry, it was used as biomass for energy production. Waste from the acai processing industry, for added value concerns, was used as biomass for energy production. The energy generated in gasification of the acai waste was quantified at 26 kWe. In addition, the charcoal resulting from this process was activated with pure NaOH and applied as biosorbent of Methylene Blue and to reactive dyes from raw textile effluents. Specific Surface Area and Pore Distribution, Thermogravimetric analysis, Scanning Electron Microscopy, Fourier Transfer Infrared Spectroscopy and X-ray Diffraction techniques were employed to characterize the acai biochar. Significant modifications were observed on the biochar surface morphology after its activation with NaOH. Anionic activation increased its specific surface area from 1.94 to 491.90 m2 g−1 and led to an expressive increase in its maximum adsorption capacity for Methylene Blue from 33.73 to 93.23 mg g−1. The equilibrium isotherm applied to fit the experimental data was the combined Langmuir Freundlich model. Kinetic experiments showed that the adsorption equilibrium was quickly reached, within 20 min. Moreover, the pseudo n order model which was the one which best fit the kinetic data and the adsorption capacity in equilibrium state (qe) was 43.45 mg g−1 with n = 2.26. Activated acai biochar was also investigated in the adsorption of raw textile wastewater, which exhibited a reduction of 84.62% in the effluent Biochemical Oxygen Demand. The Chemical Oxygen Demand decreased from 684 to 350 mg (O2)∙L−1 after the combined coagulation + adsorption treatment.

The Coagulation and Immune Systems Are Directly Linked through the Activation of Interleukin-1α by Thrombin

SummaryAncient organisms have a combined coagulation and immune system, and although links between inflammation and hemostasis exist in mammals, they are indirect and slower to act. Here we investigated direct links between mammalian immune and coagulation systems by examining cytokine proproteins for potential thrombin protease consensus sites. We found that interleukin (IL)-1α is directly activated by thrombin. Thrombin cleaved pro-IL-1α at a site perfectly conserved across disparate species, indicating functional importance. Surface pro-IL-1α on macrophages and activated platelets was cleaved and activated by thrombin, while tissue factor, a potent thrombin activator, colocalized with pro-IL-1α in the epidermis. Mice bearing a mutation in the IL-1α thrombin cleavage site (R114Q) exhibited defects in efficient wound healing and rapid thrombopoiesis after acute platelet loss. Thrombin-cleaved IL-1α was detected in humans during sepsis, pointing to the relevance of this pathway for normal physiology and the pathogenesis of inflammatory and thrombotic diseases.

Bronchoscopic Treatment of Benign Endoluminal Lung Tumors.

Background and Aim Endobronchial benign tumors are a rarely seen clinical entity but may cause significant symptoms. Endobronchial treatment has the potential for relieving symptoms while saving the patient from invasive surgical procedures. No trials have been published that present and compare the various endobronchial treatment modalities for endobronchial benign tumors. The aim of the present study is to define safety and efficacy of endobronchial treatment in patients with benign endobronchial tumors from the point of complications and success rate. Methods This study is a retrospective cohort study from a review of medical charts. Eligibility criteria included diagnosis of a benign endobronchial tumor. Our institution's bronchoscopy and pathology database was searched for specific benign tumors, and the results were further detailed based on the endobronchial location. Results Forty-four patients with pathologically confirmed benign endobronchial tumors were included. Tumor regression was achieved in all patients with diode laser and argon plasma coagulation in combination with or without cryotherapy and without any major complication. There were no significant differences between the use of either diode laser or of argon plasma coagulation as a modality with immediate effect from the occurrence of residual tissue that needed cryotherapy (P > 0.05). There were no major complications. Eight patients had minor complications including minor bleeding (6 patients) and hypertension (2 patients) that were controlled medically. Thirty-one patients (70%) had very good response, and 13 patients (30%) had good response as defined in literature before. Conclusion Diode laser and argon plasma coagulation in combination with or without cryotherapy are safe and effective methods for endobronchial treatment of benign endobronchial tumors.

A highly efficient method for concentrating DNA from river water by combined coagulation and foam separation

ABSTRACTBoth Escherichia coli and Enterococci were collected in foam within 7 min from 500 mL of bacteria-spiked water by coagulation and foam separation using ferric chloride and milk casein. These bacterial DNA isolated in the 100 µL of extract from the foam more than 87.5% recovery using the DNeasy PowerWater® Kit. To test this method with water from three natural rivers, 0.67–2.70 µg of DNA were concentrated in 100 µL of extract from 1,000 mL of river water. When the DNA extract was subjected to 16S rRNA gene sequencing analysis, information on the bacterial flora could be obtained.