Deep Bleeding Research Articles

A case of factor XIII deficiency with various deep bleeding against a background of alcoholic cirrhosis

A case of factor XIII deficiency with various deep bleeding against a background of alcoholic cirrhosis

Application of prostate resectoscope in the treatment of massive rectal bleeding after transrectal prostate puncture

BACKGROUND Ultrasound-guided prostate biopsy is a reliable diagnostic procedure for prostate cancer diagnosis with minimal procedure-related trauma. However, complications, such as massive rectal bleeding may occur after the puncture. We hypothesized that using a transrectal resectoscope could help treat massive rectal bleeding after transrectal prostate punctures. AIM To identify a simple and effective treatment for massive rectal bleeding after transrectal prostate punctures. METHODS Patients requiring treatment for massive rectal bleeding after transrectal prostate punctures were included. A SIMAI resectoscope was inserted through the anus. Direct electrocoagulation was performed for superficial bleeding points. Part of the rectal mucosa or surface muscle layer was removed to expose deep bleeding points, followed by electrocoagulation. An electric cutting ring was used to compress and stop the bleeding for jet-like points before electrocoagulation. The fluid color in the drainage tube was monitored postoperatively for continuous bleeding. RESULTS Eight patients were included from 2012 to 2022. None of the patients with massive rectal bleeding after the transrectal prostate punctures improved with conventional conservative and blood transfusion treatments. Two patients had an inferior artery embolism, and digital subtraction angiography was ineffective. All patients received emergency transanal prostate resection, which immediately stopped the bleeding. Four days after the procedure, the patients had recovered and were discharged. CONCLUSION Using a transanal prostate resection instrument is a simple, safe, and effective method for treating massive rectal bleeding after transrectal prostate punctures.

Injectable Self-Expanding/Self-Propelling Hydrogel Adhesive with Procoagulant Activity and Rapid Gelation for Lethal Massive Hemorrhage Management.

Developing hydrogels that can quickly reach deep bleeding sites, adhere to wounds, and expand to stop lethal and/or noncompressible bleeding in civil and battlefield environments remains a challenge. Herein, an injectable, antibacterial, self-expanding, and self-propelling hydrogel bioadhesive with procoagulant activity and rapid gelation is reported. This hydrogel combines spontaneous gas foaming and rapid Schiff base crosslinking for lethal massive hemorrhage. Hydrogels have rapid gelation and expansion rate, high self-expanding ratio, excellent antibacterial activity, antioxidant efficiency, and tissue adhesion capacity. In addition, hydrogels have good cytocompatibility, procoagulant ability, and higher blood cell/platelet adhesion activity than commercial combat gauze and gelatin sponge. The optimized hydrogel (OD-C/QGQL-A30) exhibits better hemostatic ability than combat gauze and gelatin sponge in rat liver and femoral artery bleeding models, rabbit volumetric liver loss massive bleeding models with/without anticoagulant, and rabbit liver and kidney incision bleeding models with bleeding site not visible. Especially, OD-C/QGQL-A30 rapidly stops the bleedings from pelvic area of rabbit, and swine subclavian artery vein transection. Furthermore, OD-C/QGQL-A30 has biodegradability and biocompatibility, and accelerates Methicillin-resistant S. aureus (MRSA)-infected skin wound healing. This injectable, antibacterial, self-expanding, and self-propelling hydrogel opens up a new avenue to develop hemostats for lethal massive bleeding, abdominal organ bleeding, and bleeding from coagulation lesions.

Gas-jet propelled hemostats for targeted hemostasis in wounds with irregular shape and incompressibility.

Since hemostats are likely to be flushed off a wound by a massive gushing of blood, achieving rapid and effective hemostasis in complex bleeding wounds with powder hemostats continues to be a significant therapeutic challenge. In order to counter the flushing effect of gushing blood, a gas-jet propelled powder hemostat ((COL/PS)4@CaCO3-T-TXA+) has been developed. (COL/PS)4@CaCO3-T-TXA+ dives into the deep bleeding sites of complex wounds for targeted hemostasis. In preparation, protamine sulfate and collagen are first electrostatically deposited on CaCO3, which is then loaded with thrombin, and finally doped with protonated tranexamic acid (TXA-NH3+) to produce the final therapeutic medicine (COL/PS)4@CaCO3-T-TXA+. When applied to bleeding tissues, CaCO3 and TXA-NH3+ from (COL/PS)4@CaCO3-T-TXA+ immediately react with each other in blood to release countless CO2 macro-bubbles, which direct the hemostatic powder, (COL/PS)4@CaCO3-T-TXA+, precisely towards deep bleeding sites from complex wounds. Then the carried thrombin is released to accomplish targeted hemostasis. According to animal studies, (COL/PS)4@CaCO3-T-TXA+ has better effects in rabbit hepatic hemorrhage models; the hemorrhage quickly stops within 30 s, which is roughly 20% less than with the commercial product CeloxTM. The present study provides a new strategy for using powder hemostats to quickly and effectively stop bleeding in complex bleeding wounds.

Efficacy of the additional use of subgingival air-polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial. Part II: effect on sub-gingival microbiome

ObjectivesTo date, scarce evidence exists around the application of subgingival air-polishing during treatment of severe periodontitis. The aim of this study was to evaluate the effect on the health-related and periodontitis-related subgingival microbiome of air-polishing during non-surgical treatment of deep bleeding pockets in stage III–IV periodontitis patients.Materials and methodsForty patients with stage III–IV periodontitis were selected, and pockets with probing depth (PD) 5–9 mm and bleeding on probing were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air-polishing and ultrasonic instrumentation. Test group received additional subgingival air-polishing at experimental sites. Subgingival microbial samples were taken from the maxillary experimental site showing the deepest PD at baseline. Primary outcome of the first part of the present study was the 3-month change in the number of experimental sites. Additional analysis of periodontal pathogens and other sub-gingival plaque bacteria sampled at one experimental site at baseline and 3 months following treatment was performed through a real-time quantitative PCR microarray.ResultsIn the test group, a statistical increase of some health-related species was observed (Abiotropha defectiva, Capnocytophaga sputigena, and Lautropia mirabilis), together with the decrease of pathogens such as of Actinomyces israelii, Catonella morbi, Filifactor alocis, Porphyromonas endodontalis, Sele-nomonas sputigena, Tannerella forsythia, Treponema denticola, and Treponema socranskii. In the control group, statistical significance was found only in the decrease of Filifactor alocis, Tannerella forsythia, and Treponema socranskii.ConclusionsThe addition of erythritol-chlorhexidine powder seems to cause a shift of the periodontal micro-biome toward a more eubiotic condition compared to a conventional treatment. The study was registered on Clinical Trials.gov (NCT04264624).Clinical relevanceSubgingival air-polishing could help re-establishing a eubiotic microbioma in deep bleeding periodontal pockets after initial non-surgical treatment.

Dual-Driven Hemostats Featured with Puncturing Erythrocytes for Severe Bleeding in Complex Wounds.

Achieving rapid hemostasis in complex and deep wounds with secluded hemorrhagic sites is still a challenge because of the difficulty in delivering hemostats to these sites. In this study, a Janus particle, SEC-Fe@CaT with dual-driven forces, bubble-driving, and magnetic field– (MF–) mediated driving, was prepared via in situ loading of Fe3O4 on a sunflower sporopollenin exine capsule (SEC), and followed by growth of flower-shaped CaCO3 clusters. The bubble-driving forces enabled SEC-Fe@CaT to self-diffuse in the blood to eliminate agglomeration, and the MF-mediated driving force facilitated the SEC-Fe@CaT countercurrent against blood to access deep bleeding sites in the wounds. During the movement in blood flow, the meteor hammer-like SEC from SEC-Fe@CaT can puncture red blood cells (RBCs) to release procoagulants, thus promoting activation of platelet and rapid hemostasis. Animal tests suggested that SEC-Fe@CaT stopped bleeding in as short as 30 and 45 s in femoral artery and liver hemorrhage models, respectively. In contrast, the similar commercial product Celox™ required approximately 70 s to stop the bleeding in both bleeding modes. This study demonstrates a new hemostat platform for rapid hemostasis in deep and complex wounds. It was the first attempt integrating geometric structure of sunflower pollen with dual-driven movement in hemostasis.

Incidences of deep vein thrombosis and major bleeding under the administration of fondaparinux for thromboprophylaxis after periacetabular osteotomy: a retrospective observational study

ABSTRACTPeriacetabular osteotomy (PAO) is an effective joint-preserving procedure for patients with developmental dysplasia of the hip. Although deep vein thrombosis (DVT) is considered a serious complication of orthopaedic surgery, there is no consensus regarding a thromboprophylaxis strategy after PAO. We have routinely administered fondaparinux for DVT prophylaxis in adult patients undergoing PAO. The aim of this study was to investigate the incidences of DVT and major bleeding under the administration of fondaparinux for thromboprophylaxis after PAO. A total of 95 patients (100 hips) who underwent PAO with post-operative administration of fondaparinux for thromboprophylaxis were retrospectively enrolled. The incidences of DVT on ultrasound, major bleeding, and administration cessation were evaluated. Asymptomatic DVT occurred in one patient, major bleeding occurred in 14 hips and the administration of fondaparinux was stopped in 17 hips. Given the observed incidence of major bleeding, safer DVT prophylaxis modalities should be considered during PAO.

Digital scan over dental dam: workflow for successful clinical outcome.

Although the use of intraoral scanners is becoming more popular, dental professionals are still presented with the challenge of obtaining precise imaging of the preparation margins. Deep preparation margins, saliva contamination, or bleeding during the scanning procedures can impair the accuracy of the digital scan. Dental dam placement can significantly improve the quality and efficiency of the digital scan, while simultaneously providing a clean restorative field and serving as a barrier to the spread of infections for the protection of dental professionals. This article describes a technique of intraoral scanning by using dental dam isolation to ensure maximum accuracy of the digital scan of the dental preparations.

Magnetic field-mediated Janus particles with sustained driving capability for severe bleeding control in perforating and inflected wounds

Severe bleeding in perforating and inflected wounds with forky cavities or fine voids encountered during prehospital treatments and surgical procedures is a complex challenge. Therefore, we present a novel hemostatic strategy based on magnetic field-mediated guidance. The biphasic Janus magnetic particle (MSS@Fe2O3-T) comprised aggregates of α-Fe2O3 nanoparticles (Fe2O3 NPs) as the motion actuator, negatively modified microporous starch (MSS) as the base hemostatic substrate, and thrombin as the loaded hemostatic drug. Before application, the particles were first wrapped using NaHCO3 and then doped with protonated tranexamic acid (TXA-NH3+), which ensured their high self-dispersibility in liquids. During application, the particles promptly self-diffused in blood by bubble propulsion and travelled to deep bleeding sites against reverse rushing blood flow under magnetic guidance. In vivo tests confirmed the superior hemostatic performance of the particles in perforating and inflected wounds (“V”-shaped femoral artery and “J”-shaped liver bleeding models). The present strategy, for the first time, extends the range of magnetically guided drug carriers to address the challenges in the hemorrhage control of perforating and inflected wounds.

Omentoplasty decreases deep organ space surgical site infection compared with external tube drainage after conservative surgery for hepatic cystic echinococcosis: Meta-analysis with a meta-regression.

The rate of deep organ space/surgical site infection after conservative surgery for hepatic cystic echinococcosis (HCE) ranges from 12% to 26% with a post-operative mortality rate between 0% and 7.5%. This systematic review with meta-analysis aimed to investigate whether omentoplasty (OP) following conservative surgery for HCE leads to decreased rates of morbidity and mortality compared to external tube drainage ETD. We identified 4540 articles through database searching. After verifying the inclusion and exclusion criteria, we retained eight studies for final analysis: two randomized controlled trials (RCT), one prospective comparative study and five retrospective comparative studies. The main outcome measure was organ space/surgical site (OS/SS) morbidity that was limited to "deep organ space/surgical site infection (Deep OS/SSI) with or without re-operation". The eight studies reported results for deep OS/SSI (6/374 (OP) and 60/403 (ETD), respectively). There were statistically significantly less deep OS/SSI with OP (vs. ETD) OR=0.17 95%CI [0.05, 0.62] (P=0.007). A random-effect meta-regression, including the eight studies, showed an interaction in favor of OP. There were also statistically significant less biliary leakage±fistula and overall morbidity in OP compared to ETD. On the other hand, no statistically significant difference was found concerning deep bleeding, mortality and recurrence between these two groups. This meta-analysis with a meta-regression showed that there were statistically significant less deep OS/SSI, biliary leakage±fistula and overall morbidity in OP compared to ETD.

Efficacy of the additional use of subgingival air polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial

To date, scarce evidence exists around the application of subgingival air polishing during treatment of severe periodontitis. The aim of this study was to evaluate the benefits of subgingival air polishing during non-surgical treatment of deep bleeding pockets in stages III-IV periodontitis patients MATERIALS AND METHODS: Forty patients with stages III-IV periodontitis were selected, and pockets with probing depth (PD) 5-9mm and bleeding on probing (BoP) were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air polishing and ultrasonic instrumentation. Test group received additional subgingival air polishing at experimental sites. The proportion of experimental sites shifting to PD ≤ 4 mm and no BoP at 3months (i.e., non-bleeding closed pockets, NBCPs) was regarded as the primary outcome variable. The proportion of NBCP was comparable between test and control group (47.9 and 44.7%, respectively). Baseline PD of 7-9 mm, multi-rooted teeth and the presence of plaque negatively influenced the probability of obtaining NBCP. The additional application of subgingival air polishing does not seem to provide any significant clinical advantage in achieving closure at moderate to deep bleeding pockets in treatment of stages III-IV periodontitis patients. The study was registered on Clinical Trials.gov (NCT04264624). While air polishing can play a role in biofilm removal at supragingival and shallow sites, ultrasonic root surface debridement alone is still the choice for initial treatment of deep bleeding periodontal pockets.

Efficacy, safety, and physicochemical properties of a flowable hemostatic agent made from absorbable gelatin sponge via vacuum pressure steam sterilization.

An effective and viable hemostatic agent is important for stopping bleeding during surgery. However, it is difficult to achieve hemostasis at uneven or deep bleeding sites using a gelatin sponge. A flowable hemostatic agent has therefore been developed by processing and improving gelatin sponge, to address bleeding under these conditions. In this study, we evaluated the efficacy, safety, and physical and chemical properties of this flowable hemostatic agent in various experiments. We examined its efficacy for stopping bleeding in a rabbit model of liver abrasion in vivo, and compared its efficacy in dynamic coagulation and erythrocyte aggregation tests with gelatin sponge in vitro. We also investigated its safety in rat histocompatibility and acute systemic toxicity tests in mice in vivo, and in hemolysis tests in vitro, to determine if the flowable hemostatic agent induced any pathological reactions or adverse events. In terms of its physical and chemical properties, we analyzed the morphology and chemical bonds of the flowable hemostatic agent by optical and electron microscopy and infrared spectroscopy, and its absorbency and density. The flowable hemostatic agent resulted in a shorter mean bleeding time, less bleeding, greater likelihood of successful hemostasis, and reduced clotting time compared with gelatin sponge. The flowable agent produced some changes in physical morphology, but no pathological changes or undesirable outcomes were detected. This flowable topical hemostatic agent thus provides a safe and more effective hemostatic method than gelatin sponge, and more promising results for intraoperative hemostasis, especially on uneven or deep bleeding surfaces.

Self‐Propelling Janus Particles for Hemostasis in Perforating and Irregular Wounds with Massive Hemorrhage

AbstractAchieving rapid and safe control of perforating and irregular hemorrhage, defined as bleeding wounds with irregular external and internal wound shape, located deep within complex and covert hemorrhage sites, is vital to decrease the risk of mortality during prehospital treatments and surgical procedures. However, current hemostatic materials do not control hemorrhage effectively as their ability to access the bleeding source and coagulate blood is limited. Here, a biphasic Janus self‐propelled hemostatic particle (MSS@CaCO3) is prepared via uniaxial growth of flower‐like calcium carbonate crystal (CaCO3) on negatively‐modified‐microporous starch (MSS). The as‐synthesized hemostatic particle (MSS@CaCO3T) is loaded with thrombin and powered by the internal component CaCO3, with the collaborative use of protonated tranexamic acid. These particles are capable of traveling against the blood flow allowing them to access deep bleeding sites, inducing synergistic blood coagulation effects to effectively halt hemorrhaging. The self‐propelling Janus hemostatic particle is sufficiently available in the deep bleeding sites of liver and femoral artery hemorrhage models, wherein the hemorrhage is rapidly controlled in ≈50 s and ≈3 min, respectively. To the authors’ knowledge, this is the first attempt of controlling hemorrhage using Janus hemostatic particles with a self‐propelling property.

HIV transmission by human bite: a case report and review of the literature\u2014implications for post-exposure prophylaxis

We report a case of a probable HIV-1 transmission by human bite. The analyzed data from ten previously reported suspected or allegedly confirmed HIV transmissions revealed a deep bleeding bite wound as the primary risk factor. A high HIV plasma viral load and bleeding oral lesions are present most of the time during HIV transmission by bite. HIV post-exposure prophylaxis (PEP) should be recommended in case of a bleeding wound resulting from a bite of an HIV-infected person. PEP was missed in this presented case.

PB1840 ACQUIRED HEMOPHILIA AND MONOCLONAL GAMMOPATHY OF HEMOSTASIC SIGNIFICANCE

Background:Acquired hemophilia A (HAA) is a rare hemorrhagic disease characterized by the appearance of autoantibodies against circulating factor VIII (FVIII). It has been described mainly in two groups: women of childbearing age and in older than 50 years, related to a very heterogeneous group of entities that include: drugs, autoimmune or neoplastic diseases. Within the hematological neoplasias, the one that has been most related is the chronic lymphocytic leukemiaAims:We present a very rare case of adquired A Hemophilia due wiirh an abnormal paraprotein.Methods:A 76‐year‐old man entered the Hematology department due to a month‐long evolution of hematoma and anemic syndrome. On physical examination, he had scattered bruises all over the body surface, especially in the extremities; with signs of deep bleeding in right upper and lower left limb, which implied limitation for mobility.Complementary tests performed:‐ Hemograme:. Hb 8.5 g / dL, normocytic and normochromic.‐ Coagulation study: APTT ratio of 2.8 and an FVIII of 0.7%. The inhibitor titre was 6.2 UB / ml.‐ Biochemistry was normal (including creatinine and calcium; and anemia study).‐ A triple monoclonal band of 2.01 g / dL was observed in electrophoresis (0.56 + 1.08 + 0.37 g / dL). IgA of 1668 mg / dL (with decrease in IgG and IgM) and a serum free light chain (lambda / kappa) ratio of 21. The monoclonal component had remained stable up to six months before admission, when a third peak appeared [Table 1].‐ In 24‐hour urine, he presented a proteinuria of 0.21 g (all Bence‐Jones lambda).‐ A low‐dose whole‐body CT was also performed, which ruled out lytic lesions or underlying tumors.Treatment with Cyclophosphamide and Prednisone was started. The response was good, with inhibitor reduction (5.6 UB), increased factor dosage (13%) and recovery from anemia. This allowed to perform bone marrow aspiration, which was compatible with multiple myeloma, with 13% of plasma cell. Cyclophosphamide was temporarily suspended due to an infectious disease. FVIII rise to 136%. After it, FVIII dropped to 18% and the MB rose to 1.2 g / dL (with a third peak of 0.6 g / dL). Cyclophosphamide was reintroduced and the dose of Prednisone increased again. Currently, the patient is asymptomatic, with no recurrence of anemia, with 90% FVIII and a monoclonal component of 1.5 g / dL; In addition, the FLC ratio has risen to 85. Continue close monitoring in our consultations.Results:The sudden onset of large bruises or extensive bruising in an adult patient with no history of bleeding disorder, should make us think of an acquired inhibitor of FVIII.The diagnosis should be based on the basic coagulation tests (lengthened APTT together with normal PT), the time correction in the Mixture Test, factor VIII dosage and Bethesda titulation.The treatment of HAA should consist, first of all, in the control of bleeding. Once the hemorrhage is controlled, next objective must be the elimination of the inhibitor by means of immunosuppressants. In the limited available evidence, it seems that the best results are obtained with Prednisone in combination with Cyclophosphamide.Summary/Conclusion:The association of HAA and myeloma is extremely rare, with only five cases published.imageFor the most part, the diagnosis of both pathologies was carried out concomitantly; and the treatment consisted, first of all, in trying to control the hemorrhagic clinic (by means of FVIII or FVIIr concentrates), and, subsequently, the start of the treatment directed to reduce paraprotein with antimyeloma treatment.

Abstract 154: Bridging to Warfarin With Direct Oral Anticoagulant Agents

Background: Anticoagulation bridging using LMWH remains a common practice to mitigate the Warfarin’s delayed onset of action. However, LMWH often creates resistance from patients given cost, fear to injections, or in patients already on direct oral anticoagulant agents (DOACs), cost coverage that demand agent change. In such circumstances, the possibility of bridging using DOACs has been adopted. Aim: To characterize the outcomes and cost benefit for patients who were bridged to Warfarin using a DOAC. Methods: We identified a case series of patients who used DOACs for bridging to Warfarin. Primary outcome was major hemorrhage and thrombosis recurrence identified 30 and 60 days after initial bridging therapy was initiated. Categorical variables were presented as percentages, continuous variables as median and range. Chi Square or Student T were used as appropriate. Results: A total of nineteen patients were included (Men = 42%, Age = 66.3 (32-93), BMI = 29 (19.5-44.6)). Twelve patients received Apixaban (63%), and seven patients received Rivaroxaban (37%). Reasons to avoid low molecular weigh heparin were patient’s preference (53%), changing indication (32%), interaction (10%), and cost (5%) The average time for successful bridging was 13.2 days (5-29). No episodes of major bleeding, deep venous thrombosis, pulmonary embolism or minor bleeding were registered after 30 and 60 days of initiation of bridging therapy. Average cost of bridging therapy with DOAC was 158.3 USD (Range 21.1-407.9). Estimated cost of bridging therapy with LMWH and current pricing would have been 652.4 US dollars (294-1421). Conclusion: Bridging strategy with direct oral anticoagulant agents seems to be a safe, cost-effective approach in patients receiving oral Warfarin. Moreover, this alternative is reasonable for patients with aversion or lack of social support to administer injections. A larger study is necessary to further explore these findings.

Lysine-specific proteolytic activity responsible for forsythia detaching factor modification

ObjectivesThe objective of the present study was to clarify the lysine-specific proteolytic activity derived from periodontal pathogens responsible for Forsythia detaching factor (FDF) modification. DesignThe activity responsible for FDF modification in Tannerella forsythia and Porphyromonas gingivalis were evaluated by colorimetric assay using Ac-Arg-Ala-Lys-p-nitroaniline as a substrate. FDF modification in T. forsythia and P. gingivalis were evaluated by Western blotting using recombinant FDF (rFDF) as a substrate. Furthermore, the activity in GCF of 20 patients with periodontitis and 10 healthy subjects was also evaluated by colorimetric assay. Bacteria in subgingival plaque were detected using polymerase chain reaction. ResultsThe activity of both bacteria in colorimetric assay were 21.35 unit (P. gingivalis) and 3.61 unit (T. forsythia), respectively. Western blot analysis revealed that P. gingivalis was found to efficiently degrade rFDF and T. forsythia partially cleaved rFDF. The activity in GCF from patients with periodontitis (clinically healthy sites: CH, deep bleeding sites: DB and deep non-bleeding sites: DNB) was significantly higher than those from healthy subjects (healthy sites: H). Among the patients with periodontitis, the activity from CH was significantly lower than those from DB and DNB. T. forsythia was detected in 68.4% of DNB, in 78.4% of DB and in none of CH. P. gingivalis was detected in 63.2% of DNB, in 84.0% of DB and in 10.5% of CH. No bacterium was detected in healthy subjects. ConclusionThe lysine-specific proteolytic activity responsible for FDF modification correlates with the presence of major periodontal pathogens.

A pilot study of active enzyme levels in gingival crevicular fluid of patients with chronic periodontal disease.

To determine whether combinations of enzymes in gingival crevicular fluid (GCF) can act as improved biomarkers compared with single enzymes for predicting the outcome of treatment and also for diagnosing the clinical status of sites. Thirty subjects with chronic periodontitis were recruited to a 12-month longitudinal pilot study. GCF samples from three representative sites: healthy (≤3mm), deep non-bleeding (NB) (≥6mm) and deep bleeding (DB) (≥6mm) sites and clinical data were collected at baseline, 3months, 6months and 12months following periodontal treatment. Active enzyme levels (MMP-8, cathepsin G, elastase, trypsin-like activity and sialidase) in GCF samples were assessed. The enzyme profiles and clinical data of each site were analysed for correlation and logistic regression was performed to find the predictive value of the active enzyme levels regarding the outcome of treatment. Twenty-two individuals completed the study. All active enzyme levels were significantly higher in diseased sites than healthy sites. Logistic regression showed that the combination of MMP8, elastase and sialidase provided accurate predictions of treatment outcome (88% for NB and 86% for DB), which was significantly better than each enzyme alone (61%). This pilot has suggested that combined active enzyme profiling could provide significant prediction of outcome of treatment.

A meta-analysis of platelet gel for prevention of sternal wound infections following cardiac surgery.

Deep sternal wound infection and bleeding are devastating complications following cardiac surgery, which may be reduced by topical application of autologous platelet gel. Systematic review identified seven comparative studies involving 4,692 patients. Meta-analysis showed significant reductions in all sternal wound infections (odds ratio 3.48 [1.08-11.23], p=0.04) and mediastinitis (odds ratio 2.69 [1.20-6.06], p=0.02) but not bleeding. No adverse events relating to the use of topical platelet-rich plasma were reported. The use of autologous platelet gel in cardiac surgery appears to provide significant reductions in serious sternal wound infections, and its use is unlikely to be associated with significant risk.

Extended Antithrombotic Therapy in Elderly Patients with Deep Venous Thrombosis

Objective. The objective of the present study was to evaluate the quality of the extended anticoagulation in elderly patients with a history of deep vein thrombosis. Material and methods. We examined and treated 50 women with deep venous thrombosis in the inferior vena cava system. The mean age was 72.8±6.08 age. The study group included 24 people taking rivaroxaban as secondary prevention of recurrent venous thrombosis (mean age 72.7±5.7). The control group included 26 patients taking vitamin K antagonist warfarin (mean age 72.9±6.5). Evaluation criteria were the frequency of recurrence of deep venous thrombosis and bleeding complications. Results. There was 3 episodes of recurrent deep venous thrombosis in the control group (11.5%) and no episodes in the basic group taking rivaroxaban (p=0.235). The number of haemorrhagic complications in the control group was 46.2% (n=12) and found to be higher than in the group taking rivaroxaban (20.8%, n=5), but not statistically significant (p=0.077). The number of patients at the age of 75—89 years who had haemorrhagic complications was higher in the control group comparing to group taking rivaroxaban (p=0.04). Doctors of clinics in a residence of patients have not managed to provide the adequate INR therapeutic range. Conclusion. Administration of rivaroxaban in elderly patients is efficient in prevention of recurrent deep venous thrombosis. Use of vitamin K antagonists is associated with certain difficulties, in particular carrying out adequate control of the anticoagulation therapy and further adjustments that in turn can lead to development of haemorrhagic complications or recurrent deep venous thrombosis.