Fibrin Strands Research Articles

Differential Role of Factor XIII in Acute Myocardial Infarction and Ischemic Stroke.

Factor XIII is a transglutaminase enzyme that plays a crucial role in hemostasis and wound healing. It crosslinks fibrin strands, stabilizing clots and promoting clot resistance to fibrinolysis. Additionally, Factor XIII has been found to have multiple other functions that extend beyond coagulation, including the regulation of inflammation and tissue repair processes. Emerging evidence suggests that Factor XIII may also have differential roles in acute myocardial infarction and ischemic stroke, two common cardiovascular events with significant morbidity and mortality. In acute myocardial infarction, Factor XIII has been implicated in promoting clot stability and reducing the risk of re-occlusion. In ischemic stroke, Factor XIII may also contribute to the pathogenesis of cerebral ischemia by promoting clot formation and exacerbating neuronal damage. Several studies have investigated the association between Factor XIII and these cardiovascular events, using various approaches such as genetic polymorphism analysis, animal models, and clinical data analysis. These studies have provided important insights into the role of Factor XIII in acute myocardial infarction and ischemic stroke, highlighting its potential as a therapeutic target for interventions aimed at improving outcomes in these conditions. In this review, we will summarize the current understanding of Factor XIII's role in acute myocardial infarction and ischemic stroke.

Proventricular and ventricular gastrointestinal stromal tumor (GIST) in a scarlet macaw (Ara chloropterus)

GISTs can be benign or malignant, and they have been reported in a wide variety of species, including humans, non-human primates, dogs, and cats; however, reports of this tumor in birds are rare. These neoplasms are seen in the gastrointestinal tract and are derived from the Cajal Cells responsible for regulating gastrointestinal motility. We report a case of a gastrointestinal stromal tumor in a scarlet macaw (Ara chloropterus) that was referred to necropsy at the Veterinary Hospital of the Federal University of Paraíba (UFPB), Northeastern Brazil. Macroscopically, the proventriculus and ventriculus were dilated, and the walls of both organs were thickened by a firm, ulcerated mass covered by fibrin strands. In the histopathology, the proventriculus presented an expansive, non-encapsulated neoplasm formed by homogeneous spindle cells, with eosinophilic cytoplasm, indistinct borders, mild to moderate pleomorphism, and rare mitotic figures, being suggestive of a leiomyoma. In immunohistochemistry, a positive multifocal immunolabeling for the C-KIT proto-oncogene was observed in the cytoplasm of neoplastic spindle cells, thus compatible with a gastrointestinal stromal tumor (GIST). The occurrence of GISTs in avian species might have been overlooked, and the authors recommend that previously reported gastrointestinal leiomyomas or leiomyosarcomas be tested for this immunomarker to rule out the possibility of GISTs.

The nature of changes in endocrine and immune factors at the initial stage of the formation of chronic wounds

Aim. The work aimed to study the nature of changes in endocrine signals (insulin and cortisol) and bioactive molecules that control inflammation and activation of process synthesis (interleukin-2 (IL-2), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), amino-terminal propeptide of type III procollagen (PIIINP)), at the initial stage of the formation of chronic wounds in the experiment.
 Materials and methods. The study was conducted in 2 groups of Wistar rats. The first group is represented by intact animals. Animals of the second group were modeled chronic wounds. On the 3rd day of the experiment, all animals were euthanized. The concentration of studied bioactive molecules was measured in blood serum by enzyme immunoassay. Selected areas of the wound were subjected to histological examination.
 Results. The levels of cortisol, insulin, VEGF, IL-2, and PIIINP in animals with chronic wounds at the stage of inflammation were significantly higher compared to intact animals. A tendency towards a decrease in the expression of IL-8 was shown. Relationships between the levels of bioactive molecules in animals of different groups were studied. According to the results of studies a correlation between the concentrations of IL-8 and cortisol in rats of the intact group was established. In the group of rats on the 3rd day after wound induction, a positive correlation was noted between the levels of IL-8 and IL-2. Wound defects healed under the scab. Microscopic analysis showed that the histoarchitectonics of tissues in the area of damage on the 3rd day corresponded to the classic manifestations of the process of healing wounds at this stage. The main part of the wound was filled with fibrin strands with a predominantly inflammatory cellular component. In some areas, signs of growth and development of young granulation tissue were noted. In the marginal sections, signs of re-epithelialization of the wound defect were observed.
 Conclusions. Even though in our study, the histoarchitectonics of tissues in the area of damage corresponded to the classical manifestations of the wound healing process at the stage of inflammation, the obtained changes and the relationship between endocrine and immune factors may be harbingers of the formation of the chronic wound in the future.

Systemic salmonellosis in 4 cats.

Clinical signs in 4 cases of salmonellosis in cats included vomiting, diarrhea (2 cases each), fever, dystocia, icterus, and seizures (1 case each). Three cats died, and one was euthanized. Grossly, all cats were in poor body condition and had yellow-to-dark-red perianal feces (3 cases), oral and ocular pallor (2 cases) or icterus (1 case), fluid or pasty yellow intestinal contents (4 cases), white or dark-red-to-black depressed areas on the hepatic surface (2 cases), yellow abdominal fluid with swollen abdominal lymph nodes (1 case), and fibrin strands on the placental chorionic surface (1 case). Histologically, all cats had necrotizing enterocolitis and random hepatocellular necrosis. Other histologic findings included mesenteric (4 cases) or splenic (2 cases) lymphoid necrosis, and endometrial and chorioallantoic necrosis (1 case). Gram-negative bacilli were observed within neutrophils and macrophages in the intestinal lamina propria (4 cases), liver, spleen, lymph node, endometrium, and placenta (1 case each). Aerobic bacterial culture on frozen samples of small intestine, mesenteric lymph node, lung, and liver yielded Salmonella enterica subsp. enterica. Serotyping was consistent with S. Enteritidis (cases 1, 3) and S. Typhimurium (cases 2, 4).

Impact of glutaraldehyde cross-linking on the advanced platelet-rich fibrin membrane: Macroscopic, conventional light microscopic and scanning electron microscopic analysis.

Advanced platelet-rich fibrin (A-PRF) is a biopolymer that releases growth factors to facilitate healing. Along with other barrier membranes, the A-PRF membrane has proven to be beneficial in guided tissue regeneration (GTR) treatment. The cross-linking of the A-PRF membrane with glutaraldehyde (GLUT) has been attempted previously, and has been shown to prolong its degradation time and improve its mechanical properties. In the present study, the effects of GLUT cross-linking on macroscopic changes in the A-PRF membrane were assessed, and microscopic features were analyzed using a light microscope and a scanning electron microscope (SEM). The aim of the present study was to evaluate and compare the effects of GLUT cross-linking on the A-PRF membrane through the macroscopic, microscopic and SEM examinations. A total of 18 human A-PRF membrane samples were prepared, half of which were treated with 0.1% GLUT, and the remaining were left untreated. The macroscopic measurements of the samples included weight, length and thickness, while specimen slides were prepared for light microscopic evaluation and SEM analysis. The GLUT cross-linked membranes weighed more and were thicker than the non-cross-linked membranes, but there was no change in length. Light microscopic images showed fewer cells at the head and tail, though cells were abundant in the body of the A-PRF membrane. The images acquired using SEM showed fibrin strands of greater thickness, but fewer interspersed cell bodies in the cross-linked membranes. This in vitro study revealed an increase in thickness and cross-linking fiber density along with the presence of viable cells in the GLUT-treated A-PRF membrane, which may prove its effectiveness in healing or serving as a barrier membrane in clinical trials.

Cardiac Tamponade with Fibrin Strands Leading to the Diagnosis of Multifocal Systemic Tuberculosis

Tuberculosis continues to be a major health problem, where an estimated 7–8 million new cases are diagnosed each year. Multifocal tuberculosis is characterized by the presence of large multifocal tuberculous areas in the same or different organs. Difficulty in diagnosis of multifocal tuberculosis and consideration of other diseases may lead to a delay in diagnosing this entity. We report the case of a young patient hospitalized for tamponade revealing a multifocal tuberculosis whose evolution was favorable after drainage and under antibacillary treatment. This to conclude that because of its propensity to cleverly mimic many diseases and affect multiple organ systems and sites, a high index of suspicion for multifocal TB should be maintained with patients presenting with multiple sites of involvement, especially in immunocompromised patients and those from countries where TB is endemic.

Histologic and Immunohistochemical Features of Antemortem Thrombus Compared to Postmortem Clot: Updating the Definition of Lines of Zahn.

Distinguishing true antemortem thrombus (AMT) from artifactual postmortem clot (PMC) can occasionally be challenging at autopsy. Lines of Zahn are cited as pathognomonic of AMT, but review of literature reveals heterogeneous definitions of the term. Neutrophil karyorrhexis and CD61 immunohistochemistry can also be used to define AMT, but there has been no systematic study determining the specificity of these features. To identify features that distinguish AMT from PMC, and to clarify the definition of lines of Zahn. PMC from the heart was collected in 50 hospital autopsies. Fifty arterial and 50 venous surgical thrombectomy specimens were reviewed for comparison. The microscopic features with hematoxylin-eosin staining, phosphotungstic acid-hematoxylin (PTAH) staining, and CD61 immunohistochemistry were documented. Thin curvilinear strands of fibrin and clumps of fibrin were frequently observed in both AMT and PMC. Thick bands of nested platelets wrapped in fibrin were nearly exclusive to AMT. Neutrophil karyorrhexis was readily apparent on low power in AMT but was seen in 40 of 50 PMCs (80%) only sparsely on high-power examination. Bone marrow elements were identified in 38 of 50 PMCs (76%). CD61 staining showed a geographic pattern in AMT and a speckled pattern in PMC. PTAH staining confirmed features seen with hematoxylin-eosin. Thin curvilinear strands of fibrin are found in both AMT and PMC and can be misinterpreted as lines of Zahn. We define lines of Zahn as thick bands formed by nested platelets wrapped in fibrin. Diffuse neutrophil karyorrhexis is common in AMT; in contrast, bone marrow elements are often seen in PMC.

Fibrinolytic Therapy in Purulent Pericarditis.

Purulent pericarditis (PP) is rare disease, and if left untreated, it is associated with very high mortality, nearly 100%. A considerable clinical problem due to PP is a very high probability of developing constrictive pericarditis (CP). Pericardial drainage is essential in the treatment of PP and should be performed urgently. The use of broad-spectrum antibiotic therapy is equally important. Unfortunately, fibrin deposits often create occulated spaces and reservoirs that reduce the penetration of antibiotics and their effectiveness. The rationale for the intrapericardial use of fibrinolytic drugs in PP is based on their ability to dissolve fibrin strands and collagen fibres, thus improving the penetration of antibiotics to the pericardial sac and lowering the risk of CP. The choice of the drug, as well as its dosage and the method of administration is still under debate. The authors of the article share their experiences and review current literature on this rare topic.

495 STANFORD TYPE-A ACUTE AORTIC DISSECTION: A LIFE-THREATENING EMERGENCY

Abstract Stanford type A acute aortic dissection is a life-threatening cardiological emergency which occurs when an intimal tear in the ascending aorta creates a false lumen within the media refilled by pulsatile blood flow. Some investigators report the immediate mortality to be as high as 40%. Both congenital and acquired conditions can be the cause of an instability of the aortic wall that can lead to dissection. Diagnosis, which requires a high level of suspicion, is usually made with aortic angio-CT. The case we present involves a 62-years old man with a history of hypertension, parossistic atrial fibrillation and familiarity for type B aortic dissection. He called 911 complaining of sudden onset dorsal pain that then irradiated anteriorly to the chest and upwardly to the neck, associated with profuse sweating. An EKG performed at patient's home showed ST elevation in V1 meaningful of right ventricle infarction. Arrived at the Emergency Ward of our hospital arterial pressure was 80/50 mmHg with an HR of 44 bpm. Rapidly, because of the suspect of aortic dissection, an angio-TC was performed showing a type A aortic dissection starting from Valsalva sinuses and extending till common right iliac artery and external left iliac artery including left subclavian artery ostium. The left renal artery originated from false lumen, but patient had a so-called horseshoe kidney. For this reason, the patient was transferred immediately to the cardiac surgery room with indication for Bentall procedure (aortic valve plus ascending aorta replacement with home-made valved Dacron tubular prosthesis), aortic arch repair with supra-aortic vessels debranching and reimplantation and saphenous graft on right coronary artery. During surgery was evident that intimal tear was located immediately after left common carotid artery and right coronary sinus was involved in the dissection thus explaining why right ventricle free wall was visibly hypokinetic. Surgery went without complication and patient entered ICU with circulation supported by a low dose of epinephrine and norepinephrine; respiratory weaning took place in day 1 post-operation. The following days patient developed circumferential pericardial effusion which needed percutaneous subxiphoid drainage despite not being hemodynamically relevant. Echocardiography before discharge showed aortic valve prosthesis and ascending aorta prosthesis well positioned, bi-ventricular normal dimensions and function and organized residual pericardial effusion with fibrin strands. Stanford type A is the most common type of aortic dissection and requires immediate surgical treatment. The Bentall procedure is considered the gold standard for patients needing ascending aorta plus aortic valve replacement. Even though mortality rates remain high for Stanford type A acute aortic dissection, this case shows how is possible to survive from such a life-threatening condition if a prompt and correct diagnosis is made and thanks to flawless surgical operation.

Awareness on D-dimer assay among dental students.

D-dimer molecules are formed by the degradation of cross-linked fibrin during the process of fibrinolysis. The formation of D-dimer requires the activity of activated factor XIII (factor XIIIa), plasmin, and thrombin. To assess the awareness about D-dimer assay among dental students. A cross-sectional study was done among 100 dental practitioners through an online survey. The survey consisted of 10 semiclosed prevalidated and reliable questionnaires based on the knowledge, attitude, and practice of the dentists on D-dimer assay. Descriptive and inferential statistics were performed to report the responses of the participants. Most participants did not know what a D-dimer assay is (55%). Forty-six percent of participants responded that the D-dimer assay is used to rule out serious blood clots. Fifty-four percent of the participants responded that fibrin D-dimers are formed when fibrin strands are formed. The current study shows that the knowledge about D-dimer assay is more in CRRI than in participants of junior year of study. Thus, more rigorous educational programs should be initiated to further enrich the knowledge among dental students.

Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report

BackgroundPericardial effusion is a late manifestation of HIV more commonly observed in individuals with depressed CD4 counts. Although Mycobacterium tuberculosis remains to be one of the most frequently identified pathogens in the pericardial fluid among people living with HIV, less commonly described etiologies include SARS-CoV-2 that causes coronavirus disease and human herpesvirus-8 which is associated with Kaposi sarcoma. Isolation of more than one pathogen in normally sterile sites remains challenging and rare. We report the first documentation of both SARS-CoV-2 and HHV-8 in the pericardial fluid.Case presentationWe present the case of a young man in his 20s with a recent history of clinically diagnosed pulmonary tuberculosis who was admitted for progressive dyspnea and cough. He had multiple violaceous cutaneous lesions on the face, neck, and trunk and diffused lymphadenopathies. He tested positive for SARS-CoV-2 on admission. The patient was clinically diagnosed with pneumonia, Kaposi sarcoma, and HIV/AIDS. Empiric broad spectrum antimicrobial regimen was subsequently initiated. HIV with low CD4 count was confirmed during hospitalization. Echocardiography revealed a large pericardial effusion, in impending cardiac tamponade. Frond-like fibrin strands, extending to the parietal pericardium, were also observed. Pericardiostomy yielded hemorrhagic, exudative effusion with lymphocytic predominance. SARS-CoV-2 and HHV-8 were detected in the pericardial fluid, and bacterial, fungal, and tuberculous studies were negative. The patient had clinical improvement after pericardial drainage. However, despite our best clinical care, he developed a nosocomial infection leading to clinical deterioration and death.ConclusionDetection of SARS-CoV-2 and HHV-8 in the pericardial fluid is rare, and interpretation of their significance in clinical care is challenging. However, coronavirus disease and Kaposi sarcoma must be considered and adequately addressed in immunocompromised adults presenting with large pericardial effusion.

Fibrinolysis in Dogs with Intracavitary Effusion: A Review.

Simple SummaryIn blood vessels there is a balance between clot formation and its dissolution. Fibrinolysis normally allows the breakdown of blood clots during the healing of injured blood vessels. This process is mediated by the activation of a blood enzyme (plasmin) which breaks down a meshed protein (fibrin) which holds blood clots at the site of the vessel injury. In some diseases, the activation of plasmin becomes excessive, leading to bleeding tendencies (hyperfibrinolysis). Under normal conditions, abdominal and thoracic cavities are filled with a small amount of fluid deriving from the blood. The results of recent studies have shown that, in dogs, all types of pathologic intracavitary fluids have an increased fibrinolytic activity. This increased fibrinolytic activity is also present in their blood, in some cases reaching a hyperfibrinolytic state. Hyperfibrinolysis and bleeding tendencies have also been documented in cardiopathic dogs with ascites. The latter result is surprising considering that thrombotic events are commonly documented in humans and cats with some cardiac diseases.Physiologic fibrinolysis is a localized process in which stable fibrin strands are broken down by plasmin in response to thrombosis. Plasmin activation can also take place separately from the coagulation process, resulting in pathologic fibrinolysis. When plasmin activation exceeds the neutralizing capacity of plasmin inhibitors, severe bleeding can potentially take place. Although the processes which regulate coagulation and fibrinolysis in the blood are well known, it is less clear as to what extent the same processes take place in the body cavities and whether they influence systemic hemostasis. The results of the studies herein cited demonstrate that coagulation followed by fibrinogenolytic/fibrinolytic activity takes place in all kinds of canine ascitic and pleural fluids. Moreover, systemic clotting abnormalities suggesting primary fibrinolysis/primary hyperfibrinolysis (i.e., elevated plasma fibrin/fibrinogen degradation products [FDPs] and normal D-dimer concentrations with fibrinogen concentrations ≤ 100 mg/dL or above this cut-off, respectively) occur in dogs with intracavitary effusion. Enhanced fibrinolytic activity in dogs with intracavitary effusion can also be detected using rotational thromboelastometry (ROTEM), although the degree of agreement between ROTEM and FDPs, D-dimer and fibrinogen concentrations is poor. Finally, contrary to the thrombotic events commonly documented in some humans and cats with cardiac diseases, bleeding tendencies due to primary fibrinolysis/primary hyperfibrinolysis have been documented in dogs with cardiogenic ascites.

Disease surveillance in England and Wales, June 2022.

Disease surveillance in England and Wales, June 2022.

Preparation of thermo-responsive polymer encapsulated exosomes and its role as a therapeutic agent for blood clot lysis

Tissue plasminogen activators induce enzymatic activation of plasminogen to plasmin that cleaves fibrin strands in blood clots. In the present study, extracellular vesicles such as exosomes from fibrosarcoma cell line HT1080 were utilized as clot-busting agents. These exosomes were being used for clot lysis of whole blood which showed 28% lysis within 10 h, which was comparable to that of the streptokinase (commercial plasmin activator) with no significant difference. These exosomes were able to facilitate the migration of endothelial cells in a scratch wound assay where normalized wound area remaining was 7.5% at 18 h. Also, exosomes aided in attenuation of oxidative stress generated on the cells, thereby maintaining cell viability. These exosomes were further encapsulated in a thermo-responsive polymer for better localized delivery that showed no cytotoxic effects, and sustained delivery was achieved up to a concentration of 117 µg/mL in 25 days, which corresponds to around 65% of the total amount of exosomes added. When a combination of exosomes and thermo–responsive polymer was utilized, the clot lysis activity reached to around 22% in 72 h. Thus, it proves the potential of this combinatorial approach which can be effectively used for thrombus degradation and healing of endothelium lining in damaged blood vessels.

Fibrin Strands Will Grow from Soluble Fibrin and Hang Up in an In Vitro Microcirculatory Viscoelastic Model: Is This a Major Cause of COVID-19 Associated Coagulopathy?

Viscoelastic testing (VET) by both TEG and ROTEM has demonstrated hypercoagulability early in corona virus disease 2019 (COVID-19) associated coagulopathy (CAC). Additional VET studies demonstrated fibrinolytic shutdown late in a majority of severely ill COVID-19 patients with an associated elevation of d-dimer. Elevated d-dimer confirms that coagulation, followed by fibrinolysis, has occurred. These findings imply that, during CAC, three enzymes—thrombin, Factor XIIIa and plasmin—must have acted in sequence. However, limitations in standard VET analyses preclude exploration of the earliest phases of clot induction, as well as clot formation and clot dissolution in flowing blood. Herein, we describe a novel method illuminating aspects of this unexplored area. In addition, we created an in vitro blood flow model in which the interactions of thrombin, Factor XIII and plasmin with fibrinogen can be studied, allowing the determination of soluble fibrin (SF), the highly unstable form of fibrin that precedes the appearance of a visible clot. This model allows the determination of the SF level at which fibrin microclots begin to form.

Microbubble-mediated adjunct treatment for cardiovascular bacterial infections

Cardiovascular bacterial infections of tissue and indwelling devices are associated with high mortality rates. Infecting bacteria encase themselves in fibrin-based biofilms that hinder the immune system and antibiotics. In this in vitro study, we investigated sonobactericide to treat these biofilms using ultrasound and microbubbles, with and without a thrombolytic agent (rt-PA). Cardiovascular-mimicking biofilms were grown using human plasma inoculated with Staphylococcus aureus from an inner heart infection. Treatment consisted of ultrasound (2 MHz, 400 kPa, 100 cycles, every second for 30 s and 1 s continuous wave) every min for 10 min, either alone or with low-dose rt-PA (158 ng/ml), microbubbles, or rt-PA and microbubbles, and was assessed by time-lapse confocal microscopy. Ultrasound-activated microbubbles bent fibrin strands (≤5.2 μm), which returned to original positions (≤25.6 s), and dislodged bacteria from fibrin encasement. Ultrasound alone did not physically alter biofilms. Oscillating microbubbles with rt-PA present led to fibrin strand bending, with and without recovery and eventual breaking, and faster fibrin degradation liberating bacterial aggregates (322 ± 161 s) than rt-PA alone (518 ± 86 s; excluding ∼45 min from rt-PA exposure until degradation began). These results demonstrate that microbubble-induced effects could aid in the treatment of cardiovascular biofilm infections.

The Effect of 5-Fluorouracil on the Adhesion Process in Patients Operated on for Colorectal Cancer

Objective:The aim of this study was to improve the direct results of reconstructive surgery in patients operated on for complicated forms of colorectal cancer, by using 5-fluorouracil in the postoperative period. Methods:The study involved 126 patients (they were divided into 2 groups) with colorectal cancer, who underwent reconstructive surgery. They underwent a standard clinical examination and a mandatory examination program. Results:The use of 5-fluorouracil in adjuvant treatment in patients with colorectal cancer significantly reduces the number of subjective clinical manifestations (positional tests) in the main group – 17%, and in the control group – 54.3%, as well as objective clinical manifestations (instrumental research methods) in Group I – 13%, and Group II – 89.5%, respectively. The study shows that in re-operated patients with colorectal cancer who received 5-fluorouracil, abdominal adhesions are characterized by a low content of collagen and fibroblasts, low vascularization and a high content of polymerized fibrin strands. It was also found that re-operated patients with colorectal cancer who did not receive 5-fluorouracil, abdominal adhesions are characterized by a high collagen content, a large number of fibroblasts, and severe angiogenesis. Conclusion:It was found that the prolonged administration of 5-fluorouracil statistically significantly reduces the risk of adhesions, thereby showing the effectiveness of preventing adhesive disease of the abdominal organs. It was shown that the prolonged administration of 5-fluorouracil significantly reduces the number of subjective and objective signs of adhesive disease of the abdominal organs, as well as significantly decreases intraoperative and postoperative complications, the duration of the operation, and the amount of blood loss. In the postoperative period, it reduces the length of hospital stay and improves the quality of life of patients.

English

BACKGROUND In the present era of automation, the quality of laboratory specimens is critical towards the delivery of accurate and useful results. The mode of collection of the sample is one such variable. Proper collection and handling of blood samples prevent erroneous results, reduce turnaround time and ensure safety of healthcare workers and patients. The study purpose is to compare open and closed systems of blood collection and the impact of closed collection system in the reduction of pre analytical errors and promoting health care worker safety. METHODS This is a prospective comparative study and it was conducted on blood samples collected in the Outpatient Department of Government Medical College, Kottayam and preanalytical study variables were assessed at Departments of Haematology and Biochemistry. At the beginning of the study, the quality and the quantity of specimen, result accuracies and healthcare safety parameters were assessed for 4778 samples using open blood collection system. This was followed by training of the phlebotomists for closed system of blood collection. The same parameters were studied for another 2508 blood samples collected via closed collection system by the same phlebotomists. The open blood collection system was carried out using non vacuum tubes (Plain and K3 EDTA), 5 ml syringe and 23G needles and closed blood collection system used BD vacutainer (K2 EDTA and serum gel tubes), Eclipse TM safety 22G needles and pronto TM reusable safety holders. The study was conducted from 01-01-2021 to 31-03-2021. RESULTS The specimen quality errors namely fibrin mass, strands, haemolysis, recentrifugation, and insufficient volume in biochemistry lab were significantly reduced with introduction of closed collection system. In haematology lab, closed collection system reduced incidence of clotted sample, insufficient volume accompanied by significant reduction in platelet and WBC differential flags. Closed collection system also reduced occurrence of blood smeared containers and blood spillage on test requisition forms, hence improving safety of health care personnel. CONCLUSIONS The study establishes a significant reduction in pre-analytical errors with closed blood collection system, prevents test cancellation and improved workflow efficiency. KEY WORDS Accuracy, Blood Collection Systems, Errors, Phlebotomist, Preanalytical, Spillage, Variables.

Optimizing fibrin hydrogel toward effective neural progenitor cell delivery in spinal cord injury

Transplantation of neural progenitor cell (NPC) possessing the potential to differentiate into neurons may guard against spinal cord injury (SCI)- associated neuronal trauma. We propose that autologous-like NPC may reduce post-transplant immune response. The study used the rat SCI model to prove this concept. For isolation and expansion of rat NPC for cell-based SCI therapy, the in vitro protocol standardized with human NPC seemed suitable. The primary aim of this study is to select a cell/neural tissue-compatible biomaterial for improving NPC survival in vivo. The composition of the fibrin hydrogel is adjusted to obtain degradable, porous, and robust fibrin strands for supporting neural cell attachment, migration, and tissue regeneration. This study employed NPC culture to evaluate the cytocompatibility and suitability of the hydrogel, composed by adding graded concentrations of thrombin to a fixed fibrinogen concentration. The microstructure evaluation by scanning electron microscope guided the selection of a suitable composition for delivering the embedded cells. On adding more thrombin, fibrinogen clotted quickly but reduced porosity, pore size, and fiber strand thickness. The high activity of thrombin also affected NPC morphology and the in vitro cell survival. The selected hydrogel carried viable NPC and retained them at the injury site post-transplantation. The fibrin hydrogel played a protective role throughout the transfer process by providing cell attachment sites and survival signals. The fibrin and NPC together regulated the immune response at the SCI site reducing ED1+ve/ED2+ve macrophages in the early period of 8–16 d after injury. Migration of β-III tubulin+ve neural-like cells into the fibrin-injected control SCI is evident. The continuous use of a non-neurotoxic fibrin matrix could be a convenient strategy for in vitro NPC preparation, minimally invasive cell delivery, and better transplantation outcome.

INTRODUCING EXHALED HUMAN BREATH WATER VAPOR AS PROPOSED MECHANISM INFLUENCING SUPERFICIAL CUTANEOUS WOUND HEALING

The concept that moist wounds heal faster than dry wounds was introduced in 1962. Most recently, in 1990 the concept was revisited with the introduction of a highly permeable wound dressing exposed to water vapors. The latter allows for water as a humidifying agent. Ideally, acceleration of superficial wound healing had been accomplished by the introduction of a highly water vapor permeable wound dressing. The breathable property allows for water vapor to interact with already present fibrin(ogen) material in blood clots. This manuscript adds a mechanism for the ultimate undisturbed success in cutaneous wound healing, being the dependency on a continuos supply of water vapor. In vitro experiments are introduced showing the cessation of exhaled human breath vapor onto a dry human blood smear as the end point of said interaction. Additionally the experiments were reproduced by exposing the blood smears to steam (water vapor) generated by machinery. In conclusion, exhaled human breath water vapor blown onto a blood clot has the same effect as water vapor emitted by machinery boiling water. Both causing a disappearance of the clot organized fibrin strands into a semisolid gelatinous state. Additionally, discontinuation of the water vapor infusion is also documented triggering a return of organized fibrin strands, albeit of greater intensity.