Fibrin Research Articles

Effect of increased renal pelvis pressure on the kidney of young pigs

Objective To study what impact the elevated intrarenal pelvic pressure (IPP) may have on the childhood kidney. Methods The childhood Guizhou miniature pigs were taken as the subjects and the elevated IPP animal models were established. The IPP pressure was set at levels of 0, 30, 60, 90 mmHg (1 mmHg=0.133 kPa). After the contrast agent was administered intravenously, the left renal cortical microvasculature blood perfusion was measured using contrast-enhanced ultrasonography (CEUS) at each pressure level respectively for 5 minutes. The retrograde pyelography by CEUS was performed at each pressure level for 5 minutes on the same side after the renal cortical microvasculature blood perfusion measurement. Finally the left kidney specimens were sent for pathology. Statistical study was performed on the cortical microvasculature perfusion difference between the various IPP level of 0, 30, 60, 90 mmHg. Results In the 10 repetitions, analysis of variance suggested the Peak intensity (PI) under 4 IPP levels was not all the same statistically (F=58.947, P 0.05); AS for PI, there was statistical difference between the 60 mmHg level and 0 mmHg level (t=5.332, P<0.01). The PI between 0 mmHg level and 90 mmHg level was different statistically (t=10.507, P<0.01). Rank sum test showed that the area under curve (AUC) under four IPP levels was statistically different (χ2=28.876, P<0.01). Compared with AUC under 0 mmHg level, the AUC under 30, 60, 90 mmHg level was statistically different respectively. AS for AUC, there was statistical difference between 0 mmHg and 30 mmHg (Z=-2.497, P<0.05). there was statistical difference between the 60 mmHg level and 0 mmHg level (Z=-2.701, P<0.05). The AUC between 0 mmHg level and 90 mmHg level was different statistically (Z=-2.803, P<0.05). Both the PI and the AUC indicated that the renal blood flow decreased rapidly with the increase of IPP. The retrograde pyelography by CEUS suggested the contrast agent penetrated into the cortex in 60% of subjects, which turned out to be the cortex lacerations in cortex by pathology. The pathology showed fibrin exudation in the Bowman capsule in 70% of specimens. However, all the gross examination for the kidneys suggested no overt rupture. Conclusion Before obvious gross damage emerge the elevated IPP has impacted the kidney microscopically, physiological and pathologically. The hidden injury should be noticed by the clinical staff especially for the young children. Key words: Nephrolith; Intrarenal pelvic pressure; Kidney injury

Effects of Platelet Rich Fibrin on Full Thickness Skin Grafts in the Rat Model-Planimetry Results.

Platelets play a crucial role in wound healing as they are reservoirs of growth factors and cytokines which play a fundamental role in homeostasis and tissue remodeling. Recently, fields such as dermatology and plastic and reconstructive surgery have become interested in the tissue regenerative properties of these compounds, especially since it promotes wound healing, improves scar outcomes and has rejuvenating effects on the skin and other tissues. We evaluated the effects of Platelet Rich Fibrin (PRF) in full thickness skin graft healing. Our study included 40 male Wistar rats. Skin grafts were assessed macroscopically using planimetry. The full thickness skin grafts in the test group, displayed a lower necrosis rate compared to the control group. Our study displays the potential benefits of using Platelet Rich compounds to facilitate wound healing and integration of full thickness skin grafts.

Antithrombotic medications and their impact on fibrin clot structure and function.

Fibrin constitutes a major protein component of intravascular thrombi in all locations. Fibrin formation and its functions are essential for physiological hemostasis and the pathologic thrombosis. Formation of dense fibrin networks which are relatively resistant to lysis is observed in patients with venous or arterial thromboembolism, including myocardial infarction, ischemic stroke and venous thromboembolism. Measures of clot characteristics, in particular clot permeability and clot lysis time, may predict arterial and venous recurrent thromboembolic events. Medications, including vitamin K antagonists (VKA), direct oral anticoagulants (DOAC), and parenteral direct or indirect thrombin or activated factor X inhibitors increase clot permeability, reflecting fibrin network density, in association with enhanced efficiency of fibrinolysis. These effects are only in part related to decreased thrombin generation. There is evidence that aspirin can also favorably alter fibrin clot properties probably through acetylation of fibrinogen. No such effects were observed for P2Y12 inhibitors. Of note, plasma fibrin clot permeability has been shown to predict adverse clinical outcomes in patients receiving oral anticoagulants, which might have practical implications. The current review summarizes data on effects of antithrombotic agents on fibrin clot phenotype in cardiovascular disease.

The research and application progress of plasma D-dimer in orthopedic trauma

Venous thromboembolism is the common complication in perioperative orthopedic trauma patients. So far, the scientists have paid more attentions on biomarkers for the early diagnosis of venous thromboembolism. D-dimer is a specific degradation product of cross-linked fibrin clots and its presence in plasma is a biomarker indicating activation of coagulation and fibrinolysis, which can screen for the venous thromboembolism. Moreover, D-dimer is used to guide the anticoagulant therapy in perioperative orthopedic trauma patients and predict the extent of trauma. This review focuses on the development of orthopedic trauma and venous thromboembolism, the generation and detection of D-dimer, as well its clinical application in orthopedic trauma and the limitations. Key words: D-Dimer; Orthopedic trauma; Venous thromboembolism; Deep vein thrombosis; Pulmonary thromboembolism

A multi-center epidemiological investigation on therapeutic plasma exchange for the children with hemolytic uremic syndrome

Objective To study the current status of therapeutic plasma exchange(TPE) for the children with hemolytic uremic syndrome(HUS) in China, and to provide evidence for further standardizing the consensus of diagnosis and treatment. Methods The questionaires were designed after discussion by Pediatric Blood Purification Specialist Committee to investigate the data of 146 hospitalized HUS children with TPE, which were collected and analyzed from January 2012 to December 2017 in 22 units. Results (1)Among the 146 cases, there were 91 males and 55 females, with an average age of 5.68 years old (2 months to 18 years old). The causes included infection(41.1%, 60 cases), complement defects(12.3%, 18 cases), drugs(10.3%, 15 cases), rheumatic diseases(6.2%, 9 cases)and hereditary metabolic diseases(4.1%, 6 cases). (2)Before TPE, the main manifestations of the sick children were oliguria or anuria(101 cases), and disturbance of consciousness(45 cases), hypertension(52 cases), and gastrointestinal bleeding(42 cases), which were significantly relieved after TPE.(3)Before TPE, hemoglobin[(68.26±18.17) g/L], red blood cell count[(2.43±0.70) ×109/L], platelet count[(77.49±72.93) ×109/L], C3[(0.70±0.26) g/L], glomerular filtration rate(GFR)[(26.98±17.16) mL/1.73 m2]were all decreased, and total bilirubin[(44.33±42.07) μmol/L], unconjugated bilirubin [(30.78±26.68) μmol/L], fibrin breakdown products(FDP)[(12.52±14.97) mg/L], D-dimer[(2 306.20±2 354.97) μg/L], creatinine[(305.45±290.19) μmol/L], 24-hour urinary protein [(2.17±2.55) g/d] all increased, the above indicators were significantly improved after the TPE[ (85.08±18.98) g/L, (2.80±0.98) ×109/L, (183.80±131.95) ×109/L, (0.85±0.25) g/L, (98.58±66.02) mL/1.73 m2, (19.71±33.24) μmol/L, (9.60±10.00) μmol/L, (7.33±9.81) mg/L, (1 322.05±1 595.23) μg/L, (139.28±163.75) μmol/L, (1.46±2.03) g/d, respectively], and the differences were all statistically significant (all P<0.05). (4)Complications occurred in 5 cases, including hypotension shock (2 cases), blockage of pipe (1 case), thrombocytopenia (1 case), anemia (1 case). (5)After TPE, 130 cases (89%) were significantly effective, but 16 cases (11%) died. Conclusions TPE for children with HUS has been widely carried out in China, and its effectiveness and safety had been confirmed.The timing of treatment is further confirmed by evidence-based medicine. Key words: Hemolytic uremic syndrome; Therapeutic plasma exchange; Child; Epidemiology

Nasal chondrocyte-based tissue engineering therapy for articular cartilage repair in a rat model

Objective To explore the effect of nasal chondrocytes combined with fibrin glue as tissue engineering cartilage for repairing full thick articular cartilage defect in a rat model. Methods Nasal chondrocytes were combined with fibrin glue for rat cartilage repair. There are three groups: nasal chondrocytes+ fibrin (NC+ Fibrin) group; Fibrin group; Defect group. At 6 and 12 weeks after surgery, Catwalk, gross observation, histological evaluation were conducted to evaluate the cartilage repair effects. Results 1, 3, 6, 12 weeks after surgery, the Catwalk results revealed that rats in NC+ Fibrin group can obtain a better recovery limb fuction in a shorter time. Gross observation and histological evaluation reveals that NC+ Fibrin group led to hyaline-like cartilage repair. While the other two groups generally led to fibrocartilage repair (P=0.018). Conclusion These findings indicate that the nasal chondrocytes can repair rat full thick articular cartilage successfully. Key words: Chondrocytes; Fibrin glue; Cartilage tissue engineering; Articular cartilage repair

Effects of fibrin glue on prevention of bleeding after endoscopic submucosal dissection: a randomized controlled trial

Objective To study the utility of fibrin glue on prevention of bleeding after endoscopic submucosal dissection (ESD). Methods Consecutive patients with gastrointestinal tumors who underwent ESD between July 2015 and June 2016 in the First Affiliated Hospital of Nanjing Medical University were enrolled in the study. The patients receiving ESD before December 31, 2015 were assigned into the fibrin glue group, and patients receiving ESD after December 31, 2015 were assigned into the control group. The fibrin glue group was sprayed with fibrin glue on wound followed by routine hemostasis method, and the control group was given routine hemostasis method only. The bleeding rate after ESD, mean hospital stays and cost were compared between the two groups. Results The bleeding rate after ESD in the fibrin glue group was significantly lower than that in the control group[7.45% (12/161) VS 14.79% (25/169), P=0.035]. There was no significantly difference in the mean hospital stays (9.09±2.65 days VS 9.20±2.99 days, P=0.744) and mean cost (24 246±5 519 yuan VS 25 214±6 258 yuan, P=0.138) between the two groups. Multivariate analysis revealed that the use of fibrin glue was a protective factor for bleeding after ESD. Conclusion Fibrin glue is safe, effective and economical in prevention of bleeding after ESD. Key words: Digestive system neoplasms; Fibrin glue; Endoscopic submucosal dissection; Postoperative hemorrhage

Application of tranexamic acid in pre-hospital emergency care of patients with craniocerebral trauma

Objective To investigate the feasibility and clinical effect of tranexamic acid in pre-hospital emergency care of patients with craniocerebral trauma. Methods A randomized, placebo controlled trial was carried out on 77 craniocerebral trauma patients [Glasgow Coma Scale (GCS) ≤12 points] enrolled between May 2015 and December 2016. There were 45 males and 32 females, with an average age of 36.5 years (range, 19-73 years). Among the patients, 37 cases were caused by traffic accidents, 19 falling from high places, 11 falling when walking, and ten by being hit. According to the random number table method, they were divided into control group (39 cases) and treatment group (38 cases). The treatment group received 1 g of tranexamic acid by intravenous injection within ten minutes on the scene and another 1 g of tranexamic acid within eight hours at the hospital. The control group received 0.9% isotonic saline. The operation and medication followed the routine process. The arrival time of ambulance and the time of first medication use were recorded. The plasma fibrin degradation products (FDP) and D-dimer at admission and 1 d post-trauma, the percentage of cranitomy operation, case fatality rate, red blood cell transfusion, length of stay in the neurosurgical intensive care unit (NICU), and the Glasgow Outcome Scale (GOS) at day 28 were all recorded and analyzed. Results No significant differences were found between the two groups in gender, age, injury causes, GCS, arrival time of ambulance, and the time of first medication use (P>0.05). The FDP and D-dimer at admission of the two groups were similar (P>0.05). One day after admission, the expression of plasma FDP was significantly lower in treatment group than that in control group [6758 (4732, 13661) μg/L vs. 11740 (8516, 21756)μg/L](P 0.05). However, treatment group showed shorter stay in NICU [4 (1, 12)days vs. 2 (0, 4)days] and higher GOS [4 (3, 5)points vs. 5 (4, 5)points]than control group (both P<0.01). Conclusions Tranexamic acid can be applied conveniently in pre-hospital emergency care of craniocerebral trauma patients. It can effectively realize the synchronization of pre hospital transport and treatment, eventually reducing the time of NICU treatment as well as improving the prognosis. Key words: Brain injuries; Tranexamic acid; Emergency medical services; Prospective studies

Effect of tranexamic acid on perioperative blood loss, D-Dimer and fibrinogen in total knee arthroplasty

Objective To investigate the effects of tranexamic acid (TXA) on perioperative blood loss, D-Dimer and fibrinogen (FIB) in total knee arthroplasty (TKA). Methods A prospective study, from December 2016 to November 2017 patients with end-stage knee osteoarthritis underwent unilateral TKA were randomly divided into two groups. Patients in treatment group received two doses of 15 mg/kg TXA by intravenous infusion 1 hour pre-operation and before the release of tourniquet; the control group was replaced with the same amount of saline. The preoperative and 3 days post-operation hemoglobin, hematocrit value, drainage, blood transfusion were recorded.The D-Dimer and FIB were dynamically monitored before operation and 1, 3, 7, 14 d after the operation. And there were also observations for whether they had deep vein thrombosis and both lower limbs of all patients were examined by the color Doppler ultrasonography 14 days after operation. Results The drainage and the total blood loss in treatment group was significantly less than in control group (P 0.05). FIB at any time point between the two groups was no significant difference (P>0.05). There was no symptomatic deep venous thrombosis (DVT) in all of the three groups within 14 days. Conclusions The TXA infused intravenous can significantly decrease drainage, the total blood loss and blood transfusion without increasing risk for DVT in TKA. but early post-operation TXA could affect the level of D-dimer, thus affecting the value of early warning of DVT. Key words: Tranexamic acid/AD; Arthroplasty, replacement, knee; Blood loss, surgical; Fibrin fibrinogen degradation products/ME; Fibrinogen/ME

Research progress of the clinical hemostatic effect of heamocoagulase agkistrodon

Haemocoagulase agkistrodon for injection is a kind of protein hemostatic which is purified from snake venom of Agkistrodon acutus, the hemostatic mechanism of the drug is it that the removal of fibrinogen from fibrinogen in blood can make it into monomeric fibrin after entering the body and enhance coagulation function.Preclinical results showed that the drug can significantly shortened the time of tail bleeding in mice and coagulation time of whole blood in rabbits.Clinical studies show that the medicine has a safe and effective hemostatic effect on incision in abdominal, thyroid, department of obstetrics and gynecology, department of urology, and the hemostatic effect of thoracic incision is not obvious.In this review, the research progress on the efficacy and safety of Agkistrodon acutus thrombin in clinical hemostasis were reviewed. Key words: Snake venoms; Thrombin; Hemostasis; Review

Use of human fibrin glue versus staples for mesh fixation in laparoscopic transabdominal preperitoneal hernioplasty of inguinal hernia

Objective To evaluate the uses of human fibrin glue versus staples for mesh fixation in laparoscopic transabdominal preperitoneal (TAPP) hernioplasty of inguinal hernia as regards postoperative pain, operative time, hospital stay, morbidity, and return to work. Background Inguinal hernia is one of the commonest conditions encountered in clinical practice. This procedure is increasingly performed with laparoscopy. Many surgeons prefer to cover the hernia gap with a mesh to prevent recurrence. During laparoscopic surgery, the mesh is generally fixed with staples or tissue glue. We designed a trial that aims to determine whether mesh fixation with glue might cause less postoperative pain than fixation with staples during TAPP repair. Patients and methods Between August 2015 and August 2016, this prospective randomized study included 40 patients presented with inguinal hernia. Patients were randomized into two groups: group I mesh was fixed by fibrin glue and the group II mesh was fixed using staples. After TAPP hernioplasty, patients were followed up at 7–10 days to assess postoperative pain and within 6–12 months to detect recurrence. Results A total of 40 patients, 20 in each group, were considered. Two cases in group II presented with severe pain postoperative, while no cases presented with severe pain in group I. On the other hand, nine cases in group II had mild pain in comparison with two cases in group one and this difference was statistically significant. Conclusion There is less postoperative pain in mesh fixation with fibrin glue and less analgesia is needed after the operation compared with mesh fixation with staples.

The effects of multiple intravenous tranexamic acid administrations after total knee arthroplasty on fibrinolytic activity and inflammatory response

Objective To explore the effects of multiple intravenous tranexamic acid (IV-TXA) administrations after total knee arthroplasty (TKA) on fibrinolytic activity and inflammatory response in an enhanced recovery after surgery (ERAS) program and to assess the efficacy and safety of IV-TXA. Methods One hundred and forty-one severe knee osteoarthritis patients following primary unilateral TKA from January 2016 to April 2017 were investigated retrospectively. The patients were divided into following three groups based on the dosage of IV-TXA after surgery: 40 patients received ≤3 g IV-TXA after surgery (group T1), 50 patients received 4 g (group T2) and the other 51 patients received ≥5 g IV-TXA (group T3). The total blood loss (TBL), hidden blood loss (HBL), transfusion rate, maximum hemoglobin (Hb) drop, the incidence of intramuscular venous thrombosis, deep vein thrombosis (DVT) and pulmonary embolism (PE), fibrinolysis parameters [fibrin(-ogen) degradation products (FDP), D-dimer], and inflammation markers [C-reactive protein (CRP), interleukin-6 (IL-6)] during perioperative period were evaluated. In addition, correlation analyses between the dosage of IV-TXA and fibrinolysis parameters and inflammation markers were conducted. Results The mean TBL, HBL and maximum Hb drop in group T2 (537.16±270.43 ml, 431.36±271.99 ml, 19.68±10.68 g/L) and T3 (541.31±290.00 ml, 439.94±290.71 ml, 20.24±8.48 g/L) were lower than those in group T1 (748.22±394.34 ml, P=0.012, 0.013; 636.47±388.14 ml, P=0.011, 0.015; 25.88±11.77 g/L, P=0.005, 0.010, respectively). No patient needed transfusion in all groups. There was no statistically difference in the incidence of intramuscular venous thrombosis of lower limbs among three groups (P>0.05). No episode of DVT or PE occurred in any group in two weeks after surgery. There were negative correlation between the dosage of IV-TXA and FDP at postoperative day 1 and day 3 (r=-0.191, P=0.025; r=-0.291, P=0.001) and D-dimer on postoperative day 3 (r=-0.176, P=0.048). Moreover, the CRP (r=-0.184, P=0.036) and IL-6 (r=-0.269, P=0.002) level in serum on postoperative day 1 also showed a negative relationship with the dosage of IV-TXA after surgery. Conclusion The multiple IV-TXA (≥4 g) after surgery can further reduce the TBL, HBL and maximum Hb drop following primary TKA in ERAS program without increasing the risk of thrombotic events. Most importantly, the effect of anti-fibrinolysis will be enhanced and may have an anti-inflammatory effect with the dosage of IV-TXA increased. Key words: Tranexamic acid; Arthroplasty, replacement, knee; Fibrinolysis; Inflammation

Observation on the efficacy and labratory analysis of tear of two methods for extraction of corneal foreign body due to chestnut eye injury

Objective To investigate the efficacy and laboratory analysis of tear of two different treatment methods: fibrin glue and mechanical extraction of cornea chestnut thorn. Methods The data of 48 eyes of 48 patients with corneal foreign bodies due to chestnut eye injury were enrolled and analyzed retrospectively. Patients were randomly divided into 2 groups: fibrine glue group of 24 cases and mechanical extraction group of 24 cases. The fibrin glue group was covered with fibrin glue on the corneal surface, and the mechanical extraction group received chestnut thorn extraction under the microscope. The treatment time and the labratory analysis of tear after surgery were compared between the two groups during the healing process. Results The time of extraction of corneal foreign body was (11.5±4.0) min in the mechanical extraction group and (3.5±2.0) min in the fibrin glue group, the difference was statistically significant (t=9.771, P=0.021). The healing time of corneal epithelium was (14.5±2.1) d in the mechanical extraction group and (5.7±1.1) d in the fibrin glue group. The difference between the two groups was statistically significant (t=19.142, P=0.037). The differnce in ocular surface index, Schirmer I test and tear measuring height were statistilally significant between the two groups(all P 0.05). Corneal matrix edema subsided 1 week after surgery in fibrin glue group and corneal epithelium was healed completely, but in mechanical extraction group it was not healed, and corneal matrix edema was obvious. Conclusion The fibrin glue for the treatment of corneal foreign body caused by chestnut eye injury can reduce the operation time, beneficial to corneal healing.It is a safe and effective method. Key words: Ocular trauma; Corneal foreign body, chestnut thorn; Fibrin glue; Mechanical extraction; Labratory analysis of tear

Application value of D-dimer detection in patients with acute spontaneous subarachnoid hemorrhage

Objective To investigate the value of serum D-dimer in evaluating the severity and the prognosis of patients with acute spontaneous subrachnoid hemorrhage. Methods The clinical data of 157 patients with acute spontaneous subrachnoid hemorrhage were collected, and the level of D-dimer in elbow vein serum were measured. The severity of the disease was judged by Hunt-Hess classification, and the patients, brain CT scans were scored according to the modified Fisher scale. The patients were followed up for 3 months. Based on the modified RANKIN scale (mRS scale), patients were divided into unfavorable prognosis group (3≤mRS≤5) and good prognosis control group (1≤mRS≤2). Results In the 157 cases of spontaneous subrachnoid hemorrhage patients, there were 45 cases in the unfavorable prognosis group and 112 cases in the good prognosis control group. The level of D-dimer in the unfavorable prognosis group was significantly higher than the level of control group and there were significant differences between them (P<0.01). By the Spearman correlation analysis, the level of D-dimer was positively correlated with Hunt-Hess score (r=0.831, P<0.01), and it was also positively correlated with unfavourable prognosis mRS scale (r=0.834, P<0.01). Furthermore, regression analysis showed that high level of D-dimer was an independent risk factor for the poor prognosis of patients (OR=1.011, 95% CI: 1.007-1.016, P<0.01). Through the receiver operating characteristic curve (ROC) analysis of the D-dimer in patients with poor prognosis, the area under ROC curve was 0.964 (95% CI: 0.93-0.98, P<0.01), sensitivity and specificity were 88.9% and 99.1%, respectively. The cut-off point of D-dimer content was 739 μg/L. Conclusions The level of D-di-mer in patients with acute spontaneous subrachnoid hemorrhage was closely related to the severity of the diseases, and high level of D-dimer was an independent risk factor for the prognosis of patients. Key words: Fibrin fibrinogen degradation products/ME; Subarachnoid hemorrhage/ME/TH; Prognosis

Investigation and analysis of hemodialysis blood tubing vein pot particle formation and related factors

Objective To investigate the composition of particulate matter in hemodialysis and to explore the influencing factors of particulate matter formation. Methods The composition of the particles was determined by chemical experiments and electron microscopy. Fifty-four outpatients in hemodialysis centers were divided into pellets and non - particulate groups (34 and 20 cases). Thirty-four variables were collected by literature review and their influencing factors were analyzed. Results The particles were white thrombus, formed by aggregated platelets and fibrin aggregates, and embedded in a small amount of red blood cells. Logistic regression analysis showed that low molecular weight heparin was statistically significant (OR = 1.001, P <0.01). In addition, male, smoking, dry weight, hypersensitive C-reactive protein, venous pressure, dialysate temperature, blood vessel thrombosis and granule formation were statistically significant (P < 0.05). Conclusions To improve the degree of attention to white thrombosis, the injection of low molecular weight heparin sodium into the machine before the vascular access intravenous injection, for the analysis of the results to take appropriate care measures to reduce the production of white thrombosis is important, and can be white thrombosis. The repeated formation is seen as a sign of blood vessel thrombosis Key words: Hemodialysis; Particulate matter; Intravenous pot; White thrombus; Scanning electron microscope

Clinical value of human acellular dermal matrix in reconstruction of giant complex abdominal wall defects after open abdomen

Objective To explore the clinical value of human acellular dermal matrix (HADM) in giant complex abdominal wall reconstruction (GCAWR) after open abdomen. Methods The retrospective cross-sectional study was conducted. The clinical data of 6 patients with severe trauma who were admitted to the Nanjing General Hospital of Nanjing Military Command of Nanjing University School of Medicine between January 2013 and January 2014 were collected. After open abdomen, fascia of the abdominal wall was fully freed using the component separation, and abdominal wall defects were reconstructed using HADM in the rectus abdominis anterior sheath and peritoneal layers bridge-type suture. Observation indicators: (1) intra- and post-operative situations: operation time, volume of intraoperative blood loss, removal time of postoperative drainage-tube, postoperative com-plications, duration of hospital stay and hospital expenses; (2) follow-up situations: recurrence of abdominal wall hernia at postoperative year 2. Follow-up using outpatient examination and telephone interview was performed to detect the recurrence of abdominal wall hernia up to April 2016. Measurement data with normal distribution were represented as ±s. Results (1) Intra- and post-operative situations: 6 patients underwent successful surgery. Operation time, volume of intraoperative blood loss and removal time of postoperative drainage-tube were respectively (77±9)minutes, (225±57)mL and (8±3)days. Two patients with postoperative seroma were cured by conservative treatment. One patient with postoperative anastomotic leakage received continuously irrigation and drainage, and leakage was stopped using the biomedical fibrin glue. There was no abdominal bulge of the 6 patients in hospital. Duration of hospital stay and hospital expenses were respectively (10±3)days and (12±7)×104 yuan. (2) Followup situations: 6 patients were followed up for 14-28 months, with a median time of 23 months. Two patients had relaxation and bulge of HADM in peritoneal layer at postoperative 2 years, without bulge of HADM in the rectus abdominis anterior sheath layer. There were no occurrence of abdominal wall hernia, chronic pain, paraesthesia, swelling in the local area and other adverse reaction. Conclusion Using of HADM in the rectus abdominis anterior sheath and peritoneal layers bridgetype suture is safe and feasible for GCAWR, with good short-term outcomes. Key words: Complex abdominal wall defect; Open abdomen; Human acellular dermal matrix

Is Tenecteplase the Preferred Thrombolytic Agent for Acute Ischemic Stroke

Alteplase is currently the only FDA-approved thrombolytic medication for acute stroke. Tenecteplase is a bioengineered compound with greater fibrin

Effect on Postpartum Hemorrhage of Prophylactic Oxytocin

Objective: To analyze the effects of postpartum prophylactic use of oxytocin on reducing the incidence of postpartum hemorrhage. Methods: 220 cases of maternal patients admitted in our hospital from December 2015 to December 2016 were selected as the subjects. According to the random number table method, the control group and the observation group were divided into 110 cases respectively. Control group was given intravenous injection of 20U oxytocin after fetal delivery to prevent postpartum hemorrhage; observation group was given intravenous injection of combination oxytocin and misoprostol for prevention of postpartum hemorrhage. The levels of serum calcium, D-dimer, fibrin (FIB), postpartum hemorrhage at 2, 24 hours and the duration of the third stage of labor were compared between the two groups. The adverse reactions and complications of the two groups were compared, to evaluate the efficacy and safety of misoprostol combined with oxytocin to prevent postpartum hemorrhage. Results: There was no significant difference in blood calcium level between the two groups after delivery (P> 0.05). The D-dimer in the observation group was lower than that in the control group, the FIB level of observation group was also higher than that of the control group, and the difference was significant (P 0.05). Conclusion: Oxytocin combined with misoprostol can reduce maternal postpartum hemorrhage, worthy of clinical promotion.

Surgery of the pterygium with fibrin glue: A clinical study in Nigeria

Aims: To assess (i) the efficacy of conjunctival autograft with fibrin glue in the management of pterygium, (ii) graft-related complications and (iii) recurrence rates over a 6-month follow-up period. Settings and Design: The study was conducted at the Orbit Thelish Eye Hospital in joint association with Dr. Agarwal Eye Hospital, Kaduna, Nigeria. This prospective study included 30 consecutive patients who underwent surgery of the pterygium using conjunctival autograft with fibrin glue by a single surgeon between August 2015 and July 2016. Inclusion criteria were primary pterygium and recurrent pterygium. Exclusion criteria were pseudopterygium, moderate-to-severe dry eye and patients with lid deformity. Materials and Methods: A total of 30 eyes with primary nasal pterygium were subjected to conjunctival autograft surgery that used fibrin glue. The outcome of surgery was noted on the 1st day, 1st week, 1st month, 3rd month and 6th month. Parameters analysed were subjective symptoms, refraction, graft status and recurrence. Statistical analysis used included the following: Student t-test and Fisher’s exact test. Results: The mean age of the patients was 43.7 years. The time of surgery was 15–20 min. During the postoperative course, 60% of the patients felt pain initialy and 25% had an initial sensation of a mild foreign body, which almost subsided in 1 week. No sutures were used. Only one case of pterygium regrowth was noted. Conclusion: Our findings demonstrate the safety and efficacy of Tissucol Duo® (Baxter AG, Vienna, Austria) as a conjunctival adhesive for autograft surgery of the pterygium. Because of its fast and easy application, this product considerably reduces the time of surgery and avoids complications derived from sutures in the eye following surgery.

Effect of polycaprolactone-ascobic acid scaffold in repairing articular cartilage defects in rabbits

To investigate the effect of polycaprolactone-ascobic acid (PCL-AA) scaffolds in promoting repair of articular cartilage defects in a rabbit model. The cartilage defects (3.5 mm in diameter and 3.0 mm in depth) were created in the trochlear groove of the bilateral knees of eight 6-month-old male New Zealand white rabbits. The rabbit models were then randomized into 3 groups to receive implantation of PCL-AA scaffolds (group A, n=8), implantation of PCL scaffolds without AA (group B, n=5), or no treatment (group C, n=3). In groups A and B, the mixture of fibrin gel (10 µg) and thrombinogen (10 µg) was injected into the defects to fix the scaffolds during the surgery. Histological analyses and quantitative assessments of defect repair were conducted at 6 and 12 weeks after implantation of the scaffold. At 6 weeks after scaffold implantation, macroscopic observation showed better filling of the cartilage defects in group A than in group B, while no obvious defect repair was observed in group C. The rabbits in group A showed a significant improvement of the Wakitani score than those in group B (4.05∓1.11 vs 7.05∓0.98, P<0.05). HE staining revealed the presence of newly generated cells in and around the PCL-AA scaffolds without inflammatory cells. Safranin O staining showed a significantly greater ECM of the newly regenerated tissue in groups A and B than in group C (P<0.05), and the volume of the regenerated cartilage and cells was significantly greater in group A than in group B (P<0.05). Samples harvested at 12 weeks showed more hyalione-like cartilage formation than that at 6 weeks in group A. PCL-AA scaffolds have a good biocompatibility and promotes the healing of articular cartilage defects. Adding ascorbic acid into PCL scaffolds better promotes cartilage formation in terms of both quantity and quality of the regenerated tissues. PCL-AA scaffolds can serve as a promising biomaterial to promote the regeneration of articular cartilage using tissue engineering techniques.