High Coagulation Research Articles

Sex Metabolic Differences and Effects on Blood Coagulation Among Rats Exposed to Sodium Dehydroacetate.

Sodium dehydroacetate (Na-DHA), a fungicide used in food, feed, cosmetics, and medicine, has been found to cause coagulation aberration accompanied by the inhibition of vitamin K epoxide reductase (VKOR) in the liver in rats. VKOR complex 1 (VKORC1) and VKORC1 like-1 (VKORC1L1) are two homologous VKOR proteins. Little information is available on the effect of Na-DHA on VKORC1L1 in the liver or VKORC1/VKORC1L1 in extrahepatic tissue and sex differences in Na-DHA metabolism. In the present study, after administration of 200 mg/kg Na-DHA by gavage, significant inhibition of VKORC1 or VKORC1L1 expression in tissues, as well as prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT), were observed. The PT/APTT in the Na-DHA-exposed males were 1.27- to 1.48-fold/1.17- to 1.37-fold, while the corresponding values in the Na-DHA-exposed females were 1.36- to 2.02-fold/1.20- to 1.70-fold. Serum or tissue Na-DHA concentrations were significantly higher in females than in males. The pharmacokinetic parameters (t1/2, Cmax, AUC0∼24 h, and MRT0∼24 h) of Na-DHA in female rats were significantly higher than those in male rats. Furthermore, cytochrome P450 (CYP) activity was investigated using the cocktail probe method. The results revealed that Na-DHA exhibited an inductive effect on CYP1A2, 2D1/2, and 3A1/2 activities by changing the main pharmacokinetic parameters of probe drugs in male rats. However, no significant change in CYP2E1 activity was found. There were sex differences in the metabolism and coagulation in rats exposed to Na-DHA. The lower metabolism and higher blood Na-DHA concentration in females may be the reasons for higher coagulation sensitivity in female rats.

Association Between Thrombogenicity Indices and Coronary Microvascular Dysfunction in Patients With Acute Myocardial Infarction

The association between thrombogenicity and coronary microvascular dysfunction (CMD) has been poorly explored in patients with acute myocardial infarction (AMI). In our real-world clinical practice (N=116), thrombogenicity was evaluated with thromboelastography and conventional hemostatic measures, and CMD was defined as index of microcirculatory resistance of >40 U using the invasive physiologic test. High platelet-fibrin clot strength (P-FCS) (≥68mm) significantly increased the risk of postprocedural CMD (odds ratio: 4.35; 95%CI: 1.74-10.89). Patients with both CMD and high P-FCS had a higher rate of ischemic events compared to non-CMD subjects with low P-FCS (odds ratio: 5.58; 95%CI: 1.31-23.68). This study showed a close association between heightened thrombogenicity and CMD and their prognostic implications after reperfusion in acute myocardial infarction patients.

Global Thrombosis Test: Occlusion by Coagulation or SIPA?

The global thrombosis test (GTT) is a point of care device that tests thrombotic and thrombolytic status. The device exposes whole blood flow to a combination of both high and low shear stress past and between ball bearings potentially causing thrombin and fibrin formation. The question arises as to whether thrombosis in the GTT is dominated by coagulation-triggered red clot or high shear-induced white clot. We investigated the nature of the thrombus formed in the GTT, the device efficacy, human factors use, and limitations. The GTT formed clots that were histologically fibrin-rich with trapped red blood cells. The occlusion time (OT) was more consistent with coagulation than high shear white clot and was strongly lengthened by heparin and citrate, two common anticoagulants. The clot was lysed by tissue plasminogen activator (tPA), also consistent with a fibrin-rich red clot. Changing the bead to a collagen-coated surface and eliminating the low shear zone between the beads induced a rapid OT consistent with a platelet-rich thrombus that was relatively resistant to heparin or tPA. The evidence points to the GTT as occluding primarily due to fibrin-rich red clot from coagulation rather than high shear platelet aggregation and occlusion associated with arterial thrombosis.

Evaluation of Sysmex Fully Automated CS Series Coagulation Analyzer at a Tertiary Care Hospital

INTRODUCTIONThe Sysmex CS coagulation series system is a high performance coagulation station that allow laboratories to perform routine and specialized testing including platelet function tests on the same platform. The CS is equipped with an optical fiber that supplies light at five wavelengths (multiwavelength detection) that simultaneously measure multiple parameters using clotting, chromogenic, immunoassay and aggregation methods. It has clot curve analysis feature.AIMS & OBJECTIVES : The aim of the present study was to evaluate the performance of the instrument as per the lab's current & future needs. The tests performed were routine coagulation (PT, APT, TT, fibrinogen, factor VIII, Lupus Anticoagulant), chromogenic (Innovance antithrombin III and Berichrom Protein C) and immunologic assays (Innovance Free Protien S). Additionally, the operational performance of the Sysmex CS- 2000i System was compared with the existing automated coagulation analyzer Sysmex CA-530.MATERIALS & METHODS :Sample collection and Preparation Blood collected in 3.2% sodium citrate vacutainers (BD) were centrifuged for 10 min at 3000g to prepare platelet poor plasma (PPP). Multiple coagulation assays were done on a total of 642 patient samples to evaluate the system. The number of tests done for different routine and specialized assays are as follows: PT (597);APTT-FS (555);APTT-FSL (545);TT (297);Fibrinogen (165);Factor VIII (23);Bethesda assay (2); Protein C (65); Free Protein S Ag(60);ATIII (76); LA1(23); LA2 (14). All assays were performed according to the manufacturers' specifications and standard laboratory methods. RESULTS1.Precision for PT,APTT was found to be <1% whereas for fibrinogen it was within 5%.(Table 1)2.Accuracy for PT,fibrinogen,AT III and factor VIII was performed and found close to the target values. (Table 2)3.Biological reference intervals were established for PT,APTT(FS,FSL),TT,LA1 and LA2. (Table 3)4.Mixing Study was carried out for a sample when a patient's PT, APTT, TT and LA were prolonged and outside the upper limit of reference range. This was done to determine the cause of prolongation in correlation with the clinical history. The mixing studies results helped clinicians to make decision regarding factor deficiencies and circulating inhibitors.5.Linearity: 21mg/dl for fibrinogen and 0.9% for factor VIII lowest limit of detection (LOD) was obtained.(Figures 1 & 2). The CS analyzer can save upto 10 calibration curves for each of the parameters viz fibrinogen,factor VIII, free protein S, Protein C, ATIII.6.Free Protein S, Protein C activity and ATIII assays were performed on CS-2000i to investigate the possibility of thrombotic disorders. The calibrators and controls were found to be within acceptable limits.7. We assessed the ability of CS-2000i to perform the platelet aggregation and examine the effect of agonist ADP at different concentrations (Figure 3). We intend to perform Plt Agg with the other agonists to enable diagnosis of platelet function defects.8. The results of the study between the CS-2000i and CA- 530 were correlated and the results are shown for PT, APTT, and Fibrinogen in Figures 4, 5 & 6. CONCLUSIONS1. The analytical performance for routine and specialized assays on CS-2000i was compared to that of Sysmex CA-530 using the same Siemens reagents on both systems. The agreement between the two systems was excellent.2.It has cap-piercing technology which supports clinical and workflow excellence by helping to prevent sample contamination and deliver accurate results.3.Platelet aggregation can be performed on CS-2000i along with routine and other specialized coagulation assays thus avoiding the requirement of procuring a separate platelet aggregometer.4.Sysmex CS analyzer showed good precision, accuracy, linearity and provided faster turn around time. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Potential utility of callus proteases as a milk clotting alternative to naturally propagated Wrightia tinctoria proteases

This study was intended to understand suitability of Wrightia tinctoria calli proteases (CCE) as vegetable coagulant through delineating their milk clotting potential and casein (whole and κ-casein) hydrolysis pattern in comparison to their plant stem crude enzyme (PSCE), rennin and Enzeco® (positive controls). Stem calli was induced using two concentrations of naphthalene acetic acid (NAA) [0.5 mg/L (M1), 1 mg/L (M2)] with fixed concentration (1 mg/L) of 6-benzylaminopurine (BAP). Healthy calli, with significant growth at the end of 14th, 28th, and 48th days, were chosen for enzyme extraction. Overall activity calculated as per gram of fresh weight of callus revealed 3-fold high milk clotting index (MCI) by 28th day CCE in comparison to PSCE (p < 0.5). 14th day CCE mimicked rennin, 28th day CCE partially mimicked rennin and Enzeco® in their casein hydrolytic pattern. 28th day CCE however exhibited a closer similarity to rennin in its κ- casein hydrolytic pattern. 48th day CCE (M1) presented high MCA, however, with low MCI in comparison to other CCEs. High affinity toward caseins similar to that of Enzeco® was observed from 48th day CCE. Results from this study indicate 28th day callus protease may serve as a prospective vegetable milk coagulant alternative.

Theoretical and experimental investigation of phosphate removal from seawater by multi-stage coagulation

Abstract Phosphate removal from seawater is important for biofouling control on RO membranes because phosphorus is one of the nutrients for microbial growth. This paper is based on the hypothesis that multi-stage coagulation results in better phosphate removal. Therefore, comparison of phosphate removal with one-step and three-step dose coagulation from the aspects of both the theoretical calculation and experimental results is investigated in this paper. The result of theoretical calculation based on the Freundlich equation shows that the final phosphate concentration from a three-step dose, i.e. 0.43 μgP/L, is ten times lower than that from a one-step dose, i.e. 4.47 μgP/L. The experimental result shows that for the three-step dose, final phosphate concentration is 1.0 μgP/L, which is lower than for the one-step dose (i.e. 4.0 μgP/L), but not as low as the theoretical calculated value (0.43 μgP/L). This discrepancy between theoretical calculation and experimental result may be the impact of equilibrium phosphate concentration, different initial Fe:P molar ratio and NOM competition between one-step dose and three-step dose coagulation. Although this discrepancy exists, the experimental results still showed that multi-stage coagulation presented better phosphate removal in seawater to concentration levels that are lower than with conventional coagulation. In other words, the problem of the high coagulant dosage in the pretreatment process while removing phosphate from seawater may be solved by application of multi-stage coagulation instead of conventional coagulation.

Nejayote biopolyelectrolytes multifunctionality (glucurono ferulauted arabinoxylans) in the separation of hazardous metal ions from industrial wastewater

The scarcity and contamination of water by suspended nanoparticles and hazardous metal ions demand more performant technologies to reduce space, time and cost of wastewater treatment. For example, it is desirable to find eco-friendly chemicals that warranty simultaneous separation of colloidal particles and hazardous metallic contaminants for a more sustainable recovery of water quality.As the second part of a series of physicochemical studies about multifunctional biopolyelectrolytes (BPEs), in this paper, we present three of the main features of the glucurono ferulauted arabinoxylans (GFAXs) from nejayote: simple extraction, physicochemical characterization and multifunctional performance when used in a wastewater treatment unit. The polyelectrolytic and macrochelating properties of the GFAXs were studied through zeta potential measurements to predict and understand the multifunctional performance of GFAXs in a conventional coagulation-flocculation unitary operation. Two real cases were approached: the wastewater from silicon wafer cutting process (SWCP) and the wastewater from electroplating baths (EPB). Nejayote GFAXs showed high coagulant, flocculant and macrochelating activity in the simultaneous separation of Si4+, Al3+, Cr3+, Ni2+, Mg2+, Ca2+, Ni2+, Cd2+, Pb2+, Cu2+, Zn2+ and Fe2+. The water treatment tests demonstrate the high performance of the GFAXs in the coagulation-flocculation of the wastewater according to the following parameters: EPB wastewater at pH = 5.0 (optimal dose = 55–65 mg GFAXs/L, clarification = 380 T%/h and sedimentation kinetics = 110.4 mm/h); SWCP wastewater at pH = 5.5 (optimal dose = 30.0–32.5 mg GFAXs/L, clarification = 295 T%/h and sedimentation kinetics = 89.4 mm/h). With these results, nejayote GFAXs showed to be a sustainable solution for the wastewater treatment from semiconductor and metal finishing industry with high content of hazardous metal ions and SiO2 nanoparticles.

Binary coagulation system (graphene oxide/chitosan) for polluted surface water treatment

In this study, chitosan (CS) is used as a natural coagulant aid alongside graphene oxide (GO) to remove turbidity and numerous pollutants from raw and artificially contaminated surface water. The coagulation capability of the system (GO/CS) was assessed with respect to a water sample's turbidity, pH, coagulant dose, settling velocity, and temperature. The presence of CS enhanced the coagulation capacity of GO at varied pH levels and no GO residue was detected in the water after the treatment. The proposed system achieved high turbidity removal efficiency (≥98.3%) for all turbidity levels. A mixture of GO (8 mg/L) and CS (2 mg/L) was ideal to remove algae (99.5%) and bacteria (≥95.0%). Furthermore, it demonstrated a high coagulation capacity to remove dyes, direct brown-2 (DB-2), methylene blue (MB), and Pb(II) ions from artificially contaminated surface water. Interestingly, the sludge exhibited an extraordinary adsorption capacity for DB-2, MB, and Pb(II) ions. The adsorption process followed the pseudo-second-order kinetic model, and was consistent with the Langmuir model, with an adsorption capacity of up to 667.8, 400.7, and 459.1 mg/g for DB-2, MB, and Pb(II) ions, respectively. Therefore, the presented binary coagulation system is of great potential economic value for the treatment of raw surface water and wastewater.

Mitigating Electrode Fouling in Electrocoagulation by Means of Polarity Reversal: The Effects of Electrode Type, Current Density, and Polarity Reversal Frequency

One of the biggest issues in electrocoagulation (EC) water treatment processes is electrode fouling, which can cause decreased coagulant production, increased ohmic resistance and energy consumption, and reduced contaminant removal efficiency, among other operational problems. While it has been suggested that switching the current direction intermittently (i.e., polarity reversal, PR) can help mitigate electrode fouling, conflicting results about the utility of this approach have been reported in the literature. The objective of this study was to systematically investigate the effects of PR frequency and current density on the performance of Fe-EC and Al-EC. It was found that operating Fe-EC under the PR mode reduced neither electrode fouling nor energy consumption. Notably, the Faradaic efficiency (ϕ) in Fe-EC decreased with increasing PR frequency; ϕ was as low as 10% when a PR frequency of 0.5 minutes was employed. Unlike Fe-EC, operating Al-EC under the PR mode resulted in high coagulant production efficiencies, reduced energy consumption, and diminished electrode fouling. In addition to comparing PR-EC and DC-EC, a novel strategy to minimize electrode fouling was investigated. This strategy involved operating Fe DC-EC and Al DC-EC with a Ti-IrO2 cathode, whose fouling by Ca- and Mg-containing minerals could be readily avoided by periodically switching the current direction.

Pre-aggregation of Al13 in optimizing coagulation for removal of humic acid

The effective removal of humic acid (HA) by coagulation has been extensively investigated for water treatments. However, the limitations of pH variation and excessive residual aluminum issues were still factors needed to be considered. In this study, to investigate the coagulation mechanism for removing HA by Al13 and optimize Al13 operation for removing HA, Al13 and preformed Al13 aggregates (Al13agg) were applied to remove HA at different pH conditions. The results showed that preformed Al13agg exhibited superior HA removal performance than Al13 due to its wide pH range and low residual Al level. During coagulation, Al13 and Al13agg interacted with HA in their original status, but the DSlope325-375 difference implied that the complexation capacity between HA and Al13agg was stronger than Al13. The new peaks of HPSEC representing larger molecular weight substances were formed under acidic and neutral conditions, which indicated that HA firstly aggregated into larger complexed molecules by interacting with Al13 or its hydrolysates and was subsequently removed by forming large flocs which was completely different from Al13agg situation. Therefore, the different coagulation mechanisms played the roles in HA removal for Al13 and Al13agg which were studied in this paper. It was believed that the complexation and charge neutralization effects dominated coagulation process for Al13 while sweep flocculation and adsorption coagulation were main driving force for Al13agg in HA removing. This work provides significant understanding of HA removal by Al13 and Al13agg coagulation, which can help to design and optimize the high efficiency coagulant based on Al polycations.

Abstract P360: Clot Burden Score and Collateral Score: Emerging Predictors of Outcome

Introduction: With the recent advancement, there are still large number of stroke patients who end up with poor outcome despite getting thrombectomy. Clot extent, location, and collateral integrity are found to be important determinants of outcome in acute stroke. The CBS is a scoring system (0-10) to define the extent of thrombus on CTA. The collateral grading system is scored on a scale of 0-3 on CTA. The purpose of this study is to compare the relationship of clot extent and collaterals with clinical and radiological outcome. Hypothesis: A novel clot burden score (CBS) and collateral score (CS) are important determinants of outcomes and serve as useful additional stroke outcome predictors. Methods: One hundred and twenty eight stroke patients with large vessel occlusion who underwent endovascular thrombectomy in our institution were reviewed retrospectively. CBS and CS were calculated on CTA by a neuroradiologist and a vascular neurologist and reached a consensus who were blinded about clinical information. Patients were dichotomized using collateral scores as good (&gt;/=2) vs bad collaterals (0-1). Univariate and multivariate analysis is performed. Results: A total of 128 patients included in the study. Poor collateral is found to be associated with prior history of Afib (47% vs 32%) whereas smoking is found to be associated with good collaterals (38% vs 29%). Low CBS (higher clot burden) is associated more with poor collaterals (70% vs 46%). Poor collateral is associated with higher inhouse mortality (23% vs 9%) and increase number of patients with mRS of 5-6 at 3 months (42% vs 21%). Revascularization rate TICI 2b-3 is not found to be significantly associated with the degree of collaterals (93% with good collaterals whereas 78% in poor collaterals) Conclusions: CBS and CS are useful additional markers predicting clinical and radiologic outcomes and could be potentially used clinically as an adjunct to other imaging and clinical features to stratify patient risk better.

Rotational thromboelastometry (ROTEM) profiling of COVID–19 patients

We evaluated coagulation abnormalities via traditional tests and rotational thromboelastometry (ROTEM) in a group of 94 patients with confirmed SARS-CoV-2 infection and different severity of pneumonia (34 moderate, 25 severe, 35 critical) with the hypothesis that ROTEM parameters differed by coronavirus disease 2019 (COVID-19) severity. Shorter than normal clotting time (CT) and higher than normal maximum clot firmness (MCF) in extrinsic rotational thromboelastometry (EXTEM) and fibrinogen rotational thromboelastometry (FIBTEM), shorter than normal EXTEM clot formation time (CFT), and higher than normal α-angle were classified as markers of hypercoagulable state. Increment in the number of patients with ≥2 hypercoagulable parameters, higher EXTEM (P = .0001), FIBTEM MCF (P = .0001) and maximum lysis decrement (P = .002) with increment in disease severity was observed (P = .0001). Significant positive correlations between IL6 and CT EXTEM (P = .003), MCF EXTEM (P = .033), MCF FIBTEM (P = .01), and negative with ML EXTEM (P = .006) were seen. Our findings based on analysis of different disease severity groups confirmed that a hypercoagulable ROTEM pattern characterized by clot formation acceleration, high clot strength, and reduced fibrinolysis was more frequent in advanced disease groups and patients with high IL6. These results supported the need for different thromboprophylaxis approaches for different severity groups.

Experimental investigation of microalgal harvesting with low cost bottom ash: Influence of temperature and pH with zeta potential and thermodynamic function

This study was aimed at harvesting of microalgae, Chlorella pyrenoidosa, by using Bottom ash (BA). Utilization of an inexpensive and an easily available BA as a flocculant can be the alternative solution for reducing the harvesting cost of the microalgae and on the other side best way to utilize the unused waste from coal based thermal power plants. Herein, aimed flocculation process was evaluated and optimized through the statistical method, response surface methodology (RSM) with Box Behnken Design (BBD). Optimized conditions for harvesting were found to be best with BA concentration of 100 mgL−1, temperature (50 ºC), pH (6.5), and incubation time (60 min) for achieving a maximum yield of 97.9%. The results obtained indicated that BA is a promising flocculant that requires low dose, temperature, and time for a high coagulation and agglomeration of the microalgae. BA is a cost effective and an environmentally friendly flocculant that could neutralize the Zeta potential (ζ) of surface charge of the microalgal cell surface. The morphological changes of microalgae were also analyzed on various temperatures with scanning electron microscopy (SEM), and elemental composition on surface by energy dispersive X-ray spectroscopy (EDS) images with and without flocculant.

BHCNet: Neural Network-Based Brain Hemorrhage Classification Using Head CT Scan

Brain Hemorrhage is the eruption of the brain arteries due to high blood pressure or blood clotting that could be a cause of traumatic injury or death. It is the medical emergency in which a doctor also need years of experience to immediately diagnose the region of the internal bleeding before starting the treatment. In this study, the deep learning models Convolutional Neural Network (CNN), hybrid models CNN + LSTM and CNN + GRU are proposed for the Brain Hemorrhage classification. The 200 head CT scan images dataset is used to boost the accuracy rate and computational power of the deep learning models. The major aim of this study is to use the abstraction power of deep learning on a set of fewer images because in most crucial cases extensive datasets are not available on the spot. The image augmentation and imbalancing the dataset methods are adopted with CNN model to design a unique architecture and named as Brain Hemorrhage Classification based on Neural Network (BHCNet). The performance of the proposed approach are analyzed in terms of accuracy, precision, sensitivity, specificity and F1-score. Further, the experimental results are evaluated by comparative analyses of the balanced and imbalanced dataset with CNN, CNN + LSTM and CNN + GRU models. The promising results are achieved with CNN by imbalancing the dataset and gain highest accuracy that outperforms the hybrid CNN + LSTM and CNN + GRU models. The results reveals the effectiveness of the proposed model for accurate prediction to save the life of the patient in the meantime and fast employment in the real life scenario.

Delicacy Management on Kiloton Dry Wet Spinning Bath Liquid

During the dry-jet wet spinning process of polyacrylonitrile carbon fiber precursor, the fluctuation of the coagulation bath liquid level affects the stability of the nozzle directly. The motion trajectory and the motion intensity in all directions of the fluid during the movement of the fiber in the coagulation bath fluid field were studied. A three-dimensional model of the cross flow and jet collision motion trajectory was established, and the impact of fluids with different strengths on the surface of the coagulation bath was analyzed. Solidification of the liquid surface in the fitting strength of the peak effect of the return wave overflow trough coupled superimposed to determine the coagulation bath surface to eliminate interfering fluctuations affecting factors. Based on the above analysis, a smart device for real-time monitoring of the coagulation bath air layer has been developed by using the damping equipment in the coagulation bath, where the impact of various fluid waves on the liquid surface can be eliminated on fixed point or position. According to the understanding of kiloton dry-jet wet spinning precursor fiber production line, in-depth exploration has been made to control the high dynamic coagulation bath level effectively from the perspective of technology and delicacy management.

Efficiency and Mechanism of Advanced Treatment for Phosphate Wastewater by High Efficiency and Low Consumption Coagulation and Phosphorus Removal System

Beaker coagulation experiments were carried out using polyaluminium chloride (PAC), polyferric sulfate (FPS), polyacrylamide (PAM), polyaluminum chloride (PAFC), polyaluminum sulfate (PAFS) and polyacrylamide (PAFC). The phosphorus removal effects of several flocculants were compared. The best combination coagulant PAM-PAC/PFS with high efficiency and economy was selected. The best ratio of PAC/PFS is 1:1, and the dosage of PAM is 1mg/L. The experiment determined the optimal hydraulic conditions: fast agitation and addition of PAC/PFS at a speed of 400 r/min for 1 min. PAM was added during slow agitation at a speed of 100 r/min for 6 min. The phosphorus removal system has a good effect on the removal of total phosphorus and other water quality indicators in the mine drainage of many phosphate mines, and all of them can meet the discharge standards.

Characteristics of psychiatric manifestations among hospitalized COVID-19 patients and their correlation with disease severity - a cross sectional study.

COVID-19 severity, characteristics of psychiatric symptoms using a brief psychiatric rating scale, and sociodemographic variables were explored and evaluated. An exploratory study was conducted during the COVID-19 pandemic, from July 13th to July 26th 2020, in an isolation facility at the COVID-designated Sola hospital in Ahmedabad, India. A total of 201 inpatients diagnosed with COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) were included in this study. We assessed the presence and severity of psychiatric symptoms using the Brief Psychiatric Rating Scale (BPRS). Of the 201 COVID-19 patients, 63 (31.3%), 36 (18%), 16 (8%) and 14 (7%) experienced anxiety, tension, somatic concern and depressed mood respectively. The effect of the severity of COVID-19 on the mean of the total BPRS score was statistically signi- ficant (F = 17.2, p = 0.000). In the severe COVID-19 group, the mean of the total BPRS score (22.6 ± 4.8) was significantly higher than in the moderate (20.3 ± 4.0) and mild (19.1 ± 2.2) COVID-19 groups. High levels of serum ferritin, IL-6 and D-dimer were associated with the presence of neuropsychiatric symptoms like hallucinatory behavior and disorientation. The majority of COVID-19 patients experienced anxiety, tension and somatic concern. The presence of serious psy- chiatric symptoms like hallucinatory behavior and disorientation were predominantly seen in severe COVID-19 patients with signi- ficantly high serum inflammation and coagulation markers.

Microsurgical Embolectomy in the Current Era of Pharmacological and Mechanical (Endovascular) Thrombolysis-A Reappraisal.

Microsurgical embolectomy though is the oldest known recanalization technique is being dismissed in favor of the latest mechanical endovascular techniques for the management of acute large vessel occlusion. We aim to highlight the role of microsurgical embolectomy in the current era of pharmacological and mechanical (endovascular) thrombolysis. An outline of the microsurgical embolectomy technique is described along with its current indications, advantages, and disadvantages. It carries higher complete (TICI 3) revascularization rates with lower risk of distal embolic events especially in cases with high clot burdens; but is more labor-intensive and has longer reperfusion time in comparison to endovascular methods along with the requirement of highly skilled neurovascular surgeons to perform it quickly. Microsurgical embolectomy is an important indispensable recanalization technique in the armamentarium of vascular neurosurgeons.

Procoagulant factor levels and risk of venous thrombosis in the elderly

Unlabelled Box AbstractBackgroundVenous thrombosis (VT) incidence increases markedly with age. Coagulation factors are also positively associated with age. ObjectiveTo study whether higher levels of coagulation factors II (prothrombin), VIII, IX, and XI are associated with risk of a first VT in the elderly. MethodsFour hundred and one patients and 431 control subjects aged 70 and older were included in the Age and Thrombosis, Acquired and Genetic risk factors in the Elderly (AT‐AGE) study. Blood was collected 1 year after the event in patients and in all control subjects for measurement of coagulation factors. To assess the risk of VT, odds ratios (ORs) were calculated after stratification of coagulation factors in quartiles and at the 90th percentile, adjusting for potential confounders (age, sex, body mass index, and study center). ResultsMean age was 78 years (range: 70‐100 years). The ORs of VT for factors in the top quartile compared with the lowest quartile were 4.5 (95% confidence interval [CI]:2.7‐7.3) for factor VIII, 2.4 (95% CI:1.1‐5.2) for factor IX, and 1.7 (95% CI:1.0‐2.9) for factor XI. High prothrombin was not associated with an increased VT risk. There was no dose‐response association between the number of high coagulation factors and VT risk. The population attributable risk (PAR) of VT was 37.6%, 23.3%, and 12.4% for factor VIII, IX, and XI, respectively. ConclusionIn this study of the elderly, higher factors VIII, IX, and XI but not prothrombin, were positively associated with the risk of VT.

Particle size measurement of electronic cigarette aerosol with a cascade impactor

Measuring the aerosol particle size of electronic cigarettes can be particularly challenging due to the volatile and dynamic nature of these aerosols. In particular, electronic cigarette aerosol particle size measurements may be convoluted by evaporation due to the high dilution ratios and coagulation when there are long residence times between sampling and measurement. To address these measurement issues, we have developed a particle size measurement system using a low flow cascade impactor with a sampling system that is capable of generating a puff on an e-cigarette and directly introducing the aerosol into the inlet flow of the impactor. The system has been used to investigate factors that may affect the aerosol size distribution, including puffing conditions, carrier composition and device construction. It was found that decreasing the puff flow rate from 2 to 0.5 L/min at a constant puff duration of 5 s, the mass median aerodynamic diameter (MMAD) of the aerosol size distribution increased from 0.5 to 1.1 µm. Increasing the mass delivery from 0.67 to 6 mg/5 s puff also resulted in increasing MMAD from 0.48 to 0.87 µm. Furthermore, the addition of a small amount of glycerin (1% by weight) to a propylene glycol based flavor formulation caused a decrease in the MMAD, while the other factors studied did not have a significant effect on the MMAD.Copyright © 2020 American Association for Aerosol Research