Prothrombin Time Research Articles

Analysis of risk factors for bleeding as a complication of ultrasound-guided percutaneous liver biopsy examination

Objective: To explore the independent risk factors for bleeding in patients following percutaneous liver biopsy examination. Methods: The clinicopathological data of patients who underwent percutaneous liver biopsy examination at Nanjing Second Hospital from January 2012 to December 2021 were retrospectively collected. Univariate and multivariate logistic regression analysis were used to investigate the effect of age, gender, lesion type (diffuse liver parenchymal lesions, focal liver lesions), number of biopsies, tissue length, presence or absence of cirrhosis, presence or absence of portosystemic shunt, erythrocytes, white blood cells, hemoglobin, platelets, prothrombin time, fibrinogen, international normalized ratio, and liver biochemical indicators on bleeding following liver biopsy, as well as to screen independent risk factors. Results: A total of 3 331 patients were examined by percutaneous liver biopsy, and 3 060 cases were actually included by excluding 271 cases who took consultation from other hospitals. The overall postoperative hemorrhagic rate was 1.6% (49/3 060). Of which, forty-four cases (1.4%) had overt bleeding (hemodynamic changes or hemoglobin decreased by more than 20 g/L), five cases (0.2%) had minor bleeding, three cases had subcapsular hepatic hemaotma, and two cases had local bleeding from liver biopsy. Among the overt bleeding cases, two cases were in the off-label group (platelet<50×109/L or international normalized ratio>1.5), and the rest were in the non-off-label group. The results of univariate analysis showed that factors such as focal liver lesions, portosystemic shunt, prolonged prothrombin time, increased international normalized ratio, bilirubin, and alkaline phosphatase were associated with bleeding after liver biopsy in the non-off-label group. The multivariate collinearity diagnosis revealed statistically significant differences for the indicators. Multivariate logistic regression analysis finally included factors such as lesion type, portosystemic shunt, international normalized ratio, total bilirubin, and alkaline phosphatase. The results showed that patients with focal liver lesions were more prone to bleed after surgery than patients with diffuse liver parenchymal lesions (OR=3.396, P=0.002, 95%CI: 1.596-7.228). Patients with portosystemic shunt were more prone to bleed than those without portosystemic shunt (OR=3.301, P=0.018, 95%CI: 1.232-8.845). Patients were more likely to experience bleeding following liver biopsy when their total bilirubin levels were elevated (OR=1.006, P<0.001, 95%CI:1.003-1.008). Conclusion: Focal liver lesions, portosystemic shunts, and elevated total bilirubin are independent risk factors for bleeding after percutaneous liver biopsy.

Anticoagulant Effect of Snow mountain garlic: In Vitro Evaluation of Aqueous Extract.

Snow mountain garlic is traditionally eaten by Himalayan locals for its medicinal properties. Although different species of the genus Allium are known to have other biological effects, such as antiplatelet and antithrombotic activities, little is known about the anticoagulant effect of Snow mountain garlic, a member of the genus Allium. Therefore, the present study examined the in vitro anticoagulant effect of the aqueous extract, the lyophilized aqueous extract, and the isoflavone extract from the lyophilized aqueous extract of Snow mountain garlic in samples from 50 human blood donors. Compared to the control, concentrations of 25, 12.5, and 6.25 mg/100 µL lengthened the clotting times of prothrombin, and concentrations of 25 and 12.5 mg/100 µL lengthened the activated partial thromboplastin time (p ˂ 0.05). The isoflavone extract from the lyophilized aqueous extract containing isoflavones, organosulfur compounds, a polyphenol, and a steroid glycoside showed a significant effect (p ˂ 0.05) on the prothrombin time and the activated partial thromboplastin time at a dose of 20 µL (volume) compared to the control. The results regarding the use of Snow mountain garlic as a preventive measure and aid in treating thromboembolic disease are promising.

Comparison of Different Prognostic Scoring Systems in Predicting the Severity and Outcome in Alcoholic Hepatitis in Indian Patients

Abstract Introduction: Alcohol abuse causes a variety of liver diseases including alcoholic steatosis, alcoholic hepatitis (AH), liver fibrosis, cirrhosis, and hepatocellular carcinoma. AH is a clinical syndrome which typically occurs after the harmful use of alcohol. There are mild forms that are likely to improve with conservative management, whereas severe cases are associated with a high mortality rate and have a high risk of death despite treatment. The identification of severe AH is important, as this can be associated with 30%–50% short-term mortality. Existing prognostic scores have been validated in the western population, and the data of application in the Indian population are scant. Materials and Methods: It is a prospective observational study conducted for 2 years at Tertiary Care Hospital Army Hospital (Research and Referral) Delhi. The sample size was kept to be 45. For each patient, clinical and laboratory values were obtained on the day of admission and used to calculate the prognostic models according to their formulas. The various scores – Maddrey’s discriminant function (mDF), Glasgow AH score (GAHS), age, bilirubin, international normalized ratio (INR), creatinine score, and model of end-stage liver disease (MELD) including its modification MELD-sodium were calculated. For patients started on steroids, early changes in bilirubin level and Lille score were calculated. Results: All the prognostic scores were found to be good predictors of mortality. When compared with each other, MELD was most indicative of mortality with maximum area under the receiver operating characteristic curve. All the scores were significantly higher in the nonsurvivors than the survivors (P &lt; 0.0001). Conclusion: AH is a clinical syndrome that occurs after the harmful use of alcohol and confers a high mortality. Effective treatment and support for patients with AH is dependent on a proper assessment of the disease severity and estimation of the risk of death as early in the course of the disease as possible.

Safety and efficacy of plasmapheresis in treatment of acute fatty liver of pregnancy-a systematic review and meta-analysis.

Acute fatty liver of pregnancy (AFLP) is a fatal disease occurring in 3rd trimester. The safety and efficacy of plasmapheresis/plasma exchange (PP/PE) as an adjunctive treatment in patients of AFLP has been studied. We performed systematic review and meta-analysis to estimate the clinical parameters that included mortality rates and improvement of the biochemical parameters including Liver and Renal function enzymes, coagulopathy factors of AFLP patients. We searched PubMed, Ovid MEDLINE, Cochrane, CINAHL and Scopus, ClinicalTrials.gov. RevMan statistical software was used for meta-analysis. Pooled survival proportion for AFLP patients treated with PP/PE was 87.74% (95% CI: 82.84 to 91.65). Efficacy of PP/PE was studied by its effect on mortality. PE/PP was associated with the reduction in the mortality with pooled odds ratio of 0.51 (95% CI: 0.08 to 3.09) with I2 = 86%. Sensitivity analysis after excluding outlier study, yielded a pooled odds ratio of 0.19 (95% CI: 0.02 to 1.52) with reduced heterogeneity (I2 = 63%). Biochemical parameter analysis demonstrated significant improvement post-PP/PE treatment, including decreased bilirubin (MD: 8.30, 95% CI: 6.75 to 9.84), AST (MD: 107.25, 95% CI: 52.45 to 162.06), ALT (MD: 111.08, 95% CI: 27.18 to 194.97), creatinine (MD: 1.66, 95% CI: 1.39 to 1.93), and Prothrombin time (MD: 5.08, 95% CI: 2.93 to 7.22). Despite some heterogeneity, PP/PE shows promise in improving biochemical parameters in AFLP patients. PE can serve as a therapeutic approach for AFLP particularly in severe or refractory cases. PE provides the time for organ to recover and helps in creating a homeostatic environment for liver. Large RCTs and propensity matched studies are needed to better understand the safety and efficacy of the treatment. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315698.

Comparison of Characteristics and Outcomes of Hepatitis B and Hepatitis C Patients in the Fars Hepatitis Registry

Background: Hepatitis, which refers to liver inflammation, can have various causes, with viral hepatitis being the most common. Objectives: This study aimed to compare demographic and laboratory variables, risk factors, and outcomes between Hepatitis B (HBV) and Hepatitis C (HCV) patients in the Fars hepatitis registry. Methods: In this cross-sectional study, a total of 6,690 eligible patients, consisting of 3,840 (57.4%) with HBV and 2,820 (42.6%) with HCV, were assessed from the database covering the period from 1995 to 2023. Comparisons between HBV and HCV were made using the Chi-square test, Fisher's exact test, or independent sample t-test with SPSS software. Results: The average age of the patients was 52.56 years (standard deviation: 13.24). Significant differences were found between HBV and HCV patients regarding sex, marital status, education level, family history of HBV and HCV, smoking status, drug use, and body mass index (P &lt; 0.001 for all). Hepatitis B patients had a higher prevalence of dental procedures (P &lt; 0.001) and uncertain sexual contacts (P = 0.009), while blood transfusion, intravenous drug use, major thalassemia (P &lt; 0.001 for all), tattoos (P = 0.004), and hemodialysis (P = 0.001) were more common in HCV patients. Hepatitis C patients showed higher levels of liver enzymes (P &lt; 0.001) and total bilirubin (P = 0.002) but lower levels of albumin (P &lt; 0.001) and prothrombin time (P = 0.034) compared to HBV patients. Cirrhosis was also more common in HCV patients (P &lt; 0.001). Conclusions: Our findings highlight different patterns of demographic factors, risk factors, and outcomes between HBV and HCV patients, which could influence their prevention and management strategies.

Management of high dose olanzapine poisoning in a young child under limited resource setting: a case report from Nepal

Introduction: Olanzapine, an atypical antipsychotic, is widely used for treating psychiatric conditions such as schizophrenia and bipolar disorder. Accidental overdose in children is rare but can lead to severe clinical effects. This case report discusses the management of a five-year-old male who accidently ingested 180 mg of olanzapine, the highest reported dose in a child under five years. Case Presentation: A five-year-old boy accidentally ingested 180 mg of Olanzapine, resulting in loss of consciousness and central nervous system depression. He exhibited hyperglycemia, elevated lactate, and prolonged prothrombin time, but no significant cardiovascular issues. Following intubation and supportive care, including intravenous medications and mechanical ventilation, the child gradually improved. He was discharged in stable condition with follow-up instructions. Discussion: Olanzapine toxicity in children presents with a variety of symptoms, including somnolence, hypotension, and neurological impairments, which are dose-dependent. Even in case of an exceptionally high overdose, the absence of cardiovascular toxicity supports safety profile of olanzapine. Common laboratory findings include hyperglycemia, elevated liver enzymes, and metabolic disturbances. Management involves airway protection, supportive care, and monitoring, as no specific antidote exists. Prompt and appropriate care, even in severe cases under limited resource settings, can lead to favorable outcomes. Conclusion: In cases of high dose accidental olanzapine poisoning in children, it is essential to begin quick intervention and comprehensive supportive care to achieve successful outcomes and can be managed even in limited resource settings. Preventive measures are crucial to avoid such incidents and careful monitoring is essential in managing pediatric olanzapine overdose.

Estimation of Gestational Age-Specific Reference Intervals for Coagulation Assays in a Neonatal Intensive Care Unit Using Real-World Clinical Data

Abstract Interpretation of coagulation testing in neonates currently relies on reference intervals defined from adult cohorts. These likely do not reflect the normative values for neonates, in whom immature synthesis of vitamin K-dependent factors may contribute to this divergence. Direct reference interval estimation studies are difficult, particularly in neonatal populations; however, advances in indirect estimation may allow us to infer normative distributions from routinely collected clinical data. To accomplish this, initial coagulation testing results from all patients admitted to a level IV neonatal intensive care unit between 1/1/2018 - 1/1/2023 were extracted from the electronic health record and analyzed. Results prior to June 2021 were performed on the viscosity-based STA Compact Max (Diagnostica Stago. Parsippany, NJ, USA). Afterward, results were performed on a nephelometry-based ACL Top (Instrumentation Laboratory. Bedford, MA, USA). Specimens collected after transfusion of blood products were excluded. Prothrombin times (PT) and international normalized ratios (INR) were available for 1,117 neonates, while activated partial thromboplastin times (aPTT) were available for 790 neonates. The 95% confidence intervals (CI) of the median PT for extremely preterm, very preterm, preterm and term neonates were [19 - 21s], [18 - 22s], [17 - 19s] and [17 - 18s]. For INR, the CI were [1.6 - 1.8], [1.5 - 1.8], [1.4 - 1.6], and [1.4 - 1.5]. For aPTT, the CI were [51 - 61s], [47 - 58s], [45 - 50s], and [42 - 46s]. Indirect reference intervals (IRIs) were then estimated across gestational age groups (binning all patients delivered at less than 37 weeks into one preterm category) using refineR. The IRI for PT was 10 - 24s for preterm,10 - 22s for term, and 10 - 24s for all neonates. The IRI for INR was 0.7 - 2.1 for preterm, 0.8 - 1.8 for term, and 0.8 - 1.9 for all neonates. The IRI for aPTT was 24.5 - 68.4s for preterm, 24.7 - 58.2s for term, and 25 - 62.3s for all neonates. When compared to currently reported reference intervals, the lower limits of the IRI were similar to currently reported reference intervals; however, the upper limits of the IRIs were 1.3 - 1.8 times higher than current reference intervals. Theoretically, implementation of these IRIs would lead to a 3-fold decrease in the number of results flagged as abnormal. In conclusion, IRIs for coagulation assays estimated from neonates using routine clinical data show substantial divergence from current reference intervals in their upper limits, possibly due to the decreased factor concentrations seen prior to liver maturation. If implemented, these IRIs would substantially reduce the proportion of abnormal results. Future work will explore whether switching to these reference intervals could lead to a reduction in unnecessary transfusions or improved clinical outcomes.

Crashing into Discovery: Nesidioblastosis in Adult, Unmasked post-Motor Vehicle Accident - A Case Study and Literature Review

Abstract Introduction/Objective Nesidioblastosis, characterized by pancreatic duct-derived B-islet cell proliferation, typically manifests with hypoglycemic symptoms. While more common in newborns, it can rarely affect adults. Here, we report an incidental finding of nesidioblastosis in a 37-year-old female following abdominal trauma due to a motor vehicle crash (MVC). Methods/Case Report A 37-year-old female with no notable medical history presented with blunt abdominal trauma following an MVC. The emergency evaluation revealed a grade 4 traumatic splenic laceration and severe hemoperitoneum. Preoperative lab results showed decreased hemoglobin, elevated white cell count, prolonged prothrombin time, and reduced calcium and magnesium levels. The patient underwent a splenectomy along with a distal pancreatectomy. While grossly unremarkable, microscopic examination revealed maintained acinar architecture with focal hyperplasia around pancreatic ducts. Enlarged acinar cells with pleomorphic nuclei and prominent nucleoli were consistent with focal nesidioblastosis. Results (if a Case Study enter NA) NA Conclusion Multiple studies have documented the first reported case of nesidioblastosis in adults was in 1975. While its exact incidence is uncertain, most sources suggest a relative frequency of 0.5 – 7% of persistent hyperinsulinemic hypoglycemia, with estimated overall an annual rate of around 9 per 100,000, with a higher occurrence among females. This unusual incidental discovery of nesidioblastosis in an asymptomatic patient undergoing pancreatic resection for unrelated reasons highlights the likelihood of underestimating the actual prevalence of this disease.

Machine learning-based prediction of mortality in acute myocardial infarction with cardiogenic shock.

In the ICU, patients with acute myocardial infarction and cardiogenic shock (AMI-CS) often face high mortality rates, making timely and precise mortality risk prediction crucial for clinical decision-making. Despite existing models, machine learning algorithms hold the potential for improved predictive accuracy. In this study, a predictive model was developed using the MIMIC-IV database, with external validation performed on the eICU-CRD database. We included ICU patients diagnosed with AMI-CS. Feature selection was conducted using the Boruta algorithm, followed by the construction and comparison of four machine learning models: Logistic Regression (LR), eXtreme Gradient Boosting (XGBoost), Adaptive Boosting (AdaBoost), and Gaussian Naive Bayes (GNB). Model performance was evaluated based on metrics such as AUC (Area Under the Curve), accuracy, sensitivity, specificity, and so on. The SHAP method was employed to visualize and interpret the importance of model features. Finally, we constructed an online prediction model and conducted external validation in the eICU-CRD database. In this study, a total of 570 and 391 patients with AMI-CS were included from the MIMIC-IV and eICU-CRD databases, respectively. Among all machine learning algorithms evaluated, LR exhibited the best performance with a validation set AUC of 0.841(XGBoost: 0.835, AdaBoost: 0.839, GNB: 0.826). The model incorporated five variables: prothrombin time, blood urea nitrogen, age, beta-blockers and Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers. SHAP plots are employed to visualize the importance of model features and to interpret the results. An online prediction tool was developed, externally validated with the eICU-CRD database, achieving an AUC of 0.755. Employing the LR algorithm, we developed a predictive model for assessing the mortality risk among AMI-CS patients in the ICU setting. Through model predictions, this facilitates early detection of high-risk individuals, ensures judicious allocation of healthcare resources.

The Association of Serum Fibrinogen Levels With the Severity of Primary Postpartum Hemorrhage: A Prospective Study.

Postpartum hemorrhage (PPH) remains a major cause of maternal mortality and morbidity worldwide. Coagulation disorders are a major risk factor for PPH that have not been studied adequately. Fibrinogen, a plasma glycoprotein, is integral to hemostasis and is involved in the final process of the coagulation cascade. Fibrinogen levels increase with advancing pregnancy probably because of an increase in estrogen levels and reach a peak (~5g/L) in the third trimester of pregnancy. However, in the postpartum period, the fibrinogen concentration shows a decreasing trend. The purpose of the study was to study the serum fibrinogen levelin patients with PPH and to find its association with the severity of primary postpartum hemorrhage. Methodology: Patients were selected according to inclusion and exclusion criteria. Written and informed consents were taken. Routine investigations were done on admission and special investigations like red blood cell count, prothrombin time, international normalized ratio,activated partial thromboplastin time, and serum fibrinogen were done later when the patient developed PPH. Serial samples of all PPH patients for serum fibrinogen levels at0, 1, 2, 4, and 24 hours were taken to study the serum fibrinogen levels and data were analyzed. Result: The mean fibrinogen level on admission was 3.92 ± 0.92 g/lin non-severe PPH and 2.03 ± 0.97 g/l in the severe PPH group.Fibrinogen levels in the non-severe group remained < 4.46 g/l at 0, 1, 2, 4, and 24 hours. In the severe group, fibrinogen levels were < 2.89 g/l at 0, 1, 2, and 4 hours and it was 2.44 ± 1.06g/l in the 24-hour samples. Statistical significance was found in all the fibrinogen values among the two study groups (p = 0.001). Our results showed that zero-hour fibrinogen levels correlate significantly with the aggravation of PPH and levels <2 g/L can serve as a predictor for progression to severe PPH.

Association Between Cerebral Microbleeds and Neurological Outcomes in Patients Who Underwent Extracorporeal Membrane Oxygenation.

Cerebral microbleeds (CMBs) are common and varied in patients receiving extracorporeal membrane oxygenation (ECMO). Here, the authors describe CMB findings in patients receiving ECMO and their association with clinical factors. A total of 138 patients receiving ECMO were enrolled and categorized as venovenous and venoarterial. Blood coagulation profiles during ECMO support and Glasgow Coma Scale (GCS) scores within 7 days were recorded. Patients with CMBs exhibited prolonged activated clotting time (P<0.001), decreased fibrinogen levels (P<0.001), reduced platelet counts (P<0.001), and extended prothrombin time (P<0.001). A significant correlation (P<0.05) was observed between the presence of CMBs and most coagulation parameters among all patients. Patients with venoarterial ECMO had significantly higher activated partial thromboplastin time, activated clotting time, and prothrombin time compared with those with venovenous ECMO (all P<0.05). Patients with a less severe CMB burden exhibited higher GCS scores and better neurological injury outcomes at both 7 and 90 days. CMB burden in all patients with ECMO was significantly correlated (P<0.05) with most blood coagulation profiles and neurological injury. CMB burdens after ECMO are common, varied, and associated with a variety of clinical conditions. These findings may guide ECMO management.

Efficacy and Safety of Ticagrelor Monotherapy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Retrospective Study

Background: Dual antiplatelet therapy (DAPT) is the standard treatment for percutaneous coronary intervention (PCI), but its optimal duration is controversial. Ticagrelor monotherapy has obvious advantages in reducing the bleeding risk, so this study investigated its efficacy and safety. Objective: The objective of this study was to explore the efficacy and safety of administering ticagrelor monotherapy to patients with acute coronary syndrome (ACS) undergoing PCI. Methods: This retrospective study chose 110 patients with ACS undergoing PCI from January 2022 to April 2024. In accordance with different antiplatelet therapy methods, 58 patients received DAPT of ticagrelor and aspirin, and 54 cases were included in the control group (CG) after excluding 4 cases. Meanwhile, 52 cases received ticagrelor monotherapy after 3 months of DAPT, and 49 cases were classified as the observation group (OG) after excluding 3 cases. The platelet inhibition rates, platelet aggregation functions, and adverse events before and after treatment were compared. Results: Intergroup comparison showed no significant difference in adenosine diphosphate-induced platelet inhibition rates 3 months (T1) and 6 months (T2) after operation (p = 0.129, 0.137), and the inhibition rate in OG was significantly lower than that in CG 12 months (T3) after operation (p &lt; 0.001). At T1, T2, and T3, no significant difference in fibrinogen and prothrombin time was found (p = 0.112, 0.751, 0.590, 0.771, 0.109, 0.121). After 12-month follow-up, intergroup comparison revealed no significant difference in the incidence of ischemic events (OG vs. CG: 4.08% vs. 9.26%; p = 0.515) and a significantly lower incidence of bleeding events in OG than in CG (OG vs. CG: 4.08% vs. 18.52%; p = 0.023). Conclusion: Administering ticagrelor monotherapy after short-term DAPT (three months) to patients with ACS undergoing PCI effectively controlled the platelet inhibition rate, reduced bleeding events, and did not increase the risk of ischemic events.

Clinical predictors of warfarin-associated bleeding: A case-control study.

Despite the advent of directly acting oral anticoagulants, warfarin is still widely used in resource-poor settings. Bleeding as a result of warfarin overdosage is common and risk factors seem to vary between patient populations. Predictors of bleeding in patients using warfarin were studied using a case-control design. We calculated the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol (HAS-BLED) score (a bleeding risk prediction tool). Cases chosen were adults prescribed warfarin presenting with bleeding and controls were likewise taking warfarin but had no bleeding in the previous six months. The most common indication for warfarin use was venous thromboembolism. Recent decrease in food intake was strongly associated with bleeding. Older age, higher warfarin doses, recent illness in the past fortnight and prior bleeding were also independent predictors. A higher HAS-BLED score was not predictive independently. Closer monitoring of international normalised ratio is therefore advisable during acute illnesses and in those with decreased food intake.

Treatment of malignant primary cardiac tumors requires attention to cardiovascular complications: a single-center, retrospective study.

Malignant primary cardiac tumors require multimodal approaches including surgery, chemotherapy and radiotherapy, but these treatments can be associated with cardiovascular complications. However, few reports have described the cardiovascular complications related to primary cardiac tumor treatment because of their rarity. Clinical records of patients with primary cardiac tumors treated at Kyushu University Hospital from January 2010 to August 2021 were retrospectively examined. Of the 47 primary cardiac tumor patients, 13 (28%) were diagnosed with malignancy, including 5 angiosarcomas, 3 intimal sarcomas, 3 diffuse large B-cell lymphomas, 1 Ewing's sarcoma and 1 fibrosarcoma. Cardiovascular events were observed in 10 patients (77%), including cardiac dysfunction in 6 patients, arrhythmias in 5 patients, right heart failure in 2 patients, and excessively prolonged prothrombin time due to the combination of warfarin and chemotherapy in 1 patient. Two patients who showed notable cardiac complications are described. Case A involved a 69-year-old woman who underwent surgery for a left atrial intimal sarcoma, followed by postoperative chemotherapy with doxorubicin plus ifosfamide and radiotherapy. After three cycles of chemotherapy and sequential radiotherapy, her left ventricular ejection fraction decreased to 34%, and ongoing heart failure therapy was required. Case B involved a 66-year-old man who received chemotherapy for primary cardiac lymphoma, resulting in tumor shrinkage. However, due to tumor involvement of the intraventricular septum, atrioventricular block developed, requiring cardiac pacemaker implantation. High incidences of cardiac failure and arrhythmias were observed during multimodal treatments for malignant primary cardiac tumors. Proper management of complications may lead to a favorable prognosis in patients with malignant primary cardiac tumors.

Effects of 60 degrees of flexion and perioperative use of tranexamic acid on recovery after knee replacement

Abstract OBJECTIVE To explore the effect of 60 knee flexion combined with multiple tranexamic acid application on postoperative recovery of knee replacement patients. METHODS Knee replacement patients admitted to our hospital from October 2020 to September 2022 were selected as the study subjects, and randomly divided into two groups. Postoperative D-dimer, prothrombin time and partial thrombin time were recorded in the two groups, and the differences between the two groups were compared. Erythrocyte, hemoglobin and erythrocyte volume were recorded before, 1 day and 3 days after surgery and the affected limb circumference were also assessed. RESULTS On the 1st and 3rd day after surgery, the red blood cells, hemoglobin, and hematocrit levels in the experimental group were higher than those in the control group, and the differences were statistically significant(P&amp;lt;0.05). The difference in VAS score and circumference between the two groups on the 1st day and 3rd day after surgery was compared, and the difference was statistically significant. The difference in VAS score and circumference was lower in the control group(P&amp;lt;0.05). After surgical treatment, knee joint function recovered, knee joint mobility and HSS score improved, and the difference between the experimental groups was statistically significant (P&amp;lt;0.05). CONCLUSION Perioperative 60-degree flexion combined with multiple tranexamic acids can significantly reduce blood loss in patients undergoing knee replacement surgery, increase red blood cells, hemoglobin levels and red blood cell volume on postoperative days 1 and 3, and reduce postoperative swelling of the affected limb.

Structural characteristics and biological evaluation of copper coating cotton material obtained by chemical reduction method

The article describes the preparation of new cotton materials obtained by chemical deposition of copper sulfide. This two-stage process consists of chelation of copper sulfate on cellulose chains of cotton (COT → COT-CuSO4) with subsequent precipitation of copper in the form of copper sulfide (COT-CuSO4 → COT-CuS) using sodium sulfide. The obtained COT-CuS composites were characterized physicobiologically. Thus, the structural characteristic of the Cotton-CuS material was determined by microscopy analysis (SEM), Atomic Absorption Spectrometry with Flame Excitation (FAAS), specific surface area and total pore volume analysis (BET). The copper functionalized cotton fabric was subjected to microbial activity tests against colonies of Gram-negative (Escherichia coli) and Gram-positive ( Staphylococcus aureus) bacteria and Chaetomium globosum, Aspergillus niger fungal molds species. Biochemical evaluation includes hematological tests of activated partial thromboplastin time (aPTT) and prothrombin time (PT). The substantial antimicrobial properties of the newly synthesized COT-CuS material with the lack of influence on blood coagulation processes offer prospects of a potential use as applications as an antibacterial/antifungal material.

Severe bleeding events among critically ill patients with haematological malignancies

BackgroundBleeding events are common complications in critically ill patients with haematological malignancies. The objective of this study was to assess the incidence and identify determinants of ICU-acquired severe bleeding events in critically ill patients with haematological malignancies. We conducted a single-center retrospective study including all adult patients with a history of haematological malignancy requiring unplanned ICU admission over a 12-year period (2007–2018). The primary endpoint was the occurrence of ICU-acquired (i.e. after the first 24 h in the ICU) severe bleeding events, as defined as grades 3 or 4 of the World Health Organization classification.ResultsA total of 1012 patients were analysed, mainly with a diagnosis of lymphoma (n = 434, 42.9%) and leukaemia or myelodysplastic syndrome (n = 266, 26.3%). Most patients were recently diagnosed (n = 340, 33.6%) and under active cancer treatment within the last 3 months (n = 604, 59.7%). The main cause for admission was infection (n = 479, 47.3%), but a significant proportion of patients were admitted for a primary haemorrhage (n = 99, 10%). ICU-acquired severe bleeding events occurred in 109 (10.8%) patients after 3.0 days [1.0–7.0] in the ICU. The main source of bleeding was the gastrointestinal tract (n = 44, 40.3%). Patients experiencing an ICU-acquired severe bleeding event displayed prolonged in-ICU length of stay (9.0 days [1.0–6.0] vs. 3.0 [3.5–15.0] in non-bleeding patients, p < 0.001) and worsened outcomes with increased in-ICU and in-hospital mortality rates (55% vs. 18.3% and 65.7% vs. 33.1%, respectively, p < 0.001). In multivariate analysis, independent predictors of ICU-acquired severe bleeding events were chronic kidney disease (cause-specific hazard 2.00 [1.19–3.31], p = 0.008), a primary bleeding event present at the time of ICU admission (CSH 4.17 [2.71–6.43], p < 0.001), non-platelet SOFA score (CSH per point increase 1.06 [1.01–1.11], p = 0.02) and prolonged prothrombin time (CSH per 5-percent increase 0.90 [0.85–0.96], p = 0.001) on the day prior to the event of interest.ConclusionsMajor bleeding events are common complications in critically ill patients with haematological malignancies and are associated with a worsened prognosis. We identified relevant risk factors of bleeding which may prompt closer monitoring or preventive measures.

Inkjet Printing Patterned Plasmonic SERS Platform with Surface-Optimized Paper for Label-Free Detection of Illegal Drugs in Urine.

Rapid quantitative testing of illegal drugs is urgently needed for precisely cracking down on drug crimes. Herein, an optimized paper-based surface-enhanced Raman spectroscopy (SERS) platform with patterned printing of plasmonic nanoparticles was constructed for the on-site quick testing of illegal drugs in urine. The filter paper was first coated with a layer of positive-charged chitosan, so as to reduce its roughness by filling the holes of the cellulose matrix and enhance the adhesion of negative-charged silver ink. Subsequently, hydrophobic modification was performed based on the binary silylation reaction, which could obviously improve the sensitivity of the paper-based SERS substrate by concentrating the amount of analyte. Meanwhile, SERS-active silver ink was fabricated and further printed on the surface of the above modified paper with custom-designed pattern (3 × 6). The performance of this SERS platform was assessed by using crystal violet (CV) as a model tag, and the obtained results proved it possesses excellent sensitivity and reproducibility, in which the relative standard deviation (RSD) dropped remarkably. More importantly, as a proof of concept, rapid detection of standard methylamphetamine (MAMP), one of the most widely abused drugs, was achieved with a limit of detection (LOD) of 1.43 ppb using a portable Raman spectrometer. And it also had a good capability in human urine sample detection, with a correlation index (R2) up to 0.9927. This optimized paper-based SERS platform was easily manufactured, cheap, and portable, providing a new strategy for the on-site detection of illicit drugs.

Comparative study of hemostatic profile between conventional methods and “Sonoclot Coagulation and Platelet Function Analyzer” in patients with septicemia

Abstract: BACKGROUND: Sonoclot Coagulation and Platelet Functional Analyzer (Sonoclot) operating on the principle of micro-viscometry is known to provide comprehensive information on the entire hemostatic process. We hypothesized that performing global hemostasis assessment in patients with sepsis would identify many more patients with altered hemostasis than the conventional tests. OBJECTIVES: We compared the hemostatic status determined by Sonoclot and that by conventional hemostatic tests. METHODS: It was a prospective analytical study conducted for 18 months in a tertiary care hospital. Sixty-one cases of septicemia admitted in the intensive care units were included in the study. RESULTS: Conventional hemostatic tests (platelet count, prothrombin time [PT], international normalized ratio, and activated partial thromboplastin time [APTT]) were compared with the Sonoclot parameters. Conventional hemostatic parameter PT was prolonged in 60.7% and APTT in 31.1%. Overall, 65.6% of the patients had prolonged coagulation on assessment by conventional hemostatic parameters. Sonoclot-derived parameter-activated clotting time was prolonged in 31.1%, indicating 31.1% of cases to have a hypocoagulable state. The clot rate was increased in 93.4% of subjects, indicating 93.4% to have a hypercoagulable state. Thrombocytopenia was seen in 34.4% and thrombocytosis in 10%. Defective platelet function was observed in 92% of the cases in Sonoclot, and all of them had normal platelet counts. This finding was statistically significant. CONCLUSION: Information about hemostatic status identified by Sonoclot is significantly higher and more complete than that identified by conventional coagulation tests in septicemic patients.

12431 14-year-old Presenting With Thrombocytopenia-Associated Multi-Organ Failure In The Setting Of Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome

Abstract Disclosure: N.C. Gunaratne-Breaux: None. D. Deplewski: None. Title: 14-Year-Old Presenting with Thrombocytopenia Associated Multi-Organ Failure in the setting of Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome Background: Coagulation complications are rare in hyperglycemia emergencies in children and adolescents. In patients presenting with severe and atypical hyperglycemia emergencies, special considerations need to be made to rule out life-threatening coagulopathy. Clinical Case: A 14-year-old male with history of Type 1 Diabetes presented in severe Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome overlap. Initially had severe hypotension and altered mental status concerning for cerebral edema. Initial venous blood gas showed pH of 6.82, pCO2 17.1, and HCO3 2.8, serum glucose was 1375 mg/dL, serum ketones &amp;gt;7.00 mmol/L, and serum osmolality was 384 mOsm/kg. Once insulin drip was started, glucose, ketones, and serum osmolality improved, but patient continued to be encephalopathic and had worsening tachypnea and desaturations. Patient was eventually intubated. After intubation, patient’s acidosis improved, but patient developed kidney failure (prompting initiation of dialysis), liver injury, decreased cardiac function, and high inflammatory state. A comprehensive multi-specialty team including pediatric intensive care, infectious diseases, rheumatology, neurology, and cardiology were involved in the care. On day three of admission, patient had multiple areas of ischemia on fingertips and ear and clotting of multiple IV and dialysis catheters, prompting a coagulopathy evaluation. Labs showed microcytic anemia (hemoglobin 10.0 g/dL; mean corpuscular volume 75fL), thrombocytopenia (platelet count 17 10e3/uL), coagulopathy (prothrombin time 16.8 sec, INR 1.3, prolonged thrombin time 48.8 sec), and elevated ferritin (507 ng/mL). Given labs and multi-organ involvement, determined by hematology to be Thrombocytopenia Associated Multi-Organ Failure (TAMOF). Patient was started on plasmapheresis and had dramatic improvement – was eventually extubated and returned to neurologic baseline without any notable deficits. Multi-specialty team ruled out all other possible causes of TAMOF; determination that the TAMOF developed secondary to DKA/HHS. Conclusion: Hyperglycemia emergencies can lead to a hyperinflammatory state that can lead to disruption of the coagulation cascade, including disseminated intravascular coagulopathy or thrombotic thrombocytopenia purpura. There have been rare reports of thrombocytopenia associated multi-organ failure provoked by DKA, thought secondary to critical illness mediated low ADAMST13 levels. This is a novel case of TAMOF caused by DKA/HHS overlap syndrome. It is important to screen for coagulopathy in cases of patients with DKA or DKA/HHS who do not show clinical improvement with resolution of ketosis and hyperosmolarity. Presentation: 6/2/2024