Removal Of Blood Clots Research Articles

Ultrasound-powered hydrogen peroxide-responsive Janus micromotors for targeted thrombolysis and recurrence inhibition

Thrombosis seriously endangers human health with high incidence and mortality worldwide, and the clinical treatment is challenged by low bioavailability of thrombolytic agents, high bleeding risk and thrombosis relapse. Herein, ultrasound-powered Janus micromotors with stimuli-responsive multiple release capabilities are developed for efficient thrombolysis and inhibition of thrombosis recurrence. Resveratrol-loaded hyaluronic acid (HARes) nanoparticles (NPs) and urokinase plasminogen activator (uPA) were entrapped into H2O2-sensitive poly(1,4-cyclohexanedimethanol-co-oxalate) (POX) microparticles (MPs), followed by polydopamine capping and RGD grafting to obtain Janus rJPox@u-HARes MPs. After RGD-mediated delivery to the thrombus site, the peroxalate ester bonds of POX are oxidized by the elevated H2O2 to produce CO2, and the MP collapse accelerates the local release of uPA and HARes NPs. The resulting CO2 bubbles amplify the cavitation effect of ultrasound to promote thrombus penetration and site-specific uPA thrombolysis. The endothelial cell targeting and sustained resveratrol release from HARes NPs dramatically improve endothelial cell viability, nitric oxide production and migration. Compared with free drug administration, the uPA loading into MPs significantly extends the half-life (15 folds) and bioavailability (7 folds), while the resveratrol inoculation into NPs increases the bioavailability 29 times. On an acute lower limb thrombosis model, the thrombus accumulation of MPs is promoted by RGD-mediated interactions with the activated platelets and ultrasound-driven penetration into thrombi, leading to almost full removal of blood clots. The H2O2-scavenging capability of POX, sustained resveratrol release and efficient thrombolysis alleviate oxidative stresses, eliminate coagulation biomarkers and repair the damaged endothelial layer to effectively inhibit thrombosis relapse. It is demonstrated that rJPox@u-HARes/US treatment could not only achieve safe and site-specific thrombolytic therapy at the early stage but also restore vascular homeostasis to effectively prevent thrombosis recurrence.

Possible roles of short-chain fatty acids produced by oral bacteria in the development of alveolar osteitis.

Alveolar osteitis (dry sockets) is a painful condition characterized by a limited immune response. It is typically caused by the removal of blood clots from extracted tooth sockets, which leads to the fermentation of trapped food remnants by oral bacteria in the cavities, producing high concentrations of short-chain fatty acids (SCFAs). This study examined the effects of SCFAs on immunity and bone metabolism. Mouse macrophage Raw264.7 cells were treated with oral bacteria supernatants or SCFA mixtures, and inducible nitric oxide synthase (iNOS) levels were determined by western blot. The same cells were treated with SCFA mixtures in the presence of receptor activator of nuclear factor-kappa B ligand (RANKL), and osteoclast-like cells were counted. MC3T3-E1 cells were treated with SCFA mixtures and stained with alizarin red S. Raw264.7 cells treated with oral bacterial culture supernatants of Porphyromonas gingivalis and Fusobacterium nucleatum inhibited lipopolysaccharide (LPS)-induced iNOS production, likely due to SCFA content. SCFA mixtures mimicking these supernatants inhibited the number of RANKL-induced tartrate-resistant acid phosphatase (TRAP)-positive cells and MC3T3-E1 cell mineralization. These data suggest that SCFAs produced by P. gingivalis and F. nucleatum may reduce the inflammatory response and mildly induce mineralization of the alveolar walls. These results may contribute to the understanding of alveolar osteitis.

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ УСПЕШНОГО СОВМЕСТНОГО ПРОВЕДЕНИЯ ТРОМБОЛИТИЧЕСКОЙ ТЕРАПИИ, МЕХАНИЧЕСКОЙ ТРОМБОЭКСТРАКЦИИ И СТЕНТИРОВАНИЯ У ПАЦИЕНТА С ИШЕМИЧЕСКИМ ИНСУЛЬТОМ В БАССЕЙНЕ ПРАВОЙ СРЕДНЕЙ МОЗГОВОЙ АРТЕРИИ

Abstract. Introduction. As of today, acute cerebrovascular accident is still the most important medical and social challenge in the modern society, due to its high growth rates of morbidity, disability, and mortality. A highly proven method of ischemic stroke treatment is reperfusion therapy, including intravenous thrombolytic therapy and mechanical thrombus extraction. Thrombus extraction is a high–tech medical procedure aimed at removing blood clots, which is the most effective way to treat patients with ischemic stroke. Aim. To illustrate the efficiency of collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting. Materials and Methods. The article presents a clinical case report on a patient with ischemic stroke in the territory of the right middle cerebral artery upon the successful collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting. The patient’s neurological status was assessed, and neuroimaging was performed before and after thrombolytic therapy, mechanical thrombus extraction, and stenting; laboratory tests and instrumental investigations were carried out, and secondary prevention was prescribed. Results and Discussion. Due to the successful staged reperfusion therapy including intravenous thrombolytic therapy followed by mechanical thrombus extraction using a stent retriever, and stenting of the right internal carotid artery, the physicians managed to achieve the restoration of blood flow along the right middle cerebral artery with significant clinical regression of neurological deficit, which achievement demonstrated the effectiveness, safety, and expediency of using this treatment technique. Combining these methods is efficient for the treatment of patients with ischemic stroke caused by the major artery occlusions in the anterior parts of Willis circle. In centers of vascular medicine where there is no high-tech medical care, thrombolytic therapy is administered intravenously in one medical institution, and then the patient is transferred to another one where it is possible to perform mechanical thrombus extraction, or both reperfusion therapy techniques can be used within one medical institution. Conclusions. Collaboratively performing the above procedures illustrates their high efficiency and safety. Time elapsed from the disease onset to the treatment initiation is essential to successful recanalization.

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ УСПЕШНОГО СОВМЕСТНОГО ПРОВЕДЕНИЯ ТРОМБОЛИТИЧЕСКОЙ ТЕРАПИИ, МЕХАНИЧЕСКОЙ ТРОМБОЭКСТРАКЦИИ И СТЕНТИРОВАНИЯ У ПАЦИЕНТА С ИШЕМИЧЕСКИМ ИНСУЛЬТОМ В БАССЕЙНЕ ПРАВОЙ СРЕДНЕЙ МОЗГОВОЙ АРТЕРИИ

Abstract. Introduction. As of today, acute cerebrovascular accident is still the most important medical and social challenge in the modern society, due to its high growth rates of morbidity, disability, and mortality. A highly proven method of ischemic stroke treatment is reperfusion therapy, including intravenous thrombolytic therapy and mechanical thrombus extraction. Thrombus extraction is a high–tech medical procedure aimed at removing blood clots, which is the most effective way to treat patients with ischemic stroke. Aim. To illustrate the efficiency of collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting. Materials and Methods. The article presents a clinical case report on a patient with ischemic stroke in the territory of the right middle cerebral artery upon the successful collaborative thrombolytic therapy, mechanical thrombus extraction, and stenting. The patient’s neurological status was assessed, and neuroimaging was performed before and after thrombolytic therapy, mechanical thrombus extraction, and stenting; laboratory tests and instrumental investigations were carried out, and secondary prevention was prescribed. Results and Discussion. Due to the successful staged reperfusion therapy including intravenous thrombolytic therapy followed by mechanical thrombus extraction using a stent retriever, and stenting of the right internal carotid artery, the physicians managed to achieve the restoration of blood flow along the right middle cerebral artery with significant clinical regression of neurological deficit, which achievement demonstrated the effectiveness, safety, and expediency of using this treatment technique. Combining these methods is efficient for the treatment of patients with ischemic stroke caused by the major artery occlusions in the anterior parts of Willis circle. In centers of vascular medicine where there is no high-tech medical care, thrombolytic therapy is administered intravenously in one medical institution, and then the patient is transferred to another one where it is possible to perform mechanical thrombus extraction, or both reperfusion therapy techniques can be used within one medical institution. Conclusions. Collaboratively performing the above procedures illustrates their high efficiency and safety. Time elapsed from the disease onset to the treatment initiation is essential to successful recanalization.

The burden of cardiovascular disease in South Asia: the need for effective treatment

Dear Ma'am, Cardiovascular disease (CVD) is rapidly becoming the leading cause of death worldwide (1). According to global health projections, it will remain the number one cause of death in 2030. The Asian region has been shown to have a higher cardiovascular disease burden than Western countries, and most of this burden is borne by economically disadvantaged people mainly located in South Asian regions such as Pakistan. (1). A large-scale survey conducted in 53 cities in Punjab, Pakistan, found that 17.5% of the population suffered from cardiovascular disease (2). Mechanical thrombectomy is a minimally-invasive procedure where a specialized interventional radiologist utilizes specific equipment to remove a blood clot from an artery in a patient's body. This procedure treats arterial blockages caused by blood clots such as Deep Vein Thrombosis (DVT), Ischemic Stroke, etc (3). MegaVac, a part of mechanical thrombectomy, is the newest technique for the removal of blood clots from arteries. It is an invasive procedure that ensures the complete removal of clots from the occluded artery. The biggest advantage of this technique over typical clot removal is that it prevents embolus formation, which can occlude smaller arteries. The MegaVac Thrombectomy System is an intravascular mechanical thrombectomy and aspiration device with a single use that includes a thrombowire with an embolectomy component. A distal silicone-coated nitinol braid used in the SafeSealTM technology of the MegaVac Catheter swells to momentarily obstruct antegrade blood flow. The braid is expanded by the inner and outer coaxial shafts of the catheter body, briefly occluding the channel and enabling aspiration. SafeSeal funnel is activated by the assembly of the proximal handle. A nitinol embolectomy component that is part of the thrombowire can be used to draw material in the direction of the MegaVac catheter when it is inflated by the proximal actuation handle (4). Thrombectomy is a common and effective procedure for clot removal but in Pakistan thrombectomy is not as common compared to developed countries, primarily due to two reasons. First, Mechanical thrombectomy is exclusively available in four hospitals nationwide, with only one public hospital in Lahore providing this procedure (5). Second, it is an expensive procedure that ranges from 1700$ to 5000$ depending on the severity of the patient and the complexity of the procedure. Health Departments of Pakistan should provide this facility in more public hospitals so it becomes accessible to more people.

Sequential Ahmed valve implantation after primary implant surgery in two dogs.

To report the outcomes of sequential Ahmed valve implantation in two dogs with uncontrolled intraocular pressure (IOP) after primary Ahmed valve implantation. A 6-year-old castrated male American Cocker Spaniel (case 1) and a 12-year-old spayed female mixed-breed dog (case 2) presented with glaucoma management in the left eyes of both dogs. Primary Ahmed valve implantation was performed because of uncontrolled IOP despite antiglaucoma medications used in both dogs. The IOP was maintained within the normal range for 14 and 2 months after surgery in cases 1 and 2, respectively. In both cases, the IOP gradually increased, which was assumed to be caused by bleb fibrosis. In particular, in case 2, one bleb revision surgery was performed during that period, but it was unsuccessful. Therefore, we decided to perform sequential implantation surgery. In case 1, hyphema occurred the day after sequential surgery and resolved with anti-inflammatory treatment. In case 2, it occurred immediately after the surgery and resolved after surgical blood clot removal. IOP remained below 15 mmHg, and menace response was positive until 40 and 23 months after the sequential surgery in cases 1 and 2, respectively. As a long-term complication, cataracts occurred at 17 months in case 1 and 10 months in case 2. Sequential implantation surgery in the same eye could be an effective alternative for long-term IOP management and vision maintenance. A better understanding of complications and appropriate postoperative management is essential for better outcomes.

Near-infrared-II photoacoustic imaging and photo-triggered synergistic treatment of thrombosis via fibrin-specific homopolymer nanoparticles

The formation of an occlusive thrombus in the blood vessel is the main culprit for numerous life-threatening cardiovascular diseases that represent the leading cause of morbidity and mortality worldwide. Herein, we develop a polymer nanoplatform that integrates long-wavelength second near-infrared (NIR-II) photoacoustic imaging-based thrombosis detection and antithrombotic activity. We design and synthesize a semiconducting homopolymer with strong absorption in the NIR-II region and molecular motion that boosts photothermal conversion and photoacoustic signal. We dope the homopolymer with a thermosensitive nitric oxide donor to formulate a nanoplatform, on which a fibrin-specific ligand is functionalized to ensure selective thrombus targeting. We show that with strong NIR-II light harvesting capability, bright photoacoustic signal and active thrombus accumulation ability, the NIR-II photoacoustic nanoprobes are able to sensitively and selectively delineate thrombi. We find that the nanoplatform also displays rapid and efficient blood clot removal activity with nearly complete blood flow restoration in both carotid thrombosis models and low extremity arterial thrombosis models under NIR-II light trigger by integrating a thrombus-localized photothermal effect and on-demand nitric oxide release. This nanoplatform offers a versatile approach for the diagnosis and treatment of life-threatening diseases caused by various thrombotic disorders.

Heart weight must not be measured before dissection during autopsies

During autopsies, weighing the heart is a standard procedure. In addition to myocardial pathologies, heart size, and ventricular wall thickness, heart weight is a common parameter to describe cardiac pathology and should be recorded as accurately as possible. To date, there exists no standard for recording heart weight at autopsy, although some authors recommend weighing the heart after dissection and removal of blood and blood clots. In the study presented, the hearts of 58 decedents were weighed after being dissected out of the pericardial sac (a), after dissection using the short-axis or inflow-outflow method with manual removal of blood and blood clots (b), and after rinsing and drying (c). Depending on the dissection method, the heart weight was 7.8% lower for the inflow-outflow method and 11.6% lower for the short-axis method after dissection compared to before and correspondingly 2.9% to 5% lower again after rinsing and drying respectively. Accordingly, the heart should be dissected, blood and blood clots removed, rinsed with water, and dried with a surgical towel after dissection, before weighing.

Surface-Tailored Nanoplatform for the Diagnosis and Management of Stroke: Current Strategies and Future Outlook.

Stroke accounts for one of the top leading reasons for neurological mortality and morbidity around the globe. Both ischemic and hemorrhagic strokes lead to local hypoxia and are brought about by the occlusion or rupturing of the blood vessels. The events taking place after the onset of a stroke include membrane ion pump failure, calcium and glutamate-mediated excitotoxicity, increased ROS production causing DNA damage, mitochondrial dysfunction, oxidative stress, development of brain edema, and microvascular dysfunction. To date, tissue plasminogen activator (tPA) therapy and mechanical removal of blood clots are the only clinically available stroke therapies, approved by Food and Drug Administration (FDA). But because of the narrow therapeutic window of around 4.5h for tPA therapy and complications like systemic bleeding and anaphylaxis, more clinical trials are ongoing in the same field. Therefore, using nanocarriers with diverse physicochemical properties is a promising strategy in treating and diagnosing stroke as they can efficiently bypass the tight blood-brain barrier (BBB) through mechanisms like receptor-mediated transcytosis and help achieve controlled and targeted drug delivery. In this review, we will mainly focus on the pathophysiology of stroke, BBB alterations following stroke, strategies to target BBB for stroke therapies, different types of nanocarriers currently being used for therapeutic intervention of stroke, and biomarkers as well as imaging techniques used for the detection and diagnosis of stroke.

The First Local Experience of Use of Extracorporeal Circulatory Support with PROTEKDuo Dual-Lumen Cannula in a Patient with Acute Right Ventricular Failure

Acute right ventricular failure is a life-threatening condition that can occur as a result of a sudden increase in total pulmonary vascular resistance, in particular, as a result of pulmonary embolism. Most patients with thromboembolism are treated with thrombolytic therapy, but in some cases open thrombextraction is preferred. Removal of blood clots from the pulmonary vascular bed and cardiopulmonary bypass can lead to spasm of the pulmonary artery and to the elevation of total pulmonary resistance, which, in turn, increases the afterload on the right ventricle and can lead to a dramatic decrease in its mechanical function.
 The aim. The aim of this report is to present the first experience of using the right ventricular bypass with the PROTEKDuo cannula for the purpose of temporary mechanical support of the right ventricle.
 Case presentation. We studied a 63-year-old patient who underwent Studer technique for bladder adenocarcinoma. On the 14th day an acute massive pulmonary embolism occurred with a drop in hemodynamics and the presence of a floating clot on the right atrium. Thrombolysis carried significant risks due to possible bleeding and clot fragmentation in the right atrium with subsequent embolization of the pulmonary arteries. In these circumstances, open thrombectomy under hypothermic arrest was performed. Intraoperatively, the patient developed acute right ventricular failure resistant to all conservative therapy, therefore, right ventricular bypass was connected using PROTEKDuo, which made it possible to overcome the phenomena of acute right ventricular failure in the postoperative period.
 Conclusions. Our experience with right ventricular bypass using the PROTEKDuo dual-lumen cannula demonstrates another useful option for saving patients with isolated right ventricular failure.

A review on photo-mediated ultrasound therapy.

Photo-mediated ultrasound therapy (PUT) is a novel therapeutic technique based on the combination of ultrasound and laser. The underlying mechanism of PUT is the enhanced cavitation effect inside blood vessels. The enhanced cavitation activity can result in bio-effects such as reduced perfusion in microvessels. The reduced perfusion effect in microvessels in the eye has the potential to control the progression of eye diseases such as diabetic retinopathy and age-related macular degeneration. Several in vivo studies have demonstrated the feasibility of PUT in removing microvasculature in the eye using rabbit eye model and vasculature in the skin using rabbit ear model. Numerical studies using a bubble dynamics model found that cavitation is enhanced during PUT due to the dramatic increase in size of air/vapor nuclei in blood. In addition, the study conducted to model cavitation dynamics inside a blood vessel during PUT found stresses induced on the vessel wall during PUT are higher than that at normal physiological levels, which may be responsible for bio-effects. The concentration of vasodilators such as nitric oxide and prostacyclin were also found to be affected during PUT in an in vitro study, which may limit blood perfusion in vessels. The main advantage of PUT over conventional techniques is non-invasive, precise, and selective removal of microvessels with high efficiency at relatively low energy levels of ultrasound and laser, without affecting the nearby structures. However, the main limitation of vessel rupture/hemorrhage needs to be overcome through the development of real-time monitoring of treatment effects during PUT. In addition to the application in removing microvessels, PUT-based techniques were also explored in treating other diseases. Studies have found a combination of ultrasound and laser to be effective in removing blood clots inside veins, which has the potential to treat deep-vein thrombosis. The disruption of atherosclerotic plaque using combined ultrasound and laser was also tested, and the feasibility was demonstrated.

Первичная отсроченная хирургическая помощь пациенту с боевым ранением глаза

Currently, injuries to the visual organ are one of the most important causes of blindness and disability due to the complicated course of the post-traumatic process and an unfavorable functional outcome, in the vast majority of cases of the able-bodied population. The timeliness of providing highly specialized ophthalmic surgical care is a fundamental factor that allows for the medical and social rehabilitation of patients with various visual organ injuries in the shortest possible time. In turn, the prolongation of the terms of primary surgical treatment dictates slightly different approaches to the conservative and surgical treatment of such patients. Objective. To evaluate the effectiveness of primary delayed simultaneous surgical care for a patient with a penetrating comminuted battle wound of the eye. Material and metods. Patient K., 35 years old, was admitted to the ophthalmological department of the State Medical Institution «OOKB» of Orenburg with complaints of decreased visual acuity of the left eye with the diagnosis: OS – Multiple military trauma. Consequences of penetrating eye injury. Corneal scar. Traumatic cataract. Partial hemophthalmos. Local retinal detachment. Intraocular foreign bodies. From anamnesis: a month ago, during military operations, he received a shrapnel wound to the head. An open penetrating comminuted fracture of the left temporal bone was performed in a military hospital. I did not receive surgical ophthalmological care. Ophthalmological status: Vis OD = 1,0: OS = movement of the shadow at the face. The IOP of both eyes is normal. OS – conjunctiva is injected, a metallic foreign body is embedded in the sclera at the meridian of 7 hours, 5 mm from the limb, the cornea is transparent, the corneal scar, the anterior chamber is shallow, the moisture is transparent, the iris is edematous, the pupil in the center is deformed, tightened for 7 hours, the pupil reaction is slowed down, inhomogeneous opacities in the lens. The reflex is dim, the details of the fundus and vitreous are not ophthalmoscoped. Preparatory measures were carried out before the surgical intervention: antibacterial and anti-inflammatory therapy. At the first stage, phacoemulsification of traumatic cataract with posterior continuous capsulorexis was performed in the conditions of medical mydriasis. The second stage was a standard three-port vitrectomy of 25 G with the removal of organized vitreous blood clots and the removal of the posterior hyaloid membrane. During the revision, a parietal foreign body with local retinal detachment is visualized in the middle outer part. A 23 G tweezers were used to remove the foreign body, which required the replacement of one of the ports. Delimitative endolasercoagulation was performed. The foreign body was removed through the posterior capsulorexis: brought to the iris in the anterior chamber of the eye, then evacuated through a tunnel incision of 2.75 mm. Then a perfluoroorganic compound (PFOS) was introduced, the retina was attached, additional retinal endolasercoagulation was performed. At the third stage, a simultaneous replacement of PFOS with silicone oil was carried out. The Miol-soft intraocular lens was implanted. At the last stage, the embedded foreign body of the sclera was removed, the conjunctival wound was sutured. On the fifth day after surgical treatment, the patient was discharged for outpatient follow-up with the functions of vis OS = 0.2 sph (+) 4.0 = 0.4 with recommendations. Conclusions. As a result of simultaneous high-tech vitreoretinal surgical treatment against the background of anti-inflammatory and antibacterial therapy, high functional results were achieved. Keywords: injury, penetrating wound of the eye, foreign body of the eye, local retinal detachment

A Research on Future Scenario in the Field Of Role of Nanorobotics a Device for Diagnosis and Treatment

Nanorobots are the nano devices that are used for protecting or treatment against pathogens in humans. The use of nanorobots technology has become familiar and increasingly common, especially with pharmaceutical technology. We conducted this research paper by observing the different types of reviews, as well as conducting and evaluating literature review papers. This research is provided detailed overview of the types, properties and application of nanorobot in the diagnosis, prevention and treatment of various diseases. Nanorobots technology is rapidly emerging in the medical field, and this subfield has been termed nanomedicine. Nanorobotics are developing wide potential applications across all fields of medicine, and expanding the number of therapeutic options available, while also improving the efficacy of existing treatments. The most recent applications of these devices include targeted drug delivery to the brain, glucose monitoring in patients with diabetes, bone reconstruction, cancer treatment, blood clot removal, nerve regeneration and protein peptide based drug delivery systems.

Impact of intravesical administration of tranexamic acid on gross hematuria in the emergency department: A before-and-after study

IntroductionLocal applications of tranexamic acid (TXA) have been effective in treating various hemorrhagic conditions. In patients with gross hematuria, the main treatment in the emergency department (ED) is continuous bladder irrigation (CBI). However, CBI has no pharmacological effects except blood clot removal from dilution. The aim of this study was to evaluate the impact of the intravesical TXA injection before CBI. MethodsThis study was a before-and-after, retrospective, and single-center study. The target population was hematuria patients who received CBI via a 3-way Foley catheter. As the intervention procedure, 1000 mg of TXA was injected through the Foley catheter and after 15 min, the Foley catheter was declamped and CBI started. Since the intervention started in March 2022, the patients from March 2022 to August 2022 were assigned to the after group and the patients from March 2021 to August 2021 were assigned to the before group. The primary outcomes were the length of stay in the ED and duration of Foley catheter placement. The secondary outcomes were the admissions and the revisits for CBI within 48 h after discharge. ResultsThe numbers of patients in the before group and after group were 73 and 86, respectively. The median length of stay in the ED was shorter in the intervention group than in the group not treated with TXA (274 min vs. 411 mins, P < 0.001). The median duration of Foley catheter placement was also shorter in the intervention group than not treated with TXA (145 min vs. 308 mins, P < 0.001). The revisits after ED discharge were lower in the after group than in the before group (2.3% vs. 12.3%, P = 0.031). There was a trend for lower admissions in the TXA treatment group than before group (29.1% vs. 45.2%, P = 0.052). ConclusionAfter the TXA intervention, reduction in the length of stay in the ED, the duration of Foley catheter placement, and the revisits after ED discharge was observed.

Blood clot removal by flexible bronchoscopic cryotherapy in a young child.

Blood clot removal by flexible bronchoscopic cryotherapy in a young child.

Hall and ion slip effects on hybrid nanoparticles (Au-GO/blood) flow through a catheterized stenosed artery with thrombosis

Present paper deals with the effect of Hall and ion slips on MHD blood flow through a catheterized multi-stenosis artery with thrombosis. Blood is considered a base fluid, and the suspension of Au and GO nanoparticles are used to form the hybrid nano-blood suspension. The hemodynamic mathematical model is presented to mimic the blood flow inside the artery subjected to Joule heating, thermal radiation, Hall and ion slip effects. The effect of the shape of nanoparticles and the variable viscosity depending upon hematocrit is taken into account. The mathematical model is presented in a curvilinear coordinate system, and a mild stenosis assumption is used to get the closed-form solutions. The reduced governing equations are solved using the Crank Nicholson scheme with “MATLAB.” The effect of various pertinent parameters on flow patterns are illustrated graphically. It is observed that increasing the Hall and ion slips parameter causes the increment in the fluid velocity due to an enhancement in the cyclotron frequency of the particles. The hybrid nanoparticles Au-GO/blood has a higher temperature profile than pure blood and unitary nanoparticles, as the thermal conductivity increases with an increase in nanoparticle concentration. Scientists and clinical researchers may find the present study useful in understanding the various illness’s conditions, including cancers, infections, and the removal of blood clots. Furthermore, current research may be helpful in the biomedical area, such as magnetic resonance angiography (MRA), which creates an image of an artery to identify any abnormalities in the artery. The current findings are consistent with recent findings in earlier blood flow research studies.

Novel approach for efficient removal of massive blood clots during emergency endoscopic hemostasis.

Novel approach for efficient removal of massive blood clots during emergency endoscopic hemostasis.

S1932 Acute Pancreatitis After Liver Biopsy: Clots or Stones?

Introduction: Percutaneous liver biopsy is a frequently utilized tool in the diagnosis of many liver diseases including metastatic liver lesions. Bleeding complications occur in 1% of cases and hemobilia is rare. Hemobilia causing acute pancreatitis after percutaneous liver biopsy is extremely rare with approximately 20 reported cases in literature. Symptoms include right upper quadrant pain, nausea, jaundice, hematemesis, hematochezia or melena. We present an interesting case of a woman who developed acute pancreatitis secondary to hemobilia after liver biopsy. Case Description/Methods: A 60-year-old female with recurrent high-grade serious peritoneal cancer and recent metastases to liver was admitted for acute pancreatitis. Patient presented with nausea and right upper quadrant pain that started after percutaneous liver biopsy one day prior. Labs notable for Hgb 10.4, lipase > 3000, amylase 3349, total bilirubin 3.6, direct 3.3, AST 631, ALT 482, alkaline phosphatase 240. CT A/P showed diffuse swelling of pancreas with fluid and mesenteric fat stranding suspicious for acute pancreatitis. Given liver enzyme elevation with mixed hepatocellular and cholestasis pattern, abdominal MRI was obtained to evaluate any biliary obstruction. MRI showed mildly prominent CBD at 0.8 cm with debris in distal CBD, cystic duct, and gallbladder indicative of hemorrhagic products. No hematoma noted in the liver parenchyma. Patient underwent ERCP with sphincterotomy and clots were cleared from the duct with balloon sweep (Figure). Discussion: Hemobilia, described as upper GI bleeding within the biliary tree has a reported incidence of less than 0.059% after percutaneous liver biopsy. It can occur within a few hours or several days later, with an average interval of five days. Although rare, hemobilia can lead to acute pancreatitis in a mechanism similar to gallstone pancreatitis. Excessive bleeding and increased clot formation cause obstruction in the biliary tree and impedes drainage from the ampulla which in turn triggers pancreatitis. Diagnosis can be made by ultrasound, angiography, ERCP, or MRCP. Treatment depends on the extent of bleeding and includes conservative management to advanced interventions-hepatic angiography with arterial embolization, ERCP with sphincterotomy or stent placement. Thus, our case highlights importance of recognizing hemobilia as an etiology for acute pancreatitis after percutaneous liver biopsy.Figure 1.: Removal of blood clots from bile duct by balloon sweep via ERCP

Effects of heat transfer, body acceleration and hybrid nanoparticles (Au–Al2O3) on MHD blood flow through a curved artery with stenosis and aneurysm using hematocrit-dependent viscosity

The present study investigates the heat transfer and body acceleration effects on unsteady MHD blood flow through a curved artery in the presence of stenosis and aneurysm using hybrid nanoparticles (). For realistic behavior of blood flow, blood is assumed to be a pulsatile, laminar, incompressible, viscous fluid with hematocrit-dependent viscosity. A uniform magnetic field is applied in the radial direction to the blood flow with radiation effect. The governing momentum and energy equations are solved using Crank-Nicolson Finite difference method through an accurate mesh using rectangular mesh units. The obtained data for both stenotic and aneurysm segments are graphically depicted and analyzed for various physical parameters. To examine the overall behavior of blood flow patterns, velocity contours for several emergent parameters have been displayed. Using clinically realistic hemodynamic data, comprehensive solutions for gold and gold- aluminium oxide hybrid mediated blood flow are presented. It is observed that the velocity profile rises as the volume fraction of gold () nanoparticles increases, while, the velocity profile decreases as the volume fraction of aluminium oxide () nanoparticles increases. It is noted that impedance of the flow decreases with increment in body acceleration parameter , while, WSS increases with increment in . The resistive impedance is higher for curved arteries than straight artery. The findings show that hybrid nanoparticles () reduce the values of hemodynamic parameters such as wall shear stress and resistive impedance, and blood flow rate decreases with an increment in and magnetic field strength. The current findings are consistent with recent findings in other studies. The outcomes of the study may be helpful in the diagnosis and treatment of plaque rupture, cancer, infections, brain aneurysms, and blood clot removal. Results may also be used to design and analyze biomedical devices for great potential treatment modalities, the anticancer drug industry, and nano-drug delivery systems.

Removal of large fibrotic bladder blood clots using prostatic tissue morcellator under real-time ultrasound guidance.

ObjectiveLarge fibrotic bladder blood clots are difficult to treat via conventional methods. Hence, we investigated the safety and reliability of real-time ultrasound guidance combined with prostate tissue morcellator in the removal of large fibrotic bladder blood clots in this study.MethodsWe chose 9 patients with large fibrotic bladder blood clots who were treated in our department from January 2019 to December 2020. Under the condition that conventional methods were ineffective in removing the bladder blood clot, real-time ultrasound guidance combined with a prostatic tissue morcellator was used to remove the large fibrotic bladder blood clot through the steps of positioning, breaking, adjusting repositioning and recrushing. After removal, the bipolar electrocautery was replaced to stop bleeding of the bladder mucosa.ResultsAll patients successfully underwent the operation. After the blood clot was removed, the bladder mucosa was examined. There was no damage to the bladder mucosa or muscle layer. The urine was clear at the end of the procedure with slow irrigation, and no bleeding was found again.ConclusionReal-time ultrasound guidance combined with a prostate tissue morcellator was a safe, effective and quick method for the removal of large fibrotic bladder blood clots.