Shortening Of Prothrombin Time Research Articles

Sex-Specific Associations between Thyroid Status, Inflammation and Hemostasis Biomarkers in Patients with Subacute Thyroiditis.

Background: Subacute thyroiditis (SAT) is characterized by profound inflammation and fluctuations in thyroid hormones which may affect the hemostasis balance. This study investigates sex-specific associations between thyroid status, inflammation and hemostasis biomarkers in SAT. Methods: We included 52 patients (40 women and 12 men) treated with non-steroidal anti-inflammatory drugs (NSAID) or methylprednisolone (MPS). Free thyroxine (fT4), thyroid stimulating hormone, C-reactive protein, complete blood count and routine hemostasis parameters were assessed. Results: Both men and women were in hyperthyroid state and had comparable levels of inflammatory biomarkers. A shortened activated partial thromboplastin time (aPTT) was observed in 16.7% of the men and 10% of the women (p = 0.562), and a shortened prothrombin time (PT) was observed in 33% of the men and 12.5% of the women (p = 0.094). In men, aPTT positively correlated with fT4 (r = 0.627; p < 0.05), while PT positively correlated with leukocyte-based inflammatory indices in women (p < 0.05). NSAID-treated patients had lower aPTTs and platelet counts than those treated with MPS (p < 0.05). Principal component analysis extracted "proinflammatory", "prothrombotic" and "antithrombotic" factors, but the "proinflammatory" factor was the independent predictor of elevated fT4 in women (OR = 2.705; p = 0.036). Conclusions: Our data demonstrated sex-specific associations of thyroid status and inflammatory biomarkers with hemostasis parameters in SAT. Routine hemostasis screening tests may help in monitoring the changes in the hemostasis system over the course of SAT.

The Relationship between the Level of Coagulative Function Hypertensive Disorder Complicating Pregnancy.

Preeclampsia, a pregnancy complication associated with significant maternal and perinatal mortality and morbidity, has been found to be closely linked to dysfunction in the blood coagulation-fibrinolysis system. However, the relationship between hematologic data and severity and onset time of preeclampsia remains unclear. This study aimed to identify specific hematologic parameters in both preeclamptic and normotensive pregnant women and determine their potential significance in the pathogenesis of preeclampsia. A total of 112 patients with gestational hypertension disease were divided into two groups: early-onset preeclampsia (32 cases) and late-onset preeclampsia (80 cases). A control group of 82 normotensive pregnant women matched for age and parity was also selected. Blood samples were collected from all participants to test for specific hematologic parameters. Mild and severe preeclampsia were associated with lower hemoglobin level (P = 0.01 and P = 0.03, respectively), higher mean platelet volume (P = 0.01 and P = 0.01, respectively) and fibrinogen (P = 0.01 and P = 0.01, respectively), and shorter prothrombin time (P = 0.02 and P = 0.01, respectively) and activated partial thromboplastin time (P = 0.01 and P = 0.02, respectively). These findings have provided evidence on the hematologic coagulative actors in the pathogenesis and severity of preeclampsia.

Improved visual outcomes of central retinal artery occlusion with local intra-arterial fibrinolysis beyond the conventional time window.

Local intra-arterial fibrinolysis (LIF) is a promising therapeutic option for CRAO. However, the narrow time window of 6h has greatly limited the application of LIF. In this study, we explored the efficacy of LIF beyond the conventional time windows and compared the result with conservative therapy. This prospective study included 179 CRAO patients with baseline visual acuity (VA) ≤ 20/400 treated at Renmin Hospital of Wuhan University. The mean time from vision loss to presentation was 5.5days. 58 patients received conventional standard therapy (CST) alone.121 patients underwent LIF. Main outcome was VA improvement ≥ 0.3 logMAR. Secondary outcome was a favorable VA outcome of 20/200 or better. Logistic regressions were performed to identify predictors of visual improvement. 43% patients in the LIF group experienced VA improvement versus 19% with CST (P = 0.002). LIF was associated with 4.0-fold higher likelihood of visual improvement compared to CST (P = 0.001). Poor baseline VA (light perception or no light perception) and shortened prothrombin time (PT) were associated with greater chance of visual improvement with LIF. However, LIF showed no significant advantage over CST for favorable VA outcomes. No major complications occurred. LIF beyond the therapeutic time window improved vision in functionally blind CRAO patients and showed better efficacy when compared with CST. PT may be a potential predictor of visual outcome after LIF. Our findings could complement existing time-based treatment guidelines and potentially allow for personalized decisions on the use of LIF beyond time windows.

Evaluation of the Hematological Patterns from Up to 985 Days of Long COVID: A Cross-Sectional Study.

Long COVID affects many individuals following acute coronavirus disease 2019 (COVID-19), and hematological changes can persist after the acute COVID-19 phase. This study aimed to evaluate these hematological laboratory markers, linking them to clinical findings and long-term outcomes in patients with long COVID. This cross-sectional study selected participants from a 'long COVID' clinical care program in the Amazon region. Clinical data and baseline demographics were obtained, and blood samples were collected to quantify erythrogram-, leukogram-, and plateletgram-related markers. Long COVID was reported for up to 985 days. Patients hospitalized in the acute phase had higher mean red/white blood cell, platelet, and plateletcrit levels and red blood cell distribution width. Furthermore, hematimetric parameters were higher in shorter periods of long COVID than in longer periods. Patients with more than six concomitant long COVID symptoms had a higher white blood cell count, a shorter prothrombin time (PT), and increased PT activity. Our results indicate there may be a compensatory mechanism for erythrogram-related markers within 985 days of long COVID. Increased levels of leukogram-related markers and coagulation activity were observed in the worst long COVID groups, indicating an exacerbated response after the acute disturbance, which is uncertain and requires further investigation.

Natural Course of COVID-19 and Independent Predictors of Mortality.

During the SARS-CoV-2 pandemic, several biomarkers were shown to be helpful in determining the prognosis of COVID-19 patients. The aim of our study was to evaluate the prognostic value of N-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) in a cohort of patients with COVID-19. One-hundred and seven patients admitted to the Covid Hospital of Messina University between June 2022 and January 2023 were enrolled in our study. The demographic, clinical, biochemical, instrumental, and therapeutic parameters were recorded. The primary outcome was in-hospital mortality. A comparison between patients who recovered and were discharged and those who died during the hospitalization was performed. The independent parameters associated with in-hospital death were assessed by multivariable analysis and a stepwise regression logistic model. A total of 27 events with an in-hospital mortality rate of 25.2% occurred during our study. Those who died during hospitalization were older, with lower GCS and PaO2/FiO2 ratio, elevated D-dimer values, INR, creatinine values and shorter PT (prothrombin time). They had an increased frequency of diagnosis of heart failure (p < 0.0001) and higher NT-pro-BNP values. A multivariate logistic regression analysis showed that higher NT-pro-BNP values and lower PT and PaO2/FiO2 at admission were independent predictors of mortality during hospitalization. This study shows that NT-pro-BNP levels, PT, and PaO2/FiO2 ratio are independently associated with in-hospital mortality in subjects with COVID-19 pneumonia. Further longitudinal studies are warranted to confirm the results of this study.

Stronger Neo‐Minophagen C (SNMC): A stronger adjuvant for TACE?

Stronger <scp>Neo‐Minophagen</scp> C (<scp>SNMC</scp>): A stronger adjuvant for <scp>TACE</scp>?

Hypercoagulability in women with adenomyosis who experience heavy menstrual bleeding

ObjectivesTo investigate whether there is any difference in coagulability between patients with adenomyosis-associated heavy menstrual bleeding (ADM-HMB) and women without adenomyosis. Methods and materialsSeventy-two premenopausal patients with histologically diagnosed adenomyosis, but free of metabolic or hematological diseases, who experienced either moderate/heavy menses (MHB) or excessive (EXB) menstrual blood loss (MBL) based on their amount of MBL (>60mL but ≤100mL vs. >100mL) were recruited. Additionally, 50 patients without adenomyosis were also recruited. Their demographic, clinical and coagulation information were collected. All recruited subjects had platelet count, prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (aPTT), and plasma fibrinogen and D-dimer levels. AMD-HMB patients also had data on anti-thrombin activity and fibrin degradation products (FDPs). ResultsADM-HMB patients had significantly higher platelet count, fibrinogen and D-dimer levels but shorter PT and aPTT as compared with women without adenomyosis. Within the ADM-HMB patients, patients who complained of EXB had significantly higher plasma D-dimer and FDP levels but shorter aPTT and lower fibrinogen levels than those who complained of MHB. ConclusionThese data strongly suggest that ADM-HMB women are in a hypercoagulable state as compared with women without adenomyosis, especially in those complained of excessive MBL. Our findings suggest that precautionary or even prophylactic measures may be advised to reduce the risk of thrombotic events in ADM-HMB patients, especially those with excessive MBL. In addition, our data suggest that anti-thrombotic/anti-coagulation therapies may hold therapeutic potentials.

Baseline ALBI Grade Predicts Benefits After Splenectomy for Cirrhotic Patients with Hypersplenism

PurposeSplenectomy is an effective treatment for correcting cytopenia caused by hypersplenism secondary to cirrhosis. However, other potential benefits have not been well characterized. In this study, we investigated the value of splenectomy as it relates to improvement in hepatic function, liver regeneration, and health-related quality of life, and their association with baseline characteristics to clarify which patients may benefit the most from splenectomy. MethodsPatients with hypersplenism secondary to cirrhosis treated by splenectomy were retrospectively reviewed. Hepatic function was reflected by hematologic indices and albumin-bilirubin score. Liver volume was measured by imaging software, and quality-of-life was assessed by a 36-question short-form questionnaire. The changes in these three aspects after splenectomy were evaluated in the whole cohort and compared between subgroups. ResultsThe hepatic function of the patients significantly improved after splenectomy, and this was reflected by elevated serum albumin, shortened prothrombin time, and decreased albumin-bilirubin score. Patients with baseline albumin-bilirubin grade 2 or 3 and age < 56 years showed significantly decreased albumin-bilirubin score after splenectomy, whereas other subgroups did not. Moreover, liver volume increased remarkably after splenectomy in patients with baseline albumin-bilirubin grade 1, but not in those with grade 2 or 3. Significant improvement in quality-of-life occurred in the entire cohort after splenectomy, but more profound improvement was found in patients with albumin-bilirubin grade 2 or 3. ConclusionsSplenectomy improves hepatic function, increases liver volume, and also improves quality-of-life in different subsets of patients with cirrhosis and hypersplenism. Baseline characteristics, such as albumin-bilirubin grade and age, are helpful in estimating the potential benefits of splenectomy for patients before surgery.

Hematological Profile Changes Among Oral Contraceptive Users: A Narrative Review.

Hematological profiles are measurable indices of blood that can be used to identify and monitor some pathological and physiological abnormalities. Oral contraceptives are one of the factors which may exert an influence on hematological laboratory test results and have a critical importance. Therefore, the main goal of this review was to evaluate the hematologic profile alterations brought on by the use of oral contraceptives. Accordingly, even though there were studies that showed no significant difference, most of the oral contraceptive users had higher hemoglobin, platelet, and erythrocyte counts than non-users. Other erythrocyte metrics, such as mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and red cell dispersion width, did not significantly change. Moreover, leukocyte count and leukocyte differential count had no significant change among the oral contraceptive users in comparison to non-users. Oral contraceptive users typically have shorter prothrombin times, activated partial thromboplastin times, thrombin times, and greater levels of fibrinogen and D-dimer compared to non-users. However, this review is a narrative review and did not show the pooled effect of oral contraceptives on these hematological parameters. Therefore, it is recommended to do systematic and meta-analysis to determine the pooled effect of oral contraceptives.

Impact of occupational exposure to petroleum products on coagulation and white blood cell indices of Petrol station attendants in Nnewi metropolis, Nigeria.

Petroleum products are complex mixture of hydrocarbon compounds that is easily vaporized during handling. Occupational exposure to petroleum product fumes has become a major public health concern especially in developing countries where adequate protective measures are elusive. These fumes are known to be toxic and can cause abnormal alterations in the functioning of many vital organs. This was a comparative cross-sectional study designed to assess the impact of occupational exposure to petroleum products on the Prothrombin time, activated partial thromboplastin time and white blood cell indices of petrol station attendants (PSAs) in Nnewi metropolis. A total of 100 subjects were recruited comprising 50 petrol station attendants and 50 control subjects. Blood sample was collected and used to assay for the prothrombin time (PT), activated partial thromboplastin time (APTT) and white blood cell parameters. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 21. The Prothrombin time was significantly shorter in the Petrol station attendants than that of the control group (P=0.004), while the activated partial thromboplastin time was significantly longer in the petrol station attendants than the control group (P&lt;0.001). The monocytes count was also significantly higher in petrol station attendants than the controls (P=0.009). Also among the petrol station attendants, the males had significantly longer PT, and APTT values compared to their female counterparts (P=0.008 and 0.006 respectively). Occupational exposure to petroleum products has a detectable impact on coagulation parameters (shorter PT and longer APTT values) which makes it needful that the petrol station workers should be provided with appropriate personal protective equipment to minimize exposure.

Diagnostic Value of Aortic Dissection Risk Score, Coagulation Function, and Laboratory Indexes in Acute Aortic Dissection.

Objective This study was aimed at studying the diagnostic value of aortic dissection (AD) risk score, coagulation function, and laboratory indicators in acute aortic dissection (AAD). Methods In this retrospective study, 57 patients with AAD and 57 with an acute coronary syndrome (ACS). During the same period, 50 healthy subjects were selected as the control group admitted to our institution which were assessed for eligibility and recruited. They were assigned to an AD group (AAD patients) and an ACS group (ACS patients). The AD risk scores, coagulation function indexes, and laboratory indexes of the two groups were compared. With digital subtraction angiography- (DSA-) based diagnosis result as the gold standard, the receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of various indexes for AD, and the sensitivity, specificity, and optimal diagnostic value (Youden index) of the diagnostic indexes were calculated. Additionally, the overall blood clot formation strength (MA), clotting factor function (R), platelet function (MAp), and functional fibrinogen (MAf) levels were evaluated. Results AAD risk, AD screening, early diagnosis of AAD, fibrinogen degradation products (FDP), fibrinogen (Fib), prothrombin time (PT), activated partial thromboplastin time (APTT), tenascin C (TN-C), D-dimer (D-D), and N-terminal B-type natriuretic peptide precursor (NT-proBNP) in the three groups were statistically different (P < 0.05). Further pairwise comparisons showed that the AD patients got higher scores of AAD risk, AD screening, and early diagnosis of AAD versus ACS patients (P < 0.05). AD was associated with lower levels of fibrinogen degradation products (FDP) and fibrinogen (Fib), shorter prothrombin time (PT), and activated partial thromboplastin time (APTT) versus ACS (P < 0.05). AD also resulted in higher levels of tenascin C (TN-C), D-dimer (D-D), and N-terminal B-type natriuretic peptide precursor (NT-proBNP) versus ACS (P < 0.05). The three risk scores, various laboratory indicators, and various coagulation function indicators were of high diagnostic values for the diagnosis of AAD (AUC > 0.9, P < 0.05). The sensitivity of the AD screening scale and TN-C expression level to the diagnosis of AAD was up to 100%, and the specificity of TN-C expression level was up to 98.25%. The influencing factors of AAD included Fib, FDP, PT, APTT, D-D, TN-C, and NT-proBNP. MA, MAf, and MAp displayed the same trend and reached the lowest point at T2. R was the opposite and reached the highest point at T2. At T4, a higher Map and a lower MAf were found than before surgery, and R and MA returned to preoperative levels. The positive detection rate of ACS by CT scan was positively correlated with the degree of stenosis (r = 0.814, P < 0.05). Conclusion AD screening scale, TN-C, and FDP are of the highest diagnostic value in the risk score of AD, laboratory indicators, and coagulation function. It has implications for the diagnosis of ADD.

Intraoperative Cell Salvage for Women at High Risk of Postpartum Hemorrhage During Cesarean Section: a Systematic Review and Meta-analysis.

Postpartum hemorrhage (PPH) can lead to substantial blood loss that compromises maternal hemodynamic stability and consequently cause severe maternal complications such as organ dysfunction or death. Intraoperative cell salvage (IOCS), an effective method of blood conservation used in other surgical specialties, can be an alternative intervention for managing PPH. Thus, our aim was to evaluate the efficacy and safety of IOCS for women at high risk of PPH undergoing cesarean sections. We conducted a systematic search of electronic databases from inception to February 25, 2021 for randomized controlled studies and observational studies published in English or Mandarin about IOCS use in cesarean sections. Primary outcomes of interest were changes in postoperative hematologic parameters and any adverse events reported among patients that had IOCS and controls that had an allogeneic blood transfusion. The certainty of the evidence of the outcomes was evaluated using the GRADE approach. A total of 24 studies with 5872 patients were included in the meta-analysis. Eleven randomized controlled trials (RCTs), and 13 observational studies were analyzed. Postoperative hemoglobin levels were higher among patients with IOCS SMD 0.39 (95% CI; 0.20, 0.60; P &lt; 0.001, high certainty). Allogeneic blood transfusion increased adverse events RR = 1.81(95% CI; 1.24, 2.62; P = 0.002, low certainty). IOCS shortened hospital stay SMD - 0.59 (95% CI: - 0.98, - 0.19; P = 0.004, low certainty) and shortened prothrombin time SMD - 0.67 (95% CI; - 1.31, - 0.04), P = 0.037, low certainty). The lower incidence of transfusion-related adverse events and shorter hospital stay among other findings demonstrate that IOCS use in obstetrics is an effective and safe alternative for the management of PPH; however, high-quality randomized control studies are required to confirm this evidence.

Determination of Survival of Gastric Cancer Patients With Distant Lymph Node Metastasis Using Prealbumin Level and Prothrombin Time: Contour Plots Based on Random Survival Forest Algorithm on High-Dimensionality Clinical and Laboratory Datasets

PurposeThis study aimed to identify prognostic factors for patients with distant lymph node-involved gastric cancer (GC) using a machine learning algorithm, a method that offers considerable advantages and new prospects for high-dimensional biomedical data exploration.Materials and MethodsThis study employed 79 features of clinical pathology, laboratory tests, and therapeutic details from 289 GC patients whose distant lymphadenopathy was presented as the first episode of recurrence or metastasis. Outcomes were measured as any-cause death events and survival months after distant lymph node metastasis. A prediction model was built based on possible outcome predictors using a random survival forest algorithm and confirmed by 5×5 nested cross-validation. The effects of single variables were interpreted using partial dependence plots. A contour plot was used to visually represent survival prediction based on 2 predictive features.ResultsThe median survival time of patients with GC with distant nodal metastasis was 9.2 months. The optimal model incorporated the prealbumin level and the prothrombin time (PT), and yielded a prediction error of 0.353. The inclusion of other variables resulted in poorer model performance. Patients with higher serum prealbumin levels or shorter PTs had a significantly better prognosis. The predicted one-year survival rate was stratified and illustrated as a contour plot based on the combined effect the prealbumin level and the PT.ConclusionsMachine learning is useful for identifying the important determinants of cancer survival using high-dimensional datasets. The prealbumin level and the PT on distant lymph node metastasis are the 2 most crucial factors in predicting the subsequent survival time of advanced GC.Trial RegistrationChiCTR Identifier: ChiCTR1800019978

State of platelet-plasma hemostasis in patients with hypertension and non-alcoholic fatty liver disease in condition of hypercholesterolemia

Abstract Non-alcoholic fatty liver disease (NAFLD) is a marker of metabolic and dyslipidemic disorders. Given the prevalence of atherogenic dyslipidemias and their proven effect on the development of thrombotic cardiovascular complications in patients with NAFLD, it is important to understand the role of hemostatic blood activity. Aim of the study To increase the effectiveness of early diagnosis of thrombophilic blood changes in patients with hypertension (HT) combined with non-alcoholic fatty liver disease by determining the state of plasma hemostasis in conditions of hypercholesterolemia and concomitant statin therapy. Materials and methods 152 patients were examined. Groups of patients: I – 46 patients with stage II GC, II – 54 patients with NAFLD without GC, group III – 52 patients with stage II GC with concomitant NAFLD. The analysis of spontaneous and induced platelet aggregation, indicators of coagulation, anticoagulant and fibrinolytic hemostasis. Results The degree of spontaneous aggregation was significantly higher in patients with hypercholesterolemia – by 32.4% (p&amp;lt;0.05). The level of fibrinogen was higher by 13.5% (p&amp;lt;0.05) due to hypercholesterolemia, at the same time there was a decrease in antithrombin (AT) III by 8.7% (p&amp;lt;0.05) in patients with high cholesterol. Patients with comorbid HT and NAFLD on statin therapy had a 16.5% (p&amp;lt;0.05) lower degree of spontaneous aggregation than patients who did not receive this treatment. In the NAFLD group, patients receiving statins had a significantly lower degree of arachidonic acid-induced aggregation against patients without lipid-lowering therapy (by 54.0%, p&amp;lt;0.001). However, the analysis of the general population of the examined revealed a decrease in the degree of collagen-induced aggregation by 38.7% (p&amp;lt;0.05) in a subgroup of patients receiving treatment. We observed a 23.4% (p&amp;lt;0.001) shortening of prothrombin time in the NAFLD group and a 16.0% (p&amp;lt;0.05) shortening in the combined course of HT and NAFLD. In the absence of statin therapy in the NAFLD group, there was a significant decrease in INR – by 9.7% (p&amp;lt;0.05) – compared with patients receiving lipid-lowering therapy. A decrease in thrombin time by 12.2% (p&amp;lt;0.05) was observed in the subgroup receiving statins among patients with NAFLD. In the general cohort, the use of statins increased the activity of AT III by 10.7% (p&amp;lt;0.01), but in the NAFLD group this difference was more significant – by 14.3% (p&amp;lt;0.001) AT III was more active in patients who received lipid-lowering therapy. Conclusion The results of the analysis showed that patients with hypercholesterolemia have procoagulant and prothrombogenic activity of blood. But statin treatment decrease platelet aggregation, blood coagulation potential and increased activity of anticoagulant hemostasis, which complements the mechanism of prophylactic effect of HMG CoA reductase inhibitor (statin). Funding Acknowledgement Type of funding sources: None.

Effect of urban air pollution on CRP and coagulation: a study on inpatients with acute exacerbation of chronic obstructive pulmonary disease

PurposeAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is an important event in the course of chronic obstructive pulmonary disease that negatively affects patients’ quality of life and leads to higher socioeconomic costs. While previous studies have demonstrated a significant association between urban air pollution and hospitalization for AECOPD, there is a lack of research on the impact of particulate matter (PM) on inflammation and coagulation in AECOPD inpatients. Therefore, this study investigated the association of changes in coagulation function and C-reactive protein (CRP) with PM levels in the days preceding hospitalization.Patients and methodsWe reviewed the medical records of AECOPD patients admitted to Putuo Hospital, Shanghai University of Traditional Chinese Medicine, between March 2017 and September 2019. We analyzed the association of coagulation function and CRP level in AECOPD patients with PM levels in the days before hospitalization. Multivariate unconditional logistic regression analyses were used to evaluate the adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of CRP data with hospitalization day. Kruskal–Wallis tests were used to evaluate mean aerodynamic diameter of ≥ 2.5 μm (PM2.5) exposure on the day before hospitalization; we assessed its association with changes in prothrombin time (PT) in AECOPD inpatients with different Global Initiative for Chronic Obstructive Lung Disease (GOLD) classes.ResultsThe peripheral blood PT of AECOPD patients with PM2.5 ≥ 25 mg/L on the day before hospitalization were lower than those of patients with PM2.5 < 25 mg/L (t = 2.052, p = 0.041). Patients with severe GOLD class exposed to greater than 25 mg/L of PM2.5on the day before hospitalization showed significant differences in PT (F = 9.683, p = 0.008). Peripheral blood CRP levels of AECOPD patients exposed to PM2.5 ≥ 25 mg/L and PM10 ≥ 50 mg/L on the day before hospitalization were higher than those of patients exposed to PM2.5 < 25 mg/L and PM10 < 50 mg/L (t = 2.008, p = 0.046; t = 2.637, p = 0.009). Exposure to < 25 mg/L of PM2.5 on the day before hospitalization was significantly associated with CRP levels (adjusted OR 1.91; 95% CI 1.101, 3.315; p = 0.024).ConclusionExposure of patients with AECOPD to high PM levels on the day before hospitalization was associated with an increased CRP level and shortened PT. Moreover, PM2.5 had a greater effect on CRP level and PT than mean aerodynamic diameter of ≥ 10 μm (PM10). AECOPD patients with severe GOLD class were more sensitive to PM2.5-induced shortening of PT than those with other GOLD classes.

Risk factors for intraoperative greater trochanteric fractures in hemiarthroplasty for intracapsular femoral neck fractures

PurposeHemiarthroplasty is widely accepted as the treatment of choice in elderly patients with a displaced intracapsular femoral neck fracture. Intraoperative greater trochanteric fractures thwart this successful procedure, resulting in prolonged recovery, inferior outcome, and increased risk of revision surgery. Hence, this study analyzed factors potentially associated with an increased risk for intraoperative greater trochanteric fracture.MethodsThis retrospective study included 512 hemiarthroplasties in 496 patients with a geriatric intracapsular femoral neck fracture from July 2010 to March 2020. All patients received the same implant type of which 90.4% were cemented and 9.6% non-cemented. Intra- and postoperative radiographs and reports were reviewed and particularly screened for greater trochanteric fractures.ResultsFemale patients accounted for 74% and mean age of the patients was 82.3 (± 8.7) years. 34 (6.6%) intraoperative greater trochanteric fractures were identified. In relation to patient-specific factors, only a shorter prothrombin time was found to be significantly associated with increased risk of intraoperative greater trochanteric fracture (median 96%, IQR 82–106% vs. median 86.5%, IQR 68.8–101.5%; p = 0.046). Other factors associated with greater trochanteric fracture were a shorter preoperative waiting time and changes in perioperative settings. Outcome of patients with greater trochanteric fracture was worse with significantly more surgical site infection requiring revision surgery (17.6% vs. 4.2%, p = 0.005).ConclusionProlonged prothrombin time, a shorter preoperative waiting time, and implementing new procedural standards and surgeons may be associated with an increased risk of a greater trochanteric fracture. Addressing these risk factors may reduce early periprosthetic infection which is strongly related to greater trochanteric fractures.

Evaluation of Some Coagulation Profile and Estimation of Fibrinogen Level in Sudanese Patients with Type II Diabetes Mellitus

BACKGROUND: Type II diabetes, fibrinogen levels have been demonstrated to predict the progression to overt nephropathy. Hyperfibrinogenemia, an indicator of inflammation, is also associated with the presence of endothelial dysfunction, insulin resistance, hypercoagulability, and increased blood viscosity and is a marker of unstable atherosclerotic lesions. AIM: This study aimed to evaluation of coagulation profile and D-dimer and estimation of Serum Fibrinogen Level in Sudanese Patients with type II Diabetes Mellitus in Khartoum State. METHODS: A questionnaire was designed to collect information about the study group, Blood sample were collected from all participants in Tri sodium citrate containers. Automated coagulometer (COATRON M1) was used to evaluate prothrombine time and activated partial thromboplastine time and measure fibrinogen level. D-dimer levels were evaluated using (ichroma™) Reader fluorescence scanning instrument an integrated Point of Care Test (POCT) system. RESULTS: The study showed that the mean and standard of PT, APTT, INR was (17.9 ± 3.8 sec, 32.6 ± 4.1 sec, 1.1 ± 0.3 respectively), the mean of age among study group was (53 ± 14.2 years), there was significant different when correlate PT and management of disease (p. value 0.01) . the present study show insignificant correlation between PT and treatment, complication and gender (0.20 , 0.13 and 0.08) respectively while APTT there was significant difference with management ,complication and gender p. value was (0.01 , 0.03 and 0.01 respectively) .The mean ± SD of fibrinogen level was 136 ± 20.7 ,the mean ± SD of fibrinogen level in male was 137.4 ± 20.6mg/dl and in female was 135.22 ± 20.9 mg/dl. The present study show the insignificant correlation among gender p-value was (0.594). The frequency of duration of disease in group less than 5 years was (34%), in 5-10 years was (41%) and in group more than 10 years was (25%). Statistically insignificant differences between fibrinogen level and duration of disease were observed p-value (0.776), there was insignificant difference between fibrinogen level and different age group p. value (0.66). The mean of D-dimer levels is (1309.3 ± 324.1mg /ml). CONCLUSION: The present study show that shortened prothrombin time, activated partial thromboplastin time, shortened PT and APTT might be useful haemostatic markers in diabetic patients, especially in those at high risk for thrombotic complications. The Mean of plasma fibrinogen level in patient with type II diabetics mellitus were136.3mg/dl, insignificant correlation with Fibrinogen levels with age, gender and duration of disease. The D. Dimer level show significant increase.

Coronavirus Disease 2019 versus Influenza A in Children: An Observational Control Study in China

This study aimed to understand the differences in clinical, epidemiological, and laboratory features between the new coronavirus disease 2019 (COVID-2019) and influenza A in children. Data of 23 hospitalized children with COVID-19 (9 boys, 5.7 ± 3.8 years old) were compared with age- and sex-matched 69 hospitalized and 69 outpatient children with influenza A from a hospital in China. The participants' epidemiological history, family cluster, clinical manifestations, and blood test results were assessed. Compared with either inpatients or outpatients with influenza A, children with COVID-19 showed significantly more frequent family infections and higher ratio of low fever (< 37.3 °C), but shorter cough and fever duration, lower body temperature, and lower rates of cough, fever, high fever (> 39 °C), nasal congestion, rhinorrhea, sore throat, vomiting, myalgia or arthralgia, and febrile seizures. They also showed higher counts of lymphocytes, T lymphocyte CD8, and platelets and levels of cholinesterase, aspartate aminotransferase, lactate dehydrogenase, and lactic acid, but lower serum amyloid, C-reactive protein, and fibrinogen levels and erythrocyte sedimentation rate, and shorter prothrombin time. The level of alanine aminotransferase in children with COVID-19 is lower than that in inpatients but higher than that in outpatients with influenza A. Pediatric COVID-19 is associated with more frequent family infection, milder symptoms, and milder immune responses relative to pediatric influenza A.

The abnormalities of coagulation and fibrinolysis in acute lung injury caused by gas explosion.

Acute lung injury (ALI) caused by gas explosion is common, and warrants research on the underlying mechanisms. Specifically, the role of abnormalities of coagulation and fibrinolysis in this process has not been defined. It was hypothesized that the abnormal coagulation and fibrinolysis promoted ALI caused by gas explosion. Based on the presence of ALI, 74 cases of gas explosion injury were divided into the ALI and non-ALI groups. The results of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and platelet count (PLT) were collected within 24 hours and compared between the groups. ALI models caused by gas explosion were established in Sprague Dawley rats, and injuries were evaluated using hematoxylin and eosin (HE) staining and histopathological scoring. Moreover, the bronchoalveolar lavage fluid (BALF) was collected to examine thrombin-antithrombin complex (TAT), tissue factor (TF), tissue factor pathway inhibitor (TFPI), and plasminogen activator inhibitor-1 (PAI-1) levels by enzyme-linked immunosorbent assay (ELISA). The patients in ALI group had shorter PT and longer APTT, raised concentration of FIB and decreased number of PLT, as compared to the non-ALI group. In ALI rats, the HE staining revealed red blood cells in alveoli and interstitial thickening within 2 hours which peaked at 72 hours. The levels of TAT/TF in the BALF increased continually until the seventh day, while the PAI-1 was raised after 24 hours and 7 days. The TFPI was elevated after 2 hours and 24 hours, and then decreased after 72 hours. Abnormalities in coagulation and fibrinolysis in lung tissues play a role in ALI caused by gas explosion.

Personalized surveillance for hepatocellular carcinoma in cirrhosis – using machine learning adapted to HCV status

Refining hepatocellular carcinoma (HCC) surveillance programs requires improved individual risk prediction. Thus, we aimed to develop algorithms based on machine learning approaches to predict the risk of HCC more accurately in patients with HCV-related cirrhosis, according to their virological status. Patients with compensated biopsy-proven HCV-related cirrhosis from the French ANRS CO12 CirVir cohort were included in a semi-annual HCC surveillance program. Three prognostic models for HCC occurrence were built, using (i) Fine-Gray regression as a benchmark, (ii) single decision tree (DT), and (iii) random survival forest for competing risks survival (RSF). Model performance was evaluated from C-indexes validated externally in the ANRS CO22 Hepather cohort (n= 668 enrolled between 08/2012-01/2014). Out of 836 patients analyzed, 156 (19%) developed HCC and 434 (52%) achieved sustained virological response (SVR) (median follow-up 63 months). Fine-Gray regression models identified 6 independent predictors of HCC occurrence in patients before SVR (past excessive alcohol intake, genotype 1, elevated AFP and GGT, low platelet count and albuminemia) and 3 in patients after SVR (elevated AST, low platelet count and shorter prothrombin time). DT analysis confirmed these associations but revealed more complex interactions, yielding 8 patient groups with varying cancer risks and predictors depending on SVR achievement. On RSF analysis, the most important predictors of HCC varied by SVR status (non-SVR: platelet count, GGT, AFP and albuminemia; SVR: prothrombin time, ALT, age and platelet count). Externally validated C-indexes before/after SVR were 0.64/0.64 [Fine-Gray], 0.60/62 [DT] and 0.71/0.70 [RSF]. Risk factors for hepatocarcinogenesis differ according to SVR status. Machine learning algorithms can refine HCC risk assessment by revealing complex interactions between cancer predictors. Such approaches could be used to develop more cost-effective tailored surveillance programs. Patients with HCV-related cirrhosis must be included in liver cancer surveillance programs, which rely on ultrasound examination every 6 months. Hepatocellular carcinoma (HCC) screening is hampered by sensitivity issues, leading to late cancer diagnoses in a substantial number of patients. Refining surveillance periodicity and modality using more sophisticated imaging techniques such as MRI may only be cost-effective in patients with the highest HCC incidence. Herein, we demonstrate how machine learning algorithms (i.e. data-driven mathematical models to make predictions or decisions), can refine individualized risk prediction.