Significant Differences In PT Research Articles

Platelet Aggregation Studies and Coagulation Profile in Sickle Cell Disease in Symptomatic and Steady State Patients.

To determine whether there is higher degree of platelet and/ or coagulation activation in sickle cell anaemia (SS) patients in complications and with clinical risk factors. A cross sectional study was conducted at a tertiary health care centre in central India with study groups: sickle cell disease (SCD): sickle cell anaemia (SS) and sickle cell trait (AS) consisting of 100 subjects each and controls (AA) with 40 subjects. Platelet aggregation (PA) with ADP, collagen and epinephrine, PT and aPTT were performed in all subjects and PA with ristocetin in ten candidates of each group. ANOVA and student's unpaired t test were used to compare PA and coagulation profile of the three groups with respect to age groups, gender, present diagnosis, history of complications, frequency of hospital admissions (high ≥ 3/year) and frequency of blood transfusion (high > 2/year). The max PA% with ADP was significantly less in SS patients in steady state, which was even lesser in those having symptoms, complications in past/ present, high-frequency hospital admission and > 2 blood transfusions per year subgroups, as compared to all other groups and subgroups, but not consistently with collagen and epinephrine. The max PA % with ristocetin was least in SS with complications. No statistically significant difference in PT and aPTT values among the various clinical risk subgroups and groups was found. SCD patients can be monitored by using PA with ADP for their timely and better management. PA with ADP, PT and aPTT should be added to the workup of these patients for improved prognostication.

Effect of Tranexamic Acid on Coagulation Profile in Patients Undergoing Brain Tumour Resection Surgery

Introduction; The majority of researchers currently believe that the haemostatic anomalies in brain tumour resection patients undergoing surgery are caused by hyperfibrinolysis, either primary or subsequent to a condition of disseminated intravascular coagulation. This Study explored the changes in haemostatic profile occurring during surgery for primary brain tumours and effect on Tranexamic acid on coagulogram. Aims & objectives:To study effect of tranexamic acid on coagulation profile in brain tumour resection patients. Materials & methods: Patients of either sex, aged 18-65 years were randomly allocated to either group - the study group and the control group (30 patients in each group) using computer generated random numbers in sealed envelopes. The investigator was present during the procedure for data collection purpose only and was not involved in the conduct of anaesthesia. Blood samples were collected preoperatively, 6hrs postoperatively and 24hrs postoperatively for coagulogram; fibrinogen levels; platelet count; D-dimer levels Results: In our study we found that there were no significant differences in PT, INR, aPTT, D- dimer preoperatively and at 6 and 24 hrs postoperatively. However, fibrinogen levels increased in tranexamic group and significantly decreased in saline group as compared to preoperatively. Conclusion: Tranexamic acid prevented decrease in levels of fibrinogen and even increased levels fibrinogen significantly during the operative and postoperative period in brain tumour resection surgery. Keywords: Coagulation profile, Meningioma

Leukocytosis and thrombocytopenia in pre-partum, post-partum cases and non-pregnant women

Thrombocytopenia is a serious condition that may cause fatal outcomes for both mother and infant, whereas leukocytosis is an essential mediator of the inflammatory process and a marker for infection during pregnancy. Objective: The aim of the study was to compare the frequency of thrombocytopenia and leukocytosis among pre-partum, post-partum cases and non-pregnant healthy controls. Methods: Total 600 samples were collected and categorized into three groups, pre-partum, post-partum and non-pregnant 200 in each. From selected groups 3-5 ml blood was collected in EDTA tube and Sodium Citrate vial. Platelets, WBCs, RBCs and Hemoglobin levels were analyzed on Sysmex KX-21. PT and APTT of all samples was performed manually. Results: Leukocytosis was detected in 60% pre-partum and 64% post-partum, there was not statistically significant difference (p=0.596). In pregnant and non-pregnant, there was significant difference statistically (p<0.05). Thrombocytopenia was detected in 11% pre-partum, 13% post-partum cases and there was no statistical difference (p>0.05). There was statistical difference in frequency of thrombocytopenia between pregnant and non-pregnant women (p=0.03). There was no statistically significant difference in PT and APTT between pre-partum and post-partum (p>0.05). APTT were significantly different between pregnant and non-pregnant cases (p<0.05). Conclusion: The study concluded that leukocytosis and thrombocytopenia was found in higher frequency among pregnant women than non-pregnant women but there was no significant difference in frequency of leukocytosis and thrombocytopenia between pre-partum and post-partum women

The Difference Coagulopathy Factor and Interleukin-6 between Survival and Non-survival Patients COVID-19

Background: Coronavirus disease 2019 (COVID-19) was caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. SARS-CoV-2 infection can result in coagulopathy and an increase in inflammatory responses. Numerous studies have shown a significant difference in interleukin levels and coagulopathy parameters such as platelet, aPTT, PT, and D- dimer between survivor and non-survivor patient COVID-19.
 Aim: The purpose of this study is to compare the age, coagulopathy characteristics, and interleukin-6 levels of non-survival versus survival patients. COVID-19.
 Methods: A cross-sectional retrospective study was conducted on COVID-19 patients. The diagnostic criteria are based on the Indonesian Ministry of Health's recommendations. The patient's blood was analyzed in the hospital's central laboratory. Patients are classified into two groups based on their likelihood of surviving: non-survival and survival. SPSS version 22 was used to analyze the data.
 Results: A total of 557 patients with COVID-19 were included in this study. Patients were categorized into 146 non-survival and 411 survival subgroups. There was a significant difference in the mean age, coagulopathy parameters, and interleukin-6 expect platelets between non-survival and survival outcomes in COVID-19 patients.
 Conclusion: This study demonstrated a statistically significant difference in PT, aPTT, D-Dimer, and interleukin-6 levels between the non-survival and survival groups of COVID-19.

ANALISIS KINERJA KEUANGAN PT. KIMIA FARMA TBK DENGAN PT. INDOFARMA TBK SEBELUM PANDEMI DAN PADA SAAT PANDEMI COVID-19

ABSTRACT
 The Covid-19 pandemic has an impact on the economic sector which has resulted in companies experiencing a decline in financial performance. This study aims to determine whether there are differences in the financial performance of PT. Kimia Farma Tbk. and PT. Indofarma Tbk. before the pandemic and during the covid-19 pandemic. This type of research is quantitative research with secondary data analysis and uses a comparative approach method. Sampling with purposive sampling method. Data collection techniques used are documentation techniques on financial reports published by PT. Kimia Farma Tbk. and PT. Indofarma Tbk. obtained from the official website of the Indonesia Stock Exchange (IDX), namely www.idx.co.id. Then processed using the SPSS Version 16.0 application and the test used in this study is a comparative test, namely the Wilcoxon Sign Test. The results of this study indicate that there are significant differences in PT. Kimia Farma Tbk. based on liquidity ratios, solvency ratios, activity ratios and profitability ratios. As for PT. Indofarma Tbk. also the same, there are significant differences based on liquidity ratios, solvency ratios, activity ratios and profitability ratios. PT. Kimia Farma Tbk. has a better performance than PT. Indofarma Tbk. before the pandemic or during the pandemic.
 Keywords: Financial Performance, Pharmaceutical Companies, Covid-19

The Difference Of PT, aPTT, Fibrinogen, D-Dimer Activities In HIV Patients With CD4 Count Of <200 uL And >200 uL

ABSTRACT
 Introduction: HIV is a developing disease that has been a global problem. The progress of HIV infection is characterized by decreased CD4 count. Hemostasis disorder is often found in patients with HIV, where the formed virus-antibody complex can activate the coagulation system, beginning from the activation of the Hageman factor (Factor XII) into the active form (Factor XIIa). This factor will activate the fibrinolysis process. Fibrin polymer is broken down into fragments X and Y. Fragment Y is further broken down into Fragment D and E, which is known as D-dimer.
 Objective: To determine the difference of PT, aPTT, Fibrinogen, and D-Dimer in HIV patients with a CD4 lymphocyte count of < 200/µL and > 200/µL in H. Adam Malik General Hospital Medan.
 Hypothesis: There is a difference of PT and aPTT activities in HIV patients with a CD4 count of < 200 cells/µL and ≥ 200 cells/µL and a difference of D-dimer and fibrinogen levels in HIV patients with a CD4 count of < 200/µL and > 200/µL in H. Adam Malik General Hospital Medan.
 Methods: This study was conducted in the Clinical Pathology Laboratory, Department of Internal Medicine, H. Adam Malik General Hospital. Samples were collected with a consecutive sampling method which included patients diagnosed with HIV in H. Adam Malik General Hospital Medan from September 2019 to July 2020 who fulfilled the inclusion and exclusion criteria. Thirty-eight patients were divided into two groups, i.e., HIV patients with a CD4 count of < 200/µL and HIV patients with a CD4 lymphocyte count of > 200/ µL.
 Results: Mann-Whitney test was used to assess the comparison of PT and aPTT values between HIV patients with a CD4 count of < 200 cells/µL and ≥ 200 cells/µL. The result was significant with a p-value = 0.002, which means that there is a significant difference in PT and aPTT values between HIV patients with a CD4 count of < 200 cells/µL and ≥ 200 cells/µL. An Independent T-test was used to assess the difference in fibrinogen level between HIV patients with a CD4 count of < 200/µL and > 200/µL, which resulted in p-value = 0.032. This means that there is a significant difference in fibrinogen levels between HIV patients with a CD4 count of < 200/µL and > 200/µL. Mann-Whitney test was used to determine the comparison in D-dimer level between HIV patients with a CD4 count of < 200/µL and > 200/µL, which showed a p-value = 0.002. This indicated a significant difference in D-dimer level between HIV patients with a CD4 count of < 200/µL and > 200/µL.
 Conclusion: The lower the CD4 lymphocyte count, the higher the activities of PT, aPTT, fibrinogen, and D-dimer in HIV patients.
 
 Keywords: HIV, PT, aPTT, D-Dimer, Fibrinogen, Hemostasis

DIFFERENCES VALUE OF PT AND APTT IN EXAMINATION OF ELECTROMECHANICAL AND PHOTO-OPTICAL METHOD

Background: Examination of PT and APTT in hospitals and clinical laboratories by utilizing the use of different instruments and methods. Examination of PT and APTT can be implemented through electromechanical or photo-optical techniques to detect changes in plasma turbidity. This method principle isprincipled that addition can affect the increase in plasma viscosity. Purpose: To analyze the differences in the values of PT and APTT between the electromechanical method and the photo-optical method. Method: Analytical observation, 32 plasma citrate without interference and hemolysis were examined at the Clinical Pathology Laboratory of RSU Haji Surabaya and the Ultra Medica Main Clinics Laboratory in Surabaya. The study used SPSS 24.0 program to determine whether there were PT and APTT values with an electromechanical and photo-optical method. Result: The result of PT and APTT with the electromechanical method was significantly higher than PT and APTT with the photo-optical method on samples without interference. In hemolytic samples, the result of PT with the electromechanical method was significantly higher than the PT result with the photo-optical method. Meanwhile, the result of APTT with the electromechanical method was significantly lower than the APTT result with the photo-optical method in hemolytic samples. Conclusion: There were significant differences in PT and APTT results between electromechanical and photo-optical in samples without interference and hemolytic. It is due to the difference in the detection principle between the two methods.

Changes In Prothrombin And Activated Partial Thromboplastin Time During Replacement Therapy With Human Recombinant Growth Hormone In Growth Hormone Deficient Adults

Abstract Introduction/Objective The aim of this study was to investigate the effects of GH administration on basic coagulation parameters: PT, aPTT and fibrinogen concentrations in adult GHD patients before and during one year of GH replacement. Methods Twenty-one adult patients with severe GHD (mean age +/- SE: 38.6 +/- 2.8 years) were included in this hospital based, prospective, interventional study. All patients were treated with rhGH for 12 months (GH dose: 0.4 mg/day for male and 0.6 mg/day for female patients). IGF-1 concentrations were determined using RIA-INEP kits. Basic coagulation tests, i.e. aPTT and fibrinogen concentrations, were measured before and after 3, 6 and 12 months of treatment with rhGH. Control values were obtained from fourteen “healthy” subjects matched by age, sex and body mass index (BMI). Results At baseline, we observed no significant differences in PT, aPTT and fibrinogen values between GHD and healthy subjects. IGF-1 concentrations increased significantly within 3 months of GH therapy (8.2 +/- 1.5 vs. 24.2 +/- 2.9 nmol/l, p <0.05) and remained stable thereafter. A significant increase in PT values, which was more pronounced in female subjects, was noted after 6 and 12 months of treatment with GH. aPTT values increased significantly after 12 months of treatment only in male patients (28.8 +/- 4.6 vs. 39.7 +/- 2.1 s.; p <0.05). No significant changes in fibrinogen concentrations were found during the study. Conclusion Twelve months of GH replacement therapy led to a significant increase in PT and aPTT values in adult GHD patients, while fibrinogen concentrations did not change. Changes in PT were more pronounced in female GHD patients, while an increase in aPTT values was observed only in male patients with GHD. The clinical significance of these changes needs further evaluation.

A study on factors influencing the hemostatic potential of fresh frozen plasma.

BACKGROUND:Fresh frozen plasma (FFP) is administered to correct deficiencies of various coagulation factors. The level of these factors in FFP varies with donor demographics and ex-vivo processing of plasma. In this study we have compared the quality control parameters of FFP collected from donors of different genders, age groups, ABO blood groups, smoking and alcohol intake habits.MATERIALS AND METHODS:Four ABO group matched plasma units were pooled, split and further processed by four different freeze-thaw algorithms: frozen by contact shock freezer; thawed at 37°C, frozen by contact shock freezer; thawed at 45°C, frozen by mechanical freezer; thawed at 37°C, frozen by mechanical freezer; thawed at 45°C. The coagulation factor levels in plasma units were compared.RESULTS:There were no significant differences in the quality parameters with donor age, gender and alcohol intake. Factor VIII levels were significantly lower in O group FFP (P < 0.05). Smokers had significantly higher levels of fibrinogen (P < 0.05). There were no significant differences in PT, fibrinogen and factor VII levels of FFP processed through various algorithms. Plasma frozen rapidly through contact shock freezer had significantly lower aPTT and higher levels of factor V and VIII compared to mechanical freezing. There were no significant differences between PT, aPTT, fibrinogen, factor V, factor VII and factor VIII levels of FFP thawed at 37°C and 45°C. Mean thawing time was 28 minutes at 37°C and 17 minutes at 45°C.CONCLUSION:Rapid freezing is recommended for optimum preservation of coagulation factors. Thawing may be done at 45°C in cases of emergency, without compromising hemostatic potential.

Clinical evaluation of Chinese disseminated intravascular coagulation scoring system (version 2017) in patients with acute promyelocytic leukemia

目的探索2017年版中国DIC诊断积分系统（CDSS）在急性早幼粒细胞白血病（APL）DIC诊断中的适用性。方法回顾性分析2004年1月至2018年2月就诊于中国医学科学院血液病医院并行诱导治疗的220例APL患者病历资料，采用CDSS、国际血栓与止血协会（ISTH）DIC积分系统和日本卫生福利部（JMHW）DIC积分系统分别进行评价及比较分析。结果220例APL患者中，男114例，女106例，中位年龄38.5（12~70）岁，其中低/中危组173例，高危组47例。11例患者诱导治疗期死亡。CDSS、ISTH、JMHW三种标准诊断DIC阳性率分别为62.27%、54.09%、69.09%。CDSS和ISTH诊断DIC的一致率为78.10%，CDSS和JMHW诊断DIC的一致率为88.32%。ROC曲线比较三者互为参照的敏感度及特异度，敏感度JMHW>CDSS>ISTH，特异度ISTH>CDSS>JMHW。CDSS DIC（+）和DIC（−）组患者PT、APTT、纤维蛋白原（FIB）、D-二聚体及纤维蛋白原/纤维蛋白降解产物（FDP）之间差异均有统计学意义（P值均<0.05）；但采用ISTH诊断积分系统时DIC（−）组的D-二聚体水平高于DIC（+）组[26.3（0.6~488.7）mg/L对21.9（1.2~477.1）mg/L，χ2=1.871，P=0.002]；采用JMHW诊断积分系统时DIC（+）与DIC（−）组的APTT差异无统计学意义[27.05（18.0~181.0）s对26.15（18.2~35.5）s，χ2=1.162，P=0.134]。CDSS DIC（+）和DIC（−）组患者的年龄及性别差异无统计学意义（P>0.05）；单因素Logistic回归显示患者起病时WBC、骨髓中异常早幼粒细胞比例对DIC的发生存在影响（P<0.05），而多因素分析显示在CDSS中起病时WBC>3×109/L是DIC发生的独立危险因素（OR=3.525，95%CI 1.875~6.629，P<0.001）。结论2017年版CDSS诊断DIC的敏感度高于ISTH DIC积分系统，特异度优于JMHW DIC积分系统。CDSS较ISTH、JMHW对于DIC相关指标具有较好区分度，适用于中国APL患者的DIC诊断。

Abstract P5-23-06: Metastatic pattern in stage IV male breast cancer at initial diagnosis: A population-based study

Abstract Background: Male breast cancer (MaBC) is a relatively uncommon disease, representing less than 1% of all breast cancers. Although men tend to present at more advanced stages, the prognostic influence of metastatic pattern (MP), sites of metastases and factors associated with specific organ involvement are unknown. The primary aim of this study was to analyze the influence of MP compared with other biologic and clinical factors in the survival of patients (pts) with stage IV breast cancer at initial diagnosis (BCID). Secondary aims were to describe sites of metastases and evaluate factors associated with specific sites of metastatic spread. Methods: We evaluated men with microscopically confirmed stage IV BCID with known metastatic sites, reported to the Surveillance, Epidemiology and End Results (SEER) 18 registries program from 2010 to 2014. Pts with other primary tumor either before or after breast cancer were excluded. MP was categorized as bone only, visceral (lung, liver or brain), bone and visceral and other. Pt characteristics were compared between MP. Univariate and multivariate analyses determined the effects of each variable on overall survival (OS). Logistic regression examined factors associated with specific sites of metastases. Results: We included 136 pts. Median age was 63 years (range 28-91). At diagnosis, bone only metastases represented 31.6% of pts, visceral 16.2%, bone and visceral 38.2% and other 14%. Median OS for the entire cohort was 33 months (95% CI 19 months – not reached). Bone was the most common site of metastases (69.9%), followed by lung (44.9%), liver (14%) and brain (8.1%). OS rate at 3 years by MP was: bone only 46.05%, visceral 53.57%, bone and visceral 37.23% and other 70.56% (p=0.41). There were no significant differences in pt or tumor characteristics between MP. However, in adjusted logistic regression, triple negative (TN) and ER/PR+/HER2+ tumors had higher odds of brain metastases than ER/PR+/HER2- (all p&amp;lt;0.05). Also, ER/PR+/HER2+ tumors had higher odds of liver metastases (p=0.027). Univariate analysis showed that older age (HR 1.7; p=0.03), no surgery (HR2.5; p=0.005), TN tumors (HR 5.6; p&amp;lt;0.001) and pts with brain metastases (HR 4.2; p&amp;lt;0.001) had worse prognosis. In multivariate analysis, TN subtype (HR 4.2; p=0.001) and pts with brain metastases (HR 3.44; p=0.012) had significantly shorter OS. Conclusions: To our knowledge, this is the first study of MP in MaBC. The cohort had an acceptable median OS which did not differ significantly according to MP. Although brain metastases were less common, it is important to recognize their worse prognosis. Independent predictors of OS included tumor subtype and brain metastases. Tumor subtype had a clear influence on specific sites of metastases, particularly for brain and liver involvement. Citation Format: Leone JP, Leone BA, Zwenger AO, Vallejo CT, Romero AO, Machiavelli MR, Perez JE, Leone J. Metastatic pattern in stage IV male breast cancer at initial diagnosis: A population-based study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-23-06.

Age-Adjusted Alignment Goals Have the Potential to Reduce PJK.

Retrospective cohort. To explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction goals. Recent adult spinal deformity (ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK. ASD patients with fusions to the pelvis were included and stratified into three groups: young adults (YA <40 years old), middle aged (MA: 40-65 years old), and the elderly (ED >65 years old). Analysis of variance compared the groups with respect to 1-year postoperative alignments and 1-year offsets from age-specific alignment targets. A total of 679 patients were enrolled (mean age = 61 years old, 77% female, body mass index = 28.1). At 1 year postoperatively, there was a significant decrease in pelvic tilt (PT; 29-23°), spinopelvic mismatch (pelvic incidence [PI]-lumbar lordosis [LL]) (28-5°), and sagittal vertical axis (SVA; 110-37 mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n = 28; MA, n = 389; ED, n = 262) revealed an increase in PJK incidence with age: YA = 17.9%, MA = 43.8%, and ED = 50.2% (P < 0.001). PJK patients had smaller postoperative PI-LL mismatches (ED 0.8° vs. 9.8°, MA 3.1° vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the postoperative offsets from age-specific norms revealed that PJK patients in the two older subgroups and in the study cohort as a whole were overcorrected as compared to non-PJK patients (PI-LL offset-all: -5.2° vs. 2.8°, MA: -1° vs. +4°, ED: -11° vs. -2°; SVA offset-all: -10 mm vs. 7 mm, MA: -3 mm vs. 10 mm, ED: -18 mm vs. -6 mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT, and 0.136 for SVA). Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard preoperative planning process. 3.

Effects of different doses of heparin - encapsulated solution on coagulation mechanism in elderly patients with cardiac surgery

Objective: To investigate the effect of different doses of heparin-encapsulated liquid on the coagulation mechanism of elderly patients with cardiac surgery using superficial venous indwelling needle, and to select safe and effective dose of heparin-sealing fluid for elderly patients without increasing cardiac load. Methods: Select the use of superficial venous catheter in the heart of the coagulation function of normal elderly patients with 100 cases were randomly divided into two groups, respectively using heparin saline solution 5mL (containing heparin 62.5U / mL), 3mL (containing heparin 50.0U / mL) for indwelling needle tube, carry out before catheterization and disable heparin tube solution 24h prothrombin time (PTT), activated partial thromboplastin time (APTT), fibrinogen (Fg), and observe for any signs of bleeding (such as skin, mucous membrane with or without bleeding), while recording the retention time of indwelling needle. Results: There were no significant differences in PT, APTT and Fg between the two different doses of heparin tube (P> 0.05). There was no significant difference in the number of days between the two different doses of heparin sealed fluid and the retention time of indwelling needle (P <0.05). Conclusion: It is safe and reliable to use the above different dose of heparin sealed fluid in elderly patients with normal cardiac coagulation mechanism. Indwelling needle sealing with a small dose of low concentration of heparin sodium dilution is better, both to reduce the burden on the heart, save time, and will not affect the coagulation function.

A protocol for management of blood loss in surgical treatment of peritoneal malignancy by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

The treatment of peritoneal malignancies with cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to be associated with massive surgical blood loss. Maintaining high fibrinogen levels throughout surgery may reduce blood loss in these patients. The primary aim of the study was to see if Tranexamic Acid (TXA) and cryoprecipitate reduced surgical blood loss and hence red cell transfusions. A comparison was made with a cohort of patients treated with fresh frozen plasma (FFP) alone. The secondary aim was to measure the effect of both protocols on coagulation parameters and the incidence of arterial or venous thrombosis. We used prospectively collected data from 201 patients who had complete CRS with HIPEC for peritoneal malignancy using different protocols during two discrete 12-month time periods. The new transfusion protocol led to a higher average fibrinogen level intra-operatively and post-operatively, with a significant reduction in average RBC, FFP and platelet transfusion intra-operatively per patient from 4·2 to 1·8 units, 6·2 to 0·2 units and 0·1 to 0 units, respectively. No significant difference in PT or APTT was seen between patients treated with the standard and new protocols. Venous thrombosis occurred in seven patients treated with the standard protocol and five with the new protocol. A single case of arterial thrombosis was seen in both groups. Patients treated with upfront TXA and cryoprecipitate during CRS required less RBC transfusion than those treated with the standard protocol of early FFP.

Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection.

To determine the correlation of the difference between postoperative lumbar lordosis (LL) and ideal LL with the sagittal vertical axis (SVA) at the final follow-up in patients with adult spinal deformity (ASD). Fifty-one patients with degenerative lumbar kyphosis (DLK) (mean age 66.5years) who underwent surgical correction with a minimum 2-year follow-up were evaluated. Based on the difference between postoperative LL and ideal LL using the Korean version of Legaye's formula, we divided the 51 patients into two groups: overcorrection (degree of postoperative LL>ideal LL) and undercorrection (degree of postoperative LL<ideal LL). Our clinical series of patients comprised 24 in the overcorrection and 27 in the undercorrection group. No significant differences were found in preoperative pelvic incidence (PI 52.6° vs. 57.3°), sacral slope (SS 23.3° vs. 18.3°), LL (-6.9° vs. -2.3°), thoracic kyphosis (TK 4.7° vs. 4.9°) and SVA (140 vs. 139mm) except pelvic tilt (PT 29.4° vs. 39.0°), between the two groups. All the patients in the overcorrection group and 16 in the undercorrection group achieved postoperative optimal sagittal balance based on SVA≤50mm. In addition, significant differences in PT (10.5° vs. 26.7°), SS (42.1° vs. 30.6°), LL (-64.3° vs. -37.1°), TK (22.6° vs. 15.8°), and SVA (-1 vs. 41mm) between the two groups were observed postoperatively. Furthermore, four patients (16.7%) in the overcorrection group and eight (50%) in the undercorrection group had sagittal decompensation at the final follow-up. Our results showed that the difference between postoperative LL and ideal LL had a significant correlation with postoperative and final follow-up SVA in our clinical series. Overcorrection of LL is an effective treatment modality to maintain optimal sagittal alignment in patients with DLK; this suggests that it should be considered in preoperative planning for patients with ASD with sagittal imbalance.

Abnormalities in cancer patients' coagulation system.

e22207 Background: It is well known cancer patients may present both hemorrhagic and thrombotic abnormalities and these phenomena are difficult to diagnose and treat. Thrombotic phenomena are developed clinicly in 15% in cancer patients and it’s higher in adenocarcinomas and myeloprolipherative disorders. These complications can be the consequence of coagulations factor direct activation or chronic DIC, because of the acquired capacity of neoplastic cells for starting coagulation cascade. Methods: In this study an untreated cancer patients group were compared with another healthy controls group, older than 14 years. Patients before treatment and controls were laboratory tested. A t – test for independent samples was employed. Results: Number: patients group: 66, control group: 73. Median age: patients: 50 (17-78). Controls: 52 (18 -93). Sex: Patients: men: 35%, women: 65%. Controls: men: 52%, women: 48%. Malignancies: breast cancer 9.7%; gastric carcinoma 8.1%; cervical carcinoma 6.5%; NH lymphomas 6.5%, unknown origen metastatic carcinoma 4.8%; oral carcinoma 4.8%. Clinical stages: I: 6.3%; II: 6.3%; III: 22.9%; IV: 62.5% (metastatic) 47.9%. Thrombotic antecedents in patients group: 19.7%. There were significant differences in: Platelets count: patients: 281121, controls: 307745 (p&lt;0.001). Protein C: 0.87 and 3.81 UI/mL, respectively (p &lt; 0.001). Antithrombin III: 97 and 101% (p&lt;0.001). Plasminogen: 92.9 and 101.1% (p &lt; 0.001). Lupus anticoagulant (RVV time): 27 and 25.6” (p&lt;0.001). There were no significant differences in PT: 18.3 and 16.9” and PTT: 31 and 34”. The same significant differences were got when the patients of every clinical stage were compared with control patients. There were no differences when the patients of every clinical stage were compared among themselves, nor between sex. Conclusions: This study shows cancer patients may have many coagulation abnormalities: anticoagulant system defects and fibrinolytic system hipoactivity, demonstrated by the significant differences found in antithrombin III, protein C and plasminogen levels between patients and controls groups. It is suggested to practice these tests to cancer patients, even without clinical coagulation disorders, to stablish prophylactic measures.

Isokinetic strength of knee flexors and extensors of adolescent soccer players and its changes based on movement speed and age

BACKGROUND: During childhood and adolescence there is growth in muscle strength. The dynamics of change in muscle strength and its causes have not yet been fully clarified and may differ within individuals and specific groups. The knowledge of current isokinetic strength levels among athletes of varying ages and disciplines represents important information from the point of view of sport performance, as well as health prevention. OBJECTIVE: The aim of this study is to determine within a group of highly trained adolescent soccer players (n = 45; age = 17 ± 1.2 years; body height 178.4 ± 5.3 cm, body weight 68.5 ± 7.6 kg) the isokinetic strength of knee flexors and extensors and to judge whether it is significantly influenced by age and movement speed. METHODS: A group of players was further divided according to age into 3 subgroups - U16 (n = 16); U17 (n = 14); U18 (n = 15). Unilateral strength was measured by the isokinetic dynamometer ISOMED 2000 (D. & R. Ferstl GmbH, Hemau, Germany) at angular speeds of 60° × s^(-1), 180° × s^(-1) and 360° × s^(-1). The parameter evaluated was the isokinetic peak torque (PT; Nm). RESULTS: The ANOVA results demonstrate that there was a significant decrease in the PT within the entire group of players with an increase in speed during both flexion and extension (dominant extremity: p ＜ 0.001 resp. p ＜ 0.019; non-dominant extremity: p ＜ 0.001; resp. p ＜ 0.001). The difference in PT among the age categories was not significant for both flexors and extensors at the speed of 60° × s^(-1) (p = 0.005; resp. p = 0.036) and the speed of 180° × s^(-1) (p = 0.036; resp. p = 0.033). However, significant differences in PT among individual categories were confirmed only in some cases and, by contrast, an insignificant decrease was marked with nondominant leg extensors.CONCLUSIONS: The results of this study indicated the state of the strength readiness of the highly trained soccer players in the junior category and the potential shortcomings in the concept of strength preparation within a leading club in the Czech Republic. These results contributed to the deepening of knowledge about changes in strength with age and confirmed the importance of applying diagnostics during systematic long-term sport preparation.

Haemostatic profile of full-term, healthy, small for gestational age neonates

Background Small for Gestational Age (SGA) neonates often appear with haemostatic alterations, principally due to hepatic dysfunction that results from chronic intrauterine hypoxia. Polycythaemia and thrombocytopenia are common findings in this neonatal population. Study design We performed a comparison of coagulation, natural inhibitors and fibrinolysis between SGA and Appropriate for Gestational Age (AGA) infants born full term [gestational age (G.A.) > 37 weeks]. Study population consisted of 188 healthy newborns, 90 of whom were SGA (62 females and 28 males), while the rest were the control group (44 females and 54 males). Blood samples were obtained within 30 minutes following birth and before the administration of vitamin K. Investigation included: PT, INR, APTT, fibrinogen, coagulation factors II, V, VII, VIII, IX, X, XI, XII, vWillebrand factor, protein C and free protein S, antithrombin (AT), APCR, tPA and PAI-1. The independent t-test was used to compare the differences between the values of haemostatic parameters. Results Statistical analysis revealed a significant prolongation in PT, INR, elevated levels of tPA ( p < 0.015, 0.01 and 0.002 respectively) and a decrease in the values of XII and free protein S ( p < 0.045 and 0.007 respectively) in SGA full term neonates. The two groups had similar demographic characteristics (except birth weight), without significant differences in the values of other haemostatic parameters. Conclusions Despite of statistically significant differences in PT, INR, values of tPA, XII and free protein S, levels of haemostatic factors range within laboratory references for healthy full term newborns. These findings were not accompanied with clinical manifestations of altered haemostasis.

Clinical application of ultra-low-dose heparin via hypodermic injection in treatment of neonate's disseminated intravascular coagulation

目的 观察超小剂量肝素皮下注射对新生儿弥散性血管内凝血(DIC)的疗效.方法 42例确诊DIC的患儿随机分为常规剂量组及超小剂量组:超小剂量组20例,以超小剂量肝素(普通肝素)皮下注射,剂量为6U/(kg·次),每6～8小时1次;常规剂量组22例,剂量为60～125U/(kg·次)静滴,必要时可4～8h给药1次;两组其他治疗原则相同.观察两组治愈率,治疗过程中每12～24小时监测凝血酶时间(TT)、活性部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(Fib)、血小板计数等出凝血指标.结果 超小剂量肝素组治愈率(85.5%)明显高于常规剂量肝素组(55.6%),P＜0.05.超小剂量组17例治愈患儿用药24h后与用药前比较PT缩短(P＜0.05)、Fib升高(P＜0.05),48h后PT、APTT、TT与用药前比较均缩短(P＜0.05),Fib升高(P＜0.05),而常规剂量组12例治愈患儿用药24h后PT较用药前延长(P＜0.05),APTT、TT、Fib无明显改变(P＞0.05),用药48h后PT、TT均延长,与用药前比较差异有显著性(P＜0.05).血小板恢复较慢,两组用药24h及用药48h后与用药前比较差异均无显著性(P＞0.05). 用药24h后超小剂量组与常规剂量组PT、Fib差异有显著性(P＜0.05),48h后两组PT、APTT、Fib差异有显著性(P＜0.05).结论 皮下注射超小剂量肝素治疗新生儿DIC安全、有效,值得推广应用。

Minimum specimen volume requirements for routine coagulation testing: dependence on citrate concentration.

We evaluated the effect of sample volume and citrate concentration on results of routine coagulation assays (prothrombin time [PT] and activated partial thromboplastin time [APTT]). The study was performed on samples obtained from healthy persons and patients receiving oral anticoagulant therapy. Standard evacuated tubes (3.2% and 3.8% sodium citrate) were filled to varying total sample volumes ranging from 3.0 to 5.0 mL, and results of routine coagulation tests were compared. Underfilling may significantly affect the APTT and PT, resulting in artifactual prolongation of results. This effect is most pronounced in samples drawn into 3.8% citrate. By using 3.8% citrate, there is a statistically significant difference in the results of PT assays in the samples less than 80% filled compared with those that are 100% filled. For APTT assays performed on samples drawn into 3.8% citrate, a statistical difference occurred at less than 90% filled. This effect was less pronounced when samples were drawn into 3.2% sodium citrate. We found no statistically significant difference in PT results from a 3.2% citrate tube between fill volumes of 60% and 100% and none for APTT results between fill volumes of 70% and 100%. This study further supports the recommendation to use 3.2% sodium citrate concentration, because 60% of the optimum filled volume for PT and 70% of the optimum filled volume for APTT are acceptable.