Vertebral fractures combined with prolonged activated partial prothrombin time:A case report / 北京大学学报(医学版)

With the development of modern medical standards,autoimmune diseases and their associ-ated successive osteoporosis have received increasing attention in recent years.Patients with autoimmune diseases,due to the characteristics of the disease and the prolonged use of glucocorticoid hormone thera-py,may affect the bone formation and bone absorption of the patient,followed by severe successive osteo-porosis,thereby increasing the risk of osteoporotic vertebral fractures.Vertebral compression fractures of the spine are common fracture types in patients with osteoporotic fractures.Osteoporosis is a common complication after glucocorticoid therapy in patients with autoimmune diseases.Percutaneous vertebro-plasty(PVP)and percutaneous kyphoplasty(PKP)are minimally invasive operation and are commonly used surgical methods for the treatment of osteoporotic vertebral compression fractures.However,due to the operation of spinal puncture during the operation,there are serious surgical risks such as bone cement leakage,spinal epidural hemorrhage,subdural hemorrhage,and subarachnoid hemorrhage in both PVP and PKP.As a result,it is necessary to evaluate the patient's body before surgery carefully,especially in the case of blood coagulation.This article reports a case of autoimmune disease patient admitted to Peking University People's Hospital due to lumbar 4 vertebral compression fracture combined with Sj?gren's syn-drome.The patient's preoperative examination showed that the activated partial thromboplastin time(APTT)was significantly prolonged.After completing the APTT extended screening experiment and lu-pus anticoagulant factor testing,the multi-disciplinary team(MDT)of Peking University People's Hospi-tal jointly discussed the conclusion that the patient's test results were caused by an abnormal self-immuni-ty anti-copulant lupus(LAC).Based on the results of the laboratory examination,the patient was con-sidered to be diagnosed with combined antiphospholipid syndrome(APS).For such patients,compared with the patient's tendency to bleed,we should pay more attention to the risk of high blood clotting in the lower limbs of the patient,pulmonary clots and so on.With timely anti-coagulation treatment,the patient safely passed the peripheral period and was successfully discharged from the hospital.Therefore,for pa-tients with autoimmune diseases with prolonged APTT in the perioperative period,doctors need to careful-ly identify the actual cause and carry out targeted treatment in order to minimize the risk of surgical and perioperative complications and bring satisfactory treatment results to the patients.

Diagnosis and treatment of the portal vein complications for children undergoing spilt liver transplantation / 器官移植

Objective To investigate the diagnosis and treatment strategy of the portal vein complications in children undergoing split liver transplantation. Methods The clinical data of 88 pediatric recipients who underwent split liver transplantation were retrospectively analyzed. Intraoperative anastomosis at the bifurcating site of the portal vein or donor iliac vein bypass anastomosis was performed depending on the internal diameter and development of the recipient's portal vein. A normalized portal venous blood stream monitoring was performed during the perioperative stage. After operation, heparin sodium was used to bridge warfarin for anticoagulation therapy. After portal vein stenosis or thrombosis was identified with enhanced CT or portography, managements including embolectomy, systemic anticoagulation, interventional thrombus removal, balloon dilatation and/or stenting were performed. Results Among the 88 recipients, a total of 10 children were diagnosed with portal vein complications, of which 4 cases were diagnosed with portal vein stenosis at 1 d, 2 months, 8 months, and 11 months after surgery, and 6 cases were diagnosed with portal vein thrombosis at intraoperative, 2 d, 3 d (n=2), 6 d, and 11 months after surgery, respectively. One patient with portal vein stenosis and one patient with portal vein thrombosis died perioperatively. The fatality related to portal vein complications was 2% (2/88). Of the remaining 8 patients, 1 underwent systemic anticoagulation, 2 underwent portal venous embolectomy, 1 underwent interventional balloon dilatation, and 4 underwent interventional balloon dilatation plus stenting. No portal venous related symptoms were detected during postoperative long term follow up, and the retested portal venous blood stream parameters were normal. Conclusions The normalized intra- and post-operative portal venous blood stream monitoring is a useful tool for the early detection of portal vein complications, the early utilization of useful managements such as intraoperative portal venous embolectomy, interventional balloon dilatation and stenting may effectively treat the portal vein complications, thus minimizing the portal vein complication related graft loss and recipient death.

Application of thromboelastography in the prediction of deep vein thrombosis after high-energy ankle injury surgery / 中国基层医药

Objective:To analyze the application value of thromboelastography (TEG) in the prediction of lower limb deep vein thrombosis (DVT) after high-energy ankle injury surgery.Methods:The clinical data of 62 patients undergoing high-energy ankle injury surgery who received treatment in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2019 to December 2021 were retrospectively analyzed. Based on the occurrence of lower limb DVT, the patients were divided into a control group (without lower limb DVT, n = 42) and an observation group (with lower limb DVT, n = 20). The conventional coagulation function indicators and TEG parameters were compared between the two groups. The receiver operating characteristic (ROC) curves were used to investigate the value of classic coagulation function indicators and TEG parameters in the prediction of lower limb DVT after high-energy ankle injury surgery. Results:The activated partial thromboplastin time in the observation group was (33.29 ± 3.40) seconds, which was significantly shorter than (35.66 ± 3.36) seconds in the control group ( t = 2.59, P < 0.05). The levels of fibrinogen and D-dimer in the observation group were (3.83 ± 0.46) g/L and (1.77 ± 0.43) g/L, respectively, which were significantly higher than (3.47 ± 0.51) g/L and (1.56 ± 0.35) g/L, respectively, in the control group ( P = -2.68, -.05, both P < 0.05). Prothrombin time and thrombin time showed no significant differences between the two groups (both P > 0.05). Coagulation reaction time and cell agglutination formation time in the observation group were (3.80 ± 0.83) minutes and (3.38 ± 0.51) minutes, respectively, which were significantly lower than (4.49 ± 1.21) minutes and (3.82 ± 0.55) minutes in the control group ( t = 2.30, 2.96, both P < 0.05). The maximum clot strength and coagulation rate (α angle) in the observation group were (78.69 ± 9.22) mm and (83.37 ± 9.30) °, respectively, which were significantly greater than (68.33 ± 9.10) mm and (71.25 ± 8.35) ° in the control group ( t = -4.17, -5.15, both P < 0.05). The ROC curve analysis found that the area under the ROC curve describing the prediction of combined indexes for lower limb DVT was 0.983, which was significantly greater than the area under the ROC curve describing the prediction of a single index for lower limb DVT (all P < 0.05). Conclusion:Activated partial thromboplastin time, fibrinogen, D-dimer, coagulation reaction time, red blood cell agglutination formation time, maximum clot strength, and α angle are significantly different between patients with DVT in the lower limb after surgery for an ankle injury and those without DVT. The combination of these indicators can serve as the basis for preventing and treating thrombosis in patients after high-energy ankle injury surgery, demonstrating remarkable practical advantages.

Prognostic value of AST/ALT ratio combined with APTT regimen in NVAF patients receiving rivaroxaban anticoagulant therapy / 国际生物医学工程杂志

Objective:To investigate the prognostic value of the ratio of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) combined with activated partial thromboplastin time (APTT) in elderly patients with non-valvular atrial fibrillation (NVAF) treated with rivaroxaban.Methods:One hundred and twenty-two elderly patients with NVAF who were anticoagulated with rivaroxaban from June 2020 to June 2021 in the Third Central Hospital of Tianjin were enrolled and divided into four groups based on the median method. The patients in the Q1 group ( n = 32) have low AST/ALT/low APTT. The patients in the Q2 group ( n = 27) have low AST/ALT/high APTT. The patients in the Q3 group ( n = 29) have high AST/ALT/low APTT. The patients in the Q4 group ( n = 34) have high AST/ALT/high APTT. The efficacy endpoint events, and safety endpoint events were analyzed in the four groups, and univariate and multivariate Cox regression analyses were performed for the composite endpoint events. Results:The effectiveness endpoint events were mainly cardiovascular deaths, the number of which in the Q1 to Q4 groups was 0 (0), 1 (3.70%), 4 (13.79%), and 5 (14.71%), respectively. The safety endpoint events were mainly non-major bleeding events, the number of which in the Q1 to Q4 groups was 5 (15.62%), 2 (7.41%), 6 (20.69%), and 5 (14.71%), respectively. Compared to the Q1 group, the Q4 group had an increased risk of composite endpoint events after incorporating traditional risk factor correction ( HR: 3.851, 95% CI: 1.167 to 12.704). Conclusions:AST/ALT ratio combined with APTT can provide risk stratification for distant bleeding and cardiovascular adverse events in elderly NVAF patients treated with rivaroxaban anticoagulation and has some predictive value for their prognosis.

Risk factors for bleeding and thrombotic events in critically ill patients undergoing extracorporeal membrane oxygenation / 中华急诊医学杂志

Objective:To investigate the risk factors for bleeding and thrombosis during extracorporeal membrane oxygenation (ECMO) therapy in critically ill patients and determine the best predictors of coagulation-related complications.Methods:A retrospective analysis was performed on patients who received ECMO for respiratory or circulatory failure at Xiangya Hospital of Central South University from January 2020 to December 2022. The outcome was whether bleeding or thrombosis occurred from 24 h after ECMO insertion to before weaning. The differences in demographic characteristics, weaning conditions, prognosis, routine blood tests, organ function, coagulation and blood product transfusion of each group were compared. Logistic regression analysis was used to evaluate the risk factors for bleeding and thrombosis, and ROC curve evaluation was used to assess their capacity to predict complications.Results:A total of 61 patients with ECMO were enrolled, with 21 cases of bleeding and 14 cases of thrombosis during ECMO. Compared with the nonbleeding group, the activated partial thromboplastin time, thromboplastin time (TT), and transfusions of frozen plasma and red blood cells were higher in the bleeding group (all P<0.05). Compared with the nonthrombotic group, the increase in body weight, D-dimer (DD), fibrinogen degradation product (FDP), and improvement of arterial oxygen partial pressure (ΔPO 2) within 24 h were significantly higher in the thrombotic group (all P<0.05). Logistic regression analysis revealed that TT ( OR=1.039, 95% CI: 1.006~1.072, P=0.018) and frozen plasma transfusion volume ( OR=1.046, 95% CI: 1.010-1.083, P=0.012) were risk factors for bleeding events. FDP ( OR=1.030, 95% CI: 1.009-1.051, P=0.005), DD ( OR=1.181, 95% CI: 1.044-1.336, P=0.008), and ΔPO 2 ( OR=1.007, 95% CI: 1.002-1.012, P=0.006) were risk factors for thrombosis. According to ROC curve analysis, the AUCs of TT, frozen plasma transfusion, and combined indexes for predicting bleeding were 0.712, 0.690, and 0.816, respectively. The combined indices had a cut-off value of 0.273, a sensitivity of 75.61%, and a specificity of 80.00%. The AUCs of FDP, DD, ΔPO 2, and combined FDP with ΔPO 2 for predicting thrombosis were 0.778, 0.748, 0.786, and 0.868, respectively. The cut-off value of the combined index was 0.157, the sensitivity was 68.09%, and the specificity was 92.86%. Conclusions:TT combined with frozen plasma transfusion volume predicted bleeding optimally, while FDP plus ΔPO 2 predicted thrombotic events better during ECMO treatment in critically ill patients.

Application value of coagulation indices and neutrophil-to-lymphocyte ratio for assessing coagulation status of ovarian cancer patients / 肿瘤研究与临床

Objective:To explore the clinical application value of general coagulation indices and neutrophil-to-lymphocyte ratio (NLR) for assessing coagulation status of patients with ovarian cancer.Methods:The data of 190 patients with ovarian cancer who were admitted to the Second Hospital of Shanxi Medical University from October 2019 to September 2022 were retrospectively analyzed. According to the International Federation of Gynecology and Obstetrics (FIGO) staging, the patients were divided into early (stage Ⅰ-Ⅱ) ovarian cancer group (70 cases) and advanced (stage Ⅲ-Ⅳ) ovarian cancer group (120 cases). Forty-four patients with benign ovarian tumors who were treated in the Second Hospital of Shanxi Medical University during the same period were selected. Plasma D-dimer (D-D), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (FIB) and thrombin time (TT) were tested. Platelet count (Plt), neutrophil count and lymphocyte count were measured by blood cell analyzer, and NLR was calculated. The receiver operating characteristic (ROC) curve was used to analyze the value of coagulation indices and NLR in the assessment of venous thromboembolism (VTE) in patients with ovarian cancer.Results:Compared with the benign ovarian tumor group, PT of patients in the early and advanced ovarian cancer groups was shorter (both P < 0.05), and D-D and Plt increased (both P < 0.05). Compared with the benign ovarian tumors group, TT of patients in the advanced ovarian cancer group decreased ( P < 0.05), and FIB and NLR increased (both P < 0.05). Compared with the early ovarian cancer group, PT and TT in the advanced ovarian cancer group were shorter (both P < 0.05), and FIB, D-D, NLR and Plt increased (all P < 0.05). The optimal cut-off values of FIB, D-D and NLR in stage Ⅰ-Ⅱ and stage Ⅲ-Ⅳ patients with VTE in ovarian cancer group were 3.165, 333.500 and 2.455, and the area under the curve (AUC) was 0.731, 0.837 and 0.759. Conclusions:The coagulation indices of patients with ovarian cancer are abnormal during treatment, suggesting that patients may produce active thrombosis, and the symptoms of patients in advanced stage are more serious.

Analysis of APTT Mixing Test Results in Factor Ⅷ Inhibitor-Positive Hemophilia Patients / 中国实验血液学杂志

OBJECTIVE@#To analyze the results of activated partial thromboplastin time (APTT) mixing test in coagulation factor Ⅷ inhibitor-positive hemophilia patients, so as to increase the value of APTT mixing test in the screen of factor Ⅷ inhibitor.@*METHODS@#Eighty plasmas samples with different titers of coagulation factor Ⅷ inhibitors had been collected and diluted for routine immediate APTT mixing test and at 37 ℃ 2 hours incubation APTT mixing test. Fifteen samples were selected for immediate and normal temperature incubation for 15 min, 30min, 1 hour, 2 hours and 37 ℃ for 30 min, 1 hour, 2 hours APTT mixing test.@*RESULTS@#The results of APTT mixing test were significantly correlated with the titers of coagulation factor Ⅷ inhibitors. The ROC curve result showed that the best diagnostic cut-off value for 2 hours incubation APTT mixing test at 37 ℃ to determine the presence or absence of coagulation factor Ⅷ inhibitors was 43.8 s (sensitivity and specificity was 85.90% and 100%, respectively), while the best diagnostic cut-off value for distinguishing high-titer and low-titer Ⅷ inhibitors was 52.4 s (sensitivity and specificity was 98.18% and 95.65%, respectively). The critical coagulation factor Ⅷ inhibitor titer that could not be corrected by immediate APTT was 5.14 BU/ml, while that could not be corrected by 37 ℃ 2 hours incubation APTT was 1.31 BU/ml. Paired samples t -test was performed on the APTT mixing test results at different times and temperatures, and the differences were statistically significant (P < 0.05).@*CONCLUSIONS@#The APTT mixing test can be used as a screening index for coagulation factor Ⅷ inhibitors. APTT mixing test result shows a significant time-temperature dependence with lower titers of coagulation factor Ⅷ inhibitor. Patients with hemophilia who cannot be corrected by immediate APTT mixing test should be alert to the possibility of high titer of coagulation factor Ⅷ.

Effectiveness Of Bowel Nosode Dysentery Compound In Cases Of Generalized Anxiety Disorders

Background: This study aim Effectiveness of bowel nosode Dysentery compound in 40 cases ofgeneralized anxiety disorder a minimum of 1year, of all the age groups and both gender were included inthe study. Material and Methods: Purposive sampling for research purpose has been done. Selection of medicine was according to concept of methods of Repertorisation. Selection of potency and Repetition wasbasedon law of study Homoeopathic posology which is described in Organon of Medicine. Result: The shows that mostly adults are more affected and acute cases are more present. As far as potencyis concerned mostly higher potency was used as nosodes are usually given in higher potency. Conclusion: Our study has concluded that the role of bowel nosode Dysentery compound is very efficacious.

A study of coagulation profile in preeclampsia compared to normal pregnancy

Background: Preeclampsia is a condition of unknown etiology of multiorgan disease and is distinguished by a raised blood pressure (B.P. >140/90 mmHg) and proteinuria (>300 mg per 24 h) and/or edema following 20 weeks of pregnancy. Aims and Objectives: The study was conducted to differentiate coagulation variables between normotensives and preeclamptic patients. Materials and Methods: Prior consent was obtained from Institutional Ethics Committee. Patients diagnosed with preeclampsia aged between 20 and 35 years were incorporated into the study. Patients with a previous history of hypertension, thyroid disease, and diabetes were excluded from the study. Age-matched controls were taken and analyzed. Data collection done by (i) BP measured in supine posture; (ii) bleeding time (B.T) estimation – by Duke’s method; (iii) clotting time (C.T) estimation – by Wright’s capillary tube method; (iv) platelet count (P.C) estimation – by automated hematology analyzer; and (v) prothrombin time (P.T) and activated partial thromboplastin time (APTT) – estimation by semi-automated analyzer. Results: The study revealed a significant interrelation between P.C and B.T when preeclampsia patients were correlated with normotensives patients while P.T, APTT, and C.T were insignificant statistically. Conclusion: A statistically significant change was observed proposing parameters derangement as the disease becomes more progressive.

Hemofilia adquirida A en embarazo. Caso clínico de medicina crítica en obstetricia por morbilidad extrema y su abordaje transdisciplinario perioperatorio / Acquired hemophilia A in pregnancy. Clinical case of critical medicine in obstetrics due to extreme morbidity and its perioperative transdisciplinary approach

Resumen: La identificación de múltiples factores de riesgo que predisponen a la hemorragia durante el evento obstétrico, como la hemofilia adquirida que es un trastorno que se desarrolla por la generación de autoanticuerpos inhibidores de factores de la coagulación, la interpretación objetiva de las pruebas de laboratorio rutinarias, el desarrollo de un pensamiento sistematizado en la integración diagnóstico-terapéutica por parte del personal de salud, y la disposición de los recursos farmacológicos hospitalarios, es lo que determina frecuentemente el pronóstico en pacientes obstétricas con morbilidad extrema que requieren atención multidisciplinaria en las diferentes unidades hospitalarias del sector salud de nuestro país. El objetivo es presentar un caso clínico de morbilidad extrema por hemofilia adquirida, su presentación clínica, evolución y desenlace fatal. Se presenta un caso referido de otra unidad del Sector Salud ISEM (Instituto de Salud del Estado de México), atendido en la Unidad de Cuidados Intensivos Obstétricos del Hospital «Mónica Pretelini Sáenz¼, resaltando la importancia en la integración diagnóstico-terapéutica y la interacción multifactorial de variables relacionadas con su desenlace fatal. Conclusiones: Desconocimiento de la patología, retraso en el diagnóstico, múltiples procedimientos condicionantes de hemorragia iatrógena y la limitación en recursos terapéuticos son factores que contribuyen a un desenlace fatal.

Abstract: The identification of multiple risk factors that predispose to bleeding during the obstetric event, such as acquired hemophilia, which is a disorder that develops due to the generation of autoantibodies that inhibit coagulation factors, the objective interpretation of routine laboratory tests , the development of systematized thinking in diagnostic-therapeutic integration by health personnel, and the provision of hospital pharmacological resources, is what frequently determines the prognosis in obstetric patients with extreme morbidity who require multidisciplinary care in the different hospital units of the health sector of our country. The objective is to present a clinical case of extreme morbidity due to acquired hemophilia, its clinical presentation, evolution and fatal outcome. A case referred from another unit of the ISEM (Instituto de Salud del Estado de México) Health Sector, treated at the Obstetric Intensive Care Unit of the «Mónica Pretelini Sáenz¼ Hospital, is presented, highlighting the importance of diagnostic-therapeutic integration, and the multifactorial interaction of variables related to its fatal outcome. Conclusions: Ignorance of the pathology, delay in diagnosis, multiple conditioning procedures of iatrogenic hemorrhage and the limitation in therapeutic resources are factors that contribute to a fatal outcome.

Manifestaciones clínicas de la deficiencia de factor XII en un lactante

RESUMEN Introducción: El factor XII o factor de Hageman pertenece al sistema de contacto al ser iniciador de la vía intrínseca de la coagulación. Concentraciones bajas de este factor se asocian a tiempo de tromboplastina parcial activado prolongado, sin embargo, no se producen manifestaciones hemorrágicas como ocurre en la deficiencia de otros factores. Objetivo: Describir las manifestaciones clínicas de un lactante con diagnóstico de deficiencia de factor XII de la coagulación. Presentación del caso: Se presenta un lactante de 10 meses que tuvo aparición espontánea de equimosis y se diagnosticó un déficit de factor XII. Conclusiones: Aunque no es común, la deficiencia del factor XII puede estar asociada a manifestaciones hemorrágicas como equimosis tal como se describe en el presente caso.

ABSTRACT Introduction: Factor XII or Hageman factor belongs to the contact system as it is the initiator of the intrinsic coagulation pathway. Low concentrations of this factor are associated with prolonged activated partial thromboplastin time, however, hemorrhagic manifestations do not occur as occurs in the deficiency of other factors. Objective: Describe the clinical manifestations of an infant diagnosed with coagulation factor XII deficiency. Case presentation: A 10-month-old infant who had spontaneous onset of ecchymosis and a factor XII deficiency was diagnosed. Conclusions: Although not common, factor XII deficiency may be associated with hemorrhagic manifestations such as ecchymosis, as described in the present case.

In vitroMeasurement of Anticoagulant Effect of Acacia Nilotica Aqueous Extract on Normal Human Plasma

Aims:To determine the anticoagulant effect of Acacia Nilotica aqueous extract on normal human plasma.Study Design:This is an experimental study.Place and Duration of the Study:Department of Haematology, Faculty of Medical Laboratory sciences, Alzaiem Alazhari, Khartoum –Sudan, during the period from July –August 2021. Methodology:A total of 20 human blood samples were collected for this study from apparently healthy subjects following ethical considerations. Samples were collected in tri-sodium citrate and platelets poor plasma (PPP) were immediately prepared by centrifugation. Aqueous solution of Acacia nilotica was prepared with distilled water (D.W), three concentrations of the solution (50%, 75% and 100%) were prepared. Prothrombin Time (PT) and Activated partial thromboplastin time (APTT) were tested by manual method before and after adding different concentrations of Acacia Nilotica solution. Statistical tests were performed by using SPSS version 16. Results:The results of study showed that Acacia Nilotica significantly prolonged the PT and APTT results of human plasma (Pvalues for 50%, 75% and 100% solutions were 0.000, 0.000 and 0.000 while for APTT 0.036, 0.000 and 0.000 for PT respectively). Also the study showed no significant correlation between control and A. nilotica concentrations among coagulation profile, except a significant positive correlation between control and 75% Acacia nilotica on APPT.Conclusion:Acacia Nilotica solutions had anticoagulant effect in human plasma, and could be nominated as a potential preventive agent for thromboembolic diseases

Clinical value of myoglobin in predicting multiple organ dysfunction in wasp sting patients / 中华急诊医学杂志

Objective:To investigate the clinical features and risk factors of multiple organ dysfunction syndrome (MODS) caused by wasp sting.Methods:A retrospective cohort study was conducted to collect the general data of wasp sting patients who had a clear history of wasp sting disease and clinical manifestations from June 2016 to December 2020 and were first diagnosed as wasp sting in hospital. Patients with hematological diseases, malignant tumors, severe liver and kidney dysfunction, cardiac insufficiency, and patients who had received hormone therapy before admission were excluded. Patients who were unable to obtain effective laboratory results due to hemolysis or other reasons within 48 h of admission were also excluded. The white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), hemoglobin count (HB), myoglobin (Mb/MYO), activated partial thromboplastin time (APTT), albumin (ALB), K, Na, and Cl of the blood samples collected within 48 h after admission were recorded. Patients were divided into the MODS group and non-MODS group according to whether MODS occurred during hospitalization. Uni- and multivariate analysis were used to analyze the factors affecting the occurrence of MODS in wasp sting patients during hospitalization, and the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive effect of myoglobin level on the occurrence of MODS in wasp sting patients during hospitalization.Results:Mb, WBC, NEU, APTT and serum potassium in the MODS group [3890.00 (1416.90-4057.00) ng/mL, (21.99 ± 8.18) × 10 9/L, (19.61 ± 7.33)× 10 9/L, (93.75 ± 45.77) s, and (4.99 ± 0.95) mmol/L] were significantly higher than those in the non-MODS group [73.50 (34.30-264.20) ng/mL, (13.40 ± 4.14)× 10 9/L, (11.18±4.73)× 10 9/L, (37.00 ± 17.16) s, and (4.05 ± 0.56) mmol/L] (all P < 0.05); blood chlorine and ALB [(101.50 (98.25-105.00) mmol/L and (35.36 ± 6.44) g/L)] were significantly lower than those in the non-MODS group [(105.00 (103.00-107.00) mmol/L and (40.71 ± 5.48) g/L)] (all P < 0.05). Multivariate logistic regression analysis showed that NEU ( OR = 0.729, 95% CI: 0.542~0.981), Mb ( OR = 0.999, 95% CI: 0.998~1.000), and APTT ( OR = 0.951, 95% CI: 0.921~0.982) were independent risk factors for MODS in wasp sting patients. ROC curve analysis showed that NEU, Mb and APTT could be used to evaluate the occurrence of MODS in wasp sting patients. Among them, Mb had the highest predictive value (AUC = 0.950, 95 % CI: 0.891~0.982). The optimal cutoff value of Mb for predicting the occurrence of MODS in wasp sting patients was 515.30 ng/mL, and the corresponding sensitivity and specificity were 90.62% and 87.23%, respectively. Conclusion:Mb is an independent risk factor for MODS in wasp sting patients, which can be used as a good predictor of MODS in wasp sting patients.

Changes of coagulation function in patients with adenomyosis / 中华妇产科杂志

Objective:To explore the different coagulation state in patients with adenomyosis and its clinical significance.Methods:Clinical data of the patients admitted to the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2021 were retrospectively analyzed. (1) Differential coagulation state between 25 healthy women and 25 patients with adenomyosis were compared during menstrual and non-menstrual periods. (2) The coagulation indexes of 145 patients with adenomyosis (observation group 1) and 129 patients with cervical intraepithelial neoplasia grade Ⅲ (control group 1) who underwent hysterectomy in non-menstrual period were compared. (3) The coagulation indexes of 154 patients with adenomyosis (observation group 2) and 147 women without myometrial lesions (control group 2) who underwent endometrial curettage during uterine bleeding period were compared. (4) Correlations of coagulation index with cancer antigen 125 (CA 125), cancer antigen 19-9 (CA 19-9) and uterine volume in patients with adenomyosis were analyzed. Results:(1) The coagulation state of each health women during the menstrual and non-menstrual period showed no significant differences (all P>0.05). For the 25 patients with adenomyosis, fibrinogen [FIB; 2.61 g/L(2.50-3.10 g/L)] and D-dimer [0.60 mg/L (0.40-1.00 mg/L)] in the menstrual period were significantly higher than those in the non-menstrual period [2.25 g/L (1.90-2.70 g/L) and 0.27 mg/L (0.20-0.40 mg/L), respectively; both P<0.01], while thrombin time [TT; 16.70 s (16.10-17.40 s)] in the menstrual period was significantly lower than that in the non-menstrual period [17.95 s (17.20-18.40 s); P<0.01]. (2) In the non-bleeding period, D-dimer [0.26 mg/L (0.20-0.40 mg/L)] and platelet count [257.0×10 9/L (212.0×10 9/L-308.5×10 9/L)] of observation group 1 were significantly higher than those of control group 1 (all P<0.01). Besides, FIB ( r=0.237, P=0.004) and D-dimer ( r=0.373, P<0.001) were positively correlated with CA 125, while prothrombin time (PT; r=-0.208, P=0.012) and internationalized normalized ratio of plasma prothrombin time (PT-INR; r=-0.201, P=0.015) were negatively correlated with CA 19-9. (3) In the bleeding period, PT [10.70 s (10.10-11.20 s)] and PT-INR [0.93 (0.90-1.00)] of observation group 2 were significantly lower than those of control group 2 (all P<0.01), while D-dimer [0.41 mg/L (0.20-0.80 mg/L)] was significantly higher than that in the control group 2 ( P<0.001). Furthermore, FIB ( r=0.252, P=0.038) and D-dimer ( r=0.321, P=0.008) were positively correlated with uterine volume, while activated partial thromboplastin time (APTT; r=-0.190, P=0.018) and TT ( r=-0.304, P=0.012) were negatively correlated with uterine volume. (4) During non-menstrual period and uterine bleeding period, APTT and TT in patients of observation group 1 and 2 combined with anemia were significantly lower than those of non-anemia patients (all P<0.05). Conclusion:Patients with adenomyosis have a tendency to hypercoagulability in both the uterine bleeding and non-bleeding periods, which may be related to enlarged uterine volume, increased serum CA 125 and anemia.

Comparison of four-coagulation-tests values in normal pregnant women during early and late pregnancy and the influence of age / 中华妇产科杂志

Objective:To explore and compare the reference ranges of four coagulation tests in normal pregnant women during early and late pregnancy and the influence of age.Methods:Values of four coagulation tests from 4 974 pregnant women, who gave single birth at Peking University First Hospital, Obstetrics and Gynecology Hospital of Fudan University, West China Second University Hospital, Peking University Third Hospital and Shengjing Hospital of China Medical University from February 2017 to July 2020, were measured and analyzed in this study, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and thrombin time (TT). The four normal reference ranges of coagulation during early and late pregnancy phases were expressed as P2.5- P97.5. The difference of two pregnancy phases was compared by non-parametric test of two related samples. And the difference between pregnant women of advanced and non-advanced age in the same pregnancy phase was compared by independent sample non-parametric test. Chi-square test was used to compare the incidence of pregnancy complications in different coagulation reference ranges. Results:The reference ranges of PT of normal pregnant women′s early and late pregnancy were 10.0-13.9 s and 9.6-12.3 s, the reference ranges of APTT were 22.6-35.3 s and 22.4-30.9 s, the reference ranges of Fib were 2.4-5.0 g/L and 3.0-5.7 g/L, the reference ranges of TT were 12.0-19.0 s and 11.5-18.4 s. Compared with early pregnancy, PT, APTT and TT shortened significantly, while the Fib significantly increased in late pregnancy (all P<0.001). PT, APTT and TT of advanced and non-advanced age pregnant women were significantly different (all P<0.01). Compared with the ranges of non-pregnant population, more pregnant women were included in the normal pregnant reference ranges of PT in early pregnancy and APTT in the early and late pregnancy, while the incidence of pregnancy complications had no significant differences (all P>0.05). The incidence of fetal distress was higher and the incidence of preterm birth was lower in the reference range of PT in late pregnancy. The incidence of gestational diabetes mellitus was higher in the early and late gestational Fib reference ranges, and the incidence of hypertensive disorders in pregnancy was higher in the late gestational Fib reference range (all P<0.05). Conclusions:The coagulation function of pregnant women increases significantly with the growth of pregnancy, and there is a significant difference between advanced significantly and non-advanced age pregnant women. The recommended ranges of normal pregnant women′s early and late pregnancy PT are 10.0-13.9 s and 9.6-12.3 s, the recommended ranges of APTT are 22.6-35.3 s and 22.4-30.9 s, the recommended ranges of TT are 12.0-19.0 s and 11.5-18.4 s. The appropriate ranges of normal pregnant women′s early and late pregnancy Fib still need further exploration.

Analysis of risk factors for hemorrhage in patients with acute poisoning treated with hemoperfusion / 中华劳动卫生职业病杂志

Objective: To explore the clinical characterist ics and risk factors of hemorrhage complicated by hemoperfusion therapy in patients with acute poisoning. Methods: In January 2021, the clinical data of 196 patients with acute poisoning who received hemoperfusion therapy in the Second Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2020 were analyzed, and the patients were divided into bleeding group and non-bleeding group according to whether the patients were complicated with bleeding. Multivariate logistic regression was used to analyze the independent risk factors for hemorrhage in patients treated with hemoperfusion. Results: A total of 21 patients in the bleeding group and 175 patients in the non-bleeding group were included. There was no significant difference in general data such as gender, age, and body mass index between the two groups (P>0.05) . Organophosphorus pesticides (χ(2)= 4.56, P=0.030) , HA230 perfusion device (χ(2)=4.12, P=0.042) , platelet count (t=-2.33, P=0.009) and activated partial thromboplastin time (t=14.53, P<0.001) at 2 h of perfusion were the influencing factors of hemorrhage in patients with acute poisoning treated with hemoperfusion. Among them, organophosphorus pesticides, 2 h perfusion activated partial thromboplastin time ≥35 s and other factors were independent risk factors forcomplicated bleeding (P<0.05) . Conclusion: Patients with acute poisoning, especially organophosphorus pesticide poisoning, are at greater risk of bleeding during hemoperfusion therapy. Monitoring of changes in activated partial thromboplastin time should be strengthened and the dose of anticoagulants should be adjusted in time to reduce the risk of bleeding.

Marcadores hematológicos y bioquímicos para el diagnóstico precoz de bacteriemiascausadas por Enterobacteriaceae resistentes a los carbapenémicos / Haematological and biochemical markers for the early diagnosis of bacteremias caused bycarbapenem-resistant Enterobacteriaceae

INTRODUCCIÓN. Las bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos se asocian con altas tasas de mortalidad a diferencia de las bacteriemias causadas por Enterobacteriaceae sensibles a carbapenémicos. Los hallazgos clínicos y de laboratorio son importantes para determinar los esquemas terapéuticos y su pronóstico; su diagnóstico precoz resulta esencial para un manejo adecuado. OBJETIVO. Relacionar valores de marcadores sanguíneos y bioquímicos en bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 427 y muestra de 224 datos de hemocultivos positivos para Enterobacteriaceae de pacientes atendidos en el Hospital de Especialidades Carlos Andrade Marín en el periodo mayo 2016 a julio 2018. Criterios de inclusión: i) al menos un hemocultivo positivo; ii) recuperación del aislado de CRE o CSE y iii) recolección simultanea de muestras de sangre y pruebas de laboratorio. Criterios de exclusión: i) bacteriemias polimicrobianas; ii) valores fuera de rango y iii) reportes sin valores numéricos. El análisis de datos se realizó mediante el programa estadístico International Business Machines Statistical Package for the Social Sciences versión 24.0. RESULTADOS. Se demostró que el recuento de leucocitos [OR 1,21 (95% IC: 1,03-1,43)], el recuento de plaquetas [OR 1,65 (95% IC: 1,37-1,98)] y el tiempo parcial de tromboplastina [OR 1,29 (95% IC: 1,04-1,60)] fueron buenas variables predictoras independientes, mediante análisis de regresión logística multivariante. CONCLUSIÓN. La trombocitopenia y el tiempo parcial de tromboplastina prolongado se asociaron con bacteremia causada por Enterobacteriaceae resistentes a carbapenémicos.

INTRODUCTION. Bacteremias caused by carbapenem-resistant Enterobacteriaceae are associated with high mortality rates in contrast to bacteremias caused by carbapenem-sensitive Enterobacteriaceae. Clinical and laboratory findings are important in determining therapeutic regimens and prognosis; early diagnosis is essential for appropriate management. OBJECTIVE. To relate blood and biochemical marker values in bacteremia caused by carbapenem-resistant Enterobacteriaceae. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 427 and sample of 224 blood culture data positive for Enterobacteriaceae from patients attended at the Carlos Andrade Marín Specialties Hospital in the period May 2016 to July 2018. Inclusion criteria: i) at least one positive blood culture; ii) recovery of CRE or CSE isolate and iii) simultaneous collection of blood samples and laboratory tests. Exclusion criteria: i) polymicrobial bacteremia; ii) out-of-range values and iii) reports without numerical values. Data analysis was performed using the statistical program International Business Machines Statistical Package for the Social Sciences version 24.0. RESULTS. Leukocyte count [OR 1.21 (95% CI: 1.03-1.43)], platelet count [OR 1.65 (95% CI: 1.37- 1.98)] and partial thromboplastin time [OR 1.29 (95% CI: 1.04-1.60)] were shown to be good independent predictor variables, by multivariate logistic regression analysis. CONCLUSION. Thrombocytopenia and prolonged partial thromboplastin time were associated with bacteremia caused by carbapenem-resistant Enterobacteriaceae.

Actividad anticoagulante in vitro del extracto etanólico de las hojas de dos especies de la familia Euphorbiaceae / In vitro anticoagulant activity of the ethanolic extract of the leaves of two species of the family Euphorbiaceae

RESUMEN Las enfermedades cardiovasculares (ECV) son un conjunto de trastornos del corazón y de los vasos sanguíneos, que constituyen la principal causa de mortalidad en el mundo. En la búsqueda de alternativas para esta problemática, plantas medicinales de la familia Euphorbiaceae, han sido empeladas con fines terapéuticos, para prevenir, atenuar o curar los efectos generados por estas enfermedades. El objetivo de este trabajo fue conocer el perfil fitoquímico y evaluar la actividad anticoagulante in vitro de los extractos etanólicos de las hojas de Croton malambo y Acalypha hispida sobre plasma humano. Para ello, se obtuvo el extracto de las hojas y se le realizó el tamizaje fitoquímico, la evaluación del Tiempo de Tromboplastina Parcial activada (TTPa) y del Tiempo de Protombina (TP). En el perfil fitoquímico, se confirmó la presencia de alcaloides, taninos, flavonoides, leucoantocianidinas, fenoles, sesquiterpenlactonas, glucósidos cardiotónicos y terpenos. En la actividad anticoagulante, se evidenció la inhibición de la coagulación en la vía intrínseca, obteniendo resultados significativos para el TTPa, a diferencia que el test TP, donde los resultados obtenidos se encontraron similares al control. Esta investigación demuestra la acción anticoagulante de las plantas, ya que induce, significativamente, a una mayor prolongación del tiempo de coagulación; ambas especies presentaron una mayor actividad, a 200 mg/mL.

ABSTRACT Cardiovascular diseases (CVD) are a group of disorders of the heart and blood vessels, which correspond to the principal causes of death in the world. In the search for alternatives to this problem, medicinal plants of the Euphorbiaceae family have been investigated for therapeutic purposes to prevent, attenuate or cure the effects generated for these illnesses. The objective of this work was to know the phytochemical profile and evaluate the anticoagulant activity in vitro of the ethanolic extracts of the leaves of Croton malambo and Acalypha hispida on human plasma. For this, extract of their leaves was obtained, and phytochemical screening was performed, as well as the evaluation of the Activated Partial Thromboplastin Time (aPTT) and the Prothrombin Time (TP). The phytochemical profile confirmed the presence of alkaloids, tannins, flavonoids, leucoanthocyanidins, phenols, sesquiterpene lactones, cardiotonic glycosides, and terpenes. In the anticoagulant activity, the inhibition of coagulation in the intrinsic pathway was evidenced, obtaining significant results for aPTT, unlike the TP test where the results obtained were like the control. This research demonstrates the effectiveness of the plant with anticoagulant action since they significantly induce a longer prolongation of the clotting time, both species showed higher activity at 200 mg/mL.

Caprini model for prevention of venous thromboembolism in coma patients after surgery for severe traumatic brain injury / 中国基层医药

Objective:To analyze the preventive effect of Caprini model on venous thromboembolism (VTE) in coma patients after severe craniocerebral trauma.Methods:A total of 190 patients with severe craniocerebral trauma who received treatment in Lishui City People's Hospital, China between January 2015 and April 2019 were randomly divided into a control group and an observation group ( n = 95/group). Patients in the control group underwent the conventional strategy to prevent lower extremity VTE. Patients in the observation group were subjected to individualized strategies to prevent lower extremity VTE based on Caprini model assessment. The drop-out rate and treatment outcome were compared between the control and observation groups. The proportion of patients developing VTE during treatment in Department of Intensive Care Unit and the changes in coagulation indexes relative to before treatment were compared between the two groups. Results:There was no significant difference in drop-out rate between the control and observation group [10.53% (10/95) vs. 8.42% (8/95), χ2 = 0.245, P < 0.05]. The proportion of patients developing VTE in the observation group was significantly lower than that in the control group [2.30% (2/87) vs. 10.59% (9/85), χ2 = 4.935, P < 0.05]. At 7 days after surgery, the coagulation indices D-dimer, platelet count, prothrombin time, activated partial thromboplastin time in the observation group were (2.27 ± 0.43) mg/L, (281.62 ± 37.29) × 10 9/L, (12.93 ± 2.87) seconds and (34.35 ± 7.19) seconds, respectively, which were (3.31 ± 0.68) mg/L, (303.28 ± 39.96) × 10 9/L, (11.24 ± 2.46) seconds and (31.16 ± 6.82) seconds, respectively in the control group. The coagulation indices in the observation group were significantly superior to those in the control group ( t = 10.013, 3.070, -3.463, -2.493, all P < 0.05). Conclusion:The Caprini model is effective in preventing VTE in patients with coma after surgery for severe traumatic brain injury. It deserves to be clinically applied.

The predictive value of D-dimer combined with activated partial thromboplastin time for slow / no reflow during PCI in patients with acute coronary syndrome / 中国医师杂志

Objective:To analyze the predictive value of D-dimer combined with activated partial thromboplastin time (APTT) for slow / no reflow in patients with acute coronary syndrome (ACS) during percutaneous coronary intervention(PCI).Methods:From June 2017 to June 2019, 316 cases of patients with ACS who were to undergo PCI in Guigang People′s Hospital were selected as the study objects. The patients were divided into slow / no reflow group (SNR) and normal blood flow group (CON) according to the blood flow grading of thrombolysis in myocardial infarction (TIMI) during the operation. The differences of D-dimer and APTT between the two groups before operation were compared, and the predictive value of D-dimer combined with APTT for SNR was analyzed.Results:According to TIMI blood flow grading, all the patients were divided into SNR group ( n=71, 22.47%) and CON group ( n=245, 77.53%). The level of D-dimer in SNR group was significantly higher than that in CON group, while APTT was significantly lower than that in CON group ( P<0.05). Logistic regression analysis showed that D-dimer elevation ( OR=1.011, 95% CI: 1.008-1.015, P<0.001) was an independent risk factor of slow / no reflow in PCI for ACS patients, while APTT elevation ( OR=0.868, 95% CI: 0.818-0.921, P<0.001) was a protective factor. The D-dimer and APTT predicted that the area under receiver operating characteristic (ROC) curve of slow / no reflow in PCI were 0.814 and 0.738 respectively. The area under ROC curve of combined detection of D-dimer and APTT increased to 0.869, and the sensitivity and specificity were 87.3% and 75.1% respectively ( P<0.001). Conclusions:The D-dimer and APTT have a high predictive value of slow / no reflow during PCI in ACS patients. The combined detection of the two is helpful to identify the occurrence of slow / no reflow in PCI.