Coagulation is more affected by quick than slow bleeding in patients with massive blood loss.

Profuse blood loss affects blood coagulation to various degrees. However, whether bleeding speed affects coagulation remains uncertain. This study aimed to evaluate the effect of bleeding speed on coagulation function. A total of 141 patients in the Department of Thoracic Surgery of our hospital were evaluated between January 2007 and February 2014. There are two groups of patients, those who received decortication for chronic encapsulated empyema were called the slow-bleeding group, and those who received thoracoscopic upper lobectomy were called the fast bleeding group; each group was further subdivided into three: group A, 1000 ml ≤ bleeding amount < 1500 ml; group B, 1500 ml ≤ bleeding amount < 1700 ml; group C, 1700 ml ≤ bleeding amount < 2000 ml. Then, coagulation function was assessed in all patients before and during surgery and at 1, 2, and 24 h after surgery, measuring prothrombin time, activated partial thromboplastin time (APTT), fibrinogen, blood pressure, hematocrit, hemoglobin, and platelets. Bleeding duration was overtly longer in the slow-bleeding group than that in quick bleeding individuals (2.3 ±â€Š0.25 h vs. 0.41 ±â€Š0.13 h, P < 0.001). Fibrinogen, hematocrit, hemoglobin, and platelets strikingly decreased, whereas prothrombin time and APTT values significantly increased with bleeding amounts in both quick and slow-bleeding groups. Interestingly, compared with slow-bleeding patients, coagulation indices at each time point and bleeding amounts had significant differences in the quick bleeding group.Increased consumption of coagulation factors in quick bleeding may have greater impact on coagulation function.

Enhanced ADAM17 expression is associated with cardiac remodeling in rats with acute myocardial infarction.

AIM: This study aimed to investigate the dynamic expression of A-disintegrin-and-metalloproteinase-17 (ADAM17) during cardiac remodeling after acute myocardial infarction (AMI). MAIN METHODS: Forty male Wistar rats with a permanent ligation of the left anterior descending artery were equally divided into four groups based on predefined sacrifice time: MI1d, MI1w, MI4w and MI12w. As controls, 36 rats only with left thoracotomy were equally divided into four groups. Cardiac remodeling was assessed by echocardiography and hematoxylin and eosin (H&E) staining. ADAM17 mRNA was detected by real-time reverse transcription polymerase chain reaction, and protein expression of ADAM17, tissue inhibitor of metalloproteinases-3 (TIMP-3) and TNF-α was analyzed by western blotting. KEY FINDINGS: The systolic function was sharply worsened in the MI1w group (versus the Con1w group, P<0.05), but left ventricular weight index was significantly increased after 4weeks post-MI (P<0.05). H&E staining revealed that one week after AMI, myocardial tissue in the epicardial border zone of the infarcted heart was mixed with broken mitochondrial cristae and decreased matrix density. ADAM17 mRNA and protein expression was significantly increased, accompanied by decreased TIMP-3 and upregulated TNF-α expression in the MI1w group (versus the MI1d group, all P<0.05). Moreover, dynamic ADAM17 mRNA expression was positively correlated with enlarged LVEDd and LVESd (P=0.001, P=0.003) and negatively with LVEF (P=0.039) in AMI rats. SIGNIFICANCE: Enhanced ADAM17 expression, along with decreased TIMP-3 and increased TNF-α expression, especially within one week after AMI, is associated with cardiac remodeling.

PPARγ suppressed Wnt/ß-catenin signaling pathway and its downstream effector SOX9 expression in gastric cancer cells.

Wnt signaling pathway activation plays a critical role in biological processes of tumor progression. SOX9 belongs to the sry-related high-mobility group box (SOX) family and is a key transcription factor in the development and differentiation of multiple cell lineages. The purpose of this study was to investigate whether suppression of Wnt signaling pathway by PPARγ gene affects target SOX9 gene expression. The pEGFP-N1-PPARγ overexpression recombinant plasmid was structured by molecular biology technology. The overexpression plasmid and empty vector pEGFP-N1 were transfected into three types of human gastric cancer cell lines, with different levels of differentiation, MKN-28, SGC-7901 and BGC-823. The PPARγ, ß-catenin and SOX9 mRNA levels and proteins were examined by real-time PCR and Western blot analysis. The pEGFP-N1-PPARγ recombinant plasmid was constructed and transfected into MKN-28, SGC-7901 and BGC-823 successfully. High expression of PPARγ (p < 0.05) for transfection recombinant plasmid group induced obviously decreased expression of ß-catenin (p < 0.05), whereas SOX9 expression decreased significantly (p < 0.05) compared with the transfection empty vector group and normal comparison group. PPARγ can suppress ß-catenin expression in Wnt signaling pathway and its downstream effector SOX9 expression in gastric cancer cells.

Preliminary study on changes in coagulation function and component transfusion time in patients with massive hemorrhage.

INTRODUCTION: To investigate the changes in coagulation function and component transfusion time in patients with massive hemorrhage. METHODS: Sixty-two patients with massive hemorrhage were enrolled in the study. Blood samples were collected from each patient when the blood loss reached 1000, 1500, 1700 and 2000 ml. The parameters FIB, PT, APTT, HGB, HCT, PLT and MAP were recorded for all patients. RESULTS: Sixty-two, 30, 20 and 8 patients showed blood loss exceeding 1000, 1500, 1700 and 2000 ml, respectively. Blood samples were successfully collected from all patients when the volume of blood lost reached 1000, 1500, 1700 and 2000 ml. However, at this time point, FIB, MAP, HGB, HCT and PLT were significantly lower than the baseline/preoperative values. These indices decreased progressively with increasing blood loss. PT and APTT were significantly higher than at baseline and increased progressively with increased blood loss. FIB, HCT and HGB were below the normal reference range when blood loss was 1500 ml. During surgery, FIB, MAP, HCT, HGB and PLT decreased substantially, whereas APTT and PT increased when blood loss exceeded 1500 ml. PT and MAP were beyond the normal range when blood loss reached 2000 ml. There was a correlation between FIB, HCT and HGB with intraoperative blood loss; the correlation coefficient was greatest between and FIB and blood loss. CONCLUSION: There were marked correlations between FIB, HCT and HGB with intraoperative blood loss, and the correlation was greatest with FIB.

Diagnostic performance of magnetic resonance venography in the detection of recanalization in patients with chronic cerebral venous sinus thrombus.

BACKGROUND: In the chronic stage of cerebral venous sinus thrombosis (CVST), recanalization can result in disparate MR appearances. We aimed to prospectively investigate the diagnostic accuracy of magnetic resonance venography (MRV) in the evaluation of the recanalization of CVST. METHODS: This study prospectively evaluated the diagnostic performance of 2-dimensional time-of-flight (2D-TOF) MRV in thirty-two consecutive patients during a three- to six-month follow-up for CVST. Both 2D-TOF MRV and digital substraction angiography (DSA) were undertaken. Diagnostic accuracy of 2D-TOF MRV in the detection of recanalized thrombus was evaluated using DSA as the reference standard. RESULTS: MRV and DSA were completed without complications in all 32 patients. The sensitivity, specificity, positive predictive value, and negative predictive value of 2D-TOF MRV for the detection of recanalization on a segmental basis were 91% (62/68), 93% (37/40), 95% (62/65), and 86% (37/43) respectively. CONCLUSION: 2D-TOF MRV provides high sensitivity and specificity for the diagnosis of recanalized CVST segments.