ObjectiveTo evaluate the changes in thrombelastography(TEG) during orthotopic liver transplantation （OLT） in Chinese. MethodsTwentyfive patients with cirrhosis of liver undergoing OLT were studied. They were composed of two groups: cirrhosis group （n=15） and liver neoplasm group （n=10）. Anesthesia was induced with propofol 1.5-2 mg/kg,fentanyl 3-5 μg/kg and vecuronium 0.1 mg/kg and maintained with isoflurane or enflurane inhalation.The operation was divided into three phases: ① before operation and preanhepatic phase （120 min after operation was started）, ② 30 min after liver was removed,③ 5 min before reperfusion and 5 min,15 min,30 min,60 min and 120 min after reperfusion.In 8 patients among the 25 patients heparinasecelite TEG was measured 5 min after reperfusion in addition to celite TEG.If there was significant differences in traces between the two TEG measurements,an intravenous bolus of 50-75 mg protamine was given and the heparinasecelite TEG was repeated.The measured variables included the r （reaction） time,representing the rate of initial fibrin formation K （coagulation） time, alpha angles （α） reflecting fibrinplatelet interaction, MA （maximal amplitude） indicating qualitative platelet function and percent fibrinolysis at 60 min. ResultsIn cirrhosis group changes in TEG occurred after liver was removed and in earlier period after reperfusion, while in liver neoplasm group changes in TEG were found in earlier period after reperfusion as compared with preoperative value.At 5 min after reperfusion there were significant differences in TEG （r，K，α and MA） values between celite and heparincelite TEG （P＜0.01）. ConclusionDuring OLT coagulation disorder occurs mainly at anhepatic and early reperfusion phase.
Objective To study the effects of total saponins of panax notoginseseng injection on the coagulation function in sepsis. Methods 50 sepsis patients with normal coagulation function were randomly divided into two groups. 25 patients in the control group received the routine treatment and the other 25 patients in the treatment group received total saponins of panax notoginseseng injection additionally. The levels of Plt, PT, TT, APTT, FIB and D-D were measured before the therapy and on 1st, 3rd and 7th day after the therapy. Results The levels of Plt, PT, TT, APTT, FIB and D-D before the therapy had no significant differences between the two groups ( P gt; 0. 05) . The levels of Plt and FIB had significant differences between the two groups on 7th day after therapy ( P lt;0. 01, P lt; 0. 05) . PT, TT, and APTT were prolonged in the controlled group gradually, butwere not prolonged or even shortened in the treatment group,which were significantly shorter in the treatment group on 7th day after therapy ( P lt; 0. 05) . D-D slightly elevated in the control group, but slightly elevated at first and dropped gradually in the treatment group, which was significantly lower in the treatment group on7th day after therapy. Conclusion Total saponins of panax notoginseseng injection has a protective effect on coagulation function in sepsis.
Perioperative monitoring of blood coagulation is critical to better understand causes of hemorrhage, to guide hemostatic therapies, and to predict the risk of bleeding. Point-of-care (POC) coagulation monitoring devices assessing the viscoelastic properties of whole blood may overcome several limitations of routine coagulation tests in the perioperative setting. The advantage of these techniques is that they have the potential to measure the clotting process, starting with fibrin formation and continue through to clot retraction and fibrinolysis at the bedside, with minimal delays. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red blood cells, and thereby providing useful additional information on platelet function. Viscoelastic POC coagulation devices are increasingly being used in clinical practice, especially in the management of patients undergoing cardiac and liver surgery, assessment of hypo-and hypercoagulable states, guiding pro- and anticoagulant therapies, monitoring of antiplatelet therapy and procoagulant therapy. To ensure optimal accuracy and performance, standardized procedures for blood sampling and handling, strict quality controls and trained personnel are required.
Objective To investigate the effect of micropulse di ode laser treatment on the retina in Brown-Norway rats (BN Rats). Methods 130 eyes of BN rats received irradiance of different powers of micr opulse diode laser with 810nm wavelength through a contact lens. Fundus color photography and fundus fluorescein angiography (FFA) were performed on day 1, 3, 7, 14 and 28 days after treatment. Animals were sacrificed on 1, 3, 7, 14 and 28 days separately for historical study. The expression of heat shock protein-70 (HSP-70) in the retina was observed with immunohistochemistry. Cell apoptosis of retina tissue was examined by TdT mediated dUTP nick end labeling (TUNEL). Results (1) No change was found in no visible reaction laser spots by light microscope. High duty cycles with threshold and suprathreshold en ergies can produce severe damage even to the inner nuclear layer. (2) HSP-70 ex pression was markedly increased in the inner nuclear layer at 1d after micropulse diode laser. This increase in HSP-70 expression peaked at day 3 whereafter a decline near to normal at 2 weeks was detected. (3) Apoptosis was detected mainl y in retinal pigment epithelium, outer nuclear layer, inner nuclear layer and ev en choroid by TUNEL after micropulse diode laser treatment. The TUNEL-positive cells increased with the laser power. Maximum TUNEL-positive cells could be seen at day 3 after treatment. Conclusions The retinal injury has positive relationship with laser energy. The thermal damage is confined to the RPE and spare the neurosensory retina when using threshold power (50mW) with 50% duty-cycle and supra-threshold power with high duty-cycle (100mW，5%～15%). The hyper expression of HSP-70 and apoptosis mechanism may play an important role in the tissue repair process. (Chin J Ocul Fundus Dis,2008,24:122-126)
Objective To investigate the early influences of laser photocoagulation on macular retinal thickness in diabetic retinopathy(DR). Methods Optic coherence tomography examination was performed in 30 eyes with DR(phase Ⅲ~Ⅳ) before, and on the 3rd day and the 7th day after photocoagulation respectively. The thickness of neuroretina and pigment epithelium were measured in the areas of fovea macula and 750 μm from fovea macula. Results Three days after photocoagulation, significant thickening of neuroretina was observed in the fovea macula, which is positively related with age, fasting blood sugar and duration of DR. There was no significant changes in the thickness of pigment epithelium in macula and in the thickness of neuroretina 750 μm from fovea macula. Conclusion Significant thickening of neuroretina in fovea macula in DR early after photocoagulation reveals progressed macular edema induced by photocoagulation which is positively related with age, fasting blood sugar and duration of DR. (Chin J Ocul Fundus Dis, 2002, 18: 31-33)
ObjectiveTo explore the use of agkistrodon halys antivenin, and the influence of its infusion time on the coagulation function of the patient bitten by agkistrodon halys. MethodsWe retrospectively analyzed the clinical data of patients suffering from pit viper bites and first diagnosed and treated in the emergency department of our hospital between April 1 and November 30, 2013. According to the allergy test results, patients were divided into two groups: negative and positive. Based on the infusion time, the negative patients were divided into ≤1.5 hours and >1.5 hours groups, and the positive patients were divided into ≤3 hours and >3 hours groups. All patients' gender, age, infusion time, and PT, APTT, TT, FIB, D-DIMER before and after infusion of antivenomous serum were recorded, and blood coagulation indicators before and after infusion of antivenomous serum and the impact of infusion time were compared among different groups. ResultsFor both the negative and positive groups, PT, APTT, TT, FIB, and D-DIMER were statistically improved after infusion of antivenomous serum. The blood coagulation indicators of infusion time ≤1.5 hours group and ≤3 hours group were significantly better than those of infusion time >1.5 hours and >3 hours groups. ConclusionAntivenomous serum can correct coagulation and the faster infusion rate, the more obvious the effect is.
ObjectiveTo investigate the influence of 6% hydroxyethyl starch (HES, 130/0.4)on blood coagulation of patients after off-pump coronary artery bypass grafting (opCAB)by thromboelastography (TEG). MethodsOne hundred patients undergoing elective opCAB in Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command between May and July 2013 were enrolled in this study. All the patients were randomly divided into 2 groups using random number table method with 50 patients in each group. In the experimental group (G1 group), there were 27 males and 23 females with their age of 64.9±4.4 years, who received intravenous 6% HES (130/0.4)20 ml/kg in 4 hours postoperatively. In the control group (G2 group), there were 31 males and 19 females with their age of 63.1±5.8 years, who received intravenous lactated ringers 20 ml/kg in 4 hours postoperatively. After postoperative ICU admission, full blood count, coagulation tests and TEG were examined. Chest and mediastinal drainage was recorded at 6 hours and 24 hours postoperatively. ResultsThere was no statistical difference in chest and mediastinal drainage 24 hours postoperatively between the 2 groups (591.7±171.7 ml vs. 542.4±174.0 ml, P > 0.05). None of the patients received reexploration for bleeding. There was no statistical difference in hemoglobin, hematocrit, platelet count or traditional coagulation index between the 2 groups (P > 0.05). TEG showed no significant change in coagulation time after intravenous fluid infusion in either group. Reaction time was slightly extended in both groups, but there was no statistical difference in reaction time between the 2 groups (P > 0.05). Maximum amplitude (MA)of G1 group was significantly decreased after intravenous fluid infusion (55.9±10.0 mm vs. 62.8±7.9 mm, P < 0.05), but still within the normal range. There was no significant change in MA after intravenous fluid infusion in G2 group. ConclusionIntravenous infusion of 6% HES (130/0.4)20 ml/kg can reduce platelet function and clot strength, but does not significantly increase postoperative chest or mediastinal drainage, or the incidence of postoperative reexploration for bleeding. It's safe to administer 6% HES (130/0.4)for patients after OPCAB.
Objective To build a score with the coagulation, inflammation indexes of sepsis patients, named Sepsis-Related Coagulo-Inflammatory Score (SRCIS), and then evaluate the prognostic capability of it in predicting the 28-day mortality of septic patients after the diagnosis. Methods In this prospective nested case-control study, we recruited septic patients according to the Sepsis 3.0 standards, who visited the Emergency Department, West China Hospital of Sichuan University from September 2017 to January 2018. Multiple factor analysis was conducted to confirm which coagulation or inflammation biomarkers were independent risk factors related to the 28-day mortality after their diagnosis. After that, the SRCIS was built based on those independent risk factors. Finally, receiver operating characteristic curve (ROC) analysis was conducted to verify its prognostic capability for the 28-day mortality of septic patients. Results A total of 123 cases were included. Among them, 17 patients died within 28 days, and the mortality rate was 13.8%. There were no significant differences in the demographic characteristics or comorbidities between the survival group and dead group (P>0.05). Multivariate logistic analysis showed that both activated partial thromboplastin time (APTT) [odds ratio (OR)=1.015, 95% confidence interval (CI) (1.017, 1.189), P=0.017] and C-reactive protein (CRP) [OR=1.100, 95%CI (1.006, 1.025), P=0.002] were independent risk factors for predicting the 28-day mortality of septic patients. ROC analysis indicated that the cut-off values of APTT and CRP predicting the 28-day mortality rate of sepsis were 39.25 seconds and 198.05 mg/L, respectively, and the areas under the curve (AUC) of them were 0.618 and 0.671, respectively. The results indicated that the mortality increased from 8.79% to 28.13%, when APTT prolonged to no less than 39.25 seconds (P<0.05). The mortality also increased from 8.89% to 27.27% when CRP elevated to no less than 198.05 mg/L (P<0.05). The AUC of SRCIS in predicting the 28-day mortality of patients with sepsis was 0.707, which was better than that of Sequential Organ Failure Assessment (SOFA) (AUC=0.681) and quick Sequential Organ Failure Assessment (qSOFA) (AUC=0.695). The corresponding 28-day mortality rates for patients with sepsis were 6.94%, 16.22%, and 42.86% (P<0.05), respectively, when the SRCIS score were 0, 1, and 2. Conclusions APTT and CRP are independent risk factors in predicting the 28-day mortality of patients with sepsis. Compared with traditional scoring systems such as SOFA and qSOFA, SRCIS performances better in predicting the 28-day mortality for patients with sepsis.
ObjectiveTo investigate whether treatment of rivaroxaban, an approved oral direct coagulation factor Xa inhibitor, attenuates functional changes in LPS -induced acute lung injury (ALI) mouse.MethodsC57BL/6 mice were randomly divided into PBS group, N-LPS group, L-LPS group, and H-LPS group. In the C57BL/6 mice being fed chow containing 0.2 mg/g or 0.4 mg/g rivaroxaban for 10 days (L-LPS group and H-LPS group), plasma concentration and coagulation indices were measured. Next, the role of rivaroxaban in ALI by using mice fed by rivaroxaban was studied in a murine ALI model induced by direct intratracheal injection lipopolysaccharides (LPS). Lung injury by histopathological scoring, micro computed tomography, pulmonary edema, inflammatory cell recruitment and activity of inflammatory cytokines in lung tissue or bronchoalveolar lavage fluid (BALF) were assessed. Western blot and immunohistochemistry were performed to examine expression of multiple proteins, including myeloperoxidase, protease-activatedreceptor 2 (PAR-2) and nuclear factor kappa B (NF-κB).ResultsThe increased plasma concentration of rivaroxaban and the prolonged prothrombin time were displayed in the mice with rivaroxaban treatment. Rivaroxaban treatment groups showed significant reductions in neutrophil sequestration and preservation of the lung tissue architecture compared to the LPS positive control (P<0.05). Tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and interleukin-6 (IL-6) levels, in addition to total protein and Evans blue concentration were all significantly reduced in BALF from the mice treated with the chow containing rivaroxaban. Administration of rivaroxaban ameliorated ALI with concomitant reductions in the expression of PAR-2 and proinflammatory cytokines. LPS-induced PAR-2 increase and NF-κB activation were also suppressed by rivaroxaban in lung tissues. Furthermore, rivaroxaban inhibited the phosphorylation levels of P65 in ALI.ConclusionsThe results demonstrate that rivaroxaban effectively attenuates LPS-induced inflammatory responses by noncoagulative pathway in ALI. The beneficial effects are associated with the decreased phosphorylation of NF-κB pathways and the reduced expression of PAR-2.
ObjectiveTo study the correlation between international normalized ratio (INR) and coagulation factor Ⅱ and Ⅹ in patients with pulmonary thromboembolism treated with warfarin at moderate and low intensity anticoagulation.MethodsFifty-one patients with pulmonary thromboembolism treated with warfarin orally were divided into low-intensity anticoagulation group (INR from 1.6 to 2.0) and standard-intensity anticoagulation group (INR form 2.0 to 3.0) according to their monitoring INR indices. The levels of coagulation factor Ⅱ and Ⅹ were measured, and the correlation between INR level and coagulation factor activity was compared.ResultsThe INR of the low intensity anticoagulation group was 1.69±0.2 and the standard intensity anticoagulation group was 2.55±0.46. The corresponding activity of coagulation factor Ⅱ was (48.3±28.0)% and (24.0±8.0)% respectively. The activity of coagulation factor Ⅹ was (32.8±24.0)% and (16.7±6.0)%. There was a negative correlation between the activity of INR and coagulation factor Ⅱ and Ⅹ, with correlation coefficients of –0.903 and –0.459, respectively. Coagulation factor Ⅱ activity < 40%, coagulation factor Ⅹ activity inhibitory level < 25% is defined as anticoagulation effect. When coagulation factor Ⅱ activity level reaches anticoagulation effect, the corresponding minimum INR value was 1.56 and as to coagulation factor Ⅹ, the corresponding minimum INR value was 1.66.ConclusionsINR is negatively correlated with the activity of coagulation factor Ⅱ and coagulation factor Ⅹ. With the increase of INR, the activity of coagulation factor Ⅱ and coagulation factor Ⅹ decrease. Low intensity anticoagulation could not effectively inhibit the activity of coagulation factor.