Easily-handled method to isolate mesenchymal stem cells from coagulated human bone marrow samples

AIM:To establish an easily-handled method to isolate mesenchymal stem cells(MSCs) from coagulated human bone marrow samples. METHODS: Thrombin was added to aliquots of seven heparinized human bone marrow samples to mimic marrow coagulation. The clots were untreated,treated with urokinase or mechanically cut into pieces before culture for MSCs. The un-coagulated samples and the clots were also stored at 4 ℃ for 8 or 16 h before the treatment. The numbers of colony-forming unit-fibroblast(CFU-F) in the different samples were determined. The adherent cells from different groups were passaged and their surface profile was analyzed with flow cytometry. Their capacities of in vitro osteogenesis and adipogenesis were observed after the cells were exposed to specific inductive agents.RESULTS: The average CFU-F number of urokinasetreated samples(16.85 ± 11.77/106) was comparable to that of un-coagulated control samples(20.22 ± 10.65/106,P = 0.293),which was significantly higher than those of mechanically-cut clots(6.5 ± 5.32/106,P < 0.01) and untreated clots(1.95 ± 1.86/106,P < 0.01). The CFU-F numbers decreased after samples were stored,but those of control and urokinase-treated clots remained higher than the other two groups. Consistently,the numbers of the attached cells at passage 0 were higher in control and urokinase-treated clots than those of mechanically-cut clots and untreated clots.The attached cells were fibroblast-like in morphology and homogenously positive for CD44,CD73 and CD90,and negative for CD31 and CD45. Also,they could be induced to differentiate into osteoblasts and adipocytes in vitro. CONCLUSION: Urokinase pretreatment is an optimal strategy to isolate MSCs from human bone marrow samples that are poorly aspirated and clotted.

CHARACTERS OF SEDIMENTATION OF SUSPENSION FLOCCULATED OR COAGULATED

ＣＨＡＲＡＣＴＥＲＳＯＦＳＥＤＩＭＥＮＴＡＴＩＯＮＯＦＳＵＳＰＥＮＳＩＯＮＦＬＯＣＣＵＬＡＴＥＤＯＲＣＯＡＧＵＬＡＴＥＤ￥ＫａｎｇＹｏｎｇ；ＨｕＸｉａｏｍｉｎ；ＤｅｎｇＣｈａｎｇｌｉｅ；ＬｕｏＱｉａｎ（ＤｅｐａｒｔｍｅｎｔｏｆＭｉｎｅｒａｌＥｎｇｉｎ...

Evaluation of Chemically Coagulated Swine Manure Solids as Value-Added Products

The objective of this research was to evaluate the chemically coagulated swine manure solids as biofuel and/or compost feedstock. Three coagulants, namely agricultural lime [CaCO3], hydrated lime [Ca(OH)2], and lime slurry [Ca(OH)2], were added to fresh swine manure to coagulate manure solids. Four levels, i.e., 0.00 (0.0X), 4.89 (0.5X), 9.77 (1.0X), and 19.77 (2.0X) gm Ca&#8901liter-1, were tested, in triplicates. Increasing the coagulant concentration increased the total solids, ash content, and pH of solid manure samples, whereas it decreased their volatile solids, chemical oxygen demand, and heating value. At the coagulant level of 2.0X rate, heating values of samples coagulated by agricultural lime, hydrated lime, and lime slurry were 2.64, 4.48, and 4.54 MJ&#8901kg-1, respectively. The heating value of raw manure solids was as high as 13.49 MJ&#8901kg-1. Increasing the coagulant concentration increased the O/C atomic ratio for all the studied coagulants. Accordingly, the high coagulant concentrations might reduce the acceptability of the feedstock as a biofuel that can be co-combusted with other feed stocks. The C/N ratio and the pH values of the solid separated swine manure increased by increasing agricultural lime and hydrated lime concentrations. The former might increase satisfactoriness for composting these solids, whereas the latter might hinder their use in the composting process. The maximum coagulant concentrations that allowed pyrolyzing the final product, based on the net energy values, were 48.80 (2.0X), 18.06 (1.0X), and 18.06 (1.0X) gm&#8901liter-1 for agricultural lime, hydrated lime, and lime slurry, respectively. The maximum acceptable coagulant concentrations that allowed composting the final product, based on the pH values, were 48.80 (2.0X), 0.00 (0.0X), and 9.03 (0.5X) gm&#8901liter-1 for the same three coagulants.

Facile synthesis of composite polyferric magnesium-silicate-sulfate coagulant with enhanced performance in water and wastewater

The coagulation process is a widely applied technology in water and wastewater treatment.Novel composite polyferric mag-nesium-silicate-sulfate(PFMS)coagulants were synthesized using Na_(2)SiO_(3)·9H_(2)O,Fe_(2)(SO_(4))_(3),and MgSO_(4) as raw materials in this paper.The effects of aging time,Fe:Si:Mg,and OH:M molar ratios(M represents the metal ions)on the coagulation performance of the as-pre-pared PFMS were systematically investigated to obtain optimum coagulants.The results showed that PFMS coagulant exhibited good co-agulation properties in the treatment of simulated humic acid-kaolin surface water and reactive dye wastewater.When the molar ratio was controlled at Fe:Si:Mg=2:2:1 and OH:M=0.32,the obtained PFMS presented excellent stability and a high coagulation efficiency.The removal efficiency of ultraviolet UV254 was 99.81%,and the residual turbidity of the surface water reached 0.56 NTU at a dosage of 30 mg·L^(-1).After standing the coagulant for 120 d in the laboratory,the removal efficiency of UV254 and residual turbidity of the surface wa-ter were 88.12%and 0.68 NTU,respectively,which accord with the surface water treatment requirements.In addition,the coagulation performance in the treatment of reactive dye wastewater was greatly improved by combining the advantages of magnesium and iron salts.Compared with polyferric silicate-sulfate(PFS)and polymagnesium silicate-sulfate(PMS),the PFMS coagulant played a better decolor-ization role within the pH range of 7-13.

Concerns about the application of resistance exercise with blood-flow restriction and thrombosis risk in hemodialysis patients

Background:Hemodialysis(HD)per se is a risk factor for thrombosis.Considering the growing body of evidence on blood-flow restriction(BFR)exercise in HD patients,identification of possible risk factors related to the prothrombotic agent D-dimer is required for the safety and feasibility of this training model.The aim of the present study was to identify risk factors associated with higher D-dimer levels and to determine the acute effect of resistance exercise(RE)with BFR on this molecule.Methods:Two hundred and six HD patients volunteered for this study(all with a glomerular filtration rate of<15 mL/min/1.73 m^(2)).The RE+BFR session consisted of 50%arterial occlusion pressure during 50 min sessions of HD(intradialytic exercise).RE repetitions included concentric and eccentric lifting phases(each lasting 2 s)and were supervised by a strength and conditioning specialist.Results:Several variables were associated with elevated levels of D-dimer,including higher blood glucose,citrate use,recent cardiovascular events,recent intercurrents,higher inflammatory status,catheter as vascular access,older patients(>70 years old),and HD vintage.Furthermore,RE+BFR significantly increases D-dimer after 4 h.Patients with borderline baseline D-dimer levels(400-490 ng/mL)displayed increased risk of elevating D-dimer over the normal range(-500 ng/mL).Conclusion:These results identified factors associated with a heightened prothrombotic state and may assist in the screening process for HD patients who wish to undergo RE+BFR.D-dimer and/or other fibrinolysis factors should be assessed at baseline and throughout the protocol as a precautionary measure to maximize safety during RE+BFR.

Comparison between sepsis-induced coagulopathy and sepsis-associated coagulopathy criteria in identifying sepsis-associated disseminated intravascular coagulation

BACKGROUND:Disseminated intravascular coagulation(DIC)is associated with increased mortality in sepsis patients.In this study,we aimed to assess the clinical ability of sepsis-induced coagulopathy(SIC)and sepsis-associated coagulopathy(SAC)criteria in identifying overt-DIC and preDIC status in sepsis patients.METHODS:Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022.The performances of the SIC and SAC were assessed to identify overt-DIC on days 1,3,7,or 14.The SIC status or SIC score on day 1,the SAC status or SAC score on day 1,and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC.The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation.RESULTS:On day 1,the incidences of coagulopathy according to overt-DIC,SIC and SAC criteria were 11.7%,22.0%and 31.5%,respectively.The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14(P<0.05).On day 1,the SIC score with a cut-off value>3 had a significantly higher sensitivity(72.00%)and area under the curve(AUC)(0.69)in identifying pre-DIC than did the SIC or SAC status(sensitivity:SIC status 44.00%,SAC status 52.00%;AUC:SIC status 0.62,SAC status 0.61).The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC(0.79 vs.0.69,P<0.001).Favorable effects of anticoagulant therapy were observed in SIC(adjusted hazard ratio[HR]=0.216,95%confidence interval[95%CI]:0.060–0.783,P=0.018)and SAC(adjusted HR=0.146,95%CI:0.041–0.513,P=0.003).CONCLUSION:The SIC and SAC seem to be valuable for predicting overt-DIC.The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.

Adverse events associated with the gold probe and the injection gold probe devices used for endoscopic hemostasis:A MAUDE database analysis

BACKGROUND Gastrointestinal(GI)bleeding accounts for over half a million admissions annually and is the most common GI diagnosis requiring hospitalization in the United States.Bipolar electrocoagulation devices are used for the management of gastrointestinal bleeding.There is no data on device-related adverse events for gold probe(GP)and injection gold probe(IGP).AIM To analyze this using the Food and Drug Administration(FDA’s)Manufacturer and User Facility Device Experience(MAUDE)database from 2013 to 2023.METHODS We examined post-marketing surveillance data on GP and IGP from the FDA MAUDE database to report devicerelated and patient-related adverse events between 2013-2023.The MAUDE database is a publicly available resource providing over 4 million records relating to medical device safety.Statistical analyses were performed using IBM SPSS Statistics V.27.0(IBM Corp.,Armonk,NY,United States).RESULTS Our search elicited 140 reports for GP and 202 reports for IGP,respec-tively,during the study period from January 2013 to August 2023.Malfunctions reportedly occurred in 130 cases for GP,and actual patient injury or event occurred in 10 patients.A total of 149 patients(74%)reported with Injection GP events suffered no significant consequences due to the device failure,but 53 patients(26%)were affected by an event.CONCLUSION GP and IGP are critical in managing gastrointestinal bleeding.This study of the FDA MAUDE database revealed the type,number,and trends of reported device-related adverse events.The endoscopist and support staff must be aware of these device-related events and be equipped to manage them if they occur.

Uremic Bleeding in 2 Patients with Dieulafoy’s Lesion: Case Report and Literature Review

Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can cause severe and intermittent arterial bleeding from small vascular stumps that are difficult to visualize. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. Recently, uremic syndrome has been identified as a risk factor for gastric mucosal lesions. We present two clinical cases of acute digestive bleeding due to Dielafoy lesion with chronic kidney disease as the main cause, where two different therapies were performed endoscopically. We concluded with the results of our patients that the best therapy was the application of the hemostatic hemoclip on the injury vs the injection with adrenaline on the wound site. Uremia is identified as a risk factor for upper gastrointestinal bleeding in patients with pre-existing Dieulafoy’s lesion, as well as a higher incidence of new bleeding.

Effects of Coagulation and Ozonation Pretreatments on Biochemical Treatment of Fluid Catalytic Cracking Wastewater

Fluid catalytic cracking (FCC) salty wastewaters, containing quaternary ammonium compounds (QACs), are very difficult to treat by biochemical process. Anoxic/oxic (A/O) biochemical system, based on nitrification and denitrification reactions, was used to assess their possible biodegradation. Because of the negative effects of high salt concentration (3%), heavy metals and toxic organic matter on microorganisms’ activities, some techniques consisting of dilution, coagulation and flocculation, and ozonation pretreatments, were gradually tested to evaluate chemical oxygen demand (COD), ammonia-nitrogen (ammonia-N) and total nitrogen (TN) removal rates. In this process of FCC wastewater, starting with university-domesticated sludge, the ammonia-N and TN removal rates were worst. However, when using domesticated SBR’s sludge and operating with five-fold daily diluted influent (thus reducing salt concentration), the ammonia-N removal reached about 57% while the TN removal rate was less than 37% meaning an amelioration of the nitrification process. However, by reducing the dilution factors, these results were inflected after some days of operation, with ammonia-N removal decreasing and TN barely removed meaning a poor nitrification. Even by reducing heavy metals concentration with coagulation/flocculation process, the results never changed. Thereafter, by using ozonation pre-treatment to degrade the detected organic matter of di-tert-butylphenol and certain isoparaffins, COD, ammonia-N and TN removal rates reached 92%, 62% and 61%, respectively. These results showed that the activities of the microorganisms were increased, thus indicating a net denitrification and nitrification reactions improvement.

A Simple Procedure for Extracting DNA from Coagulated Blood Samples for DNA Banking

Background: DNA banking is increasingly applied to collect genetic materials for biomedical studies. Traditionally, the source of DNA banking is from the anti-coagulated blood samples as it is easy to isolate cells from the samples for DNA extraction. However, substantial portion of clinical blood samples is coagulated. Because of the difficulty to release blood cells from the clots for DNA extraction, coagulated blood samples are not used for DNA banking. Methods: In this study, we developed a simple procedure for high-throughput DNA extraction from coagulated blood samples for DNA banking. Results: We showed that the extracted DNA is the same as the one extracted from anti-coagulated blood samples as reflected by the size distribution and genetic variants across all coding genes. Conclusions: We developed a simply procedure for high-throughput DNA extraction from coagulated blood cells. Validation results show that the DNA from coagulated blood cells is the same as the DNA from the anti-coagulated blood cells.

Prediction of return of spontaneous circulation in outof-hospital cardiac arrest with non-shockable initial rhythm using point-of-care testing: a retrospective observational study

BACKGROUND:Out-of-hospital cardiac arrest(OHCA) is a public health concern, and many studies have been conducted on return of spontaneous circulation(ROSC) and its prognostic factors.Rotational thromboelastometry(ROTEM?), a point-of-care testing(POCT) method, has been useful for predicting ROSC in patients with OHCA, but very few studies have focused on patients with non-shockable rhythm. We examined whether the parameters of POCT could predict ROSC in patients with OHCA and accompanying non-shockable rhythm.METHODS:This is a single-center, retrospective observational study. Complete blood count,blood gas, and ROTEM POCT measurements were used. This study included patients with nontraumatic OHCA aged 18 years or older who were transported to the emergency department and evaluated using POCT between January 2013 and December 2021. The patients were divided into the ROSC and non-ROSC groups. Prehospital information and POCT parameters were compared using receiver operating characteristic(ROC) curve analysis, and further logistic regression analysis was performed.RESULTS:Sixty-seven and 135 patients were in the ROSC and non-ROSC groups,respectively. The ROC curves showed a high area under the curve(AUC) for K^(+) of 0.77(95%confidence interval [CI]:0.71–0.83) and EXTEM amplitude 5 min after clotting time(A5) of 0.70(95%CI:0.62–0.77). The odds ratios for ROSC were as follows:female sex 3.67(95%CI:1.67–8.04);K^(+)0.64(95%CI:0.48–0.84);and EXTEM A5 1.03(95%CI:1.01–1.06).CONCLUSION:In OHCA patients with non-shockable rhythm, K^(+) level and the ROTEM parameter EXTEM A5 may be useful in predicting ROSC.

Use of biopolymers in wastewater treatment:A brief review of current trends and prospects

Indeed,polymeric materials have thrived in worldwide sectors over the last five decades due to their versatility and durability,to the point that we can no longer envisage a product that does not contain them.However,many synthetic polymers that have been produced are mostly sourced from petroleum and coal as raw materials,making them environmentally incompatible because they cannot be integrated with what is a natural recycling system.One of the most important aspects of the transition to a circular bioeconomy(CBE)is the provision of more sustainable strategies for resource and waste management.Considering the environmental consequences associated with petroleum-based polymers(PBPs),natural biopolymers,originating from biomass,can be conceived as a promising solution to gradually replace the PBPs,and address,and resolve the potential challenges and prevailing research gaps in the PBPs.The biopolymers have significant advantages over PBPs in terms of low-cost/zero-cost precursors,environmental friendliness,and user-friendliness.The present review dissects the sources,synthesis pathways,structures,characterization,and employment of biopolymers and their composites in water and wastew-ater treatment applications via different scenarios.Furthermore,the CBE model framework proposes potential approaches to applying CBE principles in the wastewater management sector,with a heavy emphasis on not only technology but also organizational and societal reforms.To sum up,the reliance on biopolymers can be considered a crucial tool for assessing the global progress toward CBE,as well as future environmental management and planning.

Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective:To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue.Methods:This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022.Coagulation tests including prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(aPTT),fibrinogen,and D-dimer were performed.Patients were monitored for bleeding manifestations.Results:Coagulation abnormalities were reported in 42.8%of the patients.Overall,prolonged aPTT was the most common coagulation abnormality(40.8%),followed by low fibrinogen(38.7%),raised D-dimer(31.2%),raised INR(26.0%)and prolonged PT(19.2%).Bleeding manifestations were present in 19.9%patients.PT,INR,aPTT and D-dimer levels were significantly higher(P<0.01)and fibrinogen level was significantly lower(P<0.001)in patients with bleeding compared to patients without bleeding.Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding(P<0.01).Conclusions:Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding.Patients with dengue should be assessed for coagulation abnormalities.

Prognostic significance of preoperative lymphocyte to monocyte ratio in patients with signet ring gastric cancer

BACKGROUND The ratio of lymphocytes to monocytes(LMR)has been shown to be an effective predictor of gastric cancer prognosis.However,its predictive accuracy for signet ring gastric cancer is currently not well understood.AIM To evaluate the prognosis predictive accuracy of preoperative LMR in signet ring gastric cancer.METHODS A total of 212 signet ring gastric cancer patients admitted at the Xiangya Hospital of Central South University,Department of Gastrointestinal Surgery,from January 2012 to December 2016 were enrolled in the study.The prognosis predictive accuracy of preoperative LMR was explored based on the area under the receiver operating characteristic.Factors that significantly affect the survival of patients were identified using single factor analysis,and those that were independently associated with signet ring gastric cancer were identified through multivariate analysis.RESULTS The results of the single factor analysis revealed a strong correlation between the survival of signet ring gastric cancer patients and several factors,including tumor invasion(χ^(2)=49.726;P<0.001),lymph node metastasis(χ^(2)=30.269;P<0.001),pTNM stage(χ^(2)=49.322;P<0.001),surgical approach(χ^(2)=8.489;P=0.004),age(t=-2.213;P<0.028),carcinoembryonic antigen(CEA)(Z=-3.265;P=0.001),platelet-to-lymphocyte ratio(Z=-2.196;P=0.028),LMR(Z=-2.226;P=0.026),ALB(t=3.284;P=0.001),prognostic nutritional index(t=-3.789;P<0.001)and FIB(Z=-3.065;P=0.002).Furthermore,the multivariate analysis further demonstrated that age(HR:0.563,95%CI:0.363-0.873),tumor invasion depth(HR:0.226,95%CI:0.098-0.520),pTNM stage(HR:0.444,95%CI:0.255-0.771),preoperative CEA level(HR:0.597,95%CI:0.386-8.790),and preoperative LMR level(HR:1.776,95%CI:1.150-2.741)were independent factors influencing the prognosis of signet ring gastric cancer.CONCLUSION In signet ring gastric cancer patients,a low preoperative LMR level predicts poor prognosis.The death risk ratio of the low LMR group compared to the high LMR group is 1.776.

Chicken Eggshell as an Innovative Bioflocculant in Harvesting Biofloc for Aquaculture Wastewater Treatment

Implementation of biofloc technology(BFT)system in aquaculture industry shows high productivity,low feed conversion ratio,and an optimum culture environment.This study was divided into two phases.The first phase involved maintaining the water quality using the optimum carbon-to-nitrogen ratio by manipulating pH in culture water.The second phase examined the performance of harvesting biofloc(remaining phytoplankton and suspended solids in the system)using chicken eggshell powder(CESP).This study showed that pH 7 to 8 were the best biofloc performance with high removal percentage of ammonia(>99%)with a remaining ammonia concentration of 0.016 mg L^(−1)and 0.018 mg L^(−1),respectively.The second phase of this study was performed to determine the optimal formulation and conditions of using CESP as a bio-flocculant in harvesting excess biofloc.The use of eggshell showed a higher harvesting efficiency of more than 80%under the following treatment conditions:0.25 g L^(−1)of eggshell dosage;with rapid and slow mixing rates of 150 and 30 rpm,respectively;30 min of settling time;settling velocity of 0.39 mm s^(−1)and pH of 6 to 7.Therefore,the results indicated that biofloc would be the best green technology approach for sustainable aquaculture wastewater and the CESP is an organic matrix that environmental-friendly bio-coagulant for biofloc harvesting.

Controversies in the management of acute pancreatitis:An update

This review summarized the current controversies in the management of acute pancreatitis(AP).The controversies in management range from issues involving fluid resuscitation,nutrition,the role of antibiotics and antifungals,which analgesic to use,role of anticoagulation and intervention for complications in AP.The interventions vary from percutaneous drainage,endoscopy or surgery.Active research and emerging data are helping to formulate better guidelines.The available evidence favors crystalloids,although the choice and type of fluid resuscitation is an area of dynamic research.The nutrition aspect does not have controversy as of now as early enteral feeding is preferred most often than not.The empirical use of antibiotics and antifungals are gray zones,and more data is needed for conclusive guidelines.The choice of analgesic is being studied,and the recommendations are still evolving.The position of using anticoagulation is still awaiting consensus.The role of intervention is well established,although the modality is constantly changing and favoring endoscopy or percutaneous drainage rather than surgery.It is evident that more multicenter randomized controlled trials are required for establishing the standard of care in these crucial management issues of AP to improve the morbidity and mortality worldwide.

Perioperative coagulation activation after permanent pacemaker placement

BACKGROUND Bradyarrhythmias are typically treated with permanent pacemakers(PM). The elimination of bradyarrhythmia by PM implantation improves the patient’s quality of life and prognosis, but it can also result in a number of sequalae. It is still unclear how PM implantation affects the hemostasis system’s parameters and how such parameters relate to different consequences after PM placement.AIM To assess the blood coagulation factor activity in PM patients throughout the perioperative period.METHODS Patients treated in the Department of Surgical Therapy of Cardiac Arrhythmias and Pacing at the Ryazan State "Regional Clinical Cardiology Dispensary" from April 2020 to December 2021 were included in the study. Before surgery, 7 and 30 d after PM placement, peripheral venous blood samples were withdrawn to measure the level of blood coagulation factor Ⅰ(FⅠ) and the activity of blood coagulation factors Ⅱ(FⅡ), Ⅴ(FⅤ), Ⅶ(FⅦ), Ⅷ(FⅧ), ⅸ(Fⅸ), ⅹ(Fⅹ), Ⅺ(FⅪ), Ⅻ(FⅫ). We used an automatic coagulometer Sysmex CA 660(Sysmex Europe, Germany) and reagents from Siemens(Siemens Healthcare Diagnostics Products GmbH, Germany).RESULTS The study included 146 patients. The activity of factors FⅤ [147.7(102.1-247.55)% vs 103.85(60-161.6)% vs 81.8(67.15-130.65)%, P = 0.002], FⅧ [80.4(60.15-106.25)% vs 70.3(48.5-89.1)% vs 63.7(41.6-88.25)%, P = 0.039], Fⅸ [86.2(70.75-102.95)% vs 75.4(59.2-88.3)% vs 73.9(56.45-93.05)%, P = 0.014], Fⅹ [188.9(99.3-308.18)% vs 158.9(83.3-230)% vs 127.2(95.25-209.35)%, P = 0.022], FⅪ [82.6(63.9-103.6)% vs 69.75(53.8-97.6)% vs 67.3(54.25-98.05)%, P = 0.002], FⅫ [87.6(67.15-102.3)% vs 78.9(63.4-97.05)% vs 81.2(62.15-97.4)%, P < 0.001] decreased at 7 and 30 d after surgery;FⅡ activity [157.9(109.7-245.25)% vs 130(86.8-192.5)% vs 144.8(103.31-185.6)%, P = 0.021] decreased at 7 d and increased at 30 d postoperatively. There were no statistically significant changes in the FVII activity within 30 d after PM placement [182.2(85.1-344.8)% vs 157.2(99.1-259)% vs 108.9(74.9-219.8)%, P = 0.128]. Subgroup analysis revealed similar changes only in patients on anticoagulant therapy. FⅫ activity decreased in patients on antiplatelet therapy [82(65.8-101.9)% vs 79.9(63.3-97.1)% vs 89.7(75.7-102.5)%, P = 0.01] 7 d after surgery, returning to baseline values at 30 d postoperatively.CONCLUSION PM placement and anticoagulant therapy were associated with decreased activity of clotting factors FⅤ, FⅧ, Fⅸ, Fⅹ, FⅪ, FⅫ in the postoperative period. FⅧ activity did not decrease within 30 d after PM placement, which may indicate endothelial injury caused by lead placement.

Short-term outcome of total knee replacement in a patient with hemophilia:A case report and review of literature

BACKGROUND Hemophilia A is a rare inherited bleeding disorder caused by mutations in the factor Ⅷ gene. This clotting factor plays an intrinsic role in the blood coagulation pathway. Patients with hemophilia may develop orthopedic manifestations such as hemarthrosis, but multiple malunion of fractures over the knee is rare and difficult to treat.CASE SUMMARY We report a patient with hemophilia A who developed severe knee osteoarthritis along with fracture malunion and nonunion. Total knee replacement was performed using a custom-made modular hinged knee prosthesis(cemented) equipped with extended distal and proximal stems. At 3 years’ follow-up, the patient exhibited excellent clinical function and remained satisfied with the surgical outcome. Surgical intervention was accompanied by rigorous coagulation factor replacement.CONCLUSION This case highlights various unique scenarios specific to individuals with hemophilia and fracture deformity.

Clinical association between coagulation indicators and bone metastasis in patients with gastric cancer

BACKGROUND Bones are one of the most common target organs for cancer metastasis.Early evaluation of bone metastasis(BM)status is clinically significant.Cancer patients often experience a hypercoagulable state.AIM To evaluate the correlation between coagulation indicators and the burden of BM in gastric cancer(GC).METHODS We conducted a single-center retrospective study and enrolled 454 patients.Clinical information including routine blood examination and coagulation markers were collected before any treatment.Patients were grouped according to the status of BM.Receiver operating characteristic curves were used to assess diagnostic performance and determine the optimal cutoff values of the above indicators.Cutoff values,sensitivity and specificity were based on the maximum Youden index.Univariate and multivariate logistic regression analyses were used to evaluate the relationships between biomarkers and BM.RESULTS Of the 454 enrolled patients,191 patients were diagnosed with BM.The receiver operating characteristic curve analysis suggested that prothrombin time(PT)Wang X et al.Coagulation indicators predict bone metastasis WJGO https://www.wjgnet.com 1254 July 15,2023 Volume 15 Issue 7[cutoff:13.25;sensitivity:0.651;specificity:0.709;area under receiver operating characteristic curve(AUC)=0.738],activated partial thromboplastin time(aPTT)(cutoff:35.15;sensitivity:0.640;specificity:0.640;AUC=0.678)and fibrin degradation products(FDP)(cutoff:2.75;sensitivity:0.668;specificity:0.801;AUC=0.768)act as novel predictors for BM.Based on multivariate logistic regression analysis,the results showed the independent correlation between PT[odds ratio(OR):3.16;95%confidence interval(CI):1.612-6.194;P=0.001],aPTT(OR:2.234;95%CI:1.157-4.313;P=0.017)and FDP(OR:3.17;95%CI:1.637-6.139;P=0.001)and BM in patients with GC.Moreover,age,carcinoembryonic antigen,erythrocyte and globulin were found to be significantly associated with BM.CONCLUSION Coagulation markers,namely PT,aPTT and FDP,might be potential predictors for screening BM in patients with GC.

Preserving finger length in a patient with symmetric digital gangrene under local anesthesia:A case report

BACKGROUND Case reports of symmetric digital gangrene resulting from high-dose vasopressors use in patients with alcoholic ketoacidosis,leading to cardiac arrest,are rare.To date,no specific treatment method for autolysis or surgical amputation or guidelines for determining the level of amputation have been established.CASE SUMMARY In this case report,we describe a treatment method that effectively preserved the function of fingers by surgical treatment under local anesthesia with a minimum operative time,while also preserving finger length to the maximum possible extent.CONCLUSION Our approach may contribute to improved postoperative quality of life by preserving finger length.