Risk Factors for Mortality in Critically Ill Patients with Coagulation Abnormalities:A Retrospective Cohort Study

Objective Coagulation abnormalities are common and prognostically significant in intensive care units(ICUs)and are associated with increased mortality.This study aimed to explore the association between the levels of coagulation markers and the risk of mortality among ICU patients with coagulation abnormalities.Methods This retrospective study investigated patients with coagulation abnormalities in the ICU between January 2021 and December 2022.The initial point for detecting hemostatic biomarkers due to clinical assessment of coagulation abnormalities was designated day 0.Patients were followed up for 28 days,and multivariate logistic regression analysis was utilized to identify risk factors for mortality.Results Of the 451 patients analyzed,115 died,and 336 were alive at the end of the 28-day period.Multivariate analysis revealed that elevated thrombin-antithrombin complex(TAT),tissue plasminogen activator inhibitor complex(tPAIC),prolonged prothrombin time,and thrombocytopenia were independent risk factors for mortality.For nonovert disseminated intravascular coagulation(DIC)patients,older age and thrombocytopenia were associated with increased risks of mortality,whereas elevated levels of plasminα2-plasmin inhibitor complex(PIC)were found to be independent predictors of survival.In patients with overt DIC,elevated levels of tPAIC were independently associated with increased risks of mortality.Nevertheless,thrombocytopenia was independently associated with increased risks of mortality in patients with pre-DIC.Conclusion Coagulation markers such as the TAT,tPAIC,PIC,and platelet count were significantly associated with mortality,underscoring the importance of maintaining a balance between coagulation and fibrinolysis.These findings highlight the potential for targeted therapeutic interventions based on specific coagulation markers to improve patient outcomes.

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.

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.

Hybrid argon plasma coagulation for the treatment of Barrett’s esophagus:A prospective,multicenter study

BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for BE treatment includes argon plasma coagulation(APC),radiofrequency ablation and cryoablation,all with varying degrees of success.AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment.These procedures were performed by seven endoscopists from different tertiary hospitals.The duration of the procedure,curative rate,complications and recurrent rate by 1-year follow-up were recorded.RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020,comprising of 39 males and 41 females with a median age of 54 years(range,30 to 83 years).The technical success rate of HybridAPC was 100%and the overall curative rate was 98.15%.No severe complications occurred during the operation.BE cases were classified as short-segment BE and long-segment BE.Patients with short-segment BE were all considered cured without complications.Thirty-six patients completed the one-year follow-up without recurrence.Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment.The mean duration of the procedure was 10.94±6.52 min.CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up,especially in cases of short-segment BE.This technique could be considered as a feasible alternative ablation therapy for BE.

Research on Treating Thallium by Enhanced Coagulation Oxidation Process

[Objective] The aim was to treat acidic wastewater containing thallium by enhanced coagulation oxidation process. [Method] Enhanced coagulation oxidation process was made use of to remove thallium in the acidic wastewater in the experiment under the condition of 0.05 kg/L of potassium permanganate, 30% hydrogen peroxide and 0.05 kg/L calcium hypochlorite as oxidant, together with 0.092 kg/L CaO as coagulation. [Result] The results showed that thallium removal efficiencies achieved 99.98%, 99.1% and 99.95% when dosages of KMnO4, H2O2and Ca（ClO）2were added at 20, 2.2 and 37 ml, respectively, under the condition of 30 ml 0.092kg/L CaO being dosed and 99.93%, 99.69% and 99.98% were achieved when different dosages of CaO were added at 25, 35 and 25 ml, under the condition of 20ml KMnO4, 2.2 ml H2O2and 37 ml Ca（ClO）2respectively. [Conclusion] The experiment demonstrates that good removal effects of removal thallium from the acidic wastewater would be achieved by enhanced coagulation oxidation process.

STRUCTURE-FUNCTION FEATURES AND EFFECTS ON BLOOD COAGULATION OF SNAKE VENOM SERINE PROTEASES*

Snake venoms,especially those from the two subfamilies,Crotalinae and Viperinae,contained a lot of serine proteases. They were responsible for the hemorrhage,shock,or disorder of blood coagulation after envenomation. They acted,by activating,inactivating,or other converting effects,on almost all the components of hemostatic and fibrinolytic systems. Their sequences were homologous to trypsin-kallikrein serine proteases. Variation of primary sequences out of active center results in the difference of substrate specificities and the further difference of biological and pharmacological activities. Because of their common and unique properties compared to their physiological corresponding factors,snake venom proteases are proved to be an excellent model for the study of protease substrate discriminating mechanism. Furthermore,they have found an important position both in basic research and application of hemostasis and thrombosis in clinic.

Percutaneous Microwave Coagulation Therapy for Patients with Primary and Metastatic Hepatic Tumors

Objective: To evaluate the efficacy and safety of percutaneous microwave coagulation therapy (PMCT) for patients with primary and metastatic hepatic tumors.Methods: The enrolled 100 patients with 186 tumor nodules who underwent PMCT included 79 cases of primary or recurrent liver cancers and 21 cases of metastatic liver cancer. The tumors were divided into two groups according to the tumor size in diameter: group A, 0.5 cm?<3 cm; group B, ≥3 cm?<5 cm. Under local and/or epidural anesthesia, a single percutaneous microwave antenna (or two antennas array applicator) was inserted directly into the tumor in the liver for thermo-coagulation with the aid of ultrasound guidance.Results: Among the 186 lesions in 100 patients with primary and metastatic liver cancers, in group A, 123 (66%) were coagulated once. A Follow-up of 6–12 months demonstrated that 112 lesions (91%) showed no local recurrence by CT or MRI; In group B, of the 63 lesions (33.87%) coagulated twice, 31 (49%) showed no local recurrence by CT or MRI during a follow-up of 6 months. There were no serious clinical side effects or complications in all the PMCT patients.Conclusion: PMCT gives satisfactory curative effect on tumors with <3 cm in size. It is partly effective on lesions ≥3 cm?<5 cm in size. It is a minimally invasive and effective therapy, can be used safely in the field of percutaneous hepatis surgery, and carried out even in patients with poor liver function. Key words hepatocellular carcinoma - microwave - coagulation - therapy

Composite control for coagulation process with time delay and disturbances

A composite control scheme consisting of modepredictive control （MPC） and disturbance observer （DOB） iproposed to solve the control performance degradationproblem of the turbidity of the treated water in the presence osignificant changes in raw water quality, water flow rate andinternal model mismatch disturbances. The MPC is employedas a feedback controller for the coagulation process with alarge time delay. The DOB is adopted to estimate the severedisturbances in the turbidity control, such as large changes inraw water quality and water flow rate. The estimated valuesare applied for feed-forward compensation to rejecdisturbances. Finally, the disturbance rejection performancesfor step disturbances and time-varying disturbances in thenominal case and model mismatch case are tested. Thesimulation results illustrate that, compared with the MPCmethod, the proposed method can significantly improve thedisturbance rejection performance in the turbidity control othe treated water, no matter if in the presence of externadisturbances or internal model mismatch disturbances.

Effect of coagulation pretreatment on the fouling of ultrafiltration membrane

The purpose of this study is to understand the effect and mechanism of preventing membrane fouling, by coagulation pretreatment, in terms of fractional component and molecular weight of natural organic matter （NOM）. A relatively higher molecular weight （MW） of hydrophobic compounds was responsible for a rapid decline in the ultrafiltration flux. Coagulation could effectively remove the hydrophobic organics, resulting in the increase of flux. It was found that a lower MW of neutral hydrophilic compounds, which could remove inadequately by coagulation, was responsible for the slow declining flux. The fluxes in the filtration of coagulated water and supernatant water were compared and the results showed that a lower MW of neutral hydrophilic compounds remained in the supernatant water after coagulation could be rejected by a membrane, resulting in fouling. It was also found that the coagulated flocs could absorb neutral hydrophilic compounds effectively. Therefore, with the coagulated flocs formed on the membrane surface, the flux decline could be improved.

Transfusion and coagulation management in liver transplantation

There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation. The use of blood products intraoperatively is declining and transfusion free transplantations take place ever more frequently. Allogenic blood products have been shown to increase morbidity and mortality. Primary haemostasis, coagulation and fibrinolysis are altered by liver disease. This, combined with intraoperative disturbances of coagulation, increases the risk of bleeding. Meanwhile, the rebalancing of coagulation homeostasis can put patients at risk of hypercoagulability and thrombosis. The application of the principles of patient blood management to transplantation can reduce the risk of transfusion. This includes: preoperative recognition and treatment of anaemia, reduction of perioperative blood loss and the use of restrictive haemoglobin based transfusion triggers. The use of point of care coagulation monitoring using whole blood viscoelastic testing provides a picture of the complete coagulation process by which to guide and direct coagulation management. Pharmacological methods to reduce blood loss include the use of anti-fibrinolytic drugs to reduce fibrinolysis, and rarely, the use of recombinant factor VIIa. Factor concentrates are increasingly used; fibrinogen concentrates to improve clot strength and stability, and prothrombin complex concentrates to improve thrombin generation. Non-pharmacological methods to reduce blood loss include surgical utilisation of the piggyback technique and maintenance of a low central venous pressure. The use of intraoperative cell salvage and normovolaemic haemodilution reduces allogenic blood transfusion. Further research into methods of decreasing blood loss and alternatives to blood transfusion remains necessary to continue to improve outcomes after transplantation.

Features and mechanism for coagulation－flocculation processes of polyaluminum chloride

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Large eddy simulation of a planar jet flow with nanoparticle coagulation

Coagulation and growth of nanoparticles subject to large coherent structures in a planar jet has been explored by using large eddy simulation. The particle field is obtained by employing a moment method to approximate the nanoparticle general dynamic equa- tion. An incompressible fluid containing particles of 1 nm in diameter is projected into a particle-free ambient. The results show that the coherent structures dominate the evolution of the nanoparticle number intensity, diameter and polydispersity distributions as the jet develops. In addition, the coherent structures act to increase the diffusion of particles, and the vortex rolling-up makes the particles distributing more irregularly while the vortex pairing causes particle distributions to become uniform. As the jet travels downstream, the time-averaged particle number concentration becomes lower in the jet core and higher in the outskirts, whereas the time- averaged particle mass over the entire flow field maintains unaltered, and the time-averaged particle diameter and geometric standard deviations grow and reach their maximum on the interface of the jet region and the ambient.

The effect of coupling coagulation and flocculation with membrane filtration in water treatment:A review

Water supply and sanitation demands are foreseen to face enormous challenges over the coming decades to meet the fast growing needs in a global perspective. Significant growth in the industry is predicted and membrane separation technologies have been identified as one of the possible solutions to meet future demands. Application and implementation of membrane technology is expected both in production of potable water as well as in treatment of wastewater. In potable water production membranes are substituting conventional separation technologies due to the superior performance, potential for less chemical use and sludge production, as well as the potential to fulfill hygienic barrier requirements. Membrane bio-reactor （MBR） technology is probably the membrane process which has had most success and has the best prospects for the future in wastewater treatment. Trends and developments indicate that this technology is becoming accepted and is rapidly becoming the best available technology for many wastewater treatment applications. A major drawback of MBR systems is membrane fouling. Studies have shown that fouling mitigation in MBR systems can potentially be done by coupling coagulation and flocculation to the process.

Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis

BACKGROUND Chronic radiation proctitis(CRP) is a complication which occurs in 1%-5% of patients who undergo radiotherapy for pelvic malignancies. Although a wide range of therapeutic modalities are available, there is no literature to date showing any particularly appropriate therapeutic modality for each disease stage. Argon plasma coagulation(APC) is currently recommended as the firstchoice treatment for hemorrhagic CRP, however, its indication based on longterm follow-up is still unclear. On the hypothesis that the long-term efficacy and safety of APC are not fully understood, we reviewed APC treatment for patients with hemorrhagic CRP from a single center.AIM To assess the long-term efficacy and safety of APC for hemorrhagic CRP.METHODS This is a retrospective study of consecutive patients treated with APC for hemorrhagic CRP from January 2013 to October 2017. Demographics, clinical variables, and typical endoscopic features were recorded independently. Success was defined as either cessation of bleeding or only occasional traces of bloody stools with no further treatments for at least 12 mo after the last APC treatment.We performed univariate and multivariate analyses to identify factors associated with success and risk factors for fistulas.RESULTS Forty-five patients with a median follow-up period of 24 mo(range: 12-67 mo)were enrolled. Fifteen(33.3%) patients required blood transfusion before APC.Successful treatment with APC was achieved in 31(68.9%) patients. The mean number of APC sessions was 1.3(1-3). Multivariate analysis showed that APC failure was independently associated with telangiectasias present on more than50% of the surface area [odds ratio(OR) = 6.53, 95% confidence interval(CI): 1.09-39.19, P = 0.04] and ulcerated area greater than 1 cm^2(OR = 8.15, 95%CI: 1.63-40.88, P = 0.01). Six(13.3%) patients had severe complications involving rectal fistulation. The only factor significantly associated with severe complications was ulcerated area greater than 1 cm^2(P = 0.035).CONCLUSION The long-term efficacy of APC for hemorrhagic CRP is uncertain in patients with telangiectasias present on > 50% of the surface area and ulceration > 1 cm^2.

Coagulation of micro-polluted Pearl River water with IPF-PACls

Water samples collected from early March 2001 to the end of April 2002 at the branch of Pearl River around the Guangzhou City were analyzed for its micro-polluted characteristics. The coagulation behavior of polyaluminum chlorides(PACls) was then examined focusing on the effect of primary water quality and speciation distribution. The results showed that PACls exhibit better coagulation efficiency than alum in accordance with the different speciation. The turbidity removal property of PACls is evidently better than alum at low dosage. While in neutral zone(about 6.5—7.5), the turbidity removal of PACls decreases owing to the restabilization of particles at higher dosage. The organic matters in raw water exhibit marked influence on coagulation. In acidic zone, organic matters complex with polymer species and promote the formation of flocs. With an increase in pH, the complexation of organics with polymer species gradually decreases, and the removal of organics mainly depends on adsorption. The effect is evidently improved with the raise of B value.

Research on mine dustfall agents based on the mechanism of wetting and coagulation

Mine dust is classified as one of five natural coal mining disasters because it can harm the health of miners and poses a serious threat to the safety of the coal mine. Therefore, preparation of an effective dust suppression agent is highly desired. To improve the capture efficiency of fine dust, this study examines the dust suppression effects of various combinations of wetting agents, additives, and coagulation agents by using the optimum seeking method to reduce mine dust, particularly respirable particles. The optimal formula is shown to contain 10wt% fatty alcohol polyoxyethylene ether（JFC）, 4.96wt% cationic polyacrylamide, and 4wt% calcium chloride. The dust suppression effect can be achieved at 96.1% in 5 min by using the optimal formula.

Natural organic matter(NOM) removal from surface water by coagulation

Poly aluminum chloride sulfate(PACS) with different SO 2- 4/Al 3+ mole ratios and bacicity(γ) of 2 0 was synthesized using AlCl 3\56H\-2O, Al\-2(SO\-4)\-3\518H 2O and Na 2CO 3 as raw materials. The effect of SO 2- \-4/Al 3+ ratio on the performance of PACS for removal of natural organic matter(NOM) with humic rich actual water was examined. It was found that PACS with SO 2- \-4/Al 3+ mole ratio of 0.0664 achieved the best NOM removal results and was selected to investigate its performance in comparison with PAC, FeCl 3 and alum(Al 2 (SO 4) 3·18H 2O). The experimental results showed that the optimum NOM removals were achieved at pH 5.0\_8.2 and the dose of about 5 0 mg/L as Al both for the selected PACS and PAC, at pH 5 0\_6 0 and the dose of about 7 0 mg/L as Fe for FeCl 3, and at pH 5 0\_7 0 and the dose of about 7 0 mg/L as Al for alum, respectively. At the optimum conditions, the selected PACS achieved the best NOM removal result, followed by PAC, FeCl 3, and then alum. The concentration of residual aluminum in treated water by the selected PACS and PAC under the optimum coagulant conditions was approximately 115 μg/L, which can completely comply with the regulated limits.

Coagulation enhanced electrokinetic settling of mature fine oil sands tailings

The mature fine oil sand tailings(MFT) remain as slurry in the tailings pond for long time. The dewatering and consolidation of MFT for sustainable management is an important task for the mining industry. The objective of this study is to accelerate electrokinetic settling of MFT solids in suspensions in presence of optimal coagulant. In the first phase, optimal coagulant and coagulant dosage for settling of suspension are identified, i.e., ferric chloride at 350 mg/L. It is found that the chemical treatment is not much effective; the final solid content of the sediment is only 6.48% from an initial of 5%. In the second phase,combined coagulation and electrokinetic treatment is carried out to enhance the settling effect. The direct electric current is applied in continuous and intermittent modes on MFT suspensions placed in electrokinetic cell. The results show the final solid content reaches 23.74% under the combined application of350 mg/L ferric chloride and 218.75 V/m applied voltage gradient in the continuous mode. The intermittent current mode with 40% save in power consumption produces a settled sediment having 20.84% final solid content.

Properties and coagulation mechanisms of polyferric silicate sulfate with high concentration

Polyferric silicate sulfate （PFSS） with high concentration was prepared using the composite-poly method. The coagulation properties and mechanisms of this new complex were probed using TEM, Fe-Ferron timed complex-colorimetric method, and infrared spectrum method. The results showed that the flocculating effect of polyferric silicate sulfate had an advantage over polyferric sulfate （PFS）, as the optimum coagulation effect could be obtained when the Si/Fe mole ratio was 0.75 in accordance with its macrostructure of PFSS. According to the Fe-Ferron timed complex-colorimetric method, the Si species was mainly Sic, whereas, the Fe species were Fea and Fec in the copolymerization system. The infrared spectra indicated that the structure of these new flocculants was formed by polymers, mainly by olation, which was different from polyferric sulfate, and the vibration of M-OH-M of around 1100 cm^-1, also proved that there existed Fe-OH-Fe and its polymers in some forms.

Thrombomodulin in the management of acute cholangitisinduced disseminated intravascular coagulation

AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial.