Promising way to address massive intragastric clotting in patients with acute upper gastrointestinal bleeding:A case report

BACKGROUND Massive intragastric clotting(MIC) makes endoscopic therapy difficult in patients with acute upper gastrointestinal bleeding. Literature data on how to address this problem are limited. Here, we report on a case of massive stomach bleeding with MIC that was successfully treated endoscopically using an overtube of singleballoon enteroscopy.CASE SUMMARY A 62-year-old gentleman with metastatic lung cancer was admitted to the intensive care unit due to tarry stools and hematemesis of 1500 mL of blood during hospitalization. Emergent esophagogastroduodenoscopy revealed massive blood clots and fresh blood in the stomach with evidence of active bleeding.Bleeding sites could not be observed even by changing the patient’s position and aggressive endoscope suction. The MIC was successfully removed using an overtube connected with a suction pipe, which was inserted into the stomach with an overtube of a single-balloon enteroscope. An ultrathin gastroscope was also introduced through the nose into the stomach to guide the suction. A massive blood clot was successfully removed, and an ulcer with oozing bleeding at the inferior lesser curvature of the upper gastric body was revealed, facilitating endoscopic hemostatic therapy.CONCLUSION This technique appears to be a previously unreported method to suction MIC out of the stomach in patients with acute upper gastrointestinal bleeding. This technique could be considered when other methods are not available or if they fail to remove massive blood clots in the stomach.

Century Clot在大咯血输血中的指导价值研究

目的 探讨Century Clot在大咯血输血中的指导价值。方法 选取收治60例大咯血患者。随机分为研究组和对照组各30例,除原有治疗方案外,研究组行centuryclot指导输血;对照组行凝血四项及血常规指导输血。比较两组咯血停止时间、治疗后总咯血量及输血总量,比较两组治疗前后的凝血功能(包含TT、PT、APTT以及FIB)及凝血功能监测的准确率。结果 研究组咯血停止时间短于对照组,总咯血量及总输血量低于对照组(P<0.05)。治疗前,两组凝血功能无明显差异(P>0.05);治疗后,两组TT、PT及APTT水平均低于治疗前,且研究组均低于对照组(P<0.05);治疗后,两组FIB均高于治疗前,且研究组高于对照组(P<0.05)。研究组误诊率及漏诊率均低于对照组,但差异无统计学意义(P>0.05),准确率高于对照组(P<0.05)。结论 通过Centuryclot指导大咯血患者输血,不仅可精准止血,还可以有效改善患者凝血功能,减少咯血量及节约血制品。

Influence of styptic fiber on clotting time in rabbits

Objective To explore the influence of styptic fiber on clotting time in rabbits so as to provide experiment data for its development.Methods Onto 0.1 mL aliquots of citrated anti-coagulant rabbit blood placed in a surfacial plate 25 ul of 0.2 mol·L-1 CaCl2 solution was dropped,and mixed well with glass stirrer;the resulting mixture was immediately capped with a piece of styptic fiber(test product group)or absorptive gelatin sponge(positive control group)of 2 cm diameter.Then,the surficial plate was rinsed with 30ml of purified water at 5,10,20,30,40 and 50 min after capping;the rinsings were allowed to stand for 1 h and were subjected to OD determination at a wavelength of 541 nm.The above procedure was repeated twice,the average value of the twice experiments was taken for evaluation of the hemostatic effect of test product.For negative control group,all procedures except for capping were same as the test product group.The haemostatic effect was judged by percent OD relative to OD at 0 min in negative control group(OD 0 min)(OD 0 min was considered as 100%);if OD value at a time was less than 80% of OD 0 min,it should be designated as primary clotting time(PCT),less than 20% as complete clotting time(CCT).Results The measured PCT was 20min for both negative and positive control groups;CCT was 50,30 and 5 min for negative control,positive control and test product groups,respectively,showing the test styptic fiber had a CCT 8 times shorter than untreated blood,10 times shorter than negative control and 6 times shorter than positive control.Conclusions The test styptic fiber has powerful hemostatic effect.

Correlation of fibrinogen level and absorbance change in both PT and APTT clotting curves on BCSXP

Objective： To investigate the correlation of fibrinogen level and absorbance change in both PT and APTT clotting curves on BCSXP Analyzer. Methods：A serial of standard fibrinogen and 250 patient plasma samples with different qualities（normal, hemolysis, icterus, and lipemia） were run on BCSXP for assays PT, APTT and Fibrinogen. The absorbance change（DeltaA） from baseline to plateau in clotting curve was retrieved and analyzed on its correlation with the Fibrinogen result. Influence of plasma quality and PT/ APTT result on this correlation was also studied respectively. Results：Both PT-DeltaA and APTT-DeltaA showed good linear regres- sion with fibrinogen level in the sample, with R2 close to 0.90 in both standard and patient samples. Hemolysis（H）, itcterus（I） and lipemia（L） of the sample with valid clotting curves were found to have no significant difference in this correlation from normal（N） sample（R2： 0.83H, 0.92I, 0.81L and 0.79N in PT; 0.89H, 0.95l, 0.91L and 0.89N in APTT） in either PT or APTT curve. PT or APTT result also has little impact on this correlation（0.71 in range 7 - 10 sec, 0.56 inl0 - 20 sec, and 0.70 in 20 sec-; R2 in APTT： 0.88 in 20-30 sec, 0.92 in 30-40 sec, and 0.95 in 40 sec-）. Conclusion：The absorbance change in either PT or APTT clotting curve correlates well with the fibrinogen level in plasma, which is independent of plasma quality PT or APTT results. The absorbance change can be used as an alternative way to roughly estimate fibrinogen level in either PT or APTT clotting curve when the result of clauss-based fibrinogen measurement is not available.

A Case of Adverse Reaction to Booster Dose of COVID-19 Vaccination: Could D-Dimer Elevation Suggest Increased Clotting Risk?

We report the clinical case of a 40-year-old Italian woman, who soon after her booster vaccination with mRNA-1273 after the two previous vaccinations with BNT162b2, developed severe headache, high fever, and Musculo-skeletal pain. She went to the emergency department, where computerized tomography (CT) scans of chest and brain were performed, resulting in both negative for pathologic findings. On the contrary, white blood count was strongly lowered and D-dimer severely elevated. She improved after treatment with enoxaparin and the blood analyses returned in the normal range after ten days. This case supports the hypothesis that COVID-19 vaccines could increase blood clotting in some predisposed subjects. Therefore, we believe that robust and well-designed clinical trials, considering the evaluation of D-dimer levels, should be performed to eliminate any doubts on this issue.

Purification and Identification of a Clotting Protein from the Hemolymph of Chinese Shrimp (Fenneropenaeus chinensis)

The clotting protein(CP) plays important and diverse roles in crustaceans,such as coagulation and lipid transportation.A clotting protein was purified from the hemolymph of Chinese shrimp Fenneropenaeus chinensis(named as Fc-CP) with Q sepharose HP anion-exchange chromatography and phenyl sepharose HP hydrophobic interaction chromatography.Fc-CP was able to form stable clots in vitro in the presence of hemocyte lysate and Ca2+,suggesting that the clotting reaction is catalyzed by a Ca2+-dependent transglutaminase in shrimp hemocytes.The molecular mass of Fc-CP was 380 kDa under non-reducing conditions and 190 kDa under reducing conditions as was determined with SDS-PAGE.CP exists as disulfide-linked homodimers and oligomers.The N-terminal amino acid sequence of Fc-CP was identical to that of shrimps including Penaeus monodon,Farfantepenaeus paulensis and Litopenaeus vannamei;and similar to that of other decapods.The purified Fc-CP was digested with trypsin and verified on an ABI 4700 matrix-assisted laser desorption/ionization tandem time-of-flight(MALDI-TOF/TOF) mass spectrometry.Our results will aid to better understanding the coagulation mechanism of shrimp hemolymph.

H∞-Feedback Control of Heparin-Controlled Blood Clotting Network for Cardiac Surgeries

This paper presents a solution methodology for H∞-feedback control design problem of Heparin controlled blood clotting network under the presence of stochastic noise. The formulaic solution procedure to solve nonlinear partial differential equation, the Hamilton-Jacobi-Isaacs equation with Successive Galrkin’s Approximation is sketched and validity is proved. According to Lyapunov’s theory, with solutions of the nonlinear PDEs, robust feedback control is designed. To confirm the performance and robustness of the designed controller, numerical and Monte-Carlo simulation results by Simulink software on MATLAB are provided.

Determination of Rennet Clotting Time by Texture Analysis Method

In this study, texture analysis method was used for the determination of rennet flocculation time (tfloc) and rennet clotting time (tclot) of rennet-induced reconstitued milk samples with different CaCl2 concentrations. The rennet flocculation time (RFT) and rennet clotting time (RCT) were also determined by using the Berridge test and sensory evaluation. The hardness value versus renneting time curves derived from texture analysis gave a good modified exponential relationship for each CaCl2 concentration and the curves were used to calculate flocculation time and clotting time parameters. It was found that the parameters (tfloc and tclot) appeared strongly correlated with RFT and RCT, respectively. Texture analysis was proved as a suitable method to control the rennet-induced coagulation and determine the rennet clotting time. It was also determined that enrichment of milk with CaCl2 leaded to a decrease in flocculation and clotting times and an increase in rate of clotting and gel hardness.

超纯透析中逆超滤冲洗用于无肝素血液透析患者效果观察

目的探讨超纯透析中逆超滤冲洗在无肝素血液透析中的应用效果。方法将便利选取的45例有出血风险的无肝素血液透析患者分为对照组26例、干预组19例;血液透析过程中对照组采用常规生理盐水冲洗法,干预组采用逆超滤冲洗法;比较两组治疗完成情况、凝血指标及护理操作便捷性。结果两组均行91例次血液透析;干预组提前下机与更换管路后完成血液透析率、透析器和静脉壶凝血发生率显著低于对照组,每例次血液透析时间及护理操作频次显著少于对照组(均P<0.05)。干预组血液透析前后相关凝血指标差异无统计学意义(均P>0.05);对照组凝血酶原时间、活化部分凝血酶时间显著延长,纤维蛋白原含量显著减少(均P<0.05)。结论超纯透析中逆超滤冲洗可有效减少无肝素血液透析患者体外管路凝血,提高血液透析效率与安全性。

一株产凝乳酶变色栓菌鉴定及其凝乳酶的分离纯化与酶学性质研究

微生物凝乳酶具有生产周期短和易于发酵生产的优点,是传统小牛皱胃酶的经济高效替代选择之一。为了筛选新的凝乳酶产生菌,该研究以从传统发酵腐乳分离的霉菌为出发菌株,筛选具有高凝乳活性和低蛋白水解活性的霉菌菌株。采用内源转录区间隔区结合线粒体小亚基核糖体DNA扩增测序的方法对菌株进行了分子鉴定。通过硫酸铵分级盐析沉淀、DEAE-Sepharose Fast Flow阴离子交换柱、Sephadex G100凝胶过滤层析法对酶进行了纯化,并研究了凝乳酶酶学特性。筛选出菌株CQ3具有良好的凝乳活性和低蛋白水解活性,该菌株鉴定为变色栓菌(Trametes versicolor)。CQ3凝乳酶纯化后经SDS-PAGE分析呈现出分子质量为61 kDa的唯一条带。该酶作用的最适温度为45℃,最适pH值为6.5,Ca^(2+)对酶活力有显著的促进作用。该酶在pH值为4.5~7.0和温度低于50℃条件下有良好的稳定性。蛋白酶抑制剂试验表明,该酶为一种天冬氨酸蛋白酶。该研究结果报道了一种新的产凝乳酶菌种资源,为丰富凝乳酶产生菌株资源,进一步评价栓菌凝乳酶在干酪加工适用性的研究提供了理论基础。

小剂量肝素钠与低分子肝素钙对脓毒症治疗作用的对比研究

目的:对比小剂量肝素钠与低分子肝素钙治疗脓毒症的效果。方法:选取2021年10月—2022年10月脓毒症患者100例,随机分为观察组和对照组,每组50例。对比两组患者的治疗效果。结果:对照组弥散性血管内凝血8例(16.0%),观察组弥散性血管内凝血1例(2.0%),观察组临床疗效高于对照组(P<0.05)。随访1个月,观察组病死率低于对照组(P<0.05)。观察组各项凝血指标显著优于对照组(P<0.05)。观察组各项炎性因子水平低于对照组(P<0.05)。两组治疗后急性生理与健康评分(APACHEⅡ)优于治疗前,且观察组优于对照组,差异有统计学意义(P<0.05)。结论:低分子肝素钙相比小剂量肝素钠治疗脓毒症更加可行,可降低并发症发生率,改善短期预后。

注射用单磷酸阿糖腺苷细菌内毒素检查方法研究

目的:建立注射用单磷酸阿糖腺苷的细菌内毒素检测方法并进行方法学验证,以期对该品种的质量控制标准进行统一规范。方法:按照《中国药典》2020年版四部通则1143“细菌内毒素检查法”,确定细菌内毒素的限值,进行干扰试验,并进行内毒素检查。结果:按经验拟定的限值标准(每1mg单磷酸阿糖腺苷中含内毒素的量应小于0.06EU)对15个厂家提供的25个批次的供试品进行细菌内毒素检查,结果均符合规定。结论:本文建立的细菌内毒素检查法检查,可用于注射用单磷酸阿糖腺苷的质量控制。

无偿献血中采血袋内血液凝块产生原因分析及预防策略

目前,我国国民素质水平不断提升,越来越多人参与无偿献血,改善了临床血液紧张状况。在采血工作中,部分献血者过于紧张、或血管较细,导致血流缓慢、采血时间延长,使采血袋内的血液产生大小不一的血液凝块,造成血液报废,因此临床亟需优化采血工作。该文分析了无偿献血中采血袋内血液凝块的原因,并提出预防策略,包括为献血者开展健康教育、加强采血技术。

贝莱斯芽孢杆菌YH-1凝乳酶对切达干酪成熟特性及生物活性的影响

为了研究贝莱斯芽孢杆菌YH-1凝乳酶对切达干酪品质的影响,以商品凝乳酶制作的切达干酪(干酪A)为对照组,以70%的商品凝乳酶和30%的YH-1凝乳酶(干酪B),以及YH-1凝乳酶(干酪C)制作的切达干酪为实验组,比较3组干酪在4℃成熟12周过程中成熟特性和生物活性的变化。结果表明,干酪A和干酪B在干酪得率、总蛋白含量和氯化钠含量等指标之间没有显著差异(P>0.05)。干酪C的得率和脂肪含量低于干酪A,但总蛋白含量更高。与干酪A相比,干酪C在成熟过程中水分含量和pH值显著偏低,其中乳酸乳球菌活菌数没有明显变化,但在第12周的pH 4.6可溶性氮含量和12%(体积分数)三氯乙酸可溶性氮含量高于干酪A。干酪C的硬度显著高于干酪A和干酪B,而干酪B中的游离氨基酸含量高于干酪C和干酪A。干酪B和干酪C在成熟过程中所产生的醇类、酮类、酸类、酯类和苯环类化合物的含量高于干酪A。干酪生物活性研究表明,用YH-1凝乳酶制作的切达干酪能提高干酪的抗氧化能力和铁离子螯合能力。因此,YH-1凝乳酶具有部分代替商品凝乳酶生产干酪的潜力。

益气活血汤联合艾灸治疗四肢骨折术后气虚血瘀证疗效研究

目的:探讨益气活血汤联合艾灸对四肢骨折术后气虚血瘀证患者的影响。方法:选取四肢骨折术后气虚血瘀证患者,随机分为对照组和观察组,每组60例,均连续治疗14 d。对照组接受常规康复治疗,观察组在对照组基础上联合益气活血汤和艾灸治疗。比较两组患者治疗前后的中医证候积分、患肢功能恢复情况、患肢肿胀度、骨代谢状态、凝血功能及并发症发生率。结果:治疗后,观察组患者中医证候评分各项数值低于对照组(均P<0.05)。观察组患者四肢功能恢复理想率高于对照组,观察组活化部分凝血活酶时间、凝血酶原时间、凝血酶时间长于对照组,差异有统计学意义(均P<0.05)。观察组骨碱性磷酸酶、骨钙素、碱性磷酸酶水平高于对照组,而Ⅰ型胶原羧基端肽低于对照组,差异有统计学意义(均P<0.05)。观察组术后相关并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论:益气活血汤联合艾灸治疗四肢骨折术后气虚血瘀证可有效改善患肢功能恢复状况,加速抗凝血作用,促进术后患者恢复,减少相关并发症发生。

Genomic DNA Isolation by Phenol/Chloroform Extracting Method from Sheep Blood Clot

[ Objective] The aim was to establish the method of extracting genomic DNA from sheep blood clot on the basis of the improvement of method for extracting genomic DNA from tissues. [Method]The genomic DNA with complete primary structure and high purity was obtained from the sheep blood clot after the steps of cutting the sheep blood clot with ophthalmic scissors, cell lysis with tissue DNA extracts and digested by proteinase K, extracting with phenol/chloroform and precipitating with ethanol were performed. [ Result] The concentration of the extracted DNA was 159.90 ±0.70 ng/μl and the ratio of the A260/A280 was 1.80 ＋0.01. The sheep microsatellite locus of BM203 was amplified by using the extracted DNA from the sheep blood clot as template of PCR, and the PCR result was perfect. [Conclusion]This method is simple and feasible, the quantity and quality of the extracted DNA can satisfy the demands for the subsequent researches. It is worth to extending and using for reference.

多囊卵巢综合征高雄激素血症与凝血功能的关系探讨

目的探讨多囊卵巢综合征患者合并高雄激素血症的影响因素及高雄激素血症与凝血指标的关系。方法通过收集274例多囊卵巢综合征患者一般资料,测定内分泌相关指标(FSH、LH、AMH、雄激素)、代谢指标(空腹血糖、胰岛素)、凝血相关指标(FIB、PT、INR、PA、TT、APTT、D-Dimer、PLT),采用单因素分析及Logistics回归分析探讨多囊卵巢综合征患者合并高雄激素血症的影响因素,进一步分析高雄激素血症与凝血指标的可能关系。结果274例多囊卵巢综合征患者合并高雄激素血症比例为52.55%(144/274),非高雄激素血症比例为47.45%(130/274),两组在年龄、超重或肥胖分布比例及AMH、PT、INR、PA、TT、APTT水平差异无统计学意义(P>0.05),高雄激素血症组月经稀发、LH/FSH≥2.5、胰岛素抵抗分布比例及FIB、D-Dimer、PLT水平均高于非高雄激素血症组(P<0.05);Logistics回归分析结果提示,月经稀发、LH/FSH≥2.5、FIB是PCOS合并高雄激素血症的独立危险因素(OR值分别为2.286、3.105、1.615,P<0.05)。结论多囊卵巢综合征合并高雄激素血症的概率较高,与月经稀发、内分泌及凝血指标相关,高雄激素血症较非高雄激素血症患者具有更显著的高凝风险。

血乳酸对局部枸橼酸抗凝下连续性肾脏替代治疗体外循环凝血的影响

目的旨在探讨枸橼酸局部抗凝(regional citrate anticoagulation,RCA)下连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中血乳酸水平对体外循环凝血的影响。方法采用回顾性队列研究设计,收集广州医科大学附属第二医院重症医学科2021年6月—2023年7月局部枸橼酸抗凝下行CRRT治疗的体外循环数据,根据48小时内是否凝血下机分为凝血组和非凝血组。采用COX回归分析CRRT体外循环48小时内凝血的危险因素。结果共纳入114例患者,共179套CRRT体外循环和对应数据,其中凝血组105例,非凝血组74例。COX回归分析显示:静脉压高(HR=1.008,95%CI:1.000~1.016,P=0.045)、乳酸≥2 mmol/L(HR=1.517,95%CI:1.009~2.280,P=0.045)是CRRT体外循环48小时内凝血的独立危险因素;枸橼酸剂量≥3.2 mmol/L(HR=0.461,95%CI:0.312~0.682,P<0.001)是其保护因素。结论CRRT上机时应对体外循环进行充分预冲,运行前测试血液透析置管功能,调整好血液透析置管位置以避免静脉压升高。乳酸高,组织灌注差的患者应积极液体复苏,避免血液过度浓缩,有助于降低CRRT体外循环48小时内凝血的风险。

用Sonoclot分析仪测评体外循环后凝血功能的改变

目的用Sonoclot凝血和血小板功能分析仪观察心脏直视手术体外循环前、后凝血功能的改变。方法选择20例体外循环下心脏手术患者,麻醉前及首次鱼精蛋白中和肝素后10 min取静脉血用Sonoclot分析仪检测全血凝血和血小板功能,并进行激活全血凝固时间(ACT)测定。结果体外循环前后ACT差异无显著性(P=0.27),而使用玻璃珠作为促凝剂的检测试剂盒(gb-ACTKit)术后明显高于术前(P<0.01),凝血速率(CR)术后明显降低(P=0.01),血小板功能(PF)降低但无显著差异(P=0.50)。结论Sonoclot分析仪能够早期检测体外循环后凝血功能的改变,是一种较为敏感的床边检测方法。

神经内镜血肿清除术治疗重型脑室出血并铸型的作用分析

目的:明确神经内镜血肿清除术治疗重型脑室出血并铸型的临床价值。方法:将本院96例患者采用随机数字表法分为对照组和观察组各48例;对照组采用侧脑室外引流术式,观察组采用神经内镜血肿清除术;比较两组患者术前术后mGS评分,术后尿激酶用量、引流管留置时间、并发症和治疗效果。结果:术前两组患者mGS评分无统计学意义,术后差异显著,观察组低于对照组(P<0.05);术后观察组尿激酶用量、引流管留置时间和并发症发生率均低于对照组(P<0.05),治疗总有效率高于对照组(P<0.05)。结论:对重型脑室出血铸型患者采用神经内镜血肿清除术,有利于改善患者临床症状,降低并发症发生率。