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.

CO_(2) electrolysis to formic acid for carbon neutralization

To avoid carbonate precipitation for CO_(2) electrolysis,developing CO_(2) conversion in an acid electrolyte is viewed as an ultimately challenging technology.In Nature,Xia et al.recently explored a proton-exchange membrane system for reducing CO_(2) to formic acid with a Pb±Pb SO_(4) composite catalyst derived from waste lead-acid batteries based on the lattice carbon activation mechanism.Up to 93%Faradaic efficiency was realized when formic acid was produced by this technology.

Kinetics of Neutralization of Polymetallic Mining Discharges from the Perkoa Zinc Deposit in Central-Western Burkina Faso

Oxidized and acidic mining discharges(pH between 4 and 5)from the Perkoa zinc mine in Burkina Faso consisting of waste rock,crusher rejects and mining tailings were sampled and used for neutralization tests with calcareous dolomite(for six months).The mining discharges and the calcareous dolomite were previously characterized.Columns of 60 cm length and 15 cm diameter were used for the tests.Then,2.62 kg of calcareous dolomite was deposited on the mining discharges in each column.Two liters of deionized water are added every 15 days to each column.Samples were taken at the outlet of the columns at time intervals and then analyzed to assess the evolution of pH,electrical conductivity and contents of PHEs(Potentially Harmful Elements)over time.Following the neutralization tests on solid mining discharges,neutralization tests were also carried out on acid leachates resulting from the oxidation of these same solid mining discharges with calcareous dolomite.The results show that calcareous dolomite is very effective for the neutralization of SR(Sterile Discharges)and the precipitation of PHEs contained therein.It is also effective in buffering acidic effluents from these sterile discharges.As for other mining discharges(crusher rejects and mining residues),although calcareous dolomite is not effective in neutralizing these oxidized and acidic solid discharges,it is however effective in precipitating PHEs such as arsenic and lead.Calcareous dolomite is also effective in buffering acid leachates from these oxidized and acidic mining discharges(crusher rejects and mining tailings).

Thermospheric neutral wind studies over the equatorial region:A review

Thermospheric neutral winds(TNWs)refer to the neutral gases in the thermosphere circulating as tides,which play a crucial role in the dynamics of the thermosphere-ionosphere system(TIS).Global geospace neutral winds,particularly over the magnetic equator,have been a subject of study for several decades.However,despite the known importance of neutral winds,a comprehensive understanding and characterization of the winds is still lacking.Various ground-based and satellite missions have provided valuable information on the contribution of neutral winds to the global atmospheric dynamics.However,efforts in the global monitoring of neutral winds are still lacking,and the drivers behind the behavior of TNWs as well as their influence on the TIS remain incomplete.To address these knowledge gaps in the global circulation of TNWs,it is crucial to develop a deep understanding of the neutral wind characteristics over different regions.The low-latitude equatorial region in particular has been observed to exert complex influences on TNWs because of the unique effects of the Earth’s magnetic field at the dip equator.Studying neutral winds over this region will provide valuable insights into the unique dynamics and processes that occur in this region,thereby enhancing our understanding of their role in the overall dynamics of the TIS.Additionally,through empirical observations,an improved ability to accurately model and predict the behavior of this region can be achieved.This review article addresses challenges in understanding equatorial winds by reviewing historical measurements,current missions,and the interactions of ionospheric and thermospheric phenomena,emphasizing the need for comprehensive measurements to improve global atmospheric dynamics and weather forecasting.

Vertical gradients of neutral winds observed by ICON and estimated by the Horizontal Wind Model during the geomagnetic storm on August 26−28,2021

The Michelson Interferometer for Global High-resolution Thermospheric Imaging(MIGHTI)onboard the Ionospheric Connection Explorer(ICON)satellite offers the opportunity to investigate the altitude profile of thermospheric winds.In this study,we used the red-line measurements of MIGHTI to compare with the results estimated by Horizontal Wind Model 14(HWM14).The data selected included both the geomagnetic quiet period(December 2019 to August 2022)and the geomagnetic storm on August 26-28,2021.During the geomagnetic quiet period,the estimations of neutral winds from HWM14 showed relatively good agreement with the observations from ICON.According to the ICON observations,near the equator,zonal winds reverse from westward to eastward at around 06:00 local time(LT)at higher altitudes,and the stronger westward winds appear at later LTs at lower altitudes.At around 16:00 LT,eastward winds at 300 km reverse to westward,and vertical gradients of zonal winds similar to those at sunrise hours can be observed.In the middle latitudes,zonal winds reverse about 2-4 h earlier.Meridional winds vary more significantly than zonal winds with seasonal and latitudinal variations.According to the ICON observations,in the northern low latitudes,vertical reversals of meridional winds are found at 08:00-13:00 LT from 300 to 160 km and at around 18:00 LT from 300 to 200 km during the June solstice.Similar reversals of meridional winds are found at 04:00-07:00 LT from 300 to 160 km and at 22:00-02:00 LT from 270 to 200 km during the December solstice.In the southern low latitudes,meridional wind reversals occur at 08:00-11:00 LT from 200 to 160 km and at 21:00-02:00 LT from 300 to 200 km during the June solstice.During the December solstice,reversals of the meridional wind appear at 20:00-01:00 LT below 200 km and at 06:00-11:00 LT from 300 to 160 km.In the northern middle latitudes,the northward winds are dominant at 08:00-14:00 LT at 230 km during the June solstice.Northward winds persist until 16:00 LT at 160 and 300 km.During the December solstice,the northward winds are dominant from 06:00 to 21:00 LT.The vertical variations in neutral winds during the geomagnetic storm on August 26-28 were analyzed in detail.Both meridional and zonal winds during the active geomagnetic period observed by ICON show distinguishable vertical shear structures at different stages of the storm.On the dayside,during the main phase,the peak velocities of westward winds extend from a higher altitude to a lower altitude,whereas during the recovery phase,the peak velocities of the westward winds extend from lower altitudes to higher altitudes.The velocities of the southward winds are stronger at lower altitudes during the storm.These vertical structures of horizontal winds during the storm could not be reproduced by the HWM14 wind estimations,and the overall response to the storm of the horizontal winds in the low and middle latitudes is underestimated by HWM14.The ICON observations provide a good dataset for improving the HWM wind estimations in the middle and upper atmosphere,especially the vertical variations.

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.

Serological survey on canine coronavirus antibodies in giant pandas by virus neutralization test

In order to survey the infectious situation of canine coronavirus (CCV) in giant panda population, a virus neutralization test detecting specific antibodies against CCV in giant panda抯 sera was established by using two-fold dilutions of serum and 100 TCID50 of the virus. The 62 sera samples of giant pandas, which were gathered from zoos and reserve region of Sichuan Province, China were detected. The neutralization antibody titer of 1:4 was recognized as the positive criterion, 8 sera samples were detected to be positive, and the positive rate was 12.9%. The titers of neutralizing antibody ranged from 1:8 to 1:32. It was the first comprehensive investigation on neutralization antibodies against CCV in giant panda population in China. The results of study showed that the infection of CCV in giant panda population was universal, which has posed a threat to the health of giant panda. Therefore, it is incumbent on us to study safe and effective vaccines to protect giant panda against CCV infection.

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.

Coagulation behavior of polyaluminum chloride: Effects of pH and coagulant dosage

Coagulation mechanisms of polyaluminum chloride(PACl) at various dosages were studied using a conventional jar test at different final and initial pH values during treating kaolin suspension. The optimal final pH and dosages for PACl were obtained based on residual turbidity and zeta potential of flocs. The coagulation zones at various PACl dosages and solution p H values were developed and compared with those of alum. It is found that the optimal mechanism under acidic condition is charge neutralization, while alkaline condition will facilitate the coagulation of PACl. Both charge neutralization coagulation and sweep coagulation can achieve high coagulation efficiency under the alkaline condition ranging from final p H 7.0 to 10.0. Stabilization, charge neutralization destabilization, restabilization and sweep zones occur successively with increasing PACl dosages with the final p H values fixed at 7.0 and 8.0, but restabilization zone disappears at final p H 10.0. When the final p H is not controlled and consequently decreases with increasing PACl dosage, no typical sweep zone can be observed and the coagulant efficiency decreases at high PACl dosage. It seems that the final pH is more meaningful than the initial p H for coagulation. Charge neutralization coagulation efficiency is dominated by zeta potential of flocs and PACl precipitates. The charge neutralization and sweep coagulation zones of PACl are broader in the ranges of coagulant dosage and p H than those of alum. The results are helpful for us to treat water and wastewater using PACl and to understand the coagulation process of PACl.

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.