Prothrombotic state and thrombotic events in COVID-19 pandemic period,including portal vein and splenic artery thromboses

This editorial article is intended to perform a discussion on the manuscript entitled“Simultaneous portal vein thrombosis and splenic vein thrombosis in a COVID-19 patient:A case report and review of literature”written by Abramowitz et al.The article focuses on the diagnostic processes in a 77-year-old-male patient with a simultaneous portal vein and splenic artery thrombosis accompanying coronavirus disease 2019(COVID-19).The authors postulated that splanchnic thrombosis should be on the list of differential diagnoses in a patient presenting with abdominal pain in presence of a COVID-19 infection.The tendency for venous and arterial thrombosis in COVID-19 patients is encountered,largely attributed to hypercoagulopathy.In general,venous thromboembolism mostly manifest as deep vein thrombosis(DVT),pulmonary embolism(PE)or catheterrelated thromboembolic events.Acute PE,DVT,cerebrovascular events and myocardial infarction are seen as the most common thromboembolic complications in COVID-19 patients.COVID-19-associated hemostatic abnormalities include mild thrombocytopenia and increased D-dimer level.Similar to other coagulopathies,the treatment of the underlying condition is the mainstay.Addition of antiplatelet agents can be considered in critically ill patients at low bleeding risk,not on therapeutic anticoagulation,and receiving gastric acid suppression Early administration of antithrombotic drugs will have a beneficial effect in both the prevention and treatment of thrombotic events,especially in non-ambulatory patients.Low molecular weight heparin(LMWH)should be started if there is no contraindication,including in non-critical patients who are at risk of hospitalization LMWH(enoxaparin)is preferred to standard heparin.

Early renal failure as a cardiovascular disease:Focus on lipoprotein(a) and prothrombotic state

Patients with renal failure are at increased risk of cardiovascular events even at the earliest stages of disease. In addition to many classic cardiovascular risk factors, many conditions that are commonly identified as emerging risk factors might contribute to occurrence of cardiovascular disease. Changes in circulating levels of many of these emerging risk factors have been demonstrated in patients with early stages of renal failure caused by different types of renal disease and have been associated with detection of cardiovascular complications. However, for most of these factors evidence of benefts of correction on cardiovascular outcome is missing. In this article, we comment on the role of lipoprotein（a） and prothrombotic factors as potential contributors to cardiovascular events in patients with early renal failure.

Correlation Study of Color Doppler Examination of Deep Veins of Both Lower Extremities Combined with Fibrinolysis System in Hypertension during Pregnancy

Objective: To investigate the correlation between deep static color Doppler ultrasound of both lower extremities combined with fibrinolytic system detection in pregnancy-induced hypertension. Methods: A total of 70 normal pregnant women, 70 pregnant women with hypertension during pregnancy, and 50 healthy non-pregnant women in the same period were selected as the research objects. The deep veins of both lower limbs were examined by Rili Erlangshen’s color Doppler ultrasound diagnostic instrument (CDU), and the fibrinolysis system was tested by enzyme-linked immunosorbent assay (ELISA) method and automatic hemagglutination analyzer. Results: Compared with the non-pregnant group, the inner diameters of the left/right femoral vein (CFV) and popliteal vein (POV) in the normal pregnancy group and the pregnancy-induced hypertension group were significantly widened, and the peak blood flow spectrum was significantly reduced. The difference was statistically significant (P < 0.01);FIB, PLG, t-PA, PAI, D-Dimer were significantly increased, the difference was statistically significant (P < 0.01);Compared with the normal pregnancy group, the inner diameter of the left/right femoral vein (CFV) in the hypertensive pregnancy group was significantly wider than that in the normal pregnancy group, and the peak value of the left/right POV blood flow spectrum was significantly lower than that in the normal pregnancy group, the difference was statistically significant (P < 0.01), while the left/right popliteal vein (POV) inner diameter, left/right CFV blood flow peak value did not change significantly from the normal pregnancy group, and the difference was not statistically significant (P > 0.05);FIB, PLG, PAI, D-Dimer of the hypertensive disease group during pregnancy significantly increased, the difference was statistically significant (P < 0.01), while t-PA was not statistically significant (P > 0.05). Conclusion: Normal pregnant women have a hypercoagulable state compared with healthy non-pregnant women, and pregnant women with hypertension during pregnancy are more likely to be in a pre-thrombotic state than pregnant women with normal pregnancy. Deep vein CDU examination of both lower extremities combined with blood fibrinolysis monitoring is of great value in the prevention and treatment of hypertension during pregnancy.

Immunometabolic bases of type 2 diabetes in the severity of COVID- 19

The outbreak of coronavirus disease 2019(COVID-19)is caused by the novel severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).COVID-19 and type 2 diabetes(T2D)have now merged into an ongoing global syndemic that is threatening the lives of millions of people around the globe.For this reason,there is a deep need to understand the immunometabolic bases of the main etiological factors of T2D that affect the severity of COVID-19.Here,we discuss how hyperglycemia contributes to the cytokine storm commonly associated with COVID-19 by stimulating monocytes and macrophages to produce interleukin IL-1β,IL-6,and TNF-αin the airway epithelium.The main mechanisms through which hyperglycemia promotes reactive oxygen species release,inhibition of T cell activation,and neutrophil extracellular traps in the lungs of patients with severe SARS-CoV-2 infection are also studied.We further examine the molecular mechanisms by which proinflammatory cytokines induce insulin resistance,and their deleterious effects on pancreaticβ-cell exhaustion in T2D patients critically ill with COVID-19.We address the effect of excess glucose on advanced glycation end product(AGE)formation and the role of AGEs in perpetuating pneumonia and acute respiratory distress syndrome.Finally,we discuss the contribution of preexisting endothelial dysfunction secondary to diabetes in the development of neutrophil trafficking,vascular leaking,and thrombotic events in patients with severe SARS-CoV-2 infection.As we outline here,T2D acts in synergy with SARSCoV-2 infection to increase the progression,severity,and mortality of COVID-19.We think a better understanding of the T2D-related immunometabolic factors that contribute to exacerbate the severity of COVID-19 will improve our ability to identify patients with high mortality risk and prevent adverse outcomes.

Fribrinolysis Kinetics and Its Application

A new, convenient, and rapid method for kinetic measurement of human fibrinolysis was established. The alteration of absorbance （A） in the process of blood coagulation and lyses was automatically scanned and recorded using a UV2000 spectrophotometer connected to a computer. The parameters of human fibrinolysis kinetics were established. Urokinase at 20 U/mL was the optimal concentration used. There was significant difference in fibrinolysis kinetics and plasma plasminogen concentration between 22 normal subjects and 27 patients with acute myeloblastic leukemia （P〈0.05 and 〈0.01 respectively）. The coefiicience of variation was （5.24±1,51）%. This method could also be used to measure the plasma fibrinogen concentration at the same time. It was concluded that this method was stable and was capable of providing dynamic, direct experimental data and multiparemeters for clinicians. It was also valuable in evaluating the anti- and pro-fibrinolytic capcity of patients＇ plasmas, allowing for monitoring of therapy, choice of drugs and adjustment of drug concentrations.

Chronic myeloid leukaemia presenting as acute small bowel gangrene:A case report

Rationale:Chronic myeloid leukaemia is a myeloproliferative disorder due to clonal hyperproliferation of myeloid cells within the bone marrow.It can present both pro-and anti-thrombotic states.CML has different presentations within the gastrointestinal tract.Patient’s concern:A 40-year-old non-diabetic and non-hypertensive male complained of abdominal pain with nausea and emesis for 1 day.Besides,he had a history of abdominal distension and fever for 1 day.Diagnosis:Acute small bowel gangrene due to chronic myeloid leukaemia.Intervention:A limited resection of small intestine with ileostomy and mucus fistula.Outcome:After 3 months following surgery the patient underwent stoma closure.The patient was followed up for more than 3 years postoperatively.During the follow-up,the patient was asymptomatic without any recurrence of the disease.Lesson:Chronic myeloid leukaemia should be considered as one of the causes for small intestine gangrene when there is increased leukocyte count,splenomegaly without evidence of atherosclerotic occlusion or systemic emboli from the heart.