Who is in the emergency room matters when we talk about door-to-needle time: a single-center experience / Quien está en el servicio de emergencia importa al hablar de tiempo puerta-aguja: experiencia de un centro clínico

Abstract Background The efficacy of intravenous thrombolysis (IVT) is time-dependent. Objective To compare the door-to-needle (DTN) time of stroke neurologists (SNs) versus non-stroke neurologists (NSNs) and emergency room physicians (EPs). Additionally, we aimed to determine elements associated with DTN ≤ 20 minutes. Methods Prospective study of patients with IVT treated at Clínica Alemana between June 2016 and September 2021. Results A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3 ± 23.6 minutes. One hundred seventy-three (57.4%) patients were evaluated by SNs, 122 (40.5%) by NSNs, and 6 (2.1%) by EPs. The mean DTN times were 40.8 ± 23, 46 ± 24.7, and 58 ± 22.5 minutes, respectively. Door-to-needle time ≤ 20 minutes occurred more frequently when patients were treated by SNs compared to NSNs and EPs: 15%, 4%, and 0%, respectively (odds ratio [OR]: 4.3, 95% confidence interval [95%CI]: 1.66-11.5, p = 0.004). In univariate analysis DTN time ≤ 20 minutes was associated with treatment by a SN (p = 0.002), coronavirus disease 2019 pandemic period (p = 0.21), time to emergency room (ER) (p = 0.21), presence of diabetes (p = 0.142), hypercholesterolemia (p = 0.007), atrial fibrillation (p < 0.09), score on the National Institutes of Health Stroke Scale (NIHSS) (p = 0.001), lower systolic (p = 0.143) and diastolic (p = 0.21) blood pressures, the Alberta Stroke Program Early CT Score (ASPECTS; p = 0.09), vessel occlusion (p = 0.05), use of tenecteplase (p = 0.18), thrombectomy (p = 0.13), and years of experience of the physician (p < 0.001). After multivariate analysis, being treated by a SN (OR: 3.95; 95%CI: 1.44-10.8; p = 0.007), NIHSS (OR: 1.07; 95%CI: 1.02-1.12; p < 0.002) and lower systolic blood pressure (OR: 0.98; 95%CI: 0.96-0.99; p < 0.003) remained significant. Conclusions Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes.

Resumen Antecedentes La respuesta a la trombólisis intravenosa (TIV) es dependiente del tiempo. Objetivo Comparar los tiempo puerta-aguja (TPAs) de neurólogos vasculares (NVs) contra los de neurólogos no vasculares (NNVs) y médicos emergencistas (MEs), y determinar los elementos asociados a un PTA ≤ 20 minutos. Métodos Análisis observacional prospectivo de pacientes con TIV tratados en Clínica Alemana entre junio de 2016 y septiembre de 2021. Resultados En total, 301 pacientes con TIV fueron tratados. El TPA promedio fue de 43,3 ± 23,6 minutos. Un total de 173 (57,4%) pacientes fueron evaluados por NVs, 122 (40,5%), por NNVs, y 6 (2,1%), por MEs; los TPAs promedios fueron de 40,8 ± 23; 46 ± 24,7 y 58 ± 22,5 minutos, respectivamente. Los TPAs ≤ 20 minutos fueron más frecuentes en pacientes tratados por NVs versus NNVs y MEs: 15%, 4% y 0%, respectivamente (odds ratio [OR]: 4,3; intervalo de confianza del 95% [IC95%]: 1,66-11,5; p = 0,004). El análisis univariado demostró que TPA ≤ 20 minutos se asoció con: tratamiento por NVs (p = 0,002), periodo de la pandemia de enfermedad por coronavirus 2019 (COVID-19; p = 0,21), tiempo a urgencia (p = 0,21), diabetes (p = 0,142), hipercolesterolemia (p = 0,007), fibrilación auricular (p < 0,09), puntaje en la National Institutes of Health Stroke Scale [NIHSS] (p = 0,001), presión arterial sistólica (p = 0,143) y diastólica menores (p = 0,21), Alberta Stroke Program Early CT Score (ASPECTS ; p = 0,09), oclusión de vasos cerebrales (p =0,05), uso de tecneteplase (p = 0,18), trombectomía (p = 0,13) y años de experiencia del médico (p < 0,001). El análisis multivariado demostró que ser tratado por NVs (OR: 3,95; IC95%: 1,44-10,8; p = 0,007), el puntaje en la NIHSS (OR: 1,07; IC95%: 1,02-1,12; p < 0,002) y la presión arterial sistólica (OR: 0,98; IC95%: 0,96-0,99; p < 0,003) se asociaron a TPA ≤ 20 minutos. Conclusões El tratamiento por NVs resultó en un TPA menor y en una mayor probabilidad de tratamiento ≤ 20 minutos.

Fibrin Clot Mistook as a Worm in the Intravenous Line

There have been several reports of foreign bodies being discovered in the intravenous set. In this case, the patient complained that he found a worm in his intravenous line. It was later confirmed as a long, white fibrin deposit by pathologic examination. This happened even though there was a non-return valve in the intravenous line. Also, since there were few red blood cells in the deposit, it did not look like a blood clot. In cases like this, we suggest that physicians keep this possibility in mind to reassure their patients.

Fibrin Clot Delivery System for Meniscal Repair

As meniscal preservation particularly in younger active individuals with a symptomatic meniscal tear remains the preferred treatment option, various methods have been suggested to increase healing and success rates after meniscal repair. The recent increase in clinical use of platelet rich plasma has contributed to the increased use of fibrin clot, which virtually has the same healing property. However, despite the relative ease of acquisition and preparation of fibrin clots, delivering it to the desired target area arthroscopically is challenging. Therefore, we report with a pertinent literature review a novel method of planting a fibrin clot to the desired area of meniscal tear arthroscopically using our delivery system to enhance healing.

Meniscus Repair with Fibrin Clot in Complete Radial Tear of Lateral Meniscus / 대한정형외과학회잡지

Meniscus tear is one of the most common knee injuries. The increasing recognition of the importance of the meniscal function has led to a range of new treatments for meniscal tears. A complete radial tear disrupts the circumferential hoop tension of the meniscus. Therefore, restoring its natural architecture is of utmost importance. However, it is difficult to achieve meniscal healing of a complete radial tear due to its structural characteristics. We report five cases of a complete radial tear of the lateral meniscus treated successfully using a fibrin clot that showed good meniscal healing and excellent clinical outcomes.

Efeito da raspagem com laser de Er, Cr: YSGG nas superfícies radiculares: estudos in vitro / Effect of Er, Cr: YSGG irradiation on root surfaces: an in vitro study

Foram utilizados 60 dentes humanos nessa pesquisa. No primeiro experimento, 15 dentes extraídos por doença periodontal foram selecionados para avaliar a influência da irradiação com laser de Er,Cr: YSGG sobre a morfologia e adesão de células sanguíneas sobre as superfícies radiculares. As 60 amostras provenientes desses dentes foram divididos em 3 grupos de acordo com o tipo de tratamento aplicado: Grupo 1- RAR; Grupo 2- Irradiação com laser de Er,Cr: YSGG; Grupo 3- RAR e irradiação com o laser de Er,Cr: YSGG. 10 amostras de cada grupo foram avaliados quanto a adesão de elementos sanguíneos, e as outras 10 amostras foram avaliados quanto a morfologia da superfície radicular por MEV. Os testes de Kruskall-Wallis e Mann-Whitney foram utilizados para avaliar os resultados. Em relação à adesão de elementos sanguíneos, este estudo não demonstrou diferenças estatísticas entre os grupos (p=0.359), a análise morfológica demonstrou que as superfícies radiculares irradiadas com o laser de Er-Cr:YSGG foram mais rugosas que as do grupo controle (G2-G1: p=0.0003 e G3-G1: p=0.0003). No segundo experimento, 20 dentes foram utilizados para avaliar a influência do ângulo de irradiação do laser de Er,Cr:YSGG sobre a rugosidade e o desgaste das superfícies radiculares. Cada face proximal foi dividida em 3 áreas, sendo que a área superior foi tratada com raspagem e alisamento radicular, a área média não foi submetida a nenhum tipo de tratamento e a área inferior foi irradiada com o laser de Er,Cr:YSGG. Os dentes foram divididos em 4 grupos ,com 5 dentes cada, a depender da angulação da aplicação da irradiação do laser de Er,Cr:YSGG na área ( 30º, 45º, 60º, 90º). A rugosidade das áreas foram avaliadas através de um rugosímetro e posteriormente os dentes foram submetidos a processamento histológico convencional e as lâminas obtidas foram analisadas em microscópio óptico onde foi avaliado o desgaste no tecido dentário. Os testes de ANOVA e de Tukey foram utilizados para analisar os resultados. Todas as regiões que foram irradiadas com o laser apresentaram-se mais rugosas que as amostras que foram raspadas e alisadas com instrumentos manuais (p≤0.05). As amostras irradiadas com laser com ângulo de trabalho de 90º apresentaram-se mais rugosas que as amostras irradiadas com laser na angulação de 30º e com 45º (p≤0.05), e as amostras irradiadas com laser na angulação de 60º apresentaram-se mais rugosas que as amostras irradiadas com o laser na angulação de 30º (p≤0.05). O grupo que foi irradiado com laser de Er,Cr:YSGG com ângulo de trabalho de 30º apresentou o menor desgaste em relação a todos os outros tratamentos (p<0.01). A raspagem manual provocou desgastes semelhante aos grupos irradiados com laser de Er,Cr:YSGG com ângulos de trabalho de 45º, 60º e de 90º(p≥0.05). No terceiro experimento, 20 dentes extraídos por doença periodontal foram utilizados para avaliar a influência do ângulo de irradiação com o laser de Er;Cr:YSGG sobre a morfologia e adesão de elementos sanguíneos nas superfícies radiculares irradiadas. Os 80 espécimes provenientes dos dentes foram divididos em 4 grupos de acordo com o ângulo de irradiação utilizado ( 30º,45º,60º,90º). 10 amostras de cada grupo foram avaliadas quanto a adesão de elementos sanguíneos, e as outras 10 amostras foram avaliadas quanto a morfologia da superfície radicular por MEV. Os testes de KruskallWallis e Mann-Whitney foram utilizados para avaliar os resultados. As superfícies radiculares irradiadas com o laser de Er,Cr:YSGG com ângulo de 45º e 60º apresentaram maior adesão de elementos sanguíneos que o grupo onde o laser de Er,Cr:YSGG foi irradiado com ângulo de 30º e 90º (G2-G1: p=0.0007 ; G3-G1: p=0.0025; G2-G4: p=0.0041 e G3-G4: p=0.0025). As amostras irradiadas com ângulo de 30º apresentaram-se menos rugosas e afetadas pela irradiação com laser de Er,Cr:YSGG, que os grupos que foram irradiados com ângulo de 45º, 60º e 90º. (G2-G1:p=0.008; G3-G1: p=0.02; G4-G1: p=0.008). Concluiu-se que a irradiação com laser de Er,Cr:YSGG promoveu uma maior rugosidade nas superfícies radiculares em relação ao tratamento de raspagem e alisamento radicular, porém esse fato não interferiu negativamente na adesão de elementos sanguíneos. Irradiações com ângulos iguais ou menores que 30º promovem uma intervenção mais conservadora a superfície radicular

60 human teeth were used in that research. In the first experiment, 15 extracted teeth for periodontal disease were selected to evaluated the effect of Er,Cr:YSGG irradiation on root surfaces for adhesion of blood components and morphology. 60 root surface specimens were obtained by selecting four from each tooth. Samples were divided into three groups of 20 each, according to treatments. Group 1 (G1) was treated by scaling and root planing (SRP), Group 2 (G2) was irradiated by Er,Cr:YSGG laser and Group 3 (G3) was treated by SRP and Er,Cr:YSGG laser irradiation. Blood was placed on each of 10 specimens from each of the three groups, to evaluate adhesion of blood components to the root surfaces. A morphological analysis was made of the root surfaces of the other 10 specimens from each group by scanning electron microscope (SEM). Statistical processing was done with the Kruskal-Wallis and Mann-Whitney tests. No statistical differences for adhesion of blood components to root surfaces were found between the groups (p = 0.359). However, morphological analysis disclosed that all root surfaces irradiated by Er,Cr:YSGG laser (100%) were rougher than surfaces that were not irradiated (G1-G2: p = 0.0003 and G1-G3: p = 0.0003). In the second experiment, 20 teeth were used to evaluated the effect of the working tip angulations on root roughness and substance removal using Er,Cr:YSGG radiation. The distal and mesial surfaces of each tooth was divided in 3 areas. The upper area was treated with scaling and root planing. The medium area was not submitted to any treatment and the lower area was irradiated with Er,Cr:YSGG laser. The teeh were divided in 4 groups, with 5 teeth each depending the working tip angulations using Er,Cr:YSGG at the lower area (30º, 45º, 60º, 90º).The roughness surfaces were evaluated by a profilometer, and the root substance removal were evaluated by histometry. Statistical processing was done with the ANOVA and Tukey tests. The area irradiated with the Er,cr:YSGG were more rougher than those that were scaling with manual curettes(p≤0.05). The areas irradiated with working tip angulation of 90º were rougher than the areas irradiated with working tip angulations of 30º and 45º (p≤0.05), and the areas irradiated with working tip angulation of 60º were rougher than the areas irradiated with working tip angulations of 30º (p≤0.05). The group that was irradiated with Er,Cr:YSGG with working tip angulation of 30º presented the lower root substance removal in relation to all other groups (p<0.01). The scaling and root planing promotes comparable root substance removal to the groups irradiated with working tip angulation of 45º, 60º and 90º(p≥0.05). In the third experiment, 20 extracted teeth for periodontal disease were selected to evaluated the effect of the working tip angulations using Er,Cr:YSGG laser on root surfaces for adhesion of blood components and morphology. 80 root surface specimens were obtained by selecting four from each tooth. Samples were divided into 4 groups of 20 each, according to the working tip angulations of Er,Cr:YSGG (30º,45º,60º,90º). Blood was placed on each of 10 specimens from each of the three groups, to evaluate adhesion of blood components to the root surfaces. A morphological analysis was made of the root surfaces of the other 10 specimens from each group by scanning electron microscope (SEM). Statistical processing was done with the Kruskal-Wallis and Mann-Whitney tests. The samples irradiated with working tip angulations of 45º and 60º presented better adhesion of blood components than the samples irradiated with working tip angulations (G2-G1: p=0.0007 ; G3-G1: p=0.0025; G2-G4: p=0.0041 e G3-G4: p=0.0025). The samples irradiated with working tip angulation were smoother than the others groups (G2-G1:p=0.008; G3-G1: p=0.02; G4-G1: p=0.008). Er,Cr:YSGG laser irradiation produced rougher root surfaces than treatment by SRP, however it did not interfere with adhesion of blood components to the root surfaces. Irradiation with working tip angulation of 30º promotes a more conservative intervention on root surfaces

Arthroscopic Meniscal Repair using Fibrin Clot for Horizontal Tear in Young Adults: A Case Report

To evaluate outcomes of arthroscopic meniscal repair using fibrin clot for horizontal tears in young adults, we investigated clinical and morphological results after the meniscal repairs were performed. Between August 1995 and August 1997, we treated five patients with horizontal tears of the meniscus, of which the meniscal tears were not accompanied any concomitant intra-articular lesions or meniscal degeneration. We assessed outcomes using Lysholm score, magnetic resonance imaging(MRI) and second-look arthroscopy. In all 5 cases, MRI showed the following results 1 complete healing, 1 incomplete healing, and 3 with no healing. Two patients underwent second-look arthroscopy, one complained of persistent pain for two years after surgery, showing meniscal tears on the MRI and received partial meniscectomy, while the other showed complete healing using second-look arthroscopy after 3 months postoperative recuperation and MRI 68 months after surgery. According to Lysholm score, two cases were assessed with less than 70 points. For the horizontal meniscal tears in young adults, arthroscopic meniscal repair using fibrin clot produced satisfactory clinical results however, it exhibited morphologically poor results.

A Case of a Large Fibrin Clot Formed in a Plama Unit Collected by Donor Plasmapheresis / 대한수혈학회지

A large aggregate was found in a plasma unit collected by plasmapheresis at the Chungbuk Blood Center. The result of the screening test for the donor was normal. The aggregate was dissolved in 1N NaOH and 10% SDS and this aggregate was analyzed with UV spectrometer and NMR spectrometer. Most of the component of it was proved to be protein. The informations about this aggregate in plasmapheresis unit were asked to other institutes. Osaka Blood Center of Japanese Red Cross gave an information that the aggregate could be made by anticoagulant. When the aggregate was treated with the plasmin, the aggregate was dissolved completely. And the band regarded as fibrin was found in SDS-PAGE. An aggregate like this could be formed when the amount of anticoagulant is deficient in the collection of blood. To prevent the formation of the fibrin clot, the addition of the proper amount of anticoagulant has to be inspected.

Study of the human amniotic epithelial cells on the fibrin clot and cellular growth factor / 重庆医科大学学报

Objective: To establish the model of cultured human amniotic epithelial cells(HAECs) on the fibrin clot in order to observe the effect of EGF,bFGF and TGF-?1 on HAEC.Methods:The cultivated HAECs on the formulated fibrin clot were examined by phase contrast microscopy,Giemsa staining and scanning electron microscopy.The effect of growth factor(EGF,bFGF,and TGF-?1) on the apoptosis of HAECs was measured by TUNEL.Results: HAECs generated on the formulated fibrin clot in vitro.HAECs exposed to EGF or bFGF showed a lower rate of apoptosis than the control group(P