Efficacy of perioperative use of tigecycline in preventing infection and incidence of hypofibrinogenemia in liver transplant recipients / 器官移植

Objective To evaluate the efficacy of perioperative use of tigecycline in preventing infection and the incidence of hypofibrinogenemia in liver transplant recipients. Methods Clinical data of 40 liver transplant recipients given with tigecycline to prevent infection were retrospectively analyzed. The incidence of infection in recipients and donor-derived infection were analyzed. The changes of clinical indexes in recipients during, upon the completion and (7±2) d after tigecycline treatment were analyzed, respectively. The incidence and treatment of hypofibrinogenemia were summarized. Results Among 40 liver transplant recipients, 2 cases were infected by aspergillus niger and cytomegalovirus, out of the antibacterial spectrum of tigecycline. After adjusting the anti-infection regimen, the infection was properly controlled. Liver allografts were positive for relevant culture in 9 cases, whereas none of them progressed into donor-derived infection. Approximately at postoperative 2 weeks, all 40 recipients restored liver function and were discharged from hospital. Among them, 6 recipients developed hypofibrinogenemia complicated with coagulation disorder at postoperative 2-4 d, whereas transaminase level, bilirubin level and infection-related indexes were gradually decreased after liver transplantation, and albumin level was stable. After supplemented with human fibrinogen and prothrombin complex, coagulation function was improved, but fibrinogen level persistently declined. After terminating use of tigecycline, fibrinogen level was gradually restored to normal range, which might be an adverse drug reaction induced by tigecycline. Conclusions Perioperative anti-infection regimen including tigecycline may reduce the incidence of infection caused by sensitive bacteria in liver transplant recipients. Nevertheless, the incidence of hypofibrinogenemia should be intimately monitored throughout the use of tigecycline.

Correlation between protein C -1641A/-1654C haplotype and coagulation disorder in sepsis / 中华急诊医学杂志

Objective:To investigate the correlation between protein C -1641A/-1654C haplotype and coagulation disorder in Chinese Han septic patients.Methods:The genotypes of protein C gene -1641A>G (rs1799809) and -1654C>T (RS1799808) in septic patients were detected by direct sequencing, and their haplotypes were analyzed and divided into two groups according to the haplotype, -1641A/-1654C (AC) carriers and non-AC haplotype carriers. At the same time, unpaired t test or Mann-Whitney U test was used to compare the differences in coagulation/fibrinolytic parameters, including partial activated thrombin time, prothrombin time, internationally standardized ratio of prothrombin time, thrombin time, fibrinogen and D-dimer levels, as well as APC levels between the two groups. Results:A total of 174 septic patients were included in this study, including 60 AC haplotype carriers and 114 non-AC haplotype carriers. Compared with non-AC haplotype carriers, AC haplotype carriers had significantly lower platelet counts, significantly longer partial activated thrombin time, and significantly decreased activated protein C levels. Other coagulation/fibrinolytic parameters including prothrombin time, internationally standardized ratio of prothrombin time, thrombin time, fibrinogen and D-dimer were not significantly different between the two groups.Conclusions:In this study, the protein C-1641A/-1654C haplotype was found to lead to decreased circulating activated protein C levels decreased platelet counts, and prolonged partial activated thrombin time in septic patients. These results suggest that the protein C-1641A/-1654C haplotype may directly affect the APC level and consequently influence the coagulation disorder of sepsis.

Reflection on 10 problems of clinical xenotransplantation / 器官移植

The shortage of donors restricts the development of organ transplantation. Xenotransplantation might act as an effective approach to resolve this problem. With the advancement of genome editing technologies as well as research and development of novel immunosuppressant, lots of breakthroughs have been achieved in the field of xenotransplantation. Nevertheless, a majority of researches are still in the preclinical stage. Recently, the success of the world's first genetically engineered pig-to-human heart transplantation has greatly inspired researchers. However, clinical xenotransplantation still faces an array of problems, including counteracting rejection, controlling inflammation, regulating coagulation disorder, improving physiological compatibility of xenografts, paying attention to the risk of interspecific infection, optimizing immunosuppressive regimen, screening donor genome editing types, selecting suitable recipients, modifying xenotransplantation guidelines, and awareness of public recognition, etc. In this article, these 10 problems were summarized, aiming to provide reference for promoting the clinical application of xenotransplantation.

A Case of Redo Ascending Aortic Replacement for Anastomotic Pseudoaneurysm through Right Thoracotomy in a Patient with Severe Coagulation Disorder / 日本心臓血管外科学会雑誌

A 51-year-old man presented to our hospital with general fatigue and lower extremity edema due to right heart failure with severe coagulation disorder. He had undergone ascending aortic and total arch replacement for type A acute aortic dissection when he was 49 years old and had diagnosed with anastomotic pseudoaneurysm in the ascending aorta by computed tomography 1 year after the operation. Preoperative computed tomography showed an enlargement of the pseudoaneurysm. Since re-median sternotomy seemed to be high risk strategy for bleeding due to severe coagulation disorder, we decided to perform ascending aortic replacement through right thoracotomy. We opened the pseudoaneurysm and found an aorto-right atrium fistula. Redo ascending aortic replacement with direct closure of the fistula was successfully performed. The postoperative course was uneventful.

Necrosis tisular local y trombocitopenia después de una intoxicación por mordedura de Bungarus multicinctusen una niña / Local tissue necrosis and thrombocytopenia following Bungarus multicinctus envenomation in a child

La intoxicación por mordedura de serpiente es un problema de salud pública global. En la población pediátrica, la intoxicación por mordedura de serpiente presenta características diferentes que en los pacientes adultos. La Bungarus multicinctus es una especie de elápido sumamente venenoso. Las presentaciones clínicas documentadas después de la intoxicación por mordedura de Bungarus multicinctus son reacciones locales mínimas, insuficiencia respiratoria, dolor generalizado e hiponatremia potencialmente mortal. Presentamos el caso de una intoxicación por mordedura de Bungarus multicinctus en una niña con manifestaciones clínicas atípicas, incluidas necrosis tisular grave y trombocitopenia con coagulopatía.

Snakebite envenoming is a global public health problem. The pediatric population poisoned by snakebite envenoming has different features than adult patients. Bungarus multicinctus is a highly venomous species of the elapid snake. The documented clinical presentations following Bungarus multicinctus envenoming are minimal local reactions, respiratory failure, general pain, and life-threatening hyponatremia. We present an uncommon case of Bungarus multicinctus envenomation in a girl with unusual clinical findings, including severe tissue necrosis and thrombocytopenia with coagulopathy.

Perfil dos hemofílicos de uma associação de pacientes de Brasília ­ DF, Brasil / Hemophyliacs profile from a patients' association in Brasília - DF, Brazil / Perfil hemofílico de una asociación de pacientes en Brasília - DF, Brasil Perfil de pacientes hemofílicos em Brasília, Brasil

Objetivo: Caracterizar o perfil de hemofílicos vinculados a uma associação de pacientes em Brasília - DF, Brasil. Método: Pesquisa transversal com amostragem por conveniência, realizada com 49 hemofílicos adultos, do sexo masculino, vinculados à Associação dos Voluntários, Pesquisadores e Portadores de Coagulopatias (AJUDE-C). O estudo foi aprovado pelo Comitê de Ética em Pesquisas com Seres Humanos. Através de um formulário foi coletado informações sociodemográficas e clínicas. A normalidade dos dados foi avaliada através do teste de Shapiro-Wilk. Resultados: Avaliaram-se 49 hemofílicos adultos com média de idade 37 ±8,4 anos, estando 43% na faixa etária de 30-39 anos. Predominou a raça/cor parda (49%), estado civil solteiro (61%), em atividade laboral (57%) e 53% residiam a menos de 30 Km do local de tratamento. Clinicamente, predominou a hemofilia A (79,6%), doença grave (77,6%) e o uso de profilaxia secundária (75,5%). Conclusão: Maior parte da amostra exerce atividade laboral. Esse fato pode ser explicado pela administração da profilaxia secundária e proximidade entre a residência/local de tratamento, mantendo os fatores de coagulação em níveis seguros, e dando capacidade de rápido atendimento em casos emergenciais, gerando maior autonomia nessa população

Objective: To characterize the hemophiliacs profile linked to a patients association in Brasília - DF, Brazil. Method: Cross-cut survey with convenience sampling, carried out with 49 male hemophiliacs adults, linked to the Association of Volunteers, Researchers and People with Coagulopathies (AJUDEC). The study was approved by the Ethics Committee in Research with Human Beings.The Sociodemographic and clinical information was collected through a form. The normality of the data was evaluated using the Shapiro-Wilk test. Results: Were evaluated 49 adult male hemophiliacs with an avarage 37 ± 8.4 years. 43% were in the 30-39 age range. The brown race predominated (49%), single marital status (61%), in work activity (57%) and 53% lived less than 30 km from the treatment place. Clinical prevalence hemophilia A (79.6%), severe disease (77.6%) and the use of secondary prophylaxis (75.5%). Conclusion: Most of the sample is in work activity. This fact can be explained by the administration of secondary prophylaxis and proximity between their residence / treatment place. This keeps the clotting factors at safe levels, and provids quick assistance to emergencies cases, generating greater autonomy in this population.

Objetivo: Caracterizar el perfil de hemofílicos vinculados a una asociación de pacientes en Brasilia - DF, Brasil. Método: Encuesta transversal con muestra de conveniencia, realizada con 49 hemofílicos adultos, vinculados a la Asociación de Voluntarios, Investigadores y Personas con Coagulopatías (AJUDE-C). El estudio fue aprobado por el Comité de Ética y Investigación en Seres Humanos. La información sociodemográfica y clínica se recogió por medio de un formulario. La normalidad de los datos se evaluó mediante la prueba de Shapiro-Wilk. Resultados: se evaluaron 49 hemofílicos adultos con una edad media de 37 ± 8,4 años, 43% estaban en el grupo de edad 30 a 39 años. Predominó la raza marrón (49%), estado civil soltero (61%), en la actividad laboral (57%) y el 53% vivía a menos de 30 km del sitio de tratamiento. Clínicamente predominaron: hemofilia A (79,6%), enfermedad grave (77,6%) y el uso de profilaxis secundaria (75,5%). Conclusión: La mayor parte de la muestra tiene actividad laboral. Este hecho puede explicarse por la administración de profilaxis secundaria y la proximidad entre el lugar de residencia / tratamiento, manteniendo los factores de coagulación en niveles seguros y promoviendo la capacidad de atender rápidamente los casos de emergencia, generando una mayor autonomía en esta población

Study on the correlation of HMGB1 and coagulation disorder in severe heatstroke rats / 解放军医学杂志

Objective To explore the association between HMGB1 and coagulation disorder in severe heat stroke rats. Methods A total of 48 rats were randomized equally into 8 groups: Room temperature group (Sham), severe heatstroke (HS) re-cooling 0 h (HS-0 h), 3 h (HS-3 h), 6 h (HS-6 h), 9 h (HS-9 h), 12 h (HS-12 h), 18 h (HS-18 h), 24 h (HS-24 h) groups. Sham group rats were housed at room temperature of (25.0±0.5) ℃ and humidity of (50.0%±5.0%), while severe heatstroke group rats were kept in an incubator at a temperature of (39.5±0.2) ℃ and humidity of 60.0%±5.0%. Rats with the rectal temperature (Tr) reached 43 ℃ were defined as the onset of severe heatstroke, followed by transferring to the room temperature for natural cooling. The blood samples were collected at 0, 3, 6, 9, 12, 18 and 24 h after natural cooling. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib) were evaluated by clotting methods. HMGB1and thrombin-antithrombin (TAT) were detected by ELISA. Results A linear association between HMGB1 and PT was found (P0.05); a nonlinear association between HMGB1 and PLT was found (P0.05). Conclusions HMGB1 has a significant association with coagulation disorder in severe heat stroke rats. The mechanism needs to be further studied.

Protein C and S deficiency as a cause of mesenteric thrombosis: Differential diagnosis of systemic vasculitis / Deficiencia de proteínas C y S como causa de trombosis mesentérica: diagnóstico diferencial de las vasculitis sistémicas

ABSTRACT Acute mesenteric ischemia is a medical emergency that accounts for less than 1/1000 hospital admissions. The disease affects adults older than 50 years predominantly with cardiac compromise, in whom the presence of acute abdominal pain is the cardinal manifestation, and should make the clinician suspect this entity. Its presentation in adolescents is unusual; therefore, in these cases, the possibility of an underlying thrombophilia should be part of the differential diagnosis. The case is presented here of a young female with a protein C and S deficiency as the cause of mesenteric thrombosis.

RESUMEN La isquemia mesentérica aguda es una urgencia médica que se presenta en menos de 1/1.000 ingresos hospitalarios. Es una entidad clínica infrecuente, predominante en adultos mayores de 50 arios con afectación cardíaca, en quienes la presencia de dolor abdominal agudo es la manifestación cardinal y debería hacer sospechar dicho diagnóstico. La presentación en adolescentes es inusual, por lo que, en estos casos, la posibilidad de una trombofilia subyacente debe formar parte del diagnóstico diferencial. Presentamos el caso de una paciente joven con deficiencia de proteínas C y S como agente causal de trombosis mesentérica.

Genetic analysis and clinical features of a pedigree affected with hereditary coagulation factor Ⅶ deficiency caused by compound heterozygotic mutations / 中华医学遗传学杂志

Objective@#To detect potential mutations of the coagulation factor Ⅶ (F7) gene in a pedigree affected with hereditary FⅦ deficiency and explore its molecular pathogenesis.@*Methods@#The FⅦ antigen (FⅦ∶Ag) was analyzed by an enzyme-linked immunosorbent assay (ELISA) method. Prothrombin time (PT), FⅦ activity (FⅦ∶C) and other coagulant parameters were quantified with an one-stage clotting assay. The F7 gene was amplified by PCR and sequenced. Mutational sites were confirmed by reverse sequencing. Impact of amino acid substitution was assessed using SIFT and PolyPhen-2 software. Structure of the mutant protein was analyzed using Swiss-pdb Viewer software based on the three-dimensional structure in the Protein Data Bank.@*Results@#The propositus had prolonged PT (36.3 s), with FⅦ∶C and FⅦ∶Ag significantly reduced to 2% and 44%, respectively. Her father, mother, younger sister and daughter had slightly prolonged PT and reduced FⅦ∶C (86%-120%). The FⅦ∶Ag of her father and younger sister were also reduced. DNA sequencing revealed that the propositus has carried compound heterozygous mutations (Lys341Glu and IVS6-1G>A) of the F7 gene. Her father and younger sister were heterozygous for the IVS6-1G>A mutation, while her mother and daughter were heterozygous for the Lys341Glu mutation. Bioinformatics analysis indicated that Lys341Glu mutation may affect the stability and function of the FⅦ protein.@*Conclusion@#The Lys341Glu and IVS6-1G>A mutations probably underlie the reduced activity of FⅦ in this pedigree.

Role of HMGB1-RAGE / TLRs-NF-κB signaling pathway on bone mesenchymal stem cells transplantation therapy for lipopolysaccaride-induced coagulation disorder rats / 中华危重病急救医学

Objective To determine the effect of bone mesenchymal stem cells (BMSCs) in transplantation therapy for lipopolysaccharide (LPS)-induced coagulation disorder and the underlying mechanism of high mobility group protein B1-receptors for advanced glycation end products / Toll-like receptors-nuclear factor-κB (HMGB1-RAGE / TLRs-NF-κB) signaling pathway.Methods BMSCs of female Sprague-Dawley (SD) rats ageing 4-5 weeks old were extracted and cultivatedin vitro, and the fourth-passaged BMSCs phenotype was identified by flow cytometry for transplantation in the following experimental study. The rats were randomly divided into normal saline (NS) control group, LPS group, and BMSC group according to the random number table with 15 rats in each group. Coagulation disorders model was reproduced by injection of 1 mg/kg LPS via saphenous vein, and the rats in the NS control group was injected with equal volume NS. Those in the BMSC group were infused BMSC 0.5 mL containing 1×106 cells via tail vein at 2 hours after LPS injection, and the rats in other groups were injected with equal volume NS. Abdominal aorta blood was collected at 1, 3 and 7 days post operation. Coagulation indexes such as platelet count (PLT), platelet volume distribution width (PDW), mean platelet volume (MPV), plateletcrit (PCT), platelet large cell ratio (P-LCR), activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), and fibrinogen (FIB) were determined. The mRNA levels and contents of HMGB1, RAGE, TLR2/4 and NF-κB were determined by real-time reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA), respectively.Results ① The cells culturedin vitro were spindle shaped or flat. The fourth-passaged BMSCs phenotype was successfully identified by flow cytometry technology. ②Coagulation indexes: compared with NS control group, PLT, PCT and FIB in LPS group were significantly decreased, PDW, MPV, P-LCP, and INR were significantly increased, and APTT, PT, and TT were significantly prolonged from the first day. Furthermore, those in LPS group were gradually ameliorated with prolongation of LPS induction time. The coagulation function abnormality induced by LPS was reversed by BMSCs with significant difference at 1 day as compared with LPS group [PLT (×109/L):398.8±17.9 vs. 239.1±15.8, PCT (％): 0.35±0.04 vs. 0.23±0.06, FIB (g/L): 1.7±0.6 vs. 0.8±0.1, PDW (％):12.4±1.6 vs. 16.2±1.5, MPV (fl): 11.0±1.6 vs. 13.7±1.1, P-LCP (％): 13.0±2.1 vs. 15.3±2.7, INR: 1.52±0.17 vs. 1.82±0.19, APTT (s): 66.3±4.1 vs. 89.5±4.5, PT (s): 18.3±0.7 vs. 25.1±1.9, TT (s): 87.5±7.8 vs. 115.0±9.7, allP < 0.05], till 7 days. ③ HMGB1-RAGE / TLRs-NF-κB signaling pathway related molecules: compared with NS control group, the mRNA expressions and contents of HMGB1, RAGE, TLR2/4 and NF-κB were significantly increased in LPS group from the first day. However, the mRNA expressions and contents of the molecules in LPS group were gradually decreased with prolongation of LPS induction time. After BMSC intervention, the mRNA expressions and contents of molecules at 1 day were significantly lower than those of LPS group [HMGB1 mRNA (2-ΔΔCt): 10.77±0.04 vs. 24.51±3.69, HMGB1 content (μg/L): 0.48±0.01 vs. 0.95±0.06; RAGE mRNA (2-ΔΔCt): 11.57±1.11 vs. 18.08±0.29, RAGE content (μg/L): 0.73±0.04 vs. 1.37±0.06; TLR2 mRNA (2-ΔΔCt): 2.60±0.22 vs. 12.61±0.27, TLR2 content (μg/L): 0.81±0.03 vs. 1.59±0.09; TLR4 mRNA (2-ΔΔCt): 2.95±0.52 vs. 4.06±0.11, TLR4 content (μg/L):0.80±0.09 vs. 1.18±0.11; NF-κB mRNA (2-ΔΔCt): 1.29±0.06 vs. 7.79±0.25, NF-κB content (μg/L): 1.22±0.24 vs. 2.42±0.26, allP < 0.05], till 7 days.Conclusion BMSCs administration could ameliorate the coagulation function in LPS-induced coagulation disorder rats and these might be associated with HMGB1-RAGE / TLRs-NF-κB signaling pathway inhibition.

Coma mixedematoso e trombo de veia cava superior. Relato de caso e revisão da literatura / Myxedema coma and superior vena cava thrombus: case report and literature review

O coma mixedematoso é uma emergência endocrinológica rara e consiste na máxima expressão do hipotireoidismo, com alta mortalidade por suas complicações hemodinâmicas e ventilatórias, podendo ser agravadas por distúrbios da coagulação. Relatamos o caso de uma paciente diagnosticada com coma mixedematoso e trombo de veia cava superior. Buscamos salientar os distúrbios de coagulação frequentes no hipotireoidismo grave, que contribuem para o aumento da mortalidade deste grupo de pacientes. O diagnóstico e o tratamento precoce do coma mixedematoso, aliados à instituição imediata da terapia para o fenômeno trombótico encontrado, permitiram a evolução favorável do quadro. O relato, juntamente da bibliografia pesquisada, orientou o raciocínio sobre a relação dos distúrbios de coagulação, que ocorrem no hipotireoidismo descompensado. Apesar de poucos relatos, estes distúrbios podem ser frequentes e devem ser pesquisados, pois contribuem com o aumento da mortalidade.(AU)

Myxedema coma is a rare endocrinological emergency, consisting of the highest expression of hypothyroidism with high mortality due to hemodynamic and ventilatory complications, which may be aggravated by coagulation disorders. We report the case of a patient diagnosed with myxedema coma and superior vena cava thrombus. We sought to emphasize the frequent coagulation disorders in severe hypothyroidism, which contribute to increased mortality in this group of patients. The diagnosis and early treatment of myxedema coma, together with the immediate institution of therapy for the thrombotic phenomenon found, allowed the favorable evolution of the condition. The report, together with the literature, has guided the rationale for the influence of coagulation disorders that occur in decompensated hypothyroidism. Despite the few number of reports, these disorders can be frequent and should be investigated because they contribute to the increase in mortality.(AU)

Retrospective Analysis of the Safety of Tigecycline in a Hospital / 中国药房

OBJECTIVE:To provide reference for rational application of tigecyclinet and alert to the occurrence of severe ADR.METHODS:Fifity patients receiving tigecycline in a level 3 general hospital during 2013-2015 were analyzed retrospectively to observe the change of symptom,sign and lab indexes after using Tigecyclinet injfection.Possible ADR of tigecycline,processing and outcomes were summarized.RESULTS:Among 50 patients,there were 24 cases of ADR,including 10 cases of inducing or aggravating blood coagulation abnormality (41.67％),9 cases of liver function injury (37.50％),4 cases of vomiting and other gastrointestinal discomfort (16.67％),1 case of red erythra with itching (4.17％).ADR of digestive system were mild and recovered after symptomatic treatment as inhibiting acid,antiemetic.Severe ADR as Liver function injury could not be recovered after symptomatic treatment as protecting liver,reducing enzyme.Nine cases of liver function injury mainly manifested as the elevation of TBIL,DBIL,ALP,LDH;8 of which suffered from liver function injury before medication and the symptom was aggravated after medication;liver function injury appeared in 3 cases on 10th day after medication and in 2 cases on 9th day after medication.Ten cases suffered from coagulation function disorder before medication and the symptom was aggravated after medication,which mainly manifested as the prolongation of APTT and TT and the elevation of INR,PT,D-dimer,etc.The coagulation function disorder was aggravated abnormally on 2nd-22th day after using tigecycline,mainly appearing on 2nd-5th day (70.00％).CONCLUSIONS:Great importance should be attached to severe ADR as coagulation function disorder,liver function injury when using tigecycline,in order to ensure the safety of drug use.

Niña con erucismo hemorrágico por Lonomia spp.: / Hemorrhagic erucism due to Lonomia spp. in a girl:

RESUMEN Los accidentes causados por las setas urticantes o venenosas de las orugas de lepidópteros, se conocen como erucismo. Estos accidentes se producen por el contacto accidental, especialmente por los niños, con las cerdas sobre el cuerpo del insecto, conectadas con glándulas venenosas. Los síntomas pueden ser locales o sistémicos, con presentaciones clínicas fatales. El accidente ocasionado por las orugas del género Lonomia spp. puede desencadenar síndromes hemorrágicos, constituyendo estos la forma más grave de erucismo. Se reporta el caso de una niña de 5 años, procedente del poblado de Villarondos, en la Amazonía del Perú, departamento de Huánuco, la cual incidentalmente se hinca con las cerdas de una oruga, cursando luego con anemia hemolítica, plaquetopenia y trastorno de la coagulación. El diagnóstico fue establecido por la anamnesis, cuadro clínico, exámenes de laboratorio y respuesta al suero antilonómico. Se discuten los aspectos clínicos, laboratoriales y terapéuticos de erucismo por Lonomia spp.

ABSTRACT Accidents caused by urticating or poisonous setae from lepidoptera caterpillars are known as erucism. These accidents are produced by accidental contact, especially in children, with bristles on the insect's body surface, connected to venom glands. Symptoms may be local or systemic, with deadly clinical presentations. The accident caused by Lonomia spp. caterpillars can trigger bleeding disorders, which is considered the most severe type of erucism. The case of a 5-year-old girl is reported. She was from the town of Villarondos, in the Peruvian Amazon, department of Huánuco, who accidentally knelt down on caterpillar bristles, and subsequently experienced hemolytic anemia, plateletopenia, and coagulation disorder. The diagnosis was made based on the medical history, clinical manifestation, laboratory examination results, and response to antilonomic serum. The clinical, laboratory, and therapeutic aspects of erucism due to Lonomia spp. are discussed.

Rationality Analysis of Hydroxyethyl Starch Clinical Application in A Hospital / 中国药房

OBJECTIVE:To provide reference for the clinical rational application and preventing the adverse reactions of hy-droxyethyl starch(HES). METHODS:The HES application of inpatients in a hospital in Jul. 2014 were retrospectively analyzed, the usage and dosage,indications,and the changes of renal functions and blood coagulation function before and after HES treat-ment were detected,and the application rationality was evaluated. RESULTS:The usage of HES in the hospital was hydroxyethyl starch 200/0.5 and Sodium chloride injection,which was the second generation of HES. In the 347 patients,295 patients had moni-tored the renal functions before the HES treatment,the result was normal;and 21 patients had monitored the renal functions after HES treatment,the result was normal. Meanwhile,326 patients had monitored the blood coagulation functions before and after HES treatment,the results were normal. HES was not used for the patient of severe sepsis,renal dysfunctions and coagulopathy in this hospital. CONCLUSIONS:The application of HES can induce renal damage and coagulation disorder,so relevant indicators should be closely monitored before and after treatment to prevent the incidence of adverse reactions;further more,clinicians should strictly handle indications,usage and dosage and precautions during the clinical application;in addition,it is suggested to replace the second generation of HES by the third generation,which is more safer.

A study on effects of Sheshang capsule on blood coagulation function of patients bitten by Trimeresurus stejnegeri snake / 中国中西医结合急救杂志

Objective To investigate the mechanism of traditional Chinese medicine (TCM) Sheshang capsule for treatment of blood coagulation dysfunction in patients bitten by Trimeresurus stejnegeri snake. Methods A prospective study was conducted. Seventy Trimeresurus stejnegeri snake envenoming patients whose manifestations conformed to the diagnostic criteria of the fire toxin syndrome in TCM were assigned into therapy group and control group by random number table (each, 35 cases). The basic treatments (including wound disinfection, intramuscular injection of 1 500 U tetanus antitoxin, conventional dose of antibiotics, 10 mg dexamethasone, 40 mg omeprazole) and 10 Jidesheng Sheyao tablets three times a day were applied in the control group. In the therapy group, the basic treatments the same as those of the control group were given, and in the mean time 5 Sheshang capsules (the drug was prepared in our hospital including ingredients:rhubarb, coptidis rhizoma, pleione bulbocodioides, elecampane inula root, bayberry bark, borneol and so on) were administered three times a day. The therapeutic course in the two groups was 1 week. The levels of platelet α-granule membrane protein (CD62p), thromboxane B2 (TXB2), platelet factor 3 (PF3) and von Willebrand factor (vWF) in serum were measured by enzyme linked immunosorbent assay (ELISA) before and after treatment. Results Before treatment, there were no significant differences in CD62p, TXB2, PF3 and vWF between therapy group and control group [CD62p (μg/L):3.81±1.64 vs. 3.52±1.43, TXB2 (μg/L):13.04±1.67 vs. 13.31±1.14, PF3 (μg/L): 2.84±1.08 vs. 2.88±1.23, vWF (μg/L):12.36±2.42 vs. 11.89±2.08, all P>0.05]. After treatment, the levels of CD62p, TXB2 and PF3 were increased, while vWF decreased compared with those before treatment in both groups, the level changes in therapy group being more remarkable [CD62p (μg/L): 6.73±1.77 vs. 5.81±1.62, TXB2 (μg/L):18.65±1.77 vs. 17.90±1.68, PF3 (μg/L):5.61±1.48 vs. 4.77±1.24, vWF (μg/L):3.87±1.01 vs. 4.58±1.09, P < 0.05 or P < 0.01]. Conclusion The Sheshang capsule is capable of treating patients with blood coagulative disorder after Trimeresurus stejnegeri snake bite, and its mechanism is possibly related to the improvement of platelet activation function and amelioration of the damage of vascular endothelial cells.

Anticoagulation Strategies during Perioperative Period for One Patient with Long-term Use of Warfarin / 中国药师

Objective:To explore the anticoagulant strategies during perioperative period for the patients with long-term anticoagu-lation therapy to show the important role of clinical pharmacist in drug treatment. Methods:The anticoagulant regimen during the peri-operative period participated by clinical pharmacists for one patient with long-term use of warfarin was reviewed, and combined with the related literatures, the drug choice, the administration time, dosage and treatment course were analyzed. Results: The clinical phar-macists could optimize the anticoagulant regimen by using the pharmacokinetic knowledge to decrease the risk of hemorrhage and embol-ism to the largest extent. Conclusion:During the perioperative period, warfarin should be withdrawn at least 5 days before the opera-tion, and the international normalize ratio ( INR) should be monitored. After the operation and no further bleeding, low molecular weight heparin combined with warfarin can be used in 12h, and INR should be monitored. Low molecular weight heparin can be with-drawn till the standard is reached. If the patient undergoes operation for many times, low molecular weight heparin is suggested to be used for anticoagulation during the whole operation period.

Rapid Spontaneous Resolution of Acute Subdural Hematoma in a Patient with Liver Cirrhosis / 대한신경손상학회지

Acute subdural hematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery and rapid spontaneous resolution of ASDH is an infrequent phenomenon. Several mechanisms have been attributed to explain this phenomenon including redistribution of subdural blood, dilution by cerebral spinal fluid and brain atrophy. Rapid resolution of ASDH related to coagulopathy is a rare phenomenon; to our knowledge, only one case has been reported. We report on a patient who showed rapid resolution of ASDH with coagulopathy and also discuss such a rare case with speculation of the coagulopathy as a factor to promote this phenomenon.

THROMBOCYTOPENIA AND PREGNANCY / Шинэ санаа Шинэ нээлт

Cases years and leads to increase in risk of hemorrhag of blood and blood products. There is a case presentation. Patient 23 years old. primigravida. Blood pathology was diagnosed in 2003. Platelets were 25.000-35.000 before pregnancy and about 6.000 during pregnancy. She was admitted to hospital and has treatment for 20 days and undergone Cesarean section and subtotal hysterectomy. She was discharged 11 days after operation with her baby. We could prevent severe pathology that would occur for mother with severe coagulation disorder by conducting treatment directed to improve platelets release, to inhibit phagocytes activities (immunoglobulin and steroids), to compensate coagulation disorders and blood product transfusions on the basis of laboratory analyses. These treatments made possible to perform surgery and severe pathology that could arise for newborn. Many times transfusion of different blood products were transfused safely. Mother delivered without complications and she had healthy baby.

Fresh Frozen Plasma in Pump Priming for Congenital Heart Surgery: Evaluation of Effects on Postoperative Coagulation Profiles Using a Fibrinogen Assay and Rotational Thromboelastometry

PURPOSE: In this prospective study, the effects of fresh frozen plasma (FFP) included in pump priming for congenital heart surgery in infants and children on post-bypass coagulation profiles were evaluated. MATERIALS AND METHODS: Either 20% albumin (50-100 mL) or FFP (1-2 units) was added to pump priming for patients randomly allocated into control or treatment groups, respectively. Hematologic assays, including functional fibrinogen level, and rotational thromboelastometry (ROTEM(R)) were measured before skin incision (baseline), after weaning from cardiopulmonary bypass (CPB) and heparin reversal, and at 24 hours (h) in the intensive care unit (ICU). RESULTS: All the baseline measurements were comparable between the control and treatment groups of infants and children. After heparin reversal, however, significantly higher fibrinogen levels and less reduced ROTEM parameters, which reflect clot formation and firmness, were demonstrated in the treatment groups of infants and children. At 24 h in the ICU, hematologic assays and ROTEM measurements were comparable between the control and treatment groups of infants and children. Transfusion requirements, excluding FFP in pump prime, and postoperative bleeding were comparable between the control and treatment groups of infants and children. CONCLUSION: Although clinical benefits were not clearly found, the inclusion of FFP in pump priming for congenital heart surgery in infants and children was shown to improve the hemodilution-related hemostatic dysfunction immediately after weaning from CPB and heparin reversal.

Anticoagulation Therapy, Thrombolytic Therapy, and Use of Blood Products in Neonates

Neonatal coagulation disorders and thromboembolism require timely management. Failure to treat these conditions at the appropriate time may lead to death or the development of significant long-term sequelae. However, most current guidelines for managing neonatal coagulation disorders and thromboembolism are empiric and not based on randomized clinical trials. Thus, it is not easy to choose an appropriate management strategy for these conditions in clinical settings. In this review, therapeutic guidelines currently utilized in clinics and novel therapeutic options still under investigation are presented and reviewed.