Activity of two extracts of Cynanchum paniculatum against Ichthyophthirius multifiliis theronts and tomonts.

The present study aims to evaluate the antiparasitic activity of active components from Cynanchum paniculatum against Ichthyophthirius multifiliis. The antiparasitic activities of two bioassay-guided fractionationated compounds from C. paniculatum identified as Cynatratoside-A and Cynanversicoside C, by comparing spectral data (NMR and ESI-MS) with literature values, were evaluated by in vitro assay. These showed that both could kill theronts of I. multifiliis at a concentration of 10·0 mg L-1, with the median effective concentration (EC50) values of 4·6 mg L-1 and 5·2 mg L-1 for Cynatratoside-A and Cynanversicoside C, respectively. Encysted tomonts were killed at concentrations of 8·0 mg L-1 with both compounds. In vivo experiments demonstrated that fish treated with both compounds at 15·0 mg L-1 carried significantly fewer parasites than controls (P < 0·05). There were no mortalities among treated fish group compared with 75% mortality of untreated fish. Cynatratoside-A and Cynanversicoside C are therefore potential candidate drugs for use against I. multifiliis.

Effect of desmopressin on platelet aggregation and blood loss in patients undergoing valvular heart surgery.

BACKGROUND: Blood loss after cardiac surgery can be caused by impaired platelet (PLT) function after cardiopulmonary bypass. Desmopressin or 1-deamino-8-D-arginine vasopressin (DDAVP) is a synthetic analog of vasopressin. DDAVP can increase the level of von Willebrand factor and coagulation factor VIII, thus it may enhance PLT function and improve coagulation. In this study, we assessed the effects of DDAVP on PLT aggregation and blood loss in patients undergoing cardiac surgery. METHODS: A total of 102 patients undergoing valvular heart surgery (from October 2010 to June 2011) were divided into DDAVP group (n = 52) and control group (n = 50). A dose of DDAVP (0.3 µg/kg) was administered to the patients intravenously when they were being re-warmed. At the same time, an equal volume of saline was given to the patients in the control group. PLT aggregation rate was measured with the AggRAM four-way PLT aggregation measurement instrument. The blood loss and transfusion, hemoglobin levels, PLT counts, and urine outputs at different time were recorded and compared. RESULTS: The postoperative blood loss in the first 6 h was significantly reduced in DDAVP group (202 ± 119 ml vs. 258 ± 143 ml, P = 0.023). The incidence of fresh frozen plasma (FFP) transfusion was decreased postoperatively in DDAVP group (3.8% vs. 12%, P = 0.015). There was no significant difference in the PLT aggregation, urine volumes, red blood cell transfusions and blood loss after 24 h between two groups. CONCLUSIONS: A single dose of DDAVP can reduce the first 6 h blood loss and FFP transfusion postoperatively in patients undergoing valvular heart surgery, but has no effect on PLT aggregation.

[Anesthetic management for patients undergoing total thoracoabdominal aorta replacement without cardiopulmonary bypass].

OBJECTIVE: To summarize the experience in anesthetic management for total thoracoabdominal aorta replacement without cardiopulmonary bypass. METHODS: From October 2009 to September 2010, 10 patients of Fuwai Hospital received off-pump total thoracoabdominal aorta replacement. Of these patients, 5 were subjected to Standford B aortic dissection, 2 were Standford A aortic dissection received total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta.1 were Marfan's syndrome, and 2 were thoracoabdominal aorta. All operations used the technique which preserved blood was transfused back by pump via the femoral artery. RESULTS: The average surgery time was (7.4 ± 1.2) h and extubation time was (14.1 ± 2.5) h, the descending thoracic aorta cross clamp time was (11.5 ± 3.6) min, the intercostal artery reconstruction time was (16.4 ± 5.5) min, the required amount of blood products was fresh frozen plasma (600.5 ± 542.8) ml, platelet(1.7 ± 0.8) U, red blood cell (4.3 ± 2.4) U, auto blood salvage (465.7 ± 242.3) ml. Three patients occurred atelectasis and one patient occurred sero peritoneum postoperation. All of the 10 patients were discharged from hospital without any neurologic complications. CONCLUSION: The anesthetic management for total thoracoabdominal aorta replacement without cardiopulmonary bypass is feasible. It can reduce the side effects of deep hypothermia circulatory arrest and had a good effect.

[Establishment of normal reference values for thromboelastography on Chinese population in Beijing].

OBJECTIVE: To determine the normal values for thromboelastography (TEG) in Chinese healthy adult volunteers residing in Beijing for over three years and compare them with those of the manufacturer's. METHODS: A total of 137 healthy adult volunteers were enrolled from June 2010 to August 2010. The technique was standardized with citrated blood and kaolin activator. And a Haemoscope 5000 device was employed. The TEG parameters analyzed were R, K, α, maximal amplitude (MA), LY30 and coagulation index (CI). All volunteers underwent the tests of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and plasma fibrinogen level with the same blood sample. RESULTS: The reference ranges of 95% for 137 volunteers were R: 3.8 - 8.4 min, K: 0.8 - 3.3 min, α-Angle: 46.2 - 76.2°, MA: 50.0 - 70.8 mm, LY30: -3.3% - 4.0% and CI: -3.8 - 2.9. Overall, 24.1% (33/137) of the volunteers had at least one abnormal parameter while 7.3% (10/137) would have been considered coagulopathy had the manufacturer's reference values been used, resulting in a test specificity of 76.0%. As compared with the western ethnicity (the manufacturer's reference values), Chinese healthy volunteers were associated with lower fibrinogen functions. There were significantly different in R, K, α-Angle, MA and CI between men and women groups (all P < 0.01). CONCLUSION: This study supports the manufacturer's recommendation that each institute should determine its own normal reference values.

[Effects of ulinastatin on coagulation and platelet function in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass].

OBJECTIVE: To investigate the effects of ulinastatin (U) on coagulation, platelet function, and postoperative bleeding in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). METHODS: Thirty-six selective patients undergoing CABG with CPB were randomly assigned to two groups: Group U (n=18) in which ulinastatin 4 x 10(6) U in 100 ml normal saline (NS) was infused intravenously for 30 min since skin incision with 4 x 10(6) U added to the CPB pump prime, and then 2 x 10(6) U of ulinastatin was infused intravenously at a rate of 4-6 x 10(4) U x h(-1) until the chest was closed; and control group (Group C, n=18) in which 100 ml NS was infused without ulinastatin. Peripheral blood samples were collected 1 min before operation (T0), 1 min before heparinization (T1), at the end of operation (T2), 6 hour after operation (T3), and 24 hour after operation (T4). Platelet membrane glucoprotein IIb/IIIa (GP IIb/IIIa) and platelet alpha granule membrane protein-140 (CD62p) were measured by flow cytometry. Activated partial thromboplasin time (APTT), activated coagulation time of whole blood (ACT), prothrombin time (PT), fibrinogen, and platelet number were also measured. Postoperative blood loss and allogeneic transfusion were recorded. RESULTS: There were no statistical differences in CD26p, GP IIb/IIIa, and PT between the 2 groups (all P > 0.05). The APTT levels was significantly shortened in Group U at T1, T3 and T4 compared to T0. The APTT levels of Group U from T1 to T4 were all significantly lower than those of Group C (all P < 0.05). The ACT levels after heparinization and during CPB in Group U were significantly shorter than those of Group C (all P < 0.01), and the amount of added heparin during CPB of Group U was significantly higher than that of Group C (P < 0.01). There were not significant differences in platelet amount, fibrinogen, total amount of blood loss in 24 h after operation was 960 (420, 1500) ml in group C, and 850 (380, 1600) ml in group U (P > 0.05). The platelet count, CD26p, GPIIb/IIIa, total amounts of blood loss and blood infusion 24 h after operation, and hemoglobin concentration between these 2 groups (all P > 0.05). CONCLUSION: Ulinastatin shortens the APTT and ACT after heparinization, increases the dose of heparin during CPB, has no effect on the expression of GP IIb-IIIa and CD62p, and does not reduce postoperative blood loss.