Study on chemical constituents of Folium Artemisiae argyi Carbonisatum,toxicity evaluation on zebrafish and intestinal hemostasis

Folium Artemisiae argyi Carbonisatum (FAAC) is a traditional medicine widely used in clinic. It has the effect of hemostasis by warming meridians. In order to further explore the chemical composition and biological activity of FAAC, the methanol extract of FAAC was isolated and purified by open column and high- performance liquid chromatography. and the complete structure was characterized by nuclear magnetic resonance (NMR) and LREI-MS for the first time, namely rutin, quercetin and octacosanol respectively. Initially the toxic effect of methanol extract of FAAC on zebrafish was evaluated by observing the phenotypic characteristics, spontaneous twitch times, heart rate, hatching rate, the distance of SV-BA and cardiomyocyte apoptosis of zebrafish. The results showed that FAAC has embryonic development toxicity and cardiotoxicity when it was higher than 62.5 μg/mL. Meanwhile, the hemostatic effect of methanol extract of FAAC was compared with FAA (Folium Artemisia argyi) by zebrafish intestinal bleeding model originally. The results showed that the hemostatic effect of the medium and high concentration dose groups (3.0 and 30.0 μg/mL) was enhanced for both FAAC and FAA. This study provided an experimental basis for the clinical application of FAAC.     

Anticoagulantes orales directos en cirugía dermatológica

Direct-acting oral anticoagulants (DOACs) have emerged as safer, easier-to-manage alternatives to traditional vitamin K antagonists and are used increasingly because they require no monitoring, have a wider therapeutic window, and react less with other drugs. However, there is little consensus on optimal perioperative management when these drugs are used in dermatologic surgery. This article describes the characteristics of DOACs and reviews current evidence on their use in this setting.     

How to tackle complications in radial procedures: Tip and tricks

Transradial interventions (TRI) are becoming increasingly popular because of accumulating recent evidence suggesting improved survival and reduced morbidity. Complications, though rare, do occur, especially for operators on their learning curve. The complications are best prevented by utilization of proper technique. Forearm hematoma are preventable and easy to treat, but a delay in detecting and managing them can lead to disastrous consequences compartment syndrome being the most dreaded one. This review deals with tips and tricks to prevent as also treat the common and rare complications.     

Optimización transfusional en el trasplante de hígado usando terapia guiada por pruebas viscoelásticas

BackgroundAssess the reduction of packed red blood cells (PRBCs) transfusion in liver transplantation (LT) after the introduction of the thromboelastometry as intraoperative coagulation monitor.MethodsWe conducted a retrospective cohort study (n = 92), randomized into two groups: group A (control), in whom transfusion therapy was based on conventional laboratory tests (CLT), and group B (ROTEM), whose blood transfusion was performed as protocolized algorithms, guided by thromboelastometry (ROTEM). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), platelets units, fibrinogen and tranexamic acid. We used the chi square test for the comparison of proportions and Student's t test to compare means when the distribution was normal. Otherwise, Mann-Whitney U test was performed.ResultsIn group A 84.8% of patients required transfusion of PRBCs, with a median (IQR) of 4 (1.5-6), compared with 67.4% in group B with a median (IQR) of 2 (0-4) (P < .05). We also found differences in the following variables: FFP transfusion rate was 84.8% with a median (IQR) of 5 (2-12) IU in group A and 56.5% (median (IQR) of 1 (0-4.5) in B (P < .001) and in the fibrinogen administration, that was 6.5% in group A and 34.8% in group B (P < .01). Backward stepwise logistic regression model showed associations between the clamping time, the preoperative hemoglobin, the portal hypertension (PHT) and being or not in the treatment group and the need for perioperative transfusion. We didn’t find significant differences in the incidence of complication during the early postoperative period between the two groups.ConclusionsThe introduction of thromboelastometry (ROTEM) measurements in hemostatic therapy algorithms reduces the transfusion rate of FFP and PRBCs during liver transplantation. The using of ROTEM derived thresholds leads to detecting higher requirements of fibrinogen compared to conventional laboratory tests.     

Comparison of a new mineral based hemostatic agent to a commercially available granular zeolite agent for hemostasis in a swine model of lethal extremity arterial hemorrhage

BACKGROUND: Gaining hemostatic control of vascular injuries sustained in combat using topical agents remains a challenge. We previously developed a new hemostatic agent consisting of a granular combination of a smectite mineral and a superabsorbent polymer (WoundStattrade mark; WS) which demonstrated the ability to stop high pressure bleeding. We have since modified WS to contain only the smectite mineral and compared the performance of WS to QuikClot'strade mark zeolite granules (QCG) in a lethal vascular injury model. METHODS: Fourteen (seven per group) anesthetized swine (35-44kg) had a lethal femoral artery injury produced by creating a 6mm arteriotomy in the vessel. After 45s of hemorrhage, animals were randomized to be treated with either WS or QCG for 3min. A second application was provided if hemostasis failed. Fluid resuscitation was begun at the time of application to achieve a mean arterial blood pressure of 65mmHg. Animals were observed for 120min or until death. Primary endpoints were survival, survival time, post-treatment blood loss, and resuscitation fluid volume. RESULTS: WS resulted in 100% survival to 120min. No animal in the QCG group survived (p=0.0005). Survival times for WS animals were significantly greater compared to QCG (p=0.0001). Post-treatment blood loss (p=0.0043) and post-resuscitation fluid volume (p=0.0043) was significantly less for animals treated with WS compared to QCG. CONCLUSION: WS consisting of just the smectite mineral was superior to QCG tested in this model. Additional study is warranted to determine its potential for use in combat and civilian trauma.     

Risk of thromboembolic complications in patients with inflammatory bowel disease

A large number of hemostasis measurements complications were performed in 20 patients with inflammatory bowel disease; whose changes have been associated with an increased risk of thromboembolic. Of the 20 patients, 9 (45%) had one or more changes suggestive of activation of the hemostatic system. Such changes were more frequently observed in patients with active disease. Two patients had changes in the fibrinolytic system (high plasminogen activator inhibitor-1 levels) and 2 in the natural anticoagulants (low antithrombin III activity). Nine patients had increased plasma fibrinogen levels and 6 patients had slightly increased levels of anticardiolipin antibodies. Most of the changes observed were not related to the type, location or activity of the disease. These data show that various biochemical abnormalities may be found in patients with inflammatory bowel disease, which may account for their increased risk of thrombosis, and suggest that multiple mechanisms may interact in determining such complications.     

髂内动脉或腹主动脉阻断对山羊髂内动脉网压力的影响

目的 评估山羊髂内动脉或腹主动脉阻断后髂内动脉压力的变化,为治疗骨盆骨折合并动脉出血合理选择阻断动脉的方法提供理论依据. 方法 共选择5只山羊,分别按以下方法测量髂内动脉的压力:(1)测量正常髂内动脉动脉压,(2)测量阻断一侧髂内动脉后远端压力,(3)测量阻断双侧髂内动脉后远端压力,(4)测量阻断腹主动脉和双侧髂内动脉后远端压力,(5)测量单纯阻断腹主动脉后髂内动脉压力. 结果 正常髂内动脉血压为(57.84±13.46) mm Hg,阻断一侧髂内动脉后远端压力为(38.40± 17.39)mm Hg,阻断双侧髂内动脉后远端压力为(29.70±12.16)mm Hg,阻断腹主动脉和双侧髂内动脉后远端动脉压力为(32.80±17.02) mm Hg 单纯阻断腹主动脉后髂内动脉远端压力为(29.20±18.52) mm Hg.不同的阻断方法对髂内动脉的压力均有明显的影响(P＜0.05),但不同的阻断方法之间差异无统计学意义(P＞0.05).结论 上述4种阻断方法对降低髂内动脉压力的作用是相似的,临床工作中选择一种方法即可,不必重复应用.     

不同肝血流阻断方法对半肝切除手术预后的影响

目的 探讨3种不同肝血流阻断方法对半肝切除术手术预后的影响.方法 总结分析216例半肝切除术患者的临床资料,按术中所采用的肝血流阻断方法将患者分为3组:Pringle法为A组98例,选择性出入肝血流阻断术为B组71例,肝悬吊法联合选择性出入肝血流阻断术为C组47例.结果 3组间平均手术时间差异无统计学意义(分别t =0.72,0.83,0.67,均P＞0.05);A组平均术中出血量为和平均输血量均明显多于B、C组(分别t=3.72,3.83,4.11,4.07,均P＜0.05),B、C两组间差异无统计学意义(t=1.08,P＞0.05);A组患者术后第1、3天血清白蛋白水平显著低于B、C组(分别t =3.65,3.77,3.90,3.74,均P＜0.05);A组患者术后第3、5天血清总胆红素水平明显高于B、C组(分别t=4.13,5.01,4.09,3.99,均P＜0.05);A组术后第1、3、5天血清丙氨酸转氨酶水平显著高于B、C组(分别t=5.36、6.14,5.70,7.01,4.94,3.98,均P＜0.05);A组患者术后并发症发生率明显高于B、C组(分别x2 =13.71,23.56,均P＜0.05).B、C组患者术后肝功能变化及并发症发生率差异无统计学意义(均P＞0.05).3组恶性肿瘤患者的术后3年生存率差异无统计学意义(t=2.38,P＞0.05).结论 半肝切除术中采用选择性出入肝血流阻断术或与肝悬吊法联合应用,均可显著减少术中出血,减轻术后肝功能损害及降低术后并发症的发生率.选择性出入肝血流阻断术可作为半肝切除术中血流阻断的首选方法.