Fibrin Glue Treatment of Low Rectal and Pouch-Anal Anastomotic Sinuses

PURPOSE: This report describes a treatment method for patients with persistent anastomostic sinuses in which fibrin glue is used. METHODS: A retrospective review was conducted of the medical records of seven patients with radiologically documented sinus tracts after restorative proctocolectomy or low rectal anastomosis was managed with fibrin glue obliteration of the tract. The sinus was gently debrided with a curette and then filled with fibrin glue. Postoperatively, the patients received metronidazole 1.5 g per day in divided doses for one week. Outpatient examination of the internal opening was performed at 1, 3, and 12 weeks postoperatively. RESULTS: In all patients, healing of the sinus was observed after one week. After an average of 11.2 months (range, 3–15) of follow-up there were no recurrences and no episodes of pelvic sepsis. CONCLUSION: On the basis of this experience, we believe that fibrin glue injection may be an alternative method of managing pelvic anastomotic sinuses. Presented at the American Society of Colon and Rectal Surgeons, Chicago, Illinois, June 3 to 8, 2002     

纤维蛋白生物胶外周支持对大鼠颈静脉移植物的增殖和凋亡的影响

目的研究纤维蛋白胶血管外周支持对静脉移植物平滑肌细胞增殖、凋亡的影响。方法建立大鼠颈总动脉自体颈静脉移植模型,按照有无纤维蛋白胶血管外周支持,分为外周支持组、无外周支持组,每组24只。术后1周、2周、4周分别切除移植静脉,用免疫组织化学方法检测静脉移植物平滑肌细胞增殖细胞核抗原(PCNA)表达,用原位DNA断裂位点3’-羟基末端标记(TUNEL)法检测静脉移植物平滑肌细胞凋亡的变化,以及检测内膜厚度。结果静脉移植术后1-4周,无外周支持组静脉移植物血管平滑肌细胞的凋亡和增殖均明显升高,内膜明显增厚;纤维蛋白胶血管外周支持组静脉移植物血管平滑肌细胞的凋亡和增殖同处于低水平,内膜增厚不明显。两组静脉移植物血管平滑肌细胞的凋亡和增殖具有显著相关性。结论纤维蛋白胶外周支持可以抑制血管平滑肌的增殖和凋亡,使两者同时处于低水平,一方面减少细胞凋不足所造成的对血管重塑造成的影响,另一方面使凋亡程度与巨噬细胞及正常血管平滑肌吞噬作用达到平衡,抑制了静脉移植物的内膜增生。     

A Case of Acute Hepatic Insufficiency Treated with Novel Plasmapheresis Plasma Diafiltration for Bridge Use Until Liver Transplantation

Abstract: A patient with acute hepatic insufficiency induced by a drug presented to our institution, and we performed a novel plasmapheresis that we call plasma dia‐filtration (PDF). The patient was a 36 year old woman. She underwent 11 sessions of PDF for a duration of about 9 h for each procedure using the Evacure EC‐2A filter together with 20 units of fresh frozen plasma and dialysate simultaneously. Serum levels of total bilirubin and prothrombin time were significantly improved after she underwent each procedure. However, after the third procedure the levels returned to the same level as on the previous day. Encephalopathy improved after the first procedure, and this improvement was maintained until the ninth procedure. The patient prepared to undergo liver transplantation after the tenth procedure because of the development of hepatic coma, but she died of respiratory insufficiency before undergoing the procedure. Accordingly in this case, PDF worked to maintain liver function in acute liver failure and may act as bridge therapy until the patient can undergo liver transplantation.     

Comparison of Fresh Frozen Plasma with a Standardized Serum Protein Solution Following Therapeutic Plasma Exchange in Patients with Autoimmune Disease: A Prospective Controlled Clinical Trial

abstract: The aim of the study was the comparison of the influence of fresh frozen plasma (FFP) (Freiburg, Germany) and Biseko, Biotest Pharma GmbH (Dreieich, Germany), as a plasma substitute (a standardized, virus inactivated human serum protein solution) on the coagulation factors, inhibitors, proteins, and complement factors in the plasma of autoimmune disease patients following membrane plasma separation. Patients (n = 24) with autoimmune disease were randomized to receive either FFP or Biseko for membrane plasma separation therapy. During each plasma exchange, 100% of the plasma volume was replaced by the respective substitute. Plasma exchange volume was performed once daily for 3 days. Target test parameters of the coagulation system were fibrinogen, fibrinopeptide A, factor VIII (FVIIIC), von Willebrand factor antigen (vWFAg), partial thromboplastin time (PTT), thromboplastin time (Quick value), and antithrombin (AT III). The immunoglobulins were IgG, IgA, and IgM and C‐reactive protein (CRP). The thrombocytes were platelet factor 4 (PF4), and complement factors were C3 and C4. Biseko was well tolerated with 1 mild adverse drug reaction (ADR) (n = 1) while FFP gave rise to ADR on 7 occasions (n = 4). Statistically significant differences in the 2 groups were observed for fibrinogen, PTT, Quick value, and AT III. From the clinical point of view, all fluctuations and differences in parameter levels remained clinically silent. The differences had no clinical consequences. Reflecting on a potential decrease in the risk of infections in comparison to FFP therapy and the lower rate of adverse drug reactions, it is possible to postulate an advantage of Biseko for plasma exchange therapy.     

Acute Changes in Plasma Levels of Hepatocyte Growth Factor During Low‐Density Lipoprotein Apheresis

Abstract: Hepatocyte growth factor (HGF) is a mesenchyme‐derived pleiotropic factor, and angiogenesis is included in a variety of its functional effects. HGF levels were measured in 5 sessions of low‐density lipoprotein (LDL) apheresis in 3 patients with severe hypercholesterolemia. Blood was collected at the start (T0) and at 1,000 ml (T1), 2,000 ml (T2), and 3,000 ml (T3) plasma treatments. During LDL apheresis, HGF levels increased from 1.59 ± 0.78 (mean ± SE, n = 5) ng/ml at T0 to 6.64 ± 0.97 at T1, 6.28 ± 0.97 at T2, and 5.20 ± 0.94 at T3. In one apheresis session, HGF increased immediately at the 100 ml plasma treatment stage. HGF was adsorbed completely by a dextran‐sulfate (DS) column. Despite the adsorption by the DS column, HGF in the patient blood increased to the levels with functional effects. The improvement of ischemic symptoms due to LDL apheresis may be related to the angiogenic activities of HGF.     

Changes in Complement Levels and Activity of Red Blood Cells,Fresh Frozen Plasma,and Platelet Concentrates During Storage

Complement cascade plays an important role in the field of transfusion medicine. The study aimed to detect the complement levels of different blood components and different blood types to explore the risk of transfusion of stored blood. The samples including red blood cells (n = 110), fresh frozen plasma (n = 120), and platelet concentrates (n = 104) from healthy blood donors in our center were collected. Complement components (C3, C4, C3b, C3d, and CH50) were assayed to evaluate the activation of complement. The complement levels of various blood components at different storage times were observed. The differences in complement levels of four blood types in various blood components were compared. The complement levels of red blood cells in storage were low, with no significant changes (P > 0.05). C3b and C3d levels in platelets began to significantly increase after storage for 3 days (P < 0.05). The fresh frozen plasma during storage had higher complement levels, and the concentrations of C3 and C4 decreased and C3b and C3d increased at month 4 (P < 0.05). The differences in complement levels of four blood types in various blood components did not significantly change (P > 0.05), but the C3b and C3d levels of AB fresh frozen plasma remained stable during storage, which different from other blood types. The transfusion of red blood cells was relatively safe in terms of complement activation. The activation of complement proteins occurred during the storage of platelet and plasma, except group AB plasma.Electronic supplementary materialThe online version of this article (10.1007/s12288-020-01338-0) contains supplementary material, which is available to authorized users.     

Antibody Reactivity of a Standardized Human Serum Protein Solution Against a Spectrum of Microbial Pathogens and Toxins: Comparison with Fresh Frozen Plasma

Abstract: In this study, we compared a standardized solution of human serum protein (HSP) and fresh frozen plasma (FFP) with regard to the antibody specificity against a number of microbial pathogens and some important pathogenicity factors of bacterial pathogens. Due to the clinical use of HSP and FFP for therapeutical plasma exchange, we have chosen a spectrum of microbial pathogens for serological analysis that is critical in clinical settings. With the enzyme‐linked immunosorbent assay technique, we could show that HSP contains marked IgG antibody reactivity against antigens of Escherichia coli, Campylobacter jejuni, Enterobacter sakazakii, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, S. epidermidis, Streptococcus pneumoniae, Enterococcus faecalis, Chlamydia pneumoniae, and Candida albicans. Although no IgM antibodies against the pathogens tested could be detected in HSP, moderate IgA reactivity was found against 4 of 12 microbial antigens. Immunoblot analysis demonstrated specific IgA and IgG responses against the endoproteinase Glu‐C and the superantigens enterotoxin A and B of S. aureus, the IgA‐protease of Neisseria gonorrhoeae, and Shiga toxin 2 of enterohemorrhagic E. coli. By using 3 different HSP batches in parallel, we could demonstrate antibody reactivity against important microbial pathogens and toxins. This antibody profile is essentially more homogeneous than that of 3 batches of FFP.     

First Steps Toward the Establishment of a German Low‐Density Lipoprotein‐Apheresis Registry: Recommendations for the Indication and for Quality Management

Abstract: New recommendations for the indication of treatment with selective extracorporeal plasma therapy low‐density lipoprotein apheresis (LDL‐apheresis) in the prevention of coronary heart disease are urgently needed. The following points are the first results of the ongoing discussion process for indications for LDL‐apheresis in Germany: all patients with homozygous familial hypercholesterolemia with functional or genetically determined lack or dysfunction of LDL receptors and plasma LDL cholesterol levels >13.0 mmol/L (>500 mg/dL); patients with coronary heart disease (CHD) documented by clinical symptoms and imaging procedures in which over a period of at least 3 months the plasma LDL cholesterol levels cannot be lowered below 3.3 mmol/L (130 mg/dL) by a generally accepted, maximal drug‐induced and documented therapy in combination with a cholesterol‐lowering diet; and patients with progression of their CHD documented by clinical symptoms and imaging procedures and repeated plasma Lp(a) levels >60 mg/dL, even if the plasma LDL cholesterol levels are lower than 3.3 mmol/L (130 mg/dL). Respective goals for LDL cholesterol concentrations for high‐risk patients have been recently defined by various international societies. To safely put into practice the recommendations for LDL‐apheresis previously mentioned, standardized treatment guidelines for LDL‐apheresis need to be established in Germany that should be supervised by an appropriate registry.     

Hyponatremia of Cirrhosis: Role of Vasopressin and Decreased 'Effective' Plasma Volume

Background: The mechanism(s) of hyponatremia of cirrhosis is not completely clarified. Although increased vasopressin activity has been proposed in some studies, there have been reports disputing its role in the pathogenesis of profound hyponatremia in patients with decompensated liver disease. Methodologic flaws and lack of correlation with indices of circulatory dysfunction may have contributed to these discrepancies. The aims of the present study were to measure levels of vasopressin both in plasma and in urine and to correlate them with the volume-dependent hormonal systems of plasma renin activity (PRA) and atrial natriuretic factor (ANF). Methods: Plasma vasopressin, ANF, and PRA were measured by radioimmunoassay in 19 patients with cirrhosis, ascites, and severe hyponatremia (mean serum sodium, 121.8 mmol/1) and 11 patients with cirrhosis and normal serum sodium (mean, 137.6 mmol/1). Vasopressin levels were also assessed by radioimmunoassay in urine. Results: Patients with hyponatremia had higher plasma and urine vasopressin levels than patients with normal serum sodium concentrations (plasma, 2.9 versus 1.0 pg/ml, P = 0.0009; urine, 38.3 versus 12.3 ng/g creatinine, P = 0.0008). PRA was higher (4.8 versus 1.0 ng/ml/h, p = 0.0004) and plasma ANF lower (111.1 versus 148.7 pg/ml, P = 0.01) in patients with hyponatremia. Conclusions: These results indicate that plasma and urine vasopressin levels are inappropriately increased in patients with cirrhosis and severe hyponatremia. The concomitant increase of PRA and decrease of plasma ANF suggest that decreased 'effective' plasma volume generates nonosmotic stimuli for vasopressin hypersecretion in these patients.     

Ethical Lessons Learned from the Use of Therapeutic Plasma Exchange in Neurologic Disease

Abstract: Conflicts of interest are inherent in the practice of medicine, particularly in the conduct of clinical research. Such conflicts can often be identified and even resolved by the application of ethical principles as an integral part of such research. The opportunity to participate in a series of controlled clinical trials of therapeutic plasma exchange (TPE) in diverse neurologic disease provided an insight into some of the ethical dilemmas posed by such conflicts of interest. Chief among these was the recognition that informed consent is a precious though fragile and multidimensional concept. In the last analysis, ethics is the “business of being human”; respect for its guidance helps to ensure the success of clinical research.     

Plasma D‐Dimer Level and the Failure of Forearm Autologous Arteriovenous Fistula in Patients With End‐Stage Renal Disease

Failed autologous arteriovenous fistula (AVF) is a major issue in the creation of functional hemodialysis vascular access. To date, the relationship between D‐dimer and AVF failure is still uncertain. Hence, we conducted a retrospective cohort study to explore the patency rate of forearm AVFs and to clarify whether plasma D‐dimer level can predict the failure of AVFs. In this study, 290 ESRD patients (the mean age 54.1 ± 14.6 years, 63.8% of them were males) receiving forearm AVFs surgery were consecutively enrolled with a median follow‐up time of 34 months. Primary patency rates and risk factors associated with AVFs failure were explored by the Kaplan–Meier method or Cox proportional hazards model. Patients were divided into two groups based on the median level of D‐dimer (group 1 <1.1 mg/L and group 2 ≥1.1 mg/L). The Kaplan–Meier survival analysis demonstrated that the patency of AVF in group 1 was similar in group 2, which were 92.4% versus 88.9%, 84.8% versus 84.0%, 80.0% versus 79.2%, 76.7% versus 78.5%, and 76.7% versus 78.5% at 12, 24, 36, 48, and 60 months (Log‐rank test, P = 0.8), respectively. In the crude analysis, D‐dimer (per 1 mg/L increase) was independently associated with AVFs failure, with OR of 1.08 (95% CI, 1.02–1.15). However, after adjusting for potential confounders, the D‐dimer (per 1 mg/L increase) was not associated with the AVFs failure (OR = 1.06, 95% CI = 0.99–1.13). This study did not find that the plasma D‐dimer level can predict the failure of forearm AVFs.     

Plasma Volume and Plasma Volume Distribution at Rest,during Muscular Work,Cold Pressure Test and Psychological Stress in Male Offspring from Families with Heavy Aggregation of Hypertension

ABSTRACT. Total and central plasma volume was measured in 51 male offspring of hypertensive individuals belonging to families with a history of essential hypertension for at least two generations. They were compared to 38 age-matched individuals without known hypertension in their families for at least two generations. Central plasma volume was determined at rest and during muscle work, cold pressure test and psychological stress. The offspring had significantly lower total plasma volume than the controls. Central plasma volume was equal in offspring and controls. The quotient central/total plasma volume was thus higher in offspring than in controls, and the difference was statistically significant during psychological stress and dynamic muscle work. Possible reasons for the differences between offspring and controls are an increased transcapillary escape of plasma, an increased quotient intracellular/extracellular fluid and/or increased tone of the capacitance vessels.     

Preparation and Performance Evolution of Plasma Sprayed Abradable CuAl/PHB–NiAl Layered Seal Coatings

In this study, a double-layered CuAl/PHB-NiAl seal coating was prepared on a GH4169 substrate by atmospheric plasma spraying. The evolution of the microstructure and mechanical properties of the coating under simulated working conditions was studied. The surface hardness of as-sprayed coating decreased with an increase in the temperature from 25 to 700 °C, decreasing from 90.42 HR15Y to 66.83 HR15Y. A CuO phase was formed in the coating and the oxidation weight gain rate increased with an increase in the temperature when the coating was constantly oxidized at 500~700 °C for 100 h. The hardness of metal matrix in the coating increased with the extension in the oxidation time at 600 °C, increasing from 120.8 HV_0.1 to 143.02 HV_0.1. The residual stress of the as-sprayed porous CuAl top-coating was less than that of the top-coating/bond-coating interface, and it is further relieved by about 15~20 MPa after heat treatment. The coating porosity first increased and then decreased when the oxidation time was 1000 h. The further ablation of PHB and the formation of oxide were concluded to be the main reasons for the evolution of porosity.     

Differential investigations from plasma‐derived and recombinant Factor IX revealed major differences in post‐translational modifications of activation peptides

Post‐translational modifications (PTMs) located on the activation peptide (AP) of recombinant FIX (rFIX, BeneFIX^®) and plasma‐derived FIX (pdFIX, Betafact^®) have been investigated by mass spectrometry to review the structural differences between these two products. Three major structural differences were pointed out. rFIX contains a low amount of phosphorylated and sulphated AP (4% for rFIX vs. 70% for pdFIX); rFIX N‐glycans are only sialylated in the α2‐3 linkage, whereas pdFIX N‐glycans contain both type of α2‐3 and α2‐6 linkages, and rFIX does not contain any sialyl Lewis^X glycoantigens contrary to pdFIX. These variations might participate in the in vivo potential different behaviours of the two molecules.