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Üstün R, Oğuz EK, Şeker A, Taspinar F. Functional and structural neurodegenerative activities of Ankaferd BloodStopper in a mouse sciatic nerve model. Exp Ther Med 2024; 28:345. [PMID: 39071898 PMCID: PMC11273257 DOI: 10.3892/etm.2024.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/22/2024] [Indexed: 07/30/2024] Open
Abstract
Traumatic and postoperative hemorrhages are life-threatening complications. Ankaferd BloodStopper (ABS) is a potent topical hemostatic agent to stop bleeding. However, ABS is associated with nerve toxicity. The present study aimed to investigate the functional and structural neurodegenerative effects of ABS in a mouse model. A total of 30 male BALB/c mice, aged 6-8 weeks, were randomly divided into control group (no treatment), a sham group (treated with saline) and an experimental group (treated with ABS). In the saline and the ABS groups, the right sciatic nerve was surgically exposed and treated with saline or ABS, respectively. No surgical procedure was performed in the control group. On day 7 post-treatment, functional changes of the sciatic nerve were evaluated by a horizontal ladder rung walking task. Structural changes were assessed with immunohistochemistry. In the horizontal ladder rung walking test, the gait impairment was proportional to the severity of sciatic nerve damage, with the ABS group showing a significantly higher rate of errors than the control and saline groups. Immunohistochemistry demonstrated extensive degeneration and deformation in the axons and myelin sheath of the sciatic nerve in the ABS group. The results provide compelling evidence for the neurotoxicity of ABS.
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Affiliation(s)
- Ramazan Üstün
- Neuroscience Research Unit, School of Medicine, Van Yüzüncü Yıl University, Van 65080, Turkey
- Department of Physiology, School of Medicine, Van Yüzüncü Yıl University, Van 65080, Turkey
| | - Elif Kaval Oğuz
- Neuroscience Research Unit, School of Medicine, Van Yüzüncü Yıl University, Van 65080, Turkey
| | - Ayşe Şeker
- Department of Physiology, School of Medicine, Van Yüzüncü Yıl University, Van 65080, Turkey
| | - Filiz Taspinar
- Department of Physiology, School of Medicine, Aksaray University, Aksaray 68100, Turkey
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Cazacu SM, Turcu-Stiolica A, Florescu DN, Ungureanu BS, Iovanescu VF, Neagoe CD, Burtea DE, Genunche-Dumitrescu AV, Avramescu TE, Iordache S. The Reduction of After-Hours and Weekend Effects in Upper Gastro-intestinal Bleeding Mortality During the COVID-19 Pandemic Compared to the Pre-Pandemic Period. J Multidiscip Healthc 2023; 16:3151-3165. [PMID: 37908341 PMCID: PMC10615097 DOI: 10.2147/jmdh.s427449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023] Open
Abstract
Background In upper gastrointestinal bleeding (UGIB), admissions after normal working hours and during weekends may be associated with increased mortality. Aim To assess the evolution of the after-hours and weekend effects during the COVID-19 pandemic as a result of progressive improved management despite management challenges during the pandemic. Methods We performed an observational study of patients admitted for UGIB at a tertiary academic center between March 2020 and December 2021, compared to the corresponding timeframe before the pandemic. Admissions were assessed based on regular hours versus after-hours and weekdays versus weekends. We stratified patients based on demographic data, etiology, prognostic scores, the time between symptom onset and admission, as and between admission and endoscopy. The outcomes included mortality, rebleeding rate, the requirement for surgery and transfusion, and hospitalization days. Results 802 cases were recorded during the pandemic, and 1006 cases before the pandemic. The overall mortality rate was 12.33%. Patients admitted after hours and during weekends had a higher mortality rate compared to those admitted during regular hours and weekdays (15.18% versus 10.22%, and 15.25% versus 11.16%), especially in cases of non-variceal bleeding. However, the difference in mortality rates was reduced by 2/3 during the pandemic, despite the challenges posed by COVID-19 infection. This suggests that there was an equalization effect of care in UGIB, regardless of the admission time. The differences observed in mortality rates for after-hours and weekend admissions seem to be primarily related to a higher proportion of patients who did not undergo endoscopy, while the proportion of severe cases remained similar. Blood requirements, hospital days, and rebleeding rate were similar between the two groups. Conclusion Admissions during weekends and after-hours have been associated with increased mortality, particularly in cases of non-variceal bleeding. However, the impact of this association was significantly reduced during the pandemic.
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Affiliation(s)
- Sergiu Marian Cazacu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Adina Turcu-Stiolica
- Biostatistics Department, University of Medicine and Pharmacy Craiova, Dolj County, Romania
| | - Dan Nicolae Florescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Bogdan Silviu Ungureanu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Vlad Florin Iovanescu
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Carmen Daniela Neagoe
- Internal Medicine Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | - Daniela Elena Burtea
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
| | | | - Taina Elena Avramescu
- Individual Sports, and Medical Disciplines Departments, University of Craiova, Dolj County, Romania
| | - Sevastita Iordache
- Gastroenterology Department, University of Medicine and Pharmacy Craiova, Clinical Emergency Hospital Craiova, Dolj County, Romania
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Yang Z, Chen L, Liu J, Zhuang H, Lin W, Li C, Zhao X. Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2301849. [PMID: 36942893 DOI: 10.1002/adma.202301849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Short designer self-assembling peptide (dSAP) biomaterials are a new addition to the hemostat group. It may provide a diverse and robust toolbox for surgeons to integrate wound microenvironment with much safer and stronger hemostatic capacity than conventional materials and hemostatic agents. Especially in noncompressible torso hemorrhage (NCTH), diffuse mucosal surface bleeding, and internal medical bleeding (IMB), with respect to the optimal hemostatic formulation, dSAP biomaterials are the ingenious nanofiber alternatives to make bioactive neural scaffold, nasal packing, large mucosal surface coverage in gastrointestinal surgery (esophagus, gastric lesion, duodenum, and lower digestive tract), epicardiac cell-delivery carrier, transparent matrix barrier, and so on. Herein, in multiple surgical specialties, dSAP-biomaterial-based nano-hemostats achieve safe, effective, and immediate hemostasis, facile wound healing, and potentially reduce the risks in delayed bleeding, rebleeding, post-operative bleeding, or related complications. The biosafety in vivo, bleeding indications, tissue-sealing quality, surgical feasibility, and local usability are addressed comprehensively and sequentially and pursued to develop useful surgical techniques with better hemostatic performance. Here, the state of the art and all-round advancements of nano-hemostatic approaches in surgery are provided. Relevant critical insights will inspire exciting investigations on peptide nanotechnology, next-generation biomaterials, and better promising prospects in clinics.
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Affiliation(s)
- Zehong Yang
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
- Institute for Nanobiomedical Technology and Membrane Biology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Lihong Chen
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ji Liu
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hua Zhuang
- Department of Ultrasonography, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, Sichuan, 610041, China
| | - Wei Lin
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Women and Children Diseases of the Ministry of Education, Sichuan University, No. 17 People's South Road, Chengdu, Sichuan, 610041, China
| | - Changlong Li
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaojun Zhao
- Institute for Nanobiomedical Technology and Membrane Biology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
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Su DS, Li CK, Gao C, Qi XS. Hemostatic powder for acute upper gastrointestinal bleeding: Recent research advances. Shijie Huaren Xiaohua Zazhi 2023; 31:249-255. [DOI: 10.11569/wcjd.v31.i7.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Acute upper gastrointestinal bleeding (AUGIB) is a clinically common emergency condition. The common causes of AUGIB are peptic ulcer and esophagogastric variceal bleeding. Despite continuous improvements in endoscopic hemostasis techniques, endoscopic treatment is still unsuccessful in 5%-15% of patients. Hemostatic powder, a new drug for endoscopic hemostasis that is sprayed on the bleeding site with the assistance of an air pump, can absorb water to promote clotting substance aggregation and then adhere over the lesion, forming a mechanical barrier and then achieving hemostasis. It is convenient to spray hemostatic powder under endoscopy, where precise positioning is not warranted. The immediate hemostasis rate of hemostatic powder is often high, and it can be used as a remedy after the failure of conventional hemostasis. However, until now, there have been no recommendations in China regarding the use of hemostatic powder for the treatment of AUGIB. This article summarizes the mechanism, clinical applicability, and side effects of five major types of hemostatic powder by reviewing the existing evidence, with an aim to strengthen endoscopists' understanding of this drug.
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Cha B, Lee D, Shin J, Park JS, Kwon GS, Kim H. Hemostatic efficacy and safety of the hemostatic powder UI-EWD in patients with lower gastrointestinal bleeding. BMC Gastroenterol 2022; 22:170. [PMID: 35392821 PMCID: PMC8991611 DOI: 10.1186/s12876-022-02247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background and aims Acute lower gastrointestinal bleeding (LGIB) is a common cause of emergency hospitalization and may require readmission for re-bleeding. Recently, a novel endoscopic hemostatic powder (UI-EWD/Nexpowder™, Nextbiomedical, Incheon, South Korea) was developed and applied for the control of LGIB. The aim of this study was to evaluate the hemostatic efficacy and long-term safety of UI-EWD in LGIB. Patients and methods We conducted a retrospective cohort study of LGIB at a single tertiary center in south Korea. One hundred and sixty-seven consecutive patients with LGIB who were initially successful in endoscopic hemostasis were included and divided into the conventional treatment group (n = 112) and the UI-EWD therapy group (n = 55; 38 patients with conventional treatment and 17 patients with UI-EWD alone). The success rate of hemostasis, adverse events related to UI-EWD, and re-bleeding rate were evaluated. Results The incidence of endoscopic hemostasis applied to the hepatic flexure (7.3% vs. 0%, p = 0.011) and larger than 4 cm (25.5% vs. 8.0%, p = 0.002) were significantly higher in the UI-EWD group than in the conventional therapy group. The cumulative rebleeding rate within 28 days in the UI-EWD group was 5.5% (3/55), which was significantly lower than that in the conventional treatment group (17.0% [19/112]; p = 0.039). No UI-EWD-related adverse events were recorded. Conclusion Based on our results, application of UI-EWD in LGIB showed promising results for the prevention of re-bleeding, especially in locations where it is difficult to approach or cases with more bleeding. There were no significant complications, such as perforation or embolism. In particular, UI-EWD should be considered first for anatomical or technical impediments to endoscopic access in LGIB.
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Affiliation(s)
- Boram Cha
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Donghyun Lee
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Jongbeom Shin
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea.
| | - Jin-Seok Park
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Gye-Suk Kwon
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Hyungkil Kim
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
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Harne PS, Mukherjee S, Achufusi T, Lowe D, Manocha D. Helicobacter pylori-Negative MALT Lymphoma Presenting as a Massive Recurrent Gastrointestinal Hemorrhage. J Investig Med High Impact Case Rep 2021; 8:2324709620937166. [PMID: 32583695 PMCID: PMC7318806 DOI: 10.1177/2324709620937166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Primary gastric lymphoma is rare, representing 5% of all primary gastric neoplasms. The presenting complaints of gastric mucosa-associated lymphoid tissue (MALT) lymphoma are usually nonspecific. However, life-threatening gastrointestinal bleeding from the stomach is unusual and sparsely reported. While studies reveal an indolent course, we present a case that presented with massive and recurrent hematemesis leading to hypovolemic shock secondary to endoscopically confirmed MALT lymphoma, which was treated with radiotherapy to achieve remission. She had no autoimmune diseases and tested negative for Helicobacter pylori. Our case emphasizes the importance of early diagnosis and timely intensive radiotherapy of a localized but aggressive gastric MALT lymphoma.
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Affiliation(s)
| | | | - Ted Achufusi
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Dhruv Lowe
- Geisinger Health System, Danville, PA, USA
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Method of diagnosis and treatment of profusional bleeding from stenosing postbulbar ulcers of the duodenum. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim. To evaluate the effectiveness of X-ray interventions in arosive bleeding in patients with complicated duodenal ulcer.
Materials and methods. X-ray endovascular interventions were used in 8 patients who developed arosive bleeding as a complication of duodenal ulcer. All patients with signs of gastrointestinal bleeding were examined according to clinical protocols. Hemodynamically stable patients underwent X-ray endovascular interventions.
Results and discussion. In the near future, bleeding stopped in all 8 (100 %, OR–0.04 [0.005–0.29], p=0.03) patients. On day 2, two patients who underwent embolization of their own hepatic artery had a recurrence of bleeding (0.56 [0.065–4.76], p=0.29). Repeated angiography and embolization attempts were ineffective, and both patients died. In patients who underwent gastroduodenal and pancreatouodenal artery embolization, bleeding did not resume. Thus, we obtained good results as 6 out of 8 patients recovered (75 %), despite the severity of their condition and a disappointing prognosis (OR–9.0 [1.0–46.7], p <0.05).
Conclusions. Adherence to the tactics mentioned above in the treatment of bleeding in duodenal ulcer was highly effective, especially in superselective embolization with the detection of bleeding gel. If the presence of arosive bleeding is confirmed, emergency surgical treatment with suturing of the damaged vessel is shown in hemodynamically unstable patients, and endovascular intervention is possible in hemodynamically stable patients. Further studies are needed to determine the criteria for a high risk of arosive bleeding developing in patients with complicated duodenal ulcer as well as to prevent its occurrence through the use of X-ray endovascular interventions.
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Hancioğlu S, Demirel BD, Biçakci Ü, Gün S, Aritürk E, Aritürk N. Histopathological and mechanical effects of Ankaferd Blood Stopper® on wound healing in rats: an experimental model. Turk J Med Sci 2020; 50:1428-1433. [PMID: 32490638 PMCID: PMC7491291 DOI: 10.3906/sag-2004-177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background/aim To evaluate the histopathological and mechanical effects of Ankaferd Blood Stopper (ABS) application on wound healing. Materials and methods A total of 24 Wistar albino rats were randomly divided into three equal groups. In each group, a 3 cm-long midline vertical skin incision was performed in the back of the rats. In Group 1, the incision was sutured primarily. In Group 2, incision was left to secondary healing. In Group 3, ABS was applied to the incision. On the 10th day, burst pressure width was measured, and rats were sacrificed. The tissue samples were examined histopathologically. Statistical analysis was conducted with IBM SPSS program. P < 0.05 was considered significant. Results The mean burst pressure widths of wound separation were 13.66 ± 0.457, 7.18 ± 2.599, and 13.66 ± 1.11 mm for Groups 1–3, respectively. The difference in burst pressure width between Groups 1 and 3 was not significant (P > 0.05) but was significant between Groups 2 and 3 (P = 0.000). The vascular proliferation median values were 1, 2, and 2, for Groups 1–3, respectively. Although the difference was significant between Groups 1 and 2 in terms of vascular proliferation score (P = 0.047), no significant difference was observed between Group 3 and others. No statistically significant difference was observed among the groups in terms of collagen score, mononuclear cell infiltration, and polymorphonuclear cell proliferation (P > 0.05). The median values of fibroblast proliferation score were 1, 2, and 3, in Groups 1–3, respectively. Fibroblast proliferation score significantly differed between Groups 1 and 3 (P = 0.003). Conclusion ABS application results in a clean wound healing that is as strong as primary repair. However, additional studies are required to evaluate the late results of increased fibroblastic activity in the early period of ABS application alone.
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Affiliation(s)
- Sertaç Hancioğlu
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Berat Dilek Demirel
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ünal Biçakci
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Seda Gün
- Department of Pathology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ender Aritürk
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Nurşen Aritürk
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Zhang Z, Jiang H, Zhang Y, Zhang D, Fawcett JP, Gu J. Comprehensive Bioanalysis of Ultrahigh Molecular Weight, Highly Disperse Poly(ethylene oxide) in Rat via Microsolid Phase Extraction and RPLC-Q-Q-TOF Coupled with the MS ALL Technique. Anal Chem 2020; 92:5978-5985. [PMID: 32212638 DOI: 10.1021/acs.analchem.0c00189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ultrahigh molecular weight (UHMW) poly(ethylene oxide) (PEO) is a synthetic hydrophilic polymer with wide dispersity which shows considerable promise as a hemostatic agent in the treatment of gastrointestinal bleeding. Currently there is no analytical method for the determination of highly disperse UHMW PEO in biological samples that would allow its characterization in vivo and support its clinical development. Although liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a powerful bioanalytical tool, it faces major challenges when applied to UHMW PEO. In this work, we report a novel bioanalytical method for the determination of UHMW PEO involving microsolid phase extraction (μ-SPE), chromatography on a PLRP-S 1000 Å reversed phase column and detection by positive ion Q-Q-TOF MS using the MSALL technique. In this mode, dissociation of all precursor ions in Q2 generated a series of product ions at m/z 89.0715, 133.0854, 177.1047, and 221.1475 of which the product ion at m/z 133.0854 was common to all precursor ions and enabled quantitation of all polymers in UHMW PEO. The method was successfully applied to the determination of UHMW PEO polymers in rat plasma, urine, and feces after oral administration of 1700 kDa PEO. The results show that UHMW PEO is not absorbed into the blood and is largely eliminated unchanged in feces over 48 h. We maintain the method is sufficiently robust to be used in routine bioanalysis of polymers with UHMW and wide dispersity.
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Affiliation(s)
- Zhi Zhang
- Research Center for Drug Metabolism, College of Life Science, Jilin University, Changchun 130012, P. R. China.,Beijing Institute of Drug Metabolism, Beijing 102209, P. R. China
| | - Hui Jiang
- School of Life Science and Medicine, Dalian University of Technology, No. 2 Dagong Road, New District of Liaodong Bay, Panjin 124221, P. R. China
| | - Yuyao Zhang
- Research Center for Drug Metabolism, College of Life Science, Jilin University, Changchun 130012, P. R. China
| | - Di Zhang
- Research Center for Drug Metabolism, College of Life Science, Jilin University, Changchun 130012, P. R. China.,Beijing Institute of Drug Metabolism, Beijing 102209, P. R. China
| | - John Paul Fawcett
- Research Center for Drug Metabolism, College of Life Science, Jilin University, Changchun 130012, P. R. China.,Beijing Institute of Drug Metabolism, Beijing 102209, P. R. China
| | - Jingkai Gu
- Research Center for Drug Metabolism, College of Life Science, Jilin University, Changchun 130012, P. R. China.,Beijing Institute of Drug Metabolism, Beijing 102209, P. R. China
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Alzoubaidi D, Hussein M, Rusu R, Napier D, Dixon S, Rey JW, Steinheber C, Jameie-Oskooei S, Dahan M, Hayee B, Gulati S, Despott E, Murino A, Subramaniam S, Moreea S, Boger P, Hu M, Duarte P, Dunn J, Mainie I, McGoran J, Graham D, Anderson J, Bhandari P, Goetz M, Kiesslich R, Coron E, Lovat L, Haidry R. Outcomes from an international multicenter registry of patients with acute gastrointestinal bleeding undergoing endoscopic treatment with Hemospray. Dig Endosc 2020; 32:96-105. [PMID: 31365756 DOI: 10.1111/den.13502] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/28/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Acute gastrointestinal bleeding carries poor outcomes unless prompt endoscopic hemostasis is achieved. Mortality in these patients remains significant. Hemospray is a novel intervention that creates a mechanical barrier over bleeding sites. We report the largest dataset of patient outcomes after treatment with Hemospray from an international multicenter registry. PATIENTS AND METHODS Prospective data (Jan 2016-May 2018) from 12 centers across Europe were collected. Immediate hemostasis was defined as endoscopic cessation of bleeding within 5 min after application of Hemospray. Rebleeding was defined as subsequent drop in hemoglobin, hematemesis, persistent melena with hemodynamic compromise post-therapy. RESULTS Three hundred and fourteen cases were recruited worldwide (231 males, 83 females). Median pretreatment Blatchford score was 11 (IQR: 8-14) and median complete Rockall score (RS) was 7 (IQR: 6-8) for all patients. Peptic ulcer disease (PUD) was the most common pathology (167/314 = 53%) and Forrest Ib the most common bleed type in PUD (100/167 = 60%). 281 patients (89.5%) achieved immediate hemostasis after successful endoscopic therapy with Hemospray. Rebleeding occurred in 29 (10.3%) of the 281 patients who achieved immediate hemostasis. Seven-day and 30-day all-cause mortality were 11.5% (36/314) and 20.1% (63/314), respectively (lower than the predicted rates as per the RS). Similar hemostasis rates were noted in the Hemospray monotherapy (92.4%), combination therapy (88.7%) and rescue therapy (85.5%) groups. CONCLUSIONS These data show high rates of immediate hemostasis overall and in all subgroups. Rebleeding and mortality rates were in keeping/lower than predicted rates.
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Affiliation(s)
- Durayd Alzoubaidi
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Mohamed Hussein
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Radu Rusu
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust Hospitals, London, UK
| | - Duncan Napier
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust - Cheltenham General Hospital, Cheltenham, UK
| | - Selena Dixon
- Department of Gastroenterology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Johannes W Rey
- Department of Gastroenterology, Clinic Osnabruck, Osnabruck, Germany
| | - Cora Steinheber
- Department of Gastroenterology, Tubingen University Hospital, Tubingen, Germany
| | | | - Martin Dahan
- Department of Gastroenterology, University Hospital Centre, Nantes, France
| | - Bu Hayee
- Department of Gastroenterology, Kings College London, London, UK
| | - Shraddha Gulati
- Department of Gastroenterology, Kings College London, London, UK
| | - Edward Despott
- Department of Gastroenterology, The Royal Free Hospital, London, UK
| | - Alberto Murino
- Department of Gastroenterology, The Royal Free Hospital, London, UK
| | | | - Sulleman Moreea
- Department of Gastroenterology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Phil Boger
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | - Maxworth Hu
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | - Patricia Duarte
- Department of Gastroenterology, University Hospital Southampton, Southampton, UK
| | - Jason Dunn
- Department of Gastroenterology, Guy's and St Thomas' Foundation Trust Hospitals, London, UK
| | - Inder Mainie
- Department of Gastroenterology, Belfast Trust, Belfast, UK
| | - John McGoran
- Department of Gastroenterology, Belfast Trust, Belfast, UK
| | - David Graham
- Department of Gastroenterology, University College London Hospital (UCLH), London, UK
| | - John Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust - Cheltenham General Hospital, Cheltenham, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Martin Goetz
- Department of Gastroenterology, Tubingen University Hospital, Tubingen, Germany
| | | | - Emmanuel Coron
- Department of Gastroenterology, University Hospital Centre, Nantes, France
| | - Laurence Lovat
- Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Rehan Haidry
- Division of Surgery and Interventional Science, University College London (UCL), London, UK.,Department of Gastroenterology, University College London Hospital (UCLH), London, UK
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de Rezende DT, Brunaldi VO, Bernardo WM, Ribeiro IB, Mota RCL, Baracat FI, de Moura DTH, Baracat R, Matuguma SE, de Moura EGH. Use of hemostatic powder in treatment of upper gastrointestinal bleeding: a systematic review and meta-analysis. Endosc Int Open 2019; 7:E1704-E1713. [PMID: 31803822 PMCID: PMC6887646 DOI: 10.1055/a-0977-2897] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background and study aims TC-325 is a novel mineral hemostatic powder that creates a mechanical barrier by absorbing blood components and promoting clotting. Recently approved for use in humans, it has shown promise for treatment of upper gastrointestinal bleeding (UGIB). However, because there have been no large studies of TC-325, its true efficacy and safety profile remain unknown. We performed a systematic review and meta-analysis to determine the safety and efficacy of TC-325 in treating UGIB, based on rates of initial hemostasis, rebleeding, and adverse events (AEs).
Methods We searched the MEDLINE/PubMed, EMBASE, CENTRAL, Latin-American and Caribbean Health Sciences Literature databases, as well as the gray literature, to identify articles describing use of TC-325 up to October 2018. Primary outcomes were initial hemostasis and rebleeding. AEs were described as a secondary outcome. Risk of bias was assessed with international scores.
Results We identified 2077 records after removal of duplicates. We included 50 studies, involving a collective total of 1445 patients, in the quantitative synthesis. Primary hemostasis and rebleeding rates were 90.7 % and 26.1 %, respectively. Subgroup analyses showed similar results. Only eight AEs were reported.
Conclusions TC-325 appears to be a safe, effective treatment for UGIB. The overall rate of initial hemostasis after TC-325 use is high, regardless of etiology of bleeding or whether TC-325 is used as a primary or rescue therapy. Although it is also associated with high rebleeding rates, rates of AEs and equipment failure after TC-325 use are extremely low.
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Affiliation(s)
- Daniel Tavares de Rezende
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Raquel Cristina Lins Mota
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Felipe Iankelevich Baracat
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Renato Baracat
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Sergio Eiji Matuguma
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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Alzoubaidi D, Lovat LB, Haidry R. Management of non-variceal upper gastrointestinal bleeding: where are we in 2018? Frontline Gastroenterol 2019; 10:35-42. [PMID: 30651955 PMCID: PMC6319149 DOI: 10.1136/flgastro-2017-100901] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/10/2018] [Accepted: 01/21/2018] [Indexed: 02/04/2023] Open
Abstract
Acute upper gastrointestinal bleeding (AUGIB) is one of the most common medical emergencies in the UK. Despite advancement in technology the management of AUGIB remains a challenge. The clinical community recognise the need for improvement in the treatment of these patients. AUGIB has a significant impact on resources. Endoscopic therapy is the gold standard treatment. The mortality in AUGIB is rarely related to the presenting bleed but significantly associated with concurrent comorbidities. The cost of blood transfusion in the management of patients with AUGIB is significant and misuse of blood products has been documented nationally. Risk stratification tools such as Glasgow-Blatchford Score, Rockall Score and the AIMS65 score have allowed clinicians to triage patients appropriately in order to deliver endoscopic therapy within a suitable time frame. Endoscopic therapeutic modalities such as epinephrine injection, heat thermocoagulation and mechanical clips have had a positive impact on patient's management. However, in order to continue to improve patient's outcomes, further developments are needed.
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Affiliation(s)
- Durayd Alzoubaidi
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Laurence B Lovat
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rehan Haidry
- Division of Surgery and Interventional Science, University College London, London, UK
- GI Services, University College London Hospital, London, UK
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Manta R, Mangiafico S, Zullo A, Bertani H, Caruso A, Grande G, Zito FP, Mangiavillano B, Pasquale L, Parodi A, Germanà B, Bassotti G, Monica F, Zilli M, Pisani A, Mutignani M, Conigliaro R, Galloro G. First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study. Endosc Int Open 2018; 6:E1317-E1321. [PMID: 30410951 PMCID: PMC6221819 DOI: 10.1055/a-0746-8435] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limitations of standard clips or thermocoagulation in high-risk bleeding lesions. We evaluate the main clinically relevant outcomes following endoscopic hemostasis with OTSC in high-risk lesions and/or patients. Patients and methods This was a retrospective analysis of prospectively collected databases including all patients with UGIB and LGIB who underwent OTCS placement as first-line treatment in eleven tertiary endoscopic referral centers. Technical success, primary hemostasis, rebleeding, blood transfusion, hospital stay, and hemorrhage-related mortality rates were evaluated. Results Data from 286 patients, with either UGIB (N = 214) or LGIB (N = 72) were available. Overall, 112 patients (39.2 %) were receiving antithrombotic therapy. Technical success and primary hemostasis rates were 97.9 % and 96.4 %, respectively. Early rebleeding occurred in 4.4 %, more frequently in those on antithrombotic therapy, and no late rebleeding was observed. Following a successful primary haemostasis, only 5.2 % patients needed blood transfusions, and the median hospital stay was 4 days (range: 3 - 11). Eighteen patients with either technical failure (N = 6) or rebleeding (N = 12) underwent radiological or surgical approaches. Overall, bleeding-related deaths occurred in 5 (1.7 %) patients, including 3 patients with technical procedural failure, and 2 in the rebleeding group. Conclusions Data from our large, multicenter study show that OTSC placement is an effective first-line treatment for hemostasis in high-risk patients and/or lesions both in upper and lower gastrointestinal tract.
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Affiliation(s)
- Raffaele Manta
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy,Corresponding author Raffaele Manta, MD Gastroenterologia ed Endoscopia DigestivaAzienda Ospedaliera Universitaria di ModenaOspedale S.Agostino-EstenseViale Giardini Nord 1355Baggiovara, ModenaItaly+0039 059 3961216
| | - Santi Mangiafico
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Helga Bertani
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | - Angelo Caruso
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | - Giuseppe Grande
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | | | | | - Luigi Pasquale
- Gastroenterology Unit, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Andrea Parodi
- Gastroenterology Unit, Galliera Hospital, Genova, Italy
| | - Bastianello Germanà
- Gastroenterology and Digestive Endoscopy Unit, Belluno Hospital, Belluno, Italy
| | - Gabrio Bassotti
- Gastroenterology Unit, Department of Medicine, Perugia University, Perugia, Italy
| | - Fabio Monica
- Gastroenterology Unit, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Maurizio Zilli
- Gastroenterology Unit, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Antonio Pisani
- Gastroenterology Section, Department of Emergency and Organ Transplantation, Bari University, Bari, Italy
| | | | - Rita Conigliaro
- Digestive Endoscopy Unit, S.Agostino-Estense Hospital, Modena, Italy
| | - Giuseppe Galloro
- Surgical Digestive Endoscopy, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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Cho YS. New endoscopic techniques in treating gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Young Sin Cho
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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Üstün R, Oğuz EK, Delilbaşı Ç, Şeker A, Taşpınar F, Öncü MR, Oğuz AR. Neuromuscular degenerative effects of Ankaferd Blood Stopper ® in mouse sciatic nerve model. Somatosens Mot Res 2018; 34:248-257. [PMID: 29334308 DOI: 10.1080/08990220.2017.1421160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Ankaferd Blood Stopper® (ABS), a licenced medicinal herbal extract, is commonly used as an effective topical haemostatic agent. This study is designed to investigate whether topical ABS application may cause peripheral nerve degeneration and neuromuscular dysfunction in a mouse sciatic nerve model. METHODS Twenty mice were randomly divided into two groups; an ABS treated experimental group and a saline-treated control group. Left sciatic nerves were treated with 0.3 ml of ABS in the experimental group and 0.3 ml of sterile saline in the control group for 5 min. Peripheral nerve degeneration and neuromuscular dysfunction were evaluated by behavioural tests, electrophysiological analysis and weight ratio comparison of target muscles. RESULTS The motor function, assessed by the sciatic function index, was significantly impaired in ABS-treated animals as compared to the animals treated with saline. Motor coordination, evaluated with the rotarod test, was significantly decreased (-42%) in ABS-treated animals compared to the saline-treated animals. The degree of pain, assessed by the reaction latency to thermal stimuli (hot-plate test), was significantly prolonged (313%) in ABS-treated mice when compared to the saline-treated mice. ABS-treated mice showed a significant reduction in motor nerve conduction velocity (MNCV) (-52%) and the compound muscle action potential (CMAP) (-47%); however, it significantly prolonged onset latency (23%). The gastrocnemius muscles weight ratio of the ABS group was considerably lower than that of the control group. CONCLUSIONS These findings demonstrate that ABS triggers peripheral nerve degeneration and functional impairment and, thus promotes a deterioration of sciatic nerves.
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Affiliation(s)
- Ramazan Üstün
- a Department of Physiology, Faculty of Medicine, Neuroscience Research Unit , Van Yuzuncu Yil University , Van , Turkey
| | - Elif Kaval Oğuz
- b Department of Science Education, Faculty of Education , Van Yuzuncu Yil University , Van , Turkey
| | - Çağrı Delilbaşı
- c Department of Oral and Maxillofacial Surgery, School of Dentistry , Istanbul Medipol University , İstanbul , Turkey
| | - Ayşe Şeker
- a Department of Physiology, Faculty of Medicine, Neuroscience Research Unit , Van Yuzuncu Yil University , Van , Turkey
| | - Filiz Taşpınar
- a Department of Physiology, Faculty of Medicine, Neuroscience Research Unit , Van Yuzuncu Yil University , Van , Turkey
| | - Mehmet Reşit Öncü
- d Department of Emergency Medicine, Faculty of Medicine , Van Yuzuncu Yil University , Van , Turkey
| | - Ahmet Regaip Oğuz
- e Department of Biology, Science Faculty , Van Yuzuncu Yil University , Van , Turkey
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