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Oyón D, Marra-López C, Bolado F, López-López S, Ibáñez-Beroiz B, Canaval-Zuleta HJ, García-Rayado G, Rivera-Irigoin R, Grau-García FJ, Boadas J, Millastre-Bocos J, Martínez-Ares D, de-Madaria E. Determinants and impact of splanchnic vein thrombosis in acute pancreatitis. Dig Liver Dis 2023; 55:1480-1486. [PMID: 37210302 DOI: 10.1016/j.dld.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Splanchnic vein thrombosis (SVT) is a well-recognised though little-studied complication in acute pancreatitis (AP). SVT risk factors, its clinical consequences and the role of anticoagulation (AC) therapy is scarce. AIMS To evaluate the incidence and natural history of SVT in AP. METHODS Post hoc analysis of a prospective multicentre cohort study involving 23 hospitals in Spain. AP complications were identified by computer tomography, and patients with SVT were re-evaluated after two years. RESULTS A total of 1655 patients with AP were included. The overall incidence of SVT was 3.6%. SVT was significantly associated with male gender, younger age and alcoholic aetiology. Every local complication increased SVT incidence, and this risk rose gradually with larger extension and infection of necrosis. These patients had a longer hospital stay and underwent a greater number of invasive treatments, regardless of AP severity. Forty-six patients with SVT were followed up. SVT resolution rate was 54.5% in the AC group and 30.8% in the non-AC group with lower thrombotic complications in the SVT resolution group (83.3% vs 22.7%; p<0.001). No AC-related adverse events occurred. CONCLUSION This study identifies the risk factors and negative clinical impact of SVT in AP. Our results justify future trials to demonstrate the role of AC in this clinical scenario.
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Affiliation(s)
- Daniel Oyón
- Department of Gastroenterology, University Hospital of Galdakao, Biocruces Bizkaia Health Research Institute, Galdakao, Spain.
| | - Carlos Marra-López
- Department of Gastroenterology, Hospital Costa del Sol, Marbella; Hospital Vithas Málaga. Málaga. Spain
| | - Federico Bolado
- Department of Gastroenterology, University Hospital of Navarre, Health Research Institute of Navarra IdiSNA, Pamplona, Spain
| | - Soraya López-López
- Department of Gastroenterology, University Hospital of Navarre, Pamplona, Spain
| | - Berta Ibáñez-Beroiz
- Navarrabiomed-HUN-UPNA, Research Network for Health Services and Chronic Diseases (REDISSEC); Research Network for Chronic Diseases, Primary Care and Health Promotion (RICAPPS), Health Research Institute of Navarra IdiSNA, Pamplona, Spain
| | | | - Guillermo García-Rayado
- Department of Gastroenterology, University Clinic Hospital, Aragón Health Research Institute, Zaragoza, Spain
| | | | | | - Jaume Boadas
- Department of Gastroenterology, Consorci Sanitari Terrassa, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - David Martínez-Ares
- Department of Gastroenterology, Hospital QuironSalud A Coruña, A Coruña, Spain
| | - Enrique de-Madaria
- Department of Gastroenterology, Dr. Balmis General University Hospital, Department of Clinical Medicine, Miguel Hernández University, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Paz C, Suárez E, Cabarcos A, Pinto SIS. Numerical Study of a Thrombus Migration Risk in Aneurysm After Coil Embolization in Patient Cases: FSI Modelling. Cardiovasc Eng Technol 2023; 14:544-559. [PMID: 37468797 PMCID: PMC10465652 DOI: 10.1007/s13239-023-00672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE There are still many challenges for modelling a thrombus migration process in aneurysms. The main novelty of the present research lies in the modelling of aneurysm clot migration process in a realistic cerebral aneurysm, and the analysis of forces suffered by clots inside an aneurysm, through transient FSI simulations. METHODS The blood flow has been modelled using a Womersley velocity profile, and following the Carreau viscosity model. Hyperelastic Ogden model has been used for clot and isotropic linear elastic model for the artery walls. The FSI coupled model was implemented in ANSYS® software. The hemodynamic forces suffered by the clot have been quantified using eight different clot sizes and positions inside a real aneurysm. RESULTS The obtained results have shown that it is almost impossible for clots adjacent to aneurysm walls, to leave the aneurysm. Nevertheless, in clots positioned in the centre of the aneurysm, there is a real risk of clot migration. The risk of migration of a typical post-coiling intervention clot in an aneurysm, in contact with the wall and occupying a significant percentage of its volume is very low in the case studied, even in the presence of abnormally intense events, associated with sneezes or impacts. CONCLUSIONS The proposed methodology allows evaluating the clot migration risk, vital for evaluating the progress after endovascular interventions, it is a step forward in the personalized medicine, patient follow-up, and helping the medical team deciding the optimal treatment.
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Affiliation(s)
- C. Paz
- CINTECX, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - E. Suárez
- CINTECX, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - A. Cabarcos
- CINTECX, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - S. I. S. Pinto
- Engineering Faculty of University of Porto, Institute of Science and Innovation in Mechanical and Industrial Engineering (LAETA-INEGI), Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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Bodera FJ, McVey MJ, Sathiyamoorthy K, Kolios MC. Detection of clot formation & lysis In-Vitro using high frequency photoacoustic imaging & frequency analysis. Photoacoustics 2023; 30:100487. [PMID: 37095887 PMCID: PMC10122060 DOI: 10.1016/j.pacs.2023.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/17/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
Clotting is a physiological process that prevents blood loss after injury. An imbalance in clotting factors can lead to lethal consequences such as exsanguination or inappropriate thrombosis. Clinical methods to monitor clotting and fibrinolysis typically measure the viscoelasticity of whole blood or optical density of plasma over time. Though these methods provide insights into clotting and fibrinolysis, they require milliliters of blood which can worsen anemia or only provide partial information. To overcome these limitations, a high-frequency photoacoustic (HFPA) imaging system was developed to detect clotting and lysis in blood. Clotting was initiated in vitro in reconstituted blood using thrombin and lysed with urokinase plasminogen activator. Frequency spectra measured using HFPA signals (10-40 MHz) between non-clotted blood and clotted blood differed markedly, allowing tracking of clot initiation and lysis in volumes of blood as low as 25 µL/test. HFPA imaging shows potential as a point-of-care examination of coagulation and fibrinolysis.
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Affiliation(s)
- Filip J. Bodera
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, Toronto, Canada
- SickKids Hospital for Sick Children, Toronto, Canada
- Correspondence to: Department of Physics Toronto Metropolitan University, 350 Victoria St, Toronto, ON M5B2K3, Canada.
| | - Mark J. McVey
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
- SickKids Hospital for Sick Children, Toronto, Canada
- Department of Anesthesia, University of Toronto, Toronto, Canada
| | - Krishnan Sathiyamoorthy
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, Toronto, Canada
| | - Michael C. Kolios
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
- Institute for Biomedical Engineering, Science and Technology, Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, Toronto, Canada
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Raffaeli G, Pesenti N, Cavallaro G, Cortesi V, Manzoni F, Amelio GS, Gulden S, Napolitano L, Macchini F, Mosca F, Ghirardello S. Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: a quality improvement study. Eur J Pediatr 2022; 181:2173-2182. [PMID: 35211816 PMCID: PMC9056479 DOI: 10.1007/s00431-022-04427-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 11/27/2022]
Abstract
Fresh frozen plasma (FFP) is largely misused in the neonatal setting. The aim of the study is to evaluate the impact of a Thromboelastography (TEG)-based Quality Improvement (QI) project on perioperative FFP use and neonatal outcomes. Retrospective pre-post implementation study in a level-III NICU including all neonates undergoing major non-cardiac surgery before (01-12/2017) and after (01-12/2019) the intervention. In 2018, the intervention included the following: (1) Training on TEG, (2) Implementation of TEG, and (3) Algorithm for TEG-directed FFP administration in surgical neonates. We compared pre- vs post-intervention patient characteristics, hemostasis, and clinical management. Linear and logistic regression models were used to evaluate the impact of the project on main outcomes. We analyzed 139 neonates (pre-intervention: 72/post-intervention: 67) with a mean (± SD) gestational age (GA) 34.9 (± 5) weeks and birthweight 2265 (± 980) grams which were exposed to 184 surgical procedures (pre-intervention: 91/post-intervention: 93). Baseline characteristics were similar between periods. In 2019, prothrombin time (PT) was longer (14.3 vs 13.2 s; p < 0.05) and fibrinogen was lower (229 vs 265 mg/dl; p < 0.05), if compared to 2017. In 2019, the intraoperative exposure to FFP decreased (31% vs 60%, p < 0.001), while the pre-operative FFP use did not change. The reduction of intraoperative FFP did not impact on mortality and morbidity. Intraoperative FFP use was lower in the post-intervention even after controlling for GA, American Society of Anesthesiologists score, PT, and fibrinogen (Odds ratio: 0.167; 95% CI: 0.070, 0.371). Conclusion: The TEG-based QI project for the management of FFP during neonatal surgery reduced intraoperative FFP exposure. What is Known: • PT and aPTT are poor predictors of bleeding risk in acquired neonatal coagulopathy, leading to likely unnecessary fresh frozen plasma (FFP) transfusion in the Neonatal Intensive Care Setting. • As neonatal hemostasis is a delicate balance between the concomitant reduction of pro- and anti-coagulants drivers, thromboelastography (TEG) is a promising alternative for coagulation monitoring. What is New: • The implementation of TEG, training, and shared protocols contributed to reduced intraoperative FFP use, which was not associated with increased mortality or bleeding events. • These findings inform future research showing that there is clinical equipoise to allow for larger studies to confirm the use of TEG in NICUs and to identify TEG cut-offs for transfusion practice.
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Affiliation(s)
- Genny Raffaeli
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
| | - Nicola Pesenti
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
| | - Valeria Cortesi
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
| | - Francesca Manzoni
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
| | - Giacomo Simeone Amelio
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
| | - Silvia Gulden
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
| | - Luisa Napolitano
- Pediatric Anesthesiology and Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Macchini
- Department of Pediatric Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 28 20122 Milan, Italy
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Anagnostakou V, Epshtein M, Kühn AL, King RM, Puri A, Gounis MJ. Preclinical modeling of mechanical thrombectomy. J Biomech 2022; 130:110894. [PMID: 34915309 DOI: 10.1016/j.jbiomech.2021.110894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022]
Abstract
Mechanical thrombectomy to treat large vessel occlusions (LVO) causing a stroke is one of the most effective treatments in medicine, with a number needed to treat to improve clinical outcomes as low as 2.6. As the name implies, it is a mechanical solution to a blocked artery and modeling these mechanics preclinically for device design, regulatory clearance and high-fidelity physician training made clinical applications possible. In vitro simulation of LVO is extensively used to characterize device performance in representative vascular anatomies with physiologically accurate hemodynamics. Embolus analogues, validated against clots extracted from patients, provide a realistic simulated use experience. In vitro experimentation produces quantitative results such as particle analysis of distal emboli generated during the procedure, as well as pressure and flow throughout the experiment. Animal modeling, used mostly for regulatory review, allows estimation of device safety. Other than one recent development, nearly all animal modeling does not incorporate the desired target organ, the brain, but rather is performed in the extracranial circulation. Computational modeling of the procedure remains at the earliest stages but represents an enormous opportunity to rapidly characterize and iterate new thrombectomy concepts as well as optimize procedure workflow. No preclinical model is a perfect surrogate; however, models available can answer important questions during device development and have to date been successful in delivering efficacious and safe devices producing excellent clinical outcomes. This review reflects on the developments of preclinical modeling of mechanical thrombectomy with particular focus on clinical translation, as well as articulate existing gaps requiring additional research.
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Bhambri A, Adapa AR, Liu Y, Boeckh-Behrens T, Procházka V, Hernández-Fernández F, Barbella-Aponte RA, Hashimoto T, Savastano LE, Gemmete JJ, Chaudhary N, Shih AJ, Pandey AS. Thrombus Histology as It Relates to Mechanical Thrombectomy: A Meta-Analysis and Systematic Review. Neurosurgery 2021; 89:1122-1131. [PMID: 34634805 DOI: 10.1093/neuros/nyab366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/06/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Appropriate thrombus-device interaction is critical for recanalization. Histology can serve as a proxy for mechanical properties, and thus inform technique selection. OBJECTIVE To investigate the value of histologic characterization, we conducted a systematic review and meta-analysis on the relationship between thrombus histology and recanalization, technique, etiology, procedural efficiency, and imaging findings. METHODS In this meta-analysis, we identified studies published between March 2010 and March 2020 reporting findings related to the histologic composition of thrombi in large vessel occlusion stroke. Studies with at least 10 patients who underwent mechanical thrombectomy using stent retriever or aspiration were considered. Only studies in which retrieved thrombi were histologically processed were included. Patient-level data were requested when data could not be directly extracted. The primary outcome assessed was the relationship between thrombus histology and angiographic outcome. RESULTS A total of 22 studies encompassing 1623 patients met inclusion criteria. Clots associated with good angiographic outcome had higher red blood cell (RBC) content (mean difference [MD] 9.60%, 95% CI 3.85-15.34, P = .008). Thrombi retrieved by aspiration had less fibrin (MD -11.39, 95% CI -22.50 to -0.27, P = .046) than stent-retrieved thrombi. Fibrin/platelet-rich clots were associated with longer procedure times (MD 13.20, 95% CI 1.30-25.10, P = .037). Hyperdense artery sign was associated with higher RBC content (MD 14.17%, 95% CI 3.07-25.27, P = .027). No relationship was found between composition and etiology. CONCLUSION RBC-rich thrombi were associated with better recanalization outcomes and shorter procedure times, suggesting that preinterventional compositional characterization may yield important prognostic and therapeutic guidance.
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Affiliation(s)
- Ankur Bhambri
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | | | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Václav Procházka
- Department of Imaging Methods, University of Ostrava, Ostrava, Czech Republic
| | - Francisco Hernández-Fernández
- Interventional Neuroradiology Unit, Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Tetsuya Hashimoto
- Department of Neurology, University of California, Los Angeles, Los Angeles, California, USA
| | - Luis E Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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Ospel JM, van der Lugt A, Gounis M, Goyal M, Majoie CBLM. A clinical perspective on endovascular stroke treatment biomechanics. J Biomech 2021; 127:110694. [PMID: 34419825 DOI: 10.1016/j.jbiomech.2021.110694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/27/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
Acute ischemic stroke (AIS) is caused by blockage of an arterial blood vessel in the brain by a thrombus, which interrupts oxygen supply to the brain parenchyma. The goal of endovascular stroke treatment (mechanical thrombectomy) is to restore blood flow as quickly and completely as possible. There are numerous factors that influence endovascular treatment success. They can be broadly grouped into a) factors related to blood vessels, b) factors related to the thrombus, c) factors related to endovascular treatment technique and tools and d) operator-related factors. While blood vessel and tgthro thrombus-related factors are mostly non-modifiable in the acute setting, operator and technique-related factors can be modified, and extensive research is currently being done to investigate the complex interplay of all these variables, and to optimize the modifiable factors to the maximum possible extent. In this review, we will describe these factors and how they interact with each other in detail, and outline some of their practical implications. We will conclude with a short summary and outlook on future directions for optimizing endovascular treatment success.
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Affiliation(s)
- Johanna M Ospel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Neuroradiology, University Hospital Basel, Basel, Switzerland; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada.
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Matthew Gounis
- Department of Radiology, University of Massachusetts Medical School, Worcester, United States
| | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
| | - Charles B L M Majoie
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Abstract
In small animals, point-of-care ultrasound can be used by nonradiologist sonographers to identify thrombosis at several anatomic sites. Dogs and cats are well-suited for vascular interrogation using ultrasound because of their small body size. Ultrasound can be used to investigate targeted vessels based on clinical signs. The safety and tolerability of the examination makes this a useful modality to evaluate critical patients for evidence thromboembolic disease. Once vascular imaging techniques are learned they can be easily coupled with other point-of-care examinations such as focused cardiac ultrasound, Vet Blue, AFAST, and TFAST.
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Bae JS, Ahn JH, Jang JY, Cho SY, Kang MG, Kim KH, Park HW, Koh JS, Park Y, Hwang SJ, Kwak CH, Hwang JY, Tantry US, Gurbel PA, Jeong YH. The Impact of platelet-fibrin clot strength on occurrence and clinical outcomes of peripheral artery disease in patients with significant coronary artery disease. J Thromb Thrombolysis 2021; 50:969-981. [PMID: 32279217 DOI: 10.1007/s11239-020-02103-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with peripheral artery disease (PAD) have shown the increased risk of cardiovascular (CV) morbidity and mortality. This study sought to evaluate the impact of clot strength on prevalence and major adverse CV events (MACE) of PAD in high-risk patients. We enrolled patients undergoing percutaneous coronary intervention (PCI) (n = 1667) with available platelet-fibrin clot strength [thrombin-induced maximal amplitude (MAthrombin) measured by thromboelastography] and inflammation [high sensitivity C-reactive protein (hs-CRP)]. PAD was defined with abnormal ankle-brachial index (≤ 0.9 or > 1.4). MACE was defined as a composite of CV death, myocardial infarction or stroke. PAD was observed in 201 patients (12.1%). In the multivariate analysis, high clot strength [MAthrombin ≥ 68 mm: odds ratio (OR) 1.70, 95% confidence interval (CI) 1.20 to 2.41, p = 0.003] and enhanced inflammation (hs-CRP ≥ 3.0 mg/L: OR 2.30, 95% CI 1.56 to 3.41, p < 0.001) were associated with PAD occurrence. During the follow-up post-PCI (median, 25 months), MACE was more frequently occurred in patients with vs. without PAD (18.7% vs. 6.4% at 3 years; hazard ratio 1.72, 95% CI 1.03 to 2.87, p = 0.039). Furthermore, combined presence of PAD and high clot strength significantly increased the risk of MACE. In conclusion, this study is the first to show the impact of clot strength on prevalence and clinical outcomes of PAD in coronary artery disease patients undergoing PCI. Whether antithrombotic strategy according to level of this biomarker can improve clinical outcomes in PAD patients deserves the further study.
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Affiliation(s)
- Jae Seok Bae
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea
| | - Jong-Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea
| | - Jeong Yoon Jang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea
| | - Sang Young Cho
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea
| | - Min Gyu Kang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Kye-Hwan Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hyun Woong Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin-Sin Koh
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea
| | - Seok-Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Choong Hwan Kwak
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Young-Hoon Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, 51472, Republic of Korea. .,Institute of the Health Sciences, Gyeongsang National University, Jinju, Republic of Korea.
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Huang WC, Lee P, Ling Wong TG, Tiong Tan JK, Hwang NC. Diagnosis of bone cement implantation syndrome using point of care ultrasound examination. Ann Card Anaesth 2021; 24:372-374. [PMID: 34269272 PMCID: PMC8404584 DOI: 10.4103/aca.aca_202_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Once regarded as a rare complication, the potentially fatal bone cement implantation syndrome (BCIS) has been increasingly reported. BCIS can present as transient desaturation, hypotension, cardiac dysrhythmias, and cardiovascular collapse. Diagnosis of BCIS is often clinical and confirmed with computed tomography (CT) imaging postoperatively. However, point of care ultrasound (POCUS) examination could be a helpful and timely tool to clinch the diagnosis in a sudden cardiovascular collapse. We present a case of Grade 3 BCIS where POCUS examination revealed a massive clot in the right atrium, which supports the diagnosis.
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Affiliation(s)
| | - Pang Lee
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | | | - Jerry Keng Tiong Tan
- Department of Anaesthesiology, Singapore General Hospital; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
| | - Nian Chih Hwang
- Department of Anaesthesiology, Singapore General Hospital; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
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11
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Assaad IE, Pastor T, O'Leary E, Gauvreau K, Rathod RH, Gurvitz M, Wu F, Fynn-Thompson F, DeWitt ES, Mah DY. Atrial pacing in Fontan patients: The effect of transvenous lead on clot burden. Heart Rhythm 2021; 18:1860-1867. [PMID: 34182172 DOI: 10.1016/j.hrthm.2021.06.1191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/09/2021] [Accepted: 06/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transvenous permanent pacemaker (PPM) implantation is an available option for Fontan patients with sinus node dysfunction. However, the thrombogenic potential of leads within the Fontan baffle is unknown. OBJECTIVE The purpose of this study was to compare the clot burden in Fontan patients with a transvenous atrial PPM to those without a PPM and those with an epicardial PPM. METHODS This was a retrospective cohort study of all transvenous PPM implantations in Fontan patients followed at our institution (2000-2018). We performed frequency matching on Fontan type and age group. Primary outcome was identification of intracardiac clot, pulmonary embolus, or embolic stroke. RESULTS Of 1920 Fontan patients, 58 patients (median age 23 years; interquartile range [25th-75th percentiles] 14-33) at the time of transvenous PPM implantation and 174 matched subjects formed our cohort. The type of Fontan performed in case subjects was right atrium-pulmonary artery or right atrium-right ventricle conduit (54%), lateral tunnel (43%), and extracardiac (3%). The cumulative incidence of clot was highest in patients with transvenous PPM, followed by patients with epicardial PPM and no PPM (1.2 vs 0.87 vs 0.67 per 100 person-years of follow-up, respectively). In multivariable analysis, anticoagulation and/or antiplatelet therapy were protective against clot and resulted in reduction of clot risk by 3-fold (incidence rate ratio 0.33; 95% confidence interval 0.21-0.53; P <.001). CONCLUSION In a large cohort of Fontan patients matched for age and Fontan type, patients with transvenous PPM had a higher but not statistically significant incidence of clot compared to those with no PPM and epicardial PPM. Patients treated with warfarin/aspirin had lower clot risk.
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Affiliation(s)
- Iqbal El Assaad
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Tony Pastor
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Edward O'Leary
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Fred Wu
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Francis Fynn-Thompson
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
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12
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Undas A. Altered fibrin clot properties and fibrinolysis in patients with atrial fibrillation: practical implications. Europace 2021; 22:185-194. [PMID: 31625555 DOI: 10.1093/europace/euz271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022] Open
Abstract
Compelling evidence indicates that a hypercoagulable state occurs in patients with atrial fibrillation (AF) including those in sinus rhythm following paroxysmal and persistent AF. Activation of blood coagulation in AF reflects heightened thrombin generation with the subsequent increased formation of fibrin as evidenced by elevated soluble fibrin monomers and D-dimer. Formation of denser fibrin meshworks, relatively resistant to plasmin-mediated lysis has been demonstrated in patients with AF. The presence of stroke risk factors in AF, such as diabetes, heart failure, hypertension, previous myocardial infarction, or stroke, advanced age have been shown to be linked to the prothrombotic clot characteristics, including reduced clot permeability and lysability. Importantly, biomarkers, including cardiac troponins and N-terminal pro-brain natriuretic peptide, are associated with thrombin generation and fibrin-related markers in AF patients. Recently, increased fibrin clot density (low clot permeability measured in plasma-based assays) and impaired fibrinolysis measured off anticoagulation have been demonstrated to predict ischaemic cerebrovascular events in patients with AF receiving vitamin K antagonists and those on rivaroxaban. The current review summarizes evidence for a role of altered fibrin clot properties and hypofibrinolysis in AF and their prognostic value in terms of adverse events.
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Affiliation(s)
- Anetta Undas
- Institute of Cardiology, Jagiellonian University School of Medicine and John Paul II Hospital, 80 Prądnicka Str., 31-202 Cracow, Poland
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13
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Osakada Y, Yamashita T, Morihara R, Matsumoto N, Sasaki R, Tadokoro K, Nomura E, Kawahara Y, Omote Y, Hishikawa N, Takemoto M, Ohta Y, Suruga Y, Nagase T, Takasugi Y, Inoue S, Watanabe K, Deguchi K, Tokunaga K, Sasada S, Kobayashi K, Maeoka R, Fukutome K, Takahashi K, Ohnishi H, Kuga Y, Ohnishi H, Abe K. 4-Hydroxyl-2-Nonenal Localized Expression Pattern in Retrieved Clots is Associated with Large Artery Atherosclerosis in Stroke Patients. J Stroke Cerebrovasc Dis 2021; 30:105583. [PMID: 33412400 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The relationship between stroke etiology and clot pathology remains controversial. MATERIALS AND METHODS We performed histological analysis of clots retrieved from 52 acute ischemic stroke patients using hematoxylin and eosin staining and immunohistochemistry (CD42b and oxidative/hypoxic stress markers). The correlations between clot composition and the stroke etiological group (i.e., cardioembolic, cryptogenic, or large artery atherosclerosis) were assessed. RESULTS Of the 52 clots analyzed, there were no significant differences in histopathologic composition (e.g., white blood cells, red blood cells, fibrin, and platelets) between the 3 etiological groups (P = .92). By contrast, all large artery atherosclerosis clots showed a localized pattern with the oxidative stress marker 4-hydroxyl-2-nonenal (P < .01). From all 52 clots, 4-hydroxyl-2-nonenal expression patterns were localized in 28.8% of clots, diffuse in 57.7% of clots, and no signal in 13.5% of clots. CONCLUSIONS A localized pattern of 4-hydroxyl-2-nonenal staining may be a novel and effective marker for large artery atherosclerosis (sensitivity 100%, specificity 82%).
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Affiliation(s)
- Yosuke Osakada
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan; Department of Neurology, Ohnishi Neurological Center, 1661-1 Eigashima Okubocho, Akashi, Hyogo 674-0064, Japan
| | - Toru Yamashita
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Ryuta Morihara
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Namiko Matsumoto
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Ryo Sasaki
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Koh Tadokoro
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Emi Nomura
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Yuko Kawahara
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Yoshio Omote
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Nozomi Hishikawa
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Mami Takemoto
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Yasuyuki Ohta
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Yasuki Suruga
- Department of Neurosurgery, Okayama City Hospital, 3-20-1 Kitanagase Omotecho, Kita-ku, Okayama 700-8557, Japan.
| | - Takayuki Nagase
- Department of Neurosurgery, Okayama City Hospital, 3-20-1 Kitanagase Omotecho, Kita-ku, Okayama 700-8557, Japan.
| | - Yuji Takasugi
- Department of Neurosurgery, Okayama City Hospital, 3-20-1 Kitanagase Omotecho, Kita-ku, Okayama 700-8557, Japan
| | - Satoshi Inoue
- Department of Neurosurgery, Okayama City Hospital, 3-20-1 Kitanagase Omotecho, Kita-ku, Okayama 700-8557, Japan
| | - Kyoichi Watanabe
- Department of Neurosurgery, Okayama City Hospital, 3-20-1 Kitanagase Omotecho, Kita-ku, Okayama 700-8557, Japan.
| | - Kentaro Deguchi
- Department of Neurology, Okayama City Hospital, 3-20-1 Kitanagase Omotecho, Kita-ku, Okayama 700-8557, Japan.
| | - Koji Tokunaga
- Department of Neurosurgery, Okayama City Hospital, 3-20-1 Kitanagase Omotecho, Kita-ku, Okayama 700-8557, Japan.
| | - Susumu Sasada
- Department of Neurosurgery, Tsuyama Chuo Hospital, 1756 Kawasaki Tsuyama, Okayama 708-0841, Japan
| | - Kazuki Kobayashi
- Department of Neurosurgery, Tsuyama Chuo Hospital, 1756 Kawasaki Tsuyama, Okayama 708-0841, Japan
| | - Ryosuke Maeoka
- Department of Neurosurgery, Ohnishi Neurological Center, 1661-1 Eigashima Okubocho, Akashi, Hyogo 674-0064, Japan.
| | - Kenji Fukutome
- Department of Neurosurgery, Ohnishi Neurological Center, 1661-1 Eigashima Okubocho, Akashi, Hyogo 674-0064, Japan.
| | - Kenkichi Takahashi
- Department of Neurosurgery, Ohnishi Neurological Center, 1661-1 Eigashima Okubocho, Akashi, Hyogo 674-0064, Japan.
| | - Hiroyuki Ohnishi
- Department of Neurosurgery, Ohnishi Neurological Center, 1661-1 Eigashima Okubocho, Akashi, Hyogo 674-0064, Japan.
| | - Yoshihiro Kuga
- Department of Neurosurgery, Ohnishi Neurological Center, 1661-1 Eigashima Okubocho, Akashi, Hyogo 674-0064, Japan.
| | - Hideyuki Ohnishi
- Department of Neurosurgery, Ohnishi Neurological Center, 1661-1 Eigashima Okubocho, Akashi, Hyogo 674-0064, Japan.
| | - Koji Abe
- Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
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14
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Kim J, DeRuiter RM, Goel L, Xu Z, Jiang X, Dayton PA. A Comparison of Sonothrombolysis in Aged Clots between Low-Boiling-Point Phase-Change Nanodroplets and Microbubbles of the Same Composition. Ultrasound Med Biol 2020; 46:3059-3068. [PMID: 32800631 PMCID: PMC8146824 DOI: 10.1016/j.ultrasmedbio.2020.07.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/08/2020] [Accepted: 07/02/2020] [Indexed: 05/06/2023]
Abstract
We present enhanced cavitation erosion of blood clots exposed to low-boiling-point (-2°C) perfluorocarbon phase-change nanodroplets and pulsed ultrasound, as well as microbubbles with the same formulation under the same conditions. Given prior success with microbubbles as a sonothrombolysis agent, we considered that perfluorocarbon phase-change nanodroplets could enhance clot disruption further beyond that achieved with microbubbles. It has been hypothesized that owing to their small size and ability to penetrate into a clot, nanodroplets could enhance cavitation inside a blood clot and increase sonothrombolysis efficacy. The thrombolytic effects of lipid-shell-decafluorobutane nanodroplets were evaluated and compared with those of microbubbles with the same formulation, in an aged bovine blood clot flow model. Seven different pulsing schemes, with an acoustic intensity (ISPTA) range of 0.021-34.8 W/cm2 were applied in three different therapy scenarios: ultrasound only, ultrasound with microbubbles and ultrasound with nanodroplets (n = 5). Data indicated that pulsing schemes with 0.35 W/cm2 and 5.22 W/cm2 produced a significant difference (p < 0.05) in nanodroplet sonothrombolysis performance compared with compositionally identical microbubbles. With these excitation conditions, nanodroplet-mediated treatment achieved a 140% average thrombolysis rate over the microbubble-mediated case. We observed distinctive internal erosion in the middle of bovine clot samples from nanodroplet-mediated ultrasound, whereas the microbubble-mediated case generated surface erosion. This erosion pattern was supported by ultrasound imaging during sonothrombolysis, which revealed that nanodroplets generated cavitation clouds throughout a clot, whereas microbubble cavitation formed larger cavitation clouds only outside a clot sample.
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Affiliation(s)
- Jinwook Kim
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Ryan M DeRuiter
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Leela Goel
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA; Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Xiaoning Jiang
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA; Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, North Carolina, USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA.
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15
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Nouh A, Mehta T, Hussain M, Song X, Ollenschleger M. Clot composition of embolic strokes of undetermined source: a feasibility study. BMC Neurol 2020; 20:383. [PMID: 33087070 PMCID: PMC7580014 DOI: 10.1186/s12883-020-01969-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/19/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A number of emerging studies have evaluated clot composition in acute ischemic stroke. Studies of clot composition of embolic strokes of undetermined strokes are lacking. OBJECTIVES We sought to analyze the RBC to platelet ratios in clots and correlated our findings with stroke etiology. METHODS This was a prospective study analyzing clots retrieved by mechanical thrombectomy in acute ischemic stroke patients at our institution. All clots were stained and scanned at 200x magnification by using a Scanscope XT digital scanner (Apergio, Vista, California). Image-J software (National Institutes of Health, Bethesda, Maryland) was used for semi quantitative analysis of percentage RBC's and platelets. Unpaired t-test was used to compare means of RBC to Platelet ratios. Correlation of RBC to Platelet ratios with stroke etiology was performed. RESULTS A total of 33 clots from 33 patients were analyzed. Stroke etiology was undetermined in 6 patients, cardioembolic in 14, large vessel atherosclerosis (LVA) in 9, and carotid dissection in 4. The mean RBC to platelet ratio was 0.78:1 (+/- 0.65) in cardioembolic clots, 1.73:1 (+/- 2.38) in LVA and 1.4:1(+/- 0.70) in carotid dissections. Although patients with undetermined etiology had a similar clot composition to cardioembolic stroke (0.36:1+/- 0.33), (p = 0.19), it differed significantly from LVA and dissections respectively (p = 0.037, p = 0.01). CONCLUSION In our study, a low RBC to Platelet ratio was found among patients with embolic strokes of undetermined source, however shared similar characteristics with cardioembolic thrombi. Ongoing collection and analysis is needed to confirm these findings and its significance in evaluating stroke etiology.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, Hartford Hospital, University of Connecticut, 80 Seymour Street, Hartford, CT, 06115, USA.
| | - Tapan Mehta
- Department of Neurology, Hartford Hospital, University of Connecticut, 80 Seymour Street, Hartford, CT, 06115, USA.,Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Mohamed Hussain
- Department of Neurology, Hartford Hospital, University of Connecticut, 80 Seymour Street, Hartford, CT, 06115, USA.,Department of Neuroradiology, Hartford Hospital, University of Connecticut, Hartford, CT, USA
| | - Xianyuan Song
- Department of Pathology, Hartford Hospital, University of Connecticut, Hartford, CT, USA
| | - Martin Ollenschleger
- Department of Neuroradiology, Hartford Hospital, University of Connecticut, Hartford, CT, USA
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16
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Berndt M, Poppert H, Steiger K, Pelisek J, Oberdieck P, Maegerlein C, Zimmer C, Wunderlich S, Friedrich B, Boeckh-Behrens T, Ikenberg B. Thrombus Histology of Basilar Artery Occlusions : Are There Differences to the Anterior Circulation? Clin Neuroradiol 2020; 31:753-761. [PMID: 33006654 PMCID: PMC8463366 DOI: 10.1007/s00062-020-00964-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND For patients with acute vessel occlusions of the anterior circulation histopathology of retrieved cerebral thrombi has been reported to be associated to stroke etiology. Due to the relatively small incidence of posterior circulation stroke, exclusive histopathologic analyses are missing for this subgroup. The aim of the study was to investigate thrombus histology for patients with basilar artery occlusions and uncover differences to anterior circulation clots with respect to underlying etiology. METHODS A total of 59 basilar thrombi were collected during intracranial mechanical recanalization and quantitatively analyzed in terms of their relative fractions of the main constituents, e.g. fibrin/platelets (F/P), red (RBC) and white blood cells (WBC). Data were compared to histopathological analyses of 122 thrombi of the anterior circulation with respect to underlying pathogenesis. RESULTS The composition of basilar thrombi differed significantly to thrombi of the anterior circulation with an overall higher RBC amount (median fraction in % (interquartile range):0.48 (0.37-0.69) vs. 0.37 (0.28-0.50), p < 0.001) and lower F/P count (0.45 (0.21-0.58) vs. 0.57 (0.44-0.66), p < 0.001). Basilar thrombi composition did not differ between the different etiological stroke subgroups. CONCLUSION The results depict a differing thrombus composition of basilar thrombi in comparison to anterior circulation clots with an overall higher amount of RBC. This may reflect different pathophysiologic processes between anterior and posterior circulation thrombogenesis, e.g. a larger proportion of appositional thrombus growth in the posterior circulation.
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Affiliation(s)
- M Berndt
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany.
| | - H Poppert
- Helios Klinikum München West, Munich, Germany
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - K Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, Munich, Germany
| | - J Pelisek
- Department of Vascular and Endovascular Surgery, Klinikum rechts der School of Medicine, Technical University of Munich, Munich, Germany
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - C Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - S Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - B Friedrich
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - T Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - B Ikenberg
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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17
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Santos Duarte Lana JF, Furtado da Fonseca L, Mosaner T, Tieppo CE, Marques Azzini GO, Ribeiro LL, Setti T, Purita J. Bone marrow aspirate clot: A feasible orthobiologic. J Clin Orthop Trauma 2020; 11:S789-94. [PMID: 32999557 DOI: 10.1016/j.jcot.2020.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 12/29/2022] Open
Abstract
Musculoskeletal disorders are one of the major health burdens and a leading source of disability worldwide, affecting both juvenile and elderly populations either as a consequence of ageing or extrinsic factors such as physical injuries. This condition often involves a group of locomotor structures such as the bones, joints and muscles and may therefore cause significant economic and emotional impact. Some pharmacological and non-pharmacological treatments have been considered as potential solutions, however, these alternatives have provided quite limited efficacy due to the short-term effect on pain management and inability to restore damaged tissue. The emergence of novel therapeutic alternatives such as the application of orthobiologics, particularly bone marrow aspirate (BMA) clot, have bestowed medical experts with considerable optimism as evidenced by the significant results found in numerous studies addressed in this manuscript. Although other products have been proposed for the treatment of musculoskeletal injuries, the peculiar interest in BMA, fibrin clot and associated fibrinolytic mechanisms continues to expand. BMA is a rich source of various cellular and molecular components which have demonstrated positive effects on tissue regeneration in many in vitro and in vivo models of musculoskeletal injuries. In addition to being able to undergo self-renewal and differentiation, the hematopoietic and mesenchymal stem cells present in this orthobiologic elicit key immunomodulatory and paracrine roles in inflammatory responses in tissue injury and drive the coagulation cascade towards tissue repair via different mechanisms. Although promising, these complex regenerative mechanisms have not yet been fully elucidated.
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18
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Khokhlova TD, Kucewicz JC, Ponomarchuk EM, Hunter C, Bruce M, Khokhlova VA, Matula TJ, Monsky W. Effect of Stiffness of Large Extravascular Hematomas on Their Susceptibility to Boiling Histotripsy Liquefaction in Vitro. Ultrasound Med Biol 2020; 46:2007-2016. [PMID: 32444137 PMCID: PMC7360281 DOI: 10.1016/j.ultrasmedbio.2020.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 05/04/2023]
Abstract
Large intra-abdominal, retroperitoneal and intramuscular hematomas are common consequences of sharp and blunt trauma and post-surgical bleeds, and often threaten organ failure, compartment syndrome or spontaneous infection. Current therapy options include surgical evacuation and placement of indwelling drains that are not effective because of the viscosity of the organized hematoma. We have previously reported the feasibility of using boiling histotripsy (BH)-a pulsed high-intensity focused ultrasound method-for liquefaction of large volumes of freshly coagulated blood and subsequent fine-needle aspiration. The goal of this work was to evaluate the changes in stiffness of large coagulated blood volumes with aging and retraction in vitro, and to correlate these changes with the size of the BH void and, therefore, the susceptibility of the material to BH liquefaction. Large-volume (55-200 mL) whole-blood clots were fabricated in plastic molds from human and bovine blood, either by natural clotting or by recalcification of anticoagulated blood, with or without addition of thrombin. Retraction of the clots was achieved by incubation for 3 h, 3 d or 8 d. The shear modulus of the samples was measured with a custom-built indentometer and shear wave elasticity (SWE) imaging. Sizes of single liquefied lesions produced with a 1.5-MHz high-intensity focused ultrasound transducer within a 30-s standard BH exposure served as the metric for susceptibility of clot material to this treatment. Neither the shear moduli of naturally clotted human samples (0.52 ± 0.08 kPa), nor their degree of retraction (ratio of expelled fluid to original volume 50%-58%) depended on the length of incubation within 0-8 d, and were significantly lower than those of bovine samples (2.85 ± 0.17 kPa, retraction 5%-38%). In clots made from anticoagulated bovine blood, the variation of calcium chloride concentration within 5-40 mmol/L did not change the stiffness, whereas lower concentrations and the addition of thrombin resulted in significantly softer clots, similar to naturally clotted human samples. Within the achievable shear modulus range (0.4-1.6 kPa), the width of the BH-liquefied lesion was more affected by the changes in stiffness than the length of the lesion. In all cases, however, the lesions were larger compared with any soft tissue liquefied with the same BH parameters, indicating higher susceptibility of hematomas to BH damage. These results suggest that clotted bovine blood with added thrombin is an acceptable in vitro model of both acute and chronic human hematomas for assessing the efficiency of BH liquefaction strategies.
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Affiliation(s)
| | - John C Kucewicz
- Center for Industrial and Medical Ultrasound, Applied Physics Lab, University of Washington, Seattle, Washington, USA
| | | | - Christopher Hunter
- Center for Industrial and Medical Ultrasound, Applied Physics Lab, University of Washington, Seattle, Washington, USA
| | - Matthew Bruce
- Center for Industrial and Medical Ultrasound, Applied Physics Lab, University of Washington, Seattle, Washington, USA
| | - Vera A Khokhlova
- Center for Industrial and Medical Ultrasound, Applied Physics Lab, University of Washington, Seattle, Washington, USA; Physics Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Thomas J Matula
- Center for Industrial and Medical Ultrasound, Applied Physics Lab, University of Washington, Seattle, Washington, USA
| | - Wayne Monsky
- Department of Radiology, University of Washington, Seattle, Washington, USA
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19
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Ohshima T, Niwa A, Kawaguchi R, Matsuo N, Miyachi S. Novel Technique for Detection of Actual Position of Clot During Endovascular Clot Retrieval: Assessment of Microcatheter Withdrawing Angiography. World Neurosurg 2020; 137:229-234. [PMID: 32035210 DOI: 10.1016/j.wneu.2020.01.233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND When endovascular clot retrievals are performed using a stent retriever and/or an aspiration catheter, identifying the accurate position of a clot is extremely important for a successful immediate recanalization. Herein, we report a new technique called microcatheter withdrawing angiography, which facilitates the identification of the precise position of a clot. The negative shadow appearance of the clot on angiography was referred to as the actual crab claw sign. METHODS When a 0.027-inch microcatheter penetrated the clot after inserting a 0.014-inch microwire, selective angiography was conducted using the microcatheter. Simultaneously, the microcatheter was slowly withdrawn with continuous contrast media injection, while the microwire was kept in the distal vessel. The precise position of the clot was found, which was referred to as the actual crab claw sign. Next, we conducted in vitro and in vivo analyses. RESULTS The actual crab claw sign could be identified in the vascular model and in actual clinical settings. Therefore the sweet spot of the stent retriever could be set over the clot, and an accurate contact aspiration could be performed using an aspirator. CONCLUSIONS Microcatheter withdrawing angiography can help identify the actual crab claw sign. This technique has a higher success rate and faster recanalization than conventional strategy, particularly in challenging cases of unsuccessful recanalization during the first attempt.
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Affiliation(s)
- Tomotaka Ohshima
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Aichi Niwa
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Reo Kawaguchi
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Naoki Matsuo
- Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shigeru Miyachi
- Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan; Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan
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20
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Tafakhori A, Parvizi M, Farzanefar S, Ahmadzadehfar H, Khalaj A, Naseri M, Abbasi M. Clinical use of 99mTc-HMPAO-labeled platelets in cerebral sinus thrombosis imaging. Acta Neurol Belg 2019; 119:549-553. [PMID: 30868466 DOI: 10.1007/s13760-019-01107-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) and computed tomography (CT) are not always conclusive for the detection of cerebral venous sinus thrombosis (CVST). 99mTc-HMPAO-labeled platelets may be useful in cases with high clinical suspicion. Three patients with headaches with or without intraparenchymal hemorrhage that were highly suspected to have CVST, despite inconclusive anatomical imaging, were selected for inclusion in the study. Platelets were extracted by two rounds of centrifugation from 49 ml of the patient's whole blood. The platelets were labeled with 99mTc-HMPAO and any unbound 99mTc was removed by centrifugation. The re-suspension of 99mTc-HMPAO-labeled platelets in cell-free plasma was reinjected into the patients. After 2 h, planar and single photon emission computed tomography (SPECT) images of the head were obtained. Extensive clots were detected in all three patients, illustrated in the planar image and even clearer in the SPECT images. We propose that 99mTc-HMPAO-labeled platelet scan is a favorable imaging method for patients suspected to have CVST with inconclusive CT and MRI results.
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21
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Janot K, Zhu F, Kerleroux B, Boulouis G, Shotar E, Premat K, Eugene F, Dargazanli C, Chalumeau V, L'Allinec V, Benhassen W, Marnat G, Lebras A, Detraz L, Ognard J, Personnic T, Chivot C, Cappucci M, Forestier G, Soize S, Bourdain F, Consoli A, Labreuche J, Desal H, Lapergue B, Rouchaud A, Bourcier R. "Adaptative endovascular strategy to the CloT MRI in large intracranial vessel occlusion" (VECTOR): Study protocol of a randomized control trial. J Neuroradiol 2019; 47:382-385. [PMID: 31726072 DOI: 10.1016/j.neurad.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/18/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
A correlation between the susceptibility vessel sign (SVS) and red thrombi has been identified in MRI. We hypothesized that the Embotrap allow better retrieving of SVS+ thrombi. The AdaptatiVe Endovascular strategy to the CloT MRI in large intracranial vessel Occlusion (VECTOR) trial is a multicenter, prospective and randomized study designed to compare a first-line strategy combining Embotrap added to contact aspiration (CA) versus CA alone in patients with SVS+ occlusions.
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Affiliation(s)
- Kevin Janot
- Department of Neuroradiology, University Hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France.
| | | | - Basile Kerleroux
- Department of Neuroradiology, University Hospital of Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | | | | | | | | | | | | | | | | | | | | | - Lili Detraz
- University Hospital of Nantes, Nantes, France
| | | | | | | | | | | | | | | | | | - Julien Labreuche
- Department of Biostatistics, University Hospital of Lille, Lille, France
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22
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Bretzner M, Lopes R, McCarthy R, Corseaux D, Auger F, Gunning G, Beauval N, Bongiovanni A, Tardivel M, Cordonnier C, Pruvo JP, Susen S, Leclerc X, Kuchcinski G. Texture parameters of R2* maps are correlated with iron concentration and red blood cells count in clot analogs: A 7-T micro-MRI study. J Neuroradiol 2019; 47:306-311. [PMID: 31726073 DOI: 10.1016/j.neurad.2019.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that mechanical revascularization in acute ischemic stroke (AIS) patients could be affected by clot histology. In this 7-T micro-MRI study, we used R2* relaxometry of clot analogs to evaluate the relationship between texture parameters of R2* maps and clot constituents. MATERIALS AND METHODS Twelve AIS clot analogs were experimentally generated to obtain a wide range of red blood cell concentrations. All clots underwent a MR acquisition using a 7-T micro-MR system. A 3D multi-echo gradient-echo sequence was performed and R2* maps were generated. First order and second order statistics of R2* histograms within the clots were calculated. Iron concentration in clots was measured using absorption spectrometry and red blood cell count (RBC) was obtained by histopathological analysis. RESULTS RBC count was strongly correlated with iron concentration within clots (r=0.87, P<.001). Higher RBC count and iron concentration were significantly correlated with first order parameters including: (a) global positive shift of the R2* histogram with higher '10th percentile', 'median', 'mean' and '90th percentile'; (b) increase of the global magnitude of voxel values with higher 'total energy' and 'root mean squared'; (c) greater uniformity of the voxel values with higher 'uniformity' and lower 'entropy'. Second order statistical parameters confirmed that higher RBC count and iron concentration correlated with (a) greater concentration of high gray-level values in the image; (b) more "coarse" texture of R2* maps. CONCLUSIONS Texture analysis of MRI-R2* maps can accurately estimate the red blood cell count and iron content of AIS clot analogs.
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Affiliation(s)
- Martin Bretzner
- Inserm U1171 Degenerative & Vascular Cognitive Disorders, University of Lille, 59000 Lille, France; CHU de Lille, Department of Neuroradiology, 59000 Lille, France.
| | - Renaud Lopes
- Inserm U1171 Degenerative & Vascular Cognitive Disorders, University of Lille, 59000 Lille, France; CHU de Lille, Department of Neuroradiology, 59000 Lille, France
| | - Ray McCarthy
- Cerenovus, Neuravi Thromboembolic Initiative, Galway, Ireland
| | - Delphine Corseaux
- Inserm U1011-EGID, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, 59000, Lille, France
| | - Florent Auger
- Inserm U1171 Degenerative & Vascular Cognitive Disorders, University of Lille, 59000 Lille, France
| | - Gillian Gunning
- Cerenovus, Neuravi Thromboembolic Initiative, Galway, Ireland
| | - Nicolas Beauval
- CHU Lille, Unité Fonctionnelle de Toxicologie, 59000 Lille, France
| | - Antonino Bongiovanni
- Bio imaging center Lille Nord-de-France Campus HU, faculté de médecine, Université de Lille, 59000 Lille, France
| | - Meryem Tardivel
- Bio imaging center Lille Nord-de-France Campus HU, faculté de médecine, Université de Lille, 59000 Lille, France
| | | | - Jean-Pierre Pruvo
- Inserm U1171 Degenerative & Vascular Cognitive Disorders, University of Lille, 59000 Lille, France; CHU de Lille, Department of Neuroradiology, 59000 Lille, France
| | - Sophie Susen
- Inserm U1011-EGID, Lille, France; Institut Pasteur de Lille, Lille, France; CHU Lille, Hematology and Transfusion, 59000, Lille, France
| | - Xavier Leclerc
- Inserm U1171 Degenerative & Vascular Cognitive Disorders, University of Lille, 59000 Lille, France; CHU de Lille, Department of Neuroradiology, 59000 Lille, France
| | - Grégory Kuchcinski
- Inserm U1171 Degenerative & Vascular Cognitive Disorders, University of Lille, 59000 Lille, France; CHU de Lille, Department of Neuroradiology, 59000 Lille, France
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23
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Nedaeinia R, Faraji H, Javanmard SH, Ferns GA, Ghayour-Mobarhan M, Goli M, Mashkani B, Nedaeinia M, Haghighi MHH, Ranjbar M. Bacterial staphylokinase as a promising third-generation drug in the treatment for vascular occlusion. Mol Biol Rep 2019; 47:819-841. [PMID: 31677034 DOI: 10.1007/s11033-019-05167-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022]
Abstract
Vascular occlusion is one of the major causes of mortality and morbidity. Blood vessel blockage can lead to thrombotic complications such as myocardial infarction, stroke, deep venous thrombosis, peripheral occlusive disease, and pulmonary embolism. Thrombolytic therapy currently aims to rectify this through the administration of recombinant tissue plasminogen activator. Research is underway to design an ideal thrombolytic drug with the lowest risk. Despite the potent clot lysis achievable using approved thrombolytic drugs such as alteplase, reteplase, streptokinase, tenecteplase, and some other fibrinolytic agents, there are some drawbacks, such as high production cost, systemic bleeding, intracranial hemorrhage, vessel re-occlusion by platelet-rich and retracted secondary clots, and non-fibrin specificity. In comparison, bacterial staphylokinase, is a new, small-size plasminogen activator, unlike bacterial streptokinase, it hinders the systemic degradation of fibrinogen and reduces the risk of severe hemorrhage. A fibrin-bound plasmin-staphylokinase complex shows high resistance to a2-antiplasmin-related inhibition. Staphylokinase has the potential to be considered as a promising thrombolytic agent with properties of cost-effective production and the least side effects.
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Affiliation(s)
- Reza Nedaeinia
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Habibollah Faraji
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. .,Department of Laboratory Sciences, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Shaghayegh Haghjooye Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Gordon A Ferns
- Brighton and Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, BN1 9PH, UK
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Goli
- Department of Food Science and Technology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Baratali Mashkani
- Department of Medical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mozhdeh Nedaeinia
- Young Researchers and Elite Club, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran
| | - Mohammad Hossein Hayavi Haghighi
- Department of Health Information Management, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Maryam Ranjbar
- Advanced Materials Research Center, Department of Materials Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran.,Deputy of Food and Drug, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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Ząbczyk M, Stachowicz A, Natorska J, Olszanecki R, Wiśniewski JR, Undas A. Plasma fibrin clot proteomics in healthy subjects: Relation to clot permeability and lysis time. J Proteomics 2019; 208:103487. [PMID: 31425886 DOI: 10.1016/j.jprot.2019.103487] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/02/2019] [Accepted: 08/10/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about fibrin clot composition in relation to its structure and lysability. We investigated plasma clots protein composition and its associations with clot properties. METHODS We studied 20 healthy subjects aged 31-49 years in whom plasma fibrin clot permeability (Ks) and clot lysis time (CLT) were determined. A proteomic analysis of plasma fibrin clots was based on quantitative liquid chromatography-mass spectrometry. RESULTS Among 494 clot-bound proteins identified in all clots, the highest concentrations were for fibrinogen chains (about 64% of the clot mass) and fibronectin (13%). α2-antiplasmin (2.7%), factor XIIIA (1.2%), complement component C3 (1.2%), and histidine-rich glycoprotein (HRG, 0.61%) were present at relatively high concentrations. Proteins present in concentrations <0.5% included (pro)thrombin, plasminogen, apolipoproteins, or platelet factor 4 (PF4). Fibrinogen-α and -γ chains were associated with age, while body-mass index with clot-bound apolipoproteins (all p < .05). Ks correlated with fibrinogen-γ and PF4 amounts within plasma clots. CLT was associated with fibrinogen-α and -γ, PF4, and HRG (all p < .05). CONCLUSIONS This study is the first to show associations of two key measures of clot properties with protein content within plasma clots, suggesting that looser fibrin clots with enhanced lysability contain less fibrinogen-γ chain, platelet-derived PF4, and HRG. SIGNIFICANCE Our study for the first time suggests that more permeable fibrin clots with enhanced lysability contain less fibrinogen-γ chain, platelet-derived factor 4, and histidine-rich glycoprotein, which is related to accelerated clot lysis. The current findings might have functional consequences regarding clot structure, stability, and propagation of thrombin generation, and detailed proteomic analysis of clots in various disorders opens new perspective for coagulation and fibrin research.
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Affiliation(s)
- Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Krakow Center for Medical Research and Technology, John Paul II Hospital, Krakow, Poland
| | - Aneta Stachowicz
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland; Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Krakow Center for Medical Research and Technology, John Paul II Hospital, Krakow, Poland
| | - Rafał Olszanecki
- Chair of Pharmacology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek R Wiśniewski
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Martinsried, Germany
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Krakow Center for Medical Research and Technology, John Paul II Hospital, Krakow, Poland.
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25
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de Saint Victor M, Barnsley LC, Carugo D, Owen J, Coussios CC, Stride E. Sonothrombolysis with Magnetically Targeted Microbubbles. Ultrasound Med Biol 2019; 45:1151-1163. [PMID: 30773375 DOI: 10.1016/j.ultrasmedbio.2018.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/18/2018] [Accepted: 12/22/2018] [Indexed: 05/13/2023]
Abstract
Microbubble-enhanced sonothrombolysis is a promising approach to increasing the tolerability and efficacy of current pharmacological treatments for ischemic stroke. Maintaining therapeutic concentrations of microbubbles and drugs at the clot site, however, poses a challenge. The objective of this study was to investigate the effect of magnetic microbubble targeting upon clot lysis rates in vitro. Retracted whole porcine blood clots were placed in a flow phantom of a partially occluded middle cerebral artery. The clots were treated with a combination of tissue plasminogen activator (0.75 µg/mL), magnetic microbubbles (∼107 microbubbles/mL) and ultrasound (0.5 MHz, 630-kPa peak rarefactional pressure, 0.2-Hz pulse repetition frequency, 2% duty cycle). Magnetic targeting was achieved using a single permanent magnet (0.08-0.38 T and 12-140 T/m in the region of the clot). The change in clot diameter was measured optically over the course of the experiment. Magnetic targeting produced a threefold average increase in lysis rates, and linear correlation was observed between lysis rate and total energy of acoustic emissions.
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Affiliation(s)
- Marie de Saint Victor
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Lester C Barnsley
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Dario Carugo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Joshua Owen
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Constantin C Coussios
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Eleanor Stride
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.
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26
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Abstract
Although rare, deep vein thrombosis (DVT) and pulmonary embolism remain a concern for foot and ankle surgeons. Most prophylactic measures against DVT formation are synthesized from orthopedic hip and knee data, and therefore the routine use of these recommendations may place patients at risk for complications associated with unnecessary prophylaxis. In this article we review and present the most current literature specific to venous thromboembolism (VTE) in foot and ankle surgery. It is clear that, given our current literature, a case-by-case approach for VTE prophylaxis should be used following foot and ankle surgery.
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Affiliation(s)
- Preston Carr
- Kent State University College of Podiatric Medicine, 6000 Rockside Woods Boulevard, Independence, OH 44131, USA
| | - Duane J Ehredt
- Division of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, 6000 Rockside Woods Boulevard, Independence, OH 44131, USA; Podiatric Medicine and Surgery Residency Program, Saint Vincent Charity Medical Center, 2351 East 22nd Street, Cleveland, OH 44115, USA.
| | - Alex Dawoodian
- Podiatric Medicine and Surgery Residency Program, Saint Vincent Charity Medical Center, 2351 East 22nd Street, Cleveland, OH 44115, USA
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27
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Goren Sahin D, Bayraktutar BN, Yıldız Taş A, Akay OM, Ozkaya A, Yalcin Ö, Sahin A. Can Rotational Thromboelastometry be a New Predictive Tool for Retinal Vein Occlusion Development? Curr Eye Res 2018; 44:406-412. [PMID: 30512971 DOI: 10.1080/02713683.2018.1554152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate clotting dynamics by a new tool called rotational tromboelastometry (ROTEM) in retinal vein occlusion. MATERIALS AND METHODS Thirty-six patients who were diagnosed with retinal vein occlusion and 43 age and sex matched healthy controls were included in this study. Diabetes and use of anticoagulant therapy were exclusion criteria. All study participants underwent detailed ophthalmologic and systemic medical examination, including blood pressure measurement, hemoglobin-hematocrit levels, platelet count, coagulation parameters including prothrombin time, activated partial thromboplastin time, fibrinogen levels, and D-dimer levels. Peripheral blood samples were collected and analyzed with ROTEM Coagulation Analyzer (Tem International, Munich, Germany). RESULTS The RVO patients and controls did not differ with respect to age, sex, hemoglobin, hematocrit, platelet numbers, prothrombin time, activated partial thromboplastin time, fibrinogen levels, D-dimer levels, and glucose levels. When extrinsic thromboelastometry results were analyzed, RVO patients showed a significantly decreased clotting time (76.5 ± 15.0 vs. 95.0 ± 21 s, respectively; p = 0.01) and clot formation time (83.3 ± 22 vs. 99.7 ± 24s; p = 0.01) as compared with healthy controls. Other ROTEM parameters did now show any difference between two groups. CONCLUSION Patients with retinal vein occlusion showed faster clotting time and shorter clotting formation time as compared with healthy controls. ROTEM detects the altered clotting dynamics and may be a useful tool to elucidate the disease pathophysiology. Further studies are needed to investigate if it can be used as a screening test for individuals who are under risk to develop RVO or as a first step test to evaluate hypercoagulable state in RVO.
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Affiliation(s)
- Deniz Goren Sahin
- a Department of Hematology , Istanbul Bilim University Medical School , Istanbul , Turkey
| | - Betül N Bayraktutar
- b Department of Ophthalmology , Koç University Medical School , Istanbul , Turkey
| | - Ayşe Yıldız Taş
- b Department of Ophthalmology , Koç University Medical School , Istanbul , Turkey
| | - Olga Meltem Akay
- c Department of Hematology , Koç University Hospital , Istanbul , Turkey
| | - Abdullah Ozkaya
- d Department of Ophthalmology , Istanbul Beyoglu Eye Education and Research Hospital , Istanbul , Turkey
| | - Özlem Yalcin
- e Department of Physiology , Koç University Medical School , Istanbul , Turkey
| | - Afsun Sahin
- b Department of Ophthalmology , Koç University Medical School , Istanbul , Turkey
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28
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Abstract
Rheumatic mitral stenosis is often associated with thrombus formation in the left atrium (LA), especially in patients with atrial fibrillation. Although thrombus can occur anywhere within the LA, the most common site is the left atrial appendage. Therefore, it is important to carefully screen the entire LA during perioperative transesophageal echocardiography to exclude thrombus.
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Affiliation(s)
- Amruta Shringarpure
- Division of Cardiovascular and Thoracic Anesthesiology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Pushkar M Desai
- Division of Cardiovascular and Thoracic Anesthesiology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Sanjeeta Umbarkar
- Division of Cardiovascular and Thoracic Anesthesiology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
| | - Manjula Sarkar
- Division of Cardiovascular and Thoracic Anesthesiology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India
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29
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Abstract
Despite the absence of an intervention shown to improve outcomes in intracerebral hemorrhage, preclinical work has led to a greater understanding of the pathologic pathways of brain injury. Methods targeting hematoma clearance through both macroscopic (surgical) and microscopic (endogenous phagocytosis) means are currently under investigation, with multiple clinical trials ongoing. Macroscopic methods for removal involve both catheter- and endoscope-based therapies to remove the hematoma through minimally invasive surgery. Microscopic methods targeting hematoma clearance involve augmenting endogenous clearance pathways for red blood cells and altering the balance between phagocytosis and red blood cell lysis with the release of potentially harmful constituents (e.g. hemoglobin and iron) into the extracellular space.
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Affiliation(s)
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Ya Hua
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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30
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Stachowicz A, Siudut J, Suski M, Olszanecki R, Korbut R, Undas A, Wiśniewski JR. Optimization of quantitative proteomic analysis of clots generated from plasma of patients with venous thromboembolism. Clin Proteomics 2017; 14:38. [PMID: 29209155 PMCID: PMC5706328 DOI: 10.1186/s12014-017-9173-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/18/2017] [Indexed: 12/17/2022] Open
Abstract
Background It is well known that fibrin network binds a large variety of proteins, including inhibitors and activators of fibrinolysis, which may affect clot properties, such as stability and susceptibility to fibrinolysis. Specific plasma clot composition differs between individuals and may change in disease states. However, the plasma clot proteome has not yet been in-depth analyzed, mainly due to technical difficulty related to the presence of a highly abundant protein—fibrinogen and fibrin that forms a plasma clot. Methods The aim of our study was to optimize quantitative proteomic analysis of fibrin clots prepared ex vivo from citrated plasma of the peripheral blood drawn from patients with prior venous thromboembolism (VTE). We used a multiple enzyme digestion filter aided sample preparation, a multienzyme digestion (MED) FASP method combined with LC–MS/MS analysis performed on a Proxeon Easy-nLC System coupled to the Q Exactive HF mass spectrometer. We also evaluated the impact of peptide fractionation with pipet-tip strong anion exchange (SAX) method on the obtained results. Results Our proteomic approach revealed 476 proteins repeatedly identified in the plasma fibrin clots from patients with VTE including extracellular vesicle-derived proteins, lipoproteins, fibrinolysis inhibitors, and proteins involved in immune responses. The MED FASP method using three different enzymes: LysC, trypsin and chymotrypsin increased the number of identified peptides and proteins and their sequence coverage as compared to a single step digestion. Peptide fractionation with a pipet-tip strong anion exchange (SAX) protocol increased the depth of proteomic analyses, but also extended the time needed for sample analysis with LC–MS/MS. Conclusions The MED FASP method combined with a label-free quantification is an excellent proteomic approach for the analysis of fibrin clots prepared ex vivo from citrated plasma of patients with prior VTE. Electronic supplementary material The online version of this article (10.1186/s12014-017-9173-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aneta Stachowicz
- Chair of Pharmacology, Jagiellonian University Medical College, Kraków, Poland.,Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Am Klopferspitz 18, Martinsried, 82152 Planegg, Germany
| | - Jakub Siudut
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Suski
- Chair of Pharmacology, Jagiellonian University Medical College, Kraków, Poland
| | - Rafał Olszanecki
- Chair of Pharmacology, Jagiellonian University Medical College, Kraków, Poland
| | - Ryszard Korbut
- Chair of Pharmacology, Jagiellonian University Medical College, Kraków, Poland
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jacek R Wiśniewski
- Department of Proteomics and Signal Transduction, Max Planck Institute of Biochemistry, Am Klopferspitz 18, Martinsried, 82152 Planegg, Germany
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Ohshima T, Ishikawa K, Goto S, Yamamoto T. Relationship Between Clot Quality and Microguidewire Configuration During Endovascular Thrombectomy for Acute Ischemic Stroke. World Neurosurg 2017; 107:657-662. [PMID: 28844922 DOI: 10.1016/j.wneu.2017.08.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although endovascular approaches for acute ischemic stroke have been developed, the appropriate selection and sequence of device application or other treatments is unclear. If information about the clot quality can be obtained before the selection of devices, fast recanalization with a suitable device and strategy can be achieved. We studied the relationship between clot quality and the configuration of a microguidewire during endovascular thrombectomy. METHODS This prospective single-center study included all patients who were admitted for acute ischemic stroke between October 2015 and June 2017 and underwent emergency endovascular thrombectomy. We used a modified pigtail-shaped microguidewire to penetrate clots. The configurations under radiograph were distinguished into 2 types and assessed according to collected clot appearance and quality. RESULTS A total of 54 patients underwent acute endovascular thrombectomy. When the tip of the microguidewire became stuck against a clot during penetration, the clot was solid and hard, with statistical significance (P = 0.013). CONCLUSIONS Our results showed that we can select a suitable device and strategy for fast recanalization according to information about clot quality obtained using the modified pigtail-shaped microguidewire.
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Affiliation(s)
- Tomotaka Ohshima
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan.
| | - Kojiro Ishikawa
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
| | - Taiki Yamamoto
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Japan
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Ariane M, Wen W, Vigolo D, Brill A, Nash FGB, Barigou M, Alexiadis A. Modelling and simulation of flow and agglomeration in deep veins valves using discrete multi physics. Comput Biol Med 2017; 89:96-103. [PMID: 28797741 DOI: 10.1016/j.compbiomed.2017.07.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/10/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Abstract
The hemodynamics in flexible deep veins valves is modelled by means of discrete multi-physics and an agglomeration algorithm is implemented to account for blood accrual in the flow. Computer simulations of a number of valves typologies are carried out. The results show that the rigidity and the length of the valve leaflets play a crucial role on both mechanical stress and stagnation in the flow. Rigid and short membranes may be inefficient in preventing blood reflux, but reduce the volume of stagnant blood potentially lowering the chances of thrombosis. Additionally, we also show that in venous valves, cell agglomeration is driven by stagnation rather than mechanical stress.
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Affiliation(s)
- M Ariane
- School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom.
| | - W Wen
- School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - D Vigolo
- School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - A Brill
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - F G B Nash
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - M Barigou
- School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - A Alexiadis
- School of Chemical Engineering, University of Birmingham, Birmingham, United Kingdom.
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Inoue H, Ito J, Uchida H, Morita M, Masuda T, Yamaya K, Hata M, Kato S. Lower airway obstruction due to a massive clot resulting from late bleeding following mini-tracheostomy tube insertion and subsequent clot removal and re-intubation. JA Clin Rep 2017; 3:16. [PMID: 29457060 PMCID: PMC5804594 DOI: 10.1186/s40981-017-0087-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Easier to perform than the conventional procedure, mini-tracheostomy (MT) is widely used in the operating room or intensive care unit to remove sputum or other obstructions of the upper airway. This option, however, does carry the risk of various complications, including malposition, disposition, bleeding, and subcutaneous emphysema. Here, we report a case of endotracheal tube obstruction due to a massive clot resulting from late bleeding around the insertion site of an MT tube. This necessitated removal of the endotracheal tube together with the clot followed tube re-introduction. Case presentation The patient was an 85-year-old man in whom an MT tube had been inserted 6 days earlier following aortic replacement surgery. On re-admittance to our intensive care unit, large amounts of hemosputum and clotting were observed around the insertion site of the tube. The MT tube was subsequently removed and tracheal intubation performed. Ventilation via the endotracheal tube proved impossible, however, and cardiac arrest ensued. Fiberoptic bronchoscopy revealed that the endotracheal tube was completely obstructed by a massive clot. Therefore, we immediately pushed the clot toward the right main bronchus to secure ventilation via the left lung. After many attempts to remove the massive clot, including suction and grasping with basket forceps, it was successfully dislodged by replacing the endotracheal tube with a new one while maintaining oxygenation by one-lung ventilation. Any small fragments of the clot that still remained were then removed by suction under fiberoptic bronchoscopy. Conclusions Here, we report a case of endotracheal tube obstruction due to a clot derived from very late (6 days) bleeding after insertion of an MT tube. The patient was successfully rescued by replacing the clot-bearing endotracheal tube with a new one. This experience suggests that the intensive care physician should be aware of the potential risk of clot retention in endotracheal tubes after the elapse of several days.
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Affiliation(s)
- Hiroshi Inoue
- 1Department of Anesthesia and Critical Care Medicine, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba-ku, Sendai City, Miyagi 9800873 Japan
| | - Jun Ito
- 1Department of Anesthesia and Critical Care Medicine, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba-ku, Sendai City, Miyagi 9800873 Japan
| | - Hiroaki Uchida
- 1Department of Anesthesia and Critical Care Medicine, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba-ku, Sendai City, Miyagi 9800873 Japan
| | - Mariko Morita
- Department of Anesthesia, Minamisoma Municipal General Hospital, 2-54-6 Haramachi-ku Takamimachi, Minami-Souma City, Fukushima 9750033 Japan
| | - Takahiko Masuda
- 3Department of Cardiovascular Surgery, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba-ku, Sendai City, Miyagi 9800873 Japan
| | - Kazuhiro Yamaya
- 3Department of Cardiovascular Surgery, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba-ku, Sendai City, Miyagi 9800873 Japan
| | - Masaki Hata
- 3Department of Cardiovascular Surgery, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba-ku, Sendai City, Miyagi 9800873 Japan
| | - Shigeaki Kato
- 4Cardiovascular Center, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba-ku, Sendai City, Miyagi 9800873 Japan
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Im JH, Muschel RJ. Protocol for Murine/Mouse Platelets Isolation and Their Reintroduction in vivo. Bio Protoc 2017; 7:e2132. [PMID: 34458453 PMCID: PMC8376615 DOI: 10.21769/bioprotoc.2132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/22/2016] [Accepted: 01/21/2017] [Indexed: 11/02/2022] Open
Abstract
Platelets and coagulation have long been known to be essential for metastasis in experimental models. In order to study the interactions between tumor cells, platelets and endothelium, we have adapted methods used in coagulation research for the isolation of platelets and their reintroduction into mice. Anti-coagulated murine blood served as the source for platelets. Platelets were separated from other elements of the whole blood by centrifugation. Here the critical elements are first inhibition of coagulation and second isolation and maintenance of the platelets in the presence of inhibitors of platelet activation. We then used the vital dye PKH26 to fluorescently label the platelets. Infusion of these labelled platelets allows microscopic observation of the introduced platelets. After reintroduction, these platelets appear to function normally and comprise approximately 50% of the total platelets. Because they are fluorescently labelled, they can easily be identified. Finally it would be possible to use these methods for the determination of specific effects of altered gene expression in platelets by using platelets from genetically engineered mice. These methods have facilitated study of the interactions between platelets and tumor cells in tissue culture and in murine models. They would also be applicable to video microscopy. Here we provide details of the methods we have used for platelet isolation from mice and their staining for further microscopy and re-introduction into mice.
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Affiliation(s)
- Jae Hong Im
- CRUK-MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Ruth J Muschel
- CRUK-MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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Brinjikji W, Michalak G, Kadirvel R, Dai D, Gilvarry M, Duffy S, Kallmes DF, McCollough C, Leng S. Utility of single-energy and dual-energy computed tomography in clot characterization: An in-vitro study. Interv Neuroradiol 2017; 23:279-284. [PMID: 28604189 DOI: 10.1177/1591019917694479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and purpose Because computed tomography (CT) is the most commonly used imaging modality for the evaluation of acute ischemic stroke patients, developing CT-based techniques for improving clot characterization could prove useful. The purpose of this in-vitro study was to determine which single-energy or dual-energy CT techniques provided optimum discrimination between red blood cell (RBC) and fibrin-rich clots. Materials and methods Seven clot types with varying fibrin and RBC densities were made (90% RBC, 99% RBC, 63% RBC, 36% RBC, 18% RBC and 0% RBC with high and low fibrin density) and their composition was verified histologically. Ten of each clot type were created and scanned with a second generation dual source scanner using three single (80 kV, 100 kV, 120 kV) and two dual-energy protocols (80/Sn 140 kV and 100/Sn 140 kV). A region of interest (ROI) was placed over each clot and mean attenuation was measured. Receiver operating characteristic curves were calculated at each energy level to determine the accuracy at differentiating RBC-rich clots from fibrin-rich clots. Results Clot attenuation increased with RBC content at all energy levels. Single-energy at 80 kV and 120 kV and dual-energy 80/Sn 140 kV protocols allowed for distinguishing between all clot types, with the exception of 36% RBC and 18% RBC. On receiver operating characteristic curve analysis, the 80/Sn 140 kV dual-energy protocol had the highest area under the curve for distinguishing between fibrin-rich and RBC-rich clots (area under the curve 0.99). Conclusions Dual-energy CT with 80/Sn 140 kV had the highest accuracy for differentiating RBC-rich and fibrin-rich in-vitro thrombi. Further studies are needed to study the utility of non-contrast dual-energy CT in thrombus characterization in acute ischemic stroke.
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Affiliation(s)
- Waleed Brinjikji
- 1 Department of Radiology, Mayo Clinic, USA.,2 Department of Neurosurgery, Mayo Clinic, USA
| | | | | | - Daying Dai
- 1 Department of Radiology, Mayo Clinic, USA
| | | | - Sharon Duffy
- 3 Neuravi Ltd., Ireland.,4 Galway-Mayo Institute of Technology, Ireland
| | - David F Kallmes
- 1 Department of Radiology, Mayo Clinic, USA.,2 Department of Neurosurgery, Mayo Clinic, USA
| | | | - Shuai Leng
- 1 Department of Radiology, Mayo Clinic, USA
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Bhatti MM, Zeeshan A, Ellahi R. Heat transfer analysis on peristaltically induced motion of particle-fluid suspension with variable viscosity: Clot blood model. Comput Methods Programs Biomed 2016; 137:115-124. [PMID: 28110718 DOI: 10.1016/j.cmpb.2016.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/03/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
In this article, heat transfer analysis on clot blood model of the particle-fluid suspension through a non-uniform annulus has been investigated. The blood propagating along the whole length of the annulus was induced by peristaltic motion. The effects of variable viscosity and slip condition are also taken into account. The governing flow problem is modeled using lubrication approach by taking the assumption of long wavelength and creeping flow regime. The resulting equation for fluid phase and particle phase is solved analytically and closed form solutions are obtained. The physical impact of all the emerging parameters is discussed mathematically and graphically. Particularly, we considered the effects of particle volume fraction, slip parameter, the maximum height of clot, viscosity parameter, average volume flow rate, Prandtl number, Eckert number and fluid parameter on temperature profile, pressure rise and friction forces for outer and inner tube. Numerical computations have been used to determine the behavior of pressure rise and friction along the whole length of the annulus. The present study is also presented for an endoscope as a special case of our study. It is observed that greater influence of clot tends to rise the pressure rise significantly. It is also found that temperature profile increases due to the enhancement in Prandtl number, Eckert number, and fluid parameter. The present study reveals that friction forces for outer tube have higher magnitude as compared to the friction forces for an inner tube. In fact, the results for present study can also be reduced to the Newtonian fluid by taking ζ → ∞.
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Affiliation(s)
- M M Bhatti
- Shanghai Institute of Applied Mathematics and Mechanics, Shanghai University, Shanghai 200072, China.
| | - A Zeeshan
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan
| | - R Ellahi
- Department of Mathematics and Statistics, International Islamic University, Islamabad, Pakistan; Department of Mathematics, Faculty of Science, Taibah University, Madinah Munawwarah, Saudi Arabia
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37
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Ebiloglu T, Kaya E, Yilmaz S, Özgür G, Kibar Y. Treatment of Resıstant Cyclophosphamide Induced Haemorrhagic Cystıtıs: Revıew of Literature and Three Case Reports. J Clin Diagn Res 2016; 10:PD15-6. [PMID: 27190887 DOI: 10.7860/jcdr/2016/16948.7642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/30/2015] [Indexed: 11/24/2022]
Abstract
Haemorrhagic Cystitis (HC) is defined as diffuse inflammatory bladder bleeding due to many aetiologies. Massive HC often arises from anticancer chemotherapy or radiotherapy for the treatment of pelvic malignancies. Phosphamides are the anti-cancer drugs used for treating breast cancer, B-cell lymphoma, leukemia, rheumatoid arthritis and systemic lupus erythaematosis by cross-linking strands of DNA and preventing the cell division. They are also used in bone marrow transplantation for prevention of Graft Versus Host Disease (GVHD). Hepatic metabolism of phosphamide forms acrolein, and acrolein makes ulceration, haemorrhage, edema and necrosis of the urothelium during its excretion by the urine. Infectious causes of HC in immunocomprimesed patients are adenovirus, BK polyoma-virus (BK), JC virus, and Cytomegalovirus (CMV). The present article attempts to make a review of literature for the treatment of intractable HC and report three cases with HC.
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Affiliation(s)
- Turgay Ebiloglu
- Faculty, Department of Urology, Etimesgut Military Hospital , Ankara, Turkey
| | - Engin Kaya
- Faculty, Department of Urology, Section of Pediatric Urology, Gulhane Military Medical Academy , Ankara, Turkey
| | - Sercan Yilmaz
- Faculty, Department of Urology, Section of Pediatric Urology, Gulhane Military Medical Academy , Ankara, Turkey
| | - Gökhan Özgür
- Faculty, Department of Heamatology, Gulhane Military Medical Academy , Ankara, Turkey
| | - Yusuf Kibar
- Faculty, Department of Urology, Section of Pediatric Urology, Gulhane Military Medical Academy , Ankara, Turkey
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Suski M, Siudut J, Ząbczyk M, Korbut R, Olszanecki R, Undas A. Shotgun analysis of plasma fibrin clot-bound proteins in patients with acute myocardial infarction. Thromb Res 2015; 135:754-9. [PMID: 25686879 DOI: 10.1016/j.thromres.2015.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/19/2015] [Accepted: 02/04/2015] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The presence and amount of the proteins within a plasma clot may influence clot properties, like susceptibility to fibrinolysis, however, the clot proteome has not yet been extensively described. The aim of the study was to investigate the protein composition of clots of four patients with acute myocardial infarction (AMI) in two time points: in the acute ischemic phase and two months later during the standard therapy. MATERIALS AND METHODS Shotgun proteomic method (2DLC-MS/MS) was used to investigate time-dependent protein composition changes of clots prepared ex vivo from citrated plasma of the peripheral blood of patients with AMI. RESULTS Proteomic analysis revealed a total number of 62 proteins identified in all 8 samples grouping into several distinct functional clusters (e.g. cholesterol transporter activity, immunoglobulin binding and peptidase regulatory activity). The protein signatures of clots differed significantly depending on time after ACS, showing 30% greater variability in protein composition of the clots prepared in the plasma two months after the onset of AMI. Several proteins potentially involved in clot formation and resolution showed an interesting pattern of changes over time. CONCLUSION We provided the first qualitative analysis of proteomes of fibrin clots generated ex vivo in plasma taken from patients with AMI showing differences between clots generated in the acute ischemic phase and those prepared two months later. It might be hypothesized that differences involving proteins of potential influence on within-clot fibrinolysis and clot stability may partially explain time-dependent changes in the clots structure and firmness in patients with AMI.
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Ananthakrishnan AN, Cagan A, Gainer VS, Cheng SC, Cai T, Scoville E, Konijeti GG, Szolovits P, Shaw SY, Churchill S, Karlson EW, Murphy SN, Kohane I, Liao KP. Thromboprophylaxis is associated with reduced post-hospitalization venous thromboembolic events in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2014; 12:1905-10. [PMID: 24632349 PMCID: PMC4162859 DOI: 10.1016/j.cgh.2014.02.034] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 01/21/2014] [Accepted: 02/19/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with inflammatory bowel diseases (IBDs) have increased risk for venous thromboembolism (VTE); those who require hospitalization have particularly high risk. Few hospitalized patients with IBD receive thromboprophylaxis. We analyzed the frequency of VTE after IBD-related hospitalization, risk factors for post-hospitalization VTE, and the efficacy of prophylaxis in preventing post-hospitalization VTE. METHODS In a retrospective study, we analyzed data from a multi-institutional cohort of patients with Crohn's disease or ulcerative colitis and at least 1 IBD-related hospitalization. Our primary outcome was a VTE event. All patients contributed person-time from the date of the index hospitalization to development of VTE, subsequent hospitalization, or end of follow-up. Our main predictor variable was pharmacologic thromboprophylaxis. Cox proportional hazard models adjusting for potential confounders were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS From a cohort of 2788 patients with at least 1 IBD-related hospitalization, 62 patients developed VTE after discharge (2%). Incidences of VTE at 30, 60, 90, and 180 days after the index hospitalization were 3.7/1000, 4.1/1000, 5.4/1000, and 9.4/1000 person-days, respectively. Pharmacologic thromboprophylaxis during the index hospital stay was associated with a significantly lower risk of post-hospitalization VTE (HR, 0.46; 95% CI, 0.22-0.97). Increased numbers of comorbidities (HR, 1.30; 95% CI, 1.16-1.47) and need for corticosteroids before hospitalization (HR, 1.71; 95% CI, 1.02-2.87) were also independently associated with risk of VTE. Length of hospitalization or surgery during index hospitalization was not associated with post-hospitalization VTE. CONCLUSIONS Pharmacologic thromboprophylaxis during IBD-related hospitalization is associated with reduced risk of post-hospitalization VTE.
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Affiliation(s)
- Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Andrew Cagan
- Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts
| | - Vivian S Gainer
- Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts
| | - Su-Chun Cheng
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Elizabeth Scoville
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Gauree G Konijeti
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter Szolovits
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Stanley Y Shaw
- Harvard Medical School, Boston, Massachusetts; Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Susanne Churchill
- i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth W Karlson
- Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shawn N Murphy
- Harvard Medical School, Boston, Massachusetts; Research IS and Computing, Partners HealthCare, Charlestown, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Isaac Kohane
- Harvard Medical School, Boston, Massachusetts; i2b2 National Center for Biomedical Computing, Brigham and Women's Hospital, Boston, Massachusetts; Children's Hospital Boston, Boston, Massachusetts
| | - Katherine P Liao
- Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts
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Easler J, Muddana V, Furlan A, Dasyam A, Vipperla K, Slivka A, Whitcomb DC, Papachristou GI, Yadav D. Portosplenomesenteric venous thrombosis in patients with acute pancreatitis is associated with pancreatic necrosis and usually has a benign course. Clin Gastroenterol Hepatol 2014; 12:854-62. [PMID: 24161350 DOI: 10.1016/j.cgh.2013.09.068] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 09/20/2013] [Accepted: 09/29/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Although there are some data on prevalence of portosplenomesenteric venous thrombosis (PSMVT) in patients with acute pancreatitis (AP), the progression of PSMVT in patients who have and have not received anticoagulants has not been studied systematically. We evaluated the prevalence and natural history of PSMVT in a well-defined cohort of individuals with AP. METHODS In a retrospective study, we analyzed data from the University of Pittsburgh Medical Center on 162 patients with a sentinel attack of AP from 2003-2010. Data were collected on patient demographics, clinical presentation, etiology, clinical course, and outcomes. One hundred twenty-two patients underwent contrast-enhanced computed tomography; the scans were reviewed to identify thromboses and/or narrowing of splanchnic veins (splenic, superior mesenteric, and portal). RESULTS PSMVT was detected in 22 patients overall (14%; 18% among patients who underwent contrast-enhanced computed tomography). Median time to detection of PSMVT was 17 days (interquartile range, 11-40 days). PSMVT formed most frequently in the splenic vein (19 of 22, 86%), followed by portal (8 of 22, 36%) and superior mesenteric (6/22, 27%) veins. Development of PSMVT was associated with presence (21 of 22, 95%), location, and extent of pancreatic necrosis. Fifty-three percent of patients (21 of 40) with necrosis developed PSMVT. Anticoagulants were administered infrequently (6 of 22, 27%) and always for indications unrelated to PSMVT. Most patients with PSMVT developed collateral veins (19 of 22, 86%), and 27% (6 of 22) were found to have varices during endoscopic evaluation, but clot resolution was infrequent (2 of 22, 9%). No patient developed complications directly related to PSMVT. CONCLUSIONS PSMVT develops in about half of patients with necrotizing AP and is rare in the absence of necrosis. Despite infrequent administration of anticoagulants, complications directly related to PSMVT are rare.
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Affiliation(s)
- Jeffrey Easler
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Venkata Muddana
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anil Dasyam
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kishore Vipperla
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Adam Slivka
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David C Whitcomb
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Georgios I Papachristou
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dhiraj Yadav
- Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Mirmohammadsadeghi M, Kiani Y, Nasr A, Zavvar R, Behjati M, Rabbani M, Majidi E, Mirmohammadsadeghi P. Five chambered heart or large atrial appendage aneurysm: A report of two cases. ARYA Atheroscler 2013; 9:213-5. [PMID: 23766780 PMCID: PMC3681275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/16/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Isolated intrapericardial LAA aneurysm is a rare cardiac anomaly which manifests with angina, dyspnea on exertion (DOE), systemic embolization, arrhythmia, and congestive heart failure. CASE REPORT A 30-year-old female and a 46-year-old male were referred for evaluation of abnormal cardiac contour on chest radiograph and echocardiographic findings and non-specific symptoms. Transesophageal echocardiography suggested left atrial appendage (LAA) mass filled with clots. The mass had no compression on cardiac chambers and global ejection fraction was within normal limits. The intraoperative diagnosis was isolated congenital LAA aneurysm. After confirmation of the diagnosis, it was resected. She was discharged with uneventful postoperative course. At follow-up she was asymptomatic. CONCLUSION These cases demonstrate the role of on-time surgical approaches in the prevention of fatal complication of this rare cardiac anomaly.
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Affiliation(s)
| | - Yalda Kiani
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Nasr
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reihaneh Zavvar
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohaddeseh Behjati
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Mohaddeseh Behjati,
| | - Majid Rabbani
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Majidi
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
PURPOSE This retrospective study was performed to determine the prevalence of lower extremity venous duplication using duplex ultrasound in the patient population of a large urban medical center. MATERIAL AND METHODS The reports of all lower extremity venous ultrasound examinations performed at our institution between January 1, 2002 and December 31, 2002 were reviewed. Ultrasound examinations that were performed for purposes other than the detection of lower extremity deep vein thrombosis were excluded. The prevalence of duplication and its specific location were recorded. In addition, the prevalence of thrombus and its specific location were also recorded. RESULTS A total of 3118 exams were performed in 2664 patients. Of the 2664 patients, 2311 had only one examination performed during the study period; 353 patients had more than one examination performed. We found that 10.1% of patients (270/2664) had at least one venous segment duplicated and 5.4% of patients (143/2664) had a thrombus in at least one venous segment. There was a statistically significant difference in the prevalence of both duplication and thrombus with a change in venous segment. Only 0.4% of patients (11/2664) had thrombus within a duplicated segment. Of those who had more than one examination performed, 15.3% (54/353) had the same venous segment(s) seen on one examination but not another. CONCLUSION Lower extremity venous duplication is a frequent anatomic variant that is seen in 10.1% of patients, but it may not be as common as is generally believed. It can result in a false negative result for deep vein thrombosis.
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Affiliation(s)
- William L Simpson
- Department of Radiology, Mount Sinai Medical Center, Box 1234, New York, NY 10029 USA
| | - David M Krakowsi
- Department of Radiology, Mount Sinai Medical Center, Box 1234, New York, NY 10029 USA
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