In the last decade,the number of transcatheter heart valve replacement for severe heart valve disease has increased exponentially.Although the bioprosthetic artificial heart valve(BHV)has similar fluid dynamics perfor...In the last decade,the number of transcatheter heart valve replacement for severe heart valve disease has increased exponentially.Although the bioprosthetic artificial heart valve(BHV)has similar fluid dynamics performance to the original heart valve compared with mechanical heart valve so that there is no need to take long-term anticoagulant drugs to prevent thromboembolism,transcatheter BHV replacement are still at risk for thrombosis during the first few months according to the clinical data.However,the use of antithrombotic drugs can also increase the risk of bleeding.Therefore,it is particularly important to improve the anticoagulant properties for the BHV itself.In this work,a kind of non-glutaraldehyde cross-linked BHV material with excellent antithrombotic ability has been prepared from carboxylated oxazolidine treated porcine pericardium(consisting of collagen,elastin and glycoprotein)with the further graft of the anticoagulant heparin sodium via hydrophilic modified chitosan.Along with the similar mechanical properties and collagen stability comparable to the glutaraldehyde cross-linked porcine pericardium(PP),these functional non-glutaraldehyde cross-linked PPs exhibit better biocompatibility,promoted endothelial proliferation and superior anti-calcification ability.More importantly,excellent anticoagulant activity can be observed in the hematological experiments in vivo and in vitro.In summary,these excellent performances make these functional non-glutaraldehyde cross-linked PPs great potentialities in the BHV applications.展开更多
Implantation of the embryo into the endometrium is the first step in the establishment of pregnancy. This process is complex, and depends on many factors. Recurrent implantation failure is a source of distress to pati...Implantation of the embryo into the endometrium is the first step in the establishment of pregnancy. This process is complex, and depends on many factors. Recurrent implantation failure is a source of distress to patients and specialists. It is defined as failure to achieve a viable pregnancy, following “>3 embryo transfers with high quality embryos or the transfer of ≥ 10 embryos in multiple transfers”. Thrombophilic conditions that contribute to recurrent implantation failure are the main concern in this review. The mechanism of implantation failure is believed to be due to decreased blood flow to the endometrium and placenta which can hinder normal endometrial receptivity leading to miscarriage. Defects in early placentation resulting in pregnancy failure, have focused attention on the therapeutic potential of low molecular weight heparin in the implantation process. Heparin has a role at all stages of implantation to improve pregnancy outcomes. There are controversies in literature regarding the association between thrombophilia and recurrent implantation failure and available literature regarding this issue is very heterogeneous. Various investigators, have shown that women with RIF are more likely to have a thrombophilia disorder, yet a clear cause cannot be acknowledged from these studies. Heparin treatment has been evaluated in several studies, showing conflicting evidence. However, several studies have pointed out that it may play a role in a subset of patients who presents a thrombophilia mutation, thus the group of patients that might benefit is needed to be identified. This review is dedicated to evaluate the published literature about the role of low molecular weight heparin in case of recurrent implantation failure with or without the presence of thrombophilia.展开更多
In acute coronary syndrome(ACS),the use of anticoagulants in conjunction with antiplatelet agents in the acute phase has resulted in reduced ischemic events and is more effective than either class of drug used alone.T...In acute coronary syndrome(ACS),the use of anticoagulants in conjunction with antiplatelet agents in the acute phase has resulted in reduced ischemic events and is more effective than either class of drug used alone.Though parenteral anticoagulation is essential at the time of diagnosis,a balance must be made between ischemic benefit and the increased risk of bleeding when prescribing anticoagulants.Adverse events associated with anticoagulants,such as heparin-induced thrombocytopenia,bleeding problems,and the need for close monitoring of anticoagulant activity,have contributed to finding agents that reduce these limitations.Studies like the Organization to Assess Strategies in Ischemic Syndromes 5 and 6 and their meta-analysis have proven the efficacy of Fondaparinux over the entire ACS spectrum.The convenience of administration(once daily),lack of monitoring,reduction in mortality,and better safety profile make Fondaparinux a simple and effective anti-coagulant for the management of ACS.展开更多
The most common vascular complication of acute pancreatitis is thrombosis of the splenic vein. Isolated thrombosis of the superior mesenteric vein is rare and may lead to mesenteric ischemia and bowel infarction. We r...The most common vascular complication of acute pancreatitis is thrombosis of the splenic vein. Isolated thrombosis of the superior mesenteric vein is rare and may lead to mesenteric ischemia and bowel infarction. We report the case of a 39 years old patient received for acute pancreatitis with a Ranson score less than 3 and image scanner for a grade C of Balthazar and a superior mesenteric vein thrombosis. The outcome was favorable with improvement of symptoms under medical treatment including anti-coagulant therapy. The contrast enhancing abdominal CT showed an absence of superior mesenteric thrombosis.展开更多
The Sepsis Coagulopathy Asahi Recombinant LE Thrombomodulin(SCARLET)trial has many defects,and thus cannot be the terminator of recombinant thrombomodulin(rTM).On the contrary,it provides sufficient evidence for furth...The Sepsis Coagulopathy Asahi Recombinant LE Thrombomodulin(SCARLET)trial has many defects,and thus cannot be the terminator of recombinant thrombomodulin(rTM).On the contrary,it provides sufficient evidence for further research.Based on analysis focusing on the failure of SCARLET and several previous anticoagulant studies,it is most important for new studies to grasp the following two points:(1)The enrolled cases should have sufficient disease severity and a clear standard for disseminated intravascular coagulation;(2)Heparin should not be used in combination with the investigated drugs.Multiple post-hoc analyses show that no combination of heparin will not increase the risk of thromboembolism.In fact,the combination of heparin can mask the true efficacy of the investigated drug.Due to the complexity of sepsis treatment and the limitations of clinical studies,the results of all treatment studies should be repeatedly verified,rather than be determined at one stroke.Some research conclusions contrary to disease physiology,pharmacology and clinical practice may be deceptive,and should be cautious rather than be simply accepted.On the other hand,the dissenting voices in the"consensus"scene are often well discussed by the authors and should be highly valued.展开更多
Vascular grafts must avoid negative inflammatory responses and thrombogenesis to prohibit fibrotic deposition immediately upon implantation and promote the regeneration of small diameter blood vessels(<6 mm inner d...Vascular grafts must avoid negative inflammatory responses and thrombogenesis to prohibit fibrotic deposition immediately upon implantation and promote the regeneration of small diameter blood vessels(<6 mm inner diameter).Here,polyurethane(PU)elastomers incorporating anti-coagulative and anti-inflammatory Gastrodin were fabricated.The films had inter-connected pores with porosities equal to or greater than 86%and pore sizes ranging from 250 to 400μm.Incorporation of Gastrodin into PU films resulted in desirable mechanical properties,hydrophilicity,swelling ratios and degradation rates without collapse.The released Gastrodin maintained bioactivity over 21 days as assessed by its anti-oxidative capability.The Gastrodin/PU had better anti-coagulation response(less observable BSA,fibrinogen and platelet adhesion/activation and suppressed clotting in whole blood).Red blood cell compatibility,measured by hemolysis,was greatly improved with 2Gastrodin/PU compared to other Gastrodin/PU groups.Notably,Gastrodin/PU upregulated anti-oxidant factors Nrf2 and HO-1 expression in H2O2 treated HUVECs,correlated with decreasing pro-inflammatory cytokines TNF-αand IL-1β in RAW 264.7 cells.Upon implantation in a subcutaneous pocket,PU was encapsulated by an obvious fibrous capsule,concurrent with a large amount of inflammatory cell infiltration,while Gastrodin/PU induced a thinner fibrous capsule,especially 2Gastrodin/PU.Further,enhanced adhesion and proliferation of HUVECs seeded onto films in vitro demonstrated that 2Gastrodin/PU could help cell recruitment,as evidenced by rapid host cell infiltration and substantial blood vessel formation in vivo.These results indicate that 2Gastrodin/PU has the potential to facilitate blood vessel regeneration,thus providing new insight into the development of clinically effective vascular grafts.展开更多
Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this stud...Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;P<0.001).At discharge,the prescription rate of OAC was 45.2%(16,757/37,087)in eligible patients with high stroke risk and 60.7%(2778/4578)in eligible patients with low stroke risk.OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time(all P<0.001).Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies,including catheter ablation(adjusted odds ratio[OR]11.63,95%confidence interval[CI]10.04-13.47;P<0.001),electronic cardioversion(adjusted OR 2.41,95%CI 1.65-3.51;P<0.001),and anti-arrhythmic drug use(adjusted OR 1.45,95%CI 1.38-1.53;P<0.001).Conclusions:In hospitals participated in the CCC-AF project,>70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov,NCT02309398.展开更多
OBJECTIVES： Thrombotic episodes occurred frequently in beta-thalassemia major （BTM） patients, leading tohypercoagulability of plasma. Protein Z （PZ） is a vitamin-K-dependent anti-coagulation factor that plays a r...OBJECTIVES： Thrombotic episodes occurred frequently in beta-thalassemia major （BTM） patients, leading tohypercoagulability of plasma. Protein Z （PZ） is a vitamin-K-dependent anti-coagulation factor that plays a role in thehuman homeostatic process. The objective of the current study is to investigate the distribution pattern of PZ plasmaconcentrations between BTM patients and the normal population in Ahvaz city, the center of Khuzestan province, southwest ofIran.展开更多
基金National Key Research and Development Programs(2020YFC1107802)the National Natural Science Foundation of China(32071357)the Sichuan Science and Technology Program(2021YFH0011),Sichuan Province Major Science and Technology Special Projects(2018SZDZX0011),the National 111 project of Introducing Talents of Discipline to Universities(No.B16033).We would be grateful to the help of VENUS Medtech Inc.(Hangzhou,China)for providing the fresh porcine pericardium.
文摘In the last decade,the number of transcatheter heart valve replacement for severe heart valve disease has increased exponentially.Although the bioprosthetic artificial heart valve(BHV)has similar fluid dynamics performance to the original heart valve compared with mechanical heart valve so that there is no need to take long-term anticoagulant drugs to prevent thromboembolism,transcatheter BHV replacement are still at risk for thrombosis during the first few months according to the clinical data.However,the use of antithrombotic drugs can also increase the risk of bleeding.Therefore,it is particularly important to improve the anticoagulant properties for the BHV itself.In this work,a kind of non-glutaraldehyde cross-linked BHV material with excellent antithrombotic ability has been prepared from carboxylated oxazolidine treated porcine pericardium(consisting of collagen,elastin and glycoprotein)with the further graft of the anticoagulant heparin sodium via hydrophilic modified chitosan.Along with the similar mechanical properties and collagen stability comparable to the glutaraldehyde cross-linked porcine pericardium(PP),these functional non-glutaraldehyde cross-linked PPs exhibit better biocompatibility,promoted endothelial proliferation and superior anti-calcification ability.More importantly,excellent anticoagulant activity can be observed in the hematological experiments in vivo and in vitro.In summary,these excellent performances make these functional non-glutaraldehyde cross-linked PPs great potentialities in the BHV applications.
文摘Implantation of the embryo into the endometrium is the first step in the establishment of pregnancy. This process is complex, and depends on many factors. Recurrent implantation failure is a source of distress to patients and specialists. It is defined as failure to achieve a viable pregnancy, following “>3 embryo transfers with high quality embryos or the transfer of ≥ 10 embryos in multiple transfers”. Thrombophilic conditions that contribute to recurrent implantation failure are the main concern in this review. The mechanism of implantation failure is believed to be due to decreased blood flow to the endometrium and placenta which can hinder normal endometrial receptivity leading to miscarriage. Defects in early placentation resulting in pregnancy failure, have focused attention on the therapeutic potential of low molecular weight heparin in the implantation process. Heparin has a role at all stages of implantation to improve pregnancy outcomes. There are controversies in literature regarding the association between thrombophilia and recurrent implantation failure and available literature regarding this issue is very heterogeneous. Various investigators, have shown that women with RIF are more likely to have a thrombophilia disorder, yet a clear cause cannot be acknowledged from these studies. Heparin treatment has been evaluated in several studies, showing conflicting evidence. However, several studies have pointed out that it may play a role in a subset of patients who presents a thrombophilia mutation, thus the group of patients that might benefit is needed to be identified. This review is dedicated to evaluate the published literature about the role of low molecular weight heparin in case of recurrent implantation failure with or without the presence of thrombophilia.
文摘In acute coronary syndrome(ACS),the use of anticoagulants in conjunction with antiplatelet agents in the acute phase has resulted in reduced ischemic events and is more effective than either class of drug used alone.Though parenteral anticoagulation is essential at the time of diagnosis,a balance must be made between ischemic benefit and the increased risk of bleeding when prescribing anticoagulants.Adverse events associated with anticoagulants,such as heparin-induced thrombocytopenia,bleeding problems,and the need for close monitoring of anticoagulant activity,have contributed to finding agents that reduce these limitations.Studies like the Organization to Assess Strategies in Ischemic Syndromes 5 and 6 and their meta-analysis have proven the efficacy of Fondaparinux over the entire ACS spectrum.The convenience of administration(once daily),lack of monitoring,reduction in mortality,and better safety profile make Fondaparinux a simple and effective anti-coagulant for the management of ACS.
文摘The most common vascular complication of acute pancreatitis is thrombosis of the splenic vein. Isolated thrombosis of the superior mesenteric vein is rare and may lead to mesenteric ischemia and bowel infarction. We report the case of a 39 years old patient received for acute pancreatitis with a Ranson score less than 3 and image scanner for a grade C of Balthazar and a superior mesenteric vein thrombosis. The outcome was favorable with improvement of symptoms under medical treatment including anti-coagulant therapy. The contrast enhancing abdominal CT showed an absence of superior mesenteric thrombosis.
文摘The Sepsis Coagulopathy Asahi Recombinant LE Thrombomodulin(SCARLET)trial has many defects,and thus cannot be the terminator of recombinant thrombomodulin(rTM).On the contrary,it provides sufficient evidence for further research.Based on analysis focusing on the failure of SCARLET and several previous anticoagulant studies,it is most important for new studies to grasp the following two points:(1)The enrolled cases should have sufficient disease severity and a clear standard for disseminated intravascular coagulation;(2)Heparin should not be used in combination with the investigated drugs.Multiple post-hoc analyses show that no combination of heparin will not increase the risk of thromboembolism.In fact,the combination of heparin can mask the true efficacy of the investigated drug.Due to the complexity of sepsis treatment and the limitations of clinical studies,the results of all treatment studies should be repeatedly verified,rather than be determined at one stroke.Some research conclusions contrary to disease physiology,pharmacology and clinical practice may be deceptive,and should be cautious rather than be simply accepted.On the other hand,the dissenting voices in the"consensus"scene are often well discussed by the authors and should be highly valued.
基金This research was supported by the National Natural Science Foundation of China(81760087/31760292/81860326/81560050)the Department of Science and Technology of Yunnan Province of China(2017FA035/2017FE467(-008)/2018FE001(-137)/2018FE001(-165)/2018FE001(-125)/2018IA048/2019ZF011-2)+1 种基金Major Program of Kunming Science and Technology Innovation Center(2019-1-N-25318000003568)Program for Innovative Research Team(in Science and Technology)in University of Yunnan Province(IRTSTYN).
文摘Vascular grafts must avoid negative inflammatory responses and thrombogenesis to prohibit fibrotic deposition immediately upon implantation and promote the regeneration of small diameter blood vessels(<6 mm inner diameter).Here,polyurethane(PU)elastomers incorporating anti-coagulative and anti-inflammatory Gastrodin were fabricated.The films had inter-connected pores with porosities equal to or greater than 86%and pore sizes ranging from 250 to 400μm.Incorporation of Gastrodin into PU films resulted in desirable mechanical properties,hydrophilicity,swelling ratios and degradation rates without collapse.The released Gastrodin maintained bioactivity over 21 days as assessed by its anti-oxidative capability.The Gastrodin/PU had better anti-coagulation response(less observable BSA,fibrinogen and platelet adhesion/activation and suppressed clotting in whole blood).Red blood cell compatibility,measured by hemolysis,was greatly improved with 2Gastrodin/PU compared to other Gastrodin/PU groups.Notably,Gastrodin/PU upregulated anti-oxidant factors Nrf2 and HO-1 expression in H2O2 treated HUVECs,correlated with decreasing pro-inflammatory cytokines TNF-αand IL-1β in RAW 264.7 cells.Upon implantation in a subcutaneous pocket,PU was encapsulated by an obvious fibrous capsule,concurrent with a large amount of inflammatory cell infiltration,while Gastrodin/PU induced a thinner fibrous capsule,especially 2Gastrodin/PU.Further,enhanced adhesion and proliferation of HUVECs seeded onto films in vitro demonstrated that 2Gastrodin/PU could help cell recruitment,as evidenced by rapid host cell infiltration and substantial blood vessel formation in vivo.These results indicate that 2Gastrodin/PU has the potential to facilitate blood vessel regeneration,thus providing new insight into the development of clinically effective vascular grafts.
文摘Background:Oral anti-coagulants(OAC)are the intervention for the prevention of stroke,which consistently improve clinical outcomes and survival among patients with atrial fibrillation(AF).The main purpose of this study is to identify problems in OAC utilization among hospitalized patients with AF in China.Methods:Using data from the Improving Care for Cardiovascular Disease in China-Atrial Fibrillation(CCC-AF)registry,guideline-recommended OAC use in eligible patients was assessed.Results:A total of 52,530 patients with non-valvular AF were enrolled from February 2015 to December 2019,of whom 38,203 were at a high risk of stroke,9717 were at a moderate risk,and 4610 were at a low risk.On admission,only 20.0%(6075/30,420)of patients with a diagnosed AF and a high risk of stroke were taking OAC.The use of pre-hospital OAC on admission was associated with a lower risk of new-onset ischemic stroke/transient ischemic attack among the diagnosed AF population(adjusted odds ratio:0.54,95%confidence interval:0.43-0.68;P<0.001).At discharge,the prescription rate of OAC was 45.2%(16,757/37,087)in eligible patients with high stroke risk and 60.7%(2778/4578)in eligible patients with low stroke risk.OAC utilization in patients with high stroke risk on admission or at discharge both increased largely over time(all P<0.001).Multivariate analysis showed that OAC utilization at discharge was positively associated with in-hospital rhythm control strategies,including catheter ablation(adjusted odds ratio[OR]11.63,95%confidence interval[CI]10.04-13.47;P<0.001),electronic cardioversion(adjusted OR 2.41,95%CI 1.65-3.51;P<0.001),and anti-arrhythmic drug use(adjusted OR 1.45,95%CI 1.38-1.53;P<0.001).Conclusions:In hospitals participated in the CCC-AF project,>70%of AF patients were at a high risk of stroke.Although poor performance on guideline-recommended OAC use was found in this study,over time the CCC-AF project has made progress in stroke prevention in the Chinese AF population.Registration:ClinicalTrials.gov,NCT02309398.
文摘OBJECTIVES： Thrombotic episodes occurred frequently in beta-thalassemia major （BTM） patients, leading tohypercoagulability of plasma. Protein Z （PZ） is a vitamin-K-dependent anti-coagulation factor that plays a role in thehuman homeostatic process. The objective of the current study is to investigate the distribution pattern of PZ plasmaconcentrations between BTM patients and the normal population in Ahvaz city, the center of Khuzestan province, southwest ofIran.
