The novel modifications of substrate-containing sodium dodecyl sulfate-polyacrylamide gel electrophoresis that can be used for the detection of proteases and its activators are reported. The protease/activator samples...The novel modifications of substrate-containing sodium dodecyl sulfate-polyacrylamide gel electrophoresis that can be used for the detection of proteases and its activators are reported. The protease/activator samples were separated on a protein substrate-SDS-polyacrylamide gel. To detect plasminogen activators fibrinogen and Glu-plasminogen were incorporated into the SDS-PAG followed by 1 h incubation at 37?C in thrombin solution (1 NIH/ml). After electrophoresis the gel was stained according to the standard protocol. To detect fibrin-unspecific plasminogen activators from snake venom incubation in thrombin solution was substituted for 12 h incubation in 50 mM Tris-HCl (pH 7.4). To detect fibrinogen-degrading enzymes fibrinogen-containing gel was used. Activity of protease/activator was visualized in the gel as clear bands against the dark background. These new techniques offer several advantages including determination of the quantity and activity of t-PA and urokinase, however cannot be recommended for precise quantification of activators;the total procedure is quite quick and simple;method is convenient tool for detection of novel protein-protein interactions in haemostasis system;the sensitivity of the method is ≤0.01 IU per track.展开更多
<b>Title:</b> Assessment of haemostasis in anaesthesia for surgery at the Sylvanus Olympio University Hospital Center in Lomé. <b>Objectives:</b> Evaluate the prescription of the preoperat...<b>Title:</b> Assessment of haemostasis in anaesthesia for surgery at the Sylvanus Olympio University Hospital Center in Lomé. <b>Objectives:</b> Evaluate the prescription of the preoperative haemostasis assessment. <b>Methodology:</b> This was a prospective descriptive and observational study which had taken place in the central operating room and in the operating room of the ENT department at UHC SO of Lomé from January 1 to June 31, 2016. It had concerned all patients who had anaesthesia for scheduled surgery after pre-anesthetic consultation and the haemostasis assessment carried out according to the anaesthesia technique and the type of surgery. <b>Results:</b> Two hundred and sixty (260) patients underwent anaesthesia during the study period. The male sex predominated (60%), the age group 18 - 40 years predominated (50.4%). GA was more practiced (62.7%) followed by spinal anaesthesia (30.3%). Minor ENT surgery was more performed (28%). ASA1 patients predominated (48.5%). The pre-anesthetic haemostasis assessment including platelet count, prothrombin rate, activated partial thromboplastin time and bleeding time was almost always done. The platelet count was achieved in all patients followed by the activated partial thromboplastin time (94%). No haemorrhagic complication related to a haemostasis disorder was observed in the perioperative period in anaesthesia than in surgery. <b>Conclusion:</b> The prescription of the pre-anesthetic haemostasis assessment should not be systematic. It must take into account the clinical history, the patient’s bleeding history during the anaesthesia consultation, the type of anaesthesia, the surgery planned and the age.展开更多
In traumatized patients, the primary cause of mortality is uncontrollable continuous bleeding and unexpected intraoperative bleeding which is likely to increase the risk of complications and surgical failure. High exp...In traumatized patients, the primary cause of mortality is uncontrollable continuous bleeding and unexpected intraoperative bleeding which is likely to increase the risk of complications and surgical failure. High expansion sponges are effective clinical practice for the treatment of wound bleeding (irregular/deep/narrow) that are caused by capillaries, veins and even arterioles as they possess a high liquid absorption ratio so can absorb blood platelets easily in comparison with traditional haemostasis treatments, which involve compression, ligation, or electrical coagulation etc. When in contact with blood, haemostatic sponges can cause platelet adhesion, aggregation, and thrombosis, preventing blood from flowing out from wounds, triggering the release of coagulation factors, causing the blood to form a stable polymerized fibre protein, forming blood clots, and achieving the goal of wound bleeding control. Haemostatic sponges are found in a variety of shapes and sizes. The aim of this review is to facilitate an overview of recent research around haemostatic sponge materials, products, and technology. This paper reviews the synthesis, properties, and characteristics of haemostatic sponges, together with the haemostasis mechanisms of haemostatic sponges (composite materials), such as chitosan, cellulose, gelatin, starch, graphene oxide, hyaluronic acid, alginate, polyethylene glycol, silk fibroin, synthetic polymers silver nanoparticles, zinc oxide nanoparticles, mesoporous silica nanoparticles, and silica nanoparticles. Also, this paper reviews commercial sponges and their properties. In addition to this, we discuss various in-vitro/in-vivo approaches for the evaluation of the effect of sponges on haemostasis .展开更多
Non-variceal upper gastrointestinal bleeding(NVUGIB)is one of the challenging situations in clinical practice.Despite that gastric ulcer and duodenal ulcer are still the main causes of acute NVUGIB,there are other cau...Non-variceal upper gastrointestinal bleeding(NVUGIB)is one of the challenging situations in clinical practice.Despite that gastric ulcer and duodenal ulcer are still the main causes of acute NVUGIB,there are other causes of bleeding which might not always be detected through the standard endoscopic evaluation.Standard endoscopic management of UGIB consists of injection,thermal coagulation,hemoclips,and combination therapy.However,these methods are not always successful for rebleeding prevention.Endoscopic ultrasound(EUS)has been used recently for portal hypertension management,especially in managing acute variceal bleeding.EUS has been considered a better tool to visualize the bleeding vessel in gastroesophageal variceal bleeding.There have been studies looking at the role of EUS for managing NVUGIB;however,most of them are case reports.Therefore,it is important to review back to see the evolution and innovation of endoscopic treatment for NVUGIB and the role of EUS for possibility to replace the standard endoscopic haemostasis management in daily practice.展开更多
AIMTo investigate the relationship between baseline platelet count, clauss fibrinogen, maximum amplitude (MA) on thromboelastography, and blood loss in orthotopic liver transplantation (OLT). METHODSA retrospective an...AIMTo investigate the relationship between baseline platelet count, clauss fibrinogen, maximum amplitude (MA) on thromboelastography, and blood loss in orthotopic liver transplantation (OLT). METHODSA retrospective analysis of our OLT Database (2006-2015) was performed. Baseline haematological indices and intraoperative blood transfusion requirements, as a combination of cell salvage return and estimation of 300 mls/unit of allogenic blood, was noted as a surrogate for intraoperative bleeding. Two groups: Excessive transfusion (> 1200 mL returned) and No excessive transfusion ( RESULTSOf 322 OLT patients, 77 were excluded due to fulminant disease; redo transplant or baseline haemoglobin (Hb) of P ≤ 0.001), platelet count (P = 0.005), clauss fibrinogen (P = 0.004) and heparinase MA (P = 0.001) were all statistically significantly different. Univariate logistic regression with a cut-off of platelets 9</sup>/L as the predictor and Haemorrhage as the outcome showed an odds ratio of 1.393 (95%CI: 0.758-2.563; P = 0.286). Review of receiver operating characteristic curves showed an area under the curve (AUC) for platelet count of 0.604 (95%CI: 0.534-0.675; P = 0.005) as compared with AUC for fibrinogen level, 0.678 (95%CI: 0.612-0.744; P ≤ 0.001). A multivariate logistic regression shows United Kingdom model for End Stage Liver Disease (P = 0.006), Hb (P = 0.022) and Fibrinogen (P = 0.026) to be statistically significant, whereas Platelet count was not statistically significant. CONCLUSIONPlatelet count alone does not predict excessive transfusion. Additional investigations, e.g., clauss fibrinogen and viscoelastic tests, provide more robust assessment of bleeding-risk in thrombocytopenia and cirrhosis.展开更多
Hepatic artery thrombosis(HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end st...Hepatic artery thrombosis(HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end stage liver disease and the disturbance of the coagulation and anticoagulation cascades play an important role in development of this lethal complication. Early recognition and therapeutic intervention is mandatory to avoid its consequences. Pharmacological prophylaxis, by the use of antiplatelet or anticoagulant agents, is an important tool to reduce its incidence and prevent graft loss. Only a few studies have shown a clear benefit of antiplatelet agents in reducing HAT occurrence, however, these studies are limited by being retrospective and by inhomogeneous populations. The use of anticoagulants such as heparin is associated with an improvement in the outcomes mainly when used for a high-risk patients like living related liver recipients. The major concern when using these agents is the tendency to increase bleeding complications in a setting of already unstable haemostasis. Hence, monitoring of their administration and careful selection of patients to be treated are of great importance. Well-designed clinical studies are still needed to further explore their effects and to formulate proper protocols that can be implemented safely.展开更多
BACKGROUND Gastrointestinal(GI) bleeding is a common indication for endoscopy. For refractory cases, hemostatic powders(HP) represent "touch-free" agents.AIM To analyze short term(ST-within 72 h-) and long-t...BACKGROUND Gastrointestinal(GI) bleeding is a common indication for endoscopy. For refractory cases, hemostatic powders(HP) represent "touch-free" agents.AIM To analyze short term(ST-within 72 h-) and long-term(LT-within 30 d-) success for achieving hemostasis with HP and to directly compare the two agents Hemospray(HS) and Endoclot(EC).METHODS HP was applied in 154 consecutive patients(mean age 67 years) with GI bleeding.Patients were followed up for 1 mo(mean follow-up: 3.2 mo).RESULTS Majority of applications were in upper GI tract(89%) with following bleeding sources: peptic ulcer disease(35%), esophageal varices(7%), tumor bleeding(11.7%), reflux esophagitis(8.7%), diffuse bleeding and erosions(15.3%). Overall ST success was achieved in 125 patients(81%) and LT success in 81 patients(67%). Re-bleeding occurred in 27% of all patients. In 72 patients(47%), HP was applied as a salvage hemostatic therapy, here ST and LT success were 81% and64%, with re-bleeding in 32%. As a primary hemostatic therapy, ST and LT success were 82% and 69%, with re-bleeding occurring in 22%. HS was more frequently applied for upper GI bleeding(P = 0.04)CONCLUSION Both HP allow for effective hemostasis with no differences in ST, LT success and re-bleeding.展开更多
BACKGROUND Conventional coagulation tests are widely used in chronic liver disease to assess haemostasis and to guide blood product transfusion.This is despite the fact that conventional tests do not reliably separate...BACKGROUND Conventional coagulation tests are widely used in chronic liver disease to assess haemostasis and to guide blood product transfusion.This is despite the fact that conventional tests do not reliably separate those with a clinically significant coagulopathy from those who do not.Viscoelastic testing such as thromboelastography(TEG)correlate with bleeding risk and are more accurate in identifying those who will benefit from blood product transfusion.Despite this,viscoelastic tests have not been widely used in patients with chronic liver disease outside the transplant setting.AIM To assess the utility of Viscoelastic Testing guided transfusion in chronic liver disease patients presenting with bleeding or who require an invasive procedure.METHODS PubMed and Google Scholar searches were performed using the key words“thromboelastography”,“TEG”or“viscoelastic”and“liver transplantation”,“cirrhosis”or“liver disease”and“transfusion”,“haemostasis”,“blood management”or“haemorrhage”.A full text review was undertaken and data was extracted from randomised control trials that evaluated the outcomes of viscoelastic test guided transfusion in those with liver disease.The study subjects,inclusion and exclusion criteria,methods,outcomes and length of follow up were examined.Data was extracted by two independent individuals using a standardized collection form.The risk of bias was assessed in the included studies.RESULTS A total of five randomised control trials included in the analysis examined the use of TEG guided blood product transfusion in cirrhosis prior to invasive procedures(n=118),non-variceal haemorrhage(n=96),variceal haemorrhage(n=60)and liver transplantation(n=28).TEG guided transfusion was effective in all five studies with a statistically significant reduction in overall blood product transfusion compared to standard of care.Four of the five studies reported a significant reduction in transfusion of fresh frozen plasma and platelets.Two studies showed a significant reduction in cryoprecipitate transfusion.No increased risk of bleeding was reported in the three trials where TEG was used perioperatively or prior to an invasive procedure.Two trials in the setting of cirrhotic variceal and non-variceal bleeding showed no difference in control of initial bleeding.In those with variceal bleeding,there was a statistically significant reduction in rate of re-bleeding at 42 d in the TEG arm 10%(vs 26.7%in the standard of care arm P=0.012).Mortality data reported at various time points for all five trials from 6 wk up to 3 years was not statistically different between each arm.One trial in the setting of non-variceal bleeding demonstrated a significant reduction in adverse transfusion events in the TEG arm 30.6%(vs 74.5%in the control arm P<0.01).In this study there was no significant difference in total hospital stay although length of stay in intensive care unit was reduced by an average of 2 d in the TEG arm(P=0.012).CONCLUSION Viscoelastic testing has been shown to reduce blood product usage in chronic liver disease without compromising safety and may enable guidelines to be developed to ensure patients with liver disease are optimally managed.展开更多
BACKGROUND Acute severe variceal bleeding(AVB)refractory to medical and endoscopic therapy is infrequent but associated with high mortality.Historical cohort studies from 1970-1980s no longer represent the current pop...BACKGROUND Acute severe variceal bleeding(AVB)refractory to medical and endoscopic therapy is infrequent but associated with high mortality.Historical cohort studies from 1970-1980s no longer represent the current population as balloon tamponade is no longer first-line therapy for variceal bleeding;treatments including vasoactive therapies,intravenous antibiotics,endoscopic variceal band ligation are routinely used,and there is improved access to definitive treatments including transjugular intrahepatic portosystemic shunts.However,only a few studies from the current era exist to describe the practice of balloon tamponade,its outcomes,and predictors with a requirement for further updated information.AIM To describe current management of AVB requiring balloon tamponade and identify the outcomes and predictors of mortality,re-bleeding and complications.METHODS A retrospective multi-centre cohort study of 80 adult patients across two large tertiary health networks from 2008 to 2019 in Australia who underwent balloon tamponade using a Sengstaken-Blakemore tube(SBT)were included for analysis.Patients were identified using coding for balloon tamponade.The primary outcome of this study was all-cause mortality at 6 wk after the index AVB.Secondary outcomes included re-bleeding during hospitalisation and complications of balloon tamponade.Predictors of these outcomes were determined using univariate and multivariate binomial regression.RESULTS The all-cause mortality rates during admission and at 6-,26-and 52 wk were 48.8%,51.2%and 53.8%,respectively.Primary haemostasis was achieved in 91.3%and re-bleeding during hospitalisation occurred in 34.2%.Independent predictors of 6 wk mortality on multivariate analysis included the Model for Endstage Liver disease(MELD)score(OR 1.21,95%CI 1.06-1.41,P=0.006),advanced hepatocellular carcinoma(OR 11.51,95%CI 1.61-82.20,P=0.015)and re-bleeding(OR 13.06,95%CI 3.06-55.71,P<0.001).There were no relevant predictors of re-bleeding but a large proportion in which this occurred did not survive 6 wk(76.0%vs 24%).Although mucosal trauma was the most common documented complication after SBT insertion(89.5%),serious complications from SBT insertion were uncommon(6.3%)and included 1 patient who died from oesophageal perforation.CONCLUSION In refractory AVB,balloon tamponade salvage therapy is associated with high rates of primary haemostasis with low rates of serious complications.Re-bleeding and mortality however,remain high.展开更多
Introduction: Haemostasis is a critical component of ear surgeries, which can be achieved by topical methods including simple manual pressure with gauze or cotton balls soaked with adrenaline, administration of haemos...Introduction: Haemostasis is a critical component of ear surgeries, which can be achieved by topical methods including simple manual pressure with gauze or cotton balls soaked with adrenaline, administration of haemostatic agents or vasoconstrictive materials. Objective: To compare efficacy of haemocoagulase and adrenaline in attaining middle ear haemostasis in type - 1 tympanoplasty with or without cortical mastoidectomy. To study the effect of haemocoagulase in middle ear. Materials and method: This is a prospective comparative study conducted in a tertiary care hospital from January 2013 to June 2014. Patients undergoing type 1 tympanoplasty with or without cortical mastoidectomy were divided into two groups. In group A (50 cases), cotton balls soaked in 2ml Haemocoagulase was used and in group B (50 cases) cotton balls soaked in 2 ml Adrenaline (1:1000 dilution) was used for middle ear haemostasis. The efficacy of haemocoagulase and adrenaline was compared. Results: The mean number of cotton balls used in haemocoagulase group in cases with congested middle ear mucosa was more than those used in the adrenaline group. Duration of surgery was more in haemocoagulase group (65 min) with congested mucosa, compared to adrenaline group (50 min). The mean blood pressure was significantly higher in adrenaline group compared to haemocoagulase group. Postoperative hearing improvement in both groups showed no significant difference with p value 0.694. Conclusions: Adrenaline is a better middle ear haemostatic than haemocoagulase. However, haemocoagulase can safely be used in patients with hypertension.展开更多
BACKGROUND Acquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages.The underlying disorder ca...BACKGROUND Acquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages.The underlying disorder causing the development of an autoimmune phenomenon is not always known,but 10%-15%could be linked to malignancies.Patients with cancer who require surgical resection represent a treatment challenge not solely due to increased risk of bleeding but also due to adverse events of immunosuppressive therapy.CASE SUMMARY We present the case of a 67-year-old man with non-metastatic adenocarcinoma of the distal bile duct who developed concomitant acquired haemophilia a month after having been diagnosed with malignant disease.Haemostasis was established with recombinant activated factor VII,and immunosuppressive therapy was started immediately.An extensive surgical procedure was performed in order to remove the cancer and,therefore,eliminate the inhibitory autoantibodies.Due to a complicated postoperative course,relatively short period of treatment and likelihood of micrometastases,no improvement in the patient’s status was observed.Diagnosis and treatment of acquired haemophilia as well as other coagulation disorders in patients with cancer are discussed.CONCLUSION Prompt diagnosis of acquired haemophilia is required in order to start appropriate treatment and reduce mortality.Among patients with cancer,other causes of abnormal bleeding related to malignancy should be considered.展开更多
In order to solve the problem of intraperitoneal haemorrhage and bile leakage caused by the iatrogenic trauma, sixty-four sequence of puncture were performed on twenty canine livers and thirty-two sequences selected b...In order to solve the problem of intraperitoneal haemorrhage and bile leakage caused by the iatrogenic trauma, sixty-four sequence of puncture were performed on twenty canine livers and thirty-two sequences selected by chance were perfused with thrombin solution. The results revealed that the bleeding time was shortened and amounts lessened significantly after application of thrombin compared with counterparts of control (P< 0. 001,t test).There was no significant difference between the levels of plasma fibringgeu prc-and Post-thrombin's using (P > 0.4,t test).The thrombin clotting time of patients with obstructive jaundice was similar to that of the group of control(P> 0. 05, t test).We conclude that thrombin is characterized by the ability of rapid,effective and safe haemostasis to the traumatic channel made by the liver puncture,and it's adaptive to most of the patients with hepatobiliary disease,and worth using and developing in clinical practice.展开更多
Objectives: Carbon monoxide (CO) is an odourless and highly toxic gas produced from incomplete combustion of fuel. This gas has capacity to bind with haemoglobin to compete for oxygen uptake when inhaled, thereby alte...Objectives: Carbon monoxide (CO) is an odourless and highly toxic gas produced from incomplete combustion of fuel. This gas has capacity to bind with haemoglobin to compete for oxygen uptake when inhaled, thereby altering the blood physiology. Aim: The aim of this study is to determine the effect of carbon monoxide on haematology and haemostasis parameters among the exposed workers at gasoline generators service centre in Benin City. Methodology: Eighty-eight participants (workers n = 44 and;controls n = 44) took part in this study. Carbon monoxide used for this study was sourced from the smoke being emitted by gasoline generators during repairs. The participants’ haematological parameters were analysed using haematology autoanalyzer (Sysmex Poch 100i model, Germany), while PT and PTTK were assayed using standard methods. Results: The mean values of red blood cells (RBC), white blood cells (WBC), platelets (PLT), haemoglobin concentration (Hb), hematocrit (HCT), mean cell volume (MCV), mean cell haemoglobin (MCH), mean cell hemoglobin concentration (MCHC) and red cell distribution width coefficient variation (RDW-CV) observed in both the workers at generator service center and their controls fell within normal ranges, but the mean red cell distribution width standard deviation (RDW-SD) of workers at generator service center fell below normal as against the normal value for controls. There were no significant differences in serum concentrations of lymphocytes (p = 0.134), and granulocytes (p = 0.584). In contrast, significantly (p Conclusion: In this study, carbon monoxide emitted during repairs has no deleterious effects on haematological and haemostasis parameters of the exposed workers at generator service centre in Benin City. However, PT and PTT exceeded normal value in the workers at the generator service centre compared to the controls. More work needs to be done especially on longer duration of exposure and at various concentrations of carbon monoxide exposure.展开更多
Background: Many surgical haemostatic agents are available which aim to reduce morbidity and mortality of bleeding, as well as associated costs. We used qualitative techniques to compare the effectiveness of two topic...Background: Many surgical haemostatic agents are available which aim to reduce morbidity and mortality of bleeding, as well as associated costs. We used qualitative techniques to compare the effectiveness of two topical gelatine-based haemostatic agents in a porcine liver trauma model. Methods: We compared the activity of Floseal? (with human or bovine thrombin), Surgiflo? and Surgiflo? plus 5000 IU bovine thrombin per 10 mL of product (n = 6 test sites/group). Different clinical scenarios were evaluated in two anaesthetised piglets;normal physiological conditions (normotension and normothermia), and a status of hypotension, hypothermia and haemodilution, requiring inotropic support. Laparotomy was performed, and five identical stab wounds were made on each liver lobe. Four of these wounds were randomly treated with one of the agents under investigation, while one wound was kept as an untreated control. Haemostasis was observed during and immediately following surgery. After euthanisation, wounds were examined (blinded for treatment) macroscopically, microscopically and using scanning electron microscopic evaluation. Results: Surgiflo? produced some degree of clotting in 1/3 applications in both piglets. Co-treatment with thrombin resulted in a minor improvement in performance in the animal with normal physiological conditions (some degree of clotting in all wounds);no improvement was seen in the animal in a status of hypotension, hypothermia and haemodilution. Floseal? induced clotting in all wounds for both piglets. Microscopic and scanning electron microscope examination of the stab wounds demonstrated that Floseal? created a stable, dense agglomerate of gelatine and fibrin, which firmly adhered to the adjacent liver tissue. In wounds treated with Surgiflo? or Surgiflo? plus thrombin, the gelatine contained more air bubbles, resulting in less fibrin inclusion in the clot and weaker adhesion of the clot to the liver tissue. Conclusion: Floseal? created a dense and stable blood clot, even in a piglet with hypotension, hypothermia and haemodilution.展开更多
In the absence of interventional endoscopy, the treatment of upper digestive haemorrhages (HDH) at Brazzaville University Hospital is essentially medicinal. The objective of this work was to identify the risk factors ...In the absence of interventional endoscopy, the treatment of upper digestive haemorrhages (HDH) at Brazzaville University Hospital is essentially medicinal. The objective of this work was to identify the risk factors for HDH mortality at Brazzaville University Hospital by conducting a retrospective prognostic case-control study over a period of 2 years, from January 2017 to December 2018. The 180 patients included in the study for an HDH were divided into 2 groups according to their evolutionary modality: deceased patients (cases) and non deceased patients (controls). The mortality risk factors were studied by logistic regression. Mortality related to upper digestive haemorrhages was 36.6%;the risk factors for death were age between 30 and 60 years with a (OR: 9.79;95% CI [1.24 - 76.83];p = 0.003);male sex (OR: 2.03;95% CI [1.03 - 4];p = 0.0393);late consultation beyond 24 hours (OR: 6.30;95% CI [2.12 - 18.72];p = 0.0009), blood transfusions (OR: 3.5;95% CI [1.66 - 7.40];p = 0.0001). Protective factors were haemoglobin greater than 7 g/dL (OR: 0.28;95% CI [0.14 - 0.54];p = 0.0001);treatment with proton pump inhibitors (OR: 0.36;95% CI [0.15 - 0.84];p = 0.0191). In conclusion, the reduction of the still high mortality rate in our country requires taking into account the identified risk factors and the acquisition of endoscopic haemostasis equipment.展开更多
Background The non-operation treatment of intra-abdominal trauma guided contrast enhanced ultrasound （CEUS） is one of the hottest research topic. Gelatin/thrombin/calcium （GTC） was developed as a novel haemostatic...Background The non-operation treatment of intra-abdominal trauma guided contrast enhanced ultrasound （CEUS） is one of the hottest research topic. Gelatin/thrombin/calcium （GTC） was developed as a novel haemostatic agent for non-operable intra-abdominal trauma. We hypothesized that GTC can achieve haemostasis （without the use of pressure）within a short time in a large wound model by percutaneous injection under CEUS guidance.Methods Forty Wister rats received large liver injuries by haemostatic clamp and were randomly divided into four groups, according to the haemostatic agent used. These included normal saline （NS） group A, lyophilising thrombin powder （LTP） group B, GTC group C, and absorbable α-cyanoacrylate （ACNA） group D. Each injury site was treated with one of the above materials and total bleeding time was recorded. All liver wounds were evaluated using CEUS at three periods： pre-injury, injury and post-treatment. The liver wounds were also evaluated by histology 3, 6, and 9 days after injury and the extents of abdominal adhesions were recorded.Results The sensitivity of CEUS （100%） in detecting blunt traumatic liver lesions was significantly higher than conventional ultrasound （42.5%）. Bleeding times at the injury site in the GTC group C （（129.3±14.0） seconds） and ACNA group D （（5.2±1.0） seconds） were significantly shorter than those in the NS group A （（369.5±48.8） seconds, P ＜0.01） and LTP group B （（324.7±52.22） seconds, P ＜0.01）. The LTP group B showed no significant difference compared with the NS group A. Gross examination of liver tissue revealed that there were fewer intra-abdominal adhesions in the GTC group C （10%） than in the ACNA group D （100%）. Histopathologic examination showed that GTC was completely absorbed after nine days.Conclusions GTC, delivered by percutaneous injection under CEUS, may achieve haemostasis （without the use of pressure） within a short time in a large wound model. GTC is absorbable and may prevent intra-abdominal adhesions.Therefore, it may be the optimal choice for first aid treatment of large abdominal wounds in the setting of blunt trauma.展开更多
文摘The novel modifications of substrate-containing sodium dodecyl sulfate-polyacrylamide gel electrophoresis that can be used for the detection of proteases and its activators are reported. The protease/activator samples were separated on a protein substrate-SDS-polyacrylamide gel. To detect plasminogen activators fibrinogen and Glu-plasminogen were incorporated into the SDS-PAG followed by 1 h incubation at 37?C in thrombin solution (1 NIH/ml). After electrophoresis the gel was stained according to the standard protocol. To detect fibrin-unspecific plasminogen activators from snake venom incubation in thrombin solution was substituted for 12 h incubation in 50 mM Tris-HCl (pH 7.4). To detect fibrinogen-degrading enzymes fibrinogen-containing gel was used. Activity of protease/activator was visualized in the gel as clear bands against the dark background. These new techniques offer several advantages including determination of the quantity and activity of t-PA and urokinase, however cannot be recommended for precise quantification of activators;the total procedure is quite quick and simple;method is convenient tool for detection of novel protein-protein interactions in haemostasis system;the sensitivity of the method is ≤0.01 IU per track.
文摘<b>Title:</b> Assessment of haemostasis in anaesthesia for surgery at the Sylvanus Olympio University Hospital Center in Lomé. <b>Objectives:</b> Evaluate the prescription of the preoperative haemostasis assessment. <b>Methodology:</b> This was a prospective descriptive and observational study which had taken place in the central operating room and in the operating room of the ENT department at UHC SO of Lomé from January 1 to June 31, 2016. It had concerned all patients who had anaesthesia for scheduled surgery after pre-anesthetic consultation and the haemostasis assessment carried out according to the anaesthesia technique and the type of surgery. <b>Results:</b> Two hundred and sixty (260) patients underwent anaesthesia during the study period. The male sex predominated (60%), the age group 18 - 40 years predominated (50.4%). GA was more practiced (62.7%) followed by spinal anaesthesia (30.3%). Minor ENT surgery was more performed (28%). ASA1 patients predominated (48.5%). The pre-anesthetic haemostasis assessment including platelet count, prothrombin rate, activated partial thromboplastin time and bleeding time was almost always done. The platelet count was achieved in all patients followed by the activated partial thromboplastin time (94%). No haemorrhagic complication related to a haemostasis disorder was observed in the perioperative period in anaesthesia than in surgery. <b>Conclusion:</b> The prescription of the pre-anesthetic haemostasis assessment should not be systematic. It must take into account the clinical history, the patient’s bleeding history during the anaesthesia consultation, the type of anaesthesia, the surgery planned and the age.
基金supported by Australian National Health and Medical Research Council(HTT:APP1037310,APP1182347,APP2002827).
文摘In traumatized patients, the primary cause of mortality is uncontrollable continuous bleeding and unexpected intraoperative bleeding which is likely to increase the risk of complications and surgical failure. High expansion sponges are effective clinical practice for the treatment of wound bleeding (irregular/deep/narrow) that are caused by capillaries, veins and even arterioles as they possess a high liquid absorption ratio so can absorb blood platelets easily in comparison with traditional haemostasis treatments, which involve compression, ligation, or electrical coagulation etc. When in contact with blood, haemostatic sponges can cause platelet adhesion, aggregation, and thrombosis, preventing blood from flowing out from wounds, triggering the release of coagulation factors, causing the blood to form a stable polymerized fibre protein, forming blood clots, and achieving the goal of wound bleeding control. Haemostatic sponges are found in a variety of shapes and sizes. The aim of this review is to facilitate an overview of recent research around haemostatic sponge materials, products, and technology. This paper reviews the synthesis, properties, and characteristics of haemostatic sponges, together with the haemostasis mechanisms of haemostatic sponges (composite materials), such as chitosan, cellulose, gelatin, starch, graphene oxide, hyaluronic acid, alginate, polyethylene glycol, silk fibroin, synthetic polymers silver nanoparticles, zinc oxide nanoparticles, mesoporous silica nanoparticles, and silica nanoparticles. Also, this paper reviews commercial sponges and their properties. In addition to this, we discuss various in-vitro/in-vivo approaches for the evaluation of the effect of sponges on haemostasis .
文摘Non-variceal upper gastrointestinal bleeding(NVUGIB)is one of the challenging situations in clinical practice.Despite that gastric ulcer and duodenal ulcer are still the main causes of acute NVUGIB,there are other causes of bleeding which might not always be detected through the standard endoscopic evaluation.Standard endoscopic management of UGIB consists of injection,thermal coagulation,hemoclips,and combination therapy.However,these methods are not always successful for rebleeding prevention.Endoscopic ultrasound(EUS)has been used recently for portal hypertension management,especially in managing acute variceal bleeding.EUS has been considered a better tool to visualize the bleeding vessel in gastroesophageal variceal bleeding.There have been studies looking at the role of EUS for managing NVUGIB;however,most of them are case reports.Therefore,it is important to review back to see the evolution and innovation of endoscopic treatment for NVUGIB and the role of EUS for possibility to replace the standard endoscopic haemostasis management in daily practice.
文摘AIMTo investigate the relationship between baseline platelet count, clauss fibrinogen, maximum amplitude (MA) on thromboelastography, and blood loss in orthotopic liver transplantation (OLT). METHODSA retrospective analysis of our OLT Database (2006-2015) was performed. Baseline haematological indices and intraoperative blood transfusion requirements, as a combination of cell salvage return and estimation of 300 mls/unit of allogenic blood, was noted as a surrogate for intraoperative bleeding. Two groups: Excessive transfusion (> 1200 mL returned) and No excessive transfusion ( RESULTSOf 322 OLT patients, 77 were excluded due to fulminant disease; redo transplant or baseline haemoglobin (Hb) of P ≤ 0.001), platelet count (P = 0.005), clauss fibrinogen (P = 0.004) and heparinase MA (P = 0.001) were all statistically significantly different. Univariate logistic regression with a cut-off of platelets 9</sup>/L as the predictor and Haemorrhage as the outcome showed an odds ratio of 1.393 (95%CI: 0.758-2.563; P = 0.286). Review of receiver operating characteristic curves showed an area under the curve (AUC) for platelet count of 0.604 (95%CI: 0.534-0.675; P = 0.005) as compared with AUC for fibrinogen level, 0.678 (95%CI: 0.612-0.744; P ≤ 0.001). A multivariate logistic regression shows United Kingdom model for End Stage Liver Disease (P = 0.006), Hb (P = 0.022) and Fibrinogen (P = 0.026) to be statistically significant, whereas Platelet count was not statistically significant. CONCLUSIONPlatelet count alone does not predict excessive transfusion. Additional investigations, e.g., clauss fibrinogen and viscoelastic tests, provide more robust assessment of bleeding-risk in thrombocytopenia and cirrhosis.
文摘Hepatic artery thrombosis(HAT) is the most serious vascular complication after liver transplantation. Multiple risk factors have been identified to impact its development. Changes in haemostasis associated with end stage liver disease and the disturbance of the coagulation and anticoagulation cascades play an important role in development of this lethal complication. Early recognition and therapeutic intervention is mandatory to avoid its consequences. Pharmacological prophylaxis, by the use of antiplatelet or anticoagulant agents, is an important tool to reduce its incidence and prevent graft loss. Only a few studies have shown a clear benefit of antiplatelet agents in reducing HAT occurrence, however, these studies are limited by being retrospective and by inhomogeneous populations. The use of anticoagulants such as heparin is associated with an improvement in the outcomes mainly when used for a high-risk patients like living related liver recipients. The major concern when using these agents is the tendency to increase bleeding complications in a setting of already unstable haemostasis. Hence, monitoring of their administration and careful selection of patients to be treated are of great importance. Well-designed clinical studies are still needed to further explore their effects and to formulate proper protocols that can be implemented safely.
文摘BACKGROUND Gastrointestinal(GI) bleeding is a common indication for endoscopy. For refractory cases, hemostatic powders(HP) represent "touch-free" agents.AIM To analyze short term(ST-within 72 h-) and long-term(LT-within 30 d-) success for achieving hemostasis with HP and to directly compare the two agents Hemospray(HS) and Endoclot(EC).METHODS HP was applied in 154 consecutive patients(mean age 67 years) with GI bleeding.Patients were followed up for 1 mo(mean follow-up: 3.2 mo).RESULTS Majority of applications were in upper GI tract(89%) with following bleeding sources: peptic ulcer disease(35%), esophageal varices(7%), tumor bleeding(11.7%), reflux esophagitis(8.7%), diffuse bleeding and erosions(15.3%). Overall ST success was achieved in 125 patients(81%) and LT success in 81 patients(67%). Re-bleeding occurred in 27% of all patients. In 72 patients(47%), HP was applied as a salvage hemostatic therapy, here ST and LT success were 81% and64%, with re-bleeding in 32%. As a primary hemostatic therapy, ST and LT success were 82% and 69%, with re-bleeding occurring in 22%. HS was more frequently applied for upper GI bleeding(P = 0.04)CONCLUSION Both HP allow for effective hemostasis with no differences in ST, LT success and re-bleeding.
文摘BACKGROUND Conventional coagulation tests are widely used in chronic liver disease to assess haemostasis and to guide blood product transfusion.This is despite the fact that conventional tests do not reliably separate those with a clinically significant coagulopathy from those who do not.Viscoelastic testing such as thromboelastography(TEG)correlate with bleeding risk and are more accurate in identifying those who will benefit from blood product transfusion.Despite this,viscoelastic tests have not been widely used in patients with chronic liver disease outside the transplant setting.AIM To assess the utility of Viscoelastic Testing guided transfusion in chronic liver disease patients presenting with bleeding or who require an invasive procedure.METHODS PubMed and Google Scholar searches were performed using the key words“thromboelastography”,“TEG”or“viscoelastic”and“liver transplantation”,“cirrhosis”or“liver disease”and“transfusion”,“haemostasis”,“blood management”or“haemorrhage”.A full text review was undertaken and data was extracted from randomised control trials that evaluated the outcomes of viscoelastic test guided transfusion in those with liver disease.The study subjects,inclusion and exclusion criteria,methods,outcomes and length of follow up were examined.Data was extracted by two independent individuals using a standardized collection form.The risk of bias was assessed in the included studies.RESULTS A total of five randomised control trials included in the analysis examined the use of TEG guided blood product transfusion in cirrhosis prior to invasive procedures(n=118),non-variceal haemorrhage(n=96),variceal haemorrhage(n=60)and liver transplantation(n=28).TEG guided transfusion was effective in all five studies with a statistically significant reduction in overall blood product transfusion compared to standard of care.Four of the five studies reported a significant reduction in transfusion of fresh frozen plasma and platelets.Two studies showed a significant reduction in cryoprecipitate transfusion.No increased risk of bleeding was reported in the three trials where TEG was used perioperatively or prior to an invasive procedure.Two trials in the setting of cirrhotic variceal and non-variceal bleeding showed no difference in control of initial bleeding.In those with variceal bleeding,there was a statistically significant reduction in rate of re-bleeding at 42 d in the TEG arm 10%(vs 26.7%in the standard of care arm P=0.012).Mortality data reported at various time points for all five trials from 6 wk up to 3 years was not statistically different between each arm.One trial in the setting of non-variceal bleeding demonstrated a significant reduction in adverse transfusion events in the TEG arm 30.6%(vs 74.5%in the control arm P<0.01).In this study there was no significant difference in total hospital stay although length of stay in intensive care unit was reduced by an average of 2 d in the TEG arm(P=0.012).CONCLUSION Viscoelastic testing has been shown to reduce blood product usage in chronic liver disease without compromising safety and may enable guidelines to be developed to ensure patients with liver disease are optimally managed.
文摘BACKGROUND Acute severe variceal bleeding(AVB)refractory to medical and endoscopic therapy is infrequent but associated with high mortality.Historical cohort studies from 1970-1980s no longer represent the current population as balloon tamponade is no longer first-line therapy for variceal bleeding;treatments including vasoactive therapies,intravenous antibiotics,endoscopic variceal band ligation are routinely used,and there is improved access to definitive treatments including transjugular intrahepatic portosystemic shunts.However,only a few studies from the current era exist to describe the practice of balloon tamponade,its outcomes,and predictors with a requirement for further updated information.AIM To describe current management of AVB requiring balloon tamponade and identify the outcomes and predictors of mortality,re-bleeding and complications.METHODS A retrospective multi-centre cohort study of 80 adult patients across two large tertiary health networks from 2008 to 2019 in Australia who underwent balloon tamponade using a Sengstaken-Blakemore tube(SBT)were included for analysis.Patients were identified using coding for balloon tamponade.The primary outcome of this study was all-cause mortality at 6 wk after the index AVB.Secondary outcomes included re-bleeding during hospitalisation and complications of balloon tamponade.Predictors of these outcomes were determined using univariate and multivariate binomial regression.RESULTS The all-cause mortality rates during admission and at 6-,26-and 52 wk were 48.8%,51.2%and 53.8%,respectively.Primary haemostasis was achieved in 91.3%and re-bleeding during hospitalisation occurred in 34.2%.Independent predictors of 6 wk mortality on multivariate analysis included the Model for Endstage Liver disease(MELD)score(OR 1.21,95%CI 1.06-1.41,P=0.006),advanced hepatocellular carcinoma(OR 11.51,95%CI 1.61-82.20,P=0.015)and re-bleeding(OR 13.06,95%CI 3.06-55.71,P<0.001).There were no relevant predictors of re-bleeding but a large proportion in which this occurred did not survive 6 wk(76.0%vs 24%).Although mucosal trauma was the most common documented complication after SBT insertion(89.5%),serious complications from SBT insertion were uncommon(6.3%)and included 1 patient who died from oesophageal perforation.CONCLUSION In refractory AVB,balloon tamponade salvage therapy is associated with high rates of primary haemostasis with low rates of serious complications.Re-bleeding and mortality however,remain high.
文摘Introduction: Haemostasis is a critical component of ear surgeries, which can be achieved by topical methods including simple manual pressure with gauze or cotton balls soaked with adrenaline, administration of haemostatic agents or vasoconstrictive materials. Objective: To compare efficacy of haemocoagulase and adrenaline in attaining middle ear haemostasis in type - 1 tympanoplasty with or without cortical mastoidectomy. To study the effect of haemocoagulase in middle ear. Materials and method: This is a prospective comparative study conducted in a tertiary care hospital from January 2013 to June 2014. Patients undergoing type 1 tympanoplasty with or without cortical mastoidectomy were divided into two groups. In group A (50 cases), cotton balls soaked in 2ml Haemocoagulase was used and in group B (50 cases) cotton balls soaked in 2 ml Adrenaline (1:1000 dilution) was used for middle ear haemostasis. The efficacy of haemocoagulase and adrenaline was compared. Results: The mean number of cotton balls used in haemocoagulase group in cases with congested middle ear mucosa was more than those used in the adrenaline group. Duration of surgery was more in haemocoagulase group (65 min) with congested mucosa, compared to adrenaline group (50 min). The mean blood pressure was significantly higher in adrenaline group compared to haemocoagulase group. Postoperative hearing improvement in both groups showed no significant difference with p value 0.694. Conclusions: Adrenaline is a better middle ear haemostatic than haemocoagulase. However, haemocoagulase can safely be used in patients with hypertension.
文摘BACKGROUND Acquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages.The underlying disorder causing the development of an autoimmune phenomenon is not always known,but 10%-15%could be linked to malignancies.Patients with cancer who require surgical resection represent a treatment challenge not solely due to increased risk of bleeding but also due to adverse events of immunosuppressive therapy.CASE SUMMARY We present the case of a 67-year-old man with non-metastatic adenocarcinoma of the distal bile duct who developed concomitant acquired haemophilia a month after having been diagnosed with malignant disease.Haemostasis was established with recombinant activated factor VII,and immunosuppressive therapy was started immediately.An extensive surgical procedure was performed in order to remove the cancer and,therefore,eliminate the inhibitory autoantibodies.Due to a complicated postoperative course,relatively short period of treatment and likelihood of micrometastases,no improvement in the patient’s status was observed.Diagnosis and treatment of acquired haemophilia as well as other coagulation disorders in patients with cancer are discussed.CONCLUSION Prompt diagnosis of acquired haemophilia is required in order to start appropriate treatment and reduce mortality.Among patients with cancer,other causes of abnormal bleeding related to malignancy should be considered.
文摘In order to solve the problem of intraperitoneal haemorrhage and bile leakage caused by the iatrogenic trauma, sixty-four sequence of puncture were performed on twenty canine livers and thirty-two sequences selected by chance were perfused with thrombin solution. The results revealed that the bleeding time was shortened and amounts lessened significantly after application of thrombin compared with counterparts of control (P< 0. 001,t test).There was no significant difference between the levels of plasma fibringgeu prc-and Post-thrombin's using (P > 0.4,t test).The thrombin clotting time of patients with obstructive jaundice was similar to that of the group of control(P> 0. 05, t test).We conclude that thrombin is characterized by the ability of rapid,effective and safe haemostasis to the traumatic channel made by the liver puncture,and it's adaptive to most of the patients with hepatobiliary disease,and worth using and developing in clinical practice.
文摘Objectives: Carbon monoxide (CO) is an odourless and highly toxic gas produced from incomplete combustion of fuel. This gas has capacity to bind with haemoglobin to compete for oxygen uptake when inhaled, thereby altering the blood physiology. Aim: The aim of this study is to determine the effect of carbon monoxide on haematology and haemostasis parameters among the exposed workers at gasoline generators service centre in Benin City. Methodology: Eighty-eight participants (workers n = 44 and;controls n = 44) took part in this study. Carbon monoxide used for this study was sourced from the smoke being emitted by gasoline generators during repairs. The participants’ haematological parameters were analysed using haematology autoanalyzer (Sysmex Poch 100i model, Germany), while PT and PTTK were assayed using standard methods. Results: The mean values of red blood cells (RBC), white blood cells (WBC), platelets (PLT), haemoglobin concentration (Hb), hematocrit (HCT), mean cell volume (MCV), mean cell haemoglobin (MCH), mean cell hemoglobin concentration (MCHC) and red cell distribution width coefficient variation (RDW-CV) observed in both the workers at generator service center and their controls fell within normal ranges, but the mean red cell distribution width standard deviation (RDW-SD) of workers at generator service center fell below normal as against the normal value for controls. There were no significant differences in serum concentrations of lymphocytes (p = 0.134), and granulocytes (p = 0.584). In contrast, significantly (p Conclusion: In this study, carbon monoxide emitted during repairs has no deleterious effects on haematological and haemostasis parameters of the exposed workers at generator service centre in Benin City. However, PT and PTT exceeded normal value in the workers at the generator service centre compared to the controls. More work needs to be done especially on longer duration of exposure and at various concentrations of carbon monoxide exposure.
文摘Background: Many surgical haemostatic agents are available which aim to reduce morbidity and mortality of bleeding, as well as associated costs. We used qualitative techniques to compare the effectiveness of two topical gelatine-based haemostatic agents in a porcine liver trauma model. Methods: We compared the activity of Floseal? (with human or bovine thrombin), Surgiflo? and Surgiflo? plus 5000 IU bovine thrombin per 10 mL of product (n = 6 test sites/group). Different clinical scenarios were evaluated in two anaesthetised piglets;normal physiological conditions (normotension and normothermia), and a status of hypotension, hypothermia and haemodilution, requiring inotropic support. Laparotomy was performed, and five identical stab wounds were made on each liver lobe. Four of these wounds were randomly treated with one of the agents under investigation, while one wound was kept as an untreated control. Haemostasis was observed during and immediately following surgery. After euthanisation, wounds were examined (blinded for treatment) macroscopically, microscopically and using scanning electron microscopic evaluation. Results: Surgiflo? produced some degree of clotting in 1/3 applications in both piglets. Co-treatment with thrombin resulted in a minor improvement in performance in the animal with normal physiological conditions (some degree of clotting in all wounds);no improvement was seen in the animal in a status of hypotension, hypothermia and haemodilution. Floseal? induced clotting in all wounds for both piglets. Microscopic and scanning electron microscope examination of the stab wounds demonstrated that Floseal? created a stable, dense agglomerate of gelatine and fibrin, which firmly adhered to the adjacent liver tissue. In wounds treated with Surgiflo? or Surgiflo? plus thrombin, the gelatine contained more air bubbles, resulting in less fibrin inclusion in the clot and weaker adhesion of the clot to the liver tissue. Conclusion: Floseal? created a dense and stable blood clot, even in a piglet with hypotension, hypothermia and haemodilution.
文摘In the absence of interventional endoscopy, the treatment of upper digestive haemorrhages (HDH) at Brazzaville University Hospital is essentially medicinal. The objective of this work was to identify the risk factors for HDH mortality at Brazzaville University Hospital by conducting a retrospective prognostic case-control study over a period of 2 years, from January 2017 to December 2018. The 180 patients included in the study for an HDH were divided into 2 groups according to their evolutionary modality: deceased patients (cases) and non deceased patients (controls). The mortality risk factors were studied by logistic regression. Mortality related to upper digestive haemorrhages was 36.6%;the risk factors for death were age between 30 and 60 years with a (OR: 9.79;95% CI [1.24 - 76.83];p = 0.003);male sex (OR: 2.03;95% CI [1.03 - 4];p = 0.0393);late consultation beyond 24 hours (OR: 6.30;95% CI [2.12 - 18.72];p = 0.0009), blood transfusions (OR: 3.5;95% CI [1.66 - 7.40];p = 0.0001). Protective factors were haemoglobin greater than 7 g/dL (OR: 0.28;95% CI [0.14 - 0.54];p = 0.0001);treatment with proton pump inhibitors (OR: 0.36;95% CI [0.15 - 0.84];p = 0.0191). In conclusion, the reduction of the still high mortality rate in our country requires taking into account the identified risk factors and the acquisition of endoscopic haemostasis equipment.
文摘Background The non-operation treatment of intra-abdominal trauma guided contrast enhanced ultrasound （CEUS） is one of the hottest research topic. Gelatin/thrombin/calcium （GTC） was developed as a novel haemostatic agent for non-operable intra-abdominal trauma. We hypothesized that GTC can achieve haemostasis （without the use of pressure）within a short time in a large wound model by percutaneous injection under CEUS guidance.Methods Forty Wister rats received large liver injuries by haemostatic clamp and were randomly divided into four groups, according to the haemostatic agent used. These included normal saline （NS） group A, lyophilising thrombin powder （LTP） group B, GTC group C, and absorbable α-cyanoacrylate （ACNA） group D. Each injury site was treated with one of the above materials and total bleeding time was recorded. All liver wounds were evaluated using CEUS at three periods： pre-injury, injury and post-treatment. The liver wounds were also evaluated by histology 3, 6, and 9 days after injury and the extents of abdominal adhesions were recorded.Results The sensitivity of CEUS （100%） in detecting blunt traumatic liver lesions was significantly higher than conventional ultrasound （42.5%）. Bleeding times at the injury site in the GTC group C （（129.3±14.0） seconds） and ACNA group D （（5.2±1.0） seconds） were significantly shorter than those in the NS group A （（369.5±48.8） seconds, P ＜0.01） and LTP group B （（324.7±52.22） seconds, P ＜0.01）. The LTP group B showed no significant difference compared with the NS group A. Gross examination of liver tissue revealed that there were fewer intra-abdominal adhesions in the GTC group C （10%） than in the ACNA group D （100%）. Histopathologic examination showed that GTC was completely absorbed after nine days.Conclusions GTC, delivered by percutaneous injection under CEUS, may achieve haemostasis （without the use of pressure） within a short time in a large wound model. GTC is absorbable and may prevent intra-abdominal adhesions.Therefore, it may be the optimal choice for first aid treatment of large abdominal wounds in the setting of blunt trauma.
