Search Results (2,529)

Background/Objectives: This paper evaluates the incidence of thrombotic and/or hemorrhagic adverse events within 30 days after oral health procedures (OHPs) in patients taking antithrombotic agents. Secondary objectives were to determine proper antithrombotic management and its association with adverse events. Methods: As part of a multicenter multispecialty prospective observational study (ReQXAA), individuals with antithrombotic therapy and receiving at least one OHP were selected. Before OHP, participants were referred to their medical doctors to indicate the antithrombotic therapy management. Adverse events were evaluated thirty days after OHP by phone call. Proportions and odds ratios (ORs) were generated applying Fisher’s exact test, chi-square tests and multiple regression models. Results: A total of 138 patients underwent 144 OHPs. Fifteen adverse events (10.5%) were registered, among which the most frequent was slight bleeding (n = 13), which was followed by bleeding that required suspension of the antithrombotic agent (n = 1) and a myocardial infarction (n = 1). Antithrombotic management was appropriate in 122 (84.7%) cases. In 15.3% of the cases it was inappropriate, the main reason being the unnecessary interruption of the antithrombotic medication (n = 11; 50%). Inadequate management was associated with a higher incidence of adverse events (OR = 4.7; 95% confidence interval [1.3, 16.3]; p = 0.016) after adjusting for confounding factors. Conclusions: The incidence of adverse events 30 days after OHPs was low (10.5%). An inappropriate perioperative/periprocedural antithrombotic management occurred in 15.3% of the cases and was associated with a higher incidence of adverse events (OR = 4.7). Full article

Hematological studies provide essential information about the health of animals, which is crucial for veterinary medicine, scientific research, and aquaculture. Automatic hematological analyzers are an alternative to manual methods, offering faster and more reliable results. The objective of this study was to validate the Sysmex XN-1000V automatic hematology analyzer for blood samples from rainbow trout (Oncorhynchus mykiss), examine the effects of two anticoagulants (K₂EDTA and lithium heparin), and establish normal blood reference values for this fish species. Additionally, comparative studies were conducted between the Sysmex XN-1000V and manual methods (hemocytometer cell count and blood smear estimation), and reference intervals were established. Ninety-nine heparinized blood samples were analyzed for validation and sample stability tests. The results showed extremely good precision, with a coefficient of variation (CV) below 3% for RBCs, HGB, and HCT and less than 5% for non-RBC cells (leukocytes plus thrombocytes). However, heterophils (%) exhibited higher variability, with a CV of 15.08%. Linearity was excellent, and the carry-over was below 1% for all parameters. The sample stability test indicated that samples could be analyzed for up to 48 h when stored at 4 °C and up to 24 h at room temperature. Non-RBC cells were the first to degrade over time. The automated and manual methods demonstrated good correlation and agreement, validating the analyzer’s accuracy. The effects of two anticoagulants, K₂EDTA and lithium heparin, on the blood samples were also studied. Heparin was the preferred anticoagulant for routine hematological analysis of rainbow trout blood with the Sysmex XN-1000V analyzer. In conclusion, the Sysmex XN-1000V enables complete hemogram analyses to be performed quickly and accurately, standardizing techniques, harmonizing results, and providing reliable reference intervals with O mykiss blood. Full article

Objectives: Stroke is a leading cause of disability worldwide, requiring timely intervention with intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT). This study evaluates real-world stroke management in a regional stroke unit, focusing on IVT administration and EVT transfer logistics. Design: A sub-analysis was performed using prospectively collected data from an observational study. Setting: This study took place at a regional, non-university stroke unit in Germany, serving approximately 253,000 inhabitants. Participants: A total of 2436 patients were admitted for suspected stroke between May 2019 and June 2021. Outcome Measures: Outcome measures included IVT administration rates, reasons for IVT non-administration, and EVT transfer logistics for acute ischemic stroke (AIS) patients. Results: Of 952 stroke cases, 14.8% received IVT, with a mean door-to-needle time (DNT) of 41 ± 36 min. The most common reasons for IVT non-administration were unclear or elapsed symptom onset (51.8%), anticoagulation (7.9%), resolving symptoms (18.4%), and intracranial hemorrhage (7.1%). EVT transfers occurred in 6.7% of AIS patients, with a mean door-in-door-out (DIDO) time of 81 ± 36 min. Conclusions: This study highlights the low IVT rate, primarily due to delayed hospital presentation, and the limited number of EVT transfers. The prolonged DIDO times emphasize the urgent need for streamlined transfer protocols to optimize stroke care delivery. Full article

Undaria pinnatifida fucoidan (UPF), a bioactive sulphated polysaccharide, is widely recognised for its anti-inflammatory, antioxidant, antitumor, anticoagulant, antiviral, and immunomodulatory properties. However, the precise mechanisms by which UPF regulates inflammation and neuronal health remain unclear. This study aimed to investigate the effects of UPF supplementation on pro-inflammatory cytokines in skeletal muscle, small intestine, and the hypothalamus, as well as plasma cytokine levels. Additionally, a brain proteomic investigation in the nucleus accumbens (NAc) was performed to assess UPF’s impact on neuronal protein expression in mice. A total of 64 C57BL/6J mice were administered either a standard chow or high-fat diet (HFD) with or without UPF (400 mg/kg/day) for 10 weeks. In HFD-fed mice, UPF significantly reduced the expression of pro-inflammatory cytokines (TNF-α, IL-1β, and IL-6) in skeletal muscle, small intestine, and hypothalamus, while also lowering circulating IL-1α and IL-6 levels. Proteomic analysis of the NAc revealed that UPF modulated proteins involved in oxidative stress, neuroinflammation, neurotransmitter regulation, and endoplasmic reticulum stress. In contrast, in chow-fed mice, UPF had no effect on the neuroinflammatory–oxidative stress markers but influenced the abundance of proteins associated with immune response and innate immunity. These findings suggest that UPF modulates stress-response pathways in a diet-dependent manner, supporting its potential neuroprotective role in inflammation-related disorders and brain health. Full article

Background: The aim of this study was to evaluate, for the first time, the feasibility of implementing LOLA, a speech-AI-driven conversational assistant, in monitoring and managing OAT for patients with non-valvular atrial fibrillation (AF). Methods: In 2023, we conducted a pilot prospective observational study of patients with non-valvular atrial fibrillation (AF) and TAO. All patients received a first-contact call from LOLATAO and then monthly calls following a protocol predefined by haematologists. At the end of the study, a satisfaction questionnaire was carried out. Results: Of the fifty patients, the mean age was 75 years, and 33% were women. One-third of the patients (n = 16) were receiving antivitamin K treatment, and two-thirds (33) DOACs. A total of 579 calls were made with a median follow-up of 278 days. LOLATAO had high rates of acceptability (85%), adherence (90%), and satisfaction (>95%). A total of 42% of the patients reported at least one missed dose within the last month, and 18% reported having a scheduled intervention requiring bridging therapy. In patients with AVKs, 94% (n = 15) reported being unaware of their TRT at least once, and 75% (n = 12) of patients reported having a TRT < 65%. Those patients in whom the TRT was <65% were switched to DOACs. LOLATAO saved a total of 10 h per month for haematologists during follow-up. Conclusions: This study suggests that LOLATAO can be a helpful tool in the management of chronic follow-up of patients with AF and undergoing OAT, reducing the burden of care and with high rates of acceptance and satisfaction by patients. Full article

Background/Objectives: We describe a case of intravascular large B-cell lymphoma (IVLBCL) presenting with recurrent cerebral infarctions and review similar reported cases. Our aim is to explore potential early diagnostic markers and discuss their prognostic implications. Methods/Results: A 79-year-old man with a history of hypertension, hyperuricemia, and postoperative bladder cancer presented with five to six cerebral infarctions over an 11-month period, despite successive changes in antiplatelet and anticoagulant medications. Neurological examination revealed decreased pain sensation, bilateral hearing loss, and right thenar atrophy. Laboratory studies showed elevated inflammatory markers and soluble IL-2 receptor. CSF analysis revealed elevated protein, β2-microglobulin, IL-6, and IL-10 levels. A skin biopsy was performed to investigate suspected IVLBCL. Histopathological examination of the skin biopsy revealed large pleomorphic CD20-positive cells within the vasculature, confirming a diagnosis of IVLBCL. The patient was treated with chemotherapy, including dose-adjusted R-CHOP and high-dose methotrexate, and achieved complete remission. No recurrence of cerebral infarction was observed during a two-year follow-up period. Conclusions: This case highlights the importance of considering IVLBCL in patients with recurrent strokes of unknown etiology, especially when laboratory or imaging findings suggest systemic involvement. Early recognition and appropriate tissue diagnosis, such as skin biopsy, are essential for timely treatment and favorable prognosis. Full article

Oral anticoagulation (OAC) is essential for preventing ischemic stroke events in patients with atrial fibrillation (AF), and leads to a significant ischemic prophylaxis, when appropriately used. However, there is still a risk of experiencing stroke events, despite being under anticoagulation. Stroke despite OAC is an increasingly common diagnosis, and pathophysiologically, it can be associated with several etiologies, ranging from AF competing mechanisms to true anticoagulation failure. While the cardioembolic origin of stroke is the most frequently identified etiology, other factors also have to be considered, as there is a significance risk of coexistence. This highlights the need for thorough diagnostic testing, evaluating each stroke etiology independently, with the use of imaging, biomarker and blood tests. Treating such patients, however, is more complex, as there is still uncertainty regarding the selection of OAC post-stroke, with data showing a superiority of direct OAC (DOAC), compared to vitamin K antagonists, in recurrent ischemic stroke prevention and conflicting results regarding OAC switch. Finally, the additive value of cardiac interventions, such as left atrial appendage occlusion (LAAO), in secondary prevention of stroke, is being explored, as it could potentially lead to significant stroke risk reduction. This review, therefore, provides an updated summary of the pathophysiology, diagnostics and therapeutics of stroke under OAC, while also discussing the future direction on the Achilles heel of AF management. Full article

Background: Transoral robotic surgery (TORS) is a minimally invasive procedure that is performed with neck dissection (ND) and postoperative radiotherapy when necessary. This study aimed to review the methods of vascular ligation and ND in cases of TORS for oropharyngeal cancer in Japan. Methods: We enrolled 44 consecutive patients who underwent TORS for laryngopharyngeal cancer between December 2019 and December 2023. Of these, 35 patients who underwent TORS as a first-line treatment for oropharyngeal cancer were included in this study. We retrospectively collected patient data on age, sex, primary tumor location, clinical tumor–node classification, Eastern Cooperative Oncology Group performance status, history of irradiation to the neck, presence of anticoagulants, pathological results, tumor size, total operative duration, console time, length of skin incision operative result, estimated blood loss, late cervical lymph node metastasis, perioperative complications, postoperative hospital stay, postoperative bleeding, period until oral intake after surgery, and swallowing function. Intra- and postoperative outcomes of TORS, TORS + ND (IIa) + vascular ligation, and TORS + ND (II–IV) + vascular ligation. Results: Significant differences were found in operative duration, blood loss during ND, and skin incision length between TORS + ND (IIa) + vascular ligation and TORS + ND (II–IV) + vascular ligation. Console time and blood loss did not significantly differ between the two groups. Each group contained one case of postoperative bleeding. Conclusions: Safe and minimally invasive treatments can be established if vascular ligation and ND are implemented based on appropriate case selection. Full article

Viola yedoensis Makino (V. yedoensis), a perennial herb in the Violaceae family, is recognized for its violet flowers and has a longstanding role in ethnomedicine for treating various inflammatory diseases, such as boils, furuncles, carbuncles, and both acute and chronic hepatitis, among others. A comprehensive literature review was conducted utilizing resources including the Chinese Pharmacopoeia, Flora of China, Web of Science, PubMed, Baidu Scholar, Google Scholar, and China National Knowledge Infrastructure (CNKI). This paper serves as the inaugural comprehensive review of the latest findings regarding the botany, traditional applications, phytochemistry, pharmacological properties, quality control, and prospective uses of V. yedoensis. The objective is to provide a robust foundation for future research and to suggest novel avenues for exploring its potential applications. To date, 162 chemical constituents have been isolated from V. yedoensis, with flavonoids and coumarins identified as particularly abundant. These compounds exhibit promising activities, including anti-inflammatory, anti-pyretic, anti-viral, anti-tumor, anti-lung injury, anti-liver injury, anti-bacterial, anti-coagulant, anti-complement, and anti-oxidant properties. Despite considerable advancements in fundamental research on V. yedoensis, further investigations are required to elucidate the underlying mechanisms of action and to discover additional uncharacterized compounds. This review underscores the plant’s significant development potential, highlighting the necessity for more in-depth exploration. Full article

Objectives: Differentiation of hyperdense areas on non-contrast computed tomography (NCCT) images as hemorrhagic transformation (HT) and contrast accumulation (CA) after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) patients are critical for early antiplatelet and anticoagulant therapy. This study aimed to predict HT and CA on initial NCCT using deep learning. Material and Methods: This study was conducted between January and December 2024. The study included 556 images of 52 patients (21 female and 31 male) who underwent EVT due to AIS, with hyperdense areas observed in the NCCT examination within the first 24 h post-EVT. The evaluated images were labeled as ‘contrast accumulation’ and ‘hemorrhagic transformation’. These labeled images were trained with nine different models under a convolutional neural network (CNN) architecture using a large dataset, such as ImageNet. These models are DenseNet201, InceptionResNet, InceptionV3, NASNetLarge, ResNet50, ResNet101, VGG16, VGG19 and Xception. After training the CNN models, their performance was evaluated using accuracy, loss, validation accuracy, validation loss, F1 score, Receiver Operating Characteristic (ROC) Curve, confusion matrix, confidence interval, and p-value analysis. Results: The models trained in the study were derived from 556 images in data sets obtained from 52 patients; 186 images in training data for CA and 186 images training data for HT (with an increase to 558 images), 115 images used for validation data, and 69 images were compared using test data. In the test set, the Area Under the Curve (AUC) metrics showing sensitivity and specificity values under different cutoff points for the models were as follows: DenseNet201 model AUC = 0.95, InceptionV3 model AUC = 0.93, NasNetLarge model AUC = 0.89, Xception model AUC = 0.91, Inception_ResNet model AUC = 0.84, Resnet50 and Resnet101 models AUC = 0.74. The InceptionV3 model demonstrates the best performance with an F1 score of 0.85. Recall scores generally ranged between 0.62 and 0.85. Conclusions: In our study, hyperdensity areas in initial NCCT images obtained after EVT in AIS patients were successfully differentiated from HT and CA with high accuracy using CNN architectures. Our findings may enable the early identification of patients who would benefit from anticoagulation or antiplatelet therapy to prevent re-occlusion or progression after EVT. Full article

Background: Patients with cerebral venous thrombosis (CVT) requiring mechanical ventilation (MV) may have a severe procoagulant state, extensive venous sinus thrombosis, and a worse outcome, but there is a paucity of studies on this topic. We compare the clinical risk factors, radiological findings, and outcomes between CVT patients requiring MV and the non-MV group. Methods: Consecutive CVT patients admitted to our service were included. Their clinical details, prothrombotic states and MRI and MRV findings were noted. The patients were admitted to the intensive care unit (ICU) if the Glasgow Coma Scale (GCS) score was below 14 and intubated if arterial blood gas analysis was abnormal. All the patients received heparin followed by an oral anticoagulant. In-hospital death was noted, and functional outcomes at 3 months were assessed using the modified Rankin Scale (mRS). Results: Ninety-eight patients with CVT were admitted during the study period; 45 (45.9%) required ICU care, and 18 of them required MV for a median of 6.5 (1–15) days. The MV patients had a shorter duration of illness, a lower GCS score, and protein C deficiency. Twelve (12.2%) patients died: five (27.8%) in the MV, four (14.8%) in the non-MV ICU, and three (5.7%) in the non-MV non-ICU groups. Poor outcomes were 5.5%, 14.8%, and 5.7%, respectively. On Cox regression analysis, the MV had an association with death [adjusted hazard ratio (AHR) 0.40, 95% confidence interval 0.21–0.77; p = 0.007] and poor outcome at 3 months (AHR 0.45, 95% CI 0.27–0.76; p = 0.003). Conclusions: About 18.4% of CVT patients require MV with a mortality of 27.8%. Amongst the survivors, 90.7% of patients have a good outcome at 3 months. Full article

Direct oral anticoagulants (DOACs) have emerged as a preferred alternative to vitamin K antagonists (VKAs) for the prevention and treatment of thromboembolic disorders, offering improved safety, predictable pharmacokinetics, and ease of administration. Despite these advantages, their use in complex clinical scenarios presents significant challenges that necessitate individualized therapeutic strategies. This comprehensive review explores the efficacy, safety, and limitations of DOAC therapy in special populations, including patients with renal or hepatic impairment, obesity, cancer-associated thrombosis, and antiphospholipid syndrome. Additionally, we examine their role in uncommon thrombotic conditions such as superficial venous thrombosis, embolic stroke of undetermined source, upper extremity vein thrombosis, inferior vena cava thrombosis, pelvic vein thrombosis, and cerebral vein thrombosis. The pharmacokinetic variability of DOACs in renal and hepatic dysfunction requires caution to balance the bleeding and thrombotic risks. In obesity, altered drug distribution and metabolism raise concerns regarding appropriate dosing and therapeutic efficacy. Cancer-associated thrombosis presents a complex interplay of prothrombotic mechanisms, necessitating careful selection of anticoagulant therapy. Furthermore, the use of DOACs in antiphospholipid syndrome remains controversial due to concerns about recurrent thrombotic events. Finally, in some unusual scenarios like inferior vena cava, pelvic vein, and cerebral vein thrombosis, the use of DOACs has scarce evidence. This review aims to guide clinicians in optimizing anticoagulation management in challenging patient populations by synthesizing current evidence and providing practical recommendations. Full article

Background: Upper Gastrointestinal Bleed (UGIB) is a common and potentially life-threatening condition with an annual incidence of 80–150 per 100,000 individuals and a mortality rate of 2–10%. Esophagogastroduodenoscopy (EGD) is the gold standard for both diagnosis and treatment, but post-discharge outcomes, including readmissions, remain underexplored. Methods: This study utilized the 2021 National Readmission Database (NRD) to analyze 30-day readmission rates following EGD for UGIB. Adult patients (≥18 years) admitted for UGIB and undergoing EGD were included; those who died during the index hospitalization were excluded. Demographic, clinical, and socioeconomic factors associated with readmission were examined using multivariate logistic regression. Results: Among 34,257 patients admitted for UGIB and undergoing EGD, 11,088 (32.4%) were readmitted within 30 days, with 5423 (49%) due to recurrent UGIB. Readmitted patients had a higher mean age (68.46 vs. 67.63 years) and greater prevalence of cirrhosis (16.71% vs. 13.84%). Hospital resource utilization was significantly higher among readmissions, with increased total hospital charges (USD 82,544.82 vs. USD 61,521.17) and longer hospital stays (5.38 vs. 4.97 days). Mortality was lower among readmitted patients (1.46% vs. 3.53%). Multivariate analysis identified cirrhosis (OR 7.20, 95% CI: 6.45–8.02), untreated H. pylori infection (OR 3.43, 95% CI: 2.15–4.30), atrial fibrillation (OR 1.52, 95% CI: 1.36–1.69), and chronic antithrombotic therapy (OR 1.63, 95% CI: 1.41–1.89) as significant predictors of recurrent UGIB readmission. Lower socioeconomic status was also associated with increased readmission risk (OR 1.15, 95% CI: 1.05–1.25). Conclusions: Readmission following EGD for UGIB is common and driven primarily by recurrent bleeding. Cirrhosis, untreated H. pylori infection, atrial fibrillation, and chronic anticoagulation therapy are key risk factors. These findings highlight the need for targeted interventions, including improved post-discharge management and optimization of anticoagulation strategies, to reduce readmission rates and improve patient outcomes. Full article

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by systemic inflammation that primarily affects the joints but can also involve extra-articular organs. Its multifactorial etiology remains incompletely understood, necessitating further investigation into its underlying mechanisms. The primary therapeutic goal in RA management is to achieve disease remission or maintain low RA activity to prevent long-term morbidity. RA therapies aim to mitigate joint damage, reduce disability, and prevent systemic complications such as cardiovascular diseases. In addition to pharmacological treatments, non-pharmacological interventions—including physiotherapy, occupational therapy, and lifestyle modifications such as smoking cessation, regular exercise, and adherence to a balanced diet—play a crucial role in managing the disease. Beyond joint inflammation, RA has been strongly associated with an increased risk of thrombosis, contributing significantly to both morbidity and mortality. The link between RA and thrombotic events arises from a complex interplay of inflammatory pathways, endothelial dysfunction, and coagulation abnormalities. This review provides an in-depth analysis of the mechanisms driving the association between thrombo-inflammatory manifestations and the incidence of RA, the impact of RA treatment on thrombosis prevalence, and potential therapeutic strategies for managing both conditions concurrently. By integrating recent advancements in rheumatoid arthritis (RA) pathophysiology and thrombo-inflammatory research, this paper provides a comprehensive resource on the inflammatory link between RA and thrombosis while discussing and comparing current and emerging treatment approaches. Further investigation into these mechanisms could facilitate the development of targeted therapies that reduce the risk of thrombosis in patients with RA. Full article

Lupus anticoagulant (LAC) is a heterogeneous mix of autoimmune antibodies that prolongs phospholipid-dependent clotting assays. Its diagnosis can be a real challenge in the hemostasis laboratory. In this review, the author describes the main pitfalls affecting the preanalytical phase and how to proceed to reduce interferences. Because of the heterogeneity of these autoantibodies, two assays with different mechanism of action should be performed to detect the majority of LACs. The dilute Russell’s viper venom test and the use of a reagent very sensitive to LAC derived from the activated partial thromboplastin time, using silica as the activator, are the most frequent techniques. The algorithms for LAC detection are reported here, and every laboratory is encouraged to introduce its own diagnostic procedure. Results should be expressed in ratio to reduce inter- and intravariability. In addition, the effect of anticoagulation in LAC assays and possible strategies for a correct diagnosis are provided. Full article