Search Results (376)

Background: Most of the advances in liver surgery have been achieved in the last few decades. The development of new diagnostic and therapeutic techniques has aided diagnosis and has facilitated more efficient and personalized resections for liver disorders. The estimation of the hepatic reserve has gained great importance because it marks the limit for more aggressive liver resections. It was hypothesized that determination of hepatic reserve by measuring plasma clearance of indocyanine green—following hepatic parenchymal liver resection—could provide earlier and more accurate knowledge of hepatic reserve and thus allow for more personalized therapy. Methods: A prospective observational post-authorization study was performed. Results: Applying ROC curves and the area under the curve (AUC) for the evaluation of the different tests as predictors of liver failure, favorable data were obtained in relation to bilirubin (AUC = 0.922) and prothrombin time (AUC = 1), and for postoperative PDR (AUC = 0.879) and GOT (AUC = 0.857), but not for preoperative PDR (AUC = 0.667) or GPT (AUC = 0.6). Conclusions: The gold standard for predicting early liver failure (the 50:50 criterion at on postoperative day 5) has a very good relationship with the plasma clearance rate of indocyanine green on postoperative day 1 and therefore has the potential to support earlier and more personalized therapeutic interventions, pending further validation. Full article

Background: Legg–Calvé–Perthes disease (LCPD) is a rare avascular osteonecrosis of the proximal femoral epiphysis and typically occurs during the childhood growth phase. LCPD is a complex illness of unknown origin, which is considered the main difficulty in the study of this disease. Various theories on LCPD etiology have been proposed; however, no consensus has been reached about its origin. Our research objective was to evaluate the polymorphisms FVL rs6025, FVIII rs5987061, FIX Malmö rs6048, PAI-1 rs1799889, eNOS rs17899983/rs2070744, IL-23R rs1569922/rs154655686/7539625, and TNF-α rs180062, and their relationship with LCPD. Methods: A blood sample was taken from each study participant. Complete blood count, coagulation times and factors, antithrombotic proteins, and homocysteine (Hcy) were determined using a coagulometric method. DNA was obtained and genotyped using real-time PCR with TaqMan probes. Genotypic and allelic distributions were analyzed using comparative analysis, the Hardy–Weinberg equilibrium, and OR. Results: This study included 46 children: 23 with LCPD (cases) and 23 without (controls). Statistically significant differences were found in Prothrombin Time, Factor V, and Factor IX activity, as well as Hcy concentration; these values suggest the presence of hypercoagulable states in patients, which can cause thrombotic events. On the other hand, significant differences were also found in the neutrophil–lymphocyte ratio and systemic immune-inflammation index, showing major inflammation states in the patient group. Moreover, statistically significant differences were found in the IL-23R rs1569922 polymorphism; it was found that carriers of the T/T and C/T genotypes have an increased risk of developing LCPD. Conclusions: Our results show greater hemostatic activity and inflammation in the group of patients included in this study, supporting various theories previously proposed. Therefore, we believe that LCPD is a multifactorial condition in which hemostatic, inflammatory, and genetic factors play a central and triggering role in the disease. Full article

Cardiac tumors are rare and linked to high mortality rates in both human and veterinary medicine. Despite their clinical significance, the effects of these tumors on coagulation and cardiac function remain poorly understood. This retrospective study assessed coagulation profiles and echocardiographic parameters in 14 dogs with cardiac tumors compared to 10 healthy controls. Tumors were identified through echocardiography, with further confirmation by computed tomography/magnetic resonance imaging. Coagulation was evaluated using conventional tests (prothrombin time (PT) and activated partial thromboplastin time (aPTT)) and thromboelastography (TEG). The employed conventional coagulation tests and echocardiographic parameters showed no significant differences between the groups. However, TEG revealed a hypercoagulable state in the majority of tumor-bearing dogs (8 out of 14), characterized by shortened reaction and clot formation times, as well as an increased α-angle and coagulation index (p < 0.05–0.001). No significant correlations were found between TEG parameters and echocardiographic indices. This study is the first to demonstrate subclinical hemostatic alterations using TEG in dogs with cardiac neoplasia. The results support the utility of TEG as a more sensitive tool than conventional tests for detecting hypercoagulability, potentially guiding individualized anticoagulant strategies in affected dogs. Full article

The proportion of laboratory tests ordered in cardiology departments without clinical utility is unclear. The objective of this study was to determine if criteria limiting testing can safely reduce admission and follow-up testing. We reviewed the charts of 471 consecutive patients admitted to the cardiology department at a regional hospital from January 2019 to June 2019. We prospectively set appropriate criteria for routine admission and follow-up testing. Commonly ordered tests and parameters considered not to be indicated either on admission or on follow-up included C-reactive protein, liver function tests, lactate dehydrogenase, creatine phosphokinase, calcium, blood urea nitrogen, uric acid, cholesterol, Hemoglobin A1c, and prothrombin times (except for patients treated with warfarin). Admission tests considered appropriate included electrolytes, glucose, creatinine, and complete blood counts. Follow-up testing was indicated only if test results were outside the reference ranges. Troponin tests were only indicated if needed to determine the need for a coronary angiogram. The outcome variables were the proportion of indicated tests and whether tests outside the criteria led to changes in acute care that positively affected the patient’s hospital care. In the 471 patients, there were 18,061 tests ordered (not including troponin), and 14,427 (79.9%) were not indicated; this led to 46 (0.3%) changes in medical care, which did not affect the patients’ clinical course. There were 47.8% (364/761) troponin tests that were not indicated and did not change patient care. Our study suggests that interventions in cardiology departments such as ours could safely reduce troponin testing by nearly 50% and other laboratory tests by around 80%. These results need to be confirmed in other settings and in interventional studies. Full article

Background/Objectives: This review aimed to evaluate whether patients undergoing dental extractions while taking antidepressants experience increased intra-operative or post-operative bleeding compared to patients not taking these medications. Methods: A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov for randomized controlled trials (RCTs) published before 17 August 2025. Studies were included if they compared bleeding outcomes between antidepressant users and non-users undergoing dental extraction procedures. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42025645035). Results: Of 689 studies screened, no RCTs met the eligibility criteria. Only one retrospective study, which did not match the inclusion criteria, identified a 1% incidence of bleeding complications in users of selective serotonin reuptake inhibitors (SSRIs) undergoing invasive dental procedures. However, it lacked a control group and standardized methodology, so this study was included in the discussion section. Conclusions: The lack of high-quality evidence, especially studies examining dynamic coagulation parameters like bleeding time and prothrombin time before and after antidepressant use, highlights a significant gap in the research. These findings emphasize the urgent need for well-designed clinical trials to determine the potential effect of antidepressants on bleeding risk. Full article

Background: Children with cystic fibrosis (CwCF) are at increased risk of fat-soluble vitamin (FSV) deficiency due to fat malabsorption. In France, children were usually supplemented with multiple individual vitamin preparations but have recently converted to DEKAs Plus Liquid (DPL), an absorption-enhanced, CF-specific, multivitamin formulation that includes vitamins D₃, E, K₁, A (beta-carotene and retinol), B, C, zinc, and selenium. We evaluated the impact of this change on FSV levels, treatment satisfaction, and compliance. Methods: Young CwCF (n = 39, mean age 2.3 ± 1.1 years) were analyzed retrospectively. Serum FSV levels, prothrombin time, treatment satisfaction, and compliance were assessed at baseline (M0) and after 12 months (M12). Results: Paired data analysis was performed on the 34 who completed 12 months. After 3 months, the initial daily dose was adjusted in nine cases. Median (interquartile range) serum levels of vitamin E (19.3 (17–27) vs. 26.3 (20–31) µmol/L, p = 0.0002) and 25-hydroxyvitamin D (80.2 (68–91) vs. 88.5 (79–108) nmol/L, p = 0.04) increased. Prothrombin time and vitamin A levels showed no significant change (p = 0.7, p = 0.4, respectively). The total number of FSV deficiencies decreased from 10 to 1, vitamin D deficiency was eliminated, and vitamin K₁ supplementation increased from 76% to 100% (p = 0.008). The median treatment satisfaction score (VAS_1–10) improved from 7 (5–9) to 9 (9–10) (p = 0.0006). Patient compliance remained high (9.5 (8.5–10) vs. 10 (9–10), p = 0.4). Conclusions: Switching from individual vitamins to DPL reduced vitamin deficiencies and improved FSV levels and patient satisfaction. Full article

Background/Objectives: Despite overlapping inflammatory responses and frequent culture-negative results in severe burn patients, early and accurate sepsis diagnosis remains challenging. We aimed to evaluate the diagnostic performance of seven candidate biomarkers and their clinical utility, particularly in culture-negative cases. Methods: We conducted a prospective diagnostic accuracy study (January 2021–December 2022; N = 221) in the burn intensive care unit, applying a two-step feature selection to 41 candidate variables. Seven top biomarkers—presepsin, procalcitonin (PCT), albumin, C-reactive protein (CRP), prothrombin time (PT), hematocrit (Hct), and D-dimer—were measured at the moment of clinical sepsis suspicion, concurrently with blood cultures and prior to empirical antibiotic administration, within ±2 h of Sequential Organ Failure Assessment (SOFA). Diagnostic performance was evaluated using a Receiver Operating Characteristic (ROC) curve analysis to determine the area under the curve (AUC), Youden index-derived cut-offs, decision curve analysis, and Net Reclassification Improvement (NRI). Results: Presepsin achieved the highest overall AUC (0.810; 95% CI, 0.742–0.878) and outperformed other markers in culture-negative cases (AUC, 0.846 vs. 0.604; p = 0.015). In the decision curve analysis, presepsin and PCT maintained the largest net benefits at high thresholds, although PT, D-dimer, and Hct also retained smaller positive benefits. Patients were stratified into high- vs. low-risk groups for survival analysis using Youden index cut-offs; Cox regression confirmed PCT (Hazard Ratio 3.78; p < 0.001) and PT (HR 2.12; p = 0.018) as a significant mortality predictor, with presepsin showing borderline significance (HR 3.14; p = 0.055). Conclusions: The high rate of culture-negative sepsis reflects early antibiotic use suppressing culture yield rather than resistance patterns alone. Presepsin’s rapid rise and preserved accuracy under pre-sampling antibiotics suggest its value for early sepsis detection and antimicrobial stewardship. Future work will incorporate polymicrobial and multidrug-resistant bloodstream infection profiles to refine biomarker utility. Full article

Alginate-based materials are widely studied for biomedical use, but their limited mechanical properties and variable biocompatibility pose challenges. In this work, hybrid composites composed of alginate, calcium, and graphene oxide were fabricated using a freeze-drying method and cross-linked with calcium ions via calcium chloride at different concentrations. Structural and morphological features were assessed using SEM, EDS, ICP-MS, and BET analysis. The resulting composites exhibited a porous architecture, with calcium incorporation confirmed by elemental analysis. Surface characteristics and pore parameters were influenced by the presence of graphene oxide and the cross-linking process. The effects of the materials on haemostasis were evaluated through activated partial thromboplastin time (aPTT) and prothrombin time (PT) assays, revealing modulation of the intrinsic coagulation pathway without significant changes in the extrinsic pathway. In this study, we analysed the effect of alginate–graphene oxide composites on the viability of peripheral blood mononuclear (PBM) cells and human foreskin fibroblasts from the Hs68 cell line. We also assessed the genotoxic potential of alginate–graphene oxide composites on these cells. Our results showed no cyto- or genotoxic effects of the material on either cell type. These findings suggest the biocompatibility and safe character of alginate–graphene oxide composites for use with blood and skin cells. Full article

Patient blood management (PBM) is a multidisciplinary approach aimed at improving patient outcomes through targeted anemia treatment that minimizes allogeneic blood transfusions, employs blood conservation techniques, and avoids inappropriate use of blood product transfusions. Viscoelastic testing (VET) techniques, such as thromboelastography (TEG) and rotational thromboelastometry (ROTEM), have led to significant advancements in PBM. These techniques offer real-time whole-blood assessment of hemostatic function. This provides the clinician with a more complete hemostasis perspective compared to that provided by conventional coagulation tests (CCTs), such as the prothrombin time (PT) and the activated partial thromboplastin time (aPTT), which only assess plasma-based coagulation. VET does this by mapping the complex processes of clot formation, stability, and breakdown (i.e., fibrinolysis). As a result of real-time whole-blood coagulation assessment during hemorrhage, hemostasis can be achieved through targeted transfusion therapy. This approach helps fulfill an objective of PBM by helping to reduce unnecessary transfusions. However, challenges remain that limit broader adoption of VET, particularly in hospital settings. Of these, standardization and the high cost of the devices are those that are faced the most. This discussion highlights the potential of VET application in PBM to guide blood-clotting therapies and improve outcomes in patients with coagulopathies from various causes that result in hemorrhage. Another aim of this discussion is to highlight the limitations of implementing these technologies so that appropriate measures can be taken toward their wider integration into clinical use. Full article

Background/Objectives: Enzymatic debridement with NexoBrid^® is an effective alternative to surgical debridement in burn care, but its potential systemic effects remain unclear. In the context of personalized burn care, understanding individual patient responses to topical agents is essential to optimize outcomes and minimize risks. This study aimed to characterize laboratory and clinical parameter changes following NexoBrid^® application in patients with small burn injuries (≤10% TBSA). Methods: We retrospectively analyzed 75 burn patients treated with NexoBrid^® to evaluate changes in systemic inflammatory markers, coagulation parameters, and clinical parameters before and after enzymatic debridement. Results: Statistically significant increases in body temperature (p = 0.018), decreases in hemoglobin (p < 0.001), and increases in C-reactive protein (CRP) levels (p < 0.001) were observed, suggesting mild systemic inflammatory changes. However, leukocyte counts did not change significantly (p = 0.927), and body temperature remained within the normothermic range, indicating that these changes were not clinically significant. A significant decrease in the prothrombin time ratio (% of normal; p = 0.002) was also observed, suggesting potential impacts on coagulation. Importantly, while body temperature was slightly higher in patients with a higher degree of BSA exposure within the ≤10% TBSA cohort (p = 0.036), the extent of NexoBrid^® application did not correlate with other inflammatory markers. Conclusions: These findings suggest that measurable systemic changes can occur following NexoBrid^® application in small burns, particularly affecting inflammatory and coagulation parameters. These observations contribute to the understanding of treatment-related responses and may help inform clinical decision-making. Full article

Background: This study intended to fully assess the predictive efficiency of different clinical laboratory parameters for the mortality risk in severe fever with thrombocytopenia syndrome (SFTS). Methods: We systematically searched the Web of Science, PubMed, Cochrane Library, and Embase up to 13 December 2024 for studies on the association of laboratory parameters with SFTS mortality. Two investigators were independently responsible for the study screening and data extraction, and they assessed the study quality using the Newcastle–Ottawa Scale (NOS). Stata17.0 was adopted for the meta-analyses. Results: We finally included 33 observational studies involving 9502 participants (1799 deaths and 7703 survivors). The results showed that increases in the viral load (odds ratio (OR) 1.93, 95% confidence interval (CI) 1.56–2.38), neutrophil-to-lymphocyte ratio (hazard ratio (HR) 1.31, 95% CI 1.13–1.51), neutrophil percentage (HR 1.02, 95% CI 1.01–1.03), white blood cells (HR 1.06, 95% CI 1.01–1.11), activated partial thromboplastin time (OR 1.07, 95% CI 1.04–1.09), prothrombin time (OR 1.31, 95% CI 1.03–1.65), creatine kinase-myocardial band (OR 1.01, 95% CI 1.01–1.02), and procalcitonin (HR 1.27, 95% CI 1.10–1.47) greatly increased the SFTS mortality, while decreases in the lymphocyte percentage (HR 0.96, 95% CI 0.94–0.98), platelets (HR 0.98, 95% CI 0.97–0.99), and albumin (HR 0.91, 95% CI 0.86–0.96) also greatly increased the SFTS mortality; the results were all statistically significant (p < 0.05). Conclusion: Abnormalities of laboratory parameters (e.g., viral load, blood routine, coagulation, multi-organ dysfunction, and inflammation indicators) are good predictors of SFTS mortality, which can provide valuable references in clinical practice. Full article

This research investigates the biochemical and microbiological characteristics of a composite comprising poly(lactide) (PLA) combined with polyethersulfone (PESf) and copper-complexed cellulose phosphate (CelP-Cu). The material was produced using the pneumothermic melt-blown method and then modified with polyethersulfone and cellulose phosphate, followed by complexation with copper ions using the dip-coating technique. Comprehensive physicochemical and biological evaluations were conducted to characterize the composite. The physicochemical assessments involved elemental analysis (C, O, Cu) and morphology examination. The biological evaluations encompassed microbiological testing and biochemical–hematological analysis, including activated partial thromboplastin time (aPTT) and prothrombin time (PT). Antimicrobial activity was assessed according to the EN ISO 20645:2006 and EN 14119:2005 standards, by placing material specimens on agar plates inoculated with representative microorganisms. The results revealed that the composites exhibited significant antimicrobial effects against model microorganisms: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacillus atrophaeus, Candida albicans, Saccharomyces cerevisiae, Aspergillus niger, Chaetomium globosum. This study highlights the potential of PLA/PESf/CelP-Cu composites for novel biomedical applications, demonstrating their biocompatibility and their influence on hemostatic processes and antimicrobial properties. Full article

Naturally occurring plant-based compounds are increasingly being explored for their therapeutic potential in treating a wide range of conditions, particularly those related to vascular health. The compound 3-deoxysappanchalcone (3-DSC), derived from Caesalpinia sappan L., has been proven to exhibit anti-inflammatory, anti-influenza, and anti-allergic properties, though its role in thrombosis and haemostasis remains unexplored. This study aimed to evaluate the anti-thrombotic potential of 3-DSC in both in vitro and in vivo models. The anticoagulant activities of 3-DSC were assessed using activated partial thromboplastin time (aPTT), prothrombin time (PT), and thrombin (FIIa) and activated factor X (FXa) activity assays, as well as fibrin polymerization and platelet aggregation tests. Its effects on plasminogen activator inhibitor type 1 (PAI-1) and tissue-type plasminogen activator (t-PA) expression were evaluated in TNF-α-stimulated human umbilical vein endothelial cells (HUVECs). The results demonstrated that 3-DSC extended aPTT and PT, suppressed thrombin and FXa activities, reduced their production in HUVECs, inhibited thrombin-induced fibrin polymerization and platelet aggregation, and exerted anticoagulant effects in mice. Furthermore, 3-DSC significantly decreased the PAI-1 to t-PA ratio. These findings suggest that 3-DSC possesses potent anti-thrombotic properties by modulating coagulation pathways and fibrinolysis. Its therapeutic potential warrants further investigation for the development of novel anticoagulant agents. Full article

This study aimed to characterize and evaluate the fibrinolytic, thrombolytic, hematological, and toxicological aspects of a serine protease (AsKSP) from Aspergillus tamarii Kita UCP 1279. The enzyme was purified using a two-phase aqueous system and assessed for optimal pH (7.0) and temperature (50 °C), stability, and effects of metal ions, inhibitors, and surfactants. AsKSP exhibited stability for up to 120 min at 50 °C and 36 h at pH 7.0. Enzymatic activity was enhanced by Na⁺ and Zn²⁺ and non-ionic surfactants (Tween-80) but inhibited by Cu²⁺, Fe³⁺, Triton X-100, and SDS, reducing activity by up to 62.35%. The highest amidolytic activity was observed for the substrate N-succinyl-Gly–Gly–Phe-p-nitroanilide. SDS-PAGE analysis indicated an approximate molecular mass of 90 kDa. The enzyme showed fibrinolytic activity, degrading 38.81% of fibrin clots in vitro after 90 min, without affecting fibrinogen. Cytotoxicity assays indicated no toxicity (cell viability > 80%). Coagulation assays showed slight prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT), with no effect on thrombin time. No red blood cell lysis was observed, and albumin increased enzymatic activity by 31.70%. These findings demonstrate that Aspergillus tamarii Kita UCP 1279 produces a fibrinolytic protease with potential for thrombus treatment, providing a promising foundation for drug development. Full article

Objectives: This study aimed to differentiate patients with placenta accreta spectrum (PAS) from those with placenta previa (PP) and to assess the association between preoperative inflammatory and coagulation parameters and intraoperative blood loss. Methods: In this retrospective case-control study, 545 pregnant women were enrolled and divided into five groups: control (n = 251), PP (n = 246), PP with accreta (PPA, n = 18), PP with increta (PPI, n = 27), and PP with percreta (PPP, n = 33). Preoperative serum levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), delta neutrophil index (DNI), prothrombin time, fibrin degradation products (FDPs), D-dimer, and activated partial thromboplastin time (APTT) were analyzed. Results: The PPP group demonstrated significantly higher values of FDP, D-dimer, NLR, PLR, SII, SIRI, and DNI, and lower APTT values compared to the other groups (p < 0.001). For predicting PAS, SIRI and DNI showed the highest diagnostic performance, each achieving 100% sensitivity and specificity, with optimal cut-off values of 2.01 and 2.45, respectively. For predicting intraoperative blood loss ≥1000 mL, PLR and SIRI exhibited the highest diagnostic accuracy, with optimal cut-off values of 122.5 (sensitivity 76.6%; specificity 72.6%) and 2.25 (sensitivity 73.4%; specificity 74.1%), respectively. Conclusions: FDP, D-dimer, NLR, PLR, SII, SIRI, and DNI may serve as valuable biomarkers for differentiating PP from PAS, thereby enhancing preoperative risk assessment and guiding surgical planning to improve maternal outcomes. Additionally, PT, D-dimer, FDP, NLR, and DNI were identified as significant independent predictors of intraoperative blood loss. Full article