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Cerebellar injury in preterm infants with central nervous system (CNS) hemorrhage results in lasting neurological deficits and an increased risk of autism. The impact of blood-induced pathways on cerebellar development remains largely unknown, so no specific treatments have been developed to counteract the harmful effects of blood after neurovascular damage in preterm infants. Here, we show that fibrinogen, a blood-clotting protein, plays a central role in impairing neonatal cerebellar development. Longitudinal MRI of preterm infants revealed that cerebellar bleeds were the most critical factor associated with poor cerebellar growth. Using inflammatory and hemorrhagic mouse models of neonatal cerebellar injury, we found that fibrinogen increased innate immune activation and impeded neurogenesis in the developing cerebellum. Fibrinogen inhibited sonic hedgehog (SHH) signaling, the main mitogenic pathway in cerebellar granule neuron progenitors (CGNPs), and was sufficient to disrupt cerebellar growth. Genetic fibrinogen depletion attenuated neuroinflammation, promoted CGNP proliferation, and preserved normal cerebellar development after neurovascular damage. Our findings suggest that fibrinogen alters the balance of SHH signaling in the neurovascular niche and may serve as a therapeutic target to mitigate developmental brain injury after CNS hemorrhage.

Psychosis risk prediction is one of the leading challenges in psychiatry. Previous investigations have suggested that plasma proteomic data may be useful in accurately predicting transition to psychosis in individuals at clinical high risk (CHR). We hypothesized that an a priori-specified proteomic prediction model would have strong predictive accuracy for psychosis risk and aimed to replicate longitudinal associations between plasma proteins and transition to psychosis. This study used plasma samples from participants in 3 CHR cohorts: the North American Prodrome Longitudinal Studies 2 and 3, and the NEURAPRO randomized control trial (total n = 754). Plasma proteomic data were quantified using mass spectrometry. The primary outcome was transition to psychosis over the study follow-up period. Logistic regression models were internally validated, and optimism-corrected performance metrics derived with a bootstrap procedure. In the overall sample of CHR participants (age: 18.5, SD: 3.9; 51.9% male), 20.4% (n = 154) developed psychosis within 4.4 years. The a priori-specified model showed poor risk-prediction accuracy for the development of psychosis (C-statistic: 0.51 [95% CI: 0.50, 0.59], calibration slope: 0.45). At a group level, Complement C8B, C4B, C5, and leucine-rich α-2 glycoprotein 1 (LRG1) were associated with transition to psychosis but did not surpass correction for multiple comparisons. This study did not confirm the findings from a previous proteomic prediction model of transition from CHR to psychosis. Certain complement proteins may be weakly associated with transition at a group level. Previous findings, derived from small samples, should be interpreted with caution.

BACKGROUND & AIMS: Despite several recent international guidelines, no consensus exists on the bleeding risk nor haemostatic parameter thresholds that define the safety of invasive procedures in patients with cirrhosis. The aim of this study was to establish a position paper on the bleeding risk associated with invasive procedures in patients with cirrhosis among the experts involved in various guidelines. METHODS: All experts involved in recent guidelines on the management of invasive procedures in patients with cirrhosis were invited to classify 80 procedures as high risk or low risk with respect to bleeding. Procedures were considered high risk when the estimated risk of major bleeding was 1.5% or more, or when even minor bleeding might lead to significant morbidity or death. The experts were also asked to choose safety thresholds for laboratory test values at which elective invasive procedures could be safely performed. The predetermined threshold considered as consensus was ≥75% agreement. RESULTS: Fifty-two experts participated in the study. Out of 80 procedures, a consensus opinion was reached for 52 procedures (65%): 17 procedures were classified as high risk, primarily interventional endoscopic procedures, percutaneous organ biopsies, or procedures involving the central nervous system; and 35 as low risk, primarily diagnostic procedures. The lowest platelet counts at which performance of a low-risk procedure or a high-risk procedure/surgery were deemed acceptable were 30 × 109/L and 50 × 109/L, respectively. Experts did not believe that international normalised ratio should be considered before performing low-risk procedures; 71% also indicated that it should not be considered before performing high-risk procedures. CONCLUSIONS: This experience-based classification may be helpful to refine future study designs and to guide clinical decision making regarding invasive procedures in patients with cirrhosis. IMPACT AND IMPLICATIONS: Several risk classifications and management guidelines for invasive procedures in patients with cirrhosis have been proposed, but with conflicting recommendations. By providing a position paper, based on the opinion of a broad panel of experts, on the bleeding risk associated with 52 invasive procedures in patients with cirrhosis, this survey will help to provide a framework for future study design. The consensus on platelet count, international normalised ratio, fibrinogen and activated partial thromboplastin time identified in this survey will inform physicians regarding the laboratory test values considered acceptable by the experts prior to the performance of an elective invasive procedure in patients with cirrhosis.

Direct oral anticoagulants (DOACs) exert anticoagulation effect by directly inhibiting Factor Xa (rivaroxaban, apixaban, and edoxaban) or thrombin (dabigatran). Though DOACs are characterized by fixed-dose prescribing and generally do not require routine laboratory drug-level monitoring (DLM), circumstances may arise where the DLM may aid in clinical decision-making, including DOAC dose adjustment, anticoagulant class change, or decisions to withhold or administer reversal agents. We review the current literature that describes high-risk patient groups in which DLM may be beneficial for improved patient anticoagulation management and stewardship. The review also summarizes the limitations of conventional coagulation testing and discuss the emerging utility of quantitative methods for routine and rapid emergent evaluation of DOAC drug levels-in particular, the Anti-Xa activity to detect Factor Xa Inhibitors (rivaroxaban, apixaban, and edoxaban). Both technical and regulatory barriers to widespread DLM implementation are limiting factors to further clinical research that must be overcome, in order to propose universal DOAC DLM strategies and provide clinical-laboratory correlation to formally classify high-risk patient groups.

Background: Optimal pharmacologic thromboprophylaxis dosing is not well described in patients with subarachnoid hemorrhage (SAH) with an external ventricular drain (EVD). Our patients with SAH with an EVD who receive prophylactic enoxaparin are routinely monitored using timed anti-Xa levels. Our primary study goal was to determine the frequency of venous thromboembolism (VTE) and secondary intracranial hemorrhage (ICH) for this population of patients who received pharmacologic prophylaxis with enoxaparin or unfractionated heparin (UFH). Methods: A retrospective chart review was performed for all patients with SAH admitted to the neurocritical care unit at Emory University Hospital between 2012 and 2017. All patients with SAH who required an EVD were included. Results: Of 1,351 patients screened, 868 required an EVD. Of these 868 patients, 627 received enoxaparin, 114 received UFH, and 127 did not receive pharmacologic prophylaxis. VTE occurred in 7.5% of patients in the enoxaparin group, 4.4% in the UFH group (p = 0.32), and 3.2% in the no VTE prophylaxis group (p = 0.08). Secondary ICH occurred in 3.83% of patients in the enoxaparin group, 3.51% in the UFH group (p = 1), and 3.94% in the no VTE prophylaxis group (p = 0.53). As steady-state anti-Xa levels increased from 0.1 units/mL to > 0.3 units/mL, there was a trend toward a lower incidence of VTE. However, no correlation was noted between rising anti-Xa levels and an increased incidence of secondary ICH. When compared, neither enoxaparin nor UFH use was associated with a significantly reduced incidence of VTE or an increased incidence of ICH. Conclusions: In this retrospective study of patients with nontraumatic SAH with an EVD who received enoxaparin or UFH VTE prophylaxis or no VTE prophylaxis, there was no statistically significant difference in the incidence of VTE or secondary ICH. For patients receiving prophylactic enoxaparin, achieving higher steady-state target anti-Xa levels may be associated with a lower incidence of VTE without increasing the risk of secondary ICH. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether prenatal fibrinogen (FIB) or other related factors could be utilized to evaluate the risk of postpartum hemorrhage (PPH). Methods: A retrospective study was conducted in a database from January 2015 to December 2019. A total of 128 patients were enrolled and evaluated with FIB, in which 55 patients were assigned to low FIB and 73 in normal FIB. Results: According to the volume of blood loss, the mean of the low FIB group (<4 g/L) was markedly higher than that of the normal FIB group (≥4 g/L). Prenatal FIB was negatively correlated with PPH volume. The receiver operating characteristic (ROC) curve results indicated that the value of prenatal FIB was 0.701 to predict refractory PPH. Conclusions: Prenatal FIB was significantly related to thrombin time (TT), which may be an independent factor to predict the coagulation state of prenatal pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Specific assays of plasma rivaroxaban level are not always readily available with short turnaround time, which hamper the management of urgent clinical situations. In this study, we aimed to build a predictive formula of plasma rivaroxaban levels from international normalized ratio (INR) value and validated in real world clinical situations. Methods: Ninety‐four patients who were taking rivaroxaban participated in the study. Patients were randomized into testing cohort and validation cohorts. The prediction formula was built from the testing cohort and then validated in validation cohort. The predictive performance was further validated on real‐world clinical requests. Results: The root mean square error (RMSE) of the predictive formula for the testing and validation cohorts were 61.81 and 69.32 ng/mL, respectively. The sensitivity and specificity for the formula to predict the threshold plasma rivaroxaban level of 75 ng/mL were 95% (95% CI: 85.4%–100%) and 87.5% (95% CI: 71.3%–100%), respectively, in real‐world clinical situations. Conclusion: Plasma rivaroxaban level of threshold level of 75 ng/mL can be calculated from prediction formula by INR value with satisfactory accuracy and it can be used to guide the decision for reversal. [ABSTRACT FROM AUTHOR]

Background: Although direct oral anticoagulants (DOACs) have been used in the adult population for over a decade, DOACs use has begun to rise in pediatric populations since FDA approval of rivaroxaban and dabigatran, DOACs offer several advantages for pediatric patients, to other anticoagulants, including a similar safety profile, minimal lab monitoring, and ease of administration. The rise in DOAC use has led to an increasing number of pediatric patients managed on DOACs presenting for elective and urgent procedures. Perioperative management of anticoagulation is often challenging for providers due to the lack of expert consensus guidelines and the difficulty in balancing a patient's thrombotic risk with bleeding risk for a given procedure. Aims: Using the most up to date literature, we provide a focused review on the perioperative management of DOACs in pediatric patients. Conclusions: This work presents a focused review for pediatric anesthesiologists on clinically available DOACs, perioperative monitoring and management of DOACs, as well as options and indications for reversal. While consensus expert practice guidelines are still needed, we hope this work will familiarize perioperative physicians with these agents, recommended uses, and potential perioperative management. [ABSTRACT FROM AUTHOR]

• High pH favored to form large and loose flocs for both coagulants though Al 13 flocs were more stable. • Large and loose flocs led to more porous cake and further generated lower reversible fouling. • In all pH conditions, Al 13 had higher HA removal than PACl due to higher removal of HA with lower MW. • Al 13 had low membrane fouling at acid pH and PACl favored to reduce membrane fouling at alkaline pH. Membrane fouling is a bottleneck issue that hindered the further application of ultrafiltration technology. To alleviate membrane fouling, coagulation-ultrafiltration (C-UF) process using polyaluminum chloride (PACl) and PACl-Al 13 with high proportion of Al 13 O 4 (OH) 24 7+ as coagulants, respectively, were investigated at various pH conditions. Results indicated that an increase in solution pH contributed to larger floc size and looser floc structure for both PACl and PACl-Al 13. It was conducive to the formation of more porous cake, as evidenced by mean pore area and pore area distribution of cake, leading to lower reversible fouling. Furthermore, humic acid (HA) removal presented a trend of first increasing and then decreasing with the increase of pH. The optimal HA removal was achieved at pH 6 regardless of coagulant type, suggesting that the slightest irreversible fouling should be occurred at this point. Interestingly, the irreversible fouling with PACl coagulant achieved a minimum value at pH 9, while the minimal irreversible fouling with PACl-Al 13 was observed at pH 6. We speculated that the cake formed by PACl could further intercept HA prior to UF process at alkaline pH. Furthermore, compared with PACl, PACl-Al 13 had a stronger charge neutralization ability, thus contributing to more compact floc structure and higher HA removal at various pH conditions. By UF fractionation measurement, higher HA removal for PACl-Al 13 was due to higher removal of HA with molecular weight less than 50 kDa. [Display omitted] [ABSTRACT FROM AUTHOR]

Factor XI (FXI) is associated with thrombosis in patients without liver disease, but it alterations and prognostic value in cirrhosis are uncertain. We studied a prospective cohort of cirrhosis patients determining FXI and its association with portal vein thrombosis (PVT), bleeding, and hepatic decompensation/ACLF during 1-year follow-up. Odds ratios (OR) and 95 % CIs were calculated using logistic regression. We included 183 patients (Child-Pugh [CP] A/B/C 57/59/57). FXI was reduced in cirrhosis, decreasing with CP stage (78 % [66–94] vs. 58 % [44–78] vs. 41 % [30–52] in CP A, B, and C, respectively; p < 0.001). FXI was correlated with MELD score (rho: -0.6, p < 0.001), INR (rho: -0.6, p < 0.001), and platelet count (rho: 0.4, p < 0.001). Sixteen patients (8.7 %) experienced PVT, which only predictor was baseline platelet count (OR: 0.94; CI95 %: 0.91–0.97, p < 0.001). Bleeding occurred in 7 patients (3.8 %). Cirrhosis severity, platelet count, fibrinogen, and FXI (60% vs. 78 %; p = 0.2) were comparable between bleeding and non-bleeding individuals. Finally, no association was found between FXI and hepatic decompensation/ACLF, which were predicted by lower albumin and platelet count, respectively. FXI seems not to be responsible for thrombosis and cirrhosis progression. The lack of association between low FXI and bleeding events, however, indirectly opens to future studies evaluating FXI inhibitors in cirrhosis. [ABSTRACT FROM AUTHOR]

Context Testosterone therapy has been variably associated with increased thrombotic risk but investigations of global coagulation in this setting are lacking. Objective This work aimed to compare global coagulation of hypogonadal men before (T0) and 6 months after (T1) starting testosterone replacement therapy (TRT), and healthy controls (HCs). Methods An observational prospective cohort study was conducted at 2 tertiary endocrinological ambulatory care centers. Patients included 38 men with hypogonadism (mean age 55 years, SD 13) and 38 age-matched HCs. Thrombin generation assay (TGA) was performed at T0 and T1 in hypogonadal men and in HCs. TGA is an in vitro procedure based on the continuous registration of thrombin generation and decay under conditions mimicking the process that occurs in vivo. The following TGA parameters were recorded: lag time; thrombin-peak concentration; time-to-reach peak, velocity index, and endogenous thrombin potential (ETP), the latter representing the total amount of thrombin generated under the driving forces of procoagulants opposed by the anticoagulants. Protein C, antithrombin, factor (F) VIII, and fibrinogen were assessed. Results No changes in TGA parameters were observed between T0 and T1. Hypogonadal men displayed significantly higher ETP, fibrinogen, and significantly lower antithrombin levels both at T0 and T1 compared to HCs. Thrombin peak of hypogonadal men was significantly higher than HCs at T0 but not at T1. ETP and antithrombin were correlated with testosterone levels. Conclusion Hypogonadal men display a procoagulant imbalance detected by increased thrombin generation. Short-term TRT does not worsen global coagulation, suggesting that the treatment can be safely prescribed to men diagnosed with hypogonadism. [ABSTRACT FROM AUTHOR]

Bleeding from a wound as a result of physical injury is a life-threatening condition. In pursuing new drug structures, the effect of crude fungal extracts fungal isolated from Jatropha multifida on wound healing and coagulation of mouse whole blood was investigated. Jatropha multifida leaves were sterilized, cut into small segments, and then incubated in Potato Dextrose Agar for seven days. Four isolates were purified and their morphologies were characterized. Identification of isolates was confirmed by a molecular protocol. Two crude extracts from Phlebiopsis gigantea (OK021602) and Phyllosticta sp (OK021603), which exhibited higher phytochemicals composition, were selected and evaluated using wound excision and coagulation of mouse whole blood, by administering 30 µg/mL, 50 µg/mL and 70 µg/mL crude extracts respectively. The percentage of wound healing in mice was higher (p<0.05) for the crude extracts of Phlebiopsis gigantea (OK021602) as compared to that of Phyllosticta sp (OK021603). The highest percentages of wound contraction were 99% at 70 µg/mL, and 53% at 70 µg/mL for Phlebiopsis gigantea (OK021602) and Phyllosticta sp (OK021603), respectively as compared to the control group which had 42% wound contraction at day 15 post-treatment. The results of the present study clearly indicate that Jatropha multifida leaves harbor endophytic fungi that produce pharmacologically important bioactive secondary metabolites with wound and hemostatic effects; therefore, further exploration is inevitable, particularly for the purification and identification of specific chemical structures of bioactive compounds. [ABSTRACT FROM AUTHOR]

The coagulation system is known to play an important role in cancer development and metastasis, but the precise mechanisms by which it does so remain incompletely understood. With this in mind, we provide an updated overview of the effects of TFPI-2, a protease inhibitor, on cancer development and metastasis. TFPI-2 interacts with the thrombin cascade and also employs other mechanisms to suppress cancer growth and dissemination, which include extracellular matrix stabilization, promotion of caspase-mediated cell apoptosis, inhibition of angiogenesis and transduction of intracellular signals. Down-regulation of TFPI-2 expression is well documented in numerous types of neoplasms, mainly via promoter methylation. However, the exact role of TFPI-2 in cancer progression and possible approaches to up-regulate TFPI-2 expression warrant further studies. Strategies to reactivate TFPI-2 may represent a promising direction for future anticancer studies and therapy development. [ABSTRACT FROM AUTHOR]

Tofu, a globally significant plant-based protein source, is traditionally produced using a variety of coagulants, including salts, acids, or enzymes, each of which influences its texture, yield, and nutritional quality. Understanding the role of these coagulants is crucial for optimizing tofu production and enhancing its commercial appeal. This study aimed to investigate the effects of magnesium chloride (MgCl2), glucono-δ-lactone (GDL), and their combination (GDL+MgCl2) on the physicochemical properties and digestibility of tofu. Results indicated that tofu made with GDL showed the highest yield (700.0 ± 10.0 g) but the lowest water retention (41.0 ± 7.5%) and the highest cooking loss (32.0 ± 3.0%). In contrast, tofu produced with MgCl2 exhibited superior water holding capacity (92.2 ± 4.6%) and lower cooking loss (3.4 ± 0.2%). The combination of GDL and MgCl2 synergistically improved water retention and reduced cooking loss to 1.5 ± 0.2%. Electrophoresis analysis revealed that the combined coagulant enhanced protein retention in tofu. During digestion, GDL + MgCl2 tofu showed higher soluble protein and peptide content than tofu prepared with single coagulants, suggesting improved protein breakdown and bioavailability. These findings underscore the significance of coagulant selection in optimizing tofu quality and suggest that composite coagulants can improve physicochemical characteristics and protein digestibility. Future research should consider in vivo studies to validate these findings, further optimize coagulant concentrations, and explore the long-term health benefits of tofu made with composite coagulants. This study provides a theoretical basis for improving tofu quality and advancing the tofu production industry through composite coagulant application. [ABSTRACT FROM AUTHOR]

In this study, the potential positive or negative effects of the coagulation process during the adsorption of micropollutants were investigated in treated waste water. Single‐walled carbon nanotubes (SWCNTs) were employed as adsorbents in batch adsorption processes. Alum was used as a coagulant in batch coagulation experiments carried out in the laboratory to coagulate water samples obtained from effluents at the advanced biological wastewater treatment plant in the center of Zonguldak (ZWWTP), Turkey. The ultrafiltration process (UF) was used to demonstrate the importance of the dissolved organic matter content (DOM) for the removal of micropollutants by coagulation and adsorption. Consequently, coagulation was found to be effective in the removal of hydrophobic organics, that is, DOM fractions with molecular weights of 5 kDa and 1–3 kDa, while adsorption with SWCNT was effective in the removal of hydrophilic organics (<1 kDa). SWCNT adsorption was effective for the removal of carbamazepine, diclofenac, and triclosan in combined treatment steps. Furthermore, the removal of carbamazepine, diclofenac, and triclosan was above 90% with SWCNT adsorption before coagulation. It was concluded that the significant correlation between micropollutant removal and the reduction in UV254 is attributed to the general non‐selectivity of adsorption on the SWCNTs surface. Micropollutants and UV254 absorbing compounds adsorb simultaneously. It can be reasonably deduced that a high/low adsorptive removal of a specific micropollutant is typically accompanied by a high/low removal of UV254‐absorbing substances. Even though the majority of micropollutants also absorb UV254, their concentrations in municipal wastewater are insignificant in comparison to the overall UV254 measurements. Hence, correcting the actual UV254 measurements of the combined treatment for removal by coagulation produces adsorptive UV254 removal. In other words, if the removal of UV254 by coagulation is already known, the actual UV254 measurements obtained in a combined treatment step can be adjusted to produce UV254 removal by SWCNT adsorption. Therefore, UV254 can be used as a control parameter for carbamazepine, diclofenac, and triclosan removal and SWCNT dosing control utilizing differential UV254 measurements can be implemented. [ABSTRACT FROM AUTHOR]

Plastic debris is unavoidably released into the ecosystems, and their physicochemical and mechanical qualities deteriorate when exposed to the environment. This, ultimately, leads to the generation of tiny fragments of plastic, which are known as nanoplastics (<1000 nm) and microplastics (<5 mm). Over the past few years, the pollution of synthetic polymers has been reported in almost all the compartments of the environment across the globe. It is regarded as a hazard to both human health and natural systems. In addition, synthetic polymers act as vectors for contaminants as they can adsorb and accumulate contaminants from seawater. The accumulation of plastic waste in the environment and its widespread presence have drawn the attention of policymakers and the public. This global issue has led to the creation of numerous remediation solutions by innovators in previous decades, either to clear up old waste or to stop plastic from entering the various matrices of the environment. This review focused on the extensive scientific research available on effective techniques for removing plastic debris to promote positive action and progress in this important area. Despite the various challenges, these techniques offer vital opportunities, from increasing awareness to enhancing environmental quality. Further, the article has been enriched by incorporating bibliometric data that illustrates the widely used methods for removing microplastics from various environmental matrices. According to the data analysis, numerous remediation techniques have been developed to date (2010 and 2024). These techniques encompass various approaches, among which the chemical‐based methods enjoy more success. This success can be attributed to the diverse advantages offered by chemical‐based methods over other remediation techniques. Much research is now focused on overcoming the disadvantages and developing more efficient and environmentally sound technologies. [ABSTRACT FROM AUTHOR]

Objective Design Setting Animals Interventions Measurements and Main Results Conclusions and Clinical Importance To establish reference intervals using a new point‐of‐care thromboelastometry device in dogs for the extrinsically activated test (EX‐test), intrinsically activated test (IN‐test), fibrin polymerization test (FIB‐test), ecarin test (ECA‐test), and tissue plasminogen activator test (TPA‐test) and to investigate the effects of storage time on the results.Prospective clinical study in 2022.University teaching hospital.Forty‐eight healthy privately or university‐owned dogs were prospectively enrolled and included on the basis of normal physical examination and normal baseline laboratory results (CBC, biochemistry profile, prothrombin time, and activated partial thromboplastin time [aPTT]).After a 30‐minute storage time, the EX‐test, IN‐test, FIB‐test, ECA‐test, and TPA‐test were performed on citrated blood samples. To determine the effect of storage time, 11 samples had the EX‐test, FIB‐test, and IN‐test repeated 90 and 150 minutes after sample collection.Ten thromboelastometry parameters were evaluated for each test. Reference intervals were calculated using the robust method for parametric data, and the robust Box–Cox transformed or nonparametric methods were used for nonparametric data. Increasing storage time resulted in more hypocoagulable tracings. A correlation was found between the IN‐test and aPTT (r = 0.62, P < 0.0001). Other weak to moderate correlations were seen between thromboelastometry parameters and platelet count and hematocrit.The development of reference intervals for the thromboelastometry device allows for the clinical use of this technology. Analyzing samples after a prolonged storage time of more than 30 minutes may result in erroneous results. Results may also be affected by an abnormal hematocrit or platelet count. [ABSTRACT FROM AUTHOR]

This review addresses the peri-procedural bleeding risks in patients with cirrhosis, emphasizing the need for careful coagulation assessment and targeted correction strategies. Liver disease presents a unique hemostatic challenge, where traditional coagulation tests may not accurately predict bleeding risk, complicating the management of procedures like paracentesis, endoscopic therapy, and various interventional procedures. As such, this paper aims to provide a comprehensive analysis of current data, guidelines, and practices for managing coagulation in cirrhotic patients, with a focus on minimizing bleeding risk while avoiding unnecessary correction with blood products. The objectives of this review are threefold: first, to outline the existing evidence on bleeding risks associated with common invasive procedures in cirrhotic patients; second, to evaluate the efficacy and limitations of standard and advanced coagulation tests in predicting procedural bleeding; and third, to examine the role of blood product transfusions and other hemostatic interventions, considering potential risks and benefits in this delicate population. In doing so, this review highlights patient-specific and procedure-specific factors that influence bleeding risk and informs best practices to optimize patient outcomes. This review progresses through key procedures often performed in cirrhotic patients. The discussion begins with paracentesis, a low-risk procedure, followed by endoscopic therapy for varices, and concludes with high-risk interventions requiring advanced hemostatic considerations. Each chapter addresses procedural techniques, bleeding risk assessment, and evidence-based correction approaches. This comprehensive structure aims to guide clinicians in making informed, evidence-backed decisions in managing coagulation in cirrhosis, ultimately reducing procedural complications and improving care quality for this high-risk population. [ABSTRACT FROM AUTHOR]

Building on traditional emulsion polymerization research, which continues to yield results up to the present day, techniques have emerged to produce hybrid materials. One such technique is Pickering emulsion polymerization, with numerous industrial applications. Despite a growing interest in Pickering emulsion polymerization, the intrinsic mechanisms involved have been based mainly on the findings of classical emulsion polymerization. In this work, by relying on a minimum of assumptions and using a simple model and experimental data on conversion and particle size, we obtain information about the prevailing mechanisms. More specifically, we present four main findings based on data reported previously in the literature. First, in contrast to the three rate-of-reaction intervals reported in classical emulsion polymerization, the integro-differential method yielded only two rate-of-reaction intervals against conversion. Second, a master curve is constructed by plotting the reaction rate against overall conversion, showing a maximum of approximately 55% conversion. Third, despite having a semicontinuous process, monomer concentration inside the particles is not constant. Finally, particle density is a strong function of the Pickering agent concentration, where two fitting parameters (nucleation and coagulation) allowed an accurate description for the particle number time evolution. Both parameters showed a power-law dependence with clay concentration. [ABSTRACT FROM AUTHOR]

Inflammatory dermatologic diseases have long been viewed as a "skin limited" disease process. Current literature on inflammatory dermatologic diseases investigates their relationship and influence on thromboembolic states and thromboembolic complications and the understanding of their pathophysiology and molecular mechanisms. Studies specifically discuss known inflammatory skin diseases including alopecia areata, vitiligo, psoriasis, hidradenitis suppurativa, atopic dermatitis, chronic spontaneous urticaria, and autoimmune bullous diseases, and their effects on systemic inflammation, associated cardiovascular comorbidities, and thromboembolic or hypercoagulable states. The limited current literature shows potential for links between inflammatory skin diseases and hypercoagulable states. Biomarkers such as F1 + 2, D-dimer, eosinophilic cationic protein, and PAI-1 are currently being studied to outline the mechanisms connecting inflammatory skin disease to the coagulation system. Further study and larger amounts of data are needed to draw definitive conclusions, especially when interpreting biomarkers alone such as PAI-1. The mechanisms, rates of systemic inflammation, and clinical outcomes of traditionally "skin limited" inflammatory diseases remain chronically understudied in dermatology. Many organ systems have well established connections between inflammatory disease and hypercoagulable states, but there are significant gaps in the literature regarding skin diseases. There is a significant need for comprehensive investigation of molecular mechanisms behind inflammatory dermatologic disease and hypercoagulability, how hypercoagulability effects clinical outcomes, and proper intervention to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Composite flocculant PAFS-PDM was prepared from Polymeric aluminium ferric sulphate (PAFS) and Poly (diallyl dimethyl ammonium chloride) (PDM) in this study. A bacterium was selected from the soil near the shale gas exploitation platform as a bioflocculant-producing bacterium, and polysaccharide was extracted and combined with PAFS-PDM to obtain composite bioflocculant (CBF) to treat shale gas fracturing flowback fluid. The prepared CBF was characterized and the results showed that the prepared PAFS-PDM contained aluminium-iron hydroxyl polymer, which was a cationic flocculant. By measuring the turbidity removal rate and chemical oxygen demand (COD) removal efficiency, the function mechanism of CBF on the shale gas fracturing flowback fluid was discussed. The results showed that CBF had a stable treatment effect on fracturing flowback fluid when the pH value was about 7.0. With the increase of dosage, the coagulation efficiency increased first and then decreased. When the dosage of the CBF was 2500 mg·L−1, the treatment effect of shale gas fracturing flowback fluid was the best, and COD removal rate reached 89.43%. Through Zeta potential analysis, it was concluded that one of the coagulation mechanisms was electrical neutralization. According to the characterization results, it could be concluded that both adsorption bridging and charge neutralization mechanisms played important roles in the treatment of shale gas fracturing flowback fluids. [ABSTRACT FROM AUTHOR]

There is an increasing demand for fresh cheese varieties such as paneer because they offer ease of production, and time savings. Studies have been conducted on understanding the impact of milk composition on paneer quality, but there is no study on the effect of processing conditions on textural, rheological, and structural properties. To improve understanding of the impacts of processing on the quality attributes of paneer, six different samples were prepared in triplicate using two milk pre‐heat treatments (90°C/no hold or 90°C/10&#x02009;min), and three coagulation temperatures (CT‐70, 80 or 90°C). Extensive interactions were observed between β‐lactoglobulin and κ‐casein at higher CT. An increase in G′ and G″ values of paneer was observed at 90°C CT. Formation of dense protein networks with less porous structure was observed at higher CT. These findings show that coagulation temperature is critical for control of the physicochemical properties, and quality of paneer. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid cancer (THCA) is the most common endocrine tumor. Coagulation may be associated with the development of cancer, but its role in THCA patients is not yet clear. Methods: In this study, we determined the predictive value of coagulation biomarker D-dimer for THCA patient lateral lymph node metastasis (LLNM) through receiver operating characteristics (ROC) analysis and logistic regression analysis. Subsequently, this study used the TCGA database to identify coagulation-related molecular subtypes through consensus clustering analysis and compared their prognosis. We identified coagulation-related genes (CRGs) associated with prognosis in thyroid cancer through gene expression data and clinical information, and constructed a prognostic model by selecting the prognostic CRGs using LASSO regression. Patients were divided into high-risk and low-risk groups based on the median score. Subsequently, prognosis, clinical characteristics, gene mutation occurrence, immune infiltration, function, and drug sensitivity of the two groups were analyzed. We also constructed a nomogram combining the model and clinical features. Finally, the expression of the prognostic CRGs was validated by RT-qPCR. Results: D-dimers had better performance in predicting LLNM(the area under the curve was 0.656 (95% CI 0.580-0.733), with a cut-off value of 0.065 mg/l), and D-dimer>0.065mg/l was an independent predictor of LLNM. Then, we selected 8 prognostic CRGs to construct a predictive model. The prognosis of low-risk group patients was significantly better than that of high-risk group (P<0.001). The results showed significant differences in clinical characteristics, gene mutation occurrence, immune infiltration, function, and drug sensitivity between the high-risk and low-risk groups. We validated by qPCR that these 8 prognostic CRGs were overexpressed in THCA cell lines. Discussion: Overall, this study provided an in-depth exploration of the potential role of the coagulation in thyroid cancer and its clinical significance, offering a new theoretical basis and research direction for personalized therapy and prognostic evaluation. [ABSTRACT FROM AUTHOR]

Context. Dust coagulation and fragmentation impact the structure and evolution of protoplanetary disks and set the initial conditions for planet formation. Dust grains dominate the opacities, they determine the cooling times of the gas via thermal accommodation in collisions, they influence the ionization state of the gas, and the available grain surface area is an important parameter for the chemistry in protoplanetary disks. Therefore, dust evolution is an effect that should not be ignored in numerical studies of protoplanetary disks. Available dust coagulation models are, however, too computationally expensive to be implemented in large-scale hydrodynamic simulations. This limits detailed numerical studies of protoplanetary disks, including these effects, mostly to one-dimensional models. Aims. We aim to develop a simple – yet accurate – dust coagulation model that can be easily implemented in hydrodynamic simulations of protoplanetary disks. Our model shall not significantly increase the computational cost of simulations and provide information about the local grain size distribution. Methods. The local dust size distributions are assumed to be truncated power laws. Such distributions can be fully characterized by only two dust fluids (large and small grains) and a maximum particle size, truncating the power law. We compare our model to state- of-the-art dust coagulation simulations and calibrate it to achieve a good fit with these sophisticated numerical methods. Results. Running various parameter studies, we achieved a good fit between our simplified three-parameter model and DustPy, a state-of-the-art dust coagulation software. Conclusions. We present TriPoD, a sub-grid dust coagulation model for the PLUTO code. With TriPoD, we can perform twodimensional, vertically integrated dust coagulation simulations on top of a hydrodynamic simulation. Studying the dust distributions in two-dimensional vortices and planet-disk systems is thus made possible. [ABSTRACT FROM AUTHOR]

Given the prevalence of hematological conditions, surgeries, and trauma incidents, hemostats—therapeutics designed to control and arrest bleeding—are an important tool in patient care. The prophylactic and therapeutic use of hemostats markedly enhances survival rates and improves the overall quality of life of patients suffering from these conditions. Since their inception in the 1960s, hemostats have witnessed remarkable progress in terms of the active ingredients utilized, therapeutic outcomes, demonstrated efficacy, and the storage stability. In this review, we provide a comprehensive analysis of commercially available hemostats approved by the FDA, along with newer investigative hemostats currently in active clinical trials. We delve into the modality of active ingredients, route of administration, formulation type, and disease indications of these approved and investigative hemostats. Further, we analyze the trends observed in the hemostat actives for Hemophilia A and B, concluding with insights into the emerging patterns and noteworthy developments to watch for in this dynamic field. [ABSTRACT FROM AUTHOR]

(1) Background: Cirrhosis is associated with frequent alterations in standard coagulation tests that do not adequately reflect hemostasis. Thromboelastography provides a global assessment of coagulation and evaluates the functional status of clotting factors, fibrinogen, platelets, and fibrinolysis. The study aimed to assess whether liver disease severity leads to progressive alterations in the thromboelastography-based assessment of coagulation. (2) Methods: Consecutive patients with cirrhosis and abnormal standard coagulation tests (at least one of International Normalized Ratio > 2, platelet count < 50 × 103/µL, fibrinogen < 200 mg/dL) were analyzed using native thromboelastography. (3) Results: A total of 106 patients were included, of whom 69 (65.1%) had a normal thromboelastography. While the standard coagulation tests were significantly worse in patients in the Child C group (n = 62, 58.5%) than in patients staged in Child A and B, no significant differences existed between any of the thromboelastography variables. Of the 50 patients (47.1%) with an International Normalized Ratio > 2, only two patients (4%) had features of hypocoagulation, while 26% had features of hypercoagulability on thromboelastography. Patients with a platelet count < 50 × 103/µL had significantly lower platelet function as assessed by thromboelastography, yet only eight patients (20%) met the criteria for platelet transfusion. A thromboelastography-based transfusion protocol might lead to a 94.6% reduction in blood product transfusion indications in a simulation where the included patients would require interventional procedures. (4) Conclusion: Standard coagulation tests showed a poor correlation with thromboelastography. Based on thromboelastography, patients with severe, decompensated liver disease have a preserved hemostasis balance despite abnormal standard coagulation tests. Therefore, standard coagulation tests should not be used to guide the administration of blood products in patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Anticoagulation treatment for patients with high bleeding risk during hemodialysis is challenging. Contact between the dialysis membrane and the blood leads to protein adsorption and activation of the coagulation cascade reaction. Activated coagulation Factor X (FXa) plays a central role in thrombogenesis, but anticoagulant modification of the dialysis membrane is rarely targeted at FXa. In this study, we constructed an anticoagulant membrane using the polydopamine coating method to graft FXa inhibitors (apixaban and rivaroxaban) on the membrane surface. Attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and atomic force microscopy (AFM) were used to characterize the membranes. The apixaban- and rivaroxaban-modified membranes showed lower water contact angles, decreased albumin protein adsorption, and suppressed platelet adhesion and activation compared to the unmodified PES membranes. Moreover, the modified membranes prolonged the blood clotting times in both the intrinsic and extrinsic coagulation pathways and inhibited FXa generation and complement activation, which suggested that the modified membrane enhanced biocompatibility and antithrombotic properties through the inhibition of FXa. Targeting FXa to design antithrombotic HD membranes or other blood contact materials might have great application potential. [ABSTRACT FROM AUTHOR]

Introduction: Thrombotic and haemorrhagic complications have been reported following transcatheter aortic valve implantation (TAVI). However, few reports have studied perioperative changes in coagulation and platelet function after TAVI. Furthermore, there are no clear guidelines for antithrombotic therapy. This study aimed to examine the perioperative changes in coagulation and platelet contribution to clot strength after TAVI using thromboelastography (TEG 6s; Hemonetics). Methods: This prospective observational study included 15 patients scheduled to undergo TAVI for severe aortic stenosis. TEG 6s global haemostasis was used to record three measurements: on the day of surgery (immediately before the operation) and postoperative days 1 and 3. The reaction time R to thrombosis; K and α, which represent the rate of thrombosis; and the maximum amplitude (MA) were measured from the kaolin thromboelastography (TEG) curves. The coagulation index (CI) was calculated from the measurement results to assess thrombotic tendency. In addition, MA was converted to elastic clot strength, and platelet function was assessed by the difference, Gp, in elastic strength depending on platelet activation. Results: R and K decreased, and α tended to increase in kaolin TEG on days 1 and 3 after TAVI, indicating elevated coagulation function compared with the preoperative period, but MA and CI did not show significant changes. Gp decreased significantly on days 1 and 3, suggesting a decrease in the platelet contribution to clot strength. Conclusions: Compared with the preoperative period, coagulation tended to increase, and platelet contribution to clot strength decreased from days 1 to 3 after TAVI. [ABSTRACT FROM AUTHOR]

Introduction: Individualized heparin and protamine management is increasingly used as a strategy to reduce coagulation activation and bleeding complications. While it is associated with increased heparin requirements during Cardiopulmonary Bypass (CPB), the impact on protamine administration remains controversial. We aim to investigate the effect of heparin level-guided monitoring on protamine dosing during cardiac surgery where low-anticoagulation protocols are implemented. Methods: This is a prospective, randomized, controlled trial. A total of 132 patients undergoing elective full-spectrum cardiac surgery with Minimal Invasive Extracorporeal Circulation (MiECC) were recruited. All patients were managed by the same anaesthetic, surgical and perfusion team. Patients were randomly allocated in two groups; the individualized heparin-protamine titration (IHPT) group and the conventional heparinization and reversal group by using ACT (cACT) with a 0.75:1, protamine: heparin ratio. Titration was accomplished with the Hepcon HMS Plus (Medtronic, Minneapolis, MN) system. The primary outcome of the study was the total protamine dose used. Secondary outcomes comprised of the total heparin dose, the percentage of patients achieving target ACT, 24-h transfusion requirements, postoperative bleeding, duration of mechanical ventilation, major morbidity and length of hospital stay. Patients in each group were divided in two subgroups according to the target ACT; those operated for coronary artery bypass grafting (CABG) using a target ACT >300 s and the rest (non-CABG) patients operated with a target ACT >400 s, respectively. Results: Protamine requirements were significantly reduced when IHPT was implemented; CABG (118 ± 24 mg vs 163 ± 61 mg; p < 0.001) and non-CABG cases (151 ± 46 mg vs 197 ± 45 mg; p < 0.001). Moreover, heparin requirements were significantly higher in the non-CABG subgroup managed with IHPT (34,539 ± 7658 IU vs 29,893 ± 9037 IU; p = 0.02). In overall, no significant differences were detected with respect to postoperative bleeding, transfusion of RBC or other blood products. Conclusions: Individualized heparin monitoring and management reduces protamine requirements in cardiac surgery with MiECC implementing reduced anticoagulation strategy. Trial registration: clinicaltrials.gov; NCT04215588. [ABSTRACT FROM AUTHOR]

The clinical laboratory uses commercial products with limited shelf life or certain expiry dates requiring frequent lot changes. Prior to implementation for clinical use, laboratories should determine the performance of the new reagent lot to ensure that there is no significant shift in reagent performance or reporting of patient data. This guideline has been written on behalf of the International Council for Standardization in Haematology (ICSH) to provide the framework and provisional guidance for clinical laboratories for evaluating and verifying the performance of new lot reagents used for coagulation testing. These ICSH Working Party consensus recommendations are based on good laboratory practice, regulatory recommendations, evidence emerged from scientific publications, and expert opinion and are meant to supplement regional standards, regulations, or requirements. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate if implementation of the 2019 Society of Interventional Radiology (SIR) guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy is associated with increased haemorrhagic adverse events, change in pre-procedural blood product utilization, and evaluation of guideline compliance rate at a single academic institution. Methods: Ultrasound guided percutaneous liver biopsies from (January 2019-January 2023) were retrospectively reviewed (n = 504), comparing biopsies performed using the 2012 SIR pre-procedural coagulation guidelines (n = 266) to those after implementation of the 2019 SIR pre-procedural guidelines (n = 238). Demographic, preprocedural transfusion, laboratory, and clinical data were reviewed. Chart review was conducted to evaluate the incidence of major bleeding adverse events defined as those resulting in transfusion, embolization, surgery, or death. Results: Implementation of the 2019 SIR periprocedural guidelines resulted in reduced guideline non-compliance related to the administration of blood products, from 5.3% to 1.7% (P =.01). The rate of pre-procedural transfusion remained the same pre and post guidelines at 0.8%. There was no statistically significant change in the incidence of bleeding adverse events, 0.8% pre guidelines versus 0.4% post (P = 1.0). Conclusion: Implementation of the 2019 SIR guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy did not result in an increase in bleeding adverse events or pre-procedural transfusion rates. The guidelines can be safely implemented in clinical practice with no increase in major adverse events. [ABSTRACT FROM AUTHOR]

Carbon nanotubes (CNTs), as a new type of carbon material with complete molecular structure, have great application potential in the field of nanocomposites. In this study, carbon nanotubes were first surface modified to give them good hydrophilicity. Subsequently, the nanocomposite coagulant (PASS-T) with different modified CNTs (m-CNTs) contents was prepared by alkaline titration method. The CNT, m-CNT, PASS and PASS-T were characterized by FTIR, XRD and XRF. Then the coagulant was applied to oily sewage, and the coagulation results showed that the PASS-T (0.1%) had the best oil reduction rate (92%) and turbidity reduction rate (97%). Appropriate addition of m-CNT can increase the local concentration of coagulant at the molecular level, making the flocs of oily sewage larger. It can be found by SEM that PASS-T produces large and knotted flocs in oily sewage. Finally, the residual turbidity and oil removal rate of the different coagulants were statistically analyzed. [ABSTRACT FROM AUTHOR]

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The currently available point-of-care hemostasis tests are burdened by criticisms concerning the use of different activators and inhibitors and the lack of dynamic flow. These operating conditions may constitute an impediment to the determination of the patient's hemostatic condition. Hence, the diffusion of these tests in clinical practice is still limited to specific scenarios. In this work, we present a new method for analyzing the patient's global hemostasis based on the visualization of the main components of the coagulation process and its computerized quantitative image analysis. The automated "Smart Clot" point-of-care system presents a micro-fluidic chamber in which whole blood flows, without the addition of any activator or inhibitor. In this micro-channel, platelet adhesion, activation and aggregation to the type I collagen-coated surface take place (primary hemostasis), leading to the production of endogenous thrombin on the surface of platelet aggregates and the consequent fibrin mesh and thrombus formation (secondary hemostasis). These observations are verified by inhibiting primary hemostasis with the antiplatelet drugs Indomethacin (−70% on platelet aggregation, −60% on fibrin(ogen) formation) and Tirofiban (complete inhibition of platelet aggregation and fibrin(ogen) formation) and secondary hemostasis with the antithrombin drugs Heparin (−70% on platelet aggregation, −80% on fibrin(ogen) formation) and Lepirudin (−80% on platelet aggregation, −90% on fibrin(ogen) formation). Smart Clot, through a single test, provides quantitative results concerning platelet aggregation and fibrin formation and is suitable for undergoing comparative studies with other coagulation point-of-care devices. [ABSTRACT FROM AUTHOR]

A description is given of the model of formation of iodine oxide nanoparticles in the volume of the containment of a nuclear reactor during radiation-chemical reactions and clustering with subsequent formation of nanoparticles. The results of test calculations are presented. Nanoparticles of radioactive iodine oxides pose a potential hazard as a source of long-term radiation exposure to NPP personnel. They also penetrate outside the power plant through the air-ventilation system even if the enclosure remains sealed. In addition, calculations have shown that the formation of radioactive iodine oxide nanoparticles is closely related to the formation of volatile iodine compounds in the gas phase. Moreover, the intensity of formation of the latter depends significantly on air humidity. The main feature of the proposed model is the consideration of the kinetics of phenomena for processes in both the gas and aerosol phases when exposed to ionizing radiation on oxygen and water vapor in the air. The main result of the calculations is confirmation of the fundamental possibility of the formation of aerosol nanoparticles consisting of iodine oxides in a humid atmosphere even with a relatively low dose rate of radiation energy absorbed by the air. At the same time, radiolysis of water vapor has a weak effect on the size and concentration of iodine oxide nanoparticles. However, taking into account the chemical interaction of radiolysis products, in particular hydrogen radicals, induced by water vapor radiolysis, significantly affects the formation of volatile iodine compounds with hydrogen: HI and HOI. The obtained results, despite their preliminary nature, are important since they indicate the inevitability of the formation of suspended nanoparticles of iodine oxides and hydrogen iodide in the atmosphere of the reactor premises in the event of emergency situations with the release of radionuclides beyond the first circuit of the reactor. Therefore, this mechanism must be taken into account when developing models of the formation and behavior of fission product aerosols at NPPs. [ABSTRACT FROM AUTHOR]

Rapid industrial growth in Bangladesh, especially in the textile industry, has led to water pollution from toxic azo dyes like orange-II, which are harmful to ecosystems and enter the food chain via irrigation. This study examined the use of chemical coagulation (using C 6 H 11 NO 4 X 2 and FeCl 3 · 6 H 2 O ) and advanced oxidation process (using NaOCl ) to treat orange-II dye for irrigation. However, C 6 H 11 NO 4 X 2 and FeCl 3 · 6 H 2 O showed limited effectiveness in removing orange-II dye across various pH (3, 6, 9, and 12) levels. In contrast, NaOCl achieved significant dye removal rates of over 90–99%. The study focused on high color removal, limited ClO 2 and neutral pH after the test. Variables included NaOCl doses (0.5 ml, 2.5 ml, and 5 ml), orange II dye doses (50 mg, 100 mg, and 150 mg) under different pH (3, 6, 8, 9 and 12) conditions. The manuscript is the first to assess orange-II dye using higher doses (2.5 ml and 5 ml) of NaOCl compared to other studies, as an alkaline chemical to neutralize pH levels post-test. The highest dye removal occurred at pH 9 with similar results at other pH levels except pH 12. However, despite effective color removal, the pH remained alkaline at pH 8, 9, and 12 after the test. Hence, optimal experimental conditions of operational parameters were pH = 3 or 6, 2.5 ml NaOCl dose with 100 mg/L or 150 mg/L dye doses. Further research is recommended on the degradation process, toxicological analysis of the final product, and cost-effectiveness for safe irrigation water. [ABSTRACT FROM AUTHOR]

The complement system, comprising over 30 proteins, is integral to the immune system, and the coagulation system is critical for vascular homeostasis. The activation of the complement and coagulation systems involves an organized proteolytic cascade, and the overactivation of these systems is a central pathogenic mechanism in several diseases. This review describes the role of complement and coagulation system activation in critical illness, particularly sepsis. The complexities of sepsis reveal significant knowledge gaps that can be compared to a profound abyss, highlighting the urgent need for further investigation and exploration. It is well recognized that the inflammatory network, coagulation, and complement systems are integral mechanisms through which multiple factors contribute to increased susceptibility to infection and may result in a disordered immune response during septic events in patients. Given the overlapping pathogenic mechanisms in sepsis, immunomodulatory therapies currently under development may be particularly beneficial for patients with sepsis who have concurrent infections. Herein, we present recent findings regarding the molecular relationships between the coagulation and complement pathways in the advancement of sepsis, and propose potential intervention targets related to the crosstalk between coagulation and complement, aiming to provide more valuable treatment of sepsis. [ABSTRACT FROM AUTHOR]

Tofu has captivated researchers' attention due to its distinctive texture and enrichment in nutritional elements, predominantly soybean protein. Coagulants play a critical role in promoting coagulation during tofu production, directly influencing its texture, quality, and physicochemical characteristics. Currently, the impact of coagulant characteristics on coagulation, as well as the underlying mechanisms, remain unclear. This review provides a summary of research progress on salt coagulants, acid coagulants, enzyme coagulants, novel coagulants, polysaccharide additives, and various coagulant formulations. The coagulation mechanisms of various coagulants are also discussed. Accordingly, this paper seeks to offer reliable theoretical guidance for the development of novel coagulants and the realization of fully automated tofu production. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effect of bittern coagulant dosage and rapid stirring speed on reducing the concentrations of biological oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), and dye absorbance in batik industry wastewater, as well as to identify the optimum coagulant dosage and stirring speed. Wastewater samples were collected from a batik industry in the batik center of Sidoarjo, East Java, Indonesia. Dosage variations of 5%, 10%, 15%, and 20% were tested alongside rapid stirring speeds of 100 rpm, 130 rpm, and 160 rpm. The study was conducted on a laboratory scale using the jar test method. Initial wastewater characteristics showed BOD, COD, TSS, and dye absorbance concentrations of 185.68 ± 29.34 mg/L, 10.091 ± 363.24 mg/L, 2.231.33 ± 155.55 mg/L, and 0.212 ± 0.02, respectively. Statistical analysis using the Pearson correlation test and Two-Way ANOVA revealed that variations in coagulant dosage and stirring speed significantly impacted the reduction percentages of BOD, COD, TSS, and dye absorbance. The optimal coagulant dosage was found to be 5%, and the optimal stirring speed was 100 rpm, with reduction percentages for BOD, COD, TSS, and dye absorbance being 80.32%, 65.86%, 92.35%, and 70.77%, respectively. [ABSTRACT FROM AUTHOR]

Context People with type 1 diabetes (T1D) are at increased risk of thrombosis compared to the general population; however, the underlying mechanisms remain unclear. Hypoglycemia induced at rest can induce coagulation activation, but little is known about the hemostatic effects of exercise-related hypoglycemia in people with T1D. Objective We compared hemostatic profiles of individuals with T1D with healthy controls and explored hemostatic effects of hypoglycemia, induced with or without exercise, in participants with T1D. Methods Thrombelastography was used for a baseline hemostatic comparison between fifteen men with T1D and matched healthy controls. In addition, the participants with T1D underwent two euglycemic-hypoglycemic clamp days in a randomized, crossover fashion. Hypoglycemia was induced with the participants at rest (Hypo-rest) or during exercise (Hypo-exercise). Thrombelastography provides data on the rate of coagulation activation (R-time), the rate of clot formation (K-time, α-Angle), the maximum clot amplitude (MA), the functional fibrinogen contribution to the clot strength (MA-FF) and the fibrinolysis (LY-30). Results The T1D group exhibited a faster rate of coagulation activation (shorter R-time) and a faster clot formation (greater α-Angle) compared with the controls. During the clamp experiments, Hypo-exercise induced an increased clot strength (MA) with a mean difference from baseline of 2.77 mm (95% CI, 2.04-3.51) accompanied with a decreased fibrinolysis (LY-30) of −0.45 percentage point (−0.60 to −0.29). Hypo-rest resulted in increased functional fibrinogen (MA-FF) of 0.74 mm (0.13-1.36) along with an increased fibrinolysis (LY-30) of 0.54 percentage point (0.11-0.98). Conclusion Individuals with T1D exhibit a hypercoagulable hemostatic profile compared with healthy controls and exercise-related hypoglycemia may increase the susceptibility to thrombosis via both procoagulant and antifibrinolytic effects. [ABSTRACT FROM AUTHOR]

Background: Coagulopathy is part of the pathological host response to infection in sepsis. Higher plasma concentrations of both tissue factor (TF) and tissue factor pathway inhibitor (TFPI) are associated with occurrence of disseminated intravascular coagulation (DIC), multi-organ dysfunction and increased mortality in patients with sepsis. Currently no treatment approaches specifically targeting this axis are available. We hypothesize that therapeutic plasma exchange (TPE) might limit this coagulopathy by restoring the balance of plasma proteins. Methods: This was a pooled post-hoc biobank analysis including 51 patients with early (shock onset < 24 h) and severe (norepinephrine dose > 0.4 μg/kg/min) septic shock, who were either receiving standard of care treatment (SOC, n = 14) or SOC + one single TPE (n = 37). Plasma concentrations of TF and TFPI were measured both at- and 6 h after study inclusion. The effect of TPE on concentrations of TF and TFPI was investigated and compared to SOC patients. Further, baseline TF and TFPI concentrations were used to modulate and predict clinical response to adjunctive TPE, indicated by longitudinal reduction of lactate concentrations over the first 24 h following study inclusion. Results: TPE led to a significant reduction in circulating concentrations of both TF and TFPI while no difference was observed in the SOC group. Relative change of TF within 6 h was + 14 (-0.8 to + 30.4) % (p = 0.089) in the SOC and −18.3 (−32.6 to −2.2) % (p < 0.001) in the TPE group (between group p < 0.001). Similarly, relative change of TFPI was + 14.4 (−2.3 to + 30.9) % (p = 0.076) in the SOC and −20 (−32.8 to −7.9) % (p < 0.001) in the TPE group (between group p = 0.022). The ratio of TF to TFPI remained unchanged in both SOC and TPE groups. SOC patients exhibited an increase in lactate over the initial 24 h when TF and TFPI concentrations were higher at baseline. In contrast, patients undergoing TPE experienced a sustained longitudinal reduction of lactate concentrations across all levels of baseline TF and TFPI elevations. In a multivariate mixed−effects model, higher baseline TF (p = 0.003) and TFPI (p = 0.053) levels led to greater longitudinal lactate concentration reduction effects in the TPE group. Conclusions: Adjunctive TPE in septic shock is associated with a significant removal of both TF and TFPI, which may contribute to the early hemodynamic improvement observed in septic shock patients receiving TPE. Higher baseline TF (and TFPI) plasma concentrations were identified as a putative predictor of treatment response that could be useful for predictive enrichment strategies in future clinical trials. [ABSTRACT FROM AUTHOR]

The article discusses the challenges posed by lipemic samples in diagnostic laboratories due to lipid interference in spectrophotometric methods. The study examines the use of high-speed centrifugation to mitigate this interference in anti-Xa activity measurement for patients on anticoagulants. Results show that high-speed centrifugation did not significantly impact anti-Xa activity measurement and was effective in overcoming lipemia for unfractioned heparin and low molecular weight heparin. The study suggests that high-speed centrifugation is a simple and effective method to address lipemia interference in laboratory measurements. [Extracted from the article]

Background: Coronary artery bypass grafting (CABG) is often performed with hypothermic cardiopulmonary bypass (CPB) to reduce metabolic demands and protect the myocardium. However, hypothermia can increase bleeding risks and other complications. Methods: This is a prospective, multi-center, randomized controlled trial. From September 2023 to December 2024, a total of 336 eligible patients planning to undergo on-pump CABG will be enrolled. All participants will be randomly divided into mild hypothermia CPB group (target oxygenator arterial outlet blood temperature at 32–33℃) or normothermia CPB group (target oxygenator arterial outlet blood temperature at 35–36℃). The primary endpoint is Universal Definition of Perioperative Bleeding (UDPB) class 2–4. Secondary endpoints are class of UDPB, levels of coagulation and inflammatory factors, in-hospital mortality, perioperative related complications, ICU length of stay, and hospital length of stay. Discussion: This clinical trial aims to compare the effects of different target temperature during CPB on postoperative bleeding and to explore optimal temperature strategy to provide new clinical evidence. Trial registration: Chictr.org.cn: ChiCTR2300075405. The trial was prospectively registered on 4 September 2023. [ABSTRACT FROM AUTHOR]

Background: Hypothermia and acidosis individually inhibit haemostasis. We designed this study with the aim to investigate whether rivaroxaban combined with hypothermia or acidosis exhibit synergistic inhibitory effects on haemostasis using ROTEM®. Methods: Patients with a clinical indication to start rivaroxaban treatment were prospectively included. Blood samples were collected before initiation of treatment and the day after. All blood samples were in vitro modified with respect to temperature (incubated and analysed at 28, 33, 37 and 40 degrees Celsius (°C)) and pH (6.8, 7.0, 7.2 and 7.4). The temperature and acidosis effects on the ROTEM EXTEM variables clotting time (CT), clot formation time (CFT) and alpha-angle (AA) were measured along with the individual effect of rivaroxaban on the same variables. The additive effect was calculated. The observed (potential synergistic) effects for the temperature and pH modified rivaroxaban samples on the same ROTEM variables, were registered. Differences between the additive and observed (potential synergistic) effects were analysed using matched non-parametric hypothesis testing. Results: In total, 13 patients were included. Hypothermia and rivaroxaban exhibited a synergistic effect on CT at 28 °C (p = 0.0002) and at 33 °C (p = 0.0007). The same applied for acidosis at pH 6.8 (p = 0.003) and pH 7.0 (p = 0.003). There were no signs of synergistic effects of rivaroxaban and temperature or acidosis on CFT. In AA there were signs of synergism at 28 °C (p = 0,001), but not at other tested temperatures or pH levels. Conclusions: The combination rivaroxaban together with hypothermia or acidosis demonstrated inhibitory synergistic effects on haemostasis. Trial registration: The study was retrospectively registered 2023-03-01 at ClinTrials.gov with NCT05669313. [ABSTRACT FROM AUTHOR]

Discovered in late 2019, the SARS-CoV-2 coronavirus has caused the largest pandemic of the 21st century, claiming more than seven million lives. In most cases, the COVID-19 disease caused by the SARS-CoV-2 virus is relatively mild and affects only the upper respiratory tract; it most often manifests itself with fever, chills, cough, and sore throat, but also has less-common mild symptoms. In most cases, patients do not require hospitalization, and fully recover. However, in some cases, infection with the SARS-CoV-2 virus leads to the development of a severe form of COVID-19, which is characterized by the development of life-threatening complications affecting not only the lungs, but also other organs and systems. In particular, various forms of thrombotic complications are common among patients with a severe form of COVID-19. The mechanisms for the development of thrombotic complications in COVID-19 remain unclear. Accumulated data indicate that the pathogenesis of severe COVID-19 is based on disruptions in the functioning of various innate immune systems. The key role in the primary response to a viral infection is assigned to two systems. These are the pattern recognition receptors, primarily members of the toll-like receptor (TLR) family, and the complement system. Both systems are the first to engage in the fight against the virus and launch a whole range of mechanisms aimed at its rapid elimination. Normally, their joint activity leads to the destruction of the pathogen and recovery. However, disruptions in the functioning of these innate immune systems in COVID-19 can cause the development of an excessive inflammatory response that is dangerous for the body. In turn, excessive inflammation entails activation of and damage to the vascular endothelium, as well as the development of the hypercoagulable state observed in patients seriously ill with COVID-19. Activation of the endothelium and hypercoagulation lead to the development of thrombosis and, as a result, damage to organs and tissues. Immune-mediated thrombotic complications are termed "immunothrombosis". In this review, we discuss in detail the features of immunothrombosis associated with SARS-CoV-2 infection and its potential underlying mechanisms. [ABSTRACT FROM AUTHOR]

Angiostrongylus vasorum is a cardiopulmonary nematode of canids and is, among others, associated with bleeding disorders in dogs. The pathogenesis of such coagulopathies remains unclear. A deep proteomic characterization of sex specific A. vasorum excretory/ secretory proteins (ESP) and of cuticular surface proteins was performed, and the effect of ESP on host coagulation and fibrinolysis was evaluated in vitro. Proteins were quantified by liquid chromatography coupled to mass spectrometry and functionally characterized through gene ontology and pathway enrichment analysis. In total, 1069 ESP (944 from female and 959 from male specimens) and 1195 surface proteins (705 and 1135, respectively) were identified. Among these were putative modulators of host coagulation, e.g., von Willebrand factor type D domain protein orthologues as well as several proteases, including serine type proteases, protease inhibitors and proteasome subunits. The effect of ESP on dog coagulation and fibrinolysis was evaluated on canine endothelial cells and by rotational thromboelastometry (ROTEM). After stimulation with ESP, tissue factor and serpin E1 transcript expression increased. ROTEM revealed minimal interaction of ESP with dog blood and ESP did not influence the onset of fibrinolysis, leading to the conclusion that Angiostrongylus vasorum ESP and surface proteins are not solely responsible for bleeding in dogs and that the interaction with the host's vascular hemostasis is limited. It is likely that coagulopathies in A. vasorum infected dogs are the result of a multifactorial response of the host to this parasitic infection. [ABSTRACT FROM AUTHOR]

This guidance document has been prepared on behalf of the International Council for Standardization in Haematology (ICSH). The aim of the document is to provide guidance and recommendations for the performance and interpretation of activated partial thromboplastin time (APTT) and prothrombin time (PT) plasma mixing tests in clinical laboratories in all regions of the world. The following areas are included in this document: preanalytical, analytical, postanalytical, and quality assurance considerations as they relate to the proper performance and interpretation of plasma mixing tests. The recommendations are based on good laboratory practice, published data in peer‐reviewed literature, and expert opinion. [ABSTRACT FROM AUTHOR]

Canine parvoviral enteritis (CPE) has a high mortality rate in untreated dogs due to systemic inflammation and multi-organ dysfunction. The inflammatory process can lead to coagulation abnormalities. This study aimed to evaluate the coagulation status using thromboelastography (TEG) and assess the thrombin generation (TG) and clot dissolution using TEG-derived velocity curve (v-curve) parameters in dogs with CPE. It included 21 dogs with CPE and five healthy dogs. In addition to the clinico-haemato-biochemical examinations, the coagulation status was analysed using citrated venous blood samples with TEG. All the dogs with CPE met at least two criteria for systemic inflammatory response syndrome (SIRS). The comparison to healthy controls showed a statistically significant prolongation of reaction times (R time; P = 0.005) and times to the maximum rate of thrombus generation (TMRTG; P = 0.003). However, the times to the maximum rate of lysis (TMRL; P = 0.041) and total lysis (L; P = 0.024) decreased significantly. The TEG tracings showed coagulation states varying from hypocoagulation to hypercoagulation in dogs with CPE. These results showed that the v-curve derivate can be used to evaluate the coagulation in dogs with CPE, and it could be superior to the standard TEG variables for determining the low fibrinolytic activity. Thus, the v-curve parameters may provide a novel insight into the underlying mechanism and clinical treatment strategy of CPE-induced inflammation. [ABSTRACT FROM AUTHOR]

It is common practice in laboratories to store biological samples in ultra-low temperature (ULT) freezers. There is growing interest in raising the temperature of ULT freezers in order to save energy and reduce expenses, as energy conservation becomes increasingly important and sustainable laboratory practices gain popularity. In our laboratory, plasma samples are stored for three months for diagnostic purposes. We therefore took the opportunity to investigate the effect of two different storage temperatures (−70 °C vs −80 °C), on activated partial thromboplastin time (APTT), factor VIII (FVIII), international normalized ratio (INR) and factor VII (FVII) measurements on paired plasma samples collected from 26 individuals after three months of storage. Automated coagulation analysers CS-5100 and ACL TOP were used to perform the tests. We found no consistent difference between the two storage temperatures for any of the four coagulation parameters (all p-values > 0.05). We conclude that the temperature of ULT freezers used to store plasma samples for APTT, FVIII, INR, and FVII measurements can be safely increased from −80 to −70 °C without affecting the stability of the samples. [ABSTRACT FROM AUTHOR]