We describe a kinetic enzymatic method for ethanol in serum, based on the use of pyrazole, a competitive inhibitor for alcohol dehydrogenase (EC 1.1.1.1). The method is rapid and is easily automated for the Cobas Bio centrifugal analyzer. No specimen pretreatment is necessary and the total reaction time is 120 s. The standard curve is linear up to 140 mmol/L. The within-run CV was between 1.9% and 3.5%; the between-run CV ranged from 2.6% to 4.1%. Mean analytical recovery of ethanol added to serum was 100.2%. We compared results of the kinetic enzymatic method with those from a gas-liquid chromatographic (GLC) method and another commercial alcohol dehydrogenase method (TDx REA Ethanol; Abbott Diagnostics). Linear regression analysis gave the following equations: kinetic = 0.991GLC - 0.354 mmol/L (r = 0.992, n = 110) and kinetic = 0.998TDx - 1.741 mmol/L (r = 0.993, n = 70). No interference from methanol or isopropanol was seen.
Systemic inflammation and the activation of the coagulation system following cardiopulmonary bypass (CPB) may contribute to postoperative complications. In vitro studies have demonstrated that heparin possesses anti-inflammatory properties. To ascertain the relative benefits of high versus low heparin doses, we studied the impact of varying heparin doses on the inflammatory response and coagulation system during and following CPB. Forty patients scheduled for elective coronary artery bypass surgery requiring CPB were randomized to either a low dose (300 U/kg) (Group L) or a high dose of unfractionated heparin (600 U/kg) (Group H). To evaluate the inflammatory response, proinflammatory cytokines [tumor necrosis factor-alpha and interleukin-6 (IL-6)] were measured at four different times: before CPB (T0), 30 min after the institution of CPB (T1), 30 min after cross-clamp release (T2), and 4 h after the end of CPB (T3). Thrombin-antithrombin complex, platelet factor 4 and anti-activated factor X heparin concentrations were also measured. Patients in Group H received greater heparin (44.934 U versus 27.741 U, P<0.001) and protamine (P=0.003) doses. Postoperative blood loss and blood products transfusions were not significantly different in the groups. At T1, mean heparin plasma concentration was higher in Group H (P<0.001). IL-6 was significantly lower in Group H compared with Group L (P=0.01) only at T1. Using a mixed-effects statistical model, tumor necrosis factor-alpha and IL-6 levels were comparable regardless of the heparin dose. Thrombin-antithrombin complex levels were lower in Group H (P=0.04) and platelet factor 4 levels were significantly lower in Group H at T2 (P=0.04). Higher heparin doses were associated with higher heparin concentrations during CPB. A high heparin dose achieved a better preservation of the coagulation system with less thrombin formation and platelet activation. The heparin dose had small influence on proinflammatory cytokines release.
Facial burns are devastating injuries that can have lasting physical and psychological effects on patients. Proper management of facial burns to minimize such morbidities continues to challenge reconstructive surgeons. The main objective of our study is to compare safety in use of amniotic membrane skin substitute in treating adult versus pediatric facial burn. Data from our institution’s burn registry in the period from March 2015 through March 2017 was retrospectively reviewed. We compared the safety of using amniotic membrane allografts in treating patients with facial burn (adults ≥16 years old versus pediatrics <16 years old) to comparing incidence of complications in each group. Data were collected from demographic information as well as outcome measures including healing at 2 weeks and complications. Paired sample t-test and Chi Squared analyses were used with significance defined as p < 0.05. A total of 77 adults and 13 pediatric patients with facial burns received amniotic membrane skin substitute were included. The mean age for adults was 40.8 years (16–88) compared to 5.6 years (0–15) in the pediatric group. The percent total body surface area burn (TBSA) range was between 1 to 57% with an average 9. 6% in the adult group compared to 2 to 14% with an average of 6.0% in the pediatric group. Injury severity score (ISS) average was 4 in adults versus 2.2 in pediatric patients. Pediatric trauma patients with facial burn had greater incidence of complications compared to the adult patients group 46.2% vs 18.2% (p = 0.02) while all patients in both groups healed at a rate of 100% by the second week after the primary procedure. Use of amniotic fluid membrane skin substitute is safe in treatment of pediatric facial burn and may result in fewer complications than in adults. Is to improve outcomes particularly healing and reduce complication rate in patients with facial burns.
The non-specific binding of anticoagulantly-active heparin to plasma proteins may influence its anticoagulant effect. We used low affinity heparin (LAH) essentially devoid of anti-factor Xa activity to investigate the extent and possible mechanism of this non-specific binding. The addition of excess LAH to platelet-poor plasma containing a fixed amount of unfractionated heparin doubled the anti-factor Xa activity presumably because it displaces anticoagulantly-active heparin from plasma proteins. Although dextran sulfates of varying molecular weights also increased the anti-factor Xa activity, less sulfated heparin-like polysaccharides had no effect. These findings suggest that the ability to displace active heparin from plasma protein binding sites is related to charge and may be independent of molecular size. In contrast to its effect in plasma containing unfractionated heparin, there was little augmentation in anti-factor Xa activity when LAH was added to plasma containing low molecular weight heparin (LMWH), indicating that LMWH binds less to plasma proteins than unfractionated heparin. This concept is supported by studies comparing the anticoagulant activity of unfractionated heparin and LMWH in plasma with that in buffer containing antithrombin III. The anti-factor Xa activity of unfractionated heparin was 2-fold less in plasma than in the purified system. In contrast, LMWH had identical anti-factor Xa activity in both plasma and buffer, respectively. These findings may be clinically relevant because the recovered anti-factor Xa activity of unfractionated heparin was 33% lower in plasma from patients with suspected venous thrombosis than in plasma from healthy volunteers.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVES To assess the evidence for using heparin in the treatment of burn injury or the complications of burn injury in adults and children. DATA SOURCES The following databases were searched: MEDLINE (1966-current), EMBASE (1980-current), Cumulative Index to Nursing & Allied Health (CINAHL) (1982-current), The Cochrane Central Database of Controlled Trials (1995-current), Web of Science (1976-current), and BIOSIS (1976-current). Additional data sources included the U.S. and European Patent Offices, technical experts, the partner organization, and reference lists. REVIEW METHODS Studies identified from the data sources went through two levels of title and abstract screening. Passing studies advanced to full text screening. Studies that met the full text screening criteria were abstracted. Criteria for abstraction included publication in any language, human patients of any age, and burns of any type, grade, or total body surface area. All formulations of heparin, and all application methods (e.g., topical, subcutaneous), were eligible for inclusion in the report. Abstracted studies required a comparison group. Outcomes of interest included mortality, pain, length of stay in hospital, thrombosis and emboli, psychiatric adjustment, and adverse effects (e.g., bleeding). RESULTS Nineteen articles from 18 unique studies were abstracted and included in this report. In these articles, there were multiple uses of heparin to treat burns (e.g., wound healing, inhalation injury, sepsis, pain). However, the overall quality of the articles was weak. Examples of weakness included unclear or inappropriate treatment allocation, no blinding, no control of confounding, poorly defined burn characteristics (e.g., thickness), unclear duration of treatment, incomplete description of heparin treatment, and use of inadequately described or invalid outcome measures. Overall, the evidence from these weak articles was insufficient to determine whether the effectiveness of heparin to treat burn injury was different from the effectiveness of other treatments, or whether treatment effectiveness varied according to (a) the method of applying heparin to (b) burn etiology. Four studies mentioned contraindications to using heparin to treat burns. These contraindications were bleeding diathesis, bleeding history, active bleeding or associated trauma with potential bleeding, active intestinal ulcer, thrombocytopenia, liver disease, renal disorders, or allergy to heparin. CONCLUSIONS There is no strong evidence in the 19 abstracted articles to suggest that heparin should be used in the treatment of burn injury on account of its non-anticoagulant properties.
