Adult-onset Stil's disease(AOSD)is a rare condition that lies between autoinflammatory syndrome and autoimmune disease.The main clinical manifestations include fever,chills,rash,joint swelling and pain,peripheral ...Adult-onset Stil's disease(AOSD)is a rare condition that lies between autoinflammatory syndrome and autoimmune disease.The main clinical manifestations include fever,chills,rash,joint swelling and pain,peripheral blood leukocytosis,splenomegaly,etc.It is a systemic disease affecting between 1 and 34 people per million.The average age of onset is 35 years old,with a slightly higher prevalence rate in women.Since AOSD lacks early specific symptoms and signs,non-specialist doctors have limited understanding of the disease,and patients are prone to clinical misdiagnosis,mistreatment,and delayed disease progression.This paper reports a patient whose AOSD was misdiagnosed as acute fibrinous and organizing pneumonia.展开更多
BACKGROUND Since the acute fibrinous and organizing pneumonia(AFOP) was first described by Beasley in 2002, some case reports of patients aged from 38 d to 80 years have been published worldwide, but there is still no...BACKGROUND Since the acute fibrinous and organizing pneumonia(AFOP) was first described by Beasley in 2002, some case reports of patients aged from 38 d to 80 years have been published worldwide, but there is still no standard therapy for this disease and the treatment methods remain controversial. Both steroid and immunosuppressive agents, such as cyclophosphamide or mycophenolate mofetil, have been reported to be effective in some studies, but with many side effects, especially in patients of advanced age. CASE SUMMARY We herein report an 81-year-old female patient who was admitted to our hospital due to dry cough, and breathlessness for 1 mo. She was treated with broadspectrum antibiotics and anti-fungal therapy, but without improvement in both symptoms and radiological findings, and her respiratory status worsened, and she required bed rest almost the whole day. Computed tomography-guided percutaneous needle lung biopsy was performed and histopathology examination confirmed the diagnosis of AFOP. She was then successfully treated with a steroid monotherapy, which resulted in a satisfactory clinical outcome without serious complications. CONCLUSION We conclude that complete remission of AFOP can be achieved by steroid monotherapy in patients of advanced age.展开更多
BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical...BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.展开更多
Background： Acute fibrinous and organizing pneumonia （AFOP） is a unique pathological entity with intra-alveolar fibrin in the form of ＂fibrin balls＂ and organizing pneumonia. It was divided into rare idiopathic i...Background： Acute fibrinous and organizing pneumonia （AFOP） is a unique pathological entity with intra-alveolar fibrin in the form of ＂fibrin balls＂ and organizing pneumonia. It was divided into rare idiopathic interstitial pneumonia according to the classification notified by American Thoracic Society/European Respiratory Society in 2013. As a rare pathological entity, it is still not well known and recognized by clinicians. We reviewed the clinical features of 20 patients with AFOP diagnosed in a teaching hospital. Methods： The medical records of 20 patients with biopsy-proven diagnosis of AFOP were retrospectively reviewed. The patients＇ symptoms, duration of the disease, comorbidities, clinical laboratory data, pulmonary function testing, radiographic studies, and the response to treatment were extracted and analyzed. Results： Fever was the most common symptom and was manifested in 90% of AFOP patients. For clinical laboratory findings, systematic inflammatory indicators, including C-reactive protein and erythrocyte sedimentation rate, were significantly higher than normal ill AFOP patients. In accordance with this increased indicators, injured liver functions were common in AFOP patients. Inversely, AFOP patients had worse clinical conditions including anemia and hypoalbuminemia. For pulmonary function testing, AFOP patients showed the pattern of restrictive mixed with obstructive ventilation dysfunction. For high-resolution computerized tomography （HRCT） findings, the most common pattern for AFOP patients was lobar consolidation which was very similar to pneumonia. However, unlike pneumonia, AFOP patients responded well to glucocorticoids. Conclusion： Patients with AFOP manifest as acute inflammatory-like clinical laboratory parameters and lobar consolidation on HRCT, but respond well to steroid.展开更多
BACKGROUND Skin wounds are common injuries that affect quality of life and incur high costs.A considerable portion of healthcare resources in Western countries is allocated to wound treatment,mainly using mechanical,b...BACKGROUND Skin wounds are common injuries that affect quality of life and incur high costs.A considerable portion of healthcare resources in Western countries is allocated to wound treatment,mainly using mechanical,biological,or artificial dressings.Biological and artificial dressings,such as hydrogels,are preferred for their biocompatibility.Platelet concentrates,such as platelet-rich plasma(PRP)and platelet-rich fibrin(PRF),stand out for accelerating tissue repair and minimizing risks of allergies and rejection.This study developed PRF and PRP-based dressings to treat skin wounds in an animal model,evaluating their functionality and efficiency in accelerating the tissue repair process.AIM To develop wound dressings based on platelet concentrates and evaluating their efficiency in treating skin wounds in Wistar rats.METHODS Wistar rats,both male and female,were subjected to the creation of a skin wound,distributed into groups(n=64/group),and treated with Carbopol(negative control);PRP+Carbopol;PRF+Carbopol;or PRF+CaCl_(2)+Carbopol,on days zero(D0),D3,D7,D14,and D21.PRP and PRF were obtained only from male rats.On D3,D7,D14,and D21,the wounds were analyzed for area,contraction rate,and histopathology of the tissue repair process.RESULTS The PRF-based dressing was more effective in accelerating wound closure early in the tissue repair process(up to D7),while PRF+CaCl_(2) seemed to delay the process,as wound closure was not complete by D21.Regarding macroscopic parameters,animals treated with PRF+CaCl_(2) showed significantly more crusting(necrosis)early in the repair process(D3).In terms of histopathological parameters,the PRF group exhibited significant collagenization at the later stages of the repair process(D14 and D21).By D21,fibroblast proliferation and inflammatory infiltration were higher in the PRP group.Animals treated with PRF+CaCl_(2) experienced a more pronounced inflammatory response up to D7,which diminished from D14 onwards.CONCLUSION The PRF-based dressing was effective in accelerating the closure of cutaneous wounds in Wistar rats early in the process and in aiding tissue repair at the later stages.展开更多
Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leadi...Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leading to a significant increase in the economic burden.Conventional treatment modalities utilized to manage knee OA have limitations.Over the last decade,the role of various autologous peripheral blood-derived orthobiologics(APBOs)for the treatment of knee OA has been extensively investigated.This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA.While numerous studies have demonstrated promising results for these preparations,a notable gap exists in the comparative analysis of these diverse formulations.This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained longterm results.Thus,more adequately powered,multicenter,prospective,doubleblind,randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.展开更多
AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repai...AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy.METHODS:A retrospective analysis included 42 males and 10 females(mean age 46.0±6.0y,range 34 to 58y)who underwent primary wound sutures and vitrectomy for globe rupture.Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated.On the first postoperative day,subconjunctival injections of either 5000 units(0.4 mL)of trypsin solution(n=25)or 0.5 mL(1 mg)DEX(n=27)were administered to accelerate exudate absorption.Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane.Safety and comfort were evaluated by monitoring intraocular pressure(IOP),allergy,pain,and foreign body sensation.RESULTS:Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane,but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group(P<0.05).Trypsin treatment was also less irritating to patients.No adverse reactions were reported,and IOP remained stable.Visual acuity improved in both groups without statistical difference.CONCLUSION:Compared to DEX,trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.展开更多
Objective Diabetic foot ulcer(DFU)is one of the most serious complications of diabetes.Leukocyte-and platelet-rich fibrin(L-PRF)is a second-generation autologous platelet-rich plasma.This study aims to investigate the...Objective Diabetic foot ulcer(DFU)is one of the most serious complications of diabetes.Leukocyte-and platelet-rich fibrin(L-PRF)is a second-generation autologous platelet-rich plasma.This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice.Methods Patients with DFU who received L-PRF treatment and standard of care(SOC)from 2018 to 2019 in Tongji Hospital were enrolled.The clinical information including patient characteristics,wound evaluation(area,severity,infection,blood supply),SOC of DFU,and images of ulcers was retrospectively extracted and analyzed.L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction(PVR)greater than 80%.Therapeutic effectiveness,including overall PVR and the overall and weekly healing rates,was evaluated.Results Totally,26 patients with DFU were enrolled,and they had an ulcer duration of 47.0(35.0,72.3)days.The severity and infection of ulcers varied,as indicated by the Site,Ischemia,Neuropathy,Bacterial Infection,and Depth(SINBAD)scores of 2–6,Wagner grades of 1–4,and the Perfusion,Extent,Depth,Infection and Sensation(PEDIS)scores of 2–4.The initial ulcer volume before L-PRF treatment was 4.94(1.50,13.83)cm3,and the final ulcer volume was 0.35(0.03,1.76)cm3.The median number of L-PRF doses was 3(2,5).A total of 11 patients achieved complete epithelialization after the fifth week of treatment,and 19 patients achieved at least an 80%volume reduction after the seventh week.The overall wound-healing rate was 1.47(0.63,3.29)cm3/week,and the healing rate was faster in the first 2 weeks than in the remaining weeks.Concurrent treatment did not change the percentage of complete epithelialization or healing rate.Conclusion Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index,SINBAD score,or Wagner grade,indicating that this method is appropriate for DFU treatment under different clinical conditions.展开更多
With the popularization of central venous catheterization in recent years,the problems arising from intravenous therapy have gradually increased.Fibrin sheath is the complication with the highest incidence rate in cen...With the popularization of central venous catheterization in recent years,the problems arising from intravenous therapy have gradually increased.Fibrin sheath is the complication with the highest incidence rate in central venous catheterization,which has always been a major problem in intravenous therapy.So the prevention and treatment of fibrin sheath has become a hot spot of research in recent years.Hence,this paper summarizes the research on fibrin sheath in recent years.展开更多
Pseudogene and fibrin peptide which has rapid evolve speed and good stability are used in this study to determine the divergence date among groups.Through calculating the evolutionary rate of hemoglobin α chain,γ ch...Pseudogene and fibrin peptide which has rapid evolve speed and good stability are used in this study to determine the divergence date among groups.Through calculating the evolutionary rate of hemoglobin α chain,γ chain in vertebrate（including birds and mammals）,it is concluded that the evolutionary rate of hemoglobin α chain,γ chain is not invariable.It shows different evolutionary rates in different periods,that is,faster in early evolution stage and relatively slow in later stage.展开更多
Two monoclonal antibodies (McAbs) against Aα chain's C terminus offibrinogen (Fg) have been prepared and designated SZ-78 and SZ-79. Both theantigens in binding assay and immunoblot analysis showed that the two M...Two monoclonal antibodies (McAbs) against Aα chain's C terminus offibrinogen (Fg) have been prepared and designated SZ-78 and SZ-79. Both theantigens in binding assay and immunoblot analysis showed that the two McAbs recognized the epitopes located in residues 549-560 of the Aαchain. The two McAbs couldaccelerate rate of fibrin polymer assembly both in the purified system and in the humanplasma. From the pictures of transmission electronmicroscope, the average diametersof the fibers increase significantly to an average diameters of 375 nm after incubationwith the McAbs, while it was only 75nm without addition of the McAbs. There were al-so more branchings of fibers with addition of McAbs. These observations demonstratethat the amino acid sequences ofα 549-560 in the COOH terminus of the Aα chain mayplay an important role in the assembly of a fibrin clot, presumably being involved in lat-eral aggregation of protofibrils. The preparation of the McAbs supplies a usuful probe for the investigation of the展开更多
Platelet concentrates(PC) [platelet-rich plasma(PRP) and platelet-rich fibrin(PRF)] are frequently used for surgical procedures in medical and dental fields,particularly in oral and maxillofacial surgery,plastic surge...Platelet concentrates(PC) [platelet-rich plasma(PRP) and platelet-rich fibrin(PRF)] are frequently used for surgical procedures in medical and dental fields,particularly in oral and maxillofacial surgery,plastic surgery and sports medicine.The objective of all these technologies is to extract all the elements from a blood sample that could be used to improve healing and promote tissue regeneration.Although leukocyte rich and leukocyte poor PRP's have their own place in literature,the importance of non-platelet components in a platelet concentrate remains a mystery.PC have come a long way since its first appearance in 1954 to the T-PRF,A-PRF and i-PRF introduced recently.These PC find varied applications successfully in periodontics and implant dentistry as well.However,the technique of preparation,standing time,transfer process,temperature of centrifuge,vibration,etc.,are the various factors for the mixed results reported in the literature.Until the introduction of a proper classification of terminologies,the PC were known by different names in different countries and by different commercial companies which also created a lot of confusion.This review intends to clarify all these confusion by briefing the exact evolution of PC,their preparation techniques,recent advances and their various clinical and technical aspects and applications.展开更多
Platelet-rich fibrin(PRF)has been widely used owing to its ability to stimulate tissue regeneration.To date,few studies have described the antibacterial properties of PRF.Previously,PRF prepared by horizontal centrifu...Platelet-rich fibrin(PRF)has been widely used owing to its ability to stimulate tissue regeneration.To date,few studies have described the antibacterial properties of PRF.Previously,PRF prepared by horizontal centrifugation(H-PRF)was shown to contain more immune cells than leukocyte-and platelet-rich fibrin(L-PRF).This study aimed to compare the antimicrobial effects of PRFs against Staphylococcus aureus and Escherichia coli in vitro and to determine whether the antibacterial effects correlated with the number of immune cells.Blood samples were obtained from eight healthy donors to prepare L-PRF and H-PRF.The sizes and weights of L-PRF and H-PRF were first evaluated,and their antibacterial effects against S.aureus and E.coli were then tested in vitro using the inhibition ring and plate-counting test methods.Flow-cytometric analysis of the cell components of L-PRF and H-PRF was also performed.No significant differences in size or weight were observed between the L-PRF and H-PRF groups.The H-PRF group contained more leukocytes than the L-PRF group.While both PRFs had notable antimicrobial activity against S.aureus and E.coli,H-PRF demonstrated a significantly better antibacterial effect than L-PRF.Furthermore,the antimicrobial ability of the PRF solid was less efficient than that of wet PRF.In conclusion,H-PRF exhibited better antibacterial activity than L-PRF,which might have been attributed to having more immune cells.展开更多
AIM: To investigate the levels of D-dimer(DD) and von Willebrand factor(vWF) and the relationship between DD and vWF in ulcerative colitis(UC) patients. METHODS: A total of 29 plasma specimens were obtained from patie...AIM: To investigate the levels of D-dimer(DD) and von Willebrand factor(vWF) and the relationship between DD and vWF in ulcerative colitis(UC) patients. METHODS: A total of 29 plasma specimens were obtained from patients with ulcerative colitis (male 13, female 16) aged 21-47 years (33+/-11). Disease activity was assessed by Truelove-Writeria. Patients with a score of above 5 were regarded as having active colitis. Twenty healthy people(male 12, female 8) aged 19-53 years(31+/-14) served as normal controls. Blood samples were taken from an antecubital vein puncture. Blood(1.8 mL) was injected into the tubes containing sodium citrate (0.13 mmol/L). The plasma was obtained by centrifugation at 3000 r.min(-1) for 10 min, and stored at -80 degrees until assayed by ELISA. RESULTS: The mean plasma levels of DD and vWF in active UC patients were significantly higher than those of the controls (0.69+/-0.41 vs 0.27+/-0.11, P【0.01 143+/-46 vs 103+/-35, P【0.01). The mean plasma levels of DD in the patients with active disease were higher than those with inactive disease(0.69+/-0.41 vs 0.48+/-0.29 P【0.05). The levels of vWF were not different between active and inactive patients. DD levels were positively related to vWF levels( r =0.574, P【0.01). There was no significant difference between levels of DD and vWF and the scope of disease and sex of the patients. CONCLUSION: vWF is an important feature and a good marker of UC intravascular thrombus and endothelial cell dysfunction were found in UC patients and the combined test of DD and vWF is helpful to distinguish the activity of the UC patients.展开更多
Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears th...Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.展开更多
Bone marrow mesenchymal stem cells were isolated from New Zealand white rabbits, culture-expanded and differentiated into Schwann cell-like cells. Autologous platelet-dch plasma and Schwann cell-like cells were mixed ...Bone marrow mesenchymal stem cells were isolated from New Zealand white rabbits, culture-expanded and differentiated into Schwann cell-like cells. Autologous platelet-dch plasma and Schwann cell-like cells were mixed in suspension at a density of 1 x 106 cells/mL, prior to introduction into a poly （lactic-co-glycolic acid） conduit. Fabricated tissue-engineered nerves were implanted into rabbits to bridge 10 mm sciatic nerve defects （platelet-rich plasma group）. Controls were established using fibrin as the seeding matrix for Schwann cell-like cells at identical density to construct tissue-engineered nerves （fibrin group）. Twelve weeks after implantation, toluidine blue staining and scanning electron microscopy were used to demonstrate an increase in the number of regenerating nerve fibers and thickness of the myelin sheath in the platelet-rich plasma group compared with the fibrin group. Fluoro-gold retrograde labeling revealed that the number of Fluoro-gold-positive neurons in the dorsal root ganglion and the spinal cord anterior horn was greater in the platelet-rich plasma group than in the fibrin group. Electrophysiological examination confirmed that compound muscle action potential and nerve conduction velocity were superior in the platelet-rich plasma group compared with the fibrin group. These results indicate that autologous platelet-rich plasma gel can effectively serve as a seeding matrix for Schwann cell-like cells to construct tissue-engineered nerves to promote perJpheral nerve regeneration.展开更多
AIM:To investigate the safety and efficacy of implant-ing fibrin sealant with sustained-release ropivacaine in the gallbladder bed for pain after laparoscopic chole-cystectomy(LC).METHODS:Sixty patients(American Socie...AIM:To investigate the safety and efficacy of implant-ing fibrin sealant with sustained-release ropivacaine in the gallbladder bed for pain after laparoscopic chole-cystectomy(LC).METHODS:Sixty patients(American Society of Anes-thesiologists physical status wasⅠorⅡand underwent LC)were randomly divided into three equal groups:group A(implantation of fibrin sealant in the gallbladder bed),group B(implantation of fibrin sealant carrying ropivacaine in the gallbladder bed),and group C(normal saline in the gallbladder bed).Postoperative pain was evaluated,and pain relief was assessed by visual analog scale(VAS)scoring.RESULTS:The findings showed that 81.7%of patients had visceral pain,50%experienced parietal,and 26.7% reported shoulder pain after LC.Visceral pain was significantly less in group B patients than in the other groups(P<0.05),and only one patient in this group experienced shoulder pain.The mean VAS score in group B patients was lower than that in the other groups.CONCLUSION:Visceral pain is prominent after LC and can be effectively controlled by implanting fibrin sealant combined with ropivacaine in the gallbladder bed.展开更多
AIM To assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy(POEM).METHODS Twenty-four patients who underwent POEM and experienced mucosal ...AIM To assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy(POEM).METHODS Twenty-four patients who underwent POEM and experienced mucosal injury of the cardia during the procedure were retrospectively identified. Of the 24 patients, 21 had mucosal penetration and 3 had only slight mucosal damage without penetration. The 21 patients with mucosal penetration received fibrin sealant for closure at the site of penetration. Penetration-related characteristics, treatment, and recovery were reviewed for all 21 patients to assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia. Clinical data, including general characteristics, procedure-related parameters, Eckardt scores, lower esophageal sphincter pressures (LESP), and esophagogastroduodenoscopy(EGD) results, were analyzed to determine their influence on treatment success after mucosal penetration during POEM.RESULTS All 21 patients had a solitary mucosal penetration in the cardia (12 in esophageal region of the cardia, 9 in the stomach region of the cardia, and 1 in both the esophageal and stomach regions). Twelve had ahole-like penetration and 9 had a linear penetration. For those with a hole-like penetration, the mean size was 0.14 cm2 (0.02-0.32 cm2). For those with a linear penetration, the median size was 0.37 cm (0.10-1.00 cm). Closure of the mucosal penetration using fibrin sealant was performed successfully in all 21 patients(two patients required 5 m L fibrin sealant, and the remaining 19 patients required 2.5 mL). Two patients had a nasogastric tube placed for five days after POEM; the remaining 19 patients were kept fasting for 3 d. All 21 patients were discharged after a median of 5 d(range: 5-7 d) postoperatively. During a median 42 mo (range: 9-62 mo) follow-up, all 21 patients with a mucosal penetration successfully healed without the occurrence of infection, ulcer, or esophagitis. Furthermore, the median LESP decreased from 31.9 mm Hg (range: 21.9-67.1 mm Hg) preoperatively to 20.3 mm Hg (range: 6.0-41.0 mm Hg) postoperatively(P < 0.05). The median preoperative and postoperative Eckardt scores were 5.0(range; 4-10) and 1.0(range: 0-4), respectively (P < 0.05). Of the 21 patients with mucosal penetration, symptom remission, which is defined as a postoperative Eckardt score ≤ 3, was achieved in 20 patients(95.2%) indicating that mucosal penetration did not influence the success of POEM treatment if closed successfully using fibrin sealant.CONCLUSION Fibrin sealant is safe and effective for closure of mucosal penetration during POEM. Mucosal penetrations do not appear to influence the treatment success of POEM if closed successfully using fibrin sealant. Additional studies regarding the feasibility, efficacy, and safety of fibrin sealant for closure of larger mucosal penetrations is warranted.展开更多
文摘Adult-onset Stil's disease(AOSD)is a rare condition that lies between autoinflammatory syndrome and autoimmune disease.The main clinical manifestations include fever,chills,rash,joint swelling and pain,peripheral blood leukocytosis,splenomegaly,etc.It is a systemic disease affecting between 1 and 34 people per million.The average age of onset is 35 years old,with a slightly higher prevalence rate in women.Since AOSD lacks early specific symptoms and signs,non-specialist doctors have limited understanding of the disease,and patients are prone to clinical misdiagnosis,mistreatment,and delayed disease progression.This paper reports a patient whose AOSD was misdiagnosed as acute fibrinous and organizing pneumonia.
文摘BACKGROUND Since the acute fibrinous and organizing pneumonia(AFOP) was first described by Beasley in 2002, some case reports of patients aged from 38 d to 80 years have been published worldwide, but there is still no standard therapy for this disease and the treatment methods remain controversial. Both steroid and immunosuppressive agents, such as cyclophosphamide or mycophenolate mofetil, have been reported to be effective in some studies, but with many side effects, especially in patients of advanced age. CASE SUMMARY We herein report an 81-year-old female patient who was admitted to our hospital due to dry cough, and breathlessness for 1 mo. She was treated with broadspectrum antibiotics and anti-fungal therapy, but without improvement in both symptoms and radiological findings, and her respiratory status worsened, and she required bed rest almost the whole day. Computed tomography-guided percutaneous needle lung biopsy was performed and histopathology examination confirmed the diagnosis of AFOP. She was then successfully treated with a steroid monotherapy, which resulted in a satisfactory clinical outcome without serious complications. CONCLUSION We conclude that complete remission of AFOP can be achieved by steroid monotherapy in patients of advanced age.
基金Supported by Natural Science Foundation of Liaoning Province,No.2021-MS-287。
文摘BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 81470253）.
文摘Background： Acute fibrinous and organizing pneumonia （AFOP） is a unique pathological entity with intra-alveolar fibrin in the form of ＂fibrin balls＂ and organizing pneumonia. It was divided into rare idiopathic interstitial pneumonia according to the classification notified by American Thoracic Society/European Respiratory Society in 2013. As a rare pathological entity, it is still not well known and recognized by clinicians. We reviewed the clinical features of 20 patients with AFOP diagnosed in a teaching hospital. Methods： The medical records of 20 patients with biopsy-proven diagnosis of AFOP were retrospectively reviewed. The patients＇ symptoms, duration of the disease, comorbidities, clinical laboratory data, pulmonary function testing, radiographic studies, and the response to treatment were extracted and analyzed. Results： Fever was the most common symptom and was manifested in 90% of AFOP patients. For clinical laboratory findings, systematic inflammatory indicators, including C-reactive protein and erythrocyte sedimentation rate, were significantly higher than normal ill AFOP patients. In accordance with this increased indicators, injured liver functions were common in AFOP patients. Inversely, AFOP patients had worse clinical conditions including anemia and hypoalbuminemia. For pulmonary function testing, AFOP patients showed the pattern of restrictive mixed with obstructive ventilation dysfunction. For high-resolution computerized tomography （HRCT） findings, the most common pattern for AFOP patients was lobar consolidation which was very similar to pneumonia. However, unlike pneumonia, AFOP patients responded well to glucocorticoids. Conclusion： Patients with AFOP manifest as acute inflammatory-like clinical laboratory parameters and lobar consolidation on HRCT, but respond well to steroid.
文摘BACKGROUND Skin wounds are common injuries that affect quality of life and incur high costs.A considerable portion of healthcare resources in Western countries is allocated to wound treatment,mainly using mechanical,biological,or artificial dressings.Biological and artificial dressings,such as hydrogels,are preferred for their biocompatibility.Platelet concentrates,such as platelet-rich plasma(PRP)and platelet-rich fibrin(PRF),stand out for accelerating tissue repair and minimizing risks of allergies and rejection.This study developed PRF and PRP-based dressings to treat skin wounds in an animal model,evaluating their functionality and efficiency in accelerating the tissue repair process.AIM To develop wound dressings based on platelet concentrates and evaluating their efficiency in treating skin wounds in Wistar rats.METHODS Wistar rats,both male and female,were subjected to the creation of a skin wound,distributed into groups(n=64/group),and treated with Carbopol(negative control);PRP+Carbopol;PRF+Carbopol;or PRF+CaCl_(2)+Carbopol,on days zero(D0),D3,D7,D14,and D21.PRP and PRF were obtained only from male rats.On D3,D7,D14,and D21,the wounds were analyzed for area,contraction rate,and histopathology of the tissue repair process.RESULTS The PRF-based dressing was more effective in accelerating wound closure early in the tissue repair process(up to D7),while PRF+CaCl_(2) seemed to delay the process,as wound closure was not complete by D21.Regarding macroscopic parameters,animals treated with PRF+CaCl_(2) showed significantly more crusting(necrosis)early in the repair process(D3).In terms of histopathological parameters,the PRF group exhibited significant collagenization at the later stages of the repair process(D14 and D21).By D21,fibroblast proliferation and inflammatory infiltration were higher in the PRP group.Animals treated with PRF+CaCl_(2) experienced a more pronounced inflammatory response up to D7,which diminished from D14 onwards.CONCLUSION The PRF-based dressing was effective in accelerating the closure of cutaneous wounds in Wistar rats early in the process and in aiding tissue repair at the later stages.
文摘Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leading to a significant increase in the economic burden.Conventional treatment modalities utilized to manage knee OA have limitations.Over the last decade,the role of various autologous peripheral blood-derived orthobiologics(APBOs)for the treatment of knee OA has been extensively investigated.This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA.While numerous studies have demonstrated promising results for these preparations,a notable gap exists in the comparative analysis of these diverse formulations.This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained longterm results.Thus,more adequately powered,multicenter,prospective,doubleblind,randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.
基金Supported by the Joint Construction Project of Henan Medical Science and Technology(No.LHGJ20220370)the Natural Science Foundation of Henan Province(No.232300420237).
文摘AIM:To compare the safety and clinical outcomes of subconjunctival trypsin and dexamethasone(DEX)injections in the treatment of anterior chamber fibrin exudates in eyes with globe rupture following primary wound repair and vitrectomy.METHODS:A retrospective analysis included 42 males and 10 females(mean age 46.0±6.0y,range 34 to 58y)who underwent primary wound sutures and vitrectomy for globe rupture.Patients with pupil-covered fibrinous exudate or/and membrane in the anterior chamber were treated.On the first postoperative day,subconjunctival injections of either 5000 units(0.4 mL)of trypsin solution(n=25)or 0.5 mL(1 mg)DEX(n=27)were administered to accelerate exudate absorption.Efficacy was assessed by observing break time and partial absorption of the fibrin exudate membrane.Safety and comfort were evaluated by monitoring intraocular pressure(IOP),allergy,pain,and foreign body sensation.RESULTS:Both groups achieved 1/3 absorption of the anterior chamber fibrin exudate membrane,but the trypsin group exhibited shorter break time and partial absorption time compared to the DEX group(P<0.05).Trypsin treatment was also less irritating to patients.No adverse reactions were reported,and IOP remained stable.Visual acuity improved in both groups without statistical difference.CONCLUSION:Compared to DEX,trypsin demonstrates a shorter absorption time for the fibrin exudate membrane with a more comfortable process in treating pupil-covered fibrinous exudate or/and membrane after vitrectomy for globe rupture.
基金supported by grants from the National Natural Science Foundation of China(No.81100581)the Bethune Merck Diabetes Research Fund(No.2018)+1 种基金the Fund of the Sichuan Provincial Western Psychiatric Association's CSPC LEADING Scientific Research Project(No.WL2021104)the China International Medical Foundation-Senmei China Diabetes Research Fund(No.Z-2017-26-1902-5).
文摘Objective Diabetic foot ulcer(DFU)is one of the most serious complications of diabetes.Leukocyte-and platelet-rich fibrin(L-PRF)is a second-generation autologous platelet-rich plasma.This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice.Methods Patients with DFU who received L-PRF treatment and standard of care(SOC)from 2018 to 2019 in Tongji Hospital were enrolled.The clinical information including patient characteristics,wound evaluation(area,severity,infection,blood supply),SOC of DFU,and images of ulcers was retrospectively extracted and analyzed.L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction(PVR)greater than 80%.Therapeutic effectiveness,including overall PVR and the overall and weekly healing rates,was evaluated.Results Totally,26 patients with DFU were enrolled,and they had an ulcer duration of 47.0(35.0,72.3)days.The severity and infection of ulcers varied,as indicated by the Site,Ischemia,Neuropathy,Bacterial Infection,and Depth(SINBAD)scores of 2–6,Wagner grades of 1–4,and the Perfusion,Extent,Depth,Infection and Sensation(PEDIS)scores of 2–4.The initial ulcer volume before L-PRF treatment was 4.94(1.50,13.83)cm3,and the final ulcer volume was 0.35(0.03,1.76)cm3.The median number of L-PRF doses was 3(2,5).A total of 11 patients achieved complete epithelialization after the fifth week of treatment,and 19 patients achieved at least an 80%volume reduction after the seventh week.The overall wound-healing rate was 1.47(0.63,3.29)cm3/week,and the healing rate was faster in the first 2 weeks than in the remaining weeks.Concurrent treatment did not change the percentage of complete epithelialization or healing rate.Conclusion Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index,SINBAD score,or Wagner grade,indicating that this method is appropriate for DFU treatment under different clinical conditions.
文摘With the popularization of central venous catheterization in recent years,the problems arising from intravenous therapy have gradually increased.Fibrin sheath is the complication with the highest incidence rate in central venous catheterization,which has always been a major problem in intravenous therapy.So the prevention and treatment of fibrin sheath has become a hot spot of research in recent years.Hence,this paper summarizes the research on fibrin sheath in recent years.
基金Supported by Youth Foundation of Hunan Institution of Humanities,Science and Technology(2009QN08)Educational Reform Project of Hunan Institution of Humanities,Science and Technology(RKJGZ1013)~~
文摘Pseudogene and fibrin peptide which has rapid evolve speed and good stability are used in this study to determine the divergence date among groups.Through calculating the evolutionary rate of hemoglobin α chain,γ chain in vertebrate（including birds and mammals）,it is concluded that the evolutionary rate of hemoglobin α chain,γ chain is not invariable.It shows different evolutionary rates in different periods,that is,faster in early evolution stage and relatively slow in later stage.
文摘Two monoclonal antibodies (McAbs) against Aα chain's C terminus offibrinogen (Fg) have been prepared and designated SZ-78 and SZ-79. Both theantigens in binding assay and immunoblot analysis showed that the two McAbs recognized the epitopes located in residues 549-560 of the Aαchain. The two McAbs couldaccelerate rate of fibrin polymer assembly both in the purified system and in the humanplasma. From the pictures of transmission electronmicroscope, the average diametersof the fibers increase significantly to an average diameters of 375 nm after incubationwith the McAbs, while it was only 75nm without addition of the McAbs. There were al-so more branchings of fibers with addition of McAbs. These observations demonstratethat the amino acid sequences ofα 549-560 in the COOH terminus of the Aα chain mayplay an important role in the assembly of a fibrin clot, presumably being involved in lat-eral aggregation of protofibrils. The preparation of the McAbs supplies a usuful probe for the investigation of the
文摘Platelet concentrates(PC) [platelet-rich plasma(PRP) and platelet-rich fibrin(PRF)] are frequently used for surgical procedures in medical and dental fields,particularly in oral and maxillofacial surgery,plastic surgery and sports medicine.The objective of all these technologies is to extract all the elements from a blood sample that could be used to improve healing and promote tissue regeneration.Although leukocyte rich and leukocyte poor PRP's have their own place in literature,the importance of non-platelet components in a platelet concentrate remains a mystery.PC have come a long way since its first appearance in 1954 to the T-PRF,A-PRF and i-PRF introduced recently.These PC find varied applications successfully in periodontics and implant dentistry as well.However,the technique of preparation,standing time,transfer process,temperature of centrifuge,vibration,etc.,are the various factors for the mixed results reported in the literature.Until the introduction of a proper classification of terminologies,the PC were known by different names in different countries and by different commercial companies which also created a lot of confusion.This review intends to clarify all these confusion by briefing the exact evolution of PC,their preparation techniques,recent advances and their various clinical and technical aspects and applications.
基金This work was supported by the National Natural Science Foundation of China(81771050).
文摘Platelet-rich fibrin(PRF)has been widely used owing to its ability to stimulate tissue regeneration.To date,few studies have described the antibacterial properties of PRF.Previously,PRF prepared by horizontal centrifugation(H-PRF)was shown to contain more immune cells than leukocyte-and platelet-rich fibrin(L-PRF).This study aimed to compare the antimicrobial effects of PRFs against Staphylococcus aureus and Escherichia coli in vitro and to determine whether the antibacterial effects correlated with the number of immune cells.Blood samples were obtained from eight healthy donors to prepare L-PRF and H-PRF.The sizes and weights of L-PRF and H-PRF were first evaluated,and their antibacterial effects against S.aureus and E.coli were then tested in vitro using the inhibition ring and plate-counting test methods.Flow-cytometric analysis of the cell components of L-PRF and H-PRF was also performed.No significant differences in size or weight were observed between the L-PRF and H-PRF groups.The H-PRF group contained more leukocytes than the L-PRF group.While both PRFs had notable antimicrobial activity against S.aureus and E.coli,H-PRF demonstrated a significantly better antibacterial effect than L-PRF.Furthermore,the antimicrobial ability of the PRF solid was less efficient than that of wet PRF.In conclusion,H-PRF exhibited better antibacterial activity than L-PRF,which might have been attributed to having more immune cells.
文摘AIM: To investigate the levels of D-dimer(DD) and von Willebrand factor(vWF) and the relationship between DD and vWF in ulcerative colitis(UC) patients. METHODS: A total of 29 plasma specimens were obtained from patients with ulcerative colitis (male 13, female 16) aged 21-47 years (33+/-11). Disease activity was assessed by Truelove-Writeria. Patients with a score of above 5 were regarded as having active colitis. Twenty healthy people(male 12, female 8) aged 19-53 years(31+/-14) served as normal controls. Blood samples were taken from an antecubital vein puncture. Blood(1.8 mL) was injected into the tubes containing sodium citrate (0.13 mmol/L). The plasma was obtained by centrifugation at 3000 r.min(-1) for 10 min, and stored at -80 degrees until assayed by ELISA. RESULTS: The mean plasma levels of DD and vWF in active UC patients were significantly higher than those of the controls (0.69+/-0.41 vs 0.27+/-0.11, P【0.01 143+/-46 vs 103+/-35, P【0.01). The mean plasma levels of DD in the patients with active disease were higher than those with inactive disease(0.69+/-0.41 vs 0.48+/-0.29 P【0.05). The levels of vWF were not different between active and inactive patients. DD levels were positively related to vWF levels( r =0.574, P【0.01). There was no significant difference between levels of DD and vWF and the scope of disease and sex of the patients. CONCLUSION: vWF is an important feature and a good marker of UC intravascular thrombus and endothelial cell dysfunction were found in UC patients and the combined test of DD and vWF is helpful to distinguish the activity of the UC patients.
文摘Anal fistula is among the most common illnesses affecting man.Medical literature dating back to 400 BC has discussed this problem.Various causative factors have been proposed throughout the centuries,but it appears that the majority of fistulas unrelated to specific causes (e.g.Tuberculosis,Crohn’s disease) result from infection (abscess) in anal glands extending from the intersphincteric plane to various anorectal spaces.The tubular structure of an anal fistula easily yields itself to division or unroofing (fistulotomy) or excision (fistulectomy) in most cases.The problem with this single,yet effective,treatment plan is that depending on the thickness of sphincter muscle the fistula transgresses,the patient will have varying degrees of fecal incontinence from minor to total.In an attempt to preserve continence,various procedures have been proposed to deal with the fistulas.These include: (1) simple drainage (Seton);(2) closure of fistula tract using fibrin sealant or anal fistula plug;(3) closure of primary opening using endorectal or dermal flaps,and more recently;and (4) ligation of intersphincteric fistula tract (LIFT).In most complex cases (i.e.Crohn’s disease),a proximal fecal diversion offers a measure of symptom-atic relief.The fact remains that an "ideal" procedure for anal fistula remains elusive.The failure of each sphincter-preserving procedure (30%-50% recurrence) often results in multiple operations.In essence,the price of preservation of continence at all cost is multiple and often different operations,prolonged disability and disappointment for the patient and the surgeon.Nevertheless,the surgeon treating anal fistulas on an occasional basis should never hesitate in referring the patient to a specialist.Conversely,an expert colorectal surgeon must be familiar with many different operations in order to selectively tailor an operation to the individual patient.
基金supported by the High Education Development Foundation of Shandong Province,No.J11LF22
文摘Bone marrow mesenchymal stem cells were isolated from New Zealand white rabbits, culture-expanded and differentiated into Schwann cell-like cells. Autologous platelet-dch plasma and Schwann cell-like cells were mixed in suspension at a density of 1 x 106 cells/mL, prior to introduction into a poly （lactic-co-glycolic acid） conduit. Fabricated tissue-engineered nerves were implanted into rabbits to bridge 10 mm sciatic nerve defects （platelet-rich plasma group）. Controls were established using fibrin as the seeding matrix for Schwann cell-like cells at identical density to construct tissue-engineered nerves （fibrin group）. Twelve weeks after implantation, toluidine blue staining and scanning electron microscopy were used to demonstrate an increase in the number of regenerating nerve fibers and thickness of the myelin sheath in the platelet-rich plasma group compared with the fibrin group. Fluoro-gold retrograde labeling revealed that the number of Fluoro-gold-positive neurons in the dorsal root ganglion and the spinal cord anterior horn was greater in the platelet-rich plasma group than in the fibrin group. Electrophysiological examination confirmed that compound muscle action potential and nerve conduction velocity were superior in the platelet-rich plasma group compared with the fibrin group. These results indicate that autologous platelet-rich plasma gel can effectively serve as a seeding matrix for Schwann cell-like cells to construct tissue-engineered nerves to promote perJpheral nerve regeneration.
文摘AIM:To investigate the safety and efficacy of implant-ing fibrin sealant with sustained-release ropivacaine in the gallbladder bed for pain after laparoscopic chole-cystectomy(LC).METHODS:Sixty patients(American Society of Anes-thesiologists physical status wasⅠorⅡand underwent LC)were randomly divided into three equal groups:group A(implantation of fibrin sealant in the gallbladder bed),group B(implantation of fibrin sealant carrying ropivacaine in the gallbladder bed),and group C(normal saline in the gallbladder bed).Postoperative pain was evaluated,and pain relief was assessed by visual analog scale(VAS)scoring.RESULTS:The findings showed that 81.7%of patients had visceral pain,50%experienced parietal,and 26.7% reported shoulder pain after LC.Visceral pain was significantly less in group B patients than in the other groups(P<0.05),and only one patient in this group experienced shoulder pain.The mean VAS score in group B patients was lower than that in the other groups.CONCLUSION:Visceral pain is prominent after LC and can be effectively controlled by implanting fibrin sealant combined with ropivacaine in the gallbladder bed.
文摘AIM To assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy(POEM).METHODS Twenty-four patients who underwent POEM and experienced mucosal injury of the cardia during the procedure were retrospectively identified. Of the 24 patients, 21 had mucosal penetration and 3 had only slight mucosal damage without penetration. The 21 patients with mucosal penetration received fibrin sealant for closure at the site of penetration. Penetration-related characteristics, treatment, and recovery were reviewed for all 21 patients to assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia. Clinical data, including general characteristics, procedure-related parameters, Eckardt scores, lower esophageal sphincter pressures (LESP), and esophagogastroduodenoscopy(EGD) results, were analyzed to determine their influence on treatment success after mucosal penetration during POEM.RESULTS All 21 patients had a solitary mucosal penetration in the cardia (12 in esophageal region of the cardia, 9 in the stomach region of the cardia, and 1 in both the esophageal and stomach regions). Twelve had ahole-like penetration and 9 had a linear penetration. For those with a hole-like penetration, the mean size was 0.14 cm2 (0.02-0.32 cm2). For those with a linear penetration, the median size was 0.37 cm (0.10-1.00 cm). Closure of the mucosal penetration using fibrin sealant was performed successfully in all 21 patients(two patients required 5 m L fibrin sealant, and the remaining 19 patients required 2.5 mL). Two patients had a nasogastric tube placed for five days after POEM; the remaining 19 patients were kept fasting for 3 d. All 21 patients were discharged after a median of 5 d(range: 5-7 d) postoperatively. During a median 42 mo (range: 9-62 mo) follow-up, all 21 patients with a mucosal penetration successfully healed without the occurrence of infection, ulcer, or esophagitis. Furthermore, the median LESP decreased from 31.9 mm Hg (range: 21.9-67.1 mm Hg) preoperatively to 20.3 mm Hg (range: 6.0-41.0 mm Hg) postoperatively(P < 0.05). The median preoperative and postoperative Eckardt scores were 5.0(range; 4-10) and 1.0(range: 0-4), respectively (P < 0.05). Of the 21 patients with mucosal penetration, symptom remission, which is defined as a postoperative Eckardt score ≤ 3, was achieved in 20 patients(95.2%) indicating that mucosal penetration did not influence the success of POEM treatment if closed successfully using fibrin sealant.CONCLUSION Fibrin sealant is safe and effective for closure of mucosal penetration during POEM. Mucosal penetrations do not appear to influence the treatment success of POEM if closed successfully using fibrin sealant. Additional studies regarding the feasibility, efficacy, and safety of fibrin sealant for closure of larger mucosal penetrations is warranted.
