• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권1호
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• pp.39-47
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• 2015

Purpose: To determine clinically useful biochemical markers reflecting disease activity and/or gastrointestinal (GI) tract involvement in Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP). Methods: A total of 185 children with HSP and 130 controls were included. Laboratory data indicating inflammation, standard coagulation, and activated coagulation were analyzed for the HSP patients, including measurements of the hemoglobin level, white blood cell (WBC) count, absolute neutrophil count (ANC), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, prothrombin time, activated partial thromboplastin time, and fibrinogen, D-dimer, and fibrin degradation product (FDP) levels. The clinical scores of the skin, joints, abdomen, and kidneys were assessed during the acute and convalescence phases of HSP. Results: The WBC count, ANC, ESR, and CRP, fibrinogen, D-dimer, and FDP levels were significantly higher in the acute phase compared with the convalescent phase of HSP (p<0.05). The total clinical scores were more strongly correlated with the D-dimer (r=0.371, p<0.001) and FDP (r=0.369, p<0.001) levels than with inflammatory markers, such as the WBC count (r=0.241, p=0.001), ANC (r=0.261, p<0.001), and CRP (r=0.260, p<0.001) levels. The patients with GI symptoms had significantly higher ANC (median [interquartile range], 7,138.0 [4,446.4-9,470.0] vs. 5,534.1 [3,263.0-8,153.5], p<0.05) and CRP (0.49 [0.15-1.38] vs. 0.23 [0.01-0.67], p<0.05), D-dimer (2.63 [1.20-4.09] vs. 1.75 [0.62-3.39]), and FDP (7.10 [0.01-13.65] vs. 0.10 [0.01-7.90], p<0.05) levels than those without GI symptoms. Conclusion: D-dimer and FDPs are more strongly associated with disease activity and more consistently reflect GI involvement than inflammatory markers during the acute phase of HSP.

• Journal of Gastric Cancer
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• 제22권1호
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• pp.47-55
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• 2022

Purpose: The use of direct oral Xa inhibitors (DXaIs) to prevent venothrombotic events is increasing. However, gastrointestinal bleeding, including that related to endoscopic resection, is a concern. In this study, we evaluated bleeding and coagulation times during the perioperative period of gastric endoscopic submucosal dissection (ESD). Materials and Methods: Patients who consecutively underwent gastric ESD from August 2016 to December 2018 were analyzed. Bleeding rates were compared among the 3 groups (antiplatelet, DXaIs, and control). DXaI administration was discontinued on the day of the procedure. Prothrombin time (PT), activated partial thromboplastin time, and the ratio of inhibited thrombin generation (RITG), which was based on dilute PT, were determined before and after ESD. Results: During the study period, 265 gastric ESDs were performed in 239 patients, where 23 and 50 patients received DXaIs and antiplatelets, respectively. Delayed bleeding occurred in 17 patients (7.4%) and 21 lesions (7.1%). The bleeding rate in the DXaI group was significantly higher than that in the other groups (30.4%, P<0.01), and the adjusted odds ratio of bleeding was 5.7 (95% confidence interval, 1.4-23.7; P=0.016). In patients using DXaIs, there was a significant (P=0.046) difference in the median RITG between bleeding cases (18.6%) and non-bleeding cases (3.8%). Conclusions: A one-day cessation of DXaIs was related to a high incidence of bleeding after gastric ESD, and monitoring of residual coagulation activity at trough levels might enable the predicted risk of delayed bleeding in patients using DXaIs.

• Natural Product Sciences
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• 제29권1호
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• pp.42-49
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• 2023

This study investigated the effect of ethanol extracts of horsetail, alfalfa, ortie, chêne and aleppo oak on blood coagulation in vitro. Extraction was performed by the maceration method. Extracts were mixed with platelet and plasma, then prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet aggregation tests were conducted. Alfalfa extract had a dose-dependent effect on the PT. Ortie, and horsetail, reduced the PT significantly compared to control group. Alfalfa, horsetail, and ortie reduced the APTT, but their effect was insignificant compared to the control group. The pooled extract showed the highest effect compared to the single extracts in a dose-dependent manner. Horsetail and alfalfa induced platelet aggregation in response to arachidonic acid but not in response to collagen. In the case of ortie, no aggregation occurred regarding the arachidonic acid, and incomplete was observed in response to collagen. Interestingly, blood clotting occurred immediately after adding the chêne, aleppo oak and the pooled extract, and therefore platelet poor plasma (PPP) and platelet rich plasma (PRP) became jelly. Generally, chêne and aleppo oak, as well as pooled extract, were more effective in inducing both primary and secondary coagulation pathways via shortening the PT and APTT, and induction of platelet aggregation.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.210-216
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• 2023

Purpose: This preliminary retrospective cohort study analyzed the relationship between the parameters provided by sonorheometry device Quantra and the coagulation values obtained from standard venous blood samples in patients admitted in intensive care unit (ICU). Methods: We reviewed medical charts of 13 ICU adult patients in whom at least one coagulation study with Quantra was performed. The relationship between Quantra and laboratory data was analyzed with the Spearman rank correlation coefficient (rho). The 95% confidence interval (CI) was computed. A P-value <0.05 was considered statistically significant. Results: We collected 28 data pairs. Statistically significant moderate correlations were found for the following parameters: clot time (CT) and activated partial thromboplastin time (rho=0.516; 95% CI, 0.123-0.904; P=0.009; clot stiffness (CS) and the international normalized ratio (INR; rho=0.418; 95% CI, 0.042-0.787; P=0.039); INR and platelet contribution to CS (rho=0.459; 95% CI, 0.077-0.836; P=0.022); platelet count and platelet contribution to CS (PCS; rho=0.498; 95% CI, 0.166-0.825; P=0.008); and fibrinogen and fibrinogen contribution to CS (FCS; rho=0.620; 95% CI, 0.081-0.881; P=0.001). Conclusions: Quantra can provide useful information regarding coagulation status, showing modest correlations with the parameters obtained from laboratory tests. During diffuse bleeding, CT and FCS values can guide the proper administration of clotting factors and fibrinogens. However, the correlation of INR with CS and PCS can cause misinterpretation. Further studies are needed to clarify the relationship between Quantra parameters and laboratory tests in the critical care setting and the role of sonorheometry in guiding targeted therapies and improving outcomes.

• 생명과학회지
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• 제19권2호
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• pp.289-298
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• 2009

본 연구는 성인 흡연자를 대상으로 NKF 정제를 단기 (4,000 U를 1회 투여)와 장기(2,000 U를 매일 1회 4주 투여) 실험을 통하여 NKF의 혈전용해 개선 및 항 동맥경화효과를 검증하였다. 임상대상자는 20세${\sim}$31세의 건강한 성인으로 하루 흡연량이 하루 1갑 이상인 고혈압 또는 항 혈전증 약을 섭취하지 않는 사람을 선정하여 무작위로 placebo군과 NKF군으로 분류하여 이중맹검법으로 실험을 하였다. NKF와 placebo 정제는 (주)HK바이오텍에서 제공하였다. 단기시험은 placebo군(10명)과 NKF군(29명)을 대상으로 NKF 섭취전과 섭취 1, 2, 4시간에 혈전용해효과를 검토하였고, 장기시험은 placebo군 10명과 NKF군 15명에게 NKF 섭취 전과 섭취 후 매주 혈전용해효과 및 혈압개서효과를 검토하였다. 단기시험에서 fibrin clot 용해능은 placebo군에 비해 NKF군에서는 섭취 후 2시간에 유의적으로 증가하여 4시까지 그 활성이 유지되었다. ECLT도 NKF 섭취 후 시간이 경과함에 따라 placebo군에 비해 현저하게 감소되었으며 aPTT는 섭취 후 4시에 섭취 전에 비해 12.5% 지연시키는 것으로 나타났다. 장기시험에서는 수축기와 이완기 혈압이 placebo군에서는 섭취 4주에 섭취 전에 비해 2.8%와 3.5%로 증가하였고 NKF군에서는 각각 1.3%와 1.0% 감소하여 두 군 모두에서 유의차는 없었다. Fibrin clot 용해능은 NKF군에서 1주에 증가하여 4주에도 높은 수준으로 유지되었고, ECLT는 NKF군은 섭취 전에 비해 1주에 현저하게 감소되어 4주 후까지 유사한 수준으로 유지하여 NKF의 효과를 볼 수 있었지만, placebo군에서는 효과가 없었다. 따라서 NKF는 PT와 aPTT를 개선하여 전 처리 기간 placebo군에 비해 혈액응고시간을 유의적으로 지연시켰다. 또한 NKF 섭취는 TG/HDL-cholesterol을 감소시켜 항 동맥경화 지수를 상승시키는 효과가 있었다. 이상의 결과로 미루어 볼 때 단기와 장기 임상시험에서 NKF는 fibrin clot 용해능을 증가시키고 ECLT를 감소시키며 PT와 aPTT를 지연시켜 혈전 용해능을 상승시키며, TG/HDL-cholesterol을 낮추어 혈중 지질수준을 개선하고 동맥경화를 예방하는데 유익하게 작용할 것으로 사료된다.

• 한국미생물·생명공학회지
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• 제44권4호
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• pp.452-460
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• 2016

함초를 이용한 고부가가치 식의약 소재 개발 연구의 일환으로, 성숙 함초로부터 씨를 회수하고 이의 성분분석 및 유용 생리활성을 평가하였다. 함초 씨의 열수 추출효율은 29.6% 이었으며, 추출물의 total polyphenol (TP) 및 total flavonoid (TF) 함량은 각각 25.7 및 11.5 mg/g을 나타내어 성숙기 함초와 유사한 함량을 보였다. Hexane, ethylacetate (EA), butanol을 이용한 순차적 유기용매 분획물 중 EA 분획이 158.3 및 136.2 mg/g의 가장 높은 TP 및 TF 함량을 보였으며, 특이하게 물 잔류물 및 butanol 분획물보다 높은 총당 함량(228.3 mg/g)을 나타내었다. 함초 씨 시료의 항균 활성 평가 결과, EA 분획에서 그람양성 세균에 대한 광범위한 항세균 활성이 나타났으며, butanol 분획에서도 Staphylococcus epidermidis에 대한 강력한 항균활성을 확인하였다. 한편, 함초 씨 열수 추출물은 우수한 radical 소거능과 환원력을 나타내었으며, 가장 강력한 항산화 활성은 EA 분획에서 나타났다. EA 분획의 DPPH 음이온 소거능, ABTS 양이온 소거능 및 Nitrite 소거능에 대한 $RC_{50}$은 각각 57.0, 29.0 및 $28.9{\mu}g/ml$로 확인되어, vitamin C의 10.7, 4.0 및 $18.0{\mu}g/ml$보다 약하지만 우수한 항산화능을 확인하였다. 항혈전 활성 평가결과, EA 분획은 5 mg/ml 농도에서 thrombin time을 무첨가구에 비해 15배 이상, 7 mg/ml 농도에서 activated partial thromboplastin time을 15배 이상 연장시켜 아스피린에 필적하는 강력한 항응고 활성을 나타내었다. 반면 함초씨 추출물과 분획물(0.25 mg/ml)은 모두 혈소판 응집저해 활성은 나타나지 않았으며, 1 mg/ml 농도까지 인간 적혈구 용혈활성도 나타나지 않았다. 상기의 연구결과는 함초 씨 추출물의 EA 분획의 활성물질을 정제하여 항세균 및 항혈전제 개발이 가능함을 제시하고 있다.

• 한국식품영양학회지
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• 제24권3호
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• pp.442-450
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• 2011

1. 본 연구는 고지방 섭취 동물 모델에서 양파 추출물을 용량별(0.01%, 0.02%, 0.05%, 0.1%)로 8주간 보충 섭취시킨 후 혈중 지질 농도와 혈행 장애 개선에 미치는 영향을 살펴보는 것을 주된 목적으로 하였다. 2. 양파 껍질 추출물 섭취에 따라 total cholesterol과 HDLcholesterol 및 LDL-cholesterol은 그룹간의 유의한 차이를 보였다. 사후분석 결과 LDL-cholesterol은 정상 대조군에 비해 고지방 대조군 및 고지방+양파 껍질 추출물 그룹이 유의하게 높았고, 고지방 대조군 대비 0.1% 양파 껍질 추출물 섭취군의 농도가 유의하게 감소되었다. HDL-cholesterol은 정상대조군 대비 고지방 식이 후 유의하게 감소하였다가 양파 껍질 추출물 섭취에 따라 용량 의존적으로 유의하게 증가하는 결과를 보였다. 3. Hematocrit, WBC, RBC, platelet count, MPV, MCV, MCH, MCHC 등 혈액학적 지표는 처치에 따른 유의적인 차이를 나타내지 않았다. Hemoglobin의 경우, ANOVA 분석 시 군간 유의한 평균값의 차이를 보였으나, Bonferroni correction을 통한 사후분석 결과 각 군간 유의적인 차이가 없었다. 4. 혈액 응고 지표로 분석된 PT, aPTT, TT와 fibrinogen은 ANOVA 분석 시 모든 군간 유의적인 차이가 없었다. 그러나 t-test 결과 고지방 대조군에 비해 0.05% 양파 추출물 첨가군에서 aPTT가 유의적으로 연장되었다. 5. 체중 증가의 cut-off에 따라 low gainer와 high gainer로 나누어 항혈전 지표를 비교한 결과, high gainer에서는 0.01%, 0.02%, 0.05% 양파 추출물 섭취군이 고지방 대조군에 비해 PT와 aPTT가 전반적으로 길어지는 경향을 보여주었다. 6. 이상의 결과에서 고지방 섭취 동물 모델에서 용량별 양파 추출물 첨가는 혈중 지질 농도에 영향을 주는 한편, 혈액응고시스템에 현저한 변화를 유발하지는 않는 것으로 보인다. 하지만 고지방 대조군에 비해 0.05% 양파 추출물 첨가 시aPTT의 유의적인 증가는 양파 추출물이 내인성 혈액 응고시스템에 부분적으로 영향을 줄 수 있는 가능성을 시사하므로 향후 비만 동물 모델을 대상으로 다양한 농도 범위의 양파 보충의 효과를 규명하는 후속 연구가 요구된다.

• Journal of Chest Surgery
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• 제51권2호
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• pp.114-121
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• 2018

Background: Unfractionated heparin is commonly used for anticoagulation in extracorporeal membrane oxygenation (ECMO). Several studies have shown that nafamostat mesilate (NM) has comparable clinical outcomes to unfractionated heparin. This study compared anticoagulation with NM and heparin in a large-animal model. Methods: Beagle dogs (n=8; weight, 6.5-9 kg) were placed on venovenous ECMO. Blood samples were taken every hour and the following parameters were compared: hemoglobin level, activated partial thromboplastin time (aPTT), thromboelastography (TEG) data, platelet function, and inflammatory cytokine levels. Results: In both groups, the aPTT was longer than the baseline value. Although the aPTT in the NM group was shorter than in the heparin group, the TEG parameters were similar between the 2 groups. Hemoglobin levels decreased in both groups, but the decrease was less with NM than with heparin (p=0.049). Interleukin $(IL)-1{\beta}$ levels significantly decreased in the NM group (p=0.01), but there was no difference in the levels of tumor necrosis factor alpha or IL-10 between the 2 groups. Conclusion: NM showed a similar anticoagulant effect to that of unfractionated heparin, with fewer bleeding complications. NM also had anti-inflammatory properties during ECMO. Based on this preclinical study, NM may be a good alternative candidate for anticoagulation in ECMO.

• 대한임상검사과학회지
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• 제43권4호
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• pp.133-137
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• 2011

The monitoring of heparin therapy is using almost aPTT assay. This study is compare to estimating aPTT therapeutic range using in vitro heparin-spiked sample and aPTT therapeutic range using in vivo heparin-treated sample. Normal pooled plasma was collected from 20 healthy representative individuals. 11 concentration of heparinized plasmas from 0 U/mL to 1.0 U/mL at intervals of 0.1 U/mL made by addition of heparin to normal pooled plasma were measured aPTT. The aPTT therapeutic range was performed through correlation analysis between heparin level 0.2 to 0.4 U/mL and aPTT. 30 plasmas from patients on heparin therapy were measured aPTT and anti-Xa activity. The aPTT therapeutic range was performed through correlation analysis between anti-Xa activity 0.3 to 0.7 U/mL and aPTT. The aPTT therapeutic range corresponded by heparin level-vs-aPTT value regression analysis was 60.7 to 102.4 seconds. The aPTT therapeutic range corresponded by anti-Xa activity-vs-aPTT value regression analysis was 85.3 to 147.5 seconds. The validation of heparin sensitivity using in-vitro heparin sample was not considered. The establishing aPTT therapeutic range is recommended anti-Xa activity using in-vivo sample.

• 동의생리병리학회지
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• 제20권2호
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• pp.460-466
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• 2006

We wondered whether the mechanisms of antiplatelet aggregation of DJS-WE were through multiple pathways. Danggijakyak-san(DJS) consisting of 6 herbes of Paeoniae Radix, Poria Cocos, Angelicae Sinensis Radix, Cnidii Rhizoma, Atractylodis Macrocephalae Rhizoma and Alismatis Rhizoma, is a crude mixture of a commonly used Korean herbal medicine. The water extract (DJS-WE) of DJS has been known to have an anti-platelet aggregation activity. We have reported that DJS-WE inhibited ADP-induced aggregation as well as arachidonic acid-induced aggregation of human platelet. Clinical studies on the cardiovascular effects of DJS-WE have been done in Korea. The DJS has been used as a remedy for gastrointestinal disorders (abdominal pain, dysentery), headache, amenorrhea, and postpartum hemorrhage. It has also been claimed to have a remarkable central stimulant effect, a transient hypertensive effect, and positive inotropic and chronotropic effects. In this paper, we evaluated the possible mechanisms of the antiplatelet activity of DJS-WE using human platelets. On the other hand, the role of DJS-ethanol extract on the inhibition of platelet aggregation and hemolytic effect have not yet been investigated in detail. We also used the method of activated partial thromboplastin times (APTT) for the first time to study the inhibition on platelet aggregation activity of DJS-ethanol extract. The effect of DJS-WE on hemolysis was also investigated. DJS-WE showed a high hemolysis ability on human blood.