In both Traditional Chinese Medicine(TCM)and modern medicine,they agree that the integrity and healthy structure of the vascular endothelium are essential for normal hemodynamics.Damage to the vascular endothelium can...In both Traditional Chinese Medicine(TCM)and modern medicine,they agree that the integrity and healthy structure of the vascular endothelium are essential for normal hemodynamics.Damage to the vascular endothelium can quickly activate the extrinsic coagulation pathway by triggering the tissue factor(TF)and lead to coagulation.This damage,along with a loss of anticoagulant properties through antithrombinⅢ(ATⅢ),TF pathway inhibitors,and the protein C system,can result in a hypercoagulable state and even thrombosis.Hypercoagulability is not only a common feature of many cancers but also an important factor promoting tumor development and metastasis,which corresponds to the TCM theory of“blood stasis leading to tumors.”The pharmacological effects of heparin and aspirin have similarities with TCM's“activating blood circulation and removing blood stasis”theory in improving blood circulation,treating related diseases,and their anti-inflammatory effects.展开更多
Background: Bilateral adrenal hemorrhage (BAH) is a rare condition that may lead to life-threatening adrenal insufficiency or adrenal crisis if not addressed appropriately. Case Report: A 54-year-old male with a histo...Background: Bilateral adrenal hemorrhage (BAH) is a rare condition that may lead to life-threatening adrenal insufficiency or adrenal crisis if not addressed appropriately. Case Report: A 54-year-old male with a history of venous thromboembolism (VTE) on warfarin presented to the hospital with nausea, vomiting, and abdominal and flank pain shortly following colonoscopy preparation. Initial imaging of the abdomen and pelvis was notable for hyperdense thickening of the bilateral adrenal glands raising concerns for hemorrhages, and subsequent magnetic resonance imaging (MRI) confirmed BAH. During hospitalization, the patient was placed on prophylactic heparin, and shortly after decompensating, he became tachycardic, hypotensive, and febrile. This led to heparin reversal followed by administration of a single dose of Hydrocortisone 100 mg and Hydrocortisone 50 mg TID due to concern for adrenal insufficiency. The patient also necessitated sepsis work-up and fluid resuscitation. Repeat CT imaging showed no significant change in hemorrhage size bilaterally. Endocrinology, vascular surgery, hematology/oncology, and rheumatology were consulted for the management of adrenal insufficiency, anticoagulation in the presence of hemorrhage, thrombocytopenia, and hypercoagulable state. Towards the end of his hospital course, the patient had asymptomatic diffuse ST elevations, elevated troponin, and an ejection fraction of 10% - 15%, leading to cardiac catheterization and placement of an intra-aortic pump. During subsequent stay in the ICU, the patient developed hemodynamic shock and was transferred to a facility with a higher level of care and medical support therapies. After this transfer, the patient was stabilized from a cardiac standpoint but developed acute respiratory failure suspected to be secondary to diffuse alveolar hemorrhage and immune thrombocytopenic purpura, necessitating platelet transfusion. He was on continued monitoring from rheumatology given his myocarditis believed to be secondary to his antiphospholipid antibodies, and was treated with IVIG, rituximab, and hydroxychloroquine. A repeat echocardiogram revealed an improved ejection fraction of 52% and the patient was then discharged on an enoxaparin bridge to warfarin and a cardiac home event monitor. Discussion: BAH is a life-threatening condition that should be promptly identified and managed in patients presenting with nonspecific symptoms and a history of hypercoagulability or anticoagulation. In these cases, the risk of AH and subsequent adrenal insufficiency is drastically increased, so immediate imaging as well as initiation of steroid therapy is crucial to stabilize patients and prevent adrenal crisis. A multidisciplinary approach, involving endocrinology, hematology, and cardiology as in this case is also imperative to optimize patient outcomes and increase survival. Conclusion: BAH should be considered in patients presenting with a history of VTE and hypercoagulable state when precipitating stressors or predisposing risk factors are present. This case report highlights the importance of clinical awareness of BAH for clinicians to accurately identify and manage it to prevent fatal sequelae and ensure long-term favorable patient outcomes.展开更多
Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control grou...Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control group (saline) and three ellagic acid (EA)-treated groups (low, middle, and high doses). In the mice, bleeding time (BT) was estimated with tail transaction, and clotting time (CT) with template method. Prothrombin time (PT) and the activated partial thromboplastin time (APTT) in rats and rabbits were measured by means of Quick's one-stage assay and modified APTT assay respectively. In addition, thrombin activity was estimated in rats with PT assay using a hemagglutination analyzer. The circulating platelet aggregates were de- tected in rabbits through platelet counting and presented as the circulating platelet aggregate ratio (CPAR). Results EA shortened BT and CT in mice, PT and APTT in rats, and increased thrombin activity and CPAR, all in a dose-dependent manner. EA also brought reduction of PT and APTT in rabbits in dose- and time-dependent manners. Conclusion EA could induce hypercoagulable state through activating coagulation system and platelets in mice, rats, and rabbits.展开更多
Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cance...Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cancer. Portal vein thrombosis is the most feared complication of the surgery and chances are increased if the patient has a hypercoagulable disorder. We present a challenging case of islet auto transplantation from our institution. A 29-year-old woman with plasminogen activator inhibitor-4G/4G variant and a clinical history of venous thrombosis was successfully managed with a precise peri- and postoperative anticoagulation protocol. In this paper we discuss the anti-coagulation protocol for safely and successfully caring out islet transplantation and associated risks and benefits.展开更多
Objective: To investigate the effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia. Methods: A ...Objective: To investigate the effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia. Methods: A total of 71 patients with preeclampsia who were treated in Zigong Third People's Hospital between December 2014 and February 2017 were retrospectively analyzed and divided into the control group (n=38) who accepted conventional low molecular heparin therapy and the study group (n=33) who accepted low molecular heparin combined with Roy adaptation model therapy. The differences in hypercoagulable state, endothelial function and placental blood perfusion were compared between the two groups before intervention and after 8 weeks of intervention. Results: Before intervention, there was no statistically significant difference in the hypercoagulable state, endothelial function and placental blood perfusion between the two groups of patients. After 8 weeks of intervention, peripheral blood coagulation indexes TT and AT-Ⅲ levels of study group were higher than those of control group while D-D level was lower than that of control group;serum endothelial function index NO content was higher than that of control group while ET-1 content was lower than that of control group;ultrasonic placental blood perfusion parameters FI, VI and VFI levels were higher than those of control group. Conclusion: Low molecular heparin combined with Roy adaptation model intervention could further reduce the hypercoagulable state, decrease the vascular endothelial injury, and eventually increase the placental blood perfusion in patients with preeclampsia.展开更多
Purpose: This study is to identify the prevalence of preoperative hypercoagulability in Thailand high-risk population assessed by Rotational thromboelastography (ROTEM) and test hypothesis that the pre-surgical ROTEM ...Purpose: This study is to identify the prevalence of preoperative hypercoagulability in Thailand high-risk population assessed by Rotational thromboelastography (ROTEM) and test hypothesis that the pre-surgical ROTEM statuses are related to MACCE at 1, 12, 60 months after coronary bypass graft surgery (CABG). Method: This is a prospective cohort in consecutive patients who underwent on-pump CABG between 2013-2015. Blood samplings were collected and analyzed using ROTEM preoperatively. Hypercoagulable state was defined as any clotting time (CT) or clot formation time (CFT) below the lower normal limit or amplitude 10 min after CT (A10), Maximum clot firmness (MCF) in ROTEM measurement is above the upper normal limit of EXTEM, INTEM and FIBTEM. Results: 43% of CABG patients who were diagnosed as hypercoagulability state assessed by ROTEM. Mortality rate was slightly higher in hypercoagulable patients without statistical significance (9% vs 5.1%;P = 0.461). However, overall combined uneventful rate was significantly increased in hypercoagulable patients in 5 years follow-up (27.2% vs 8.6%;P = 0.012). In univariate analysis, ROTEM hypercoagulability is associated major adverse cardiovascular and cerebral event (MACCE) in 5-years follow up [OR (95% CI) = 3.975 (1.28 - 12.32);P = 0.017]. Conclusion: Hypercoagulable patients were identified 43 percent of patients associated with combine uneventful in 5 years follow-up. ROTEM could be applied as a useful tool in the prediction of outcome after CABG surgery.展开更多
Background:Hypercoagulability has been shown to act as an important component of ulcerative colitis(UC)pathogenesis and disease activity,and is strongly correlated with the occurrence of venous thromboembolism(VTE).Th...Background:Hypercoagulability has been shown to act as an important component of ulcerative colitis(UC)pathogenesis and disease activity,and is strongly correlated with the occurrence of venous thromboembolism(VTE).This study aimed at providing novel therapeutic clues for hypercoagulable active UC.Methods:The coagulation score model was developed using VTE cohorts,and the predictive performance of this model was evaluated by coagulation subtypes of UC patients,which were clustered by the unsupervised method.Subsequently,the response of UC of distinct coagulation types,as identified by the coagulation scoring model,to different biological agents was evaluated.Immunoinflammatory cells and molecules that were associated with hypercoagulable active UC were explored by employing gene set variation analysis,single-sample gene set enrichment analysis,univariate logistic regression analysis,and immunohistochemistry.Results:A coagulation scoring model was established,which includes five key coagulation factors(ARHGAP35,CD46,BTK,C1QB,and F2R),and accurately distinguished the coagulation subtypes of UC.When comparing anti-TNF-αagents with other biological agents after determining the model,especially golimumab,it showed more effective treatment for hypercoagulable active UC.CXCL8 has been identified as playing an important role in the tightly interconnected network between the immune-inflammatory system and coagulation system in UC.Immunohistochemical analysis showed that the expression of CXCL8,BTK,C1QB,and F2R was upregulated in active UC.Conclusions:Anti-TNF-αagents have significant therapeutic effects on hypercoagulable active UC,and the strong association between CXCL8,hypercoagulation,and disease activity provides a novel therapeutic insight into hypercoagulable active UC.展开更多
This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National ...This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.展开更多
Gastric cancer remains a major cause of cancer-related mortality worldwide,with immunotherapy emerging as a promising treatment strategy.Neoadjuvant im-mune checkpoint therapy has shown potential in enhancing antitumo...Gastric cancer remains a major cause of cancer-related mortality worldwide,with immunotherapy emerging as a promising treatment strategy.Neoadjuvant im-mune checkpoint therapy has shown potential in enhancing antitumor responses and improving surgical outcomes.However,its effects on systemic coagulation and thrombotic risk remain poorly understood.This study aims to investigate the relationship between neoadjuvant immune checkpoint therapy and coagulation dynamics in patients with gastric cancer,exploring potential mechanisms that may contribute to a hypercoagulable state.By assessing coagulation markers,thrombotic events,and inflammatory responses,this research seeks to provide insights into the interplay between immune modulation and hemostatic alte-rations.A better understanding of these interactions may help optimize patient management and guide thromboprophylaxis strategies in this clinical setting.展开更多
There is no standard treatment for patients with locally advanced gastric cancer(LAGC).Neoadjuvant immunochemotherapy(NICT)is an emerging therapeutic strategy in LAGC.The prognosis of patients undergoing NICT plus rad...There is no standard treatment for patients with locally advanced gastric cancer(LAGC).Neoadjuvant immunochemotherapy(NICT)is an emerging therapeutic strategy in LAGC.The prognosis of patients undergoing NICT plus radical surgery varies.Hypercoagulation is frequently identified in cancer patients.A retrospective study by Li et al confirmed that in LAGC patients undergoing radical resection post-NICT,elevated D-dimer and fibrinogen levels were asso-ciated with poor prognosis,and their combined assessment improved predictive accuracy.This retrospective study has some limitations,and further prospective research is required to validate hypercoagulation as a prognostic indicator and develop a more precise predictive model.Establishing such a model can facilitate personalized treatment strategies for patients with LAGC.展开更多
Coronavirus disease 2019(COVID-19)is a multi-system disease that can lead to various severe complications.Acute limb ischemia(ALI)has been increasingly recognized as a COVID-19-associated complication that often predi...Coronavirus disease 2019(COVID-19)is a multi-system disease that can lead to various severe complications.Acute limb ischemia(ALI)has been increasingly recognized as a COVID-19-associated complication that often predicts a poor prognosis.However,the pathophysiology and molecular mechanisms underlying COVID-19-associated ALI remain poorly understood.Hypercoagulability and thrombosis are considered important mechanisms,but we also emphasize the roles of vasospasm,hypoxia,and acidosis in the pathogenesis of the disease.The angiotensin-converting enzyme 2(ACE2)pathway,inflammation,and platelet activation may be important molecular mechanisms underlying these pathological changes induced by COVID-19.Furthermore,we discuss the hypotheses of risk factors for COVID-19-associated ALI from genetic,age,and gender perspectives based on our analysis of molecular mechanisms.Additionally,we summarize therapeutic approaches such as use of the interleukin-6(IL-6)blocker tocilizumab,calcium channel blockers,and angiotensin-converting enzyme inhibitors,providing insights for the future treatment of coronavirus-associated limb ischemic diseases.展开更多
AIM To examine the role of soluble fibrin monomer complex(SFMC)in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related mak...AIM To examine the role of soluble fibrin monomer complex(SFMC)in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1,2014 and March 31,2015.We investigated the clinical significance of SFMC,which is known to reflect the early plasmatic activation of coagulation,in the view of these fibrin related markers.RESULTS A total of 123 patients were included in the present study.There were no patients with symptomatic VTE.Thirty-five(28%)patients received postoperative anticoagulant therapy.In the multivariate analysis,a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7(OR=4.31,95%CI:1.10-18.30,P=0.03).The cutoff SFMC level was 3.8μg/ml(AUC=0.78,sensitivity,63%,specificity,89%).The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to highSFMC patients who did not.CONCLUSION The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers.展开更多
Increased ischemic stroke risk is observed in patients with inflammatory bowel disease(IBD).Causes and physiopathological aspects of cerebral infarct,in this specific population,are less often described.There is littl...Increased ischemic stroke risk is observed in patients with inflammatory bowel disease(IBD).Causes and physiopathological aspects of cerebral infarct,in this specific population,are less often described.There is little information to provide guidelines for the best curative and preventive treatment.We report 2 cases of ischemic strokes due to internal carotid thrombus in patients during active phase of IBD.Ulceration of early atherosclerotic plaques activated by a hypercoagulation state may cause a thrombus.A combined therapy with heparin and corticosteroids was used for both our patients.Lysis of the thrombus was obtained after several days without surgical treatment and shown by ultrasonography.These cases highlight an aetiology of stroke in patients with IBD and use of a synergic treatment to respond to hypercoagulability in link with IBD. Benefits and safety of this therapy should be confirmed with clinical studies.展开更多
Coronavirus disease has unarguably been the largest pandemic of recent times.Over 150 million cases have occurred worldwide,and more than 3 million have succumbed to the disease.Cardiac manifestations can have varied ...Coronavirus disease has unarguably been the largest pandemic of recent times.Over 150 million cases have occurred worldwide,and more than 3 million have succumbed to the disease.Cardiac manifestations can have varied presentations from an asymptomatic troponin rise to fulminant myocarditis.The pathogenesis of myocardial damage could be direct or indirect,including inflammation,coronary spasm,plaque rupture,and cytokine storm.Thromboembolism is also an important feature of cardiovascular affliction with both arterial and venous systems being affected.Hence,anticoagulation has also been a matter of debate.Fulminant myocarditis is the most severe form and can lead to circulatory shock with a high mortality.Management of cardiac patients with coronavirus disease 2019(COVID-19)infection is not considerably different from non-COVID-19 cardiovascular disease,but interaction between cardiovascular drugs and anti-COVID-19 therapy requires careful attention.More recently,vaccines have emerged as a ray of hope for the disease.But simultaneously,there have been reports of thromboembolism following vaccination.In this review,we discuss the various aspects of coronavirus disease affecting of heart and its management.展开更多
Background: Heamatological problems have been associated with human immunodeficiency virus infection. Hypercoagulability, in particular, thrombosis is becoming more common in HIV-positive patients. Aim: The goals of t...Background: Heamatological problems have been associated with human immunodeficiency virus infection. Hypercoagulability, in particular, thrombosis is becoming more common in HIV-positive patients. Aim: The goals of this study were to determine levels of plasma fibrinogen, protein C, Hemoglobin, and ESR among Sudanese HIV-positive patients. Materials and Methods: This is a case-control study, for this investigation, a total of 100 participants were recruited for this study. Fifty people were diagnosed with HIV, 25 of whom were males (50 percent) and 25 of whom were females (50 percent), with an average age of 35.5 years. Further fifty healthy people, 26 (52%) of whom were men and 24 (48%) of whom were women, with a mean age of 37.1 years, matched the case group. Fresh Poor Plasma was obtained by centrifuging citrated venous blood samples at 3000 rpm for 15 minutes. The fibrinogen level was determined using an automated coagulation analyzer. Total protein C level was measured by a fully-automated blood coagulation analyzer (SYSMEX CA-500’JAPAN). The haemoglobin parameter was measured from EDTA anticoagulant samples using the Sysmex KX 21-N automated haematological analyzer. In one hour, the ESR was done using a Westergren tube. Data was collected using a structured direct questionnaire. SPSS version 21 was used to analyse the data. Results: The current study discovered that in Sudanese HIV infection, the mean and standard deviation of plasma fibrinogen levels were statistically substantially higher than in the normal control group (370.5 ± 67 vs 214.7 ± 21 with P value 0.001). Protein C levels were statistically significantly lower in HIV positive patients compared with control group (0.6 ± 0.1 vs 1.3 ± 0.2 with P value 0.001). In HIV positive patients, haemoglobin was statistically substantially lower than in healthy people (10.8 ± 1.8 vs 13.7 ± 1.9, P value 0.01). The erythrocyte sedimentation rate was statistically significantly higher in HIV positive patients than in the control group, with (58.00 ± 27 vs 7.68 ± 3 with P value 0.00). Conclusions: HIV infected patients had higher plasma fibrinogen levels and lower haemoglobin levels than normal healthy control groups. In 16 percent of HIV positive patients, protein C deficiency was discovered. HIV-positive patients had significantly greater ESR.展开更多
Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism (VTE) is a rare complication of this disease, it may be a po...Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism (VTE) is a rare complication of this disease, it may be a potentially life-threatening event. A 58-year-old man was admitted due to hematemesis due to inflammation at the anastomosis site after a gastrectomy years ago. After 3 days in-hospital, he showed a peroneal deep vein thrombosis and superficial thrombosis of left cephalic vein. Although reduced mobility and lack of prophylactic heparin could explain vein thrombosis, a simple etiologic workup was performed and active tuberculosis was diagnosed. This case illustrates a rare and unusual presentation form of tuberculosis, a condition that remains now-a-days one of the leading infectious causes of death worldwide. The association between tuberculosis and VTE is rare, but it should be systematically investigated.展开更多
<strong>Objective:</strong> To analyze the coronavirus disease-2019 (COVID-19) patients presenting with acute stroke by determining their clinical characteristics, hospitalization course and prognosis. The...<strong>Objective:</strong> To analyze the coronavirus disease-2019 (COVID-19) patients presenting with acute stroke by determining their clinical characteristics, hospitalization course and prognosis. The common and conventional stroke risk factors in these patients were assessed with the aim of determining the role and contribution of the COVID-19 infection to stroke pathogenesis. <strong>Methods:</strong> Retrospective observational study involving 24 patients from a single tertiary care center over a time period of three months. Risk factors such as Age, Hypertension, Diabetes Mellitus, smoking status and underlying cardiac history were analyzed. COVID-19 relevant laboratory and radiological data were documented. <strong>Results:</strong> 87.5% of patients had ischemic stroke, with 58.3% of total patients being younger than 55 years. An equal incidence of both Diabetes Mellitus and Hypertension (37.5%) was identified. 29.2% were completely asymptomatic for COVID-19, of which 85.7% had no chest X-ray changes on admission. Eight patients (61.5%) developed pneumonia during admission despite an initially normal chest X-ray.<strong> Conclusion:</strong> Patients without COVID-19 symptoms and with normal chest radiography presenting with stroke does not rule out a possible underlying COVID-19 infection. Such patients may be positive for the virus and may go on to develop pneumonia shortly after suffering from strokes. This could suggest that stroke in COVID-19 patients is a possible initial presenting feature and consequence of the inflammatory state triggered by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. It is imperative to analyze the association of COVID-19 and stroke, and to maintain a high index of suspicion of COVID-19 infection in stroke patients, to enhance early detection and reduce transmission.展开更多
Inferior vena cava thrombosis is an under-recognized entity associated with significant morbidity and mortality. This is the reason why, although the diagnosis is challenging, a high index of suspicion is required. Re...Inferior vena cava thrombosis is an under-recognized entity associated with significant morbidity and mortality. This is the reason why, although the diagnosis is challenging, a high index of suspicion is required. Regarding this condition, we present the case of a 63-year-old man who had repeatedly visited the emergency room suffering from abdominal and back pain and painful lower limb edema. After several tests, including magnetic resonance imaging (MRI), he was diagnosed to have agenesis of left renal vein and inferior vena cava thrombosis, from hypercoagulable state secondary to Antiphospholipid Syndrome. He had anticoagulation treatment with low-molecular-weight heparin with good subsequent evolution. This study sets out a descriptive retrospective study of fifty cases of inferior vena cava thrombosis diagnosed in a third-level hospital in the north of Spain over a ten-year period (2010-2018). The aim of this article is to identify the epidemiology, predisposing factors and symptoms that characterize this entity, in order to be able to achieve an early diagnosis that allows us to initiate immediate treatment, minimizing acute and chronic complications of this disease.展开更多
We bring report the case of a young woman who presents with neurological symptoms, and to which the practised investigations led to the discovery in chain of unexpected pathologies. These neurological disorders were r...We bring report the case of a young woman who presents with neurological symptoms, and to which the practised investigations led to the discovery in chain of unexpected pathologies. These neurological disorders were revealing of the picture associating a nephrotic syndrome and a patent foramen ovale. This foramen was the major route of a rain of emboles ring peripheral favored by the nephrotic syndrome towards the cerebral hemispheres.展开更多
Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer...Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer who were treated in the Affiliated Hospital of Hebei University were selected as the research subjects,and a retrospective analysis was conducted to analyze and observe the D-dimer(DD),fibrinogen(FIB),and platelet(PLT)levels in peripheral blood,as well as detect peripheral CTC.Results:There were statistical differences in TMN staging,tumor metastasis,and lymph node metastasis in the clinical data,but there were no statistical differences in gender,smoking history,and pathological classification.After retrospective analysis and comparison of the patients,the DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels of the CTC positive group were 3.41±0.58,3.98±0.87,and 367.26±34.98,respectively;the CTC negative group’s DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels were 0.89±0.49,1.06±0.45,and 234.69±35.69,respectively,and the differences were statistically significant.The factors affecting the prognosis of patients included TMN staging and CTC;the number of CTC positives in the death group was significantly higher than that in the survival group,and there was a statistical difference between the groups.Gender,age,smoking history,pathological type,and surgical resection had no effect on the prognosis of patients.Among the enrolled patients,the survival rate was 71.91%.Conclusion:CTC-positive patients have a higher probability of hypercoagulability after surgery and are prone to tumor metastasis;thus,CTC can be used as a judgment index for the prognosis of patients.展开更多
基金supported by the Guizhou Provincial Basic Research Program(Natural Science)Youth Guidance Project{Qian Kehe Foundation-[2024]Youth 307}。
文摘In both Traditional Chinese Medicine(TCM)and modern medicine,they agree that the integrity and healthy structure of the vascular endothelium are essential for normal hemodynamics.Damage to the vascular endothelium can quickly activate the extrinsic coagulation pathway by triggering the tissue factor(TF)and lead to coagulation.This damage,along with a loss of anticoagulant properties through antithrombinⅢ(ATⅢ),TF pathway inhibitors,and the protein C system,can result in a hypercoagulable state and even thrombosis.Hypercoagulability is not only a common feature of many cancers but also an important factor promoting tumor development and metastasis,which corresponds to the TCM theory of“blood stasis leading to tumors.”The pharmacological effects of heparin and aspirin have similarities with TCM's“activating blood circulation and removing blood stasis”theory in improving blood circulation,treating related diseases,and their anti-inflammatory effects.
文摘Background: Bilateral adrenal hemorrhage (BAH) is a rare condition that may lead to life-threatening adrenal insufficiency or adrenal crisis if not addressed appropriately. Case Report: A 54-year-old male with a history of venous thromboembolism (VTE) on warfarin presented to the hospital with nausea, vomiting, and abdominal and flank pain shortly following colonoscopy preparation. Initial imaging of the abdomen and pelvis was notable for hyperdense thickening of the bilateral adrenal glands raising concerns for hemorrhages, and subsequent magnetic resonance imaging (MRI) confirmed BAH. During hospitalization, the patient was placed on prophylactic heparin, and shortly after decompensating, he became tachycardic, hypotensive, and febrile. This led to heparin reversal followed by administration of a single dose of Hydrocortisone 100 mg and Hydrocortisone 50 mg TID due to concern for adrenal insufficiency. The patient also necessitated sepsis work-up and fluid resuscitation. Repeat CT imaging showed no significant change in hemorrhage size bilaterally. Endocrinology, vascular surgery, hematology/oncology, and rheumatology were consulted for the management of adrenal insufficiency, anticoagulation in the presence of hemorrhage, thrombocytopenia, and hypercoagulable state. Towards the end of his hospital course, the patient had asymptomatic diffuse ST elevations, elevated troponin, and an ejection fraction of 10% - 15%, leading to cardiac catheterization and placement of an intra-aortic pump. During subsequent stay in the ICU, the patient developed hemodynamic shock and was transferred to a facility with a higher level of care and medical support therapies. After this transfer, the patient was stabilized from a cardiac standpoint but developed acute respiratory failure suspected to be secondary to diffuse alveolar hemorrhage and immune thrombocytopenic purpura, necessitating platelet transfusion. He was on continued monitoring from rheumatology given his myocarditis believed to be secondary to his antiphospholipid antibodies, and was treated with IVIG, rituximab, and hydroxychloroquine. A repeat echocardiogram revealed an improved ejection fraction of 52% and the patient was then discharged on an enoxaparin bridge to warfarin and a cardiac home event monitor. Discussion: BAH is a life-threatening condition that should be promptly identified and managed in patients presenting with nonspecific symptoms and a history of hypercoagulability or anticoagulation. In these cases, the risk of AH and subsequent adrenal insufficiency is drastically increased, so immediate imaging as well as initiation of steroid therapy is crucial to stabilize patients and prevent adrenal crisis. A multidisciplinary approach, involving endocrinology, hematology, and cardiology as in this case is also imperative to optimize patient outcomes and increase survival. Conclusion: BAH should be considered in patients presenting with a history of VTE and hypercoagulable state when precipitating stressors or predisposing risk factors are present. This case report highlights the importance of clinical awareness of BAH for clinicians to accurately identify and manage it to prevent fatal sequelae and ensure long-term favorable patient outcomes.
文摘Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control group (saline) and three ellagic acid (EA)-treated groups (low, middle, and high doses). In the mice, bleeding time (BT) was estimated with tail transaction, and clotting time (CT) with template method. Prothrombin time (PT) and the activated partial thromboplastin time (APTT) in rats and rabbits were measured by means of Quick's one-stage assay and modified APTT assay respectively. In addition, thrombin activity was estimated in rats with PT assay using a hemagglutination analyzer. The circulating platelet aggregates were de- tected in rabbits through platelet counting and presented as the circulating platelet aggregate ratio (CPAR). Results EA shortened BT and CT in mice, PT and APTT in rats, and increased thrombin activity and CPAR, all in a dose-dependent manner. EA also brought reduction of PT and APTT in rabbits in dose- and time-dependent manners. Conclusion EA could induce hypercoagulable state through activating coagulation system and platelets in mice, rats, and rabbits.
文摘Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cancer. Portal vein thrombosis is the most feared complication of the surgery and chances are increased if the patient has a hypercoagulable disorder. We present a challenging case of islet auto transplantation from our institution. A 29-year-old woman with plasminogen activator inhibitor-4G/4G variant and a clinical history of venous thrombosis was successfully managed with a precise peri- and postoperative anticoagulation protocol. In this paper we discuss the anti-coagulation protocol for safely and successfully caring out islet transplantation and associated risks and benefits.
文摘Objective: To investigate the effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia. Methods: A total of 71 patients with preeclampsia who were treated in Zigong Third People's Hospital between December 2014 and February 2017 were retrospectively analyzed and divided into the control group (n=38) who accepted conventional low molecular heparin therapy and the study group (n=33) who accepted low molecular heparin combined with Roy adaptation model therapy. The differences in hypercoagulable state, endothelial function and placental blood perfusion were compared between the two groups before intervention and after 8 weeks of intervention. Results: Before intervention, there was no statistically significant difference in the hypercoagulable state, endothelial function and placental blood perfusion between the two groups of patients. After 8 weeks of intervention, peripheral blood coagulation indexes TT and AT-Ⅲ levels of study group were higher than those of control group while D-D level was lower than that of control group;serum endothelial function index NO content was higher than that of control group while ET-1 content was lower than that of control group;ultrasonic placental blood perfusion parameters FI, VI and VFI levels were higher than those of control group. Conclusion: Low molecular heparin combined with Roy adaptation model intervention could further reduce the hypercoagulable state, decrease the vascular endothelial injury, and eventually increase the placental blood perfusion in patients with preeclampsia.
文摘Purpose: This study is to identify the prevalence of preoperative hypercoagulability in Thailand high-risk population assessed by Rotational thromboelastography (ROTEM) and test hypothesis that the pre-surgical ROTEM statuses are related to MACCE at 1, 12, 60 months after coronary bypass graft surgery (CABG). Method: This is a prospective cohort in consecutive patients who underwent on-pump CABG between 2013-2015. Blood samplings were collected and analyzed using ROTEM preoperatively. Hypercoagulable state was defined as any clotting time (CT) or clot formation time (CFT) below the lower normal limit or amplitude 10 min after CT (A10), Maximum clot firmness (MCF) in ROTEM measurement is above the upper normal limit of EXTEM, INTEM and FIBTEM. Results: 43% of CABG patients who were diagnosed as hypercoagulability state assessed by ROTEM. Mortality rate was slightly higher in hypercoagulable patients without statistical significance (9% vs 5.1%;P = 0.461). However, overall combined uneventful rate was significantly increased in hypercoagulable patients in 5 years follow-up (27.2% vs 8.6%;P = 0.012). In univariate analysis, ROTEM hypercoagulability is associated major adverse cardiovascular and cerebral event (MACCE) in 5-years follow up [OR (95% CI) = 3.975 (1.28 - 12.32);P = 0.017]. Conclusion: Hypercoagulable patients were identified 43 percent of patients associated with combine uneventful in 5 years follow-up. ROTEM could be applied as a useful tool in the prediction of outcome after CABG surgery.
基金supported by the Zhejiang Chinese Medicine University Postgraduate Scientific Research Fund Project[grant number 2022YKJ02]Medical Scientific Research Foundation of Guangdong Province of China[grant number A2021433]+2 种基金Guangdong Basic and Applied Basic Research Foundation[grant numbers 2021A1515010280,2022A1515012170,and 2024A1515011242]China Postdoctoral Science Foundation[grant number 2023M730743]National Natural Science Foundation of China[grant number 82470422].
文摘Background:Hypercoagulability has been shown to act as an important component of ulcerative colitis(UC)pathogenesis and disease activity,and is strongly correlated with the occurrence of venous thromboembolism(VTE).This study aimed at providing novel therapeutic clues for hypercoagulable active UC.Methods:The coagulation score model was developed using VTE cohorts,and the predictive performance of this model was evaluated by coagulation subtypes of UC patients,which were clustered by the unsupervised method.Subsequently,the response of UC of distinct coagulation types,as identified by the coagulation scoring model,to different biological agents was evaluated.Immunoinflammatory cells and molecules that were associated with hypercoagulable active UC were explored by employing gene set variation analysis,single-sample gene set enrichment analysis,univariate logistic regression analysis,and immunohistochemistry.Results:A coagulation scoring model was established,which includes five key coagulation factors(ARHGAP35,CD46,BTK,C1QB,and F2R),and accurately distinguished the coagulation subtypes of UC.When comparing anti-TNF-αagents with other biological agents after determining the model,especially golimumab,it showed more effective treatment for hypercoagulable active UC.CXCL8 has been identified as playing an important role in the tightly interconnected network between the immune-inflammatory system and coagulation system in UC.Immunohistochemical analysis showed that the expression of CXCL8,BTK,C1QB,and F2R was upregulated in active UC.Conclusions:Anti-TNF-αagents have significant therapeutic effects on hypercoagulable active UC,and the strong association between CXCL8,hypercoagulation,and disease activity provides a novel therapeutic insight into hypercoagulable active UC.
文摘This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.
文摘Gastric cancer remains a major cause of cancer-related mortality worldwide,with immunotherapy emerging as a promising treatment strategy.Neoadjuvant im-mune checkpoint therapy has shown potential in enhancing antitumor responses and improving surgical outcomes.However,its effects on systemic coagulation and thrombotic risk remain poorly understood.This study aims to investigate the relationship between neoadjuvant immune checkpoint therapy and coagulation dynamics in patients with gastric cancer,exploring potential mechanisms that may contribute to a hypercoagulable state.By assessing coagulation markers,thrombotic events,and inflammatory responses,this research seeks to provide insights into the interplay between immune modulation and hemostatic alte-rations.A better understanding of these interactions may help optimize patient management and guide thromboprophylaxis strategies in this clinical setting.
文摘There is no standard treatment for patients with locally advanced gastric cancer(LAGC).Neoadjuvant immunochemotherapy(NICT)is an emerging therapeutic strategy in LAGC.The prognosis of patients undergoing NICT plus radical surgery varies.Hypercoagulation is frequently identified in cancer patients.A retrospective study by Li et al confirmed that in LAGC patients undergoing radical resection post-NICT,elevated D-dimer and fibrinogen levels were asso-ciated with poor prognosis,and their combined assessment improved predictive accuracy.This retrospective study has some limitations,and further prospective research is required to validate hypercoagulation as a prognostic indicator and develop a more precise predictive model.Establishing such a model can facilitate personalized treatment strategies for patients with LAGC.
基金supported by the Zhejiang Provincial Medical Scientific Research Program(No.2022RC136),China.
文摘Coronavirus disease 2019(COVID-19)is a multi-system disease that can lead to various severe complications.Acute limb ischemia(ALI)has been increasingly recognized as a COVID-19-associated complication that often predicts a poor prognosis.However,the pathophysiology and molecular mechanisms underlying COVID-19-associated ALI remain poorly understood.Hypercoagulability and thrombosis are considered important mechanisms,but we also emphasize the roles of vasospasm,hypoxia,and acidosis in the pathogenesis of the disease.The angiotensin-converting enzyme 2(ACE2)pathway,inflammation,and platelet activation may be important molecular mechanisms underlying these pathological changes induced by COVID-19.Furthermore,we discuss the hypotheses of risk factors for COVID-19-associated ALI from genetic,age,and gender perspectives based on our analysis of molecular mechanisms.Additionally,we summarize therapeutic approaches such as use of the interleukin-6(IL-6)blocker tocilizumab,calcium channel blockers,and angiotensin-converting enzyme inhibitors,providing insights for the future treatment of coronavirus-associated limb ischemic diseases.
文摘AIM To examine the role of soluble fibrin monomer complex(SFMC)in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1,2014 and March 31,2015.We investigated the clinical significance of SFMC,which is known to reflect the early plasmatic activation of coagulation,in the view of these fibrin related markers.RESULTS A total of 123 patients were included in the present study.There were no patients with symptomatic VTE.Thirty-five(28%)patients received postoperative anticoagulant therapy.In the multivariate analysis,a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7(OR=4.31,95%CI:1.10-18.30,P=0.03).The cutoff SFMC level was 3.8μg/ml(AUC=0.78,sensitivity,63%,specificity,89%).The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to highSFMC patients who did not.CONCLUSION The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers.
文摘Increased ischemic stroke risk is observed in patients with inflammatory bowel disease(IBD).Causes and physiopathological aspects of cerebral infarct,in this specific population,are less often described.There is little information to provide guidelines for the best curative and preventive treatment.We report 2 cases of ischemic strokes due to internal carotid thrombus in patients during active phase of IBD.Ulceration of early atherosclerotic plaques activated by a hypercoagulation state may cause a thrombus.A combined therapy with heparin and corticosteroids was used for both our patients.Lysis of the thrombus was obtained after several days without surgical treatment and shown by ultrasonography.These cases highlight an aetiology of stroke in patients with IBD and use of a synergic treatment to respond to hypercoagulability in link with IBD. Benefits and safety of this therapy should be confirmed with clinical studies.
文摘Coronavirus disease has unarguably been the largest pandemic of recent times.Over 150 million cases have occurred worldwide,and more than 3 million have succumbed to the disease.Cardiac manifestations can have varied presentations from an asymptomatic troponin rise to fulminant myocarditis.The pathogenesis of myocardial damage could be direct or indirect,including inflammation,coronary spasm,plaque rupture,and cytokine storm.Thromboembolism is also an important feature of cardiovascular affliction with both arterial and venous systems being affected.Hence,anticoagulation has also been a matter of debate.Fulminant myocarditis is the most severe form and can lead to circulatory shock with a high mortality.Management of cardiac patients with coronavirus disease 2019(COVID-19)infection is not considerably different from non-COVID-19 cardiovascular disease,but interaction between cardiovascular drugs and anti-COVID-19 therapy requires careful attention.More recently,vaccines have emerged as a ray of hope for the disease.But simultaneously,there have been reports of thromboembolism following vaccination.In this review,we discuss the various aspects of coronavirus disease affecting of heart and its management.
文摘Background: Heamatological problems have been associated with human immunodeficiency virus infection. Hypercoagulability, in particular, thrombosis is becoming more common in HIV-positive patients. Aim: The goals of this study were to determine levels of plasma fibrinogen, protein C, Hemoglobin, and ESR among Sudanese HIV-positive patients. Materials and Methods: This is a case-control study, for this investigation, a total of 100 participants were recruited for this study. Fifty people were diagnosed with HIV, 25 of whom were males (50 percent) and 25 of whom were females (50 percent), with an average age of 35.5 years. Further fifty healthy people, 26 (52%) of whom were men and 24 (48%) of whom were women, with a mean age of 37.1 years, matched the case group. Fresh Poor Plasma was obtained by centrifuging citrated venous blood samples at 3000 rpm for 15 minutes. The fibrinogen level was determined using an automated coagulation analyzer. Total protein C level was measured by a fully-automated blood coagulation analyzer (SYSMEX CA-500’JAPAN). The haemoglobin parameter was measured from EDTA anticoagulant samples using the Sysmex KX 21-N automated haematological analyzer. In one hour, the ESR was done using a Westergren tube. Data was collected using a structured direct questionnaire. SPSS version 21 was used to analyse the data. Results: The current study discovered that in Sudanese HIV infection, the mean and standard deviation of plasma fibrinogen levels were statistically substantially higher than in the normal control group (370.5 ± 67 vs 214.7 ± 21 with P value 0.001). Protein C levels were statistically significantly lower in HIV positive patients compared with control group (0.6 ± 0.1 vs 1.3 ± 0.2 with P value 0.001). In HIV positive patients, haemoglobin was statistically substantially lower than in healthy people (10.8 ± 1.8 vs 13.7 ± 1.9, P value 0.01). The erythrocyte sedimentation rate was statistically significantly higher in HIV positive patients than in the control group, with (58.00 ± 27 vs 7.68 ± 3 with P value 0.00). Conclusions: HIV infected patients had higher plasma fibrinogen levels and lower haemoglobin levels than normal healthy control groups. In 16 percent of HIV positive patients, protein C deficiency was discovered. HIV-positive patients had significantly greater ESR.
文摘Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism (VTE) is a rare complication of this disease, it may be a potentially life-threatening event. A 58-year-old man was admitted due to hematemesis due to inflammation at the anastomosis site after a gastrectomy years ago. After 3 days in-hospital, he showed a peroneal deep vein thrombosis and superficial thrombosis of left cephalic vein. Although reduced mobility and lack of prophylactic heparin could explain vein thrombosis, a simple etiologic workup was performed and active tuberculosis was diagnosed. This case illustrates a rare and unusual presentation form of tuberculosis, a condition that remains now-a-days one of the leading infectious causes of death worldwide. The association between tuberculosis and VTE is rare, but it should be systematically investigated.
文摘<strong>Objective:</strong> To analyze the coronavirus disease-2019 (COVID-19) patients presenting with acute stroke by determining their clinical characteristics, hospitalization course and prognosis. The common and conventional stroke risk factors in these patients were assessed with the aim of determining the role and contribution of the COVID-19 infection to stroke pathogenesis. <strong>Methods:</strong> Retrospective observational study involving 24 patients from a single tertiary care center over a time period of three months. Risk factors such as Age, Hypertension, Diabetes Mellitus, smoking status and underlying cardiac history were analyzed. COVID-19 relevant laboratory and radiological data were documented. <strong>Results:</strong> 87.5% of patients had ischemic stroke, with 58.3% of total patients being younger than 55 years. An equal incidence of both Diabetes Mellitus and Hypertension (37.5%) was identified. 29.2% were completely asymptomatic for COVID-19, of which 85.7% had no chest X-ray changes on admission. Eight patients (61.5%) developed pneumonia during admission despite an initially normal chest X-ray.<strong> Conclusion:</strong> Patients without COVID-19 symptoms and with normal chest radiography presenting with stroke does not rule out a possible underlying COVID-19 infection. Such patients may be positive for the virus and may go on to develop pneumonia shortly after suffering from strokes. This could suggest that stroke in COVID-19 patients is a possible initial presenting feature and consequence of the inflammatory state triggered by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. It is imperative to analyze the association of COVID-19 and stroke, and to maintain a high index of suspicion of COVID-19 infection in stroke patients, to enhance early detection and reduce transmission.
文摘Inferior vena cava thrombosis is an under-recognized entity associated with significant morbidity and mortality. This is the reason why, although the diagnosis is challenging, a high index of suspicion is required. Regarding this condition, we present the case of a 63-year-old man who had repeatedly visited the emergency room suffering from abdominal and back pain and painful lower limb edema. After several tests, including magnetic resonance imaging (MRI), he was diagnosed to have agenesis of left renal vein and inferior vena cava thrombosis, from hypercoagulable state secondary to Antiphospholipid Syndrome. He had anticoagulation treatment with low-molecular-weight heparin with good subsequent evolution. This study sets out a descriptive retrospective study of fifty cases of inferior vena cava thrombosis diagnosed in a third-level hospital in the north of Spain over a ten-year period (2010-2018). The aim of this article is to identify the epidemiology, predisposing factors and symptoms that characterize this entity, in order to be able to achieve an early diagnosis that allows us to initiate immediate treatment, minimizing acute and chronic complications of this disease.
文摘We bring report the case of a young woman who presents with neurological symptoms, and to which the practised investigations led to the discovery in chain of unexpected pathologies. These neurological disorders were revealing of the picture associating a nephrotic syndrome and a patent foramen ovale. This foramen was the major route of a rain of emboles ring peripheral favored by the nephrotic syndrome towards the cerebral hemispheres.
基金Baoding Science and Technology Project(Project Number:18ZF134)Youth Fund of Affiliated Hospital of Hebei University(Project Number:2017Q018)。
文摘Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer who were treated in the Affiliated Hospital of Hebei University were selected as the research subjects,and a retrospective analysis was conducted to analyze and observe the D-dimer(DD),fibrinogen(FIB),and platelet(PLT)levels in peripheral blood,as well as detect peripheral CTC.Results:There were statistical differences in TMN staging,tumor metastasis,and lymph node metastasis in the clinical data,but there were no statistical differences in gender,smoking history,and pathological classification.After retrospective analysis and comparison of the patients,the DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels of the CTC positive group were 3.41±0.58,3.98±0.87,and 367.26±34.98,respectively;the CTC negative group’s DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels were 0.89±0.49,1.06±0.45,and 234.69±35.69,respectively,and the differences were statistically significant.The factors affecting the prognosis of patients included TMN staging and CTC;the number of CTC positives in the death group was significantly higher than that in the survival group,and there was a statistical difference between the groups.Gender,age,smoking history,pathological type,and surgical resection had no effect on the prognosis of patients.Among the enrolled patients,the survival rate was 71.91%.Conclusion:CTC-positive patients have a higher probability of hypercoagulability after surgery and are prone to tumor metastasis;thus,CTC can be used as a judgment index for the prognosis of patients.
