Salih Aksu

Endoscopic Application of Ankaferd Blood Stopper as a Novel Experimental Treatment Modality for Upper Gastrointestinal Bleeding: A Case Report

Endoscopic Application of Ankaferd Blood Stopper as a Novel Experimental Treatment Modality for Upper Gastrointestinal Bleeding: A Case Report

Hemostatic Efficacy of Ankaferd Blood Stopper® in a Swine Bleeding Model

Objective: The purpose of this study was to show the hemostatic effect of spray, solution and tampon forms of Ankaferd Blood Stopper® (ABS), a unique medicinal plant extract historically used as a hemostatic agent in Turkish folklore medicine, in a porcine bleeding model. Materials and Methods: Two 1-year-old pigs were used as bleeding models for superficial and deep skin lacerations, grade II liver and spleen injuries, grade II saphenous vein injury and grade IV saphenous artery injury. Spray, solution or tampon forms of ABS were applied after continuing bleeding was confirmed. The primary outcome was time to hemostasis. Volume of blood loss was not measured. The pigs were euthanized at the end of the experiment. Results: Spray or direct application of ABS solution resulted in instant control of bleeding in superficial and deep skin lacerations as well as puncture wounds of the liver. A 40-second application of ABS tampon was sufficient to stop bleeding of skin lacerations, while 1.5- and 3.5-min applications were used to control hemorrhage from the saphenous vein and artery, respectively. No rebleeding was observed once hemostasis was achieved. However, repeated applications of ABS solution and tampon were only temporarily effective in the hemostasis of spleen injury. Conclusions: The data showed that ABS was an effective hemostatic agent for superficial and deep skin lacerations and minor/moderate trauma injuries in a porcine bleeding model.

Endoscopic topical application of Ankaferd Blood Stopper for neoplastic gastrointestinal bleeding: A retrospective analysis

AIM The aim of this study was to retrospectively assess the haemostatic efficacy of the endoscopic topical use of Ankaferd Blood Stopper (ABS) in the setting of neoplastic GI bleeding. METHODS The records of 10 patients with neoplastic GI bleeding (7 gastric, 3 rectal) were evaluated retrospectively. Written informed consent regarding the off-label use of ABS as a means of attaining haemostasis had been obtained from all of the patients prior to the procedure. In all patients, ABS was applied topically. Rates of bleeding control and post-procedural complications were documented. RESULTS Haemostasis was achieved in all patients within seconds of endoscopic application of ABS, with no immediate complications. Seven patients underwent subsequent cancer surgery after a bleeding-free post-procedural period. CONCLUSIONS ABS as a novel haemostatic agent could have a potential benefit in controlling bleeding from GI tumours. Prospective controlled studies are needed to help establish its efficacy, and perhaps offer a comparison to conventional haemostatic interventions.

Over-expression of angiotensin-converting enzyme (CD 143) on leukemic blasts as a clue for the activated local bone marrow RAS in AML

Local bone marrow renin-angiotensin system (RAS) is an autocrine-paracrine system affecting hematopoiesis. Angiotensin II type 1a (AT1a) receptors are present on the CD34+ hematopoietic stem cells. Angiotensin II stimulates the proliferation of bone marrow and umbilical cord blood hematopoietic progenitors. There are preliminary data that local RAS might also be involved in leukemogenesis. ACE hyper-function may lead to the acceleration of negative hematopoietic regulator peptide, AcSDKP, metabolism, which in turn lowers its level in the bone marrow micro-environment, finally removing the anti-proliferative effect of AcSDKP on the hematopoietic cells and blasts. Renin expression could have a role on the leukemia development and angiotensin may act as an autocrine growth factor for acute myeloid leukemia (AML) cells. The aim of this study is to search ACE (CD 143) surface antigen by flow-cytometric analyses on the leukemic blast cells taken from the bone marrow of the patients with AML. Bone marrow aspiration materials and peripheral blood samples were obtained from 11 patients with AML (eight males, three females; aged 46 (range 26–67) years) and six patients with non-malignant hematological disorders (four males, two females; aged 56 (range 22–71) years). ACE (CD 143) surface antigen was shown to be over-expressed in leukemic myeloid blast cells. ACE is positively correlated with bone marrow blast count. Elucidation of the pathological activity of the local RAS-mediated regulation of the leukemogenesis is both pathobiologically and clinically important, since the angiotensin peptides represent a molecular target in the disease management.

Local umbilical cord blood renin–angiotensin system

Local bone marrow (BM) renin–angiotensin system (RAS) is an autocrine-paracrine system affecting normal and neoplastic hematopoiesis. Angiotensin II type 1a (AT1a) receptors are present on the CD34+ hematopoietic stem cells (HSC). Angiotensin II stimulates the proliferation and differentiation of the HSC populations through the activation of AT1 receptors on HSC. Umbilical cord blood (UCB) is a rich source of HSC. The existence of a complete local UCB RAS has not been previously investigated. In this study, local synthesis of the major RAS components, namely, angiotensin-converting enzyme (ACE), renin, and angiotensinogen, was identified by demonstrating their corresponding mRNAs using quantitative reverse transcriptase polymerase chain reaction (RT-PCR) in human UCB. Local RAS could regulate cellular growth in a variety of tissues including the BM. Major RAS peptides can exert significant effects on primitive pluripotential HSC populations. Further studies should focus on the interactions between possible autocrine, paracrine, endocrine, and intracrine actions of the local UCB RAS and growth, engraftment, differentiation, and plasticity functions of HSC of UCB origin.

EUTOS CML prognostic scoring system predicts ELN-based ‘event-free survival’ better than Euro/Hasford and Sokal systems in CML patients receiving front-line imatinib mesylate

Abstract Objectives The validity of the three currently used chronic myeloid leukemia (CML) scoring systems (Sokal CML prognostic scoring system, Euro/Hasford CML scoring system, and the EUTOS CML prognostic scoring system) were compared in the CML patients receiving frontline imatinib mesylate. Patients and methods One hundred and fourty-three chronic phase CML patients (71 males, 72 females) taking imatinib as frontline treatment were included in the study. The median age was 44 (16–82) years. Median total and on-imatinib follow-up durations were 29 (3.8–130) months and 25 (3–125) months, respectively. Results The complete hematological response (CHR) rate at 3 months was 95%. The best cumulative complete cytogenetic response (CCyR) rate at 24 months was 79.6%. Euro/Hasford scoring system was well-correlated with both Sokal and EUTOS scores (r = 0.6, P < 0.001 and r = 0.455, P < 0.001). However, there was only a weak correlation between Sokal and EUTOS scores (r = 0.2, P = 0.03). The 5-year median estimated event-free survival for low and high EUTOS risk patients were 62.6 (25.7–99.5) and 15.3 (7.4–23.2) months, respectively (P < 0.001). This performance was better than Sokal (P = 0.3) and Euro/Hasford (P = 0.04) scoring systems. Overall survival and CCyR rates were also better predicted by the EUTOS score. Discussion EUTOS CML prognostic scoring system, which is the only prognostic system developed during the imatinib era, predicts European LeukemiaNet (ELN)-based event-free survival better than Euro/Hasford and Sokal systems in CML patients receiving frontline imatinib mesylate. This observation might have important clinical implications.

Discovering Blood Donor Arrival Patterns Using Data Mining: A Method to Investigate Service Quality at Blood Centers

Blood centers without fixed appointments for collecting blood often experience nonconstant donor arrival rates, which vary due to time-of-day, day-of-week, etc. When a constant workforce size is employed in such blood centers, there is either idle personnel, or donor satisfaction is compromised due to long waiting times, or both conditions alternate over time. Consequently, a method to obtain adaptive workforce requirements might be valuable. This study utilized the Two-Step Cluster method and the Classification and Regression Trees method in succession to identify both daily and hourly donor arrival patterns at Hacettepe University Hospitals’ Blood Center. A serial queuing network model of the donation process was then employed for each of the identified donor arrival patterns. By considering and accomodating variations in the donor arrival patterns, required workforce sizes and their decomposition among process steps were predicted to achieve predetermined target values of expected waiting times and to balance workforce utilizations in the blood donation processes. Although a blood center is considered for the proposed methodology, the approach is general and applications in various operations of healthcare organizations are possible.

Spontaneous tumor lysis syndrome in a patient with diffuse large B cell lymphoma and Richter syndrome

A 77-year-old man with a past medical history of hypertension, coronary heart disease, a cerebrovascular accident, and squamous cell lung cancer cured only by surgery 5 years ago, was admitted to our emergency department with complaints of dyspnea, fatigue, lethargy, and vague abdominal pain. When the patient was hospitalized for a cerebrovascular accident about 1 month before, he was diagnosed as having stage 1 chronic lymphocytic leukemia by lymphocytosis and enlarged peripheral lymph nodes with a greatest size of 3×2 cm, and was taken to a watch and wait program. Upon the current admission, physical examination revealed arterial blood pressure of 140/60 mmHg, heart rate of 100 bpm, respiration of 26 bpm, body temperature of 36.2°C, cervical multiple lymphadenopathies that were slightly smaller than those revealed 1 month before, marked splenomegaly, and marked peripheral edema. Fine crackles were also heard from the lung bases. Laboratory findings on the patient in due course are been depicted in Table 1. Abdominal ultrasound disclosed a 175mm splenomegaly. Many uric acid crystals were observed upon urine analysis. Since the findings were consistent with hypervolemia and acute renal failure accompanied with many electrolite disturbances, emergent hemodialysis was employed. Peripheral flow cytometric analysis revealed cluster of differentiation 3 (CD3) 1%, CD5 95%, CD19 74%, CD20 98%, CD23 15%, kappa 17%, lambda 17%, CD38 5%, FMC-7 negative, and human leukocyte antigen-DR (HLA-DR) 63%, indicating a monoclonal B cell population bearing lambda weakly on their surfaces. Cervical lymph node biopsy exhibited diffuse large B cell lymphoma. On the patient’s second day of admission, hemodialysis was repeated for anuria. On his third day of hospitalization, he developed upper gastrointestinal bleeding and hypotension. Esophagogastroduodenoscopy revealed gastroesophageal junctional erosive ulcers that were not actively bleeding. Despite the proper management, he died due to ventricular fibrillation and shock. Consent for an autopsy was refused.

Determination of burnout levels of nurses working in stem cell transplantation units in Turkey

Although burnout has been researched widely with regard to nurses working in different settings, until now it has not been investigated among stem cell transplantation unit nurses. This studys aim was to determine the burnout level of 57 nurses who were working in stem cell transplantation units in Turkey. The research instruments that were used included a form of demographic characteristics and the Maslach Burnout Inventory. For all the hematopoietic stem cell transplantation nurses, the mean subscale scores for emotional exhaustion were the highest, followed by personal accomplishment and then depersonalization. The burnout level rose with increasing age and duration on the job. Interventions to reduce burnout are needed at both the administrative and organizational levels. In addition, it is essential to address and prevent the problems that are related to burnout, especially among nurses who work in the same unit for a long time.

Renin-angiotensin system expression in the K562 human erythroleukaemic cell line:

Local renin-angiotensin system (RAS) may affect leukaemic cell production within the bone marrow microenvironment.Angiotensin-converting enzyme (ACE), renin, and angiotensin could influence leukaemogenesis. In this study, mRNA expressions of the major RAS components (ACE, renin, and angiotensinogen) in K562 human erythroleukaemia cell line have been searched by Real Time quantitative polymerase chain reaction. K562 blasts are multipotential, haematopoietic malignant cells that spontaneously differentiate into recognisable progenitors of the erythrocyte, granulocyte and monocytic series.We observed significant expressions of ACE, renin, and angiotensinogen in K562 leukaemic blast cells.Therefore, K562 human erythroleukaemia cell line may serve as an in vitro model to elucidate the role of RAS in leukaemia and to test the effects of RAS-affecting drugs on leukaemic cellular proliferation.