IntroductionCoagulation pathway changes play an important role in the outcome of both clot propagation and fibrinolysis. The structurefunction relationship of the developing fibrin clot is known to be affected by many factors, such as environment, therapy, and disease, compared with normal clot growth. 1,2 A fibrin clot's primary microstructure consists of a disordered network of entangled, branching fibrin fibers. Thinner fibers are associated with networks that display an increased number of branch points, creating denser, less permeable clots that have a known association with thromboembolic disease. [3][4][5][6] More open/permeable networks are formed from thicker fibers, the latter displaying a reduced number of branch points for a given amount of fibrinogen and producing a more porous system. [7][8][9][10] Clots with altered fibrin microstructure exhibit different susceptibility to fibrinolysis, 8,10,11 with clot permeability being the rate-limiting factor for the activity of the fibrin network degradation enzyme plasmin. The permeability will aid or hamper the ability of tissue plasmin activator, tPA, and/or urokinase plasmin activator to move through the 3-dimensional fibrin network and activate the zymogen plasminogen to fibrinolytic plasmin. The effect of anticoagulants such as heparin in the therapeutic manipulation of fibrin clot microstructure by thrombin inhibition increases clot permeability/porosity and produces clots with thicker fibers. 12,13 The evolution of clot microstructure is associated with significant changes in blood viscoelasticity (a measure of a material's viscous and elastic properties). Viscoelastic properties are among the most sensitive measures of fibrin polymerization and blood clot structure. 7,14 In the present study, we focused on the formation of the incipient clot, which provides the microstructural template that determines the future clot morphology, 15-17 by measuring the incipient clot's viscoelastic properties with an oscillatory shear technique known as Fourier transform mechanical spectroscopy (FTMS). [18][19][20] This technique provides an accurate determination of the gel point (GP) of coagulating blood and allows the microstructure of the incipient clot to be quantified by fractal analysis, a technique widely used in medicine and biology to characterize nonlinear growth in branching network structures. 21 The authors of previous studies of clot structure on the basis of techniques such as scanning electron microscopy have reported qualitative descriptions of clot microstructure (involving terms such as "rigid clot structures," "open/porous/dense/loose," etc 1 ), whereas studies of the fractal properties of fibrin gels on the basis of light-scattering techniques have been restricted to dilute solutions of fibrinogen, at concentrations less than those of physiologic relevance in whole blood. 22 A recent study of fibrin clot structure suggests there is a definitive diagnostic potential of characterizing clot structure and the modulation of clot architecture as a pos...

Chronic obstructive pulmonary disease (COPD) is associated with a continuous systemic inflammatory response. Furthermore, COPD is associated with an excess risk for cardiovascular disease and type II diabetes. Systemic inflammation in other populations is a factor in atherogenesis and has been associated with insulin resistance. We assessed the association between systemic inflammation and insulin resistance in non-hypoxaemic patients with COPD. Fasting plasma glucose, insulin and inflammatory mediators were measured in 56 patients and 29 healthy subjects. Body mass index (BMI) and height squared fat- and fat-free-mass index were similar between subject groups. Using homeostatic modelling techniques, mean (SD) insulin resistance was greater in the patients, 1.68 (2.58) and 1.13 (2.02) in healthy subjects, p=0.032. Fasting plasma insulin was increased in patients while glucose was similar to that in healthy subjects. Patients had increased circulating inflammatory mediators. Insulin resistance was related to interleukin-6 (IL-6), r=0.276, p=0.039, and tumour necrosis factor alpha soluble receptor I, r=0.351, p=0.008. Both IL-6 and BMI were predictive variables of insulin resistance r(2)=0.288, p<0.05. We demonstrated greater insulin resistance in non-hypoxaemic patients with COPD compared with healthy subjects, which was related to systemic inflammation. This relationship may indicate a contributory factor in the excess risk of cardiovascular disease and type II diabetes in COPD.

BackgroundStroke is the second largest cause of death worldwide. Hypercoagulability is a key feature in ischaemic stroke due to the development of an abnormally dense clot structure but techniques assessing the mechanics and quality of clot microstructure have limited clinical use. We have previously validated a new haemorheological technique using three parameters to reflect clot microstructure (Fractal Dimension (df)) ex-vivo, real-time clot formation time (TGP) and blood clot strength (elasticity at the gel point (G’GP)). We aimed to evaluate these novel clotting biomarkers in ischaemic stroke and changes of clot structure following therapeutic intervention.MethodsIn a prospective cohort study clot microstructure was compared in ischaemic stroke patients and a control group of healthy volunteers. Further assessment took place at 2–4 hours and at 24 hours after therapeutic intervention in the stroke group to assess the effects of thrombolysis and anti-platelet therapy.Results75 patients (mean age 72.8 years [SD 13.1]; 47 male, 28 female) with ischaemic stroke were recruited. Of the 75 patients, 32 were thrombolysed with t-PA and 43 were loaded with 300 mg aspirin. The following parameters were significantly different between patients with stroke and the 74 healthy subjects: df (1.760 ± .053 versus 1.735 ± 0.048, p = 0.003), TGP (208 ± 67 versus 231 ± 75, p = 0.05), G’GP (0.056 ± 0.017 versus 0.045 ± 0.014, p < 0.0001) and fibrinogen (3.7 ± 0.8 versus 3.2 ± 0.5, p < 0.00001). There was a significant decrease in df (p = 0.02), G’GP (p = 0.01) and fibrinogen (p = 0.01) following the administration of aspirin and for df (p = 0.003) and fibrinogen (p < 0.001) following thrombolysis as compared to baseline values.ConclusionPatients with ischaemic stroke have denser and stronger clot structure as detected by df and G’GP. The effect of thrombolysis on clot microstructure (df) was more prominent than antiplatelet therapy. Further work is needed to assess the clinical and therapeutic implications of these novel biomarkers.

SummaryVenous thromboembolism (VTE) is common in cancer patients, and is the second commonest cause of death associated with the disease. Patients with chronic inflammation, such as cancer, have been shown to have pathological clot structures with modulated mechanical properties. Fractal dimension (df) is a new technique which has been shown to act as a marker of the microstructure and mechanical properties of blood clots, and can be performed more readily than current methods such as scanning electron microscopy (SEM). We measured df in 87 consecutive patients with newly diagnosed lung cancer prior to treatment and 47 matched-controls. Mean group values were compared for all patients with lung cancer vs controls and for limited disease vs extensive disease. Results were compared with conventional markers of coagulation, fibrinolysis and SEM images. Significantly higher values of df were observed in lung cancer patients compared with controls and patients with extensive disease had higher values than those with limited disease (p< 0.05), whilst conventional markers failed to distinguish between these groups. The relationship between df of the incipient clot and mature clot microstructure was confirmed by SEM and computational modelling: higher df was associated with highly dense clots formed of smaller fibrin fibres in lung cancer patients compared to controls. This study demonstrates that df is a sensitive technique which quantifies the structure and mechanical properties of blood clots in patients with lung cancer. Our data suggests that df has the potential to identify patients with an abnormal clot micro-structure and greatest VTE risk.

Plant-derived products such as date syrup (DS) have demonstrated antibacterial activity and can inhibit bacteria through numerous different mechanisms, which may be attributed to bioactive compounds including plant-derived phenolic molecules. DS is rich in polyphenols and this study hypothesized that DS polyphenols demonstrate inherent antimicrobial activity, which cause oxidative damage. This investigation revealed that DS has a high content of total polyphenols (605 mg/100 g), and is rich in tannins (357 mg/100 g), flavonoids (40.5 mg/100 g), and flavanols (31.7 mg/100 g) that are known potent antioxidants. Furthermore, DS, and polyphenols extracted from DS, the most abundant bioactive constituent of DS are bacteriostatic to both Gram positive and Gram negative Escherichia coli and Staphylococcus aureus, respectively. It has further been shown that the extracted polyphenols independently suppress the growth of bacteria at minimum inhibitory concentration (MIC) of 30 and 20 mg/mL for E. coli and S. aureus, and have observed that DS behaves as a prooxidant by generating hydrogen peroxide that mediates bacterial growth inhibition as a result of oxidative stress. At sub-lethal MIC concentrations DS demonstrated antioxidative activity by reducing hydrogen peroxide, and at lethal concentrations DS demonstrated prooxidant activity that inhibited the growth of E. coli and S. aureus. The high sugar content naturally present in DS did not significantly contribute to this effect. These findings highlight that DS’s antimicrobial activity is mediated through hydrogen peroxide generation in inducing oxidative stress in bacteria.