We studied 37 patients in order to evaluate the heparin-neutralizing efficacy of the protamine dose calculated by either the fixed dose method or the dose response curve method on the activated coagulation time(ACT) during open heart surgery. According to the method calculating the protamine dose, the patients were randomly allocated to receive the protamine dose calculated by either the fixed dose method(N=17) or the dose response curve method(N= 20). The ACT was measured at immediately after sternotomy(baseline ACT) and 5 minutes after protamine administration(post-protamine ACT). There were no significant differences in baseline ACT or post-protamine ACT values between the two groups. The baseline ACT values in each group were not significantly different from those of post-protamine ACT. The patient numbers of post-protamine ACT values over 130 seconds and the differences from baseline ACT to post-protamine ACT were not significantly different between both groups. The results suggest the a dose of protamine sulfate calculated by a fixed dose method instead of a dose response curve method is available for neutralizing a heparin effect during open heart surgery.
Heparin ; Humans ; Protamines* ; Thoracic Surgery

Fatal anaphylactic reactions to protamine sulfate during cardiac surgery are very rare. We report a case of catastrophic bronchial spasm due to an anaphylactic reaction to protamine. The patient was managed successfully using a bronchodilator, steroid treatment, and extracorporeal membrane oxygenation.
Anaphylaxis* ; Bronchial Spasm* ; Extracorporeal Membrane Oxygenation ; Humans ; Protamines ; Thoracic Surgery

Systemic hypotension is commonly observed in association with the administration of protamine after cardiopulmonary bypass. To elucidate the circulatory changes and arterial blood gas changes of protamine sulfate administration, we studied 27 patients following cardiopulmonary bypass. In the intraaortic protamine administration group (N=5), the mean arterial pressure decreased significantly (p<0.05) in 5 minutes during protamine infusion and after protamine, infusion respectively. Heart rate, central venous pressure and blood gas analysis did not change significantly. In intravenous protamine administration group (N=22), the arterial oxygen tension increased significantly(p<0.05 %amp; p<0.01) in 10 minutes during protamine infusion and after protamine infusion respectively. There were no special changes when the more than 0.3mg/kg/min rate of protamine was injected but the mean arterial pressure decreased significantly(p<0.05) in 5 minutes during the protamine infusion. Mean arterial pressure, heart rate, central venous pressure and blood gas analysis did not change in the less than 0.3mg/kg/min rate of protamine was injected. There were no circulatory changes in the less than one hour CPB time group but the arterial oxygen tension increased significantly in 5 minutes and 10 minutes during the protamine infusion and after the protamine infusion. But in the more than one hour CBP time group, the mean arterial pressure decreased significantly in 10 minutes during the protamine infusion and after protamine infusion.
Arterial Pressure ; Blood Gas Analysis* ; Cardiopulmonary Bypass* ; Central Venous Pressure ; Heart Rate ; Humans ; Hypotension ; Oxygen ; Protamines

Anaphylactic reaction to protamine sulfate, which is used widely to reverse the anticoagulative effect of heparin after cardiopulmonary bypass, is very rare. But the result of anaphylactic reaction can be very fatal and the mechanism of it is still not clear. We report a case of severe anaphylactic reaction to protamine sulfate following the replacement of the mitral valve and Maze procedure using microwave in a non-diabetic 57-year-old female patient.
Anaphylaxis* ; Cardiopulmonary Bypass* ; Female ; Heparin ; Humans ; Microwaves ; Middle Aged ; Mitral Valve ; Protamines

BACKGROUND: Protamine sulfate (PS), used to neutralize the effect of heparin, is often associated with systemic hypotension. The present study was aimed to investigate the protective effects of CaCl2 on adverse hemodynamic reaction to PS. METHODS: Forty-six dogs of three groups were studied. Animals were randomly allocated to receive either; saline 10 ml (controls, n = 26), CaCl2 5 mg/kg (n = 10) or 10 mg/kg (n = 10), added to PS 3 mg/kg given intravenously 5 min after heparin (300 IU/kg, iv). Mean aortic pressure (MAP), mean pulmonary arterial pressure (MPAP), left ventricular end-diastolic pressure (LVEDP), LVdP/dtmax, and -LVdP/dtmin, and pulmonary artery (cardiac output) and left circumflex blood flow (LCX flow) were recorded up to 15 min after PS. RESULTS: PS caused significant reductions in MAP (-49%), cardiac index (CI, -66%), systemic vascular resistance index (SVRI, -22%), LVEDP (-67%), LVdP/dtmax (-36%), and LVdP/dtmin (-55%), but increased MPAP (39%) and PVRI (3.8 fold), which all increases and reductions peaked 1-3 min after PS injection in the control group. The addition of CaCl2 to PS significantly attenuated reductions of MAP (-35 and -26% in CaCl2 5 and 10 mg/kg treated dogs, respectively), CI (-34 and -37%), LVdP/dtmax (-14, -11% ), and -LVdP/dtmin (-34, -21%), and increases in PVRI (1.8 and 2.4 fold). However, both doses of CaCl2 increased MPAP (48, 82%), but not SVRI (-28, -21%) or LVEDP (-73, -75%). LCX flow increased similarly in all groups (75-137%). CaCl2 5 and 10 mg/kg iv increased plasma Ca2+ by 0.23 and 0.36 mM, respectively. CONCLUSIONS: These results suggest that the simultaneous administration of CaCl2 attenuates the adverse hemodynamic effects of PS, used to reverse heparin anticoagulation in the dog.
Animals ; Arterial Pressure ; Calcium Chloride* ; Calcium* ; Dogs* ; Hemodynamics* ; Heparin ; Hypotension ; Plasma ; Protamines* ; Pulmonary Artery ; Vascular Resistance

BACKGROUND: Aprotinin is a potent, nonspecific broad serine protease inhibitor. It's inhibitory effects on intrinsic pathway of coagulation cascade can augment anticoagulation by heparin. This study designed to demonstrate augmented anticoagulation of aprotinin to heparin contaminated blood on thromboelastography(TEG). METHODS: This study designed into two phases for 21 healthy volunteers undergoing elective opeation. The first phase study, it was for looking at TEG differences between blood treated with aprotinin 200 KIU and blood treated with heparin 0.05 unit and 0.1 unit per blood 1 ml. The second phase study was for looking at anticoagulation of aprotinin added by heparin 0.05 unit and 0.1 unit per blood 1 ml and their reversal added by optimal dose of protamine sulfate. RESULTS: The aprotinin treated blood showed only a prolonged reaction time. Blood treated with incremental dose of heparin showed longer reaction time and smaller alpha angle than TEGs of native blood. Aprotinin added to the heparin contaminated blood showed much longer reaction time and much less alpha angle when compared with TEGs of aprotinin or heparin treated blood. Depressed TEG pattern by the heparin and aprotinin mixture reversed back to the TEGs of blood treated with aprotinin when optimal dose of protamine added. CONCLUSIONS: Those results suggest that aprotinin administered in open cardiac surgery can augment the remained anticoagulation effect due to heparin even after first dose fo protamine after weaning of cardiopulmonary bypass. This is of clinically improtance to distinguish heparin related coagulopathy from heparin non related coagulopathy by thromboelastography.
Aprotinin* ; Cardiopulmonary Bypass ; Healthy Volunteers ; Heparin* ; Protamines ; Reaction Time ; Serine Proteases ; Thoracic Surgery ; Thrombelastography* ; Weaning

OBJECTIVE: Many cases of fertilization failure after ICSI is attributed to decondensation defect of sperm head, therefore, selection of sperm with well-condensed, fully-matured nucleus is critical for successful fertilization. During mammalian spermiogenesis, replacement of the somatic histones by protamines allows normal sperm nuclear condensation. The degree of condensation can be shown with the aid of acidic aniline blue staining, which is able to discriminate between lysine-rich histones and arginine- or cysteine-rich protamines. The objective of this study was to investigate the possible relation between nuclear maturity of human sperm and hypo-osmotic swelling patterns. Hypo-osmotic swelling test is very simple and convenient test to measure functional integrity of human sperm membrane, and each already tested sperms can be used for fertilization. METHODS: For assessment of sperm nuclear maturity, aniline blue staining was performed on the slides, already undergone hypo-osmotic swelling test in 5 subfertile patients with abnormal semen parameters and 8 fertile donors. After 3 hours swim-up, these procedures were repeated in each cases. RESULTS: Sperms with negative aniline blue were significantly increased after swim-up in each group. There was a significant increase in the proportion of negative aniline blue in sperms with swelling patterns(e+f+g) compared to sperms with non-swelling patterns(a), except swim-up group in subfertile patients. CONCLUSION: Choosing the swelling patterns, rather than non-swelling sperms after hypo-osmotic test may be beneficial for the selection of sperms with well-condensed, mature nucleus and intact membrane.
Fertilization ; Histones ; Humans ; Membranes ; Protamines ; Semen ; Sperm Head ; Sperm Injections, Intracytoplasmic ; Spermatogenesis ; Spermatozoa* ; Tissue Donors

OBJECTIVETo study the significance of the change of protamine content in the management of male infertility.

METHODSSperm nuclear proteins extracted from 199 infertile patients were analyzed by polyacrylamide gel-electrophoresis and scanning microdensitometry.

RESULTSForty-two (21%) cases of the total number had normal sperm nuclear proteins and 157 (79%) had aberrant ones, which mainly presented the interruption of HPRR and abnormality of P2 protamine. Thirty patients were selected at random from 157 abnormal cases for clinical treatment. After the treatment, the sperm nuclear proteins were extracted and analyzed and the results demonstrated that 11 cases (36.6%) improved markedly, 5 (16.6%) restored to normal and the other 16 (46.6%) remained unchanged.

CONCLUSIONThere is a reduced level or selective absence or even complete selective absence of protamines in infertile patients. Protamines may act as a parameter for evaluating the treatment effect of infertile males and protamine content can be influenced by a certain or several factors.

Adult ; Electrophoresis, Polyacrylamide Gel ; Humans ; Infertility, Male ; metabolism ; Male ; Oligospermia ; metabolism ; Protamines ; analysis ; Spermatozoa ; chemistry

PURPOSE: To determine the optimal combination of commercially available superparamagnetic iron oxide (SPIO) nanoparticles with transfection agents (TA). MATERIALS AND METHODS: Protamine sulfate (Pro) and poly-L-lysin (PLL) were incubated with ferumoxide and ferucarbotran in human mesenchymal stem cells at various concentrations, and cellular viability were evaluated. Cellular iron uptake was qualitatively and quantitatively evaluated. Cell visibility was assessed via MR imaging and the T2-relaxation time was calculated. RESULTS: The cellular viabilities with ferucarbotran were more significantly decreased than those with ferumoxide (p < 0.05). Iron uptake with ferumoxide was significantly higher than that for those with with ferucarbotran. The T2-relaxation time was observed to be shorter with ferumoxide in comparison to those with ferucarbotran (p < 0.05). Ferumoxide at a concentration of 25 microg/ml in combination with either Pro or PLL at a concentration of 3.0 microg/ml did not adversely impact cell viability, maximized iron uptake, and exhibited a lower T2-relaxation time in comparison to other combinations. CONCLUSION: Stem cells with ferumoxide exhibited a higher cellular viability and iron uptake in comparison to ferucarbotran- treated stem cells. A 25 microg/ml of ferumoxide with a 3.0 microg/ml of TA is sufficient to label mesenchymal stem cells.
Cell Survival ; Contrast Media ; Dextrans ; Ferric Compounds ; Humans ; Iron ; Magnetite Nanoparticles ; Mesenchymal Stromal Cells ; Nanoparticles ; Protamines ; Stem Cells ; Transfection

OBJECTIVETo establish a modified plasma protamine paracoagulation test.

METHODSPlasma protamine paracoagulation, modified plasma protamine paracoagulation and D-dimer (D-D) tests were performed for the plasma samples collected from 98 cases of disseminated intravascular coagulation (DIC) and 156 normal subjects. The sensitivity and specificity of the 3 tests were analyzed. The plasma samples from 8 cases of suspected myocardial infarction were detected using modified plasma protamine paracoagulation for diagnostic purpose.

RESULTSThe sensitivity of plasma protamine paracoagulation, modified plasma protamine paracoagulation and D-D tests was 16.33%, 88.76% and 77.56%, and the specificity was 100%, 88.46% and 97.44%, respectively. Positive results occurred earlier in modified plasma protamine paracoagulation test than in plasma protamine paracoagulation and D-D tests in 5 cases of myocardial infarction.

CONCLUSIONThe modified plasma protamine paracoagulation test has a higher sensitivity than plasma protamine paracoagulation test and a higher specificity than D-D test, and can be helpful in early diagnosis of thrombosis and fibrinolysis.

Adult ; Blood Coagulation Tests ; methods ; Female ; Humans ; Male ; Middle Aged ; Protamines ; blood ; Sensitivity and Specificity ; Thrombosis ; blood ; diagnosis