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Transcription Factors02:16

Transcription Factors

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Tissue-specific transcription factors contribute to diverse cellular functions in mammals. For example, the gene for beta globin, a major component of hemoglobin, is present in all cells of the body. However, it is only expressed in red blood cells because the transcription factors that can bind to the promoter sequences of the beta globin gene are only expressed in these cells. Tissue-specific transcription factors also ensure that mutations in these factors may impair only the function of...
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Factors Affecting Activity Coefficient01:17

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The extended Debye-Hückel equation indicates that the activity coefficient of an ion in an aqueous solution at 25°C depends on three partially interdependent properties: the ionic strength of the solution, the charge of the ion, and the ion size. 
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Complexation Equilibria: Factors Influencing Stability of Complexes01:09

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In complexation reactions, metal cations are the electron pair acceptors, and the ligands are the electron pair donors. The stability of the metal complexes depends primarily on the complexing ability of the central metal ion and the nature of the ligands. Generally, the complexing ability of the metal ion depends on the size and charge of the ion. As the metal ion size increases, the stability of the metal complexes decreases, provided that the valency of the metal ion and the ligands remain...
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Transcription Elongation Factors02:35

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Transcription elongation is a dynamic process that alters depending upon the sequence heterogeneity of the DNA being transcribed. Hence, it is not surprising that the elongation complex's composition also varies along the way while transcribing a gene.
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Factors Affecting Solubility04:01

Factors Affecting Solubility

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Compared with pure water, the solubility of an ionic compound is less in aqueous solutions containing a common ion (one also produced by dissolution of the ionic compound). This is an example of a phenomenon known as the common ion effect, which is a consequence of the law of mass action that may be explained using Le Chȃtelier’s principle. Consider the dissolution of silver iodide:
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Factors Affecting Drug Distribution: Miscellaneous Factors01:19

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Drug distribution in the human body is a complex process influenced by various individual factors, including age, pregnancy, obesity, diet, body water composition, pH levels, and specific disease conditions.
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Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay
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Activated Factor 7 Versus 4-Factor Prothrombin Complex Concentrate for Critical Bleeding Post-Cardiac Surgery.

Sarah L Mehringer1, Zachary Klick2, Jonathan Bain1

  • 11 TriStar Centennial Medical Center, Nashville, TN, USA.

The Annals of Pharmacotherapy
|January 16, 2018
PubMed
Summary

Four-factor prothrombin complex concentrate (4-factor PCC) and activated factor seven (rFVIIa) show similar efficacy for managing critical bleeding after cardiac surgery. Neither agent demonstrated a significant difference in chest tube output or bleeding complications.

Keywords:
PCCactivated factor 7bleedingcardiac surgerythrombocytopenia

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Area of Science:

  • Cardiology
  • Hematology
  • Surgical Innovation

Background:

  • Off-label use of recombinant and plasma-derived factor products like activated factor seven (rFVIIa) and four-factor prothrombin complex concentrate (4-factor PCC) is common for post-cardiac surgery bleeding.
  • Limited evidence exists on the comparative efficacy and safety of these agents in this critical patient population.

Purpose of the Study:

  • To compare the efficacy of 4-factor PCC versus rFVIIa in reducing chest tube output for patients experiencing critical bleeding after cardiovascular surgery.
  • To evaluate secondary outcomes including bleeding, thromboembolic events, and re-exploration rates.

Main Methods:

  • Retrospective chart review of adult patients undergoing cardiac surgery with significant bleeding between April 2015 and December 2016.
  • Inclusion criteria specified perioperative or postoperative administration of either 4-factor PCC or rFVIIa, excluding patients who received both agents or for other indications.
  • Chest tube output at 24 hours postoperatively served as the primary efficacy endpoint.

Main Results:

  • No significant difference was observed in 24-hour chest tube output between patients treated with 4-factor PCC and those treated with rFVIIa.
  • Bleeding, thromboembolic events, and re-exploration rates were comparable between the two treatment groups.
  • Differences were noted in the units of fresh frozen plasma administered and the overall hospital length of stay.

Conclusions:

  • Four-factor PCC presents a potentially equally efficacious alternative to rFVIIa for managing significant bleeding in cardiac surgery patients.
  • The study supports the use of 4-factor PCC as a comparable treatment option based on similar bleeding outcomes and chest tube output.