Correlation between multiphase CT angiography, serum lipid peroxidation and thrombus precursor protein levels and recurrence of acute cerebral infarction in older adults / 中国基层医药

Objective:To correlate multiphase CT angiography (mCTA), serum lipid peroxidation (LPO) and thrombus precursor protein (TpP) levels with recurrence of acute cerebral infarction (ACI) in older adults and investigate the value of these indicators in the predication of ACI recurrence.Methods:A total of 128 older adult patients with ACI who received treatment in Ningbo Medical Center Lihuili Hospital, China between January 2019 and January 2020 were included in this study. All of them were followed up for 1 year. They were divided into ACI recurrence group ( n = 29) and no ACI recurrence group ( n = 99) according to whether they had recurrent cerebral infarction. All patients underwent mCTA. Maas system and Tan score were used according to mCTA images. Serum TpP level was measured using enzyme-linked immunosorbent assay. Serum LPO level was measured using Yagi's fluorescence method. Multiple linear regression analysis was used for correlation analysis. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of mCTA and serum LPO and TpP levels in the diagnosis of ACI. Results:Tan score in the ACI recurrence group was significantly lower than that in the no ACI recurrence group [(1.06 ± 0.26) points vs. (1.89 ± 0.82) points, t = 5.35, P < 0.05]. Serum TpP and LPO levels in the ACI recurrence group were (7.22 ± 1.35) mmol/L and (11.23 ± 2.58) nmol/mL, respectively, which were significantly higher than those in the no ACI recurrence group [(3.06 ± 0.28) mmol/L, (7.23 ± 0.37) nmol/mL, t = 28.86, 15.04, both P < 0.001]. ACI recurrence in older adult patients was correlated with Tan score and serum LPO and TpP levels (both P < 0.05). The sensitivity of mCTA combined with serum LPO and TpP levels in the diagnosis of ACI in older adults was 93.10%-96.60% and its specificity was 100.00%. The ROC curve analysis showed that the area under the ROC of mCTA, LPO and TpP in the prediction of ACI recurrence in older adults was 0.986 (95% CI = 0.966-1.000), 0.976 (95% CI = 0.930-1.000) and 0.968 (95% CI = 0.905-1.000), respectively. Conclusion:ACI recurrence in older adults is correlated with Tan score and serum LPO and TpP levels. mCTA, Tan score, and serum LPO and TpP levels have high sensitivity and specificity in the diagnosis of ACI recurrence in older adults, and therefore have a high diagnostic value.

Economic Evaluation of Dexamethasone Combined with Rituximab for the First-line Treatment of Chronic Primary Immune Thrombocytopenia in Adults / 中国药房

OBJECTIVE：To evaluate the economy performance of dexamethasone （DXM）combined with rituximab （RTX） for the first-line treatment of chronic primary immune thrombocytopenia （ITP）in adults. METHODS ：From the perspective of China ’s medical and health system ，Markov model for eight states was constructed with a period of 4 weeks and a time limit of 20 years， using DXM regimen as control. The cost-utility of DXM+RTX regimen for the treatment of chronic ITP in adults were evaluated. The parameters of clinical efficacy and utility value were derived from own published literature ；cost parameters were from the MENET website and the official websites of local health committees and medical insurance bureaus ；one-way sensitivity analysis ， probability sensitivity analysis and scenario analysis were performed to observe the uncertainty of model and data source. RESULTS：The average cost of DXM+RTX regimen was 51 064 dollars and that of DXM regimen was 50 455 dollars. Compared with DXM regimen ，DXM+RTX regimen yielded an additional 0.14 QALYs for each patient ；the incremental cost-effectiveness ratio（ICER）was 4 356 dollars/QALY，and was lower than the willingness-to-pay threshold of China ’s per capita gross domestic product（GDP）in 2020. In the one-way sensitivity analysis ，the cost of drugs was the main driver in the model. Probability sensitivity analysis demonstrated that DXM+RTX regimen had 57.5％-61.0％ probability of being cost-effective at a willingness- to-pay threshold of 1-3 times per capita GDP in 2020. The results of scenario analysis showed that DXM+RTX regimen would have obvious long-term benefits ，and the utility value had little impact on the conclusion. CONCLUSIONS ：DXM + RTX is more economical than DXM in the treatment of chronic ITP in adults ，but the results have the uncertainty.

Analysis of related factors of deep venous thrombosis in upper extremity after PICC catheterization / 中国基层医药

Objective To investigate the related risk factors of upper extremity deep venous thrombosis associated with peripherally inserted central catheter ( PICC). Methods From January 2014 to February 2018, 300 patients with PICC in the No. 117 Hospital of the Chinese People's Liberation Army were selected in the study,of whom 30 patients developed deep venous thrombosis(thrombosis group),the other 270 patients had no deep venous thrombosis( non-thrombotic group) . General data of the patients ( gender,age,body mass index) ,catheter technical parameters(number of punctures,length of catheter,position of catheter tip),retention vessel index(inner side of catheter,indwelling vein, internal diameter of catheter ) , past history ( history of hypertension, history of diabetes, history of oncology,history of cancer chemotherapy,history of smoking,history of blood clots,history of PICC,or CVP insertion),and laboratory tests(platelet count,plasma D - dimer,plasma fibrin original,prothrombin time) were collected. Univariate analysis was used to find out the differences between the thrombosis group and the non-throm-bosis group. Logistic regression analysis was used to identify the risk factors for deep vein thrombosis of the upper extremities after PICC catheterization. Results Univariate analysis showed that variables that differed between the thrombus group and the non-thrombosis group included catheter tip location,diameter of the cannulated vein,history of cancer,history of chemotherapy,plasma D -dimer (χ2 =4. 556,10. 973,11. 940,5. 357,11. 623,P =0. 033, 0. 001,0. 001,0. 021,0. 001). Multivariate Logistic regression analysis showed that the risk factors of upper extremity deep venous thrombosis after PICC catheterization were catheter tip placement on the upper vena cava 2/3,catheter vein diameter<4mm,tumor history and chemotherapy history(P=0. 014,0. 023,0. 017,0. 028). Conclusion The risk factors of upper extremity deep venous thrombosis after PICC catheterization are catheter tip placed on the upper 2/3 of the superior vena cava,diameter of the catheter vein<4 mm,tumor history and chemotherapy history.

Clinical applicacation of ultrasound-guided abdomen nerve block combined with remifentanil infusion in cesarean section in patients with thrombocytopenia / 临床麻醉学杂志

Objective To observe the effect of ultrasound-guided abdomen nerve block combined with remifentanil infusion in cesarean section in patients with thrombocytopenia. Methods Sixty parturients recruited for the first cesarean delivery with thrombocytopenia (Plt<7.0 ×109/L),aged 20-32 years,in ASA physical status Ⅰ or Ⅱ,having no preterm birth and no fetal distress before surgery,were randomly divided into two groups:transversus abdominis plane block, ilioinguinal-iliohypogastric nerve block combined with remifentanil group (group T)and general anes-thesia group (group G).Both groups received patient-controlled intravenous analgesia (PCIA)after cesarean delivery;the delivery time from the cut to the fetus,Apgar score after delivery of the fetus, hemodynamics of the two groups of patients before surgery (T1 ),immediate cut (T2 )and fetal deliv-ery (T3 )and 48 h postoperative analgesic satisfaction were recorded and compared between the two groups.Results Compared with group G,the delivery time from the cut to the fetus was extended in group T (P < 0.05 ),but the fetus were removed within 6 minutes in the two groups.The Apgar score of 1 min after birth of newborns was significantly higher in group T than that in group G (P <0.05).Compared with group G,the blood pressure and the heart rate had increased at T3 in group T (P <0.05 ),but the parturients did not appear obvious symptoms.Compared with group G,the number of successfully delivered doses within 48 h were significantly lower in group T (P <0.05 ), TAP guided by sonography had excellent effect.Conclusion Ultrasound-guided abdomen nerve block combined with remifentanil infusion in cesarean section has little effect on neonatal,similar anesthesia effect to general anesthesia and obvious postoperative analgesia.

Role of α2-macroglobulins and a disintegrin and metallo-proteinase with throm-bospondin motifs in pathogenesis of osteoarthritis:a review / 中华地方病学杂志

Osteoarthritis is a chronic disabling disease that tends to occur in middle-aged and elderly population, the main pathological characteristics are the dynamic imbalance between the synthesis and degradation of articular chondrocytes, extracellular matrix and subchondral bone. The occurrence and development is related to many factors. This article reviews the structure, the function and the interaction between α2-macroglobulins and a disintegrin and metallo-proteinase with throm-bospondin motifs in the development of osteoarthritis.

Changes and significance of B cell specific monoclonal murine leukemia virus integration site -1 and helper T cell-related cytokine in children with immune thrombocytopenia / 中华实用儿科临床杂志

Objective To analyze the functional changes and the clinical significance of B cell specific mono-clonal murine leukemia virus integration site -1 (Bmi -1 )and Th1 /Th2 cells in children with newly diagnosed im-mune thrombocytopenia(ITP)by testing the mRNA expressions of Bmi -1,helper T cell -related cytokine interferon (IFN)-γand interleukin(IL)-4 in children with newly diagnosed ITP.Methods Thirty -six cases of patients with newly diagnosed ITP in the experimental group came from the inpatient and outpatient children admitted to the Depart-ment of Pediatrics of the First Affiliated Hospital of Xinxiang Medical University from April to December 201 3.In the control group,26 cases of children requiring selective operation were admitted to the Department of Pediatric Surgery during the same period.The mRNA expressions of Bmi -1,IFN -γand IL -4 in the peripheral blood lymphocytes were detected by means of the reverse transcription -polymerase chain reaction(RT -PCR)method,and were analyzed and compared by t test and linear correlation analysis.Results (1 )The mRNA expressions of Bmi -1,IFN -γand IL -4 in peripheral blood lymphocytes in the experimental group were 2.63 ±0.54,3.84 ±0.43 and 1 .44 ±0.39,respec-tively;while the mRNA expressions of Bmi -1,IFN -γand IL -4 in the peripheral blood lymphocytes in the control group were 3.91 ±0.92,2.88 ±0.57 and 1 .87 ±0.34,respectively.The levels of IFN -γof the experimental group were significantly higher than those of the control group (P 0.05).Conclusions Bmi -1 may be involved in the pathogenesis of ITP by regulating Th cell, and Th cell dysfunction may occur in the children with ITP,and the disproportion between Th1 and Th2 may be due to the advantages of Th1 .

Prognosis Effect of Shengmai Injection to the rt-PA Thrombolysis on Broadened Therapeutic Window Pa-tients of Mild-to-moderate Cerebral Infarction / 中国药房

OBJECTIVE:To explore the prognosis effect of Shengmai injection to the rt-PA thrombolysis on broadened thera-peutic window patients of mild-to-moderate cerebral infarction under the guidance of computer tomography(CT). METHODS:168 patients with mild-to-moderate cerebral infarction were randomly divided into control group (84 cases) and observation group (84 cases). Control group received rt-PA(0.9 mg/kg),and 10% of the total rt-PA was mixed and injected into patients within 1 min, the rest 90% adding into 250 ml 0.9% Sodium chloride injection (no less than 1 h),CT was performed after 24 h thrombolytic therapy,and the patients with no intracerebral hemorrhage in re-examination received 300 mg/d aspirin for 10 d,then 100 mg/d for 90 d,and appropriate statins,calcium antagonists,β-blockers and nitrates;observation group additionally received 40 ml Sheng-mai injection,adding into 250 ml 5% Glucose injection,intravenous infusion,once a day,for 28 d. National Institutes of Health Stroke Scale (NIHSS) score,Rankin score,daily living-Barthel Index (Barthel) score,rate of symptomatic intracranial hemor-rhage,rate of secondary hemorrhage,hospitalization time,3-month postoperative mortality and incidence of adverse reactions in 2 groups were observed. RESULTS:Before treatment,there were no significant differences in the NIHSS score,Rankin score and Barthel score(P>0.05). The NIHSS score in 2 groups after 6 h,24 h and 7 d were significantly lower than before,and observa-tion group was lower than control group after 24 h and 7 d;Rankin score after 3 months was significantly lower than before,and observation group was lower than control group;Barthel score after 3 months was significantly higher than before,and observation group was higher than control group,The differences were statistically significant (P<0.05). The hospitalization time in observa-tion group was significantly shorter than in control group,and 3-month postoperative mortality was significantly lower than control group,the differences were statistically significant(P<0.05). There were no obvious adverse reactions during treatment. CONCLU-SIONS:Based on conventional treatment,Shengmai injection has improvement in the rt-PA intravenous thrombolysis on broadened therapeutic window patients of mild-to-moderate cerebral infarction under the guidance of CT,it can reduce NIHSS score and Rankin score,increase Barthel score,shorten hospitalization time and reduce the 3-month postoperative mortality,with good safety.

Manejo obstétrico de la deficiencia hereditaria de antitrombina durante el embarazo y puerperio. Dos casos clínicos / Obstetric management of hereditary antithrombin deficiency in pregnancy and postpartum. Two case studies

La deficiencia de antitrombina III hereditaria es una rara enfermedad que afecta al 0.02-0.2 por cento de la población. Puede presentar mayor frecuencia de complicaciones y resultados adversos tanto en la madre como en el feto. Se presenta el manejo obstétrico de dos gestaciones consecutivas en una mujer con deficiencia de antitrombina III. Descripción: en ambos embarazos la madre realiza profilaxis de la enfermedad tromboembólica con heparina de bajo peso molecular para evitar la aparición de esta patología tanto en el embarazo como en el puerperio y mejorar el flujo útero-placen-tario. Con respecto a las complicaciones obstétricas, sólo existe un enlentecimiento del crecimiento fetal que obliga a un control obstétrico estricto. En ambas gestaciones los estudios eco-Doppler están dentro de la normalidad lo que permite una conducta expectante, consiguiendo llegar a término. Discusión: la profilaxis con heparina de bajo peso molecular en las gestantes con esta trombofilia y las intervenciones preventivas de factores de riesgo de enfermedad tromboembólica, junto con un control obstétrico adecuado, ha conseguido evitar la apari-ción de complicaciones derivadas de esta patología en el embarazo y en el puerperio. Por otra parte, el control del crecimiento fetal y el estudio Eco-Doppler han permitido asegurar el bienestar fetal no adelan-tando el parto, consiguiendo partos a término...

Hereditary antithrombin III deficiency is a rare disease that affects 0.02-0.2 percent of the population. It may be associated with a higher rate of complications and adverse outcomes in both mother and fetus. The present study describes the management of a woman with antithrombin III deficiency and two consecutive pregnancies. Description: in both pregnancies, the woman under went prophylaxis with low molecular weigh heparin, to prevent thromboembolic disease and improve the utero-placental flow during pregnancy and the postpartum period. The only obstetric compli-cation was fetal growth retardation requiring strict obstetric control. In these two cases the eco-Doppler studies offeto-placentalflow were normal, leading to the expectation of managing a term birth. Discussion: low molecular weigh heparin prophylaxis in pregnant women with thrombophilia and preventive interventions for risk factors for throm-boembolic disease, together with appropriate obstetric care managed to avoid the emergence of complications of this disease in pregnancy and puer-perium. Fetal growth control and a Doppler study also help to ensure the well-being of the fetus and avoid a preterm birth...

Forensic Analysis of 33 Cases of Fatal Pulmonary Thromboembolism / 法医学杂志

Objective To explore the related risk facts of pulm onary throm boem bolism (PTE ) and analyze the relation betw een PTE and the traum a or m edical behavior by investigating the cases of PTE . Methods Thirty-three cases w ere selected from Institute of Forensic Science (IFS) from 2000 to 2014. Results In 33 cases, 16 decedents w ere m ale, 17 decedents w ere fem ale;different degrees of dyspnea, chest tight-ness and syncope sym ptom s w ere the clinical m anifestation of the deceased; the throm bus w as mainly distributed in the left and right pulm onary arteries. The main source of em bolism w as the deep vein of low er lim b and the left probability w as higher. Traum a, lim ited position, operation and cardiovascular disease show ed high-risk factors of PTE; D-D im er test, hem olytic test and com puter tom ography pul-m onary angiography w ere the diagnostic tools for PTE . In som e cases, traum a and m edical m alpractice could be involved in the cause of death. Conclusion N on-typical clinical sym ptom s present in the m ost cases caused by PTE , and these cases alw ays show m any high-risk factors. The relation betw een PTE and injury or m edical behavior should be considered carefully in the forensic pathological practice.

Injection of tissue plasminogen activator into the optic nerve in an animal model of retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the feasibility and efficacy of tissue plasminogen activator (tPA) injection into the optic nerve as a treatment for retinal vein occlusion in rabbits. METHODS: Rose Bengal-mediated laser-induced retinal vein occlusions were produced in rabbit eyes. Fluorescein angiography (FA) was performed on each eye 3 days before laser irradiation and 30 minutes after laser irradiation.The treatment group (n=20 veins) received intra-optic nerve injection of tPA (12.5μg in 0.05mL BSS) and the controls (n=24 veins) received 0.05mL BSS. FA was repeated to determine the recanalization of the vessel at 3 and 7 days after treatment, followed by histological examination.RESULTS: Rose Bengal-mediated laser-induced retinal vein occlusions were successfully developed and confirmed by FA. The incidence of the recanalization of the vessels in treatment animals was 70.0%, while 16.7% in the control animals (P=0.001). CONCLUSION: Intra-optic nerve tPA injection increased the incidence of recanalization of the occluded vessels. Although further studies are needed, our data suggested that injection of tPA into the optic nerve may have a potential benefit in the treatment of central retinal vein occlusion.

Report of 3 Cases of Chronic Myelogenous Leukemia with Thrombocythemic Onset / 대한진단검사의학회지

BACKGROUND: Differential diagnosis may be difficult between essential thrombocythemia (ET) and chronic myelogenous leukemia (CML) with marked thrombocytosis, mild leukocytosis, and a few immature myeloid cells in peripheral blood at onset. The aim of the present study was to analyze clinical, hematologic, and molecular features of patients with CML, mimicking ET. METHODS: Among patients from Ewha and Gachon Gil Medical Center between January 1990 and June 2001, our study group included 3 patients with Ph-positive CML with marked thrombocy-tosis (>600 X 10(9)/L) and mild leukocytosis (<20 X 10(9)/L) and 12 patients of the typical ET as a con-trol group. RESULTS: Peripheral blood basophilia (4 - 12%) and a few immature granulocytes (1 - 9%) were the characteristic features of CML with thrombocythemic onset, compared with the typical ET. There was no evidence of bone marrow eosinophilia, basophilia, or fibrosis in CML with thrombocythemic onset. CONCLUSIONS: Our study suggests that peripheral basophilia as well as the positivity of Ph chromo-somes or bcr/abl gene rearrangement can be a clue to diagnosis of CML.

Study on Extraction Technique of Whitmania Pigra Whiman / 中国药房

OBJECTIVE:To select an optimal extraction technique of Whitmania pigra whiman.METHODS:The af?fecting factors such as variety of solvent,temperature,time,the amount of solvent and the frequency of the extraction were studied on the basis of protein content in the hirudo extract and activated partial thromboplastin time(APTT).RESULTS:The optimum extraction result was obtained in4%NaCl solvent of10-fold as much as the medicine with3times of extraction at60℃for6h((3h+2h+1h).CONCLUSION:The present technique is simple,scientific and practicable.