Diagnostic value of D-dimer combined with echocardiography and vascular ultrasonography of lower extremity in pulmonary thromboembolism / 上海交通大学学报（医学版）

Objective: To analyze and evaluate the diagnostic value of plasma D-dimer combined with echocardiography and lower extremity vascular ultrasound for pulmonary thromboembolism (PTE). Methods: The clinical data of 140 clinically suspected PTE patients admitted to Department of Respiratory and Critical Care Medicine, Ruijin Hospital between January 2012 and December 2016 were retrospectively analyzed. Based on the results of computed tomographic pulmonary angiography (CTPA), all included patients were divided into CTPA negative group (non-PTE group) and CTPA positive group (PTE group). The univariate and multivariate analyses were used to compare and evaluate the diagnostic and predictive efficacy of plasma D-dimer combined with echocardiography and lower extremity vascular ultrasound for PTE. Results: There was no significant difference in gender, age, smoking, underlying diseases (malignancy, hypertension, coronary heart disease, dyslipidemia, and chronic obstructive pulmonary disease) and surgical history within 30 days between the two groups (All P>0.05). Univariate analysis revealed significant differences in D-dimer (P=0.003), pulmonary artery pressure (P=0.000), and partial pressure of carbon dioxide (P=0.000) between the groups. Multivariate analysis suggested that deep venous thrombosis of the lower extremities, pulmonary hypertension, and elevated D-dimer levels were significantly associated with the incidence of PTE. Further ROC curve analysis suggested that the area under the curve (AUC) of deep venous thrombosis, pulmonary hypertension and D-dimer increase was 0.624, 0.673 and 0.624, respectively. The AUC of combined three factors was 0.837. The sensitivity, specificity, positive predictive value and negative predictive value of the combined diagnosis reached 86.8%, 88.4%, 87.5%, and 84.6%, respectively. Conclusion: D-dimer combined with echocardiography and vascular ultrasound of lower extremity might have diagnostic and predictive value for PTE.

Caffeine is responsible for the bloodglucose-lowering effects of green tea and Puer tea extractsin BALB/c mice / 中国天然药物

The present study was designed to determine the effects of Puer tea and green tea on blood glucose level. Male BALB/c mice were administered green tea extract (GTE) or Puer tea extract (PTE), either intragastrically or in their drinking water. The major components of these teas are epigallocatechin gallate (EGCG) and caffeine, respectively. Blood glucose measurement results showed that mice fed intragastrically or mice that drank GTE, PTE or caffeine showed significantly lower blood glucose levels compared to the control group. However, EGCG exhibited no influence on the blood glucose levels. When caffeine was eliminated from the GTE and PTE, the effect on the blood glucose levels was abolished, but the effect was recovered when caffeine was re-introduced into the extracts. Evaluation of hematological and biochemical indices at the time of the greatest caffeine-induced decrease in blood glucose levels showed that the effect of caffeine was specific. Microarray analyses were performed in 3T3-L1 preadipocytes and mature adipocytes treated with 0.1 mg · mL(-1) caffeine to identify factors that might be involved in the mechanisms underlying these effects. The results showed that few genes were changed after caffeine treatment in adipocytes, and of them only phospholipid transfer protein (PLTP) may be ralated to blood glucose. In conclusion, this study indicates that caffeine may be the key constituent of tea that decreases blood glucose levels, and it may be used to treat type 2 diabetes.

Sudden cardiovascular collapse after platelet transfusion during liver transplantation: flat-line thromboelastometry and inferred pulmonary thromboembolism: A case report

Despite the well-known bleeding diathesis in patients with end-stage liver disease, inappropriate hypercoagulation is also emerging as a major concern. Pulmonary thromboembolism (PTE) is a major cause of perioperative morbidity and mortality during liver transplantation (LT). Flat-line thromboelastography is reported to predict PTE during LT. In this case, a 52-year-old woman with hepatocellular carcinoma underwent living-related LT. During the pre-anhepatic phase, one unit of apheresis platelets was transfused because of thrombocytopenia (32,000 /ml). After 20 minutes, blood pressure became unstable and circulatory collapse suddenly developed. In the middle of cardiopulmonary resuscitation, transesophageal echocardiography was immediately conducted, which revealed flail thrombi in the right atrium. Rotational thromboelastometry (ROTEM) conducted at that time was surprisingly flat in 4 channels, contradictory to the finding of hypercoagulation. This finding lead to a management dilemma during LT. Flattening in ROTEM requires caution in interpretation of severe hypocoagulation or ongoing PTE.

Effectiveness and Necessity of Early Postoperative Rehabilitation for Total Hip Arthroplasty / The Japanese Journal of Rehabilitation Medicine

When treating coxarthrosis, each treatment method including conservative treatment, osteotomy, or artificial joint replacement, has an optimal stage for treatment of the disease. Joint preservation surgery has a good result for cases in the early stage, but total hip arthroplasty (THA) is selected for advanced stage hip osteoarthritis, and in Japan, more than a 40000 THAs are performed each year. Good postoperative results lasting up to 15 years are reported today, but, on the other hand, postoperative problems still clearly exist. Deep venous thrombosis/pulmonary embolism (VTE/PTE) are given as perioperative problems, and postoperative dislocation and postoperative range of motion of the hip joint are given as the problems that most relate to ADL. These days, information about THA is abundant so that there is extensive demand for the procedure amongst patients, and elevated technique is demanded of the surgeon. The onset of postoperative VTE/PTE as a lethal complication and interest about its prevention have risen these days with the increase in the number of artificial joint replacements performed in Japan. This time, we introduce a postoperative THA rehabilitation schedule and report the results of our postoperative complication prevention efforts carried out in our hospital. When THA of late years is thought about, for a patient, it is natural that the long-term results are good, and the postoperative satisfaction degree from an early stage is the demand that it is necessary. In consideration of these things, the range of hip motion needed about the origin and preventing dislocation that were one element of long-term satisfaction since only a short-term of normal ADL movement was investigated, and this was viewed from the aspect of joint stability against postoperative dislocation by difference in the approach method of surgery. Finally, we also discussed the importance of early rehabilitation after surgery for the prevention of VTE/PTE as a serious complication of surgery.