Effectiveness and safety of the home-made umbrella-shaped Octoparms inferior vena cava filter in the prevention of pulmonary embolism / 中华放射学杂志

Objective:To evaluate the effectiveness and safety of the home-made umbrella-shaped Octoparms inferior vena cava filter in the prevention of pulmonary embolism.Methods:A multicenter, randomized, positive parallel controlled, non-inferiority clinical trial was conducted in ten hospitals in China from October 2017 to March 2019. A total of 188 subjects were enrolled according to the same inclusion and exclusion criteria in different institutes. The 188 subjects were randomly divided into the trial group or the control group according to 1∶1 by the central randomization system, with 94 cases in each group. Octoparms inferior vena cava filter was used in the trial group, and the Celect inferior vena cava filter in the control group. The primary effective index was clinical success rate,including the clinical success rate of filter placement and filter retrieval. The secondary index included the rate of manual success of the delivery sheath system,incidence of pulmonary embolism(within 6 months), incidence of filter fracture,migration (>20 mm),tilt(>15°) on insertion/retrieval,and the situation of inferior vena cava flow(within 6 months). Safety evaluation included the incidence of filter related complications and device-related adverse events immediately after surgery and during follow-up.Results:The success rate of implantation was 100% in 188 subjects. Filter retrieval was performed in 87 cases (92.55%) in the trial group and 91 cases (96.81%) in the control group. The clinical success rate of the trial group was 97.87%(92/94) and that of the control group 98.94%(93/94). There was no significant difference between the two groups (χ 2=0.77, P=0.380). The success rate of delivery sheath system was 96.81%(91/94) and 98.94%(93/94) in the trail group and the control group,respectively. There was no significant difference between the two groups( P=0.621). There was 1 case (1.22%) of new asymptomatic pulmonary embolism in the trial group after filter placement and 2 cases (2.44%) in the control group. There was no significant difference between the two groups ( P>0.05). No filter fracture or migration (>20 mm) occurred in either group. The tilting of filter (>15°) was found in 1 case (1.06%) in the test group and 1 case (1.06%) in the control group when the filter was placed. The tilting of filter (>15°) was found in 0 case in the test group and 2 cases (2.44%) in the control group when the filter was retrieved. There was no significant difference between the two groups ( P>0.05). Inferior vena cava thrombosis before filter retrieval was found in 5 cases (5.75%) in trial group and 3 cases (3.30%) in control group. There was no significant difference between the two groups ( P=0.489). There were no immediate serious complications during filter placement/removal in either group. No filter obstruction,migration,deformation,penetration and occlusion of inferior vena cava. The incidence of device-related adverse events was low in both group. There was no significant difference between the two groups ( P>0.05). Conclusion:The home-made umbrella-shaped Octoparms inferior vena cava filter is effective and safe in preventing pulmonary embolism, and is not worse than Celect filter.

Effect of AngioJet thrombectomy on proximal iliofemoral vein thrombosis after trauma / 中华普通外科杂志

Objective:To investigate the effect of AngioJet thrombectomy on proximal iliofemoral vein thrombosis after trauma.Methods:The clinical data of patients with proximal iliofemoral vein thrombosis treated with AngioJet thrombectomy were retrospectively analyzed at Vascular Surgery Department of our hospital in 2019.Results:A total of 76 patients were enrolled. After PMT 20 patients had grade Ⅲ thrombolysis clearance(26.3%), 41 patients (53.9%) had grade Ⅱ clearance, and 15 cases (19.7%) had grade Ⅰ clearance. Thirty four cases (44.7%) of grade Ⅲ were cleared after catheter aspiration or catheter thrombolysis, 35 cases (46.1%) of grade Ⅱ, 7 cases (9.2%) of grade Ⅰ were cleared, thrombus clearance rate increased significantly ( P<0.05). Cerebral hemorrhage occurred in 1 case (1.3%), and thrombosis recurred in 2 cases (2.6%). The patency rate was 91.8% at 3 months follow-up. Conclusions:AngioJet thrombectomy is a safe and effective method for treating post-traumatic proximal iliac femoral vein thrombosis. Intraoperative application of urokinase thrombolysis, catheter aspiration and catheter-directed thrombolysis can increase thrombus clearance effect.

Identification and homology analysis of Ochrobactrum-like species infection in bloodstream of children / 临床检验杂志

Objective To identify and analyze the homology of Ochrobactrum isolated from clinical blood samples of children.Methods The 26 strains of Ochrobactrum anthropi were identified by Vitek 2 Compact and test strips of API 20 NE bacterial identification system.The biochemical phenotypes were identified by manual tests.The 16S rRNA and recA gene were amplified by PCR and sequenced.The drug sensitivity tests of Ochrobactrum anthropi were performed by Vitek 2 Compact and matched GN13 card.The homology was analyzed by pulsed field gel electrophoresis.Results Based on the identification of the instruments and the manual tests for biochemical phenotype,all the 26 experimental strains were Ochrobactrum anthropi.The results of sequencing for 16S rRNA and recA gene amplification products showed 25 strains were Pseudochrobactrum saccharolyticum and the other 1 was O.grignonensein.Drug sensitivity analysis showed that the all the 26 strains were resistant to aztreonam,but the sensitive rates to quinolones,aminoglycosides,trimethoprim sulfamethoxazole,four generation of cephalosporins and the antibiotics compound of piperacillin/tazobactam were all more than 80％.Pulsed field gel electrophoresis analysis showed that the 25 strains were highly homologous with differences of only 1 to 3 bands in fingerprint profiles.Conclusion Based on the biochemical phenotype and the sequencing of 16S rRNA and recA gene,the Ochrobactrum-like bacteria could be identified to the level of species.The highly homologous strains of Pseudochrobactrum saccharolyticum may be sourced from a clustered infection.

Blood coagulation biomarkers for postoperative venous thromboembolism diagnosis in orthopedic traumatic patients:a case control study / 中华检验医学杂志

Objective To evaluate the value of blood coagulation biomarkers in orthopaedic traumatic patients after surgery and analyze its diagnostic values for venous thrombosis embolism.Methods In thiscase control study, we consecutive enrolled 108 traumatic patients after surgery.54 patients have thrombosis and other 54 patients have no thrombosis.Blood was taken 3 -4 days after surgery.Routine coagulation screening test , FDP(fibrinogen/fibrin degradation products) , D dimer and new item such as TM( thrombomodulin) , TAT( thrombin-anti-thrombin complex) , t-PAIC( tissue-type plasminogen activator-plasminogen activator inhibitor complex),PIC(plasmin-anti-plasmin complex) were tested.The difference between groups of these biomarkers was compared, and then the receiver operation curve ( ROC) was drew to determine the diagnostic cut-off point and diagnostic performance.Results ALL blood coagulation biomarkers in orthopaedic traumatic patients after surgery were significantly increased.The group of patients with thrombosis have higher TM(9.04 ±2.06) IU/ml,t-PAIC(10.15 ±4.23) ng/ml, PIC(1.15 ±0.70)μg/ml, D dimer(5.31 ±5.10) ng/ml than group without thrombosis TM(7.50 ±1.70) IU/ml, t-PAIC (6.97 ±2.56)ng/ml, PIC(0.93 ±0.84)μg/ml,D dimer(2.35 ±2.12)ng/ml,and P=0.000 2,<0.000 1,<0.000 1,<0.000 1, respectively.However, TAT(4.79 ±4.32)ng/ml, (6.51 ±5.92)ng/ml, FDP (8.87 ±7.68 )μg/ml, ( 4.91 ±4.67 )μg/ml showed no difference between thrombosis groupand no thrombosis group, (P=0.212 3,0.050 8; respectively).The area under the ROC curve of TM, t-PAIC, PIC and D-dimer were 0.718 5,0.741 6,0.648 0,0.670 0, respectively; P values were <0.000 1,<0.000 1, 0.009 3,0.004 1, respectively; cut-off values were 11.15 IU/ml, 10.65 ng/ml, 1.36 μg/ml, 7.69 ng/ml, respectively;positive likelihood ratios were 9.00,11.29,3.66,14.60, respectively;specificity were 98.15%,96.23%, 90.20%, 97.96%, respectively; the diagnostic rates were 20.3%, 46.3%, 35.8%, 25.9%, respectively.Conclusions There were coagulation and fibrinolysis system activated in orthopaedic traumatic patients after surgery.TM, t-PAIC, PIC, D dimer were good biomarkers for the diagnosis of thrombosis after trauma surgery.TAT was not fit for screening thrombosis after surgery because of influence of anti-coagulation.

Evaluation of the actual demand for laboratory tests in the clinical managementof venous thromboembolism / 中华检验医学杂志

Venous thromboembolism ( VTE ) is a common vascular disease.It has become an important public health problem because of its high incidence, recurrence and mortality rate.Because the clinical symptom of VTE is relatively hidden, it is difficult to diagnose and treat it.This article focuses on the clinical diagnosis,treatment and laboratory examination of VTE.

Study of a preoperative deep venous thrombosis predictor score for patients with fresh lower extremity fractures / 中华外科杂志

<p><b>OBJECTIVE</b>To establish a preoperative deep venous thrombosis predictor score for patients with fresh lower extremity fractures by statistical analysis.</p><p><b>METHODS</b>From January 2011 to December 2012, 1 705 patients with fresh lower extremity fractures were admitted to department of orthopaedic trauma, Beijing Jishuitan Hospital. They were randomly divided into two groups, the group 1 (n = 879) was used to screen risk factors and derived a predictive models based on logistic regression, the group 2 (n = 826) validated the models.</p><p><b>RESULTS</b>Among the patients, there were 1 106 male and 599 female patients, with an average age of (50 ± 18) years.Variables related to preoperative deep venous thrombosis were age, length of time before surgery, cause of injury, low/high-energy injury, location of injury, history of cardiovascular and cerebrovascular diseases, and D-Dimer. The scores based on OR were: age ≤ 35 years: 1 point, > 35- < 65 years: 4 points, ≥ 65 years: 6 points; length of time before surgery, < 8 days:1 point, ≥ 8 days:2 points;low-energy injury:1 point, high energy injury:3 points;location of injury, foot and ankle:1 point, calf:3 points, around the knee: 5 points, femoral diaphysis and proximal femur:7 points, pelvis and acetabulum:4 points, ≥ 2 sites:6 point;history of cardiovascular and cerebrovascular diseases, yes:2 points, no:1 point. D-Dimer < 600 µg/L:1 point, ≥ 600 µg/L:3 points. Area under receiver operating characteristic curve was 0.79, critical point 15.5 points, sensitivity was 77.00%, specificity was 68.17%.</p><p><b>CONCLUSION</b>The score can predict the preoperative deep venous thrombosis for patients with fresh lower extremity fractures, but limited.</p>

Temporary vena cava filters in cases of lower limb fractures / 中华普通外科杂志

Objective To evaluate the necessity and safety of implanting temporary vena eava fihers to prevent pulmonary emboli in patients of lower extremity fractures concomitant with acute deep venous thrombosis(DVT). Methods A total of 782 patients with lower extremity fractures were complicated with DVT perioperatively. Among them, 91 received temporary vena cava filters implantation before orthopedic operations for the prevention of pulmonary embolism. All patients were followed up post-operation. Results Vena cava filters were successfully implanted in 89 patients. Mean implantation time was 27 days (range from 14 to 42 days). Thrombus trapped within the filters were found in 78 patients (87.6%) after the filters removal. Eight-two filters (92.1%) were retrived successfully at the first attempt as scheduled. Seven filters(7.9%) with big trapped thrombi were removed at the 2nd attempt after additional thrombolytic therapy. No patients needed a permanent filter. No fetal pulmonary embolism (PE) or other major complications were detected during the three to six months follow-ups period. Conclusion Temporary vena cava filter can reduce the incidence and mortality of pulmonary embolism as well as the occurrence of mid- or long-term complications in lower limb fracture patients complicated with DVT.

Early diagnosis and treatment for deep venous thromboembolism in patients with fracture / 中华全科医师杂志

Objective To explore the measures in early diagnosis and treatment for venous thromboembolism(VTE)in patients with fracture.Methods All the patients with fracture visiting Beijing Jishuitan Hospital in emergency during October 2004 to October 2007 were screened by Well's prediction rules,and anticoagulation and thrombolysis were instituted for those with established diagnosis of VTE by color Doppler ultrasonography and venography.Results Totally,1 508 patients at higg-risk of VTE were identified by D-dimer test.1 455 by color ultrasonography and 53 by venography.Diagnosis of VTE was established in 652 of them(43.2%),619(94.9%)received anticoagulant treatment,162(24.8%)received anticoagulant plus thrombolytie treatment and 25 (3.8%) received anticoagulation plus thrombectomy.In order to prevent fatal pulmonary embolism,vena cava filters(VCFs)were implanted in 146(22.4%)patients,and 33(5.1%)of them were contraindicated to anticoagulation.After treatment,412 cases were cured and 240 were improved,with no one failed.Conclusions Patients with fracture are at high-risk of VTE and should be screened by D-dimer test and color Doppler ultrasonography based on Well's evaluation,as well as by venography for confirming the diagnosis of VTF as appropriate.Anticoagulation and thrombolysis are still the treatment of choice,with thrombectomy and VCF implantation performed only if necessary.

Lipoteichoic acid of Bifidobacterium down-regulates VEGF expressions and inhibits the metastasis of colon carcinoma / 第三军医大学学报

Objective To study the effect of lipoteichoic acid(LTA) of Bifidobacterium on the expression of vascular endothelial growth factor(VEGF) and invasion and metastasis of colon carcinoma cell lines.Methods The effects of LTA on adhesion,invasion and metastasis of human colon carcinoma lines LoVo and HT-29 in vitro were examined by MTT colorimetric and transwell chamber.The mRNA and protein expressions of VEGF in the two colon carcinoma cells treated with LTA were detected by RT-PCR and Western blot.Results The adhesion ability decreased in LoVo cells and HT-29 cells after the treatment of LTA(20,50,80 ?g/ml) for 30,60,90,120 min(P

Thrombolysis with anticoagulation treatment for early stage of posttraumatic and postoperative deep vein thrombosis of lower extremity / 中国普通外科杂志

Objective To explore the effect of thrombolysis with anticoagulation treatment for early stage of posttraumatic and postoperative deep vein thrombosis of lower extremity. Methods The clinical data of 38 palients with early stage of posttraumatic and postoperative deep vein thrombosis(DVT) of lower extemity treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results The thrombolytic effect was significant. After the treatment, the deep veins were recanalization without regorging in 71.0% of patients. The total effective rate was 100%. Only one patient had hemorrhagic complication, two patients had symptomatic pulmonary embolism,but none of the patients died. Conclusions Thrombolysis with anticoagulation is an effective and safe method for posttraumatic and postoperative DVT in the early stage.