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Des-γ-carboxy prothrombin in the diagnosis of primary hepatocellular carcinoma: a systematic review

ObjectiveTo systematically review clinical value of des-γ-carboxy prothrombin (DCP) in the diagnostic of primary hepatocellular carcinoma (PHC).MethodsDatabases including PubMed, The Cochrane Library, EMbase, Medline (Ovid), CNKI, VIP, WanFang Data and CBM were electronically searched to collect relevant studies on DCP in the diagnosis of PHC from inception to December 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-Disc 1.4 software and RevMan 5.3 software.ResultsA total of 50 studies involving 15 099 cases were included. The results of meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio and area under the curve of SROC were 0.69 (95%CI 0.67 to 0.70), 0.89 (95%CI 0.89 to 0.90), 7.35 (95%CI 6.08 to 8.90), 0.31 (95%CI 0.27 to 0.35), 26.63 (95%CI 20.42 to 34.73) and 0.909 9, respectively.ConclusionsSerum DCP has higher diagnostic efficacy for PHC, especially with higher specificity of diagnosis. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.

系统性红斑狼疮并抗磷脂综合征致视网膜中央动静脉阻塞1例

心脏机械瓣膜置换术后抗凝治疗的安全性

目的 探讨心脏机械瓣膜置换术后服用华法令的安全剂量及抗凝期间的注意事项。 方法 回顾性分析1999 年12 月至2010 年10 月皖南医学院附属弋矶山医院132 例行心脏瓣膜置换术后进行华法令抗凝治疗患者的临床资料，其中男73 例，女59 例；年龄27 ～ 78 岁；术后口服华法令抗凝，随访3 个月～ 10 年，分析华法令应用情况及其并发症发生情况。 结果 手术时间（240±96） min，体外循环时间（112±52） min，主动脉阻断时间（81±23） min。全组术后出现皮肤紫癜2 例，死亡2 例。随访117 例，随访率90%（117/130），随访期间月经期月经量过多导致贫血4 例，血尿3 例，反复鼻衄或牙龈出血共4 例，消化道出血1 例，脑出血1 例，下肢栓塞1 例，脑梗死1 例，均治愈或好转。 结论 心脏机械瓣膜置换术后正确服用华法令抗凝治疗，及时监测，注意各种干扰因素可以明显降低并发症的发生率。

Curative Effect Observation of Thrombin in Treatment of Subcutaneous Effusion Following Radical Resection of Breast Cancer

ObjectiveTo explore the efficacy of thrombin in treatment of subcutaneous effusion after radical resection of breast cancer. MethodsOne hundred and ninety patients underwent radical resection of breast cancer from July 2008 to July 2013 in this hospital were divided into postoperative observation group and postoperative control group according to the operation time. A daily injection of thrombin by drainage tube was performed on day 3 after operation in the postoperative observation group, the negative pressure drainage only was performed in the postoperative control group. The drainage volume in 72 h after operation, time of extubation, cases of subcutaneous effusion were counted after operation. Then the patients with subcutaneous effusion were divided into subcutaneous effusion observation group and subcutaneous effusion control group according to the time of extubation, the thrombin was injected into cavity after pumping subcutaneous effusion with pressing and dressing in the subcutaneous effusion observation group and only pressed after pumping subcutaneous effusion in the subcutaneous effusion control group, respectively. The healing time of subcutaneous effusion was counted in these two groups. ResultsCompared with the postoperative control group, the drainage volume in 72 h after operation was less(P < 0.001), the time of extubation was earlier(P < 0.001), the rate of subcutaneous effusion was lower(P < 0.05), color of drainage fluid on day 2 after mastectomy was lighter(P < 0.001)in the postoperative observation group. Compared with subcutaneous effusion control group, when subcutaneous effusion was 20-50 mL or > 50 mL, the healing time of subcutaneous effusion was significantly shorter in the subcutaneous effusion observation group(P < 0.05). ConclusionsInjecting thrombin by drainage tube after operation can reduce the drainage volume, decrease the rate of subcutaneous liquid, and shorten the time of extubation. Injecting thrombin into cavity of subcutaneous liquid can shorten the healing time of patients with middle and large subcutaneous effusions after radical resection of breast cancer.

The Effects of Sleeping-inclued Hypoxema at Different Time and Level on Pulmonary Emphysema and of Coagulation System Function in Rats with Pulmonary Emphysema

Objective To investigate whether the sleep-induced hypoxemia ( SIH) at different time and different level have different effects on pulmonary emphysema and coagulation systemfunction in the rats with pulmonary emphysema. Methods Thirty Wistar rats were randomly divided into three groups( n = 10 in each group) . All rats were exposed to cigarette smoke twice a day ( 30 min each time) . From29th day on, the rats in Group A ( pulmonary emphysema with short SIH) were also exposed to mixed gas of 12. 5% oxygen for 1. 5 hours during sleeping time every day ( the expose time was divided into 4 periods, 22. 5 min each) . The rats in Group B ( pulmonary emphysema with mild SIH) were also exposed to mixed gas of 15% oxygen for three hours during sleeping time every day( the expose time was divided into 4 periods, 45 min each) . The rats in Group C( pulmonary emphysema with standard SIH) were also exposed to mixed gas of 12. 5% oxygen for three hours during sleeping time every day( the expose time was divided into 4 periods,45 min each) . After continuous exposure for 56 days, the rats were sacrificed. Semi-quantitative image analytic method was employed for histopathological analysis including pathological score of lungs, mean linear intercept ( MLI) and mean alveolus number( MAN) . ATⅢ, FIB, vWF, FⅧ were measured. Results All animals in three groups manifested the histopathological features of emphysema. Pathological scores of lungs and MLI of every group were significantly different from each other( F = 21. 907, F = 18. 415, all P lt; 0. 05) , Group A [ ( 61. 90 ±4. 25) % , ( 92. 45 ±1. 78) μm] and Group B[ ( 64. 60 ±3. 95) % , ( 92. 80 ±3. 65) μm] were significantly lower than Group C[ ( 73. 30 ±3. 86) % , ( 99. 32 ±2. 81) μm, q= 8. 96, q =6. 84, q = 12. 64, q =9. 65, all P lt; 0. 05] . Levels of FIB were significantly different among three groups ( F = 20. 592, P lt; 0. 05) while FIB in Group A[ ( 189. 98 ±5. 29) mg/ dL] and Group B[ ( 182. 70 ±2. 78) mg /dL] were significantly lower than that in Group C[ ( 198. 40 ±7. 37) mg/ dL, q = 4. 86, q= 9. 07, all P lt; 0. 05] , and FIB in Group A was significantly higher than that in Group B( q = 4. 20, P lt; 0. 05) . Levels of FⅧ were significantly different from each other( F = 33. 652, P lt;0. 05) while FⅧ in Group A[ ( 232. 26 ±4. 17) % ]and Group B[ ( 242. 53 ±14. 50) % ] were significantly lower than that in Group C[ ( 303. 25 ±32. 93) % ,q= 10. 73, q = 9. 18, all P lt; 0. 05] . Conclusions Pulmonary emphysema and hypercoagulable states increases with time and severity of SIH in rats with pulmonary emphysema. The elevated activity of blood coagulation factor may be a critical role in the hypercoagulable states.

A Clinical Comparison on the Treatment of lntractable Hemoptysis Tubentolosis by Using Thrombin Combined with Phentolamine and Pituitrin

目的:观察凝血酶雾化吸入联用酚妥拉明治疗肺结核顽固性咯血的临床效果。方法:将47例住院肺结核顽固性咯血患者随机分为两组,治疗组采用凝血酶超声雾化吸入联用酚妥拉明静滴,对照组采用垂体后叶素静滴。结果:治疗组总有效率87.50%,对照组总有效率86.96%。结论:在常规止血治疗无效的基础上,加用凝血酶超声雾化吸入联用酚妥拉明止血快,副作用少,是治疗肺结核顽固性咯血的有效药物。

Correlation of the prothrombin gene G20210A mutation and cerebral venous thrombosis risk: a meta-analysis

Objective To systematically review the association between prothrombin gene G20210A mutation and the risk of cerebral venous thrombosis (CVT). Methods Databases including PubMed, Springer, Google Scholar, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and CBM were searched for case-control studies concerning the association between prothrombin gene G20210A mutation and cerebral venous thrombosis risk from inception to January 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software and Stata 12.0 software. Results A total of 26 case-control studies were included, involving 1 361 CVT cases and 6 323 controls. The results of meta-analysis showed that: there was a significant association between prothrombin gene G20210A mutation and CVT risk (OR=4.56, 95% CI 3.51 to 5.93,P<0.000 01). Sensitivity analysis showed no significant publication bias was detected confirmed the stability of results. Subgroup analysis showed that G20210A mutation increased CVT risk in adults (OR=5.02, 95% CI 3.81 to 6.60,P<0.000 01), but not in children (OR=1.99, 95% CI 0.83 to 4.79,P=0.12). Conclusion Prothrombin gene G20210A mutation can significantly increase the CVT risk. Due to the limited quality and quantity of included studies, the above results are needed to be validated by more high quality studies.

鼻内镜下凝血酶加明胶海绵局部填塞治疗鼻腔嗅裂区出血

目的 评价鼻内镜下凝血酶加明胶海绵局部填塞治疗鼻腔嗅裂区出血的临床疗效。 方法 2007年2月-2009年8月应用鼻内镜明确16例鼻腔嗅裂区出血患者，使用凝血酶加明胶海绵局部填塞止血。 结果 16例均一次填塞后止血，术后1个月复诊无再次出血，明胶海绵均已排出。 结论 鼻内镜下凝血酶加明胶海绵局部填塞治疗鼻腔嗅裂区出血疗效确切，患者痛苦少，是治疗鼻腔嗅裂区出血的一种有效方法。

Modified method for intratumoral injection of thrombin for the treatment of iatrogenic pseudoaneurysms

ObjectiveTo explore the value of modified method for intratumoral injection of thrombin in the treatment of iatrogenic pseudoaneurysms.MethodsClinical data of 28 patients with iatrogenic pseudoaneurysms after interventional treatment in our hospital from October 2012 to June 2018 were retrospectively analyzed. Twenty-one cases were treated with ultrasound-guided thrombin injection for pseudoaneurysms (Ultrasound group), and seven cases were treated with DSA-mediated balloon occlusion and thrombin injection for pseudoaneurysms (DSA group). The patients were followed-up at 1 day, 1 month and 3 monthS after operation.ResultsThe total success rates of the two groups were 100%. There was no treatment-related complications in the two groups. There was no recurrence after 1–3 months of treatment.ConclusionsIntratumoral injection of thrombin can be used for the treatment of iatrogenic pseudoaneurysm. The effect of the improved treatment is more significant. These two methods can be used as the best way to treat iatrogenic pseudoaneurysm with different neck diameters.

遗传性抗凝血酶缺乏症一例并文献复习

目的 加强临床医生对遗传性抗凝血酶缺乏症的认识，促进该病的早期诊断，改善患者预后。方法总结了1例罕见的遗传性抗凝血酶缺乏症患者的临床特点及诊治经过，并以 “遗传性抗凝血酶缺乏症”“临床特征”“达比加群酯”为关键词检索万方中文数据库，以“Hereditary antithrombin deficiency”“clinical characteristics ”“dabigatran etexilate ”为关键词检索PubMed数据库予以文献复习。结果该患者青年时期即发现非寻常部位血栓（颅内静脉窦），本次就诊期间发现多部位血栓形成，低分子肝素抗凝效果不佳，多次查抗凝血酶Ⅲ明显低于正常，进一步行基因全外显子组测序提示存在遗传性抗凝血酶Ⅲ缺乏症相关的SERPINC1基因致病变异，明确诊断为遗传性抗凝血酶缺乏症后予以达比加群酯抗凝治疗好转，随访至今未再复发。检索相关文献发现，遗传性抗凝血酶缺乏症临床相对罕见，该病具有不同的临床和基因分型，诊断的建立需依据相应的流程，其治疗及预后尚缺乏统一的认识。结论遗传性抗凝血酶缺乏症系静脉系统血栓的罕见病因，对于年轻血栓形成患者、复发性血栓或有家族聚集倾向的血栓患者，需警惕此病的可能；通过对该病的早期诊断、早期合理使用抗凝药物有助于改善预后。