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Clinical application of ultrasound-guided thrombin injection in treatment of iatrogenic femoral artery pseudoaneurysm

ObjectiveTo explore the ultrasonic morphological indexes influencing the effectiveness of ultrasound-guided thrombin injection (UGTI) in the treatment of iatrogenic femoral artey pseudoaneury (IFAP).MethodsThe patients with IFAP treated by UGTI in the West China Hospital of Sichuan University from 2015 to 2017 were collected according to the inclusion criteria. The demographic data, comorbidities, clinical symptoms, ultrasonic morphological parameters, thrombin dosage, and postoperative complications were analyzed. The risk factors of technical success of UGTI were analyzed by logistic regression analysis. The technical success was defined as absence of flow within the FAP immediately after UGTI. ResultsA total of 53 patients who met the criteria of inclusion were included in this study. The technical and treatment success rates of UGTI were 84.9% (45/53) and 96.2% (51/53), respectively. No deep venous thrombosis, arterial thromboembolism, infection, bleeding, allergy, and other complications or death occurred in all patients. There were no statistical differences in the age, clinical symptoms, comorbidities (except hypertension, P=0.040), ultrasonic morphological parameters (except femoral artery diameter, P<0.001), and thrombin dosage between the patients with technical success and failure (P>0.05). Multivariate logistic regression analysis showed that the smaller femoral artery diameter was the risk factor of the technical failure [OR=0.350, 95%CI (0.165, 0.743), P=0.006]. Further adjustment of thebaseline data of patients (excluding patients with hypertension), the logistic regression analysis still found that smaller femoral artery diameter was the risk factor of the technical failure [OR=0.419, 95%CI (0.205, 0.860), P=0.018].ConclusionsUGTI in treatment of IFAP is minimally invasive and has a higher technical success rate. Smaller femoral artery diameter might affect technical success rate of UGTI.

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.

Preliminary Analysis of Randomized Controlled Trials on Thrombin Like Enzyme in China

ObjectiveTo investigate the current situation of randomized controlled trials (RCTs) of thrombin like enzyme research and the ability to provide a reliable basis for the clinical practice. MethodsRCTs identified from four Chinese databases up to the year 2012 were assessed according to international standard, including SinoMed (1978-2012), CNKI (1979-2012), Wanfang Data (1986-2012), and VIP (1989-2012). ResultsA total of 2358 articles were searched and 53 RCTs were identified. The results showed that the quality of these articles was not high enough to meet the needs of clinical practice in China. ConclusionIn China, current quantity and quality of RCTs of thrombin like enzyme can not meet the need of clinical practice. In order to improve the prevention and treatment of hemorrhagic diseases, and surgical bleeding, especially for patients lacking clotting factor, more high-quality RCTs are required.

Transfered Human Thrombomodulin Gene into Artery Wall of Rabbit by High-Pressure Injection in Vivo

Objective To explore the feasibility of high-pressure injection to transfer human thrombomodulin (hTM) gene into arterial wall of rabbits.Methods Eighty-four healthy New Zealand rabbits were randomly divided into three groups: pcDNA3.1/hTM plasmid group (n=28), pcDNA3.1(+)/neo plasmid group (n=28) and untransfected group (n=28). After gene transfection, the model of arterial injury-blocking was established. Then, the expressions of hTM mRNA and protein in arterial wall were examined by RT-PCR and immunohistochemistry at 3 d, 7 d, 14 d and 28 d after operation. Results Seventeen rabbits died accidentally from the day of operation to 3 d after operation. The expressions of hTM mRNA of different time points in pcDNA3.1/hTM plasmid group were significantly higher than that in pcDNA3.1(+)/neo plasmid group and untransfected group (Plt;0.01). For the expressions of hTM mRNA at different time points in pcDNA3.1(+)/neo plasmid group and untransfected group, the difference of inter-group and intra-group was not significant (Pgt;0.05). hTM protein was expressed in every group and mainly localized in the inner lining of arterial wall. The expressions of hTM protein at different time points in pcDNA3.1/hTM plasmid group were significantly higher than that in pcDNA3.1(+)/neo plasmid group and untransfected group (Plt;0.05). The expression of hTM protein at different time points in pcDNA3.1(+)/neo plasmid group and untransfected group kept relative constancy, the difference of inter-group and intra-group was also not significant (Pgt;0.05). Conclusion High-pressure injection is feasible to transfer pcDNA3.1/hTM plasmid into arterial wall of live animals.

RESEARCH PROGRESS OF A DISINTEGRIN AND METALLOPROTEINASE WITH THROMBOSPONDIN MOTIF 4 AND 5 IN OSTEOARTHRITIS

Objective To review the progress of a disintegrin and metalloproteinase with thrombospondin motif 4 (ADAMTS-4) and ADAMTS-5 in osteoarthritis. Methods Recent literature about the ADAMTS-4 and -5 in osteoarthritis was analyzed; the structure, function, inhibitors of the ADAMTS-4 and -5, and the relationship between the proteases and osteoarthritis were analyzed and summarized. Results ADAMTS-4 and -5 can reduce chondrocyte and extracellular matrix by degrading aggrecan and cartilage oligomeric matrix protein, which induced the pathogenesis of osteoarthritis. Conclusion ADAMTS-4 and -5 have been demonstrated to play important roles in osteoarthritis. It can better guide treatment and prevention of osteoarthritis to further study related mechanism of ADAMTS-4 and -5, and to promote the establishment of a clinical drug targets.

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.

重組組織型纖溶酶原激活劑對機體凝血酶原時間和纖維蛋白含量的影響

遺傳性抗凝血酶缺乏癥一例并文獻復習

目的 加強臨床醫生對遺傳性抗凝血酶缺乏癥的認識，促進該病的早期診斷，改善患者預后。方法總結了1例罕見的遺傳性抗凝血酶缺乏癥患者的臨床特點及診治經過，并以 “遺傳性抗凝血酶缺乏癥”“臨床特征”“達比加群酯”為關鍵詞檢索萬方中文數據庫，以“Hereditary antithrombin deficiency”“clinical characteristics ”“dabigatran etexilate ”為關鍵詞檢索PubMed數據庫予以文獻復習。結果該患者青年時期即發現非尋常部位血栓（顱內靜脈竇），本次就診期間發現多部位血栓形成，低分子肝素抗凝效果不佳，多次查抗凝血酶Ⅲ明顯低于正常，進一步行基因全外顯子組測序提示存在遺傳性抗凝血酶Ⅲ缺乏癥相關的SERPINC1基因致病變異，明確診斷為遺傳性抗凝血酶缺乏癥后予以達比加群酯抗凝治療好轉，隨訪至今未再復發。檢索相關文獻發現，遺傳性抗凝血酶缺乏癥臨床相對罕見，該病具有不同的臨床和基因分型，診斷的建立需依據相應的流程，其治療及預后尚缺乏統一的認識。結論遺傳性抗凝血酶缺乏癥系靜脈系統血栓的罕見病因，對于年輕血栓形成患者、復發性血栓或有家族聚集傾向的血栓患者，需警惕此病的可能；通過對該病的早期診斷、早期合理使用抗凝藥物有助于改善預后。

心臟機械瓣膜置換術后抗凝治療的安全性

目的 探討心臟機械瓣膜置換術后服用華法令的安全劑量及抗凝期間的注意事項。 方法 回顧性分析1999 年12 月至2010 年10 月皖南醫學院附屬弋磯山醫院132 例行心臟瓣膜置換術后進行華法令抗凝治療患者的臨床資料，其中男73 例，女59 例；年齡27 ～ 78 歲；術后口服華法令抗凝，隨訪3 個月～ 10 年，分析華法令應用情況及其并發癥發生情況。 結果 手術時間（240±96） min，體外循環時間（112±52） min，主動脈阻斷時間（81±23） min。全組術后出現皮膚紫癜2 例，死亡2 例。隨訪117 例，隨訪率90%（117/130），隨訪期間月經期月經量過多導致貧血4 例，血尿3 例，反復鼻衄或牙齦出血共4 例，消化道出血1 例，腦出血1 例，下肢栓塞1 例，腦梗死1 例，均治愈或好轉。 結論 心臟機械瓣膜置換術后正確服用華法令抗凝治療，及時監測，注意各種干擾因素可以明顯降低并發癥的發生率。

鼻內鏡下凝血酶加明膠海綿局部填塞治療鼻腔嗅裂區出血

目的 評價鼻內鏡下凝血酶加明膠海綿局部填塞治療鼻腔嗅裂區出血的臨床療效。 方法 2007年2月-2009年8月應用鼻內鏡明確16例鼻腔嗅裂區出血患者，使用凝血酶加明膠海綿局部填塞止血。 結果 16例均一次填塞后止血，術后1個月復診無再次出血，明膠海綿均已排出。 結論 鼻內鏡下凝血酶加明膠海綿局部填塞治療鼻腔嗅裂區出血療效確切，患者痛苦少，是治療鼻腔嗅裂區出血的一種有效方法。