Table of Content

05 April 2016, Volume 31 Issue 4

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Progression of diagnosis and treatment in acute pulmonary thromboembolism

Yang Yuanhua, Zhou Rongrong

2016, 31(4):  349-351.  doi:10.3969/j.issn.1004-583X.2016.04.001

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In recent years, as the new evidence-based medical evidence on diagnosis and treatment of pulmonary thromboembolism(PTE) appear constantly, some new concepts have been pointed out, such as the clinical classification of the severity of acute PTE becomes more elaborated, recommendation for management of high-risk patients, plasma D-dimer is more suitable to rule out acute PTE, treatment of moderate-risk patients, early discharge or home treatment of low-risk patient and so on. In order to make clinicians get the newest trends in diagnosis and treatment of PTE and finally formulate the most effective therapeutic plan for patients with PTE, we unscramble the new guidelines on the diagnosis and management of acute PTE according to above mentioned problems.

New anticoagulants and clinical application of venous thromboembolism

Yang Yuanhua, Yang Suqiao,Zhang Mingyuan

2016, 31(4):  352-354.  doi:10.3969/j.issn.1004-583X.2016.04.002

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In China, the new anticoagulants, which mainly include two categories: factor Ⅹa inhibitors and factor Ⅱa inhibitors, have been gradually applied in the treatment of venous thromboembolism (VTE). This article illustrates the results of clinical study, application methods and cautions of VTE treatments that employed various new anticoagulants for better clinical using of these drugs and getting best effect of therapy.

Advances in diagnosis and treatment of air embolism

Wang Xiaohui, Chen Hong

2016, 31(4):  355-358.  doi:10.3969/j.issn.1004-583X.2016.04.003

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Air embolism is a life-threatening complication caused mainly by a variety of surgical or other invasive procedures. Air embolization may occur in the venous or the arterial circulation, even without any symptoms or signs. Its diagnosis could be missed and delayed. Early detection and appropriate treatment may improve the prognosis.

Focus on venous thromboembolism during pregnancy

Li Hongwei, Wu Qi

2016, 31(4):  359-362.  doi:10.3969/j.issn.1004-583X.2016.04.004

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Venous thromboembolism (VTE) is constituted by pulmonary thromboembolism (PTE) and deep venous thrombosis (DVT). Blood hypercoagulable, along with vascular damage and stasis during pregnancy and puerperium contribute to a high incidence of VTE. In clinically suspected VTE, anticoagulation therapy should be commenced immediately until the diagnosis is excluded by objective testing, unless treatment is strongly contraindicated. Low molecular weight heparin (LMWH) does not pass through the placenta and is safe in breastfeeding, hence will be the best choice for pregnancy and puerperium. Treatment with LMWH should be employed during the remainder of the pregnancy and last for at least 6 weeks postnatally and at least 3 months of treatment will be necessary.

Fat embolism syndrome

Zhang Jin

2016, 31(4):  363-367.  doi:10.3969/j.issn.1004-583X.2016.04.005

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Fat embolism syndrome (FES) is one of severe fatal complication of long bone fractures and trauma. Fat emboli passed through the capillary beds, led to multisystem dysfunction and inflammatory response in lung,brain,retina,cutis etc. Early awareness and diagnosis play important role to decrease FES mortality.

Progress in diagnosis and treatment of amniotic fluid embolism

Zhang Yangyang, Yuan Yadong

2016, 31(4):  368-372.  doi:10.3969/j.issn.1004-583X.2016.04.006

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Amniotic fluid embolism is a rare but dreadful obstetric complications with a high maternal mortality, which caused by the transfer of amniotic fluid substances into the maternal circulation. In order to reduce the mortality, it is necessary to be familiar with the pathogenesis and clinical manifestations, and then make early diagnosis and choose the effective treatment.

Malignant neoplasms and venous thromboembolism

Jiang Mingming, Yuan Yadong

2016, 31(4):  373-377.  doi:10.3969/j.issn.1004-583X.2016.04.007

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Venous thromboembolism (VTE) is a major complication of malignant neoplasms,and is one of the leading causes of death in patients with malignant neoplasms. The incidence of VTE in this particular population is widely increasing.Several risk factors for developing venous thrombosis usually coexist in malignant neoplasms patients. Effective prophylaxis and treatment of VTE would reduce morbidity and mortality,and improve quality of life. This review will focus on the pathophysiology,risk factors,and as well as discuss the prevention and management regimens of VTE in malignant neoplasms.

Evaluation and analysis on combination therapy of diabetes information management system and patient peer education for type 2 diabetes mellitus in outpatient service

Xu Xia, Li Qing,Jia Weiping,Luo Yun, Gu Yaping

2016, 31(4):  378-381.  doi:10.3969/j.issn.1004-583X.2016.04.008

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Objective To study the effect of the combination therapy of diabetes information management system (DIMS) and diabetes patient peer education on self-management level and comprehensive index in patients with type 2 diabetes mellitus(T2DM).Methods A total of 200 out-patients with T2DM were chosen and randomly divided into three groups: group A with combination treatment of making e-medical records using DIMS and patient peer education, group B with combination treatment of DIMS and traditional health education,group C with common diabetes treatment. The levels of FPG, 2 hPG, HbA₁c, BP, TC, TG, HDL-C, LDL-C and BMI were recorded before and after 12 months’ treatment.All the patients’ knowledge of diabetes and self-management behavior before and after 12 months’ treatment were evaluated.Results After 12 months’ treatment, the goal attainment rates of FPG, 2 hPG, HbA₁c, HDL-C, LDL-C, TG, TC, BMI and BP were significantly improved in group A and B(P＜0.05),the goal attainment rate of BP was significantly improved in group C(P<0.05).After 12 months’ treatment, the goal attainment rates of FPG, 2 hPG, HbA₁c, HDL-C, LDL-C, TG, TC and BMI were significantly increased in group A than in group C(P＜0.05), the goal attainment rates of 2 hPG, HbA₁c, HDL-C, LDL-C, TG, TC and BMI were significantly increased in group A than in group B(P＜0.05).After 12 months’ treatment, the knowledge of diabetes and self-management behavior were significantly improved in group A than in group B and C(P＜0.05).Conclusion Combination model of DIMS and patient peer education management can improve the self-management level of T2DM and the metabolic parameters.

Analysis on risk factors of recurrence of cerebral infarction in elderly residents of Hebei Renqiu

Li Fang,Yu Kai,Yang Hongna

2016, 31(4):  382-385.  doi:10.3969/j.issn.1004-583X.2016.04.009

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Objective To investigate the related risk factors of the recurrence of cerebral infarction in elderly residents of Hebei Renqiu and to provide basis for its prevention and cure.Methods A cluster random sampling method was used for the age 60 to 70 years of Renqiu permanent residents as a screening object, including 5 010 cases, 459 cases of residents as the research object, They were screened in history of the first cerebral infarction,not losing after two years of follow-up. 53 cases of the cerebral infarction were recurrent. Prospective analysis was made on the related risk factors of the recurrence in cerebral infarction of the elderly community residents.Results Multivariate logistic regression analysis showed that LDL-C(OR=1.502,95%CI=1.023-2.207) and carotid artery plaque(OR=2.298,95%CI=1.085-4.867) were significantly related to the recurrence of cerebral infarction in Hebei Renqiu elderly residents(P<0.05).Conclusion LDL-C and carotid artery plaque are the primary risk factors of the recurrence of cerebral infarction in Hebei Renqiu elderly residents. Enough knowledge and active intervention on cerebral infarction have important significance in the effective prevention of recurrence.

Relationship analysis between subclinical hypothyroidism and atherosclerosis

Guo Ni, Gan Zhenzhao, Su Jianqing

2016, 31(4):  386-388.  doi:10.3969/j.issn.1004-583X.2016.04.010

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Objective To explore the relationship between subclinical hypothyroidism (SCH) and atherosclerosis.Methods Eighty patients with SCH and eighty volunteers with euthyroidism were contained in the study as SCH group and control group, respectively. All indicators were examined as follows:thyroid function-related indicators such as TSH, FT3 and FT4; atherosclerosis-related indicator such as HDL-C,LDL-C,TC,TG,TXB2,CRP and cIMT. Correlation study was performed between indicators.Results The levels of TSH, LDL-C, TC and TXB2 in SCH group were significantly higher than those of control group(P<0.01). Pearson correlation analysis showed that TSH level was positively correlated with TC, LDL-C, TXB2 and cIMT level. Multivariate regression analysis showed that cIMT was independently correlated with LDL-C and TSH.Conclusion There appeared some correlation bteween the high level of TSH in patients with SCH and the development of atherosclerosis

Clinical efficacy of chemotherapy combined with location intervened by bronchoscope in central lung cancer

Liu Xinyan,Wei Hongyan, Dai Xianli, Liu Ying

2016, 31(4):  389-391.  doi:10.3969/j.issn.1004-583X.2016.04.011

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Objective To explore the clinical effects of advanced central lung cancer by chemotherapy combined with location intervened with electronic bronchoscopy.Methods Thirty-six cases of advanced central lung cancer patients were delt with standard first GP chemotherapy combined with location intervened by the electronic bronchoscopey.Treatment involved respectively argon plasma coagulation group(APC) then placed the bronchial support into bronchia. The another central group accepted simple anti-tumor drugs standard first GP treated. Both groups were evaluated for curative effect after two treatment cycles(21 days a cycle).Results The effective rate of combined group was 72.2% and the remission rate of symptoms was 69.4%. The one-year survival rate was 77.8%. The effective rate of the simple chemotherapy group was 28.6% and the remission rate of symptoms was 38.8%. The one-year survival rate was 44.9%.There were significant differences between two groups(P<0.01).Conclusion The efficacy of the chemotherapy combined with location intervened by the electronic bronchoscopy was significantly better than that of simple chemotherapy. It is a better way to treat advanced central lung cancer patients currently and it rapidly relieves the clinical symptoms.

Heart type fatty acid binding protein and neuron specific enolization enzyme for early diagnosis and prognosis evaluation in acute cerebral infarction

Li Junjun,Zhao Li,Lin Xiaodong,Tian Xiaowei,Wang Xuemin,Wang Haiying,Tian Guangping

2016, 31(4):  392-395.  doi:10.3969/j.issn.1004-583X.2016.04.012

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Objective To explore early diagnosis and prognosis evaluation in acute cerebral infarction (onset < 24 h) using the heart acid binding protein (H-FABP) accompanied with neuron-specific enolase (NSE).Methods 109 patients with acute cerebral infarction (ACI group) were selected as experimental group. Then, the patients were divided into three subgroups(light, medium, heavy) according to the defect degree of nerve function. 80 patients with transient ischemic attack (TIA group) were selected as control group. H-FABP and NSE in serum, NIHSS score and volume of nidus were tested before and after treatment. The difference of H-FABP and NSE in serum before and after treatment were compared, and the relationships between H-FABP, NSE and NIHSS score and volume of nidus were explored.Results ①The serum H-FABP and NSE of ACI group were obviously higher than normal values(P<0.01). ②The H-FABP of ACI group was higher than that of TIA group (P<0.01). ③The serum H-FABP of the three subgroups from ACI group rose as the disease aggravated (P<0.01). ④The serum H-FABP of ACI group was positive related to NIHSS score and infarct volume(r_s=0.338,0.246,P<0.01). The serum NSE was positive related to infarct volume (r_s=0.203,P<0.05). The infarct volume was positive related to NIHSS score (r_s=0.265,P<0.01). ⑤The serum H-FABP and NSE of ACI group decreased after treatment as comparing with before treatment(P<0.05,P<0.01). The different values of serum H-FABP and NSE were positive related to different values of NIHSS score before and after treatment (r_s=0.665,0.512,P<0.01).Conclusion The serum H-FABP and NSE would rise abnormally in ACI patients and were positively related to nerve damage and the degree of prognosis. Both indexes can be used as sensitive indicators for disease outcome and prognosis evaluation.

Relationship between PCSK9 and inflammation factor expression in ox-LDL-induced endothelial cells apoptosis

Qian Zhengyao, Li Guangping, Li Jiao, Liang Xue, Xu Zhao, Chen Yan, Zhao Hui

2016, 31(4):  396-402.  doi:10.3969/j.issn.1004-583X.2016.04.013

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Objective To investigate the relationship between proprotein convertase subtilisin/kexin type 9 (PCSK9) and inflammatory factor expression in apoptosis of human umbilical vein endothelial cells (HUVECs) induced by oxidized low density lipoprotein(ox-LDL).Methods HUVECs were incubated with ox-LDL for different times (0 h,12 h,24 h,36 h,48 h). The mRNA and protein expression of PCSK9, inter leukin 6(IL-6), monocyte chemotactic protein-1(MCP-1), matrix metalloprotein-9(MMP-9), C-reactive protein (CRP) and the nucler displacement of nucler factor-kappa B (NF-κB) were detected. The siRNA for PCSK9 was designed and synthesized,then was transfected into HUVECs by Lipofectamine 2000. After transfection for 6 h, cells were treated with ox-LDL for 24 h, the mRNA and protein expression of PCSK9, IL-6, MCP-1, MMP-9, CRP and the nucler displacement of NF-κB were detected.Results With the increase of ox-LDL processing time, the mRNA expressions of PCSK9, IL-6, MCP-1, MMP-9 and CRP were significantly higher, and the nucler displacement of NF-κB was significantly increased, especially for 24 h incubation, and the subsequent expression and the nucler displacement were gradually decreased (P<0.05). The protein concentration of IL-6, MCP-1, CRP and MMP-9 in cell culture supernatant increased gradually over time, and reached the peak at 48 h. Compared with the 0 h group, the 48 h group increased most obviously (P<0.01). The mRNA and protein expressions of PCSK9, IL-6, MCP-1, MMP-9, CRP and the nucler displacement of NF-κB in siRNA group were significantly lower than those in negative transfection group (P<0.01).Conclusion PCSK9 siRNA can inhibit inflammation factor expression in apoptosis of HUVECs induced by ox-LDL. And PCSK9 may be involved in the regulation of inflammation.

Efficacy and safety of ticagrelor treated on patients with low clopidogrel response

Liu Xiaoyu, Jia Guowei, Sun Rongguo, Zhang Wei, Ma Bocong, Zhao Ming, Zhang Hongbin

2016, 31(4):  403-406.  doi:10.3969/j.issn.1004-583X.2016.04.014

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Objective To observe the efficacy and safety of ticagrelor treated on patients with low clopidogrel response.Methods A total of 173 of 493 patients undergoing percutaneous coronary intervention(PCI)with acute coronary syndrome(ACS) were selected as low colpidogrel response identified by thrombelastography and enrolled in this study. Patients with low clopidogrel response were randomized into clopidogrel treated group(n=87) and ticagrelor treated group(n=86). Patients responding to clopidogrel were still treated with clopidogrel(75 mg daily)and patients with low clopidogrel response received ticagrelor treatment(90 mg twice daily). Platelet aggregation rate was compared between two groups after treatment for 3 days, 7 days and 30 days. All patients were followed 12 months for major adverse cardiovascular events(MACCE) and bleeding events.Results Patients in ticagrelor treated group showed significantly lower platelet aggregation rate compared with patients in clopidogrel treated group after 3 days, 7 days, and 30 days (P<0.05). Patients in ticagrelor treated group showed significantly lower MACCE rate compared with patients in clopidogrel treated group in the postoperative 12 months' follow-up(P<0.05). There were no significant difference in bleeding events(P＞0.05).Conclusion Ticagrelor therapy can achieve ideal antiplatelet effects for patients with low clopidogrel response. For the patients with low clopidogrel response receiving PCI, ticagrelor can be an effecive and safe choice for antiplatelet therary.

Qualitative estimation of right ventricular function and pulmonary artery obstruction degree after acute pulmonary embolism with computed tomographic pulmonary angiography

Yang Jiping, Niu Caihong, Qi Jinchong, Yang Bei, Xiu Baoxin, Cao Qizhen, Song Peng, Geng Zuojun

2016, 31(4):  407-410.  doi:10.3969/j.issn.1004-583X.2016.04.015

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Objective To qualitatively evaluate the right ventricular function and the pulmonary artery obstruction degree in patients of acute pulmonary embolism (APE) with computed tomographic pulmonary angiography (CTPA).Methods Retrospective assessment was made in 75 APE patients, mean age (59.2±13.3) years; range 25-80 years; 33 women. CT pulmonary angiography examinations were performed in the patients. CT pulmonary artery obstruction scores (OS) were used in the assessment of pulmonary arterial obstruction severity. All patients were divided into mild (n=18), moderate (n=25), or severe groups (n=32) according to OS <30%, 30%-50%, ≥50% respectively. Right ventricular function was assessed on CT in all patients by measuring right ventricular short axis diameter(RVd), left ventricular short axis diameter (LVd), RVd to LVd(RVd/LVd) ratio, main pulmonary artery, azygos vein, superior vena cava diameters. Also, these CT parameters for right ventricular function were compared among three groups.Results The correlation between CT pulmonary artery OS and cardiovascular parameters was significant (P<0.01). The cardiovascular parameters including RVd, RVd/LVd ratio, main pulmonary artery diameter, azygos vein diameter, superior vena cava diameter in patients with moderate and severe APE (OS 30%-50% and OS≥50%, respectively) were higher than those with mild APE (OS<30%) (P<0.05). And LVd in patients with moderate and severe APE was lower than that with mild APE (P<0.05). In the meantime, comparison of cardiovascular parameters between patients with moderate and severe APE showed significant differences (P<0.05).Conclusion Quantitative CT parameters prove useful in evaluating the right ventricular function and the pulmonary artery obstruction degree in APE, and there was significant correlation between the right ventricular function and the pulmonary artery obstruction degree.

Clinical analysis of 103 patients with subacute combined spinal core degeneration

Wang Lijuan,Gu Shue,Ma Yanru, Niu Xiaoyan, Liu Qiang

2016, 31(4):  411-413.  doi:10.3969/j.issn.1004-583X.2016.04.016

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Objective By analyzing the clinical characteristics of subacute combined spinal core degenerationin (SCD),to improve recognition and early diagnosis.Methods The general clinical data, nerve function defect situation, and related examination results were collected and analyzed retrospectively in 103 patients with clinically confirmed SCD.Results All 103 patients had nerve function defect. Reduced hemoglobin was found in 48 of 103 cases (46.6%), reduced mean corpuscular volume in 59 of 103 cases(57.3%) and reduced mean corpuscular hemoglobin in 62 of 103 cases(60.2%). The serum vitamin B12 was lower than before the disease onset in 52 of 93 cases (55.9%). 46.1% in 91 patients were observed with the lower folic acid level. Elevated homocysteine and cerebrospinal fluid protein level were observed in 80.6% and 27% patients respectively. 58 of 79 patients(73.4%) showed abnormal changes in electromyography, 93.3% patients(56/60) the abnormal somatosensory evoked potentials (SEP),49.4% of the patients were found lesions by magnetic resonance imaging,the lesions involved thoracic cord, cervical cord and cerebral white matter.Conclusion The clinical manifestations and auxiliary examination of SCD are diversified. The high rate in misdiagnosis existed, comprehensive consideration played an important role in the diagnosis of SCD.

Study on using ROC curve evaluation of α-L-fucosidase, 5'-nucleo tidase and alpha fetoprotein diagnostic and predictive value in hepatocellular carcinoma

Liu Huimin,Liu Ping

2016, 31(4):  414-417.  doi:10.3969/j.issn.1004-583X.2016.04.017

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Objective To explore the diagnosis value of α-L-fucosidase (AFU),5'-nucleo tidase (5’-NT) and alpha fetoprotein (AFP) detection in patients with primary hepatic carcinoma(PHC).Methods The study involved 40 patients with hepatocellular carcinoma as experimental group and 60 cases of physical examination as control group, using ROC curve to make a comparative analysis. The patients with hepatocellular carcinoma who experienced surgical treatment were followed up for average six months.The patients were divided into relapse group and non-recurrent group, to AFU, 5 - NT, AFP levels were detected to assess the predictive value.Results The level of AFU,5’-NT and AFP in PHC group were higher than those in control group (P<0.05).The area under the ROC curve for the three indexes were 0.904, 0.870 and 0.866,respectively. The concentrations of AFU in preoperative and postoperative detection were significantly higher than those of non-recurrent group. However, 5 - NT concentration showed no statistic difference between preoperative and postoperative concentration detection. Preoperative concentration of AFP was no significantly higher than that of non-recurrent group, but preoperation concentration of AFP was significantly higher than that of non recurrent group.Conclusion ROC curve suggests that the combined detection of AFU and 5' –NT is superior to any single index in PHC diagnosis.It can greatly increase the detection of PHC. AFU could be used as early recurrence indicator of PHC.

Meta-analysis of stroke risk factors among Chinese women

Wang Xiaolin, Xie Ying, Du Hongzhen, Li Zengning

2016, 31(4):  418-422.  doi:10.3969/j.issn.1004-583X.2016.04.018

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Objective To evaluate stroke risk factors in Chinese women.Methods A comprehensive quantitative analysis was conducted by Meta analysis method, on the domestic research results of stroke risk factors of Chinese women .Using RevMan5.1 test for heterogeneity was performed, pooled OR value and 95% confidence interval calculated.Results The pooled OR values of the relationship of passive smoking, obesity, oral contraceptives were OR 2.11,95%CI 1.19-3.74,P=0.01;OR 1.18;95%CI 1.01-1.38,P=0.04;OR 1.64,95%CI 1.18-2.28,P=0.003,respectively, and there were significant differences. The analytical result of sensitivity proved that the results of Meta-analysis were coherent.Conclusion The available evidence suggested that passive smoking, obesity and oral contraceptives are the risk factors for stroke in Chinese women.

Interpretation of the guidelines for prevention and control of lika virus disease released by American center for disease control and prevention

Song Ning,Guo Xianli,Liu Yue,Yuan Shengfang,Jia Weihua

2016, 31(4):  423-429.  doi:10.3969/j.issn.1004-583X.2016.04.019

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Recently,United States Center for Disease Control and Prevention (CDC) released several guidelines for the evaluation and testing of Zika virus (ZIKV) in neonatal, infant,young children and pregnant women during a ZIKV outbreak, and published an interim guideline for the prevention of sexual transmission of ZIKV.This paper reviewed the current research progress of ZIKV and Zika virus disease (ZVD),and interpreted the CDC guidelines.The course covered biological characteristics, epidemic trends, clinical manifestations, route of transmission, laboratory examinations, diagnostic criteria,treatments and prevention protocols of ZIKV infection and ZVD in special population groups and etc,in order to improve the clinicians' understanding of ZIKV and ZVD.