Staging of liver fibrosis or cirrhosis: The role of hepatic venous pressure gradient measurement

Liver fibrosis is a common histological change of chronic liver injury and it is closely related with portalhypertension which is hemodynamic complication of chronic liver disease. Currently, liver fibrosis has been known as a reversible dynamic process in previous literatures. Although liver biopsy is a gold standard for assessing the stage of liver fibrosis, it may not completely represent the stage of liver fibrosis because of sampling error or semi-quantative measurement. Recent evidences suggested that histologic, clinical, hemodynamic, and biologic features are closely associated in patients with chronic liver disease. Hepatic venous pressure gradient(HVPG) measurement has been known as a modality to evaluate the portal pressure. The HVPG measurement has been used clinically for fibrosis diagnosis, risk stratification, preoperative screening for liver resection, monitoring the efficacy of medical treatments, and assessing the prognosis of liver fibrosis. Therefore, the HVPG measurement can be used to monitor areas the chronic liver disease but also other important areas of chronic liver disease.     

氨甲环酸减少双侧全膝关节置换失血量的有效性及安全性评价

背景：双膝关节置换后出血量及输血需求较大,因此氨甲环酸等止血药物在全膝关节置换中的应用成为近来的研究热点,大量研究证明氨甲环酸能有效减少该类患者的失血量,但专门针对双侧全膝关节置换患者的研究较少。 目的：观察氨甲环酸对双侧全膝关节置换患者围术期出血量、血红蛋白变化的影响,并探讨其安全性。 方法：选取69例需进行双侧全膝关节置换的患者,随机分为两组,试验组给予氨甲环酸1 g溶于100 mL 5%葡萄糖溶液中静脉滴注,对照组给予5%葡萄糖溶液       100 mL静脉滴注。比较两组患者的总失血量、术中失血量、隐性失血量、置换后引流量、输血率、血红蛋白、D-二聚体、凝血酶原时间和活化部分凝血酶时间等指标的动态变化情况,并对比两组患者血栓事件的发生率。 结果与结论：试验组的失血量明显低于对照组(t=2.194-2.908,P < 0.05),输血率也明显低于对照组(χ2=5.219,P=0.022)。比较置换后第3天和第5天的血红蛋白量,试验组明显高于对照组(t=-3.481,2.319,P < 0.05)。置换前、置换后两组患者的凝血酶原时间、活化部分凝血酶时间差异无显著性意义(P > 0.05)。两组患者置换后均未出现血栓栓塞事件,置换后下肢静脉彩超检查未见深静脉血栓形成。上述结果提示氨甲环酸能显著减少双侧全膝关节置换患者的围术期失血量,降低对输血的需求,减少血红蛋白的动态变化,同时不增加血栓形成的风险。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程       

高龄全膝关节置换中全麻和硬膜外麻醉对凝血功能的影响

背景：在行全膝关节置换的高龄患者围手术期,维持正常的凝血功能至关重要。但多种因素会对患者的围手术期凝血功能产生影响,其中麻醉是一重要的因素。不同的麻醉方式会对患者的凝血功能产生不同的影响,临床需要积极的选择适当的麻醉方式以维持稳定的凝血功能。 目的：观察全麻和硬膜外麻醉在高龄全膝关节置换中的应用及对患者凝血功能的影响。 方法：回顾性分析山东省立集团东营医院2012年9月至2013年9月收治的135例行全膝关节置换高龄患者的临床资料,按照麻醉方式分为两组,对照组67例给予全身麻醉,观察组68例给予硬膜外麻醉。观察两组患者麻醉前、麻醉后6 h、置换后第1天清晨的凝血指标和D-二聚体水平变化,随访12个月检测两组深静脉血栓发生情况,并进行比较。 结果与结论：经统计和比较,两组患者在不同时间点的凝血功能各项指标差异均无显著性意义(P均 > 0.05);但两组患者的D-二聚体水平在麻醉后6 h以及置换后第1天清晨差异有显著性意义,观察组显著低于对照组(P均< 0.05);观察组和对照组的置换后深静脉血栓发生率分别为3%和21%,差异有显著性意义(P < 0.05)。表明在高龄全膝关节置换中对患者实施硬膜外麻醉可以获得更好的应用效果,维持稳定的凝血功能状态。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

髋关节置换后下肢深静脉血栓形成的血液动力学改变

背景：髋关节置换后下肢深静脉血栓的早期诊断非常重要,对及时治疗及疗效判断也具有十分重要的意义。 目的：观察髋关节置换后并发下肢深静脉血栓患者的血液改变情况,为早期预测和干预提供参考。 方法：2009年1月至2014年9月收治60例髋关节置换患者,其中置换后并发下肢深静脉血栓者32例(下肢深静脉血栓组),未并发下肢深静脉血栓者28例(非下肢深静脉血栓组)。分别于置换后1,3,5 d检测患者的血流变指标改变情况。 结果与结论：通过检测显示,下肢深静脉血栓组置换后各种凝血标记物均异常高于非下肢深静脉血栓组,表明置换后患者的血液高凝状态度与下肢深静脉血栓的发生有密切相关的关系;而下肢深静脉血栓组置换后3,5 d D-二聚体、纤维蛋白原水平显著高于非下肢深静脉血栓组,说明D-二聚体、纤维蛋白原水平的增高与置换后发生下肢深静脉血栓呈正相关关系,提示对髋关节置换后应对患者进行动态的血液监测,如果各检测结果呈持续性增高,则应怀疑是否有血栓的发生,并及早采取预防措施。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

面颈深部静脉畸形和淋巴管畸形的彩色多普勒超声鉴别诊断

目的 分析面颈深部静脉畸形和淋巴管畸形的彩色多普勒超声特点,总结其鉴别诊断要点,探讨彩色多普勒超声在2种深部病变鉴别诊断中的意义。方法 回顾分析2012年12月—2013年12月临沂市肿瘤医院收治的经手术病理或DSA下经皮穿刺瘤体造影确诊的32例静脉畸形和29例面颈部淋巴管畸形的临床和彩色多普勒超声资料,分析静脉畸形和淋巴管畸形的彩色多普勒超声特点,以病理诊断或DSA诊断为金标准,应用SPSS 18.0软件包对数据进行统计学分析,计量特异度和敏感度。结果 32例静脉畸形病例,二维超声均显示无回声,无间隔,14例病变内见低回声血栓,11例内见高回声静脉石。多普勒超声均见周边动脉血流, PSV为(13.98±7.93) cm/s,RI为(0.71±0.83) cm/s, 30例探头加压可见静脉频谱的血流信号;29例淋巴管畸形病例,单囊者8例,多囊者10例,网格状11例,二维超声也均呈无回声,但21例病变内可见多发强回声间隔;多普勒超声2例探头加压见血流信号,PI下为静脉频谱,间隔内均可见动脉血流信号,PSV为(14.32±6.57) cm/s,RI为(0.68±0.79) cm/s。经t检验,2组PSV和RI比较无显著差异（P均>0.05）。经χ²检验2组低回声血栓、高回声静脉石、探头加压见血流信号和多发强回声间隔出现率,有显著差异（P<0.05）。探头加压见血流信号诊断静脉畸形的敏感度为93.75%,低回声血栓、高回声静脉石和探头加压见血流信号诊断静脉畸形的特异度较高,分别为96.55%、93.33%和100%。多发强回声间隔诊断淋巴管畸形的敏感度和特异度较高,分别为72.41%和100%。结论 彩色多普勒超声鉴别面颈深部静脉畸形和淋巴管畸形具有无创、价廉、准确的特点。病变内出现低回声血栓或高回声静脉石,探头加压出现血流信号支持静脉畸形诊断;病变内有多发强回声间隔,同时间隔内见动脉血流信号时支持淋巴管畸形诊断。     

小型猪静脉增流DIEP皮瓣的血流动力学研究

目的 研究静脉增流对小型猪腹壁下动脉穿支(DIEP)皮瓣成活面积的影响及其血流动力学特点。方法 选取24头小型猪,在其腹部形成模拟增流DIEP皮瓣和传统DIEP皮瓣,并进行相应指标测量。包括皮瓣的血流灌注,静脉血管的压力,以及静脉血气分析。血流动力学测量后,所有腹部皮瓣原位缝合,随机选取12只形成静脉增流的DIEP皮瓣(实验组),其余12只为传统的DIEP皮瓣(对照组)。术后7 d进行活检,测量皮瓣的成活面积。结果 在静脉增流模式下,各血流动力学指标均较无增流情况下明显改善。对照组皮瓣成活率为(82.1±7.6)%,实验组为(99.4士1.2)%,差异显著。结论静脉增流技术可显著改善DIEP皮瓣灌注并增加皮瓣成活面积。就大面积皮瓣而言,静脉增流技术是改善静脉淤血和增大皮瓣成活面积的可靠方式。     

恶性肿瘤、化学治疗与静脉血栓栓塞性疾病的关系研究进展

静脉血栓栓塞性疾病是恶性肿瘤的常见并发症之一,尤其是对于接受化学治疗的患者,其发生率更高。静脉血栓栓塞性疾病可引发致命性后果,从而增加恶性肿瘤患者的死亡率。本文拟对恶性肿瘤、化学治疗与静脉血栓栓塞性疾病的关系作一总结,并对其临床表现、治疗、预后进行综述,以期提高认识．做好防治工作。     

Chronic lymphocytic leukaemia is a risk factor for venous thromboembolism

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in cancer patients. The literature is sparse on the incidence in the most common lymphoid malignancy, chronic lymphocytic leukaemia (CLL). We calculated the incidence rates for VTE in an unselected UK CLL clinic population at 1.45% per patient year. This represents a tenfold increase over previously published estimates of incidence in the general population and a twofold increase over that of the local hospital inpatient population. In our cohort, the risk of VTE was related to stage C disease. Clinicians should be aware that CLL patients are at risk of VTE.     

Little impact of antiplatelet agents on venous thromboembolism after hip fracture surgery

Since the late 1980s, low dose aspirin has been used to prevent stroke and ischemic heart disease. However, prophylactic effect of antiplatelets against venous thromboembolism (VTE), in patients who undergo hip fracture surgery (HFS) is controversial. Our purpose was to determine the incidence of symptomatic VTE after HFS and to evaluate whether antiplatelets reduce the development of symptomatic VTE following HFS. We retrospectively reviewed 858 HFS in 824 consecutive patients which were performed from May 2003 to April 2010 at an East Asian institute. We compared the incidence of symptomatic VTE in antiplatelet users and non-users using multivariate logistic regression analyses. Overall incidences of symptomatic pulmonary embolism including fatal pulmonary embolism, and symptomatic deep vein thrombosis in this study were 2.4% (21/858), and 3.5% (30/858), respectively. The incidence of symptomatic VTE was 4.8% (12/250) in antiplatelet users and 4.3% (26/608) in non-users (P = 0.718). It is suggested that antiplatelet agents are not effective in prevention of symptomatic VTE after HFS.     

Familial cardiac valvulopathy due to filamin A mutation

We report on the clinical findings in siblings affected by the recently characterized X-linked form of hereditary cardiac valvular dystrophy or cardiac valve disease (OMIM 314400) due to mutations in the FLNA gene and review the literature on this condition. Although FLNA related cardiac valve disease is presumed to be a rare disorder, it is likely underdiagnosed. Several features of this condition may aid in its identification. FLNA related valvular disease can be recognized on the basis of its distinctive inheritance, early age of onset, and frequent multi-valve involvement.