低分子肝素预处理对髋关节置换中骨水泥填充后凝血指标改变的影响

目的探讨髋关节置换术中填充骨水泥时用低分子肝素预处理对患者的凝血机制的影响。方法老年股骨颈骨折患者行人工关节置换术患者60例,随机分为两组,对照组股骨颈骨折行人工关节置换术前未预先用药;实验组股骨颈骨折在行人工关节置换术前12小时皮下给予常规剂量低分子肝素注射。观察两组在填充骨水泥前后PT、APTT、FIB、TT及D-二聚体的变化。结果对照组在填充骨水泥前后PT缩短,FIB和D-二聚体在注入骨水泥后增多,APTT及TT在骨水泥注入前后变化不明显。实验组中在填充骨水泥前后PT、APTT、TT及FIB变化不明显,D-二聚体增多。结论骨水泥充填前用低分子肝素预处理,可以明显减少凝血指标的波动,减少血管内凝血发生的机会,对早期深静脉血栓的形成有预防作用。     

Significance of Decreased Plasma D-Dimer Levels following Lipopolysaccharide-Induced Disseminated Intravascular Coagulation in Rats

Plasma D-dimer (DD) is considered to be one of the most useful markers in the diagnosis and assessment of disseminated intravascular coagulation (DIC). The present study was performed to clarify the role of DD in a rat model of lipopolysaccharide (LPS)-induced DIC in which low-molecular-weight heparin (LMWH) and tranexamic acid (TA) were used. We investigated whether a relationship exists between plasma DD levels and severity of DIC. Experimental DIC was induced in rats by a sustained 4-hour infusion of 30 mg/kg LPS administered via the tail vein (LPS group). Rats received either LPS alone (LPS group) or LPS combined with 200 U/kg LMWH (LPS+LMWH group) or 50 mg/kg TA (LPS+TA group) from -30 minutes to 4 hours. Blood was drawn from each rat at 4, 8, and 12 hours. Plasma levels of thrombin-antithrombin complex (TAT) and creatinine were suppressed in the LPS+LMWH group, and less glomerular fibrin deposition was observed compared with the LPS group. On the other hand, an increased level of creatinine and increased glomerular fibrin deposition were observed in the LPS+TA group compared with the LPS group. LMWH demonstrated a protective effect against LPS-induced DIC, resulting in increased survival at 12 hours, whereas TA had the opposite effect. From these results, it appears that LMWH protects against LPS-induced DIC, but TA exacerbates LPS-induced DIC. It was interesting that plasma levels of DD were almost completely suppressed by concurrent administration of either TA or LMWH in this LPS-induced DIC model. This finding suggested that plasma levels of DD were suppressed by inhibition of coagulation (reduced deposition of fibrin) in the LPS+LMWH group and that DD levels were also suppressed by inhibition of fibrinolysis (reduced degradation of fibrin by plasmin) in the LPS+TA group. Thus care should be taken when evaluating the significance of plasma DD levels, because suppressed levels can occur with progressive fibrin deposition and worsening organ dysfunction or improvement in the course of DIC.     

低分子肝素治疗早发型子痫前期及预防再发的系统评价

目的 评价低分子肝素治疗早发型子痫前期及预防再发的疗效和安全性.方法 应用RevMan 4.2软件对检索的15项随机对照试验研究进行统计学分析.结果 联合使用低分子肝素能明显延长孕周时间(WMD=4.50,95％CI:3.27～5.72,P＜0.00001),并降低围生儿死亡率(WMD=0.35,95％CI:0.19～0.67,P=0.001);降低新生儿窒息率(WMD=0.34,95％ CI:0.17～0.69,P=0.003);不增加产后出血量(WMD=-2.22,95％CI:-14.33～9.9,P=0.72),提示肝素对产后出血量无影响;且不增加胎盘早剥的发生(WMD=0.31,95％CI:0.05～2.08,P=0.23),早发型子痫前期再度发生的相对危险度、相对危险降低率均降低(RR=0.12,P=0.04,95％ CI:0.02～0.91,RRR为88.3％).结论 联合低分子肝素治疗早发型子痫前期可以延长孕周时间,降低围生儿死亡及新生儿窒息率,且不增加产后出血及胎盘早剥的发生,是预防早发型子痫前期发生的保护因素.     

Fucoidan induces apoptosis of HepG2 cells by down-regulating p-Stat3

Summary： Fucoidan is one of the main bioactive components of polysaccharides. The current study was focused on the anti-tumor effects of fucoidan on human heptoma cell line HepG2 and the possible mechanisms. Fucoidan treatment resulted in cell cycle arrest and apoptosis of HepG2 cells in a dose-dependent manner detected by MTT assay, flow cytometry and fluorescent microscopy. The results of flow cytometric analysis revealed that fucoidan induced G2/M arrest in the cell cycle progression. Hoechst 33258 and Annexin V/PI staining results showed that the apoptotic cell number was increased, which was associated with a dose-dependent up-regulation of Bax and down-regulation of Bcl-2 and p-Stat3. In parallel, the up-regulation of p53 and the increase in reactive oxygen species were also observed, Which may play important roles in the inhibition of HepG2 growth by fucoidan. In the meantime, Cyelin B 1 and CDK1 were down-regulated by fucoidan treatment. Down-regulation of p-Stat3 by fucoidan resulted in apoptosis and an increase in ROS in response to fucoidan exposure. We therefore concluded that fucoidan induces apoptosis through the down-regulation of p-Stat3. These results suggest that fucoidan may be used as a novel anti-cancer agent for hepatocarcinoma.     

低分子肝素治疗急性冠状动脉综合征患者的疗效观察

目的观察单用阿斯匹林和联合低分子肝素(法安明)治疗急性冠状动脉综合征(ACS)的临床疗效。方法将78例急性冠状动脉综合征,包括不稳定心绞痛和非 ST 段抬高的心肌梗死患者。随机分为对照组(阿斯匹林)及治疗组(阿斯匹林 法安明)疗程为一周,观察治疗前后:(1)临床疗效;(2)凝血指标的变化;(3)治疗后30天心绞痛再发率,急性心肌梗死(AMI)发生率。结果低分子肝素组总有效率91.43%,对照组总有效率58.3%(P<0.05)治疗组未发生不良反应。观察30天内心绞痛再发率及 AMI 发生率;治疗组12%和0,对照组39%和6.1%(P<0.05)。结论在常规阿斯匹林治疗基础上加用法安明,能更有效地控制心绞痛发作,减少心肌梗死发生率。     

海带褐藻多糖硫酸酯的抗氧化活性研究

目的 研究海带褐藻多糖硫酸醋的抗氧化作用。方法 采用体外实验研究海带褐藻多糖硫酸醢对超氧阴离子、羟自由基、DPPH的清除作用以及对H2O2诱导的红细胞氧化溶血和大鼠肝匀浆脂质过氧化的保护作用。结果 海带褐藻多糖硫酸醋对超氧阴离子具有良好的清除作用，IC50为20．3μg／mL，其对羟自由基的清除作用较弱，对有机自由基DPPH的作用很弱。褐藻多糖硫酸醋能够抑制H2O2诱导的红细胞氧化溶血，对FeSO4-抗坏血酸体系造成的脂质过氧化具有良好的保护作用。结论 海带褐藻多糖硫酸醋具有显著的体外抗氧化活性。     

Biological monitoring of three antithrombotic drugs: single dose therapy

A randomised study using 40 New Zealand White male rabbits was performed to compare the effects of three antithrombotic drugs on eight clinical haemostatic function tests. The animals were divided into four treatment groups. The treatment groups were saline (control), unfractioned heparin (UFH), low-molecular-weight heparin (LMWH), and recombinant hirudin (r-hirudin).Blood samples were collected 2 and 12 h after administration of the drugs. The following tests were performed: bleeding time (BT), platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen concentration (Fg), antithrombin III (ATIII), and antifactor Xa activity (antiXa activity). Effects attributable to drug treatment for each analyte were determined by comparison with the control group.At 2 h after medication, in the UFH treated group, TT was moderately prolonged (p<0.05) and antiXa activity was significantly higher (p<0.05) than the respective values of the control group. In the LMWH-treated group the antiXa activity was significantly higher (p<0.01) than that of the control group. In the r-hirudin-treated group, the APTT and TT were significantly prolonged (APTT,p<0.01; the TT samples did not clot) when compared to the control group. However, 12 h after administration, no significant differences (p>0.05) between groups were observed for any of the studied analytes. It might be concluded that the antiXa assay has the potential of being a sensitive screen for heparin therapy and that the absence of changes in the bleeding time, antithrombin III, and antiXa assays —with a markedly prolonged thrombin time - indicates that,in vivo, r-hirudin acts as a specific inhibitor of thrombin.     

Pseudomyxoma peritonei due to mucinous cystadenocarcinoma in situ of the urachus presenting as an inguinal hernia

Pseudomyxoma peritonei is generally caused by appendiceal and ovarian tumors. Other primary sites have been rarely reported. We describe herein the second reported case of pseudomyxoma peritonei due to mucinous cystadenocarcinoma of the urachus. A 54-year-old man was admitted with a left inguinal hernia that had developed several months prior to his admission. During herniorrhaphy, we found a large amount of gelatinous mucinous material in the indirect-hernia sac and made a diagnosis of pseudomyxoma peritonei on cytological grounds. At re-operation, the origin of the pseudomyxoma peritonei proved to be a ruptured urachal cyst. The urachal cyst and the dome of the urinary bladder were excised. In addition, we removed as much of the gelatinous material as possible. On histological examination, a unilocular cyst was found to consist of noninvasive mucinous adenocarcinoma. We succeeded in removing the rest of the mucinous material by postoperative intraperitoneal lavage with dextran solution, and have observed no evidence of recurrence for 7 years since the operation.     

磺达肝葵钠治疗不稳定心绞痛的临床观察

目的:探讨磺达肝葵钠与低分子肝素钙治疗不稳定心绞痛(unstable angina,UA)的临床效果.方法:将40例UA患者随机分为磺达肝葵钠组20例和低分子肝素钙20例.观察两组的临床疗效并记录两组患者住院期间、出院后30 d内发生的心脏事件.结果:磺达肝葵钠组显效12例,有效7例,无效1例,总有效率95.0％;低分子肝素钙组显效11例,有效7例,无效2例,总有效率90.0％.显效率和总有效率比较,差异无统计学意义(P＞0.05).低分子肝素钙组发生出血事件3例,磺达肝葵钠组发生出血事件0例,磺达肝葵钠组与低分子肝素钙组不良反应相比,差异有统计学意义(P＜0.05).结论:在UA的基础治疗上加用磺达肝葵钠或低分子肝素钙治疗的死亡终点,没有区别,但磺达肝葵钠与低分子肝素钙组比较明显减少了出血.     

Venous Thromboembolism: A Review of Risk and Prevention in Colorectal Surgery Patients

Hospitalization for surgery has a high risk of developing venous thromboembolism, a condition that encompasses both deep-vein thrombosis and its potentially fatal complication, pulmonary embolism. Colorectal surgery implies a specific high risk for postoperative thromboembolic complications relative to other general surgery. This may be a result of pelvic dissection, the perioperative positioning of these patients, or the presence of additional risk factors common to this patient group, such as cancer, advanced age, or inflammatory bowel disease. The potential impact of venous thromboembolism and the need for effective thromboprophylaxis often are underestimated in these patients. Recommendations for thromboprophylaxis in colorectal surgery patients are based on the American College of Chest Physicians guidelines for thrombosis prevention in general surgery patients, with treatment stratified according to the type of surgery and additional venous thromboembolism risk factors present. Prophylaxis with low-molecular-weight heparin or unfractionated heparin is recommended for colorectal surgery patients classified as moderate to high risk. The small number of studies focusing specifically on colorectal patients, or on cancer or abdominal surgery patients with a colorectal subgroup, has shown that both low-molecular-weight heparin and unfractionated heparin can effectively reduce the incidence of venous thromboembolism. Low-molecular-weight heparin has the practical advantage of once-daily administration and shows a lower risk of heparin-induced thrombocytopenia. This review will assess the risk of venous thromboembolism in colorectal surgery patients and discuss current evidence-based guidelines and recommendations for prevention of venous thromboembolism. Funded by Sanofi-Aventis, NJ. Reprints are not available.