94例老年人凝血象的观察

凝血象的检测对老年人的健康具有十分重要的参考价值.为此我们对94例老年人的凝血酶原时间(PT)、凝血酶时间(TT),纤维蛋白原(Fbg)含量、活化部分凝血活酶时间(APTT)进行了检测,并对其结果进行了分析.

干扰素增强双香豆素的作用

在丙型肝炎患者服用双香豆素期间,同时使用干扰素,作者发现双香豆素的抗凝作用增强,血清中双香豆素的浓度增高,以至必须减少其用量。一名32岁的女性病人,因1985年心脏外科手术,输血后染上丙型肝炎。术后接受双香豆素治疗,剂量维持在3.5mg～2.5mg/d之间。

Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

AIM:To compare the incidence of early portal or splenic vein thrombosis(PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.METHODS:We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010.Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation,respectively.Group A(153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin(LMWH) irregularly.Group B(148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery,followed by oral warfarin and aspirin for one month regularly.The target prothrombin time/international normalized ratio(PT/INR) was 1.25-1.50.Platelet and PT/INR were monitored.Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.RESULTS:The patients' data were collected and analyzed retrospectively.Among the patients,94 developed early postoperative mural PSVT,including 63 patients in group A(63/153,41.17%) and 31 patients in group B(31/148,20.94%).There were 50(32.67%) patients in group A and 27(18.24%) in group B with mural PSVT in the main trunk of portal vein.After the administration of thrombolytic,anticoagulant and antiaggregation therapy,complete or partial thrombus dissolution achieved in 50(79.37%) in group A and 26(83.87%) in group B.CONCLUSION:Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization,and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy.Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.

Preoperative predictors of portal vein thrombosis after splenectomy with periesophagogastric devascularization

AIM:To evaluate the predictive value of preoperative predictors for portal vein thrombosis(PVT)after splenectomy with periesophagogastric devascularization.METHODS:In this prospective study,69 continuous patients with portal hypertension caused by hepatitis B cirrhosis underwent splenectomy with periesophagogastric devascularization in West China Hospital of Sichuan University from January 2007 to August 2010.The portal vein flow velocity and the diameter of portal vein were measured by Doppler sonography.The hepatic congestion index and the ratio of velocity and diameter were calculated before operation.The prothrombin time(PT)and platelet(PLT)levels were measured before and after operation.The patients'spleens were weighed postoperatively.RESULTS:The diameter of portal vein was negatively correlated with the portal vein flow velocity(P<0.05).Thirty-three cases(47.83%)suffered from postoperative PVT.There was no statistically significant difference in the Child-Pugh score,the spleen weights,the PT,or PLT levels between patients with PVT and without PVT.Receiver operating characteristic curves showed four variables(portal vein flow velocity,the ratio of velocity and diameter,hepatic congestion index and diameter of portal vein)could be used as preoperative predictors of postoperative portal vein thrombosis.The respective values of the area under the curve were 0.865,0.893,0.884 and 0.742,and the respective cut-off values(24.45 cm/s,19.4333/s,0.1138 cm/s-1 and 13.5 mm) were of diagnostically efficient,generating sensitivity values of 87.9%,93.9%,87.9%and 81.8%,respectively,specificities of 75%,77.8%,86.1%and 63.9%,respectively.CONCLUSION:The ratio of velocity and diameter was the most accurate preoperative predictor of portal vein thrombosis after splenectomy with periesophagogastric devascularization in hepatitis B cirrhosis-related portal hypertension.

Sulfated polysaccharides with antioxidant and anticoagulant activity from the sea cucumber Holothuria fuscogliva

Sea cucumber is a traditional nutritional food and medicinal resource with many bioactive components in China. Holothuriafuscogliva is a big sea cucumber with a rich of bioactive polysaccharides. To investigate the bioactivities of the polysaccharides from sea cucumber H. fuscogliva, we prepared the sulfated polysaccharides （HfP） from sea cucumber H. fuscogliva using a protease hydrolysis method. Antioxidant activities of HfP were investigated, including hydroxyl radical scavenging activity and superoxide radical scavenging activity. And, the anticoagulant activities of HfP were studied, including the activated partial thromboplastin time （APTT）, prothrombin time （PT） and thrombin time （TT）. The average molecular weight was 1 867.1 Da, with a sulfate content of 20.7%. In addition, the molar ratio of monosaccharide composition of HfP was Man： Rha： Glc A： Glc： Gal： Xyl： Fuc=0.083 6： 0.437： 0.134： 0： 1.182： 0.748： 1. It had a strong antioxidant activity, the hydroxyl and superoxide radical scavenging activity ECs0 of HfP was 3.74 and 0.037 mg/mL, respectively. It also showed a good anticoagulant activity in our study. The APTT of HfP was much higher than that of heparin sodium, and the PT and TT of HfP was close to that ofheparin sodium at a low concentration. Therefore, HfP shows a good antioxidant and anticoagulant activity and it may become a potential candidate of the natural antioxidant and anticoagulant and will have a good application future in health product or medicine industry.

Liver-protecting effects of omega-3 fish oil lipid emulsion in liver transplantation

AIM:To investigate the liver-protecting effect of parenteral nutrition(PN) support with omega-3 fatty acids in a randomized controlled clinical trial.METHODS:Sixty-six patients with the diagnosis of end-stage liver disease or hepatic cellular carcinoma were admitted to the Affiliated Drum Tower Hospital,Nanjing University,China for orthotopic liver transplantation.The patients were randomly divided into two groups:PN group(n = 33) and polyunsaturated fatty acid(PUFA) group(n = 33).All patients received isocaloric and isonitrogenous PN for seven days after surgery,and in PUFA group omega-3 fish oil lipid emulsion replaced part of the standard lipid emulsion.Liver function was tested on days 2 and 9 after surgery.Pathological examination was performed after reperfusion of the donor liver and on day 9.Clinical outcome was assessed based on the post-transplant investigations,including:(1) post-transplant mechanical ventilation;(2) total hospital stay;(3) infectious morbidities;(4) acute and chronic rejection;and(5) mortality(intensive care unit mortality,hospital mortality,28-d mortality,and survival at a one-year post-transplant surveillance period).RESULTS:On days 2 and 9 after operation,a significant decrease of alanine aminotransferase(299.16 U/L ± 189.17 U/L vs 246.16 U/L ± 175.21 U/L,P = 0.024) and prothrombin time(5.64 s ± 2.06 svs 2.54 s ± 1.15 s,P = 0.035) was seen in PUFA group compared with PN group.The pathological results showed that omega-3 fatty acid supplement improved the injury of hepatic cells.Compared with PN group,there was a significant decrease of post-transplant hospital stay in PUFA group(18.7 d ± 4.0 d vs 20.6 d ± 4.6 d,P = 0.041).Complications of infection occurred in 6 cases of PN group(2 cases of pneumonia,3 cases of intra-abdominal abscess and 1 case of urinary tract infection),and in 3 cases of PUFA group(2 cases of pneumonia and 1 case of intra-abdominal abscess).No acute or chronic rejection and hospital mortality were found in both groups.The one-year mortality in PN group was 9.1%(3/33),one died of pulmonary infection,one died of severe intra-hepatic cholangitis and hepatic dysfunction and the other died of hepatic cell carcinoma recurrence.Only one patient in PUFA group(1/33,3.1%) died of biliary complication and hepatic dysfunction during follow-up.CONCLUSION:Post-transplant parenteral nutritional support combined with omega-3 fatty acids can significantly improve the liver injury,reduce the infectious morbidities,and shorten the post-transplant hospital stay.

In-vitro anticoagulant activity of fucoidan derivatives from brown seaweed Laminaria japonica

Fucoidan, a group of sulfated heteropolysaccharides, was extracted from Laminaria japonica, an important economic alga species in China. The anticoagulant activity of fucoidan and its derivatives (including sulfated, phosphorylated, and aminated fucoidan) was examined using in-vitro anticoagulant systems. The correlation between chemical variations within the fucoidan group and anticoagulant activity was determined. The in-vitro anticoagulant properties of fucoidan and its derivatives were determined by measuring activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT). The results indicate anticoagulant activity in all samples using APTT and TT assays; however, only the fucoidan derivatives affected the PT assay. Thus, the fucoidan derivatives were able to inhibit both intrinsic and extrinsic blood coagulants. Fucoidan (FPS) and its derivatives presented better anticoagulant activity than low molecular weight fucoidan (DFPS) and its derivatives, suggesting that molecular weight and proper conformation are contributing factors for anticoagulant activity of polysaccharides. Amino groups have a positive charge and can thus change the charge density of fucoidan. Accordingly, among the tested samples, aminated fucoidan (NF) was the most active reflecting the importance of charge density for anticoagulant activity. Available data obtained using in-vitro models suggest that the sulfate content, sulfate/total-sugar ratio, molecular weight, and the substituted group of fucoidan are important factors for anticoagulant activity but that the influence of sulfate, phosphate and amino groups on anticoagulant activity was different.

Factors relating to the short term effectiveness of percutaneous biliary drainage for hilar cholangiocarcinoma

AIM: To identify factors that were related to the short term effectiveness of percutaneous transhepatic biliary drainage in cholangiocarcinoma patients and to evaluate the impact of palliative drainage on their survival. METHODS: Seventy-four patients with hilar cholangiocarcinoma who underwent percutaneous biliary drainage were enrolled in the study. The demographic and laboratory data as well as the imaging characteristics were retrospectively analyzed to correlate with the bile output and reduction rate of serum bilirubin 1 wk after drainage.RESULTS: Patients with more bile duct visualized on percutaneous transhepatic cholangiography or absence of multiple liver metastases on imaging studies had more bile output after biliary drainage [odds ratio (OR): 8.471, P = 0.010 and OR: 1.959, P = 0.022, respectively]. Patients with prolonged prothrombin time had a slow decrease in serum bilirubin (OR: 0.437, P = 0.005). The median survival time was not signif icantly different in patients with low or high bile output (75 d vs 125 d, P = 0.573) or in patients with slow or rapid reduction of serum bilirubin (88 d vs 94 d, P = 0.576). CONCLUSION: The short term effectiveness of percutaneous biliary drainage was related to patient's prothrombin time or the extent of tumor involvement. It, however, had no impact on survival.

Study on Coagulation Activity of Callicarpa nudiflora

[Objective] This study aimed to study the coagulation effect of Callicarpa nudiflora. [Method] The effects of CaUtcarpa nudiflora on blood coagulation system of mice were investigated by measuring prothmmbin time （PT）, thrombin time（TT）, activated partial thromboplastin time （APTT） and plasma fibrinogen （FIB）, [Result] Compared with the control group, the crude extracts and ：eluted parts of Ca#/carpa nudiflora all significantly shortened PT, APTT and TT, and increased the content of FIB in mice, [Coadadon] The crude extracts and eluted parts of Callicarpa nudiflora have a coagulation-promoting effect through affecting several links of the coagulation process in mice,

Serum manganese superoxide dismutase and thioredoxin are potential prognostic markers for hepatitis C virus-related hepatocellular carcinoma

AIM:To evaluate the clinical significance of oxidative stress markers in patients with hepatitis C virus(HCV)related hepatocellular carcinoma(HCC).METHODS:Sixty-four consecutive patients who were admitted to Kagoshima University Medical and Dental Hospital were enrolled in this retrospective study.All patients had chronic liver disease(CLD) due to infection with HCV.Thirty patients with HCV-related HCC,34 with HCV-related CLD without HCC(non-HCC),and 20 healthy volunteers(HVs) were enrolled.Possible associations between serum manganese superoxide dismutase(MnSOD) and thioredoxin(TRX) levels and clinical parameters or patient prognosis were analyzed over a mean follow-up period of 31.7 mo.RESULTS:The serum MnSOD levels were significantly higher in patients with HCV-related HCC than in patients without HCC(P = 0.03) or HVs(P < 0.001).Similarly,serum TRX levels were also significantly higher in patients with HCV-related HCC than in patients without HCC(P = 0.04) or HVs(P < 0.01).However,serum levels of MnSOD and TRX were not correlated in patients with HCC.Among patients with HCC,the overall survival rate(OSR) was lower in patients with MnSOD levels ≥ 110 ng/mL than in patients with levels < 110 ng/mL(P = 0.01),and the OSR tended to be lower in patients with TRX levels < 80 ng/mL(P = 0.05).In addition,patient prognosis with HCC was poorest with serum MnSOD levels ≥ 110 ng/mL and serum TRX levels < 80 ng/mL.Furthermore,a multivariate analysis using a Cox proportional hazard model and serum levels of five factors(MnSOD,prothrombin time,serum albumin,serum α-fetoprotein(AFP),and serum des-γ-carboxy prothrombin) revealed that MnSOD levels ≥ 110 ng/mL(risk ratio:4.12,95% confidential interval:1.22-13.88,P = 0.02) and AFP levels ≥ 40 ng/mL(risk ratio:6.75;95% confidential interval:1.70-26.85,P < 0.01) were independent risk factors associated with a poor patient prognosis.CONCLUSION:Serum MnSOD and TRX levels are potential clinical biomarkers that predict patient prognosis in HCV-related HCC.

Ellagic Acid-induced Hypercoagulable State in Animals:a Potentially Useful Animal Hypercoagulable Model for Evaluation of Anticoagulants

Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control group (saline) and three ellagic acid (EA)-treated groups (low, middle, and high doses). In the mice, bleeding time (BT) was estimated with tail transaction, and clotting time (CT) with template method. Prothrombin time (PT) and the activated partial thromboplastin time (APTT) in rats and rabbits were measured by means of Quick's one-stage assay and modified APTT assay respectively. In addition, thrombin activity was estimated in rats with PT assay using a hemagglutination analyzer. The circulating platelet aggregates were de- tected in rabbits through platelet counting and presented as the circulating platelet aggregate ratio (CPAR). Results EA shortened BT and CT in mice, PT and APTT in rats, and increased thrombin activity and CPAR, all in a dose-dependent manner. EA also brought reduction of PT and APTT in rabbits in dose- and time-dependent manners. Conclusion EA could induce hypercoagulable state through activating coagulation system and platelets in mice, rats, and rabbits.

Open Surgical Insertion of Tenkchoff Straight Catheter Without Guide Wire

Objective To compare the clinical outcomes of open surgical peritoneal dialysis catheter （PDC） insertion with guide wire and the outcomes of PDC insertion without guide wire. Methods Data of the patients receiving open surgical Tenkchoff straight catheter insertion in our department from January 2005 to January 2011 were retrospectively analyzed. The 117 patients in whom PDC insertion was conducted with the guidance of guide wire were enrolled into group A, and the 121 cases receiving PDC insertion without guide wire were enrolled into group B. The incidences of post-operative complications （catheter obstruction, catheter displacement, bloody dialysate, and dialysate leakage）, catheter survival, and patient survival rates were compared between the 2 groups. Results The baseline characteristics （gender, age, body mass index, prothrombin time, activated partial thromboplastin time, platelet count, serum creatinine, follow-up time, primary diseases, and outcomes） of the 2 groups were comparable （all P〉0.05）. In post-operative complications, only the incidence of early bloody dialysate showed significant difference, being 16.2% in group A and 7.4% in group B （P=0.04）. Catheter and patient survival rates were not significantly different between the two groups. Overweight patients showed a higher incidence of catheter obstruction compared with normal weight patients [16.0% （4/25） vs. 3.3% （7/213）, P=0.02], but no differences in post-operative between the 2 groups. complications were found among overweight patients Conclusions Open surgical Tenkchoff straight catheter insertion without guide wire does not lead to higher risk of post-operative complications and catheter removal. It may be an alternative option when guide wire is not available.

Chemical Characteristics and Anticoagulant Activities of Two Sulfated Polysaccharides from Enteromorpha linza (Chlorophyta)

Two sulfated polysaccharides, designated MP and SP, were extracted from the marine green alga Enteromorpha linza using hot water and then purified using ion-exchange and size-exclusion chromatography. The anticoagulant activities of MP and SP were examined by determination of their activated partial thromboplastin time （APTT）, thrombin time （TT） and prothrombin time （PT） using human plasma. Results showed that MP and SP were composed of abundant rhamnose with small amounts of xylose and glucuronic acid, whereas SP also contained a small amount of galactose. Approximate molecular weights of MP and SP were 535 and 502 kDa, respectively. As compared with SP, MP had higher contents of sulfate ester （19.0%） and uronic acid （14.9%）. The MP mainly consisted of （1→4）-linked rhamnose residues with partially sulfated groups at the C-3 position, and small amounts of （1→3, 4）-linked rhamnose, （1→2,4）-linked rhamnose, （1→4）-linked glucuronic acid and （1→4）-linked xylose residues. The SP contained abundant （1→4）-linked rhamnose with minor amounts of （1→3）-linked rhanmose, （1→3, 4）-linked rhamnose, （1→2, 4）-linked rhanmose, （1→4）4inked glucuronic acid, （1→4）-linked xylose, and （1→3）-linked galactose residues. The sulfate groups were mainly located at C-3 of （1→4）-linked rhamnose residues. Both MP and SP, in particular the former, effectively prolonged APTT and TT. This work demonstrates that MP and SP have unique structural characteristics distinct from those of other sulfated polysaccharides from Enteromorpha. The MP is a potential source of anticoagulant, and the difference in anticoagulant activities of the two sulfated polysaccharides is directly linked to the discrepancy of their chemical features.

LOW MOLECULAR WEIGHT HEPARIN DECREASES THE ALBUMINURIA AND RENAL PATHOLOGICAL CHANGES IN DIABETIC NEPHROPATHY RATS

Objective To investigate the renoprotection effect of low molecular weight heparin(LMWH)in diabetic rats.Methods Diabetic rats were induced by injection of steptozotocin(STZ).Rats were randomly divided into three groups:control group,diabetic model group,and LMWH treatment group.The levels of total cholesterol(TC),triglyceride(TG),prothrombin time(PT),kaolin partial thromboplastin time(KPTT),24-hour urinary albumin excretion rate(UAER),and serum soluble P-selectin were determined after 8 weeks.Glomerular morphology was observed by light microscopy.Results The levels of TG,UAER,and P-selectin in LWMH treatment group were lower than those in model group(all P<0.01).The levels of PT and KPTT in LWMH treatment group were shorter than those in model group.And LWMH improved the histological changes of diabetic rats.Conclusion LMWH has some renal protective effects in diabetic rats,partly through down-regulating the expression of P-selectin.

Anticoagulation early after mechanical heart valve replacement

Objective： To explore the changes of coagulation activity and the characters of anticoagulation early after mechanical heart valve replacement. Methods： All patients only took warfarin orally for anticoagulation. The predicted international normalized ratio （INR） was 1.5 to 2.0. Several coagulation markers were monitored early after valve replacement. Complications associated with anticoagulation were recorded and analyzed. The patients were divided into three groups based on the number and position of mechanical valve prothesis, including group M （mitral valve replacement）, group A （aortic valve replacement） and group D （mitral and aortic valve replacement）.Comparison was made between the three groups. Results： Three events of mild cerebral embolism and five events of mild bleeding occurred during the early postoperative period. One patient suffered from mild cerebral embolism on the 4th day after operation, accompanied by large volume of pericardial drainage. Two patients with bleeding had lower INRs than predicted range. However, INR in one patient with mild cerebral embolism was in the predicted range. There was no significant difference in thrombo time （TT）, activated partial thromboplastin time （APTT） and 1NR on the 3rd day after operation compared to those before operation; meanwhile, plasma fibrinogen （FIB） concentration was higher than that before operation （P〈0.05）. 1NR had no significant changes on the 2nd day after the beginning of anticoagulation compared to that before operation; however, 1NR was significantly elevated on the 4th day （P〈0.05）. Warfarin doses and INRs were similar among the three groups, but FIB concentrations in plasma were higher in groups M and D than in group A （P〈0.01）. Conclusion： Hypercoagulabale state exists early after mechanical heart valve replacement. When anticoagulation begins is determined by the change of coagulation markers, not by the volume of chest or pericardial drainage. INR can not accurately reflect the coagulation state sometimes, especially during the first 3 days after anticoagulation. The number and position of mechanical valve prothesis could affect coagulation state. Therefore, anticoagulation therapy should be regulated accordingly.

Anti-embolic effect of Taorenchengqi Tang in rats with embolic stroke induced by occluding middle cerebral artery

OBJECTIVE: To investigate the anti-embolic effect of Taorenchengqi Tang(TRCQT), a formulas from Traditional Chinese Medicine, plus aspirin in rats with embolic stroke induced by selective occlusion of the middle cerebral artery(MCA). Possible side effects of hemorrhagic incident and other bleeding events and anti-platelet effect were also explored.METHODS: Ninety rats were randomly separatedinto 9 groups(n = 10): group 1 a sham-operated group(n = 10); groups 2 and 3 orally treated with an isovolumetric solvent(distilled water) for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 4 and 5 orally treated with aspirin(5 mg/kg) alone for 1 and 3 months, followed by thromboembolic occlusion(n = 10); groups 6 and 7orally treated with TRCQT(0.5 g/kg) alone for 1 and3 months, followed by thromboembolic occlusion(n = 10); groups 8 and 9 orally treated with TRCQT plus aspirin for 1 and 3 months, respectively followed by thromboembolic occlusion(n = 10). The ischemic stroke in rats was induced by selective MCA occlusion. One was orally administered. After the treatments, rats' brains were removed, sectioned and stained with triphenyltetrazolium chloride(TTC) for infarct volume measurement. The incidence of subarachnoid hemorrhage(SAH) and intracerebral hemorrhage(ICH) were observed. A potential gastric bleeding side effect was assessed by measuring hemoglobin(Hb), and prothrombin time(PT). Collagen-induced platelet activation and tail vein bleeding time were measured.RESULTS: Treatment with TRCQT alone or in combination with aspirin reduced infarct volume for 1(P < 0.05), and 3(P < 0.01) months without SAH and ICH incidences, and gastric bleeding. TRCQT treatment for 1 month was also not altered PT. Moreover, a concentration dependent inhibition of collagen-induced platelet activation, followed by increasing of tail vein bleeding time was observed after TRCQT treatment.CONCLUSION: Either TRCQT alone or TRCQT plus aspirin exhibits potent neuroprotective effect by reducing infarct volume without changing the status of SAH, ICH and gastric bleeding possibly via inhib-iting the platelet activation and increasing bleeding time.