Deep Vein Thrombosis in a Queensland Hospital

Investigation in the postoperative period of 75 patients by means of the radioiodinated fibrinogen uptake method, by the use of the Doppler ultrasonic flow detector, and by clinical assessment revealed an incidence of deep vein thrombosis of only 12%. This is distinctly lower than has been reported by other investigators using the same techniques both in Australia and elsewhere. It appears from this study and associated work that the Doppler ultrasonic technique is sufficiently accurate to be of value in the clinical diagnosis of significant deep vein thrombosis.     

Statins Improve the Resolution of Established Murine Venous Thrombosis: Reductions in Thrombus Burden and Vein Wall Scarring

Despite anticoagulation therapy, up to one-half of patients with deep vein thrombosis (DVT) will develop the post-thrombotic syndrome (PTS). Improving the long-term outcome of DVT patients at risk for PTS will therefore require new approaches. Here we investigate the effects of statins—lipid-lowering agents with anti-thrombotic and anti-inflammatory properties—in decreasing thrombus burden and decreasing vein wall injury, mediators of PTS, in established murine stasis and non-stasis chemical-induced venous thrombosis (N = 282 mice). Treatment of mice with daily atorvastatin or rosuvastatin significantly reduced stasis venous thrombus burden by 25% without affecting lipid levels, blood coagulation parameters, or blood cell counts. Statin-driven reductions in VT burden (thrombus mass for stasis thrombi, intravital microscopy thrombus area for non-stasis thrombi) compared similarly to the therapeutic anticoagulant effects of low molecular weight heparin. Blood from statin-treated mice showed significant reductions in platelet aggregation and clot stability. Statins additionally reduced thrombus plasminogen activator inhibitor-1 (PAI-1), tissue factor, neutrophils, myeloperoxidase, neutrophil extracellular traps (NETs), and macrophages, and these effects were most notable in the earlier timepoints after DVT formation. In addition, statins reduced DVT-induced vein wall scarring by 50% durably up to day 21 in stasis VT, as shown by polarized light microscopy of picrosirius red-stained vein wall collagen. The overall results demonstrate that statins improve VT resolution via profibrinolytic, anticoagulant, antiplatelet, and anti-vein wall scarring effects. Statins may therefore offer a new pharmacotherapeutic approach to improve DVT resolution and to reduce the post-thrombotic syndrome, particularly in subjects who are ineligible for anticoagulation therapy.     

Short-term Preoperative Dietary Restriction Is Neuroprotective in a Rat Focal Stroke Model

Stroke is a major complication of cardiovascular surgery, resulting in over 100,000 deaths and over a million postoperative encephalopathies annually in the US and Europe. While mitigating damage from stroke after it occurs has proven elusive, opportunities to reduce the incidence and/or severity of stroke prior to surgery in at-risk individuals remain largely unexplored. We tested the potential of short-term preoperative dietary restriction to provide neuroprotection in rat models of focal stroke. Rats were preconditioned with either three days of water-only fasting or six days of a protein free diet prior to induction of transient middle cerebral artery occlusion using two different methods, resulting in either a severe focal stroke to forebrain and midbrain, or a mild focal stroke localized to cortex only. Infarct volume, functional recovery and molecular markers of damage and protection were assessed up to two weeks after reperfusion. Preoperative fasting for 3 days reduced infarct volume after severe focal stroke. Neuroprotection was associated with modulation of innate immunity, including elevation of circulating neutrophil chemoattractant C-X-C motif ligand 1 prior to ischemia and suppression of striatal pro-inflammatory markers including tumor necrosis factor α, its receptor and downstream effector intercellular adhesion molecule-1 after reperfusion. Similarly, preoperative dietary protein restriction for 6 days reduced ischemic injury and improved functional recovery in a milder cortical infarction model. Our results suggest that short-term dietary restriction regimens may provide simple and translatable approaches to reduce perioperative stroke severity in high-risk elective vascular surgery.     

Useful Measures in the Prevention of Deep Vein Thrombosis in the Legs

The three probable factors involved in deep venous thrombosis are: (1) stasis, (2) alteration in the endothelium of the veins, and (3) alteration in the clotting mechanism of the blood.Control of stasis is assisted by elevation of the foot of the bed and by the use of washable elastic stockings and early ambulation, together with foot exercises. To prevent damage to the endothelium of the veins during operation, the heels should be elevated off the operating table by means of a small rolled towel in order to take weight off the calf muscles. The use of elastic stockings demonstrated in diagrams and some of the fallacies in connection with their use are outlined.     

Heparin in the Prevention of Deep Vein Thrombosis after Myocardial Infarction

A trial of continuous intravenous heparin in the prevention of deep vein thrombosis was undertaken in 48 patients who had suffered a myocardial infarction. Of the 24 control patients who did not receive heparin seven (29%) developed calf vein thrombosis as detected by the radioactive fibrinogen technique. None of the 24 heparinized patients had any evidence of venous thrombosis. This difference is significant at the 1% level.     

Increased Incidence of Deep Vein Thrombosis after Myocardial Infarction in Non-smokers

Out of 102 patients with cardiac infarction admitted to the coronary care unit at this hospital and not treated with anticoagulants 30 (29%) developed isotopic evidence of deep vein thrombosis. Of the 65 smokers only 7 (11%) developed a deep vein thrombosis, whereas of the 37 non-smokers 23 (62%) developed a deep vein thrombosis. This difference is highly significant (P < 0·00001).     

Prevention of Postoperative Deep Vein Thrombosis in Patients with Malignant Disease

We have used the ¹²⁵I-fibrinogen test to asses the value of an improved method of peroperative intermittent calf compression as a prophylactic measure against postoperative thrombosis. In a group of 99 patients over the age of 40 undergoing operations lasting more than 30 minutes the technique reduced the incidence of postoperative thrombosis by over 75%. In patients suffering from malignant disease, who are generally considered to be in the very high risk category, the reduction achieved was almost 90%.     

中性粒细胞计数、D-二聚体及Caprini血栓评分对脑血管狭窄介入术后下肢深静脉血栓形成的预测价值及模型构建

摘要 目的：探讨中性粒细胞计数、D-二聚体及Caprini血栓评分对脑血管狭窄介入术后下肢深静脉血栓形成（DVT）的关系及预测模型构建。方法：选择2021年2月至2022年2月于我院神经外科行血管内介入治疗的281例脑血管狭窄患者,术前检测外周血中性粒细胞计数、D-二聚体,并采用Caprini血栓评分评估患者DVT风险,并根据术后是否发生DVT将患者分为DVT组（31例）和无DVT组（250例）。收集临床资料,采用多因素Logistic回归分析影响脑血管狭窄介入术后DVT的危险因素,构建预测模型,Hosmer-Lemeshow检验预测模型拟合度,受试者工作特征（ROC）曲线分析预测模型对脑血管狭窄介入术后DVT的预测价值。结果：DVT组中性粒细胞计数、D-二聚体、Caprini血栓评分高危和极高危比例高于无DVT组（P＜0.05）。且中心静脉导管、卧床时间超过72 h、高中性粒细胞计数、高D-二聚体、Caprini血栓评分分级高危和极高危是脑血管狭窄介入术后DVT的危险因素（P＜0.05）。由上述指标构建的预测模型,其预测脑血管狭窄介入术后DVT的曲线下面积AUC（0.95CI）为0.871（0.779～0.938）,灵敏度为0.871（27/31）,特异度为0.832（208/250）。经Hosmer-Lemeshow检验模型拟合效果良好（P＞0.05）。结论：中心静脉导管、卧床时间超过72 h、高中性粒细胞计数、高D-二聚体、Caprini血栓评分分级高危和极高危是脑血管狭窄介入术后DVT的危险因素,根据回归分析构建预测模型对脑血管狭窄介入术后DVT的预测能效较好。     

Dietary Restriction Affects Neuronal Response Property and GABA Synthesis in the Primary Visual Cortex

Previous studies have reported inconsistent effects of dietary restriction (DR) on cortical inhibition. To clarify this issue, we examined the response properties of neurons in the primary visual cortex (V1) of DR and control groups of cats using in vivo extracellular single-unit recording techniques, and assessed the synthesis of inhibitory neurotransmitter GABA in the V1 of cats from both groups using immunohistochemical and Western blot techniques. Our results showed that the response of V1 neurons to visual stimuli was significantly modified by DR, as indicated by an enhanced selectivity for stimulus orientations and motion directions, decreased visually-evoked response, lowered spontaneous activity and increased signal-to-noise ratio in DR cats relative to control cats. Further, it was shown that, accompanied with these changes of neuronal responsiveness, GABA immunoreactivity and the expression of a key GABA-synthesizing enzyme GAD67 in the V1 were significantly increased by DR. These results demonstrate that DR may retard brain aging by increasing the intracortical inhibition effect and improve the function of visual cortical neurons in visual information processing. This DR-induced elevation of cortical inhibition may favor the brain in modulating energy expenditure based on food availability.     

超敏C 反应蛋白与深静脉血栓形成的相关性分析

目的：分析超敏C反应蛋白（hs-CRP）与深静脉血栓形成（DVT）的相关性,探讨炎症反应在DVT 发生及发展中的作用。方 法：选取2013 年9 月至2015 年3 月我院收治的DVT 患者113 例,按病变部位分为中央型、周围型以及混合型,按发病时间分为 急性期、亚急性期以及慢性期。另选取同期体检的健康志愿者50例作为对照组。检测所有研究对象血清hs-CRP水平。结果：DVT 患者血浆hs-CRP 高于正常健康人群（P＜0.05）;不同临床分型DVT 患者血浆hs-CRP 水平不同,混合型最高,周围型最低,差异 具有统计学意义（P＜0.05）;不同发病时期DVT 患者血浆hs-CRP 水平不同,急性期最高,恢复期最低,差异具有统计学意义（P＜ 0.05）;接受溶栓治疗的DVT 患者术后3 天血浆hs-CRP 水平持续升高,术后第5 天开始快速下降。结论：hs-CRP 可作为DVT 诊 断的参考指标,DVT发生及发展与炎症反应存在相关性。     

Diagnosis of Established Deep Vein Thrombosis with the 125I Fibrinogen Uptake Test

One hundred and two patients with clinical signs indicating a possible diagnosis of deep vein thrombosis were studied with the fibrinogen uptake test and phlebography to assess the reliability of the test as a means of diagnosing established venous thrombosis. The test gave a correct diagnosis in 78% of the 85 legs shown to contain thrombus by phlebography and only 19 (10%) false-negative results in the 195 legs examined. The duration of the symptoms, the administration of anticoagulants, and mild leg swelling did not affect the accuracy of the test. Very old thrombus, phlebographically more than 11 days old, was associated with an increased false-negative rate.The fibrinogen uptake test is accurate enough to make it a valuable method of clinical investigation.     

A Collision Probability Model of Portal Vein Tumor Thrombus Formation in Hepatocellular Carcinoma

Hepatocellular carcinoma is one of the most common malignancies worldwide, with a high risk of portal vein tumor thrombus (PVTT). Some promising results have been achieved for venous metastases of hepatocellular carcinoma; however, the etiology of PVTT is largely unknown, and it is unclear why the incidence of PVTT is not proportional to its distance from the carcinoma. We attempted to address this issue using physical concepts and mathematical tools. Finally, we discuss the relationship between the probability of a collision event and the microenvironment of the PVTT. Our formulae suggest that the collision probability can alter the tumor microenvironment by increasing the number of tumor cells.     

影响妇科腹腔镜术后下肢深静脉血栓形成的相关因素分析

目的:探讨妇科腹腔镜手术后下肢深静脉血栓形成(DVT)的危险因素。方法:回顾性分析339例行妇科腹腔镜手术患者的临床资料,对患者的一般临床资料、术前实验室检查指标、手术类型、术中治疗及术后干预措施等进行单因素及多因素Logistic回归分析。结果:339例行妇科腹腔镜手术患者中30例术后发生DVT(发生率约8.8%),年龄(OR=1.438)、手术类型(腹腔镜妇科恶性肿瘤手术)(OR=3.153、血浆D-二聚体水平≥0.5 mg/L(OR=2.531)、术前合并症(OR=2.885)、术中气腹压(OR=2.835)、手术时间≥1h(OR=1.397)、术后卧床天数(OR=1.498)与妇科腹腔镜手术后发生DVT呈正相关(P0.05)。结论:年龄、手术类型、血浆D-二聚体水平、术前合并症、术中气腹压、手术时间及术后卧床天数是妇科腹腔镜术后发生VDT的独立危险因素。     

Prevention of Early Postoperative Deep Vein Thrombosis by Intermittent Compression of the Leg during Surgery

A clinical trial is described in which the effect of intermittent compression of the lower limb during surgery on the incidence of early postoperative deep vein thrombosis was assessed. Deep vein thromboses were diagnosed by the ¹²⁵I-fibrinogen uptake test. Peroperative intermittent compression was achieved by means of an inflatable plastic splint coupled to a pneumatic controller. By compressing only one leg of each patient, each patient acted as his own control.With a sequential statistical analysis, 39 patients were required to pass the 5% level of significance. Eleven thrombi were detected in the control (uncompressed) legs and two occurred in the compressed legs; one of the latter was bilateral. The investigation shows that increasing the pulsatility of the venous flow in the leg is a potent prophylactic against postoperative deep vein thrombosis.     

Intervention for Diagnosis of Deep Vein Thrombosis in Acute Stroke Patients: A Hospital-Based Study

Background

Immobile stroke patients are at high risk of deep vein thrombosis (DVT). Demographic studies suggest a low incidence of DVT in Asian patients, but that might be underestimated.

Objective

Intervention by in-hospital case management for diagnosis of DVT in patients with acute stroke.

Patients and Methods

Intervention was defined as: recommendation of D-dimer test for patients who are immobile by day 4 after stroke onset and compression ultrasonography if the level of D-dimer is ≥500 ng/ml. Treating physicians were notified by case managers before they failed to do so for qualified patients. Data of patients hospitalized 12 months before and 8 months after the intervention, including basic demographics, Glasgow Coma Scale score, National Institute of Health Stroke Scale (NIHSS) score, laboratory results, and examination reports, was retrieved from electronic medical records for analysis by code searches for acute stroke.

Results

A total of 2523 patients were identified. 1528 were before and 995 after intervention. More patients after intervention had D-dimer test and ultrasound examination than that before intervention (22.1% vs 8.6%, P<0.001 and 15.1% vs 1.2%, P<0.001, respectively). Ultrasound diagnosis of DVT was significantly more after than before intervention (2.0% vs 0.3%, P<0.001). DVT was 55.7 per 1000 in patients with a NIHSS score≧18. Male sex (Odds ratio 0.33, 95% confidence intervals: 0.11–0.98), NIHSS score (Odds ratio 1.05, 95% confidence intervals: 1.00–1.09), and intervention (Odds ratio 5.39, 95% confidence intervals: 1.88–15.44) were independent predictors of ultrasound diagnosis of DVT.

Conclusions

Intervention by in-hospital case management may be an effective strategy for improvement of under-diagnosis of DVT in acute stroke patients.     

高凝状态对非小细胞肺癌患者深静脉血栓形成的影响

目的:探讨高凝状态对非小细胞肺癌患者深静脉血栓形成的影响,为临床治疗提供依据。方法:选择2010年5月至2013年6月在我院接受治疗的非小细胞肺癌患者195例,记录患者姓名、年龄、性别、病理类型、手术、临床分期、放化疗、伴随疾病、身体状况评分(eastern cooperative oncology group,ECOG评分)及是否发生血栓等指标。调查入选患者的高凝状态指标,包括血小板(platelet,PLT)、纤维蛋白原(fibrinogen,Fib)、血浆凝血酶原时间(plasma prothrombin time,PT)、凝血酶时间(thrombin time,TT)、活化部分凝血活酶时间(activated coagulation time of whole blood,APTT)和D-二聚体(D-dimer)。结果:195例非小细胞肺癌患者中,PLT高于正常上限的有42例(21.5%),FIB升高的有78例(40%),TT延长的有12例(6.2%),PT缩短的有45例(23.1%),D-D升高的有60例(30.8%),APTT缩短的有15例(7.7%)。两项指标异常的有62例(31.8%),FIB和D-D升高的有32例(16.4%);三项指标异常的有27例(13.8%),PLT、FIB及D-D升高的有15例(7.7%);四项指标异常的有5例(2.6%),PLT、FIB及D-D升高,而PT缩短的有5例(2.6%)。所有患者各凝血指标中位值PLT为219×109/L,FIB为3.6 g/L,TT为13.4 s,PT为10.8 s,D-D为0.341 mg/L,APTT为29.7 s。结论:高凝状态对非小细胞肺癌患者深静脉血栓形成具有重要的促进作用,应受到临床的重视。     

Dietary Restriction Enhances Kainate-Induced Increase in NCAM While Blocking the Glial Activation in Adult Rat Brain

In the present study effect of dietary restriction (DR) on neuronal plasticity markers neural cell adhesion molecule (NCAM) and its polysialylated form PSA-NCAM and astrocytic marker glial fibrillary acidic protein (GFAP) was assessed following brain injury by intraperitoneal injection of kainic acid or physiological saline in adult male wistar rats. After 7-day recovery period, rats were sacrificed to study the NCAM-ir, PSA-NCAM-ir, and GFAP-ir in all the groups with immunohistofluorescence and immunoblotting. We noticed increase in NCAM and PSA-NCAM expression after KA excitotoxicity, and DR enhanced this increase in NCAM and PSA-NCAM expression. A marked increase in NCAM and PSA-NCAM-ir was observed in CA3 region of hippocampus, subgranular region and hilus of dentate gyrus, hypothalamus, and piriform cortex in both vehicle treated as well KA-treated DR rats as compared to vehicle and KA-treated AL rats, respectively. Whenever, CNS is damaged it undergoes an injury response called reactive gliosis. Our study confirmed the neuroprotective role of DR as evident from attenuation of GFAP-ir and enhanced levels of neuronal plasticity markers NCAM and PSA-NCAM. The potential beneficial role of DR regimen in attenuating KA-induced reactive astrogliosis and enhancing expression of neuronal plasticity markers may point the way to new strategies of intervention therapy by DR that will facilitate recovery from ageing and disease related neuronal dysfunction and enhance restorative processes by modulating astrogliosis.     

兔急性肠系膜上静脉血栓形成模型建立及其病理学观察

目的 建立稳定的兔急性肠系膜上静脉血栓形成模型,观察其病理学变化.方法 采用扎闭静脉、损伤血管壁、激活凝血因子等方法建立模型,分期观察病理学改变.结果 成模后可见血管腔内明显血栓形成;肠道粘膜上皮细胞水肿至坏死脱落伴大量炎性细胞浸润;血管内皮细胞从凹陷到局部坏死脱落,直至大面积坏死脱落,内皮下基质暴露.结论 本实验可成功建立兔肠系膜上静脉血栓形成模型,病理学改变符合临床,模型稳定可靠.