Objective To explore the measures in early diagnosis and treatment for venous thromboembolism(VTE)in patients with fracture.Methods All the patients with fracture visiting Beijing Jishuitan Hospital in emergency during October 2004 to October 2007 were screened by Well's prediction rules,and anticoagulation and thrombolysis were instituted for those with established diagnosis of VTE by color Doppler ultrasonography and venography.Results Totally,1 508 patients at higg-risk of VTE were identified by D-dimer test.1 455 by color ultrasonography and 53 by venography.Diagnosis of VTE was established in 652 of them(43.2%),619(94.9%)received anticoagulant treatment,162(24.8%)received anticoagulant plus thrombolytie treatment and 25 (3.8%) received anticoagulation plus thrombectomy.In order to prevent fatal pulmonary embolism,vena cava filters(VCFs)were implanted in 146(22.4%)patients,and 33(5.1%)of them were contraindicated to anticoagulation.After treatment,412 cases were cured and 240 were improved,with no one failed.Conclusions Patients with fracture are at high-risk of VTE and should be screened by D-dimer test and color Doppler ultrasonography based on Well's evaluation,as well as by venography for confirming the diagnosis of VTF as appropriate.Anticoagulation and thrombolysis are still the treatment of choice,with thrombectomy and VCF implantation performed only if necessary.

Venous thromboembolism ( VTE ) is a common vascular disease.It has become an important public health problem because of its high incidence, recurrence and mortality rate.Because the clinical symptom of VTE is relatively hidden, it is difficult to diagnose and treat it.This article focuses on the clinical diagnosis,treatment and laboratory examination of VTE.

Platelets is the important hemostatic component in the blood and the critical participants in inflammation. It is an important promoting factor during inflammation and can recruit leukocytes and aggregate in sepsis. Decreasing plate?let count was correlated with reverse clinical outcome. Therefore, the value of the platelets examination in clinical monitor was studied by many researchers. Under circumstance of fungal infections, platelets mediate antimicrobial activity and assist dissemination of the fungi synchronously. Regulating interaction between platelets and fungi is difficult. In allergic inflamma?tion patients, the excessive activating of platelets aggravates airway obstruction and worsen pulmonary function. We reviewed current research in activating platelets during inflammation.

Objective To explore the clinical value of Glucosamine hydrochloride tablets(GH)alone and combination with Xianlinggubao capsules(XLGB)for treatment patients with knee osteoarthritis(KOA).Methods 96 patients with KOA were selected,and were divided into two groups according to the random number method, 48 cases in each group.The control group was treated with GH alone,while the observation group was treated with XL-GB on the basis of the control group.US Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used to evaluate the symptoms change,including pain,stiffness,physical function scores and total scores before and after treatment.The onset time,knee function (HSS)score at 3 months and 6 months after treatment were recor-ded.CRP and ESR were measured,and the total efficacy was evaluated at the end of treatment.Results The differ-ence of WOMAC score between the two groups was not statistically significant before treatment (P >0.05 ).After treatment,pain,stiffness,physical function scores and total scores were (10.2 ±1.4)points,(3.5 ±1.6)points, (40.5 ±5.0)points and (56.4 ±6.7)points in the observation group,those were (14.8 ±2.6)points,(6.2 ±2.3)points, (52.2 ±6.8)points and (73.3 ±4.5)points in the control group,the differences were statistically significant (t =7.631,4.721,6.791,10.26,all P <0.01).The onset time,HSS score at 3 months and 6 months after treatment in the observation group were (6.0 ±2.2)d,(68.2 ±6.4)points and (84.3 ±6.2)points,while those were (9.8 ± 2.8)d,(58.5 ±3.9)points and (72.8 ±5.4)points in the control group,the differences were statistically significant (t =5.228,6.341,6.852,all P <0.01 ).The improvements of CRP level and ESR in the observation group were more pronounced than those in the control group (t =3.880,2.668,all P <0.05).After treatment,the total effective rate of the observation group was 93.8%(45 /48),while that was 77.1%(37 /48)in the control group,the difference was statistically significant (χ2 =5.352,P <0.05).Conclusion GH combines with XLGB can significantly improve symptoms in patients with KOA,with more rapid recovery of knee function,thus it is a safe and effective therapy.

Objective To observe and compare the effect of different concentration of ropivacaine on elderly patient with bra-chial plexus block under ultrasound-guided ,to assess its effectiveness and security ,so as to determine the optimum dosage of anes-thetic for elderly patients with brachial plexus block .Methods 120 patients undergoing elective surgery of forearm or hand in this hospital from February 2013 to December 2014 were selected as the observation group in this study .These patients were randomly divided into four groups on average ,narcosis was conducted in each group with ultrasound-guided :group A with 30 mL of 0 .250%ropivacaine ,group B with 30 mL of 0 .375% ropivacaine ,group C with 30 mL of 0 .500% ropivacaine ,group D with 30 mL of 0 .750% ropivacaine .The onset time of sensory block ,motor block level ,duration of analgesia and adverse reactions were observed and recorded .Results With the increase of concentration of ropivacaine ,the onset time of narcotize became shorter(P< 0 .05) and duration of analgesia became longer(P < 0 .05) .There were no significant difference in the effects of brachial plexus block (P>0 .05) .There was no complications occurred in four groups after narcosis .Conclusion Concentration of ropivacaine more than 0 .375% can achieve perfect clinical effect on elderly patients with brachial plexus block under guidance of ultrasound .

Objective:To investigate the clinical value of changes of platelet and anticoagulation function in patients with acute pancreatitis. Methods:β-TG, PF4 ,TXB2 ,GMP-140,antithrombin-Ⅲ,and protein C were measured in all patients. Results:There was no significant difference in all parameters between acute edema pancreatitis group and normal group(P＞0.05).Compared with the control group, parameters of platelet significantly increased in acute necrosis pancreatitis group(P＜0.01),and parameters of anticoagulation significantly decreased(P＜0.01). Conclusion: The platelet system was activated and the level of anticoagulation system decreased in acute necrosis pancreatitis. Parameters are important in understanding and preventing this disease.

Objective To study the effect of lipoteichoic acid(LTA) of Bifidobacterium on the expression of vascular endothelial growth factor(VEGF) and invasion and metastasis of colon carcinoma cell lines.Methods The effects of LTA on adhesion,invasion and metastasis of human colon carcinoma lines LoVo and HT-29 in vitro were examined by MTT colorimetric and transwell chamber.The mRNA and protein expressions of VEGF in the two colon carcinoma cells treated with LTA were detected by RT-PCR and Western blot.Results The adhesion ability decreased in LoVo cells and HT-29 cells after the treatment of LTA(20,50,80 ?g/ml) for 30,60,90,120 min(P

Objective To observe the clinical efficacy and safety of close-loop muscle relaxant injcction system (CLMRIS) combined with auditory evoked potentials index for monitoring in elderly patients during general anesthesia.Methods A total of 100 patients undergong abdominal operation with ASA Ⅰ-Ⅱ anesthesia in our hospital from February 2012 to October 2012 were selected.Patients were randomly divided into 2 groups:the traditional group (n=50) and the CLMRIS group (n=50).The traditional group was anaesthetized according to clinical experience,and the CLMRIS group was used with the muscle relaxant guided by the close-loop muscle relaxant injection system.The auditory evoked potential (AEP) index and the life index were observed,and the dose of muscle relaxant,the time of consciousness recovery,dynamic response rate during operation and the adverse reaction were recorded at the time points at entering the operating room,induction of anesthesia,tracheal intubation,incision,into the abdominal,exploration,closing abdomen,skin suture,consciousness recovery,tracheal extubation,out of room (T0-T10).Results The vital signs in all patients were stable.The dynamic response rate during operation was lower in the CLMRIS group than in the traditional group at each time points of T8-T10 (all P＜0.05).There was no increase in mean artery pressure (MAP) and heart rate in groups at the time points of T0-T1,T8-T10 (all P＞0.05).The time of tracheal intubation,tracheal extubation and consciousness recovery were shorter in the CLMRIS group than in the traditional group [(268±30.4) min vs.(172±23.7) min,(14±6.4) min us.(18±7.9) min,(8.8±2.9) min vs.(12.2±4.6) min,respectively,t=3.277,6.341,3.346,all P＜0.05].There were no significant differences in AEP index between groups at the time of T0 (P＞0.05),but at the time of T1,the AEP index was lower in CLMRIS group than in the traditional group (P＜0.05).Conclusions The application of close loop muscle relaxant injection system can improve the safety of general anesthesia in the elderly and reduce the incidence of postoperative residual paralysis.The CLMRIS combined with the auditory evoked potential for monitoring depth of anesthesia can prevent and reduce the incidence of intraoperative awareness,has a strong controllability in general anesthesia with smooth induction,and can reduce the dose of anesthetic drugs to achieve the best anesthetic effect.

Objective To explore the influences of Dexmedetomidine for laparoscopic cholecystectomy on stress reaction and hepatic/renal functions. Methods Totally 100 cases with laparoscopic cholecystectomy were divided into two groups:Dexmedetormidine group and Propofol control group (n=50 for each group) according to the different anesthetic methods.The hemodynamic change,stress reaction and hepatic/renal function were measured and analyzed. Results Heart rate [(85.7±13.4)times /min vs.(62.7±9.9) times/min; (81.3±14.9) times/min vs.(60.3±8.8)times/min,t=2.296,2.714,P=0.045,0.022] and mean artery pressure(MAP )[(86.3±11.9)mm Hg vs.(66.5+11.7) mm Hg; (88.6±15.6) mm Hg vs.(68.7± 12.3) mm Hg,t=2.653,2.240,P=0.024,0.049] immediately at trachea cannula and 1 min after trachea cannula were significantly increased in Propofol control group as compared with Dexmedetomidine group.In contrast to Propofol control group,epinephrine[(680.1±112.3) pmol/L vs.(576.1±83.1)pmol/L; (705.4±127.6)pmol/L vs.648.8±105.3) pmol/L,(689.6±123.4) pmol/L vs.(628.2±94.3) pmol/L,t=2.628,2.242,2.224,P=0.019,0.039,0.040],norepinephrine[(3953.6±514.6) pmol/L vs.(3695.1±196.2) pmol/L; (3967.2=514.9) pmol/L vs.(4367.1±565.7) pmol/L; (4095.8±415.1) pmol/L vs.(3813.4 ± 513.7) pmol/L, t =2.454, 2.500, 2.255, P =0.032, 0.030,0.045] and hydrocortisone [(796.6±198.7) nmol/L vs.(698.7±176.3) nmol/L; (835.5+217.2) nmol/L vs.(783.7±201.9) nmol/L; (822.4±203.3) nmol/L vs.(720.6±188.1) nmol/L,t=2.334,2.167,2.189,P=0.033,0.044,0.043] immediately at trachea cannula,1 min and 5 min after trachea cannula were decreased in Dexmedetomidine group.There were not significantly differences in hepatic/renal function between the two groups (P＞ 0.05). Conclusions Dexmedetomidine is safe and effective for laparoscopic cholecystectomy in view of more stable hemodynamics,less stress reaction,and non influence on hepatic/renal function.

Objective To study the assessment value of serum protein C activity ( PC∶A) test in the patient′s condition and prognosis in bronchial asthma.Methods 202 bronchial asthma patients were selected from the Tianjin medical university general hospital from 2010 to 2012 for this retrospective cohort study, 77 males and 125 females with a mean age of 41.2 ±11.4 years.the level of PC∶A were analysed by IL ACL TOP 700 coagulation analyzer.Receiver operating characteristic curve ( ROC) was used to analyze the diagnosis performance of PC∶A, χ2 test was used to analyze the relevance between PC∶A and clinical pathological factors , Cox regression analysis model was used to evaluate the effect on prognosis , Kaplan-Meier curve to implement survival analysis.Results The elevels of PC∶A were:control group ( 102.2 ± 13.6)%, intermittent attack group (104.8 ±11.9)%, mild persistent group (136.3 ±15.8)%, moderate persistent group ( 129.0 ±13.5 )% and severe persistent ( 126.8 ±14.7 )% respectively , and there was significantly difference among the all groups ( F =7.15, P <0.01 ).Compared the control group and intermittent attack group with other groups , the PC∶A level was higher in mild persistent group ( q=16.83, q=15.54, P<0.05), moderate persistent group (q=19.94,q=12.15, P<0.05), and severe persistent group(q=11.37,q=10.66, P<0.05).The PC∶A level was lower in moderate and severe persistent group than mild persistent group ( q =3.82, q =4.30, P <0.05 ).After undergoing regular treatment for six months, the PC∶A level was higher in partly controlled group and uncontrolled group than complete controlled group (q=12.45, q=9.91,P<0.05).The optimum cut-off point of PC∶A (after undergoing regular treatment for six months ) for asthma condition with uncontrolled was 118.0%, the area under ROC curve was 0.892 ( 95% confidence interval:0.851-0.936 ).The χ2 test results showed that there was the relevance between the serum PC∶A level and the eosinocyte , total serum IgE , complicated allergic rhinitis and lung function ( FEV1%) ( P<0.01 ).The Cox analysis and survival analysis showed that the serum PC∶A level ( after undergoing regular treatment for six months ) was the independent assessment parameter for asthma acute attack in 7th-12th month, the cumulative probability of acute attack was increased obviously in the patients who with PC∶A level over the cut-off value.Conclusions The serum PC∶A level was increased obviously in asthma patients , and was related to patient′s condition, level of asthma control and severe attacks risk , which could be used as an effective indicator for assessment of disease progression and asthma control in asthma patients.