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.

ObjectiveThe present study was designed evaluate the aspirin effectiveness in the inhibition of platelet aggregation in patients after OPCAB.Methods290 patients were recruited.145 patients underwent first time OPCAB (surgery group).Arachidonic acid induced platelet aggregation and urine 11-dehydro thromboxane B2 (11-dehydroTxB2) were measured before operation and on aspirin re-administered days 1,4, 10, and 6 months after surgery.The same tests were also detected in 145 patients from the cardiology department (non-surgery group) received medicine therapy as controls.Results Ninety-nine patients were defined as aspirin sensitive after OPCAB (AS Group).Postoperative aspirin resistance was identified in 46 (32％) patients at the first day after aspirin treatment started (AR Group).19 (13％) and 5 (3％) patients remained as AR at day 4 and 10 after aspirin re-administration, respectively.Patients in the AR group had higher 11-dehydroTxB2 levels than those in the AS group (P = 0.049).Six months follow-up showed ARA-induced platelet aggregation was (11.5 ± 3.4) ％.Urine level of 11-dehydroTxB2 was (50.3 ± 15.4) ng/L.No resistance was found.All cardiologic patients were identified as aspirin sensitive, the change of platelet aggregation and 11-dehydroTxB2 were similar as those in the AS group.Weight ＞75 kg and postoperative drainage ＞500 ml were risk factors of aspirin resistance after OPCAB.ConclusionAnti-platelet effect of aspirin was reduced during the early postoperative period in certain patients undergoing OPCAB.In case of resistance,antiplatelet treatment strategy should be intensified or modified.

Objective To investigate the reasonable time limit for stopping the aspirin treatment in preoperative pa-tients with general surgery and the effects on platelet function in postoperative patients with recovering the therapy of aspirin. Methods A total of 121 patients undergoing elective general surgery were divided into stopping aspirin treatment 5 d group (n=59) and stopping aspirin treatment 7 d group (n=62). Fifty healthy volunteers were used as the control group. The arachi-donic acid (AA)-induced platelet aggregation test was used to detect the platelet agglutination rate in all groups. Aspirin was reused 24~48 h after surgery. The level of urinary 11-dehydro-thromboxane B2 (11-DH-TXB2) was assayed by ELISA 7 and 10 d after retreatment. Results The levels of the PAgT (5 min, 8 min and 10 min) were decreased significantly in pa-tients with stopping aspirin treatment 5 d group compared with those of patients with stopping aspirin treatment 7 d group and control group (P<0.05). There was no significant difference in the level of PAgT between patients with stopping aspirin treatment 7 d group and control group. The platelet aggregation showed two different characteristic curves after stopping aspi-rin treatment for 5 d. And the normal curve of platelet aggregation was found after stopping aspirin treatment for 7 d. The lev-els of PAgT and urinary 11-DH-TXB2 were significantly lower in patient recovered the aspirin treatment for 7 d and 10 d than that of control, and which was significantly higher in 7 d group than that of 10 d group (P>0.05). Conclusion The platelet aggregative function returned to normal level in patients with 7-d preoperative stopping aspirin. The laboratory moni-toring of aspirin therapy should be more than 7 d after postoperative reusing aspirin.

Objective To explore the effect of thrombolysis with anticoagulation treatment for early stage of posttraumatic and postoperative deep vein thrombosis of lower extremity. Methods The clinical data of 38 palients with early stage of posttraumatic and postoperative deep vein thrombosis(DVT) of lower extemity treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results The thrombolytic effect was significant. After the treatment, the deep veins were recanalization without regorging in 71.0% of patients. The total effective rate was 100%. Only one patient had hemorrhagic complication, two patients had symptomatic pulmonary embolism,but none of the patients died. Conclusions Thrombolysis with anticoagulation is an effective and safe method for posttraumatic and postoperative DVT in the early stage.

Objective:To assess aspirin efficacy in the early postoperative period following off-pump coronary artery bypass(OPCAB)surgery.Methods:Sixty patients undergoing OPCAB surgery were enrolled in the study.Previous aspirin treatment Was terminated 5-7 days before OPCAB and continued to take at the day with food intake after surgery.The functional and biochemical responses to aspirin were evaluated by arachidonie acid (ARA)-induced platelet aggregation.Samples were collected before and on days 1,4 and 10 after aspirin intake(100 mg/d).Results:There were 17 patients(28.3%),9 patients (15%)and 2 patients(3.3%)with aspirin resistance on day 1,4 and 10 of aspirin intake.The overall levels of platelet aggregation(%)were 63(52,70),13(11,22),12(10,14),and 12(11,14)before the surgery and on day 1,4 and 10 of aspirin intake.The level was stable from the 4th day after aspirin intake.It was found that aspirin resistance was not an independent risk factor for the operation.Conclusion:Aspirin did not sufficiently inhibit platelet aggregation at the early stage after OPCAB.It is important to keep potential anti-coagulation therapy in the early postoperative period.

Objective To study the clinical efficacy of tolterodine tartrate combined with transcutaneous electrical nerve stimulation(TENS)in the treatment of elderly female patients with overactive bladder(OAB).Methods 30 patients with OAB were randomly divided into single treatment with tolterodine tartrate and combination treatment of tolterodine tartrate and TENS for 10d.The efficacy was evaluated by overactive bladder symptom score(OABSS),patient perception of bladder condition(PPBC),quality of life(QOL),visual analogy scale(VAS)and 5 grade pain scores.Results The post-treatment symptoms of urgent urination and urinary incontinence,OABSS,PPBC,QOL,VAS and 5 grade pain scores in single treatment group[(1.67±1.45)times /d,(1.53±1.25)times /week,(6.67±2.55)scores,(2.07±0.96)scores,(2.07±1.03)scores,(3.67±0.90)scores and(4.07±0.80)scores]were improved as compared with pre-treatment[(6.40±1.45)times /d,(3.93±1.03)times/week,(13.00±1.00)scores,(4.20±0.68)scores,(3.80±0.68)scores,(7.13± 1.19)scores and(9.40± 1.55)](t=8.94,5.74,8.94,7.03,5.44,9.01 and 11.85,all P＜0.01).The above indexes in combination treatment group after treatment[(1.27±0.80)times/d,(1.20±0.77)times/week,(5.33±1.72)scores,(1.67±0.62)scores,(1.47±0.52)scores,(2.93±0.80)scores and(3.40±0.99)scores]were also improved as compared with pretreatment[(6.20±1.26)times/d,(4.00±1.25)times/week,(12.73±1.03)scores,(4.07±0.80)scores,(4.00±0.65)scores,(7.47±0.74)scores and(9.67±1.35)scores](t=12.77,7.36,14.29,9.21,11.77,16.09 and 14.55,all P＜0.01).The VAS and 5 grade pain scores were higher in combination treatment group than in single treatment group(t=4.879 and 2.746,P＜0.01).Conclusions Tolterodine tartrate combined with TENS is safe and effective for the treatment of elderly female patients with OAB,and may alleviate pain and improve quality of life.

Objective To evaluate the necessity and safety of implanting temporary vena eava fihers to prevent pulmonary emboli in patients of lower extremity fractures concomitant with acute deep venous thrombosis(DVT). Methods A total of 782 patients with lower extremity fractures were complicated with DVT perioperatively. Among them, 91 received temporary vena cava filters implantation before orthopedic operations for the prevention of pulmonary embolism. All patients were followed up post-operation. Results Vena cava filters were successfully implanted in 89 patients. Mean implantation time was 27 days (range from 14 to 42 days). Thrombus trapped within the filters were found in 78 patients (87.6%) after the filters removal. Eight-two filters (92.1%) were retrived successfully at the first attempt as scheduled. Seven filters(7.9%) with big trapped thrombi were removed at the 2nd attempt after additional thrombolytic therapy. No patients needed a permanent filter. No fetal pulmonary embolism (PE) or other major complications were detected during the three to six months follow-ups period. Conclusion Temporary vena cava filter can reduce the incidence and mortality of pulmonary embolism as well as the occurrence of mid- or long-term complications in lower limb fracture patients complicated with DVT.

Objective To investigate the value of application of multi-slice helical CT(MSCT) indiagnosis of basicranial fracture. Methods Sixty-two patients with basicranial fracture were scanned withthin-section scanning mode after conventional CT scanning The images were transferred to the work-station for reconstruction including multiplanar reconstruction (MPR), volume rendering (VR). Comparison between thin-section scanning images and conventional CT scanning images were performed. Results Compared with the conventional CT scanning (67.9% and 45.0% respectively),the rates of fracture displayed of images acquired from thin-section scanning in diagnosis of fractures of anterior and middle cranial fossa (100.0% and 95.0% respectively) ,P＜0.01. The two scanning mode in diagnosis of fractures of posterior cranial fossa( 88.9% and 100.0% respectively )differed from each other unstatistically(P＞0.05 ). ConclusionThe thin-section scanning of MSCT can improve the diagnostic correctness of basicranial fracture.

0.8). Conclusions This DNA chip combined with multiplex PCR is a rapid diagnostic assay with high specificity and sensitivity for the detection of Neisseria gonorrhoeae, Chlamydia trachomatis and Ureaplasma Urealyticum and their drug-resistance, and may be applied in the diagnosis of urogenital infections.

Objective To evaluate the efficacy and safety of tension free vaginal tape obturator technique (TVT-O) in females stress urinary incontinence (SUI).Methods From June 2008 to May 2012,156 cases of female SUI were treated with TVT-O procedure in our hospital.The mean age is 56.3 ±13.9 years.There were 79.5％ patients who suffered simple SUI while 20.5％ patients with SUI and urge urinary incontinence (UUI).The mean follow-up time was 16.5 months.All patient’s ICI-Q-SF scores and I-QOL scores were collected.The efficacy and safety of TVT-O were analyzed.Results The mean operative time was 34 ± 11 minutes and the mean estimated blood loss were 15 ± 9 ml.One hundred and forty-five cases were cured with TVT-O (92.9％) while 8 cases were improved (5.1％).The preoperative and postoperative ICI-Q-SF symptom scores were 8.2 ± 2.1 and 0.5 ± 1.3 while the I-QOL life quality scores were 28.5 ± 10.3 and 69.8 ± 9.9 respectively.There was statistical difference between the preoperative and postoperative scores (P ＜ 0.05 ).No bladder injury was recorded during the procedures.There were two cases whose vaginal walt were injured and repaired intraoperatively.No pelvic hematoma,long-term pain,sling erosion,infection and fistula were found in all cases.Three cases ( 1.9％ ) suffered temporary urinary retention and were cured by two weeks urethral catheterization.Conclusions TVT-O technique seems to be an easy and minimally invasive procedu(r)e with less complication,which supports its safety and reliability in the treatment of female SUI.