组织因子途径抑制物基因转移对动脉血栓形成的抑制作用

目的:研究日本凝血病毒(HVJ)-人工病毒包膜(AVE)脂质体介导的组织因子途径抑制物(TFPI)基因转移对损伤血管局部血栓形成抑制作用的有效性及安全性。方法:在兔球囊损伤髂动脉局部分别转染含TFPI基因(TFPI组)或pcDNA3．1质粒(空质粒组)的HVJ-AVE脂质体复合物或HVJ-脂质体(空载体组)或生理盐水(盐水组),1,3和7天后用逆转录多聚酶链反应和免疫组化法检测血管局部TFPI表达;组织病理学和扫描电镜观察比较各组血栓形成情况;各组实验动物观察6个月评价这种疗法的安全性。结果:TFPI基因转移后1天即检测到TFPI mRNA表达,第3天为高峰;TFPI组血栓形成例数明显少于其它3组(P<0.05);体内凝血指标及生化指标无明显变化;重要脏器组织病理学检查未见明显变化;各器官未见到HVJ感染及复制迹象。结论:HVJ-AVE脂质体介导TFPI基因转移能够安全而有效地抑制损伤血管局部血栓形成。     

颅内静脉窦血栓形成的血管内治疗

目的 探讨经血管内途径治疗颅内静脉窦血栓形成的疗效和安全性。 方法 对12例难治性颅内静脉窦血栓形成的患者进行了静脉接触性溶栓、机械性破栓、颈动脉溶栓和静脉窦内支架置入多途径联合血管内治疗。所有患者均有颅内静脉窦血栓形成的危险因素。术后积极治疗原发病,抗凝治疗6个月。术后随访17~29个月,平均23个月。 结果 12例患者均接受了经静脉途径溶栓治疗,其中10例患者同时接受机械性血栓切割治疗,另有2例患者同时接受经颈动脉途径溶栓治疗。尿激酶使用总量80万~290万U,每例患者平均每天剂量低于100万U。出院时,所有患者的闭塞静脉窦均获再通,临床症状改善,颅内压恢复。术后积极治疗原发病和抗凝治疗6个月,平均随访23个月,无一例血栓再形成。回顾文献,经血管内途径治疗颅内静脉窦血栓形成临床症状改善率为92％,死亡率为5％本组患者的临床症状改善率为93％,病死率为3.8％。联合血管内治疗组与单一血管内治疗组临床症状改善率差异无显著性意义(x2=1.27,P>0.05)。 结论 血管内治疗颅内静脉窦血栓是安全、有效的治疗手段。     

Role of the growth arrest-specific gene 6 (gas6) product in thrombus stabilization

Growth arrest-specific gene 6 (gas6) product enhances the formation of stable platelet macroaggregates in response to various agonists. To determine whether Gas6 amplifies the response to known platelet agonists through one or more of its receptor tyrosine kinases of the Tyro3 family, mice deficient in any one of the Gas6 receptors (Gas6-Rs: Tyro3, Axl, or Mer) were submitted to thrombosis challenge and their platelet function. The loss of any one of the Gas6-Rs protects mice against thromboembolism induced by collagen-epinephrine and stasis-induced thrombosis. Importantly, these mice do not suffer spontaneous bleeding and have a normal bleeding time but a tendency to repetitively re-bleed after transient hemostasis. Re-bleeding in mice lacking any one of the Gas6-Rs is not due to thrombocytopenia or coagulopathy but to a platelet dysfunction characterized by a lack of the second wave of platelet aggregation and an impaired clot retraction, at least in part by reducing outside-in alpha(IIb)beta(3) signaling and platelet granule secretion. The early release of Gas6 by agonists perpetuates platelet activation through its three receptors, reinforcing outside-in alpha(IIb)beta(3) signaling by activation of PI3K and Akt signaling and stimulation of tyrosine phosphorylation of the beta(3) integrin. Furthermore, "trapping" Gas6 prevents pathological thrombosis, which indicates that blocking this novel cross-talk between the Gas6-Rs and alpha(IIb)beta(3) integrin may constitute a novel target for antithrombotic therapy.     

Echocardiographic diagnosis of a giant thrombus passing through a patent foramen ovale from right atrium to the left atrium

Pulmonary embolus sourced by right atrial thrombus trapped in a patent foramen ovale is an unusual, rare condition. Thus in suspicion of massive pulmonary thromboembolus, echocardiographic examination carries great importance evaluate right ventricular functions and diagnose right sided intracardiac thrombus. We report a 76-year-old female with massive pulmonary embolism caused by a gigantic thrombus trapped in a patent foramen ovale. The echocardiography was the diagnostic procedure to display the source of the thromboembolism and urgent cardiac surgery was successful and life-saving treatment in this case.     

Two cases of eosinophilic vasculitis with thrombosis

Vasculitides are characterized by vessel wall inflammation of unknown etiology. We report two cases of eosinophilic vasculitis and hypereosinophilia with thrombosis. They have been treated with a high-dose glucocorticoid and anticoagulation. These cases emphasize that thrombosis should be anticipated in patients with eosinophilic vasculitis.     

凝血因子VR2等位基因多态性在血栓相关性疾病患者中的分布

目的：通过检测血栓相关性疾病患者的凝血因子V（coagulation factorV)R2等位基因多态性，探讨R2单体型与血栓形成的相关性。方法：采用PCR-酶切法对100个脑血栓患者，96个心肌梗塞患者，45个深静脉血栓患者，80个系统性红斑狼疮患者，以及98个正常对照进行FVR2等位基因检测。结果：首次发现2例系统性红斑狼疮患者基因型为R2等位基因杂合子。结论：中国汉族人群血栓形成的遗传分子背景与FVHR2等位基因可能没有相关性。     

Group A streptococcal meningitis in a pediatric patient

A case of group A streptococcal meningitis is reported in a 14-year-old girl with a history of recurrent otitis media. She presented to the emergency room with an altered level of consciousness; the organism was isolated from her spinal fluid and blood. Her course was complicated by a left-sided sinus vein thrombosis with extension to the external jugular vein, which has previously been reported in the literature only once. Streptococcus pyogenes is a common cause of invasive infections, but is a highly uncommon cause of meningitis.     

Low molecular weight heparin (Fragmin(R)) prevents early reocclusion following femoral artery thrombolysis with rt-PA in rabbits

The purpose of this study was to evaluate the effect of lowmolecular weight heparin Fragmin on thrombolysis with tissue-typeplasminogen activator (rt-PA) and to compare its effect to thatof standard heparin. A rabbit thrombosis model was used, consistingof a blood clot produced in an isolated femoral artery segmentwith superimposed endothelial damage and distal stenosis. Thirtyrabbits were randomized to three treatment groups with rt-PA(30 µ.g. kg^–1. min^–1 for 60 min and no additionaltherapy), rt-PA with Lv. standard heparin (200 IV. Kg^–1bolus and then 70 IU. Kg^–1 hourly) and rt-PA with s.c.Fragmin (a single dose of 500 IU. Kg^–1) prior to rt-PAadministration. In six of 10 rabbits given rt-PA only, recanalizationwas observed, which was persistent in three. In eight of 10rabbits given rt-PA with intravenous heparin, reflow was achieved,which was persistent in three. Fragmin resulted in recanalizationin eight of 10 rabbits, with persistent patency in each recanalizedrabbit. Reflow time was not shortened with either standard heparinor Fragmin compared with rt-PA alone (64±41, 56 ±18, 50 ±23 min respectively), (P=0·7). Persistentreocclusion after reflow was not observed with Fragmin (0/8)but was present with both standard heparin (518, P=0·03vs Fragmin) and rt-PA alone (316, P=0·05 vs Fragmin). Thus, in the femoral artery of the rabbit, Fragmin, unlike standardheparin, was found to prevent reocclusion following rt-PA thrombolysis.     

Occlusion of the Modified Blalock–Taussig Shunt: Unique Methods of Treatment and Review of Catheter‐based Intervention

Objective. To report unique methods of treatment and review catheter‐based intervention for occluded modified Blalock–Taussig shunts (BTS). Methods. Case reports and articles involving children undergoing catheter‐based treatment for occluded modified BTS were reviewed. Results. Literature review detailed 38 patients in whom occluded modified BTS were treated with 39 catheter‐based interventions. Thrombolytics alone were delivered by catheter in 13 cases. Balloon angioplasty was performed in 23 cases, 5 with stent implantation. Both thrombolytic delivery and angioplasty were performed in 3 cases, 2 with stent implantation. Intervention was initially successful at re‐establishing modified BTS patency in 35/39 (90%) of cases. Patency could not be established in 2 patients who then proceeded to the operating for surgical shunt revision. Two deaths occurred during the procedures. Three cases at Emory University demonstrate uncommon or unique instances of catheter‐based intervention: (1) declotting of a shunt in a patient supported by extracorporeal membrane oxygenation (ECMO); (2) declotting of a shunt via a right axillary arterial approach; and (3) declotting of a shunt using a carotid arterial (ECMO) cannula for percutaneous access. Conclusions. The use of catheter‐based techniques for the treatment of BTS occlusion is highly successful, and potentially avoids high‐risk re‐operative intervention. ECMO can provide for a stable patient during the procedure. Hopefully, with improved technology and innovative procedures, more children in the future with BTS occlusion can be served by successful percutaneous intervention.     

Arterial thromboembolic complications in patients with Starr-Edwards aortic ball valve prostheses.

Aterial thromboembolic complications were studied in 253 patients who had a single aortic Starr-Edwards ball valve implanted. During the first postoperative month, six patients died from myocardial infarction, one was reoperated because of leakage caused by thrombus on the valve, and five others suffered six thromboembolic episodes. Forty-six late thromboembolic complications occurred in 40 of the 216 patients who survived the postoperative period. Seven died, four from cerebral emboli and three from myocardial infarction. The late incidence was 7 episodes per 100 patients per year. Valves of series 1200 carried a significantly higher risk of arterial thromboembolism than did those of series 2300, and most episodes occurred in patients with cell controlled anticoagulant treatment. The incidence was not influenced by time since operation, continuous arrhythmia, concomitant mitral valve disease, heart size, or the degree of intravascular hemolysis. It is concluded that arterial thromboembolic complications represent a major threat to patients with aortic ball valves even several years after operation and in spite of intense anticoagulant therapy.