Risks factors for highly unstable response to oral anticoagulation: a case-control study

The factors associated with persistent instability of oral anticoagulant treatment (OAT) were investigated in a case-control study. The most unstable patients from 35 Italian anticoagulation clinics were matched with stable controls, for gender, age and OAT indication. Socio-demographic data, medical history, dietary and life habits, cytochrome P450 CYP2C9 variants, blood cell count, liver and renal functions were investigated. An 'Abbreviated Mental Test' (AMT) and a questionnaire to assess patient compliance to, and comprehension of, OAT indications and mechanisms were administered. An International Normalized Ratio (INR) above 4.5 was more frequently found in cases (n = 77) than controls (n = 80) (12.3% vs. 0.4%; P < 0.0001). The odds ratio for instability was significantly higher for: people who worked versus pensioners, acenocoumarol versus warfarin, and an insufficient score in the AMT and/or in the questionnaire. Cytochrome P450 CYP2C9 variants *1/*3 or *2/*3 or *3/*3 were more frequent among cases than controls (29.9% vs.15.0%; P = 0.042). No differences were observed as regards the other variables. In conclusion, we found that high intra-individual variability in OAT control was multifactorial, but poor OAT comprehension was prevalent.     

关于组织细胞肉瘤的若干问题

1　ＷＨＯ新分类中如何评价组织细胞肉瘤新的ＷＨＯ造血和淋巴组织肿瘤分类中 ,依然把组织细胞肉瘤 (ｈｉｓｔｉｏｃｙｔｉｃｓａｒｃｏｍａ)作为一个独立的罕见病〔1〕。定义该瘤是一种形态和免疫表型均与成熟组织细胞相似的细胞恶性增生 ,表达 1种或 1种以上组织细胞标记 ,但不表达树突细胞标记 ,并且不伴有急性单核细胞白血病。2　组织细胞肉瘤的临床特征各年龄组均可发生 ,多见于成人 ,中位年龄为 4 6岁。累及淋巴结、皮肤 (孤立性或多灶性 )或结外其它部位者各占1/ 3,后者以肠道最多见。部分病例有全身性表现 ,累及多个部位。病变可为…     

An Immunologic Study on Age-related Macular Degeneration

Forty-one patients with age-related macular degeneration(AMD) were detected for serum autoantibodies against normal humanretinal protein by means of Western immunoblot analysis.Twenty-sevenout of the 41 patients showed positive response,with a rate of 66 percent.The positive rate of antiretinal antibody in the AMD patients wassignificantly higher than that in normal controls (18%) and in patients withother retinal diseases (24%) (p<0.0005).These antiretinal antibodies fromthe AMD patients partly reacted with the retinal protein of molecular weightbetween 28 and 32 Kd,partly with Mr of 38 to 42 Kd,48 to 52 Kd,62 to65 Kd or 110 to 130 Kd.Of them,the antiretinal antibody against theprotein with Mr of 28 to 32 Kd in the AMD patients was higher than innormal controls (p<0.05).Two or more antibodies were found in theserum from AMD patients,showing a significant difference between thepatients and the controls (p<0.005).The results indicated that in theoccurrence of AMD and/or during its developing process there wereinflammation and immunological response,involving antibodies againstretinal proteins of various molecular weight.Eye Science 1993;9:113-120.     

Vitamin C Inhibits Benzo[a]pyrene-Induced Cell Cycle Changes Partly via Cyclin D1/E2F Pathway in Human Embryo Lung Fibroblasts

INTRODUCTION Polycyclic aromatic hydrocarbons (PAHs) such as B[a]P are widespread environmental contaminants formed as byproducts of combustion[1]. PAHs have been found to be potent mammary carcinogens in rodents[2-3]. It is believed that B[a]P requires biological activation through oxidative metabolism to be carcinogenic. The ultimate carcinogenic metabolite has been considered to be the cytochrome P450 isozyme- and microsomal epoxide hydrolase- derived metabolite, BPDE, which forms…     

近年来长江流域上海等六市医院质子泵抑制剂应用分析

目的:了解近年来长江流域六市医院质子泵抑制剂用药的情况和变化趋势。方法:调查2009-2011年长江流域上海、杭州、南京、武汉、成都、重庆六城市样本医院质子泵抑制剂品种用药金额、占比、生产厂商及临床评价。结果:常用品种为奥美拉唑、泮托拉唑、埃索美拉唑、雷贝拉唑和兰索拉唑,用药金额名列第1是奥美拉唑,第2是泮托拉唑。结论:质子泵抑制剂市场前景看好。     

评中国成人2型糖尿病胰岛素促泌剂应用专家共识

中国成人2型糖尿病的病理生理特点与欧美国家不同,其β细胞胰岛素分泌功能下降可能比胰岛素敏感性降低更明显。因此,中国成人2型糖尿病患者适合使用胰岛素促泌剂。为了强调其重要性,2012年4月在《中华内分泌代谢杂志》发表了《中国成人2型糖尿病胰岛素促泌剂应用的专家共识》,它对我国临床实践具有重要指导意义。本文重点评价了目前对胰岛素促泌剂认识的一些误区,比如低血糖、体重、β细胞功能及心血管安全性等问题。     

儿童肺炎链球菌感染的防治进展

肺炎链球菌是引起儿童肺炎、脑膜炎、菌血症等疾病的主要致病菌之一。近年来,世界各地多重耐药肺炎链球菌的出现,导致很多抗菌药物治疗无效。接种肺炎链球菌疫苗是预防儿童肺炎链球菌感染的重要措施之一,不仅可以很好的保护接种者避免感染肺炎链球菌相关疾病,而且还能产生群体免疫效果,减少抗生素的使用。     

中医临床技能实训教学体系的构建

提出构建中医临床技能实训教学体系的重要意义,从实训课程体系建设、教学大纲与教材体系建设、专职实训教师队伍建设、实训教学考核与评价体系建设等方面进行研究实践,最终形成适应现代医学人才培养需求的中医临床技能实训教学体系,充分发挥临床技能实训教学的作用。