蝮蛇抗栓酶对骨内高压降压作用实验研究

本实验随机将家兔一侧后肢于膝关节伸直位夹板外固定５周，制成固定侧胫骨上端骨内高压模型。对其全身和局部血液流变学指标进行测定，发现全血粘度，血浆粘度增大，血沉增快，血浆纤维蛋白原含量明显增高。对上述模型应用蝮蛇抗栓酶（ｓｖａｔｅ）连续治疗２１天，骨内压降低，血液流变学各项指标亦降低。本实验结果显示，蝮蛇抗栓酶通过改善骨内高压状态下的异常血液流变学状态可使骨内高压降低，从而认为血液流变学疗法可能成为临床治疗骨内高压症的一种新手段，而蝮蛇抗栓酶可能为其中高效药物之一。     

Epistaxis

Epistaxis is a common problem that can affect the whole population. The majority of cases are self-limiting and do not require any medical intervention, but epistaxis can be associated with morbidity and even death in very rare circumstances. If epistaxis does not resolve with first aid measures, or episodes are frequent, patients may require specialist assessment and treatment by ENT, either in the outpatient clinic or via an unscheduled (emergency) admission to the hospital. Here, we provide an overview of the management of epistaxis in the outpatient setting and during an emergency admission in both paediatric and adult patients. We highlight the key considerations in the history and management, covering the common and rare conditions that are associated with epistaxis. This article provides an update from our previous article published in 2018 to include the more recent literature and a useful learning resource for examinations.     

“In vitro” and “ex vivo” effects of picotamide,a combined thromboxane A2-synthase inhibitor and -receptor antagonist,on human platelets

Summary Picotamide (G 137), a new non prostanoid inhibitor of in vitro arachidonic acid induced platelet aggregation, has been further characterized in in vitro and ex vivo studies.When whole blood was activated with collagen in the presence of picotamide 5×10^–4 M, thromboxane B₂ production was decreased, and 6-keto-PGF₁ generation was significantly increased, suggesting a reorientation of platelet endoperoxide metabolism following blockade of thromboxane synthetase. Picotamide also inhibited platelet aggregation and clot retraction induced by the endoperoxide analogue U46619 in human platelets, indicating thromboxane A₂-receptor antagonism, possibly of competitive nature.A single oral dose of picotamide 1 g in 24 healthy volunteers produced a significant inhibition of collagen, arachidonic acid and U46619-induced platelet aggregation. Serum levels of thromboxane B₂ were also reduced.Chronic administration of picotamide 1.2 g/d to patients with vascular disease resulted in a prompt and persistent fall in their increased plasma levels of -thromboglobulin.The results indicate that picotamide is a combined thromboxane B₂-synthetase inhibitor and thromboxane A₂-receptor antagonist in human platelets, and that it may prove useful as an antithrombotic agent.     

三种蝮蛇抗栓酶的毒性及性质的实验研究

目的:对三种蝮蛇抗栓梅的毒性及其性质进行实验研究。方法:小白鼠尾静脉注射急性毒性实验法和家兔亚急性毒性实验法。结果:三种蝮蛇抗栓酶的毒性强度用LD_50表示,分别是,蛇岛蝮蛇抗栓酶为1.68±0.35u/kg,东北陆生白眉蝮蛇抗栓酶为5.223±0.61u/kg,浙江蝮蛇抗栓酶为1.94±0.15u/kg。对家兔亚急性毒性实验表明,对血细胞、肝及肾功能、脏器等无明显影响。     

106例高龄老年房颤患者的抗栓治疗分析

目的探讨75岁以上高龄老年房颤患者的栓塞及出血风险及目前本院的抗栓治疗现状。方法根据2010年欧洲心脏病学会《房颤治疗指南》中的CHA2DS2．VASe评分标准和HAS．BLED评分标准，对2011年3月-2011年9月在我院老年医疗科病房明确诊断存在心房纤颤、且年龄I〉60岁的老年患者分成〈75岁（老年组）和〉175岁（高龄老年组）两组，对两组患者的相关资料进行对照分析。结果高龄老年组的CHA2DS2-VASe评分（5．65±1．12）和HAS-BLED评分（3．60±0．84）均显著高于老年组（分别为3．55±1．15和2．85±0．81）；两组的抗栓治疗的比例均较低，且有显著差异（51．28％vs62．34％）。结论年龄〉75岁的高龄老年房颤患者存在极高的栓塞及出血双重风险，抗栓治疗的实施率也显著降低。对该类人群的治疗必须依托安全有效的抗栓策略，以改善目前的治疗现状。     

Oral antithrombotic treatment and postoperative thrombotic complications after head and neck reconstruction using free flaps

Abstract

Recently, oral antithrombotic treatment has been used to treat cerebral infarction, myocardial infarction, and vascular diseases, and these patients may have vascular damage. However, we know of no reports about the development of postoperative complications in patients who have free tissue transfers with preoperative antithrombotic prophylaxis. We retrospectively reviewed 150 patients who had had immediate reconstruction with free tissue transfer after excision of cancers in the head and neck between April 2001 and March 2006. We found nine patients who had been given preoperative antithrombotic prophylaxis: four of the nine had thrombotic complications (myocardial infarction (n = 1), cerebral infarction (n = 1), and necrosis of the flap caused by thrombus at an anastomotic site (n = 2)), whereas 4 of the remaining 141 patients had thrombotic complications, all of which were flap necrosis from thrombotic occlusion of an anastomotic site. Patients given antithrombotic prophylaxis may easily develop a thrombus, and our findings suggest that management of the coagulation system is necessary.