急性冠状动脉综合征患者阿司匹林与其他抗栓药物联合应用的出血风险及其防治

急性冠状动脉综合征(ACS)的治疗包括冠状动脉血运重建及多种抗栓药物的合理、联合应用等.阿司匹林在冠心病的救治与二级顶防中,可以使严重心血管事件风险降低25%,非致命心肌梗死下降1/3,所有血管事件下降1/6;其与多种抗栓药物(包括抗血小板、抗凝和溶栓药物)联合应用的疗效已由大量临床研究证实并写入各国ACS的治疗指南.     

抗凝和抗血小板制剂在急性冠状动脉综合征中的应用

急性冠状动脉 (冠脉 )综合征 (ACS)包括急性心肌梗死 (AMI)和不稳定型心绞痛 (UAP) ,通常是由易碎的动脉粥样硬化 (AS)斑块破裂继而血栓形成所致。抗凝和抗血小板联合治疗ACS比单一抗血小板的治疗效果优越。本文对口服抗凝和抗血小板制剂在ACS的应用情况及进展综述如下。1　阿司匹林阿司匹林是治疗ACS的基石 ,并广泛用于缺血性血管性事件的一级和二级预防。研究证实 ,血栓烷素A2 (TxA2 )是血小板的强力激动剂 ,它激活血小板并使血栓对纤溶抵抗 ,结果导致血小板聚集和阻塞性血栓。阿司匹林通过其酰基部分与血小板内环氧化酶不可逆…     

长疗程低分子量肝素治疗急性冠脉综合征68例

急性冠脉综合征(ACS)包括不稳定型心绞痛(UAP)和非ST段抬高心肌梗死(NSTEM I),二者发病的病理及病理生理基础相似。对ACS使用常规抗凝治疗方案,口服阿司匹林和静脉滴注普通肝素1周,能明显减少UAP急性心血管事件的发生,但该治疗方案须常规监测活化的全血凝固时间(ACT)或活化的部     

阿司匹林与氯吡格雷联合抗血小板治疗不稳定型心绞痛临床疗效观察

目的观察阿司匹林与氯吡格雷联合应用抗血小板聚集治疗不稳定型心绞痛(UAP)临床疗效和安全性。方法选择62例UAP患者,随机分成治疗组与对照组,各31例。治疗组在常规抗凝、抗缺血等治疗基础上,联合应用阿司匹林与氯吡格雷抗血小板聚集治疗;对照组在常规抗凝、抗缺血等治疗基础上,单用阿司匹林抗血小板聚集治疗。随访6个月,评价心绞痛、心电图改善情况及心脏血管事件发生率。结果治疗组总有效率94%,对照组71%,且治疗组心脏血管事件发生率明显降低,两组差异有统计学意义(P<0.05)。结论阿司匹林与氯吡格雷联合应用抗血小板聚集治疗UAP,可改善心绞痛症状,降低心血管事件发生率,出血风险小。     

术前抗血小板药物应用策略对冠状动脉旁路移植术的影响

<正>目前,广泛应用的抗血小板药物包括阿司匹林和氯吡格雷,新型抗血小板药物如普拉格雷、替格雷洛和坎格雷洛等正处于临床研究试用阶段。已证实阿司匹林等抗血小板药物可以降低冠状动脉旁路移植手术(CABG)的病死率和缺血事件发生率。急性冠状动脉综合征(ACS)的指南和最新研究提示,阿司匹林和氯吡格雷联合治疗可以降低心血管事     

急性冠脉综合征患者抗凝治疗策略亟待优化——针对磺达肝癸钠的临床应用我国诸多专家达成共识

<正>"磺达肝癸钠用于急性冠脉综合征(ACS)的抗凝治疗不仅能够有效的减少心血管事件,而且大大降低出血风险,无论患者的年龄、性别、肾功能情况和危险分层,尤其对于出血     

真实世界心房颤动合并急性冠脉综合征抗栓策略变迁与心源性卒中的关系

目的探究真实世界心房颤动(房颤)合并急性冠脉综合征(ACS)人群的抗栓策略变迁及其对心血管不良事件的影响。方法本研究为单中心、前瞻性、观察性研究。选取2017—2019年于中国医学科学院阜外医院就诊的房颤合并ACS患者, 根据抗栓策略分为抗凝治疗组与未抗凝治疗组, 根据就诊时间将研究人群分为2017年组、2018年组、2019年组。对所有患者开展1年随访, 主要终点为心源性卒中, 次要研究终点为随访1年内发生主要不良心血管事件(MACCE), 定义为全因死亡、心源性卒中、非中枢神经系统的体循环栓塞、心肌梗死、靶血管血运重建、缺血驱动的血运重建。结果共入选1?333例房颤合并ACS患者, 其中男922例, 年龄(68.3±9.7)岁。其中接受抗凝治疗患者534例(抗凝治疗组), 未接受抗凝治疗患者799例(未抗凝治疗组)。与未抗凝治疗组相比, 抗凝治疗组患者的CHA2DS2-VASc评分更高[(3.7±1.9)分对(4.3±1.8)分, P<0.001]。2017—2019年, 接受抗凝治疗(P<0.001, P for trend<0.001)、口服抗凝药(OAC)+...     

急性冠状动脉综合征患者应用新型口服抗凝药物仍需更多证据

尽管采取以双联抗血小板等药物治疗为基础的二级预防措施,急性冠状动脉综合征(ACS)患者1年随访时缺血事件复发率仍达10%。研究表明,ACS后凝血系统的持续激活可能是导致残余缺血风险较高的重要环节,因此可以在二级预防中联合口服抗凝治疗。多项评价新型口服抗凝药物(NOAC)对ACS后复发缺血事件预防价值的Ⅱ期和Ⅲ期试验一致显示,联合应用NOAC和抗血小板治疗增加出血风险,但是仅有小剂量利伐沙班显示了疗效获益。     

急性冠脉综合征合并胃肠道出血的危险因素研究

目的观察急性冠脉综合征（ACS）患者合并胃肠道出血（GIB）的发生情况,评价ACS合并GIB的危险因素及预后。方法 486例ACS患者给予拜阿司匹林、氯吡咯雷等规范抗血小板治疗,具有溶栓治疗适应证的ST段抬高心肌梗死（STEMI）者,给予阿替普酶进行溶栓治疗,观察ACS患者GIB的发生并评价其危险因素。随访30 d,评价病死率。结果 486例ACS患者中出现GIB 54例,STEMI组、NSTEMI组、UA组间GIB发生率有差异（P〈0.01）。溶栓治疗的STEMI患者GIB发生率高于单纯抗凝抗栓治疗的患者（P〈0.05）;高龄、合并糖尿病、既往发生心血管事件及长期服用阿司匹林的患者GIB的发生率明显增高。GIB患者30 d病死率高于非GIB患者（P〈0.01）。结论 ACS合并GIB的患者病死率明显增加,临床应加以预防。     

心房颤动合并急性冠状动脉综合征患者的抗栓治疗研究进展

正国内外指南或共识均已达成共识,心房颤动(atrial fibrillation,AF)患者需口服抗凝药物预防脑卒中等栓塞事件发生,急性冠状动脉综合征(acute coronary syndromes,ACS)尤其经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)后,患者需行抗血小板治疗减少心血管事件的发生。AF合并ACS患者的抗栓治疗难点在于这两类药物不能     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.