幽门螺杆菌根除疗法治疗慢性特发性血小板减少性紫癜的疗效预测

目的:观察抗幽门螺杆菌三联疗法治疗Hp阳性的慢性特发性血小板减少性紫癜的疗效,并分析抗Hp治疗后,血小板应答的预测因子.方法:59例Hp阳性的慢性特发性血小板减少性紫癜患者,随机分组为抗Hp组和安慰剂对照组,对照组在随访3个月后给予三联抗Hp治疗.每例患者治疗前检测血清CagA蛋白浓度.结果:抗Hp组有效率明显高于对照...     

32例急性ST段抬高型心肌梗死急诊介入治疗临床观察

目的评价急性ST段抬高型心肌梗死(STEMI)患者急诊介入治疗的临床疗效及安全性。方法2005年6月～2008年9月共32例急性ST段抬高型心肌梗死在我院行急诊直接PCI治疗,观察介入治疗效果,患者主要心脏不良事件(MACE,包括死亡、非致命性再梗死、靶血管再血管化治疗)的发生率。结果PCI成功率为87.5%,术后住院期间死亡2例,MACE发生率为6.25%;出院后临床随访30例患者,随访时间3～39个月,无死亡和再发心肌梗死发生,5例患者在术后10～12月时行冠状动脉造影复查,未发现支架内再狭窄。结论急性STEMI患者行急诊直接PCI治疗,有较好的临床疗效,在充分给予阿司匹林、氯吡格雷和肝素进行抗血小板和抗凝治疗基础上,联合使用替罗非班可显著降低直接PCI术后不良心脏事件的发生。     

原发性血小板增多症患者经皮冠状动脉介入治疗随访结果分析

目的回顾性分析原发性血小板增多症患者行经皮冠状动脉介入治疗(PCI)的特点、治疗及预后。方法收集2010年1月至2017年7月北京协和医院心内科收治的9例原发性血小板增多症患者因合并有冠心病后行PCI的临床资料,并对PCI数据、术后药物治疗和长期随访结果进行回顾性分析。结果 9例患者中男性5例,女性4例,平均年龄(60.9±14.3)岁;急性心肌梗死患者3例,陈旧性心肌梗死患者2例,不稳定型心绞痛患者2例,稳定性冠心病患者2例;单支病变患者4例,多支病变5例;所有患者均置入药物洗脱支架,PCI术前血小板计数(596±233)×109/L,其中4例住院期间诊断原发性血小板增多症患者血小板计数为(803±105)×109/L;所有患者术后均接受阿司匹林联合氯吡格雷的双联抗血小板治疗,8例患者同时长期服用羟基脲,平均随访(53.2±26.9)个月,术后随访期间血小板计数(485±133)×109/L,随访期间无不良心血管事件发生,仅有1例患者因胃溃疡出现消化道出血事件。结论对于原发性血小板增多症合并冠心病行PCI患者,给予长期双联抗血小板治疗并合用羟基脲是安全有效的。     

不同剂量盐酸替罗非班联合PCI治疗老年急性冠脉综合征合并糖尿病患者的有效性与安全性

目的评价在应用阿司匹林、氯吡格雷、低分子肝素等药物的基础上合用不同剂量盐酸替罗非班及冠状动脉内介入治疗(PCI)对老年急性冠脉综合征(ACS)合并糖尿病(DM)患者的有效性与安全性。方法选择2011年10月至2013年3月于该院住院的ACS合并DM患者126例,随机分为低分子肝素治疗组40例(肝素组),低分子肝素联合半量替罗非班组44例(半量组),低分子肝素联合全量替罗非班组42例(全量组),观察三组出血事件发生率,血小板减少发生率,住院期间及术后半年主要心血管事件发生率(包括恶性心律失常、严重心衰、再梗死、再次靶血管重建及心源性死亡)。结果三组血小板减少发生率比较差异无统计学意义(P>0.05);全量组出血事件发生率高于肝素与半量组(P<0.05),肝素与半量组比较差异无统计学意义(P>0.05)。三组住院期间及术后6个月主要不良心脏事件(MACE)发生率比较:半量与全量组发生率低于肝素组(P<0.05),后两组比较差异无统计学意义(P>0.05)。结论 ACS合并DM且行PCI治疗的老年患者早期应用盐酸替罗非班加强抗血小板治疗较只应用基础抗凝抗栓治疗效果好,且应用半量盐酸替罗非班更为安全。     

Sonoclot血栓监测指标对经皮冠状动脉介入治疗围手术期心肌梗死的预测作用

目的经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)围手术期心肌梗死的发生与术前抗栓治疗关系密切,但至今还没有理想的临床指标评价PCI术前的抗栓治疗效果。Sonoclot是一种以血液黏度为基础体外实时监测凝血功能和血小板功能的方法。本研究拟入选急性冠状动脉综合征(ACS)患者,PCI术前进行Sonoclot检测,评价Sonoclot指标与PCI围手术期心肌梗死发生的相关性,寻找可以评价PCI术前抗栓疗效的指标。方法前瞻性连续入选2009年9月至2010年7月收住在北京大学第一医院心内科、临床诊断为非ST段抬高急性冠脉综合征并接受冠状动脉造影及介入治疗的患者。收集一般临床资料,根据PCI术后心肌标记物升高至正常值上限3倍以上与否判断患者是否发生围手术期心肌梗死,使用Sonoclot凝血及血小板功能分析仪(Sonoclot coagulation&platelet function analyzer,SCA,SIENCO,Inc,USA)完成ACT(activited clotting time,激活凝血时间)、CR(clot rate,凝血速率)、PF(platelet function,血小板功能)等指标的检测。结果共入组患者246例,其中,男性163例(66.3%),女性83例(33.7%),年龄分布于27～87岁之间,平均(64.3±11.2)岁。其中119例(48.4%)发生围手术期心肌梗死,与未发生者相比,性别、术中肝素用量、多支血管病变比例差异具有统计学意义。另外,经Sonoclot测得的肝素化前CR(gbCR)在两组间差异存在统计学意义(21.32比19.83,t=-2.000,P<0.05)。进一步按照gbCR的75%分位数(gbCR=24)将患者分为两组,结果显示,gbCR高于四分位数患者围手术期心梗风险明显增加(OR:1.94,95%CI:1.05～3.59,P=0.04)。对性别、年龄、BMI、多支血管病变、肝素用量、PT值、FIB值、gbCR等多个因素进行Logistic回归分析显示,gbCR是PCI围手术期心梗的独立预测因素(OR=2.36,95%CI:1.05～5.28)。结论肝素化前CR值与PCI围手术期心肌梗死具有显著相关性,提示对该指标的监测可能会预测PCI围术期心肌梗死的发生风险。     

国产比伐卢定和普通肝素在急诊经皮冠状动脉介入治疗中的比较

目的评价国产比伐卢定在急诊经皮冠状动脉介入治疗(PCI)中抗凝的有效性及安全性。方法选择2012年7月至2013年3月收治的90例发病12 h以内、接受急诊PCI的急性ST段抬高型心肌梗死(STEMI)患者为研究对象,采用随机数字表法分为比伐卢定组(40例)和肝素组(50例),术中分别使用比伐卢定和普通肝素抗凝,观察并比较两组患者的冠状动脉病变特征、心肌梗死溶栓实验(TIMI)血流分级、术后1 h和4 h部分凝血活酶时间(APTT)、术前及术后24 h血小板计数,以及30 d主要不良心血管事件(MACE)等,评价安全性的指标主要为血小板是否减少和出血并发症。结果两组患者病变支数、罪犯血管、TIMI血流分级差异均无统计学意义(P>0.05)。两组患者随访30 d,无再发心肌梗死、支架内血栓、心原性死亡发生。两组患者急诊PCI术前血小板计数、凝血酶时间、凝血酶原时间、纤维蛋白原、APTT值比较,差异均无统计学意义(P>0.05),比伐卢定组停药后1 h的APTT值明显小于肝素组[(160.0±25.6)s比(165.0±27.6)s,t=2.412,P=0.02],但停药后4 h的APTT值虽仍小于肝素组,但差异无统计学意义[(37.6±11.5)s比(40.3±12.6)s,t=0.573,P=0.56]。两组均无严重出血发生,无血小板减少,比伐卢定组轻度出血事件少于肝素组,但差异无统计学意义[2例(5.0%)比4例(8.0%),χ2=0.321,P=0.57]。结论在急诊PCI术中,国产比伐卢定抗凝治疗具有良好的安全性和有效性。     

尿激酶静脉溶栓联合治疗急性ST段抬高性心肌梗死冠脉再通率观察临床报道

目的观察尿激酶静脉溶栓联合强化抗凝、抗血小板、调脂综合治疗急性ST段抬高性心肌梗死冠脉再通率。方法使用尿激酶静脉溶栓联合强化抗凝、抗血小板、调脂综合治疗方法,对我科收治的68名急性ST段抬高性心肌梗死患者进行治疗和用药过程的全程监测,通过冠脉造影证实治疗效果。结果 68名急性ST段抬高性心肌梗死患者,通过综合治疗,冠脉造影证实血管完全再通12例,部分再通49例,完全未通7例。结论通过尿激酶静脉溶栓联合强化抗凝、抗血小板、调脂综合治疗急性ST段抬高性心肌梗死,疗效满意,快速开通血管,能较好的为无条件实施急诊PCI治疗的患者实施初步治疗,并能为患者安全转运到上级医院实施PCI治疗起到了保驾护航作用。     

冠状动脉介入诊断治疗时那屈肝素与普通肝素联合应用的安全性研究

目的评价在无ST段抬高的急性冠脉综合征(ACS)患者行冠状动脉(冠脉)介入治疗(PCI)前后接受那屈肝素皮下注射与PCI术中普通肝素联合应用的安全性。方法190例ACS患者接受抗血小板治疗和2—4天那屈肝素治疗后分成3组：A组未行介入诊断和治疗,继续那屈肝素治疗;B组行冠状动脉造影(CAG)而未行PCI治疗;C组CAG后立即接受PCI治疗。B组和C组分别在停用最后1次那屈肝素注射后8—12小时内行CAG及CAG和PCI,介入操作时给予普通肝素,术后继续那屈肝素治疗。那屈肝素总的治疗时间不超过7天,观察10天期间出血发生情况。结果3组总的出血发生率分别为8．33％、12．7％和14．5％,差异无显著性。结论对接受抗血小板治疗的ACS患者,行PCI术前、术后那屈肝素皮下注射和术中普通肝素联合应用是安全的。     

老年人特发性血小板减少性紫癜76例临床分析

对76例老年人特发性血小板减少性紫癜(ITP)患者的临床资料进行回顾性分析。76例老年患者中男女之比1∶2.8,慢性ITP 73例、急性ITP 3例,血小板计数平均为36×109/L,并存其他疾病者共58例。单一激素治疗总有效率100%,激素加大剂量维生素C治疗总有效率82.7%,单一大剂量维生素C治疗有效率82.2%。激素治疗期间并发肺炎、上消化道出血各4例,急性胆道感染、发热与腹泻各2例,其中死亡3例。     

丙种球蛋白联合地塞米松在小儿特发性血小板减少性紫癜中的临床探讨

目的对丙种球蛋白联合地塞米松在小儿特发性血小板减少性紫癜中的临床疗效进行探讨。方法随机抽取我院2011年1月-2013年12月治疗的80例小儿特发性血小板减少性紫癜患儿,分为两组:观察组与对照组,对照组患者使用地塞米松进行治疗,观察组患者在对照组治疗方案的基础之上,再使用丙种球蛋白,对两组患者的治疗效果进行对比与分析。结果观察组患者的出血控制时间、治疗有效率、血小板上升时间等明显优于对照组,存在较大差异,具备统计学意义(P0.05)。结论丙种球蛋白联合地塞米松在小儿特发性血小板减少性紫癜治疗中的应用,不仅能够改善患儿的临床表现,而且能够大大提高小儿特发性血小板减少性紫癜患儿的血小板水平,治疗效果较为明显,具有非常重要的意义,值得在临床治疗中进行大范围的推广与应用。     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.