高血压治疗的现代途径(MATH)

标　　题　硝苯地平胃肠治疗系统对老年患者的抗高血压治疗作用作　　者　ＢｒａｖｏＥＬ,ＫｒａｋｏｆｆＬＲ,ＴｕｃｋＭＬ,ｅｔａｌ.　　参考文献　ＡｍＪＨｙｐｅｒｔｅｎｓ,1990,3:326Ｓ目　　的　评估硝苯地平的新剂型胃肠治疗系统ＧＩＴＳ治疗高血压的疗效和安全性。研究疾病　高血压病。设　　计　多中心、开放性临床研究。病人资料　1155例ＤＢＰ在95～110ｍｍＨｇ的高血压患者。随　　访　至目标血压达到后12周。治疗方案　硝苯地平控释片30ｍｇ/ｄ,在6周内剂量逐渐增至最大量180ｍｇ/ｄ,每次增量为30ｍｇ,目标血压为舒张压降至90…     

Spectrum and origin of phenylketonuria mutations in Spain

In order to characterize the molecular heterogeneity of phenylalanine hydroxylase deficiencies in the Spanish population, 37 PKU patients were initially screened for 16 known European mutations. For the remaining unidentified alleles, we used a combined strategy based on single strand conformation polymorphism analysis and DNA sequencing. Overall, a total of 15 different mutations were found in our sample, which account for 62% of the total mutant alleles. We also investigated the association between the mutations, haplotypes and variable number of tandem repeats described on the phenylalanine hydroxylase gene. In addition, we analyzed the geographical distribution in Spain of the two most prevalent mutations in our population: IVS10 and I65T.     

Detection of pericentric inversion of X chromosome in a male fetus

Amniocentesis on a 32-year-old woman at risk for trisomy 21 by maternal serum triple screen showed a 46,Y,inv(X) (p22.1q24) karyotype in all cells analyzed. A blood sample was obtained from the mother for cytogenetic evaluation. Since she had the same inversion, DNA replication studies were performed to determine if the X inactivation pattern was random or not, since skewed inactivation of the inverted X might suggest that the breakpoints disrupted functional genes. DNA replication studies demonstrated that 68% of mother's cells with the inverted X were active, suggesting random X inactivation. The random X inactivation pattern suggested that the inversion is probably balanced and should not affect the fetus. A normal male was delivered at 40 weeks gestation.     

Low-molecular-weight heparin for thromboprophylaxis in pregnant women with mechanical heart valves.

BACKGROUND: Pregnancy in a woman with a mechanical heart valve is a life-threatening situation. Due to the inability of unfractionated heparin to prevent valvular thromboses, warfarin or other vitamin K antagonists have been the preferred anticoagulants for the mother. They are, however, potentially harmful to the fetus. With the advent of low-molecular-weight heparins, clinicians were hopeful for an alternative that was safe for the fetus, but more effective than unfractionated heparin, which carries a 29-33% risk of life-threatening thromboses and a 7-15% chance of mortality. Unfortunately, fatal thromboses have occurred with low-molecular-weight heparin as well. METHODS: We searched the MEDLINE database and other sources to identify cases of the use of low-molecular-weight heparin for thromboprophylaxis in women with mechanical heart valves. RESULTS: We found 73 cases and added three of our own for a total of 76. There were 17 thrombotic events (22%). Thirteen were valve thromboses, two were strokes, and two were myocardial infarctions. There were three deaths (4%). CONCLUSIONS: While pregnant women with mechanical heart valves who receive low-molecular-weight heparin for thromboprophylaxis are at extremely high risk of life-threatening thromboses, there is no evidence that low-molecular-weight heparin is inferior to unfractionated heparin.     

妊娠期及产后静脉血栓栓塞的发生率、危险因素及死亡率

目的:本研究对妊娠相关的静脉血栓栓塞的发生率、危险因素及死亡率进行评估。研究设计:对来自健康研究和质量机构的健康支出和使用项目中全国住院患者样本中2000—2001年诊断为妊娠相关静脉血栓栓塞患者进行问卷调查。结果:静脉血栓栓塞发生率为1.72例/1000次分娩,死亡率为1.1/     

Aspirin and reproductive outcomes

In the late 1980s and early 1990s, researchers hypothesized that aspirin could be used to prevent or delay the onset of preeclampsia. This hypothesis was tested in numerous trials which showed limited, but positive results. Subsequently, aspirin has been used in an attempt to improve pregnancy outcomes in women who have both antiphospholipid antibodies and a history of recurrent loss, and has also been used in an attempt to improve the success of in vitro fertilization. In theory, aspirin has both positive and negative effects on reproduction. Aspirin, which suppresses cyclooxygenase, has the potential to interfere with implantation, but also has the potential to support the maintenance of pregnancy. Aspirin is prescribed with increasing frequency to reduce the risk of maternal thrombosis and reduce the risk of miscarriage and poor pregnancy outcome. Aspirin alone, however, is not considered sufficient to prevent thrombosis and even in women with the antiphospholipid syndrome, the question as to whether low-dose aspirin improves pregnancy outcomes has not been answered affirmatively. Aspirin has potential risks. Aspirin inhibits platelet function and can contribute to maternal and fetal bleeding. Aspirin crosses the placenta. Although aspirin has not been associated with other congenital anomalies, it has been associated with an increased risk of vascular disruptions, particularly gastroschisis and possibly premature closure of the ductus arteriosus. Nonetheless, large trials demonstrate low-dose aspirin's relative safety and generally positive effects on reproductive outcomes.