口服抗凝药的过去、现在与未来

口服抗凝药（OACs)对于预防以及治疗血栓栓塞性疾病该病具有重要的临床价值。作为维生素K拮抗剂,华法林曾长期作为OACs的唯一选择。近年来,非维生素K口服拮抗剂（NOACs)因相对简单的药物间相互作用以及无需检测凝血功能等特点极大的提高了患者服药便利性,迅速在临床上得到广泛应用。但该类药物仍存在长期应用出血风险偏高、消化道出血风险较华法林增加等问题。目前以FXI为靶点的下一代口服抗凝药正在积极研发中,有望在未来为血栓栓塞性疾病患者提供更为优异的药物选择。     

慢性阻塞性肺疾病急性加重期住院时间延长的因素分析

目的探讨引起慢性阻塞性肺疾病急性加重(AECOPD)住院患者的住院时间延长的危险因素。方法选取在2017至2018年因AECOPD入住上海市浦东医院综合内科及呼吸内科的661例患者,分析比较患者的基线特点、COPD稳定期的治疗措施以及住院期间的实验室检查、治疗经过。结果在661例患者中76.6%为男性,平均年龄74.5岁,平均住院时间11.9 d,有24%的患者出现住院时间延长,2.57%的患者需入住重症监护病房(ICU),14.67%的患者需使用无创机械通气(NIV)。AECOPD患者住院时间延长与多种因素有关,首先,患者自身条件包括年龄、低血红蛋白血症、合并慢性肾脏病;其次还与入住的科室、AECOPD的严重程度、住ICU时间以及对NIV的需求相关,差异均具有统计学意义(P值均<0.05)。结论导致AECOPD患者住院时间延长的因素主要与住院科室以及对ICU、NIV的需求相关。     

Clinical report and analysis of 24 cases of multiple magnetic beads foreign body in gastrointestinal tract of children

Background/AimsThis study aimed to analyze the data of 24 cases of multiple perforation or obstruction of the digestive tract caused by accidental ingestion of magnetic beads, to improve the understanding of its harmfulness to children and explore the best treatment.Materials and MethodsIn total, 24 cases were collected and retrospectively analyzed. These patients were divided into two groups: perforation group and non-perforation group. The medical history, number of magnetic beads, white blood cell (WBC) count, and C-reactive protein (CRP) were analyzed.ResultsThere was no significant difference in age, gender, medical history, number of magnetic beads, and WBC count between the perforation group and non-perforation group, but there was a significant difference in CRP. After the diagnosis, 70% of the cases underwent laparotomy and perforation repair. All cases recovered smoothly after the operation, and no complications occurred during the follow-up.ConclusionThis study offers diagnosis and treatment methods for the perforation or obstruction of the digestive tract caused by accidental ingestion of magnetic beads and raises the awareness regarding the harmfulness of the presence of foreign bodies in the digestive tract.     

Long-term follow-up for ectopic ACTH-secreting pituitary adenoma in a single tertiary medical center and a literature review

Pituitary - Ectopic ACTH-secreting pituitary adenoma (EAPA) are a rare cause of Cushing’s disease. Due to the lack of consensus and experience in terms of the diagnosis and treatment of...     

Thermal Ablation Damage Analysis of CFRP Suffering from Lightning Based on Principles of Tomography

Coupled electrical–thermal finite element analysis (FEA) models are widely adopted to analyze the thermal ablation damage of carbon fiber reinforced polymer (CFRP) caused by lightning, but it is still difficult to analyze the ablation due to its complex space geometry. According to the principle of computerized tomography (CT), tomographic images of FEA models’ temperature fields with different thicknesses were obtained to calculate the mass loss and compare the damage morphology. The four areas including Area 0, Area I, Area II, and Area III; were separated from the temperature fields in terms of different vaporization and pyrolysis temperature ranges of carbon fiber (CF) and resin matrix. Ablation mass losses were calculated by pixel statistics and tomographic intervals, which were consistent with the experimental results. The maximum ablation area of unprotected CFRP was found on the tomography images of 50 μm rather than the surface by comparing tomographic images with different thickness due to the influence of the thermal radiation, but this effect was not found in CFRP protected by copper mesh. Some other phenomena, including continuous evolutions of ablation areas and the influence of the intersection angle on the direction of the ablation extension, were also discovered.