Combined treatment with APCC (FEIBA®) and tranexamic acid in patients with haemophilia A with inhibitors and in patients with acquired haemophilia A – a two‐centre experience

The management of bleeding in haemophilia patients with inhibitors can be challenging when using monotherapy with either activated prothrombin complex concentrate (APCC) or recombinant activated FVII (rFVIIa) fail. The antifibrinolytic agent tranexamic acid (TXA) increases clot stability and is used concomitantly with coagulation factor replacement to improve haemostasis in haemophilia patients without inhibitors in many countries in Europe. Combined treatment with TXA and rFVIIa is not contraindicated in haemophilia patients with inhibitors. However, the combined approach of TXA and APCC has not been investigated due to safety concerns of increased risk of thrombosis or disseminated intravasal coagulation (DIC). The aim of this study is to report our experience of concomitant use of APCC and TXA in haemophilia A patients with inhibitor and in patients with acquired haemophilia A with respect to safety and efficacy. Seven (n = 6) haemophilia A patients with inhibitors and one (n = 1) with acquired haemophilia A from Oslo (Norway) and Stockholm (Sweden) were included in the study. The APCC was given at doses consistent to the manufacturers' recommendation. TXA was administered concomitantly either 10 mg kg(-1) every 6-8 h intravenously or 20 mg kg(-1) every 6-8 h orally. Haemostatic response was assessed by thromboelastography (TEG) and thrombin generation assay (TGA) in three of the patients. A total number of three bleeding episodes and two minor and six major surgical procedures were performed under the coverage with APCC and TXA. Haemostatic outcome was rated excellent or good in 10 of 11 (91%) treatment episodes. One episode was rated with poor effect. No episodes of arterial, venous thrombosis or DIC occurred during or after the treatment. Data from TEG and TGA analysis showed no signs of hypercoagulability following the combined treatment. This report demonstrates that, in a limited number of patients, combined treatment with APCC and TXA seemed to be safe, tolerated and relatively effective in management of bleeding episodes and in preventing haemorrhage during surgery in haemophilia patients with inhibitors and in a patient with acquired haemophilia A. Further studies should be performed to confirm these data.     

富含自体骨髓间充质干细胞的聚ε-己内酯/明胶补片修复大鼠肛门括约肌损伤

目的 构建载有自体骨骼间充质干细胞(MSCs)的聚ε-己内酯(PCL)/明胶补片,观察其对大鼠肛门括约肌损伤的修复作用.方法 制备Wistar大鼠肛门括约肌损伤模型,分为3组:A组不做处理,B组直接缝合,C组外科缝合+富含MSCs的PCL/明胶补片.术后30 d评估肛门括约肌收缩能力,观察肛管及下端直肠组织形态学改变.结果 MSC均匀分布于PCL/明胶支架,MSCs特异性抗原(81.5±7.1)％ CD45+,(97.6±1.6)％CD90+,(85.3±5.1)％CD44-,(95.4±1.5)％ CD34-,MSCs未发生表型改变;细胞生长较常规方法缓慢[(0.27 ±0.25) ×104比(5.12±0.48) ×104,P ＜0.05).组织学观察C组新生的括约肌区域胶原沉积较少,并有明显的新生血管形成.结论 联合MSC-PCL/明胶补片修补肛门括约肌损伤,具有减少瘢痕和促进组织血管生成的作用.     

Failure of enteric-coated peppermint oil in the irritable bowel syndrome: A randomized, double-blind crossover study

Enteric-coated capsules containing peppermint oil were compared with placebo in a double-blind crossover trial involving 25 patients with the irritable bowel syndrome, carefully selected for the predominance of colonic symptoms. Patients were randomly allocated to receive active drug or placebo, three capsules per day, for 4 weeks and then changed to the alternative medication for a further 4 weeks. Symptom scores were assessed by the patient using visual analogue scales. While on peppermint oil, there was a small but statistically significant increase in stool frequency but no significant change in scores for global severity or scores for the specific symptoms of pain, bloating, urgent defecation and the sensation of incomplete evacuation. Seven patients failed to complete the study, three because of perianal burning associated with peppermint oil. Enteric-coated capsules containing peppermint oil are unhelpful in patients with the irritable bowel syndrome and prominent colonic symptoms.     

儒医合璧,以文化人——陈修园《医学三字经》传统文化特性刍议

中医学与中国传统文化有着密切关系。陈修园《医学三字经》巧妙地将中医和儒家思想结合起来，在中医药学术传播中凸显了鲜明的传统文化特性。文章从儒家的"仁"、文韵和尊崇经典特点对这一特性进行简要探讨。     

浅议《沈菊人医案》“气为血帅”理论的运用

医案是中医临床实践的真实记录，收录医家成功治疗案例的经验和心得，体现诊疗过程中理法方药的具体运用。文章通过清末名医沈菊人的3则医案，从气生血、行血、摄血浅谈"气为血帅"理论在临床上如何指导辨证用药。