Prolonged bleeding time in cirrhotic patients: Relationship to peripheral vasodilation and severity of cirrhosis

Abstract A prolonged bleeding time (>540 s), measured with a Simplate single template device, was found in 0% of 50 patients with chronic hepatitis and 38% of 154 cirrhotic patients. Cirrhotic patients with a prolonged bleeding time (n= 59) had lower platelet counts (P < 0.001) and a longer prothrombin time (P < 0.001) and activated partial thromboplastin time (P < 0.001) compared with cirrhotic patients with a normal bleeding time (n= 95). A weak but significant negative correlation existed between the bleeding time and platelet count in cirrhotic patients (n= 154, r= -0.3668, P < 0.001). Patients with decompensated cirrhosis had a longer bleeding time in comparison to patients with compensated cirrhosis (621±39 vs 478 ± 27 s, respectively, P < 0.01). The prolonged bleeding time was also discovered in 25% of 83 cirrhotic patients with a platelet count >80 × 10⁹/L and a prothrombin time < 17 s (usually taken as safe limits for invasive procedures). Twenty-seven of the 83 cirrhotic patients received a haemodynamic study by Swan-Ganz catheterization. A lower systemic vascular resistance was found in cirrhotic patients with an abnormal bleeding time than in cirrhotic patients with a normal bleeding time (844 ± 57 vs 1171 ± 60 dyne·s·cm^?5, respectively, P < 0.001), whereas both groups had similar hepatic venous pressure gradient (16.2 ± 1.2 vs 18.1 ± 1.4 mmHg, respectively, P > 0.05). There was a significant negative correlation observed between systemic vascular resistance and bleeding time in cirrhotic patients with a platelet count >80 × 10⁹/L and a prothrombin time < 17 s (n= 27, r= -0.63, P < 0.001). These results demonstrate that prolonged bleeding time is common in patients with cirrhosis. Peripheral vasodilation is probably an important factor in addition to platelet counts and the severity of liver disease in determining the bleeding time in cirrhosis.     

白花蛇舌草的化学成分研究Ⅱ.

前报曾报导自茜草科(Rubiaceae)植物白花蛇舌草[Oldenlandia diffusa(Willd.)Roxb.]中分得七个成分,其中四个已分别证明为三十一烷、豆甾醇、乌索酸、土当归酸。本文对另外三个成分进行鉴定。其中结晶,Ⅲ为β-谷甾醇;结晶Ⅴ为β-谷甾醇D-葡萄糖甙,水溶性成分结晶Ⅶ经光谱分析,衍生物以及氧化产物等性质鉴定,证明为对香豆酸。     

吉非替尼(Gefitinib)对非小细胞肺癌的脑部转移具有疗效

目的 比较分析吉非替尼对不同体能表现、既往不同化疗次数、有或无脑部转移病灶的非小细胞肺癌患者的治疗结果。方法 总共有76例患者参加试验。结果 患者的疾病控制率为63．2％(95％CI为52．1％～74．3％)．无疾病恶化牛存期的中位数为5．0个月(95％CI为3．5～6．6个月)，整体生存期的中位数为9．9个月(95％CI为4．9～14．8个月)。其中具有可测量病灶的57例患者的客观反应率为33．3％(95％CI为20．7％～46．0％)。76例患者中有21例患者同时具有可评估的颅内及颅外病灶，其中17例(81．0％)对吉非替尼有相同的颅内及颅外肿瘤反应．而出现脑部转移并不影响患者的生存期。药物引起的副作用大部分是中等反应．仅5例患者发生不可耐受的毒性，其中1例(5．8％)为间质性肺炎。结论 吉非替尼对非小细胞肺癌的脑部转移有疗效．值得进一步没计随机临床试验观察单剂吉非替尼治疗或加上其它形式的治疗在脑部转移的非小细胞肺癌患者中所扮演的角色。     

Clinical characteristics and survival of trisomy 13 in a medical center in Taiwan, 1985–2004

BACKGROUND: This study investigated the survival and natural history of trisomy 13 in a series of patients, comparing the management and outcome before and after the implementation of Taiwan's National Health Insurance program (NHI). METHODS: A total of 28 cases of trisomy 13 seen at Mackay Memorial Hospital, Taipei, Taiwan, from 1985 to 2004 were retrospectively reviewed. Survival and management before (12 cases) and after (16 cases) the implementation of National Health Insurance were compared, and structural defects, imaging findings, and cytogenetic results were analyzed. The cases that were diagnosed prenatally, and finally terminated, were excluded from this study. The diagnosis of trisomy 13 was based on the postnatal chromosome analysis. RESULTS: All patients except one with trisomy 13 translocation died in their first year because of severe malformations of the cardiovascular or central nervous system. The median survival was 9 days. After implementation of National Health Insurance, survival with trisomy 13 was significantly longer than before (P < 0.05). The three most common structural defects were abnormal auricular helices or low-set ears (89%), cryptorchidism and abnormal scrotum of male (73%) and cleft lip and/or palate (71%). Using echocardiography, the most commonly detected heart defects were patent ductus arteriosus (68%), ventricular septal defect (50%) and atrial septal defect (50%), and eight cases (36%) had complex congenital heart defects. The most common brain lesion was lenticulostriate vasculopathy (22%), followed by holoprosencephaly (17%), brain edema (13%) and subependymal cyst (13%). CONCLUSIONS: Early diagnosis and the survival patterns from the data collected should be used to inform parents and health-care professionals to assist in decision making. Although most patients with trisomy 13 die within the first weeks after birth, it is important to recognize that a few may survive the first year. When counseling families, the long-term survival prospects of trisomy 13 patients should be included.     

Leukemia Inhibitory Factor Expression in Different Endometrial Locations Between Fertile and Infertile Women Throughout Different Menstrual Phases

Purpose: The purpose was to demonstrate the leukemiainhibitory factor (LIF) expression in different endometriallocations between fertile and infertile women throughoutdifferent menstrual phases. The relationship betweenprogesterone level and LIF expression were evaluated. Methods: Endometrial biopsies were performed onidiopathic infertile and normal fertile women accepted theinfollicular, periovulatory, and luteal phases. The lutealprogesterone level was measured. Endometrial LIFimmunostaining of luminal epithelium, glandular epithelium, andstroma were detected. The relationship between luteal LIFexpression and progesterone level was evaluated. Results: Significant LIF expression was noted in theendometrium of fertile women rather than that of infertile women.The LIF expression was highest in the luminal epithelium,moderate in the glandular epithelium, and lowest in thestroma. The luminal and glandular epithelial staining werelowest in follicular phase, moderate in periovulatory phase,and strongest in luteal phase. The stromal LIF presentedwith a noncyclical manner. The LIF expression is not relatedwith the progesterone level. Conclusions: Endometrial LIF expression is related tohuman fertility. Endometrial LIF expression is dependenton cellular localizations and menstrual stages. Stronger LIFexpression presents in the endometrial epithelium duringluteal phase.     

正常髌股关节在体运动学研究回顾

髌骨轨迹不良被认为是引起髌股疼痛综合征的主要病理生理机制之一。本文回顾迄今已发表的正常髌股关节运动分析结果,介绍正常髌股关节在不同功能活动下的6自由度运动动态特征。髌骨内外移位、翻转、前后移位以及屈曲在不同的功能运动中都存在较为统一的运动模式。然而,不同测量方法限制了研究之间的深入比较。今后广泛运用动态磁共振成像（magnetic resonance imaging,MRI）或/和双平面正交荧光透视成像系统（dual fluoroscopic imaging system,DFIS）,规范坐标系的建立或骨性形态参数的定义与使用,并增加实验的样本量,将有助于明确在体髌股关节6自由度运动的特征,完善对髌股关节动态功能的临床评价依据。     

Effects of the number of neoadjuvant therapy cycles on clinical outcomes,safety, and survival in patients with metastatic colorectal cancer undergoing metastasectomy

The controversial outcomes in patients with metastatic colorectal cancer (mCRC) highlight the need for developing effective systemic neoadjuvant treatment strategies to improve clinical results. The optimal treatment cycles in patients with mCRC for metastasectomy remain undefined. This retrospective study compared the efficacy, safety, and survival of cycles of neoadjuvant chemotherapy/targeted therapy for such patients. Sixty-four patients with mCRC who received neoadjuvant chemotherapy/targeted therapy following metastasectomy were enrolled between January 2018 and April 2022. Twenty-eight patients received 6 cycles of chemotherapy/targeted therapy, whereas 36 patients received ≥7 cycles (median, 13; range, 7–20). Clinical outcomes, including response, progression-free survival (PFS), overall survival (OS), and adverse events, were compared between these two groups. Of the 64 patients, 47 (73.4%) were included in the response group, and 17 (26.6%) were included in the nonresponse group. The analysis revealed chemotherapy/targeted therapy cycle and pretreatment serum carcinoembryonic antigen (CEA) level as independent predictors of the response as well as overall survival and chemotherapy/targeted therapy cycle as an independent predictor of progression (all p < 0.05). Furthermore, our results revealed shorter operation time, lower estimated operative blood loss, higher response rate, lower progression rate, and higher survival rate in ≥7 cycles of chemotherapy/targeted therapy group (all p < 0.05), but no statistical differences in adverse events were observed between the two groups (all p > 0.05). The median OS and PFS were 48 months (95% CI, 40.855–55.145) and 28 months (95% CI, 18.952–37.48) in the ≥7-cycle group and 24 months (95% CI, 22.038–25.962) and 13 months (95% CI, 11.674–14.326) in the 6-cycle group, respectively (both p < 0.001). The oncological outcomes in the ≥7-cycle group were significantly better than those in the 6-cycle group, without significant increases in adverse events. However, prospective randomized trials are mandatory to confirm the potential advantages of cycle numbers of neoadjuvant chemotherapy/targeted therapy.     

The neurophysiological performance of visuospatial working memory in children with developmental coordination disorder

Aim The objective of this study was to investigate the mechanisms underlying the deficit in visuospatial working memory (VSWM) seen in children with developmental coordination disorder (DCD) and to compare brain activity while performing a VSWM task in children with DCD and typically developing children. Method Behavioural performance and event‐related potentials (ERPs) were recorded in 24 children (12 males, 12 females; mean age 139mo, SD 4mo) with DCD (as determined by a score <5th centile on the Movement Assessment Battery for Children – Second Edition) and in 30 age‐ and sex‐matched typically developing children (15 males; 15 females; mean age 140mo, SD 5mo) recruited from local schools, while performing one spatial non‐delay and two time‐delayed spatial memory tasks. Results Compared with typically developing children, children with DCD exhibited longer reaction times (p = 0.022; partial η²=0.10) and lower accuracy rates (p < 0.001; partial η² = 0.35) on the two spatial memory tasks. Electrophysiological indices also showed distinct modulatory effects, with children with DCD exhibiting smaller P3 (p < 0.001; partial η² = 0.26) and positive slow wave (pSW; p = 0.003; partial η² = 0.16) amplitude and a smaller area under the curve of P3 and pSW components (p = 0.002; partial η² = 0.17). Interpretation The combined analysis of behavioural performance and ERP data suggests that children with DCD have deficits of visuospatial working memory owing to fewer resources being allocated to comparison of spatial locations, less effort allotted to the response selection, and less neural processing employed during the retrieval process phase.     

Comparison of residual renal function in patients undergoing twice-weekly versus three-times-weekly haemodialysis

Aim:   Patients with end-stage renal disease (ESRD) often start long-term haemodialysis (HD) thrice weekly, regardless of the level of residual renal function (RRF). In this study, we investigated whether ESRD patients having sufficient RRF can be maintained on twice-weekly HD, and how they fare compared to patients without RRF on thrice-weekly HD.
Methods:   We analyzed 74 patients who had undergone long-term HD and maintained on the same dialysis frequency from February 1998 to July 2005, and followed until December 2005. We compared the clinical variables between twice-weekly and thrice-weekly HD patients and a second analysis testing the residual urine output as an independent predictor for twice-weekly HD.
Results:   After a mean follow up of 18 months, twice-weekly HD patients ( n  = 23) had lower serum β2-microglobulin than thrice-weekly HD patients ( n  = 51). Moreover, the twice-weekly group had a slower decline of RRF, as indicated by their higher urine output and creatinine clearance, fewer intradialytic hypotensive episodes, and required less frequent hospitalization. There was no difference between the two groups in cardiothoracic ratio or indices of nutrition and inflammation. Multivariable logistic regression identified age (odds ratio (OR), 1.866; 95% CI, 1.093–3.183), dry body mass index (OR, 0.790; 95% CI, 0.625–0.999), and urine output (OR, 1.093; 95% CI, 1.026–1.164) as predictors for maintaining twice-weekly HD.
Conclusion:   Our data suggest that when patients who have sufficient urine output are given twice-weekly HD, they maintain dialysis adequacy and exhibit better preservation of RRF than patients on thrice-weekly HD.