Erythrocytes: Anemias in Chronic Liver Diseases

Anemia is a frequently observed manifestation during the clinical course of chronic liver disease. In this study, we retrospectively reviewed the hospital files of 500 chronic liver disease patients and assessed the frequency, etiology and morphology of anemia in 50 patients who fulfilled the criteria to be included in the study. The mean age of the patients was 48+/-16 years and male/female ratio was 1.4/1. The mean hemoglobin value was 9.54+/-2.03 g/dl. The mean MCV was 82.9+/-10.52 fl. Iron deficiency anemia, defined as absent bone marrow iron stores, was the most common anemia present in 50% of patients. Classical laboratory criteria used in the diagnosis of iron deficiency anemia (MCV < 80 fl, ferritin < 10 ng/ml) could not be applicable to all of the patients with iron deficiency anemia and hepatic disorders. Hemolytic anemia due to hypersplenism was the second most common anemia (24%) followed by anemias, namely anemia due to gastrointestinal hemorrhage (22%), anemia of chronic disease (8%), beta-thalassemia major (8%), folate deficiency (6%), vitamin B12 deficiency (4%), macrocytic anemia (2%), aplastic anemia (2%) and immune hemolytic anemia (2%). Twenty-eight percent of the patients had more than a single cause of anemia. Morphologically, microcytic anemia was the most common seen in 46% of the patients followed by normocytic (42%) and macrocytic anemia (12%). As patients do not always present with classical laboratory findings and may have more than a cause of anemia, a complex diagnostic approach should be considered in anemic patients with hepatic disorders.     

Spontaneous Reinitiation of Atrial Fibrillation Following Transvenous Atrial Defibrillation

Spontaneous reinitiation of atrial fibrillation (AF) has not been systematically looked at in patients undergoing transvenous AF. This study involved 11 patients, the mean age 60 ± 8 years. 3 male and 8 female, in whom transvenous atrial defibrillation successfully converted AF to sinus rhythm. Eight patients had paroxysmal AF and three patients had chronic persistent AF for 4 weeks or more. Four patients were taking antiarrhythmic medications at the time of testing. Multipolar transvenous catheters were positioned inside the coronary sinus, right atrium, and the right ventricle. Atrial defibrillation testing was performed using the METRIX atrial defibrillation system in nine patients and the Ventritex HVSO2 in the remaining two patients. A total of 64 therapeutic shocks (range 3–11) were delivered in the 11 patients, and 31 of these successfully converted AF to sinus rhythm. In four patients spontaneous AF was reinitiated following 12 successful transvenous atrial defibrillation episodes. The mean time to reinitiation of AF following shock delivery and restoration of sinus rhythm was 8.26 ± 5.25 seconds, range 1.8–19.9 seconds. All 12 episodes of spontaneous AF were preceded by a spontaneous premature atrial complex. The coupling interval of the premature atrial complexes was 443 ± 43 ms, range 390–510 ms. None of the patients taking antiarrhythmic medications or those demonstrating no premature atrial complexes had spontaneous reinitiation of AF. In conclusion, spontaneous reinitiation of AF can occur in a significant proportion of patients with AE undergoing transvenous atrial defibrillation. This phenomenon is preceded by the occurrence of atrial premature complex. Findings of this study may have significant clinical implications.(PACE 1998; 21:1105–1110)     

Electrophysiological Behavior of Atrioventricular Node After Selective Fast or Slow Pathway Ablation in Patients with Atrioventricular Nodal Reentrant Tachycardia

One hundred twenty consecutive patients with symptomatic atrioventricular nodal reentrant tachycardia (AVNRT) underwent catheter ablation using radiofrequency energy. Fast pathway ablation was attempted in the first 16 consecutive patients by application of radiofrequency current in the anterior and superior aspect of the tricuspid annulus. Successful results were accomplished in 13 patients, complete atrioventricular (AV) block occurred in three. One hundred four patients underwent ablation of the slow pathway in the posterior and inferior aspect of the tricuspid annulus, which was successful in 98 patients. The remaining six patients subsequently underwent a fast pathway ablation with successful results in four and AV block in two. Therefore. 102 (98%) of the last 104 patients became free of AVNRT while maintaining intact AV conduction. This study characterizes the electrophysiological properties of the residual AV node following a selective fast or slow pathway ablation.     

Reproducibility of digital exercise echocardiography

We determined the intra, inter-observer and temporal variabilityof upright bicycle exercise echocardiography in 50 consecutivepatients with suspected coronary heart disease. Using significantartery stenoses as reference, the sensitivity of digital exerciseechocardiography was 89% and the specificity 92%. Regardingthe presence or absence of exercise-induced ischaemia, intra-observeragreement was 86% (73–94% with 95% confidence limits,kappa value (K) 0.70 (0.50–0.91)). Inter-observer agreementbetween two independent observers was 92 (81–98)% (K=0.81(0.63–0.99)). Temporal variability was examined by repeatingexercise echocardiography after one week in 30 stable patients;it demonstrated 90 (78–97)% agreement (K=0.71 (0.40–1.00)). The inter-observer agreement appeared to be lower in patientsor myocardial segments with wall motion abnormalities at rest(86% and 82%, respectively) than in patients or segments withnormal myocardial function at rest (96% and 94%, respectively);ns, P<005, respectively). Analysis of specific regions showeda significantly higher level of agreement (P<0.05) regardingexercise-induced ischaemia in segments supposed to be suppliedby the circumflex branch of the left coronary artery (96%) thanin the perfusion bed of the left anterior descending branch(87%) and right coronary artery (88%). Comparing estimated values of echocardiographic ejection fraction,analysis of intra-observer variability showed a correlationcoefficient of 0.91 and 95% confidence limits of a single estimateof ejection fraction of ± 10.3%. Corresponding analysesof inter-observer and temporal variability showed correlationcoefficients of 0.93 and 0.84, respectively, and 95% confidencelimits of single estimates of ejection fraction of ±9.6% and ± 1.30%, respectively. Thus, the diagnosticresult and the reproducibility of digital exercise echocardiographyare satisfactory and comparable with those obtained by myocardialscintigraphy. However, approximately 10% of the examinationresults may be reversed when the test is repeated or reevaluatedby the same or by another observer. The result seems to be lessreproducible in patients with abnormal wall motion at rest thanin patients with normal myocardial function before exercise.     

珍珠层粉复合富血小板纤维蛋白对颅骨缺损模型兔的修复作用

目的:制备珍珠层粉(NP)和富血小板纤维蛋白(PRF)的复合材料,分析其修复颅骨缺损模型兔效果,阐明其可能的作用机制.方法:选择12只新西兰兔建立兔颅骨缺损模型,颅骨顶部矢状缝周围3 cm×3 cm区域脱毛处理,全身麻醉后,于矢状缝两侧,造成4个直径8 mm的全层颅骨缺损孔,并保留完整的硬脑膜.每只新西兰兔4个颅骨缺损...     

Evidence on Scaling in Health and Social Care: An Umbrella Review

Policy Points

• More rigorous methodologies and systematic approaches should be encouraged in the science of scaling. This will help researchers better determine the effectiveness of scaling, guide stakeholders in the scaling process, and ultimately increase the impacts of health innovations.
• The practice and the science of scaling need to expand worldwide to address complex health conditions such as noncommunicable and chronic diseases.

• Although most of the scaling experiences described in the literature are occurring in the Global South, most of the authors publishing on it are based in the Global North. As the science of scaling spreads across the world with the aim of reducing health inequities, it is also essential to address the power imbalance in how we do scaling research globally.