冠心病患者氯吡格雷抵抗的研究进展

氯吡格雷是临床常用的抗血小板药物,但近年来的研究发现,部分患者存在氯吡格雷抵抗,即描述服用氯吡格雷而不能提供充分抗血小板作用的一种现象。氯吡格雷抵抗者血小板聚集率高,易发生心血管事件。本文对目前有关氯吡格雷抵抗的定义、可能发生的机制和解决方法进行综述。     

Normal and degenerative posterior spinal structures: MR imaging

A retrospective study of the magnetic resonance (MR) images of the lumbar spines of 13 healthy subjects and 30 patients with degenerative changes was done. In the healthy subjects, the vertebral facets, thickness of the cartilage and ligamentum flavum, signal characteristics of the bone marrow, and size of the spinal canal were studied. In the patients with degenerative changes in one of these structures, MR images in the sagittal plane were useful in demonstrating hypertrophy of the ligamentum flavum or the vertebral facets, in grading the degree of foraminal stenosis, and in measuring the sagittal diameter of the spinal cord. MR images in the axial plane facilitated detailed analysis of the facet joint and more accurate measurements of the thickness of the ligamentum flavum and spinal canal diameter. MR images were compared with computed tomography scans in 12 patients.     

A phase III trial of recombinant human erythropoietin therapy in nonanemic orthopedic patients subjected to aggressive removal of blood for autologous use: dose, response, toxicity, and efficacy

BACKGROUND: Previous clinical trials have shown that the use of recombinant human erythropoietin (EPO) can facilitate autologous blood donation and reduce allogeneic blood transfusions in autologous blood donors who are anemic at first donation. However, the role of EPO therapy in nonanemic patients remains undefined. To identify this role, a randomized, controlled, multicenter dose-escalation trial was conducted in patients whose initial hematocrit was > 39 percent (0.39). STUDY DESIGN AND METHODS: EPO (150, 300, or 600 units/kg) or placebo was administered intravenously at each of six phlebotomy visits over a 3-week study period. Sixteen (14%) of 116 patients were unable to complete the treatment protocol because of adverse events (n = 11) or for personal reasons (n = 5); 2 patients (1 EPO and 1 placebo) experienced serious adverse events. RESULTS: In 91 evaluable patients, additional red cell production during the study period was 440 +/− 176, 621 +/− 215, 644 +/− 196, and 856 +/− 206 mL (mean +/− SD), respectively, for patients receiving placebo and EPO at 150, 300, and 600 units/kg (p < 0.05 for all EPO groups compared to placebo). However, the percentages of patients in each group who received allogeneic blood did not differ: 2 (9%) of 23 placebo patients and 6 (9%) of 68 EPO patients. CONCLUSION: It is concluded that, while EPO therapy increased preoperative red cell production, no clinical benefit could be demonstrated in autologous blood donors who were not anemic at first blood donation.     

Recurrent mutations in DNAJC5 cause autosomal dominant Kufs disease

We sought to identify the molecular basis of the autosomal dominant form of Kufs disease, an adult onset form of neuronal ceroid lipofuscinosis. We used a combination of classic linkage analysis and Next Generation Sequencing to map and identify mutations in DNAJC5 in a total of three families. We analyzed the clinical manifestations in 20 individuals with mutation in DNAJC5. We report here the mapping and the identification of a p.L116del mutation in DNAJC5 segregating with the disease in two distinct American families, as well as a p.L115R mutation in an additional family. The age of onset and clinical manifestations were very homogeneous among mutation positive individuals, including generalized tonic–clonic seizures, myoclonus, ataxia, speech deterioration, dementia, and premature death. A few individuals also exhibited parkinsonism. DNAJC5, which encodes the cysteine string protein (CSPα), a presynaptic protein implicated in neurodegeneration, causes autosomal dominant Kufs disease. The leucine residues at positions 115 and 116 are hotspots for mutations and result in a homogeneous phenotype of progressive myoclonus epilepsy with onset around 30 years old.     

Marrow culture in diffusion chambers in rabbits. I. Effect of mature granulocytes on cell production

Factors influencing granulopoiesis have been evaluated using diffusion chambers implanted in the peritoneal cavity of rabbits. An increase in granulopoiesis in chambers implanted in hosts made neutropenic by nitrogen mustard occurs in mice made neutropenic by x-ray or drug. The intraperitoneal injection of leukocytes inhibited the growth of cells in chambers implanted in rabbits. Removal of mature granulocytes from marrow prior to chamber inoculation produced a marked in-increase in cell growth, especially of granulocytes. Mature granulocytes clearly inhibited cell replication and this inhibition involved both myeloid and erythroid elements, although the data suggest a greater effect on myelopoiesis. In contrast to the mouse, erythropoiesis in chambers in rabbits remained prominent for over 1 wk.     

社区老年人可摘局部义齿戴用者义齿使用及口腔卫生习惯的调查分析

目的：了解社区内戴用可摘局部义齿的老年人对义齿的使用以及口腔卫生保健情况,为社区针对老年人制定口腔保健策略提供依据。方法：以社区内180例戴用可摘局部义齿1年以上的老年人为对象,采用问卷方式调查其义齿使用及对口腔卫生的维护情况。结果：180例答卷者中,仅有20.0%的老年人清洁义齿的方式较为合理,仅有22.2%的老年人知道义齿在戴用后要在3个月到半年内进行复查,仅有25.6%的老年人是采用竖刷的方法清洁口腔卫生。53.9%的义齿使用者能做到饭后漱口。绝大数的老年人在义齿及时更换方面的意识较差。结论：社区应针对老年人,尤其是可摘局部义齿使用者的口腔保健工作制定相应的策略,以加强老年人的口腔保健意识。     

应用Tei指数对冠心病患者左室功能的研究

目的：探讨应用Tei指数评价冠心病患者左室功能的临床意义。方法：选取行冠脉造影确诊的冠心病患者36例,根据左室射血分数（LVEF）分两组,A组LVEF50％（20例）;B组LVEF〈50％（16例）,正常对照组为C组。研究对象行超声心动图检查,测量左室射血分数（LVEF）、Tei指数。结果：A组和B组的Tei指数均显著高于C组,具有极显著性差异。B组Tel指数显著高于A组（P〈0．01）。结论：Tei指数能早期、敏感、简便、客观反映左室整体功能。     

基于数据挖掘和“方-药-性-效”的藏医治疗慢性胃炎用药规律研究＊

目的 鉴于慢性胃炎是藏医优势病种且有较好的疗效，研究藏医治疗慢性胃炎的用药规律，为藏医临床与科研提供参考。方法 多中心收集藏医治疗慢性胃炎2613例有效临床医案，统一归纳藏医诊断确定归类分型，采用Gephi 0.9.2、SPSS Statistics 23、SPSS Modeler18等软件的描述性统计、Apriori算法、K-均值聚类分析方法，结合藏医“味性化味”药性理论进行分析，构建藏医治疗慢性胃炎的“方-药-性-效”复杂网络。结果 本研究涉及的慢性胃炎的藏医诊断可归纳为四种证型，其中隆型472例、赤巴型811例、培根型974例，其他证型356例。涉及藏药方剂共有137首，其中五鹏丸（1012次）、仁青芒觉（864次）、六味能消散（811次）等频次最高；关联规则分析发现，五味金色散和六味能消散关联最高。其中隆型以六味木香散等平隆助动、促进胃肠蠕动类方剂为主；赤巴型以五味金色散等清热凉血、消炎治疮类方剂为主；培根型以五味石榴散等平培根、助胃火类方剂为主。组方中诃子、木香、红花等使用频次最多，设置“支持度 ≥ 40%，置信度 ≥ 80%”时诃子、石榴子、木香等关联最强。药性分析发现，甘味、苦味、辛味等偏盛，十七效中以凉、钝、重、糙等为主，其中凉效、钝效可对治热、锐特性引起的胃热、胃肠糜烂等疾病，并分析方剂对治三因的比值，发现主要对治赤巴，其次为隆和培根。结论 通过构建“方-药-性-效”的研究模式，发现藏医对慢性胃炎的诊疗具有一定的规律可循，慢性胃炎在藏医诊断中可分为四种证型，总体治疗具有以“清血热-抑胃液-养胃火-通胃隆”四位一体的隐形用药规律，其中隆型以镇隆平气为主，赤巴型以清热凉血为主，培根型以平寒温胃为主，藏医临床治疗慢性胃炎提供有益参考。