Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis

Objective

To compare the efficacy of intra-articular (IA) steroid injection and distension in patients with frozen shoulder.

Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016

Objective

To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.

Gait Training in Acute Spinal Cord Injury Rehabilitation—Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab Project

Objectives

To investigate the relation of gait training (GT) during inpatient rehabilitation (IPR) to outcomes of people with traumatic spinal cord injury (SCI).

脂肪乳对PT、APTT和Fib凝血结果的影响与对策

目的探讨减少脂肪乳对凝血酶原(PT)、部分凝活酶时间(APTT)和纤维蛋白原(Fib)干扰的方法。方法制备正常新鲜混合血浆并检测PT、APTT、Fib;在正常新鲜混合血浆中加入不同浓度的脂肪乳并检测其PT、APTT和Fib,取均值计算干扰物影响度,同时在强生干化学分析仪VITRO FS5.1上检测血浆指数,并分析血浆指数与脂肪乳干扰之间的关系。通过CS2000i自带的稀释功能,寻找最佳的稀释倍数,减少脂肪乳对Fib的干扰。结果当添加干扰物脂肪乳4.76%体积分数时,对PT、APTT和国际标准化比值(INR)影响均7.5%,未超过1/2 CLIA’88规定的允许误差;脂肪乳添加的体积与血浆指数存在良好的线性相关:y=18.284x+4.557 9,R2=0.993 3;脂肪乳添加的体积与衍算纤维蛋白原(PT-der fibrinogen,PT-DFbg)添加前后的差值也存在良好的线性相关:y=0.146 9x-0.891 4(x≥6),R2=0.961 7;标本稀释可以很好地消除脂肪乳对Fib检测结果的干扰。结论利用血浆指数,可以减少一定浓度内脂肪乳对PT、APTT和Fib的干扰,标本稀释可以很好地消除脂肪乳对Fib检测结果的干扰。     

通心络胶囊联合阿加曲班治疗轻中度急性脑梗死的疗效观察

目的研究通心络胶囊联合阿加曲班注射液治疗轻中度急性脑梗死的临床疗效。方法选取2017年3月-2019年9月在天津市滨海新区大港医院治疗的80例轻中度急性脑梗死患者,随机分为对照组和治疗组,每组各40例。对照组静脉滴注阿加曲班注射液,60 mg加入生理盐水250 mL中静滴24 h,持续2 d,第3天开始剂量调整为60 mg加到生理盐水100mL,静滴3 h,2次/d,持续5 d。治疗组在对照组的基础上口服通心络胶囊,4粒/次,3次/d,连续治疗14 d。观察两组患者临床疗效,同时比较治疗前后两组患者血凝功能指标和美国国立卫生研究院卒中量表(NIHSS)评分。结果治疗后,对照组和治疗组临床有效率分别为77.50%和95.00%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)水平明显升高(P<0.05),而D-D二聚体(D-D)、纤维蛋白原(FIB)水平明显降低(P<0.05),且治疗组的血凝功能指标明显好于对照组(P<0.05)。治疗后,两组NIHSS评分均显著降低(P<0.05),且治疗组评分明显低于对照组(P<0.05)。结论通心络胶囊联合阿加曲班注射液治疗轻中度急性脑梗死有较明显的临床疗效,具有一定的临床推广应用价值。     

Gliadin effect on the oxidative balance and DNA damage: An in-vitro,ex-vivo study

Background

Gliadins are involved in gluten-related disorders and are responsible for the alteration of the cellular redox balance. It is not clear if the gliadin-related oxidative stress can induce DNA damage in enterocytes.

Direct Oral Anticoagulants: New Drugs and New Concepts

Direct oral anticoagulants (DOACs) are approved for multiple thromboembolic disorders and provide advantages over existing agents. As with all anticoagulants, management protocols for the eventuality of bleeding are important. Randomized phase III studies generally show that DOACs have a similar risk of clinically relevant bleeding compared with standard anticoagulants, with reductions in major bleeding in some cases. This may be particularly important in patients with atrial fibrillation, for whom the rate of intracranial hemorrhage was approximately halved with DOACs compared with warfarin. Conversely, the risk of gastrointestinal bleeding may be increased. Specific patient characteristics, such as renal impairment, comedications, and particular aspects of each drug, including the proportion eliminated by the kidneys, must be taken into account when assessing the risk of bleeding. Although routine coagulation monitoring of DOACs is not required, it may be useful under some circumstances. Of the traditional clotting assays, a sensitive and calibrated prothrombin time may be useful for detecting the presence or absence of clinically relevant factor Xa inhibitor concentrations (rivaroxaban or apixaban), but specific anti–factor Xa assays can measure drug levels quantitatively. For dabigatran, the results of an activated partial thromboplastin time test may exclude a clinically relevant pharmacodynamic effect, but a calibrated dilute thrombin time assay can be used for quantification of drug levels. In the event of mild or moderate bleeding, normal hemostatic support measures are recommended. For life-threatening bleeding, use of nonspecific prohemostatic agents may be considered, although clinical evidence is scarce. Specific antidotes are in development.     

Comparison of the effect of edoxaban,a direct factor Xa inhibitor,with a direct thrombin inhibitor,melagatran, and heparin on intracerebral hemorrhage induced by collagenase in rats

Introduction

Intracerebral hemorrhage (ICH) is a major clinical concern with anticoagulation therapy. The effect of a new oral direct FXa inhibitor, edoxaban, was determined in a rat model of ICH and compared with a direct thrombin inhibitor, melagatran, and heparin.

Methods

To induce ICH, 0.1 U collagenase type VII was injected into the striatum of male Wistar rats under anesthesia with thiopental or halothane. Immediately after ICH induction, edoxaban, melagatran, or heparin were infused intravenously. Five hours after ICH induction, the brain was removed and ICH size was measured. To estimate the margin of safety, antithrombotic effects were evaluated in a rat venous thrombosis model.

Results

Edoxaban at 6 mg/kg/h significantly increased ICH volume (1.8-fold) and prolonged prothrombin time (PT) 2.8-fold compared to the vehicle group. No deaths were observed with edoxaban. Melagatran at 1 mg/kg/h increased ICH volume at 1 mg/kg/h (2.8-fold) with 6.1-fold PT prolongation. At 3 mg/kg/h, all rats died due to severe ICH (3.9-fold). Heparin at both 100 and 500 U/kg/h significantly increased ICH. At 500 U/kg/h, 5 out of 8 rats died. The doses required for 50% inhibition of thrombosis of edoxaban, melagatran, and heparin were 0.045 mg/kg/h, 0.14 mg/kg/h, and 55 U/kg/h, respectively. The safety margins between antithrombotic and ICH exacerbation effects of these anticoagulants were 133, 7.1, and 1.8, respectively.

Conclusion

The safety margin of edoxaban was wider than that of melagatran or heparin. These results suggest that edoxaban may be preferable from the perspective of ICH exacerbation risk.     

Measurement of thrombin generation intra-operatively and its association with bleeding tendency after cardiac surgery

Introduction

Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are susceptible to haemostatic disturbances. Monitoring the haemostatic capacity by conventional clotting tests is challenging.

Materials and Methods

Thrombin generation (TG) by Calibrated Automated Thrombography, clotting tests and tissue factor pathway inhibitor (TFPI) measurements were performed to describe the relationship between haemostatic changes and alterations in these tests. Blood samples were collected before, during and after CPB. Furthermore, it was investigated whether TG measured intraoperatively, is associated with increased risk of bleeding postoperatively.

Results

TG diminished significantly (p < 0.01) after heparinization in the presence and absence of platelets (37% and 50%) compared to baseline. After the start of CPB, TG elevated and persisted till the end of surgery but remained lower than preoperatively. Activated clotting time increased after heparinization and after the start of bypass compared to baseline (400% and 500%). Anti-FXa activity reduced on the start of CPB compared to the level after heparinization, to almost the baseline value following protamine reversal of heparin. The plasma levels of total and free TFPI elevated 9 and 14 fold during bypass and remained after protamine administration higher than preoperatively. Plasma D-dimer levels reduced (p < 0.01) when bypass started. However, a marked elevation was observed in the following time points. TG in platelet-rich plasma measured after heparinization and after the start of CPB associated (p < 0.05) with postoperative blood loss.

Conclusions

TG can be determined during CPB despite the high heparinization level, it reflects the haemostatic capacity better than clotting-based assays and might better predict bleeding when performed intraoperatively.