临床医师对新型冠状病毒肺炎患者凝血相关事件认知的调查

目的评估疫情初期一线医师对新型冠状病毒肺炎（COVID-19）患者凝血相关事件的认知情况。 方法通过网络调查问卷进行数据收集,分别对受访者一般情况、凝血系统的关注与评估,以及深静脉血栓（DVT）和急性肺栓塞（APE）的评估、诊断和治疗情况进行统计分析。 结果在回收的70份调查问卷中,所有受访者均认为关注COVID-19患者的凝血系统改变是非常必要的,且大多数受访者认为危重型和重型患者应常规进行凝血指标的检测,分别为100.00%、92.86%。75.71%的受访者进行了弥散性血管内凝血（DIC）评分,其中大部分受访者倾向应用2017中国DIC评分标准（34.29%）。大多数受访者所收治的COVID-19患者DVT和APE发生率均＜5%,分别为84.29%、82.86%。分别有92.86%和82.86%的受访者进行了DVT的评估、筛查,大多数受访者更易选择机械联合药物的方式预防DVT（60.00%）,应用最多的预防药物是低分子量肝素（54.29%）。 结论临床医师已经注意到监测COVID-19患者的凝血系统变化是非常重要的,并且对于DVT和APE的评估与治疗相对规范。多数受访者所收治的患者DVT和APE的发生率很低,但大家对DIC诊断标准的选择差异很大。D-二聚体对于评估凝血系统改变是一项非常重要的指标,但纤溶过程在感染性疾病凝血功能障碍中的作用应重新审视。     

Influence of prothrombin complex concentrates on plasma coagulation in critically ill patients

Objective: To evaluate thrombogenicity of prothrombin complex concentrates (PCCs) in critically ill patients.¶Design: Prospective clinical study.¶Setting: Medical intensive care unit at a university hospital.¶Patients: 16 consecutive patients suffering from acquired deficiencies of coagulation factors and with either overt bleeding from any site or a planned invasive procedure.¶Interventions: 2000 factor IX units of PCCs intravenously.¶Measurements and results: Prothrombin time (PT), activated partial prothrombin time, fibrinogen, platelet count, plasma levels of coagulation factors II, V, VII, VIII, IX, X, antithrombin, protein C, thrombin-antithrombin complex (TAT), prothrombin fragment F₁₊₂, and the fibrin degradation product D-dimer were measured prior to and 1, 3, and 24 h after administration of PCCs. PT as well as coagulation factors II, VII, IX, and X, TAT, and F₁₊₂ showed a significant increase after administration of PCCs. All other parameters remained unchanged.¶Conclusions: Administration of PCCs induces thrombin generation. No evidence for induction of disseminated intravascular coagulation in biochemical terms could be found. When rapid correction of acquired coagulation factor disturbances is warranted, the use of PCCs seems reasonable, but the elevated risk of intravascular thrombus formation should be kept in mind.     

抑肽酶对围术期急性失血性休克DIC转归的保护作用

目的 :探讨抑肽酶对围术期急性失血性休克弥漫性血管内凝血 (DIC)转归的保护作用。方法 :选择外伤后失血较多并出现急性失血性休克病人 2 7例 ,随机分为 2组 ,Ⅰ组 (15例 )为静脉应用抑肽酶组 ;Ⅱ组 (12例 )为立止血对照组 ,静脉应用立止血。两组患者于术前、术中低容量期、术中容量恢复期、术后 1小时、术后 1天分别观测血小板计数 (PLC)以及凝血功能检查 ,包括凝血酶原时间 (PT)、激活部分促凝血酶原激酶时间 (APTT)、凝血酶凝结时间 (TT)、纤维蛋白原(FIB)。结果 :抑肽酶组术中容量恢复期、术后 1小时、术后 1天PLC、PT、APTT、TT、FIB均正常或接近正常 ,而对照组则出现明显异常 ,其中 4例病人出现PLC低于 5 0× 10 9/L ,FIB低于 1 5g ,PT、APTT明显延长的DIC诊断指征。结论 :严重失血性休克患者应用抑肽酶对休克转归DIC具有保护作用。     

Multiple intestinal atresias and encephalomalacia in the survivor after in-utero death of a monozygous co-twin

A twin infant who survived the death of his monochorionic co-twin in utero and was born with multiple jejunoileal atresias and severe cerebral damage is reported. The pathogenesis of these defects is discussed in the light of previously reported similar cases. The incidence of severe brain damage in twins born alive after the intrauterine death of a monochorionic co-twin is high, suggesting brain destruction by embolization of thromboplastin-rich material from the dead fetus via placental vascular anastomoses. A similar mechanism could be evoked in the present case to account for the intestinal atresias, which likely occurred after the 22nd gestational week, i.e. after the normal permeabilization of the embryonic gut. In the light of this observation and similar ones made by others, it is clear that surgical management of congenital defects during the neonatal period should be influenced by the knowledge of in-utero death of a monochorionic co-twin during the second half of gestation.     

Abscisic acid regulates dormancy of prostate cancer disseminated tumor cells in the bone marrow

Prostate cancer (PCa) commonly metastasizes to the bone where the cells frequently undergo dormancy. The escape of disseminated tumor cells from cellular dormancy is a major cause of recurrence in marrow. Abscisic acid (ABA), a phytohormone, is known to regulate dormancy of plant seeds and to regulate other stress responses in plants. Recently, ABA was found to be synthesized by mammals cells and has been linked to human disease. Yet the role of ABA in regulating tumor dormancy or reactivation is unknown. We found that ABA is produced by human marrow cells, and exogenous ABA inhibits PCa cell proliferation while increasing the expression of p27, p21, and p16 and decreasing the expression of the proliferation marker, Ki67. Further, ABA significantly increased the percentage of PCa cells in the G₀ phase of the cell cycle as well as the duration the cells were arrested in G₀. We found that ABA regulates an increase of PPARγ receptor expression and suppressed phosphorylation of mTOR/p70S6K signaling and resulting in the induction of the cellular dormancy. We then confirmed that ABA regulates G₀ cell cycle arrest through PPARγ receptor signaling in vitro and under co-culture conditions with osteoblasts. Finally, we demonstrate that ABA regulates PCa dormancy in vivo following intratibial injection in an animal model. Together these data suggest that the ABA and PPARγ signaling pathways contribute to the establishment of PCa cellular dormancy in the bone marrow microenvironment. These findings may suggest critical pathways for targeting metastatic disease.     

Dengue outbreak in Karachi, Pakistan, 2006: experience at a tertiary care center

This is the first report of the largest epidemic of dengue hemorrhagic fever (DHF) virus infection (2006) with IgM-confirmed cases from Karachi, Pakistan. Medical records of 172 IgM-positive patients were reviewed retrospectively for demographic, clinical and laboratory data. Patients were categorized into dengue fever (DF) and DHF according to the WHO severity grading scale. The mean+/-SD age of the patients was 25.9+/-12.8 years, 55.8% were males and the hemoconcentration was recorded in a small number of patients [10 (7.0%)]. Male gender [odds ratio (OR)=14.7, P=0.003), positive history of vomiting (OR=4.3, P=0.047), thrombocytopenia at presentation (OR=225.2, P<0.001) and monocytosis (OR=5.8, P=0.030) were independently associated with DHF, but not with DF. Five cases (2.9%) had a fatal outcome, with a male-to-female ratio of 1:4. Three were from a pediatric group (<15 years). Pulmonary hemorrhages, disseminated intravascular coagulation and cerebral edema preceded death in these patients. The results have highlighted significant findings, such as adult susceptibility to DHF, pronounced abdominal symptoms and lack of hemoconcentration at time of presentation in the study population. These findings may play an important role in the case definitions of future studies from this part of the world.     

儿童感染性疾病凝血指标检测的临床意义

目的探讨儿童感染性疾病中,凝血功能变化对感染的诊断及转归的意义。方法取患儿感染期标本,分别以凝固法、发色底物法、免疫胶体金法等检测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原含量(FIB)、凝血酶时间(TT)、抗凝血酶活性(AT:A)、D-二聚体(DD)等凝血及抗凝指标。结果感染患儿的凝血指标与正常对照组儿童间差异有统计学意义,特别是AT:A与DD的结果在弥散性血管内凝血(D IC)组与非D IC组中差异有统计学意义。结论各凝血指标特别是AT:A和DD的检测可作为D IC前期诊断和预后评估的指标。