内镜下氩离子凝固术治疗老年患者胃低级别瘤变

目的探讨内镜下氩离子凝固术(APC)治疗老年人低级别瘤变的有效性及安全性。方法回顾性研究分析2013年10月~2014年4月在解放军总医院南楼消化内镜诊疗科行胃镜检查,病理证实为胃低级别瘤变的老年患者62例临床资料。随机选择两种治疗方法:先黏膜下注射生理盐水,再进行APC治疗和直接APC治疗。术后随诊不良反应,治疗后6周及6个月后进行内镜及病理组织学复查。结果 6周后51例患者返院复查共62个病灶,57个无残留,治疗有效率91.9%,6个月后43例患者返院复诊45个病灶,42个无残留,治疗有效率为93.3%。中度不典型增生病灶复发率较高(6/14)。两种治疗方法的有效率差异无统计学意义(P0.05)。所有患者无1例出现出血、穿孔等并发症,术后不良反应轻微,均可耐受。结论内镜下氩离子凝固术治疗老年患者胃低级别瘤变安全有效,治疗后要拟定个体化的内镜随诊方案。     

经尿道膀胱镜电切或电凝治疗膀胱黏膜白斑的疗效观察

目的：观察经膀胱镜电切或电凝治疗膀胱黏膜白斑的临床效果。方法：将68例膀胱黏膜一斑忠行随机分成两组,32例行电切术,36例行电凝术。每3个月随访决定是否行下一次治疗。治愈后随访12～36个月。结果：两组一次性治愈率分别为60％和26％,两次和三次性治愈率两组无明显差别。随访期间,两组分别有3例和5例复发。结论：经尿道膀胱镜电切或电凝术是治疗膀胱黏膜白斑有效的治疗疗法,其中电切术一次性治愈率高于电凝术。     

双极电凝镊在扁桃体摘除术中的应用

目的：通过比较采用双极电凝镊与传统的剥离法实施扁桃体摘除的手术效果,探讨双极电凝镊在扁桃体摘除术中的应用效果。方法：选取行扁桃体手术摘除的患者100例,前瞻性地分为两组,比较手术时间、术中出血量及术后患者并发症、疼痛程度及恢复时间。结果：用双极电凝镊行扁桃体摘除与普通法扁桃体摘除相比,手术时间短,术中出血少,术后并发症发生率低,患者痛苦轻。结论：采用双极电凝镊扁桃体摘除手术效果明显优于普通剥离法扁桃体摘除,两方法术后恢复时间无统计学差别。     

Effects of tranexamic acid on coagulofibrinolytic markers during the early stage of severe trauma: A propensity score–matched analysis

Tranexamic acid (TXA) reduces the risk of bleeding trauma death without altering the need for blood transfusion. We examined the effects of TXA on coagulation and fibrinolysis dynamics and the volume of transfusion during the early stage of trauma. This subanalysis of a prospective multicenter study of severe trauma included 276 patients divided into propensity score–matched groups with and without TXA administration. The effects of TXA on coagulation and fibrinolysis markers immediately at (time point 0) and 3 hours after (time point 3) arrival at the emergency department were investigated. The transfusion volume was determined at 24 hours after admission. TXA was administered to the patients within 3 hours (median, 64 minutes) after injury. Significant reductions in fibrin/fibrinogen degradation products and D-dimer levels from time points 0 to 3 in the TXA group compared with the non-TXA group were confirmed, with no marked differences noted in the 24-hour transfusion volumes between the 2 groups. Continuously increased levels of soluble fibrin, a marker of thrombin generation, from time points 0 to 3 and high levels of plasminogen activator inhibitor-1, a marker of inhibition of fibrinolysis, at time point 3 were observed in both groups. TXA inhibited fibrin(ogen)olysis during the early stage of severe trauma, although this was not associated with a reduction in the transfusion volume. Other confounders affecting the dynamics of fibrinolysis and transfusion requirement need to be clarified.     

保龄麦胚美健丸的药理作用

本文通过小鼠应激反应实验证明:保龄麦胚美健丸对应激刺激具有保护作用,有抗疲劳、抗缺氧、耐寒之功效;本药可提高家兔单核—巨噬细胞系统的吞噬功能,延长凝血时间。     

凝血因子与荨麻疹的关系

Urticaria is a common, recurrent and refractory skin disease. The exact pathogenic mechanism of urticaria is complex and unclear. It has been proposed that the development of urticaria is associated with coagulation status. Related studies on thrombinogen fragment F (1+2), D dimmer, factor Ⅶ and factor Ⅻ revealed the activation of extrinsic pathway of coagulation cascade and signs of fibrinolysis in patients with chronic urticaria. Thromhin generation may play a key role in the pathogenesis of urticaria. And anticoagulant drugs have exhibited a good prospect in the medication of urticaria.     

Evaluation on blood coagulation and C-reactive protein level among children with mycoplasma pneumoniae pneumonia by different chest imaging findings

Mycoplasma pneumoniae infection may induce a systemic hypercoagulable abnormality, like organ embolism and infarction. Indexes of blood coagulation and C-reactive protein (CRP) have been reported different between healthy people and mycoplasma pneumoniae pneumonia (MPP) patients, but this difference in MPP patients with different chest imaging findings has rarely been reported.We performed a retrospective study of 101 children with MPP and 119 controls, combined with radiological examination and blood tests, to compare the blood coagulation and CRP level among MPP children with different chest imaging findings.For the MPP children with different chest imaging findings, there were significant differences in CRP, fibrinogen (FIB) and D-dimer (D-D) levels among subgroups (P = .004, P = .008 and P < .001 respectively). The CRP level in group of interstitial pneumonia was significantly higher than that in groups of bronchopneumonia and hilar shadow thickening (P = .003 and P = .001 respectively). And the FIB and D-D values in group of lung consolidation were significantly higher than that in the other 3 groups (all P < .05). When compared with controls, the white blood cell, CRP, FIB, and D-D levels in MPP children were significantly higher, and the activated partial thromboplastin time and thrombin time levels were significantly lower (all P < .05).Our results showed that CRP level changed most significantly in group of interstitial pneumonia, whereas FIB, D-D levels changed most significantly in the lung consolidation group.     

Comparison of the effects of in-vivo thermal ablation of pig liver by microwave and radiofrequency coagulation

Microwave and radiofrequency coagulation is frequently used for the treatment of hepatic tumors. However, differences between these types of therapy have not been clearly demonstrated so far. We performed both types of thermal ablative treatment on pig liver, and compared the size and shape of the coagulated areas produced. The effects of combining both treatments and interrupting hepatic blood flow were also evaluated. The liver of an anesthetized pig was thermally coagulated, with or without interruption of hepatic blood flow, using a needle electrode at 40 W for 150 s with 2450-MHz microwaves and/or with a 460-kHz radiofrequency current. The diameters of the coagulated areas in the liver were 20 ± 3 mm (mean ± SD; n = 4) after microwave coagulation and 28 ± 3 mm following radiofrequency coagulation when blood flow was not interrupted, whereas they were 31 ± 2 mm and 37 ± 3 mm, respectively, when blood flow was interrupted. When these treatments were combined sequentially, the diameters of the lesions were 43 ± 3 mm and 29 ± 2 mm with and without blood flow interruption, respectively. The ellipticity of the coagulated area, as measured by the largest-to-smallest ratio of its diameters, was 2.3 ± 0.4 after microwave coagulation and 1.1 ± 0.1 following radiofrequency coagulation. We conclude that radiofrequency coagulation produces a larger and more spherical coagulated area in the liver (P < 0.01) than does microwave coagulation. The lesion becomes larger (P < 0.05) with both treatments when hepatic blood flow is interrupted during the treatment. The sequential combination of these treatments produces a much larger lesion (P < 0.05) than that produced by either treatment alone.     

Lack of evidence for increased inhibitor incidence in patients switched from plasma-derived to recombinant factor VIII

De novo inhibitor development is a rare event in PTPs switched from pdFVIII to rFVIII. Based on previously published data of clinical studies a change in FVIII product is unlikely to provoke inhibitor formation.