Mean platelet volume is elevated in patients with patent foramen ovale

Introduction

Platelets play a major role in thromboembolic events. Increased mean platelet volume (MPV) indicates higher platelet reactivity and also a tendency to thrombosis. Patent foramen ovale (PFO), persistence of the fetal anatomic shunt between right and left atria, is strongly associated with cryptogenic stroke. The aim of this study is to determine the relationship between MPV and PFO and if such an association exists, whether higher MPV levels may require antiplatelet therapy before a thromboembolic event happens, together with a literature review.

Material and methods

Thirty patients (15 women, 15 men), free of any cerebrovascular events, were diagnosed with PFO by transesophageal echocardiography (TEE), enrolled as the study group. Thirty consecutive patients (16 women and 14 men), who were diagnosed as normal in TEE, were enrolled as the control group. These two groups were compared according to MPV and anatomical features of the right atrium.

Results

There was no significant difference between study and control groups in clinical features and also no difference was observed in platelet counts; however, MPV in the PFO group was significantly higher than the control group (8.38 ±0.93 fl and 7.45 ±0.68 fl respectively).

Conclusions

Our results indicate that elevated MPV may be detected in patients with PFO. This might be one of the explanations for the relationship between PFO and cryptogenic stroke; however, larger cohorts are warranted in order to define further mechanisms.     

The society for cardiovascular angiography and interventions structural heart disease early career task force survey results: Endorsed by the society for cardiovascular angiography and interventions

Over the last decade, structural heart disease interventions have emerged as a new field in interventional cardiology. Currently, the Accreditation Council for Graduate Medical Education accredited interventional cardiology fellowship programs in the United States provide high‐quality and well established training curriculum in coronary and peripheral interventions, but training in structural interventions remains in its infancy. The current survey seeks to collect relevant information and assess the opinion of interventional cardiology program directors in ACGME‐accredited institutions that are actively involved in structural interventional training. Our study describes the actual number of structural procedures performed by interventional cardiology fellows in ACGME‐accredited programs, the form of the structural training today and the suggestions from program directors who are actively trying to integrate structural training in the interventional cardiology fellowship programs. © 2012 Wiley Periodicals, Inc.     

Surgical closure of patent foramen ovale in patients with suspected paradoxical embolism: long‐term results

Objective—It is thought that a patent foramen ovale (PFO) is the crucial mechanism in patients with suspected paradoxical embolism and cryptogenic stroke. It has been hypothesized that closure of the PFO would prevent further cerebrovascular incidents. We describe our early and late experience with surgical closure of PFO in patients with paradoxical embolism.

Patients and methods—Between May 1994 and December 2001, 33 patients (26 men, 7 women; mean age, 55.2?±?8.7 years; range, 37–74 years) underwent surgical closure of a PFO at our institution. All patients had preoperatively suffered from a stroke and/or a transient ischemic attack, after which echocardiography showed a PFO. Mean follow‐up at 99?±?30 months (range, 10–111 months) was 100% complete.

Results—All patients survived the operative procedure. Early complications occurred in four patients (12%). Actuarial survival at 1, 5 and 8 years was 97?±?3%, 97?±?5% and 94?±?8%, respectively. At long‐term follow‐up all but two patients were alive. The deaths of these two patients were related to malignancy and ischemic heart disease, respectively. Two patients (6%) had suffered a residual cerebrovascular event after successful surgery.

Conclusion—Surgical closure of PFO in patients with paradoxical embolism can safely be performed with a low risk of early mortality. Residual thromboembolic events were rare and in those few it occurred it did so with the interatrial septum being closed, indicating that in those patients the PFO was not the mechanism of the thromboembolic event in the first place.     

2015年煤炭总医院门诊处方中妊娠及哺乳期妇女中成药使用分析

目的 分析2015年煤炭总医院门诊处方中妊娠及哺乳期妇女中成药的使用情况,为特殊人群合理使用中成药提供依据.方法 从HIS系统提取相关数据,分析2015年煤炭总医院中成药的销售金额、品种、用药频度(DDDs)和日均费用(DDC)值;收集使用过的中成药说明书,并对其中涉及妊娠期及哺乳期妇女用药内容进行分析.结果 益气维血颗粒的DDDs值排名第1位,DDC最低,五加生化胶囊的DDC最高;妇产科计生门诊使用的中成药品种数共计56种;妊娠期贫血、上呼吸道感染是常见疾病;涉及妊娠期妇女慎用、忌用、禁用的品种占总数的比例分别为7.14%、5.36%、14.29%.用药辨证不当、用法用量不当、疗程不合理是不合理应用的主要原因.结论 2015年煤炭总医院妇产科中成药使用情况基本合理,然而说明书中关于妊娠期及哺乳期用药安全性的信息不全,处方书写不规范,哺乳期妇女尤为严重,药品监管部门应加强监督,保证妊娠期及哺乳期妇女用药安全.     

中药专利申请中毒性药材的安全性问题

专利信息往往受到公众所关注,当中药发明专利申请中含有毒性药物时,其应用可能危害公众健康。梳理了中药毒性药物的主要品种,结合具体的复审案例分析了毒性药物的审查思路,从专利这个层面为食品、药品的安全把关,将所授权的专利可能引起的风险控制到最小的程度,使中药专利信息能够更好地服务于人民群众的身体健康。     

布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭对患儿血浆和尿前列腺素E_2水平的影响

目的分析布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭(sPDA)对患儿血浆和尿前列腺素E_2(PGE_2)水平的影响。方法纳入2014年7月至2016年12月我院出生的患有sPDA的84例早产儿作为观察对象。随机纳入42例给予布洛芬进行治疗(A组),另外42例给予对乙酰氨基酚治疗(B组)。对比两组治疗疗效,治疗前后血浆和尿PGE_2水平以及不良反应。结果两组患儿在各时段的关闭率以及总关闭率的组间差异均无统计学意义(P>0.05)。经治疗,两组患儿血浆PGE_2和尿PGE_2水平均较治疗前下降,与治疗前比较差异有统计学意义(P<0.05);A组下降程度稍大于B组,但组间差异均无统计学意义(P>0.05)。经治疗,两组患儿肝肾功能指标血肌酐(SCr)和丙氨酸氨基转移酶(ALT)水平均较治疗前略有上升(P>0.05),血小板(PLT)较治疗前有所下降,但差异无统计学意义(P>0.05);两组SCr、ALT及PLT水平比较差异无统计学意义(P>0.05)。B组高胆红素血症比例低于A组,组间差异有统计学意义(P<0.05),其他不良反应上,组间差异均无统计学意义(P>0.05)。结论布洛芬与对乙酰氨基酚的疗效相当,其对血浆PGE_2和尿PGE_2水平的影响略强于对乙酰氨基酚,但对乙酰氨基酚高胆红素血症的比例低于布洛芬。     

蛋白酶抑制剂茚地那韦的知识产权保护状况和风险分析

通过对蛋白酶抑制剂茚地那韦国内外知识产权保护状况的初步分析,以及茚地那韦国际和国内的申请量、申请地区、申请人、保护状况和期限等方面统计,可见国外原研企业对于茚地那韦专利申请已逐年下降,但目前专利仍对该药有一定的保护力度,该药在合成方法、衍生物、新剂型、新用途等方面尚有较大的研发和保护空间,相关医药企业仍可从这些方面对该药进行研究改进或创新.     

血N端脑钠肽前体在早产儿症状性动脉导管未闭诊治中的应用价值

目的探讨血浆N端脑钠肽前体(NT-pro BNP)在早产儿症状性动脉导管未闭(s PDA)诊治中的临床应用价值。方法选取2013年10月—2014年9月入住新生儿重症监护病房、胎龄28~32周、出生体质量??1 500 g的早产儿107例,分别于生后第4、7天检测NT-pro BNP,采血后30 min内行超声心动图检查。根据生后第4天超声心动图检查结果分PDA组(39例)与对照组(68例);PDA组根据有无超声血流动力学显著改变及临床表现分为症状性PDA(s PDA组,20例)和无症状性PDA(as PDA组,19例);s PDA组再根据是否服用布洛芬分为治疗组(13例)与非治疗组(7例)。结果生后第4天,s PDA组患儿血浆NT-pro BNP水平高于as PDA组,as PDA组高于对照组,差异均有统计学意义(P??0.05);生后第7天,s PDA组患儿血浆NT-pro BNP水平高于as PDA组和对照组,差异有统计学意义(P??0.05),as PDA组与对照组的差异则无统计学意义(P??0.05)。治疗组生后第7天血浆NT-pro BNP水平较第4天显著下降,差异有统计学意义(P??0.05);非治疗组生后第7天与第4天血浆NT-pro BNP水平的差异无统计学意义(P??0.05)。PDA患儿生后第4天血浆NT-pro BNP水平与动脉导管(DA)直径、左心房/主动脉根部内径比值(LA/AO)及DA直径与左肺动脉内径比值(TDD/LPA)呈正相关(r=0.498~0.670,P均??0.05)。生后第4天血浆NT-pro BNP水平预测s PDA的ROC曲线下面积(AUC)为0.969(95%CI:0.938~1.000),NT-pro BNP水平在13 964 pg/m L时,诊断s PDA的灵敏度为95%,特异度为95.4%。结论 s PDA早产儿血浆NT-pro BNP水平明显增高,治疗后下降。第4天血浆NT-pro BNP是预测s PDA的敏感指标,动态监测血浆NT-pro BNP水平变化对指导早产儿PDA治疗策略的选择有重要临床价值。