Recent developments in the understanding of the combined deficiency of FV and FVIII

Combined deficiency of factor V (FV) and factor VIII (FVIII) (F5F8D) is a genetic disorder characterized by mild-to-moderate bleeding and coordinate reduction in plasma FV and FVIII levels, as well as platelet FV level. Recent studies identified mutations in two genes ( LMAN1 and MCFD2 ) as the cause of F5F8D. Though clinically indistinguishable, MCFD2 mutations generally exhibit lower levels of FV and FVIII than LMAN1 mutations. LMAN1 is a mannose-specific lectin that cycles between the endoplasmic reticulum (ER) and the ER-Golgi intermediate compartment. MCFD2 is an EF-hand domain protein that forms a calcium-dependent heteromeric complex with LMAN1 in cells. Missense mutations in the EF-hand domains of MCFD2 abolish the interaction with LMAN1. The LMAN1-MCFD2 complex may serve as a cargo receptor for the ER-to-Golgi transport of FV and FVIII, and perhaps a number of other glycoproteins. The B domain of FVIII may be important in mediating its interaction with the LMAN1-MCFD2 complex.     

联合小剂量氯丙嗪治疗肺结核咯血疗效观察

目的：观察联合小剂量氯丙嗪治疗肺结核咯血的临床效果。方法：对186例肺结核合并咯血患者随机分为三组，分别用（1）垂体后叶素；（2）垂体后叶素＋小剂量氯丙嗪；（3）普鲁卡因。结果：第二组在止血时间与止血效果上明显优于其它两组（P＜0．05）。结论：联合小剂量氯丙嗪对治疗肺结核咯血可明显提高疗效，且方便、经济、实用。     

老年急性上消化道出血患者93例住院费用分析

目的分析老年急性上消化道出血（acute upper gastrointestinal bleeding,AUGIB）患者住院费用的影响因素及近5年变化趋势,为加强医疗费用管理、控制住院费用提供参考。方法选择2005年1月~2009年12月急诊收住我院的AUGIB患者93例作为研究对象,采用Logistic回归分析方法对住院费用的影响因素进行筛选、运用单因素方差分析法比较年度间住院费用差异、用Excel 2003分析住院费用变化趋势。结果影响我院老年AUGIB患者住院费用的主要因素为患者年龄、住院天数、合并疾病及血红蛋白含量（P〈0.05）,OR值分别为0.900、1.642、0.779和2.453,5年内住院费用的平均增长速度为-0.96%,年度间住院费用的ANOVA结果表明其差异无统计学意义（F=0.50,P=0.73）。结论高龄、住院天数延长、合并其他疾病及血红蛋白含量显著降低是导致老年AUGIB患者住院费用增加的重要危险因素,近5年老年AUGIB患者的住院费用总体呈下降趋势,但仍维持在相对较高的水平,降低其住院费用重点应从老年患者的健康教育及老年性疾病防控、缩短住院天数等方面入手。     

中老年人慢性支气管炎急性发作期出凝血功能检测的临床意义

目的 对６０例中老年慢笥急性气管炎急性发作的部分出凝血功能进行检测，探讨中老年慢性所管炎发作期出凝血功能检测的临床意义。方法 用凝集法和电泳法等分别检测病人和对照组的ＰＴ、ＡＰＴＴ、ＢＰＣ、ＰＡｄＴ、ＰＡｇＴ、ＰＦ４、ＡＴⅢ；Ａｇ、ＶＷＦ：Ａｇ、ＦＤＰ、血浆Ｄ－二聚体和３Ｐ实验。结果 ６０例患者与３０例健康对照组有明显的差异，其中ＰＴ、ＡＰＴＴ、ＢＰＣ、ＡＴⅢ：Ａｇ、ＰＡｄＴ、ＰＡｇＴ、均降低。而     

康复新液联合生长抑素治疗急性十二指肠溃疡出血的临床研究

目的 探析康复新液联合注射用生长抑素治疗急性十二指肠溃疡出血的临床效果。方法 选取2020年1月—2022年1月中国人民解放军南部战区总医院诊治的106例急性十二指肠溃疡出血患者，以随机数字表法将所有患者分为对照组和治疗组，各53例。对照组首先缓慢静脉注射0.25 mg注射用生长抑素作为负荷剂量，而后立即静脉点滴0.25 mg/h。如果两次输液给药间隔大于3～5 min，采取重新静脉注射0.25 mg注射用生长抑素以确保给药的连续性。治疗组在对照组治疗的基础上口服康复新液，10 mL/次，3次/d。两组连续治疗7 d。比较两组的临床疗效、临床指标、血清炎性因子水平。结果 治疗后，治疗组总有效率为98.11%，显著高于对照组的总有效率83.02%（P＜0.05）。治疗后，治疗组大便隐血转阴时间、禁食时间均短于对照组（P＜0.05）。治疗后，两组血清白细胞介素-6（IL-6）水平均较治疗前下降（P＜0.05）；且治疗组的血清IL-6水平均低于对照组（P＜0.05）。结论 康复新液联合注射用生长抑素治疗急性十二指肠溃疡出血的效果更显著，可有效改善临床症状、降低血清IL-6水平。     

Prediction and management of bleeding in cardiac surgery

Summary.  Excessive bleeding after cardiac surgery can result in increased morbidity and mortality related to transfusion- and hypoperfusion-related injuries to critical organ systems.
Our objective was to review mechanisms that result in bleeding after cardiac surgery as well as current and emerging interventions to reduce bleeding and transfusion.
We discovered that of point-of-care (POC) tests of hemostatic function can facilitate the optimal management of excessive bleeding and reduce transfusion by facilitating administration of specific pharmacologic or transfusion-based therapy and by allowing physicians to better differentiate between microvascular bleeding and surgical bleeding. Emerging interventions like recombinant FVIIa have the potential to reduce bleeding and transfusion-related sequelae and may be life-saving; however, randomized, controlled trials are needed to confirm safety before they can be used as either first-line therapies for bleeding or bleeding prophylaxis.
In conclusion, careful investigation of the role of new interventions is essential as the ability to reduce use of blood products, to decrease operative time and/or re-exploration rates has important implications for overall patient safety and health care costs.     

益宫颗粒联合抗生素用于药流后出血临床效果观察

目的探讨益宫颗粒联合抗生素治疗药流后阴道出血的临床效果。方法随机选择400例早孕行药流的健康女性进行对照试验,其中研究组（益宫颗粒联合抗生素治疗）200例,对照组（单纯抗生素治疗）200例。1个疗程均为7天,观察流产后阴道流血止血时间以及第一次月经复潮时间等。结果两组阴道出血时间、出血量P〈0.05有显著性差异,第一次月经复潮时间P〈0.05有显著性差异,清宫率P〉0.05无显著性差异。本研究中各组均未发生不良反应。结论益宫颗粒联合抗生素可以减少药流后出血时间,促进子宫复旧,药物安全性良好,值得临床推广应用。     

Cannabis can augment thrombolytic properties of rtPA: Intracranial hemorrhage in a heavy cannabis user

Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke. However, hemorrhagic strokes, which are often seen with sympathomimetic illicit drugs (e.g. cocaine and amphetamines), have rarely been reported due to cannabis. Many cellular mechanisms within non-ischemic tissue post stroke may be augmented by heavy cannabis use. Here, we describe a rapid development of hemorrhage following thrombolytic therapy in a patient with heavy cannabis use with an ischemic stroke.     

State-of-the-Art Management of Acute Bleeding Peptic Ulcer Disease

The management of patients with non variceal upper gastrointestinal bleeding has evolved, as have its causes and prognosis, over the past 20 years. The addition of high-quality data coupled to the publication of authoritative national and international guidelines have helped define current-day standards of care. This review highlights the relevant clinical evidence and consensus recommendations that will hopefully result in promoting the effective dissemination and knowledge translation of important information in the management of patients afflicted with this common entity.