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.     

A review of ischemic colitis: is our clinical recognition and management adequate?

Ischemic colitis is a common cause of hospital admissions; however it is frequently confused intellectually with mesenteric ischemia and often misdiagnosed as infectious diarrhea or Clostridium difficile colitis. Ischemic colitis is caused by non-occlusive insult to the small vessels supplying the colon without a clear precipitating factor. It is more common in females and in patients above 60 years of age. The classic presentation includes sudden onset of lower abdominal pain followed by the urge to defecate and bloody diarrhea. Focal right-sided ischemic colitis has more pain and a worse prognosis. Choosing the correct diagnostic studies is challenging and requires proficient knowledge of the disease. Management is usually conservative, however around 10–20% of the patients will require surgery. Acute ischemic colitis usually resolves; nevertheless some patients may develop chronic segmental colitis or a stricture. One ischemic colitis caveat is that it may be the first sign of undiagnosed cardiac disease. A firm grasp on this common yet little discussed condition is valuable to a gastrointestinal consultant and hospitalist alike.     

Four factor prothrombin complex concentrate (human): review of the pharmacology and clinical application for vitamin K antagonist reversal

Vitamin K antagonists (VKAs) have been used for decades for the treatment and prophylaxis of thromboembolic events. Due to their wide range of therapeutic indications, they are the most prescribed oral anticoagulant worldwide. However, they are associated with bleeding complications due to their narrow therapeutic range, variability in individual dose responses and laboratory monitoring, and overdoses. Despite off-label use of 3-factor prothrombin complex concentrates and recombinant activated factor VII, until recently, vitamin K and plasma were the only recommended therapeutic options for reversing VKAs in the USA. In 2013, a 4-factor prothrombin complex concentrate (4F-PCC) was approved in the USA for VKA reversal in patients with bleeding or requiring emergency surgery and invasive procedure. Recent randomized controlled clinical trials have shown that 4F-PCC (Kcentra?) is non-inferior for hemostatic efficacy and superior for international normalized ratio correction as compared to plasma and has a similar safety profile.     

Recombinant activated factor VII administration in a patient with congenital lack of factor VII undergoing laparoscopic hysterectomy: A case report

Introduction and importanceCase report of patient with congenital lack of factor VII, suffering from recurrent hematomas and massive menstrual bleedings resulting in severe anemia and multiple hospitalization.Case presentationPatient was diagnosed with endometrial hyperplasia and not responding to hormonal treatment and substitution with recombinant factor VII was not effective to reduce the bleedings. This case describes successful laparoscopic technique of using bipolar coagulation and non-absorbable clips.Clinical discussionWe describe premedication and post-surgical management – which we had to modify from this found in very scarce literature. Despite previous vaginal deliveries without any complications during the puerperium, 20 days after the surgery patient presented with intraperitoneal bleeding after stopping rFVIIa therapy. It was treated medically without the need for re-laparoscopy.ConclusionLaparoscopic surgery is possible in patients with lack and deficiency of FVIIa, but they need close post-operative surveillance and prolonged supplementation with recombinant FVIIa.     

Dosing Strategies for Antiplatelet Therapy in Percutaneous Coronary Intervention

Abstract

Both clopidogrel and aspirin have been shown to decrease the rate of cardiovascular events and especially stent thrombosis in patients undergoing percutaneous coronary intervention (PCI). However, recent studies have suggested that there is large inter-individual response variability to these drugs (especially to clopidogrel) and that improved inhibition of platelet reactivity using higher doses or new, more potent agents would further reduce the occurrence of cardiovascular events, but may also increase the risk of bleeding. Many different protocols of antiplatelet therapy have been studied and have shown benefit in reducing the rate of major adverse cardiovascular events after PCI. Therefore, the choice of an appropriate antiplatelet therapy protocol is sometimes difficult for the clinician and should be individualized as per the particular patient risk, accounting for both the risk of recurrent cardiovascular events and bleeding. We review the recent data on efficacy and safety of dosing strategies for antiplatelet therapy in PCI.     

Thrombin generation in patients with factor XI deficiency and clinical bleeding risk

Summary. Factor XI (FXI) deficiency is a rare bleeding disorder. Most patients with FXI deficiency are mild bleeders but certain patients with similar FXI activity exhibit different bleeding phenotype. Routine laboratory assays do not help physicians to estimate the individual bleeding risk in these patients. Thrombin generation test (TGT) is a more comprehensive, global function test of the clotting system. We investigated whether or not the bleeding tendency of patients with FXI deficiency is correlated with features of the TGT. Twenty‐four patients with FXI deficiency were divided in two groups: (i) severe bleeders (n = 9) and (ii) mild or non‐bleeders (n = 15). All severe bleeders had a personal history of surgery‐related severe bleeding. Thrombin generation (TG) was measured in platelet‐rich plasma (PRP) using a low concentration of tissue factor 0.5 pm . In patients exhibiting severe bleeding tendency, independently of their FXI level, a dramatically impaired TG was observed. For example, despite a low plasma FXI = 1 IU dl^?1, a clinically non‐bleeding individual exhibited normal TG results whereas another patient with severe bleeding history and FXI = 40 IU dl^–1 had a very low TG capacity. Low velocity and delayed TG were the main parameters suggesting a higher bleeding risk. DNA analysis of patients reported eight novel mutations of the FXI gene but neither mutation location nor secretion or not of the variant correlated with the bleeding tendency. The results of this study suggest that TG measurement in PRP may be a useful tool to predict bleeding risk in FXI deficiency and should be studied further in larger prospective clinical studies.