HCY、D-D、hs-CRP联合检测在妊娠期高血压疾病诊断中的临床意义

目的:探讨血浆同型半胱氨酸(HCY)、D-二聚体(D-D)、超敏C-反应蛋白(hs-CRP)水平变化与妊娠期高血压疾病(以下简称妊高征)发生、发展间的关系。方法:检测118例妊高征患者及116名同孕周正常单胎妊娠妇女的血浆HCY、D-D、hs-CRP水平,并进行比较,分析其变化的意义。将妊高征组按血压水平分为4个亚组,妊娠高血压者15例;轻度子痫间前期48例;重度子痫间前期42例;子痫间13例,组间两两比较以上3个指标。结果:妊高征患者与正常孕妇比较,其血浆HCY、D-D、hs-CRP水平差异均有统计学意义(P<0.05);妊高征患者按血压的亚分组中(4个亚分组),组间两两比较3项指标,差异均有统计学意义(P<0.05),且随着妊高征病情的发展,这3项指标均呈逐渐升高趋势。结论:HCY、D-D、hs-CRP联合检测对妊娠期高血压疾病早期诊断、了解病情变化及预后评估具有重要的临床意义。     

Hospital Management of Acute Iron Ingestion

Abstract

This overview summarizes the major and minor side effects and drug interactions of fluoxetine. The adverse reactions include the “serotonin syndrome”, cardiovascular complications, extrapyramidal side effects such as akathisia, dyskinesias, and parkinsonian-like syndromes and an apparently increased risk of suicidality. Fluoxetine-induced mania and hypomania, seizures and sexual disorders are evaluated along with minor symptoms of allergic reactions, stuttering, hematological changes, psoriasis, and inappropriate secretion of the antidiuretic hormone. The major fluoxetine-drug interactions involve the amino acids L-dopa and L-tryptophan, anorexiants, anticonvulsants, antidepressants, anxiolytics, calcium channel blockers, cyproheptadine, lithium salts, and drugs of abuse. The underlying mechanism and the paradoxical effects of fluoxetine are addressed.     

Non‐pharmacological means to prevent fractures among older adults

Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long‐standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a ‘simple’ fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high‐impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called ‘fall‐induced high‐impact injuries’ instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal‐trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury‐site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone‐specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor‐assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury‐site protection, padded strong‐shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.     

Impact of Planned Delivery on the Perinatal Outcome of Term Fetuses with Isolated Heart Defects

ObjectivePregnancies complicated by fetal heart defects often undergo a planned delivery prior to term by either induction of labour or cesarean delivery to ensure optimal availability of neonatal care. We aimed to assess whether such planned deliveries achieve their goal of better perinatal care.MethodsWe conducted a retrospective case-control study of pregnancies complicated by isolated fetal cardiac defects, without other fetal comorbidities, managed at a single fetal medicine unit over a 10-year period. Only pregnancies delivered past 37 weeks gestation were included. Patients undergoing elective delivery for care planning reasons only were compared with patients in whom planned delivery was clinically indicated and patients who laboured spontaneously. Obstetric and perinatal outcomes were recorded.ResultsOf the 180 pregnancies included in the study, 59 (32.8%) were in the elective group, 49 (27.2%), in the indicated group, and 72 (40%), in the spontaneous group. Mean gestational age at delivery was 39.0 ± 1.1 weeks overall and did not differ between the groups. For the elective group, only 35.6% of deliveries occurred during office hours, which was similar to the 2 other groups. The rate of adverse obstetric or postnatal outcomes was not statistically significantly different between groups.ConclusionTimed delivery at term does not seem to be associated with an increased risk of poor perinatal outcomes. It may improve perinatal care by providing proximity to a neonatal intensive care unit and convenience for patients and providers.     

从胰岛细胞移植到胰腺干细胞移植，治愈糖尿病还有多远？

背景：胰岛细胞移植和胰腺干细胞移植是近年来糖尿病治疗的研究热点,也是治愈糖尿病最有希望的途径。目的：探讨胰岛细胞移植和胰腺干细胞移植治疗糖尿病的可行性、优势、面临的问题及解决的办法。方法：收集胰岛细胞移植和胰腺干细胞移植治疗糖尿病的相关实验和临床研究,进行实验数据分析两种细胞移植途径治疗糖尿病的影响因素,从细胞分子生物学水平认识胰岛细胞移植和胰腺干细胞移植治疗糖尿病的优势和缺点。结果与结论：胰岛细胞移植治疗糖尿病受供体不足的制约,胰腺干细胞移植解决了胰岛细胞供体短缺的有效途径,但胰腺干细胞移植的研究还停留在动物实验阶段,需要进行广泛的临床研究。首先要明确胰腺干细胞的特异性标志物,其次要掌握将相关干细胞诱导分化为胰腺干细胞的方法和技术。     

Autoimmune heparin‐induced thrombocytopenia

Summary

Autoimmune heparin‐induced thrombocytopenia (aHIT) indicates the presence in patients of anti‐platelet factor 4 (PF4)–polyanion antibodies that are able to activate platelets strongly even in the absence of heparin (heparin‐independent platelet activation). Nevertheless, as seen with serum obtained from patients with otherwise typical heparin‐induced thrombocytopenia (HIT), serum‐induced platelet activation is inhibited at high heparin concentrations (10–100 IU mL^?1 heparin). Furthermore, upon serial dilution, aHIT serum will usually show heparin‐dependent platelet activation. Clinical syndromes associated with aHIT include: delayed‐onset HIT, persisting HIT, spontaneous HIT syndrome, fondaparinux‐associated HIT, heparin ‘flush’‐induced HIT, and severe HIT (platelet count of < 20 × 10⁹ L^?1) with associated disseminated intravascular coagulation (DIC). Recent studies have implicated anti‐PF4 antibodies that are able to bridge two PF4 tetramers even in the absence of heparin, probably facilitated by non‐heparin platelet‐associated polyanions (chondroitin sulfate and polyphosphates); nascent PF4–aHIT‐IgG complexes recruit additional heparin‐dependent HIT antibodies, leading to the formation of large multimolecular immune complexes and marked platelet activation. aHIT can persist for several weeks, and serial fibrin, D‐dimer, and fibrinogen levels, rather than the platelet count, may be helpful for monitoring treatment response. Although standard anticoagulant therapy for HIT ought to be effective, published experience indicates frequent failure of activated partial thromboplastin time (APTT)‐adjusted anticoagulants (argatroban, bivalirudin), probably because of underdosing in the setting of HIT‐associated DIC, known as ‘APTT confounding’. Thus, non‐APTT‐adjusted therapies with drugs such as danaparoid and fondaparinux, or even direct oral anticoagulants, such as rivaroxaban or apixaban, are suggested therapies, especially for long‐term management of persisting HIT. In addition, emerging data indicate that high‐dose intravenous immunoglobulin can interrupt HIT antibody‐induced platelet activation, leading to rapid platelet count recovery.

     

Programming a Long Paced Atrioventricular Interval May Be Risky in DDDR Pacing

In patients with intermittent AV block and dual chamber pacemakers, a long paced AV interval of 200 msec or more can be selected to prolong pulse generator life (by avoiding the ventricular pace output) and to enable a more physiological and hemodynamically superior activation sequence. This case report describes the potential risks of programming a long paced AV interval in a patient with a DDDR pacemaker. T wave pacing, as described here, can occur if the conducted QRS complex is not sensed because it occurs during the ventricular blanking period (delivery of the atrial stimulus). This can be initiated by the mechanisms that induce apparent and actual P wave undersensing of the conducted QRS complex. In this case report apparent P wave undersensing and subsequent T wave pacing with ventricular capture (in a patient with intermittent AV block) occurred frequently during an exercise test done in the DDDR mode with a paced AV interval of 200 msec, according to the clinical evaluation protocol.     

慢性阻塞性肺疾病患者气道局部氧化应激与体重指数及肺功能下降的关系

目的：研究慢性阻塞性肺疾病（COPD）患者气道局部氧化应激水平的变化及其与体重指数（BMI）、肺功能下降的相关性。方法：对70例COPD患者（A组）、30例健康对照（B组）进行痰诱导及肺功能、BMI测定,并测定诱导痰中丙二醛（MDA）、还原型谷胱甘肽（GSH）含量,超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-PX）活性。结果：COPD患者诱导痰MDA含量较健康对照高,P〈0.05;而诱导痰GSH含量、SOD、GSH-PX活性较健康对照下降,P〈0.05;BMI与痰SOD、痰MDA、GSH、GSH-PX的相关系数分别为0.751、-0.694、0.685、0.701,P〈0.05;3.FEV1与痰SOD、痰MDA、GSH、GSH-PX的相关系数分别为0.874、-0.826、0.853、0.809,P〈0.05。结论：COPD患者气道局部均存在氧化/抗氧化失衡;气道局部氧化应激是导致COPD患者BMI及肺功能水平下降的原因之一。     

沙利度胺及氨甲蝶呤抗CIA大鼠滑膜血管新生及其作用机制的研究

目的研究沙利度胺、氨甲蝶呤对大鼠Ⅱ型胶原诱导型关节炎血管新生的影响及相关的机制。方法建立类风湿性关节炎大鼠模型.自造模次日治疗组分别给予沙利度胺、甲氨蝶呤和沙利度胺联合甲氨蝶呤治疗,在第6周取膝关节应用免疫组化检测其滑膜的微血管密度(MVD),取血清进行Western Blot检测大鼠体内血管内皮细胞生长因子(VEGF)、基质金属蛋白酶-1、2、3、9的表达并计算相对含量。结果①免疫组织化学染色显示沙利度胺、氨甲蝶呤和沙利度胺联合氨甲蝶呤治疗模型大鼠可使关节滑膜中新生血管数量明显减少.微血管密度(MVD)明显降低(P<0.05).以沙利度胺联合氨甲蝶呤组作用最强。②沙利度胺、氨甲蝶呤和沙利度胺联合氨甲蝶呤可抑制VEGF、MMP-1、2、3、9表达(P均<0.05)。结论沙利度胺和氨甲蝶呤可能通过抑制VEGF,MMP-1、2、3、9的表达而发挥抗滑膜血管新生的作用,且两者有协同作用。