Low-dose aspirin and risk of gastric and oesophageal cancer: A population-based study in the United Kingdom using The Health Improvement Network

There is increasing interest regarding potential protective effects of low-dose aspirin against various gastrointestinal cancers. We aimed to quantify the association between use of low-dose aspirin and risk of gastric/oesophageal cancer using a population-based primary care database in the UK. Between January 2005 and December 2015, we identified a cohort of 223 640 new users of low-dose aspirin (75-300 mg/day) and a matched cohort of nonusers at the start of follow-up from The Health Improvement Network. Cohorts were followed to identify incident cases of gastric/oesophageal cancer. Nested case-control analyses were conducted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for current vs nonuse of low-dose aspirin using logistic regression. Current use was defined as when low-dose aspirin lasted 0 to 90 days before the index date (event date for cases, random date for controls) and previous duration was ≥1 year. We identified 727 incident cases of gastric cancer and 1394 incident cases of oesophageal cancer. ORs (95% CIs) were 0.46 (0.38-0.57) for gastric cancer and 0.59 (0.51-0.69) for oesophageal cancer. The effect remained consistent with no clear change seen between previous duration of low-dose aspirin use of 1-3, 3-5 or >5 years. The reduced risks was seen with 75 mg/day, and effects were consistent in lag-time analyses. In conclusion, our results indicate that use of low-dose aspirin is associated with a 54% reduced risk of gastric cancer and a 41% reduced risk of oesophageal cancer as supported by mechanistic data.     

长期口服阿司匹林高血压颅内出血患者的手术治疗

目的 探讨长期口服阿司匹林高血压脑出血患者的手术治疗方案及效果。方法 2014年8月-2016年8月我科手术治疗的长期服用阿司匹林高血压脑出血患者共10例,收集其临床资料,分析手术方式与效果,进行总结。结果 5例患者行开颅血肿清除术,其中3例为急诊手术。急诊手术者术中止血困难,1例予术中输血后好转。2例行急诊手术者有大小不一再出血。术后3个月患者均存活,其中GOS评分2分者3例,3分者1例,4分者1例。5例行急诊穿刺引流术者,术中发现血肿易吸出,颜色偏鲜红。2例出现术后血肿扩大。2例患者分别在发病后14天及37天死亡,余患者术后3个月GOS评分均为2分。结论 长期口服阿司匹林高血压脑出血患者初发出血量大,应停服阿司匹林,给予输注血浆或血小板。病情危重者应根据患者具体情况选择不同手术方式进行治疗。     

双抗加他汀联合丁苯酞治疗短暂性脑缺血发作

目的探讨双抗（阿司匹林加氯吡格雷）治疗、双抗加他汀类降脂药物治疗、双抗加他汀联合丁苯酞治疗三种不同治疗方法,对短暂性脑缺血发作（TIA）的临床治疗效果。方法将150例短暂性脑缺血发作患者随机分成3组,分别为A组：双抗治疗对照组,B组：双抗治疗加他汀类降脂药物治疗组,C组：双抗加他汀联合丁苯酞治疗组。3组均给予控制血糖、血压等对症治疗,A组同时给予口服阿司匹林及氯吡格雷治疗,B组同时给予口服阿司匹林、氯吡格雷及阿托伐他汀钙治疗,C组同时给予口服阿司匹林、氯吡格雷、阿托伐他汀钙及丁苯酞治疗。3组治疗时间均为12周。结果治疗后临床疗效：B组、C组总有效率为90％、94％,优于A组的86％（P〈0．01）,但B组C组疗效相当（P〉0．05）;TIA发作次数及每次发作持续时间控制情况：3组对TIA的控制均有明显效果（P〈0．01）,且C组优于B组,B组优于A组（P〈0．01）。结论双抗加他汀类降脂药物联合丁苯酞治疗短暂性脑缺血发作有效。     

阿咖酚散中游离水杨酸检查方法的改进

摘 要 目的：建立HPLC法检查阿咖酚散中的游离水杨酸。方法: 色谱柱Welch Ultimate C18柱(250 mm×4.6 mm, 5 μm),流动相为乙腈 四氢呋喃 冰醋酸 水（22〖KG*9〗∶〖KG-*2〗5〖KG*9〗∶〖KG-*2〗5〖KG*9〗∶〖KG-*2〗68）,检测波长为303 nm,流速为1.0 ml·min-1。结果: 线性范围为1.500～75.000 μg·ml-1（r=0.999 9）,平均回收率为99.12%,RSD为0.75%（n = 9）,检出限为1.5 ng（S/N=3）。结论: 本方法简便准确、灵敏度高,稳定性比现行标准大幅提高,可用于阿咖酚散中游离水杨酸的检查。     

MANAGEMENT OF ANTIPLATELET THERAPY FOR ENDOSCOPIC PROCEDURES: OPTIMAL CESSATION PERIOD OF ANTIPLATELET THERAPY FOR JAPANESE

Although antiplatelet agents are widely used for the treatment and prevention of thrombotic diseases, only a few studies have reported the validity of the cessation period prior to endoscopic procedures. In 2002, the American Society for Gastrointestinal Endoscopy (ASGE) published a reference on the management of anticoagulation and antiplatelet therapy for endoscopic procedures, but it should be confirmed as appropriate for use in Asian patients. To evaluate the optimal cessation period of antiplatelet agents prior to endoscopic procedures for Japanese, we have studied: (i) the current clinically adopted cessation period of antiplatelet agents prior to invasive endoscopic procedures in Japan; (ii) the relationship between the cessation period of antiplatelet agents and complications around the invasive endoscopic procedures; (iii) colonic mucosal bleeding time after aspirin ingestion; and (iv) the time course of primary hemostasis after cessation of antiplatelet agents. We conclude that 3 days cessation period for aspirin, 5 days cessation for ticlopidine and 7 days cessation for aspirin + ticlopidine administration should be sufficient for Japanese.     

Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage

Summary The radiological aspect, pathology, treatment and results of 132 subdural haematomas observed in 100 patients, are discussed.The majority of these cases were characterized by a nonhomogenous CT scan picture, resulting from repeated bleeding in a previous subdural haematoma evolving to chronicity, or in a pre-existent subdural hygroma. Taking aspirin may have constituted a predisposing factor in 16% of our patients, whilst coagulation disturbances, including anticoagulant treatment, were observed in another 6%; ethylism was present in 11%. A traumatic origin was ascertained in 80% of the patients.The treatment consisted of burr hole evacuation and drainage in 91.5% of the haematomas, corresponding to 92% of the patients; it was eventually repeated once or twice in some cases. In 6% of the patients, a subduro-peritoneal drainage had to be placed ultimately and in 2%, a membranectomy had to be performed because the haematoma had become nearly completely fibrous. The necessity for repeated evacuation and eventual subduro-peritoneal drainage seems to depend mainly on a slow brain re-expansion in some elderly people, who are actually more frequently referred.Two patients died; one was deeply comatose and another in poor general condition. Morbidity in the 96 remaining patients, 2 being lost to follow-up, was 11%: 5% related to the haematoma or to the causal trauma, and 6% from other concomitant neurological disease. The functional result was satisfactory in 85%.     

L－SOD对阿司匹林诱发大鼠急性胃粘膜损伤的保护作用 Ⅱ．血流量与血管通透性的观察

本文应用计算机反射分光光度法检测胃粘膜血流量（ＧＭＢＦ），利用Ｅｖａｎｓ蓝观察血管通透性的改变，旨在探讨Ｌ－ＳＯＤ的粘膜保护作用与血管因素之间关系。