开心胶囊对大鼠垂体后叶素心肌缺血模型的影响

临床发现,由西洋参,川苍,苍术,香附,蒲黄,红花,山楂等组成的呀约开心胶囊对心肌缺血有改善作用。为探讨其作用机理,建立垂体后叶素（Ｐｉｔ）造成的心肌缺血大鼠模型,观察中药开心胶囊不同剂量对心肌缺血大鼠的防治作用,并以肠溶阿斯匹林作阳性对照,结果中药开心胶囊高剂量组可改善Ｐｉｔ引起的心肌缺血并提高大鼠６－酮－前列腺素Ｆ１α－（６－Ｋｅｔｏ－ＰＧＦ１α）的含量（与模型组比Ｐ〈０．０１）;中、高剂量组可     

脑脉通口服液治疗急性缺血性中风的实验研究

脑脉通口服液（ 由制大黄、水蛭、川芎、三七、瓜蒌、石菖蒲、枳实、川朴、葛根等组成） 为山东中医药大学附属医院临床治疗急性缺血性中风的有效制剂。为探讨其药理学机制, 观察了不同剂量组脑脉通口服液对结扎大鼠双颈总动脉造成的不完全性脑缺血实验模型的保护作用。结果表明, 脑脉通可以减轻大鼠脑毛细血管通透性, 减轻脑水肿（ Ｐ＜０ ．０５ 或Ｐ＜ ０ ．０１） ; 延长断头小鼠脑功能维持时间（ Ｐ＜ ０ ．０５ 或Ｐ＜ ０．０１ ） ; 对二磷酸腺苷（ＡＤＰ） 诱发的大鼠血小板聚集及血栓性死亡呈拮抗作用（ Ｐ＜ ０．０５ 或Ｐ＜ ０．０１） 。本研究结果为脑脉通口服液临床治疗急性缺血性中风提供实验依据     

Vitamin D deficiency and level of asthma control in women from North of Jordan: a case–control study

Introduction: Reduced vitamin-D levels in patients with asthma have been associated with impaired lung function, increased airway hyper-responsiveness, and reduced glucocorticoid responsiveness. Nationwide studies revealed a considerable prevalence of vitamin-D deficiency (VDD) in Jordanian women. Objective: A case–control study was conducted to determine the relationship between serum vitamin A and D levels and asthma among women in North of Jordan. Methods: Sixty-eight asthmatics, age range between 14 and 65 years and 77 healthy women, age range between 19 and 51 years, were enrolled. Asthma severity was classified using Global Initiative for Asthma (GINA) guidelines and Asthma Control Test (ACT) questionnaire. Serum vitamin-A and 25-hydroxyvitamin-D (25(OH)D3) levels were measured using high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods, respectively. Results: The prevalence of VDD (<15?ng/ml) was higher but not statistically significant for women with asthma compared with controls (95.6% vs. 87.0%; p?=?0.070). The severity of VDD correlated with the number of asthma medications (p?=?0.020). 25(OH)-D3 serum levels directly correlated with asthma control level using ACT score (p?=?0.012) and GINA classification (p?=?0.046). After adjusting for age, the odds of having VDD for asthmatic women were 35.9 times higher than that for women with no asthma. There was no difference in serum vitamin-A level between healthy and asthmatic women (p?=?0.214) and none had vitamin-A deficiency (<200?µg/dl). Conclusions: VDD is prevalent in women with asthma in northern Jordan. The severity of VDD correlated with poor asthma control and a need for more medications to control asthma. There was no association between vitamin-A and asthma.     

Patients réfractaires aux soins : quelle évolution après le suivi intensif d’une équipe mobile de psychiatrie ?

ObjectivesBeneficial effects of Assertive Community Treatment (ACT) programs on patients with severe mental disorders are well established over short or medium term. However, studies that investigate long term clinical and psychosocial outcomes are remarkably scarce, and it is not known whether the support and intensive care delivered by these programs maintain their benefits over time, especially after discharge. Thus, the present study sought further understanding on this issue by evaluating long term clinical and psychosocial evolution of patients who had been treated by an ACT team in 2007. We investigated the nature of treatment interventions and the level of care since discharge from ACT, especially in terms of adherence to care and number of psychiatric hospitalizations. We also examined factors, at inclusion in the ACT program and after six months of treatment, that could predict better long-term outcomes.MethodsTwenty-nine patients with severe mental disorders, characterized by the heavy use of inpatient facilities and refusal of care, were treated by an ACT team which was implmented between 2007 and 2009. They participated at that time in an initial study on the effect of the program and were therefore assessed at inclusion and again after six months of treatment. Between 2016 and 2017, the present follow up took place and patients were assessed again on their current psychosocial functioning, quality of life and intensity of symptoms, using the same scales as those administered in the initial study. This design allowed us to compare baseline with “early” (after six months) and “late” (after a mean of 8.7 years) effects of ACT program on patients. In order to assess adherence to care since discharge from ACT, data on nature and level of psychiatric treatment was systematically reviewed, including all public and private inpatient and outpatient treatments since the end of the ACT program.ResultsDetailed tables on hospitalizations before, during and after ACT treatment are reported, as well as tables summarizing the level of care and nature of treatment since discharge from ACT. During the mean of 8.7 years of evolution and 6.3 years after discharge from ACT, these patients, characterized by severe mental disorders, heavy use of inpatient facilities and refusal of care, sustained a reduced rate of hospitalizations and a minor rate of disengagement from outpatient care (6.9 %). Both severity of symptoms, poorer quality of life and worst functioning in the community at inclusion (baseline) as well as early improvements (after six month of ACT treatment) of the same outcomes were significantly associated with long term improvements. Results also show other baseline predictors of long term improvement: fewer years since disorder onset was associated with improvement of functioning in the community; further advancement in the recovery process predicted better enhancement in quality of life, and a better initial functioning in the community was associated with a better improvement of symptomatology.ConclusionsThis study provides insight on the sustainability of the benefits of ACT programs, suggesting that these interventions can help patients who are refractory to care to gain clinical and psychosocial improvement in the long term. Our results also suggest that baseline severity as well as early improvements after six months of treatment were associated with larger improvement at follow up. These clinical predictors provide some help to distinguish which patients are more likely to benefit from an ACT approach.     

The challenge of asthma control grading in clinical practice

Asthma is a chronic disease for which control is considered the management goal. However, the different methods to measure asthma control, including the Global Initiative for Asthma (GINA) criteria and Asthma Control Test (ACT), can produce conflicting results. This nationwide pediatric study compared both methods in 465 enrolled children (322 males, mean age 11.2 years). Lung function and symptom perception were also evaluated. The results showed fair concordance (k = 0.253) between GINA grading and childhood-ACT (C-ACT). Multivariate analysis revealed an association between the parents' perception of asthma and uncontrolled asthma (odds ratio [OR] = 1.52).These findings highlight the persisting puzzle of asthma control grading in primary care, which could confuse doctors. Therefore, asthma control assessment deserves adequate attention and requires substantial expertise in clinical practice.     

Measurement of thrombin generation intra-operatively and its association with bleeding tendency after cardiac surgery

Introduction

Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are susceptible to haemostatic disturbances. Monitoring the haemostatic capacity by conventional clotting tests is challenging.

Materials and Methods

Thrombin generation (TG) by Calibrated Automated Thrombography, clotting tests and tissue factor pathway inhibitor (TFPI) measurements were performed to describe the relationship between haemostatic changes and alterations in these tests. Blood samples were collected before, during and after CPB. Furthermore, it was investigated whether TG measured intraoperatively, is associated with increased risk of bleeding postoperatively.

Results

TG diminished significantly (p < 0.01) after heparinization in the presence and absence of platelets (37% and 50%) compared to baseline. After the start of CPB, TG elevated and persisted till the end of surgery but remained lower than preoperatively. Activated clotting time increased after heparinization and after the start of bypass compared to baseline (400% and 500%). Anti-FXa activity reduced on the start of CPB compared to the level after heparinization, to almost the baseline value following protamine reversal of heparin. The plasma levels of total and free TFPI elevated 9 and 14 fold during bypass and remained after protamine administration higher than preoperatively. Plasma D-dimer levels reduced (p < 0.01) when bypass started. However, a marked elevation was observed in the following time points. TG in platelet-rich plasma measured after heparinization and after the start of CPB associated (p < 0.05) with postoperative blood loss.

Conclusions

TG can be determined during CPB despite the high heparinization level, it reflects the haemostatic capacity better than clotting-based assays and might better predict bleeding when performed intraoperatively.     

社区脑卒中高危人群服用脑安胶囊强化干预效果评价

目的评价在社区脑卒中高危人群中应用中药脑安胶囊进行脑卒中一级预防的干预效果。方法采用多中心、随机对照研究,筛选出脑血管血流动力学分值<75分的脑卒中高危人群4069例作为干预对象。根据知情同意原则,以村或居委会为单位随机分为强化干预组2000例和一般干预组2069例。2组干预观察2年,随访脑卒中发病情况。评价指标为干预结束时,2组脑卒中累积发病率。结果干预结束时,2组共新发生脑卒中52例,强化干预组新发生脑卒中18例,脑卒中累积发病率为900人/10万人。一般干预组新发生脑卒中34例,发病率为1643人/10万人。与一般干预组比较,强化干预组脑卒中累积发病率明显降低,差异有统计学意义(X~2=4.957,P=0.026)。采用多因素Cox回归分析,在调整了年龄、性别及其他几种主要危险因素后,服用脑安胶囊可降低脑卒中发病风险(HR=3.798,P=0.001)。结论在社区脑卒中高危人群中应用脑安胶囊进行脑卒中一级预防是安全有效的,可以降低脑卒中发病率。