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Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in Low Body Weight Patients 依诺肝素在低体重患者静脉血栓栓塞预防中的应用
IF 3 Q2 Medicine Pub Date : 2019-07-01 DOI: 10.1177/1179545X19863814
Daniel Dybdahl, G. Walliser, M. Pershing, Christy Collins, David Robinson
Background: The appropriate dose of enoxaparin for venous thromboembolism (VTE) prophylaxis in low body weight patients is unknown. Objective: The aim of this study is to evaluate the impact of enoxaparin dosing on major and minor bleeding events in low body weight patients. Methods: This was a retrospective cohort study of patients weighing less than 45 kg receiving subcutaneous (SC) enoxaparin for VTE prevention. The primary objective was to determine whether enoxaparin dose was associated with major and minor bleeding. The secondary objective was to determine the incidence of VTE by enoxaparin dose. Results: There were 173 patients included in the study, of which 37 patients received 2 different courses of enoxaparin during hospitalization, resulting in 210 enoxaparin courses. Among all enoxaparin courses, 16.2% were associated with major bleeding and 5.2% with minor bleeding. There was no difference in the incidence of major bleeding by dose (enoxaparin 30 mg SC daily, 30 mg SC twice daily, or 40 mg SC daily; P = .409). Patients who experienced major bleeding were older (54.9 ± 16.1 years) than patients who did not (48.4 ± 18.4 years) (P = .043). There was no difference in the incidence of minor bleeding by dosing schedule (P = .14). No patients experienced a VTE. Conclusion and Relevance: The risk of bleeding was similar by enoxaparin dose but increased with age in low body weight patients. Given the low incidence of VTE in this study, it is reasonable to consider decreasing the prophylactic enoxaparin dose in low body weight patients, especially in the elderly population.
背景:低体重患者预防静脉血栓栓塞(VTE)的适当剂量尚不清楚。目的:本研究的目的是评估依诺肝素剂量对低体重患者大出血和小出血事件的影响。方法:这是一项回顾性队列研究,体重小于45公斤的患者接受皮下(SC)依诺肝素预防静脉血栓栓塞。主要目的是确定依诺肝素剂量是否与大出血和小出血相关。次要目的是通过依诺肝素剂量确定静脉血栓栓塞的发生率。结果:173例患者纳入研究,其中37例患者在住院期间接受了2个不同疗程的依诺肝素治疗,共210个疗程。在所有依诺肝素疗程中,16.2%与大出血相关,5.2%与小出血相关。不同剂量的大出血发生率无差异(依诺肝素每日30mg SC,每日两次30mg SC,或每日40mg SC;P = .409)。发生大出血的患者年龄(54.9±16.1岁)大于未发生大出血的患者(48.4±18.4岁)(P = 0.043)。不同给药方案对轻度出血发生率的影响无统计学差异(P = 0.14)。没有患者发生静脉血栓栓塞。结论及意义:低体重患者的出血风险与依诺肝素剂量相似,但随年龄增加而增加。鉴于本研究中静脉血栓栓塞发生率较低,低体重患者,尤其是老年人群,可考虑减少预防性依诺肝素剂量。
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引用次数: 6
Effects of Serum Albumin Levels on Antithrombin Supplementation Outcomes Among Patients With Sepsis-Associated Coagulopathy: A Retrospective Study. 血清白蛋白水平对败血症相关凝血病患者抗凝血酶补充结果的影响:一项回顾性研究。
IF 3 Q2 Medicine Pub Date : 2019-06-21 eCollection Date: 2019-01-01 DOI: 10.1177/1179545X19858361
Masatomo Ebina, Kazunori Fujino, Akira Inoue, Koichi Ariyoshi, Yutaka Eguchi

Background: Severe sepsis is commonly associated with mortality among critically ill patients and is known to cause coagulopathy. While antithrombin is an anticoagulant used in this setting, serum albumin levels are known to influence serum antithrombin levels. Therefore, this study aimed to evaluate the outcomes of antithrombin supplementation in patients with sepsis-associated coagulopathy, as well as the relationship between serum albumin levels and the effects of antithrombin supplementation.

Methods: This retrospective study evaluated patients who were >18 years of age and had been admitted to either of two intensive care units for sepsis-associated coagulopathy. The groups that did and did not receive antithrombin supplementation were compared for outcomes up to 1 year after admission. Subgroup analyses were performed for patients with serum albumin levels of <2.5 g/dL or ⩾2.5 g/dL.

Results: Fifty-one patients received antithrombin supplementation and 163 patients did not. The Cox proportional hazards model revealed that antithrombin supplementation was independently associated with 28-day survival (hazard ratio [HR]: 0.374, P = 0.025) but not with 1 year survival (HR: 0.915, P = 0.752). In addition, among patients with serum albumin levels of <2.5 g/dL, antithrombin supplementation was associated with a significantly lower 28-day mortality rate (9.4% vs 36.8%, P = .009).

Conclusion: Antithrombin supplementation may improve short-term survival, but not long-term survival, among patients with sepsis-associated coagulopathy.

背景:严重脓毒症通常与危重病人的死亡率相关,并且已知会引起凝血功能障碍。虽然抗凝血酶是在这种情况下使用的抗凝血剂,血清白蛋白水平已知会影响血清抗凝血酶水平。因此,本研究旨在评价补充抗凝血酶对脓毒症相关凝血功能障碍患者的预后,以及血清白蛋白水平与补充抗凝血酶效果的关系。方法:本回顾性研究评估了年龄>18岁且因脓毒症相关凝血病入住两间重症监护病房的患者。在入院后1年内,对服用和未服用抗凝血酶的两组进行比较。结果:51例患者补充了抗凝血酶,163例患者没有补充。Cox比例风险模型显示,抗凝血酶补充与28天生存率独立相关(风险比[HR]: 0.374, P = 0.025),但与1年生存率无关(风险比:0.915,P = 0.752)。此外,患者血清白蛋白水平P = 0.009)。结论:补充抗凝血酶可以改善败血症相关凝血病患者的短期生存,但不能改善长期生存。
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引用次数: 1
Diffuse Large B-Cell Lymphoma Relapsing in Leukaemic Phase Presenting as Acute Leukaemia. 弥漫性大b细胞淋巴瘤在白血病期复发表现为急性白血病。
IF 3 Q2 Medicine Pub Date : 2019-01-15 eCollection Date: 2019-01-01 DOI: 10.1177/1179545X18821160
Priyavadhana Balasubramanian, Prashant Ramteke, Saumyaranjan Mallick, Lalit Kumar, Pranay Tanwar

Diffuse large B-cell lymphoma (DLBCL) accounts for 30% to 40% of the newly diagnosed adult non-Hodgkin lymphomas, but rarely presents in leukaemic phase. Here in, we report a case of DLBCL presenting in leukaemic phase and masquerading as acute leukaemia. A 28-year-old woman presented to our outpatient department with complaints of fever for 1 week. Her peripheral blood smear showed 5% to 8% blasts. Bone marrow aspirate showed an infiltration by ~30% blasts. Flow cytometry and immunohistochemistry confirmed relapse of DLBCL. Also, patient's poor response to therapeutic regimen for DLBCL prompted to consider second differential diagnosis of acute leukaemia. This case is a learning case, as it emphasizes the combined role of diagnostic ancillary techniques along with clinical judgments for management. The case also makes us more vigilant towards the pathobiology of DLBCL and dynamics of personalized individual treatment response.

弥漫性大b细胞淋巴瘤(DLBCL)占新诊断成人非霍奇金淋巴瘤的30% ~ 40%,但很少出现在白血病期。在这里,我们报告一个病例DLBCL在白血病期和伪装成急性白血病。一名28岁女性以发热1周就诊于门诊部。她的外周血涂片显示5%到8%的细胞。骨髓抽吸显示约30%的原细胞浸润。流式细胞术和免疫组织化学证实DLBCL复发。此外,患者对DLBCL治疗方案的不良反应促使考虑急性白血病的二次鉴别诊断。本病例是一个学习案例,因为它强调了诊断辅助技术与临床判断对管理的综合作用。该病例也使我们对DLBCL的病理生物学和个体化治疗反应的动态更加警惕。
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引用次数: 3
Routine Preoperative Coagulation Tests in Children Undergoing Elective Surgery or Invasive Procedures: Are They Still Necessary? 儿童择期手术或侵入性手术的常规术前凝血检查:是否仍有必要?
IF 3 Q2 Medicine Pub Date : 2019-01-05 eCollection Date: 2019-01-01 DOI: 10.1177/1179545X18821158
Azzah Alzahrani, Nada Othman, Tahani Bin-Ali, Huda Elfaraidi, Eman Al Mussaed, Fahad Alabbas, Qanita Sedick, Fatma Albatniji, Ziyad Alshahrani, Mohammed Asiri, Omar Alsuhaibani, Ghaleb Elyamany

Introduction: Preoperative coagulation screening tests in pediatric patients was once routine clinical practice globally and still used as standard practice in some countries before surgical procedures to assess of perioperative bleeding risk.

Objective: The study aimed to evaluate unselected routine preoperative coagulation testing in children undergoing elective or invasive surgery to predict abnormal perioperative bleeding. The study also aimed to provide a rational approach of determining bleeding and family history of coagulation disorders as a predictive risk for bleeding.

Methods: This retrospective study conducted between 2014 and 2015 (1 year) on normal healthy children aged under 15 years admitted to the hospitals for elective mild to intermediate surgery or invasive procedures. We reviewed and collected the details of the clinical history, previous surgery, trauma, family history, detail of anti-thrombotic medication and coagulation tests performed (prothrombin time (PT), the activated partial prothrombin time (APTT), and international normalized ratio (INR)) at the time of admission.

Results: Among 2078 cases, 1940 cases had normal coagulation tests (93.4%), 77 cases had abnormal coagulation results (3.7%), and 61 patients underwent surgery without preoperative coagulation screening (2.9%). In 15 of 77 patients, coagulation tests were normal on repeat testing. A total of 52 were confirmed to have abnormal screening testing. Among these 52 cases, 45 had normal factors assay; where seven patients had abnormal factors assay. Postoperative bleeding occurred only in three cases (0.14%), two cases due to surgical procedures with normal preoperative testing and one due to hemophilia A which was detected postoperatively as no preoperative testing was performed.

Conclusions: Routine coagulation screening before surgery or invasive procedures to predict perioperative bleeding in unselected patients is not recommended. Our study emphasizes that selective preoperative testing is more appropriate. Selective criteria for consideration of the latter includes physical examination, type of surgery, family and bleeding history, and concomitant use of antiplatelet and anti-thrombotic therapy.

导论:儿科患者的术前凝血筛查曾经是全球常规临床实践,在一些国家仍将其作为手术前评估围手术期出血风险的标准做法。目的:本研究旨在评价非选择性常规术前凝血检查在儿童择期或侵袭性手术中预测围手术期异常出血的价值。该研究还旨在提供一种合理的方法来确定出血和凝血障碍家族史作为出血的预测风险。方法:回顾性研究2014 - 2015年(1年)住院接受选择性轻度至中度手术或有创手术的15岁以下正常健康儿童。我们回顾并收集了患者入院时的临床病史、既往手术、创伤、家族史、抗栓药物细节和凝血试验(凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)和国际标准化比值(INR))。结果:2078例患者中,凝血检查正常1940例(93.4%),凝血检查异常77例(3.7%),手术前未进行凝血筛查61例(2.9%)。在77例患者中,15例凝血试验在重复试验中正常。共有52人被确认为筛查结果异常。52例患者中45例正常因子检测;其中7例患者进行异常因素分析。术后出血仅3例(0.14%),其中2例为术前检查正常的手术所致,1例为术前未检查的A型血友病所致。结论:不建议术前常规凝血筛查或侵入性手术预测未选择患者围手术期出血。本研究强调选择性术前检查更为合适。考虑后者的选择标准包括体格检查、手术类型、家族史和出血史,以及同时使用抗血小板和抗血栓治疗。
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引用次数: 16
Efficacy of Afternoon Plerixafor Administration for Stem Cell Mobilization. 下午给药普利沙对干细胞动员的影响。
IF 3 Q2 Medicine Pub Date : 2018-08-30 eCollection Date: 2018-01-01 DOI: 10.1177/1179545X18792253
Cynthia El Rahi, James Eldin Cox, Romelia May, George Carrum, Gloria Obi Anyadike, Audrey Scholoff, Rammurti Kamble

Background: When used for hematopoietic stem cell mobilization, plerixafor was originally recommended to be administered 11 hours prior to apheresis based on the peak effect of 10 to 14 hours translating into an administration time of 10 to 11 pm. Reports of post-plerixafor anaphylactic reactions mandated labeling change by the Food and Drug Administration with recommendation of monitoring patients after administration. Based on data suggesting sustained plerixafor activity at 18 hours, we changed our administration time to 4 pm at our center.

Objective: The objective of this study is to compare the stem cell collection efficiency before and after the practice change at our institution.

Methods: A retrospective chart review for patients with multiple myeloma, Hodgkin lymphoma, and non-Hodgkin lymphoma who received a plerixafor-containing mobilization regimen was conducted. The primary end point was the percentage of patients achieving the minimal CD34+ cell goal in ⩽2 apheresis days. The secondary end points included the percentage of patients achieving the preferred CD34+ cell goal in ⩽2 apheresis days, days of apheresis, total CD34+ cells Collected, and engraftment time.

Results: A total of 208 patients (4 pm group n = 68, 10 pm group n = 140) with multiple myeloma (n = 112), Hodgkin lymphoma (n = 10), and non-Hodgkin lymphoma (n = 86) were included in the analysis. About 91% and 89% (P = .804) of the patients in the 4 and 10 pm groups, respectively, collected minimum cell dose. Preferred CD34+ cell goal was achieved in 57% and 53% of patients in the 4 and 10 pm groups, respectively.

Conclusions: Late afternoon administration of plerixafor provides efficient stem cell mobilization.

背景:当用于造血干细胞动员时,基于10 - 14小时的峰值效应转化为晚上10 - 11点的给药时间,最初建议在采血前11小时给药。美国食品和药物管理局(Food and Drug Administration)要求改变标签,并建议在给药后对患者进行监测。基于数据显示持续18小时的普利沙活动,我们将我们的管理时间改为下午4点在我们的中心。目的:本研究的目的是比较我院实践改变前后的干细胞收集效率。方法:回顾性分析多发性骨髓瘤、霍奇金淋巴瘤和非霍奇金淋巴瘤患者接受含普利沙的动员方案的病例。主要终点是在采后2天内达到最小CD34+细胞目标的患者百分比。次要终点包括患者在≥2采珠天数、采珠天数、收集的CD34+细胞总数和移植时间内达到首选CD34+细胞目标的百分比。结果:共纳入多发性骨髓瘤(112例)、霍奇金淋巴瘤(10例)和非霍奇金淋巴瘤(86例)患者208例(4pm组n = 68, 10pm组n = 140)。4 pm组和10 pm组分别约91%和89% (P = .804)的患者收集到最小细胞剂量。在下午4点组和10点组中,分别有57%和53%的患者达到了首选CD34+细胞目标。结论:下午晚些时候给药普利沙可有效地动员干细胞。
{"title":"Efficacy of Afternoon Plerixafor Administration for Stem Cell Mobilization.","authors":"Cynthia El Rahi,&nbsp;James Eldin Cox,&nbsp;Romelia May,&nbsp;George Carrum,&nbsp;Gloria Obi Anyadike,&nbsp;Audrey Scholoff,&nbsp;Rammurti Kamble","doi":"10.1177/1179545X18792253","DOIUrl":"https://doi.org/10.1177/1179545X18792253","url":null,"abstract":"<p><strong>Background: </strong>When used for hematopoietic stem cell mobilization, plerixafor was originally recommended to be administered 11 hours prior to apheresis based on the peak effect of 10 to 14 hours translating into an administration time of 10 to 11 pm. Reports of post-plerixafor anaphylactic reactions mandated labeling change by the Food and Drug Administration with recommendation of monitoring patients after administration. Based on data suggesting sustained plerixafor activity at 18 hours, we changed our administration time to 4 pm at our center.</p><p><strong>Objective: </strong>The objective of this study is to compare the stem cell collection efficiency before and after the practice change at our institution.</p><p><strong>Methods: </strong>A retrospective chart review for patients with multiple myeloma, Hodgkin lymphoma, and non-Hodgkin lymphoma who received a plerixafor-containing mobilization regimen was conducted. The primary end point was the percentage of patients achieving the minimal CD34<sup>+</sup> cell goal in ⩽2 apheresis days. The secondary end points included the percentage of patients achieving the preferred CD34<sup>+</sup> cell goal in ⩽2 apheresis days, days of apheresis, total CD34<sup>+</sup> cells Collected, and engraftment time.</p><p><strong>Results: </strong>A total of 208 patients (4 pm group n = 68, 10 pm group n = 140) with multiple myeloma (n = 112), Hodgkin lymphoma (n = 10), and non-Hodgkin lymphoma (n = 86) were included in the analysis. About 91% and 89% (<i>P</i> = .804) of the patients in the 4 and 10 pm groups, respectively, collected minimum cell dose. Preferred CD34<sup>+</sup> cell goal was achieved in 57% and 53% of patients in the 4 and 10 pm groups, respectively.</p><p><strong>Conclusions: </strong>Late afternoon administration of plerixafor provides efficient stem cell mobilization.</p>","PeriodicalId":43083,"journal":{"name":"Clinical Medicine Insights-Blood Disorders","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2018-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179545X18792253","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36463118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
The Diving Bell and the Butterfly Revisited: A Fatal Case of Locked-in Syndrome in a Man With Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified. 潜水钟和蝴蝶重访:一名患有爱泼斯坦-巴尔病毒阳性弥漫性大b细胞淋巴瘤的男子闭锁综合征的致命病例,没有其他说明。
IF 3 Q2 Medicine Pub Date : 2018-03-26 eCollection Date: 2018-01-01 DOI: 10.1177/1179545X18762799
Jacqueline N Poston, Russell Dorer, David M Aboulafia

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) is a rare variant of DLBCL. The natural history of this subtype is poorly understood. Incomplete literature in the era of rituximab suggests that patients with EBV-positive DLBCL have similar outcomes to patients with EBV-negative DLBCL when treated with rituximab and anthracycline-based chemotherapy regimens; however, there are few prospective studies on this subtype and little is known about the risk of central nervous system (CNS) relapse with EBV-positive DLBCL. Herein, we describe the case of a 64-year-old man who presented with stage IIA EBV-positive DLBCL. His international age-adjusted International Prognostic Index (IPI) was 2. He achieved a complete response to 6 cycles of rituximab combined with chemotherapy consisting of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin. After 10 days of completion of chemotherapy, he had a fulminant neurologic decline manifested by diffuse weakness followed by a locked-in syndrome; he could only communicate by moving his eyes. He had been deemed at low risk for CNS relapse based on the application of the recently developed CNS-IPI score of 2 (1 point for age >60 years and 1 point for lactate dehydrogenase higher than normal) and consequently did not receive therapy for CNS prophylaxis. A limited postmortem autopsy revealed extensive lymphoma throughout the brain, particularly in the deep basal nuclei, midbrain, pons, centrum semiovale, and corpus callosum. This presentation of CNS relapse is rare and has not yet been described in EBV-positive DLBCL. We discuss some of the unique aspects of this case including the clinical manifestations of locked-in syndrome and its differential diagnosis and the uncertain benefits of CNS prophylaxis in this clinical context.

eb病毒(EBV)阳性弥漫大b细胞淋巴瘤(DLBCL)是一种罕见的DLBCL变体。这种亚型的自然历史尚不清楚。利妥昔单抗时代的不完整文献表明,接受利妥昔单抗和蒽环类化疗方案治疗时,ebv阳性DLBCL患者与ebv阴性DLBCL患者的结局相似;然而,关于该亚型的前瞻性研究很少,并且对ebv阳性DLBCL的中枢神经系统(CNS)复发的风险知之甚少。在这里,我们描述的情况下,64岁的男子谁提出了IIA期ebv阳性DLBCL。他的国际年龄调整国际预后指数(IPI)为2。利妥昔单抗联合由剂量调整依托泊苷、强的松、长春新碱、环磷酰胺和阿霉素组成的化疗6个周期后,患者完全缓解。化疗完成10天后,患者出现暴发性神经功能下降,表现为弥漫性虚弱,随后出现闭锁综合征;他只能通过转动眼睛来交流。根据最近开发的CNS- ipi评分为2分(年龄60岁1分,乳酸脱氢酶高于正常1分),他被认为是CNS复发的低风险,因此没有接受CNS预防治疗。有限的尸检显示广泛的淋巴瘤遍及大脑,特别是在深基底核、中脑、桥脑桥、半囊椎体和胼胝体。这种中枢神经系统复发的表现是罕见的,在ebv阳性的DLBCL中尚未被描述。我们讨论了这个病例的一些独特方面,包括闭锁综合征的临床表现及其鉴别诊断,以及在这种临床背景下中枢神经系统预防的不确定益处。
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引用次数: 2
Preeclampsia: From Inflammation to Immunoregulation. 子痫前期:从炎症到免疫调节。
IF 3 Q2 Medicine Pub Date : 2018-01-10 eCollection Date: 2018-01-01 DOI: 10.1177/1179545X17752325
Denise C Cornelius

Preeclampsia (PE) affects 5% to 7% of pregnant women each year worldwide, accounts for up to 18% of maternal deaths in the United States each year, and is the number 1 cause of premature births. Preeclampsia is associated with hypertension after the 20th week of gestation with or without proteinuria, in conjunction with fetal growth restriction, maternal endothelial dysfunction, and chronic immune activation. The mechanisms leading to the development of PE are unclear. However, it is thought that shallow trophoblast invasion and insufficient remodeling of uterine spiral arteries result in placental ischemia. Consequently, an immune imbalance characterized by increases in proinflammatory CD4+ T cells and cytokines along with decreases in regulatory T cells and anti-inflammatory cytokines occurs. This imbalance leads to chronic inflammation and ensuing oxidative stress, proinflammatory cytokines, and autoantibodies. Studies performed in our laboratories, using the Reduced Uterine Perfusion Pressure (RUPP) rat model of placental ischemia, have demonstrated a role for this immune imbalance to mediate PE pathophysiology and identified potential mechanisms of immunoregulation that may be of benefit in the treatment of PE. Therefore, the purpose of this commentary is to review studies demonstrating the positive effects of immunoregulatory factors in the RUPP rat model of PE. Restoration of the immune balance in PE may be a potential strategy for the development of therapeutic interventions that could improve maternal and fetal outcomes associated with this maternal syndrome.

先兆子痫(PE)每年影响全球5%至7%的孕妇,占美国每年孕产妇死亡人数的18%,是早产的第一大原因。先兆子痫与妊娠20周后伴有蛋白尿或无蛋白尿的高血压有关,并伴有胎儿生长受限、母体内皮功能障碍和慢性免疫激活。导致PE发展的机制尚不清楚。然而,滋养细胞浸润较浅和子宫螺旋动脉重构不足被认为是导致胎盘缺血的原因。因此,以促炎CD4+ T细胞和细胞因子的增加以及调节性T细胞和抗炎细胞因子的减少为特征的免疫失衡发生。这种不平衡导致慢性炎症和随后的氧化应激、促炎细胞因子和自身抗体。在我们的实验室中,使用子宫灌注压降低(RUPP)大鼠胎盘缺血模型进行的研究已经证明了这种免疫失衡介导PE病理生理的作用,并确定了可能有益于PE治疗的免疫调节潜在机制。因此,本评论的目的是回顾证明免疫调节因子在RUPP大鼠PE模型中的积极作用的研究。恢复PE的免疫平衡可能是开发治疗干预措施的潜在策略,可以改善与该母体综合征相关的母体和胎儿结局。
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引用次数: 114
Effect of the Ginger Derivative, 6-Shogaol, on Ferritin Levels in Patients With Low to Intermediate-1-Risk Myelodysplastic Syndrome-A Small, Investigative Study. 姜衍生物6-Shogaol对低至中危骨髓增生异常综合征患者铁蛋白水平的影响——一项小型调查研究
IF 3 Q2 Medicine Pub Date : 2017-11-02 eCollection Date: 2017-01-01 DOI: 10.1177/1179545X17738755
Terry Golombick, Terrence H Diamond, Arumugam Manoharan, Rajeev Ramakrishna, Vladimir Badmaev

Background: Myelodysplastic syndrome (MDS) is a heterogeneous group of clonal stem cell disorders characterized by dysplastic and ineffective hematopoiesis and peripheral cytopenias. Elevated serum ferritin (SF) is often observed in nontransfused, lower risk MDS. It has been reported that ineffective erythropoiesis enhances iron absorption in MDS through downregulation of hepcidin and its prohormones such that SF rises.

Aim: To determine the effect of 6-shogaol, a dehydration derivative of ginger, known to have hepatoprotective and chemotherapeutic activity, on 6 early-stage, transfusion-independent patients with MDS, 3 of whom had raised levels of SF.

Method: Six patients with MDS with low or intermediate-1 subtypes, as defined by the International Prognostic Scoring System (IPSS), were recruited into the study and were administered 1 gel capsule daily containing 20 mg ginger extract standardized for 20% 6-shogaol. Blood and urine samples were collected and various markers monitored at regular intervals.

Results: 6-shogaol caused a decrease in SF levels in 3 of 6 patients with early MDS (50%) whose SF levels were elevated at the start of the study. Our findings suggest upregulation of hepcidin and its prohormones, possibly through an improvement in liver function.

Discussion: In light of the encouraging results in this small, investigative study, we are planning a larger study to confirm the beneficial effect of 6-shogaol in patients with raised ferritin levels due to ineffective erythropoiesis.

背景:骨髓增生异常综合征(MDS)是一种异质性克隆干细胞疾病,其特征是造血功能异常和外周血细胞减少。血清铁蛋白(SF)升高是经常观察到在非输血,低风险MDS。据报道,无效的红细胞生成通过下调hepcidin及其前激素,使SF升高,从而增强MDS的铁吸收。目的:确定6-shogaol(生姜的脱水衍生物,已知具有肝保护和化疗活性)对6例早期不依赖输血的MDS患者的影响,其中3例患者SF水平升高。方法:招募6例国际预后评分系统(IPSS)定义的低或中1亚型MDS患者,每天给予1粒凝胶胶囊,含有20 mg标准化的6-shogaol。收集血液和尿液样本,并定期监测各种标志物。结果:6-shogaol导致6例早期MDS患者中3例(50%)SF水平下降,这些患者在研究开始时SF水平升高。我们的研究结果表明,hepcidin及其原激素的上调可能通过改善肝功能。讨论:鉴于这项小型调查研究的令人鼓舞的结果,我们正在计划进行一项更大规模的研究,以确认6-shogaol对因红细胞生成无效而导致铁蛋白水平升高的患者的有益作用。
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引用次数: 4
Diffuse Large B-Cell Breast Lymphoma: A Case Series. 乳腺弥漫性大b细胞淋巴瘤:一个病例系列。
IF 3 Q2 Medicine Pub Date : 2017-08-14 eCollection Date: 2017-01-01 DOI: 10.1177/1179545X17725034
Afaf H Al Battah, Einas A Al Kuwari, Zsolt Hascsi, Abdulqadir J Nashwan, Halima Elomari, Hisham Elsabah, Safa Al Azawi, Samah Kohla, Dina Soliman, Mohamed A Yassin

Primary breast lymphoma (PBL) is a rare disease, and few clinicohistopathologic features of the disease have been discussed in previous studies. It represents 2.2% of extranodal lymphomas and constitutes 0.04% to 0.5% of malignant breast neoplasms, despite the clinical and radiographic similarities between breast lymphoma and carcinoma, the prognosis, as reported in the literature, varies. No consensus exists on the best way to treat PBL. However, radiotherapy and chemotherapy were used alone or in combination to treat various cases of PBL. We retrospectively studied 3 cases of PBL of the breast seen in patients attending a tertiary cancer center in Qatar, between 2012 and 2015, in an attempt to determine the common clinical features, therapy, and prognosis of PBL.

原发性乳腺淋巴瘤(PBL)是一种罕见的疾病,在以往的研究中很少讨论该病的临床组织病理学特征。它占结外淋巴瘤的2.2%,占乳腺恶性肿瘤的0.04%至0.5%,尽管乳腺淋巴瘤和癌在临床和影像学上有相似之处,但文献报道的预后却各不相同。对于治疗PBL的最佳方法尚无共识。然而,放疗和化疗被单独或联合用于治疗各种PBL病例。我们回顾性研究了2012年至2015年间在卡塔尔某三级癌症中心就诊的3例乳腺PBL患者,试图确定PBL的共同临床特征、治疗方法和预后。
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引用次数: 4
Thromboprophylaxis With Apixaban in Patients Undergoing Major Orthopedic Surgery: Meta-Analysis and Trial-Sequential Analysis. 阿哌沙班在骨科大手术患者中的血栓预防作用:荟萃分析和试验序列分析。
IF 3 Q2 Medicine Pub Date : 2017-05-08 eCollection Date: 2017-01-01 DOI: 10.1177/1179545X17704660
Daniel Caldeira, Filipe B Rodrigues, Fausto J Pinto, Joaquim J Ferreira, João Costa

Background: Venous thromboembolism (VTE) is a potentially fatal complication of orthopedic surgery, and until recently, few antithrombotic compounds were available for postoperative thromboprophylaxis. The introduction of the non-vitamin K antagonists oral anticoagulants (NOAC), including apixaban, has extended the therapeutic armamentarium in this field. Therefore, estimation of NOAC net clinical benefit in comparison with the established treatment is needed to inform clinical decision making.

Objectives: Systematic review to assess the efficacy and safety of apixaban 2.5 mg twice a day versus low-molecular-weight heparins (LMWH) for thromboprophylaxis in patients undergoing knee or hip replacement.

Data sources: MEDLINE, Embase, and CENTRAL were searched from inception to September 2016, other systematic reviews, reference lists, and experts were consulted.

Study eligibility criteria participants and intervention: All major orthopedic surgery randomized controlled trials comparing apixaban 2.5 mg twice daily with LMWH, reporting thrombotic and bleeding events.

Data extraction: Two independent reviewers, using a predetermined form.

Study appraisal and synthesis methods: The Cochrane tool to assess risk bias was used by two independent authors. RevMan software was used to estimate pooled risk ratio (RR) and 95% confidence intervals (95% CI) using random-effects meta-analysis. Trial sequential analysis (TSA) was performed in statistical significant results to evaluate whether cumulative sample size was powered for the obtained effect. Overall confidence in cumulative evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group methodology.

Results: Four studies comparing apixaban 2.5 mg twice daily with LMWH were included, with a total of 11.828 patients (55% undergoing knee and 45% hip replacement). The overall risk of bias across studies was low. In comparison with LMWH (all regimens), apixaban showed a significantly lower risk of VTE events and overall mortality combined (RR: 0.63, 95% CI: 0.42-0.95, I2 = 84%, n = 8346), but not of major VTE events (RR: 0.62, 95% CI: 0.32-1.19, I2 = 63%, n = 9493), or of symptomatic VTE events and VTE-related mortality combined (RR: 1.14, 95% CI: 0.68-1.90, I2 = 0%, n = 11 879). Trial sequential analysis showed that the risk reduction obtained for VTE and mortality was based on underpowered cumulative sample size and effect dimension. Subgroup analysis according to LMWH regimens showed that apixaban reduced the risk of VTE events and overall mortality, and major VTE events, when compared with LMWH once daily, without differences between apixaban and LMWH twice daily.

Conclusions: There is low to moderate evidence that in patients undergoing knee or hip r

背景:静脉血栓栓塞(VTE)是骨科手术中一种潜在的致命并发症,直到最近,很少有抗血栓化合物可用于术后血栓预防。非维生素K拮抗剂口服抗凝剂(NOAC)的引入,包括阿哌沙班,扩展了该领域的治疗手段。因此,需要估计NOAC与现有治疗方法的净临床效益,以便为临床决策提供信息。目的:系统评价阿哌沙班2.5 mg /天2次与低分子肝素(LMWH)在膝关节或髋关节置换术患者血栓预防中的疗效和安全性。数据来源:MEDLINE、Embase和CENTRAL从成立到2016年9月进行检索,并咨询了其他系统综述、参考文献列表和专家。研究资格标准参与者和干预措施:所有主要骨科手术随机对照试验比较阿哌沙班2.5 mg每日两次与低分子肝素,报告血栓和出血事件。数据提取:两个独立的审稿人,使用预定的表单。研究评价和综合方法:两名独立作者使用Cochrane工具评估风险偏倚。采用RevMan软件进行随机效应meta分析,估计合并风险比(RR)和95%置信区间(95% CI)。对具有统计学意义的结果进行试验序列分析(TSA),以评估累积样本量是否为获得的效果提供了动力。使用建议分级评估、发展和评价(GRADE)工作组方法评估累积证据的总体置信度。结果:纳入4项比较阿哌沙班2.5 mg每日2次与低分子肝素的研究,共11.828例患者(55%行膝关节置换术,45%行髋关节置换术)。各研究的总体偏倚风险较低。与低分子肝素(所有方案)相比,阿哌沙班明显降低了静脉血栓栓塞事件和总死亡率的风险(RR: 0.63, 95% CI: 0.42-0.95, I2 = 84%, n = 8346),但没有降低主要静脉血栓栓塞事件的风险(RR: 0.62, 95% CI: 0.32-1.19, I2 = 63%, n = 9493),也没有降低症状性静脉血栓栓塞事件和静脉血栓栓塞相关死亡率的风险(RR: 1.14, 95% CI: 0.68-1.90, I2 = 0%, n = 11879)。试验序贯分析显示,静脉血栓栓塞和死亡率的风险降低是基于低功率累积样本量和效应维数。根据低分子肝素方案进行的亚组分析显示,与低分子肝素相比,阿哌沙班降低了静脉血栓栓塞事件、总死亡率和主要静脉血栓栓塞事件的风险,每日1次,阿哌沙班与低分子肝素每日2次之间没有差异。结论:有低至中度证据表明,在接受膝关节或髋关节置换术的患者中,阿哌沙班似乎与低分子肝素一样有效和安全,每天两次。与低分子肝素相比,阿哌沙班似乎是一种更好的血栓预防选择。然而,结果是不充分的,这排除了关于阿哌沙班与低分子肝素在这种临床背景下的真正净临床获益的明确答案。
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引用次数: 8
期刊
Clinical Medicine Insights-Blood Disorders
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