Development status and new challenges of heart transplantation / 器官移植

Heart transplantation is the primary therapeutic option for patients with end-stage heart failure. The shortage of donors has been the main limiting factor for the increasing quantity of heart transplantation. With persistent updating and introduction of novel technologies, the donor pool has been increasingly expanded, such as using the heart from older donors, donors infected with hepatitis C virus, donors dying from drug overdose or donation after cardiac death (DCD) donors, etc. Meantime, the proportion of recipients with advanced age, multiple organ dysfunction, mechanical circulatory support and human leukocyte antigen antibody sensitization has been significantly increased in recent years. The shortage of donors, complication of recipients' conditions, individualized management of immunosuppressive therapy and prevention and treatment of long-term cardiac allograft vasculopathy are all challenges in the field of heart transplantation. In this article, novel progresses on donor pool expansion, improving the quality of recipients, strengthening the diagnosis and treatment of rejection, and preventing cardiac allograft vasculopathy were reviewed, aiming to prolong the survival and enhance the quality of life of patients with end-stage heart failure on the waiting list or underwent heart transplantation.

Diferencia de niveles de dímero D ante la presencia de hipoxemia severa en pacientes con neumonía por SARS-CoV-2 ingresados a terapia intensiva / Difference in D-dimer levels in the presence of severe hypoxemia in patients with SARS-CoV-2 pneumonia admitted to therapy intensive / Diferença nos níveis de dímero D na presença de hipoxemia grave em pacientes com pneumonia por SARS-CoV-2 internados em terapia intensiva

Resumen Introducción: El SARS-CoV-2 se desconocía hasta el brote en Wuhan, China en diciembre de 2019, las características ultraestructurales de este virus con predisposición a receptores expresados en los neumocitos tipo II (CD209L y ECA2) resultan en daño alveolar difuso y un tercio de los pacientes con SARS-CoV-2 cumplen criterios de SIRA con hipoxemia severa. Tras el curso severo de la enfermedad y alta mortalidad se reportó en estudios la asociación del dímero D (DD) con casos graves y atribuyéndose al estado protrombótico de la enfermedad, contribuyendo directamente en ventilación mecánica prolongada y muerte. Objetivo principal: Determinar los diferentes niveles de dímero D ante la presencia de hipoxemia severa en pacientes con neumonía por SARS-CoV-2 ingresados en la terapia intensiva. Material y métodos: Estudio transversal comparativo retrospectivo unicéntrico, se revisaron expedientes de pacientes mayores de 18 años que ingresaron a la Unidad de Cuidados Intensivos con diagnóstico de neumonía por SARS-CoV-2; se tomaron en cuenta los valores de DD al ingreso, al séptimo día y la relación PaO2/FiO2 de gasometrías arteriales. Definimos hipoxemia severa PaO2/FiO2 menor de 150 mmHg y tras prueba U de Mann-Whitney se evaluaron niveles de DD, curva de ROC y AUC para punto de cohorte de DD y la asociación con terapia de aporte de oxígeno y su desenlace con OR e IC95%. Resultados: Se estudiaron expedientes de 82 pacientes, 81.7% presentó hipoxemia severa al ingreso, y 74.4% al séptimo día; se reportó una mediana de DD de 1,410 ng/mL con hipoxemia severa y al séptimo día 2,238 ng/mL (p = 0.001). Curva ROC encontró DD 1,500 ng/mL como punto de cohorte asociado a hipoxemia severa (AUC: 0.808, IC al 95% 0.706-0.910). En escalas pronósticas reportó mayor puntuación, APACHE II (24 pts, p = 0.036), SOFA (12 pts, p = 0.012), y SAPS II (67 pts, p ≤ 0.0001); así como en defunciones (81.6%, p ≤ 0.0001, OR 16.50 IC al 95% 5.472-49.80). Conclusión: Dímero D mayor y/o igual a 1,500 ng/mL se asocia con hipoxemia severa y con mayor mortalidad al séptimo día de estancia en UCI, indicándonos que el DD es un potencial marcador temprano y útil para guiar la terapéutica y evaluar el pronóstico del paciente.

Abstract Introduction: SARS-CoV-2 was unknown until the outbreak in Wuhan, China in December 2019, the ultra-structural characteristics of this virus with predisposition to receptors expressed in type II pneumocytes (CD209L and ECA2), results in diffuse alveolar damage and a third of the patients with SARS-CoV-2 meet criteria for SIRA with severe hypoxemia. After the severe course of the disease and high mortality, the association of DD with severe cases was reported in studies and attributed to the prothrombotic state of the disease, directly contributing to prolonged mechanical ventilation and death. Main objective: To determine the different levels of DD in the presence of severe hypoxemia in patients with SARS-CoV-2 pneumonia admitted to intensive care. Material and methods: Cross-sectional retrospective single-center study, records of patients older than 18 years who were admitted to the intensive care unit with a diagnosis of SARS-CoV-2 pneumonia were reviewed; DD values on admission, on the seventh day and the PaO2/FiO2 ratio of arterial blood gases were considered. We defined severe hypoxemia PaO2/FiO2 less than 150 mmHg and after the Mann-Whitney U test, DD levels, ROC curve and AUC were evaluated for the DD cohort point and the association with oxygen supply therapy and its outcome with OR and HF 95%. Results: Records of 82 patients were studied, 81.7% presented severe hypoxemia on admission, and 74.4% on the seventh day; A median DD of 1,410 ng/mL was reported with severe hypoxemia and 2,238 ng/mL on the seventh day (p = 0.001). ROC curve found DD 1,500 ng/mL as a cohort point associated with severe hypoxemia (AUC: 0.808, 95% CI 0.706-0.910). On prognostic scales I report a higher score, APACHE II (24 pts, p = 0.036), SOFA (12 pts, p = 0.012), and SAPS II (67 pts, p ≤ 0.0001); as well as in deaths (81.6%, p ≤ 0.0001, OR 16.50 95% CI 5.472-49.80). Conclusion: DD greater than and/or equal to 1,500 ng/mL is associated with severe hypoxemia and higher mortality on the seventh day of stay in the ICU, indicating that DD is a potential early and useful marker to guide the therapy and evaluate the prognosis of the patient.

Resumo Introdução: O SARS-CoV-2 era desconhecido até o surto em Wuhan, China, em dezembro de 2019, as características ultraestruturais desse vírus com predisposição a receptores expressos em pneumócitos tipo II (CD209L e ACE2), resultando em dano alveolar difuso e um terço dos pacientes com SARS-Cov-2 atendem aos critérios para SDRA com hipoxemia grave. Após o curso grave da doença e alta mortalidade, estudos relataram a associação do D-Di com casos graves e atribuindo-se ao estado pró-trombótico da doença, contribuindo diretamente para ventilação mecânica prolongada e óbito. Objetivo principal: Determinar os diferentes níveis de dímero-D na presença de hipoxemia grave em pacientes com pneumonia por SARS-CoV-2 internados em terapia intensiva. Material e métodos: Estudo transversal comparativo retrospectivo unicêntrico, foram revisados prontuários de pacientes maiores de 18 anos admitidos na unidade de terapia intensiva com diagnóstico de pneumonia por SARS-CoV-2; foram considerados os valores de D-Di na admissão, no sétimo dia e a relação PaO2/FiO2 da gasometria arterial. Definimos hipoxemia grave PaO2/FiO2 menor que 150 mmHg e após o teste U de Mann-Whitney, os níveis de D-Di, curva ROC e AUC foram avaliados para o ponto de coorte D-Di e a associação com oxigenoterapia e seu desfecho com OR e IC 95%. Resultados: Foram estudados prontuários de 82 pacientes, 81.7% com hipoxemia grave na admissão e 74.4% no sétimo dia; relatou-se um D-Di médio de 1,410 ng/mL com hipoxemia grave e 2,238 ng/mL no sétimo dia (p = 0.001). A curva ROC encontrou D-Di 1,500 ng/mL como um ponto de coorte associado à hipoxemia grave (AUC: 0.808, IC 95% 0.706-0.910). Em escalas de prognóstico, APACHE II (24 pontos, p = 0.036), SOFA (12 pts, p = 0.012) e SAPS II (67 pts, p ≤ 0.0001); bem como em óbitos (81.6%, p ≤ 0.0001, OR 16.50, IC 95% 5.472-49.80). Conclusão: O D-Di maior e/ou igual a 1,500 ng/ml está associada à hipoxemia grave e maior mortalidade no sétimo dia de internação na UTI, indicando que o D-Di é um potencial marcador precoce e útil para orientar a terapia e avaliar o prognóstico do paciente.

Research progress and application of donor-derived cell-free DNA in diagnosis and treatment of kidney transplantation / 器官移植

Early diagnosis and treatment of rejection after kidney transplantation play a critical role in alleviating allograft injury. Detection of donor-derived cell-free DNA (dd-cfDNA) could be performed based on the next-generation sequencing and other techniques. The content of DNA fragments derived from necrotic and apoptotic donor kidney tissues in circulating body fluids could be determined by concentration and absolute quantitative methods, which has application potential in monitoring allograft injury in clinical practice. Compared with traditional serum creatinine and other indicators, dd-cfDNA detection may monitor allograft injury from several weeks to months in advance, providing a "time window" for clinical treatment and delaying graft failure. Along with deepening research of dd-cfDNA in recent years, dd-cfDNA has captivated widespread attention due to its non-invasiveness, high sensitivity and real-time evaluation of therapeutic effect. In this article, current study evidence and conclusions related to multidimensional application of dd-cfDNA detection in diagnosis and treatment of kidney transplantation were reviewed, and the future research and clinical application direction of dd-cfDNA were discussed, aiming to provide reference for widespread application of dd-cfDNA detection in clinical practice in China.

DD Genotype and Atherosclerosis in Overweight Menopausal Women

Abstract Background Sex-specific pathology of coronary artery disease (CAD) has not been recognized. Women with obstructive or nonobstructive CAD associated with traditional risk factors have similar events; no studies have explored both populations in association with genetic markers. Objective To evaluate the DD genotype in overweight menopausal women and its association with CAD and traditional risk factors. Method This cross-sectional study included 356 menopausal women who underwent coronary angiography as CAD assessment. The patients' DNA was extracted and polymorphisms were detected with a single polymerase chain reaction assay. Two groups were formed based on luminal lesions (normal [n = 134] or pathological [n = 222]) with a cutoff value > 30%, considering overweight and age. The chi-square test, Student's t-test, and multivariate logistic regression were performed as appropriate (p < 0.05) using the following variables: overweight, diabetes, hypertension, dyslipidemia, smoking status, sedentary lifestyle, and a family history of CAD. Results The mean age of the sample was 63 + 8 years, and the mean BMI was 28 + 5 kg/m2. The DD genotype was slightly more prevalent in the pathological group (30.2% vs. 21.6%, p = 0.079), but this significantly changed when BMI > 25 was considered (33% vs. 18%, p = 0.012). In multivariate analysis with two threshold levels (> 50 and > 60 years), diabetes was significantly associated with CAD in both models (p = 0.021 vs. 0.009) but the genotype was only associated with younger age (p = 0.034). Conclusion These data support an association between atherosclerosis and the renin-angiotensin system in overweight menopausal women that is dependent on the age at which the ischemic event occurs.

A Cross Sectional Study to Evaluate Decision to Delivery Interval in Emergency Caeserian Section at a Tertiary Care Hospital

Background:One of the main factors affecting maternal morbidity and mortality is the decision to delivery interval (DDI) that is, the time taken from the decision to take the patient up for caesarean section to the delivery of the fetus. Method:This is a retrospective observational study conducted over a period of twelve months where 370 patients were studied. Results:No delay was seen in 49.2% cases whereas most delay was noted after decision by obstetricians to transfer patient to OT(22.2%). Conclusion:In order to get favourable maternal and fetal outcome decision to delivery interval should be within 30 minutes and this can be made possible if factors like results of blood investigations and cross matching of blood can be made available on time.

Diagnostic criteria and research progress on heart allograft pathology / 器官移植

With the improvement of surgical technique of heart transplantation and clinical application of potent immunosuppressant, the quantity of heart transplantation and the survival time of heart allograft have been significantly improved. However, a series of complications, such as right ventricular failure, ischemia-reperfusion injury, acute rejection, "Quilty lesion", infection and chronic rejection characterized by transplant coronary artery disease (TCAD) may still occur at different stages after heart transplantation. The application of endomyocardial biopsy (EMB) makes it possible to observe and understand the pathological features of multiple complications of heart allograft including rejection, which has become the most accurate diagnostic tool for postoperative complications. In this article, the brief history of heart allograft pathology, main postoperative complications and pathological diagnostic criteria, and cutting edge research progress on diagnostic criteria of rejection were illustrated, aiming to bring clinical benefits to more recipients undergoing heart transplantation.

Assessment and monitoring of immune risk of kidney transplantation rejection / 器官移植

Kidney transplantation is the most efficacious treatment for end-stage renal failure. Although the shortterm survival and functional recovery of the kidney graft have been significantly improved, the long-term survival of the kidney graft remains to be enhanced. Antibody-mediated rejection (AMR) and T cell-mediated rejection (TCMR) caused by immune factors are still the most critical causes of kidney graft failure. In this article, the immune risk assessment and monitoring of kidney transplant recipients during the awaiting period, before and after kidney transplantation were reviewed. Through the evaluation of preexisting human leukocyte antigen (HLA) antibodies and non-HLA antibodies, HLA matching, lymphocytotoxicity cross-matching and immune memory cells in the recipients before kidney transplantation, programmed biopsy of the kidney graft of the recipients after kidney transplantation and monitoring of HLA antibodies, non-HLA antibodies and donor-derived cell-free DNA (dd-cfDNA), individualized immunosuppressive treatment and monitoring regimes could be established, and the incidence of rejection could be prevented, timely detected and diagnosed. According to the immune monitoring results, ineffective treatment or over-treatment could be avoided, thereby improving the long-term survival of kidney graft.

Epidemiological characteristics and changes of D-D and FIB levels in patients with high-altitude pulmonary thromboembolism / 公共卫生与预防医学

Objective The epidemiological characteristics of high-altitude pulmonary thromboembolism (PTE) were investigated, and to enhance people's cognitive level of high-altitude PTE. Methods A tatal of 286 patients with PTE admitted to our hospital from May 2017 to October 2019 were selected and divided into study group (n = 143) living at high altitude of 2500 ~ 4500 m and control group (n=143) living at low altitude of 1500~2450m according to altitude.The clinical data, D-D, FIB levels, and laboratory routine examinations were compared between the two groups, and the risk factors were analyzed using univariate analysis and the independent risk factors were analyzed by multivariate logistic regression. Results The levels of D-D and FIB in the control group were significantly increased (P 0.05). Conclusion  Those were independent risk factors affecting the incidence of PTE at high altitude，including multivariate logistic regression analysis indicated that red blood cell level, HGB level, DVT, D-D, and FIB. The higher the plasma D-D and FIB levels, the recurrence interval, especially the related diseases of patients at high altitude need regular monitoring.

The Impact Of Antihypertensive Drug Therapy In Patients With Chronic Kidney Disease: A Prospective Observational Cohort Study

Objective: Hypertension (HTN) is both a cause and an effect of chronic kidney disease (CKD). To adequately control blood pressure (BP) in CKD, choosing antihypertensive strategies with the highest nephro-protective effect is crucial for preventing or reversing end-stage renal disease (ESRD) progression and reducing cardiovascular disease (CVD) risk. The present study was therefore designed to evaluate the impact of clinical use of antihypertensive drug therapy in patients with CKD and ESRD. Methods: It is a prospective observational cohort study. The patients were divided into two cohorts i.e.; non-dialysis dependent (NDD) and dialysis-dependent (DD) CKD. This study was conducted for six months in the Nephrology department, Osmania General Hospital, Hyderabad, India. The data collected and entered into Microsoft Excel (2007) and mean, SD and range were calculated using SPSS version 25. Results: Antihypertensive drugs were prescribed alone or in combination based on the co-morbidities associated with CKD and HTN. Loop diuretics (Furosemide and Torsemide) and calcium channel blocker (Amlodipine, Nifedipine and Cilnidipine) were most commonly prescribed antihypertensive drugs. Triple therapy (44.11%) was prescribed mostly in both the cohorts (NDD = 16.66%+DD = 27.45%) of which calcium channel blockers+loop diuretic+sympatholytic accounts for 19.16% (NDD = 5.88%+DD = 13.73%).  Conclusion: The practice of prescribing antihypertensive drugs for the management of HTN and to achieve BP targets in CKD and ESRD remains uncertain. The development of new and revised guidelines is needed to reduce inappropriate variations in practice and promote better delivery of evidence-based treatment.

Effects of Tongmai Decoction on PLT, PAgR, D-D and TEG in elderly patients with intertrochanteric fracture in perioperative period / 中成药

AIM To investigate the effects of Tongmai Decoction on PLT,PAgR,D-D and TEG in elderly patients with intertrochanteric fracture in perioperative period.METHODS One hundred and fifteen recruited patient subjects were randomly divided into two groups.Fifty-seven cases in the control group were treated with Low Molecular Weight Heparins Calcium Injection,and 58 cases in the treatment group were intervened with both Low Molecular Weight Heparins Calcium Injection and Tongmai Decoction.The preoperative and postoperative dynamic changes of PLT,PAgR,D-D and TEG (R value,K value,alpha angle,MA),and adverse drug reactions in the two groups were detected 1,3,7 d prior to,and after the treatments,respectively.RESULTS No statistically significant difference between the two groups' PLT,PAgR and D-D contents were observed before the operation (P ＞ 0.05).The levels of PLT,PAgR and D-D in both groups increased one day after the operation with similar change degree (P ＞ 0.05).On the 3rd and 7th days after the surgery,the PLT,PAgR and D-D contents in the two groups began to drop,and the decline in the treatment group was more significant (P ＜ 0.05).No significantly different TEG (R value,K value,alpha angle,MA) between the two groups was noticed before the operation (P ＞ 0.05).Patients of both groups displayed their R value,K value decrease,and alpha Angle,MA increase (P ＞ 0.05) one day after the operation with similar change degree.Their R value,K value increased,and alpha angle,MA decreased,and as well as the statistically significant change between the two groups were discovered on the 3rd and 7th postoperative days (P ＜ 0.05).CONCLUSION Tongmai Decoction can effectively reduce blood hypercoagulability and prevent deep venous thrombosis in terms of PLT,PAgR,D-D and TEG (R value,K value,alpha angle,MA) improvement in elderly patients with intertrochanteric fracture in perioperative period.

-D-/-D- Phenotype Frequency among Korean Donors / 대한수혈학회지

BACKGROUND: To improve Rh-related antigen negative blood supply effectively, the Korean Red Cross (KRC) blood centers have performed Rh phenotype screening tests of C, c, E and e antigens for all donors since April, 2013. Especially for rare ‘-D-/-D-’ blood supply and donor recruitment, we have implemented Rh phenotype confirmation test for all C, c, E and e antigen negative donors. In this study, we report the test results of 7 donors with ‘-D-/-D-’ phenotype. METHODS: All three KRC Blood Laboratory Centers performed Rh phenotype screening tests using the automatic machine, PK7300 (Beckman Coulter, Japan), for all 876,920 donors from January 1, 2018 to April 30, 2018. We then performed the Rh phenotype confirmation test using the tube method manually, at room temperature, 37℃ and antihuman globulin phase. RESULTS: Among 876,920 donors, 14 were Rh antigen C, c, E, e negative as results of Rh phenotype screening test. The results of Rh phenotype confirmation test of these 14 donors showed that 7 donors were Rh antigen C, c, E, e negative. The ratio of -D-/-D- phenotype for all donors was 0.000798%. CONCLUSION: Our data suggests that -D-/-D- phenotype is one of the rare blood groups among Koreans. Although ‘-D-/-D-’ phenotype was confirmed by serologic tests, it is necessary to re-confirm it by molecular genetic techniques.

Assessment of nephrotoxicity and histopathological lesions of albino rats exposure to DD-force and baygon insecticides / Evaluación de la nefrotoxicidad y lesiones histopatológicas tras la exposición de ratas Albino a los insecticidas DD-Force y Baygon

Although studies suggest adverse effects of pesticides, human exposure to insecticides in homes is increasing and reports on their health effects are limited. The study investigated nephrotoxic effects of organo phosphate and carbamate insecticides, DD-Force and Baygon, in albino rats. Forty-five albino rats divided into groups were exposed to DD-Force (dichlorvos) or Baygon (propoxur) indoor insecticidein wooden boxes in separate exposure duration of 1, 2, 3 and 4 hours/day for 14 consecutive days. Serum and kidney tissue obtained after sacrifice were used to determine markers of renal damage and histopathological analysis, respectively. Exposure of rats to the insecticides showed duration-dependent significant increases (p<0.05) in serum levels of urea, uric acid and creatinine compared to control. However, rats exposed to DD-Force insecticide induced significantly higher levels of urea, uric acid and creatinine compared to Baygon (p<0.05). Histopathological lesions were observed in rats exposed to the insecticides, particularly in the exposure duration of 3 or 4 hours/day. These findings suggest that acute exposure to DD-Force and Baygonis nephrotoxic and may induce renal damage in rats.

Aunque los estudios sugieren efectos adversos de los pesticidas, la exposición humana a los insecticidas en los hogares está aumentando y los informes sobre sus efectos sobre la salud son limitados. Este estudio investigó los efectos nefrotóxicos de los insecticidas órgano fosfato y carbamato, DD-Force y Baygon, en ratas albinas. Cuarenta y cinco ratas albinas divididas en grupos fueron expuestas a DD-Force (diclorvos) o Baygon (propoxur) insecticidas de interior en cajas de madera en una duración de exposición separada de 1, 2, 3 y 4 horas / día durante 14 días consecutivos. Muestras séricas y de tejido renal obtenidas después del sacrificio se utilizaron para determinar los marcadores de daño renal y el análisis histopatológico, respectivamente. La exposición de las ratas a los insecticidas mostró aumentos significativos dependientes de la duración (p<0.05) en los niveles séricos de urea, ácido úrico y creatinina en comparación con el control. Sin embargo, las ratas expuestas al insecticida DD-Force indujeron niveles significativamente más altos de urea, ácido úrico y creatinina en comparación con Baygon (p<0.05). Se observaron lesiones histopatológicas en ratas expuestas a los insecticidas, particularmente en la duración de exposición de 3 o 4 horas/día. Estos hallazgos sugieren que la exposición aguda a DD-Force y Baygonis nephrotóxico y puede inducir daño renal en ratas.

Diagnosis Value of CEA,FDP and DD in the Pleural Effusion Specimens for Benign and Malignant Pleural Effusion / 现代检验医学杂志

Objective To investigate the significance of expressions of carcinoembryonic antigen(CEA),fibrinogen degrada-tion products(FDP)and D-dimer(DD)in the pleural effusion specimens for differential diagnosis between the benign and malignant pleural effusion.Methods 40 patients with benign pleural effusion patients and 30 patients with malignant pleural effusion were divided into benign or malignant group.The levels of CEA in pleural effusion was detected by electrochemilu-minescence,and FDP and DD were measured by turbidimetry.The value of diagnosis of three separate indicators and combine detection was compared by ROC analysis.Results The levels of CEA,FDP and DD in the pleural effusion specimens of ma-lignanat group were significantly higher than the benign group(t=2.523~3.889,all P<0.01).The sensitivity of combined detection of CEA,FDP and DD was 76.7%,and the rate of correct diagnosis was 82.9%.The sensitivity and diagnostic dffeiciency of combined detection were higher than separate indicators(χ2=1.036~3.324,all P<0.05).Conclusion Com-bined detection of CEA,FDP and DD is helpful to differential diagnosis of benign and malignant pleural effusion.

Influence of clopidogrel on platelet function and inflammation factor in treatment of severe carotid artery stenosis after stent-assisted angioplasty / 药物评价研究

Objective To investigate the effect of clopidogrel on platelet function and inflammation factor in treatment of severe carotid artery stenosis after stent-assisted angioplasty.Methods Patients (120 cases) with severe carotid artery stenosis after stent-assisted angioplasty were chosen and divided into two groups,the control group were given atorvastatin combined with aspirin,and the observation group were given atorvastatin combined with chlorine.The serum coagulants DD level,FIB level,inflammation factor P-chosen element level and restenosis event incidence of two groups were observed.Results D-double polymer of two groups had no significant difference;After surgery,the D-double polymer and FIB level of two groups were all higher (P ＜ 0.05).After surgery for 24 h,the D-double polymer and FIB level of observation group were higher,after 3 months of surgery,the D-double polymer and FIB level had no significant differences compared with before surgery,which were all in normal level.After 24 h,1 month,3 months of surgery,the D-double polymer and FIB level of observation group were all lower than control group (P ＜ 0.05).Before treatment,the P-chosen selectin of two groups had no significant differences,which were all decreased after surgery,and the observation group was lower than control group (P ＜ 0.05);The restenosis event of observation group was lower than control group (P ＜ 0.05).Conclusion Clopidogrel could control the platelet aggregation of severe carotid stenosis after surgery to prevent the thrombogenesis and decrease the restriction incidence,while control the inflammation factor expression to prevent the atherosclerosis.

FIB and D-D with GRACE Risk Score to Predict the Risk of Acute Coronary Syndrome / 现代检验医学杂志

Objective To investigate FIB and D-D with GRACE risk score to predict the risk of acute coronary syndrome (ACS)during hospitalization.Methods Plasma FIB,D-D and GRACE risk score were measured in 90 patients with ACS and 23 healthy controls,the number of coronary artery lesions of ACS patients also was obtained.Results The results of FIB,D-D levels and GRACE risk score in ACS group were 2.77±0.79 g/L,1.67±2.13 mg/L,147.19±32.50,respective-ly.Compared to controls,FIB,D-D and GRACE risk score in ACS group were significantly increased (t=6.256,6.465, 10.317,all P<0.001).There were significant differences in plasma D-D and FIB levels in different risk stratification (F=18.475,9.426,all P<0.001).FIB (r=0.485,P<0.000 1)and D-D (r=0.357,P<0.000 6)levels were found positively related with GRACE risk score.Conclusion Pasma FIB ,D-D levels and GRACE risk score were increased in ACS group. FIB and D-D can be used as indicators to predict the risk stratification for ACS patients,and D-D was better than FIB.

Korean Medication Algorithm for Depressive Disorder: Comparisons with Other Treatment Guidelines

In this review, we compared recommendations from the Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAP-DD 2017) to other global treatment guidelines for depression. Six global treatment guidelines were reviewed; among the six, 4 were evidence-based guidelines, 1 was an expert consensus-based guideline, and 1 was an amalgamation of both evidence and expert consensus-based recommendations. The recommendations in the KMAP-DD 2017 were generally similar to those in other global treatment guidelines, although there were some differences between the guidelines. The KMAP-DD 2017 appeared to reflect current changes in the psychopharmacology of depression quite well, like other recently published evidence-based guidelines. As an expert consensus-based guideline, the KMAP-DD 2017 had some limitations. However, considering there are situations in which clinical evidence cannot be drawn from planned clinical trials, the KMAP-DD 2017 may be helpful for Korean psychiatrists making decisions in the clinical settings by complementing previously published evidence-based guidelines.

Effects of Sanqi Huayu Oral Liquid on femoral shaft comminuted fracture caused by trauma in perioperative period of high-risk groups / 中成药

AIM To investigate the effects of Sanqi Huayu Oral Liquid (Notoginseng Radix et Rhizoma,Corydalis Rhizoma) on femoral shaft comminuted fracture caused by trauma in perioperative period of high-risk groups.METHODS One hundred and twenty patients meeting the inclusion criteria were randomly and equally divided into treatment group and control group.The control group was treated by low molecular weight heparin calcium injection,while the treatment group was additionally given Sanqi Huayu Oral Liquid.Two groups' levels of serum IL-6,TNF-α and D-D were detected on pre-operation and the 1 st,3rd,7th after operation,respectively.Additionally,the adverse drug reactions were also observed.RESULTS There were no statistically significant differences in the levels of serum IL-6,TNF-α and D-D between the two groups before operation.The first day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups showed increasing trends,which had similar elevated levels without statistically significant differences.The third day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups presented downward trends,but those in the treatment group were decreased more markedly with statistically significant differences.Furthermore,the seventh day after operation,the levels of serum IL-6,TNF-α and D-D between the two groups were lower than those before the operation,and these indices in the treatment group were lower than those in the control group with statistically significant differences.CONCLUSION Sanqi Huayu Oral Liquid can not only effectively reduce the levels of serum IL-6,TNF-α and D-D in perioperative period of high-risk groups,but also prevent the formation of deep vein thrombosis.

Influence of clopidogrel on platelet function and inflammation factor in treatment of severe carotid artery stenosis after stent-assisted angioplasty / 药物评价研究

Objective To investigate the effect of clopidogrel on platelet function and inflammation factor in treatment of severe carotid artery stenosis after stent-assisted angioplasty.Methods Patients (120 cases) with severe carotid artery stenosis after stent-assisted angioplasty were chosen and divided into two groups,the control group were given atorvastatin combined with aspirin,and the observation group were given atorvastatin combined with chlorine.The serum coagulants DD level,FIB level,inflammation factor P-chosen element level and restenosis event incidence of two groups were observed.Results D-double polymer of two groups had no significant difference;After surgery,the D-double polymer and FIB level of two groups were all higher (P ＜ 0.05).After surgery for 24 h,the D-double polymer and FIB level of observation group were higher,after 3 months of surgery,the D-double polymer and FIB level had no significant differences compared with before surgery,which were all in normal level.After 24 h,1 month,3 months of surgery,the D-double polymer and FIB level of observation group were all lower than control group (P ＜ 0.05).Before treatment,the P-chosen selectin of two groups had no significant differences,which were all decreased after surgery,and the observation group was lower than control group (P ＜ 0.05);The restenosis event of observation group was lower than control group (P ＜ 0.05).Conclusion Clopidogrel could control the platelet aggregation of severe carotid stenosis after surgery to prevent the thrombogenesis and decrease the restriction incidence,while control the inflammation factor expression to prevent the atherosclerosis.

Assessment of biliary complication after liver transplantation in Mongolia / Мэс засал

Introduction: A considerable proportionof adult living donor liver transplantation(LDLT) recipients experience biliarycomplication (BC), but there are few reportsregarding BC based on long-term studies ofa large LDLT population.Methods: The present study examinedBC incidence, from 16 adult and pediatricpatients (14 right liver and 2 left liver graft )between 2011 and 2016 First Central Hospitalof Mongolia.Results: The mean follow-up period was36±1 months. First Central Hospital has DDanastmosis (n=22) double DD (n=2) singlehepaticojejunostomy (n=3). There 3 caseshave biliary stricture after operation. One ofthe 3 cases has biliary laek 2 months laterafter the operation.Conclusion: Close surveillance for BCappears necessary for at least the first 3 yrafter LDLT. In terms of anastomotic stenosisrisk, HJ appears a better choice than DD forright liver grafts involving ducts less than 4mm in diameter.