tbuckley/cabot-search huggingface dataset:
A phase II study of siG12D-LODER in combination with chemotherapy in patients with locally advanced pancreatic cancer (PROTACT).
Authors: Anna M. Varghese, Celina Ang, Christopher J. Dimaio, Milind M. Javle, Martin Gutierrez, Nirit Yarom, Salomon M. Stemmer, Talia Golan, Ravit Geva, Valeriya Semenisty, Iyad Khamaysi, Rosario Ligresti, Shay Rotkopf, Racheli Gabai-Malka, Eithan Galun, Amotz Shemi, Mark Schattner, Eileen Mary O'Reilly
Journal: Journal of Clinical Oncology (2020)

TPS4672 Background: KRAS alterations are the most frequent driver alterations identified in pancreas cancer; however, KRAS has remained an elusive therapeutic target. siG12D-LODER is a novel, miniature bio-degradable polymeric matrix encompassing a novel small interfering RNA targeting KRAS G12D and all additional G12X mutations (G12C, G12V...). The siG12D-LODER is inserted directly into the pancreas tumor via endoscopic intervention. A Phase 1/2a dose escalation and expansion study of patients receiving a one-time dose of siG12D-LODER with ongoing chemotherapy demonstrated that the combination was well-tolerated and safe and exhibited promising potential efficacy with 10/12 patients achieving disease control and median overall survival 15.1 months (Golan, Oncotarget 2015). Methods: This phase 2 study was initially designed as a randomized, two arm, open label study of gemcitabine and nab-paclitaxel with or without siG12D-LODER for patients with locally advanced pancreas cancer with planned 40 patients in each arm and primary endpoint of progression-free survival. Eighteen patients were enrolled in the chemotherapy alone arm and 18 in the chemotherapy and siG12D-LODER arm. After an interim analysis, the study design has been amended and is now a single arm study in which patients (N=39) with both borderline resectable and locally advanced pancreas cancer will receive investigator’s choice of chemotherapy (the combination of gemcitabine/nab-paclitaxel or modified FOLFIRINOX) and all patients will receive up to three doses of the siG12D-LODER administered once every 12 weeks. Primary endpoint is overall response rate after final siG12D-LODER insertion. Secondary endpoints include duration of response, progression-free survival, overall survival, time to response, percentage of patients proceeding to surgical resection, and percentage of patients receiving radiation therapy. Exploratory analyses include evaluation of KRAS mutation status and monitoring of circulating free DNA and circulating tumor cells. The amended protocol is now open for accrual and four patients having been enrolled to date. Trial accrual is anticipated to be completed by December 2020. Clinical trial information: NCT01676259 .
Pathologic changes of the central nervous system in primary Sjogren's syndrome
Authors: 费允云, 吴迪, 张奉春
Journal: BMJ (2006)

原发性干燥综合征(primary Sjogren's syndrome,pSS)是主要累及外分泌腺体的慢性炎症性自身免疫病,临床上除有外分泌腺受损外,尚有多脏器受累,约有10%～20%的患者发生外周神经病变,但其中枢神经系统损害的发生率一直存在争议.我们回顾了近年来发表的相关文献,分析、探讨pSS的中枢神经系统病变(CNS-SS)。
Swabs Collected by Patients or Health Care Workers for SARS-CoV-2 Testing
Authors: Yuan-Po Tu, Rachel Jennings, Brian Hart, Gerard A Cangelosi, Rachel C Wood, Kevin Wehber, Prateek Verma, Deneen Vojta, Ethan M Berke
Journal: New England Journal of Medicine (2020)

Patient-Collected Swabs for SARS-CoV-2 Testing Tongue, nasal, and mid-turbinate swabs to detect SARS-CoV-2 were collected by 530 outpatients before a health care worker collected nasopharyngeal swa...
浅析药物剂型的合理使用
Authors: 张雷
Journal: BMJ (2012)

剂型是将各种药物根据其自身的理化特性、药理作用及不同的临床需要制成适合患者应用的最佳给药形式.随着社会的进步,人们越来越关注药物的合理使用,然而,由于临床医生对有关药物剂型知识的缺乏,擅自改变用药方式,药学人员未能及时进行用药指导,导致患者剂型乱用的现象时有发生.殊不知剂型影响药物在体内的吸收和利用,对药效发挥起着重要作用,其合理使用事关药物的最佳疗效和安全性.下面列举几种误区。
手术治疗外伤性脾破裂38例
Authors: 吴志民, 杨玉国
Journal: BMJ (2006)

脾破裂是外科常见急症,在积极扩容的同时,宜尽早手术挽救患者生命,保留脾脏功能.自1998年以来,我院对38例外伤性脾破裂患者急诊行脾修补、脾部分切除和切脾后脾片网膜种植术,疗效满意,现报告如下。
Genomic analysis of driver-negative lung adenocarcinoma (LA) in lifetime never smokers.
Authors: Aline Fusco Fares, Sebastiao N. Martins-Filho, Quan Li, Andrew Seto, Erin L. Stewart, Tong Zhang, Sally CM Lau, Deepti Ravi, Jessica Weiss, Devalben Patel, Nhu-An Pham, Adrian G. Sacher, Penelope Ann Bradbury, Tracy Stockley, Natasha B. Leighl, Frances A. Shepherd, Ming Sound Tsao, Geoffrey Liu
Journal: Journal of Clinical Oncology (2020)

3571 Background: Genomic events giving rise to driver negative LA in never smokers remain elusive. Here we report results of whole exome sequencing (WES) and targeted RNA sequencing in NS who had no mutation drivers found on routine clinical testing by targeted next generation sequencing (NGS). Methods: The cohort of never smokers with EGFR/ALK negative LA by clinical biomarker testing at Princess Margaret Cancer Centre, were first subjected to various clinical NGS profiling platforms (table). Where tissue was available, those negative for potential drivers in the clinical NGS then underwent WES (mean coverage &gt; 200x) and Oncomine comprehensive v.3 RNA sequencing. We analyzed mutational signatures (MS) of the driver negative cohort based on the COSMIC catalog and assessed the median tumor mutation burden (mTMB mut/Mb -Megabase) in cases without a smoking MS, to avoid confounders. Results: Of 159 never smokers profiled with clinical NGS, potential drivers were found in 86 (54%): 75 (87%) with mutations in known LA driver genes and 11 (13%) with fusions. Among the remaining never smokers that tested negative by clinical NGS, 35 (48%) had available tissue for further testing. The Oncomine panel identified 9 cases (25%) with fusions or MET exon14 mutation (n = 7). Within the driver negative group, 24 (92%) underwent WES. Three tumors had WES base substitution patterns that were consistent with a smoking-related MS (MS4). Twenty-one patients exhibited signatures found common across all cancer types (MS 5), associated with DNA mismatch repair (MS 6, MS 20) or APOBEC over-activation (MS 2, MS13). In the driver-negative group, we identified 7 pts with somatic mutations in the KMT2 family (4 KMT2C, 4 KMT2A, 1 KMT2D), known for putative tumor suppressors and histone methyltransferases. mTMB on the driver negative group was 1.92, while one outlier with APOBEC MS and KMT2C/A mutations had a TMB of 16.8. Conclusions: Never smokers with driver negative LA are a heterogeneous group, with different MS and a wide TMB range. Mutations on KMT2 family are frequently found in driver negative LA in never smokers and warrant further investigations. [Table: see text]
A review of head and neck squamous cell carcinoma response to taxane chemotherapy treatment in the pre versus post nivolumab era.
Authors: carolyn moloney, Sue Sukor, Michael Thomas McCarthy, Cliona Grant
Journal: Journal of Clinical Oncology (2020)

e18504 Background: Nivolumab received FDA approval as monotherapy for the treatment of recurrent or metastatic squamous cell carcinoma (SCC) of the head and neck after failure of platinum-based therapy in 2016. This approval was based on CheckMate 141. When patients ultimately relapse after immunotherapy in the second line setting, third line agents include single agent or combination treatment with a Taxane. Methods: We identified patients with metastatic or recurrent squamous cell head and neck cancer in an Irish hospital who had received Taxane chemotherapy after immunotherapy. We looked at outcomes for these patients including progression free survival (PFS) and overall survival (OS). We then identified a group of patients who received a Taxane following platinum failure in the pre-Nivolumab era to act as a comparator. Our objective was to compare PFS and OS to subsequent Taxane chemotherapy in the era before and after the introduction of Nivolumab as a therapy for platinum refractory head and neck SCC. Results: This retrospective cohort study was made up of 26 patients with metastatic or recurrent head and neck cancer. Primary sites included oropharynx, oral cavity, larynx and nasal cavity squamous cell cancers. The patients had a median age of 56. 13 of these patients identified had progressed on Nivolumab but remained fit for a next line of treatment. Median PFS in this group on Taxane based chemotherapy in the third line setting was 3.8 months. Median OS post progression on Nivolumab was 10 months. One patient remarkably had a complete response to Paclitaxel chemotherapy after progression on previous lines of treatment including immunotherapy, platinum chemotherapy and radiotherapy. We then identified a group of 13 patients with metastatic or recurrent head and neck cancer that had progressed on platinum based therapy in the era before Nivolumab was available. Median PFS after Taxane second line chemotherapy was 2.2 months. Median OS in this group after progressing on platinum treatment was 5.8 months. Conclusions: We set out to share our experience of real-world outcomes for head and neck cancer patients in the Nivolumab era. We found that our patients have shown to have an improved overall survival benefit with subsequent Taxane chemotherapy after immunotherapy compared to those who have not received immunotherapy. All fit patients should be considered for Taxane therapy post failure of Nivolumab.
节育环膀胱异位一例
Authors: 项允成, 王燕, 安杰, 曹峰, 陈学刚
Journal: BMJ (2004)

患者女,32岁,间歇性尿频、尿急、尿痛9个月余,应用抗生素治疗有效,但易复发,1周前出现肉眼血尿来我院就诊.无排尿困难、尿失禁及尿漏. 患者24岁结婚,生育1子,5年前放置环行节育环避孕,以后曾先后2次怀孕行人工流产术.B超示:膀胱充盈好,其内探及一直径2.4 cm强回声光团,后伴声衰,随体位改变而移动,子宫后位,大小、外形正常,其内未探及异常回声.尿常规示:白细胞阳性,红细胞2～5/HP.腹部平片于耻骨联合上2 cm处见一直径约2.5 cm环形高密度阴影.初步诊断:膀胱异物.膀胱镜检查于膀胱底部见一金属环,表面有尿盐附着,活动,异物钳无法取出,更换大力碎石钳取出。
Accurate diagnosis and reasonable treatment for osteonecrosis of the femoral head
Authors: 李子荣
Journal: BMJ (2006)

骨坏死可累及全身许多部位,但以股骨头坏死(osteonecrosis of the femoral head,ONFH)最常见且危害最严重.ONFH可由创伤(股骨颈骨折、髋脱位等)和非创伤两大原因引起.在我国非创伤性ONFH主要由糖皮质激素及酗酒引起,此类患者主要特点是发病年龄轻(国外资料为38.0岁,本中心为33.5岁),累及双髋者多.该病为逐渐进展性疾病,自然病史(natural history)研究显示,未经有效治疗的ONFH约80%会在患病后1～4年进展到股骨头塌陷,股骨头一旦出现塌陷(crescent,新月征阳性),则87%的髋关节会在24个月内进展到需进行人工关节置换[1].就目前水平,中青年的人工关节置换的长期疗效(超过15～20年)仍不理想.因此,寻求有效方法,尽可能保留患者自身关节有非常重要的社会和经济价值.取得保留关节治疗成功的先决条件是早期准确的诊断和科学的分期。
A novel TGF-beta targeted peptide HTPEP-001 enhances antitumor efficacy of anti-PD1 in mice models.
Authors: Xiaomei Li, Yi Ding, Ling Xiao, Rui Chen, Ying Qing, Qiu Jiang, Yuanxue Gao
Journal: Journal of Clinical Oncology (2020)

e15200 Background: With the emergence of immunotherapy in recent years, therapeutic antibodies against programmed death 1 (PD1) and its ligand (PDL1) have proven to be a huge success in multiple cancer types. However, these robust responses only occur in a subset of patients. Identifying mechanisms of responses and resistance is key to improve outcomes and setup new treatment strategies. Transforming Growth Factor-beta (TGF-beta) is an immunosuppressive cytokine and overexpression of TGF-beta in the tumor microenvironment is proven to be a key element of resistance to anti-tumor response. We have developed a novel peptide HTPEP-001 which blocks TGF-beta signaling in both cellular and fibrosis animal models (ATS-2020 abstract). In this study, we explored the antitumor effect and mechanism of HTPEP-001 when administered together with anti-PD1 antibody in mice models. Methods: Animal models: 1. C57BL/6 mice were inoculated subcutaneously with 5*10 5 MC38 cells. 2. BALB/c mice were inoculated on the right mammary fat pad with 1*10 5 EMT-6 cells. Treatment groups: A. HTPEP-001 (60 mg/kg, intravenously, qd); B. isotype IgG; C. rat anti-mouse PD1 (10 mg/kg, intraperitoneally, twice a week); D. Coadminstration of HTPEP-001 and anti-PD1 (combo). Treatments were initiated 4-5 days after inoculation and lasted for 10 days. ELISA, immunofluorescence and flow cytometry analysis of dissected tumors were performed. Results: Compared to anti-PD1 group, mice treated with both HTPEP-001 and anti-PD1 exhibited additional reductions in tumor size and 13% higher inhibition of tumor growth (59% in Anti-PD-1 vs 72% in combo) in MC38 model. In the EMT6 model, coadministration of HTPEP-001 and anti-PD1 also showed additional reduction in tumor burdens. Coadmistration of HTPEPE-001 and anti-PD-1 significantly decreased active TGF-beta 1 and phosphorylated Smads expression in tumors in both MC38 and EMT6 models. Furthermore, immunofluorescence and flow cytometry analysis of CD8 + lymphocytes in tumor mass revealed markedly elevated number of cytotoxic tumor infiltrating lymphocytes in combo group compared to HTPEP-001 and anti-PD1 groups. Conclusions: This study showed that HTPEP-001 enhanced the anti-tumor activity of anti-PD1 via suppressing TGF-beta signaling and promoting infiltration of cytotoxic lymphocytes in two syngeneic tumor models. We will continue to develop HTPEP-001 as an add-on therapy to checkpoint inhibitors with a goal to improve the outcomes of current immunotherapy.
Test measuring signaling activity in live patient tumor cells to identify PI3KCA WT patients who may benefit from PI3K inhibitors.
Authors: Lance G. Laing, Salmaan Khan, Ian A. MacNeil, Catherine Kuzmicki, Benjamin E. Rich, Abhay Shukla, Kelly Brass, Brian Sullivan
Journal: Journal of Clinical Oncology (2020)

e13000 Background: Biological factors other than PIK3CA status, such as aberrant GPCR-linked signaling, may be important to measure when identifying patients eligible for PI3K inhibitors. A new assay, the CELx PI3K test, using an impedance biosensor was developed to measure ex vivo live tumor cell response to specific S1P agonists and PI3K antagonists to diagnose breast tumors with PI3K-involved hyperactive signaling. This study set out to: 1) compare CELx PI3K test results and xenograft results using cell lines with PIK3CA mutations; and 2) assess whether PI3K-involved hyperactive S1P signaling is found in PIK3CA WT breast cancer patient tumors. Methods: A panel of 17 fresh HER2-/PIK3CA WT tumor cells from breast cancer patients and three PIK3CA mutated breast tumor cell lines were obtained. Live cell response to an S1P agonist, PI3K-α antagonist (alpelisib), PI3K-γ antagonist (IPI-549), and a pan-PI3K inhibitor (taselisib) were measured using an xCELLigence RTCA impedance biosensor. From these responses, PI3K-involved signaling was quantified and characterized as normal or abnormal using a previously determined cutpoint. For the xenograft study, 16 NSG mice were injected with HCC1954 PIK3CA mutated breast cancer cells and randomly assigned to either the control or taselisib group (10 mg/kg). Results: Four of the 17 PIK3CA WT tumor cells had abnormal levels of combined PI3K-α and PI3K-γ signaling. Only one of the three PIK3CA mutated breast tumor cell lines (BT20) had abnormal levels of PI3K-α and pan-PI3K involved signaling. The HCC1954 cell line had normal PI3K-α and abnormal pan-PI3K signaling. CAL-51 reported normal PI3K-α and pan-PI3K signaling. The normal levels of PI3K-α signaling found in the HCC1954 and CAL-51 cell lines correlated with previously reported xenograft studies that found alpelisib had no anti-tumor effect. The xenograft study reported here using HCC1954 cells found taselisib induces a significant anti-tumor effect (T/C ratio = 0.21; p = 0.009; t-test). Conclusions: A sub-set of PIK3CA WT patient breast cancer tumors had abnormal PI3K-involved signaling comparable to levels found in PI3KCA mutated cell lines. Abnormal pan-PI3K signaling and normal PI3K-α signaling in the HCC1954 cell line correlated with xenograft results. This study thus suggests that measurement of PI3K-involvement in hyperactive S1P signaling in live patient breast cancer cells may provide a means to identify breast cancer patients who may or may not benefit from treatment with PI3K inhibitors.
FOLFIRI versus irinotecan monodrug as second-line treatment in metastatic colorectal cancer patients: An open, multicenter, prospective, randomized controlled phase III clinical study.
Authors: Weijian Guo, Xiaowei Zhang, Yusheng Wang, Wen Zhang, Xin Liu, Wei Shen, Yifu He, Xiaodong Zhu, Zhiyu Chen, Hong Qiang Wang, Mingzhu Huang, Zhe Zhang, Xiaoying Zhao, Lixin Qiu, Chenchen Wang, Xuedan Sheng
Journal: Journal of Clinical Oncology (2020)

4038 Background: The most commonly used treatment methods for metastatic colorectal cancer (mCRC)are systemic chemotherapy, molecular targeted therapy and local treatment. The main chemotherapy drugs for mCRC include Irinotecan, Oxaliplatin and 5-Fu. V308 Research shows that FOLFOX and FOLFIRI can be standard first or second-line of each other in the treatment of metastatic colorectal cancer. However if the first-line treatment regimen containing 5-FU fails, whether it is necessary to re-challenge 5-FU when Irinotecan is applied in the second line is unknown. There is no head-to-head comparative study to answer whether the FOLFIRI regimen is better than the Irinotecan monodrug. Therefore, it is necessary to carry out a comparative study of FOLFIRI Versus Irinotecan monodrug to observe whether adding 5-Fu on the basis of Irinotecan can improve the therapeutic effect. Methods: This was a randomized phase III trial. Patients from 5 centers in China with metastatic colorectal adenocarcinoma, for whom first-line of chemotherapy including oxaliplatin combined with fluorouracil drugs (combined or not combined with targeted therapy) had failed, were enrolled. 172 patients with mCRC were randomly treated with FOLFIRI or Irinotecan monodrug were included in this study. FOLFIRI group: Irinotecan 180mg/m 2 ; Lecovorin 400mg/m 2 ; 5-Fu 400mg/m 2 ; 5-Fu 2400mg/m 2 CIV 46h. Irinotecan monodrug group 180mg/m 2 , The regimen was repeated every 2 weeks. The primary endpoint is PFS, and this clinical trail is a superiority trial. Results: ITT (Intention-To-Treat) analysis: Among 172 patients, 10 had PR, 93 had SD, and 63 had PD, 6 patients have not received efficacy evaluation yet. The ORR was 5.68% VS. 5.95%, and the DCR was 61.36% and 54.76% in FOLFIRI group and Irinotecan monodrug group, respectively. Adverse reactions included neutropenia, stomatitis, diarrhea, fatigue, abnormal liver enzymes, pyrexia, arrhythmia, nausea and most of these were grade 1-2. The dose reduction rate induced by drug tocixity of was 13.64% and 7.14% in FOLFIRI group and Irinotecan monodrug group, respectively. Conclusions: These data show that Irinotecan monodrug has the similar ORR and DCR with FOLFIRI regimen in second-line treatment of mCRC. Irinotecan monodrug has lower adverse effect. Clinical trial information: NCT02935764 .
幽门螺杆菌根除治疗的适应证及治疗方案
Authors: 胡品津
Journal: BMJ (2004)

幽门螺杆菌(Hp)感染相当普遍(尤其在一些发展中国家如我国),其中绝大多数Hp感染者并无症状,因此并不需要对每个Hp感染者都进行根除治疗.考虑到成本-效益比、治疗药物的不良反应以及滥用抗生素所造成耐药菌株的流行,应对Hp根除治疗的适应证达成共识。
Dissection of primary prostate cancer to determine the clonal origin of synchronous lymph node metastasis.
Authors: Srinivas Nallandhighal, Jeffrey J. Tosoian, Udit Singhal, Razeen Karim, Romain Mathieu, Komal Plouffe, Nathalie Rioux-Leclercq, Javed Siddiqui, Chia-Jen Liu, Daniel H. Hovelson, Claudio Doglioni, Todd Matthew Morgan, Martin Susani, Roberta Luciano Luciano, Shahrokh F. Shariat, Scott A. Tomlins, Alberto Briganti, Ganesh S. Palapattu, Aaron M. Udager, Simpa Samuel Salami
Journal: Journal of Clinical Oncology (2020)

e17614 Background: Primary prostate cancer often consists of multiple, genomically-distinct clones. The clonal source of lymph node metastasis in multifocal disease is unknown. We sought to analyze and determine the histopathologic and molecular characteristics of the tumor sub-clones capable of metastasis in primary prostate cancers with synchronous lymph node metastasis. Methods: We identified patients with primary prostate cancer found to have lymph node (LN) metastasis at the time of radical prostatectomy, including those with multifocal disease. Punch biopsies were obtained from multiple regions of primary tumors and LN metastases. Targeted next generation sequencing to assess somatic DNA mutations, copy number alterations (CNA), and TMPRSS2:ERG fusion status. Bioinformatic analyses were performed using in-house developed pipelines. Phylogenetic evolutionary analyses were performed to delineate the primary cancer clone responsible for LN metastasis. Results: We identified 2 patients with LN cancer regions. In one patient, while all four Grade Group (GG) 5 primary tumor (PT) regions showed concordant TP53 and TPR non-synonymous mutations and broad copy number alterations (CNAs) with two LN foci, only two regions shared high level CNAs with both lymph node foci. In this case, a GG1 tumor focus showed no TP53 somatic mutation or CNA overlap with the high-grade tumor or lymph node samples. Critically, phylogenetic analysis revealed that the GG5 PT with extra-prostatic extension (EPE) showed higher concordance with the LN metastases than regions confined to the prostate. In another patient with four PT, phylogenetic analysis revealed that the PT with EPE closely resembled the LN metastasis; both were TMPRSS2:ERG fusion positive share PTEN copy number loss. Two PT (GG1 and 2) appeared to be independent clones and were TMPRSS2:ERG fusion negative. One of the six circulating tumor cells (isolated pre-prostatectomy) from this patient demonstrated a significant PTEN copy loss consistent with the findings in the region of EPE and the LN metastasis. Conclusions: Our findings confirm molecular heterogeneity of primary prostate cancers and homogeneity of LN metastases supporting the use of shared molecular alterations to infer clonal lineage. Our results highlight the critical role of adverse pathologic features, such as grade and EPE, in prostate cancer with synchronous lymph node metastasis.
Rehabilitation effect research of electro-acupuncture combined with computer aided training on brain injury patients with cognitive deficits
Authors: Jian-bo Yu, Li-juan Zhang, Xiao-fen Wu, Xiao-mei Yang
Journal: BMJ (2013)

A total of 60 brain injury patients with cognitive impairment were randomly divided into electro-acupuncture, computer and combination groups (n=20 each). The electro-acupuncture group received electroacupuncture, computer group cognitive rehabilitation training with specialized equipment and combination group both regimens. The treatment lasted for 2 months. Before training, Loewenstein occupational therapy cognitive assessment (LOTCA) test was not statistically significant among all groups (P>0.05). After 1 month, the combination group scored higher than pre-training(P 0.05), the combination group scored higher than the other two groups in improved orientation after 2 months (P<0.05).


Key words: 
Hospitals, convalescent; Brain injuries
脑膜瘤误诊为一氧化碳中毒一例
Authors: 朱祥悌
Journal: BMJ (2007)

患者,女,45岁.因昏迷30 min于2007年1月11日3时多车接来院.患者家属于30 min前发现其唤不醒,遂通知120救护车接来院,给予吸氧20 min后神志逐渐转清,醒后自述头痛、头晕,并呕吐胃内容物2次,无抽搐.查体:血压130/80 mm Hg(1 mm Hg=0.133 kPa),双侧瞳孔等大同圆,直径3 mm,光反射存在,双眼球活动正常,无视野缺损.颈软,心肺听诊无异常.左上肢肌力4级,无病理反射.因患者居住房间的阳台有煤炉,且冬季为一氧化碳中毒高发季节,因此诊断为一氧化碳中毒收入院行高压氧治疗。
Clinical observations on patients with surgical treatment after heart valve prosthesis implantation
Authors: 徐铁峥, 周珉, 朱海宏, 邵雪泉
Journal: BMJ (2007)

目的 探讨心脏瓣膜置换术后患者行外科手术的安全性.方法 回顾分析1996年1月至2005年12月收治12例心脏瓣膜置换术后因外科疾病行外科手术的临床资料,12例患者均口服华法林进行抗凝治疗.心功能Ⅰ～Ⅲ级.7例择期手术,5例急诊手术.择期手术者停用华法林2～3 d,急诊手术者术前6～8 h肌内注射维生素K1 5～10 mg,术前凝血酶原时间(PT)平均值分别为15.1和15.3 s,凝血酶原国际标准化比值(INR)分别为1.24和1.30.术中视创面渗血情况,予维生素K1 5～10 mg静脉滴注.结果 12例患者手术时间20～160 min,手术出血量5～280 ml,未发生术中术后大出血、血栓、心力衰竭等并发症.结论 心脏瓣膜置换术后的患者应用维生素K1并将PT、INR控制在15 s、1.30左右,结合术中细致操作,加强围手术期管理,进行外科手术是安全的。