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Efficacy of Different Treatment Regimens for Antiphospholipid Syndrome-related Recurrent Spontaneous Abortion

Chinese Medical Journal 2017年第12期130卷 1395-1399页

作者： Sheng-Long Ye Xun-Ke Gu Li-Yuan Tao Ji-Mei Cong Yong-Qing Wang Department of Obstetrics and Gynaecology Peking University Third Hospital Beijing 100191 China Research Center of Clinical epiderniology Peking University Third Hospital Beijing 100191 China

Background： Antiphospholipid syndrome （APS）-related immune factors are considered as an important cause of recurrent spontaneous abortion （RSA）. Anticoagulant and anti-inflammatory treatments are believed to effectively improve adverse pregnancy outcomes by affecting the abnormal autoimmune response of the maternal-fetal interface. The aim of this study was to observe the clinical characteristics and treatment outcomes of anticoagulant regimens and anti-inflammatory plus anticoagulation regimens for APS-related RSA. Methods： APS-related RSA cases from September 2011 to September 2016 at Peking University Third Hospital were retrospectively analyzed. The patients were assigned to study group （anti-inflammation plus anticoagulation） and control group （simple anticoagulation）, The incidence of repeat abortion, the incidence of placental dysfunction, the gestational weeks of pregnancy, and the mean weight of the fetus were observed. Results： The pregnancy and neonatal outcome indicators of the repeat pregnancy loss rate （ 11. 11% vs. 22.70%）, placental dysfunction-related diseases （6.35% vs. 15.60%）, the mean birth weight of infants born after 24 weeks gestation （3152.4 ± 844.67 g vs. 2765.76 ± 816.40 g）, full-ternl delivery weight （3456.28 ±419.79 g vs. 3076.18±518.79 g）, the proportions of low birth weight infants （ 12.70% vs. 21.98%）, and small for gestational age （6.35% vs. 14.18%） differed significantly between the study and control groups （all P 〈 0.05）. The incidence of preterm delivery, term delivery, and stillbirth was not significantly different between the two groups, and there was no significant difference between the study and control groups in gestational age at birth （37.6 ± 3.3 weeks vs. 36.9 ± 3.2 weeks： P 〉 0.05）. Conclusion： The anti-inflammatory and anticoagulation regimen is more effective than the simple anticoagulation regimen in the treatlnent of APS recurrent abortion.

关键词： Anticoagulant Therapy Anti-inflammatory Therapy Antiphospholipid Syndrome Recurrent Spontaneous Abortion

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Gene expression changes in blood RNA after swimming in a chlorinated pool

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Journal of Environmental Sciences 2017年第8期29卷 250-261页

作者： Lucas A.Salas Laia Font-Ribera Mariona Bustamante Lauro Sumoy Joan O.Grimalt Sarah Bonnin Maria Aguilar Heidi Mattlin Manuela Hummel Anna Ferrer Manolis Kogevinas Cristina M.Villanueva ISGlobal Centre for Research in Environmental Epidemiology(CREAL)Barcelona Spain Department of epiderniology The Geisel School of Medicine at Dartmouth Lebanon NH USA Universitat Pompeu Fabra (UPF) Barcelona Spain CIBER Epiclemiologia y Salud Publica (CIBERESP) Barcelona Spain IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain Genomics and Disease Centre for Genomic Regulation (CRG) The Barcelona Institute of Science and Technology Barcelona Spain Genomics Core Facility Centre for Genomic Regulation (CRG) The Barcelona Institute of Science and Technology Barcelona Spain Institute of Predictive and Personalized Medicine of Cancer (IMPPC) Institut Germans Trias i Pujol (IGTP) Can Ruti Campus Badalona Spain Department of Environmental Chemistry Institute of Environmental Assessment and Water Research (CSIC) Barcelona Spain

Exposure to disinfection by-products（DBP） such as trihalomethanes（THM） in swimming pools has been linked to adverse health effects in humans, but their biological mechanisms are unclear. We evaluated short-term changes in blood gene expression of adult recreational swimmers after swimming in a chlorinated pool. Volunteers swam 40 min in an indoor chlorinated pool. Blood samples were drawn and four THM（chloroform,bromodichloromethane, dibromochloromethane and bromoform） were measured in exhaled breath before and after swimming. Intensity of physical activity was measured as metabolic equivalents（METs）. Gene expression in whole blood m RNA was evaluated using Illumina Human HT-12v3 Expression-Bead Chip. Linear mixed models were used to evaluate the relationship between gene expression changes and THM exposure. Thirty-seven before-after pairs were analyzed. The median increase from baseline to after swimming were： 0.7 to 2.3 for MET, and 1.4 to 7.1 μg/m^3 for exhaled total THM（sum of the four THM）.Exhaled THM increased on average 0.94 μg/m^3 per 1 MET. While 1643 probes were differentially expressed post-exposure. Of them, 189 were also associated with exhaled levels of individual/total THM or MET after False Discovery Rate. The observed associations with the exhaled THM were low to moderate（Log-fold change range：-0.17 to 0.15）. In conclusion, we identified short-term gene expression changes associated with swimming in a pool that were minor in magnitude and their biological meaning was unspecific. The high collinearity between exhaled THM levels and intensity of physical activity precluded mutually adjusted models with both covariates. These exploratory results should be validated in future studies.

关键词： Trihalomethanes Disinfection by-products Gene expression Swimming pools Metabolic rate

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The medieval Persian manuscript of Afyunieh:the first individual treatise on the opium and addiction in history

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Journal of Integrative Medicine 2018年第2期16卷 77-83页

作者： Abdolali Moosavyzadeh Farzaneh Ghaffari Seyed Hamdollah Mosavat Arman Zargaran Azarakhsh Mokri Soghrat Faghihzadeh Mohsen Naseri Department of lranian Traditional Medicine Faculty of MedicineShahed UniversityTehran 33191-18651Iran School of Traditional Medicine Shahid Beheshti University of Medical SciencesTehran 15167-45811Iran Research Center for Traditional Medicine and History of Medicine Shiraz University of Medical SciencesShiraz 71356-44144Iran Department of History of Medicine School of Traditional MedicineTehran University of Medical SciencesTehran 16687-53961Iran Psychiatry Department and National Center for Addiction Studies Tehran University of Medical SciencesTehran 14176-53761Iran Department of Biostatistics and epiderniology Faculty of MedicineZanjan University of Medical SciencesZanjan 45371-38791Iran Traditional Medicine Clinical Trial Research Center Shahed UniversityTehran 14179-53836Iran

According to historical evidence, the abuse of opium has been reported all over the globe-specifically throughout Eastern nations-since the sixteenth century. Before that, opium had mostly been applied as medication. Reference has been made in traditional Persian medical literature to the method of cultivation, properties, side effects and toxicity. In sixteenth century Iran, during the reign of the Safavids, opium abuse began. It was from then that prominent Persian scholars started to think of solutions to this societal problem. One of the most famous scholars was Imad al-Din Mahmud ibn Mas＇ud Shirazi, who composed a book concerning addiction-Afyunieh, a comprehensive book on the topic of opium and all issues of opium. Furthermore, he recommended methods for reducing opium dose as well as substitution with other medications that had a narrower range of side effects, in order to eradicate dependency upon opium and opium-derived materials. This is most likely the first book that comprehensively addressed opium and discussed drug rehabilitation methodology, in traditional Persian medical literature. In this historical review, the authors have introduced the book Afyunieh, which presents methods for treating addiction to and giving up opium; the text comprises a synthesis of the author＇s opinions, professional experience and references to the work of other famous physicians.

关键词： Persian medicine Opium addiction Imad al-Din Mahmud

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质子泵抑制剂与社区获得性肺炎观察到的两者联系可能是源于初始偏倚和指征混杂

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英国医学杂志中文版 2017年第6期20卷 304-305页

作者： Kristian B Filion 石欣雨施焕中 Center for ClinicalEpidemiology Lady Davis InstituteJewish General Hospital MontrealQuebec Canada Departments of Medicine and of epiderniology Biostatistics and Occupational HealthMcGill UniversityMontreal QuehecCanada 首都医科大学附属北京朝阳医院呼吸重症科

2004年一项巢式病例对照研究发表，此后，人们开始担忧质子泵抑制剂（PPI）与患社区获得性肺炎的风险。此项研究表明，正在使用PPI的人群患社区获得性肺炎的风险明显高于停止使用PPI的人群。这项发现得到生物学基础理论的有力支持：

关键词：质子泵抑制剂原发性混杂偏倚社区链接肺炎

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视网膜病与充血性心力衰竭的危险

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美国医学会杂志（中文版） 2006年第1期25卷 22-27页

作者： Tien Y. Wong Wayne Rosamond Patricia P. Chang David J. Couper A. Rickey Sharrett Larry D. Hubbard Aaron R. Folsom Ronald Klein 范琰（译）刘梅林（校） Centre for Eye Research Australia University of Melbourne Victoria Singapore Eye Research Institute National University of Singapore Department of epiderniology Division of Cardiology Department of Biostatistics University of North Carolina Chapel Hill Department of Epidemiology Johns Hopkins University Baltimore Md Department of Ophthalmology Uni- versity of Wisconsin Madison Division of Epidemiology University of Minnesota Minneapolis 不详

摘要：充血性心力衰竭（congestive heart failure，CHF）影响了相当一部分成年人，包括既往没有冠心病的人群。CHF的病因还不完全清楚，但是微血管病是可能的因素之一。目的：明确视网膜病作为全身微血管疾病的一个标志与CHF的关系。... 详细信息

摘要：充血性心力衰竭（congestive heart failure，CHF）影响了相当一部分成年人，包括既往没有冠心病的人群。CHF的病因还不完全清楚，但是微血管病是可能的因素之一。目的：明确视网膜病作为全身微血管疾病的一个标志与CHF的关系。设计、地点、参试者：应用动脉粥样硬化危险社区研究资料库，在美国4个社区进行的长达7年的人群前瞻性队列研究。参试者（n=1l612，年龄49—73岁）于1993—1995年曾行视网膜照相。视网膜照相根据标准按照视网膜病（如微血管瘤、视网膜出血、软渗出）、动静脉压迹、局限性小动脉狭窄和普遍小动脉狭窄分级。主要结局指标：视网膜病与CHF的关系，后者经由住院及死亡记录证实。结果：7年累计CHF发生率为5．4％（492例）。与没有视网膜病的参试者比较，有视网膜病的参试者CHF的发生率较高（15．1比4．8，P〈0．001）。在校正年龄、性别、种族、已有冠心病、平均动脉压、糖尿病、血糖水平、胆固醇水平、吸烟、体重指数（BMI）和研究地点后，视网膜病的存在与CHF发病危险增加2倍相关（相对危险，1．96；95％可信区间，1．51—2．54）。在既往没有冠心病、糖尿病或高血压的参试者中，有视网膜病者发生CHF的危险增加3倍（相对危险，2．98；95％可信区间，1．50—2．92）。结论：视网膜病是CHF的独立危险预测因素，即使是在没有冠心病、糖尿病或高血压的人群。这提示，微血管疾病可能对普通人群心力衰竭的发病具有重要的作用。某些眼科检查发现无症状视网膜病的患者，可从进一步的CHF危险评估受益。

关键词：充血性心力衰竭视网膜病 failure 前瞻性队列研究微血管疾病普通人群动脉粥样硬化 CHF 社区研究动脉狭窄

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亚临床甲状腺疾病科学综述及诊治指南

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美国医学会杂志（中文版） 2005年第2期24卷 112-120页

作者： MartinI.Surks,MD EduardoOrtiz,MD,MPH GilbertH.Daniels,MD ClarkT.Sawin,MD NanandaF.Col,MD,MPP,MPH RhodaH.Cobin,MD JayneA.Franklyn,MD JeromeM.Hershman,MD KennethD.Burman,MD MargoA.Denke,MD ColumGorman,MD,PhD RichardS.Cooper,MD NeilJ.Weissman,MD 陈雷冷希圣不详 EndocrineSection WashingtonHospitalCenterWashingtonDC DepartmentofMedicine UniversityofTexasSouthwesternMedicalCenteratDallas ResearchDevelopment MayoFoundationRochesterMinn epiderniology LoyolaUniversityMedicalSchoolChicagoIII andCardiacUltrasound WashingtonHospitalCenterandDepartmentofMedicineGeorgetownUniversityMedicalCollegeWashingtonDC DepartmentsofMedicineandPathology MontefioreMedicalCenterandtheAlbertEinsteinCollegeofMedicineBronxNY CenterforPrimaryCare PreventionandClinicalPartnershipsAgencyforHealthcareResearchandQualityRockvilieMd ThyroidUnitandDepartmentofMedicine MassachusettsGeneralHospitalHarvardMedicalSchoolBoston VeteransAdministration WashingtonDC HarvardMedicalSchool BrighamandWomen＇sHospitalDivisionofWomen＇sHealthandDepartmentofMedicineBoston DepartmentofMedicine MountSinaiSchoolofMedicineNewYorkNY DivisionofMedicalSciences UniversityofBirminghamBirminghamEngland EndocrinologyandDiabetesDivision WestLosAngelesVAMedicalCenterUniversityofCaliforniaatLosAngelesSchoolofMedicine

背景：临床上常常可以看到血清促甲状腺素(thyroid—stimulating hormone，TSH)水平超出正常范围而游离甲状腺素(free thyroxine，FT4)和三碘甲状腺氨酸(triidothyromine，T3)水平处于正常范围的患者。对这些患者是否需要进一步检查，... 详细信息

背景：临床上常常可以看到血清促甲状腺素(thyroid—stimulating hormone，TSH)水平超出正常范围而游离甲状腺素(free thyroxine，FT4)和三碘甲状腺氨酸(triidothyromine，T3)水平处于正常范围的患者。对这些患者是否需要进一步检查，可以采用何种治疗以及治疗的急迫性尚无定论。目的：明确亚临床甲状腺疾病的定义，复习其流行病学，推荐适当的评估方式，探讨治疗的危险和获益以及不予治疗的后果，确定是否应进行人群普查。资料来源：我们检索了MEDLINE、EMBASE、Biosis、卫生保健研究及医疗质量机构、国家临床指南交流库、系统综述和对照试验登记处Cochrane数据库以及若干国家健康服务(英国)数据库，查寻了1995—2002年发表的有关亚临床甲状腺疾病的文章。1995年以前发表的文章由专家顾问推荐。研究选择和资料提取：总共复习195篇英语文章或译文。述评、个案研究、病例少于10人的研究和非系统性综述排除在外。提取有关作者身份、发表年代、病例数量、研究设计和结果的信息，这是证据报告的基础。该报告由相应专题图表和摘要组成。资料综合：我们评价了未予治疗与临床症状和不良临床结局相关的证据的强度，并为临床实践提出了建议。有关亚临床甲状腺功能低下可发展为显性疾病的资料其证据分级强度良好；但是有关治疗防止疾病进展的资料，对确认治疗的获益而言，证据不足。有关血清TSH水平高于10mIU／L与血清胆固醇增高关系的资料，强度分级一般；但是有关治疗是否获益的资料则分级为不充分。所有其他有关症状与治疗获益关系的资料其分级均为不充分或是缺乏。有关血清TSH浓度低于0．1mIU／L与心房纤颤的关系或发展成为显性甲状腺功能亢进的资料分级为良好，但是没有资料支持治疗能阻止这些结果的产生。有关TSH水平恢复正常与骨矿物质密度改善关系的资料分级一般。其他阐述亚临床甲状腺疾病与不良后果或治疗获益关系的资料强度分级均为不充分或缺乏。怀孕期间的亚临床甲状腺疾病是一种特殊情况，对孕妇采取积极诊断和治疗是恰当的。结论：几乎没有资料支持亚临床甲状腺疾病与症状、不良临床预后、治疗获益有关。亚临床甲状腺疾病(血清TSH 0．1～0．45mIU／L或是4．5～10．0mIU／L)的后果微不足道，我们不建议对TSH水平处于这些范围的病人采用常规治疗。没有充分的证据支持有必要对普通人群进行普查。对于怀孕、年龄大于60岁的妇女和其他有甲状腺功能异常的高危病人应予积极检查。

关键词：亚临床甲状腺疾病诊治指南亚临床甲状腺功能低下 Cochrane TSH水平三碘甲状腺氨酸 MEDLINE 甲状腺功能亢进血清TSH浓度甲状腺功能异常科学游离甲状腺素骨矿物质密度正常范围促甲状腺素 2002年 1995年系统性综述

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降脂药物治疗病人需住院肌溶解症的发生率

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美国医学会杂志（中文版） 2006年第1期25卷 28-33页

作者： David J, Graham Judy A , Staffa Deborah shatin Susan E. Andrade Stephanie D, Schech Lois La Grenade Jerry H. Gurwitz K. Arnold Chan Michael .J. Goodman Richard Platt 徐成斌（译） Office of Drug Safety Center for Drug Evaluation and Research Food and Drug Administration Rockvilte Md Center for Health Care Policy and Evaluation Eden Prairie Minn Meyers Pdmary Care Institute Fallon Foundation and the University of Massachusetts Medical School Worcester Channing Laboratory Brigham and Wornen＇s Hospital and Harvard Medical School Department of Ambulatory Care and Prevention Harvard Pilgrim Health Care and Harvard Medical School Department of epiderniology HarvardSchool of Public Health Boston Massi and HealthPartners Research Founda＇don Minneapolis Minn 不详

背景：在美国降脂药物已获广泛应用。但是对各种降脂药物发生肌溶解症的危险性目前尚缺乏可靠的估计。目的：对门诊情况下，不同他汀及贝特类药物（单用或联用）治疗病人肌溶解症的发生率进行估计。设计、地点及病人：根据全美11个卫生... 详细信息

背景：在美国降脂药物已获广泛应用。但是对各种降脂药物发生肌溶解症的危险性目前尚缺乏可靠的估计。目的：对门诊情况下，不同他汀及贝特类药物（单用或联用）治疗病人肌溶解症的发生率进行估计。设计、地点及病人：根据全美11个卫生保健计划申报数据建立不同他汀和贝特类用药起始队列。人选本队列的病例为1998年1月1H至2001年6月30日人组保健计划前至少用药180天的病人。人-时间按照单药治疗或他汀-贝特类联合治疗分类。主要结局指标：每治疗10000人一年肌溶解症的发生率、所需治疗例数以及发生肌溶解症的相对危险性。结果：在252460例采用降脂药物治疗的病人中，24例于治疗期间发生住院的肌溶解症。采用阿托伐他汀、普伐他汀或辛伐他汀单药治疗平均每10000人一年肌溶解症的发生率为0．44（95％可信区间[confidence interval，CI]，0．20～0．84）；西立伐汀为5．34（95％CI，1．46～13．68）；贝特类为2．82（95％CI，0．58—8．24；P=0．056）。未用药者（unexposed person—time）肌溶解症的发生率为0（95％CI，0—0．48，P=0．56）。阿托伐他汀、普伐他汀与一种贝特联川肌溶解症的发生率增至5．98（95％CI，0．72～216．0），西立伐他汀与叭特类联用增至1035（95％CI，389—2117）。每治疗1年，发现1例肌溶解症的所需治疗例数他汀单药治疗为2272例，采用他汀和贝特类联合治疗的年龄较大的糖尿病人为484例，采用西立伐他汀加贝特类治疗的病人为9．7到12．7例。结论：采用阿托伐他汀、普伐他汀及辛伐他汀单药治疗发生肌溶解症的危险相似而且很低；联合使用他汀及贝特类者危险增加，特别是在老年糖尿病病人。西立伐他汀联合贝特类每年治疗10例即可能有1例发生肌溶解症。

关键词：药物治疗糖尿病人降脂药物肌溶解发生率住院贝特类药物阿托伐他汀 interval 卫生保健计划

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