吡喹酮、甲苯咪唑、阿苯达唑、三氯苯达唑治疗巨片形吸虫病的临床疗效观察

目的 采用临床对照方法,观察吡喹酮、甲苯咪唑、阿苯达唑、三氯苯达唑治疗巨片形吸虫病的效果.方法 18例巨片形吸虫病例依次用甲苯咪唑片[5 mg/(kg·d),2次/d口服,连用15 d]；阿苯达唑片[ 20 mg/( kg·d),2次/d口服,连用15 d]；三氯苯达唑[10 mg/(kg·d),顿服,2 d一疗程]；18例中的3例给予吡喹酮总剂量120～180 mg/kg,总剂量平均分为4 日,每日分2次服用.治疗结束后进行疗效评定,疗效评定标准:(1)治疗一疗程后临床症状明显缓解,尤其发热频率及程度较治疗前有明显改善；(2)治疗期间动态复查血常规其中白细胞计数较前下降；嗜酸粒细胞计数或其比例较治疗前下降；血沉、C-反应蛋白等炎症反应指标较前减低；(3)治疗半月后复查肝脏CT,低密度影较前吸收；(4)粪检无巨片形吸虫虫卵排出.显效:符合以上标准中(1)、(2)、(3)、(4)四项；有效:必须有标准(1),加上(2)、(3)、(4)中任意一项；无效:不符合(1)、(2)、(3)、(4)中任意一项.结果 吡喹酮、甲苯咪唑、阿苯达唑治疗巨片形吸虫病无效,三氯苯达唑治疗18例巨片形吸虫病有效.结论 三氯苯达唑治疗巨片形吸虫病效果显著.     

2016年云南3例就诊片形吸虫病例报告

目的了解片形吸虫病例特征,为及时诊治提供参考。方法描述分析片形吸虫病3例患者的流行病学、临床表现、实验室检查、诊治及愈后。结果 3病例均有食生凉拌生菜史,粪便检查发现肝(大)片形吸虫卵。采用三氯苯达唑治疗片形吸虫病疗效显著,预后良好。结论片形吸虫病症状不典型,极易造成误诊,流行区应注意及时诊治。     

云南省首次暴发巨片形吸虫感染的临床诊治分析

目的分析云南省首次暴发巨片形吸虫(Fasciola gigantica)感染的临床诊治过程,为今后对该病的诊治提供参考。方法收集27例患者的发病、诊断和治疗资料。对患者及其家属和部分村民进行问卷调查,内容包括生食史和宠物饲养史等。采集各类动物粪便,使用粪便沉淀法和虫卵孵育法进行粪检。选择两户患者家饲养的牛各1头,剖检寄生虫感染情况。ELISA检测患者、患者家属和部分患者同村居民的血样。在患者居住的15个村庄附近(共选35个点)的溪流和水塘边,采集中间宿主螺类,检测感染情况。结果 27例患者,最早1例发病于2011年3月10日,最后1例发病于2012年1月10日。临床表现主要为不明原因发热、血红蛋白下降、嗜酸粒细胞增高、肝脾肿大等。粪检寄生虫卵均为阴性。先后给予抗菌、抗寄生虫治疗,均未见好转。经流行病学调查27例患者均有食生拌鱼腥草史。后经ELISA检测血清巨片形吸虫抗体,其中23例患者为阳性。2012年2月16日经反复粪检于4例患者粪便中查见巨片形吸虫卵。剖解牛的肝胆系统中查到巨片形吸虫虫卵及成虫。确诊该组病例为巨片形吸虫感染。给予三氯苯达唑[10 mg/(kg.d)×2 d]连服2 d,临床症状全部缓解,在宾川州城存在中间宿主尖膀胱螺(Physa acuta)、椭圆萝卜螺(斯氏萝卜螺)(Radix swinhoei)和小土蜗(Galba pervia)。结论人体感染巨片形吸虫较为少见,该病因无特异的临床表现而较难确诊,三氯苯达唑治疗效果良好。     

阿苯达唑和三氯苯哒唑对人体大片形吸虫的驱虫效果比较

目的 目的 比较阿苯达唑和三氯苯哒唑对人体大片形吸虫的驱虫效果。方法 方法 第1例患者口服阿苯达唑200 mg, 1日 2次, 连服5 d, 另1例患者每日顿服三氯苯哒唑片剂10 mg/kg, 连服2 d。收集2例患者服药后第1、 2、 5天的全量粪便 （共3 份）, 以及第2例患者服药前和服药期间的全量粪便 （共7份）, 采用尼龙袋集卵法收集虫卵, 并置于28 ℃水浴箱中孵化。结 结 果 果 第1例患者口服阿苯达唑后的第1、 2、 5天粪便中均检出片形吸虫卵, 经28 ℃水浴箱孵化, 持续观察25 d, 未见毛蚴孵 出, 也未见虫卵发育的迹象, 同时患者体温波动在37.4 ~ 38.3 ℃之间, 仍感腹痛。另1例患者在服用三氯苯哒唑前和服药 期间以及结束后第1天的粪便中检出虫卵, 服药结束后的第2、 5天粪便中未检出虫卵。服药前及期间排出的虫卵经28 ℃ 水浴箱孵化至第13天孵化出毛蚴; 而服药结束后第1天的虫卵持续观察25 d未见毛蚴孵出, 也未见虫卵发育的迹象, 同时 患者在服药结束后第4天症状和体征完全消失。结论 结论 阿苯达唑对大片形吸虫成虫短期内无明显的杀虫作用, 但可明显 影响虫卵的发育, 致使虫卵不能孵化出毛蚴; 三氯苯哒唑对人体大片形吸虫成虫和虫卵可能均有杀灭作用, 具有疗效好, 疗程短, 无明显不良反应的特点。     

三氯苯达唑治疗肝片形吸虫病例报告

报告1例肝片形吸虫患者采用三氯苯达唑、吡喹酮和阿苯达唑的治疗情况,吡喹酮和阿苯达唑对人肝片形吸虫病治疗无效,而三氯苯达唑能有效治疗。     

云南省65例片形吸虫病临床特点

收集2011年11月-2018年11月云南省6地(市)片形吸虫病病例的临床资料。65例病例中,男28例,女37例。职业以农民为主,占64.6%(42/65),民族以汉族为主,占89.2%(58/65),病例主要来自大理地区,占72.3%(47/65)。65例病例均食过凉拌生菜,6例喝过生的山沟箐水。18例涉及5户家庭,有家庭聚集现象。全部病例均因不同程度发热、腹痛等就诊,血常规均提示嗜酸粒细胞增高,腹部彩超或CT (和/或)MRI检查结果示,以肝脏为主不同程度的脏器损害;粪检片形吸虫卵阳性率23.1%(15/65),血清片形吸虫抗体检测强阳性58例,阳性7例,阳性率100%(65/65)。全部病例经三氯苯达唑治疗后发热、腹痛明显好转,血常规嗜酸粒细胞、肝脏等病变也恢复正常。     

巨片形吸虫26～28 kDa循环抗原的鉴定与特性分析

巨片形吸虫感染主要在亚洲、非洲、欧洲和澳洲部分地区的食草类动物中流行。以往主要用粪便检查虫卵的方法进行诊断,虽然有些血清学方法对其诊断有价值,但因与其它虫种有交叉反应使特异性降低。Attallah等利用特异性兔抗鼠血清抗体检测家畜血清中的循环抗原,并对其进行鉴定和纯化,建立了一种简便、快速、敏感、特异的检测巨片形吸虫的方法。从欧洲Damietta地区的一个屠宰场收集了36头牛血清,并保留其粪便和胆汁标本,先后制备巨片形吸虫成虫抗原、排泄 分泌抗原、曼氏血吸虫成虫抗原、人蛔虫成虫抗原、弓形虫抗原及巨片形吸虫抗原的兔抗鼠多…     

片形吸虫病研究进展北大核心CSCD

片形吸虫病(fascioliasis)是由片形吸虫(Fasciola spp.)感染引起的人兽共患病,可导致感染者肝、胆病理损伤;牲畜感染引起产奶、产肉量降低,造成经济损失,是影响中国公共卫生和畜牧业经济发展的重要问题。由于其症状与其他肝胆疾病类似,常被误诊。片形吸虫对三氯苯达唑耐药性的出现成为片形吸虫病防治的重大隐患,寻找敏感特异的诊断方法和有效的药物、疫苗成为片形吸虫病防治的重点。本文综述了片形吸虫病流行概况、诊断、药物治疗与耐药性。     

巨片形吸虫硫氧还蛋白过氧化物酶的克隆、表达和免疫学诊断价值评价

目的免疫筛选巨片形吸虫成虫c DNA表达文库,并克隆和重组表达巨片形吸虫硫氧还蛋白过氧化物酶(TPx),初步评价其免疫诊断价值。方法用巨片形吸虫病患者的混合血清免疫学筛选巨片形吸虫成虫λZAP c DNA表达文库,取阳性噬菌体进行克隆、测序及序列比对分析。将TPx基因全长片段和N段截短片段分别克隆至原核表达质粒p ET28a(+)中,用组氨酸标签亲和纯化柱(Ni-NTA树脂)纯化2种重组蛋白r Fg TPx和r Fg TPx_nt(N端截短型)。以间接ELISA法,检测27例巨片形吸虫病患者治疗前后的血清,15例日本血吸虫病和15例华支睾吸虫病的患者血清,32位健康人血清,评价重组蛋白的免疫诊断价值。结果克隆的巨片形吸虫TPx基因,经原核表达、纯化并复性,获得其可溶性重组蛋白r Fg TPx和r Fg TPx_nt,相对分子质量(Mr)分别为30 000和26 000。以重组蛋白r Fg TPx_nt为检测抗原的ELISA检测的敏感性为66.7%(18/27),特异性为96.8%(60/62),总符合率为87.6%(78/89),与日本血吸虫病和华支睾吸虫病患者血清的交叉反应率分别为0和1/15。巨片形吸虫病患者治疗前后血清的A450值分别为0.233±0.088和0.129±0.072,差异有统计学意义(t=4.27,P0.01)。结论筛选并克隆了巨片形吸虫TPx抗原基因,实现原核表达,并证明该重组蛋白作为人体巨片形吸虫病的免疫诊断抗原具有较好的诊断意义,亦有可能具有早期诊断和疗效考核价值。     

华支睾吸虫重组半胱氨酸蛋白酶用于血清学调查的效果评价

目的 以华支睾吸虫重组半胱氨酸蛋白酶(CsCp)为ELISA包被抗原检测流行人群血清特异性抗体水平,与成虫粗抗原比较,评价其用于华支睾吸虫病血清学调查的价值. 方法 以佛山市南海区的1个行政村为调查点,用改良加藤厚涂片法检查粪便华支睾吸虫虫卵.同时采集血清,分别以rCsCP与成虫粗抗原(CsCAA)的ELISA方法检测血清特异性抗体水平,对粪检及两种抗原的ELISA结果进行统计学分析. 结果 接受血清检测的97人中,华支睾吸虫虫卵阳性率60.8%,CsCAA-ELISA阳性率75.3%,rCsCP-ELISA阳性率76.3%,特异性抗体阳性率高于虫卵阳性率(P<0.05),不同抗原ELISA阳性率差异无统计学意义(P>0.05);CsCAA-ELISA、rCsCP- ELISA结果与粪检结果的符合率分别为56.7%和55.7%,两种抗原ELISA结果的符合率为82.5%.59例粪检阳性者CsCAA-ELISA和rCsCP-ELISA阳性率均为76.3%,38例粪检阴性者CsCAA-ELISA和rCsCP-ELISA阳性率分别为73.7%和76.3%. 结论 以rCsCP为包被抗原,用ELISA检测华支睾吸虫病流行区人群血清特异性IgG抗体与使用CsCAA的检测结果有较高的符合率,但同样不能区分现症与既往感染.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.