急诊经皮冠状动脉腔内成型术加冠脉支架置入术治疗老年急性心肌梗死的疗效与安全性评价

目的：观察急诊经皮冠状动脉腔内成型术加冠脉内支架置入术治疗老年急性心肌梗死的临床疗效和安全性。方法：对5例发病时间在2－6．5小时内，年龄＞70岁的急性心肌梗死患者作冠脉造影，确定梗死相关血管。在OEC9800下给予2．0－2．5mm直径球囊6－8atm预扩张后置入支架6枚。结果：5例患者支架置入均获成功。TIMI血流均达3级，无残余狭窄，无严重并发症。住院期间无再梗、心绞痛及死亡发生。结论：老年急性心肌梗死行急诊经皮冠状动脉腔内成型术加支架置入术临床疗效佳，是较好的抢救治疗手段。     

PTCA及冠脉内支架术治疗不稳定心绞痛

目的 探讨PTCA及冠脉内支架术治疗不稳定心绞痛的临床疗效、应用价值。方法 对7例经内科常规芗治疗不能缓解的不稳定心绞痛（UAP）行冠脉造影术,5例为双枝或多枝复杂病变,2例为单枝严重狭窄。对“罪犯”血管施行经皮冠脉腔内成形术（PTCA）,有残留狭窄而植入冠脉内支架。结果 7例全部成功,术后重复造影“罪犯”血管开通无残留狭窄。随3-4个月无心绞痛发作,恢复正常生活与工作。结论 PTCA及冠脉内支架术是治疗不稳定心绞痛的安全、有效的方法。     

经皮冠状动脉腔内成形术治疗不稳定型心绞痛的初步体会

目的　探讨不稳定型心绞痛 (U AP)患者在合理的药物治疗效果不佳时采用经皮冠状动脉 (冠脉 )腔内成形术 (PTCA)及冠脉内支架术治疗的临床应用价值。方法　对药物治疗疗效不佳的 U AP患者行冠脉造影术 ,根据冠脉造影结果对 2 8例患者的 33处病变进行介入性治疗 ,单支血管病变行 PTCA术 ,并酌情置入支架 ,对多支血管病变先判断“罪犯”血管 ,一般只处理“罪犯”血管。结果　手术成功率为 10 0 % ,病变狭窄程度由术前的 (87± 13) %降为术后的 (4± 10 ) % ,术后所有患者的心绞痛症状较术前明显减轻或消失 ,活动耐量显著增加。无严重并发症发生 ,随访期有 4例 (14.2 )复发心绞痛。结论　 PTCA及冠脉内支架术治疗 UAP是一种安全、有效的介入性治疗方法     

经皮冠状动脉介入治疗急性心肌梗死86例临床研究

目的探讨经皮冠状动脉介入治疗急性心肌梗死的手术方法和临床疗效。方法对86例ST段抬高型急性心肌梗死患者发病12h内行急诊经皮冠脉介入（PCI）,梗死相关动脉置入支架。结果86例成功行PCI,置入支架90枚,无严重并发症。术后即刻TIMI血流3级者80例（93％）,2级者6例（6．9％）,术后随访1～16个月,无心脏事件发生,无死亡病例。结论急性心肌梗死行急诊PCI成功率高,效果好,并发症少。     

经皮冠脉腔内成形术治疗不稳定心绞痛24例研究

目的 探讨经皮冠脉腔内成形术（PTCA）及冠脉内垤架术治疗不稳定心绞痛（UAP）的临床应用价值。方法,对药物治疗疗效欠佳的不稳定心绞痛患行冠脉造影术,单支血管病变行PTCA术并置入支架,双支或三支血管病变先判断“罪犯”病变血管,根据病情扩张包括“罪犯”病变血管在内的主要病变血管,可同期手术扩张双支血管或分期手术。结果 11例单支血管病变全部成功扩张后植入支架11枚,双支或三支血管病变中,3例患首期仅扩张了“罪犯”血管,均接受了二期手术,5例患同期手术扩张双支病变血管,5例患仅扩张了“罪犯”血管,PTCA成功率为96.8%,置入支架30枚,成功率100%,术后血管前向血流全部TiMi3级。结论 PTCA及冠脉内支架术治疗UAP疗效确切。安全系数大,多支血管病变即使行不完全血运重建亦能显缓解症状,减少病死率,提高生活质量,值得在基层医院推广。     

急性心肌梗死PTCA+ICS治疗观察

目的　评价急诊PTCA +ICS术治疗急性心肌梗死 (AMI)的疗效与安全性。方法　 38例AMI病人在入院 12h内接受PTCA +ICS术 ,共用球囊扩张 15例 ,置入支架 2 3例 ,术后即行冠状动脉造影评价梗阻血管血流情况 ,观察住院及近期临床事件。结果　 35例 (92 1% )病人梗死相关动脉 (IRA)重建TIMIⅢ级 ,全部病例IRA残余狭窄 <10 % ,皮下血肿 2例 ,无脑出血及死亡病例。结论　急性PTCA +ICS术治疗急性心肌梗死成功率高 ,住院及近期临床效果好 ,是抢救及挽救濒死心肌的安全可靠方法。     

PTCA术后再狭窄不同介入方法治疗效果观察

目的探讨经皮冠状动脉内血管成形术(PTCA)术后冠脉再狭窄临床治疗效果。方法已进行过至少一次PTCA,临床和冠脉造影有再狭窄证据的患者共38例,再行PTCA19例(简称PTCA组),行冠脉内支架置入术19例(简称支架组)。结果术后6个月,设定第一观察终点为冠脉造影再狭窄(定义为狭窄率超过管腔内径的50%),第二观察终点为死亡、Q波心肌梗塞、冠脉搭桥术及目标血管再成形术。术后6个月,PTCA组再狭窄率明显高于支架术组(33%vs8%,P<0.05);目标血管再成形术发生率PTCA组为21%而支架组仅为10.5%(P≤0.001);PTCA组平均最小血管腔内径为(1.85±0.56)mm,而支架组为(2.14±0.66)mm,前者比后者平均小0.29mm(P<0.01);亚急性血栓发生率PTCA为0,支架组为5.2%。随访10个月无事件生存率PTCA组为73.6%,支架组为89.4%(P<0.05)。结论冠脉支架置入术治疗PTCA术后再狭窄优于再次PTCA。     

冠状动脉支架术后应用低分子肝素抗凝的疗效观察

目的：观察经皮腔内冠状动脉成形术(PTCA) 支架置入术后应用低分子肝素抗凝与普通肝素相比的安全性及有效性.方法：对76例冠心痛患者置入96个支架．在1个月的短期随访中,观察术后低分子肝素抗凝和普通肝素对PTCA 支架术后各种心脏事件发生的影响及其副作用。结果：在PTCA 支架术后,皮下应用低分子肝素可使各种心脏事件发生率降低,未发生严重出血并发症及支架内血栓。结论：PTCA 支架术后使用低分子肝素代替普通肝素是安全有效的。     

冠心病介入治疗的临床应用分析

目的 分析冠心病介入治疗的临床价值。方法 从1998年2月－2000年7月,共有30例患（男18例,女12例）,造影显示冠状动脉狭窄程度均≥50％,2例单纯行球囊扩张术,28例行冠脉支架术。结果 42枚支架植入28例患中,支架全部置入成功,1例左主干病变直接支架置入成功。44支相关冠脉再通成功,成功率84．69％。术后冠脉造影显示管腔扩张满意。随访1－28个月,心绞痛症状较术前明显减轻或消失,未发生并发症,1例术后3月发生猝死。结论 由于支架的应用,扩大了PTCA的适应症,减少了PTCA的并发症。选择性左主干病变直接置入支架,安全,有效,可行。     

慢性肾功能不全合并急性心肌梗死行PTCA术临床分析

目的 分析慢性肾功能衰竭合并急性心肌梗死临床表现,并评价行PTCA及支架术临床疗效。方法 我们对1992年至2002年12例行PTCA术的慢性肾功能不全合并急性心肌梗死病例进行回顾性分析。结果 12例患者心肌酶谱中LDH、CK、CKMB、LD1等均有不同程度地升高,8例患者CK-MB阳性,9例患者肌钙蛋白测试,结果都呈阳性;PTCA示3支病变者9例,2支病变者3例。12例患者血管术前狭窄为80％～90％,术后残余狭窄为5％～10％,冠脉血流从TIMI O～Ⅰ级全部达到TIMI Ⅲ级,其中7例置入支架。冠脉造影前血Cr(281.6±128.8)μmol/L,冠脉造影后血Cr(366.8±164.3)μmnol/L。结论慢性肾功能不全患者合并急性心肌梗死时,PTCA及支架植入术是行之有效的治疗方法,但在氮质血症期,PTCA时非离子型造影剂近期会导致肾功能进一步减退。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.