鼻用糖皮质激素治疗儿童阻塞性睡眠呼吸暂停低通气综合征临床分析

目的:探讨鼻用糖皮质激素对儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的治疗效果。方法:符合条件的OSAHS患儿96例,根据多导睡眠监测结果分成轻度OSAHS组32例,中重度OSAHS组64例。所有患儿经鼻用糖皮质激素喷鼻,连续用药1月以上,1月后进行多导睡眠监测复查。结果:轻度OSAHS组睡眠呼吸监测呼吸暂停低通气指数(AHI)经鼻用糖皮质激素喷鼻剂治疗1月后由治疗前的8.43±1.32降低为治疗后的3.23±1.32,差异有统计学意义(P<0.05);中重度OSAHS组治疗前AHI为26.32±8.56,治疗后为17.32±4.22,差异无统计学意义(P>0.05)。结论:鼻用糖皮质激素对儿童OSAHS治疗有一定疗效,尤其对于轻度OSAHS患儿,对于中重度OSAHS患儿疗效不显著。     

腺样体扁桃体切除术对儿童睡眠结构和生活质量的影响

目的探讨腺样体扁桃体切除术对儿童睡眠结构和生活质量的影响。方法回顾性分析我院2008年3月至2012年3月收治入院的阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患儿行腺样体扁桃体切除术100例,对100例OSAHS患儿术前及术后1个月行多导睡眠监测(PSG)和生活质量调查(OSA-18),分析手术治疗前后宏观和微观睡眠结构的变化。结果本组100例患者手术前后最低SaO2情况和觉醒指数(AI)变化比较差异具有显著性意义(P均<0.01);100例患儿手术前后睡眠障碍、身体症状、对监护人的影响以及OSA-18总分等均较手术前明显提高,且差异有显著性意义(P均<0.01)。结论腺样体扁桃体切除术能明显改善OSAHS患儿的睡眠结构和生活质量。     

鼻用糖皮质激素治疗阻塞性睡眠呼吸暂停低通气综合征临床分析

目的 探讨鼻用糖皮质激素治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的效果。方法 56例经多导睡眠监测(PSG)确诊的OSAHS患者随机分为轻度OSAHS组18例,中重度OSAHS组38例。所有患者连续用鼻用糖皮质激素喷鼻28 d,28 d后行PSG复查。结果 经鼻用糖皮质激素治疗28 d后轻度OSAHS组呼吸暂停低通气指数(AHI)由治疗前的(10.7±2.6)降低为治疗后的(8.8±2.2),差异有统计学意义(P<0.05);中重度OSAHS组治疗前AHI为(42.1±2.3),治疗后为(41.5±3.0),差异无统计学意义(P>0.05)。结论 鼻用糖皮质激素对轻度OSAHS有一定疗效,值得进一步研究。     

手术治疗儿童阻塞性睡眠呼吸暂停低通气综合征临床疗效分析

目的:探讨扁桃体和(或)腺样体切除术治疗儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的临床疗效.方法:经多导睡眠检测(polysomnography,PSG)证实的儿童OSAHS患儿共61例,行单纯扁桃体切除1例,扁桃体伴腺样体切除53例,单纯腺样体切除7例.术后随访3～6个月,采用儿童OSA-18生活质量调查表(quality of life for children with obstructive sleep apnea-18 items,OSA-18)评价临床疗效.结果:术后大多数患儿打鼾、睡眠呼吸暂停、张口呼吸等主要症状得到明显缓解,生活质量调查表(OSA-18)显示:生活总体指标(85.25%)、睡眠呼吸障碍(96.72%)、身体症状(81.96%)均得到明显改善.结论:扁桃体和(或)腺样体切除术是治疗儿童OSAHS的有效方法,可有效预防并发症,改善患儿术后的生活质量.     

低温等离子刀辅助内镜下治疗大龄儿童阻塞性睡眠呼吸暂停低通气综合征的临床效果分析

目的比较低温等离子刀辅助内镜下切除腺样体和部分切除双扁桃体(A)和传统剥离法切除扁桃体、刮匙法刮除腺样体(B)的治疗大龄儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)手术效果差异。方法 65例OSAHS的6~12岁患儿,其中32例采用A术式,33例采用B术式,采用t检验比较两组手术时间、术中出血量。患儿手术前及术后12个月采用多导睡眠监测(PSG)评估打鼾症状。结果等离子刀组的手术时间较传统手术组显著缩短,出血量较后者显著减少(均P<0.01),PSG监测结果显示两组在疗效上均为有效。结论低温等离子刀辅助内镜下切除腺样体和部分切除双扁桃体能显著缩短手术时间、减少出血量,术后疗效满意。     

中重度睡眠呼吸暂停低通气综合征患者白天嗜睡与生活质量的关系

目的 探讨中重度睡眠呼吸暂停低通气综合征(OSAHS)患者白天过度嗜睡(EDS)程度与生活质量的关系.方法 选择多导睡眠图(PSG)确诊的中重度OSAHS患者123例为病例组,同期PSG排除OSAHS的良性打鼾患者52例为对照组.以Epworth嗜睡评分(ESS)量表表示患者EDS程度,Calgary生活质量指数(SAQLI)评价中重度OSAHS患者生活质量,比较两组患者一般资料、PSG结果和SAQLI总分及各项评分.结果 中重度OSAHS患者与对照组相比,体质量指数(BMI)、呼吸紊乱指数(RDI)、最低氧饱和度( LSpO2)、最长呼吸暂停时间(Tmax)和氧饱和度低于90％时间占总睡眠时间(T90)、ESS评分和SAQLI总分及各项评分等均存在显著性差异.ESS评分与SAQLI总分及各项评分呈显著相关.结论 中重度OSAHS患者存在EDS;中重度OSAHS的EDS与生活质量降低有关;EDS可能在一定程度上反映了中重度OSAHS患者的生活质量下降.     

鼻喷激素联合白三烯受体拮抗剂治疗儿童OSAHS的效果观察

目的探讨鼻喷激素联合白三烯受体拮抗剂治疗儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床效果.方法90例OSAHS患儿,采用随机数字表法分为对照组和观察组,各45例.对照组采用鼻喷激素进行治疗,观察组采用鼻喷激素联合白三烯受体拮抗剂治疗.比较两组患者的临床疗效、治疗后疾病特异性生活质量调查表(OSA-18)评分及治疗前后呼吸暂停低通气指数(AHI)、动脉血氧饱和度(SaO2).结果观察组总有效率97.8%明显高于对照组的80.0%,差异有统计学意义(P<0.05).治疗前,两组AHI和SaO2比较,差异无统计学意义(P>0.05);治疗后1个月,观察组AHI、SaO2均明显优于对照组,差异有统计学意义(P<0.05).治疗后,观察组睡眠问题、身体不适、情绪问题、日间问题评分分别为(13.21±2.31)、(14.42±2.74)、(10.41±2.01)、(9.21±2.08)分,均低于对照组的(14.52±2.41)、(15.67±2.87)、(11.94±1.92)、(10.11±1.94)分,差异有统计学意义(P<0.05).结论鼻喷激素联合白三烯受体拮抗剂治疗儿童OSAHS的临床效果显著,可明显提高患儿的生活质量,值得推广.     

宜宾市6~12岁儿童阻塞性睡眠呼吸暂停低通气综合征患病情况及生活质量调查

目的 调查宜宾市6~12岁儿童阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患病情况,了解患病特征和OSAHS患儿生活质量,为OSAHS防治和开展健康宣教提供指导依据。方法 于2018年1~6月采用分层整群抽样方法,抽取宜宾市6~12岁儿童1 903例,采用Berlin问卷进行OSAHS初筛,初筛阳性儿童94例,纳入OSAHS组,1 825例正常儿童纳入非OSAHS组。对初筛阳性的儿童进行多导睡眠监测（PSG）确诊,了解OSAHS患病情况,将初筛阳性的儿童根据体型分为体型正常组（51例）和超重肥胖组（43例）,用睡眠呼吸障碍儿童生活质量问卷（OSA-18）量表评估两组患儿生活质量,分析不同体型患儿的PSG监测指标和生活质量的差异。结果 Berlin问卷初筛阳性94例,阳性率4.94%,男性高于女性,差异有统计学意义（P<0.05）,PSG确诊78例,OSAHS总体患病率4.10%。超重肥胖组呼吸暂停指数、低通气指数、呼吸暂停低通气指数、阻塞性呼吸暂停指数均高于正常体型组,而平均血氧饱和度和最低血氧饱和度均低于正常体型组,差异均有统计学意义（P<0.05）。OSAHS患儿体质指数、颈围、收缩压和舒张压均高于非OSAHS儿童（P<0.05）。超重肥胖组OSA-18总分,睡眠问题、情绪问题及日间问题3个维度高于正常体型组,差异有统计学意义（P<0.05）。结论 宜宾市6~12岁儿童OSAHS患病率约4.10%,超重肥胖者PSG指标和生活质量明显差于正常体型者,应重视健康教育和行为干预。     

鼻部手术对阻塞性睡眠呼吸暂停综合征治疗的意义

目的探讨鼻部手术对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的治疗意义。方法34例OSAHS患者均经PSG、鼻内镜、鼻咽纤维镜检查确诊,同时存在鼻阻塞性病变并行鼻部相关手术。术后2月复查PSG,26例无效患者再联合UPPP。结果34例患者鼻部手术后2月行PSG检查有效8例,术前AHI 11．9±5．8,最低SaO2 87．8±2．9,术后AHI 5．8±5．2,最低SaO2 91．8±4．4,均为轻度OSAHS。26例无效病例再联合UPPP术,术后半年复查PSG,AHI有明显改善。随访1年均无复发。结论单纯鼻部手术对部分以鼻阻塞为主的轻度OSAHS有效。术后再行睡眠监测对是否选择联合腭咽手术有指导意义。     

改良腭帆成形术治疗轻、中度阻塞性睡眠呼吸暂停低通气综合征疗效

目的 探讨改良腭帆成形术(VPP)治疗轻、中度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效.方法 32例腭咽平面狭窄、扁桃体占据气道＜50％的轻、中度OSAHS患者,随机均分为两组:A组行改良腭咽成形术(H-UPPP);B组行VPP术.术前1d及术后6个月行多导睡眠检测(PSG),填写Epworth嗜睡量表(ESS)及鼾声视觉模拟评分(VAS).结果 两组术后睡眠呼吸暂停低通气指数(AHI)、最低血氧饱和度(LSaO2)、ESS评分及VAS评分均明显改善(P＜0.05).B组术后VAS评分较A组改善明显[(-4.38±0.46)分vs.(-3.63±1.02)分](P＜0.05).结论 对腭咽平面狭窄且无扁桃体肥大的轻中度OSAHS患者行改良VPP术,在保证疗效的同时降低了患者术后鼾声.     

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.     

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.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

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.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.