CT测量透明隔腔宽度在诊断新生儿缺氧缺血性脑病的价值及临床意义

目的:探讨新生儿头颅CT测量透明隔腔(CSP)宽度在诊断新生儿缺氧缺血性脑病(HIE)的价值及临床意义.方法:对11O例新生儿脑CT与临床资料进行回顾分析,其中新生儿HIE 80例,新生儿单纯蛛网膜下腔出血20例,新生儿头颅CT正常10例,讨论HIE的CT征象与透明隔腔(CSP)宽度的关系.结果:在新生儿HIE 80例中轻度38例、中度26例、重度16例,CSP宽度分别为:3.75～5.63±0.31 mm、6.09-7.50±0.22 mm、大于8.30 mm.CSP在2.0 mm以下者20例,脑组织密度无明显改变,仅有轻微蛛网膜下腔出血.新生儿脑CT CSP闭合者10例,脑CT提示脑组织密度正常,无HIE发生.结论:CSP是新生儿脑内中线结构,新生儿HIE的程度与CSP的宽度成正比,CSP越宽,HIE程度就越重,CSP增宽是新生儿脑组织发育不全的佐证,可以导致HIE的发生.     

超声心动图对川崎病和正常儿童冠状动脉检测的对比研究

目的本文对81例川崎病患儿的冠状动脉与65例正常儿童的冠状动脉进行了超声检测的对比研究,旨在探讨超声对川崎病及临床非典型病例冠状动脉异常改变的诊断价值。方法对81例川崎病患儿和65例正常儿童的冠状动脉进行了超声检测对比。结果正常儿童的左冠状动脉内径（LCA）1.95-2.45 mm,平均2.2±0.25 mm,LCA/AO=0.145±0.016（AO为主动脉内径）;右冠状动脉内径（RCA）1.6-2.0 mm,平均1.8±0.18 mm,RCA/AO=0.12±0.016。而川崎病的左冠状动脉内径（LCA）2.5-6.7 mm,平均3.4±0.94 mm,LCA/AO=0.24±0.075;右冠状动脉内径（RCA）2.5-10 mm,平均3.8±1.68 mm,RCA/AO=0.25±0.094。两组对比差异有统计学意义（P〈0.01）。结论超声对川崎病冠状动脉病变的诊断是一项安全无创、快捷可靠和能重复检查的最佳首选方法,且对非典型病例的诊断有决定性意义。认为,L.RCA/AO〉0.17为冠状动脉扩张,L.RCA/AO〉0.30为冠状动脉瘤形成。     

血清神经元特异性烯醇化酶缺血修饰蛋白与新生儿缺氧缺血性脑病严重程度的相关性分析

目的 探讨血清神经元特异性烯醇化酶（NSE）、缺血修饰蛋白（IMA）与新生儿缺氧缺血性脑病（HIE）病情严重程度的关系。方法 选择2016年3月至2017年2月潮州市中心医院新生儿科收治的81例HIE患儿作为HIE组,根据病情轻重,将HIE组分为轻度HIE组32例、中度HIE组24例及重度HIE组25例;选择同期30例正常足月新生儿作为对照组。分别检测对照组生后1~2 d及3组患者HIE急性期与恢复期血清NSE、IMA水平,分析两者与HIE病情严重程度的关系。采用Pearson相关分析,分析三组HIE急性期及恢复期NSE、IMA的相关性。结果 3组HIE急性期及恢复期NSE、IMA均高于对照组,差异有统计学意义（P<0.05）。其中重度HIE组急性期NSE、IMA[（61.14±30.8）μg/L,（97.26±2.46） U/mL]高于中度HIE组[（40.30±10.81）μg/L,（93.08±1.90） U/mL]及轻度HIE组[（18.75±1.40）μg/L,（83.75±0.78） U/mL],差异均有统计学意义（P<0.05）。恢复期重度HIE组NSE,IMA[（20.81±9.57）μg/L,（83.34±2.01） U/mL]及中度HIE组[（21.14±7.04）μg/L,（82.28±2.17） U/mL]均高于轻度HIE组[（10.89±5.14）μg/L,（73.17±1.91） U/mL],差异均有统计学意义（P<0.05）。Pearson相关性显示,三组患者HIE急性期,恢复期NSE与IMA均呈正相关（P<0.05）。结论 血清NSE与IMA水平的变化与HIE病情严重程度正相关。     

利多卡因联合多巴胺治疗新生儿缺氧缺血性脑病

目的 探讨多巴胺与利多卡因联合对新生儿缺血缺氧性脑病（HIE）的治疗作用及预后改善的临床意义。方法 将2004年6月至2006年10月我院收住的足月中、重度HIE患儿，随机分为治疗组和对照组各45例，对照组采用常规治疗，治疗组在常规治疗的基础上加用利多卡因和多巴胺，治疗期间严密观察患儿神经系统症状和体征，并进行神经行为评分，比较两组病例的近期治疗效果。结果 对照组惊厥发生40例（89％）、惊厥持续（8．79±6．84）d、住院时间（14．36±6．67）d、预后不良率34％，均较治疗组为差，两组的总有效率分别为66．7％和91．1％，差异有统计学意义（P〈0．01）。结论 多巴胺与利多卡因联合对新生儿中、重度HIE有一定的协同治疗作用，尤其对患儿症状控制及预后改善有明显效果。     

新生儿缺氧缺血性脑病血清NSE和VILIP-1水平变化及意义

目的 探讨新生儿缺氧缺血性脑病（HIE）血清神经元特异性烯醇化酶（NSE）和视椎蛋白样蛋白1（VILIP-1）水平变化及意义。方法 选取2012年3月至2015年4月在郑州市儿童医院住院治疗的136例HIE患儿,根据病情分为轻度（n=58）、中度（n=46）、重度（n=32）,同期,选取正常新生儿45例作为对照组,HIE患儿分别于出生后第24小时（T₀）、48小时（T₁）、72小时（T₂）和7天（T₃）时,对照组于T₀时,检测血清中NSE和VILIP-1水平,HIE患儿和对照组均于T₀时,进行新生儿行为神经测定（NBNA）评分。结果 HIE患儿T₀时血清NSE和VILIP-1水平分别为（28.82±6.34）、（0.91±0.26）μg/L,均高于对照组的（13.94±2.82）、（0.38±0.15）μg/L,NBNA评分为（33.83±2.25）分,低于对照组的（38.24±2.41）分,差异均有统计学意义（P<0.05）;Pearson相关分析显示,HIE患儿T₀时血清NSE水平与VILIP-1水平呈正相关（r=0.612,P<0.05）,血清NSE和VILIP-1水平均与NBNA评分呈负相关（r=-0.481、-0.440,P<0.05）;与轻度相比,中度和重度患儿T_0～3时血清NSE和VILIP-1水平均升高,且重度均高于中度,差异均有统计学意义（P<0.05）。结论 HIE患儿血清NSE和VILIP-1水平升高,动态监测血清NSE和VILIP-1水平对HIE早期诊断、病情判定及治疗效果评估具有重要意义。     

联合检测CD64 CRP和PCT对早期诊断新生儿败血症的意义

目的 探讨联合检测中性粒细胞CD64、C-反应蛋白（CRP）和降钙素原（PCT）在早期诊断新生儿败血症中的临床意义。方法 选取2015年1月至2018年9月安徽省儿童医院收治的80例败血症患儿作为观察组,同期选择80例非感染性疾病患儿作为对照组。分别采用流式细胞术、固相免疫测定法、免疫透射比浊法对两组患儿中性粒细胞CD64表达、血清PCT水平、CRP水平进行检测,比较3种独立检测和联合检测的灵敏度、特异度、阳性预测值及阴性预测值;比较观察组治疗前后中性粒细胞CD64、PCT、CRP水平的变化。结果 观察组中性粒细胞CD64[（7.68±1.40）比（1.65±0.25）]、CRP[（98.92±36.63）mg/L比（7.52±3.71）mg/L]及PCT[（28.31±17.77）μg/L比（0.35±0.10）μg/L]水平均高于对照组（P<0.05）。另三者联合诊断新生儿败血症的灵敏度、阳性预测值、阴性预测值以及准确度最高,分别为70.1%、74.3%、91.8%、87.4%,均高于中性粒细胞CD64、PCT及CRP单独检测。败血症新生儿治疗后中性粒细胞CD64、CRP和PCT水平低于治疗前（P<0.05）。结论 联合中性粒细胞CD64、CRP及PCT检测能有效提高新生儿败血症早期诊断率。     

新生儿游泳100例在临床应用的分析

目的 探讨在住院期间新生儿游泳后体重增长，胎便转黄时间等指标变化的临床意义。方法 将200例正常新生儿按分娩顺序分为观察组（游泳组）100例，全部是阴道分娩；对照组（单纯沐浴组）100例，全部是阴道分娩。测定两组新生儿的出生体重，出院时体重、胎便转黄时间。结果 两组新生儿出生时体重无明显差异（P〉0．05），观察组新生儿出院时平均体重（3250±310）g，对照组新生儿出院时体重平均（3020±430）g，两组比较差异有显著性（P〉0．05）。观察组胎便转黄时间（36．86±8.94）h，对照组胎便转黄时间（46．89±14．97）h，两组比较差异有显著性（P〈0.01）。结论 新生儿游泳有助于新生儿体重增加，加速胎便排出，有利于新生儿生长发育。     

脑血流阻力指数监测在窒息新生儿中的应用

目的研究新生儿窒息患儿脑血流阻力指数(RI)变化,并探讨其临床意义。方法运用彩色多普勒超声于生后18～24h内对336例新生儿窒息患儿行RI检测,并与同期345例正常足月儿对照。结果新生儿窒息不伴缺氧缺血性脑病(HIE)患儿RI与同期正常足月儿相比无明显差异,新生儿窒息伴HIE患儿存在血流动力学紊乱,RI降低,降低的程度与病情程度密切相关。结论运用彩色多普勒超声检测新生儿窒息患儿RI,有利于HIE的早期诊断及病情判断,对指导治疗具有重要意义。     

新生儿缺血缺氧性脑病患儿血清CCL5 GM-CSF表达及其与预后相关性

目的 探究新生儿缺血缺氧性脑病（HIE）患儿血清趋化因子5（CCL5）、粒细胞-巨噬细胞集落刺激因子（GM-CSF）的表达水平及与预后的关系。方法 选取2015年1月至2019年5月在海南省妇女儿童医学中心诊治的82例HIE患儿作为患病组,根据患儿病情严重程度,分为轻度组（31例）、中度组（26例）与重度组（25例）,另取同期60例健康新生儿作为健康组。采用酶联免疫吸附法检测受试者血清中CCL5、GM-CSF的表达水平,采用新生儿神经行为测定（NBNA）评分评估各组新生儿的神经系统的发育情况,分析血清CCL5、GM-CSF之间及二者与NBNA评分的相关性;采用格塞尔发育量表（GDS）评估患儿预后情况,并分析其与CCL5、GM-CSF表达的关系。结果 HIE患儿血清CCL5、GM-CSF的表达水平分别为（83.41±10.95）ng/L、（52.27±11.71）pg/mL,与健康组相比,差异有统计学意义（P<0.05）。随着病情加重,HIE患儿血清中CCL5表达水平升高,GM-CSF表达水平下降,差异有统计学意义（P<0.05）。HIE患儿血清CCL5与NBNA评分呈负相关（r=-0.318,P<0.05）,GM-CSF水平与NBNA评分呈正相关（r=0.338,P<0.05）,CCL5水平与GM-CSF水平呈负相关（r=-0.359,P<0.05）。对HIE患儿随访1年,CCL5高表达患儿GDS评分低于CCL5低表达患儿, GM-CSF高表达患儿GDS评分高于GM-CSF低表达患儿,差异有统计学意义（P<0.05）。结论 血清CCL5在HIE患儿中表达上调,GM-CSF在HIE患儿中表达下调,二者水平与HIE患儿预后有关,可能作为评价HIE患儿预后的潜在标志物。     

新生儿缺氧缺血性脑病血清IL-8水平与脑血流变化的临床研究

目的 研究新生儿缺氧缺血性脑病（HIE）血清IL-8、脑血流变化水平与HIE脑损伤程度关系。方法采用双抗体夹心ELSIA法检测41例不同程度HIE患儿、14例正常新生儿血清IL-8水平，同时采用经颅多谱勒超声（TCD）技术观察双侧大脑中动收缩峰流速（Vs）、舒张末期流速（Vd）、脉动指数（RI）。结果 HIE患儿血清IL-8水平明显高于对照组（P〈0．01），重度组增高尤其明显；中、重度组Vd、Vs低于对照组，RI指数重度组高于对照组（P〈0．05）。相关分析发现，急性期患儿血清IL-8水平与脑血流速度呈负相关，与脉动指数（RI）呈正相关。结论 检测血清IL-8和脑血流变化对判断HIE病情严重程度、指导治疗有一定临床意义。     

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.