高危组急性肺栓塞分层诊断相关因素的分析

目的：探讨临床表现、辅助检查及多种评分体系对高危组急性肺栓塞（ APE）分层诊断的价值。方法收集苏州大学附属第一医院2006年6月至2013年3月确诊的43例急性肺栓塞患者资料。其中男25例,女18例,平均年龄（59．49±16．49）岁,依据相关标准将患者再分为高危、中危及低危亚组。比较高危、中危、低危APE患者在症状学、常规辅助检查、修订后Ge-neva评分、急性肺栓塞严重指数（ PESI）及APACHEⅡ评分的特征及差异,并绘制ROC曲线探讨相关因素对高危组急性肺栓塞的诊断价值。结果高危组急性肺栓塞与中危组急性肺栓塞相比,其心率、PESI、超敏C反应蛋白（ HsCRP ）较高（ P＜0．05）;根据ROC曲线,PESI最佳界值为97分,其对应诊断高危组APE的灵敏度和特异度分别为100％和81．5％;心率最佳界值为每分钟94次,其诊断高危组APE的灵敏度为91．7％,特异度为55．6％;HSCRP最佳界值为13．7 mg/L,对诊断高危组APE的灵敏度及特异度分别为88．3％和77．8％。结论 PESI对高危组急性肺栓塞分层诊断、病情评估具有较好的参考价值。     

血浆脑钠肽、肌钙蛋白I联合D-二聚体检测在急性肺栓塞中的临床意义

目的探讨联合检测急性肺栓塞（APE）患者的血浆脑钠肽（BNP）、肌钙蛋白I（cTnI）及D-二聚体（D-dime）r水平在急性肺栓塞诊治中的意义。方法 2011年12月～2012年11月间经256层螺旋CT肺动脉成像确诊的急性肺栓塞患者48例,分为大面积肺栓塞组和非大面积肺栓塞组,测定2组患者血浆cTnI、BNP及D-dimer水平。比较分析2组间测值水平的差异及2组间右心功能及病死率的差异。结果 48例APE患者中,大面积肺栓塞组21例,非大面积肺栓塞组27例,大面积肺栓塞组血浆cTnI、BNP浓度明显高于非大面积肺栓塞组,2组间差异有统计学意义（P〈0.05）;而D-dimer浓度在2组间差异无统计学意义（P=0.121）;大面积肺栓塞组发生右心功能不全者和病死率均高于非大面积肺栓塞组,差异有统计学意义（P=0.001）。结论联合应用BNP、cTnI及D-dimer浓度水平对APE患者诊断有一定的价值,在APE患者早期危险分层、临床决策及预后判断中具有重要的临床意义。     

急性肺栓塞的临床研究与分析

目的分析急性肺栓塞（APE）的临床特点以及诊疗措施。方法对2010年9月至2012年9月收住院22例APE患者的临床表现、心电图及辅助检查进行综合分析。结果 APE患者常见的临床表现为呼吸困难、胸痛、咯血、晕厥等,心电图常见SIQⅢTⅢ结合胸部CT等辅助检查,可使APE的确诊率明显提高,漏诊率及误诊率显著下降。结论对临床表现可疑APE的患者及时行心电图、彩色超声、胸部CT、肺动脉造影,动态观察其变化趋势,可及早确诊,尽早治疗,降低死亡率。     

脑钠肽和肌钙蛋白I联合检测对急性肺栓塞预后评估的意义

目的探讨急性肺栓塞（APE）患者血浆脑钠肽（BNP）和肌钙蛋白I（cTnI）水平对预后评估的价值。方法20例APE患者通过胸部增强螺旋CT、肺核素扫描、磁共振确诊。结果BNP〉100pg／mL的患者共8例，BNP〈100pg／mL的患者共12例，BNt，升高组心源性休克发生率及院内死亡率均高于BNP正常组（P〈0．05），且BNP水平与右心室舒张末内径显著相关（r=0．739）。，cTnI〉0．05ng／mL的患者共9例，cTnI〈0．05ng／mL的患者共ll例，cTnI水平与APE患者心血管不良事件显著相关（OR=27．65，95％CI=4．67％～148．65％）。结论BNP和cTnI可作为判断APE的预后指标，有助于明确危险分层，指导治疗。     

小剂量rt-PA治疗老年急性肺栓塞17例

近年来，随着医学诊断技术及水平的不断提高，临床确诊急性肺栓塞（APE）的患者逐年增多。其中老年人似呈递增趋势。静脉溶栓治疗是公认降低APE病死率和致残率的有效方法。我院应用小剂量（50mg）重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗17例老年APE患者，效果较好。     

急性肺栓塞快速临床诊断探讨

目的探讨临床综合评价结合血清D-二聚体测定及增强CT在快速诊断急性肺栓塞中的应用价值。方法通过回顾性分析，对近6年我院内科收住的70例急性肺栓塞（PE）疑诊患者（治疗组）和我县中医院内科同期收住的43例急性肺栓塞（PE）疑诊患者（对照组）进行总结。对照组43例疑诊患者主要通过胸片、彩超、动脉血气分析、心电图结合临床症状，体征作为主要诊断手段，治疗组70例疑诊患者采用临床综合评价（包括病史、症状、体征及胸片、心电图等）结合血清D-二聚体测定及增强CT新诊断方法。结果对照组43例疑诊患者确诊6例，治疗组70例疑诊患者确诊23例，应用临床综合评价结合D-二聚体测定及增强CT新诊断方法后确诊率明显上升。结论临床综合评价结合血清D-二聚体测定及增强CT检查是快速准确诊断急性肺栓塞（PE）的较好方法，且均为无创性检查，值得基层推广。     

主动脉夹层62例分析

目的：探讨主动脉夹层的临床特点和诊治方法，提高诊治水平，降低病死率。方法：分析62例主动脉夹层患者的病因、I临床表现、确诊手段及治疗方法。结果：AD患者中合并高血压者占67．7％，血压控制均未达标；主要首发症状为突发性撕裂样剧烈疼痛；MRI、增强CT的诊断符合率高（100％）。结论：以突发剧痛就诊，尤其有高血压者，应考虑主动脉夹层的诊断，可行MRI或增强CT检查确诊；药物治疗的首要问题是稳定控制血压并达到目标要求。     

IMA与SCUBE1联合检测在急性肺栓塞诊断中的价值

目的 探讨联合检测缺血修饰性白蛋白（IMA）与新型血小板活化蛋白血浆内皮生长因子样单链蛋白1相关补体Clr/Cls单肽（SCUBE1）在急性肺栓塞（APE）诊断中的价值。方法 收集2013年6月至2017年3月邢台市第三医院呼吸科就诊的APE患者130例为病例组；同时选取同期健康体检者为对照组（48例）。比较分析病例组和对照组血清中IMA和血浆中SCUBE1的水平，并用ROC曲线分析IMA、SCUBE1指标单独和联合应用对诊断APE的价值。结果 病例组患者IMA和SCUBE1水平均高于对照组，差异有统计学意义（P<0.05）。IMA单独诊断APE的敏感度和特异度分别为66.92%、77.08%；SCUBE1单独诊断APE的敏感度、特异度分别为67.69%与72.91%；IMA与SCUBE1联合检测诊断APE的敏感度、特异度分别为76.92%和85.42%。IMA、SCUBE1指标单独及联合应用诊断APE的ROC曲线的曲线下面积分别为0.796、0.839和0.888。结论 血清IMA和血浆SCUBE1均可作为诊断APE的生物标志物，在APE诊断中具有重要价值，同时检测二者有利于APE的诊治。     

循证护理及综合护理在急性肺栓塞诊治中的应用

目的：探讨循证护理及综合护理的综合干预在急性肺栓塞（ APE）诊治中的应用效果。方法将住院APE 104例,随机分为2组,观察组和对照组,每组52例。观察组：实施循证护理和综合护理的综合干预;对照组：仅实施内科常规护理。比较2组的确诊时间、住院天数及护理满意度。结果观察组明显优于对照组,观察组平均确诊天数（1?．7±0．2）d vs （8．8±0．3）d,平均住院天数为（12．9±2．7）d vs（18．5±2．3）d,护理满意度为98．1％ vs 77％,2组差异均有统计学意义（ P ＜0．05）。结论经过循证护理及综合护理的综合干预,缩短了APE的确诊时间,得到了及早救治,缩短了住院天数,对康复具有促进作用,提高了护理满意度。     

急性肺栓塞29例临床分析

目的探讨急性肺栓塞（acutepulmonaryembolism,APE）的临床特点、危险因素、检查、诊断、治疗,以提高该病的诊治水平。方法本院2008年1月至2009年3月入院并确诊的29例肺栓塞患者的临床表现、危险因素、检查、诊断、治疗方法进行分析。结果患者均存在1个以上的危险因素,临床表现多样,以呼吸困难、胸痛、咯血、休克和下肢肿胀为主,呼吸困难最为多见,26例患者有一例行溶栓治疗,其他均予抗凝治疗,自动出院2例,死亡1例。结论急性肺栓塞大多有危险因素,但表现不典型,临床医师应提高诊断意识,减少漏诊、误诊,提高生存率。     

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.

     

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.     

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.     

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.