长期使用低钙透析液对维持性腹透患者钙磷代谢的影响

目的观察维持性腹透患者使用低钙腹透液的有效性和安全性。方法在规律性随访的维持性腹膜透析患者中选择18例血钙〉2．2mmol／L,血磷〉1．78mmol／L,全段甲状旁腺素（iPTH）〈300pg／ml的患者,改用低钙透析液（BaxterPD4,透析液Ca1．25mmol／L,其余成分不变）,同时增加碳酸钙用量。每2周查血钙、血磷,每4周查iPTH,根据血钙、iFrH水平,调整碳酸钙及骨化三醇用量,比较观察低钙透析前,低钙透析后2、4、8、16、24周血钙、磷、钙磷乘积、iPTH的变化。同时观察患者使用低钙透析液有何不适。结果低钙透析24周后,血磷、钙磷乘积呈下降趋势,差异具有显著性;血钙、igrH的变化差异无显著性。在整个治疗过程中,1例患者治疗2周后出现低钙,iPTH升高明显升高而停用低钙透析液,其余患者能很好地耐受低钙透析,没有低血压或抽搐等情况发生。结论在高钙、高磷、低转运骨病的腹膜透析患者中使用钙浓度为1．25mmol／1的透析液同时注意钙的补充,有助于钙磷代谢紊乱和骨病的改善。     

低钙透析联合碳酸钙治疗血透患者(HD)高磷血症疗效观察

目的观察应用低钙透析联合口服碳酸钙对血液透析患者(HD)高磷血症的治疗及对血钙、血磷、甲状旁腺激素(iPTH)水平的影响和副反应。方法选择2010年10月至2011年12月于我院血透中心治疗的HD患者34例,随机分成AB两组,A组常规透析组17例,B组低钙透析组(透析液Ca离子浓度为1.25mmol/L联合口服碳酸钙1.5g/d)17例。所有患者均透析4个月,观察血钙、血磷、血iPTH水平的变化。所有入选患者治疗前、治疗后每个月测血钙、血磷、血iPTH水平的变化。结果常规透析组透析4个月后,患者血钙水平无明显变化,血磷无明显下降趋势(P>0.05),iPTH亦无明显升高(P>0.05)。低钙透析组透析4个月后,患者血钙水平无明显下降趋势(P>0.05),血磷呈下降趋势(P<0.05),iPTH呈上升趋势(P<0.05)。低钙透析组不良反应发生率为4/34(11.76%),主要为肌痉挛和低血压。结论对合并高磷血症的血透患者(iPTH<300ng/L)阶段性采用低钙透析联合口服碳酸钙的方法可以降低血磷,能维持比较正常的血钙血磷浓度,值得临床推广使用。     

活性维生素D联合低钙透析在治疗维持性血液透析继发性甲旁亢患者中的疗效观察

目的探讨活性维生素D联合低钙透析对维持性血液透析继发性甲旁亢（SHPT）患者的疗效情况。方法根据全段甲状旁腺素（iPTH）水平将24例SHPT患者分为轻度（iPTH300～500pg/ml）、中度（iPTH500～1000pg/ml）和重度（iPTH〉1000pg/ml）。在低钙透析（透析液钙浓度为1.25mmol/L）的基础上,轻度者予活性维生素D1～2μg,中度者予活性维生素D2～4μg,重度者予活性维生素D4～6μg,均每周2次,于透析后当晚睡前服用,连续观察12周。观察治疗前后患者血磷、钙磷乘积、iPTH及血清白蛋白（sAB）的变化。并根据iPTH水平,逐渐调整剂量,直至以最小剂量维持iPTH在目标值范围（150～300pg/ml）。结果所有患者均能完成疗程。30例患者治疗期间的血钙和血清白蛋白水平与治疗前比较,差异无统计学意义（P〉0.05）,钙磷乘积、iPTH水平均较治疗前降低（P〈0.05）。结论活性维生素D联合低钙透析可有效控制维持性血液透析SHPT,安全可靠。     

不同钙浓度透析液对维持性血液透析患者钙磷代谢的影响

目的探讨不同钙浓度透析液对维持性血液透析(MHD)患者钙磷代谢紊乱的影响。方法溧水县人民医院157例MHD患者随机分为2组,分别采用钙浓度1.25及1.75mmol/l透析液连续进行3个月透析治疗,分别检测治疗前后血钙及血磷浓度。结果实验结束后,高钙浓度组血钙水平明显升高(P<0.05),血钙×磷浓度水平降低(P<0.05),血磷水平无明显变化(P>0.05)。结论高钙透析液能有效的提高MHD患者血钙浓度,减少钙磷代谢紊乱发生。     

透析液钙浓度对血液透析患者血清钙平衡及血压的影响

目的探讨透析液钙浓度变化对血液透析患者透析过程中钙平衡及血压的影响，为透析患者选择个体化的钙浓度提供依据。方法15例血钙正常的稳定的维持性血液透析（MHD）患者分别使用钙离子浓度1．25mmol／L（DCa 1．25）、1．5mmol／L（DCa1．5）和1．75mmol／L（DCa1．75）的透析液进行血液透析（透析液其他成分不变）治疗4周．每次透析4．5～5h。监测透析前、后血压，检测透析前、后血清总钙（tCa）、离子钙（iCa）浓度。结果使用DCa1．25时，透析后血压及rCa、iCa均较透析前明显降低（P〈0．05）。使用DCa1．5时，透析前后血压及tCa、iCa均无明显变化（P〉0．05）。使用DCa1．75时，透析后血压及tCa、iCa均较透析前明显升高（P〈0．01）。结论对于血压正常、透前血钙正常或轻度低血钙者，DCa1．5的透析液是适用的；列于MHD中出现明显高血压、高钙血症患者，应当短期使用DCa1．25的透析液；对于MHD中出现明显低血压、低钙血症忠者，短期使用DCa1．75的透析液是恰当的。透析液应该注重个体化的钙浓度。     

低钙透析液联合醋酸钙对维持性血液透析患者钙磷代谢影响观察

目的：探讨低钙透析液联合醋酸钙对维持性血液透析患者钙磷代谢影响。方法将50例维持性血液透析患者患者随机分为实验组和对照组,两组患者均采用低钙透析液透析,在此基础上,对照组服用碳酸钙和骨化三醇胶囊,而实验组采用服用醋酸钙和骨化三醇胶囊,别于透析前、透析3、6个月时检测血钙、血磷以及iPTH水平的变化。结果实验组患者血钙水平稳定,且于透析6月后低于对照组,但均在正常范围,且两组均可明显降低血磷、而iPTH水平无明显差异。结论低钙透析液联合醋酸钙在透析过程中,能稳定的维持血钙水平,对防止血透患者高磷血症、降低患者心血管并发症具有积极意义,值得临床推广应用。     

腹膜透析钙磷代谢紊乱患者使用低钙腹膜透析液及碳酸镧的随访分析

调查我科腹膜透析患者血钙(Ca)、血磷(P)及甲状旁腺激素的情况,并观察通过使用低钙腹膜透析液结合药物的治疗高Ca、高P及甲旁亢的效果。方法：统计2010年以后在南京鼓楼医院规律随访一直使用普通钙腹膜透析液(钙离子浓度为1.75mmol/L)一年以上时间的腹膜透析患者血Ca、血P及全段甲状旁腺激素(iPTH)水平。根据患者血Ca、血P及iPTH水平挑选120例高Ca、高P、甲旁亢患者,平均分为A、B两组,A组改用低钙腹膜透析液(钙离子浓度为1.25mmol/L),B组改用低钙腹膜透析液的同时加用碳酸镧降磷治疗。结果：六个月后,A组与之前比较,血Ca降低,血P、iPTH升高(P<0.05),B组与之前比较血Ca、血P、iPTH降低(P<0.05),半年后B组与A组比较血Ca、血P、iPTH降低(P<0.05)。结论：对于出现高Ca、高P及高iPTH的患者建议使用低钙腹膜透析液,同时必须加强使用碳酸镧降磷治疗。     

透析液钙浓度对血液透析患者血钙和血磷及甲状旁腺激素的影响

目的 观察透析钙浓度对维持性血液透析患者血钙、磷及甲状旁腺激素（iPTH）的影响.方法 将北京安贞医院应用Ca^2＋浓度1.50 mmol/L透析液进行血液透析治疗的患者中血钙超过2.10 mmol/L的患者改用Ca^2＋＋1.25 mmol/L透析液,共107例,脱落6例.将患者应用Ca^2＋浓度1.50 mmol/L透析液时及应用Ca^2＋浓度1.25 mmol/L透析液6个月后血钙、磷和iPTH的化验数值进行统计分析,并根据血iPTH水平进行分组分析.结果 110例应用Ca^2＋浓度1.25 mmol/L透析液后较应用Ca^2＋浓度1.50 mmol/L透析液血钙升高[（2.39±0.22） mmol/L比（2.32±0.29） mmol/L]、血磷降低[（2.04±0.62） mmol/L比（2.19 ±0.71） mmol/L] （P ＜0.05）.血iPTH＜ 150 ng/L组20例,iPTH 150～300 ng/L组23例,301 ～600 ng/L组37例,iPTH＞ 600 ng/L组21例.血iPTH＜ 150 ng/L组应用Ca^2＋浓度1.25 mmol/L透析液进行血液透析6个月后血iPTH均值＞150 ng/L,差异有统计学意义（P＜0.05）;iPTH150～300 ng/L组应用Ca^2＋浓度1.25 mmol/L后较应用Ca^2＋浓度1.50 mmol/L透析液血磷下降[（1.87±0.55） mmol/L比（2.09 ± 0.70） mmol/L],但差异无统计学意义（P＞0.05）;iPTH 301 ～ 600 ng/L组应用Ca^2＋浓度1.25 mmol/L后较应用Ca^2＋浓度1.50 mmol/L透析液iPTH和血磷略下降[（410±330） ng/L比（443 ± 92） ng/L,（2.03±0.55） mmol/L比（2.11 ±0.69） mmol/L],差异无统计学意义（P＞0.05）,血钙升高差异有统计学意义[（2.38±0.21） mmol/L比（2.26 ±0.22） mmol/L] （P ＜0.05）.结论 应用Ca^2＋浓度1.25 mmol/L透析液不会降低患者血钙水平,iPTH＜ 150 ng/L或＞600 ng/L应用Ca^2＋＋浓度1.50 mmol/L透析液治疗会导致血钙水平偏高,血钙磷乘积明显升高;血iPTH＜ 150 ng/L应用Ca^2＋浓度1.25 mmol/L透析液可刺激甲状旁腺使iPTH升高,对预防低转运骨病有益;应用Ca^2＋浓度1.25 mmol/L透析液可给含钙的磷结合剂治疗提供空间.     

醋酸钙配合低钙透析液对维持性血液透析患者高磷血症的影响

目的探讨醋酸钙配合低钙透析液对维持性血液透析患者高磷血症的影响。方法将40例行维持性血液透析的高磷血症患者随机分为实验组和对照组两组,维持常规血液透析治疗。对照组采用透析液钙浓度为1.50mmol/L,实验组采用透析液钙浓度为1.25mmol/L,同时给予控制基础病治疗及常规蛋白饮食,实验组加服醋磷钙。观察治疗前及治疗后2个月血清磷、血清钙及全段甲状旁腺激素动态变化。结果治疗后两组各个时间点血钙水平与治疗前比较以及两组之间比较差异无统计学意义(P>0.05),实验组血磷水平逐渐下降(P<0.05),各时间点血磷水平与对照组比较明显下降(P<0.05)。实验组和治疗组血钙水平无明显变化(P>0.05)。实验组iPTH水平从治疗后1个半月开始逐渐下降,和治疗前及对照组比较差异有统计学意义(P<0.05)。结论醋酸钙配合低钙透析液可以在不升高血钙水平的情况下有效控制高磷血症。     

低钙透析在维持血液透析患者继发性甲旁亢治疗的应用

目的 探讨低钙透析在维持性血液透析患者继发性甲状旁腺功能亢进行骨化三醇冲击治疗中的临床应用,方法采用浓度1.25mmol/L低钙透析液,观察32例维持性血液透析继发甲旁亢患者在骨化三醇冲击治疗中血清钙、磷、钙磷乘积、血清全段甲状旁腺素(iPTH)等指标变化.结果 所有患者治疗期间的血钙与治疗前比较差异无统计学意义(P>0.05),血磷、钙磷乘积、iPTH水平均较治疗前降低(P<0.05).结论 维持性血液透析患者继发甲状旁腺功能亢进在骨化三醇冲击治疗中同时应用低钙透析是安全有效的.避免了高钙血症,降低了骨外软组织钙化的风险.     

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.     

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.     

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.     

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.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.