中药土三七致肝小静脉闭塞病六例临床分析及文献研究

目的探讨土三七致肝小静脉闭塞病(HVOD)的发病机制、临床表现、诊疗方法及体会。方法回顾性分析我院土三七致HVOD共6例患者的临床特点及诊治经过。结果 6例土三七致HVOD患者均以腹水腹胀为主要临床表现,同时伴有乏力、恶心、食欲减退、双下肢浮肿、轻度黄疸。结论土三七致HVOD的突出临床表现为大量腹水。增强CT及介入造影检查对本病的诊断及鉴别诊断有重要价值。目前治疗尚无特效方法,抗凝治疗存在争议。加强患者对中药的鉴别能力,规范合理用药,才能减少疾病发生。     

植物土三七致肝小静脉闭塞病1例的中西医结合治疗

肝小静脉闭塞病(hepatic veno-occlusive disease,HVOD)是一种罕见病,国内文献报道,其常见致病因素为植物土三七。由于发病机制复杂、缺乏特效治疗药物,HVOD的误诊、漏诊率高,预后差。笔者对中西医结合治疗土三七所致肝小静脉闭塞病的病例进行了报道,并通过回顾性分析和文献复习,总结治疗经验,为临床诊治HVOD提供参考。     

土三七致肝小静脉闭塞病2例

肝小静脉闭塞病（HVOD）是指肝小叶中央静脉和小叶下静脉损伤导致管腔狭窄或闭塞而产生的肝内窦后性门静脉高压。近年来,我院诊治2例服用土三七后发生的HVOD。现回顾分析其临床资料,以了解土三七致肝小静脉闭塞病的临床特点,提高对该病的认识,报道如下：     

土三七致肝小静脉闭塞症81例文献分析

目的探讨土三七致肝小静脉闭塞症（HVOD）的临床特点和危险因素,为临床合理用药提供参考。方法以＂土三七＂、＂菊三七＂、＂肝小静脉闭塞症＂、＂肝静脉闭塞病＂等为检索词,检索中国期刊全文数据库和万方数据知识服务平台,收集土三七致HVOD的文献进行统计分析。结果共收集到土三七致HVOD患者81例,其中男性50例（61.7%）,女性31例（38.3%）;年龄17~81（51±1）岁,≥45岁者73例（90.1%）。81例患者中,原发疾病为骨伤科疾病者60例,伴有慢性肝病者11例。所有患者均为自行服药。发病时间为用药后1周至2年。每日服用剂量越大者,发病时间越早;每日服用剂量小但服用时间长者,发病时间相对较晚。慢性起病者36例,亚急性起病者45例。临床表现以消化系统症状和水钠潴留为主。实验室检查以凝血功能和肝功能指标异常为主。46例肝活检显示肝小叶的静脉内皮损害及管腔狭窄。停药并给予对症治疗后,14例治愈;32例好转;15例死亡;20例放弃治疗,转归不详。结论土三七引起的HVOD与服药剂量相关,病死率较高。土三七所致HVOD重在预防,应加强宣传教育,引导患者正确使用中草药。     

土三七致肝小静脉闭塞病5例临床分析并文献复习

目的探讨肝小静脉闭塞病（HVOD）的临床特点和治疗预后,以提高临床对此病的认识。方法 回顾性分析南昌大学第一附属医院2008年1月至2011年10月收治的5例HVOD患者的临床资料。结果 5例患者均有服用土三七病史,临床表现为肝肿大、腹水,均予以护肝、利尿、改善微循环及补充白蛋白等支持治疗。1例死亡;1例甲强龙治疗后生化指标及临床症状无明显改善,放弃治疗;1例腹腔置管引流及白蛋白、血浆支持治疗后好转;2例治愈。结论临床医师应该提高对该病的认识,在接诊类似病例诊断尚不明确的患者时,应认真分析病情。早期预防,早期诊断,早期治疗,能减少该病的发病率和死亡率。     

土三七致肝小静脉闭塞病的血小板及凝血功能临床表现分析

目的 分析土三七所致的肝小静脉闭塞病(hepatic venular occlusive disease,HVOD)的血小板及凝血功能的临床表现。方法 搜集35例外伤后服用土三七致HVOD的血小板及凝血功能临床资料,结合文献报道进行分析。结果 35例患者中,32例血小板小于正常值,占91.4%,检测值为(81.94±17.92)×10⁹·L^-1;凝血酶原时间延长33例,占94.2%,检测值为(18.73±3.28)s,国际标准化比值检测值为1.76±0.35,部分活化凝血酶原时间检测值为(42.35±6.57)s。结论 临床上土三七致HVOD血小板数量减少、凝血功能受抑制,应用活血化瘀、抗凝为主的方案治疗土三七致HVOD有待进一步研究。     

土三七致肝小静脉闭塞病1例报告及文献复习

【】 目的 了解土三七导致肝小静脉闭塞病的临床特征,以加强对该病的认识。方法 回顾分析1例因服用土三七致肝小静脉闭塞病的临床及影像学表现,并进行文献复习。结果 该患者临床表现主要为腹水、右上腹胀痛、肝脏增大,并伴不同程度肝功能异常。腹部增强CT扫描：肝实质内不均匀强化,呈高低密度相间的斑片状,腔静脉肝段变扁,肝静脉显示不清。发病前1个月服用土三七病史。结合患者症状、体征以及腹部CT,可诊断为肝小静脉闭塞病。停用土三七并给予抗凝、改善循环等治疗后病情逐渐缓解。结论 长期大量服用土三七可致肝小静脉闭塞病。腹部增强CT扫描典型特征基本可对肝小静脉闭塞病行临床诊断。抗凝、改善循环治疗有一定疗效。     

10例肝小静脉闭塞病(HVOD)的临床病理分析

目的通过分析HVOD的临床及病理组织学表现,提高对该病的认识,探讨对该病的诊断方法。方法回顾性分析本科室2007年~2010年诊断的10例HVOD的临床情况及肝穿刺病理组织学表现。结果 10例HVOD患者中7例明确服用中药土三七史,3例原因不明,临床以出现腹水,黄疸,肝功能异常为主要表现。病理表现为:肝窦扩张,淤血,红细胞渗出,肝小静脉内皮肿胀,管壁硬化,不完全闭塞,肝细胞肿胀,无菌性坏死,网状纤维支架残留。结论患者有土三七服用史,结合CT、B超、实验室检查可临床诊断HVOD,但确诊需要病理活检。组织学主要表现为:肝小静脉的硬化闭塞,伴有不同程度的肝细胞无菌性坏死,网状纤维支架残留,肝窦扩张,红细胞渗出。     

土三七致肝窦阻塞综合征30例临床分析

目的 分析土三七致肝窦阻塞综合征（HSOS）的临床特征，为提高对该病的认识及诊治水平提供参考。方法 回顾性分析中国科学技术大学附属第一医院2014年10月至2018年12月收治的30例HSOS患者的临床资料，对此病的临床表现、实验室及影像学检查、临床治疗方案及其疗效转归等进行统计分析。结果 30例患者均以腹胀、尿黄为首发表现。实验室检查示患者血小板下降、肝功能异常、凝血酶原活动度下降。部分患者肝脏CT检查可见"花斑样""地图样"改变，肝静脉变细或不显示。28例患者均有不同程度的腹水。胃镜检查可见患者食道胃底静脉曲张。病理检查可见患者肝窦扩张充血，肝内小静脉管壁增厚，管腔狭窄、闭塞。30例患者均予内科综合保守支持治疗，其中23例行经颈静脉肝内门体分流术（TIPS）治疗，共治愈好转28例，2例患者经上述治疗无效未愈死亡。结论 土三七致HSOS患者可出现肝内窦后性门脉高压等一系列症候群；诊断主要依据肝脏CT特征性表现；早期抗凝、改善微循环治疗有一定疗效；TIPS对改善患者早期症状效果明显。     

菊叶三七致肝小静脉闭塞1例报告及文献复习

目的 了解菊叶三七导致肝小静脉闭塞病的临床特征,以加强对该病的认识。方法 回顾分析1例因服用菊叶三七致肝小静脉闭塞病的临床及影像学表现,并进行文献复习。结果 该患者临床表现主要为腹水、右上腹胀痛、肝脏增大,并伴不同程度肝功能异常。腹部增强CT扫描:肝内弥漫性低密度影,与正常密度肝实质相间,伴大小不等片状异常强化,下腔静脉内径缩窄,肝静脉轮廓模糊。发病前1个月服用菊叶三七病史。结合患者症状、体征以及腹部CT,可诊断为肝小静脉闭塞病。停用菊叶三七并给予抗凝、改善循环等治疗后病情逐渐缓解。结论 长期大量服用菊叶三七可致肝小静脉闭塞病。腹部增强CT扫描典型特征基本可对肝小静脉闭塞病行临床诊断。抗凝、改善循环治疗有一定疗效。     

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.