维持性血液透析并脑出血患者血浆超敏C反应蛋白、D-二聚体与同型半胱氨酸的变化

目的探讨维持性血液透析并脑出血患者HsCRP、D-D及HCY的变化与意义。方法选取医院血液净化中心维持性血液透析并发脑出血患者30例(维持性血液透析脑出血组),维持性血液透析未并发脑血管病为维持性血液透析组(34例),医院体检中心健康体检者(正常对照组)31例,分别测定各组患者血清HsCRP、D-D、HCY及尿素动力学指数(Kt/V)进行统计分析。结果 (1)维持性血液透析脑出血组和单纯维持性血液透析组患者Hs-CRP、D-D及HCY水平较正常对照组显著升高(P<0.05);(2)维持性血液透析脑出血组Hs-CRP、D-D及HCY水平较单纯MHD组显著升高(P<0.05);(3)MHD脑出血组患者Kt/V与血清HsCRP、D-D及HCY呈负相关(r=-0.633,r=-0.645,r=-0.655,均P<0.005),单纯MHD组Kt/V与HsCRP、D-D及HCY间无相关性(均P>0.05)。结论 MHD患者血浆Hs-CRP、D-D及Hcy水平增高对对预测MHD患者脑出血发生及早期诊断具有重要的临床意义。     

OCM在监测与评估单中心维持性血液透析患者透析充分性中的应用价值分析

目的利用在线尿素清除率监测(OCM)评估维持性血液透析(MHD)患者血液透析尿素清除指数(Kt/V)值,寻找透析不充分的原因,并进行干预,从而保证患者的透析充分性,提高患者生活质量,延长患者生存期。方法290例维持性血液透析患者,应用OCM在线监测Kt/V值,以OCM测定Kt/V值≥1.2为透析达到充分性标准,对透析不充分患者找出原因并进行干预2次。分析第1、2、3次评估Kt/V情况。结果62例患者血液透析不充分,不达标率为21%(62/290)。Kt/V值≥1.2的患者的男女比例(135/93)、年龄(60.64±13.6)岁、干体重(67.92±11.63)kg、平均血流量(224.35±18.51)ml/min与Kt/V值<1.2的患者的(45/17)、(61.77±12.94)岁、(75.53±16.31)kg、(221.27±22.40)ml/min比较,差异具有统计学意义(P<0.05)。对62例透析不充分患者进行干预,将其中43例血流量不足患者增加血流量,其余19例患者适当增加透析时间或更换为高通量透析器,重新评估结果显示,仍有16例患者Kt/V值<1.2;Kt/V值≥1.2的患者的年龄(62.36±9.55)岁与Kt/V值<1.2的患者的(69.58±4.32)岁比较,差异有统计学意义(P<0.05)。第二次评估Kt/V值中,16例透析不充分的MHD患者,年龄均≥65岁,再次应用上述干预措施,重新评估后均未达标。结论OCM监测Kt/V值可以很好地反映血液透析患者的透析充分性,可以利用0CM对血液透析中心进行透析充分性评估。     

辛伐他汀对维持性血液透析患者血清hs-CRP、IL-6和ADPN水平的影响

目的：探讨辛伐他汀对维持性血液透析患者的血清细胞高敏C反应蛋白（hs-CRP）、白细胞介素6（IL-6）和脂联素（ADPN）水平的影响。方法：回顾性分析2013年5月—2015年5月我院肾内科收治的维持性血液透析患者80例,按其是否用药分为辛伐他汀组和对照组,辛伐他汀组给予辛伐他汀+血液透析治疗,剂量为20 mg/d,对照组单纯给予血液透析治疗。比较两组患者治疗前、治疗6个月后血清hs-CRP、IL-6和ADPN水平,同时测定治疗前、后患者的血脂TG、TC、LDL、HDL的水平,观察并记录患者治疗期到治疗结束1年内发生的心血管事件。结果：与对照组比较,辛伐他汀组治疗后血清hs-CRP、IL-6的水平均有所下降,ADPN水平升高,血脂TG、TC、LDL水平下降, HDL水平升高。辛伐他汀组发生的心血管事件有6例,发生率为15%,显著低于对照组发生的心血管事件13例,发生率为32.5%,组间差异有统计学意义（P<0.05）。结论：辛伐他汀能降低维持性血液透析患者的血清hs-CRP、IL-6水平,并使ADPN水平升高,具有良好的抗炎、降血脂作用,能有效改善维持性血液透析患者动脉粥样硬化症状,降低心血管事件的发生率。     

维持性血液透析患者透析充分性相关因素分析

目的：探讨维持性血液透析（MHD）患者透析充分性的影响因素。方法以2008年1月至2012年12月南昌大学第一附属医院血液净化中心378例维持性血液透析患者为研究对象。每月监测患者血红蛋白、肌酐、尿素氮等10余项临床指标,计算得出尿素清除指数（Kt/V）和尿素下降率（URR）。用单因素和多因素分析探讨MHD患者透析充分性与临床指标的关系。结果单因素ANOVA分析显示原发病、年龄、血钠、血钾、血总蛋白、尿素氮、iPTH、血磷、血钙与Kt/V有关。而多重线性回归分析显示年龄、每周透析时间、干体重和血红蛋白是Kt/V的独立影响因素。年龄、每周透析时间、干体重与Kt/V呈负相关（P〈0.05）;血红蛋白与Kt/V呈正相关（P〈0.05）。其中年龄是最主要的因素。结论 MHD患者透析充分性与患者年龄、每周透析时间、血红蛋白和干体重密切相关。     

维持性血液透析后血清尿素反弹及其影响因素研究

目的 观察维持性血液透析患者透析后血清尿素反弹情况,并研究相关影响因素.方法 选取稳定的维持性血液透析患者50例,取透析前、透析结束时、透析后15和30min的血样,定量观察尿素反弹及其对透析充分性指标单室尿素清除指数(spKt/V)和血清尿素下降率(URR)的影响,并分析其与患者人口学特征、透析参数的相关关系.结果 血液透析后的血清尿素反弹平均达13.6%,导致URR和spKt/V分别高估0.04个百分点和0.14个单位.影响尿素反弹最重要的因素是透析效率K/V,此外还有较高的血红蛋白、较多的相对超滤量、动脉-静脉通路和男性.结论 血液透析后的尿素反弹是普遍存在的现象,对于特定的个体和透析过程,其对充分性指标的影响不能忽略.     

提高血流量及透析液流量对血液透析充分性的影响

目的探讨提高血流量及透析液流量对血液透析充分性的影响,以期为临床透析治疗提供参考。方法选择2009年12月～2011年12月本院收治的行稳定透析的尿毒症患者20例。血透透析液流量定于500 mL/min,血流量定于250 mL/min时,行2个月透析治疗后,将血透透析液流量定于800 mL/min,血流量定于300 mL/min。比较提高血流量及透析液流量前后尿素氮清除效率(Kt/V)、尿素下降率(URR)、血清清蛋白(ALB)、血红蛋白(Hb)、血肌酐(SCr)、C反应蛋白(CRP)水平及充分透析患者所占百分率情况。结果血透透析液流量为800 mL/min,血流量为300 mL/min时可提高Kt/V及URR,与500 mL/min透析液流量及250 mL/min血流量比较差异有统计学意义(P<0.05),而ALB、Hb、SCr、CRP水平差异无统计学意义(P>0.05);提高血流量及透析液流量后充分透析患者所占百分率为90%,显著高于提高前(70%,P<0.05)。结论 800 mL/min透析液流量及300 mL/min血流量的维持性血液透析可选择性用于常规透析不充分的患者,值得临床推广使用。     

研究不同血管通路对慢性肾衰竭患者血液透析效果的影响

目的:研究慢性肾衰竭患者采用不同血管通路治疗,其血液透析效果的差异.方法:择取2016年10月—2019年10月期间在我院应用血液透析治疗的160例慢性肾衰竭患者,采用随机数字表法分为2组,各80例.A组采用聚四氟乙烯移植血管及长期留置皮下隧道涤纶套导管通路进行治疗,B组采用自体动静脉内瘘通路进行治疗,比较两组患者的血液透析治疗效果[血清C反应蛋白(CRP)、尿素清除量/体积(Kt/V)、尿素氮下降率(URR)、白蛋白(ALB)水平],统计两组透析相关并发症的发生情况.结果:治疗前,两组的CRP、URR、Kt/V、ALB水平比较,差异无统计学意义(P>0.05);治疗30天后,两组CRP水平低于治疗前,URR、Kt/V、ALB水平高于治疗前,且B组CRP水平低于A组,URR、Kt/V、ALB水平高于A组,差异有统计学意义(P<0.05);B组透析相关并发症发生率(11.25％)低于A组(26.25％),差异有统计学意义(P<0.05).结论:临床上针对采取血液透析治疗的慢性肾衰竭患者采用自体动静脉内瘘血管通路的效果较好,可以有效降低炎症反应,提高血液透析效果,降低相关并发症的发生风险,利于病情控制.     

糖尿病肾病患者维持性血液透析营养状况分析

目的通过对糖尿病肾病维持性血液透析患者营养状况的科学评估,研究分析促进血液透析效果与患者营养状况的关系。方法对60例原发2型糖尿病并发糖尿病肾病行维持性血液透析(MHD)的患者进行膳食分析、一般临床检查结果和透析效果进行统计学分析。结果 60例患者摄入的蛋白质为(0.79±0.32)g/(kg.d),热能为(78±32)KJ/(kg.d),透析不充分组的糖尿病肾病维持性HD患者TSF、AC、Scr、BUN、RBC水平显著低于透析充分组患者水平(P<0.05),其而CRP水平显著高于透析充分组患者水平(P<0.05),CRP与RBC、Hb、Alb的含量水平呈显著负相关(P<0.05)。结论应加强对于糖尿病肾病维持性血液透析的患者营养状态的评估及饮食方案的制定与改善,从而提高患者的生活质量、减少血液透析并发症的风险。     

中、高通量透析对维持性血液透析患者效果比较

目的 对比中、高通量透析在维持性血液透析患者应用中的治疗效果及对患者预后影响，进一步优化临床血液透析。方法 收集2020年1月至2021年12月行维持性血液透析(MHD)治疗患者78例资料进行回顾性分析，根据透析方案不同进行分组，其中40例采用中通量血液透析(MFHD)患者纳入对照组，另外38例采用高通量血液透析(HFHD)患者纳入观察组。收集并对比2组治疗前后肾功能指标、尿素清除率(URR)、 Kt/V值；同时收集患者生活质量评估结果和并发症发生情况。结果 治疗后，观察组SCr、BUN、β2-MG等肾功能指标水平低于对照组(P<0.05),URR、 Kt/V水平高于对照组(P<0.05);生活质量对比，治疗后，观察组患者SF-36评分高于高于对照组(P<0.05);观察组并发症发生率(15.79%)与对照组(7.5%)对比差异无统计学意义(χ²=0.626,P=0.429)。结论 HFHD方案在MHD患者治疗中，能更好地清除体内有毒物质，改善肾功能，提高患者生活质量，但需要做好低血压的预防干预，提高治疗安全性。     

糖尿病肾病血液透析的护理

目的探讨提高行血液透析糖尿病肾病(DN)患者的生存率和生活质量的护理方法。方法回顾性分析2000~2004年在我院行维持性血液透析的DN患者40例,了解影响其生存率和生活质量的因素。结果DN患者普遍存在建立内瘘和开始透析时间迟;建立永久性血管通道难、内瘘易闭塞;营养状况差;进入HD后血糖波动大;透析中并发症较多影响透析的充分性等因素,使得DN患者长期生存率和生活质量低。结论早期透析、保护血管通道、提高营养状况、加强透析中并发症的监护是提高DN患者生存率和生活质量的关键。     

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.

---

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.     

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.     

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.