重症急性胰腺炎早期ICU综合救治

目的探讨重症急性胰腺炎早期重点监护病房(ICU)综合救治的方法与疗效。方法 80例重症急性胰腺炎患者,随机分为观察组与对照组,各40例。对照组给予重症急性胰腺炎ICU常规治疗,观察组在常规重症急性胰腺炎ICU治疗的基础之上,采取综合治疗手段。比较两组患者症状缓解时间、生命体征稳定时间、肠功能恢复时间以及ICU住院天数。结果观察组的症状缓解时间、生命体征稳定时间、肠功能恢复时间以及ICU住院天数均优于对照组,比较差异均有统计学意义(P<0.05)。结论经过综合救治的方法 ,重症急性胰腺炎患者的治疗效果得到了有效的提高,促进了患者的康复,值得临床应用。     

肠内及肠外营养支持在重症急性胰腺炎合并肠源性感染患者中的效果分析

目的:探究肠内、肠外营养支持在重症急性胰腺炎合并肠源性感染患者中的治疗效果。方法:选取某院重症急性胰腺炎合并肠源性感染患者114例,按随机数字表法分为肠内组(n=57)、肠外组(n=57)。肠内组采用肠内营养支持治疗,肠外组采用肠外营养支持治疗。观察2组肠功能恢复时间、治疗前后病情相关指标[C-反应蛋白(CRP)、白细胞(WBC)、内毒素、肿瘤坏死因子-α(TNF-α)]、治疗前后血清免疫指标(IgG、IgA、IgM)变化、治疗前后肝功能及胰腺功能相关指标[白蛋白(ALB)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、血淀粉酶(AMS)]变化。结果:肠内组首次通气时间、排便次数、首次排便时间、肠鸣音个数、肠鸣音恢复时间改善情况优于肠外组(P <0.05);治疗后肠内组CRP、WBC、内毒素、TNF-α低于肠外组,IgG、IgA、IgM、ALB、AST、ALT、AMS改善水平优于肠外组(P <0.05)。结论:与肠外营养支持比较,肠内营养支持治疗重症急性胰腺炎合并肠源性感染,能明显改善患者肠功能,提高免疫功能,减轻炎性反应,有利于病情恢复。     

大黄、芒硝、硫酸镁治疗重症急性胰腺炎合并麻痹性肠梗阻的疗效

目的探讨大黄、芒硝及硫酸镁治疗急性重症胰腺炎合并麻痹性肠梗阻的疗效及护理要点。方法对我院ICU近2年收治的9例急性重症胰腺炎合并麻痹性肠梗阻患者,给予大黄、芒硝及硫酸镁治疗,监测服药前后患者的腹围、膀胱压及肠鸣音等。结果9例患者腹围平均由(130±10)cm降至(115±6)cm,膀胱压由(28±4)cmH2O降至20cmH2O以下,肠鸣音由消失增至3～5次/min,排出大量稀便,腹胀减轻,肠功能恢复。结论大黄、芒硝及硫酸镁可促进肠蠕动,降低腹内压,改善患者的麻痹性肠梗阻,对于急性重症胰腺炎合并麻痹性肠梗阻的治疗及预后有积极作用。     

肠内营养联合肠外营养治疗重症急性胰腺炎临床观察

目的 探讨肠内营养联合肠外营养治疗重症急性胰腺炎临床观察.方法 将我院收治的65例重症急性胰腺炎患者随机分为两组,治疗组32例采取肠内营养联合肠外营养治疗,对照组33例采取全肠外营养治疗,观察两组患者治疗前后的各项指标.结果 两组患者治疗前血清白蛋白水平无明显差异,治疗后均有所改善,治疗组的血清白蛋白营养指标略高于对照组,手术失败率、病死率、感染发生率略低于对照组.结论 肠内联合肠外营养治疗重症急性胰腺炎优于全肠外营养治疗,它减少了并发症发生率、降低患者病死率,缩短平均住院时间,是治疗重症急性胰腺炎安全有效的一种方法.     

重症急性胰腺炎合并感染的治疗策略

目的:探讨重症急性胰腺炎合并感染的治疗策略。方法:选择某院2006年7月～2017年10月收治的重症急性胰腺炎合并感染患者114例,两组入院后均接受基础治疗,此基础上,随机抽取57例作为观察组,应用亚胺培南联合谷氨酰胺治疗,另57例作为对照组,应用亚胺培南治疗,观察治疗效果。结果:治疗前,观察组血小板计数、白细胞计数、C反应蛋白水平与对照组基本相同,无显著差异(P>0.05);治疗后,观察组治疗总有效率、血小板计数高于对照组,白细胞计数、C反应蛋白水平低于对照组,差异显著(P<0.05)。结论:重症急性胰腺炎合并感染治疗中,除基础治疗外,应积极利用亚胺培南合并谷氨酰胺治疗,以提升治疗效果,促进患者康复。     

谷氨酰胺对急性重症胰腺炎合并急性肺损伤患者肺部转归的影响

目的观察谷氨酰胺对急性重症胰腺炎合并急性肺损伤患者肺部转归的影响。方法将急性重症胰腺炎合并急性肺损伤患者98例随机分为谷氨酰胺治疗组(Gln组)和对照组各49例。2组均按146.44kJ/kg标准给予肠外营养支持,Gln组另给予谷氨酰胺0.15mg.kg-1.d-1。比较2组患者治疗后APACHEⅡ评分、Murray肺损伤评分、机械通气时间和重症监护室(ICU)停留时间。结果 Gln组APACHEⅡ评分和Murray肺损伤评分低于对照组,机械通气时间和ICU停留时间短于对照组,差异均有统计学意义(P<0.05)。结论谷氨酰胺治疗有利于改善急性重症胰腺炎合并急性肺损伤患者的转归。     

急性重症胰腺炎60例治疗体会

目的探讨急性重症胰腺炎（SAP）的治疗方法和疗效。方法回顾性分析60例急性重症胰腺炎患者的临床资料。结果全部患者经使用生长抑素、抑肽酶和全肠外营养（TPN）治疗,49例好转出院,其中合并胆道梗阻10例均急诊手术,11例因合并糖尿病、冠心病导致多器官功能障碍（MODS）而死亡。结论急性重症胰腺炎非手术治疗疗效明显,成功率较高,但需要严密观察和严格掌握适应证。     

急性胰腺炎合并肾脏损害的临床观察

目的:探讨急性胰腺炎(AP)合并肾畦损害的发病机理及治疗策略.方法:对183例AP住院患者进行回顾性分析.结果:本组病人中,伴有肾损害的86例,占47.0%,重症组明显高于轻症组.不同病因的急性胰腺炎肾损害发生率差异无显著性.随着肾损害的加重,病死率上升.结论:急性胰腺炎合并肾损害发病率高,重症可合并急性肾功能衰竭,死亡率高.加强对本病的认识,做到早期预防和治疗,是改善预后的关键.     

早期肠道营养在重症胰腺炎治疗中的应用价值

目的:探讨早期肠内营养在重症胰腺炎中的应用价值。方法将41例重症胰腺炎患者随机分为两组,实验组21例使用蕃泻叶导泻和早期肠内营养,常规治疗组20例采用重症胰腺炎常规治疗和肠外营养,进行对比研究。结果实验组比常规治疗组肠道功能恢复快、合并感染率低、平均住院天数少。结论大剂量肠道清洁和术后早期肠内营养对重症胰腺炎的治疗具有重要作用,还可减少并发症,又经济、省时,患者及早进食,对其的后期恢复也有积极的促进作用。     

生长抑素对急性重症胰腺炎患者肿瘤坏死因子-α水平的影响

目的 观察生长抑素治疗急性重症胰腺炎的临床疗效及对血清肿瘤坏死因子-α(TNF-α)水平的影响.方法 将68例急性重症胰腺炎患者随机分为两组,对照组34例给予常规治疗,观察组34例在常规治疗的基础上给予生长抑素治疗,连续应用5～7d.观察两组的临床疗效及临床指标的变化.结果 观察组治疗后第3天血清TNF-α水平显著低于对照组(P＜0.05),且观察组患者恢复较快;观察组治疗后血淀粉酶恢复时间、肠功能恢复时间、住院时间、并发症发生率、病死率均明显少于对照组(均P＜0.05).结论 生长抑素治疗急性重症胰腺炎的疗效确切,能明显降低患者血清TNF-α水平,缩短病程,明显改善患者预后.     

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.     

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.     

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.     

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.