自体血循管预防血透病人首次使用综合征的疗效分析

目的 研究使用自体血循管预防血透病人首次使用综合征的可行性,提高透析质量、减轻患者痛苦及医疗费用.方法 将维持性血液透析的患者156人共1158例次,按照透析时间分为对照组和实验组.对照组按常规血透流程操作,实验组在对新的透析器和管路进行常规预冲后使用患者自体血密闭式循管10 ～ 15 min,对两组患者血透过程中首次使用综合征（First-useSyndrome,FUS）发生率及体外凝血发生率进行对比.结果 对照组在560例次透析治疗的病人中,共发生FUS 23例次（4.11％）,而实验组在598例次透析治疗的病人中,共发生FUS 5例次（0.84％）.FUS发生率实验组明显低于对照组,两组比较差异有统计学意义（P＜0.01）,而体外凝血发生率则两组无明显改变,差异无统计学意义（P＞0.05）.结论 使用患者自体血循管能有效预防血透病人血透过程中首次使用综合征的发生,且不增加出血及体外凝血现象风险.     

甲状旁腺激素在终末期肾脏病患者血液透析中的意义

目的：探讨甲状旁腺激素(PTH)在终末期肾脏病患者血液透析中的意义。方法将100例长期行维持性血液透析的患者分为≤60岁、>60岁组,测定100例患者血液透析前后的PTH、血尿素氮(BUN)、血肌酐(SCr)、收缩压(SBP)、血红蛋白(Hb)、血浆白蛋白(Alb)、血磷(P3+)、血钙(Ca2+)水平等,分析BUN、SCr、SBP、Hb、Alb、P3+、Ca2+等与PTH的相关性。结果透析后,患者的BUN、SCr、SBP、P3+、PTH水平显著低于透析前(P<0.01),而Hb、Alb、Ca2+水平显著高于透析前(P<0.01);透析后,>60岁组患者的PTH水平低于≤60岁组患者(P<0.05);透析前,PTH与BUN、SCr、SBP呈正相关(r=0.148、0.651、0.326),与Hb、Alb、KT/V呈负相关(r=-0.621、0.337、0.598)。结论 PTH能对血液透析充分性进行有效评估。     

尿毒清颗粒联合高通量血液透析治疗尿毒症皮肤瘙痒的临床效果及对血肌酐水平的影响

目的 观察尿毒清颗粒联合高通量血液透析治疗尿毒症皮肤瘙痒的临床效果及对血肌酐(SCr)水平的影响。方法 回顾性选取2019年1月—2020年10月广东省兴宁市人民医院收治的尿毒症皮肤瘙痒患者120例为研究对象,根据不同治疗方案分为试验组和对照组,每组60例。在常规治疗基础上,对照组患者采用高通量血液透析治疗,试验组在对照组基础上加用尿毒清颗粒治疗,2组疗程均为12周。比较2组患者治疗前后肾功能指标[尿酸(UA)、尿素(BUN)、SCr]、血生化指标[血磷、血钙、甲状旁腺激素(iPTH)]、血液净化指标[同型半胱氨酸(Hcy)、晚期糖基化终末产物(AGEs)]、瘙痒程度评分,不良反应及生活质量评分。结果 治疗12周后,2组患者UA、BUN、SCr水平均较治疗前降低,且试验组低于对照组(P均<0.01);2组患者血磷、血钙、iPTH水平较治疗前降低,但试验组治疗后血磷、血钙、iPTH水平高于对照组(P均<0.01);2组患者Hcy、AGEs水平及瘙痒程度评分均较治疗前下降,且试验组低于对照组(P<0.05或P<0.01);试验组与对照组不良反应总发生率比较差异无统计...     

血液透析联合血液灌流与联合血液透析滤过治疗维持性血液透析患者皮肤瘙痒的效果观察

目的：比较血液透析联合血液灌流与联合血液透析滤过治疗维持性血液透析患者皮肤瘙痒的效果。方法选取2013年6月~2014年6月本院收治的48例维持性血液透析伴皮肤瘙痒患者作为研究对象,随机分为观察组和对照组,各24例。观察组采用血液灌流联合血液透析治疗,对照组采用血液透析滤过联合血液透析治疗。比较两组治疗前后的皮肤瘙痒缓解程度以及血尿素氮(BUN)、肌酐(SCr)、血清钙(Ca2+)、血清磷(P3-)和血清甲状旁腺激素(PTH)水平。结果观察组的瘙痒总缓解率为87.5%,显著高于对照组的50.0%,差异有统计学意义(P<0.05)。观察组的Ca2+、P3-水平显著低于对照组,差异有统计学意义(P<0.05)。两组的BUN和SCr水平比较,差异无统计学意义(P>0.05)。观察组治疗后的PTH水平显著低于对照组,差异有统计学意义(P<0.05)。结论血液透析联合血液灌流治疗尿毒症皮肤瘙痒患者的效果显著优于血液透析联合血液透析滤过,值得临床推广应用。     

加巴喷丁治疗维持性血液透析患者皮肤瘙痒的疗效和安全性

目的观察加巴喷丁治疗维持性血液透析患者皮肤瘙痒的疗效及不良反应。方法维持性血液透析经常规治疗无效的皮肤瘙痒患者47例,随机分为试验组24例和对照组23例。在充分透析、血液灌流的基础上,对照组维持原外用药及氯雷他定10 mg,po,qd;试验组加巴喷丁100~300 mg,每次透析当日晚间服用,疗程4周。检测治疗前后患者血钙、磷、甲状旁腺素水平,评估皮肤瘙痒的视觉模拟量表(VAS)评分、Shiratori评分,并记录不良反应发生情况。结果试验组完成22例,对照组完成23例。治疗后,对照组患者皮肤瘙痒症状无明显改善,VAS评分和Shiratori评分与治疗前比较无显著差异(P>0.05);试验组患者皮肤瘙痒症状明显改善,VAS评分和Shiratori评分均低于治疗前(P<0.05),且低于对照组(P<0.05)。治疗前后两组患者血钙、磷、甲状旁腺素水平均无显著变化(P>0.05)。试验组中有1例因眩晕、头痛、感觉异常症状停药,6例出现嗜睡、头晕不适等症状,均1周内缓解。结论加巴喷丁治疗经常规治疗无效的维持性血液透析患者的皮肤瘙痒有效且安全,长期疗效及安全性尚待进一步观察。     

高通量血液透析联合肾康注射液对慢性肾功能不全临床疗效和微炎症状态的影响

目的研究高通量血液透析联合肾康注射液治疗慢性肾功能不全对临床疗效和微炎症状态的影响。方法选取2019年12月至2020年11月阿勒泰地区人民医院收治的84例慢性肾功能不全患者,按随机数字表法分为试验组(n=42)和对照组(n=42)。对照组实施高通量血液透析治疗,试验组开展高通量血液透析联合肾康注射液治疗。比较两组临床疗效、肾功能指标和微炎症状态。结果试验组临床治疗总有效率为95.24%,高于对照组的76.19%,差异有统计学意义(P 0.05)。两组患者治疗前微炎症各项指标比较,差异无统计学意义(P 0.05);试验组患者治疗后白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)指标值均低于对照组(P 0.05)。两组患者治疗前血肌酐(SCr)、尿素氮(BUN)比较,差异无统计学意义(P 0.05);试验组患者治疗后SCr、BUN指标水平均低于对照组(P 0.05)。结论高通量血液透析联合肾康注射液治疗慢性肾功能不全能够有效改善患者机体微炎症状态和肾功能指标,提高患者综合疗效,具有较高的推广应用价值。     

维持性血液透析患者C-反应蛋白与其营养不良、贫血的关系

目的 探讨维持性血液透析患者C-反应蛋白与营养不良、贫血的关系.方法 选择我院血液透析中心治疗的患者28例,所有患者均透析3个月以上,并抽取其血液透析前和血液透析后C-反应蛋白(CRP)、血红蛋白(Hb)、肌酐(SCr)、血清白蛋白(ALB)及18例健康者作为对照组.结果 维持性血液透析患者透析前CRP正常与异常组之间ALB、Hb有显著差异性(P＜0.05),透析后CRP水平升高,血液透析前与血液透析后比较有显著差异性(P＜0.05),且血液透析患者CRP与其ALB、Hb呈显著负相关(P＜0.05).结论 CRP升高发生炎症反应在维持性血液透析患者营养不良及贫血中起重要作用.且CRP升高与血液透析本身的因素及营养不良、贫血等相关.     

对比分析地塞米松与自体血循管预防首次使用综合征的临床效果

目的探究应用地塞米松与自体血循管预防首次使用综合征的临床疗效。方法选取近3年在我院接受血液透析治疗并发生首次使用综合征的患者360例,将其随机分为地塞米松组、自体血循管组,平均每组180例,地塞米松组患者应用地塞米松进行预充处理,自体血循管组患者采用自体血循管进行预充处理,观察并比较两组患者预防首次使用综合征发生的有效率。结果自体血循管组预充处理后的有效率(99.44%)明显高于地塞米松组预充处理后的有效率(73.33%),两组有显著性差异,统计学上有意义(P<0.05)。结论地塞米松与自体血循管在预防首次使用综合征中,自体血循管有更好的疗效,值得临床应用推广。     

免疫抑制剂泼尼松对急性间质性肾炎患者肾功能改善作用的疗效评价

目的:评价免疫抑制剂泼尼松对急性间质性肾炎患者肾功能改善作用的临床疗效。方法:选取医院2013年12月—2014年12月收治的急性间质性肾炎患者78例作为研究对象,采用随机数字法将其分为治疗组与对照组,每组39例;对照组患者均给予常规对症疗法,治疗组患者在对照组基础上加用免疫抑制剂泼尼松治疗;评价治疗后两组患者的血肌酐(SCr)、血尿素氮(BUN)、内生肌酐清除率(Ccr)以及血尿酸(SUA)等指标。结果:治疗后,治疗组患者的SCr、BUN、Ccr以及SUA等指标的改善情况显著优于对照组(P<0.05)。结论:治疗急性间质性肾炎患者,采用免疫抑制剂泼尼松治疗,能够显著改善患者肾功能。     

高通量血液透析治疗老年慢性肾衰竭的临床分析

目的研究高通量血液透析治疗老年慢性肾衰竭患者的治疗效果。方法选取2012年12月—2013年5月收治的79例慢性肾衰竭患者,随机分为两组,A组42例,B组37例。A组患者采用高通量血液透析治疗,B组患者采用常规血液透析实施透析治疗,对比分析透析前以及透析后5个月相关指标指标改善情况以及并发症发生情况。结果治疗后,两组患者的血浆清蛋白（ALB）、三酰甘油（TG）、β2微球蛋白（β2-MG）、血尿素氮（BUN）、血肌酐（Scr）、血红蛋白（Hb）、血磷（P）以及并发症发生情况比较,差异均有统计学意义（P〈0.05）。结论给予老年慢性肾衰竭患者高通量血液透析治疗,可显著改善患者的慢性肾衰竭临床症状,提高患者生命质量,应用效果显著。     

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.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

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.     

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.