左氧氟沙星序贯给药治疗下呼吸道感染的疗效以及安全性评价

目的探讨左氧氟沙星序贯治疗下呼吸道感染的临床疗效及安全性。方法将我院收治的146例急性下呼吸道感染患者随机分为A组和B组，每组各73例。A组和B组分别给予左氧氟沙星和头孢呋辛静滴．口服治疗，疗程7-10d。观察两组有效率、致病茵清除率及不良反应发生情况。结果A组有效率为90．4％，显著高于B组78．1％，差异有统计学意义（P〈0．05）；A组的清除率为89．9％，显著高于B组74．6％，差异有统计学意义（P〈0．05）；A组和B组不良反应发生率分别为6．9％和9．6％，差异无统计学意义（P〉0．05）。结论左氧氟沙星序贯治疗下呼吸道感染安全有效，且耐药性低，致病菌清除率高，值得·临床推广。     

改良复合式小梁切除术治疗原发性青光眼的临床探讨

目的：探讨改良复合式小梁切除术治疗原发性青光眼的效果。方法将120例原发性青光眼患者随机分为A组和B组各60例。 A组选择常规小梁切除术，B组选择改良复合式小梁切除术治疗，比较2组治疗前后眼压变化、满意度和并发症发生情况。结果治疗前2组眼压水平差异无统计学意义（ P＞0．05）。治疗后第1、14和90d，B组眼压水平均低于A组，差异均有统计学意义（P＜0．05）。 B组满意度为98．3％高于A组的66．7％，并发症发生率为8．3％低于A组的50．0％，差异均有统计学意义（P＜0．05）。结论针对原发性青光眼患者，采用改良复合式小梁切除术进行治疗，能对患者的眼压情况进行有效治疗，且能降低患者并发症发生率，值得临床推广应用。     

不同剂量左氧氟沙星对高龄下呼吸道感染患者白细胞数的影响

目的：探讨不同剂量的左氧氟沙星注射液（可乐必妥）对80a以上急性下呼吸道感染患者白细胞数的影响。方法：将128例住院治疗的急性下呼吸道感染患者，根据应用可乐必妥的剂量不同分为2组，A组（n=60例）静脉滴注可乐必妥每天500mg，B组（n=68例）静脉滴注可乐必妥每天300mg，疗程均为5～13d，用药前及用药后第3，7天查白细胞数。结果：A组患者治疗后第3，7天白细胞数明显下降且低于B组，组间比较差异有统计学意义（P〈0．05）。白细胞数低于4×10^9·L^-1的患者A组有8例（13．33％），B组1例（1．47％），两组比较差异也有统计学意义（P〈0．05）。结论：高龄下呼吸道感染患者在应用左氧氟沙星时．适当减少剂量．可以减少白细胞数下降的不良反应．对临床治疗有一定的指导意义。     

非诺贝特辅治老年性高脂血症性胰腺炎疗效观察

目的：观察非诺贝特辅治老年性高脂血症性胰腺炎的临床疗效。方法将70例老年性高脂血症性胰腺炎患者随机分为A组和B组各35例。 B组患者采用常规抗胰腺炎治疗, A组在B组治疗的基础上加用非诺贝特,比较2组患者治疗前后三酰甘油（ TG）、血淀粉酶（ AMY）以及血钙（ Ca）水平变化。结果2组患者的TG、AMY较治疗前明显下降（P＜0．05）;且A组患者的TG、AMY水平显著低于B组（P＜0．05）;2组患者血液中Ca水平与治疗前对比差异无统计学意义（P＞0．05）。结论老年性高脂血症性胰腺炎患者具有病情复杂的特点,治疗高脂血压胰腺炎在常规治疗的基础上加用非诺贝特,疗效更为显著。     

四联药物治疗消化性溃疡临床疗效观察及护理体会

目的：探讨四联药物治疗消化性溃疡的临床疗效和护理经验。方法选取消化性溃疡患者150例。按照随机数字表分为三组,每组有50例。三组患者都接受抗生素左氧氟沙星,A组再接受埃索美拉唑,B组再接受埃索美拉唑和果胶铋胶囊,C组接受埃索美拉唑、果胶铋胶囊和护理干预。结果相对A组和B组,C组的临床总有效率具差异有统计学意义（χ2＝4．12,3．94,均P＜0．05）。相对B组,C组的总有效率具有明显差异,结果具有统计学意义（χ2＝4．01,P＜0．05）;A组转阴率为74％;B组转阴率为88％;C组转阴率94％。相对A组,B组和C组的转阴率差异有统计学意义（χ2＝4．52,3．97,均P＜0．05）;相对B组,C组的转阴率差异有统计学意义（χ2＝3．91,P＜0．05）。结论四联药物联合护理干预治疗消化性溃疡临床疗效显著,不良反应少,值得推广使用。     

经皮肝动脉插管在肝脏细菌性感染脓肿前期治疗中的应用

目的：研究经皮肝动脉插管给药在肝脏性感染脓肿前期治疗中的效果。方法：将62例脓肿前期患者随机分成两组。A组：31例，经皮肝动脉插管，导管内应用抗生素。B组：31例，传统静脉内应用抗生素，观察两组脓肿形成率和平均治愈时间。结果：脓肿形成率：A组，3．45％；B组，45．16％（P＜0．01）。平均治愈时间：A组，11．76（天）；B组，19．36（天）（P＜0．05）。结论：肝动脉导管内应用抗生素治疗肝脏细菌性感染脓肿前期效果优于传统治疗方法。     

Pcv－aCO2与老年重症肺炎患者病情危重程度及预后关系的研究

目的：探讨Pcv－aCO2与老年重症肺炎患者病情危重程度及预后的关系。方法选择2014年3月至2015年1月ICU科收治的老年重症肺炎患者95例,根据Pcv－aCO2水平分为3组：A组：Pcv－aCO2＜6．0 mm Hg;B组：6．0 mm Hg≤Pcv－aCO2＜10 mm Hg;C组：Pcv－aCO2≥10．0 mm Hg。检测3组患者血乳酸、氧合指数、ApacheⅡ评分及Sofa评分;统计住院时间及死亡例数。结果 B组、C组患者血乳酸水平、ApacheⅡ评分及Sofa评分均较A组患者明显升高（ P ＜0．05）,PO2／FIO2较A组患者明显下降（ P ＜0．05）;C组患者血乳酸水平、ApacheⅡ评分及Sofa评分均较B组患者明显升高,PO2／FIO2较B组患者明显下降,差异有统计学意义（ P ＜0．05）;B组、C组患者住院时间均较A组患者明显延长（ P ＜0．05）,病死率明显升高（ P ＜0．05）;C组患者住院时间较B组明显延长,病死率明显升高,差异有统计学意义（ P ＜0．05）;Pcv－aCO2与血乳酸、住院时间、ApacheⅡ评分及Sofa评分均呈明显正相关（R＝0．650, P ＝0．000;R＝0．570, P ＝0．000;R＝0．704, P ＝0．000;R＝0．781, P ＝0．000）,与PO2／FIO2呈明显负相关（R＝－0．809, P ＝0．000）。结论 Pcv－aCO2可以评估老年重症肺炎患者的病情危重程度及预后。     

2型糖尿病患者伴泌尿系感染多重耐药大肠埃希菌对不同抗菌药物的耐药性分析

目的:分析2型糖尿病患者伴泌尿系感染多重耐药大肠埃希菌对不同抗菌药物的耐药性特点,为临床治疗多重耐药大肠埃希菌感染的合理用药提供参考。方法:抽取2013年1月—2018年10月间收治的2型糖尿病并发泌尿系多重耐药大肠埃希菌感染患者200例资料,按感染致病菌的不同将其分为多重耐药患者100例(A组)和非多重耐药患者100例为(B组),比较和分析其患者不同疾病因素(糖尿病肾病、留置尿管、泌尿系结石、尿道器械操作、有创操作)菌株感染的发生率差异,以及致病菌对不同抗菌药物的耐药性。结果:A组患者多重耐药菌株感染发生率大于B组(P<0.05);A组患者多重耐药菌对磺胺类、庆大霉素、喹诺酮以及β-内酰胺类药抗菌药物高度耐药,而阿米卡星、呋喃妥因、美罗培南、亚胺培南、头孢哌酮-他唑巴坦等对其具有较高的敏感性;在其对头孢他啶、左氧氟沙星、头孢吡肟的耐药性方面,B组小于A组(P<0.05)。结论:2型糖尿病并发大肠埃希菌泌尿系感染患者存在多种耐药问题,治疗期间应依据药敏试验结果调整用药方案,及早采用敏感性较强的抗菌药物治疗,以确保其疗效。     

HbA1 c 水平对 AMI 患者冠状动脉介入术后 Kllip 分级、心脏功能及 MACE 发生风险的影响

目的：探讨糖化血红蛋白水平对行冠状动脉介入急性心肌梗死（ AMI）患者术后Kllip分级、心脏功能及MACE发生风险的影响。方法研究对象选取2012年5月至2015年5月收治行冠状动脉介入AMI患者共110例,依据PCI术前随机静脉糖化血红蛋白水平分为2组,其中A组（76例）患者糖化血红蛋白值＜8％,而B组患者（34例）糖化血红蛋白值≥8％;比较2组患者术后Killip分级、NYHA心功能分级、超声心动图指标、MACE发生率及死亡率等。结果 A组患者术后Killip分级水平显著优于B组,差异有统计学意义（ P ＜0?．05）;A组患者术后NYHA分级水平显著优于B组,差异有统计学意义（ P ＜0．05）;B组患者LVDd和LA水平均显著高于A组,差异有统计学意义（ P ＜0．05）;B组患者LVEF水平显著低于A组,差异有统计学意义（ P ＜0．05）;B组患者MACE发生率和死亡率均显著高于A组,差异有统计学意义（ P ＜0．05）。结论行冠状动脉介入AMI患者高糖化血红蛋白水平可严重影响术后心脏功能改善,增加MACE发生及死亡风险。     

早产儿1100例临床分析

目的通过对早产儿患病率、病死率的相关因素分析,探讨降低早产儿病死率的措施。方法对1100例早产儿按时间前后分为两组（A组,B组）。对两组早产发生率、死亡原因、并发症发生情况进行回顾性对比分析。结果早产发生率A组2．85％,B组3．67％,两组差异有统计学意义（P〈0．05）。早产儿病死率A组12．06％,B组2．36％,差异有统计学意义（P〈0．01）。结论加强围生儿的监测和保健护理,可以降低早产儿的患病率和病死率。     

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.