不同类型胃食管反流病24h食管pH监测的临床研究

目的：研究不同类型胃食管反流病24h食管pH监测指标之间的相关性。方法对符合胃食管反流病（GERD）诊断标准的43例患者,经内镜检查分为反流性食管炎（RE）组、非糜烂性反流病（NERD）组、Barrettt食管组,随后进行高分辨多通道毛细灌注测压检查及食管pH动态监测,比较各组24h食管pH监测指标。结果三组患者食管pH〈4反流次数（次）,反流持续时间≥5 min反流次数（次）、pH〈4总时间, pH〈4百分时间（%）, DeMeester积分差异无统计学意义（P〉0.05）。结论不同类型胃食管反流病食管粘膜损伤与食管酸反流无相关性,食管组织化生与食管酸反流无相关性。     

胃食管反流病亚型反流特点分析

目的 比较反流性食管炎(RE)、非糜烂性反流病(NERD)、Barretts食管(BE)患者的反流特点.方法 将胃食管反流病(GERD)患者根据内镜表现分为RE、NERD、BE 3组,同步进行食管下段24 h pH及胆红素监测,比较其反流特点.结果 (1)RE、BE组酸暴露指标及中重度酸反流患者比例显著高于NERD组.(2)BE组中病理性反流(82.61%),尤其是酸胆汁混合反流(30.43%)比例明显高于NERD组.(3)无病理性反流的SI+患者酸暴露水平高于SI-患者.结论 酸、胆汁暴露程度差异是造成胃食管反流病患者内镜表现不同的原因之一.     

胃食管反流病患者的内镜分级与食管动力学指标的关系研究

目的　探讨胃食管反流病的内镜分级与食管各项动力学检测结果之间的关系。方法有典型胃食管反流 (GER)患者 73例 ,全部进行内镜检查、食管测压及 2 4小时食管 pH监测 ,其中 32例做 2 4小时食管胆红素监测 ,并对观察结果进行相关分析。结果　下食管括约肌压力 (LESP)和食管炎的等级之间存在着轻度但显著的负相关 (r =- 0 38,P <0 0 1) ,食管体蠕动的波幅 (PA)和GERD等级之间存在着轻度但显著的负相关 (r =- 0 33,P <0 0 5 )。 2 4小时食管 pH监测表明不同等级的GERD患者 pH <4占总时间的百分比、反流≥ 5分钟次数、综合评分等均有显著性差异 (P <0 0 5～ 0 0 0 1)。Ⅲ级组与其他三组相比 ,2 4小时食管胆红素监测各项指标均有显著性差异 (P <0 0 1)。结论　内镜下不同等级GERD患者的食管动力学检测结果不同 ,将内镜检查和各种食管动力学检测作综合分析 ,有助于对临床合理治疗提供指导。     

内镜下胃食管阀瓣分型与胃食管反流病食管动力的关系

目的探讨内镜下胃食管阀瓣(GEFV)分型与胃食管反流病(GERD)食管动力的关系。方法回顾性分析 2015年 1月至 2018年 12月就诊于芜湖市第二人民医院诊断为 GERD病人 76例,均行内镜、食管高分辨测压、 24 h食管 pH监测,根据内镜下 HILL分级,将 GEFV分为 Ⅰ~Ⅳ级, Ⅰ级、 Ⅱ级为正常组, Ⅲ级、 Ⅳ级为异常组,比较两组内镜下表现、食管测压、 24 h食管 pH监测相关指标。结果异常组反流性食管炎(RE)、 Barrett食管(BE)检出率为 73.0%,高于正常组(41.0%)差异有统计学意义(P＜0.05)两组食管上括约肌静息压(UESP)［(57.69±32.65)mmHg比(56.32±28.50)mmHg］差异无统计学意义P＞0.05),异常组食管下括静息压(LESP)［(7.93±3.85)mmHg比(19.64±5.95)mmHg］、远端收缩积分(DCI)［(223.59±195.67)mmHg·s-1·cm-1比(,约肌,(533.64±289.71)mmHg·s-1·cm?1］、 4s综合松弛压(IRP4s)［4.0(3.3,4.8)比 5.6(4.6,6.8)］低于正常组,差异有统计学意义(P＜0.05)。两组食管收缩模式、食管蠕动力度相比,差异无统计学意义(P＞0.05),异常组 Demeester评分［9.02(7.28,16.28)分比 3.57(1.65,5.60)分］、酸反流次数［45.00(25.00,56.50)次比 15.00(10.00,32.00)次］、pH＜4所占的总时间百分比高于正常组,差异有统计学意义(P＜0.05)。结论 GEFV异常者内镜下阳性表现发生率高, GEFV可能参与食管抗反流机制,可以有效的预测反流。     

和胃汤辅助奥美拉唑治疗胃食管反流病的疗效观察

目的观察和胃汤辅助奥关拉唑治疗胃食管反流病（GERD）的疗效。方法67例GERD患者随机分为治疗组和对照组,前者清晨顿服奥美拉唑20mg,夜间睡前服用和胃汤,对照组清晨顿服奥美拉唑20mg,疗程6周。于治疗后2、4、6周观察胃灼热、反酸、胸骨后痛等症状的缓解情况,并于6周后复查胃镜及24h食管pH值,比较两组的治愈率。结果治疗组治疗2、4、6周后总有效率分别为80．00％、85．71％、94．28％,对照组治疗2、4、6周后总有效率分别为62．50％、68．75％、71．88％,两组比较有极显著性差异（P〈0．05）;治疗组治疗6周后内镜下A、B、C—D级食管炎治愈率分别达82．35％、73．33％、66．67％,对照组治疗6周后内镜下A、B级食管炎内镜下治愈率分别为46．67％、37．14％,C—D级食管炎治愈率为零,两组比较有极显著性差异（P〈0．05）;两组治疗6周后经24h食管pH值监测,治疗组反流次数明显少于对照组（P〈0．05）。结论和胃汤辅助奥关拉唑治疗GERD的疗效明显优于单用奥美拉唑者（P〈0．05）。     

根除幽门螺杆菌在胃食管反流病药物治疗中的作用

目的 探讨根除幽门螺杆菌（HP）对胃食管反流病（GERD）药物治疗效果的影响。方法 选取诊断为GERD Ⅰ～Ⅱ级（胃镜检查）伴HP感染（快速尿素酶测定）的患者36例，随机分成两组。对照组口服奥美拉唑40mg／d，观察组口服奥美拉唑40mg／d＋甲硝唑0．4g（2次／d），克拉霉素0．25g（2次／d），疗程均为14d。于治疗前及治疗后1个月进行24h食管内pH值监测及HP检测。结果 所有患者均完成了研究。治疗后1个月两组24h食管酸反流的各项参数均有改善，胃灼热和反流的症状评分总分显著降低（P〈0．05），且观察组症状改善更明显，但是两组间差异不显著（P〉0．05）。结论 在口服奥美拉唑的基础上根除HP1个月，时GERD患者胃食管反流没有显著优越性，但可更明显地改善一些反流相关症状。     

三种不同检查方法在胃食管反流病诊断中的应用比较

目的:探讨电子胃镜、24 h食管pH值监测及胃食管反流病(GERD)Q评分三种方法在GERD诊断中的临床应用价值。方法:将于2011年4月—2012年6月因烧心、反酸等症状就诊于消化科门诊的120例患者随机分为胃镜组、24 h食管pH值监测组及GERD Q评分组,每组40例,分别接受电子胃镜、24 h食管pH值监测及GERD Q问卷评分,比较分析各种方法对GERD的检出情况。结果:24 h食管pH值监测组40例患者中病理性反流者19例,生理性反流者5例,GERD阳性率显著高于胃镜组及GERD Q评分组,差异具有统计学意义(P<0.05);胃镜组与GERD Q评分组之间差异无统计学意义(P>0.05)。结论:24 h食道pH值监测可以对食管内反流情况进行实时、动态监测,为GERD的临床诊断及不同类型的反流治疗方案提供客观、准确的依据。     

Barrett食管的动力学研究

目的对比研究Barrett食管（BE）与正常对照组的动力学差异，揭示BE的动力学改变。方法对比分析22例BE患者与18例正常对照的动力学数据。结果食管动力学检查提示，食管下括约肌压力及屏障压明显降低，酸反流总时间、酸反流总次数以及食管下段pH〈4时间百分比均明显增加（P〈0．05或P〈0．01）。结论屏障压的降低及食管廓清能力的下降导致酸反流的产生，进而促进BE的发生。     

GerdQ量表用于矿区人群胃食管反流病诊断的研究

目的 探讨GerdQ量表在矿区人群胃食管反流病(GERD)诊断中的应用价值.方法 选择因烧心等反流症状就诊的矿区GERD患者122例,均完成内镜检查、24h食管pH值监测及GerdQ量表,根据结果将患者分为GERD组(88例)和非GERD组(34例),糜烂性食管炎(RE)组(65例)和非糜烂性GERD(NERD)组(23例),酸暴露组(79例)和非酸暴露组(43例),观察GerdQ评分和酸暴露之间的相关性.以内镜检查、24 h食管pH值监测任一阳性为金标准,根据GerdQ评分绘制受试者工作特征曲线(ROC曲线).结果 GERD组的GerdQ评分[(10.3±2.6)分]高于非GERD组[(4.8±2.2)分],差异有统计学意义(t=3.125,P＜0.01).GerdQ评分与24 h食管动态pH值监测有很好的相关性,酸暴露组患者的GerdQ评分[(11.0±3.3)分]亦高于非酸暴露组[(6.7±2.8)分],差异有统计学意义(t =4.102,P ＜0.01).RE组与NERD组的GerdQ评分比较差异无统计学意义(t=3.251,P＞0.05).以GerdQ评分取诊断临界值为9分时,敏感度为82.3％,特异度为86.0％,ROC曲线下面积为0.905,面积的标准误为0.035,P＜0.05,95％置信区间为0.836～ 0.973.结论 GerdQ量表为适合矿区人群GERD初步诊断的客观、可行的诊疗工具.     

小儿胃食管反流病106例临床分析

目的探讨小儿胃食管反流病（GERD）临床特点、诊断与治疗。方法对106例GERD患儿的临床资料进行回顾性分析。结果小儿GERD以新生儿和婴幼儿发病较多,小于3岁的占75.4%（80/106）。临床表现除有呕吐、溢乳等反流征状外,81.8%具有呼吸道症状表现。部会患儿仅表现呼吸道症状,反流症状反而不明显。91例监测24h食管pH,89例异常,检出率97.8%。卧位时各项反流指标均大于立位时。28例行食管钡剂造影阳性23例,诊断阳性率82.1%。10例食管内镜检查3例有食管炎,其中1例食管溃疡伴Barrett食管。结论小儿胃食管反流临床表现复杂,缺乏特异性;24h食管pH监测是目前首选的诊断方法,不仅可以发现反流,还可以了解反流的程度,食管X线检查仍可作力小儿GER常用的诊断方法;内镜检查和食管黏膜病理检查有助于尽早发现食管病变,增加食管炎的查出率,凡诊断为GER的患儿,特别是有合并症或影响生长发育者必须及时进行治疗。     

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.

     

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.     

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.