维持性血透患者高血压控制不良相关因素分析

目的探讨维持性血液透析患者高血压控制不良相关因素。方法对在安徽省立医院血透室进行血液透析的58例患者进行研究,血压控制良好组28例,血压控制不理想组30例,观察两组患者的KT/V、透析间期体重增长、HDF治疗等。采用单因素分析与多因素Logistic回归分析方法,分析维持性血透患者高血压控制不良的相关因素。结果单因素分析结果显示:未定期做HDF治疗、服用降压药物<3种、透析不充分(KT/V<1.2)、透析间期体重增加≥3 kg等与患者血压控制不良有关;多因素Logistic回归分析显示:未定期做HDF、透析不充分(KT/V<1.2)、透析间期体重增加≥3kg是维持性血透患者血压控制不良的独立危险因素。结论透析间期体重增长过多、透析不充分、未能定期行HDF治疗是维持性血透患者高血压控制不良的独立危险因素。     

维持性血透患者高血压控制不良原因探讨

目的 对接受维持性血透治疗的患者高血压控制不良的原因进行总结.方法 采用随机抽样的方法,在2008年6月至2011年6月这3年时间里,抽取70例在我院接受维持性血液透析治疗的临床患者病例,再将其分为A、B两组,每组35例.A组为血压情况控制良好的患者；B组为血压情况控制不理想的患者.以患者的KT/V、透析期间体重增长、HDF治疗情况作为变化因素,对接受维持性血透治疗的患者高血压控制不良的原因进行总结.结果 总结研究结果显示,患者没有定期进行HDF治疗,在治疗过程中所使用的降压药物少于3种,透析不够充分,在透析期间体重增加3 kg以上,都是导致患者在接受维持性血液透析过程中血压控制不理想的重要因素.结论 如果想对接受维持性血液透析患者的血压情况进行良好的控制,就必须在治疗期间对患者的体重进行严格的控制,透析时务必保证充分,HDF治疗必须按时保质保量的完成.在今后的临床工作中必须对上述因素给予足够的重视.     

动态监测尿毒症血液透析患者超声心动图的意义

目的观察尿毒症血液透析患者超声心动图 (UCG)的动态变化 ,并探讨相关危险因素。方法采用UCG对83例尿毒症患者左房内径(LAD)、左室内径(LVD)、室间隔厚度(IVST)、左室后壁厚度(IVPWT)、E/A值进行动态检测 ,并探讨UCG多次异常与透析间期体重增加过多、高血压、营养不良、透析不充分等因素的相关关系。结果尿毒症患者左室内径、左房内径、室间隔厚度、左室后壁厚度明显增高 ,E/A值降低 ,与正常对照组比较存在显著性差异 (P<0.05) ;UCG多次异常与患者透析间期体重增加过多、高血压、营养不良、透析不充分等密切相关。结论尿毒症患者存在UCG的异常 ,动态监测UCG对指导尿毒症血液透析患者的治疗有一定的价值     

强化透析剂量对维持性血液透析患者高血压的影响

<正>高血压是维持性血液透析患者的常见并发症,研究显示透析患者高血压发病率为81.5%[1]。血压控制不良易导致透析患者心血管疾病患病率和病死率增加,是影响其预后的独立危险因素[2]。为更好地控制透析患者的血压,降低透析患者高血压的发生率,本次研究将通过改变透析剂量,观察对维持性血液透析患者高血压的影响。     

血液透析对心脏形态和功能的影响

目的:了解长期血液透析患者心脏形态结构和功能情况以及血液透析对心脏形态和功能的改变,探讨可能引起血液透析患者心血管损害的相关因素.方法:随机选取成都铁路分局医院血液净化中心维持血液透析6月以上患者32例,分别于透析前2 h和透析后2 h用彩色多普勒超声检测左心室舒张末期内径(LVDd)、室间隔厚度(IVS)、左室后壁厚度(LVPW),同时测量射血分数(EF)、过二尖瓣口前向最大血流速度(舒张早期E、舒张晚期A),收集患者的临床资料并计算出Kt/V、左室重量指数(LVMI)和透析间期体重增加率.结果:与透析前相比,透析后左室肥厚改善不明显,但左室腔明显缩小;心脏舒张功能明显减弱,但心脏收缩功能减弱不明显. COX 风险比例模型分析显示,透析前后左室直径的变化量、心脏舒张功能的变化量均与透析间期体重增加率呈正相关;透析前后心脏舒张功能的变化量与Kt/V呈负相关.直线相关分析显示,左室重量指数与透析间期体重增加率呈直线相关关系;左室重量指数与收缩压呈直线相关关系.结论:容量超负荷、收缩压是促进左室肥厚的危险因素;容量超负荷是促进左室腔扩大的危险因素;控制透析间期体重增长、充分透析,对改善心脏舒张功能具有重要意义.     

维持性血液透析患者透析间期动态血压改变与临床转归的相关性分析

目的 分析维持性血液透析患者透析间期动态血压改变与临床转归的相关性.方法 80例维持性血液透析患者,依据患者随访2年内生存状况分为对照组(死亡,30例)与观察组(生存,50例).所有患者均接受维持性血液透析治疗,并进行动态血压监测.对比两组一般资料、透析过程中血压指标变化情况,采用多因素Logistic回归分析维持性血...     

维持性血液透析患者高血压的控制及其相关因素分析

目的分析维持性血液透析患者高血压的控制情况及相关因素,为维持性血液透析患者高血压的有效控制提供临床依据。方法选取我院2012年6月至2015年6月收治的维持性血液透析患者共98例,依据血压控制情况分为对照组(血压控制良好)和观察组(血压控制不良),分析两组患者的相关指标,并对血液透析时间、干体质量达标情况、EPO使用剂量、血液透析治疗与否等情况进行单因素及多因素Logistic回归分析。结果血压控制良好(对照组)患者22例(22.4%),血压控制不良(观察组)患者76例(77.6%),两组Scr、白蛋白、PTH、EPO使用剂量、透析时间、干体质量达标情况的对比具有统计学差异(P<0.05);Logistic回归分析提示血液透析治疗情况与干体质量达标情况具有统计学差异(P<0.05)。结论血液透析治疗情况与干体质量达标情况是维持性血液透析患者高血压控制的相关影响因素,积极评估干体质量,定期予以透析治疗,采取综合措施是控制维持性血液透析患者高血压的主要手段。     

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。     

对维持性血液透析患者及家属同步实施健康教育的体会

目的:探讨对维持性血液透析患者及家属同步实施健康教育对维持性血液透析患者的影响。方法:2010年1月—2012年1月对50例维持性血液透析患者及家属同步进行首次透析前、透析中、透析间期的心理护理、饮食指导、用药指导和生活指导。结果:50例患者没有急诊透析,未出现心力衰竭和高血钾危像,血压平稳,体重及血色素均明显提高。结论:对维持性血液透析患者及家属同步实施健康教育,对提高维持性血液透析患者的生存质量及减少并发症有积极的影响。     

低血压在维持性血液透析患者中的发病危险因素及其对预后的影响分析

目的：分析低血压在维持性血液透析患者中的发病危险因素及对预后的影响。方法选取维持性血液透析患者96例，分析低血压在维持性血液透析患者中的发病危险因素及对预后的影响。结果年龄、透析龄、透析前收缩压、透析前MAP、TC、PTH和失重干体质量比是发生低血压的危险因素，P＜0．05。结论透析过程中低血压可增加维持性血液透析患者的不良事件发生率。     

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.     

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.