免疫球蛋白对重症格林-巴利综合征的治疗效果评价

目的探讨静脉注射免疫球蛋白(IVIG)对重症格林-巴利综合征(GBS)的治疗价值。方法将58例重症GBS患者分为两组:IVIG组和激素组。两组均以维生素B族、神经保护、改善血循环及对症支持治疗为基础。区别是IVIG组应用IVIG 0.4 g.kg-1.d-1,5 d为1个疗程,激素组急性期应用地塞米松20-30mg/d冲击,以后逐渐减量停药。结果IVIG组疗效明显优于激素组(P<0.05)。与激素组比较IVIG组起效时间短,呼吸肌麻痹发生率低,病程明显缩短,病死率明显下降。结论大剂量IVIG治疗重症GBS疗效确切,可以大大降低病死率,应该作为首选治疗。     

大剂量人血丙种球蛋白治疗急性吉兰-巴雷综合征24例

急性吉兰-巴雷综合征(Guillain-Barre'Syndrome.GBS)是神经系统常见病,常累及运动脑神经、脊神经根,引起广泛的下运动神经元瘫痪,甚至出现呼吸肌麻痹,是神经系统常见急症之一.我们采用大剂量静脉滴注人血丙种球蛋白(IVIG)治疗急性期GBS取得满意结果,现报告如下:     

格林-巴利综合征的临床与药物治疗

目的:探讨儿童格林鄄巴利综合征(GBS)的临床特点和治疗方法。方法:对符合GBS诊断的70例进行临床分析,并对治疗方法及其疗效进行对比观察。结果:GBS主要表现为上行性、对称性、驰缓性麻痹。脑脊液(CSF)有蛋白细胞分离现象。大剂量IVIG在控制病情进展,减少继发感染、缩短疗程明显优于其他治疗方法(P<0.05)。结论:IVIG治疗儿童GBS是—种安全有效的方法。     

小儿格林-巴利综合征26例临床分析及诊疗体会

目的：探讨小儿格林-巴利综合征（GBS）的临床分析及诊疗体会。方法：农村患儿发病率高，入院率多集中于每年7～10月，占46％。病前1～3周有上感、腹泻病史者占69％，26例均有急性四肢对称性迟缓性瘫痪为固有特点，并发颅神经损害及呼吸肌麻痹，脑脊液有蛋白-细胞分离现象，发病1周后阳性率高达71．4％。其中2份便标本送北京有关部门分离出格林-巴利病毒。急性期给予大剂量丙种球蛋白，大部分病例配合用激素、甘露醇、抗生素及抗病毒药物。结果：26例患儿中治愈或好转出院占92．3％（24／26），死亡2例。平均住院天数28天。结论：目前认为是多种感染性因素引起细胞和体液免疫共同介导导致的免疫损伤性疾病，大剂量IVIG对控制急性进展性GBS的病情，促进其各项神经功能的恢复，缩短病情及住院时间，降低病死率及减少并发症等效果均明显优于以往用皮质激素的病例，而且早期给予IVIG疗效更为明显。     

中西医结合治疗格林-巴利综合征临床观察

格林-巴利综合征(GBS)又称急性感染性多发性神经根炎,以渐进性、对称性肢体麻痹为特点,可并有不同程度的感觉障碍,甚至出现呼吸肌及颅神经麻痹.2002年1月至2006年12月共收治住院患者54例,采用中西医结合治疗,疗效满意,现报告如下. 　　……     

免疫球蛋白联合甲泼尼龙治疗重型-极重型格林巴利综合征效果观察

目的探讨免疫球蛋白联合甲泼尼龙治疗重型-极重型格林巴利综合征(GBS)的效果。方法 2008年1月至2010年9月我院收治并诊断重型-极重型GBS患者42例,按入院顺序分为对照组和观察组,每组各21例。观察组给予免疫球蛋白(IVIG)和甲泼尼龙治疗。对照组给予甲泼尼龙,观察两组疗效。结果观察组治愈率高于对照组,差异有统计学意义。结论 IVIG联合激素治疗GBS效果良好。     

吉兰-巴雷综合征12例护理体会

<正>吉兰-巴雷综合征(Guillain-Barre sydrome,GBS)是神经系统常见的急危重症病,是一种急性免疫性周围神经系统的脱髓鞘疾病,临床表现为急性对称性、渐进性四肢弛缓性瘫痪,伴有感觉障碍,严重者可发生颅神经损害,延髓受累,呼吸肌瘫痪。其中呼吸肌麻痹及合并症是本病的重要死因[1]。其预后与护理效果密切相关。我科2011年5月至2013年5月共收治GBS患者12例,经积极治疗和     

综合护理干预吉兰-巴雷综合征效果观察

<正>吉兰-巴雷综合征(GBS)为急性或亚急性起病的多发性脊神经根(可伴脑神经)受累的一组疾病,严重者可发生颅神经损害,延髓受累,呼吸肌瘫痪,其中呼吸肌麻痹及并发症是本病重要的死亡原因[1]。2007年以来,我院共收治GBS患者68例,经过药物治疗及精心护理,取得满意效果,现将护理体会报告如下。1临床资料1.1一般资料:2007年1月至2013年6月,我     

初始剂量丙种球蛋白无反应性川崎病的治疗进展

虽然静脉用丙种球蛋白(IVIG)可以有效的治疗川崎病(KD),但仍有10%~20%的KD患儿对初始剂量IVIG治疗无反应,使他们合并冠状动脉病变(CAL)的风险增加.对初始剂量丙种球蛋白无反应性川崎病的治疗方案仍有争议.其他疗法主要包括再次输注IVIG、糖皮质激素药物、TNF-α抑制剂、钙调磷酸酶抑制剂、他汀类药物、MTX治疗、血浆置换等.本文综述初始剂量IVIG无反应性KD的治疗进展.     

重症格林-巴利综合征呼吸机治疗的指征及护理

格林-巴利综合征（GBS）是迅速进展且大多能自愈的周围神经疾病。部分患者发生呼吸肌麻痹而死亡。自呼吸机广泛用于临床后,救治成功率明显提高。因此加强GBS急性期呼吸肌麻痹呼吸机治疗的护理是降低死亡的关键措施之一。本文将我院2000年1月至2008年8月应用呼吸机救治25例重症GBS患者的护理体会报道如下。     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Polymorphisms in genes involved in neurotransmission in relation to smoking

Smoking behavior is influenced by both genetic and environmental factors. The genetic contribution to smoking behavior is at least as great as its contribution to alcoholism. Much progress has been achieved in genomic research related to cigarette-smoking within recent years. Linkage studies indicate that there are several loci linked to smoking, and candidate genes that are related to neurotransmission have been examined. Possible associated genes include cytochrome P450 subfamily polypeptide 6 (CYP2A6), dopamine D₁, D₂, and D₄ receptors, dopamine transporter, and serotonin transporter genes. There are other important candidate genes but studies evaluating the link with smoking have not been reported. These include genes encoding the dopamine D₃ and D₅ receptors, serotonin receptors, tyrosine hydroxylase, trytophan 2,3-dioxygenase, opioid receptors, and cannabinoid receptors. Since smoking-related factors are extremely complex, studies of diverse populations and of many aspects of smoking behavior including initiation, maintenance, cessation, relapse, and influence of environmental factors are needed to identify smoking-associated genes. We now review genetic polymorphisms reported to be involved in neurotransmission in relation to smoking.     

Tramadol concentrations in blood and in cerebrospinal fluid in a neonate

Based on blood and cerebrospinal fluid samples collected in a full-term neonate, the penetration of tramadol in the central nervous system is described. Following intravenous administration of tramadol, a lag time of about 4 h was observed until full blood–brain equilibration was achieved. This pharmacokinetic observation is in line with a recent pharmacodynamic evaluation of the central opioid effects of tramadol in adults.     

Disease control in asthmatic children seen in private practice in Switzerland

ABSTRACT

Background: Asthma is the most common chronic childhood disease in Switzerland with a prevalence of 10%. Asthma has a high economic burden accounting for high medical costs. Assessment of disease control is likely to be of help in the implementation of strategies to improve asthma. Therefore, we aimed to evaluate asthma control and therapy regimens among children in private practice.

Methods: We assessed asthma control as well as therapy regimens in 575 asthmatic children in an experience programme in Switzerland by using an abbreviated questionnaire based on the asthma control questionnaire and the child health questionnaire on Visit 1 and Visit 2.

Results: Good asthma control at Visit 1 was only present in 25.7% of asthmatic children. Occasional asthma symptoms, limitation of physical activity, nocturnal awakening and anxiety of the parent was present in 80.5%, 41.2%, 46.8% and 57% of the children, respectively. After adjustment of therapy regimens at Visit 1, mainly by adding a leukotriene receptor antagonist, asthma control was reported to be much better in 53.4% of the children at Visit 2.

Conclusions: As asthma control is inadequately achieved within a major portion of asthmatic children, it is imperative to find measures to improve asthma control and hence, to reduce the burden of disease.