猪肺磷脂注射液联合经鼻持续气道正压通气治疗早产儿RDS疗效观察

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气治疗早产儿RDS临床效果观察。方法 选取2018年5月至2020年10月本院呼吸暂停早产儿102例,按治疗方案不同分观察组（53例）、对照组（49例）。对照组予以nCPAP模式,观察组予以猪肺磷脂注射液联合nCPAP模式,对比两组治疗效果、开始时、治疗1h、治疗6h、治疗24h时呼吸机相关参数[呼吸末正压（PEEP）、吸入氧浓度（FiO2）]、确诊时、治疗3d、7d、14d后血清CCSP、SPA水平。结果 观察组nCPAP天数、氧疗天数、住院天数短于对照组（P<0.05）;两组脑室出血发生率、脑室周围白质软化发生率对比,差异无统计学意义（P>0.05）;治疗1h、治疗6h、治疗24hPEEP、FiO2逐渐降低,观察组低于对照组（P<0.05）;治疗3d、7d、14d,血清CCSP水平逐渐升高,观察组高于对照组,血清SPA水平逐渐降低,观察组低于对照组（P<0.05）。结论 猪肺磷脂注射液联合nCPAP模式应用于早产儿呼吸暂停治疗能进一步促进肺成熟,改善肺功能,效果显著。     

凝血酶加奥美拉唑治疗残胃出血的疗效观察

目的:对凝血酶加奥美拉唑治疗残胃出血的临床效果进行观察研究.方法:随机选择2015年1月~2016年6月我院救治的100例残胃出血患者,依据治疗手段,对照组50例采取奥美拉唑治疗,研究组50例采取凝血酶加奥美拉唑治疗,就临床效果进行观察比较.结果:研究组PaO(21.1±0.3)mm/Hg、U-ALB(29.3±4.2)mm/Hg、D一二聚体(0.9±0.3)mg/L,对照组(77.2±13.1)mm/Hg、(25.1±5.5)mm/Hg、(0.4±0.1)mg/L,两组之间差异明显(P<0.05);研究组总有效率98.0%,对照组总有效率84.0%,两组之间差异明显(P<0.05).结论:凝血酶加奥美拉唑治疗残胃出血临床效果可观,具备临床推广价值.     

P2X7受体表达在肺炎支原体肺炎早期诊断中的价值

目的：探讨肺炎支原体肺炎患儿中P2X7受体表达水平及与TNF-α、IL-1β水平的相关性。方法：选取300例肺炎支原体肺炎患儿作为研究组并选取健康儿童50例作为对照组,检测两组间P2X7受体、TNF-α和IL-1β表达水平的差异及相关性。结果：研究组P2X7受体表达水平为（151.4±14.3）ng/mL,显著高于对照组的（64.7±10.8）ng/mL（P<0.01）;研究组TNF-α表达水平为（1.72±0.14）ng/mL,显著高于对照组的（0.74±0.16）ng/mL（P<0.01）;研究组IL-1β表达水平为（0.89±0.14）ng/mL,显著高于对照组的（0.23±0.15）ng/mL（P<0.01）。肺炎支原体肺炎患儿中P2X7受体表达与TNF-α、IL-1β表达水平呈正相关（R2分别为0.533、0.666,P<0.05）。结论：肺炎支原体肺炎患儿中存在P2X7受体及TNF-α、IL-1β过度表达,且P2X7受体与TNF-α、IL-1β表达呈正相关。     

复方甘草酸苷片联合双歧杆菌三联活菌胶囊治疗儿童非酒精性脂肪肝的疗效和安全性

目的：观察复方甘草酸苷片联合联合双歧杆菌三联活菌胶囊（培菲康）治疗儿童非酒精性脂肪性肝病（NAFLD）的临床疗效和安全性。方法：选择2015年12月到2018年2月我院诊治的NAFLD患儿136例,使用随机数字表法将患儿分为对照组和观察组各68例。对照组给予复方甘草酸苷片,观察组给予复方甘草酸苷片+双歧杆菌三联活菌胶囊（培菲康）,疗程24周,比较两组临床疗效和不良反应发生情况。结果：治疗后观察组IL-6、TNF-α、AST、ALT、HA、LN、PC Ⅲ和C Ⅳ分别为（15.64±2.82）μg/L、（25.63±5.14）μg/L、（51.72±10.33）U/L、（57.48±10.65）U/L、（117.25±21.46）ng/mL、（55.62±10.24）ng/mL、（85.61±14.92）ng/mL和（70.35±12.72）ng/mL,均显著低于对照组的（22.23±3.68）μg/L、（36.82±6.38）μg/L、（64.35±11.24）U/L、（70.14±13.52）U/L、（162.43±31.35）ng/mL、（87.56±15.14）ng/mL、（120.26±21.57）ng/mL和（102.37±19.43）ng/mL（P<0.05）。对照组临床治疗有效率为76.5%,显著低于观察组的92.6%（P<0.05）。对照组不良反应发生率为7.4%,观察组不良反应发生率8.8%,两组不良反应发生率比较差异无统计学意义（P>0.05）。结论：复方甘草酸苷片联合双歧杆菌三联活菌胶囊（培菲康）抑制NAFLD患儿炎症反应和肝纤维化,临床疗效显著,使用安全。     

猪肺磷脂注射液与氨溴索分别联合 nCPAP 治疗30～34周早产儿呼吸窘迫综合征的疗效比较

目的：比较猪肺磷脂注射液（商品名固尔苏,意大利 Chiesi Farmaeeatici SPA）与氨溴索分别联合鼻塞式持续气道正压通气（nCPAP）治疗30～34周早产儿呼吸窘迫综合征（NRDS）的临床疗效。方法选取 NRDS 患儿230例,患儿根据家长的治疗意愿分为观察组120例和对照组110例。观察组患儿采用固尔苏联合 nCAPA 治疗,对照组患儿采用氨溴索联合 nCAPA 治疗。观察2组临床疗效,并观察2组血气分析指标,记录2组并发症发生情况及死亡情况。结果观察组总有效率为90．8％高于对照组的89．1％,但差异无统计学意义（ P ＞0．05）。2组治疗后血动脉血氧分压（PaO2）、pH 值高于治疗前,血二氧化碳分压（PaCO2）低于治疗前,且观察组变化幅度大于对照组,差异均有统计学意义（ P ＜0．05）。观察组并发症发生率为11．7％低于对照组的33．6％,病死率为8．3％低于对照组的20．9％,差异均有统计学意义（ P ＜0．05）。结论固尔苏与氨溴索分别联合 nCPAP 治疗30～34周早产儿 NRDS 治疗效果均显著,但固尔苏联合 nCPAP 在改善血气分析指标,降低并发症发生率及病死率方面优于氨溴索联合 nCPAP。     

中西医结合治疗对腹型过敏性紫癜病人的疗效及血清免疫学指标的影响

目的 探究腹型过敏性紫癜患儿采用中西医结合治疗的疗效及对患儿血清免疫学指标的影响。方法 选取黄冈市中心医院收治的120例腹型过敏性紫癜患儿,按照随机数字表法分为对照组和观察组,每组60例,对照组给予其泼尼松、氢化可的松、甲氰米胍及止血、护胃等常规西药治疗,观察组在此基础上给予半夏泻心汤加减辩证治疗,对比分析两组患儿治疗效果。结果 观察组患儿总有效率(96.67%)明显高于对照组患儿(83.33%),差异有统计学意义(P<0.05)。观察组治疗后患儿的补体C3(1.47±0.45) g/L、IgA水平(2.78±0.54) g/L明显优于对照组患儿(2.87±0.64) g/L、(3.11±0.69) g/L,差异有统计学意义(P<0.05)。观察组治疗后患儿IgM(1.35±0.23) g/L、IgG(9.12±1.21) g/L、IL-2(21.43±4.58) ng/L、IL-4(13.42±3.37) ng/L免疫学指标水平明显优于对照组患儿IgM(2.43±0.75) g/L、IgG(10.32±1.54) g/L、IL-2(18.56±3.12) ng/L、IL-4(17.33±4.87) ng/L(P<0.05)。结论 腹型过敏性紫癜患儿采用中西医结合治疗的疗效显著,促进患儿免疫血指标恢复,改善免疫功能。     

益生菌辅助治疗儿童支气管哮喘伴变应性鼻炎的疗效及机制研究

目的：探讨益生菌辅助治疗儿童支气管哮喘伴变应性鼻炎（AR）的疗效及机制。方法：选取100例哮喘伴AR患儿,随机分为观察组和对照组各50例,对照组给予常规治疗,观察组在对照组基础上联合双歧杆菌乳杆菌三联活菌片治疗,连续治疗6个月。比较两组患儿哮喘控制测试（C-ACT）量表评分、第1秒时间肺活量（FEV1）、呼气峰值流速（PEF）、鼻部症状评分及血清干扰素-γ（IFN-γ）和白介素-4（IL-4）水平。结果：治疗后,观察组C-ACT评分、FEV1、PEF、鼻部症状评分、IFN-γ及IL-4分别为（24.6±2.3）分、（123.7±10.6）%、（125.2±8.3）L/min、（0.5±0.2）分、（43.6±4.8）g/L及（32.4±3.9）ng/L,对照组分别为（20.1±2.0）分、（108.4±14.3）%、（110.8±7.4）L/min、（0.9±0.3）分、（35.2±3.9）g/L及（44.8±4.7）ng/L,与对照组相比较,观察组C-ACT评分、FEV1、PEL、IFN-γ显著提高（P<0.05）,同时鼻部症状评分及IL-4显著降低（P<0.05）。结论：益生菌辅助治疗哮喘伴AR可有效缓解临床症状,纠正Th1/Th2免疫失衡是其可能作用机制。     

双歧杆菌四联活菌联合孟鲁司特钠对过敏性紫癜患儿炎性因子和免疫功能的影响

[摘要]目的：探讨双歧杆菌四联活菌联合孟鲁司特钠对过敏性紫癜患儿炎性因子和免疫功能的影响。方法：选取2016年6月到2017年6月在我院接受治疗的过敏性紫癜患儿120例，根据随机数表法分为观察组和常规治疗组各60例，常规治疗组采用常规方法治疗，观察组在常规治疗的基础上加用双歧杆菌四联活菌联合孟鲁司特钠进行治疗，两组均连续治疗1个月，观察两组患儿的临床疗效、不良反应发生率和复发率，比较两组患儿治疗前后的炎症因子、T淋巴细胞亚群及免疫球蛋白水平。结果：观察组的总有效率为95.00%，明显高于常规治疗组的83.33%（P<0.05）；在治疗过程中，两组患儿均未出现明显的不良反应；观察组的复发率为8.33%，低于常规治疗组的21.67%（P<0.05）。治疗后观察组的IL-9、IL-17、IL-23、TNF-α水平分别为（21.89±6.97）pg/mL、（19.49±3.48）pg/mL、（20.68±3.97）pg/mL、（110.26±21.26）ng/L，均低于常规治疗组的（29.46±7.83）pg/mL、（24.16±4.26）pg/mL、（27.56±4.61）pg/mL、（150.37±26.48）ng/L（P<0.05）；治疗后观察组的IFN-γ水平为（23.68±2.57）pg/mL，高于常规治疗组的（19.52±2.04）pg/mL，IL-4水平为（13.29±2.28）pg/mL，低于常规治疗组的（16.19±2.36）pg/mL（P<0.05）；治疗后观察组的CD4+、CD4+/CD8+分别为（36.52±3.93）%、（1.47±0.16），高于常规治疗组的（32.73±4.22）%、（1.21±0.11），CD8+为（24.83±2.41）%，低于常规治疗组的（27.02±2.45）%（P<0.05）；治疗后观察组IgA水平为（1.42±0.64）g/L，低于常规治疗组的（1.95±0.71）g/L（P<0.05）。结论：双歧杆菌四联活菌联合孟鲁司特钠应用于过敏性紫癜患儿可降低机体炎症反应，促进Th1/ Th2细胞平衡，改善机体免疫功能，降低复发率，具有较好的临床疗效，且安全性较好。     

B型钠尿肽在小儿重症肺炎诊疗及预后评价中的应用

目的：探讨小儿重症肺炎患者血浆B型钠尿肽（BNP）表达水平在疾病诊疗和预后评价中的价值。方法：将120例于我院就诊的重症肺炎患儿作为研究对象,根据临床结局分为痊愈出院组（A组,n=92）和死亡组（B组,n=28）,回顾性分析两组患儿治疗前的血浆BNP水平、超敏C反应蛋白（hsCRP）、动脉血氧分压（PO2）以及急性生理和慢性健康状况评分(APACHE II)。分析患儿血浆BNP与病情以及预后的相关性。结果：A组和B组患儿的血浆BNP分别为（86.65±37.44）pg/mL和（128.55±42.86）pg/mL,hsCRP分别为（1.89±0.45）mg/L和（3.11±0.62）mg/L,PO2分别为（56.07±7.85）mm Hg和（52.38±8.14）mm Hg,APACHE II分别为（17.53±5.54）分和（20.89±7.22）分,B组患儿的血浆BNP、hsCRP和APACHE II明显高于A组,PO2明显低于A组,以上指标比较差异均有统计学意义（均P<0.05）;患儿血浆BNP水平与hsCRP水平呈正相关（r=0.672,P=0.025）,与APACHE II评分呈正相关（r=0.732,P=0.036）,与PO2呈负相关（r=-0.511,P=0.046）;血浆BNP预测患儿死亡结局的ROC曲线下面积为0.96。结论：血浆BNP在小儿重症肺炎的疾病诊疗和预后评价中有较好的临床应用价值。     

右美托咪定经鼻腔黏膜给药对小儿腹腔镜疝修补术围术期血气指标及拔管质量的影响

[摘要]目的：探讨右美托咪定（Dex）经鼻腔黏膜给药对小儿腹腔镜疝修补术围术期血气指标及拔管质量的影响。方法：选取2020年1月至2021年4月我院拟行腹腔镜疝修补术的患儿80例，根据随机数字表法分为 对照组（n=26）、Dex 1组（n=27）和Dex 2组（n=27）。比较三组患儿术前、气腹后5 min以及放气后30 min动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）和pH；比较三组患儿使用Dex前（T0）、Dex用药30 min后（T1）、手术开始3 min（T2）和手术结束3 min（T3）时血氧饱和度（SpO2）、心率（HR）、平均动脉压（MAP）；比较三组患儿苏醒时间、拔管时间、拔管质量、躁动评分和不良反应发生率。结果： 对照组气腹后5 min PaO2、pH、PaCO2分别为（73.16±7.45）mm Hg、7.21±0.06、（45.16±5.96）mm Hg；Dex 1组和Dex 2组气腹后5 min PaO2分别为（78.46±6.64）mm Hg、（79.43±6.51）mm Hg，pH分别为7.38±0.10、7.49±0.08，均较 对照组升高，PaCO2分别为（40.14±4.19）mm Hg、（37.06±4.32）mm Hg，均较 对照组降低（P<0.05）；Dex 2组气腹后5 min pH高于Dex 1组，PaCO2低于Dex 1组（P<0.05）。Dex 1组和Dex 2组T1、T2、T3时HR、MAP降低（P<0.05）；Dex 2组T1、T3时HR低于Dex 1组，T1时MAP低于Dex 1组（P<0.05）；Dex 1组和Dex 2组T1、T2、T3时HR、MAP均较T0时降低（P<0.05）。 对照组拔管评分和躁动评分分别为（4.51±0.95）分、（13.25±2.59）分，Dex 1组拔管评分和躁动评分分别为（2.93±1.03）分、（9.27±2.23）分，Dex 2组拔管评分和躁动评分分别为（2.15±1.14）分、（6.38±2.62）分，与 对照组比较，Dex 1组和Dex 2组拔管评分和躁动评分降低，且Dex 2组低于Dex 1组（P<0.05）。3组患儿苏醒时间、拔管时间、不良反应发生率比较，差异无统计学意义（P>0.05）。结论：经鼻腔黏膜给予Dex，可有效改善行腹腔镜疝修补术患儿围术期呼吸循环功能，减轻拔管应激反应和苏醒期躁动反应，且不延长拔管时间，不增加不良反应发生率，安全可靠。     

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.     

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.