螺内酯联合非洛地平对慢性心力衰竭患者B型钠尿肽前体及心功能的影响

目的探讨小剂量螺内酯联合非洛地平对慢性心力衰竭（CHF）B型钠尿肽前体（NT—proBNP）以及心功能的影响。方法将98例CHF患者按照数字表法随机分为观察组和对照组,各49例。两组患者均予标准三联抗心衰治疗,观察组联用螺内酯（20—40mg／d）和非洛地平（5mg／d）。两组治疗前和治疗后6周分别进行心功能（NYHA）分级评估、6min步行距离测定以及NT－proBNP含量测定并比较。结果观察组总有效率为93．88％,明显高于对照组的40．82％（Z=－2．051,P〈0．05）;治疗6周后两组6min步行距离均显著改善（t=3．196、5．048,均P〈0．05）,且观察组优于对照组（t=4．595,P〈0．05）;治疗6周后两组NT—proBNP含量均显著降低（t=－4．402、－13．191,均P〈0．05）,且观察组改善更显著（t=－8．431,P〈0．05）。结论应用小剂量螺内酯联合非洛地平治疗CHF疗效肯定。     

N端B型脑钠肽对急性心肌梗死运动耐量的预测价值

目的观察N端B型脑钠肽（NT—proBNP）对急性心肌梗死运动耐量的预测价值。方法将60例急性sT段抬高型心肌梗死患者,按入院后床旁超声心动图测定的左心室射血分数（LVEF）分为LVEF≥50％组（30例）和LVEF〈50％组（30例）,比较两组患者入院当时、2周、6个月时血清NT—proBNP水平及6个月时6min步行试验步行距离。结果LVEFi〉50％组与LVEF〈50％组心肌梗死后2周、6个月的NT—proBNP水平均差异有统计学意义（P〈0．05）。两组6min步行试验步行距离差异有统计学意义（P〈0．05）。结论NT—proBNP对急性心肌梗死运动耐量有较好的预测价值。     

曲美他嗪对冠心病心力衰竭患者血浆氮末端脑钠肽水平及运动耐量的影响

目的观察曲美他嗪对冠状动脉粥样硬化性心脏病（冠心病）心力衰竭（心衰）患者血浆氮末端脑钠肽前体（NT．proBNP）水平及运动耐量的影响。方法冠心病心衰患者82例,完全随机分为曲美他嗪组及常规治疗组各41例,于开始治疗前及药物治疗6个月后测定NT-proBNP,并行超声心动图检查和6min步行试验,对2组不同时段相关数据进行比较。结果治疗后曲美他嗪组与治疗前及与常规治疗组治疗后相比,NT-proBNP水平明显下降（P〈0．05）,左心室舒张末期容积明显缩小,而左心室射血分数显著增加（P〈0．05）;6min步行距离显著增加（P〈0．05）。结论曲美他嗪可改善冠心病心衰患者运动耐量,有效降低血浆NT-proBNP水平。     

NT—proBNP在鉴别慢性肺源性心脏病病程进展分期的临床价值

目的观察NT—proBNP（11]t清N-端B型钠尿肽前体）在鉴别慢性肺源性心脏病病程进展分期的临床价值。方法选取慢性肺源性心脏病功能代偿期患者45例（f弋偿组）和功能失代偿期患者45例f失代偿组），并选取同时期住院的慢性阻塞性肺疾病非慢性肺源性心脏病不合并心功能不全患者45例作为对照组，测定他们的血清NT—proBNP值，对比各组之间NT—proBNP值的变化。结果代偿组、失代偿组及对照组的NT—proBNP水平分别为（996．34±832．44）pg／ml、（6302．68±2451．54）pg／ml、（43．27±36．4）pg／ml。各组间比较，差异有极显著性（F=237．57，P〈0．01）。结论检测慢性肺源性心脏病患者血清NT—proBNP有助于鉴别慢性肺源性心脏病病程进屠分期。     

N末端脑钠肽原检测对参麦注射液治疗老年心力衰竭疗效的评价

目的 探讨参麦注射液治疗老年心力衰竭（CHF）中检测血浆N末端脑钠肽（BNP）原（NT-proBNP）的价值. 方法 选择经1~2周常规抗CHF治疗的老年患者 52 例,随机分为对照组和治疗组各26例. 对照组患者给予常规治疗：强心（地高辛） 、利尿药（呋塞米和螺内酯） 、血管紧张肽转换酶抑制药（盐酸贝那普利） 、吸氧、抗感染治疗. 治疗组在常规治疗的基础上每天给予参麦注射液30 mL静脉滴注,15 d为1个疗程. 治疗前进行NT-proBNP测定、6 min步行试验及左心室射血分数（LVEF）检查,治疗结束即刻测定NT-proBNP并记录6 min步行距离,次日超声心动图检查LVEF. 结果 两组CHF患者治疗后NT-proBNP显著下降（ P＜ 0.01）,LVEF明显升高（ P＜ 0.01）,NT-proBNP与6 min步行距离呈负相关（r＝－0.801, P＜0.01）,治疗组NT proBNP下降及6 min步行距离增加最显著（P＜0.05）. 结论 参麦注射液对老年CHF患者可产生积极的作用,能增加6 min步行距离,改善心功能,NT-proBNP在治疗CHF疗效评价中有较高的参考价值.     

伊伐布雷定治疗慢性阻塞性肺疾病合并心力衰竭的临床效果及安全性

目的 探讨伊伐布雷定治疗慢性阻塞性肺疾病（COPD）合并心力衰竭的临床效果及安全性。方法 选取2018年1月至2021年1月茂名市人民医院收治的80例COPD合并心力衰竭患者作为研究对象,按随机数字表法分为对照组与观察组,各40例。对照组予以常规抗心力衰竭治疗,观察组在对照组的基础上加用伊伐布雷定治疗。两组均持续用药3个月。比较两组的心功能[左室射血分数（LVEF）、心排血量（CO）及每搏输出量（SV）]、静息心率变化、N末端脑钠肽前体（NT-proBNP）水平、6 min步行距离及肺功能[呼气峰流速（PEF）、用力肺活量（FVC）及第1秒用力呼气容积（FEV1）],并记录两组的不良反应发生情况。结果 两组患者治疗后的LVEF、CO、SV水平高于治疗前,差异有统计学意义（P<0.05）;观察组治疗后的LVEF、CO、SV水平高于对照组,差异有统计学意义（P<0.05）;两组患者治疗前的静息心率变化、NT-proBNP水平及6 min步行距离比较,差异无统计学意义（P>0.05）;两组患者治疗后的静息心率、NT-proBNP水平低于治疗前,6 min步行距离长于治疗前,...     

加用曲美他嗪治疗慢性心力衰竭的疗效观察

目的:观察加用曲美他嗪治疗慢性心力衰竭患者的临床疗效及不良反应.方法:将90例慢性心力衰竭(NYHA心功能Ⅲ～Ⅳ级及左室射血分数LVEF≤45％)患者随机分为观察组和对照组.对照组(n=46)用常规抗心衰药物治疗,观察组(n=44)在对照组治疗的基础上加用曲美他嗪,治疗8周,观察治疗前后NYHA心功能分级、LVEF、左室短轴缩短分数(FS)、N末端B型利钠肽( NT - proBNP)及6分钟步行试验.结果:2组治疗后心功能各项指标均较治疗前改善(P＜0.01).与对照组相比,观察组能更明显改善NYHA心功能分级(P＜0.05),提高EF值、FS值及6分钟步行距离(6 - MWD)(P＜0.01),降低NT - proBNP(P＜0.05),均有统计学意义,且无严重不良反应出现.结论:慢性心力衰竭患者在常规治疗基础上,加用曲美他嗪可进一步改善心功能,提高运动耐量,安全有效,值得推广.     

芪参益气滴丸治疗慢性心力衰竭的临床观察

目的观察芪参益气滴丸治疗慢性心力衰竭的临床疗效。方法将122例患者随机分为对照组和治疗组,对照组应用常规治疗心力衰竭药物,治疗组在常规治疗基础上加用芪参益气滴丸,疗程8周,观察两组患者的临床疗效及治疗前后左心室收缩及舒张末内径、射血分数、脑钠肽水平及6 min步行距离。结果经治疗后治疗组较对照组在临床疗效、射血分数、脑钠肽水平及6 min步行距离方面有明显改善,差异有统计学意义（P〈0.05）。结论芪参益气滴丸联合常规治疗心力衰竭药物能显著提高临床疗效、改善心功能及相关指标。     

6分钟步行试验在慢性心力衰竭患者康复治疗中的应用

目的 探讨运动康复治疗对慢性心力衰竭（CHF）患者心功能的影响.方法 将50例慢性心力衰竭患者随机分为运动康复治疗组和对照组,运动康复治疗组在应用药物治疗上进行康复运动治疗,对照组进行药物治疗.3个月后以6 min步行实验和心脏三维超声对两组患者进行评定.结果 运动康复治疗组心功能明显改善,左室射血分数（LVEF）、6 min步行距离增加,优于对照组.结论 在应用药物治疗基础上进行康复运动治疗可以改善慢性心力衰竭患者心功能,提高生活质量.     

重组人脑利钠肽治疗重度心力衰竭疗效观察（附67例分析）

目的观察重组人脑利钠肽（rhBNP）治疗重度心力衰竭（下称心衰）的临床效果。方法选择心功能分级（NYHA）Ⅳ级的重度心力衰竭患者67例,随机分为rhBNP,治疗组和硝普钠对照组,观察两组患者治疗前1小时及治疗后48小时生命体征、尿量、心功能分级及血浆N末端脑利钠肽前体（NT—proBNP浓度的变化。结果两组临床疗效及血浆NT—proBNP浓度变化的差异均有统计学意义（P〈0．05）,治疗组优于对照组。结论rhBNP能改善重度心衰患者的心功能,血浆NT—proBNP浓度明显下降,治疗安全可靠。     

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.

---

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.