血小板相关抗体与血小板输注效果的关系探讨

目的探讨血小板相关抗体与血小板输注效果的关系。方法采用简易致敏血小板血清学技术（SEPSA）检测79例多次输血患者的血小板相关抗体，在血小板输注前后监测血小板计数，并计算1h和24h血小板增高指数（CCI），输注无效者进行血小板交叉配型后再行配合性输注，分析配合性输注效果。结果47例检测出血小板抗体阳性，占59．5％，抗体阳性组输注后1h和24h的CCI均显著低于阴性组（t=2．462、2．583，均P〈0．05）；阳性组有40例输注无效，无效率为85．1％，显著高于阴性组（x^2=34．46，P〈0．05）；配型成功组输注后1h和24h的CCI均显著高于不成功组（t=2．152、2．230，均P〈0．05）；配型成功组有27例输注有效，有效率为87．1％，显著高于不成功组（x^2=4．34，P〈0．05）。结论血小板相关抗体的产生可导致血小板输注无效，采用血小板配合性输注能较好地解决问题。     

微柱凝胶技术在血小板交叉配型中的临床应用

目的探讨微柱凝胶技术在血小板交叉配型中的临床应用价值。方法采用微柱凝胶免疫分析技术对8例免疫性血小板输注无效的患者进行交叉配型,选择结果为＂相合＂的血小板进行血小板治疗,计算分析血小板计数增高指数（CCI）,CCI〉4.5×109/L说明血小板输注有效。选择8例输注无效进行配型的作为实验组,另选择8例输注无效未配型的作为对照组,比较两组的血小板输注结果。结果实验组患者CCI均〉4.5×109/L,输注有效,对照组患者CCI均〈4.5×109/L,差异有统计学意义（P〈0.01）。结论微柱凝胶免疫分析技术可以避免或减轻由免疫原因引起的输注无效,此方法简单快速,结果准确可靠,值得推广。     

血小板抗体检测及交叉配型在临床血小板输注中的应用

目的探讨血小板抗体检测及交叉配型对血小板输注疗效的影响。方法需输注血小板治疗的患者350例分为既往无输血史（A组,110例）和有输血史（B组,240例）两组,采用固相凝集法检测血小板抗体。其中,血小板抗体阳性99例,61例行给予配合性血小板输注（C组）,38例行随机血小板输注（D组）;计算输注后1 h和24 h血小板升高指数（CCI）,CCI＞4.5×109／L判为输注有效。结果 B组血小板抗体阳性率为37.50％,高于A组的8.18％（ P＜0．05 ）,且随着输血次数增多而增高。C组血小板输注有效率高于D组（83.61％ vs ．26.32％）（P＜0．05）。结论接受异体输血的患者易产生血小板抗体;对血小板抗体阳性患者实施交叉配型可明显提高血小板输注的有效性。     

血小板抗体检测对患者临床血小板输注疗效的影响

目的：探讨血小板抗体筛查对临床血小板输注疗效的影响。方法256例临床需输注血小板治疗的患者为研究对象,采用固相凝集法检测血小板抗体,并分析血小板输注无效的原因。结果有输血史患者血小板抗体阳性率为12.50%,无输血史者为8.59%,两者阳性率比较差异有统计学意义（P＜0.05）;有输血史患者随输注次数的增加,血小板抗体阳性率越高;血小板抗体阴性患者输注血小板后1、24 h时CCI均显著高于血小板抗体阳性患者,差异有统计学意义（P＜0.05）。结论多次输血可导致患者产生同种抗体,血小板输注前抗体检测和交叉配型可提高患者临床血小板输注的疗效。     

患者HPA 1-6,9,15基因多态性对血小板输注无效的临床意义

目的观察人类血小板特异性抗原(human platelet alloantigens,HPA)1-6,9,15系统及其基因多态性与血小板输注无效(platelet transfusion refractoriness,PTR)的研究。方法选取40例血小板输注无效患者的外周血标本和供者标本,对其进行血小板特异性糖蛋白抗体检测,根据血小板回收率评判血小板输注效果,采用聚合酶链式反应(PCR)结合直接测序方法,对供、患者进行HPA1-6,9,15抗原系统基因进行分型,动态观察患者同型血小板输注后血小板恢复百分率(percent platelet recovery,PPR),探讨HPA基因多态性和血小板输注无效的关系。结果患者和供者HPA-1、4、9均未检测出HPA-b基因,呈呈aa纯合子单态性分布;HPA-5、6则主要以aa纯合子为多,较少看到bb纯合子。而HPA-2、3、15呈明显多态性分布,HPA-2、3、5、6、15等位基因频率均呈多态性分布。结论对反复多次发生血小板输注无效的患者,除需考虑HLA基因相关外,还与HPA基因多态性相关。在做HPA配型时,多数人只需检测供者与患者HPA2、3、15基因就可以显著减少血小板输注无效的发生。     

血小板抗体产生对血小板输注效果的影响

目的探讨血小板相关抗体与血小板输注效果的关系。方法采用简易致敏红细胞血小板血清学技术（SEPSA）,对100例长期反复输血而又需输注血小板的患者,检测血小板相关抗体,在血小板输注前后计数血小板,并计算1h和24h血小板增值（CCI）。采用微量淋巴细胞毒试验和SEPSA法对部分血小板抗体阳性且血小板输往无效的患者进行了血小板配合性输注。结果反复输血的患者,血小板抗体阳性比率为59．0％,59例血小板抗体阳性者中,再次输注血小板时51例输注无效;血小板抗体阳性组与阴性组比较CCI差异有显著性（P〈0．01）,血小板输注无效率差异也有显著性（P〈0．01）。结论血小板配合性输注能较好地解决血小板抗体阳性引起的输注无效问题。     

献血员血小板抗原基因分型的研究

目的：鉴定采献血员血小板抗原（HPA）全部等位基因，方法：采用聚合酶链技术（PCR）对27例机采献血员血小板抗原的等位基因进行分型研究，结果：根据PCR产物片断大小来指定血小板抗原等位基因，其中全部检出者无一例，检出9个抗原、4个抗原、2个抗原者各1例，检出8个抗原，7个抗原、6个抗原、5个抗原则分别为8、7、4、5例。结论：血小板抗原基因分型在研究血小板抗原多态性中有十分重要作用。     

机采和手工血小板在血液病治疗中的效果分析

目的观察机采血小板和手工血小板在临床血液病输血治疗中提升血小板的疗效,为临床合理应用不同种类的血小板制剂提供参考。方法选择本院2009年9月～2012年9月输注机采血小板患者139例,输注手工血小板患者96例,观察输注后24h两组患者的止血效果、输血反应,比较计算血小板增加数校正值（CCI）、血小板回升率（PPR）。结果机采血小板组与手工血小板组比较CCI明显升高,PPR升高,输血反应发生率较低（5．0％vs 15．6％）,止血效果较好。结论输注机采血小板能有效提高患者的血小板值,止血效果优于手工血小板．且能减少输血反应的发生。     

血液病患者血小板抗体检测与血小板输注效果的临床探讨

目的：探讨血液病患者血小板抗体检测与血小板输注效果的影响及意义。方法以本院收治的70例血液病患者为研究对象,首先,检测患者血小板抗体,观察血小板抗体阳性表达率及其与输血次数的关系;其次,给患者输注血小板,评价血小板输注效果及其与血小板抗体检测结果的关系;最后,将70例患者随机分为观察组35例和对照组35例,对照组采用随机血小板输注,观察组采用配型血小板输注,评价两组的血小板输注效果。结果70例患者中32例（45.71%）患者血小板抗体检测呈阳性,且随着患者输血次数增加,血小板抗体阳性表达率逐渐增高（P〈0.05）。血小板抗体阳性组血小板输注有效率为25.00%,血小板抗体阴性组血小板输注有效率为86.84%,两组比较差异有统计学意义（P〈0.05）。对照组血小板输注有效率为45.71%,观察组血小板输注有效率为85.71%,两组比较差异有统计学意义（P〈0.05）。结论血液病患者血小板抗体的检测及配型血小板的输注,对提高血小板输注效果具有重要意义。     

机采血小板引起的输血反应9例患者的调查分析

血小板输注适用于预防和治疗血小板减少或血小板功能缺陷引起的出血，是临床上重要的支持疗法。但是，患者在多次输注血小板后，可产生血小板相关抗体。因为血小板表面除了具有血小板特异性抗原（HPA）外，还存在着白细胞抗原（HIA）和红细胞抗原（ABH），如果输注了HLA和HPA不配合的血小板，就会发生同种免疫，发生输血反应，为了解临床输注血小板发生的输血反应，作者对郑州市部分医院临床血小板应用进行调查分析，报告如下：     

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.