卡维地洛序贯给药治疗慢性心力衰竭的疗效观察

目的 探讨运用卡维地洛序贯给药的方法治疗慢性心力衰竭(CHF)患者的疗效.方法 选取自2009年7月至2011年6月在我院住院治疗的CHF患者42例,在常规治疗基础上加服卡维地洛片从小剂量2.5 mg,1次/d开始,以后每周递增2.5 mg,逐步达到靶剂量,直至达到目标心率(55～65次/min),治疗5～6个月后观察患者的血压,心率变化;超声检测测左心室功能(EF)、及IVS;心脏功能(NY-HA)分级改善情况;血肌酐(Cr)、血糖(GLU)、总胆固醇(TC)、三酰甘油(TG)改变.结果 用药后患者心率明显降低,左室射血分数(LVEF)及IVS明显改善,差异有统计学意义(P<0.01,0.05);治疗后6个月心功能评估显效9例,有效29例,无效4例,总有效率90.5%.结论 运用卡维地洛序贯给药的方法治疗慢性心力衰竭(CHF)患者具有抑制左室重构和改善心脏收缩功能的作用,而且安全性高.     

厄贝沙坦联合卡维地洛治疗高血压病及对左心室舒张功能的影响

目的观察厄贝沙坦联合卡维地洛治疗原发性高血压的疗效及对左心室舒张功能的影响。方法将2011年2月～2012年2月笔者所在医院50例原发性高血压患者口服厄贝沙坦150～300mg/d及卡维地洛20～40mg/d治疗。观察治疗前后血压、心率以及左心室舒张功能指标变化,评价临床疗效,观察不良反应及对糖脂代谢的影响。结果 50例患者经厄贝沙坦及卡维地洛联合治疗,收缩压、舒张压和心率由治疗前的(160.6±12.4)mmHg、(99.2±6.4)mmHg、(79.6±8.3)次/min下降到治疗后的(129.4±13.4)mmHg、(81.8±9.2)mmHg、(65.4±9.2)次/min,治疗前后比较差异有统计学意义(P<0.05);E峰、E/A明显增加,差异有统计学意义(P<0.05),室间隔舒张末期厚度和左室后壁舒张末期厚度明显下降,差异有统计学意义(P<0.05)。3例患者治疗早期出现乏力症状,3周后缓解;无低血压、血管神经性水肿等严重不良反应;未出现血糖、血脂代谢异常。结论厄贝沙坦联合卡维地洛治疗原发性高血压安全、疗效显著,并可同时改善左心室舒张功能。     

缬沙坦联合卡维地洛治疗慢性心力衰竭的临床研究

目的:探讨缬沙坦联合卡维地洛对慢性充血性心力衰竭心功能及心室重塑的影响。方法:66例充血性心力衰竭患者随机分为观察组(缬沙坦联合卡维地洛)和对照组(常规治疗)。对照组给强心苷及利尿药常规治疗,观察组在常规治疗基础上加用缬沙坦及卡维地洛。疗程6个月。比较2组治疗前后心率、收缩压、6min步行试验、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF),并进行统计学分析。结果:对照组治疗后心率显著下降、6min步行试验、LVEF等指标均显著改善,与治疗前比较,差异有统计学意义(P<0.05);观察组治疗后心率、收缩压、LVEDD、LVESD均显著下降、6min步行试验及LVEF显著改善(P<0.05),与对照组比较,差异均有统计学意义(均P<0.05)。结论:缬沙坦联合卡维地洛改善慢性充血性心力衰竭心功能并逆转心室重塑。     

卡维地洛治疗充血性心力衰竭39例疗效观察

目的观察卡维地洛治疗慢性心力衰竭(CHF)的临床疗效。方法将78例CHF患者,随机分为治疗组和对照组,对照组予血管紧张素转化酶抑制剂(ACEI)、利尿剂、硝酸酯类及洋地黄等常规治疗,治疗组在此基础上加用卡维地洛3.125mg,2次/d,并逐渐加量,最大剂量50mg,2次/d,。两组治疗3个月后观察临床症状、心率、血压、心功能分级、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)。结果治疗组和对照组治疗后左室内径、左心室射血分数(LVEF)提高,与治疗前比较差异有统计学意义(P<0.05)。治疗组总有效率为89.74%;对照组总有效率为69.23%,两组总有效率比较差异有统计学意义(P<0.05)。治疗后两组间左室内径、左心室射血分数比较差异有统计学意义(P<0.05),且无明显不良反应发生。结论在强心、利尿、血管紧张素转换酶抑制剂治疗基础上,应用卡维地洛能显著改善心功能、提高生活质量,且安全有效,副反应小。     

倍他乐克治疗慢性心力衰竭的疗效观察

目的观察倍他乐克治疗慢性心力衰竭的疗效及安全性。方法46例慢性心力衰竭(CHF)患者随机分为常规治疗组(ACEI+利尿剂+地高辛)和倍他乐克治疗组(在充分使用上述药物治疗的基础上加用倍他乐克),随访半年,观察两组治疗前后血流动力学、心功能分级、左心室射血分数、左心室内径的变化。结果①治疗后两组静息状态下的心率、收缩压均较治疗前明显下降,而倍他乐克治疗组的下降程度[(78.2±6.0)次/min,收缩压(123.1±11.1)mmHg)]显著高于常规治疗组[(84.3±7.0)次/min,收缩压(130.9±6.6)mmHg);②治疗后,两组的LVESD、LVEDD均较治疗前下降,LVEF升高(P<0.01),而治疗后倍他乐克治疗组的LVESD、LVEDD的下降程度[分别为(41.9±2.7)mm、(58.7±2.1)mm、LVEF升高(49.5±12.1)%]均较常规治疗组治疗后明显[分别为(46.9±3.7)mm、(64.5±2.2)mm,LVEF升高(40.4±11.3)%;P<0.01]。结论β受体阻滞剂倍他乐克治疗慢性心力衰竭有效,可以改善心功能和临床症状,延缓心室重塑,阻止心脏扩大,从小剂量开始,严密观察心率、血压及临床症状,逐渐增加到最大耐受量,是非常安全的。     

培哚普利联合卡维地洛治疗心力衰竭的疗效观察

目的观察培哚普利联合卡维地洛治疗心力衰竭的疗效。方法将56例慢性心力衰竭患者随机分为培哚普利和卡维地洛联合治疗组(28例)与对照组(传统治疗,28例)。3个月为1个疗程。观察治疗后心功能情况,彩色多普勒超声心动图测量左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及左室射血分数(LVEF)、6min步行试(6-MWT)变化及不良反应等。结果治疗组的心功能疗效总有效率71.4%,对照组为53.6%;两组患者用药后LVEDD、LVESD下降,LVEF增加,治疗组改善更明显(P<0.05)。结论培哚普利和卡维地洛联合治疗可提高疗效,明显改善CHF患者的远期预后。     

卡维地洛在扩张型心肌病治疗中适当剂量的临床研究

目的 探讨卡维地洛在扩张型心肌病治疗中的适当剂量与效果.方法 35例扩张型心肌病心力衰竭患者以靶心率作为治疗目标,将患者分为治疗组(靶心率55次/min,n=25)和对照组(靶心率60次/min,n =10),都采用常规药物配合卡维地洛治疗.结果 两组患者观察指标治疗后都有明显改善,其中治疗组的收缩压、左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、6MWT和心胸比率改善程度明显好于对照组(P＜0.05).两组患者达到药物最大耐受剂量的比例类似,无显著差异(P＜0.05).结论 卡维地洛治疗扩张型心肌病心力衰竭(NYHA心功能分级Ⅱ～Ⅲ级)患者3个月可以获得显著疗效;卡维地洛治疗扩张型心肌病心力衰竭患者,将靶心率设为55次/min左右是安全的,同时建议适当剂量为0.8 mg/(kg?d).     

吲哒帕胺联合美托洛尔治疗高血压合并心力衰竭的临床疗效及安全性观察

目的 观察吲达帕胺联合美托洛尔联合治疗高血压合并慢性心力衰竭(CHF)的有效性与安全性.方法 78例高血压合并CHF患者在常规抗心力衰竭治疗基础上给予吲达帕胺2.5 mg/d及美托洛尔6.25 mg/d,服用2周后剂量加倍,以后再依据患者病情及个体反应来调整用药剂量,观察患者血压、心率及心功能变化情况.结果 与治疗前比较,治疗后患者的收缩压[(142.6±5.1)mm Hg与(178.0±7.5)mm Hg]、舒张压[(91.3±3.6)mm Hg与(109.5±4.2)mm Hg]、心率[(76±9)次/min与(117±11)次/min]、左心室舒张末期容积指数(LVEDVI)[(133±14) ml/m2与(164±21) ml/m2]及左心室收缩末期容积指数(LVESVI)[(92±10) ml/m2与(118±17)ml/m2]均显著降低,差异均有统计学意义(均P＜0.01);患者心功能得到明显改善,总有效率为93.6％.结论 美托洛尔、吲哒帕胺联合治疗高血压合并CHF,疗效确切,安全性较好,值得临床推广使用.     

卡维地洛治疗CHF的临床疗效及对心室重塑的影响

目的探讨卡维地洛对慢性充血性心力衰竭(CHF)的临床疗效和对心室重塑的影响。方法66例CHF患者在应用硝酸酯制剂、利尿剂、洋地黄等常规治疗的基础上,随机分为A、B两组。B组在A组常规治疗基础上口服卡维地洛,起始量为2.5mg,2次/d,逐渐递增至目标剂量20mg,2次/d,维持稳定剂量至3个月。治疗前、后分别进行心功能(NYHA分级)评估,行超声心动图检查,6min步行距离分析。结果卡维地洛治疗3个月后心功能分级明显改善,左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)缩小,相对室壁厚度(RWT)增厚,左室射血分数(LVEF)、每搏输出量(SV)、短轴缩短率(FS)明显提高,6min步行距离明显增加,上述指标与该组治疗前及与A组治疗后比较差异有统计学意义。结论卡维地洛对CHF,患者有较好疗效,并可显著逆转心室重塑,安全可靠。     

卡维地洛治疗扩张型心肌病合并心力衰竭30例临床观察

目的观察卡维地洛治疗扩张型心肌病合并心力衰竭的临床疗效。方法入选的30例扩张型心肌病患者在原有强心、利尿、扩血管等治疗基础加用卡维地洛,从3.125mg,开始2次/d,每2周剂量增加1倍,直至目标剂量12.5mg,2次/d,疗程6个月。治疗前后观察心功能,血压,心率,心脏超声,24h动态心电图及6min步行试验,评价药物疗效。结果卡维地洛治疗6个月后患者的心功能好转,血压,心率降低,6min步行试验距离增加,左室收缩舒张末期内径缩小,左室射血分数增加。结论长期服用卡维地洛可改善扩张型心肌病患者的心功能,提高运动耐量。     

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.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

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.