他汀类药物在心房颤动治疗中的作用分析

目的 观察他汀类药物在心房颤动治疗中的作用.方法 将2008年1月至2011年1月阿拉善盟中心医院收治的86例持续性心房颤动患者完全随机分为他汀组和对照组,各43例.给予体外同步直流电复律后2组均给予胺碘酮200 mg、3次/d口服,1周后改为200 mg、2次/d,再1周后改为200 mg、1次/d维持;他汀组同时给予辛伐他汀20 mg,每晚1次口服.患者复律前后均给予华法林钠正规抗凝治疗,共治疗6个月.患者恢复窦性心律后1、2周及以后每4周分别行心电图和动态心电图检查.结果 他汀组维持窦性心律38例(88.4％),未维持窦性心律5例(11.6％);对照组维持窦性心律29例(67.4％),未维持窦性心律14例(32.6％).他汀组维持窦性心律的比例明显高于对照组(P＜0.05).结论 他汀类药物在预防心房颤动复发上有应用价值.     

厄贝沙坦和胺碘酮联用在房颤复律后维持窦性心律的疗效观察

目的:观察厄贝沙坦和胺碘酮联用在房颤复律后维持窦性心律的疗效。方法:选取我院2001—01～2004—01门诊及住院的持续性房颤患者30例,恢复窦律后随机分为胺碘酮组(13例)和厄贝沙坦 胺碘酮组(17例),胺碘酮组治疗方案:恢复窦性心律后,给予胺碘酮0.2/d一次口服;厄贝沙坦 胺碘酮组在上述方案基础上加厄贝沙坦75～150mmg/d,疗程观察18个月。结果:两组比较厄贝沙坦 胺碘酮组窦性心律维持率高于胺碘酮组。结论:长期服用厄贝沙坦可逆转左房扩大,降低左房压,抑制RAS活性,防止房颤复发。     

ARB在特发性心房颤动复律后维持窦性心律中的作用

目的观察ARB在特发性心房颤动复律后维持窦性心律中的作用。方法选择特发性心房颤动转律患者46人,随机分为两组。治疗组常规用药加缬沙坦片80mg/d,对照组在原治疗基础上加安慰剂,随访6个月。结果治疗组共有3例心房颤动复发,对照组11例复发,治疗组心房颤动复发率较对照组明显降低（P〈0.05）。结论缬沙坦可降低特发性房颤患者复律后的复发率。     

氯沙坦治疗持续性心房颤动的疗效

目的探讨氯沙坦在持续性心房颤动(房颤)复律后维持窦性心律的作用及其对左心房收缩功能的影响。方法82例持续性房颤患者(持续时间超过1 wk)中71例经药物或电复律转复成功的房颤患者随机分为2组,试验组(Ⅰ组)39例,给予氯沙坦100 mg,po,qd;对照组(Ⅱ组)32例给予胺碘酮200 mg,po,tid,1 wk后改为200 mg,po,bid,在wk 3开始以200 mg,po,qd维持治疗。2组均连续服用6 mo。于治疗后1、2 wk及1、2、4、6 mo分别行ECG或DCG以检测是否房颤复发;复律次日及6 mo后做超声心动图检查,观察左房形态功能变化。结果随访6 mo,房颤复发率Ⅰ组23.1%,Ⅱ组43.7%,组间比较差异有统计学意义(P<0.05)。Ⅰ组房颤转复6 mo后患者左心房内径缩小,治疗前后比较差异有统计学意义(P<0.05)。Ⅱ组患者治疗前后比较差异无统计学意义(P>0.05)。结论氯沙坦用于持续性房颤复律后维持窦性心律,较胺碘酮有效;长期服用氯沙坦可逆转左心房扩大,降低左心房压力,有利于降低房颤复发。     

胺碘酮治疗冠心病房颤疗效观察

目的观察胺碘酮对冠心病房颤复律及窦性心律维持的治疗作用.方法选择冠心病房颤84例,除外胺碘酮的禁忌症,用药前原用的抗心律失常药至少停服5个半衰期,给予胺碘酮负荷量600mg/d,1～2周后用维持量100～300mg/d,若转复为窦性心律随访12～36个月.结果胺碘酮治疗冠心病房颤显效50例(59.5%),有效12例(14.3%),总有效率73.8%.未见明显副作用及毒性作用.结论胺碘酮对冠心病房颤复律及窦性心律维持有较好的疗效,副作用小,耐受性良好.     

胺碘酮转复心房颤动并维持窦性心律的疗效

目的观察胺碘酮转复心房颤动(房颤)并维持窦性心律(窦律)的临床疗效。方法48例持续性房颤患者，复律前均进行适当的病因治疗。48例患者给予胺碘酮，第1周每次200 mg，tid，第2周每次200 mg，bid，第3周以后，每次给予维持量200 mg，每周5次。如第2周房颤未转复窦律者，可给予一次体外电复律。结果35例在服用胺碘酮负荷量时(2周内)转复为窦律，其余13例患者于第3周采用了电复律，11例首次150 J复律成功，2例第2次200 J复律成功。6例患者分别于复律后0.5，0.6，1.0，1.2，2.0，3.0 a房颤复发。发生不良反应者4例(8.3%)。结论胺碘酮是房颤转复窦律并维持窦律的安全、有效的药物。     

醛固酮受体拮抗剂螺内酯治疗持续性心房纤颤的疗效观察

目的观察醛固酮受体拮抗剂螺内酯治疗持续性心房纤颤(房颤)的疗效。方法选择持续性房颤胺碘酮复律后患者40例,随机分成两组,试验组口服胺碘酮0.2g1次/d维持,对照组为胺碘酮0.2g1次/d+螺内酯40mg1次/d。随访1年,观察房颤转复窦性心律后1年房颤复发率。结果治疗后口服螺内酯组患者房颤的复发率明显少于对照组,差异有统计学意义(P<0.05)。结论螺内酯可以减少持续性房颤的复发。     

低分子肝素联合华法林对心房颤动早期复律的影响

目的:观察低分子肝素联合华法林对心房颤动(简称房颤)早期复律的影响。方法:58例特发性房颤患者随机分为观察组(32例)和对照组(26例)。两组患者均给予常规治疗。与此同时,对照组患者给予华法林钠片初始剂量2.5 mg,口服,每日1次,待患者国际标准化比值(INR)维持在2.5左右3周后口服胺碘酮转复心律。观察组患者给予华法林(用法同对照组)+注射用低分子量肝素钠5 000 U,皮下注射,q12 h,连用3~5 d,在INR 2.5左右时停用,3周后开始转复心律,如患者心率较快,给予胺碘酮负荷剂量150 mg,以1 mg/min维持6 h,以0.5 mg/min维持24 h以上;如患者血流动力学稳定,则口服胺碘酮转复心律,胺碘酮应用4周未能复律或QTc>0.50 ms者,停服胺碘酮,改用控制心率药物加华法林治疗。两组患者心律转复后均继续服用华法林4周,维持INR在2.5左右。应用胺碘酮1个月后评价两组患者转复率、复发率、转复时间、胺碘酮总量及不良反应发生情况。结果:观察组患者转复率、复发率、转复时间、胺碘酮总量均显著优于对照组,差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:低分子肝素联合华法林可提高房颤早期复律成功率,不增加出血及栓塞并发症,安全性较好。     

缬沙坦治疗合并高血压的阵发性房颤的疗效观察

目的研究缬沙坦对合并高血压的阵发性房颤患者转复为窦性心律后复发的影响。方法选择120例合并高血压的阵发性房颤患者,随机分为两组,两组均使用胺碘酮复律,观察组降压药使用缬沙坦,对照组使用氨氯地平,如血压控制不理想,加用利尿剂随访2年,观察两组患者的疗效及超声心动图（左房内径）变化。结果观察组治疗合并高血压的阵发性房颤复发率显著低于对照组。结论缬沙坦联合抗心律失常药物,能有效防止房颤复发,维持窦性心律。     

缬沙坦在阵发性房颤复律后维持窦性心律中的作用

目的评价缬沙坦在阵发性房颤复律后维持窦性心律中的作用。方法将68例阵发性房颤患者随机分为2组。对照组30例给予胺碘酮0.2g,每日1次口服治疗,6个月后胺碘酮减量为0.2g,每周4次,此剂量持续维持到12个月;治疗组30例除了给予上述用法相同的胺碘酮外,加用缬沙坦80 mg,每日1次,共12个月。结果两组服药后3个月、6个月、12个月做24h动态心电图检查,治疗组6个月、12个月窦性心律维持率明显优于对照组,两组比较差异有显著意义(P<0.05)。结论缬沙坦对于预防房颤的复发有一定的作用,在常规应用胺碘酮的基础上加用缬沙坦治疗阵发性房颤,能提高疗效,有利于维持窦性心律。     

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.