中西医结合保守治疗异位妊娠的临床效果分析

目的观察甲氨蝶呤（methotrexate,MTX）联合米非司酮及中药在药物保守治疗异位妊娠中的临床疗效。方法选取104例符合保守治疗条件的异位妊娠患者,随机分为A、B、C 3组,A组54例,为研究组;B组29例、C组21例,为对照组。A组予MTX（50mg.m-2）单次肌肉注射,在治疗1周后血β-HCG未下降再次肌内注射MTX 50mg.m-2。同时予米非司酮50mg口服,1日2次,总量300mg,用宫外孕2号方作基本方,水煎服每日1剂2次。B组予MTX（50mg.m-2）单次肌肉注射,在治疗1周后血β-HCG未下降再次肌内注射MTX 50mg.m-2。同时予米非司酮50mg口服,1日2次,总量300mg。C组予MTX（50mg.m-2）单次肌肉注射,在治疗1周后血β-HCG未下降再次肌内注射MTX50mg.m-2。定期监测血人绒毛膜促性腺激素（β-human chorionic gonadotrophin,HCG）水平,B超监测包块缩小情况。结果 A组治愈50例,无效4例,治愈率92.6%,无严重不良反应。B组治愈25例,治愈率86.2%,4例因急腹症手术。C组治疗成功16例治愈率71.4%。结论 MTX联合米非司酮及中药治疗异位妊娠效果明显且安全性良好。     

甲氨蝶呤联合米非司酮治疗输卵管妊娠40例分析

目的：观察甲氨蝶呤（MTX）联合米非司酮治疗输卵管妊娠的疗效。方法：将符合保守治疗条件的输卵管妊娠患者73例随机分为两组,观察组40例MTX50mg/m2单次静脉注射,第二天米非司酮150mg（6片）空腹顿服,连续3天;对照组33例只用MTX50mg/m^2一次性静脉注射。两组均定期监测血β-HCG水平,彩超监测包块缩小情况。结果：观察组34例治愈,治愈率达85%,对照组20例治愈,治愈率60.6%。观察组症状消失时间、血β-HCG下降、包块缩小时间均优于对照组,差异显著。结论：MTX联合米非司酮治疗输卵管妊娠疗效显著。     

甲氨蝶呤联合中药治疗异位妊娠的疗效观察

目的观察甲氨蝶呤联合中药治疗输卵管妊娠的疗效。方法 A组:MTX单次肌肉注射并口服中药,对照组:-48(50mg/m2)单次肌肉注射,定期检测血β-HCG水平及阴道B超检测包块情况直至正常。结果 A组较对照组明显缩短血β-HCG降至正常所需的时间,减少住院日。结论 -48单次肌肉注射联合中药治疗输卵管妊娠疗效好,副反应少,值得临床推广。     

甲氨蝶呤联合米非司酮治疗异位妊娠临床观察

目的：观察甲氨蝶呤（MTX）联合米非司酮治疗输卵管妊娠的疗效。方法：将44例异位妊娠患者随机分为观察组和对照组,每组22例。观察组甲氨蝶呤单次肌内注射0.4mg/（kg·d）,5d为1个疗程,并口服米非司酮（200mg/次,1次/d,共3d）;对照组甲氨蝶呤0.4mg/（kg·d）单次肌内注射。定期监测两组的包块大小及血β-HCG水平。结果：观察组治愈率为90.9%,对照组治愈率为72.7%,且观察组能明显缩短血β-HCG降至正常的时间（P〈0.05）。结论：甲氨蝶呤联合米非司酮治疗输卵管妊娠疗效优于MTX单次肌内注射,值得临床推广使用。     

早期异位妊娠三种保守治疗方法疗效分析

目的:探讨三种方法治疗异位妊娠的疗效。方法:22例患者采用甲氨蝶呤50mg/m2单次肌肉注射(组),19例患者给予甲氨蝶呤20mg肌肉注射,每日1次,5d为1个疗程(组),17例患者给予米非司酮300mg一次口服(组),比较三组治疗后血β-HCG下降百分率、包块直径大小及成功率。结果:三组治疗后血β-HCG下降百分率及包块直径变化无显著差异,成功率有显著差异。结论:异位妊娠的保守治疗方法中,单次肌肉注射甲氨蝶呤成功率最高,分次注射甲氨蝶呤成功率次之,口服米非司酮治疗成功率最低。     

甲氨蝶呤联合米非司酮治疗未破裂型异位妊娠的临床观察

目的:探讨甲氨蝶呤和米非司酮联合治疗未破裂型异位妊娠的效果。方法:A组:米非司酮50mg口服每日2次,连用4天,甲氨蝶呤50mg/m2肌肉注射每日1次;B组:米非司酮50mg口服每日2次,连用4天。观察患者自觉症状、一般情况、血β-HCG浓度和B超检查,直至正常。结果:A组治愈率高于B组,两组比较差异有显著性(P<0.05)。A组血β-HCG降至正常时间、包块缩小和症状消失时间均短于B组,两组比较差异有极显著性。结论:米非司酮联合甲氨蝶呤治疗未破裂型异位妊娠安全、有效。     

药物保守治疗异位妊娠疗效观察

目的观察甲氨蝶呤联合米非司酮保守治疗异位妊娠的效果。方法选择我院2006年6月至2008年4住院治疗的异位妊娠并能够保守治疗的患者48例,给予米非司酮（MTX）50mg,1次/d×3d,甲氨蝶呤50mg,肌肉注射1次,治疗期间严密观察生命体征变化、药物反应、尿HCG、血β-HCG、超声检测等,如血β-HCG不下降或轻度升高则重复MTX50mg肌肉注射1次。结果治疗后2周血β-HCG明显下降,包块平均直径明显缩小,与治疗前比较差异有统计学意义（P〈0.05）。结论对于部分早期未破裂的异位妊娠的病例,行药物保守治疗,效果显著。     

两种方法保守治疗异位妊娠124例分析

目的 探讨米非司酮配伍MTX治疗稳定型异位妊娠的效果.方法 将我院2003年1月～2006年7月收治的124例患者随机分为观察组和对照组,观察组采用单次MTX肌肉注射,剂量为50mg/m2,同时服用米非司酮,对照组只采用单次MTX肌肉注射,剂量为50mg/m2定时检测血β-HCG值,直至正常.观察比较两组的疗效.结果 观察组52例治疗成功,成功率为81.5%.对照组患者单次MTX肌肉注射,48例成功,成功率为80%,两组比较无显著性差异.结论 在治疗稳定型异位妊娠中米非司酮配伍MTX的治疗可以强化MTX的协同作用,提高成功率,血HCG下降快,缩短住院时间,特别是在包块比较大的患者中效果更好,值得推广.     

米非司酮联合甲氨蝶呤治疗异位妊娠的临床观察

目的探讨异位妊娠2种非手术治疗方法的效果。方法将异位妊娠并有非手术治疗指征的孕妇52例,随机分为2组。A组27例采用甲氨蝶呤（MTX）单次肌内注射并口服米非司酮;B组25例给予MTX（50mg/m2）单次肌内注射。监测2组血β-hCG水平和附件包块大小情况。结果 A组治愈率、血β-hCG下降≥15%、包块缩小≥30%、血β-hCG转阴时间及附件包块消失时间与B组比较,差异均有统计学意义（P〈0.05）。结论 MTX联合米非司酮用药治疗异位妊娠效果好,不良反应少,值得临床推广。     

不同药物保守治疗异位妊娠的临床疗效观察

目的:观察不同药物保守治疗异位妊娠的临床疗效。方法:156例异位妊娠患者随机分为三组,每组52例。A组:肌肉注射甲氨蝶呤(MTX);B组:肌肉注射MTX,且服用米非司酮治疗;C组:肌肉注射MTX与亚叶酸钙(CF)。对患者血中人绒毛膜促性腺激素(β-HCG)水平进行定期检测,并用B超进行包块监测,直到正常。结果:A组治愈率为82.69%,B组治愈率为90.38%;C组治愈率为94.23%。与A组相比,B,C组的治愈率要高,C组更为明显;且B,C两组患者住院时间及血β-HCG水平下降到正常的时间,比A组明显缩短(P<0.05),B,C两组比较差异无统计学意义。结论:MTX联合米非司酮或者亚叶酸钙治疗具有协同作用,治疗效果提高明显。     

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.

     

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.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.