增加透析频率对维持性血液透析患者左心室重构的影响

目的探讨增加透析频率对维持性血液透析(MHD)患者左心室重构的影响。方法MHD患者60例根据单室尿素清除指数(spKt/V)分为A组(spKt/V<1.2,36例)和B组(spKt/V≥1.2,24例),比较两组干预前(血液透析2次/周)和干预后(血液透析3次/周,至少6个月)的相关血液透析指标及彩色多普勒超声心动图指标变化。结果两组干预后,透析间期体重增加、体重增长百分比和超滤量等指标均下降,而spKt/V、每周spKt/V和血红蛋白等指标升高(P<0.05)。两组干预后左心室后壁厚度、左心室舒张末期内径、左心室质量和左心室重量指数均下降,而左心室射血分数、舒张早期/舒张晚期峰值比升高(P<0.01)。结论增加血液透析频率能逆转MHD患者左心室重构,有利于改善心室收缩和舒张功能。     

厄贝沙坦长期治疗对原发性高血压患者左室肥厚及心功能的影响

目的 :探讨血管紧张素II受体拮抗剂 (厄贝沙坦 )对原发性高血压患者左室肥厚及心功能的影响。方法 :原发性高血压患者经超声心动图检查证实左室肥厚 12 0例 ,随机分为 2组 ,每组 6 0例。厄贝沙坦组口服 15 0～ 30 0mg·d-1厄贝沙坦 ,阿替洛尔组口服 2 5～ 5 0mg·d-1阿替洛尔 ,疗程为 8个月。治疗前后各检查一次超声心动图及放射性核素心室显像 ,分析治疗前后左室重量指数及左心功能参数变化 ,并分析 2组间差异。结果 :两组治疗后收缩压与舒张压明显下降 (P <0 .0 1)。厄贝沙坦组治疗后 ,左室后壁与室间隔厚度显著下降 (P <0 .0 5 ) ,左室重量及左室重量指数下降更显著 (P <0 .0 1) ;阿替洛尔组治疗后左室后壁与室间隔厚度无明显的变化 ,而左室重量及左室重量指数下降显著 (P <0 .0 5 )。厄贝沙坦组治疗后左室高峰充盈率明显增加 (P <0 .0 5 ) ,阿替洛尔组无明显变化 ,厄贝沙坦组比阿替洛尔组左室高峰充盈率明显增高 (P <0 .0 5 )。结论 :原发性高血压患者在厄贝沙坦治疗 8个月后可使左室肥厚显著逆转及左心室舒张功能显著改善 ,对左心室舒张功能的作用优于阿替洛尔。     

107例尿毒症患者血液透析心功能改变的临床意义研究

目的探讨尿毒症患者血液透析前后心功能的改变情况,及其对于疾病诊断和治疗的临床意义。方法收集2008年11月至2011年2月来我院肾脏内科和门诊就诊的具有血液透析适应证的尿毒症患者共107例。测量血液透析前后反映患者心脏功能的指标,并比较心功能改变的情况。结果透析后,左房内径、左室收缩末内径、左室舒张末内径均有所下降,差异具有统计学意义(P<0.05)。反映心脏舒张功能的指标TEI指数在血透前较血透后改变显著,差异具有统计学意义(P<0.05)。反映心脏收缩功能的指标每搏量、每分排血量、左心室射血分数和左心室短轴缩短率改变明显,差异具有统计学意义(P<0.05)。结论血液透析可显著改变患者的心功能,减少心血管并发症的发生,临床意义重大,值得推广。     

口服缬沙坦对维持性血液透析患者心功能的保护作用

目的 探讨口服缬沙坦对尿毒症维持性血液透析患者心功能保护作用以及应用安全性.方法 选择我院慢性肾功能不全尿毒症68例,随机分为对照组(常规治疗组)与观察组(缬沙坦治疗组),经6个月规律血液透析治疗后,使用彩色多普勒心脏超声检查左室结构和功能,同时检测血清钾含量以及血肌酐.结果 经6个月降血压及血液透析治疗后,两组收缩压、舒张压、血清钾及血肌酐水平与治疗前比较差异具有统计学意义(P0.05).与透析前比较,两组左心室舒张末期内径和左室重量指数透析治疗6个月后均有明显减少(P<0.05);但对照组室间隔厚度(IVST)、左室后壁舒张末期厚度(LVPWT)和最大血流速度比(E/A)透析前后比较差异无统计学意义(P>O.05),观察组透析6个月后IVST、LVPWT明显降低,E/A值显著升高,与透析前及对照组透析后比较差异均有统计学意义(P<0.05).结论 口服缬沙坦对维持性血液透析患者心功能具有保护作用,且服用安全.     

动态监测尿毒症血液透析患者超声心动图的意义

目的观察尿毒症血液透析患者超声心动图 (UCG)的动态变化 ,并探讨相关危险因素。方法采用UCG对83例尿毒症患者左房内径(LAD)、左室内径(LVD)、室间隔厚度(IVST)、左室后壁厚度(IVPWT)、E/A值进行动态检测 ,并探讨UCG多次异常与透析间期体重增加过多、高血压、营养不良、透析不充分等因素的相关关系。结果尿毒症患者左室内径、左房内径、室间隔厚度、左室后壁厚度明显增高 ,E/A值降低 ,与正常对照组比较存在显著性差异 (P<0.05) ;UCG多次异常与患者透析间期体重增加过多、高血压、营养不良、透析不充分等密切相关。结论尿毒症患者存在UCG的异常 ,动态监测UCG对指导尿毒症血液透析患者的治疗有一定的价值     

高血压病动态血压与左心功能的探讨

目的 :观察收缩压、舒张压 ,分别对左心室收缩及舒张功能的不同影响。方法 :应用诊断血压、24小时动态血压监测及超声心动图 ,观察41例Ⅰ、Ⅱ期高血压病患者血压与左室心肌质量、左室收缩及舒张功能的相关关系。结果 :24小时及白天平均收缩压及诊断收缩压均与舒张早期充盈峰值流速 (EPFV)呈负相关 (P值均<0 05) ,24小时、白天及夜间平均舒张压与年龄呈负相关 (P值均<0 05) ,与舒张功能各参数之间无相关关系 ,诊断收缩压与年龄、心房收缩期充盈峰值流速 (APFV)呈正相关 (P<0 001及0 005) ,夜间平均收缩压诊断收缩压与左室心肌质量指数呈正相关 (P<0 01及0 05)。而24小时平均收缩压 (或舒张压 )、白天及夜间平均收缩压 (或舒张压 )均与左室心肌质量指数无明显相关。结论 :24小时平均收缩压是影响左室舒张功能的重要因素之一 ,24小时平均舒张压与左室舒张功能无相关关系。夜间平均收缩压增高是导致左心室肥厚的重要因素之一。     

腹膜透析和血液透析对心血管疾病的影响

目的比较腹膜透析和血液透析对尿毒症患者心血管疾病的影响。方法收集2015年6月~2017年6月在本院行透析治疗的尿毒症患者86例,分为腹膜透析组和血液透析组,两组患者在透析前后均进行心脏彩超检査,收集患者透析2年后心脏结构和功能的各项指标变化,包括心脏室间隔舒张末期厚度(IVSd)、左心室舒张末期厚度(LVPWd)、左心室舒张末内径(LVEDd)、左心房内径(LA),并计算左心室重量指数(LVMI)。比较两组患者生化指标、心脏结构、功能指标在透析前后组间及组内的差异。结果透析前,两组患者心脏结构指标组间比较无统计学差异。透析后,腹膜透析组患者的白蛋白(ALB)和C反应蛋白(CRP)水平显著低于于血液透析组患者,而低密度脂蛋白(LDL)、甘油三酯(TG)和总胆固醇(CHOL)水平明显高于血液透析组患者;透析后,两组患者的LVMI、IVSd、LVPWd均显著升髙,而腹膜透析组与血液透析组比较,血液透析组患者的LVMI、IVSd、LVPWd升髙较腹膜透析组明显,以上差异均有统计学意义(P<0.05)。结论不同的透析方式均会不同程度地影响尿毒症患者的心脏结构和功能,且血液透析的影响可能更大,本文结果提示相对于血液透析,腹膜透析对心脏结构的影响小,能更好的保护心功能,而对血液透析治疗的患者的心功能进行早期干预,减少透析对心脏功能和结构的影响能减少心血管事件的发生,延长患者的寿命。     

缬沙坦降低慢性肾衰竭大鼠心肌内皮素的表达

目的：观察缬沙坦对慢性肾衰竭大鼠心肌肥厚及心肌内皮素-1（ET-1）表达的影响,探讨其作用机制。方法：SD雄性大鼠24只,通过5/6肾切除法制备慢性肾衰竭模型,术后2周随机分为模型组、缬沙坦组,并设假手术组作为对照。术后第10周末测定各组大鼠血压及肾功能（BUN、Cr）后处死大鼠,取出心脏进行病理组织形态学观察;并采用原位杂交方法检测心肌ET-1 mRNA转录水平。结果：模型组术后第10周收缩压、心脏重量、心脏重量指数、左室重量及左室重量指数均明显增加,缬沙坦组能显著降低5/6肾切除大鼠收缩压、心脏重量、心脏重量指数、左室重量及左室重量指数（P〈0.01）;缬沙坦组心肌ET-1 mRNA转录水平较模型组减弱。结论：缬沙坦能改善慢性肾衰竭大鼠的左室肥厚,其机制可能是通过下调心肌ET-1 mRNA转录来实现的。     

腹膜透析患者左室质量指数与其它相关指标的关系

目的探讨腹膜透析患者左室质量指数(LVMI)与相关临床指标的关系。方法选择腹膜透析患者78例,测量血压、残余尿量、血清氨基末端脑钠肽前体(NT-proBNP)、超声心动图及相关临床指标,计算LVMI,并与其它相关指标进行Spearman相关分析和多元线性回归分析。结果LVMI与收缩压、舒张压、平均动脉压、NT-proBNP和肌钙蛋白I(TnI)呈正相关(P<0.05),与残余尿量呈负相关(P<0.01)。多元线性回归分析结果显示,左室质量指数与收缩压(β=0.542,P<0.01)、NT-proBNP(β=0.008,P<0.01)及残余尿量(β=-0.033,P<0.01)相关。结论左室质量指数与NT-proBNP均能反应腹膜透析患者左室肥厚状况。收缩压、残余尿量与左室质量指数密切相关。     

14例慢性肾功能衰竭患者血液透析相关低血压原因及防治探讨

目的探讨慢性肾功能衰竭患者血液透析相关低血压原因及防治。方法选择14例血液透析低血压者 (低血压组), 与17例无低血压患者 (对照组) 进行相关因素比较, 并对低血压组的治疗进行分析。结果(1) 低血压组与对照组对比, 透析间期体重增长率、超滤量 (FUV) 及超滤率 (FUR) 较高 (P<0 .01); 而血钠、血红蛋白 (Hb)、血浆白蛋白 (Alb)、血肌酐 (Scr) 及尿素氮 (BUN) 较低 (P<0 .01)。(2) 低血压组左室收缩、舒张功能均较对照组明显下降。(3) 监控体重增长, 调整透析模式, 采取综合治疗可降低低血压的发生率。结论血透相关低血压是多因素综合作用的结果。分析具体病情采取针对性的措施, 关注高发人群, 可防治透析低血压的发生。     

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.