脑钠肽和NT—Pro BNP检测在心力衰竭诊断中的意义

目的探讨慢性充血性心力衰竭（CHF）患者血浆B型脑钠肽（BNP）及NT-proBNP改变及其临床意义。方法对该院明确诊断为CHF的120例不同病因、不同心功能分级的慢性充血性心衰患者及50例对照组,测定人院时血浆NT—proBNP及LVEDD、LVESD、LVEF变化,并进行治疗前后对比观察。结果CHF组总体血浆NT-proBNP水平明显高于对照组（P〈0．05）,NYHAI级心功能时血浆BNP明显高于对照组（P〈0．05）,且Ⅰ、Ⅱ、Ⅲ、Ⅳ级组间血浆BNP依次递增（P〈0．05）。CHF在治疗后明显低于治疗前（P〈0．05）。结论血浆NT-proBNP的水平对CHF的诊断、严重程度和预后评价有重要价值。     

老年慢性心力衰竭患者血清尿酸水平变化及氯沙坦的影响

目的探讨充血性心力衰竭（CHF）血清尿酸（UA）水平变化及氯沙坦的影响。方法80例CHF患者随机被分为氯沙坦和依那普利组，观察治疗前后UA变化，并比较CHF患者不同心功能状态下的血清尿酸浓度。结果①CHF患者心功能Ⅰ～Ⅱ、Ⅲ、Ⅳ级者UA分别为（344±105）μmol／L、（417v112）μmol／L、（488±123）μmol／L；心功能Ⅳ级明显高于Ⅰ～Ⅱ级患者（P〈0．01）；②氯沙坦组治疗后UA水平显著降低，（414Ⅰ112）μmol／L、（273±99）μmol／L（P〈0．05）；依那普利组治疗前后无显著差异（P〉0．05）。结论慢性心力衰竭患者UA水平随心功能不全加重而明显升高，氯沙坦在改善心功能同时具有降血清尿酸作用。     

充血性心力衰竭患儿血清白细胞介素-18检测的临床意义

目的探讨检测充血性心力衰竭（CHF）患者血清白细胞介素-18（IL-18）水平的价值。方法检测52例CHF患儿（CHF组）和15例健康体检者（对照组）血清IL-18水平,分析IL-18水平变化与心功能的关系。结果检测血清IL-18水平为：CHF组（199．5±79．0）ng／L,对照组（50．9±23．5）ng／L,心功能Ⅱ级组（128．1±37．9）ng／L、Ⅲ级组（193．4±52．9）ng／L、Ⅳ级组（281．3±51．6）ng／L,CHF组明显高于对照组（P〈0．01）,心功能Ⅳ级组显明显高于Ⅲ级组、Ⅱ级组及对照组（均P〈0．01）,心功能Ⅲ级组明显高于Ⅱ级组及对照组（均P〈0．01）,心功能Ⅱ级组明显高于对照组（P〈0．01）。结论患儿血清IL-18水平与CHF的严重程度有关,监测血清IL-18水平可作为CHF患者心功能状态及疗效的有效评价指标之一。     

慢性充血性心力衰竭患者的心率变异性分析

目的：探讨慢性充血性心力衰竭（CHF）患者的心率变异性（HRV）的变化。方法：用24d,时动态心电图分析51例心力衰竭患者、27例心功能代偿的心血管病患者、25例健康人的HRV指标。比较3组HRV指标与心功能NYHA分级和关系。结果：心功能代偿组SDNN、SDANN较对照组显著下降（P〈0.01,P〈0．05）SDNNi、rMSSD和pNN50与对照组差异无显著性（P〉0．05）;CHF组的HRV各指标均显著低于对照组（P〈0．01）。心功能≥Ⅲ级者较Ⅱ级HRV各项指标显著降低（P〈0．01）,各种病因SDNN、SDANN较对照组显著下降（P〈0．01）,但各种病因间差异无显著性（P〉0．05）。结论：CHF患者HRV指标下降的变化与心功能损害程度相关,但原发病之间HRV指标下降无差异。     

辛伐他汀联合缬沙坦对慢性心力衰竭患者血清TNF-α、IL-1、BNP水平和心功能的影响

目的观察辛伐他汀联合缬沙坦对慢性充血性心力衰竭患者血清TNF-α、IL-1、BNP水平和心功能的影响。方法68例慢性充血性心力衰竭患者随机分为治疗组和对照组。对照组给予缬沙坦及常规治疗,治疗组在此基础上加用辛伐他汀,疗程均为1年。比较两组治疗前后血清TNF-α、IL-1、BNP水平的变化和心功能疗效及心脏彩超指标。结果治疗组1年后血清TNF-α、IL-1、BNP水平较对照组显著下降（P〈0．05）;心功能改善总有效率显著优于对照组（P〈0．05）;左心室射血分数（LVEF）、左室收缩末内径（LVSD）、左室舒张末内径（LVDD）和左室内径缩短率（FS）均较对照组有明显改善（P〈0．01）。结论辛伐他汀联合缬沙坦治疗慢性充血性心力衰竭能显著降低患者血清TNF-α、IL－1、BNP水平,明显改善心功能,疗效优于单加缬沙坦。     

慢性充血性心力衰竭患者甲状腺激素变化临床分析

目的观察慢性充血性心力衰竭（CHF）患者血清甲状腺激素的变化情况。方法用化学发光免疫分析技术微粒子酶免分析法测定72例CHF患者和48例健康者血清甲状腺激素水平。结果CHF患者与健康者相比血清三碘甲状腺原氨酸、游离三碘甲状腺原氨酸明显降低,差异具有统计学意义（P〈0．05）;而总甲状腺素浓度、游离甲状腺素、促甲状腺激素2组间相似,差异无统计学意义（P〉0．05）。结论慢性充血性心力衰竭患者常合并正常甲状腺功能病态综合征。     

非洛地平治疗慢性充血性心力衰竭的临床药学分析

目的：探讨非洛地平对慢性充血性心力衰竭（CHF）的治疗作用。方法：选择Ⅱ～Ⅲ级CHF患者100例,随机分为对照组50例,以洋地黄、利尿剂和卡托普利治疗;治疗组50例,在对照组方案的基础上,加用非洛地平每日2．5～5mg,疗程4周。观察血压、心率及心功能变化,通过X线胸片、超声心动图测定治疗前后心胸比率、LVEF及LVDd参教。结果：发现两组治疗后均有收缩压下降、心率减慢、LVEF升高（P〈0．001或P〈0．05）。治疗组心胸比率、LVDd缩小（P〈0．05）而对照组变化不明显（P〉0．05）;治疗组收缩压下降,LVEF升高的幅度比对照组明显（P〈0．001或P〈0．01）。结论：在CHF治疗中短期应用非洛地平可进一步改善心功能,降低血压,逆转扩大的心脏。增加心排量。     

卡维地洛治疗慢性充血性心力衰竭的疗效观察

目的：观察卡维地洛对慢性充血性心力衰竭（CHF）病人心功能的临床疗效。方法：对56例冠心病、扩张型心肌病、高血压性心脏病的CHF病人,随机分为治疗组和对照组各28例。对照组采用常规治疗,治疗组在常规治疗的基础上,每天给卡维地洛3．125mg口服治疗,逐渐增至每天50mg,疗程6个月。观察治疗前后心功能、心率、左室射血分数（LVEF）等指标的变化。结果：治疗组总有效率为92．9％优于对照组的67．9％（P〈05）。两组治疗后心功能各项参数的变化,治疗组明显优于对照组（P〈0．05）。结论：在常规治疗的基础上加用卡维地洛对CHF患者有更好的疗效。     

左卡尼汀对充血性心力衰竭患者近期NT-proBNP和心功能的影响

目的探讨左卡尼汀注射液对充血性心力衰竭（CHF）患者近期血清N-端脑利钠肽前体（NT-proBNP）和心功能的影响。方法将110例确诊为CHF患者,随机分为观察组（心力衰竭常规治疗＋左卡尼汀）和对照组（心力衰竭常规治疗）各55例。采用胶体金干式免疫层析技术体外定量检测入选患者血清NT-proBNP的含量。比较两组患者治疗前后的血清NT-proBNP水平及心功能改善情况。结果治疗前后观察组与对照组相比,血浆NT-proBNP水平显著下降（P〈0.01）,心功能明显改善,治疗总有效率有显著差异（P〈0.01）。结论左卡尼汀能显著降低慢性充血性心力衰竭患者血清NT-proBNP水平及改善心功能状态,能够显著改善CHF患者预后。     

阿尔达克通与怡那林治疗慢性充血性心力衰竭42例报告

目的探讨阿尔达克通与怡那林治疗慢性充血性心力衰竭（CHF）的临床疗效和安全性。方法84例NYHA心功能Ⅲ-Ⅳ级CHF住院患者随机分为治疗组和对照组。对照组常规扩血管、强心、利尿基础上加用怡那林10mg／d;治疗组在上述治疗基础上加用阿尔达克通40mg／d,连续用药12个月。用药前后分别观察心率、血压、左室射血分数、心功能的变化,并定期测定血清钾、钠、尿素氮、肌酐。结果两组再住院率及病死率比较差异有统计学意义（P〈0．05）。治疗后治疗组的心功能、左室射血分数、心率较对照组明显改善（P〈0．05）,血钾无显著升高（P〉0．05）,两组血压、血清肌酐、尿素氮增高差异无统计学意义（P〉0．05）。结论长期使用阿尔达克通和卡托普利治疗CHF临床疗效好,副反应少,能明显减少住院率和死亡率。     

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.