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。     

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.     

3种血液净化方式对透析患者左室舒张期功能的影响

目的评价并比较不同血液净化方式(血液吸附、血液透析滤过、血液透析)对肾功能衰竭患者透析后左室舒张功能的影响。方法将309例需要血液净化治疗的透析患者随机分为A组、B组、C组各103例。分别采取血液吸附联合血液透析、血液透析和血液透析滤过治疗,10个月后,对3组患者的心脏左室结构与功能指标变化进行统计学对比。结果治疗前3组心脏左室结构变化指标LVDd、LVPWT、IVST、LAD差异无统计学意义(P>0.05);治疗10个月后,3组患者LAD明显增大(P<0.05),LVDd明显缩短(P<0.05);LVDd指标中A组与C组明显优于B组(P<0.05),而A组与C组比较差异无统计学意义(P>0.05);LAD组间差异不显著(P>0.05)。3组治疗前后LVPWT和IVST差异均无统计学意义(P>0.05)。治疗前3组心功能E/A、LVEF水平比较差异无统计学意义(P>0.05);治疗后E/A、LVEF较治疗前有显著变化(P<0.05)。A组与C组明显优于B组(P<0.05),而A组与C组比较差异无统计学意义(P>0.05)。结论血液吸附、血液透析滤过及血液透析均能在临床上改善心功能,但是血液吸附和血液透析过滤能更好的维持内环境,优于血液透析技术。     

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（P〈0.01）,但组间比较,差异无统计学意义（P〉0.05）。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〉0.05）,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。     

充分血液透析对尿毒症患者左心室结构和功能的影响

目的 探讨充分血液透析对尿毒症患者左心室结构和功能的影响.方法 45例尿毒症血液透析患者,在接受血液透析治疗前和治疗后第12个月时分别接受彩色多普勒超声心动图检测,测定室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室舒张末期内径(LVIDd),计算左室质量指数(LVMI);测定舒张早期充盈峰速度E峰(E)和舒张晚期充盈峰速度A峰(A),计算E/A比值,并测左室射血分数(LVEF).结果 45例尿毒症患者治疗前LVMI(153.8±29.5)g/m2、LVEF(48.8±8.3)%、E/A(0.83±0.25);充分血液透析后LVMI(113.9±25.8)g/m2、LVEF(57.7±10.6)%、E/A(1.17～0.22),超声心动图提示左室结构及功能改善.结论 尿毒症血液透析患者多伴有左心室肥厚及功能障碍,充分透析可得到有效改善.     

炙甘草汤治疗高龄糖尿病性心肌病患者疗效分析及对超声心动图指标的影响

目的研究炙甘草汤治疗高龄糖尿病性心肌病患者疗效。方法收集糖尿病性心肌病患者30例,根据患者入院时间的奇偶数分为对照组(n=14)和治疗组(n=16)。2组采用控制血糖、降血压、降血脂、抗心力衰竭、心绞痛等基础治疗,治疗组在以上药物基础上加用炙甘草汤,早晚2次温服,1剂/d,2周为1疗程。采用超声心动图检测2组患者左心房内径(LA)、左心室舒张末径(LVDd)、舒张期室间隔厚度(IVSd)、左心室后壁厚度(LVPWd)、室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、舒张早期血流速度E峰/舒张晚期血流速度A峰(E/A值)和射血分数(EF)。观察2组治疗效果。结果 2组治疗前各指标比较,差异无统计学意义(P>0.05),对照组治疗后LVPWd、E/A值与治疗前比较,差异有统计学意义(P<0.05)。治疗组治疗后LA、LVDd、IVSd、LVPWd、LVEDV、LVEDV、E/A值和EF值与治疗前比较,差异有统计学意义(P<0.05)。治疗组治疗后LA、LVEDV、LVESV、E/A值、EF值与对照组比较,差异有统计学意义(P<0.05)。治疗组显效率明显高于对照组(P<0.05),2组疗效比较,差异有统计学意义(u=2.063,P<0.05)。结论炙甘草汤治疗高龄糖尿病性心肌病有确切疗效,对心功能改善有明显效果。     

缬沙坦和非洛地平联合治疗中重度高血压病伴左心室肥厚临床观察

目的观察缬沙坦和非洛地平联合治疗中、重度高血压病的临床疗效和安全性。方法 138例高血压患者随机分为对照组和治疗组治疗3个月。治疗期间监测血压,超声心动图检测左室舒张末期内径(LVDd)、舒张末期室间隔厚度(IVSd)、左室后壁厚度(LVPWd)、左室重量指数(LVMI)、射血分数(EF)、二尖瓣口舒张早期最大峰值流速与舒张晚期最大峰值流速比值(E/A),并进行治疗前后对比分析。结果治疗组和对照组降压治疗的总有效率分别为94.1%和85.7%,两组差异显著(P<0.01),两组均未见明显的不良反应。彩色多普勒诊断仪复查LVDd、LVPWd及LVMI均降低,EF及E/A均增高。与治疗前相比差异均有统计学意义(P<0.05)。结论缬沙坦、非洛地平联合治疗高血压病疗效显著并改善左心室肥厚和舒张功能。     

腹膜透析和血液透析对尿毒症患者血清肌钙蛋白T/I及钙磷代谢的影响

目的观察腹膜透析和血液透析对尿毒症患者血清肌钙蛋白T/I及钙磷代谢的影响效果。方法选择尿毒症患者88例,根据患者的自身情况进行分组,其中进行腹膜透析治疗组(观察组)56例,进行血液透析治疗组(对照组)32例,观察2组患者透析前后血清肌钙蛋白T/I水平变化以及钙磷含量变化情况。结果透析后,观察组CTnT/I、hs-CTnT/I水平均低于对照组,高血磷的发生率则高于对照组,差异有统计学意义(P<0.05)。治疗前,观察组患者的甲状旁腺激素水平低于对照组,差异具有统计学意义(P<0.05),治疗后6个月,观察组患者的血钙、血磷、钙磷乘积以及甲状旁腺激素水平均低于对照组,差异有统计学意义(P<0.05)。结论腹膜透析不仅可降低血清肌钙蛋白含量,降低心血管事件发生可能,而且可更好地控制尿毒症患者的钙磷代谢,保护残肾功能,具有临床推广价值。     

雷米普利联合美托洛尔治疗慢性心力衰竭疗效观察

目的探讨雷米普利联合美托洛尔治疗慢性心力衰竭的临床疗效及心功能变化。方法 64例慢性心力衰竭患者随机分为治疗组和对照组,治疗组采用雷米普利和美托洛尔治疗,对照组仅给予美托洛尔治疗,观察比较两组的临床疗效及心功能指标的变化情况。结果 A组的总有效率为87.5%,B组的总有效率为59.4%,两组疗效经统计学分析,差异有显著性(P<0.05)。A组与B组患者的左室舒张末内径(LVEDd)、左室收缩末内径(LVESD)、室间隔厚度(IVSd)均有所降低,且A组降低程度优于B组(P<0.05);两组LVEF均有提高,治疗组提高明显(P<0.05)。结论雷米普利联合美托洛尔治疗慢性心力衰竭疗效优于单独应用美托洛尔治疗的疗效,心功能改善明显,值得临床推广和应用。     

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.     

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.     

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.