维持性血液透析患者透析充分性相关因素分析

目的:探究维持性血液透析患者透析充分性的相关因素,为临床提供指导。方法:以2015年6月～2017年5月某院125例维持性血液透析患者作为观察对象,对125例维持性血液透析患者的临床资料进行回顾性分析,结合透析充分性结果将其分为透析充分性好组(75例)、透析充分性差组(50例),研究维持性血液透析患者透析充分性的相关因素。结果:透析充分性好组和透析充分性差组患者之间的年龄、每周透析次数、付款方式、营养状况结果存在显著差异,P0.05;对透析充分性好的相关因素进行Logistic回归分析可知,年龄、每周透析次数、付款方式、营养状况的结果均具有统计学意义,P0.05。结论:影响维持性血液透析患者透析充分性好的相关因素较多,例如年龄、每周透析次数、付款方式、营养状况等。     

不同透析模式对老年维持性血液透析患者低血压的疗效观察

目的：探讨不同血液透析方式对老年尿毒症血液透析患者透析相关低血压的预防。方法：选择我院透析室规律血液透析的老年血透患者80例,以随机抽样法分为普通透析组和可调钠透析组、可调钠联合超滤曲线、低温可调钠联合超滤曲线等4组,观察治疗过程中患者的血压情况、透析前后血钠水平、透析间期体质量增加及口渴感。结果：可调钠透析组、可调钠联合超滤曲线组及低温可调钠联合超滤曲线组患者低血压发生率较普通透析组均显著降低（P〈0.01）。结论：可调钠透析、低温可调钠及其联合超滤曲线等模式能改善老年患者血液透析相关低血压的发生,并可改善预后。     

老年尿毒症患者进行血液透析的临床护理对策探析

目的：探讨老年尿毒症患者行血液透析的临床护理对策。方法行血液透析治疗的尿毒症患者128例,对所有患者均加强临床护理,观察并分析其疗效。结果本组128例患者中,118例（92.2%）仍进行维持性透析的治疗,且透析充分,病情稳定,营养状况良好,无严重并发症发生。结论加强对行血液透析治疗的老年尿毒症患者透析前、透析过程中以及透析后的护理,对降低并发症发生,提高透析效果具有重要作用。     

长期血液透析患者的舒适护理介绍

肾脏相关慢性疾病具有治疗周期长、难彻底治愈等特点,需要长期维持性血液透析[1]。透析是尿毒症患者维持治疗的重要措施,患者稳定、良好的身心状态,对于保证透析质量和降低透析意外发生率具有重要意义[2]。为了给患者提供更好的服务,我们对长期血液透析患者采用舒适护理模式,取得较好效果。现将舒适护理方法介绍如下:     

透析用水和透析液中细菌内毒素考察

目的:拟订和建立血液透析用水和透析液细菌内毒素的质量控制标准和方法。方法:结合各国药典对透析用水和透析液的生物学限值标准,依据2005年版《中国药典》相关方法建立微生物细菌培养及动态比浊法,对样本进行监测和评估。结果:拟定标准为微生物和内毒素的制成水、透析液(没有滤过)、超滤透析液分别为<100、<200、<1cfu.mL-1及<0.25、<1.0、<0.10EU.mL-1,据此标准所检查样本结果合格。结论:所建立方法可行,能确保血液透析的医疗使用安全。     

低温配合可调钠曲线超滤预防血液透析相关低血压

低血压是血液透析中常见的并发症之一,发生率约20%～40%[1],其不仅直接影响透析效果,而且严重影响患者心脑血管功能的稳定性,因此,预防透析相关性低血压,降低其发生率具有重要的临床意义。本文就低温可调钠曲线超滤透析方式的联合应用,对透析相关低血压的预防作用进行了临床观察。     

关于某区血液透析患者心律失常发生原因的调查与防治

目的探讨维持性血液透析患者在透析期间发生心律失常的原因及防治办法,透析中心律失常的发生与患者的年龄、营养状况,贫血程度及超滤脱水量等有着直接的关系。方法收集30例维持性血透患者,分析在血液透析中心律失常发生情况及其原因。结果在30例患者每周透析2～3次,1年约共血液透析约3600例次,出现心律失常420次,发生率12%左右。结论积极纠正诱发透析相关心律失常的危险因素,是完全可以避免或减少透析相关心律失常的发生。     

腹膜透析联合血液透析一例临床分析

目的 探讨腹膜透析联合血液透析的临床意义.方法 对北京市朝阳区小红门社区卫生服务中心血液透析中心的一例腹膜透析联合血液透析的患者进行总结,并结合文献进行分析.结果 该患者经过腹膜透析联合血液透析及营养支持,患者症状明显比之前好转.结论 腹膜透析和血液透析各有优势和不足,根据患者的具体情况采用合适的透析方法是十分重要的,...     

低温可调钠透析防治老年患者血液透析中低血压的观察

常规的血液透析经常出现一些并发症如低血压、失衡综合征、高血压及心功能不全等,其中低血压的发生率约为20%～40%[1]。近年来随着血液净化技术的提高,血液透析患者逐年增加,老年透析患者人数亦明显增多,但在老年人发生透析中低血压者概率较多,成为影响透析疗效的重要原因。近年来采用调节血液透析液中钠浓度,使超滤量随血钠浓度改变而改变,从而稳定透析中血容量的方法,明显减少了血液透析中的并发症[2]。笔者对老年透析患者采用低温可调钠透析观察,减少了低血压的发生概率,报告如下。     

血液透析相关低血压观察及护理

目的 探讨血液透析相关低血压发生的原因及护理措施.方法 2009年10月至2011年10月我院门诊和住院部共接诊血液透析患者34例,行血液透析3326次.所有患者在行血液透析前均进行健康宣教,透析过程中一旦发生低血压则及时采取相关处理措施.结果 共发生血液透析相关性低血压227次,占透析总数的6.83%.其中201例次(88.5%)经有效处理后血压恢复正常,可继续完成血液透析;26例次(11.5%)经治疗无效,停止血液透析后血压逐渐恢复正常.结论 血压透析相关低血压发生率较高,提前预防和及时处理是纠正低血压的关键措施.     

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.     

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.     

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.     

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.