无创血流动力学监测技术应用于感染性休克患者早期复苏液体管理的意义分析

目的 探究感染性休克患者于早期复苏液体管理期间应用无创血流动力学监测技术的临床意义。方法 84例感染性休克患者,依据随机数字表法分为对照组和观察组,各42例。所有患者均接受早期复苏液体管理,观察组应用无创血流动力学监测,对照组应用常规非无创血流动力学监测,对比两组干预前后血流动力学参数、并发症发生情况及观察组干预前后无创动力学监测指标[心率(HR)、心输出量(CO)、心脏指数(CI)、每搏输出量(SV)]。结果 干预后,观察组舒张压、HR、血氧饱和度均优于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率2.38%低于对照组的16.67%,差异有统计学意义(P<0.05)。观察组干预前HR(178.61±12.35)次/min、SV(16.39±4.78)cm³、CI(5.57±1.37)L/(min·m²)、CO(2.14±0.74)L/min;干预后HR(121.48±13.06)次/min、SV(20.36±5.18)cm³、CI(4.25±1.16)L/(min·m²...     

两种方法评估肝硬化病人营养状况及其与肌肉减少症的关联性

目的比较全球领导人营养不良倡议( GLIM)标准和英国皇家自由医院 -营养优先工具( RFH-NPT)在评估肝硬化病人营养不良中的应用，并分析其与肌少症的关联性。方法 2020年 1月至 2021年 12月采用系统抽样方法抽取宜宾市第二人民医院肝硬化病人 173例，采用营养风险筛查工具 2002(NRS 2002)和 RFH-NPT筛查病人营养风险， GLIM标准诊断病人营养不良，并分析各方法诊断结果的一致性和与肌少症的关联性。结果肝硬化病人 NRS 2002和 RFH-NPT评分分别为( 3.43±0.53)和(1.48±0.36)分，两方法筛查出营养风险发生率分别为 78.6%和 85.6%，年龄越大和 Child-pugh分级越高营养风险发生率越高(P<0.05)。以 GLIM标准确诊营养不良阳性率为 72.8%，肌少症发生率为 53.2%，不同年龄段和 Child-pugh分级营养不良发生率差异有统计学意义( P<0.05)。RFH-NPT与 NRS 2002营养风险筛查、 GLIM标准诊断营养不良的 Kappa值分别为 0.61和 0.45，一致性一般。 RFH-NPT评分与骨骼肌质量指数( SMI)呈负相关，其关联系数 r为0.51(P<0.01)。配对 χ2检验显示: GLIM标准诊断营养不良、 NRS 2002和 RFH-NPT筛查营养风险与肌少症之间的列联系数分别为 0.50、0.29和 0.20(P<0.01)。结论肝硬化病人营养风险、营养不良和肌少症发生率高，采用 NRS 2002、RFH-NPT和 GLIM标准评估病人营养风险和营养不良与病人肌少症有一定关联性。     

肌肉减少症评价肝硬化患者营养状况及其影响因素

目的比较肌肉减少症与传统营养评价方法评估肝硬化患者营养状况,并进一步探讨肝硬化患者影响肌肉减少症发生的因素。方法收集2016年1月至2017年1月我科肝硬化患者资料,比较应用主观全面评价法(SGA)评分、传统营养指标及通过第3腰椎平面CT图像计算第3腰椎骨骼肌质量指数评估肝硬化患者的营养不良发生率。同时将52例肝硬化患者分为肌肉减少症组和非肌肉减少症组,分析2组间各营养指标有无差异,并进一步采用二分类Logistic回归分析法筛选影响肌肉减少症发生的危险因素。结果 52例肝硬化患者肌肉减少症的发生率为64%,2组患者年龄、性别、体质量指数(BMI)、血清白蛋白(ALB)、三头肌皮褶厚度(TSF)、上臂肌围(AMC)差异均有统计学意义(P<0.05)。二分类Logistic回归分析结果示:性别[OR=0.001,95%CI(0.000,0.223),P=0.011]、BMI[OR=0.312,95%CI(0.134,0.722),P=0.007]是肌肉减少症发生的主要危险因素。结论应用肌肉减少症可较客观地评估肝硬化患者的营养状况,且男性肝硬化患者,BMI越低,越容易发生肌肉减少症。     

老年住院患者握力和骨骼肌量与营养状况的相关性研究

目的 探索老年住院患者握力和骨骼肌量与营养状况的关系。方法 对在2020年10月—12月期间于武汉市中心医院全科医学科新入院的142例老年患者进行营养风险筛查(Nutritional Risk Screening 2002,NRS-2002)。测量患者体重、身高、BMI、腰围、小腿围、臀围、上臂围、握力、骨骼肌量和体脂肪。统计患者血液血红蛋白、白蛋白和总蛋白等反映机体营养状况的生化指标。Pearson和Spearman相关分析营养状况与握力及骨骼肌量的相关性。结果 老年住院患者NRS-2002评分显示营养不良风险(评分≥3分)构成比为12.6%(18/142),营养不良风险组的握力明显低于无营养不良风险组(评分<3分)[(18.45±10.330)kg/m² vs.(23.49±8.796)kg/m²,P=0.028]。营养不良风险组小腿围低于无营养不良风险组[(32.06±3.809)cm vs.(33.91±3.069)cm,P=0.022]。相关性分析显示,握力与NRS-2002评分呈显著负相关,与臀围、小腿围、骨骼肌量、血红蛋白...     

绝经后女性2型糖尿病病人骨钙素水平与糖尿病肾脏病的相关性研究

目的 探讨绝经后女性2型糖尿病(T2DM)病人骨钙素水平与糖尿病肾脏病(DKD)之间的相关性。方法 选取2018年5月至2019年6月在合肥市第二人民医院广德路院区住院的绝经后女性T2DM病人203例,根据尿白蛋白与肌酐比值(UACR)水平分为正常白蛋白尿组(N-DKD组,138例,UACR<30 mg/g),DKD组(65例,UACR≥30 mg/g)。检测并比较两组病人临床、生化指标及骨钙素水平的差异,同时进行多因素logistic回归分析探索DKD与骨钙素的相关性。结果 两组间病程、体质量指数(BMI)、尿酸、骨钙素及25羟维生素D₃[25(OH)D₃]比较差异有统计学意义(P<0.05),其中DKD组病程11(6,16)年、BMI(25.51±3.72)kg/m²、尿酸331(270,400)μmol/L明显高于N-DKD组[9(3,12)年、(24.40±3.55)kg/m²和284(243,329)μmol/L](P<0.05),而DKD组骨钙素(12.28±4.88)...     

微RNA-802在肥胖人群脂肪组织中的表达及临床意义

目的 探讨微RNA-802(miR-802)在肥胖人群脂肪组织中的表达情况及临床意义。方法 选择2019年3月至2021年7月在枣庄市三家医院因慢性胆囊结石而需手术治疗的病人102例,其中体质量指数(BMI)≥28 kg/m²有59例作为肥胖组,BMI<24 kg/m²有43例作为非肥胖组。手术过程中取皮下脂肪组织,采用实时荧光定量逆转录PCR(RT-qPCR)检测脂肪组织miR-802相对表达量;比较两组人体学指标、血脂、血糖等临床资料;采用Pearson分析肥胖病人脂肪组织miR-802水平与各指标的相关性。结果 肥胖组、非肥胖组病人性别、年龄及血清高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平之间比较,差异无统计学意义(P>0.05),肥胖组病人BMI[(31.81±2.43)kg/m²]、腰臀比(WHR)(1.03±0.07)、空腹血糖(FBG)[(10.51±2.71)mmol/L]、空腹胰岛素(FINS)[(16.54±3.26)mU/L]、胰岛素抵抗指数(HOMA-IR)...     

妊娠女性孕前体质量指数与肾功能及妊娠结局的关系

目的 分析单胎孕妇孕前体质量指数(BMI)、分娩前肾功能相关指标及妊娠结局,探讨孕前BMI对肾功能及妊娠结局的影响。方法 回顾性分析1218例常规围生保健及分娩的单胎孕妇资料,并按孕前BMI不同分为体重过轻组(<18.5 kg/m²,176例)、体重正常组(18.5～24.9 kg/m²,670例)、超重组(25.0～27.9 kg/m²,266例)、肥胖组(≥28.0 kg/m²,106例)。其中重度子痫前期孕妇806例,以34周为界,分为早发型组(442例)和晚发型组(364例)。对各组孕妇的肾功能相关指标及妊娠结局进行比较。结果 早发型组的孕前BMI(23.32±4.30)kg/m²高于晚发型组的(22.44±3.74)kg/m²,差异有统计学意义(P<0.05)。体重正常组和体重过轻组肾功能指标比较,差异均无统计学意义(P>0.05);体重正常组肾功能指标均低于超重组及肥胖组,差异均有统计学意义(P<0.05);超重组尿酸、...     

SARC-F联合小腿围、握力、维生素D测量在社区老年人群肌少症筛查中的应用价值

目的 探讨简易五项评分问卷(SARC-F)联合小腿围、握力、维生素D测量在社区老年人群肌少症筛查中的应用价值。方法 选取在社区居住的180例老年人作为研究对象,对受试者开展肌少症诊断金标准检查,依据亚洲肌少症工作组(AWGS)发布的肌少症诊断标准,将老年人群分为肌少症组(n=70)和非肌少症组(n=110)。分别检测两组SARC-F阳性率、小腿围、握力、维生素D水平并予以比较。通过多因素Logistic回归分析影响老年人发生肌少症的独立危险因素,根据影响因素进行赋值用以建立风险评估模型,经受试者工作特征曲线(ROC曲线)评估模型诊断效能。结果 肌少症组SARC-F阳性率68.57%高于非肌少症组的19.09%,小腿围(31.48±4.72)cm、握力(17.25±2.58)kg小于非肌少症组的(35.47±5.32)cm、(25.11±3.76)kg,维生素D(16.43±2.46)ng/ml低于非肌少症组的(22.56±3.38)ng/ml,差异明显(P<0.05)。经Logistic回归模型多因素分析, SARC-F阳性、小腿围、握力、维生素D水平是老年人发生肌少症的独立危险...     

快速康复外科护理对围手术期喉癌患者营养状态及负性情绪的影响评价研究

目的:探究快速康复外科护理对围手术期喉癌患者营养状态及负性情绪的影响。方法:选取72例2021年1月至2022年12月在耳鼻咽喉头颈外科接受喉癌治疗患者临床资料进行回顾性分析。按护理模式分为基础组(36例，基础护理)与康复组(36例，快速康复外科护理),对比护理效果进行统计分析。结果:康复组胃肠功能恢复时间为(13.46±4.46)h、下床活动时间为(17.32±4.25)h、术后住院时间为(7.11±2.14)天、疼痛持续时间为(2.68±0.47)天，短于基础组的(18.35±4.15)h、(22.47±4.34)h、(9.85±2.32)天、(3.77±1.24)天(P<0.05);术后14天康复组血红蛋白为(121.47±5.11)g/L、白蛋白为(39.99±2.73)g/L、总蛋白为(60.58±4.47)g/L、体质指数为(22.93±0.54)kg/m²、上臂肌围为(20.35±1.42)cm,高于基础组的(114.58±5.06)g/L、(36.95±2.15)g/L、(55.98±3.25)g/L、(21.51±0.25)kg/m     

常规疗法结合导引功法对绝经后骨质疏松症患者的治疗效果

目的 探讨常规疗法结合导引功法对绝经后骨质疏松症患者的治疗效果。方法 选取2021年1—10月在黑龙江省牡丹江林业中心医院治疗的绝经后骨质疏松症患者90例为研究对象,采取随机数表法将患者分为常规治疗组和导引功法组,每组各45例。常规治疗组口服盐酸雷洛昔芬+碳酸钙D₃,导引功法组增加导引功法治疗。比较两组患者治疗前后的骨密度、骨代谢指标和中医症候评分。结果 治疗后,导引功法组患者腰椎正位(L₁～L₄)骨密度为(0.88±0.08) g/cm²,左股骨颈骨密度为(0.80±0.09)g/cm²,均高于常规治疗组的(0.81±0.06) g/cm²和(0.76±0.10) g/cm²。导引功法组骨钙素为(6.95±1.00)μg/L,高于常规治疗组的(6.22±0.98)μg/L,Ⅰ型前胶原氨基端前肽为(52.39±4.72)ng/ml,低于常规治疗组的(58.15±7.26) ng/ml。导引功法组中医症候评分为(8.35±2.00)分,...     

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.