儿童344例心率变异性分析

目的分析儿童心率变异性的临床意义。方法对344例患儿进行24h动态心电图分析，且按年龄分成六组（新生儿组9例，婴儿组27例，幼儿组26例，学龄前组41例，学龄组150例，青春期组91例），分析比较各组心电图时域参数。结果经过分析，各组低于正常心率变异性：新生儿组9例（100．O％）、婴儿组24例（88．8％）、幼儿组18例（69．2％）、学龄前组15例（36．6％）、学龄组21例（14．0％）、青春期组12例（13．1％）；在心率变异性小于正常值的患儿中，幼儿期组房性心律失常1例，学龄前期组室性期前收缩2例、房性期前收缩1例；学龄期组室性期前收缩4例、室性心动过速2例、房性期前收缩1例、房性过速1例、心肌病3例、心肌炎2例、甲状腺功能亢进症3例、糖尿病2例；青春期组室性期前收缩1例、室性心动过速1例、心肌病2例、心肌炎1例、糖尿病2例、甲状腺功能亢进症1例。结论儿童心率变异性多低于正常，年龄越小越明显，且易合并心脏病变。     

老年1万次以上室性期前收缩动态心电图分析

目的探讨老年1万次以上室性期前收缩动态心电图的特征及其临床意义。方法选择老年室性期前收缩患者86例，分为A、B两组。A组为器质性心脏病47例，B组为非心脏病39例，采用动态心电图系统对所有老年患者24h心电监测进行分析。结果两组老年患者24h室性期前收缩平均发生次数分为（25172±4752）、（24957±4984）次，差异无统计学意义（P〉0．05）；两组老年室性期前收缩患者心率变异指标之间的差异有统计学意义（P〈0．05）；A组复合型室性期前收缩（74．5％）明显高于B组（20．5％）（P〈0．05），A组ST-T改变（44．7％）明显高于B组（7．7％）（P〈0．01）。结论室性期前收缩次数不适于作为判别老年人是否患有心脏病的关键性条件，但室性期前收缩心率变异以及复合型室性期前收缩异常对临床诊断有一定参考价值。     

硫酸镁对室性期前收缩及心率变异性的影响

目的观察硫酸镁对充血性心力衰竭患者室性期前收缩及心率变异性变化的影响。方法50例充血性心力衰竭患者在应用硫酸镁治疗前后用动态心电图对室性期前收缩的发生、心率变异性各项指标进行分析，并与对照组50例进行比较。结果治疗组用药后与对照组及治疗组用药前比较室性期前收缩显著下降（P〈0．05），而代表心率变异性的各项指标则显著升高（P〈0．05）。结论硫酸镁不但能降低室性期前收缩的发生，改善症状，而且提高心率变异性，改善预后。     

高血压患者心率变异与室性心律失常相关性研究

目的 通过分析高血压患者心率变异情况,探讨其变化与室性心律失常的相关性.方法 收集30例高血压患者为观察组,另设30例健康查体者为对照组,24 h动态心电图记录60例入组者的心率变异时域指标(SDNN、SDANN、RMSSD、PNN50)与频域指标(HF、LF、LVF、LF/HF),分析对比两组心率变异变化与室性心律失常的关系以及室性心律失常发生率.结果 观察组四个心率变异时域指标均低于对照组,差异均有统计学意义(均P ＜0.05)；观察组频域指标HF、LF及LVF亦明显低于对照组,而LF/HF高于对照组,差异均有统计学意义(均P＜0.05)；观察组室性心律失常发生率(63.33％)明显高于对照组(6.67％),差异有统计学意义(x2 =2.03,P＜0.01).结论 高血压患者心率变异性明显低于健康人,其变化与室性心律失常密切相关,根据心率变异性变化情况可早期干预高血压患者以预防室性心律失常的发生.     

心率变异时域及频域分析对儿童病毒性心肌炎的临床价值

目的监测病毒性心肌炎患儿的心率变异时域、频域指标,评价其对儿童病毒性心肌炎的临床价值。方法采用计算机心电监测系统,分别对42例病毒性心肌炎患儿和42例健康儿童进行HRV时域、频域指标检测,对两组间检测结果进行比较分析。结果病毒性心肌炎患儿心率变异时域指标、心率总体标准差(SDNN)、心率差值均方的平均根(RMSSD)均降低,频域指标低频成分(LF)、高频成分(HF)降低,而LF/HF增高。与对照组均有显著性差异(P<0.05)。结论病毒性心肌炎患儿自主神经功能受损,表现以迷走神经活性降低为主,HRV指标可为儿童病毒性心肌炎的早期诊断提供参考,提示重新调整自主神经平衡对病毒性心肌炎的防治有不可忽视的价值。     

高频心电图和心率变异对小儿病毒性心肌炎的应用价值

目的 联合应用高频心电图和心率变异对小儿病毒性心肌炎进行检测用以探讨其应用价值。方法 选小儿病毒性心肌炎118例,对照组208例,两组按年龄分为学龄前组(1～6岁)、学龄期组(7～14岁)。分别统计其高频切迹总数、心率变异时域指标SDNN 、rMSSD、HRVI、PNN50和频域指数LF/HF进行对比分析,并对57例经过治疗的患儿复查观察各数值。结果 心肌炎组高频切迹明显增多,阳性率共95例占80.5%,对照组阳性率9例为5.4%,两者有非常显著性差异(p<0.01),心肌炎组与对照组的心率变异各指标比较显示, 学龄前心肌炎组的SDNN、 rMSSD、HRVI有显著性差异(p<0.01),而学龄期组除SDNN之外其余均有显著性差异(p<0.01),心肌炎组心电图异常共53例占44.9%,高频心电图阳性与心电图异常两者有非常显著性差异(p<0.01),而高频心电图阳性同时合并心率变异性低下(以SDNN、rMSSD、HRVI低于对照组计)共83例占70.3%,与心电图异常比较有非常显著性差异(p<0.01)。经治疗后的57例患儿有45例转为阴性,心率变异指标均有回升。结论 高频心电图对小儿病毒性心肌炎的诊断率优于常规心电图。高频心电图能反映心肌损害,而心率变异提供心脏自主神经调控信息,联合应用对于及早诊断小儿病毒性心肌炎及动态观察病情转归、指导治疗有很好的价值。     

黄芪注射液联合左卡尼汀治疗儿童病毒性心肌炎对心率减速力及心律变异性的影响

目的 探讨黄芪注射液联合左卡尼汀对儿童病毒性心肌炎心率减速力(DC)及心率变异性(HRV)的影响.方法 将80例病毒性心肌炎患儿随机分为A组、B组、C组,A组(26例)在常规治疗基础上加用黄芪注射液;B组(27例)在常规治疗基础上加用左卡尼汀,C组(27例)在常规治疗基础上联合应用黄芪注射液和左卡尼汀,对所有病毒性心肌炎患儿在治疗前及治疗后均进行24 h动态心电图检查,运用动态心电图系统采集患儿的心电信号进行DC和HRV各项指标的分析.结果 3组治疗后DC值及HRV时域指标的各项参数值较治疗前均明显升高(P<0.05),HRV时域指标主要包括RR间期总体标准化差(SDNN)、RR间期均值的标准差(SDANN)、相邻RR间期差值的均方根值(RMSSD),且C组DC及SDNN、SDANN、RMSSD值比A、B组升高更明显,差异有统计学意义(P<0.05),A、B组DC及SDNN、SDANN、RMSSD值升高差异无统计学意义(P>0.05).结论 病毒性心肌炎患儿DC及HRV各时域值均降低,而DC及HRV各时域值能可靠反应迷走神经功能,可以作为患儿病情严重程度判断、临床治疗指导的可靠依据.黄芪注射液与左卡尼汀均可改善迷走神经功能,对心肌有保护作用,两者联合应用,效果更佳.     

病毒性心肌炎患儿动态心电图及左心功能的观察

目的观察病毒性心肌炎患儿动态心电图及左心功能的变化。方法对62例该病患儿进行24h动态心电图监护和超声心动图检测EF、FS、CI，并对出现期前收缩患儿做了对比性观察。结果心律失常乃病毒性心肌炎患儿最常见的心电异常，动态心电图的检出率（46／62）明显高于常规心电图（30／62），并且能发现常规心电图难以发现的复杂心律失常。24h心脏早搏〉14400次者较24h早搏〈14400次者左心功能明显受影响（P〈0．05）。结论动态心电图能全面地显示心电异常活动，提高心律失常的检出率；部分病毒性心肌炎患儿心功能降低；频发早搏可影响心功能。     

参松养心胶囊治疗高龄期前收缩39例分析

目的 观察参松养心胶囊治疗高龄期前收缩疗员疗效及其对心率变异性（HRV）的影响.方法 随机选取江苏省钟山干部疗养院住院39例高龄疗员,在常规治疗的基础上,给予口服参松养心胶囊,每次4粒,3次/d治疗,比较治疗6个月前后疗员24h动态心电图（DCG）、HRV.结果 治疗后高龄疗员室上性期前收缩总数和室性期前收缩总数减少（P＜0.05）,24h内全部正常心动周期的标准差（SDNN）和24h内每5min平均RR间期平均值的标准差（SDANN）显著增高（P＜0.05）,24h内全部相邻NN间期之差的均方根值（rMSSD）显著增高（P＜0.01）.结论 经参松养心胶囊治疗后,高龄疗员室上性期前收缩和室性期前收缩总数减少,HRV各项指标显著增高.     

高血压合并冠心病患者的心率变异性分析

目的 探讨高血压并发冠心病患者的心率变异性和心律失常的特点.方法 对50例原发性高血压(EH)患者、44例冠心病(CHD)患者和52例EH并发CHD患者与35例健康老年人的心率变异性(HRV)进行对比研究.结果 EH组和CHD组与对照组HRV时域法所有参数差异均有统计学意义(P＜0.05);EH并发CHD组与对照组比较,各参数差异均有统计学意义(P＜0.01);但不同疾病组间比较,差异均无统计学意义(P＞0.05).三个疾病组与对照组比较,房性期前收缩、房性心动过速和室性期前收缩的发生率差异均有统计学意义(P＜0.01);而EH组、CHD组及EH+CHD组间,除外CHD组与EH+CHD组房性期前收缩的发生率差异有统计学意义(P＜0.05)外,其余差异均无统计学意义.结论 高血压患者和冠心病患者的自主神经功能受损,心律失常发生率增加(以房性期前收缩最常见,其次为室性期前收缩);当高血压患者并发冠心病时这种受损更加明显,其迷走神经张力降低,交感神经紧张性相对增高是导致老年患者心率变异性降低的主要原因和心律失常的可能因素.     

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.     

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.