婴幼儿腹泻伴良性惊厥45例临床分析

目的探讨婴幼儿腹泻伴良性惊厥的原因并分析其预后。方法回顾性分析我院近年来收治的45例婴幼儿腹泻伴良性惊厥患儿的临床资料。结果本组患儿给予补液、抗病毒、纠正电解质紊乱、止惊等对症治疗5～7d后,全部治愈出院;出院后均未给予抗癫痫治疗,随访6个月～1年,均未遗留神经系统后遗症状,无再次惊厥发生。结论婴幼儿腹泻伴良性惊厥的原因可能是多因素作用的结果,其中轮状病毒感染是主要病因。临床医师应密切观察患儿的病情变化,进行必要的实验室检查,以明确病因,做出准确诊断,积极对症治疗,终止惊厥发作,大多预后较好。     

婴幼儿腹泻伴惊厥49例临床分析

目的探讨婴幼儿腹泻伴惊厥的原因。方法回顾分析49例婴幼儿腹泻时伴发惊厥的临床资料。结果腹泻时伴血钙降低10例，血钠降低8例，血钠升高4例，高热惊厥13例，病毒性脑炎8例，中毒性菌痢2例，癫痫1例，甲状旁腺功能减低症1例，原因不明2例。结论婴幼儿腹泻伴惊厥主要与电解质紊乱、高热、中枢神经系统感染有关。     

儿童热性惊厥的临床特征

目的探讨热性惊厥住院患儿患病情况、影响因素等,以便为治疗及预防该疾病提供参考依据。方法采取回顾性研究方法,对某三甲儿童医院神经科2014年6月至2015年5月因首诊热性惊厥所收治出院的患儿1 129例进行调查,了解患儿病史,分析其年龄、性别构成、发病季节、生化指标值、贫血、腹泻等,找寻热性惊厥患儿患病的临床特征。结果 (1)在1 129例因热性惊厥住院患儿中,年龄最小的29 d,最大的11岁,其中男童683例,占60.5%;女童446例,占39.5%,男女比例为1.53∶1。虽然各年龄组因热性惊厥住院儿童人数构成均为男童高于女童,但经χ2检验,差异无统计学意义(χ2=4.098,P=0.129)。(2)热性惊厥发生月份以2014年12月至2015年1月患儿人数最多,占总患病人数的27.4%,5~6月份次之,占总患儿的20.2%。(3)不同年龄住院儿童热性惊厥合并低血钾、低血钠、癫痫及入院严重程度差异有统计学意义;不同性别、年龄住院儿童热性惊厥合并腹泻、缺铁性贫血差异有统计学意义。女性缺铁性贫血、腹泻患儿合并发热时发生惊厥的比例分别是9.4%、9.0%,大于男性缺铁性贫血及腹泻合并发热时发生惊厥的比例6.1%、4.8%。结论热性惊厥的发生与患儿年龄、性别、季节关系密切,山西省以冬季及春夏交界患病率最高;6岁以上热性惊厥患儿应注意合并低钠、低钾、癫痫等疾患;女性缺铁性贫血、腹泻患儿合并发热时惊厥发生概率大于男性患儿。     

季节性婴幼儿腹泻并发惊厥临床病因及预后分析

目的探讨季节性婴幼儿腹泻并发惊厥临床病因及预后分析。方法回顾性分析我院2014年11月～2017年11月期间就诊的季节性婴幼儿腹泻婴幼儿病历资料,对所有研究对象一般资料进行收集,对比季节性婴幼儿腹泻并发惊厥一般资料差异情况,有差异项带入Logistic回归方程,分析季节性婴幼儿腹泻并发惊厥病因,并给予针对性预防措施。结果所选取调查对象中共有33例患儿发生惊厥,占3.30%。在高热、血钠、中毒性菌痢及血钙上,发生季节性婴幼儿腹泻并发惊厥与未发生季节性婴幼儿腹泻并发惊厥对象对比有差异,P 0.05。将上述因素带入Logistic回归方程计算发现,上诉情况均是引起季节性婴幼儿腹泻并发惊厥的影响因素。结论季节性婴幼儿腹泻会受高热、血钠、中毒性菌痢及血钙的影响,增加惊厥发生率,临床应针对性给予相关预防措施,减少季节性婴幼儿腹泻并发惊厥发生率。     

高热惊厥患儿血清钠水平变化的研究

目的：探讨高热惊厥患儿血钠值的变化,为防止再次惊厥以及在高热惊厥的救治中应该注意的问题提出建议。方法：对120例高热惊厥患儿血清钠浓度变化进行回顾分析。结果：在120例高热惊厥患儿中,发生低血钠的为46例,发生比例为38.3%。在发生2次及2次以上惊厥的26例患儿中,发生低血钠的20例,发生率为76.9%。惊厥持续时间〈10min 101例,发生低血钠的占29例,≥10min 19例,发生低血钠的占17例。结论：发生热性惊厥的患儿中,常存在低钠血症,与惊厥次数及持续时间关系密切。因此,在救治高热惊厥时,要注意补充钠,以维持内环境的稳定,并可在一定程度上防止再次发生惊厥。     

122例急性腹泻合并惊厥患儿的临床特点及预后分析

目的探讨急性腹泻合并惊厥患儿的临床特点及预后。方法收集笔者所在医院2016年9月—2018年9月122例急性腹泻合并惊厥患儿的临床资料,回顾性分析其临床特点。结果 122例急性腹泻合并惊厥患儿多数在3岁以内,占总例数的95.08%。66例患儿在腹泻第1天出现惊厥发作,占总例数的54.10%;28例患儿在腹泻第2天出现惊厥发作,占总例数的22.95%;38例患儿在腹泻第3～5天出现惊厥发作;平均出现在(43.2±33.6) h。惊厥持续时间多在5 min以内;发作次数多数在2次以下。平均住院日(7.0±3.5) d。临床诊断轻度胃肠炎伴良性婴幼儿惊厥(benign infantile convulsions associated with mild gastroenteritis,BICE)52例,占总例数的42.62%;热性惊厥36例,占总例数的29.51%;病毒性脑炎8例,中毒性脑病6例,癫痫20例。其中惊厥持续状态患儿8例,占总例数的6.56%。结论急性腹泻合并惊厥的患儿病因多样,BICE及热性惊厥最为多见,病毒性脑炎及感染性腹泻合并中毒性脑病也需警惕,多次无热惊厥者还需考虑癫痫。     

婴幼儿轮状病毒腹泻146例临床分析

目的探讨婴幼儿轮状病毒(RV)腹泻的流行状况、临床表现及预后。方法对2012年2月至2013年2月苏州永鼎医院儿科收住院的146例轮状病毒腹泻患儿资料进行了回顾性分析和总结。结果 RV腹泻发病年龄:91.78%的轮状病毒腹泻发生在2岁以下儿童,平均发病年龄11.65个月;流行高峰季节为11月~12月;临床表现:以腹泻、呕吐、发热为主要症状,合并心肌损害81例,占55.48%,侵犯神经系统至惊厥5例,占3.42%,平均惊厥发作次数1.2次;预后:轮状病毒腹泻为一自限性疾病,预后良好。结论 2岁以下婴幼儿是轮状病毒腹泻的主要流行人群,秋冬季多发,11~12月是发病高峰,以水样便、呕吐、发热为主要症状,除肠道内感染,亦可引起肠道外多脏器损害,以心肌损害及惊厥为多发。RV感染腹泻及其肠道外损害虽为自限性疾病,但临床治疗仍需积极控制RV所致的病毒血症,降温可减轻患儿心肌和神经组织的受损。     

婴幼儿重症肺炎酸碱失衡的临床意义

目的:探讨婴幼儿重症肺炎血气分析及酸碱失衡的影响因素,以降低肺炎患儿的病死率。方法:对92例临床确诊为重症肺炎患儿的动脉血气分析结果,结合其电解质结果进行分析,找出酸碱失衡的类型,并分析其预后。结果:92例重症肺炎患儿均存在酸碱失衡和不同程度电解质紊乱,其中混和性酸中毒62例(占67%),单纯性呼吸性酸中毒24例(占26%),单纯性代谢性酸中毒6例(占7%),合并代谢性酸中毒的患儿病情多数危重,预后差;先天性心脏病的肺炎患儿易合并代谢性酸中毒(100%)。35例重症肺炎患儿合并电解质紊乱,其中低钠血症25例(占71%),低钾血症6例(占17%),低钙血症4例(占12%)。结论:治疗婴幼儿重症肺炎患儿除抗感染外,改善呼吸道通畅比单纯用碱纠正酸中毒更重要,同时应维持水电解质平衡。对合并有先天性心脏病的患儿在保持呼吸通畅的同时,要积极纠正酸中毒。     

婴幼儿营养不良合并腹泻伴低钾危象诊治体会

目的：对婴幼儿营养不良合并腹泻伴低钾危象诊治的探讨。方法：自1993.1-2002.11收治Ⅱ，Ⅲ度营养不良伴腹泻患儿74例，出现低钾危象40例按营养不良伴腹泻原则进行计算输液量。均主要选用2/3等张含钾液，用10%氯化钾2-3ml/kg/d,加入4：3：2液中稀释为0.3%浓度，以1-2gtt/kg/min匀速滴注，其中9例病情危重伴轻度脱水、周围循环衰竭，首先用2：1等张含钠液20ml/kg静脉推注，并给予5%碳酸氢钠液5ml/kg静脉注射。脱水纠正后给予ORS适量口服。有低钙血症亦给补钙。治疗过程严密观察病情，每隔1-2d复查血浆电解质，予以调整，严重得输白蛋白或全血加强支持疗法，有感染用抗生素及对症处理。结果：38例于治疗后1-3天脱水纠正，2-6天腹泻停止，3-10天血钾恢复正常，治愈率95%。死亡2例。结论：营养不良合并腹泻患儿在农村基层比较多见，是婴幼儿重要死亡原因之一，尤其合并代钾危象，必须及时正确诊断及治疗才能转危为安。     

中西医联合治疗婴幼儿腹泻的疗效观察

探讨中西医联合治疗婴幼儿腹泻的临床疗效。方法：对我院2013年3月～2015年3月210例婴幼儿腹泻患者随机分为两组,研究组105例给予添加参苓白术散加味治疗,并配合西医补液,纠正酸中毒、电解质紊乱、抗病毒等治疗5～6d。对照组105例给予西医补液,纠正酸中毒、电解质紊乱、抗病毒等治疗。结果：研究组治愈98例（93.33%）,好转5例,无效2例;对照组治愈89例（84.76%）,好转11例,无效5例。结论：用祖国医学联合西医方法治疗婴幼儿腹泻疗效显著,并发症少,方法肯定,可在基层推广。     

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.