血乳酸水平与重症肺炎病变程度及预后的关系

目的探讨重症肺炎患者动脉血乳酸水平与肺炎病变程度及预后的关系。方法回顾性分析2013年9月至2014年12月我院呼吸内科126例重症肺炎患者临床资料。分别对两组患者入院时、治疗后第3、5、7天时血乳酸水平、24 h乳酸清除率、APACHEⅡ评分变化情况以及血乳酸水平与APACHEⅡ评分相关性进行分析。结果与入院时情况相比较,存活组患者在入院后第3、5、7天时的APACHEⅡ评分、血乳酸水平降低,而未愈组的APACHEⅡ评分、血乳酸水平升高,差异有统计学意义(P<0.05)。与未愈组患者入院后不同时间点的APACHEⅡ评分、血乳酸水平相比较,存活组患者入院后APACHEⅡ评分、血乳酸水平降低,差异有统计学意义(P<0.05)。与未愈组患者的24 h乳酸清除率相比较,存活组患者的24 h乳酸清除率升高,差异有统计学意义(P<0.05)。Pearson相关性分析结果表明,重症肺炎患者的血乳酸水平与APACHEⅡ评分呈现相关性,差异有统计学意义(r=0.357,P=0.00)。结论动态检测血乳酸水平及24 h乳酸清除率,有利于改善重症肺炎患者的预后。     

动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值研究

目的 探讨动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值.方法 选择脓毒性休克患者40例,采用早期目标指导治疗(EGDT),将其中死亡患者15例作为死亡组,其余25例作为存活组,比较其在入院时、入院6h和入院24h动脉血乳酸水平及乳酸清除率.结果 存活组入院时、入院6h、入院24h血乳酸浓度均低于死亡组,差异有统计学意义(P<0.01).存活组6h乳酸清除率和24h乳酸清除率均高于死亡组,差异有统计学意义(P<0.05).结论 动脉血乳酸浓度持续增高或6h乳酸清除率低的脓毒性休克患者预后差,6h乳酸清除率较24h乳酸清除率具有良好的早期预后评估作用.     

早期乳酸清除率、氧合指数对重症肺炎合并休克患者预后的评估作用

目的分析早期乳酸清除率、氧合指数对重症肺炎合并休克患者预后的评估作用。方法选取2014年1月~2015年12月期间我院收治ICU重症肺炎患者40例。将患者按照治疗结果分为存活组和死亡组,比较两组患者的氧合指数、初始血乳酸水平以及6h乳酸清除率、APACHEⅡ评分。按照6h乳酸清除率的高低将超过10%患者分为高乳酸清除率组和小于或等于10%分为低乳酸清除率组,对两组的6h血乳酸水平、APACHEⅡ评分以及治疗28d后死亡率以及呼吸衰竭发生率进行比较。结果存活组与死亡组患者初始血乳酸差异无统计学意义(P0.05),APACHEⅡ评分、氧合指数以及血乳酸清除率差异有统计学意义(P0.05)。高乳酸清除率组与低乳酸清除率组患者初始血乳酸以及APACHEⅡ评分差异无统计学意义;两组患者28d后死亡率、发生率差异有统计学意义(P0.05)。结论乳酸清除率、氧合指数对重症肺炎合并休克患者预后具有的评估作用,值得深入研究与推广应用。     

动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值研究

目的探讨动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值。方法选择脓毒性休克患者40例,采用早期目标指导治疗(EGDT),将其中死亡患者15例作为死亡组,其余25例作为存活组,比较其在入院时、入院6h和入院24h动脉血乳酸水平及乳酸清除率。结果存活组入院时、入院6h、入院24h血乳酸浓度均低于死亡组,差异有统计学意义(P<0.01)。存活组6h乳酸清除率和24h乳酸清除率均高于死亡组,差异有统计学意义(P<0.05)。结论动脉血乳酸浓度持续增高或6h乳酸清除率低的脓毒性休克患者预后差,6h乳酸清除率较24h乳酸清除率具有良好的早期预后评估作用。     

大黄川芎汤对严重脓毒症患者血乳酸及乳酸清除率的影响

目的探讨大黄川芎汤对严重脓毒症患者血乳酸及乳酸清除率的影响。方法按照随机数字表的分组方法将90例严重脓毒症患者分成观察组和对照组,每组45例。对照组患者接受脓毒症集束化治疗,观察组在对照组的基础上给予大黄川芎汤鼻饲。比较两组患者治疗后6 h、24 h及48 h的APCHEⅡ评分及治疗后6 h及24 h的血乳酸水平,计算6 h及24 h乳酸清除率。结果观察组治疗后6 h、24 h及48 h的APCHEⅡ评分均低于对照组,两组比较差异均有统计学意义(P<0.05)。观察组治疗后6 h、24 h血乳酸水平及乳酸清除率均优于对照组,两组比较差异均有统计学意义(P<0.05)。结论大黄川芎汤可改善严重脓毒症患者急性生理紊乱状况,能有效降低患者血乳酸水平及乳酸清除率,对严重脓毒症患者具有较好的临床应用价值。     

乳酸清除率对急性呼吸窘迫综合征患者的预后评估价值

目的探讨乳酸清除率与ARDS患者预后的相关性。方法回顾性分析45例ARDS患者入院后24h内的急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,根据入院初始和入院后6h、24h测定的血乳酸值计算乳酸清除率。按照预后分为存活组和死亡组,按照6h乳酸清除率≥10%、24h乳酸清除率≥50%分为高乳酸清除率组和低乳酸清除率组。结果存活组与死亡组的年龄、性别构成比较,差异无统计学意义(P>0.05)。存活组与死亡组APACHEⅡ评分分别为16.5±4.60、31.0±8.87;初始血乳酸浓度分别为(5.48±1.88)、(9.56±4.35)mmol/L,6h乳酸清除率分别为(47.02±27.47)、(6.15±8.68)%,24h乳酸清除率分别为(71.21±22.31)、(12.68±22.83)%,组间差异均有统计学意义(P<0.05)。并且,高乳酸清除率组死亡率也明显低于低乳酸清除率组(P<0.01)。结论乳酸清除率联合APACHEⅡ评分可用于ARDS患者预后的评估。     

参附注射液对重症肺炎患者血乳酸及预后的影响

目的：对参附注射液治疗重症肺炎患者血乳酸及预后的效果进行研究。方法我院将2013年3月至2016年3月收治的60例重症肺炎患者进行分组为对照组与观察组,各30例,其中对照组患者给予机械通气、输液、消炎、化痰、营养支持等常规治疗,观察组则给予重症肺炎患者常规治疗与参附注射液的联合治疗。观察两组重症肺炎患者在入院后6h、24h、第三天的体内血乳酸含量,ICU病房停留时间和预后情况。结果观察组重症肺炎患者入院后24h、第三天的体内血乳酸含量、ICU病房停留时间和预后情况均优于对照组（P<0.05）,两组患者入院6h后血乳酸水平无统计学差异（P>0.05）。结论对重症肺炎患者静注参附注射液能够有效的降低患者体内的血乳酸水平,不仅降低了患者的死亡概率,还改善了患者的预后情况,效果显著,值得在临床上推广实施。     

乳酸早期清除率对重症感染患者预后的评估分析

目的探讨乳酸早期清除率对重症感染患者预后评估的临床意义。方法 50例重症感染患者进行分组,其中生存患者为生存组,死亡患者为病死组。其中生存组患者23例,病死组患者27例。两组患者入院时进行APACHEⅡ评分。测定所选患者的血液乳酸水平（测定患者入院时的血液乳酸水平和入院后6 h的乳酸水平）。结果生存组和病死组的APACHEⅡ评分比较,差异无统计学意义（P〉0.05）;病死组入院时血乳酸水平高于生存组,差异有统计学意义（P〈0.05）;病死组入院6 h的血乳酸水平高于生存组,差异有统计学意义（P〈0.05）;生存组入院6 h的血乳酸清除率高于病死组,差异有统计学意义（P〈0.05）。高乳酸清除率患者的病死率低于低乳酸清除率患者,差异有统计学意义（P〈0.05）。结论监测血乳酸水平并计算乳酸早期清除率有助于评估重症监护室重症感染患者的预后,较高的血乳酸清除率重症患者的生存率较高。     

血乳酸监测对感染性休克预后判断的意义

目的探讨动态监测血乳酸浓度对感染性休克预后评价的意义。方法收集我院重症医学科诊治的50例感染性休克患者,分为存活组28例,死亡组22例。测定患者入院时、经积极液体复苏后6 h、24 h、48 h血乳酸值并计算血乳酸清除率,24 h进行急性生理与慢性健康评分Ⅱ(APACHEⅡ)。分析2组血乳酸浓度、6 h乳酸清除率、APACHEⅡ评分的差异及APACHEⅡ评分与血乳酸相关性。结果死亡组入院0 h、6 h、24 h、48 h血乳酸浓度及APACHEⅡ评分高于存活组,差异有统计学意义(P<0.05,P<0.01),6 h乳酸清除率低于存活组(P<0.05)。APACHEⅡ评分与血乳酸呈正相关(r=0.621,P<0.01)。结论血乳酸浓度持续增高或6 h乳酸清除率低的感染性休克患者预后差,动态监测血乳酸浓度及早期乳酸清除率能很好判断感染性休克预后。     

多巴胺、去甲肾上腺素对重症感染性休克患者血乳酸清除率及死亡率的影响

目的探讨多巴胺、去甲肾上腺素对于重症感染性休克患者血乳酸清除率及死亡率的影响。方法选取重症感染性休克患者84例,采用随机数字表法分为多巴胺组(42例)、去甲肾上腺素组(42例),分别给予多巴胺8²0μg/(kg·min)和去甲肾上腺素0.0520μg/(kg·min)和去甲肾上腺素0.05².0μg/(kg·min)微量泵入;比较两组患者临床死亡率、治疗前后心率(HR)、平均动脉压(MAP)、血乳酸水平及24 h乳酸清除率等。结果多巴胺组和去甲肾上腺素组患者临床死亡率分别为30.95%、16.67%,两组比较差异有统计学意义(P<0.05);多巴胺组患者治疗前后的HR分别为(123.15±18.41)、(110.12±17.05)次/min,MAP分别为(72.25±9.36)、(73.72±9.84)mmHg;去甲肾上腺素组患者治疗前后的HR分别为(120.38±18.20)、(108.69±16.52)次/min,MAP分别为(73.01±9.40)、(74.28±9.96)mmHg。两组患者治疗后HR水平均显著降低,差异有统计学意义(P<0.05);两组患者治疗前后MAP水平比较差异无统计学意义(P>0.05);多巴胺组和去甲肾上腺素组患者24 h乳酸清除率分别为45.82%±6.07%、67.15%±8.24%,两组比较差异有统计学意义(P<0.05)。多巴胺组患者治疗前后血乳酸分别为(5.10±0.88)、(3.19±0.65)mmol/L;去甲肾上腺素组分别为(3.29±0.65)、(2.11±0.43)mmol/L。两组患者治疗前血乳酸水平比较差异无统计学意义(P>0.05);治疗后血乳酸水平均显著降低,且去甲肾上腺素组患者血乳酸水平下降程度高于多巴胺组,差异有统计学意义(P<0.05)。结论相较于多巴胺,去甲肾上腺素用于重症感染性休克患者可有效减慢心率,提高血乳酸清除率,降低血乳酸水平及死亡率。     

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.