肝硬化自发性细菌性腹膜炎腹水感染的细菌分布及耐药性分析

目的探讨肝硬化自发性细菌性腹膜炎腹水感染的细菌分布及耐药性。方法 2012年3月至2013年3月期间,本院诊治的30例肝硬化自发性细菌性腹膜炎腹水患者,进行腹水病原菌培养、药敏试验,分析其结果。结果 30例肝硬化自发性细菌性腹膜炎腹水患者中,共培养15株阳性病原菌（50.0%）,其中9例大肠埃希菌（60.0%）、2例肺炎克雷伯杆菌（13.3%）、4例其他杆菌（26.7%）。15株阳性病原菌的药敏试验得到14株耐药菌（93.3%）,其中12株革兰阴性菌、2株革兰阳性菌。结论对于肝硬化自发性细菌性腹膜炎腹水感染患者根据病原菌及其耐药性,合理选择抗菌药物。     

乳果糖联合培菲康对肝硬化自发性腹膜炎血清和腹水TNF-α、IL-6水平的影响

目的探讨乳果糖联合培菲康对肝硬化自发性细菌性腹膜炎血清及腹水TNF-α、IL-6水平的影响。方法选择自发性细菌性腹膜炎患者120例,随机分为对照组（n=60）和治疗组（n=60）,另外选择健康体检者30例为健康对照组。所有患者均于治疗前、治疗后7 d测定血清及腹水TNF-α、IL-6水平,并统计患者的病死率。结果治疗组和对照组患者血清及腹水TNF-α、IL-6水平显著高于健康对照组（P〈0.05）;治疗后相比,治疗组血清及腹水TNF-α、IL-6水平较对照组明显下降（P〈0.05）;治疗组的病死率明显低于对照组。结论乳果糖联合培菲康可以降低肝硬化自发性腹膜炎患者血清及腹水TNF-α、IL-6水平,改善患者预后。     

肝硬化并发自发性腹膜炎腹水培养的病原菌耐药性分析

目的探讨肝硬化并发自发性细菌性腹膜炎腹水培养的病原菌耐药情况。方法选取我院2010年1月至2011年1月收治的肝硬化并发自发性腹膜炎患者腹水培养结果170例抽取腹水进行病原菌培养并进行药敏试验。结果本组采集的170例腹水,经培养分离得到病原菌168株。其中,革兰阴性菌有112株(66%),这当中又以大肠埃希菌最多;革兰阳性菌54株(32.1%),这当中以金黄色葡萄球菌最多。革兰阴性菌对三代头孢及喹诺酮类药物均产生耐药;而革兰阳性菌则对三代头孢发生耐药。结论正确检验出肝硬化并发自发性腹膜炎腹水病原菌的情况,有助于早期科学治疗,提高患者的预后。     

乙型肝炎肝硬化并发腹膜炎患者血清及腹腔积液TNF-α、IL-8、IL-18水平临床意义的探讨

目的：探讨乙型肝炎肝硬化并发自发性腹膜炎（SBP）患者血清和腹腔积液中肿瘤坏死因子（TNF-α）、白细胞介素-8（IL-8）、白细胞介素-18（IL-18）的水平,及其在疾病发生发展中的作用。方法：应用双单克隆抗体夹心法酶联免疫吸附测定（ELISA）法检测48例乙型肝炎肝硬化并发腹腔积液患者血清和腹腔积液中TNF-α、IL-8、IL-18的水平,其中肝炎肝硬化并发SBP患者24例,肝硬化腹腔积液未合并自发性腹膜炎患者24例,并与24例正常人比较。结果：乙型肝炎肝硬化合并SBP患者的血清和腹腔积液中的TNF-α、IL-8、IL-18的水平明显高于未合并SBP者及对照组,未合并SBP者亦明显高于对照组（P〈0.05）。结论：乙型肝炎后肝硬化并发SBP患者血清和腹腔积液中的TNF-α、IL-8、IL-18明显升高,TNF-α、IL-8、IL-18参与了肝硬化腹腔积液并发SBP的发生与发展,检测乙型肝炎后肝硬化自发性腹膜炎患者血清及腹腔积液的TNF-α、IL-8、IL-18水平对SBP的早期诊断有重要的临床意义。     

肝硬化自发性腹膜炎腹水的病原菌及耐药性探讨

目的分析肝硬化自发性腹膜炎腹水的病原菌及耐药性。方法回顾性分析本院收治的70例肝硬化自发性细菌性腹膜炎腹水患者的临床资料,对腹水细菌培养结果及药物敏感性结果进行分析。结果在本组资料中,革兰阴性杆菌52例,占74.3%,大肠埃希菌32例,占45.7%,革兰阳性菌对万古霉素比较敏感,革兰阴性菌对亚胺培南和阿米卡星敏感性较高,对其他抗生素敏感性较差。结论肝硬化自发性腹膜炎腹水要尽早进行腹水培养,结合临床症状,根据药敏结果合理选择抗生素。     

降钙素原对肝硬化并发自发性腹膜炎的诊断价值

目的：探讨降钙素原水平在诊断肝硬化并发自发性腹膜炎中的价值。方法收集2010年1月～2014年5月在北京大学首钢医院诊断的96例肝硬化腹水患者的临床和实验室检查资料,分析血清和腹水钙素原水平与自发性腹膜炎的相关性。结果31例自发性腹膜炎患者的血清和腹水降钙素原水平均明显高于65例无自发性腹膜炎患者,差异有统计学意义（P〈0.05）;血清和腹水降钙素原诊断自发性腹膜炎的灵敏度分别为90.3%和96.8%。结论血清和腹水降钙素原水平对肝硬化并发自发性腹膜炎具有良好的诊断价值。     

肝硬化并自发性腹膜炎腹水培养的病原菌及耐药性分析

目的探析肝硬化并自发性腹膜炎腹水培养的病原菌及耐药性。方法选择130例肝硬化并自发性腹膜炎腹水患者的临床资料展开回顾性分析,将患者的腹水病原菌行病原菌培养,并通过药敏实验,对病原菌的耐药性展开分析。结果腹水病原菌培养阳性率为19.23%(25/130),共检测出25株细菌。25株细菌中,革兰阳性菌占32.00%(8/25),革兰阴性菌占56.00%(14/25),真菌占12.00%(3/25)。革兰阳性菌中主要为表皮葡萄球菌,对三代和四代头孢菌类抗生素具有较低的耐药性,而对青霉素类抗生素的耐药性较高。革兰阴性菌中主要为肺炎克雷伯菌与大肠埃希菌,其对头孢哌酮舒巴坦、阿米卡星的耐药性较低,但对三代头孢菌素类药物、氨苄青霉素、青霉素类阿莫西林等抗生素的耐药性较高。结论抽取肝硬化并自发性腹膜炎腹水患者的病原菌实施培养,能够更加充分地认识致病菌,掌握其耐药性,为患者选择抗菌治疗药物提供借鉴。     

血清降钙素原与血清淀粉样蛋白A诊断肝硬化腹水感染的研究

目的探讨降钙素原(PCT)和淀粉样蛋白A(SAA)检测在诊断肝硬化腹水感染中的价值。方法 100例肝硬化伴腹水患者,根据腹水有无感染分为感染组(38例)和非感染组(62例)。比较两组患者血清PCT、SAA水平;感染组不同病原菌感染患者血清PCT、SAA水平;血清PCT、SAA水平对肝硬化腹水感染的诊断效能。结果感染组患者血清PCT、SAA水平分别为(5.22±1.21)ng/ml、(35.49±8.11)mg/L,均明显高于非感染组的(0.17±0.19)ng/ml、(4.18±0.25)mg/L,差异有统计学意义(P<0.05)。革兰阴性菌感染患者血清PCT水平高于革兰阳性菌感染患者,差异有统计学意义(P<0.05);不同病原菌感染患者血清SAA水平比较差异无统计学意义(P>0.05)。血清PCT、SAA诊断肝硬化腹水感染的灵敏度、特异度、准确率均>80%,血清PCT诊断肝硬化腹水感染的灵敏度、特异度、准确率稍高于血清SAA,但差异无统计学意义(P>0.05)。结论血清PCT和SAA均可作为判断肝硬化腹水患者早期感染的重要指标,二者联合检测对肝硬化腹水感染的早期诊治具有重要的临床应用价值。     

早期血清降钙素原与细菌性血流感染病原菌相关性研究

目的：探讨早期血清降钙素原（PCT）水平与细菌性血流感染患者病原菌种类之间的相关性;同时,试图找到适宜的PCT临界值,为细菌性血流感染起始抗感染经验治疗方案的制定提供依据,减少不必要的广谱、超强、联合用药。方法：抽取某院2014年5月-2016年3月203例怀疑细菌性血流感染且在血培养前后<12 h行血清降钙素原（PCT）检查的患者,按照革兰阳性菌和革兰阴性菌分组记录患者血清降钙素原（PCT）,比较2组PCT水平的差异,用受试工作者曲线（ROC曲线）分析PCT在鉴别革兰阳性菌和革兰阴性菌血流感染的作用。结果：革兰阴性菌血流感染与革兰阳性菌血流感染早期PCT水平存在显著性差异（P<0.05）,且革兰阴性菌血流感染早期PCT明显高于阳性菌,中位数分别为3.92 ng·mL^-1和0.62 ng·mL^-1;2组患者受试工作者曲线（ROC曲线）显示PCT作为鉴别革兰阴性菌和革兰阳性菌血流感染有一定的意义（AUC为0.70,P<0.05）;以初次血清PCT 1.81 ng·mL^-1作为临界值时,对革兰阴性菌所致血流感染阳性预测值敏感性为62.3%,特异性为71.4%。结论：革兰阴性菌血流感染患者早期血清降钙素原（PCT）高于革兰阳性菌;PCT对革兰阴性菌和革兰阳性菌所致细菌性血流感染有一定的鉴别作用;在PCT高于1.81 ng·mL^-1时,细菌性血流感染革兰阴性菌可能性较革兰阳性菌大;可结合初次PCT结果做出病原体的初步判断,为选择适宜的起始抗感染治疗方案提供帮助。     

肝硬化腹膜炎患者血清及腹水降钙素原水平检测的意义

目的探讨肝硬化腹膜炎患者血清及腹水降钙素原(PCT)水平及其临床意义。方法选择71例肝硬化腹水患者,其中伴自发性细菌性腹膜炎(SBP)49例,非SBP22例,采用免疫透射比浊法测定其血清及腹水中PCT的含量,并与正常对照组比较。结果伴SBP组及非SBP组患者血清PCT水平明显高于正常对照组(P<0.01);伴SBP组血清PCT水平明显高于非SBP组(P<0.01);伴SBP组腹水PCT水平明显高于非SBP组(P<0.01);30例治疗有效的SBP患者血清及腹水PCT水平均明显下降,与其治疗前血清及腹水PCT水平比较有显著性差异(P<0.01)。结论检测血清及腹水降钙素原水平对于肝硬化腹膜炎的早期诊断及判断预后有一定临床价值。     

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.     

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.