血管内超声对冠脉内支架植入效果的评价

目的应用血管内超声(IVUS)了解冠脉内支架植入的满意程度及其影响因素.方法30例冠心病患者行冠脉内支架植入,IVUS测量植入前狭窄段血管直径和截面积(CSA)、斑块性质,植入后最小支架CSA,远端参照血管段管腔CSA.结果14/30例(47%)未达到理想的支架植入术后IVUS诊断标准,表现为支架扩张不全或与血管壁间有明显空隙.最小支架CSA示狭窄钙化Ⅱ～Ⅲ度的8例(4.76±1.88mm2)明显小于钙化≤Ⅰ度的22例(7.69±3.17mm2),P＜0.01.结论冠脉内支架植入术中的应用IVUS,有助于选择支架植入的适应证和合适的支架,评价支架扩张是否满意,以达到最佳的支架植入效果.     

应用IVUS比较DEB和第二代DES治疗冠脉支架内再狭窄的疗效

目的 应用血管内超声比较药物洗脱球囊和第二代药物洗脱支架治疗冠脉支架内再狭窄的疗效.方法 纳入2018年7月至2020年7月在我院住院,年龄在18～80岁之间,经冠脉造影诊断为DES-ISR的患者.根据手术方式的不同,分为DEB组和第二代DES植入组.术后12个月复查冠脉造影及血管内超声,比较两组MACE发生率、靶病变重建率、原病变处IVUS再狭窄率、最小管腔面积、新生血管内膜增生面积的差异.结果 术后1年DEB组新生内膜增生面积较第二代DES组小,两组MACE发生率、靶病变重建率、IVUS再狭窄率、最小管腔面积相当.结论 DEB较第二代DES能更有效抑制DES术后冠脉内膜增生,其在DES-ISR患者中的远期疗效与第二代DES植入相当.     

冠状动脉内支架植入术的临床总结

目的 总结冠脉内支架植入术的经验及疗效。方法 稳定型心绞痛（SAP）、不稳定型心绞痛（UAP）、急性心肌梗死（AMI）和陈旧性心肌梗死（OMI）患者共95例,经冠状动脉造影（CAG）证实有106支血管115处病变,其中A型19处,B1型37处,B2型31处,C型28处,植入支架7种121只,所有病人均于术前术后常规口服阿斯匹林和抵克力得,对于部分病人酌情选用抗凝治疗。结果 121只支架全部植入成功,血管平均直径狭窄程度由术前75%-100%降低到术后-10%-10%。术后随访5-9个月复发心绞痛10例,7例经CAG证实为支架内再狭窄,无支架内急性或亚急性血栓形成。结论 冠脉内支架术治疗冠心病安全有效。     

药物洗脱支架植入后冠脉支架内再狭窄的影响因素分析

目的 探讨药物洗脱支架植入后冠状动脉(冠脉)支架内再狭窄的影响因素.方法 182例置入药物洗脱支架的患者,根据是否发生冠脉支架内再狭窄分为再狭窄组(32例)和未狭窄组(150例).分析冠脉支架内再狭窄的影响因素.结果 再狭窄组与未狭窄组的年龄、体质量指数(BMI)、性别、高血压、饮酒史、肾小球滤过率(eGFR)、糖化血...     

药物洗脱支架在临床的应用

冠心病介入治疗(PCI)用金属普通支架取代球囊扩张,使支架内再狭窄(ISR)近50%下降到20%～30%;药物涂层支架,在防止支架内再狭窄及再次血运重建术(Repeat revasculazation)明显优于金属普通支架.近年药物洗脱支架(DES drug electing stent)问世,使支架内再狭窄率下降至10%以下,成为介入冠心病学发展最快的领域之一,被称为第三个里程碑.我国从2002年开始应用药物洗脱支架,主要有美国强生公司Cypher支架和美国波斯顿公司Taxus支架及国内微创公司的FireBird药物洗脱支架.     

冠脉支架内再狭窄的发生机制及影响因素分析

冠状动脉内支架置入术是Jaceques针对经皮冠脉腔内成形术(PTCA)的高狭窄率所提出的解决方案,目前,该术式已成为冠心病常规介入治疗的主要手段,适应范围广,对治疗复杂性冠脉病变具有重要意义.但随着冠脉支架置入术病例的随访观察例数及时间的增加,以及虚拟组织学IVUS技术等医学影像学技术的应用,冠脉支架内再狭窄(IsR)问题也逐渐暴露出来.     

两种药物洗脱支架治疗冠状动脉长病变疗效比较

目的 评价冠状动脉(冠脉)长病变植入两种药物洗脱支架(DES)的疗效.方法 回顾性分析112例冠脉长病变(＞20 mm)患者,植入雷帕霉素DES(SES,64处)或紫杉醇DES(PES,62处),术后1、6、12、24个月临床随访及冠脉造影复查支架内血栓及管腔径丢失情况.结果 术后1、6个月支架内血栓发生率PES组明显高于SES组(P＜0.05),12、24个月支架内血栓发生率两组已无差异(P＞0.05), 但支架内管腔径丢失PES组较SES组更明显(P＜0.01).结论 冠脉长病变DES植入,SES较PES能够减少支架内血栓及管腔径丢失发生率.     

罗格列酮对2型糖尿病患者冠脉支架内再狭窄的预防作用

目的 探讨罗格列酮对2型糖尿病患者行冠脉成形及支架植入术后支架内再狭窄的预防作用。方法 选择行冠脉成形及支架植入术的2型糖尿病患者60例。在原有降糖药物治疗的基础上，研究组(n=31)加服罗格列酮；对照组(n=29)用药方案不变。术后随访6mo，观察患者死亡、急性心肌梗死及再次血管重建术等心血管事件的发生情况，在随访结束时行活动平板检查，结果 阳性的再次行选择性冠脉造影术。结果2组患者随访期间均无死亡、急性心肌梗死等心血管事件发生。6mo内研究组9例再次心绞痛发作，5例活动平板试验阳性，其中5例(16．1％)冠脉支架内再狭窄；而对照组18例再次心绞痛发作，其中15例活动平板阳性，15例(48．4％)冠脉造影术证实支架内再狭窄，2组再狭窄对比有显著差异(P=0．013)。结论 对于2型糖尿病合并冠心病行冠脉成形及支架植入术患者，罗格列酮能有效降低支架内再狭窄。     

高压球囊后扩张对冠脉植入雷帕霉素药物洗脱支架再狭窄的影响分析

目的 探讨高压球囊后扩张对冠脉植入雷帕霉素药物洗脱支架再狭窄的影响.方法 选择我科住院已植入雷帕霉素药物洗脱支架(SES)并1年后复查冠脉造影患者379例,根据有无高压球囊后扩张分为无后扩张组235例和有后扩张组144例,比较两组之间临床特征的差异.结果 两组患者基础临床特征相似,冠状动脉病变中钙化、血栓、闭塞及是否串联支架及冠脉病变支数的差异无统计学意义(P＞0.05),而支架内再狭窄率差异具有统计学意义(P＜0.05).结论 支架内后扩张能减少支架再狭窄率.     

IVUS指导下PTCRA+PTCSI治疗严重冠脉钙化13例

目的 探讨血管内超声IVUS指导下PTCRA+PTCSI治疗严重冠脉钙化病变的有效性及安全性。方法 连续收集2021年4月-2023年5月收住曲靖市第一人民医院,IVUS指导下行RA+支架植入共13例患者的临床资料、手术信息、疗效和安全性指标。结果 13例患者的手术即刻成功率100%,病变冠脉最小管径、最小管腔面积均比术前改善(1.94±0.25mm VS 3.24±0.49mm; 2.74±0.47mm² VS 8.10±1.47mm²;P<0.05)。1例患者发生休克及心衰,1例患者术前行临时起搏保护,无急性支架内血栓、支架内再狭窄、穿刺部位血肿。结论 IVUS指导下RA联合支架植入治疗严重冠脉钙化病变可显著提高PCI疗法的有效性及安全性。     

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.