32例肺缺血型复杂先心病肺循血流来源的临床分析

肺缺血型复杂先天性心脏病是指伴有肺动脉狭窄或闭锁的紫绀型复杂先心病[1],其共同的病理生理表现是肺循环血流量明显减少。肺血来源变异较大,常伴有动脉导管未闭(PDA)和/或主动脉至肺动脉侧支动脉血管(体-肺侧支APCAs)参与肺部供血。本文对32例肺缺血型复杂先心病肺血来源进行     

二维及彩色多普勒超声心动图诊断先天性心脏病99例

自2003年1月我科应用二维及彩色多普勒超声心动图诊断先天性心脏病136例,主要包括室间隔缺损、房间隔缺损、动脉导管未闭、肺动脉瓣狭窄及法乐氏四联征等13种先天性心脏病,其中99例经手术证实,现报告如下。     

儿童先天性心脏病介入治疗及护理

儿童先天性心脏病介入治疗分为两大类:一类系球囊扩张为解除血管及瓣膜狭窄,如主动脉瓣狭窄(AS)、肺动脉瓣狭窄(PS)、主动脉缩窄(COA)等;另一类为利用各种栓子堵闭不应有的缺损,如房间隔缺损(ASD)、动脉导管未闭(PDA)等。由于导管介入性治疗不仅可避免开胸手术的风险及创伤,而且住院时间短,成为很有前途的非手术治疗方法,康复护理也成为人们关注的一个重要问题,现就其目前治疗及康复护理进展作如下阐述。     

先天性冠状动脉-右室瘘2例报告

例1,男性,23岁。1981年1月住某部医院,诊为先天性心脏病动脉导管未闭,并在全麻下剖胸探查未发现动脉导管未闭存在,疑为主动脉窦瘤破袭而转入我院。心电图示广泛导联T波改变。升主动脉造影示左冠状动脉-右室瘘。同年2月在全麻下经正中胸骨劈开切口,剪开心包后见左冠状动脉的前降支增粗扭曲,在前降支的前间隔支处触及震颤,将该支阻断试验后震颤消失,以带垫片缝线作前间隔支下褥式缝合.封闭瘘口,震颤消失,术后两周痊愈出院。     

二维-脉冲多普勒超声心动图诊断先天性心脏病

本文报道二维-脉冲多普勒超声心动图(2DE-PDE)诊断常见先天性心脏病48例。其中房间隔缺损15例,室间隔缺损15例,动脉导管未闭9例,肺动脉瓣狭窄2例,法乐四联症5例和法乐三联症2例。手术结果表明2DE-PDE是一项敏感而特异的非侵入性诊断方法。本文就诊断和鉴别诊断问题进行了讨论。     

婴幼儿主动脉缩窄外科治疗研究进展

主动脉缩窄（coaretation of aorta,CoA）指胸降主动脉先天性局限性狭窄,狭窄区域一般在动脉导管和主动脉连接处[1]。严重的CoA患者主动脉狭窄部位管腔可接近闭锁,但主动脉壁是延续的。CoA发病率在西方国家约占先天性心脏病的5%～8%,我国发病率约占先天性心脏病的3%～5%。病变部位通常在动脉导管附近,常伴动脉导管未闭（patent ductus arteriosus,PDA）[2-3],可伴发其他心脏畸形,如室间隔缺损（ventricular septaldefect,VSD）、房间隔缺损、右室双出口等。CoA分为单纯型和复杂型,单纯型指仅伴或不伴PDA的CoA。     

心脏超声左锁骨上窝切面在先天性心脏病动脉导管未闭介入术中的应用

超声心动图已成为先天性心脏病动脉导管未闭（Patent duetus ateriosus,PDA）常规可信赖的检查手段。但随着经皮心导管PDA封堵术的开展。对PDA的超声检测值要求更为准确,血管造影是测量未闭导管内径、长度、分型及所处解剖关系的金标准。     

复合型先天性心脏病的介入治疗

目的研究复合型先天性心脏病经导管介入治疗策略并评价其疗效。方法共6例适合经导管介入治疗的复合型先天性心脏病,复合类型为：房间隔缺损（ASD）伴动脉导管未闭（PDA）5例,VSD伴PDA1例。经导管介入治疗原则为：先行PDA封堵,再行ASD或VSD封堵。术后第1个月、3个月、6个月、1年分别行经胸超声心动图、X线及心电图检查,以后每年定期随访。结果6例复合型先天性心脏病经导管介入治疗均获成功。术后即刻均无残余分流,无任何并发症发生。结论复合型先天性心脏病经导管介入治疗较单纯型复杂,但如指征掌握恰当,治疗策略合理,操作规范,同样可获良好的治疗效果。     

动脉导管未闭的诊断与治疗进展

动脉导管未闭（PDA）是一种常见的先天性心血管疾病。动脉导管连接肺动脉总干与降主动脉，是胎儿期血液循环的主要渠道。出生后一般在数月内因废用而闭塞，如1岁后仍未完全闭塞，即为动脉导管未闭。它可单独存在，也可合并其他心内畸形，大约占先天性心脏病的7％～10％。传统的诊断和治疗方法多用二维超声诊断与外科手术治疗，其漏诊率高，手术并发症多。20世纪80年代出现的彩色多普勒、经食管超声心动图和负荷超声心动图，90年代的造影超声心动图和三维超声心动图，90年代中后期出现并迅速发展的组织多普勒成像（tissue Doppler image，TDI），以及上世纪80年代以后介入诊断与治疗迅速发展，为动脉导管未闭的诊断和治疗带来了广阔的应用前景。     

动脉导管末闭合并重度肺动脉高压1例的介入治疗报告

动脉导管末闭（PDA）是一种常见的先天性心脏病．发病率约占先心病的10-15％，男女比例约1：3。病情视分流量大小而不同，分流量大者易引起肺动脉高压及心衰。介入治疗为动脉导管末闭患者提供了更为安全有效的治疗方法。现报道1例动脉导管末闭合并重度肺动脉高压患者的介入治疗情况。     

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.     

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.