重症监护室儿童遗传代谢病死亡13例临床分析

目的开展遗传代谢病在儿童重症监护病房（PICU）高危儿童中的筛查,了解危重患儿遗传性代谢病的发病种类及发病率。方法利用串联质谱（MS/MS）技术对在我院PICU住院不明原因的18例可疑代谢病患儿的血液样本进行MS/MS筛查。结果 18例患儿均为阳性：其中甲基丙二酸血症2例,丙酸血症1例,肉碱棕榈酰转移酶缺乏Ⅰ型1例,长链酰基辅酶A脱氢酶缺乏症1例,中链酰基辅酶A脱氢酶缺乏症1例,枫糖尿症1例,短链酰基辅酶A脱氢酶缺乏症1例,戊二酸血症Ⅰ型2例,异戊酸血症1例,同型胱氨酸尿症2例,肉碱缺乏症1例,酪氨酸血症1例,精氨酸琥珀酸尿症1例,瓜氨酸血症1例,精氨酸血症1例。涉及遗传代谢病15种。住院死亡或放弃治疗后死亡13例。结论 MS/MS技术可用于检测遗传性代谢病,对病因不明危重或死亡患儿的明确诊断有重要价值。     

重症监护室儿童遗传代谢病死亡13例临床分析

目的 开展遗传代谢病在儿童重症监护病房(PICU)高危儿童中的筛查,了解危重患儿遗传性代谢病的发病种类及发病率.方法 利用串联质谱(MS/MS)技术对在我院PICU住院不明原因的18例可疑代谢病患儿的血液样本进行MS/MS筛查.结果 18例患儿均为阳性:其中甲基丙二酸血症2例,丙酸血症1例,肉碱棕榈酰转移酶缺乏Ⅰ型1例,长链酰基辅酶A脱氢酶缺乏症1例,中链酰基辅酶A脱氢酶缺乏症1例,枫糖尿症1例,短链酰基辅酶A脱氢酶缺乏症1例,戊二酸血症Ⅰ型2例,异戊酸血症1例,同型胱氨酸尿症2例,肉碱缺乏症1例,酪氨酸血症1例,精氨酸琥珀酸尿症1例,瓜氨酸血症1例,精氨酸血症1例.涉及遗传代谢病15种.住院死亡或放弃治疗后死亡13例.结论 MS/MS技术可用于检测遗传性代谢病,对病因不明危重或死亡患儿的明确诊断有重要价值.     

甲基丙二酸血症9例回顾分析

目的 提高对儿童遗传代谢病诊断及治疗的认识.方法 应用气相色谱／质谱联用仪(GU/MS)对9例确诊甲基丙二酸血症(MMA)给予药物和控制饮食治疗.结果 1例在确诊前死亡,8例确诊患儿给予维生素B12和低蛋白饮食.随访3个月-12个月,1例症状消失,6例症状显著好转,1例无效死亡.结论 GC/MS尿有机酸分析是甲...     

东莞地区串联质谱技术筛查遗传代谢病患儿的初步应用

目的探讨串联质谱技术在东莞地区筛查先天性遗传代谢病的应用价值,为先天性遗传代谢病的临床诊断提供实验室依据。方法采用干血滴滤纸片法将患儿血液标本滴于采血纸片形成血斑,自然风干后应用API3200串联质谱仪进行检测。结果在1206例遗传代谢病高危儿的检测中,筛查出高瓜氨酸血症12例,Citrin缺陷病4例,丙酸血症4例,戊二酸血症2例,高精氨酸血症3例,脂肪酸代谢异常6例(其中短链酰基辅酶A脱氢酶缺乏症2例,中短链酰基辅酶A脱氢酶缺乏症1例,极长链酰基辅酶A脱氢酶缺乏症1例,肉碱棕榈酰转移酶-Ⅱ缺乏症1例多种酰基辅酶A脱氢酶缺乏症1例),多种氨基酸代谢异常症2例,尿素循环障碍症2例,同型半胱氨酸尿症1例,高甲硫胺酸血症5例,苯丙酮尿症5例,高苯丙氨酸血症5例。结论串联质谱技术具有高效快捷并可实现标准化自动化操作等优点,在先天性遗传代谢病早期诊断方面有重要应用价值。     

苯丙酮尿症筛查检测方法进展

苯丙酮尿症（phenylketonuria，PKU）是一种常染色体隐性遗传氨基酸代谢病，为一种较常见的遗传性代谢病，发病率约为1／10000，它是由于患儿肝脏内苯丙氨酸羟化酶（phenylalanine hydroxylase，PHA）先天性缺陷或突变，四氢生物蝶呤（tetrahydrobiopterin，BH4）辅因子的合成和BH4的再循环障碍，导致苯丙氨酸（phenylalanine，Phe）代谢障碍，     

新生儿先天性甲状腺功能减低症和苯丙酮尿症筛查结果分析

先天性甲状腺功能减低症（CH）是最常见的内分泌疾病之一，以往亦称为呆小病或克汀病。可因甲状腺发育不良、异位以及先天酶缺陷、下丘脑-垂体病变，碘缺乏等引起。通过新生儿疾病筛查获得早期诊断和治疗可以防止体格和智能发育障碍。苯丙酮尿症（PKU）是较常见的遗传代谢病，导致患儿严重的智能障碍。若能早期发现，限制患儿苯丙氨酸（phe）的摄入员，可使患儿正常生长发育。     

新生儿甲基丙二酸血症3例临床分析

甲基丙二酸血症（MMA）是有机酸血症中最常见的一种．为常染色体隐性遗传,现已发现8个亚型。本病临床表现各异且特异性不强,误诊率较高。2002年大连市儿童医院开展了GC／MS检测即气相色谱／质谱串联技术,逐渐对遗传代谢疾病有了一些认识。MMA还应注意与败血症、颅内感染等鉴别,尽早进行尿筛查以达到早诊断、早治疗的目的,重视产前诊断。     

伴脊髓损伤的晚发型戊二酸尿症Ⅱ型合并家族性高胆固醇血症一例报告#br#

摘要:戊二酸尿症Ⅱ型是一种影响脂肪酸、氨基酸和胆碱代谢的常染色体隐性遗传病,是引起脂质沉积病的重要病因。该病儿童少见,临床医生认识不足,易误诊、漏诊。伴腹痛、脊髓损伤的晚发型戊二酸尿症Ⅱ型更为罕见。本文对1例伴腹痛、脊髓损伤的晚发型戊二酸尿症Ⅱ型合并家族性高胆固醇血症的患儿进行回顾性分析。早期进行血脂、尿有机酸和基因检测对患儿的诊治及提高生活质量有重要意义。     

新生儿甲基丙二酸尿症七例报告并12例文献复习

目的探讨新生儿甲基丙二酸尿症的临床特点及诊治经验。方法分析2009年1月-2012年10月我院收治的7例新生儿甲基丙二酸尿症资料,并结合近7年来已报道的12例进行文献复习。结果19例患儿中男11例,女8例;发病年龄24 h～27 d;主要临床表现为喂养困难、呼吸困难、抽搐等;常规实验室检查表现为代谢性酸中毒、高氨血症等;气相色谱-质谱法(GC/MS)分析尿有机酸显示19例患儿尿甲基丙二酸浓度均明显高于正常;10例死亡,6例随访2～8个月发育显著迟缓,3例放弃治疗失访。结论甲基丙二酸尿症新生儿期临床表现复杂,早期常出现喂养困难等非特异性症状,常规检查缺乏特异性,致死率及致残率很高,对疑似病例应及时进行血、尿氨基酸检测。     

新生儿有机酸血症22例误诊学分析

目的探讨有机酸血症的临床特点,减少误诊。方法对2008年1月至2012年12月在我院新生儿科住院的22例应用气相色谱-质谱联用有机酸分析法（GC-MS）确诊的有机酸血症患儿做回顾性分析,总结临床特点,减少临床误诊发生,比较早期检查对患儿治疗效果的影响。结果 22例患儿均应用气相色谱-质谱联用有机酸分析法（GC-MS）确诊为有机酸血症,其中甲基丙二酸血症14例,丙酸血症6例,戊二酸血症2例;对可疑有机酸尿症的患儿,应早期做气相色谱-质谱联用有机酸分析法（GC-MS）检查,早期治疗临床治愈率较高。结论新生儿有机酸血症表现复杂,临床症状不典型,极易误诊,且病死率高。应早发现、早诊断、早治疗,减少误诊率、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.     

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.