医用生物蛋白胶在心脏外科手术创面应用的止血效果

目的探讨医用生物蛋白胶在心脏外科手术创面应用的止血效果。方法183例心脏手术患者随机分为试验组9l例、对照组92例，观察两组术后24h引流量、总引流量及拔管时间。结果试验组术后24h引流量、总引流量和拔管时间均明显少于对照组（P〈0．05）。结论医用生物蛋白胶可减少术后出血量，有利于患者术后康复。     

芬太尼复合罗哌卡因臂丛麻醉及术后镇痛时效的观察

目的探讨芬太尼用于臂丛麻醉的可行性。方法40例需实施臂丛神经阻滞麻醉患者，随机分为两组：对照组（Ⅰ组）与试验组（Ⅱ组）．臂丛麻醉所用局麻药相同，试验组另加芬太尼0．1mg，观察两组患者围麻醉期RR、BP、ECG、Sp02的变化和麻醉起效时间、阻滞完善时间、麻醉维持时间和术后镇痛效果。结果试验组麻醉起效时间和阻滞完善时间短于对照组（P〈0．05），试验组麻醉维持时间长于对照组（P〈0．01），术后8h、12h、24h时的疼痛评分，对照组显著高于试验组（P〈0．05）。结论复合应用芬太尼可增强罗哌卡因臂丛麻醉的效果，延长术后镇痛的时效。     

术中氧合血持续肺动脉灌注对室间隔缺损合并肺动脉高压患儿的肺保护作用

目的研究在体外循环手术中使用氧合血进行持续肺动脉灌注对合并肺动脉高压的室间隔缺损患儿的肺保护作用。方法30例室间隔缺损合并肺动脉高压的患儿，随机均分为试验组和对照组。均在体外循环下进行室间隔缺损修补手术。试验组在体外循环中采用氧合血持续肺动脉灌注，对照组未行肺动脉灌注。两组患儿在体外循环前，主动脉开放后6、12、24h时抽取动脉血3ml．采用酶联免疫吸附法（ELISA法）检测丙二醛（MDA）的水平。并抽取动脉血进行血气分析．计算体外循环前．主动脉开放后6、12、24h时的氧合指数（QI），并记录气道峰压和呼吸机辅助时间，进行统计分析。结果试验组术后12、24h的OI高于对照组（P〈0．05），试验组术后6、12h的气道峰压明显低于对照组（P〈0．05）。试验组术后呼吸机辅助时间明显低于对照组（P〈0．05）。试验组术后6、12、24h时MDA水平均低于对照组（P〈0．05）。结论氧合血持续肺动脉灌注能减轻室间隔缺损合并肺动脉高压患儿在体外循环中的肺损伤。     

左西孟旦在左心室功能低下患者不停跳冠状动脉旁路移植术中的应用

目的：探讨左西孟旦对左心室收缩功能低下患者在不停跳冠状动脉旁路移植术（CABG）中心肌保护效果。方法：本院心外科在2010年5月至2012年11月,抽取术前左室射血分数小于45％的CABG病例40例,随机分为试验组和对照组各20例,对照组在手术中开始应用多巴胺静脉维持泵入,试验组同期加用左西孟旦,初始负荷量为10ug／kg,注射时间10min,随即以0．1～0．2μg·kg-1·min-1起泵入持续23h。记录两组患者治疗后监护室滞留时间、房颤发生率、多巴胺治疗时间、30d死亡率、记录手术后前3d的床边心脏超声测量左心室射血分数（LVEF）值比较,以及手术后早期ICU即刻（0）、术后6、24、48h的肌钙蛋白I（cTnI）指标变化。结果：试验组和对照组均无死亡病例。与对照组比较,试验组患者手术后多巴胺治疗时间缩短（P〈0．05）,房颤发生率降低（P〈0．05）。术后6h和24h试验组的cTnI指标低于对照组（P〈0．05）。试验组第1、2天LVEF指标高于对照组（P〈0．05）。其余无统计学差异（P〉0．05）。结论：左西孟旦对于术前左心室收缩功能低下的CABG患者具有一定心肌保护作用。     

肾炎康复片治疗慢性肾功能衰竭的疗效观察

目的观察肾炎康复片治疗慢性肾功能衰竭的疗效。方法采用随机、对照的方法将52例慢性肾功能衰竭患者分为肾炎康复片治疗组和阿魏酸钠对照组，疗程均为2个月，观察治疗前后两组肾功能、24h尿蛋白定量、血C反应蛋白的变化。结果肾炎康复片组较阿魏酸钠组改善肾功能疗效显著（P〈0．05），尿蛋白量明显减少（P〈0．05），血C-反应蛋白明显下降（P〈0．05）。结论肾炎康复片能有效改善慢性肾功能衰竭患者的血尿素氮、肌酐值，从而减轻患者临床症状，并能减少尿蛋白排出，改善其营养状况，降低血C-反应蛋白，从而改善慢性肾衰竭的微炎症状态。     

药物雾化吸入治疗小儿呼吸道感染的临床疗效及其对血清 C-反应蛋白、中性粒细胞、白细胞水平的影响

目的：探讨药物雾化吸入治疗小儿呼吸道感染的临床疗效及共对血清C-反应蛋白（ CRP）、中性粒细胞、白细胞水平的影响。方法将204例呼吸道感染患儿随机分为试验组和对照组各102例。试验组给予盐酸氨溴索雾化吸入治疗,对照组给予盐酸氨溴索静脉注射治疗。2组患者均给予相同对症治疗,抗生素抗感染和营养支持,检测2组患者治疗前后CRP、中性粒细胞及白细胞水平,观察2组患者治疗效果,比较其差异。结果治疗前2组CRP、中性粒细胞和白细胞差异均无统计学意义（P＞0．05）。治疗后2组CRP、中性粒细胞、白细胞水平均低于治疗前,且试验组低于对照组,差异均具有统计学意义（P＞0．05）。试验组患者咳嗽消失时间、啰音消失时间和住院时间均短于对照组,差异均有统计学意义（P＜0．05）。试验组患者治疗总有效率为91．18％远高于对照组的74．51％,差异有统计学意义（P＜0．05）。结论药物雾化吸入治疗小儿呼吸道感染可显著降低患者血清CRP、中性粒细胞、白细胞水平,缩短患者治疗所需时间,提高治疗效果。     

辛伐他汀对缺血性心肌病患者尿酸、高敏C-反应蛋白及心功能的影响

目的观察辛伐他汀对缺血性心肌病心力衰竭患者血清尿酸（UA）、高敏C-反应蛋白（hsCRP）及心功能的影响。方法选择104例缺血性心肌病心力衰竭患者，其中辛伐他汀治疗组54例，对照组50例，治疗前后均检查UA、hsCRP及超声心动图检查。结果与治疗前相比，治疗6个月后每组患者UA及hs—CRP明显降低（P〈0．05）；并且与对照组相比，辛伐他汀治疗组UA及hs-CRP明显降低（P〈0．05）。与治疗前相比，治疗6个月后每组患者左心室射血分数（LVEF）及短轴缩短率（FS）明显升高（P〈0．05），左心室收缩末期内径（LVSD）明显降低（P〈0．05）；与对照组相比，辛伐他汀治疗组LVEF及Fs明显升高（P〈0．05），LVSD明显降低（P〈0．05）。结论辛伐他汀可通过降低血清尿酸、高敏C-反应蛋白水平而改善缺血性心肌病患者的心功能。     

两种途径给予尖吻蝮蛇血凝酶用于老年患者行单髋关节置换止血的临床效果观察

目的：通过两种途径使用尖吻蝮蛇血凝酶（HCA）,用于老年患者行单髋关节置换术,观察其围术期止血效果。方法择期行单髋关节置换术的患者60例随机分为试验组和对照组,每组30例。试验组于切皮前15 min,将 HCA 2 kU 溶于0．9％氯化钠溶液100 ml 中经静脉快速滴入,关闭关节腔后将 HCA 1 kU 用0．9％氯化钠溶液40 ml稀释后注入。对照组于切皮前15 min,将0．9％氯化钠溶液100 ml 中经静脉快速滴入,关闭关节腔后不注入任何药物。手术过程中对患者手术切口的长度、深度及面积进行测量、记录,并计算切口出血时间、出血量、单位面积出血量;于术前1 d、术毕即刻、术后24 h 抽取静脉血,检测血常规;记录术中出血量、术后24 h 内引流量。结果2组手术切口长度、深度及切口面积比较,差异无统计学意义（ P ＞0．05）。试验组切口平均出血量、止血时间和单位面积出血量均显著低于对照组（ P ＜0．01）。对照组术毕、术后24 h 的 RBC、Hb、HCT 与试验组相比均降低（ P ＜0．05）,术中出血量、术后24 h 引流量试验组均显著低于对照组（ P ＜0．05）。结论两种途径共同使用 HCA 可显著减少围术期出血量。     

“多切口双挂线引流术”治疗高位马蹄型肛周脓肿临床研究

目的：观察“多切口双挂线引流术”治疗高位马蹄型肛周脓肿临床疗效。方法：将80例高位马蹄型肛周脓肿患者随机分成试验组（多切口双挂线引流术组）和对照组（传统切开挂线术组）各40例。观察两组病例术后疼痛、创口愈合时间、肛门形态、肛门功能情况和随访1年内的复发情况。结果：两组在术后疼痛、创口愈合时间、术后瘢痕大小、肛门形态及复发率等方面比较,差异有统计学意义（P〈0．05）,显愈率方面比较,差异无统计学意义（P〉0．05）,试验组优于对照组。结论：“多切口双挂线引流术”治疗高位马蹄型肛周脓肿具有较好的效果,并能有效减少术后并发症及后遗症。     

术后镇痛与无术后镇痛对开胸术后应激反应的临床观察

目的观察术后镇痛与无术后镇痛对胸部手术患者应激激素的影响。方法42例肺癌手术患随机分为全麻复合硬膜外腔阻滞并术后镇痛（GEA）组和全麻（GA）无术后镇痛组，每组24例，分别测定麻醉诱导前，手术2h、术毕、术后1d的血浆去甲肾上腺素、肾上腺素、内皮素、C-反应蛋白、皮质醇的水平。结果GEA组的血浆去甲肾上腺素、内皮素和血清皮质醇，术中、术后差异无显著性（p〉0．05），与GA组比较差异有非常显著性（P〈0．01）。两组血浆去肾上腺素，术中、术后差异均无显著性（P〉0．05）。两组血清C-反应蛋白，术中、术后均显著升高（P〈0．01），组间比较差异无显著性。结论全麻复合硬外腔阻滞可以减轻胸部手术的应激反应，促进呼吸功能的恢复。     

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.

     

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.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.