肝炎肝硬化并发低钠血症120例临床分析

目的分析肝炎肝硬化失代偿期合并低钠血症的临床特点.方法对120例肝炎肝硬化失代偿期合并低钠血症进行分析,并依据血钠值分为轻度(135mmo1/L～130mmol/L);中度(121mmol/L～129mmol/L);重度(≤120mmol/L)低钠血症,分别比较其肝性脑病及肝肾综合征的发生率、低钠血症与Child-Pugh分级及病死率的关系.结果肝炎肝硬化失代偿期并发低钠血症的发生率为51.9%(120/231);轻、中、重度低血钠症,其肝性脑病或肝肾综合征的发生率分别为14.04%(8/57)、20.45%(9/44)、42.11%(8/19)及5.27%(3/57)、9.09%(4/44)、42.11%(8/19),轻与重度低血钠症者之间有显著差异(P＜0.05),轻与中度低血钠者无显著差异(P＞0.05);轻、中、重度低血钠症病死率分别为8.77%(5/57)、25.00%(11/44)及68.42%(13/19),三者之间有显著的差异(P＜0.05);肝功能A级与肝功能C级的重度低血钠发生率比较P＜0.01;肝功能B级与肝功能C级的重度低血钠发生率比较P＜0.05.结论肝炎肝硬化失代偿期并发低钠血症时血钠越低其肝性脑病和肝肾综合征的发生率及病死率越高,且低钠血症程度越重对应的Child-Pugh分级也越差.     

肝硬化腹水合并低钠血症32例临床研究

目的 研究肝硬化腹水合并低钠血症的发病机制以及肝肾综合征、肝性脑病等并发症的发生情况,探讨治疗方法.方法 依据患者血钠范围将患者分为轻度、中度、重度三组,血钠范围在131 ～ 135 mmol/L的11名患者为轻度组,血钠范围在126 ～ 130 mmol/L的11名患者为中度组,血钠范围≤125mmol/L的10名患者为重度组,观察三组患者肝肾综合征、肝性脑病发生情况以及肝脏储备功能量化评估分级标准（Child-pugh分级）和预后.结果 三组患者肝性脑病、肝肾综合征发生率比较差异具有统计学意义（P＜0.05）,且严重的低血钠症患者预后不良.结论 低钠血症的严重程度与肝硬化腹水合并低钠血症患者的治疗预后息息相关,因此采取措施对低钠血症进行针对性治疗可减少肝肾综合征、肝性脑病等并发症的发生率,并提升治疗效果.     

肝硬化腹水并发低钠血症92例临床分析

目的探讨肝硬化腹水并发低钠血症的原因、低血钠与肝性脑病、肝肾综合征、顽固性腹水的关系.方法对2001年1月～2004年1月辽宁抚顺矿物局总医院92例肝硬化腹水并发低钠血症患者的临床资料进行回顾性分析.结果92例肝硬化并发腹水患者中,Child-Pugh改良分级法B级56例,C级36例.其中,并发肝性脑病26例(28.3%)、肝肾综合征17例(18.5%)、顽固性腹水24例(26.1%).结论低血钠程度与肝功能分级及病死率均显著相关(P＜0.05).严重低血钠与肝性脑病及肝肾综合征等肝硬化并发症的发生有显著相关.     

重症肝病患者低渗性脑病72例临床分析

目的:探讨重症肝病患者并发脑病的诊断及其预后.方法:回顾分析72例重症肝病、肝硬化并低渗性脑病患者的临床表现、血生化及肝功能指标.结果:38例患者早期均误诊为肝性脑病,误诊率52.8%(38/72),合并腹水发生率94.4%.所有低渗性脑病的患者多为中度以上低钠血症97.2%(40/42),且随肝功能分级的增高而明显,低渗性脑病时重症肝病、肝硬化的相关并发症及病死率也明显增高(P＜0.01).结论:重症肝病患者治疗中易发生低钠血症诱发低渗性脑病,但多误诊为肝性脑病.低渗性脑病的发生与腹水的产生及肝功能状况有关,易与其他严重并发症合并存在,是常见的死因之一.     

肝硬化腹水并发低钠血症47例临床分析

目的探讨分析肝硬化腹水并发低钠血症的危害。方法收集了2000年4月至2009年12月收治的肝硬化腹水并发低钠血症患者47例,回顾分析该病与肝功能以及肝性脑病、肝肾综合征、顽固性腹水的关系及其转归。结果Child-Pugh改良分级法B级30例,病死率6.67%,C级17例,病死率14.89%;47例中,并发肝性脑病13例(27.66%),肝肾综合征9例(19.55%),顽固性腹水15例(31.91%)。结论低钠血症是肝硬化腹水常见的并发症,低血钠程度与肝功能分级及病死率显著相关(P<0.05),与肝性脑病、肝肾综合征、顽固性腹水显著相关。     

肝硬化腹水并低钠血症的临床分析

目的探讨不同治疗方法对肝硬化腹水并中度低钠血症的患者治疗效果。方法选取2010年4月至2011年5月我科肝硬化(肝功能Child-Pugh分级B级)腹水并中度低钠血症(血Na浓度在120~125mmol/L之间)76例。随机分为保肝利尿控钠组和保肝利尿补钠组。结果两组患者在腹水消退情况(腹水消退人数,消退率,腹水显效时间,平均显效时间)和肝硬化腹水并中度低钠血症的并发症和死亡率方面,保肝利尿补钠组的各项指标均明显好于保肝利尿控钠组,P值均<0.05,具有统计学意义。结论采用保肝利尿补盐的方法能够对肝硬化腹水并中度低钠血症的症状得到很好的缓解。     

肝硬化腹水并低钠血症临床分析

目的探讨肝硬化腹水并低钠血症的临床特点及治疗。方法对62例肝硬化腹水并低钠血症患者进行临床分析。结果肝硬化腹水患者低钠血症的发生率为42.2%(62/147),随低钠血症的加重,疗效明显降低,病死率增高(P<0.01),低钠血症的程度与肝功能分级、肝性脑病及肝肾综合征的发生等显著相关(P<0.01)。结论低钠血症是肝硬化常见的并发症,应高度重视。正确诊治肝硬化腹水低钠血症,对预后至关重要。     

不同钠盐摄入量对肝炎肝硬化合并难治性腹水疗效影响

目的 探讨不同钠盐摄入量对肝炎肝硬化合并难治性腹水的疗效影响.方法 将74例肝炎肝硬化合并难治性腹水病人随机分为严格限制钠盐组(A组)、一般限制钠盐组(B组)、不限制钠盐组(C组),予以不同钠盐摄入量,观察临床症状、血钠、肝肾功能、腹水吸收情况、主要并发症、病死率.结果 C组患者临床症状改善明显,差别有统计学意义(P＜0.01);治疗后A、B组血钠水平下降,重度低钠血症患者比例增高,差别有统计学意义(P＜0.01);C组腹水消退时间短,差别有统计学意义(P＜0.01);C组并发肝性脑病或低渗性脑病、肝肾综合症较少,死亡率低,差别有统计学意义(P＜0.01).结论 肝炎肝硬化合并难治性腹水时,严格限钠易发生明显低钠血症,适量的钠盐摄入,能使患者临床症状改善明显,腹水消退时间缩短,减少肝性脑病或低渗性脑病、肝肾综合症的发生率,降低死亡率.     

肝硬化腹水低钠血症

目的探讨肝硬化腹水低钠血症的临床特点及补钠治疗的好处.方法对98例肝硬化腹水低钠血症患者的临床资料进行回顾性分析.结果肝硬化腹水并低钠血症发生率为41.1%,不同程度的低血钠与肝性脑病、肝肾综合症发生率显著相关(P＜0.01).结论低钠血症是肝硬化腹水病人的常见并发症,可明显增加肝性脑病等严重并发症的发生率,是预后不良标志之一,治疗过程中应密切监测血钠变化,及时补钠以纠正低钠血症,改善预后.     

肝硬化患者血钠水平与肝功能分级关系的临床分析

目的探讨肝硬化患者不同血清钠水平与肝功能分级的关系。方法回顾分析我科收治的35例肝硬化并发低钠血症患者,根据其入院时血清钠水平分为低钠血症轻(A)、中(B)、重(C)3组。然后比较肝硬化腹水患者不同血钠水平的肝功能分级。结果不同的低钠程度的肝功能分级存在显著性差异(P<0.05)。B、C两组分别与A组比较,肝功能Child分级的差异有显著性(P<0.05),但B、C两组之间比较并无显著性差异(P>0.05)。结论肝硬化患者的血清钠水平与肝功能损害程度有紧密相关性。提示在临床诊疗过程中需重视预防,及时发现并治疗低钠血症。     

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.

---

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.     

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.     

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.