血浆降钙素原在小儿脓毒症早期的诊断价值

目的 探讨血浆降钙素原（PCT）在小儿脓毒症早期的诊断价值.方法 将90例重症感染性疾病患儿分为脓毒症组40例和非脓毒症组50例,入院后对两组患儿进行PCT、CRP测定和WBC计数,比较两组患儿的测定结果和PCT检测阳性率.结果 脓毒症组血浆PCT水平高于非脓毒症组（t=44.746,P＜0.01）,脓毒症患儿中严重组PCT高于非严重组（t=9.899,P＜0.01）,CRP水平和WBC计数各组比较差异无统计学意义（P＞0.05）;脓毒症组PCT检测阳性率明显高于非脓毒症组（x2=38.154,P＜0.01）.结论 血浆PCT检测对小儿脓毒症早期诊断有较高的特异性,对于判断病情程度、检测病情发展具有重要意义.     

血清C-反应蛋白及降钙素原在儿童社区获得性肺炎病情严重程度评估中的应用

目的：探讨血清C-反应蛋白（CRP）和降钙素原（PCT）在儿童社区获得性肺炎（CAP）病情严重程度评估中的作用。方法：选取62例符合CAP诊断标准的儿童患者（CAP组）及57例体检健康的正常儿童（对照组）作为研究对象,根据儿童病情不同将CAP组分为重症组（28例）和轻症组（34例）。检测所有儿童血清中CRP及PCT水平,并进行对比分析。结果：CAP患儿的血清CRP及PCT水平分别为（12.49 ± 2.76）mg/L和（1.622 ± 0.105）ng/mL,均显著高于健康儿童的CPR和PCT水平［(5.37 ± 1.81) mg/L & (0.051 ± 0.003) ng/mL］,差异有统计学意义（t值分别为8.736、9.251,P<0.01）;重症组患儿的PCT水平为（2.445 ± 0.134）ng/mL,显著高于轻症组的（1.019 ± 0.157）ng/mL（t=8.976,P<0.01）,但重症组患儿的CPR水平［(12.75 ± 2.11) mg/L］与轻症组［(12.17 ± 2.03) mg/L］比较差异无统计学意义（t=0.896,P>0.05）。结论：CAP患儿的血清CRP及PCT水平均明显升高,但应用PCT作为CAP病情严重程度评估的指标较CRP更为有效。     

血清降钙素原、C-反应蛋白、前清蛋白及白细胞计数联合检测在小儿重症肺炎诊断中的临床价值

目的 探讨血清降钙素原(PCT)、C-反应蛋白(CRP)、前清蛋白(PA)及白细胞计数(WBC)联合检测在小儿重症肺炎诊断中的临床价值.方法 选取本院2015年3月至2016年9月收治的105例重症肺炎患儿,根据感染病原体的不同分为支原体感染组(34例)、病毒感染组(34例)和细菌感染组(37例),另选同期体检健康儿童30例为对照组.检测并比较各组受检者血清PCT、CRP、PA、WBC水平的差异.结果 对照组儿童血清PCT、CRP、WBC水平均明显低于重症肺炎患儿(t1=27.099,t2=33.273,t3=24.893,均P＜0.05),血清PA水平明显高于重症肺炎患儿(t=10.307,P＜0.05);支原体感染组患儿血清PCT、CRP、WBC水平均明显高于病毒感染组(t1=26.840,t2=15.360,t3=15.768,均P＜0.05),血清PA水平明显低于病毒感染组(t=4.912,P＜0.05);细菌感染组患儿血清PCT、CRP、WBC水平均明显高于支原体感染组(t1=8.276,t2=4.219,t3=10.982,均P＜0.05),血清PA水平明显低于支原体感染组(t=12.871,P＜0.05);细菌感染组患儿血清PCT、CRP、PA、WBC阳性率均明显高于支原体感染组(x21=8.272,x22=9.234,x23=11.992,x24=6.406,均P＜0.05),支原体感染组患儿血清PCT、CRP、PA、WBC阳性率均明显高于病毒感染组(x21=19.125,x22=3.985,x 23=3.985,x 24=3.886,均P＜0.05).结论 PCT、CRP、PA及WBC联合检测不仅可作为小儿重症肺炎的重要临床诊断指标,还能有效预测感染病原体的种类,对于小儿重症肺炎的临床诊治具有较高的临床指导价值.     

多种指标在儿童上呼吸道感染早期诊断中的临床意义

目的探究白细胞计数(WBC)、中性粒细胞比例(NC)、血小板计数(PLT)、C-反应蛋白(CRP)、降钙素原(PCT)以及血清淀粉样蛋白A(SAA)等多种指标联合检测在儿童上呼吸道感染早期诊断中的临床意义。方法将本院2018年1～12月间收治上呼吸道感染患儿100例作为观察组,同期进行健康体检儿童50例作为对照组,观察组患儿依据感染类型不同分为病毒亚组(n=46)与细菌亚组(n=54),分别检测并对比各组受检儿童的WBC、NC、PLT、CRP、PCT以及SAA等6项指标的差异。结果观察组患儿WBC、NC、PLT、CRP、PCT以及SAA指标水平均显著高于对照组儿童,差异有统计学意义(P <0.05);细菌亚组患儿WBC、NC、PLT、CRP、PCT以及SAA指标水平相比病毒亚组患儿,差异有统计学意义(P <0.05);PCT指标诊断的符合率、阳性预测值、阴性预测值、敏感度以及特异度在各指标中最高,各指标对比差异有统计学意义(P <0.05)。结论在儿童上呼吸道感染早期诊断中,WBC、NC、PLT、CRP、PCT以及SAA等多指标联合检测可较准确发挥诊断与鉴别诊断作用,PCT指标在儿童上呼吸道感染早期诊断的效能最高。     

降钙素原联合C-反应蛋白在儿童细菌性肺炎诊断中的价值

目的 探讨降钙素原联合C-反应蛋白(CRP)在儿童细菌性肺炎诊断中的价值。方法 将张家口市第一医院2015年1—12月收治的细菌性肺炎患儿根据病原体的不同分为细菌组(43例),病毒组(29例)和支原体组(23例),选取同期来院体检的健康儿童35例作为对照组,均检测降钙素原(PCT)和CRP的水平,并比较四组PCT和CRP水平是否有差异;根据PCT、CRP、PCT/CRP串联试验和 PCT/CRP并联试验阳性判定标准分别评价其在儿童细菌性肺炎诊断中的价值。结果 细菌组PCT水平为(5.42±1.41)μg/L,CRP水平为(26.25±10.08)mg/L,均高于支原体组[(0.36±0.15)μg/L和(17.14±6.02)mg/L]、病毒组[(0.23±0.10)μg/L和(3.25±0.74)mg/L]和对照组[(0.18±0.06)μg/L和(2.78±0.88)mg/L],差异有统计学意义(P<0.001);PCT单独检测和PCT/CRP串联试验中细菌组阳性率分别为86.05%和69.77%,均高于支原体组(43.48%和21.74%)和病毒组(27.59%和13.79%),差异有统计学意义(P<0.001),但是在CRP单独检测和PCT/CRP并联试验中,病毒组与支原体组比较差异无统计学意义(P>0.017);四种评估策略中,PCT/CRP并联试验的灵敏度最高为90.70%,PCT/CRP串联试验的特异度最高为82.69%,且PCT/CRP串联试验具有最高的Youden指数为0.51。 结论 PCT和PCT/CRP串联试验对儿童细菌性肺炎有较好的诊断特异度,可以作为儿童细菌性肺炎临床诊断的依据之一。     

外周血白细胞形态联合CRP、降钙素原检测在儿科感染性疾病早期诊断的价值研究

目的 分析外周血白细胞(WBC)形态联合C反应蛋白(CRP)、降钙素原(PCT)检测在儿科感染性疾病早期诊断中的应用效果。方法 选取2017年8月～2018年12月215例儿科感染性疾病患儿,回顾性分析其临床资料。根据感染类型分为A组(细菌感染,n=107)和B组(病毒感染,n=108),对两组患儿开展外周血白细胞形态联合CRP、PCT检测,对检测结果进行分析和对比,探讨WBC及炎性因子与感染之间的相关性。结果 A组CRP、PCT、WBC水平明显高于B组,差异有统计学意义(P 0.05);A组粒细胞毒性变阳性率(75.70%)明显高于其他B组,差异有统计学意义(P 0.05);B组异型淋巴细胞阳性率(80.56%)高于A组,差异有统计学意义(P 0.05);A和B组WBC形态变化率分别达到88.79%、90.74%。结论 儿科感染性疾病发生后,WBC、CRP、PCT均发生明显变化,与病毒性感染相比,细菌性感染患儿上述指标明显升高,WBC形态与CRP、PCT检测能够准确反应患儿病情变化情况,对早期鉴别感染类型具有一定帮助。     

川崎病患儿血清降钙素原水平变化的临床意义

目的通过检测川崎病(KD)患儿血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)水平的变化以探讨PCT对于川崎病诊断的临床意义。方法选取98例川崎病患儿作为观察对象(观察组),同时选择31例健康儿童作为对照组,分别比较观察组和对照组间以及观察组内静脉用丙种球蛋白(IVIG)前后患儿血清PCT、CRP、WBC的变化情况。结果观察组98例患儿在IVIG治疗后PCT均值(0.23±0.09)μg/L,较治疗前[(1.23±0.40)μg/L]明显下降,差异有统计学意义(t=14.487 0,P<0.05),且患儿IVIG治疗后体温均恢复正常,口唇皲裂,结膜充血等临床症状明显改善。CPR及WBC治疗前后也分别由(68.12±19.36)g/L和(13.82±5.9)×109/L下降至(11.64±7.72)g/L和(8.21±3.71)×109/L,与PCT值变化相符;观察组治疗前PCT值亦显著高于对照组,差异有统计学意义(t=8.853 7,P<0.05)。98例川崎病患儿中合并冠状动脉病变65例,其PCT阳性率(43.07%)与冠脉正常者(39.39%)比较,差异无统计学意义(P>0.05),冠脉病变组PCT均值(1.421±0.791)与冠脉正常组(1.218±0.885)比较,差异无统计学意义(P>0.05)。结论 PCT能够反映川崎病的免疫性炎症改变,但其数值高低与冠状动脉损害之间无必然联系。     

血管生成素及其受体与降钙素原联合检测在急性肺损伤诊治中的作用

目的 研究急性肺损伤(ALI)病人血清中血管生成素-1(Ang-1)、血管生成素-2(Ang-2)及其受体(Tie-2)与降钙素原(PCT)的变化规律,探讨Ang-1、Ang-2、Tie-2与PCT在ALI病情评估和预后判断中的临床意义。方法 选取2016年9月至2017年3月南通大学附属医院重症监护病房的病人102例为ALI组,同时选择50例体检健康者为对照组。ALI组根据病人开始入院到随访28 d结束后生存情况再分成存活组和死亡组,比较病人血清中Ang-1、Ang-2、Tie-2与PCT的前后变化及急诊脓毒症病死率评分(MEDS)的严重程度及对预后评估的临床价值。结果 ALI组血清Ang-1、Tie-2水平分别为(0.99±0.08)、(0.96±0.08)μg/L,对照组分别为(2.07±0.15)、(1.51±0.31)μg/L,ALI组显著高于对照组,均差异有统计学意义(t=78.921,P<0.001;t=228.818,P<0.001),ALI组Ang-2、PCT、MEDS评分分别为(18.63±3.03)μg/L、(9.52±1.22)μg/L、(10.59±2.06)分,对照组分别为(1.75±0.22)μg/L、(0.31±0.15)μg/L、(2.97±0.33)分,ALI组均显著低于对照组,差异有统计学意义(t=153.629,P<0.001;t=22.545,P<0.001;t=420.623,P<0.001);存活组Ang-1、Tie-2分别为(0.85±0.32)、(1.08±0.64)μg/L,死亡组分别为(0.66±0.07)、(0.61±0.14)μg/L,存活组均显著高于死亡组,差异有统计学意义(t=20.241,P<0.001;t=16.515,P<0.001),存活组Ang-2、PCT分别为(0.85±0.32)、(8.20±0.93)μg/L、死亡组分别为(11.01±1.21)、(13.65±3.68)μg/L,存活组均显著低于死亡组,差异有统计学意义(t=14.197,P<0.001;t=277.114,P<0.001);存活组病人入院24 h Ang-1、Tie-2分别为(0.85±0.32)、(1.08±0.64)μg/L,治疗28 d后分别为(1.30±0.57)、(1.49±0.57)μg/L,均显著升高,差异有统计学意义(t=35.805,P<0.001;t=10.441,P<0.001),入院24 h Ang-2、PCT分别为(8.30±0.98)、(8.20±0.93)μg/L,治疗28 d后分别为(2.09±1.56)、(4.88±1.64)μg/L,均显著降低,差异有统计学意义(t=797.817,P<0.001;t=8.323,P<0.001)。结论 通过抑制Ang-2、PCT的表达并促进Ang-1、Tie-2表达,可能有利于控制ALI病人的病情,发病时同时检测上述四项对ALI病人预后有较好的预测作用,可提高检出率。     

血清降钙素原检测对儿童下呼吸道感染的诊断价值

目的 探讨血清降钙素原(PCT)检测对儿童下呼吸道感染的诊断价值.方法 应用免疫荧光法定量法检测60例呼吸系统感染患儿PCT,同时与患儿的白细胞计数(WBC)、C反应蛋白(CRP)进行比较.结果 细菌感染组PCT阳性率显著高于非细菌感染组(P＜0.01).细菌感染组中PCT阳性率与CRP阳性率差异无统计学意义(P＞0.05),而高于WBC阳性率(P＜0.05);非细菌感染组中PCT阳性率明显低于CRP和WBC阳性率(均P＜0.01).结论 在儿童下呼吸道细菌感染疾病中,PCT对细菌感染的诊断价值优于WBC及CRP等传统炎症指标.     

降钙素原检测对脓毒症病情及预后判断的指导价值(附46例分析)

目的探讨血清降钙素原(PCT)检测对脓毒症病情及预后判断的指导价值。方法 46例脓毒症患者按病情轻重分早期脓毒症组、严重脓毒症组和脓毒症休克组,分别比较组间血清PCT、C反应蛋白(CRP)、WBC和急性生理与慢性健康状况评分(APACHEⅡ),并行PCT与APACHEⅡ评分相关性分析;同时按PCT水平,分为PCT<5.0、5.0～<10.0、PCT≥10.0ng/mL 3组,比较各组的病死率、抗生素使用时间、住院时间和外周血培养结果。结果脓毒症休克组与其他两组比较,PCT、CRP、WBC和APACHEⅡ评分差异均有统计学意义(P<0.05);严重脓毒症组与早期脓毒症组比较,PCT、CRP、APACHEⅡ差异有统计学意义(P<0.05),WBC差异无统计学意义(P>0.05),PCT与APACHEⅡ评分之间呈显著正相关(r=0.68,P<0.05);随着PCT水平升高,脓毒症患者病死率呈增高趋势,抗生素使用时间及住院时间延长(P<0.05),同时血培养阳性率升高。结论血PCT对脓毒症病情判断及评估预后有一定指导意义。     

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.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

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.     

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.