舒必利、奥美拉唑联合铝碳酸镁治疗反流性胃炎的疗效观察

目的观察舒必利及奥美拉唑联合铝碳酸镁治疗反流性胃炎的临床疗效。方法将204例反流性胃炎患者随机分为研究组和对照组各102例。研究组给予舒必利及奥美拉唑联合铝碳酸镁治疗,对照组给予舒必利及奥美拉唑治疗。比较2组的临床症状总积分、GERD-HROQ总积分及Zung氏总评分、临床治疗效果及药物不良反应发生率。结果 2组患者治疗前临床症状总积分、生活质量(GERD-HRQL)总积分及焦虑量表(Zung氏)总评分比较无统计学差异(P>0.05),治疗后研究组临床症状总积分、GERD-HRQL总积分及Zung氏总评分均低于对照组,差异均有统计学意义(P<0.05)。研究组总有效率高于对照组,差异有统计学意义(P<0.05)。2组药物不良反应发生率比较差异无统计学意义(P>0.05)。结论舒必利及奥美拉唑联合铝碳酸镁可有效提高反流性胃炎的临床疗效。     

GerdQ量表用于矿区人群胃食管反流病诊断的研究

目的 探讨GerdQ量表在矿区人群胃食管反流病(GERD)诊断中的应用价值.方法 选择因烧心等反流症状就诊的矿区GERD患者122例,均完成内镜检查、24h食管pH值监测及GerdQ量表,根据结果将患者分为GERD组(88例)和非GERD组(34例),糜烂性食管炎(RE)组(65例)和非糜烂性GERD(NERD)组(23例),酸暴露组(79例)和非酸暴露组(43例),观察GerdQ评分和酸暴露之间的相关性.以内镜检查、24 h食管pH值监测任一阳性为金标准,根据GerdQ评分绘制受试者工作特征曲线(ROC曲线).结果 GERD组的GerdQ评分[(10.3±2.6)分]高于非GERD组[(4.8±2.2)分],差异有统计学意义(t=3.125,P＜0.01).GerdQ评分与24 h食管动态pH值监测有很好的相关性,酸暴露组患者的GerdQ评分[(11.0±3.3)分]亦高于非酸暴露组[(6.7±2.8)分],差异有统计学意义(t =4.102,P ＜0.01).RE组与NERD组的GerdQ评分比较差异无统计学意义(t=3.251,P＞0.05).以GerdQ评分取诊断临界值为9分时,敏感度为82.3％,特异度为86.0％,ROC曲线下面积为0.905,面积的标准误为0.035,P＜0.05,95％置信区间为0.836～ 0.973.结论 GerdQ量表为适合矿区人群GERD初步诊断的客观、可行的诊疗工具.     

老年胃食管反流病患者临床症状及心理障碍分析

目的探讨老年胃食管反流病(GERD)患者的临床症状及心理障碍情况,为临床诊断、治疗提供帮助。方法根据反流性疾病问卷(RDQ)量表评分标准、胃镜检查确定食管炎及分级(洛杉矶分类标准)及GERD相关症状将GERD分为老年组和中青年组。统计两组患者食管症状、并发症及食管外症状发生率,并进行比较;统计两组患者内镜下食管炎分级,并进行比较;采用Zung抑郁自评量表(SDS)和Zung焦虑自评量表(SAS)对两组患者进行评分,并进行比较,同时计算两组患者抑郁状态、焦虑状态的发生率。结果老年GERD组反流、烧心、胸骨后疼痛的发生率明显低于中青年组,差异有统计学意义(P<0.05);老年GERD组厌食、吞咽困难、消瘦、呕血或黑粪发生率明显高于中青年组,差异有统计学意义(P<0.05);老年GERD患者组食管外症状,慢性咳嗽、咽喉炎、哮喘、牙龈炎发生率明显高于中青年组,差异有统计学意义(P<0.05);老年组重度食管炎发生率高于中青年组,差异有统计学意义(P<0.05);老年组SDS、SAS评分高于中青年组,差异有统计学意义(P<0.05),老年组抑郁、焦虑发生率高于中青年组,差异有统计学意义(P<0.05)。结论老年GERD患者症状多不典型,食管外症状发生率较高,食管炎程度较重,伴随焦虑、抑郁等心理障碍比较明显。     

比较奥美拉唑和雷贝拉唑治疗反流性食管炎的临床疗效

目的 比较奥美拉唑和雷贝拉唑治疗反流性食管炎患者的临床疗效。方法 108例反流性食管炎患者,以随机数字表法分为研究组和对照组,每组54例。对照组患者使用奥美拉唑治疗,研究组患者使用雷贝拉唑治疗。比较两组患者的症状改善时间及症状积分,内镜检查分级,不良反应发生率,治疗效果,生活质量评分及睡眠质量评分。结果 研究组患者的症状缓解时间(6.97±1.25)d、症状消失时间(12.10±1.87)d短于对照组的(9.11±1.37)、(18.79±1.93)d,症状积分(0.31±0.25)分低于对照组的(0.59±0.37)分,差异具有统计学意义(P<0.05)。研究组患者内镜检查分级优于对照组,差异具有统计学意义(P<0.05)。研究组患者的不良反应发生率为5.56%,低于对照组的25.93%,差异具有统计学意义(P<0.05)。研究组患者治疗总有效率为96.30%,高于对照组的75.93%,差异具有统计学意义(P<0.05)。研究组患者的生活质量评分(85.46±3.15)分高于对照组的(72.05±3.87)分、睡眠质量评分(6.23±0.87)分低于对照组的(...     

熊去氧胆酸联合莫沙必利对胆汁反流性胃炎的应用效果探讨

目的研究对胆汁反流性胃炎患者应用熊去氧胆酸联合莫沙必利治疗的临床效果。方法246例胆汁反流性胃炎患者,采用计算机随机分组法分为对照组和观察组,每组123例。对照组应用莫沙必利治疗,观察组应用熊去氧胆酸联合莫沙必利治疗。比较两组患者治疗效果及治疗后症状积分、治疗后24 h内胃内胆汁情况。结果观察组患者治疗总有效率为98.37%,高于对照组的88.62%,差异具有统计学意义(P<0.05)。治疗后,观察组口干口苦积分(1.12±0.21)分、腹胀嗳气积分(0.84±0.22)分、恶心呕吐积分(0.75±0.24)分、腹痛积分(0.35±0.15)分均低于对照组的(1.95±0.42)、(1.32±0.34)、(1.24±0.26)、(0.95±0.31)分,差异具有统计学意义(t=19.603、13.145、15.358、19.322,P=0.000、0.000、0.000、0.000<0.05)。观察组患者反流>5 min次数(6.14±1.24)次、总反流次数(52.24±4.12)次均少于对照组的(9.15±1.35)、(74.18±5.64)次,最长反流时间(92.14±6.84)min短于对照组的(105.84±7.18)min,差异具有统计学意义(t=18.211、34.838、15.322,P=0.000、0.000、0.000<0.05)。结论对胆汁反流性胃炎患者应用熊去氧胆酸联合莫沙必利治疗的临床效果显著,可快速纠正临床症状,预防胆汁反流,值得临床推广应用。     

胃食管反流病问卷对老年人胃食管反流病的诊断价值

目的探讨分析胃食管反流病问卷即GerdQ量表在诊断对老年人胃食管反流病(GERD)过程中的应用价值。方法应用数字表法随机选取于2015年2月~2016年4月在本院就诊的存在反流相关症状的老年患者60例,以GerdQ量表问卷调查对所有病例患者进行评分,结果 GerdQ积分以8分为判断标准,高于8分者40例为GERD组,低于8分者20例为非GERD组,并采用胃内窥镜和质子泵抑制剂(PPI)试验等检查作为诊断标准,与GerdQ评分结果进行比较,分析GerdQ量表在临床应用价值。结果 (1)60例患者中有24例为反流性食管炎患者(RE),占比40.00%,另36例患者为非糜烂性者(NERD),占比60.00%,差异有统计学意义(P<0.05);(2)GERD组的GerdQ评分结果显示有35.00%的患者评分在13~18分,所占比例均明显高于非GERD组的10.00%,差异有统计学意义(P<0.05);(3)GerdQ与内镜诊断的敏感度分别为78.94%、51.43%,特异度分别为59.09%、88.00%。两者敏感度、特异度比较差异有统计学意义(P<0.05)。结论通过使用GerdQ量表对GERD患者进行诊断,具有便捷、快速和无创伤等诊断优势,因此对于患者特别是老年患者而言,该诊断方式具有较高的应用价值。     

莫沙必利联合奥美拉唑治疗胃食管反流病的临床研究

目的:评价莫沙必利与奥美拉唑联合用药治疗胃食管反流病(GERD)的疗效与不良反应。方法:将80例GERD患者随机分为治疗组和对照组(各40例)。治疗组服用奥美拉唑(20 mg,bid)+莫沙必利(5 mg,tid),对照组服用莫沙必利(5 mg,tid),疗程均为8周。治疗结束后比较两组患者的常见症状缓解率以及药物的不良反应,并通过胃镜观察比较有效率。结果:治疗8周后,治疗组患者烧心、反酸、反流、胸痛等症状的平均缓解率高于对照组患者(85.7%vs.63.3%,P<0.05),镜下有效率高于对照组患者(77.5%vs.52.5%,P<0.05),差异均有统计学意义。治疗过程中,患者耐受均良好,无严重不良反应。结论:莫沙必利联合奥美拉唑治疗GERD可达到较高的症状缓解率和镜下有效率,临床疗效、安全性均较好。     

马来酸曲美布汀与伏诺拉生联合治疗胃食管反流病的临床疗效及安全性分析

目的 观察马来酸曲美布汀与伏诺拉生联合治疗胃食管反流病的临床疗效及安全性。方法 70例胃食管反流病患者,以随机数字表法分为对照组及研究组,各35例。对照组接受马来酸曲美布汀联合艾司奥美拉唑治疗,研究组接受马来酸曲美布汀与伏诺拉生联合治疗。比较两组患者治疗前后的反酸、烧心症状评分及生活质量评分,临床治疗效果,不良反应发生情况。结果 治疗后,两组患者的反酸、烧心症状评分低于本组治疗前,生活质量评分高于本组治疗前,且研究组患者的反酸症状评分(0.47±0.09)分、烧心症状评分(0.37±0.08)分低于对照组的(0.78±0.18)、(0.90±0.20)分,生活质量评分(94.02±3.06)分高于对照组的(89.13±4.72)分,差异具有统计学意义(P<0.05)。研究组治疗后的总有效率97.14%高于对照组的77.14%,差异具有统计学意义(P<0.05)。研究组患者治疗过程中的不良反应发生率5.71%低于对照组的25.71%,差异具有统计学意义(P<0.05)。结论 胃食管反流病患者实施马来酸曲美布汀与伏诺拉生联合治疗,可显著改善患者的反酸、烧心等症状,生活质量...     

胃复春片联合雷贝拉唑钠肠溶片治疗慢性胃炎伴反流性食管炎的临床观察

目的:观察胃复春片联合雷贝拉唑钠肠溶片治疗慢性胃炎伴反流性食管炎的疗效和安全性。方法:894例慢性胃炎合并反流性食管炎患者随机分为对照组(407例)和观察组(487例)。对照组患者于早餐前30 min口服雷贝拉唑钠肠溶片10 mg,每日1次;观察组患者在对照组治疗的基础上给予胃复春片1 440 mg,口服,每日3次。两组患者疗程均为4~8周。观察两组患者的临床疗效,治疗前后反流性食管炎镜检分级情况、症状总积分、抑郁量表(SAS)评分、焦虑量表(SDS)评分、生活质量量表(QOLS)评分、纽芬兰纪念大学幸福度量表(MUNSH)评分及不良反应发生情况。结果:观察组患者总有效率显著高于对照组,差异有统计学意义(P<0.01)。治疗前,两组患者反流性食管炎镜检各级例数,症状总积分、SAS评分、SDS评分、QOLS评分、MUNSH评分比较,差异均无统计学意义(P>0.05)。治疗后,两组患者反流性食管炎镜检各级例数均显著优于同组治疗前,且观察组优于对照组;症状总积分、SAS评分、SDS评分均显著低于同组治疗前,且观察组低于对照组;QOLS评分、MUNSH评分均显著高于同组治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05或P<0.01)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:胃复春片联合雷贝拉唑钠肠溶片治疗慢性胃炎伴反流性食管炎较单用雷贝拉唑疗效显著,可缓解患者临床症状,安全性较好。     

三种不同检查方法在胃食管反流病诊断中的应用比较

目的:探讨电子胃镜、24 h食管pH值监测及胃食管反流病(GERD)Q评分三种方法在GERD诊断中的临床应用价值。方法:将于2011年4月—2012年6月因烧心、反酸等症状就诊于消化科门诊的120例患者随机分为胃镜组、24 h食管pH值监测组及GERD Q评分组,每组40例,分别接受电子胃镜、24 h食管pH值监测及GERD Q问卷评分,比较分析各种方法对GERD的检出情况。结果:24 h食管pH值监测组40例患者中病理性反流者19例,生理性反流者5例,GERD阳性率显著高于胃镜组及GERD Q评分组,差异具有统计学意义(P<0.05);胃镜组与GERD Q评分组之间差异无统计学意义(P>0.05)。结论:24 h食道pH值监测可以对食管内反流情况进行实时、动态监测,为GERD的临床诊断及不同类型的反流治疗方案提供客观、准确的依据。     

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.     

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.     

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.     

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.