食管心房调搏诱发特发性室性心动过速临床分析

目的研究特发性室性心动过速(IVT)食管心房调搏诱发与终止方式及心动过速特征.方法13例患者均接受食管心房调搏,首先行分级递增刺激(S1S1),然后行程控早搏刺激(S1S2,S1S2S3),若上述方法均不能诱发心动过速,则静脉注射阿托品1～2mg后重复刺激.心动过速后,先以超速抑制法进行终止,无效者改用心律平、异搏定或可达龙静脉注射,或结合超速抑制法终止发作.结果13例中8例由S1S1和S1S2刺激诱发心动过速,另5例应用阿托品后重复S1S2(S3)刺激诱发;6例超速抑制法终止发作,4例以可达龙或心律平终止,3例应用异搏定或心律平后,心率明显减慢,但心动过速仍持续发作,结合超速抑制法终止成功.心动过速QRS形态均呈右束支传导阻滞图形伴电轴左偏,频率140～170bpm,11例呈房室分离,2例呈11室房传导,心室夺获、室性融合波各11例.结论食管心房调搏检查对IVT,特别是特发性左室室速有一定临床意义.     

食管心房调搏不同方法检出室上性心动过速成功率的比较

阵发性室上性心动过速(室上速)是临床常见的心律失常,其发生机制为异位节律点兴奋性增高、折返、触发激动,由折返机制引起的室上速可通过食管心房调搏诱发和终止。为了比较不同方法检出室上速的成功率,我们采用三个不同的刺激方案进行观察对比,现总结如下:     

食管心房调搏终止室上性心动过速的疗效分析与临床研究

目的研究分析食管调搏终止室上性心动过速的疗效与临床意义。方法回顾性分析144例既往有阵发性室上速发作而行食管心房调搏诊治患者的临床资料。结果房室结折返性心动过速和房室折返性心动过速140例均被食管调搏终止。2例房扑和2例房性心动过速出现心室率逐渐减慢,未即刻终止,治疗总有效率97.2%(140/144)。诊治过程中,插管时少数患者有恶心呕吐,部分患者在治疗时胸部有烧灼感。结论食管心房调搏快速终止室上性心动过速方法安全、操作简单,作用准确迅速,从插管到治疗结束在10多分钟内便可完成,临床验证,疗效满意,值得临床推广应用。     

提高食管心房调搏术对阵发性室上性心动过速检出率的研究

目的：提高食管心房调搏术对阵发性室上性心动过速的检出率。方法：对主为一过性心悸的病人，先行动态心电图检查，当记录到适于食管心房调搏术（TEAP）的病征（室上性心动过速、间发预激综合征、长短P－R间期交替出现）时，根据诱发室上速的易难程度，分别给予常规食管心房调搏术、静脉滴注异丙肾上腺素、心内电生理检查。结果：84例因心悸做动态心电图检查的病人，检出适于食管心房调搏术的心律失常36例行食管心房调搏术，其中短阵室上速29例，间发预激综合征4例，长短P－R间期交替出现3例。常规食管心房调搏术诱发室上速25例；另11例应用异丙肾上腺素，有7例室上速诱发成功，余4例给予心内电生理检查室上速诱发成功。结论：（1）采取症状（心悸）→动态心电图→食管心房调搏术的方法，能提高阵发性室上性心动过速的检出率，此法优于我们以往采取的症状→食管心房调搏术的简单步骤。（2）异丙肾上腺素和心内电生理检查可进一步提高室上速的检出率。     

食道心房调搏与普罗帕酮药物治疗老年人室上性心动过速疗效对比分析

目的探讨食管心房调搏超速抑制与普罗帕酮药物治疗老年人室上性心动过速的疗效对比。方法将食管心房调搏与普罗帕酮药物治疗老年人阵发性室上性心动过速进行分组对比观察。结果食管心房调搏超速抑制终止老年人群室上性心动过速临床有效率为93.3%。不良反应发生率为6.7%;普罗帕酮药物组成功率76%,不良反应发生率为24%。结论食管心房调搏超速抑制治疗老年人群室上性心动过速安全,有效,明显优于药物治疗。     

经食管心房调搏术诊断典型预激综合征的应用价值

目的:通过应用经食道心房调搏术(TEAP)诊断典型预激综合征并判断其类型,探讨TEAP对典型预激综合征的诊断价值。方法:用TEAP对40例主诉有过心动过速病史患者进行检查,起搏电压20~40V,脉宽10ms。根据需要给予分级递增刺激(S 1 S 1),程序早搏刺激(S 1 S 2),猝发刺激(Burst)法诱发和终止室上速(SVT)发作。结果:4例为隐性预激,有12例诱发出房室折返性心动过速(AVRT)诊断为隐匿预激。10例显性预激综合征中有3例诱发出逆向型房室折返性心动过速。结论:通过经食管心房调搏术检查能够阐明典型预激综合征的某些原理、诊断和治疗问题,可以弥补常规体表心电图的不足,对某些介入性治疗更是必不可少的手段。     

经食管心房调搏终止室上性心动过速36例

阵发性室上性心动过速(PsVT)通常应用药物治疗．当药物不能终止发作而发生血流动力学改变时．可应用电击复律，但不易被病人接受．我们自1992年10月起应用经食管心房调搏方法终止PsVT36倒，收到满意疗效．报道如下。     

食道心房调搏亚速递减刺激终止室上性心动过速的研究

目的:探讨经食道心房调搏亚速递减刺激终止室上性心动过速的价值.方法:病例选择1999-2008年急诊入院的室上性心动过速的患者69例,对其进行100次/rain起S1S1递减刺激,心电图证实被心房夺获后立即停止刺激,观察疗效.结果:69例患者,67被亚速递减刺激终止室上速发作,终止率97.1%.结论:经食道心房调搏亚速递减刺激可有效地终止室上性心动过速,可作为急诊终止室上速发作的一个有效方法.     

潘生丁食管心房调搏超声心动图复合试验诊断冠心病

将６０例患者以冠状动脉造影结果分为典型冠心病人组４４例，可疑冠心病人组１６例。用潘生丁食管心房调搏超声心动图复合试验、潘生丁—二维超声心动图试验和潘生丁食管心房调搏心电图复合试验进行诊断观察。结果潘生丁食管心房调搏超声心动图复合试验诊断冠心病的敏感性为９３．１％，特异性为８７．５％，准确性为９５．３％；而潘生丁—二维超声心动图试验的敏感性、特异性、准确性分别为６８．１％、８７．５％、９３．７％；潘生丁食管心房调搏心电图复合试验则分别为７９．５％、７５％、８９．７％。试验中未发生严重不良反应。说明潘生丁食管心房调搏超声心动图复合试验，对冠心病是一种安全、准确的无创性诊断方法。     

食管调搏终止室上性心动过速临床观察

食管调搏终止室上性心动过速临床观察山西省心血管疾病研究所（０３０００１）高明兰王晋军刘卓敏李运乾王爱环食管心房调搏（ＴＥＡＰ）广泛用于多种心律失常的诊断和治疗〔１〕，其特点是简便、无创和有效。由于刺激方式有多种，用何种方法及终止室上性心动过速疗效如何...     

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.     

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.     

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.     

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.