心力衰竭患者血脑钠素与心功能关系的研究

目的研究心力衰竭（心衰）患者血浆脑钠素（BNP）水平的变化及其与心衰患者心功能之间的关系。方法采用放射免疫法测定66例心衰患者治疗前后和30例对照组血浆BNP的浓度；用心脏彩色多普勒超声测定左室射血分数（LVEF）、左室舒张末期内径（LVEDD）。结果心衰患者血浆BNP浓度显著高于对照组（P〈0．01）；BNP水平随着心衰程度（NYHA分级）的加重而显著升高，与LVEF呈负相关（r=-0．911，P〈0．01），与LVEDD呈正相关（r=0．909，P〈0．01）。治疗后随心功能改善BNP浓度下降，LVEDD明显减小（P〈0．01）。结论心衰患者血浆BNP浓度随心衰严重程度的增加而升高，能较好地反映左室功能。     

B-型钠尿肽在心衰诊断中的应用价值

目的：心力衰竭患者血浆B-型钠尿肽（BNP）水平明显高于健康人群的观点已得到证实，本文着重研究探讨慢性心力衰竭患者血浆BNP水平的变化与心功能状态的关系以及其在早期心衰诊断中的应用价值。方法115例慢性心力衰竭患者用微粒子发热法（MEIA）测定血浆BNP浓度，用心脏彩色多普勒超声诊断仪测定左室结构和功能。结果：慢性心力衰竭患者血浆BNP浓度与心功能衰竭严重程度相关。血浆BNP水平与左室射血分数（LVEF）呈负相关（r=-0．586，P=0），与左室舒张末期内径（LVEDD）呈正相关（r=0556，P=0）。结论：血浆BNP水平可作为心衰患者早期诊断和反映心功能状态的指标。     

脑利钠肽在呼吸困难鉴别诊断中的价值

目的探讨床边即时检测脑利钠肽（BNP）对呼吸困难患者的鉴别诊断价值。方法荧光免疫法测定205例呼吸困难患者血浆BNP,心脏超声测定心脏左室射血分数（LVEF）和左室舒张末期内径（LVEDd）。结果（1）心力衰竭（心衰）患者血浆BNP水平明显高于非心衰组患者[（706±89）ng／L与（48±9）ng／L,P〈0．01];（2）如以100ng／L为正常参考值,BNP诊断心衰的敏感性为95．8％,特异性为97．3％,排除心衰的阴性预测价值为96．0％;（3）心衰患者血浆BNP浓度与左室射血分数呈负相关（r=-0．752,P〈0．01）,与左室舒张末期内径呈正相关（r=0．706,P〈0．01）。结论床边即时检测BNP诊断心衰敏感性、特异性均高,可作为急性呼吸困难鉴别诊断的一个观察指标。     

心力衰竭患者脑利钠肽检测的临床意义

目的探讨心力衰竭（心衰）患者快速检测血浆脑利钠肽（BNP）水平对心衰诊断的临床意义。方法应用美国Triage诊断仪检测心衰组（106例）和对照组（32例）血浆BNP水平。超声心动图检查左室舒张期末内径（LVEDD）、左室射血分数（LVEF）。结果心力衰竭各组血浆BNP（ng·L^-1）水平明显高于对照组（P〈0．01）,且Ⅱ、Ⅲ、Ⅳ级组间血浆BNP水平依次递增（P〈0．01）。血浆BNP与超声指标做直线相关回归分析表明,BNP与LVEDD呈正相关（r=0．68,P〈0．01）,与LVEF呈负相关（r=-0．75,P〈0．01）。房颤组血浆BNP水平（929．65±240．60）ng·L^-1,明显高于非房颤组患者（465．98±169．28）ng·L^-1。（P〈0．01）。结论血浆BNP水平对心衰的诊断及严重程度评价有重要价值。     

118例呼吸困难患者快速检测血浆BNP的临床价值分析

目的评价呼吸困难患者快速检测血浆BNP（B型钠脲肽）对指导临床诊治的价值。方法测定118例急性呼吸困难患者的血浆BNP,部分心衰患者复查BNP,同时每位患者均给予超声心动图检查。结果心源性呼吸困难患者血浆BNP水平明显高于非心源性呼吸困难患者。心源性呼吸困难患者血浆BNP数值与LVEF（左室射血分数）呈负相关（P〈0．05）。心衰患者BNP数值与心衰程度呈正相关（P〈0．05）。结论快速血浆BNP检测有助于鉴别心源性呼吸困难与非心源性呼吸困难,有助于了解心衰程度。     

不同心绞痛患者血清脑钠肽的临床意义

目的：探讨心绞痛患者血清脑钠肽（BNP）水平在评估心功能以及冠状动脉病变程度方面的临床价值。方法：经选择性冠状动脉造影（CAG）证实为心绞痛的患者68例。其中稳定型心绞痛（SA）患者32例，不稳定型心绞痛（UA）患者36例，根据NYHA标准分为心功能Ⅰ-Ⅳ级，采用荧光免疫法定量测定患者血清BNP水平、彩色超声心动图测定左室射血分数（LVEF），分析BNP水平与不同病情的关系。结果：BNP水平随着病情加重而逐渐升高，且与心功能的级别、冠脉的病变呈正相关（分别为r=0．82，P〈0．05；r=0．68，P〈0．05），与左室射血分数呈负相关（r=-0．53，P〈0．05）。结论：BNP是检测心功能衰竭和冠脉病变的重要指标．对临床病情的评估具有重要价值。     

慢性心力衰竭患者血清尿酸水平与心功能的相关性研究

目的探讨慢性心力衰竭患者血清尿酸水平与心功能的相关性研究。方法随机选取我院慢性心功能衰竭Ⅱ级40例,Ⅲ级30例,Ⅳ级25例,并选取40例门诊正常体检人群为对照组,观察不同级别心衰患者血清尿酸水平的差异及其与左室射血分数的相关性。结果心衰患者血清尿酸水平随着心功能分级的增加而升高,具有统计学差异（P〈0．05）,血清尿酸水平与患者左室射血分数具有负相关性（r=-0．74,P〈0．05）。结论血清尿酸水平可能参与慢性心功能衰竭的发生发展,影响患者预后。     

309例慢性心力衰竭患者的心率变异性分析

目的评价心率变异性在慢性充血性心力衰竭患者中的变化。方法用24h动态心电图及彩超测定心率变异性,左室射血分数（LVEF）,左室舒张末内径（LVEDD）,左室短轴缩短率（LVSF）与对照组比较。结果慢性充血性心力衰竭组的心率变异性与LVEF,LVEDD及LVSF改变相关（P〈0．05或P〈0．01）。结论心率变异性测定可作为了解心力衰竭程度、指导治疗和判定预后的参考指标之一。     

前列地尔脂对慢性心力衰竭患者脑钠肽及左室功能的影响

目的观察前列地尔脂微球载体制剂对慢性充血性心力衰竭（CHF）患者治疗前后左心功能、血浆B型脑钠肽（BNP）水平的变化及6rain步行距离的影响。方法对武汉市第一医院2010年2月至2012年9月收治的慢性充血性心力衰竭患者70例按入院先后顺序随机分为治疗组和对照组各35例,对照组采用常规心力衰竭药物治疗,治疗组在此基础上加用前列地尔脂微球载体制剂治疗。比较两组患者治疗前后血浆B型脑钠肽（BNP）水平、左室射血分数（LVEF）、左室短轴缩短率（FS）、每搏量（SV）、左室舒张末期容积（LVEDD）及6min步行距离的变化。结果两组患者治疗后各项指标均得到改善,治疗组较对照组左室射血分数、搏出量及左室短轴缩短率增加（P〈0．05）,左室舒张末期内径减小（P〈0．05）,血浆BNP水平显著下降（P〈0．05）,6min步行距离明显延长。结论慢性心力衰竭在常规治疗的同时,加用前列地尔辅助治疗,可进一步提高慢性充血性心力衰竭患者的心功能,且无明显不良反应。     

脑钠肽在心力衰竭诊断及预后中的应用探讨

目的探讨慢性心力衰竭（CHF）患者脑钠肽（BNP）水平在CHF诊断和预后中的价值。方法选择106例CHF患者为观察组,100例健康者为对照组,分别检测血浆BNP水平和测定左室射血分数（LVEF）。随访3个月,观察患者病死率、再住院率。结果观察组BNP平均水平显著高于对照组（P〈0．01）,观察组平均LVEF水平明显低于对照组（P〈0．05）。BNP水平随心功能级数上升而增高,各分级组间BNP水平差异明显（P〈0．05）。患者LVEF水平随心功能级数上升而下降,NYHA心功能分级Ⅲ、IV级患者LVEF水平较II患者下降明显,差异明显（P〈0．05）。CHF患者BNP水平与LVEF呈显著负相关。出院时BNP〉110pg／mL患者终末事件发生率77.3％,BNP〈110vg／mL患者终末事件发生率3．6％,两组终末事件发生率相比,差异有显著统计学意义（P〈0．01）。结论BNP对CHF的诊断及预后均有重要临床价值。     

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.     

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.