不同透析方式清除尿毒症患者非对称性二甲基精氨酸的临床研究

目的 比较不同透析方式对尿毒症患者体内非对称性二甲基精氨酸(asymmetic dimethylarginine,ADMA)的清除作用.方法 选择我院血液净化中心行维持性血液透析(HD)、血液透析滤过(HDF)、连续性非卧床腹膜透析(CAPD)的终末期肾脏疾病患者60例,年龄18~60岁,检测其清晨空腹透析前血清ADMA的水平,测算每周透析清除ADMA的总量,对比HD组(20例)、HDF组(20例)、CAPD组(20例)患者与健康对照者(20例)的血清ADMA水平,比较维持性血液透析患者残余肾脏及透析每周清除ADMA的总量.结果 透析的各组患者血清ADMA水平与健康对照者比较差异均有统计学意义(P＜0.01),CAPD组患者血清ADMA水平与HD组、HDF组比较差异有统计学意义(P＜0.01),HD组与HDF组患者血清ADMA水平间差异无统计学意义(P＞0.05);健康对照组每周尿量及ADMA经尿液的排泄量与透析的各组比较差异均有统计学意义(P＜0.01),CAPD组尿量及ADMA排泄量与HD组、HDF组比较差异均有统计学意义(P＜0.01),HD组与HDF组比较差异无统计学意义(P＞0.05);HD组、HDF组、CAPD组每周透析清除ADMA的量间差异有统计学意义(P＜0.05).结论 维持性血液透析患者的血清ADMA水平明显高于健康人,CAPD清除ADMA的能力优于HD和HDF,HDF清除ADMA的能力优于HD.     

尿毒症患者64例不同透析模式治疗效果分析

目的 研究血液透析滤过（HDF）和血液透析（HD）交替模式治疗尿毒症的临床疗效.方法 将64例尿毒症患者随机分为两组,即观察组与对照组.对照组给予每周3次HD治疗;观察组给予每周2次HD加每周1次HDF治疗.结果 （1）两组血肌酐（Scr）、尿素氮（BUN）水平治疗后均明显低于治疗前（P＜0.05）,观察组治疗后Scr、BUN水平明显低于对照组治疗后（P＜0.05）;观察组β2-微球蛋白（β2-MG）水平治疗后明显低于治疗前（P＜0.05）,也明显低于对照组治疗后（P＜0.05）,而对照组β2-MG治疗前后无明显变化（P〉0.05）.（2）观察组高血压、心律失常、低血压、肌肉痉挛、透析失衡综合征等并发症发生率均明显低于对照组（P＜0.05）.结论 采用HDF和HD交替模式治疗尿毒症,能够高效清除患者体内的中、小分子毒性物质,减少了并发症的发生,值得临床推广应用.     

不同血液净化方式对血管活性肽的影响

目的 观察不同血液净化方式对透析患者血管活性肽的影响及临床疗效.方法 选取45例透析患者,采用自身对照法,随机分为3组：血液透析组（HD组）、血液透析滤过组（HDF组）、血液透析＋血液灌流组（HD＋HP组）.观察3组治疗前、治疗3个月后血内皮素（ET-1）、肾素活性（PRA）、血管紧张素Ⅱ（ATⅡ）水平的变化和临床疗效.结果 HD＋HP组与HDF组治疗后血ET-1和ATⅡ均显著下降（P＜0.05）,而PRA明显升高（P＜0.05）.HD组治疗后PRA、ATⅡ均显著升高（P＜0.01）,ET-1无明显变化（P＞0.05）.HDF组与HD＋HP组治疗后收缩压及舒张压均显著下降（P＜0.01）,而HD组治疗后血压无明显变化（P＞0.05）.结论 HDF与HD＋HP治疗均可改善透析患者难治性高血压,可能与降低血ET-1、ATⅡ水平有关.HD对难治性高血压情况无改善.     

不同频次的血液透析滤过对尿毒症患者瘦素水平变化与改善营养状态的影响

目的 探讨不同频次血液透析滤过对尿毒症患者瘦素水平、营养状态的影响。方法 选取2018年1月至2019年12月在沈阳医学院附属中心医院行血液透析治疗的患者90例,根据不同的治疗方法将其分为血液透析组（HD组）、血液透析滤过A组（HDF A组）、血液透析滤过B组（HDF B组）,于首次血液净化治疗前及3个月试验结束后下一次血液透析前检测患者瘦素、血红蛋白（HGB）、血清白蛋白（Alb）、前白蛋白（PA）、总胆固醇（CHOL）、肌酐（Scr）、尿素氮（BUN）,应用主观综合性营养状况评估表（PG-SGA）评估患者的营养状态。结果 与透析前比较,透析3个月后,HDF A组、HDF B组患者血标本中瘦素水平均降低,但HDF B组水平更低,差异有统计学意义（P <0.05）;治疗3个月后,与HD组比较HDF B组血瘦素水平明显下降,差异有统计学意义（P <0.05）;治疗3个月后,HDF组、HDF A组、HDF B组的营养质量评分均优于治疗前,且HDF B组较HDF A组更明显,差异有统计学意义（P <0.05）。结论 对尿毒症患者采用每周3次血液透析滤过能够更好地降低血液中瘦...     

不同透析方式清除尿毒症患者非对称性二甲基精氨酸的临床研究

目的比较不同透析方式对尿毒症患者体内非对称性二甲基精氨酸(asymmetic dimethylarginine,AD-MA)的清除作用。方法选择我院血液净化中心行维持性血液透析(HD)、血液透析滤过(HDF)、连续性非卧床腹膜透析(CAPD)的终末期肾脏疾病患者60例,年龄18～60岁,检测其清晨空腹透析前血清ADMA的水平,测算每周透析清除ADMA的总量,对比HD组(20例)、HDF组(20例)、CAPD组(20例)患者与健康对照者(20例)的血清ADMA水平,比较维持性血液透析患者残余肾脏及透析每周清除ADMA的总量。结果透析的各组患者血清AD-MA水平与健康对照者比较差异均有统计学意义(P<0.01),CAPD组患者血清ADMA水平与HD组、HDF组比较差异有统计学意义(P<0.01),HD组与HDF组患者血清ADMA水平间差异无统计学意义(P>0.05);健康对照组每周尿量及ADMA经尿液的排泄量与透析的各组比较差异均有统计学意义(P<0.01),CAPD组尿量及ADMA排泄量与HD组、HDF组比较差异均有统计学意义(P<0.01),HD组与HDF组比较差异无统计学意义(P>0.05);HD组、HDF组、CAPD组每周透析清除ADMA的量间差异有统计学意义(P<0.05)。结论维持性血液透析患者的血清AD-MA水平明显高于健康人,CAPD清除ADMA的能力优于HD和HDF,HDF清除ADMA的能力优于HD。     

血液透析滤过治疗尿毒症皮肤瘙痒的观察及护理

目的：观察On—Line血液透析滤过（简称联机HDF）对尿毒症皮肤瘙痒的观察并总结护理体会。方法：在常规血液透析（HD）的基础上，每1-2周进行联机HDF治疗1次，采用高通量透析器APS650，面积1．3m^2。检测患者透析前后血肌酐（Cr）、尿素氮（BUN）、甲状旁腺激素（唧）的水平及皮肤瘙痒程度。结果：联机HDF对尿毒症患者皮肤瘙痒有明显疗效。透析后血清BUN、Cr、PTH较前下降明显。结论：联机HDF可以有效清除PTH，明显改善皮肤瘙痒程度。     

血液透析滤过治疗尿毒症10例临床报告

目的：观察联机血液透析滤过（On 1ine HDF）对尿毒症患者的临床疗效。方法回顾性分析10例尿毒症患者行前稀释法 On-line HDF,并与10例行常规血液透析（HD）治疗的患者进行比较,观察血清肌酐（Scr）、尿素氮（BUN）、血磷（SP）下降率及治疗中患者常见并发症和不良反应发生率。结果联机HDF治疗后血清Scr、BUN、SP水平显著降低,患者对联机HDF治疗效果和耐受性显著优于HD,透析并发症和不适症状发生率显著低于HD。结论联机HDF治疗尿毒症患者疗效优于普通透析,尤其适合心血管功能不稳定或有透析相关并发症的患者,从而提高患者治疗效果及生活质量。     

应用联机血液透析滤过治疗尿毒症的临床体会

目的观察联机血液透析滤过（On-line HDF）对尿毒症患者的临床疗效。方法回顾性分析15例尿毒症患者行后稀释法On-line HDF,并与15例行常规血液透析（HD）治疗的患者进行比较,观察血清肌酐（Scr）、尿素氮（BUN）、血磷（SP）、β2-微球蛋白（β2-M）、甲状旁腺素（PTH）下降率及治疗中患者常见并发症和不良反应发生率。结果联机HDF治疗后血清Scr、BUN、SP、β2-M、PTH水平显著降低,患者对联机HDF治疗效果和耐受性显著优于HD,透析并发症和不适症状发生率显著低于HD。结论联机HDF治疗尿毒症患者疗效优于普通透析,尤其适合心血管功能不稳定或有透析相关并发症的患者,从而提高患者治疗效果及生活质量。     

不同透析方法治疗老年尿毒症的临床分析

目的分析不同透析方法治疗老年尿毒症的临床效果。方法选取我院收治的老年尿毒症患者45例,根据透析不同方法分成3组,血液透析组(n=15)采取血液透析治疗,腹膜透析组(n=15)采取腹膜透析治疗,血液透析滤过组(n=15)采取血液透析滤过治疗,比较3组的临床效果。结果腹膜透析组患者治疗后Alb、BUN、TG、Scr、β-MG水平均与血液透析组有差异,具有统计学意义(P <0.05)。血液透析滤过组患者治疗后BUN、Scr、β-MG水平均与血液透析组有差异,Alb、BUN、TG、Scr、β-MG水平均与腹膜透析组有差异,均具有统计学意义(P <0.05)。血液透析组并发症率87.88%,腹膜透析组并发症率81.82%,血液透析滤过组并发症率9.09%,血液透析滤过组患者并发症率低于血液透析组、腹膜透析组,差异均有统计学意义(P <0.05)。3组患者尿素清除指数水平比较,差异无统计学意义(P> 0.05)。结论血液透析滤过是安全有效的老年尿毒症治疗方法,具有较高的临床价值。     

血液灌流、血液透析滤过治疗尿毒症难治性高血压对比研究

目的：探讨尿毒症难治性高血压（RH）的有效治疗方法。方法：将42例尿毒症RH行维持性血液透析（HD）患者随机分为血液灌流（HP）组和血液透析滤过（HDF）组，HP组在每周2次常规HD的同时，接受每周1次HD＋HP治疗；HDF组行每周1次常规HD治疗，接受每周2次HDF治疗。治疗前、治疗4周后分别观察两组患者血压、血浆肾素（RA）、血管紧张素Ⅱ（AngⅡ）浓度的变化。结果：两组经过4周的透析后血压、血浆RA及AngⅡ浓度明显降低，与治疗前比较差异有显著性（P〈0．01）；HP组与HDF组比较差异也有显著性（P〈0．01）。结论：尿毒症RH患者在常规HD治疗的同时接受定期HP或HDF治疗能有效地清除血浆RA、AngⅡ，降低血压，尤以HP组更方便有效，易于临床推广。     

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.     

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.