地氯雷他定联合玉屏风治疗儿童慢性荨麻疹的疗效及其作用机制

目的 观察地氯雷他定联合玉屏风治疗儿童慢性荨麻疹的疗效,探讨其作用机制。方法 选取2016年8月至2017年6月安徽省儿童医院门诊收治的43例慢性荨麻疹患儿为研究对象（设为观察组）,采用地氯雷他定联合玉屏风治疗2个月;选择本院同期健康体检儿童20例为对照组,比较观察组患儿治疗前后瘙痒程度、风团数目、风团大小评分不良反应发生情况,比较两组对象血清肿瘤坏死因子-α（TNF-α）水平变化。结果 治疗后瘙痒程度[（0.62±0.33）分vs（2.12±0.67）分]、风团数目[（1.26±0.41）分vs（10.97±2.64）分]和风团大小[（0.54±0.31）分vs（1.92±0.65）分]评分均低于治疗前,差异有统计学意义（P<0.05）;治疗前观察组患儿血清中TNF-α水平（22.98±16.82） pg/mL高于对照组（8.3±3.65） pg/mL,差异有统计学意义（P<0.05）,治疗后TNF-α水平（7.07±3.38） pg/mL与对照组差异无统计学意义（P>0.05）。随访期间观察组仅2例患儿出现轻微的嗜睡反应。结论 地氯雷他定联合玉屏风治疗儿童慢性荨麻疹效果良好,能够改善患儿的临床症状和机体的免疫异常,TNF-α可能参与慢性荨麻疹的发病机制。     

重组人脑利钠肽对老年急性心肌梗死患者经皮冠状动脉介入治疗后心功能及组织灌注的影响

目的 探讨重组人脑利钠肽对老年急性心肌梗死患者经皮冠状动脉介入（PCI）治疗后心功能及组织灌注的影响。方法 选取2015年9月至2017年2月在开封市中心医院住院治疗的急性心肌梗死且行PCI手术的老年患者96例,按照随机数字表法分为对照组和观察组,每组各48例。对照组患者采用急性心肌梗死的常规疗法,观察组患者在常规疗法基础上应用重组人脑利钠肽。术后6个月,比较两组患者心肌组织灌注水平、心功能[左心室舒张期末内径（LVEDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、舒张早期与晚期最大血流比（E/A）、左心室重量指数（LVMI）、左心室射血分数（LVEF）]以及主要的心脏不良事件情况。结果 心脏相关指标：治疗后,观察组患者的心脏指数高于对照组[（4.12±0.34）vs（3.68±0.43）],观察组患者的乳酸水平及N端前脑钠肽（NT-proBNP）水平均低于对照组[（2.51±0.34）mmol/L vs（3.42±0.52）mmol/L;（14.72±5.21）ng/mL vs（18.14±4.32）ng/mL],差异均有统计学意义（P<0.05）。心肌组织灌注水平：治疗后,观察组患者的TIMI分级3级比例高于对照组,观察组患者TIMI帧数（CTFC）低于对照组[（27.62±4.74）vs（37.34±5.11）],差异均有统计学意义（P<0.05）。心功能指标：治疗后,两组患者的LVEDd差异无统计学意义（P>0.05）,观察组患者的IVST、LVPWT、LVMI低于对照组,E/A、LVEF高于对照组,差异均有统计学意义（P<0.05）。心脏不良事件：术后6个月,观察组患者发生严重心力衰竭比例低于对照组[2.08%vs 20.83%],差异有统计学意义（P<0.05）。结论 在常规治疗基础上将重组人脑利钠肽应用于老年急性心肌梗死患者PCI术后,有助于心脏功能和组织灌注水平进一步改善,值得临床推广。     

帕利哌酮缓释片与利培酮片对女性首发精神分裂症患者糖脂代谢影响的对比研究

目的 观察对比帕利哌酮缓释片与利培酮片对女性首发精神分裂症患者糖脂代谢影响。方法 将85例在德阳市精神卫生中心治疗的女性首发精神分裂症患者随机分为观察组42例和对照组43例，分别给予帕利哌酮缓释片和利培酮片单药治疗2个月。治疗前后测量体质量指数（BMI）、腰围、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDLC）、低密度脂蛋白（LDLC）、空腹血糖（FPG）、餐后2 h血糖（2 h PG），采用阳性和阴性症状量表（PANSS）进行疗效评价。结果 治疗前两组PANSS总分及各因子分（阳性症状、阴性症状和精神病性分）及治疗后两组PANSS总分及各因子分分别比较，差异均无统计学意义。与治疗前相比，治疗后两组PANSS总分[观察组（47.94±13.64）分，对照组（49.07±12.56）分]及各因子分均显著低于治疗前PANSS总分[观察组（86.31±9.21）分，对照组（85.95±9.77）分]及各因子分，差异具有统计学意义（P<0.05）。治疗前两组患者糖、脂各指标比较，差异无统计学意义。治疗后对照组TG、TC、LDLC、BMI和腰围上升，HDLC降低，与治疗前比较，差异具有统计学意义（P<0.05）；观察组BMI和腰围与治疗前比较明显变大，差异具有统计学意义（P<0.05）。观察组治疗后TG、TC、LDLC、BMI和腰围均显著低于对照组，HDLC显著高于对照组，差异具有统计学意义（P<0.05）。两组FPG、2hPG、SBP和DBP比较，差异无统计学意义。观察组患者不良反应发生率明显低于对照组（P<0.05）。结论 帕利哌酮缓释片和利培酮对女性首发精神分裂症患者具有相同的疗效，但是帕利哌酮缓释片对女性患者血脂、BMI和腰围的影响较小，要优于利培酮片。     

70岁及以上非肥胖腹股沟疝患者临床路径预防性使用抗菌药物的临床效果

目的 探讨非肥胖腹股沟疝患者（≥70岁）围手术期是否使用预防性抗菌药物在临床路径（CP）中的效果。方法 选择合肥市第三人民医院普外科2017年2月至2019年12月CP中控制好合并症的76例非肥胖高龄腹股沟疝患者,按照随机数字表法,分为试验组（38例）与对照组（38例）。试验组患者不使用抗菌药物,对照组患者使用预防性抗菌药物。分析两组患者术后切口情况及相关指标。结果 试验组患者术后切口并发症发生率为7.89%,对照组为5.26%,两组差异无统计学意义（P>0.05）。两组患者术前白细胞计数[（5.52±1.28）×10⁹/L vs（5.73±1.59）×10⁹/L]、中性粒细胞比值[（63.91±6.55）% vs（63.77±9.18）%]、C反应蛋白（CRP）[（3.35±0.80）mg/L vs（3.30±0.79）mg/L]及最高体温[（36.59±0.44）℃ vs（36.62±0.36）℃]进行比较,差异无统计学意义（P>0.05）。两组患者术后白细胞计数[（5.98±1.37）×10⁹/L vs（6.11±1.66）×10⁹/L]、中性粒细胞比值[（65.22±6.49）% vs（64.98±9.09）%]、CRP[（7.47±0.85）mg/L vs（7.13±0.86）mg/L]及最高体温[（36.84±0.45）℃ vs（36.81±0.34）℃]进行比较,差异无统计学意义（P>0.05）。两组患者手术前后白细胞计数、中性粒细胞比值、CRP及最高体温差值进行比较,差异无统计学意义（P>0.05）。。结论 对于CP中控制好合并症的非肥胖高龄腹股沟疝患者,围手术期可以不使用预防性抗菌药物。     

早期口服营养液对肝硬化胃食管静脉曲张出血患者内镜治疗后再出血的预防作用

目的 观察胃食管静脉曲张出血（GEVB）患者行内镜术后,早期给予肠内营养液对患者再出血的预防作用。方法 选取2013年3月至2015年12月于三门峡市中心医院行内镜术的GEVB患者108例,随机分成治疗组和对照组,每组各54例,所有行内镜治疗患者12 h后进食。治疗组于内镜治疗后12 h进食常规流质饮食,同时口服补充营养液,对照组常规流质饮食无营养液补充,内镜治疗后14天比较两组患者再出血率、营养不良情况、感染情况以及肝功能指标。结果 治疗组患者在观察期14 d内无出血情况发生,对照组有7例患者再出血,差异有统计学意义（P=0.019）;两组患者在观察期内感染情况,包括尿路感染、肺部感染及自发性腹膜炎的发生率及病死率比较,差异无统计学意义（P>0.05）,治疗第14天两组患者肝生化指标比较,治疗组中前清蛋白和清蛋白高于对照组[（161.5±27.6）mg/mL vs（150.1±29.9）mg/mL,（31.6±4.9）g/mL vs（27.2±4.7）g/mL],差异有统计学意义（P<0.05）,且治疗组转氨酶和总胆红素低于对照组[（20.1±4.6）μmol/L vs（26.9±4.9）μmol/L,（41.8±5.9）U/L vs（54.7±5.4）U/L;P<0.05）],治疗组患者营养不良情况较对照组有所改善（P<0.05）。结论 早期给予肠内营养液可降低行内镜治疗的GEVB患者早期再出血的风险,改善患者营养不良情况,促进其肝功能恢复。     

益气活血方联合沙库巴曲缬沙坦对慢性心衰患者的疗效观察

目的 观察中药益气活血方配合沙库巴曲缬沙坦在慢性心衰治疗中的疗效及对患者心率变异性指标、血清NT-proBNP、MMP-9水平的影响。方法 将2017年7月-2018年8月期间收治的126例慢性心衰患者随机分为沙库巴曲组（61例）和益气沙库组（65例）,沙库巴曲组均给予常规抗慢性心衰基本治疗和沙库巴曲缬沙坦治疗,益气沙库组在沙库巴曲组基础上加以益气活血方治疗,观察2组治疗6个月后的临床疗效、心率变异性指标、血清NT-proBNP、MMP-9及不良反应情况。结果 益气沙库组的临床总有效率显著优于沙库巴曲组（89.23%vs 72.13%）（χ²=5.979,P=0.031）;治疗后,2组心率变异性指标（SDNN、SDANN、pNN50）及NT-proBNP、MMP-9比较均较治疗前改善和降低。益气沙库组治疗后心率变异性指标SDNN、SDANN、pNN50显著高于沙库巴曲组[（129.53±34.26 vs 114.28±31.84）ms、（112.31±36.02 vs 101.44±29.59）ms、（8.71±7.64 vs 6.37±5.80）%]（P<0.05）;益气沙库组治疗后血清NT-proBNP、MMP-9显著低于沙库巴曲组[（207.45±51.71 vs 268.62±74.15）pg·mL^-1、（561.79±64.03 vs 688.19±87.94）pg·mL^-1]（P<0.05）。结论 中药益气活血方配合沙库巴曲缬沙坦在慢性心衰治疗中的疗效显著,该治疗方案可改善患者心率变异性指标、NT-proBNP、MMP-9指标的异常情况。     

芬太尼透皮贴剂联合吗啡皮下注射治疗晚期肝癌介入治疗后疼痛的护理观察

目的 观察芬太尼透皮贴剂联合吗啡皮下注射在晚期肝癌介入术后疼痛护理应用中的优势。方法 回顾性分析166例晚期肝癌介入治疗后疼痛治疗护理的临床资料,对89例芬太尼联合吗啡治疗组和77例吗啡治疗组在疼痛评分、缓解率两方面数据进行比较,并进行统计学分析;同时记录各组治疗中的副反应。结果 与吗啡治疗组比较,芬太尼联合组疼痛评分,在12 h（1.97±0.56 vs 3.23±1.49,P<0.05）以及24 h（1.63±0.44 vs 4.19±1.68,P<0.01）均有显著降低。与吗啡治疗组比较,芬太尼联合组介入治疗后疼痛总缓解率,在介入后12 h（92.1% vs 76.6%,P<0.05）以及24 h（97.8% vs 70.1%,P<0.05）均有显著缓解。结论 晚期肝癌介入治疗后联合使用吗啡皮下注射+芬太尼透皮贴剂外贴治疗,可以显著提高患者介入术后72 h内的疼痛缓解率。     

临床护理路径在原发性肝癌介入治疗中的应用效果

目的 探讨临床护理路径在原发性肝癌介入术的应用效果。方法 选取2013年1月至2014年8月在阜阳市第二人民医院行原发性肝癌介入术治疗的80例患者,随机分为观察组和对照组,每组40例。观察组给予临床护理路径护理,对照组给予常规护理,对两组患者的住院时间、并发症的发生率、医疗费用和护理工作满意度进行比较。结果 观察组住院时间、并发症发生率、医疗费用及优质护理满意度均优于对照组[（7.02±2.51）d vs（11.01±4.33）d、10.53% vs 30.00%、（5 423.13±301.38）元 vs（6 287.38±467.23）元、94.74% vs 77.50%],差异均有统计学意义（P<0.05）。结论 原发性肝癌介入治疗的患者实施临床护理路径能够缩短住院时间、降低并发症发生率、减少医疗费用和提高患者满意度。     

经椎间孔腰椎椎体间融合术联合补肾活血方治疗腰椎间盘突出症的疗效

目的 观察经椎间孔腰椎椎体间融合术（TLIF）联合补肾活血方治疗腰椎间盘突出症的临床疗效及安全性。方法 选取2014年2月至2018年2月在阜阳市太和县人民医院骨科就诊的176例腰椎间盘突出症患者，采用随机数字表法分为治疗组与对照组，每组88例。治疗组患者接受TLIF联合补肾活血方治疗，对照组患者接受TLIF治疗。观察两组患者的临床总有效率、视觉模拟评分（VAS）和日本骨科协会评估治疗分数（JOA）及不良事件发生情况。结果 治疗组患者的总有效率高于对照组（94.32%vs 88.64%），VAS评分、JOA评分均优于对照组[（4.75±0.98）分vs（3.47±1.04）分，（10.59±2.54）分 vs（5.81±3.11）分]，差异有统计学意义（P<0.05），治疗组患者治疗前后VAS评分、JOA评分差值均高于对照组，差异有统计学意义（P<0.001），且治疗组患者无不良事件的发生。结论 TLIF联合补肾活血方可以有效缓解腰椎间盘突出症患者的疼痛，改善患者的功能活动，疗效确切且安全性高。     

比伐卢定对急性冠状动脉综合征患者介入术后内皮损伤和炎性反应的影响

目的 探究比伐卢定对急性冠状动脉综合征（ACS）患者介入术后内皮损伤和炎性反应的影响。方法 选取2015年2月至2016年3月南阳市中心医院收治的90例行PCI患者,随机数表法分为观察组与对照组各45例。对照组采用常规肝素治疗,观察组则采用比伐卢定治疗。对比两组手术前后内皮损伤指标[血浆内皮素1（ET-1）、一氧化氮（NO）、血浆血管性假血友病因子（vWF）]、炎性指标[白介素-18（IL-18）、白介素-10（IL-10）、超敏C反应蛋白（hs-CRP）]、心功能指标[左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）、脑钠肽（BNP）]变化及心脑血管不良事件发生率。结果 术前,两组患者内皮指标比较,差异无统计学意义（P>0.05）,术后24 h,观察组ET-1及vWF水平均低于对照组[（68.37±6.17）ng/L vs（101.83±10.24）ng/L、（514.33±86.57）U/L vs（588.92±98.46）U/L],观察组NO水平高于对照组[（72.42±7.06）mmol/L vs（58.26±6.49）mmol/L],差异均有统计学意义（P<0.05）。观察组IL-18水平（53.84±23.67）pg/mL、hs-CRP水平（7.22±2.74）mg/L、LVEDV水平（88.63±10.24）mL、LVESV水平（32.47±4.26）mL及BNP水平（74.82±7.94）ng/L均低于对照组IL-18水平（73.58±26.79）pg/mL、hs-CRP水平（8.67±3.56）mg/L、LVEDV水平（95.16±9.58）mL、LVESV水平（44.83±5.72）mL及BNP水平（163.51±15.44）ng/L,IL-10水平（43.61±6.08）pg/mL及LVEF水平（51.82±10.19）%高于对照组IL-10水平（33.56±4.18）pg/mL及LVEF水平（39.14±9.28）%,差异有统计学意义（P<0.05）。两组患者术后1个月心脑血管不良事件发生率比较,差异无统计学意义（P>0.05）。结论 ACS患者术后采用比伐卢定治疗可有效缓解内皮损伤,同时可降低炎性反应,恢复心功能,治疗安全性高。     

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.     

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.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

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.