急性百草枯中毒预后影响因素的临床分析

目的分析影响百草枯中毒病人预后的因素,研究改善患者预后的临床诊治方案。方法随机选取该院2010年11月1日至2012年1月31日期间急性百草枯中毒病例共49例,进行前瞻性观察研究,根据百草枯中毒严重程度指数(severity indexof paraquat poisoning,SIPP)高低分为低百草枯中毒严重程度指数组(A组)(≤20 h×mg.L-1)35例、高百草枯中毒严重程度指数组(B组)(20 h×mg.L-1)14例;按有无血液灌流分为血液灌流组26例、未行血液灌流组23例;根据患者病情转归分为存活组20例、死亡组29例。使用高压液相色谱法测定患者血清百草枯药物浓度,定期监测患者肝、肾功能、血气分析,并行肺部高分辨CT检查了解肺纤维化情况。分析百草枯血清药物浓度、脏器受损情况、肺纤维化、氧合指数等与患者预后的关系。结果 A、B两组比较,B组肺部纤维化范围大、脏器功能受损数目多,差异有统计学意义(分别P=0.022和P=0.01);B组氧合指数较低,差异有统计学意义(P=0.001)。存活组与死亡组比较,死亡组肺部纤维化范围较大、死亡组脏器功能受损数目多,差异有统计学意义(P0.05);死亡组氧合指数较低,差异有统计学意义(P0.05)。A、B两组比较,死亡率无统计学意义(P=0.081)。存活组与死亡组相比,服毒量、血清药物浓度、百草枯中毒严重程度指数差异均有统计学意义(P0.05)。血液灌流组与未行血液灌流组比较,存活率无统计学意义(χ2=0.882,P=0.348)。结论影响急性百草枯中毒患者预后的因素分别为服毒剂量、肺纤维化范围、氧合指数、脏器功能损害个数。提倡早期综合治疗,保护脏器功能,以提高中毒患者存活率。     

百草枯中毒致胸部损害的CT分析

目的探讨CT在百草枯中毒胸部损害的应用价值。方法回顾性分析5例口服百草枯中毒致胸部损害的CT资料。结果 5例患者首次CT检查4例表现为肺内斑点状、斑片状、线条状密度增高影,伴少量胸腔积液;1例胸部未见明显异常。5例首次CT复查肺部病变和胸腔积液同时吸收1例,仅肺部病变吸收1例;1例首次CT检查胸部未见明显异常者出现肺部病变和胸腔积液;2例肺部病变范围增大;1例胸腔积液增多。4例第2次复查2例肺部病变和胸腔积液增多。3例第3次复查胸部病变基本吸收。结论 CT对百草枯中毒后胸部损害的评估、治疗和判断疗效有一定的指导价值。     

百草枯中毒致肺损伤的64层螺旋CT表现

目的探讨百草枯中毒肺部64层螺旋CT表现及临床价值。方法对百草枯中毒患者的不同时期分别行胸部64层螺旋CT检查,并对74例胸部CT影像征象进行回顾性分析。结果 74例患者出现了肺纹理增多、肺实变和肺纤维化。结论百草枯中毒在肺部有明确的影像学征象,其影像学表现与病理密切相关,多层CT征象与中毒机制的对照研究对临床治疗有非常重要的指导意义。     

急性百草枯中毒17例的救治体会

通过对本院急诊科2011·08～2013·0317例百草枯中毒患者（死亡4例,存活13例）的临床资料进行回顾性分析,探讨百草枯中毒的预后因素和合理的治疗方案。结果发现,服毒量是影响预后的关键,但合理的综合治疗能使部分口服超致死量患者存活。出现周围血白细胞明显升高,肝肾功能受损出现早、持续时间长,肺部病变出现早、范围大是预后不良的重要因素;及早洗胃、有效导泻、反复血液净化、早期应用抗氧化损伤药物、肾上腺皮质激素及免疫抑制剂可降低病死率;中药在抗氧化损伤和抗肺纤维化方面有其潜力;但大量激素及免疫抑制剂因其严重不良反应,仍需根据患者中毒方式及量调整使用剂量。     

百草枯肺损伤MSCT征象与中毒机制的对照研究

目的 探讨百草枯中毒肺MSCT(多层计算机X线断层扫描)征象及其中毒机制.方法 对百草枯中毒患者的不同时期分别行胸部MSCT检查,并对30例胸部MSCT影像征象及其中毒机制进行回顾性分析.结果 30例病例均出现了肺纹理增多、磨玻璃征,部分出现肺实变、胸水和气肿,存活到晚期者均见到肺纤维化.结论 百草枯中毒在肺部有明确的影像学征象,其中毒机制与影像学表现密切相关,MSCT征象与中毒机制的对照研究对临床治疗有不可或缺的指导意义.     

外周血中性粒细胞绝对值/淋巴细胞绝对值比值在急性百草枯中毒早期预后评估中的价值

目的 探讨外周血中性粒细胞绝对值/淋巴细胞绝对值比值(NLR)在急性百草枯中毒早期评估预后的价值.方法 选择2014年1月-2015年10月第四军医大学西京医院收治的百草枯中毒患者164例,根据随访结果分为死亡组和生存组,观察影响急性百草枯中毒死亡的危险因素,评价NLR对急性百草枯中毒预后的评估价值.结果 164例患者存活65例,死亡99例,病死率60.37％.死亡组血白细胞计数、中性粒细胞、NLR高于存活组,血淋巴细胞、血钾低于存活组(P＜0.05).血淋巴细胞、NLR是百草枯中毒患者死亡的独立危险因素,NLR＞ 12.07时预测百草枯中毒患者30 d病死率的特异度为96.9％,敏感性为65.7％.结论 血NLR对百草枯中毒的预后有较高的评估价值.     

百草枯肺儿童肺部影像学改变和预后结局的临床分析

目的:总结百草枯肺儿童的肺部影像学改变和预后结局,提高随访诊治经验。方法:回顾性分析百草枯中毒合并肺部损害的52例患者的临床资料,统计分析肺部影响学改变情况,电话随访临床预后结局。结果:百草枯肺损害早期(7天)主要表现为双肺纹理增多、斑片影、条索影,可出现气肿表现,如纵膈积气等;中期(7~14天)主要表现为斑片影及磨玻璃密度影,伴不同程度的间质改变;晚期(14天)表现以肺间质纤维化为主。在明确预后结局的患儿中,病死率较高,为52.78%,平均死亡离服毒时间为8.84±7.81天。结论:百草枯肺是百草枯中毒的主要并发症和死亡原因,但儿童肺部发育与成人有差异,临床应加强对肺部影像学征象和临床预后结局的长期规范化的随访观察。     

百草枯中毒肺损伤的治疗前后CT表现特征与预后相关性分析

目的：探讨百草枯中毒所致肺损伤患者在不同剂量、治疗不同时期的CT影像学特征以及临床预后。方法选取我院2011～2013年收治的50例百草枯中毒患者,对患者不同剂量、不同治疗分期的CT表征与临床预后进行观察。结果患者早期治疗中的主要特征为肺纹理增多、纵隔气肿、磨玻璃征或无明显异常,而中期的主要特征为肺纹理增多、纵隔气肿、磨玻璃征、肺间质纤维化,治疗晚期阶段患者存活患者主要表现为肺间质纤维化。少量组22例患者均好转出院;中量组21例患者中15例好转出院,6例预后不良;大量组患者9例全部死亡。结论百草枯中毒患者肺损伤包括肺实质与间质同时受损,以纵隔气肿、磨玻璃征、实质病变、肺气肿与胸腔积液为主,晚期主要表现为间质纤维化,可以明确百草枯中毒肺损伤治疗具有明显的CT表征,且与预后存在明显相关性。     

百草枯中毒肺损伤的影像学征象与病理基础对照分析

目的:探讨百草枯(Paraquat,PQ)中毒致肺损伤的影像学征象,并与病理学基础对照分析.方法:对8例PQ中毒患者的胸片及胸部CT资料进行回顾性分析.结果:病变早期(＜7 d)以肺纹理增多、模糊为主,部分出现磨玻璃样变；中期(7～14 d)主要表现为两肺弥漫磨玻璃样变和两下肺基底段肺实变；晚期(3周后)以肺间质纤维化及肺实质损害为主.结论:胸片、CT均能很好显示PQ中毒肺损伤的病理演变过程,对评估预后及指导临床治疗有重要意义.     

47例自服百草枯中毒患儿病例分析

目的:通过分析47 例儿童自服百草枯中毒病例的特征、治疗情况及预后,为防治儿童百草枯中毒措施的制定提供参考。 方法:回顾性分析某三甲儿童医院自2012年1月至2017年1月自服百草枯中毒患儿的临床资料,分析其人口学特征、临床特征、影响预后的因素以及随访生存情况。结果:自服患儿男29例,女18例,年龄(12.3±1.7)岁。所有患儿均来自农业种植地区,留守儿童占比42.6%(20/47)。百草枯均为浓度20%的水剂,服药量10(5,20)mL。34例患儿出现肺、肾、肝、心等两个以上器官损害。服药7 d后26例患者出现呼吸困难。病死率48.9%(23/47),死亡时间分布在中毒后30 d内,早期病死率高。将病例资料分为存活组、死亡组,与死亡组相比,存活组患儿服药量少、就医时间短(P<0.01)。结论:儿童自服百草枯以青少年为主,具有服药量大、致死率高的特点。急性百草枯中毒缺乏特效解毒药物,应采取综合治疗措施,中毒后早期的医疗干预尤为重要。     

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.     

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.