四氯化碳两种途径亚急性实验染毒时某些肝酶指标的对比研究

本文用CCl_41.356g/kg和5.87g/kg分别对大鼠进行皮下和呼吸道静式染毒,为期8周亚急性中毒试验,研究临床常用血清肝酶指标的变化。结果发现:CCl_4除使大鼠体重增长减慢外,第1周起出现肝细胞脂变、浊肿,进而坏死、纤维增生和肝硬化;肝糖元及SHD酶活性减少或消失,G-6-P酶活性先升高后降低的病理形态和组织化学的改变。与此同时或稍后出现SGPT和SGOT活性升高,持续至第8周。停药两周,肝病理改变趋于恢复,SGPT和SGOT活性也恢复至接近正常,两肝酶与病理改变相平行。AKP酶活性第4周后才升高;ChE酶似有先升高后降低趋势,但无明显差异性;γ-GT酶变化不规则。提示CCl_4亚急性中毒时,SGPT和SGOT酶活性升高与肝损关系较密切,可作临床早期诊断指标。血清AKP和ChE酶亦一定程度反映肝损的发展情况,可供作临床观察病情发展的辅助指标。     

Dénutrition et affections neuromusculaires de l''adulte et de l''adolescent

Patients with neuromuscular diseases have protein malnutrition related to the muscle mass decrease. When associated with a decrease in food intake below requirements, patients become cachectic. Respiratory complications are then frequent and severe. In case of respiratory distress, the acute stress might aggravate the protein loss which will be particularly difficult to restore if the muscular activity is reduced. Although there are no curative therapies for neuromuscular diseases but all symptomatic treatments are useful in maintaining function and quality of life; therefore the prevention of malnutrition is essential. Nutritional care is difficult because of the lack of norms for body composition and protein and energy requirements. The nutritional support must take into account the swallowing difficulties, the digestive and polyvisceral involvement and the natural history of the disease. The nutritional support is usually enteral. Feeding through a gastrostomy tube, feasable at home, has improved the quality of life of the patient. Parenteral nutrition is prescribed for limited periods for surgery or acute respiratory failure.     

Injecting nation: achieving control of hepatitis C in Australia

Since Australia banned heroin in 1953 consumption of illicit drugs, deaths, crime and corruption related to drugs have steadily increased. Injecting drug use (IDU) in Australia is now a significant public health problem linked each year to approximately 500 overdose deaths and more than 6000 hepatitis C infections. At least 85% of prevalent and incident hepatitis C cases in Australia are injecting drug users (IDUs) with annual incidence estimated at 15%. Although poorly documented, increasing numbers of patients with end-stage liver disease from hepatitis C now appear to present in Australia. This reflects a heroin-injecting epidemic commencing a quarter of a century ago, the close association between drug injecting and hepatitis C and the long delay between hepatitis C infection and complications. The overall health and economic burden of hepatitis C may soon exceed HIV. Control is far more difficult to achieve for hepatitis C than HIV because of much higher baseline prevalence levels and far greater infectiousness by blood to blood spread. Transmission appears to follow minimal breaches of infection control guidelines. Hepatitis C has not yet become a priority public health issue in Australia. No national prevention strategy has been proposed. Prevention strategies (such as needle exchange or methadone) which controlled HIV among IDUs should be expanded, with the expectation of some useful reduction of spread but without achieving control of hepatitis C. Other options for control must be considered. Eradicating illicit drug use in Australia is unachievable. Virtually eradicating injecting drug use by facilitating a switch to non-injecting routes of administration (NIROA) is achievable (although difficult) and this could control hepatitis C. NIROA will have the probable additional benefit of reducing drug overdose deaths. NIROA has begun recently to replace injecting in several countries without government intervention. Powerful cultural, pharmacological and economic factors strongly reinforce drug injecting. Economic impediments to NIROA could be reduced by drug policy reform. Facilitating a switch to NIROA carries some risk of increased discrimination directed against an already marginalized population. A major obstacle to harm reduction is the common assumption that any relaxation of drug policy invariably leads to increased consumption. Switching the predominant route of administration of illicit drugs from IDU to NIROA should be the major focus of national efforts to control hepatitis C and overdose deaths in Australia.     

Electromotive administration of intravesical bethanechol and the clinical impact on acontractile detrusor management: introduction of a new test

PURPOSE: It is often difficult to determine the functional status of the detrusor muscle in patients with detrusor areflexia. We performed a clinical study to establish a test defining residual detrusor capacity in such patients. MATERIALS AND METHODS: In phase 1, 5 controls with detrusor areflexia were tested with an intravesical instillation of 20 mg. bethanechol in 150 cc of sodium chloride 0.3% with and without 20 mA. of pulsed current applied via an electrode catheter through the saline. Cystometry simultaneously recorded intravesical pressure changes. In phase 2, 45 patients with detrusor areflexia were tested with electromotive administration of intravesical bethanechol. In phase 3, 25 mg. bethanechol given orally once daily were prescribed for 15 patients and voiding control was assessed after 6 weeks of therapy. RESULTS: Neither bethanechol without current nor current through saline only led to increased intravesical pressure. However, we noted a mean pressure increase of 34 cm. water during the electromotive administration of bethanechol in 24 of 26 patients with areflexia and neurological disease compared to only 3 cm. water in 3 of 11 with a history of chronic bladder dilatation. Oral bethanechol restored spontaneous voiding in 9 of 11 patients who had had a positive response to the electromotive administration of bethanechol, whereas all 4 without a pressure increase during the electromotive administration of bethanechol did not void spontaneously. CONCLUSIONS: Electromotive administration of intravesical bethanechol identifies patients with an atonic bladder and adequate residual detrusor muscle function who are candidates for restorative measures, such as oral bethanechol and intravesical electrostimulation. Those who do not respond to the electromotive administration of bethanechol do not benefit from oral bethanechol and are candidates for catheterization.     

微针技术的研究进展

微针以微机电系统(m icroelectro-mechani-cal systems,MEMS)技术为基础,在近年来发展迅速。本文主要介绍微针的制备方法,插入皮肤的机制,微针给药的特点以及微针的应用,详细介绍了微针在经皮给药中的应用。由于微针给药可以避免胃肠道对药物的降解作用和肝脏的首过效应等口服给药的缺点,并可消除注射给药时引起的疼痛,随着其发展不断完善,微针给药将会有广阔的应用前景。     

Arenium ions are not obligatory intermediates in electrophilic aromatic substitution

Our computational and experimental investigation of the reaction of anisole with Cl₂ in nonpolar CCl₄ solution challenges two fundamental tenets of the traditional S_EAr (arenium ion) mechanism of aromatic electrophilic substitution. Instead of this direct substitution process, the alternative addition–elimination (AE) pathway is favored energetically. This AE mechanism rationalizes the preferred ortho and para substitution orientation of anisole easily. Moreover, neither the S_EAr nor the AE mechanisms involve the formation of a σ-complex (Wheland-type) intermediate in the rate-controlling stage. Contrary to the conventional interpretations, the substitution (S_EAr) mechanism proceeds concertedly via a single transition state. Experimental NMR investigations of the anisole chlorination reaction course at various temperatures reveal the formation of tetrachloro addition by-products and thus support the computed addition–elimination mechanism of anisole chlorination in nonpolar media. The important autocatalytic effect of the HCl reaction product was confirmed by spectroscopic (UV-visible) investigations and by HCl-augmented computational modeling.Interest in the chemistry of electrophilic aromatic substitution reactions continues because of their widespread application for the production of a great variety of chemicals and materials (1–4). Electrophilic substitution, considered to be the most characteristic reaction of aromatic systems, is typically described in textbooks, monographs, and reviews by the two-stage S_EAr mechanism depicted in Fig. 1 (5–11). Arenium ion (σ-complex) intermediates are often ascribed to Wheland (9) inaccurately, since Pfeiffer and Wizinger (10) laid out the principles of such species for bromination in 1928. Following Brown and Pearsall (11), they are widely believed to have σ-complex structures. Arenium ions (σ-complexes) (9–11) are widely accepted to be obligatory intermediates and are used to rationalize ortho/para vs. meta position orientation preferences (6–11).Open in a separate windowFig. 1.Typical depiction of the arenium ion mechanism for S_EAr reactions.We now reinforce our challenges (12, 13) of this conventional “reaction mechanism paradigm” (14) by a combined computational and experimental study of the facile chlorination of anisole (methoxybenzene) with Cl₂ in CCl₄ solution (15, 16). We find that Fig. 1 is not the favored pathway. Instead, addition reactions of Cl₂ to anisole have the lowest activation energies (Fig. 2). Ready HCl elimination from the initially formed adducts leads to ortho- and para-chloroanisole as the predominate products. This addition–elimination (AE) mechanism (the historical antecedent to Fig. 1) (17–26) predicts the same positional orientation as the usually assumed direct substitution (“S_EAr”) alternative. Instead of this classic S_EAr mechanism (Fig. 1), we find that direct concerted substitution, not involving an arenium ion, σ-complex (“Wheland”) (9–11) intermediate, competes energetically with the AE route. Like some earlier computational studies on aromatic substitution (12, 13, 27, 28) (Rzepa H, www.ch.imperial.ac.uk/rzepa/blog/?p=2423, accessed March 10, 2013), our study finds no such intermediates in the direct substitution of anisole by Cl₂. A concerted mechanism without an arenium ion intermediate was computed at some levels for the related arene nitrosation, but reaction medium and counter ion effects were not considered. Gwaltney et al. (28) reported a single concerted transition state after reoptimizing all saddle points at CCSD(T)/6-31G(d,p) and modeling bulk solvation by the Onsager approximation, and Rzepa (www.ch.imperial.ac.uk/rzepa/blog/?p=2423, accessed March 10, 2013) also found a concerted transition state including a trifluoroacetate counterion. Instead, one-step reactions via single transition states take place (Fig. 2). Our experimental investigations of the chlorination of anisole in CCl₄ solution revealed tetrachloro by-products, which must have arisen by further reaction of intermediate dichloro-adducts. Both our UV-visible (UV-VIS) spectroscopic investigation and our theoretical modeling of this reaction clearly verified the autocatalytic effect of the HCl by-product, in harmony with Andrews and Keefer’s (29, 30) early experimental kinetic studies of the chlorination of arenes, which found that HCl reduces the activation barriers significantly.Open in a separate windowFig. 2.The HCl-catalyzed concerted and addition–elimination pathways of para-chlorination of anisole in nonpolar media.We also applied reliable theoretical methods to model a typical experimental example of the highly investigated S_EAr electrophilic aromatic halogenations, the electrophilic chlorination of anisole by molecular chlorine in simulated CCl₄ solution (15, 16). Although the elucidation of the classic S_EAr mechanism [Fig. 1, involving the initial formation of a π-complex, followed by a transition state leading to a σ-complex (arenium) intermediate in the rate-controlling stage, and, finally, proton loss from the ipso-position leading to the reaction product] is considered to be a triumph of physical organic chemistry (1, 31–37), an alternative addition–elimination pathway leading to substitution products has been discussed since the 19th century (19–26, 38, 39). Nevertheless, it is commonly believed that the classic multistep S_EAr mechanism involving the formation of a σ-complex intermediate in the rate-controlling stage is the only mechanistic route to aromatic substitution products. Our present and previous (12, 13) results challenge the generality of such traditional interpretations. Although the initial stages of the alternative AE route seem unattractive because aromaticity is lost, many arenes are known experimentally to give addition products in considerable amounts (19–26, 38, 39). Thus, de la Mare (21, 25, 38, 39) demonstrated the formation of halogen adduct intermediates. Polybenzenoid hydrocarbons (PBHs) react with halogens to give isolable addition products, which then give substitution products easily by hydrogen halide elimination (23). Our computational investigations of arene bromination with molecular bromine (12) and sulfonation with SO₃ (13) provided clear evidence that the mechanisms of the inherent substitution reactions (i.e., uncatalyzed, gas phase, or weakly solvated) are concerted and do not involve the conventional σ-complex (or any other) intermediates. Moreover, the energetics of the bromination processes document the significance of competition between AE and direct substitution mechanisms leading to the same substitution products. Thus, the computed barrier in a simulated nonpolar (CCl₄) medium is 4 kcal/mol lower for Br₂ addition to benzene (followed by HBr elimination) than that for the direct substitution pathway to bromobenzene (12).Previous theoretical studies of electrophilic aromatic halogenation processes have been based on the classic S_EAr mechanism, involving arenium ion intermediates (Fig. 1). Osamura et al.’s (40) Hartree-Fock computations of the AlCl₃-catalyzed electrophilic aromatic chlorination mechanism found an initial π-complex, a transition state preceding the intermediate σ-complex, and a second transition state leading to final products. Aluminum chloride was important as a Lewis acid catalyst throughout the process. AlCl₃ coordination polarizes Cl₂ and thereby assists its reaction with the arene. Rasokha and Kochi (41) considered the interaction of Br₂ with benzene and toluene in detail in their survey of theoretical and experimental data on the prereactive charge-transfer complexes in electrophilic aromatic substitutions. They argued that the structures and properties of the prereactive complexes provide important mechanistic insights for the S_EAr reactions. Wei et al.’s (42) theoretical study of the iodination of anisole by iodine monochloride at the B3LYP/6-311G* and MP2//B3LYP/6-311G* levels (B3LYP, Becke''s three parameter hybrid functional, using the Lee-Yang-Parr correlation functional; MP2, second order Møller-Plesset perturbation theory computations) found that the highest energy transition state precedes the formation of an intermediate, which they interpreted to be a σ-complex. Instead, the structure of this complex represents a protonated iodobenzene. Volkov et al.’s MP2/LANL2DZ(d)+ study (43) of the chlorination of benzene established that dimers of group 13 metal halides catalyzed the processes more effectively. Optimized geometries of π- and σ-complexes as well as transition structures were reported. Theoretical investigations by Ben-Daniel et al. (44) and by Filimonov et al. (45) of the chlorination of benzene with Cl₂ (and other related processes) reported structural details of transition states purported to lead to the chlorobenzene product. Our reinvestigations revealed errors in major suppositions of both these studies. Our IRC computations show clearly that the transition states in question lead to 1,2 Cl₂–benzene addition products (rather than to chlorobenzene). Zhang and Lund (46) investigated the neat chlorination of toluene by Cl₂ experimentally and theoretically at B3LYP/cc-pVTZ(-f) [cc-pVTZ(-f), correlation consistent polarized triple-zeta without f-functions basis set]. Although we verified their reported geometry of the concerted transition state (figure 6 in ref. 46), our stability check revealed that its wavefunction is unstable. This casts doubt on their conclusions because of the homolysis vs. heterolysis issues. In contrast, all wavefunctions in our paper were checked and all are stable. Most prior theoretical studies of S_EAr halogenations did not consider the connections between transition states, intermediates, and products explicitly, as we have done.Experimental findings not always have been in accord with the prevailing mechanistic assumption for aromatic halogenation: that arenium ion formation is the rate-limiting step. Thus, Olah et al. (47), Kochi and coworkers (48), and Fukuzumi and Kochi (49) have emphasized that substrate and positional selectivity are inconsistent (e.g., low toluene/benzene reactivity ratios but high toluene ortho–para vs. meta regiospecificity) for some electrophiles under certain conditions. This disparity indicates the existence of at least one other mechanistic pathway. It has been suggested that π-complexes may control product formation. Olah et al.’s (47) kinetics of the ferric chloride-catalyzed bromination of benzene and alkyl benzenes provided strong evidence for low substrate selectivity in the rate-determining step, which precedes the formation of a σ-complex intermediate (Fig. 1). High positional selectivity is governed by the transition state associated with the second step of the reaction.However, our earlier study (50) examined the possible participation of π-complexes in the key mechanistic steps of S_EAr bromination reactions in detail but found no link between the energy of formation of these complexes and the overall reactivity. Although there is no doubt that π-complexes form easily (via essentially barrierless processes) in most S_EAr reactions after mixing the electrophile and the aromatic substrate, it is unlikely that these low-energy “bystander” structures influence rates of S_EAr reactions significantly. Thus, the lack of accord between substrate and positional selectivity, established by Olah et al. (47), Kochi and coworkers (48), and Fukuzumi and Kochi (49) may be due to other mechanistic differences. De la Mare and Bolton (21) and de la Mare (51) have stressed the plurality of aromatic substitution mechanisms, depending on the substrate and the conditions.Reactive substrates are known to undergo uncatalyzed aromatic substitution in nonpolar solvents at room temperature. Thus, our computational investigations modeled Watson’s careful experiments on the chlorination of anisole in CCl₄ at 25 °C (15, 16). His low conversion (25%) conditions for chlorophenol permitted more accurate determination of the initial product ratios (and avoided further Cl₂ additions to 4-chloroanisole, which ultimately gave 1,3,4,5,6-pentachloro-4-methoxycyclohexene). After introduction of gaseous Cl₂ into a CCl₄ solution of anisole for 1 h, the products were 4-chloroanisole (76%), 2-chloroanisole (13.6%), 2,6-dichloro anisole (2.1%), 2,4-dichloroanisole (3.0%), and 2,4,6-trichloroanisole (0.4%).Analogous chlorinations of phenol, 2-methylphenol, and 2-chlorophenol in CCl₄ also have been carried out with high conversion rates at the reflux temperature (79 °C) (16). Chlorination of phenol with Cl₂ in CCl₄ has been reported by other groups (52, 53).     

New routes in frontotemporal dementia drug discovery

Introduction: Research into the pathogenic mechanisms behind frontotemporal dementia (FTD) has yielded several new targets for therapeutic intervention; such targets include specific new pathways uncovered by mutations as well as targets involving the modulation, formation and degradation of protein aggregates.

Areas covered: Herein, the authors outline the principal molecular causes underlying FTD to date and the research that has been performed in these areas with respect to an eventual corrective strategy.

Expert opinion: While it is worthwhile targeting pathways affected by specific mutations with a causative loss of function linked to FTD, research still has to contend with issues including the remaining presence of protein aggregates or that treatments are rarely universally applicable. Aiming to recover function in a downstream target caused by the protein aggregates will likely be insufficient due to the large cascade of events affected. It is our belief that the clearance of these aggregates and the inhibition of protein misfolding are more appropriate and direct routes to an eventual therapy.     

持续气管内滴药预防气管切开术后肺部感染的疗效观察

目的 观察持续气管内滴药预防气管切开术后肺部感染的临床效果,比较其与多种方法治疗结果的差异.方法 回顾性分析92例气管切开患者的病例资料,其中36例给予持续气管内滴药治疗（A组）,29例给予雾化吸入治疗（B组）,27例行间歇气管内滴药治疗（C组）,分析不同方法治疗后不同时间点三组患者痰液细菌培养阳性率及血液内氧氟沙星浓度的差异,分析持续气管内滴药预防肺部感染的临床效果.结果 三组气管切开后3、6、9、12 d痰液细菌培养阳性率比较,差异有统计学意义（P=0.031、0.025、0.016、0.021）,A组显著低于其他两组;三组治疗后6、12、24、48、72 h血中氧氟沙星浓度差异有统计学意义（F=2.630、3.004、3.346、3.035、2.938,P=0.007、0.011、0.019、0.020、0.017）,A组高于其他两组.结论 持续气管内滴药用于预防气管切开术后的肺部感染,疗效显著,优于雾化吸入及间歇气管内滴药治疗的临床效果.     

外周静脉插入中心静脉导管采血路径的设计与实践

目的减少肿瘤患者在治疗过程中反复穿刺采取血标本的痛苦,确保从外周静脉插入的中心静脉导管（PICC）中取得的血标本所受干扰因素最小。方法将82位患者随机分为3组,分别从PICC导管处弃血1ml、2ml和2．5ml,采血标本进行血常规、血生化检查,与同时采集周围静脉的血标本进行对照。结果按照合理的果血路径从PICC导管中取血标本,3组检验结果经统计学处理均有差异（P〈0．05）,但是按照美国CLIA’88的规定是在实验室允许误差指标范围内。结论按照合理的采血路径从PICC导管处采取血标本进行血常规、血生化检查是可行的,且可以根据对检验结果精确性要求的不同选择不同的弃血量。