联合应用生长抑素与小剂量垂体后叶素治疗门静脉高压性上消化道出血疾病的临床疗效

目的分析并评价联合应用生长抑素与小剂量垂体后叶素对门静脉高压性上消化道出血患者的临床治疗效果。方法将我院2009年12月至2011年10月收治的62例门静脉高压引发上消化道出血患者随机分为2组。对照组32例,单独采用小剂量垂体后叶素治疗;观察组30例,联合应用生长抑素与小剂量垂体后叶素治疗。比较两组患者的止血时间以及止血有效率。结果观察组平均止血时间(22.4±1.8)h,少于对照组的(32.4±2.5)h,两组比较差异有统计学意义(P<0.05);观察组止血有效率(93.3%)高于对照组(78.1%),两组比较差异有统计学意义(P<0.05)。两组均有少数病例发生腹痛以及大便次数增加现象,通过及时调整垂体后叶素的给药剂量后均得以缓解。结论联合应用生长抑素与小剂量垂体后叶素对门静脉高压性上消化道出血疾病具有令人满意的临床疗效,该方法值得临床广泛推广应用。     

内镜止血术治疗老年急性非静脉曲张性上消化道出血的效果观察

目的评价老年急性非静脉曲张性上消化道出血行内镜止血术治疗的临床效果,为急性非静脉曲张性上消化道出血患者止血治疗工作提供参考。方法66例老年急性非静脉曲张性上消化道出血患者,采取随机数字表法分为对照组和观察组,每组33例。对照组患者行常规内科止血治疗,观察组患者在常规内科治疗基础上应用内镜止血术治疗。比较两组患者的止血效果以及康复时间。结果观察组患者即时止血率100.00%高于对照组的69.70%,72 h后再出血率3.03%低于对照组的30.30%,差异具有统计学意义(P<0.05)。观察组患者出血停止时间(2.0±0.5)d、黑便消失时间(3.2±0.5)d、肠鸣音恢复时间(2.0±1.0)d、住院时间(6.5±1.5)d均短于对照组的(3.0±0.5)、(5.3±1.0)、(5.0±1.0)、(12.0±2.0)d,差异具有统计学意义(P<0.05)。结论对比常规内科止血治疗,内镜止血术治疗老年急性非静脉曲张性上消化道出血止血效果明显、再出血风险低,且患者治疗后恢复快,是优选止血方案。     

肠溶阿司匹林相关的上消化道出血150例临床分析

目的 分析小剂量肠溶阿司匹林相关上消化道出血的临床特点、危险因素以及预后.方法 回顾性分析2011年1月至2012年10月首都医科大学附属北京安贞医院收治的150例非静脉曲张性上消化道出血住院患者的临床资料,按出血是否与肠溶阿司匹林相关分为肠溶阿司匹林组(71例)和非肠溶阿司匹林组(79例),对2组患者的临床特点、危险因素及预后等进行分析并加以比较.结果 肠溶阿司匹林组的上消化道出血患者年龄高于非肠溶阿司匹林组[(66±12)岁比(56±16)岁],差异有统计学意义(P＜0.05).肠溶阿司匹林组的急性胃黏膜病变的发生比例及幽门螺杆菌的感染比例均高于非肠溶阿司匹林组[18.3％(13/71)比3.8％ (3/79),26.8％(19/71)比12.7％(10/79)],差异均有统计学意义(均P＜0.05).2组血红蛋白水平比较差异无统计学意义[(83 ±22)g/L比(90 ±25) g/L,P＞0.05].止血时间及住院时间肠溶阿司匹林组明显长于非肠溶阿司匹林组[分别为(2.4±0.9)d比(1.7±1.3)d,(13±4)d比(10±4)d],差异均有统计学意义(P＜0.05).肠溶阿司匹林组中服用肠溶阿司匹林不足1个月的患者较服用时间＞1个月的患者血红蛋白水平低,止血时间较长,住院时间延长,差异均有统计学意义[(55±20) g/L比(86±20) g/L,(3.8±1.7)d比(2.2±0.6)d,(17.3±1.8)d比(12.3±3.6)d,均P＜0.01].结论 口服小剂量肠溶阿司匹林可增加上消化道出血的风险,且胃黏膜损伤较常见,患者出血量较大,预后较差.口服肠溶阿司匹林的高危患者服药前应评估其风险,清除幽门螺杆菌治疗、加用抗溃疡药物可降低其出血风险.     

奥美拉唑在急性非静脉曲张性上消化道出血治疗中的应用

目的:评价奥美拉唑在急性非静脉曲张性上消化道出血治疗中的应用效果。方法:采取随机分组法将100例急性非静脉曲张性上消化道出血患者分为对照组和治疗组各50例,两组患者常规治疗基础上,对照组:雷尼替丁,治疗组:奥美拉唑。结果:治疗组总有效率96%高于对照组总有效率72%,治疗组止血时间(2.16±0.84)d短于对照组止血时间(4.52±1.63)d,数据有统计学意义(P0.05)。两组患者用药期间未出现肝肾功能、血尿常规异常,两组不良反应比较(P0.05)。结论:奥美拉唑治疗急性非静脉曲张性上消化道出血效果显著。     

老年人急性非食管静脉曲张性上消化道出血的临床特征研究

目的：探讨老年人急性非食管静脉曲张性上消化道出血的临床特征。方法以本院2013年1月~2014年2月收治的90例急性非食管静脉曲张性上消化道出血患者为研究对象,按照患者年龄分为观察组和对照组,年龄≥60岁为观察组(49例),年龄<60岁为对照组(41例)。于患者入院后给予相应治疗,比较两组患者的临床表现、病因、合并症、治疗及疾病转归、再出血率等。结果观察组心率加快、呕血症状患者所占比例明显低于对照组,低血压、休克患者所占比例高于对照组,差异有统计学意义(P<0.05)。观察组中胃癌导致上消化道出血患者所占比例明显高于对照组,贲门黏膜撕裂患者所占比例明显低于对照组,差异有统计学意义(P<0.05)。观察组出血量、止血所用时间、住院时间分别为(10.1±2.3)ml、(10.5±2.4)h、(12.5±3.0)d,对照组出血量、止血所用时间、住院时间分别为(3.6±1.1)ml、(6.7±2.0)h、(11.0±2.6)d,两组差异有统计学意义(P<0.05)。观察组再出血率为14.3%,对照组无复发患者,观察组再出血率显著高于对照组,差异有统计学意义(P<0.05)。结论老年急性非食管静脉曲张性上消化道出血病情严重,出血量更高,易引发低血压性休克,临床医生应尽快控制出血并治疗基础并发症,改善预后。     

国产注射用奥美拉唑治疗非食管静脉曲张上消化道出血的疗效与安全性

目的:评价和比较国产与进口注射用奥美拉唑治疗非食管静脉曲张上消化道出血的疗效及安全性.方法:采用多中心随机对照试验,将123例非食管静脉曲张上消化道出血患者随机分为试验组(n=62)及对照组(n=61),试验组给予国产奥美拉唑,对照组给予进口奥美拉唑(商品名洛赛克),两组给药方法相同,均为静脉注射,每次40 mg,qd,疗程3 d.观察两组止血情况和临床疗效以及药物不良反应.结果:试验组和对照组显效率(24h内停止出血)和总有效率(72 h内停止出血)分别为64.5%(40/62),98.4%(61/62)和62.3%(38/61),98.4%(60/61)(P＞0.05),两组患者均未发生与药物相关的不良反应.结论:国产奥美拉唑治疗非食管静脉曲张的上消化道出血安全有效.     

内镜止血应用于急性非静脉曲张性上消化道出血治疗中的意义分析

目的观察内镜下止血治疗急性非静脉曲张性上消化道出血的临床疗效。方法收集2016年5月至2017年5月收治的100例急性非静脉曲张性上消化道出血患者。对患者数据进行分类,将100例患者随机分为2组(每组50例)。基于第一组患者的治疗,第二组患者接受内镜止血治疗。比较两组患者的治疗效果,两组患者症状改善时间(肠道恢复时间,止血时间)和住院时间。结果第二组肠鸣恢复时间是(2.35±0.32)d、止血时间是(2.12±0.35)d、住院时间为(3.58±1.52)d,均比第一组时间短,差异有统计学意义(P <0.05)。第二组患者的总有效率为96.77%,显着高于第一组患者的总有效率(75.81%),差异有统计学意义(P <0.05)。结论在临床治疗中,急性非静脉曲张性上消化道出血患者可采用内镜止血。内镜止血具有一定的疗效,明显优于常规止血方式,更值得临床应用。     

奥美拉唑治疗严重烧伤患者上消化道出血的疗效观察

目的探讨奥美拉唑治疗严重烧伤患者上消化道出血的疗效。方法对2003年3月至2006年3月我院烧伤科的54例上消化道出血,治疗组采用奥美拉唑40 mg加入0.9%氯化钠100 mL内,静脉滴注(30~60 min),每日2次,共5 d;对照组采用雷尼替丁氯化钠注射液250 mL,静脉滴注(20~40 min),每日2次,共5 d,观察其疗效及不良反应。结果两组间治疗有效率差异有显著性(P<0.05)。治疗后3 d内奥美拉唑组有26例止血(96%),雷尼替丁组有19例止血(70%),无明显不良反应发生。结论奥美拉唑使用安全有效,是治疗严重烧伤患者上消化道出血的理想药物。     

奥美拉唑和奥曲肽联合治疗急性上消化道出血的可行性及安全性

目的:研究急性上消化道出血选择奥曲肽和奥美拉唑联合治疗的临床效果.方法:选取我院在2015年1月～2016年12月收治的100例急性上消化道出血患者按照随机数字表法平均分为两组,50例采用奥美拉唑治疗(对照组),50例给予奥美拉唑和奥曲肽联合治疗(研究组).将两组临床疗效、止血时间、住院时间、止血情况、再出血情况以及不良反应情况进行对比.结果:研究组临床疗效(94％)较对照组(78％)显著要高(P<0.05).研究组止血时间(19.6±5.9h)(46.1±6.4h)显著要低,住院时间(7.2±1.4d)较对照组(13.1±1.7d)显著要低(P<0.05).研究组24h止血率60％及48h止血率68％显著高于对照组的24h止血率26％及48h止血率30％(P<0.05).研究组再出血率(6％)较对照组(22％)显著要低(P<0.05).研究组不良反应发生率(8％)与对照组(14％)比较无显著差异(P>0.05).结论:奥曲肽和奥美拉唑联合治疗急性上消化道出血可令临床疗效显著提升,止血时间显著缩短,促使早日出院,降低再出血率,具有一定安全性.     

泮托拉唑联合血凝酶治疗上消化道出血的疗效分析

目的:探讨泮托拉唑基础上联合血凝酶治疗上消化道出血的临床效果。方法:选择某院2013年7月~2014年7月期间收治的上消化道出血患者共56例作为观察组,在采用泮托拉唑治疗的基础上,给予注射用白眉蛇毒血凝酶辅助治疗;并以同期收治的上消化道出血患者52例作为对照组,仅单独采用泮托拉唑治疗。观察并记录两组患者的止血时间及住院时间差异,比较治疗3d内的止血有效率。结果:观察组的平均止血时间及住院时间分别为(1.23±0.62)d、(8.41±1.72)d,均显著短于对照组的(2.91±0.94)d、(15.71±3.12)d;并且观察组治疗1d、2d、3d内的止血有效率分别为73.21%、87.50%、96.43%,均显著高于对照组的42.31%、65.38%、86.54%,两组间差异比较均具有统计学意义(P<0.05)。结论:泮托拉唑联合血凝酶应用于上消化道出血的治疗中,具有起效快,疗效好等特点,其效果显著优于单独使用泮托拉唑,值得在临床上推广使用。     

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.

     

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.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.