抢救眼镜王蛇（Ophiophagus hannah）咬伤中毒12例临床报告

本文报告1986年至1992年作者主持抢救眼镜王蛇咬伤中毒12例的临床研究结果,其中男11例,女1例,年龄最大69岁,最小11岁,农民9例.临床主要局部表现为剧痛,肿胀,部分病例有轻度坏死,所有病人均有吞咽困难、眼睑下垂、呼吸困难等神经毒表现。引起自主呼吸停止8例(67%)。心跳停止1例,经抢救死亡1例,死亡率8.33%。抢救存活11例,救活率91.67%。     

Organophosphate poisoning in the developed world – A single centre experience from here to the millennium

Organophosphate (OP) poisoning is still associated with high morbidity and mortality rates, both in resource-poor settings and in well-developed countries. Despite numerous publications dealing with this particular poison, detailed clinical data on more severe overdoses with these agents are relatively sparsely reported. A retrospective study was consequently conducted on 33 patients with OP poisoning admitted to our intensive care unit (ICU) to provide additional data on clinical features. We included moderate to severe poisonings between 2000 and 2012 who required admission to ICU.     

Lead-induced oxidative stress and hematological alterations and their response to combined administration of calcium disodium EDTA with a thiol chelator in rats

The therapeutic efficacy of calcium disodium ethylenediaminetetracetic acid (CaNa(2)EDTA) and the two thiol chelators, 2,3-dimercaptopropane 1-sulfonate (DMPS) and monoisoamyl dimercaptosuccinic acid (MiADMSA) was studied, both individually and in combination, in reducing lead concentration in blood and soft tissues and in restoring lead induced altered biochemical variables in rats. Exposure to subacute dose of lead implicated a critical role of reactive oxygen species (ROS) and oxidative stress in altering the normal values of these variables. Exposure to lead caused a significant inhibition of blood delta-aminolevulinic acid dehydratase (ALAD), an important enzyme in the haem synthesis pathway and glutathione (GSH) level. These changes were also accompanied by inhibition of ALAD activity in kidney, delta-aminolevulinic acid synthase (ALAS) activities in liver and changes in platelet counts in whole blood suggesting disturbed haem synthesis pathway. Lead exposure also led to a pronounced depletion of brain GSH contents, superoxide dismutase (SOD) activity, an increase in thiobarbituric acid reactive substances (TBARS), and activity of glutathione S-transferase (GST). Specific activities of membrane-bound enzymes, acetylcholinesterase (AChE) and monoamine oxidase (MAO), were significantly inhibited on lead exposure. These biochemical changes were correlated with increased uptake of lead in blood and soft tissues. Post lead exposure treatment with MiADMSA in particular provided significant recovery in altered biochemical variables besides significant depletion of tissue lead burden. Treatment with CaNa(2)EDTA and DMPS individually had only moderate beneficial effects on tissue oxidative stress, although they were equally effective in the removal of tissue lead burden. Tissue zinc and copper levels did not depict any significant depletion, although changes like marked depletion of zinc following CaNa(2)EDTA and copper after MiADMSA administration were of some concern. Combined administration of CaNa(2)EDTA, particularly with MiADMSA, was the most effective treatment protocol compared to all other treatments. It can be concluded from our present results that combined therapy with CaNa(2)EDTA and MiADMSA proved significantly better in restoring biochemical and clinical variables over monotherapy with these chelating agents against subacute lead exposure in adult rats.     

盐酸戊乙奎醚治疗有机磷中毒重度中间综合症临床研究

目的:探讨分析盐酸戊乙奎醚在急性有机磷中毒重度中间综合症治疗中的效果。方法:选取急性有机磷中毒并发重度中间综合症患者34例,依治疗方案分为对照组和观察组,各17例。2组患者基础治疗相同,对照组给予氯解磷定+阿托品+机械通气治疗;观察组采用氯解磷定+盐酸戊乙奎醚+机械通气治疗。观察比较2组患者肌无力症状消失时间、机械通气时间以及住院时间。结果:观察组患者肌无力症状消失时间、机械通气时间以及住院时间均明显低于对照组,经比较,差异均有统计学意义(P0.01)。结论:盐酸戊乙奎醚可快速有效缓解急性有机磷中毒重度中间综合症患者的临床症状,显著缩短病程。     

Poison-related mortality effects in the endangered Egyptian vulture (<Emphasis Type="Italic">Neophron percnopterus</Emphasis>) population in Spain

A total of 211 poisoning incidents registered over the period 1990–2007 and affecting 294 Egyptian vultures (Neophron percnopterus) were studied to address the impact of poison-related mortality in the Spanish population. Poison-related mortality mainly affected the birds on an individual level, with low numbers of individuals being found in each incident (mean 1.39) with 94.9% being adults. Deaths were largely recorded (81.8%) during the breeding season, with mortality peaking during May and June (52.1%). In contrast with other raptor species, a high proportion of adult individuals (74.2%) were found in the nest or its surroundings. Age-related differences in the poisoning rate are probably related with different feeding and behavioral strategies between age classes. The illegal use of poison to control predators was the main cause of mortality (93.8%), and particularly in small hunting reserves (74.9%), since the kind of food resources that adults exploit are coincident with the type of baits employed to illegally control predators and the preferred habitat coincides with areas of small game hunting. Our results suggest that poisoning is probably one of the main causes of Egyptian vulture mortality in Spain. The eradication of the illegal use of poisoning and supplementary feeding in specific territories to provide safe food seems priority for its conservation.     

血液透析对急性百草枯中毒的临床疗效分析

目的：探讨血液透析（hemodilalysis,HD）治疗急性百草枯中毒的临床疗效,为临床应用HD治疗急性百草枯中毒提供依据。方法：选择我院2003 年3 月~2012 年7 月收治的百草枯中毒患者40 例,根据患者使用是否行透析治疗分为透析组（A组17 例）和非透析组（B 组23 例）,比较分析两组患者治疗后的肝功能、肾功能、肺功能及心肌酶学指标的变化,治疗效果及存活情况。结果：两组患者入院后前3 天ALT、AST、BUN、CR、CK、CK-MB 水平均呈上升趋势,且非透析组患者以上指标的水平高于透析组患者,但差异无统计学意义（P〉0.05）,入院后第7 天,两组以上指标的比较亦无统计学差异（P〉0.05）;两组患者之间入院时和入院后72小时内最低的SPO2%、血气分析中PaO2和PaCO2水平比较无统计学意义（P〉0.05）;透析组和非透析组患者的病死率分别为70.6%和69.6%,差异无统计学意义（P〉0.05）。结论：百草枯溶液中毒的患者预后差、病死率高,血液透析治疗并不能显著提高急性百草枯中毒患者的生存率。     

应用APACHEⅡ在百草枯中毒评估的研究

目的应用急性生理学及慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评估百草枯农药中毒患者的病情危重程度并判断其预后。方法收集2005~2010年入住我院急诊重症监护室(EICU)百草枯农药中毒资料完整患者28例,追踪随访患者将其分为生存组和死亡组,分别计算各自APACHEⅡ评分及死亡风险系数,并进行统计分析。结果 28例患者APACHEⅡ评分为4~32分,平均(15.26±5.77)分。生存组8例,APACHEⅡ评分为(8.86±4.14)分,死亡风险系数为0.15±0.05;死亡组20例,APACHEⅡ评分为(17.5±4.44)分,死亡风险系数为0.37±0.18。两组APACHEⅡ评分以及死亡风险系数的差异有统计学意义(前者t=4.5,P0.01;后者t=4.7,P0.01)。结论 APACHEⅡ评分系统可应用于百草枯农药中毒患者危重程度及预后的评估。     

Chromatin specialization in bivalve molluscs: a leap forward for the evaluation of Okadaic Acid genotoxicity in the marine environment

Marine biotoxins synthesized by Harmful Algal Blooms (HABs) represent one of the most important sources of contamination in marine environments as well as a serious threat to fisheries and aquaculture-based industries in coastal areas. Among these biotoxins Okadaic Acid (OA) is of critical interest as it represents the most predominant Diarrhetic Shellfish Poisoning biotoxin in the European coasts. Furthermore, OA is a potent tumor promoter with aneugenic and clastogenic effects on the hereditary material, most notably DNA breaks and alterations in DNA repair mechanisms. Therefore, a great effort has been devoted to the biomonitoring of OA in the marine environment during the last two decades, mainly based on physicochemical and physiological parameters using mussels as sentinel organisms. However, the molecular genotoxic effects of this biotoxin make chromatin structure a good candidate for an alternative strategy for toxicity assessment with faster and more sensitive evaluation. To date, the development of chromatin-based studies to this purpose has been hampered by the complete lack of information on chromatin of invertebrate marine organisms, especially in bivalve molluscs. Our preliminary results have revealed the presence of histone variants involved in DNA repair and chromatin specialization in mussels and clams. In this work we use this information to put forward a proposal focused on the development of chromatin-based tests for OA genotoxicity in the marine environment. The implementation of such tests in natural populations has the potential to provide an important leap in the biomonitoring of this biotoxin. The outcome of such monitoring may have critical implications for the evaluation of DNA damage in these marine organisms. They will provide as well important tools for the optimization of their harvesting and for the elaboration of additional tests designed to evaluate the safety of their consumption and potential implications for consumer's health.     

Caspase-12抑制剂对百草枯中毒大鼠肝损伤的保护作用

目的:观察caspase-12抑制剂Z-ATAD-FMK对百草枯染毒大鼠肝脏caspase-12蛋白表达和肝细胞凋亡的影响,以及通过血清SOD和MDA的检测,探讨其对百草枯中毒大鼠肝脏保护作用和对机体氧化应激反应的作用。方法:50只健康Wistar大鼠随机分三组:A组为正常对照组;B组为模型组(PQ染毒);C组抑制剂组(PQ/Z-ATAD-FMK),于3d、7d处死B组和C组各10只大鼠。取血检测ALT、TBIL、SOD和MDA;HE染色观察肝组织病理学变化;免疫组化法检测caspase-12蛋白;二苯胺法检测细胞凋亡率。SPSS18.0统计分析。结果:Z-ATAD-FMK抑制剂组ALT、TBIL、MDA值低于模型组(P0.05),SOD高于模型组(P0.05);caspase-12蛋白表达和细胞凋亡率亦低于模型组(P0.05);HE染色显示凋亡和坏死程度也较模型组轻。结论:Caspase-12抑制剂Z-ATAD-FMK能减少百草枯中毒大鼠肝脏caspase-12蛋白表达和肝细胞凋亡率,减轻肝细胞坏死,对肝脏具有保护作用,同时可以抑制百草枯中毒大鼠的氧化应激反应。