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Vitamin C pretreatment protects from nickel-induced acute nephrotoxicity in mice 维生素C预处理对小鼠镍致急性肾毒性有保护作用
Pub Date : 2016-09-22 DOI: 10.1515/aiht-2016-67-2753
Imededdine Kadi, F. Dahdouh
Abstract Nickel is an abundant carcinogenic and nephrotoxic metal whose activity leads to renal impairment. Previous studies have shown a protective effect of simultaneous vitamin C administration on acute and chronic nickel toxicity. However, very little research relating to the effect of vitamin C pretreatment in preventing nickel-induced acute nephrotoxicity is available. Therefore, the present study aimed to determine the efficiency of vitamin C (VC) pretreatment in preventing acute renal toxicity of nickel. Mice were pretreated orally with vitamin C (16.6 mg kg-1 body weight, b.w.) for seven consecutive days, prior to intraperitoneal (i.p.) administration of nickel chloride at different doses (3, 5, and 10 mg Ni kg-1 b.w.) for an exposure period of 24 hours. Thereafter, animals were killed and kidney tissue and blood samples were taken for histological examination and biochemical marker analyses. Vitamin C pretreatment alone did not alter the levels of serum kidney markers (creatinine, urea, and uric acid). However, treatment with Ni alone showed a significant increase in the levels of serum creatinine, urea, and uric acid with marked necrotic epithelial cells and infiltration by inflammatory cells in kidney sections as compared to the control group. Pretreatment with vitamin C and treatment with Ni at all doses tested for 24 hours showed a significant decrease in the levels of serum creatinine, urea, and uric acid, as well as an improvement in histological changes compared to those previously seen in the group treated with Ni alone. It is concluded that vitamin C pretreatment effectively improved renal function and tissue damage caused by nickel.
摘要镍是一种丰富的致癌和肾毒性金属,其活性可导致肾脏损害。先前的研究表明,同时服用维生素C对急性和慢性镍中毒有保护作用。然而,关于维生素C预处理在预防镍引起的急性肾毒性中的作用的研究很少。因此,本研究旨在探讨维生素C (VC)预处理对镍急性肾毒性的预防作用。小鼠连续7天口服维生素C (16.6 mg kg-1体重,体重),然后腹腔注射不同剂量的氯化镍(3、5和10 mg Ni kg-1体重),暴露时间为24小时。随后处死动物,取肾脏组织和血液标本进行组织学检查和生化标志物分析。单独的维生素C预处理不会改变血清肾标志物(肌酐、尿素和尿酸)的水平。然而,与对照组相比,单独使用镍治疗显示血清肌酐、尿素和尿酸水平显著增加,肾切片有明显的坏死上皮细胞和炎症细胞浸润。用维生素C预处理和用所有剂量的镍治疗24小时的试验显示,血清肌酐、尿素和尿酸水平显著降低,与先前单独用镍治疗的组相比,组织学变化也有所改善。由此可见,维生素C预处理能有效改善镍致肾组织损伤。
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引用次数: 16
Occurrence of intersex in wild freshwater fish in Slovenian rivers: a histological evaluation 斯洛文尼亚河流中野生淡水鱼中双性人的发生:组织学评价
Pub Date : 2016-09-22 DOI: 10.1515/aiht-2016-67-2730
M. Vrecl, V. Jenčič
Abstract The aim of this preliminary research was to establish if there are intersex occurrences in wild freshwater fish in Slovenian rivers and streams. In the first study we evaluated all fish species of both sexes obtained from the river Ljubljanica from its source to mouth. In the second study we focused on the rainbow trout (Oncorhynchus mykiss) and brown trout (Salmo trutta m. fario) males from 30 rivers and streams in different parts of Slovenia. The male gonads were histologically assessed for the presence of oocytes to determine the frequency and degree of intersex. Oocytes were found in the testicular tissue of a single grayling (Thymallus thymallus) and in the adipose tissue adjacent to the testis of a single common barbel (Barbus barbus), both from the Ljubljanica. Several cyst-like structures that resemble degenerated presumptive oocytes were also present in several trout testes. This preliminary report is the first of its kind in Slovenia. To gain a better insight into the intersex issue in Slovenia, we plan to regularly biomonitor freshwater pollution by histologically examining fish gonads and, if possible, by determining vitellogenin plasma levels in fish.
摘要本初步研究的目的是确定斯洛文尼亚河流和溪流中的野生淡水鱼是否存在双性人。在第一项研究中,我们评估了从卢布尔雅尼察河源头到河口获得的所有两性鱼类。在第二项研究中,我们重点研究了来自斯洛文尼亚不同地区30条河流和溪流的虹鳟(Oncorhynchus mykiss)和褐鳟(Salmo trutta m. fario)雄性。对男性性腺进行组织学评估,以确定存在卵母细胞的频率和程度。在卢布尔雅那一条灰鲑(胸腺鱼)的睾丸组织和一条普通鲃(Barbus Barbus)睾丸附近的脂肪组织中都发现了卵母细胞。在一些鳟鱼睾丸中也发现了一些类似于退化卵母细胞的囊肿样结构。这份初步报告是斯洛文尼亚同类报告中的第一份。为了更好地了解斯洛文尼亚的双性人问题,我们计划定期对淡水污染进行生物监测,方法是对鱼的性腺进行组织学检查,如果可能的话,还可以测定鱼体内的卵黄原蛋白血浆水平。
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引用次数: 0
Variations in lead, cadmium, arsenic, and mercury concentrations during honeybee wax processing using casting technology 在使用铸造技术处理蜂蜡过程中铅、镉、砷和汞浓度的变化
Pub Date : 2016-09-22 DOI: 10.1515/aiht-2016-67-2780
I. Tlak Gajger, M. Kosanović, N. Bilandžić, M. Sedak, Bruno Čalopek
Abstract Beeswax foundations are a necessary material in intensive modern beekeeping. Heavy metals can accumulate in these foundations for decades, as it is a common beekeeping practice to recycle wax. Beeswax samples were analysed using GFAAS for As, Cd, Pb, and Hg concentrations during the production of beeswax foundations using casting technology with a prolonged cooling and sedimentation phase. Significant differences were determined in the concentrations of As, Cd, Pb (p<0.01, all), and Hg (p<0.05) between the three levels of wax in a double-walled steel casting container and comb foundations (CF) during the processing stage. Concentrations (mg kg-1) of the examined metals in comb foundations as the final product ranged as follows: As 0.01-0.88; Cd 1.26-3.55; Pb 82.5-171, and Hg 0.29-1.46. All examined element concentrations demonstrated similar distribution and ratio in different layers, ranging from the lowest concentrations in layers from which wax material is used for comb foundations as the final product, to the highest concentrations in sedimented layer, which represents waste. The obtained results suggest that the described method could effectively eliminate a significant amount of heavy metals from the initial material used for the production of new beeswax foundations.
摘要蜂蜡地基是现代集约化养蜂的必备材料。重金属可以在这些基础中积累数十年,因为回收蜂蜡是一种常见的养蜂做法。在蜂蜡基础的生产过程中,使用GFAAS对蜂蜡样品进行了砷、镉、铅和汞的浓度分析,该过程采用了长时间冷却和沉积阶段的铸造技术。双壁铸钢容器蜡和梳状地基蜡在加工阶段的As、Cd、Pb和Hg含量差异均显著(p<0.01)。梳状地基中检验金属的最终产品浓度(mg kg-1)范围如下:0.01-0.88;Cd 1.26 - -3.55;铅82.5-171,汞0.29-1.46。所有检测到的元素浓度在不同层中的分布和比例相似,从用于梳状地基的蜡料作为最终产品的层中的最低浓度到代表废物的沉积层中的最高浓度。所得结果表明,所述方法可以有效地消除用于生产新蜂蜡基础的初始材料中的大量重金属。
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引用次数: 9
Phytoremediation potential of wild plants growing on soil contaminated with heavy metals 重金属污染土壤中野生植物的修复潜力
Pub Date : 2016-09-01 DOI: 10.1515/aiht-2016-67-2829
Vladica Čudić, D. Stojiljković, A. Jovović
Abstract Phytoremediation is an emerging technology that employs higher plants to cleanup contaminated environments, including metal-polluted soils. Because it produces a biomass rich in extracted toxic metals, further treatment of this biomass is necessary. The aim of our study was to assess the five-year potential of the following native wild plants to produce biomass and remove heavy metals from a polluted site: poplar (Populus ssp.), ailanthus (Ailanthus glandulosa L.), false acacia (Robinia pseudoacacia L.), ragweed (Artemisia artemisiifolia L.), and mullein (Verbascum thapsus L). Average soil contamination with Pb, Cd, Zn, Cu, Ni, Cr, and As in the root zone was 22,948.6 mg kg-1, 865.4 mg kg-1, 85,301.7 mg kg-1, 3,193.3 mg kg-1, 50.7 mg kg-1, 41.7 mg kg-1,and 617.9 mg kg-1, respectively. We measured moisture and ash content, concentrations of Pb, Cd, Zn, Cu, Ni, Cr, and As in the above-ground parts of the plants and in ash produced by combustion of the plants, plus gross calorific values. The plants’ phytoextraction and phytostabilisation potential was evaluated based on their bioconcentration factor (BCF) and translocation factor (TF). Mullein was identified as a hyperaccumulator for Cd. It also showed a higher gross calorific value (19,735 kJ kg-1) than ragweed (16,469 kJ kg-1).The results of this study suggest that mullein has a great potential for phytoextraction and for biomass generation, and that ragweed could be an effective tool of phytostabilisation.
植物修复是一种利用高等植物修复污染环境,包括金属污染土壤的新兴技术。由于它产生的生物质富含提取的有毒金属,因此有必要对这些生物质进行进一步处理。我们研究的目的是评估以下本地野生植物在5年内产生生物量和去除污染场地重金属的潜力:杨树(Populus ssp.)、臭椿(ailanthus glandlosa L.)、假金合欢(Robinia pseudoacacia L.)、豚草(Artemisia artemisiifolia L.)和毛蕊花(Verbascum thapsus L.)根区Pb、Cd、Zn、Cu、Ni、Cr和As的平均污染分别为22,948.6 mg kg-1、865.4 mg kg-1、85,301.7 mg kg-1、3,193.3 mg kg-1、50.7 mg kg-1、41.7 mg kg-1和617.9 mg kg-1。我们测量了水分和灰分含量,植物地上部分和植物燃烧产生的灰分中Pb、Cd、Zn、Cu、Ni、Cr和As的浓度,以及总热值。以植物的生物浓缩因子(BCF)和转运因子(TF)评价植物的提取和稳定潜力。毛蕊草的总热值(19,735 kJ kg-1)高于豚草的总热值(16,469 kJ kg-1)。本研究结果表明,毛蕊蛋白在植物提取和生物质生成方面具有巨大的潜力,而豚草可能是植物稳定的有效工具。
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引用次数: 25
Mutagenic and carcinogenic structural alerts and their mechanisms of action 致突变和致癌结构警报及其作用机制
Pub Date : 2016-09-01 DOI: 10.1515/aiht-2016-67-2801
Alja Plošnik, M. Vračko, M. Dolenc
Abstract Knowing the mutagenic and carcinogenic properties of chemicals is very important for their hazard (and risk) assessment. One of the crucial events that trigger genotoxic and sometimes carcinogenic effects is the forming of adducts between chemical compounds and nucleic acids and histones. This review takes a look at the mechanisms related to specific functional groups (structural alerts or toxicophores) that may trigger genotoxic or epigenetic effects in the cells. We present up-to-date information about defined structural alerts with their mechanisms and the software based on this knowledge (QSAR models and classification schemes).
摘要了解化学物质的致突变性和致癌性对其危害(和风险)评估非常重要。引发基因毒性甚至致癌效应的关键事件之一是化合物与核酸和组蛋白之间加合物的形成。本文综述了与特定功能基团(结构报警或毒性基团)相关的机制,这些功能基团可能引发细胞中的遗传毒性或表观遗传效应。我们提供了关于已定义的结构警报及其机制的最新信息,以及基于这些知识的软件(QSAR模型和分类方案)。
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引用次数: 36
Impact of meteorological parameters and air pollution on emergency department visits for cardiovascular diseases in the city of Zagreb, Croatia 气象参数和空气污染对克罗地亚萨格勒布市心血管疾病急诊就诊的影响
Pub Date : 2016-09-01 DOI: 10.1515/aiht-2016-67-2770
S. Pintarić, I. Zeljković, G. Pehnec, V. Nesek, Mislav Vrsalović, H. Pintarić
Abstract The aim of this study was to investigate whether nitrogen dioxide (NO2), ozone (O3), and certain meteorological conditions had an impact on cardiovascular disease (CVD)-related emergency department (ED) visits in the metropolitan area of Zagreb. This retrospective, ecological study included 20,228 patients with a cardiovascular disease as their primary diagnosis who were examined in the EDs of two Croatian University Hospitals, Sisters of Charity and Holy Spirit, in the study period July 2008-June 2010. The median of daily CVD-related ED visits during the study period was 28 and was the highest during winter. A significant negative correlation was found between CVD-related emergency visits and air temperature measured no more than three days prior to the visit, and the highest negative correlation coefficient was measured two days earlier (R=0.266, p≤0.001). The number of CVD-related emergency visits significantly correlated with the average NO2 concentration on the same day (R=0.191, p<0.001). The results of multiple stepwise regression analysis showed that the number of CVD-related emergency visits depended on air temperature, and NO2 and O3 concentrations. The higher the air temperatures, the lower the number of daily CVD-related emergency visits (p<0.001). An increase in NO2 concentrations (p=0.005) and a decrease in O3 concentrations of two days earlier (p=0.006) led to an increase in CVD-related ED visits. In conclusion, the decrease in O3 concentrations and the increase in NO2, even if below the legally binding thresholds, could be associated with an increase in CVD-related emergency visits and a similar effect was observed with lower temperature measured no more than three days prior to the visit.
摘要本研究旨在探讨二氧化氮(NO2)、臭氧(O3)和某些气象条件对萨格勒布市区心血管疾病(CVD)相关急诊科(ED)就诊的影响。这项回顾性生态学研究纳入了2008年7月至2010年6月期间在克罗地亚两所大学医院(仁爱姐妹医院和圣灵医院)的急诊科检查的20,228名以心血管疾病为主要诊断的患者。在研究期间,与心血管疾病相关的每日急诊就诊中位数为28次,在冬季最高。与心血管疾病相关的急诊就诊与就诊前不超过3天测量的气温呈显著负相关,且2天前测量的负相关系数最高(R=0.266, p≤0.001)。cvd相关急诊就诊次数与当日NO2平均浓度显著相关(R=0.191, p<0.001)。多元逐步回归分析结果显示,与心血管疾病相关的急诊次数与气温、NO2和O3浓度有关。气温越高,每日心血管疾病相关急诊就诊次数越少(p<0.001)。2天前NO2浓度升高(p=0.005)和O3浓度降低(p=0.006)导致cvd相关ED就诊次数增加。总之,O3浓度的下降和NO2浓度的增加,即使低于具有法律约束力的阈值,也可能与心血管疾病相关急诊就诊的增加有关,并且在就诊前不超过三天测量较低温度时观察到类似的效果。
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引用次数: 7
Workplace noise exposure and serum testosterone in men enrolled in the 1999-2004 National Health and Nutrition Examination Survey 1999-2004年全国健康和营养检查调查中男性的工作场所噪音暴露和血清睾酮
Pub Date : 2016-09-01 DOI: 10.1515/aiht-2016-67-2774
A. Dzhambov
Abstract There is compelling evidence from animal experiments that noise exposure suppresses testosterone in males by affecting the hypothalamic-pituitary-testicular axis. Virtually nothing is known about its effect in humans. Therefore, the aim of this study was to explore the association between occupational noise exposure and serum testosterone in a representative sample of the general population. The sample has been taken from the National Health and Nutrition Examination Survey (NHANES) data for the period between 1999 and 2004 and is limited to employed men aged 16-85+ years at the time. The associations between noise exposure (either established according to the Occupational Information Network - O*NET categories or self-reported) and total and free testosterone (TT and FT, respectively) were analysed using linear regression models with increasing adjustments. In the fully adjusted model (n=414), the third quartile of the O*NET noise exposure was associated with lower TT and FT, which reached statistically significant decrease of -58.32 ng dL-1 (95 % CI: -111.22, -5.42) and -1.58 ng dL-1 (95 % CI: -2.98, -0.18), respectively. In stratified analyses, younger, lower income, normal weight, better hearing, and workers not using hearing protection at work experienced significantly more severe adverse effects than the rest. The odds for hypogonadism (TT<300 ng dL-1) did not significantly rise with one interquartile range increment in O*NET noise exposure (OR=1.24, 95 % CI: 0.64, 2.39). Self-reported loud noise exposure did not significantly decrease TT when all men were considered (n=214) and only in the men ≥37 years did it decrease TT significantly by -87.55 ng dL-1 (95 % CI: -158.35, -16.74). In conclusion, noise exposure was associated with lower TT and FT only in some population subgroups and these associations were non-linear.
来自动物实验的令人信服的证据表明,噪音暴露通过影响下丘脑-垂体-睾丸轴来抑制雄性睾丸激素。实际上,人们对它对人类的影响一无所知。因此,本研究的目的是探讨职业性噪声暴露与普通人群中具有代表性的血清睾酮之间的关系。样本取自1999年至2004年期间国家健康和营养检查调查(NHANES)的数据,仅限于当时16-85岁以上的在职男性。噪音暴露(根据职业信息网络- O*NET类别建立或自我报告)与总睾酮和游离睾酮(分别为TT和FT)之间的关系使用线性回归模型进行了分析。在完全调整模型(n=414)中,O*NET噪声暴露的第三四分位数与较低的TT和FT相关,分别达到-58.32 ng dL-1 (95% CI: -111.22, -5.42)和-1.58 ng dL-1 (95% CI: -2.98, -0.18),具有统计学意义。在分层分析中,较年轻、收入较低、体重正常、听力较好和在工作中不使用听力保护的工人比其他人经历了更严重的不良反应。性腺功能减退(TT<300 ng dL-1)的几率没有随着O*NET噪声暴露增加一个四分位数范围而显著增加(OR=1.24, 95% CI: 0.64, 2.39)。当所有男性被考虑(n=214)时,自我报告的大声噪音暴露并没有显著降低TT,只有在≥37岁的男性中,它显著降低TT -87.55 ng dL-1 (95% CI: -158.35, -16.74)。综上所述,噪声暴露与较低的TT和FT仅在某些人群亚组中相关,并且这些关联是非线性的。
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引用次数: 5
Furan-induced hepatotoxic and hematologic changes in diabetic rats: the protective role of lycopene 呋喃诱导的糖尿病大鼠肝毒性和血液学改变:番茄红素的保护作用
Pub Date : 2016-09-01 DOI: 10.1515/aiht-2016-67-2762
Hatice Baş, D. Pandır, S. Kalender
Abstract Furan forms as a result of thermal treatment of food and induces harmful effects on organisms. In our work, lycopene, furan, and a combination of the two were given to diabetic male rats for 28 days. Hematological changes, total protein and cholesterol, triglyceride, and albumin levels, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and alkaline phosphatase activities of the serum, malondialdehyde levels, glutathione peroxidase, catalase, glutathione-S-transferase, superoxide dismutase activities, DNA damage in liver tissues and hepatic histopathological alterations were compared to a control group. There were significant changes in the liver function tests, DNA damage, activities of antioxidant enzymes, and malondialdehyde levels between diabetic control and non-diabetic control groups, between diabetic control and diabetic lycopene groups, and also between diabetic furan and diabetic control groups. In diabetic lycopene and diabetic furan + lycopene treated groups we designated the preventive effects of lycopene against diabetes and furan, however, on the analysed parameters only. In spite of some pathological alterations designated in diabetic furan treated group’s liver, fewer pathological alterations were observed in furan+lycopene treated groups at the end of week 4. Consequently, lycopene significantly reduced furan- and diabetes-induced toxicity in rat liver.
摘要呋喃的形成是食品热处理的结果,并对生物体产生有害影响。在我们的研究中,将番茄红素、呋喃以及两者的组合给予糖尿病雄性大鼠28天。与对照组比较血液学变化、总蛋白和胆固醇、甘油三酯和白蛋白水平、血清丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶和碱性磷酸酶活性、丙二醛水平、谷胱甘肽过氧化物酶、过氧化氢酶、谷胱甘肽- s转移酶、超氧化物歧化酶活性、肝脏组织DNA损伤和肝脏组织病理学改变。在糖尿病对照组和非糖尿病对照组之间、糖尿病对照组和糖尿病番茄红素组之间、糖尿病呋喃组和糖尿病对照组之间,肝功能测试、DNA损伤、抗氧化酶活性和丙二醛水平都有显著变化。在糖尿病番茄红素和糖尿病呋喃+番茄红素治疗组中,我们指定了番茄红素对糖尿病和呋喃的预防作用,然而,仅对分析参数进行了分析。尽管糖尿病呋喃治疗组肝脏出现了一些病理改变,但呋喃+番茄红素治疗组在第4周末观察到的病理改变较少。因此,番茄红素显著降低呋喃和糖尿病引起的大鼠肝脏毒性。
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引用次数: 28
A review of aluminium phosphide poisoning and a flowchart to treat it 磷化铝中毒综述及处理流程
Pub Date : 2016-09-01 DOI: 10.1515/aiht-2016-67-2784
Behrooz Hashemi-Domeneh, N. Zamani, H. Hassanian‐Moghaddam, Mitra Rahimi, S. Shadnia, Peyman Erfantalab, A. Ostadi
Abstract The use of pesticides such as aluminium phosphide (AlP) has increased in the recent years and improved the quantity and quality of agricultural products in a number of developing countries. The downside is that AlP causes severe chronic and acute health effects that have reached major proportions in countries such as India, Iran, Bangladesh, and Jordan. Nearly 300,000 people die due to pesticide poisoning in the world every year. Poisoning with AlP accounts for many of these deaths. Unfortunately, at the same time, there is no standard treatment for it. The aim of this article is to give a brief review of AlP poisoning and propose a treatment flowchart based on the knowledge gained so far. For this purpose we reviewed all articles on the management of AlP poisoning published from 2000 till now. Using a modified Delphi design, we have designed a handy flowchart that could be used as a guide for AlP poisoning management of patients in emergency centres.
近年来,在一些发展中国家,磷化铝(AlP)等农药的使用量有所增加,提高了农产品的数量和质量。不利的一面是,AlP造成严重的慢性和急性健康影响,在印度、伊朗、孟加拉国和约旦等国家已占很大比例。全世界每年有近30万人死于农药中毒。这些死亡中有许多是AlP中毒造成的。不幸的是,与此同时,它没有标准的治疗方法。这篇文章的目的是给一个简短的审查AlP中毒,并提出一个治疗流程图的基础上所获得的知识到目前为止。为此,我们回顾了2000年至今发表的所有关于AlP中毒管理的文章。采用改进的德尔菲设计,我们设计了一个方便的流程图,可作为急诊中心患者AlP中毒管理的指南。
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引用次数: 66
How much Tramadol should be considered lethal in overdose? 多少曲马多应该被认为是过量致死的?
Pub Date : 2016-09-01 DOI: 10.1515/aiht-2016-67-2863
S. Marashi
A 17-year-old female was admitted to our emergency room 30 min after suicidal ingestion of about 10 g Tramadol. The patient had several short-lived clonic seizures before admission. On arrival, she had an episode of tonic-clonic seizure, lasting for three minutes, which lead to cardiopulmonary arrest after administration of 10 mg diazepam intravenously. Endotracheal intubation and cardiopulmonary resuscitation were attempted. After 30 min, normal sinus rhythm with a palpable pulse was noted, and the patient was put on mechanical ventilation and transferred to the intensive care unit (ICU). Her vital signs were stable with vasopressor medication support (norepinephrine infusion at 10 μg min-1). She had repeated short-lived tonic-clonic seizure-like movements, which responded well to midazolam. Her past medical and family history was negative for seizure, heart diseases, and hereditary disorders. Repeated neurological examination indicated that the patient had no motor response to pain and had fixed dilated pupils without corneal and vestibuloocular reflexes. About 48 h after admission to the ICU, she experienced asystole, which did not respond to resuscitation. Tramadol HCl is a synthetic opioid drug that blocks reuptake of monoamine and inhibits NMDA glutamatergic activity, while it has low affinity for mu-opioid receptors (1). It has a low potential for abuse and is usually prescribed for control of moderate to severe pain (2). Tramadol is mainly metabolised by the hepatic cytochrome P450 2D6 (CYP2D6), and its active metabolites are responsible for complications, meaning that in a CYP2D6 rapid metaboliser patient excessive side effects may develop within a short time following its overdose (2, 3). It has been reported that the LD50 value for Tramadol is about 300-350 mg kg-1 body weight in animal models (4). However, reviewing the literature, we found that it is generally considered to be non–life threatening in humans, hence, co-ingestion of Tramadol and other agents such as analgesics, muscle relaxants, and CNS depressants is occasionally reported from toxicological samples of postmortem human specimens (2, 5). In fact, there are only a few case reports of human fatality due to Tramadol overdose alone (2). It has been suggested that CYP2D6 ultra-rapid metaboliser patients may develop fatal complications (5). As its overstated toxic manifestations and accordingly its fatality are prospected during the first hours, which is related to its metabolism (5), this time is crucial in patient's care. Moreover, in the emergency situation, we have no idea about the activity of the cytochrome P450 2D6 in patients with Tramadol overdose, which can be induced by other drugs. Therefore, as cardiopulmonary arrest can be a fatal complication (5), we strongly suggest that all patients with exaggerated signs or symptoms of toxicity who consumed more than 150 mg kg-1 (the half dose of LD50 values in animal models) of Tramadol (4), should be intubated prophylactic
一名17岁女性在自杀性摄入约10g曲马多后30分钟被送入急诊室。患者入院前有几次短暂的阵挛性发作。到达时,患者出现强直阵挛发作,持续3分钟,静脉注射10毫克地西泮后导致心肺骤停。尝试气管插管和心肺复苏。30min后,窦性心律正常,脉搏可触,给予患者机械通气,转重症监护病房(ICU)。在血管加压药物支持下(去甲肾上腺素滴注10 μg min-1),生命体征稳定。她反复出现短暂的强直阵挛性癫痫样运动,对咪达唑仑反应良好。既往病史及家族史均无癫痫、心脏病及遗传性疾病。反复的神经学检查表明,患者对疼痛没有运动反应,瞳孔固定扩大,没有角膜和前庭反射。入院后约48 h,患者出现心脏骤停,复苏无效。曲马多HCl是一种合成阿片类药物,可阻断单胺的再摄取并抑制NMDA谷氨酸能活性,但它对多阿片受体的亲和力较低(1)。曲马多的滥用可能性较低,通常用于控制中度至重度疼痛(2)。曲马多主要由肝细胞色素P450 2D6 (CYP2D6)代谢,其活性代谢物可导致并发症。这意味着在CYP2D6快速代谢患者中,过量服用后短时间内可能会出现过多的副作用(2,3)。据报道,在动物模型中,曲马多的LD50值约为300-350 mg kg-1体重(4)。然而,回顾文献,我们发现曲马多通常被认为对人类没有生命威胁,因此,曲马多与其他药物如镇痛药、肌肉松弛剂、在人类死后标本的毒理学样本中,偶尔会报道使用中枢神经系统抑制剂(2,5)。事实上,仅有少数病例报告仅因曲马多过量致死(2)。有研究表明,CYP2D6超快速代谢患者可能会出现致命性并发症(5)。由于CYP2D6超快速代谢患者的毒性表现被夸大,因此其致死率在最初几个小时内被预测,这与其代谢有关(5),因此这段时间对患者的护理至关重要。此外,在紧急情况下,我们不知道细胞色素P450 2D6在曲马多过量患者中的活性,这可能是由其他药物引起的。因此,由于心肺骤停可能是一种致命的并发症(5),我们强烈建议,所有服用曲马多(动物模型中LD50值的一半剂量)超过150 mg kg-1(4)的毒性体征或症状夸大的患者(4),应预防性插管并使用苯二氮卓类药物镇静,至少在曲马多的前9小时,即报道的人类过量服用曲马多的半衰期(3)。在提出任何明确建议之前,需要对这一主题进行适当设计的研究。
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引用次数: 3
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Archives of Industrial Hygiene and Toxicology
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