机械性取栓结合颅内外动脉支架治疗急性缺血性脑卒中临床应用

目的观察应用Solitaire AB型支架机械取栓结合颅内外动脉支架治疗急性缺血性脑卒中的疗效及安全性。方法回顾性分析2011年1月至2012年10月我院神经外科收治的Solitaire AB型支架机械取栓结合颅内外动脉支架治疗急性缺血性脑卒中患者8例,取栓治疗后残余狭窄率≥50%则同时行支架成形术。分析其即时取栓效果,术后出血情况,比较患者治疗前后神经功能缺损(NIHSS)评分及预后情况。结果①6例患者经1～3次取栓后动脉获得再通,对其中4例有残余狭窄者联合使用球囊扩张支架成形术;②6例患者术后3～7 d复查颅脑MRI,均未见脑梗死灶扩大;③患者出院时NIH-SS评分较入院时降低2～16分。结论应用Solitaire AB型支架机械取栓结合颅内外动脉支架治疗急性缺血性脑卒中是相对安全、有效的,患者预后良好。     

磁敏感加权成像在脑微出血诊断中的应用

目的 探讨磁敏感加权成像(SWI)在脑微出血中的诊断价值.方法 收集经MRI证实的脑微出血60例,行T1WI、T2WI序列与SWI序列扫描,评价SWI序列对脑微出血检出的优越性.结果 60例患者中单发17例,多发43例,共发现病灶591个,主要分布于皮层和皮层下、基底节区.T1WI发现病灶242个,T2WI发现病灶318个,SWI发现病灶591个,检出率分别为40.95％,53.81％和100％.SWI表现为点状、圆形低信号灶.病变范围的显示较常规序列范围大.结论 SWI序列对颅内微小出血的敏感性明显高于常规MRI序列.     

急性脑梗闭塞动脉介入取栓术的围手术期护理

目的:探讨急性脑梗死患者闭塞动脉介入取栓术的围手术期护理,最大限度地预防及减少并发症的发生。方法:回顾2016年1月-2018年10月在我院行急性脑梗死闭塞动脉介入取栓术的21例患者的临床资料,分析总结其护理方法。结果:21例急性脑梗死患者经动脉介入取栓治疗,术后第2天肌力恢复3级及以上者5例,2级者6例,无明显改变者6例;死亡4例。结论:术前完善的准备,术中密切、细致的配合及术后优质的护理,能够有效降低急性脑梗死患者闭塞动脉介入取栓术的并发症发生率,提高患者临床治疗效果。     

3.0磁共振磁敏感加权成像对轻型脑外伤评估价值探讨

目的分析探讨3.0磁共振磁敏感加权成像(SWI)对轻型脑外伤评估价值。方法选择轻型颅脑外伤患者49例,受伤7 d内进行头部CT及SWI检查,分析并简要评价检查效果。根据症状是否昏迷,分为昏迷组30例,非昏迷组19例。结果昏迷组中经SWI检查检出病灶28例,比非昏迷组(检出病灶者11例)要高;阳性出血灶患者中脑损伤后综合征发病率(63.16%,24/38)高于阴性出血灶患者(27.28%,3/11),P<0.05。结论 SWI检查对于脑外伤后综合征患者而言,其敏感性明显高于CT,尤其是头部存在实质性出血灶患者;轻型脑外伤患者脑内存在微小出血灶,与脑外伤综合征联系比较密切。     

急性肠系膜上动脉闭塞13例诊治分析

目的 探讨急性肠系膜上动脉闭塞的诊断与治疗.方法 对2007～2011年收治的13例急性肠系膜上动脉血栓闭塞患者的临床资料进行回顾性分析.其中行肠系膜上动脉取栓术3例,肠系膜上动脉取栓加坏死肠切除术4例,小肠切除吻合术1例,剖腹探查术2例,股动脉取栓术1例,2例放弃治疗.结果 诊断为急性肠系膜上动脉栓塞8例,急性肠系膜上动脉血栓形成5例.术后恢复6例,复发2例,转院治疗1例,死亡2例,放弃治疗2例.结论 早期诊断、早期行肠系膜上动脉取栓术是提高治愈率的关键.     

机械碎栓联合颅内动脉注射尿激酶、罂粟碱治疗急性脑血管闭塞的疗效观察

目的：评价动脉途径给予尿激酶和罂粟碱结合微导丝、微导管机械碎栓对急性脑血管闭塞的临床效果及安全性。方法：总结近5个月来治疗的急性脑血管闭塞,并给予尿激酶和罂粟碱结合微导丝、微导管机械碎栓治疗的8例病例资料进行回顾性分析总结。结果：治疗后8例中,闭塞血管即刻全部开通,术后1d、1周、2周临床症状明显改善,NIHSS、ADL评分改善（P〈0．01）,1例术后第5天死于中枢性呼吸衰竭。结论：对时间窗内的急性脑血管闭塞患者,微导管、微导丝机械性碎栓结合动脉内注射尿激酶、罂粟碱治疗是安全有效的。     

磁敏感加权成像诊断脑出血疾病的临床价值研究

目的分析磁敏感加权成像在临床上诊断脑出血疾病的临床价值。方法收集2011年1月至2012年10月于我院就诊初步疑似脑血管疾病患者86例,均经CT检查、MRI、T2WI序列及SWI序列检查,比较各种检查方法的检出率及差异。结果 86例患者中22例手术后经病理证实,分别为动脉瘤7例,脑动静脉畸形5例,脑海绵状血管瘤6例,脑海绵状血管瘤伴脑静脉畸形1例,脑海绵状血管瘤伴毛细血管扩张3例;29例经数字减影血管造影证实,分别为颅内小动脉瘤15例,动静脉畸形9例和颅内毛细血管扩张症5例。35例经临床治疗及随访证实为脑梗塞并出血。结论 SWI序列是检查出血性病变最敏感序列,CT+常规MRI+SWI是诊断脑微出血、蛛网膜下腔出血最佳组合检查,MRI+T2WI是筛选脑动静脉瘤、脑血管畸形的最佳组合,MRI+SWI是筛选脑血管扩张的最佳组合。     

急性颅内大动脉闭塞取栓后不良结局的影响因素分析

目的 探讨急性颅内大动脉闭塞患者经机械取栓后不良结局的影响因素。方法 回顾性分析2019年1月至2020年4月在我院行SOLITAIRE支架系统支架取栓治疗急性颅内大动脉闭塞的患者76例,术后90 d采用改良的Rankin评分量表(mRS)评估患者的预后情况进行分组,mRS评分≤2分的42例患者列入预后良好组,mRS评分≥3分的34例患者列入预后不良组,采用Logistic回归进行分析。结果 两组在年龄、高血压、糖尿病、入院时美国国立卫生研究院卒中量表(NIHSS)评分、术后NIHSS评分、闭塞的部位、侧支循环、取栓次数、血管再通例数上比较,差异有统计学意义(P 0.05),对危险因素进行Logisit回归分析,年龄、术后NIHSS评分、闭塞的部位、侧支循环不良、取栓次数 3次、血管再通不良是急性颅内大动脉闭塞取栓不良结局发生的独立危险因素(P 0.05)。结论 年龄、术后NIHSS评分、闭塞的部位、侧支循环、取栓次数及血管再通情况是急性颅内大动脉闭塞患者预后不良的独立危险因素。     

急性后循环动脉闭塞血管内介入治疗的探究

目的分析急性后循环动脉闭塞血管内介入治疗效果。方法选取本院收治的20例后循环血管急性闭塞患者,均给予血管内介入治疗,其中单纯动脉溶栓7例,动脉溶栓并机械取栓7例,直接取栓6例。结果术后即刻行脑血管造影检查,其中血管完全再通11例,部分再通5例,未再通4例,再通率为80.0%(16/20)。行CT复查发现并无脑出血情况。随访3个月,其中恢复良好7例(44.8%),中度残疾1例(6.3%),严重功能障碍7例(44.8%),死亡1例(6.3%)。结论为急性后循环闭塞患者行血管内介入治疗的效果较佳,可提高血管再通概率,且能够改善患者预后。     

应用磁共振SWI对服用氯吡格雷与脑微出血的相关性研究

目的应用磁共振SWI对服用氯吡格雷与脑微出血的相关性进行研讨。方法收集无高血压、高血压且没服用氯吡格雷、高血压并服用氯吡格雷超过3个月共三组患者,每组100人,行SWI检查,观察是否有脑微出血,并对每组微出血灶的数量进行统计学比较。结果无高血压组SWI显示微出血灶例数为5例(5/100),出血灶共为24个;高血压组没服用氯吡格雷微出血灶例数为34例(34/100),出血灶共为134个;高血压服用氯吡格雷微出血灶例数为41例(41/100),出血灶共为129个。三组的腔隙性脑梗死、脑白质变性发生率中,有高血压的两组患者均高于无高血压组。上述数据无高血压组与有高血压组具有显著性差异,而两组高血压患者(没服用或服用氯吡格雷)无显著性差异。结论高血压、腔隙性脑梗死、脑白质变性都是脑微出血灶的危险因素,而氯吡格雷与脑微出血没有明显的相关性,故服用氯吡格雷不会引起高血压患者脑微出血灶发生率的显著增加。     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

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.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

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.     

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.