两镜联合3种碎石方式清除复杂性肾结石

目的 探讨单通道经皮肾微造瘘后在肾镜联合输尿管软镜下利用钬激光、气压弹道联合超声碎石取石,清除复杂性肾结石的治疗效果。方法 选择2013年4月至2014年8月在该院泌尿外科住院治疗的200例复杂性肾结石患者,采用单通道经皮肾微造瘘,通道大小在F14~F20,在标准肾镜或短输尿管肾镜(F8~9.8/F8.5~11.5,315 mm)下,利用钬激光、气压弹道联合超声碎石取石,根据残余结石的情况,利用输尿管软镜术中或二期钬激光碎石取石。结果 200例患者中有182例一次或二次清除肾结石,结石清除率91%。18例残留结石大小0.5~1.5 cm,患者放弃二次或三次手术,改为体外震波等其他治疗手段,无一例肾严重出血改为开放止血或介入栓塞止血,无一例穿刺通道周围其他脏器损伤,手术时间30~75 min,平均(48.0±5.0)min,住院时间5~10 d,平均(7.0±0.5)d。结论 单通道经皮肾微造瘘后在肾镜联合输尿管软镜下利用钬激光、气压弹道联合超声碎石取石,清除复杂性肾结石安全、有效,明显提高了结石清除率,减少了肾出血等严重并发症,值得推广应用。     

单微通道经皮肾镜联合输尿管软镜治疗复杂肾结石的疗效评价

目的 总结分析单微通道经皮肾镜联合输尿管软镜治疗复杂肾结石的临床疗效.方法 整理采用单微通道经皮肾镜联合输尿管软镜钬激光碎石术治疗47例复杂性肾结石的临床资料,统计手术时间,结石残余率.结果 47例复杂肾结石一期建立单微通道且成功碎石、取石,平均手术时间126 min ,平均出血量90 mL,二期输尿管软镜手术中顺利留置输尿管软镜鞘并成功进镜,43例患者成功发现结石并粉碎,成功率为91.5%(43/47).平均手术时间61 min,无输尿管穿孔、撕脱、断裂、感染性休克等严重并发症发生.4例未找到残余结石,术后观察结石无移位,结石排净率为91.5%.结论 单微通道经皮肾镜联合输尿管软镜治疗复杂肾结石能够提高结石清除率,减少手术并发症,是安全、有效的方法.     

超声定位经皮肾镜钬激光治疗复杂性肾结石

目的探讨超声定位经皮肾镜钬激光碎石治疗复杂性肾结石的方法和疗效。方法 B超引导下穿刺并扩张建立F18经皮肾镜操作通道。在F15.5肾镜下采用德国科医人钬激光碎石机,一期粉碎结石并借助高压水泵将碎结石冲出体外。结果单侧结石清除时间18-105min,平均46min。结石粉碎率100%,结石清除率达93.88%(46/49)。术后3-5d拔除肾造瘘管,拔除肾造瘘管2d后拔除导尿管,术后30d拔除双"J"管。术后住院3-10d,平均7d。4例肾盏内及输尿管上段结石残留,直径<10mm,术后20d行体外冲击波碎石治疗1-2次,结石顺利排出体外。49例患者术后随访3-6个月,平均4.5月,均未出现严重出血及感染,无结石复发。结论超声定位经皮肾镜钬激光碎石术治疗复杂性肾结石具有高效、安全的特点,值得临床推广应用。     

经皮肾镜钬激光碎石取石术治疗上尿路结石123例临床分析

目的了解经皮肾镜钬激光碎石取石术治疗上尿路结石的效果。方法对123例泌尿外科住院患者在B超引导下建立经皮肾镜钬激光碎石通路,通过通路进行输尿管镜和(或)肾镜探查结石,再予以大功率钬激光粉碎结石并取石,分析钬激光碎石取石时间、结石清除率及并发症等。结果 123例上尿路结石患者在B超引导下经皮肾镜钬激光碎石取石,一期结石清除率为93.5%(115/123),手术时间45-220 min,术中平均出血120 mL,术后低、中度发热14例,平均住院时间15 d。结论采用B超引导下经皮肾镜钬激光碎石取石术是治疗上尿路结石创伤小、且安全有效的方法。     

输尿管软镜下钬激光碎石术治疗肾结石的临床效果观察

目的:探讨输尿管软镜下钬激光碎石术治疗肾结石的临床效果.方法:将76例肾结石患者按照随机数字表法分成对照组(n=38)和观察组(n=38),对照组采取经皮肾镜碎石取石术治疗,观察组采取输尿管软镜下钬激光碎石术治疗.对比两组肾结石清除率、手术指标、肾损伤程度和并发症发生情况.结果:治疗后,两组结石清除比例差异无统计学意义...     

微通道经皮肾镜联合软镜钬激光治疗复杂性肾结石的疗效分析

目的:分析微通道经皮肾镜联合软镜钬激光治疗复杂性肾结石的疗效。方法:随机选取2016年8月～2018年8月某院收治的复杂性肾结石患者60例,随机分为两组:1组30例患者接受微通道经皮肾镜联合软镜钬激光术,2组30例患者接受常规经皮肾镜碎石术。分析两组患者的术中术后指标、结石清除率、残留结石直径、术后并发症情况。结果:两组患者的手术时间、术中出血量、术后住院时间之间的差异均不显著(P0.05);两组患者残留结石直径、结石清除率对比有显著差异(P0.05)。结论:对于合并狭窄盏颈的复杂性肾结石患者,微通道经皮肾镜联合软镜钬激光碎石较常规经皮肾镜碎石有优势。     

微创经皮肾气压弹道联合钬激光碎石治疗复杂性肾结石

目的 探讨微创经皮肾气压弹道联合钬激光碎石治疗复杂性肾结石的临床疗效.方法 采用X线或B超定位引导经皮肾穿刺建立F18通道,使用德国WOLF李氏肾镜,应用国产APL气压弹道碎石机联合科瑞达钬激光治疗复杂性肾结石86例.结果 全组无中转手术及严重并发症,手术时间1.5～4.0 h,平均2.0 h,输血2例.术后4周结石排净率为74.4%(64/86).结论 微创经皮肾气压弹道联合钬激光碎石治疗复杂性结石碎石效率高、创伤小、恢复快、并发症少,术后配合ESWL及中药排石可进一步提高肾结石的清除率,值得临床推广应用.     

超声引导下微创经皮肾镜钬激光碎石术治疗无积水肾结石

目的探讨与评价超声引导下微创经皮肾镜钬激光碎石术治疗无积水肾结石的临床疗效和安全性。方法超声引导下微创经皮肾镜钬激光碎石术治疗无积水肾结石患者41例,对其手术时间、结石清除率、手术并发症等资料进行分析。结果 41例患者均一期成功建立经皮肾通道,31例行一期碎石术,10例行二期碎石术。手术时间86～180min,平均（105±28）min,无肾蒂损伤、大出血、腹腔脏器损伤等严重并发症发生。结石取尽率为87.8%（36/41）。结论超声引导下微创经皮肾镜钬激光碎石术治疗无积水肾结石安全、方便、疗效可靠。     

N-Trap在URL治疗输尿管上段结石中的临床应用

目的探讨输尿管镜下钬激光结合N‐T rap结石拦截网治疗输尿管上段结石的方法和应用价值。方法输尿管镜下 N‐T rap结石拦截网配合钬激光碎石系统治疗输尿管上段结石62例,用输尿管镜技术将N‐T rap沿结石与输尿管壁间隙插入至结石上方,再采用钬激光碎石术将结石粉碎,对一次性碎石成功率、手术时间、手术并发症、住院时间、术后1个月结石清除率情况进行分析。结果59例手术均碎石成功,3例结石返流入肾盂,留置双J管,术后再行体外冲击波碎石,一次性碎石成功率95.16％。56例封堵导管直接越过结石,3例用钬激光碎石出现通道后再插入N‐Trap。本组手术时间15‐61 min ,平均41 min。所有患者术中均未发生输尿管黏膜撕脱,1例出现钬激光击穿输尿管壁致输尿管穿孔。术后住院时间1‐3 d ,术后1个月复查B超结石清除率96.77％。结论 N‐Trap结石拦截网可有效防止结石逃逸,提高一次性碎石成功率,减少术后结石残留,安全性好、创伤小、住院时间短,不增加手术难度,值得临床推广。     

微刨经皮肾镜钬激光碎石术治疗上尿路结石160例临床分析

目的:探讨微创经皮肾镜钬激光碎石术(MPCNL)治疗上尿路结石的方法和疗效.方法:采用B超引导下穿刺,扩张建立经皮肾通道,在输尿管镜下采用钬激光碎石系统治疗肾、上段输尿管结石160例.结果:本组患者158例行Ⅰ期穿刺取石成功,8例复杂性肾结石采用分期穿刺取石,单通道取石154例,双通道取石4例;一次取石149例,2次取石9例;平均手术时间为105 min.2例穿刺扩张失败,中转开放手术.结论:经皮肾镜钬激光碎石术是治疗上尿路结石较好的方法.     

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.     

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.     

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.     

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.