经皮肾镜与输尿管软镜治疗肾结石的比较研究

目的 比较经皮肾镜碎石取石术和输尿管软镜钬激光碎石术治疗1～2cm肾结石,探讨1～ 2cm肾结石的适宜治疗方案.方法 选取2014年3月至2015年3月山西省长治市人民医院泌尿外科收治的单侧肾结石47例,结石直径1～ 2cm,将其随机分为经皮肾镜碎石术组24例和输尿管软镜钬激光碎石术组23例,分别行手术治疗,比较两种术式患者的年龄、性别、结石数目、结石大小、手术时间、术后无石率、术中出血量、术后高热发生率,术后疼痛、住院天数和手术费用.结果 两组年龄、性别、结石数目及结石大小差异无统计学意义(P＞0.05),具有可比性.经皮肾镜碎石取石术组手术时间(57.9±13.4) min,输尿管软镜钬激光碎石术组(54.3±12.9) min,差异无统计学意义(P＞0.05).经皮肾镜碎石取石术组有2例有残留结石,清除率为91.7％,输尿管软镜钬激光碎石术组有3例有残留结石,清除率为86.9％,差异无统计学意义(P＞0.05).输尿管软镜钬激光碎石术组术中出血(44.6±15.3) ml,经皮肾镜碎石取石术组出血量(76.1±17.2)ml,差异有统计学意义(P＜0.05).输尿管软镜钬激光碎石术组术后高热发生率13.0％ (3/23),经皮肾镜碎石取石术组术后高热发生率16.7％(4/24),差异无统计学意义(P＞0.05).经皮肾镜碎石取石术组术后镇痛发生率20.8％ (5/24),输尿管软镜钬激光碎石术组术后未使用镇痛药物,差异有统计学意义(P＜0.05).输尿管软镜钬激光碎石术组术后住院天数(5.2±1.5)天,经皮肾镜碎石取石术组(8.4±1.6)天,差异有统计学意义(P＜0.05).输尿管软镜钬激光碎石术组手术费用(1.5±0.2)万元,经皮肾镜碎石取石术组(1.1±0.1)万元,差异有统计学意义(P＜0.05).结论 输尿管软镜钬激光碎石术比经皮肾镜碎石取石术有术中出血少、术后疼痛少、术后住院时间短、并发症少的优势,而在无石率、手术时间方面差异无统计学意义,对于1～2 cm的肾结石的手术治疗,首选输尿管软镜钬激光碎石术.     

微通道与标准通道经皮肾镜取石术治疗肾结石的疗效对比

目的 比较微通道与标准通道经皮肾镜取石术的临床效果。方法 96例肾结石患者,随机分为观察组与对照组,每组48例,观察组采用微通道经皮肾镜取石术,对照组采用标准通道经皮肾镜取石术,比较两组手术时间、术中出血量、住院时间以及手术并发症发生情况等,术后3个月随访并评价结石清除率。结果 观察组手术时间、术中出血量均较对照组增加(P<0.05),两组患者术后住院时间、并发症发生率及结石清除率等差异无统计学意义(P>0.05)。结论 与标准通道经皮肾镜取石术相比,微通道经皮肾镜取石术手术时间及术中出血量增加,但并不增加患者住院时间,术后并发症发生率也未增加,可取得与标准通道经皮肾镜取石术一样的结石清除效果,临床选择哪一种方式需根据患者实际情况综合分析。     

微通道经皮肾镜与输尿管镜治疗嵌顿性输尿管上段结石的疗效对比分析

目的对比分析嵌顿性输尿管上段结石采取微通道经皮肾镜与输尿管镜治疗的临床效果。方法150例嵌顿性输尿管上段结石患者作为研究对象,随机均分为皮肾镜组与输尿管镜组,各75例。其中皮肾镜组患者采取微通道经皮肾镜取石术(MPCNL)治疗,而输尿管镜组患者采取经尿道输尿管镜碎石术(URL)治疗,观察记录两组患者手术时间、术中出血量、结石清除率、住院时间与并发症情况,并对比分析。结果皮肾镜组患者手术时间、术中出血量、住院时间虽然稍高于输尿管镜组,但组间对比差异无统计学意义(P>0.05);皮肾镜组患者术后并发症发生率稍低于输尿管镜组,但对比差异无统计学意义(P>0.05);皮肾镜组患者术后结石清除率明显优于输尿管镜组,对比差异有统计学意义(P<0.05)。结论嵌顿性输尿管上段结石患者采取微通道经皮肾镜取石术治疗效果明显,安全性高,结石清除率显著,值得借鉴。     

微创经皮肾镜取石术与标准通道经皮肾镜取石术治疗肾结石的临床对比观察

目的 探讨微创经皮肾镜取石术与标准通道经皮肾镜取石术治疗肾结石的效果及临床应用价值.方法 选择在本院治疗的肾结石患者82例作为研究对象,将其随机分为观察组与对照组,每组41例,对照组给予标准通道经皮肾镜取石术治疗,观察组采用微创经皮肾镜取石术治疗,观察两组的临床治疗效果.结果 观察组手术时间较对照组长,术中出血量少于对照组,差异有统计学意义（P＜0.05）.两组患者结石清除率、结石残留率、术后不良反应发生率比较,差异无统计学意义（P＞0.05）.结论 微创经皮肾镜取石术与标准通道经皮肾镜取石术治疗肾结石,疗效均可靠,结石清除率高,标准通道经皮肾镜取石术手术时间短,微创经皮肾镜取石术出血量少,两种手术方法均可在临床上推广应用.     

微道与标准通道经皮肾镜取石术治疗复杂性肾结石的比较

目的对微通道与标准通道经皮肾镜取石术治疗临床复杂性肾结石疗效进行分析比较。方法选取我院确诊患有复杂性肾结石患者作为研究对象。对照组患者接受标准通道经皮肾镜取石术治疗,观察组患者接受微通道经皮肾镜取石术治疗,对诸上患者临床疗效情况进行统计记录。结果观察组患者手术时间(87.2±15.6)较对照组患者(107.2±26.2)明显缩短,输血率及术后高热率均明显低于对照组的(5%vs 10%)、结石清除率(97.5%)明显高于对照组(87.5%),上述差异均具有显著性。结论与标准通道经皮肾镜取石术治疗相比,微通道经皮肾镜取石术在治疗临床复杂性肾时更具优势,可有效减少输血及术后高情况出现,此种手术方法具有手术时间短、结石清除率高等优势,存在深入研究价值。     

标准通道与微通道经皮肾镜取石术对肾结石患者术后感染的影响

目的探讨标准通道与微通道经皮肾镜取石术对肾结石患者术后感染的影响。方法选取在我院进行治疗的肾结石患者94例,按随机数表法分为对照组与观察组,各47例。对照组行标准通道经皮肾镜取石术治疗,观察组予微通道经皮肾镜取石术治疗,比较两组手术相关指标、肾主动脉血流动力学指标及术后感染和结石清除情况。结果观察组术中出血量及术中输液量均明显少于对照组,手术时间较长,差异有统计学意义(P<0.05);术后30d,观察组肾主动脉收缩期峰值(Vmax)流速、收缩期峰值和舒张期流速比值(S/D)均明显高于对照组,阻力指数(RI)较低,差异有统计学意义(P<0.05);观察组术后感染率明显高于对照组,结石清除率较低,差异有统计学意义(P<0.05)。结论与标准通道相比,微通道经皮肾镜取石术可减少肾结石患者术中出血量,改善肾主动脉血流,但其手术时间较长,结石清石率较低,且术后感染率较高。     

微造瘘经皮肾镜取石术治疗复杂性输尿管上段结石效果观察

目的探讨微造瘘经皮肾镜取石术治疗复杂性输尿管上段结石的效果。方法选择本院治疗的复杂性输尿管上段结石患者270例,按数字表法随机分为观察组和对照组,各135例。对照组采用腹腔镜下输尿管切开取石术,观察组采用微造瘘经皮肾镜取石术,观察两组患者的临床治疗效果、并发症发生情况,以及手术时间、术中出血量。结果观察组结石完全清除率优于对照组,手术时间、出血量少于对照组,差异有统计学意义;两组并发症发生率差异无统计学意义。结论采用微造瘘经皮肾镜取石术治疗复杂性输尿管上段结石安全有效。     

微创经皮肾镜取石术治疗输尿管上段结石合并肾积脓

目的分析微创经皮肾镜取石术在治疗输尿管上段结石合并肾积脓中的临床疗效。方法选取2015年6月~2016年8月我院采用经皮肾镜取石术治疗的输尿管上段结石合并肾积脓患者41例作为研究对象,将所有患者随机分为两组,A组20例,B组21例。A组采用经皮肾镜取石术,B组先行肾造瘘术,后行取石术,对比两组治疗情况及并发症发生率。结果 A组手术时间、住院时间及住院费用均低于B组,差异有统计学意义(P0.05),两组术中出血量、取石成功率及并发症发生率比较,差异无统计学意义(P0.05)。结论微创经皮肾镜取石术治疗输尿管上段结石合并肾积脓临床效果显著,安全可靠,可有效可减少住院时间及住院费用,术后需严密观察,加强抗感染治疗。     

标准通道与微通道经皮肾镜治疗上尿路结石的临床对比研究

目的 探讨标准通道经皮肾镜取石术(sPCNL)与微通道经皮肾镜取石术(mPCNL)治疗上尿路结石的疗效与安全性.方法 选择2011年1月至2015年12月,在我科治疗的上尿路结石患者216例,其中101例采用sPCNL治疗,115例采用mPCNL治疗.比较并分析两组的手术时间、术中出血量、一期结石清除率、手术并发症的发生率.结果 sPC-NL组手术时间[(105.34±23.14) min]明显少于mPCNL组[(136.45±18.71) min] (P＜0.05).sPCNL组术中出血量[(163.27±20.17) mL]明显大于mPCNL组[(105.19±20.17) mL] (P＜0.05).sPCNL组一期结石清除率为89.10％,明显高于mPCNL组的74.78％ (P＜0.05).两组输尿管上段结石清除率分别为88.00％和89.65％ (P＞0.05).两组手术并发症总发生率分别为13.86％和14.78％ (P＞0.05).结论 sPCNL与mPCNL均为肾结石和输尿管上段结石的首选治疗方式.应根据结石大小及分布情况及肾脏的解剖及病理改变,综合评估,选择合理的操作通道.     

26例上尿路结石经皮肾输尿管镜碎石术治疗分析

目的探讨经皮肾微造瘘输尿管镜碎石、取石术（PCNL）治疗肾、输尿管上段结石的临床疗效。方法在B超引导下经皮肾穿刺造瘘,并将通道扩张至F16-18,从通道插入输尿管镜到结石处,用气压弹道碎石机将结石击碎,取出碎石片。结果 26例患者,17例一期取净结石,4例1周二期取净结石,5例肾盏内有小块结石残留,经体外震波碎石（ESWL）或软性膀胱镜取石后治愈。结论经皮肾微造瘘碎石、取石术疗效好、创伤小,可作为治疗肾、输尿管上段复杂结石的重要疗法,若与ESWL结合疗效更佳。     

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.     

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.     

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.