慢性精神分裂症合并肠梗阻的临床放射学分析

目的探讨抗精神病药所致麻痹性肠梗阻的临床放射学特征。方法对56例精神分裂症患者治疗中发生肠麻痹不同时期临床放射学表现进行分析。结果56例临床表现均有渐进式腹胀,肠鸣音减弱或消失。依据卧立位腹部X线平片表现分为四期:胃结肠积气型(早期)19例;结小肠积气型(中期)18例;肠梗阻型(重症期)15例;肠坏死型(晚期)4例。早～中经保守治疗可痊愈;重症～晚期经减药、加用胃肠动力药、行胃肠加压和抗菌等治疗措施,部分可恢复功能;其中3例因低血钾、电解质紊乱和多器官功能障碍而死亡,1例在手术中发现肠坏死面广,粘连而行姑息手术,术后死亡。结论各类抗精神病药均可引起麻痹性肠梗阻,以氯氮平(53.5%)最多见,可能与剂量及个体对药物的敏感性有关,X线检查可及时准确诊断肠梗阻,不同时期采取不同治疗措施,提高精神病的治愈率具有重要意义。     

Polio revisited: reviving knowledge and skills to meet the challenge of resurgence

Purpose

To date, polio has not been eradicated and there appears to be a resurgence of the disease. Hence, there is a need to revive decision-making skills to treat the effects of polio.

Methods

Here, we outline the aspects of treatment of paralysis following polio based on the literature and personal experience of the authors. The surgical treatment of the lower and upper extremities and the spine have been reviewed. The scope of bracing of the lower limb has been defined.

Results

The effects of polio can be mitigated by judicious correction of deformities, restoration of muscle balance, stabilising unstable joints and compensating for limb length inequality.

Conclusions

As polio has not been eradicated and there is a risk of resurgence of the disease, paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques for managing the effects of paralysis following polio is needed.     

Differential accumulation of paralytic shellfish toxins from Alexandrium minutum in the pearl oyster, Pinctada imbricata

To investigate the potential for differential accumulation of paralytic shellfish toxins (PSTs) in various tissues of the akoya pearl oyster, Pinctada imbricata, two feeding trials were carried out using the PST-producing dinoflagellate, Alexandrium minutum. When fed with A. minutum at concentrations between 100 and 1300 cells ml⁻¹, the maximum clearance by P. imbricata was shown to occur at a density of 300 cells ml⁻¹. When fed twice daily at this rate for up 12 days, P. imbricata accumulated analogues of gonyautoxins (GTXs): GTXs 1,4 and 2,3. The levels of GTXs in the viscera increased progressively on days 4, 8 and 12 to peak at 17.9 ± 4.47 μg STX-equivalent 100 g⁻¹ biomass. Following 12 days of depuration, in the absence of A. minutum, GTX levels fell by approximately 65% to 6.0 ± 2.20 μg STX-equivalent 100 g⁻¹ biomass. No GTX was found in the oysters at the start of the trial or in untreated controls. The accumulation of GTX was found to be tissue specific. No GTX was detected in the muscle tissue of P. imbricata during the feeding trial.     

改进的胫后肌前移术治疗垂足畸形(附17例报告)

目的 研究关于提高麻痹性马蹄内翻足畸形疗效的新术式。方法 从1989年至现在,由作者设计的新术式治疗17例麻痹性马蹄足内翻畸形。该术式是将前移的胫骨后肌腱缝合到腓骨长肌腱的远端。结果 在全部病例中随访12个月～10年,这新术式的疗效是满意的。原有足畸形基本上被矫正。足背屈肌在抗重力达到Ⅲ～Ⅳ级。结论 本术式操作简单、易于掌握,是治疗麻痹性马蹄内翻足畸形的一种新方法。     

First evidence of “paralytic shellfish toxins” and cylindrospermopsin in a Mexican freshwater system, Lago Catemaco, and apparent bioaccumulation of the toxins in “tegogolo” snails (Pomacea patula catemacensis)

Exposure to cyanobacterial toxins in freshwater systems, including both direct (e.g., drinking water) and indirect (e.g., bioaccumulation in food webs) routes, is emerging as a potentially significant threat to human health. We investigated cyanobacterial toxins, specifically cylindrospermopsin (CYN), the microcystins (MCYST) and the “paralytic shellfish toxins” (PST), in Lago Catemaco (Veracruz, Mexico). Lago Catemaco is a tropical lake dominated by Cylindrospermopsis, specifically identified as Cylindrospermopsis catemaco and Cylindrospermopsis philippinensis, and characterized by an abundant, endemic species of snail (Pomacea patula catemacensis), known as “tegogolos,” that is both consumed locally and commercially important. Samples of water, including dissolved and particulate fractions, as well as extracts of tegogolos, were screened using highly specific and sensitive ELISA. ELISA identified CYN and PST at low concentrations in only one sample of seston; however, both toxins were detected at appreciable quantities in tegogolos. Calculated bioaccumulation factors (BAF) support bioaccumulation of both toxins in tegogolos. The presence of CYN in the phytoplankton was further confirmed by HPLC-UV and LC-MS, following concentration and extraction of algal cells, but the toxin could not be confirmed by these methods in tegogolos. These data represent the first published evidence for CYN and the PST in Lago Catemaco and, indeed, for any freshwater system in Mexico. Identification of the apparent bioaccumulation of these toxins in tegogolos may suggest the need to further our understanding of the transfer of cyanobacterial toxins in freshwater food webs as it relates to human health.     

中医药治疗麻痹性斜视的临床进展与述评

从辨证论治、定方加减、针刺治疗、电针治疗及推拿按摩5 个方面综述了中医药治疗麻痹性斜视的临床进展,并进行了述评,提出了今后值得重视与研究的3 个问题。     

First report of saxitoxin in octopi.

We report for the first time, the presence of saxitoxin (STX) in a common cephalopod, Octopus (Abdopus) sp. 5, collected from Cooke Point on the northern coastline of Western Australia. Sodium channel and saxiphilin based radio-receptor assays detected saxitoxin-like binding in octopi extracts. Further analysis by liquid chromatography-fluorescence detection (LC-FLD) identified STX as the major contributing toxin in these samples. The presence of STX was confirmed by LC-mass spectrometry and comparison of fragmentation patterns with an authentic STX standard. LC-FLD quantitation and conversion of the Octopus sp. 5 extracts revealed toxin concentrations as high as 246 microg STX/100g tissue, more than three times the US, European and Australian regulatory limit for human consumption of shellfish of 80 microg STX/100g tissue. There was no evidence of tetrodotoxin or other paralytic shellfish toxin derivatives. This level and distribution of STX in octopi poses a potential public health risk, particularly when routine toxin screening of wild catch is not regulated.     

Analysis of paralytic shellfish poisoning toxin congeners by a sodium channel receptor binding assay.

This study was carried out to characterize the detection and quantitation of several paralytic shellfish poisoning (PSP) toxin congeners using a receptor binding assay (RBA). This involved competitive binding of the toxin congeners against tritium-labeled STX for receptor sites on rat brain sodium channels. Competitive binding curves were described by a four-parameter logistic equation. Half-saturation values (EC(50)) ranged from 4.38 nM for STX to 142 nM for GTX5. Receptor binding affinity was in the order STX>GTX1/4>neoSTX>GTX2/3>dcSTX>GTX5, and this was similar to the order of mouse toxicity of these congeners. Predicted toxin concentrations from observed STXeq values and EC(50) ratios relative to STX were within 20% or better of the actual concentrations used in the assay. In contrast predicted toxin concentrations using mouse toxicity ratios relative to STX did not provide a good match to actual concentrations, except for GTX1/4. This study has shown that the rat brain sodium channel RBA will provide a reliable integration of total toxicity of various PSP toxin congeners present in a sample.     

AlphaA-Conotoxin OIVA defines a new alphaA-conotoxin subfamily of nicotinic acetylcholine receptor inhibitors.

The venoms of cone snails are rich in multiply disulfide-crosslinked peptides, the conotoxins. Conotoxins are grouped into families on the basis of shared cysteine patterns and homologous molecular targets. For example, both the kappaA- and alphaA-conotoxin families share the same Class IV Cys pattern (-CC-C-C-C-C-), but differ in their molecular targets. The kappaA-conotoxins are excitatory toxins that purportedly block potassium channels, while the alphaA-conotoxins are paralytic conotoxins that inhibit nicotinic acetylcholine receptors (nAChRs). In this work, we describe the isolation and characterization of a novel Conus peptide from venom milked from Hawaiian specimens of Conus obscurus. This peptide shares the Class IV Cys pattern but differs from both previously characterized alphaA- and kappaA-conotoxins in the spacing of amino acids between Cys resides. However, the peptide is similar to previously characterized alphaA-conotoxins in its paralytic effects on fish and its antagonist activity on the neuromuscular nAChR. Unexpectedly, the peptide differs in its disulfide bonding from alphaA-conotoxin PIVA. We have named this unique peptide alphaA-conotoxin OIVA, and we consider it the defining member of a subfamily of alphaA-conotoxins that we designate the alphaA(1-3)-conotoxins to identify them by their unique disulfide bonding framework. These results indicate that the alphaA-conotoxin family is both more structurally diverse and broadly distributed than previously believed.