静输氧对重型脑损伤患者血糖的影响

目的探讨重型脑损伤后血糖改变与静输氧疗效之间的关系。方法选取60例脑损伤患者为研究对象,分为治疗组和对照组,以GCS评分判断疗效,并测定两组患者治疗前、后的血糖浓度,进行比较判定。结果治疗组治疗后GCS评分为(8.7±1.5)分,对照组评分为(7.5±1.8)分,治疗组疗效明显优于对照组。治疗后治疗组血糖为(5.44±0.82)mmol/L,对照组为(6.02±0.84)mmol/L,两组比较差异有非常显著性意义(P<0.01),治疗组血糖明显低于对照组。结论重型脑损伤后血糖显著升高;静输氧能提高受损脑组织对葡萄糖的利用,使血糖下降;静输氧治疗是脑损伤的辅助治疗新方法。     

依达拉奉治疗重型颅脑损伤的临床疗效

目的:探讨早期应用依达拉奉对重型颅脑损伤的疗效。方法:48例重型颅脑损伤患者随机均分为依达拉奉治疗组(n=24)和对照组(n=24)。对照组给予常规治疗(手术和脱水、神经营养、高压氧治疗等),治疗组在常规治疗基础上加用依达拉奉注射液30mg静脉滴注,bid,共14d。两组病例于治疗前、治疗后14d和3个月进行格拉斯哥昏迷评分(GCS)、格拉斯哥预后评分(GOS)和预后比较。结果:治疗后14d治疗组GCS增分率明显高于对照组[(130．9±28．4)%,(90．8±21．6)%,P＜0．05];3个月后治疗组GOS评分明显高于对照组[(4．52±2．68)分, (3．78±2．24)分,P＜0．05];治疗组与对照组的治愈率分别为29．2%,16．7%,总有效率为87．5%,79．2%,植物状态或死亡率为12．5%,20．8%,均有显著性差异(P＜0．05)。治疗组无明显不良反应。结论:早期应用依达拉奉可减轻继发性颅脑损伤的损害,有利于重型颅脑损伤患者的神经功能康复。     

亚低温在重型颅脑损伤治疗中的临床疗效分析

目的探讨总结亚低温(32～35℃)脑保护疗法在救治重型颅脑损伤(GCS记分3～8)中的疗效。方法对辽源市中医院2003年1月至2009年12月收治的96例重型损伤患者进行回顾性总结。将96例重型颅脑损伤随机平均分为治疗组与对照组,每组48例进行对比分析,治疗组在常规治疗的基础上加亚低温治疗;对照组进行常温常规治疗。结果治疗组48例患者,存活率为79.2%(38/48),恢复良好率58.3%(28/48),病死率20.8%(10/48)。疗效明显优于对照组。结论两组在预后、血糖、电解质等指标方面差异均有显著性,亚低温治疗是颅脑损伤的综合治疗措施之一,对重型颅脑损伤有肯定的疗效,能改善重型颅脑损伤患者神经功能预后,并具有安全、病残率低,提高治愈率降低病死率及癫痫发生率等优点,值得推广应用。     

早期呼吸支持治疗对颅脑损伤患者预后的影响

目的观察早期呼吸支持对颅脑损伤患者预后的影响。方法将60例颅脑损伤患者随机分为治疗组和对照组各30例。对照组给予常规对症处理,治疗组在对照组基础上给予早期呼吸支持治疗,比较2组神经功能情况、病死率和前后氧分压(PaO2)、二氧化碳分压(PaCO2)和血氧饱和度(SaO2)水平。结果治疗组良好率和病死率均高于对照组,差异均有统计学意义(P<0.05)。治疗后,2组PaO2、PaCO2和SaO2水平均优于治疗前,且治疗组优于对照组,差异均有统计学意义(P<0.05)。结论早期呼吸支持治疗可明显提高颅脑损伤患者的临床疗效,改善患者的呼吸功能及预后,降低病死率。     

大剂量纳洛酮对急性重型颅脑损伤患者促醒的疗效评价

目的:评价大剂量纳洛酮对急性重型颅脑损伤患者促醒的临床疗效。方法:选取2015年1月—2017年1月期间收治的急性重型颅脑损伤患者,采用格拉斯哥昏迷指数(Glasgow Coma Scale,简称GCS)评分后,选取其得分值为3~8分间的患者80例,将其随机分为观察组和对照组(每组40例);对照组患者根据其自身病情给予针对性的常规治疗,观察组患者在对照组治疗基础上加用大剂量纳洛酮注射液静脉注射治疗,比较两组患者用药后觉醒时间,以及治疗前后早期临床疗效和晚期的语言功能和运动功能的评分值。结果:观察组患者用药后觉醒时间明显优于对照组(P<0.05),治疗早期、晚期的临床疗效均明显优于对照组(P<0.05),病死率明显低于对照组(P<0.05)。结论:大剂量纳洛酮用于治疗急性重型颅脑损伤患者的临床疗效确切,患者觉醒快且病死率低。     

超早期针刺治疗重型颅脑损伤 35例

目的探讨超早期应用针刺治疗重型颅脑损伤的临床疗效及对病人脑脊液中白细胞介素 ?6(IL?6)含量的影响。方法选取 2016年 7月至 2019年 2月广西壮族自治区人民医院生命体征平稳的重型颅脑损伤病人 71例,采用随机数字表法分为对照组( 36例)及针刺组( 35例)对照组行常规西医治疗;针刺组在常规西医治疗基础上加用针刺治疗(于入院后第 1天开始),治疗时间为 3周。治疗前及开始治,疗后第 1、3、7天时,使用酶联免疫吸附法( ELISA)测定两组病人脑脊液 IL?6水平,并比较两组病人治疗前后格拉斯哥昏迷评分( GCS)、苏醒率及催醒时间的差异。结果治疗前针刺组与对照组 IL?6水平差异无统计学意义［(3 596.4±1 906.8)比( 3 650.9±2 001.6)mg/L,P＞0.05)］,治疗后第 1,3,7天时,针刺组 IL?6水平［(1 694.5±739.1)、(250.6± 100.6)、(469.7±196.3)mg/L］明显低于对照组［(2 384.9±1 007.4)、(556.2±166.9)、(695.2±277.8)mg/L］均差异有统计学意义(P＜0.05); GCS评分针刺组［(11.9±4.3)比( 5.6±1.8)分］与对照组［(10.2±4.1)比( 5.5±1.6)分］治疗后较治疗,前均明显改善( P＜0.05);针刺组 GCS评分［(11.9±4.3)比( 10.2±4.1)分］及催醒所需时间［(6.8±2.9)比( 9.1±3.6)d］、苏醒率［80.0%比 60.0%］均优于对照组( P＜0.05)。结论超早期针刺治疗可有效降低颅脑损伤后病人脑脊液中 IL?6的含量,提高重型颅脑损伤病人的 GCS评分,促进重型颅脑损伤昏迷病人苏醒。     

依达拉奉联合醒脑静治疗急性重型颅脑损伤的临床观察

目的:观察依达拉奉联合醒脑静治疗急性重型颅脑损伤的疗效。方法:选择2008年11月～2009年11月的急性重型颅脑损伤患者72例,将其随机分为2组:治疗组36例,采用依达拉奉联合醒脑静治疗;对照组36例,单用依达拉奉治疗。治疗后第14天统计2组APACHE-Ⅱ、格拉斯哥昏迷(GCS)评分,伤后3个月评价2组总体疗效。结果:治疗组GCS评分升高,APACHE-Ⅱ评分降低,与对照组比较差异均有统计学意义(P<0.05);治疗组疗效优于对照组(P<0.05)。结论:依达拉奉联合醒脑静治疗急性重型颅脑损伤,能够明显提高疗效,改善其神经功能缺损和预后。     

亚低温治疗重型颅脑损伤的临床研究

目的探讨亚低温脑保护疗法对救治重型颅脑损伤的疗效。方法将132例重型颅脑损伤随机平均分为治疗组与对照组,进行对比分析,并且前瞻性分析两组疗效。结果治疗组66例患者,存活率为77.3%,恢复良好率54.5%(36/66),病死率18.2%(12/66)。疗效明显优于对照组,未发生相关的并发症。结论亚低温治疗能显著降低重型颅脑损伤患者的死亡率,改善颅脑损伤患者神经功能预后,并具有安全、显著降低病死率及癫痫发生率等优点。     

早期气管切开对重型颅脑损伤并发肺部感染的干预作用研究

目的观察早期气管切开对重型颅脑损伤并发肺部感染的防治作用及对预后影响。方法回顾分析100例重型颅脑损伤患者的临床病历资料,按1∶1分为观察组和对照组,每组各50例,对照组进行常规治疗,观察组在对照组基础上,行早期气管切开,在术后24h以内实施,比较两组的肺部感染发生率、感染控制率、感染控制时间及病死率的差异,利用SPSS16.0进行统计分析。结果观察组肺部感染为32%,对照组为90%,观察组的肺部感染率明显低于对照组,P<0.01;观察组感染控制率为81.25%,观察组感染控制时间为(6.4±1.7)d;对照组感染控制率为28.89%,感染控制时间为(15.8±3.4)d,观察组感染控制率明显低于对照组,感染控制时间明显缩短,P<0.01;观察组病死率为18%,对照组病死率为52%,观察组病死率明显低于对照组,P<0.01。结论早期气管切开能有效降低重型颅脑损伤术后并发的肺部感染的概率,减轻感染病情程度,缩短感染控制疗程,降低病死率,推荐临床适当实施治疗。     

小脑幕切开术配合大骨瓣减压治疗重型颅脑损伤的临床疗效观察

目的 观察小脑幕切开术配合大骨瓣减压治疗重型颅脑损伤的治疗效果。方法 重型颅脑损伤患者28例,分为两组。观察组(n=13)采用小脑幕切开术配合大骨瓣减压治疗,对照组(n=15)单纯采用大骨瓣减压治疗,对比两组治疗效果。结果 经过治疗,观察组良好率(69.23%)与对照组(26.67%)相比明显较高,GCS评分提高明显,两组治疗效果差异有统计学意义(P<0.05)。结论 小脑幕切开术配合大骨瓣减压治疗重型颅脑损伤有利于患者脑功能及早改善,效果明显,预后良好,值得临床广泛应用。     

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.     

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.     

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.     

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.     

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.