幕下小脑上锁孔入路的显微解剖学

目的 研究幕下小脑上锁孔入路的显微解剖和应用技术.方法 神经导航辅助下完成尸头模拟幕下小脑上锁孔入路手术16例,测量并分析解剖学数据.结果 小脑天幕面桥静脉对幕下小脑上锁孔入路无影响;Galen静脉系统可被安全解剖;幕下小脑上锁孔手术能充分暴露松果体区的Galen静脉系统、松果体、四叠体等;可经帆间池进入第三脑室;天幕切开能增加向上向前的手术范围.结论 幕下小脑上锁孔入路能充分暴露松果体区,为该区域手术的一种有效的微创入路.     

单侧眶上眉弓锁孔入路夹闭双侧颅内动脉瘤的应用解剖研究

目的 探讨经单侧眶上眉弓锁孔入路夹闭同侧与对侧颅内动脉瘤的相关解剖及临床研究.方法 本研究起止时间为2019年2—7月,福尔马林灌注尸体头颅标本来源于徐州医科大学附属连云港医院颅底解剖实验室,标本15例30侧并模拟眶上眉弓锁孔入路(SEK)进行显露操作,显微镜下暴露颅内对侧颈内动脉远端(DICA)、大脑前动脉(ACA)、大脑中动脉(MCA)、和颈内动脉眼段(OICA)并测量所能观察的最大长度,为临床提供解剖学数据.模拟临床处理方法,应用改良的(Salma)模拟夹闭动脉瘤的评分表量化评分.结果 经单侧眶上眉弓锁孔入路可显露动脉瘤位于对侧颈内动脉眼动脉段(3.67±1.14)mm、对侧大脑前A2外侧段(5.28±0.96)mm、大脑中动脉M1段后方(15.83±0.76)mm、大脑中动脉M2段、未被视神经遮挡的颈内动脉(7.08±2.32)mm、大脑前动脉A1段(14.77±1.45)mm.大脑前A2近段、大脑中动脉M1段、大脑中动脉M2段近端、颈中动脉分叉处下方、颈内动脉未被视神经遮挡的后方和外侧方以及颈内动脉眼动脉段的上、下和外侧方,评估后可操作性几率小于75％,其不能完全显露进行模拟夹闭操作.结论 模拟单侧眶上眉弓锁孔入路可显露夹闭动脉瘤位于对侧大脑前动脉A1段、指向前、后、内侧的大脑前动脉A2段、指向前、上、下的大脑中动脉M1段、指向上、外侧的大脑中动脉分叉部、颈内动脉分叉、指向前、内侧未被视神经遮挡的颈内动脉、指向内侧的颈内动脉眼动脉段.     

脉络膜裂囊肿的MRI诊断

目的：探讨脉络膜裂囊肿的MRI诊断价值。方法：回顾性分析13例脉络膜裂囊肿的MRI表现,其中8例行CT检查,5例行MR增强扫描。结果：13例均位于脉络膜裂内,发生于右侧7例,左侧6例;均为单发病灶：最大1．8mm×2．0mm,最小3min×5mm。呈边界清楚的卵圆形或类圆形水样信号灶,与环池或四叠体池相连,灶周无水肿,5例行MR增强扫描病例未见强化。结论：MR具有多参数、多平面成像的特点,可明确脉络膜裂囊肿的诊断,并可清楚地显示脉络膜裂,对脉络膜裂囊肿的诊断明显优于CT。     

枕下远外侧入路的显微解剖学研究及临床应用

目的 介绍枕下远外侧入路相关的解剖学研究并探讨临床应用效果.方法 采用福尔马林固定的成人头颅标本12例24侧和28例成人干性颅骨标本进行模拟枕下远外侧入路的显微解剖学研究和相关参数的测量.并应用于临床切除斜坡下段和枕骨大孔区肿瘤9例.结果 乙状窦、枕髁和椎动脉是该入路重要的解剖标志,乳突尖到枕髁外缘中点为(29.56±3.24)mm;枕髁后缘距舌下神经管内口为(12.23±3.13)mm.临床应用该入路肿瘤全切5例,次全切除3例,大部切除1例,无手术死亡.结论 采用枕下远外侧入路切除斜坡下段、颈静脉孔区、枕骨大孔区腹侧和高位颈髓腹侧病变,可以增加术野空间、减少对脑干和重要血管神经的牵拉,是较好的手术入路.     

不同解剖入路显露颈静脉孔区的定量研究

目的对枕下远外侧与耳后经颞解剖入路显露颈静脉孔区的显露程度展开定量研究,优化临床手术入路的选择。方法随机抽取20具(40侧)经10%福尔马林固定的成人2标本,将其分成两组,分别经枕下远外侧入路和耳后经颞解剖入路展开解剖研究,对两组颈静脉孔区的显露程度进行比较分析。结果在远外侧入路中,磨除颈静脉突以及部分磨除枕髁后对颈静脉孔区显露程度明显增加;而在耳后经颢入路中,迷路后入路以及部分磨除迷路对颈静脉孔区的显露程度能够得以明显增加。结论对于枕下远外侧入路对颈静脉孔区进行显露而言,磨除静脉突具有关键作用。     

改良乙状窦前经迷路内侧人路的显微解剖

目的 探讨改良乙状窦前经迷路内侧入路的手术方法.方法 在手术显微镜下解剖20具尸头标本,记录岩斜区重要结构的显露情况.结果 该入路能够提供岩斜区和海绵窦后部宽大的操作空间,椎-基底动脉、小脑前下动脉、小脑上动脉、同侧第Ⅲ～X和对侧第Ⅵ脑神经、三叉神经腔、海绵窦后部等均显露良好.结论 改良乙状窦前经迷路内侧入路能够保留面、听神经功能,获得岩斜区深面和海绵窦后部良好暴露,具有暴露范围大、观察角度多、能够在手术早期阻断肿瘤的血供等方面的优势.     

早期天幕疝的CT诊断

目的：探讨早期天幕疝的CT表现。材料与方法：作回顾性分析50例单侧颅内压增高病人的平行OM线扫描CT图像,全部病人均经斜坡垂线CT扫描法证实存在早期天幕疝。随机选取50例经斜坡垂线CT扫描法证实无早期天幕疝的病人作为对照组。结果;脑疝组中,病变侧脑室受压变形、中线结构向对侧移位50例,中线移位程度大于1.5CMJF 32例,病变侧脑沟明显受压消失50例,中间帆腔变窄50例,四叠体池及大脑大静脉池变形或闭塞50例,外侧裂池及鞍上池闭塞31例,大脑大静脉内见与海马回相连的软组织块24例。无脑疝组中,病变侧脑室受压变形、中线结构向对侧移位50例,中线移位程度大于1.5CM例12例,病变侧脑沟明显受压消失50例,中间帆腔变窄50例,四叠体池及大脑大静脉池变形或闭塞27例,外侧裂池及鞍发池闭塞25例,大脑大静脉池内未见与海马回相连的软组织块。结论：平行OM线CT扫描图像仅能对部分早期天幕疝的病人做出诊断。     

小脑水平裂-小脑桥脑裂入路治疗三叉神经痛手术前后的护理

<正>微血管减压术是目前临床上经常采用的治疗三叉神经痛的手术方法,过去多采用传统的枕下乙状窦后入路,自2009-02-23～2010-08-26笔者所在科采用经小脑水平裂-小脑桥脑裂入路微血管减压术治疗三叉神经痛55例,此入路对三叉神经根部显露充分,且不切断岩静脉,对小脑半球和     

小脑延髓裂入路的显微解剖学研究

目的本研究是为了探讨是否可以通过解剖小脑延髓裂,不切开小脑蚓部,即可以到达第四脑室和脑干侧方,获得必要的手术空间以及沿途组织结构间关系,以指导第四脑室肿瘤手术入路.方法应用显微外科解剖学技术,对经甲醛固定、血管内灌注彩色乳胶的5例成人尸头标本,按手术入路逐层解剖.观察小脑延髓裂、下髓帆和脉络膜的组成、分布与菱形窝的关系;观察小脑后下动脉及其分支的走行与分布.结果经小脑延髓裂入路,可通过脉络膜、下髓帆及蚓小结到达菱形窝的任何部位,通过外侧隐窝到达脑桥和延髓的背外侧.小脑后下动脉的扁桃体延髓段和膜髓帆扁桃体段是该入路涉及的重要血管.结论第四脑室肿瘤手术时,充分解剖小脑延髓裂,即可以在不需切开小脑蚓部的情况下获得足够手术空间,经此入路通过正常的解剖间隙可到达第四脑室甚至脑干的侧方,可减少对组织的损伤,提高手术疗效.     

一侧梗阻性脑积水的血管造影表现

中线结构向对侧移位表示大脑半球有占位性病变。但在某些病例此种移位并非肿物直接作用结果,而是继发于肿物造成的侧脑室的梗阻性扩张。鉴别上述两种性质不同的移位对治疗是重要的。一侧脑室梗阻性积水可分二型:一为室间孔梗阻,侧脑室呈一致性扩张;另一型为室内梗阻,部分侧脑室扩张。血管造影表现包括中线结构向对侧移位和侧脑室扩张引起的改变。大脑中动脉和胼胝体周围动脉移位的程度较大脑内静脉为轻,但这只能说明病变多不在额叶。胼胝体周围动脉呈宽扫帚状或弓状绕胼胝体膝走行,其皮层分枝伸长如风吹样。大脑中动脉之脑岛部向外侧移位,颞枝和顶枝牵直,彼此分离。大脑后动脉可向下移位,其分枝伸长。脉络膜前动脉向内侧移位。大脑内静脉变扁平,且向前之延伸不若正常之远,乃因室间孔增宽所致。大脑内静脉亦可向下移位,特别是当第三脑室大小正常时。视丘纹状体静脉和大脑内静脉形成     

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.     

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.