大脑镰及小脑幕硬膜下血肿的CT、MRI诊断探讨

目的探讨大脑镰及小脑幕硬膜下血肿的CT、MRI表现,提高诊断准确率。方法回顾性分析32例经临床证实为大脑镰及小脑幕硬膜下血肿的头部外伤患者CT、MRI表现。结果①32例患者中大脑镰硬膜下血肿15例,小脑幕硬膜下血肿14例,大脑镰并小脑幕下血肿3例。②CT表现：大脑镰硬膜下血肿为条索状、带状高密度影,可位于大脑镰一侧或两侧;小脑幕硬膜下血肿可位于双侧或局限于单侧、幕上或幕下。血肿边缘清晰,不延伸入邻近脑沟或脑池。③MRI表现：轴位形态与CT大致相同,冠、矢状位显示血肿更清晰,根据血肿不同时期信号的特异性表现,可对其作出更加准确的诊断。结论大脑镰及小脑幕硬膜下血肿的CT、MRI表现均具有特征性,MRI检查对亚急性期血肿的显示较CT更优越。     

大脑镰、小脑幕硬膜下血肿的CT诊断

目的探讨大脑镰、小脑幕硬膜下血肿的CT诊断价值。方法回顾性分析19例大脑镰、小脑幕硬膜下血肿的CT表现。结果19例中大脑镰硬膜下血肿8例，CT表现为内缘平直、外缘弧形或波浪形的带状高密度影；小脑幕硬膜下血肿6例，CT表现为扇行高密度影，幕缘密度最高，边缘光滑、锐利，离幕缘密度变淡而模糊；大脑镰合并小脑幕硬膜下血肿5例，CT表现为具有大脑镰和小脑幕硬膜下血肿的CT表现，二者相连，右侧呈S形，左侧呈反S形。结论大脑镰、小脑幕硬膜下血肿CT表现具有特征性，CT检查对其诊断和鉴别诊断有重要意义。     

少见部位硬膜下血肿的CT诊断

目的大脑镰小脑幕硬膜下血肿，是属特殊形态的硬膜下血肿，发病率相对较少。以前常常被诊断为蛛网膜下腔出血。因此，本文在于对大脑镰小脑幕硬膜下血肿能明确诊断，为临床提供可靠的治疗依据。方法分析了2例大脑镰小脑幕硬膜下血肿的发病情况，CT诊断及血肿演变过程。探讨了大脑镰小脑幕硬膜下血肿的发病机理及血肿形态。结果为避免误诊，讨论了大脑镰小脑幕硬膜血肿与蛛网膜下腔出血的鉴别诊断。结论重点论述了CT表现及CT诊断。为今后认证提供参考。     

真菌性角膜炎预后效果影响因素相关性分析

目的：探究真菌性角膜炎预后效果影响因素。方法：回顾性分析2013年1月～2014年6月我院收治的103例（112眼）真菌性角膜炎患者的资料,探究真菌性角膜炎预后效果及其影响因素。结果：本次研究103例真菌性角膜炎患者治疗失败23例,失败率为22.33%;溃疡面积≥16mm2、浸润深度≥0.2mm、前房积脓≥3mm2以及镰孢菌感染患者的治疗预后效果较差;真菌性角膜炎患者的角膜溃疡面积、浸润深度、前房积脓程度以及感染镰孢菌均与治疗预后效果呈明显的正相关性（P<0.05）。结论：初诊病灶溃疡面积大于16mm2,浸润深度大于0.2mm,前房积脓大于3mm2以及茄病镰孢菌感染的真菌性角膜炎临床药物治疗预后效果较差,建议及早进行外科手术治疗。     

外伤性硬膜下积液继发出血的机制探讨与治疗

1993年11月至2002年10月，我们收治28例外伤性硬膜下积液保守治疗后转化为慢性硬膜下血肿的患者，占同期收治外伤性硬膜下积液患者的14．1％（28／199）。现结合患者的临床资料和相关文献报道如下。     

角化囊肿综合征病例报告1例

角化囊肿综合征是一种较为罕见的常染色体显性遗传疾病,以颌骨多发性角化囊肿为主要临床表现,可同时伴发分叉肋、大脑镰钙化、小脑幕钙化等骨骼异常,当同时伴发痣样基底细胞癌时,又称痣样基底细胞癌综合征。本文报道1例角化囊肿综合征病例,并对其临床、病理及治疗进行了讨论。     

出血性脑卒中330例临床分析

目的：对比分析出血性脑卒中患者经内科保守治疗和外科手术治疗的疗效和预后情况。方法：将330例出血性脑卒中患者分两组,一组177例,经内科保守治疗;另一组153例,行外科手术治疗。结果：经过外科手术治疗,治愈率明显高于内科保守治疗,内科保守治疗好转率稍高于外科手术治疗。死亡率相比,外科少于内科,两组差异无统计学意义。结论：严格掌握外科手术治疗适应证及禁忌证,且外科手术应选择早期或超早期进行。     

等密度硬膜下血肿影像分析(附颅骨钻孔引流术后24例)

目的通过分析等密度硬膜下血肿的CT表现,总结具有诊断意义的CT征象。方法回顾分析30例经手术和保守治疗证实的资料完整的等密度硬膜下血肿的CT表现,临床症状体征。结果 30例等密度硬膜下血肿CT检查出36个血肿灶,单例25,双例5例。左侧15个,右侧21个,病灶分布以额颞顶部为主,其次分布在额顶或顶枕部,血肿呈新月形或半月形,位于大脑凸面,跨越颅缝,密度与脑实质相仿,CT值40～45HU。同侧脑皮髓质界面内移,脑室受压变形,移位,双侧血肿时,中线结构向血肿小的一侧偏移。血肿较大时可以产生脑疝。CT增强扫描,脑膜及脑表面小血管强化使血肿轮廓变清晰。结论具有诊断意义的征象有:①脑灰质界面内移;②病灶侧脑沟消失,脑回聚拢,内移;③侧脑室受压变形中线结构向健侧或血肿较小的一侧移位;④大脑镰下疝。CT增强扫描及MRI对发现小血肿及脑疝更有意义。     

内科治疗脑出血78例的临床观察

脑出血是临床常见病，疾病负担大，具有发病率、致残率和病死率高的特点。目前，脑出血的治疗方法主要包括外科手术治疗及内科保守治疗，治疗方法的选择多以神经内、外科医师的临床经验为主，尚缺乏可靠的证据支持，其治疗效果亦存在很大争议。本文选择我院78例脑出血患者给予内科治疗，观察其治疗效果，现报道如下。     

等密度硬膜下血肿CT影像分析

目的：通过分析等密度硬膜下血肿的CT表现,总结具有诊断意义的CT征象。方法：回顾分析29例经手术和保守治疗证实的资料完整的等密度硬膜下血肿的CT表现,临床症状、体征。结果：29例等密度硬膜下血肿CT检查出36个血肿灶,单侧24例,双侧5例。左侧15个,右侧21个,病灶分布以额颞顶部为主,其次分布在额顶或顶枕部,血肿呈新月形或半月形,位于大脑凸面,跨越颅缝,密度与脑实质相仿,CT值40~45Hu。同侧脑皮髓质界面内移,脑室受压变形,移位,双侧血肿时,中线结构向血肿小的一侧偏移。血肿较大时可以产生脑疝。CT增强扫描,脑膜及脑表面小血管强化使血肿轮廓变清晰。结论：具有诊断意义的征象有,①脑灰质界面内移;②病灶侧脑沟消失,脑回聚拢,内移;③侧脑室受压变形中线结构向健侧或血肿较小的一侧移位;④大脑镰下疝。CT增强扫描及MRI对发现小血肿及脑疝更有意义。     

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.