血管内栓塞介入治疗前交通动脉瘤的疗效分析

目的探讨血管内栓塞介入治疗前交通动脉瘤的临床疗效及并发症的防治。方法回顾性分析我科从2015年1月至2016年12月通过血管内栓塞介入治疗的前交通动脉瘤患者31例,评估其临床疗效及并发症,随访6个月分析术后动脉瘤复发情况。结果术中即刻栓塞结果Ⅰ级23例,Ⅱ级8例,术中动脉瘤破裂再出血1例。术后血管痉挛9例,继发脑梗死3例,残疾2例,死亡2例。6个月术后随访24例,11例接受DSA造影无动脉瘤复发,1例动脉瘤复发破裂出血,再次介入手术治疗。结论血管内栓塞介入治疗前交通动脉瘤是一种创伤小、安全、有效的治疗方式。     

血管内介入治疗颈内动脉床突上段动脉瘤的效果及预后影响因素分析

目的 通过2~5年的长期随访,总结颈内动脉床突上段动脉瘤的介入治疗效果,分析影响预后的相关因素。方法 回顾性分析2009年1月至2013年3月安徽医科大学第二附属医院神经外科收治的57例血管内介入治疗的床突上段动脉瘤患者的影像及临床资料,探讨动脉瘤大小、部位、Hunt-Hess分级、症状性脑血管痉挛、手术时机、低钠血症、脑积水等可能影响介入治疗效果的相关因素。结果 所有病例中完全栓塞48例,不完全栓塞9例;2例术中动脉瘤破裂,1例发生动脉栓塞事件;术后6个月格拉斯哥预后评分（G0S评分）评价：满意50例（87.7%）,残疾6例（10.5%）,死亡1例（1.8%）。随访2~5年,1例明显复发增大,行二次介入治疗。单因素分析Hunt-Hess分级III~IV级、症状性脑血管痉挛、脑积水与临床疗效密切相关（P均<0.05）。多因素分析显示,Hunt-Hess III~V级、症状性脑血管痉挛是手术预后差的独立危险因素（P均<0.05）。结论 血管内介入治疗床突上段动脉瘤相对于开颅夹闭手术是一种安全有效的方法。术前Hunt-Hess分级III~IV级、症状性脑血管痉挛对预后有重要影响。     

血管内栓塞治疗破裂前交通动脉瘤92例临床分析

目的总结讨论血管内栓塞治疗破裂前交通动脉瘤的经验和体会。方法回顾性分析我院92例进行血管内栓塞治疗破裂前交通动脉瘤患者的临床资料并进行随访。结果92例中,100％栓塞者81例,95％栓塞5例,90％栓塞3例;动脉瘤破裂死亡3例,术后脑梗塞5例,死亡2例。随访87例,复发1例。结论破裂前交通动脉动脉瘤治疗比较困难,通过血管内治疗能够达到良好的治疗效果。     

栓塞治疗颅内破裂动脉瘤术中再破裂的危险因素分析

目的 探讨血管内治疗颅内破裂动脉瘤并发术中再破裂的危险因素。方法 回顾性分析2010年1月至2015年12月安徽医科大学附属省立医院收治的678例经血管内栓塞治疗的颅内破裂动脉瘤患者的临床资料,通过单因素结合多因素分析探讨术中再破裂的相关危险因素。结果 引起术中再破裂事件的危险因素有血管痉挛、动脉粥样硬化及动脉瘤大小（P<0.05）,而性别、年龄、高血压病史、糖尿病病史、Hunt-Hess分级、瘤颈特征、治疗方案及治疗时间与术中再破裂无明显关系（P>0.05）。结论 血管痉挛、动脉粥样硬化及微小动脉瘤是血管内治疗颅内破裂动脉瘤并发术中再破裂的危险因素,临床需谨慎选择手术方案,充分做好术中再破裂的预防。     

破裂前交通动脉瘤38例急性期介入栓塞治疗的疗效分析

目的 探讨破裂前交通动脉瘤急性期行血管内介入栓塞治疗的疗效.方法 回顾性分析我科采用急性期介入栓塞治疗的38例破裂前交通动脉动脉瘤的临床资料.结果 38例中,26例应用支架辅助弹簧圈栓塞,12例单纯弹簧圈栓塞,术后即刻造影显示,Roymond分级Ⅰ级29例,Ⅱ级6例,Ⅲ级3例,无手术例死亡病例.出院时mRS评分:0分2...     

栓塞介入术治疗单发颅内破裂小动脉瘤患者近期疗效及预后

目的 探讨栓塞介入术治疗直径≤ 5 mm颅内破裂小动脉瘤患者近期疗效和预后。方法 回顾性分析2013年1月至2018年1月焦作市人民医院收治的单发颅内破裂小动脉瘤（直径≤ 5 mm）335例患者的临床资料,依据其治疗方式不同分为对照组85例（动脉瘤破裂后3 d内行开颅夹闭术）、观察组250例（动脉瘤破裂后3 d内行栓塞介入术）,对比两组患者围术期指标、术后动脉瘤闭塞程度、手术前后动脉瘤影像特征[入射角、动脉瘤瘤体高度与瘤颈长度之比（AR）、动脉瘤瘤体直径与载瘤动脉直径之比（SR）]、并发症及预后。结果 观察组手术时间、住院时间短于对照组,而术后动脉瘤完全闭塞率、住院费用均高于对照组,差异有统计学意义（P<0.05）;术后两组患者入射角、AR、SR均较术前减少,且观察组入射角、AR、SR降低值均高于对照组,差异均有统计学意义（P<0.05）;观察组并发症发生率为10.00%,低于对照组的20.00%,差异均有统计学意义（P<0.05）,术后观察组GOS评分分级较对照组优,差异均有统计学意义（P<0.05）。结论 采用栓塞介入术对直径≤ 5 mm颅内破裂小动脉瘤进行治疗,有近期疗效好、预后佳、并发症少等优势,值得在临床推广应用。     

血管内介入治疗硬脑膜动静脉瘘7例分析

目的 探讨分析血管内介入治疗硬脑膜动静脉瘘的方法与疗效。方法 回顾性分析安徽医科大学第一附属医院神经外科2012年1月至2016年5月收治的7例硬脑膜动静脉瘘（DAVF）患者临床资料,其中经动脉途径栓塞6例,经静脉途径栓塞1例,均应用Onyx胶予以栓塞。结果 7例患者术后即刻造影显示栓塞完全,无死亡病例,无新发神经功能缺失症状,1例海绵窦DAVF患者术后第3天球结膜充血症状完全缓解,所有患者随访3~24个月未出现新发神经功能缺失症状。结论 根据影像学特点,针对不同类型的DAVF选用不同的栓塞途径,血管内栓塞DAVF是微创、安全、有效的治疗方法,可作为DAVF的首选治疗方法。     

早期血管内介入联合依达拉奉治疗颅内动脉瘤破裂出血的临床研究

目的观察血管内介入治疗对颅内动脉瘤破裂出血急性期的临床治疗效果。方法选取我院神经外科收治的颅内动脉瘤破裂出血急性期血管内介入治疗患者62例,观察其临床治疗效果和并发症情况。结果62例患者共66个颅内动脉瘤,100％完全栓塞43个,95％栓塞14个,90％栓塞4个,80％栓塞3个,〈80％栓塞2个。治疗后,格拉斯哥预后分级为五级的患者49例,四级11例,三级1例,二级1例。本研究中,3例在介入治疗过程中出现颅内动脉瘤破裂出血,2例介入治疗后复查头颅CT扫描,发现颅内血肿过大,遂给予开颅血肿清除术治疗。结论对颅内动脉瘤破裂出血急性期患者,采用血管内介入治疗,能够有效预防动脉瘤再次出血,提高其临床疗效,改善患者的预后,值得在临床上进一步推广应用。     

脉络膜前动脉瘤的血管内介入治疗

目的探讨脉络膜前动脉动脉瘤的特点,分析脉络膜前动脉动脉瘤的血管内介入治疗的治疗效果并进行评价。方法回顾性分析自2008年3月至2010年12月就诊的12例脉络膜前动脉瘤患者,给予介入栓塞治疗,对治疗前后患者的临床表现、治疗结果及并发症进行分析。结果 12例脉络膜前动脉动脉瘤患者,均通过门诊或电话随访,无颅内动脉瘤再破裂出血及死亡病例,取得满意的治疗效果。结论脉络膜前动脉动脉瘤,瘤体常较小,破裂后蛛网膜下腔出血广泛,易引起血管痉挛,血管内介入栓塞治疗能够取得良好的治疗效果。     

128层螺旋CT在经导管肝动脉化疗栓塞术前血供及术后疗效 评价中的应用

目的 探讨128层螺旋CT在肝癌经动脉化疗检塞术（TACE）前血供情况及疗效评价的应用价值。方法 选取2013年1月至2017年1月在六安市中医院住院的28例肝癌患者,在TACE治疗前先行上腹部平扫、增强及肝部腹腔动脉血管成像检查,观察肝癌供血血管的起源和走行,评价128层螺旋腹腔血管成像对肝癌介入治疗的指导作用,观察介入治疗后碘油沉积情况。结果 经TACE治疗4周后,CT观察碘油情况,7例全瘤均匀致密,21例病灶内散在沉积高密度碘化油影,密度不均匀,形态不规整,增强128层螺旋CT扫描显示17例患者肿瘤较治疗前缩小。结论 128层螺旋CT能清楚显示肿瘤供血血管的解剖结构,肝脏肿块内的碘油沉积分布情况,对介入栓塞治疗后的疗效进行评价,有助于临床制定肝癌介入治疗计划、治疗方案。     

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.     

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.     

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.     

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.