臀部转移筋膜皮瓣治疗老年高龄骶尾褥疮16例

目的 探讨臀部转移筋膜皮瓣治疗老年高龄骶尾褥疮患者的疗效.方法 对16例老年高龄骶尾褥疮患者行臀部转移筋膜皮瓣修复的手术方法及术中观察、术后随访.结果 采用臀部转移筋膜皮瓣修复老年高龄骶尾褥疮,手术方法简单,手术时间短,术后伤口愈合好结论治疗骶尾褥疮转移筋膜皮瓣的应用疗效可靠,减少高龄患者手术风险,具有简单可靠等特点.     

负压引流结合打包加压包扎在改良菱形筋膜皮瓣修复骶尾部褥疮中的应用

目的 探讨负压引流结合打包加压包扎在预防改良菱形筋膜皮瓣修复骶尾部褥疮术后皮下积液和皮瓣坏死中的作用.方法 选择2004年1月至2012年12月间采用改良菱形筋膜皮瓣修复骶尾部褥疮的56例患者作为试验组,术后应用负压引流结合打包加压包扎的方法预防皮下积液和皮瓣坏死的发生,选择2000年1月至2004年12月间采用同样手术方式,但术后未进行加压包扎的23例患者作为对照组,比较两组皮下积液和皮瓣坏死发生率.结果 试验组发生皮下积液3例,发生率5.36％;发生皮瓣坏死4例,发生率7.14％.对照组发生皮下积液6例,发生率26.09％;发生皮瓣坏死7例,发生率30.43％.两组差异具有统计学意义(P＜0.05).结论 负压引流结合打包加压包扎是一种相对简单、有效的预防改良菱形筋膜皮瓣修复骶尾部褥疮术后皮下积液和皮瓣坏死的方法.     

股外侧筋膜皮瓣在股骨大转子部褥疮修复中的应用

目的探讨股外侧筋膜皮瓣修复股骨大转子部褥疮的临床治疗效果。方法对8例共16处坐骨结节褥疮应用股外侧筋膜皮瓣修复,褥疮范围3cm×4cm～6cm×8cm,皮瓣大小6cm×12cm～11cm×17 cm。结果术后第12～14天拆线,皮瓣全部成活,切口Ⅰ期愈合。随访3个月至4年皮瓣质地优良,外形丰满,原手术部位未再发生褥疮。结论应用股外侧筋膜皮瓣修复股骨大转子部褥疮时皮瓣转移方便,对局部功能影响小,供区不需植皮,远期效果好,是一种可靠的修复方法。     

臀大肌皮瓣修复顽固性骶尾部褥疮

臀大肌皮瓣修复顽固性骶尾部褥疮常敏，苏开荣我院自１９９０年以来应用臀大肌旋转皮瓣修复顽固性骶尾部褥疮８例，均获得优良效果，现报告如下：临床资料本组共８例，其中男２例，女６例，年龄２８～４９岁，７例为截瘫后长期卧床所致，１例为昏迷病人压迫所致．褥疮发生...     

臀上皮神经营养血管皮瓣修复骶尾部褥疮临床观察

以往骶尾部褥疮的手术修复中,臀大肌肌皮瓣作为最成功的经典术式,已得到推广。腰臀皮瓣进行修复,并认为该皮瓣仅仅利用了腰4动脉后支的主轴提供血运,李澎等…对该皮瓣做了详细的解剖学研究,腰臀皮瓣也归属于神经营养血管皮瓣范畴。我院2005年1月至2010年6月利用以腰4动脉后支为蒂的臀上皮神经营养血管皮瓣修复骶尾部褥疮18例,皮瓣感觉良好,疗效满意,报告如下。     

肌皮瓣修复瘫痪患者臀骶部Ⅳ期褥疮及窦道

目的探讨瘫痪患者臀布及骶尾部Ⅳ期褥疮及窦道的修复方法。方法采用臀大肌、臀中肌、阔筋膜张肌肌皮瓣等肌皮瓣转移修复瘫痪患者臀部及骶尾部Ⅳ期褥疮及窦道24例36处,其中扩创前创面最小为5.0 cm×6.2 cm,扩创后创面最大为6.4 cm×8.5 cm,创面平均大小为6.0 cm×7.5 cm。结果瘫痪患者Ⅳ期褥疮及窦道24例36处肌皮瓣全部成活,3处肌皮瓣的边缘部分坏死,经换药治愈。本组病例经6个月~10年随访均无复发。结论临床可常规应用肌皮瓣转移修复瘫痪患者臀部及骶尾部Ⅳ级褥疮及窦道。     

臀部Ⅳ期褥疮皮瓣转移的外科策略

目的 探讨臀部Ⅳ期褥疮行皮瓣修复的外科策略,介绍特殊Ⅳ期褥疮选择手术技巧、皮瓣应用和效果. 方法从1998年10月至今,对我院16例臀部Ⅳ期褥疮患者的手术治疗效果进行回顾性分析,其中2例为特殊Ⅳ期褥疮;6例采用臀大肌转移皮瓣,10例采用局部转移皮瓣.结果 6例肌皮瓣全部成活,Ⅰ期愈合,1例发生边缘部分坏死,经第二次转移皮瓣愈合.10例局部皮瓣4例Ⅰ期愈合,2例经更换敷料2～3月愈合.随访3～10个月,肌皮瓣及供区组织弹性良好,无复发. 结论特殊Ⅳ期褥疮需根据情况应按肿瘤规范的方法完整切除;臀部任意皮瓣与臀大肌转移皮瓣修复臀部Ⅳ期褥疮都是比较好的手术术式,都具有成活率高、复发少的特点,具体术式选择取决于褥疮深度和面积.     

腓肠神经营养血管蒂逆行岛状筋膜皮瓣临床应用8例

目的探讨应用腓肠神经营养血管蒂逆行岛状筋膜皮瓣修复足踝部软组织缺损的方法。方法应用腓肠神经营养血管蒂逆行岛状筋膜皮瓣修复踝部、足跟部软组织缺损8例,皮瓣切取范围5cm×7cm～10cm×14cm,蒂长5cm～8cm。结果本组8例术后皮瓣均成活,7例伤口一期愈合,1例皮瓣边缘表层坏死,经换药、植皮后愈合。术后5例经3个月至4年随访,皮瓣血运、质地、弹性佳,外观较满意,踝关节活动功能正常。结论腓肠神经营养血管蒂逆行岛状筋膜皮瓣设计容易,操作简便,无需牺牲知名动脉,不需吻合血管,且皮瓣可获得较长蒂部,旋转灵活,皮瓣成活率高,是足踝部软组织缺损的较好的修复方法。     

上臂远端内侧逆行穿支筋膜蒂皮瓣在肘部的应用

目的 报道上臂远端内侧逆行穿支筋膜蒂皮瓣在肘部的临床应用和疗效.方法 以上臂远端内侧穿支筋膜为蒂的皮瓣逆行修复肘部创面5例,肘关节屈侧瘢痕挛缩2例.皮瓣面积16 cm×9 cm-5 cm×4 cm.结果 7例患者皮瓣全部成活,供区一期愈合.经6-12个月随访,皮瓣质地柔软,外形满意.结论 上臂远端内侧逆行穿支筋膜蒂皮瓣切取方便,血运可靠,应用于肘部,外形满意,利于功能锻炼.     

颜面部筋膜蒂皮瓣修复颜面部皮肤软组织缺损的探讨

目的探讨颜面部筋膜蒂皮瓣修复颜面部皮肤软组织缺损的临床效果。方法 48例患者,其中颜面部皮肤肿瘤20例,外伤缺损伤8例,色素痣9例,溃疡6例,瘢痕3例,瘢痕合并组织凹陷2例,缺损面积最小1.0 cm×1.0 cm,最大4.0 cm×3.0 cm,所有病例均应用颜面部筋膜蒂皮瓣进行修复。结果本组48例,皮瓣面积最大为5.0 cm×3.5 cm,最小为1.5 cm×1.2 cm,蒂宽1.0～3.0 cm,皮瓣全部成活。随访6～12个月,颜面部外观满意。结论本方法具有良好的美学效果,颜面部外形美观、皮瓣成活率高、供区就近取材、切口隐蔽且瘢痕小等优点。     

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.