宫颈癌术后补充放疗患者预置输尿管支架改善泌尿系统并发症的临床研究

摘要： 目的 分析预置输尿管支架对宫颈癌术后补充放疗患者降低泌尿系梗阻发生率和保护肾功能的临床应用价值。方法 宫颈癌 （ⅠA 期、 ⅠB 期和ⅡA 期） 患者 81 例, 分为 2 组。观察组 39 例于放疗定位前预置输尿管支架并带管放疗; 对照组 42 例采用常规补充放疗, 不预置输尿管支架。观察 2 组肾积水、 肌酐、 尿素氮情况, 记录包括发热、 感染、 腰痛、 肾区叩击痛、 放射性膀胱炎等与留置输尿管支架相关并发症的发生率。结果 观察组肾积水总发生率 （10.3% vs. 33.3%） 和轻度肾积水发生率 （5.1% vs. 21.4%） 少于对照组 （P＜0.05）; 2 组中度和重度肾积水发生率差异无统计学意义; 治疗后观察组肌酐水平 ［（116.9±43.0） μmol/L vs.（170.8±68.4） μmol/L］ 和尿素氮水平 ［（5.4±1.9） mmol/L vs.（7.7±2.5） mmol/L］ 均低于对照组 （P＜0.05）, 且除观察组尿素氮外, 2 组治疗前后肌酐和尿素氮差异均有统计学意义 （P＜0.05）。观察组留置输尿管支架期间发热、 感染、 腰痛、 肾区叩击痛和放射性膀胱炎发生率与对照组差异均无统计学意义。结论 对宫颈癌术后补充放疗患者预置输尿管支架可以防治输尿管梗阻, 保护肾功能, 该方法有效、 安全、 可行, 具有较高的临床应用价值。     

腔内置双J管并ESWL治疗肾结石28例

目的探讨腔内置双J管并ESWL治疗肾结石的临床效果。方法对28例肾结石引起肾积水患者．采用腔内置双J管后行ESWL治疗。结果全部患者均获明显效果，均顺利排石。均未出现肾积水加重及石街形成。结论腔内置双J管并ESWL是治疗较大肾结石引起肾积水的有效办法。具有住院时间短、术后感染低，杜绝了石街形成肾积水加重等并发症。     

双 J管联合坦索罗辛在盆腔肿瘤治疗中预防输尿管副损伤的意义

目的 探讨双J管联合坦索罗辛在盆腔肿瘤治疗中预防输尿管副损伤的应用意义.方法 选取2010年10月至2019年9月佛山市三水区人民医院盆腔肿瘤手术病人404例,分为预置管组120例,未置管组246例,单纯口服坦索罗辛组38例.预置管组术前膀胱镜下输尿管逆行插管留置双J管并保留至术后盆腔放疗结束,联合口服坦索罗辛缓释胶囊;未置管组未预置双J管;单纯口服坦索罗辛组在盆腔肿瘤手术术后单纯口服坦索罗辛缓释胶囊.比较三组临床资料、术中输尿管损伤情况及术后放疗并发症.结果 预置管组术中输尿管损伤2(1.67％)例,未置管组损伤13(5.28％)例,两组损伤率比较,差异有统计学意义(P<0.05);三组术后放疗后,预置管组89例中有2例出现输尿管狭窄导致肾功能损伤(2.25％),未置管组162例中有22例(13.58％),单纯口服坦索罗辛组38例中有6例(15.79％),预置管组与另外两组术后放疗并发症发生率比较,均差异有统计学意义(P<0.05).结论 双J管联合坦索罗辛在盆腔肿瘤术中对提高术中输尿管的辨识,减少术中输尿管损伤及术后输尿管纤维化狭窄,降低放射性输尿管狭窄致肾功能损伤的风险,减少术后留置双J管尿路刺激症状,促进输尿管损伤康复,保护肾功能有重要意义.     

间苯三酚联合膀胱镜下双“J”管植入治疗妊娠中晚期肾积水的可行性研究

目的对间苯三酚联合膀胱镜下双"J",管植入治疗妊娠中晚期肾积水的可行性予以研究。方法选取我院2013年9月至2015年9月间治疗的妊娠中晚期肾积水患者168例为研究对象,按随机数字表法将其分为观察和对照组,分别采用问苯三酚联合膀胱镜下双"J"管植入术和膀胱镜下双"J"管植入术治疗,并对其基线资料、疗效、安全性及新生儿质量等数据进行组问比较。结果两组基线资料比较差异无统计学意义(P>0.05);两组总有效率分别为95.3%和83.1%,观察组显著优于对照组(P<0.05);并发症发生率分别为17.6%和14.5%;组问比较差异无统计学意义(P>0.05);术后观察组中重度疼痛率和新生儿质量评分分别为22.4%和(8.6±1.3)分,均显著优于对照组(P<0.05)。结论间苯三酚联合膀胱镜下双"J"管植入是治疗妊娠中晚期肾积水安全有效的疗法,且能改善术后疼痛和新生儿质量,具有可行性。     

应用双J管治疗肾结石的临床观察

目的分析双J管在肾结石临床应用效果,探讨其在肾结石治疗中的合理应用。方法 2007年1月至2009年1月收治的356例肾结石患者随机分为治疗组和对照组,治疗组(n=180),采用ESWL治疗,在治疗中使用双J管作内支架;对照组(n=176),同样采用ESWL治疗,术中不放双J管。结果治疗组结石排净时间短于对照组,肾盂尿液引流、伤口愈合、并发症等均优于对照组,比较有统计学差异(P<0.05)。结论双J管在治疗中的应用,不仅能防治伤口吻合不当,而且具有内支架和内引流的双重作用,同时术中并发症少,减少了患者的痛苦,缩短了住院时间,值得上尿路治疗推广。     

输尿管镜下腹膜后纤维化肾积水患者置入双J管的护理研究

目的:分析和研究输尿管镜下腹膜后纤维化肾积水患者置入双J管的护理效果。方法:收集60例腹膜后纤维化肾积水患者的临床资料,随机分为观察组与对照组各30例,对照组患者进行常规护理,观察组进行全面护理,将两组患者的临床效果进行观察和对比。结果:观察组患者的有效率明显高于对照组,患者的满意度显著高于对照组,P0.05。结论:在腹膜后纤维化肾积水患者通过输尿管镜置入双J管的护理当中,通过实施全面的护理有助于患者的康复,保证治疗的效果。     

奈达铂联合紫杉醇同步放化疗治疗宫颈癌的临床观察及安全性评估

目的研究奈达铂联合紫杉醇同步放化疗治疗宫颈癌的临床疗效及安全性。方法选择宫颈癌患者作为研究对象,随机分为给予放疗联合奈达铂加紫杉醇化疗方案的观察组和放疗联合顺铂加紫杉醇化疗方案的对照组,观察肿瘤缓府晴况、分期情况、疗效相关指标及安全性相关指标。结果观察组化疗缓解总有效率57．69％,TNMI期2例、Ⅱ期6例、Ⅲ期11例、Ⅳ期7例,肿瘤缓解情况及分期情况均明显好于对照组;化疗效果指标VEGFB以及化疗安全性指标肾功能损害、肝功能损害、心功能损害例数明显低于对照组,sFh-1水平明显高于对照组。结论奈达铂联合紫杉醇同步放化疗治疗能够有效的改善肿瘤分期和治疗效果,减少不良反应,具有积极的临床价值。     

泌尿外科手术留置双J导管的疗效观察与护理干预

目的探讨泌尿外科手术留置双J导管内引流的疗效及护理干预措施。方法回顾性分析本院2010年1月～2012年1月采用双J管支架治疗输尿管狭窄合并肾积水患者36例的资料,比较治疗前后的肾功能,对出现的并发症给予护理干预。结果 36例患者治疗前后肾功能进行比较,患者肾功能明显改善,差异有统计学意义（P〈0.05）;36例出现并发症的患者积极进行护理干预,不适症状均消失。结论泌尿外科患者应用双J导管作内引流,可明显改善患者的肾功能,采取积极的护理干预措施,有利于减轻术后并发症的症状。     

输尿管支架管放置术后体外冲击波碎石治疗肾结石的疗效观察

目的探讨输尿管支架管(双J管)放置术后体外冲击波碎石(ESWL)治疗肾结石的疗效。方法选择肾结石最大直径2cm以上病例共58例,双侧结石者选直径大于2cm任何一侧,随机分为两组,对照组单纯行ESWL,实验组于ESWL前置入双J管。观察两组疗效及并发症发生率有无差别。结果 ESWL成功治疗55例,实验组全部治疗成功且无并发症,对照组12例"石街"形成,改用其他方法治疗。结论输双J管放置术后ESWL治疗肾结石,可有效减少并发症的出现。     

双J管支架内置人应用于输尿管狭窄治疗效果分析

目的分析双J管支架内置人应用于输尿管狭窄治疗中的临床效果。’方法选取2013年1—6月于我院就诊需行双J管支架置人手术的20例输尿管狭窄患者,所有患者于输尿管镜下行逆向双J管置人手术,跟踪随访3个月,观察治疗前后肾积水肾功能及治疗效果。结果20例患者治疗后肾积水情况均无较治疗前加重现象,其中显著减轻10例;治疗后患者的尿素氮及肌酐水平显著低于治疗前,差异有统计学意义（P〈0．05）;总的有效率为80％,其中治愈35％,好转45％。结论双J管支架内置入应用于输尿管狭窄治疗的安全性高,并发症少,效果显著,值得临床推广应用。     

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.

---

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.