中心静脉导管胸腔闭式引流对气胸的治疗效果观察

目的:比较中心静脉导管与传统硅胶管胸腔闭式引流治疗自发性气胸的疗效及并发症。方法:将自发性气胸患者62例,随机分成两组:治疗组30例予中心静脉导管进行胸腔闭式引流术配合负压吸引;对照组32例予传统硅胶管行胸腔闭式引流术配合负压吸引。分别比较两组患者的肺完全复张时间及治愈率与并发症发生率。结果:中心静脉导管与硅胶管行胸腔闭式引流术治疗自发性气胸的疗效无统计学意义,但治疗组的并发症明显少于、轻于对照组。结论:中心静脉导管进行闭式引流治疗自发性气胸,优于传统的硅胶管胸腔闭式引流术。     

细管引流加持续低负压吸引治疗自发性气胸疗效观察

目的:评估细管引流加持续低负压吸引治疗自发性气胸的疗效。方法:将1995年以来随机抽取的150例需进行胸腔闭式引流术治疗的自发性气胸患者分为两个治疗组。A组:65例使用深静脉留置套管针行胸腔闭式引流术加持续低负压(0.5～1.5kPa)吸引治疗自发性气胸。B组:85例常规大导管组治疗自发性气胸。两组结果进行比较。结果:两组在治愈率、有效率、复发率方面差异均无显著性(P>0.05),但在肺复张时间及并发症比较差异有显著性。结论:A组治疗自发性气胸创伤小,感染、发热、皮下气肿、胸痛、胸水机会少,患者病痛小,易接受,疗效满意。     

自发性气胸41例诊疗体会

目的分析自发性气胸的发病特点,探讨气胸合理的诊疗方案。方法回顾分析41例自发性气胸患者临床资料,总结影响治疗效果的相关因素。结果 41例患者中肺压缩:<20%者10例经过保守治疗后缓解,平均住院天数12.5d;肺压缩>20%者首选胸腔闭式引流术并加持续负压吸引,有46.3%(19/41)肺完全复张,平均肺复张时间为7.5d;2.4%(1/41)张力性气胸合并COPD,纵膈气胸患者胸腔闭式引流术后3d死于呼吸衰竭;19.5%(8/41)反复多次气胸发作,闭式引流术紧急减压缓解症状后开胸手术治疗,7.4%(3/41)的患者经闭式引流术后超过15d持续漏气,开胸手术治疗,11例开胸手术患者全部治愈,术后平均住院12d。结论自发性气胸是长期慢性肺部疾病病理演变的结果,是多方面的因素共同作用的结局,应在全身整体上高度的认识,治疗上应重视全身情况的调整,严格控制开胸手术的适应症。胸腔闭式引流加负压吸引对生理影响较小,可以作为一种安全有效的处理方案,应为自发性气胸的首选治疗方法。     

自发性气胸一次性吸痰管胸腔闭式引流术疗效观察

目的 总结自发性气胸采用一次性吸痰管胸腔闭式引流术治疗效果.方法 对2004～2006年收治的62例自发性气胸患者采用一次性吸痰管行胸腔闭式引流术治疗.结果 63例胸腔闭式引流,其中胸腔闭式引流电动负压吸引4例,平均住院时间为8 d,治愈60例,再次置管2例.结论 一次性吸痰管行胸腔内置管引流术避免了皮下气肿、复张性肺水肿及循环障碍,且创伤小,术后患者疼痛小.     

双腔气囊尿管在自发性气胸胸腔闭式引流术中的应用

目的探讨双腔气囊尿管在自发性气胸胸腔闭式引流术中的应用价值及护理。方法对50例自发性气胸采用双腔气囊尿管替代普通胸腔引流管行胸腔闭式引流术患者进行临床观察,做好术前准备,讲解术中、术后注意事项。结果 50例自发性气胸患者胸腔闭式引流均获成功,成功率达100%,管道最长保留时间15 d,发生管道阻塞1例,无脱落现象,发生皮下气肿2例,50例均无逆行感染。结论注意引流中的护理及病情观察是置管成功并取得良好治疗效果的重要保证,同时,在减少或避免并发症的发生、减轻患者痛苦等方面也有重要作用。     

腹腔引流导管行胸腔闭式引流联合持续负压吸引治疗COPD合并气胸的临床疗效研究

目的探讨腹腔引流导管行胸腔闭式引流联合持续负压吸引治疗COPD合并气胸的疗效。方法选择2015年6月～2018年6月共67例患者作为观察对象。其中治疗组28例,采用腹腔引流导管行胸腔闭式引流联合持续负压;对照组39例,采用常规胸腔闭式引流术治疗。回顾性观察分析两组患者的临床疗效和并发症。结果观察治疗组患者平均带管时间、肺复张时间、住院时间均小于对照组,术后无疼痛;治疗组的肺功能、动脉血气分析分析均较对照组有明显改善(P 0.05)。结论腹腔引流导管行胸腔闭式引流联合持续负压吸引治疗COPD合并气胸,疗效好,并发症少,值得临床推广。     

不同胸腔闭式引流术治疗自发性气胸的疗效比较

目的:比较使用双腔气囊导尿管和中心静脉导管行胸腔闭式引流治疗自发性气胸的临床效果及并发症。方法:对收治的70例自发性气胸患者,按就诊顺序随机分为治疗组35例和对照组35例。治疗组采用双腔气囊导尿管行胸腔闭式引流术。对照组采用中心静脉导管行胸腔闭式引流术。比较2组患者手术时间、疗效及并发症等。结果:2组在手术时间、总体有效率、留管时间、住院时间、术后疼痛程度、术后胸腔感染率、切口感染率等方面比较无显著性差异(P>0.05);2组患者术后并发症中管腔堵塞、脱管、皮下气肿发生率及住院费用比较有显著性差异(P<0.05),治疗组优于对照组。结论:使用双腔气囊导尿管和中心静脉导管行胸腔闭式引流术治疗效果相同,但使用双腔气囊尿管行胸腔闭式引流术具有操作简单、取材方便、并发症少、住院费用少的优点。     

老年自发性气胸22例临床分析

目的 探讨老年自发性气胸的特点。方法 对2000年5月～2004年5月我院收治的老年自发性气胸22例和青年自发性气胸20例就诱因、临床表现、治疗效果等进行临床分析。结果 22例老年自发性气胸中6例经胸腔抽气减压后肺复张，14例经胸腔闭式引流术后肺复张，2例死亡。20例青年自发性气胸中15例经胸腔抽气后肺复张，5例经胸腔闭式引流术后肺复张，20例均痊愈出院，无一例死亡。结论 老年自发性气胸多有基础疾病，并发症多，危害较大，症状往往与原发病混淆，缺乏气胸体征，易延误诊断，须仔细全面查体并及时行X线检查，一经确诊应立即排气减压，促使肺尽快复张。     

老年难治性自发性气胸的治疗

目的：探讨老年难治性自发性气胸的治疗。方法按照老年性自发性气胸的纳入标准筛选34例患者,均采用胸腔闭式引流术治疗,部分加用负压吸引,肺复张后向胸腔内注入促胸膜粘连剂,夹闭引流管并间断开放,部分需要反复注入,针对产生的临床症状行对症治疗,待胸管停止排气后复查胸片,如肺复张良好可拔除引流管,临床治愈。结果29例患者胸腔内注入药物后3~15 d停止漏气拔除胸管,2例1个月左右拔除胸管,1例4个月左右拔除胸管。全组无无效及死亡患者。28例随访1年以上,复发2例,再次行胸腔闭式引流术及胸腔内注射药物后治愈。结论34例患者均采用保守治疗,效果较好。     

微创闭式引流治疗慢阻肺并发自发性气胸的安全性研究

目的探讨微创闭式引流术治疗慢阻肺并发自发性气胸的临床价值。方法 2010年2月至2012年2月收治慢阻肺患者103例,以治疗时间划分为治疗组58例、观察组55例进行基础对症治疗后,治疗组患者采用微创胸腔闭式引流,对照组患者采用负压吸引闭式引流注入粘连剂治疗。结果治疗组58例患者有效53例,无效5例;对照组患者有效41例,无效14例,P=0.0168,术后一般情况肺复张时间、术后胸痛时间、伤口愈合时间、住院时间均有显著差异。结论微创闭式引流治疗慢阻肺并发自发性气胸可减少疼痛时间、肺复张时间短、伤口愈合快适合慢阻肺并发自发性气胸治疗,并发症及不良反应少安全性高。     

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.