无骨折脱位型颈脊髓损伤25例临床治疗分析

目的：探讨治疗无骨折脱位型颈脊髓损伤的手术方法及临床效果。方法分析25例无骨折脱位型颈脊髓损伤患者的临床资料,根据脊髓损伤情况及MRI表现,采取颈前路或后路手术,并比较手术前后的Frankel分级变化。结果本组患者术中无副损伤,术后恢复良好,无并发症。随访时间3~20个月,按Frankel分级：术前A级2例,1例未恢复,1例恢复到B级;术前 B级6例,恢复到C级4例,2例未恢复;术前C级13例,恢复到D级4例,其余及术前分级为D级的4例患者全部恢复到E级。结论根据脊髓损伤情况及MRI表现,采取颈前路或后路手术治疗无骨折脱位型颈脊髓损伤,可获得满意的临床效果。     

颈前路减压植骨带锁钛板内固定治疗颈椎损伤

目的观察颈前路减压植骨带锁钛板内固定治疗下颈椎损伤的疗效。方法2001-01～2005-04对65例下颈椎骨折脱位并脊髓损伤患者行颈前路减压植骨融合钛板内固定手术。Frankel分级:A级8例,B级14例,C级33例,D级10例,所有患者均有椎管侵占现象。结果术后随访6～12个月,平均10.5个月。59例植骨块于3个月内全部骨性融合,病死3例。生存者脊髓功能均有不同程度改善,Frankel分级平均提高1.15级。结论颈前路减压植骨融合钛板内固定是治疗下颈椎骨折脱位并脊髓损伤的有效方法。     

无骨折脱位型急性颈脊髓损伤的手术治疗

目的探讨无骨折脱位型急性颈脊髓损伤的手术疗效。方法1998年至2007年本院收治23例无骨折脱位型急性颈脊髓损伤患者,所有患者均采用手术治疗,其中前路减压脊柱稳定重建8例,后路减压9例,前后联合减压脊柱稳定重建6例,观察各组手术治疗前后及随访时JOA评分变化。结果所有病例未发生血管、神经损伤等严重并发症,JOA评分平均较术前改善。结论对无骨折脱位型急性颈脊髓损伤,根据病理基础及受伤机理选择手术治疗,可以获得良好的临床疗效。     

无骨折脱位型颈脊髓损伤手术与非手术治疗疗效对比观察

目的:探讨手术治疗无骨折脱位型颈脊髓损伤的治疗效果.方法:回顾性分析40例无骨折脱位型颈脊髓损伤患者,其中23例行手术治疗(A组),17例行非手术治疗(B组).对两组患者治疗前、后ASIA分级情况比较分析.结果:每个患者随访10个月.依据神经功能改善国内标准,A组患者神经功能改善率为82.60%,B组患者神经功能改善率为41.18%.两组比较差异有统计学意义(P＜0.05).结论:无骨折脱位型颈脊髓损伤手术治疗预后相对较好.只要术式选择合理、手术操作正确,颈前路、颈后路手术均能获得较理想脊髓神经功能恢复.     

颈前路手术治疗无骨折脱位脊髓中央损伤综合征

目的评价无骨折脱位脊髓中央损伤综合征（CCSWORFD）的颈前路手术治疗。方法回顾总结CCSWORFD资料,分析颈前路减压植骨钢板内固定治疗CCSWORFD疗效。结果重建颈椎稳定性可靠,依据JOA评分比较疗效显著。结论颈前路手术治疗CCSWORFD,采用钛网植骨与取髂骨植骨均可得到满意疗效。     

无骨折脱位型颈脊髓损伤的手术治疗及疗效观察

目的探讨无骨折脱位型颈脊髓损伤的手术治疗及效果。方法回顾分析深圳市光明新区光明医院2003年10月至2008年6月收治28例无骨折脱位型颈脊髓损伤患者,依据影像学表现、致伤特点及病理基础采用3种手术方式:颈前路椎间盘摘除减压cage植入钢板内固定术7例。全椎板切除减压颈椎后路钉棒系统内固定辅以侧块间植骨融合术12例。颈前路椎体次全切除减压钛网植入钢板内固定术9例,术后根据不同情况进行对症及康复治疗。结果所有病例术中均未发生血管、神经损伤等并发症,28例均得到随访,随访时间6～38个月(平均18.5个月)。术后按Frankel分级标准及计算JOA改善率进行评定。其中1例A级患者术后到C级;16例B级患者,术后4例达C级,10例达D级,2例达E级;9例C级患者,术后4例达D级,5例达E级;2例D级患者,1例达E级,1例稍改善。术后JOA评分较术前平均增加7.34分,术后JOA评分改善率为68.9%。结论无骨折脱位型急性颈脊髓损伤应早期手术治疗,根据病理基础及受伤机理采取合理手术方式,可以获得良好的临床疗效。     

颈椎前路手术治疗颈椎骨折脱位并发脊髓损伤的围手术期护理

目的颈椎前路手术治疗颈椎骨折脱位并发脊髓损伤的围手术期护理。方法选择我院于2017年3月至2018年2月间收治的78例颈椎骨折脱位并发脊髓损伤患者,所有患者均接受颈椎前路手术治疗,为患者提供围手术期综合护理干预,评价患者术后脊髓分级结果、并发症发生情况。结果术后10 d患者切口均愈合,期间无1例患者出现切口感染并发症;有2例患者住院期间发生压疮。术前78例患者Frankel脊髓分级结果显示:A级10例(12.82%)、B级26例(33.33%)、C级25例(32.05%)、D级17例(21.79%)、E级0例;而术后患者Frankel脊髓分级结果显示A级2例(2.56%)、B级17例(21.79%)、C级18例(23.08%)、D级31例(39.74%)、E级10例(12.82%)。结论为颈椎前路手术治疗颈椎骨折脱位并发脊髓损伤患者提供围手术期护理干预可积极降低术后并发症发生率,促进康复。     

后入路脊髓前后减压术治疗脊髓型颈椎病与颈椎骨折脱位颈髓损伤疗效观察

目的 探讨颈椎病及颈椎骨折脱位手术的有效途径，观察后入路脊髓前后减压术治疗脊髓型颈椎病与颈椎骨折脱位颈髓损伤手术效果。方法 通过对7例脊髓型颈椎病，8例颈椎骨折脱位伴脊髓损伤患采用后入路脊髓前后减压的方法进行治疗，并进行随访观察。结果 术后平均随访2－5年取得良好的效果，8例颈椎骨折脱位颈髓损伤患，大都有2级以上功能恢复，7例脊髓型颈椎病患大都有1级以上功能改善。结论 后入路脊髓前后减压术，可一次性解决脊髓前后及周围所有压迫，同时可行复位、内固定及融合，是治疗脊髓颈椎病，颈椎骨折脱位伴颈髓损伤的有效方法。     

无骨折脱位颈脊髓损伤临床治疗28例

目的：分析探讨无骨折脱位颈脊髓损伤的损伤机制、漏诊原因及治疗措施。方法：本组报告28例此类患者．其中手术治疗24例：前路减压、植骨融合16例、后路单开门椎管减压8例；非手术治疗4例。合并伤及漏诊、漏治者4例．均在伤后3～5天确诊治疗。结果：28例患者中，因合并伤而延误诊治及非手术治疗者．脊髓功能恢复较差；早期确诊、手术治疗者，效果满意。结论：无骨折脱位颈脊髓损伤应早期确诊、早期手术治疗，漏诊、漏治者会严重影响脊髓功能的恢复。     

前后路联合手术治疗颈椎骨折脱位并脊髓损伤的临床观察

目的 探讨前后路联合手术治疗颈椎骨折脱位合并脊髓损伤患者的疗效观察及其临床分析.方法 2010年01月至2012年01月期间,我院诊治的颈椎骨折脱位伴有脊髓损伤的40例患者,给予前后路联合手术,对其进行减压复位内固定治疗,对其病例进行回顾性分析.结果 经过前后路联合手术治疗后,40例颈椎骨折脱位伴有脊髓损伤患者全部治愈出院,术后随访12个月,都没有出现严重的并发症,拍片复查显示骨折愈合良好,没有出现脊柱畸形.经过手术治疗后,处于Frankle分级A级有5例,B级有6例,C级有7例,D级16例,E级6例,较术前相比,脊髓神经功能有了明显改善.结论 对于颈椎骨折脱位伴有脊髓损伤患者,前后路联合手术内固定治疗,显著提高临床疗效,值得临床广泛推广.     

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.