改良式腹膜外剖宫产术的临床观察

目的 探讨改良式腹膜外剖宫产术的临床应用效果.方法 选取本院2012年9月～2013年9月收治入院行改良式腹膜外剖宫产术的产妇86例与同期行传统的子宫下段剖宫产术的产妇86例进行回顾性的分析,观察两组患者的手术时间、肛门排气时间、下床活动时间、术中出血量、新生儿评分、新生儿体重等情况.结果 改良组的手术时间、肛门排气时间、下床活动时间等情况明显低于传统组,差异具有统计学意义（P＜0.05）,而术中出血量、新生儿评分以及新生儿体重与传统组对比,差异无统计学意义（P＞0.05）.结论 应用改良式腹膜外剖宫产术对产妇分娩具有较好的效果,值得临床推广应用.     

椎管内麻醉与全身麻醉用于妊娠合并血小板减少症产妇剖宫产术的临床观察

目的探究对妊娠合并血小板减少症产妇在当前椎管内麻醉和全身麻醉的麻醉方式上进行剖宫产术的临床应用价值效果,为以后此类患者的临床方案的制定提供可靠依据。方法选自本院2010年1月至2013年1月收治的血小板计数低于100×109的产妇共有100例,将其分为椎管内麻醉组和全麻组,每组各有患者50例,其中椎管内麻醉组血小板计数每升超过50×109,全麻组患者血小板计数低于50×109。对2组患者的临床资料以回顾性的方法进行分析,了解2种麻醉方法在剖宫产术中的临床指标。结果 2组产妇均顺利完成剖宫产手术。2组产妇术中出血量对比并无统计学意义(P>0.05);新生儿在分娩后1 min进行Apgar评分,椎管内麻醉组患者新生儿发生窒息事件的概率相对于全麻组要低很多,二者对比有统计学意义(P<0.05);新生儿在分娩后5 min进行Apgar评分,2组对比无统计学意义(P>0.05)。结论妊娠合并血小板减少症产妇在应用剖宫产终止妊娠的时候需要结合其具体临床情况,针对性的选择麻醉方式,需要充分的对病情进行估计和做好术前准备,最大程度保障母婴生命健康。     

剖宫产术同期联合子宫肌瘤剔除术在妊娠合并子宫肌瘤患者中的可行性与安全性观察

目的探究剖宫产术同期联合子宫肌瘤剔除术在妊娠合并子宫肌瘤患者中的可行性与安全性。方法选择妊娠合并子宫肌瘤产妇116例,随机分为对照组与观察组,各58例。对照组产妇分娩时行单纯性剖宫产术,术后择期行子宫肌瘤剔除术;观察组产妇分娩时行剖宫产术同期联合行子宫肌瘤剔除术,比较两组产妇围手术期临床指标、并发症、恢复情况及新生儿情况,并分析不同肌瘤数目、肌瘤位置的观察组产妇术中出血量、术后并发症及新生儿不良结局情况。结果观察组产妇手术时间显著长于对照组(P<0.05),两组产妇术中出血量、肛门排气时间、手术前后血红蛋白差值、住院时间、切口感染与产褥病发生率、产后出血量、恶露干净时间、月经恢复时间比较差异无统计学意义(P<0.05);两组新生儿中低体质量儿、新生儿窒息、Apgar评分≤7发生率比较差异无统计学意义(P>0.05);不同肌瘤数目、肌瘤位置产妇术中出血量、产后并发症及不良新生儿结局比较差异无统计学意义(P>0.05)。结论子宫肌瘤直径≤5 cm妊娠合并子宫肌瘤患者同期行剖宫产术联合子宫肌瘤剔除术安全可行。     

120例剖宫产的临床体会

目的探讨120例剖宫产的临床情况。方法采用回顾性分析的方法分析本院收治的120例剖宫产情况,依据剖宫产术式的不同,将产妇随机分为观察组（新式剖宫产组）70例和对照组（传统剖宫产组）50例。结果观察组平均手术时间、切皮至胎儿娩出时间、术中平均出血量、术后排气时间均明显低于对照组,P〈0．05,差异均有统计学意义。组产妇的术后感染情况、新生儿及Apgar评分比较均无显著性差异,P〉0．05。结论新式剖宫产术式手术时间短、出血少、组织损伤少、术后排气快、拆线时间短、医疗费用少、术后恢复快、切口愈合好的优点,值得临床推广使用。     

腹膜外剖宫产术临床分析

目的 研究腹膜外剖宫产术的临床应用价值.方法 将2010年3月至2011年4月住院行腹膜外剖宫产的产妇360例与同期行子宫下段剖宫产术的产妇380例进行比较,对比观察2组术中情况及术后并发症.结果 2组术式总手术时间、术后肠胀气、肛门排气时间及术后病率差异有统计学意义(P<0.05);而切皮至胎儿娩出时间、新生儿体重、Apgar评分及术中出血量差异无统计学意义(P>0.05).结论 腹膜外剖宫产手术时间短,术后胃肠功能恢复快,安全可行,值得推广.     

剖宫产新旧术式的比较

目的探讨剖宫产术式的手术效果、操作技巧。方法分析1668例剖宫产产妇术中、术后情况,并以剖宫产手术不同的术式比较,观察手术时间、出血量、术后疼痛持续时间及术后肛门排气时间等。结果新式剖宫产术组手术时间、切皮到取胎头平均时间明显缩短,术后持续性疼痛、术后肛门排气时间明显缩短,住院天数减少(P<0.01)。新式剖宫产组出血量比腹膜内子宫下段剖宫产术少排气时间明显缩短(P<0.01)。结论新式剖宫产术手术时间短,操作简单,术后疼痛排气时间明显缩短,出血量少,易于基层医院医生学习,值得推广应用。     

妊娠高血压疾病行剖宫产麻醉的临床观察

目的分析和研究不同麻醉方式对妊娠高血压疾病行剖宫产术的效果。方法我们选取2011年10月至2013年2月妊娠高血压患者68例,将其分为两组,观察组34例与对照组34例。对照组患者给予持续硬膜外麻醉,观察组患者给予腰-硬联合麻醉。两组患者手术结束后,将其麻醉效果、新生儿评分、术后并发症、术中出血量、手术时间等指标进行对比。结果观察组患者的麻醉起效时间明显低于对照组(P<0.05),具有统计学意义。观察组患者的手术时间、术中出血量、术后并发症发生例数均低于对照组(P<0.05),具有统计学意义。两组新生儿的Apgar评分没有明显的差异(P>0.05),无统计学意义。结论妊娠高血压患者剖宫产术给予腰-硬联合麻醉,安全有效,能够更好的抑制患者的应激反应,有效地缩短了手术时间,减少术后并发症发生概率,值得临床应用与推广。     

探讨剖宫产中行子宫肌瘤切除术的临床效果

目的观察剖宫产中行子宫肌瘤切除术的临床效果,并探讨对母婴安全性的影响。方法以2016年2月至2019年2月在我院行剖宫产术同时行子宫肌瘤切除术治疗的24例妊娠合并子宫肌瘤患者为研究对象,设为观察组;并选取同期剖宫产术后择期行子宫肌瘤切除术的24例患者,设为对照组。对比分析两组患者术中及术后情况,评估临床疗效及新生儿Apgar评分、并发症。结果观察组手术时间明显长于对照组(P <0.05),但两组术中出血量、术后排气时间和住院时间差异不大,均无统计学意义(P> 0.05);比较患者恶露持续时间,及新生儿Apgar评分、并发症情况,两组间均无统计学差异(P> 0.05)。结论剖宫产中行子宫肌瘤切除术治疗妊娠合并子宫肌瘤效果确切,同时不会对母婴安全造成影响,可使患者避免二次手术创伤。     

不同麻醉方式对凶险性前置胎盘剖宫产母婴结局的影响

目的 通过回顾性病例数据分析,探讨不同麻醉方式对凶险性前置胎盘剖宫产母婴结局的影响。方法 选择昆明医科大学附属延安医院2018年1月-2020年12月因凶险性前置胎盘行剖宫产的122例产妇,根据麻醉方式不同分为全身麻醉组(G组,n=94)和腰硬联合麻醉组(C组,n=28),分析比较2组产妇手术时间、术中失血量、输血量、术后是否转ICU、术后至出院时间和总住院时间,以及新生儿娩出后1、5 min Apgar评分情况。结果 C组产妇手术时间、术后至出院时间和总住院时间明显短于G组,术中失血量、输血量和术后住ICU比率明显低于G组(P<0.05);新生儿1 min Apgar评分C组优于G组(P<0.05); 2组5 min Apgar评分差异无统计学意义(P=0.80)。结论 与全身麻醉相比,腰硬联合麻醉用于合并凶险性前置胎盘的剖宫产产妇,对于母婴更为安全,术后能更快康复出院,在无禁忌症的情况下,该类产妇行剖宫产术可优先选择腰硬联合麻醉。     

依托咪酯诱导全身麻醉在剖宫产术中的临床疗效分析

目的:探讨依托咪酯诱导全身麻醉在剖宫产术中对产妇及婴儿的影响.方法:选择2016年1月～2017年1月至我院产科行剖宫产手术采用全身麻醉80例足月产妇作为观察对象,分为观察组(n=40)和对照组(n=40),观察组静脉注射诱导量依托咪酯,对照组静脉注射诱导量丙泊酚,观察对比两组术后1h血流动力学、苏醒时间、不良反应以及两组新生儿不同时间点Apgar评分.结果:观察组与对照组在HR、恶心呕吐发生率方面差异无统计学意义(P>0.05);观察组的SAP、DAP及苏醒时间均明显低于对照组,差异具有统计学意义(P<0.05);观察组新生儿1min、2min Apgar评分明显高于对照组,差异具有统计学意义(P<0.05),观察组与对照组新生儿5min、10min Apgar评分无显著差异(P>0.05).结论:依托咪酯诱导全身麻醉用于剖宫产术,能够减少对新生儿的影响,缩短术后苏醒时间.     

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.     

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.     

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.