应用PPH术替代内扎外剥术治疗重度痔的研究

目的探讨应用吻合器行痔上黏膜环切吻合术（PPH）治疗重度痔（Ⅱ～Ⅳ度）的效果。方法将184例需手术治疗的重度痔患者分成2组。PPH组104例采用吻合器行PPH,对照组80例采用传统内扎外剥术。比较2组患者疗效及术后出血、黏膜脱出及疼痛情况。结果PPH组治愈率明显高于对照组（93．3％vs52．5％,P〈0．01）。PPH组术后出血2例（1．92％）,对照组8例（10．00％）。PPH组术后黏膜脱出1例（0．96％）,对照组7例（8．75％）。PPH组术后疼痛第,1d 39例（37．50％）,第2d 2例（1．92％）,第5d始没有疼痛病例;对照组术后疼痛第1d 80例（100％）,第2d 80例（100％）,第5d 18例（22．50％）,第9d 5例（6．25％）。PPH组术后出血、黏膜脱出及疼痛发生率均明显低于对照组（P〈0．05）。结论应用吻合器行PPH治疗重度痔优于传统的内扎外剥术．疗效满意．     

吻合器痔上黏膜环切术（PPH）治疗痔疮的应用体会

目的探讨吻合器痔上黏膜环切术（PPH）治疗痔疮的效果。方法采用吻合器痔上黏膜环切术（PPH）对364例重度脱垂痔及内痔为主的环状混合痔患者手术治疗并对结果进行分析,随访。结果手术时间10～32min,平均18min,住院时间3～5d,平均3．8d,经PPH治疗后,所有病人脱出痔核全部回缩,切除直肠黏膜完整者98％,术后90％病人不用止痛剂。术后随访6个月,有效率100％,满意率88％,基本满意率12％。结论吻合器痔上黏膜环切术（PPH）在环形脱垂内痔治疗中具有手术创伤小、手术时间短、病人痛苦轻、住院时间短等优点,是治疗重度脱垂痔及内痔为主的环状混合痔的较好术式。     

吻合器痔上黏膜环切术与外剥内扎术治疗Ⅲ～Ⅳ期混合痔疗效比较

目的：比较外剥内扎术（ Milligan-Morgan术）与吻合器痔上黏膜环切术（ procedure for prolapse and haemorrhoids ，PPH）术式治疗Ⅲ～Ⅳ期环状痔的临床效果。方法选取120例Ⅲ～Ⅳ期环状痔患者，按照入院顺序随机分为Milligan-Morgan（MM）组和PPH组。 PPH组采用痔上黏膜环形切除吻合器及其附件，MM组按传统采取Milligan-Morgan术常规操作。对比分析两组术后临床疗效、临床指标和不良反应发生率。结果治疗后，PPH组治愈率为83．33％，高于MM组的85．00％（χ2＝0．29，P＞0．05）。 PPH组手术时间、创面愈合时间、住院时间分别为（18．93＆#177;3．18） min、（8．30＆#177;2．16） d（5．00＆#177;2．74） d，均短于 MM 组的（32．65＆#177;3．92）min、（20．40＆#177;2．78）d、（8．00＆#177;2．83）d（U＝21．05、26．62、5．90，均 P＜0．01）。 PPH 组术中出血量[（29.41＆#177;4．29）mL]少于MM组[（53．37＆#177;4．14）mL]（U＝31．13，P＜0．01）。 MM组术后疼痛发生率为6.67％，高于对照组的3.33％（P＝0．68）。结论与MM术相比，PPH治疗Ⅲ～Ⅳ期混合痔疗效较好，并发症较少，恢复快，值得在临床上推广。     

国产吻合器痔上黏膜环形切除术治疗中重度痔65例的体会

目的：探讨国产吻合器用于吻合器痔上黏膜环形切除术（PPH）的安全性、治疗效果及实用性。方法：使用国产吻合器进行PPH手术治疗Ⅲ、Ⅳ度内痔患者65例．并对临床资料分析评估。结果：65例均1次吻合成功,平均手术时间20min。平均术后住院时间5天。本组无术后出血。18例（28％）术后需用止痛剂,47例（72％）术后无疼痛。手术后随访8～16个月,59例（91％）痔核脱出症状完全消失,2例（3％）有所改善。全组无肛门狭窄,大便失禁,肛周感染。结论：国产吻合器用于PPH手术效果满意,吻合器可以重复使用,价格低廉,患者容易接受,有利推广。     

吻合器痔上黏膜环形切除术治疗重度痔疮的临床疗效

目的探讨吻合器痔上黏膜环形切除术（PPH）治疗重度痔疮的临床疗效。方法本院肛肠科治疗的重度痔患者156例,平均分为治疗组和对照组各78例,治疗组患者采用PPH治疗,对照组患者采用传统外科手术治疗。比较两组患者的手术情况。结果治疗组患者的出血率明显高于对照组患者（P〈0.05）,治疗组术后出血为外痔创面渗血;治疗组手术时间、术后的疼痛情况、术后尿潴留情况、复发率、肛门狭窄发生、住院时间等方面明显少于对照组（P〈0.05）。结论吻合器痔上黏膜环形切除术治疗重度痔具有疗效确切、复发率低、安全可靠的特点,值得在临床推广。     

吻合器痔上粘膜环形切除术治疗重度痔疮50例临床体会

目的 探讨吻合器痔上粘膜环形切除术(PPH)治疗重度痔疮的临床价值。方法 回顾性总结吻合器痔上粘膜环切除术(PPH)治疗50例重度痔疮的临床资料。结果 手术时问平均15min，术后平均住院时间3d，术后恢复正常生活的平均时间为5d，98％的病人对手术效果满意。术后常见的并发症：便血2例(4．0％)，经静脉使用止血药治疗后好转；术后肛门部胀感9例(18％)，其中只有4例适当使用止痛药。随访3．18月，无肛门失禁、肛门狭窄等并发症的发生，近期效果良好。结论 与传统手术相比，吻合器痔上粘膜环形切除术(PPH)具有安全、手术时间短、住院时间短、创伤小、恢复快、并发症少的优点，是一种治疗重度痔疮较好的手术方法。     

吻合器痔上黏膜环切术治疗重度痔病58例临床体会

目的探讨吻合器痔上黏膜环切术（PPH）治疗重度痔病的临床应用。方法回顾性总结分析2009年8月至2012年12月应用PPH治疗重度痔病患者58例临床资料。结果手术时间为20～55min,平均40min,术后平均住院时间3d。术后感觉疼痛者12例,尿潴留20例,无术后出血、大便失禁、肛门狭窄病例,随访2月～3年无复发。结论 PPH治疗重度痔病安全有效,恢复快,近期效果满意。     

痔上黏膜环形切除肛垫悬吊术治疗重度脱垂痔

目的评价痔上黏膜环形切除肛垫悬吊术(PPH)治疗痔的价值。方法利用环形吻合器对32例重度脱垂痔行PPH手术。结果本组患者平均手术时间为22min，平均住院时间为5d。所有患者痔脱出症状立即消失，无一例肛门狭窄、直肠阴道瘘、肛周感染。结论PPH治疗重度脱垂痔具有安全、有效、手术时间短、住院时间少、恢复快等优点。     

PPH加痔上黏膜悬吊治疗重度脱垂痔疗效分析

目的 探讨痔疮吻合器痔上黏膜钉合术(PPH)加痔上黏膜悬吊术治疗重度痔疮的临床疗效.方法 对37例Ⅲ～Ⅳ期重度痔用PPH加痔上黏膜悬吊术治疗的临床资料进行回顾性分析.结果 手术时间平均35 min,平均住院时间3～4 d,术后痔核37例均恢复较好,排便时无痔核脱出,术后3d无大便出血,无病例使用哌替啶止痛.结论 PPH加痔上黏膜悬吊术可拓展PPH手术适应证范围,减少或者延缓术后复发,并且提高患者满意度.     

PPH术治疗重度痔26例

目的探讨吻合器直肠下端环形黏膜及黏膜下层切除＋肛垫悬吊（PPH）术治疗Ⅲ，Ⅳ期内痔的临床疗效。方法回顾分析26例重度痔患者的临床资料。结果平均手术时间25min，平均住院时间4．5d，术后并发尿潴留8例，肛门部疼痛5例，少量便血1例，随访2～8月无复发。结论PPH手术操作简单，手术时间短，患者痛苦小，术后恢复快，近期疗效满意。     

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.