髂内动脉结扎及栓塞术治疗产后大出血14例

目的 分析比较髂内动脉结扎、栓塞术治疗产后大出血的疗效。方法 经腹膜外或腹腔入路结扎双侧髂内动脉；采用Seldinger式股动脉穿刺插管法，先行动脉造影，明确出血原因和部位，再注入明胶海绵颗粒，栓塞双侧髂内动脉前支。结果 髂内动脉结扎6例，止血效果比较满意，手术时间平均60min，2例术后出现臀部疼痛，5～7天后症状消失。髂内动脉栓塞8例，止血效果良好，介入时间平均45min，2例术后臀部疼痛，5天后症状缓解。结论 髂内动脉结扎术治疗产后大出血是一种可选择的、有效的止血方法，尤其基层医院更为适用；而髂内动脉栓塞术介入时间短，创伤微小，止血效果可靠，术后恢复快。但需要特殊设备，技术条件要求高。     

子宫动脉栓塞术治疗剖宫产后疤痕妊娠大出血19例临床疗效

目的 探讨剖宫产后子宫疤痕妊娠大出血急诊双侧子宫动脉栓塞术的应用价值.方法 19例剖宫产后大出血患者,DSA监视下以Seldinger技术先行猪尾巴导管腹主动脉照影,明确双侧子宫动脉出血后行选择性插管,经导管于双侧子宫动脉内注入MTX和明胶海绵颗粒栓塞.结果 19例大出血患者全部栓塞成功,随访3～6个月无再次大出血.结论 双侧子宫动脉化疗栓塞术治疗子宫大出血成功率高,损伤小,操作简便,并发症少.     

明胶海绵颗粒栓塞治疗产后大出血的临床应用

目的评价明胶海绵颗粒栓塞治疗产后大出血的临床应用价值。方法30例产后大出血患者,均在产科经保守治疗无效,于栓塞前行双侧髂内动脉及子宫动脉造影,观察出血部位,然后用明胶海绵颗粒对出血动脉进行栓塞。结果30例患者中,18例栓塞双侧子宫动脉,5例栓塞单侧子宫动脉加对侧髂内动脉前干,7例栓塞双侧髂内动脉前干。所有患者于栓塞后造影显示出血灶消失,术后30min内出血量明显减少,3例短期内出血复发,其中2例行再次栓塞,1例行手术切除子宫。结论用明胶海绵颗粒栓塞治疗产后大出血是一种安全有效的治疗方法。     

髂内动脉造影和栓塞治疗在妇产科出血中早期和晚期应用的研究

随着放射介入学的发展及普及,临床上盆腔各种原因引起的急性大出血,采用介入治疗手段进行靶动脉栓塞术都取得了非常好的治疗效果,由于介入方法止血迅速、疗效可靠、患者不良反应少已得到临床的肯定和认可。近年来我院引进GE大型C臂血管治疗仪,对30例妇产科急性大出血患者进行急诊介入髂内动脉或双侧子宫动脉栓塞术,报告如下。1资料与方法     

经导管盆腔动脉栓塞术的临床应用

本文报告18例经导管单侧或双侧髂内动脉栓塞。其中外伤出血8例，盆腔肿瘤8例，骶骨肿瘤2例。经髂内动脉栓塞后，外伤出血均得到控制，膀胱肿瘤的顽固性血尿停止，全身情况好转，肿瘤缩小。骶骨肿瘤术中出血较同类手术明显减少。文内对盆腔动脉栓塞的适应证，止血效果，晚期盆腔肿瘤的姑息治疗，栓塞材料及并发症等作了讨论。     

术前预防性应用双侧髂内动脉球囊封堵术对凶险性前置胎盘孕妇剖宫产术中出血的影响

目的 研究术前预防性应用双侧髂内动脉球囊封堵术对凶险性前置胎盘孕妇剖宫产术中出血的影响。方法 回顾性分析宝鸡市妇幼保健院2000年4月至2015年4月86例凶险性前置胎盘孕妇的临床资料,其中46例患者术前应用了双侧髂内动脉球囊封堵术设为介入组,另外40例患者在术前未应用双侧髂内动脉球囊封堵术设为对照组,比较两组患者术中的出血量,子宫切除率以及术后的并发症等。结果 两组术中使用球囊填塞,胎盘植入率,子宫切除率和产后出血率的差异无统计学意义(P均＞0.05),对照组患者术中平均出血率显著高于介入组(t=-26.534,P＜0.01)。两组患者的新生儿体质量和发生窒息的例数比较,差异均无统计学意义(P＞0.05)。结论 凶险性前置胎盘孕妇剖宫产术前预防性应用双侧髂内动脉球囊封堵术,可以降低孕妇在手术中的出血量,降低子宫切除率,减少术后并发症。     

治疗难治性妇产科大出血的临床对比研究

目的：探讨治疗难治性妇产科大出血的临床对比观察。方法：选择2008年1月～2010年1月难治性大出血患者48例,将其随机分为两组,观察组19例施行动脉栓塞术,对照组29例施行髂内（或子宫）动脉结扎术。观察两种方法的平均手术时间、出血量,同时观察是否需要进一步行子宫切除术及术后并发症的发生情况。结果：施行动脉栓塞术治疗难治性妇产科大出血平均手术时间为（42.92±7.00）min、平均出血量为（966.8±227.4）ml、术后阴道流血天数为（11.3±2.5）d、子宫切除率为5.3%、止血有效率为94.7%;施行髂内（或子宫）动脉结扎术手术治疗难治性妇产科大出血平均手术时间为（71.25±10.60）min、平均出血量为（1 451.9±250.4）ml、术后阴道流血天数为（16.2±2.5）d、子宫切除率为34.5%、止血有效率为65.5%。两组比较,差异有统计学意义（P〈0.05）。结论：经导管动脉栓塞术治疗难治性妇产科出血具有手术时间短、止血快、出血量少、并发症低、可保留子宫等优点,值得在临床推广应用。     

产后大出血急诊介入治疗

目的探讨产后大出血的急诊介入治疗的临床疗效。方法对6例产后大出血的患者选择Seldinger技术行右侧股动脉穿刺插管双侧髂内动脉造影,明确出血部位后注入明胶海绵颗粒行子宫动脉或髂内动脉栓塞,观察治疗效果。结果 6例产后大出血的患者均一次用子宫动脉或髂内动脉栓塞治疗成功,无复发病例,无栓塞后再出血,介入后无死亡患者并保留了子宫和卵巢的生理功能。结论产后大出血的急诊介入治疗止血效果好,病死率低,并发症少,患者创伤小。     

急诊子宫动脉栓塞治疗产后大出血在基层医院中的价值

目的探讨介入放射经皮动脉插管行双侧髂内脏支、子宫动脉栓塞治疗产后大出血在基层县医院应用价值。方法选取36例产后大出血产妇,在数字减影血管造影(DSA)下,经股动脉穿刺5F动脉鞘置入后,经动脉鞘内插入5F美国COOK子宫动脉管或美国COOK5F COBRA C2导管,置管头于双侧髂内脏支、子宫动脉内造影,进一步明确出血血管后,双侧注入明胶海绵粒、条栓塞到双侧髂内脏支、子宫动脉闭塞。结果 36例产后大出血产妇,急诊动脉栓塞治疗成功。结论急诊子宫动脉栓塞治疗产后大出血在基层医院的价值和重要性;急诊子宫动脉栓塞治疗的优势它不但能挽救产妇的生命,而且能保留产妇的子宫,值得继续推广以及应用。     

介入化疗栓塞在瘢痕妊娠综合治疗中的价值

目的探讨双侧子宫动脉化疗栓塞在剖宫产术后瘢痕妊娠（CSP）综合治疗中的临床价值。方法回顾性分析我院2009年6月至2011年12月临床确诊为CSP的10例患者,2例为刮宫术中出现阴道大出血经保守治疗不佳急诊行介入治疗,其余8例为预防性双侧子宫动脉化疗栓塞,采用Seldinger技术,导管插至双侧子宫动脉内,灌注杀胎药后再用明胶海绵颗粒栓塞双侧子宫动脉。结果 2例阴道出血的急症患者介入治疗后出血症状即可停止,10例患者均在介入治疗后48h行清宫术,术中出血量10～70ml,平均出血量约30ml,组织病理学为坏死的绒毛或蜕膜组织,术后血β-HCG下降到正常。结论双侧子宫动脉化疗栓塞治疗CSP,能有效控制和预防出血,减少清宫术的出血量,降低了危险性,保留患者子宫,是治疗CSP安全有效的方法。     

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.     

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.     

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.