剑突下小切口非胸腔镜辅助Nuss手术治疗小儿漏斗胸

目的:探讨剑突下小切口非胸腔镜辅助Nuss手术治疗小儿漏斗胸的手术方法和治疗经验。方法:16例漏斗胸患儿采用剑突下小切口非胸腔镜辅助Nuss手术治疗,全部为对称型。结果:16例均顺利完成手术,手术时间36~70min;术中平均出血10 mL左右,无严重并发症发生,术后6~8 d出院。术后近期疗效评价:优12例,良4例。所有病例进行随访,复查胸部X线片,1例因钢板移位致胸骨轻度凹陷。结论:剑突下小切口非胸腔镜辅助Nuss手术具有创伤小、方法简单且要领易于掌握等优点,特别适合于胸腔镜技术不太成熟的基层医院开展。     

非胸腔镜辅助Nuss手术治疗漏斗胸

目的探讨非胸腔镜辅助下Nuss手术矫治漏斗胸的初步经验。方法 2008年5月～2012年2月笔者所在科室采用非胸腔镜辅助的Nuss手术矫治漏斗胸25例,年龄3～19岁,均在非胸腔镜辅助下完成,部分胸骨凹陷较重病例剑突下小切口辅助完成,24例为对称型,1例为非对称型。结果 25例均顺利完成手术,无术中并发症,手术时间35～60min,术中出血量为20mL,术后平均住院时间(7.5±3.0)d,无一例输血,术后随访1～15个月,除2例间歇性疼痛,2例少量气胸外,其余无特殊不适,无钢板移位,矫形效果23例优,2例良。结论非胸腔辅助下的Nuss手术创伤小,手术时间短,恢复快,安全有效。     

改良Nuss手术治疗小儿漏斗胸的临床疗效

目的 探讨无胸腔镜辅助下改良Nuss手术治疗小儿漏斗胸的方法及疗效.方法 采用改良的Nuss方法矫正漏斗胸患儿68例.结果 68例病儿手术顺利,手术时间35 ～ 55 min,术中出血量5 ～10 ml.术后住院天数约6～8d,矫形效果评定62例为优,6例为良,差0例.全部病例均获随访,随访时间5 ～21个月,均无明显不适,无钢板移位,矫形效果满意.结论 非胸腔镜辅助下改良Nuss手术治疗小儿漏斗胸,创伤小,出血少,操作简单,恢复快,效果满意,值得推广.     

使用NUSS微创矫正术治疗漏斗胸4例分析

目的总结使用Nuss微创畸形矫正术治疗漏斗胸的经验。方法于右侧腋中线第8肋间切开皮肤2cm,用胸腔镜观察患者胸骨后无异常血管后,延漏斗胸最低点水平面的两侧腋中线处,切开皮肤2cm,皮下潜行游离至漏斗胸边缘,用Nuss导引器自右侧皮肤切口进入经皮下隧道至漏斗边缘,穿通胸腔,在胸腔镜监视下至左侧漏斗胸边对应点穿出胸腔,经左侧皮下皮肤切口穿出,10^#丝线一头打结连于导引器,另一头打结连于事先塑性好的Nuss棒,缓慢退出导引器,将Nuss棒带人胸腔,并使其两头置于分离的潜行的切口皮下,再用Nuss翻转器接右侧的Nuss棒头,旋转180°,即刻漏斗胸被顶起,右侧Nuss棒头装上Nuss固定器缝合固定于胸壁肌肉。缝合两侧的皮肤切口。胸腔镜探视口置胸腔闭式引流管。结果近期结果：患者术后恢复良好,24～72h拔除胸腔引流管,第4～5天出院,除1例患者出现术中心包破裂外（未损伤心脏大血管）,未出现其它术中术后并发症;远期结果：已随访1～10月,患者均正常生活,无特殊不适主诉。复查X片,Nuss棒条未见移位。结论Nuss微创畸形矫正术和传统的漏斗胸手术相比,具有安全易操作,微创美观之优点,长期疗效有待进一步观察。     

Nuss手术治疗小儿漏斗胸的临床效果观察

目的:探讨Nuss手术治疗漏斗胸的安全性及疗效.方法:胸腔镜辅助下行Nuss手术,治疗漏斗胸患者36例,其中男26例,女10例,平均年龄7岁1个月(2岁1个月～21岁).结果:36例患者均顺利完成手术,手术时间为50～90min;术中出血1～2ml,均恢复顺利;患者均用钢支撑架;术后平均住院天数为9d;随访9～12个月...     

胸腔镜下Nuss手术矫治先天性漏斗胸的手术配合

目的探讨胸腔镜下Nuss手术矫治先天性漏斗胸的手术配合。方法对22例先天性漏斗胸患者在胸腔镜辅助下实施Nuss手术矫治。结果平均手术时间45min,出血量5～10mL,术后住院时间4～6d,随访2个月,钢板无移位,矫形效果显著。结论胸腔镜下Nuss手术矫治漏斗胸创伤小、出血少、恢复快。护士熟练的配合是手术成功的关键。     

同期电视胸腔镜手术治疗双侧肺大疱

目的 探讨同期电视胸腔镜手术治疗双侧肺大疱的术式及疗效.方法 对26例双侧肺大疱患者行电视胸腔镜同期肺大疱切除+胸膜固定术.结果 手术效果满意,无中转开胸及术后死亡.手术时间85～210 min,平均150 min;术中出血35～200 ml,平均65 ml;术后胸腔引流液350～1600 ml,平均860 ml;术后胸腔引流管留置3～6 d.结论 同期电视胸腔镜手术治疗双侧肺大疱,疗效满意,安全可靠.     

非胸腔镜辅助的Nuss手术治疗小儿漏斗胸

目的探讨非胸腔镜辅助下改良的Nuss手术矫治漏斗胸的初步经验。方法 2009年2月至2010年3月,采用改良的Nuss手术矫治漏斗胸23例,年龄2.5～15岁,平均6.5岁,所有病例均在非胸腔镜辅助下完成。21例为对称型,2例为非对称型。结果 23例顺利完成手术,术中平均出血〈20 ml,5例出现少量气胸及皮下气肿,保守治疗后消失。术后平均住院6.2 d,矫形效果21例为优,2例良。所有患者术后均获随访,随访1～14个月,均无明显不适,无钢板移位。结论非胸腔镜辅助下改良的Nuss手术安全易行,创伤小,手术时间短,术后恢复快,近期矫形效果满意,远期效果待进一步观察。     

电视胸腔镜辅助小切口食管癌切除食管、胃胸内吻合术

目的探讨胸腔镜辅助小切口行食管癌切除食管、胃胸内吻合的可行性,并介绍手术具体操作方法。方法2002-08～2003-05采用胸腔镜辅助小切口施行食管癌切除食管胃胸内吻合12例,其中中段癌2例、下段癌8例、贲门癌2例;肿瘤长度2～5cm。结果手术时间平均为110min,术中失血量平均为110ml,术后引流量平均130ml。术后48～72h拔除胸腔引流管,拔管后即能自行下床活动,切口疼痛轻微。术后无严重并发症发生。平均住院11d。结论胸腔镜辅助小切口行食管癌切除食管、胃胸内吻合是可行的,但应严格掌握适应证和手术操作技术。     

非胸腔镜辅助Nuss手术矫治儿童漏斗胸113例

目的探讨非胸腔镜辅助Nuss手术治疗漏斗胸的手术方法、效果和并发症。方法收集2011年3月至2014年3月收治的漏斗胸患儿113例,采用非胸腔镜辅助Nuss手术治疗,分析手术时间、术中出血量、术后住院时间、术后并发症及术后疗效评价。结果全组患儿均完成手术,手术时间(50±15)min。出血量(8±12)m L,全组病例恢复,平均(7.5±3.2)d出院。并发症发生率11.5%(13/113),胸廓矫形效果:优103例;良10例。结论非胸腔镜辅助Nuss手术方法安全,微创,效果满意。     

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.     

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.