重症心脏瓣膜病的外科治疗

目的 总结重症心脏瓣膜患者围术期处理及外科手术经验,提高患者的治愈率.方法 回顾性研究1999年9月至2004年10月外科治疗78例重症心脏瓣膜患者的围术期处理、术中心肌保护及术中手术方法.结果 78例中75例治愈;发生并发症13例：低心排综合征5例、活动性出血二次开胸止血3例、脑栓塞2例、迟发性心脏破裂1例、肾功能不全1例、肺部感染1例,其中死亡3例.结论 加强围术期处理,采用冷-温血心肌保护液,选择双叶瓣、保留左房室瓣瓣下结构或左房室瓣后瓣及瓣下结构,延长辅助呼吸时间,重症心脏瓣膜病亦可取得良好的手术效果.     

重症心脏瓣膜病的外科治疗

目的为探讨重症心脏瓣膜病外科治疗的安全性、手术成功率、治疗效果的方法。方法对200例重症心脏瓣膜病患者进行了手术治疗，按重症心脏瓣膜病的诊断标准，均存在多项心脏瓣膜病外科手术的高危因素；其中单纯左房室瓣替换94例、单纯主动脉瓣替换10例、左房室瓣替换加主动脉瓣替换90例、右房室瓣替换3例、感染性心内膜炎赘生物清除加左房室瓣替换3例，并且进行了回顾性的分析。结果本组手术大部分取得良好恢复，并发症发生率25％（50／200），术后早期死亡率7％（14／200）。随访157例中，远期死亡8例。结论重症心脏瓣膜病外科手术的卉度症发生率较高，手术风险相对较高，但术前准备、麻醉平稳、术中对病变的纠治合理和注意并发症的预防等，仍能取得较好的疗效。     

18例心脏瓣膜疾病合并冠心病的外科治疗

目的 探讨心脏瓣膜疾病合并冠心病的手术治疗方法及围术期处理。方法 1998年3月～2002年12月,同期手术治疗冠心病合并心脏瓣膜疾病18例,其中二尖瓣病变10例,主动脉病变6例,联合瓣膜病变2例,手术均在中低温体外循环下进行。二尖瓣置换(MVR)8例,成形(MVP)3例,其中1例因成形失败而改为换瓣,主动脉瓣置换6例,双瓣置换2例,换瓣加三尖瓣De Vaga成形8例。结果 手术中死亡1例,术后发生低心排需要IABP支持4例,出现肾功能衰竭3例,多器官功能衰竭而死亡1例。术后生存病人心功能明显改善。结论 瓣膜疾病合并冠心病者,尽管手术死亡率偏高,但若能彻底纠正瓣膜的功能,将缺血心肌完全再血管化,以及完善的围术期处理,此类疾病的治疗仍可取得良好效果。     

重症心脏瓣膜病的围术期处理

目的 总结重症心脏瓣膜病患者围术期处理经验，提高患者的治愈率。方法 回顾性研究1999年9月至2004年10月外科治疗78例重症心脏瓣膜病患者的围术期处理、心肌保护方法、手术方式。结果 低心排综合征5例，活动性出血二次开胸止血3例，脑栓塞2例，迟发性心脏破裂1例，肾功能不全1例，肺部感染1例，死亡3例。结论 加强围术期处理，加强术中心肌保护，彻底纠正瓣膜畸形及注意人工瓣膜的选择，重症心脏瓣膜病亦可取得良好的早期效果。     

冠状动脉搭桥和心脏瓣膜手术同期施行的应用

目的：总结同期施行冠状动脉搭桥和心脏瓣膜手术的早期效果和经验。方法：23例病人中16例为风湿性心脏瓣膜病合并冠状动脉病变,7例为冠心病合并心脏瓣功能不全。冠状动脉单支病变13例,其余为多支病变,23例均在全麻体外循环下同期施行冠状动脉搭桥和心脏瓣膜手术,同期室壁瘤手术3例,瓣膜置换24个,瓣膜成形6例次,人均搭桥1．74支,手术后低心排2例需主动脉内球囊反搏支持。结果 23例病人取得了良好的临床效果,无手术死亡,心脏功能得到明显改善,结论：同期施行冠状动脉搭桥和心脏瓣膜手术是有效可行的,近期效果满意。     

同期心脏瓣膜手术与冠状动脉旁路移植术68例临床分析

目的 总结同期施行心脏瓣膜手术和冠状动脉旁路移植术(CABG)的临床经验.方法 2004年1月至2008年1月我科同期施行心脏瓣膜手术 CABG 68例.其中冠心病合并瓣膜病变38例,瓣膜病合并冠心病者27例,瓣膜病合并心肌桥者3例.结果 术后发生呼吸功能不全者3例,胸骨切口并发症1例,严重心律失常2例,胸腔积液3例,心包积液2例,经治疗早期死亡3例,死亡原因:低心排1例,多器官功能衰竭1例,心律失常1例;其余均好转出院.结论 同期施行心脏瓣膜手术 CABG其近期疗效显著.     

感染性心内膜炎瓣膜损害的外科治疗

目的 总结56例感染性心内膜炎(IE)瓣膜损害的外科治疗经验.方法 56例IE患者均在体外循环下施行心内直视手术,其中左房室瓣置换24例.双瓣膜置换19例,主动脉瓣置换7例,右房室瓣成形3例,右房室瓣置换2例,Bentall手术1例;同期矫治合并其他心血管畸形8例.急诊手术占34%(19/56).结果 长期存活50例,心功能均为Ⅰ～Ⅱ级.早期死亡4例(7.2%).其中3例为低心排综合征,1例为人工瓣感染性心内膜炎;晚期死亡2例.结论 对IE,尤其是急性心衰伴进行性加重不能控制者,应在血流动力学及瓣膜条件恶化前积极采用手术治疗.     

瓣膜置换术32例报告

20 0 2年 6月至 2 0 0 3年 11月底 ,我们心脏中心心外科 ,与首都医科大学附属北京同仁医院心脏中心心外科合作 ,共行瓣膜置换术 32例 ,除 1例死亡之外 ,无致死性并发症和后遗症 ,均在随访中。报告如下。1　临床资料本组瓣膜置换病人共 32例 ,其中男 16例 ,女 16例 ;年龄 16～ 5 5岁 ,平均 4 1岁。手术类别为MVR 19例 ,其中 12例同期行右房室瓣Devega法成形术 (TVP) ,2例因合并冠心病同期冠状动脉旁路手术 (CABG) ,2例系 10余年前外院行经胸左房室瓣闭式扩张后出现再狭窄而行左房室瓣置换术(MVR)。 1例系本院MVR TVP术后出现瓣周漏…     

重症风湿性瓣膜病合并重度三尖瓣关闭不全的临床研究

目的总结重症风湿性瓣膜病二尖瓣和主动脉瓣置换或二尖瓣置换的同时,三尖瓣同期成形或置换治疗心脏瓣膜病的手术疗效。方法2000年7月至2007年7月共收治重症瓣膜病合并重度三尖瓣关闭不全患者52例,38例行二尖瓣和主动脉瓣双瓣置换,12例行二尖瓣置换,2例行二尖瓣主动脉瓣三尖瓣联合置换,其余50例均行三尖瓣成形。结果死亡4例,手术死亡率为7.69%。随访3～18个月,无死亡病例。心功能明显改善,三尖瓣反流明显减少。I～Ⅱ级46例、Ⅲ级2例。结论对于重症风湿性瓣膜病变者,三尖瓣存在重度关闭不全或严重器质性病变时,在进行二尖瓣主动脉瓣置换的同时进行三尖瓣有效成形或置换,有利于术后右心功能的恢复,改善心功能,能明显提高远期生活质量。     

初期开展心脏瓣膜病外科治疗23例的经验和教训分析

目的：回顾性分析23例心脏瓣膜病患者的临床资料,总结初期开展瓣膜外科治疗所应汲取的经验和教训。方法全组除1例为主动脉右瓣冠脱垂外,其余22例均为风湿性心脏瓣膜病,共有二尖瓣病变19例次,主动脉瓣病变15例次,其中主动脉瓣、二尖瓣联合瓣膜病变11例;均在气管插管＋静脉复合麻醉下,经胸正中切口,常规建立体外循环。二尖瓣置换术（MVR）采用右房—房间隔入路,多数采用2-0 prolene 线连续缝合,主动脉瓣膜替换（AVR）采用主动脉根部切口,采用双头带垫间断褥式缝合,必要时可间断单针缝合。双瓣膜置换先置换二尖瓣,再置换主动脉瓣。合并三尖瓣中度以上关闭不全病例,同期行 Devega 术或置环成形术（TVP）。合并 CABG 患者先在体外循环下行桥血管远端吻合,再行瓣膜置换术,并行循环下进行桥血管近端吻合。结果术后心脏21例自动复跳,2例心外膜除颤后复跳,术后再次开胸止血 1例,房间隔切口裂开1例,呼衰及精神症状 1例,均经积极治疗痊愈出院。全组无死亡病例。术后1周复查心超均未发现瓣周漏。术后全部随访至今,随访患者心功能都有不同程度好转。结论准确掌握手术时机,充分术前准备及正确围术期处理,术中积极保护心肌和左室功能,正确处理合并症,可明显提高瓣膜置换术的成功率,降低手术并发症,提高患者生存质量。     

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.