子宫全切术后输卵管脱垂的相关因素分析

目的通过分析保留附件的子宫全切术后输卵管脱垂的相关病例,总结子宫全切术后输卵管脱垂相关因素。方法回顾性分析2008年1月至2012年12月5年间,收治行子宫全切除术的患者936例,其中646例行经腹子宫切除术(对照组),229例行经阴道子宫切除术(观察组1),61例行腹腔镜辅助下经阴道子宫切除术(观察组2),观察三种手术方式以及术中后腹膜的缝合方式、术后是否放置阴道引流管,与输卵管脱垂的关系。结果术中后腹膜的不同缝合方式,与输卵管脱垂有管,差异有显著性(P<0.05);子宫切除的手术方式以及是否放置阴道引流管,与输卵管脱垂无相关性,(P>0.05)。结论子宫全切术中后腹膜的缝合方式与输卵管脱垂有密切相关性,不完全腹膜化,输卵管脱垂发生率高。     

腹腔镜辅助阴式子宫全切术与开腹子宫全切术的疗效对比

目的对比分析腹腔镜辅助阴式子宫全切术与开腹子宫全切术的疗效,探求子宫全切术的最佳术式。方法将在我院行子宫全切术的84例患者按手术方式分为观察组(n=51)与对照组(n=33),前者接受腹腔镜辅助阴式子宫全切术治疗,后者接受开腹子宫全切术治疗。现对比分析两组患者的疗效。结果①两组患者手术成功率相比差异无统计学意义(P>0.05)。②观察组手术时间显著长于对照组,术中出血量显著少于对照组,术后肛门排气时间、术后下床活动时间、术后住院时间显著短于对照组,两组比较差异有统计学意义(P<0.05)。③观察组术后止痛药使用率、术后病率、术后并发症发生率显著低于对照组,两组比较差异有统计学意义(P<0.05)。结论腹腔镜辅助阴式子宫全切术具有微创、恢复快、并发症发生率低等优点,如果患者符合腹腔镜辅助阴式子宫全切术的手术指征,可考虑尽量给予患者该术式治疗。     

阴式子宫全切术和腹腔镜子宫全切术的疗效及并发症比较

目的研究对比阴式子宫全切术和腹腔镜子宫全切术的疗效及并发症情况。方法 156例行子宫切除术的患者,随机分成观察组(87例)和对照组(69例),观察组采用腹腔镜子宫全切术治疗,对照组采用阴式子宫全切术治疗,对两组患者疗效和并发症进行比较。结果与对照组比较,观察组手术时间短、术中出血量少,差异有统计学意义(P<0.05);观察组术后疼痛时间(22.97±5.98)h和术后肛门排气时间(6.26±0.38)h显著少于对照组的(31.17±4.02)h、(7.10±0.52)h,差异有统计学意义(P<0.05);观察组出现并发症4例,对照组出现并发症2例,差异无统计学意义(P>0.05)。结论阴式子宫全切术和腹腔镜子宫全切术临床疗效基本一致,但腹腔镜子宫全切术用时短,术中出血量少,术后疼痛时间短,临床可根据患者病情选择合适的方式进行手术。     

改良腹式子宫全切术

目的 总结改良腹式子宫全切术临床体会。方法 对98例子宫全切术进行改进，采用腹壁横切口钝性撕拉开腹壁，保留腹壁下浅静脉；集束法处理子宫韧带及附件；筋膜内切除子宫，不处理子宫主、骶韧带；盆腔腹膜及壁层腹膜不缝合；筋膜层连续缝合，皮肤连同皮下脂肪仅缝3针。结果明显缩短了手术时间；减少术中出血，术后恢复快；减少脏器损伤、粘连及术后疼痛；预防附件和阴道脱垂，提高术后性生活质量：腹部美观，满足病人的心理需求；缩短住院时厄，降低住院费用。结论 改良子宫全切术优于传统术式；更适合肥胖妇女、慢性炎症及子宫内膜异位症造成的盆腔粘连病人选用。     

筋膜下子宫全切术式及术后观察

子宫全切术后常因阴道残端肉芽增生或因失去了盆腔韧带的支持导致阴道壁松弛 ,甚至阴道顶端脱垂以及部分因阴道形态及深度的改变而影响性生活。我们对筋膜下子宫全切术与普通术式比较 ,并对其术后并发症进行追踪观察 ,报道如下。1　资料与方法1.1　一般资料　对象择自 1996年 1月～ 1998年 12月住院有子宫全切术适应证、宫颈无恶性倾向的病人2 0 0例 ,随机分为筋膜下子宫全切术组 (观察组 ) ,普通式子宫全切术组 (对照组 )各 10 0例。对照组年龄 31～6 9岁 ,平均 4 7岁 ;观察组 31～ 6 4岁 ,平均 4 5岁。病种 :对照组子宫肌瘤 88例 ,子宫内…     

改良筋膜内子宫切除术85例临床体会

目的:总结改良筋膜内子宫切除的方法和经验。方法:对85例子宫全切术进行改进,采用集束法处理子宫韧带,筋膜下脱袖式切除子宫,不处理主韧带和宫骶韧带,行再造子宫颈,盆腔腹膜间断缝合,与同期85例子宫全切两组病人手术时间、术中出血、术后性功能、阴道脱垂情况进行对照。结果:两组术中出血量差异无显著性(P>0.01),改良组手术时间和术后排气时间均短于对照组(P<0.05和P<0.01)。结论:改良腹式筋腹内子宫切除术简便快捷,损伤小,安全性高。可预防术后阴道壁松弛和脱垂,提高术后性生活质量,值得推广应用。     

阴式子宫全切术优于开腹子宫全切术48例分析

目的研究分析阴式子宫全切术与于开腹子宫全切术的治疗方式及临床疗效。方法回顾分析本院2014年3月至2015年3月期间收治并行子宫全切患者48例临床资料,根据患者手术治疗方式的不同而分为观察组与对照组,对照组24例,采用常规开腹式子宫全切术,观察组24例,实施阴式子宫全切术治疗,观察两组患者术中治疗情况、术后恢复情况及相关并发症的发生率,通过统计学分析对比。结果观察组患者术中出血量、住院时间、术后肛门首次排气时间、患者疼痛程度及相关并发症的发生率均低于对照组(P<0.05),差异有统计学意义。结论阴式子宫全切术与开腹子宫全切术相比较优势更为明显,其创口小、恢复快、痛苦少等特点受到患者充分肯定,适合临床推广应用。     

促进子宫全切术后愈合的措施分析

目的探讨促进子宫全切术后愈合的措施与效果。方法子宫全切术患者400例根据随机数字表法分为治疗组与对照组各200例,所有患者都给予腹腔镜下全子宫切除术,对照组切除后给予常规缝合,治疗组在子宫切除后采用改进的缝合方法。结果所有患者都完成手术,治疗组切口愈合时间为(5.38±1.32)d,对照组切口愈合时间为(7.46±1.54)d,治疗组的切口愈合时间明显少于对照组,差异有统计学意义(P<0.05)。治疗组术后腹部伤口感染、泌尿系感染、阴道残端出血、直肠损伤等并发症总体发生率为3.0%,对照组并发症总体发生率为12.0%,两组组间差异有统计学意义(P<0.05)。结论改良缝合方法能促进子宫全切术后切口愈合,减少并发症的发生,值得推广应用。     

预见性护理对提高子宫全切术后患者睡眠质量的临床研究

目的观察预见性护理对提高子宫全切术后患者睡眠质量的临床效果。方法 96例子宫肌瘤子宫全切术患者,按照完全抽样法1∶1分成对照组与研究组,每组48例,对照组应用常规护理,研究组在对照组基础上予预见性护理,观察两组睡眠质量与并发症发生情况。结果研究组睡眠质量评分低于对照组,两组比较差异有统计学意义(P<0.05);对照组并发症情况为切口感染6例(12.5%),肺部感染5例(10.42%),静脉血栓2例(4.17%),研究组无并发症发生,两组比较差异有统计学意义(P<0.05)。结论对子宫全切术后患者实施预见性护理,获得满意效果,可有效提高患者睡眠质量,值得推广实施。     

双腔管负压吸引对盆腔淋巴结清扫术后预防淋巴囊肿的作用

目的探讨双腔管持续低负压吸引在盆腔淋巴结清扫术后预防盆腔淋巴囊肿的效果。方法将1992～2000年62例因妇科恶性肿瘤行广泛子宫切除并盆腔淋巴结清扫术患者,于术后分为A组(盆腔单管引流,29例)和B组(盆腔双管引流并低负压吸引,33例),观察两组术后引流量及囊肿发生率的异同。结果引流量A组平均为(150±67)ml,B组(270±82)ml;淋巴囊肿发生率A组21%(6/29),B组6%(2/33),二组差异非常显著(P<0.01)。两组术后淋巴囊肿发生时间无显著差异(P>0.05)。结论对广泛子宫切除并盆腔淋巴结清扫术后患者双腔管负压加大引流有利于预防该手术后淋巴囊肿的发生率。     

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.