腹腔镜胆囊和阑尾联合切除术的临床研究

目的探讨腹腔镜胆囊和阑尾联合切除术的临床价值。方法结石性胆囊炎并慢性阑尾炎20例和急性阑尾炎并慢性结石性胆囊炎8例施行了腹腔镜胆囊和阑尾联合切除术,并与同时期行腹腔镜胆囊切除术(LC)和腹腔镜阑尾切除术(LA)进行对照。结果28例均顺利完成手术,无手术并发症;平均手术时间(60.4±21.7)min,平均住院(5.2±1.9)d,术后住院平均(4.8±1.7)d,平均住院费用(4865±1892)元。腹腔镜胆囊和阑尾联合切除术手术时间较LA和LC长(P<0.05),住院时间和术后恢复时间较LA和LC差异无统计学意义;住院费用与单纯LC差异无统计学意义,较单纯LA高(P<0.01)。结论联合切除术式可同时治疗胆囊和阑尾疾病,具有创伤小、住院时间短、医疗费用低等优点。     

腹腔镜胆囊切除术和内镜奥迪括约肌切开取石68例

目的探讨联合应用腹腔镜行胆囊切除和内镜奥迪括约肌切开术治疗胆囊及胆总管结石的方法和临床价值。方法对68例胆总管结石患者,在全麻下行腹腔镜胆囊切除术及内镜奥迪括约肌切开术,清除胆总管结石。结果 68例患者手术均顺利完成,手术时间为(2.2±1.4)h,术中及术后无严重并发症,平均住院时间(4.0±1.7)d。结论联合应用腹腔镜胆囊切除术及内镜奥迪括约肌切开术治疗胆囊和胆总管结石,具有减少患者痛苦,恢复快,住院时间短费用少等优点。     

腹腔镜胆囊大部分切除术在胆囊手术中的应用分析

目的探讨并分析腹腔镜胆囊大部分切除术在胆囊手术中的临床应用价值。方法选取2014年1月至2014年10月经我院确诊的复杂胆囊疾病(如化脓性胆囊炎、急性坏疽性胆囊炎等)的患者72例,随机分为对照组和观察组,每组36例。对照组患者进行传统开腹手术,观察组患者进行腹腔镜胆囊大部分切除手术治疗。观察并比较两组患者手术过程中时间、出血量以及术后住院时间等。结果两组患者手术过程中并未出现严重不良反应,均顺利完成,但在手术时间、术中出血量、术后离床活动时间以及平均住院时间方面,观察组的结果显著优于对照组结果,两组之间有统计学差异(P<0.05)。结论腹腔镜胆囊大部分切除术在胆囊手术中具有良好的应用价值,值得在临床上广泛推广。     

开腹胆囊手术与腹腔镜胆囊手术的对比观察

目的观察开腹胆囊手术与腹腔镜胆囊手术行胆囊切除的疗效和安全性,为临床工作提供参考。方法选择我院2008年12月至2010年11月收治的胆囊疾病患者116例,随机分为对照组和观察组各58例。对照组患者行开腹胆囊切除术,观察组患者行腹腔镜胆囊切除术。观察并比较两组患者疗效和术后并发症的差异。结果观察组患者的手术时间、术后肠功能恢复时间、住院时间均明显短于对照组,术中出血量明显少于对照组,差异均有统计学意义(P<0.05)。观察组患者术后并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论与开腹胆囊手术比较,腹腔镜胆囊手术具有损伤小、术后恢复快、住院时间短,术后并发症发生率低等优点,值得临床推广应用。     

老年患者腹腔镜胆囊切除术与开腹胆囊切除术的效果观察与分析

目的探讨老年人患者腹腔镜胆囊切除术(1aparoscopic Cholecystectomy,LC)的可行性及围术期的处理。方法回顾性分析该院2005年1月～2010年12月81例70岁以上老年胆囊炎患者分别实施的腹腔镜胆囊切除术和传统开腹胆囊切除术(Open Cholecystectomy,OC),并对2组临床资料进行对比分析。结果腹腔镜组在手术时间、术后肛门排气时间、输液时间、卧床时间、术后应用抗生素时间及术后住院时间比开腹手术组均缩短(P<0.01),而术后疼痛发生的例数又少(P<0.01);腹腔镜组有3例术后发生并发症,其术后并发症发生率为7.32%;开腹手术组有6例术后发生并发症,其术后并发症发生率为15%,两组相比较差异有显著性(χ2=52.848,P<0.01)。结论老年良性胆囊疾病患者采用腹腔镜胆囊切除术,其总体效果优于传统开腹胆囊切除术。     

腹腔镜与传统开腹胆囊切除术治疗胆囊疾病效果比较

目的对比腹腔镜与传统开腹胆囊切除术的临床效果。方法选取2010年12月至2011年12月在本院行胆囊切除治疗的患者102例,按照不同手术方式分为两组,观察组和对照组各51例,对照组进行传统开腹胆囊切除术治疗,观察组进行腹腔镜胆囊切除术治疗,比较两组患者临床效果。结果观察组在手术时间、手术中出血量、排气时间、住院时间、并发症发生率、止痛药使用率等均明显优于对照组,差异有统计学意义。结论同传统开腹胆囊切除术相比,腹腔镜胆囊切除术具有微创、术后恢复快、术后住院时间短、并发症少等优点。     

老年患者腹腔镜胆囊切除术围手术期的处理

目的总结老年患者行腹腔镜胆囊切除术围手术期处理的方法,为临床医生提供经验。方法回顾性分析笔者所在医院2010年1月～2012年1月23例老年胆囊炎患者实施腹腔镜手术治疗的资料,观察疗效并总结围手术期的处理经验。结果 53例患者腹腔镜手术均顺利获得成功,手术平均时间(50.0±12.7)min,下床活动时间(1.3±0.5)d,肛门排气时间(2.1±0.3)d,住院时间(6.3±1.8)d;其中中转开腹手术2例,均由于胆囊三角区粘连严重解剖关系分辨不清而开腹行胆囊切除。手术后有3例出现胆瘘,经保守治疗后得到痊愈,2例出现肺部感染,经抗炎对症治疗后痊愈。结论老年患者行腹腔镜胆囊切除术应严格掌握手术适应证,术前做好充分准备,对合并的慢性内科病进行全面评估,有效治疗,术中操作谨慎,严密监测术后生命体征,强化术中、术后预防并发症发生的意识,得到了满意的疗效,减轻了患者开腹手术带来的创伤,术后恢复快,并发症少。     

老年急诊患者腹腔镜胆囊切除术和开腹胆囊切除术的临床对比分析

目的对比分析腹腔镜胆囊切除术与开腹胆囊切除术在老年急诊患者中的应用效果。方法收集2011年1月至2013年9月期间,我院收治的老年急诊胆囊疾病患者84例,随机均分为观察组与对照组,各42例,对照组行传统开腹胆囊切除术,观察组行腹腔镜胆囊切除术,对比分析两组的临床治疗效果。结果观察组患者的手术时间、术中出血量、术后肛门排气恢复时间、输液时间、卧床时间、住院时间均显著短于对照组,术后并发症发生率显著低于对照组(P<0.05)。结论对老年良性胆囊疾病患者实施腹腔镜胆囊切除术创伤小、并发症少、术后恢复快,值得在临床中推广应用。     

腹腔镜下胆囊切除术治疗胆囊相关疾病126例回顾性分析

目的探讨腹腔镜胆囊切除术(LC)的适应证、手术方法、临床效果及相关的并发症。方法对近年来贵州省桐梓县人民医院外科126例腹腔镜胆囊切除术患者的临床资料进行回顾性总结分析。结果126例中122例利用LC成功切除胆囊,手术成功率为96.83%,中转行开腹手术4例,占3.17%,手术时间30～140min,平均(48.6±19.8)min,术后住院时间3～7d,平均4d,3例发生并发症,其中胆管损伤2例,胆漏1例,126例患者均治愈。结论①腹腔镜胆囊切除术具有创伤小、出血少、对腹腔器官干扰小、手术时间短、术后恢复快等优点,值得临床推广应用。②并发症较开腹胆囊切除术要高,可能与视觉差异、对Calot三角解剖不熟悉或操作熟练程度有关。     

老年胆囊疾病经腹腔镜实施胆囊切除与开腹手术治疗的临床效果分析

目的：探讨和比较经腹腔镜实施胆囊切除与开腹胆囊切除术的临床效果。方法：选取我院2012年1月-2013年12月收治的96例老年胆囊疾病患者为研究对象,按就诊先后顺序将上述患者分为对照组（48例）和观察组（48例）,对照组应用开腹胆囊切除术治疗,观察组应用腹腔镜下胆囊切除术进行治疗,对围术期各项指标及并发症发生情况进行比较。结果：两组患者手术均取得了成功,其中,观察组的手术时间、术后通气时间、下床时间和住院天数均明显短于对照组,手术出血量也明显少于对照组,差异具有统计学意义（P＜0.05）;对照组的并发症发生率明显高于观察组,差异具有统计学意义（P＜0.05）。结论：与开腹胆囊切除术相比,腹腔镜胆囊切除术治疗老年胆囊疾病的安全性更高,也更为有效,术后并发症也较少,值得临床借鉴和推广。     

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.