A型肉毒毒素与综合康复治疗对痉挛型脑性瘫痪的疗效观察

目的探讨A型肉毒毒素注射配合运动疗法和神经肌肉电刺激治疗痉挛型脑瘫患儿的效果。方法 75例下肢痉挛脑瘫患儿分为两组:对照组38例采用运动疗法;研究组37例采用A型肉毒毒素注射后配合运动疗法和神经肌肉电刺激。治疗前后采用改良Ashworth评定量表(MAS)、粗大运动功能测试量表(GMFM-88)进行评定。结果治疗3个月后,两组患儿MAS评分、GMFM评分均优于治疗前(P<0.05),研究组疗效优于对照组(P<0.05)。结论 A型肉毒毒素注射配合运动疗法和神经肌肉电刺激可以快速降低肌张力,有效提高痉挛型脑瘫患儿的粗大运动功能。     

多点靶肌注射与非多点靶肌注射A型肉毒毒素对小儿痉挛型脑性瘫痪临床效果比较

目的 对比分析多点靶肌注射与非多点靶肌注射A型肉毒毒素对小儿痉挛型脑性瘫痪的临床效果。方法 选择2013年3月-2016年3月在河南中医药大学第一附属医院进行诊治的小儿痉挛型脑性瘫痪患者118例,随机分为两组,每组各59例。对照组采用非多点靶肌注射A型肉毒毒素治疗,观察组采用多点靶肌注射A型肉毒毒素治疗,比较两组治疗前、治疗1个月、治疗3个月、治疗6个月以及治疗12个月的改良Ashworth评分、CSS评分和GMFM评分。结果 治疗后两组的改良Ashworth评分均明显降低,同组治疗前后比较差异有统计学意义（P < 0.05）;治疗12个月后比较,观察组明显低于对照组,差异有统计学意义（P < 0.05）。治疗后两组的CSS评分均明显降低,同组治疗前后比较差异有统计学意义（P < 0.05）;但两组间无明显差异。治疗后两组的GMFM评分均明显升高,同组治疗前后比较差异有统计学意义（P < 0.05）;但两组间无明显差异。结论 多点靶肌注射与非多点靶肌注射A型肉毒毒素对小儿痉挛型脑性瘫痪均具有显著的临床治疗效果,且多点靶肌注射Ashworth评分优于非多点靶肌注射,更加有效缓解患儿的肢体痉挛程度,改善粗大运动能力。     

电刺激定位引导埋线治疗脑瘫患儿小腿三头肌痉挛的疗效观察

目的观察电刺激定位引导埋线治疗脑瘫患儿小腿三头肌痉挛的疗效。方法将18例脑瘫患儿随机分为电刺激定位引导埋线组（埋线组）和电刺激定位引导A型肉毒毒素（BTX．A）注射组（肉毒素组）,观察治疗1月后患儿的踝背屈曲度、综合痉挛量表CSS评分、改良Ashworth法评分。结果肉毒素和埋线治疗1月后患儿踝背屈曲度、综合痉挛量表CSS评分、改良Ashworth法评分均有明显改善（P〈0．05）,埋线组对患儿踝背屈曲度的改善弱于肉毒素组（P〈0．05）,但综合痉挛量表CSS评分、改良Ashworth法评分与肉毒素组比较差异无统计意义（P〉0．05）。结论电刺激定位引导埋线治疗脑瘫患儿小腿三头肌痉挛有较好的临床疗效。     

小剂量A型肉毒毒素治疗痉挛型脑瘫

目的 观察小剂量A型肉毒毒素（BTX—A）治疗痉挛型脑瘫的疗效。方法 选择65例痉挛型脑瘫患儿，进行小剂量A型肉毒毒素注射．再进行家庭康复治疗及配带矫形器进行步态训练治疗3—6个月，并设对照组对比观察。结果 经BTX—A注射后患儿肌张力降低，关节活动度扩大，继续康复治疗及配带足踝矫形器训练，肌张力、关节活动度、步态得到进一步改善。BTX—A组显效41侧，有效16例，无效8例，总有效率87．69％。对照组显效12例，有效8例，无效35例，总有效率46.16％。两组对比差异有显著性（P〈0．001）。结论 小剂量BTX—A神经阻滞术治疗痉挛型脑瘫具有解痉快，不良反应小，操作方便。安全可靠，费用低等优点．     

肌骨超声联合肌电图引导下注射A型肉毒毒素治疗脑卒中后足下垂的临床疗效

目的 观察肌骨超声联合肌电图引导下注射A型肉毒毒素(BTX-A)治疗脑卒中后足下垂的临床疗效。方法 脑卒中后足下垂患者60例随机均分为两组。观察组在常规治疗基础上加用肌骨超声联合肌电图引导下注射BTX-A治疗,对照组在常规治疗基础上加用肌电图引导下注射BTX-A治疗。比较两组BTX-A注射前和注射后第3个月胫骨前肌和腓肠肌的积分肌电值、踝关节活动度、步行功能和日常生活活动能力。结果 与注射前比较,注射后第3个月两组胫骨前肌和腓肠肌积分肌电值、踝关节活动度、步行功能和日常生活活动能力均改善,且观察组上述指标改善更明显(P<0.05)。结论 肌骨超声联合肌电图引导下注射BTX-A治疗脑卒中后足下垂患者,通过提高胫骨前肌兴奋性和降低腓肠肌兴奋性,可有效改善踝关节活动度和步行能力,从而提高日常生活活动能力。     

脑清穴穴位注射改善痉挛型脑瘫患儿踝关节活动度的临床观察

目的采用脑清穴穴位注射方法,观察其对痉挛型脑性瘫痪患儿踝关节活动度的影响。方法 46例痉挛型脑瘫患儿治疗前测定其双侧足背屈角,选用维生素B1、维生素B12注射液的混合液注射双侧脑清穴,10次为1个疗程,3个疗程后观察其足背屈角变化。结果 46例中,显效16例,有效25例,无效5例,总有效率89.1%。结论脑清穴穴位注射对改善痉挛型脑瘫患儿踝关节活动度有较好疗效,且操作简便,值得临床推广。     

某三甲妇儿专科医院注射用A型肉毒毒素处方分析

目的分析我院门诊及住院处方使用注射用A型肉毒毒素的特点,讨论A型肉毒毒素临床实际应用情况,为临床合理用药提供依据。方法统计分析我院2013-2016年门诊及住院注射用A型肉毒毒素处方。结果 342张注射用A型肉毒毒素处方中,女306例,占89.47%,男36例,占10.53%,其中医学美容科女性比例高于男性,而康复医学科男性比例高于女性;患者临床诊断分布情况:医学美容科主要为面部皱纹整容(40.05%)及下颌角肥大伴咬肌肥大(26.90%),康复医学科主要为痉挛型脑性瘫痪(9.06%)。结论我院注射用A型肉毒毒素在医学美容科主要用于面部皱纹整容、咬肌肥大、腓肠肌肥大、局限性多汗、腋臭、眼睑松弛等;康复医学科主要用于痉挛型脑性瘫痪,其他科室(内科及外科)主要用于面肌痉挛,肉毒毒素属于医疗用毒性药品,临床应用领域广泛,合理使用A型肉毒毒素至关重要。     

A型肉毒毒素注射治疗眼睑和面肌痉挛52例临床观察

目的:观察A型肉毒毒素注射治疗眼睑、面肌痉挛的疗效及不良反应。方法:采用A型肉毒毒素局部注射治疗眼睑痉挛、面肌痉挛52例(73例次),使用痉挛强度分级量表进行病情评估。结果:患者中98%症状明显改善,疗效持续8～30周,可在3～6个月后重复注射仍有疗效。未发现有全身反应,不良反应轻微,所有局部并发症均在数周内恢复正常。结论:局部注射A型肉毒毒素治疗眼睑痉挛、面肌痉挛安全有效。     

A型肉毒杆菌毒素治疗面肌及眼睑痉挛46例

目的探讨A型肉毒杆菌毒素局部注射治疗面肌痉挛的疗效和安全性.方法采用A型肉毒杆菌毒素局部多点注射痉挛肌肉治疗46例.结果治疗有效率100%;作用持续时间＞6个月者39.1%,3～5个月者47.8%,＜3个月者13.0%;副作用轻微、可逆.结论该疗法安全有效,可作为面肌痉挛的首选治疗.     

对痉挛型脑瘫患儿进行蜡疗的护理体会

目的 通过护理观察总结出蜡疗能有效降低患儿肌张力．扩大关节活动度,提高痉挛型脑性瘫痪患儿治疗效果。方法 对187例痉挛型脑性瘫痪患儿在一般治疗的基础上加用蜡疗进行护理观察。结果 187例痉挛型脑性瘫痪患儿两个疗程后肌张力评估(Ashworth评分法)和关节活动度测量两种方法进行评定,显效98例．有效84例．无效5例．总有效率97％．与对照组比明显提高疗效。结论 蜡疗能增强痉挛型脑性瘫痪患儿疗效．明显改善或消除患儿的运动障碍．提高患儿生活质量。     

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.     

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.