气压止血带受压处不同衬垫材料在老年四肢骨折手术患者止血消肿及预防皮肤损害中的应用效果评价

目的:探究气压止血带受压处不同衬垫材料在老年四肢骨折手术患者的效果.方法:纳入某院四肢骨折手术老年患者123例分为对照组(61例)和观察组(62例),对照组给予在气压止血带受压处使用石膏棉纸作为衬垫材料,观察组在气压止血带受压处使用水胶体敷料作为衬垫材料,对比两组患者止血效果、消肿疗效、皮肤损害并发症发生率.结果:手术...     

电动气压止血带在儿童骨科四肢手术中的安全应用

目的 探讨电动气压止血带应用于儿童骨科手术中的安全效果.方法 选取2009年3月-2010年5月年本院收治的需经手术治疗的四肢骨折患儿86例,随机分成试验组和对照组,每组43例.试验组在手术过程中采用电动气压止血带行术中止血,对照组采用传统止血带行术中止血,两组患者分别从止血带休克发生率,上下肢放松止血带前、后血压、心率变化情况进行比较.结果 试验组止血带休克发生率为2.33%（1/43）,对照组为9.30%（4/43）,两组比较差异有统计学意义（P＜0.05）.两组上、下肢放松止血带前后血压、心率比较,差异有统计学意义（P＜0.05）.放松止血带后3、5min两组血压、心率间比较,差异均有统计学意义（P＜0.05）.结论 电动气压止血带应用于儿童骨科四肢手术,能够明显降低止血带休克发生率,减少术中出血量,具有较好的临床推广价值.     

数控气压止血带在骨科四肢手术中的应用效果观察

目的观察数控气压止血带在骨科四肢手术中的应用效果。方法将胫腓骨骨折择期手术及内固定取出患者67例随机分为观察组34例和对照组33例。观察组在手术时使用数控气压止血带,对照组在手术时使用普通气压止血带。观察2组患者术中的手术野暴露情况及术后的不良反应。结果 2组患者在手术野暴露方面差异无统计学意义(P>0.05)。观察组术后不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论数控气压止血带的使用不但减少了手术中的出血量,使手术野暴露清晰,还降低了术后的不良反应。     

自动气压止血带不同保护垫与充气时间对病人皮肤的影响

目的探讨使用气压止血带的有效方法.方法下肢骨折行切开复位内固定手术病人246例,随机分为2组,每组123例,采用棉纸作止血带保护垫者为实验组,采用手术巾或绷带作保护垫者为对照组,比较2组病人在使用止血带后皮肤受损的差异性.然后根据止血带使用时间再将实验组和对照组按随机表法分为A组(55±5)分钟,B组(70±5)分钟,C组(85±5)分钟3组,每组41例,比较实验组和对照组各组间的皮肤反应.结果经统计学x 2检验,比较出对照组与实验组的皮肤反应有差异(P＜0.01).但实验组在使用止血带的不同时间段内皮肤出现压痕、红肿、小水泡等皮肤反应很少,且组间比较无差异,(P＞0.05),而对照组随着止血带使用时间的延长皮肤反应越严重,组间比较有差异(P＜0.01),结论止血带使用过程中出现皮肤反应的轻重与使用止血带保护垫的正确与否有关.所以,优质有效的护理能减轻病人的不适,降低手术并发症的发生.     

活动衬垫型和固定衬垫型膝关节假体在置换后1年时膝关节活动度和临床效果的对比研究

目的比较活动衬垫型和固定衬垫型膝关节假体在置换后1年时膝关节活动度和临床效果。方法将80例膝关节骨关节炎且患膝既往无手术史的患者按照奇偶数字法随机地均分为A、B组,各为40例。A组采用活动衬垫型膝关节假体,B组采用固定衬垫型膝关节假体。比较两组术后HSS评分结果以及置换术后膝关节相关活动度的角度。结果①A、B两组术后6周、术后3个月、术后6个月及术后1年HSS评分结果相比,差异均无统计学意义(P>0.05);②A、B两组置换术后患膝屈曲挛缩、最大屈曲度、股骨角、胫骨角、胫骨平台后倾角及置换术后髌骨高度比较,均无统计学差异(P>0.05)、结论活动衬垫型和固定衬垫型膝关节假体治疗置换后1年时膝关节骨关节炎均具有较好的临床疗效,因此二者均可行。     

护理干预对术中使用电子气压止血带患者不良反应的影响

目的:观察护理干预措施对手术室术中使用电子气压止血带患者不良反应的影响.方法:将骨科四肢手术术中使用电子气压止血带的180例患者随机分成对照组(90例)与观察组(90例).对照组按骨科四肢手术常规护理,观察组在常规护理基础上进行认知、心理和行为护理干预.比较2组病人出现不良反应的情况.结果:观察组患者术中及术后的不良反应明显低于对照组.结论:护理干预措施有效地预防术中使用电子气压止血带患者的不良反应.     

膝关节置换手术中全程及半程应用止血带对术中出血及术后康复的影响

目的 探讨膝关节置换手术中全程及半程应用止血带对术中出血及术后康复的影响.方法 选取2013年1月至2015年5月我院收治的膝关节骨性关节炎68例为研究对象,均择期行膝关节置换术,采用随机数表法分为观察组和对照组各34例,观察组术中半程应用止血带止血,对照组术中全程应用止血带,比较两组手术时间、住院时间、术中出血量、红细胞计数(RBC)、C反应蛋白(CRP)等围术期指标,并应用膝关节HSS评分表评价膝关节功能优良率,同时记录术后并发症发生率.结果 观察组手术时间、住院时间及术中出血量高于对照组(P＜0.05),观察组治疗后RBC低于对照组(P＜0.05);两组术后出血量、CRP水平比较无统计学差异(P＞0.05).观察组膝关节功能优良率与对照组比较无统计学差异(91.2％ vs.94.1％;x2=0.07,P＞0.05).两组并发症发生率比较无统计学差异(8.8％vs.5.9％;x2=0.216,P＞0.05).结论 膝关节置换手术中半程应用止血带可能会延长手术时间、住院时间,增加术中出血,但不会增加术后出血,对术后康复无明显影响.     

石膏棉纸和纱布用作气压止血带衬垫材料的对比观察

气压止血带在四肢手术中使用已非常普遍,应用止血带可最大限度地制止创面出血,使手术野干净无血,便于辨认各种组织,有利于手术操作,而缩短手术时间,并可减少或免除输血[1].原来使用的气压止血带使用压力高,现在我院采用美国ZIMMER公司的A.T.S750自动气压止血带,其袖带材料的改善和宽度增加,具有使用压力低、设定时间长、止血更彻底的优点[2].     

气压止血带在院前急救中的应用

院前急救中四肢创伤的患者所占外伤患者比例较大,常规止血采用橡胶止血带法、加压包扎止血等方法.气压止血带一般用于四肢手术中控制出血量,确保切口无渗血,缩短手术时间.2011年我急救中心车载设备中增加了JXX-001型手动气压止血带,用于院前四肢外伤止血,报告如下.     

气压止血带恰当放气时机可保证双下肢手术患者血压及心率的平稳

目的观察气压止血带不同放气时机对双下肢同时手术患者血压及心率的影响。方法我院骨科行双下肢同时手术患者60例,按入手术室序号分为A、B、C三组,各20例。三组患者均采用个性化压力充气、纯棉螺纹弹性衬垫、间隙放气法等。一侧肢体气压止血带放气后A组间隔10分钟再放另一侧,B组间隔15分钟,C组间隔20分钟。比较三组一侧肢体放气前后即刻和另一侧放气前后有创血压和心率的变化。结果一侧肢体止血带放气后即刻三组均血压下降,心率增快;另一侧放气后,A组血压继续下降,心率进一步增快;B组波动幅度没有A组明显;C组血压下降,心率增快,但基本能维持在安全范围。结论在骨科双下肢同时手术时,气压止血带恰当放气时机可保证患者手术过程中生命体征的平稳。     

添加四针状氧化锌晶须抗菌剂对义齿软衬材料机械性能的影响

目的:研究添加四针状氧化锌晶须(T-Znow)抗菌剂对义齿软村材料机械性能的影响.方法:将T-ZnOw抗菌剂按0%(对照组)、1%、2%、3%分别加入到Silagum软衬材料和上海自凝软衬垫中,按国家相关标准检测其粘结强度、拉伸强度、拉伸伸长率、邵氏硬度的变化.结果:当T-Znow抗菌剂添加质量分数为2%时,软衬材料机...     

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.

     

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.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.