尖吻蝮蛇血凝酶对腹部手术切口止血作用的有效性和安全性

目的评价尖吻蝮蛇血凝酶在腹部手术切口的止血作用及对凝血功能的影响及其安全性.方法随机、盲法、平行对照的多中心研究.180例外利腹部择期中等手术患者分为高剂量组(A),低剂量组(B)和安慰剂组(C)三组,各60例.A组予尖吻蝮蛇血凝酶3U,B组予2U,C组给予0.8%右旋糖苷,术前15 min静脉注射.观察腹部手术切口出血的止血时间、出血量、单位面积出血量及机体凝血功能和安全性.结果A,B,C三组的平均止血时间分别为(37.5±21.4),(37.5±19.),(59.7±25.1)s,切口出血量分别为(1.83±1.32),(1.86±1.03),(3.47±1.55)g,单位面积出血量分别为(0.030±0.017),(0.033±0.014),(0.077±0.033)g·cm-2.A和B组3方面结果相似(P＞0.05);B组3方面的结果均明显少于C组(P＜0.01),A和B组的止血效果明显优于C组.三组凝血指标和全血黏度结果相似.无不良事件.结论尖吻蝮蛇血凝酶对腹部切口毛细血管出血有较好的止血作用和安全性,疗效不随药物剂量增加而增加.     

血凝酶在皮肤移植术中对供皮区的止血效果

目的:观察注射用血凝酶对皮肤移植术中供皮区创面出、渗血的止血的效果与安全性。方法:切瘢植皮病人 60例,随机分为 2组,进行前瞻对照研究。血凝酶组病人术前 30min肌内注射血凝酶 1单位,术中于取皮前 15min静脉注射血凝酶 1单位,术后每日静脉注射血凝酶 1单位,连续 3d。空白对照组不用任何止血药。观察 2组术中出血、渗血量,检测停药后d3凝血功能。结果:血凝酶组供皮区创面出、渗血量为 (0. 20±s0. 09)g·cm-2,空白对照组为(0. 37± 0. 14)g·cm-2,P<0. 01。2组凝血酶原时间、凝血酶时间、活化部分凝血活酶时间、纤维蛋白原相比较差异无显著意义 (P>0. 05)。结论: 血凝酶能够有效减少供皮区创面的出、渗血量,是一种安全的止血药。     

注射用白眉蛇毒血凝酶对外科手术切口的止血效果

目的:观察白眉蛇毒血凝酶对外科手术切口的止血效果。方法:采用随机单盲法,入选220例外科手术患者,随机分为治疗组60例,阳性对照组60例,空白对照组60例和自身对照组40例。治疗组60例患者分别于术前90min肌注及术前30min静注1KU的白眉蛇毒血凝酶,观察其对手术切口单位面积出血量和出血时间的影响,以单位面积出血量的减少率作为评价临床疗效的指标。阳性对照组和空白对照组分别用蛇凝血酶注射剂(立止血)和生理氯化钠溶液,自身对照组观察40例患者用和不用白眉蛇毒血凝酶自身对照。结果:治疗组和阳性对照组的单位面积出血量的减少率分别为53%和56%,差异无显著性(P>0.05)。自身对照组给药前、后的单位面积出血量和出血时间分别为(0.34±0.15)g·cm~(-2),(133.6±55.8)s及(0.23±0.11)g·cm~(-2),(96.0±38.0)s,单位面积出血量的减少率为32%。治疗组及自身对照组共100例患者的显效率为49%,有效率为41%,总有效率为90%。结论:注射用白眉蛇毒血凝酶能减少手术切口的单位面积出血量,缩短出血时间。     

人纤维蛋白胶对供皮区创面的疗效观察

目的:探讨局部应用人纤维蛋白胶(FS)对中厚供皮区创面的止血和修复作用。方法:选择30例90个中厚供皮区创面为研究对象,分FS止血组、自然止血组以及凝血酶止血组,均选择自体相应部位及相似深度创面进行对照。分别观察各组间创面的止血时间和术后创面完全愈合时间。结果:FS止血组的平均止血时间比自然止血组与凝血酶止血组分别缩短36秒和13秒(P<0.01);创面完全愈合时间,FS止血组为(12.10±2.32)天,自然止血组和凝血酶止血组分别为(19.80±3.86)天和(19.20±3.65)天,FS止血组明显提前(P<0.01)。结论:FS对中厚供皮区创面有明显的止血作用,并能促进创面提前愈合和预防创面感染。     

尖吻蝮蛇血凝酶与氨甲环酸术中止血效果比较

目的:评价术中使用尖吻蝮蛇血凝酶对手术切口止血作用的有效性及安全性。方法:对行妇产科腹腔镜手术的40例患者术中分别采用尖吻蝮蛇血凝酶与氨甲环酸术中止血,并进行效果比较。尖吻蝮蛇血凝酶组20例,氨甲环酸氯化钠组20例。术中分别静脉给予尖吻蝮蛇血凝酶2 U、氨甲环酸氯化钠1 g。观察2组患者手术切口出血量、术中出血量、切口创面止血时间及术后3天血常规、凝血功能、肝肾功能变化情况。结果:2组患者的止血效果无显著性差异(P>0.05)。2组患者术后3天的血常规、凝血功能、肝肾功能检查结果与术前比较均无显著性差异。本组病例无不良事件发生。结论:尖吻蝮蛇血凝酶对手术伤口的止血作用与氨甲环酸氯化钠相似,均有较好的安全性。     

血凝酶对伴凝血功能障碍的经尿道等离子体前列腺切除术止血效果观察

目的:观察血凝酶对伴凝血功能障碍的经尿道等离子体前列腺切除术的止血效果。方法:将132例患者随机分为2组,A组为血凝酶组,B组为对照组。结果:A组与B组的手术时间分别为(44.7±18.1)、(110.6±26.2)min(P<0.01),术中输血量分别为0、(325.2±261.2)mL(P<0.01),术后膀胱持续冲洗时间分别为(30.3±6.1)、(79.2±33.1)h(P<0.01)。结论:血凝酶对伴凝血功能障碍的经尿道等离子前列腺切除术止血效果好。     

蛇毒凝血酶用于神经外科手术的止血效果

目的研究蛇毒凝血酶在神经外科手术中的止血效果。方法 138例行神经外科择期手术患者,随机分为对照组(A组,n=64)和蛇毒凝血酶组(B组,n=74),比较2组的术中出血量和手术时间,并检测活化部分凝血激酶时间(APPT)、血浆凝血酶原时间(PT)、凝血酶时间(TT)和纤维蛋白原(FIB)。结果 B组术中出血量明显少于对照组(P<0.05);2组手术时间差异无统计学意义(P>0.05)。2组FIB均减少(P<0.05);B组凝血状态未发生明显变化(P>0.05),A组APPT、PT、TT均显著高于术前(P<0.05)。结论蛇毒凝血酶用于神经外科手术可明显减少术中出血量,不影响患者凝血功能,且不会增加血栓形成的危险。     

rhFGF与rhEGF分期使用修复深Ⅱ度烧伤创面的临床观察

目的:观察分期使用重组牛碱性成纤维细胞生长因子(rhFGF)与重组人表皮细胞生长因子(rhEGF)治疗深Ⅱ度烧伤创面愈合的临床疗效。方法:随机选择同一患者4处深度相同、部位相应的创面进行自身对照,4处创面分别标记为A、B、C、D,20例深Ⅱ度烧伤患者共80个创面,相应归为A、B、C、D组:A组创面采用rhEGF治疗,B组创面采用rhFGF治疗,C组创面先使用rhFGF,10d后使用rhEGF治疗,D组创面为0.9%氯化钠对照组。观察创面完全愈合所需要的时间、创面愈合质量,以及全身和局部反应。结果:A组的平均愈合时间为(18.20±1.67)d,B组为(19.15±2.01)d,C组为(16.45±1.57)d,D组为(23.65±2.41)d。A、B、C组的平均愈合时间较D组短,C组的平均愈合时间较A、B组短,差异均具有统计学意义(P<0.05);A组与B组相比,愈合时间无显著性差异(P>0.05)。A、B、C组的平均愈合质量比D组好。各组治疗期间未见明显的全身或局部不良反应。结论:分期使用rhFGF和rhEGF能有效促进深Ⅱ度烧伤创面的愈合和修复,缩短愈合时间。     

巴曲亭在乳腺癌改良根治术中止血作用的临床观察

目的观察巴曲亭在乳腺癌改良根治术中、术后的止血效果。方法将乳腺癌改良根治术的40例患者随机分成巴曲亭组(I组)和对照组(II组)。观察创面止血时间,术中出血量、术后6d创面、渗血量及巴曲亭对患者凝血功能的影响。结果I组创面止血时间、术中出血量、术后引流量均少于II组(P<0·05),两组术前、术后凝血功能无显著性差异(P>0·05)。结论巴曲亭在乳腺癌改良根治术中及术后具有较好的止血效果,对患者的凝血功能无影响。     

注射用血凝酶在鼻内镜手术中对出血量和凝血功能的影响

目的:观察注射用血凝酶在鼻内镜手术中的止血效果。方法:将80例行鼻内镜下鼻息肉摘除手术患者随机分为2组,观察组采用入手术室后即肌肉注射血凝酶1KU,术中静脉注射血凝酶2KU;对照组注射相同容量生理盐水。比较2组患者术中出血量及凝血功能指标的变化。结果:对照组平均出血(198.8±1.73)mL,观察组平均出血(126.3±1.02)mL,观察组平均出血量较对照组减少(72.5±0.51)mL,差异有统计学意义(P<0.05);与观察组比较,对照组手术结束时凝血酶原时间和活化部分凝血活酶时间明显延长(P<0.01)。结论:在鼻内镜手术中,术前肌肉注射及术中静脉注射血凝酶止血效果好,出血量少。     

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.     

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.     

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.     

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.     

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.