神经外科昏迷患者人工气道管理方案的制订及实践

目的探讨神经外科重症昏迷患者人工气道管理方案的临床应用效果。方法制订神经外科昏迷患者人工气道管理方案,包括综合评估、系统实施、量表督查和落实改进4个方面。收集我院神经重症监护单元收治的283例格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)<6分且建立气管切开人工气道的神经重症昏迷患者的临床资料。其中2013年—2015年的161例患者为对照组,采取常规气道管理模式;2016年—2018年的122例患者为试验组,实施神经外科昏迷患者人工气道管理方案,分别收集两组干预前和干预1周后痰液性状、声门下吸引物性状、肺部感染发生率、ICU住院时间和平均住院日的资料。结果试验组痰液和声门下吸引物显著减少,性状较对照组明显改善(P<0.001);试验组肺部感染发生率为32.8%,较对照组显著下降(P<0.01);试验组ICU住院时间和平均住院日均显著降低(P<0.01和P<0.001)。人工气道工作小组气道综合管理措施执行效果量化评分为(94.6±1.8)分。结论落实神经外科昏迷患者人工气道管理方案,能够改善患者的痰液性状,降低肺部感染发生率,缩短住院日,改善患者预后。

Alginate hydrogel cross-linked by Ca^(2+)to promote spinal cord neural stem/progenitor cell differentiation and functional recovery after a spinal cord injuryhh

Alginate capillary hydrogels seeded with differentiated cells can fill the lesion cavity and promote axonal regeneration after grafting into the injured spinal cord.Neural stem/progenitor cells(NSPCs)can potentially repair the spinal cord;however,effects of alginate hydrogels(AHs)on NSPCs remain unknown.In this study,we fabricated AHs cross-linked by Ca^(2+)and seeded hydrogels with rat embryonic day 14 NSPCs.Immunocytochemistry and electron microscopy show that NSPCs survive,proliferate and differentiate into neurons in vitro within the capillaries.After transplantation into an acute T8 complete spinal cord transection site in adult rats,approximately one-third(38.3%)of grafted cells survive and differentiate into neurons(40.7%),astrocytes(26.6%)and oligodendrocytes(28.4%)at 8weeks post-grafting.NSPCs promote the growth of host axons within the capillaries in a time-dependent manner.Host axons make synapse-like contacts with NSPC-derived neurons within the hydrogel channels,and graft-derived axons extend into the host white and gray matter making putative synapses.This is paralleled by improved electrophysiological conductivity across the lesion and partial hindlimb locomotor recovery.

Comorbidity of purulent meningitis with COVLD-19:A case report

To date,only a few cases of intracranial infection related to severe acute respiratory syndrome-coronavirus-2(SARS-Co V-2)were reported.Here we describe a case of coronavirus disease 2019(COVID-19)that was comorbid with purulent meningitis.A 62-year-old male patient was diagnosed with moderate COVID-19 and had no fever or cough after treatment.However,he suffered from a head injury and experienced headache and fever immediately after the accident.Computed tomography(CT)of the brain showed bilateral frontal lobe contusion,subdural hematoma,and subarachnoid hemorrhage.In the following days,the patient suffered from recurrent fever,although chest CT did not show evidence of worsening of infection.Several lumbar punctures were made,confirming increased cerebrospinal fluid(CSF)pressure and karyocyte count.SARS-Co V-2 nucleic acid was not detected in CSF but revealed the presence of Escherichia coli.Thus,the patient was diagnosed with purulent meningitis,presumably caused by brain trauma or the immunologic dysfunction caused by COVID-19,which was supported by the significant reduction of all kinds of immune cells.Since immunologic dysfunction is commonly presented in COVID-19 patients,comorbidity with meningitis should be considered when a COVID-19 patient presents with headache and fever.Lumbar punctures and CSF cultures may help in the diagnosis.