Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication:a single-center cohort study

BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation(ECMO)center.However,the predictive factors showing the need for venous-arterial ECMO(VA-ECMO)had never been evaluated.METHODS:A retrospective,descriptive,and single-center cohort study.All consecutive patients admitted in the largest ICU of Reunion Island(Indian Ocean)between January 2013 and September 2018 for beta-blockers(BB),calcium channel blockers(CCB),renin-angiotensin-aldosterone system blockers,digoxin or anti-arrythmic intentional poisonings were included.ECMO implementation was the primary outcome.RESULTS:A total of 49 consecutive admissions were included.Ten patients had ECMO,39 patients did not have ECMO.Three patients in ECMO group died,while no patients in the conventional group died.The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure,heart rate,arterial lactate concentration,liver enzymes and left ventricular ejection fraction(LVEF)at ICU-admission.Only pulse pressure at first medical contact and LVEF were significant after logistic regression.CONCLUSION:A transfer to an ECMO center should be considered for a pulse pressure<35 mmHg at first medical contact or LVEF<20%on admission to ICU.

Membranes for the life sciences and their future roles in medicine

Since the global outbreak of COVID-19,membrane technology for clinical treatments,including extracorporeal membrane oxygenation(ECMO)and protective masks and clothing,has attracted intense research attention for its irreplaceable abilities.Membrane research and applications are now playing an increasingly important role in various fields of life science.In addition to intrinsic properties such as size sieving,dissolution and diffusion,membranes are often endowed with additional functions as cell scaffolds,catalysts or sensors to satisfy the specific requirements of different clinical applications.In this review,we will introduce and discuss state-of-the-art membranes and their respective functions in four typical areas of life science:artificial organs,tissue engineering,in vitro blood diagnosis and medical support.Emphasis will be given to the description of certain specific functions required of membranes in each field to provide guidance for the selection and fabrication of the membrane material.The advantages and disadvantages of these membranes have been compared to indicate further development directions for different clinical applications.Finally,we propose challenges and outlooks for future development.

High matrix metalloproteinase-9 expression induces angiogenesis and basement membrane degradation in stroke-prone spontaneously hypertensive rats after cerebral infarction

Basement membrane degradation and blood-brain barrier damage appear after cerebral infarc- tion, severely impacting neuronal and brain functioning; however, the underlying pathogenetic mechanisms remain poorly understood. In this study, we induced cerebral infarction in stroke- prone spontaneously hypertensive rats by intragastric administration of high-sodium water （1.3% NaC1） for 7 consecutive weeks. Immunohistochemical and immunofluorescence assays demonstrated that, compared with the non-infarcted contralateral hemisphere, stroke-prone spontaneously hypertensive rats on normal sodium intake and Wistar-Kyoto rats, matrix metalloproteinase-9 expression, the number of blood vessels with discontinuous collagen IV expression and microvessel density were significantly higher, and the number of continuous collagen IV-positive blood vessels was lower in the infarct border zones of stroke-prone sponta- neously hypertensive rats given high-sodium water. Linear correlation analysis showed matrix metalloproteinase-9 expression was positively correlated with the number of discontinuously collagen IV-labeled blood vessels and microvessel density in cerebral infarcts of stroke-prone spontaneously hypertensive rats. These results suggest that matrix metalloproteinase-9 upregula- tion is associated with increased regional angiogenesis and degradation of collagen IV, the major component of the basal lamina, in stroke-prone spontaneously hypertensive rats with high-sodi- um water-induced focal cerebral infarction.

Fresh human amniotic membrane effectively promotes the repair of injured common peroneal nerve

Suture and autologous nerve transplantation are the primary therapeutic measures for completely severed nerves. However, imbalances in the microenvironment and adhesion of surrounding tissues can affect the quality of nerve regeneration and repair. Previous studies have shown that human amniotic membrane can promote the healing of a variety of tissues. In this study, the right common peroneal nerve underwent a 5-mm transection in rats. Epineural nerve repair was performed using 10/0 non-absorbable surgical suture. The repair site was wrapped with a two-layer amniotic membrane with α-cyanoacrylate rapid medical adhesive after suture. Hindlimb motor function was assessed using footprint analysis. Conduction velocity of the common peroneal nerve was calculated by neural electrical stimulation. The retrograde axoplasmic transport of the common peroneal nerve was observed using fast blue BB salt retrograde fluorescent staining. Hematoxylin- eosin staining was used to detect the pathological changes of the common peroneal nerve sputum. The mRNA expression of axon regeneration-related neurotrophic factors and inhibitors was measured using real-time polymerase chain reaction. The results showed that the amniotic membrane significantly improved the function of the injured nerve;the toe spread function rapidly recovered, the nerve conduction velocity was restored, and the number of fast blue BB salt particles were increased in the spinal cord. The amniotic membrane also increased the recovery rate of the tibialis anterior muscle and improved the tissue structure of the muscle. Meanwhile, mRNA expression of nerve growth factor, growth associated protein-43, collapsin response mediator protein-2, and brain-derived neurotrophic factor recovered to near-normal levels, while Lingo-1 mRNA expression decreased significantly in spinal cord tissues. mRNA expression of glial-derived neurotrophic factor did not change significantly. Changes in mRNA levels were more significant in amniotic-membrane-wrapping-treated rats compared with model and nerve sutured rats. These results demonstrate that fresh amniotic membrane wrapping can promote the functional recovery of sutured common peroneal nerve via regulation of expression levels of neurotrophic factors and inhibitors associated with axonal regeneration. The study was approved by the Committee on Animal Research and Ethics at the Affiliate Hospital of Zunyi Medical University, China (approval No. 112) on December 1, 2017.

Fabrication of anti-fouling polyamide nanofiltration membrane by incorporating streptomycin as a novel co-monomer

Polyamide(PA)thin-film composite(TFC)na nofiltration(NF)membrane has extremely broad application prospects in separation of monovalent/diva lent inorganic salts mixed solutio n.However,membrane fouling is the main obstacle to the application of PA,TFC and NF membrane.Streptomycin(SM)is a hydrophilic antibiotic containing a large number of hydroxyl and amino groups.In this work,the NF membrane was prepared via interfacial polymerization(IP)between trimesoyl chloride(TMC)in the organic phase and SM/piperazine(PIP)mixture in the aqueous phase.The NF membrane structure and performance were characterized in detail.The results showed that SM successfully participated in the IP.The negative charge and hydrophilicity of membrane surface were improved.The prepared membrane exhibited good anti-adhesion and anti-bacterial performance,Additionally,when the SM concentration was 2%,the prepared membrane exhibited the optimal permselectivity.The water permeance was 89.4L·m^(-2)·h^(-1)·MPa^(-1).The rejection of NaCl and Na_(2)SO_(4) were 17,17%and 97.84%,respectively.The NaCl/Na_(3)SO_(4) separation factor of the SM2-PIP/TMC membrane in 1000 mg·L^(-1) NaCl and 1000 mg·L^(-1)Na_(2)SO_(4) mixed solution was 40,which was 3.3 times that of PIP/TMC membrane.It indicated that SM2-PIP/TMC demonstrated excellent monovalent/divalent salts separation performance.This work provided an easy and effective approach to preparing anti-fouling NF membrane while possessing superior monovalent/divalent salts separation performance.

Biomembrane-inspired design of medical micro/nanorobots:From cytomembrane stealth cloaks to cellularized Trojan horses

Micro/nanorobots are promising for a wide range of biomedical applications(such as targeted tumor,thrombus,and infection therapies in hard-to-reach body sites)because of their tiny size and high maneuverability through the actuation of external fields(e.g.,magnetic field,light,ultrasound,electric field,and/or heat).However,fully synthetic micro/nanorobots as foreign objects are susceptible to phagocytosis and clearance by diverse phagocytes.To address this issue,researchers have attempted to develop various cytomembrane-camouflaged micro/nanorobots by two means:(1)direct coating of micro/nanorobots with cytomembranes derived from living cells and(2)the swallowing of micro/nanorobots by living immunocytes via phagocytosis.The camouflaging with cytomembranes or living immunocytes not only protects micro/nanorobots from phagocytosis,but also endows them with new characteristics or functionalities,such as prolonging propulsion in biofluids,targeting diseased areas,or neutralizing bacterial toxins.In this review,we comprehensively summarize the recent advances and developments of cytomembrane-camouflaged medical micro/nanorobots.We first discuss how cytomembrane coating nanotechnology has been employed to engineer synthetic nanomaterials,and then we review in detail how cytomembrane camouflage tactic can be exploited to functionalize micro/nanorobots.We aim to bridge the gap between cytomembrane-cloaked micro/nanorobots and nanomaterials and to provide design guidance for developing cytomembrane-camouflaged micro/nanorobots.

体外膜肺氧合经编膜织物自适应张力的低损伤制备

针对体外膜肺氧合(ECMO)系统中使用的氧合膜织物国产化制备技术难题,进行了ECMO系统用经编膜织物低损伤制备及其透气性能研究。采用特种特里克型经编机开展了不同送经量下的氧合膜织物制备实验,分析了聚甲基戊烯(PMP)中空纤维膜丝的编织损伤机制;提出一种自适应张力控制下的ECMO系统用氧合膜织物低损伤制备方法,对比分析了采用该方法制备的氧合膜织物性能指标。实验结果表明:基于氧合膜织物提出的自适应张力控制方法可有效调控经纱张力的“削峰补谷”缺陷,实现氧合膜织物的低损伤制备;用该法制备的ECMO系统用氧合膜织物纵密为20横列/cm,编织位置外径损失3%,强力损失5%;编织前后N 2通量衰减17%,CO_(2)通量衰减12%,O_(2)通量衰减14%;同时,氧合膜织物平整度、密度、气通量等均已达到国外同类产品水平。

聚四氟乙烯微孔膜复合材料及其防护应用进展

总结聚四氟乙烯微孔膜在个体防护领域中的应用研究进展。介绍了聚四氟乙烯膜的研发历程,分析了聚四氟乙烯膜在不同环境介质中的防护作用机理。从聚四氟乙烯膜在阻隔类和主动类防护领域应用两方面出发,探讨了目前聚四氟乙烯膜在医用防护服、医用口罩、核生化防护服、热管理和自清洁等材料中的研究和应用。认为:通过复合支撑材料优选、成膜加工工艺优化、功能纳米粒子掺杂等方式,可以改善和丰富膜性能,进而根据实际防护应用需求制备高性能、多功能的聚四氟乙烯复合材料,并在智能防护领域发挥重要作用。

基于数据挖掘分析“温阳化积法”治疗膜性肾病

目的:基于数据挖掘分析“温阳化积法”治疗膜性肾病的用药规律。方法:以首都医科大学附属北京中医医院2021年1月至2022年8月门诊治疗的420例膜性肾病患者作为研究对象,对所有患者的首诊处方均进行统计分析,使用SPSS Modeler 18.0软件进行药物频数分析,利用熵层次聚类方法分析方剂组方规律,采用Aprior算法进行药物关联规则分析,采用组间连接的聚类分析方法分析处方中核心药物组合。结果:共计收集659份首诊处方,累计收集药物129味,使用频率≥2%的高频药物38味,其中使用频率超过90%的中药为附子、茯苓、麻黄、炙甘草,使用频率在60%~89%的中药为麸炒白术、干姜、大枣、桂枝、防已、赤小豆、黄芪、泽泻、葫芦巴。其主要为温里药、解表药、补虚药、利水渗湿药等。出现频率在50%以上的中药组合分别为麻黄、附子,附子、干姜,防己、黄芪,防己、茯苓,附子、防己等。药物组合关联规则分析中,置信度前3位依次为:麻黄,附子-防己;附子,茯苓-黄芪;黄芪,麻黄-防已。采用组间连接的聚类分析方法分析核心药物组合结果发现,共得到12大类。高频药物聚类得到4个聚类方。结论:通过数据挖掘探究刘宝利治疗膜性肾病的用药规律,在温阳化积基础上结合解表、补虚、利水渗湿等治法,对于临床治疗膜性肾病的具有一定的参考意义。

A functional PVA aerogel-based membrane obtaining sutureability through modified electrospinning technology and achieving promising anti-adhesion effect after cardiac surgery

Pericardial barrier destruction,inflammatory cell infiltration,and fibrous tissue hyperplasia,trigger adhesions after cardiac surgery.There are few anti-adhesion materials that are both functional and sutureable for pericardial reconstruction.Besides,a few studies have reported on the mechanism of preventing pericardial adhesion.Herein,a functional barrier membrane with sutureability was developed via a modified electrospinning method.It was composed of poly(L-lactide-co-caprolactone)(PLCL)nanofibers,poly(vinyl alcohol)(PVA)aerogel,and melatonin,named PPMT.The PPMT had a special microstructure manifested as a staggered arrangement of nanofibers on the surface and a layered macroporous aerogel structure in a cross-section.Besides providing the porosity and hydrophilicity obtained from PVA,the structure also had suitable mechanical properties for stitching due to the addition of PLCL nanofibers.Furthermore,it inhibited the proliferation of fibroblasts by suppressing the activation of Fas and P53,and achieved anti-inflammatory effects by affecting the activity of inflammatory cells and reducing the release of pro-inflammatory factors,such as interleukin 8(IL-8)and tumor necrosis factorα(TNF-α).Finally,in vivo transplantation showed that it up-regulated the expression of matrix metalloproteinase-1(MMP1)and tissue inhibitor of metalloproteinase-1(TIMP1),and down-regulated the expression of Vinculin and transforming growth factorβ(TGF-β)in the myocardium,thereby reducing the formation of adhesions.Collectively,these results demonstrate a great potential of PPMT membrane for practical application to anti-adhesion.

Numerical simulation of membrane humidifier with different flow fields for medical application

Medical humidifier is one of the vital instruments for a respiratory patient in hospital,which is used to humidify the required oxygen for respiratory patients.The conventional type of humidifier,bubble humidifier,has some technical problems,including the need to drain condensed water and a lack of accurate control of air or oxygen required by the patient.In contrast,Membrane humidifier has exciting advantages,including the simplicity of the system,the absence of moving parts,very low noise,and the ability to control temperature and humidity.In this study,three configurations,including parallel,cross,and serpentine of a single module of a membrane humidifier according to the person's weight and breathing rate(the range of 10–28 SLPM)are numerically investigated.For validation of numerical models,a membrane humidifier experimental setup test is used.The obtained results indicated that the crossflow configuration for membrane humidifier has a minimum Dew Point Approach Temperature(DPAT)(2<DPAT<5),which confirms that this flow field has better performance than other flow fields.The results show that increasing the volume flow rate increases the DPAT for membrane humidifiers and Water Vapor Temperature Recovery(WVTR).Furthermore,with an increase of 7 L/min of the gas mixture,the relative humidity has decreased by about 30%.This decrease was most outstanding in the cross-flow field and less in the serpentine flow field.

评估体外膜氧合高仿真模拟培训在医学临床教育中的效果

目的通过理论知识和综合评分评估体外膜氧合(ECMO)高仿真模拟培训在医学临床教育的效果,同时观察有无ECMO临床经验是否影响培训的效果。方法选取2022年9月至2022年12月期间本中心进修学员作为参与者,4名具有教学资格的本中心医生作为模拟培训讲师,时间为期2天。通过专业笔试、考核指标及问卷调查等形式评估培训效果。结果共有20名参与者纳入此研究,75%参与者为临床医师,有45%参与者的所属医院至今没有开展ECMO。研究结果发现所有参与者经过高仿真模拟培训后理论知识、综合评分等各项指标均得到明显的提高(P<0.05),且无ECMO临床经验的参与者得到相同的效果。结论ECMO高仿真模拟培训可明显改善参与者ECMO相关理论知识和处理问题的能力,且不受是否有ECMO临床经验的影响。

可洗涤医用防护服面料的制备与性能研究

为提高医用防护服面料的耐洗涤性和穿着舒适性,开发了可洗涤医用防护服面料,对其防护性能进行研究。以机织物为内外层,以静电纺丝制备的聚酰亚胺纳米纤维膜为核心阻隔层,采用点式离线复合工艺,制备了4种医用防护服面料,对其洗涤前后的外观、防护性能、舒适性和力学性能进行了测试和分析。结果表明:以涤棉混纺机织物为外层面料而制备的防护服面料,经20次洗涤后依然具备良好的防护性能、穿着舒适性能和力学性能,可满足医用防护服面料耐洗涤性的要求。

两性离子材料在生物化工领域的应用

两性离子材料是一类具有相同数量阳离子和阴离子官能团、整体呈电中性的材料。两性离子聚合物能够通过与水分子之间形成超强水化层抵抗蛋白质等污染物的表面吸附,因此具有突出的抗污特性。此外,两性离子材料还具有黏附性、抗冻性、药物增溶性、离子选择性等性能,已广泛应用于生物医药、工业生产等领域。本文首先总结了两性离子材料的抗污特性,介绍其在抗蛋白、抗细菌、抗病毒吸附方面的应用,接着以医用传感器、药物递送和分离膜为生物化工领域的代表方向,介绍两性离子材料的抗污及其他应用,最后讨论了发展两性离子材料存在的问题与挑战,展望了两性离子材料作为一类新型功能化材料的应用前景。

2022年中国体外生命支持医疗质量控制报告

体外膜氧合(ECMO)是一项心肺辅助技术,用于部分或全部替代心肺功能。我国自21世纪初开始应用ECMO支持,目前正处于发展阶段。2021年,国家心血管疾病医疗质量控制中心专家委员会成立体外循环与体外生命支持专家工作组,在《2021年中国心血管疾病医疗质量报告》中首次纳入体外生命支持相关内容,在《2021年中国体外生命支持医疗质量控制报告》中汇报2020年体外生命支持质量控制工作。本年度体外循环与体外生命支持专家工作组基于2021年全国医疗质量监测数据,整理发布《2022年中国体外生命支持医疗质量控制报告》,分析并展现我国体外生命支持专业的医疗服务资源、能力,为帮助各级中心全面了解我国体外生命支持工作形势以及提高科学化、精细化管理水平提供数据支持。

雷根平教授治疗特发性膜性肾病经验撷菁

[目的]总结雷根平教授治疗特发性膜性肾病的经验。[方法]通过跟诊学习,整理分析典型病案,并参阅相关文献,结合雷教授临证时所谈所述,从病因病机、辨证论治、遣方用药三个层面总结其治疗特发性膜性肾病的经验,并附验案加以佐证。[结果]雷教授认为,特发性膜性肾病病性为本虚标实,以脾肾亏虚为本,湿热、瘀血为标,治疗上主张“培、补、固、宣、清、通”六法并施,标本兼治,并自拟芪地固肾方作为基础方剂,经临床检验疗效显著。所举案例辨为脾肾不足、气阴两虚、水湿内蕴证,治以健脾补肾、益气养阴、活血利水,以芪地固肾方为基础方。患者大量蛋白尿,平素情绪易怒易躁,且有高脂血症病史,遂以“活血化瘀”之法贯穿治疗始终,全方“阴阳双补”且以补阴为主,随症加减,用药灵活,治疗1年余尿蛋白显著减少,水肿、失眠及气喘等症状均明显改善。[结论]雷教授临床辨治特发性膜性肾病,以益肾健脾、清利湿热、活血化瘀为总治则,思路清晰,用药灵动,组方精良,疗效显著,值得借鉴。

基于多中心疾病登记系统的膜性肾病中医主要证型分布特征分析

【目的】分析特发性膜性肾病(IMN)患者临床诊疗数据,探讨IMN患者中医证型分布特征及影响因素,以期丰富对IMN中医证型的认识,为研究IMN的主要病机和中医临床诊治提供一定依据。【方法】基于IMN临床研究电子数据采集系统,采用横断面调查方法,分析多中心来源的187例IMN患者的临床诊疗数据,归纳其中医证型分布规律;根据IMN的危险分层将患者分为低风险组、中风险组、高风险组3组,并根据地域将患者分为广东组和黑龙江组2组,分析不同IMN的危险分层及地域对中医证型分布特征的影响。【结果】(1)中医证候分布情况:187例患者中,分布频率居前3位的分别为:小便混浊或有明显泡沫尿167例(89.30%),舌苔腻、舌胖大或齿痕158例(84.49%),水肿134例(71.65%);中医证型分布情况:湿阻证频次最高,共169例(90.37%),其次为气虚证165例(88.24%)、血瘀证89例(47.59%)。(2)分组情况:187例患者中,低风险组102例(54.54%)、中风险组54例(28.88%)、高风险组31例(16.58%);广东组147例(78.61%),黑龙江组40例(21.39%)。(3)IMN证型分布的影响因素中,在IMN的危险分层方面,低风险组患者中湿阻证的占比为83.33%(85/102),中风险组为98.15%(53/54),高风险组为100.00%(31/31),3组患者的湿阻证比例比较,差异有统计学意义(P=0.002);在地域方面,广东组和黑龙江组的瘀血证比例分别为55.10%(81/147)和20.00%(8/40),不同地域的血瘀证比例比较,差异有统计学意义(P<0.001);在兼夹证型方面,高风险组的气虚血瘀湿阻证比例[64.52%(20/31)]明显高于低风险组和中风险组的34.31%(35/102)、38.89%(21/54);广东组的气虚血瘀湿阻证比例[46.94%(69/147)]明显高于黑龙江组的17.50%(7/40),而气虚湿阻证比例[31.97%(47/147)]明显低于黑龙江组的60.00%(24/40),差异均有统计学意义(P<0.05)。【结论】本研究归纳和分析了IMN患者的中医证候、中医证型分布规律及其影响因素,探讨了湿证在IMN疾病发生中的关键作用,这对于进一步揭示湿证内涵、促进IMN中医证候研究具有重要意义。

飞行员黄斑前膜一例病例报告并文献复习

目的探讨飞行员患黄斑前膜(epiretinal membrane,ERM)的发病机制、临床特点、诊断与治疗,分析黄斑前膜与飞行的关系,探讨飞行员黄斑前膜航空医学鉴定问题。方法分析1例黄斑前膜飞行员的临床资料及复习相关文献。结果本例黄斑前膜起病无明显诱因及相关性眼病,起始症状、体征不明显。入院前约半年时间感觉视物轻微变形,未引起注意,此次疗养体检时不经意间提及视物变形症状。做光学相干断层扫描(optical coherence tomography,OCT)及眼底荧光血管造影(fundus fluorescence angiography,FFA)检查,确诊为黄斑前膜。经3个月的地面观察后复飞,限双座,健康等级乙,并每半年复查一次。1年半后再复查时黄斑前膜已自行剥离,视物变形症状消失,结论为飞行合格,健康等级甲。结论黄斑前膜早期症状轻微,不易察觉,需尽早做出诊断,避免误诊。

聚乙烯醇水溶膜的研究进展

聚乙烯醇(PVA)水溶膜具有良好的水溶性和生物降解性,同时具有优良的力学性能、气体阻隔性、透明性、抗静电性、耐有机溶剂性等,是一种新型的绿色环保包装材料,应用领域十分广泛。详细介绍了PVA水溶膜的环境友好性、可调节水溶性、气体阻隔性、抗静电等诸多优良特性;重点概述了溶液流延、湿法熔融挤出吹塑、干法熔融挤出吹塑生产工艺;另外,介绍了PVA水溶膜在重点领域的国内外应用现状,并对其广阔的发展前景进行了展望。

医用壳聚糖膜的性能及用途

为对医药领域开发和研制壳聚糖膜提供一些借鉴,综述了壳聚糖膜可以应用于医药领域的优良性能:易降解性、生物相容性、促创伤愈合性、抗菌性和药物缓释性;以及壳聚糖膜剂的一些医药用途,有人工肾膜、人工皮肤、口腔溃疡膜、牙周GTR膜、不同给药途径药膜等。