体外膜肺氧合在治疗肺损伤所致呼吸窘迫综合征中的应用效果

急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）是指心源性之外的各种肺内、外致病因素导致的急性进行性呼吸衰竭，主要病理特征是肺微血管通透性增加，富含蛋白质的液体渗出，进而出现肺水肿和透明膜形成，可伴有肺间质纤维化。病理生理改变以肺容积减少、肺顺应性降低和严重通气／血流比例失调为主。

眶周骨折患者术后生活质量评估

目的:利用患者术后调查问卷的结果数值(PROM)评估接受切开复位内固定术治疗的鼻眶筛骨骨折和其他中面骨折患者的生活质量。方法:统计2016~2019年间眶周骨折患者50例,根据年龄、性别、损伤外因等进行分类,以术后问卷调查的形式随访,所得结果进行数据分析。结果:交通事故其中最常见的因素26%,其次为机动车事故20%,不慎跌倒占18%,被他人打伤占12%。患者以50~57岁男性居多约占30%,其次为18~25岁(20%)和42~49岁(20%)。男女比例约为3.2:1,最常见的并发症为颅脑损伤,其次为眶下区麻木,最后为不同程度视力下降。结论:及时的手术对眶周骨折的并发症有一定的改善作用,可以提高患者的术后生活质量。

PDCA循环管理在ICD编码质量管理中的应用

目的探索PDCA循环管理在国际疾病分类(international classification of dis eases,ICD)编码质量管理中的应用价值。方法选取2020年10月—2021年8月湛江中心人民医院收治的8000例出院病案首页疾病分类编码以及手术操作编码作为本次研究对象,对其进行核对、检查等,并用在ICD编码工具,开展PDCA循环管理,比较管理效果。结果管理后病理诊断漏编、损伤以及重度外因编码遗漏、手术操作编码错误等问题低于管理前,差异有统计学意义(P<0.05);管理后的ICD编码质量评分高于管理前,差异有统计学意义(P<0.05)。结论在ICD编码质量管理中应用PDCA循环管理,可以明显降低诊断选择错误、病理诊断漏编、损伤以及重度外因编码遗漏、手术操作编码错误等发生率。

抗结核药物有害效应诊断编码及其外因编码探讨

抗结核药物种类繁多,多存在有害效应。常见有害效应有神经系统反应、肝功能损害、胃肠道反应、血液循环系统障碍、心功能异常、肌肉骨骼系统反应、皮疹和听力、视力下降等。在ICD-10中,抗结核药物有害效应外因编码多以药物名称作为主导词进行查询,若药物名称无法直接查询,则以药物类别,即抗分枝杆菌药或抗生素作为主导词进行查询。对于多种抗结核药物同时作用导致的有害效应,若多种药物均为同一类别药物,则以药物类别作为主导词进行查询;若是异烟肼和利福平导致的有害效应,则编码于Y40.6利福霉素类的有害效应;若是其他抗分枝杆菌药和全身性抗生素导致的有害效应,则需要对抗分枝杆菌药和全身性抗生素的有害效应外因分别编码。在编码实践中应注意区分有害效应与中毒的概念差异,明确中毒的类型。在实际工作中编码员应加强病案内容阅读,积极与临床医师沟通,准确填写抗结核药物有害效应及其外因编码。

Upregulated gene expression of local brain-derived neurotrophic factor and nerve growth factor after intracisternal administration of marrow stromal cells in rats with traumatic brain injury

Objective: To examine the effects of rat marrow stromal cells (rMSCs) on gene expression of local brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) after injection of rMSCs into Cistern Magnum of adult rats subjected to traumatic brain injury(TBI).Methods: A modified Feeney’s TBI model was created in 48 adult rats. rMSCs were harvested from 3-month-old rats, and injected into Cistern Magnum in 24 rats subjected to TBI(Group cell transplantation). Saline was given through Cistern Magnum to another 24 rats subjected to TBI (Group saline control). Animals were sacrificed 1, 2 and 3 weeks after intervention, and special brain tissue blocks were dissected for total RNA extraction from each block. BDNF and NGF mRNA were reverse-transcribed into cDNA and further expanded by polymerase chain reaction (PCR). The expression of target genes was evaluated using semi-quantitative methods. Results: Group cell transplantation had higher BDNF and NGF gene expressions than Group saline control during a period of less than 3 weeks (P< 0.05).Conclusions: rMSCs transplantation via Cistern Magnum in rats subjected to traumatic brain injury can enhance expressions of local brain NGF and BDNF to a certain extent.

Analysis on the risk factors of intracranial infection secondary to traumatic brain injury

Objective： To discuss the characteristics and risk factors for intracranial infection post traumatic brain injury to prevent and better the clinical care. Methods： Retrospective study of 520 patients with traumatic brain injury were included, 308 male and 212 female. The risky factors of intracranial infection were identified. Results： Thirty two cases （6.54%, 321520） of intracranial infection were diagnosed, lntracranial infection most likely happened 4-10 days after injury. Cerebrospinal fluid leakage, drainage, multiple craniotomies were significant related to intracranial infection. Logistic regression predicted cerebrospinal fluid leakage and drainage as independent factors. Conclusion： Intracranial infection is a serious complication after traumatic brain injury, Patients with drainage or cerebrospinal fluid leakage are more risky for intracranial infection, Aggressive precaution should be taken to better outcome.

Tie2 mRNA in peripheral blood： a new marker to assess damage of endothelial cells in a rat model of sepsis

Objective： To evaluate the endothelial cell damage by detecting the circulating Tie2 mRNA level in a rat model of sepsis. Methods： The model of sepsis was established by cecal ligation and puncture （CLP） in 90 rats which were divided into 6 groups： normal, sham, CLP-3 h, CLP-6 h, CLP- 12 h and CLP-24 h. Serum biochemical markers were detected by automatic biochemical analyzer. Serum IL-6 was measured with enzyme linked immunosorbent assay. The vascular permeability of liver, kidney, lung and heart was detected with Evans blue. Circulating endothelial cells （CEC） were separated using density gradient separation and counted. Total RNA of whole blood were extracted and the mRNA levels of two endothelial specific genes, Tie2 and vascular endothelial growth factor receptor 2 （VEGFR2）, were measured by quantitative real-time PCR. Results： The level of serum biochemical indexes increased after CLP. The amount of serum IL-6 in CLP-6 h, 12 h,and 24 h group was increased 6.5-fold （P〈 0.05）, 8.4-fold （P〈 0.01 ）, and 13.3-fold （P〈0.001 ） compared with normal group （ 170.68 pg/mli42.46 pg/ml） respectively （F= 14.319, P〈0.001）. Significantly increased organ vasopermeability of liver, kidney, lung and heart was observed after CLP respectively. The number of CEC peaked （11.83±1.94） 3 hours after CLP compared with normal control （5.33±1.21, P〈0.05）, and then decreased gradually （F=54.183, P〈0.001）. The mRNA level of Tie2 in CLP-3 h group （3.47±1.47） was also markedly higher than that in other groups （F=10.640, P〈0.001 ）. Conclusion： Using quantitative real-time PCR to measure the level of Tie2 mRNA in peripheral blood is a simple and relatively sensitive method to evaluate the damage of endothelial cells.

Effects of moxibustion pretreatment on extracellular signal-regulated kinase signaling transduction pathway in the gastric tissues of rats with gastric mucosal damage

Objective： To observe the effects of moxibustion pretreatment on the protein expressions of epidermal growth factor receptor （EGFR）, phosphorylation extracellular signal-regulated kinase I/2 （p-ERKI/2） and activated protein-1 （AP-2）, the key factors of extracellular signal-regulated kinase signaling transduction pathway in gastric tissue of rats with stress-induced gastric mucosal damage, and to discuss the mechanisms of moxibustion therapy in promoting the restoration of damaged gastric mucosa. Methods： Thirty Sprague-Dawley （SD） rats were randomly divided into a normal group, a model group, and a moxibustion group using the random digits table, 10 in each group. Except the rats in the normal group, rats in the other two groups were used to make stress-induced gastric mucosal damage model using restraint and cold stress. Before modeling, rats in the moxibustion group were alternately treated with moxibustion a/t Zusanli （ST 36） and Zhongwan （CV 12）, or Pishu （BL 20） and Weishu （BL 22）, once a day, for a total of 8 d. Histolo^cal changes of gastric mucosa were observed under the light microscopy, the expression of gastric tissue p-ERKI/2 was detected by immunohistochemistry assay, and the protein levels of EGFR and AP-I were measured by Western blots. Results： Compared with rats in the normal group, gastric mucosal damage was more serious, and protein expressions of gastric tissue EGFR, p-ERK1/2 and AP-1 increased in the model group （P〈0.01, P〈O.05, P〈0.05）. Compared with rats in the model group, gastric mucosal damage was milder, and protein expressions of gastric tissue EGFR, p-ERK1/2 and AP-1 increased in the moxibustion group （all P〈0.01）. Conclusion： Moxibustion at Zusanli （ST 36）, Zhongwan （CV 12）, Pishu （BL 20） and Weishu （BL 21） could increase EGFR, p-ERK1/2 and AP-1 expression levels in gastric tissue of stress-induced gastric mucosal damage rats, maintain the information transfer function of ERK signaling transduction pathway, and promote restoration of gastric mucosal damage.

Nanoparticle mediated controlled delivery of dual growth factors

Peripheral nerve functional recovery after nerve injury generally requires multiple growth factors by synergistic effect.However,the optical combination of multiple synergistic growth factors for axonal regeneration has been scarcely considered up to now.Meanwhile,the use of growth factors in promoting nerve regeneration was limited by its short biological half-life in vivo,its vulnerability to structure disruption or hydrolyzation,leading to loss of bioactivity.Herein,a novel polymeric nanoparticle delivery system composed of heparin andε-poly-L-lysine(PL)was prepared for control release of nerve growth factor(NGF)and basic fibroblast growth factor(bFGF).The nanoparticles were synthesized by polyelectrolyte complexation in aqueous solution at room temperature,followed by cross-linking with biological genipin.The obtained nanoparticles had a spherical shape,with a mean diameter of about 246 nm,and high growth factors encapsulation efficiency as well as good stability.NGF and bFGF were encapsulated in the nanoparticles and showed a continuous and slow release behavior in vitro.The bioactivities of the released growth factors were evaluated,and exhibited the synergistic effect.The controlled release of the dual synergistic growth factors would improve the treatment of peripheral nerve injury to mimic the natural cellular microenvironments.