小儿心脏术后急性呼吸窘迫综合征的预防及治疗

为探讨小儿心脏术后急性呼吸窘迫综合征（ARDS）的临床发病特点及治疗对策,对23例ARDS患儿（包括早期发病8例、迟发15例）采用：①限制吸气峰压≤35cmH2O(3.43kPa);②早期应用呼气末正压（PEEP）8-12cmH2O(0.78-1.18kPa);③反复性侧卧体位等措施。结果23例中1例（1/23）继发感染、急性肾功能衰竭死亡;并发气胸2例（2/23）;严重肺不张3例（3/23）;痰培养阳性5例（5/23）。结果显示：对ARDS高危患儿应慎重选择早期拔管指征;对诊断明确者应用低容量限压通气配合体位变换可减少并发症、提高治愈率。     

充血性心力衰竭治疗前后内皮素，肿瘤坏死因子和血管紧张素转化酶含量比较

目的探讨充血性心力衰竭(CHF)患儿不同心功能级数及分组治疗前后血浆ET、TNF和ACE含量的变化及其意义。方法用放免法和比色法分组测定充血性心力衰竭(CHF)80例患儿血中ET、TNF和ACE含量的变化。结果80例CHF患儿中血中ET、TNF和ACE含量分别为(141.33±8.56)ng/L、(168.25±35.14)ng/L和(429.45±61.33)IU,与正常对照组比较均明显升高(P＜0.05);心功能Ⅱ级与心功能Ⅲ级、心功能Ⅳ级TNF、ET含量间比较均有显著性差异(P＜0.05～0.01),相关有显著性意义;不同心功能级数CHF患儿血浆TNF、ET和ACE含量治疗后较治疗前明显降低,均有显著性差异(P＜0.05～0.01),而且心功能越差,血浆TNF、ET水平恢复越慢,洛汀新组心功能改善较常规组明显,两者含量间比较有显著性差异(P＜0.05)。结论血浆ET、TNP和ACE含量的测定有助于判断心力衰竭的程度,洛汀新组的疗效明显优于常规组。     

磁性阿霉素白蛋白纳米粒的研制

目的：制作具有稳定磁性、能够携带化疗药物的白蛋白纳米粒,并对白蛋白纳米粒的磁性,药物含量进行检测。方法：将市售用Fe3O4粉末,经化学方法处理,制成纳米大小的Fe3O4泥糊,将Fe3O4泥糊、纯盐酸阿霉素、人体血清白蛋白按一定比例混合,通过在棉仔油中超声乳化,加热变性、乙醚洗涤等工艺制作出磁性阿霉素白蛋白纳米粒,用乙醇提取法提取磁性纳米粒中的阿霉素,并用荧光光度计测定含量。将纳米粒溶于生理盐水中,在光学显微镜下观察在磁场作用下磁性纳米粒的运动情况,通过检测溶液中的游离药物,观察在不同的加热温度下,磁性纳米粒的稳定性,并用电子显微镜观察纳米粒的内部结构。结果：磁性白蛋白纳米粒阿霉素含量为57．5μg/g,阿霉素包含率为98．3％,磁性白蛋白纳米溶液在光学显微镜下观察,在磁场的作用下,纳米粒迅速向磁铁的方向移动并发生聚集,当磁铁与纳米粒的距离加大时,纳米粒运动速度减慢,并沿磁力线的方向形成串珠状聚集。电子显微镜下观察,Fe3O4颗粒均匀分布在白蛋白纳米粒中,结论：磁性白蛋白纳米粒具有磁性稳定、靶向性强、药物包含率高、释药速率可控制的特点,为靶向药物治疗提供了可靠的载药工具。     

切开髌内侧支持带翻转髌骨治疗髌骨严重粉碎性骨折

目的 :探讨一种治疗髌骨严重粉碎性骨折的新途径。方法 :本组对髌骨严重粉碎性骨折均采用缝合髌前筋膜 ,切开髌骨内侧支持带 ,将髌骨翻转进行直视下复位固定的方法治疗 32例。结果 :随访时间为 6～ 18个月 ,平均随访 13.5月 ,伤口均一期愈合 ,骨折愈合时间为 1～ 2个月。膝关节康复后的平均总活动度为 12 5°。结论 :本入路治疗髌骨严重粉碎性骨折具有简捷、可靠 ,可最大限度保留髌骨完整性的优点     

Establishment of in vitro cellular model predicting histocompatibity in allograft

Histocompatibility is crucial in effecting survivalof allografts.Due to differences in histocompatibilitybetween donor and recipient,rejection would happento some extent after transplantation. Therefore,theevaluation of differences in histocompatibility betweendonor and recipient would be contributive to selectionof donor and judgement on prognosis oftransplantation. HLA typing and mixed lymphocyticreaction (MLR) are the classical methods to evaluatethe histocompatibility between donor and r…     

Deregulated microRNA-22-3p in patients with sepsis-induced acute kidney injury serves as a new biomarker to predict disease occurrence and 28-day survival outcomes

Background

Acute kidney injury (AKI) is a common and serious complication of sepsis. MicroRNA-22-3p (miR-22-3p) has been found to be involved in septic AKI progression. The purpose of this study was to analyze both the serum and urinary expression of miR-22-3p in septic AKI patients, and evaluated the clinical value of miR-22-3p in the diagnosis and prognosis of sepsis-induced AKI.

Methods

Serum and urinary expression of miR-22-3p was examined using qRT-PCR. The risk factors related with septic AKI onset were assessed using logistic analysis. A receiver-operating characteristic (ROC) curve was constructed to evaluate the diagnostic performance of miR-22-3p, and the Kaplan–Meier survival curves and Cox regression analysis were used to evaluate the predictive value of miR-22-3p for the 28-day survival of septic AKI patients.

Results

Both serum and urinary miR-22-3p expression was decreased and negatively correlated with kidney injury biomarkers in septic AKI patients. MiR-22-3p expression was a risk factor for AKI onset and had diagnostic accuracy in septic AKI patients. The expression of both serum and urinary miR-22-3p was lower in patients who died, and served as a prognostic biomarker to predict 28-day survival in septic AKI patients.

Conclusion

Serum and urinary miR-22-3p was reduced in sepsis-induced AKI patients, and served as a biomarker to predict AKI occurrence and 28-day survival in sepsis patients.

     

Hand grip strength as a predictor of recovery from low back pain in the pregnant women-a prospective study

BackgroundLow back pain (LBP) is a common musculoskeletal problem during pregnancy with an estimated prevalence ranging from 30% to 78%. The symptoms usually disappear gradually after delivery, but some women may have persistent problems even later in their lives. The definite mechanism behind LBP during pregnancy remains unknown. Therefore, the purpose of this study was to investigate whether hand grip strength (HGS), which is a straightforward and reliable indicator of overall muscle strength, is associated with unrecovered LBP after delivery.Methods257 pregnant women who registered at obstetrics units in two tertiary hospitals from January 2016 to June 2017 and meanwhile suffered the LBP during pregnancy were included. They were grouped based on whether they recovered from LBP after delivery (recovery was de?ned as a pain rating of ≤3). The variables such as age, HGS, and education level were recorded and examined for the risk analysis of unrecovered LBP. Also, the Pearson correlation between HGS levels and pain intensities was investigated.ResultsLBP without recovery at two years after delivery was reported among 22.7% of the subjects. Women with increasing age, low HGS (<25 kg), LBP in a previous pregnancy, back pain, sick leave, and a large amount of physical demand (all p < 0.05), were more likely to report LBP without recovery. Besides, there was a significant correlation between HGS values and the intensities of LBP (r = ?0.525; p = 0.003).ConclusionsLow HGS has the highest OR value (adjusted OR = 9.12, P < 0.001) among these factors. The present findings may be used to design and encourage a specific stabilization exercise regime to build well stability of the lumbar spinal column and thus alleviating the LBP.     

心理筛查异常孕妇产后抑郁发生状况及影响因素分析

目的 调查建档产检时心理筛查异常孕妇产后抑郁症状发生情况并分析其影响因素.方法 纳入建档产检时心理筛查异常孕妇681例.根据爱丁堡产后抑郁量表筛查结果判定产妇是否存在产后抑郁症状,采用Logistic回归分析探讨产后抑郁症状的影响因素.结果 681例中出现产后抑郁症状105例(占15.4％).个人精神心理疾病史,孕晚期存在焦虑症状、抑郁症状和焦虑抑郁症状并存是发生产后抑郁症状的危险因素(P＜0.05,P＜0.01).结论 建档产检时心理筛查异常产妇产后抑郁症状发生率不高,提示可能需要重新考虑合适的孕期心理筛查时间点和量表.需重视孕晚期心理筛查异常孕妇和有精神心理疾病史孕妇的跟踪随访,同时提高从业者的心理保健能力,保障心理保健效果.     

肝胆外科智慧化病房建设与应用

目的 介绍智慧化病房系统在肝胆外科的实现机制和运行效果.方法 引进某科技公司开发的智慧化系统建设肝胆外科智慧化病房,通过身份识别机、智慧手环、电子一览表、主班护士信息反馈平板、智慧门禁、医护手机端、护士智能手表、患者床尾屏等,实现护患呼叫、门禁管理、患者动态情况管理、健康教育等功能.结果 提高了医护人员工作效率和改善患者就医服务体验.结论 肝胆外科智慧化病房建设为患者、医生、护士提供了一个可以相互联系的平台,实现三方沟通信息共享,促进了信息化管理的有益尝试.