The effect of coupled haemofiltration and adsorption on inflammatory cytokines in an ex vivo model.

BACKGROUND: The objective of this study was to evaluate the ex vivo removal of cytokines with an extracorporeal circuit using coupled large-pore haemofiltration and sorbent adsorption. METHODS: The setting for this study was a laboratory attached to the Intensive Care Unit of a tertiary hospital. Six healthy volunteers donated blood, which was incubated with endotoxin. Control blood was left at room temperature. Treatment blood was recirculated for 6 h through a closed circuit with a large-pore polysulfone haemofilter (average pore size 150 kDa) and an activated charcoal cartridge. Blood and ultrafiltrate were sampled hourly from three sites (pre-haemofilter for the circulating concentration, at cartridge inlet and cartridge outlet) to measure the concentrations of interleukins (IL)-1beta, -6, -8 and -10, and tumour necrosis factor (TNF). RESULTS: Control cytokine concentrations remained the same or increased slightly. Most of the preformed circuit cytokines were removed, with the exception of IL-10. The average sieving coefficients were 0.61 for IL-1beta, 1.34 for IL-6, 0.30 for IL-8, and 0.56 for TNF. Average single-pass clearances were 49, 107, 24 and 45 ml/min, respectively. The cartridge adsorbed 90% of IL-1beta, 72% of IL-6, 100% of IL-8, and 7% of TNF during each pass. CONCLUSION: The combination of a large-pore haemofilter and charcoal cartridge removed several cytokines efficiently under ex vivo conditions. This technique can now be tested for cytokine removal in vivo.     

Opacification of refractive bifocal intraocular lens in one month: Three case reports

Rationale:Multifocal intraocular lenses (IOLs) are used widely. However, the discovery of LS-313 MF15/30 (Oculentis B.V.) opacity during surgery has not yet been reported. This article reports 3 cases of LS-313 MF15/30 (Oculentis B.V.) IOL opacity found during cataract surgery implantation within 1 month.Patient concerns:Three patients underwent cataract surgery, and opacification of their IOL (LS-313 MF15/30, Oculentis B.V.) was found intraoperatively.Diagnosis:The patient was diagnosed with a postoperative intraocular opacity.Interventions:In case 1, the surgeon scrubbed the IOL with intraocular perfusion fluid and a gelatin sponge swab to reduce opacity in the central optical area of the IOL and then implanted it into the capsule bag. In case 2, the surgeon used the infusion-aspiration polishing mode for cleaning. To avoid IOL wear and bag damage, washing was stopped when turbidity in the center of the optical area was reduced. In case 3, we learned from our previous experience that the surgeon cut the IOL into 2 pieces and moved it out at the main incision, which was replaced and implanted with a brand new IOL, after the implanted IOL was again found cloudy.Outcomes:In case 1, more than 10 months after the surgery, the IOL was restored to transparency, no obvious eye discomfort was noted, and uncorrected visual acuity was 20/25. In case 2, the patient''s IOL surrounding area was still partially turbid after more than 10 months of follow-up. In case 3, the patient''s uncorrected visual acuity on postoperative day 1 was 20/20, and the best-corrected visual acuity was 20/20.Lesson:There are many reasons for the opacification of the IOL. In addition to the patient''s own factors, the material, production, and packaging of the IOL, as well as the influence of external environmental temperature, the influence of the IOL implant instrument should not be ignored and needs to be considered.     

固相萃取形式应用概况

固相萃取作为一种新发展起来的预处理技术,近年来得到了广泛的重视.本文分别介绍了固相萃取的三种形式:固相萃取柱、固相萃取盘和固相微萃取的原理及其在药物分析和其他方面的应用情况.     

舱室内外爆炸伤复合失血致休克大鼠伤情特点研究

目的探索研究舱室内外爆炸伤后复合失血致休克大鼠不同的伤情特点。方法模拟战时装甲车密闭舱室,将200～220g大鼠根据随机数字表法分为舱内组、舱外组、纯失血性休克组3组。观察时间均为致伤后270min。用数据采集系统记录压力变化并通过Origin7.0进行滤波和分析处理。观察各组死亡率、平均动脉压变化和病理改变。于爆炸后30、90、150、210min检测动脉血气,计算肺含水率。结果与舱外组相比,舱室内爆炸冲击波压力持续时间达3倍以上,压力峰值高,反射波高,具有复杂波的特点。舱内组死亡率为53.8%,高于舱外组死亡率38.5%,而舱外组死亡率高于对照组(P0.05)。大鼠爆炸伤同时放血致休克后,舱内组平均动脉压一直低于40mmHg,舱外组于爆炸后210min以前平均动脉压高于60mmHg,之后迅速下降,2组平均动脉压在爆炸后30、150、210min存在显著差异(P0.05)。舱内组肺含水率在炸后270min明显高于舱外组(P0.05),病理观察见舱内组肺组织损伤重,肺泡萎陷,组织间隙大量红细胞堆积,炎性细胞浸润,肺间隔增宽。动脉血氧饱和度(SaO2)、动脉氧分压[p(O2)]在舱内组低于舱外组,而红细胞压积(Hct)及乳酸(LAC)在舱内组高于舱外组(P0.05)。结论复杂冲击波作用下,舱室内爆炸伤大鼠脏器损伤程度重,代偿能力较开阔地爆炸伤后失血休克大鼠弱,休克发生时间早,程度重,大鼠死亡率高。     

Bye bye chemical desinfection with canisters

This paper describes and evaluates disinfection techniques of dialysis monitors available in our dialysis unit. We demonstrate disinfection techniques with regards to the risk of human error. To achieve a high hygienic standard and to support the safety and efficiency of each disinfection procedure, we emphasise the use of single‐use‐disinfection cartridges.     

封闭式管理新生儿科患儿入院时对家属实施健康教育与评价

目的探讨新生儿科封闭式管理病房在入院时对患儿家属实施健康教育的效果。方法随机选取80例入住新生儿科封闭式管理病房的患儿家属为研究对象,比较开展健康教育前后家属焦虑程度的变化。结果健康教育后家属的焦虑程度较健康教育前显著降低(P<0.05)。结论对封闭式新生儿科家属及时开展健康教育,可减轻其心理压力,消除误解,增加其对护士的理解、信任、配合及合理的依从性,减少医患矛盾,使治疗方案及护理计划顺利落实、护理质量得到提高。     

The Effect of Direct Hemoperfusion with a Polymyxin B-Immobilized Fiber Column (DHP-PMX Therapy) on Pulmonary Ischemia-Reperfusion Injury in a Canine Model

This study evaluates the effectiveness of direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX therapy) on warm ischemia-reperfusion injury of the lung using a canine mode.

Materials and Methods: Ten adult mongrel dogs weighing 13–16 kg were used. After a left thoracotomy, the left pulmonary artery and vein were clamped. The left main bronchus was also clamped and then divided, and complete ischemia of the left lung was maintained for 3 h. The left main bronchus was re-anastomosed before reperfusion of the left lung. The right pulmonary artery was ligated immediately after reperfusion of the left lung. The dogs were divided into two groups: the DHP-PMX group (n = 5, DHP-PMX was performed for 120 min, from 30 min before reperfusion to 90 min after reperfusion) and the control group (n = 5). The body temperature of the animals was maintained at 36°C–37°C during the experiment. The PaO₂/FiO₂ (P/F ratio), AaDO₂, and lt-pulmonary vascular resistance (PVR) were measured at 30, 60, 120, 180, and 240 min after reperfusion in both groups, and the two groups were compared. The water content of the lung tissues and histopathology was also analyzed. Results: The P/F ratio decreased remarkably after reperfusion in the control group, and was significantly (p <. 05) lower than that in the PMX-DHF group until 240 min after reperfusion. The AaDO₂ was significantly (p <. 05) lower in the DHP-PMX group than in the control group at 30, 60, and 120 min after reperfusion. The lt-PVR level differed significantly (p <. 05) between the two groups until 240 min after reperfusion. The water content in the control group was significantly (p <. 05) higher than that in the DHP-PMX group at 240 min after reperfusion. Lung tissues at 120 and 240 min after reperfusion were better preserved pathologically in the DHP-PMX group. Conclusion: DHP-PMX therapy reduced warm ischemia-reperfusion injury in the lung using a canine model.     

便携式智能快速输血输液装置的泵体设计

目的:便携式智能快速输血输液装置以其独特的泵体设计,解决了传统输血输液泵功耗、重量与体积过大,需要交流供电,无法在野外使用的问题。方法:该泵体由集单向阀双泵管、空气消除膜片技术与阻抗探测电极于一体的输血输液板总成,微电机直线驱动机构组成。整个装置,体积99mm×60mm×45mm,重250g。结果:样机实验结果证明,使用该装置,六节7#干电池可以在最高控制流量(6L/h)下,连续运行8～10h;结论:输液袋(瓶)可置于人体的任何位置,甚至可置担架以下合适部位,进行快速精确、安全可靠静脉输液。     

小儿肾病综合征60例护理体会

目的：探讨Ⅳ期压疮治疗中功能锻炼的地位及应对方法.方法：对我科Ⅳ期压疮的病人进行功能锻炼的时机和方法.结果：Ⅳ期压疮治愈率88%,肢体康复47%,能下地活动60%,能坐轮椅40%.结论：通过本组病例的护理,认为功能锻炼对Ⅳ期压疮的治疗起到良好的辅助作用（应用封闭式负压引流的观察护理）.