The report of death cases is an important source of information for cause analysis and monitoring of trends, which can reflect the death situation and characteristics of a population in a relatively accurate manner. It helps understand the health status of the population and the level of healthcare. The special deployment of case review for in-hospital deaths is not only the high priority for health authorities in terms of quality and safety of medical care but also a practical implementation of the concept that values people and life. Currently, there is a lack of scientific and standardized evaluation for the review of death cases in various specialties, excluding maternal and neonatal cases. To standardize the quality control and management of death cases in medical institutions, the Guidelines for quality control and management of death cases in medical institutions (2023) has been developed by the Hunan Province Resuscitation Quality Control Center. The members of the working group of this guideline visited medical institutions, conducted research, reviewed relevant guidelines from domestic and international sources, and integrated clinical experience to form a preliminary consensus. This consensus was submitted to the expert group for multiple discussions, underwent several revisions, and finally, it was sent to the experts in the form of a questionnaire for feedback. The guidelines clarify the scope, data collection, and quality control requirements for death case quality control, providing a reference for the quality control and management of death cases in medical institutions.
Hemorrhagic diseases are common clinical diseases characterized by abnormal hemostasis or coagulation mechanisms caused by various reasons, which seriously threaten the life safety of patients. Rapid and accurate diagnosis, as well as timely and appropriate treatment, are crucial for improving clinical outcomes. This consensus aims to comprehensively evaluate the critical state of patients with hemorrhagic disease from multiple perspectives, such as laboratory, radiographic, and ultrasound examinations. Through the compilation of relevant literature and wide-ranging expert opinions, a preliminary expert consensus on critical values of hemorrhagic diseases has been formulated to help optimize clinical care for these patients.
脓毒症引起的心血管功能障碍或心肌病是脓毒症患者病死率增加的主要原因之一.研究表明,脓毒症心肌病病死率高达70％,且脓毒症幸存者也存留心血管事件的高度危险性.脓毒症导致心肌纤维化加剧心肌功能障碍,影响心脏的顺应性以及收缩舒张等功能,进而促进充血性心力衰竭的发生.microRNAs(miRNAs)是近年来发现的内源性、小编码RNA,通过调节转录后的基因表达,影响相关通路蛋白表达水平,在预防与阻断脓毒症MF中起到重要作用.本文试总结前人关于miRNAs的相关研究结果,为临床上防治脓毒症心肌纤维化提供理论依据.
脓毒症的病理生理机制复杂,是严重感染引起的机体反应失调和免疫紊乱而导致的多器官功能障碍.尽管采取积极的治疗措施,脓毒症的病死率仍居高不下.间充质干细胞衍生的细胞外囊泡可调节脓毒症的免疫反应,在脓毒症脏器功能保护方面发挥重要作用.因此,本文对脓毒症的免疫紊乱机制及MSC-EVs在脓毒症中的免疫调节作用进行综述.
目的 探讨大黄素对脓毒症大鼠肝细胞线粒体水通道蛋白8(AQP-8)表达的影响.方法 成年雄性SD大鼠96只,分为4组:对照组、脓毒症组、预处理组、治疗组,每组24只,采用盲肠结扎穿孔法构建脓毒症大鼠模型,对照组探查盲肠后回纳腹腔.预处理组、治疗组采用大黄素悬浊液连续喂养5d,治疗组大鼠建模2h后腹腔内注射大黄素.18h后随机每组处死12只大鼠,采集标本,剩余12只大鼠观察生存时间.生化分析仪测定外周血ALT、AST、m-AST含量;ELISA法测定外周血IL-1β、IL-6、TNF-α、HMGB-1、NO含量;肝组织行ATP含量测定,肝细胞线粒体膜Na+-K+-ATP酶、Mg+-ATP酶、Ca2+-ATP酶、Ca2+-Mg2+-ATP酶的活性测定;RT-PCR法测定线粒体内膜AQP-8mRNA含量,蛋白免疫印迹法测定AQP-8蛋白水平.结果 对照组、预处理组和治疗组大鼠存活时间较脓毒症组长(P＜0.01);与对照组相比,脓毒症组血清ALT、AST和m-AST水平显著升高,肝细胞ATP含量显著降低,肝细胞线粒体膜ATP酶活性、肝细胞线粒体AQP8mRNA和AQP8蛋白表达量明显下降(P＜0.01).与脓毒症组相比,预处理组和治疗组血清ALT、AST和m-AST水平显著升高,肝细胞ATP含量显著降低,肝细胞线粒体膜ATP酶活性、肝细胞线粒体AQP8 mRNA和AQP8蛋白表达量明显上升(P＜0.01),预处理组和治疗组间无差异(P＞0.05);与对照组相比,脓毒症组血清IL-1β、IL-6、TNF-α、HMGB-1、NO含量明显上升(P＜0.01);与脓毒症组相比,预处理组和治疗组血清IL-1β、IL-6、TNF、HMGB-1、NO含量明显下降(P＜0.01),预处理组和治疗组间无差异(P＞0.05).结论 脓毒症可以导致肝细胞线粒体膜AQP8 mRNA和蛋白表达下降.大黄素可以上调脓毒症大鼠肝细胞线粒体膜AQP8 mRNA和蛋白的表达,延缓大鼠CLP手术后出现脓毒症症状的时间,延长脓毒症大鼠的生存时间.
