Objective To introduce a self- assembled adjustable traction frame for the patients with severe trauma and lower limb fracture in ICU, compared with Brawns traction frame. Methods 96 patients with severe trauma and lower limb fracture diagnosed by clinical signs and X-ray who had to be transferred to ICU were randomly divided into the study group (46 cases) and the control group (50 cases) by sealing letters method.The study group were tracted by the self-assembled adjustable traction frame, and the control group were tracted by the Brawns traction frame. The fracture alignment, degree of pain, incidence of pressure ulcers, nursing limit time of changing the sheets of the two groups were observed. Results The results declared that 37 cases with 2 pain score points, 9 cases with 0-1 points in the study group and 19 cases with 2 pain score points, 3 cases with 0-1 points, 28 cases with Grade 3 in the control group (χ2=38.683, P<0.01). In the control group, pressure ulcer were occurred, 5 of them at Level one, 1 of them at Level two, 1 of them at Level three and the incidence rate was 14.00% (7/50). In the study group, pressure ulcer were occurred, 1 of them at Level two and the incidence rate was 2.17%(1/46). The pain level and incidence of pressure sore in the study group were decreased and the difference between the two groups was significant (χ2=8.197, P < 0.05). Conclusions The self-assembly adjustable traction rack can not only ensure the same effect as the Brawns traction frame but also reduce the deficiency caused by Brown traction frame. It is safer and more comfortable for the patients and can reduce nursing complications and improve the quality and efficiency of the nursing work.

OBJECTIVETo construct and identify a lentiviral vector of RNA interference targeting human Notch-1 gene.

METHODSTo determine the Notch-1 gene sequences, three RNAi target sequences (shRNA1-3) were designed in accordance with the RNAi sequence design principles and cloned into the lentiviral vector pLenOR-THM by endonuclease BamH I restriction, EcoR I double digestion, and T4 DNA-ligase ligation. After the transformation into competent DH5alpha bacteria, the candidate clones were identified by Kpn I and EcoR I double digestion and DNA sequencing. The recombinant and three packaging plasmids were co-transfected into human embryonic kidney cell line 293T cells by lipofectamine to produce the lentiviral particles. The viral titer was determined. The 293T cells were infected by the lentiviral particles obtained, and transfection efficiency was assessed using a fluorescent microscope. The lentiviral vector particles were also transfected into ACC-M cells. The Notch-1 expression in the transfected cells was assayed by quantitative reverse transcription polymerase chain reaction (QRT-PCR) and Western blot analysis.

RESULTSThe lentiviral RNAi vector pLenOR-THM-Notchl for Notch-1 gene was constructed successfully. Strong green fluorescence was observed in the 293T cells under fluorescent microscope after co-transfection of the cells with the four plasmids of lentiviral vector. The virus in the supernatant reached a titer of 5.8 x 10(8) TU x mL(-1). The transfection efficiency of the collected virus exceeded 90% in 293T cells with 1 as a multiplicity of infection. The third lentiviral vector was found to significantly inhibit the Notch-1 expression at the mRNA and protein levels.

CONCLUSIONThe lentiviral RNAi vector of Notch-1 has been successfully constructed and identified.

Cell Line ; Genetic Vectors ; Humans ; Lentivirus ; Plasmids ; RNA Interference ; RNA, Messenger ; RNA, Small Interfering ; Receptor, Notch1 ; Transfection

Objective The nano-zirconia scaffolds we previously prepared had a good 3-dimensional ( 3D ) connectivity but did not achieve the ideal sintering rate and compressive strength .The objective of this study was to explore the enhancing effect of polyvinyl butyral ( PVB) as a dispersant on the compressive strength of 3D nano-zirconia porous scaffolds for bone tissue engineering . Methods We prepared the slurry containing different concentrations of PVB and ana-lyzed the improving effect of PVB on the mechanical properties of the scaffolds by sediment experiment , compressive strength test and scan-ning electron microscopy . Results The sediment experiment showed
no significant stratification in the slurry with 0.2wt%PVB, white suspension in the upper layer and white precipitate in the lower layer , with a significantly higher compressive strength of the scaffold ([0.324 ±0.030] MPa) than that of the scaffold prepared by adding other concentrations of PVB to the slurry (P <0.01).And the compressive strength of the scaffold constructed by adding no dispersant ([0.109 ±0.021] MPa) was remarkably lower than that of the scaffold constructed by adding PVB to the slurry (P<0.05).Scanning electron microscopy demonstrated that the scaffold prepared by adding 0.2wt%PVB to the slurry had a complete porous structure with the fewest and most sparsely distributed surface cracks as compared with other PVB concentration groups . Conclusion PVB can signifi-cantly improve the stability of zirconia slurry , enhance the compressive strength of the nano-zirconia porous scaffold , and make the scaf-fold more applicable to bone tissue engineering .

Objective To explore the impact of diagnosis related groups (DRGs) payment and drug zero plus on the management of intensive care medicine department. Methods The clinical data of patients in one year from 2016 to 2017 admitted into the Department of ICU in Liuzhou Worker's Hospital concerning their numbers of discharged patients, transferred patients, bed utilization rate, number of bed turnover, average length of stay of discharged patients, cure and improvement rates, admission and discharge diagnostic coincidence rate, 3-day definite diagnosis rate, clinicopathological diagnosis coincidence rate, rescue success rate, total income, drug proportion, consumable proportion, DRGs payment and settlement data, etc were retrospectively analyzed to explore the dual challenges, DRGs payment and drug zero plus, facing the department and how to respond and deal with them. Results In 2016 and 2017, the total incomes of the department of critical care medicine in our hospital were 42.107 0 million yuan and 41.371 3 million yuan respectively, and the medical insurance incomes were 15.03 million yuan and 16.69 million yuan respectively;in 2016 and 2017, 2 693 patients and 2 922 patients were admitted and treated respectively; 595 patients and 577 patients were discharged respectively, with 2 071 patients and 2 334 patients transferred respectively; the balances of the department were 15.48 million yuan and 29.11 million yuan, respectively. From July to December 2017, the medical insurance DRGs payment data suggested that the proportion of loss of the department be 7.02%. Accelerating the Grade 6 electronic medical records and informationization construction, adopting the severe disease information solution program and fine quality control management in the department of critical care medicine can reduce the cost of manpower. Conclusion Our future development direction in the Department of Intensive Care Medicine includes the following aspects: Open source and reduce expenditure, strictly control the proportions of drugs and consumables, improve the balance of the department, and actively respond and deal with the medical insurance DRGs payment.

Objective To explore the effective strategies of clinical pathway construction in intensive care unit (ICU).Methods From January 2016 to July 2018,1 488 patients were discharged from ICU of Liuzhou Worker's Hospital of Guangxi Zhuang Autonomous Region.The pilot project of "postoperative monitoring of heart disease" with simpler route and less variation was selected first,and then the pilot project was promoted to "post-operative monitoring" after its success.The implementation of the clinical pathway was divided into three stages:the first stage,January 2016 to May 2017,for the pilot phase,a total of 87 patients were enrolled in the clinical pathway trial;the second stage,June 2017 to December 2017,surgical ICU "postoperative monitoring of heart disease" was put into the pathway 111 times;the third stage,January 2018 to July 2018,surgical ICU "postoperative monitoring of heart disease" was entered in the path 116 times;comprehensive ICU "postoperative care" was put into the path 96 times.After carefully analyzed the reasons and sum up the experience,internet+medical treatment (Liuzhou Worker's Hospital became the fifih deep partner of Tencent Inc in the internct+medical field,and carried out the plan and practice of "WeChat wisdom hospital 3.0" in 2017) was used,four aspects of connection,payment,security and ecological cooperation were upgraded,and the construction of 6 level of electronic medical record (EMR) was accelerated.At the same time,through diagnosis related groups system (DRGs),the concept of evidence-based medicine,quality management and continuous improvement as the leading factor,and combined with the construction status of hospital information system (HIS) and EMR system,step by step implementation and design of information management platform for clinical pathway were formulated.The completion rate of clinical pathway,average length of hospital stay,average cost,cure rate and improvement rate were the main observation parameters.Results In the first stage,none of the 87 patients who entered the clinical pathway completed the clinical pathway.In the second stage,the completion rate of surgical ICU clinical pathway was increased from 33.33％ in June 2017 to 94.44％ in December 2017,and up to 100％ in October 2017,and the average completion rate from January to July 2018 was 94.00％.The completion rate of ICU clinical pathway was increased from 81.82％ in January 2008 to 92.86％ in July 2008.There was a significant difference in the overall clinical pathway completion rate from 2016 to 2018 (x2 =204.300,P =0.000).After the effective implementation of clinical pathway in June 2017,the length of hospital stay of patients was significantly shortened as compared with that before implementation (days:2.96 ± 0.43 vs.6.66 ± 0.75,P ＜ 0.01),and the daily cost was significantly reduced (Yuan:3 550.92 ± 755.51 vs.6 171.48 ± 377.29,P ＜ 0.01).The average length of hospital stay was shortened by about 3.84 days (P ＜ 0.01),and the average daily cost was reduced by about 2 108.39 Yuan (P ＜ 0.01) after the implementation of clinical pathway by surgical ICU "postoperative monitoring of heart disease" as compared with those before implementation.The average length of hospital stay was shortened by about 2.98 days (P ＜ 0.01) and the average daily cost was reduced by 5 094.13 Yuan (P ＜ 0.01) after the implementation of clinical pathway by comprehensive ICU "post-operative monitoring" as compared with those before implementation.At the same time,the cure rate was increased from 1.16％ (7/603) to 42.26％ (105/227),and the improvement rate was decreased from 94.36％ (569/603) to 52.86％ (120/227,both P ＜ 0.01) after the implementation of surgical ICU clinical pathway,but there was no significant difference in the cure rate or the improvement rate after the implementation of comprehensive ICU [2.77％ (33/1 193) vs.2.22％ (2/90),79.21％ (945/1 193) vs.97.78％ (88/90),both P ＞ 0.05].Conclusions Application of clinical pathway to control ICU quality and guide diagnosis and treatment,more refined diagnosis and treatment schemes including clinical guidelines,average length of stay,average cost of hospitalization,cost-efficiency ratio and so on were completed,which confirmed that the improvement of clinical pathway management strategy originated from clinical were needed.Informatization,intellectualization,standardization and effective control of medical cost of clinical pathway could improve medical quality and accurate management.The integration of ICU clinical pathway construction and HIS could promote the development of digital hospitals.

Objective To construct and identify a lentiviral vector of RNA interference targeting human Notch-1 gene. Methods To determine the Notch-1 gene sequences, three RNAi target sequences (shRNA1-3) were designed in accordance with the RNAi sequence design principles and cloned into the lentiviral vector pLenOR-THM by endonuclease BamHⅠres-triction, EcoRⅠdouble digestion, and T4 DNA-ligase ligation. After the transformation into competent DH5αbacteria, the candidate clones were identified by KpnⅠand EcoRⅠdouble digestion and DNA sequencing. The recombinant and three packaging plasmids were co-transfected into human embryonic kidney cell line 293T cells by lipofectamine to produce the lentiviral particles. The viral titer was determined. The 293T cells were infected by the lentiviral particles obtained, and trans-fection efficiency was assessed using a fluorescent microscope. The lentiviral vector particles were also transfected into ACC-M cells. The Notch-1 expression in the transfected cells was assayed by quantitative reverse transcription polymerase chain reaction (QRT-PCR) and Western blot analysis. Results The lentiviral RNAi vector pLenOR-THM-Notch1 for Notch-1 gene was constructed successfully. Strong green fluorescence was observed in the 293T cells under fluorescent microscope after co-transfection of the cells with the four plasmids of lentiviral vector. The virus in the supernatant reached a titer of 5.8× 108 TU·mL-1. The transfection efficiency of the collected virus exceeded 90% in 293T cells with 1 as a multiplicity of in-fection. The third lentiviral vector was found to significantly inhibit the Notch-1 expression at the mRNA and protein levels. Conclusion The lentiviral RNAi vector of Notch-1 has been successfully constructed and identified.