Risk factors for complications of endoscopic full-thickness resection of upper gastrointestinal submucosal tumors / 中华胃肠外科杂志

Objective: To analyze the risk factors for complications of endoscopic full-thickness resection (EFTR) of upper gastrointestinal submucosal tumors (SMTs). Methods: This was a retrospective observational study. The indications for EFTR included: (1) SMTs originating from the muscularis propria layer and growing out of the cavity or infiltrating the deep part of the muscularis propria layer; (2) SMTs diameter <5 cm; and (3) tumor identified as closely adherent to the serous layer during endoscopic submucosal dissection or endoscopic mucosal resection. This study included patients with SMTs originating from the muscularis propria layer in upper digestive tract, diagnosed preoperatively by endoscopic ultrasonography or computed tomography, who were successfully treated with EFTR. Those with incomplete clinical data were excluded. The clinical data of 154 patients with upper gastrointestinal SMTs who underwent EFTR at the Department of Gastroenterology, First Affiliated Hospital of Soochow University from January 2016 to January 2022 were retrospectively analyzed. Post-EFTR complications (such as delayed perforation, delayed bleeding, and postoperative infection, including electrocoagulation syndrome) were monitored and the risk factors for them were analyzed. Results: Among the 154 study patients, 33 (21.4%) developed complications, including delayed bleeding in three (1.9%), delayed perforation in two (1.3%), and postoperative infection in 28 (18.2%). One patient with bleeding was classified as having a major complication (hospitalized for more than 10 days because of complication). According to univariate analysis, complication was associated with tumor diameter >15 mm, operation time >90 minutes, defect closure method(purse string suture), and diameter of resected specimen ≥20 mm (all P<0.05). Multivariate logistic regression analysis showed that operation time >90 minutes (OR=6.252, 95%CI: 2.530-15.446, P<0.001) and tumor diameter >15 mm (OR=4.843, 95%CI: 1.985-11.817, P=0.001) were independent risk factors for complications after EFTR in patients with upper gastrointestinal SMTs. The independent risk factors for postoperative infection in these patients were operation time>90 minutes (OR=4.993, 95%CI:1.964-12.694, P=0.001) and purse string suture (OR=7.142, 95%CI: 1.953-26.123, P=0.003). Conclusion: Patients with upper gastrointestinal SMTs undergoing EFTR with tumor diameter >15 mm or operation time >90 minutes have a significantly increased risk of postoperative complications. Postoperative monitoring is important for these patients with SMTs.

Study on the mechanism of carbapenem resistance in Pseudomonas aeruginosa / 中国感染与化疗杂志

Objective To investigate if the 23 strains of highly-resistant P.aeruginosa isolated from different patients in the in- tensive care unit (ICU) have the same origin;and explore the related mechanisms of carbapenem resistance in these multidrug- resistant P.aeruginosa.MethOds Antimicrobial susceptibility testing was performed using disk-diffusion technique.The strains were genotyped by rep-PCR with the primer ERIC2 followed by electrophoresis in agarose gel.We used a previously described imipenem-EDTA double-disk test for screening MBL-producing P.aeruginosa.Polymerase chain reaction for amplification of blaOprD, blaIMP, and bla VIM were performed to detect corresponding mutants.Results The result of antimicrobial suscepti- bility testing showed that 20 of the 23 P.aeruginosa isolates were muhidrug-resistant and highly resistant to imipenem and meropenem, and at least 5 antimicrobial agents tested in this study.The analysis of the rep-PCR products indicated that all the 19 carbapenem-resistant strains had an identical band pattern, which was different from that seen in the sensitive strains.Al- though imipenem-EDTA double-disk test identified 5 MBL-producing strains, PCR found that all the 23 strains were negative for bla VIM and blaIMP.Only one OprD-deficient mutant was identified.Conclusions The 19 highly-resistant strains of P. aeruginosa derive from a common origin.More researches are needed to clarify their mechanism of carbapenem resistance.