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Objective:To analyze the differences and similarities of pre-treatment and post-treatment lung microbiome of acute respiratory distress syndrome (ARDS) and find out the change rules of the lung microbiome in the progression of ARDS according to different prognosis.Methods:A retrospective study was conducted. Patients with ARDS caused by severe pneumonia admitted to intensive care unit (ICU) of Jiangmen Central Hospital from February 2019 to January 2020 were enrolled as the study subjects. The patients were divided into pre-treatment (ARDS-preT) group (24 cases), post-treatment survival (ARDS-poT-Survival) group (17 cases), and post-treatment death (ARDS-poT-Dead) group (7 cases). ICU patients with mild pulmonary infection and non-ARDS admitted to ICU during the same period were enrolled as control group (25 cases). The similarities and differences of lung microbiome in four groups were analyzed and compared, and the possible pathogenic bacteria (potential risk factors for death) and probiotics (potential survival and protective factors) related to death caused by ARDS were screened.Results:In terms of pathogenic microorganisms, the positive rates of Escherichia coli and Candida albicans in the ARDS-poT-Dead group were significantly higher than those in the ARDS-poT-Survival group [57.1% (4/7) vs. 5.9% (1/17) and 57.1% (4/7) vs. 0% (0/7), both P < 0.05]. In the screening of background bacteria, the decrease of bacteria in the ARDS-preT group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the control group, the reduced bacteria might be pulmonary probiotics (potential protective factor for ARDS). The screening result was Hydrobacter [ARDS-preT group vs. ARDS-poT-Survival group: 62.5% (15/24) vs. 94.1% (16/17); ARDS-poT-Dead group vs. ARDS-poT-Survival group: 14.3% (1/7) vs. 94.1% (16/17); ARDS-poT-Dead vs. control: 14.3% (1/7) vs. 96.0% (24/25), all P < 0.05]. In the screening of background bacteria, the increase of bacteria in the ARDS-poT-Dead group compared with the ARDS-preT group, the ARDS-poT-Dead group compared with the ARDS-poT-Survival group, the ARDS-poT-Dead group compared with the control group, and the increased bacteria might be potential pulmonary pathogen (potential risk factor for death of ARDS), which belonged to Enterobacteria: Edwardsiella, Enterobacteriaceae, Escherichia, Klebsiella, Kluyvera, Lelliottia, Pantoea, Raoultella. Conclusions:The results revealed the increase of Escherichia coli or Candida albicans in pulmonary pathogenic microorganisms, or the increase of Enterobacteria in background bacteria may be the risk factors for the death of ARDS. Additionally, background bacteria Hydrobacter probably is a protective factor for the survival of ARDS. Whether it can be used as a novel treatment for ARDS is worth further investigation.
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Objective To evaluate the efficacy and safety of modified intracystic ethanol irrigation for traumatic iris cyst eyes.Methods A retrospective analysis was designed.Twelve cases of traumatic iris cyst patients were observed from August 2016 to August 2018 in Xiamen Eye Centre of Xiamen University.After anterior chamber filled with DisCoVisc,cyst fluid was drained gently via a 30-gauge needle,and ethanol was irrigated into the cyst through 3-way T-extension until the cyst wall turned white.DisCoVisc was washed in the end.Patients were followed for cornea and anterior chamber condition,best-corrected visual acuity (BCVA),intraocular pressure (IOP) and endothelial cell density (ECD).The diameters of maximal length and width in maximal cross-sectional area were calculated by ultrasound biomicroscopy (UBM) preoperatively and postoperatively.The follow-up period was 3 to 24 months.Written informed consent was obtained from each patient before surgery.Results BCVA (LogMAR) and IOP had no significant changes after surgery in one week (t=1.30,P=0.22;t=-0.91,P=0.38).BCVA was elevated in 5 cases at the last follow-up,but declined in 3 cases,kept stable in 4 cases.Mean intensity of ECD before and 3 months after operation was (2 270.79±458.43)/mm2 and (2 111.52±483.46)/mm2,respectively,the mean loss of ECD was 159.27 cells/mm2,and there was a significant change between the two time points (t=3.76,P=0.00).Mean postoperative maximal length diameter before and 3 months after operation was (5.87±0.95)mm and (1.46±0.83) mm,mean postoperative maximal width diameter was (3.10 ±0.55) mm and (0.89 ±0.47) mm,respectively,the mean postoperative maximal length diameter was reduced by 5.33 mm,and the mean postoperative maximal width diameter was reduced by 2.22 mm,with significant changes between the two time points (t =18.55,P =0.00;t =11.75,P =0.00).All cysts were resolved and without recurrence at the last follow-up.No significant complications,such as cornea endothelial decompensation,endophthalmitis,sympathetic ophthalmia and retinal detachment were seen during the follow-up period.Conclusions Modified intracystic ethanol irrigation is a safe and effective procedure to treat traumatic iris cysts,which is more simple with less injury and low rate of complications.
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Objective To compare the operational feasibility and efficacy of inguinal obturator nerve block (ONB) beside the vessel by ultrasound combined with nerve stimulation and traditional ONB guided by nerve stimulation preventing obturator nerve reflex. Methods Forty patients with American Society of Anesthesiology (ASA)Ⅰ or Ⅱ, aged 35~91 years who underwent transurethral electric excision of bladder tumor in our hospital in 2014 were ran-domly divided into beside vessel group (group V, = 20) and traditional group (group T, = 20). Adductor strength was measured before and after the block. Frequencies of obturator nerve block puncture, operation time, visual ana-log scale (VAS) pain score, and incidence of complications were recorded during and after ONB. Results The suc-cess rate of the first puncture was significantly higher in group V than that in group T ( <0.01). The operation time in group V was significantly shorter than that in group T ( < 0.01). The decreased degree of adductor strength has significant difference of the two groups ( < 0.05 or < 0.01). The VAS pain score in group T was higher than that in groups V ( < 0.01). There are two cases contract blood vessel in group T, while none in group V ( < 0.01). There was no case with the local anesthetic toxicity and paresthesia in the area of the obturator nerve and the obtu-rator nerve injury in the two groups. Conclusion Compared with traditional ONB guided by nerve stimulation, in-guinal ONB beside the vessel by ultrasound combined with nerve stimulation showed more accurate positioning, less adjustment, less puncture time, more comfortable and safe.
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Objective To observe the feasibility of combining dezocine with fentanyl in the application of single integral high in‐tensity focused ultrasound(HIFU)ablation of uterine fibroids .Methods One hundred and sixty patients with uterine fibroids trea‐ted by HIFU under conscious sedation were randomly divided into 2 groups(n=80):group A with treatment combined fentanyl and midazolam and group B treated with combined dezocine ,fentanyl and midazolam .Analgesic effect was evaluated with visual analog scale (VAS) .Variation of patients′vital signs (blood pressure ,heart rate ,electrocardiogram ,oxygen saturation) ,pain scores ,com‐fort scores ,sedation scores ,analgesic consumption and side effects were recorded before treatment (T0 ) ,during drug delivery (T1 ) , at the beginning of the treatment(T2 ) ,30 minutes after drug delivery (T3 ) ,at the end of the treatment(T4 ) ,2 hours after treatment (T5 ) ,4 hours after treatment (T6 ) ,8 hours after treatment (T7 )and 24 hours after treatment(T8 ) .Results Both groups showed reliable analgesic effects and vital signs of each time point were stable .VAS scores and Ramsay scores of group A were higher than those of group B ,but there was no statistical difference (P>0 .05) .Three patients in group A showed dysuria and relieved after symptomatic treatment .No respiratory depression occurred in both groups .But compared to group A ,the incidence of the analgesic side effects of group B was significantly lower and patients satisfaction was significantly higher(P<0 .05) .Conclusion The analge‐sic effects of dezocine combined with fentanyl are reliable in HIFU ablation of uterine fibroids with fewer side effects ,and could be worthy to be promoted in clinical use .
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Objective To investigate antimicrobial resistance of Acinetobacter baumannii (A.baumannii)causing hospital-acquired pneumonia (HAP),so as to guide rational use of antimicrobial agents and reduce antimicrobial re-sistant rate.Methods Clinical data of patients with A.baumannii HAP in a hospital between 2009 and 2012 were collected and analyzed retrospectively.Antimicrobial resistance data were summarized and analyzed statistically ac-cording to uniformed methods.Results A total of 284 patients developed A.baumannii HAP,patients mainly distributed in intensive care unit(45.07%),department of respiratory diseases(19.01%),neurosurgery (9.15%),and neurology (5.99%).The incidences of A.baumannii HAP,multidrug-resistant A.baumannii (MDR-AB)HAP,and extensively drug-resistant A.baumannii (XDR-AB)HAP increased year by year.The total resistant rates of A.baumannii to cef-operazone/sulbactam (9.51%)and minocycline(9.86%)were low,to levofloxacin(43.66%)and ciprofloxacin(45.42%) were relatively higher;resistant rates to imipenem and meropenem were 16.20%and 20.42% respectively.The resistant rates to meropenem,imipenem,cefoperazone/sulbactam,and ampicillin/sulbactam increased year by year (all P <0.05). Conclusion Antimicrobial resistance of A.baumannii is serious,it is essential to strengthen the monitoring of antimicrobial resistance of A.baumannii,and prevent the spread in hospital.
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Objective To investigate the relationship between interleukin-8 (IL-8),interleukin-6 (IL-6) and pathogenesis of lower respiratory infection(RI).Methods Bronchoalveolar lavage fluid (BALF) and serum IL-8,IL-6 levels were detected by enzyme linked immunosorbent assay (ELISA) in 36 patients with lower RI,28 patients with unstable asthma and 12 controls. Neutrophils (PMN) and alveolar macrophages (AMs) of BALF were examined.Results The levels of serum IL-8 and IL-6 of RI before treatment were significantly higher than those of RI after treatment,of unstable asthma,and of controls (P