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Objective:To investigate the application and surgical effect of lobed anterolateral femoral chimeric perforator flap in repairing the complex soft tissue defects of limbs.Methods:Clinical materials of 52 cases with complex soft tissue defects of limbs were retrospectively reviewed from October 2013 to October 2020. Thirty-two males and 20 females were reviewed, and the age of them ranged from 6 to 65(mean 39) years old. The injuries include 17 cases of traffic accidents, 15 machine crush injuries, 12 engineering accidents, and 8 extensive resection of malignant tumors. The size of soft tissue defects ranged from 26.0 cm×10.0 cm to 35.0 cm×15.0 cm. Lobed anterolateral thigh chimeric perforator flaps or lobed Flow-through chimeric perforator flaps were designed according to the soft tissue defects and blood circulation of the distal extremities. Start from 8-month post-operation, upper limb function was assessed according to the Upper Limb Function Assessment Standard of Hand Surgery Branch of Chinese Medical Association and Disability of arm shoulder and hand(DASH) score scale, and Fugl-Meyer score system was used to evaluate the lower limb function. Long-term follow-up was conducted through WeChat video call and outpatient clinic evaluation.Results:All flaps survived. One patient with crush injury got delayed wound healing due to deep hemaetoma after surgery, and the rest were healed at the first stage. All the cases entered followed-up, ranged from 6 to 20(mean 8) months. The appearance of the flaps was satisfactory, and the color of the flaps has no significant difference compared with the recipient area. No recurrence of tumor was reported during the follow-up period. According to the Upper Limb Function Assessment Standard of Hand Surgery Branch of Chinese Medical Association, there were 21 excellent cases and 8 good cases, and the total excellent and good rate was 100%. The DASH score of upper limbs ranges from 11.5 to 45.1(mean 25.4±13.7), and the Fugl-Meyer score of lower limbs range from 18.6 to 31.8(mean 26.2±11.2) at the last follow-up.Conclusion:The complex soft tissue defect of limbs is a common complication caused by high-energy trauma, which is difficult to repair. The lobed anterolateral thigh chimeric perforator flap through a Decompose-Combine and arrange method for reconstruction, which is flexible in flap design. A variety of tissue flaps can be obtained by anastomosing only one group of blood vessels. It is an ideal choice for repairment of complex soft tissue defects of limbs.
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Objective:To study serum procalcitonin (PCT), C-reactive protein (CRP) and platelet count (PLT) in evaluation of severity of acute cholangitis (AC).Methods:Ninety patients with AC who were treated at the General Surgery Department, Guangming Hospital, Liaocheng, Shandong Province from January 2016 to December 2018 entered into the observation group, while 60 patients with bile duct stones but without infection treated at the hospital during the study period entered into the control group. Using the " Guidelines for the Diagnosis and Treatment of Acute Biliary Tract Infections" , the study group of patient was further divided into the mild infection, moderate infection, and severe infection groups. The PCT, CRP and PLT levels of all the subjects were checked. Spearman correlation was used to analyze the relationship between PCT, CRP, PLT indexes with severity of infection. The receiver operating characteristic curve was used to analyze the sensitivity and specificity of PCT, CRP and PLT in the diagnosis of patients with different degrees of infection.Results:In the observation group, there were 46 males and 44 females with a Mean±SD age of (45.6±21.1) years. In the control group, there were 30 males and 30 females, with a Mean±SD age of (45.0±19.3) years. The levels of PLT in the observation group and the control group were (8.2±1.1) ng/ml and (0.4±0.1) ng/ml, respectively. The corresponding CRP were (92.7±21.1) mg/L and (6.1±1.0) mg/L, respectively. The observation group had higher levels than the control group. The PLT counts were (62.6±17.6)×10 9/L and (156.3±35.3)×10 9/L for the two groups, with the observation group having lower platelet count than the control group (both P<0.05). The severity of infection was positively correlated with blood PCT levels and CRP indicators ( r=0.427, r=0.584, all P<0.05), and negatively correlated with the PLT ( r=-0.429, P<0.05). The sensitivity and specificity of PCT using a cut-off value of 9.4 μg/L were 84.0% and 65.0%, respectively, which were higher than the CRP using a cut-off value of 145.7 mg/L. The sensitivity and specificity were 67.0% and 48.0%, respectively. When PLT using a cut-off value of 52.8×10 9/L, the sensitivity and specificity were 71.0% and 52.0%, respectively. Conclusions:Changes in serum PCT, CRP and PLT reflected the severity of infection in patients with AC; PCT had a higher sensitivity and specificity, and it can be used to guide treatment.
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Objective To analyze the clinical prevalence,distributed characteristic of different ages,clinical characteristics and pathogenic factors of chronic abdominal pain in children.Methods A database in which outpa-tient and inpatient of abdominal pain during 2 -14 years old were collected from January 2011 to December 2015 was established by utilizing HIS system.A statistical analysis was made in age,sex,onset time,time of duration,mesenteric lymph node status and surgical situation.Results A total of 13 256 times abdominalgia were enrolled from January 2011 to December 2015.7 390 patients were diagnosed as unexplained abdominal pain,including 1 005 patients (13.59%)were diagnosed as chronic abdominal pain.A male -to -female ratio was 1.06:1.The average age was 6 years(ranged 2 -14 years).The average age of the boys was (6.02 ±2.87)years,which of the girls was (5.93 ± 2.79)years,there was no statistically significant difference between them(t =0.47,P =0.63).The peak age of chro-nic abdominal pain in children was mainly from 3 to 7 years old.The incidence decreased with age increased.The average time of duration was (16.70 ±11.69)months,that of the boys was (17.39 ±12.12)months,and that of the girls was (15.96 ±11.19)months,there was statistically significant difference between them(t =1.93,P =0.05). Mesenteric lymphadenectasis was detected in 731 patients(72.74%).The age constituent ratio decreased with age increased.The peak age of the prevalence coincided with peak age of the mesenteric lymphadenectasis.21 patients underwent surgical procedures,organic lesions accounted for 2.08%.Conclusion The peak age of the prevalence of chronic abdominal pain in children is mainly from 3 to 7 years old.Potential organic causes are rarely linked to chronic abdominal pain in children.Most of them are functional abdominal pain.The appendix and mesenteric lymphadenecta-sis might play an important role in children with chronic abdominal pain.The therapeutic aim of CAP in children is to make the children back to their normal life by exclude the organic causes and relieve their pain.The natural history of chronic abdominal pain suggests that symptoms remit spontaneously with increasing age.
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Objective To study the incidence and risk factors of infection caused by methicillinresistant staphylococcus aureus (MRSA) with a targeted surveillance at intensive care unit (ICU) acquired MRSA infection in Tianjin area.Methods A prospective multi-center observational analysis of consecutive patients admitted to 15 adult ICUs from March 1,2012 through March 31,2014 was carried out.The ICUs were divided into four groups according to the type of the ICU.All of the patients were cared for with routine MRSA surveillance.A number of risk markers and prognostic factors were recorded.The risk factors contributing to ICU acquired MRSA were evaluated using a logistic regression model.Comparison of survival between groups was analyzed with Kaplan-Meier method.Results A total of 1 787 patients were enrolled,and 144 cases of them were MRSA infections.The patients with MRSA infection were significantly older than those with non-MRSA infection (P =0.043),length of ICU stay,length of antimicrobial therapy,the history of repeated administration of antibiotics in recent days,history of operation in the past five years,history of MRSA infection or colonization,frequent application of and the overall length of time for mechanical ventilation and central venous catheter and catheter-associated infection were significantly higher than those with non-MRSA infection.The survival rate of patients with non-MRSA infection were higher than those with MRSA infection (x2 =9.23,P =0.004).The rate of MRSA infection and MRSA colonization in 2013 were significantly lower than that in 2012,because the rate of hand hygiene rule execution and bacterial clearance rate were significantly higher in 2013.Multivariate Logistic regression analysis demonstrated that advanced age (OR =1.05,95％ CI:1.009-1.086),length of ICU stay (OR =1.05,95％ CI:1.01-1.08),history of MRSA infection or colonization (OR =1.33,95％ CI:1.82 -3.27),glucocorticoid therapy (OR =2.85,95％ CI:1.18-6.91),antacid medicine (OR =4.92,95％ CI:1.18-20.58),history of recent or repeated application of antibiotics (OR =3.26,95％ CI:1.06-4.59) catheter-associated infections (OR =2.22,95％ CI:1.08-4.59) were associated with ICU acquired MRSA infections.Conclusions Performing the rule of hand hygiene strictly as well as strengthening prevention and control of MRSA infections can effectively reduce the incidence of ICU acquired MRSA infections.The advanced age,length of ICU stay,history of MRSA infection or colonization,glucocorticoid therapy,antacids medicine,history of recent or repeated application of antibiotics,catheterassociated infections were independent risk factors of ICU acquired MRSA infections.
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Objective To study the correlation between expression level of als3 gene and the in vivo biofilm formation of Candida albicans in mice.Methods The real-time polymerase chain reaction (PCR) assay was used to detect als3 gene expressions of the clinical Candida albicans isolates from February 2016 to August 2016 in Tianjing No.1 Central Hospital.According to the expression levels of als3 gene, Candida albicans isolates were divided into high and low-expression groups.Thirty C57 mice were randomly assigned to high-expression group (n=15), low-expression group (n=5) and blank group (n=5).Animal model of Candida albicans biofilm was established based on venous catheter and intraperitoneal injection of Candida albicans.Catheters were removed after two weeks;inverted microscope was used for the observation of Candida albicans biofilm formation and transmission electron microscope was used for the observation of its ultrastructure.After irrigating the catheter, the growth of Candida albicans was observed;real-time PCR was used to detect the expression levels of als3 gene 12, 24, and 48 h after the catheter being removed.In this study, t test was used for measurement data and chi-square test was used for rate comparisons.Results In high-expression group, 11 strains (11/15) formed biofilms.In als3 low-expression group, only one strain (1/10) formed biofilm.The difference between these two group was statistically significant (x2=9.64,P0.05).In the als3 high-expression group, the expression of als3 gene declined gradually during the biofilm formation.In the als3 low-expression group, the change of als3 gene expression was not obvious.The expressions of als3 gene over time between two groups were significantly different (t=8.7, 10.3 and 9.2, respectively, all P<0.05).Conclusion The high expression of als3 gene in Candida albicans facilitates the formation of biofilm in vivo.
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Objective The expression of agr and sigB regulation system in Staphylococcus aureus with different infection types were assessed by analyzing the characteristics of m /z value generated by MALDI-TOF-MS.Methods A total of 50 isolates with specific genotypes were collected from Tianjin First Center Hospital during Jun 2013 to Feb 2014 for retrospective study .The pattern profiles of these isolates were obtained by MALDI-TOF-MS with RUO model, and the m/z value was also analysed to evaluate the expression the agr and sigB regulation system .The phylogenetic tree based on mass spectrum peak feature was constructed using SARAMIS software .Results A total of 50 strains of Staphylococcus aureus were divided into two groups: acute infection and chronic persistent and recurrent infection .The expression of delta toxin in acute infection and in chronic infection was 99.2 ±4.1 and 60.5 ±10.1 ( t =16.83, P<0.05), respectively.The regulation of stress proteins of sigB system was enhanced in chronic persistent and recurrent infections , and the expression intensities of SAS 030, SAS049 and SA0772 were 27.1 ±14.7, 54.8 ±21.5 and 51.6 ±19.2, respectively; while in acute infections , those were 4.9 ±1.9, 12.4 ±2.8 and 15.7 ±6.9, respectively.The t values between the two groups were -6.88 (P<0.05),-8.98 (P<0.05) and -1.87 (P<0.05), respecitively.The expression of phenol-soluble modulins (PSMs) was inconsistent , and the relative strength of PSMα3 was 100%in the colony variants small strains .Conclusions Different types of the Staphylococcus aureus infections could be evaluated through the assessment of the agr and sigB regulation system .The m/z value obtained by MALDI-TOF mass spectrometry is a marker for the expression of agr and sigB regulation system .The application of this technology needs further development .
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Objective To investigate the drug resistant genes and genotypes of carbapenem-resistant Klebsiella pneumoniae in Tianjin First Center Hospital. Methods A total of 52 strains of carbapenem-non-susceptible Klebsiella pneumoniae were collected from 2012 to 2015. The MICs of antimicrobial drugs were detected using agar dilution methods. Phenotypes of carbapenemases were screened using modified Hodge test. Drug resistant genes were detected by multiplex-PCR assay. Multilocus sequence typing ( MLST) was used to determine the genotypes and homology of these carbapenem-resistant Klebsiella pneumoniae strains. Results Susceptibility of antimicrobial agents indicated that all these strains with multiple drug resistance. The resistance rate to piperacillin/tazobactam, ceftriaxone, ceftazidime, cefepime, aztreonam imipenem,meropenem was 100%( 52/52 ) . The resistance rate of ST11 type to amikacin was 93. 5%( 43/46), ciprofloxacin was 97. 8%(45/46), levofloxacin was 97. 8%(45/46), compound sulfamethoxazole was 17. 4%(8/46), tigecycline was 0. The resistance rate of ST101 type to amikacin was 3/3, ciprofloxacin was 2/3, levofloxacin was 3/3, compound sulfamethoxazole was 3/3, tigecycline was 0. The resistance rate of ST709 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. The resistance rate of ST1393 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. The resistance rate of ST2068 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. PCR results showed that 43 isolates were blaKPC-2 positive and 5 isolates were blaOXA-48 positive, 1 isolate was blaDNM-1 positive. There were 46 strains of ST11 type. The 43 strains of Klebsiella pneumoniae producing KPC-2 type carbapenemase were all ST11. While among 5 strains of Klebsiella pneumoniae carrying OXA-48 carbapenem resistant gene, 3 strains were ST101, 1 was ST709, 1 was ST1393. One strain of Klebsiella pneumoniae harboring DNM-1 type carbapenemase was ST2068. Conclusions Drug resistant genes of carbapenem-resistant Klebsiella pneumoniae were KPC-2 dominant, OXA-48 and DNM-1 were sporadical;the genotype was mainly ST11 by MLST in the hospital. The research provided effective basic and reference for the hospital infection t control.
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The aim of this study is to develop a physiologically based pharmacokinetic (PBPK) model in intraabdominal infected rats, and extrapolate it to human to predict moxifloxacin pharmacokinetics profiles in various tissues in intra-abdominal infected human. 12 male rats with intra- abdominal infections, induced by Escherichia coli, received a single dose of 40 mg/kg body weight of moxifloxacin. Blood plasma was collected at 5, 10, 20, 30, 60, 120, 240, 480, 1440 min after drug injection. A PBPK model was developed in rats and extrapolated to human using GastroPlus software. The predictions were assessed by comparing predictions and observations. In the plasma concentration versus time profile of moxifloxcinin rats, Cmax was 11.151 microg/mL at 5 min after the intravenous injection and t1/2 was 2.936 h. Plasma concentration and kinetics in human were predicted and compared with observed datas. Moxifloxacin penetrated and accumulated with high concentrations in redmarrow, lung, skin, heart, liver, kidney, spleen, muscle tissues in human with intra-abdominal infection. The predicted tissue to plasma concentration ratios in abdominal viscera were between 1.1 and 2.2. When rat plasma concentrations were known, extrapolation of a PBPK model was a method to predict drug pharmacokinetics and penetration in human. Moxifloxacin has a good penetration into liver, kidney, spleen, as well as other tissues in intra-abdominal infected human. Close monitoring are necessary when using moxifloxacin due to its high concentration distribution. This pathological model extrapolation may provide reference to the PK/PD study of antibacterial agents.
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Animals , Humans , Male , Rats , Anti-Bacterial Agents , Body Weight , Escherichia coli , Heart , Injections, Intravenous , Intraabdominal Infections , Kidney , Kinetics , Liver , Lung , Pharmacokinetics , Plasma , Skin , Spleen , VisceraABSTRACT
Objective To evaluate the method of PSM-mec detection by Vitek MS for nosocomialacquired methicillin-resistant Staphylococcus aureus (MRSA) identification.Methods Totally 167 isolates of MRSA and 100 isolates of methicillin-sensitive Staphylococcus aureus (MSSA) used in this research were non-repetitively and prospectively collected between June 2012 and December 2013,two different SCCmec genotyping methods were applied for the MRSA strains,Vitek MS was used for identification of the isolates,the acquisition mass-spectrogram and the result mass-spectrogram at Myla system were analyzed among the different SCCmec type of MRSA.Results The 167 isolates of MRSA were classified into 5 major SCCmec types,among which SCCmec Ⅰ accounting for 3.6％ (6 isolates);SCCmec Ⅱ 6.0％ (10 isolates);SCCmec Ⅲ and Ⅲa 84.4％ (141 isolates);SCCmec Ⅳand Ⅳ a 4.8％ (8 isolates);SCCmec Ⅴ 1.2％ (2 isolates),respectively.The peak adjacent to the horizontal axis of a m/z 2 500 could be visually identified between the SCCmec Ⅱ and Ⅲ MRSA,of which the delta toxin peak were presented at m/z 3 005-3 009 or m/z 3 037-3 056,while the strains without delta toxin peak and the other types of MRSA or MSSA had no characteristic peak at the same position.Conclusions Nosocomial-acquired MRSA of the drug-resistant condition could be rapidly differentiated and forecasted by Vitek MS.Vitek MS could serve as a routine clinical assistance for epidemiological investigations of nosocomial-acquired MRSA in local area.
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Objective To evaluate the clfB typing method in discriminating the ST239 methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients under nosocomial infection in Tianjin first central hospital so as to access the clinical risk factors and outcomes of the MRSA nosocomial infection from ICU and non-ICU departments.Methods Forty-two stains of MRSA with known SCCmec type were chosen in both ICU (n=35) and non-ICU (n=7) wards,from 2006 to 2012,of which MLST genotype was ST239.Clinical risk factors and rates on drug resistant to MRSA were counted,respectively.Results All the isolates of MRSA belonged to the same lineage 3 and 6 heplotypes,based on clfB variable-number random repeats typing.Thirty-five isolates from ICU belonged to 6 heplotypes,among which clfB3-52,3-52E,3-50,3-52C,3-50A and 3-50E were accouted for 42.9％,37.1％,8.6％,5.7％,2.9％ and 2.9％,respectively.Seven isolates from non-ICU belonged to 3 heplotypes,in which 3-52,3-52E and 3-50 were accouted for 42.8％,28.6％,28.6％,respectively.When clfB typing was combined with SCCmec typing in use,results showed that the index of discrimination as 0.767,better than clfB (ID=0.688) or SCCmec (ID=0.303) used alone.SCCmec Ⅲ-clfB3-52E seemed as the major clone among the 10 heplotypes of clfB/SCCmec typing,which was accounted for 40.4％.There were significant differences on the length of hospitalization (P＜0.005) and the duration of antibiotics use (P＜0.05) between ICU and non-ICU.Conclusion The clfB typing method which was based on variable-numbers of tandom repeats showed powerful ability of resolution.It could also be combined with MLST and SCCmec typing to be used in local epidemiological investigations.
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Objective To investigate the clinical influence about levetiracetam on cognitive function and emotional influence in the patients with partial epilepsy.Methods A total of 62 patients with partial epilepsy were divided into carbamazepine group (30 cases) and levetiracetam group (32 cases) by random digits table method,carbamazepine group was treated by carbamazepine while levetiracetam group was treated by levetiracetam.The patients were assessed before treatment and 4,8,12,16 weeks after treatment by the Montreal cognitive assessment scale (MoCA),self rating anxiety scale (SAS) and self rating depression scale (SDS).Results There was no significant difference in MoCA score between two groups before treatment and 4 weeks after treatment (P ＞ 0.05).MoCA score at 8,12,16 weeks after treatment in levetiracetam group was better than that in carbamazepine group [(22.6 ± 2.1) scores vs.(20.8 ± 2.6) scores,(23.5±2.7) scoresvs.(21.3± 2.8) scores,(24.6±4.7) scoresvs.(21.2±3.0) scores],the difference was statistically significant (P ＜ 0.05).There was no significant difference between SAS score,SDS score between two groups before and after treatment (P ＞ 0.05).Conclusion In the process of treating the patients with partial epilepsy by drug,levetiracetam is superior to carbamazepine on the improvement of cognitive function,but the mood improvement is not obvious.
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Objective To investigate the influence of preoperative diabetes mellitus (DM) on postoperative morbidity of pancreatoduodenectomy for pancreatic ductal adenocarcinoma.Methods The clinical data of 302 pancreatic ductal adenocarcinoma patients who underwent pancreatoduodenectomy from January 1,2005 to August 31,2012 were retrospectively analyzed.Results 113 patients (37.4％)had preoperative DM among the total 302 patients.The percentage of the major complication including pancreatic fistulas,delayed gastric emptying,infections,acute kidney injury and mortality accounted for 19.9％,12.9％,25.9％,36.0％,3.2％ and 3.5％ respectively.In the DM group,firm pancreatic texture was more common than that in non-DM group (x2 =15.175,P ＜ 0.01).While pancreatic fistula in the DM group developed less frequently(x2 =7.811,P =0.005) than that in non-DM group.Delayed gastric emptying,infections,acute kidney injury,hemorrhage,pulmonary,cardiovascular and neurologic complications,as well as length of stay in hospital and mortality were in similar frequency in the two groups (P ＞ 0.05).Binary Logistic regression analysis showed DM(OR =0.358,P =0.035) and firm pancreatic texture(OR =0.395,P =0.032) were protective factors against pancreatic fistula while preoperative jaundice(OR =3.819,P =0.010) and intraoperative blood transfusion (OR =1.268,P =0.001) were predisposing factors for pancreatic fistula.Conclusions With good control of perioperative glucose level,DM does not increase operation risk in pancreatoduodenectomy for pancreatic ductal adenocarcinoma.
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ObjectiveTo evaluate the value of tissue mitral annular displacement (TMAD) in the assessment of left ventricular long axis systolic function and the relationship of obese degree with left ventricular long axis systolic function in patients with abdominal obesity.MethodsThirty-eight abdominal obesity cases and thirty-four healthy cases were investigated using echocardiography.The images of apical four-chamber view and apical two-chamber view were obtained,systolic mitral annular displacement (MADs),mid-point of mitral annular displacement(MAD-midpt),mid-point of mitral annular normalized displacement(MAND-midpt) and mid-point of mitral annular biplanar normalized displacement(MABNDmidpt) were measured by the technique of TMAD.Their characteristics between patients with abdominal obesity and healthy group were compared,and the relationship of waist-hip ratio(WHR) and related indexes of MAD were analyzed.ResultsIn abdominal obesity group,the MADs at the four site were significantly decreased compared with control group (P＜0.001,respectively),the MAD-midpt and MAND-midpt of apical four-chamber view and apical two-chamber view were significantly decreased compared with control group (P＜0.001,respectively).The WHR related with MABND-midpt independently by the analysis of partial correlation(r=-0.697,P=0.000).ConclusionsThe left ventricular long axis systolic function were damaged in patients with abdominal obesity.The technique of TMAD could quantitatively assess the left ventricular long axis systolic function in patients with abdominal obesity.
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Objective To study genotypes,antibiotic resistance and epidemiology of extendedspectrum β-lactamases (ESBL)-producing Shigella isolated in Tianjin,and to discuss the relationship between ESBL-producing Shigella and drug-resistance plasmid.Methods A total of 136 Shigella spp.were isolated from stool specimens of patients with diarrhea who presented mainly with bloody purulent stool from Tianjin Children's Hospital,Tianjin Medical University No.2 Hospital and Tianjin No.1 Central Hospital between May 2009 and September 2010.Suspicious ESBL-producing isolates were screened by K-B disc diffusion method. The conjugation experiment was performed in the confirmed ESBL-producing strains and antibiotic resistance was compared between clinical strains and transconjugants to confirm the plasmid-mediated resistance. The genotypes of these isolates were detected by polymerase chain reaction (PCR) using universal primers for TEM,SHV,CTX-M-1 group,CTX-M-2 group,CTX-M-9 group,respectively.Intergenic consensus PCR (ERIC-PCR) was employed to understand the molecular homology of the ESBL-producing isolates. The data were analyzed by x2 test.ResultsESBL were identified in 14.7％ (20/136) of Shigella isolates,but no AmpC enzyme were detected.Among all the Shigella isolates,16 strains were genotype CTX-M-14,4 were genotype CTX-M-15.The strains with CTX-M ESBL were resistant to multiple antibiotics,while 100％ sensitive to imipenem.The transconjugant test of 18 ESBL-producing isolates were positive,and these conjugations were only resistant to β-lactamases. Conclusions CTX-M type is the common genotype of ESBL-producing Shigella isolates in Tianjin. ESBL-producing is the main cause of multiple resistance to β-lactams.The transmission of CTX-M producing strains is mainly mediated by plasmids.
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ObjectiveTo study the effect of a fast-track surgery (FTS) program on the clinical outcomes in cirrhotic patients with portal hypertension.Methods42 cirrhotic patients with portal hypertension were randomly allocated into the FTS group (n=21) and the conventional therapy control group (n=21).The postoperative time to first defecation,hospital stay,hospitalization cost,and postoperative complications were compared between the two groups.ResultsCompared with the control group,the postoperative time to first defecation was significantly shorter in the FTS group (P=0.0287).Furthermore,the postoperative hospital stay was significantly shorter in the FTS group than the control group (P=0.002).Additionally,hospitalization cost was significantly lower in the FTS group than the control group (P＜0.001).The postoperative complication was also significantly different between the two groups (7.15 ％ vs 21.5 ％,P=0.001).ConclusionA FTS program contributed to better postoperative rehabilitation in cirrhotic patients with portal hypertension.
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OBJECTIVE To study the mechanisms of quinolones resistance in Escherichia coli.METHODS Forty E.coli clinical isolates were randomly collected from clinical specimens at the Tianjin First Central Hospital from Mar 2004 to Dec 2005.Then we detected the susceptibility to antibiotics in 40 clinical isolates of E.coli by MICs and K-B disk diffusion method.In order to investigate the mutations in the target genes,we amplified the QRDR of gyrA and parC by PCR.Later we analyzed the PCR products by single strand conformation polymorphism analysis(SSCP).In the meantime,the PCR products of marOR region were sequenced to detect the possible gene changes which contributed to the increasing expression of MarA and then lead to the Mar phenotype.RESULTS The alterations in gyrA were found in all quinolones-resistante strains.Asp87→Asn and Ala84→Pro were found besides the common amino acid alteration.The alterations in parC were found in thirty-six strains resistant to quinolones.There were no parC alterations in ECO24 which was nalidixic acid-resistant and ofloxacin/gatifloxacin-susceptible.ECO11 Which was resistant to quinolones only had no gene changes in marOR region.Six gene changes in marOR region were found in ECO5 which was resistant to mutiple antibodies.The alteration in 1879 bp changed the terminator.CONCLUSIONS The alterations in gyrA and parC are responsible for the resistant phenotypes in E.coli.That is,the alterations in the gyrA are primarily responsible for resistance to quinolones,and the alterations in the parC may play a complemental role in enhancing resistance to fluoroquinolones.Moreover,the randomly collected strains resistant to quinolones,have found some mutations in marOR.It may be play certain roles in multiple antibiotic resistance of E.coli.
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OBJECTIVE To analyze the pattern of antibiotic usage and antibiotic resistance tendency in our hospital.METHODS The use of antibiotics was evaluated by calculating DDDs;the bacteria were isolated and identified,and the susceptibility was tested by using microdilution method.Ten species of the most common bacteria,such as Staphylocccus aureus,and their antibiotic resistance tendency in two years were evaluated.RESULTS The average antibiotics days were 11.6 in two years.Ten species with 8967 strains were isolated in which 57.70% bacteria were Gram-negative.The rate of extended spectrum ?-lactamases(ESBLs) of Enterobacteriacae was 31.18%.42.3% Bacteria were Gram-positive,the isolation rate of MRSA was up to 76% and 56.8%,respectively.CONCLUSIONS The total cost of antibiotics remains at a high level.The ESBLs is still the major problem in gram negative germ.Vancomycin-resistant Enterococcus has been discovered.It is urgent to conduct epidemiological investigation and to take appropriate measures to control bacterial resistance and antibiotics usage.
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Objective To determine the nucleic acid content of hepatitis B virus with different clinical types of hepatits B before、after liver transplantation patients and explore the approach for detection of hepatitis B.Methods The HBV DNA content in before the liver transplantation, 7 day, 30 day, 90 day after the liver transplantation was detected with fluorescent quantitative PCR and HBV M with ELISA in 275 liver transplantation patients.Results HBsAg、HBcAb was positive of 275 patients;HBV DNA was positive in all HBsAg(+)/HBeAg(+)/HBcAb(+) specimens;79( 73.8 % )out of the 107 HBsAg(+)/HBeAb(+)/HBcAb(+) specimens; 48( 67.6 % )out of the 71 HBsAg(+)/HBcAb(+) specimens in before the liver transplantation.HBV DNA was negative in out of the 275 HBsAg(-) in 7 day after the liver transplantation; 48( 69.6 % ) out of the 69 HBsAg(+) in 30 day after the liver transplantation;104( 75.9 % ) out of the 137 HBsAg(+) in 90 day after the liver transplantation.Conclusions The recurrent hepatitis B were higher in the different clinical types of hepatitis B after liver transplantation,Detection of HBV DNA with fluorescent quantitative PCR can accurately reflect the state of HBV infection and HBV replication and HBV DNA was complementarity with HBV M,it can be used to guide clinical diagnosis with recurrent hepatitis B.