Pharmacokinetics and pharmacodynamics of antibiotics in septic children treated with extracorporeal membrane oxygenation / 中华儿科杂志

Objective: To investigate the characteristics of pharmacokinetic (PK) and pharmacodynamic (PD) parameters of antibacterial agents in children with sepsis treated by extracorporeal membrane oxygenation (ECMO). Methods: In this prospective cohort study, 20 children with sepsis (confirmed or suspected) who were treated with ECMO and antimicrobial in the Department of Critical Medicine of Hunan Children's Hospital from March 2021 to December 2022 were enrolled as the ECMO group. Through therapeutic drug monitoring (TDM), the PK-PD parameters of antibacterial agents were analyzed. Twenty five children with sepsis in the same department who were treated with vancomycin but no ECMO at the same time were enrolled as the control group. The individual PK parameters of vancomycin were calculated by Bayesian feedback method. The PK parameters in the two groups were compared, and the correlation between trough concentration and area under the curve (AUC) was analyzed. Wilcoxon rank sum test was used for inter group comparison. Results: Twenty patients in the ECMO group, included 6 males and 14 females, with an onset age of 47 (9, 76) months. In the ECMO group, 12 children (60%) were treated with vancomycin, and the trough concentration was less than 10 mg/L in 7 cases, 10-20 mg/L in 3 cases, and >20 mg/L in 2 cases; AUC/minimum inhibitory concentration (MIC) (MIC=1 mg/L)<400 was in 1 case, 400-600 in 3 cases, and >600 in 8 cases. Among the 11 children (55%) who were treated with β-lactam antibiotics, there were 10 cases with drug concentration at 50% dosing interval (CT50)>4 MIC and 9 cases with trough concentration>MIC, both CT50 and trough concentration of cefoperazone reached the target. Among the 25 cases of control group, 16 were males and 9 females, with an onset age of 12 (8, 32) months. There was a positive correlation between vancomycin trough concentration and AUC (r2=0.36, P<0.001). The half-life of vancomycin and the 24-hour AUC (AUC0-24 h) in the ECMO group were higher than those in the control group (5.3 (3.6, 6.8) vs. 1.9 (1.5, 2.9) h, and 685 (505, 1 227) vs. 261 (210, 355) mg·h/L, Z=2.99, 3.50, respectively; both P<0.05), and the elimination rate constant and clearance rate was lower than those in the control group (0.1 (0.1, 0.2) vs. 0.4 (0.2, 0.5), 0.7 (0.5, 1.3) vs. 2.0 (1.1, 2.8) L/h, Z=2.99, 2.11, respectively; both P<0.05). Conclusion: The PK-PD parameters in septic children treated by ECMO varied with a longer half-life, higher AUC0-24 h, lower elimination rate constant and clearance rate.

Comparison of no drain or with a drain after unilateral total knee arthroplasty: a prospective randomized controlled trial / 中华外科杂志

<p><b>OBJECTIVE</b>To prospectively compare of no drain or with drain after unilateral total knee arthroplasty (TKA).</p><p><b>METHODS</b>A randomized prospective study was conducted between February 2006 and February 2007. The study included 100 patients who were divided into 2 groups: group A (n = 50), which included patients without drain release, and group B (n = 50), which included patients who had a drain release. The true total blood loss was calculated depending on the height, body mass and pre-and post-operative Hct, and hidden blood loss was gotten by subtracting the visible blood loss from total loss. The recovery after surgery, the correlative complications and transfusion amounts were compared and analyzed.</p><p><b>RESULTS</b>All 100 patients undergoing TKA were involved in the result analysis. In patients without a drain, the total blood loss was (535 +/- 295) ml and the hidden blood loss was (513 +/- 290) ml, in patients with a drain, the total blood loss was (853 +/- 331) ml and the hidden blood loss (689 +/- 324) ml. The total and hidden blood loss, blood transfusion amount between drain-group and without drain-group was significantly different (P < 0.05). The difference in the incidence of infection and post-op recovery and correlative complications did not reach statistical significance.</p><p><b>CONCLUSIONS</b>In patients having primary TKA, using a drain, compared with no use of a drain, does not show us a clear advantage that make us accept it. Without a drain release could present an effective and economic method for reducing blood loss and preventing blood transfusion in patients undergoing unilateral TKA.</p>

Constricted ear therapy with free auricular composite grafts / 中华整形外科杂志

<p><b>OBJECTIVE</b>A simple and effective therapy for single side constricted ear.</p><p><b>METHODS</b>Transplanting normal side free composite auricular grafts to constricted ear (15 patients and 15 sides), then lengthening the helix, exposing the scapha, correcting deformity.</p><p><b>RESULTS</b>The 15 patients composite grafts all survived. The helix has been lengthened, the scapha exposed, the normal ear reduced, the constricted ear augmented and two sides ear have become symmetry.</p><p><b>CONCLUSION</b>This method is simple and results are satisfied.</p>