ABSTRACT
Objective:To explore the characteristics of type 3 secretion system and biofilm of Pseudomonas aeruginosa in diabetic foot wound, and to analyze the relationship between these factors, as well as to the antibiotic sensitivity.Methods:Thirty-three strains of Pseudomonas aeruginosa were collected from the foot wounds of diabetic foot inpatients in Tianjin Medical University Chu Hsien-I Memorial Hospital from February 1, 2018 to December 31, 2018. Thirteen strains of Pseudomonas aeruginosa were collected from non-diabetic wounds. All strains were tested for antibiotic sensitivity. The virulence genes exoS or exoU of Pseudomonas aeruginosa and the ability of biofilm formation were tested. The characteristics of exoS or exoU and biofilm of Pseudomonas aeruginosa were analyzed. Patients′ clinical outcomes were also analyzed.Results:Pseudomonas aeruginosa with exoS gene was the major pathogen, 90.9% found in diabetic foot group and 84.6% in control group, with no significant difference( χ2=0.54, P=0.46). The drug-resistant strains of Pseudomonas aeruginosa with exoS accounted for 16.7% in diabetic foot group and 18.2% in control group, also with no significant difference( χ2=0.18, P=0.83). There were 5 strains of Pseudomonas aeruginosa carrying exoU, 3 strains in diabetic foot group, of which 1 was resistant, 2 in control group, no resistant strain. Pseudomonas aeruginosa increased the ability of biofilm formation in diabetic foot group, accounting for 57.6%, and for resistant strains, 83.3% of them increased the biofilm formation ability. Two kinds of Pseudomonas aeruginosa produced different biofilms, but they were effectiveless for carbapenem antibiotics. The times of debridement ( P<0.01), time of antibiotic use ( P<0.01) were more in biofilm wound, but the healing rate reached 75%-90%. Conclusion:Pseudomonas aeruginosa secreting ExoS is the main one in the diabetic foot wound. The ability of Pseudomonas aeruginosa to produce biofilm in DF wound is increased. Biofilm is one reason for its antibiotic resistance. Multiple debridement combined with sensitive antibiotics is an effective method to remove biofilm.
ABSTRACT
Objective To investigate the application of jugular bulb oxygen saturation (SjvO2) in the treat-ment of patients with severe traumatic brain injury (sTBI).Methods From August 2016 to August 2017,fifty-three patients with sTBI admitted to intensive care unit ( ICU) of Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences were randomly divided into the intracranial pressure - guided treatment group ( ICP group) and the SjvO2 -guided treatment group (SjvO2 group) by draw lots method.The patients in ICP group ( n=25) were treated according to the routine regimen,and the SjvO2 group (n=28) was dynamically detected SjvO2,and the SjvO2 was maintained at the target range of 55% -75% by adjusting the treatment scheme in addition to the routine treatment regimen.The early GCS score,GOS score and the mortality rate were compared between the two groups three months after injury.Results A total of 36% (9/25) patients had SjvO2 <55% events within 3 days after injury.On the fourth day after injury,the GCS score in the SjvO2 group was better than that in the ICP group [(7.17 ± 1.41)points vs.(6.91 ± 1.10)points,t=1.78,P=0.03],and there was no statistically significant difference in mortality between the two groups at 90 days after injury ( P=0.80).The SjvO2 group had a better prognosis rate compared with ICP group (24.00% vs.10.70% ,χ2 =2.31,P=0.05).Conclusion The treatment strategy of sTBI patients guided by SjvO2 can improve early consciousness level and improve the overall prognosis of sTBI patients.