Risk factors for venoarterial-extracorporeal membrane oxygenation related nosocomial infection in children after cardiac surgery / 中南大学学报(医学版)

OBJECTIVES@#Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support strategy for the treatment of critically ill children with reversible heart and lung failure, increasingly being used in patients with low cardiac output after cardiac surgery. However, the mortality of patients is closely related to the complications of ECMO, especially bleeding, thrombosis, and infection, ECMO-related nosocomial infection has become a challenge to the success of ECMO. This study aims to analyze the incidence and risk factors for venoarterial-ECMO (VA-ECMO)-related nosocomial infections in children after cardiac surgery.@*METHODS@#We retrospectively collected the data of patients who underwent VA-ECMO treatment after pediatric cardiac surgery in the Second Xiangya Hospital of Central South University from July 2015 to March 2021, and divided them into an infected group and a non-infected group. The clinical characteristics of the 2 groups of patients, VA-ECMO-related nosocomial infection factors, pathogenic microorganisms, and patient mortality were compared. Logistic regression was used to analyze the risk factors for nosocomial infection related to VA-ECMO after cardiac surgery.@*RESULTS@#Of the 38 pediatric patients, 18 patients (47.37%) had VA-ECMO related nosocomial infection, served as the infected group, including 7 patients with blood infections and 11 respiratory tract infections. Gram-negative pathogens (16 strains, 88.9%) were the main bacteria, such as Acinetobacter baumannii (6 strains), Klebsiella pneumoniae (3 strains), and Stenotrophomonas maltophilia (3 strains). Compared with the non-infected group (n=20), the infection group had longer time of cardiopulmonary bypass, time of myocardial block, and time of VA-ECMO assistance (All P<0.05). Multivariate logistic regression analysis showed that time of cardiopulmonary bypass (OR=1.012, 95% CI 1.002 to 1.022; P=0.021) was an independent risk factor for ECMO-related nosocomial infection. The number of surviving discharges in the infected group was less than that in the non-infected group (1 vs 11, P<0.05).@*CONCLUSIONS@#Cardiopulmonary bypass time is an independent risk factor for VA-ECMO-related nosocomial infection in children after cardiac surgery. Shortening the duration of extracorporeal circulation may reduce the incidence of VA-EMCO-related nosocomial infections in children after cardic surgery. The occurrence of VA-ECMO-related nosocomial infections affects the number of patient's discharge alive.

Clinical application of laparoscopy combined with choledochoscopy and duodenoscopy in treatment of gallstones complicated by intra- and extrahepatic bile duct stones / 临床肝胆病杂志

ObjectiveTo summarize the experience in laparoscopy combined with choledochoscopy and duodenoscopy in the treatment of gallstones complicated by intra- and extrahepatic bile duct stones, and to investigate its therapeutic effect. MethodsA total of 413 patients with gallstones complicated by intra- and extrahepatic bile duct stones who visited Meizhou People′s Hospital from March 2010 to March 2015 were enrolled, and according to the patients′ individual conditions, they were given laparoscopy combined with choledochoscopy and/or duodenoscopy. ResultsA total of 31 patients underwent laparoscopic cholecystectomy (LC)+laparoscopic transcystic common bile duct exploration (LTCBDE), and the success rate was 29.0% (9/31); 101 patients underwent LC+LTCBDE+T tube drainage, and the success rate was 93.1% (94/101); 96 patients underwent LC+laparoscopic common bile duct exploration (LCBDE)+choledochoscopic cholecystolithotomy+primary suture, and the success rate was 97.9% (94/96); 61 patients underwent LC+LCBDE+partial hepatectomy, and the success rate was 91.8% (56/61); 155 patients underwent endoscopic sphincterotomy (EST)+LC or LC+EST, and the success rate was 93.5% (145/155); 10 patients underwent laparoscopy+duodenoscopy+choledochoscopy (at the same time), and the success rate was 90%(9/10). Nineteen patients were converted to open surgery, and the overall success rate was 95.4％（394/413）. All the patients were cured, and there were no serious complications or deaths. ConclusionLaparoscopy combined with duodenoscopy and choledochoscopy is feasible, safe, and reliable in the treatment of gallstones complicated by intra- and extrahepatic bile duct stones.

The expression of basigin mRNA in early ischemic myocardium of rats / 中国法医学杂志

Objective To determine the expression differences of Basigin(BSG)mRNA between early ischemic myocardium(EIM) and non-ischemic myocardium(NIM) in rats and then to evaluate the possibility of BSG examination in ischemic myocardium accidents occurred in forensic medicine. Methods Real-time polymerase chain reaction (RT-PCR) technique was applied for detecting the expression of BSG mRNA in EIM and NIM of rats at 15min, 30min, 1h and 2h post myocardial ischemia, and in sham operation(SO) group. Results Compared with NIM, SO and control groups, expression of BSG mRNA decreased after 15min when myocardium ischemia occurred; compared with SO, it was of 0.5 folds when 1h(P<0.5), and rebounded to SO level when 2h. Conclusion BSG could be involved in protection and myocardial remodeling in early ischemic myocardium, and may serves as a biomarker of early ischemic myocardium.

Clinical studies of cerebrospinal lfuid replacement combined with Vancomycin and dexamethasone intrathecal injection on intracranial infection / 中国生化药物杂志

Objective To investigate the effect of cerebrospinal lfuid replacement combined with vancomycin and dexamethasone intrathecal therapy on biochemical indicators of postoperative intracranial infection, in order to improve the clinical diagnosis and treatment. Methods 70 cases with intracranial infection collected in Third Hospital of Beijing Armed Police Corps from February 2010 to April 2013 were as subject, and randomly divided into two groups. Control group(n=35) were given cerebrospinal lfuid replacement and ceftriaxone intravenously, observation group(n=35) were given cerebrospinal lfuid replacement combined with vancomycin and dexamethasone intrathecal injection. The clinical effects and biochemical indicators were observed after treatment in two groups. Results In control group, the cure rate was 22.86%and total efifciency was 77.14%. In observation group, the cure rate was 37.14% and total efficiency was 91.43%. The differences between two groups were statistically significant (P<0.05). The differences of leukocytes, glucose, protein, intracranial pressure in two groups after treatment were also statistically signiifcant(P<0.05). Conclusion Cerebrospinal lfuid replacement combined with vancomycin and dexamethasone intrathecal injection therapy can increase intracranial infection.

Study on preparation of berberine microemulsion and its absorption in intestine / 中国中药杂志

<p><b>OBJECTIVE</b>To prepare berberine microemulsion, and to investigate its properities and the absorption character in rat intestine in situ.</p><p><b>METHOD</b>The optimum formulation of the blank microemulsion selected by pseudo tertiary phase diagrams and the berberine microemulsion was prepared based on the blank microemulsion. The viscosity, conductance, refraction rate and particle size of berberine microemulsion were surveyed. An in situ rat perfusion method was used to investigate the intestinal absorption of berberine microemulsion. A UV method for determination of berberine in the intestinal flux was established.</p><p><b>RESULT</b>The viscosity, conductance, refraction rate and particle size of berberine microemulsion were 2.11 cPas, 125.5 microomega, 1.363 and 24.0 nm, respectively. The absorption rate of berberine at the ileum was the best. The absorption of berberine microemulsion at the ileum was significantly higher than that of raw medicine (P < 0.01).</p><p><b>CONCLUSION</b>The microemulsion system might improve the absorption of berberine in the intestinal tract.</p>