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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 investigate the diagnosis,operation characteristics and clinical effect of anterior Pilon fracture.Methods A retrospective analysis was carried out to analyze 13 patients who had been treated for anterior pilon fracture from September 2012 to March 2014.All had fresh closed fracture.Mean age was 39.8 years (range,18-61 years).Injury resulted from high falls in 11 patients and falls in 2 patients.According to the preoperative imaging manifestations and four column fracture classification,the fracture type was mainly anterior column fracture.All underwent open reduction and internal fixation with buttress plates,and allograft bone was performed in 8 patients.At the last followup,American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale(VAS) were employed for clinical evaluation.Results Mean period of follow-up was 15.7 months (range,12-30 months).Mean AOFAS score was 91.38 points (range,74-100 points).Excellent results were found in 10 patients,good in 2 and fair in 1,with the excellent-good rate of 92％.Mean VAS score was 1.08 points (range,0-3 points).Traumatic arthritis occurred in 1 patient.Skin necrosis occurred in 1 patient,and was cured by dressing change.There were no complications such as infection,refracture or implant failure.Conclusions Mechanism of injury in anterior pilon fracture is vertical violence when the foot in dorsiflexion position.Imaging findings are mainly characterized by the compression in anterior articular surface of the distal tibia,which is often implicated in the anterior medial malleolus but in part is combined with lateral malleolus fracture.The fracture is the result of high energy injury,and can be diagnosed by mechanism of injury and imaging manifestations.Through anterior approach,open reduction and internal fixation with buttress plates plus allogenic bone grafting obtain satisfactory outcomes.
