Use of Pre?Operative Hemoglobin A1c to Predict Early Post?Operative Renal Failure and Infection Risks in Patients who are not Diabetics and Undergoing Elective off Pump Coronary Artery Bypass Graft Surgery

Background: Recent studies have indicated that patients, both with and without diabetes with an increased HbA1c, have a higher rate of adverse outcomes following cardiac surgeries. Our study is focused on to evaluate the prognostic impact of admission value of HbA1c in non?diabetic patients for postoperative renal failure and infections. Materials and Methods: Plasma HbA1c levels were collected from 200 consecutive nondiabetic patients who got admitted for elective off pump coronary artery bypass graft (CABG) procedure over a 2?year period under two groups, Group A whose HbA1c was < 6% at admission and Group B whose HbA1c was ?6% and ?6.4% at admission. After surgery, patients were followed up to see if they have got infection or renal failure as postoperative complication. Student抯 unpaired t test was used to test the significance of difference between the quantitative variables, Yate抯 and Fisher抯 chi square tests were used for qualitative variables. Results: We found early postoperative renal failure in 14 (3/96 in Group A and 11/104 in Group B) out of 200 patients (7%) and infection in 21 (8/96 in Group A and 13/104 in Group B) out of 200 patients (10.5%). After data analysis, it was noted that there is a positive correlation between HbA1c and postoperative renal failure (P = 0.0213) whereas no association was found between HbA1c and postoperative infections (P = 0.175) in patients undergoing off?pump CABG surgery. Conclusion: In patients without diabetes, a plasma HbA1c ?6% was a significant independent predictor for early postoperative renal failure.

Changes and its influencing factors of procalcitonin in pediatric cardiac surgery under cardiopulmonary bypass / 中国胸心血管外科临床杂志

@#Objective    To explore the natural changes of procalcitonin (PCT) in the early period after pediatric cardiac surgery with cardiopulmonary bypass (CPB). Methods    A prospective and observational study was done on patients below 3 years of age, who underwent cardiac surgery involving CPB, with the risk adjustment of congenital heart surgery (RACHS) score of 2 to 5 and free from active preoperative infection or inflammatory disease. Blood samples for measurement of PCT, C-reactive protein (CRP) and white blood cell (WBC) were taken before surgery and daily for 7 days in postoperative period. Infections and complications within 7 days after operation were investigated. According to the presence or absence of infection and complications within 7 days after operation, the enrolled children were divided into an infection+complications group, a simple infection group, a simple complication group, and a normal group. Results     Finally, 429 children with PICU stay≥ 4 days were enrolled, including 268 males and 161 females, with a median age of 8.0 (0.7, 26.0) months. There were 145 children in the simple infection group, 38 children in the simple complication group, 230 children in the normal group and 16 children in the infection+complications group. The levels of PCT, CRP and WBC were significantly higher after CPB. CRP and WBC peaked on the second postoperative day (POD) and remained higher than normal until POD7. PCT peaked on POD1 and would generally decrease to normal on POD5 if without infection and complications. Age, body weight, RACHS scores, the duration of CPB and aortic cross-clamping time were correlated with PCT level. There was a statistical difference in PCT concentration between the simple infection group and the normal group on POD 3-7 (P<0.01) and a statistical difference between the simple complication group and the normal group on POD 1-7 (P<0.01). A statistical difference was found between the simple infection group and the simple complication group in PCT on POD 1-5 (P<0.05). Conclusion    WBC, CRP and PCT significantly increase after CPB in pediatric cardiac surgery patients. The factors influencing PCT concentration include age, weight, RACHS scores, CPB and aortic cross-clamping time, infection and complications.

Consideraciones en torno a la génesis de las infecciones posoperatorias

Introducción: La tasa de complicaciones infecciosas posoperatorias se eleva en el paciente quirúrgico, entre otras razones, debido a que con elevada frecuencia, resulta insuficiente el conocimiento sobre la génesis de los factores que las provocan. Se realizó una revisión documental sobre el tema durante 2020 y 2021. Fueron consultadas las bases de datos Web of Science, PubMed, Medline, Cochrane, SciElo así como el motor de búsqueda Google académico. Se seleccionaron 32 artículos en idiomas inglés y español. Objetivo: Analizar los aspectos fundamentales concernientes a la génesis de las infecciones posoperatorias. Desarrollo: Las infecciones del sitio quirúrgico constituyen el 25 % de las asociadas a la atención de salud. A pesar de todas las medidas para su prevención, no se ha logrado su desaparición, lo que conlleva una elevada morbilidad, aumento de los costos de hospitalización, de la estadía hospitalaria y uso de antibióticos de última generación. Esto puede explicarse por la aparición de microorganismos resistentes a los antibióticos y el aumento de pacientes quirúrgicos de edad avanzada e inmunodeprimidos por enfermedades asociadas, con inclusión de los trasplantados, con injertos o prótesis. Conclusiones: Los microorganismos que provocan las infecciones posquirúrgicas, pertenecen predominantemente a la microbiota presente en el lugar de la incisión. Los factores del enfermo, de la técnica quirúrgica y los relacionados con la hospitalización, juegan roles importantes en su aparición.

Introduction: The rate of postoperative infectious complications rises in the surgical patient, among other reasons, frequently due to insufficient knowledge about the genesis of the factors that cause them. A documentary review on the subject was carried out during 2020-2021. The Web of Science, PubMed, Medline, Cochrane, SciElo databases were consulted, as well as the academic Google search engine. There were selected 32 articles in English and Spanish. Objective: To analyse the fundamental aspects concerning the genesis of postoperative infections. Development: Surgical site infections constitute 25 % of those associated with health care. Despite all the measures for its prevention, its disappearance has not been achieved, which entails high morbidity, increased costs of hospitalization, hospital stay and use of the latest generation of antibiotics. This can be explained by the appearance of microorganisms resistant to antibiotics and the increase in surgical patients of advanced age and immunosuppressed by associated diseases, including those transplanted, with grafts or prostheses. Conclusions: The microorganisms that cause postoperative infections predominantly belong to the microbiota present at the incision site. The factors of the patient, the surgical technique and those related to hospitalization play important roles in its appearance.

Association between anesthesia regimen and postoperative infection in patients undergoing cardiac surgery: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. Methods    The clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results     A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion     The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult  patients undergoing elective cardiac surgery with cardiopulmonary bypass.

Influence of perioperative probiotics supplement on short-term clinical outcomes in gastric cancer patients receiving neoadjuvant chemotherapy combined with radical gastrectomy: a prospective study / 中华消化外科杂志

Objective:To investigate the influence of perioperative probiotics supplement on short-term clinical outcomes in gastric cancer patients receiving neoadjuvant chemotherapy combined with radical gastrectomy.Methods:The prospective randomized controlled study was conducted. The clinicopathological data of 80 patients who underwent neoadjuvant chemotherapy combined with radical gastrectomy in the Affiliated Hospital of Qingdao University from July 2020 to September 2021 were selected. Based on random number table, patients were allocated into two groups. Patients undergoing perioperative probiotics supplement were allocated into the experiment group, and patients undergoing perioperative conventional treatment were allocated into the control group, respectively. Observation indicators: (1) grouping situations of the enrolled patients; (2) intraoperative situations; (3) follow-up and postoperative situations; (4) inflammation related hematological indexes. Follow-up was conducted using telephone interview and outpatient examina-tion to detect postoperative complications and startup of adjuvant chemotherapy up to October 31,2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was performed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the Mann-Whitney U test. Repeated measurement data were analyzed by the repeated ANOVA or generalized estimating equation. Results:(1) Grouping situations of the enrolled patients. A total of 80 patients were selected for eligibility. There were 51 males and 29 females, aged 64(42-80)years. Of the 80 patients, there were 40 patients in the experiment group and 40 patients in the control group, respectively. (2) Intraoperative situations. All patients in the experiment group and the control group underwent radical gastrectomy successfully. Cases with yield pathologic TNM (ypTNM) stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲ after neoadjuvant chemotherapy, cases undergoing laparoscopic radical gastrectomy or Da Vinci robotic radical gastrectomy, the operation time, the volume of intraoperative blood loss, cases undergoing digestive tract recons-truction as Billroth Ⅱ anastomosis or Roux-en-Y anastomosis were 2, 7, 15, 13, 19, 21,205(180-240)minutes, 50(30-60)mL, 6, 34 in the experiment group, versus 4, 6, 12, 16, 23, 17, 218(190-251)minutes, 50(43-60)mL, 11, 29 in the control group, showing no significant difference in the above indicators between the two groups ( U=683.00, χ2=0.80, U=668.00, 681.00, χ2=1.87, P>0.05). (3) Follow-up and postoperative situations. All the 80 patients were followed up for 1 month after surgery. Cases with postoperative infectious complications were 6 in the experiment group, versus 15 in the control group, showing a significant difference between the two groups ( χ2=5.23, P<0.05). The application of antimicrobial agent, time to postoperative first flatus, time to postoperative first defecation, time to tolerance of solid food, duration of postoperative hospital stay, time to postopera-tive startup of adjuvant chemotherapy were 3(3-6)doses, 53(49-66)hours, 72(62-82)hours, (72±18)hours, 6.0(5.5-7.0)days, 26.0(25.0-28.0)days in the experiment group, versus 6(3-10)doses, 66(60-88)hours, 94(82-112)hours, (107±23)hours, 7.0(6.4-8.3)days, 30.0(28.0-33.0)days in the control group, showing significant differences in the above indicators between the two groups ( U=471.50, 432.00, 343.50, t=-7.62, U=411.50, 319.50, P<0.05). (4) Inflam-mation related hematological indexes. ① The white blood cell counts before surgery and at postoperative day 1, 3, 5 were (5.6±1.4)×10 9/L, (9.9±3.2)×10 9/L, (7.7±2.6)×10 9/L, (6.8±1.8)×10 9/L in the experiment group, versus (6.1±1.9)×10 9/L, (12.3±2.9)×10 9/L, (9.7±3.6)×10 9/L, (7.8±2.7)×10 9/L in the control group, meeting the mauchly′s test of sphericity ( χ2=4.17, P>0.05). Results of intrasubject effect test showed that there were significant differences in the time effect, intervention effect and interaction effect of white blood cell counts between the two groups ( F=106.61, 10.45, 4.56, P<0.05). ② The neutrophilic granulocyte percentages before surgery and at postoperative day 1, 3, 5 were 55%±10%, 76%±11%, 73%±9%, 69%±9% in the experiment group, versus 56%±9%, 84%±5%, 79%±8%, 74%±9% in the control group, not meeting the mauchly′s test of sphericity ( χ2=16.63, P<0.05). Results of multi-variate test showed that there were significant differences in the time effect, intervention effect and interaction effect of neutrophilic granulocyte percentages between the two groups ( F=92.42, 11.46, 5.55, P<0.05). ③ The levels of C-reactive protein before surgery and at postoperative day 1, 3, 5 were 1.35(1.15-1.97)mg/L, 14.94(8.24-21.22)mg/L, 33.39(13.02-66.02)mg/L, 18.36(8.27-60.43)mg/L in the experiment group, versus 1.62(0.97-2.27)mg/L, 24.03(10.42-36.52)mg/L, 81.66(31.20-116.76)mg/L, 46.84(28.30-80.26)mg/L in the control group, not meeting the normal distribution. Results of generalized estimation equation test showed that there were significant differences in the time effect, intervention effect and interaction effect of levels of C-reactive protein between the two groups ( Waldχ2=145.74, 9.48, 9.90, P<0.05). ④ The levels of procalcitonin before surgery and at postoperative day 1, 3, 5 were 0.02(0.02-0.04)μg/L, 0.08(0.06-0.12)μg/L, 0.12(0.07-0.21)μg/L, 0.09(0.06-0.15)μg/L in the experiment group, versus 0.02(0.02-0.04)μg/L, 0.14(0.07-0.71)μg/L, 0.35(0.14-0.71)μg/L, 0.24(0.10-0.48)μg/L in the control group, not meeting the normal distribution. Results of generalized estimation equation test showed that there were signifi-cant differences in the time effect, intervention effect and interaction effect of levels of procalcitonin between the two groups ( Waldχ2=62.88, 14.71, 18.33, P<0.05). Conclusion:Perioperative supple-ment of probiotics can reduce the incidence of postoperative infectious com-plications and the application of antimicrobial agent, promote recovery of gastrointestinal function, reduce the level of inflammation related indexes, shorten the duration of postoperative hospital stay and the time to postoperative startup of chemotherapy in patients undergoing neoadjuvant chemotherapy combined with radical gastrectomy.

Prevention and treatment strategies of postoperative infection after liver resection / 中华消化外科杂志

Liver resection is an important method for the treatment of benign and malig-nant hepatobiliary diseases. Due to severe surgical injury, complicated surgical procedures and operation difficulty, the postoperative complications are relatively more common, and infections are the frequent complications. Postoperative infection not only increases the economic burden and treatment difficulty of patients, but also affects the prognosis. There are many risk factors leading to postoperative infection. Controlling and improving these factors are effective measures to reduce or avoid postoperative infection. By reviewing the domestic and abroad literatures, and combined with the clinical experiences, the authors discuss the types of postoperative infection, the related risk factor and the corresponding prevention and treatment strategies after liver resection.

Correlation between preoperative sleep disorders and postoperative delayed neurocognitive recovery in elderly patients / 中南大学学报(医学版)

OBJECTIVES@#Perioperative neurocognitive disorders (PND) is one of the important factors affecting the recovery of the elderly after surgery, and sleep disorders are also one of the common diseases of the elderly. Previous studies have shown that the quality of postoperative sleep may be factor affecting postoperative cognitive function, but there are few studies on the relationship between preoperative sleep disorders and postoperative cognitive dysfunction. This study aims to explore the relationship between preoperative sleep disorders and postoperative delayed neurocognitive recovery in elderly patients, and provide references for improving the prognosis and quality of life of patients.@*METHODS@#This study was porformed as a prospective cohort study. Elderly patients (age≥65 years old) underwent elective non-cardiac surgery at Xiangya Hospital of Central South University from October 2019 to January 2020 were selected and interviewed 1 day before the operation. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) were used to assess the patient's baseline cognitive status. Patients with preoperative MMSE scores of less than 24 points were excluded. For patients meeting the criteria of inclusion, Pittsburgh Sleep Quality Index (PSQI) scale was used to evaluate the patients, and the patients were divided into a sleep disorder group and a non-sleep disorder group according to the score. General data of patients were collected and intraoperative data were recorded, such as duration of surgery, anesthetic time, surgical site, intraoperative fluid input, intraoperative blood product input, intraoperative blood loss and drug use. On consecutive 5 days after surgery, Numerical Rating Scale (NRS) was used to evaluate the sleep of the previous night and the pain of the day, which were recorded as sleep NRS score and pain NRS score; Confusion Assessment Method for ICU (CAM-ICU) scale and Confusion Assessment Method (CAM) scale were used to assess the occurrence of delirium. On the 7th day after the operation, the MMSE and MoCA scales were used to evaluate cognitive function of patients. We compared the incidence of postoperative complications, the number of deaths, the number of unplanned ICU patients, the number of unplanned secondary operations, etc between the 2 groups. The baseline and prognosis of the 2 groups of patients were analyzed by univariate and multivariate logistics to analyze their correlation.@*RESULTS@#A total of 105 patients were collected in this study, including 32 patients in the sleep disorder group and 73 patients in the non-sleep disorder group. The general information of the 2 groups, such as age, gender, body mass index, and surgery site, were not statistically significant (all @*CONCLUSIONS@#Preoperative sleep disorders can increase the risk of delayed neurocognitive function recovery in elderly patients. Active treatment of preoperative sleep disorders may improve perioperative neurocognitive function in elderly patients.

Factores de riesgo de infección tras el implante de marcapasos permanente / Infection risk factors after the permanent pacemaker implantation

Introducción: La mayor expectativa de vida en la población general ha aumentado la prevalencia de las enfermedades del sistema eléctrico de conducción cardíaca y, con ello, la indicación e implante de marcapasos. Objetivo: Identificar los factores de riesgo de infección tras la implantación de marcapasos permanente. Métodos: Se realizó un estudio analítico, de casos y controles, de los 192 pacientes, a los cuales se les implantó marcapasos permanente entre enero de 2017 y diciembre de 2019 en el Servicio de Cardiología del Hospital Clinicoquirúrgico Docente Celia Sánchez Manduley de la provincia de Granma. El grupo de estudio estuvo integrado por los 38 que presentaron infección tras ese proceder y por cada paciente de este grupo se escogieron 2, que también recibieron este dispositivo y no tuvieron infección, que formaron parte de los controles. Se estudiaron variables dependientes del paciente, del dispositivo, del proceder y de los exámenes practicados. Se utilizaron el test de Fisher y la prueba de la X2 para variables cualitativas, según correspondiera y la prueba de la T de Student para las cuantitativas. Para determinar los factores de riesgo de infección se utilizó un modelo de regresión logística. Resultados: Prevaleció el sexo masculino (60,5 %) y la media de edad fue de 76,1 años. Como factores de riesgo predominaron el uso de antiagregantes y anticoagulantes, el antecedente de diabetes mellitus y las cifras de glucemia mayores de 8,0 mmol/L. Conclusiones: Existen factores de riesgo de infección modificables, por lo que constituye un gran reto médico actuar sobre estos para prevenir complicaciones letales para la vida.

Introduction: The higher life expectancy in the general population has increased the prevalence of diseases of the heart conduction of electric system and, with it, the indication and implant of pacemaker. Objective: To identify the risk factors of infection after the permanent pacemaker implantation Methods: A cases and controls analytic study of 192 patients, to whom a permanent pacemaker was implanted between January, 2017 and December, 2019 was carried out in the Cardiology Service of Celia Sánchez Manduley Teaching Clinical Surgical Hospital from Granma. The study group was integrated by the 38 patients that presented infection after that procedure and every each patient of this group 2 were chosen that also received this device and had no infection that were part of the control group. The variables dependent on the patient, the device, the procedure and the exams were studied. The Fisher test and the chi-square test were used for qualitative variables, as corresponded and the Student t test for the quantitative variables. To determine the risk factors of infection a model of logistical regression was used. Results: The male sex prevailed (60.5 %) and the mean age was of 76.1 years. As risk factors the use of antiagregants and anticoagulants, history of diabetes mellitus and glucemia figures higher than 8.0 mmol/L prevailed. Conclusions: There are modifiable risk factors of infection, what constitutes a great challenge in medicine to influence on these factors to prevent lethal complications for life.

Significación del lactato sérico como biomarcador de infección del neonato intervenido quirúrgicamente / Significance of serum lactate as a biomarker of infection of the newborn undergoing surgery

Introducción: El neonato que se interviene quirúrgicamente está expuesto al desarrollo de infecciones. El lactato sérico ha sido recomendado como criterio diagnóstico de sepsis. Objetivo: Determinar la magnitud de asociación del valor del lactato sérico con la sepsis en el neonato intervenido quirúrgicamente. Métodos: Estudio entre 2013 y 2016, en el Hospital Pediátrico Universitario William Soler, en 307 neonatos intervenidos quirúrgicamente. Las variables se agruparon en: clínicas (edad gestacional, peso al nacer, causa de la intervención quirúrgica, localización de la infección) y paraclínicas (microorganismo causal, lactato sérico). Se aplicó la prueba de correlación lineal de Pearson parcial y se estimó odds ratio con el control de la variable infección (sí y no) para identificar la correlación entre los valores de lactato sérico en el preoperatorio y en el posoperatorio. Resultados: De los neonatos 63 tenían bajo peso (20,52 por ciento) y 55 eran pretérminos (17,92 por ciento). En los neonatos infectados 20,83 por ciento fueron operados por afecciones digestivas (n= 35); las infecciones sistémicas alcanzaron 67,74 por ciento (n= 42), ocasionadas en 45,24 por ciento por Cándida sp. La velocidad de cambio de los valores del lactato sérico en los infectados (p= 0,001) significó que por cada unidad en mmol/L que ascendió el lactato preoperatorio, en el posoperatorio se incrementó 0,489 mmol/L y estos cambios fueron debidos en 16,9 por ciento a los valores del lactato preoperatorio. Conclusiones: El lactato sérico está asociado a la infección en los neonatos intervenidos quirúrgicamente y es un biomarcador de sepsis útil en los cuidados intensivos neonatales(AU)

Introduction: The newborn undergoing a surgery is exposed to the development of infections. The serum lactate has been recommended as a diagnostic criterion of sepsis. Objective: To determine the magnitude of association of the value of serum lactate with sepsis in the newborn undergoing a surgery. Methods: Study conducted from 2013 to 2016 in William Soler Pediatric Teaching Hospital, to 307 newborns whom underwent surgery. The variables were grouped in: clinical (gestational age, birth weight, cause of surgical intervention, location of the infection) and paraclinical (causative microorganisms, serum lactate). The partial Pearson's test of linear correlation was applied and it was estimated the odds ratio with the control of the variable infection (yes and no) to identify correlation between serum lactate values in the preoperative and postoperative results. Results: Of the newborns, 63 were under weight (20.52 percent) and 55 were preterm infants (17.92 percent). In the infected newborns, 20.83 percent were operated due to digestive conditions (n= 35); systemic infections reached 67.74 percent (n= 42), caused in 45.24 percent by Candida sp. The rate of change of the values of serum lactate in infected subjects (p= 0.001) meant that for each unit in mmol/L in which increased the preoperative lactate, the postoperative increased 0.489 mmol/L; and these changes were due in a 16.9 percent to the values of preoperative lactate. Conclusions: The serum lactate is associated to the infection in newborns that underwent surgery and is a useful biomarker of sepsis in neonatal intensive care(AU)

Hemoglobina Glicosilada un factor aliado en la Prevención de Infección Postquirúrgica del Pie Diabético / Glycosiled Hemoglobin A Factor Allied In The Prevention Of Post-Surgical Infection Of The Diabetic Foot

En este trabajo se ha realizado una búsqueda exhaustiva de estudios que evidencien el efecto de la Hemoglobina glicosilada (HbA1c) en el desarrollo de infección post quirúrgica en paciente con pie diabético. En nuestro país la prevalencia de pacientes con diabetes mellitus alcanza hasta un 8.4%, al respecto se sabe que una de las mayores complicaciones de esta enfermedad es el desarrollo de pie diabético y que consecuentemente a esta patología hasta un 20% de estos pacientes termina en una amputación, se sabe también que los pacientes con diabetes mellitus tienen un alto riesgo de complicaciones postoperatorias, incluyendo infecciones, curación inadecuada de heridas, eventos cardiovasculares, trombo embolismo venoso, y la mortalidad. Debido a que se ha pensado que la hiperglucemia media este riesgo, sean realizado diferentes estudio internacionales que buscan comprobar y dar a conocer esta asociación, sin embargos, debido a que no se han encontrado estudios nacionales al respecto, no se puede hacer conclusiones sólidas para nuestra población, por lo cual este manuscrito pretende motivar a la realización de los mismos que reflejen la problemática nacional

In this work an exhaustive search has been made of studies that show the effect of glycosylated hemoglobin (HbA1c) in the development of post surgical infection in diabetic foot patients. In our country the prevalence of patients with diabetes mellitus reaches up to 8.4%, in this regard it is known that one of the biggest complications of this disease is the development of diabetic foot and that consequently to this pathology up to 20% of these patients end in An amputation, it is also known that patients with diabetes mellitus have a high risk of postoperative complications, including infections, inadequate wound healing, cardiovascular events, venous embolism thrombus, and mortality. Because it has been thought that hyperglycemia mediates this risk, different international studies are carried out that seek to verify and publicize this association, however, because no national studies have been found in this regard, no solid conclusions can be drawn for our population, for which this manuscript aims to motivate the realization of them that reflect the national problem

Meta-analysis of independent risk factors for surgical site infection after spinal surgery / 中国组织工程研究

BACKGROUND: The risk factors of surgical site infection after spinal surgery are diverse and complex. At present, there is still a great controversy on the study of the risk factors of postoperative infection of spine. OBJECTIVE: To systematically evaluate the independent risk factors of surgical site infection after spinal surgery, and to provide theoretical basis for the prevention and treatment of surgical site infection. METHODS: Between January 2004 and June 2019, the Chinese and foreign databases were retrieved. According to the inclusion and exclusion criteria, we collected case-control and cohort studies on independent risk factors for surgical site infection after surgery. After extraction of available data, independent risk factors (hypertension, diabetes, obesity, smoking, history of surgery) for the merger OR value and 95%CI were calculated by using the fixed effect model and random effect model for meta-analysis. The consistency of the results was compared. The reliability of the merge result was analyzed. RESULTS AND CONCLUSION: (1) A total of 19 articles were included, with 1 008 cases of surgical site infection, and the control group contained 7 527 cases. (2) The independent risk factors for merger OR value (95%CI) from high to low in turn were diabetes (OR=3.24, 95%CI: 2.09-5.02), obesity (OR=2.99, 95%CI: 1.77-5.05), surgical history (OR=2.12, 95%CI: 1.79-2.50), hypertension (OR=1.90, 95%CI: 1.34-2.69), and smoking (OR=1.85, 95%CI: 1.39-2.48). (3) Results indicated that diabetes, hypertension, obesity, smoking and surgical history are all independent risk factors for the occurrence of surgical site infection after spinal surgery, and each independent risk factor is positively correlated with the occurrence of surgical site infection after spinal surgery.

El efecto inhibitorio del EDTA sobre el crecimiento microbiano en suspensiones de propofol / The inhibitory effect of EDTA on microbial growth in propofol suspensions

Resumen: Las suspensiones comerciales de propofol, por su composición farmacéutica, soportan el crecimiento de diversos microorganismos; la aplicación de propofol, contaminado microbianamente luego de ser retirado de su envase original, ha sido vinculada a brotes de infección postoperatoria. La adición de sales de ácido etilendiaminotetraacético (EDTA) retarda el crecimiento de estos microorganismos. Aquí se comparó el crecimiento, a lo largo de 48 horas y en tres temperaturas (ambiente, 35 y 42 oC), de siete cepas bacterianas y tres de levaduras, en cuatro formulaciones de propofol disponibles en México, una de ellas adicionada con EDTA. Consistentemente, el crecimiento fue menor en la suspensión con EDTA, comparada con las tres que no lo contienen, con variaciones entre microorganismos y temperaturas: desde muerte inicial de parte del inóculo, o inhibición completa y sostenida del crecimiento, hasta inhibición parcial. Aunque la adición de EDTA no debe considerarse como un sustituto del manejo aséptico del propofol, que debe extenderse durante el período perioperatorio, ciertamente disminuye la proliferación microbiana que puede darse por contaminación accidental, disminuyendo asimismo el riesgo de infección para el paciente.

Abstract: Commercially available propofol suspensions, due to their pharmaceutical composition, support the growth of several microorganisms; the administration of propofol suspensions that became microbially-contaminated after being removed from their original vial, has been linked to postsurgical infections. Addition of ethylenediaminetetracetic acid (EDTA) salts delays the growth of such microorganisms. Here, we compared the growth of seven bacterial strains and three yeast strains, along 48 hours and at three different incubation temperatures (room temperature, 35 and 42 oC), in four propofol formulations available in Mexico, one of them with supplemented EDTA. Consistently, microbial growth was diminished in the formulation supplemented with EDTA, compared to the other three, although with variations between microorganisms and incubation temperatures: from initial reduction in viable organisms, to complete and sustained growth inhibition, to only partial growth inhibition. While the addition of EDTA to propofol suspensions must not be considered as a substitute for aseptic handling of the drug, it certainly diminishes microbial growth that can occur after accidental contamination, reducing the infection risk for the patient.

Analysis of 11 cases of ABO incompatible living kidney transplantation / 器官移植

Objective To evaluate the clinical efficacy and safety of ABO incompatible living kidney transplantation(ABOi-KT). Methods Clinical data of 11 donors and recipients with ABOi-KT were retrospectively analyzed. All the recipients were treated with desensitization before operation. The recovery condition of renal function and blood type antibody titer of the ABOi-KT recipients were monitored after operation. The incidence of complications and clinical prognosis of ABOi-KT recipients were observed. Results The serum creatinine (Scr) of 11 recipients were well recovered after ABOi-KT. No delay in recovery of graft renal function. Among them, 2 recipients experienced a significant increase in the Scr level at postoperative 14 and 45 d respectively, 1 recipient showed criticality cellular rejection after operation and 1 recipient presented with elevated Scr level at postoperative 33 d, accompanied by an increase in blood type antibody titer. The condition became stable after corresponding treatment. The remaining 7 recipients obtained normal graft renal function and postoperative blood type antibody titer did not rebound. During postoperative follow-up until November 2018, no recipient died or graft renal failure occurred. The survival rate of the recipient and graft renal was 100%. Among them, 3 patients suffered from postoperative complications, including pulmonary infection, BK viruria and granulocytopenia, which were cured after symptomatic treatment. Conclusions ABOi-KT is safe, feasible and yields high long-term clinical efficacy, which can increase the source of living donor kidney and relieve the shortage of donor kidney.

Epidemiological and lethal risk factors of Klebsiella pneumoniae infection in neurosurgical patients / 中国综合临床

Objective We performed a retrospective study to determine the epidemiological characteristics of Klebsiella pneumoniae infection after neurosurgery and to elucidate the risk.Methods Patients who underwent neurosurgery between January 2012 and December 2016 were included.Demographic,clinical,laboratory,and microbiological data were systemically recorded.17 clinical trials and 7 clinical laboratory indicators were evaluated as risk factors for meningitis.Results Forty-five cases of neurosurgery patients led to K.pneumoniae infection were analyzed,K.pneumoniae ESBLs production ratio is 37.8％ (17/45),the sensitivity rate of carbapenem antibiotics was more than 80.0％ (36/45).The patients were mainly in the north of China with an average age of 36.3±18.3 years old and a male ratio of 53.3％ (24/45).The highest proportion of patients are pituitary adenoma and glioblastoma and the mortality rate was 22.2％ (10/45).The mean length of hospital stay was 29.2± 13.7 days,and the most likely to develop K.pneumoniae were 7.8±6.9 days after neurosurgery.The ICU occupancy rate was 51.1％ (23/45).Chi-square test showed that older age (＞50 years old) and sepsis were risk factors for death from K.pneumoniae infection after neurosurgery.Multivariate logistic analysis showed that the risk of infection was associated with the incidence of sepsis (OR 16.199,P =0.010).There were no statistically significant differences between the survival and death patients by seven laboratory tests (P＞0.05).Conclusion The infection of neurosurgery caused by K.pneumoniae has a high mortality rate.Among them,concurrent sepsis is the lethal risk factor of infection.Clinically,identification of the risk factors as soon as possible will help physicians to improve patient care and improve the surgical success.

Cellular immune level changes of patients with different grades of glioma in perioperative period and its relationship with postoperative intracranial infection / 肿瘤研究与临床

Objective To detect the changes of cellular immune level in patients with different grades of glioma in perioperative period, and to investigate its relationship with the postoperative intracranial infection. Methods A total of 53 patients with glioma newly diagnosed by pathology who underwent the surgical treatment in the First Hospital of Shanxi Medical University from September 2017 to September 2018 were collected. According to the World Health Organization (WHO) classification criteria, the patients were divided into the low-grade group (grade Ⅰ-Ⅱ, 21 cases) and the high-grade group (grade Ⅲ-Ⅳ, 32 cases). The peripheral blood at the time of 1 day before the operation, 1 day and 7 days after the operation was drawn to detect the T lymphocyte subsets, and then the differences of cell immunity indexes from different grade gliomas were analyzed. The relationship between immune level and postoperative intracranial infection was analyzed. SPSS 22.0 statistical software was used to analyze the data. Results The levels of CD3+, CD4+, CD8+, CD4+CD25+Foxp3+and CD4+/CD8+in the high-grade group at the time of 1 day before the operation were (54.09±4.25)％, (31.93±3.08)％, (34.23±2.48)％, (9.66±1.47)％, 0.93±0.06, respectively; the levels at the time of 1 day after the operation were (48.84±3.69)％, (27.49±2.41)％, (34.99±2.96)％, (11.09±1.70)％, 0.84± 0.05, respectively; the levels at the time of 7 days after the operation were (59.45 ±3.47)％, (33.59 ±2.66)％, (31.99±1.97)％, (7.45±1.48)％, 1.05±0.07, respectively. The levels of CD3+, CD4+, CD8+, CD4+CD25+Foxp3+and CD4+/CD8+in the low-grade group at the time of 1 day before the operation were (62.37±6.57)％, (34.88± 4.43)％, (30.16 ±3.75)％, (6.30 ±1.29)％, 1.16 ±0.11, respectively; the levels at the time of 1 day after the operation were (55.44 ±7.25)％, (29.05 ±4.04)％, (31.66 ±3.13)％, (7.95 ±1.67)％, 0.92 ±0.11, respectively; the levels at the time of 7 days after the operation were (67.73 ±7.18)％, (35.55 ±4.95)％, (28.10 ±3.12)％, (5.50 ± 1.25)％, 1.27±0.12, respectively. The levels of CD3+, CD4+, CD4+/CD8+before and after the operation in the high-grade group were lower than those in the low-grade group (all P< 0.05), while the levels of CD8+and CD4+CD25+Foxp3+were higher than those in the low-grade group (all P<0.05). Compared with the levels at the time of 1 day before the operation, the levels of CD3+, CD4+, CD4+/CD8+at the time of 1 day after the operation of both groups were decreased, while the levels of CD8+and CD4+CD25+Foxp3+were increased (all P< 0.05). The levels of CD3+, CD4+and CD4+/CD8+ at the time of 7 days after the operation in the both groups were increased, while the levels of CD8+ and CD4+ CD25+ Foxp3+ were decreased (all P< 0.05). Among 53 patients, 8 cases had postoperative intracranial infection, and the infection rate was 15.09％. Age, duration of surgery, pathological stage, and intraoperative blood transfusion were the independent affecting factors of postoperative intracranial infection of cerebral glioma (OR= 1.513, P= 0.024; OR= 1.722, P<0.01; OR= 1.365, P= 0.001; OR= 1.262, P< 0.01). Conclusions The peripheral blood cellular immune level of glioma patients is related with the malignancy of glioma. The inhibition degree of the cellular immunity could be relieved after the resection of glioma. The detection of T lymphocyte subsets could be considered as an evaluating index for the malignancy and prognosis in patients with glioma. The clinical detection of cellular immune can play a positive role in predicting and preventing the postoperative intracranial infection in patients with glioma.

Pathogenic bacteria distribution and drug resistance of postoperative infection in elderly patients with gastric cancer complicated with diabetes mellitus / 国际检验医学杂志

Objective To investigate the distribution and drug resistance of pathogens in elderly patients with gastric cancer complicated with diabetes mellitus.Methods 367 elderly patients with gastric cancer and diabetes mellitus were selected from the hospital from March 2010 to March 2017.The samples were isolated and cultured.The Gram positive bacteria were tested by GN201,the Gram negative bacteria susceptibility test was carried out by GP,and the drug susceptibility test was carried out by disk diffusion method.Results There were 68 cases of postoperative infection in gastric cancer patients with diabetes mellitus,and 79 strains were isolated and cultured.Among the gram negative bacteria,Escherichia coli,Klebsiella pneumoniae and Pseudomonas aeruginosa were the main pathogens.Among the Gram positive bacteria,Staphylococcus aureus and Staphylococcus epidermidis were the main pathogens.The main Gram negative bacteria,Escherichia coli to ceftazidime with levofloxacin resistance rates were 93.33% and 80.00%;Klebsiella pneumoniae had a higher drug resistance rate for cefoperazone and ciprofloxacin,76.92% and 69.23% respectively;a relatively high rate of Pseudomonas aeruginosa resistant to levofloxacin was 80.00%.Among the gram positive bacteria,the re-sistance rates of Staphylococcus aureus to penicillin and erythromycin were relatively high,respectively 91. 67% and 83.33%.Staphylococcus epidermidis had relatively high resistance rates to penicillin and erythromy-cin,100.00% and 77.78% respectively.Conclusion Gastric cancer complicated by diabetes mellitus elderly patients with postoperative infection of pathogenic bacteria distribution is given priority to with Gram-negative bacteria was the most common in,Pseudomonas aeruginosa,the main pathogenic bacteria of Escherichia coli to ceftazidime with levofloxacin resistant rate of Klebsiella pneumoniae was higher on cefoperazone and ciproflox-acin resistant Pseudomonas aeruginosa,the resistance rate of Pseudomonas aeruginosa to levofloxacin is high, and it is important to apply antibiotics rationally according to drug sensitivity test.

The influencing factors for the infection occurring after TACE in patients with liver cancer / 介入放射学杂志

Objective To investigate the incidence and influencing factors of postoperative infection in patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods A retrospective study was conducted on the HCC patients who received TACE during the period from January 2016 to December 2016. The possible risk factors that might induce postoperative infection after TACE were evaluated by using univariate analysis and multivariate logistic regression analysis. The risk factors were further stratified into very high risk factors, high risk factors, moderate risk factors and low risk factors. Results Among 386 HCC patients who showed effective response to TACE, postoperative infection occurred in 17 patients, the incidence rate was 4.4％. Ascites, history of hepatobiliary resection surgery or preoperative liver cancer rupture with bleeding, history of liver abscess or previous postoperative infection after TACE were the very high risk factors of infection after TACE. Preoperative serum total protein value <60 g/L was a high risk factor. The presence of tumor thrombus in portal vein or in vena cava was a moderate risk factor. Conclusion Ascites, previous hepatobiliary surgery, preoperative liver cancer rupture with bleeding, history of liver abscess and history of infection after TACE are significantly correlated with the occurrence of infection after TACE.

Influence of postoperative infection on hospitalization day and medical costs of patients with nervous system tumor / 中华流行病学杂志

Objective To investigate the influence of postoperative infection on average hospitalization days and medical costs in patients with nervous system tumor.Methods The tumor patients treated in neurosurgery ward from July 1,2015 to June 30,2017 were included in the study.The patients with and without postoperative infections were divided into a case group and a control group,respectively (1:1 ratio),matched by admission time (± 3 months),age (± 5 years) and surgical site.Average hospitalization days and medical costs between the two groups were analyzed.Results The incidence of postoperative infection was 5.66％,the surgical site infection and lower respiratory tract infection accounted for 54.72％ and 31.32％ of the total,respectively.The median of hospitalization days in the case group was 20.5,8.5 days longer than that in the control group (Z=-10.618,P＜0.001).The median of total medical costs in the case group was 91 573.42 yuan,higher than that of the control group by 30 518.17 yuan (Z=-9.988,P＜0.001).The average costs of surgical and lower respiratory tract infection were 84 888.50 yuan and 110 442.64 yuan,respectively.Among them,surgical site infection or lower respiratory tract infection caused the extra cost of 23 627.49 yuan (Z=-6.627,P＜0.001) and 43 631.36 yuan (Z=-4.954,P＜0.001),respectively.Conclusions Postoperative infection greatly increased the patient's financial burden,prolonged the hospitalization duration and resulted in unnecessary use of health resources.It is necessary to pay close attention to postoperative infection.

Influence of postoperative infection on hospitalization day and medical costs of patients with nervous system tumor / 中华流行病学杂志

Objective To investigate the influence of postoperative infection on average hospitalization days and medical costs in patients with nervous system tumor.Methods The tumor patients treated in neurosurgery ward from July 1,2015 to June 30,2017 were included in the study.The patients with and without postoperative infections were divided into a case group and a control group,respectively (1:1 ratio),matched by admission time (± 3 months),age (± 5 years) and surgical site.Average hospitalization days and medical costs between the two groups were analyzed.Results The incidence of postoperative infection was 5.66％,the surgical site infection and lower respiratory tract infection accounted for 54.72％ and 31.32％ of the total,respectively.The median of hospitalization days in the case group was 20.5,8.5 days longer than that in the control group (Z=-10.618,P＜0.001).The median of total medical costs in the case group was 91 573.42 yuan,higher than that of the control group by 30 518.17 yuan (Z=-9.988,P＜0.001).The average costs of surgical and lower respiratory tract infection were 84 888.50 yuan and 110 442.64 yuan,respectively.Among them,surgical site infection or lower respiratory tract infection caused the extra cost of 23 627.49 yuan (Z=-6.627,P＜0.001) and 43 631.36 yuan (Z=-4.954,P＜0.001),respectively.Conclusions Postoperative infection greatly increased the patient's financial burden,prolonged the hospitalization duration and resulted in unnecessary use of health resources.It is necessary to pay close attention to postoperative infection.

Analysis of the risk factors, pathogenic bacteria and drug resistance of postoperative infection in patients with colorectal cancer / 新乡医学院学报

Objective To analyze the risk factors for postoperative infection of patients with colorectal cancer,and to investigate the distribution of pathogenic bacteria and drug resistance.Methods A total of 300 patients with colorectal cancer who underwent operation were selected from June 2013 to June 2017 in the Central Hospital of Tongchuan Mining Bureau,and the patients were divided into the infection group and the non-infection group according to the postoperative infection.The clinical data were compared between the two groups,and the risk factors for postoperative infection in colorectal cancer patients were analyzed by logistic regression.The total automatic bacterial culture apparatus was used for bacterial culture,and the drug sensitivity test was carried out by Kirby-Bauer.Results Among the 300 colorectal cancer patients,there were 61 cases of incision infection (infection group) and 239 cases without incision infection (non-infection group) after operation,the postoperative infection rate was 20.33％ (61/300).There were significant differences in the operation method,red blood cell counts,the levels of albumin,prealbumin and hemoglobin between the two groups (P ＜ 0.05);but there was no significant difference in sex,age,body mass index,diabetes mellitus history,abdominal surgery history,smoking history,drinking history,operation time,intraoperative bleeding volume,hospitalization time,indwelling time of urethral catheter,white blood cells and C-reactive protein levels between the two groups(P ＞ 0.05).Multiple factor logistic regression analysis showed that the decrease of albumin and prealbumin level was the independent risk factor for postoperative infection in patients with colorectal cancer (P ＜0.05).A total of 52 strains of pathogenic bacteria were detected in 61 cases of colorectal cancer combined with postoperative infection,including 38 strains of gram negative bacteria (73.08％),10 strains of gram positive bacteria (19.23％) and 4 strains of fungi (7.69％).Escherichia coli,Klebsiella pneumoniae,Enterobacter cloacae,Pseudomonas aeruginosa had high drug resistance to ampicillin,cefaclor,ceftriaxone,ceftizoxime,cefepime,cefoperazone,ceftazidime and ofloxacin;but they had low drug resistance to piperacillin,imipenem and amikacin.Conclusion The incidence of postoperative infection in patients with colorectal cancer is higher,the decrease of albumin and prealbumin is the independent risk factor for postoperative infection in patients with colorectal cancer.Gram-negative bacteria are the main pathogens of postoperative infection in patients with colorectal cancer and have high resistance to common antibiotics.