Analysis of Nosocomial Infections in Post-Cardiac Surgery Extracorporeal Membrane Oxygenation Support Therapy.

OBJECTIVES: This study aims to analyze the nosocomial infection factors in post-cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). METHODS: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%). RESULTS: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000). CONCLUSIONS: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.

Utility of multiple-locus variant-repeat analysis method for the outbreak of the Pseudomonas aeruginosa isolates.

BACKGROUND: Pseudomonas aeruginosa (P. aeruginosa) predominated in hospitals. METHODS: In order to determine the source of the outbreak and take effective measures to prevent the spread, we tested their relationships between the strains. 97 P. aeruginosa samples were analyzed by multiple-locus variable-number tandem repeat (VNTR) analysis (MLVA) method. In order to identify a minimal subset that could provide high discrimination, we evaluated the ability of various VNTR sets. RESULTS: The result showed all of the 11 loci displayed high discrimination, and the lowest loci was ms223 (h = 0.59). The 97 strains were all discriminated (HGDI = 1.0000). The top 7-locus set produced a HGDI value of 1.0000, which was the same as the 11-locus set. The 4-locus set had a HGDI value of 0.9972 with a clustering rate of 11.3%. The strains were divided into four groups based on the phylogenetic clustering and genotypic characteristics. There were obvious differences among the four groups regarding the drug-resistance patterns of Imipenem, Ciprofloxacin, Ceftazidime, Levofloxacin, Meropenem, Piperacillin, Cefepime, Aztreonam (p < 0.05). CONCLUSIONS: In conclusion, the transmission of the strains was not found in this study. The 7-locus set yielded a high discrimination, while for an easier and more robust MLVA scheme, the number of markers can be reduced to 4 loci of ms212, ms211, ms213, and ms142. These four strains from four inpatients in the same ward displayed the same drug resistance spectrum. The MLVA genotype results showed the four strains had the same gene structures. The four patients were from the same treatment group. They showed the IMP-1 allele and belonged to the aac (6')-I type, and there was a deletion of the OprD2 gene in four strains, supporting the MLVA results in suggesting that they are similar.

Antidepressant Active Components of Bupleurum chinense DC-Paeonia lactiflora Pall Herb Pair: Pharmacological Mechanisms.

Depression is a serious psychological disorder with a rapidly increasing incidence in recent years. Clinically, selective serotonin reuptake inhibitors are the main therapy. These drugs, have serious adverse reactions, however. Traditional Chinese medicine has the characteristics of multiple components, targets, and pathways, which has huge potential advantages for the treatment of depression. The antidepressant potential of the herbal combination of Bupleurum chinense DC (Chaihu) and Paeonia lactiflora Pall (Baishao) has been extensively studied previously. In this review, we summarized the antidepressant active components and mechanism of Chaihu-Baishao herb pair. We found that it works mainly through relieving oxidative stress, regulating HPA axis, and protecting neurons. Nevertheless, current research of this combined preparation still faces many challenges. On one hand, most of the current studies only stay at the level of animal models, lacking of sufficient clinical double-blind controlled trials for further verification. In addition, studies on the synergistic effect between different targets and signaling pathways are scarce. On the other hand, this preparation has numerous defects such as poor stability, low solubility, and difficulty in crossing the blood-brain barrier.

[Pathogenicity of hp jhp947 gene to C57BL/6 mice].

OBJECTIVE: To study the effects of Helicobacter pylori jhp947 gene on the pathogenesis of epithelial cells and gene express pattern by animal studies. METHODS: Twenty-seven special pathogen free (SPF) C57BL/6 mice were divided equally into 3 groups, and challenged with Helicobacter pylori J99, Helicobacter pylori deltaJ99-947 and phosphate buffer (PBS) respectively, at a dose of 10(9) colony formine unit (CFU) at 0, 2, and 4 days. Mice were sacrificed 4 weeks after the last challenge, and went through rapid urease test, culture of Hp, histological examination, immunofluorescent histochemistry and semiquantitative reverse transcription PCR (RT-PCR) of gastric mucosa. RESULTS: The result of rapid urease test and culture of Hp indicated that the positive rates in J99 and deltaJ99-947 group were both 100% while 0% in PBS group. The result of histology examination indicated that garstric mucosa is all normal in PBS group; in J99 group, 33.3% (3/9) had slightly anabrosis, 66.7% (6/9) had seriously anabrosis; in deltaJ99-947 group, 22.2% (2/9) is normal, 77.8% (7/9) had slightly anabrosis. The degree of anabrosis seems to be more severe in J99 than in deltaJ99-947. The result of immunofluorescent histochemistry and semiquantitative RT-PCR of gastric mucosa indicated that the expression level of ets homologous factor, N-myc downstream regulated gene 1, methylthioadenosine phosphorylase is significantly lower in J99 than in deltaJ99-947 group (P < 0.05). CONCLUSION: The degree of anabrosis seems to be more severe in Hp with jhp947 gene than in Hp without jhp947 gene. In vivo, jhp947 may induce tumorigenesis by inhibiting anti-oncogenes (N-myc downstream regulated gene 1 and methylthioadenosine phosphorylase).

Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy. / Factores de riesgo de las infecciones nosocomiales en pacientes que reciben oxigenación por membrana extracorpórea.

BACKGROUND AND OBJECTIVE: The aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support. PATIENTS AND METHODS: Clinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively. RESULTS: Among 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population. CONCLUSIONS: ECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible.

Factores de riesgo de las infecciones nosocomiales en pacientes que reciben oxigenación por membrana extracorpórea / Risk factors for nosocomial infections in patients receiving extracorporeal membrane oxygenation supportive therapy

Antecedentes y objetivo: El objetivo de este estudio fue analizar los factores de riesgo de la infección nosocomial (IN) en pacientes que reciben soporte de extracorporeal membrane oxygenation (ECMO, «oxigenación por membrana extracorpórea»). Pacientes y métodos: Se recolectaron los datos clínicos de las IN de los pacientes que recibieron tratamiento de soporte ECMO, analizándose retrospectivamente. Resultados: Entre los 75 pacientes con ECMO, se encontró que 20 habían desarrollado IN (tasa de infección del 26,7%), aislándose un total de 58 patógenos, incluyendo 43 cepas de bacterias gramnegativas (74,1%) y 15 cepas de bacterias grampositivas (25,9%). Las cepas resistentes a múltiples fármacos se hallaban altamente concentradas, componiéndose principalmente de Acinetobacter baumannii, Pseudomonas aeruginosa y estafilococos coagulasa negativos. La incidencia de IN se relacionó con la duración del tratamiento de soporte ECMO y la estancia hospitalaria total, siendo las diferencias estadísticamente significativas (p<0,05). Un período prolongado de soporte ECMO ampliaba la estancia hospitalaria, aunque no incrementaba la tasa de mortalidad. Sin embargo, la elevación del nivel de ácido láctico incrementaba la tasa de mortalidad en esta población de estudio. Conclusiones: Las IN secundarias asociadas a ECMO guardaron una correlación considerable con la duración de la estancia hospitalaria y la duración del soporte ECMO. Por tanto, para reducir la incidencia de las IN asociadas a ECMO, deberán aplicarse estrategias en aras de reducir la duración del tratamiento de soporte ECMO y evitar la hospitalización prolongada, cuando ello sea posible (AU)

Background and objective: The aim of this study was to analyze risk factors for nosocomial infection (NI) in patients receiving extracorporeal membrane oxygenation (ECMO) support. Patients and methods: Clinical NI data were collected from patients who received ECMO support therapy, and analyzed retrospectively. Results: Among 75 ECMO patients, 20 were found to have developed NI (infection rate 26.7%); a total of 58 pathogens were isolated, including 43 strains of gram-negative bacteria (74.1%) and 15 strains of gram-positive bacteria (25.9%). Multi-drug resistant strains were highly concentrated and were mainly shown to be Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Incidence of NI was related to the duration of ECMO support therapy and the total length of hospital stay, and the differences were statistically significant (P<.05). A prolonged period of ECMO support extended the hospital stay, but it did not increase the mortality rate. However, an elevated level of lactic acid increased the mortality rate in this study population. Conclusions: ECMO-associated secondary NIs correlated significantly with the length of hospital stay and with the duration of ECMO support. Therefore, to reduce the incidence of ECMO-associated NIs, preventive strategies that aim to shorten the duration of ECMO support therapy and avoid lengthy hospitalization should be applied, wherever possible (AU)