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Objective:To investigate the etiological characteristics and drug resistance patterns of multidrug-resistant organism (MDRO) infection in patients after cardiac surgery, so as to help clinicians rationally prescribe antimicrobials recommended by guidelines, increase the success rate of empirical antibacterial therapy and improve the prognosis of inpatients.Methods:Clinical data of 409 patients diagnosed with nosocomial infection (NI) after cardiac surgery from January 2018 to October 2021 were retrospectively collected. According to the results of culture, these cases were divided into two groups: MDR bacterial infection group (MDR, n=176) and non-MDR bacterial infection group (non-MDR, n=233). The etiological characteristics of MDRO infection and the patterns of drug resistance to commonly used clinical antibiotics were analyzed. Meanwhile, the etiological distribution, drug resistance and clinical outcome corresponding to different surgical types and clinical infection types were statistically analyzed. Results:A total of 306 strains of MDR bacteria were detected. Among the 176 patients, 97 (55.1%) were infected with more than one kind of MDRO and the mix infections were mainly caused by Klebsiella pneumoniae, Acinetobacter baumannii and/or Pseudomonas aeruginosa. Carbapenem-resistant (CR) bacteria accounted for 69.6% (213/306). Regardless of surgical type and clinical infection type, Acinetobacter baumannii (114/306, 37.3%) was the most common pathogenic bacteria, followed by Klebsiella pneumoniae (72/306, 23.5%) and Pseudomonas aeruginosa (55/306, 18.0%). Most of the clinical specimens were sputum specimens (528/601, 87.9%) and most of the isolated strains were carbapenem resistant, MDR and extensively drug-resistant (XDR). The positive rates of MDR bacteria were 53.7% and 53.1% in patients undergoing coronary artery bypass grafting (CABG) and aortic surgery, respectively, while the positive rates of pandrug-resistant bacteria were relatively low. In vitro drug sensitivity test results showed that MDR bacteria were highly resistant to levofloxacin (64.4%) and cefepime (61.4%), and then to ciprofloxacin (54.6%), ceftazidime (53.9%) and cotrimoxazole (52.4%). However, the resistance rates to polycolistin (5.5%) and amikacin (7.2%) were low. Compared with non-MDR bacteria, MDR bacteria were less susceptible to ceftazidime (χ 2=156.663, P<0.001), ceftriaxone (χ 2=27.844, P<0.001), cefepime (χ 2=210.181, P<0.001), imipenem (χ 2=173.242, P<0.001), levofloxacin (χ 2=201.521, P<0.001), ciprofloxacin (χ 2=180.187, P<0.001), amikacin (χ 2=16.661, P<0.001), gentamicin (χ 2=46.047, P<0.001), tobramycin (χ 2=106.546, P<0.001), piperacillin (χ 2=7.325, P=0.007), ampicillin/sulbactam (χ 2=5.415, P=0.020), piperacillin/tazobactam (χ 2=139.506, P<0.001), cefoperazone/sulbactam (χ 2=102.832, P<0.001), cotrimoxazole (χ 2=121.217, P<0.001), aztreonam (χ 2=6.977, P=0.008) and minocycline (χ 2=53.107, P<0.001). Although there was no significant difference in the detection rates of pathogenic bacteria between patients undergoing different types of surgery or having different types of infection, the mortality rate of NI after cardiac surgery, especially MDR bacterial infection, was as high as 30.0%. Moreover, the mortality rate was closely related to the types of clinical infection. The all-cause mortality of common pulmonary infection and bloodstream infection (BSI) was 10.0% to 20.0%, and once the patient′s condition was not under control and progressed to severe infection or even septic shock, the all-cause mortality would double. Conclusions:MDR bacterial infections would bring great challenges to patients after cardiac surgery, especially gram-negative bacteria (GNB) such as Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. More than half of the patients would have mixed infections caused by carbapenem resistant, XDR or even pandrug-resistant bacteria, resulting in limited choice of anti-infective drugs and poor prognosis in hospitalized patients.
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Objective:To investigate the clinical and radiological outcomes of ultrasound guided injection of platelet-rich plasma (PRP) in the treatment of intratendinous rotator cuff tear.Methods:A retrospective study was conducted to analyze the clinical data of 43 patients (46 shoulders) who had been treated for intratendinous partial-thickness rotator cuff tear by ultrasound guided injection of PRP consecutively from July 2021 to March 2022 at Department of Sports Medicine, Peking University Third Hospital. There were 23 males and 20 females, with an age of (47.8±13.5) years and a course of disease of 6 (4, 18) months, involving 22 left shoulders and 24 right shoulders. The visual analog scale (VAS) pain score, the University of California at Los Angeles (UCLA) rating scale, and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) were determined before injection and at the last follow-up. The changes in tear size were also evaluated by magnetic resonance imaging (MRI) before PRP injection and 3 to 5 months after PRP injection.Results:The 43 patients were followed up for 15 (12, 17) months after treatment. Of this cohort, 7 shoulders (15.2%, 7/46) were recovered to complete normal and very satisfied with the injection effects while 19 shoulders(41.3%, 19/46) satisfied with the effects after injection, yielding an overall satisfaction rate of 56.5% (26/46). At the last follow-up, the VAS score [3.0 (2.0, 4.0) points], ASES score [80.0 (65.0, 88.8) points], and UCLA score [29.0 (20.0, 32.0) points] were significantly improved compared with those before injection [5.5 (4.0, 8.0) points, 55.0 (39.2, 65.0) points, and 16.0 (12.0, 20.3) points] ( P < 0.05). MRI evaluation showed the tear volume was significantly reduced after PRP injection [46.1 (20.9, 77.5) mm 3 before injection versus 28.2 (12.5, 63.6) mm 3 after injection] ( P<0.05), and a >50% tear volume diminution was observed in 13 shoulders (34.2%,13/38). There were no complications during or after injection. Conclusion:As the ultrasound guided injection of PRP into intratendinous lesions is effective and safe for patients with intratendinous partial-thickness rotator cuff tear, it can be an alternative treatment for the patients or professional athletes who are unwilling to undergo surgery.
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Objective To measure and determine the position of the tibial attachment of the anterior cruciate ligament (ACL)in relation to its anterior ridge on the magnetic resonance imaging (MRI)of normal knee joints,and to explore the clinical role of the anterior ridge in guiding tunnel positioning during ACL reconstruction as well as in facilitating postoperative radiographic evaluation.Methods The knee MRI of one hundred young adult patients with an intact ACL and normal knee joint (mean age:25.1 years,range:18-40 years)was retrospectively reviewed.All MR images were obtained at full extension of the knee on the same MRI machine.Using digital image software on MRI,the measurements in the sagittal view were taken,including the depth of the tibia,the distance from the anterior edge of the tibial plateau to the most anterior and posterior portions of the ACL insertion on the tibia and the anterior ridge according to Staubli and Rauschning's method.Results The center of the tibial insertion of the ACL is located between 28.43％ and 50.94％ of the total anterior-posterior depth of the tibia,which was less than 43.3％ in 58 patients.The average distance from the anterior edge of the tibial plateau to the anterior ridge was 13.61 ± 2.17 mm (ranging from 8.03 to 18.65 mm),26.80％ ±3.89％ (ranging from 17.74％ to 33.94％)across the tibial plateau.There were significant positive correlations between the distance from the anterior edge of the tibial plateau to the most anterior portion of the ACL insertion and that to the anterior ridge.The distance from the most anterior portion of the ACL insertion to the anterior ridge was averaged 0.56 ± 0.68 mm (ranging from-0.28 to 2.71 mm).During the ACL reconstruction,with the anterior edge of the tibial tunnel determined at posterior 0.5 mm to the anterior ridge,the graft size as 8 mm,and the tibial guider angle set as 55 degree,96of the patients (96％)would have the center of the tibial tunnel located before the center of their native ACL attachment.Conclusions On sagittal MR images,the location of the anterior ridge and the most anterior portion of the ACL insertion correlated well,with the average distance between them of 0.56 mm.The study indicates that during ACL reconstruction,tibial tunnel drilling with the anterior edge of the ACL graft positioned at the anterior ridge can achieve a more anterior position than the traditional methods to orientate according to the center of the bone tunnel.
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A method for simultaneous determination of 12 kinds of chlorinated disinfection byproducts (DBPs) in drinking water was developed based on liquid-liquid extraction gas chromatography equipped with electron capture detector (GC/ECD).The procedural standard calibration was adopted to eliminate the interference of different matrix.The method detection limits for 12 DBPs were 0.08-0.21 μg/L and the entire analytical procedure was finished in 21.50 min.The recoveries were in the range of 80.9%-115.7% and the relative standard deviations (RSD) were between 0.9% and 9.9% at different concentration levels (5 and 50 μg/L) in tap water and surface water.The correlation coefficients for all 12 kinds of DBPs were greater than 0.99 in the linearity range of 0.5-200 μg/L.The method was applied to determine DBPs in drinking water and source water.This method was rapid and competent for detection of volatile DBPs in drinking water.
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Objective To investigate the effect of fire needling on tumor marker CA-125 levels and endometrial antibody (EMAb) in endometriosis patients.Methods Eighty endometriosis patients were randomly allocated to a treatment group of 43 cases and a control group of 37 cases. The treatment group received fire needling and the control group took gestrinone capsules. CA-125 levels and EMAb were measured in the two groups before and after treatment.Results CA-125 levels and EMAb positive rate decreased significantly in the two groups after treatment compared with before (P0.05).Conclusion Fire needling has a good interference effect on CA-125 levels and EMAb in endometriosis patients.
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Objective To ob serve the clinical effect of blood-activating and stasis-dissolving drugs combined with western medicine ( WM) for the treatment of recurrent spontaneous abortion ( RSA) induced by prethrombotic state ( PTS). Methods A total of 120 patients with RSA at PTS were randomly assigned to treatment group (68 cases) and control group (52 cases). Patients in both groups were treated with aspirin and low molecular weight heparin, while those in the treatment group additionally received Chinese medicine for activating blood and dissolving stasis. Before and after treatment, indexes of coagulation-fibrinolysis and the development of embryos were compared between the two groups. Results The therapeutic effective rate was 88.24% in the treatment group, higher than that of the control group ( 69.23%, P<0.05). The levels of plasma thrombin time ( TT) , D-dimer, fibrinogen and antithrombin Ⅲ ( AT-Ⅲ) were all improved ( P<0.05) in the two groups after treatment. Besides, the treatment group had better effect on improving levels of plasma D-dimer, fibrinogen and AT-Ⅲ ( P<0.05). During the treatment, no drug-induced adverse reaction was found. Neither neonatal deformity nor maldevelopment occurred. Ninety-seven cases achieved successful pregnancy, and 45 cases had given term girth ( 29 cases from the treatment group and 16 from the control group). Fifty-two cases were in stable middle- and late-stage of pregnancy. Conclusion Therapy of activating blood and dissolving stasis is an effective method for RSA at PTS. It has obvious effects on improving high coagulation state during pregnancy. Chinese medicine combined with WM shows better therapeutic efficacy than WM alone.
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Objective To investigate the clinical efficacy of fire needling in treating endometriosis.Method Fifty-eight endometriosis patients were randomly allocated to treatment and control groups. The treatment group received fire needling at specific points. The treatment was given at one week before menstruation until the end of it, twice a week, three months as a course. The control group took gestrinone 2.5 mg from the first day of menstruation, twice a week, for three consecutive months. The therapeutic effects were evaluated in both groups at three months after the end of treatment.Result The cure rate and the efficacy rate were significantly higher in the treatment group than in the control group (P＜0.05). The pregnancy rate was also higher in the treatment group than in the control group (P＜0.05).Conclusion Fire needling treatment for endometriosis has the advantages of good therapeutic effect, high cure rate and no influence on pregnancy.
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Objective To explore the value of contrast-enhanced ultrasound(CEUS) in the evaluation of the renal cortical perfusion in rabbits in low temperature conditions.Methods 20 New Zealand rabbits were randomly divided into five groups,4 rabbits in each group:1) with the first group as the control group (under the conditions of room temperature) ; 2)The second group was treated under-15℃--23℃ for 8hours; 3)the third group was treated under-15℃--23℃ for 4 hours; 4)the fourth group was treated under-6℃--14℃ for 8 hours; 5) the fifth group was treated under-6℃--14℃ for 4 hours.SonoVue was injected via the ear vein at a dose of 0.1 ml/kg,the renal perfusion imaging was made,observing the dynamic image of 0-3 min after the injection and analyzing the time-intensity curves(TIC)obtained from the following parameters:the slope rate of ascending curve(A),the slope rate of descending curve(α),area under the curve (AUC),time to peak (TTP),and derived peak intensity(DPI).Results Compared with the control group,the A,α of the second and the fourth group were significantly decreased (P ＜ 0.05),while the AUC was significantly increased (P ＜ 0.05) and the TTP was significantly prolonged(P ＜0.05),for the third and the fifth group,only the A was decreased (P ＜0.05),and the DPI in each group showed no significant difference.Compared with the third and the fourth group,the AUC of the second group was increased and the TTP was prolonged (P ＜0.05).Conclusions Contrast-enhanced ultrasound can reflect the earlier renal cortical hemodynamic changes in rabbits in the low-temperature conditions,and is of great value for the early diagnosis of renal damage caused by low temperature.
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Objective To understand the effect of anti-cysticercus therapy for patients with cerebral cysticercosis and the changes of cysticercus on CT image after treatment. Methods The patients with cerebral cysticercosis were classified by the presentation of their brain CT image before treatment, then the effect of anti-cysticercus therapy on them after treatment was analyzed and the presentations of their brain CT images between before and after treatment were compared. Results There were different changes on CT image of cysticercus in brain tissues after anti-cysticercus therapy for different types of patients with cerebral cysticercosis. Type Ⅰ: the focus was absorbed completely after treatment in the majority of patients and calcificated in the minority. Almost all the patients were cured clinically after anticysticercus therapy. Type Ⅱ: the focus was absorbed completely in the minority, and one to two or more calcification dots were observed in the majority of patients. Anti-cysticercus therapy was effective. Type Ⅲ and Ⅳ: the absorption of focus was not very good and the effect of anti-cysticercus therapy was lower relatively. Conclusion The changes of CT image such as absorption, calcification, has important significance in forecasting prognosis and instructing clinical usage.