【 Abstract 】 Objective To investigate the features and risk factors of bacterial infection after orthotopic liver transplantation (OLT) and summarize the experiences for prevention and treatment of infection. Methods The clinical materials of 79 patients underwent OLT from December 2004 to January 2007 were reviewed. The incidence and sites of postoperative bacterial infections as well as species of bacteria and the situation of drug resistance were retrospectively analyzed. Results Thirty-two (40.5%) out of 79 patients developed bacterial infections. Infection mainly occurred in lung, abdominal cavity and blood, which were mainly caused by Escherichia coli, staphylococcus aureus, klebsiella pneumoniae, staphylococcus epidermidis and enterococcus bacteria. The main risk factors included delayed restoration of gastrointestinal function (gt;5 d), poorly preoperative liver function (Child C grade), hypoproteinemia and persistent postoperative hyperglycemia (gt;11.0 mmol/L). Perioperative decontamination in digestive tract was a protective factor in the prevention of bacterial infection. Conclusion Bacterial infection is one of the most severe complications after OLT. Therefore, it is very important to remove those risk factors, make early diagnosis and take effective treatment ．
Abstract A new kind of soft tissue expander with exteriorized injection valve was reported. Two types of expanders were designed: one with single cyst, single tube and single chamber, and the other with single cyst, single tube but double chambers, i.e, an additional drainage chamber. The drainage orifice could be controlled by a valve. An animal experiment had been conducted, and the outcome suggested that the new expander could provide rapid expansion of the soft tissue, sufficient drainage of the expanded area. The bacterial culture showed that among the 42 samples obtained from the expanded cyst, only 3 were positive. (2 of bacteria and 1 of fungus), suggesting comparatively low cyst infection.
Objective To investigate the effect of recombinant human growth hormone (rhGH) on intestinal bacteria and endotoxin translocation in experimental obstructive jaundice. MethodsObstructive jaundice rat models were made and divided into three groups: sham operation (SO) group, obstructive jaundice (OJ) group and obstructive with rhGH (OG) group. The number in each group was 20. The mice in rhGH group underwent subcutaneous injection each day of Saizen, with the dose of 0.75 u/kg, while SO group and OJ group received nitric sodium injection. All these maitained for 2 weeks, then the animals were killed and the endotoxin were determined by limulus test, and bacterial cultures of ascites, blood, mesenchymal lymph node, kidney, spleen and liver were made, and the height of villi and the thickness of intestinal walls were examined.ResultsThe value of endotoxin in OJ group was (0.77±0.03) u/ml, higher than that in OG group and SO group, while it was (0.40±0.02) u/ml and (0.33±0.03) u/ml (Plt;0.01). The bacteria translocation rate in OJ group was 58.8%, much higher than that in OG group, which was 10.0% (Plt;0.01). There was no difference between OG group and SO group (Pgt;0.05). Villi height in OJ group was (183.39±11.09) μm, and thickness was (255.62±16.58) μm. While in OG group was (237.52±13.65) μm, and (320.81±14.34) μm (Plt;0.01) respectively.Conclusion rhGH has significant effect on protecting the injuried mucosa barrier in obstructive jaundice, and can decrease endotoxemia and bacteria translocation.
ObjectiveThe changes of intestinal permeability and relationship of intestinal mucosa and bacterial translocation were studied in rat acute necrotizing pancreatitis (ANP) models.MethodsThe ANP models were made by injection of 5% sodium taurocholate 1.0 ml into pancreatic subcapsula.Then wistar rats were divided into four groups,control group (n=20),ANP group(n=22),treatment model group fed with lactose (n=22) and treatment model group fed with MgSO4 and antibiotic (n=22).After 72 hours,the experimental models were sacrificed.Tissues of pancreas,mesenteric lymph node, ascites were collected for microbiological study.The intestinal permeability was observed by lanthanum tracer.The blood samples were obtained from portal vein and ascites in order to assay the amount of amylase in serum.The pathologic lesions were found in the intestinal villus of the model group, including acute necrosis of intestinal mucosa,necrotichaemorrhage as well as enteroparalysis and a mass of haemorrhagic ascites.ResultsBacterial translocation of model group were markedly elevated than that of control (P＜0.05).There were statistically significant differences in bacterial translocation among three model groups （P＜0.05）.The pathologic lesions were found in the intestinal villus of the model group,including acute necrosis of intestinal mucosa,necrotichaemorrhage as well as enteroparalysis and a mass of haemorrhagic ascites.The lanthanum grain in clearance of intestinal cell of model group can be observed by eletron microscope.ConclusionThere is a severe gut barrier damage and injury in the intestinal mucosa,which lead to bacterial translocation from intestine as the source of pancreatic infection.Cleaning out enteric bacteria,improving intestinal movement and feeding with lactose could decrease bacterial translocation to treat and prevent acute necrotizing pancreatitis.
Objective
To investigate the feasibility of bacterial cellulose patch to repair and reconstruct rabbit tracheal defect, so as to lay the foundation for the development of bacterial cellulose artificial trachea.
Methods
Thirty adult rabbits (weighing, 2.5-3.5 kg) were selected to establish full-thickness defect of the cervical trachea (1.0 cm×0.6 cm in size) which involved the anterior and side walls and 2-3 rings. Defect was repaired with sheet bacterial cellulose (1.2?cm in diameter and 6 layers) in experimental group (n=15), and with autologous cervical fascia in control group (n=15). The general condition of the animals was observed after operation; after 4, 8, and 12 weeks, the samples were obtained for measuring the tracheal stenosis degree, counting new microvessels, and observing lumen reconstruction situation by scanning electron microscope.
Results
Three rabbits died of infection, tracheal stenosis, or asphyxia caused by airway secretions retention in 2 groups respectively, and the other rabbits survived to the end of experiment. Gross observation showed that reconstruction materials gradually adhered?to?adjacent?tissue and were enwrapped?by connective tissue, small blood vessels like nutrient vessel were seen in 2 groups; no significant difference was found in the tracheal lumen stenosis degree between 2 groups (P > 0.05). Histological observation showed that the continuous growth of mucosal epithelial cells was observed near patch and anastomosis site with time, and cell morphology gradually turned mature in experimental group; while mucosal epithelial cells arranged loosely in control group. At each time point, new capillaries of experimental group were significantly more than those of control group (P < 0.05). Scanning electron microscope observation showed the continuous epithelioid cells were observed at anastomosis site with time, and gradually grew into the middle of the patch in experimental group; while less and discontinuous epithelioid cells were observed in control group.
Conclusion
Bacterial cellulose patch is feasible to reconstruct cervical tracheal defect in rabbits, and the new mucosa is formed early and completely, so it is expected to be used as artificial trachea material.
ObjectiveTo investigate the antibacterial pretreatment protocol for primary fibroblast cell culture from transbronchial biopsies in patients with benign tracheal stenosis (BTS).
MethodsFifteen specimens of intratracheal hyperplastic granulation tissue were obtained from 14 BTS patients by transbronchial biopsies. The tissues were divided into 3 groups according to different antibacterial pretreatment with 5 specimens in each group. An usual concentration of antibiotics pretreatment group (group 1) was pretreated by washing with PBS contained 1%-2% penicillin/streptomycin. A high concentration of antibiotics pretreatment group (group 2) was pretreated by washing with PBS contained 6% penicillin/streptomycin. An alchohol and high concentration of antibiotics pretreatment group (group 3) was pretreated by washing with 75% alcohol 3-4 seconds firstly,then by washing with 6% penicillin/streptomycin. After different pretreatment,all tissues were cultured with tissue culture method in the same condition.
ResultsThe primary fibroblasts were successfully cultured from the tissue pretreated by method 2 and 3,but not cultured from the tissue pretreated by method 1 with large amount of bacteria. There were significant differences in the furthest radius of cell proliferation between different culture time points in three groups (P<0.01). The differences in the furthest radius of cell proliferation between three groups were not different at 24,48 or 72 h (P>0.05),but were significant between three groups at 96 h (P<0.05).
ConclusionAn pretreatment protocol with high concentration of antibiotics or 75% alcohol is feasible in human primary fibroblasts culture from small specimens obtained by transbronchial biopsy.
0bjective To study the effect of bacterial infection on acute exacerbation of chronic obstructive pulmonary disease(AECOPD)，and to compare the airway inflammation caused by different isolated bacteria．Methods A total of 159 sputum samples were collected from AECOPD patients diagnosed according to GOLD 2004 standard，in which conventional culture and identification of bacteria was conducted．The patients with purulent sputa were divided into different groups according to bacteria separated．Levels of IL-6．IL-8 and TNF-α in sputum supernatant were assayed and compared in different bacteria groups．the purulent sputum without isolated bacteria group(NG)and normal control group(NC)． Results One hundred and twenty-nine strains of bacteria were isolated in 159 qualified sputa，including 26 strains of Klebsiella pneumoniae(KB)，21 strains of Hemophilus influenza(Hi)，17 strains of Pseudomonas aeruginosa(PA)，37 strains of Haemophilus parainflb~enzae(HP)(mixed infection not included)and 28 strains of other bacteria．Among of all samples，20 were double infection of Haernophilus parainfluenzae with another bacterium．Ninety-seven purulent sputa were collected．According to bacteria isolated，these sputa were divided into five groups，named HP(24 samples)，Hi(20 samples)，PA(16 samples)，KB(19 samples)and NG(18 samples)．Contrast to NC，concentration of IL-8 and TNF-α rose in sputa from which PA，Hi，KB were isolated(Plt;0．05)．The level increased much more in sputa from which PA and Hi were isolated compared with KB(Plt;0．05)．Concentration of IL-6 rose in sputa of each group collected from AECOPD patients contrast to sputa collected from NC(Plt;0．05)，without significant differences among all other group except for NC．Conclusions Bacterial infection plays an important role in AECOPD characterized with high level of inflammatory factors especially when PA，Hi，KB were infected bacteria．This study provides evidence for antibacterial therapy in AECOPD patients．
Objective To determine the effectiveness of percutaneous catheter drainage (PCD) and to compare PCD with percutaneous needle aspiration (PNA) in the management of bacterial liver abscess. Methods The medical records of 206 patients with bacterial liver abscess admitted to this hospital between January 1989 and December 2009 were analyzed retrospectively. The outcomes of 96 patients receiving percutaneous treatment including PCD (PCD group, n=56) and PNA (PNA group, n=40) were compared, including the length of hospital stay, rates of procedure-related complications, treatment success, and death. Results There was no statistical difference in patients’ demographics or abscess characteristics between two groups (Pgt;0.05). The morbidity, mortality, and length of hospital stay in the PCD group and the PNA group were 1.79% vs 2.50%， 1.79% vs 2.50%， and (19.2±13.1) d vs (20.2±12.9) d, respectively, and the P values were 1.000, 1.000, and 0.887, respectively. There was statistically significant difference in successful rate between two groups （96.43% vs 75.00%， P=0.002）, but all simple abscesses with diameter of 5 cm or less were successfully managed in both PNA group and PCD group （13/13 vs 16/17， P=1.000）. Conclusions PCD is more effective than PNA in the management of bacterial liver abscess. PNA can be used as a valid alternative for simple abscesses with 5 cm in diameter or smaller.
ObjectivesTo identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. MethodsWe conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. ResultsThe lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ2=8.338, P=0.004), more application of the combined medicine (χ2=26.3, P<0.001), prolonged hospital stays (χ2=–2.217, P=0.027) and more expenses on antibiotics (χ2=12.855, P=0.005), and the declined survival rates in 14 days (χ2=4.269, P=0.039) and 21 days (χ2 =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ2 =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ2=6.352, P=0.012), tracheotomy (χ2 =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). ConclusionsCRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.
ObjectiveTo review the advances of lymphocinesia in the abdominal cavity infection.
MethodsDomestic and foreign literatures about the research of lymphocinesia in the abdominal cavity infection were collected and reviewed.
ResultsBacterial translocation occurred when abdominal infection happened. At early phase, bacteria and endotoxin translocation could return and arrive the other tissues or organs through the lymphatic system. The peritoneal lymphatic stomata played an important role in lymphatic circulation, with strong absorption function and immune function.
ConclusionsThe theory of lymphatic channels and lymphatic stomata immune pathway is a beneficial supplement to the theory that bacterial and endotoxin can spread to whole body through portal vein pathway, and combination of the 2 kinds of theories can explain the abdominal infection-related systematic infection better. Research of abdominal infection intervention which embarked on the lymphatic pathways would be a promising field.
