Objective
To review the clinical features and trend in antimicrobial resistance of Acinetobacter baumannii (A. baumannii) bloodstream infections.
Methods
Retrospective analysis was performed by collecting data of underlying diseases, potential risk factors, clinical characteristics, blood test results, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores at onset, bacterial resistance to antibiotics and antimicrobial therapy were collected in Hunan Provincial People’s Hospital from January 2010 to June 2016.
Results
There were 114 non-duplicated A. baumannii complex blood isolates identified in this research. All patients had at least one underlying disease and accepted at least one surgery or invasive operation within the past 14 days. Multidrug-resistant A. baumannii (MDRAB) was isolated from 89 (78.1%) patients. Of the 114 strains of A. baumannii, 12.3% were resistant to tigecycline, 55.3% to amikacin and 61.4% to cefoperazone-sulbactam. The overall mortality was 51.8% (59/114). The patients with MDRAB had higher mortality rate than those with non-MDRAB (62.9% vs. 12.0%, χ2=20.268, P<0.001). With higher incidence of being in the intensive care unit, intubation/tracheotomy and increased APACHEⅡ score among patients with MDRAB bacteremia (P<0.05). Compared with subjects treated with tigecycline based regimen, those treated with non tigecycline for multidrug resistantA. baumannii had a higher mortality (64.8% vs. 60.0%) but there was no statistical significance (P>0.05).
Conclusions
The isolated A. baumannii are mainly multidrug resistant and with high mortality. Being in the intensive care unit, increased APACHEⅡ score and intubation/tracheotomy were risk factors for higher mortality among patients with MDRAB bloodstream infection. Tigecycline based regimen doesn’t improve patients’ prognosis.
【摘要】目的介紹華西醫院支援西部地區衛生工程項目的實踐和成效。方法過去5年間，華西醫院響應國家號召，通過各種幫扶形式，開展了一系列對口支援活動。結果華西醫院利用自身的資源優勢，通過各種幫扶形式，提高基層醫院的醫療救治水平和綜合服務能力，為建立城市支援農村衛生工作的長效機制進行了積極的實踐和探索，取得顯著成效。結論基層衛生事業與人民健康需求和現代醫學進步存在著相當的差距，醫療體制改革對部屬部管醫院的對口支援提出了更高的要求，對口支援的許多細節還需要我們去進一步完善。【Abstract】Objective To introduce the practice and progress of the supportive rural hygiene program of West China Hospital. Methods In the past five years, West China Hospital had made a lot of supportive rural hygiene practice. Results West China Hospital made good use of its own advantages in resources to develop the treatment level and the comprehensive service capability of primary hospital. West China Hospital did a lot of practice to establish the effective system of assistance of city medical care to rural areas, and had already achieved remarkable effects. Conclusionre is a lot of disparity between the basic public health or the requirement of people and the modern medicine progress. Many details for support should be further consummated.
Patients with pathological tracheal loss more than a certain length may need tracheal transplantation.Traditional natural tissue and autologous tissue have failed to produce satisfactory clinical outcomes to replace the trachea because of local infection，tracheal stenosis，tracheomalacia，immune rejection et al. In recent years，the emergence oftissue engineering trachea provides a new idea for tracheal transplantation. But scientists have not yet reached a consensus about how to choose ideal extracellular matrix to construct tissue engineering trachea. At present research and applicationof tissue engineering trachea，extracellular matrices mainly include allogenic trachea，allogenic aorta and biologicalcomposite materials. Each allogenic matrix or biological composite material has its own advantages and disadvantages. Therefore，this article mainly summarizes recent application and research progress of extracellular matrix in long segmental tracheal defect and its future perspective.
【摘要】 目的 加強輸血管理是保障血液合理利用和臨床用血安全的重要手段。 方法 通過對醫院臨床用血情況的分析，以減少手術輸血為切入點，采取強化意識，嚴控指征，完善術前準備，倡導自體輸血，加強考核管理等方式促進臨床合理用血。 結果 有效提升了醫療服務品質，保障醫療安全。 結論 其方法與措施此方法與措施供大型醫院醫療管理參考借鑒。【Abstract】 Objective Strengthening blood transfusion management is an important means to ensure reasonable blood usage and clinical security during blood use. Methods With reducing surgery blood transfusion as a breakthrough point, We promotes clinical reasonable blood use and medical service quality by strengthening awareness of health workers, controlling indicators strictly, perfecting preoperative preparation, initiating autologous blood transfusion, enhancing assessment and management, and so on. Results The medical service quality was improved and the medical safety was ensured. Conclusion The experience could provide a reference for medical management in large hospitals.
Objective
To summarize the recent research situation and progress of decellularized matrix in tissue engineered trachea transplantation and to forecast the possible perspects.
Methods
Recent original articles about study and application for decellularized matrix in tissue engineered trachea were reviewed. The application and study of different decellularized matrices involved in animals or patients with tracheal lesions were elaborated.
Results
Decellularized matrices researched and applied in tissue engineered trachea include jejunum, urinary bladder, aorta, and trachea.
Conclusion Decellularized urinary bladder matrix and jejunal matrix appears to be efficacious method for the patch repair of partial circumferential tracheal defects. The application of decellularized aortic matrix may need more study, and decellularized tracheal matrix has a bright future in long tracheal defects.
Objective
To explore clinical effect and safety of rivaroxaban in treatment of acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs.
Methods
The clinical data of 60 patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, collected from January 2010 to March 2017 in Hunan Provincial People’s Hospital, were retrospectively analyzed. According to the different treatment, these patients were randomly divided into a rivaroxaban group and a control group (traditional warfarin anticoagulation), with 30 patients in each group. The clinical effect and safety were compared between two groups on the 10th day, 20th day and 30th day after treatment.
Results
Compared with the control group, maximum short axis diameter, ratio of right and left ventricles, systolic pulmonary artery pressure, and main pulmonary artery diameter measured by CTPA and echocardiography in the rivaroxaban group were not significantly different on the 10th day, 20th day and 30th day after treatment. However, the intragroup differences were statistically significant at different timepoint (P<0.05). Levels of N-terminal-pro-brain natriuretic peptide of two groups after treatment were significantly reduced on the 10th day, 20th day and 30th day after treatment, and the values of PO2 were significantly increased on the 10th day and 20th day after treatment (P<0.05), but no significant differences were found in the values of PO2 on 20th day and 30th day after treatment. D-dimer in the two groups was obviously increased on the 10th day after treatment but significantly declined on the 20th day and 30th day after treatment (all P<0.05). These changes were predominant in the rivaroxaban group.
Conclusion
Rivaroxaban is effective and safe for acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, and worthy of clinical implementation and application.
During the medical rescue of Wenchuan earthquake, as a hospital which mainly admitted the severely wounded, West China Hospital immediately shifted to the double-track emergent system from the previous single-track system and dispatched sufficient manpower and materials. The beds in the Department of Orthopaedics were increased to 680. In addition, in order to ensure effective treatment, the hospital dealt with the wounded based on their specific conditions in different stages and optimized the flow of admission of the wounded. Besides, we opened the referral channel for the wounded. Up to June 2nd, 2008, a total of 2?618 wounded people have been treated in to the hospital, and 648 with minor injuries after proper treatment have been referred to the nearby basic-level hospitals.
Objective To compare the clinical efficacy and safety of suturesuspension single hole laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy (LC) in the treatment of gallbladder disease. Methods A total of 86 cases who got treatment in our hospital from February 2014 to July 2015 were collected prospectively, and then 86 cases were divided into 2 groups: 43 cases of control group underwent LC and 43 cases of experimental group underwent suturesuspension single hole laparoscopic cholecystectomy. Clinical efficacy and safety of the two groups were compared. Results ① Complication. No one suffered from bile duct injury, bile leakage, bile duct stricture, and umbilical hernia; but there were 2 cases suffered from complications in control group, including 1 case of abdominal pain and 1 case of bloating, and the morbidity was 4.65% (2/43). The morbidity of experimental group was 0, there was no significant difference between the 2 groups in the morbidity (P>0.05). During the follow-up period, 1 case suffered from long-term compilation in experimental group, and 2 cases in normal group, there was no significant difference in the long-term complication between the 2 groups (P>0.05). ② Operation and hospitalization. The blood loss and operation time in the experimental group were lower than those of the control group (P<0.05), but there was no significant difference in the hospital stay and hospitalization cost between the 2 groups (P>0.05). ③ Postoperative electrolytes, liver and kidney function. The levels of Na+ and K+ in the experimental group were higher than those of the control group (P<0.05), and the levels of alanine aminotransferase and aspartate aminotransferase were lower than those of control group (P<0.01), but there was no significant difference in the blood urea nitrogen and serum creatinine between the 2 groups (P>0.05). ④ The recovery of gastrointestinal function after surgery. The anal exhaust time and bowel sounds recovery time in experimental group were shorter than those of the control group (P<0.01). Conclusion Suturesus-pension single hole laparoscopic cholecystectomy in the treatment of gallbladder disease is safe, effective, and minimally invasive, and it has little disturbance on gastrointestinal function and liver function, which is worthy of clinical application.
ObjectiveTo observe the long-term outcome and biocompatibility of the porcine collagen membrane (DermalGen) after xenotransplantation in vivo.MethodsTwenty Sprague Dawley rats were randomly divided into 2 groups (n=10). DermalGen were implanted subcutaneously into the dorsum of rats in experimental group, and the rats in control group were treated with sham-operation. At 3, 7, and 15 days and 1, 3, 6, and 12 months after operation, the samples of experimental group were harvested and gross observation, histological observation, CD31 immunohistochemical staining, and transmission electron microscope observation were taken to observe the inflammatory reaction, angiogenesis, and collagen arrangement. The skin tissues of the control group at 12 months were observed and compared.ResultsAll incisions healed in experimental group, without obvious swelling and inflammatory reaction. The DermalGen was closely contact with the surrounding tissue without obvious rejection, and it was still legible at 12 months. Histological observation of experimental group showed that the infiltration of fibroblasts and inflammatory cells were seen at 7 days. More capillaries and fibroblast cells were seen and the inflammatory response gradually faded at 15 days and 1 month. There were abundant vessels and cells in the DermalGen at 3 months. The angiogenesis and fibroblasts decreased gradually, and the collagen started to format and margin blended simultaneously at 6 and 12 months. The inflammatory cells in experimental group at 15 days and 1 month were significantly more than that in control group (P<0.05), and no significant difference was found at 12 months between experimental group and control group (P>0.05). Immunohistochemical staining of experimental group showed that the angiogenesis changed obviously with the time, and the density of vessels decreased significantly at 12 months. Compared with control group, the possitive expressions of CD31 in experimental group at 15 days and 12 months after operation were signi?cantly decreased (P<0.05), and were significantly increased at 1 month (P<0.05). Transmision electron microscope observation showed that the arrangement of collagen in grafted DermalGen had no obvious changed when compared with the DermalGen, and vascular endothelial cell, capillarypericytes and fibroblast cells could be seen inside.ConclusionThe DermalGen structure is stable after long-term xenotransplantation and with good tolerogenic property in vivo.
