ObjectiveTo study the feasibility of using paper hand towels instead of sterilized hand towels in non-rinse surgical hand antisepsis, and make a hygienic and economic evaluation on sterilized hand towels and paper hand towels.MethodsFrom July to September 2016, a cluster sampling method was used to study the hand samples of all health care workers who performed surgical hand sanitization in the operating room on Thursday. According to their work contents, they were asigned into the intervention group (using paper hand towels to dry hands) and the control group (using sterilized hand towels to dry hands); further, according to the odd or even number of the staff identification number, the intervention group was divided into Group A (using Likang hand towels to dry hands) and Group B (using Qingfeng hand towels to dry hands). The packing specifications and costs of hand-drying items in the warehouse were surveyed, as well as the average number of medical workers performing an operation and the number of sheets of sterilized hand towels or paper hand towels used per person, and the cost of different hand dryers for each procedure was calculated. Finally, the hygienic and economic effects of using paper hand towels were evaluated.ResultsThere were 30, 39, and 30 hand hygiene samples collected in the control group, Group A, and Group B, respectively. The total bacterial count of each group was less than 5 cfu/cm2, which met the hygienic requirements of surgical hand disinfection in the manual hygiene standard for medical personnel (WS/T 313－2019), i.e., the passing rate of each group was 100%. According to the calculation that each operation required at least 4 medical workers, each operation consumed 8 sterilized hand towels at a cost of 15.2 yuan; if using paper hand towels, each operation consumed 16 sheets at a cost of 0.8 yuan.ConclusionThe hygienic effect of surgical hand disinfection is not affected by the use of paper hand towels before applying hand sanitizer, while the operating cost of hospital operating room can be significantly reduced by using paper hand towels instead of sterilized hand towels.
Objective To explore the predictive value of simplified acute physiological score Ⅱ (SAPS-Ⅱ) combined with lactate clearance rates (LCR) at different moments for mortality in sepsis patients. Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected, who were evaluated using the SAPS-Ⅱ scale. Spectrophotometry was used to detect blood lactate at baseline, after 6h, 12h, 24h, and 48h, then the LCR after 6h, 12h, 24h, and 48h were calculated. The patients were divided into a survival group (n=139) and a death group (n=37) based on 28 day outcome. Logistic regression analysis was used to explore the risk factors of sepsis death, and the efficacy of SAPS-Ⅱ scores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic (ROC) curve. Results Twelve patients fell off, and 37 died in the remaining 176 patients, the mortality rate was 21.02%. The age, temperature, random blood glucose, blood urea nitrogen, serum creatinine, and SAPS- Ⅱ scores in the death group were significantly higher than those in the survival group (P<0.05), while platelet count and LCR at all moments were significantly lower than those in the survival group (P<0.05). The LCR of the death group continued to decrease with time. The trend of changes in the survival group were opposite, and the differences in the two groups between each two moments were statistically significant (P<0.05). The SAPS-Ⅱ scores and LCR at all moments were risk factors for patient death (P<0.05). The SAPS-Ⅱ score and LCR at all moments had predictive value for patient death, and the area under ROC curve of the combined prediction was 0.921 (95%CI 0.825 - 1.000), which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction (P<0.05). Conclusion The SAPS-Ⅱ scores and LCR at different moments are all related to death of sepsis patients, and the combined prediction of death by the above indicators is highly effective.
Despite the continuous improvement in perioperative use of antibiotics and aseptic techniques, the incidence of infection continues to rise as the need for surgery increasing and brings great challenges to orthopedic surgery. The rough or porous structure of the prosthesis provides an excellent place for bacterial adhesion, proliferation and biofilm formation, which is the main cause of infection. Traditional antibiotic therapy and surgical debridement are difficult to determine whether the infected focus have been removed completely and whether the infection will recur. In recent years, nanotechnology has shown obvious advantages in biomaterials and drug delivery. Nano drug carriers can effectively achieve local antimicrobial therapy, prevent surgical infection by local sustained drug release or intelligent controlled drug release under specific stimuli, and reduce the toxic side effects of drugs. The unique advantages of nanotechnology provide new ideas and options for the prevention and treatment of periprosthetic infection. At present, the application of nano-technology in the prevention and treatment of infection can be divided into the addition of nano-drug-loaded materials to prosthesis materials, the construction of drug-loaded nano-coatings on the surface of prosthesis, the perfusable nano-antimicrobial drug carriers, and the stimulation-responsive drug controlled release system. This article reviews the methods of infection prevention and treatment in orthopaedic surgery, especially the research status of nanotechnology in the prevention and treatment of periprosthetic infection.
ObjectiveTo investigate the clinical significance of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of patients with severe intra-abdominal infection (SIAI).MethodsThe clinical data of 7 patients with SIAI who underwent the debridement and drainage under ultrasound-guided puncture and catheterization combined with choledochoscopy from January 1, 2015 to December 31, 2017 in this hospital were retrospectively analyzed. The drainage sinus tracts were dilated for all patients. Then the choledochoscope was inserted into the infected areas along the dilated sinus tract. Finally, the drainage tube was placed under the guidance of the choledochoscope.ResultsOf the 7 patients, 6 patients were cured by this treatment, 1 case was converted to open surgery because the symptoms of illness were not improved. No relevant complications occurred. All patients were discharged after improvement of the disease. Currently, all cases were survival and no infection remained or recurred after follow-up to June 28, 2019.ConclusionsUltrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of SIAI is simple, safe, and effective. It could be used as an effective treatment for SIAI or alternative to open surgery.
ObjectiveTo elucidate the metabolic characteristics of mitochondria in sepsis and review its cellular mechanism, so as to provide new ideas for the treatment of sepsis. MethodThe previous literatures and latest research results about mitochondrial metabolism during sepsis were reviewed. ResultsAt present, the researchers were not only concerned about the inflammatory response of sepsis, but also concerned about the systemic metabolic disorder caused by sepsis. It was believed that the damage of mitochondria caused by sepsis was one of the main reasons for the disorder of cell metabolism. During the sepsis, the patient’s metabolism had changed, for example, enhancement of aerobic glycolysis, lactic acid accumulation, elevated levels of fatty acids and triglycerides in blood, and so on. ConclusionMetabolic change during sepsis is related to mitochondria, which can provide some new methods for treatment of sepsis.
Objective
To compare clinical outcomes of percutaneous nephrolithotomy (PCNL) in patients who initially presented with and without urosepsis.
Methods
The study included patients who underwent PCNL for renal and ureter urolithiasis removal from January 2010 to December 2014 in our hospital. A 1∶1 matched-pair analysis was performed to compare outcomes and complications of patients who had obstructive urolithiasis with urosepsis initially (OUU) with patients who had obstructive urolithiasis with no urosepsis initially (NOUU) before PCNL.
Results
A total of 172 patients were included involving 122 (71%) males and 50 (29%) females with a mean age of 46.2 years (range 32 to 65 years). There were no significant differences between two groups in age, gender, BMI, complications, the size of the stones, stone's number and stone location (P>0.05). OUU groups had the similar stone-free rates (86.0%vs. 84.8%, P=0.829) as the NOUU group. OUU group had higher overall complications rate, longer duration of nephrostomy tube (NT), longer hospital length of stay (LOS), longer courses of postoperative antibiotics and higher grade of antibiotics after PCNL (all P<0.05). Higher fever developed postoperatively (11.6%vs. 3.5%, P=0.043), higher asymptomatic bacteriuria (11.6% vs. 3.5%, P=0.043) and symptomatic urinary tract infections (10.5% vs. 2.3%, P=0.029) were also found in OUU groups. There was no significant difference between two groups in sepsis (2.3% vs. 1.2%, P=0.560).
Conclusion
PCNL after decompression for urolithiasis-related urosepsis has similar success but higher complication rates than obstructive urolithiasis with no urosepsis initially.
Sepsis is a multiple organ dysfunction syndrome caused by a dysregulated host response to infection. The mortality rate remains high under current treatment methods, and there is an urgent need to explore new therapeutic targets. Ubiquitination modification, as a key posttranslational regulation mechanism of proteins, plays a central role in the occurrence and development of sepsis and multiple organ damage by regulating key pathological processes such as inflammatory response, cell death and barrier function. This article aims to systematically elucidate the molecular mechanism of ubiquitination modification system in sepsis related organ damage, summarize the latest research progress on treatment strategies targeting the ubiquitination pathway, and explore the challenges and future transformation directions faced in this field. Through comprehensive analysis of existing research, this review aims to provide new ideas and theoretical basis for precise treatment of sepsis.
Objective To evaluate the efficacy and safety of in vitro anticoagulation with nafamostat mesilate in continuous renal replacement therapy (CRRT) in patients with sepsis complicated with acute kidney injury (AKI). Methods The study subjects were sepsis patients with AKI who underwent CRRT in West China Hospital of Sichuan University and were at high risk of bleeding. CRRT patients who received in vitro anticoagulation with nafamostat mesilate between July 2021 and January 2022 were included in the nafamostat group. The medical records of CRRT patients who did not use anticoagulants between January 2020 and December 2020 were retrospectively collected as a control group. The general situation, the lifespan of the first CRRT filter, the number of filters used within 72 hours of treatment, laboratory tests before and after treatment, and the occurrence of adverse reactions during treatment of the two groups of patients were analyzed. Results There were 42 patients in the control group and 21 patients in the nafamostat group. There was no statistically significant difference in age, gender, body mass index, mean arterial pressure, primary disease, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation Ⅱ score, or pre-treatment laboratory test results between the two groups of patients (P>0.05). Kaplan-Meier survival analysis showed that the lifespan of the first filter was longer in the nafamostat group than in the control group (hazard ratio=0.408, P<0.05). The number of filters used by the control group patients after 72 hours of treatment was greater than that of the nafamostat group patients (2.1±0.6 vs. 1.3±0.5, P<0.05). After 72 hours of treatment, serum creatinine levels [(99.4±15.7) vs. (127.6±20.5)] μmol/L], urea nitrogen [(4.5±1.9) vs. (6.8±2.3) mmol/L], cystatin C [(1.0±0.2) vs. (1.2±0.2) mg/L], uric acid [(86.5±15.3) vs. (105.3±20.3) μmol/L] in the nafamostat group were lower than those of the control group (P<0.05), and there was no statistically significant difference in the results of other laboratory tests (P>0.05). There was no statistically significant difference in adverse reactions between the two groups of patients (P>0.05). Conclusion For patients with sepsis complicated with AKI who undergo CRRT and are at high risk of bleeding, nafamostat mesilate may be a safe and effective anticoagulant for in vitro anticoagulation.
Objective To systematically evaluate the effect of vitamin C supplementation on the mortality of patients with sepsis and septic shock. Methods The Cochrane Library, PubMed, EMbase, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure Database and Chinese Science and Technology Periodical Database were searched by computer for randomized controlled trials (RCTs) on the effect of vitamin C on the mortality of patients with sepsis. The retrieval time of each database was from the establishment of the database to January 20, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality, and then used STATA 16.0 software for meta-analysis. Results A total of 15 RCTs were included, with a total of 2077 patients, including 1041 in the experimental group and 1036 in the control group. The results of literature quality showed that 7 studieswere grade A and 8 studies were grade B, indicating that the overall quality of the included literature was good. The results of meta-analysis showed that compared with the control group, the mortality of patients with sepsis and septic shock in the experimental group were effectively reduced [odds ratio (OR)=0.81, 95% confidential interval (CI) 0.67 - 0.98, P=0.027]. The results of subgroup analysis showed that vitamin C supplementation therapy for more than 4 days could significantly reduce the mortality of the patients with sepsis (OR=0.67, 95%CI 0.49 - 0.90, P=0.008); single treatment could significantly reduce the mortality rate of patients with sepsis (OR=0.50, 95%CI 0.34 - 0.74, P=0.001); vitamin C supplementation can effectively reduce the short-term (≤30 days) mortality of patients with sepsis (OR=0.77, 95%CI 0.63 - 0.96, P=0.017). The funnel plot showed that the included literature was basically symmetrical, and publication bias could not be considered. Conclusions Vitamin C supplementation can effectively reduce the mortality rate of patients with sepsis and septic shock. Vitamin C supplementation treatment course of 4 days or less and single treatment can reduce the mortality rate of patients with sepsis and septic shock, but cannot reduce the long-term (90 days) mortality rate of patients.
ObjectiveTo summarize the protective effect of peroxisome proliferator-activated receptor-beta (PPAR-β) in sepsis-induced liver injury and the mechanism, and to provide new ideas for the prevention and treatment of sepsis-induced liver injury.MethodRelevant literatures about protective effect of PPAR-β in sepsis-induced liver injury were collected and reviewed.ResultsPPAR-β played an important role in cell survival, anti-inflammatory, and anti-oxidation. It acted on a variety of pathophysiological processes, could reduce the activation of inflammatory factors, reduce the production of oxygen free radicals, and inhibit the expression of apoptotic proteins, as well as played an important role in anti-inflammatory, anti-oxidative, and anti-apoptotic.ConclusionPPAR-β can inhibit the activation of NF-κB, reduce the release of inflammatory factors, reduce apoptosis, and reduce liver injury by antioxidation, thereby reducing the mortality of sepsis-induced liver injury.
