Quantification of risk factors in Hospital infection at a surgical service

In this paper we have analyzed several risk factors for developing nosocomial infections at a Surgical Service of the Hospital Clinico Universitario San Cecilio 2>, based on a retrospective follow-up program designed specifically for this study. Of all patients admitted to the Service from January 1 to June 17, 1987, we examined the following variables: age, sex, cause of admission, emergency or non-emergency admission, operation and related variables. The overall rate of nosocomial infections was 16.46%. The most significant risk factors we found were operation , which had a linear correlation coefficient of '0.929 (p < 0.01) with hospital infection when stratified by its lenght, advanced age ( >60 years old), especially in non-operated patients, and chemoprophylaxis. Such risk factors were ascertained taking into account the confounding effect produced by the variables studied in this survey.Corresponding author.     

血清炎性因子在骨折延迟愈合患者富血小板血浆治疗中的变化

探讨血清炎性因子在骨折延迟愈合患者富血小板血浆治疗中的变化。方法 选取2020年4月—2021年4月我院收治的98例骨折患者,均予以富血小板血浆联合钢板内固定手术治疗,根据术后6个月内是否发生骨折延迟愈合分为延迟愈合组（37例）和正常愈合组（61例）。分别于骨折后1、4、8、12周采集患者血清样本,采用酶联免疫吸附法检测血清人可溶性细胞间粘附分子-1（sICAM-1）、人可溶性血管细胞粘附分子-1（sVCAM-1）、肿瘤坏死因子-α（TNF-α）等炎症因子水平,并绘制ROC曲线,评估其对骨折延迟愈合的预测价值。采用酶联免疫双抗体夹心法检测血清骨钙素（BGP）、Ⅰ型胶原氨基端肽原（PINP）、碱性磷酸酶（ALP）、胰岛素样生长因子-1（IGF-1）等骨生化代谢指标水平,并采用Pearson分析骨生化代谢指标与炎症因子的关系。结果 骨折1周时,两组患者血清sICAM-1、sVCAM-1、TNF-α等炎症因子水平比较差异无统计学意义（P＞0.05）;骨折4、8、12周时,延迟愈合组患者血清sICAM-1、sVCAM-1、TNF-α等炎症因子水平均高于正常愈合组（P＜0.05）,且随着时间推移,两组患者血清sICAM-1、sVCAM-1、TNF-α水平先升高后降低,但延迟愈合组炎症因子水平波动较正常愈合组更明显（P＜0.05）。骨折1周时,两组患者血清BGP、PINP、ALP、IGF-1等骨生化代谢指标水平比较差异无统计学意义（P＞0.05）,且两组各时间点血清ALP水平比较差异无统计学意义（P＞0.05）; 骨折4、8、12周时延迟愈合组患者血清BGP水平逐渐升高并高于正常愈合组,血清IGF-1水平逐渐升高但低于正常愈合组,骨折8、12周时延迟愈合组患者血清PINP水平低于正常愈合组（P＜0.05）。Pearson相关性分析结果显示,血清sICAM-1、sVCAM-1、TNF-α等炎症因子水平与血清BGP呈正相关（r=0.523,P＜0.001）,与血清IGF-1呈负相关（r=-0.467,P＜0.001）。ROC曲线分析结果显示,骨折8周时,血清炎症因子水平诊断骨折延迟愈合的曲线下面积高于0.7,提示其具有较好诊断价值,且联合检测对骨折延迟愈合诊断的灵敏度更高（P＜0.05）。结论 延迟愈合骨折患者血清sICAM-1、sVCAM-1、TNF-α等炎症因子指标水平随骨折时间增加呈现先升高后降低变化,炎症因子指标水平波动明显,且术后8周时血清炎症因子对预测骨折延迟愈合具有一定参考意义     

Guided tissue regeneration in the treatment of furcation defects in mandibular molars

The present investigation was designed to evaluate the regenerative potential of the periodontal tissues in degree III furcation defects at mandibular molars using a treatment procedure based on the principle of guided tissue regeneration. The patient sample included 21 patients, 26-65 years of age, who presented periodontal lesions in the right and left molar regions including "through and through" furcation defects. After an initial examination, each patient was subjected to a series of full-mouth scaling and root planing. 2-3 months later, they were recalled for a baseline examination. The furcation-involved molars were randomly assigned in each patient to either a test or a control treatment procedure. The test procedure included the elevation of muco-periosteal flaps at the buccal and lingual aspects of the molars. Granulation tissue was removed and the exposed root surfaces were debrided and planed. The width and the height of the entrance openings to the furcation defects were assessed. A teflon membrane was adjusted to cover the entrances to the defects (buccal and lingual) and was retained in the manner described by Pontoriero et al. (1988). The flaps were repositioned on the outer surface of the membrane and secured by sutures which were removed after 10 days. Following surgery, the patients were instructed to rinse the mouth twice daily for 4 weeks with chlorhexidine gluconate. The membranes were removed after a healing period of 1-2 months. A surgical procedure identical to the test procedure was performed in the control tooth regions with the exception of the placement of membranes.(ABSTRACT TRUNCATED AT 250 WORDS)     

In vitro Virulenz wundinfizierender Staphylokokken-Isolate von schwerbrandverletzten Patienten

Zusammenfassung 30Staphylococcus aureus Stämme von drittgradig verbrannten Patienten wurden hinsichtlich ihrer Fähigkeit zur Hämolysingenerierung und ihres Vermögens zur Histaminfreisetzung aus Mastzellen (RPMC) untereinander verglichen. Die bakteriellen Kulturüberstande von 8 Stämmen aus Wundbiopsien zeigten signifikant niedrigere in vitro Aktivitäten als die übrigen Staphylokokken-Kulturüberstände. Bei dem Vergleich der in vitro Aktivitäten der gewaschenen Bakterienzellen ergab sich ein umgekehrtes Verhältnis. Diese Befunde zeigen, daß beiS. aureus Isolaten, welche zum Zeitpunkt einer invasiven Brandwundeninfektion isoliert werden können, die mikrobiellen Pathogenitätsfaktoren an die Bakterienzelle gebunden bleiben.

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In vitro measurement of pathogenicity ofStaphylococcus aureus isolated from heavily burned patients

Summary The hemolysin and histamine releasing activity of 30S. aureus strains isolated from third degree burns of heavily burned patients was detected. The culture supernatants (cs) ofStaphylococcus aureus isolated during episodes of invasive burn wound infection displayed significantly lower amounts of hemolysin and histamine releasing activity as compared to cs of bacteria isolated when no sign of septicemia was present. In contrast, when washed bacterial cells were analysed, a reversed ratio could be observed. These data clearly indicate that in strains isolated during invasive burn wound infection pathogenicity factors remain attached to the bacterial surface of the staphylococci investigated.

Gefördert durch das Bundesamt für Zivilschutz (ZS 8-122-42)     

细胞松弛素B对内皮细胞损伤修复的影响

目的观察细胞松弛素B对内皮细胞损伤修复过程中微丝骨架系统的形态结构变化,研究阻断微丝功能对内皮细胞损伤修复的影响。方法以培养单层内皮细胞损伤模型,采用免疫荧光染色和3H-TdR掺入法,研究微丝功能对创面愈合及细胞增殖的影响。结果内皮细胞在损伤修复过程中伴随微丝特殊而有序的变化。用细胞松弛素B破坏微丝,可不同程度抑制创面的愈合及细胞增殖,并呈一定的时间-剂量依赖关系。结论微丝功能在促进内皮细胞修复过程中起重要作用,可通过直接或间接效应影响DNA合成,从而影响修复过程。     

Local injection of a mixture of beta-aminopropionitril fumarate and sodium hyaluronate together with controlled exercise for treatment of subacute superficial digital flexor tendonitis in horses

Local injection of a mixture of beta-aminopropionitril fumarate (BAPN-f) and sodium hyaluronate (NaH⁺) together with controlled exercise were evaluated for treatment of superficial digital flexor tendon (SDFT) injuries in horses. Fourteen mixed breed horses with subacute SDF tendon injuries in forelimbs were randomly assigned to two groups. One group received BAPN-f (0.7 mg/ml) and the other received NaH⁺ (10 mg/ml) all by intratendinous injection. Controlled exercise started during the first week after intratendinous treatment and continued for 12 weeks. Cross-sectional area (CSA) of the SDFT, diameter of the SDFT, and relative area of the lesion (presence of CSA) were measured by ultrasonographic examination. Lesions were semiquantitatively graded for echogenicity on a scale of 0 to 4. The lesion severity in CSA was significantly reduced by BAPN and NaH compared to those horses treated by BAPN only (p < 0.05). Lesion echogenicity score was significantly higher in horses treated with BAPN and NaH⁺ at day 0 compared to horses treated with BAPN (p < 0.05). At the end of the study, lesion echogenicity score was significantly reduced in the horses treated with BAPN and NaH⁺ compared to horses treated by BAPN only (p < 0.05). According to the results of the present study, a combination of BAPN-f and NaH⁺ has a greater beneficial effect on tendon healing and remodeling in horses, as assessed by sonographic examination, compared to treatment with single drugs.     

糖尿病大鼠创面愈合过程中成纤维细胞增殖及Ⅰ型胶原合成减少

目的：观察链脲佐菌素诱导的大鼠糖尿病复合创伤修复过程中成纤维细胞增殖与胶原合成的变化。 方法： 实验采用Wistar大鼠112只，随机分对照组和模型组。模型组大鼠腹腔注射链脲佐菌素（STZ）55 mg/kg，3周后各组动物复合背部2.04 cm²全厚皮切除形成伤口。观察创面愈合时间和愈合率；采用HE染色和免疫组化法观察成纤维细胞和增殖细胞核抗原(PCNA)表达水平；采用苦味酸-天狼星红染色和图像分析技术观察创面Ⅰ、Ⅲ型胶原含量及Ⅰ/Ⅲ型比值。 结果： STZ诱发的糖尿病大鼠复合创伤后创面的愈合时间为(27.13±1.81)d，明显长于对照组（15.25±1.67）d，P<0.01；模型组在创伤第3、7和15 d创面愈合率明显低于对照组，分别P<0.01；在3、5、7和9 d模型组创面成纤维细胞数量和PCNA表达也明显少于对照组，分别P<0.05和P<0.01。两组创面在不同时点上Ⅰ型胶原分布均呈递增趋势，但对照组明显多于模型组，分别P＜0.05；尽管对照组在创伤3、7 d Ⅲ型胶原含量高于模型组，但在创伤3、7和11 d模型组Ⅰ/Ⅲ胶原比值都明显低于对照组，分别P＜0.01。 结论： STZ可能通过影响创面细胞增殖和创面胶原合成，从而导致创面愈合迟缓。     

负压封闭吸引对糖尿病溃疡愈合的促进作用

目的 在"创而床准备(WBP)"理论指导下,观察负压封闭吸引局部处理糖尿病溃疡的疗效.方法 收集2000年1月至2005年1月间收治的27例糖尿病溃疡患者作对照组,2005年1月至2007年6月的8例糖尿病溃疡患者为试验组.两组患者均经常规系统的治疗,试验组在创面的黑、黄期采用清创后负压吸引治疗.观察两组创而各分期间的演进情况.比较两组手术Ⅰ期修复率、入院首次及实施负压治疗后1、2、3周创面细菌学检查结果 .观察各期创面组织标本的HE染色和黄、红两期Ⅰ、Ⅲ型胶原纤维苦味酸-天狼猩红染色结果 及对其含量进行图像分析.结果 试验组患者创面各分期的演进速度、于术Ⅰ期修复率均优于以照组(100%比46%,P<0.05).治疗2周后试验组创面末检出致病菌,对照组检出率为66.7%(P<0.05).HE染色显示试验组各期间的演进类似于急性创面愈合过程,且试验组黄期Ⅰ、m型胶原总含量为12.28%,对照组为24.77%(P<0.01).结论 基于WBP方案的负压吸引治疗能促进糖尿病溃疡的创面愈合过程.     

Report of the symposium

Summary The past decades have seen considerable shifts of emphasis in surgical care. The recognition that pus was not laudable, was followed by a realisation that not all complications were inevitable and that prophylaxis could effectively reduce the incidence of most common problems in the post-operative period. As anaesthesia has become safer, it has been possible to embark on more intricate and prolonged procedures and for sufficient time to be available to ensure adequate intraoperative care.These two phenomena have firstly increased the complexity of management in the post-operative period, and have brought this aspect of surgical care more obviously to the limelight. However, many separate disciplines are involved in the care of the patient post-operatively, and the Symposium was organised¹ to bring the different groups together to identify the areas of recent development in the different specialities and to integrate the overall care of the individual patient.Abbreviations ARDS adult respiratory distress syndrome - DIC disseminated intravascular clotting     

Bedeutung der Fibroblasten-Chemotaxis für Wundheilung und Tumorzellevasion

Summary Fibroblast are responsable for the synthesis of the structural proteins of the connective tissue. A further property of these cells, their migratory ability, could be analyzed in the last years. A special form of migration is chemotaxis, which can be quantitatively measured in a modified Boyden chamber in-vitro. Using this method chemoattractive substances could be characterized, which are able to stimulate fibroblasts and tumorcells to chemotactic migration. Furthermore it could be proved, that benign and transformed cell lines react in a different manner towards these chemoattractive substances. The in-vitro results allow some hypotheses about both fibroblast migration in wound healing or chronic inflammation, and the mechanisms of tumor cell evasion in the tumor surrounding tissue or the metastasizing process in other organs.

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Abkürzungen PDGF platelet derived growth factor - LTB₄ Leukotrien B 4 Mit Unterstützung der Deutschen Forschungsgemeinschaft Me 766/1–3