Risk Factors and Prevention of Early Infection After Implantation or Revision of Transjugular Intrahepatic Portosystemic Shunts (Results of a Randomized Study)

The aim of this study was to evaluate theefficacy of a single dose of a second-generationcephalosporine to prevent postinterventional infectionand to identify risk factors for postinterventionalinfection in patients receiving implantation or revisionof a transjugular intrahepatic portosystemic shunt(TIPS). Eighty-four patients (105 transjugularinterventions) were randomized receiving no antibiotictreatment (46 interventions) or 2 g cefotiam (56interventions) given at the beginning of the procedure.Patients with overt infection or those receivingantibiotic treatment in the preceding two weeks wereexcluded. Groups were comparable with respect tobiographic and medical data. Postinterventionalinfection was defined as an increase in WBC count(15,000/l), fever (38.5°C), or a positiveblood culture. Infection occurred in 17% of the patients. Patients notreceiving cefotiam had a slightly higher incidence ofinfection (20%) than patients treated with cefotiam(14%, NS). Multivariate analysis demonstrated prognostic relevance for multiple stenting andperiprocedural use of a central venous line. Theclinical outcome of the patients was unaffected bycefotiam treatment. In conclusion, a single dose ofintrainterventional cefotiam does not prevent postinterventionalinfection. This may be due to the antimicrobial spectrumand short half-time of cefotiam. Strict adherence toaseptic conditions during intervention and early removal of central venous lines may reduce therate of post interventional infection considerably.Antibiotic prophylaxis with cefotiam does not seem to beuseful since it will not influence outcome andcosts.     

炉式熏灸器艾熏治疗外科感染性疾病1200例疗效观察和实验研究

用自制的炉式熏灸器治疗外科感染性疾病１２００例，其中治愈１１２８例，占９４．００％；好转７２例，占６．００％。有效率为１００％。经实验室的抑杀菌试验研究证实。使用该器具的熏灸效力强于手持艾条熏灸组。提示，使用有效的熏灸器具，有助于缩短疗程，提高疗效。     

胃肠道癌患者围手术期输血与术后感染

目的为了观察胃肠道癌患者围手术期输血与术后感染的关系。方法作者回顾性地分析了２８９例此类患者术后感染的多种因素。结果２８９例中有１０５例进行了围手术期输血,其感染率为３４２８％（３６例）;围手术期未输血的１８４例中,术后感染率为３８０％（７例）,两者比较有显著性差异（Ｐ＜０．０５）。术后感染发生随输血量而增大（Ｐ＜０．０１）。结论胃肠道癌肿患者围手术期输血会增加术后感染并发症的发生。故在保证患者能够耐受麻醉,手术治疗及术后恢复顺利的情况下,应尽量不输血或少输血。对确需输血者应采取红细胞成份输血,提高输血质量。     

胰十二指肠切除术后腹腔感染发生的影响因素

目的探讨胰十二指肠切除术（PD）术后腹部并发症发生率及其有关因素。方法对近7年来196例施行PD患者腹部并发症发生的有关因素进行回顾性分析。结果腹腔感染的发生率明显高于其他并发症。胰腺残端硬度接近正常或中等者，或有肺部感染者，其腹腔感染率明显高于胰腺质地较硬者及无肺部感染者（均为P<0.01）。结论腹腔感染与胰腺残端质地、有无肺部感染有明显关系。应重视术中残胰质地的判断，积极防治肺部并发症，以尽量避免腹腔感染的发生。     

Enhancement of Impaired MRSA-Infected Fracture Healing by Combinatorial Antibiotics and Modulation of Sustained Inflammation

Fracture healing is impaired in the setting of infection, which begets protracted inflammation. The most problematic causative agent of musculoskeletal infection is methicillin-resistant Staphylococcus aureus (MRSA). We hypothesized that modulation of excessive inflammation combined with cell-penetrating antibiotic treatments facilitates fracture healing in a murine MRSA-infected femoral fracture model. Sterile and MRSA-contaminated open transverse femoral osteotomies were induced in 10-week-old male C57BL/6 mice and fixed via intramedullary nailing. In the initial therapeutic cohort, empty, vancomycin (V), rifampin (R), vancomycin-rifampin (VR), or vancomycin-rifampin-trametinib (VRT) hydrogels were applied to the fracture site intraoperatively. Rifampin was included because of its ability to penetrate eukaryotic cells to target intracellular bacteria. Unbiased screening demonstrated ERK activation was upregulated in the setting of MRSA infection. As such, the FDA-approved mitogen-activated protein kinase kinase (MEK)1-pERK1/2 inhibitor trametinib was evaluated as an adjunctive therapeutic agent to selectively mitigate excessive inflammation after infected fracture. Two additional cohorts were created mimicking immediate and delayed postoperative antibiotic administration. Systemic vancomycin or VR was administered for 2 weeks, followed by 2 weeks of VRT hydrogel or oral trametinib therapy. Hematologic, histological, and cytokine analyses were performed using serum and tissue isolates obtained at distinct postoperative intervals. Radiography and micro-computed tomography (μCT) were employed to assess fracture healing. Pro-inflammatory cytokine levels remained elevated in MRSA-infected mice with antibiotic treatment alone, but increasingly normalized with trametinib therapy. Impaired callus formation and malunion were consistently observed in the MRSA-infected groups and was partially salvaged with systemic antibiotic treatment alone. Mice that received VR alongside adjuvant MEK1-pERK1/2 inhibition displayed the greatest restoration of bone and osseous union. A combinatorial approach involving adjuvant cell-penetrating antibiotic treatments alongside mitigation of excessive inflammation enhanced healing of infected fractures. © 2022 American Society for Bone and Mineral Research (ASBMR).     

Development of a Wound Dressing Composed of Hyaluronic Acid and Collagen Sponge with Epidermal Growth Factor

This study was designed to investigate the effect of a wound dressing composed of hyaluronic acid (HA) and collagen (Col) sponge containing epidermal growth factor (EGF) on various parameters of wound healing in vitro and in vivo. High-molecular-weight (HMW) HA solution, hydrolyzed low-molecular-weight (LMW) HA solution and heat-denatured Col solution were mixed, followed by freeze-drying to obtain a spongy sheet. Cross-linkage between Col molecules was induced by UV irradiation to the spongy sheet (Type-I dressing). In a similar manner, a spongy sheet containing EGF was prepared (Type-II dressing). The efficacy of these products was firstly evaluated in vitro. Fibroblast proliferation was assessed in culture medium in the presence or absence of a piece of each wound dressing. EGF stimulated cell proliferation after UV irradiation and dry sterilization at 110°C for 1 h. In the second experiment, fibroblasts-embedded Col gels were elevated to the air–liquid interface to create a wound surface model, on which wound dressings were placed and cultured for 1 week. Cell proliferation and the production of vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) were investigated. With Type-II dressings, the amounts of VEGF and HGF released from fibroblasts in the Col gel were significantly increased compared with Type-I dressing. Next, the efficacy of these products was evaluated in vivo using Sprague–Dawley (SD) rats. Wound conditions after 1 and 2 weeks of treatment with the wound dressings were evaluated based on the gross and histological appearances. Type-II dressings promoted a decrease in wound size, re-epithelialization and granulation tissue formation associated with angiogenesis. These findings indicate that the combination of HA, Col and EGF promotes wound healing by stimulating fibroblast function.     

营养治疗途径对急性胰腺炎患者胰床感染的影响

目的探讨重症急性胰腺炎时营养治疗途径对胰床感染的影响。方法３８例急性胰腺炎患者随机分成全胃肠道外营养（ＴＰＮ）２３例,及全肠内营养（ＴＥＮ）１５例两组,对其胰床感染及肠道细菌移位情况进行观察。结果ＴＰＮ组胰床感染率５７１％,而ＴＥＮ组仅为１６７％,胰床感染病例肠系膜淋巴结细菌易位率达８５７％,远高于非胰床感染者（３１６％）（Ｐ＜０．０５）。结论胰床感染菌源自于肠道。胰腺炎患者早期行肠内营养对预防胰床感染及其并发症的发生具有重要作用。     

骨外固定器固定加柳豆叶制剂外敷治疗胫腓骨开放性骨折骨裸露合并严重感染的临床观察

应用自制体外钢板固定和柳豆叶外敷的方法治疗胫腓骨开放性骨折感染、骨裸露不连接这一类复杂创面4例,获得感染创面和骨折良好愈合的效果。疗效的根源在于该疗法的合理性。1.体外钢板的应用解决了骨折端的固定问题,患肢可早期下床活动,骨折端接受适当的压应力是骨痴生长的重要因素之一;2.柳豆叶外用促进了骨裸露创面的愈合,且具有促进骨痂生长的药理作用。     

Crohn's Disease Stable Remission After Human Immunodeficiency Virus Infection

We retrospectively assessed the clinical coursein four patients with long-standing Crohn's disease whobecame infected with human immunodeficiency virus (HIV).The duration of active Crohn's disease was 21, 10, 4, and 4 years in our four patients.They experienced a stable remission of Crohn's diseasesymptoms after HIV infection. In three patients Crohn'sdisease was in stable remission for 5, 8, and 8 years after HIV infection and all three diedfrom acquired immunodeficiency syndrome-related disease.One patient was still alive without recurrence ofCrohn's disease symptoms 7 years following HIVdetection. Our observations of a spontaneous improvementin the clinical course of Crohn's disease after HIVinfection, suggests that the integrity of the immuneresponse, especially that of CD4 T cells, plays a major role in the tissue injury mechanism in Crohn'sdisease.