Objective:To investigate the clinical manifestation and determine the distribution of pathogens and their characteristics of drug susceptibility to bloodstream infections (BSIs), and provide evidence for clinical anti-infection treatments after renal transplantation.
Methods:Totally 81 episodes of BSIs occurred in 71 patients between July 2003 and June 2013. We retrospectively analyzed the pathogens and their drug susceptibility characteristics with BD microbiological assay system. We also collected the clinical and laboratory data of the patients . Results:The main pathogens were gram negative bacteria (67.90%), followed by gram positive bacteria (28.40%) and fungi (3.70%). The most common gram negative bacillus was Escherichia coli.While for gram positive bacteria, the main bacillus was coagulase-negative staphylococci. The gram negative bacteria were relatively sensitive to aminoglycosides and carbapenem. The gram positive bacteria were sensitive to glycopeptides and oxazolidone.
Conclusion:The clinical manifestations included high body temperature, onset in the early period after kidney transplantation and high mortality. Though gram positive coccus plays an important role, most infections are caused by gram negative bacteria in BSIs after the renal transplantation. The antibiotic resistant rate for gram negative bacteria is very high as well as gram positive bacteria.

OBJECTIVETo study the management for the perineal incision after laparoscopic-assisted abdominoperineal resection for rectal cancer.

METHODSClinical data of 87 patients undergoing laparoscopic Miles operation for lower rectal cancer from June 2009 to February 2014 were collected and studied. Presacral space drainage group: presacral space drainage tube was applied in 42 patients. Combined drainage group: presacral space drainage tube combined with subcutaneous vacuum pressure suction was applied in 45 cases. In combined drainage group, except the presacral drainage tube, another drainage tube was placed subcutaneously and connected to a negative pressure ball, which was fixed on the lateral anterior of perineal wound by the further incision and drainage. After subcutaneous tube was placed for 2 weeks, as drainage fluid was limpid and <15 ml/d for 3 days, meanwhile no obvious pelvic fluid was detected by ultrasound, and the wound healed quite well without redness and edema, then the subcutaneous tube with the negative pressure ball could be removed.

RESULTSThere were 51 males and 36 females with the mean age of 26-78(56.9±10.8) years old. The laparoscopic Miles operation was successfully completed in all the cases without death and complications. The drainage tube was placed for 4-13(8.0±2.5) days in presacral space drainage group, and for 4-14(6.7±2.4) days in combined drainage group. The subcutaneous tube was placed for 14-24(15.8±3.0) days. The primary healing rate of perineal wound in presacral space drainage group and combined drainage group was 66.7%(28/42) and 91.1%(41/45) respectively, while the perineal wound infection rate was 21.4%(9/42) and 4.4%(2/45) respectively, whose differences between two groups were both significant (χ=7.911, P=0.005 and χ=5.674, P=0.017).

CONCLUSIONPresacral space drainage tube combined with subcutaneous vacuum pressure suction in laparoscopic-assisted abdominoperineal resection for rectal cancer has better efficacy and lower infection rate for perineal incision, which is worth wide application.

Objectives:To observe the osteogenic properties and sustained release of 3D printed nano-hydroxyapatite(nHA)artificial bone loaded with a novel triple anti-tuberculosis drug combination(PaMZ)of Pretomanid(Pa),Moxifloxacin(M),Pyrazinamide(Z)and bone morphogenetic protein 2(BMP-2)in vivo.Methods:40 New Zealand rabbits were divided into four groups randomly and constructed spinal bone defect models.Group A(experimental group)implanted with 3D-printed PaMZ/BMP-2-loaded nHA artificial bone;group B(negative control group)implanted with blank nHA artificial bone;group C(positive control group)implanted with autologous iliac bone;group D(blank group)without bone grafting.The general conditions were observed,body temperature,weight,and liver and kidney function were monitored.The bone defect restoration was observed by spiral CT 3D reconstruction at the 4th,8th and 12th week postoperatively and was evaluated with CT-Hedberg scale;the gross observation of tissues and histopathological observation of the implants-bone defect interface were carried out at the 8th and 12th week postoperatively.100 SD rats were divided into two groups randomly,experimental group implanted with 3D-printed PaMZ/BMP-2-loaded nHA artificial bone,control group implanted with blank nHA artificial bone.The drug concentrations in the plasma and muscle tissue around the material at different time points was tested with high performance liquid chromatography.Results:All animal models were successfully constructed without incision infection or death.The body temperature,weight and liver and kidney function indexes of the experimental groups in the rabbit models were normal,with no statistical differences from those of the control groups(P＞0.05).The CT-Hedberg score showed that there was no statistical difference between group A and group C at the 4th,8th and 12th week(P＞0.05),however,there was statistical difference between all the other groups at different time points(P＜0.05).The observation of the gross specimens at the 12th week after surgery showed that the artificial bone in group A was completely encapsulated or replaced by new bone,but there was still some artificial bone exposed in group B.Quantitative analysis of the total trabecular area at the implant-bone defect interface showed no statistical difference between groups A and C at the 8th and 12th week postoperatively(P＞0.05),and a statistical difference between the remaining groups(P＜0.05).No drug components were detected in the SD rat model control group,the three drugs Pa,M,Z in experimental group can be sustained-released in local tissues for at least 84d.The blood drug concentration was not detected at the initial time point after local implantation of the drug-loaded artificial bone,and the subsequent measured results were much lower than the local tissue drug concentration,and the two had a positive correlation.Conclusions:The 3D printed PaMZ/BMP-2-loaded nHA artificial bone has good osteogenic properties in vivo,the effect of restoring spinal bone defects is comparable to that of autologous iliac bone,which is better than that of HA artificial bone scaffold alone.Its sustained release behavior in vivo is satisfactory,and the blood drug concentration is much lower than the local tissue drug concentration.