Liver transplantation rapidly has become the best choice for pediatric patients with end-stage and metabolic liver disease, since the first liver transplantation succeeded in 1989. In pediatric liver transplantation, significantly improved short-term and long-term survival is attributed to advances in surgical techniques and reasonable immunosuppression regimens in the last 20 years. However, postoperative infections, which remain the most common complication following pediatric liver transplantation, severely affect posttransplantation morbidity and mortality. This paper summarizes the infections after liver transplantation in children and rational drug use.

ObjectiveTo study the main bacterial species,distribution and drug sensitivity of nosocomial bacterial infections after living donor liver transplantation (LDLT) in children.Methods The clinical data of the incidence,pathogen distribution and antibiotic-sensitivity of early postoperative bacterial infection occurring in 41 cases of LDLT were retrospectively analyzed.ResultsThe bacterial infections rate after LDLT was 80.5％,and 71.3％ of bacterial infections occurred in the first two weeks after LDLT. The most common sites of bacterial infection were lower respiratory tract,abdomen andbiliarytract, andPseudomonasAeruginosa, Staphylococcusepidermidis, and Escherichia coli were the most common bacterial pathogens. 101 microorganisms were found and gram-negative bacteria (73.3％) predominated over gram-positive bacteria (26.7％).The detectable rate of ESBLs in gram-negative bacteria was 81.1％.Moreover,the detectable rate of MRCNS in gram-positive bacteria was 59.3％,and 11.1％ of gram-positive bacteria were HLAR Enterococcus.Most gram-negative bacteria had high drug-resistance rate of β-lactam inhibitors and cephalosporins (more than 60％),but were sensitive to imipenem and meropenem (less than 10％). ESBLs and AmpC-lactam,mediated by Chromosomal and plasmid,could not damage the structure of imipenem and meropenem.Pseudomonas aeruginosa was highly resistant to imipenem,meropenem,and most antibiotics used for pediatrics. Coagulase-negative staphylococcus was sensitive to vancomycin,linezolid,quinupristin/dalfopristin.ConclusionThe bacterial infection rate was high after LDLT in children.Most of the pathogens were antibiotics multi-resistant.Effective prevention of infection,early diagnosis and appropriate use of antibiotics are the key to control the infection.

Objective: To explore the correlation among overweight, obesity and markers of prethrombotic state in patients with coronary heart disease (CHD). Methods: A total of 288 patients to hospital from 2013 to 2014 and diagnosed as CHD by coronary angiography were selected. According to body mass index (BMI), they were divided into CHD control group (n=106), overweight group (n=121) and obesity group (n=61). Levels of fibrinogen (Fg), plasma D dimmer (D-D), von Willebrand factor (vWF), antithrombin Ⅲ (AT-Ⅲ) and plasminogen activator inhibitor (PAI)-1 were compared among three groups, then received correlation analysis.Results: Compared with CHD control group, there were significant rise in levels of triglyceride, total cholesterol, fasting blood glucose and mean arterial pressure, morbidity rates of hypertension and diabetes mellitus in overweight group and obesity group, P<0.05 or <0.01. Compared with CHD control group, there were significant rise in levels of Fg [(2.89±0.60) g/L vs. (3.54±0.63) g/L vs. (3.92±0.94) g/L], D-D [(282.13±73.15) ng/ml vs. (390.04±73.54) ng/ml vs. (471.92±80.38) ng/ml], vWF [(108.62±24.66)% vs. (138.45±25.96)% vs. (161.20±29.39)%] and PAI-1 [(6.97±1.28) ng/ml vs. (9.60±1.73) ng/ml vs. (12.33±2.16) ng/ml] in overweight group and obesity group, P<0.01 all, and those of obesity group were significantly higher than those of overweight group, P<0.01 or <0.05; AT-Ⅲ level [(89.94±17.99)% vs. (69.89±20.22)%] significantly reduced in obesity group (P<0.05). Pearson correlation analysis indicated that BMI was positively correlated with markers of prethrombotic state [Fg: r=0.536, P<0.001; D-D: r=0.250, P<0.001; vWF: r=0.611, P<0.001;PAI-1: r=0.788,P<0.001). Conclusion: BMI is positively correlated with markers of prothrombotic state in CHD patients.