Objective To compare the effect of anesthesia management between enhanced recovery after surgery (ERAS) protocol and traditional protocol on stress level of thyroid surgery.Methods Sixty-two patients receiving thyroid surgery from May 2016 to August 2016, 13 males and 49 females, aged 18-65 years, of ASA physical status Ⅰ or Ⅱ, were randomly divided into group ERAS (n=29) and traditional group (group C, n=33).Each group had its own anesthesia management protocol.Operation method, operation duration, the level of pain during emergence and on the first postoperative day, the occurrence rate of complications and the satisfaction evaluation of pain and nausea and vomiting after the operation day were recorded.C-reactive protein (CRP), serum cortisol, interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor (TNF-α) before and after the operation day were evaluated.Results The visual analogue scale (VAS) pain score in group ERAS was lower than that in group C during emergence [(0.42±0.83) points vs (0.95±1.16) points]and on the first postoperative day [(1.90±1.21) points vs (2.73±1.40) points] (P<0.05).Group ERAS was more satisfied with pain relief at first day after the surgery than that of group C (P<0.05).The level of CRP in group ERAS was lower than that in group C on the operative day and the first postoperative day (P<0.05).In group C, the level of CRP on the operative day and the first postoperative day were much higher than those before the surgery (P<0.05).The occurrence rate of complications between the two groups had no statistical difference.Conclusion The perioperative ERAS anesthesia management of thyroid surgery is safe and effective in pain management, patient satisfaction and accelerated recovery.

Objective To analyze the distribution and drug resistance of pathogen isolated from severely burned patients with bloodstream infection,so as to provide reference for the clinical treatment of these patients.Methods Blood samples of 162 severely burned patients (including 120 patients with extremely severe burn) with bloodstream infection admitted into our burn ICU from January 2011 to December 2014 were collected.Pathogens were cultured by fully automatic blood culture system,and API bacteria identification panels were used to identify pathogen.Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of major Gram-negative and-positive bacteria to 37 antibiotics including ampicillin,piperacillin and teicoplanin,etc.(resistance to vancomycin was detected by E test),and drug resistance of fungi to 5 antibiotics including voriconazole and amphotericin B,etc.Modified Hodge test was used to further identify imipenem and meropenem resistant Klebsiella pneumonia.D test was used to detect erythromycin-induced clindamycin resistant Staphylococcus aureus.The pathogen distribution and drug resistance rate were analyzed by WHONET 5.5.Mortality rate and infected pathogens of patients with extremely severe burn and patients with non-extremely severe burn were recorded.Data were processed with Wilcoxon rank sum test.Results (1) Totally 1 658 blood samples were collected during the four years,and 339 (20.4％) strains of pathogens were isolated.The isolation rate of Gram-negative bacteria,Gram-positive bacteria,and fungi were 68.4％ (232/339),24.5％ (83/339),and 7.1％ (24/339),respectively.The top three pathogens with isolation rate from high to low were Acinetobacter baumannii,Staphylococcus aureus,and Pseudomonas aeruginosa in turn.(2) Except for the low drug resistance rate to polymyxin B and minocycline,drug resistance rate ofAcinetobacter baumannii to the other antibiotics were relatively high (81.0％-100.0％).Pseudomonas aeruginosa was sensitive to polymyxin B but highly resistant to other antibiotics (57.7％-100.0％).Enterobacter cloacae was sensitive to imipenem and meropenem,while its drug resistance rates to ciprofloxacin,levofloxacin,cefoperazone/sulbactam,cefepime,piperacillin/tazobactam were 25.0％-49.0％,and those to the other antibiotics were 66.7％-100.0％.Drug resistance rates of Klebsiella pneumoniae to cefoperazone/sulbactam,imipenem,and meropenem were low (5.9％-15.6％,two imipenem-and meropenem-resistant strains were identified by modified Hodge test),while its drug resistance rates to amoxicillin/clavulanic acid,piperacillin/tazobactam,cefepime,eefoxitin,amikacin,levofloxacin were 35.3％-47.1％,and those to the other antibiotics were 50.0％-100.0％.(3) Drug resistance rates of methicillin-resistant Staphylococcus aureus (MRSA) to most of the antibiotics were higher than those of the methicillin-sensitive Staphylococcus aureus (MSSA).MRSA was sensitive to linezolid,vancomycin,and teicoplanin,while its drug resistance rates to compound sulfamethoxazole,clindamycin,minocycline,and erythromycin were 5.3％-31.6％,and those to the other antibiotics were 81.6％-100.0％.Except for totally resistant to penicillin G and tetracycline,MSSA was sensitive to the other antibiotics.Fourteen Staphylococcus aureus strains were resistant to erythromycin-induced clindamycin.Enterococcus was sensitive to vancomycin and teicoplanin,while its drug resistance rates to linezolid,chloramphenicol,nitrofurantoin,and high unit gentamicin were low (10.0％-30.0％),and those to ciprofloxacin,erythromycin,minocycline,and ampicillin were high (60.0％-80.0％).Enterococcus was fully resistant to rifampicin.(4) Fungi was sensitive to amphotericin B,and drug resistance rates of fungi to voriconazole,fluconazole,itraconazole,and ketoconazole were 7.2％-12.5％.(5) The mortality of patients with extremely severe burn was higher than that of patients with non-extremely severe burn.The variety of infected pathogens in patients with extremely severe burn significantly outnumbered that in patients with non-extremely severe burn (Z =-2.985,P =0.005).Conclusions The variety of pathogen in severely burned patients with bloodstream infection is wide,with the main pathogens as Acinetobacter baumannii,Staphylococcus aureus,and Pseudomonas aeruginosa,and the drug resistance situation is grim.The types of infected pathogen in patients with extremely severe burn are more complex,and the mortality of these patients is higher when compared with that of patients with non-extremely severe burn.

Objective:To investigate the epidemiological characteristics and etiological distribution of infection on 3 067 hospitalized pediatric patients with burns, and explore the prevention and treatment strategy of pediatric burns.Methods:A cross-sectional survey was conducted. An analysis was performed on the data of 3 067 hospitalized pediatric patients with burns who met the inclusion criteria and were admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from January 2012 to December 2020, including gender, age, causative factors, locations and severities of burns, seasons of accidents, and the type, source of tissue or body fluid, and drug resistance of pathogenic bacteria. API bacterial identification batten and automatic microbial identification system were applied for pathogen identification. Drug sensitivities of top 3 consistent ratio pathogen identifed were tested with minimum inhibitory concentration and disk diffusion method. WHONET 5.6 software was applied to analyze the data.Results:There were 3 067 hospitalized pediatric patients with burns, including 1 768 boys and 1 299 girls. The majority of pediatric burn patients were >1 and ≤4 years, accounting for 72.9% (2 236/3 067), and the minority of pediatric burn patients were >8 and ≤12 years, accounting for 4.9% (150/3 067). Moderate burns and severe burns of pediatric burn patients accounted for the majority parts, and the proportions of the two were close. The top cause of pediatric burns was scald, accounting for 81.6% (2504/3 067). Extremities were the most common burn sites in that of entire 3 254. The most pediatric burns occurred in winter, accounting for 29.4% (903/3 067). A total of 1 018 strains of pathogenic bacteria were collected from pediatric burn patients, all of which were non-repeated isolates. The pathogens with top five consistent ratio were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae, and Escherichia coli, among which Staphylococcus aureus ranked the first every year. The pathogens were mainly isolated from the wound exudate, accounting for 81.34% (828/1 018). Staphylococcus aureus from 2012 to 2020 showed no resistance to vancomycin, linezolid or teicoplanin while Staphylococcus aureus isolated in 2019 was 100% resistant to macrolides, penicillin, aminoglycosides, and quinolones. Pseudomonas aeruginosa was not resistant to polymyxin B. Acinetobacter baumannii showed a high rate of drug resistance to most antibiotics. Conclusions:Among the pediatric burn patients admitted to the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from 2012 to 2020, the majority are male children aged >1 and ≤4 years with moderate burns. Scalds are the leading cause; and extremities are the common burn sites; and the most pediatric burns occurre in winter. Staphylococcus aureus from wound exudate is the primary pathogen of burn wound infections in pediatric patients.

Constructing ethanologenic strains with cellulose activity is important to achieve consolidated bioprocessing of lignocellulose for ethanol production. In this study, we integrated the pyruvate decarboxylase gene pdc and alcohol dehydrogenase gene adhB from Zymomonas mobilis ZM4 into Escherichia coli JM109 by Red recombination method to generatea recombinant strain E. coli P81 that could produce ethanol from glucose. Abeta-glucosidase gene bglB from Bacillus polymyxa 1.794 was cloned into the recombinant E. coli P81 and beta-glucosidase was expressed to give a new recombinant strain E. coli P81 (pUC19-bglB) with dual functions of cellobiose degradation and ethanol production. The extracellular beta-glucosidaseactivity was 84.78 mU/mL broth and the extracellular cellobiase activity of E. coli P81 (pUC19-bglB) was 32.32 mU/mL broth. E. coli P81 (pUC19-bglB) fermented cellobiose to ethanol with a yield of 55.8% of the theoretical value, and when glucose and cellobiose were co-fermented, the ethanol yield reached 46.5% of thetheoretical value. The construction of consolidated bioprocessing strain opens the possibility to convert cellobiose to ethanol in a single bioprocess.
Bacterial Secretion Systems ; Cellulose ; metabolism ; Escherichia coli ; genetics ; metabolism ; Ethanol ; metabolism ; Fermentation ; Recombinant Proteins ; biosynthesis ; genetics ; beta-Glucosidase ; biosynthesis ; genetics