Objective:To explored the clinical characteristics and risk factors of acute kidney injury (AKI) caused by vancomycin combined with piperacillin sodium and tazobactam sodium (VPT) in adult patients with severe infections.Methods:Clinical data of adult patients with VPT-related AKI (AKI group) hospitalized at the Affiliated Hospital of Gansu Medical College and People′s Hospital of Hengshui from January 2022 to August 2023 due to severe infections were collected. The occurrence time, severity, and prognosis of AKI in the AKI group were descriptive statistically analyzed. According to the ratio of 1∶1, patients in the control group were randomly selected from those who did not develop AKI after using VPT in the same period. The general information, disease status, baseline laboratory tests results, and the application of VPT and combined drugs, etc. in patients of the 2 groups were collected. The influencing factors of AKI caused by VPT were analyzed by univariate and multivariate logistic regression.Results:A total of 1 547 adult patients with severe infections were treated with VPT, of which 175 (11.3%) developed AKI. Among the 175 patients, 81 (46.3%) were male and 94 (53.7%) were female, with an age of (55±22) years; the time from VPT treatment to the occurrence of AKI was (4±1) days, and the severity of AKI was staged as grade 1, 2 and 3 in 97 (55.4%), 54 (30.9%), and 24 (13.7%) patients, respectively. After drug withdrawal, the renal function gradually recovered in 169 (96.6%) of the 175 patients with AKI, and 6 (3.4%) patients needed continuous renal replacement therapy. Multivariate logistic regression analysis showed that the trough concentration of vancomycin >20 mg/L [odds ratio ( OR)=2.105, 95% confidence interval ( CI): 1.427-3.105, P=0.022], the duration of vancomycin treatment ≥11 days ( OR=1.518, 95% CI: 1.232-1.871, P=0.014), the duration of piperacillin sodium and tazobactam sodium treatment ≥14 days ( OR=1.826, 95% CI: 1.152-2.894, P=0.029) and longer duration of combined vasoactive drugs ( OR=3.315, 95% CI: 1.428-7.695, P=0.005) were independent risk factors for VPT-related AKI. Conclusions:VPT-related AKI in adult patients with severe infections mostly occurs within one week of combination therapy, and the severity was mostly stage 1 and 2. The trough concentration of vancomycin >20 mg/L, longer course of VPT treatment, and longer time of combined vasoactive drugs can increase the risk of VPT-related AKI.

Objective:To explored the clinical characteristics and risk factors of acute kidney injury (AKI) caused by vancomycin combined with piperacillin sodium and tazobactam sodium (VPT) in adult patients with severe infections.Methods:Clinical data of adult patients with VPT-related AKI (AKI group) hospitalized at the Affiliated Hospital of Gansu Medical College and People′s Hospital of Hengshui from January 2022 to August 2023 due to severe infections were collected. The occurrence time, severity, and prognosis of AKI in the AKI group were descriptive statistically analyzed. According to the ratio of 1∶1, patients in the control group were randomly selected from those who did not develop AKI after using VPT in the same period. The general information, disease status, baseline laboratory tests results, and the application of VPT and combined drugs, etc. in patients of the 2 groups were collected. The influencing factors of AKI caused by VPT were analyzed by univariate and multivariate logistic regression.Results:A total of 1 547 adult patients with severe infections were treated with VPT, of which 175 (11.3%) developed AKI. Among the 175 patients, 81 (46.3%) were male and 94 (53.7%) were female, with an age of (55±22) years; the time from VPT treatment to the occurrence of AKI was (4±1) days, and the severity of AKI was staged as grade 1, 2 and 3 in 97 (55.4%), 54 (30.9%), and 24 (13.7%) patients, respectively. After drug withdrawal, the renal function gradually recovered in 169 (96.6%) of the 175 patients with AKI, and 6 (3.4%) patients needed continuous renal replacement therapy. Multivariate logistic regression analysis showed that the trough concentration of vancomycin >20 mg/L [odds ratio ( OR)=2.105, 95% confidence interval ( CI): 1.427-3.105, P=0.022], the duration of vancomycin treatment ≥11 days ( OR=1.518, 95% CI: 1.232-1.871, P=0.014), the duration of piperacillin sodium and tazobactam sodium treatment ≥14 days ( OR=1.826, 95% CI: 1.152-2.894, P=0.029) and longer duration of combined vasoactive drugs ( OR=3.315, 95% CI: 1.428-7.695, P=0.005) were independent risk factors for VPT-related AKI. Conclusions:VPT-related AKI in adult patients with severe infections mostly occurs within one week of combination therapy, and the severity was mostly stage 1 and 2. The trough concentration of vancomycin >20 mg/L, longer course of VPT treatment, and longer time of combined vasoactive drugs can increase the risk of VPT-related AKI.

Background: Antibiotic resistance is a significant public health concern around the globe.Antimicrobial peptides exhibit broad-spectrum and efficient antibacterial activity with an added advantage of low drug resistance. The higher water content and 3D network structure of the hydrogels are beneficial for maintaining antimicrobial peptide activity and help to prevent degradation. The antimicrobial peptide released from hydrogels also hasten the local wound healing by promoting epithelial tissue regeneration and granulation tissue formation. Objective: This study aimed at developing sodium alginate based hydrogel loaded with a novel antimicrobial peptide Chol-37(F34-R) and to investigate the characteristics in vitro and in vivo as an alternative antibacterial wound dressing to treat infectious wounds. Methods: Hydrogels were developed and optimized by varying the concentrations of crosslinkers and subjected to various characterization tests like cross-sectional morphology, swelling index, percent water contents, water retention ratio, drug release and antibacterial activity in vitro, and Pseudomonas aeruginosa infected wound mice model in vivo. Results: The results indicated that the hydrogel C proved superior in terms of cross-sectional morphology having uniformly sized interconnected pores, a good swelling index, with the capacity to retain a higher quantity of water. Furthermore, the optimized hydrogel has been found to exert a significant antimicrobial activity against bacteria and was also found to prevent bacterial infiltration into the wound site due to forming an impermeable barrier between the wound bed and external environment. The optimized hydrogel was found to significantly hasten skin regeneration in animal models when compared to other treatments in addition to strong inhibitory effect on the release of pro-inflammatory cytokines (interleukin-1β and tumor necrosis factor-α). Conclusions Our results suggest that sodium alginate -based hydrogels loaded with Chol-37(F34-R) hold the potential to be used as an alternative to conventional antibiotics in treating infectious skin wounds.

Objective:To investigate the effects of breast milk to total milk intake ratio during hospitalization on the duration of antibiotic therapy in preterm infants less than 34 weeks of gestation.Methods:Clinical data of preterm infants ( n=1 792) less than 34 gestational weeks were retrospectively collected in 16 hospitals of Jiangsu Province Neonatal-Perinatal Cooperation Network from January 1, 2019, to December 31, 2021. The days of therapy (DOT) were used to evaluate the duration of antibiotic administration. The median DOT was 15.0 d (7.0-27.0 d). The patients were divided into four groups based on the quartiles of DOT: Q 1 (DOT≤7.0 d), Q 2 (7.0 d27.0 d) groups. According to the breast milk intake ratio (breast milk intake to total milk intake during hospitalization×100%), they were also divided into four groups: very-low-ratio breastfeeding group (breast milk intake ratio≤25%), low-ratio breastfeeding group (25%75%). Univariate analysis ( Chi-square test and Kruskal-Wallis rank-sum test) was used to analyze the factors influencing DOT. Spearman correlation analysis and trend Chi-square test were used to explore the relationship between breast milk intake ratio and DOT. After using multiple imputations to address missing data, two models were constructed after adjusting for different factors, and multinomial logistic regression model was applied to evaluate the effects of the breast milk intake ratio on DOT. Finally, sensitivity analysis was conducted to assess the stability of the models. Results:(1) Of the 1 792 preterm infants, there were 507 (28.3%) in the Q 1 group, 422 (23.5%) in the Q 2 group, 438 (24.4%) in the Q 3 group and 425 (23.7%) in the Q 4 group. (2) The median values of DOT in the very-low-ratio, low-ratio, medium-ratio and high-ratio breastfeeding groups were 20.0 d (11.0-31.0 d), 20.0 d (11.0-32.0 d), 13.0 d (6.0-25.8 d) and 10.0 d (4.0-21.0 d), respectively. Compared with the very-low-ratio and low-ratio breastfeeding groups, the medium-ratio and high-ratio breastfeeding groups had shorter DOT (all P<0.05). (3) After adjusting for factors with P<0.1 (prenatal glucocorticoid exposure, antimicrobial use within 24 h before delivery, gestational age at delivery, birth weight, Apgar score≤7 at 1 min, neonatal respiratory distress syndrome, infectious pneumonia and early-onset neonatal sepsis) between the DOT quartile groups, it showed that medium-ratio and high-ratio breastfeeding were protective factors in contrast to very-low-ratio breastfeeding in the Q 2, Q 3 and Q 4 groups as compared with the Q 1 group [Q 2 group: OR=0.50 (95% CI: 0.30-0.85) and OR=0.36 (95% CI: 0.26-0.51); Q 3 group: OR=0.31 (95% CI: 0.18-0.55) and OR=0.20 (95% CI: 0.14-0.29); Q 4 group: OR=0.22 (95% CI: 0.12-0.42) and OR=0.17 (95% CI: 0.12-0.26)]. Conclusion:Breast milk intake accounting for over 50% of total milk intake has a positive impact on reducing DOT in premature infants requiring antibiotics, which suggests that breastfeeding should be actively encouraged.

Objective To retrospectively analyze the characteristics of postoperative complications of endoscopic submucosal dissection (ESD) in patients of different age groups with lesions at different locations . Methods From January 2011 to October 2017, at The First Affiliated Hospital of Zhejiang University , clinical data of 1688 patients who received ESD treatment (1799 ESD operations) were collected.The lesions were located in the esophagus (n =232), stomach (n =1225), duodenum (n =9), colon (n =152) and rectum (n =181).There were 500 patients (508 ESD operations) with underlying diseases, and 1188 patients without underlying diseases.Most patients with lesions at stomach, esophagus and colon rectum, and these patients were divided into four age groups <45 years (n =202), 4559 years (n =643), 6074 years (n =744), and ≥75 years (n =99).The postoperative complications rates of ESD in different lesions among four age groups were compared.Chi-square test was performed for statistical analysis .Results From 2011 to 2017, the complication rates after ESD were 20.0％ (8/40), 18.3％ (21/115), 15.9％ (35/220), 10.7％ (31/291), 11.3％ (40/355), 10.7％ (41 /384) and 10.7％ (42/394), respectively, and the difference was not statistically significant (χ2 =10.432, P =0.064).Further analysis revealed that the complication rates after ESD between 2011 and 2013 was significantly higher than that between 2014 and 2017 (17.1％, 64/375 vs.10.8％, 154 /1424);and the difference was statistically significant (χ2 =10.895, P <0.01).The complication rates of patients with lesions in the esophagus of <45 years group,4559 years group, 6074 years group and ≥75 years group were 4.5％ (1/22), 23.6％ (17 /72), 24.4％ (31 /127) and five cases (totally 11 cases).The complication rates of patients with lesions in the stomach of <45 years group,4559 years group, 6074 years group and ≥75 years group were 19.2％ (28 /146), 14.2％ (68 /479), 15.8％ (85 /539) and 16.4％ (10/61).The complication rates of lesions in the colon of <45 years group, 4559 years group, 6074 years group and ≥75 years group were one case ( totally 12 cases), 3.4％ (2 /58), 10.9％ (7/64) and five cases ( totally 18 cases), respectively.The complication rates of lesions in the rectum of <45 years group, 4559 years group, 6074 years group and ≥75 years group were 3.3％ (1 /30), 10.4％ (7 /67), 19.4％ (14/72) and two cases (totally 12 cases), respectively.There were significant differences in complication rates between different age groups with lesions in the esophagus (χ2 =10.894, P =0.012) and the colon (χ2 =13.540, P =0.004). In addition, the complication rates of patients with underlying diseases and without underlying diseases were 14.6％ (74 /508) and 12.5％ (149 /1188), respectively, and there was no statistically significant difference (χ2 =1.278, P =0.258).Conclusions The postoperative complications of ESD is closely associated with lesion location and age.For elderly patients, especially those with lesions in the esophagus and colon , paying more attention and strengthening the clinical practice can effectively reduce the incidence of complications .

Objective? To explore the effects of WeChat combined with module teaching in minimally invasive surgery nursing training. Methods? From July 2016 to June 2018, 56 junior nurses in operating room were randomly divided into control group and experimental group, 28 nurses in each group by random table. Control group carried out routine teaching combined with module teaching, while experimental group adopted WeChat combined with module teaching. We compared the theoretical achievements, skills performance and satisfaction of surgeons with nursing. Results? Twelve months after training, the theoretical achievements and skills performance of experimental group were (76.93±5.31) and (78.79±4.86) respectively, higher than those of control group with statistical differences (t=-3.34, -3.13;P＜ 0.05). Satisfaction of surgeons with nursing provided by nurses was (94.68±3.37) in experimental group and (72.26±4.67) in control group with a statistical difference (t=-35.64,P＜ 0.05). Conclusions? The application of WeChat combined with module teaching in minimally invasive surgery nursing training for junior nurses can stimulate the enthusiasm of autonomous learning, raise the theoretical achievements and skills performance and improve satisfaction of surgeons with nursing for surgeries.

Objective To analyze the curative effect of teprenone capsule combined with quadruple therapy in the treatment of chronic atrophic gastritis.Methods From June 2013 to June 2017,one hundred and fifty patients with chronic atrophic gastritis admitted to the First Hospital of Ninghai County were retrospectively selected.According to different treatment schemes,they were divided into control group and observation group,with 75 patients in each group.The control group was treated with routine quadruple therapy, and the observation group was treated with teprenone capsule combined with quadruple therapy.The effective rate of the two groups was compared.Results The total effective rate of the observation group was 97.33% ,which was higher than 85.33% of the control group,the difference between the two groups was statistically significant(χ2 =3.197,P<0.05).After treatment,the levels of interleukin-8 and tumor necrosis factor - alpha in the observation group were ( 7.04 ± 1.03 ) ng/L, ( 41.02 ± 1.72)ng/L,respectively,which in the control group were (10.81 ± 1.63)ng/L,(57.35 ± 2.95) ng/L,respectively, the differences between the two groups were statistically significant (t=6.028,7.281,all P <0.05).The gastric mucosa score and the gastrin concentration in the observation group were (1.13 ± 0.32)points,(8.97 ± 2.33)pmol/L, respectively,which in the control group were ( 1. 82 ± 0. 61 ) points, ( 5. 36 ± 1. 52 ) pmol/L, respectively, the differences between the two groups were statistically significant ( t =5. 661, 6. 024, all P <0. 05 ). Conclusion Teprenone capsule combined with quadruple therapy can improve the clinical efficacy and reduce the degree of inflammation in patients with chronic atrophic gastritis,which is worthy of clinical application.

Objective To investigate optimum dose of anesthesia in pediatric axillary brachial plexus branch block under ultrasound-guided. Methods Forty-eight children from May 2012 to May 2013 in hand surgery of our hospital,whose age was from 6 to 12 years,were randomly divided into four groups, each group has 12 cases. The doses of Ropivacaine were different in different groups. Group A was 0. 25 mL/kg,group B was 0. 2 mL/kg,group C was 0. 15 mL/kg,group D was 0. 10 mL/kg. And Ketamine was added to the treatment ac-cording to the incidence of anesthesia intraoperative. Evaluating the effect of anesthesia according to the situation of nerve block,observing an-esthesia duration time,dosage of anesthesia and rates of complications. Results The blocking effect of group A,B and C in each nerve area was correspond after 30 min,and anesthesia efficiency was higher than group D,but additional rate was lower than group D,the differences were statistically significant (P<0. 05). The block time in group D was shorter than the other groups,and the dose of Ketamine was most, and the block onset,perfect time were longer than the other groups (P<0. 05). But the differences between group A,B,C were not signifi-cant. Two cases in group D converted to general anesthesia. Four groups did not occur complication related narcotic drug. Conclusion In pediatric brachial plexus block used Ropivacaine under ultrasound-guided would get complete branch block,the exact effect of anesthesia, smaller dosage of local anesthesia. When the dosage of Ropivacaine was 0. 15 mL/kg could achieve a better anesthesia effect.

OBJECTIVE:To systematically review the clinical efficacy and safety of macrolide antimicrobial drugs in the adju-vant treatment of lung infection of Pseudomonas aeruginosa (PA) and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from PubMed,Ovid,CJFD,VIP,CBM and Wangfang database,randomized controlled trials(RCT)about sensitive antimicrobial drugs of PA combined with macrolide antimicrobial drugs (test group) vs. sensitive antimicrobial drugs of PA alone(control group)in the treatment of lung infection of PA were included and comprehensively evaluated using Jadad scale. The homogeneity results were analyzed by Rev Man 5.2 software. RESULTS:13 RCTs were included,involving 872 patients. Me-ta-analysis showed that the effective rate [OR=6.42,95%CI(4.23,9.74),P<0.001] and PA clearance rate[OR=6.10,95%CI(4.10, 9.09),P<0.001] in test group were significantly higher than control group;the time of body temperature returned to normal[MD=-1.14,95%CI(-1.35,-0.94),P<0.001],time of cough sputum disappearance [MD=-1.70,95%CI (-1.97,-1.44),P<0.001] and time of the blood returned to normal[MD=-1.24,95%CI(-2.04,-0.43),P<0.001] were significantly shorter than control group,there were significant difference between 2 groups. There was no significant difference in the incidence of adverse re-action [OR=1.30,95%CI(0.73,2.31),P=0.37]. CONCLUSIONS:Macrolide antimicrobial drugs have good efficacy and safety in the adjuvant treatment of PA infection. Duo to the limit of research methodology quality,it remains to be further verified by large-sample and high-quality RCT.

OBJECTIVE: To evaluate the effect of partial inferior turbinectomy in treating inferior nasal meatus epistaxis. METHOD: Twenty one case of inferior nasal meatus epistaxis were subjected to submucoperiosteous partial inferior turbinectomy and nasal cavity plugging under nasal endoscopy Its effect were analyzed. RESULT: All patients cured and discharged after 3-7 days. After 2 months to 3 years of follow up, no recurrence were seen. CONCLUSION Submucoperiosteous partial inferior turbinectomy under nasal endoscopy is an effective and reliable method in treating inferior nasal meatus epistaxis.
Adult ; Endoscopy ; Epistaxis ; surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Turbinates ; surgery