OBJECTIVE: To explore the clinical features of patients with necrotizing soft tissue infection (NSTI) and the related factors for sepsis, so as to provide a basis for early intervention and improvement of patients' prognosis. METHODS: A retrospective case series study was conducted to analyze the clinical data of NSTI patients admitted to the department of burns and wound repair surgery of Guangdong Provincial People's Hospital from October 2021 to December 2024. Demographic information, underlying diseases, infection characteristics, laboratory test results and etiological findings at admission, treatment status, occurrence of complications (including sepsis) and prognosis were collected. Univariate and multivariate Logistic regression analyses were used to identify the associated factors for sepsis in NSTI patients. Receiver operator characteristic curves (ROC curves) were plotted to evaluate the predictive value of individual and combined factors for sepsis. RESULTS: A total of 159 NSTI patients were enrolled, mainly middle-aged and elderly males. Most patients had comorbidities, including diabetes mellitus (110 cases, 69.2%) and hypertension (67 cases, 42.1%). The main infection site was the lower extremities (104 cases, 65.4%). Common symptoms included redness (96 cases, 60.4%), swelling (129 cases, 81.1%), local heat (60 cases, 37.7%), pain (100 cases, 62.9%), and skin ulceration or necrosis (9 cases, 5.7%). Imaging findings included soft tissue swelling (66 cases, 57.9%), gas accumulation (41 cases, 36.0%), and abnormal signal/density shadows (50 cases, 43.9%). Staphylococcus aureus was the main pathogenic bacterium [12.0% (31/259)], and drug-resistant Escherichia coli had the highest detection rate among drug-resistant bacteria [35.1% (13/37)]. Regarding debridement and repair, most patients (80 cases, 50.3%) underwent debridement ≥ 72 hours after admission, while only 10.1% (16 cases) received debridement within 6 hours. Most patients underwent multiple debridements, with 2 times of debridements being the most common (68 cases, 42.8%), and the maximum times of debridements reached 6. The largest number of patients received secondary suture (44 cases, 27.7%). In terms of complications, sepsis was the most common (66 cases, 41.51%), followed by acute kidney injury, respiratory failure requiring mechanical ventilation, and multiple organ dysfunction syndrome (MODS), while disseminated intravascular coagulation (DIC) was the least common. During the follow-up period, 9 patients (5.66%) were readmitted within 90 days, and 11 patients died, with a mortality rate of 6.92%. Univariate analysis showed that diabetes, coronary heart disease, gout, body temperature, heart rate, C-reactive protein, platelet count, total bilirubin, albumin, creatinine, out-of-hospital treatment, and out-of-hospital use of antimicrobial agents were significantly associated with sepsis in NSTI patients (all P < 0.05). Multivariate Logistic regression analysis showed that coronary heart disease [odds ratio (OR) = 30.085, 95% confidence interval (95%CI) was 2.105-956.935], C-reactive protein (OR = 1.026, 95%CI was 1.009-1.054), and total bilirubin (OR = 1.436, 95%CI was 1.188-1.948) were independent associated factors for sepsis in NSTI patients (all P < 0.05). ROC curve analysis revealed that the combination of the three predictors yielded the highest AUC for predicting sepsis in NSTI patients compared to any individual predictor [area under the curve (AUC) = 0.799 (95%CI was 0.721-0.878)]. CONCLUSIONS The clinical features of NSTI patients show certain regularity. Coronary heart disease, C-reactive protein, and total bilirubin are independent associated factors for sepsis in NSTI patients.
Humans ; Retrospective Studies ; Male ; Sepsis ; Soft Tissue Infections/microbiology* ; Female ; Middle Aged ; Aged ; Adult ; Prognosis ; Risk Factors ; Necrosis ; Logistic Models ; Fasciitis, Necrotizing

Objective:To investigate the effects of antibacterial absorbable suture closure in the repair of small range of bone defect wounds due to deep sternal wound infection after median thoracotomy.Methods:This study was a retrospective non-randomized clinical controlled study. A total of 32 patients (20 males and 12 females, aged (58±11) years) who met the inclusion criteria and underwent closure with antibacterial absorbable sutures (hereinafter referred to as direct closure surgery) admitted to Guangdong Provincial People's Hospital of Southern Medical University (hereinafter referred to as our hospital) from October 2017 to December 2021 were included in direct closure group. A total of 39 patients (27 males and 12 females, aged (59±11) years) who met the inclusion criteria and received bilateral pectoralis major muscle flap packing repair admitted to our hospital from January 2015 to January 2020, were included in muscle flap packing group. In the two groups, sternal infected wounds were thoroughly debrided during stage Ⅰ surgery, followed by wound repair during stage Ⅱ surgery. The width of sternal cross-section defects after debridement was less than 1 cm for patients in the two groups. For patients in direct closure group, stage Ⅱ wound repair involved intermittent sutures to the anterior sternal plate or full-thickness sternum with a total of 6 or 7 double sternal sutures. Relevant data including the duration of the stage Ⅱ wound repair surgery and the volume of blood loss during surgery, length of hospital stay, and bacterial wound infection of patients in the two groups were recorded. The postoperative complications and wound healing of patients in the two groups were recorded. During follow-up, the wound infection or recurrence of patients in the two groups and the sternal healing of patients in direct closure group were observed.Results:Compared with those in muscle flap packing group, the duration of stage Ⅱ wound repair surgery and length of hospital stay of patients in direct closure group were significantly shorter (with t values of 13.61 and 6.25, respectively, P<0.05), and there was no statistically significant difference in intraoperative blood loss volume of the stage Ⅱ wound repair surgery between the two groups ( P>0.05). The main bacterial infection in the two groups was Staphylococcus. In direct closure group, one patient had exudation in the wound two weeks post-operation, however the wound healed well after two weeks of conservative dressing changes; the wounds of the other patients healed well. In muscle flap packing group, 5 patients had postoperative complications, of which one patient died, and the wounds of 4 patients healed after dressing change or reoperation; the wounds of the other patients healed well. There was no statistically significant difference in complication incidence of patients between the two groups ( P>0.05). During the follow-up of 22-45 months, there was no re-infection or recurrence in the wound of patients in direct closure group and surviving patients in muscle flap packing group, the sternum of patients in the direct closure group achieved anatomical union. Conclusions:Direct closure surgery can not only effectively repair sternal cross-sectional defects with width below 1 cm due to deep sternal wound infections after median thoracotomy, but can also significantly shorten the operation time and duration of hospitalization.

Objective: To examine the association between secondhand smoke exposure (SHS) in indoor public places and carotid intima media thickness (cIMT) in children and adolescents, so as to provide guidance for the prevention of early abnormal vascular architecture. Methods: The data were obtained from the second follow up of the Children Cardiovascular Health Cohort Study conducted from November to December 2021. A total of 1 297 children and adolescents for who completed data relating to sex, age, cIMT, physical examinations, questionnaires variables and blood biochemical indices, were included for analysis. Linear regression analysis was performed to examine trends in the levels of cIMT with exposure to SHS in indoor public places. Multiple linear regression analysis was carried out to assess the association between SHS exposure in indoor public places and cIMT after adjustment for potential covariates. Results: During the previous 7 days, 407 (31.4%) children and adolescents were exposed to SHS in indoor public places for 1-2 days, 86 (6.6%) for 3-4 days, and 82 (6.3%) for ≥5 days. The levels of cIMT in youth increased on different models, with the duration of SHS exposure during the previous 7 days ( t=3.30, 3.05, 2.87, P <0.05). After adjusting for various covariates, the cIMT values of children and adolescents were[0 day:(551.5±29.3) μm, 1-2 days:(554.0±28.6) μm, 3-4 days:(557.0±27.7) μm, ≥5 days:(559.4±27.5) μm]. Compared to those who were not exposed to SHS in indoor public places during the previous 7 days, those exposed for ≥5 days had significantly higher cIMT levels ( β=7.91, 95%CI=1.47-14.34, P <0.05). Conclusion Among children and adolescents, exposure to SHS in indoor public places remains high and is significantly associated with cIMT. The findings highlight the need for stricter regulation and tobacco control policies to provide healthy smoke free environments for children and adolescents, and to reduce the risk of early abnormal vascular architecture.

Objective:To recognize the characteristics of necrotizing fasciitis patients complicated with sepsis and summarize the experience the treatment.Methods:A retrospective study was conducted. The clinical data of 57 patients with necrotizing fasciitis complicated with sepsis admitted to Guangdong Provincial People's Hospital from July 2009 to December 2019 was analyzed by collecting such factors as gender, age, complications, infection sites, pathogens, surgery information, treatment options and outcome. The patients were divided into debridement group ( n = 14) and control group ( n = 43) according to whether the debridement was completed within 48 hours of admission, and the mortality during hospitalization between the two groups was compared. A telephone follow-up had been done to record the long-term outcome of these patients. Results:Among 57 patients with necrotizing fasciitis complicated with sepsis, there were 43 males and 14 females with the average age of (57.9±12.1) years old. Most of the underlying diseases were diabetes mellitus (70.17%), other diseases included hypertension (8.77%), tumor chemotherapy (7.02%), liver disease (hepatitis, cirrhosis, 7.02%), coronary artery heart disease (3.51%), systemic lupus erythematosus (3.51%), etc. Most of the infection site was lower limbs (71.93%). There were 78 pathogens cultured in 57 patients, in which 52 were non-drug resistant bacteria (66.67%), and 26 were drug resistant bacteria (33.33%). There were 40 Gram positive (G +) bacteria (51.28%), 29 Gram negative (G -) bacteria (37.18%), 8 fungi (10.26%) and 1 mixed bacteria (1.28%). Finally, of 57 patients, 46 patients were cured, and 11 patients died with hospital mortality of 19.30%. Among 57 patients, the hospital mortality in the debridement group was significantly lower than that in the control group [0% (0/14) vs. 25.58% (11/43), P < 0.05]. Among the 46 cured patients, 11 had accepted amputations, accounting for 23.91%. In December 2020, 43 patients who were cured (3 patients were lost to follow-up) were followed up by telephone. Twenty-three patients were completely self-care, 9 patients were partly self-care, 8 patients were completely unable to take care of themselves, and 3 patients died. Conclusions:Necrotizing fasciitis with sepsis mostly occurs in people with weakened immunity, and has a high mortality and disability rate. Early identification and active surgical debridement may be the key to improve the treatment effect.

Objective:To investigate the clinical features and prognostic influencing factors of toxic epidermal necrolysis (TEN).Methods:A retrospective observational study was conducted. From January 2008 to March 2019, a total of 46 TEN patients who met the inclusion criteria were admitted to Guangdong Provincial People's Hospital. The gender, age, and hospital admission diagnosis of the 46 patients, the category of department admitted of patients complicated with sepsis, death ratio of the sepsis patients with or without treatment history in intensive care unit (ICU)/department of burns and wound repair, and the cause of death of the deceased patients were recorded. Depending on whether complicated with sepsis, the patients were divided into sepsis group (32 cases) and non-sepsis group (14 cases). According to whether died or not, the patients were divided into death group (9 cases) and survival group (37 cases). The specific conditions of suspected pathogenic agents and combined underlying diseases, the abnormality of transaminase/bilirubin, creatinine, and platelet count in blood on admission, and the detection of pathogenic microorganisms and drug resistance during the course of disease of patients were recorded in both sepsis group and non-sepsis group. The gender, age, lesion area, severity of illness score for TEN (SCORTEN) system score, combined underlying diseases on admission, and blood microbial culture positivity, hormone use, and gamma globulin use during the course of disease of patients between sepsis group and non-sepsis group, death group and survival group were compared respectively. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Mann-Whitney U test. The factors with statistically significant differences between sepsis group and non-sepsis group, death group and survival group were selected for binary multivariate logistic regression analysis, so as to screen the independent risk factors affecting sepsis and death in TEN patients. Results:Of the 46 TEN patients, 30 were male and 16 were female, aged from 8 months to 92.0 years, with 11 cases (23.91%) of epidermolysis bullosa, 9 cases (19.57%) of exfoliative dermatitis, 9 cases (19.57%) of TEN, 7 cases (15.22%) of epidermolysis bullosa, 6 cases (13.04%) of Stevens-Johnson syndrome, and 4 cases (8.70%) of severe drug rash for hospital admission diagnosis. The patients complicated with sepsis were admitted to 11 departments, and the death ratio of patients with treatment history in ICU/department of burns and wound repair was similar to that of patients without such department treatment history ( P>0.05). All the deceased patients were complicated with sepsis, which was also the main cause of death. On admission, the suspected pathogenic agents of patients in sepsis group were mainly allopurinol (8 cases) and non-steroidal anti-inflammatory drugs (4 cases), while those in non-sepsis group were allopurinol (3 cases) and psychotropic drugs (3 cases). Patients in sepsis group combined as many as 10 underlying diseases, while those in non-sepsis group combined only 4 underlying diseases. The proportions of patients with increased creatinine ( χ2=13.349, P<0.01) and decreased platelet count ( P<0.01) in sepsis group were significantly higher than those in non-sepsis group, while the transaminase/bilirubin abnormality was similar to that in non-sepsis group ( P>0.05). A wide variety of pathogens were detected in the blood, respiratory tract secretions, and skin secretions of 21 patients in sepsis group, and 14 patients were infected with drug-resistant bacteria; among the 9 strains cultured from the blood samples, 8 were drug-resistant bacteria and 6 were Gram-positive bacteria. In non-sepsis group, pathogens were detected in blood, respiratory tract secretions, and skin secretions of 8 patients, with fewer species, and 6 patients were infected with drug-resistant bacteria. The gender, age, lesion area, blood microbial culture positivity, hormone use, and gamma globulin use of patients in sepsis group were similar to those in non-sepsis group ( P>0.05). The proportion of patients combined with underlying diseases ( χ2=4.493, P<0.05) and the proportion of patients with SCORTEN system score of 4-6 points ( P<0.01) of patients in sepsis group were significantly higher than those in non-sepsis group. The gender, combined underlying diseases, lesion area, blood microbial culture positivity, hormone use, and gamma globulin use of patients were similar between survival group and death group ( P>0.05). The proportion of patients with age≥60 years and the proportion of patients with SCORTEN system score of 4-6 points of patients in death group were significantly higher than those in survival group ( χ2=4.412, 11.627, P<0.05 or P<0.01). The SCORTEN system score was an independent risk factor affecting sepsis and death in TEN patients (odds ratio=3.025, 2.757, 95% confidence interval=1.352-6.769, 1.244-6.110, P<0.05 or P<0.01). Conclusions:The diagnosis of TEN is difficult on admission. Male population is susceptible to TEN, and allopurinol is the common pathogenic agent. The proportion of patients combined with underlying diseases is high in TEN patients complicated with sepsis, with mainly drug-resistant bacteria and mostly Gram-positive bacteria in blood-borne infections. The deceased patients are older than the survived, and the main cause of death is sepsis. The SCORTEN system score is an independent risk factor affecting sepsis and death in TEN patients.

Objective:To examine the association between dairy intake frequency and left ventricular hypertrophy(LVH) in childhood.Methods:Data were obtained from Huantai Childhood Cardiovascular Health Cohort study in Huantai County, Zibo City, Shandong Province. A convenient cluster sampling method was used to conduct a baseline survey on 1 515 children aged 6-11 years old in a primary school from November 2017 to January 2018. A total of 1 237 children who had complete data on questionnaire, physical, ultrasound and laboratory examinations were included for analysis. The frequency of dairy intake was divided into five groups (never,≤3 times/month, 1-2 times/week, 3-5 times/week and nearly every day). Multivariate linear regression models and chi-square trend test were used to examine the trend in level of LVMI and prevalence of LVH, respectively. With the increase of dairy intake frequency, and multivariate logistic regression models were used to evaluate the association between dairy intake frequencies and LVH in childhood.Results:The age of children was (8.4±1.6) years, and the number of boys was 655 (53.0%). There was no significant difference in LVMI levels among different frequencies of dairy intake ( P>0.05). With the increase of dairy intake frequencies, the level of LVMI and the prevalence of LVH decreased significantly ( P for trend<0.05). After the adjustment of potential covariates, compared with no dairy intake group, children who consumed dairy products 1-2 times/week ( OR=0.27, 95% CI:0.09-0.82), 3-5 times/week ( OR=0.33, 95% CI:0.12-0.91) and almost every day ( OR=0.22, 95% CI:0.09-0.54) had a lower risk of LVH. Conclusion:Dairy intake frequency is associated with LVH in childhood, and children who consume dairy products frequently (more than once a week) are less likely to have LVH.

Objective:To evaluate the association of abdominal obesity and obesity types with carotid intima-media thickness (cIMT) in children and provide scientific evidence for the prevention of abnormal vascular structure.Methods:Based on the "Children’s Cardiovascular Health Cohort" conducted in Huantai county of Zibo, Shandong province from November 2017 to January 2018, a total of 1 240 children, including 657 boys (53.0%), who had completed data of sex, age, physical examinations, blood biochemical indices and lifestyle variables (collected by questionnaires) were included for the analysis. Covariance analysis was used to compare the levels of cIMT in groups with normal waist circumference, pre-abdominal obesity and abdominal obesity. Logistic regression analysis was used to evaluate the association of pre-abdominal obesity and abdominal obesity with high cIMT, and the association of combined effect of general overweight or obesity and abdominal obesity or pre-abdominal obesity with high cIMT.Results:The levels of cIMT in children with pre-abdominal obesity (0.47±0.03) mm and abdominal obesity (0.50±0.04) mm were higher than that in children with normal waist circumference (0.45±0.05) mm, the difference was significant ( P<0.001). The detection rates of high cIMT in children with pre-abdominal obesity(20.8%) and abdominal obesity (49.5%) were higher than that in children with normal waist circumference (8.8%), the difference was significant ( P<0.001). Compared with normal waist circumference, pre-abdominal obesity and abdominal obesity were significantly associated with high cIMT (pre-abdominal obesity: OR=2.53, 95 %CI: 1.67-3.84; abdominal obesity: OR=8.56, 95 %CI: 5.97-12.29) after adjustment for potential covariates. Compared with normal body mass index and normal waist circumference, abdominal obesity or pre-abdominal obesity alone ( OR=2.24, 95 %CI: 1.36-3.69), and mixed overweight and obesity ( OR=6.94, 95 %CI: 4.87-9.90) were significantly associated with high cIMT. Conclusions:The association between abdominal obesity and high cIMT was significant in children, and the association was stronger between mixed overweight or obesity and high cIMT, suggesting that we should consider mixed overweight and obesity in the prevention of abnormal vascular structure.

Objective:To analyze the trends in blood pressure (BP) values and the elevated BP based on the measurements at three occasions in different days and its relationship with obesity in children and provide scientific evidence for the identification and prevention of hypertension in children.Methods:A public primary school in Huantai county of Zibo, Shandong province, was selected as the investigation field by using a convenient cluster sampling method. The baseline survey of "Children’s Cardiovascular Health Cohort" was carried out from November 2017 to January 2018. All the students with willingness and informed consent in this school were included in the survey, and the valid sample size was 1 505 children (aged 6-11 years). Children with elevated BP at the measurement of the first occasion should had a second measurement 2 weeks later, and a third measurement was given 2 weeks later if BP was still high at the measurement of the second occasion. Hypertension was confirmed if elevated BP was detected in the measurements at all the three occasions in different days. Multivariate linear regression model was used to assess the trend in BP values in children in the measurements at three occasions in different days, Cochran-Armitage trend analysis was used to evaluate the trend of elevated BP, and logistic regression model was used to analyze the relationship of elevated BP with obesity at three occasions in different days.Results:In this study, with the increase of follow-up visits, the BP levels continued to rise (trend P<0.05). The elevated BP rates at three occasions were 15.5%, 4.0% and 1.9%, respectively, showing a significantly downward trend (trend P<0.05). Compared with both normal weight and normal waist circumference, the association between obesity types (general obesity only, abdominal obesity only, and mixed obesity) and elevated BP at three occasions increased (the first occasion: OR=3.62, 95 %CI: 2.65-4.96; the second occasion: OR=9.50, 95 %CI: 4.95-18.22; and the third occasion: OR=8.94, 95 %CI: 3.48-22.96; all P<0.05). Stratified analysis by gender showed similar results. Conclusions:The elevated BP rates based on the measurements at three occasions in different days in children aged 6-11 years showed a significant decrease trend. The association between different types of obesity (especially mixed obesity) and elevated BP in children became stronger gradually with the progress of the follow up.

Objective:To examine the association between dairy intake frequency and left ventricular hypertrophy(LVH) in childhood.Methods:Data were obtained from Huantai Childhood Cardiovascular Health Cohort study in Huantai County, Zibo City, Shandong Province. A convenient cluster sampling method was used to conduct a baseline survey on 1 515 children aged 6-11 years old in a primary school from November 2017 to January 2018. A total of 1 237 children who had complete data on questionnaire, physical, ultrasound and laboratory examinations were included for analysis. The frequency of dairy intake was divided into five groups (never,≤3 times/month, 1-2 times/week, 3-5 times/week and nearly every day). Multivariate linear regression models and chi-square trend test were used to examine the trend in level of LVMI and prevalence of LVH, respectively. With the increase of dairy intake frequency, and multivariate logistic regression models were used to evaluate the association between dairy intake frequencies and LVH in childhood.Results:The age of children was (8.4±1.6) years, and the number of boys was 655 (53.0%). There was no significant difference in LVMI levels among different frequencies of dairy intake ( P>0.05). With the increase of dairy intake frequencies, the level of LVMI and the prevalence of LVH decreased significantly ( P for trend<0.05). After the adjustment of potential covariates, compared with no dairy intake group, children who consumed dairy products 1-2 times/week ( OR=0.27, 95% CI:0.09-0.82), 3-5 times/week ( OR=0.33, 95% CI:0.12-0.91) and almost every day ( OR=0.22, 95% CI:0.09-0.54) had a lower risk of LVH. Conclusion:Dairy intake frequency is associated with LVH in childhood, and children who consume dairy products frequently (more than once a week) are less likely to have LVH.

To investigate the effect of venous super drainage applying in free flaps. Methods From June, 2017 to December, 2018, 7 cases who had severe soft tissue injuries were treated with free flap. Cause of injury: 1 electric injuries, 2 tumor-related wounds, 1 deep burns, 2 mechanical trauma, and 1 necrotizing fasciitis. All patients were underwent free flap transplantation. There were 5 cases of anterolateral thigh artery perforator flap, 1 case of superficial circumflex iliac artery perforator flap, and 1 case of first dorsal metatarsal artery perforator flap.The application of venous super-drainage technology was carried out according to needs and specific conditions. Two sets of venous passages were prepared in both recipient and donor site to form a double set of venous reflux super-drainage mode. Blood supply, swelling, exudation, secondary exploration and survival rate of the flap were observed after operation, and regularly followed-up. Results All 7 flaps survived. Venous super drainage technique was ap-plied in 7 cases. No arteriovenous crisis occurred after the operation. The flaps had good blood circulation, slight swelling, less exudation, rapid edema regression and no secondary surgical exploration. Followed-up for 2-18 (average 10.5) months, there was no infection recurred. Flaps survived well, and the donor sites healed well without sensory loss.The flexion and extension function of joint was normal. Conclusion The technique of venous super-drainage prepares 2 sets of venous systems for the free flap in the treatment of vascular pedicle in the free flap repair operation, which is conducive to reducing the venous crisis after flap surgery, reducing flap edema, reducing exudation, reducing secondary surgical exploration and improving the survival rate of the flap.