Objective To analyze the characteristics of postoperative hospital-acquired infections and drug sensitivity in lung transplant recipients over the past 5 years in a single center. Methods A total of 724 lung transplant recipients at Wuxi People's Hospital from January 2019 to December 2023 were selected. Based on the principles of hospital-acquired infection diagnosis, a retrospective analysis was conducted on the hospital infection situation and infection sites of lung transplant recipients, and an analysis of the distribution of hospital-acquired infection pathogens and their antimicrobial susceptibility test status was performed. Results Among the 724 lung transplant recipients, 275 cases of hospital-acquired infection occurred, with an infection rate of 38.0%. The case-time infection rate decreased from 54.2% in 2019 to 22.8% in 2023, showing a downward trend year by year (Z=30.98, P<0.001). The main infection site was the lower respiratory tract, accounting for 73.6%. The pathogens were mainly Gram-negative bacteria, with the top four being Acinetobacter baumannii (37.1%), Pseudomonas aeruginosa (17.3%), Klebsiella pneumoniae (13.7%), and Stenotrophomonas maltophilia (13.4%), with imipenem resistance rates of 89%, 53%, 58% and 100%, respectively. Gram-positive bacteria were mainly Staphylococcus aureus (3.6%), with a methicillin resistance rate of 67%. Conclusions Over the past 5 years, the hospital-acquired infections in lung transplant recipients have shown a downward trend, mainly involving lower respiratory tract infections, with the main pathogens being Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, all of which have high resistance rates to imipenem.

Objective To evaluate the effectiveness of multi-disciplinary team (MDT) mode in the prevention and control of multidrug resistant organism (MDRO) infection in lung transplant recipients. Methods Lung transplant recipients admitted to the hospital from 2019 to 2022 were enrolled. MDT expert group was established in January, 2020. A series of prevention and control measures were conducted. The implementation rate of MDRO prevention and control measures and the detection rate of MDRO on the environmental surface from 2020 to 2022, and the detection rate of MDRO in lung transplant recipients from 2019 to 2022 were analyzed. Results The overall implementation rate of MDRO prevention and control measures for medical staff was increased from 64.9% in 2020 to 91.6% in 2022, showing an increasing trend year by year (P<0.05). The detection rate of MDRO on the environmental surface was decreased from 28% in 2020 to 9% in 2022, showing a downward trend year by year (P<0.05). The detection rate of MDRO in lung transplant recipients was decreased from 66.7% in 2019 to 44.3% in 2022, showing a decreasing trend year by year (P<0.001). Conclusions MDT mode management may enhance the implementation of MDRO prevention and control measures for medical staff, effectively reduce the infection rate of MDRO in lung transplant recipients and the detection rate of MDRO on the environmental surface, which is worthy of widespread application.

Objective To summarize current status of multidrug-resistant organism (MDRO) infection in lung transplant recipients and analyze the risk factors of MDRO infection. Methods Clinical data of 321 lung transplant recipients were retrospectively analyzed. According to the incidence of postoperative MDRO infection, they were divided into the MDRO group (n=122) and non-MDRO infection group (n=199). The incidence of MDRO infection in lung transplant recipients was summarized. The risk factors of MDRO infection in lung transplant recipients were analyzed by logistic regression model. The dose-response relationship between MDRO infection and time of ventilator use was determined by restricted cubic spline model. Results Among 321 lung transplant recipients, 122 cases developed MDRO infection, with an infection rate of 38.0%. Two hundred and twenty-nine strains of pathogenic bacteria were detected in the MDRO infection group, mainly Gram-negative bacteria (92.6%), and the top three strains were carbapenem-resistant acinetobacter baumannii (46.3%), carbapenem-resistant pseudomonas aeruginosa (22.3%) and carbapenem-resistant klebsiella pneumoniae (14.8%), respectively. MDRO infection mainly consisted of lower respiratory tract infection (61.5%), followed by ventilator-associated pneumonia (26.2%). Univariate analysis showed that the risk factors of MDRO infection in lung transplant recipients were single-lung transplantation, long-time postoperative use of extracorporeal membrane oxygenation (ECMO), long operation time, long-time urinary catheterization, long-time central venous catheterization and long-time ventilator use (all P < 0.05). Multivariate logistic regression analysis indicated that single-lung transplantation and long-time ventilator use were the independent risk factors for MDRO infection in lung transplant recipients (both P < 0.05). Results of restricted cubic spline model analysis showed that the risk of infection continued to increase with the prolongation of ventilator use time within 20 d. After 20 d, prolonging the time of ventilator use failed to increase the risk of infection, showing a plateau effect. Conclusions The MDRO infection rate tends to decline in lung transplant recipients year by year. Single-lung transplantation and long-time ventilator use are the independent risk factors for MDRO infection in lung transplant recipients.

Objective:To summarize the best evidence for early enteral nutrition support in postoperative patients with gastric cancer and evaluate its effectiveness.Methods:From March to August 2021, 108 postoperative patients with gastric cancer admitted to the Gastrointestinal Surgery of the First Affiliated Hospital of Ningbo University were selected. We applied evidence-based nursing methods to summarize the best evidence for early enteral nutrition support in postoperative gastric cancer patients, and constructed and implemented the best evidence application strategy through baseline review, evaluation of evidence application clinical scenarios and barriers. We compared the various indicators of two groups of patients before the application of evidence (March to May 2021, n=55) and after the application of evidence (June to August 2021, n=53) . Results:No adverse events occurred during the application of evidence. After applying evidence, the correct nutritional assessment rate increased from 41.82% (23/55) at baseline review to 90.57% (48/53), the implementation rate of early postoperative enteral nutrition increased from 0 to 45.28% (24/53), the start time of postoperative enteral nutrition shortened from (3.75±2.33) days to (2.06±1.38) days, and the implementation rate of postoperative priority oral nutrition increased from 63.64% (35/55) to 86.79% (46/53), nutritional related complications decreased from 40.00% (22/55) to 20.75% (11/53), and the differences were all statistically significant ( P<0.05) . Conclusions:The application of the best evidence for early enteral nutrition support in postoperative gastric cancer patients can shorten the start time of postoperative enteral nutrition, reduce postoperative nutrition related complications, and promote early recovery of patients.

p-coumaric acid is one of the aromatic compounds that are widely used in food, cosmetics and medicine due to its properties of antibacterium, antioxidation and cardiovascular disease prevention. Tyrosine ammonia-lyase (TAL) catalyzes the deamination of tyrosine to p-coumaric acid. However, the lack of highly active and specific tyrosine ammonia lyase limits cost-effective microbial production of p-coumaric acid. In order to improve biosynthesis efficiency of p-coumaric acid, two tyrosine ammonia-lyases, namely Fc-TAL2 derived from Flavobacterium columnare and Fs-TAL derived from Flavobacterium suncheonense, were selected and characterized. The optimum temperature (55 ℃) and pH (9.5) for Fs-TAL and Fc-TAL2 are the same. Under optimal conditions, the specific enzyme activity of Fs-TAL and Fc-TAL2 were 82.47 U/mg and 13.27 U/mg, respectively. Structural simulation and alignment analysis showed that the orientation of the phenolic hydroxyl group of the conserved Y50 residue on the inner lid loop and its distance to the substrate were the main reasons accounting for the higher activity of Fs-TAL than that of Fc-TAL2. The higher activity and specificity of Fs-TAL were further confirmed via whole-cell catalysis using recombinant Escherichia coli, which could convert 10 g/L tyrosine into 6.2 g/L p-coumaric acid with a yield of 67.9%. This study provides alternative tyrosine ammonia-lyases and may facilitate the microbial production of p-coumaric acid and its derivatives.
Ammonia-Lyases/chemistry* ; Coumaric Acids ; Escherichia coli/genetics* ; Tyrosine

Objective:To retrieve relevant evidence for early enteral nutrition support in patients after gastric cancer surgery and summarize the best evidence, so as to provide evidence-based evidence for clinical implementation of postoperative enteral nutrition management for gastric cancer.Methods:Evidence-based questions were established according to PIPOST principles, UpToDate, Cochrane Library, Joanna Briggs Institute Library, BMJ Best Practice, Agency for Healthcare Research and Quality website, Medlive, European Society for Clinical Nutrition and Metabolism website, American Society for Parenteral and Enteral Nutrition website, Embase, Medline, PubMed, SinoMed, Wanfang Database, China National Knowledge Infrastructure were searched according to the "6S" evidence model. The retrieval period of every database was from January 1, 2016 to May 31, 2021. The Evidence Pre-Grading and Evidence Recommendation Grading System (2014) of Australian Joanna Briggs Institute Evidence-Based Health Care Center was used to extract evidence from the literature that met the quality standards, determine the evidence grading and recommendation level and form the best evidence.Results:A total of 317 literatures were retrieved, and 10 literatures were included, including 1 guideline, 4 expert consensus and 5 systematic reviews. The 10 evidences were summarized from 4 aspects, including indication evaluation, timing management, route and preparation management and risk management.Conclusions:Current evidence shows that early enteral nutrition is safe and feasible in patients after gastric cancer surgery. In the process of implementing enteral nutrition, medical staff should fully evaluate the indications and needs of patients and make clear and prudent choices for nutritional support channels and preparations of patients, so as to form the best evidence and clinical management programs for early enteral nutrition support for patients after gastric cancer surgery and accelerate postoperative recovery of patients.

Objective? To explore the effects of enteral nutrition program based on intensive ultrasound monitoring gastric residual on patients receiving lung transplantation. Methods? Totally 100 patients who received lung transplantation in a Class Ⅲ Grade A hospital between January and December 2016 were selected and divided into the treatment group (n=50) and the control group (n=50) according to the random number table. Patients in the treatment group received enteral nutrition based on intensive ultrasound monitoring gastric residual, while patients in the control group received conventional enteral nutrition. The indicators of enteral nutrition application and complications were observed in both groups. Results? The gastric residual of the treatment group was (130.32±40.44) ml; the nutrition interruption rate was 6%; the time for achieving the target feed volume was (3.47±0.62) d, lower than those of the control group (t/χ2=-2.341, 8.575, 2.193;P＜ 0.05), which were (198.13±40.25) ml, 28% and (5.59±0.71) d. The dripping speed of the treatment group was (87.00±10.59) ml/h, higher than that of the control group (t=6.121, P＜0.05). The incidence rate of aspiration of the treatment group was 4%, and there was no statistically significant difference compared with that of the control group (χ2=0.298; P＞0.05), which was 6%. The incidence rates of enteral nutrition reflux, diarrhea and reintubation rates of the treatment group were 10%, 10% and 8%, respectively, lower than those of the control group (33%,26%,24%) (χ2=6.250, 4.336, 4.762; P＜ 0.05) . Conclusions? The enteral nutrition program based on intensive ultrasound monitoring gastric residual conforms to target-oriented nursing care for patients receiving lung transplantation, which helps to achieve the target feed volume more quickly and ameliorate enteral nutrition-related complications.

Objective? To investigate the effect and safety of high-flow nasal cannula (HFNC) oxygen therapy for patients after extubation in lung transplantation. Methods? A retrospective study was conducted on 60 hospitalized patients with lung transplant during January 2017 to December 2017 in Wuxi People＇s Hospital. According to the different methods of respiratory support prescribed after extubation, the patients were divided into two groups: observation group (n=28, via HFNC) and control group (n=32, via nasal oxygen tube) . The two groups were compared in terms of the clinical indicators including their blood gas analysis(oxygenation index, lactic acid, partial pressure of carbon dioxide) , viscosity of sputum and comfort, etc. Results? Six hours after extubation and before transferring to other departments, the observation group＇s oxygenation index was(263.70±48.97)and(273.22±43.26)mmHg, which were statistically different from those of the control group with (217.83±77.30)and(229.08±68.64)mmHg respectively (P＜ 0.05). Before transferring to other departments, the partial pressure of carbon dioxide in the observation group was (37.04±8.56)mmHg, lower than the control group with (42.43±6.14)mmHg with a statistical difference (P＜0.05); the viscosity of sputum in the obseration group was lower than the control group with statistical difference (P＜0.05); the patients＇ comfort in the observation group achieved (7.72±1.06)points, higher than the control group＇s (4.39±0.82)points with statistical difference (P＜ 0.05). Conclusions? HFNC oxygen therapy for the patients after extubation in lung transplantation has good effects, is safe and reliable, and can be widely applied in clinical practice.

Objective To summarize the experiences of postoperative care of 7 patients with lung transplantation patients receiving high flow nasal cannulae oxygen therapy. Methods The key points to ensure the success of operation were oxygen therapy waiting for lung transplantation,sequential treatment after tracheal intubation, assisted by fiberoptic bronchoscopy, nasal high flow oxygen therapy failed to switch to non-invasive treatment or re intubation. Results All 7 patients got through the intensive care period successful. Conclusions High flow nasal cannulae can improve the comfort and compliance of lung transplant patients,and easy to operate.

Objective To investigate the effects of analgesia and sedation scheme on ICU delirium among patients with cardiac surgery. Methods A total of 235 patients undergoing mechanical ventilation were enrolled via simple random number sampling method from January to December,2016, and divided into the experimental group(117 cases)and the control group(118 cases).The experimental group received analgesia and sedation scheme designed by our department,and the control group received routine sedation protocol. The incidence of ICU delirium, the dosages of drugs, duration of mechanical ventilation, length of ICU stay were recorded. Results The compliance rate of shallow sedation in the experimental group was 87.17% (102/117), which was lower than 57.62% (68/118) in the control group with statistical difference(χ2=25.642,P<0.05).The incidence of ICU delirium in the experimental group was 17.09% (20/117), which was lower than 34.75% (41/118) in the control group with statistical difference (χ2=9.524, P<0.05). The dosages of sedation drugs were: dexmedetomidine, (269.46 ± 32.47) μg,disoprofol,(286.84±81.96)mg,the duration of mechanical ventilation was(14.31±1.43)h,the length of ICU stay was(16.02±1.25)h.Those data were all lower than those of the control group[(507.29±58.27) μg,(575.63±95.74)mg,(20.45±2.29)h,(22.82±2.45)h]with statistical difference(t=-5.529--4.371, P<0.05). Conclusion Analgesia and sedation scheme was worthy of popularization and application.