Objective To investigate the effect of new type ultrafiltration technique in preventing and relieving the main organ injury that may follow open heart surgery with cardiopulmonary bypass (CPB),and improve the operative effects and decrease the postoperative complications. Methods Thirty patients with congenital heart diseases were randomly divided into two groups. Modified ultrafiltration group: modified ultrafiltration was used after CPB; new type ultrafiltration group: new type ultrafiltration technique was used throughout CPB. The serum concentrations of nflammatory mediators,hematocrit,serum albumin concentrations, pulmonary function, operative duration time and main organ function parameters were measured in both groups. Results Ultrafiltration time after CPB in new type ultrafiltration group was significantly shorted as compared with modified ultrafiltration group（6.35±1.28 min vs. 12.45±4.52 min，P=0.000）; serum concentrations of interleukin6(IL-6)and tumor necrosis factor α(TNF-α) after CPB were significantly decreased as compared with modified ultrafiltration group（292.84±58.23 μg/L vs. 383.79±66.24 μg/L,P=0.000; 13.32±2.31 μg/L vs. 16.41±2.65 μg/L,P=0.000）; the hematocrit and serum albumin concentrations at the ten minutes after CPB were increased as compared with modified ultrafiltration group (0.39±0.04 vs. 0.35±0.03,P=0.003; 38.32±4.26 g/L vs. 34.04±2.83 g/L, P=0.003); the mechanical ventilation support time and ICU time after operation was shorted as compared with modified ultrafiltration group (Plt;0.05); main organ function was improved as compared with the modified ultrafiltration group. Conclusion The clinical application of new type ultrafiltration throughout CPB can effectively exclude some harmful inflammatory mediators, concentrate blood,short operation time,attenuate the main organ edema and injury.
Objective The intercellular adhesion (ica) gene of Staphylococcus epidermidis (SE) is a key factor to bacterial aggregation, to analysis the genotype of iatrogenic SE and to explore the effect of iatrogenic SE ica operon on theformation of bacterial biofilm on the surface of polyvinyl chloride (PVC). Methods Fifty-six cl inical isolates of iatrogenic SEwere selected, and PCR and gene sequencing were used to detect the genes related with bacterial biofilm formation. The genes contained 16S rRNA, autolysin (atlE), fibrinogen binding protein (fbe), and icaADB. The bacteria suspension of 1 × 105 cfu/mL iatrogenic SE was prepared; according to the test results of target genes, the PVC material and the genotype of icaADB+, atlE+, fbe+ strains were co-cultivated as the ica positive group; the PVC material and the genotype of icaADB-, atlE+, fbe+ strains were co-cultivated as the ica negative group. The thickness of biofilm and bacterial community quantity unit area on PVC materials were measured by confocal laser scanning microscope, and the surface structure of biofilm formation was observed by scanning electron microscope (SEM) at 6, 12, 18, 24, and 30 hours. Results The positive rate of 16S rRNA of iatrogenic SE strains was 100% (56/56). The genotype of icaADB+, atlE+, and fbe+ strains accounted for 57.1% (32/56). The genotype of icaADB-, atlE+, and fbe+ strains accounted for 37.5% (21/56). The sequencing results showed that the product sequences of 16S rRNA, atlE, fbe, and icaADB were consistent with those in GenBank. With time, no significant bacterial biofilm formed on the surface of PVC in ica operon negative group. But in ica operon positive group, the number of bacterial community was gradually increased, and the volume of bacterial biofilms was gradually increased on the surface of PVC. At 24 hours, mature bacterial biofilm structure formed, and at 30 hours, the volume of bacterial biofilms was tending towards stabil ity. The thickness of biofilm (F=6 714.395, P=0.000) and the bacterial community quantity unit area on PVC materials (F=435.985, P=0.000) in ica operon positive groupwere significantly higher than those in ica operon negative group. Conclusion Iatrogenic SE can be divided into 2 types ofica operon negative and ica operon positive bacteria. The iatrogenic SE ica operon can strengthen bacterium biofilm formation capabil ity on PVC materials, bacterium community quantity, and thickness of biofilm, it plays an important role in bacterium biofilm formation on PVC materials.
目的总结1例亲体部分肝移植的临床体会。方法受者为5.5岁男童，诊断为先天性肝脏巨大肿瘤; 供者为患儿母亲，34岁; 切取供者肝脏的左叶并原位移植给患儿。术后给予抗感染、抗免疫排斥反应等支持治疗。结果患儿手术历时9 h，失血250 ml; 供者手术历时3 h，失血450 ml。术后供、受者均健康存活，肝功能正常。结论活体肝部分移植技术是可行的，良好的手术及术后处理是确保肝移植手术成功的关键。