[Investigation and factor analysis of postoperative surgical site infections in emergency abdominal surgery in China from 2018 to 2021 based on Chinese SSI Surveillance]

Objective: We investigated the incidence of surgical site infection (SSI) following emergency abdominal surgery (EAS) in China and further explored its risk factors, providing a reference for preventing and controlling SSI after EAS. Methods: This was an observational study. Data of patients who had undergone EAS and been enrolled in the Chinese SSI Surveillance Program during 2018-2021were retrospectively analyzed. All included patients had been followed up for 30 days after surgery. The analyzed data consisted of relevant patient characteristics and perioperative clinical data, including preoperative hemoglobin, albumin, and blood glucose concentrations, American Society of Anesthesiologists (ASA) score, grade of surgical incision, intestinal preparation, skin preparation, location of surgical site, approach, and duration. The primary outcome was the incidence of SSI occurring within 30 days following EAS. SSI was defined as both superficial and deep incisional infections and organ/space infections, diagnoses being supported by results of microbiological culture of secretions and pus. Secondary outcomes included 30-day postoperative mortality rates, length of stay in the intensive care unit (ICU), duration of postoperative hospitalization, and associated costs. The patients were classified into two groups, SSI and non-SSI, based on whether an infection had been diagnosed. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with SSI following EAS. Results: The study cohort comprised 5491 patients who had undergone EAS, comprising 3169 male and 2322 female patients. SSIs were diagnosed in 168 (3.1%) patients after EAS (SSI group); thus, the non-SSI group consisted of 5323 patients. The SSIs comprised superficial incision infections in 69 (41.1%), deep incision infections in 51 (30.4%), and organ or space infections in 48 (28.6%). Cultures of secretions and pus were positive in 115 (68.5%) cases. The most frequently detected organism was Escherichia coli (47/115; 40.9%). There were no significant differences in sex or body mass index between the SSI and non-SSI groups (both P>0.05). However, the proportion of individuals aged 60 years or older was significantly greater in the SSI than in the non-SSI group (49.4% [83/168] vs. 27.5% [1464/5323), χ2=38.604, P<0.001). Compared with the non-SSI group, the SSI group had greater proportions of patients with diabetes (11.9% [20/168] vs. 4.8% [258/5323], χ2=16.878, P<0.001), hypertension (25.6% [43/168] vs. 12.2% [649/5323], χ2=26.562, P<0.001); hemoglobin <110 g/L (27.4% [46/168] vs. 13.1% [697/5323], χ2=28.411, P<0.001), and albuminemia <30 g/L (24.4% [41/168] vs. 5.9% [316/5323], χ2=91.352, P<0.001), and a reduced rate of preoperative skin preparation (66.7% [112/168] vs. 75.9% [4039/5323], χ2=7.491, P=0.006). Furthermore, fewer patients in the SSI group had preoperative ASA scores of between one and two (56.0% [94/168] vs. 88.7% [4724/5323], χ2=162.869, P<0.001) in the non-SSI group. The incidences of contaminated and infected incisions were greater in the SSI group (63.1% [106/168] vs. 38.6% [2056/5323], χ2=40.854, P<0.001). There was a significant difference in surgical site distribution between the SSI and non-SSI groups (small intestine 29.8% [50/168] vs. 10.6% [565/5323], colorectal 26.2% [44/168] vs. 5.6% [298/5 323], and appendix 24.4% [41/168] vs. 65.1% [3465/5323]) χ2=167.897, P<0.001), respectively. There was a significantly lower proportion of laparoscope or robotic surgery in the non-SSI group (24.4 % [41/168] vs. 74.2% [3949/5323], χ2=203.199, P<0.001); the percentage of operations of duration less than 2 hours was significantly lower in the SSI than non-SSI group (35.7% [60/168] vs. 77.4% [4119/5323], χ2=155.487, P<0.001). As to clinical outcomes, there was a higher 30-day postoperative mortality rate (3.0%[5/168] vs. 0.2%[10/5323], χ2=36.807, P<0.001) and higher postoperative ICU occupancy rate (41.7% [70/168] vs. 19.7% [1046/5323], χ2=48.748, P<0.001) in the SSI group. The median length of stay in the ICU (0[2] vs. 0[0] days, U=328597.000, P<0.001), median total length of stay after surgery (16[13] vs. 6[5] days, U=128146.000, P<0.001), and median hospitalization cost (ten thousand yuan, 4.7[4.4] vs. 1.7[1.8], U=175965.000, P<0.001) were all significantly greater in the SSI group. Multivariate logistic regression analysis revealed that the absence of skin preparation before surgery (OR=2.435,95%CI: 1.690-3.508, P<0.001), preoperative albuminemia <30 g/L (OR=1.680, 95%CI: 1.081-2.610, P=0.021), contaminated or infected incisions (OR=3.031, 95%CI: 2.151-4.271, P<0.001), and laparotomy (OR=3.436, 95% CI: 2.123-5.564, P<0.001) were independent risk factors of SSI. Operative duration less than 2 hours (OR=0.465, 95%CI: 0.312-0.695, P<0.001) and ASA score of 1-2 (OR=0.416, 95% CI: 0.289-0.601, P<0.001) were identified as independent protective factors for SSI. Conclusions: It is important to consider the nutritional status in the perioperative period of patients undergoing EAS. Preoperative skin preparation should be conducted and, whenever possible, laparoscope or robot-assisted surgery. Duration of surgery should be as short as possible while maintaining surgery quality and improving patient care.

Changes in methylation of genomic DNA from chicken immune organs in response to H5N1 influenza virus infection

DNA methylation is an important epigenetic modification in eukaryotes, which plays a significant role in regulating gene expression. When the host is invaded by the influenza virus, gene expression is regulated via changes in DNA methylation levels or patterns, leading to the activation or suppression of relevant signaling pathways or networks, triggering a series of immune responses against viral invasion. Here, we investigated the changes in genomic DNA methylation in the immune organs of chicken infected with H5N1 influenza virus. Genome-wide DNA methylation levels in the spleen, thymus, and bursa of Fabricius of specific pathogen-free (SPF) chicken infected with the Guangdong (G-H5N1) and Anhui (A-H5N1) H5N1 strains, and water (control) were analyzed by fluorescence-labeled methylation-sensitive amplified polymorphism (F-MSAP). The results indicated that total DNA methylation levels did not differ between spleen genomic DNA in chicken treated with different viral strains and the control (P > 0.05). However, the total DNA methylation levels were significantly upregulated in the thymus (P < 0.01) and bursa (P < 0.05) of chicken in the A-H5N1 group compared to those in the G-H5N1 and control groups. These results provide a basis for the screening of avian influenza-resistance genes or methylation markers, analyzing the epigenetic regulation mechanisms of avian influenza, and performing selective breeding for disease resistance.

Osteoblast Growth on Poly(L-lactic acid)-Negative Ion Powder Composite Films

Composite films made from poly(L-lactic acid) (PLLA) and negative ion powder (NIP, opal powder) were fabricated and the growth of human osteoblasts cultured in vitro on these composite films was assessed. The surface properties of the composite film and the control (100% PLLA) were investigated by contact angle and scanning electron microscopy (SEM). The former indicated that hydrophilicity did not change significantly, whereas the latter indicated that the surface of the composite films was not as smooth as the control, but without holes or caves. After osteoblast cells were seeded on the composite and control films, the cell densities and the morphology on these films were studied by light microscopy and SEM. The differential function of the cells was assessed by testing their alkaline phosphatase (ALP) activity. These results indicate that the addition of powder improved the adhesion between the osteoblasts and the composite films. The improvement came from the negative ions which were given off by the negative ion powder. The mechanism of negative ion was reviewed and a model of the mechanism was developed. This paper provides the first evidence that negative powder (functional material) can be used to fabricate composite films with PLLA for better cell growth.

RO filtration of biologically treated textile and dyeing effluents using ozonation as a pre-treatment

Bench-scale experiments were conducted to investigate the application of ozonation pre-treatment for biologically treated textile and dyeing wastewater to improve performance of the RO process. Based on ozonation experiments, four specific ozone consumptions (SOC), 0, 0.3, 0.6, 4.0 mg O₃/mg DOC₀ were chosen for study of the effects of ozonation on the reverse osmosis (RO) process. Membrane flux was recorded. Also, the permeate water quality parameters such as TOC, conductivity were analyzed. In addition, fouled membrane cleaning was studied. The study further examined the nature and mechanisms of membrane fouling using scanning electron microscopy (SEM) and the energy dispersive X-ray spectrometer (EDS). The effect of ozonation on RO filtration was found to depend on SOC. The study revealed that significant improvement can be achieved in the efficiency of RO filtration by employing ozonation with 0.6 mg O₃/mg DOC₀ SOC. Although the product water purity slightly decreased, the ozonation pre-treatment showed advantages at 0.6 mg O₃/mg DOC₀ SOC for the following: (i) mitigation of flux decline due to membrane fouling; (ii) improvement in foulants cleanability. In addition, hypotheses were put forward to explain the reasons from the aspect of organic matter characteristics changed by ozonation, such as changing on functional groups and molecular weight of organic matter.

Clinical features of patients with multiple sclerosis from a survey in Shanghai, China

Objective

To describe clinical features of patients with multiple sclerosis (MS) in Shanghai, China.

Methods

Prevalent patients with MS were identified and investigated by a network of physicians in 11 districts of Shanghai during the period from 1 September 2004 to 31 August 2005. Admission registries of each hospital in the study area were checked systematically for patients with a diagnosis of MS, neuromyelitis optica or other demyelinating disorders. All patients with collected information were evaluated by four senior neurologists according to the McDonald criteria.

Results

There were 249 (146 female and 103 male) patients with a confirmed MS diagnosis, at a female-to-male ratio of 1.4. The mean age at onset of MS was 37.4 years for the 249 patients with MS and, on the prevalence day, 42.7 years. The most frequent location of clinical MS lesions in the central nervous system was the spinal cord (61%), followed by the cerebrum (55%) and optic nerves (41%). Nearly all (96%) of the patients with MS had been examined by magnetic resonance imaging, and 226 (94%) patients of those examined were suggestive of MS. No family history of MS was found in any of the patients. Most (86%) of the patients had no or mild disability on the prevalence day (31 December 2004). Almost all (96%) patients with MS had been treated with corticosteroids.

Conclusion

Clinical features of patients with MS are described based on the information from the largest case series reported among Chinese. Comparisons and discussions are made with findings from the other populations.

In vivo protective performance of N95 respirator and surgical facemask

BACKGROUND

The SARS outbreak in 2003 has spawned a major controversy concerning protective performance facemasks for healthcare workers. This study reports a study on in-vivo protective performance of surgical masks and N95 respirators.

METHODS

Typical surgical masks and N95 respirators used in Hong Kong hospitals were tested in comparison with those treated with nano-functional materials (called nano-masks) on various physical properties and in-vivo wear filtration efficiency, as well as usability test in hospitals for surgical masks.

RESULTS

Tests on physical properties showed that N95 respirators had significantly lower air permeability and water vapor permeability than surgical masks. The in-vivo filtration tests illustrated that N95 respirators filtered out 97% of potassium chloride (KCl) solution, while surgical masks filtered out 95% of KCl solution. Nano-masks show stronger water repellency and antibacterial activities, but no difference in usability, comparing with normal N95 and surgical masks.

CONCLUSIONS

Surgical masks can provide in-vivo filtration protection of 95% filtration efficiency. N95 respirators provide higher in-vivo filtration efficiency of 97% with significant reduction of air permeability and water vapor permeability. Compared to normal surgical masks/respirators, the nano-masks can provide additional protective functions in stopping capillary diffusion and antibacterial activities.

The transformation of aluminium species in the processes of coagulation, sedimentation and filtration

The aluminium toxicity is closely related to aluminium species. In this work aluminium was fractionated into seven forms: Al(T), Al(Sus), Al(C + S), Al(S), Al(C), Al(O) and Al(I). Four Al-based coagulants and simulated raw water were used in the laboratory to investigate the aluminium transformation in coagulation, sedimentation and filtration processes. It is the use of Al-based coagulants that contributes more to the increase of the residual aluminium for the low-turbidity raw water, while the Al-based coagulants, especially the polymeric aluminium coagulants, work to remove the aluminium from the high-turbidity raw water. In the case of traditional coagulants, the increase of the turbidity or the dissolved organic carbon (DOC) concentration in the raw water results in a high concentration of Al(C + S). The removal rate of aluminium species in the filtration process is not only related to its size: RAl(Sus) > RAl(C+S), RAl(C) > RAl(S), but also to the physicochemical properties of aluminium species and filter. For the kaolin-polyaluminium chloride system, a lower removal rate of aluminium species results is due to the complexation of humic acid and aluminium species.

Phosphorus removal and greenhouse gas N2O emission in a lime-induced aerobic sludge granule process

Aerobic sludge granulation was achieved in an activated sludge process continuously fed with lime (Ca2+ 100 mg l(-1) influent) every other day. Eighteen days after lime addition, activated sludge granules with the size of 0.5-2.2 mm were formed, which occupied 10-25% of total sludge volume. Sludge volume index (SVI) was reduced to an average of 50 ml g(-1), which increased average sludge concentration to 3.6-5.0 g VSS l(-1), 1.6-2.1 times of that of control. Greenhouse gas N2O emission was also significantly reduced: N2O concentration from the lime-addition reactor was 5-15 ppmv, 47-61% of that of control, Effluent PO4-P concentration was generally lower than 1 mg l(-1) when average influent PO4-P concentration was 6.07-6.37 mg l(-1). Total phosphorus (TP) and total nitrogen (TN) removal efficiencies were around 89.6% and 14.5-16.1%, over 3.5 and 1 times higher than those of control, respectively. COD removal rate in the lime-addition reactor was 2.05-2.48 kg COD m(-3) d(-1), higher than 1.34-1.61 kg COD m(-3) d(-1) in the control.

Radioneurosurgery using the LINAC scalpel: technique, indications, and literature review

Two available commercial units for radiosurgery are the modified linear accelerator (LINAC scalpel) and the gamma knife. Advantages of the LINAC scalpel over the gamma knife are its greater accuracy, the availability of a wide range of collimator sizes that allow for a more homogeneous field of radiation for large lesions, state-of-the-art computer software programs, and lower expense. Radiosurgery does not require an incision, is painless, and can be performed on an outpatient basis. It is ideally suited for the treatment of inaccessible, deep intracranial lesions that are radioresistant to conventional forms of radiotherapy, such as arteriovenous malformations, meningiomas, vestibular schwannomas, selected primary brain tumors, and cerebral metastases. Radiosurgery is an attractive treatment alternative to conventional neurosurgery for several intracranial lesions.