Successful surgical treatment of polybacterial gas gangrene confirmed by metagenomic next-generation sequencing detection:A case report

BACKGROUND We report on a case of Vibrio vulnificus(V.vulnificus)detected by metagenomics next-generation sequencing(mNGS)in a 53-year-old male patient with polymicrobial gas gangrene and successful treatment by surgery.This report raises awareness among dermatologists that when a patient is clinically suspected of a special type of pathogenic infection,the mNGS method should be preferred to identify the patient’s pathogen infection as soon as possible and then take effective treatment in time to save patients’lives.CASE SUMMARY A 53-year-old male who worked in the aquatic market complained of redness and swelling of the lower limbs,blisters and ulcers with fever for 3 d.We used mNGS to test the pathogens in ulcer secretions.The results were returned in 24 h and indicated:V.vulnificus,Fusobacterium necrophorum,Staphylococcus haemolyticus,Staphylococcus aureus,Streptococcus dysgalactiae and Klebsiella aerogenes.This patient was diagnosed with V.vulnificus infection.The emergency operation was performed immediately under combined lumbar and epidural anesthesia:Left leg expansion and exploration(August 10,2021).After surgery,we continued to use piperacillin sodium tazobactam sodium 4.5 g every 8 h and levofloxacin 0.5 g for anti-infection treatment.The patient underwent further surgery under lumbar anesthesia on August 17,2021 and August 31,2021:Left leg deactivation and skin grafting,negative pressure closed drainage and right thigh skin removal.After treatment,the transplanted flap survived.CONCLUSION We could confirm the diagnosis of Vibrio vulnificus infection within 24 h through mNGS detection and then immediately performed emergency surgery.

Effect of artificial dermis combined with jinfu ning on skin healing and bacterial detection rate of finger abdomen

Objective: To explore the effect of artificial dermis combined with rhGM-CSF(Jinfuning) on healing of soft tissue defect of finger ventral skin and the influence of bacterial detection rate. Methods: Totally 110 patients with finger injury admitted to the rehabilitation department of our department from January 2017 to June 2018 were collected and divided into control group and observation group according to the random number table method with 55 cases in each group. The control group received direct artificial derma lrepairing after thorough debridement, while the observation group received recombinant gm-csf gel coating on the wound surface before artificial dermal repairing, Wound healing, wound inflammation, bacterial detection rate, inflammatory factor expression, follow-up and adverse reactions were compared between the two groups. Results: The wound healing rate of the observation group at 7, 14, 21 and 28 days after treatment was significantly higher than that of the control group (t= 11.211, P =0.000).( T = 14.895, P =0.000;T = 25.346, P=0.000;T =8.247, P=0.000). The wound healing time of the observation group was (19.7±2.3) d, and that of the control group was (27.4±3.3) d. The average wound healing time of the observation group was significantly shorter than that of the control group, and the difference was statistically significant (t=14.197, P= 0.000). Observation group wound inflammation at each time point score was significantly lower than the control group, the group rooms, time points, ·point interaction effect between the comparison, the differences were statistically significant (P <0.05), the observation group wound bacteria detection rate of 7.27% (4 cases) : the control bacteria detection rate was 21.81% (12 cases), difference was statistically significant (chi-square = 4.68, P= 0.0305), the observation group of bacteria detection rate was significantly lower than the control group;The bacteria detected in the two groups were mainly e. coli, tetanus bacillus and fungi. There was no significant difference in the indicators between the two groups before treatment, and the values of inflammatory cytokines il-1 and TNF- IOD in the two groups were significantly decreased after treatment, and the observation group was significantly lower than the control group, with statistically significant differences (P < 0.05). No serious adverse reactions occurred in either group during the treatment. Conclusion: the application of artificial dermals combined with jinfuning can promote wound healing of skin and soft tissue defect of finger abdomen, effectively inhibit bacterial infection of wound surface, reduce inflammation and infection,reducing bacterial detection rate.

Emergency treatment of 16 patients with necrotizing fasciitis caused by Vibrio vulnificus infection complicated with septic shock

Necrotizing fasciitis （NF） caused by vibrio vulnificus （VV） is a rare but fatal clinical emergency characterized by hemorrhagic bullous skin lesions,septic shock and multiple organ dysfunction syndrome （MODS）,commonly occurring in patients with chronic liver disease.1,2 In general,mortality of these patients is higher than 60%,which could approach 100% when complicated with septic shock.Therefore,early diagnosis and effectively surgical intervention in emergency room are the mainstays for better outcomes of these patients.However,many emergency physicians lack experiences in diagnosing and managing vibrio NF.Furthermore,due to the preexisting severe medical complications including hypotension,lactic acidosis,coagulation disorders and thrombocytopenia,the optimal therapeutic strategies for these critical patients should obviously be evaluated on a patient-to-patient basis,which remains largely undefined.

Cell fragments and collagen structure of cell-free dermal substitutes

The antigenicity of inartificial dermis can be minimized by removing cell components while keeping the intrinsic structures. To minimize the antigenicity, the cell fragments must be wiped off as clearly as possible. Thus, the test of cell fragments is very important for the evaluation of dermal matrix production. And in the process of the production, the structure must be kept integrated to avoid scar formation resulting from breakage. By new methods, we have produced swine acellular dermal matrix （SADM） and goat acellular dermal matrix （GADM） without using glutaraldehyde. In this study, we tested the cell fragments and collagen structure of these two dermal substitutes.

Changes in electrocardiogram and cardiac function after minimally invasive surgery for pectus excavatum

Background Thoracoscopic minimally invasive pectus excavatum repair （Nuss operation） features its little trauma, simple, short operation time, and good outcome compared with traditional treatment of pectus excavatum surgery-sternal elevation （Ravitch operation） and sternal turnover. The effect of the operation on patients＇ heart and heart function remains unclear. This study aimed to understand the changes of electrocardiogram and cardiac function after Nuss procedure. Methods From 2008 January to 2013 July, thoracoscopic Nuss operation was performed in 217 patients with pectus excavatum. All the patients underwent the preoperative, postoperative detection of ECG and cardiac function in 3 months to 1 year after operation. Results After 3 months to 1 year follow-up, arrhythmias persisted in 46 out of 135 patients with preoperative symptoms （P 〈 0.05）; Stroke volume and cardiac output significantly increased （P 〈 0.05）; And cardiac parameters greatly improved （P 〈 0.05）. Conclusions Minimally invasive repair of pectus excavatum deformity can correct the chest malformation, alleviate arrhythmia, and improve cardiac function.

Pilot study of gated-PET / CT for evaluating myocardial blood-supply and myocardial metabolism in pigs

Background As for the patients with coronary arteriosclerosis, the presence of ischemic myocardial survival is significant for the treatment and prognosis. Gated 13N-NH3 and 18SF-FDG PET/CT imaging provides myocardial perfusion, metabolism and cardiac function which can valuate myocardial viability accurately and noninvasively. Methods Four pigs were subjected to bilateral internal mammary artery Y-bypass operation in operating room. The pigs under the anesthetized state were sent to PET center when the operation finished. Then 13N-NH3 gated-PET/CT and 18F-FDG gated-PET/CT were performed. Results The myocardial perfusion and myocardial metabolism is well-distributed of left ventricular wall. The motion of the wall was normal. The ejection function was greater than 50%. Conclusion Gated-PET/CT can be used for noninvasive evaluation of myocardial perfusion, myocardial metabolism and left ventricle function.

Airinspace plasmair system in cardiac postoperative infection wards

Background Postoperative wound infection was frequently reported in patients undergoing heart valve re- placement and coronary artery bypass surgery （CABG） due to major trauma, long-term bed rest, malnutrition and compromised immune system. Infected patients were usually housed in the same airborne infection isolation rooms. A series of air monitoring and control strategies should be strictly enforced to aim at avoiding airborne fungal contamination and achieving higher cure rate in infected patients. The efficacy of Airinspace plasmair sys- tem in reducing airborne fungal contamination in cardiac postoperative infection wards has not been clearly de- termined. Methods A survey of air contamination was conducted in the cardiac postoperative infection ward using Airinspace plasmair system. 0.3μm？ and 0.5 μm？ in size. Air Laser particle counter was used to determine the air borne particles of samples were incubated and examined for fungal development. Airborne par- ticle counts and fungal loads of air samples collected before and after treatment with Airinspace plasmair system were compared. Results The particle counts in 0.3 μm range collected before （52206 〈 2345） and after （9408 〈 4317） treated with Airinspace plasmair system differed significantly （P 〈 0.01）. The particle counts in 0.5μm range before （12995 〈 422） and after （2016 〈 915） treatment with Airinspace plasmair system also differed significantly （P 〈 0.01 ）. The fungal loads before and after using Airinspace plasmair system showed significant difference [（1975.3 〈 356.1）cfu/m3 vs. （193.83 〈 29.5）cfu/m3, P 〈 0.01]. Conclusion Airinspace plasmair system used in cardiac postoperative infection wards has shown remarkable efficacy in reducing airborne particles and fungal contamination and helpes prevent cross infection.

Relationship between heart failure and the early NT-proBNP in burn patients

Background Myocardial damage often occurs after burns. Previously, cardiac enzyme profile was often measured to determine myocardial injury, but was hardly specific. In this study, we investigated early changes of plasma N-terminal pro-brain natriuretic peptide （NT-proBNP） over time and its diagnostic value in burned patients. Methods 39 patients with heat burned were assigned to heart failure group （n = 9）, control group （n = 30）. Plasma NT-ProBNP and troponin Ⅰ（cTnT） were measured at 1st, 3rd, 5th days and 7th day, and patients were subdivided into 2 groups according to their cardiac function. Results Nine patients had heart failure （27.7%） and their NT-proBNP was 1676.03 ± 2190.41 pg/L. Significant difference was found between the heart failure group and control group （P 〈 0.01 ）. Conclusion NT-proBNP is related to the severity of burning and can well reflect the status of myocardial injury in patients with severe burn, and can be used as an ideal marker for myocardial injury in burned patients.