Objective To explore the application value of intraoperative gamma detector in patients with chronic kidney disease secondary hyperparathyroidism (sHPT) undergoing total parathyroidectomy (tPTX)+auto transplantation (AT). Methods A retrospective analysis of the clinical data of 110 sHPT patients who received tPTX+AT at Northern Jiangsu Province People’s Hospital from July 2014 to June 2019 was performed. Among them, 80 patients underwent tPTX+AT guided by the gamma detector during the operation (observation group), 30 patients underwent tPTX+AT under routine exploration (control group). We compared the operation time, number of parathyroid glands removed, serum intact parathyroid hormone (iPTH) concentration, serum calcium and phosphorus levels, as well as the occurrence of postoperative complications and recurrence rate were compared between the two groups. Results The number of parathyroid glands removed of the control group was lower than that of the observation group [(3.87±0.35) per case vs. (4.01±0.11) per case, P<0.05], but the operation time of the control group was longer [(115±25) min vs. (75±27) min, P<0.05]. Postoperative iPTH, serum calcium and serum phosphorus levels were significantly reduced in all patients. After the operation, the symptoms of pruritus, bone pain, and muscle weakness were relieved or disappeared. There was no death, dysphagia, drinking water choking cough, and superior laryngeal nerve injury occurred. One patient in the observation group and one patient in the control group had hoarseness, and one patient in the control group had cervical incision bleeding; one patient in the observation group and four patients in the control group suffered short-term postoperative recurrence due to incomplete parathyroidectomy. There was no significant difference in the incidence of complications (χ2=2.413, P>0.05), but the short-term postoperative recurrence rate of the observation group was lower than that of the control group (χ2=7.342, P<0.05). Conclusion Gamma detector is helpful for rapid identification of typical hyperplasia and ectopic parathyroid glands during operation, and can improve the accuracy of tPTX , save operation time, and reduce the recurrence.
Objective To investigate antimicrobial resistance profiles of carbapenem-resistant Enterobacter spp. (CREn) and the bactericidal effects of aztreonam combined with avibactam. Methods The CREn strains isolated from the West China Hospital of Sichuan University between 2016 and 2021 were identified by gyrB gene amplification and subsequent sequencing. The drug sensitivity results, sample types and distribution of relevant patient departments of these strains were summarized. Colistin-resistant and -intermediate strains were selected to carry out the bactericidal test of colistin and aztreonam combined with avibactam. Results A total of 110 clinical strains of CREn were included. The most common strain was Enterobacter xiangfangensis (91 strains), the highest proportion was in the intensive care unit (27.27%), and the proportion of respiratory tract samples was more than 40%. The antimicrobial sensitivity results showed that CREns were all resistant to carbapenems, the resistance rate to colistin was 23.64%, and the resistance rate to aztreonam combined with avibactam was 0. Among other antimicrobial agents, the antimicrobial resistance rate of amikacin and tigecycline were less than 10%. The time-kill curve showed that for colistin-intermediate strains, colistin could achieve bactericidal effect in a shorter time than aztreonam combined with avibactam. However, whether the strain was resistant to colistin or not, the bactericidal rate of 2 μg/mL aztreonam combined with avibactam in 24 hours could exceed 99%. Conclusion CREn is resistant to most commonly used clinical antibacterial drugs, but remains sensitive to aztreonam combined with avibactam, and aztreonam combined with avibactam has bactericidal effect on it.