Gram-negative bacteria are the common pathogens causing nosocomial infections.The drug resistance of gram-negative bacteria has become increasingly serious in last two decades.Carbapenems were once considered as the last line of defense against serious infections of gram-negative pathogens.As carbapenemase-producing strains are spreading, the incidence of infections caused by carbapenem-resistant isolates is increasing worldwide.The pathogens are usually multiple drug resistant strains or extensively drug resistant strains, and effective treatment options are limited, even there are no more drugs in certain conditions.This article focuses on appropriate antibiotics and therapeutic strategies for effective control of infections with carbapenem-resistant gram-negative pathogens.

As a new kind of perioperative management strategy and ideas,enhanced recovery after surgery (ERAS) brings a series of traditional perioperative treatment measures for optimization based on evidence-based medicine.Its primary aim is to decrease surgery-related stress,complications,and also to facilitate recovery with multimodal treatments.The ERAS pathway has been widely applied and proved to be efficient in gastrointestinal,colorectal,orthopedic,thoracic and gynecological surgery.Owing to the complexity of surgical procedure,long operation time and high perioperative complication rate in liver transplantation compared with other surgeries.This new concept has not been widely accepted or recommended in liver transplantation,although some previous studies have validated its safety and effectiveness.This paper overviewed the recent literature on the specific procedures,efficacy,safety and development of ERAS applied in liver transplantation.

Objective To investigate the safety and clinical effect of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatocellular carcinoma (HCC) with cirrhosis.Methods The retrospective cohort study was adopted.The clinical data of 5 patients with primary HCC with cirrhosis who underwent ALPPS at the First Bethune Hospital of Jilin University between October 2014 and August 2015 were collected.The surgical plan was determined according to preoperative liver function and liver functional reserve.The patients underwent portal vein (PV) ligation and liver partition in the first staged surgery.The second staged surgery was performed when growing future live remnant (FLR) came up to the standard of safe section by rescan of computed tomography (CT) at 10,14,18 days after the first staged surgery,and hemihepatectomy and hepatic segmentectomy were applied to patients.(1) The intraoperative situations were observed,including the severity of liver cirrhosis,first staged surgery time,volume of intraoperative blood loss and FLR in the first staged surgery,interval time of surgery,growth rate of liver volume,ratio of FLR and standard liver volume (SLV),time and volume of intraoperative blood loss in the second staged surgery.(2) Pre-and postoperative biochemical indicators in the first and second staged surgeries were detected,including total bilirubin (TBil) and alanine phosphatase (ALT).(3) Postoperative situations were observed,including occurrence of complications,results of pathological examination and duration of hospital stay.(4) The follow-up using telephone reservation and outpatient examination was performed to detect tumors recurrence and metastasis and survival of patients by imaging examination and tumor marker test up to November 2015.Count data were represented as mean (range).Results (1) Intraoperative situations:of 5 patients,there were 1 patient with F3 of liver cirrhosis and 4 with F4 of liver cirrhosis.One patient was complicated with lots of peritoneal effusion,followed by acute renal failure,and didn't receive the second staged surgery.Four patients underwent successful ALPPS.The first staged surgery of 5 patients:average operation time,volume of intraoperative blood loss,FLR,interval time of surgery,growth rate of liver volume,ratio of FLR and SLV were 282 minutes (range,240-320 minutes),500 mL (range,300-700 mL),457 em3(range,338-697 cm3),15 days (range,14-18 days),58％ (range,46％-67％) and 42％ (range,32％-44％),respectively.Average operation time and volume of intraoperative blood loss in second staged surgery were 220 minutes (range,200-260 minutes) and 412 mL (range,300-600 mL).(2) Pre-and post-operative biochemical indicators:levels of TBil and ALT of 5 patients from pre-operation to postoperative day 12 in the first staged surgery were from 4.9-30.4 μmol/L to 9.8-56.1 μmol/L and from 12.9-156.1 U/L to 46.3-207.3 U/L,respectively.Levels of TBil and ALT of 4 patients from pre-operation to postoperative day 10 in the second staged surgery were from 10.1-21.2μmol/L to 6.9-38.0 μmol/L and from 30.8-55.5 U/L to 19.8-72.8 U/L,respectively.(3) Postoperative situations:there were no perioperative death and postoperative complications of liver failure and intraperitoneal infection.One patient complicated with bile leakage was cured by non-operative treatment for 30 days.Results of pathological examination:5 patients were confirmed as Ⅱ-Ⅲ stage HCC,and 4 tumors had vascular tumor thrombi and negative resection margin with tumor size of 8-13 cm.Duration of hospital stay of 5 patients was 36 days (range,28-48 days).(4) Results of follow-up:4 patients undergoing successful ALPPS were followed up for 4-12 months.One patient was emerged with a new lesion of 2 cm in left half liver at postoperative month 7,level of AFP of which was 512 μg/L before the first staged surgery reduced to normal level at postoperative month 2,and then the patient received transcatheter arterial chemoembolization (TACE) and radio frequency ablation (RFA) treatments without tumor recurrence up to postoperative month 12.No tumor recurrence and new lesions in liver were detected in other 3 patients by abdominal enhanced scan of CT,with a normal level of AFP.Conclusion ALPPS is safe and feasible for HCC with cirrhosis,with a satisfactory short-term outcome.

ObjectiveTo investigate postoperative application of multidisciplinary treatment (MDT) in hepatobiliary and pancreatic malignancies based on the pathological results. MethodsThe clinical data of patients who were diagnosed as hepatobiliary and pancreatic malignancies who were diagnosed and treated with postoperative MDT in our hospital from Apirl 2014 to March 2015 were analyzed. MDT was performed by consultation for four to six patients once every other week. The postoperative comprehensive treatment strategy for each patient was discussed and determined by all experts in the consultation. The effect of postoperative treatment and prognosis was summarized . Results25 postoperative MDT consultations on hepatobiliary and pancreatic malignancies were held for 131 patients, including 53 patients with hepatocellular carcinoma, 7 patients with intrahepatic cholangiocarcinoma, one patient with mixed-type liver cancer, 3 patients with metastatic liver cancer, 2 patients with liver sarcoma, 29 patients with extrahepatic cholangiocarcinoma, 22 patients with pancreatic cancer, 5 patients with gallbladder cancer, and 9 patients with periampullary cancer. After surgery, 38 patients received interventional treatment, 19 systemic chemotherapy, 15 radiotherapy, 17 cell biotherapy, and 5 molecularly targeted therapy. The case fatality rate was 2.29%（3/131）. ConclusionPostoperative MDT provides scientific and rational personalized comprehensive treatment for patients with hepatobiliary and pancreatic malignancies, and improves medication compliance in patients, which holds promise for wide application.

Objective To compare the features of different heating modes cauterization mode and standard ablation mode of Cool-tip on coagulation zone and thermal field distribution in order to provide references for focused and accurate vascular occlusion and explore the primary efficacy of Cool-tip applied to intrahepatic vascular occlusion in living dogs Methods Ex-vivo porcine livers were ablated for 2 4 6 8 minites with cauterization mode and standard ablation mode respectively and the long- and short-axis diameters in the greatest dimension were compared The tissue temperature around the tip midpoint and end of the exposed part of radiofrequency electrode were measured under the circumstance of 4 min ablation by the two modes respectively Animal experiment the intrahepatic vessels of 2 Beagles were ablated with cauterization mode one procedure for each animal and contrast-enhanced ultrasound was used to evaluate the perfusion change of liver tissue Gross anatomy and pathological examination of the liver was performed after 1 week Results In the 2 min 4 min 6 min and 8 min ablation the coagulation volume of cauterization mode and standard ablation mode were 1 01 ± 0 41 cm 3 vs 2 95 ± 0 74 cm 3 1 47 ± 0 33 cm 3 vs 5 03±1 06 cm 3 2 29±0 49 cm 3 vs 9 23±2 53 cm 3 2 70±0 24 cm 3 vs 1 5 89±0 77 cm 3 The coagulation volume was significant smaller in cauterization mode than in standard ablation mode P <0 05 for all The peak temperature of cauterization mode presented on the tip of electrode which averaged 94 4℃ in maximum and maintain around 70 ℃ in the equilibrium phase The peak temperature of standard mode presented on the midpoint of the electrode which periodically variated between 70 ℃- 100 ℃ The result of the animal experiment showed that cauterization mode could be used to occlude the intrahepatic vessel in vivo which induced the ischemia and necrosis in the corresponding area Conclusions Cauterization mode and standard alation mode of Cool-tip have different characteristic in terms of coagulation zone and thermal distribution and carterization mode may have a promising application in intrahepatic vascular occlusion.

Objective To evaluate the clinical significance of personalized biomechanical modeling of prostate deformation based on ultrasound elastography for magnetic resonance imaging(MRI)-transrectal ultrasound(TRUS)image registration.Methods A total number of 5 patients and 1 commercial prostate phantom were imaged via transrectal ultrasound elastography,3D-TRUS and MRI from June 2016 to December 2016.A personalized biomechanical model via the patient-specific ultrasound elastography was made for the deformable registration of prostate MRI and 3D-TRUS images.The registration accuracy was evaluated by the target registration error(TRE)and also the t-test was conducted to validate the statistical significance of our results.Results All the 5 sets of patient data as well as the phantom data were successfully registered.The TRE value of the phantom data was 1.65 mm.The mean TRE value of 5 patients was 1.31 mm,compared with the 2.52 mm TRE value of the registration method without patient-specific biomechanical properties via elastography,was approximately 48% lower(P <0.05).Conclusions Personalized biomechanical modeling of prostate deformation based on ultrasound elastography for MRI-TRUS image registration possesses important clinical significance and is a promising way to provide more quality guidance and improve the accuracy of prostate biopsy.

Objective To analyze the influence factors of local efficacy by parametric contrast enhanced ultrasound (CEUS) of the hepatocellular carcinoma (HCC) patient treated with transcatheter arterial chemoembolization (TACE),and to investigate the application value of parametric CEUS in TACE.Methods From August 2011 to March 2014,a total of 61 HCC patients [60 men,1 women;age range:18-76 years,mean age:(53 ± 13)years old] who underwent one procedure of TACE were enrolled in this prospective study.All cases were scanned by CEUS 1-7 days before and after TACE (3 days,15 days and 30 days post-TACE).Analysis of tumor perfusion during the procedure of CEUS was performed with dedicated software (SonoLiver,TomTec,Germany and Bracco,Italy).Time-intensity curves were plotted and parameters were extracted.According to modified response evaluation criteria in solid tumors (mRECIST),we evaluated the response of TACE using contrast-enhanced computed tomography (CECT) and CEUS 30 days after TACE,which was as reference standard.Results There was a middle negative correlation between the reference standard and the PSV of the hepatic artery pre-TACE,and the correlation coefficient was 0.436 (P =0.011).There was a low negative correlation between the reference standard and the TTP of the reference region on 3 days post-TACE and the analysis region pre-TACE,and the correlation coefficient was -0.264 and-0.268 (P =0.047,P =0.037).Conclusions Our preliminary study suggests,some parameters of CEUS can predict the local response of TACE.

Cryptococcal meningitis is a common and refractory central nervous system infection,with high rates of mortality and disability.The experts of the Society of Infectious Diseases of Chinese Medical Association have reached this consensus after a thorough discussion.Based on the current situation of cryptococcal meningitis in China,the management of cryptococcal meningitis includes 6 aspects:introduction,microorganism identification,clinical manifestations and diagnosis,principles of antifungal therapy,treatment of refractory and recurrent meningitis,treatment of intracranial hypertension.There is not a separate consensus on human immunodeficiency virus (HIV) infection in patients with cryptococcal meningitis.This article focuses on different antifungal regimens and reducing intracranial pressure by reference to Infectious Disease Society of America (IDSA) guidelines.The importance of early diagnosis,combined long-term antifungal therapy,control of intracranial hypertension are emphasized.

Objective:To investigate the safety and dose of 4D template (real-time adjustable angle template) in the treatment of advanced malignant tumors with 125I seeds. Methods:98 patients with advanced malignant tumors admitted to Department of Thoracic Surgery of Shaanxi Provincial Tumor Hospital were treated with 4D template-navigated radioactive 125I seed implantation from June 2018 to December 2019. Preoperative TPS plan, intraoperative optimization, postoperative verification of immediate dose and postoperative evaluation of implantation dose were performed. The treatment results were observed. Results:All 98 patients completed the seed implantation. The implantation dose of GTV of implantation site receiving external irradiation was (12 489±414) cGy and the dose of no external irradiation was (15 036±514) cGy. V 100% was 84.7%-94.1%, and 88.2%-93.7%. The implantation dose of CTV was (7 450±621) cGy, and (9 080±761) cGy. The quality of dose implantation was evaluated as: excellent in 89 cases (91%, 89/98), good in 7 cases (7%, 7/98), fair in 2 cases (2%, 2/98), and poor in 0 case, respectively. The symptom relief rate of patients with pain was 92%(36/39). The 1-and 2-year local control rates were 61%, 36% and 82%, 54% in patients treated with and without external irradiation, respectively. The difference was statistically significant ( P=0.02). The incidence rates of pneumothorax and hemoptysis were 19%(9/48) and 10%(5/48). No corresponding complications were observed in other parts of the patients. Conclusion:4D template-assisted 125I seed therapy is safe and effective for malignant tumors, and intraoperative adjustment of needle angle and dose optimization can realize the precise control of implantation dose.

Presently, nonalcoholic fatty liver disease has become the most common pathogenic factor of chronic liver disease worldwide that can lead to the occurrence of hepatocellular carcinoma (HCC). Lipid metabolism in cancer cells is closely related to tumorgenesis, invasion and metastasis, and thus acts as one of the hallmark of cancer cells. Lipolipomics is an important branch of metabolomics, which has been adapted recently in the study of HCC for analysis of the structure and function of lipid components by chromatography and mass spectrometry. Fatty acids, glycerides, glycerophospholipids, sphingolipids, and sterol are significantly different in HCC tissues or serum. Therefore, it contributes to the diagnosis, determination of prognosis, mechanistic study and targeted therapy of HCC.