Lactate acid is an attractive biomarker reflecting microcirculatory dysfunction and tissue hypoxia.Surviving Sepsis Campaign in 2012 recommend lactate acid as one of the practical biomarkers representingtissue hypoxiato guide management of patients of septic shock.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) in 2016 updated septic shock clinical criteria as a vasopressor requirement to maintain a mean arterial pressure of 65mmHg(1mmHg=0.133kPa) or greater and serum lactate acid level greater than 2mmol/L(>18mg/dl) in the absence of hypovolemia.Lactate acid ≥4mmol/L is often associated with poor clinical outcomes in septic shock patients.Lactate-guided therapy is becoming increasingly important in guiding the resuscitation and the use of vasoactive agents of septic shock.Lactate clearance and early lactate area are valuable indicators to predict the prognosis in patients with septic shock.

OBJECTIVE To evaluate bacterial drug resistance detection value in lower respiratory tract infection treatment.METHODS The data of distribution and antimicrobial resistance of clinical strains in sputum samples in patients with lower respiratory tract infection within some periods were collected and analyzed by WHONET software.Meanwhile,the delivery rates and detection positive rates of clinical species and antibiotics application status in clinic were retrospectively analyzed.RESULTS The delivery rates and detection positive rates of clinical species in patients with lower respiratory tract infection within some periods were 67.8% and 55.9%,respectively.The proportion of Gram-negative bacilli and Gram-positive cocci was 82.39% and 14.18%,respectively.Different drug resistance was displayed in different pathogenic bacteria.Resistant rate of Enterobacteriaceae bacteria and non-ferment bacteria against ciprofloxacin and piperacillin/tazobactam was 47.8%,34.8%and 31.5%,44.7%,respectively and resistant rate of S.aureus against levofloxacin was 63.9%.CONCLUSIONS Although the pathogenic bacteria in patients with lower respiratory tract infection show higher drug resistance to general antibiotics,most of patients with lower respiratory tract infection are treated according to clinical experience of doctors,not based on the results of bacterial culture and antimicrobial susceptibility test.Therefore,the results of bacterial culture and antimicrobial susceptibility test do not play a proper role to direct anti-infective therapy in clinic.

OBJECTIVE To analyze infection state and drug resistance feature of Staphylococcus spp with a view of offering references for controlling and treating infection led by it.METHODS Totally 652 strains of Staphylococcus isolated from patients with infection were identified and their drug resistance was analyzed.RESULTS From them 204 strains were Staphylococcus aureus and 448 strains were coagulase negative Staphylococcus detected and the isolating rate of MRSA and MRCNS were respectively accounted for 55.4% and 84.6%.The most common coagulase negative Staphylococcus strains were S.haemolyticus and S.epidermidis.The drug-resistant rates of MRS were higher transparently than MSS.CONCLUSIONS Staphylococcus are one of the main pathogens leading to nosocomial infections.As a result, it is very important to use antibiotics properly for infection control and nosocomial infection management.

Objective To discuss the incidence,clinical characteristics of sepsis-associated liver injure in pediatric patients and risk factors that may affect the prognosis.Methods A retrospective analysis was made on the data of patients with sepsis-associated liver injure that had been hospitalized in Shanghai Children′s Hospital from January 2011 to December 2015.The cases were divided into the survival group and the death group.Logistic regression analysis was made to screen out risk factors of patients with sepsis-associated liver injure that influence the prognosis.Results The incidence of sepsis associated liver dysfunction was 9.7%(120/1242),the mortality rate was 35.8%(43/120).The most common focus of infection was respiratory tract infection(50.0%),followed by abdominal cavity infection(33.3%) and central nervous system infection(6.7%).The pathogenic microorganisms were mainly gram-negative bacilli(51.3%),followed by virus(26.5%) and gram-positive bacterium(17.7%).The main manifestations of the liver injure were elevated glutamic-pyruvic transaminase(117 cases,97.5%),prolonged prothrombin time(PT)(93 cases,77.5%),hypoproteinemia(83 cases,69.2%) and hyperbilirubinemia(70 cases,58.3%).The total bilirubin(TBIL),PT,activated partial thromboplastin time and total bile acid of the death group were higher than thoes of the survival group.Logistic regression analysis indicated that elevated TBIL(OR=2.937,95%CI 1.179-7.315,P=0.021) was the independent risk factor for death.The area under receiver operating characteristic curve for TBIL(cut off was 64.5μmol/L)was 0.736 with sensitivity 57.7% and specificity 84.8%.Conclusion The incidence rate of sepsis-associated liver injure among pediatric patient is high.Gram-negative bacilli are the main pathogenic microorganisms.This disease is manifested as the elevated glutamic-pyruvic transaminase,hypoproteinemia,prolonged PT and hyperbilirubinemia.Hyperbilirubinemia is the independent risk factor that influences the prognosis.

Objective To compare the diagnostic value of high frequency ultrasound,mammography and breast blood-oxygen function imaging system in diagnosis of breast masses.Methods The images of 89 breast masses by high frequency ultrasound,mammography and breast blood-oxygen function imaging system were reviewed.The study compared the sensibilities and specificities of the three methods in the masses and analyzed their cause of missed diagnosis.Results The sensitivity of the diagnosis of breast cancer by high frequency ultrasound,mammography and breast blood-oxygen function imaging system were 80.00％,70.00％ and 50.00％,respectively.The specificity of the diagnosis of breast cancer by them were 94.94％,98.73％ and 97.47％,respectively.There were sigmfiacant differences in diagnosis of breast benign lesion among the high frequency ultrasound,mammography and breast blood-oxygen function imaging system.The sensitivity of high frequency ultrasound in detecting fibroadenoma of breast was 98.11％ higher than the other methods.Mammography was insensitive to the benign breast lesions,but its specificity was high.Conclusions High frequency ultrasound,mammography and breast blood-oxygen function imaging system are the highly effective diagnostic tool for breast cancer,but the diagnostic value of mammography and breast blood-oxygen in breast fibroadenoma and in cystic disease of breast aren' t high.Breast blood-oxygen function imaging system can enhance the accuracy of the diagnosis of mammary inflammation.

Objective To investigate the diagnostic and prognostic value of serum soluble CD163 (sCD163 )and the positive rate of membrane -bound CD163 (mCD163 )in peripheral blood mononuclear cells (PBMC)in children with infection -associated hemophagocytic syndrome (IAHS).Methods Between July 2012 and June 2016,26 pediatric patients with IAHS (IAHS group)and 28 pediatric patients with sepsis(sepsis group)admitted to Children′s Hospital Affiliated to Shanghai Jiaotong University were selected,and 20 healthy children were taken as healthy control group. Sandwich enzyme linked immunosorbent assay was used to detect serum sCD163 .The population of circulating mCD163 positive monocytes was determined by using flow cytometry.Receiver operating characteristic (ROC)curves were used to evaluate the diagnostic and prognostic values of sCD163 and mCD163 in children with IAHS compared with the diagnos-tic and prognostic values of plasma ferritin,and so on.Results The serum levels of sCD163 in patients of IAHS group, sepsis group and healthy control group were (1264 ±538)mg/L,(862 ±332)mg/L,(610 ±316)mg/L,respective-ly.And the population of mCD163 -positive PBMC in patients of IAHS group,sepsis group and healthy control group was (88.3 ±9.7)%,(68.5 ±18.3)%,(28.9 ±5.2)%,respectively.Both serum sCD163 and the population of mCD163 -positive PBMC were significantly higher in IAHS group compared with those of sepsis group (t =2.031 ,P =0.048;t =3.191 ,P =0.002,respectively).The serum sCD163 and population of mCD163 -positive PBMC in sepsis group were higher than controls (t =3.848,P =0.002;t =4.049,P =0.000,respectively).Moreover,the areas under the ROC curve (AUC)for the mCD163 ,sCD163 ,were 0.853(P =0.013),0.762(P =0.004),0.755(P =0.049),respec-tively.mCD163 at a cutoff of 83.7% had a high diagnosis sensitivity (81 .8%)and specificity (72.4%).The optimal cutoff values of sCD163 and ferritin for predicting IAHS was 888 mg/L (sensitivity 66.7% and specificity 63.3%)and 2880 μg/L (sensitivity 80.0% and specificity 54.5%).In addition,the serum level of sCD163 and the population of mCD163 -positive PBMCs were significantly increased in acute phase and decreased in recovery phase[(1553 ±542) mg/L vs.(866 ±92)mg/L,(91 .0 ±6.4)% vs.(79.0 ±4.6)%,t =2.450,χ2 =3.419,P =0.036,0.007]in IAHS group.Furthermore,subgroup analysis indicated that the serum level of sCD163 and the population of mCD163 -positive PBMCs were significantly higher in dead patients than those in survived patients [(1748.91 ±518.17)mg/L vs. (909.69 ±171 .35)mg/L,t =3.070,P =0.011 ;(93.50 ±8.42)% vs.(77.30 ±3.28)%,χ2 =3.005,P =0.024, respectively].Conclusion Serum sCD163 and the population of mCD163 -positive PMSCs are specific and validity bio-markers for early diagnosis of IAHS,which also are associated with treatment response assessment and prognostic analy-sis in IAHS.

Objective:To examine the roles of follicular helper T(Tfh)cells,serum IL-21 and B cells in the pathogenesis of alcohol abuse non-traumatic osteonecrosis of the femoral head ( NONFH ) .Flow cytometry was used to measure the frequencies of peripheral blood inducible Tfh cells and B cells in alcohol abuse NONFH patients and healthy controls.The disease progression and the extent of femoral head collapse,the serum IL-21 were quantified.Methods: A significantly higher percentages of CD19+B cells(t=3.765,P=0.0005),CD86+CD19+B cells(t=5.506,P<0.0001),and CD95+CD19+B cells(t=4.152,P=0.0002) in patients than those in controls was found.The percentages of CD86+CD19+B cells were positively associated with the index of femoral head collapse in alcohol abuse NONFH(P<0.0001,r=0.536).Results: The frequencies of Tfh cells (t=7.611,P<0.0001),and IL-21+Tfh cells (t=5.281,P<0.0001) were higher than those in controls;The frequencies of Tfh cells were positively associated with the percentages of CD19+B cells(P=0.0002,r=0.455),IL-21+Tfh cells were positively associated with the percentages of CD86+CD19+B cells(P=0.0002,r=0.447).Conclusion: Tfh cells and B cells may participate in the pathogenesis of alcohol abuse NONFH,and increased CD86+CD19+B cells may be associated with the extent of femoral head collapse,the interaction of Tfh cells and B cells may have an im-portant role in pathogenesis of alcohol abuse NONFH.

Objective To develop a rapid detection method of flow cytometry for antifungal susceptibility testing.Methods The experiment conditions of flow cytometry were optimized and the minimum inhibitory concentrations (M1Cs) of 230 strains of Candida spp to flucytosin,fluconazol,itraconazole,amphotericin B were detected.The MIC results obtained by flow cytometry were compared with M27-A2 reference assay.Results The agreement of MIC results between flow cytometry and M27-A2method was 85.0％ - 100％.Conclusion Flow cytometry can be used as a rapid and reliable method for antifungal susceptibility testing.

Purpose To investigate the expression of miR-200a and PTEN in colorectal carcinoma (CRC) and their relationships with clinicopathologic features. Methods In situ hybridization and immunohistochemistry ( EnVision method) for miR-200a and PTEN were performed in 87 CRCs and normal colorectal tissues distant from tumors. Relationship between expression of miR-200a and PTEN and clinicopathologic parameters of CRC was also analyzed. Results The in situ hybridization showed that the positive expression rate of the miR-200a in CRC was higher than those in normal colorectal mucosa (P<0. 01). The expression of miR-200a was correlated with the degree of tumor differentiation (rs =0. 503, P<0. 01). The immunohistochemistry showed that the positive expression rate of the PTEN in CRC was lower than those in normal colorectal mucosa (P<0. 01). The expression of miR-200a was correlated with the degree of tumor differentiation (rs = -0. 493, P<0. 01). Expression of miR-200a and PTEN was not correlated with age, sex, tumor size, depth of tumor invasion, lymph node metastasis and TNM stage (P>0. 05). The expression of miR-200a had a close negative correlation to that of PTEN in CRC (P<0. 01). Conclusions Overexpression of miR-200a might be associated with the occurrence and development by targeting PTEN, and they could be the indicators in the early diagnosis,treatment and prognosis of CRC.

Objective: To investigate the incidence and prognosis of hypophosphatemia in critically ill children treated with continuous blood purification (CBP). Methods: The medical records of the critically ill patients, who were treated with CBP, admitted to pediatric intensive care unit (PICU) of Shanghai Children's Hospital from May 2014 to April 2017 were retrospectively analyzed. The serum phosphorus levels were tested before CBP, at 48-72 h during CBP, at the end of CBP and on the next day after CBP finished. Phosphorus supplement was given to the children with severe hypophosphatemia. Results: A total of 85 patients met the inclusion criteria. The serum phosphorus levels at the 4 indicated time points were (1.4±0.5), (0.7±0.3), (0.8±0.3), (0.9±0.4) mmol/L, respectively (F=45.21, P<0.05). Among the children, 66 cases (78%) had hypophosphatemia during CBP. The incidences of moderate and severe hypophosphatemia were 32 (48%) and 9 (14%), respectively. There were 41 patients with CBP replacement rates of (35-49) ml/(kg·h), while 44 patients with CBP replacement rates of 50-70 ml/(kg·h). There were significant differences at 48-72 h during CBP, the end of CBP and on the next day after CBP ((0.8±0.4) vs. (0.5±0.2), (1.0±0.3) vs. (0.6±0.2), and (1.1±0.4) vs. (0.8±0.2) mmol/L; t=7.672, 4.060, 14.440, P<0.05). Atotal of 9 cases were treated with sodium glycerophosphate. Among the 85 children, 24 (28%) patients died while 61 (72%) survived. There were no significant differences between the two groups in serum phosphorus levels at the indicated time points ((1.4±0.5) vs. (1.4±0.5), (0.7±0.3) vs. (0.7±0.3), (0.7±0.3) vs. (0.8±0.3), and (1.0±0.3) vs. (0.9±0.3) mmol/L, respectively, P>0.05). Conclusions Hypophosphatemia is prone to occur during CBP, which probably related to the replacement rate. There was no significant relationship between hypophosphatemia and mortality in critically ill children after giving phosphorus supplementation.