Objective To evaluate the detection of membrane neutrophil alkaline phosphatase (NAP)in diagnosis of infection in patients with acute cerebral hemorrhage.Methods A total of 208 patients with acute cerebral hemorrhage,including 1 52 cases without infection (uninfected group)and 56 cases with infection (infected group),admitted in the Second Affiliated Hospital of Nantong University during January 201 0 to July 201 6 were enrolled,30 healthy subjects were also enrolled in the study as control group.The peripheral blood from all subjects were collected,and the counts of white blood cell (WBC), percentage of neutrophil,serum procalcitonin (PCT)and NAP were measured.The value of above 4 indicators in diagnosing infection was determined by receiver operating characteristic (ROC ) curves. ANOVA and t test were used to analyze the data,Pearson correlation was performed to analyze the correlation between NAP and PCT in infected group.Results The levels of WBC,percentage of neutrophil and NAP in both infected and uninfected group were higher than those in healthy control group at admission(F =1 1 7.64, 1 00.69 and 425.09,all P <0.01 ),and the levels of WBC,PCT and NAP were also higher when infection occurred compared with those at admission in infected group (t =3.1 4,34.30 and 36.39,all P <0.01 ). The expression of NAP was positively correlated with PCT in infected group (r =0.762,P <0.05).ROC curve analysis showed that the areas under the curves of NAP and PCT in diagnosis of infection were 0.875 and 0.884,respectively.When 1 0655.28 AB/c and 5.01 mg/L were taken as cut-off values,the sensitivities of NAP and PCT in diagnosis of infection were 85.50% and 87.66%;the specificities were 90.50%和 90.31 %,respectively.The level of NAP in infected patients with gram-positive bacterial infections was higher than that in patients with gram-negative bacterial infections (t =6.29,P <0.01 ). Conclusion The expression of NAP in patients with acute cerebral hemorrhage increases when infection occurs,which may be helpful to the clinical diagnosis of bacterial infection.

T follicular helper cells(Tfh)possess the function to induce efficient B cell maturation in germinal center (GC).However,HIV infection can destroy the structure of lymphoid follicles,and disturb the quantity and function of Tfh,resulting in the dysfunction of B cells.Meanwhile,HIV may remain dormant in the Tfh after invading host and escape the elimination of immunologic system.Consequently,the Tfh turns into the sanctuary of HIV.By the above mentioned mechanism,HIV infection leads to the progressive damage of CD4 + T lymphocytes, hypergammaglobulinemia and the loss of memory B lymphocytes.

Objective To identify the drug resistance-related genes in a clinically isolated strain of Enterobacter cloacae.Methods A strain of Enterobacter cloacae was isolated from sputum of a patient with chronic obstructive pulmonary disease from the Affiliated Hospital of Xuzhou Medical University in March 2013.Modified Hodge test and metal enzyme inhibition test were performed for drug-resistant phenotype screening.Carbapenemase genes blaMUS-1, blaVIM-1, blaVIM-2, blaIMP, blaKPC-2, blaNDM-1, blaOXA-48 and blaGESwere amplified by polymerase chain reaction (PCR), and the positive products were sequenced and analyzed.Plasmid conjugation and transformation experiments were used to confirm that the resistance gene mediated by plasmids.Agar dilution method was used for antibiotic susceptibility test.Results Both modified Hodge test and metal enzyme inhibition test were positive in this strain of Enterobacter cloacae.blaNDM-1 gene and blaKPC-2 gene were detected by PCR, and further confirmed by sequencing.blaNDM-1 gene was carried by IncX plasmid with 54×103 bp, KPC-2 gene was carried by untyping plasmid with 42×103 bp.The strain was only sensitive to tetracycline (MIC=2 μg/mL) and tigecycline (MIC=1 μg/mL).The symptoms were improved after the patient was treated by tigecycline combined with Piperacillin/Tazobactam.Conclusion blaNDM-1 and blaKPC-2 genes in Enterobacter cloacae can be mediated by plasmids, and appropriate therapy for its infection should be based on the result of antibiotic susceptibility test.

Objective To investigate the clinical characteristics and risk factors of bacterial liver abscess (BLA) complicated with septicemia.Methods Fifty two BLA patients complicated with septicemia admitted in our hospital from January 2011 to December 2015 were retrospectively reviewed;and 52 cases of BLA without septicemia admitted at the same period were randomly selected as control group.The clinical manifestations, laboratory and radiographic findings, clinical outcome of these patients were analyzed.Logistic regression analysis was used to study the clinical features and risk factors of BLA complicated with septicemia.Results Compared to the control group, the BLA with septicemia group had higher prevalence rates in diabetes mellitus, malignant tumors, jaundice, albumin <35 g/L, BUN≥8.2 mmol/L, hyperglycemia, multiple abscesses and abscesses size ≥10 cm(P<0.05 or <0.01).The blood culture showed that K.pneumoniae(63.3%) was the most commonly isolated pathogen, followed by E.coli(16.7%).Univariate analysis revealed that diabetes mellitus(OR=2.200,95%CI 1.042-4.646), malignant tumors (OR=3.667,95%CI 1.023-13.143), albumin <35 g/ L(OR=2.800,95%CI 1.009-7.774), BUN≥8.2 mmol/L(OR=3.167,95%CI 1.265-7.929), hyperglycemia(OR=3.400,95%CI 1.254-9.216), multiple abscesses(OR=2.667,95%CI 1.043-6.815), abscesses size≥10 cm (OR=5.000,95%CI 1.096-22.820) were positively associated with bacterial liver abscess complicated with septicemia.Multivariate Logistic regression showed that abscesses size≥10 cm (OR=14.016,95%CI 1.354-145.070) was an independent risk factor for complication of with septicemia.Conclusion septicemia is a common complication for bacterial liver abscess, clinically effective measures shauld be taken to prevent and control risk factors associated with septicemia.

Objective To evaluate the efficacy and safety of autologous peripheral blood stem cell transplantation (APBSCT) in treatment of patients with decompensated hepatitis B cirrhosis.Methods Sixty two patients with decompensated hepatitis B cirrhosis admitted in Ningbo Second Hospital during January 2010 and December 2013 were enrolled in the study.Patients were randomly assigned in two groups: 50 patients in control group received comprehensive medical treatment only, and 12 patients in combination group received APBSCT on the basis of medical treatment.The levels of serum total bilirubin (TBil), albumin (Alb), alanine aminotransferase (ALT) and prothrombin time (PT) in two groups were mearsured at the 4th,12th,24th week.Overall survival (OS),progression-free survival (PFS) and complications were compared between two groups after 3 years follow-up.SPSS17.0 software was used to analyze the data.Results After APBSCT treatment, the level of Alb and PT at week 4,12 and 24 in combination group improved significantly(tAlb=-4.437,-5.210 and-6.915,tPT=12.083,11.251 and 10.640,all P<0.01),there were also significant differences between combination group and control group (tAlb=4.985, 5.565 and 6.260,tPT =-3.013、-3.727 and-3.983,all P<0.01).The 3-year OS and 3-year PFS of patients in combination group were higher than those of control group [(90.9±8.7)%vs.(60.7±7.4)%, (75.8±12.5)% vs.(47.9±7.3)%](χ2=6.887 and 5.565,P<0.05).Besides,APBSCT had more advantages than control group in reducing ascitic fluid and hepatic encephalopathy(χ2=7.992 and 4.681,P<0.05 or <0.01).Conclusion APBSCT combined with medical treatment can improve liver function and 3-year survival rate with mild adverse reaction in patients with decompensated hepatitis B cirrhosis.

Liver failure is characterized by hepatic encephalopathy, jaundice, hypo-coagulation and high mortality.Artificial liver support aims to temporarily replace hepatic function until liver function recover or bridge to liver transplantation.Individualized artificial liver support should be balanced and cover the following aspects: removing albumin bound toxins and/or water soluble toxins, eliminating inflammatory mediators and correcting blood coagulation disorders, in order to support metabolism and modulate immune function and to promote the regeneration of hepatocyte and reverse multiple organ failure that may lead to death of patients.Traditional non-biological artificial liver support can't meet individualized treatment.Recently developed hybrid blood purification model, such as albumin dialysis, fractionated plasma separation and adsorption (Prometheus system) and plasma diafiltration (PDF) have provided more and better choices for individualized artificial liver support.Based on the characteristics of pathophysiology and organ dysfunction of liver failure, the author has designed an alignment diagram of individualized artificial liver support for clinical selection.

Severe liver diseases have various etiology.Hepatitis B and hepatitis C are commonly seen in China.However,alcoholic liver disease, autoimmune liver disease (ALD) and other non-viral severe liver diseases have shown an upward trend in recent years.There are no special therapeutical methods for severe alcoholic liver disease so far, glucocorticoids and pentoxifylline are mainly used for etiological treatment.The autoimmune liver disease is still one of the remarkable problems in the filed of liver diseases;at present, immunosuppressive agents and corticosteroids are routinely used for this liver disease, study on transduction pathway of biological agents interfering signals is expected to be a new therapy for ALD.The Wilson's disease is treated by administrating in a staggered manner or alternate manner to avoid the overlap of adverse reactions, while cell transplantation therapy and gene therapy will be the direction of future research.In conclusion, effective therapy should be given with reference to detailed condition, so as to improve survival rate in patients with severe liver diseases.

Liver failure progresses quickly with high mortality.Li's artificial liver systems (Li-ALS), which including Li's non-bioartificial liver (Li-NBAL), Li's bioartificial liver (Li-BAL) and Li's hybrid artificial liver (Li-HAL), play an important role in treatment of liver failure.Li-NBAL integrates various of purification methods such as plasma exchange, plasma perfusion, blood filtration modules and so on, providing a standardized treatment of liver failure, and the Li-HAL system has been used to treat animals with liver failure and achieved good results.Besides, this paper also reviews the research progress of the stem cell transplantation as a promising alternative in treatment of liver failure.

Liver failure caused by hepatitis B virus (HBV) infection is common in China, among which acute-on-chronic liver failure (ACLF) is the main type.Because the pathogenesis is complex and the diagnosis and treatment is difficult,HBV related ACLF has high mortality.In recent years, some progress has achieved in diagnosis and therapy of ACLF.This article reviews the new strategies and advances about HBV related ACLF on basis of researches at home and abroad,including the definition, mechanisms, management and prognosis assessment of ACLF.

In the progress of viral hepatitis, lymphocytes migrate and infiltrate liver tissues, which is relevant to antiviral therapy.However, the related mechanism is still poorly understood.In recent years,CXC chemokine ligand (CXCL)10 and its receptor CXCR3 have been extensively studied.The interaction between CXCL10 and CXCR3 would be a breakthrough point for study of the mechanism of viral hepatitis pathogenesis.This article reviews the research advances of CXCL10 in the progression of viral hepatitis and in the evaluation of antiviral therapy.