Objective:To study the clinical efficacy of adjuvant therapy with thymosin alpha -1 in patients with severe peritoneal cavity infection(sIAI),and to explore its effect to celluar immune function and T-like receptor.Methods: A total of 60 patients with sIAI,who received treatment in the intensive care unit of our hospital in January 2012-December 2014,were divided into observation group and control group.Cases in control croup received routine treatment ,and cases in observation group received routine treatment besides thymosin alpha-1.T-lymphocyte subsets were determined by flow cytometry and expression of Toll-like receptor (TLR)2 and TLR4 in the peripheral blood mononuclear cells were determined by real time PCR before treatment and in the 2nd week after treatment.The scores of acute physiology and chronic health evaluation ( APACHE)Ⅱscore and gastrointestinal function were recorded before treatment and in the 2nd week after treatment.The rate of systemic inflammatory response syndrome (MODS),the rate of death in hospital stays,intestinal function recovery and hospital stays in both groups were compared .Results: (1) CD3+,CD4+and CD4+/CD8+of cases in observation group significantly increased ( P<0.01 ) , and CD8+significantly decreased ( P<0.01 ) compared with those in control group.(2) The expression levels of TLR2 and TLR4 mRNA in PBMCs of cases in observation group significantly decreased compared with those in control croup (P<0.01).(3)The scores of APACHEⅡ and gastrointestinal function in observation group significantly decreased compared with those in control group ( P<0.01 ) .( 4 ) The recovery of intestinal function , vanishment of SIRS,hospital stays and the rate of MODS in observation group significantly decreased compared with those in control group (P<0.01), the rate of death in hospital stays had the trend of reduction with no statistic significance (P>0.05).Conclusion:Adjuvant therapy with thymosin alpha-1 in patients with sIAI has good clinical efficacy ,and can improve the cellular immune function ,decrease the expression of Toll-like receptor.

Objective To evaluate effects of trichostain A (TSA) on cell proliferation, cell cycles, apoptosis and invasiveness of multiple myeloma cell line U266; as well as active changes of methylation regulating proteins including DNA methyl-transferase(DNMTs), methyl-binding domain (MBD) proteins: MBD2 and MeCP2 after treated with TSA. Methods U266 cells were treated with different concentrations of TSA for 12, 24, 48 and 60 h. The proliferation activity of U266 cells was detected by MTT and the IC50 of 24 h was calculated. After U266 cells were treated with IC50, cell cycles were check out by dying with PI. mRNA of matrix metalloproteinase-2(MMP-2), bc1-2, bcl-xl and methylation regulating proteins (DNMTs, MBD2 and MeCP2) were detected by real-time PCR. FCM and Western blotting were used to measure expressions of MMP-2 and MBD2. Results MTT results revealed TSA inhibited proliferation of U266 cells in a dose-and time-dependent manner and the IC50 of 24 h was 0.07 μmol/L FCM analysis showed that TSA could arrest the cell cycle in G0/G1 and the proliferation index (PI) in U266 cells [(49.90 0.39)%]were significantly different after exposed to TSA (0.7 μmnol/L for 24h compared with that in the control cells[(55.78 0.49)%](P <0.01). After treated by TSA, the 2-△△Ct of MMP-2, bcl-2 and bcl-xl were 0.71 0.06, 5.04 0.92 and 2.95 0.35, respectively. There were great changes on mRNA of DNMT, MBD2 and MeCP2. TSA could reverse the transcription of DNMT, MBD2 and MeCP2. Conclusion TSA can arrest the U266 cell cycle in GVG, to prevent its proliferation and promote apoptosis, which maybe greatly connect with the changes of the methylation regulating proteins.

Objective To conduct the molecular epidemiologic analysis of Staphylococcus aureus (S.aureus) in the intensive care units(ICUs) and general wards and to compare their clinical characteristics.Methods Ninety-six clinically isolated strains of S.aureus(43 strains from the emergency intensive care unit(EICU) and neurosurgical intensive care unit(NICU) and 53 strains from the general wards) collected from Sepetember 2015 to April 2016 were performed the bacterial identification and antibiotic susceptibility test.The molecular typing was performed by adopting staphylococcal protein A (spa) typing method.Results Among 96 strains of S.aureus,the detection rate of methicillin-resistant S.aureus(MRSA) was 40.6%(39/96),which among 43 strains in ICU was 62.8%(27/43) and which among 53 strains in the general words was 22.6%(12/53).The resistance rates of strains from ICUs to gentamicin,levofloxacin,clindamycin,fosfomycin and minocycline were 23.3%,48.8%,46.5%,32.6% and 32.5% respectively,while which from the general wards were 7.5%,24.5%,18.9%,2.1% and 0% respectively.The Spa typing results showed that the main types of ICUs were t002,t091 and t311.The major epidemic strain was t002(n=16,37.2%) and mainly isolated from EICUs(12 strains),26 spa types were identified among the general wards trains,mainly were t189,t377,t571,t034,t091,t127.Conclusion The detection rate of MRSA in ICUs is higher than that in the general wards,these strains have high resistant rate to routine antibacterial drugs.t002 is the major epidemic strain.The general wards have more spa types with higher genetic diversity.

Objective To explore the clinical characteristics,drug resistance and prognosis of Klebsiella pneumoniae bloodstream infection (KP-BSI),and to analyze the risk factors of death and drug resistance.Methods The clinical data of hospitalized patients with KP-BSI from April 2015 to April 2017 in Huashan Hospital were retrospectively analyzed.Continuous variables were compared using t test.Categorical variables were compared using x2 test or Fisher exact test.The independent risk factors for death were determined by logistic regression model.Results The majority of the 74 patients with KP-BSI were male (67.6％) and elderly patients (78.4％).Nosocomial infection occurred in 58 cases (78.4％) and a total of 24 (32.4％) cases died.The patients were widely distributed in various departments of the hospital.The first was the Department of Infectious Diseases (29.7％),followed by the intensive care unit (23.0％).The patients were often complicated with various underlying diseases and the most common was pulmonary infection (56.8％).There were 45 (60.8％) multiple drug resistance (MDR) strains and 29 (39.2％) Carbapenems resistant Klebsiella pneumoniae (CRKP) strains.There were significant differences of nosocomial infections (x2 =4.655,P =0.031),deep venous catheters (x2 =5.432,P-0.02),and invasive mechanical ventilation (x2 =7.630,P =0.006) between MDR and non-MDR patients.Deep venous catheters (x2 =5.923,P=0.015),invasive mechanical ventilation (x2 =16.845,P=0.000),other catheters (x2 =4.009,P=0.045) and surgery (x2 =3.910,P=0.048) were all significantly different between CRKP and non-CRKP patients.APACHE Ⅱ scores were performed in all patients.The average APACHE Ⅱ score was 8.74-±5.32 of the 50 cases (67.6％) in the survival group and that was 16.46 ± 6.62 of the 24 cases (32.4％) in the death group.The APACHE Ⅱ score in the survival group was significantly lower than that in the death group.The difference was statistically significant (t=5.091,P=0.000).APACHE Ⅱ ≥15 was the independent factor of death (B =-2.708,P=0.000).Conclusions The situation of drug-resistant KP-BSI is severe in the clinic.According to the clinical data,nosocomial infections,invasive mechanical ventilation and deep venous catheters may be the risk factors for MDR bloodstream infection.Deep venous catheters,invasive mechanical ventilation,other catheters and surgery may be the risk factors for bloodstream infection with CRKP.APACHE Ⅱ ≥15 is the independent risk factor for death.The evaluation of APACHE Ⅱ score may predict the prognosis of patients with bloodstream infection.

Colorectal cancer patients with potential resectable liver metastases may benefit from hepatectomy or other local treatment to achieve R 0 resection or no evidence disease after conversion treatment by chemotherapy with or without target therapy. FOLFOX or FOLFIRI combined with cetuximab is appropriate for RAS and BRAF wide type and primary tumor at left-side colon cancer and rectal cancer. It is complex for RAS and BRAF wide type and primary tumor at right-side colon cancer or RAS or BRAF mutated patients. FOLFOXIRI combined with bevacizumab may be the first choice for those patients with young age and good performance score to achieve best conversion chance, while FOLFOX/CapeOx/FOLFIRI combined with bevacizumab could be the second choice. A surgical re-evaluation should be planned every 2 months after initiation of conversion treatment in multi-disciplinary treatment assessment. Once it is demonstrated conversion treatment is successful, surgery should be performed as soon as possible.

Objective:To summarize the clinical features of patients with Klebsiella pneumoniae pyogenic liver abscess(KP-PLA). Methods:Clinical data of 133 patients with pyogenic liver abscess(PLA) and positive results of blood or pus culture were retrospectively analyzed in Huashan Hospital Affiliated to Fudan University from 2009 to 2018. According to the culture results, patients were divided into KP-PLA group ( n=92) and non-KP-PLA group ( n=41). Results:KP-PLA and non-KP-PLA were similar in gender composition with males accounting for 67.39% and 70.73%, and had age of (56.8±13.8) years and (55.0±13.0) years (χ 2=0.146, 0.708, P>0.05) respectively. The underlying diseases were more common in KP-PLA group, including diabetes accounting for 45.65% and 24.39%, and hypertension accounting for 32.61% and 14.63% (χ 2=5.384, 4.642, P<0.05) respectively. Patients with KP-PLA had more invasive infections beyond liver than those with non-KP-PLA, which were 27.17% and 9.76% (χ 2=5.046, P=0.025). The laboratory results showed that hemoglobin levels in KP-PLA and non-KP-PLA were (109.88±20.97) g/L and (97.75±20.25) g/L ( t=3.086, P=0.002). Serum alkaline phosphatase levels were 146.50 (114.50, 237.50) U/L and 220.50 (120.00, 316.75) U/L in KP-PLA and non-KP-PLA ( U=2 239.500, P=0.048) patients. Conclusions:KP-PLA mainly develops in middle-aged and elderly men, especially those with diabetes and hypertension. Patients with KP-PLA need to be paid more attention for invasive manifestations beyond liver.

OBJECTIVE：To systematicall y evaluate the efficacy and safety of a new oral anticoagulant Ⅹ a inhibitor （apixaban，rivaroxaban，edoxaban）in the prevention and treatment of venous thromboembolism （VTE）in cancer patients ，and to provide evidence-based reference for rational use of drugs in clinic. METHODS ：Retrieved from Cochrane Library ，PubMed， Embase，CBM，CNKI，VIP and Wanfang database ，randomized controlled trials （RCTs）about Ⅹa inhibitor （trial group ）versus routine treatment or placebo （control group ）in the prevention and treatment of VTE in cancer patients were collected. After literature screening ，data extraction and quality evaluation was evaluated by using biasrisk evaluation tool recommended by Cochrane System Evaluator M anual 5.1.0，and Meta-analysis was conducted by using Rev Man 5.3 software. RESULTS ：A total of 7 RCTs were included ，including 5 666 patients. Meta-analysis showed that recurrent rate of VTE in trial group was significantly lower than control group [RR ＝0.58，95％CI（0.47，0.71），P＜0.000 01]；there was no statistical significance in the incidence of major bleeding [RR ＝1.12，95％CI（0.67，1.85），P＝0.67] and clinically relevant non-major bleeding [RR ＝1.06，95％CI（0.72，1.55）， P＝0.77] between 2 groups. CONCLUSIONS ：Ⅹa inhibitors can effectively reduce the recurrent risk of VTE in cancer patients ， safety comparable with routine treatment （placebo）.