Infection is one of the most frequent complications in liver failure and results in high mortality rates.Patients with liver failure have altered and impaired immunity,which favors bacterial translocation.The most common infections in liver failure are pneumonia,spontaneous bacterial peritonitis (SBP),urinary tract infections (UTI),and bloodstream infection.Risk factors associated with the development of infections are variceal bleeding,low ascitic protein level,using of hormones,using of antibiotics,and application of invasive operation,etc.The prognosis of these patients is closely related to a prompt and accurate diagnosis.An appropriate treatment decreases the mortality rates.Preventive strategies are the mainstay of the management of these patients.

The outbreak of COVID-19 occurred in January 2020, the epidemic is still rampant around the world. The Shanghai Expert Consensus on Comprehensive Treatment and Management of Corona Virus Disease 2019 was issued in early March 2020, which provided the guidance of the standardized treatment and rational medication for COVID-19. The administration of " four agents (glucocorticoids, heparin, high-dose vitamin C, Interferon-κ) and one peptide (thymic peptide)" recommended by the consensus is the key to successfully block and treat critical illness.

Objective To evaluate the value of 3-dimensional conformal radiotherapy combined with Hydroxycamptothecin(HCPT) in the treatment of local advanced non-small cell lung cancer.Methods A total of 95 cases were enrolled and randomly assigned to treatment group and control group.The treatment group was treated with 3-dimensional conformal radiotherapy(3DCRT) combined with HCPT.The control group was treated with 3DCRT only.Results Response rate(CR+PR) is respectively 73.4 % and 62 %.The response rate of treatment group is higher than that of control group(P

AIM To substantiate the therapeutic effects of carbonate buffer mixture on naturally occurring gastrointestinal atony in cattle. METHODS Therapeutic effects of carbonate buffer mixture (Na2CO3 50 g, NaHCO3 420 g, KCI 20 g, NaCI 100 g, water 10 L) were observed in 120 cases of gastrointestinal atony including forestomach atony, rumen impaction, rumen acidosis, omasum impaction and intestinal constipation. RESULTS Average cure rate of carbonate buffer mixture on abovementioned diseases was 95 %, and average dose was 1.4-0. 5. CONCLUSION Being a new approach for treatment of gastrointestinal atony in ruminants, the carbonate buffer mixture can eliminate the gastrointestinal atony originated from the over acidity in gastrointestinal canal.

Objective To discuss the reasons of false judgments of localization of the rupture aneurysms and find the way to fix this problem in patients with multiple intracranial aneurysms. Methods The clinical data of 25 consecutive patients, who presented with their first spontaneous subarachnoid hemorrhage and had multiple intracranial aneurysms from 2003 to 2009 in our hospital, were analyzed retrospectively. The rupture aneurysms were determined according to Nehls' method that reported before, and the supposed responsible rupture aneurysms w0ere clipped within 48 hours after hemorrhage in all patients. More aneurysms that could not be accessed in the same surgical session were surgically terated later. Results The location of the rupture aneurysm was verified at the time of surgery in all 25 patients. The concordance rate of the prediction and the reality of the rupture aneurysm was 80% (20/25). Four patients ( 16% ) ,in whom the ruptured aneurysm was not correctly identified,rebled after surgery,and 2 patients died as a result of the rebleeding One patients had no clear diagnosis at the end. Conclusion In the reported cases, about 80% rupture aneurysms could be correctly diagnosed before treatment according to the CT and DSA examinations. If clear diagnosis couldn't be made,additional examinations should be considered, such as CTA or MRI. Rupture aneurysms must be confirmed during the operation and the other aneurysms should be checked to exclude additional responsible aneurysms in all cases.

[ ABSTRACT] AIM: To investigate the effects of bone marrow mesenchymal stem cells ( BMSCs) modified by programed death ligand-1 immunoglobulin ( PDL1 Ig) gene on immune rejection of orthotopic liver transplantation in rats. METHODS:Rat BMSCs were cultured and identified.The protein expression of PDL1 Ig in the BMSCs 72 h after infection with pAdEasy-1/PDL1 Ig was detected by Western blot.Mixed lymphocyte reaction was used to detect the inhibitory effect of BMSCs on the viability of T-lymphocytes in peripheral blood.The male Wistar rats were used as donors (n=40), and the male SD rats were used as recipients ( n=40 ) .The rat model of orthotopic liver transplantation was established by im-proved cuff method for observing acute rejection.The rats were randomly divided into control group, BMSCs treatment group, BMSCs/GFP treatment group and BMSCs/PDL1 Ig treatment group with 10 pairs each.Five rats were executed at the 7th day and the remains were used for measuring the survival time.RESULTS:The expression of PDL1 Ig in the BM-SCs was detected after pAdEasy-1/PDL1 Ig infection.The effect of BMSCs/PDL1 Ig on the viability of the lymphocytes was stronger than that of BMSCs/GFP.The level of IL-4 in BMSCs/PDL1 Ig group was significantly higher than that in the other 3 groups, while the levels of IFN-γand IL-2 were significantly decreased.The liver function in BMSCs/PDL1 Ig group was significantly improved and the levels of ALT, AST and TBil were almost recovered to normal at the 7th day after transplan-
tation.Severe rejection reaction was observed in control group, and rejection reactions were decreased with different degrees in BMSCs treatment group and BMSCs/GFP treatment group.Much slighter rejection reaction and significantly longer sur-vival time were showed in BMSCs/PDL1 Ig group than those in the other 3 groups.CONCLUSION:PDL1 Ig-modified BM-SCs inhibit the rejection of liver transplantation in rats and induce the immune tolerance, and the effect is better than that of BMSCs alone.

Objective To evaluate the effect of computer-aided design of composite materials with epoxide acrylate maleic (E) and hydroxyapatite (H) in cranioplasty. Methods A total of 45 patients with cranium defects were treated with cranioplasty by using skull bone flaps made of composite materials including epoxide acrylate maleic (E) and hydroxyapatite (H) ,which was designed with computer aid according to individual requirements. The patients were followed up for 6-36 months. Results After cranioplasty with composite EH, there occurred subcutaneous fluid in one patient and mild bone collapse in one. The composite EH showed good histocompatibility, with no infection or rejection. Conclusion During cranioplasty, use of computer-aided design of composite EH takes advantages of good accuracy, short operation time, good biocompatibility and good clinical efficiency.

Objective The aim of the study is to evaluate clinical efficacy and safety of azatreonam or ceftazidime on treatment of lower respiratory tract infection .Methods Four English databases (MEDLINE、EMBASE、Pubmed、Cochrane li‐brary) and three Chinese databases (CNKI、VIP、WANFANG) were searched .Meta‐analysis was performed using Review Manager 5 .2 .Results The Meta‐analysis revealed azatreonam was superior to ceftazidime in total efficiency (RR=1 .15 ,95%CI is 1 .09‐1 .21) .No significant differences are seen between azatreonam and ceftazidime (RR=1 .03 ,95% CI is 0 .98‐1 .09) on the bacterial eradication rates or the incidence of adverse reactions (RR=0 .66 ,95% CI is 0 .39‐1 .12) .Conclusion Azatreonam is more effective than ceftazidime on the treatment of lower respiratory tract infection in the clinical practice .

Objective To investigate whether poly (lactic?co?glycolic acid) (PLGA) as protein delivery vehicles that encapsulate CC chemokine receptor 5 antibody (anti?CCR5) has more suppressive function on macrophages than single anti?CCR5 in mouse endometriosis model. Methods The PLGA/anti?CCR5 nanoparticles were synthesized. The cumulative release of anti?CCR5 from PLGA/anti?CCR5 nanoparticles was evaluated. The mouse endometriosis model was established and divided into control group, anti?CCR5 group and PLGA/anti?CCR5 group. Meanwhile, ectopic endometrial cells (EEC) and macrophages isolated from peritoneal fluid were cultured in vitro. Flow cytometry was used to detect the proportion of macrophages in the peritoneal fluid of each group. The secretion of interleukin 10 (IL?10) and transforming growth factor β (TGF?β) in each group were determined by ELISA. The proliferation and infiltration of EEC were detected by 5?bromodeoxyuridine proliferation kit and matrigel invasion kit. Results The PLGA/anti?CCR5 nanoparticles were successfully synthesized. The mouse endometriosis model was established and the EEC and macrophages were cultured. Compared with the anti?CCR5 without nanoparticles, the bioconjugate PLGA/anti?CCR5 nanoparticles could control the release of anti?CCR5 from day 3 to day 24. The proportion of macrophages in PLGA/anti?CCR5 group were gradually reduced compared with those in anti?CCR5 group (P<0.01), the ratios of day 7 [(4.5±1.5)%] and day 3 [(6.3±0.6)%], day 14 [(2.6±0.7)%] and day 7 were significantly different (P<0.01 and P<0.05). PLGA/anti?CCR5 reduced IL?10 and TGF?β levels relative to anti?CCR5 (P<0.01),and decreased gradually on day 3, day 7, and day 14 (P<0.01). Anti?IL?10+anti?TGF?β could reduce the proliferation [(70.8 ± 7.6)% ] and invasion ability [(50.2 ± 9.1)% ] of EEC (P<0.05). Conclusions In mouse endometriosis model, PLGA/anti?CCR5 may inhibit the proliferation and invasion of EEC by inhibiting the secretion of IL?10 and TGF?β by macrophages, suggesting that it provide a new idea for the treatment of clinical endometriosis.

Objective:To investigate the nurses' attitude towards open visitation policy in intensive care unit (ICU) and its potential influence factors, and further to provide evidence for carrying out this policy in ICU.Methods:A self-designed, anonymous online questionnaire of "attitude of ICU nurses to open visiting system in ICU" was performed in 31 provinces, autonomous regions and municipalities in China from October to December 2019, using convenient sampling method approach. Only nurses working in ICU (including specialized ICU, but excluding the critical ward in general ward) and willing to participate in the survey were included. The survey included 35 items, including the general information of each participant, the attitude towards the implementation of the open visitation system in ICU and its potential influencing factors. Ordinal Logistic regression analysis was used to identify the significant influencing factors.Results:A total of 1 558 questionnaires were sent out and 1 546 effective questionnaires were retrieved, with a response rate of 99.2%. Overall, 32.2% of them agreed with the policy, 41.3% of them disagree with the policy and 26.5% of them were uncertain. The Ordinal Logistic regression analysis showed that the independent influencing factors of ICU nurses' attitude towards open visitation policy including the possibility of increasing healthcare-associated infection [disagree: β = 1.327, 95% confidence interval (95% CI) was 0.242 to 2.413, P = 0.017; uncertain: β = 0.697, 95% CI was 0.244 to 1.151, P = 0.003], the improvement of nurses' job satisfaction (disagree: β = -1.406, 95% CI was -1.750 to -1.062, P = 0.000; uncertain: β = -0.748, 95% CI was -1.030 to -0.466, P = 0.000), the information support for medical staffs from family members (disagree: β = -0.644, 95% CI was -1.048 to -0.240, P = 0.002; uncertain: β = -0.422, 95% CI was -0.721 to -0.124, P = 0.006), the feasibility that the family members can assist the nurses in the basic nursing for patients (uncertain: β = -0.465, 95% CI was -0.729 to -0.202, P = 0.001), reducing the time that a nurse spent on caring for the patients (uncertain: β = 0.349, 95% CI was 0.052 to 0.646, P = 0.021), improving early rehabilitation (disagree: β = -0.593, 95% CI was -1.166 to -0.019, P = 0.043), and getting psychological support for patients from family members (disagree: β = 1.293, 95% CI was 0.426 to 2.159, P = 0.003), family members' satisfaction (disagree: β = -0.981, 95% CI was -1.431 to -0.531, P = 0.000). Conclusion:ICU nurses in China have realized that open visitation policy has positive effect on patients' early rehabilitation, willing to live and satisfaction; meanwhile, this policy may need more improvement in many ways such as healthcare-associated infection control, disinfection and isolation, allocation of human resources and time spent treating and caring for patients.