回顾性分析2例肝移植术后军团菌肺炎受者的临床资料，并结合文献进行总结，1例治愈出院，1例于术后60 d死亡。分析肝移植术后军团菌肺炎的临床特征，提高该病的诊疗能力。

本文报道1例因"胆道闭锁"行劈裂式肝植术后发生淋巴增殖性疾病合并自发性肿瘤溶解综合征的1岁儿童受者，其肝移植术后6个月出现发热伴恶心呕吐，实验室检查提示EB病毒感染，全身多发淋巴结肿大，术后7个月淋巴结活检诊断为移植后淋巴组织增殖性疾病(PTLD)。后因急性肾损伤3期伴急性左心衰考虑高肿瘤负荷导致自发性肿瘤溶解综合征，经持续性肾脏替代治疗(CRRT)、血浆置换等抢救措施后脱离生命危险，之后应用利妥昔单抗以及5个疗程R-CHOP治疗，该儿童受者脏器功能迅速恢复，全身多处淋巴结明显减小。

Objective:To study the use of digital subtraction angiography (DSA) guided transnasal ileus tube placement in management of abdominal compartment syndrome (ACS) after liver transplantation.Methods:From January 2015 to December 2019, a total of 30 patients who developed ACS after liver transplantation who were admitted to the Transplantation Intensive Care Unit of Tianjin First Central Hospital were retrospectively studied. According to the way of decompression, these patients were divided into the study group and the control group. Patients in the control group were treated with conventional abdominal decompression, while patients in the study group were treated with DSA guided transnasal ileus tube placement based on management principles developed in conventional abdominal decompression. Changes in intra-abdominal pressure, treatment efficacy rates and liver functions were monitored in the two groups up to 7 days after abdominal decompression.Results:There were 23 males and 7 females, aged (53.4±11.6) years. After treatment, the IAP, portal venous blood flow velocity, bile drainage volume, ALT and AST in the study group were significantly better when compared with the findings before treatment: [IAP: (7.13±3.87) vs (22.73±2.09) mmHg, portal vein blood flow velocity: (34.76±10.31) vs (21.45±6.47) cm/s, bile drainage volume: (198.43±19.94) vs (80.72±9.52) ml/d, ALT: (158.92±67.56) vs (278.73±99.17) U/L, AST: (79.36±15.63) vs (196.71±89.05) U/L], ( P<0.05). After treatment, when compared with the control group, the IAP, portal vein blood flow velocity, bile drainage and TBil in the study group were significantly better [IAP: (7.13±3.87) vs (13.47±6.19) mmHg, portal vein blood flow velocity: (34.76±10.31) vs (24.98±8.54) cm/s, bile drainage: (198.43±19.94) vs (108.73±21.30) ml/d, TBil: (258.85±91.95) vs (343.69±89.45) μmol/L], ( P<0.05). In the control group, the IAP significantly decreased on the fourth day after treatment, ( P<0.05); compared with the significant difference in the study group on the second day after treatment ( P<0.05). After 7 days of treatment, the efficacy rate of the control group was 46.7% (7/15), compared to 86.7% (13/15) in the study group. The difference between the two groups was significant (χ 2=5.400, P<0.05). Conclusion:DSA guided transnasal ileus tube placement for treatment of abdominal compartment syndrome after liver transplantation resulted in a better treatment efficacy rate than conventional treatment.

目的 采用网络药理学和多中心临床数据探讨清肺承气汤治疗腹腔感染所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的作用机制.方法 通过中药系统药理学分析平台(Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform,TCMSP)数据库检索清肺承气汤的化学成分和靶点.采用Cytoscape 3.7.1软件建立"化合物-靶点"网络、靶点间的蛋白相互作用(protein protein interaction,PPI)网络,并对预测靶点进行京都基因与基因组百科全书(Kyoto encyclopedia of genes and genomes,KEGG)富集分析.从3所医院选取27例腹腔感染所致ARDS患者,随机分为13例对照组和14例清肺承气汤组,分别于治疗前后3d取肺泡灌洗液,微球检测法检测患者肺泡灌洗液中白细胞介素-4(interleukin 4,IL-4)、白细胞介素-6(interleukin 6,IL-6)、白细胞介素-10(interleukin 10,IL-10)水平;流式细胞术检测患者肺泡巨噬细胞的凋亡情况.结果 筛选得到清肺承气汤中78种活性成分,对应63个潜在靶点;"化合物-靶点"网络和PPI网络度值靠前的靶点为过氧化物酶体增殖物激活受体γ(peroxisome proliferators-activated receptor γ,PPARy)、B细胞淋巴瘤/白血病-2(B-cell lymphoma-2,Bcl-2)、IL-6、IL-10、γ干扰素(interferon-gamma,INFG),化合物为槲皮素和木犀草素;潜在靶点的KEGG通路排序靠前的炎症相关通路为核因子-kB(nuclear factor-kB,NF-kB)通路、肿瘤坏死因子(tumor necrosis factor,TNF)信号通路、白细胞介素-17(interleukin 17,IL-17)通路、T细胞受体通路等信号通路.与对照组比较,清肺承气汤组患者肺泡灌洗液中IL-6水平显著升高(P＜0.05),IL-10水平显著降低(P＜0.05),肺泡巨噬细胞的凋亡面积显著降低(P＜0.001).结论 清肺承气汤中的有效成分可以通过IL-6、Bcl-2、IL-10、趋化因子配体2(CXC chemokine ligand 2,CXCL2)等靶点参与调控多条信号通路来影响IL-4、IL-6、IL-10分泌和细胞凋亡,从而治疗ARDS.

Objective:To explore the predictive value of SIRT2 in the progression of sepsis to persistent inflammation-immunosuppression and catabolism syndrome (PICS).Methods:From June 2018 to June 2019, 81 sepsis patients in Intensive Care Unit of Tianjin First Center Hospital were enrolled, and 20 healthy adult volunteers were recruited as controls. Forty-five patients who had been hospitalized for more than 14 d were selected and divided into the non-PICS group and PICS group. Blood samples were collected at 0, 24 h, 4 d, 7 d, 10 d, 14 d, 17 d, and 21 d. The levels of SIRT2, PD-1, TNF-α, IL-6, IL-10 and TGF-β were measured at different time points. In the control group, and fasting was taken only once in the morning. ROC curve was drawn and AUC was calculated to evaluate the value of SIRT2 and PD-1 in predicting sepsis progression to PICS.Results:(1) Compared with the control group, the expression of SIRT2 and PD-1 decreased at admission in the non-PICS group and PICS group ( P<0.05). Compared with the non-PICS group, the expression of SIRT2 and PD-1 in the PICS group increased at 10 and 14 d, respectively. SIRT2 in the PICS group had statistical difference at 10 d [(0.87±0.08) and (1.15±0.09), respectively; P<0.05]. PD-1 was statistical difference at 14 d between the two groups[ (0.86±0.04 )and (1.01±0.02), respectively; P<0.05]. (2) Over time, TNF-α and IL-6 in the two groups declined gradually, but IL-10 and TGF-β in the PICS group were higher than those in the non-PICS group at 10 d ( P<0.05). (3) The AUC of PD-1 was 0.766 (95% CI: 0.624-0.908), and the sensitivity and specificity were 70.8% and 81.0%, when the cut-off value was 1.01. The AUC of SIRT 2 was 0.841 (95% CI: 0.722-0.960), and the sensitivity and specificity were 79.2% and 81.0%, when the cut-off value was 1.10. Conclusions:SIRT2 expression level changes when sepsis patients enter PICS stage. SIRT2 has certain predictive value for the occurrence of PICS.

目的:了解我院鲍曼不动杆菌临床分布情况及ICU内鲍曼不动杆菌的耐药性变迁,为临床指导用药、合理使用抗生素、预防耐药菌产生提供依据.方法:回顾性分析2014至2017年我院鲍曼不动杆菌分布及耐药情况,细菌药敏试验采用VITEK仪器法.结果:我院2014至2017年共分离出鲍曼不动杆菌2 246株,各年度分别检出数量为:413株(2014年)、565株(2015年)、644株(2016年)和624株(2017年).标本类型主要为痰,占88％,其次为胆汁及腹腔引流液,占5.7％,除此之外,血液、伤口分泌物、胸水及脑脊液等也分离出鲍曼不动杆菌.鲍曼不动杆菌在我院各科室分布广泛,其中,综合ICU检出比最高,占20％,其次为呼吸内科,占9.3％,其余临床科室也均有分布.我院ICU病房内鲍曼不动杆菌对多种抗菌药物均表现较高的耐药性,其中,左氧氟沙星耐药率最低,为23.16％,且呈现逐年降低趋势,差异具有统计学意义(P＜0.05).其次是阿米卡星,其耐药率为27.62％.头孢哌酮舒巴坦耐药率变化较大,2014～2016年呈逐年上升,但2017年较2016年明显下降,且差异具有统计学意义(P＜0.05).其他抗生素耐药率均在80％以上,近几年来变化不大.结论:鲍曼不动杆菌可造成多部位的感染,且临床科室分布广泛,并对临床多种常用抗生素均具有较高的耐药性.

Objective To study the effect and mechanism of recombinant human thrombopoietin (rhTPO) on platelet activation and pyroptosis in mice with lipopolysaccharide (LPS)-induced thrombocytopenia,and provide a theoretical basis for the clinical use of rhTPO.Methods One hundred C57BL/6 mice were randomly(random number) divided into 5 groups:blank control group (sham group),experimental control group (LPS group),low dose (L group,1.35 ×103U · kg-1 · d-1),medium dose (M group,2.7 ×103U · kg-1 · d-1),and high dose (H group,5.4 ×103U · kg-1 · d-1) rhTPO treatment groups.Continuous observation for 72 h.The positive expression rates of CD61/CD62p,Gasdermin D and Caspase-1 in washed platelets were detected by flow cytometry at 72 h,and the levels of IL-1β and IL-18 in plasma were detected by ELISA.Results Compared with the sham group,the survival rate of the LPS group was significantly lower (P＜ 0.01).Compared with the LPS group,the survival rates of the L,M and H groups were slightly increased,but the difference was not statistically significant (P＞0.05).There was no significant change in platelet count of the sham group before and after the experiment.The platelet count in the LPS group decreased significantly.The platelet count at 72 h in the L group was signiftcantly higher than those in the LPS,M and H groups (P＜0.01),and there was no significant difference between the M and H groups and LPS group (P＞0.05).Compared with the sham group,CD61/CD62p and Gasdermin-D protein expressions in the LPS group were significantly increased (P＜0.01),significantly decreased in the L group (P＜0.05),and not significantly changed in the M and H groups (P＞0.05).Caspase-1 expression was significantly increased in the LPS group compared with the sham group (P＜0.01),significantly decreased in the L and M groups compared with the LPS group (P＜0.05),and not significantly changed in the H group compared with the LPS group (P＞0.05).The levels ofplatelet-rich plasma IL-1 beta and IL-18 in the LPS group were significantly higher than those in the sham group (P＜0.01),while those in the L group were significantly lower than those in the LPS group (P＜0.01),and those in the M and H groups were not significantly changed than those in the LPS group (P＞0.05).Conclusions rhTPO can inhibit platelet activation and pyroptosis in LPS-induced thrombocytopenia mice,which provides basic research basis for the treatment of sepsis thrombocytopenia.

Objective Summarize the literatures of HMGB1 and the interrelated TCM drug targets. To explore therapeutic effect of these herb extract for biological markers of sepsis HMGB1. Methods Find the latest literatures at home and abroad. Summarized the mechanism of traditional Chinese medicine extract inhibit HMGB1 secretion and release in this paper. Results BBR, GZA and TSN not only inhibit HMGB1 induced by lipopolysaccharide and expression of animal models of sepsis, but also reduce mortality rate. Conclusion HMGB1 as therapeutic targets of drugs, some herb extract like BBR, GZA and TSN can provide a good foundation. In the future research to develop some cheap and effective small molecule drugs of traditional Chinese medicines, can play a role for the clinical treatment of sepsis.

Objective To investigate the expression of IL-18 in severe sepsis and sepsis-associated throm-bocytopenia and explore its clinical significance.Methods Real-time polymerase chain reaction was applied to de-tect the expression of IL-18 miRNA in 28 samples of sepsis-associated thrombocytopenia patients and 32 samples of severe sepsis. The enzyme-linked immunosorbent assay was applied to detect the concentration of IL-18 in their plasma. Results The miRNA expression of IL-18 in the sepsis-associated thrombocytopenia group was higher than in the severe sepsis group(P=0.015).The concentration of IL-18 in the severe sepsis-associated thrombocyto-penia group were also higher than those in the severe sepsis group(P=0.034). Conclusion The expression level of IL-18 is related with the severity of thrombocytopenia in patients with sepsis and is likely to play an important role in the pathogenesis of sepsis-associated thrombocytopenia.

Sepsis is a lethal organ dysfunction caused by infection induced reaction maladjustment. Thrombocytopenia is not only a common complication of sepsis, but also closely related to the patient's prognosis. In the clinical treatment, it is important to identify the etiology and pathogenesis of thrombocytopenia associated with sepsis and choose appropriate methods to correct thrombocytopenia in time to improve the prognosis of patients. This article gives an introduction to the research status of the etiology, pathophysiological mechanism and molecular mechanism of sepsis-related thrombocytopenia.

目的 探讨脓毒症大鼠血小板活化状态与IL-18表达量的相关性.方法 雄性SD大鼠78只,随机分为模型组(12、24、48h)和假手术组(12、24、48h),各组每个时间点各12只,6只健康大鼠取血后作体外观察用.模型组大鼠行盲肠结扎穿孔术(CLP)建立大鼠脓毒症模型;假手术组大鼠只开腹,不结扎盲肠,不穿孔.术后各时间点麻醉大鼠,行腹主动脉取血、 抗凝,离心分别获取富血小板血浆(PRP)和贫血小板血浆(PPP),酶联免疫吸附实验(ELISA)检测大鼠血浆白细胞介素18(IL-18)表达水平,流式细胞术检测大鼠PRP中血小板表面PE-CD62P阳性标记情况.LPS体外刺激正常大鼠PRP,并检测上清中IL-18表达情况.结果 ELISA结果显示,模型组大鼠各时间点血浆中IL-18表达水平均高于假手术组(P<0.01);流式细胞术结果显示,模型组大鼠各时间点血小板活化率均较假手术组大鼠显著升高(P<0.01);体外实验结果显示,LPS刺激大鼠PRP后,上清中IL-18表达水平显著升高(P<0.01).结论 CLP大鼠血浆中IL-18的表达量与血小板活化程度相关.

目的 探究黄连素对脂多糖诱导小鼠血小板减少模型是否具有保护作用.方法 C57BL/6小鼠100只随机分为5组,黄连素干预小鼠分低、中、高剂量组,分别给予5、25和50 mg/kg黄连素灌胃3 d,每天1次;3 d后,黄连素干预组和LPS组给予单次腹腔注射终浓度为25 mg/kg的LPS建立小鼠血小板减少模型;空白对照组给予相应的生理盐水;观察各组小鼠的一般状况、生存率,于LPS注射后0、2、6和24 h取外周血检测血小板参数、ELISA法检测血清中TNF-α、IL-1β和IL-18的表达情况,LPS注射后24 h取肺脏组织,免疫组织化学检测肺脏中血小板的滞留情况.结果 黄连素能够改善LPS诱导血小板减少模型小鼠的一般状况和生存率;可抑制LPS诱发的血小板减少及抑制LPS引发的TNF-α、IL-1β和IL-18水平的升高,且呈剂量依赖性;黄连素可减少LPS诱发的小鼠肺脏中血小板的滞留量.结论 黄连素可通过抑制LPS诱发的血小板减少、炎症反应和血小板在肺脏中的滞留对LPS诱导的血小板减少模型小鼠具有一定程度的保护作用.

Objective To explore the relationship between immature platelet fraction(IPF) with severity of sepsis and prognosis in patients with septic shock.Methods A total of 40 patients admitted to intensive care units of Tianjin First Central Hospital from June 2016 to June 2017 were enrolled.Of them,10 patients contracted non-sepsis infected,13 patietns with septic shock,and 17 patients with non-complicated sepsis.Ten healthy subjects were recruited as control groups from Tianjin Medical University.IPF and immature reticulocyte fraction (IRF) were detected,and SOFA and APACHE Ⅱ scores were calculated,and clinical findings of all groups were recorded.The differences in IPF and IRF between the groups were analyzed.The relationship between the IPF and SOFA score was studied,and the role of IPF in the diagnosis of septic shock was evaluated.Statistical methods include t test,MarmWhitney test,Spearman correlation analysis,and ROC procedure,and P＜0.05 was considered significant.Results Significantly higher IPF level was observed in patients with sepsis than that in patients with nonsepsis infection.(6.25 + 2.92) vs.(2.49 ± 1.03),P＜0.01.Significantly higher IPF level was observed in patients with septic shock than that in patients with non-complicated sepsis(4.71 ± 1.79) vs.(8.25 ± 2.94),P＜0.01.IPF correlated with sepsis severity scores (7.41 ± 3.51) vs.(4.5 ± 1.7),P=0.005;r=0.58,P=0.001.This study presented the highest diagnostic accuracy for the presence of sepsis by all studied clinical and laboratory parameters (AUC=0.78,P=0.01).Conclusion IPF levels could be used as a biomarker for diagnosis and severity of sepsis.

目的:探讨脓毒症及脓毒症休克患者血浆炎症因子水平与患者死亡率的相关性.方法:选取入住ICU并确诊为脓毒症的患者51例(试验组),包括25例脓毒症患者及26例脓毒症休克患者;对照组为随机选取的入住ICU的非脓毒症且病情危重的患者20例.采用酶联免疫吸附试验分别检测试验组及对照组病人的血浆炎症因子IL-6、IL-8、IL-10、IL-18、IL-1β及TNF-0的浓度水平,同时根据APACHEⅡ、SOFA评分评估病情的严重程度.结果:与对照组相比,脓毒症患者组及脓毒症休克患者组IL-1β、IL-6、IL-8、TNF-α、IL-18浓度水平均有显著升高(P＜0.05).比较脓毒症患者组及脓毒症休克患者组内生存者与死亡者血浆炎症因子水平发现,死亡者的IL-6、IL-8及IL-18浓度水平明显升高(P＜0.05),其他炎症因子无明显升高(P＞0.05).采用多变量Logistic回归分析显示IL-18是患者预后的独立影响因素.结论:IL-18对于脓毒症及脓毒症休克患者死亡的预测有十分重要的作用.

目的 提高对非HIV感染患者肺孢子菌肺炎(PCP)合并急性呼吸衰竭的诊断和治疗的认识.方法 对2015年1月-2017年12月我院重症监护科收治的16例非人类免疫缺陷病毒(HIV)感染的肺孢子菌肺炎合并急性呼吸衰竭患者的临床表现、实验室检查、影像特点、治疗及转归等临床资料进行总结及讨论.结果 15例患者在发病前存在激素或免疫抑制剂使用史,均以发热和干咳、呼吸困难为首发症状后病情进展迅速.患者均存在呼吸衰竭[氧合指数(85.8±16.8)mmHg],有创呼吸机辅助呼吸11例,高流量氧疗5例.胸部CT主要表现为弥漫性磨玻璃影.支气管肺泡灌洗液六胺银染色阳性2例,肺孢子菌PCR检测阳性16例.16例患者应用复方磺胺甲噁唑(SMZco)联合卡泊芬净与激素治疗,8例痊愈,7例死亡,1例放弃治疗后死亡.入住ICU时间为3～29 d,平均(13.0±7.1)d.结论 PCP是应用免疫抑制剂患者易患的机会性感染,对于重症PCP患者SMZco联合卡泊芬净与激素治疗效果良好.

Objective To investigate the role of PI3K/AKT in acute kidney injury (AKI) induced by abdominal sepsis in rat model. Methods The cecal ligation and puncture (CLP) was used to establish rat model of abdominal sepsis. The serum levels of creatinine (Cr) and urea nitrogen (BUN) were detected by automatic biochemical analyzer at different time points (24, 48 and 72 h) after operation. The expressions of PI3K/AKT mRNA were detected by real-time PCR. Western blot assay was used to verify the expression levels of NLRP3, ASC and Caspase-1. The serum levels of TNF-α, IL-1β and IL-18 were detected by enzyme-linked immunosorbent assay. Results The serum levels of Cr and BUN were increased significantly in CLP group compared with those of control group (P＜0.05). The expression levels of PI3K/AKT in kidney were significantly increased in rats with abdominal sepsis (P＜0.01). And the released NLRP3 inflammasome, which was activated by PI3K/AKT, was significantly increased (P＜0.01). Meanwhile, compared with the sham-operated group, the serum levels of IL-1β, TNF-α and IL-18 were increased significantly (P＜0.01). Conclusion PI3K/AKT signaling pathway plays an important role in acute kidney injury induced by abdominal sepsis, which activates the NLRP3 inflammasome, increases the release of inflammatory cytokine and aggravates the sepsis condition.

细胞死亡一直都是疾病进展的核心环节,通常包括凋亡和坏死两种方式.凋亡是能量依赖的细胞内死亡程序活化而致的细胞死亡方式;是主动的、有序的、由基因调控的.而坏死是由损伤因子引起的退行性(自溶)的病理现象;是被动的、无序的、不可逆的过程.2005年,Degterev等[1]发现在细胞内无凋亡信号传导因子存在下产生的一种新的死亡方式,其具有坏死细胞的形态和凋亡细胞相类似的信号机制,将其命名为程序性坏死(Necroptosis),并筛选出程序性坏死的特异性抑制剂Necrostatin-1(Nec-1),从而揭开程序性坏死的研究序幕.至今研究已证实死亡受体家族、Toll样受体[2]、NOD样受体、DNA受体、干扰素受体等家族均可引起程序性坏死.本文将对死亡受体家族引起细胞程序性坏死的分子传导机制做一综述.

Objective To determine whether plasma soluble CD40L level correlates to the degrees of sepsis,and its potential to be a marker of adverse outcome for sepsis patients. Methods This was a single center, prospective study carried out in ICU of the First Central Hospital of Tianjin. Plasma levels of sCD40L, APACHEⅡ, SOFA score and some other physiological and clinical laboratory test index were measured in 84 patients with sepsis at the time of diagnosis,who are divided into two groups are without thrombocytopenia group and thrombocytopenia group,and put the thrombocytopenia group into mild thrombocytopenia group, moderate thrombocytopenia group and severe thrombocytopenia group. Survival at 28 days was used as the endpoint. To compare the association with sCD40L and APACHEⅡ, SOFA score in different groups,and to observe sCD40L prediction of adverse consequences. Results①Plasma soluble CD40L levels were higher in without thrombocytopenia group than other groups( P<0. 001),there was significant difference in the levels of sCD40L among mild thrombocytopenia group, moderate thrombocytopenia group and severe thrombocytopenia group(P<0. 001).②No found sCD40L of without thrombocytopenia group was related to PLT counts(P > 0. 05),but it was relation with APACHEⅡ and SOFA score(r1 =0. 869,P <0. 001,r2 =0. 437,P =0. 018). sCD40L levels of thrombocytopenia groups were association with PLT counts(r=0. 936,P<0. 001),but no association with APACHEⅡ and SOFA score(P >0. 05);③Receiver operator characteristic curve(ROC)of the levels of sCD40L of without thrombocytopenia group was 0. 799,95%CI 0. 625~0. 973,P=0. 019. The best cut-off value of plasma sCD40L was 229. 411 pg/mL. Conclusion Thereis a relationship between plasma sCD40L level and the degree of sepsis for the patients without thrombocytopenia. Furthermore, plasma sCD40L level could be a marker of adverse outcome in patients of sepsis without thrombocytopenia.

Objective To study the incidence and risk factors of infection caused by methicillinresistant staphylococcus aureus (MRSA) with a targeted surveillance at intensive care unit (ICU) acquired MRSA infection in Tianjin area.Methods A prospective multi-center observational analysis of consecutive patients admitted to 15 adult ICUs from March 1,2012 through March 31,2014 was carried out.The ICUs were divided into four groups according to the type of the ICU.All of the patients were cared for with routine MRSA surveillance.A number of risk markers and prognostic factors were recorded.The risk factors contributing to ICU acquired MRSA were evaluated using a logistic regression model.Comparison of survival between groups was analyzed with Kaplan-Meier method.Results A total of 1 787 patients were enrolled,and 144 cases of them were MRSA infections.The patients with MRSA infection were significantly older than those with non-MRSA infection (P =0.043),length of ICU stay,length of antimicrobial therapy,the history of repeated administration of antibiotics in recent days,history of operation in the past five years,history of MRSA infection or colonization,frequent application of and the overall length of time for mechanical ventilation and central venous catheter and catheter-associated infection were significantly higher than those with non-MRSA infection.The survival rate of patients with non-MRSA infection were higher than those with MRSA infection (x2 =9.23,P =0.004).The rate of MRSA infection and MRSA colonization in 2013 were significantly lower than that in 2012,because the rate of hand hygiene rule execution and bacterial clearance rate were significantly higher in 2013.Multivariate Logistic regression analysis demonstrated that advanced age (OR =1.05,95％ CI:1.009-1.086),length of ICU stay (OR =1.05,95％ CI:1.01-1.08),history of MRSA infection or colonization (OR =1.33,95％ CI:1.82 -3.27),glucocorticoid therapy (OR =2.85,95％ CI:1.18-6.91),antacid medicine (OR =4.92,95％ CI:1.18-20.58),history of recent or repeated application of antibiotics (OR =3.26,95％ CI:1.06-4.59) catheter-associated infections (OR =2.22,95％ CI:1.08-4.59) were associated with ICU acquired MRSA infections.Conclusions Performing the rule of hand hygiene strictly as well as strengthening prevention and control of MRSA infections can effectively reduce the incidence of ICU acquired MRSA infections.The advanced age,length of ICU stay,history of MRSA infection or colonization,glucocorticoid therapy,antacids medicine,history of recent or repeated application of antibiotics,catheterassociated infections were independent risk factors of ICU acquired MRSA infections.

Objective To investigate the expression of inflammatory cytokines in serum of sepsis patients with thrombocytopenia.Methods Collected sepsis platelet decreased in 10 patients,sepsis were not associated with platelet reduced in patients with 7 cases,healthy controls 7 cases,using an antibody chip to detect and analyze 34 related cytokines in serum.Results Sepsis without thrombocytopenia compared with healthy control group,part of pro-inflammatory and anti-inflammatory cytokines up regulation,anti-inflammatory cytokines IL-17F,IL-21 and IL-6sR and anti-inflammatory cytokine IL-10 expression was down-regulated (fold change ＜ 0.67).Sepsis thrombocytopenia compared with healthy control group,the majority of pro-and anti-inflammatory cytokines expression were down-regulated;anti-inflammatory cytokine IL-10 expression was down-regulated (fold change ＜ 0.67).Sepsis thrombocytopenia group compared with sepsis without thrombocytopenia,most of pro-and anti-inflammatory cytokine were up-regulated,anti-inflammatory cytokine IL-13,IL-10,GM-CSF expression were down-regulated (change fold ＜ 0.67).Conclusion Sepsis platelet reduce patients compared with sepsis without thrombocytopenia patients and healthy control,most anti-inflammatory factor in serum,pro-and anti-inflammatory cytokines are raised,only a small part of the anti-inflammatory cytokines are down-regulated;thrombocytopenia may further aggravate the inflammatory over reaction.