Objective To analyze the distribution and drug resistance of mycobacterium tuberculosis(MTB) and non-tuberculosis mycobacteriu(NTM) among AIDS patients with positive results of mycobacterium culture in Shanghai public health clinical center from 2006 to 2015.Methods From January 2006 to December 2015,the patients who were admitted to our hospital with clinical symptoms and positive results of mycobacterium culture were collected.The general data such as age and gender,the results of subsequent drug resistance test and NTM typing results were collected and analyzed.Results In 816 cases with mycobacterium,679 cases were male and 137 cases were female.The median age was 40 years.There were 364 patients(44.6%) infected with MTB and 377 patients(46.2%) with NTM.There were 275 cases with MTB infection and drug resistance test data.The drug resistance rates to streptomycin and isoniazid were 24.0%(66 cases) respectively,the drup resistance rate to ethambutol was 17.1%(47 cases),and the drug resistance rate to rifampicin was 16.7%( 46 cases);42 cases(15.3%) were multi-drug resistant tuberculosis.There were 124 patients with NTM infection and drug resistance test data.The resistance rate to isoniazid was 91.1%(113 cases),and the resistance rate to streptomycin was 83.9%(104 cases).The drug resistance rate to rifampicin was 47.6%(59 cases),and the drug resistance rate to ethambutol was 38.7%(48 cases).A total of 102 NTM typing data were collected,including 33 cases(32.3%) of mycobacterium avium,29 cases(28.4%) of mycobacterium Gordon and 25 cases(24.5%) of mycobacterium Kansas.Conclusion For AIDS patients with mycobacterium infection,the proportion of NTM is significantly higher than that of the general population without HIV infection,so it is necessary to adjust the regimen according to the results of drug sensitivity test.

Objective To investigate the characteristics of major adverse cardiovascular events(MACE) and the risk of all-cause mortality in patients with diabetes mellitus and sepsis within 30 days of hospitalization.Methods A total of 720 patients with sepsis were enrolled.According to whether or not with diabetes mellitus,the patients were divided into diabetic group（n=252） and non-diabetic group（n=468）.The occurrence of MACE and all-cause mortality as well as the characteristics of MACE occurred on the 1st to 15th day(D₁₅) and the 16th to 30th day(D₃₀) were compared between the two groups.Results The incidence of MACE in the diabetic group was 36.5%,which was higher than that in non-diabetic group(22.2%，P<0.05),but there was no statistical difference in the incidence of acute cerebrovascular accidents between the two groups（P＞0.05）.The incidence of all-cause death in patients with diabetes was 25.0%,which was higher than that in non-diabetic group（15.6%，P<0.05).The incidences of ACS,acute heart failure,severe arrhythmia and cardiogenic death in D₁₅ of the two groups were respectively higher than those of D₃₀ in the same groups(P<0.05),but there was no statistical difference in the incidence of acute cerebrovascular accidents between D₁₅ and D₃₀ in both two groups（P＞0.05）.Multivariate logistic regression analysis showed that diabetes was an independent predictor of MACE(P<0.05).Conclusion In patients with diabetes mellitus and sepsis,the incidence of MACE and all-cause death during the 30day hospital stay increases significantly.Effective control of blood glucose may reduce MACE and all-cause mortality in sepsis patients with diabetes mellitus.

Objective To explore the effect of different ischemic time on benefit of interventional thrombus aspiration(TA) in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 198 patients with STEMI who received percutaneous coronary intervention(PCI) were concluded.The 109 patients receiving TA were selected as TA group,and 89 patients who did not reveive TA were selected as control group.Patients were divided into early PCI group[total myocardial ischemia time(TTT)≤4h,72 cases) and non-early PCI group(TTT>4h,126 cases) according to TTT.Epicardial coronary flow was evaluated by myocardial infarction thrombolysis(TIMI) blood flow grading.The effect of TA and TTT on PCI prognosis in patients with STEMI was analyzed.Results The proportion of patients with TIMI blood flow grading 0 in TA group before PCI was higher than that in control group(P＜0.05).The proportion of patients receiving TA in early PCI group was higher than that in nonearly PCI group,while the proportion of patients who occurred major adverse cardiovascular events(MACE) was lower than that in nonearly PCI group(P＜0.05).There was a negative correlation between TA treatment and MACE in patients with STEMI(P＜0.001),while TTT was positively correlated with all-cause death and MACE after PCI(P＜0.001).Logistic regression analysis showed that TTT>4h significantly increased the risk of MACE,and TA treatment reduced the risk of MACE for all STEMI patients(P＜0.05).For the patients in TA group,TTT>4h increased the risk of death and all-cause MACE(P＜0.05).Conclusion For STEMI patients receiving TA treatment during PCI,TTT>4h increases the risk of death and all-cause MACE.

Objective To evaluate the effect of sustained low-efficiency diafiltration(SLEDF) on intestinal mucosal barrier dysfunction and immune dysfunction in patients with severe acute pancreatitis（SAP）.Methods Fifty-one patients with SAP were randomly divided into continuous veno-venous hemofiltration(CVVH) group with 25 patients and SLEDF group with 26 patients,CVVH and SLEDF were treated separately on the basis of routine treatment.Prognosis,recovery time for blood and urine amylase,blood D-lactic acid,endotoxin(ET),diamine oxidase(DAO),CD3⁺,CD4⁺,CD8⁺ T lymphocyte levels,CD4⁺/CD8⁺ T lymphocyte ratio before and on the 2nd,4th,8th,14th day after treatment,complications related to blood purification were collected and compared in the two groups.Results There were no significant differences between the two groups in the mortality rate and the recovery time of blood and urine amylase,there were no significant differences in blood D-lactic acid,ET,DAO,CD3⁺,CD4⁺,CD8⁺ T lymphocyte levels,CD4⁺/CD8⁺T lymphocyte ratio between the two groups before and on the 2nd,4th,8th,14th day after treatment（P>0.05）.The levels of D-lactic acid,ET and DAO in both groups were lower on the 2nd,4th,8th,14th day after treatment,the levels on the 8th and 14th day were lower than those on the 4th day（P＜0.05）.CD3⁺,CD4⁺ T lymphocyte levels,CD4⁺/CD8⁺ T lymphocyte ratio in the two groups on the 4th,8th,14th day were higher than those in the same group before treatment,the levels on the 8th and 14th day were higher than those on the 4th day（P＜0.05）.CD8⁺ T lymphocyte level in the two groups on the 4th,8th day were lower than those in the same group before treatment,the levels on  the 8th and 14th day were lower than those on the 4th day（P＜0.05）.Conclusion SLEDF and CVVH could improve intestinal mucosal barrier dysfunction and immune dysfunction in SAP patients.SLEDF is worth popularizing in clinic because of convenient operation and low medical cost.

Objective To explore the effects of hemodialysis and peritoneal dialysis on microinflammation of chronic renal failure（CRF）uremic patients and its relationship with cardiovascular disease.Methods A total of 120 CRF uremic patients treated in our hospital were divided into hemodialysis group(60 cases) and peritonealdialysis group(60 cases) according to the type of dialysis.After 6 months of treatment,the levels of C reactive protein(CRP)，tumor necrosis factor(TNF)-α，interleukin(IL)-1β，IL-6 btween the two groups were compared.Patients in the two groups were divided into the group with and without chronic heart failure(CHF) according to the presence or absence of combined with CHF,the levels of TNF-α、IL-1β，IL-6 in each group were compared.Results There were no significant differences in the levels of CRP,TNF-α,IL-1β，IL-6 between the two groups before treatment(P>0.05).After treatment,the levels of TNF-α,IL-1β，IL-6 in both groups were significantly reduced than the same group before treatment(P<0.05),the levels of TNF-α,IL-1β，IL-6 in the peritoneal dialysis group were lower than those in the hemodialysis group(P<0.05).In patients with CHF,the levels of TNF-α,IL-1β，IL-6 in patients of the group with heart failure were significantly higher than those in the same group of the group without heart failure(P<0.05).Conclusion Both hemodialysis and peritoneal dialysis can reduce the level of TNF-α,IL-1β，IL-6 in CRF uremic patients,and peritoneal dialysis is better.Microinflammation is correlated with cardiovascular disease.

Objective To evaluate the value of erythrocyte sedimentation rate(ESR)/C reactive protein(CRP) ratio combined with procalcitonin(PCT) in the differential diagnosis of systemic lupus erythematosus(SLE) activity and bacterial infection.Methods A total of 167 patients with SLE were divided into active group(SLE active patients,64 cases) and infection group(SLE patients with bacterial infection,103 cases).Levels of ESR,CRP,ESR/CRP ratio and PCT were compared between the two groups.Value of above indexes in differential diagnosis of SLE activity and bacterial infection was evaluated by receiver operating characteristic(ROC) curve.Results CRP and PCT in patients of active group were lower than those of infection group,while ESR and ESR/CRP ratio were higher than those of infection group(P<0.05).Sensitivity of PCT combined with ESR/CRP ratio in differential diagnosis of SLE activity and bacterial infection was higher than that of PCT,CRP,ESR/CRP ratio and PCT combined with CRP(P<0.05),while there were no significant differences among specificity of above 5 indexes（P>0.05）.Area under ROC curve(AUC) for differential diagnosis of SLE activity and bacterial infection by PCT combined with ESR/CRP ratio was higher than that of CRP,ESR,PCT,ESR/CRP ratio and PCT combined with CRP(P<0.05),and Youden index(YI) of CRP,ESR,PCT,ESR/CRP ratio was 0.36,0.23,0.40 and 0.54 respectively,whose corresponding values were 22.02mg/L,39mm/h,1.69ng/ml and 11.75 respectively.Conclusion Levels of PCT and CRP increase in SLE patients with bacterial infection.ESR/CRP ratio can be used as a new index to identify SLE activity and bacterial infection,and ESR/CRP ratio<11.75 indicates a high possibility of bacterial infection.PCT combined with ESR/CRP ratio can improve the differential diagnosis value of SLE activity and bacterial infection.

Objective To explore the changes of thyroid stimulating hormone(TSH) and thyroid hormone(TH) levels in type 2 diabetic patients with different body mass index(BMI) and waist circumference(WC) and the influence of obesity on TSH and TH.Methods A total of 275 hospitalized patients with type 2 diabetes were collected.They were divided into the normal group(18.5kg/m²≤BMI<24kg/m²，88 cases),overweight group(24kg/m²≤BMI<28kg/m²，90 cases) and obesity group(BMI≥28kg/m²，97cases) according to BMI.The blood lipid levels and thyroid function among these three groups were compared.Then,them were divided into M1 group（male WC<85cm）,M2 group（male WC≥85cm）,F1 group（female WC<80cm）,F2 group(female WC≥80cm) according to gender and WC.Make a comparison among the above indexes among these groups.Spearman correlation analysis was used to analyze correlation and multiple linear stepwise regression was used for influence factor analysis.Results Compared with the normal group,TSH levels in the overweight group and obesity group were significantly increased(P<0.05).TSH level in F2 group was obviously higher than those in F1 group and M2 group,and free thyroxine（FT₄） level was lower than that in M2 group(P<0.05).The results of correlation analysis showed that BMI of type 2 diabetic patients was positively correlated with TSH(r=0.25,P<0.05),TC was negatively related with FT₃(r=-0.39,P<0.05),and BMI and WC were negatively related with FT₄(r=-0.31,r=-0.29,P<0.05).The results of multiple linear stepwise regression showed that BMI was an independent correlative factor for TSH,and WC was an independent correlative factor for FT4(P<0.05).Conclusion The TSH level of obese patients with type 2 diabetes is increased,and FT4 is decreased，which are more obvious in female patients with abdominal obesity than those in males.

Objective To explore the effect of RNA interferring programmed cell death 4(PDCD4) expression on apoptosis of hypoxia/reoxygenation（H/R） H9C2 cardiomyocytes and its mechanism.Methods H9C2 cardiomyocytes were divided into control group,H/R group,H/R+NC group and H/R+siPDCD4 group.Levels of PDCD4 mRNA and protein of H9C2 cardiomyocytes in 4 groups were detected by reverse transcription-polymerase chain reaction(RT-PCR) and Western blotting respectively.Apoptosis rates of them were detected by flow cytometry.Levels of malondialdehyde(MDA),superoxide dismutase(SOD) and lactate dehydrogenase(LDH) in supernatant of H9C2 cardiomyocytes were measured by enzyme Linked immunosorbnent assay(ELISA).Levels of the phosphatidylinositol-3-kinase(PI3K)/protein kinase B(AKT) signaling pathway related proteins were examined by Western blotting.Results Levels of PDCD4 mRNA and protein,activated Caspase-3,Bcl-2 related X(Bax) protein,LDH,MDA and apoptosis rate of H9C2 cardiomyocytes in H/R group were higher than those in control group,while levels of SOD in supernatant and Bcl-2 and p-AKT protein in H9C2 cardiomyocytes were lower than those in control group(P<0.05).Levels of PDCD4 mRNA and protein,activated Caspase-3,Bax protein,LDH,MDA and apoptosis rate of H9C2 cardiomyocytes in H/R+siPDCD4 group were lower than those in H/R group,while levels of SOD in supernatant,Bcl-2 and p-AKT protein in H9C2 cardiomyocytes were higher than those in H/R group(P<0.05).Conclusion RNA interferring PDCD4 expression can inhibit H/R induced H9C2 cardiomyocyte apoptosis,and its mechanism may be related with the activation of PI3K/AKT signaling pathway to reduce oxidative stress.