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Objective To explore the effects of iron overload on neutrophil function and peritonitis, as well as the possible mechanisms. Methods C57BL/6 mice were randomly divided into a control group and an iron overload group (10 mice in each group). Acute peritonitis model was induced by intraperitoneal injection of E.coli. The iron deposition in liver and spleen was assessed using H&E staining and the iron level in neutrophils was quantified by colorimetric analysis. The proportion and morphology of neutrophils were evaluated by blood cell counting plate and MGG staining, and the cellular aging of neutrophils was determined by senescence-associated β-galactosidase (SA-β-Gal) staining. The protein expression levels of P16 in neutrophils was detected using Western blot analysis and the bactericidal function of neutrophils was detected by LB smears. The mitochondrial membrane potential and mitochondrial function of neutrophils were detected by JC-1 staining and ATP kit, respectively. Results Compared with the control group, mice in the iron overload group exhibited following effects, including significantly higher iron content in the liver and spleen, a shorter survival time, significantly reduced bactericidal ability of neutrophil with no significant differences in the quantity or morphology, aggravated aging in neutrophils (indicated by increased expression of P16 and a higher number of SA-β-Gal positive cells), and decreased mitochondrial membrane potential and ATP levels. Conclusion Iron overload aggravates peritonitis by reducing the bactericidal ability of neutrophils.

Chinese Society of Hepatology of Chinese Medical Association organized relevant experts to update the Guidelines on the management of ascites and complications in cirrhosis in 2017 and renamed it as Guidelines on the management of ascites in cirrhosis. It provides guiding recommendations for the diagnosis and treatment of cirrhotic ascites, spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS).

Objective: To observe ascitic interleukin-7 expression level in cirrhotic patients complicated with spontaneous bacterial peritonitis, and to detect the effect of recombinant human IL-7 on CD4(+) and CD8(+)T lymphocyte function. Methods: A total of 84 patients with liver cirrhosis who were hospitalized from August 2017 to April 2018 were selected. Among them, 51 cases were complicated with cirrhosis and untainted ascites, and 33 cases were cirrhosis complicated with spontaneous bacterial peritonitis. Peripheral blood and ascites were collected routinely. The levels of IL-7 in peripheral blood and ascites were measured by enzyme-linked immunosorbent assay. CD4(+)T cells and CD8(+)T cells were purified from ascites, and were stimulated with recombinant IL-7. Cellular proliferation, key transcription factors for mRNA, and cytokines production by CD4(+)T cells in response to IL-7 stimulation was measured. mRNA expression corresponding to perforin, granzyme B, and granulysin as well as cytokines production by CD8(+)T cells was also measured in response to IL-7 stimulation. Cytolytic and non-cytolytic activity of CD8(+)T cells in response to IL-7 stimulation was also investigated in both direct and indirect contact co-culture system. Measurement data of the normal distribution were compared between the two groups by Student's t-test and the data before and after stimulation were compared by paired t-test. Measurements that did not conform to normal distribution were compared between the two groups using Mann-Whitney U test, and data before and after stimulation were compared using Wilcoxon paired test. Results: There was no significant statistical difference in serum IL-7 levels between the two groups [(5 001 ± 1 458) pg/ml vs. (4 768 ± 1 128) pg/ml, P = 0.41]. The level of ascitic IL-7 in cirrhotic patients complicated with SBP was significantly lower than cirrhosis patients with untainted ascites [(966.4 + 155.8) pg/ml vs. (792.1 + 126.4) pg/ml, P < 0.01]. Recombinant IL-7 stimulation promoted the proliferation of CD4(+) and CD8(+)T cells from ascites in patients with liver cirrhosis complicated by SBP. T-bet mRNA relative expression and IFN-γ secretion in CD4(+)T cells was also elevated in response to IL-7 stimulation in vitro. Moreover, IL-7 stimulation also increased the mRNA expressions of perforin, granzyme B, and granulysin as well as productions of IFN-γ and TNF-α by CD8(+)T cells. Recombinant IL-7 stimulation elevated cytolytic and non-cytolytic activity of CD8(+)T cells from ascites in patients with liver cirrohosis complicated by SBP, which manifested as increased target cell death and IFN-γ production in both direct and indirect contact co-culture system. Conclusion: Ascitic IL-7 promotes T lymphocyte function in patients with liver cirrhosis complicated with SBP.

Patients with end-stage liver disease have an increased risk of developing bacterial infections, resulting in an increase in the number of hospitalizations and medical expenses, a decline in the quality of life of patients, and an increased fatality rate. Bacterial infections in patients with end-stage liver disease is mainly due to the falling off the body's immune response causing respiratory infections, spontaneous bacterial peritonitis, urinary tract infections and gastrointestinal infections. The diagnosis of bacterial infection is more challenging because the occurrence of infection shows no typical symptoms and signs. The examination of some biological markers has important clinical significance for early diagnosis. The clinical prognosis is entirely marked on the patient conditions, the effective control of infection, appropriate broad-spectrum antibiotics, and empiric therapy. Antibiotics are the choice, but also need to be alert against drug-induced liver damage.

Objective: To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis early. The positive rates for bacterial culture need to be enhanced through improvement of methods. At the same time, doctors could improve the outcome of CAPD associated peritonitis by adjusting the medication according to the drug sensitivity results.

Objective: To investigate the correlation between human neutrophil peptide (HNP) and spontaneous bacterial peritonitis (SBP) in order to assess the diagnostic value of quantitative measurement of these alpha-defensins., Methods: Seventy-seven patients with cirrhosis and ascites were divided into two groups according to diagnosis of SBP (n = 45 with SBP and n = 32 without SBP). Twenty-eight healthy individuals were analyzed as controls. HNP was detected by double-antibody sandwich assay. Peripheral white blood cell (WBC) counts, neutrophil ratio, and levels of procalcitonin (PCT) and C-reactive protein (CRP) were determined by standard methods. Receiver operating characteristic (ROC) curves were used to compare the diagnostic values of HNP, PCT and CRP in SBP., Results: There were no significant differences between the three groups (SBP, non-SBP, and healthy controls) for WBC count ((6.01+/-2.25)*109 /L, (4.85+/-1.94)*109 /L, and (5.49+/-1.76)*109 /L; F = 2.91, P more than 0.05) and neutrophil ratio (70.70%+/-10.42%, (68.20%+/-8.97%, and 69.50%+/-8.69%; F = 3.07, P more than 0.05). However, compared to the non-SBP group and the healthy controls, the SBP group showed significantly higher levels of HNP ((9.99+/-3.33) ng/ml and (8.92+/-2.30) ng/ml vs. (17.66+/-6.40) ng/ml; q = 3.20 vs. 3.52, P less than 0.05), serum CRP ((15.08+/-9.95) ng/ml and (5.96+/-2.91) ng/ml vs. (31.32+/-18.65) mg/L; q = 11.03 vs. 3.69, P less than 0.05), and positive rate of PCT (25.0% and 10.0% vs. 62.2%; X2 = 10.41 vs. 15.40, P less than 0.0125). The areas under the curve (AUC) showed the following descending trend: HNP more than PCT more than CRP (0.719, 0.707, and 0.629 respectively). Using cut-off points of 10 ng/ml for HNP, 0.5 ng/ml for PCT, and 8 mg/L for CRP, the respective sensitivities for diagnosis of SBP were 71.1%, 62.2%, and 73.3%, the respective specificities were 71.9%, 75.0%, and 56.3%, and the respective Youden's indexes were 0.430, 0.372, and 0.296., Conclusion: HNP is closely related to SBP and can diagnose SBP as reliably as PCT. CRP may help to diagnose SBP, but the results from routine blood testing did not show sufficient statistical significance for diagnosing SBP.

Objective: To investigate the effect of Pseudomonas quinolone signal (PQS) on the virulence of Pseudomonas aeruginosa., Methods: Pseudomonas aeruginosa strain PAO1 was treated with PQS alone, PQS plus farnesol, or farnesol alone. The transcriptional levels of the regulator gene ExsA and virulence protein gene ExoS of type III secretion system were examined using quantitative real-time PCR, and spectrophotometry was employed to detect pyocyanin production in the bacteria. The adhesion and invasiveness of the treated PAO1 in cultured alveolar epithelial cells A549 were assessed on plate count agar, and their effects on the survival of a mouse model of peritonitis was compared., Results: The increase or decrease of PQS did not affect the growth of PAO1. Compared with the untreated bacteria, PQS-treated PAO1 showed obviously increased transcription levels of ExsA and ExoS (P<0.01) and pyocyanin production, which was significantly lowered by farnesol (P<0.01). In A549 cell cultures, farnesol-treated PAO1 exhibited significantly lowered adhesion and invasiveness, while PQS-treated PAO1 caused a significantly decreased survival time of mice with peritonitis (P<0.01). Farnesol treatment did not obviously affected ExsA transcription (P>0.05) but caused a significant reduction in the transcriptional level of Exos (P<0.05) in PAO1. PQS showed no significant effect on the adhesion and invasiveness of PAO1 (P<0.05)., Conclusion: PQS can maintain the adhesion and invasiveness of Pseudomonas aeruginosa, and in the hosts of the bacteria, PQS concentration is positively correlated with pyocyanin production and hence negatively with the survival time of the hosts.

Objective: To investigate the pathogens and their resistance in continuous ambulatory peritoneal dialysis (CAPD) related peritonitis., Methods: A total of 78 cases with CAPD related peritonitis from Xiangya Hospital between January 2007 and January 2011 were reviewed. Pathogens, resistance and outcomes of the 78 cases CAPD related peritonitis were analyzed retrospectively., Results: Among them, 53 cases cultured positive (66.67%), 3 of which were combined infection and 2 strains were cultured. A total of 55 strains were cultured, including 32 gram-positive strains (58.18%), 18 gram-negative strains (32.72%) and 5 fungi (9.09%). The most common pathogens were coagulase negative staphylococcus, staphylococcus aureus and Escherichia coli. Drug sensitivity test of the gram-positive strains showed that the three with lowest antibiotic resistance were linezolid (0), teicoplanin (3.13%) and vancomycin (4.0%). Drug sensitivity test of the gram-negative bacteria showed that antibiotics with the lowest resistance were amikacin and imipenem, followed by piperacillin/tazobactam and cepoperazon/sulbactam. Cephazolin had the highest resistance rate of 83.33%. Clinical outcomes: 63 cases cured (80.77%); 11 cases transferred to hemodialysis (14.1%); 4 cases died (5.13%), including 2 cases fungus infections, 1 gram-negative bacteria infection and 1 combined infection., Conclusion: The most common pathogens causing peritoneal dialysis associated peritonitis is gram positive bacteria. In the empirical treatment, in addition to traditional treatment of Cefazolin combined with aminoglycosides, cefazolin combined with piperacillin/tazobactam or cepoperazon/sulbactam is preferable for CAPD associated peritonitis.

Objective: To investigate the levels of lipopolysaccharide binding protein (LBP) in serum and ascites of cirrhotic patients, and determine their diagnostic value for spontaneous bacterial peritonitis (SBP)., Methods: Cirrhotic patients were divided into groups according to diagnosis of SBP, ascites without SBP, no ascites. To explore the significance of LBP in clinically suspect SBP cases, the ascites without SBP group was sub-divided into two groups according to the symptoms of abdominal pain or elevated white blood cell (WBC) count, and abdominal pain combined with elevated WBC count. Two control groups were composed of patients with intraperitoneal pus and a group of healthy, non-cirrhotic individuals. The LBP levels in serum and ascites were determined by enzyme-linked immunosorbent assay (ELISA). The ascites routine, ascites culture and albumin assay were carried out in the Second Affiliated Hospital of Chongqing Medical University. Data between the two groups were compared using the t-test or nonparametric test of independent samples, and the areas under the curve were compared using the Z test. Results The levels of LBP in serum and pus were significantly higher in the intraperitoneal pus group than in the cirrhosis group with ascites (P less than 0.01)., Results: The level of serum LBP was significantly higher in the cirrhosis group with SBP than in the cirrhosis group without SBP but with ascites and the cirrhosis group with no ascites (P less than 0.01). There was no significant difference in the level of ascites LBP in the cirrhosis group with SBP and the cirrhosis group without SBP but with ascites (P more than 0.05). In the clinically suspect cases with SBP, the levels of LBP in serum and ascites were significantly higher than those in the cirrhosis group without SBP but with ascites (228.00 mug/ml vs. 80.95 mug/ml and 22.50 mug/ml vs. 11.45 mug/ml, P less than 0.05). Determination of serum LBP had a higher sensitivity than the determination of ascites LBP or ascites WBC., Conclusion: Gram-negative bacteria infection in the intra-abdominal cavity causes serum and body fluid levels of LBP to increase significantly. Patients with cirrhosis complicated with SBP have significantly elevated levels of serum LBP. The serum and ascites LBP levels are significantly elevated in SBP patients with suspected clinical diagnosis. Measurements of both the serum LBP and ascites LBP may have diagnostic value for SBP.

Objective: To evaluate the significance of determining ascitic bacterial 16S rRNA by quantitative PCR combined with microarray (PCR-microarray) in the diagnosis of spontaneous bacterial peritonitis (SBP)., Methods: Ascitic bacterial 16SrRNA was determined by real time fluorescent quantitative PCR-microarray in 76 cases of suspected SBP and 6 cases of non-infectious ascites with chronic liver diseases. The results were compared with ascitic bacterial culture simultaneously., Results: Of 76 ascitic samples, 17 were detected bacteria positive by PCR-microarray, including 8 Grams positive(G+) and 9 Grams negative(G-), which was higher than that by bacterial culture which had only 6 ascitic samples detected positive (all G-); the positive rates were 22.4% vs 7.9%, respectively (P < 0.01). The bacterial strains detected by both methods in 6 cases had a consistency with each other. No bacteria were detected in another 6 cases of non-infectious ascites with chronic liver diseases., Conclusions: Determination of ascitic bacteria 16S rRNA by PCR-microarray has a higher specificity and sensitivity in the diagnosis of SBP as compared with the bacteria culture. Application of this novel method can not only accelerate SBP diagnosis but also stratify the different pathogens.

Objective: To evaluate the value of ascitic bacterial 16S rRNA gene determination in the rapid diagnosis of spontaneous bacterial peritonitis (SBP)., Methods: 16S rRNA gene from bacterial DNA in ascites was determined by quantitative fluorescent polymerase chain reaction (PCR) in 76 patients with suspected SBP and 6 patients with non-infectious ascites. The results were compared with those obtained from bacterial culture., Results: The positive rate of SBP was 22.4% among patients detected with ascitic bacterial 16S rRNA gene determination-based quantitative fluorescent PCR, which was significantly higher than that (7.9%) in patients only received bacterial culture (P<0.05). In addition,in 6 patients with non-infectious ascites,both the 16S rRNA gene determination-based quantitative fluorescent PCR and bacterial culture showed negative results., Conclusions: 16S rRNA gene determination-based quantitative fluorescent PCR can be an effective tool for the rapid diagnosis of SBP. It is more sensitive than the bacterial culture.

Objective: Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhotics with ascites. Early identification of high-risk patients is crucial for prognostic improvement. We aimed to investigate the predictive value of model for end-stage liver disease (MELD) score at admission in predicting incidence rate of SBP in cirrhotic patients with ascites, so as to evaluate its use in early diagnosis and prognosis of this complication., Methods: A retrospective study enrolling 254 consecutive patients with cirrhosis and ascites between June 2003 and June 2006 was carried out. The data collected included the age, sex, etiology of liver disease, serum creatinine, total bilirubin, prothrombin time with international normalized ratio and ascitic fluid analysis of the patients. The patients were graded with MELD formula into 4 groups (MELD < or = 9, 10-19, 20-29, MELD > or = 30). The incidence rate of SBP was compared in the 4 groups according to the MELD score. The predictive accuracy in patients with and without SBP was evaluated with receiver operating characteristic (ROC) curve., Results: SBP developed in 65 (26%) patients during hospitalization. The clinical characteristics were similar between the patients with and without SBP. The mean MELD score for patients with SBP was 23 and for those without was 14 (P < 0.01). Patients with 10-19 had an odds ratio of 1.44 (P > 0.05) for SBP, as compared with patients with MELD < or = 9. The frequency of spontaneous bacterial peritonitis was higher in the patients with MELD > or = 20 than those with MELD < or = 19. The incidence rate of SBP with MELD < or = 19, 20-29 and MELD > or = 30 were 12.5%, 52.38%, and 66.67% respectively. Patients with MELD > or = 30 had an odds ratio of 14 (95% CI 5.41-36.20) for SBP, as compared with patients with MELD < or = 19. Patients with 20-29 had an odds ratio of 7.7 (95% CI 4.17-14.20) for SBP, as compared with patients with MELD < or = 19. Area under curve (AUC) of MELD was 0.774 (95% CI 0.689-0.855)., Conclusion: The cirrhotic patients with complicating ascites with higher MELD score have a greater risk of SBP. High MELD score might be an useful predictor of SBP in cirrhotic patients with ascites.

The presence of hyl gene in 364 PFGE clones of Enterococcus faecium was detected by colony hybridization under conditions of high stringency. The isogenic hyl-deficient mutant (* hyl) was constructed with suicide pTX4577 and screened by allelic replacement. Moreover, an in vitro study was made on the effect of hyl gene detection on the growth ability of hylgene detection on the mutant, and an in vivo study was made on the decrease of virulence in the mouse peritonitis model. The results showed, in the clinical isolates, the positive percentage of hyl gene was 32.8%, which was significantly higher than that (5.3%) in the non-clinical isolates. The * hyl was selected by kanamycin and identified by PCR, pulsed field gel electrophoresis (PFGE) and Southern blot. The experimental evidence indicated that the growth ability of * hyl was remarkably reduced in comparison with that of the wild-type strain. The percentage survival of mice in TX2466 groups was 0, while that of * hyl groups was 50% at the same inoculum in mouse peritonitis. The differences were significant. These data suggest that hyl gene in specific E. faecium strains may be enriched in determinants that make them more likely to cause clinical infections. Being important in the pathogenesis, hyl gene is probably a major virulence factor of Enterococcus faecium.

Objective: To evaluate the effect of carbon dioxide pneumoperitoneum on the translocation of intestinal endotoxin/bacteria., Methods: The ampicillin-resistant E. coli JM109 labeled with plasmid PUC18 was given by gavage to 48 rats to detect the translocation of intestinal bacteria. Hydrochloric acid was peritoneal inoculated to the rats to induce acute chemical peritonitis. The rats were randomly allocated to the control group without pneumoperitoneum (n = 16), the experimental groups with low insufflation (5 mmHg of carbon dioxide, n = 16) and with high insufflation (15 mmHg of carbon dioxide, n = 16). The blood endotoxin in the femoral veins were detected every hour. The ampicillin-resistant E. coli JM109 were identified by restricted digest and agrose gel-electrophoresis. The rats were killed at the end of the 3 hour experiment and blood samples from the portal and mesenteric lymph nodes were taken for culture. The levels of SIgA in the plasma and the intestinal mucosal were detected by radioimmunoassay., Results: The blood endotoxin in the femoral veins of the rats increased significantly 1 hour after the induction of pneumoperitoneum with 15mmHg of carbon dioxide (P < 0.01) and continued to increase with time. The plasma and intestinal mucosal SIgA of the rats decreased significantly (P < 0.01) after 3 hours of exposure to 15 mmHg of carbon dioxide pneumoperitoneum. The bacterial translocation rates from intestinal to portal were 0%, 25% and 50% for the control, 5 mmHg and 15 mmHg groups respectively, and 12.5%, 25%, and 75% from intestinal to mesenteric lymph nodes for the three groups respectively., Conclusion: Carbon dioxide pneumoperitoneum increase intestinal Endotoxin/bacterial translocations and the effect increases with pressures.

Objective: To construct a hyaluronidase (hyl) gene mutant strain of Enterococcus faecium and to study the function of hyl gene., Methods: An isogenic hyl-deficient mutant (*hyl) with suicide plasmid pTX4577 was constructed and screened by allelic replacement. The mutant strain and wild type strain TX2466 were cultured to observe the growth curves. Both *hyl and TX2466 strains were cultured in solid with kanamycin (KAN) to detect the tolerance to KAN. The study of virulence in mice peritonitis and rabbit endocarditis models in vivo were made., Results: A mutant strain, *hyl, was selected by KAN and identified by PCR, pulsed field gel electrophoresis, and Southern blotting. The growth ability of the *hyl strain was remarkably reduced in comparison with the wide-type strain. The survival rate of the mice within 100 h after the inoculation of Enterococcus faecium. TX2466 was 0, significantly lower than that of the *hyl group (50%, P<0.01). The numbers of colonies in the aortic valve and ventricular wall vegetations of the TX2466 group rabbits were (3.04+/-0.63)x10(6) and (6.87+/-0.58)x10(6) CFU/g respectively, both significantly higher than those of the *hyl group [(0.21+/-0.06)x10(6) and (0.66+/-0.05)x10(6) CFU/g respective, both P<0.01]., Conclusion: Probably a major virulence factor of Enterococcus faecalis, hyl gene is important in the pathogenesis of this bacterium.

Objective: To study the therapeutic effect of ceftazidime (CAZ) in a rabbit model of peritonitis caused by Escherichia coli producing CTX-M-14 extended-spectrum beta-lactamase (ESBL)., Methods: The peritonitis model was produced by intra-abdominal injection of a mixture of 3 x 10(8) CFU/ml Escherichia coli producing CTX-M-14 ESBL and 10% BaSO(4). All rabbits were randomized into four groups. Four hours after the bacteria were injected, three groups were intramuscularly administered ceftazidime (100 mg/kg, twice a day), cefotaxime (100 mg/kg, twice a day) and piperacillin/tazobactam (225 mg/kg, every 8 h) respectively. The fourth group did not receive any therapy as a control. The temperature, leucocyte counts and percentage of neutrophils were closely observed. The dying time of rabbits was recorded and anatomized immediately, and pathology of the great omentum was examined., Results: The temperature of the control group became normal on the 6th day, while the temperature of the other three groups returned normal 48 h after the injection of the bacteria. Compared with the mortality of the cefotaxime-treated group (50%) and the control group (52%), the mortality of the ceftazidime-treated group (22%) was significantly decreased (chi(2) = 5.64, 6.13, P < 0.05). The administration of ceftazidime also inhibited the incidence of abdominal abscess in the survived rabbits (16%) in comparison with the control group (50%, chi(2) = 3.93, P < 0.05). In addition, the leucocyte counts of the ceftazidime-treated group returned normal at the end of treatment, while those of the cefotaxime group and the control group were still high. The above measurements showed no difference between the ceftazidime-treated group and the piperacillin/tazobactam-treated group (P > 0.05)., Conclusion: Ceftazidime showed good therapeutic effect in peritonitis caused by Escherichia coli producing CTX-M-14 ESBL.

Objective: To improve the diagnosis and treatment level of spontaneous bacterial peritonitis (SBP) in the patients with advanced liver disease, get better curative effect and prognosis., Methods: Registered the body temperature, symptoms and signs in the abdomen, and blood routine test, the polymorphonuclear (PMN) cell count, and ascites culture in the patients with cirrhosis and fulminant hepatitis. These patients were given supporting therapies including use plasma and albumin as well as antibiotics treatment according to drug sensitivity or empiric. Changes of the body temperature, symptoms and signs were used to evaluate the effect of therapy., Results: 186 of 275 inward patients with end-stage liver disease during this period were considered as SBP by ascites culture or clinical experience with various degree symptoms and signs such as pain, distention, higher tension and touch pain in the abdomen. Infective rate was 67.6%. Among them 138 patients had abnormal body temperature more than 37.4 degrees C. 106 patients with leukocyte count in the peripheral blood more than 10 x 10(9)/L; 137 patients with PMN more than 80% in differential cell count; 103 patients with PMN more than 250/mm(3) in ascites. Only 29 patients were culture positive. 82 patients were cured, 17 patients with improvement, 18 patients with inefficacy or deterioration. 42 patients died of hepatic-renal failure and 27 patients died because of upper alimentary tract bleeding, respectively., Conclusion: Signs and symptoms of SBP were atypical in the patients with end-stage liver disease. Ascites culture positive rate was not high. Early diagnosis and proper use antibiotics according to culture and empirics were important to increase effect and improve prognosis

Objective: To establish a rabbit model corresponding with clinical characteristics of peritoneal dialysis related peritonitis., Methods: Twelve New Zealand rabbits were randomly divided into peritonitis group and control group. They were infused standard living Staphylococcus aureus 3 x 10(9) colony forming unit (cfu) (peritonitis group) or 0.9% NaCl 1 ml (control group). After 48 hours, Laboratory rabbits in acute uremic model underwent regular dialysis for 6 hours. At different points of time, the concentration of glucose in dialysate and the dialysate/plasma (D/P) ratio of the concentration creatinine (Cr), total protein(TP), album(Alb) and IgG, the counts of leukocyte in dialysate and water ultrafiltrate were determined., Results: D/D0 were significantly lower in the peritonitis group than that in the control group (P < 0.05). The counts of leukocyte and D/P ratio of Cr, TP, Alb and IgG were significantly increased in the peritonitis group (all P < 0.05). The drained volume was lower in the peritonitis group than that in the control group (but P > 0.05)., Conclusion: In the rabbit model infused intraperoneally staphylococcus aureus, (1) transport peritoneum of low and large molecular weight solutes is increased, (2) the volume of ultrafiltrate is decreased, (3) the counts of leukocyte in dialysate is increased. These change in this model is basic all correspond with the clinical feature of patients of peritoneal dialysis related peritonitis. So this rabbit model of peritoneal dialysis related peritonitis is a successful experimental infection model.

Objective: To observe the antiseptic effect of Dachengqi Decoction (DCQD) or rhubarb, one of the ingredients of DCQD in mice., Methods: The model mice were established by peritoneal injection of Escherichia coli (10(8)/ml) or Proteus vulgaris (10(6)/ml) respectively. DCQD or rhubarb was given from 2 days before to 2 days after modelling for preventing and treating., Results: The mortality and bacteremia occurrence of the treatment group were significantly lower than those of the control group (P < 0.05). Both DCQD and rhubarb showed protective effect on Escherichia. coli or Proteus vulgaris infection in mice. The cardiac blood smear and culture of survival mice in prevention plus treatment group and model group showed negative (bacteria) results but those of dead mice showed positive result., Conclusion: DCQD and rhubarb have excellent bactericidal effect.

Objective: To study the clinical features, prognosis and influence factors of renal impairment (RI) in chronic severe viral hepatitis with spontaneous bacterial peritonitis (SBP)., Methods: 129 discharged patients with chronic severe viral hepatitis(CSVH) complicated with spontaneous bacterial peritonitis were analyzed retrospectively., Results: Renal impairment is a frequent event in CSVH patients with SBP. SBP-R I is functional in nature, it may be followed by a rapidly progressive or a stable disease course, or may be reversed after recovery of the infection., Conclusion: Independent prognostic factors were age, clinical course of liver disease, other infection or diabetes, severe renal impairment, serum sodium level before SBP and negative response to antibiotic therapy.