Invasive pulmonary aspergillosis is valued in intensive care unit (ICU) patients, but in ICU patients, the diagnosis standard of the European Organization for Research on the Treatment of Cancer/Mycosis Study Group (EORTC/MSG) could easily lead to misdiagnosis and missed diagnosis. It’s imaging manifestations are diverse: halo sign, nodules or micro nodules, nodular shadow, pulmonary consolidation, wedge-shaped consolidation, voids, air crescent sign, ground glass shadow, and so on, and with the relative characteristic features. The sensitivity and specificity of galactomannan detection in bronchoalveolar lavage fluid (BALF) are high for diagnosis of invasive pulmonary aspergillosis in ICU patients, but the significance of the cultivation of lower respiratory tract specimens is limited.

Nosocomial infection is one of the most common diseases in the intensive care unit (ICU), which has received much concern due to its multi-type infection, more severe infection, difficulty in treatment and high mortality. However, the drug resistance of bacteria is increasingly serious with the wide use of the antibiotics which is no longer an ideal strategy. Instead, the control and prevention of infection from their sources is the key to reduce ICU infection. Especially for some particular nosocomial infections, such as hospital acquired pneumonia (HAP) and ventilator associated pneumonia(VAP), comprehensive measures are needed to take to break the spell of ICU infection.

0.05]. Conclusion: Cigarettes smoking may increase the levels of sera IL-8 in rats,and it can been depressed by glycyrrhiza uralensis and glucocorticoid respectively,however glycyrrhiza uralensis show significantly faster and were powerful action than glucocorticoid.

Objective To prepare magnetic adriamycin-verapamil-albumin nanoparticles(MAVANs) and measure the physical property of the MAVANs,such as magnetism,drug loading(DL)and size of nanoparticles in order to direct its further experimental study on animals and its application in clinical practice.Methods Commercial cottonseed oil was refined,then mixed with adriamycin,verapamil,human albumin and Fe3O4 magnetic powder according to appropriate proportion,and MAVANs was prepared by using a heat denaturation technique.The size and shape of nanoparticles were determined by electron transmission micro-photography.The magnetic response and structure of the MAVANs were analyzed by upside-down microscope.The standard curve was plotted.The drug loading of verapamil in the MAVANs was quantified by high performance liguid chromatography.The drug loading of adriamycin was quantified by a standard spectrophotonuorometry.Results The nanoparticles featured homogenous size,regular and spherical shape,and good magnetic response.The mean diameter of nanoparticles was 0.5?m.The loading amount of verapamil was 0.8%.The drug loading of adriamycin was 1.25%.Conclusions The heat denaturation technique is feasible to prepare the nanoparticles which can load two kinds of drug with good physical property.The process is simple and the testing condition is easy to control.

Objective To analyze the clinical, radiological, pathological and microbiological features of invasive pulmonary aspergillosis (IPA) to improve clinical management.Methods Retrospective analysis of 20 pathologically and/or microbiologically confirmed IPA cases in our hospital from January 2005 to August 2008. Results Group A (with underlying diseases) included 13 patients (underlying malignancy in 9 patients, including 5 cases of hematological malignancy, COPD in 2 patients, pulmonary tuberculosis and bronchiectasis in 1 each). Group B (without underlying disease) included 7 patients (2 patients with a long time of fluffy toy contact, another 1 had exposure to moldy rice, and 3 had exposure to polluted water). All these 20 patients had pulmonary invasion revealed by CT imaging. Multiple changes were identified in 16 patients. Bilateral pulmonary infiltrates and/or consolidation were revealed in 7 patients. Multiple nodules were seen in 9 patients. Four patients had solitary lesions, including isolated nodules in 2 patients and segment consolidation in the other 2 patients. Pulmonary cavity without fluid level was found in 8 patients (40.0%). Eighteen cases received antifungal therapy. The overall efficacy rate was 55.6%. The efficacy rate in group A and B was 45.5% and 5/7 respectively. The average time to symptomatic relief was (12.0±2.8) days. The time to lung lesion improvement on CT was (17.4±2.9) days. The time to significant CT improvement was (34.3±9.9) days. The time to the resolution of active lesion was (56.4±6.2) days.Conclusions IPA may occur in immunocompetent patients without underlying disease. Most IPA patients have bilateral multiple pulmonary nodules and cavities on CT. The time to the resolution of active pulmonary lesions is about 6 weeks.

Objective To develop a scale of social adaptation degrees of special service personnel (referred to as scale) applying Traditional Chinese Medicine and psychological theory and to assess its reliability and validity. Methods By literature review, job analysis, inventory survey, topics interview, this scale was determined in dimensions, items and items pool based on theoretical model. Results After specialist important analysis and combining the different results of statistical analysis, including Cronbach's α coefficient, resolution factor, correlation analysis and confirmatory factor analysis, 6 dimensions, 14 factors and 40 items were finally kept in the scale. The dimensions were psychological characteristics, physical condition, intelligence level, interpersonal relationships, environmental factors and moral character. The factors were self-control, self-esteem character bias, self-confidence, physiological function, learning intelligence, creating intelligence, leadership intelligence, gregariousness, cooperative, confidence feeling, natural environment, social environment and moral character. Conclusion This scale was made on the basis of general international principle, it had good reliability and validity meeting measurement standard of traditional Chinese medicine and psychological theory, and it is an effective and practical evaluation tool of social adaptation degrees of special service personnel.

BACKGROUND: In patients with obstructive sleep apnea(OSA),the degree of severity of OSA is mostly related to the sleep time spent in the supine position. According to the apnea-hypopnea index(AHI), positional and n onpositional OSA has been distinguished.OBJECTIVE: To compare the clinical characteristics of positional and nonpositional OSA and investigatethe relationship between sleep position and respiratory function of patients with OSA.DESIGN: A comparative clinica] observation based on the OSA patients.SETTING: Center of Sleep Disorders,Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA.PARTICIPANTS: From October 1998 to May 2002,225 patients were examined with overnight polysomnography in the Center of Sleep Disorders,Department of Respiratory Disease, Nanjing General Hospital of Nanjing Command. According to the inclusion criteria of ① AHI≥10 times/hour;② Sleep time in supine and lateral positions≥30 minutes; ③ Over 20years of age; 225 patients were selected from the total of 415 consecutive patients,including 63 with positional and 162 with nonpositional OSA.METHODS: All patients received overnight monitoring with HMS-5500polysomnography system(Respironics Inc USA) in the sleep laboratory. Queries for a detailed case history and physical examination were performed with the pulmonary functions evaluated with body p lethysmography. The clinical data and results of polysomnographic and pulmonary function tests were compared between the two groups of patients and a multiple stepwise regression analysis was employed to evaluate the determinant factors for sleep position dependence of the patients' condition.MAIN OUTCOME MEASURES: Main outcome: Comparisons of the clinical data,polysomnographic result and pulmonary function between the two groups. Secondary outcome: Correlation between classification of OSA and the clinical data.RESULTS: Totally 63 (28%) of the 225 OSA patients were identified as the positional type,who had significantly greater body mass index (BMI)then the nonpositional type patients [(43.46 ± 16.43) kg/m2 vs (23.90 ± 12.36) kg/m2,t =3. 977,P<0.01]. Except for sleeping time in lateral and supine positions, minimal SatO2 and basic SatO2 before the matching for BMI,all the other factors in polysomnograms of the two groups were significant different(P<0.05 or P<0.01). After BMI matching,all the measurements were identical to those recorded for the primary grouping with the exception of nocturnal limb movement frequency,which differed but insignificant between the two groups. The pulmonary function in the two groups was no significant difference(P>0.05) . Multiple stepwise regression analysis indicated that AHI and BMI were the two determinant factors for positional dependence of OSA with a predictive power of 26. 2%. Linear correlation analysis showed correlation of AHI and SatO2 with BMI in the whole group and nonpositional group(P<0.05 or P<0.01),but not in the positional group (P>0.05).CONCLUSION: About one-third of the OSA patients shows sleep position dependence,who may respond favorably to sleep position training. Sufficient patency can be retained in the upper airway of these patients to relieve respiratory obstruction during sleep and improve the respiratory function.

Objective Toll-like receptor ( TLR) gene family is the most important pathogen recognition receptor and animal experiment have found TLR4 mice is inclined to infect aspergillosis ( IA) .The study was to investigate the variation of TLR4 gene in Chinese Han nationality and its relation with the susceptibility of IA. Methods 25 patients diagnosed with proven IA from June 2011 to December 2012 in our hospital were enrolled, among which 17 were males.Their average age was 52.4 ±12.3, and 12 pa-tients had underlying diseases, the others had no underlying diseases.The control group consisted of 103 normal persons, among which 70 were males.Their average age was 56.0 ±17.2.All of the subjects were Chinese Han population.DNA was extracted from periph-eral blood.Polymerase chain reaction ( PCR) was applied to amplify the coding sequence of TLR4 gene followed by sequencing.The sequencing result was compared with TLR4 coding sequence in NCBI GenBank along with the analysis on amino acid change caused by genetic mutation and its effect on protein function.Comparison analysis was made on genetic mutation rate between IA group and con-trol group. Results Two missense mutations,TLR4 219 C>G and 1420 C>T, were identified in TLR4.The prediction result of protein structure showed 219 C>G resulted in the change of functional area for TLR4 to recognize pathogen and 1420 C>T caused no change in domains.The variation rate of TLR4 in IA group was 8%( 2/25 ) and both the patients had no underlying diseases. No mutation has been founded in control group and the difference between two groups was of statistical significance (P=0.037). Conclusion Two missense mutations (219 C>G and 1420 C>T) have been detec-ted in encoding area of TLR4 gene of IA patients.Variation in the cod-ing region of TLR4 gene may increase the susceptibility to IA.

Objective This paper explored the effect of the early clinical exposure in im-proving medical students' cognitive aspects of the doctor-patient relationship. Methods (1)From 280 undergraduate students of Grade 2010 who participated in early clinical exposure of Xi'an Jiaotong University College of Medicine and 280 undergraduate students of Grade 2011 who did not participate in the early clinical exposure, we selected 140 students respectively to conduct a simple random sam-pling survey. The results were analyzed by SPSS after using Microsoft Excellsoftware for entry. Statis-tical methods selected χ2-test/Fisher exact test(P<0.05). (2)We had an interview to students,teachers leading the project, instructor,experts engaging in the study of the doctor-patient relationship by using focus group discussion and in-depth interview, and then using thematic analysis to analyze the data. (3)The main aspects of questionnaires and interviews were: details, activity participation/interest, general cognitive on the doctor-patient relationship, passion for profession, choice of career, the effect in improving medical students' cognitive aspects of the doctor-patient relationship and the suggestions and comments. Results The effective questionnaires collected from Grade 2010 were 134, and124 from Grade 2011.The participation rate of the undergraduates of Grade 2010(participating group) was 94.0%(126/134), while the interest rate of undergraduates of Grade 2011 (control group) was only 76.6%(95/124). Participating group had a better cognitive understanding of doctor-patient relationship than control group(P=0.0192). The activities had significant effects on choice of career(P=0.0002), and no effect on passion for profession(P=0.7372). There was statistically significant difference on their views of employment(P=0.0002). The key words for the interview were: not enough preparation before activity, not reasonable timing, teachers leading the project, stimulation of professional pride. Conclusions Early clinical exposure activities can be effective in improving medical students' awareness of the current doctor-patient relationship. Still we have some shortages in the activity, some more exploration and amelioration should be made in late stage.

BACKGROUND:A novel biodegradable Mg-Zn alloy has been designed,in which the density and the Young's modulus are proximal to human bone,at the same time,it depletes the toxicity of aluminium and rare earth element in commercial magnesium alloys.OBJECTIVE:To evaluate the cytocompatibility of biodegradable Mg-Zn alloy.DESIGN,TIME AND SETTING:Contrast study was performed in the central laboratory of the Sixth People's Hospital of Shanghai Jiao Tong University between November 2007 and March 2008.MATERIALS:The Mg-6wt%Zn was prepared by School of Materials Science and Engineering of Shanghai Jiao Tong University,with the density was 1.82 g/cm3 and the Young's modulus was 44 GPa.L-929 cells for cytocompatibility test were provided by Chinese Academy of Science Type Culture Collection.Ten male New Zealand rabbits were employed in the hemolysis test.METHODS:The Mg-Zn alloy extraction medium was prepared by serial dilutions with fresh medium to 10%,50% and 100%.The experiments were carried out in a 96-well tissue-culture plate.Simple DMEM culture solution was taken as negative controls,while DMEM culture solution supplemented with 0.64% phenol served as positive controls.MAIN OUTCOME MEASURES:Relative proliferation rate of L-929 cells was determined at 2,4 and 7 days with MTT assay.The cytotoxicity of Mg-Zn alloy was evaluated according to ISO 10993-5:1999.The L-929 cell morphology and growth at 2,4 and 7 days were determined under inverted microscope.Based on ISO 10993-4:2002,hemolysis in vitro was evaluated through measuring erythrocyte lysis and ferrohemoglobin freeing degree with indirect contact method.RESULTS:The number of L-929 cells increased significantly and the morphology was not changed.The growth and morphology of cells in different Mg-Zn extraction medium had no difference from negative control group.Cytotoxicity test showed that biodegradable Mg-Zn alloy did not have obvious toxicity on L-929 cells,and the cytotoxicity of these extracts was in grade 0-1.Hemolysis test suggested that the Mg-Zn alloys did not have obvious hemolysis reaction,and the hemolysis index was 3.4%,which was less than the national standard (5%).CONCLUSION:The Mg-Zn alloys do not have obvious cytotoxicity and hemolysis reaction,which demonstrate that Mg-Zn alloys have good cytocompatibility.