Objective To study and analyze the efficacy and safety of caspofungin in the treatment of acute exacerbation of chronic obstructive pulmonary disease patients complicated with pulmonary fungal infections.Methods 62 patients of acute exacerbation of chronic obstructive pulmonary disease complicated with pulmonary fungal infec-tions were randomly divided into study group and control group,31 cases in each group.Study group was intravenously given caspofungin,with an initial dose of 70mg/d,follow 50mg/d.The control group was intravenously given liposomal amphotericin B,dose control in 3mg? kg-1 ? d-1 .After treatment lasted symptoms 5d,clinical efficacy and side effects of two groups were recorded.Results The effective rate of the study group was 67.74%,which was signifi-cantly higher than 41.93% of the control group, the difference was statistically significant ( χ2 =2.0251, P =0.0429).The incidence rate of adverse reactions of the study group was 16.13%,which was significantly lower than 48.39% of the control group,the difference was statistically significant(χ2 =2.6948,P =0.0070).After treatment, liver and kidney function parameters in the control group such as ALT,AST,BUN,Cr had significant differences com-pared with before treatment (P <0.05).Conclusion For chronic obstructive pulmonary disease patients complicated with acute exacerbation of pulmonary fungal infection,the treatment efficacy and the incidence of adverse reactions of caspofungin therapy are significantly better than liposomal amphotericin B,and has small renal damage,which is wor-thy of clinical application.

As quantum dots( QDs),an advanced porduct of nanotechnology,have been widely used in bio-medicine due to their unique photoelectric properties. QD safety evaluation has become a hot area of research. So far,some researchers have expressed concern about the neurotoxic potential of QDs because the central nervous system was confirmed to be one of the target organs. Several studies found that QDs could enter the central nervous system by crossing the blood brain barrier and following neural pathways and produce some neurotoxic effects,such as damaging the structure and function of neural cells and impairing synaptic plasticity. The potential toxicity mechanisms could include oxidative stress,inflammation and change of ion channels.

Animals ; Cell Proliferation ; drug effects ; Cells, Cultured ; Collagen ; biosynthesis ; Cricetinae ; Cricetulus ; Fibroblasts ; cytology ; drug effects ; metabolism ; Macrophages ; drug effects ; Nanostructures ; Silicon Dioxide ; pharmacology

Objective To investigate the attitude of medical students towards standardized resident training in Shanghai and to provide references for policy adjustment.Methods Self-made questionnaire was used to investigate the attitude of 267 clinical medical students towards standardized resident training in Shanghai.Reference reviewing and expert consultation were also performed.Results Nearly eighty percent of students believed that they had basic knowledge of the training.Two thirds of students hold objective attitude towards the policy.Conclusions Income and pressure in finding jobs are the main reasons why students object the policy.Standardized resident training program need to improve in aspects of advertisement,incoming,quality of teaching staff,connection between medical education and training.

Objective:To study the characteristics of the adverse reactions caused by tacrolimus and analyze the risk factors. Methods:Totally 280 cases of renal transplant recipients received standard treatment options were selected from 1997 to 2013 in Wuhan general hospital of Guangzhou military command. The tacrolimus-related adverse reactions and their risk factors were analyzed statistically. Results:Totally 39. 65% of the patients had the tacrolimus-related adverse reactions. The main adverse reactions were hematotoxicity,diabetes mellitus and hyperlipidemia. The univariate analysis showed that age,weight,BMI and treatment course were the suspected risk factors. The multivariate analysis results showed that age,BMI and treatment course were the risk factors of tacrolimus-related adverse reactions. Conclusion:The incidence of tacrolimus-related adverse reactions is relatively high,and if the patient is in advanced age,with poor nutritional status or long-term medication,the probability of adverse reactions will be increased.

Objective To offer a theory that supports the individualized tacrolimus dosage regimen by retrospectively investigating the influences of gene polymorphism and other clinical factors on tacrolimus concentration in renal transplant recipients. Methods A total of 280 renal transplant recipients were genotyped for CYP3A4?5, CYP3A4?6, CYP3A4?18B, CYP3A5?3, MDR1 1236C>T, MDR1 2677G>T/A, MDR1 3435C>T polymorphisms by PCR followed by restriction fragment length polymorphism (RFLP) analysis.PXR 6bp deletions (rs3842689) genotypes were determined by Allelic Special-Touch down PCR.Correlation between gene polymorphisms and tacrolimus concentrations was analyzed. Results The mutation frequency of CYP3A4?18B, CYP3A5?3, MDR1 1236C>T, 2677G>T/A, 3435C>T and PXR rs3842689 in the renal transplant recipients was 29.11%, 69.29%, 43.57%, 49.64%, 36.43% and 26.07%, respectively.Multiple regression analysis showed that, CYP3A5?3 and red blood cell count were associated with the value of C0/D of FK506, the best regression model was:D=C0/(-60.445 +95.777×CYP3A5 +34.938×RBC), and the equation could explain 38.8% of tacrolimus individual differences. Conclusion Gene polymorphism of CYP3A5?3 and red blood cell count may be responsible, in part, for the large interindividual variability of FK506 dose and concentration.

Objective To analyze the immune state and discuss the effects of immunoregulation therapy of combined use of ulinastatin and thymosin ?1 in the treatment of posttraumatic sepsis. Methods Forty-eight patients with posttraumatic sepsis admitted to ICU during Oct. 2005 to Oct. 2007 were included and randomly divided into treatment group and control group (24 each). Patients in control group received conventional SSC treatment, while those in treatment group received conventional SSC treatment plus immunoregulation therapy with a combination of ulinastatin and thymosin ?1. Peripheral blood CD14+ monocyte HLA-DR expression was detected by flow cytometry to determine the innate immunity of posttraumatic septic patients on day 1, 5, 7 and 28 (or death), and serum levels of IL-6 and IL-10 were assessed by ELISA to evaluate the nonspecific immunity at day 1 and 28 (or death). APACHE Ⅱ scores were recorded on day 1, 5, 7 and 28 (or dearth). Ten healthy volunteers were enrolled as healthy controls. Results At admission the expression of CD14+ monocyte HLA-DR was lower than 30% in 9 posttraumatic septic patients. The expression levels of CD14+ monocyte HLA-DR in the patients in treatment group were much higher than those in control group (P0.05). Before treatment, no significant difference existed in APACHE Ⅱ scores between treatment group and control group, while this score in the patients in treatment group was much lower than that in control group on day 5, 7 and 28 (P0.05). Conclusions There is immunosuppression in some posttraumatic patients with somplication of sepsis. All these patients manifest exaggerated nonspecific immunity at the early stage, and then manifest immunodepression as sepsis progresses. The immunoregulation effects of a combination of ulinastatin and thymosin may facilitate the balance of pro-inflammatory and anti-inflammatory media, thus ameliorating septic symptoms. No improvement in 28 day mortality has been seen, probably due to limited number of patients in present study.

Objective To study inductively coupled plasma atomic emission spectrometry(ICP-AES) used to determine blood boron(B),and to investigate the level of B in blood of children in Nanjing.Methods ICP-AES was applied to determine the level of B in the blood of 1032 healthy children and 1364 children patients after using 1mol/L HNO_(3) to treat whole blood.Results Precision of this method was 1.60%-4.31%,and recovery ratio was 93.3%-98.9%.The level of B in blood of the 1032 healthy children was(41.8?16.7)?g/L and that in blood of the 1464 patients was(25.1-58.5)?g/L(77%).Conclusion Precision and recovery ratio determined by the method are high,so it can be used as a reference method to detect the level of B in blood.And it preliminarily determines the reference levels of blood B of children in Nanjing as ranging from 25.1-58.5?g/L(except children below 1 year old).

Quantitative structure activity relationship ( QSAR ) study attempts to correlate chemical structure with activity using statistical approaches and is now being applied to high throughput toxicity screening and prediction of nanomaterials. This paper is interded to discuss the present QSAR study methods of nanomaterials based on traditional QSAR study, such as the use of measurement instrument and quantum chemistry methods of structure descriptor selection, evaluation criteria for the quality of published experimental data on nanomaterials, modeling methods such as K-nearest neighbor ( KNN) and support vector machine(SVM), validation methods such as leave-one-out(LOO) and leave-N-out ( LNO) . We also review the problems and challenges existing in this area and predict future development.

The paper gives an account of the four systems that are currently used for evaluating hospital quality in America, viz. America's Best Hospitals, Solucient 100 Top Hospitals, International Quality Indicator Project, and the Joint Commission on Accreditation of Healthcare Organizations. The "America's Best Hospitals" methodology takes into account three factors, infrastructure, process and outcome. Hospitals are first ranked in specialties, then the index of hospital quality is calculated by means of weighted indexes, and after that the best hospitals are selected according to the specialty rankings and the number of the hospitals. The "Solucient 100 Top Hospitals" methodology selects 100 top hospitals among hospitals of the same size on the basis of hospital quality and safety indexes. The evaluation indexes include eight items, such as index of risk-adjusted mortality rates, index of complications, and disease severity-adjusted average length of hospital stay. The methodologies of "International Quality Indicator Project" and "the Joint Commission on Accreditation of Healthcare Organizations" are used in many countries to evaluate clinical efficiency and enjoy high reputation in monitoring and promoting medical quality.