OBJECTIVE To evaluate mortality prediction by analyzing clinical features and pathogens of patients with candidemia in intensive care unit(ICU).METHODS The clinical data of candidemia cases admitted to ICU of the First Affiliated Hospital of Zhejiang University in recent five years were analyzed retrospectively,including risk factors,accompanied diseases,Candida species,drug sensitivity,mortality and prognosis.RESULTS Seventy five cases with candidemia were diagnosed in recent five years.Single factor Logistic regression analysis combined with multiple conditional Logistic regression model analysis was conducted.Compared to other risk factors,indwelling central venous catheter(97.2% vs 74.3%,P=0.043,OR=6.4,95%CI 1.06-38.72),hypoproteinemia(91.7% vs 56.4%,P=0.020,OR=6.01,95%CI 1.33-27.0)and APACHEⅡ score(19.6?3.7 vs 15.0?3.8,P=0.00,OR=1.36,95%CI 1.15-1.62) were markedly different.CONCLUSIONS Candidemia cases in ICU increase gradually and lead to higher mortality.Indwelling central venous catheter,hypoproteinemia and APACHEⅡ score are related to mortality of candidemia cases.

Objective To investigate the effect of CKLF-like MARVEL transmembrane domain contai-ning member 5(CMTM 5)on EG-VEGF expression in prostate cancer cells , and to detect the potential mechanism of CMTM5 inhibiting prostate cancer .Methods The relative expression of CMTM 5 and EG-VEGF in prostate cells and prostate cancer cells was detected .Prostate cancer cells were given Plasmid transfection to overexpress CMTM5 and EG-VEGF expression was again detected .Then CMTM5 and EG-VEGF were compared between be-fore and after CMTM5 plasmid transfecting prostate cancer cells .Results Compared with the relative expresion of EG-VEGF and CMTM5 in prostate cells , prostate cancer cells showed high expression of EG-VEGF and low ex-pression of CMTM5, which were statistically significant , P<0.05.Compared with prostate cancer cells , the rela-tive expression of CMTM5 were obviously upregulated and EG-VEGF obviously decreased in prostate cancer cell after transfected by CMTM5 plasmid, which were statistically significant , P<0.05.Conclusions Prostate canc-er cells shows higher EG-VEGF expression and lower CMTM 5 campared with normal prostate cells .EG-VEGF is suppressed significantly when the prostate cancer cell is transfected by CMTM 5 plasmid and shows highlevel of CMTM5 expression , suggesting high expression of CMTM 5 may inhibit the development of prostate cancer by downregulating EG-VEGF expression .

In order to improve the teaching competence of clinical teachers in standardized nursing training and ensure the teaching quality of the training, since 2014, Chongqing Municipal Health and Family Planning Commission has held a unified training course for teachers in a standardized training base for new nurses in the city annually, and formulated a teacher training system; on the basis of fully considering the study needs of clinical teachers, the course of "taking teaching competence as the direction and improving clinical teaching ability as the core" has been set up, and the training teachers are evaluated by various ways. At the end of the training, the satisfaction survey on the training effect has been carried out, and the participants are satisfied with the contents and methods of the teaching. Higher satisfaction can improve the teaching competence of teachers.

Objective To investigate the clinical value of the precision liver surgery in the liver graft procurement for pediatric living donor liver transplantation.Methods The clinical data of 58 living donors of left hepatic lobe graft who were admitted to the Renji Hospital of Shanghai Jiaotong University from December 2012 to January 2014 were retrospectively analyzed retrospectively from December 2012 to January 2014.All the donors donated voluntarily and gratuitously and were approved by the ethics committee of the hospital.All the donors received computed tomography (CT),and the two dimensional data were converted to three dimensional images for evaluating the intrahepatic bile ducts and blood vessles,and the typs of the left hepatic arteries and veins were determined.The donor's liver graft volume was assessed by CT before operation.The standard liver volume of the donors and the recipients,and the volume of liver to be reseeted and the total liver volume were measured.A virtual surgery was conducted for designing the actual surgery.The liver graft was resected with the precision liver surgery technique.Patients were followed up by the out-patient examination and phone call till April 2014.Results The results of CT angiography confirmed that 28 donors were with type Ⅰ left hepatic artery,10 with type Ⅱ left hepatic artery and 20 with type Ⅲ left hepatic artery; 35 patients were with type Ⅰ left hepatic vein and 23 with type Ⅱ left hepatic vein.The left-lobe volume estimated by CT was (243 ± 65) mL.Liver graft procurement was successfully carried out on the 58 donors,including 7 left hemihepatectomy and 51 left lateral lobectomy.Two donors received cholecystectomy concomitantly.The actual volume of liver resected was (255 ±59) mL,and the error rate of the liver volume to be resected was 4.94％.The weight of the liver graft to the body weight of the recipient was 3.3％ ± 1.0％.The operation time and the volume of blood loss were (260 ± 89) minutes and (181 ± 35)mL,respectively.One donor received red blood cell infusion of 2 U.The time for gastrointestinal function recovery was (2.0 ± 1.1) days,and the time of drainage tube pull-off was (3.0 ± 1.2) days.The duration of postoperative stay was (7 ± 3) days.The white blood cells,hemoglobin,alanine transaminase,aspartate transaminase,total bilirubin,direct bilirubin and albumin were at the normal levels at the discharge.Two donors were complicated by incisional bleeding and fat liquefaction,and they were cured by symptomatic treatment.All the donors were followed up for a median time of 8.7 months.The donors were recovered well without complications during the follow-up.Conclusions Liver graft procurement guided by precision liver surgery has the advantages of high accurate rate,little injury to the liver of the donors,few postoperative complications and quick recovery of the donors.

Objective To develop a chemiluminescence ( CL ) imaging DNA microarray method for simultaneous detection of seven rickettsiae.Methods Primers and probes were designed based on the specific sequence of seven rickettsia genomes.The probes were immobilized on the aldehyde modified glass surface to prepare DNA microarray for rickettsiae.The nucleic acids of the selected rickettsiae were amplified and labelled by multiplex PCR method, and then hybridized with microarray that was scanned after washing and chemiluminescence coloration, before the results were analyzed.Facilitated by the optimization of the multiplex PCR system, hybridization, and chemiluminescence imagination, we evaluated the specificity,sensitivity and reproducibility of the chip.The serial diluted nucleic acid of Rickettsia mooseri was detected using microarray and real-time PCR approach to compare the sensitivity of these two methods.Double-blind simulated samples were prepared to further evaluate the accuracy of the detection methods.Results One universal primer, four specific primers, one universal probe, and nine specific probes were selected.This DNA microarray demonstrated high specificity and sensitivity.The detection sensitivity of plasmid DNA and double-blind simulated sample DNA was 1.5 ×102 -3 ×103 copies per reaction and 103 -104 copies/μl.The detection results of real-time PCR method was consistent with the microarray, and the microarray possessed 10 fold lower detection sensitivities than the real-time PCR method.The coincidence rate of double-blind simulated sample detection was 100%.Conclusion A chemiluminescence imaging DNA microarray method for simultaneous detection of seven rickettsiae is established successfully,which can serve as a new high throuthput detection method for clinical diagnosis and epidemiological investigation of rickettsiae.

Objective To develop a chemiluminescence imaging DNA microarray method for simultaneous,fast and accurate detection of nine rash-and fever-causing pathogens,namely,Measles virus,Rubella virus,Enterovirus type 71, Varicella zoster virus,Dengue fever virus,Human small FDNA virus B19,Coxsackie virus type A16,A-βStreptococcus pyogenes (hemolytic streptococcus)and Salmonella typhi.Methods Primers and probes were designed based on the specific sequence in the conserved region of genomes of the nine pathogens.The nucleic acids of the nine pathogens were amplified and labelled by multiplex PCR method.The multiplex PCR amplification products were hybridized with specific probes of microarray that was scanned after washing and chemiluminescence coloration to identify the nine pathogens.After the optimization of the multiplex PCR system,hybridization and chemiluminescence imaging,the specificity,sensitivity and reproducibility of the chip were evaluated.The serial diluted nucleic acid of Enterovirus type 71 was detected using microarray and real-time PCR approach to compare the sensitivity of these two methods.Results Nine specific primers and eleven specific probes were selected.The microarray demonstrated high sensitivity and specificity.The minimum detection limit of plasmid DNA and in vitro transcribed RNAs was 3 ×103 copies per reaction.The detection sensitivity of this microarray was 10 percent of that by the real-time PCR method.The rate of sensitivity and specificity of clinical sample detection was 95% and 85.7% respectively,and the rate of accuracy was 93.2%.Conclusion A chemiluminescence imaging DNA microarray method for simultaneous,fast and accurate detection of nine pathogens that cause rash and fever illnesses is established successfully,which can serve as a new high throuthput screening method for clinical diagnosis and epidemiological investigation of rash and fever illnesses.

Objective To develop a chemiluminescence imaging DNA microarray method for simultaneous,quick and accurate detection of serotypes of human adenovirus (HAdV ),namely,HAdV3,HAdV7,HAdV11,HAdV14 and HAdV55.Methods Based on the specific gene sequences in the conserved region of adenovirus from GenBank, oligonucleotide primers and probes were designed and synthesized to prepare the oligonucleotide microarray.The specific genomic sequences were amplified by multiplex PCR method.The multiplex PCR amplification products were hybridized with the specific probes of microarray that was scanned after washing and chemiluminescenceb before the result was analyzed.After optimization of the multiple PCR system,hybridization reactions and conditions of chemiluminescence,the specificity,sensitivity and reproducibility of the chip were evaluated.Results The microarray displayed high sensitivity, specificity and reproducibility.The minimum detection limit of plasmidg DNA was 3 ×103 copies/reaction.The microarray detection results of 38 clinical samples were approximately consistent with those using the direct sequencing method(37 /38).Conclusion A chemiluminescence imaging DNA microarray method for quick,sensitive and specific detection of five serotypes of HAdV is established,which can provide a new means for detecting serotypes of HAdV.

Objective To report two cases of familial Gitelman syndrome and literature review regarding the updates of relevant genes,classification,treatment,and prognosis.Methods The clinical data of two sisters with Gitelman syndrome were retrospectively analyzed.Results Their blood pressures were within normal range.Hypokalaemic alkalosis,hypomagnesemia,and hypocalciuria were corrected almost completely after three days of intravenous magnesium and potassium infusion,spirolactone and indometacin.However,the maintenance of normal potassium was unsuccessful over one year.Conclusion Hypokalaemic alkalosis,hypomagnesemia,and hypocalciuria were normalized in Gitelman syndrome.There was some debate in regard to using PGE2 synthetase inhibitors.Tolerance of long-term medication will be the big challenge for curative effect.

Objective To determine the renal function compromised in patients after ST-segment elevation myocardial infarction (STEMI) with left ventricular aneurysms (LVA) by measurement of serum cystatin C (Cy-C) concentrations and Cy-C-based eGFR.Methods A total of 355 patients admitted from January 2011 to December 2012 could be categorized into group A (STEMI without LVA,n =183) and group B (STEMI with LVA,n =172) confirmed by echocardiography in 24 hour after admission.Of them,273 patients were treated with primary percutaneous coronary intervention (PCI) after admission and included in the analysis.Cy-C-based estimated glomerular filtration rate (eGFR) and creatinine (Cr)-based eGFR were calculated for evaluating cardiac function in tern to assess the magnitude of compromised renal function.The correlation between magnitude of compromised renal function and in-hospital mortality was analyzed.Distributions of categorical variables were compared using the chi-square test.Continuous variables were compared by one-way ANOVA with the Bonferroni test.Results The in-hospital mortality rate of whole patient cohort was 14.0％.Mortality in the group B was 18.6％ and in the group A was 9.8％ (P ＜ 0.01).With multivariable regression analysis,the compromised renal function was found when the Cr-based eGFR was ＜60 mL/ (min · 1.73 m2) or Cy-C-based eGFR was ＜ 60 mL/min/1.73m2 which were independently associated with in-hospital mortality (OR 0.13,95％ CI 0.02-0.7,P =0.02 ; OR 0.01,95％CI 0.003-0.05,P ＜ 0.01).Compared with the acute myocardium infarction (AMI) patients with chronic kidney disease (CKD) stage 2,the Cy-C based eGFR was greater in the AMI patients with LVA group (P ＜ 0.05),and compared with AMI with CKD stages 3 or CKD 3-5,this difference was also significant (P ＜ 0.01).Conclusions Renal dysfunction was an independent predictor of in-hospital mortality in patients with STEMI,especially in patients with LVA.Cy-C and Cy-C based eGFR were more sensitive to judge renal dysfunction in STEMI patients with LVA.

Objective To establish a HPLC method for the determination of Shionone in Ziwan Zhisou granule. Methods Phenomenex C18 column (250? 4.6 mm) was used. The mobile phase was acetonitrile and the detection wave length was at 203 nm. Result A good linearity of Shionone was in the range of 0.025～ 0.250 ? g/? L, r=0.9996. The average recovery was 97.8 % , RSD was 2.37 % ( n=5) . Conclusion This method is sensitive, accurate and simple and with good reproducibility for the determination of Shionone in Ziwan Zhisou granule. 