[Summary] This article reviewed the clinical features in two diabetes cases complicated with nasal‐brain mucormycosis by pathology and pulmonary mucormycosis. In one patient with diabetes combined with pulmonary mucormycosis ,manifestations of chest pain and hemoptysis ,the right upper lung biopsy tip morphology was consistent with Mucor ,successfully cured with amphotericin and operation treatment. The other patient with diabetes‐complicated nasal mucormycosis with headache and nasal cavity clump , showed black caseous matter ,finally hemiplegia. A nasal cavity tumor was proved by pathological examination. After treatment with fluconazole and operation ,the patientdied. Mucormycosisis rare and may be secondary to diabetes and hypoimmunity disease. It needs rapid diagnosis and treatment.

Objective To explore the clinical significance of the three indicators combined detection that plasma endotoxin,pro-calcitonin (PCT)and (1,3)-β-D-glucan(BG)in pulmonary tuberculosis patients complicated with bacterial,fungal infection.Methods Retrospective investigation was conducted in 240 pulmonary tuberculosis patients,who were divided into gram negative bacteria (G- )group(39cases),gram positive bacteria (G+ )group(45 cases)including fungal,germ-free group(156 cases).Other 45 healthy people were selected into control group.The levels of plasma endotoxin,PCT and BG in the four groups were compared.Results The levels of plasma endotoxin(0.682±0.418)EU/mL,PCT(2.93±0.87)μg/L in the G- group were significant higher than those of the G+ group (0.063±0.034)EU/mL,(0.85±0.52)μg/L,the difference was significant (P <0.05).The levels of the plasma endotoxin,PCT in the G- group were higher than those of the germ-free group.The levels of plasma endotoxin,PCT and BG in the control group had no significant difference with those of the germ-free group.Conclusion The combined detection of plasma endo-toxin,PCT and BG have some clinical value on the early diagnosis of the patients with pulmonary tuberculosis complicated with G-fungal infection for the advantages of fast and sensitiveness.

BACKGROUND: Selenium is one of necessary microelement of human body. It acts as the active center of selenium-contained enzyme with antioxidant function, which can clean up internal free radical, effectively catalyze harmful perhydride deoxidizing into innocuous hydroxyl compound,reinforce immunity of human body, prevent and cure cardio-cerebrovascular diseases and cancer.OBJECTIVE: To provide evidence for preventing and treating cardiocerebrovascular diseases via comparison of blood selenium content between patients and healthy persons.DESIGN: Case-control analysis.SETTING: Dalian Railway Medical School, Dalian Railway Hospital, Department of Applied Chemistry, Dalian Railway College.PARTICIPANTS: Totally 319 blood samples (169 males, 150 females)were collected from patients with cardio-cerebrovascular diseases from Dalian Railway Hospital from March 2000 to May 2001. Among them,there were 164 with hypertension, 97 with coronary atherosclerotic heart disease (CAHD), 41 with cardiac dysrhythmia and 17 with cerebral vascular accident. 300 healthy patients (159 males and 141 females) were in the healthy group.METHODS: The blood selenium content of patients with cardio-cerebrovascular diseases was detected with neopolarography.MAIN OUTCOME MEASURES: ①Total level of blood selenium of testees of the two groups. ②Comparison of level of blood selenium between males and females. ③Comparison of level of blood selenium of patients with different diseases.RESULTS: A total of 619 testees were involved in the result analysis. ①The total level of blood selenium of the patient group was lower than that of the healthy group [(114.0±52.5), (146.5±51.0) μg/L,P ＜ 0.001],which was only 76% of that of the healthy persons. ②Content of blood selenium of males and females was normal distribution. There was insignificant difference between males and females (P ＞ 0.10), but the level of blood selenium in females was slightly higher than that of males. ③The levels of blood selenium of patients with hypertension, CAHD, cardiac dysrhythmia were 82.7%, 68.6% and 66.0% of that of healthy persons, respectively, but the difference between males and females was insignificant(P ＞ 0.10). The level of blood selenium of patients with cerebrovascular accident (CVA) was the lowest, (84.4±28.9)μg/L, which was 57.6% of healthy persons.CONCLUSION: The content of blood selenium of patients with cardiocerebrovascular diseases is lower than that of healthy persons. Organic selenium and inorganic selenium should be supplemented moderately.

Objective To compare the effect of endoscopic ultrasonography (EUS),magnetic resonance chlangiopancreatography (MRCP) and endoscopic retrograde cholangiography (ERCP) in the diagnosis of suspicious intermediate choledocholithiasis.Methods One hundred and eighty-six patients with suspicious intermediate of choledocholithiasis successively received MRCP,EUS,and ERCP examination.The stone taking out by endoscopic as diagnositic standard,and the sensitivity,specificity and accuracy in different methods was compared.Results Sensitivity and accuracy of EUS was significantly higher than that of MRCP [97.5％(155/159) vs.92.5％(147/159),97.3％(181/186) vs.91.9％(171/186)](x2 =4.21,5.30,P =0.04,0.02).There was no statistically significant difference between EUS and ERCP in specificity [96.3％(26/27) vs.88.9％ (24/27)] (x2 =115.40,P ＜ 0.05).Sensitivity,specificity and accuracy of ERCP was 98.9％(184/186),98.7％(157/159) and 100.0％(27/27),and there was no difference between EUS and ERCP in the diagnosis of choledocholithiasis (P ＞ 0.05).Conclusions EUS is similar with ERCP for the diagnosis of choledocholithiasis.By performing EUS or MRCP first,ERCP may be avoided in patients with suspicious intermediate choledocholithiasis.

Objective To improve the cleaning quality of reusable medical instruments continuously through root cause analysis,reduce healthcare-associated infection(HAI)and the wear and tear of instruments.Methods The major factors influencing the cleaning quality of instruments were analyzed and clarified by fishbone diagram,contin-uous quality improvement was carried out based on 5 terminal factors,the rate of rusting,stain,repeated cleaning, damage,and clinical department satisfaction before and after the implementation of continuous improvement were compared.Results The qualified rate of instrument clean increased from 94.24% before implementing measures to 97.60% after implementing measures,the rate of rusting,stain,repeated cleaning,damage decreased from 3.39%, 2.37%,5.76%,and 2.08% to 1 .55%,0.85%,2.40%,and 0.48% respectively,there were significant difference among different groups(all P <0.001 );the score of satisfaction rate to central sterile supply department elevated from(93.87±3.87)before implementing measures to (98.08 ±0.59)after implementing measures(t =6.80,P <0.001).Conclusion Root cause analysis is important in improving cleaning quality of reusable instruments continu-ously,as well as reducing HAI and the wear and tear of instrument,it can save medical cost.

Objective To explore the continuous improvement to reduce the suctioning pediatrics lumen instruments return-cleaning rate of the first time washing, improve work efficiency and reduce the cost by applying root cause analysis. Methods Using causal analysis of fishbone diagram to analysis and verify the main reason of leading to high lumen instruments return-cleaning rate. According to the three terminal factors of continuous quality improvement, quality control group was set up, lumen instruments cleaning quality control standards was made, water flow mode of lumen instruments cleaning was changed, selected the appropriate cleaning tools and real picture show, synchronize quality control measures of publishing the quality and safety board. Compared before and after return-cleaning rate of three different detection methods and the different parts of the same suction lumen instruments. Results Before carrying out eye-measurement, cotton swab to wipe, ATP bioluminescence back washing rate was 0.89% (2/225), 7.11%(16/225), 27.11%(61/225), respectively after implementation of 0, 0.44%(1/226), 3.98%(9/226), visual observation before and after the return rate of washing was no statistically significant difference (χ2=2.018, P>0.05);Cotton swab to wipe, ATP bioluminescence back washing rate difference was statistically significant (χ2=13.820, 45.999, P<0.01). The lumen instruments total return-washing rate was decreased from 35.11% (79/225) to 4.42% (10/226). Among them, the return- washing rate of the inside surface of lumen instruments was decreased from 32.89% (74/225) to the 3.10% (7/226) and the difference was statistically significant(χ2=67.028, 67.915,P<0.01). By contraries, the thread interface and the outside surface of lumen instruments return- cleaning rate before and after the implementation has no statistical significance (P>0.05). Conclusions ATP bioluminescence assay has fine effects to detect the return-washing rate of the inner wall of the lumen instruments. The Root Cause Analysis method significantly reduced the return-washing rate of the inside surface of the suction lumen instruments, improve the efficiency, save the medical cost and reduce the hospital infection.

Objective To explore the substantial results of using comprehensive practical teaching mode and holistic nursing thinking method in the course of teaching fundamentals of nursing science,and then improve the vocational quality and ability of nursing students.Methods Randomly determined two classes as objectives: experiment class and control class.control class was adopt traditional practical teaching mode,experiment class was adopt comprehensive practical teaching mode in small community.Results Ability of standard operation,communication and knowledge were significant higher in experiment class than those of in control class.Conclusions Comprehensive practical teaching mode in small community has actual significance for strengthen the comprehendsive ability of nursing students.

Objective To evaluate the feasibility and safety of the treatment for ventricular septal rupture (VSR) by transcatheter interventional therapy coordinated with percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA).Methods Six patients who suffered from cardiogenic shock due to acute myocardial infarction (AMI) and VSR were given intra-aortic balloon pump (IABP) and mechanical ventilation support. After three weeks, they underwent transcatheter closure of ventricular septal rupture with Amplatzer ventricular septal occluder, and at the same time PCI and PTCA were performed. Results All the patients successfully underwent ventricular septal defect occlusion, including two cases of residual shunt. Segmental stenosis of the middle of anterior descending branch and circumflex artery were noted in three patients, and then stent implantation was used. The other three cases had multi-vessel lesion but were without stent implantation. All the patients with stent implantation survived and discharged. Conclusions It is safe and feasible to apply transcatheter closure of ventricular septal rupture with Amplatzer ventricular septal occluder, coordinated with PCI and PTCA for patients with acute myocardial infarction complicated with ventricular septal rupture.

Objective: To compare the shear strength of the self-etching techniques and the all-etching techniques for enamel adhesion and to provide evidence for the selection of different bonding methods in clinical practice. Methods: Ten middle incisors recently extracted were collected,each was cut into two parts following its sagittal axis,thus divide each tooth into two groups.For group 1 Single BondTM 2 was used to bond FiltekTM Z250 resin to the teeth.For group 2,SE Bond was used to bond Filtek Z250 resin to the teeth.After that,according to the principle of pressing from the incisal margin to the cervix,the shear strength of each bonding unit was tested and statistically analyzed. Results: The shear strength of Single BondTM 2 was significantly higher than that of SE Bond(P