Objective To understand the distribution and drug resistance of fungus isolated from urinary tract infection for guid-ing clinical rational drug use.Methods The clinically submitted urinary system samples from January 2012 to June 2013 were per-formed the fungal identification and the drug susceptibility test to 5 kinds of anti-fungal drugs.The detection results were analyzed by the WHONET software.Results (1)239 strains of fungi were isolated,in which Candida albicans occupied the top place,fol-lowed by Candida glabrata and Candida tropicalis;(2)the sensitivity rates of 239 fungal strains to fluconazole(FCA),itraconazole (ITR),voriconazole(VRC),5-fluorocytosine(5-FC)and amphotericin B(AMB)were 63.2%,61.9%,92.5%,93.7% and 93.7%respectively;(3)Candida albicans had the high sensitivity to 5 kinds of anti-fungal drugs,which reached more than 95%;(4)Candida gla-brata had the lowest sensitivity to FCA and ITR,only 9.7%.Conclusion The fungal infection in the urinary system is dominated by Candi-da albicans,due to the different sensitivity to 5 kinds of anti-fungal drugs in different fungi,therefore strengthening the fungal identification of the urinary system and the drug sensitivity test can provide the important reference basis for clinical rational use of anti-fungal drugs.

[Objective] To investigate the anatomical relation between manubrium sternum incisure(MSI)with the level of upper thoracic vertebrae(UTV)and to find out the basis of operative approach of UTV.[Method]Standing pan chest radiographs of 400 male and 400 female were equally divided into 4 year groups:≤19 years,20～39 years,40～59 years and ≥60 years and were used to observe the relationship between MSI with the level of UTV.On the basis of this relationship,a suitable UTV approach was advocated.There were fracture and dislocation of UTV 7 cases,UTV tumor 9 cases,tuberculosis of UTV 3 cases;OPLL ossification of UTV 2 cases.Diseases located at T1 6 cases,T2 7 cases,T3 2 cases,T4 3 cases,T1、2 2 cases,T2、3 1 case.Lower anterior cervical approach was performed for 7 cases including T1、2 one case and T2 one case,improved T3 1 case,and right subscapular transthoracic posterolateral approach was used for 5 cases.[Result]The number of UTV in relationship with the level of MSI was successively increased from T1 to T3 and was gradually decreased on T4,i.e.rate of cases of level of MST in relationship with T1、2 level was 1%,to T2 level 5.5%,to T2、3 level 15.87%,to T3 level 43.5%,to T3、4 level 20.75%,to T4 13.375%.No relationship was found in trend of distribution with the age and gender.The operative approach of UTV according its relationship with MSI was performed with the advantages of satisfactory exposure easily manipulation and satisfactory clinic results in most follow-up cases.One case died of metastasis of tumor in 9 months,3 cases were complicated with cerebrospinal fluid leakage and 3 cases with injury of recurrent laryngeal nerve.[Conclusion]Approach to UTV should be selected according to its relationship between MSI and diseased UTV preoperatively.The operative approach of UTV according to its relationship with MST has the advantages of satisfactory exposure,easily manipulation and satisfactory clinic results.

ObjectiveTo assess the feasibility and efficacy of a docetaxel plus cisplatin regimen for patients of locally advanced nasopharyngeal carcinoma(NPC)treated concurrently with definitive IMRT in a short-term observation.MethodsRadiation consisted of 7000 cGy given to the planning target volume (PTV) of primary tumor, 6600 cGy given to the PTV of metastatic lymph nodes and 6000 cGy to the PTV of subclinical disease in 220-228 cGy/fraction were delivered over 31-32 treatment days. Thirty-two patients with newly diagnosed NPC received definitive intensity-modulated radiation therapy(IMRT)concurrent with docetaxel 75 mg/m2 on day 1 and DDP 75 mg/m2 on day 1(or DDP 25 mg/m2 on day 1-day 3), repeating every 21 to 28 days for 2 cycles.ResultsAll patients received the full dose of radiotherapy and completed 2 cycles of chemotherapy with a median follow-up of 13 months (2-28 months).No treatment-related death was observed. Major toxicities included hematologic toxicity and mucositis. The incidence rates of grade 3-4 leucopenia,grade 3-4 neutropenia and grade 3 acute mucositis were 46.9 ％ (15/32),59.4 ％ (19/32) and 40.6 ％ (13/32) respectively.The complete remission (CR) rate was 96.9 ％ (31/32).During treatment,90.6 ％ (29/32)patients acquired granulocyte colony stimulating factor (G-CSF)for leucopenia. The 1-year overall survival, local recurrence-free survival, regional recurrence-free survival and distant metastasis-free survival were 100 ％ (31/32),96.9 ％ (31/32),96.9 ％ (31/32),96.9 ％ (31/32),respectively,for the whole cohort.Conclusions2 cycles of the docetaxel plus cisplatin regimen with concurrent IMRT are demonstrated being feasible and effective in treating locally advanced NPC with promising results.The major toxicities are leucopenia and neutropenia, but they are tolerable with the use of G-CSF. Further investigation of long-term efficacy of the regimen is required.

Objective To investigate the changes and clinical significance of the coagulation function after mitral valve replace‐ment (MVR) .Methods 163 cases of MVR admitted in our hospital from January 2012 to January 2014 were included in the obser‐vation group and contemporaneous 163 individuals of healthy physical examination were selected as the control group .The pro‐thrombin time (PT) ,activated partial thromboplastin time (APTT ) ,fibrinogen concentration (FIB) ,thrombin time (TT ) and pro‐thrombin time international normalized ratio (INR) in the two groups were detected and the detected results were performed the statistically comparative analysis .Results PT ,APTT and INR in the majority of the observation group were significantly higher than those in the control group ,the differences had statistical significance (P < 0 .05) .Conclusion The regular determination of blood coagulation function after MVR can effectively reflect the disorder status of anticoagulant and coagulation mechanism ,and can improve the efficiency of diagnosis and treatment and clinical predictive value .

Some measures about improving the teaching quality in respiratory department training are described in this report,including identifying the aim and importance of major training,raising students'enthusiasm,enhancing the basic major procedure training,performing various teaching,concentrating on the students'response and altering teaching methods continuously

Objective To understand the status of depression and quality of life in the patients with advanced gastric cancer , and to explore their relationship .Methods The depression self rating scale (SDS) and the Chinese Scale of World Health Organiza‐tion Quality of Life Scale‐Brief Form Questionnaire (WHOQOL‐BREF) were adopted to conduct the questionnaire investigation on 131 patients with advanced gastric cancer ,then the results were compared with those of the health population .Results Among 131 patients with advanced gastric cancer ,the prevalence rate of depression was 47 .33% ,and the average SDS score was 45 .99 ± 15 .47 ,which were higher than those of the health population .The scores of quality of life were 61 .61 ± 12 .66 for the physiologic health domain ,59 .54 ± 12 .49 for the mental health domain ,64 .95 ± 14 .16 for the social relation domain and 52 .93 ± 14 .07 for the surrounding environment domain .There was a significant correlation between the depression score with the four domains scores of life quality ,in which the correlation with the mental health domain was strongest (r= -0 .636 ,r2 =0 .405) .Conclusion High depression level and poor quality of life exist in the patients with advanced gastric cancer ,and there is a correlation between them , in which the correlation between depression with the mental health domain is strongest .

With the advantages of displaying visceral organs intuitively,showing the operative procedure vividly,making and spreading videos conveniently in clinical teaching,electrobronchoscopy image system was adopted in clinical teaching of respiratory medicine to assist the traditional teaching method,to make up for the deficiencies of tradition method and to improve the learning effectiveness of respiratory medicine for medical students at internship.

Objective To evaluate the safety,tumor radical and early postoperative efficacy through comparison of laparoscopic gastric D2 radical surgery with traditional open gastric D2 radical surgery.Methods 254 patients with upper stomach cancer underwent surgery were selected,132 cases using conventional open gastrectomy (the traditional laparotomy group),122 patients underwent laparoscopic radical gastrectomy (laparoscopic surgery group).Laparoscopic surgery group with traditional open surgery group had no statistically significant differences in gender,age,tumor location,histological type and TNM staging.Results Open surgery group and laparoscopic surgery group had statistically significant differences in operative time [(235.78±31.56) min,(256.43±54.08) min,P ＜ 0.001],blood loss [(326.69±89.73) ml,(158.31±62.98) ml,P ＜ 0.001],incision length [(16.53±2.34) cm,(5.51±1.15) cm,P ＜ 0.001],gastrointestinal recovery time [(4.22±0.91) d,(3.31±0.83) d,P ＜ 0.001],first time eating liquid [(5.78±0.95) d,(5.56±0.78) d,P ＜ 0.001] and postoperative hospital stay [(12.62±2.89) d,(11.18±1.78) d,P ＜ 0.001].The total number of lymph node dissection and complications was not statistically significant.Conclusions Laparoscopic gastric D2 radical surgery is a safe,minimally invasive surgical method.Laparoscopic gastric D2 radical surgery has the same lymph node dissection and good early outcome compared with the traditional gastric D2 radical surgery,but postoperative recovery fast and less invasive.

Objective To analyze psychological status of the donors and the recipients before and after the relative kidney transplantation.Method Symptom checklist 90 (SCL-90) were performed for 147 renal transplant recipients and donors preoperative and postoperative.Statistical analysis were performed to analyze the scores between the recipients,donors and normal standards.Results Over 90％ recipients were of obvious anxiety preoperative.The scores of most factors of recipients were significantly higher than those of donors.The scores of somatization,interpersonal sensitivity,depression,anxiety,hostility,phobia and paranoia between two groups has statistical significance(P＜0.05).Part of recipients retest SCL-90 3 month after operation,the data showed that the scores of somatization,interpersonal sensitivity,depression,anxiety,hostility were obviously declined after operation(P＜0.05).And the test also showed that most of the donors were willing to help preoperative.Conclusion Preoperative psychological test was useful in preoperational psychological intervention for transplantation recipients.It can increase the safety of the recipients during perioperative period.

目的观察神经外科与针刺联合治疗急性脊髓不完全损伤的疗效。方法神经外科治疗组根据指征确定是否进行手术,药物治疗均给予激素、脱水、抗去甲肾上腺素类药物、神经营养药物,高压氧。神经外科与针刺联合治疗组除上述神经外科治疗外,采用针刺治疗,针刺处方:电针刺激夹脊穴,根据不同辨证配合远端取穴。结果神经外科治疗组9例,持续治疗 3—6个月,出院后随访6个月,6例好转,肌力有所改善,最好者可达到肌力IV—IV+级,3例无效,甚至退步,瘫痪进一步加重。神经外科与针刺联合治疗组病人5例,经针刺及电针治疗10—80天时间后,4例临床治愈,1例经针刺治疗好转后,因转入骨科手术治疗腰椎压缩性骨折时脱离针刺治疗。结论神经外科与针刺联合治疗急性脊髓损伤效果好,并能抑制脊髓损伤的进一步恶化。