Objective To analyze 137 cases of clinical invasive fungal infection (IFI), and to sum up clinical experiences in the treatment of early anti-fungal. Methods 137 patients with 91 males and 46 females, who suffered from invasive fungal infection in ICU from January 1, 2000 to June 30, 2006, were enrolled in this study. The age ranged from 17 to 82 years. Among 137 patients with IFI, the respective incidence of infection of Candida albicans, Candida glabirate, Candida tropicalis and Candida parapsilosis was 47.4%, 26.3%, 20.4% and 3.6%. The sputum, urine, blood and other excreta were collected for examination three days after admission and then every three days. Results Out of the 137 patients, 42 patients were complicated with hemorrhage (30.7%), 53 patients developed candida rash in the chest, abdomen and extremity (38.7%), and 49 patients developed organ dysfunction (35.8%). The chest films revealed that infiltration caused by IFI mainly occurred in the apex of lung in some patients. 137 patients were treated with fluconazole at first, and among them, 64 patients were cured. The cure rate was 46.7%. 39 patients out of 61 patients treated with Amphotericin B(AmB) or lipid AmB were cured. The cure rate was 63.9%. 11 patients were treated with voriconazole and 6 patients were cured. The cure rate was 54.5%. 28 patients failed to respond to the above therapy and died.The mortality was 20.4%. Conclusion The clinical symptons of IFI included hemorrhage, candida rash, organ dysfunction, and infiltration in apex of lung. Fluconazole and amphotericin B(AmB) or lipid AmB still have a good curative effect on invasive fungal infection.

ObjectiveTo study the effects of small-dose glucocorticoid (GC) on glucocorticoid receptor (GR) and cellular immune function in critical patients.MethodsForty ICU critical patients admitted in Shanghai Changzheng Hospital from March 2007 to March 2009 were enrolled in the study and were divided into GC group and non-GC group according to the use or absence of GC.Blood samples were collected at days 1,7 and 10 after GC treatment to detect GR binding affinity of mononuclear leukocytes (MNLs) and polymorphonuclear leukocytes (PMLs) in the peripheral blood and the CD4/CD8 ratio in the T lymphocytes.The method of GC use was that the hydrocortisone was given intravenously at a dose of 100 mg every eight hours.ResultsGR binding capacity of MNLs at day 1 and 7 showed no statistical difference between the GC and non-GC groups.GR binding capacity of MNLs in the GC group was lower at day 1 and was much lower at day 7 (P ＜ 0.05 ).However,in the non-GC group,it was lower at day 1,but showed significant improvement at day 7 ( P ＜ 0.05 ).The change of GR binding capacity of PMLs was similar to that of MNLs.There was no significant difference of CD4/CD8 ratio between the GC and non-GC group at day 1.The ratio of CD4/CD8 in the non-GC group was significantly higher than that in the GC group at day 10 (P ＜0.05).CD4/CD8 ratio in the GC group showed a slight reduction at day 10,with no significant difference from that at day 1.While,the non-GC group showed a significant increase of CD4/CD8 ratio at day 10 as compared with that at day 1 (P ＜ 0.05 ).ConclusionLow-dose GC plays some role in the negative feedback regulation of GR binding capacity of peripheral blood leukocytes and in the inhibition of cellular immune function.

Medical consumables is the indispensible material foundation for diagnosis and treatment in hospital.The management of medical consumables is rather complicated for the multiplicity of its manufacture factories,suppliers and marketing ways.ISO9001 certification is extensively applied to the management of medical consumables,which can effectively ensure the consumables quality,prevent medical accident and protect consumer's privilege.

Objective To observe the indications for early surgical trea tment of thoracolumbar burst fracture (TLBF). Methods 139 cases who had been def initely diagnosed as TLBF were analyzed retrospectively. They were divided into 2 groups: operation and non-operation. 47 patients had non-surgical treatment, such as bed-rest plaster brace. 92 patients had surgical treatment with plate and root screw. Spinal cord functions were evaluated according to the ASIA metho d. Results All patients were followed up for 6 months to 10 years (averaged 6 y ears and 2 months). Their average kyphosis angle measured with Cobb method was 2 3.5? before the operation and 8.5? after the operation. The average degree o f middle column posterior convexity was 25%～85% before the operation (averag ed 33%) and 0～53% after the operation (averaged 12%). The average height of anterior column was 45% before the operation and 85% after the operation. T he average degree of spinal stenosis was 30%～85% before the operation (avera ged 55%) and 0-50% after the operation (averaged 20%). There were more case s whose neural function recovered to grade E in the operation group than in the non-operation group (P

Objective To investigate the effects of rhubarb on the expression of glucocorticoids receptor (GR)and peripheral blood lymphocytes in burning-induced septic rats. Methods Sixty-six male healthy Sprague-Dawley(SD)rats were randomly divided into sham operated control group(n=18),sepsis model group(n=24) and rhubarb treatment group(n=24),each group was further randomly divided into 12,24 and 72 hours subgroups according to different time points. The model of scald sepsis was replicated by scald injury induced by boiling water at the rat back accounting for 30% total body surface area(Ⅲ grade of scald),and administration of endotoxin (5 mg/kg)into the peritoneal cavity 12 hours after scald injury. After the successful establishment of septic models, the rats in the rhubarb treatment group were immediately infused with 50 mg/kg rhubarb powder dissolved in 1 mL saline through a gastric tube,while the rats in sham operated control group and sepsis model group received saline by the same way as a substitute for rhubarb. The the binding capacity of GR of peripheral blood leucocyte and binding activity of GR of hepatocyte were analyzed by radiation ligands binding assay. The CD4+,CD8+as well as CD4+/CD8+ ratio in peripheral blood lymphocytes were detected by flow cytometer. Results The binding capacity of GR of peripheral blood leucocyte and binding activity of GR of hepatocyte were significantly decreased in a time-dependent manner in sepsis model group compared to those of the sham operated control group,while in the rhubarb treatment group they were increased in a time-dependent manner after interference of rhubarb, and they were higher than those in the model group at the same time points〔leukocyte GR binding capacity (locus/cell)at 12,24,72 hours :1 515.38±300.44,1 859.63±258.26,1 890.50±307.88 vs. 1 122.63±225.39, 1 008.88±150.41,724.38±91.19;hepatocyte GR binding capacity(fmol/mg):210.19±26.26,258.01±20.98, 283.38±38.21 vs. 153.11±30.07, 129.83±26.89, 94.08±14.30, all P<0.01〕. Compared with the sham operated control group,the CD4+ and CD8+ were decreased in various degrees at 12 hours and 24 hours in the septic group, at 24 hours the differences being statistically significant (P<0.01 and P<0.05). CD4+/CD8+ratios were decreased significantly at all time points,the differences were statistically significant at 24 hours and 72 hours(both P<0.01). The CD4+ T cell and CD4+/CD8+ ratio at all the time points were increased at various degrees in the rhubarb treatment group,and the differences from those in the sepsis model group at 24 hours and 72 hours were statistically significant (1.58±0.69, 1.56±0.49 vs. 1.02±0.41, 1.01±1.68, both P<0.01). Conclusion Rhubarb can modulate the binding capacity of GR of peripheral blood leucocyte and the binding activity of GR of hepatocyte,and via its influence on the number of peripheral leucocytes,the immune dysfunction in the sepsis processes is improved.

BACKGROUND: It is often seen in clinical practice that children, aged3-15 years, suffer from knee pain of unknown cause at night, which occurs frequently. Most of them can be called "pain of growth".OBJECTIVE: To analyze the related factors of knee pain in adolescents and observe the interventional effect of alpha-D3 (α-D3).DESIGN: Case control analysis, self-control analysis SETTING: Department of Orthopaedics, Jinshan Hospital Affiliated to Shanghai Fudan University PARTICIPANTS: We admitted 22 children outpatients, aged 3 to 15years, who suffered from recurrent attack of knee pain of unknown reasons and received treatment in Jinshan Hospital Affiliated to Shanghai Fudan University from June 1998 to August 2002, servingas group A. Another 20children outpatients of fracture recovered for half a year were recruited simultaneously, serving as Group B (control group).METHODS: Group A adopted the therapy of α- D3 of 0.25 μg taken orally once everyday for successive 7 days then stopped to observe the symptoms for the next three weeks. Four weeks was one therapeutic course.If the pains were still alive or reoccurred, another therapy period was needed until they vanished. The contents of bone gla protein (BGP), blood calcium (Ca2+), blood phosphorus (P3+), blood magnesium (Mg2+), alkaline phosphatase (ALP) and bone mineral density (BMD) of patients were detected between Group A and Group B. GBP index and change of pain in knee at night was observed with α-D3 before therapy and 1,3 and 6months after therapy. After one therapy period, the levels of blood Ca2+, P3+,Mg2+, ALP, BGP, CT, urine and X-ray of knees were detected again, so was BMD after 6 months.MAIN OUTCOME MEASURES: ① Blood Ca2+, P3+, Mg2+, ALP contents of children patients were detected before and after therapy . ② In the Group A, content of BGP was detected before and 1,3 and 6 months after therapy, and BMD before and 6 months after therapy; The above indexes were detected 6 months and one year after bone fracture healing in the control group. ③ Therapeutic effect of α-D3.RESULTS: All the 42 patients entered the stage of result analysis. ① The levels of blood Ca2+, P3+, Mg2+, ALP of patients who suffered pain in knee were all normal before and after therapy . ②BGP content of patients in the control group was significantly lower 1 year after bone fracture healing than 6 months after bone fracture healing [(7.06±0.74), (7.44±1.16)μg/L,P ＜ 0.01]; BGP content of patients in Group A was 15.98 μg/L before therapy , which was significantly higher than that in the control group .BGP content was (12.12±2.2), (10.6±81.31), (7.60±0.95)μg/L , respectively in 1,3 and 6 months after therapy. There was significant difference of BGP content between before and after therapy (P ＜ 0.05). ③ There was no significant difference of BMD of patients between two groups (P ＞ 0.05).④ Symptoms of pain in knee at night improved or disappeared after α-D3therapy, and the therapeutic time was 9 to 83 days.CONCLUSION: Although the knee pain of adolescents and children at night can not reach the diagnostic criterion of rachitis, it is still correlated with the deficiency of bone mineralization, in clinical practice, the BGP determination should be used as a means of monitoring the pain of unknown cause. There is significant effect using vitamin D3 in treatment of knee pain of children at night.

Objective To further control the indications and to improve the effect of intra-esophageal metallic stents.Methods 83 metallic stents were be planted into esophageal through endoscopy and under X-ray TV guiding using two kinds of stent meterials in 72 cases with benign or maligant stenosis(esophageal,cardiac orifice).Results The operation of planting stents was successful in all patients and the effect of treatment of esophageal stenosis with stents covered by dacron kint membrane was best.The clinical symptoms and food intaking ablities of all patients were improved.Conclusion Home-made nitinol stents can be plant in treatment of malighent esophageal stenosis.It should be first choice for the patients without indications of surgery or after operation.

To explore the differentiation of gastrointestinal stromal tumor(GIST) with synchronous carcinoma clinical and pathological features,diagnosis and differential diagnosis.Methods Clinical characteristics,pathological morphology and immunohistochemical staining were observed in 9 cases of GIST with synchronous carcinoma,with review of the relevant literature.Results Microscopically,in 4 cases GIST with esophageal carcinoma,most of tumor cells in central focus were squamous cells and keratin pearls which were well differentiated and the rest of tumor cells are basal like cells on the edge.In the other 5 cases (4 of them with gastric carcinoma and 1 with rectal cancer).Microscopically,the tumors were composed of dysplastic glands which presented as adenoid structures and poorly differentiated.The majority of gastric GIST were spindle cell tumors,which resembled smooth muscle tumors histologically and showed a variety of histological pattern,such as lace like pattern,palisading pattern,antique coins like pattern and eddy pattern.And a perinuclear vacuolization pattern was common.Immunohistochemistry showed that the tumor cells were positive for CK5/6,CK14 and p53,but negative for S-100,CK7 of the 4 cases GIST with esophageal carcinoma.In the other 5 cases (4 of them with gastric carcinoma and 1 with colorectal cancer),showed that CK7,CK20,CEA and HER-2 were positive and negative for S-100.In all the 9 case of GIST,the tumor cells were positive for CD34,CD117 (+),DOG1 and SMA,but negative for S-100,desmin,etc.Conclusion There are no special clinical symptoms in most of GIST with synchronous carcinoma,because these GISTs are generally incidental findings.The proliferative index of GIST with synchronous carcinoma is observably lower than that of GIST without synchronous carcinoma.Most GISTs with synchronous carcinoma can be treated by the standard treatment for the accompanying carcinoma,and do not need specific additional treatments.

Objective: To investigate changes of the endothelin-1(ET-1) and its receptor (endothelin receptor subtype A, ET AR ) mRNA expression in some organs(kidney, lung and small intestinal mucous membrane) in the sepsis and septic shock rats. Methods: Twenty-four male rats randomized into sepsis group, septic shock group, control and normal group was infused with endotoxin(LPS) via indwelling right atria catheters except normal and control group. RT-PCR was used to detect kidney, lung and small intestinal mucous membrane tissue mRNA expression of the ET-1 , ET AR and glucose-6-phospho dehydrogenase(G-6-PD) in every group.Serum BUN, Cr, ALT and A were determined. The arterial oxygen tension (PaO 2) and arterial carbon dioxide partial pressure(PaCO 2)were measured in every group. Results: ET-1 mRNA and ET AR mRNA expression in the sepsis group and septic shock group were significantly higher than in normal group. There were significant differences between the normal/control group and sepsis/shock group in BUN,Cr,ALT,PaO 2 and PaCO 2. Conclusion: A higher expression of ET-1 mRNA and ET AR mRNA may be one of the startup factors on multiple organ dysfunction syndrome (MODS) and may play an important role on pathogenesis in sepsis and septic shock.

Objective This study is designed to explore the regulation of carboxyamidotriazole(CAI)on inflammatory factors in vitro and its underlying mechanisms.Methods Peritoneal macrophages were incubated with different concentrations(5～40 μmol/L),and then cell viabilities were evaluated by MTT assay.Cells were pretreated with CAI(5～40 μmol/L),LPS was then added,and celia were incubated for 18 h.NO and TNF-α levels were determined with Griess reagent and ELISA kit,respectively.The iNOS expression and NF-κB activation were detected by Western blot method.Results The rat peritoneal macrophage viability was not affected at the concentrations of CAI used.CAI(5～40 μmol/L)was found to reduce NO(P＜0.01,P＜0.001)and TNF-α production(P＜0.05,P ＜ 0.01)in a dose-dependent manner.CAI was also found to inhibit the LPS-induced expression of iNOS and degradation of IκBα in rat peritoneal macrophages.Conclusion The findings from the present study suggest that CAI has suppressive effect on iNOS expression,and this inhibitory effect was found to be associated with NF-κB inactivation via the blockade of IκBα phosphorylation.