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.

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.

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 predict the risk of 28-day mortality in septic patients in intensive care unit (ICU) with the combination of Weighted index of comorbidities (WIC) and sepsis-related organ failure assessment (SOFA) score.Methods The clinical data of adult severe sepsis/septic shock patients in Department of Emergency Medicine of Changzheng Hospital and Department of Critical Care Medicine of Jinan Military General Hospital from October 2011 to February 2013 were analyzed retrospectively.The etiological factor,past history,having severe sepsis or not were recorded.Age score,WIC score,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and SOFA score were calculated at or 24 hours after admission.The logistic regression was used and the receiver operating characteristic curve (ROC curve) was drawn to calculate the patients' outcome.Results In 310 enrolled patients,223 (71.9％) patients survived and 87 (28.1％) died.Univariate analysis showed that the P values of the age score,WIC score,APACHE Ⅱ score and SOFA score,chronic cardiac insufficiency,type 2 diabetes,cerebrovascular disease,tumor,multiple injury,pulmonary infection and having severe sepsis or not were all less than 0.2.The above 11 variables were put into the multivariate logistic regression equation 1,of which predicted probability was reserved.It revealed that 5 variables were independently associated with 28-day prognosis,of which influence power in descending order were SOFA score [odds ratio (OR) =1.308,95％ confidence interval (95％ CI):1.158-1.478,P=0.000],having severe sepsis or not (OR =0.206,95％ CI:0.100-0.424,P=0.000),APACHE Ⅱ score (OR =1.090,95％CI:1.021-1.164,P=0.010),WICscore (OR=1.441,95％CI:1.067-1.947,P=0.017),agescore (OR=1.228,95％CI:1.027-1.468,P=0).024),the Walswere 18.554,18.369,6.725,5.662,5.067,respectively.The 3 variables,age score,WIC score and SOFA score,were brought into the multivariate logistic regression equation 2,of which predicted probability was reserved too.It revealed that age score (OR=1.330,95％CI:1.145-1.546,P=0.000),WIC score (OR =1.496,95％ CI:1.145-1.546,P=0.000) and SOFA score (OR =1.429,95％ CI:1.303-1.567,P=0.000),were independently associated with the septic patients' 28-day prognosis.There was no significant difference in the area under receiver operating characteristic curve (AUC) between the SOFA score and APACHE Ⅱ score (0.784 vs.0.780,Z=0.014,P=0.989).However,compared with APACHE Ⅱ score,the AUC of equation 1 (0.888) and 2 (0.851) were much more (Z=4.333,P=0.000; Z=2.669,P=0.008).Conclusion The sensitivity of 28-day prognosis by WIC score was improved greatly with the combination of SOFA score and age score.

Objective To evaluate the value of 128-slice CT on locating the obstruction site of the upper airway in obstructive sleep apnea hypopnea syndrome (OSAHS)patients by three-dimensional reconstruction technology.Methods There were 52 patients with OSAHS diagnosed by the PSG and 32 cases of healthy volunteers in our hospital.All objects were performed 128-slice CT scan of the upper airway during awake state,and those patients’upper airways were scaned on Muller test.The airway volume of the ret-ropalatal region,retroglottal region and epiglottal region,and the total length of upper airway were measured,and statistical analysis of the each index was obtained.Results During awake state,compared with the control group,the length of upper airway in OSAHS patients increased significantly(P <0.001).Compared with the awake state,OSAHS patients’airway volume of the retropalatal region, retroglottal region and the total airway volume on the Muller test were reduced significantly(P <0.001).OSAHS patients’upper air-way length was correlated negatively to the average MSaO 2 (r=-0.33,P <0.05).Conclusion The three-dimensional reconstruc-tion of upper airway on 128-slice CT can evaluate the position and degree of the obstruction site in OSAHS patients’upper airway better,which has important significance to guide clinical treatment.

Objective To discuss the clinical diagnostic and guiding treatment value of changed positions of hyoid bonein the upper airway of patients with obstructive sleep apnea hypopnea syndrome. Methods 128-slice computed tomography was performed for 52 patients with severe OSAHS and 32normal healthy people to measure thehyoid bone in the upper airway in sober state and Muller maneuver. The correlationsbetweenthese indexes were analyzed under linear relation. Results (1)In comparison of the Muller maneuver with sober state , chinnodules and palatal plane to the hyoid in the OSAHS group were statistically higher than the healthy controlgroup (P < 0.001). (2)The distance of hyoid to chinnodules in the OSAHS group was significantlylonger and greater than that of the healthy control group (P < 0.001).(3)The distance of palatal plane to the hyoid was positively correlated with AHI , while thedistances of palatal plane andchinnodules to the hyoidwere both negatively correlated with MSaO2. Conclusion The changes ofhyoid positionare indicative for the clinical diagnosis and is helpful for the guidance of clinical treatment of OSAHS.

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.