OBJECTIVE To investigate the risk factors of fungal ventilator associated pneumonia(FVAP) and the characteristic of pathogenic fungi.METHODS Thirty seven VAP patients were divided into FVAP group and nonfungal ventilator associated pneumonia(NFVAP) group.Risk factors were compared between the two groups and the characteristic of pathogenic fungi was analyzed.RESULTS Compared to the NFVAP group,the FVAP group showed a significant higher rate in systemic usage of glucocorticosteriod and combined application of antibiotics.The cases of FVAP appeared frequently over the period since 7th to 14th days after intubation.Twelve strains of fungi were isolated from the sputum of patients in FVAP group.Ten strains(83.3%) of the isolates belonged to Candida species included(C.albicans 6 strains(50.0%),C.tropicalis 2 strains(16.7%),C.krusei 1 strain(8.3%),and C.parapsilosis 1 strain(8.3%),and 2 strains(16.7%) of the isolates belonged to Aspergillus.CONCLUSIONS The rate of tracheal intubation should be decreased and the time of mechanical ventilation should be shortened to avoid FVAP.Identifying the strains of fungi and their sensitivity are useful to direct the treatment.

Purpose:To study the clinical characteristics and therapy of acquired fungemia in acute leukemia patients. Methods:Retrospective analysis of the clinical characteristics and therapy of 34 acquired fungemia patients from 127 acute leukemia patients was done. Results:52 fungus strains were isolated from the blood culture of 34 acquired fungemia patients. Monilia was the main pathogen (92.4%). 24 fungemia patients also had bacteremia and the percentage was (70.6%). The overall mortality rate was 55.7% .The mortality rate of fungemia and fungemia together with bacteremia were (23.5%) and 76.4% respectively. The effective rates were 70.8% for diflucan treated group, 66.7% for the liposome treated group, and 75% for the combined treatment group respectively. Conclusions:Fungus infection has been one of the main causes of death in acute leukemia patients. So timely monitoring of the fungus infection and appropriate antifungal therapy have become the principle management to reduce the incidence rate and mortality rate of fungemia in acute leukemia patients. Diflucan and liposome are still effective antifungal drugs.

ObjectiveTo evaluate the diagnostic performance of bone SPECT and CT fusion imaging in bone metastases from pediatric neuroblastoma.MethodsTwenty-four pediatric patients with neuroblastoma were included in this retrospective study.All patients underwent planar imaging and SPECT integrated with CT.Lesion visibility,diagnostic certainty and diagnostic performance were evaluated with KolmogorovSmirnov test andx2 test.ResultsLesion visibility of SPECT alone,SPECT integrated with CT were significantly better than that of planar imaging ( both H =69.000,P ＜ 0.05 ).SPECT and CT fusion imaging,SPECT alone both detected five more bone lesions than planar bone imaging (77 vs 72).The diagnostic accuracy of SPECT imaging (62.34％,48/77 )was significantly higher than that of planar imaging (45.45％,35/77; x2 =4.416,P ＜ 0.05 ).The sensitivity,specificity and accuracy of SPECT and CT fusion imaging for diagnosing malignant bone lesions were significantly higher than those of planar imaging:82.35％ (42/51) vs 53.19％ ( 25/47),88.46％ ( 23/26 ) vs 40.00％ ( 10/25 ),84.42％ ( 65/77 ) vs 45.45％ (35/77 ; x2 =12.571,14.016,25.667,all P ＜ 0.01 ).The diagnostic specificity and accuracy of SPECT and CT fusion imaging were significantly higher than those of SPECT alone ( 53.85％,14/26 ;62.34％,48/77) (x2 =7.589,9.606,both P ＜0.01 ).However,there was no significant difference of sensitivity between the two methods (x2 =2.942,P ＞ 0.05 ).Diagnostic certainty by SPECT and CT fusion imaging was significantly higher than that by SPECT alone ( H =28.000,P ＜ 0.05 ) and by planar imaging (H =21.000,P ＜ 0.05).ConclusionSPECT and CT fusion imaging can detect more bone lesions in patients with pediatric neuroblastoma.It is helpful for diagnosing bone metastases from pediatric neuroblastoma.

0.05).CONCLUSIONS Levofloxacin 500mg orally administered is effective in the treatment of acute suppurative tonsillitis.

Animals ; Disease Models, Animal ; Female ; Interferon-gamma ; therapeutic use ; Lung ; drug effects ; pathology ; Random Allocation ; Rats ; Rats, Wistar ; Silicosis ; classification ; drug therapy ; Treatment Outcome

BACKGROUND:Drainage has been applied as a routine to hip and knee replacement surgery. However, as a potential channel, drainage could become a portal for bacteria and other pathogens to invade the joint cavity. OBJECTIVE:To evaluate the clinical significance and safety of drainage in total knee arthroplasty.
METHODS:The 80 patients were prospectively randomized into two groups:Group 1 included 38 patients with wound drainage;Group 2 included 42 patients without any drainage. According to a formula calculation, blood loss, the number of subjects requiring blood transfusion, volume of blood transfusion, complications and the recovery of function after total knee arthroplasty were statistical y analyzed.
RESULTS AND CONCLUSION:The subjects were fol owed up for 2 years after discharge. Two patients lost to fol ow up in the non-drainage group. 78 patients were involved in the result analysis. The total blood loss, the number of subjects requiring blood transfusion and volume of blood transfusion were more in the drainage group than those in the non-drainage group after surgery. At 3 days after arthroplasty, active range of motion was larger in the drainage group than that in the non-drainage group. No significant differences in hemoglobin levels and Keen Society Score scores were detected after arthroplasty between the two groups. Results suggested that draining wil increase the blood loss and blood transfusion, but it may contribute to the early recovery of knee function. No significant differences in long-period Keen Society Score scores and postoperative complications were detectable between the two groups.

Objective To observe the effect of iodine deficiency and hypothyroidism on the protein expressions of calcineurin in the hip-pocampus of pups. Methods Female Wistar rats (n=28) after pregenancy were randomly divided into control group,hypothyroid group and iodine deficient group. According to the dose of propylthiouracil (PTU) in the fed water, hypothyroid group was divided into 5 ppm group and 15 ppm group (7 rats in each group). Totally 5 pups from each group were sacrificed and perfused intracardially in postnatal day (PN) 7,PN14 and PN21. Brains were removed,fixed and sectioned coronally. All sections were observed and analysed for the protein exression of calcineurin by immunohistochemistry in the hippocampus CA1,CA3 and DG regions. Results In PN14 and PN21,protein levels of cal-cineurin in GA1 and CA3 regions of the hippocampus in iodine-deficient and 15 ppm treatment groups were significantly higher than those of the controls (P< 0.05) and in DG region,the contrary was true. In PN7,the positive products were scarely observated in each region and the protein expression was no significantly different in all four groups. Conclusion Iodine deficiency and hypothyroidism may increase the protein expression of calcineurin.

Objective To investigate the value of modified loop ileostomy in laparoscopic low and superlow radical resection of the rectal cancer with reservation of anus.Methods The clinical data of 108 patients who received laparoscopic low and super-low radical resection of rectal cancer with preservation of anus at the Subei Hospital of Jiangsu Province from January 2010 to June 2012 were retrospectively analyzed.Fifty-three patients who received preventive ileostomy were in the ileostomy group,and 55 patients who did not receive preventive ileostomy were in the non-ileostomy group.The operation,incidence of complication and follow-up of the 2 groups were analyzed.All data were analyzed using the t test,chi-square text or Fisher exact test.Results The operation time and blood loss were (185 ± 14)minutes and (31 ± 26)ml in the ileostomy group,and (154 ± 12)minutes and (28 ± 19)ml in the non-ileostomy group,with no significant difference between the 2 groups (t =2.34,1.82,P ＞ 0.05).The time to first flatus,time to liquid diet intake,time to pelvic drainage tube removal,duration of hospital stay,hospital costs were (1.1 ± 0.3) days,(1.1 ± 0.2) days,(5.2 ± 1.0) days,(7.2 ± 1.4) days,(3.0 ± 0.2) ×104 yuan in the ileostomy group,and (4.2 ± 0.6) days,(4.3 ± 0.6) days,(8.4 ± 3.9) days,(12.9 ±4.4)days,(3.8 ±0.7) × 104 yuan in the non-ileostomy group,with significant differences between the 2 groups (t =7.25,28.12,15.34,34.01,7.83,P ＜ 0.05).The incidences of postoperative complications and anastomotic fistula were 5.7％ (3/53) and 0 in the ileostomy group,and 21.8％ (12/55) and 12.7％ (7/55) in the non-ileostomy group,with significant differences between the 2 groups (P ＜ 0.05).Conclusion Modified loop ileostomy in laparoscopic low and super-low radical resection of rectal cancer can effectively reduce the incidence of anastomotic fistula,and helps the recovery of patients.

OBJECTIVE To investigate the isolation and drug resistance of Chryseobacterium spp in our hospital,and to explore the mechanisms of drug resistance.METHODS Bacteria were identified in our hospital for the last five years(Jan 2001-Dec 2005) and the antimicrobial susceptibility was tested by Kirby-Bauer plate dilution method.Forty-three isolates of C.meningosepticum,16 isolates of C.indologenes and 10 isolates of C.gleum were isolated and selected for further studies.Minimum inhibitory concentrations(MICs) against 14 antibiotics were determined by the agar dilution method.Extended-spectrum ?-lactamase(ESBL) and carbapenemase were detected by three-dimensional test and 2-mercaptopropionic acid inhibitory test.RESULTS One thousand and one hundred twenty-eight Chryseobacterium and others strains in total were isolated during the described period.Among them C.meningosepticum,C.indologenes,C.gleum,and other Chryseobacterium species were 88.3%,8.0%,2.9%,0.6% and 0.2%,respectively.The resistant ratios against antibiotics containing enzyme inhibitors were lower than other antibiotics.The MIC50 and MIC90 against most antibiotics were high except for quinolones.As for carbapenemase,the positive rate was 60.5%,68.8% and 90.0% in C.meningosepticum,C.indologenes,and C.gleum,respectively.CONCLUSIONS Chryseobacterium are highly resistant against a variety numbers of antibiotics.Nevertheless,there exists a significant difference in the resistance against different antibiotics for different species of Chryseobacterium.The major drug resistant mechanism in Chryseobacterium is due to the production of ?-lactamases,especially metallo-?-lactamases.

Dystonia is a common movement disorder characterized by abnormal gestures and involuntary movement as a result of incoordinate contraction of agonistic and antagonistic muscles.The underlying pathogenesis is very complicated and there are various clinical manifestations.The recent findings in genetics and clinical features of primary dystonia,dystonia-plus syndrome and heredodegenerative dystonia are introduced in this paper.