Objective To investigate the epidemiological characteristics of nosocomial fungal infections in severe sepsis patients and analyze the influencing factors by logistic regression.Methods The clinical data of 578 patients with severe sepsis admitted to our hospital from January 2008 to January 2016 were retrospectively analyzed.The epidemiological characteristics were investigated.The possible influencing factors of nosocomial fungal infection were analyzed by univariate analysis and multivariate logistic regression analysis.Results Among 578 cases of severe sepsis,215 cases were accompanied by nosocomial fungal infection (infection rate 37.20％).The infection sites were mostly lungs and the fungal types were Candida albicans.The prognosis of the patients was poor.The survival time was less than 90 days,accounting for 42.33％ (91/215).There were significant differences in age,length of stay in intensive care unit (ICU),duration of more than two antibiotics,use of ventilators,hormones,invasive procedures,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score between the infected group and the uninfected group (P ＜ 0.05).The danger degree from high to low of the risk factors were ICU stay ≥ 100 h (OR =5.697),use respirator (OR =5.388),invasive operation (OR =4.987),age ≥65 years (OR =4.584),and continuous use of two antibiotics ＞ 7 d (OR =3.287),use steroid (OR =2.141).Conclusions Severe sepsis with hospital acquired fungal infection is more common in the lung,and most of them are Candida albicans infection,with poor prognosis and high mortality.ICU stay ≥ 100 h,use respirator and steroid,invasive operation,age ≥65 years,and continuous use of two antibiotics ＞ 7d are risk factors.Specific preventive measures should be taken to reduce fungal infections.

Objective To explore the effect of Shuanglu Tongnao Formula on neuronal ferroptosis in ischemic stroke rats and its regulatory mechanism on the silent information regulator 2 homolog 1(SIRT1)/nuclear factor erythroid 2-related fac-tor 2(Nrf2)/glutathione peroxidase 4(GPx4)signaling pathways.Methods Twenty rats were selected as sham operation group by the random number table method,and the remaining seventy rats were made ischemic stroke rat models by the middle cerebral artery occlusion method.The rats that had been successfully modeled were randomly divided into the model control group,Shuanglu Tongnao formula group,Shuanglu Tongnao formula+SIRT1 inhibitor group(Shuanglu Tongnao formula+EX527 group),with 20 rats in each group.After 14 days,the rats were scored for neurological injury;TTC staining was applied to detect the area of cerebral infarction in rats;HE staining was applied to detect pathological changes in rat brain tissue;Nissl staining was applied to detect the number of neurons in rat brain tissue;the kit was applied to detect the levels of ferri ion(Fe2+),superoxide dismutase(SOD),glutathione(GSH),and malonaldehyde(MDA)in rat brain tissue;immunohistochemistry was applied to de-tect the positive expression of acyl-CoA synthetase long-chain family member 4(ACSL4),transferrin receptor(TFR),and ferritin heavy polypeptide 1(FTH1)proteins in rat brain tissue;Western blotting method was applied to detect the expression of SIRT1,Nrf2,GPx4,and cystine/glutamate antiporter solute carrier family 7 member 11(SLC7A11)proteins in rat brain tissue.Results Compared with the sham operation group,the neurological deficit score,cerebral infarction area,the contents of Fe2+and MDA,and the protein expressions of ACSL4 and TFR in model control group were increased(P<0.05);the number of neurons,the con-tents of SOD and GSH,the protein expression of FTH1,SIRT1,Nrf2,GPx4,and SLC7A11 were all reduced(P<0.05).Compared with the model control group,the neurological deficit score,cerebral infarction area,the contents of Fe2+and MDA,and the protein expression of ACSL4 and TFR in the Shuanglu Tongnao formula group were reduced(P<0.05),and the number of neurons,the contents of SOD and GSH,the protein expressions of FTH1,SIRT1,Nrf2,GPx4,and SLC7A11 are all increased(P<0.05).The results of the SIRT1 inhibitor supplementation experiment showed that the SIRT1 inhibitor reversed the inhibitory effect of Shuan-glu Tongnao formula on neuronal ferroptosis,while also inhibited the expression of Nrf2 and GPx4(P<0.05).Conclusion The Shuanglu Tongnao formula may inhibit neuronal ferroptosis in ischemic stroke rats by activating the SIRT1/Nrf2/GPx4 signa-ling pathway.