The incidence of invasive fungal infection in critically ill patients is increasing year by year. Its clinical manifestation lacks specificity which is difficult for early diagnosis. It′s hard to identify inva-sive fungal infection with fungal colonization in clinical practice. We need to find out the way to distinguish them.

Objective To investigate the current work situation of senior clinical nurses to provide some advices for the nursing management .Methods The self-made questionnaires were adopted to investigate the work situation of 60 senior nurses for conduc-ting the descriptive analysis .Results The senior nurses′ satisfaction degrees to the professional self -identity ,the chief nurse′s scheduling ,the current work environment ,the approval by hospital and the emphasis degree by the department were not high .They thought that the suitable position for them was the office nurse and the second was the responsibility group leader .Whereas ,the un-dertaking key post at present was the responsibility group leader and the second was the office nurse .Conclusion Due to the partic-ularity of nursing work and the physiological and psychological change ,the senior nurses are unsuitable to the busy front -line work ;the senior clinical nurses have the rich clinical experience ,the stronger communicational and organizational coordination abili-ty ,and are more suitable for the posts of the office nurse and health education nurse ,and second is the post of responsibility group leader .

OBJECTIVE Making knowledge of the marine medication animal species distribution and the resource situation in Zhoushan sea area. METHODS According the experiment explored, the marine animal specimen collected, checked, corrected. RESULTS There were about 103 species marine animal for medicating, included 4 species of Coelenterata, 3 species of Annelida, 14 species of Arthropoda, 21 species of Mollusca, 55 species of Vertebrata, 6 species of Echinodermate . CONCLUSIONS The reliable base of protecting ecological environment of marine organisms and exploiting resources of marine medicinal animals rationally were founded.

Objective To investigate changes in cerebral white matter after transplantation of neural stem like cells (MS-NSCs) derived from the bone marrow mesenchymal stem cells, in rats with severe acute carbon monoxide poisoning. Method Forty Sprague-Dawley rats weighing 200 ～ 250 g were divided randomly into 4 groups: the normal control group, the poisoned control group, the BMSCs transplanted group and the MS-NSCs transplanted group (each group 6 rats). BMSCs were harvested from whole bone marrow in vitro, and then differentiated into MS-NSCs under the cock tail of certain growth factors, followed by BrdU labelling. The seed cells were infused into the brain via the left internal carotid artery 24 hours post poisoning. Remodelling of cerebral white matter was assessed using H & E staining, myelin staining and immunohistochemitry assay after 5 weeks later. Results Cellular transplantation improved the compactness and orderliness of cerebral white matter. BrdU-positive cells were found in the focal insulted areas of sparse white matter; and greater numbers of Brdu-Positive ceus were observed in the MS-NSCs group thar in the BMSCs group (P ＜0.05). Conclusions MS-NSCs participates in the remodeling of cerebral white matter in rats with severe acute carbon monoxide poisoning, and shows promising evidence as seed cells transplanted for brain tissue regeneration.

Objective To investigate cerebral functional remodeling of the rat with severe acute carbon monoxide poisoning transplanted with neural stem-like cells derived from bone marrow mesenchymal stem cells (MS-NSCs) . Method Forty Sprague-Dawley rats weighing 200 ～ 250 g were divided randomly into 4 groups: the normal control group, the poisoning control group, the bone marrow mesenchymal stem cells(BMSCs) transplantation group and the MS-NSCs transplantation group. BMSCs were harvested from whole bone marrow in vitro, then were differentiated into MS-NSCs under certain growth factors cocktail,and were followed by BrdU labelling.Twenty-four hours after poisoning, the seed cells were infused into brain via left internal carotid and the functional remodeling of cerebrum was assessed by neurological severity score(NSS) and Morris water maze(MWM) tests. Results There was no significant differences in NSS test between groups after transplantation. However, the differences in MWM test were very significant between 5 weeks after transplantation ( P < 0.01). Conclusions Transplantation of MS-NSCs may improved cerebral function of rats after severe acute CO poisoning. Moreover, the cultured and idfferentiated MS-NSCs induced in vitro preliminarily is potentially more efficient than directly transplanted BMSCs without culture and differentiation.

Objective To study the echocardiographic characteristics and its diagnosis value on congenital supravalvular aortic stenosis (SVAS) in children. Methods Thirty-one patients with SVAS diagnosed by multiplane echocardiography were enrolled in the study. Their echocardiographic characteristics were compared with cardiac catheterization, operation, and gene detection results. Echocardiographic changes were mainly observed in aortic valve, supravalve, descending aortic arch, pulmonary artery valve, main pulmonary artery and its branches,and coronary artery. Results Of the 31 patients,26 had hourglass type SVAS,4 hypoplastic type,and 1 membranous type; 2 patients had extremely mild stenosis (defined as a Doppler gradient <25 mm Hg) ,20 mild (25～49 mm Hg) ,5 moderate (50～75 mm Hg) ,and 4 severe C>75 mm Hg) ones. Nineteen patients were diagnosed with Williams syndrome by gene detection. Three patients were associated with aortic valve stenosis including one missed at the initial diagnosis; 10(32.26%) patients with pulmonary stenosis, including pulmonary valve stenosis in 6, left and right pulmonary artery stenosis in 3 ,and branch stenosis in 1:6 patients with coronary stenosis. Conclusions The sternal border and five chamber apical views are the best to detect SVAS. Williams syndrome patients are prone to SVAS.Pulmonary stenosis echocardiography forms a great proportion of the SVAS patients. Routine examination is necessary for coronary stenosis in cases of SVAS.

Objective Calcium-sensing receptor(CaSR)belongs to the family C of G-protein coupled receptors.This study was carried out to observe the influence and mechanism of CaSR on anoxia/reoxygenation(A/R)-induced cardiomyocytes apoptosis.Methods The model of A/R injury was established through anoxia for 2 hours and reoxygenation for 24 hours in cultured cardiomyocytes of neonatal rats.Cardiomyocytes were randomly divided into three groups:control group,A/R group and GdCl3 group(300μmol/L GdCl3 was added to the culture medium at the beginning of reoxygenation).Apoptosis of cardiomyocytes was assessed by 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL).The expression of CaSR,cysteine-requiring aspartate protease(caspase)-3,9 and cytochrom c (Cytc)were analyzed by Western blot.Results The TUNEL showed that cardiomyocytes apoptosis was 17%±3% in A/R group,and was higher than that in the control group.At the same time,expression of CaSR in A/R group was markedly increased in response to control group.Compared with A/R group,GdCl3,a specific activator of CaSR,further enhanced cardiomyocytes apoptosis to (28±4)% and decreased the ability of cardiomyocytes to (51.2±6.8)%,along with an increment in CaSR,caspase-3,caspase-9 and Cytc expressions.Conclusion CaSR is involved in anoxia/reoxygenation-induced apoptosis of neonatal rat cardiomyocytes through Cytc-caspase-3 pathway.

OBJECTIVE:To optimize the extraction technology of Paeonia lactiflora. METHODS:The surface figure made by mixed uniform design combined with the quadratic polynomial stepwise regression equation is adopted to optimize the extraction technology of P. lactiflora by using the content of paeoniflorin as index,with extraction solvent,the amount of extraction solvent, extraction time,extraction times as factors. RESULTS:The optimal extraction technology of P. lactiflora was as follows as 90%ethanol,12-folds extraction solvent,extracting for 150 min,extracting for 2 times. The measured value of 3 validation tests were 2.848 4%,2.795 7%,2.841 9%(RSD=0.82%,n=3),which was close to the predicted value 2.848 4%. CONCLUSIONS:The method is convenient and accurate,and can be used for the extraction of P. lactiflora.

Objective To explore risk factors for coronary artery aneurysms (CAA) in children with Kawasaki disease (KD),and reduce the rate of serious sequelae of cardiovascular diseases.Methods All the patients were diagnosed as KD in Children’s Hospital Affiliated to Medical College of Zhejiang University from January 2009 to January 2014.A total of 679 cases was included,and 42 with concurrent CAA,181 with concurrent coronary artery expansion (CAD),and 456 without coronary artery damage cases (non-coronary artery lesion,NCAL).Coronary artery damage was related to factors such as gender,age,fever,white blood cell count (WBC),hemoglobin (Hb),platelet count (PLT),erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),alanine aminotransferase,serum potassium,plasma amino terminal brain natriuretic peptide precursor (NT-proBNP),and acrylic ball resistance.SPSS 18.0 software package was used for risk factor analysis.Qualitative data using chi-square test,was used to analyze the high risk factors of CAA group,and logistic multivariate regression analysis was also used.Results Chi-square test showed that male,with febrile days ＞ 14 d,NT-proBNP ≥ 1 000 ng/L,immunoglobulin resistance was more likely to have KD concurrent CAA (P ＜ 0.05).Multiple Logistic regression analysis showed that male [OR =4.092,95％ CI (1.514,11.060),P =0.004],febrile days ＞14 d [OR =12.436,95％ CI (4.599,33.631),P =0.000],NT-proBNP≥ 1 000 ng/L [OR =3.305,95％ CI (1.401,7.794),P =0.005],and immunoglobulin resistance [OR =3.842,95 ％ CI (1.562,9.453),P =0.000] were independent risk factors for KD concurrent CAA.Conclusions Male children,febrile days ＞ 14 d,NT-proBNP≥ 1 000 ng/L,and immunoglobulin resistance were independent risk factors of CAA.

Objective To explore the value of echocardiography in the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in children.Methods The echocardiographic images of 14 patients with ALCAPA confirmed by operation and 18 patients with endocardial fibroelastosis (EFE) diagnosed by clinical were compared and analyzed.Results Both ALCAPA and EFE exhibited obvious dilated left ventricle,decreased left ventricular systolic function,thick endocardium and mitral regurgitation of different degree.The former additionally showed dilated right coronary artery(RCA) with normal origin,left coronary artery(LCA) emerging from the root or wall of the pulmonary artery(PA),the retrograde flow into PA in LCA and abundant collateral vessels in myocardium.However the later exhibited normal diameter of LCA and RCA and no collateral vessels.Conclusions Color Doppler echocardiography not only demonstrates left ventricular systolic function,endocardium,mitrial regurgitation and collateral vessels in myocardium,but also shows the origination and courses of LCA clearly,which provide exact informations to diagnose ALCAPA.The echocardiography can be used as a powerful tool of ALCAPA diagnosis and preoperative assessment.