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.

OBJECTIVETo assess the association of single nucleotide polymorphisms of hsa-miR-196a2, hsa-miR-149, hsa-miR-146a, hsa-miR-499 with susceptibility to ischemic stroke.

METHODSTaqman-PCR and DNA sequencing assays were employed to determine the genotypes of the 4 loci among 510 patients and 523 controls. And their association with the disease was assessed.

RESULTSAnalysis showed that smoking, diabetes, hypertension, BMI index and abnormal serum lipid metabolism were significantly associated with ischemic stroke, and that rs2910164 was significantly associated with the disease in codominant (CG vs. CC: P=0.002, OR=1.878, 95%CI=1.269-2.789), dominant (P=0.012, OR=1.325, 95%CI=1.110-1.580), recessive (P=0.008, OR=1.630, 95%CI=1.130-2.342) and allele (P=0.002, OR=1.449, 95%CI=1.210-1.731) genetic models. Stratified analysis further showed that the significant association only existed in population with smoking and hypertension. By contrast, no association was found between hsa-miR-196a2 rs11614913, hsa-miR-149 rs2292832 and hsa-miR-499 rs3746444 with the disease.

CONCLUSIONOur study indicated that smoking, diabetes, hypertension, fat and hyperlipidemia are risk factors for ischemic stroke. Hsa-miR-146a rs2910164 is significantly associated with the disease in those with smoking and hypertension in Dongyang region and may be involved in the process of the disease. The G allele G, GG and CG+GG genotypes of the locus may underlie the susceptibility to the disease in Dongyang region.

Aged ; Alleles ; Case-Control Studies ; China ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; MicroRNAs ; genetics ; Middle Aged ; Polymorphism, Single Nucleotide ; Stroke ; genetics