Invasive fungal disease(IFD) is one of the causes leading to death in intensive care unit,and now more likely to occur in non-neutropenic critically ill patients.Early diagnosis and appropriate selection of patients at high risk of IFD to receive prophylactic antifungal therapy are of great concern.Risk factors related to IFD were established by multivariable analysis and then risk evaluation models were developed.Candida score could accurately select patients who would benefit from early antifungal treatment.Evaluation and validation of risk models for non-neutropenic critically ill patients at high risk of IFD were reviewed in this article.

The prevalence of invasive pulmonary fungal infections (IPFIs) has increased in children,which becomes a clinical concern in recent years.With the availabilities of new diagnostic tools for fungi and more antifungal agents,children with IPFIs may achieve a much earlier diagnosis and treatment.This article reviewed the development of laboratory tests,diagnostic criteria,treatment strategies and commonly used antifungal agents for IPFIs.

Objective The national essential medicine select system is the core of Chinese medicine policy.How to select drugs fundamental for eyes scientifically is an important ring in establishing the Chinese essential drug system.The present study attempted to compare the National Essential Medicines List and National Essential Insurance List of China with that of the WHO in order to provide reasonable evidence for the adjustment of a new National Essential Medicines List of China. MethodsThe WHO Essential Medicine List (15th edition,Version in 2007),National Essential Medicine List (Version in 2009,China),2009 National Essential Medicine List Chemical Medicine Name (Version in 2009) and National Essential Insurance List of China (Version in 2004) were reviewed.The similarity and difference in the category and number of drugs in the National Essential Medicines List and National Essential Insurance List between China and WHO were compared and analyzed.A descriptive method was adopted to analyze the sorts and numbers of eye drugs in the lists mentioned above.The analysis of drug price was based on the summary sheet from Zhejiang Province. ResultsLittle difference was found in the numbers of eye drugs between the National Essential Medicines List of China and WHO Essential Medicines List.Differences in the sorts of eye drugs were observed in the lists,especially between the National Essential Medicines List of China and WHO Essential Medicines List.Except for levofloxacin,all of the drugs in the National Essential Medicine List of China were included in the National Essential Insurance List of China.ConclusionThe selecting principle and renewing procedure of the National Essential Medicines List and National Essential Insurance List of China should be further improved in China based on the list from WHO.More attention should be paid to the standard,dosage form,affordability,maneuverability etc.during the selecting procedure of eye essential drugs.

The paper analyzes the current situation of domestic second-tier hospitals from such perspectives as the allocation of nursing human resources, professional titles, the time needed to complete nursing tasks, and the actual number of nurse hours. It puts forward suggestions on the appropriate size and work load of the nursing force in domestic second-tier hospitals in the hope of providing empirical basis for revising the size of the nursing force in such hospitals.

Objective To analyze changes of DNA demethylation analysis of FOXP3 TSDR at the beginning of the secondary pulmonary tuberculosis patientsby utilizing real-time PCR technology.Methods To select 47 patients of secondary pulmona-ry tuberculosis as a research group from June 2014 to May 2015 and 40 healthy donors as a control group.The peripheral blood mononuclear cells (PBMC)of research group and control group were isolated.CD4+CD25+T cells were isolated from PBMC.Genomic DNA was isolated from CD4+CD25+T cells.PCR was performed in a final reaction volume containing dem-ethylation-specific primers.Plasmid standard was generated by PCR products were enzyme digestion,TOPO TA cloning,and recycling and purification.A real-time PCR system was established by quantitatively analyzing the specificity of FOXP3 TS-DR demethylation to treg (regulatory T-cell).Treg numbers of control group at week 0 and research group treated at week 0,week 2,week 4 and week 8 by using real-time PCR assay of the FOXP3 TSDR demethylation.The experimental data was analyzed by using SPSS 1 6.0 software.Results The M.tuberculosis in sputum of research group were positive by smear mi-croscopy,however the results of control group were negative.The treg frequency of control group,2+ group and 3+ group respectively was 1.63%±0.70%,1.96%±0.10% and 0.86%±0.21%,respectively.The difference between the treg fre-quency of control group and that of 2+ group by smear microscopy had not statistical significance,however which of 3+group was opposite.The average treg frequency of research group treated at week 0,2,4 and 8 respectively was at 1.05%, 2.04%,3.44% and 2.79%,range of which respectively was 0.32%~2.03%,0.95%~3.95%,2.35%~4.95% and 1.02%~4.27%,95% confidence interval of which respectively was (0.93%,1.18%),(1.85%,2.24%),(3.27%,3.61%) and (2.60%,2.98%).The treg frequency of difference between control group and research group at week 0 had statistical significance (t=4.669,P<0.05).The treg frequency was influenced by time of therapy,using One-Way ANOVA analysis (F=347.2,P<0.001,df=3,within-subjects Contrasts:F=407.4,P<0.001,df=3).Test of the treatment time and group interaction effect was linear (F=678.2,P<0.001,df=1).Conclusion DNA demethylation analysis of FOXP3 TSDR was high sensitivity and specificity in monitoring changes of treg at the beginning of the secondary pulmonary tuberculosis pa-tients.

Myelodysplastic syndrome (MDS) is characterized by dysplastic and ineffective hematopoiesis that can result from aberrant expansion and activation of myeloid-derived suppressor cells (MDSC) within the bone marrow microenvironment. The proliferation and activation of MDSC lead to the dysfunction and depletion of natural killer cells and CD8 + T cells, and the recruitment of inflammatory cells and factors leads to the further accumulation of genetic abnormalities in MDS patients, leading to the progression of MDS. The accumulation of inflammatory cytokines in the tumor environment induces the expression of programmed death receptor 1 (PD-1) in hematopoietic stem cells and hematopoietic progenitor cells and the overexpression of programmed death receptor ligand 1 (PD-L1) in MDSC, and the interaction of PD-1/PD-L1 leads to the apoptosis of MDS hematopoietic progenitor cells and ineffective hematopoiesis. The experiments and clinical studies targeting MDSC have confirmed that correcting or reversing the bone marrow microenvironment of immune disorders in MDS is a therapeutic strategy to restore effective hematopoietic function.

Objective To explore the effect of suledexide on renal injury and podocalyxin expression of podocytes in STZ diabetic desoxycorticosterone acetate (DOCA)-hypertensive rats. Methods Wistar rats were subjected to subcutaneous injection of streptozotocin(STZ), followed by uninephrectomy and subcutaneous administration of DOCA. Diabetic and hypertensive rats were randomly allocated to treatment with sulodexide or a combination of sulodexide and telmisartan for 8 weeks. Blood pressure (BP), 24-hour urinary albumin were measured every 2 weeks. Blood and urinary samples were collected to detect biochemical indexes of plasma and urinary β-acetyl-β-D-glucosaminidase (NAG) at the end of the study. Immunohistochemistry (IHC), RT-PCR and Western blot were performed to examine the expression and distribution of podocalyxin. Results STZ +DOCA-treated rats progressively developed hypertension, albuminuria and hyperglycemia. Hyperlipidemia and hypoinsulinemia were found in diabetic and hypertensive rats compared with controls. Albuminuia was significantly reduced in sulodexide group at week 8 and sulodexide plus telmisartan group at week 6 and week 8. Blood pressure decreased in sulodexide plus telmisartan group. No significant effects on lipid and glucose metabolism were observed in all treated groups. Histopathological index increased in STZ+DOCA-treated rats, but was significantly lower in sulodexide group as well as sulodexide plus telmisartan group. The number of podocytes on glomerular cross-section of the four groups were comparable. Segmental loss and down-regulation of podocalyxin were detected in STZ+DOCA-treated rats, which were greatly attenuated by sulodexinde, meanwhile, combination treatment preserved more podocalyxin expression in glomeruli than sulodexide monotherapy. Conclusion Sulodexide effectively reduces albuminuria, prevents loss of podocyte podocalyxin and alleviates renal damage in STZ diabetic DOCA-hypertensive rats.

The species of bromine and iodine in aerosol samples were extracted using ultra-pure water-ultrasonic method with different time in-length and pressurizing decomposition with dilute ammonia, respectively. The efficiency of extraction and the stability of bromine and iodine species were compared under different extraction) conditions. Results showed that(1) the efficiency of extraction using pressurizing decomposition, which might destroy some unknown form of organic iodine, was relatively higher than the one by ultrasonic method;(2) I~- was unstable in added standard cellular blank filter during ultrasonic assisted extraction for long time;(3) The optimum condition was ultra-pure water-ultrasonic assisted extraction for 5 min. Moreover), the suitability of glass microfiber filter(GF) and cellular filter(CF) during extraction for bromine and iodine) species in aerosol was also compared, which indicated that GF is favorable for species analysis than CF under different kinds of extraction conditions. Based upon the extraction results, HPLC-ICP-MS approach was developed to analyze bromine and iodine) species in atmospheric aerosol. The total iodine, bromine and species in the aerosol samples collected in Hefei were then determined accordingly. The levels of total bromine and iodine) in Hefei aerosols were 883 and 231 pmol/m~3, respectively. Br~- was found to be dominant species with 68%, while BrO_3~- was undetectable. 70% of total iodine occurred as unidentified forms including soluble organic) iodine and insoluble iodine.

Objective To summarize theskill practice as the coremethods and training effect in tumor specialist nurse training , and to explore the suitable effective methods and pattern of China′s national conditions of specialist nurse training in China, for providing a reference for conducting cancer specialist nurse training. Methods Reviewed and analyzed tumor specialist nurse training method to make clear the training effect from 2012 to 2013, 100 students was investigated by using questionnaires , which contain 15 aspects, before and after the training respectively. designskill practice as the coreof the training content (160 hours) and theoretical classes (80 hours), established training evaluation criteria and the organization management system. Results All 100 students had grasped maintenance technology, observation of the complications of treatment, infusion port of the maintenance, the use of chemotherapy drugs, health education for patients with PICC catheter, and the use of effective order, the grasp rate was 100%. Complications rate was decreased significantly after using PICC catheter, (the rate of catheter related blood stream infections and the rate of thrombosis was reduced from the top 35%and 12%before training to 4%and 1%after training respectively (P<0.05). Conclusions In order to train more practical clinical nurse specialists, reduce the complications, raise the overall level of nursing profession, and improve the quality of nursing after using PICC catheter. Skill practice as the core methods in tumor specialist nurse training should be advocated.

Objective To evaluate the clinical effect of CEREC chairside on atypical porcelain inlay restoring class [[cavity.Methods 30 patients that required re-treatment because of resin restoration failure and early posterior proximal caries were selected randomly.The original fillings,secondary carious tissues and undercut parts were removed.The clear and round edge lines were prepared.With Sirona CEREC Blocs,35 atypical ceramic inlays were produced in accordance with CEREC AC CAD/CAM standard procedures.After clinical trial and modification,the inlays were bonded with 3M Veneer resin adhesive cement.Evaluation was done immediately and 3,6,12 and 24 months after restoration.Two senior prosthodontists did the evaluation according to the modified USPHS criteria.Results The evaluation results were all A when estimated immediately after restoration.None inlay falled off during the first two years.However,3 inlay were found to be damaged when reviewed at the 24th month.There exsited two patients having mild symptoms of dentine hypersensitivity which appeared at the beginning and died out gradually.Generally speaking,more than 90％ of inlay restorations had reached the USPHS criteria A.Color match and retention represented better effects.Conclusions CEREC atypical ceramic inlays can effectively restore Class Ⅱ cavity,short-term effect is good,but long-term effect still needs further observations.