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.

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 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.

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 evaluate the effect of aldosterone (Ald) on glomerular mesangial cells apoptosis and to explore the possible mechanisms.Methods Twenty-four Sprngue-Dawley rats were subcutaneously embedded with osmotic mini-pumps and randomly divided into 3 groups.Aldosterone (1.5 μg/h) was administrated subcutaneouly by osmotic mini-pumps in Ald group,eplerenone (Epl,100 mg·kg-1·d-1) and Ald (1.5 μg/h) was given to Epl group.And normal saline was used in control group (Con group).Systolic blood pressure and urinary albumin excretion rate (UAER) were detected on day 0,7,14,21,28.Blood and kidney samples were harvested on day 28.Plasma creatinine,potassium and aldosterone were measured.Renal paraffin sections were stained by PAS and the morphological changes were evaluated by light microscopy.Apoptosis index of mesangial cells were detected by TUNEL assay.The glomerular mesangial cells (MCs) were cultured in a DMEM-F12 media.MCs apoptosis was evaluated by staining cells with Annexin V and propidium iodide (PI) using flow cytometer.Expression of Bcl-2 and Bax mRNA was examined by RT-PCR.The protein level of Bad or phospho-Bad was measured by Western blotting.Results Ald-infused rats developed hyperaldosteronemia and hypokalemia.Rats in Ald group exhibited significant hypertension and marked albuminuria.Ald group rats showed increased number of TUNEL-positive mesangial cells when compared with control rats (P＜0.05).Aldosterone induced mesangial cells apoptosis in a time-dependent manner.Expression of Bcl-2 mRNA was decreased but Bax mRNA was increased in aldosterone treated MCs compared to that in Con group (P＜0.05).Aldosterone promoted dephosphorylation of cytosolic phospho-Bad compared with vehicle treated cells (P＜ 0.05).However,eplerenone attenuated these effects of aldosterone.Conclusion Aldosterone directly promotes mesangial cells apoptosis,and eplerenone can attenuate this effect of aldosterone.Dephosphorylation of cytosolic phospho-Bad may be the key role in the progression of mesangial cells apoptosis induced by aldosterone.

BACKGROUND: Neuroprotective role of hypothermia on cerebral ischemic-reperfusional impairment has been long acknowledged. Since general hypothermia is complicated and unfit for observing postoperative consciousness and neurological function, it is of important significance to explore novel methods of focal cerebral hypothermia.OBJECTIVE: To study the neuroprotective effect of lateral ventricle infusion of low-temperature fluid on ischemic neurons of middle cerebral artery (MAC) occlusion models established on New Zealand rabbits.DESIGN: A randomized case-control study based on experimental animal models.SETTING: Neurosurgical department and pathological department of a general military hospital of Chinese PLA.MATERIALS: This study was carried out at Neurosurgical Laboratory of Nanjing General Hospital, Nanjing Military Area Command of Chinese PLA. Altogether 18 healthy New Zealand male rabbits, weighing from 2. 8 to 3.2 kg, were selected 4 - 6 months after birth, and randomly divided into occlusion group, hypothermia group and control group.INTERVENTIONS: Cerebral focal ischemic-reperfusional model was established on the New Zealand rabbits through MCA occlusion for 2 hours followed by reperfusion for 24 hours.MAIN OUTCOME MEASURES: Scores for neurological function, water content in the left and right brain, pathological changes of nerve cells in the left MCA supplying region.pothermia group, significantly higher than that in occlusion group(7.58 ± 0.58 )( P ＜ 0.01 ), but no significant difference could be observed in contrast with brain was(81.64 ± 0.82)% and (79.26 ± 1.30)% in occlusion and hypothermia groups with significant difference between them( P ＜ 0.05), and it was significantly different between the left side [ (81.64 ± 0. 82 )% ] and opyknosis and deep staining could be observed in nerve ganglion cells in occlusion group under optical microscope, but no obvious pathological changes were observed in MCA supplying brain regions in hypothermia group.CONCLUSION: Permanent infusion of low-temperature fluid into the lateral ventricle plays an important neuroprotective role by attenuating cerebral ischemic-reperfusional impairment and improving post-ischemic neurological functions.

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.

Clinical practice training is a interim curriculum of basic courses and clinical courses, medical university and hospital, which is an important part of medical education system. Clinical practice training teachers, as the main subject of teaching activity, is a key in guaranteeing a better teaching quality. Therefore, we should attach great importance to the construction of clinical practice training teachers, renewal of the idea of clinical practice training, training system and measures of clinical practice training teachers and the improvement of the management of clinical practice training