Objective To investigate clinical features,pathogen distribution and prognostic risk factors of candidemia in patients from non-intensive care unit (ICU) wards.Methods Seventy two patients with blood culture-confirmed candidemia were admitted in non-ICU wards in the First Affiliated Hospital of Zhejiang University during January 1 st 2011 and January 31 th 2014.The clinical data of patients,including clinical features,pathogen distribution,treatment and prognosis were retrospectively analyzed.The risk factors for the infection and the fatality of patients were assessed by chi-square test,Fisher exact probability test and multivariate Logistic regression analysis.Results Among 72 patients with candidemia,29 (40.28％) were related to Candida albicans and 43 (59.72％) were related to non-Candida albicans.Univariate analysis showed that elderly people (x2 =6.109,P ＜ 0.05),male (x2 =5.258,P ＜ 0.05),solid tumor (x2 =7.186,P ＜ 0.01),parenteral nutrition (x2 =6.512,P ＜ 0.05),surgery within 30 d (x2 =4.284,P ＜ 0.05),indwelling gastric tube (x2 =4.164,P ＜ 0.05),and indwelling urethral catheter (x2 =3.952,P ＜ 0.05) were risk factors of Candida albicans-related candidemia;while patients with hematologic malignancies (P ＜ 0.0l) and neutropenia (P ＜ 0.05) were prone to non-Candida albicansrelated candidemia.Fourteen cases died within 28 days from the diagnosis of candidemia with an overall 28-d fatality rate of 19.44％.Multivariate Logistic regression analysis indicated that septic shock(OR:84.818,95％ confidential interval:3.560-2020.567,P ＜ 0.01)and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score (OR:1.252,95％ confidential interval:1.035-1.515,P ＜ 0.05) were independent risk factors of death,while removal or replacement of central venous catheter (OR:0.002,95 ％ confidential interval:0-0.135,P ＜ 0.01) was a protective factor.Conclusions There are more non-Candida albicans-related candidemia than Candida albicans-related candidemia in non-ICU wards.Patients with high APACHE Ⅱ score and septic shock usually have poor prognosis,while removal or replacement of central venous catheter may improve the prognosis.

This paper presented the effects of experimental hyperinsulinemia on the main apolipoproteins (At, B) and on tbe process of reverse cholesterol transport in rabbit, which consisted of 1) uptake of cholesterol from peripheral tissue by HDL; 2) cholesterol esterification and 3) cholesterol ester transfer. The results showed that insulin could significantly decrease both serum and lymph Apo A1 levels and inhibit all the three steps of reverse cholesterol transport. The larger the dose of insulin, the greater the effects. Apo B did not seem to be influenced by insulin. It was further demonstrated by a series of statistical analyses that insulin had both direct and indirect inhibitory actions, to different extent, on each of the three main steps of reverse cholesterol transport.

Objective To discuss the therapeutic methods and strategies of fractionated embolization in treating large cerebral arteriovenous malformation (cAVM). Methods During the period from May 2005 to May 2013 at authors’ hospital, endovascular fractionated embolization was performed in 35 cases with large cAVM. The lesions were located in the frontal lobe (n = 11), the parietal lobe(n = 8), the temporal lobe (n = 6), the occipital lobe (n = 4), the lateral temporal area (n = 2) and the deep white matter and basal ganglia (n = 4). The longest diameter of the lesions was 6 - 12 cm, with a mean of 7.23 cm. The number of supply vessels was 2 - 5. The lesions were drained by superficial veins in 13 cases, by deep veins in 9 cases and by both superficial and deep veins in 17 cases. The exit stenosis of the draining vein was seen in 3 cases, while the dilatation of the draining vein was found in 6 cases. Angiography showed that the lesions were situated at the right side in 16 cases and at the left side in 19 cases. Results A total of 297 times of embolization operating-process were carried out in the 35 patients, of which NBCA was used in 107, ONYX in 153 with, FuAiLe medical adhesive in 15, combination use of NBCA and ONYX in 9 and combination use of ONYX and FuAiLe medical adhesive in 13. No death occurred after treatment. After the first embolization, the residual malformation volume usually decreased to < 50%. The interval between the first and the second embolization was 1 - 3 months. Generally, two to four times of embolization were performed in each patient. Complete occlusion of the lesion was obtained in 26 cases, and sub - complete occlusion of the lesion (> 80%embolization) in 9 patients. Good recovery was achieved in all patients. After fractionated embolization, the volume of the cAVMs was decreased gradually and ultimate clinical cure was achieved, which laid the foundation for conducting further micro - neruosurgery or radiation therapy. Conclusion For the treatment of large cerebral arteriovenous malformation, fractionated embolization has reliable therapeutic effect. Therefore, this technique should be recommended in clinical practice.

Cardiac Pacing, Artificial ; Electrodes, Implanted ; Female ; Humans ; Middle Aged ; Postoperative Complications ; etiology ; Subclavian Artery ; injuries ; Treatment Outcome

Adolescent ; Defibrillators, Implantable ; Female ; Humans ; Long QT Syndrome ; therapy

Adult ; Catheter Ablation ; methods ; Humans ; Male ; Sinus of Valsalva

Objective:To investigate the regulation of acupuncture on γ-interferon (INF-γ) and tumor necrosis factor (TNF) of lung cancer-operative cases. Methods: to determine the INF-γ and TNF contents in the blood serum of lung cancer patients by double antibody sandwich immuno-enzymatic method (ELISA); to measure the INF-γ and TNF contents of 30 lung cancer patients in the acupuncture anesthesia group and 30 lung cancer patients in general anesthesia group before the operation and at the 8th days, the 12th day after the operation respectively and make comparison between the two groups. Results:The pre-operation INF-γ contents of the two groups showed no significant difference (P＞0.05); the post-operation INF-γ contents of the two groups showed significant difference at 8th day and 12th day after the operation (P＜0.05); the acupuncture anesthesia group was superior to the general anesthesia group; the self-comparison of the anesthesia group showed significant difference at the 12th day and 8th day after the operation (P＜0.05); the pre-operation TNF contents of the two groups showed no significant difference (P＞0.05) and the post-operation TNF contents of the two groups showed significant difference at the 8th day and 12th day after the operation (P＜0.05). Conclusion:Acupuncture can increase the serum INF-γ and TNF contents of lung cancer patients and therefore regulate the immunity of the patients.

Objective To evaluate the role of multidetector CT(MDCT) and high magnetic field MRI in diagnosis of small cystic-solid renal mass. Methods Fifty-two cases with small renal cystic-solid mass(≤3 cm) were consecutively collected,including small cystic-solid renal cell carcinoma(n=25),carcinoid(n=1),complex cysts(n=16),small angiomyolipoma(n=7) and benign cystic nephroma(n=3).All were examined by both 1.5T MRI and multidetector CT at intervals between 3 days and 2 months. Results All cases were proved by pathology.Multi-planar reconstruction techniques were useful for MDCT in differentiating small cystic-solid renal mass,with the sensitivity of 98.1%,which was as high as MRI.However,the accuracy for MDCT was 71.2%,significantly lower than that of MRI(90.4%)(P=0.001).MRI helped to identify the components and structure of renal masses,and behaved better in the detection of pseudo-capsule of renal cell carcinoma(57.7%).Conclusion High magnetic field MRI may play an important role in the diagnosis of small renal cystic-solid masses,and it may be feasible as a noninvasive examination when CT can not make the ultimate determination.

Objective To analyze the epidemiographic features of malignant tumors of urinary system in renal allograft recipients in our center.Methods A retrospective analysis was performed on 3150 patients who received renal transplantation between June 1978 and Autumn 2006.Twelve cases of urinary tumors were selected for study.Results Among 3150 recipients,33(1.05%)were diag- nosed as malignancies including 12(0.38%)cases in urinary system.The mean age of these patients when diagnosed as urinary tumors was 58.3?4.6(range 48-66).The mean duration of immunosup- pressive treatment was 62?18(range 26-120)months.Six cases received cyclosporine A+azalthio- prine+prednisone(CsA+Aza+Pred),5 cases cyclosporine A+mycophenolate mofetil+prednisone (CsA+MMF+Pred),and one case tacrolimus+mycophenolate mofetil+prednisone(FK506+MMF +Pred).Surgical treatment was carried out in 11 patients.Ten of them were still alive.One case died of cerebral hemorrhage.Conclusions Malignant tumors of urinary system,especially TCC is an im- portant complication in renal transplantation in our center.The occurrence of malignant tumors is inti- mately related to immunosuppressive treatment.The immunological status of patients after renal transplantation should be evaluated in follow-up studies.The treatment consists of complete resection of the mass,decreases of immunosuppressants,chemotherapy or radiotherapy.

Objective To evaluate the curative effect of chemotherapy combined with radiotherapy for limited-stage small cell lung cancer(LD-SCLC).Methods 34 cases of patients with LD-SCLC were rand- mized into interdigitating chemoradiotherapy group and sequential chemoradiotherapy group.All patients re- ceived four to six cycles of alternating CE(C:carboplatin 300 mg/m~2 d_1;E:etoposide100 mg d_(1～5)and CAP(C: cyclophosphamide 600 mg/m~2 d_(1,8);A:adriamycin 40 mg/m~2 d_1;P:cisplatin 50 mg d_(3～5)chemotherapy,three weeks for a cycle.All patients also received thoracic radiotherapy with conventional fraction,2.0 Gy per frac- tion,five fractions per week.The total dose was 60 Gy.Results In interdigitating chemoradiotherapy group, CR was 64.7%,PR was 29.4%,NR was 5.9% and PD was 0 after chemo-radiation therapy.In sequential chemoradiotherapy group,CR was 23.5%,PR was 52.9%,NR was 23.5% and PD was 0 after chemothera- py,and CR was 58.8%,PR was 35.3%,NR was 5.9% and PD was 0 after radiotherapy.Conclusion The therapeutic effect of chemotherapy combined with radiotherapy for LD-SCLC was satisying.There was no sig- nificant difference in the effect between the two groups.