Objective To investigate the invasive aspergillosis (IA) status in a surgical intensive care unit (SICU).Methods The clinical data including general state,operation,pathogenic microorganisms,infection position,clinical situation,treatment and prognosis of patients with IA admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were retrospectively analyzed.Results 8 220 patients admitted to the SICU of Peking University First Hospital from January 2004 to December 2013 were enrolled.Of 8 220 patients,there were 29 cases experienced IA,with an incidence of 0.35％,and the incidence of hospital onset of IA infection was 0.27％ (22/8 220).The incidence of hospital onset of IA infection was accounted for 6.98％ (22/315) of the incidence of hospital onset of infection in SICU in the same period.Compared with 2004-2008,in 2009-2013,the incidence of hospital onset of infection was significantly decreased [3.19％ (137/4 293) vs.4.53％ (178/3 927),x2=10.020,P=0.002],while the incidence of IA [0.56％ (24/4 293) vs.0.13％ (5/3 927),x2=10.874,P=0.001],the incidence of hospital onset of IA infection [0.40％ (17/4 293) vs.0.13％ (5/3 927),x2=5.556,P=0.019],and the percentage of incidence of hospital onset of IA infection according to the incidence of hospital onset of infection were increased by 5 years [12.40％ (17/137) vs.2.81％ (5/178),x2=10.982,P=0.001].Of 29 patients with IA,25 cases had occurred after operation,and the majority of them were from the Department of General Surgery (13 cases),and followed by post-renal transplantation (6 cases) and post-thoracic surgery (3 cases).In the total submission of 155 specimens from 29 patients with IA,there were 17 strains isolated aspergillosis,among which included 2 strains of Aspergillus fumigatus,and 15 other un-subgrouped strains.The most common infection site was lower respiratory tract (23 cases,79.31％).Sixteen patients were found with positive galactomannan (GM) test.In all the risk factors contributing to IA,the ratio of the long-term usage of broad-spectrum antibiotics over 4 days was the highest [36.25％ (29/80)],which followed by the long-term use of hormone [18.75％ (15/80)],complicated with acute kidney injury [18.75％ (15/80)],liver injury [13.75％ (11/80)],the long-term use of immunosuppressive orally [7.50％ (6/18)],and complicated with neutropenia [5.00％ (4/80)].In 29 patients with IA,there were 28 patients received anti-fungal treatment except for 1 patient without treatment,and those were single use of itraconazole in 1 case,single use of echinocandins in 3 cases,single use of liposomal amphotericin B in 5 cases,8 cases with voriconazole,single use of liposomal amphotericin B or echinocandins then replaced by voriconazole in 8 cases,and 3 cases of echinocandins therapy combined with voriconazole.Seventeen of 29 patients died,with a mortality rate of 58.62％.Conclusions IA is an uncommon but increasing postoperative complication of patients in SICU in recent 5 years.The most common sites of IA were lower respiratory tract.The mortality of IA is very high.So clinicians should pay more attention to the careful monitor for IA.

OBJECTIVEDiscussion on utility and purposed value of obesity and abdomen obesity when body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) used as indexes predicting hypertension, hyper-blood glucose, and both clusters, to provide scientific basis for the decision on the indexes and their cut-off points of obesity and abdomen obesity in Chinese people.

METHODSUsing the data of diabetes mellitus (DM) from epidemiological studies carried out in 11 provinces/autonomous regions/municipalities of China from July 1995 to June 1997. Partial relative analysis, logistic multi-factors regression analysis, interaction analysis were used. Relative risk (RR), attributable risk proportion (ARP) and population attributable risk proportion (PARP) of hypertension, hyper-blood glucose, and the both cluster as BMI, WC, WHR with the different cut off points were analysed.

RESULTS1) The correlations between BMI, WC and blood pressure, blood glucose were better than the WHR. 2) After adjusted by age, sex, occupation leisure physical activity, education degree and the family history of DM, the results suggested that BMI, WC, WHR were important predictive factors, with relative importance as BMI > WC > WHR. 3) There were augment interactions on BMI, WC and WHR with hypertension, hyper-blood glucose, with the interaction of BMI and WC in particular. Their pure attributable interaction proportion were from 5.95% to 29.34%. 4) The values of RR were about 2.5 when BMI >/= 23, >/= 24 and >/= 25, suggesting the relationship with exposure factors and diseases were with medium and high maleficent extent. Their ARP were from 0.580 to 0.623 with PARP from 0.259 to 0.425. The values of RR were from 2.06 to 3.08 as WC >/= 85 cm in males, WC >/= 80 cm in females while WC >/= 90 cm in males, WC >/= 80 cm in females, which suggested that the relationship with exposure factors and diseases were in medium and high maleficent extent. Their ARP were from 0.515 to 0.676 while PARP from 0.241 to 0.431.

CONCLUSIONSSince the maleficent extent of exposure factors to diseases, the acceptability for overweight and obesity in population, and the prevention and care for overweight and obesity were just in the introduction stage in China. The utility value of predicted hypertension, hyper-blood glucose in BMI and WC seemed to be better then in WHR. We suggested that BMI used as the obesity index, with the diagnostic cut-off point BMI >/= 24. WC as the abdomen obesity index. The diagnostic cut-off points are suggested to be WC >/= 85 cm in males, and WC >/= 80 cm in females.

Adult ; Aged ; Blood Glucose ; metabolism ; Blood Pressure ; physiology ; Body Constitution ; Body Mass Index ; Diastole ; Female ; Humans ; Hyperglycemia ; diagnosis ; physiopathology ; Hypertension ; diagnosis ; physiopathology ; Logistic Models ; Male ; Middle Aged ; Obesity ; physiopathology ; Predictive Value of Tests ; Systole

Objective To explore the effect of preoperative neutrophil lymphocyte ratio (NLR) on the prognosis of patients with laryngeal carcinoma.Methods Clinical data of 202 patients with laryngeal carcinoma treated from January 2004 to October 2009 were retrospective analyzed to determine the optimal critical value of NLR.To study whether NLR is an independent factor affecting the recurrence and 5-year survival rate of patients with laryngeal cancer after surgery,single factor and multivariate analyses were performed.The factors included age,gender,T stage,pathological differentiation,lymph node metastasis,primary tumor site and NLR value.The relationship between NLR and cervical lymph node metastasis was analyzed.Results The optimal critical value of NLR was 2.85,by which cases were divided into high NLR group (NLR≥2.85) and low NLR group (NLR ＜ 2.85).Single factor and multivariate analyses indicated that T staging,lymph node metastasis,primary tumor location,and NLR were the independent factors affecting the recurrence of laryngeal carcinoma.T stage and lymph node metastasis were the independent factors affecting 5-year survival rate of laryngeal carcinoma.The increase of NLR value increased the rate of cervical lymph node metastasis.Conclusion Preoperative NLR level influences the recurrence and cervical lymph node metastasis of laryngeal carcinoma and can be considered a prognosis factor of laryngeal cancer.

Mitochondria are the main site of energy metabolism in cardiomyocytes， and at the same time mediate apoptosis and immune response， so mitochondrial dysfunction is closely related to the development of heart failure. Combined with the pathogenesis of mitochondrial dysfunction and heart failure， it is proposed that the mitochondrial function is similar to "sweat pore - collaterals - zang and fu organs"， according to which the treatment of heart failure is based on the theory of "sweat pore - collaterals - zang and fu organs". It is believed that the core mechanism of heart failure is qi deficiency， and qi deficiency leads to the weakness of the sweat pore opening and closing， or even the sweat pore closure， then resulting in qi deficiency and blood stasis， collaterals stagnation fail to flourish， and qi， blood， and body fluids can not infiltrate and nourish zang-fu organs， so that the heart fail to be nourished， and the disease will develop. The treatment should be based on the method of boosting qi and opening sweat pore， using acridity to unblock the collaterals， and invigorating blood and draining water， with medicinal of boosting qi， invigorating blood， and draining water as treatment.