Objective To evaluate the prognostic factors of elderly patients with noscomial Candidemia in intensive care unit. Methods A retrospective study was carried out in 75 elderly patients with noscomial Candidemia from 2001 to 2008. Multivariate logistic regression analysis was performed to find the correlations of prognosis with clinical and biochemical parameters. Results A total of 75 Candida strains were isolated from blood. The proportion of non-albicans species reached to 70.7%. Fluconazole-resistant candidiasis was increased. Overall mortality rate was 48.0%.Multivariate logistic regression analysis showed that septic shock, comorbid bacteremia, higher serum creatinine and sequential organ failure assessment (SOFA) score more than 10 were independent predictors for in-hospital mortality (Ward=6.34, 5.15, 8.04, 6.82, all P＞0.05). Conclusions Noscomical Candidemia in elderly critical illness patients leads a high mortality, the proportion of nonalbicans species and fluconazole-resistant candidiasis increase. The blood culture and drug sensitive test should be performed routinely to provide proper evidence for antifungal therapy. Monitoring the high risk factors, effective and reasonable therapeutics are the guarantee for reducing the mortality induced by Candidemia.

Administration, Topical ; Ear, Inner ; pathology ; Humans ; Meniere Disease ; therapy

AlM: To evaluate the clinical efficacy of canalicular intubation combined with external dacryocystorhinostomy ( ext-DCR ) for treatment of chronic dacryocystitis and upper lacrimal duct stenosis.
METHODS:Thirty-three patients (33 eyes) with chronic dacryocystitis and upper lacrimal duct stenosis who underwent canalicular intubation combined ext-DCR were retrospective analyzed. The silicon tube was indwelt for 6mo. All cases were re-examined 1wk;1, 3, 6, 9mo post-operation, flow of tears, pus excretion and lacrimal duct clearance were observed.
RESULTS: Clear lacrimal duct ratio was 100% in all cases during 1wk~6mo post-operation; Silicon tube was removed 6mo post-operation, 3mo after tube removal, rechecking reported 32 cases with clear lacrimal duct (97%) and 1 case with resistant duct (3%). Two cases ( 6%) with minor lacerations, no other complications were observed.
CONCLUSlON: Canalicular intubation combined ext-DCR is an effective treatment for chronic dacryocystitis and upper lacrimal duct stenosis.

Objective To study whether the measure of consumption of iodized salt to prevent iodine deficiency disorders could lead to residents excessive iodine intake in the coastal areas in China.Methods A large population-based cross-sectional study was carried out in four typical costal provinces along the coastline from north to south,including Liaoning,Shanghai,Zhejiang and Fujian.In addition to survey all of its area of Shanghai,the other three provinces' investigation was carried out at urban and rural levels,respectively,including 5 costal cities,5 costal villages and 3 inland rural areas(as a control point) in each province.In each investigated spot,the local water iodine,residents qualified iodized salt consumption rate,per capita daily intake of salt and urinary iodine levels in different populations were investigated.Results A total of 7552 copies of drinking water samples,7996 salt samples and 9873 urine samples of different populations(adults,lactating women,pregnant women and children) were collected from the 4 provinces.Except the coastal cities and counties of Zhejiang province,the qualified iodized salt consumption rates at household were all greater than 90％ in the investigated spots.The median urinary iodine(MUI) of adults and children investigated in the costal areas were in the range of 100 - 299μg/L.The MUIs of lactating women of all investigated areas were all greater than 100 μg/L.The MUI of pregnant women was at an insufficient iodine level which was lower than 150 μg/L in Shanghai,the costal cities of Zhejiang and the coastal counties of Fujian.Conclusions The overall level of iodine nutrition of coastal residents is appropriate; and it is insufficient among pregnant women in some coastal areas; coastal areas should adhere to the salt iodization measures to control iodine deficiency disorders.

OBJECTIVEThis study aims to construct a long-term, osteogenesis-targeting HU-308 drug delivery implant by the layer-by-layer electrostatic self-assembly (LBL) technique, and observe the features of its delayed release in vitro.

METHODSA heparin (Hep) and chitosan (Chi) multilayer was coated on pure titanium using the LBL technique, and the titanium implants were dipped into the solution to load HU-308. The amount of loaded drug and release rates were measured using a UV-Vis spectrophotometer. The relationships between the loading efficiency, release time, and multilayer films were evaluated. The morphology of all the multilayers was characterized by scanning electron microscopy (SEM) and atomic force microscopy (AFM).

RESULTSThe results showed that the Hep/Chi self-assembly multilayer was gradually fabricated on the titanium surface. HU-308 was successfully loaded on the titanium implants. The amount of loaded drug increased with the amount of multilayer films, except in the T20 group. In vitro drug release study showed that drug release was more difficult in the system with thicker films, and large amounts of multilayer films decreased the release speed. Both SEM and AFM measurements showed typical LBL deposition of Hep and Chi.

CONCLUSIONThe HU-308 drug delivery implant is successfully fabricated via LBL technology. It could provide sustained release of HU-308 over 30 d. This type of implant may provide a new possi- bility of promoting implant-bone osseointegration for osteoporotic patients.

Objective To summarize the laboratory, pathologic and imaging characteristics of patients with autoimmune pancreatitis (AIP) retrospectively for early diagnosis and treatment. Methods Eleven AIP patients were selected in our hospital from 2007 to 2009. Laboratory parameters including complete blood count, tumor markers, hemodiastase and autoantibodies were tested. Abdominal ultrasonography and computerized tomography (CT) scanning were also performed. Results Five patients had elevated hemodiastase and liver enzymes, four patients had hyperbilirubinemia and three patients had hyperglobulinemia. Increased serum CA199 levels (mean 78.4 U/ml) were found in six patients. All of the 11 patients had enlarged pancreas on imaging. Four cases were treated with three months of drug therapy. After the treatment, the pancreas volumereturned to normal size, pancreatic duct and bile duct became normal in size. Seven cases received surgical operation. Pathology examination showed fibrous tissue and folliculus lymphaticus formation in the pancreas,with a large number of lymphocytes and plasma cells infiltration. Two of seven cases were diagnosed with Sj(o)gren's syndrome and rheumatoid arthritis after being followed-up for six to twelve months post-operation.Their symptoms relieved after corticosteroid and immunosuppressive therapy. Conclusion AIP is a special type of chronic pancreatitiswith characteristic laboratory, imaging and histological features. Glucocorticoid and immunosuppressive agents therapy are effective for AIP.

Objective:To study the anti-inflammatory effect of immune milk. Method:Twenty four strains of pathogenic bacteria (including 12 strains of pathogenic E.coli, 8 strains of Salmonella, 3 strains of Shigella and 1 strain of Yersinia enterocolitica) originated from human intestinal tract were selected as antigens, and dairy cows were immunized. Results:Vaccination could not increase the concentration of IgG in the immune milk, but significantly highten the specificity of milk antibodies. The antibody titers against 24 pathogenic bacteria in immune milk was 128, 64 folds of control regular milk. Conclusion:Feeding of immune milk could inhibit edema of rat footpad induced by carrageenin and formaldehyde and the formation of acestoma of mice caused by cotton embedded hypophloedally. Meanwhile, the PGE2 level in inflammatory footpad of rat fed with immune milk was remarkably lower than that of rat fed with regular milk. These results indicate that immune milk has anti-inflammatory property.

Objective To evaluate the efficacy and safety of Caspofunjin on invasive fungal infections in patients refractory to Fluconazole in ICU.Methods The open clinical trial was conducted in 44 invasive fungal infections patients who was refractory to Fluconazole,including 7 cases of confirmed,28 cases of suspected and 9 cases for empire treatment.They were treated with Caspofunjin in a dose of 70 mg in the first day,and then in a dose of 50 mg/d for 10～40 d.Results The cure rate of patients was 42.86%,the effective rate was 76.19%,and the eradication rate was 65.22%.All patients were well tolerated.Conclusion Caspofunjin is effective and safe in the treatment of severe invasive fungal infections.

Objective To investigate the effects of simvastatin preconditioning on the pulmonary heme oxygenase-1 (HO-1) expression in rats with lung injury induced by ischemia-reperfusion (I/R) of hind limbs. Methods Forty-eight adult male SD rats weighing 250-300 g were randomly divided into 6 groups ( n = 8 each) : sham operation group (group S) ; I/R group; I/R + simvastatin 1,5, 10 mg/kg groups (S1 , S2, S3 groups) ; simvastatin control group (group SC) . I/R of hind limbs was produced by occlusion of bilateral femoral arteries for 2 h followed by 3 h reperfusion. Croups S1 , S2 , S3 received simvastatin 1, 5, 10 mg/kg respectively via an oro-gastric tube for 3 days before I/R. Group SC received simvastatin 10 mg/kg via an oro-gastric tube for 3 days. Arterial blood samples were taken at 3 h of reperfusion for blood gas analysis and PaO2 and PaCO2 were recorded. The animals were then sacrificed and the lungs removed immediately for pathologic examination and determination of the wet/dry lung weight ratio (W/D ratio), superoxide dismutase (SOD) activity and polymorphonuclear neutrophil (PMN) count . Hie expression of HO-1 mRNA and protein in lung tissues was detected using RT-PCR and Western blot analysis respectively.Results Alveolar edema, localized pulmonary atelectasis and large amount of PMN infiltration were found in I/R group and were ameliorated in S1, S2, S3 groups. Compared with group S, PaO2 and PaCO2 were significantly decreased in I/R group, W/D ratio and PMN count were increased and SOD activity was significantly decreased in I/R, S1 , S2 groups, and expression of HO-1 mRNA and protein was up-regulated in the other five groups ( P ＜ 0.05). PaO2, PaCO2 and SOD activity were significantly increased, W/D ratio and PMN count were significantly decreased, and HO-1 mRNA and protein expression was up-regulated in S1, S2 and S3 groups as compared with I/R group ( P ＜ 0.05 or 0.01). W/D ratio and PMN count were gradually decreased, SOD activity was gradually increased, and HO-1 mRNA and protein expression was gradually up-regulated in S1, S2 and S3 groups. Conclusion Simvastatin preconditioning has protective effect against lung injury induced by I/R of hind limbs in rats through up-regulation of HO-1 expression in the lung tissues and in a dose-dependent manner.

A rarely reported postoperative complication following biliary surgery,and to discuss its possible mechanism.This article summarizes I reported HSB case that developed after laparoscopic cholecystectomy in our department and 9 other cases reported in literature.HSB occurred most frequently after simple cholecystectomy in addition to post operative bile duct exploration with cholecystectomy or endoscopic retrograde cholangiopancreatography.The main clinical presentation of HSB was paroxysmal colic in the upper abdomen early in the postoperative period,which could be induced after a meal.Imaging revealed subcapsular hepatic fluid collection,and successful treatment involved placement of a percutaneous drain in the biloma.The mechanism of HSB still needs to be clarified even though it is a rarely reported postoperative complication following biliary surgery.We hypothesize,after analyzing these 10 cases,that sphincter of Oddi dysfunction after biliary surgery and the subsequent persistence of high biliary system pressure may be the root cause of HSB formation.More awareness should be paid to the changes of the sphincter's motility after biliary surgery and its related complications (biliary colic,HSB etc.).