OBJECTIVE:To evaluate efficacy and safety of caspofungin for non-effect/intolerant to fluconazole in patients with invasive fungal infetion(IFI) in intensive care unit(ICU).METHODS:A retrospective analysis was conducted in 14 IFI patients in ICU who was without effect/intolerant to gluconazole.They were treated with caspofungin in a dose of 70 mg in the first day,and then in a dose 50 mg?d-1 for 3～28 d.RESUITS:Of total 14 cases,2 cases had been diagnosed including 1 case of candidemia albicans and 1 case of pulmonary candidosis glabrata;5 probable cases including 2 cases of pulmonary aspergillus species,2 cases of pulmonary candidosis albicans and 1 cases of pulmonary candidosis parapsilosis;In 7 suspected cases pathogen fungus were not found out.One patient died of respiratory failure at third day of treatment.Clinical efficacy of death case cannot be evaluated.Of total evaluable 13 cases,2 were cured(2/13,15.4%),4 markedly effective cases(4/13,30.8%),2 improved cases(2/13,15.4%) and 5 ineffective cases(5/13,38.5%),the overall effective rate was 46.2%.Caspofungin can be tolerated by all patients during therapy without drug related adverse reaction.CONCLUSION:Caspofungin is certain of efficacy and safety for non-effect/intolerant to fluconazole in IFI patients in ICU,and is the first choice for IFI patients in ICU.

OBJECTIVE To analyze the application of antibacterials in liver transplanted patients of our hospital in order to improve the rational use of antibacterials in perioperative period of liver transplantation.METHODS According to the criteria of DDD and DUI recommended by WHO,a retrospective study of the application of antibacterials in 82 patients with liver transplantation who discharged hospital during from Jun 2003 to Jun 2005 was made.RESULTS Among the 82 patients,100.0% patients had received antibacterials and 48 patients received combined medication,in which 45.10% used two kinds and 13.41% used three kinds.The longest medication time was 49 days while the shortest was 10 days.Nineteen antibacterials′ DUI were all less than one except meropenem whose DUI was 1.03.CONCLUSIONS This study proved that patients with liver transplantation in our hospital received rational antibacterials.

Objective To study the feasibility of measuring radiation absorbed dose with the fluorescent probe Alexa Fluor 488-DNA-BHQ1.Methods An oligonucleotide dually labeled at its 5'-and 3'-end with fluorescent molecular Alexa Fluor 488 and specific fluorescence inhibitors BHQ1 was prepared.The Alexa Fluor 488-DNA-BHQ1 aqueous solution was exposed with X-ray and its fluorescence intensity was measured.Results When the concentration of Alexa Fluor 488-DNA-BHQ1 was between 0.5 and 1 μmol/L,the fluorescence intensity of its aqueous solution had excellent linear dose response from 0.1 to 30 Gy (R2 =0.99) and it was stably maintained after 40-80 min of irradiation especially at 4℃.Conclusions In the dose range of 0.1-30 Gy,the Alexa Fluor 488-DNA-BHQ1 fluorescent probe can be used to measure radiation absorbed dose.

Objective To study the effects of microRNAl01 (miR-101)on radiosensitization of human uterine cervix cancer HeLa cells and underlying mechanism.Methods HeLa cells were divided into three groups including blank control,miRNA negative control and miR-101 transfection group.The cells were irradiated by 160 kVp X-ray generated from a linear accelerator at a dose rate of 1.15 Gy/min.Real-time quantitative PCR (qRT-PCR) was used to detect the expression of miR-101.The clonogenic survival assay was applied to evaluate the effect of miR-101 on radiosensitization of HeLa cells.γ-H2AX immunofluorescence and Western blot assays were performed to observe DNA double-strand breaks and the protein expressions of ATM and DNA-PKcs of HeLa cells,respectively.Results Compared with the negative control group,the expression of miR-101 was significantly increased in the HeLa cells at 48 h after transfection with miR-101 mimic,and the survival of HeLa cells over expression of miR-101 was significantly reduced(t =10.75,P ＜ 0.05).The miR-101 had remarkable radiosensitive effect on HeLa cells(F =7.72,P ＜0.05) with a SERD0 of 1.29.Moreover,over-expression of miR-101 could inhibit the repair of DNA damage induced by irradiation.Compared with the control group,the protein expressions of ATM and DNA-PKcs were significantly decreased in the HeLa cells over expression of miR-101.Conclusions Over-expressions of miR-101 could inhibit cell growth and enhance radiosensitivity of HeLa cells by inhibiting the repair of radiation-induced DNA damage.

Objective To study the effects of AuNPs@PEG-AS1411 nanoparticles on radiosensitization of human uterine cervix cancer HeLa cells.Methods AuNPs were synthesized by citrate reduction method and then functioned with PEG and PEG-AS1411, respectively.CCK-8 assay and colon forming assay were used to detect the acute and chronic toxicity effects of AuNPs on HeLa cells, respectively.At the same time, clonogenic survival assay was applied to measure the cell survival rate of HeLa cells after exposure to AuNPs@PEG and AuNPs@PEG-AS1411 combined with X-ray radiation.The intracellular uptake of AuNPs@PEG and AuNPs@PEG-AS1411 in HeLa cells were detected by ICP-MS.Results The CCK-8 assay showed that AuNPs@PEG and AuNPs@PEG-AS1411 were not toxical on HeLa cells(P ＞0.05).But the clonogenic survival assay showed that AuNPs@PEG and AuNPs@PEG-AS1411 had toxicity on HeLa cells significantly after 10 d(t =4.38-11.60, P ＜ 0.05).AuNPs functioned with AS1411 could increase the cellular uptake of AuNPs.AuNPs@PEG and AuNPs@PEG-AS1411 both had significant radiosensitive effect on HeLa cells (F =7.90,48.23, P ＜ 0.05).The values of SERDo for AuNPs@PEG and AuNPs@PEG-AS1411 were 1.12 and 1.20, respectively, when the concentration of Au was 10 mg/L.Conclusions AuNPs@PEG and AuNPs@PEG-AS1411 could cause chronic toxicity on HeLa cells instead of acute effect.PEGylated AuNPs functioned with AS1411 could enhance the radiosensitivity of HeLa cells in vitro.

Objective To investigate the expression and clinical significance of leptin receptor (OBR) and phosphorylation of signal transducer and activator of transcription (p-STAT3) in patients with diffuse large B-cell lymphoma (DLBCL).Methods Immunohistochemical analysis was used to detect the expression of OBR and p-STAT3 in 80 patients with DLBCL and 10 patients with reactive lymphoid hyperplasia (RLH).Using a panel of immunohistochemical markers (CD10,bcl-6 and Mum-1),all cases of DLBCL were further divided into two groups,GCB (germinal center B-cell-like) or non-GCB.Results Immunohistochemistry revealed high expression of OBR and p-STAT3 in 45.0 ％ (36/80) and 28.8 ％ (23/80) cases of DLBCL,respectively,and minimal straining in 100.0 ％ (10/10) cases of RLH (P ＜ 0.05).Compared with GCB group (8.7 ％,2/23),non-GCB group had higher p-STAT3 high expression rate (36.8 ％,21/57) (P ＜ 0.05).There was no significant difference in the expression of OBR between these two groups.Compared with clinical stage Ⅰ-Ⅱ [46.2 ％ (18/39) and 25.6 ％ (10/39)],stage Ⅲ-Ⅳ had higher OBR and p-STAT3 high expression rate [61.9 ％ (13/21) and 38.1％ (8/21)] (P ＞ 0.05).The expression of OBR and p-STAT3 were not correlated with age,gender,extranodal infiltrations,LDH level,B-symptoms and IPI(international prognostic index)(P ＞ 0.05).The expression of OBR was positively related with that of p-STAT3 in DLBCL patients (r =0.232,P =0.039).Conclusion OBR could stimulate the JAK-STAT signaling pathway and induces the phosphorylation of STAT3.This may be involved in carcinogenesis and prognosis of DLBCL.

Objective To discuss the curative effects of alfacalcidol combined with losartan potassium tablets in the treatment of early diabetic nephropathy (EDN).Methods 90 EDN patients in our hospital were chosen and randomly divided into the observation group and control group (45 cases in each group).The control group was given losartan potassium tablets treatment,while the observation group was given alfacalcidol combiend with telmisartan treatment.All the two groups were treated for 3 months.Before and after treatment,the fasting blood glucose (FBG), 24h urine trace albumin quantitative (UAER),24h urine protein (24h pro),serum creatinine (SCr),25 -hydroxyl vitamin D [2 5 (OH )D ],blood calcium (Ca2+),potassium (K+),glycosylated hemoglobin (HbA 1 C )and serum inflammatory factors[C-reactive protein (CRP),tumor necrosis factor alpha (TNF-α),interleukin-6 (IL-6 )] were observed,and the correlation between 25 (OH)D and UAER,24h pro was analyzed.At the same time,the clinical curative effects and adverse reactions during treatment were evaluated.Results In the observation group,the total effective rate was 93.3%,which was significantly higher than 71.1% in the control group (χ2 =7.601,P<0.05).In the two groups after treatment,the FBG,HbA1c,blood Ca2+and K+had no significant changes (all P>0.05).After treatment,Scr,24h pro and UAER in the two groups were all significantly reduced compared with before treatment (P<0.05),and 24h pro and UAER in the observation group were significantly lower than those in the control group (t=6.296,11.530,all P<0.05),but Scr had no statistically significant difference between two groups (t=0.331,P>0.331).After treatment,25(OH)D in the observation group decreased significantly compared with before treatment (t=12.000,P<0.05),which was significantly higher than that in the control group after treatment (t=11.278,P<0.05).Compared with before treatment,25(OH)D in the control group had no significant change after treatment (t=0.436,P>0.436).Pearson correlation analysis showed that 25 (OH)D level was negatively correlated with 24h pro and UAER (r=0.483,0.778,all P<0.05 ).In the two groups after treatment,the CRP, TNF-αand IL-6 levels significantly reduced (P<0.05 ),which in the observation group decreased more obviously (all P<0.05).In the two groups,no serious adverse events were found,the difference was not statistically significant (χ2 =0.212,P >0.151 ).Conclusion Alfacalcidol combined with losartan potassium tablets can significantly reduce the proteinuria levels of EDN patients and inflammation,which has better clinical curative effects and higher safety.

Objective To provide immunological evidence for clinical transfer of chemical extracted acellular nerve allografL Methods One hundred and twenty-eight BALB/C mice were randomly divided into 4 groups of equal size according to their different treatments:negative contrast group(NC),fresh autograft group(AG),fresh allogeneic nerve group(FN)and chemical extracted aceflular allogeneic nerve group(CEN).Then we implanted various kinds of nerve grafts into the thigh muscle of BALB/C mice in corresponding groups.At 3,7,14,28 days postoperatively,8 mice from each group were killed each time to harvest their spleens,from which T lymphocytes were collected.Theu monoclonal antibodies(CD3,CD4 CD8 CD25,IL-2,IFN-γ, TNF-α)were added into the suspension.Then fluorescence.activated cell sorting(FACS)was used to determine the positive rates of cells combined with the above monoclonal antibodies. Results There were no statistically significant differences between CEN group,NC group,and AG group,but indexes of FN group were significantly higher than those of the other 3 groups at corresponding time points. Conclusion There is no obvious immune reiection of chemical extracted acellular nerve allograft when compared with fresh nerve autograft.

BACKGROUND:Surgical treatment is commonly used for decompressing the spinal cord in multilevel cervical spondylotic myelopathy, but the optimum anterior cervical reconstructive method has not been determined. OBJECTIVE:To compare and analyze the biomechanical characteristics of four anterior cervical reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy utilizing the three-dimensional finite element model. METHODS:A three-dimensional finite element model of an intact C2–7 segment was developed and validated based on healthy adult male CT images. Four additional models were developed from the fusion model, including anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, anterior cervical hybrid decompression and fusion and anterior cervical discectomy and fusion with Cage alone. Von Mises stresses on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed. RESULTS AND CONCLUSION:(1) The C2/3 disc stress in flexion, extension, lateral bending and rotation condition was significantly higher than the C6/7 disc in 4 anterior cervical reconstructive techniques, and the adjacent disc stress (C2/3, C6/7) was lowest in the anterior cervical discectomy and fusion with Cage alone, and highest in the anterior cervical corpectomy and fusion. (2) The stress at the plate-screw interface was highest in the anterior cervical corpectomy and fusion, and lowest in the anterior cervical discectomy and fusion. (3) In conclusion, among the four anterior cervical reconstructive techniques for multilevel cervical spondylotic myelopathy, the anterior cervical discectomy and fusion with Cage alone makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment disease after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.

OBJECTIVE:To explore the necessity of developing therapeutic drug monitoring of vancomycin in our hospital and its existing problems,and provide a reasonable basis for the clinical rational use of vancomycin. METHODS:The cross-sectional survey was designed to collect the clinical data of 92 patients with therapeutic drug monitoring of vancomycin and statistically ana-lyze 192 cases of plasma concentration monitoring data. RESULTS:The average plasma trough concentration was (15.96 ± 8.06) mg/L;with the increase of age,the plasma trough concentration was increasing,there was no significant difference in the plasma trough concentration among different age groups (P=0.000);there were only 13 cases (6.77%) that obtained the plasma trough concentration within 30 min before the fourth dose;after using wancomycin,clearance rates of Cr and the endogenous creatinine were slightly higher than before,but there was no significant difference(P=0.722);36 cases(39.13%)showed vancomycin sus-ceptible gram positive cocci;after using wancomycin,the body temperature,white blood cell count and neutrophil percentage were lower than before,the differences were statistically significant (P=0.006,P=0.000,P=0.000);48 cases (52.17%) in treatment received initial loading dose,and only 15 cases (16.30%) did not use in combination with other anti infective drugs. CONCLU-SIONS:The results showed there are still a lot of problems in the treatment of vancomycin in our hospital,for example,the stan-dard rate of the plasma trough concentration is about 50%;most of the time of blood sampling is not reasonable;the detection rate of the pathogen is low;only about half of the cases are given the loading dose,etc. Therefore clinical pharmacists’intervention for blood sampling is an important part to promote rational drug therapy monitoring. Meanwhile,data interpretation of the monitoring results of serum drug concentration of vancomycin is a basic method for clinical pharmacists in clinical monitoring to correct the un-reasonable operations,and also the necessary measures for preventing the drug renal toxicity,it is a very important significance for the medication safety and effectiveness especially in severe infection patients,the elderly,the children and the people with renal function insufficiency.