Objective To analyze the constitute and antifungal susceptibility of Candida spp . causing bloodstream infection in a hospital,so as to provide evidence for the prevention and treatment of bloodstream infection caused by Candida spp .Methods Candida spp . isolated from blood specimens of clinical patients in a hospital between 2009 and 2013 were analyzed retrospectively,the high risk factors for Candida bloodstream infection were analyzed. Results A total of 42 isolates of Candida spp . were isolated from blood specimens of 42 patients between 2009 and 2013,the major was Candida parapsilosis (C.parapsilosis ,n =20,47.62%),followed by C.albicans (n =16, 38.10%),C.tropicalis (n=4,9.52%),and C.glabrata(n=2,4.76%).Candida spp .were mainly distributed in emergency intensive care unit(n=11),departments of urologic surgery (n=9)and cardiothoracic surgery(n=8). The venous catheters of 37 patients(88.10%)were isolated the same Candida spp . as blood culture,the average time from indwelling venous catheters to positive culture of blood and catheters were 31 .47 and 33.18 days respec-tively;the percentage of positive culture for blood and catheters both increased with the prolongation of catheteriza-tion (both P < 0.001 ).Susceptibility rates of Candida spp . to fluconazole and voriconazole were 75.00% -100.00%,to amphotericin B were all 100.00%,to itraconazole varied significantly with different species (0 -87.50%).Conclusion The major Candida strains causing bloodstream infection in this hospital is C.parapsilosis , and is related to the use of intravenous catheters,susceptibility rates to fluconazole,amphotericin B,and voricon-azole are all high.

Objective To analyze the distribution and change of antimicrobial resistance of common pathogenic bacteria from geriatric ward,and provide reference for rational use of antimicrobial agents.Methods Specimens from hospitalized patients in a geriatric ward from 2009 to 2013 were analyzed,the isolated pathogenic bacteria and antimicrobial resistance of bacteria were analyzed statistically.Results From 2009 to 2013,a total of 7 426 patho-genic bacteria were isolated,the percentage of gram-negative bacilli,gram-positive cocci,and fungi were 90.96%(n=6 755),7.23%(n =537),and 1 .81 % (n = 134),respectively.The top 5 detected bacteria were Pseudomonas aeruginosa (39.16%),Escherichia coli (16.47%),Stenotrophomonas maltophilia (10.65%),Klebsiella pneu-moniae (7.22%),and Acinetobacter baumannii (6.21 %),these strains were mainly isolated from sputum (94.15%,n =5 573 ).Resistance rates of Acinetobacter baumannii to all detected antimicrobial agents,Pseudo-monas aeruginosa to 8 kinds of common antimicrobial agents (piperacillin / tazobactam,ceftazidime,aztreonam, imipenem,et al),Escherichia coli to 5 kinds of common antimicrobial agents (piperacillin/ tazobactam,cefopera-zone/sulbactam,aztreonam,levofloxacin,and ciprofloxacin),and Stenotrophomonas maltophilia to ceftazidime and levofloxacin all showed an increased tendency (all P <0.01 );there was no obvious change in resistance rates of Klebsiella pneumoniae to all detected antimicrobial agents (all P >0.05).Conclusion The major pathogenic bacteria isolated from geriatric ward is Pseudomonas aeruginosa ,which is highly resistant to multiple antimicrobial agents, antimicrobial agents should be chosen based on antimicrobial susceptibility testing results.

Objective To investigate the relationship between the expression of Fascin and breast cancer prognosis. Methods Paraffin sections of breast cancer from 110 patients were investigated by immunohostochemistry with monoclonal anti-fascin antibody. Data of the Fascin expression and clinicopathological variables were analyzed for disease-free survival(DFS)and overall survival(OS)by Kaplan-miere and cox model. Results The expression of Fascin was significantly associated with ER negative,PR negative and lymph node metastasis,but not with age,HER2 status and tumor size. The patients with positive expression of Fascin had shorter disease free survival time than those without Fascin expression. Conclusion High expression of Fascin is associated with poor prognosis in breast cancer. Fascin is an independent prognostic indicator of disease-free survival time.

Objective To investigate the reproducibility and influencing factors of relative quantification of phosphorus metabolites with two-dimensional chemical shift imaging (2D CSI) in rabbit liver. Methods Using 2D CSI MRS, 500 ml phosphate (NaH2PO4) solution phantom with 0. 05 mol/E concentration and one healthy rabbit were scanned 30 times respectively in one day and rescanned 30 times in the next day, and the stability of MR scanner and reproducibility of within-run and between-days in the same individual were analyzed. Each of thirty rabbits was scanned and rescanned one time respectively in different days, and the reproducibility of between-days in one group was analyzed. The data were statistically analyzed with t tests. Results (1) Phosphate solution phantom had a good reproducibility of within-run with the coefficient variation (CV) of 4. 92% and 5. 12% respectively in different two days. No significant change of phosphorus metabolites was detected in between-days, which was 16. 68 ± 0. 82 and 16. 56 ± 0. 85 respectively(t = 0. 665, P > 0. 05 ). (2) The CV of metabolites in one healthy rabbit ranged from 8. 04% to 34. 13%. Among the metabolites, β-ATP had the best reproducibility with the CV less than 10%. PME was 0. 88 ± 0. 28 and 0. 88 ± 0. 30, PDE was 4. 35 ± 0. 66 and 4. 35 ± 0, 66, Pi was 0. 95 ± 0.30 and 0.97±0.28, α-ATP was 5.58±0.60 and 5.61±0.61, β-ATP was 2.70±0.22 and 2.71± 0. 22, γ-ATP was 2. 20±0. 63 and 2. 18±0.44 respectively, no significant changes of metabolites were detected in between-days( P >0. 05 ). (3) The CV of metabolites in 30 healthy rabbits ranged from 8.48% to 36. 21%. Among the metabelites, β-ATP had the best reproducibility with CV less than 10%. PME was 0. 84 ± 0. 30 and 0. 79 ± 0. 28, PDE was 4. 29 ± 0.72 and 3.94 ± 0. 84, Pi was 0. 91 ± 0. 28 and 0. 92 ± 0. 31, α-ATP was 5.65±0. 66 and 5. 36±0. 60, β-ATP was 2. 71±0. 23 and 2. 66±0. 25, γ-ATP was 2. 07±0. 29 and 1.99±0. 37 respectively, no significant changes of metabolites were detected in between-days (P > 0. 05). Conclusions The relative quantification of hepatic β-ATP may be most reliable among the phosphorus metabolites for rabbit liver because of its good reproducibility and small CV. The quantification of phosphorus metabolites by 31p MRS with 2D CSI in rabbit liver is affected by many factors.

This list of clincal data management documentation is to ensure standardized and adequate archival of trial documents and records in clinical data management, which is applicable to all of phase I-IV clinical trials.

Objective To investigate the effect of preoperative oral midazolam on emergence agitation after sevoflurane anesthesia in children.Methods Sixty children,34 males,26 females, aged 2-7 years,ASA grade Ⅰ or Ⅱ,receiving sevoflurane for tonsillectomy/adenoidectomy were ran-domly divided into low dose midazolam group (group M1),high dose midazolam group (group M2) and control group (group C)(n=20 each).The 5 ml mixture of midazolam 0.5 mg/kg,0.75 mg/kg and 10% glucose was taken orally 30 min before anesthesia in group M1 and group M2,respectively. While 5 ml of 10% glucose was given in group C.Anesthesia was induced with inhalation of 8%sevoflurane and maintained with intravenous infusion of remifentanil and inhalation of sevoflurane. Scores of parental separation anxiety scale(PSAS),pediatric anesthesia emergence delirium scale (PAED scale),FLACC scale were compared.Times to extubation and discharge from PACU were al-so recorded.Results Group C showed significantly higher incidence of separation anxiety(P <0.05). The incidence of emergence agitation,peak PAED scores,FLACC scores,time to extubation were similar among three groups.Discharge time from PACU was longer in group M2 (P < 0.05). Conclusion Preoperative oral midazolam 0.5 mg/kg or 0.75 mg/kg can effectively reduce parental separation anxiety.This,however,dose not result in a reduced incidence of emergence agitation after sevoflurane anesthesia.Midazolam 0.75 mg/kg can extend the discharge time from PACU.

BACKGROUND:How to control the orderly formation of colage in skin repair and scarring process is worthy of attention. OBJECTIVE: To investigate the effect of basic fibroblast growth factor (bFGF) combined with insulin-like growth factor 1 (IGF-1) on the proliferation and colagen synthesis of rat bone marrow mesenchymal stem celsin vitro. METHODS:Rat bone marrow mesenchymal stem cels were isolated and cultured to induce adipogenic differentiation assessed by oil red O staining and osteogenic differentiation identified by alizarin red stainingin vitro. Passage 3 cels were cultured in the medium containing bFGF, IGF-1, combination of them or the control fluid, respectively. MTT assay was used to detect cel proliferation at 12, 24, 48, 72 and 96 hours of culture. The expression of type I colagen and type III colagen were detected by RT-PCR and western blot after 10 days of incubation. RESULTS AND CONCLUSION:Compared with the control group, bFGF or IGF-1 alone significantly promoted the proliferation of bone marrow mesenchymal stem cels, and inhibited the expression of type I colagen and type III colagen. After combined use of bFGF and IGF-1, the proliferation of bone marrow mesenchymal stem cels was improved more significantly, and the expression of type I colagen and type III colagen returned to normal levels. These findings indicate that the combination of IGF-1 and bFGF can promote proliferation of bone marrow mesenchymal stem cels and restrain the expression of type I colagen and type III colagen, which may be helpful for control and repair of scar formation during wound healing.

Objective To explore the diagnosis and treatment of clinical possible organizing pneumonia.Methods The medical records of 31 patients with clinical probable organizing pneumonia were retrospectively analyzed.The clinical presentation,radiographic results and treatment were collected and analyzed.Results Thirty-one patients with non-response to antibiotics were preliminary diagnosed as organizing pneumonia.By percutaneous lung biopsy or transbronchial lung biopsy the tuberculosis,fungi,suppurative inflammation,lung cancer and other diseases were ruled out in 24 patients,and 7 patients were diagnosed by perfect effect of corticosteroids treatment.Twenty-one patients had typical CT findings.All the patients responded rapidly and completely to the administration of corticosteroids.Six patients relapsed after the reduction or stop of corticosteroid in a follow-up time of 6-25 months.Conclusions Non-response to antibiotics,the typical imaging findings and lung biopsy ruling out other diseases are important for diagnosing organizing pneumonia.Rapid response to administration of corticosteroids may be helpful to the diagnosis.Decreasing the dose of corticosteroid too early may cause recurrence of organizing pneumonia.

Objective To investigate the prognostic value of interim and post-therapy 18fluorine-fluododeoxyglucose(18F-FDG) PET-CT in patients with T-cell lymphoma.Methods A retrospective analysis was conducted on data from 50 patients diagnosed with T-cell lymphoma(12 patients underwent interim PET-CT only,19 patients underwent interim and post-therapy PET-CT,and the rest 19 patients underwent only post-therapy PET-CT).Interim and post-therapy PET-CT(positive versus negative) were visually interpreted according to the criteria of the International Harmonization Project.The progression-free survival (PFS) and overall survival(OS) of two groups were calculated.We used the Fisher exact test and KaplanMeier testfor data analysis.Results Interim 18F-FDG PET-CT results were positive in 19 cases and negative in 12 cases.The median PFS and OS were 8 months and 16 months,in patients with positive results,versus 30 months and 36 months,in patients with negative results.The 1-year PFS and 3-year OS rates were 21.1％ (4/19) and 10.5％(2/19) in patients with positive results at interim PET/CT versus 100.0％(12/12) and 66.7％ (8/12) in patients with negative results(P＜0.01.Post-therapy 18F-FDG PET-CT results were positive in 16 cases and negative in 22 cases,the median PFS and OS were 10 months and 20 months in patients with positive results versus 32 months and 41 months in patients with negative results.The 1-year PFS and 3-year OS rates were 12.5％(2/16) and 12.5％(2/16),in patients with positive results at post-therapy PET-CT versus 95.5％(21/22) and 54.5％(12/22),in patients with negative results(P＜0.01).Conclusion Both interim PET-CT status and post-therapy PET-CT have significant value in monitoring response to therapy and predicting prognosis for patients with T-cell lymphoma.

Objective To investigate the effective ways of improving medical students' clinical competence during the process of internship. Methods Totally 398 students of clinical medicine from 2006 and 2007 grade in Soochow University were enrolled as research objects. Forty objects distribut-ed to the First Affiliated Hospital were taken as experiment group while 358 objects distributed to other hospital as control group. In experiment group, objective structured clinical examination (OSCE) was introduced during regular internship, innovation was made on test on completion of a course and autonomous learning and clinical practice was advocated and enhanced. Traditional practice and ex-amination method was used in control group. SPSS 19.0 was used to do statistical analysis on the test scores of students. Paired sample t test and independent sample t test were employed. Measurement data is expressed as x±s and P<0.05 signifies statistically significant differences. Results Clinical practice ability of students in experiment group was enhanced to various degrees after internship com-pared with that before internship. ECG interpretation, heart and lung auscultation, interrogation tech-nique, medical and surgical operation performances of students in experiment group were promoted significantly (P<0.05). Students' overall competence in the final graduation skill test was better in ex-periment group than in control group (P<0.05). Conclusions OSCE-test on completion of a course not only make intern management more effective, but also make students' aim more definite, therefore it is conducive to enhancing clinical competence.