Objective To analyze the pathogenic fungus distribution and the risk factors affecting the prognosis in patients with bloodstream infection critically ill sepsis in intensive care unitso as to provide evidence for clinical treatment. Methods From January 2008 to January 2015 , the clinic data of patients with severe sepsis and septic shock were retrospectively studied. The factors affecting the prognosiswere found out using a multivariate logistic regression analysis. Results From January 2008 to January 2015 , there were 870 bloodstream infection critically ill sepsis. Risk factors affecting the prognosis of critically ill sepsis patients were as follows: serum albumin, age, APACHEⅡ and procalcitonin. Conclusion Bloodstream infection critically ill sepsis in intensive care unit contributes a high motality. APACHEⅡ, age, blood lactate, procalcitonin , blood lactate and serum albumin are the risk factors affecting the prognosis of critically ill sepsis patients.

Objective: To study the relationship between Framingham risk score for coronary artery disease (CAD) and cognitive function in healthy community elders.
Methods: A total of 276 healthy community elders were evaluated by Framingham score to predict the risk for suffering from CAD in 10 years. The subjects were divided into 3 groups. High risk group (the risk > 20%), n=46, Mid risk group (the risk at 10%-20%), n=76 and Low risk group (the risk < 10%), n=154. The cognitive function was measured by mini-mental state examination (MMSE) and China adult intelligence scale (CISA). The differences of cognitive function levels to 3 CAD risk groups were studied.
Results: With the increased CAD incidence from Low risk, Mid risk to High risk groups, the MMSE score reduced accordingly (26.9 ± 1.45) vs (24.3 ± 1.53) vs (22.2 ± 1.43), P=0.014. Pearson analysis presented that MMSE score was negatively related to Framingham risk score (r=-0.213, P<0.001). There were several elements of cognitive function related to Framingham risk score including MMSE score, question answering, grid filling, oral arithmetic and word distinguishing (r=-0.247), (r=-0.167), (r=-0.132), (r=-0.152) and (r-0.256), all P<0.05.
Conclusion: CAD risk level was negatively related to cognitive function, the higher Framingham risk score resulted in the lower cognitive function in healthy community elder subjects.

Objective To investigate the risk factors of cerebral infarction in newborns and to provide a theoretic basis for prevention.Methods From January 2002 to December 2010,8840 newborns were admitted into the Neonatology Department of Peking University First Hospital,among which 44 patients were diagnosed as cerebral infarction by review of brain imaging and medical records.These patients were taken as study group,and 175 patients were randomly selected as the control group matched by birthday and gestational age.Risk factors of neonatal cerebral infarction were analyzed by univariate analysis and binary Logistic regression.Results Of 27 352 infants born in Peking University First Hospital,21 infants were diagnosed as neonatal cerebral tnfarction,giving the prevalence of neonatal cerebral infarction of 7 per 10 000 live births (21/27 352).Of the 8840patients in Department of Neonatology,neonatal cerebral infarction accounts for 5.0‰ (44/8840).81.8％ (36/44) of the affected babies were delivered at term.The incidence of hypoxia and polycythemia in study group were 50.0％ (22/44) and 11.4％ (5/44),higher than those in control group [27.4％(48/175) and 2.9％(5/175)],differences were statistical significant (x2 =8.237,OR=2.646,95％CI:1.343-5.211,P=0.004; x2 =5.838,OR=4.359,95％CI:1.203-15.796,P=0.030).Logistic regression showed that hypertensive disorder complicating pregnancy (OR=3.388,95％CI:1.174-9.778,P=0.024),polycythemia (OR=4.319,95％CI:1.136-16.427,P=0.032)and hypoxia (OR =2.860,95％ CI:1.415-5.782,P =0.003) were risk factors for neonatal infarction.Further analysis suggested that the severity of hypoxia (x2 =- 3.470,P =0.001 ) and hypertensive disorder complicating pregnancy (x2=-2.074,P=0.038) had positive correlation with neonatal cerebral infarction.Conclusions Hypertensive disorder complicating pregnancy,polycythemia and hypoxia were risk factors of cerebral infarction,especially when preeclampsia and severe hypoxia occurred.

In this study, we prepared various matrices of hydrogel patches and studied their cross-linking mechanism by observing their rheological properties, which could provide theoretical basis and deep technical support for further industrial development of hydrogel patch. Rheology method was used to do the amplitude scanning and single-frequency scanning for various hydrogel matrix, under the condition of oscillation mode of the rheometer. Then the linear viscoelastic region, composite modulus value, as well as changes in slope with time of the composite modulus and phase angle of various hydrogel matrix were analyzed in detail. The results showed that the stability of matrix was mainly determined by hydrogel frame; only in acidic environment, the cross-linking reaction between cross-linker and hydrogel frame can occur; elasticity of matrix can be decreased by organic acid and the effect level was related to the ratio of the number of carboxyl and hydroxyl (-COO(-)/-OH) in adjusters: if the ratio was not equal, the higher -COO(-)/-OH in adjusters would be the less elasticity of matrix decreased; the cross-linking speed of matrix was determined by adjuster, the cross-linking speed of matrix contain different adjusters was ranged in following order: matrix containing tartaric acid > matrix containing lactic acid > matrix containing malic acid > matrix containing citric acid; the cross-linking speed of matrix was not uniform in the whole cross-linking process.

Objective To explore risk factors of cerebral infarction in newborns by systematic reviews.Methods Case-control studies and case reports on risk factors of cerebral infarction in newborns from January 1997 to December 2011 were collected from database of CNKI,CQVIP,Wanfang Database,PubMed,OVID,Springer,Medline,Science Direct On Site,Besco and MD Consult.Meta analysis was performed on case-control studies with fixed or random effect model by Review Manager 5.0.Constitution ratio of risk factors of cerebral infarction in newborns in case reports was investigated.Results Two hundred and sixty-nine articles were found and among which,36 articles in English were selected for this study.Three case-control studies were found and adopted for meta analysis.Cumulative number of patients and control cases were 80 and 228,respectively.The pooled OR and 95 ％CI of selected factors were as follows:decreased fetal movement [7.10 (2.92-17.24)],abnormal fetal heart rate [4.45 (2.54-7.80)],vacuum delivery [2.99 (1.23-7.25)],resuscitation at birth [(3.14 (1.17-8.46)],premature rupture of membranes [2.40 (0.62-9.29)],cesarean section [2.64 (1.44-4.82)],preeclampsia [3.05 (1.44-6.43)],history of infertility [1.25 (0.18-8.67)],primiparous [1.79 (0.51-6.36)],oxytocin used [2.05 (0.99-4.25)],fetal growth restriction [0.99 (0.47-2.11)],meconium stained amniotic fluid [2.08 (0.94-4.58)],adverse pregnancy history [0.85 (0.43-1.68)] and breech presentation [0.38 (0.10-1.46)].Meta analysis showed that decreased fetal movement,abnormal fetal heart rate,vacuum extraction,resuscitation at birth,cesarean section and preeclampsia were risk factors of neonatal cerebral infarction.Decreased fetal movement,abnormal fetal heart rate and resuscitation at birth suggested that newborns suffered from perinatal hypoxia,vacuum extraction,cesarean section suggested abnormal delivery.It suggested that perinatal hypoxia and abnormal delivery were high risk factors of neonatal cerebral infarction.Among those factors,proportion of abnormal labor,fetal distress and hypercoagulabe state was 31.70％,21.13％ and 20.19％ respectively.Conclusions Abnormal birth,hypoxia,preeclampsia and hypercoagulation state might relate to neonatal cerebral infarction.

ObjectiveTo analyze the application value of diffusion-weighted magnetic resonance imaging (DWMRI) in gross tumor volume (GTV) delineation of esophageal squamous cell carcinoma (SCC).MethodsTwenty-nine patients with esophageal SCC treated with radical surgery were analyzed.Routine CT scan,MRI T2-weighted and DWMRI were employed before surgery;diffusion-sensitive gradient b-values were taken 400,600 and 800 s/mm2.GTVs were delineated using CT,MRI T2-weighted images and DWMRI under different b-value images.The length of GTVs measured under different images was compared with the pathological length and confirm the most accurate imaging condition.Use radiotherapy planning system to fuse DWMRI images and CT images to investigate the possibility of delineate GTVs on fused images.ResultsThe difference of GTV length value between CT,T2 WI images and specimen was 3.36 mm and 2.84 mm.When b =400,600 and 800 s/mm2,the difference between GTV length value on the DWMRI images and on specimen was 0.47 mm,-0.47 mm and - 1.53 mm;the correlation coefficient of the measuring esophageal lengths on DWMRI images and the pathological lengths was 0.928,0.927 and 0.938.DWMRI images and CT images could fuse accurately on radiotherapy planning system.GTV margin could.show clearly on fused images.ConclusionsDWMRI images can display the esophageal carcinoma lengths and margin accurately.When DWMRI images fused with CT images,GTV margin could show clearly,it can be used to delineate GTV accurately.

Objective To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) caused by lung infections,so as to explore the clinical efficacy and application value of ECMO.Methods The patients with 7 ARDS who were responded poorly to mechanical ventilation in Zhongshan Affiliated Hospital of Sun Yat-sen University from January 2003 to January 2015 were collected.All patients were divided into a study group (7 cases) treated by ECMO and a control group (7 cases) treated by traditional methods.The percutaneous incision on femoral vein-internal jugular vein (V-V) was selected to carry out ECMO intubation,and the V-V ECMO model was used for auxiliary bypass of flow.The comparisons between the two groups for the results of hemodynamics,blood-gas analysis and oxygen metabolism were performed to evaluate synthetically the adjuvant effects of ECMO.Results Seven ARDS patients caused by lung infections were treated by ECMO,including 4 cases with bacterial pneumonia,2 cases with H7N9 and 1 case with H1N1.Thc duration of ECMO was (21.00 ± 10.06) days;2 cases were weaned from ECMO successfully,and 1 case recovered and discharged.Seven cases with ARDS caused by severe lung bacterial infections in control group were all not recovered on discharge.After treatment,the heart rate (HR),pulmonary arterial wedge pressure (PCWP),venous partial pressure of oxygen (PvO2),arterial blood lactic acid (Lac) in study group were significantly lower than those in the control group [HR (bpm)was 100± 12 vs.120± 19,PCWP (mmHg,1 mmHg =0.133 kPa) was 8.8 ± 2.6 vs.11.6± 3.8,PvCO2 (mmHg) was 40.8 ± 13.1 vs.48.9 ± 16.2,Lac (mmol/L) was 2.1 ± 0.8 vs.5.2 ± 0.6,all P ＜ 0.05],the mean arterial pressure (MAP),cardiac output index (CI),arterial and venous blood pH values,arterial partial pressure of oxygen (PaO2),arterial partial pressure carbon dioxide (PaCO2),arterial oxygen saturation (SaO2),oxygen delivery (DO2),oxygen consumption (VO2),oxygen extraction (ERO2) were obviously higher in study group than those control group [MAP (mmHg) was 83.6 ± 8.2 vs.72.2 ± 94,CI (mL· s-1 · m-2) was 93.35 ± 3.33 vs.81.68 ± 8.33,pH of arterial blood was 7.4 ± 0.1 vs.7.1 ± 0.3,PaO2 (mmHg):98.5 ± 20.4 vs.49.3 ± 12.6,PaCO2 (mmHg):38.9 ± 16.2 vs.26.1 ± 17.4,SaO2:0.95 ± 0.02 vs.0.58 ± 0.04,pit of venous blood was 7.1 ± 0.2 vs.6.4 ± 0.3,PvCO2 (mmHg) was 40.8 ± 13.1 vs.48.9 ± 16.2,SvO2 was 0.75 ± 0.07 vs.0.49 ± 0.08,DO2 (mL· min-1 · m-2) was 651 ± 36 vs.400 ± 81,VO2 (mL· min-1 · m-2) was 245.0 ± 11.2 vs.103.0 ± 14.8,ERO2 was (35.6± 3.9)％ vs.(21.3± 5.2)％,all P ＜ 0.05].Conclusions ECMO can improve hypoxemia.So it can improve the metabolism and maintain hemodynamic stability,in the mean time the patients may gain more time for diagnosis and treatment of their primary lung diseases.The key points of a successful ECMO are suitable selection of patients and forceful prevention of complications.

To observe the relationship between positive rate of β1-adrenergic and AT1 receptors autoantibodies with serum concentration of cystatin C in 371 patients with diabetic nephropathy patients,107 patients with type 2 diabetes,and 47 subjects as healthy control.In patients with diabetic nephropathy,the positive rates of the β1 and AT1 receptors autoantibodies were significantly higher than those in patients with type 2 diabetes and normal controls.The titers of β1 and AT1 receptors autoantibodies in diabetic nephropathy patients with abnormal cystatin C were significantly higher than those with normal cystatin C concentration.These findings suggested that β1 and AT1 receptors autoantibodie may play important roles in the pathogenesis of diabetic nephropathy.