OBJECTIVE To study the prevalence,fungal species,therapy and prevention of invasive fungal infections in our Affiliated Hospital.METHODS From Jan 2004 to Dec 2005,all patients with positive results for fungal culture of blood and sterile fluid were reviewed retrospectively.The in vitro activity of antifungal agents against fungal isolates was determined.RESULTS Eighty-eight positive patients were collected in this analysis based on the diagnosis of invasive fungal infection in our hospital for two years,from them the majority were diagnosed as candidal infections(n=72,81.8%),the others were Cryptococcus neoformans(n=8,9.1%),Aspergillus(n=5,5.7%) and other different fungal infections.The most common was C.albicans(n=48,66.7%),C.glabrata(n=12,16.7%),and C.tropicalis(n=8,11.1%),C.parapsilosis and C.krusei were both the same results(n=2,2.8%).CONCLUSIONS Infections caused by Candida are the most common invasive fungal ones in our hospital,and C.albicans is the most common one.Fluconazole remains effective for treament of candidal infections,especially those caused by C.albicans.

Objective To study the correlation of the serum levels of pro-gastrin-releasing peptide (ProGRP) and neuro-specific enolase (NSE) with different treatments in limited-disease small cell lung cancer (L-SCLC) patients.Methods 150 L-SCLC patients were randomly divided into three groups including concurrent chemo-radiotherapy group,sequential chemo-radiotherapy group,and chemotherapy group.The serum levels of ProGRP and NSE were detected by enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay before and after different treatments.The follow-up phase was 12 months.Results The serum levels of ProGRP and NSE were significantly decreased in all 3 groups after treatment (318.96,250.77,226.18 pg/ml and 31.72,23.95,17.89 μg/L),and the lowest level was observed in concurrent chemo-radiotherapy group,then the sequential chemo-radiotherapy group and chemotherapy group.The short term therapeutic effects were in the same sequence,and there was statistical significance between concurrent chemoradiotherapy group and chemotherapy (P ＜ 0.05).The decrease extent of ProGRP and NSE in effective cases (CR+PR) was significantly higher than that in failure cases in all 3 groups.The serum levels of ProGRP and NSE were increased with disease progress (P ＜ 0.05).Conclusion The serum levels of ProGRP and NSE can be used to reflect the patient' s condition and evaluate therapeutic effect in L-SCLC.The concurrent chemo-radiotherapy is more effective than sequential chemo-radiotherapy and chemotherapy only in L-SCLC.

Before and after treatment as well as before metastasis,the combined detection of progastrin-releasing peptide (ProGRP) and neuron-specific enolase (NSE) was performed in 150 patients with small cell lung cancer.The follow-up period was 1 year.Enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay were conducted.The result showed a negative correlation between the serum levels of ProGRP and NSE the curative effect.And a positive correlation existed between the serum levels of ProGRP and NSE and disease development.The difference had statistical significance (P ＜ 0.05).The levels of ProGRP and NSE may be used to indicate the disease development and evaluate the curative effect.

Objective To investigate the factors associated with postoperative metastasis, recurrence, and survival in patients with stage ⅢA ( N2 ) non?small cell lung cancer ( NSCLC ) , and to provide an objective basis for postoperative radiotherapy in patients. Methods Clinical data were collected from 199 patients who underwent complete resection and were diagnosed with stage ⅢA ( N2 ) NSCLC after surgery in our hospital from 2009 to 2013. The Cox regression model was used for the multivariate analyses of metastasis and recurrence. The survival rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. Results In the 199 patients, 173 had complete follow?up data. The 1?and 2?year metastasis, recurrence, and survival rates were 38?7%/52?6%, 27?8%/39?1%, and 92?5%/51?4%, respectively. The multivariate analysis showed that pathological type and two positive indices among preoperative CEA/CY211/SCC were two risk factors for metastasis ( P=0?013,0?014) . Positive lymph node number, metastatic lymph node number, lymph node metastasis rate, and two positive indices among preoperative CEA/CY211/SCC were risk factors for recurrence ( P=0?046,0?004,0?028,0?001) . All the above indices were risk factors for low survival rates ( P= 0?013 , 0?011 , 0?002,0?026 ) . Conclusions Patients with stage ⅢA ( N2 ) NSCLC who have positive lymph nodes, lymph node metastases, and two positive indices among preoperative CEA/CY211/SCC may benefit from postoperative radiotherapy.

Objective: To explore the impact of insulin resistance (IR) and adiponectin (APN) lacking on myocardial remodeling in experimental mice. Methods:16 normal C57 mice were divided into 2 groups: Control group and IR group; in addition, 16 APN gene knockout(APNKO) mice were divided into another 2 groups: APNKO group and APNKO+IR group.n=8 in each group. The mice in Control group and APNKO group were fed with normal diet, in IR group and APNKO+IR group were fed with high fat diet to create the IR model. All animals were treated for 12 weeks. Blood levels of total cholesterol(TC), triglycerides(TG),fasting plasma glucose(FPG) and fasting insulin(FINS) were examined; heart weight and left ventricular weight were measured; left ventricular myocardial morphological changes and the degree of ifbrosis were assessed by HE staining and Masson staining; protein expressions of myocardial matrix metalloproteinase-9 (MMP-9) and APN were detected by immunehistochemistry and Western blot analysis. Results: Compared with Control group, IR group, APNKO group and APNKO+IR group showed elevated blood levels of TC, TG, FPG and FINS; increased heart weight and left ventricular weight, allP<0.05; IR group, APNKO group and APNKO+IR group presented more myocardial hypertrophy, decreased protein expression of APN and increased protein expression of MMP-9, allP<0.05.Conclusion: IR and APN lacking could incur myocardial remodeling in experimental mice and they had synergistically facilitated effect.

ObjectiveTo investigate the effects of lipopolysaccharide (LPS) on mRNA expression of iron metabolism related genes. Methods Ten male mice (2 months) were injected intraperitoneally with lipopolysaccharide(0.5 μg/g). After 6 hours, mice were sacrificed and then sera, liver and spleen were collected. The mice blood routine was measured. The serum iron and total iron binding capacity (TIBC) were determined with reagent kit. The quasi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was performed for mRNA of hepatic hepcidin(HP), ferroportin1(Fpn1), transferrin receptor 1(TfR1) and spleenic HP, Fpn1 and interleukin-6(IL-6). Results The serum iron and TIBC were reduced in mice injected LPS, which exhibited mild anemia(P＜0.05) . LPS can increase the expression of hepatic hepcidin and decrease Fpn1 and TfR1 in liver after LPS administration 6 hours(P＜0.05). In spleen, IL-6 was upregulated and Fpn1 downregulated(P＜0.05). Conclusion LPS can influence serum iron through regulating the mRNA expression of hepatic and spleenic iron metabolism related genes, such as HP, Fpn1 and TfR1.

Objective The study the effect on cardiac remodeling induced by low level adiponectin(APN)and insulin resistance(IR).Methods 16 wild-type C57 mice were randomly divided into control and IR groups.16 APN gene knockout mice were randomly divided into APNKO and APNKO+IR groups.The IR and APNKO+IR groups were a high-fat feed to induce insulin resistance.After 12 weeks,cholesterol(TC),triglycerides(TG),fasting plasma glucose(FPG), fasting insulin(FINS) were measured.HOMA-IR,HWI and LVWI were calculated.The left ventricular myocardial were examined by microscopy to observe the degree of myocardial fibrosis,and the protein expression of matrix metalloproteinase-9(MMP-9) and APN in myocardial were detected with western blot.ResultsLow level APN and IR increased heart weight, left ventricular weight, HWI, LVWI(P<0.05).There were interaction between IR and low level APN on the TC,TG, FPG, FINS, and the index related myocardial fibrosis(P<0.05), and they were positive effect.There was also interaction effect between IR and low level APN on myocardial APN expression, but it was the negative effects (P<0.05).Conclusions Both low level adiponectin and insulin resistance could lead to cardiac remodeling synergistically.

Objective Through the detections of the heterozygote frequencies tests of fetal specific genes PLAC4 and COL6A2 mRNA alleles in plasma of pregnant women, to explore its possibility of application in the noninvasive prenatal screenings of trisomy-21. Methods A toltal of 500 cases (males and females 250 cases respectively)of Han ethnic groups with Henan Provice of China who were subject to the physical checkup clinic of the Third Affiliated Hospital,Zhengzhou University from June to December, 2013 were selected as the healthy physical checkup group, and such techniques as DNA sequencing and PCR-restriction fragment length polymorphism (RFLP) were adopted to the determinations of the heterozygote frequencies of the single nucleotide polymorphism(SNP)of the PLAC4 and COL6A2 genes in the maternal peripheral blood in the healthy physical checkup group, and the differential comparisons of the determination results of the SNP heterozygote frequencies and the corresponding heterozygote frequencies in the National Center for Biotechnology Information (NCBI) database;30 cases of healthy pregnant women who spontaneously underwent pregnancy checkups at the maternity clinic were randomly selected as the healthy pregnancy group, and real-time fluorescence quantitative reverse transcription-PCR technique was adopted for determining the expression levels of PLAC4 and COL6A2 mRNA in the peripheral blood of pregnant women of 8 weeks, 10 weeks, 12 weeks, 14 weeks and 16 weeks;40 cases of the same phase were selected for acting as the specimens for the karyotype analyses of the amniotic fluid cells, among which 20 cases were trisomy-21, and the 20 cases of the negative control group, and reverse transcription-multiplex ligation dependent probe amplification (RT-MLPA) technique was adopted for screening the fetal trisomy-21. Results (1) The allele heterozygote frequencies of the SNP of the healthy physical checkup group:determinations of the genotypes and hybrid rates of the 10 SNP sites of the PLAC4 and COL6A2 genes indicated that those with higher heterozygote frequencies were respectively rs7717, rs559, rs1044598, rs59066201 and rs1042917, with population coverage of 98%. Among them, the allele hybrid rates of rs59066201 were never seen in the NCBI database;in the respective comparisons of the allele hybrid rates of rs8130833, rs9977003 and rs7844 with the hybrid rates of the NCBI database, the variations had statistical significance (P<0.05). (2) The expression levels of PLAC4 and COL6A2 mRNA of the different pregnancy weeks of the healthy pregnancy group: the levels of PLAC4 mRNA in the peripheral blood of women of 8 weeks, 10 weeks, 12 weeks, 14 weeks and 16 weeks of pregnancy were respectively 7.22 ± 1.05, 8.02±1.41,9.51±1.69,11.33±2.11 and 13.31±2.58, with their expression levels rising along with the increase of the pregnancy weeks; among them, the comparison of pregnancy 8 weeks and pregnancy 10 weeks, the variations had no statistical significance (P>0.05);in the mutual comparisons among the expression levels of the various pregnancy weeks, the variations had statistical significance (P<0.05). The expression levels of COL6A2 mRNA in 8 weeks, 10 weeks, 12 weeks, 14 weeks and 16 weeks were respectively 8.95 ± 1.28, 11.19 ± 1.36,15.00 ± 1.58,16.87 ± 1.72 and 18.96 ± 2.79, with their expression levels rising along with the increase of the pregnancy weeks, and in the mutual comparisons between the expression levels of the various pregnancy weeks, the variations all had statistical significance (P<0.05). (3) Prenatal screenings of trisomy-21 in the validation group of the trisome:a total of 5 sites of rs7717, rs559, rs1044598, rs59066201 and rs1042917 were selected from the allele heterozygote frequencies of SNP sites were selected from the subjects of the healthy physical checkup group, and 10 cases of trisomy-21 specimens and 10 cases of negative CTR specimens were accurately determined, with the sensitivity reached 80%(17/20), and the specificity reached 90%(18/20). One case of the trisomy-21 and two negative cases were both homozygotes, and among the trisomy-21 specimens of two cases, only one SNP was a heterozygote, and it was impossible to conduct screenings on these 5 cases, with the screening accuracy reaching 100%(35/35). Conclusions Fetal specific genes PLAC4 and COL6A2 mRNA are expressed in the peripheral blood of pregnant women in different gestational age;its expression level increases with the increase of gestational age. Among them, five SNP including rs7717, rs559, rs1044598, rs59066201 and rs1042917 show highest heterogeneity rate, which is different from the corresponding heterogeneity rate in NCBI database. RT-MLPA technology is a rapid, effective, noninvasive and low cost method of prenatal screening 21 trisomy.

Objective To compare the different goal-directed fluid therapy(GDFT)strategies on the recovery of tissue perfusion and postoperative recovery in patients undergoing hepatectomy. Methods Ninety patients undergoing hepatectomy with ASA physical status Ⅱor Ⅲ were divided into three groups based on fluid treatment by random number table method:control group(conventional fluid therapy), observation group Ⅰ(GDFT filled with colloi) and observation group Ⅱ(GDFT filled with crystalloids),with 30 cases in each group.The ScvO2,Lac and Glu were tested at 5 min before anesthesia induction(T1),5 min before hepatectomy(T2),5 min after hepatectomy(T3)and the end of operation(T4). The duration of operation,fluid requirement,urinary output, bleeding volume and the use of vasoactive agent were recorded. The exhaust time, ambulation time and postoperative hospital stay were recorded. Preoperative and postoperative liver and kidney function tests and postoperative complications were followed up.Results Compared with that in control group,the amount of crystalloids[(1408.5 ± 348.4) ml vs. (1 819.4 ± 315.1) ml],the amount of colloids [(468.6 ± 193.4) ml vs. (1 009.7 ± 440.9) ml],the total volume[(1 867.3 ± 370.4)ml vs.(2 821.3 ± 264.6)ml]were all lower,first flatus time[(51.8 ± 8.5)h vs.(63.6 ± 9.2) h], ambulation time [(3.4 ± 0.7) d vs. (4.3 ± 0.7) d] and postoperative hospital stay [(7.8 ± 1.7)d vs.(10.5 ± 2.9)d]were all shorter,ScvO2at T3,T4was higher,Lac at T2-T4were lower,Glu at T3,T4was lower, and ALT and AST on the third day and the fifth day after surgery were lower in observation groupⅠ(P<0.05).Compared with those in observation groupⅠ,the amount of crystalloids [(2 014.7 ± 388.2)ml vs.(1 408.5 ± 348.4)ml]was increased,and the incidences of postoperative nausea and vomiting[33.3%(10/30)vs.10.0%(3/30)]were significantly higher than those in observation groupⅡ(P<0.05). Conclusions GDFT using colloids in hepatectomy probably improves the microcirculation and tissue oxygenation, protects liver function, promotes gastrointestinal function recovery and shortens postoperative hospital stay. It has a much lower incidence of postoperative nausea and vomiting, compared with crystalloids.

OBJECTIVE:To investigate the effects of dexmedetomidine on myocardial injury and postoperative cognitive function in patients with cardiopulmonary bypass(CPB)valve replacement. METHODS:A total of 90 patients underwent elective CPB valve replacement in our hospital during Jan. 2015-Dec. 2017 were divided into group C and group D according to random number table,with 45 cases in each group. Group D was given Dexmedetomidine hydrochloride injection 0.6 μg/kg after anesthesia induction and intravenous injection at 0.6μg/(kg·h)to the end of the operation;group C was given 0.9％ Sodium chloride injection at equal volume and rate. SBP,DBP,HR and MAP were observed in 2 groups immediately before medication (T0),immediately after medication (T1), immediately after incision (T2), immediately after sternotomy (T3), immediately before CPB (T4), immediately after CPB stopping(T5)and immediately after operation(T6),respectively. The levels of CK-MB,H-FABP and cTnⅠwere observed at T0,T5,T6,at 6 h(T7)and 24 h(T8)after operation. The levels of S-100β protein and NSE were observed at T0, T8 and 72 h after operation (T9). MMSE and MoCA scores were observed 1 d before operation and 3,7 d after operation. The application of cardiovascular active drugs and the occurrence of ADR were observed during operation. RESULTS:SBP and DBP of group C at T2-T6,SBP at T4-T6 and DBP at T4 of group D were significantly lower than at T0;SBP and DBP of group D were significantly higher than group C at T4-T6. HR of 2 groups at T4 were significantly lower than at T0,while those of 2 groups at T5-T6 were significantly higher than at T0;the group D were significantly lower than group C at T2-T3. MAP of 2 groups at T2-T3 were significantly higher than at T0,and those of group D were significantly higher than group C at T4,with statistical significance(P<0.05). At T5-T8,the levels of CK-MB,H-FABP and cTnⅠ in 2 groups were significantly higher than at T0;the levels of CK-MB and cTnⅠ at T7-T8,the level of H-FABP at T5-T8 ingroup D were significantly lower than group C,with statistical significance(P<0.05). At T8-T9,the levels of S-100β protein and NSE in 2 groups were significantly higher than at T0,but the group D was significantly lower than group C,with statistical significance(P<0.05). MMSE scores and MoCA scores of 2 groups 3 d after operation,MMSE score and MoCA score of group C 7 d after operation were significantly lower than 1 d before surgery;those of group D 3,7 d after operation were significantly higher than group C,with statistical significance(P<0.05). The amount of dopamine and norepinephrine,the rate of adrenalin use in group D were significantly lower than group C,with statistical significance (P<0.05). There was no statistical significance in the amount of milrinone between 2 groups (P>0.05). The incidence of ADR in group D (6.7％) was significantly lower than group C(24.4％), with statistical significance(P<0.05). CONCLUSIONS:Dexmedetomidine is helpful for hemodynamic stability,relieve myocardial damage,and improve postoperative cognitive dysfunction in patients with CPB valve replacement with good safety.