Objective To evaluate the combined detection of serum galactomannan (GM test) and 1,3-β-D-glucan (G test) in diagnosis of invasive pulmonary aspergillosis (IPA).Methods A total of 136 patients suspected for IPA were enrolled in the study from Jinhua Central Hospital in Zhejiang Province from January 2007 to December 2011.GM and G tests were performed.x2 test was used to conpare the sensitivity,specificity,positive predictive value and negative predictive value of individual test and combined test,and the area under the ROC curve (AUC) was used to determine the effectiveness of the tests.Results The sensitivity and specificity of G test were 84.0％ and 80.9％,and those for GM test were 78.0％ and 88.2％,respectively.The combination of two tests (parallel) increased sensitivity to 92.0％ and the serial test increased the specificity to 92.6％.The AUC of the combined test was 0.923(95％ CI:0.867-0.980).Conclusion The combination of GM test and G test can improve the diagnostic effectiveness for IPA.

Objective To evaluate the early effect of leukocyte-and platelet-rich fibrin (L-PRF)on tendon-bone healing in rabbits' extra-articular bone tunnel.Methods Thirty healthy New Zealand rabbits were randomly divided into an experimental group and a control group,each of 15.The semitendinosus tendon harvested from the hind leg of each rabbit was prepared as free autografts.Each autograft was implanted into the bone tunnel created at ipsilateral proximal tibial metaphysis.The experimental group was added with autologous peripheral blood-derived L-PRF,while the control group did not add anything.Speciments from each group were harvested at 4,8 and 12 weeks after operation.The morphological changes were observed and evaluated at each time point.The fibroblasts on the tendon-bone interface were counted and analyzed under the high magnification microscope.Results The number of fibroblasts between the tendon and bone in the experimental group was significantly higher than that of the control group at each time point (P＜0.05).And the connection between tendon and bone was closer and the collagen fibers were more regular in the experimental group than the control group at each time point.Sharpey's-like fibers which marked the early healing of the tendon to bone,were observed at 4th week in the experimental group,while they were observed at 8th week in the control group.As the healing time extended,Sharpey's like fibers continue to increase in both groups and significant differences were observed in the histological morphology (Buark grades)between the two groups (P＜0.05).Conclusion Autologous peripheral blood-derived L-PRF can promote early healing of autologous tendon to bone in the extra-articular bone tunnel of model rabbit.

ObjectiveTo evaluate the treatment efifcacy of the treatment promotion of standardized management for chil-dren with asthma.MethodsMedical records of 150 children with asthma were reviewed and divided into management group or control group according to whether standardized management was accepted. Comprehensive asthma education for asthma pa-tients and their parents including asthma associated basic knowledge education, health education as well as follow-ups at deifned intervals was conducted in 78 cases. In the meantime, standardized asthma therapies were performed. Control group involved 72 cases who did not receive asthma education managements and only accepted regular clinical therapies. After 1-year observational follow-up, , clinical efifcacy of children with asthma, changes of knowledge-attitude-practice of parents, and compliance of med-ication were compared between the two groups.ResultsAfter promotion of standardized managements treatment, asthma con-trol rates in the management group were signiifcantly higher than that of the control group(χ2=54.68,P<0.01); In addition, the rate of asthma attacks, emergency visits as well as hospitalizations were obviously reduced in the management group than control group (both withP<0.01). Knowledge associated with asthma, therapy and management executions as well as knowledge-atti-tude-practice of parents also demonstrated apparent elevations in the management group (P<0.01); At the same time, management group has illustrated superior medication compliance over the control group (χ2=66.27,P<0.01).ConclusionPromotion of standardized treatment management among children with asthma can help to achieve effective control by raising levels of knowl-edge-attitude-practice of the parents as well as the patient’s compliance to the treatment.

Objective To report treatment of infectious bone and soft tissue defects caused by tibial shaft fracture of Gustilo type Ⅲ B using free flap and Ilizarov bone transport.Methods Nineteen patients who had suffered from infectious bone and soft tissue defects following tibial shaft fracture of Gustilo type Ⅲ11 B were treated from May 2010 to February 2015.They were 15 men and 4 women,aged from 21 to 58 years (average,45.3 years).Their course of disease ranged from 16 to 21 months,averaging 17.9 months.The area of their infectious defects ranged from 10 cm × 6 cm to 21 cm × 12 cm,and the length of their bone defects from 5 to 11 cm (average,7.4 cm).They were treated with debridement,simple external fixation to reconstruct bony support,coverage of wounds with free flap,and stuffing the dead space with antibiotic concrete beads,followed by Ilizarov bone transport and bone graft after control of infection to reconstruct the defective tibia and function of the affected limb.Results All the flaps survived.Necrosis occurred at the distal margin of one flap but responded to dressing.Pin tract infection occurred in 4 cases but also responded to dressing and antibiotic therapy.Autografts of iliac cancellous bone were implanted into the gliding and traction ends of the bone fragments one month after bone transport had come to rest.All the patients achieved direct bony union.The patients were followed up for an average of 25 months(range,from 19 to 36 months).No secondary fractures or angular deformity was observed.The total treatment time averaged 17.9 months,with no recurrence of infection.According to the Puno score system for functional evaluation at the last follow-up,7 cases were rated as excellent,6 as good and 6 as fair.Conclusion The infectious bone and soft tissue defects caused by tibial shaft fracture of Gustilo type Ⅲ B can be treated by free flap and Ilizarov bone transport,resulting in definitely positive outcomes.

Objective To investigate the time of spontaneous recovery of atelectasis after removing the acute airway foreign bodies in miniature pigs.Methods Twenty-two miniature pigs were inserted into the occlusion stent in the right lower lobe bronchus by using bronchoscopy.After confirming the formation of atelectasis,the occlusion stent was removed and the imaging changes were observed for 3 weeks continuously.Results Atelectasis was formed within 1 week after the airway occlusion stent implantation in miniature pigs.Pulmonary reexpansion was observed obviously on week 3 after removal of airway occlusion stent (P ＜0.05).Conclusions The spontaneous recovery time of atelectasis,which caused by an acute foreign body airway obstruction within 1 week,may take 3 weeks at least.

OBJECTIVE:To study the effects of rhei radix and astragali radix on renal protection and intestinal barrier function in rats with chronic renal failure(CRF),and analyze its pharmacological mechanism from the theory of"gut-renal axis"in TCM. METHODS:Rat models of CRF were established by 5/6 nephrectomy. Rats were randomly divided into sham operations group (group J,n=6),model group(group M,n=8),and administration groups(n=9),which included benazepril group(group Y, positive control,2 mg/kg),rhei radix high-dose,medium-dose,low-dose groups(group DH,DM,DL,calculated by crude drug as 3,1.5,0.75 g/kg),and astragali radix high-dose,medium-dose,low-dose groups (group HH,HM,HL,calculated by crude drug as 6,3,1.5 g/kg). After 1 week of modeling,rats in each administration group were intragastrically administrated,once a day,for 5 weeks. Rats in group J,M were intragastrically administrated equal volume distilled water. After 12 h of administration, the 24 h urine protein(Upr),serum levels of creatinine(SCr),urea nitrogen(BUN),uric acid(UA)and plasma endotoxin level were detected,and kidney index was calculated. Changes in renal tissue,villi of small intestinal mucosal tissue and crypt depth were observed by microscope. RESULTS:Compared with group J,24 h urine volume and 24 h water drinking volume of rats in group M were increased,24 h Upr,serum levels of SCr,BUN,UA,plasma endotoxin level,and kidney index were increased, with statistical significances(P<0.05 or P<0.01). Most glomerular volume were increased and rigid in group M,showing intersti-tial infiltration in large number of inflammatory cells;villus length,villus width,mucosal thickness and villus length/crypt depth ra-tio of intestinal mucosa were decreased (P<0.05 or P<0.01),and crypt depth was increased (P<0.01). Compared with group M,24 h urine volume in group DM,DL,HM,HL was decreased;24 h water drinking volume in group HM was decreased;24 h Upr,serum levels of SCr,BUN levels,and kidney index of rats in each administration group were decreased. Except for group HH,serum UA levels in other administration groups was decreased;and except for group HH,HM,HL,plasma endotoxin level in other administration groups was decreased,with statistical significances(P<0.05 or P<0.01). The pathological morphologies of renal tissue,intestinal mucosal tissue and intestinal villi in each administration group were improved to varying degrees. CONCLU-SIONS:Both rhei radix and astragali radix can effectively reduce the metabolic toxin levels of rats,improve filtration function of glomerular and enhance the exclusion of metabolic trash,which may be restoring the intestinal function to achieve the goal of treat-ing CRF. And both show optimal effect in medium dose.

Objective:To investigate the influence of admission to intensive care unit (ICU ) on the postoperative complications in patients with esophageal carcinoma .Methods :A total of 391 patients with esophageal carcinoma confirmed by surgery in Department of Thoracic Surgery ,Zhongshan Hospital ,Fudan University ,from Jan 2009 to Dec 2009 ,were chosen .All the patients had clinical data and postoperative follow‐up data in detail . Patients were divided into postoperative ICU group (treatment group) and postoperative general ward group(control group) .The control group was further classified into control group A(without unplanned ICU admission) and control group B(with unplanned ICU admission) based on whether unplanned admission to ICU was conducted .The occurrence rates of postoperative complications were compared among the three groups . Logistic regression was performed in multivariate analysis of postoperative complications .Results:On Day 1 after surgery ,the APACHE Ⅱ score was higher in treatment group than in control group I(P<0 .05) .However ,there was no increase on rate of postoperative complications in treatment group .The APACHE Ⅱ score ,as well as the occurrence rate of postoperative complications ,was lower in control group A than those in control group B (P<0 .01) .The APACHE Ⅱ score in treatment group was higher than that in control group B (P< 0 .05) .However ,the occurrence rate of postoperative complications in treatment group was lower than that in control group B (P<0 .01) .On Day 1 after surgery ,the higher the postoperative acute physiology and chronic health evaluation(APACHE)Ⅱ score was ,the higher the occurrence rate of postoperative complications was(HR= 0 .631 ,95% CI:0 .405~ 0 .983 ,P< 0 .05) .Postoperative planned ICU admission could diminish postoperative complications ,and it was the independent factor(HR= 1 .588 ,95% CI:1 .147‐2 .199 ,P< 0 .01).Conclusions :If prompt admission to ICU for comprehensive treatment was conducted after esophageal cancer operation , the occurrence rate of complications could be reduced in esophageal cancer patients .

Objective:To investigate the risk factors related to intensive care unit (ICU) readmission .Methods :A total of 2491 patients who had been transferred into Department of Critical Care Medicine of Zhongshan Hospital ,Fudan University from Nov 2008 to Dec 2011 were included .Clinical data of all the patients during their first admission to ICU were collected .All the patients were classified into non‐readmission group(Group A) and readmission group(Group B) on the basis of whether there was readmission to ICU .All the patients’ treatments were conducted under supervision of attending intensivist and in accordance with routine treatment of Department of Critical Care Medicine and related clinical guidelines .Logistic regression was performed in multivariate analyses of ICU readmission .Results:If the first admission to ICU was due to emergency ,then the chance of ICU readmission was raised(HR=4 .929 ,95% CI:1 .936‐12 .549 ,P<0 .01) .If patient underwent tracheotomy during the first ICU stay ,then the chance of ICU readmission increased (HR= 3 .395 ,95% CI:1 .622‐7 .107 , P< 0 .01) . Conclusions :Both the admission to ICU under emergency and the tracheotomy during the first ICU admission are independent risk factors for ICU readmission .