OBJECTIVE To explore the reason, characteristic,prevention and treatment measures of acquired fungal infection in cardiosurgery intensive care unit(CSICU). METHODS A total of 153 patients who were admitted to our CSICU ward and had perfect microorganism materials from Jan 1999 to Jul 2002 were investigated with retrospective method,in which 34 cases were acquired fungal infection. RESULTS The rate of fungal infection was 21.52%.The most common infection site was lower respiratory tract.The patients after cardiac injury were easy to be infected.The Candida were the main pathogens,especially Candida tropicalis.The cardiopulmonary bypass(CPB) time,the time stayed in ICU,mechanical ventilation time, urinary dwelling tracheal intubation or tracheotomy,fiber bronchoscope and central venous intubation were the risk factors. CONCLUSIONS The reason of acquired fungal infection in CSICU is that CPB decreases patient′s immunity and every invasive exam or treatment can break the normal immunity.

Objective To study the professional value of freshman who specializes in nursing in college,which can help us to take effective strategies to help nursing students form correct and steady professional value.Methods 208 nursing students in college were investigated with nursing professional value questionnaire.Results The total score of the professional value of freshman was (124.53±3.41)points,and caring was (32.41±1.39) points,trust was (22.98±1.64) points,justice was(26.66±l.55) points,profession was (19.73±1.27) points and behaviorism was (22.94±1.31) points among the professional value.Compared with the female nursing students,the scores of the professional values in trust,justice and behaviorism were lower in male,and the score of trust dimension was significantly lower.But the score of the item “Patients have the right to accept or refuse treatment and caring” in justice was significantly lower in female nursing students than male.Conclusions The professional value of nursing students were not optimistic,especially in male nursing students.So colleges and universities need to find effective ways to enhance the training of the professional value of nursing students.

Objective To obtain a lasting and purified cell line of vascular smooth muscle cells (VSMCs) by primary culture, and to provide these test materials related research. Methods The primary and transfer culture was done by tissue - piece inoculationand trypsin digestion,respectively. The cells were frozen in liquid nitrogen,and cultured cells were identified by phase contrast microscopy and immunohistochemical SP kit. Results 85% of inoculated tissue pieces survived. More than 90% of VSMCs regrew in transfered culture. The frozen cells could recover their proliferation by several culture transfers. The VSMCs showed the typical "peak and valley" characteristics under microscopy. Immunohistochemical staining with antibody against SM - a - actin expression in these cells was positive. Conclusion The tissue - piece inoculation is a simple method for obtaining satisfactory VSMCs in short term.

Objective To investigate the effect of lentivirus-mediated siRNA interference of USP39 on proliferation and migration of mice vascular smooth muscle cell in vitro.Methods Five siRNAs of siControl, siRNAUSP39-70, siRNAUSP39-71, siRNAUSP39-72 and siRNAUSP39-73 were designed and sythezied,mice VSMCs were infected with the lentivirus for delivering siRNAUSP39-73, and the stably transfected cells were selected by puromycin.The interference efficiency of siRNAUSP39-73 was assessed with Western blot.The effect of USP39 interference on the proliferation of VSMCs was determined by cells counting and MTT assay.Transwell assay was used to detect the migration of VSMCs.Results Recombinant lentiviral vector siRNAUSP39-73 was successfully transfected into mice VSMCs.Comparing with siControl group and Normal group, USP39 protein level of siRNAUSP39-73 VSMCs were decreased(P<0.05), and the proliferation and migration ability were all inhibited(P<0.05).Conclusion Targeted down-regulation of USP39 expression can inhibit the proliferation and migration of mice VSMCs in vitro.

Objective To study the effect of hidden curriculum on the professional value of nursing students in higher education.Methods A total of 300 full-time nursing students in higher education were collected by the cluster sampling method.They were divided into experimental group and control group by natural class lottery method with 150 students each.The students in experimental group accepted the hidden curriculum such as administrator working of nursing students training,simulated the candidates and the volunteer activities.Then the professional value of the 2 groups was evaluated with nursing professional value questionnaire.Results The total score of the professional value in experimental group after intervention was (126.38±3.29) scores,and caring was (32.50±1.20) scores,trust was (24.40±1.59) scores,justice was (25.54±1.55) scores,profession was (19.64±1.26) scores and behaviorism was (24.31±1.30) scores.The total score of the professional value in control group after intervention was (123.62±2.76) scores,and caring was (32.51±1.24) scores,trust was (22.36±1.30) scores,justice was (26.47±1.54) scores,profession was (19.80±1.23)scores and behaviorism was (22.54±1.59) scores.The scores of trust and behaviorism in experimental group were higher than those in control group,and there were significant differences,t=2.813,2.441,P＜0.05.Conclusions Nursing students of college have positive professional values.The hidden curriculum can cultivate the nursing students' trust and positive psychological quality in higher education.And thus it can be reasonably used in teaching,which would produce a more proactive effect in higher education.

Objective To summanrize the operative method and follow-up data of total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta (Sun's procedure) for acute Stanford type A aortic dissection.Methods Between August 2004 and March 2012,73 patients with acute type A aortic dissection underwent this procedure.60 males and 13 females ranging in age from 26 to 79 years (mean age,49,6 years).Right axillary or femoral artery cannulation was routinely used for cardiopulmonary bypass.Cerebral protection was achieved by bilatero-antegrade or selected hrain perfusion.The stented elephant trunk was implanted throuugh the aortic arch under hypothermic circulatory arrest.The stented elephant trunk was a 10cmlong self expandable graft.Patent false lumina were evaluated using computed tomography 3 months and once each year after discharge to evaluate the postoperative time course of the residual false lumen.Results Mean cardiopulmonary bypass time was (248.1±69.8)min,and selected cerebral perfusion time was (38.2±10.5)min.Hospital morality was 6.85 ％ (5/73).Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 9 1.7％ of the aortic dissections 3 months postoperatively.The mean follow-up time was(36.4 ± 31.6)months (range,2 to91 months).Survival at 1,5,7 years was 97％,87％ and 81％,respectively.Conclusion Total aortic arch replacement combined with transaortic stented paft implantation into the descending aorta is an effective treatment and n more promising choice for acute type A aortic dissection.

Treatment of ischemic mitral incompetence (IMI) is an important problem in cardiovascular surgery, and it is arguing to the best strategies for surgical treatment of IMI. IMI can be quantitative assessment precisely by three-dimensional ultrasonic sound. Perioperative transesophageal echocardiography can acquire detailed information about IMI, but it is possible to underestimate the degree of IMI. The effective mitral regurgitation area at resting are the independently prognosis factor in patients with IMI. So it is necessary to sufficiently evaluate the patients before operation in order to predict the operative effect and risk. It is the choice for the best strategies for surgical treatment of IMI regarding to patients symptom, the degree of IMI, cardiac reconstruction. The therapy strategies should be weighed the operative risk and long-term benefit for moderate IMI, so that combining CABG with concomitant mitral surgery or not would be decided. It is arguing to mitral valve replacement or repair for surgical treatment of severe IMI. The surgical methods should be chosen carefully according to left ventricular remodeling and pathological changes of mitral valve. The effect of mitral valve repair is dependent on correctly perform. The suitable repair technique and plasty ring should be selected actively.

Objective: To investigate the incidence of small intestinal bacterial overgrowth (SIBO) and systemic low-grade inflammation in patients with irritable bowel syndrome (IBS). Methods: From June to October in 2017, 50 cases of IBS patients who met Rome Ⅳ criteria were consecutively collected at Outpatient Department of Gastroenterology of Shanghai Huashan Hospital. The incidence of SIBO was detected by hydrogen lactulose breath test (LBT) and methane LBT. The incidence of systemic low-grade inflammation in IBS patients was determined by fractional exhaled nitric oxide(FeNO) breath test. Chi-square test was used for statistical analysis. Results: Among 50 IBS patients, the positive rate of FeNO was 70%(35/50), and the number of FeNO positive cases in diarrhea-predominant (n=28), constipation-predominant (n=14) and mix-type (n=8) IBS paitents was 18, 11 and six, respectively, and the difference was not statistically significant among three groups (χ²=1.020, P=0.600). The incidence rate of SIBO was 60% (30/50), with 20 cases (40%) being only positive for hydrogen LBT, seven cases (14%) being methane LBT, and three cases (6%) being both positive. The numbers of hydrogen LBT and methane LBT in diarrhea-predominant, constipation-predominant, and mix-type IBS patents were 17, three, three and two, six, two, respectively. There were statistically significant differences in positive rates of hydrogen LBT and methane LBT among three groups (χ²=6.076 and 6.392, both P<0.05). The positive rate of FeNO in IBS patients with SIBO was higher than that of IBS patients without SIBO (90%, 27/30 vs. 40%, 8/20), and the difference was statistically significant (χ²=14.286, P<0.01). Conclusions Combination of hydrogen LBT and methane LBT has a higher detection rate of SIBO than traditional single hydrogen LBT. There is a correlation between SIBO and systemic low-grade inflammation in IBS patients.

Objective: To investigate the efficacy of low dose and short-term oral rifaximin in patients with small intestinal bacterial overgrowth (SIBO) related irritable bowel syndrome (IBS). Methods: From June 2017 to June 2018, at the Department of Gastroenterology of Huashan Hospital, Fudan University in Shanghai, a total of 37 patients with SIBO related IBS were sequentially enrolled and divided into three groups: diarrhea type, constipation type and mixed type. All the patients received rifaximin 200 mg each time, three times per day for 14 days. The clinical efficacy before and after treatment were compared by the scores of irritable bowel syndrome symptom severity scale (IBS-SSS) and irritable bowel syndrome associated quality of life (IBS-QoL). The efficacy of rifaximin on SIBO clearance and SIBO related chronic low-grade inflammation was evaluated by lactulose breath test (LBT) and exhaled nitric oxide (eNO). T test and variance analysis were used for statistical analysis. Results: Among 39 patients with SIBO related IBS, 24 patients were diarrhea type, seven were constipation type and six were mixed type. Except one patient quitted the study because of chest tightness and palpitation, the IBS-SSS score of the left 36 patients before treatment was (250.83±55.10), and decreased to (151.11±33.96), and the difference was statistically significant (t=13.686, P<0.01). Before treatment the score of IBS-QoL was (28.03±16.16), and decreased to (14.39±9.31) after treatment, and the difference was statistically significant (t=6.867, P<0.01). There was no significant difference in IBS-SSS and IBS-QoL scores among the diarrhea type, constipation type and mixed type groups (all P>0.05). After treated by rifaximin, the negative conversion rate of SIBO was 52.8%(19/36). The negative conversion rate of hydrogen LBT was 54.5%(12/22) and among 11 methane LBT positive patients, six cases turned negative; and one of three patients with both positive hydrogen LBT and methane LBT turned negative. The negative conversion rate of eNO was 41.7%(15/36). Conclusions Low dose and short term rifaximin treatment can improve the severity of clinical symptoms and quality of life in SIBO-related IBS patients, and the efficacy is not related with the subtypes of IBS.

Objective To study the clinical and pathological characteristics of early gastric cancer ( EGC) and to evaluate the value of blue laser imaging combined with magnification endoscopy ( BLI-ME) in the diagnosis of EGC. Methods A retrospective study was conducted on data of 255 patients with EGC diagnosed in Huashan Hospital from January 2014 to January 2017, including 33 cases of preoperative BLI-ME intensive examination. According to the Japanese classification of gastric carcinoma of Japanese Gastric Cancer Association, the EGCs were histopathologically divided into differentiated and undifferentiated subtypes. Clinical characteristics, endoscopic features, pathological type, lymph node metastasis, and lesion characteristics of BLI-ME were analyzed. Results Among the 255 cases of EGC, 164 cases ( 63. 31％) were male, 242 cases ( 94. 90％) were over 40 years old, 182 cases ( 71. 37％) belonged to differentiated type, 93 cases ( 36. 47％) were located in gastric antrum, 92 cases ( 36. 08％) were type 0-Ⅱc under endoscopy, and 37 cases (14. 51％) had lymph node metastasis. Comparative analysis showed that the lymph node metastasis rate was significantly lower in mucosal carcinoma compared to submucosal carcinoma[ 5. 04％(7/139) VS 25. 86％ (30/116),χ2=22. 109, P=0. 000], lower in differentiated carcinoma compared to undifferentiated carcinoma[9. 89％ (18/182) VS 26. 03％ (19/73), χ2=10. 938, P=0. 002], and lower in tumors with maximum diameter of lesion≤2. 0 cm compared to maximum diameter of lesion>2. 0 cm [ 9. 88％ ( 16/162 ) VS 22. 58％ ( 21/93 ) , χ2 =7. 687, P=0. 009 ] . Among the 33 cases undergoing BLI-ME, differentiated EGC was mainly fine-network pattern (13. 64％, 3/22), intralobular loop pattern (ILL)-1 (59. 09％, 13/22) and ILL-2 (22. 73％, 5/22), whereas undifferentiated subtype patients were characterized as ILL-2 ( 45. 45％, 5/11 ) and corkscrew pattern ( 54. 55％, 6/11 ) . Conclusion The incidence of EGC is higher in male with age over 40 years. Gastric lesions occur most frequently in the antrum, and the most common microscopic morphology is 0-Ⅱc type. Tumor>2. 0 cm or invasion of submucous layer, and undifferentiated carcinoma are prone to lymph node metastasis. The assessment of mucosal microvascular pattern and micro surface structure under BLI-ME facilitate to determine the pathological type of EGC.