The incidence of invasive fungal diseases has been increasing annually, becoming one of the most serious infectious diseases affecting clinical departments. Currently, the primary indicators for early diagnosis of invasive fungal disease are the 1-3-β-D-glucan test and the galactomannan antigen test, known as the G test and GM test, respectively. The National Health Commission of the People′s Republic of China, in Goal Four of the'National Medical Quality and Safety Improvement Goals′, proposed to'increase the submission rate of pathogen examination before antibiotic treatment in hospitalized patients′, and emphasized the importance of tests such as G test as common clinical mycological diagnostic tools. Moreover, it is of paramount significance for clinical laboratories to ensure the quality of fungal detection. This paper provides a detailed discussion of the key factors affecting the G test and GM test, and the importance of launching the national external quality assessments.

Objective:To explore the effect of early clinical clerkship training in the early exposure to clinical practice of eight-year program medical students.Methods:Experimental control method was used in this study. A total of 120 eight-year program medical students in the third year of Batch 2014 to 2016 from the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were selected as the research objects. The students of each grade were randomly selected by computer and divided into experimental group and control group, with 20 students in each group. Before early clinical exposure, the experimental group received 16 class hours of early clinical clerkship training, while the control group did not receive early clinical clerkship training. After the early clinical exposure, the clinical diagnosis and treatment ability of the two groups of students was compared. SPSS 24.0 software was used for t test. Results:The scores of medical history inquiry of experimental group and control group were [(17.45±1.96) points and (15.95±1.93) points; (18.30±1.03) points and (16.75±1.86) points; (17.95±1.36) points and (16.40±1.60) points, respectively]. The physical examination scores were [(17.75±1.65) points and (16.05±1.64) points; (17.85±1.18) points and (16.80±1.47) points; (18.25±1.16) points and (16.85±1.63) points, respectively]. The clinical judgment scores were [(18.15±1.42) points and (16.35±2.41) points; (18.20±1.24) points and (16.65±1.53) points; (18.35±1.35) points and (16.25±1.83) points, respectively]. Diagnosis and treatment scheme scores were [(17.15±1.57) points and (14.55±2.56) points; (17.30±1.42) points and (15.90±1.48) points; (17.80±1.06) points and (16.35±1.87) points, respectively]. The scores of communication skills were [(17.95±1.15) points and (17.00±1.19) points; (18.55±0.83) points and (17.45±1.50) points; (18.45±1.00) points and (17.45±1.23) points, respectively], with statistically significant differences (all P<0.05). Conclusion:The application of early clinical clerkship training in the early exposure to clinical practice of eight-year program medical students can improve the quality of students' clerkship.

Objective To study the effect and mechanism of autophagy in gastric cancer cells induced by β-sitosterol in vivo and in vitro,providing experimental evidence for antitumor study of β-sitosterol on gastric cancer.Methods Human gastric cancer SGC-7901 cells were cultured in vitro.The control group was treated with phosphate buffer (PBS) only,and the experimental group was treated with different concentrations of β-sitosterol.Tetrazolium salt colorimetry (MTT) was used to detect the inhibitory effect of β-sitosterol on gastric cancer cells.Flow cytometry was used to detect the apoptotic effect of β-sitosterol on gastric cancer cells.Green fluorescent protein labeling (GFP) was used to detect the induction of autophagy by β-sitosterol.Western blot was used to detect the expression of signal pathway proteins phosphorylated phosphoinositid 3-kinase (p-PI3K),phosphorylated protein kinase B (p-AKT) and phosphorylated mammalian target of rapamycin (p-mTOR).The nude mice model of gastric cancer was established by SGC-7901 cells.β-sitosterol was injected abdominally once every 3 days for 42 days.The weight and volume of transplanted tumors were observed.The expression of LC3-Ⅱ and LC3-Ⅰ in transplanted tumors was detected by immunohistochemistry.Results β-sitosterol could inhibite the viability and promote the apoptosis of SGC-7901 cells,inducing the autophagy of SGC-7901 cells when its concentration reached 20 μmol/L.The autophagy rate of experimental group was (19.32 ±2.51,32.25 ±3.18,57.45 ±4.02,78.93 ±4.21),which was significantly higher than that in the control group (7.28 ± 2.83,P ＜ 0.05).In the experimental group,the expression of p-PI3K,p-AKT and mTOR was down-regulated by β-sitosterol,which was significantly different from that in the control group (P ＜ 0.05).The inhibition rate of the experimental group was (69.8 ± 3.6) ％,and the weight and volume of the transplanted tumors were significantly reduced compared with those in the control group (P ＜ 0.05).β-sitosterol increased the expression of LC3-Ⅱ,decreased expression of LC3-Ⅰ,leading the rise of ratio of LC3-Ⅱ to LC3-Ⅰ in nude mouse tumor (t =7.28,P =0.008).Conclusions β-sitosterol can inhibite proliferation and promote apoptosis of SGC-7901 cells.The antitumor mechanism may related to the autophagy induced by beta-sitosterol through PI3K/AKT/mTOR pathway.

Objective: To investigate the diagnostic value of whole liver CT perfusion imaging in the quantitative evaluation of hemodynamic changes before and after transcatheter arterial chemoembolization (TACE). Methods: Twenty-six patients with hepatocellular carcinoma underwent TACE therapies were recruited. Whole -liver computed tomographic perfusion imaging (CTPI) was performed 2~3 days before TACE and 1 month after TACE. We measured the following perfusion parameters: hepatic arterial perfusion (HAP), portal venous perfusion (PVP), total liver perfusion (TLP), hepatic arterial perfusion index (HAPI), and time-to-peak (TTP).The F-test, t-test and Rank sum test were used for statistical analysis. Results: A total of 34 HCC lesions were detected. According to the deposition of lipiodol after TACE, they were divided into a lipiodol dense group (21) and a lipiodol light group (13). The length of hepatocellular carcinoma lesions after TACE showed a decreasing trend compared with preoperative TACE. The lesions in the lipiodol dense group had smaller lesions than those in the lipiodol light group. The preoperative and postoperative longitudinal diameters were (3.12 ± 0.58) cm vs. (1.93 ± 0.79) cm, (2.98 ± 2.01) cm vs. (2.58 ± 2.00) cm, the differences were statistically significant (t = 15.1, 8.65, P < 0.05). The preoperative HAP and HPI of the lipiodol dense group were the highest, and the peritumoral within 1cm was higher than that of the surrounding liver parenchyma. The PVP, TLP, and TTP were highest in the surrounding of liver parenchyma, and 1 cm higher than the tumor area in the background. The corresponding perfusion parameters were statistically significant (P < 0.05); HAP and HPI were 1 cm higher than the surrounding liver parenchyma. After the operation, PVP, TLP and TTP were lower than the background liver parenchyma, the difference was statistically significant (P < 0.05); HAP and HPI decreased by 1 cm after the operation, and the PVP, TLP, and TTP increased. There was no significant difference after operation in the blood perfusion of background liver parenchyma (P ˃ 0.05). The HAP and HPI decreased, and the PVP and TTP increased in the lipiodol light group after operation (P < 0.05). There was no significant difference between the other two regions (P ˃ 0.05). Conclusion There was no blood perfusion in the lipiodol deposition area after TACE. The perfusion volume of hepatic artery in the peritumoral 1 cm and lipiodol light group decreased and the portal venous perfusion increased. CTPI can quantitatively evaluate blood perfusion state, which is of great significance for the determination of treatment plans before TACE treatment to assume the postoperative therapeutic effect in liver cancer.

Objective To observe the clinical efficacy of drilling and drainage combined with atorvastatin calcium tablets in treatment of chronic subdural hematoma (CSDH).Methods Totally,46 patients with CSDH,admitted to and received therapy in our hospital from January 2014 to January 2017,were selected for this research.These patients were divided into control group (n=16) and experimental group (n=30) according to therapeutic schemes.The patients from the control group underwent drilling and drainage.Besides that,the patients from the experimental group were given atorvastatin calcium tablets additionally,20 mg/d×2 months.Two months after that,the curative efficacy,hematoma volume before and after operation,pneumocephalus volume one week after operation,duration of tube drainage,length of hospital stay,China stroke scale (CSS) scores,activities of daily life-Barthel index scale (ADL-BI) and visual analog scale (VAS) score were compared between the patients from the two groups.Results Two months after treatment,patients from the experimental group had significantly decreased hematoma volume as compared with those from the control group (P＜0.05).The hematoma volume in both groups 2 months after treatment was significantly decreased as compared with that before treatment (P＜0.05).The pneumocephalus volume,indwelling time of drainage tube,and hospital stays in the experimental group were significantly shorter/lower than those in the control group (P＜0.05).The CSS scores and VAS scores in the experimental group 2 months after treatment were significantly lower than those in the control group (P＜0.05).The ADL-BI scores in the experimental group 2 months after treatment were significantly higher than those in the control group (P＜0.05).The ADL-BI scores in both groups 2 months after treatment was significantly increased as compared with those before treatment (P＜0.05).Conclusion As compared with simple use of drilling and drainage,drilling and drainage combined with atorvastatin calcium tablets can help hematoma absorption,decrease incidence of pneumocephalu,and improve prognosis effectively.

Objective To observe the effect of Hp infection on the expression of Foxp3 and ROR in peripheral blood of patients with hepatitis C cirrhosis ,and to explore the effect of Hp infection on the regulation of Treg cells. Methods Totally 42 hepatitis C cirrhosis patients with Hp infection were chosen as observation group and 30 patients without as control group. Gene expressions were determined by RE-PCR and relative cell factors were detected by ELISA in two groups. Results Expression of FoxP3 and RORγt in observation group was significantly higher than that in control group;the expression level of IL-10,IL-6,IL-17,TGF-β1 and IFN-γin observation group was significantly higher than that in control group but IL-2 expression level was lower than that in control group and expression of IL-10 and TGF-βwas positively correlated with Foxp3 expression and was negatively correlated with IL-2. Conclusion Through inducing the high expression of Treg cells ,Hp may promote the expres-sion of IL-10,TGF-β1,IL-6 and IL-17,inhibit the expression of IL-2 and IFN-γ,imbalance of Treg/Th17 and Th1/Th2 balance in the body and promote the liver inflammation and fibrosis in patients with hepatitis C liver cirrhosis.

[Summary] This article reviewed the clinical features in two diabetes cases complicated with nasal‐brain mucormycosis by pathology and pulmonary mucormycosis. In one patient with diabetes combined with pulmonary mucormycosis ,manifestations of chest pain and hemoptysis ,the right upper lung biopsy tip morphology was consistent with Mucor ,successfully cured with amphotericin and operation treatment. The other patient with diabetes‐complicated nasal mucormycosis with headache and nasal cavity clump , showed black caseous matter ,finally hemiplegia. A nasal cavity tumor was proved by pathological examination. After treatment with fluconazole and operation ,the patientdied. Mucormycosisis rare and may be secondary to diabetes and hypoimmunity disease. It needs rapid diagnosis and treatment.

OBJECTIVE: To determine the relation between serum myostatin with body mass index (BMI) and PaO₂/PaCO₂ in men with chronic obstructive pulmonary disease (COPD). METHODS: A cohort of outpatients with stable COPD was evaluated. We evaluated the myostatin, PaO₂/PaCO₂ and BMI, and the patients were stratified by BMI. The plasma level of myostatin and PaO₂/PaCO₂ was measured by high sensitivity ELISA or blood gas analysis. RESULTS: PaCO₂ and myostatin increased significantly compared with those in the control group (P<0.05), but PaO₂ decreased significantly. There was positive correlation between myostatin and PaCO₂ (P<0.05), and negative correlation between myostatin and BMI/FEV1/pred value/PaO₂ (P<0.05). CONCLUSION Patients with higher myostatin levels had a lower BMI, lower PaO₂ and higher PaCO₂, with poor pathogenetic condition and prognosis. Myostatin may be a potential treatment target in patients with chronic obstructive pulmonary disease.
Blood Gas Analysis ; Body Mass Index ; Humans ; Male ; Monitoring, Physiologic ; Myostatin ; blood ; Prognosis ; Pulmonary Disease, Chronic Obstructive ; blood

Objective To investigate the relationship between single nucleotide polymorphism (SNP) of Fas ligand (FasL) and fulminant hepatitis B in Han Chinese. Methods HBV infected subjects were enrolled in this case-control study, including 233 cases of inactive HBsAg carrier, 68 patients with fulminant hepatitis B,100 cases of spontaneous hepatitis B clearance, 102 patients with hepatitis B virus (HBV) related cirrhosis and 112 patients with HBV related primary hepatocellular carcinoma. The blood samples and clinical data were collected. FasL-844T/C polymorphisms of enrolled subjects were examined by TaqMan real time fluorescent genotyping polymerase chain reaction (RT-PCR). A adjusted odds ratios (OR)and 95% confidence intervals (CI)were calculated using the Logistic regression model. Results After adjusting the factors of gender and age, binary Logistic regression analyses indicated that the genotype frequencies of FasL-844 CC,CT,TT in inactive HBsAg carriers were 50. 64% ,39. 91% and 9. 44% respectively, and those in cases of fulminant hepatitis B were 79. 41%, 17. 65% and 2. 94%, respectively. The analysis also revealed that FasL-844CC genotype in inactive HBsAg carriers was high risk factor of developing fulminant hepatitis B (OR =4. 729,95%CI:0. 510 - 21. 282,P = 0. 043), while there were no statistic significances in other cases (P>0. 05). Conclusion The inactive HBsAg carriers harboring FasL-844CC may have greater susceptibility to fulminant hepatitis B, which need arouse high attention.