Gene mutation of Candida albicans is one of the main causes for azole drug resistance. Different types of variation play different roles in promoting the process of drug resistance. ERG series of gene mutations primarily affect the ergosterol synthesis pathway. When the regulatory factors TAC1 for CDR1 gene and Mrr1 for MDR1 gene generate mutations, the expression level of drug efflux pump protein in Candida albicans may be changed. In addition, gene copy number variation is also gaining attention. Therefore, the research of mutation resistance-associated genes has a positive meaning to explore the mechanism of drug resistance in Candida albicans.

The incidence of candidiasis caused by Candida albicans has increased dramatically in recent years. With the widespread use of antifungal agents, the emergence of drug resistant strains pose a major challenge to drug treatment. The overexpression of membrane proteins functioning as drug efflux pumps is one of the main mechanisms for multidrug resistance of Candida albicans. Membrane transporters associated with drug resistance in Candida albicans are reviewed in this article.

Cap1p, encoded by CAP1, is a basic region-leucine zipper (bZip) transcription factor in Candida albicans. It has been proven to play important roles in both drug resistance and oxidative stress. Within the AP-1 family, Cap1p belongs to the same subgroup which also includes Yap1p, Yap2p, and Pap1p. The function of Cap1p is regulated by a nuclear localization mechanism. In recent years, some target genes of Cap1p have been discovered and the differences as well as similarities between Cap1p and Yap1p have been revealed. However, the role of Cap1p in the drug resistance of Candida albicans still needs to be further investigated. Currently drug resistance and oxidative stress are the 2 focuses in the research of fungal pathogens, making Cap1p very important in the future study. The authors have been involved in Cap1p research for a long time and this review introduces the current progress in the area.

ATP binding cassette transporter (ABCT),a membrane transporting protein existing in mammalian, bacterial, fungal and many other types of cells, is correlated with multidrug resistance in many cells. To date 10 ABCT have been described in Candida albicans , but only CDR1 and CDR2 genes were associated with multidrug resistance. Moreover, their encoding proteins Cdr1p and Cdr2p have many functions such as efflux pump and phospholipid translocator. The progress in the study of Cdr1p and Cdr2p proteins mediating multidrug resistance in Candida albicans was summarized in the paper.

Objective:To study the practical efficacy of the clinical decision support system for diagnosis and treatment of thyroid cancer (CDSS-TC) in assisting doctors to complete several diagnosis and treatment tasks, and to make a preliminary evaluation of its clinical practicability according to the test results.Methods:From Jan. 2022 to Mar. 2022, 90 patients with thyroid cancer who were admitted to the Head and Neck Surgery Department of Shaw Hospital affiliated to Zhejiang University were prospectively analyzed, and the average time spent in reading the pre-operative B-ultrasound report, as well as the individual fitness of the dose adjustment of eugenol in 70 patients with thyroid cancer after surgery. A retrospective analysis was made of the compliance of the basis of the "recommended scheme" and the deviation of the basis of the doctor’s "final scheme" for the preoperative surgery of 120 patients with thyroid cancer who were treated for the first time in the head and neck surgery of Shaw Hospital affiliated to Zhejiang University from Mar. 2021 to May. 2021. All cases were treated by pure artificial (group A) and CDSS-TC assisted (group B) , and the differences in organization were compared.Results:The average time for disposal of a single B-ultrasound report in Group B was much shorter than that in Group A ( P=5.600E-04) ; The number of patients with excellent grade and the total number of patients with excellent grade and qualified grade recommended by the doctor in group B were significantly higher than those in group A ( P=7.819E-20 and P=1.335E-18) ; The conformity rate of the basis of CDSS-TC "Recommended Scheme" ≥ 98%; The deviation rate of the basis for "final protocol" of doctors in group B was lower than that in group A ( P=0.059 for total resection or not, P=0.075 for lateral neck dissection or not) . Conclusions:CDSS-TC can accurately extract the disease-related source information in all the original examination/laboratory reports, and provide accurate decision-making suggestions through efficient correlation analysis. In view of the accurate and objective conclusions of its analysis, it can provide high-quality and all-link decision support for doctors’ clinical diagnosis and treatment, and is an ideal information work platform.