Objective To investigate whether efflux mechanism is involved in azole resistant Candida albicans strains isolated in China. Methods We compared rhodamine 6G uptake and glucose induced efflux between azole sensitive and azole resistant strains to elucidate resistance to azole due to efflux pump, then measured mRNA level of efflux gene cdr1 and cdr2 by reverse transcriptase polymerase chain reaction (RT PCR). Results Rhodamine 6G moved from extra into the intracellular compartment in both azole resistant and azole sensitive strains quickly when in glucose free incubation condition. However, efflux of rhodanmine 6G was enhanced significantly in azole resistant strains and decreased in azole sensitive strains while adding glucose in the media. The mRNA level of efflux gene cdr1 and cdr2 was higher in clinical azole resistant strains and fluconazole induced resistant strains than strains reverted from resistance to sensitivity. However, all such strains had higher efflux gene expression than azole sensitive strains. Conclusions Efflux mechanism is associated with the resistance to azole in Candida albicans strains isolated in China. Fluconazole can induce efflux pumps expression leading to resistance to azole but the resistance to azoles can be reversed after withdrawing fluconazole.

Objective To observe the safety and efficacy of the SLIPA mask airway in the cesarean section operation under general anesthesia.Methods Fifty single birth pregnant women who underwent cesarean operation under general anesthesia were randomized into 2 groups.SLIPA mask group(group S,25 cases)and endotracheal intubation(ETT)group(group T,25 cases).Mean arterial pressure(MAP),heart rate(HR),partial pressure of carbon dioxide in end expired gas(P_(ET)CO_2),peak airway pressure(Paw)were measured before induction of anesthesia,just before intubation,2min after intubation,just before extubation,2 min after extubation.Bucking,style,reflow,vomiting,aspiration were observed at inmbation or SLIPA mask airway insertion,before and after extubation and intraoperative.Umbilical arteries and veins blood were collected at delivery for the blood gas analysis.All delivery times,operation time and Apgar scores at 1,5 min were recorded.Results The successful rate ofthe first time intubation was 100% in group S,there was 2 cases by the second time intubation in group T.There Was 3 cases with gently air leak,but no influence on respiratory management.After intubation and extubation,MAP and HR increased significantly in group T (P<0.05),while group S had no significant change.There was no occurrence of bucking,style,reflow,vomiting,aspiration intmoperative,but 17 cages occurred at extubation in group T.The incidence and degree of sore throat in group T(10 cases after 2 hours and 6 cases after 24 hours) were significantly higher than those in group S(P<0.05).The Apgar scores at 1,5 min and delivery times were not significant between the two groups(P>0.05).Conclusion There is less adverse effects of SLIPA mask airway than ETT under general anesthesia in the cesarean section operation,SLIPA mask airway is safe and efficacious.

Objective:To compare the effects of dexmedetomidine and nicardipine in the induction of controlled hypotension in the pa-tients during orthognathic surgery.Methods:60 patients were randomly divided into 2 groups(n =30).The patients in group D were intravenously pumped with 1 μg/kg dexmedetomidine for 10 min followed by 0.2 ~0.7 μg/(kg·h).Those in group N were pumped with nicardipine for an initial dose of 0.75 μg/(kg·min)followed by 0.2 ~0.5 μg/(kg·min).HR,MAP were recorded before in-duction (T0 ),start of hypotension(T1 ),10 min(T2 ),20 min (T3 ),30 min(T4 )and 60 min(T5 )after hypotension,10 min(T6 ), 30 min(T7 )after stop of hypotension,and at the end of surgery(T8 ).The remifentanil dosage was recorded.Riker sedation-agitation score (RSAS)before extubation and Ramsay score 5 min after extubation were observed.Results:Comparing with T0 ,MAP at T2 -T7 in the 2 groups were significantly decreased(P <0.05).The intraoperative remifentanil consumption in group D was significantly lower than that in group N (P <0.05).The Ramsay score in group D was significantly higher than that in group N(P <0.05).The RSAS in group D was significantly lower than that in group N(P <0.05).Conclusion:Both dexmedetomidine and nicardipine are safe for con-trolled hypotension in providing ideal surgical field during orthognathic surgery.Dexmedetomidine can produce more stable hemdynamic indexes and offer more advantage in postoperative sedation.

Objective To investigate the efficacy of botulinum toxin type A injection with ankle-foot orthosis (AFO) for the treatment of post-stroke lower limb spasticity.Methods One hundred and three stroke patients with lower limb spasticity were randomly divided into control group,observation group and treatment group.The patients in control group were given routine treatment,those in observation group were given botulinum toxin type A injection in addition to routine treatment,and those in treatment group were treated with AFO on the basis of the interventions of observation group.Before treatment and at 1,3 and 6 months after treatment,clinic spasticity index (CSI) and Fugl-Meyer assessment (FMA),Berg balance scale (BBS) and functional independence measure (FIM) were used to evaluate the efficacy of all groups.Results When compare the assessment results at 1 month after treatment with those before treatment,statistically significant difference in terms of scores of CSI,FMA and FIM were revealed in treatment group and observation group (P ＜ 0.05),but not in the control group (P ＞ 0.05).Within-group comparison with the results at 1 month after treatment,the scores of CSI at 3 and 6 months increased in control group and observation group,while decreased in treatment group(P ＜ 0.05),although the scores of FMA and FIM increased in all groups and the increase was statistically significant only in treatment group(P ＜ 0.05).Between-group comparison of the scores in CSI,FMA and FIM showed no significant difference between the observation and control groups(P ＞ 0.05).It was shown that the scores of BBS at 1,3,and 6 months improved continuously in all groups(P ＜0.05),the improvements in treatment group were significantly greater than that of observation group and control group (P ＜ 0.05).Conclusion Ultrasound-guided botulinum toxin type A injection with AFO could further improve lower limb muscle spasticity,and enhance motor,balance and activities of daily life for stroke patients.

Objective:To study the feasibility of using sevoflurane induction in infants' removing stitches after cleft lip surgery. Methods:60 infants after cleft lip surgery were randomly divided into three groups:group K (ketamine group,n=20),group S (sevoflurane group,n=20) and group SN (sevoflurane and nitrous oxide group,n=20). Group K were given intramuscular ketamine 5 mg/kg,midazolam 0.05 mg/kg and atropine 0.01 mg/kg. Group S were induced with inhalation of 8% sevoflurane under 6 L/min oxygen. Group SN were induced with inhalation of 8% sevoflurane under 4 L/min nitrous oxide and 2 L/min oxygen. After induction,anesthesia was continued with inhalation of sevoflurane under 3 L/min oxygen for 2 min before starting removing stitches. HR and SpO2 were monitored regularly during operation. The induction time,recovery time,occurrence of head moving,complication such as respiratory depression and increased secretion were recorded. Results:Induction and recover time in group S and group SN were similar,but faster than that of group K. Head moving in group S and group SN were less than that in group K. There happened glossoptosis and increased secretion in all the three groups,but no differences were found significantly. Conclusion:Inhaled induction of sevoflurane has more rapid induction and recover compared with intramuscular ketamine,and can be used safely in infants' removing stitches after cleft lip surgery. Additional inhalation of nitrous oxide can not shorten infants' induction and recovery time than sevoflurane inhalation alone.

Objective To study incidence of deep vein thrombosis (DVT) in the acute phase and follow-up period after stroke, and to investigate risk factors of DVT. Methods This was a prospective study at multi-centers. Ultrasonography was used for detecting DVT on both lower extremities in all patients at 10-14 days after the onset of stroke. All patients were followed up for 6 months after discharge. The incidence of DVT was examined in the acute phase and in the follow-up period of stroke. A variety of patient and treatment related factors were compared between stroke patients with DVT and without DVT to identify DVT risk factors. Results The incidence of DVT in the acute period of stroke was 4. 49%. Among DVT patients, 51.6% patients presented clinical DVT symptoms. By multiple factors logistic regression analysis,age ( ≥70 years, OR = 1.63, 95% CI 1.08-2. 84), bedridden( OR =4. 85, 95% CI 2.65-9. 68 ), wells score ≥ 2 ( OR = 3.96, 95% CI 1.86-7. 86 ), lower limbs NIHSS score ≥ 3 ( OR = 4. 56, 95% CI 2. 07-8. 85 ), high D-dimer ( OR = 3.45, 95% CI 2. 01-8. 52 ), low BI scores ( OR = 2. 98, 95% CI 1.52-6. 47 ), rehabilitation therapy ( OR = 1.82, 95% CI 1.22-3.43 ) and anticoagulant therapy ( OR =1.91,95% CI 1. 34-4. 92 ) were independent risk factors of DVT in the acute phase of stroke. Among them, the rehabilitation therapy and anticoagulant therapy were protective factors. The incidence of DVT in the follow-up periods was 1. 51%. Age ( ≥ 70 years, OR = 1.82, 95% CI 1.21-3.98 ), bedridden after discharge( OR = 5. 12, 95% CI 2. 82-11.32), lower limbs NIHSS score ≥3 ( OR = 4. 25, 95% CI 2. 11-7. 87), low BI score( OR = 2. 18, 95% CI 1.18-6.23 )at the time of discharge and DVT in acute period (OR =3.81,95%CI 1.87-7.48)were independent risk factors of DVT in the follow-up period of stroke.Conclusions Stroke patients, particularly old-aged stroke patients, are a high-risk group of developing DVT. 48.4% DVT patients had no clinical DVT symptoms but were diagnosed only by ultrasonography.There are multiple independent risk factors of DVT after stroke. It is necessary to monitor and prevent DVT in the stroke patients with the risk factors. The rehabilitation therapy and anticoagulant therapy may decrease incidence of DVT.

Objective To evaluate the predictive value of modified early warning score (MEWS) and SMART-COP score on mechanical ventilation in patients with severe influenza A H1N1. Methods Fifty cases diagnosed with severe influenza A H1N1 were retrospectively analyzed. The MEWS and SMART-COP score were calculated. The area under the receiver operating characteristic (ROC) curve (AUC) was evaluated using ROC curve. MEWS, SMART-COP score and AUC were analyzed by Z test. Results The AUCs of MEWS and SMART-COP score for predicting mechanical ventilation were 0. 923 and 0. 889, respectively, which were not significantly different (Z=0. 548, P =0. 584).Conclusion Both of MEWS and SMART-COP score are predictive factors of mechanical ventilation in the patients with severe influenza A H1N1.

Objective To summarize the characters of the elastograms of different pathological nodules, and to observe the value of elastography in differentiating benign from malignant thyroid solid nodules. Methods One hundred and sixteen patients with thyroid nodules were enrolled in the study and 122 nodules were detected in total. All of them were examined by elastography and conventional ultrasound. Five sonographers were invited to evaluate the nodules double blinded basing on the images and the four-point system proposed by Fukunari. The interobserver agreement was evaluated by Kappa coefficient. Diagnostic performances of the five readers were compared by the ROC curves. Distributions of elastography scores of different pathological nodules were compared by one-way ANOVA. Results Interobserver agreements on scoring the nodules were moderate. Mean value of benign nodules was obvious lower than that of the malignant ones. The mean score of nodular goiters was 2.67 ± 0.89, range from 1 to 3. Most of the adenomas got score of 2, but the score of thyroiditis was quite high. No significant differences were found between the comparison of thyroiditis and thyroid cancers. Areas under the ROC curve (AUC) of the five readers were 0.82,0.81,0.79,0.73 and 0.83 respectively. When 3.5 was choosen as the cut-off point, the sensitivity of elastography was 82.4%, and specificity was 71.6%. Conclusions Elastography was really a useful technique for it can provide a new index for the differential diagnosis of thyroid nodules. However, the 4-point score system is not comprehensive enough.

Objective To explore the effect of Yes-associated protein 1 (YAP1) and potential mechanism on erlotinib ( ER) resistance in lung adenocarcinoma.Methods In PC-9 cells and acquired ER resistant PC-9 ( PC-9/ER) cells, the expression changes in YAP1 gene were measured by quantitative real-time PCR( RT-qPCR) and Western blot.Indirect immunofluorescence was adopted to observe the location of YAP1.PC-9/ER cells were treated with the verteporfin ( VP, YAP1 inhibitor) for 24 h and 48 h, respectively.Expression changes in mRNA and proteins of YAP1, AKT and p-AKT were detected in the presence or absence of VP.The effect of VP was analyzed by drug resistance index using Cell Counting Kit 8(CCK-8) assay.Results The resistance index of PC-9/ER cells was (99.80 ±25.81).Compared with PC-9 cells, the expression levels of YAP1 mRNA and protein were increased in PC-9/ER.The inhibitory efficiency of VP was (50.96 ±5.86)%, and the levels of AKT and p-AKT proteins were down-regulated by the inhibition of YAP1 simultaneously.The half maximal inhibitory concentration (IC50) of PC-9/ER decreased from (11.10 ±2.72) to (1.47 ± 0.32)μmol/L (P =0.024).Resistance index was reduced to one eighth of the original.Conclusion These results indicate that the YAP1 mediates ER resistance in lung adenocarcinoma.Suppression of YAP1 can reduce the resistance through PI3K/AKT signaling pathway.Therefore, YAP1 may be a potential target for lung cancer gene therapy.

Objective To detect the changes of G protein-coupled inwardly rectifying potassium channels (GIRK)expression in allergic asthma model and identify the regulatory factors.Methods The E3 rat asthma models were induced by challenge with ovalbumin 14 days after immunization with ovalbumin and aluminium adjuvant.The asthma models were evaluated based on changes in lung pathomorphology and total IgE levels.The levels of GIRK1-4 mRNA and protein were detected using real time-PCR and Western blot.The anatomic sites where GIRK was expressed dominantly in the lung were identified using immunohistological staining.To identify the effects of IL-4 on the expressions of GIRK channels,GIRK 1 -4 mRNA and protein in IL-4 stimulated bronchial epithelial cell line A549 were detected by RT-PCR and Western blot.Results The levels of GIRK1-4 mRNA and protein decreased significantly in the lung in asthmatic E3 rats.The results of immunohistological staining showed that GIRK channels were dominantly expressed in airway epithelia in the lung.The levels of GIRK 1-4 mRNA and protein were down-regulated in time-and dose-dependent manners in IL-4 treated A549.Conclusion IL-4 down-regulates the expression levels of GIRK subunits in bronchial epithelia during allergic asthma.