OBJECTIVE To investigate predisposing factors of candidemia in nosocomial infections.METHODS To retrospectively review the clinical features of 120 cases,including 59 who developed candidemia and 61 cases with bacteremia during the period of 1990-2004.RESULTS The incidence of candidemia was stable over a 14-year period.Candida albicans remained the predominant Candida species recovered(30.5%),followed by C.tropicalis(25.7%),C.glabrata(12.9%),C.parapsilosis(12.9%) and others(17.1%).Of the total 59 cases of candidemia,were administrated by broad spectrum antibiotic therapy for long time,urinary catheters,malignant tumor,etc.Multivariate analysis showed that candidemia was related with many factors.CONCLUSIONS C.albicans was the major pathogen in our hospital during 14 years;the candidemia is related with the use of quinolones,ventilator,central venous catheters and radiation-chemotherapy(P

Objective To evaluate the effect of 3D printing models applied to Medical Imaging Di-agnosis Undergraduate Teaching. Methods Students in the year 2012/2013 of Shanghai Jiao Tong Univer-sity School of Medicine stomatology specialty were chosen for this study, including 38 students in the exper-imental group (2013) and 40 students in the control group (2012). All of them were taught by the same group of teachers, including 28 core curriculum hours and 5 practice class hours. 3D printing technology with PPT was applied to the experimental group in the medical imaging diagnostic teaching, and conventional teaching including PPT and usual models in the control group. Medical students were given a test about cardiovascular system and tasked with completion of drawing hand and foot bones. Students in experimental group were also asked to complete a questionnaire about their experience. Results The questionnaire showed that 3D printing teaching molds with PPT was of great significance to improve the students interest in learning imaging anatomy, to meet the vast majority of students' learning requirements, and to achieve satis-factory results. The average scores of the circulatory system test in the experimental group were higher than that of the control group [(8.32 ±2.352) vs. (6.15 ±1.284), P<0.05)]. Students in experimental group per-formed better than students in the control group on the Locomotor system test [(6.81 ±1.347] vs. (3.84 ± 0.985), P<0.01]. Conclusions 3D printing mold combined with PPT teaching method can promote the med-ical imaging anatomy structure, learning effect and teaching quality, and has practical value in the under-graduate teaching of medical imaging diagnosis.

Objective To investigate the prevalence of plasmid-mediated quinolone resistance qnr and aac(6')-Ib-cr in Enterobacteriaceac in Chiha.Methods A total of 197 clinical isolates with ciprofloxacin≥0.25μg/ml,cefotaxime≥2.0μg/ml and ceftriaxone≥2.0 μg/ml were screened from the 421 non-repetitive clinical isolates of Enterobac teriaceae(Escherichia coli,Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae)from the nine teaching hospitals in China.qnrA,qnrB,qnrS and aac(6')-Ib gene were detected by PCR.aac(6')-Ib-cr gene was further identified by the digestion with BtsCI followed by sequencing.Conjugation experiments were done.The MIC of ciprofloxacin and other antibacterial agents in donor strain and acceptor strain were determined by agar dilution.Results Qnr was present in 42%(83/197)of isolares,and among these,17 isolates carried qnrA(9%),46 isolates carried qnrB(23%),24 isolates carried qnrS(12%),2 isolates carried qnrA and qnrB,and 2 isolates carried qnrB and qnrS.aac(6')-Ib was present in 46%(90/197)of isolates,40%(36/90)of which carried the cr variant responsible for low-level ciprofloxacin resistance.18 isolates carried qnr and aac(6')-Ib-cr.Qnr wag present in 66% of Enterobacter cloacae isolates,66% of Klebsiella pneumoniae isolates,63% of Citrobacter freundii isolates,and 6% of Escheriehia coil isolates,respectively,aac(6')-Ib-cr was present in 9% of Enterobacter cloacae isolates,22% of Klebsiella pneumoniae isolates,27% of Citrohacter freundii isolates,and 17% of Escherichia coil isolates,respectively,qnr and aac(6')-Ib-cr were present in 20% (83/421)and 9% (36/421) of all isolates respectively. The 13 transconjugants showed 16 to 125 fold increases in the MICs of ciprofloxacin and 16 to 31 fold increases in the MICs of levofloxacin relative to that of the recipient Conclusion Transferable plasmid-medlated low level quinolone resistance associated with qnr and aac(6')-Ib-cr widely exists in the enterobacteriaceae strains and perhaps this may contribute to the rapid increase of bacterial resistance to quinolones in China.

Objective To evaluate the in vitro activity of daptomycin, vancomycin, teicoplanin, tigecycline, ceftobiprole and linezolid against 499 strains of blood-isolated gram-positive cocci. Methods Determination of the minimal inhibitory concentration (MICs) of daptomycin with microbrothdilution method and the MICs of other 9 antimicrnhial agents with agar dilution method against 499 strains of blood-isolated gram positive cocci was carried out. The data was analyzed with WHONET 5.4 software. Results The susceptibility rates of staphylococci to daptomycin, tigecycline, linezolid, ceftobiprole, vancomyein and teicoplanin were 100%. All staphylococcus strains were inhibited by daptomycin at a MIC of 1 mg/L. The MIC50 and MIC60 of daptomyein were both 0.5 mg/L against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant Staphylococcus coagalase-negative (MRSCnN). Among Enterococcus spp, the highest MIC of daptomycin was 4 mg/L. The MIC50 and MIC90 of daptomycin were both 2 mg/L against E.faecalis, whereas they were 2 mg/L and 4 mg/L against E.faecium. One strains of linezolid-resistant E.faecalis(MIC:8 mg/L)was susceptible to daptomycin (MIC: 1 mg/L). Three strains of E.faecium carrying vanA gene with vancomycin MICs above 32 mg/L and teicoplanin MICs also 32 mg/L were susceptible to daptomycin, tigeeycline and linezolid. The MIC range of daptomycin against Streptococcus pneumoniae and Streptococcus viridans was 0.032-0.25 mg/L and 0.125-1.000 mg/L separately. Conclusions Daptomycin has excellent in vitro activity against common gram-positive pathogens isolated from blood. It may be a good choice for clinicians to treat drug-resistant gram-positive cocci.

Objective To compare the in vitro activity of cefminox with other antimicrobial agents against clinical Escherichia coil, Klebsiella pneumoniae isolates and Bacteroides species. Methods MICs of sixteen antimicrobial agents against 945 Escherichia coli and 588 Klebsiella pneumoniae isolates from 15 teaching hospitals and MICs of four antimicrobial agents against 50 Bacteroides species isolates were determined by agar dilution method. WHONET 5.4 software was used to analyze the data. Results Among 1533 Escherichia coli and Klebsiella pneumoniae isolates, 628 isolates produced neither extended-spectrum beta-lactamases (ESBLs) nor AmpC, while 837 isolates produced only ESBLs and 68 isolates produced AmpC enzymes. The susceptibility rate of cefminox against non-ESBLs-producing or ESBLs-producing isolates was above 90%. MIC_(50) of eefminox was 2-4 fold lower than cefometazole and 8-16 fold lower than cefoxitin. MIC50 of cefminox was 2-8 fold lower than cefometazole and 8-16 fold lower than cefoxitin. Against ESBLs-producing isolates, the in vitro activity of cefminox was superior to the third and fourth generation cephalosporins, aztreonam, cefoperazone/sulbactam, levofloxacin, amikacin and inferior to carbapenems. Its activity was similar to piperacillin-tazobactam. The susceptibility rate of cefminox against AmpC-producing isolates was less than 20%. The susceptibility rate of cefminox against Bacteroides species was 90%, which was higher than that of cefometazole (50% -70%) and penicillin (0%) and similar to that of metronidazole. Conclusion Cefminox exhibites good activity against ESBLs-producing and non-ESBLs-producing Escherichia coli and Klebsiella pneumoniae isolates and Bacteroides species, which indicates that cefminox could be one of the options for the treatment of infections caused by these organisms.

Objective To investigate the expression characteristics of miR-155 and miR-146a in mice with schistosomiasis and praziquantel(PZQ)treatment. Methods Totally 40 BABL/c mice were divided into 4 groups:a normal group,a 6W infect-ed group that were infected cutaneously with 10 Schistosoma japonicum cercariae for 6 weeks,a 12W infected group that were in-fected cutaneously with 10 Schistosoma japonicum cercariae for 12 weeks,and a praziquantel treated group that were infected cuta-neously with 10 Schistosoma japonicum cercariae and intragastrically administered with PZQ(300 mg/kg/day)for 1 day in 6 weeks post-infection and continuing surviving 6 weeks. The animals were sacrificed in 6 weeks and 12 weeks post-infection respectively. The left front lobe of each liver was stained with hematoxylin-eosin(HE)to detect pathological lesions. The levels of mRNA ex-pressions of miR-155,miR-146a and pro-inflammatory cytokines(TNF-α,IL-1βand IL-6)in the liver tissue were determined by using quantitative real-time PCR. Results The levels of mRNA expressions of miR-155,miR-146a and pro-inflammatory cyto-kines(TNF-α,IL-1βand IL-6)in the 6W infected mice were significantly higher than those of the normal mice and of the 12W in-fected mice. Compared with the 12W infected mice,the inflammation response of liver egg granuloma in the PZQ-treated mice was ameliorated. Furthermore,there was a marked increase in the levels of mRNA expressions of miR-155,miR-146a and three pro-in-flammatory cytokines in the PZQ-treated mice compared to the 12W infected mice. Conclusion miR-155 and miR-146a may play a role in schistosomiasis liver inflammation response and the inflammation regulation of praziquantel treatment.

Objective To study the uncertainty and traceability of HBV DNA assays and discuss the comparability of results among different detection systems. Methods Different detecting systems were used to detect HBV DNA using the national standard substance as "quality control substance". The uncertainty of the results was evaluated referring "Guidelines for estimating and reporting measurement uncerTAinty of chemical test results" of NATA The results were traced back to the national standard substance. According to the CLSI document EP9-A2, the results were analyzed and subjected to bias estimation with the t(0.05sv) √u2b1+ u2b2 as the criterion clinically accepted to investigate the comparability of different detecting systems. Results The means (-y) measured by 3 HBV DNA assay systems were 6.15,5.88,and 6.31 lg(kIU/L) respectively. Except system A,both the biases of system B and C had statistical significance (all P ＜ 0. 05) and expanded uncertainty of three detection systems was varied, but the difference was within the maximum acceptable range (± 0. 5) of the external quality assessment by National Center for Clinical Laboratory. Being traceable to national standard substance, the results of HBV DNA of the three detecting systems were (5.45 ± 1.23), (5.55 ± 1.32) and (5.42 ± 1.25) lg(kIU/L), respectively.There was significant difference among three systems (F = 5.63, P ＜ 0. 05). Comparing system A and B,there was significant difference in statistic (q = 5. 12, P ＜ 0. 05) and the difference between system B and C also had statistically significant (q = 6. 85, P ＜ 0. 05), but the results between system A and C had no statistical difference (q = 1.85,P ＞ 0. 05). Among these three systems, the difference of any two detection systems had no statistical significance (all P ＞ 0. 05). It showed that system bias was acceptable in clinical application and the results between different systems were comparable. Conclusions It is necessary to estimate the uncertainty and traceability when comparing the HBV DNA assay among the different labs. It also needs to estimate the bias of different systems and evaluate the clinical acceptability to ensure the accuracy and comparability of the results.

Objective: To evaluate the surgView-RFT electromagnetic navigation system in radiofrequency thermocoagulation(RFT). Methods: 6 foramen ovales of 3 cadavers were punctured by 3 beginners. Every one tried 5 times by free-hand and 5 times by SurgView-RFT electromagnetic navigation-guidance. After each puncture, CT scans were used as golden standard to measure the distance between the tip of needle and the anterior margin of the foramen ovale. T test and variance of SAS 6.12 statistical software was used to do the statistic analysis. Results: The punctures by free-hand failed, and the distances between the tip of needle and the anterior margin of the foramen ovale were 8-10.6 mm. The punctures by navigation guidance were successful, and the distances between the tip of needle and the anterior margin of the foramen ovale were 2.68-3.54 mm. The error of navigation system was 0.59 mm which was verified by CT scan. There was significant difference between free-hand puncture and navigation-guided puncture. Conclusion: The surgView-RFT electromagnetic navigation system is characteristic with high performance, high accuracy and minimal invasion, while it is applied in training or clinical using.

Objective To analyze the clinical features of 6 patients with imported schistosomiasis mansoni,including the epidemic history,clinical manifestations,laboratory tests and therapeutic effect,so as to provide references for improving the levels of diagnosis and treatment of physicians. Methods The clinical data of 6 patients with imported schistosomiasis mansoni from January 2009 to July 2016 were collected and analyzed. Results All the 6 imported patients with schistosomiasis mansoni had a clear history of cercarial infested water exposure. The main manifestations were continuous fever and eosinophilia. Three (50%)patients were accompanied with diarrhea. Anti-Schistosoma japonicum IgG antibody were cross positive in 2(33.3%)pa-tients,while live eggs of S. mansoni were explored in intestinal mucosa specimens of all the patients. CD3+CD8+T cell ratio was decreased significantly but B cell ratio was elevated in all the patients,and the main immunoglobulin of the patients was IgG. Hydroperitoneum and splenomegaly signs were discovered by abdominal ultrasonography in 16.6%(1/6)of the patients. Multi-ple liver nodules and wall thickening of rectum and sigmoid colon were revealed by pelvic MR scan in 16.6%(1/6)of the pa-tients. Colitis was found in all the patients,and 66.6%(4/6)of the patients were combined with multiple colonic ulcers by the electronic colonoscopy examination. Chronic inflammation and eosinophil infiltration were found in all the patients by rectum pa-thology. All 6 patients were cured with chemotherapy named praziquantel. Conclusion Comprehensive analysis of clinical data including epidemiological history,specific manifestations,laboratory tests and intestinal mucosa pathology may be benefit of the management of schistosomiasis mansoni.

Objective:To revise the family resilience assessment scale (FRAS) in patients with stroke and to evaluate its psychometric properties and applicability.Methods:FRAS was authorized and translated into Chinese.The scale items were revised based on the interview results of 13 patients with stroke and 11 caregivers and the opinions of 20 experts in related fields.A convenience sampling method was used to sample neurology and neurosurgery inpatients from 2 tertiary hospitals in Hangzhou twice from June to November 2022, with 325 questionnaires (sample 1) distributed the first time for item analysis and exploratory factor analysis, and 285 questionnaires (sample 2) distributed the second time for confirmatory factor analysis, criterion validity and reliability test.Data analysis was conducted by SPSS 26.0 and AMOS 24.0.Results:The exploratory factor analysis extracted 6 common factors(family beliefs, family spirit, family connection, family resources, family communication, family collaboration) with 32 items.Confirmatory factor analysis showed that the model fit well( χ2/ df=2.67, RMSEA=0.025, CFI=0.98, GFI=0.90, IFI=0.98, RMR=0.031). The cronbach's α coefficient of the total scale was 0.96, and 0.82-0.92 for the dimensions.The 2-week retest reliability was 0.99.The total scale score was positively correlated with the validity scale (family resilience scale) ( r=0.882, P<0.001). Conclusion:The family resilience scale for patients with stroke has good reliability and validity and can be used to assess the family resilience of patients with stroke.