Objective To understand the clinical features of candidemia.Methods A retrospective analysis was performed based on the data of 88 candidemia cases treated in Huashan Hospital during the period from 2007 to 2012.The clinical data were re-viewed in terms of species distribution,underlying diseases,clinical manifestations,treatment and outcomes.The prognostic factors were analyzed by chi-square test or Fisher exact probability test.Multivariate analysis was conducted by multiple Logis-tic regression.Results Candida albicans (40/88,45.5%)was the most common pathogen isolated from these candidemia ca-ses,followed by Candida tropicalis (20/88,22.7%),Candida parapsilosis (17/88,19.3%),Candida glabrata (10/88, 11 .4%),and Candida krusei (1/88,1 .1 %).Solid malignancy,diabetes,and surgical procedure were the most frequently identified underlying diseases.Fatal or deteriorative outcome was reported in 28 cases.The attributable mortality was 18.2%. Multivariate prognostic analysis indicated that presence of central venous catheter (OR:6.322,95% CI :1 .055-37.891 ,P =0.044)was independently correlated to increased mortality.Appropriate antifungal therapy was an independent predictor of de-creased overall mortality (OR:0.137,95% CI :0.039-0.480,P =0.002).Conclusions The pathogen distribution of candi-demia has changed slightly.Appropriate antifungal therapy plays a key role in the treatment of candidemia.

Objective To investigate the features of resting energy expenditure (REE) in patients with well controlled type 2 diabetes mellitus (T2DM). Methods Totally 45 T2DM patients with stable blood glucose were enrolled. The general conditions, biochemical indicators, measurements of REE ( MREE), and basal energy expenditure (BEE) calculated with Harris-Benedict formula (HBEE) and Owen formula (OBEE) were recorded and compared. Results MREE had no significant difference with HBEE or OBEE in T2DM patients with stable blood glucose (P ＞ 0. 05). Correlation analysis showed that REE was significantly correlated with gender, age, body weight, body height, body surface area, and fat-free mass ( all P ＜ 0.05 ), but was not correlated with body mass index, fat mass, fasting plasma glucose, postprandial plasma glucose, haemoglobin Alc, total cholesterol, triglyceride, total protein, albumin, and haemoglobin (P ＞ 0. 05 ). Multiple regression analysis showed that fat free mass and age had the closest correlation with REE. Conclusions REE does not increase in T2DM patients with well controlled blood glucose. Factors that influence their REE are similar with healthy individuals. Determi nation of REE can provide useful information for the nutrition treatment of T2DM.

Objective To investigate the correlation between de nove anti-endothelial cell antibodies (AECA) and adverse events after renal transplantation and the effect of transplanted renal function within six months after operation.Methods The expression of AECA in serum of 85 renal transplant recipients was detected by indirect immunofluorescence assay (ⅡF) before and 1 day,3 days,7 days,15 days and 1 month after renal transplantation.The patients were divided into double positive group (AECA positive before and after surgery),single positive group (postoperative de nove AECA positive) and negative group (preoperative and postoperative AECA negative) according to AECA test results.The occurrence of adverse events in each group such as DGF,rejection,infection and so on,as well as the serum creatinine levels were recorded at each time point within six months.Results Of the 85 recipients,29 were positive for AECA,including 19 in the double positive group,10 in the single positive group,and 56 in the negative group.The incidence of rejection in single positive group (30％) was higher than that in the rest two groups (5.3％ for double positive group,and 17.9％ for negative group),but there was no statistically significant difference (P =0.21).The incidence of DGF in the single positive group,double positive group and negative group was 70.0％,26.3 ％ and 32.1 ％ respectively.The positive rate of the single positive group was significantly higher than that of the rest two groups (P =0.04),and the duration of DGF was significantly longer in the single positive group than that of the rest two groups (P＜0.01).The incidence of infection in the single positive group,double positive group and negative group was 20.0％,21.1％ and 8.9％respectively,and there was no significant difference among the three groups (P =0.31).As compared with the double positive group and the negative group,the serum creatinine level was significantly increased in the single positive group at 1st week,1st month,3rd month and 6th month after operation (P =0.02,P =0.04,P =0.04 and P =0.02 respectively).Conclusion Postoperative AECA can increase the risk of DGF,prolong the duration of DGF,and affect the recovery of renal function within 6 months after renal transplantation.

Leptotrombidium eothenomydis.There was a wide niche overlap between any two chigger species with all indices beyond 0.76.Slight positive association existed between each two dominant species of chigger mites by the coefficient of association(V).Conclusion The community structure of chigger mites on the 7 major species of rodent hosts is complex,reflecting a high diversity of mite species.The niche breadth of the 6 dominant chigger species is different with a wide niche overlap.

Objective To investigate the effect of the synthetic rehabilitation treatment using the assistive devices for children with cerebral palsy.Methods 60 outpatients (male 31,female 29) diagnosed as cerebral palsy in our hospital from June 2009 to June 2010 were divided into trial group (n =30) and control group (n =30).Both of the two groups received our rehabilitation treatment three times a week.Compared with the daily family rehabilitation training of the control group,trial group still received a daily rehabilitation treatment by their parents using the assistive devices under the guidance of the therapist.They were assessed with Gross Motor Function Measure 66 items version (GMFM-66)and 88 items version (GMFM-88) before and after 6 months treatment.Results The total score of GMFM-66 and each dimension score of GMFM-88 improved in both group after 6 months treatment,except the centrol group Lying & Rolling dimension.Trial group 51 ± 13 vs.44 ± 15,control group 42 ± 17 vs.38 ± 16 (t =-3.580,P =0.001).There was significant difference on the total score of GMFM-66 and the three dimensions score (Lying & Rolling,Sitting and Walking,Running & Jumping) of GMFM-88 between two group.Lying & Rolling:F =4.59,P =0.036; Sitting:F =6.40,P =0.014 ; Walking,Running & Jumping:F =4.35,P =0.041.Conclusion The synthetic rehabilitation treatment in Medical institutions associate with family rehabilitation treatment using the assistive devices can effectively improve the recovery of gross motor function in children with cerebral palsy.

Objective:To analyze the application value of the mechanical thrombectomy system in the treatment of acute limb ischemia.Methods:The clinical data of 50 patients with lower limb ischemia who were treated with the Rotarex mechanical thrombectomy system from Jun 2017 to Sep 2019 were retrospectively analyzed.Results:In 4 cases of popliteal artery rupture occurred during the operation. The success rate of the operation was 92%. Catheter-directed thrombolysis was used in 7 cases, percutaneous transluminal angioplasty was used in 4 cases and percutaneous transluminal angioplasty combined with stent implantation was used in 39 cases. The ankle-brachial index of these 50 patients before and after operation was 0.18±0.24 and 0.64±0.28 respectively ( t=12.87, P<0.001). Treatment was successful in 43 cases. Follow-up ranged from 1 to 24 months, 5 cases were amputated, 2 cases had no improvement of toe ulcer gangrene, 9 cases had thrombus recurrence, and no complications such as bleeding were observed. The primary patency rates at 3, 6 and 12 months were 92%, 84% and 74%, respectively. Conclusion:The mechanical thrombectomy system is safe and effective in the treatment of acute lower limb ischemia with ideal short-term patency.

Objective:To develop evidence-based postoperative nausea and vomiting (PONV) management program, so as to provide a reference for standardizing PONV management in Anesthesiology Department and reduce PONV incidence and severity of patients.Methods:From January to November 2021, based on the evidence clinical transformation model chart, the PONV management program in Anesthesiology Department was developed through evidence retrieval, quality evaluation, evidence summary, obstacle factor analysis and other methods, and 2 rounds of clinical practice reform were carried out. The implementation of quality review indicators of medical staff and the incidence of postoperative nausea, postoperative vomiting and PONV of patients and severity of postoperative nausea, postoperative vomiting were evaluated.Results:At baseline, after the first review and the second review, the implementation rate of quality review indicators of medical staff gradually increased, and the differences were statistically significant ( P<0.05) . After the second review, the incidence of postoperative nausea, postoperative vomiting and PONV and severity of postoperative nausea, postoperative vomiting decreased compared with the first review, and the differences were statistically significant ( P<0.05) . Conclusions:Evidence-based PONV management program can standardize the PONV management behavior of anesthesiology medical staff, reduce the incidence of postoperative nausea, postoperative vomiting and PONV and severity of postoperative nausea, postoperative vomiting, and improve the quality of PONV management.

Objective To investigate the effect of mechanical stretch on the proliferation and differen-tiation of skeletal satellite cells in mice,and explore its mechanism.Methods The research was divid-ed into two parts.In the first part,all mice were not given osteogenic or adipogenic induction,and randomly divided into a control group,a mechanical stretch(MS)group,a solvent control group[Di-methyl sulfoxide(DMSO)+mechanical stretch],a Notch inhibitor(KY-02111)+mechanical stretch group and a Wnt inhibitor(FLI-06)+mechanical stretch group,with the aim to evaluate cell prolifera-tion and migration,and the effect of mechanical stretch on the Wnt and Notch signaling pathway.In the second part,all mice were randomly divided into 6 groups:a control group,an induced differentia-tion(ID)group,an induced differentiation+mechanical stretch(IDMS)group,an induced differentia-tion+DMSO+mechanical stretch(IDDMS)group,an induced differentiation+Notch inhibitor(KY-02111)+mechanical stretch(IDNMS)group,and an induced differentiation+Wnt inhibitor(FLI-06)+mechanical stretch(IDWMS)group.All groups except the control group were induced differenti-ation using osteoblastic or adipogenic medium,and the IDMS group was applied tensile stress to the cell basement membrane,with the IDDMS and IDNMS groups given DMSO and KY-02111 or FLI-06 with a final concentration of 5 μM into the culture medium,respectively.On the 7th and 14th days af-ter culture,cell proliferation was detected using CCK-8,while on the 14th day after culture,cell mi-gration was observed using the streak method.Alkaline phosphatase and oil red staining were per-formed on all cells.Moreover,the mRNA expression of osteogenic[alkaline phosphatase(ALP)and Runt-related transcription factor(Runx)-2]and adipogenic[fatty acid-binding protein(FABP)4 and li-poprteinlipase(LPL)]differentiation marker genes were quantitatively detected by using the real-time PCR.Meanwhile,while the expression of c-Myc and Cyclin B(CCNB)1 proteins was measured using Western blotting.Results Cell proliferation increased significantly in MS group compared with the con-trol group(P<0.01),while that of IDMMS and IDNMS groups decreased significantly compared with MS group.As to cell migration,MS group was significantly better than the control group(P<0.01),while there was a significant decrease in both IDMMS and IDNMS groups compared with MS group(P<0.01).According to ALP and oil red staining,a significant increase in ALP activity and lipid droplet secretion was observed in skeletal muscle satellite cells of ID groups compared with the control group,with the increase in IDMMS and IDNMS groups significantly greater than MS group.More-over,the results of real-time PCR showed that the expression of ALP and Runx-2mRNA in the osteo-genic induction group and the FABP4 and LPL mRNA in the adipogenic induction group increased sig-nificantly compared with the control group(P<0.05),with a significant decrease in the above measure-ments of IDMS group compared with ID group,but a significant increase in IDMMS and IDNMS groups compared with IDMS group(P<0.01).Meanwhile,according to Western blotting,the expres-sion of c-Myc and CCNB1proteins increased significantly in the skeletal muscle satellite cells of MS group compared with the control group(P<0.01),while that of IDMMS and IDNMS groups decreased significantly compared with MS group(P<0.01).Conclusion Mechanical stretch can promote the prolif-eration and migration of skeletal satellite cells in mice,but inhibit osteogenic and adipogenic differenti-ation.Its mechanism is related to the activation of Wnt and Notch signal pathways.

Objective:To investigate the clinical effect of Ilizarov technique of tibial bone transverse transport combined with flap transfer in the treatment of severe diabetic foot.Methods:From April 2016 to March 2020, 7 patients with severe diabetic foot were treated by Ilizarov technique of tibial bone transverse transport combined with flap transfer in the Department of Hand and Foot Surgery of Foshan Nanhai Public Health Hospital. Diabetes Wagner classification: 2 cases were in Grade 3, in which, 1 case was ulcer in right heel and deep plantar with abscess and infection, and 1 case was ulcer in left great toe and phalanx infection; Other 5 cases were in Grade 4, of them, 2 cases were gangrene in proximal and distal of left great toe, 1 case were gangrene and infection in proximal, middle and distal segment of right 2nd toe, 1 case were gangrene and infection in proximal, middle and distal segment of left 4th toe, and 1 case were gangrene in distal segment of left 4th toe. Wound area was 2.0 cm×2.0 cm-6.0 cm×12.0 cm. Sural neurouascular flaps were used in 1 case, dorsal plantar artery flaps in 4 cases and medial plantar artery flaps in 2 cases. Size of flap was 2.0 cm×2.0 cm-6.0 cm×12.0 cm. Follow-up was conducted regularly by outpatient clinic, telephone and WeChat interviews. Content of the follow-up included foot wound healing, skin temperature of dorsal foot, lower limb paralysis, puncture exudation of external fixation stent, and blood supply of calf skin. Foot function was assessed according to the American Orthopedic Foot and Ankle Association (AOFAS) score.Results:All 7 patients entered the follow-up for 6-28 months, with an average of 8.2 months. All the foot ulcers healed. The pain of affected limbs eased off in 5 patients, and 2 patients had significant pain relief in affected limbs. Foot paralysis significantly alleviated in 7 patients, with calf skin temperature increased (1.81±0.56) ℃, and no recurrence of foot ulcers. According to AOFAS score, 3 cases were excellent, 3 cases were good and 1 case was fair.Conclusion:Ilizarov technique of tibial bone transverse transposition combined with flap transfer in the treatment of severe diabetic foot has a good clinical effect and it could be an option in the treatment of diabetic foot.

Objective: To explore the longitudinal association of the levels of plasma irisin among children with changes in obesity related parameters and newly onset obesity, and to explore whether physical activity (PA) and sedentary behavior(SB) have regulatory effects, to provide a scientific basis for the prevention and control of childhood obesity work. Methods: Cluster random sampling method was used to select 521 children from five schools in Guangzhou in 2017 at baseline and were followed up in 2019. A based on baseline PA and SB, children who meet the following criterion were selected:moderate vigorous intensity PA≥60 min/d or <150 min/week; and gender , age specific SB≥ P 75 or SB < P 25 . Plasma irisin concentration was measured in all the selected children. Multiple linear regression and Logistic regression were conducted to analyze the association. Results: The two year cumulative incidence of obesity, overweight and obesity, and central obesity was 2.82%, 6.57%, and 6.81%, respectively. There was no statistically significant association between plasma irisin levels and changes in obesity related parameters, newly onset overweight obesity or central obesity among children ( P >0.05). After stratified by PA, the irisin concentration in the low PA group was positively associated with weight change ( B=0.229, P =0.03). After stratified by SB, the irisin concentration in the low SB group was positively associated with the height change ( B=0.210, P <0.05). In addition, PA level and SB level both had a moderating effect on the association between plasma irisin levels and the weight change ( P PA=0.01, P SB =0.05). Conclusion PA and SB show moderating effect on plasma irisin concentration and weight gain. No association of irisin concentration with newly onset overweight or obesity among children has been found.