Objective:To evaluate the diagnostic value of 1, 3-β-D glucan (BDG), mannan IgM antibody (Mn-IgM) and mannan IgG antibody (Mn-IgG) in invasive candidiasis and to compare the differences in the diagnostic capability of serological markers used alone or in combination.Methods:Serum samples of 126 patients with invasive candidiasis and 104 healthy people who took physical examination during the same period were collected. BDG was detected by dynamic chromogenic method, and Mn-IgM and Mn-IgG were detected by ELISA. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, coincidence rate and Kappa value of the three serological markers used alone or in combination in the diagnosis of invasive candidiasis were analyzed and compared. The receiver operating characteristic (ROC) curves were drawn and the areas under the curves (AUCs) were calculated.Results:The levels of BDG, Mn-IgM and Mn-IgG in patients with invasive candidiasis were significantly higher than those in healthy people ( P<0.01). The sensitivity, specificity, Kappa value and AUC of BDG were 48.41%, 92.31%, 0.389 and 0.842. The sensitivity, specificity, Kappa value and AUC of Mn-IgM were 64.29%, 91.35%, 0.540 and 0.829. The sensitivity, specificity, Kappa value and AUC of Mn-IgG were 27.78%, 95.19%, 0.214 and 0.737. The sensitivity, specificity, Kappa value and AUC of BDG+ Mn-IgM were 76.19%, 88.46%, 0.637 and 0.921. The sensitivity, specificity, Kappa value and AUC of BDG+ Mn-IgG were 59.52%, 91.35%, 0.491 and 0.856. The sensitivity, specificity, Kappa value and AUC of Mn-IgM+ Mn-IgG were 69.84%, 90.38%, 0.588 and 0.891. The sensitivity, specificity, Kappa value and AUC of BDG+ Mn-IgM+ Mn-IgG were 80.16%, 88.46%, 0.679 and 0.922. Conclusions:The sensitivity of Mn-IgM was higher than that of BDG and Mn-IgG in the diagnosis of invasive candidiasis. When the serological biomarkers were used in combination, BDG+ Mn-IgM and BDG+ Mn-IgM+ Mn-IgG had relatively high Kappa value and AUC, showing high accuracy. The clinical diagnostic value of multiple serological biomarkers used in combination was significantly higher than that of any serological biomarkers used alone. Early combined detection and continuous monitoring of multiple serological biomarkers in patients with high risk of invasive candidiasis could be used clinically to adjust antifungal treatment strategies timely.

Objective:To investigate the effects of laparoscopic total extraperitoneal hernia repair (TEP) on respiratory function and motilin (MOL) in elderly patients with inguinal hernia.Methods:One hundred and twenty elderly patients with inguinal hernia admitted in Chongqing Fengdu People′s Hospital from January 2020 to December 2021 were divided into two groups according to the method of operation, 60 patients who performed laparoscopic preperitoneal hernia repair (TAPP) was enrolled in control group, and 60 patients who performed TEP was enrolled in the study group. The operation index, visual analogue scale (VAS) scores at different time, respiratory function index and gastrin (GAS), MOL levels and postoperative complications were compared between the two groups.Results:Compared with the control group, the operation time in the study group was longer, the recovery time was shorter and the VAS scores were lower on the 1st, 3rd and 7th day after operation: (66.36 ± 10.05) min vs. (53.69 ± 8.59) min, (4.09 ± 0.59) d vs. (5.15 ± 1.06) d, (4.49 ± 1.26) scores vs. (5.46 ± 1.48) scores, (3.65 ± 0.58) scores vs. (4.52 ± 0.95) scores, (2.42 ± 0.41) scores vs. (3.54 ± 0.48) scores, there were statistical differences ( P<0.05). The levels of end-expiratory carbon dioxide pressure (P ETCO 2) and airway pressure (Paw) in the study group at 10, 30 and 90 min postoperatively were higher than those in the control group: (40.66 ± 4.52)mmHg(1 mmHg = 0.133 kPa) vs. (37.48 ± 5.26) mmHg, (19.88 ± 1.63) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (16.59 ± 2.15) cmH 2O; (44.65 ± 4.18) mmHg vs. (41.58 ± 4.58) mmHg, (20.49 ± 1.65) cmH 2O vs. (16.95 ± 2.84) cmH 2O; (50.16 ± 3.54) mmHg vs. (45.59 ± 4.65)mmHg, (21.69 ± 1.78) cmH 2O vs. (17.49 ± 2.15) cmH 2O, there were statistical differences ( P<0.05). The levels of MOL and GAS in the study group at 3 d postoperatively were higher than those in the control group: (396.54 ± 13.58) ng/L vs. (332.52 ± 16.95) ng/L, (118.95 ± 8.95) ng/L vs. (102.58 ± 10.65) ng/L, there were statistical differences ( P<0.05). There was no significant difference in the incidence of complications between the two groups ( P>0.05). Conclusions:Both TEP and TAPP have certain therapeutic effects on the inguinal hernia, but TEP has shorter postoperative recovery time, less pain, less impact on gastrointestinal function, but it will have a certain impact on respiratory function.

Objective:To explore the echocardiographic characteristics of isolated brachiocephalic artery branches, and to analyze the reason of missed diagnosis and misdiagnosis in order to improve the diagnostic accuracy.Methods:Echocardiographic features of isolated subclavian artery and brachibrachial trunk confirmed by operation or CT angiography (CTA) or digital subtraction angiography (DSA) were retrospectively analyzed in Hebei Children′s Hospital from May 2017 to July 2021. Related literatures of other rare types of isolated brachiocephalic artery branches retrieved in PubMed were reviewed, and the echocardiographic characteristics of such vascular malformations were summarized.Results:A total of 4 children with isolated brachiocephalic artery branches were included. Echocardiography correctly diagnosed isolated brachiocebrachial trunk in 1 case and missed or misdiagnosis in 3 cases, including isolated subclavian artery was missed in 1 case, isolated subclavian artery was misdiagnosed as aberrant subclavian artery in 1 case and patent ductus arteriosus in 1 case. A total of 105 cases of isolated brachiocephalic artery branches were reviewed, including isolated brachiocephalic artery in 31 cases (53.3%), isolated common carotid artery in 15 cases (29.5%), isolated common carotid artery in 15 cases (14.3%) and isolated internal carotid artery in 3 cases (2.9%). The characteristic of echocardiography was that the brachiocephalic branch of the aortic arch was disconnected from the aortic arch, often via the ductus arteriosus or directly connected to the bifurcation of the pulmonary artery.Conclusions:Isolated brachiocephalic artery branches have certain characteristic echocardiographic features and these kinds of vascular malformations are accompanied by different degrees of stealing blood phenomenon. Careful tracing of the origin of brachiocephalic artery branches and combined with cervical vascular ultrasound when necessary can improve the diagnosis rate of isolated brachiocephalic artery branch lesions.

Consecutively hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) in Wuhan, China were retrospectively enrolled from January 2020 to March 2020 to investigate the association between the use of renin-angiotensin system inhibitor (RAS-I) and the outcome of this disease. Associations between the use of RAS-I (angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)), ACEI, and ARB and in-hospital mortality were analyzed using multivariate Cox proportional hazards regression models in overall and subgroup of hypertension status. A total of 2771 patients with COVID-19 were included, with moderate and severe cases accounting for 45.0% and 36.5%, respectively. A total of 195 (7.0%) patients died. RAS-I (hazard ratio (HR)= 0.499, 95% confidence interval (CI) 0.325-0.767) and ARB (HR = 0.410, 95% CI 0.240-0.700) use was associated with a reduced risk of all-cause mortality among patients with COVID-19. For patients with hypertension, RAS-I and ARB applications were also associated with a reduced risk of mortality with HR of 0.352 (95% CI 0.162-0.764) and 0.279 (95% CI 0.115-0.677), respectively. RAS-I exhibited protective effects on the survival outcome of COVID-19. ARB use was associated with a reduced risk of all-cause mortality among patients with COVID-19.
Angiotensin Receptor Antagonists/therapeutic use* ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use* ; COVID-19 ; Humans ; Hypertension/drug therapy* ; Renin-Angiotensin System ; Retrospective Studies

Objective:To investigate the predictors of the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral calculi, and to evaluate the predictive value of the maximum ureteral wall thickness (UWT) in the treatment of ureteral calculi with ESWL.Methods:The clinical data of 138 patients with ureteral calculi treated with ESWL in the Second People's Hospital of Hefei from January 2020 to December 2020 were retrospectively analyzed. There were 91 males and 47 females. The age was (50.9±14.8) years old. The body mass index was (25.3±3.6) kg/m 2. The stones of 73 cases were located on the left side and 65 cases were on the right side. 70 cases had upper ureteral stones, 18 cases had middle ureteral stones, and 50 cases had lower ureteral stones. The median length of the stone was 8.5 (7.5, 10.5) mm. The CT value of the stone was 509 (343, 783) HU. The anteroposterior diameter of the renal pelvis was 12.0 (10.1, 16.0) mm, and UWT was (2.8 ± 0.8) mm. All patients underwent urinary non-contrast CT before lithotripsy, and the UWT of the stone bed was measured on the CT images. According to the stone removal situation 2 weeks after the operation, the patients were divided into a successful lithotripsy group and a failed lithotripsy group. Univariate analysis was used to compare the differences of various indicators between the two groups, and multivariate logistic regression was used to analyze the independent predictors of ESWL in the treatment of ureteral calculi for the indicators. The receiver operating characteristic (ROC) curve was used to calculate the area under the curve (AUC) of each independent predictor, and the cut-off value, sensitivity and specificity were analyzed. Results:All operations were successfully completed, and the success rate of the first-stage lithotripsy was 71.7% (99/138). The results of univariate analysis showed that the stone length diameter, stone CT value, anteroposterior diameter of renal pelvis, stone skin distance, and UWT were significantly different between the successful lithotripsy group and the failure group ( P<0.05). There was no significant difference in age, gender, body mass index, stone side and stone location ( P>0.05). The results of multivariate logistic analysis showed that stone length ( OR=1.393, P=0.015), stone CT value ( OR=1.002, P=0.043) and UWT ( OR=17.997, P<0.001) were all for the efficacy of ESWL in the treatment of ureteral stones. The ROC curve was used to compare the three independent predictors. The area under the UWT curve was the largest (AUC=0.898, P<0.001), followed by the length of the stone (AUC=0.744, P<0.001), and the CT value of the stone (AUC=0.672, P= 0.002). The cut-off value for UWT was 3.19 mm, which had a sensitivity of 91.9% and a specificity of 71.8% for predicting the success of ESWL lithotripsy. When dividing the patients into thin wall group (UWT ≤3.19 mm) and thick wall group (UWT>3.19 mm) according to the cut-off value, the success rates of one-stage lithotripsy in the two groups were 89.2% (91 / 102) and 22.2% (8/36), respectively ( P<0.05). Conclusions:UWT, calculus length and calculus CT value are independent predictors of the efficacy of ESWL in the treatment of ureteral calculi, and UWT has the best predictive value. When UWT≤3.19 mm, the success rate of ESWL in the treatment of ureteral calculi is higher.

Objective: To explore the value of chest CT features and clinical indexes in the differential diagnosis between suspected COVID-19 with two or more negative nucleic acid tests and confirmed COVID-19. Methods: The clinical data and chest CT images of 105 cases withconfirmedCOVID-19 (55 males and 50 females, aged from 2 month to 88 years) and 97 cases with suspected COVID-19(59 males and 38 females, aged from 1 month to 93 years) were analyzed retrospectively in Shiyan Taihe Hospital from January 21 to February 10, 2020. χ²test and two independent sample t test were used to analyze the clinical data and CT signs of the two cases, with P<0.05 for the difference statistically significant. Results: Compared with the suspected patients, the average age of diagnosis of covid-19 was higher (t = 2.460, P = 0.01). The main pathological changes were pure ground glass (68 cases) and mixed ground glass density (53 cases) (χ² = 50.016, P< 0.01). Interstitial thickening (83 cases) (χ² = 55.395, P< 0.01), vascular thickening (73 cases) (χ² = 57.527, P< 0.01), air bronchoscopic sign or bronchiectasis Zhang (67 cases) (χ² = 17.899, P< 0.01), cord focus (54 cases) (χ² = 5.500, P = 0.02), easily distributed under the pleura and the long axis of the lesion was parallel to the pleura (89 cases) (χ² = 23.597, P< 0.01), most of them had no pleural effusion (χ² = 7.017, P< 0.01); both lesions were mainly distributed in patches (89 cases were confirmed, 87 suspected) (χ² = 19.573, P< 0.01). In addition, the lesions of patients with confirmed covid-19 showed progress in short term (72 / 87, 82.76%), and those with suspected covid-19 showed remission in short term (63 / 89, 70.78%). The difference was statistically significant (χ² = 51.114, P< 0.01). There was no significant difference in gender and distribution of pulmonary lobes (χ² = 1.462, P= 0.23; χ² = 7.381, P= 0.19). The number of white blood cells (χ² = 17.891, P< 0.01) and the percentage of lymphocytes (χ² = 11.151,P< 0.01) of covid-19 were mostly normal or decreased, creatine kinase (χ² = 9.589, P< 0.01) were mostly normal, and erythrocyte sedimentation rate was mostly normal or increased (χ² = 4.240, P= 0.04). Conclusions The imaging features and biochemical indexes of diagnosed COVID-19 are different from those of suspected COVID-19. The comparative analysis of imaging features, clinical indexes and reexamination are helpful for the differential diagnosis of COVID-19 and suspected COVID-19.

Objective: To investigate the effect and safety of apatinib in the treatment of advanced gastric cancer. Methods: A total of 60 patients with advanced gastric cancer at the first Affiliated Hospital of Hainan Medical College from April 2015 to October 2018 were retrospectively analyzed, and all patients were divided into two groups according to the treatment method, each group of 30 cases. The control group was treated with conventional treatment, and the observation group was given the treatment of apatinib on the basis of the control group, and then the clinical curative effect and adverse reactions were compared between the two groups. Results: There were 2 cases (6.67%) of complete remission in the observation group, 14 cases (46.67%) of partial remission, 10 cases (33.33%) of stability and 4 cases (13.33%) of disease progression, and the total effective rate was 53.33% (16/30). The control group had no complete remission, 8 cases (26.67%) of partial remission, 11 cases (36.67%) of stability and 11 cases (36.67%) of disease progression, and the total effective rate was 26.67% (8/30). The difference of total effective rate between the two groups was statistically significant (χ ² = 4.444, P = 0.035). There was no significant difference in the level of tumor marker carcinoembryonic antigen (CEA), carbohydrate antigen (CA)199, CA125, cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) between the two groups before and after treatment (all P > 0.05). The incidence of hand-foot syndrome and hypertension in the observation group was higher than that in the control group [73.33% (22/30) vs. 43.33% (13/30), H = 5.554, P = 0.018; 76.67% (23/30) vs. 46.67% (14/30), H = 5.711, P = 0.017]. The incidence of proteinuria, bone marrow suppression and the cardiac adverse reactions in the observation group was higher than that in the control group [63.33% (19/30) vs. 33.33% (10/30), H = 3.300, P = 0.069; 60.00%(18/30) vs. 36.67% (11/30), H = 5.455, P = 0.071; 53.33% (16/30) vs. 30.00% (9/30), H = 3.360, P = 0.067]. Conclusion Apatinib is effective in the treatment of advanced gastric cancer, but the occurrence of hand-foot syndrome and hypertension should be paid close attention during the treatment.

Objective To compare the efficacy of erlotinib and pemetrexed in treatment of advanced non-small cell lung cancer (NSCLC) and its effect on the immunity of patients. Methods A total of 82 patients with NSCLC at the First Affiliated Hospital of Hainan Medical College from June 2014 to May 2018 were retrospectively analyzed. According to the different treatment methods, the patients were divided into erlotinib group (150 mg/d, oral administration, 2 hours after the meal) and pemetrexed group (500 mg/m2, intravenous drip, 21-day each cycle). There were 41 cases in each group. The clinical effects of the two groups were analyzed. Flow cytometry was used to detect the immune index. Results The objective effective rate in pemetrexed group was lower than that in erlotinib group [34.2％ (14/41) vs. 39.0％ (16/41), χ 2 = 0.210, P =0.647). There was no significant difference in T lymphocyte subsets between the two groups before and after treatment (both P > 0.05). The values of CD3+ T cells, CD4+ T cells, CD4+ / CD8+ in both groups after the treatment were decreased compared with the values before the treatment; CD8 + T cells was increased after the treatment compared with the value before the treatment (all P < 0.05). Quality of life questionnaire-C30 (QLQ-C30) score in erlotinib group was higher than that in pemetrexed group [(75.1±13.5) vs. (68.9±12.9), t = 2.158, P = 0.017]. Myelosuppression and gastrointestinal reactions were the main adverse events in pemetrexed group; rashes and diarrhoea were the main adverse reactions in erlotinib group. Grade Ⅰ-Ⅱ side effects occurred in both groups. There were statistical differences in the incidence of myelosuppression, gastrointestinal reactions, rashes and diarrhoea of both groups (all P < 0.05). Conclusions The efficacy oferlotinib and pemetrexed in treatment of advanced NSCLC is similar, and both of them could regulate the immune response. Erlotinib has a significant advantage in improving the quality of life.

Objective To discuss the application value of the peritoneal catheter via pneumoperitoneum puncturation in cerebral spinal fluid (CSF) peritoneal shunt surgery. Methods The clinical data of 490 hydrocephalus patients admitted to Zhejiang Provincial Tongde Hospital from June 2002 to December 2016 were retrospectively analyzed, among them 147 cases accepted ventriculoperitoneal shunt (VPS) operation from June 2002 to January 2009 were assigned as a control group (open abdomenal catheterization group), and 343 cases accepted pneumoperitoneum puncturation from February 2009 to December 2016 were arranged as an observation group (abdominal paracentesis group). The patients in the abdominal paracentesis group were further subdivided into a VPS group (228 cases) and a lumboperitoneal shunt (LPS) group (115 group) according to different ways of catheterization. The clinical data such as infection, shunt obstruction (blockage), bleeding and other complications (such as insufficient or excessive drainage, bleeding, epilepsy, intestinal obstruction) 6 mouths after operation were collected in open catheterization group and abdominal paracentesis group, the difference of incidences of complication in each group were compared. Results The incidences of infection [10.20% (15/147) vs. 3.79% (13/343)], shunt obstruction [14.29% (21/147) vs. 7.58% (26/343)], other complications [23.13% (34/147) vs. 10.79% (37/343)] in open catheterization group were significantly higher than those in abdominal paracentesis group (all P < 0.05); the rate of shunt obstruction in VPS group was higher than that in LPS group [9.65% (22/228) vs. 3.48% (4/115), P < 0.05]. Conclusions Pneumoperitoneum puncturation is a simple, safe, minimally invasive technique to implant an abdominal cavity shunt catheter in CSF peritoneal shunt surgery, and it can effectively reduce the rates of infection and shunt blockage; LPS is more effective than VPS in reducing the incidence of the blockage by this paracentesis method.

Objective To observe the effect and mechanism of human umbilical cord blood mesenchymal stem cells-derived microvesicles (hUMSCs-MVs) on the injury of the primary rat retinal ganglion cells (RGCs) by high glucose environment.Methods The primary RGCs of Sprague Dawley rats were cultured in vitro,hUMSCs-MVs were isolated and extracted by ultra-centrifugation.hUMSCs-MVs were internalized with RGCs.The RGCs were divided into 4 groups under the conditions below:normal control group (group A),high glucose condition group (group B,RGCs+glucose 33 mmol/L),normal RGCs co-cultured with hUMSCs-MVs group (group C,RGCs+hUMSCs-MVs),and RGCs co-cultured with hUMSCs-MVs in high glucose condition group (group D,RGCs+hUMSCs-MVs+glucose 33 mmol/L).The cell activity was detected by CCK-8 test.Annexin V/PI staining detected the cell apoptosis rate by flow cytometry.And the relative expression levels of the genes such as Bcl-2,Bax and Caspase-3 were detected by fluorescence quantitative reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.Statistical analysis was performed by using One-way analysis of variance and SNK-q test was used for the comparison between groups.Results The hUMSCs-MVs were extracted by ultra-centrifugation,which were characterized as single or cluster of circular membranous vesicle-like structure with diameter ranging from 100 nm to 1000 nm.The flow cytometry analysis showed that hUMSCS-MVs were highly positived by the surface markers of CD44,CD29,CD73,and CD105 whereas been poorly expressed the integrin (CD49f),HLA class Ⅱ,CD34,CD45.There were significant differences in the cell activity and the apoptosis rate among 4 groups,the cell apoptosis rate of group B was higher significantly than that of group A and group D (F=107.92,P=0.000),the cell activity of group B was lower than that of group A and group D (F=382.11,P=0.000).The results of RT-PCR and Western blot showed that the relative mRNA (F=219.79,339.198,1 071.21;P=0.000,0.000,0.000) and protein (F=544.28,295.79,224.75;P=0.000,0.000,0.000) expression of Bcl-2,Bax,Caspase-3 and the protein expression of cleaved Capspase-3 (F=533.18,P=0.000) in group B and D were higher significantly than those in group A and C.The relative expression of Bcl-2 mRNA and protein in group B was significantly lower than that of in group D (P＜0.05).The relative expression of Bax,Caspase-3 mRNA and protein in group B was higher than that in group D (P＜ 0.05).The relative expression of cleaved Caspase-3 protein in group B was higher significantly than that in group D (P＜0.05).Conclusion The hUMSCs-MVs can protect the cultured rat RGCs from the damage of the high glucose condition through increasing the cell activity and reducing the apoptosis rate of RGCs by promoting the Bcl-2 expression,decreasing the expression of Bax and Caspase-3 and inhibiting the Caspase-3 into the activity form of cleaved Caspase-3.