Vulvovaginal candidiasis（VVC）is an opportunistic infection of the vaginal mucosa mainly caused by Candida albicans， which is the second most common vaginal infection other than bacterial vaginosis. The azole antifungal agent fluconazole is the drug of the first choice for treatment of VVC. With the widespread and non-standard use in clinical practice，the resistance of Candida albicans to fluconazole is on the rise. This article reviews the mechanisms of vaginal Candida vaginalis resistance to fluconazole，including the target mutations or high expression of drug action-related genes，the overexpression of drug efflux pump，the regulation of stress response，and the formation of biofilms，in order to provide information for a new strategy of VVC treatment.

Objective To investigate the effects of indirubatin derivative E804 on proliferation and migration of non-small cell lung cancer(NSCLC)A549 cells,and to elucidate the possible mechanism of Nrf2-HO-1/GPX4 pathway.Methods Lung cancer A549 cells were used as the cell model.The proliferation and migration of differ-ent specific inhibitors(Nec-1,CQ,Z-VAD,DFO,Fer-1 and Lip-1)in 0,10 μmol/L E804 and 10 μmol/L E804+groups were observed by MTT and cell scratch assay.The contents of reactive oxygen species(ROS)were de-tected by DCFH-DA fluorescence probe method,the contents of Fe2+were detected by colorimetric method,the contents of reduced glutathione(GSH)were detected by spectrophotometry,and the contents of malondialdehyde(MDA)were detected by micromethod.The expression levels of SLC7A11,Transferrin,GPX4,SLC40A1,Nrf2 and HO-1 were detected by Western blot in cells of 0,2.5,5 and 10 μmol/L E804 groups.Results Compared with the control group(0 μmol/L E804),2.5,5 and 10 μmol/L E804 significantly increased intracellular ROS,Fe2+and MDA levels,and decreased intracellular GSH content(P＜0.01).Meanwhile,the expression levels of SLC7A11,GPX4,SLC40A1,Nrf2 and HO-1 significantly decreased(P＜0.01),and the expression level of Transferrin increased(P＜0.05).Compared with the 10 μmol/L E804 group alone,the apoptosis inhibitor(Z-VAD)group and the ferroptosis inhibitor(DFO,Fer-1 and Lip-1)group could significantly reverse the inhibition of proliferation and migration of A549 cells by 10 μmol/L E804(P＜0.01).Conclution E804 can induce ferrop-tosis and inhibit the proliferation and migration of A549 cells,which may be related to the inhibition of Nrf2-HO-1/GPX4 pathway.

Skeletal muscle injury is a common disease in clinical practice,and an in-depth understanding of its repair mechanisms is crucial for the development of effective therapeutic strategies.This paper focuses on the key role of TGF-β in skeletal muscle injury repair,introduces the diversity of its family members and signaling pathways,explores the expression and regulation part of TGF-β after skeletal muscle injury,analyzes its early expression dynamics and regulatory factors,and thoroughly investigates the effects of TGF-β on skeletal muscle repair,revealing its inflammatory regulation,cellular activation and proliferation as well as fibrosis.Key role.Special attention was paid to its mechanism of action in muscle regeneration and its regulatory mechanism at the cellular level.In addition,the potential clinical applications of TGF-β in the repair of skeletal muscle injury were discussed,and the development and application of it as a therapeutic target and modulator were explored.However,controversies and shortcomings still exist in the current study,such as the dual roles of TGF-β and the impact of individual differences on treatment.Future research directions should include digging deeper into the details of signaling pathways and biomarker discovery.By overcoming these challenges,the potential clinical application of TGF-β in skeletal muscle injury repair is expected to usher in new breakthroughs and provide patients with more individualized and effective treatment strategies.

Worster-Drought syndrome (WDS) is a special and rare type of cerebral palsy, which is characte-rized by pseudobulbar palsy, selective weakness of the muscles of the lips, tongue, and soft palate, dysarthria, dysphagia, salivation, and jaw spasm.The onset of WDS is linked with a variety of prenatal, intrapartum and postnatal factors.The report of family cases of WDS suggested the genetic predisposition.Although there is no cure at present, early genetic counseling, early diagnosis and intervention can reduce the morbidity of offspring and improve the symptoms of children with WDS, which will greatly reduce the burden on the family and society in the future.In the present study, this paper aims to explore the etiology, pathogenesis, clinical manifestation, imaging examination, diagnosis, disease spectrum and current treatment of WDS, thus improving the diagnostic and therapeutic efficacy.

Objective:To observe the effects of Xiaoqinglong Decoction and Tingli-Dazao-Xiefei Decoction in treating chronic heart failure with syndrome of cold phlegm obstructing lung. Methods:Eighty-six chronic heart failure patients from January of 2017 to December of 2018 in our hospital who met the inclusion criteria were selected and divided into 2 groups according to the random number table method with 43 patients in each group. The control group was treated with conventional therapy, and the observation group was orally treated with Xiaoqinglong Decoction and Tingli-Dazao-Xiefei Decoction. Both groups were treated for 3 months. Then scored the symptoms of cold phlegm obstructing lung from four aspects: palpitations, cough and asthma, uria and edema, and sputum. The ultrasonic cardiogram was used to detect the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF). The ELISA method was used to measure levels of vascular pseudohemophilia factor (vWF),endothelin-1 (ET-1) and serum levels of total antioxidant capacity (TAC), lipid peroxide (LPO), SOD, MDA. The efficacy was evaluated. Results:The total effective rate of the observation group was 90.7% (39/43), significantly higher than that of the control group as 69.8% (30/43), and the difference between the two groups was statistically significant ( χ2=4.692, P=0.030). After the treatment, scores of palpitation, cough and asthma, urine and sputum in the observation group were obviously lower than those of the control group ( t value were 7.621, 7.033, 6.831, 6.635, respectively, all Ps<0.01); the LVEDD (51.41 ± 5.69 mm vs. 58.49 ± 6.77 mm, t=9.809), LVESD (40.04 ± 4.48 mm vs. 43.25 ± 5.21 mm, t=6.776) of the observation group were significantly lower than that of the control group, and while LVEF (50.16% ± 5.89% vs. 45.87% ± 5.16%, t=7.761) was significantly higher than that of the control group ( P<0.01). Plasma levels of vWF (103.55% ± 11.98% vs. 138.11% ±15.71%, t=41.453) and ET-1 (67.05 ± 7.18 pg/ml vs. 81.72 ± 10.03 pg/ml, t=18.990) in the observation group were significantly lower than that of the control group ( P<0.01). The serum levels of TAC and SOD levels in the observation group were significantly higher ( t value were 4.662, 13.331, respectively, all Ps<0.01), while LPO and MDA levels were significantly lower than the control group ( t value were 4.982, 4.031, all Ps<0.01). Conclusions:The Xiaoqinglong Decoction and Tingli-Dazao-Xiefei Decoction in treating chronic heart failure can improve the heart function and symptoms with syndrome of cold phlegm obstructing lung, and increaseclinical efficacy.

Objective:To investigate and analyze the current situation, screening, clinical characteristics, prevention and treatment of bleeding esophageal varices in cirrhotic patients with portal hypertension in Tibet region.Methods:Clinical data of cirrhotic patients with portal hypertension through March 2017 to February 2020 from Tibet region were collected and analyzed retrospectively.Results:511 cases with liver cirrhosis were included in the study, of which 185 cases (36.20%) had compensated cirrhosis and 326 cases (63.80%) had decompensated cirrhosis. Further analysis of the etiological data of liver cirrhosis showed that 306 cases (59.88%) were of chronic hepatitis B, 113 cases (22.11%) of alcoholic liver disease, and 68 cases (13.31%) of chronic hepatitis B combined with alcoholic liver disease. Among patients with compensated liver cirrhosis, 48 cases (25.95%) underwent endoscopic examination of which 33 diagnosed as high-risk variceal bleeding. However, none of these 33 cases had received non-selective β-blocker therapy, and only four patients had received endoscopic variceal banding therapy. Among patients with decompensated liver cirrhosis, 83 cases (25.46%) had a history of upper gastrointestinal bleeding, 297 cases (91.10%) had ascites, 23 cases (7.05%) had hepatic encephalopathy, and 3 cases (0.92%) had hepatorenal syndrome. Among the patients with a history of upper gastrointestinal bleeding, 42 cases (50.60%) had received secondary preventive treatment for bleeding esophageal varices, including 39 cases of endoscopic treatment, 1 case of endoscopic combined drug treatment, 3 cases of interventional treatment, and 2 cases of surgical treatment.Conclusion:Chronic hepatitis B and alcoholic liver diseases are the main causes of liver cirrhosis in Tibet region. Moreover, this region lacks screening, prevention and treatment for bleeding esophageal varices in cirrhotic patients with portal hypertension. Therefore, it is necessary to increase the screening of high-risk groups to prevent and improve the first-time bleeding, and promote multidisciplinary team to prevent and treat re-bleeding.

Objective:To explore the clinical technique and method of reconstruction large soft tissue defect of plantar by skin soft tissue dilatation combined with thigh cross leg flap to improve the weight-bearing function of plantar standing.Methods:From February 2015 to June 2019, 8 cases with plantar soft tissue defects were repaired with cross leg flap expanded from the healthy side of the thigh. Right foot in 4 cases, left foot in 3 cases and bilateral in 1 case. There were 5 males and 3 females. Ages ranged from 16 to 56, with an average age of 31. Clinical features: scar ulcer in 4 cases, bone-sticking scar in 4 cases, bone exposure in 1 case. After debridement, the area of skin and soft tissue defect was 9 cm×16 cm-12 cm×29 cm, the area of harvest expanded flap was 11 cm×18 cm-14 cm×30 cm. All flaps were fixed by cross-leg with pedicle. The pedicle division were performed one month after the skin flap transmission.Results:Of the 9 flaps transferred, 8 survived, 1 died in the distal part of the flap and was repaired by secondary expanded flap, and the donor site healed in linear scar stage. After 6-24 months follow-up, the plantar flap was in good shape and could walk with weight-bearing, without ulceration, and the protective tactile sensation was gradually restored in 12 months.Conclusions:The large-area soft tissue defect of plantar was repaired with the expanded cross leg flap in the healthy thigh, which also provide sufficient thickness of soft tissue to increase the ability of bearing weight and wearing resistance of the sole. It is a good alternative method to repair large area soft tissue defect of plantar under the condition of limited transfer of perforator flap and free flap.

Objective:To explore the clinical technique and method of reconstruction large soft tissue defect of plantar by skin soft tissue dilatation combined with thigh cross leg flap to improve the weight-bearing function of plantar standing.Methods:From February 2015 to June 2019, 8 cases with plantar soft tissue defects were repaired with cross leg flap expanded from the healthy side of the thigh. Right foot in 4 cases, left foot in 3 cases and bilateral in 1 case. There were 5 males and 3 females. Ages ranged from 16 to 56, with an average age of 31. Clinical features: scar ulcer in 4 cases, bone-sticking scar in 4 cases, bone exposure in 1 case. After debridement, the area of skin and soft tissue defect was 9 cm×16 cm-12 cm×29 cm, the area of harvest expanded flap was 11 cm×18 cm-14 cm×30 cm. All flaps were fixed by cross-leg with pedicle. The pedicle division were performed one month after the skin flap transmission.Results:Of the 9 flaps transferred, 8 survived, 1 died in the distal part of the flap and was repaired by secondary expanded flap, and the donor site healed in linear scar stage. After 6-24 months follow-up, the plantar flap was in good shape and could walk with weight-bearing, without ulceration, and the protective tactile sensation was gradually restored in 12 months.Conclusions:The large-area soft tissue defect of plantar was repaired with the expanded cross leg flap in the healthy thigh, which also provide sufficient thickness of soft tissue to increase the ability of bearing weight and wearing resistance of the sole. It is a good alternative method to repair large area soft tissue defect of plantar under the condition of limited transfer of perforator flap and free flap.

OBJECTIVE:To provide reference for the classification of the specification grade of Dioscorea opposite.METHODS:Using the Delphi method,17 experts,who were associated with the study of the distribution and clinical application of D.opposite,were selected to conduct two rounds of consultation on 18 samples of medicinal herbs.The importance of the sensory evaluation indexes of D.opposite was screened and the overall satisfaction was evaluated.The specification grade of D.oppositewas determined preliminarily.RESULTS:Totally 17 questionnaires were issued for each round of consultation,and 17 were recovered with recovery rate of 100％.According to statistical analysis,the average value of expert's authority coefficient was 0.77 +0.07,and average recurrence rate of individual review was (91.18 + 7.64)％.The average recurrence rates of group review in two rounds of consultation were (66.67 + 13.50)％ and (65.97 + 14.01)％.The influence of working life,business background and educational background on recurrence rates of group review for interviewed experts was comprehensive.The full score ratio of appearance and cross-sectional characteristics importance was more than 80％,and the average value was more than 0.8.The full score ratio and average value of iron yam were higher.CONCLUSIONS:It is accurate and scientific to evaluate the specification grade of Chinese medicinal herbs with sensory experience.The most important evaluation indicators of D.opposite were the appearance,shape and cross-sectional characteristics.And it is divided into iron yam and non-iron yam preliminarily.The iron yam grade in descending order:Henan sandy iron yam,Shandong sandy iron yam,Henan loquat iron yam.The non-iron yam grade in descending order:Henan Huaiqingfu D.opposite,Hebei Xiaobaizui D.opposite,Hebei Ma D.opposite and Shanxi Chang D.opposite.

Objective To evaluate the left ventricular function and the synchrony of myocardial ischemic segments in patients with coronary heart disease (CHD) after PTCA and stent implantation by quantitative tissue velocity imaging (QTVI). Methods Thirty-six patients with isolated left anterior descending stenosis (≥75%) were examined by QTVI three days before, one week and one month after successful PTCA and stent implantation to measure the following items of 5 different left ventricular segments: peak systolic velocity( Vs), early diastolic velocity (Ve), late diastolic velocity (Va), time to peak systolic velocity(Ts). Then the coefficient of variation (SD/mean) of the 5 different Ts were calculated.Results The value of Vs,Ve and Va were decreased and the Ve/Va ratio was reverses three days before PTCA + stent. Compared with that before PTCA + stent,the value of Vs and Ve were increased significantly in one week ( P ＜0. 05) and one month( P ＜0.01 ) after PTCA + stent,respectively,the value of Va was not statistically significant. Ve/Va ratio was recovered in one week after PTCA treatment. Ts and Ts-SD were shorted dramatically in one week( P ＜0. 05) and one month( P ＜0.01 ) after PTCA + stent compared with that before PTCA + stent in which Ts were prolonged more than 33 ms. Conclusions QTVI can quantitatively assess the left ventricular function and the synchrony of myocardial ischemic segments, and can be used to real-time detect the changes of function and synchrony of left ventricle after PTCA and stent implantation.