Objective:To recheck the Histoplasma capsulatum and Coccidioides sp. strains of the past by molecular identification and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS). Methods:The phylogenetic relationships among the ten Histoplasma capsulatum isolates and reference strains were analyzed by multilocus sequence typing (MLST). Based on the Coi region, Coccidioides posadasii was distinguished from Coccidioides immitis accurately. MALDI-TOF MS was used to set up the MALDI-TOF MS database of Histoplasma capsulatum and Coccidioides sp. for rapid identification. In addition, hierarchical clustering of spectra was compared with MLST. Results:An unrooted dendrogram constructed with MLST showed that ten individuals of Histoplasma capsulatum were divided into three clades: Eurasia clade, Australia clade and North American class 2 clade, in agreement with the establishment by MALDI-TOF MS cluster analysis. All individuals of Coccidioides sp. were identified as Coccidioides posadasii with Coi region primers. The in-house MALDI-TOF MS database of Histoplasma capsulatum and Coccidioides posadasii was expanded and reached an identified accuracy of 100%. Conclusions:We improve the recognition of Histoplasma capsulatum and Coccidioides posadasii by molecular pathways which shows the major species or clades in Chinese mainland. The in-house MALDI-TOF MS database of Histoplasma capsulatum and Coccidioides posadasii can provide a new efficient way to identify those pathogens rapidly.

Objective:To retrieve and obtain relevant evidence of intra-abdominal pressure-oriented enteral nutrition assessment and management in patients with intra-abdominal hypertension, in order to provide evidence-based evidence for clinical medical staff to make enteral nutrition-related clinical decisions for patients with intra-abdominal hypertension.Methods:Systematic retrieval of Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature, UpToDate, PubMed, Cochrane Library, BMJ Best Practice and other English data, as well as domestic and foreign guidelines such as American Society for Parenteral and Enteral Nutrition, Scottish Intercollegiate Guidelines Network, etc. All evidence available on the Internet in both Chinese and English on intra-abdominal pressure-guided enteral nutrition strategies in adults with intra-abdominal hypertension, study types including clinical decision-making, systematic reviews/meta-analyses, evidence summaries, expert consensus, guidelines or related to the subject of this study closely related high-quality original research. The retrieval time was from the establishment of the database to November 2021. The literature evaluation tool was selected according to the research type. Two researchers trained in the evidence-based system independently evaluate the quality of the included literature, fully considering the clinical situation and expert opinions, and completed the evidence. Extracted and summarized.Results:Totally 13 articles were finally included, including 5 guidelines, 3 expert consensuses, 1 evidence summary and 4 original studies, and 29 evidence-based practice evidence of enteral nutrition in patients with intra-abdominal hypertension were collected, including the monitoring timing of enteral pressure, the pressure of enteral high pressure and the way of enteral nutrition, the pressure measurement of the abdominal cavity, the setting of abdominal pressure, the temperature conditions for early start of enteral nutrition, the selection of enteral pressure, the temperature setting of enteral nutrition nine aspects such as speed and regulation of internal nutrition and abdominal compartment syndrome prevention.Conclusions:This study summarizes the best evidence of intra-abdominal pressure management and enteral nutrition therapy in patients with intra-abdominal hypertension, and provides evidence-based basis for risk management, standardizing clinical practice, and ensuring treatment safety. In the stage of evidence transformation, clinical medical staff need to comprehensively weigh the benefits and risks of early enteral nutrition, and integrate evidence in combination with clinical practical application scenarios, so as to form a standardized early enteral nutrition management plan suitable for patients with intra-abdominal hypertension.

Objective:To summarize clinical characteristics of patients with Aspergillus fumigatus infection in a hospital in Nanjing, to preliminarily assess azole resistance in clinical isolates of Aspergillus fumigatus, and to investigate risk factors for the emergence of azole-resistant Aspergillus fumigatus. Methods:Clinical isolates of Aspergillus fumigatus were collected from inpatients in Department of Laboratory, Nanjing Drum Tower Hospital from March 2017 to February 2021. Clinical data on these infected patients were analyzed, azole sensitivity testing and mutation analysis of the cyp51A gene and its promoter region were performed for these Aspergillus fumigatus isolates. Results:A total of 201 strains of Aspergillus fumigatus were collected, and mainly isolated from sputum specimens. Among the infected patients, there were 131 males and 70 females, and their age were 64.2 ± 15.8 years. The patients were mainly collected from department of respiratory medicine (79 cases), department of intensive medicine (34 cases), department of rheumatology (19 cases), etc. Among these patients, common underlying diseases included interstitial pneumonia (32 cases), malignant tumors (18 cases), pneumonia (13 cases), trauma (12 cases), systemic lupus erythematosus (8 cases), etc. Drug susceptibility testing showed that 6 (2.99%) strains of Aspergillus fumigatus were resistant to itraconazole and posaconazole, and 3 patients infected with azole-resistant Aspergillus fumigatus had used antifungal drugs before testing. Sequencing was performed on the cyp51A gene and its promoter region in the 6 strains of azole-resistant Aspergillus fumigatus, and showed TR34/L98H/S297T/F495I mutation in 5 strains and TR34/L98H mutation in 1 strain. Conclusion:Compared with previously published data about azole resistance in China during 2010 -2015, the resistance of Aspergillus fumigatus to azoles in Nanjing Drum Tower Hospital did not increase from 2017 to 2021, and the mechanism of azole resistance was mostly associated with TR34/L98H/S297T/F495I mutation in the cyp51A gene and its promoter region.

Sarcopenia is a low-cognition, high-incidence syndrome in the aged, which seriously affects the health and quality of life of the aged. This article reviews the low-cognition status and common assessment tools of sarcopenia, aiming at improving the cognition of the public and medical staff, and providing a reference for the evaluation of sarcopenia.

Objective:To investigate the mediating and moderating effects of resilience on frailty and depression in the community-dwelling old adults.Methods:Totally 871 community-dwelling old adults chosen from different communities were investigated by the geriatric depression scale, Tilburg frailty indicator and 10-item Connor-Davidson resilience scale.SPSS 22.0 and AMOS 24.0 were used for data analysis, including descriptive analysis, correlation analysis, structural equation modeling and hierarchical regression analysis.Results:(1)The score of frailty (3.72±2.89)was positively correlated with the score of depression (2.63±2.57, r=0.16-0.58, P<0.01). The score of resilience(28.24±6.80) was negatively correlated with the score of frailty and depression ( r=-0.10~-0.49, both P<0.01), and frailty predicted 35% of the total variation of depression in the elderly.(2)The mediating effect of resilience was significant and the indirect effect was 0.10, accounting for 12.66% of the total variance.(3) Resilience moderated the relationship between frailty and depression ( β=-0.12, t=-4.11, R2=0.41, P<0.001). The frailty of old adults with lower resilience played a stronger predictive role in depression (simple slope=0.50, t=14.73, R2=0.01, P<0.001). Conclusion:There is a close relationship between frailty and depression in the community-dwelling older adults, and resilience plays both mediating and moderating role in the relationship.

Objective:To investigate the diversity and structural characteristics of fungal communities on lesions of the face, upper limbs and back in patients with atopic dermatitis (AD) .Methods:Samples were collected from the lesions on the face, upper limbs and back of 10 AD patients, who visited the Department of Dermatology, the First Affiliated Hospital of Chengdu Medical College from September to October in 2015, and collected from the corresponding body sites of 10 healthy controls. DNA was extracted from the samples, and subjected to MiSeq high-throughput sequencing for diversity index analysis, species composition analysis and principal component analysis. Statistical analysis was carried out by using two-independent-sample t test for comparisons between two groups, one-way analysis of variance for comparisons among multiple groups, and least significant difference- t test for multiple comparisons. Results:Diversity index analysis showed that Shannon index was significantly higher in the samples from the lesions on the face, upper limbs and back of the AD patient group than in those from corresponding body sites of the healthy control group ( t = 2.67, 2.37, 3.34 respectively, all P < 0.05) . Species composition analysis showed that Malassezia was predominant in the skin samples from the face, upper limbs and back of the AD patient group and healthy control group, and the total abundance of Malassezia globosa and Malassezia restricta was about 80%. The abundance of Candida and Aspergillus in the total samples was significantly higher in the AD patient group than in the healthy control group ( t = 3.515, 2.137 respectively, both P < 0.05) . There was no significant difference in the abundance of major fungal genera on the face between the AD patient group and healthy control group (all P > 0.05) ; the abundance of Candida in the upper limbs was significantly higher in the AD patient group than in the healthy control group ( t = 3.186, P < 0.05) , and the abundance of Aspergillus in the back was significantly higher in the AD patient group than in the healthy control group ( t = 2.736, P < 0.05) . In either the AD patient group or the healthy control group, there was no significant difference in the abundance of major fungal genera among samples from the face, upper limbs and back (all P > 0.05) . Moreover, no significant difference in the abundance of major fungal genera was observed among the mild, moderate and severe AD patient groups (all P > 0.05) . Principal component analysis showed that fungal communities in the samples from the lesions on the face, upper limbs and back of the AD patient group were not clustered by the disease severity. Conclusions:The diversity of fungal communities is significantly higher in the lesions on the face, upper limbs and back of the AD patients than in the normal skin at the corresponding body sites of the healthy controls. Malassezia is the dominant fungal genus in both lesions of the AD patients and normal skin of the healthy controls at the above body sites. The composition of fungal communities in lesional samples may be uncorrelated with the disease severity in AD patients.

Objective To investigate the diagnosis and treatment status of neonatal respiratory dis-tress syndrome (NRDS) in Inner Mongolia and explore the problems and countermeasures for NRDS diagno-sis and treatment. Methods Data of infants with NRDS in 4 hospitals(3 hospitals were in the west,which were the Affiliated Hospital of Inner Mongolia Medical University,Baotou Steel Three Hospital and Ordos Central Hospital,1 hospital was in the east,which was the Affiliated Hospital of Chifeng Institute) participat-ing in the study during the period from 1th January,2016 to 30th June,2018 were investigated retrospectively with descriptive epidemiological survey,including basic situation,perinatal period, clinical manifestations, treatment,complications and prognosis. Results Among 11406 newborns admitted in 4 hospitals during the study period,748 infants were diagnosed with NRDS,accounting for 6. 56％ . In the eastern region,279 infants were diagnosed with NRDS,the rate was 9. 30％ ,and in the western region were 469(5. 58％ ). The average hospitalization time in the eastern region was longer than that in the western region,and the age of motherswas higher than that in the western region. There were significant differences between the two groups(P <0. 05). The antenatal hormone use,cesarean delivery,multiple gestation,low Apgar score,premature rupture of membrane in the western region were higher than those in the eastern region(P < 0. 05). The proportion of NRDS grade Ⅰ and gradeⅢ,pulmonary surfactant(PS) utilization ratio and INSURE technology usage in the eastern region were higher than those in the western region. The ratio of NRDS(grade Ⅱ) and the first dose of PS in the western region were higher than those in the eastern region(P < 0. 05). The total mortality of neonates with NRDS was 6. 15％ (46 / 748). The incidence rates of patent ductus arteriosus,bronchopulmo-nary dysplasia,necrotizing enterocolitis,ventilator-associated pneumonia in the western region were higher than those in the eastern region(P < 0. 05). Conclusion The level of diagnosis and treatment of NRDS in four hospitals in two districts of Inner Mongolia varies widely. But overall compared with other areas,the treatment of NRDS in Inner Mongolia has the problems of low antenatal hormone use,insufficient use of PS and INSURE technology,and late use of PS. The treatment of NRDS should continue to standardize antenatal hormone use,early and sufficient use of PS,the promotion of the use of INSURE technology.

Objective: To explore the feasibility of difference between hematocrit and albumin (HCT-ALB) to evaluate the severity in patients with severe scrub typhus (Tsutsugamushi disease). Methods: The clinical data of 408 patients with scrub typhus in 37 hospitals located in 15 prefectures of Yunnan Province from January 1st, 2017 to December 31st, 2018 were retrospectively collected. The patients were divided into the non-severe scrub typhus disease group (n = 265) and the severe scrub typhus disease group (n = 143) according to the diagnostic criteria. Volunteers attending Kunming City Medical Center in Yunnan Province for routine physical examination were enrolled as healthy control group (n = 230). HCT, ALB, lactate dehydrogenase (LDH), uric acid (UA), and acute physiology and chronic health evaluationsⅡ(APACHEⅡ) and sequential organ failure assessment (SOFA) within 24 hours after admission were collected. HCT-ALB difference was calculated. Pearson method was used to analyze the correlation between HCT-ALB difference and LDH, UA, APACHEⅡ and SOFA scores in patients with severe scrub typhus disease; the receiver operating characteristic (ROC) curve was used to analyze the value of HCT-ALB difference in the diagnosis of severe scrub typhus disease. Results: ① There was no significant difference in gender composition between patients with non-severe scrub typhus disease group and severe scrub typhus disease group, but the age of the severe scrub typhus disease group was significantly higher than that of the non-severe scrub typhus disease group (years old: 53.57±15.23 vs. 35.03±23.47, P < 0.01). ② Compared with the healthy control group, the HCT, ALB of the non-severe scrub typhus disease group and severe scrub typhus disease group were significantly decreased [HCT: (36.54±6.82)%, (38.13±7.60)% vs. (46.20±4.42)%; ALB (g/L): 35.53±5.87, 26.90±6.10 vs. 47.75±4.28, all P < 0.01], and the HCT-ALB difference was significantly increased (5.28±3.90, 11.26±6.62 vs. 1.55±5.32, both P < 0.01). Compared with the non-severe scrub typhus disease group, the HCT of the severe scrub typhus disease group was significantly increased [(38.13±7.60)% vs. (36.54±6.82)%, P < 0.01], the ALB was significantly decreased (g/L: 26.90±6.10 vs. 35.53±5.87, P < 0.01), and the HCT-ALB difference was significantly increased (11.26±6.62 vs. 5.28±3.90, P < 0.01). ③ Pearson correlation analysis showed that HCT-ALB difference was positively correlated with LDH and UA in patients with severe scrub typhus disease (r values were 0.316 and 0.284, respectively, both P < 0.01), and negatively correlated with APACHEⅡ score and SOFA score (r values were -0.229 and -0.198, respectively, both P < 0.05). ④ ROC curve analysis showed that the area under the curve (AUC) of HCT-ALB difference in the diagnosis of severe scrub typhus disease was 0.786, standard error was 0.024, P = 0.000, and 95% confidence interval (95%CI) was 0.739-0.832. When the best diagnostic value was 8.56, the sensitivity was 81.1%, the specificity was 60.8%, and the Youden index was 0.419. Conclusions HCT-ALB difference is an indicator to evaluate the severe scrub typhus disease. When HCT-ALB difference is above 8.56, it can be used as an indicator to identify severe scrub typhus disease.

Objective: To investigate the efficacy and adverse effects of sustained lung inflation (SLI) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: This prospective randomized controlled trial included 124 premature infants (gestational age <34 weeks and birth weight <2 000 g) diagnosed with NRDS and in need of PS treatment in Shenzhen Maternity & Child Healthcare Hospital affiliated to Southern Medical University from July 1, 2016 to October 31, 2018. They were randomly divided into experimental or control group, with 62 cases in each. Infants in the experimental group were treated with SLI using T-piece and intratracheal PS, while those in the control group were given PS only. Blood gas analysis and measurement of fraction of inspiration O₂ (FiO₂) and ratio of partial pressure of oxygen (PO₂) over FiO₂ were performed before and 1 h after PS injection. Results of the treatments and incidence of complications were compared. Paired samples t-test, two independent samples t-test, rank-sum test and Chi-square test were used for statistical analysis. Results: There were 56 participants in the experimental group and 54 in the control group who were eventually analyzed. In the experimental group, the pH value, partial pressure of carbon dioxide (PCO₂), FiO₂ and PO₂/FiO₂ at 1 h after PS injection were all improved compared with those before treatment [pH value: 7.26±0.09 vs 7.19±0.09, t=3.814; PCO₂: (51.5±12.6) vs (59.8±16.3) mmHg (1 mmHg=0.133 kPa), t=2.610; FiO₂: 26.0 (21.0-31.5)% vs 40.5 (38.5-51.5)%, U=392.000; PO₂/FiO₂: (284.6±117.9) vs (173.4±59.7) mmHg, t=6.427; all P<0.05]. The overall decrement of FiO₂ after PS injection in the experimental group was more significant than that in the control group [-10.0 (-15.0 to -5.0)% vs -5.0 (-8.0 to 0.0)%, U=706.500, P<0.001]. The experimental group had a higher rate of extubation within 24 h than the control group [80% (45/56) vs 71% (32/54), χ²=5.830, P=0.016]. However, no significant differences were shown in total mechanical ventilation time, non-invasive/high-flow nasal cannula ventilation time, the ratio of re-intubation within 72 h, or the incidence of air leak, bronchopulmonary dysplasia, periventricular-intraventricular hemorrhage, necrotizing enterocolitis or patent ductus arteriosus between the two groups (all P>0.05). Conclusions SLI combined with PS for NRDS babies can increase the rate of extubation within 24 h and promote the down-regulation of FiO₂ without causing significant complications.

Objective: To explore the current status and predictive factors of frailty among community-dwelling old adults. Methods: A total of 1 012 community-dwelling older adults aged 65 years and above in Sichuan Province were enrolled and investigated by self-made general condition scale, Tilburg Frailty Indicator (TFI), Short Physical Performance Battery(SPPB), 10-item Connor-Davidson Resilience Scale(CD-RISC-10), Mini-Mental State Examination(MMSE) and Geriatric Depression Scale Short-form(GDS-15). Results: (1) The prevalence of frailty was 30.73%.(2) There were significant differences in the frailty scores of community-dwelling older adults in terms of gender, education, marital status, living condition, spouse support, children support, family economic conditions, self-perceived health status, number of chronic diseases, body mass index, number of falls in the past year, exercise state and sleep time at night(all P<0.05). (3) The frailty (3.72±2.88) was significantly positively correlated with depression (2.69±2.58; r=0.58, P<0.01), and negatively correlated with the scores of balance ability(3.28±1.01), walking speed(2.92±1.05), chair rise test(2.92±1.27), strength of resilience(13.99±3.57) and MMSE(23.71±5.55) (r=-0.33-0.43, P<0.01). (4) Depression (β=0.416, P<0.001), the number of chronic diseases(β=0.219, P<0.001), balance ability(β=-0.166, P<0.001), spousal support(β=-0.089, P<0.01), strength of resilience(β =-0.097, P<0.01), family economic status(β=0.093, P<0.01) and gender(β=0.082, P<0.01) significantly influenced frailty, with a combined explanation variance of 45.9%. Conclusions The rate of frailty of community-dwelling old adults is high, which is influenced by physiological, psychological and social factors.Therefore, it is necessary to adopt a comprehensive model of multi-disciplinary cooperation to carry out frailty intervention in community.