Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.

Objective:To investigate the safety and effectiveness of endoscopic cold snare resection of small colorectal polyps and prophylactic hemostatic clip.Methods:A total of 260 patients diagnosed as having small colorectal polyps in Qinghai Provincial People's Hospital from January 2021 to March 2022 were randomly assigned to cold snare polypectomy (CSP) group (receiving CSP), CSP+hemostatic clip group (receiving CSP+prophylactic hemostatic clip), hot snare polypectomy (HSP) group, and HSP +hemostatic clip group (receiving HSP+prophylactic hemostatic clip). Each group had 65 cases. The treatment, incidence of bleeding, and other complications were compared.Results:There was no significant difference in the basic characteristics of patients or polyps among the four groups ( P>0.05). Immediate intraoperative bleeding occurred in 5 cases (7.69%), 4 cases (6.15%), 3 cases (4.62%), and 3 cases (4.62%) in the four groups respectively with no significant difference ( χ2=0.778, P=0.855), while only 1 delayed postoperative bleeding was observed in HSP group with no significant difference among the four groups ( χ2=3.012, P=0.390). The incidence of postoperative abdominal pain was the highest in the HSP group ( n=7, 10.77%) significantly different from those of the CSP group ( n=1, 1.54%) and the CSP+hemostatic clip group ( n=1, 1.54%) ( P<0.05). Polypectomy time of single polyp in CSP group was the shortest (2.18±1.07 min) , followed by HSP group (2.83±0.82 min), then CSP+hemostatic clip group (3.15±1.16 min), with HSP+hemostatic clip group (4.88±1.85 min) being the longest ( F=50.397, P<0.001). Conclusion:It is suggested to use CSP for small colorectal polyps. If there is no risk of bleeding or perforation during the operation, it is not necessary to use prophylactic hemostatic clips.

Objective:To investigate the relationship between Helicobacter pylori(Hp)infections in Parkinson's disease(PD)patients at high altitude and peripheral inflammatory markers.Methods:In this prospective study, 120 PD patients in Qinghai Province(altitude: 2260 m)were enrolled and evaluated using PD motor symptom scales and a non-motor symptom scale.The 13C-Urea breath test was used to detect Hp, and patients were divided into an Hp infection group and a non-Hp infection group based on test results.The levels of high-sensitivity C-reactive protein(hs-CRP), white blood cell counts and ratios, serum interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α)were measured. Results:The incidence of Hp infections in PD patients was 56.67%(68/120).The scores of Unified Parkinson's Disease Rating Scale(UPDRS)-Ⅲ, UPDRS-Ⅳ, total UPDRS, Hoehn-Yahr(H-Y)score, constipation scoring system(CSS)and Leeds dyspepsia questionnaire(LDQ)in the Hp infection group were higher than those in the non-Hp infection group, while the mini-mental state examination(MMSE)score was lower in the non-Hp infection group(all P<0.05).The neutrophil count, neutrophil-to-lymphocyte ratio(NLR), monocyte-to-lymphocyte ratio(MLR), serum IL-6 and TNF-α in the Hp-infection group were elevated compared with the non-Hp infection group(all P<0.05).Multivariate Logistic regression analysis showed that IL-6, TNF-α, NLR and H-Y score were independent risk factors for Hp infections in PD patients( OR=1.103, 1.188, 3.320, 4.593, respectively, all P<0.05).Correlation analysis showed that IL-6, TNF-α and NLR had positive correlations with UPDRS-Ⅲ( r=0.676, 0.644, 0.488, respectively), UPDRS-Ⅳ( r=0.679, 0.660, 0.430, respectively), UPDRS-total score( r=0.391, 0.448, 0.319, respectively), H-Y( r=0.610, 0.750, 0.460, respectively), CSS( r=0.529, 0.366, 0.212, respectively)and LDQ( r=0.581, 0.440, 0.263, respectively), but were negatively correlated with MMSE score( r=-0.617, -0.596, -0.321, respectively)(all P<0.05). Conclusions:Peripheral inflammation caused by Hp infections may be involved in the occurrence and development of Parkinson's disease at high altitude and serum IL-6, TNF-α and NLR could serve as indicators to evaluate PD patients with Hp infections.

Objective:To explore the clinical significance of standardized screening for diagnosis and treatment of early gastric cancer in Qinghai Province.Methods:Opportunistic early gastric cancer screening was conducted in outpatients of Digestive Department, Physical Examination Center and inpatients of Qinghai Provincial People′s Hospital from January 2016 to December 2020, according to the optimal cut-off values of serum pepsinogen (PG)Ⅰ, PGⅠ/PGⅡ ratio (PGR) and serum gastrin 17 (G17) obtained from the previous screening study of gastric cancer and precancerous diseases in different areas of Qinghai Province. At the same time, the standardized early gastric cancer screening program was applied in 10 municipal (county-level) hospitals in Qinghai Province. The detection rate, early diagnosis rate and endoscopic treatment rate of early gastric cancer in Qinghai Provincial People′s Hospital and the above 10 hospitals in the past five years were analyzed respectively.Results:In the five years, the total detection rate, early diagnosis rate and endoscopic treatment rate of early gastric cancer in Qinghai Provincial People′s Hospital were 0.214% (407/190 178), 17.54% (407/2 321) and 81.82% (333/407), respectively. The above indices in 10 other hospitals were 0.085% (264/309 217), 12.94% (264/2 040) and 37.12% (98/264), respectively. The overall detection rate of early gastric cancer was higher than 0.024% reported previously.Conclusion:The standardized early gastric cancer screening program can not only improve the diagnosis rate of early gastric cancer in Qinghai Province, but also save medical resources. It is an economical, efficient and feasible program, suitable for the highin-cidence area of gastric cancer in Qinghai Province.

Objective:To evaluate the screening value of serum pepsinogen (PG) Ⅰ, pepsinogen ratio (PGR, PG Ⅰ/PG Ⅱ) and gastrin 17 (G17) levels combined with gastroscopy for early-stage gastric cancer in high incidence areas of gastric cancer in Qinghai Province.Methods:A total of 2 700 cases were identified as the appropriate age (40-69 years) target population through the questionnaire survey from 25 000 local residents in high incidence areas of gastric cancer in Qinghai Province. The serum PGⅠ, PGⅡ and G17 levels of the 2 700 target population were determined by ELISA, and PGR were calculated. And then 949 patients with abnormal levels of PG and G17 were screened out as a high-risk group of gastric cancer to receive gastroscopy and pathologic biopsy. According to the results of gastroscopy and biopsy, the patients were divided into non-atrophic gastritis group, atrophic gastritis group, peptic ulcer group, early-stage gastric cancer group, and advanced gastric cancer group. The optimal threshold and its sensitivity and specificity of serum PG Ⅰ, PGR and G17 levels for diagnosis of early-stage and advanced gastric cancer were determined based on the receiver operator characteristic curve (ROC).Results:Totally 949 cases received gastroscopy and 649 cases received pathological biopsy, including 239 cases of non-atrophic gastritis, 500 cases of atrophic gastritis, 197 cases of peptic ulcer, 5 cases of early-stage gastric cancer, and 8 cases of advanced gastric cancer. The level of serum PG Ⅰ in the early-stage gastric cancer group (70.00±12.35 μg/L) and advanced gastric cancer group (38.39±2.77 μg/L) was significant lower than that in the non-atrophic gastritis group (103.89±37.45 μg/L, both P<0.05), and the value of early-stage gastric cancer group was obviously higher than that of advanced gastric cancer group ( P<0.05). The PGR of the early-stage gastric cancer group (3.74±1.40) and the advanced gastric cancer group (2.05±0.59) was significantly lower than that in the non-atrophic gastritis group (9.18±4.10, both P<0.05), and the value of early-stage gastric cancer group was significantly higher than that of the advanced gastric cancer group ( P<0.05). The level of serum G17 in the early gastric cancer group (18.03±4.52 pmol/L) and the advanced gastric cancer group (25.15±3.76 pmol/L) was significantly higher than that in the non-atrophic gastritis group (14.99±7.12 pmol/L, both P<0.05), and the level of early-stage gastric cancer group was significantly lower than that of advanced gastric cancer group ( P<0.05). According to the analysis of ROC in the diagnosis of early-stage gastric cancer, the best threshold of PG Ⅰ, PGR and G17 was 71.85 μg/L, 5.04, and 15.65 pmol/L, respectively, and the corresponding sensitivity and specificity was 80.0% and 59.0%, 100.0% and 70.4%, and 80.0% and 69.3%, respectively, for PG Ⅰ, PGR and G17. The analysis of ROC in the diagnosis of advanced gastric cancer showd that the best critical value of PG Ⅰ, PGR and G17 was 42.55 μg/L, 2.79 and 20.55 pmol/L, respectively, and the corresponding sensitivity and specificity was 100.0% and 95.3%, 100.0% and 92.1%, and 100.0% and 89.7%, respectively. Conclusion:Using serological detection of PG and G17 to screen high-risk group of gastric cancer, and then making diagnosis by gastroscopy and biopsy is an effective, low-cost and non-invasive approach for the early-stage gastric cancer in high incidence areas of gastric cancer in Qinghai Province.

Objective    To explore the safety and effectiveness of video-assisted thoracoscopic surgery (VATS) pneumonectomy for bronchiectasis. Methods    The clinical data of 164 patients undergoing VATS pneumonectomy or open thoracotomy for bronchiectasis in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group (122 patients, 63 males, 59 females) and a thoracoscopic surgery group (42 patients, 15 males, 27 females). Surgical and follow-up indicators were compared between the two groups. Results    There was no difference between the two groups in the blood loss, operation time, perioperative mortality or complication. However patients undergoing VATS had shorter length of postoperative stay than those undergoing thoracotomy (6.9±2.6 d vs. 8.1±3.1 d, P=0.030). In the thoracoscopic surgery group, 3 patients were lost to follow-up and in the thoracotomy group, 5 patients were lost to follow-up. In a median follow-up of 51 months (ranging from 2 to 116 months), 36 patients (92.3%) fully recovered with no sputum or haemoptysis and 3 (7.7%) partially recovered with a reduced sputum or haemoptysis in the thoracoscopic surgery group; 105 (89.7%) fully recovered with no sputum or haemoptysis, 10 (8.5%) partially recovered with a reduced sputum or haemoptysis while 2 (1.7%) without any improvement in the thoracotomy group with no statistical difference (P=0.700). Conclusion    VATS pneumonectomy for bronchiectasis is equivalent to thoracotomy in terms of safety and effectiveness, and can be used as an alternative surgical procedure for the treatment of bronchiectasis.

OBJECTIVETo evaluate the efficacy and metabolic safety of long-term treatment with ethinyl oestradiol/cyproteroneand desogestrel/ethinyl oestradiol tablets in women with polycystic ovary syndrome (PCOS).

METHODSWomen with PCOSfrom West China Second Hospital of Sichuan University enrolled between September, 2011 and August, 2013 were randomlyallocated to receive either ethinyl oestradiol/cyproterone tablets (Group A, =355) or desogestrel/ethinyl oestradiol tablets(Group B, =357) for a prospective observation period of 6 months. Women with insulin resistance also received metformin. Atbaseline, 3 months, and 6 months, the patients were evaluated for menstruation, acne score, body mass index (BMI), waist-tohip ratio (WHR), plasma levels of sex hormones, fasting blood glucose (FPG), HOMA-insulin resistance index (HOMA-IR), serum lipid, ovarian volume, and the number of ovarian follicles.

RESULTSAll the patients had a regular menstrual cycle aftertreatments. Testosterone level, acne score, LH/FSH, ovarian volume, and the number of follicles decreased significantly afterthe treatments without significant differences between the two groups. Significant increases were noted in TG, TCh, LDL, HDL, and AIP, and HDL level in group A as compared with group B ( < 0.001). FPG decreased in both groups, and wassignificantly lower in group B at 6 months ( < 0.05). BMI and WHR decreased in all the patients with insulin resistance aftercombination treatment with metformin ( < 0.05), but increased significantly in patients without insulin resistance ( < 0.05). Ingroup A, HOMA- IR significantly increased in patientswithout insulin resistance at 3 months ( < 0.05), whereas asignificant increase was not observed until 6 months ingroup B ( < 0.05).

CONCLUSIONSBoth ethinyl oestradiol/cyproterone tablets and desogestrel/ethinyl oestradioltablets can relieve the symptoms of PCOS, but it isadvisable to assess the risk of cardiovascular diseasebefore the treatments.

Objective To observe the effect of Kinesio Taping with lattice shapes on pregnancy-related low back pain (PLBP). Methods From March, 2017 to April, 2018, 56 patients with PLBP were randomly divided into the control group (n = 28) and experimental group (n = 28). Both groups received the core stability training, while the experimental group accepted Kinesio Taping with lattice shapes additionally. They were assessed with Visual Analogue Scale (VAS), Roland-Morris Dysfunction Questionnaire (RMDQ), range of lumbar activity and torso angle before, three days and two weeks after treatment. Results The range of lumbar activity improved significantly in both groups (t > 6.327, P < 0.01) three days after treatment, while the scores of VAS and RMDQ, and the torso angle improved significantly in the experimental group (t > 4.862, P < 0.001). The scores of VAS and RMDQ, the range of lumbar activity, and the torso angle improved significantly in both groups two weeks after treatment (P < 0.001), and improved more in the experimental group than in the control group (P < 0.05). Conclusion Kinesio Taping with lattice shapes combined with core stability training can further reduce the lower back pain and improve the function for the PLBP patients.

Objective To investigate the status quo of humanistic caring ability of undergraduate nursing students, and to analyze the influencing factors.Methods By convenient sampling method, 171 students majoring in Nursing, enrolled to School of Nursing, Shanxi University of Traditional Chinese Medicine in 2015, were selected and surveyed by Caring Ability Inventory (CAI) about their humanistic caring ability and influencing factors.Results In the scale CAI, total scores, scores of dimension courage, and scores of dimension patience of the nursing students were (185.29±23.32), (58.30±9.91), and (56.94±9.35), lower than the norm (208.58±23.32), (65.25±11.57) and (63.11±4.19) (t/Z=-12.907, -9.068, 2.229;P<0.001). Scores of students, who were the only child in their family, on the dimension courage and patience were (55.17±10.51) and [57(46,61)], lower than those who came from non-only-child family (59.16±9.59) and [59(55,63)], (t/Z=-2.166, -2.651;P<0.05).Conclusions Overall humanistic caring ability of nursing students in our country is relatively low. Educators should pay attention to related factors, formulate targeted training strategies, so as to strengthen education on humanistic caring of nursing students.

Objective To study the role of expressions of vascular endothelial growth factor C (VEGF-C), vascular endothelial growth factor receptor-3 (VEGFR-3) and lymphatic vessel hyaluronan receptor-1(LYVE-1) on the lymphangio-genesis and prognosis in gastric cancer. Methods The tissue microarray technology was used to detect the expressions of VEGF-C, VEGFR-3 and LYVE-1 in 125 gastric cancer specimens, 96 adjacent normal tissues and 20 benign gastric lesion samples. The lymphatic vessel density (LVD) marked by Podoplanin was detected as well. Results The positive rates of VEGF-C, VEGFR-3 and LYVE-1 in gastric cancer tissues were 62.4%, 56.0%and 58.4%, which were significantly higher than those in adjacent normal tissues (10.4%,12.5%and 9.4%) and benign gastric lesion tissues (20%, 30%and 25%, P<0.05). The LVD score was significantly higher in gastric intra-tumoral and peri-tumoral samples (2.98±0.81 and 4.22±1.09) than that in adjacent normal tissues or benign gastric lesion samples (1.82±0.63 or 0.89±0.45, P<0.01). The LVD score was significantly higher in peri-tumoral samples than that of intra-tumoral samples (P<0.01). There was a positive relationship between expression levels of VEGF-C,VEGFR-3 and LYVE-1 with LVD (P<0.05). The positive expressions of the three indexes were the risk factors of lymph node metastasis and distant metastasis (P<0.05). There was a significantly longer 5-year survival rate in patients with negative expression of the three indexes (P<0.05). Conclusion VEGF-C, VEGFR-3 and LYVE-1 proteins were positively highly expressed in gastric cancer tissues, which were risk factors affecting the progno-sis of gastric cancer. The expression levels of the three indexes can be used to predict the prognosis and lymphangiogenesis of gastric cancer.