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.

To sum up integrative nursing experience of a case with chronic refractory wound formation caused by drug extravasation.The essentials of integrative nursing are:structured nursing intervention of"assessment-management-treatment"based on the Triangle of Wound Assessment;determination of the timing for integrative nursing according to the theory of TCM sores and ulcers;implementation of copper board scraping method to promote circulation of qi and blood;use of Huo-long Comprehensive Moxibustion Therapy to promote muscle regeneration.With the help of the cooperation of the multidisciplinary specialist nursing team,the wound was completely healed after 59 days of integrated traditional Chinese and Western medicine nursing interventions.

Objective:To explore the clinical characteristics, diagnosis and treatment of allergic bronchopulmonary aspergillosis(ABPA) with eosinophilic granulomatous with polyvasculitis(EGPA) as a comorbidity.Methods:We collected the clinical data of a patient with EGPA who sought treatment with ABPA as a comorbidity. We summarized the diagnosis and treatment process of the patient, and reviewed the literature. After that, we discussed the relationship between the pathogenesis of ABPA and EGPA and the diagnosis and treatment experience.Results:A 61-year-old male patient suffered from repeated coughing, expectoration, hemoptysis, wheezing. His blood eosinophils count and immunoglobulin (Ig)E level were elevated. He was tested positive for aspergillus fumigatus. His Computer Tomography (CT) showed pulmonary nodules and bronchiectasis. He was diagnosed as ABPA. He also suffered limb numbness, sinusitis, and renal dysfunction and was diagnosed as EGPA. His condition improved after treatment with glucocorticoids, immunosuppressants and antifungal agents. We reviewed the relevant literature and retrieved 10 case reports, of which 5 cases were diagnosed as ABPA first and then EGPA, 3 cases were diagnosed as EGPA first and then ABPA, 2 cases were diagnosed simultaneously. We found that there was a certain correlation between them in the pathogenesis, and the main treatment is glucocorticoids, immunosuppressants and antifungal drugs.Conclusion:ABPA with EGPA as a comorbidity is rarely reported, which reminds us that when diagnosing one of the diseases in clinical work, we should be alert to the coexistence of another disease to avoid misdiagnosis.

Objective To detect the expressions of two protein factors hypoxia-inducible factor (HIF)-1α and Helicobacter pylori (Hp) in gastric cancer in Mongolian and Han two nationalities respectively,and to explore the relationship of HIF-1α and Hp in the development of gastric cancer.Methods A modified Warthin-Starry (W-S) silver staining method was used to detect Hp infection in 27 Mongolian patients with gastric cancer and 30 Han patients with gastric cancer.Immunohistochemical (S-P) method and reverse transcription polymerase chain reaction (RT-PCR) method were used to detect protein and mRNA expressions of HIF-1α in cancer tissue,paracancerous tissue and normal tissue samples.The relationship of HIF-1α protein and Hp expression was analyzed between gastric carcinoma tissue samples of Mongolian patient group and Han patient group.Results Hp infection rates were 81.5％ (22/27) and 66.7％ (20/30) in Mongolian and Han patients with gastric cancer.The difference in infection rate was not statistically significant between two groups of patients (~=1.608,P ＞ 0.05).The positive expression levels of HIF-1α protein were 62.96％ (17/27) and 70.00％ (21/30) in gastric cancer tissue samples of Mongolian and Han groups.The relative expression levels of HIF-1α mRNA were 0.891 4±0.075 0 and 0.907 4±0.065 5.There was no significant difference in the HIF-1 α mRNA expression between the two nationalities.No positive expressions of HIF-1α protein and mRNA were found in paracancerous tissue and normal tissue samples.There was a positive correlation in the positive expression of HIF-1α protein and Hp infection in gastric cancer tissue samples of Mongolian and Han patient groups (r,=0.424 and 0.617,P ＜ 0.05).Conclusion HIF-1α and Hp are pathogenic factors of gastric cancer.Hp and HIF-1α may promote the occurrence of gastric cancer together.The pathogenic mechanism of HIF-1α and Hp in gastric cancer may be the same for Mongolian and Han patients.

Objective To discuss the correlation between the level of serum cystatin C and lipids in patients with system lupus erythematosus.Methods Used automatic biochemical analyzer to detect serum cystatin C (CysC),triglyceride (TG),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C)and hsCRP levels in 136 cases of SLE patients and 113 cases of healthy people.Data obtained using SPSS13.0 software to carry on sta-tistical analysis.Results Outcome of SLE patients group compared with healthy controls,hsCRP (13.5 ± 4.85 mg/L vs 2.03±0.88 mg/L),CysC (2.63±1.95 mg/L vs 0.85±0.37 mg/L),LDL-C (3.06±1.21 mmol/L vs 2.33±0.41 mmol/L),TC (5.32±2.63 mmol/L vs 4.02±1.67 mmol/L)and TG (1.92±0.83 mmol/L vs 1.44±0.8 mmol/L)were signifi-cantly higher the difference between groups was statistically significant(t=2.45~12.4,P <0.05).Compared with healthy controls,HDL-C (1.12±0.31 mmol/L vs 1.52±0.85 mmol/L)was decreased (P <0.01).In SLE patients group,the ser-um CysC level and hsCRP,TC,TG and LDL-C were positively correlated,and the level of HDL-C was negative to the level of CysC.The health control group was no significant correlation.Conclusion Serum lipid levels of SLE patients were posi-tive to the level of CysC.Suggest that joint detection of SLE patients serum CysC and blood lipids index is helpful to the di-agnosis of SLE treatment and condition monitoring.

ObjectiveTo investigate the occurrence rule and mechanism of ischemia-reperfusion injury (IRI)-induced gastric oxidative damage during perioperative period of liver transplantation.Methods Twenty-eight SD rats were randomized into 4 groups according to the random number table. The modelof orthotopic autologous liver transplantation was established in 3 groups, which were 4 h, 8 h, 16 h group according to the reperfusion time of the liver grafts. The other group was set as Sham group. Gastric tissues were stained with HE to observe pathological changes of gastric mucosal injury. Superoxide anion (O2-), malondialdehyde (MDA), glutathione (GSH) and glutathione peroxidase (GSH-PX) in gastric tissues were detected. The expression of thioredoxin (Trx)-2 in gastric tissues was detected by Western blot. The comparison on experimental data was conducted using one-way analysis of variance and LSD-t test.Results In 4 h group, congestion, edema and hemorrhage were observed in deep stratum and submucous stratum of stomach, as well as disorganized glands, regional hemorrhage and necrosis, and erosion was observed deep to the muscularis mucosa. In 8 h group and 16 h group, gastric mucosal injury was alleviated, and only congestion and edema in superifcial and deep layer were observed. In Sham group, the epithelium structure of most gastric mucosa was intact. The O2- and MDA of 4 h group were respectively (185±26) U/mg and (0.4±0.1) nmol/mg and those of 8 h group were respectively (192±59) U/mg and (0.5±0.1) nmol/mg, which were signiifcantly higher than (102±34) U/mg and (0.2±0.1) nmol/mg of Sham group (LSD-t=4.99, 4.23 and 6.37, 4.52;P<0.05). GSH and GSH-PX of 4 h group were respectively (17±6) mg/g and (781±174) U/mg and those of 8 h group were respectively (15±4) mg/g and (750±160) U/mg, which were signiifcantly lower than (30±6) mg/g and (1 162±215) U/mg of Sham group (LSD-t=-3.26,-4.01 and-3.78,-4.36;P<0.05). The O2-, MDA, GSH and GSH-PX of 16 h group were respectively (169±27) U/mg, (0.3±0.1) nmol/mg, (25±8) mg/g and (1 108±183) U/mg, and signiifcant difference was observed comparing with 8 h group (LSD-t=-2.85,-3.46, 2.66, 3.69;P<0.05). The relative expression of Trx-2 in 4 h group and 8 h group were respectively 52±10 and 43±8, which were signiifcantly lower than 125±16 of Sham group (LSD-t=-5.34,-6.23;P<0.05). The expression of Trx-2 in 16 h group was 160±18, which was signiifcantly higher than that of 8 h group (LSD-t=4.75,P<0.05). ConclusionIRI causes gastric oxidative damage in the early phase after liver transplantation in rats, which may be associated with the decrease of Trx-2 expression, increase of active oxygen and decrease in organic antioxidative ability.

Objective This retrospective study is performed to analyze the epidemiological and clinical features of patients with infective endocarditis (IE) hospitalized in Fuwai Cardiovascular Hospital during the latest 7 years.Methods This retrospective study included a cohort of 368 infective endocarditis patients hospitalized in Fuwai Hospital form August 2005 to August 2012.Predisposing cardiac diseases,causative organisms,clinical features and outcomes were analyzed.Risk factors related to outcome including NYHA classes,causative organisms and complications,were evaluated.Results Among the IE patients,6.8％ (25/368) patients had rheumatic heart diseases 31.8％ (117/368) had congenital heart diseases,22.8％ (84/368) were post-PCI or operative endocarditis and IE developed in 14.1％ (52/368) patients without previous cardiac diseases.Blood culture positive rate was 46.2％ (170/368).Streptococci viridians [27.6％ (47/170)]were the most common causative organisms,followed by coagulase-negative staphylococci [15.9％ (27/170)].Fever and cardiac murmur were the most common clinical presentations.Congestive heart failure was the most common complication [87.8％ (323/368)].Systemic and pulmonary embolism occurred in 16.0％ patients,80.9％ IE was detected by echocardiography.In-hospital mortality rate was 6.7％,mostly due to refractory congestive heart failure and sepsis.Subgroup analysis showed that incidence of post-PCI or operative endocarditis was significantly higher in IE patients hospitalized after 2009 compared to IE patients hospitalized before 2009 (27.5％ vs.19.2％,P ＜ 0.05).Higher incidence of staphylococcal infection was evidenced in mechanical valves than in native valves(44.4％ vs.19.8％,P ＜ 0.05).Conclusion During the past decade,there is a significant change on epidemiology and clinical features of IE in China.Incidence of post-surgical and interventional IE increased significantly.Staphylococcal and Gram negative bacilli infection are major pathorganisms of endocarditis of mechanical valves.Due to the lower positive rate of blood culture,echocardiography serves as the most important diagnostic tool for infective endocarditis.

Objective To investigate the availability of N-terminal pro-brain natriuretic peptide (NT proBNP) in the detection of early ventricular diastolic dysfunction by polymyositis/dermatomyositis (PM/DM).Methods A total of 46 PM/DM patients without symptoms of heart involvement were prospectively studied by standard echocardiography and the longitudinal mitral annular velocities was measured by tissue Doppler echocardiography (TDI).Plasma NT-proBNP was measured in all patients.Multivariate Logistics regression analysis was applied to investigate the risk factors for early cardiac complications.The availability of NTproBNP was evaluated by receiver operating characteristic (ROC) analysis.Results There were 22 patients complicated with early diastolic dysfunction (E/Em ≥ 8) by TDI.The multi-factors Logistic regression analysis showed that the age of onset (OR=1.117,95％CI 1.005-1.243,P=0.040) and plasma NT-proBNP (OR=1.022,95％CI 1.001-1.042,P=0.036) were risk factors for early left ventricular diastolic dysfunction.The level of NT-proBNP was positively correlated with E/Em value(r=0.687,P=0.000).ROC showed NT-proBNP could reliably detectearly ventricular diastolic dysfunction [area under the curve 0.858 (95％ CI 0.735-0.981,P＜0.01)].If PM/DM patients with normal TDI(E/Em＜8) were used as controls,and 120 pg/ml was used as the cut-off concentration,the sensitivity and specificity of NT-proBNP for the early ventricular diastolic dysfunction was 81.8％ and 91.7％ respectively.Conclusion Age at onset and plasma NT-proBNP are risk factors for early left ventricular diastolic dysfunction.The level of NT-proBNP is positively correlated with E/Em value.The plasma NT-proBNP concentration higher than 120 pg/ml maybe a marker for early left ventricular diastolic dysfunction.

Objective To study the imaging findings of hip involvement and to compare the sensitivity of radiography,CT,and MRI in the identification of hip involvement in patients with ankylosing spondylitis(AS).MethodsAnteroposterior radiography of the pelvis and MRI of hip were performed in 55 patients with AS.CT scan of hip was performed in 29 of 55 patients.T1-weighted,T2-weighted,short tau inversion recovery (STIR) and three dimensional balanced turbo field echo with water selective excitation (3D-BTFE-WATS) coronal sequences of hips were obtained in all patients,of which fat-saturated contrastenhanced T1-weighted sequence was performed in 24 patients.The imaging data of 55 patients were analyzed.The chi-square test was used to analyze the sensitivity in the identification of hip involvement among radiography,CT,and MRI.ResultsAmong 110 hips in all 55 patients,abnormal changes were detected in 13 hips by radiography,85 hips by MRI.The findings of radiography included bone erosions in 13 hips,joint space narrowing in 4 hips,syndesmophytes in 5 hips.MRI revealed bone erosive destruction in 31 hips,joint space narrowing in 4 hips,joint effusion in 80 hips,subchondral bone marrow edema in 32 hips,fat accumulation of bone marrow in 28 hips,enthesitis in 21 hips.Bilateral synovial enhancement was showed in 19 of 24 patients who underwent fat-saturated contrast-enhanced T1-weighted sequence.Of the 58 hip joints in 29 patients who underwent CT examination,not only did CT show all bone erosions detected by radiography and MRI,but CT revealed bone erosive destruction that were not identified by radiography in 10 hips and by MRI in 1 hip as well.Abnormal changes were detected in 10.3％ (6/58)by radiography,27.6％ (16/58) by CT,and 77.6％ (45/58) by MRI.The sensitivity of MRI in the identification of hip involvement is higher than that of radiography and CT ( x2 =53.22 and 29.08,P ＜ 0.05 ).In addition to chronic bone structural changes,MRI depicted acute inflammatory changes which could not be detected by radiography and CT.ConclusionsMRI can detect early acute inflammatory changes of hip joint that can not be showed by radiography and CT.Effusion of joint and synovial enhancement caused by synovitis are the most common MRI findings of the hip in patients with AS.

Objective To compare X-ray,CT,and MRI in detection of abnormal sacroiliac joint changes in patients with early stage of ankylosing spondylitis (AS).Methods Fifty-three patients with clinical suspected early stage of AS underwent X-ray and MRI scan.MR scan sequences for the sacroiliac joints consisted of T1-weighted,T2-weighted,short time inversion recovery (STIR) and three dimensional balance turbo field echo with water selective excitation (3D-BTFE-WATS) in all patients.In 24 of the patients,fat-saturated contrast-enhanced T1-weighted was used.Twenty-five of 53 patients underwent CT scan.The Chi-square test was used to analyse the uniformity of bone erosions detected by X-ray,CT,and MRI.Results Of the 106 sacroiliac joints in 53 patients,16 sacroiliac joints with bone erosions were detected by X-ray and 63 sacroiliac joints by MRI.Of the 50 sacroiliac joints in 25 patients,26 sacroiliac joints with bone erosions were found by CT.With regard to the detection of bone erosions,there was no difference between CT and MRI (x2 =0.16,P ＞0.05 ) and there was significant difference between CT and X-ray or MRI and X-ray ( x2 =14.44 and 17.36,P ＜ 0.05 ).3D-BTFE-WATS was better than other sequences in detection of bone erosions.Acute inflammatory changes were determined by MRI,which included subchondral bone marrow edema in 32 patients,synovitis in 35 patients,fat depositions in 16 patients,enthesitis in 15 patients,capsulitis in 9 patients,and cartilaginous disruption in 31 patients.Conclusions MRI can detect acute inflammatory changes that can not display by X-ray and CT.Compared with radiography and CT,MRI is more useful in detection of abnormal sacroiliac joint changes in patients with early stage of AS.