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 accurately ascertain the whole genome sequencing and the composition of open reading frames (ORFs) of non-replicating Tiantan strain of vaccinia virus (NTV) using next-generation long-read sequencing technology.Methods:NTV, obtained from our laboratory stock, was amplified and purified on chicken embryo fibroblast cells(CEFs), and the full-length genomic nucleic acid of NTV was extracted. The PacBio HiFi sequencing platform was utilized for de novo assembly to obtain the complete genomic sequence of NTV. Using a homology annotation strategy, we identified its ORF composition and compared it with known non-replicating vaccinia virus strains. Results:The total length of NTV′s genome was 171 729 bp, with a GC content of 33%. Its unique inverted terminal repeat (ITR) region comprised hairpin structures, two tandem repeat regions, and three non-repeat regions. NTV contained 166 ORFs, with major differences observed in the ITR and its surrounding regions when compared to MVA-BN and NYVAC. These three strains shared a common set of 138 ORFs. NTV encoded six unique ORFs related to virus evasion of host antiviral response.Conclusions:This study accurately determines the whole genome sequencing and ORFs composition of NTV, and reveals its similarities and differences with other replication-deficient vaccinia virus strains, which pave a way for the development and application of the next generation of monkeypox vaccines and novel viral vectors.

Objective:To construct the selection index system of clinical nursing teachers, and to provide theoretical basis for improving the comprehensive quality of clinical teachers and the comprehensive clinical practice ability of undergraduate nursing students.Methods:Using the methods of literature review, brainstorming and semi-structured interview, the selection index system of clinical nursing teachers was initially constructed. Delphi method was used to conduct two rounds of consultation on 25 experts. SPSS 20.0 was used to analyze the consulting data and calculate the experts' positive coefficient, authority coefficient, degree of concentration of opinions and degree of coordination, and the index contents were modified and improved according to the expert opinions. Finally, the selection index system of clinical nursing teachers was established.Results:Based on the two rounds of expert consultation, the positive coefficient of experts was 96%, the authoritative coefficient of experts was 0.857 and 0.848 respectively, and the coordination coefficient of experts was 0.277~0.442 ( P<0.001). Four first level indexes, 12 second level indexes and 45 third level indexes were determined. Conclusion:The selection index system of clinical nursing teachers is scientific and reliable, which can provide a theoretical basis for the selection of clinical nursing teachers.

Objective:To explore the application effect of TBL (team-based learning) + PAL (peer assisted leaning) + Flipped Class mixed teaching mode in the course of "nursing psychology" for nursing undergraduates.Methods:A total of 146 nursing undergraduates from four classes enrolled in 2018 were subjected to cluster sampling and assigned to classes 1-2 (experimental group, n=73) and classes 3-4 (control group, n=73). The experimental group adopted the TBL + PAL + Flipped Class mixed teaching mode, while the control group adopted the traditional teaching method. After the course, the two groups were evaluated by final exam score, case analysis score, and core competence self-assessed score with a t-test in SPSS 18.0. Results:The final examination score (82.30±7.77) and case analysis score (46.13±2.91) of the experimental group were significantly higher than those in the control group (74.97±7.05 and 40.36±4.25). The experimental group showed significantly higher scores in autonomous learning ability (8.03±0.91), problem analysis ability (7.99±0.99), teamwork ability (7.67±1.09) and critical thinking ability (7.03±1.33) as compared with the control group (6.21±1.17, 5.64±1.28, 5.79±1.27, 5.15±1.16).Conclusion:TBL + PAL + Flipped Class mixed teaching mode integrates the advantages of the three teaching forms, promotes students' understanding and application of knowledge points, improves students' ability of independent learning, teamwork, and problem analysis, strengthens students' ability of transfer and application of knowledge and skills, increases the teaching effect, and expands the teaching method of nursing psychology.

Objective:To explore the relationship between serum cytokine levels and cognitive impairment in patients with bipolar I manic episode.Methods:Forty-four patients with bipolar I manic episode (BDI group) and 42 healthy volunteers (HC group) matched with demographic data were included.Peripheral serum interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-23 (IL-23), and tumor necrosis factor-α (TNF-α) levels were detected by enzyme-linked immunosorbent assay (ELISA). The repeatable battery for the assessment of neuropsychological status (RSPM) was used to evaluate the cognitive function of the two groups.Young manic rating scale (YMRS) was used to evaluate the clinical manic symptoms of patients.Hypothesis testing and correlation analysis were processed by SPSS 22.0.Results:(1) The expression levels of serum cytokines IL-6, IL-10, IL-23 and TNF-α in BDI group ((38.872±7.803), (33.259±7.260), 42.350(33.600, 55.390), (108.309±19.398)) were significantly different with those in HC group ((24.664±6.083), (29.257±5.208), 17.360(12.870, 30.690), (68.674±13.610)), and the differences were statistically significant (( t=9.387, t=2.947, Z=-5.477, t=10.921, all P<0.01)). (2) In the RBANS cognitive test, the visual span, attention, delayed memory and total scale scores of the BP group ((92.909±16.126). (83.091±8.529), (80.636±9.592), (416.318±33.438)) were significantly different with those of the HC group ((82.905±10.958), (92.381±14.850), (93.714±7.613), (436.905±37.228), t=3.378, t=-3.538, t=-6.982, t=-2.700, all P<0.05). (3)Correlation analysis showed that in the BDI group, the course of disease was positively correlated with IL-6 and IL-23( r=0.509, r=0.298, P<0.05), the visual breadth was positively correlated with IL-10 and TNF-α ( r=0.426, r=0.647, P<0.05), language was negatively correlated with IL-23 level ( r=-0.372, P<0.05), attention was significantly negatively correlated with IL-6, IL-10, and TNF-α ( r=-0.315, r=-0.318, r=-0.498, all P<0.05), delayed memory was positively correlated with IL-10 and TNF-α ( r=-0.360, r=-0.621, P<0.05). No significant correlation was found between YRMS score, immediate memory score and cytokines ( P>0.05). Conclusion:Patients with bipolar I disorder manic have changes in serum levels of cytokines and cognitive dysfunction. The course of disease and cognitive function are related with serum cytokine level.

Objective:To investigate the distribution characteristics of bacteria in urine of patients with ureteral stent crusting.Methods:Thirty-five patients who underwent ureteral stent placement at the Shandong Provincial Third Hospital, Shandong University Qilu Hospital, Jinan Central Hospital, and Jinan Jigang Hospital were selected from October, 2018 to March, 2019(the clinical study registration number is ChiCTR1800020025). The inclusion criteria were patients who had the stent intubated for 4 weeks after ureteroscopic lithotripsy, aged between 18 and 65 years. Exclusion criteria were patients with positive urine bacterial culture, severe gross hematuria, recent oral antibiotics, and patients with significant residual stones. This clinical study uses a cross-sectional study method, and those patients were divided into crusting group (n=23) and non-crusting group (n=12) according to the presence or absence of stent crusting. On the day of extubation, urine of the patients was collected for bacterial 16s DNA detection. The distribution characteristics of bacteria in urine of the two groups were analyzed using UPARSE, UCHIME and RDP calssifier. The total number of bacteria species, bacterial abundance and bacterial species with large-scale abundance in urine of the two groups were determined. The quantity of bacteria species and bacterial abundance in the urine between the two groups were compared, and the bacterial species with large-scale abundance in urine of the patients with stent crusting were identified.Results:There were no significant differences in general information such as age, body mass index, gender, affected side, type of stent tube, and stone composition between the two groups. Using 16s DNA sequencing to detect the bacteria in the urine of the two groups revealed that the number of bacterial species with abundance >1% was 11, and the number of bacterial species with abundance >0.01% was 74 in the crusting group. In the non-crusting group, the number of bacterial species with abundance >1% and >0.01% was 7 and 11, respectively. Compared with the non-crusting group, the number of bacterial species with abundance >1% in the crusting group was significantly larger ( t=5.12, P=0.000). In the crusting group, bacterial species with the top three abundance were g_Lactobacillus (23.1%), g_Bacteroides (18.8%) and g_norank_Bacteroides (17.1%). In the non-crusting group, bacterial species with the top three abundance were g_Escherichia-Shigella (32.2%), g_Enterococcus (24.9%) and g_Pseudomonas (18.2%). The three bacteria with the greatest difference between the two groups were g_ Lactobacillus ( P=0.010), g_Bacteroides ( P=0.004) and g_norank_Bacteroides ( P=0.004), respectively. Conclusion:The species and quantity of bacteria in the urine of patients with stent crusting are both significantly larger than those of patients without stent crusting. Bacteroides with larger-scale abundance in the urine of patients with stent crusting may promote the deposition of crystals on the stent wall through its structure, function and urease positive characteristics.

Objective To study the application value of laparoscopic curettage in the standardized training for residents.Methods In this study,we selected residents of the Wuhan First Hospital as the research subjects.Thirty of the subjects from the 2015 grade were the control group and another 29 from the 2016 grade were the experimental group.Both groups had three classes,including one theory class,and two practice classes.After the theoretical class,the experimental group practiced laparoscopic curettage,while the control group practiced curettage.After practice,the experimental group filled out the questionnaire on teaching quality,and both groups participated in the theory test.Results Laparoscopic curettage can significantly improve students' ability to learn and understand curettage,so that most students can adapt to curettage,eliminate the panic from uterine perforation and be more sensitive to the uterus textures,and satisfactory teaching results were achieved.The average score of the practice test for the experimental group (9.150 ± 2.461) was statistically higher than that for the control group (7.053 ± 1.347).The average score of the theory test (7.581 ± 1.632) for the experimental group was not statistically different from that for the control group (6.983 ± 1.726).The average scores of the two tests for the experimental group (9.037 ± 1.951) and the control group (6.891 ± 2.140) were statistically different.Conclusions Laparoscopic curettage can significantly improve the ability to learn,understand and feel curettage for residents who are under standardized training,and it has great application value in the three basic operation trainings.

Objective To evaluate the value of 3T magnetic resonance imaging (MRI) in the preoperative T staging of potentially resectable esophageal cancer(EC), compared with endoscopic ultrasonography (EUS). Methods Patients with resectable EC pathologically confirmed by biopsy from March 2015 to September 2016 were prospectively enrolled. All patients underwent MRI (including T2-TSE-BLADE,DWI and radial-VIBE)and EUS one week after the biopsy,and MRI were performed prior to EUS, both MRI and EUS were acquired within one week before surgery. Two readers with more than 5 years experiences in the MRI diagnosis evaluated the MR image quality using a 5-point score independently. T staging was assigned on MRI and EUS by the two MRI readers using double-blind method and one endoscopist in accordance with the 7th edition of AJCC TNM Classification for EC, and any disagreement between two MRI readers was resolved by consensus with discussion to the third senior MRI doctor. The inter-observer agreement between two MRI readers were calculated using Kappa test for image quality scores and T staging results. Considering postoperative pathological T staging results as the gold standard, the performances of MRI and EUS were evaluated based on the accuracy rate and analyzed by χ2 test. Results A total of 70 patients were enrolled in the study, the good image quality cases (≥ 3 scores) were 66 in reader 1 and 68 in reader 2. The inter-observer agreement of the image quality scores by two readers was excellent (Kappa=0.824, P<0.05). The pathological results revealed 16 cases of T1 stage, 18 cases of T2 stage, 30 cases of T3 stage, and 6 cases of T4a stage. The inter-observer agreement of the preoperative T staging of EC by two readers was excellent (Kappa=0.809, P<0.05). The accuracy rates of MRI and EUS for preoperative T staging of EC were 92.9% (65/70) and 67.1% (47/70), respectively, and the difference in accuracy rates of two techniques was statistically significant (χ2=14.5, P<0.05). Conclusions The accuracy rate of MRI for preoperative T staging of EC is significantly higher than that of EUS. MRI can be used as a noninvasive method for preoperative T staging of EC.

Objective To investigate the metabolite changes in systemic lupus erythematosus (SLE) patients with and without neuropsychiatric symptoms using magnetic resonance spectroscopy (MRS) and explore the associations between image findings and clinical variables. Methods Twenty-two SLE patients with neuropsychiatric symptoms (NPSLE), twenty-one SLE patients without neuropsychiatric symptoms (non-NPSLE) and twenty healthy controls (HCs) underwent routine MRI scan and multivoxel magnetic reson-ance spectroscopy (MVS). The absolute metabolite concentrations were measured bilaterally in the posterior cingulate gyrus (PCG), dorsal thalamus (DT), lentiform nucleus (LN) and posterior paratrigonal white matter (PWM) using LCModel and SAGE software. The relationships between metabolite con-centrations and cognitive function scores were analyzed by Spearman rank correlation. Single-factor Chi-square analysis and t-test were used for analysis. Results ① Compared to control subjects, NPSLE patients had significantly lower N-acetylaspartate (NAA) values in bilateral PCG and DT, with the mean differences of -1.504 [95% confidence interval ( CI) (-2.335, -0.672), P=0.001], -1.460 [95%CI (-2.349, -0.570), P=0.002], -1.259 [95%CI (-1.894, -0.625), P=0.000] and -1.022[95%CI (-1.688, -0.356), P=0.003] for RPCG, LPCG, RDT and LDT, respectively. The concentration of total creatinine were observed to decline in RPCG and RDT, with the mean differences of-1.094 [95%CI (-1.845, -0.342), P=0.003], -0.955 [95%CI (-1.630, -0.280), P=0.006], -1.259 [95%CI (-1.894,-0.625), P=0.006] respectively. Glutamine and glutamate-values decreased significantly in RDT [mean difference=-2.586, 95%CI (-4.139, -1.033), P=0.002]. ② Compared to non-NPSLE patients, NPSLE patients had a lower NAA level in LPCG [mean difference=-1.256, 95%CI (-2.146, -0.367), P=0.006]. Positive correlations between mini-mental state examination scores [RPCG: rs=0.312, P<0.05; LPCG: rs=0.355, P<0.01], Montreal cognitive assessment scores (RPCG: rs=0.362, P<0.01; LPCG: rs=0.285, P<0.05) and NAA values in bilateral PCG were detected. Conclusion Both NPSLE and non-NPSLE patients may have metabolite dysfun-ctions in different brain regions. The cognitive disorder in SLE patients may be interpreted by neuronic damage of PCG.

Most academic information appears in the database and academic websites;in rencent years the blog and podcast also transmit academic information.Medical graduates need to check new information regularly after busy routine work,but how to effectively collect and manage academic information is a problem.This paper describes the new strategies and methods for them to use.