Abstract:Objective To investigate fungal distribution and drug resistance of fungi isolated from elderly invasive pulmonary fungal infection(IPFI)patients'bronchoalveolar lavage fluid,thereby providing a guide for clinical management and infection prevention.Methods Retrospective analysis of fungal culture and drug susceptibility data from bronchoalveo-lar lavage fluid samples(from January 2022 to December 2024)was performed.Results There were 155 fungal isolates i-dentified.C.albicans was predominated(47.7%),followed by C.tropicalis(17.4%),Aspergillus spp.(11.0%)and C.glabrata(10.3%).Multidrug-resistantC.auris accounted for 5.8%.Non-auris Candida showed>95.9%suscepti-bility to(AMB)and 5-fluorocytosine.Conclusion C.albicans remains primary pathogen.Susceptibility testing-guided therapy and strengthened infection control are crucial for elderly IPFI patients.

Abstract:A case of HIV-positive Talaromycosis marneffei infection with hemophagocytic syndrome is reported.The patient was a 41-year-old female who was admitted to the hospital due to recurrent fever lasting for 10 days.Through comprehensive macro-genetic testing,bone marrow cytology,and biopsy,she was diagnosed with AIDS,Talaromyces marneffei infection,and secondary hemophagocytic syndrome.Following treatment with amphotericin B combined with itraconazole and dexamethasone,the patient's fever was significantly subsided.At the half-year follow-up,her CD4+T-cell count was 131 cells/μL and bone marrow cytology findings were normal.

Abstract:To report a case of fungal colitis discovered and confirmed through colonoscopy examination,aiming to enhance clinicians'understanding of this disease.The patient,a 61-year-old male,presented to our outpatient department with a 7-week history of diarrhea.Electronic colonoscopy revealed congested and edematous mucosa in the colon and rec-tum with adherent white turbid secretions.Fecal culture revealed significant growth of Candida albicans,with a few num-ber of colonies(++).A diagnosis of fungal colitis was made.The patient was treated with nystatin tablets(500,000 u-nits three times daily)for one month,his symptoms resolved.Follow-up stool examinations showed no fungal elements,and no recurrence was observed.

Abstract:Objective To establish a liquid chromatography-mass spectrometry(LC-MS/MS)method for the deter-mination of the concentration of the antifungal drug amphotericin B(AmB)in mouse plasma and tissues.Methods Using liver as representative tissue sample,the protein precipitation method was used for sample pretreatment of mouse plasma and liver.Chromatographic separation was performed using a shim-pack GIST-HP C18 AQ(2.10 mm×50.00 mm,3.00 μm)chromatographic column.Gradient elution was performed using water containing 2.00 mmol/L ammonium acetate and 0.10%formic acid as mobile phase A,and acetonitrile containing 0.10%formic acid as mobile phase B(sample vol-ume was 5.00 μL,mobile phase flow rate was 0.45 mL/min,column temperature was 40℃).The electrospray ion source was set up detection conducted in positive ion mode and multiple reaction monitoring mode.The quantitative ion pairs of AmB and the internal standard natamycin were m/z 924.50→906.50 and m/z 666.50→503.40,respectively.Re-sults The response of this LC-MS/MS method to interfering components was less than 10.00%of the response at the lower limit of quantification of the analyte,demonstrating good specificity.The lower limit of quantification for AmB and the internal standard detection in both plasma and tissue was 0.1 μg/mL,with good linearity in the range of 0.10 μg/mL-100.00 μg/mL,accuracies(recoveries)of intra-day and inter-day were all more than 95.00%,and the relative standard deviations(RSD)of precision,matrix effect,and dilution effect were all less than 10.00%.AmB could be stored stably under avoid light and low-temperature conditions.Conclusions The LC-MS/MS method for determining AmB concentra-tion in mouse plasma and tissues was successfully established,and all investigation results meet the methodological re-quirements.

Abstract:Objective To look into the prevalence and risk factors for pulmonary fungal infections in patients who have had open chest surgery for esophageal cancer.Methods Fifty-one patients with pulmonary fungal infections following esophageal cancer thoracotomy in our hospital between May 2021 and November 2024 were chosen as the infection group in a retrospective study,while 153 patients who did not have an infection following esophageal cancer thoracotomy during the same time period were chosen as the non-infection group.Gather clinical information from two patient groups,use a multi-ple logistic regression model to assess the risk factors for pulmonary fungal infection in patients with esophageal cancer fol-lowing open chest surgery,assess the predictive value using receiver operating characteristic(ROC)curves,and build a decision tree model based on risk factors.Results A total of 65 fungal strains were found in 53 esophageal cancer patients who had open chest surgery and pulmonary fungal infections,with Candida albicans making up the largest percentage(39.68%);Age(≥60 years old)was one of the multivariate results.[OR=3.307(95%CI 1.281～8.536)],compli-cated with diabetes[OR=4.975(95%CI 1.730～14.308)],tumor site(upper/middle esophageal segment)[OR=4.480(95%CI 1.596～12.575)],duration of antibiotic treatment(≥14 days)[OR=3.898(95%CI 1.424～10.674)],Operation time(≥240 min)[OR=2.656(95%CI 1.034～6.826)],Duration of postoperative catheteriza-tion(≥7 days)[OR=5.194(95%CI 1.760～15.331)],postoperative WBC(<4.0×109/L)[OR=2.815(95%CI 1.105～7.172)]and postoperative IL-8[OR=1.215(95%CI 1.135～1.330)]were independent risk factors for pulmo-nary fungal infection following esophageal cancer thoracotomy(P<0.05).Following esophageal cancer thoracotomy surgery,ROC analysis revealed that the aforementioned indicators and combined prediction had statistical significance(P<0.05)for the occurrence of pulmonary fungal infection.AUC=0.916,95%CI(0.871～0.960)The combined detec-tion diagnostic efficacy analysis shows a sensitivity of 78.4%and a specificity of 92.8%.With a classification accuracy of 85.3%,the decision tree model demonstrates that the IL-8 level in the first layer is the most significant predictor.Con-clusion Independent risk factors for pulmonary fungal infection following thoracotomy for esophageal cancer include age(≥60 years),combined diabetes,tumor site(upper/middle esophagus),antibiotic treatment duration(≥14 days),oper-ation duration(≥240 min),postoperative catheterization duration(≥7 days),postoperative WBC(<4.0×109/L),and postoperative IL-8.Following thoracotomy for esophageal cancer,the prediction model based on the aforementioned fac-tors plays a guiding role in pulmonary fungal infection.

Abstract:The patient,82-year-old male,was hospitalized with repeated cough,poor appetite,fatigue and emer-gency"respiratory failure".After admission,whole blood culture result shows fungal growth.The patient was identified as Cryptococcus humicola infection by the VITEK MS of automatic microbial monitoring system.The patient received anti-fungal treatment such as fluconazole 200 mg/d for two weeks but ultimately died.Combined with this case,the stream in-fection cases caused by Cryptococcus humicola at home and abroad were summarized and analyzed,so as to improve the judgment ability of clinical medical workers to rare fungal diseases and pay attention to them.

Abstract:A 21-day-old female newborn,presented with'scalp erythema,scab,hair loss for 1 week'.Fungal mi-croscopic examination revealed mycelium positive.Fungal culture and identification confirmed the pathogen was Candida albicans.Diagnosis was scalp candidiasis.Treatment as followed,wet compress of compound Phellodendri,once daily;miconazole nitrate cream,external use,twice daily.After a week,the lesions increased and the extent of the lesions in-creased,so terbinafine gel,external use,twice daily.After 5 weeks,the skin lesions disappeared.

Abstract:Objective To analyze the etiological distribution and prognostic analysis of patients with fungal blood-stream infections in Guangzhou Red Cross Hospital,with the aim of providing relevant etiological basis and preventive and therapeutic measures for clinical practice.Methods A retrospective analysis was conducted on a total of 68 cases of pa-tients diagnosed with invasive fungal bloodstream infections in Guangzhou Red Cross Hospital from January 2020 to March 2024.The patients were divided into the survival group(42 cases)and the death group(26 cases)based on the prognosis,and a comparative analysis of related risk factors for death between the two groups was performed.Results The depart-mental distribution of the 68 patients was mainly in the Intensive Care Unit(35.3%)and the Burn and Plastic Surgery De-partment(13.2%);The top four fungi isolated were Candida albicans(29 strains,42.65%),Candida glabrata(14 strains,20.59%),Candida parapsilosis(7 strains,10.29%),Candida tropicalis(7 strains,10.29%);among them,male patients outnumbered female patients,but there was no significant difference;the vast majority of patients were in the age range of 61-90 years old(79.4%);the in vitro drug susceptibility of Candida was as follows:the sensitivity rate of amphotericin B was 92.3%,that of 5-fluorocytosine was 98%,that of itraconazole was 93.8%,that of voriconazole was 95.8%,and that of fluconazole was 91.8%.Univariate analysis indicated that age,mechanical ventilation,admission to the Intensive Care Unit,malignant tumors,and initial(1,3)-β-D-glucan>100 ng/L,Initiate antifungal therapy,were associated with mortality(P<0.05).Multivariate Logistic regression analysis revealed that initial(1,3)-β-D-glucan>100 ng/L,having malignant tumors,mechanical ventilation,and admission to the ICU were independent risk factors associated with the mortality of patients with fungal bloodstream infections.Conclusion Patients with invasive fungal bloodstream infections are mainly aged 60-90 years old,and the pathogenic species are mainly Candida.Initial(1,3)-β-D-glucan>100 ng/L,malignant tumors,and mechanical ventilation are independent risk factors associated with the mortality of patients with fungal bloodstream infections.

Abstract:Objective To analyze the distribution of pathogenic fungi and related risk factors of pulmonary fungal in-fection after heart valve replacement(HVR),establish a prediction model and verify its predictive efficacy.Methods A total of 23 patients with valvular heart disease who had secondary pulmonary fungal infection after HVR surgery in our hospital from January 2020 to January 2024 were retrospectively included in the infected group(n=23).In addition,pa-tients with valvular heart disease who had no complications after HVR surgery during the same period were included as the non-infected group(n=41).The clinical data of the two groups were collected,and the distribution of pathogenic fungi was analyzed.The logistic regression model was used to analyze the influencing factors of pulmonary fungal infection after HVR surgery,and a prediction model was constructed.Results A total of 32 strains of fungi were detected in 23 patients with postoperative pulmonary fungal infection,and Candida albicans was the most common,accounting for as high as 37.50%.Multivariate logistic regression showed that hypoalbuminemia,arteriovenous intubation,reintubation,duration of antibacterial drug use,length of hospital stay,and level of tumor necrosis factor(TNF-α)were important influencing factors for pulmonary fungal infection after HVR surgery(P<0.05);lymphocyte count(LYM)was a protective factor(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that there were significant differences in the evaluation of pulmonary fungal infection after HVR surgery by the above factors and combined prediction(P<0.05);a-mong them,the area under the curve(AUC)of the combined prediction for evaluating fungal infection after HVR surgery was 0.967,with a 95%confidence interval of 0.907-1.000,a sensitivity of 0.957,and a specificity of 0.976.The decision tree model showed that the duration of antibacterial drug use at the first layer was the most important predictor,and the classification accuracy of the model was 96.40%.The Pearson correlation coefficient showed that pulmonary fungal infec-tion after HVR surgery was significantly positively correlated with hypoalbuminemia,arteriovenous intubation,reintuba-tion,duration of antibacterial drug use,length of hospital stay and level of TNF-α(P<0.05),and significantly negatively correlated with LYM(P<0.05).Conclusion The risk factors for pulmonary fungal infection after HVR surgery include hypoalbuminemia,arteriovenous intubation,reintubation,duration of antibacterial drug use,length of hospital stay,and level of TNF-α;the protective factor is LYM.Therefore,during the perioperative period,close attention should be paid to patients with the above risk factors to prevent postoperative pulmonary fungal infection.

Abstract:Objective To investigate the use of serum cryptococcal antigen(CrAg)titer testing in diagnosing and treating non-HIV-associated Cryptococcus neoformans meningitis patients.Methods A retrospective analysis was per-formed on the clinical data of 76 non-duplicate patients with C.neoformans meningitis admitted to the Third Affiliated Hospital of Sun Yat-sen University between July 2021 and December 2022.The study aimed to investigate the relationship between the serum cryptococcal antigen(CrAg)titer of the patients and their other clinical characteristics.Results Serum CrAg titers in patients with C.neoformans meningitis patients were significantly correlated with cerebrospinal fluid CrAg titers(P<0.001).In the high titer group of serum CrAg,procalcitonin levels,cerebrospinal fluid white blood cell counts,and cerebrospinal fluid protein levels were significantly higher than those in the low titer group(P=0.001,P=0.003,P=0.015).The number of patients with increased neutrophil values in the high titer group and the number of pa-tients with decreased cerebrospinal fluid glucose levels were also significantly higher than those in the low titer group(P=0.005,P=0.049).The presence of headache as a symptom also differed significantly among different serum CrAg titer groups(P=0.019).The positive rates of India ink staining and meningeal irritation signs were significantly higher in the high titer group of serum CrAg than in the low titer group.Conclusion Serum CrAg titers exhibited a strong association with various clinical characteristics in patients with C.neoformans meningitis.Therefore,it can serve as a valuable tool for diagnosing,treating,and monitoring the prognosis of these patients,particularly those with lumbar puncture contrain-dications.

Abstract:A 32-year-old male patient with Philadelphia chromosome positive acute lymphoblastic leukemia was re-ported.After complete remission of chemotherapy,related haploidentical hematopoietic stem cell transplantation was per-formed.67 days after transplantation,a large number of black dry scabs were found in the nasal cavity,and the secretion and black scab culture results were Fusarium solani.He was diagnosed as a rare nasal Fusarium infection in combination with clinical diagnosis.By summarizing the literatures,the only 6 cases in China were analyzed.Nasal infection was con-trolled after local natamycin application combined with systemic voriconazole treatment.No invasive infection in other parts and disseminated infection in the whole body occurred.

Abstract:Objective To explore the clinical characteristics and independent risk factors of extended-spectrum β-lac-tamase(ESBLs)infection in patients with type 2 diabetes mellitus(T2DM)complicated by Candida urinary tract infec-tion,so as to provide a basis for accurate clinical prevention and treatment.Methods A retrospective analysis was per-formed on the clinical data of 119 T2DM patients with urinary tract infection admitted to Fuyang Hospital Affiliated to An-hui Medical University from January 2020 to March 2024.According to the infection type,patients were divided into ES-BLs+Candida infection group(study group,n=60)and Candida alone infection group(control group,n=59).The clinical characteristics,pathogen distribution and drug sensitivity results were compared between the two groups.Univari-ate analysis and multivariate logistic regression were used to screen independent risk factors for combined infection,and a risk prediction model was constructed.Results The comparison of baseline data between the study group and the control group showed that there were no statistically significant differences in age[study group:(64.1±7.9)years old,control group:(63.5±8.2)years old],gender ratio,diabetes duration[study group:(11.6±4.2)years,control group:(10.7±3.9)years],and body mass index[study group:(24.7±2.1)kg/m2,control group:(24.5±2.3)kg/m2](P values were 0.681,0.850,0.307,0.598,respectively).Among 119 patients,Candida albicans was the main pathogen(68.1%),and ESBL-producing strains in the study group were mainly Escherichia coli(86.7%).Fasting blood glucose[(10.7±2.3)mmol/L vs.(8.5±1.9)mmol/L]and systolic blood pressure[(136.8±10.5)mmHg vs.(128.3±9.7)mmHg]in the study group were significantly higher than those in the control group(P<0.05),while 25-hydroxyvitamin D[(31.8±6.5)nmol/L vs.(42.3±7.1)nmol/L]was significantly lower(P<0.05).The proportions of diabetic peripheral neu-ropathy(85.0%vs.64.4%),neurogenic bladder(30.0%vs.10.2%)and broad-spectrum antibiotic use≥14 days(70.0%vs.42.4%)in the study group were significantly higher than those in the control group(P<0.05).The study group showed significantly higher values than the control group in the following parameters:white blood cell count[(11.2±3.5)×109/L vs(7.8±2.1)×109/L],neutrophil percentage(76.5%vs.62.3%)and 76.5%,hematogenous infec-tion rate(20.0%vs.5.1%),pyelonephritis incidence(41.7%vs.16.9%),urinary tract stone occurrence(25.0%vs.8.5%),and prior history of urological malignancy(13.3%vs.3.4%)(P<0.05).The resistance rate of Candida to flu-conazole was 15.1%,with no significant difference between the two groups(P>0.05).Multivariate logistic regression showed that elevated fasting blood glucose(OR=1.382,95%CI=1.126-1.695),combined neurogenic bladder(OR=16.735,95%CI=5.218-53.642),25-hydroxyvitamin D reduction(OR=1.258,95%CI=0.915-0.980)and urinary stones(OR=3.215,95%CI=1.236-8.367)were independent risk factors for combined infection.The area under the ROC curve of the risk prediction model based on the above factors was 0.792(95%CI=0.615-0.869),with a sensitivity of 85.0%and specificity of 83.1%.Conclusion In T2DM patients with urinary tract infection,ESBL-producing strains combined with Candida infection are closely related to poor blood glucose control,neurogenic bladder and vitamin D defi-ciency.Clinical targeted intervention should be taken to reduce the infection risk.

Abstract:Objective To investigate the predisposing factors for fungal infections in patients with liver cirrhosis and esophagogastric variceal bleeding(EGVB)after endoscopic treatment.Methods Fifteen patients with cirrhosis who devel-oped fungal infections after endoscopic treatment for esophagogastric variceal bleeding(EGVB)were retrospectively select-ed from the First Affiliated Hospital of Air Force Medical University(January 2019 to September 2024)as the infection group,and 65 patients with cirrhosis who underwent EGVB endoscopic treatment without infections during the same peri-od were randomly selected as the non-infection group.Clinical data from both groups were collected,and multivariate lo-gistic regression analysis was used to identify predisposing factors.The predictive value was assessed using receiver operat-ing characteristic(ROC)curves,and a decision tree model was constructed.Results Among the 15 patients with fungal infections after endoscopic treatment,16 fungal strains were detected,with Candida albicans being the most prevalent(7 strains,43.75%).Additionally,13 strains(81.25%)were isolated from sputum/bronchoalveolar lavage fluid.Logistic regression analysis revealed that age,hospitalization duration,Child-Pugh classification of liver function,hepatic encepha-lopathy,and long-term use of broad-spectrum antibiotics were predisposing factors for fungal infections after endoscopic treatment in EGVB patients(P<0.05),while albumin and serum 25-hydroxyvitamin D3[25-(OH)D3]were protective factors(P<0.05).ROC curve analysis showed that the above indicators and their combined prediction were statistically significant for predicting fungal infections after endoscopic treatment(P<0.05).The combined prediction had an area un-der the curve(AUC)of 0.999(95%CI:0.996～1.000),with a sensitivity of 1.000 and specificity of 0.985,indicating higher predictive value.The decision tree model identified age as the most significant predictor,with a classification accura-cy of 100%.Conclusion Age,hospitalization duration,Child-Pugh classification of liver function,hepatic encephalopathy,and long-term use of broad-spectrum antibiotics are predisposing factors for fungal infections after endoscopic treatment in EGVB patients,while albumin and 25-(OH)D3 are protective factors.Clinicians should assess these related factors and im-plement targeted preventive measures.

Abstract:Objective To investigate the therapeutic effect and safety of joint of CO2 dot matrix laser and itracon-azole capsule in treating onychomycosis.Methods From March 2022 to February 2024,102 patients with onychomycosis accepted by Hebei PetroChina Central hospital were grouped into a treatment group and a Western medicine group ran-domly.The treatment group was treated with joint of CO2 dot matrix laser and itraconazole capsule,while the Western medicine group was treated with itraconazole capsule.The two groups were compared in terms of therapeutic effect,fungal clearance rate,fungal negative conversion rate,Scoring Clinical Index for Onychomycosis(SCIO),Onychomycosis Severi-ty Index(onychomycosis severity index,OSI)scores,interleukin-12(IL-12),interferon-γ(IFN-γ),and incidence of ad-verse reactions during treatment.Results The treatment group had a better therapeutic effect than Western medicine group(P<0.05).Three months after treatment and three months after the end of treatment,the fungal clearance rate in the treatment group was higher than that in the Western medicine group.Three months after the end of treatment,the IFN-γ levels of patients in both groups increased,while the SCIO,OSI scores and IL-12 levels decreased.The treatment group performed better than the Western medicine group(P<0.05).The adverse reactions were not greatly different be-tween the two groups(P>0.05).Conclusion The joint of CO2 dot matrix laser and itraconazole capsules in treating ony-chomycosis can improve therapeutic effect,ameliorate the clinical symptoms and condition of patients,reduce the inflam-matory response,and is safe.

Abstract:Objective To explore the preventive effect of bundled management mode on fungal urinary tract infec-tions in ICU patients with indwelling catheterization.Method A total of 162 patients admitted to the ICU of Dazhou Inte-grated Traditional Chinese and Western Medicine Hospital in Sichuan Province with indwelling catheterization from January 2024 to November 2024 were randomly divided into a control group and an experimental group,with 81 patients in each group.The control group received routine nursing management,while the experimental group implemented a bundled management model.The incidence of fungal urinary tract infections,duration of catheterization,ICU stay,site of infec-tion,distribution of fungal species,serum inflammatory factor levels,bed unit microbial contamination,and use of antibi-otics between two groups of patients were compared.Result The incidence of fungal urinary tract infection in the experi-mental group was lower than that in the control group,and the difference was statistically significant(P<0.05).The in-fection sites in two groups were bladder mostly.The incidence of fungal urinary tract infections in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).In the control group,there were 5 cases of Candida albicans infection(62.5%),2 cases of C.tropical infection(25%),and 1 case of C.gla-brata infection(12.5%);There was one case each(33.3%)of C.albicans infection,C.tropicalis infection and C.gla-brata infection in the experimental group.Due to the small number of cases,the difference was not statistically significant.After 7 days of intervention,the serum levels of IL-6 and PCT in the experimental group were lower than those in the con-trol group,and the difference was statistically significant(P<0.05).The fungal infection rate of the experimental group's bed unit and the homologous fungal rate with urine culture were lower than those of the control group,and the difference was statistically significant(P<0.05).Conclusion The bundled management model has shown significant effectiveness in preventing fungal urinary tract infections in ICU patients with indwelling catheters.

Abstract:Objective To investigate thefungicidal activity and mechanism of Sophoraalopecuroides alkaloids(including al-operine,matrine,sophoridine,andsophocarpine)against Candida albicans in vitro.Methods The sensitivity of C.albicans to S.alopecuroides alkaloids was determined using the agar diffusion assay.The combined drug sensitivity effects were eval-uated through the checkerboard microdilution method,and the time-kill curves were constructed.Fungal metabolic activity was measured by XTT assay,while biofilm biomass was quantified via crystal violet staining.The content of extracellular secreted proteins was determined using the Bradford method.Apoptosis rates were analyzed by flow cytometry using annexin V-FITC/PI double staining.Mitochondrial membrane potential was monitored using JC-1 staining,while reactive oxygen species(ROS)levels were tracked with DCFH-DA,both via fluorescence-based detection.Results The minimum fungicidal concentrations(MFCs)were 7.50 mg/mL(aloperine),8.00 mg/mL(matrine),12.50 mg/mL(sophoridine),and 4.25 mg/mL(sophocarpine).Compared with the blank control,treatment with S.alopecuroidesalkaloids significantly reduced fungal viability and biofilm formation,remarkably increased the extracellular protein secretion content and apoptosis rate of C.albicans,and had no statistically significant effect on the decrease of mitochondrial membrane potential and accumulation of reactive oxygen species except for the optimal combination F(matrine 1 mg/mL+sophoridine 0.78 mg/mL+aloperine 3.75 mg/mL)of the three S.alopecuroidesalkaloids showed a trend of action.Conclusion S.alopecuroides alkaloids inhibit C.albicans through a dual mechanism:direct fungicidal activity and induction of apoptosis.The mechanism likely involves ROS burst and mitochondrial dysfunction.

Abstract:Objective Design of a dual-purpose dry-wet toe separator for patients with intertriginous tinea pedis and evalua-tion of its clinical efficacy.Methods Sixty patients with intertriginous tinea pedis in the dermatology department of the First Affiliated Hospital of Naval Military Medical University from January 2022 to March 2024 were selected as study subjects.The patients were divided into a control group and an experimental group(30 cases each)using a random number table meth-od.The experimental group used a dual-purpose dry-wet toe separator,while the control group used dry gauze for toe divi-sion.The differences in patient comfort,pain scores,and itching scores before and after intervention were compared;the de-gree of symptom improvement,patient and nurse satisfaction,and the total number of dressing changes after intervention were also compared between the two groups.Results The treatment before and after intervention showed better comfort,pain scores,itching scores,skin symptom improvement,patient satisfaction,and nurse usage satisfaction in the experimen-tal group compared to the control group,with statistically significant differences(P<0.05).Additionally,the total number of dressing changes was less in the experimental group than in the control group,with a statistically significant difference(P<0.05).Conclusion The design of the dual-purpose dry-wet toe separator for patients with intertriginous tinea pedis is sci-entifically designed,easy to operate,improves patient comfort,improves skin symptoms,reduces pain and itching,and in-creases patient and nurse satisfaction,making it worthy of clinical promotion and application.

Abstract:Objective To investigate the clinical characteristics and risk factors of secondary fungal osteomyelitis in patients with traumatic fractures,aiming to provide evidence for early clinical prediction.Methods A retrospective analysis was con-ducted on the clinical data of 342 patients with traumatic fractures treated in the Department of Orthopedics,Wuhan Central Hospital of China Construction Third Engineering Bureau,from December 2021 to December 2024.The enrolled patients were divided into a secondary fungal osteomyelitis group and a non-secondary fungal osteomyelitis group according to whether they developed fungal osteomyelitis postoperatively.Differences in baseline characteristics,clinical features,fracture-related factors,surgery-related factors,and routine laboratory indicators were compared between the two groups.Multivariate lo-gistic regression analysis was used to screen independent influencing factors associated with the risk of secondary fungal oste-omyelitis in patients with traumatic fractures,and receiver operating characteristic(ROC)curve was plotted to analyze the value of combined prediction of secondary fungal osteomyelitis by each influencing factor.Results Among the 342 enrolled patients with traumatic fractures,there were 223 males and 119 females,aged 35-69 years,with a median age of 51(47,56)years.Postoperative secondary fungal osteomyelitis occurred in 28 patients,with an incidence of 8.2%.Candida albi-cans was the most prevalent pathogen in secondary fungal osteomyelitis(46.9%).Patients in the secondary fungal osteomy-elitis group had significantly higher values in the following parameters compared to the non-secondary fungal osteomyelitis group(all P<0.05):age,proportion of diabetes mellitus comorbidity,history of corticosteroid use,proportion of Mini-Nu-tritional Assessment score<24,proportion of open fractures,proportion of complete fractures,proportion of unstable frac-tures,proportion of Type C fractures,proportion of severe soft tissue injuries,proportion of wound size>5 cm2,propor-tion of severe wound contamination,surgical timing,proportion of open reduction and internal fixation(ORIF),proportion of plate/screw usage,types and duration of antimicrobial use,white blood cell count on postoperative day 2,and C-reactive protein(P<0.05).Conversely,the secondary fungal osteomyelitis group showed significantly lower values in CD4+T-cell ratio,CD4+T/CD8+T ratio,and natural killer(NK)cell count(P<0.05).Multivariate logistic regression analysis identi-fied the following independent risk factors for secondary fungal osteomyelitis in traumatic fracture patients(P<0.05):dia-betes mellitus[OR(95%CI)=5.21(1.219-22.255)],unstable fractures[OR=5.784(1.336-25.045)],severe soft tissue injuries[OR=3.545(1.390-9.045)],severe wound contamination[OR=5.819(1.190-28.456)],delayed surgical timing[OR=2.774(1.366-5.632)],ORIF[OR=6.631(1.373-32.015)],and C-reactive protein[OR=1.024(1.000-1.048)].ROC curve analysis showed that the area under the curve(AUC)values for independent and combined prediction of seconda-ry fungal osteomyelitis risk by the above risk factors were 0.585,0.597,0.632,0.614,0.625,0.611,0.573,and 0.893,respectively.The combined prediction of the seven factors achieved the highest efficacy,with a sensitivity of 0.847 and spe-cificity of 0.695.Conclusion Diabetes mellitus,fracture type,degree of soft-tissue injury,wound contamination,timing and method of surgery,and inflammation level were all influencing factors for fungal osteomyelitis in traumatic fracture pa-tients.The risk of fungal osteomyelitis in patients could be effectively predicted based on the above-mentioned indicators.

Abstract:Objective To explore the etiology and influencing factors of fungal infection in patients with severe acute pan-creatitis.Methods Fifty-six patients with severe acute pancreatitis complicated with fungal infection in the First Affiliated Hospital of PLA Air Force Medical University from January 2022 to September 2024 were retrospectively selected as the in-fection group,and their etiological characteristics were analyzed.At the same time,53 patients with severe acute pancreatitis without concurrent fungal infection were selected as the control group.Clinical data of all patients were collected,and the in-fluencing factors of concurrent fungal infection were analyzed by univariate and multivariate logistic regression.Results A total of 72 strains of fungi were detected in 56 patients with severe acute pancreatitis complicated by fungal infection,inclu-ding 27 strains of Candida tropicalis(37.50%).19 strains of C.albicans,accounting for 26.39%.There were 15 strains of C.glabrata,accounting for 20.83%.There were 7 strains of C.krusei,accounting for 9.72%;Univariate analysis showed that there were statistically significant differences in age,diabetes mellitus,hyperlipidemia,hypoxemia,mechanical ventilation time,multiple organ failure time,intestinal paralysis time,pleural effusion,abdominal effusion and fasting time between the two groups(P<0.05).Multivariate logistic regression analysis showed that age>60 years old,combined with hypoxemia,multiple organ failure,mechanical ventilation time≥10 d,intestinal paralysis time>5 d,pleural effu-sion,abdominal effusion and fasting time>10 d were all independent risk factors for severe acute pancreatitis complicated with fungal infection(P<0.05).Conclusion The pathogenic characteristics of fungal infection in patients with severe acute pancreatitis were mainly C.tropicalis,C.albicans and C.glabrata.The incidence of infection in patients was associated with independent risk factors such as age>60 years old,combined hypoxemia,multiple organ failure,mechanical ventila-tion time≥10 d,intestinal paralysis time>5 d,pleural effusion,abdominal effusion,fasting time>10 d,etc.In clinical diagnosis and treatment,it is necessary to focus on monitoring related risk factors for early intervention.Reduce the risk of fungal infection in patients.

Abstract:A 40-year-old female patient presented with red spots,papules,and itching on her right forearm 5 days ago.Dermatological examination showed dark red macules and papules on the back of the right hand,with crusting.Localized dotted and linear vascular shadows were observed under the skin microscope,accompanied by circumferential desquamation at the edges of the skin lesions.Reflective confocal microscope showed focal keratosis,numerous hyphal like structures in the stratum corneum,dilation of dermal papillae and superficial blood vessels,and normal basal cell cytochrome.Based on fungal microscopy and culture results,it was diagnosed as cutaneous candidiasis and treated with external application of benz-imidazole cream for 2 weeks before recovery.