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Summary Background The purpose of this study was to determine the species distribution and to monitor the antifungal susceptibility profiles of clinical Candida isolates collected in China from 2009 to 2013. Methods The antifungal susceptibilities of 952 Candida isolates were tested. Results Candida albicans was the most common species, accounting for 65.7% of the total isolates. The most frequently isolated non-albicans Candida species in this study was Candida glabrata (193, 20.3%). Nearly 7.6%, 3.2%, 1.8%, and 1.1% of the 952 isolates exhibited decreased susceptibility to fluconazole, voriconazole, itraconazole, and flucytosine, respectively. Moreover, seven C. albicans and one Candida krusei had an amphotericin B minimum inhibitory concentration (MIC) of 2 μg/ml. Conclusions The distribution of species and the prevalence of antifungal resistance in Candida isolates varied among different areas in China. Continuous monitoring of resistance patterns is necessary to control the spread of resistance in clinical isolates of Candida species. [ABSTRACT FROM AUTHOR]

• The positive rate of Metagenomic next-generation sequencing in critically ill patients who could not be diagnosed with blood culture was 41.3% (26/63). • Metagenomic next-generation sequencing exhibited the ability to detect co-infections in critically ill patients. • Metagenomic next-generation sequencing should be carried out as soon as possible to obtain higher positive detection rates. To explore the applicability of metagenomic next-generation sequencing (mNGS) technology for the detection of blood pathogens in intensive care unit patients. The clinical data of 63 critically ill patients who could not be diagnosed with blood culture (BC) and who underwent mNGS blood sample testing were retrospectively analyzed. The diagnostic efficacy of mNGS was compared with that of traditional detection methods; the distribution of the pathogens identified by mNGS was analyzed; and the differences in laboratory tests, comorbidities, treatment, and prognosis between the mNGS-positive and mNGS-negative groups were compared. The positive rate of mNGS was 41.3% (26/63), and 16 patients were found to have mixed infections. However, the positive rate of BCs performed simultaneously with mNGS was only 7.9% (5/63). The results of univariate analysis showed that the average length of intensive care unit stay (β, −8.689 [95% CI, −16.176, −1.202]; P = 0.026) and the time from onset to sequencing (β, −5.816 [95% CI,−9.936, −1.696]; P = 0.007) of the mNGS-positive group were significantly shorter than those of the mNGS-negative group. More patients in the positive group were adjusted for anti-infective treatment after mNGS (OR, 3.789 [95% CI,1.176, 12.211]; P < 0.001). Detection of blood pathogens by mNGS has good applicability for critically ill patients who cannot be diagnosed by BC in the early stages of infection, and mNGS should be performed as early as possible to obtain higher pathogen detection rates. [ABSTRACT FROM AUTHOR]

Abstract A new dataset based on in-situ observations and a numerical model are employed to reveal the spatio-temporal variation and driving mechanism of counter-wind current (CWC) in the western Taiwan Strait (TWS) during the winter monsoon. Our results confirm the existence of the CWC in the western TWS during the months of strong northeasterly wind, which is well supported by a rarely observed through-flow pattern recorded by a Lagrangian drifter, during which the average wind speed was 11 m/s. Moreover, both the synchronous ADCP observations and model results demonstrate that the CWC acted as an episodic local event when the winter monsoon went into transient relaxation. By examining the model results, the momentum budget and the time-dependent dynamics, we further revealed that the wind relaxation mechanism is crucial in explaining the existence of the CWC, which acted as a short-lived local event in the form of a return current that lied in the downstream of a significant along-strait sea-level set-up in the northern Taiwan Bank when the prevailing strong wind experienced a short transient relaxation. Last but not least, the large-scale pressure gradient related to the open-ocean forcing was found to play a predominant role in driving a stable CWC in the frame of geostrophy when the winter-monsoon wind gradually relaxed. Highlights • We confirm the existence of the CWC in the western TWS during the months of strong northeasterly wind. • The wind relaxation mechanism was crucial in explaining the existence of the CWC. • The CWC acted as a short-lived local event when the prevailing strong wind experienced a short transient relaxation. • The large-scale pressure gradient plays a predominant role in driving a stable CWC when the winter-monsoon wind gradually relaxed. [ABSTRACT FROM AUTHOR]