性病门诊120例RVVC病原体检测分析

目的探讨复发性外阴阴道假丝酵母菌病(RVVC)真菌及合并其他病原体感染情况,为有效治疗提供依据。方法对性病门诊120例RVVC患者和120例同期在本院做健康查体妇女(对照组)行病原学检查及酵母菌培养鉴定。结果 120例RVVC患者阴道分泌物分离出124株假丝酵母菌,其中白假丝酵母菌85株(68.55%),非白假丝酵母菌39株(31.45%),对两性霉素B,5-氟胞嘧啶,制霉菌素及咪康唑具有较高的体外抗菌活性,敏感率分别为98.39%,95.97%,91.94%和90.32%;支原体感染63例(52.50%),衣原体感染20例(16.67%),其他病原体感染37例(30.83%)。对照组120例仅查出白假丝酵母菌7例,支原体感染14例,未查见衣原体,其他病原体感染4例。结论 RVVC的主要病原菌仍是白假丝酵母菌,制霉菌素、咪康唑仍可作为经验用药的首选药物;RVVC常合并支原体、衣原体感染,对久治不愈的RVVC患者,需注意是否合并有其他病原体感染,应予积极治疗。     

皮肤性病门诊就诊患者支原体感染状况及耐药性分析

目的:探讨皮肤性病门诊就诊患者支原体感染状况及耐药性情况,为临床治疗提供依据。方法:通过分析2015年1月至2015年12月医院皮肤性病门诊收治的1546例性病患者的临床资料,采集患者生殖道分泌物标本并进行支原体培养,分析患者感染支原体类型及耐药性情况。结果:1546例性病患者中共有664例患者感染支原体,感染率占42.95%,其中感染解脲支原体(Uu)472例占比71.08%,感染人型支原体(Mh)患者有66例占比9.94%,混合感染患者126例占比18.98%;Uu对交沙霉素、原始霉素、四环素、强力霉素临床耐药率相对较低在5.00%以内,对左氧氟沙星和环丙沙星耐药率相对较高在40.00%以上;Mh对四环素、强力霉素、美满霉素、交沙霉素和原始霉素耐药率较低在10.00%之内,对阿奇霉素、克拉霉素和环丙沙星耐药率在50.00%以上;Uu+Mh混合感染患者临床耐药率显示其对红霉素、左氧氟沙星、阿奇霉素、环丙沙星和克拉霉素耐药率在70.00%以上,对强力霉素和原始霉素耐药率在10.00%之内。结论:对性病患者支原体感染类型及耐药性进行检测分析对生殖道感染患者的治疗有较大的临床价值。     

复发性外阴阴道假丝酵母菌病菌种与药敏特征的研究

目的:了解假丝酵母菌在复发性外阴阴道假丝酵母菌病的菌种分布和药物敏感性,为临床治疗提供帮助。方法:收集108例复发性外阴阴道假丝酵母菌病阴道分泌物标本,应用法国生物梅里埃酵母菌鉴定试剂盒ID32C和药敏试剂盒ATBTM FUNGUS3进行鉴定和药敏试验。结果:108株假丝酵母菌中分离出光滑假丝酵母菌36例,白色假丝酵母菌35例,近平滑假丝酵母菌20例,热带假丝酵母菌7例,其他11例;对抗真菌药物AMB、5FC敏感性分别为96.30%、85.19%,对FCA、VRC、ITR耐药率分别为42.59%、50.93%、72.22%。有26株白色假丝酵母菌对3种三唑类药物均耐药。光滑假丝酵母菌对ITR耐药率高达83.33%。结论:复发性外阴阴道假丝酵母菌病的致病菌主要是光滑假丝酵母菌、白色假丝酵母菌,呈现非白假丝酵母菌占67.59%的分布特征,并且对AMB、5FC敏感性高,ITR耐药率高于VRC、FCA。     

妇科门诊患者外阴阴道假丝酵母菌感染情况调查

目的:调查本地妇科门诊患者外阴阴道假丝酵母菌的感染情况,指导临床。方法:随机选取2014年5月至10月在笔者所在医院妇科门诊就诊的1385例患者的阴道分泌物标本,采用10%KOH直接涂片法在显微镜下找芽孢和假菌丝,对检查结果进行不同年龄组感染率的差异对比。结果:1358名患者中确诊外阴阴道假丝酵母菌性阴道炎(VVC)为267名,占19.3%,其中30~39岁年龄组感染率为53.5%,其次20~29岁年龄组为31.4%,明显高于其他年龄组。结论:VVC是较常见的阴道炎,好发于生育年龄。     

3492例生殖器炎症患者假丝酵母菌病原学及药敏情况分析

目的:了解江门地区生殖器假丝酵母菌病病原菌分布及药敏情况。方法:采用科玛嘉假丝酵母菌显色培养基和YBC(酵母菌)鉴定卡对3 492例生殖器炎症患者标本的致病真菌进行分离和鉴定,用ROSCO纸片扩散法检测分离菌株对制霉菌素、酮康唑、氟康唑、伊曲康唑、咪康唑和特比奈芬的药敏情况。结果:共分离出11种891株致病假丝酵母菌,其中白色假丝酵母菌占85.19%,热带假丝酵母菌占7.41%,近光滑假丝酵母菌占3.37%,其他假丝酵母菌占4.03%。891株假丝酵母菌对制霉菌素、酮康唑、氟康唑、伊曲康唑、咪康唑和特比奈芬的敏感性分别为98.09%、95.96%、88.33%、71.42%、45.68%和35.81%。结论:江门地区生殖器假丝酵母菌病致病菌种类较多,对药物的敏感性有降低趋势,耐药菌株在假丝酵母菌的构成比中有增高趋势,应加强假丝酵母菌的检测和药敏分析。     

阴道分泌物支原体检测及耐药性分析

目的:了解和探讨成年女性阴道分泌物支原体感染情况及对各类抗菌药物的耐药性,以指导临床合理治疗。方法:对2012年6月至2013年6月期间在我院就诊的589例女性患者的阴道分泌物进行支原体检测及药敏试验,药敏试验抗菌药包括:美满霉素(MIN)、强力霉素(DOX)、交沙霉素(JOS)、阿奇霉素(AZI)、克拉霉素(CLA)、罗红霉素(ROX)、红霉素(ERY)、琥乙红霉素(ECC)、甲砜霉素(THI)、环丙沙星(CPF)、左氧氟沙星(CRA)、加替沙星(GAT),观察和分析支原体检测及药敏试验结果。结果:589份阴道分泌物标本中,390例检出支原体,支原体感染率为66.21%,其中Uu占所有感染病例的67.95%,Uu+Mh占29.49%,Mh占2.56%。药敏试验结果显示:Uu、Mh、Uu+Mh三种类型的感染对强力霉素、美满霉素及交沙霉素表现了较低的耐药性,对氟喹诺酮类抗菌药物表现了较高的耐药性,甚至达50%以上;对加替沙星的耐药率均维持在20%左右;单一Uu感染对大环内酯类抗菌药耐药性多维持在20%以下,而Mh、Uu+Mh对大环内酯类耐药性维持在50%左右;单一Uu感染对强力霉素、美满霉素及交沙霉素耐药率为0,而Mh、Uu+Mh对上述三药表现了10%左右的耐药率。结论:女性生殖道支原体感染已相当普遍且比较严重,不同的感染类型对临床常用抗菌药物可表现出不同的耐药性,临床上应加强支原体培养及药敏试验,以指导合理应用抗菌药,同时应加强对重点人群的监测,预防或降低支原体感染的发生。     

假丝酵母菌性阴道炎患者的综合护理分析

目的对假丝酵母菌性阴道炎患者的综合护理措施及效果进行分析。方法选取2017年1月~2017年12月,入住的58例假丝酵母菌性阴道炎患者为研究对象,按随机数字表法分组,分为观察组(29例;综合护理)和对照组(29例;常规护理)。观察对比2组患者护理干预后临床效果。结果观察组患者总有效率96.55%、复发率3.44%;对照组患者总有效率68.96%、复发率27.58%。两组比较差异明显(P0.05)。结论假丝酵母菌性阴道炎患者的综合护理效果较为理想,可明显提高总有效率,降低疾病复发率。     

妊娠期女性生殖系统感染病原菌分布及耐药性分析

目的:探讨妊娠期女性生殖系统感染病原菌的分布以及耐药性分析,为妊娠期生殖系统感染患者的治疗和母婴的健康提供参考。方法:选取2013年5月至2015年5月期间医院的1249例妊娠期妇女为本次的研究对象,对所有妊娠期妇女的阴道或宫颈分泌物做生殖系统的感染检测,对被检出的菌种进行鉴定以及药敏试验。结果:在本次研究的1249例妊娠期妇女中,出现生殖系统感染的妊娠期妇女有412例,其生殖系统感染率为32.99%,主要感染的疾病有支原体性阴道炎、衣原体性阴道炎、滴虫性阴道炎、细菌性阴道病、淋病、梅毒等等,引起妊娠期生殖系统感染的主要病原菌为真菌中的念珠菌,经病原菌的鉴定试验发现患者主要感染的念珠菌有白色念珠菌,占85.44%(352/412),光滑念珠菌,占2.91%(12/412),克柔念珠菌,占5.58%(23/412),热带念珠菌,占1.94%(8/412),以及其他病原菌。对病原菌进行药敏试验发现白色念珠菌主要是对5-氟胞嘧啶和两性霉素B比较敏感,而对与咪康唑、酮康唑以及伊曲康唑都有一定的耐药性,其耐药率依次为36.50%、23.25%和18.5%,而光滑念珠菌、克柔念珠菌、热带念珠菌以及其他念珠菌对治疗过程中所使用的抗菌药物都比较敏感。结论:妊娠期女性生殖系统感染率比较高,其感染病原菌主要为念珠菌,在临床中要重视妊娠期女性生殖系统感染的筛查工作。     

女性尖锐湿疣患者合并解脲支原体感染的临床分析及治疗研究

目的:女性尖锐湿疣患者合并解脲支原体感染的发病率及支原体耐药性的研究。方法:本研究选择的对象为2011年6月至2012年5月接受治疗的128例女性尖锐湿疣患者,将其作为观察组,另外选取同期接受体检的80例无尖锐湿疣的患者,将其作为对照组,两组患者的一般资料比较无显著性差异(P0.05),对尖锐湿疣患者合并感染的情况、合并解脲支原体的阳性检出率以及解脲支原体对常用抗生素的耐药性进行研究。结果:从尖锐湿疣患者的合并感染的临床分析中可以看出,尖锐湿疣合并支原体的感染的阳性率较高,阳性率为19.5%,从尖锐湿疣患者的合并感染的年龄分布来看,20~45岁患者占了阳性病例的大部分,该年龄段是尖锐湿疣患者合并感染的多发年龄;观察组检出解脲支原体发病率为19.5%,对照组检出解脲支原体的发病率为8.8%,两组患者的解脲支原体发病率进行比较有显著性差异(P0.05);解脲支原体对环丙沙星以及氧氟沙星的耐药性较高,分别为81.25%与68.75%。对阿奇霉素、克拉霉素、罗红霉素的耐用性在20%左右,分别为18.75%、21.88%、18.75%,对强力霉素的耐药性最低,耐药率为6.25%。结论:女性尖锐湿疣患者往往合并解脲支原体的感染,因此在治疗尖锐湿疣的过程中要注意对解脲支原体的检测,从解脲支原体对常用抗生素的耐药性来看,在临床上应根据致病菌的耐药情况灵活掌握,合理选择抗生素,尽量减少耐药情况的发生。     

2004-2008年院内深部真菌感染的菌群分布与变迁情况

目的了解宁夏医科大学总医院2004-2008年院内深部真菌感染的菌群分布与变迁情况,探讨本院深部真菌感染的总体情况及变化趋势。方法采用回顾性调查方法,收集2004-2008年在本院住院诊断为院内深部真菌感染的261例患者的临床资料,对检出真菌的标本来源、菌群分布及菌种变迁进行调查和分析。结果 2004-2008年院内深部真菌感染的菌种以白假丝酵母菌所占比例最高,为51.02%;但白假丝酵母菌的比例由2004年的69.56%下降为2008年的43.16%,差异有统计学意义(χ2=5.171,P=0.023);检出的499株真菌中,痰标本所占的比例最高,平均为33.87%。结论 2004-2008年本院院内深部真菌感染菌群分布已经发生了变迁,非白假丝酵母菌感染正在取代白假丝酵母菌感染,深部真菌感染的部位以呼吸道和泌尿道为主。     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Deutliche Einschränkung der Lebensqualität bei Patienten mit Pemphigus vulgaris: Ergebnisse der deutschen Bullous Skin Disease (BSD)‐Studiengruppe

Background: Pemphigus vulgaris is a potentially life‐threatening autoimmune disorder of the skin and mucous membranes characterized by antibodies against epidermal adhesion molecules. Clinically characteristic are painful chronic blisters or erosions of mucous membranes and skin. There are no published studies on the impact o this disease on quality of life. Patients and methods: This registration was performed within the scope of the German BSD (Bullous Skin Disease) study group, from November 1997 until January 2002. A total of 36 patients with the first diagnosis of pemphigus vulgaris were registered at the university hospitals of Dresden, Erlangen, Kiel, Mannheim, München and Würzburg. Thirty of the 36 (83 %) patients participated in the quality of life questionnaire utilizing the German version of ‘Dermatology Life Quality Index’ (DLQI) provided by A. Y. Finlay. The DLQI varies from 0 to 30 with an increased DLQI score indicating a decrease in quality of quality. Results: The overall DLQI total score of 10 ± 6,7 in the investigated pemphigus patients was significantly increased in comparison to other skin diseases. Conclusions: These results suggest that the DLQI can be a very useful additional outcome criteria for clinical studies with pemphigus vulgaris and in the treatment of these patients.