口腔念珠菌病菌群分布及药敏试验和临床疗效分析

目的探讨口腔念珠菌病的菌群分布特点及体外抗真菌药敏试验和临床疗效情况。方法采用科玛嘉显色培养基鉴定78株分离自口腔念珠菌病的患者临床分离株的菌群分布;ROSCO纸片扩散法检测念珠菌对氟康唑和伊曲康唑的敏感性;用氟康唑和伊曲康唑进行治疗。结果白念珠菌占71.79%,热带念珠菌占11.54%,光滑念珠菌占7.69%,克柔念珠菌占5.13%,其他念珠菌占3.85%。氟康唑和伊曲康唑对念珠菌的敏感率分别为73.08%和65.38%。氟康唑治疗组有效率87.80%,真菌清除率为87.80%;伊曲康唑治疗组依次为91.89%和91.89%。结论口腔念珠菌病仍以白念珠菌为主要致病菌。氟康唑和伊曲康唑对念珠菌均有较好的敏感性。氟康唑体外药敏试验结果与临床疗效有较好的相关性,伊曲康唑体外药敏试验结果与临床疗效有一定的相关性,但不完全一致。ROSCO纸片扩散法有在临床实验室推广应用的前景。     

复发性阴道念珠菌病念珠菌的菌种及药敏分析

目的：了解复发性外阴阴道念珠菌病(RVVC)临床分离菌株及其对几种常见抗真菌药物的敏感性：方法：分别采用念珠菌显色培养基和ROSCO纸片扩散法进行RVVC念珠菌菌种鉴定和药敏试验。结果：62株阳性标本中,分离出白念珠菌47株(75．81％),热带念珠菌4株(6．45％),光滑念珠菌2株(3．23％),克柔念珠菌5株(8．06％),其他念珠菌4株(6．45％)．62株念珠菌对4种常用的抗真菌药物,即两性霉素B、酮康唑、氟康唑和伊曲康唑的敏感率分别为：100．00％(62／62)、88．71％(55／62)、96．77％(60／62)、95．16％(59／62)。结论：RVVC的主要致病菌仍是白念珠菌,但非白念珠菌所占比例呈上升趋势：RVVC分离菌株对咪唑类抗真菌药物仍有较高的敏感率。     

氟康唑联合伊曲康唑治疗口腔黏膜念珠菌病临床观察及体外抗真菌药敏试验

目的观察氟康唑片和伊曲康唑胶囊对口腔黏膜念珠菌病的临床疗效,并检测口腔黏膜念珠菌对氟康唑和伊曲康唑的体外敏感性,了解体外抗真菌药敏试验结果与临床疗效的关系。方法对126例确诊为口腔黏膜念珠菌病患者给予氟康唑片口服治疗,对32例患者给予伊曲康唑胶囊口服治疗。采用Etest法检测30株念珠菌对氟康唑和伊曲康唑的最小抑菌浓度(M IC)。结果氟康唑片对口腔黏膜念珠菌病的有效率为94.44%,真菌清除率为94.44%;伊曲康唑胶囊对口腔黏膜念珠菌病的有效率93.75%,真菌清除率93.75%。采用Etest法检测30株念珠菌对伊曲康唑和氟康唑的M IC值,范围分别为0.0160~4μg/m l和0.250~2μg/m l。结论氟康唑片和伊曲康唑胶囊对口腔黏膜念珠菌病的疗效好,副作用小。Etest法可以作为一种较好的体外抗真菌药敏试验方法在临床实验室使用。     

念珠菌性包皮龟头炎的致病菌种及其药敏试验分析

目的了解念珠菌性包皮龟头炎的致病菌种及其对常见抗真菌药物的敏感性。方法分别采用科玛嘉念珠菌显色培养基、YBC鉴定卡和ROSCO纸片扩散法进行念珠菌培养、菌种鉴定及药敏试验。结果380例患者共培养出93株阳性标本(24.47%),分离出白念珠菌81株(87.10%),非白念珠菌12株(12.90%)。93株念珠菌对制霉菌素、酮康唑、氟康唑、伊曲康唑、咪康唑和特比萘芬的敏感率分别为100%,95.70%,92.47%,67.74%,56.99%,45.16%。结论白念珠菌是念珠菌性龟头包皮炎的主要致病菌种,分离菌株对制霉菌素敏感性最高,其次是酮康唑和氟康唑,特比萘芬最低。     

126株生殖器部位念珠菌对三唑类药物的敏感性分析

目的:了解生殖器部位念珠菌感染的菌型、分布及其对三唑类药物的敏感性,指导临床合理使用抗真菌药。方法:对2015年1月-2016年9月培养出的126株念珠菌,用ATBID32C酵母菌鉴定反应板鉴定菌种,用Rosco纸片扩散法进行体外药敏检测,比较不同菌型念珠菌的药敏趋势。结果:126例生殖器部位念珠菌感染者中,白念珠菌93例(73.81%)、近平滑念珠菌13例(10.32%)、平滑念珠菌9例(7.14%)、无名念珠菌4例(3.17%)、其他念珠菌7例(5.56%);念珠菌检出构成比以30-39岁最多;女性多于男性。药敏结果分析发现,白念珠菌中74.19%对氟康唑敏感,而仅有45.16%对伊曲康唑敏感,敏感率差异具有统计学意义(χ~2=16.29,P0.01);非白念株菌中60.61%对氟康唑敏感51.52%对伊曲康唑敏感,差异无统计学意义(χ~2=0.55,P=0.457)。结论:生殖器部位念珠菌感染以白念珠菌为主,其次为近平滑念珠菌。白念珠菌对氟康唑的敏感率较伊曲康唑高,非白念珠菌对两种药物的敏感率无明显差别。     

224例阴道念珠菌病的病原学特征及其对药物敏感性检测分析

目的:探讨阴道念珠菌的病原学特征及其对常用抗真菌药物的敏感性。方法:分别采用念珠菌显色培养基和ROSCO纸片抗散法进行念珠菌菌种鉴定和药敏试验。结果:224株阳性标本,分离出白色念珠菌185株(82.59%)、平滑念珠菌26株(11.61%)、热带念珠菌9株(4.02%)、其他念珠菌4株(1.78%)。224株念珠菌对氟康唑、酮康唑、伊曲康唑和二性霉素B的敏感率分别为93.75%、85.71%、95.09%、100%。结论:在阴道念珠菌病标本中,以白色念珠菌感染为主,其次是平滑念珠菌,还有少量的其他念珠菌引起阴道炎,分离菌株对咪唑类抗真菌药仍有较高的敏感性。     

综合医院住院患者口腔念珠菌分离株对抗真菌药物的敏感性研究

目的了解综合医院口腔念珠菌感染与带菌者分离菌株对抗真菌药物的耐药现状,为临床预防和治疗念珠菌感染提供参考。方法选择昆明医科大学第一附属医院多科室同期住院患者口腔分离的念珠菌菌株242株,采用微量稀释法(参照美国国家临床实验标准化委员会(NCCLS)推荐的M-27A方案)测定临床菌株对氟康唑、伊曲康唑、伏立康唑及两性霉素B的敏感性。结果白念珠菌对氟康唑、伊曲康唑、伏立康唑及两性霉素B的耐药率分别为9.20%、10.34%、5.75%及0%,非白念珠菌组对氟康唑、伊曲康唑、伏立康唑的耐药率分别为39.70%、11.76%、7.35%,1株光滑念珠菌对两性霉素B耐药。结论白念珠菌对唑类抗真菌药有一定的耐药性,无两性霉素B耐药;非白念珠菌对唑类抗真菌药耐药比例高于白念珠菌,尤其是对氟康唑,少数非白念珠菌对两性霉素B出现耐药性,应引起临床重视。     

51株甲真菌病白念珠菌体外药物敏感性试验

参照美国国家临床实验室标准化委员会M27-A棋盘微量稀释法,检测了分离自2005年1月至2007年10月,于北京大学第三医院第二门诊部就诊的甲真菌病患者的51株白念珠菌对伊曲康唑、特比萘芬和氟康唑3种抗真菌药物的体外敏感性.伊曲康唑、特比萘芬、氟康唑对51株甲源性白念珠菌的平均最小抑菌浓度(MIC)分别为:0.23 μg/mL、3.84 μg/mL、6.52 μg/mL.伊曲康唑在体外对白念珠菌敏感性高于特比萘芬和氟康唑.     

微量稀释法检测氟康唑和伊曲康唑对白念珠菌的敏感性

目的了解氟康唑和伊曲康唑对白念珠菌敏感性.方法采用NCCLS公布的M27-A方案微量稀释法,对19株白念珠菌临床分离株和3株标准株进行氟康唑和伊曲康唑药物的敏感性观测.结果19株临床分离株发现氟康唑耐药株7株,敏感株8株,剂量依赖的敏感菌株4株;伊曲康唑耐药株9株,敏感株8株,余2株为剂量依赖的敏感菌株;3株标准株结果符合.结论M27-A方案微量稀释法适合于临床检测白念珠菌的药物敏感性,氟康唑和伊曲康唑在白念珠菌中存在较高的耐药率和交叉耐药现象.     

白念珠菌506株对氟康唑和伊曲康唑的体外药敏试验

目的了解白念珠菌临床株对氟康唑和伊曲康唑的体外药物敏感性。方法收集鉴定白念珠菌临床株,采用美国国家临床实验室标准化研究所CLSI(即以前的NCCLS)推荐的M27-A2微量肉汤稀释法,进行氟康唑和伊曲康唑的MIC值测定。结果共收集白念珠菌506株,检测出氟康唑耐药株3株,剂量依赖性敏感株1株,耐药率为0.59%;伊曲康唑耐药株18株,剂量依赖性敏感株269株,耐药率为3.56%;其中1株对氟康唑和伊曲康唑交叉耐药。结论白念珠菌对唑类药物有耐药及交叉耐药现象的发生;伊曲康唑耐药率高于氟康唑。     

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.     

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.     

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.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

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.