诱导白念珠菌对氟康唑耐药所伴随的毒力因子的改变

白念珠菌常可以寄居在正常人体的消化道和阴道而不致病 ,一旦宿主与菌株间的这种平衡关系被破坏 ,就会发生念珠菌病 ,其间菌株的毒力起了重要作用。作者将氟康唑敏感型的白念珠菌野生株诱导为耐氟康唑的实验室变异株 ,然后观察其毒力因素诸如出芽、粘附于口腔上皮细胞和丙烯盐酸的能力、天门冬氨酸蛋白酶的分泌、细胞外磷脂酶的活性以及它们的生长能力与对照的野生株相比有何不同 ,并在动物实验中予以证实。方法 :氟康唑耐药株的诱导通过氟康唑敏感株在培养基中增加氟康唑的浓度持续振荡培养而获得。用ＣＹＧ[3%酵母提取物 ,3%胰蛋白酶 ,6 %…     

白假丝酵母菌对氟康唑的敏感性及与其毒力的相关性

目的观察白假丝酵母菌对氟康唑的敏感性,并探讨其敏感性与毒力的相关性。方法对昆明医学院第二附属医院临床分离鉴定为白假丝酵母菌的124株菌株,根据美国国家临床实验室标准化委员会(NCCLS)制订的M27-A方案进行氟康唑药物敏感实验;并测定白假丝酵母菌氟康唑敏感组和耐药组的磷脂酶和分泌型天冬氨酸蛋白酶的阳性率及活力。结果 124株白假丝酵母菌中68.55%对氟康唑敏感;白假丝酵母菌氟康唑敏感株和耐药株磷脂酶阳性率分别为26.67%和66.67%;二者分泌型天冬氨酸蛋白酶阳性率分别为33.33%和73.33%,差异均有统计学意义(P均<0.05)。结论昆明医学院第二附属医院院内白假丝酵母菌中,有68.55%菌株对氟康唑敏感;白假丝酵母菌耐药株的磷脂酶和分泌型天冬氨酸蛋白酶的阳性率及活力均明显高于敏感株,可认为白假丝酵母菌耐药株的毒力较敏感株强。     

唑类药物体外诱导白念珠菌耐药的初步研究

目的：了解不同抑菌浓度的唑类药物体外诱导白念珠菌的耐药情况。方法：将质控株及敏感白念珠菌在含不同抑菌浓度的氟康唑(FCZ)、酮康唑(KCZ)、伊曲康唑(ICZ)的液体培养基中进行人工传代诱导耐药。结果：敏感白念珠菌在高浓度的唑类药物培养基中能诱导耐药，且为交叉耐药，而在低浓度中经传20代仍不能诱导耐药；诱导后的耐药菌株在无药物培养基中传代可恢复敏感性。结论：唑类药物能诱导耐药白念珠菌的产生，但与诱导药物的浓度有关，且为不稳定耐药。     

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。     

外阴阴道白念珠菌氟康唑敏感株与耐药株型别分布比较

目的：分离念珠菌性外阴阴道炎白念珠菌临床株,比较氟康唑敏感株组和耐药株组的A、B、C型别分布。方法：收集念珠菌性外阴阴道炎患者阴道分泌物标本,用柯玛嘉显色培养基初步鉴定并分纯其中的白念珠菌临床株。联用微量稀释法和药敏纸片法体外测定菌株对氟康唑的敏感性。分别各取15株敏感株和耐药株,扩增其25SrDNA转座内含子保守序列,鉴定分型。结果：15株敏感株包括9株A型、5株B型和1株C型;15株耐药株全部为A型。敏感株组和耐药株组间的A、B、C型别分布有显著性差异（P〈0.005）。结论：念珠菌性外阴阴道炎耐药白念珠菌以A型为主,白念珠菌耐药性形成与型别相关。     

微量稀释法测定白念珠菌对氟康唑的MIC值及两种药敏试验的比较

目的: 测定临床分离白念珠菌对氟康唑的耐药.方法: 应用1997年美国临床和实验室标准化研究院(CLSI)推荐的微苗稀释法(M27-A)对我科真菌实验室分离保存的120株白念珠菌进行了氟康唑的体外药物敏感试验,并对药敏结果进行分析.结果: 120株白念珠菌中73株对氟康唑敏感,13株剂量依赖敏感,34株耐药.结论: 白念珠菌对氟康唑的敏感性下降,可能与氟康唑的广泛应用有关.     

真菌病

20 0 4 0 779　唑类药物体外诱导白念珠菌耐药的初步研究/宋晓静(浙大一附院皮肤科)…∥临床皮肤科杂志.- 2 0 0 3,32 (10 ) .- 575～576将质控株及敏感白念珠菌在含不同抑菌浓度的氟康唑(FCZ)、酮康唑(K CZ)、伊曲康唑(ICZ)的液体培养基中进行人工传代诱导耐药。结果白念珠菌在高浓度的唑类药物培养基中能诱导耐药,且为交叉耐药,而在低浓度中经传2 0代仍不能诱导耐药,诱导后的耐药菌株在无药物培养基中传代可恢复敏感性。提示唑类药物能诱导耐药白念珠菌的产生,但与诱导药物的浓度有关,且为不稳定耐药。(汤亚娥)2 0 0 4 0 780　白念珠…     

阴道白念珠菌致病株与携带株分泌性蛋白酶活力的比较

目的比较阴道白念珠菌致病株与携带株分泌性蛋白酶的活力,以探讨其与外阴阴道念珠菌病之间的关系。方法:采用牛血清白蛋白培养基对外阴阴道念珠菌病患者和无症状携带者阴道白念珠菌分离株的分泌性蛋白酶活力进行测定。结果:致病株组和携带株组分泌性蛋白酶阳性株的检出率无明显差异,但二组间酶的活力有显著性差异(P<0.001)。结论:外阴阴道念珠菌病的发病可能与白念珠菌分泌性蛋白酶在宿主局部某些因素的影响下表达水平升高有关。     

白念珠菌二相性与毒力关系的实验研究

目的　探讨白念珠菌二相性与毒力的关系。方法　分别将孢子相、菌丝相白念珠菌与人口腔颊黏膜细胞 (BEC)进行黏附试验 ,比较二相性白念珠菌对BEC的黏附率 ;分别用牛血清白蛋白培养基及卵黄培养基测定二相性白念珠菌的分泌性酸性蛋白酶与细胞外磷脂酶的活力 ;分别将二相性白念珠菌进行小鼠毒力实验。结果　菌丝相白念珠菌对BEC的黏附率显著高于孢子相 (P <0 .0 0 1) ;菌丝相白念珠菌分泌性酸性蛋白酶与细胞外磷脂酶的活力均显著高于孢子相 (P分别 <0 .0 0 1和 <0 .0 0 2 ) ;注射菌丝相白念珠菌的小鼠死亡率高于注射孢子相的小鼠 (P <0 .0 2 5 ) ,且平均存活期低于注射孢子相的小鼠 (P <0 .0 0 1)。结论　菌丝相白念珠菌的毒力强于孢子相。     

携带G487T和T916C的白念珠菌ERG 11及外流泵基因表达与氟康唑耐药的关系

目的:检测携带相同突变的耐氟康唑白念珠菌多个耐药基因的表达。方法:选取耐氟康唑白念珠菌14株(均携带相同的ERG11突变G487T和T916C),氟康唑敏感白念珠菌14株,通过实时定量PCR反应检测两组多个耐药基因的表达。结果:14株携带相同突变的耐氟康唑白念珠菌主动外排基因CDR1和CDR2 mRNA表达较敏感组显著增加(P0.01);而ERG11、FLU1和MDR1基因mRNA水平较敏感株表达无明显差异(P0.05)。结论:携带G487T和T916C突变的白念珠菌的耐氟康唑机制可能与主动外排泵基因CDR1和CDR2的高表达密切相关。     

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.