A case of primary cutaneous Cryptococcus neoformans infection.

BACKGROUND: Cryptococcosis is an infectious disease caused by encapsulated heterobasidiomycete yeasts. As an opportunistic pathogen, cryptococcal inhalation infection is the most common. While Primary cutaneous cryptococcosis is extremely uncommon. CASE PRESENTATION: A 61-year-old woman with a history of rheumatoid arthritis on long-term prednisone developed a red plaque on her left thigh. Despite initial antibiotic treatment, the erythema worsened, leading to rupture and fever. Microbiological analysis of the lesion's secretion revealed Candida albicans, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus epidermidis. Skin biopsy showed thick-walled spores, and culture confirmed primary cutaneous infection with Cryptococcus neoformans. Histopathological stains were positive, and mass spectrometry identified serotype A of the pathogen. The patient was treated with oral fluconazole and topical nystatin, resulting in significant improvement and near-complete healing of the skin lesion within 2.5 months. CONCLUSIONS: Primary cutaneous cryptococcosis was a primary skin infection exclusively located on the skin. It has no typical clinical manifestation of cutaneous infection of Cryptococcus, and culture and histopathology remain the gold standard for diagnosing. The recommended medication for Primary cutaneous cryptococcosis is fluconazole. When patients at risk for opportunistic infections develop skin ulcers that are unresponsive to antibiotic, the possibility of primary cutaneous cryptococcosis needs to be considered.

Serum Metabolomics Study Based on LC-MS and Antihypertensive Effect of Uncaria on Spontaneously Hypertensive Rats.

Our previous studies have shown that Uncaria has an important role in lowering blood pressure, but its intervention mechanism has not been clarified completely in the metabolic level. Therefore, in this study, a combination method of HPLC-TOF/MS-based metabolomics and multivariate statistical analyses was employed to explore the mechanism and evaluate the antihypertensive effect of Uncaria. Serum samples were analyzed and identified by HPLC-TOF/MS, while the acquired data was further processed by partial least squares discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA) to discover the perturbed metabolites. A clear cluster among the different groups was obtained, and 7 significantly changed potential biomarkers were screened out. These biomarkers were mainly associated with lipid metabolism (dihydroceramide, ceramide, PC, LysoPC, and TXA2) and vitamin and amino acids metabolism (nicotinamide riboside, 5-HTP). The result indicated that Uncaria could decrease the blood pressure effectively, partially by regulating the above biomarkers and metabolic pathways. Analyzing and verifying the specific biomarkers, further understanding of the therapeutic mechanism and antihypertensive effect of Uncaria was acquired. Metabolomics provided a new insight into estimate of the therapeutic effect and dissection of the potential mechanisms of traditional Chinese medicine (TCM) in treating hypertension.

Free perforating branch flap for primary repairing the huge soft-tissue defects on the scalp and face.

OBJECTIVE: This study aimed to explore the effect of free perforating branch flap on the reconstruction of huge soft-tissue defects on the scalp and face. METHODS: Sixteen cases of huge soft-tissue defects on the scalp and face were reconstructed by nine latissimus dorsi-free perforator flaps and seven anterolateral thigh-free perforator flaps. The defects area was from 12 cm× 7 cm to 20 cm × 11 cm, while the flaps area was from 14 cm × 8 cm to 23 cm × 12 cm. The survival, planeness, chromatic aberration, radiotherapy toleration of flap and the function, scar of donor site were observed postoperatively. RESULT: All of the flaps were survived completely, and 15 cases presented for primary reconstruction; one underwent secondary reconstruction. One of the patients died one-year postoperatively due to intracranial tumor recurrence and the others had no recurrence. All of the flaps showed perfect shape and appropriate thickness. No roentgen ulcer was observed except for some extent of chromatic aberration. The donor-site scar was larvaceous and the function was good. CONCLUSION: This study indicated that the latissimus dorsi-free perforator flap or anterolateral thigh-free perforator flap was an ideal choice for the reconstruction of defects on the scalp and face.

Efficacy of tandospirone in patients with irritable bowel syndrome-diarrhea and anxiety.

AIM: To investigate the efficacy of tandospirone in patients with irritable bowel syndrome-diarrhea (IBS-D) and anxiety in a prospective, randomized, controlled study. METHODS: Two hundred patients with IBS-D and moderate anxiety were randomized to receive pinaverium and tandospirone (arm A) or pinaverium and placebo (arm B). Tandospirone or placebo was given thrice daily at a fixed dose of 10 mg and pinaverium was given thrice daily at a fixed dose of 50 mg. The duration of treatment was 8 wk. Patients were assessed for abdominal pain and diarrhea. Anxiety was evaluated using the Hamilton Rating Scale for Anxiety (HAM-A). The primary study endpoints were response rates for abdominal pain and diarrhea. The secondary study endpoints were response rates for anxiety. Adverse events were also evaluated. RESULTS: One hundred and seventy of 200 patients (82 patients in arm A and 88 patients in arm B) completed the study. Demographic and baseline characteristics of the 200 participants were comparable in the two arms. At week 8, the overall response rate for abdominal pain and diarrhea was 52.0% for arm A and 37.0% for arm B (P < 0.05). The HAM-A score showed that the response rate was 61.0% for arm A and 21.0% for arm B (P < 0.01). The treatments were well tolerated and no significant adverse events were reported. CONCLUSION: Tandospirone is effective and can be combined with pinaverium in IBS-D patients with anxiety.

[Cutis verticis gyrata].

OBJECTIVE: To improve the recognition and treatment of Chinese cutis verticis gyrata. METHODS: Based on the review of the etiopathology, clinical features, diagnosis, classification and treatment of the disease in the literatures, six patients with the cutis verticis gyrata were treated with the skin graft or the expanded scalp flap. RESULTS: The operative effects were satisfactory during 6 months to 5 years of the follow-ups. No recurrence was found in all cases. Two patients treated with skin graft had lead to baldness, four patients treated with the expanded scalp flap had been good appearance. CONCLUSIONS: The method of the expanded scalp flap is good and effective treatment for the cutis verticis gyrate.