Aetiology of tinea capitis in China: a multicentre prospective study.

BACKGROUND: Tinea capitis is still common in developing countries, such as China. Its pathogen spectrum varies across regions and changes over time. OBJECTIVES: This study aimed to clarify the current epidemiological characteristics and pathogen spectrum of tinea capitis in China. METHODS: A multicentre, prospective descriptive study involving 29 tertiary hospitals in China was conducted. From August 2019 to July 2020, 611 patients with tinea capitis were enrolled. Data concerning demography, risk factors and fungal tests were collected. When necessary, the pathogens were further identified by morphology or molecular sequencing in the central laboratory. RESULTS: Among all enrolled patients, 74·1% of the cases were in patients aged 2-8 years. The children with tinea capitis were mainly boys (56·2%) and were more likely than adults to have a history of animal contact (57·4% vs. 35·3%, P = 0·012) and zoophilic dermatophyte infection (73·5% vs. 47%). The adults were mainly female (83%) and were more likely than children to have anthropophilic agent infection (53% vs. 23·9%). The most common pathogen was zoophilic Microsporum canis (354, 65·2%), followed by anthropophilic Trichophyton violaceum (74, 13·6%). In contrast to the eastern, western and northeastern regions, where zoophilic M. canis predominated, anthropophilic T. violaceum predominated in central China (69%, P < 0·001), where the patients had the most tinea at other sites (20%) and dermatophytosis contact (26%) but the least animal contact (39%). Microsporum ferrugineum was the most common anthropophilic agent in the western area, especially in Xinjiang province. CONCLUSIONS: Boys aged approximately 5 years were the most commonly affected group. Dermatologists are advised to pay more attention to the different transmission routes and pathogen spectra in different age groups from different regions.

[A preliminary observation of implanting a double-eyelet capsular tension ring in eyes with serious lens subluxation].

Objective: To evaluate the clinical efficiency of an iris hook combined with a modified double-eyelet capsular tension ring (MCTR) in the treatment of serious lens subluxation. Methods: Retrospective case series. A total of 16 patients (20 eyes) with serious lens subluxation were enrolled in Zhongshan Ophthalmic Center from March 2016 to December 2016. All the patients had an iris hook inserted to support the capsule during the phacoemulsification. Then an MCTR was implanted and sutured onto the sclera. Both intraoperative and postoperative complications, such as posterior capsular opacification and macular edema, were recorded. The postoperative examinations included visual acuity, intraocular pressure, slit-lamp examination, and Pentacam for evaluation of the positions of the capsule and the intraocular lens(IOL). The best corrected visual acuities before and after operation were compared with the matched t test. Results: There were 11 males(12 eyes) and 5 females (8 eyes) among the 16 patients (20 eyes) aged (36±16) years, including 5 cases of Marfan's syndrome (7 eyes), spontaneous ectopia lentis in 7 patients (9 eyes), and traumatic lens dislocation in 4 patients (4 eyes). All the MCTRs were successfully implanted into the capsule. The best corrected visual acuity ranged from 0.3 to 1.0, with 0.5 or higher accounting for 90% (18 eyes). It was 0.20±0.14 and 0.21±0.13, respectively, at 3 and 6 months, which was significantly better than the preoperative best corrected visual acuity (logarithm of the minimal angle of resolution) (0.74±0.51;t=5.302, P<0.001; t=5.131;P<0.001). One eye had macular edema 3 months after surgery, and then was treated by conservative management. Two eyes(2 case) developed mild posterior capsular opacification 6 months after operation. No intraocular hypertension was persistently observed. All IOLs and capsular bags were in the expected position without an obvious tilt or displacement. Conclusion: The surgical strategy of iris hooks combined with MCTRs in the treatment of serious lens subluxation could maintain long-term stability of the capsule. (Chin J Ophthalmol, 2018, 54: 343-348).

[Clinical effectiveness of super pulsed carbon dioxide fractional laser debridement surgery in treating chronic wounds].

Objective: To investigate the clinical effectiveness of super pulsed carbon dioxide fractional laser debridement surgery on the treatment of chronic wounds. Methods: From December 2018 to May 2019, 37 patients with chronic wounds who met the inclusion criteria were admitted to the Affiliated Hospital of Southwest Medical University for a prospective randomized controlled study. Using the random number table, the patients were divided into surgical debridement group (19 patients, 4 males and 15 females, aged (58±16) years, 25 wounds) and laser debridement group (18 patients, 9 males and 9 females, aged (58±10) years, 23 wounds). In patients of surgical debridement group, oedematous and aging granulation tissue was scraped from the wound by scalpel handle or curet, and the residual necrotic tissue was removed by sharp surgical instruments. In patients of laser debridement group, oedematous and aging granulation tissue and necrotic tissue was removed by super pulsed carbon dioxide fractional laser therapeutic machine, laser gasification debridement was performed repeatedly till fresh normal tissue layer observed. In patients of the two groups, according to the wound in the first 3 d after the first debridement, debridement dressing was performed twice at least as before, then wound debridement dressing was performed once every 1 to 4 days as before according to the wound conditions. The wound healing rates on 7, 14, 21, and 28 d after the first debridement were calculated. The positive rates of bacterial culture of wounds before and after the first debridement were calculated. The color and texture of the wound granulation tissue before the first debridement and on 7, 14, and 28 d after the first debridement were observed and scored. The pain scores before every debridement, during every debridement, and after every debridement dressing change were evaluated by visual analogue scale. The times of debridement dressing change were recorded. Data were statistically analyzed with two independent sample t test, analysis of variance for repeated measurement, Fisher's exact probability test, Mann-Whitney U test, and Bonferroni correction. Results: (1) On 7, 14, 21, and 28 d after the first debridement, the wound healing rates of patients in laser debridement group (29.5% (24.1%, 36.0%), 47.1% (42.7%, 62.4%), 71.4% (62.2%, 76.8%), and 88.6% (79.2%, 96.3%) were significantly higher than those of surgical debridement group (1.6% (1.0%, 12.8%), 12.7% (2.0%, 16.6%), 24.5% (8.9%, 45.5%), 43.9% (23.2%, 70.8%), Z=3.477, 3.553, 2.721, 2.193, P<0.05 or P<0.01). (2) Before the first debridement, the positive rates of bacterial culture of wounds in patients of laser debridement group and surgical debridement group were 92% (23/25) and 91% (21/23), respectively, which were similar (P>0.05). After the first debridement, the positive rate of bacterial culture of wounds of patients in surgical debridement group was 64% (16/25), which was significantly higher than 13% (3/23) of laser debridement group (P<0.01). (3) On 7, 14, and 28 d after the first debridement, the scores of color and texture of wound granulation tissue of patients in laser debridement group were significantly higher than those of surgical debridement group (Z=3.420, 5.682, 6.142, 4.461, 5.337, 4.458, P<0.01). (4) The pain scores during every debridement and after every debridement dressing change in patients of laser debridement group were significantly lower than those of surgical debridement group (t=2.847, 5.046, P<0.05 or P<0.01). (5) The time of debridement dressing change in laser debridement group was 8.0 (7.0, 10.0) times, which was significantly less than 10.0 (9.5, 12.5) times in surgical debridement group (Z=2.261, P<0.05). Conclusions: Compared with traditional surgical debridement method, super pulsed carbon dioxide fractional laser debridement surgery is more effective in treating patients with chronic wounds. Laser debridement makes the wound healing more efficiently with reduced pain and better infection control; significantly reduces the number of dressing changes, and is especially suitable for the wound treatment in outpatients.

Maternal serum uric acid concentration is associated with the expression of tumour necrosis factor-α and intercellular adhesion molecule-1 in patients with preeclampsia.

We aimed to investigate whether there is a correlation between elevated serum uric acid (SUA) concentration and endothelial inflammatory response in women with preeclampsia (PE). On the basis of clinical and laboratory findings, patients were assigned to three groups: normal blood pressure (Control (Con)), gestational hypertension (GH) and PE (n=50 in each group). SUA concentration was measured by spectrophotometry, and serum tumour necrosis factor-α (TNF-α) and intercellular adhesion molecule-1 (ICAM-1) levels were measured by enzyme-linked immunosorbent assay. Western blotting and immunohistochemical staining were also used to detect the changes in TNF-α and ICAM-1 expression in subcutaneous fat tissue. PE patients showed significantly higher systolic and diastolic blood pressures compared with Con and GH pregnant women (P=0.02 and P=0.02, respectively). The changes of body mass index (ΔBMI) before and after pregnancy and 24-h urine protein were significantly different among the three groups (P<0.001). Maternal SUA, TNF-α and soluble ICAM-1 (sICAM-1) levels were significantly increased in the patients with PE (P<0.05) compared with the other two groups. Scatterplot analysis revealed that elevated SUA concentration positively correlated with TNF-α and sICAM-1 in pregnant women. Moreover, vessels in subcutaneous fat tissues of preeclamptic patients showed intense TNF-α and ICAM-1 staining compared with Con and GH patients. The results support that, to a certain extent, elevated SUA concentration is significantly associated with inflammation of maternal systemic vasculature as indicated by increased TNF-α and ICAM-1 expression in women with PE.

Variability of urinary sodium and potassium excretion in north Chinese men.

Variability of urine sodium (Na), potassium (K) and sodium/potassium (Na/K) excretion was studied in a sample of 50 employed normotensive male health professionals aged 27-50 in Beijing, China. Six 24-h urine specimens were collected from each participant during night-time (12-h) and daytime (12-h) fractions. The estimated ratio of intra- to inter-individual variances was 2.12 for night-time and 1.48 for 24-h urine Na, and 1.85 and 1.54, respectively, for urine K. Based on these values, six night-time and four 24-h urine specimens are necessary to reduce to 15% the diminution of a correlation between urine Na and another physiological variable. The corresponding numbers are five and four, respectively, for urinary K measurement. These data suggest that the ratio of within-person variation to between-person variation in Na excretion is smaller in these Chinese men than in Americans. The dietary Na intake of Chinese men can therefore be characterized with fewer urine specimens than are required for western populations. Night-time urinary Na and K showed good concordance with those from 24-h specimens in distinguishing high or low Na and K intake. These findings indicate that in large-scale epidemiological studies, overnight specimens may be adequate for classifying individuals with regard to Na and K intake.

Aortoarteritis: a report of 480 cases.

We report 480 patients with aorto-arteritis studied in our group. Among 320 patients, who were diagnosed by aortography the female to male ratio was 2.8:1, and the age of onset ranged from 5-45 years. The patients were followed for 1-27 years (average 6.8 years). Two hundred and eighty-six (59.6%) patients with renovascular hypertension were found in the group. All patients were treated with medical or surgical procedures. One hundred and thirty patients with renovascular hypertension were operated upon by revascularisation or uninephrectomy and 11 patients with renal artery stenosis were subjected to percutaneous transluminal renal angioplasty. There were 55 deaths (11.5%) in the group, cerebral haemorrhage being the major cause of death. Five year and ten year survival rates were 93.1% and 91.1% respectively.

Comparison of erythrocyte membrane Ca2(+)-Mg2(+)-ATPase activity in children with and without family history of essential hypertension.

The causes of elevated intra-erythrocyte calcium in the offspring of essential hypertensive patients are unknown. Fourteen children with and without a family history of essential hypertension were chosen to compare erythrocyte membrane Ca2(+)-Mg2(+)-ATPase activity (Rbc-M Ca2(+)-Mg2(+)-ATPase activity) measured by biochemical methods. We found that Rbc-M Ca2(+)-Mg2(+)-ATPase activity was lower in children with family history of hypertension compared with children with no family history (2.16 +/- 1.10 vs 3.36 +/- 1.19 microM Pi/mg protein/hour P less than 0.01). These results suggest that the reduced Rbc-M Ca2(+)-Mg2(+)-ATPase activity may be one of the mechanisms causing the high erythrocyte calcium levels in the offspring of essential hypertensive patients.

Clinical studies in 500 patients with aortoarteritis.

Five hundred patients with aortoarteritis were studied in this series. The long-term administration of small dosage of corticosteroid is effective in treating this disease in its active stage. The patients with renal vascular hypertension should be treated by percutaneous transluminal renal angioplasty or by surgery if indicated. About one third of the pulsations of the involved arteries were improved. The incidence of complications was 17% and the mortality rate was 11% in this series. Cerebral thrombosis was found as a common complication and hemorrhage as a common cause of death. Three patients died of heart failure without aortic regurgitation. Five-year and ten-year survival rates were 93.1% and 91.1% respectively.

Effects of atrial natriuretic factor on patients with renovascular hypertension.

Previous studies have shown the effects of atrial natriuretic factor (ANF) on rats with renovascular hypertension (RVH). In the present study low dose alpha-hANF (0.025 microgram/kg/min) was administered intravenously for 60 minutes to seven RVH patients. Results demonstrated an inhibition of renin-angiotensin-aldosterone system (RAAS), reduction of plasma catecholamine and arginine vasopressin(AVP), diuresis and natriuresis, increase of hematocrit and creatinine clearance, and slight decrease of blood pressure. These results showed that most factors involved in the establishment and maintenance of RVH are affected by ANF infusion.

[Functional and histological evidence of insulin resistance in spontaneously hypertensive rat].

In order to confirm the existence of insulin resistance in spontaneously hypertensive rat (SHR), rich musculature glucose tolerance test (GTT) and histological method examination of the insulin receptor were carried out in SHR and the normotensives (WKY). The basal serum insulin level was higher and the area under insulin curve during GTT was also higher in SHR than those in WKY, while the basal serum glucose level and the area under glucose curve during GTT in SHR were similar to those in WKY. As compared with WKY, SHR displayed a significantly lower percentage of insulin sensitive slow-twitch fiber of plantaris and medial head of gastrocnemius (type I fiber). There were strong positive correlations between blood pressure (BP) and insulin as well as between BP and the area under insulin curve, but the correlation between insulin and percentage of type I fiber was negative. In conclusion, the present study provides both functional and structural evidence of insulin resistance in SHR.

[Aortoarteritis complicated by aortic insufficiency (with an analysis of 10 cases)].

Ten cases of aortic regurgitation in the patients with aortoarteritis in our group were studied during the period 1958-1988. Nine out of 10 patients with aortoarteritis were performed by aortography. The incidence of aortic regurgitation is 2.2 per cent in 450 patients with aortoarteritis. In all the patients with aortic regurgitation diastolic murmurs were heard in the aortic valves. X-ray findings showed dilatation of ascending aorta with aortic regurgitation in 10 patients and enlargement of left ventricle in 7 patients. Subclavian artery and carotid artery were involved in all patients. Descending aorta or abdominal aorta were also involved in 6 of them. Two patients with angina pectoris were studied by coronary arteriography and the coronary arteries were normal. Clinically, these cases should be differentiated from aortic regurgitation of other etiology.

[Comparison of erythrocyte membrane Ca2(+)-Mg2(+)-ATPase activity in children with and without a family history of essential hypertension].

15 children with and without family history of essential hypertension respectively were chosen to compare erythrocyte membrane Ca2(+)-Mg2(+)-ATPase activity measured with biochemical method. Results were as follows: erythrocyte membrane Ca2(+)-Mg2(+)-ATPase activity was lower in children with family history of essential hypertension (2.16 +/- 1.10 vs 3.36 +/- 1.19 mumol Pi.mg protein-1/hour, P less than 0.01). This may be the cause of increase of intraerythrocyte calcium in offspring of hypertensive patients.

The visual diagnosis of tuberculous pleuritis under medical thoracoscopy: a retrospective series of 91 cases.

BACKGROUND: Despite progress of medical, the fast and accurate diagnosis of tuberculous pleuritis (TP) continues to be a challenge, mainly because of the lack of specific clinical features and the difficulty in isolating the Mycobacterium tuberculosis. OBJECTIVES: To investigate the role of medical thoracoscopy in definite diagnosis of tuberculous pleuritis, especially the feature of visual diagnosis in tuberculous pleuritis via medical thoracoscopy. We performed a retrospective review of the utility of medical thoracoscopy in tuberculous pleuritis. PATIENTS AND METHODS: A retrospective chart review was performed of 91 patients who had medical thoracoscopy for suspected TP at the Second Xiangya Hospital from October 1, 2006 to July 30, 2012. RESULTS: In ninety one cases, 76 patients were diagnosed with TP by pathologic diagnosis. The visual findings via thoracoscopy of 76 TP patients included the following: (1) necrosis (76.32%, n=58), (2) diffuse miliary nodules (64.67%, n=49), (3) single or multiple pleural nodules (14.47%, n=11), (4) hyperemic, edematous and thickened pleura (56.58%, n=43), and (5) pleural adhesions or fibrotic septa (78.95%, n=60), and all of these samples had hydrothorax or loculated effusion. The diagnostic efficiency of visual diagnosis via medical thoracoscopy about tuberculous pleuritis was 93.41%. In the non-invasive test, ADA > 40 u/l with LDH > 200 u/l for TP showed relatively high sensitivity and specificity (73.68%, 80.00%, respectively). CONCLUSIONS: TP presents a variety of scopic phenotypes under medical thoracoscopy. The experienced pulmonologists visually diagnose TP efficiently and directly via medical thoracoscopy. Medical thoracoscopy with combined biopsy is an accurate and safe method for diagnosing TP.