Combination therapy with itraconazole and terbinafine for phaeohyphomycosis caused by Exophiala spinifera: A case report and literature review.

Exophiala spinifera is a rare dematiaceous fungus causing cutaneous, subcutaneous and disseminated phaeohyphomycosis (PHM). Standard antifungal therapy for PHM is still uncertain. Here, we report a case of a Chinese male with PHM caused by E. spinifera, who received significant clinical improvement after the treatment with oral itraconazole and terbinafine. With the aim of evaluating the antifungal therapy for PHM caused by E. spinifera, a detailed review was performed.

Deep learning-based diagnosis models for onychomycosis in dermoscopy.

BACKGROUND: Onychomycosis is a common disease. Emerging noninvasive, real-time techniques such as dermoscopy and deep convolutional neural networks have been proposed for the diagnosis of onychomycosis. However, deep learning application in dermoscopic images has not been reported. OBJECTIVES: To explore the establishment of deep learning-based diagnostic models for onychomycosis in dermoscopy to improve the diagnostic efficiency and accuracy. METHODS: We evaluated the dermoscopic patterns of onychomycosis diagnosed at Sun Yat-sen Memorial Hospital, Guangzhou, China, from May 2019 to February 2021 and included nail psoriasis and traumatic onychodystrophy as control groups. Based on the dermoscopic images and the characteristic dermoscopic patterns of onychomycosis, we gain the faster region-based convolutional neural networks to distinguish between nail disorder and normal nail, onychomycosis and non-mycological nail disorder (nail psoriasis and traumatic onychodystrophy). The diagnostic performance is compared between deep learning-based diagnosis models and dermatologists. RESULTS: All of 1,155 dermoscopic images were collected, including onychomycosis (603 images), nail psoriasis (221 images), traumatic onychodystrophy (104 images) and normal cases (227 images). Statistical analyses revealed subungual keratosis, distal irregular termination, longitudinal striae, jagged edge, and marble-like turbid area, and cone-shaped keratosis were of high specificity (>82%) for onychomycosis diagnosis. The deep learning-based diagnosis models (ensemble model) showed test accuracy /specificity/ sensitivity /Youden index of (95.7%/98.8%/82.1%/0.809) and (87.5%/93.0%/78.5%/0.715) for nail disorder and onychomycosis. The diagnostic performance for onychomycosis using ensemble model was superior to 54 dermatologists. CONCLUSIONS: Our study demonstrated that onychomycosis had distinctive dermoscopic patterns, compared with nail psoriasis and traumatic onychodystrophy. The deep learning-based diagnosis models showed a diagnostic accuracy of onychomycosis, superior to dermatologists.

A soluble bone morphogenetic protein type 1A receptor fusion protein treatment prevents glucocorticoid-Induced bone loss in mice.

Glucocorticoid-induced osteoporosis (GIOP) is a frequent complication of systemic glucocorticoid (GC) therapy, is the most common form of secondary osteoporosis, and is associated with skeletal fragility and increased fracture risk. A soluble form of BMP receptor type 1A fusion protein (mBMPR1A-mFc) acts as an antagonist to endogenous BMPR1A and could increase bone mass in both ovariectomized and ovary-intact mice, but its effects in GIOP mice remained unclear. The aim of this study was to evaluate the effects of mBMPR1A-mFc on the skeleton in experimental models of GIOP. mBMPR1A-mFc treatment could increase the bone mineral density (BMD), trabecular bone volume, thickness, and number, and cortical thickness, and reduce the structure model index and trabecular separation in GIOP mice. mBMPR1A-mFc treatment could also prevent bone loss and enhance biomechanical strength in GIOP mice by promoting osteoblastic bone formation and inhibiting osteoclastic bone resorption. Mechanistic studies revealed that mBMPR1A-mFc treatment increased murine osteoblastogenesis by activating the Wnt/ß-catenin signaling pathway while decreasing osteoclastogenesis by inhibiting the RANK/RANKL/osteoprotegerin (OPG) signaling pathway. These findings demonstrate that mBMPR1A-mFc treatment in GIOP mice improves bone mass, microarchitecture, and strength by enhancing osteoblastic bone formation and inhibiting osteoclastic bone resorption in GIOP mice and offers a promising novel alternative for the treatment of GIOP.

A new technique for immediate endoscopic realignment of post-traumatic bulbar urethral rupture.

OBJECTIVES: Urethral injury with partial or complete disruption of urethral integrity can lead to voiding problems and serious infections. We report a new management technique involving immediate endoscopic realignment with drainage via peel-away sheath for post-traumatic bulbar urethral rupture. METHODS: Thirteen patients presenting with post-traumatic bulbar urethral rupture between July 2010 and May 2013 were treated. An 18F peel-away sheath was inserted into the anterior urethra, then a ureteroscope or nephroscope was inserted into the peel-away sheath with continuous normal saline infusion and drainage through the cavity between ureteroscope and sheath to maintain operative field clarity. A guide wire was negotiated across the disruption to the bladder and an 18F Foley catheter inserted for 2-4 weeks. Rupture severity was evaluated by urethroscopy during operation. Two patients had partial urethral rupture and 11 complete rupture. Before Foley catheter removal, pericatheter urethrography was performed to determine if urinary extravasation had occurred. Urethroscopy was performed after catheter removal. Follow-up uroflowmetry was conducted monthly for 1 year. RESULTS: This technique was successful in all patients and none experienced urinary extravasation or required open surgery. Mean operation time was 4.9±1.6 min (3-8 min) and the mean Foley catheter indwelling time was 25.8±5.3 days. During follow-up (18.4±5.4 months, 12-26 months), 6 patients developed urethral strictures (8.7±10.5 weeks, 1-28 weeks post-treatment). Strictures were managed by internal urethrotomy (1 patient) or urethral sound dilation (5) without open urethroplasty. CONCLUSIONS: Immediate endoscopic realignment with drainage via peel-away sheath is a fast, effective, and safe technique for bulbar urethral rupture.

[Modified urethral pull-through procedure for posterior urethral stricture or atresia].

OBJECTIVE: To evaluate the feasibility and safety of the modified urethral pull-through procedure for the treatment of posterior urethral stricture or atresia. METHODS: We retrospectively analyzed 212 cases of posterior urethral stricture or atresia treated by the modified urethral pull-through procedure. The length of the stricture or atresia was 1.5 - 12 cm, and 66 cases had experienced 1 - 4 previous unsuccessful urethral repairs. Simple transperineal approach was adopted in 208 cases and transperineal-inferiorpubic approach in the other 4. And 15 of the patients underwent urethral construction with grafts. RESULTS: Satisfactory voiding was achieved in 198 (93.4%) of the patients, of whom 16 received 3 - 15 urethral dilations. Of the 14 cases that failed, 10 succeeded after a second and 2 after a third operation. Of the 15 cases that underwent substitution urethroplasty, 14 achieved satisfactory voiding, and only 1 needed repeat dilation. No serious complications were observed in any of the patients. CONCLUSION: Modified urethral pull-through procedure, with its advantages of safety, mini-invasiveness, simple operation and high success rate, is feasible for the treatment of posterior urethral stricture or atresia, while for that with the length >5 cm, substitution urethroplasty should be considered.

[Reduced cardiopulmonary exercise capacity in patients with essential hypertension: impact of left ventricular hypertrophy].

OBJECTIVE: To evaluate the cardiopulmonary exercise capacity in patients with essential hypertension (EH) complicating with or without left ventricular hypertrophy (LVH). METHODS: Graded maximal exercise test on the bicycle ergometer with respiratory gas analysis were performed in 30 gender and age matched normotensive controls, 40 EH patients without LVH and 30 EH patients with LVH (LVMI>125 g/m2 in males and > 120 g/m2 in females). Metabolic equivalents (METs), oxygen uptake (VO2), oxygen uptake to body mass ratio (VO2/kg) and oxygen uptake to heart beat ratio (VO2/HR) at time of reaching anaerobic threshold (AT) and at maximal oxygen uptake (VO2max) were measured and compared. RESULTS: METs and VO2/kg were significantly reduced in EH patients with or without LVH compared with controls [at AT, METs: 3.57 +/- 0.8 and 4.34 +/- 1.47 vs. 5.21 +/- 1.45; VO2/kg: 12.38 +/- 2.85 and 14.42 +/- 4.33 vs. 18.48 +/- 4.52, all P < 0.01; at VO2max, METs: 4.94 +/- 1.24 and 5.90 +/- 1.51 vs. 6.96 +/- 1.85; VO(2)/kg: (17.20 +/- 4.34) mlxmin(-1)xkg(-1) and (20.41 +/- 4.59) mlxmin(-1)xkg(-1) vs. (24.04 +/- 5.21) mlxmin(-1)xkg(-1), all P < 0.01]. METs and VO2/kg at both time points were also significantly reduced in EH patients with LVH compared EH patients without LVH (all P < 0.05). The lower VO2/kg in hypertensive patients was significantly correlated to higher LVMI (P < 0.05). CONCLUSIONS: Cardiopulmonary exercise capacity was reduced in hypertensive patients, especially in hypertensive patients with LVH.

[Biomechanical evaluation of glenohumeral ligament in holding anterior stability of shoulder joint].

OBJECTIVE: To investigate the effect of glenohumeral ligament (GHL) in static stabilizing structure of shoulder joint. METHODS: Fifteen upper limbs specimen from fresh adult corpse were made shoulder joint-bone ligament specimen and divided in 5 groups (n=3). The load-shift curve of the following specimen was measured respectively at the shoulder joint in abductive angles of 0 degrees, 45 degrees and 90 degrees, influenced by 50 N posterior-anterior load to evaluate anterior stability of shoulder joint. According to different selective-cutting test, 5 groups were divided subgroups: group A (A1-A4), respectively normal group, superior GHL (SGHL) injury group; SGHL/middle GHL (MGHL) injury group and SGHL/MGHL/inferior GHL (IGHL) injury group; group B (B1-B3), respectively normal group, MGHL injury group, MGHL/IGHL injury group; group C (C1-C2), respectively normal group, IGHL-anterior band (IGHL-AB) injury group; group D D1-D2), respectively normal group, IGHL-posterior band (IGHL-PB) injury group; and group E (E1-E2), respectively normal group, IGHL injury group. RESULTS: For complete shoulder joint (A1 group), there was very small average shift (15.00+/-4.99 mm), for A4 group, there was the worst stability of shoulder joint, the average shift was 22.34+/-5.70 mm. For B2 group, the stability of shoulder joint had no obvious decrease. For B3 group, the stability of shoulder joint was worst at abduction angle of 45 degrees and 90 degrees. For C2 group, the stability of shoulder joint at abduction angle of 45 degrees (23.19+/-4.58 mm) and 90 degrees (15.32+/-1.30 mm) was worse than that of A1 group (P<0.05); half-dislocation or dislocation could be seen. For D2 group (17.30+/-4.93 mm), there was less effect on anterior stability of shoulder joint than that of A1 group (P<0.05). For E2 group (20.26+/-4.75 mm), the effect on anterior stability was similar to C2 group. CONCLUSION: GHL is a key static stabilizing structure of shoulder joint. SGHL has no obvious effect on anterior stability of shoulder joint. MGHL and IGHL together holds anterior stability of shoulder joint, and IGHL plays the most important role.