Exploration of the teaching mode in critical clinical diagnosis and treatment / 基础医学与临床

Objective The clinical diagnosis and treatment remain unstandardized , and the teaching mode of critical clinical diagnosis and treatment in remote area was investigated and summarized .Methods The Critical Care County Working Group had summarized seven protocols of critical clinical diagnosis and treatment , which have been taught in the hospital located in the remote areas .The teaching mode included the theory , case discussions , and simulated practice .The examination was used to assess the effect of the teaching mode .Results A total of 573 ICU doctors from 15 provinces participated in the teaching courses .The accuracy rate of the examination was 49%at the baseline , then raised to 61%after the teaching course .Conclusions The critical diagnostic thinkings was poor in the remote area hospital ,and the education should be further strengthened .The teaching mode of "medical theory-case discussion-simulated practice" may improve the training of critical clinical diagnosis and treatment in the ICU doctors .

Application of ultrasonography guided water injection for insertion of naso-jejunal tubes / 中华护理杂志

Objective To examine the effects of application of ultrasonography guided water injection for inser-tion of naso-jejunal tubes. Methods Hospitalized patients in ICU who needed naso-jejunal tubes were recruited from one tertiary hospital in Beijing from November 2016 to April 2017. Ultrasonography guided water injection was used to assist insertion of naso-jejunal tubes. Meanwhile,we conducted semi-structured interviews to learn feel-ings and suggestions from the patients. Results A total of 40 patients were included in this study,37 patients (92.5%) were successfully inserted with the tubes at the first attempt. The duration of insertion of naso-jejunal tubes was 25 (20,38.75) min. Conclusion Ultrasonography guided water injection is a simple and convenient method to guide the placement of naso-jejunal tubes for critical ill patients,which provides guarantee for early en-teral nutrition.

Effect of phospholipomannan of Candida albicans on the production of interleukin 6 and interleukin 8 in monocytes / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate whether Candida albicans-native phospholipomannan (PLM) induce an inflammation response through Toll-like receptor(TLRé2 in human acute monocytic leukemia cell line (THP-1) cells.</p><p><b>METHODS</b>Human THP-1 monocytes were challenged with PLM in vitro. The mRNA expressions of TLR2, TLR4, proinflammatory cytokine [interleukin(IL)-6], and chemokine (IL-8) were assayed by real time reverse transcription polymerase chain reaction. The secretions of IL-6 and IL-8 were measured by enzyme-linked immunosorbent assay. The expression of TLR2 was analyzed with Western blot.</p><p><b>RESULTS</b>PLM increased the mRNA expressions and secretions of proinflammatory cytokines (IL-6) and chemokines (IL-8) in THP-1 cells (all P=0.0000). PLM up-regulated the mRNA and protein levels of TLR2 (P=0.0000), whereas the mRNA level of TLR4 was not altered. PLM hydrolyzed with β-D-mannoside manno hydrolase failed to induce gene and protein expressions of TLR2, IL-6, and IL-8. Anti-TLRS-neutralizing antibody blocked the PLM-induced secretions of IL-6 and IL-8 in THP-1 cells (P = 0.0003, P = 0.0010).</p><p><b>CONCLUSION</b>Canidada albicans-native PLM may contribute to the inflammatory responses during Candida infection in a TLR2-dependent manner.</p>

Higher concentration of CO₂ and 37°C stabilize the less virulent opaque cell of Candida albicans / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Candida albicans (C. albicans) strains can spontaneously switch at a very low frequency from white to opaque phase. The ability to switch reversibly between white and opaque phenotype and contributes to the pathogenicity of C. albicans. White and opaque switching can be induced by various environmental signals. Previous study showed that opaque cells switch en masse to white when transferred in vitro to 37°C, the temperature of their animal host. The objective of the present study was to determine the effect of different concentration of carbon dioxide and temperature on white-opaque switching, and to determine the different anti-candida killing activity of white and opaque form by human monocyte-macrophage cell line THP-1.</p><p><b>METHODS</b>White-opaque switching and opaque-white switching were assayed. Modified Lee's medium supplemented with phloxine B was used to detect white and opaque forms of C. albicans under 0.03% CO2 at 25°C, 0.03% CO2 at 37°C and 5% CO2 at 37°C. Growth curve of C. albicans was monitored using OD value at 630 nm simultaneously. White and opaque forms of C. albicans and THP-1 cells were cocultured at ratio of 1:10. Colony serial dilutions were used to assay for intracellular candidacidal activity. MTT assay was used to measure the extracellular candidacidal activity.</p><p><b>RESULTS</b>Phenotype switching was successfully induced in vitro in all three strains of C. albicans. When evaluating white to opaque switching, opaque colony proportion of all colonies was 0.572 ± 0.087, 0.920 ± 0.030 and 0.985 ± 0.026 exposure of white cells to 0.03% CO2 at 25°C, 0.03% CO2 at 37°C and 5% CO2 at 37°C. When evaluating opaque to white switching, opaque colony proportion of all colonies was 0.600 ± 0.114, 0.983 ± 0.003 and 0.998 ± 0.003 exposure of white cells to 0.03% CO2 at 25°C, 0.03% CO2 at 37°C and 5% CO2 at 37°C. No significant difference of white or opaque form growth rate was found among three conditions (P > 0.05). THP-1 mediated extracellular anti-candida activity in white form was (79.80 ± 3.71)% and (56.28 ± 19.12)% at different dilution ratio, which were significantly lower than that in opaque form (100%, P < 0.01). THP-1 mediated intracellular anti-candida activity in white form ((62.98 ± 5.02)%) was significantly lower than that in opaque form ((87.07 ± 1.80)%, P < 0.01).</p><p><b>CONCLUSIONS</b>Our results showed that opaque form is more vulnerable and less virulent than that in white form. It suggested that higher concentration of CO2 and 37°C in host niches stabilize the less virulent opaque cell of C. albicans, which might have implications for pathogenesis, commensalism and mating.</p>

Insoluble beta-glucan from the cell wall of Candida albicans induces immune responses of human THP-1 monocytes through Dectin-1 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>beta-glucan is the major structure component of Candida albicans (C. albicans) cell wall. It has been demonstrated that Dectin-1 as the principal C-type lectin pattern-recognition receptor (PRR) can recognize fungal beta-glucan and induce immune responses. In this study, we sought to clarify whether insoluble beta-glucan from the cell wall of C. albicans (CaIG) could induce immune responses in human THP-1 monocytes (a human acute monocytic leukemia cell line) and to determine the underlying mechanisms.</p><p><b>METHODS</b>Human THP-1 monocytes were challenged with CaIG in vitro. The mRNA expression of Dectin-1, Toll-like receptors (TLR2), proinflammatory cytokine (TNF-alpha) and chemokine (IL-8) was assayed by real-time reverse transcription polymerase chain reaction (RT-PCR). The secretion of TNF-a and IL-8 were measured by enzyme-linked immunosorbent assay (ELISA). H(2)O(2) release was determined by microplate fluorescent assay. Western blotting was used to analyze IkappaB-a phosphorylation and degradation.</p><p><b>RESULTS</b>Exposure of THP-1 monocytes to CaIG led to increased gene expression and secretion of TNF-alpha and IL-8. CaIG induced H(2)O(2) release in a time-dependent manner. CaIG hydrolyzed with zymolyase failed to induce gene expression and secretion of TNF-alpha, IL-8 and H(2)O(2) release. CaIG up-regulated the mRNA of Dectin-1, whereas the mRNA level of TLR2 was not altered. THP-1 monocytes challenged with CaIG resulted in the activation of NF-kappaB in a time-dependent manner. Dectin-1 inhibitor laminarin blocked the CaIG-induced production of TNF-alpha and H(2)O(2) in THP-1 monocytes, but no such effect was observed in pretreatment with anti-TLR2 neutralizing antibody and the LPS inhibitor (polymyxin B).</p><p><b>CONCLUSION</b>CaIG may play a role in activation of immune responses in human THP-1 cells through Dectin-1, not TLR2.</p>

Establishing an experimental guinea pig model of dermatophytosis Using Trichophyton rubrum / 中国医学科学院学报

<p><b>OBJECTIVE</b>To construct an animal model infected by Trichophyton rubrum.</p><p><b>METHODS</b>Three different strains of Trichophyton rubrum were separated from clinical specimen for the infection of guinea pigs. Corticosteroids were given before and after the construction of animal model to facilitate the infection. Direct microscopy, culture, and histopathologic methods were adopted to verify the construction.</p><p><b>RESULTS</b>Ten days after the inoculation of Trichophyton rubrum, with the intervention of corticosteroid, the guinea pigs were examined. Prominent scales and inflammation could be seen on the inoculation site of the Trichophyton rubrum infected guinea pig. Scales and hairs of Trichophyton rubrum infected guinea pig dealt with 10% potassium hydroxide, hypha out of the hair and microconidia or hypha in the hair shaft could be seen. Seven days after the inoculation of scales and hair on SDA plate, cultures of Trichophyton rubrum showed that the colonial morphology were identical to the original dermatophytes. PAS staining of infected guinea pig skin tissue showed that hypha and microconidia could be seen in the infundibula and hair root.</p><p><b>CONCLUSION</b>With the intervention of corticosteroid, a stable guinea pig model infected by Trichophyton rubrum were successfully constructed.</p>

Genotype comparisons of strains of Candida albicans from patients with cutaneous candidiasis and vaginal candidiasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is uncertain whether genotypes of Candida albicans (C. albicans) are associated with colonizing body locations or variant conditions of infection. The aim of this study was to investigate whether there are significant associations between strain genotypes and body sites of infection and to determine the potential pathogenesis of cutaneous candidiasis at multiple locations.</p><p><b>METHODS</b>A total of 151 strains of C. albicans were isolated from 74 infant patients with cutaneous candidiasis and 61 female patients with vaginal candidiasis. Patients were grouped according to the body sites and underlying conditions of infection. Genotypes were identified by polymerase chain reaction (PCR) of the 25S rDNA and PCR-restriction fragment length polymorphism (RFLP) of ALT repeats digested with EcoRI and Clal.</p><p><b>RESULTS</b>Ten genotypes were detected. There were significant differences in genotype frequencies between the two groups. However, we found no clear association between genotypes and the sites of cutaneous infection or the underlying conditions of vaginal candidiasis (VVC). In addition, strains of C. albicans from multiple cutaneous locations of the same patient had identical genotypes.</p><p><b>CONCLUSIONS</b>Populations of C. albicans from patients with cutaneous and vaginal candidiasis were genetically different. However, the lack of genetic difference between strains from different body sites with cutaneous infections or from different underlying conditions for VVC suggests no evidence of genotype selection for different skin surfaces or patients with different underlying conditions for VVC.</p>

Effects of Malassezia isolates on cytokines production associated with melanogenesis by keratinocytes / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the co-culture of keratinocytes with Malassezia isolates which cause the pityriasis versicolor with different color and to analyze the changes of cytokines associated with melanogenesis.</p><p><b>METHODS</b>The effects of Malassezia species with different proportions on the growth rate of keratinocytes was assessed with 5 g/L methyl thiazolyl tetrazolium (MTT). Co-culture of keratinocytes and Malassezia species were performed with isolates from hyer- and hypo-pigmentation areas of pityriasis versicolor. The supernatants were collected at different time points, and the changes of basic fibroblast growth factor (b-FGF), endothelin-1 (ET-1), nerve growth factor-beta (NGF-beta), interleukin-1alpha (IL-1alpha), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), stem cell factor (SCF) were recorded. Three control groups were established accordingly.</p><p><b>RESULTS</b>When the ratio between keratinocytes and Malassezia species was lower than 1: 10, the growth rate of keratinocytes was not affected by Malassezia (P > 0.05). When the ratio was increased above 1:20, the growth rate of keratinocytes was significantly inhibited by Malassezia (P < 0.01). The secretions of IL-1alpha, IL-6, TNF-alpha, and ET-1 was significantly increased after the co-culture of keratinocytes and Malassezia (P < 0.01), while those of b-FGF, NGF-beta, and SCF had no significant changes (P > 0.05). Compared with the isolates from the hypo-pigmentation area, ET-1 induced by isolate from hyperpigmentation area significantly increased (P < 0.01).</p><p><b>CONCLUSION</b>When Malassezia isolates are co-cultured with keratinocytes, the secretions of cytokines associated with melanogenesis may differ from each other. ET-1 may play certain role in the hyper-pigmentation of pityriasis versicolor.</p>