Mucormycosis is a rare opportunistic infection usually associated with immunosuppression, diabetes mellitus or haematological malignancy. Herein, we report an unusual case of mucormycosis in a 46-yr-old male patient with diabetes presenting with an endotracheal mass obstructing the trachea and cartilage damage. Histological examination of the bronchoscopy biopsy specimens revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by removal of the lesion via bronchoscopy.KEYWORDS: Cartilage damage, dyspnoea, mucormycosis, tracheal stenosis M ucormycosis, also called zygomycosis, is an important opportunistic infection caused by fungus that belongs to the class Zygomycetes, which is the third most common invasive fungal infection after candidosis and aspergillosis [1]. Although the infection rate of mucormycosis is very low, patients with immunosuppression, diabetes mellitus or haematological malignancy are at the highest risk for mucormycosis. Mucorales rarely invades the trachea. Tracheal cartilage damage is extremely rare in pulmonary mucormycosis. Herein, we report an unusual case of mucormycosis in a diabetic male presenting with an endotracheal mass obstructing the trachea and cartilage damage with histological confirmation of endotracheal mucormycosis. CASE REPORTA 46-yr-old male nonsmoker was admitted to our hospital (West China Hospital, Sichuan University, Chengdu, China) because of throat discomfort, cough and expectoration of 1 month duration. Simultaneously, he had mild dyspnoea, especially during exercise. He also had type 2 diabetes, which had been diagnosed ,5 yrs previously; his diabetes had been poorly controlled by diet alone. Physical examination revealed that bilateral lung breathing sounded rough and moist rales could be heard in the left lung. Laboratory data showed that the white blood cell count was 11.82610 9 L -1 with 76.7% neutrophils and hyperglycemia (18.57 mmol?L -1 ) was observed. Blood urea nitrogen and creatinine were normal. Acid-fast bacilli smears and cultures of sputum were negative. We also excluded the possibility of HIV infection. Computed tomography of the chest and neck indicated that the tracheal wall was thickened, the cricoid cartilage was damaged and the lumen was narrow ( fig. 1). Fibreoptic bronchoscopy revealed that the upper airway mucosal was oedematus, thickened and that the lumen was narrow and funnel-shaped. A valve-like neoplasma was seen on the right wall of upper trachea ( fig. 2). Biopsies were obtained by removal of the lesion via bronchoscopy and the histological sections revealed moderate chronic inflammation in the mucosa of the upper trachea, associated with inflammatory exudates, necrosis, granulation tissue proliferation and numerous hyphae of mucormycosis. Histochemical staining indicated negative acid-fast stain, positive periodic acidSchiff, positive hexamine stain and positive mucus carmine stain. He was diagnosed with endotracheal mucormycosis with granulation formation and diabetes mellitus.Diab...

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ObjectiveTo observe the associations between regional peripheral refraction and myopia development in young Chinese people.MethodsTwo hundred and forty-one young adult subjects (21 emmetropes, 88 low myopes, 94 moderate myopes, and 38 high myopes) aged 18–28 years were included, and only the right eyes were tested. Eye biometrics were measured before pupil dilation using the Lenstar. Relative peripheral refractive errors (RPRE) were measured after pupil dilation using multispectral refractive topography (MRT), at nine retinal eccentricities: 0–5, 5–10, 10–15, 15–20, 20–25, 25–30, 30–35, 35–40, and 40–45 degrees.ResultsIn this study, RPRE increased with eccentricity, and it shows a growing trend with the increase of the degree of myopia among emmetropia, low myopia and moderate myopia groups, and RPRE varied with myopia severity at eccentricities between 20 and 35 degrees only. In addition, axial length (AL) and RPRE were positively correlated between 20 and 45 degrees, and AL was an independent risk factor for RPRE between 20 and 35 degrees.ConclusionThese findings indicate that the eccentricities between 20 and 35 degrees RPRE may be closely related to refractive development and eye growth in young Chinese people.

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Diabetic kidney disease (DKD) is the most common complication of diabetes mellitus and has become the primary cause of End-Stage Renal Disease (ESRD) globally. Icariin (ICA), an effective component extracted from Epimedium, has antiosteoporosis effect, antitumor effects, anti-ischemia effects, and other effects. In this study, a mouse DKD model was established, and Icariin solid nanoliposomes were administered to determine whether ICA had a protective effect on the renal function of DKD mice by regulating estrogen level and endoplasmic reticulum (ER) stress pathway. The results showed that the microalbumin/creatinine in urine, serum urea nitrogen, and CHOL in ICA cultured DKD mice significantly decreased, and mice nephropathy improved significantly. rat renal tubule epithelial cells were further tested, and the rat renal tubule epithelial cells were modeled by cultured cells with high glucose. The results showed that high glucose could promote the proliferation of renal tubular epithelial cells. Simultaneously, ICA can inhibit the proliferation of renal tubular epithelial cells and induce cell apoptosis. Furthermore, the expression of ER stress-related proteins IRE1 and XBP-1S was further detected. Additionally, to ICA intervention, a GPER antagonist (G-15) was added for intervention, the inhibitory effects of IRE1 and XBP-1S were reversed, and the ER stress pathway was activated. Cell experiments showed that ICA could promote GPER expression, while inhibiting GPER expression promoted the activation of ER stress pathway, and GPER expression was negatively correlated with ER stress protein expression. Therefore, the experiment proved that in DKD tissues, a high concentration of ICA can inhibit the ER stress response by promoting the expression of GPER, reducing the proliferation of diabetic nephropathy, and increasing the rate of tissue apoptosis.

BACKGROUND Cholesterol crystal embolization (CCE) is a multisystemic and fatal disease with multiple clinical manifestations; however, there are few cases of idiopathic CCE. Here we report a patient with idiopathic CCE accompanied by atheroembolic renal disease and blue toes who had a relatively good prognosis in the short-term due to early treatment with corticosteroids and statins. CASE SUMMARY A 76-year-old man complained of coldness, numbness and purple color change in his left foot for 7 d. He had a feeling of fatigue, constipation, foamy urine, poor appetite and sleep. He had a lacunar infarction for 5 years and hypertension for 9 mo. Laboratory results showed elevated eosinophils, cholesterol, uric acid, serum creatinine, urea and 24 h urine analysis revealed proteinuria. A renal biopsy revealed atheroembolic renal disease. Taken together, these findings strongly supported the diagnosis of idiopathic CCE and atheroembolic renal disease. CONCLUSION Atheroembolic renal disease and blue toes syndrome can be caused by idiopathic CCE, and early treatment with corticosteroids is effective but requires further investigation.