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Objective: Occasionally, the clinical diagnosis of Candida-associated lesion is difficult because of a variety of its clinical manifestations. There have been a few reports on Candida-associated lip lesion except angular cheilitis. In this paper, we investigate the relation of Candida in persistent lesions of the lip. Subjects and methods: The present study includes consecutive nine patients with persistent erosive lip lesion. For each patient the age at presentation, gender, duration of the disease, other symptoms or signs, complete medical history and prior treatment or medications for the symptom were obtained. Then, mycological examination and the direct cytologic examination were performed. Results: The reported average duration of the disease was 7 months. Six of nine patients had received prior treatments with topical steroids at the other clinic, which failed to resolve their symptoms. Six of nine patients had a predisposing factor for candidiasis. In the culture examination, Candida albicans were isolated in seven patients (77.8%). Five of nine patients received the direct cytologic examination, and four of them revealed pseudohyphae of fungi. The anti-fungal treatment was miconazol gel 25 mg four times per day, and average duration of the treatment was 2 weeks. The outcome was as follows: complete remission in five, remarkable response in two and no response in two. Conclusion: Our results suggested that one form of the varieties of Candida-associated lesions might be considered in the case of lip lesion with unknown origin that was persistent and ineffective to the topical steroids treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Traditionally, total atrophic tongue has been due to nutritional deficiencies, such as vitamin B12, folic acid, or iron deficiencies, and partial atrophic tongue has been well known as median rhomboid glossitis or geographic tongue. The other cause of atrophic tongue is oral candidiasis. METHODS: Forty patients with atrophic change of the tongue were examined on a relation to candidiasis. All of them complained of tongue pain on spicy or hot diet. Laboratory examinations included blood examination for diabetes and anemia, culture test and direct cytologic examination. The intensity of tongue pain was evaluated pre- and post-treatment using visual analogue scale (VAS). RESULTS: Twenty-four of 40 (60%) had pre-disposing factors of candidiasis including diabetes mellitus, malignancy, systemic steroid therapy, long-term antibiotic therapy and others in their medical history. Blood examinations revealed mild anemia and/or Fe deficiency in 5 (12.5%), mild diabetes in 4 (10.0%), both in two, while residual 29 patients (72.5%) were within reference levels. In the culture examination, candidal species were isolated in 72.5%, and almost all of them were candida albicans. The direct cytologic examination performed in 17 of 40 patients, witch revealed pseudohyphae of fungi in 14 patients (82.4%). After the antifungal treatment, the tongue pain disappeared or improved markedly in 80%. Simultaneously, the regenerative tendency of filifolm papilla of the tongue dorsum was observed in these patients. CONCLUSION: Atrophic tongue associated with pain at eating, even though it is mild atrophic change, has a high probability of being a candida-induced lesion. Long disease duration and no benefit by topical steroids are suggestive and diagnostic factors of this disease. [ABSTRACT FROM AUTHOR]

Objective: We investigated patients with tongue pain to examine whether the differential diagnosis of burning mouth syndrome and Candida-associated lesion was possible. Patients and methods: Sixty patients with tongue pain were divided into three groups according to the intensity of pain at rest and that when eating using the visual analogue scale: Group A: Functional pain group. Group B: Non-functional pain group. Group C: Mixed pain group. Antifungal treatment was scheduled for patients suspected clinically, mycologically or cytologically as having candidal infection. Results: The results of the culture test and direct examination indicated that group A was different from others by its high positivity for Candida, a good response to the antifungal treatment was obtained. On the other hand, antifungal treatment was not useful in group B, and the low possibility of Candida infection in the direct examination supported the result in this group. In group C, the positivity of Candida and the effect of the antifungal treatment were between groups A and B. Conclusion: These results may suggest that tongue pain in group A is Candida-associated, that in group B is burning mouth syndrome-induced and that of group C is mixed conditions. [ABSTRACT FROM AUTHOR]

Background Chronic kidney disease (CKD) might influence fractional flow reserve (FFR) value, potentially attenuating its prognostic utility. However, few large-scale data are available regarding clinical outcomes after FFR-guided deferral of revascularization in patients with CKD. Methods and Results From the J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry), 1218 patients were divided into 3 groups according to renal function: (1) non-CKD (estimated glomerular filtration rate ≥60 mL/min per 1.73 m 2 ), n=385; (2) CKD (estimated glomerular filtration rate 15-59 mL/min per 1.73 m 2 , n=763); and (3) end-stage renal disease (ESRD) (eGFR <15 mL/min per 1.73 m 2 , n=70). The primary study end point was the cumulative 5-year incidence of target vessel failure (TVF), defined as a composite of cardiac death, target vessel myocardial infarction, and clinical driven target vessel revascularization. Cumulative 5-year incidence of TVF was significantly higher in the ESRD group than in the CKD and non-CKD group, whereas it did not differ between the CKD and non-CKD groups (26.3% versus 11.9% versus 9.5%, P <0.001). Although the 5-year TVF risk increased as the FFR value decreased regardless of renal function, patients with ESRD had a remarkably higher risk of TVF at every FFR value than those with CKD and non-CKD. Conclusions At 5 years, patients with ESRD showed a higher incidence of TVF than patients with CKD and non-CKD, although with similar outcomes between patients with CKD and non-CKD. Patients with ESRD had an excess risk of 5-year TVF at every FFR value compared with those with CKD and non-CKD. Registration URL: https://www.umin.ac.jp; Unique identifier: UMIN000014473.

Recently, we established a collagen-binding growth factor consisting of epidermal growth factor and the fibronectin collagen-binding domain (FNCBD-EGF). FNCBD-EGF is a biologically active fusion protein that could stably bind to collagen materials, and exert its growth factor activity even after collagen binding. In this study, we investigated the concept that FNCBD moiety with high collagen affinity may enhance the effective local concentration of EGF at the site of administration in the following tissues: skin wounds, catheter-injured arteries, and hind limb muscles. In an animal model of impaired wound healing, application of FNCBD-EGF in combination with collagen gel induced granulation tissue formation in the wounds due to its sustained retention. In the injured artery, infused FNCBD-EGF remained bound to collagen exposed on the injured tissues even after blood circulation was restored. Injection of the fusion protein into the hind limbs revealed that our delivery system was effective for direct administration to muscular tissue.