带状疱疹的发生与脊柱损伤的关系探讨

目的探讨带状疱疹（Hz）的发生与脊柱损伤之间的关系。方法首先明确脊柱损伤的四项标准：即脊柱损伤史，与Hz相对应的脊柱部位的疼痛和压痛，相应的X线或cT检查诊断。然后将16例确诊为脊柱损伤的Hz病例与同期的56例Hz依其就诊时间和地点自然形成的6个组别进行检验。结果显示了脊柱损伤是Hz发生的重要原因之一。结合现代脊柱病学观点，一元化的解释了Hz的发病机制、临床体征，特别是呈单侧性的带状分布现象的原因。结论Hz的发生是脊柱损伤和类水痘病毒感染二者共同作用的结果，前者为先决条件，后者是继发感染的病原因素。     

The association of infectious agents and schizophrenia

Abstract

Objectives. The influence of infectious agents on the pathogenesis of psychiatric disorders has been discussed for decades. Pre- and postnatal infections are risk factors for schizophrenia. This may be explained by chronic infections or an altered immune status. However most of the studies have only focused on one single pathogen and not on the impact of different infectious agents. We investigated the association between schizophrenia and various neurotophic infectious agents. Methods. A total of 31 schizophrenic patients and 30 healthy matched individuals were included. Antibody titres of cytomegalovirus, herpes simplex virus, Epstein-Barr virus, mycoplasma, chlamydia and toxoplasma were evaluated. For statistical analysis we used Fisher's exact and Wilcoxon test. Results. Significantly elevated positive antibody titres within schizophrenic patients were found only for Chlamydia trachomatis (P=0.005) and a trend to significance for herpes simplex virus (P=0.055). Combining the different agents, schizophrenics had a significantly higher rate of positive titres to infectious agents as compared to controls (P=0.04). Conclusions. The higher prevalence of antibodies within schizophrenic patients emphasizes a possible role of infectious agents in the pathogenesis of schizophrenia. Our data indicates that not one specific agent might be responsible for schizophrenic symptoms but the resulting immune response in the central nervous system.     

Insurance reimbursements for recombinant zoster vaccine in the private sector

A two-dose series of the recombinant zoster vaccine (RZV, Shingrix) was licensed by the Food and Drug Administration in 2017 and recommended by the Advisory Committee on Immunization Practices in 2018 for adults in the United States age 50 years and older. Despite the health benefits of shingles vaccination, coverage has remained low, with financial barriers among healthcare providers identified as one potential factor. This study estimates the reimbursement levels for RZV among a large sample of privately insured individuals in the US from the 2018 IBM® MarketScan® Commercial Claims and Encounters database. Of 198,534 claims for an RZV dose, the mean reimbursement was $149. Most claims (83%) exceeded $140, which was the private sector vaccine price reported on the CDC vaccine price list in April 2018. These results can be useful for providers considering procuring RZV and for state immunization programs considering ways to improve vaccination coverage.     

微波配合阿昔洛韦治疗女性生殖器疱疹的临床疗效

目的:探讨了微波配合阿昔洛韦治疗女性生殖器疱疹的疗效和安全性。方法:选择2010年3月～2011年3月女性生殖器疱疹患者36例,按照分层分组法随机分为两组,对照组和治疗组,对照组采用阿昔洛韦进行治疗,治疗组在对照组治疗基础上采用微波进行治疗。对两组治疗效果进行评定。结果:对照组和治疗组有效率分别为90.5%和60.0%,治疗组有效率明显高于对照组(P<0.05)。治疗组复发次数明显低于对照组(P<0.05)。两组均未出现不良反应。结论:微波配合阿昔洛韦治疗女性生殖器疱疹疗效显著,安全性较高,值得临床推广使用。     

害羞生产力

创业过程里,帅也是一种生产力.我亲弟弟是“木知道”古典家具创始人,很帅,他最初是与朋友合伙创业,分管角色是销售经理,非常成功……我笑问：你卖的是色？他说,不是,是老实.怎么看你老实？他说：“我的普通话口音重,有一些害羞.”小缺点,往往是让人亲近信任的“心”武器. 据说,传统藏人做大笔生意谈价钱时,会说“拉特”（交手）,就是要你伸出手来!要你开个价,然后无论买方还是卖方,其中一方会主动把手伸到对方的长袖里面,买方会握住卖方的五指,卖方则用比手指的方式来暗示卖价.     

Successful differentiation of herpes zoster‐associated erythema multiforme from generalized extension of herpes by rapid polymerase chain reaction analysis

The polymerase chain reaction (PCR) assay for varicella zoster virus (VZV), herpes simplex virus (HSV)‐1 and HSV‐2 is available for use. Sometimes the differential diagnosis of the generalized herpes zoster (HZ), HSV1/2, and drug eruption is difficult. We report a case of HZ followed by the vesicular erythema multiforme (EM)‐like lesion. In this case the use of PCR was of great assistance. A 78‐year‐old Japanese man without any significant previous history of disease was admitted to our hospital complaining of zosteriform vesicle on an erythematous base from his right shoulder to the upper arm. We diagnosed him with HZ at the level of right Th2. In spite of the prompt start of antiviral therapy, a secondary new vesiculous erythema developed on his trunk. Clinically, it was quite difficult to differentiate the lesion from the generalized HZ. Rapid PCR assay of effusion and crust for VZV was performed. A PCR assay of VZV was positive for the crust taken from the primary lesion, while it was negative for the effusion and crust of the secondary widespread lesion. We diagnosed the secondary widespread lesion as an EM‐type drug eruption induced by acyclovir, or an EM associated with herpes zoster. We then stopped the use of acyclovir and applied steroid ointment of a very strong class for the secondary lesions, which improved after a few days. A PCR assay for VZV was useful for ruling out the generalized HZ in our case with secondary developed vesiculous lesions.     

疱疹病毒和牙周致病菌在牙周炎中相互作用的研究进展

疱疹病毒和牙周致病菌的相互作用影响着牙周炎的发生发展,二者共同感染是牙周病发病的主要病因.在牙周炎患者的龈下菌斑中,病毒的检出率远较健康者高.疱疹病毒和牙周致病菌二者可在牙周病发病的多个阶段内相互影响:病毒促进细菌的黏附和定植、牙周致病菌促进病毒的活化,二者共同改变宿主的免疫反应.在牙周病发病过程中,牙周致病菌的黏附定植、疱疹病毒的活化以及宿主的免疫抑制机制等,可相对科学合理地解释牙周病的发作区域、进展速度和严重程度等特征.如果疱疹病毒介导的分子旁路与牙周炎导致的系统性疾病的生物联系被证实,那么传统的以清除细菌为目的的治疗方法对于牙周炎治疗的效果将是有限的,而将抗病毒药物和龈下刮治和根面平整术相结合的治疗方法可能在治疗和预防牙周病及其复发方面更加有效.疱疹病毒-牙周致病菌模型不仅使人们对牙周炎的发病机制有了更深的认识,也为牙周病治疗指出了新的方向.     

Concurrent hyphema and orbital apex syndrome following herpes zoster ophthalmicus in a middle aged lady

IntroductionHyphema and orbital apex syndrome occurring concurrently in a patient with herpes zoster ophthalmicus have not been reported previously. We present a case with these unique findings and discuss the pathogenesis of these conditions and their management.Presentation of caseA 59-year-old Malay lady with underlying diabetes mellitus presented with manifestations of zoster ophthalmicus in the left eye. Two weeks later, she developed total hyphema, and complete ophthalmoplegia suggestive of orbital apex syndrome. She was treated with combination of intravenous acyclovir and oral corticosteroids, and regained full recovery of ocular motility. Total hyphema persisted, and she required surgical intervention.DiscussionHyphema is postulated to occur due to an immune vasculitis affecting the iris vessels. Orbital apex syndrome is probably due to an occlusive vasculitis affecting the vasculature of the extraocular muscles and optic nerve, resulting from a direct invasion by varicella zoster virus or infiltration of perivascular inflammatory cells. Magnetic Resonance Imaging of the brain is essential to exclude possibility of local causes at the orbital apex area.ConclusionHerpes zoster ophthalmicus is an uncommon ocular presentation. Managing two concurrent complications; persistent total hyphema and orbital apex syndrome is a challenging clinical situation. Early diagnosis and prompt treatment are essential to prevent potential blinding situation.