OKT单克隆抗体检测单纯疱疹性角膜炎中药治疗前后外周血T细胞亚群的研究

为探讨单纯疱疹性角膜炎中药治疗前后外周血Ｔ细胞亚群变化。用ＯＫＴ单克隆抗体检测了１１２例单纯疱疹性角膜炎，随机分为中药治疗组６０例，西药对照组５２例。结果表明：中药治疗组治愈率８６６％，总有效率９８３３％；西药对照组治愈率７１１５％，总有效率９０３８％；两组差异有显著性意义（Ｐ＜００５）。外周血Ｔ细胞亚群：治疗前两组患者辅助性Ｔ细胞的比例明显低于抑制性Ｔ细胞（Ｐ＜００１）；中药治疗组辅助性Ｔ细胞治疗后较治疗前明显提高（Ｐ＞００５），而西药对照组治疗后辅助性Ｔ细胞较治疗前虽有提高，但无显著性差异（Ｐ＞０１）。认为单纯疱疹性角膜炎患者服中药后，机体内辅助性Ｔ细胞比值增加，细胞免疫功能增强。     

刘以敏导赤泻黄散治疗小儿急性疱疹性咽峡炎

刘以敏认为"手少阴,心之经也,心气通于舌;足太阴,脾之经也,脾气通于口。腑脏热盛,热乘心脾,气冲于口与舌,故令口舌生疮也","诸痛痒疮疡,皆属心火",小儿疱疹性咽峡炎特点为疱疹性溃疡性黏膜损害。以心脾火旺立论,清心泄热,升阳散火,以导赤泻黄散化裁(生地黄3~10g,灯芯1~3g,生甘草梢3~6g,竹叶3~6g,藿香叶3~10g,山栀仁1~4g,石膏10~20g,升麻3~10g,柴胡6~10g,大青叶4~6g,神曲6~10g),发热重用柴胡、石膏,惊厥加全蝎、僵蚕,伤阴加沙参、天花粉,大便干结,腑气不通,加大黄、枳实,中病即止,不可多服。不宜一味清热解毒,注意升阳散火,单纯清里,易引邪内行,邪传心包,发生心悸;清热不宜过于苦寒,小儿脾常不足,苦寒败胃,易伤及小儿脾胃,"脾胃内伤,百病由生"、"脾胃之气既伤,而元气亦不能充,而诸病之所由生也",始终要顾护脾胃,"留得一份胃气,便有一分生机"。避免使用西药抗病毒药引起肝肾损伤,骨髓抑制等副作用。     

三联综合治疗带状疱疹后遗神经痛临床观察

目的:观察内服中药、梅花针叩刺加拔火罐、TDP加冷喷疗法三者联合治疗PHN的疗效。方法:100例带状疱疹后遗神经痛患者随机分成5组,A组予中药、梅花针叩刺后加拔火罐、冷热疗;B组予中药、梅花针叩刺后加拔火罐;C组予中药、冷热疗;D组叩梅花针后加拔火罐、冷热疗;E组予传统药物治疗。结果:有效率A组90.0%,B组80.0%,C组75.0%,D组70.0%,E组45.0%。讨论:三联综合治疗组疗效优于传统药物对照组,也优于其他二联对照组。     

Animal models of neuropathic pain

Animal models are pivotal for understanding the mechanism of neuropathic pain and development of effective therapy for its optimal management. A battery of neuropathic pain models has been developed to simulate the clinical pain conditions with diverse etiology. The present review exhaustively discusses the methodology, behavioral alterations, limitations, and advantages of about 40 different animal models of neuropathic pain along with their modifications. Development of these models has contributed immensely in understanding the chronic pain and underlying peripheral as well as central pathogenic mechanisms. Furthermore, research has resulted in the development of new therapeutic agents for neuropathic pain management, and the preclinical data obtained using these animal models have been successively translated to effective pain management in clinical setup also. As each animal model has been created with specific methodology and results tend to vary largely with the slight changes related to methodology, therefore, it is essential that data from different models should be reported and interpreted in the context of the specific pain model.     

No evidence of family history as a risk factor for herpes zoster in patients with post‐herpetic neuralgia

Little is known about reactivation of latent varicella zoster virus as herpes zoster in individuals with no underlying immunosuppression. Risk factors include age, sex, ethnicity, exogenous boosting of immunity from varicella contacts, underlying cell‐mediated immune disorders, mechanical trauma, psychological stress, and immunotoxin exposure. An association between herpes zoster and family history of zoster has been proposed. A case‐control study involving patients affected by post‐herpetic neuralgia, which usually follows more severe acute herpes zoster, was performed. The patients with post‐herpetic neuralgia were enrolled at the Pain Clinic of the Policlinico Tor Vergata in Rome, Italy, within 1 year from the onset of acute zoster. The controls matched for sex and age were chosen among healthy subjects without a history of herpes zoster presenting at the Internal Medicine Outpatient Clinic for hypertension in the same time period. All the participants in the study gave informed consent and were interviewed by medically trained and blinded investigators using a questionnaire. Similar proportions of the patients and the controls reported a family history of herpes zoster irrespective of the degree of relationship, i.e., 17.4% and 18.2%, respectively, by analyzing only the first‐degree relatives [RR 1.03 (CI 95%: 0.78–1.37)], and 28.4% and 29.6%, respectively, by analyzing the total number of relatives [RR 1.03 (CI 95%: 0.81–1.31)]. Further and larger prospective cohort studies are needed to ascertain whether a family history of herpes zoster is really an independent predictor of zoster in different geographical settings. J. Med. Virol. 82:1007–1011, 2010. © 2010 Wiley‐Liss, Inc.     

A Randomized,Prospective Study of Efficacy and Safety of Oral Tramadol in the Management of Post‐Herpetic Neuralgia in Patients from North India

Objective: To evaluate the safety and efficacy of oral tramadol therapy (50 to 200 mg/day) in the treatment for post‐herpetic neuralgia (PHN). Methods: The study was a prospective, single‐blind, non‐responder vs. responder, randomized trial conducted in 100 outpatients of PHN after oral administration of tramadol for 4 weeks. Those patients who had achieved 50% or greater pain relief after 14 days of oral tramadol treatment were categorized as responders and those reporting < 50% pain relief were categorized as non‐responders. Rescue analgesia was provided by the topical application of a cream consisting of the combination of 3.33% doxepin and 0.05% capsaicin to the affected areas of PHN patients of both groups for at least 14 days, along with tramadol therapy. The rescue analgesia was extended to 4 weeks in patients of the non‐responder group. The primary endpoints were measured using a Numerical Rating Scale (NRS) at rest and with movement. Secondary endpoints included additional pain ratings such as global perceived effect (GPE), Neuropathic Pain Symptom Inventory scores (NPSI), daily sleep interference score (DSIS), Quality of life (QOL) as per WHO QOL‐BREF Questionnaire scores, patient and clinician ratings of global improvement. The 2 groups were compared on the basis of pain intensity scores, encompassing primary as well as secondary endpoints, and QOL after 28 days of the treatment regimen. Results: Pain intensity scores measured by NRS (at resting and with movement), NPSI, and DSIS were consistently reduced (P < 0.001) over 28 days at varying intervals in both the groups, but the magnitude of reduction was higher in responders than non‐responders. A concomitant improvement (P < 0.001) was observed in GPE on days 3, 14, and 28 as compared to the respective baseline scores in both the groups. Although the WHO QOL‐BREF scores showed significant (P < 0.001) improvement in QOL of PHN patients at days 14 and 28 in both the groups, the magnitude of improvement was higher in responders as compared to non‐responders. Significant improvement in pain intensity scores and QOL in non‐responders is mainly attributed to the use of rescue analgesia for 28 days rather than recommended tramadol therapy. Conclusions: Treatment with tramadol 50 to 200 mg per day was associated with significant pain reduction in terms of enhanced pain relief, reduced sleep interference, greater global improvement, diminished side‐effect profile, and improved QOL in PHN patients from North India. Further categorization of PHN patients may be helpful so that additional or alternative therapy may be prescribed to non‐responders.     

张炜教授临证之三仁汤新用举隅

三仁汤为清代吴鞠通所著《温病条辨》中的名方,是治疗湿温病的代表方,备受后世医家喜爱,笔者依据老师张炜教授在临床上辨证应用三仁汤治疗儿科常见病(小儿厌食、荨麻疹)及疑难病(血小板减少性紫癜、肺含铁血黄素沉积症)验案举隅,探讨三仁汤在中医学的辨证论治和异病同治理论指导下,被广泛应用于临床各类疾病的治疗.     

Persisting epithelial herpes simplex keratitis while on cyclosporin-A ointment

Background: This is the first report of cyclosporin-A ointment (CsA) adversely affecting epithelial herpes simplex virus keratitis in a corneal graft.
Methods: The details of this case were obtained from the patient's record at The Wilmer Ophthalmological Institute.
Results: Ceasing CsA ointment resulted in resolution of the epithelial HSV keratitis.
Conclusion: Immunosuppression caused by CsA ointment resulted in persisting epithelial HSV keratitis despite adequate topical treatment.     

Evaluation of topical 0.03% flurbiprofen drops in the treatment of herpetic stromal keratitis

Purpose: The management protocol for herpetic stromal keratitis (HSK) is still controversial. We have attempted to compare the relative efficacy of topical dexamethasone 0.01 % and flurbiprofen 0.03% in combination with topical acyclovir 3% in HSK.
Methods: In this institutional, prospective, randomized, controlled, double-blind study, 45 clinically diagnosed cases of HSK were randomly distributed into three coded treatment groups — topical placebo, dexamethasone 0.01 %, and flurbiprofen 0.03% each in tapering frequency and in combination with acyclovir 3% ointment five times per day for four weeks. Therapeutic response was assessed every third day for four weeks. Decoding of the treatment groups was done at the conclusion of the study and data analysed.
Results: Four-week success rate was 93.3% (14 of 15) in the dexamethasone-acyclovir treatment group, 66.7% (10 of 15) in the flurbiprofen-acyclovir treatment group and 20% (3 of 15) in the placeboacyclovir treatment group.
Conclusion: While dexamethasone in combination with acyclovir gives the best results in HSK with minimal side-effects, the role of topical flurbiprofen seems promising.