辨“疹”论治在中医皮肤病教学中的运用

辨证论治是运用中医的理论和方法,观察疾病,分析诊断疾病,从而治疗、处理疾病的过程。通过将皮疹的形态、颜色、发病部位、出现的缓急程度以及皮疹局部自觉症状作为辨证要点加以阐述,探寻辨"疹"论治在中医皮肤病教学中的运用方法,具有一定的现实意义。

“疹”之音义与“反(返)”之文化内涵

本文对现行高一语文教材的两处文言注释提出疑问,并阐明如下观点:一、《勾践灭吴》中“疾疹”为名词活用作动词,“疹”通“疢”,音chen。二、从先秦礼仪的角度入手,援引相关史料分析了先秦诸侯已嫁之女“归宁”、“来归”的两种情形,挖掘出《触龙说赵太后》中“必勿使反”之“反”的文化蕴含,指出“反”具有“古代已嫁之女被夫家遣返回娘家”的特指义。行文的目的是试图为传统说解提供些许文化性补注。

陈士铎治疗“斑”“疹”“痘”学术思想及用药规律探析

探讨陈士铎治疗“斑”“疹”“痘”学术思想以及用药规律;陈士铎所述“斑”“疹”“痘”学术思想继承《黄帝内经》;对于“斑”“疹”“痘”的治疗陈氏突出“散法”和“润法”。病因病机可归纳为以下5条:①火毒致盛;②气血亏虚,虚处留邪;③内有热毒,风寒束表;④下焦水蓄不消,上焦心火独亢;⑤误用寒凉,毒热内陷。补散结合,补阴制火等理论运筹帷幄于病变之中,同时提出火毒非补不可,但亦不可呆补。治则可归纳为以下3条:①扶正、祛邪;②调达气血阴阳;③协调五脏。药物频数前16位有当归、甘草、荆芥、玄参、麦冬、地黄、人参、升麻、天花粉、陈皮、白术、桔梗、黄芪、丹皮、茯苓、牛蒡子、芍药、金银花等;药类有:补气类、养血类、益阴类、散表类、清热类、解毒类。

自拟疏风透疹汤治疗肺癌靶向药物相关性皮疹的临床观察

目的观察疏风透疹汤治疗肺癌靶向药物(酪氨酸激酶抑制剂EGFR-TKIs)相关皮疹的临床疗效及安全性。方法将60例口服靶向药物,包括吉非替尼(易瑞沙)、厄洛替尼(特罗凯)、埃克替尼(凯美纳)出现皮疹的非小细胞肺癌患者随机分为两组:治疗组和对照组,治疗组口服疏风透疹汤配合外用氢化可的松软膏及红霉素软膏,对照组仅予外用氢化可的松软膏及红霉素软膏治疗。观察治疗10d后患者皮疹消退程度,皮肤病生活质量DLQI评分、焦虑抑郁状态(汉密尔顿焦虑量表HAMA和汉密尔顿抑郁量表HAMD)评分以及安全性指标血常规、肝肾功能变化情况。结果两组治疗均有疗效,且治疗组疗效高于对照组,差异具有显著性;两组治疗前后生活质量均有改善、焦虑抑郁状态亦有缓解,且治疗组疗效高于对照组,差异具有显著性;两组治疗安全性指标无显著变化。结论自拟疏风透疹汤治疗肺癌靶向药物相关性皮疹临床效果好,安全性高,不良反应少,充分发挥了中医药在靶向治疗中的作用,体现了中西医结合的治疗原则,值得临床应用。

Two-sample Mendelian randomization analysis of causal relationship between eczema and autoimmune diseases

Objective:The causal relationship between eczema and autoimmune diseases has not been previously reported.This study aims to evaluate the causal relationship between eczema and autoimmune diseases.Methods:The two‐sample Mendelian randomization(MR)method was used to assess the causal effect of eczema on autoimmune diseases.Summary data from the Genome-Wide Association Study Catalog(GWAS)were obtained from the Integrative Epidemiology Unit(IEU)database.For eczema and autoimmune diseases,genetic instrument variants(GIVs)were identified according to the significant difference(P<5×10−8).Causal effect estimates were generated using the inverse‐variance weighted(IVW)method.MR Egger,maximum likelihood,MR-PRESSO,and MR-RAPS methods were used for alternative analyses.Sensitivity tests,including heterogeneity,horizontal pleiotropy,and leave-one-out analyses,were performed.Finally,reverse causality was assessed.Results:Genetic susceptibility to eczema was associated with an increased risk of Crohn’s disease(OR=1.444,95%CI 1.199 to 1.738,P<0.001)and ulcerative colitis(OR=1.002,95%CI 1.001 to 1.003,P=0.002).However,no causal relationship was found for the other 6 autoimmune diseases,including systemic lupus erythematosus(SLE)(OR=0.932,P=0.401),bullous pemphigoid(BP)(OR=1.191,P=0.642),vitiligo(OR=1.000,P=0.327),multiple sclerosis(MS)(OR=1.000,P=0.965),ankylosing spondylitis(AS)(OR=1.001,P=0.121),rheumatoid arthritis(RA)(OR=1.000,P=0.460).Additionally,no reverse causal relationship was found between autoimmune diseases and eczema.Conclusion:Eczema is associated with an increased risk of Crohn’s disease and ulcerative colitis.No causal relationship is found between eczema and SLE,MS,AS,RA,BP,or vitiligo.

抗敏汤治疗慢性荨麻疹随机平行对照研究

[目的]观察抗敏汤治疗慢性荨麻疹疗效。[方法]使用随机平行对照方法,将46例门诊患者按就诊顺序编号简单随机分为两组。对照组23例咪唑斯汀10mg,1次/d。治疗组23例抗敏汤(生地、荆芥、防风、川芎、当归各20g,白芍15g,丹参20g,蝉蜕3g,刺蒺藜18g,甘草10g;肝阴内损去荆芥,加天麻9g,钩藤12g,石决明30g;气血双虚去荆芥,加桂枝9g,黄芪12g,细辛3g;冲任不调加淫羊藿、巴戟天各10g,续断13g,柴胡、香附各12g),1剂/d,水煎400mL,早中晚温服。连续治疗2周为1疗程。观测临床症状、体征积分、症状积分、不良反应。连续治疗2疗程,判定疗效。[结果]治疗组痊愈12例,显效8例,有效2例,无效1例,总有效率96.32%;对照组痊愈7例,显效12例,有效2例,无效2例,总有效率91.30%;组间无明显差异(P>0.05)。不良反应治疗组优于对照组(P<0.05)。[结论]抗敏汤治疗慢性荨麻疹,疗效满意,无严重不良反应,值得推广。

Effect of HSV-2 Infected Monocytes on the Production of TNF-a and IL-6

Objective: In order to detect the role of monocytes inHSV-2 infection, we studied the effect of herpes sim-plex Virus-2 infection on the production of tumor ne-crosis factor (TNF-σ), interleukin-6 (IL-6) secretedby monocytes. Methods: Monocytes were infected by HSV-2 (333Strain). Culture supernatants were collected at 1, 3,5, 7 days post-infection. The levels of TNF-α, IL-6were measured by enzyme-linked immunosorbent as-say (ELISA). Results: The levels of TNF-α secretion by mono-cytes significantly decreased on first day post-infection. The levels of IL-6 significantly decreasedon first and third days post-infection, and then gradu-ally increased to the control on seventh day post-infection. Conclusions: TNF-α and IL-6 production by mono-cytes was inhibited during HSV-2 infection. The pro-duction of cytokines may play an important role inherpes simplex viurs-2 pathogenicity and immunity.

Comparison of Multiplex Fluorescent PCR with Serum Type-specific Antibody Detection in Diagnosis of Genital Herpes

Objectives: To compare multiplex fluorescent PCRwith serum type-specific antibody detection in thediagnosis of herpes simplex virus (HSV) infection andto evaluate its significance in the diagnosis of genitalherpes.Methods: We detected HSV infection in 121 speci-mens collected from patients with genital herpesusing both multiplex fluorescent PCR and serum type-specific antibody detection. HSV viral isolation wasused as the standard control.Results: When compared with the viral isolation, thesensitivity and specificity for multiplex fluorescentPCR were 100% and 88.89%, respectively afterdiscrepant analysis. The sensitivity and specificity fortype-specific antibody detection was 77.68 % and77.78 %, respectively. However, the type-specificantibody detected HSV in two asymptomatic patientswhile the multiplex fluorescent PCR couldn’t detectany HSV DNA from those specimens.Conclusions: Multiplex fluorescent PCR is a verysensitive and specific method for detection and typingof HSV in the lesion of genital herpes, it failed todetect HSV DNA from the asymptomatic patients.Serum type-specific antibody detection was a lesssensitive and specific test but could detect the specificantibody from some asymptomatic patients. Thecombination of these two techniques would allow rapid,sensitive and accurate detection and typing of HSVand help clinical diagnosis and epidemiologic survey-ing of genital herpes.

Association Between Genital Ulcer Disease and HIV Seroprevalence among STD Patients in Guangzhou

Objectives: To understand genital ulcer disease(GUD) among patients attending sexually transmitteddisease (STD) clinics in Guangzhou, China, and itsassociation with HIV infection.Methods: Between September 9th, 1997 and Octo-ber 30th, 2002, 8 962 patients with STDs wereevaluated. 285 patients were diagnosed with GUD basedon clinical manifestations and microbiologic evalua-tions including dark field microscopy and serologytest for syphilis (RPR, TPPA). Swabs of each genitalulcer were processed in a multiplex PCR assay (M-PCR) for simultaneous detection of Herpes simplexvirus (HSV), Treponema pallium, and Haemophilusducreyi. Other STDs were classified by routine diag-nostic criteria, including microscopy or culture forNeisseria gonorrhoeae, Chlamydia trachomatis,Urea- plasma urealyticum, Human papillomavirus,Trichomonas, etc.Results: Of the 8 962 patients with STDs, the HIVseroprevalence in patients with and without GUD was1.75% (5/285) and 1.53% (133/8677), respectively,with no statistically significant difference (χ 2=0.09,P>0.05; OR=1.15, 95%CI=0.47-2.81) . HIVseroprevalence in patients with syphilis, genital her-pes and other STDs was 2.81% (22/784), 0.74% (6/814) and 1.49% (110/7 364), respectively. Prevalencein patients with syphilis was significantly higher thanthat in patients with genital herpes and other STDs,(χ 2=9.92, P<0.005, OR=3.89, 95%CI=1.67-9.05;χ 2=7.66, P<0.001, OR=1.90, 95%CI=1.21-3.00).Conclusions: The study shows that the HIV sero-prevalence in this population of patients with GUDis very low. The results also indicate an associationbetween syphilis and HIV infection. The relationshipbetween genital herpes and HIV infection needsfurther research.

A Study of Monocyte Excretion of TNF- α and IL-6 and Monocyte Expression of HLA Class Ⅱ Antigen In Genital Herpes

Objective: To study the role of monocytes in the pathogenesis of genital herpes. Methods: TNF- α and IL-6 levels in 27 cases of genital herpes were detected by enzyme linked immunosorbant assay (ELISA). HLA class Ⅱ antigen expression on monocytes were detected by an alkaline phosphatase anti-alkaline phosphatase method. Results: Compared with normal controls, levels of TNF- a and IL - 6 secreted by monocytes responding to LPS mitogen in vitro were significantly decreased [(3.13 ± 0.44ng/ml) vs (4.68 ± 0.54ng/ml), P<0.05 and (3.32 ± 1.06ng/ml) vs (6.46 ± 1.94ng/ ml), P<0.05, respectively]. HLA class Ⅱ antigen expression on monocytes in the genital herpes group was also significantly decreased [HLA-DR (67.48% ± 1.51%) vs (81.03% ± 1.32%), P<0.01 and HLA-DQ (29.54% ± 1.15%) vs (37.63% ± 1.79%), P <0.01 respectively]. Conclusion: These findings suggest that the decreased monocyte function may contribute to the pathogenesis of genital herpes. Augmenting or inducing monocyte function may be important in the prevention, treatment, and reduction of genital herpes cases.

Effect of Herpes Simplex Virus-2 Infection in Vitro on the Expression of HLA Class II Antigen of Monocytes

Objectives: In order to investigate the role of mono-cytes and human leukocyte antigen (HLA) class II an-tigen in herpes simplex virus-2 (HSV-2) infection, westudied the effect of HSV-2 infection in vitro on theexpression of HLA class II antigen on monocytes.Methods: Monocytes were infected with HSV-2(Strain 333). Culture cells were collected 1, 3, 5 and 7days after infection. The levels of expression of HLAclass II antigen were measured by using alkaline phos-phatase antialkaline phosphatase method (APAAP).Results: The levels of the expression of HLA class IIantigen on monocytes significantly decreased on thefirst day of post-infection, and then gradually returnedto levels found in the controls by the 7th day post-infection.Conclusion: HLA class II antigen expression onmonocytes was inhibited with HSV-2 infection, whichmight be one means of virus escape at an early phase.The expression of HLA class II antigen may play animportant role in herpes simplex viurs-2 pathogenic-ity and immunity.

Antiviral active peptide from oyster

An active peptide against herpes virus was isolated from the enzymic hydrolysate of oyster(Crassostrea gigas) and purified with the definite direction hydrolysis technique in the order of alcalase and bromelin.The hydrolysate was fractioned into four ranges of molecular weight(>10 kDa,10-5 kDa,5-1 kDa and <1 kDa) using ultrafiltration membranes and dialysis.The fraction of 10-5 kDa was purified using consecutive chromatographic methods including DEAE Sephadex A-25 column,Sephadex G-25 column,and high performance liquid chromatogram(HPLC) by activity-guided isolation.The antiviral effect of the obtained peptide on herpetic virus was investigated in Vero cells by observing cytopathic effect(CPE).The result shows that the peptide has high inhibitory activity on herpetic virus.

Establishment of an ELISA to Detect Kaposi's Sarcoma-associated Herpesvirus Using Recombinant ORF73

Kaposi's sarcoma-associated herpesvirus (KSHV) is causally related to Kaposi's sarcoma (KS), primary effusion lymphoma (PEL) and a proportion of cases of multicentric Castleman's disease (MCD). The ORF73 protein was cloned into pQE80L-orf73 and expressed in E.coli and purified. The expressed recombinant ORF73 was identified by sodium dodecyl sulfatepolyacrylamide gel electrophoresis (SDS-PAGE). A protein of about 27 kDa was expressed as expected. Western Blotting showed that the purified recombinant ORF73 reacted with KSHV positive serum. The immunogenicity of the recombinant ORF73 was further analysed by ELISA and the optimal conditions were determined. The ORF73 ELISA was used to compare the KSHV seroprevalence between Hubei and Xinjiang Han people. The Han people in Xinjiang have significantly higher KSHV seroprevalence than their counterparts in Hubei (6.7% vs 2.9%, P = 0.005).

The Herpes Simplex Virus Type 1 Multiple Function Protein ICP27

The herpes simplex virus type 1 （HSV-1） infected-cell protein 27 （ICP27） is an essential, highly conserved protein involved in various steps of HSV-1 gene regulation as well as in the shut-off of host gene expression during infection. It functions primarily at the post-transcriptional level in inhibiting precursor mRNA splicing and in promoting nuclear export of viral transcripts. Recently, many novel functions performed by the HSV- 1 ICP27 protein were shown, including leptomycin B resistance, inhibition of the type I interferon signaling, regulation of the viral mRNA translation and determining the composition of HSV-1 virions

Human herpesvirus 6 infections after liver transplantation

Human herpesvirus 6(HHV-6) infections occur in > 95% of humans.Primary infection,which occurs in early childhood as an asymptomatic illness or manifested clinically as roseola infantum,leads to a state of subclinical viral persistence and latency.Reactivation of latent HHV-6 is common after liver transplantation,possibly induced and facilitated by allograft rejection and immunosuppressive therapy.Since the vast majority of humans harbor the virus in a latent state,HHV-6 infections after liver transplantation are believed to be mostly due to endogenous reactivation or superinfection(reactivation in the transplanted organ).In a minority of cases,however,primary HHV-6 infection may occur when an HHV-6 negative individual receives a liver allograft from an HHV-6 positive donor.The vast majority of documented HHV-6 infections after liver transplantation are asymptomatic.In a minority of cases,HHV-6 has been implicated as a cause of febrile illness with rash and myelosuppression,hepatitis,pneumonitis,and encephalitis after liver transplantation.In addition,HHV-6 has been associated with a variety of indirect effects such as allograft rejection,and increased predisposition and severity of other infections including cytomegalovirus(CMV),hepatitis C virus,and opportunistic fungi.Because of the uncommon nature of the clinical illnesses directly attributed to HHV-6,there is currently no recommended HHV-6-specific approach to prevention.However,ganciclovir and valganciclovir,which are primarily intended for the prevention of CMV disease,are also active against HHV-6 and may prevent its reactivation after transplantation.The treatment of established HHV-6 disease is usually with intravenous ganciclovir,cidofovir,or foscarnet,complemented by reduction in the degree of immunosuppression.This article reviews the current advances in the pathogenesis,clinical diagnosis,and therapeutic modalities against HHV6 in the setting of liver transplantation.

Immunogenicity Analysis of Prokaryotic Expression Products of Kaposi's Sarcoma Associated Herpesvirus orf65

To purify the protein encoding the small capsid protein （SCP） of KSHV and analyze its immunogenicity, the carboxyl terminus of orf65 of Kaposi＇s sarcoma associated-herpesvirus （KSHV） was expressed in a prokaryotic expression system. The expression of recombinant E.coli containing pQE-80L-orf65 was induced by isopropyl-13-D-thiogalactopyranoside （IPTG） and the fusion protein was purified by chromatography. The expressed protein and its purified product were identified by sodium dodecyl sulfate- polyacrylamide gel electrophoresis （SDS-PAGE） and showed that 9 kDa was the expected size of the purified orf65 protein. The antiserum was produced in rabbit which was immunized by purified orf65 protein. An ELISA assay was established to analyze the immunogenicity of the purified orf65 protein. The ELISA analysis demonstrated that orf65 protein has strong immune activity, and the immune activity of polyclonal antibody against orf65 was more than 4 fold higher than that in the serum of the non-immunized rabbit. These results demonstrate that purified orf65 protein has very strong immunogenicity and can be used in screening KSHV infection in the general population using ELISA.

In vitro Anti-viral Activity of the Total Alkaloids from Tripterygium hypoglaucum against Herpes Simplex Virus Type 1

Herpes simplex virus type 1 （HSV-1） is a commonly occurring human pathogen worldwide. There is an urgent need to discover and develop new alternative agents for the management of HSV-1 infection. Tripterygium hypoglaucum （level） Hutch （Celastraceae） is a traditional Chinese medicine plant with many pharmacological activities such as anti-inflammation, anti-tumor and antifertility. The usual medicinal part is the roots which contain about a 1% yield of alkaloids. A crude total alkaloids extract was prepared from the roots of T. hypoglaucum amd its antiviral activity against HSV-1 in Vero cells was evaluated by cytopathic effect （CPE） assay, plaque reduction assay and by RT-PCR analysis. The alkaloids extract presented low cytotoxicity （CC50 = 46.6μg/mL） and potent CPE inhibition activity, the 50% inhibitory concentration （ICs0） was 6.5 μg/mL, noticeably lower than that of Acyclovir （15.4μg /mL）. Plaque formation was significantly reduced by the alkaloids extract at concentrations of 6.25 μg/mL to 12.5 μg/mL, the plaque reduction ratio reached 55% to 75% which was 35% higher than that of Acyclovir at the same concentration. RT-PCR analysis showed that, the transcription of two important delayed early genes UL30 and UL39, and a late gene US6 of HSV-1 genome all were suppressed by the alkaloids extract, the expression inhibiting efficacy compared to the control was 74.6% （UL30）, 70.9% （UL39） and 62.6% （US6） respectively at the working concentration of 12.5μg/mL. The above results suggest a potent anti-HSV-1 activity of the alkaloids extract in vitro.

Feasibility of herpes simplex virus type 1 mutants labeled with radionuclides for tumor treatment

For over one hundred years, viruses have been recognized as capable of killing tumor cells. At present, people are still researching and constructing more suitable oncolytic viruses for treating different malignant tumors. Although extensive studies have demonstrated that herpes simplex virus type 1 (HSV-1) is the most potential oncolytic virus, therapies based on herpes simplex virus type 1 vectors still arouse bio-safety and risk management issues. Researchers have therefore introduced the new idea of treating cancer with HSV-1 mutants labeled with radionuclides, combining radionuclide and oncolytic virus therapies. This overview briefly summarizes the status and mechanisms by which oncolytic viruses kill tumor cells, discusses the application of HSV-1 and HSV-1 derived vectors for tumor therapy, and demonstrates the feasibility and prospect of HSV-1 mutants labeled with radionuclides for treating tumors.

Protective effect of prednisolone on ischemia-induced liver injury in rats

AIM: To investigate the effects of prednisolone on cell membrane bleb formation, calpain μ activation and talin degradation during hepatic ischemia-reperfusion injury in rats. METHODS: The hilar area of the left lateral and median lobes of rat liver (68%) was clamped for 60 min and followed by 120 min reperfusion. Prednisolone was administered at 1.0, 3.0, or 10 mg/kg at 30 min before ischemia. In addition to biochemical and microscopic analyses, activation of calpain μ was determined using specific antibodies against the intermediate (activated) form of calpain μ. Degradation of talin was also studied by Western blotting. RESULTS: In the control and prednisolone (1.0 mg/kg) groups, serum aspartate transaminase (AST) and alanine transaminase (ALT) level were elevated, and cell membrane bleb formation was observed after 120 min of reperfusion. Moreover, calpain μ activation and talin degradation were detected. Infusion of prednisolone at 3.0 or 10 mg/kg significantly suppressed serum AST and ALT, and prevented cell membrane bleb formation. At 10 mg/kg, prednisolone markedly suppressed calpain μ activation and talin degradation. CONCLUSION: Prednisolone can suppress ischemia- reperfusion injury of the rat liver. Its cytoprotective effect is closely associated with the suppression of calpain μ activation and talin degradation.

The Importance of Heparan Sulfate in Herpesvirus Infection

Herpes simplex virus type-1 (HSV-1) is one of many pathogens that use the cell surface glycosaminoglycan heparan sulfate as a receptor. Heparan sulfate is highly expressed on the surface and extracellular matrix of virtually all cell types making it an ideal receptor. Heparan sulfate interacts with HSV-1 envelope glycoproteins gB and gC during the initial attachment step during HSV-1 entry. In addition,a modified form of heparan sulfate,known as 3-O-sulfated heparan sulfate,interacts with HSV-1 gD to induce fusion between the viral envelope and host cell membrane. The 3-O-sulfation of heparan sulfate is a rare modification which occurs during the biosynthesis of heparan sulfate that is carried out by a family of enzymes known as 3-O-sulfotransferases. Due to its involvement in multiple steps of the infection process,heparan sulfate has been a prime target for the development of agents to inhibit HSV entry. Understanding how heparan sulfate functions during HSV-1 infection may not only be critical for inhibiting infection by this virus,but it may also be crucial in the fight against many other pathogens as well.