Clinical Study on External Use of Chinese Medicine in Treating Children with Herpetic Stomatitis

Background: Pediatric herpetic stomatitis is a common pediatric disease, the course of the disease is about 1 - 2 weeks, and it usually occurs in 1 - 3 years old children, due to infection of herpes simplex virus I and onset. Objective: To observe the curative effect of Chinese medicine prescription (Yueshi, Zhongbai, Qingdai, Phelloderma phelloderma and glycyrrhiza) on children with herpetic stomatitis. Methods: 90 patients were divided into 2 groups by random number table method. 45 patients in the observation group were treated with traditional Chinese medicine, and 45 patients in the control group were treated with iodine glycerin. The total effective rate after treatment was compared between the two groups. Results: The total effective rate of the treatment group was 95.55%;the total effective rate of the control group was 71.11%;the total effective rate of the two groups after treatment was compared;the treatment group was significantly better than the control group;the difference was significant (P 0.05). Conclusion: The external use of Chinese medicine in the treatment of pediatric herpetic stomatitis has achieved good results, improving the condition of children, and significantly improving the clinical efficacy.

Motor cortex transcranial magnetic stimulation to reduce intractable postherpetic neuralgia with poor response to other threapies:Report of two cases

BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied by negative emotions(e.g.,anxiety and depression)and substantially reduces the quality of life.In addition to analgesia(e.g.,pregabalin and gabapentin),nerve radiofrequency technology is an effective treatment for intractable PHN.However,there is still a significant portion of patients who do not benefit from this treatment.As a non-invasive form of brain stimulation,repetitive transcranial magnetic stimulation(rTMS)targeting the motor cortex is able to reduce neuropathic pain with grade A evidence.CASE SUMMARY Here we report two cases in which motor cortex rTMS was used to treat intractable PHN that did not respond to initial drug and radiofrequency therapies.Moreover,we specifically investigated rTMS efficacy at 3 mo following treatment.CONCLUSION Motor cortex rTMS can treat intractable PHN that did not respond to initial drug and radiofrequency therapies.

Ocular herpes:the pathophysiology,management and treatment of herpetic eye diseases

Herpesviruses are a prominent cause of human viral disease, second only to the cold and influenza viruses. Most herpesvirus infections are mild or asymptomatic. However, when the virus invades the eye, a number of pathologies can develop and its associated sequelae have become a considerable source of ocular morbidity. The most common culprits of herpetic eye disease are the herpes simplex virus(HSV), varicella zoster virus(VZV), and cytomegalovirus(CMV). While primary infection can produce ocular disease, the most destructive manifestations tend to arise from recurrent infection. These recurrent infections can wreck devastating effects and lead to irreversible vision loss accompanied by a decreased quality of life, increased healthcare usage, and significant cost burden. Unfortunately, no method currently exists to eradicate herpesviruses from the body after infection. Treatment and management of herpes-related eye conditions continue to revolve around antiviral drugs, although corticosteroids, interferons, and other newer therapies may also be appropriate depending on the disease presentation. Ultimately, the advent of effective vaccines will be crucial to preventing herpesvirus diseases altogether and cutting the incidence of ocular complications.

Evaluation of a Newly Developed Laser Pen as a Home Care Device for Pain Reduction of Recurrent Aphthous Stomatitis (Preliminary Study)

Objective: The aim of this survey is to evaluate the effect of a new developed laser pen as a home care device for patients’ pain reduction with recurrent aphthous stomatitis. Background data: Recurrent aphthous stomatitis (RAS) is one of the most common and painful ulcers in the oral cavity. Low Level Laser Therapy (LLLT) has been used successfully for reducing pain and healing time in comparison with corticosteroids and placebo in some studies. But these treatments are done in the clinics and it seems that there is no report of the laser treatment as a home care device up to this study. Methods: This was a prospective, randomized trial pilot study. Thirty patients with RAS were divided into three similar groups. The group one (n = 10) was treated with a diode laser, 660 nm, 40 mw, continuous wave, 1.2 J, 6 J/cm2, for five consecutive days (twice per day, 30 seconds each session). The second group (n = 10) was treated with a topical triamcinolone (adcortyl in orabase) ointment four times per day and the third group (n = 10) was treated with placebo (red light pen) the same way as Group 1. All the patients were evaluated with a Visual Analogue Scale (VAS) before and after treatment on the consecutive days. The data was analysed by one way ANOVA and PostHoc tests. Results: The results show that the laser pen and triamcinolon in orabase ointment have similar results and both have better results than placebo in the control of the recurrent aphthous stomatitis pain (p value: 0.001). Conclusion: In this clinical pilot study the laser pen as a home care device seems to be useful for the treatment of RAS.

Comparison of anterior segment optical coherence tomography findings in acanthamoeba keratitis and herpetic epithelial keratitis

This study is to investigate the characteristic features of Acanthamoeba keratitis（AK） that differentiating it from herpetic epithelial keratitis（HEK） using anterior segment optical coherence tomography（AS-OCT）. Medical records of three eyes of each AK and herpetic keratitis who had AS-OCT examination were reviewed in this study. Slitlamp biomicroscopy and AS-OCT was performed on the initial visit and on every follow-up visits in all patients. In all three AK cases, reflective bands in the corneal stroma that correspond to the area of radial keratoneuritis were observed. The depth of the reflective bands varied in each case. After AK treatment, slit-lamp biomicroscopy confirmed that radial keratoneuritis had resolved and AS-OCT confirmed that reflective bands in the corneal stroma had also disappeared in all patients. Unlike the AS-OCT results found in AK, highly reflective HEK lesions were observed only in the subepithelial area, not in the stroma. AS-OCT seems to be helpful analyzing the specific depth of the lesion which enables to distinguish AK from HEK.

Diagnosis and Control of Swine Vesicular Stomatitis

Swine vesicular stomatitis is an acute, febrile, highly contagious zoonotic diseases caused by vesicular stomatitis virus （VSV）. Disease in affected pigs was typically characterized by vesicular lesions on the mouth, snout, oral mucosa, coronet and interdigital skin. The disease is endemic in the Americas, Europe and Africa and other places. As the foreign trade of animals and animal products increase, the risk of swine vesicular stomatitis spreading into our country also will be increased. Therefore, the accurate and timely diagnosis and control of swine vesicular stomatitis are critical and necessary.

Necrotising stomatitis as a presenting symptom of HIV

Background: Necrotising Stomatitis is an uncommon oral infection associated with diminished systemic resistance (immunocompromised state) including HIV infection. Significant predisposing factors include poor oral hygiene, unusual life stress, recent illness (e.g. Measles), malnutrition, smoking and even inade- quate sleep. It occurs commonly in developing na-tions with poor living conditions. Objective: To present a case of severe Necrotising Stomatitis in a previously undiagnosed HIV Seropositive patient. Patient and method: This case report describes severe, rapidly spreading necrotising stomatitis in a 35 years old lady, the condition which led to her being diagnosed with HIV. The treatment modalities, challenges of man-agement and the differential diagnosis were discussed. Result: During the course of her management, pa-tient’s oral condition improved. However, later re-currence was seen due to severe anaemia caused by malnutrition and aggravated by Zidovudine antiret-roviral drug. Conclusions: There is need for interdis-ciplinary interactions between the dentists and the physicians managing HIV patients, to allow effective management and afford patient the best treatment.

Salivary cytokines and levels in denture stomatitis: An exploratory case-control study

We aimed to evaluate the microbial and inflammatory characteristics associated with Denture Stomatitis (DS) analyzing: l) Levels of salivary cytokines and cultivable C. albicans;2) DNA-DNA checkerboard on biofilm associated with mucosal tissue-bearing denture surfaces, 3) Serum C-reactive protein (CRP) levels. Thirty-two subjects were enrolled in the study with control (n = 17) and DS types II and III (n = 15) subjects. Samples were collected from unstimulated whole saliva, serum and swabs from denture surfaces. Salivary levels of inflammatory mediators and CRP were measured by multiplex. Samples from denture and mucosal surfaces were analyzed by DNA-DNA checkerboard. Saliva from DS subjects showed increase in IL-8 (p = 0.04) and IL-1β (p = 0.04) with trend for increase in IL-1β, TNFα and IL-6 levels. C. albicans higher counts in DS saliva (p = 0.03) showed association with elevated levels of IL-8 (p = 0.03) and IL-1α (p = 0.01). CRP levels were not different among groups (p = 0.74). DNA-DNA checkerboard analyses indicated typical periodontal pathogens below the detection threshold of 104 organisms on both denture and inflamed mucosal surfaces. The data suggest that DS is associated with elevation of salivary IL1 and IL-8 together with increased C. albicans. There was no evidence of systemic inflammation as measured by serum C-reactive protein levels.

The Current Treatment and Prevention of Post Herpetic Neuralgia

Post herpetic neuralgia (PHN) is a chronic neuropathic pain syndrome in the area of the herpes zoster (HZ) rash, persisting after the cutaneous lesions have subsided. Despite numerous treatment advances, many patients remain refractory to the current therapies and continue to have pain, physical, economical and psychological distress. In this review, we will focus on the current treatment and prevention of PHN.

Therapeutic Role of Isotretinoin in the Management of Recurrent Aphthous Stomatitis (Single-Blind Controlled Therapeutic Study)

Background: Recurrent aphthous ulcer (RAS) is a common oral disease where its etiopathogenesis is not well elucidated. There was no effective curative therapy for this disease. Isotretinoin has been recently used in the treatment of Behcet’s disease. Objectives: To evaluate the efficacy and safety of isotretinoin in treating RAS and the long term remission of RAS. Patients and Methods: This single-blind controlled therapeutic study conducted in Department of Dermatology-Baghdad Teaching Hospital during February 2011-January 2012. Thirty patients with typical RAS were included in this work. Detailed history and full examination were done for all patients. They were given isotretinoin 20 mg orally once daily for three months to be seen on Day 14 firstly and then monthly to be assessed using the oral clinical manifestation index (OCMI). After isotretinoin was stopped three months later, patients were given placebo therapy for another 3 months. Results: The results of 30 treated patients were as follows: 17 (56.67%) males and 13 (43.33%) females with male to female ratio was 1.3:1. Their ages ranged from 12 - 60 (35.33 ± 12.06) years. The OCMI before isotretinoin therapy ranged from 7 - 17 (13.13 ± 2.55), while after therapy the mean started to decline to a lower level within the first 14 days (P = 0.103), and continued to decline significantly until the end of the first month of therapy (P = 0.023). Then the OCMI declined very significantly until the end of fourth month of therapy (P < 0.001). After that the mean started to increase until the end of the 5 months (with placebo) but it remained statistically significant compared with the baseline of mean of OCMI before treatment (P = 0.046). Then it continued to increase to become not significant at the end of 6 months of therapy (P = 0.107). Conclusion: Isotretinoin is an effective therapeutic and prophylactic promising remedy in treatment of RAS.

Adverse Effects of Morphine and Fentanyl for Stomatitis in Patients Receiving Allogeneic Hematopoietic Cell Transplantation—A Single Center Retrospective Analysis

Opioids are widely used as analgesics for oral mucositis in allogeneic hematopoietic cell transplantation (allo-HCT). Their main adverse events are nausea, vomiting, constipation, psychological symptoms, and respiratory depression. In our institute, continuous intravenous morphine was generally used until 2007, followed by intravenous fentanyl as the first-line agent because of its potential fewer adverse events. We retrospectively analyzed 99 patients who underwent allo-HCT in the University of Tsukuba Hospital from 2004 to 2009. Out of 99 patients, 64 were treated with opioids (morphine, 32 and fentanyl, 32). The attending physicians were in charge of providing stable pain control. Median age, sex, stem cell source, preparative regimen, and GVHD prophylaxis were similar in the two groups. There were no significant differences in psychological symptoms, drowsiness, nausea, and vomiting in both groups. Defecation ratio (the days having a bowel movement/the days taking opioids) was 63% and 94% in the morphine and fentanyl group, respectively (P < 0.0001). The percentage of patients who needed to use purgative drugs was 25% and 6% in the morphine and fentanyl group, respectively (P = 0.04). It is suggested that fentanyl has less adverse effects on gastrointestinal movement and is safer than morphine when used for oral mucositis in allo-HCT.

Treatment of Recurrent Aphthous Stomatitis by 100% Topical Pumpkin Seed Oil

Background: Recurrent aphthous stomatitis (RAS) is a major oral health problem, where its etiopathogenesis is not well understood. Accordingly, its therapy whether topical or systemic can induce clearance, but the relapse rate is high. Objective: To use 100% topical pumpkin seed oil in RAS as it has many actions as anti-inflammatory and antioxidant effects. Patients and Methods: This single, blind, clinical, therapeutic trial was conducted in the Department of Dermatology-Baghdad Teaching Hospital, Baghdad, Iraq, during February 2015-August 2016. Twenty-five patients with RAS were included in this work. After full history and clinical examination, the clinical diagnosis was established. Oral clinical manifestation index score (OCMI) was carried out before, during and after stopping therapy to assess the different parameters of this score. 100% Topical pumpkin seed oil was given two times daily for 3 months during which short term assessment for each patient was done by using OCMI before, after 4 days and after 8 days of therapy in addition to assessing the mean size of largest diameter of ulcers in each visit to evaluate the therapeutic efficacy of the therapy, while long term assessment of the OCMI was done every month for 3 months after starting of the therapy to evaluate the prophylactic effect of the therapy. After 3 months, pumpkin seed oil was stopped and assessment of OCMI was done monthly for another 3 months to evaluate the remission action of pumpkin seed oil. Results: Twenty-five patients were included in this study: 15 (60%) males and 10 (40%) females. While their ages ranged from 9 - 60 (27.48 ± 11.97) years. The mean of OCMI before pumpkin seed oil therapy was ranged from 9 - 15 (12.96 ± 1.42), while after the therapy the mean started to decline to lower level within 4 days of therapy and was statistically significant (p < 0.0001) and continued to decline significantly till the end of third month of therapy (p < 0.0001). The percent reduction was 79.30% after 4 days of therapy and 94.38% after 8 days of therapy. After stopping therapy, the mean of OCMI started to increase, but it is remained statistically highly significant (p < 0.0001) at the end of third months after stopping therapy when it is compared with baseline mean of OCMI. Conclusion: Pumpkin seed oil had an effective therapeutic and prophylactic action against RAS, in addition, it induced remission for at least 3 months after stopping therapy. No local or systemic side effects were observed during the course of therapy.

The Local Immunity of the Oral Cavity in Women with Recurrent Aphthous Stomatitis Associated with Urogenital Infection

This paper studied the dynamics of local immunity factors of the oral cavity in women with recurrent aphthous stomatitis against the background of urogenital infection. The research proves the maximum efficacy of hydroxyzine hydrochloride, aminodihydrophthalasindione sodium and Eplan used in multiple treatments of recurrent aphthous stomatitis in patients with urogenital infection as evidenced by a marked reduction in the coefficient of local immunity factors balance, which is observed as early as on day 7 of the therapy provided. Moreover, the findings show the growth of immunological parameters of oral fluid (lysozyme and SIgA), the normalization of the coefficient of local immunity factors balance in the treatment of recurrent aphthous stomatitis in women with urogenital infection, the improvement being observed 3 months after the treatment suggesting a favorable local immunity of the oral cavity.

Effects of Zingiber officinalis (WILLD.)ROSC.Membranes on minor recurrent aphthous stomatitis: a randomized pragmatic trial

Objective:To evaluate the effects of dried ginger rhizome (DGR;Zingiber officinalis (WILLD.) ROSC.),prepared as a membrane,in minor recurrent aphthous stomatitis (miRAS)treatment and explore its mechanism of action by detecting changes in levels of epidermal growth factor (EGF) and tumor necrosis factor (TNF)-α in saliva.Methods:Fifty-nine miRAS patients were enrolled in this study.The number of participants in the dried ginger rhizome membrane (DGRM) group was 30,and 29 were in the placebo membrane (PM) group.Sixty sealed envelopes containing either type of membrane were coded randomly.Investigators and participants were blinded to group assignments.A visual analog scale (VAS) was used for pain,follow-up information for healing time,and enzyme-linked immunosorbent assays to measure the concentrations of EGF and TNF-α.Results:In terms of VAS,there was a significant difference between pre-and post-DGRM treatment (P <.001),but not so for the PM group (P >.05).A significant difference was observed in the healing time between the two groups (6.08 (2.712) vs.8.04 (2.142) days).The mean healing time in the DGRM group was shorter than that in the PM group (P <.05).In both groups,the salivary EGF concentration decreased significantly after treatment (P <.05),but the mean level in the DGRM group was significantly lower than that in the PM group (P <.05).The mean TNF-α level in both groups was increased significantly after treatment (P <.05),but patients who used DGRMs had a significantly lower level than that in the PM group (P <.05).Conclusion:The present study provides evidence that DGRMs are effective treatment for RAS.Dried ginger rhizome has obvious effects on pain relief,shortening of healing time,reducing the EGF level in saliva,and has an inhibitory effect on TNF-α release.

Meta-Herpetic Keratitis and Therapeutic Approach: Case Report

The purpose of this study is to disclose the steps in the therapeutic approach for meta-herpetic corneal ulcer. Report of a case with anterior segment photography was used. The 6 months of follow-up results of the case were disclosed. The efficacy of the therapeutic approach for meta-herpetic corneal ulcer was discussed.

Effect of NF-κB Inhibitor PDTC on a Herpetic Stromal Keratitis Mouse Model

Purpose:To investigate the effect of NF-κB inhibitor PDTC on inflammation response in mice with herpetic stromal keratitis (HSK). Methods:A total of 120 female BALB/c mice,aged 4 -6 weeks, were treated by scuffing the epithelium of the right cornea with the tip of a 30G syringe needle, and approximately 1×106 PFU of HSV-1virus was seeded onto the corneal surface. The eye was then exposed to 170 mJ/cm2 of UV light 7 weeks later, in order to induce the relapse of HSK. PDTC eye drops were adjusted to various concentrations (0.1,1.0, and 10 mg/ml) with PBS; PBS only was used on control animals.All animals received PDTC or PBS eye drops 6 times/day,1 drop/time, for 7 consecutive days. Mice were sacrificed at 8h, and 1, 3, and 7d after administration. Corneal tissues were prepared for the detection of IL-1β, IL-4, IL-6, and IL-12 by ELISA and histological study. Results: Neutrophilic leukocytes and lymphocytes were found in the corneas of HSK mice. ELISA results showed fluctuating expressions of IL-1β, IL-4, IL-6, and IL-12. The IL-1β and IL-4 expressions were significantly lower in the high dose group than in the control group (P<0.05), while IL-6 and IL-12 expressions were significantly higher in the high dose group than in the control group (P<0.05). Conclusion:A high concentration of PDTC can suppress the expression of certain inflammatory factors in HSK mice while improving the expression of others.

Identification and Functional Analysis of Serum Specific miRNAs in Recurrent Aphthous Stomatitis Patients with Excess-heat or Yin-deficiency

Background:The treatment of Traditional Chinese Medicine(TCM)in recurrent aphthous stomatitis(RAS)based on syndrome differentiation has won the international acceptance,but the molecular mechanism of excess-heat syndrome and yin-deficiency syndrome of RAS remains unclear.Objective:To clarify specific microRNAs(miRNAs)and their functions in RAS patients with excess-heat or yin-deficiency.Methods:Serum samples were collected from patients meeting the RAS diagnostic criteria of excess-heat or yin-deficiency syndrome and healthy individuals.Core miRNAs were then identified under miRNA microarray anal-yses.Target prediction and bioinformatic analyses were carried out and gene-pathway-networks were visualized to better understand the relationship between different genes and pathways.Results:(1)90 individuals meeting the inclusion criteria were collected in this study.Among them,9 miRNAs were screened out in excess-heat syndrome group(EH group),with 1 upregulated and 8 downregulated.And four miRNAs(hsa-miR-20b-5p,hsa-miR-122-5p,hsa-miR-483-5p and hsa-miR-3197)were validated by real-time PCR method.14 miRNAs were screened out in yin-deficiency syndrome group(YD group)(7 upregulated and 7 downregulated).And hsa-miR-17-5p,hsa-miR-106-5p and hsa-miR-20b-5p were validated.(2)A total of 4,776 target genes were identified in EH group which enriched in GO categories including nervous system development and calcium ion binding and pathway such as PI3K-Akt signaling pathway and Calcium signaling pathway.10,172 target genes were identified in YD group which enriched GO categories included protein binding and positive regulation of transcription from RNA polymerase II promoter and pathway included MAPK signaling pathway and Ras signaling pathway.Conclusion:Hsa-miR-20b-5p in patients with RAS could act as the novel target for the classification of the syndrome.It is upregulated in RAS patients with excess-heat syndrome while downregulated in patients with yin-deficiency syndrome.The PI3K-Akt and MAPK signaling pathways and their related target genes may provide new insights into the molecular mechanisms of RAS with excess-heat syndrome or yin-deficiency syndrome,respectively.

止痛如神汤在腰骶部带状疱疹后神经痛(脾虚湿蕴)患者中的应用及对疼痛程度的影响

目的:观察止痛如神汤在腰骶部带状疱疹后神经痛(脾虚湿蕴)患者中的应用及对疼痛程度的影响。方法:本研究纳入2020年1月—2023年1月于彭州市人民医院就诊的60例腰骶部带状疱疹后神经痛(脾虚湿蕴)患者作为研究对象,根据随机数表法将患者分为观察组和对照组,各30例。对照组给予基础治疗,观察组给予基础治疗联合口服止痛如神汤。比较两组临床疗效、疼痛程度[视觉模拟评分法(visual analogue scale,VAS)]、睡眠质量[匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)]及不良反应发生情况。结果:观察组总有效率高于对照组,差异有统计学意义(χ^(2)=8.822,P=0.003)。治疗前,两组VAS评分比较,差异无统计学意义(P>0.05);治疗后3周、4周、12周,两组VAS评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗前,两组PSQI评分比较,差异无统计学意义(P>0.05);治疗后3周、4周、12周两组PSQI评分低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。两组整个研究过程中均治疗顺利,治疗期间无过敏、皮肤感染等不良反应发生。结论:腰骶部带状疱疹后神经痛(脾虚湿蕴)患者在基础治疗基础上加用止痛如神汤,具有镇痛效果好,安全性高,对睡眠质量改善作用明显。

脉冲射频治疗急性期带状疱疹性神经痛与带状疱疹后遗神经痛效果比较

目的 综合比较脉冲射频治疗急性期带状疱疹性神经痛和带状疱疹后遗神经痛的临床效果。方法 回顾性分析287例胸段带状疱疹相关性疼痛患者,按发病时间分为急性期带状疱疹性神经痛组(AHN组,3个月内)和带状疱疹后遗神经痛组(PHN组,3个月以上)。分析和比较两组脉冲射频术后1周、1个月、3个月、6个月和12个月的疼痛程度(VAS)、睡眠质量(AIS)、焦虑抑郁(GAD-7和PHQ-9)情况。结果 两组术后12个月各时点的VAS、AIS、GAD-7和PHQ-9评分均较术前明显下降(P<0.001)。AHN组在术后1个月至12个月,VAS、AIS、GAD-7和PHQ-9评分均较PHN组下降更多(P<0.001)。随访12个月时,AHN组口服普瑞巴林和阿片类药物患者例数少于PHN组(P=0.001)。结论 脉冲射频对带状疱疹相关性疼痛具有良好的治疗效果,对于急性期带状疱疹性神经痛在缓解疼痛、改善睡眠及焦虑抑郁方面优于带状疱疹后遗神经痛,这可能有利于预防带状疱疹后遗神经痛的发生。