Background In recent years, the incidence of syphilis has increased year by year. Our study is to explore the risk factors for the development of neurosyphilis in patients who failed syphilis treatment. Methods A total number of 165 patients with complete medical records and who agreed to undergo lumbar puncture were divided into 47 neurosyphilis cases and 118 non-neurosyphilis cases according to the diagnostic criteria of neurosyphilis, and the differences in clinical characteristics and laboratory features between the two groups were analyzed. Significant variables were entered into multivariable logistic regression models. Results (1) There were statistical differences (p < 0.05) between the neurosyphilis (NS) group and the non-neurosyphilis (NNS) group in terms of the higher proportion of male and serum rapid plasma reagin (RPR) > 1:32 and the elevated cerebrospinal fluid white blood cell (CSF WBC) and CSF protein in the neurosyphilis group compared with the non-neurosyphilis group. (2) Male gender, serum RPR titers >1:32 at lumbar puncture, CSF WBC >8 × 106/L were significantly associated with neurosyphilis. Conclusion For patients who have failed syphilis treatment, lumbar puncture should be performed to exclude neurosyphilis, to enable early diagnosis and treatment, and to prevent irreversible damage of neurosyphilis, especially if the patient is male and has a serum RPR>1:32 and elevated CSF WBC at lumbar puncture, which are risk factors for neurosyphilis.

目的 观察超分子水杨酸联合强脉冲光(intense pulsed light,IPL)治疗玫瑰痤疮的疗效及安全性、复发率.方法 回顾性分析首都医科大学附属北京佑安医院2018-2020年70例I型及Ⅱ型玫瑰痤疮患者,分为三组,联合组、水杨酸组及IPL组.其中联合组采用超分子水杨酸联合强脉冲光治疗,水杨酸组及IPL组分别给予超分子水杨酸、强脉冲光治疗,每月治疗1次,共3次,治疗结束后比较各组疗效及不良反应、复发率情况,随访3个月.结果 联合组有效率为96.00％(24/25)明显高于水杨酸组68.18％(15/22)及IPL组73.92％(17/23),差异具有统计学意义(P<0.05);各组均无严重不良反应发生率、复发率未见明显统计学差异.结论 强脉冲光联合超分子水杨酸治疗I型及Ⅱ型玫瑰痤疮的疗效较常规仅使用水杨酸或者IPL好,可进一步提升玫瑰痤疮的治疗效果,且安全性良好.

目的:分析症状性神经梅毒的临床表现及实验室检查结果.方法:回顾分析2014年3月至2019年1月本院诊治的症状性神经梅毒患者的临床资料.数据资料统计学分析采用SPSS 17.0软件.结果:共分析71例症状性神经梅毒患者,男52例,女19例,年龄23～71岁.20例(28.2％)有明确梅毒史,12例血清RPR滴度≤1:4,23例1:8～1:32,36例≥1:64,44例(62％)脑脊液RPR阳性.该组病例中,脑膜血管型39例(54.9％),脑膜炎型6例(8.5％),麻痹性痴呆23例(32.4％),脊髓痨3例(4.2％).不同临床类型神经梅毒患者中脑脊液蛋白含量四组间比较差异有统计学意义(P<0.05),血清RPR滴度和脑脊液白细胞计数差异均无统计学意义(P>0.05);麻痹性痴呆组脑脊液蛋白含量和RPR阳性率高于脑膜血管型(Ps<0.05).结论:本研究中最常见的神经梅毒类型是脑膜血管型神经梅毒.脑脊液蛋白含量水平的升高,可能预示着症状性神经梅毒实质受损的发生.

目的:评价点阵CO2激光治疗原发性皮肤淀粉样变病的疗效.方法:采用点阵CO2激光治疗躯干及四肢原发性皮肤淀粉样变病,60～80 mJ/脉冲,每4周1次,共治疗3次.根据皮损大小、色素沉着及瘙痒对皮损进行评分.结果:共收集2017年12月至2018年12月10例患者,其中苔藓样淀粉样变性4例,斑状淀粉样变性6例.皮损大小、色素沉着及瘙痒由治疗前的36分,35分,38分下降至9分,12分,4分.三次治疗后的总有效率为100％,显效率为90％.未出现严重不良反应.结论:点阵CO2激光治疗原发性皮肤淀粉样变病安全有效.

目的:检测无症状神经梅毒患者治疗前后血液、脑脊液(CSF)相关指标的变化,探讨其对预后的意义.方法:回顾性分析2016年3月至2018年12月于我科确诊并治疗的34例无症状神经梅毒患者的一般资料及相关实验室检查:包括血液快速血浆反应素环状卡片试验(RPR)、脑脊液白细胞(CSF-WBC)、蛋白量(CSF-PRO)、CSF-RPR、脑脊液梅毒螺旋体明胶颗粒凝集试验(CSF-TPPA).结果:经过1个疗程头孢曲松钠驱梅治疗,治疗前及治疗后脑脊液白细胞中位数(四分位数)分别为0.0105(0.0068,0.022)和0.005(0.0028,0.0105),差异有统计学意义(Z=-2.738,P=0.005);脑脊液蛋白中位数(四分位数)分别为0.3(0.155,0.485)和0.16(0.13,0.245),差异有统计学意义(Z=-2.092,P=0.036);与治疗前相比,治疗后3个月、6个月、12个月时血RPR下降≥4倍者分别为6例(17.65％)、9例(26.47％)和16例(47.06％).结论:头孢曲松钠治疗后,脑脊液白细胞下降及蛋白下降,对于无法行腰椎穿刺的患者,可通过血RPR下降≥4倍来初步评价疗效.

目的 分析87例神经梅毒患者的临床及实验室特征.方法 回顾性总结分析87例HIV阴性的神经梅毒患者发病年龄、临床症状、脑脊液检查(包括脑脊液白细胞计数、蛋白定量)、快速血浆反应素环状卡片试验(rapid plasma reagent test,RPR)、梅毒螺旋体明胶颗粒凝集试验(treponema pallidum particle assay,TPPA)、梅毒荧光抗体吸收试验(fluorescent treponemal antibody absorption test,FTA-ABS)等资料.结果 87例神经梅毒患者中有症状神经梅毒患者54例(62.1％),其中眼部受损者最多见;无症状患者33例(37.9％).87例患者中脑脊液白细胞异常率为82.8％,脑脊液蛋白异常率为44.8％,脑脊液RPR的异常率为44.8％,脑脊液TPPA阳性率为80.5％,脑脊液FTA-ABS IgG抗体阳性率为87.4％、IgM抗体阳性率为3.4％.有症状患者与无症状患者脑脊液RPR、白细胞计数和蛋白定量,差异均无统计学意义(P均>0.05).有症状患者脑脊液FTA-ABS IgG抗体阳性率为94.4％,IgM抗体阳性率为3.7％.结论 有症状神经梅毒患者中眼部受损者多见,临床医生对有眼部损害的梅毒患者须警惕神经梅毒的可能.神经梅毒患者中脑脊液RPR检测阳性率较低,脑脊液RPR在诊断神经梅毒中的作用仍需要大样本研究进一步证实.有症状神经梅毒患者脑脊液FTA-ABS抗体阴性不能排除神经梅毒.

目的:分析HIV合并梅毒神经系统的临床表现及实验室特征.方法:回顾性分析2014年3月至2017年7月在我院皮肤科进行腰穿的HIV合并梅毒感染的43例患者的人口学特点、临床表现及实验室检查.结果:43例患者中男39例,女4例,中位年龄为31.5岁.有3例(7.0％)符合神经梅毒诊断(脑脊液表现为白细胞≥20/μL并伴有脑脊液RPR阳性).这3例患者均为二期梅毒,临床表现均为眼部症状,CD4均<350个/μL,血清RPR均≥1:32.结论:在HIV合并梅毒感染时,神经梅毒尤其好发于血清RPR≥1:32,CD4<350个/μL的二期梅毒患者.

目的 比较HIV合并早期梅毒及单纯早期梅毒患者经过苄星青霉素治疗后快速梅毒血清反应素(RPR)的阴转率.方法 HIV阳性组和HIV阴性组各入组93例患者.对HIV阳性和HIV阴性早期梅毒患者均给与240万苄星青霉素肌注,每周一次共3周.于最后一次治疗后3,6,9,12个月进行随诊,比较两者的阴转率.HIV阳性组患者根据基线CD4水平进行了分组,进一步对比了两组的阴转率.结果 HIV阳性组在各个随访点的RPR阴转率为11.8％,32.3％,40.9％,44.1％,HIV阴性组为20.4％,46.2％,47.3％,52.7％,各个随访点两组之间差异无统计学意义.在HIV阳性组内,CD4≥350个/μl(n=51)与CD4<350个/μl(n=29)的两组患者在12个月时RPR阴转率分别为51.0％和27.6％,两组之间差异有统计学意义(P=0.042).结论 HIV阳性合并早期梅毒患者可以使用苄星青霉素进行治疗,疗效与单纯梅毒患者相当.对于CD4<350个/μl的HIV阳性患者,可能需要加强治疗.

Objective To determine whether HIV infection affects biological false positive (BFP) for Rapid plasma regain (RPR) in populations of "men sex with men (MSM)".Methods Screening of RPR、TPPA and HIV antibody was performed in a cohort of MSM.The incidence of BFP for RPR (RPR-BFP) was compared in HIV + vs.HIV-.Result A total of 10,000 MSM subjects were tested.The rates of RPR-BFP were no significant differences in HIV + vs.HIV-groups [0.15 ％ (3/1 989) vs.0.27％ (22/8 011),p.0.05].Conclusion HIV infection does not affect the rate of RPR-BFP.

A rapidly escalating outbreak of syphilis infection has been affected men who have sex with men, particularly those with HIV-1 infection. γδ T cells are unconventional immune cells with two main subsets, Vδ1 T cells and Vδ2 T cells, which possess a combination of innate and adaptive immune features allowing them against HIV-1. However, whether syphilis infection affects the phenotype and function of γδ T cells in HIV-1-infected patients remains unclear, especially in acute HIV-1 infection (AHI). In this study, we enrolled 57 HIV-1-infected patients (24 with HIV-1 infection only and 33 coinfected with syphilis) from an acute HIV-1-infected cohort in Beijing (PRIMO). A comprehensive analysis of γδ T-cell phenotype and function was performed by flow cytometry. We found syphilis coinfection could reverse the imbalance of Vδ1/Vδ2 ratio in AHI. Syphilis infection results in decreased γδ T-cell activation in AHI, but increased γδ T-cell activation in chronic HIV-1 infection (CHI). Moreover, patients with CHI had larger numbers of IL-17-producing γδ T cells than those with AHI, regardless of syphilis status. Thus, syphilis affected the γδ T-cell immune response differently in patients depending on the stages of HIV-1 disease. In addition, the percentage of IL-17-producing γδ T cells was positively correlated with the percentage of neutrophils. These results suggest that the γδ T-cell/IL-17/neutrophil axis is involved in HIV-1 pathogenesis and disease progression. Taken together, our observations provide new insight into the roles of γδ T cells in immunopathogenesis of syphilis and HIV-1 coinfection, particularly during AHI, and our findings may be helpful for the prevention of syphilis and other sexually transmitted infections and highlight the great significance on the remedy of patients coinfected with HIV-1.

To strengthen medical students’ humanistic quality education is an inevitable trend of the development of the society in the 21st century ,many higher medical colleges and universities take va‐rious measures in succession ,Integrate into the humanity quality education in specialized course edu‐cation ,we discuss from the following aspects of the patriotism education ,Chinese traditional culture education ,the cultivation of the fear of life ethics morals ,dedication to service ,in medical students , Aimed at promoting students establish a sense of service and dedication ,to form the fear of life care patient’s noble character ,motivate students strive for the realization of the great revival of the Chi‐nese nation .

Objective To observe the therapeutic effect of qi-boosting spleen-fortifying therapy combined with highly active antiretroviral therapy(HAART)on human immunodeficiency virus infection/acquired immunodeficiency syndrome(HIV/ AIDS).Methods Totally 86cases of HIV/AIDS were randomized into the treatment group and control group,with 43cases in each.The treatment group was given qi-boosting spleen-fortifying formulas combined with HAART.The control group was given HAART.Observed indicators including CD4+T cell count,symptom and sign integral,Karnofsky performance scale(KPS)and liver function before,6months and 12months after treatment.The therapeutic effect was judged after 12-month treatment.Results There were 5cases(11.63%)and 6cases(13.95%)of endpoint events occurred in the treatment group and control group respectively,with no significant difference between groups(P0.05).The symptom and sign scores were significantly decreased but the KPS scores were significantly increased in both groups after 6-month and 12-month treatment(P0.05).There were significant differences between groups in the symptom and sign scores and KPS scores after 6-month treatment(P0.05),but there was no significant difference between groups after 12-month treatment(P0.05).The CD4+ T cell count was significantly increased in both groups after 6-month and 12-month treatment(P0.05),but with no significant difference between groups(P0.05).The level of Alanine aminotransferase(ALT)was significantly decreased in the treatment group but significantly increased in the control group after 6-month and 12-month treatment(P0.05).There was no significant difference between groups in ALT after 6-month treatment(P0.05),but with a significant difference between groups after 12-month treatment(P0.01).Conclusion The combo therapy of qi-boosting spleen-fortifying therapy and HAART can relieve symptoms and signs,improve quality of life and reduce liver damage.

水痘是由水痘-带状疱疹病毒所引起的一种小儿常见的急性传染病.临床特征是分批出现的皮肤、黏膜的斑疹、丘疹、疱疹及结痂,全身症状轻微.