Recombinant zoster vaccine (Shingrix®): a new option for the prevention of herpes zoster and postherpetic neuralgia.

Postherpetic neuralgia (PHN) is a challenging condition for pain management specialists. The prevention of herpes zoster (HZ) and subsequent PHN in individuals aged 50 years and older, via the development of new vaccines, is an ongoing research project. The live zoster vaccine (LZV, Zostavax®) was the first proof of concept that vaccination could prevent HZ, but LZV cannot be used in various immunecompromised patients. This led to the development of a new non-live recombinant zoster vaccine (RZV, Shingrix®). This RZV has shown promising results in many clinical trials, with high reactogenicity and similar systemic adverse effects compared to those of LZV. The National Advisory Committee on Immunization has recommended LZV as a standard vaccine for HZ prevention in adults ≥ 50 years of age, but no studies directly comparing the safety and efficacy of RZV and LZV vaccines have been conducted. This article reviews the brief history, efficacy, and safety of the two vaccines and discusses the advantage of RZV over LZV based on the available literature.

Anatomical Feasibility of Right Oblique Approach for L5-S1 Oblique Lumbar Interbody Fusion.

BACKGROUND: We compared left and right vascular anatomy at the L5-S1 disc space and validated the anatomical feasibility of the right oblique approach for L5-S1 oblique lumbar interbody fusion. METHODS: Axial T2-weighted magnetic resonance imaging studies at the L5-S1 disc level were used to study 274 subjects (164 women and 110 men; average age, 62.97 years). The distance from the center of the L5-S1 disc to the medial wall of the left or right vessel was measured. Using the vessel position, 3 groups were established: medial, middle, and lateral. To describe the morphological configuration, the vessel type and the presence of perivascular adipose tissue (PVAT) around the vessels were identified on both sides. RESULTS: The vessels on the left L5-S1 disc space were located 12.47 mm from the midline and most subjects (209 subjects; 76.3%) were included in the medial or middle group. On the right side, the vessels were located more laterally (16.93 mm; P = 0.000) and most subjects (248 subjects; 90.5%) were in the middle or lateral group. On the left side, vessels were mostly veins (260 subjects; 94.9%) and 139 subjects (50.7%) had PVAT. On the right side, the vessels were mostly arteries (213 subjects; 77.7%) and 242 (88.3%) had PVAT. CONCLUSIONS: The vessels on the right side of the L5-S1 disc were located more laterally, and most vessels on the right side were arteries accompanying PVAT, which might minimize vessel manipulation. These results indicate that the right side of the L5-S1 disc could provide feasible access for oblique lumbar interbody fusion at L5-S1.

The effect of long-term oral dantrolene on the neuromuscular action of rocuronium: a case report.

Oral dantrolene causes a dose-dependent depression of skeletal muscle contractility. A 52-year-old man treated with oral dantrolene for spasticity after spinal cord injury was scheduled to undergo irrigation and drainage of a thigh abscess under general anesthesia. He had taken 50 mg oral dantrolene per day for 3 years. Under standard neuromuscular monitoring, anesthesia was performed with propofol, rocuronium, and sevoflurane. A bolus dose of ED95 (0.3 mg/kg) of rocuronium could not depress T1 up to 95%. An additional dose of rocuronium depressed T1 completely and decreased the train-of-four (TOF) count to zero. There was no apparent prolongation of the neuromuscular blocking action of rocuronium. The TOF ratio was recovered to more than 0.9 within 40 minutes after the last dose of rocuronium. A small dose of oral dantrolene does not prolong the duration of action and recovery of rocuronium.

From superspreaders to disease hotspots: linking transmission across hosts and space.

Since the identification and imprisonment of "Typhoid Mary," a woman who infected at least 47 people with typhoid in the early 1900s, epidemiologists have recognized that 'superspreading' hosts play a key role in disease epidemics. Such variability in transmission also exists among species within a community (amplification hosts) and among habitat patches across a landscape (disease 'hotspots'), underscoring the need for an integrative framework for studying transmission heterogeneity. Here, we synthesize literature on human, plant, and animal diseases to evaluate the relative contributions of host, pathogen, and environmental factors in driving transmission heterogeneity across hosts and space. We show that host and spatial heterogeneity are closely linked and that quantitatively assessing the contribution of infectious individuals, species, or environmental patches to overall transmission can aid management strategies. We conclude by posing hypotheses regarding how pathogen natural history influences transmission heterogeneity and highlight emerging frontiers in the study of transmission heterogeneity.

Characterizing microbial communities through space and time.

Until recently, the study of microbial diversity has mainly been limited to descriptive approaches, rather than predictive model-based analyses. The development of advanced analytical tools and decreasing cost of high-throughput multi-omics technologies has made the later approach more feasible. However, consensus is lacking as to which spatial and temporal scales best facilitate understanding of the role of microbial diversity in determining both public and environmental health. Here, we review the potential for combining these new technologies with both traditional and nascent spatio-temporal analysis methods. The fusion of proper spatio-temporal sampling, combined with modern multi-omics and computational tools, will provide insight into the tracking, development and manipulation of microbial communities.

Our microbial selves: what ecology can teach us.

Advances in DNA sequencing have allowed us to characterize microbial communities--including those associated with the human body--at a broader range of spatial and temporal scales than ever before. We can now answer fundamental questions that were previously inaccessible and use well-tested ecological theories to gain insight into changes in the microbiome that are associated with normal development and human disease. Perhaps unsurprisingly, the ecosystems associated with our body follow trends identified in communities at other sites and scales, and thus studies of the microbiome benefit from ecological insight. Here, we assess human microbiome research in the context of ecological principles and models, focusing on diversity, biological drivers of community structure, spatial patterning and temporal dynamics, and suggest key directions for future research that will bring us closer to the goal of building predictive models for personalized medicine.