2012年 · 第125卷第04期

Abstract：Background Potentially lethal ventricular arrhythmias (PLVAs) occur frequently in survivors after acute myocardial infarction and are increasingly recognized in other forms of structural heart diseases.This study investigated the prevalence and prognostic significance of PLVAs in patients with chronic heart failure (CHF).Methods Data concerning demographics,etiology of heart failure,NYHA functional class,biochemical variables,electrocardiographic and echocardiographic findings,and medical treatments were collected by reviewing hospital medical records from 1080 patients with NYHA Ⅱ-Ⅳ and a left ventricular (LV) ejection fraction ≤45％.PLVAs were defined as multi-focal ventricular ectopy (＞30 beats/h on Holter monitoring),bursts of ventricular premature beats,and nonsustained ventricular tachycardia.All-cause mortality,sudden death,and rehospitalization due to worsening heart failure,or cardiac transplantation during 5-year follow-up after discharge were recorded.Results The occurrence rate of PLVAs in CHF was 30.2％,and increased with age; 23.4％ in patients ＜45 years old,27.8％ in those between 45-65 years old,and 33.5％ in patients ＞65 years old (P=0.033).Patients with PLVAs had larger LV size and lower ejection fraction (both P ＜0.01) and higher all-cause mortality (P=0.014) during 5-year follow-up than those without PLVAs.Age (OR 1.041,95％ Cl 1.004-1.079,P=0.03) and LV end-diastolic dimension (OR 1.068,95％ Cl 1.013-1.126,P=0.015) independently predicted the occurrence of PLVAs.And PLVA was an independent factor for all-cause mortality (RR 1.702,95％ Cl 1.017-2.848,P=0.031) and sudden death (RR 1.937,95％ CI 1.068-3.516,P=0.030) in patients with CHF.Conclusion PLVAs are common and exert a negative impact on Iona-term clinical outcome in patients with CHF。

Abstract：Background The association of emerging biomarkers such as high-sensitivity C-reactive protein (hs-CRP),homocysteine and fibrinogen with the risk of coronary artery disease (CAD) is still uncertain in Asian population including Koreans and little is known about the combined effect of biomarkers on the risk of CAD.Methods A total of 10 650 subjects (6538 men and 4112 women) were enrolled in this study.A 10-year CAD risk was calculated using Framingham risk score modified by the National Cholesterol Education Program (NCEP) Adult Treatment Panel Ⅲ (ATP Ⅲ ) and levels of circulating hs-CRP,homocysteine and fibrinogen were measured using validated assays.Results The 10-year CAD risk gradually augmented with increase in the circulating levels of hs-CRP,homocysteine and fibrinogen.For the highest quartile of hs-CRP,odds ratio (OR) of high-risk for CAD (10-year risk ≥20％) compared with the lowest quartile was 3.97 (95％ C/:2.51-6.29).For homocysteine and fibrinogen,ORs in the highest quartile compared to the lowest quartile were 5.10 (95％ Cl:3.05-8.53,P ＜0.001) and 1.46 (95％ Cl:0.69-3.11,P=0.325),respectively.OR of high-risk for CAD in both the highest quartile of hs-CRP and homocysteine was 9.05 (95％ CI:5.30-15.45) compared with the below median of hs-CRP and homocysteine.Conclusions The present study demonstrated that hs-CRP and homocysteine are well associated with the 10-year CAD risk estimated using NCEP ATP Ⅲ in Koreans and combination of hs-CRP and homocysteine can have strong synergyin predicting the development of CAD。

Abstract：Background Few data on ankle fractures in China from large multicenter epidemiological and clinical studies are available.The aim of this research was to evaluate the epidemiological features and surgical outcomes of ankle fractures by reviewing 235 patients who underwent ankle fracture surgery at five hospitals in China.Methods This study included patients who underwent ankle fracture surgery at five Chinese hospitals from January 2000 to July 2009.Age,gender,mechanism of injury,Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture type,fracture pattern,length of hospital stay and treatment outcome were recorded.Statistical analyses were conducted using SPSS software.The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale,visual analogue scale (VAS),and arthritis scale were used to evaluate outcome.Results Of 235 patients with ankle fractures,105 were male with an average age of 37.8 years and 130 were female with an average age of 47.3 years.The average follow-up period was 55.7 months.There were significant differences in the ratios of patients in different age groups between males and females,and in mechanisms of injury among different age groups.There were also significant differences in the length of hospital stay among different fracture types and mechanisms of injury.In healed fractures,the average AOFAS ankle-hindfoot score was 95.5,with an excellence rate of 99.6％,the average VAS score was 0.17,and the average arthritis score was 0.18.Movement of the injured ankle was significantly different to that of the uninjured ankle.There were no significant differences between AO fracture types,fracture patterns or follow-up periods and AOFAS score,but there were some significant differences between these parameters and ankle joint movements,pain VAS score and arthritis score.Conclusions Ankle fractures occur most commonly in middle-aged and young males aged 20-39 years and in elderly females aged 50-69 years.The most common mechanisms of injury are twisting injuries and falls from a standing height or less.The results of surgical treatment are satisfactory。

Abstract：Background Systemic non-steroidal anti-inflammatory drugs have been evaluated for their possible preemptive analgesic effects.The efficacy of flurbiprofen axetil for preemptive analgesia in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach needs further investigation.The aim of this study was to research the preemptive analgesic effects of flurbiprofen axetil in thoracic surgery,and the influence of preoperative administration on postoperative respiratory function.Methods This randomized,double-blind,controlled trial enrolled 60 patients undergoing radical resection of esophageal carcinoma via the left thoracic approach.Anesthesia management was standardized.Each patient was randomly assigned to receive either 100 mg flurbiprofen axetil intravenously 15 minutes before incision (PA group) or intravenous normal saline as a control (C group).Postoperative analgesia was with sufentanil delivered by patient-controlled analgesia pump.Postoperative sufentanil consumption,visual analog scale pain scores,plasma levels of interleukin-8,and oxygenation index were measured.Results Compared with the preoperative baseline,postoperative patients in the PA group had no obvious increase in pain scores (P ＞0.05),but patients in the C group had significantly increased pain scores (P＜0.05).Pain scores in the C group were significantly higher at 24 hours postoperatively than preoperatively.Intergroup comparisons showed lower visual analog scale scores at 2-24 hours postoperatively in the PA group than the C group (P ＜0.05).Sufentanil consumption and plasma interleukin-8 levels at 2 and 12 hours postoperatively were significantly lower in the PA group than the C group (P ＜0.05).The oxygenation index at 2 and 12 hours postoperatively was significantly higher in the PA group than the C group (P＜0.05).Conclusions Intravenous flurbiprofen axetil appears to have a preemptive analgesic effect in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach,and appears to contribute to recovery of respiratorv function and to reduction of the postoperative inflammatory reaction。

Abstract：Background The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was developed to address the systematic underestimation of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) Study equation in patients with relatively well-preserved kidney function.Performance of the new equation in the Chinese population is unknown.The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease (CKD).Methods We enrolled 450 Chinese patients (239 women and 211 men) with CKD in the present study.The renal dynamic imaging method was used to measure the referenced standard GFR (rGFR) for comparison with estimations using the two equations.Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics (ROC) analysis.Performance of the two equations in lower and higher estimated GFR (eGFR) subgroups was further investigated.Results Both eGFRs correlated well with rGFR (r=0.88,0.81,P＜0.05).In overall performance,the CKD-EPI equation showed less bias,higher precision and improved accuracy,and was better for detecting CKD.In the higher-eGFR subgroup,the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.Conclusions The CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied.For the present,the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR。

Abstract：Background Carbon dioxide (CO2) laser soldering is an alternative technique for tissue bonding.Basic fibroblast growth factor (bFGF) and transforming growth factor β1 (TGFβ1) are two key factors for wound healing.This study was performed to demonstrate the efficacy of CO2 laser soldering for dural reconstruction and the effect of bFGF and TGFβ1 on healing.Methods In Part Ⅰ,10 minipigs were randomized into two equal groups.Dural defects were reconstructed by conventional fibrin glue bonding (group Ⅰa) or CO2 laser soldering (group Ⅰb).The reconstructed dura was subjected to burst pressure (BP) measurement and immunohistochemical staining after 1 week.In Part Ⅱ,36 minipigs were randomized into three equal groups.Dural reconstruction was achieved by CO2 laser soldering.Exogenous bFGF (group Ⅱb) or TGFβ1 (group Ⅱc) was administered while group Ⅱa served as a control group.The specimens were subjected to BP measurement after 1,2,3,and 4 weeks,respectively.Results In Part Ⅰ,the dura specimens displayed positive staining of only bFGF in group la and of both bFGF and TGFβ1 in group lb.Group Ⅰb showed higher BP than group la ((98.00-±21.41) mmHg vs.(70.80±15.09) mmHg,respectively; P ＜0.05).In Part Ⅱ,BP of group Ⅱc was significantly higher than that of group Ⅱla (P ＜0.01).The BP of group Ⅱa trended toward stabilization after 3 weeks of growth,while that of groups lⅡb and Ⅱc trended toward stabilization after 2 weeks of growth.Conclusions CO2 laser soldering is a reliable technique for dural reconstruction.The superior healing of dural reconstruction by CO2 laser soldering may be related to higher expression of bFGF and TGFβ1,and CO2 lasers may stimulate their secretion.Exogenous bFGF or TGFβ1 may improve healing by shortening the wound healing time,and exogenous TGFβ1 may improve the tensile strength。

Abstract：Background Aspergillus fumigatus (A.fumigatus) is a ubiquitous saprophytic fungus responsible for the majority of invasive mold infections in patients undergoing chemotherapy,organ transplantation or with persistent neutropenia.This study aimed to determine the role of E-cadherin for adhesion and endocytosis of A.fumigatus blastospores in the human epithelial cell line A549.Methods A.fumigatus blastospores were incubated with the total protein of A549 to investigate the binding of E-cadherin and blastospores followed by an affinity purification procedure.After establishing the adhesion model,the adhesion and endocytosis of A.fumigatus blastospores by A549 cells were evaluated by down-regulating E-cadherin of A549 cells using blocking antibody or small interfering RNA (siRNA).Results E-cadherin was adhered to the surface of A.fumigatus blastospore.Adhesion and endocytosis of the blastospores were reduced by blocking or down-regulating E-cadherin in A549 cells.Conclusions E-cadherin is a receptor for adhesion and endocytosis of A.fumigatus blastospores in epithelial cells.This may open a new approach to treat this fungal infection。

Abstract：Background Genetic association studies on populations of European origin have identified the DCDC2 gene as a susceptibility locus for developmental dyslexia.Here,we sought to investigate the association of DCDC2 polymorphisms with developmental dyslexia in children of Han Chinese origin.Methods We undertook a case-control genetic association study on 76 dyslexic children and 79 non-dyslexic matched controls.We isolated DNA from oral mucosal cell samples and genotyped two DCDC2 coding-sequence single nucleotide polymorphisms,rs2274305 and rs6456593,in each sample using SNaPshot single nucleotide extension.We compared the allele and genotype frequencies between the groups using the X2 test and analyzed the relationship between dyslexia and the polymorphism at both loci using unconditional logistic regression.We also predicted haplotypes and compared their frequencies between the two groups.Results The differences in the genotype distribution and the allelic genes of the two single nucleotide luci of the DCDC2 gene,rs2274305 and rs6456593,between the two dyslexic and non-dyslexic groups were statistically meaningless (P ＞0.05).The differences in the haplotype distributions of the DCDC2 gene between the dyslexic and normal group were statistically meaningless (P ＞0.05).Conclusion The DCDC2 gene may not be a susceptibility factor for developmental dyslexia among the Han Chinese.However,methodological issues may have prevented the detection of oositive associations。

Abstract：Background Aspirin and clopidogrel resistance plays a significant role in the development of cardiovascular ischemic events for ninety patients undergoing percutaneous coronary intervention.Recent studies have indicated that increasing the dose of antiplatelet drugs maybe a potent method to improve the inhibition of platelet aggregation.Methods Thrombelastograph (TEG) determinations were used to evaluate the effect of antiplatelet therapy.According to the results,90 patients were divided into three groups and given different doses of aspirin and clopidogrel.Thirty patients with both an inhibition rate of aspirin ＞50％ and an inhibition rate of clopidogrel ＞50％ were defined as the control group.Sixty patients with an inhibition rate for aspirin ＜50％ and an inhibition rate for clopidogrel ＜50％ were defined as the resistance group.Patients in resistance group were randomly assigned to be given a routine dose (100 mg aspirin plus 75 mg clopidogrel per day,which we called a resistance plus routine dose group,R+R) and a loading dose (200 mg aspirin and 150 mg clopidogrel per day,which we called resistance plus loading dose group,R+L) of antiplatelet therapy.A 12-month follow-up was observed to examine the change of inhibition rate of antiplatelet therapy and to estimate the relationship between inhibition rate and the occurrence of cardiovascular ischemic events.Results After 6 months of antiplatelet therapy,the inhibition rate of aspirin in the R+L group increased from (31.4±3.7)％ to (68.6±7.1)％,which was significantly higher than that in R+R group,(51.9±8.2)％ (P ＜0.01).The inhibition rate of clopidogrel in the R+L group increased from (22.1±3.8)％ to (60.2±7.4)％,which was significantly higher than in the R+R group,(45.9±4.3)％ (P ＜0.01).The occurrence rates of cardiovascular ischemic events,stent thrombosis,recurrent unstable angina and myocardial infarction in the R+R group were 20％,36％ and 17％,respectively.Occurrence was significantly increased compared with that in the control group,3％,10％ and 1％,respectively (P ＜0.01).In contrast,the occurrence rates in the R+L group (10％,23％ and 6％,respectively) were attenuated compared with those in the R+R group (P ＜0.01 ),although still higher than in the control group (P ＜0.01).Conclusions Almost all of the cardiovascular ischemic events occurred in the first six months after percutaneous coronary intervention.According to the result of TEG determinations,earlier application of a loading dose of aspirin and clopidogrel can decrease the rate of recurrent cardiovascular ischemic events。

Abstract：Background Community-acquired pneumonia (CAP) remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit (ICU),and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index (PSI),CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay (LOS) were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in the high-risk CAP sub-group.The 30-day mortality of patients who underwent ICU treatment on admission was also higher than for non-ICU treatment,but much lower than for those patients who took ICU treatment subsequent to the failure of non-ICU treatment.Conclusions Each severity score system,CURB-65,sepsis severity score and especially PSI,was capable of effectively predicting CAP mortality.Delayed ICU admission was related to higher mortality rates in severe CAP patients。

Abstract：Background Uric acid (UA) is suspected to play a neuro-protective role in Parkinson's disease (PD).This study aimed to evaluate whether the serum UA level was associated with the disease progression of PD in a relatively large population of Chinese patients.Methods Serum UA levels were measured from 411 Chinese PD patients and 396 age-matched controls; following the uric acid colorimetric method,the serum creatinine (Scr) levels were also measured to reduce the bias caused by possible differences in renal excretion function.The disease progression was scored by Hoehn and Yahr (H&Y) scales and disease durations; PD group was divided into 3 subgroups according to H&Y scales.Independent-samples ttest was performed to analyze the differences between PD group and control group.Multiple analysis of covariance was performed to analyze the differences between PD subgroups.Spearman rank-correlation was performed to evaluate the associations between serum UA or Scr level and disease progression.Results PD patients were found to have significantly lower levels of serum UA than controls ((243.38±78.91) vs.(282.97±90.80) pmol/L,P＜0.01).As the disease progression,the serum UA levels were gradually reduced.There was a significantly inverse correlation of UA levels with H&Y scales (Rs=-0.429,P ＜0.01) and disease duration (Rs=-0.284,P ＜0.01) in PD patients of both females and males.No significant difference of the Scr level between PD patients and controls was found ((70.01±14.70) vs.(69.84±16.46) μmol/L),and the Scr level was not involved in disease progression.Conclusion Lower serum UA levels may possess a higher risk of PD,which may be a potential useful biomarker to indicate the progression of PD。

Abstract：Background Parkinson's disease (PD) is an autosomally inherited neurodegenerative disease in elderly people.The etiology of PD has long been thought to be associated with both genetic and environmental factors.To explore potential genetic risk factors for PD in the northern Han Chinese population,we investigated three single nucleotide polymorphisms (SNPs) (rs4538475,rs11107 and rs12564040) in the BST1,PARK15 and PARK9 genes.Methods Genomic DNA from 215 PD patients and 212 matched controls was amplified in two independent PCR systems and subsequently genotyped by digestion with the endonuclease Pstl.Genetic parameter and association studies were carried out with SPSS 13.0 and PLINK 1.07 software.Results We could accurately detect all genotypes in the three loci with the PCR-RFLP or mismatched PCR-RFLP techniques.The observed heterozygosities of the rs4538475 and rs11107 loci in PD and control groups ranged from 0.460-0.481 and 0.410-0.441,in BST1,PARK15 respectively,while we detected no heterozygosity at the rs12564040 locus in PARK9.The similar distributions of genotypic frequency between both groups suggest that the three SNPs investigated in this study are unlikely to play roles as common risk factors or pathogenic mutations for PD in northern Han Chinese.Conclusion The SNPs investigated in the BST1,PARK15 and PARK9 genes associated with PD susceptibility are not associated with PD in the northern Han Chinese population。

Abstract：Background Intensive treatment such as autologous peripheral blood stem cell (PBSC) transplantation is an important therapeutic strategy in many hematologic malignancies.A number of factors have been reported to impact PBSC mobilization,but the predictive factors varied from one study to another.This retrospective study assessed our current mobilization and collection protocols,and explored the factors predictive of PBSC mobilization in patients with hematologic malignancies.Methods Data of 64 consecutive patients with hematologic malignancies (multiple myeloma,n=22; acute leukemia,n=27; lymphoma,n=15) who underwent PBSC mobilization for over 1 year were analyzed.Four patients with response to treatment of near complete remission or better were administered granulocyte colony-stimulating factor (G-CSF) to mobilize PBSCs.Sixty patients received G-CSF followed by chemotherapy mobilizing regimens.Poor mobilization (PM) was defined as when ≤2.0×106 CD34+ cells/kg body weight were collected within three leukapheresis procedures.Results The incidence of PM at the first mobilization attempt was 19％ (12/64).The PM group was older than the non-PM group (median age,51 vs.40 years; P=0.013).In univariate analysis,there were no significant differences in gender,diagnosis,and body weight between the PM and non-PM groups.A combination of chemotherapy and G-CSF was more effective than G-CSF alone as a mobilizing regimen (P=0.019).Grade Ⅲ or Ⅳ hematopoietic toxicity of chemotherapy had no significant effect on the mobilization efficacy.Supportive care and the incidence of febrile neutropenia were not significantly different between the two groups.In multivariate analysis,age (odds ratio (OR),9.536;P=-0.002) and number of previous chemotherapy courses (OR 3.132; P=0.024) were two independent negative predictive factors for CD34+ cell yield.PM patients could be managed well by remobilization.Conclusion Older age and a heavy load of previous chemotherapy are the negative risk factors for PBSC mobilization。

Abstract：Background Successful aging (SA) and mild cognitive impairment (MCI) are heterogeneous groups of aging.To explore the heterogeneity,the functional connectivity was studied in these populations.Methods The present study utilized functional connectivity magnetic resonance imaging (fcMRI) to investigate default mode network (DMN) in 8 healthy subjects of SA,8 subjects of usual aging (UA),and 8 MCI patients during verbal fluency tests (VFTs).Functional connectivity (based seeds) of different groups was analyzed by using statistical test.Results Compared with SA and UA groups,MCI subjects exhibited decreased functional connectivity in the DMN regions,including the inferior parietal Iobule and left angular gyrus (t=3.53,P ＜0.001).Compared with UA and MCI groups,the SA elderly exhibited increased functional connectivity in the precuneus (t=3.53,P＜0.001).Conclusions These findings suggested that abnormalities of functional connectivity in DMN might be related with semantic memory impairment in aging.Left angular gyrus and precuneus might be the potential imaging-based biomarker for distinguishing heterogeneous process of elderly。

Abstract：Background Primary malignant germ cell tumors (GCTs) of mediastinum are rare neoplasms.We introduce our institutional experience in managing patients with primary malignant GCTs of the mediastinum,focusing on the analysis of therapeutic modalities.Methods A retrospective review was done in 39 consecutive patients with mediastinal malignant GCTs treated in our institution between 1991 and 2007.Results A total of 39 patients were enrolled in this study with a median age of 27 years.The 5-year overall survival (OS) and progression-free survival (PFS) rates of the whole population were 60.2％ and 57.7％,respectively.Stratified by the histology,18 patients (46.2％) had seminoma and 21 patients (53.8％) had nonseminomatous germ cell tumors (NSGCTs).The 5-year OS rate of patients with seminoma was 87.4％ as compared with 36.7％ in patients with NSGCTs (P=-0.0004).The 5-year PFS rate was also significantly higher in seminoma patients (87.4％ vs.31.6％,P=-0.003).For 19 patients with NSGCTs managed with multi-modality treatment,chemotherapy exposure appeared to impact the prognosis.The 5-year OS rate was 44.9％ in patients with chemotherapy exposure as compared with 20.0％ in patients without it (P=0.43).Conclusion Our study confirmed the significance of systemic chemotherapy in the treatment of primary mediastinal GCTs。

Abstract：Background Gemifloxacin is a fluoroquinolone antibiotic with broad spectrum of antibacterial activity.The aim of the study was to evaluate the comparative effectiveness and safety of gemifloxacin for the treatment of patients with community-acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB).Methods We performed a meta-analysis of randomized controlled trials (RCTs) comparing gemifloxacin with other approved antibiotics.The PubMed,EMBASE,Chinese Biomedical Literature Database and the Cochrane Central Register of Controlled Trials were searched,with no language restrictions.Results Ten RCTs,comparing gemifloxacin with other quinolones (in 5 RCTs) and β-lactams and/or macrolides (in 5 RCTs),involving 3940 patients,were included in this meta-analysis.Overall,the treatment success was higher for gemifloxacin when compared with other antibiotics (odds ratio 1.39,95％ confidence interval 1.15-1.68 in intention-to-treat patients,and 1.33,1.02-1.73 in clinically evaluable patients).There was no significant difference between the compared antibiotics regarding microbiological success (1.19,0.84-1.68) or all-cause mortality (0.82,0.41-1.63).The total drug related adverse events were similar for gemifloxacin when compared with other quinolones (0.89,0.56-1.41),while lower when compared with β-lactams and/or macrolides (0.71,0.57-0.89).In subgroup analyses,administration of gemifloxacin was associated with fewer cases of diarrhoea and more rashes compared with other antibiotics (0.66,0.48-0.91,and 2.36,1.18-4.74,respectively).Conclusions The available evidence suggests that gemifloxacin 320 mg oral daily is equivalent or superior to other approved antibiotics in effectiveness and safety for CAP and AECB.The development of rash represents potential limitation of gemifloxacin。

Abstract：Background Functional neuroimaging study has opened an avenue for exploring the pathophysiology of cluster headache (CH).The aim of our study was to assess the changes in brain activity in CH patients by the regional homogeneity method using resting-state functional magnetic resonance imaging technique.Methods The functional magnetic resonance imaging scans were obtained for 12 male CH patients with spontaneous right-sided headache attacks during “in attack” and “out of attack” periods and 12 age- and sex-matched normal controls.The data were analyzed to detect the altered brain activity by the regional homogeneity method using statistical parametric mapping software.Results Altered regional homogeneity was detected in the anterior cingulate cortex,the posterior cingulate cortex,the prefrontal cortex,insular cortex,and other brain regions involved in pain processing and modulation among different groups.Conclusion It is referred that these brain regions with altered regional homogeneity might be related to the pain processing and modulation of CH。

Abstract：Background The infection of Kaposi's sarcoma-associated herpes virus (KSHV) is most likely the cause of clinical Kaposi's sarcoma,primary effusion lymphoma,and multi-center Castleman's disease.KSHV infection has very limited epidemiological survey data in China,and its definite mode of transmission remains controversial.This study aimed to determine the infection status and the main transmission route of KSHV in Chinese population.Methods An enzyme-linked immunosorbent assay (ELISA) utilizing KSHV ORF65 recombinant protein was employed to analyze the antibody response to KSHV ORF65 in sera from 122 healthy physical examination people,107intravenous drug users,135 non-intravenous drug users,211 hepatitis B (HBV) patients infected via blood transmission,107 kidney transplant recipients,and 72 female sex workers in Zhejiang Province in Southeast China.Results KSHV infection occurred relatively common (13.1％) in healthy population in Zhejiang,China.Infection rate was 16.7％ in female sex workers,but significantly elevated in intravenous drug addicts (58.9％),blood-transmitted HBV patients (28.0％) and kidney transplant patients (41.1％).Conclusion Blood borne transmission of KSHV is probably the main route of infection in Zhejiang Province。

To the Editor:Cystic fibrosis (CF) is quite rare in the Asian population that an epidemiological study in the Japanese population revealed the incidence of CF being about 1 in 350000.1Wright and Morton2 estimated that the incidence of CF in the Asiatic races was about 1 in 90000 infants in Hawaii.Here we report a Chinese girl with CF,who was diagnosed by both sweat chloride and genetic test。