2008年 · 第121卷第17期

Since human bocavims(HBoV)was first described in 2005 by Allander et al,1 a considerable number(at least nine)of original articles on this virus were published by authors from China.including two from the Hong Kong Special Administrative Region,within a relatively short period of time.These studies conducted in China cover basically the clinical aspects of children infected with the vires and genomic characteristics。

Abstract：Background Human bocavirus(HBoV)is a parvovirus recently found to possibly cause respiratory tract disease in children and adults.This studV investigated HBoV infection and its clinical characte rist:ics in children younger than five years of age suffering from acute Iower respiratory tract infection in Beijing Children's Hospital.Methods Nasopharyngeal aspirates were collected from children suffering from acute Iower respiratory tract infection during the winters of 2004 to 2006 (from November through the following February).HBoV was detected by polymerase chain reaction amplification and virus isolation and the amplification products were sequenced for identification.Results HBoV jnfection was detected in 16 of 333 study subjects.Coinfections with respiratory syncytial virus were detected in 3 of 16 HBoV positive patients with acute lower respiratory tract infection.The median age for HBoV positive children was 8 months(mean age,17 months;range,3 to 57 months).Among the HBoV positive children,14 were younger than 3 years old.9 were younger than 1 year old and 7 were younger than 6 months.These 16 positive HBoV children exhibited coughing and abnormal chest radiography findings and more than 60%of these children had wheezing and fever.Ten children were clinically diagnosed with pneumonia,2 bronchiolitis,2 acute bronchitis and 2 asthma.One child died.Conclusions HBoV was detected in about 5%of children with acute Iower respiratory infection seen in Beijing Children's Hospital.Fudher investigations regarding clinical and epidemiologic charactedstics of HBoV infection are needed。

Abstract：Background In the present study,we characterized multidrug-resistant Pseudomonas aeruginosa (MDRP) clinical isolates from a paediatric facility and investigated the types and features of the metallo-β-lactamases (MBLs) produced by carbapenem-resistant strains.Methods Four hundred and ninety-eight strains of Pseudomonas aeruginosa were isolated from patients at Beijing Children's Hospital between January 2005 and December 2006.The minimal inhibition concentrations (MICs) of the strains for 13 antibiotics were measured.A combination of the E test and PCR amplification/DNA sequencing was used to define the carbapenem-resistant strains.Results We found that 24.1% (120/498) of the isolates were MDRP.The frequencies of resistance to imipenem and meropenem were 34.2% and 35.8%,respectively,and the MIC50 and MIC50 values for the two antibiotics were identical at 4 μg/ml and 32 μg/ml,respectively.The detection rate for carbapenem resistance was 49.2% (59/120).Among the 59 carbapenem-resistant Pseudomonas aeruginosa strains,39 (66.1%) were positive for the MBL genotype;35 (89.7%)strains carded the blaIMP gene and 4 (10.3%) strains carried the blaVIM gene.Neither blaSPM nor blaa~M was amplified from any of the 59 isolates.DNA sequencing revealed that IMP-1 was present in 35 IMP-producing isolates and VIM-2 was detected in four VIM-producing isolates.Conclusions These MDRP isolates exhibited high frequencies of resistance to carbapenems among clinical isolates from a paediatric facility in Beijing,China.The production of MBL appears to be an important mechanism for carbapenem resistance in Pseudomonas aeruginosa。

Abstract：Background Reading Chinese,a kind of ideogram,relies more on visual cognition.The visuospatial cognitive deficit of Chinese dyslexia is an interesting topic that has received much attention.The purpose of current research was to explore the visuopatial cognitive characteristics of Chinese dyslexic children by studying their eye movements via a picture searching test.Methods According to the diagnostic criteria defined by ICD-10,twenty-eight dyslexic children (mean age (10.12+1.42)years) were enrolled from the Clinic of Children Behavioral Disorder in the third affiliated hospital of Sun Yat-sen University.And 28 normally reading children (mean age (10.06±1.29) years),1:1 matched by age,sex,grade and family condition were chosen from an elementary school in Guangzhou as a control group.Four groups of pictures (cock,accident,canyon,meditate) from Picture Vocabulary Test were chosen as eye movement experiment targets.All the subjects carried out the picture searching task and their eye movement data were recorded by an Eyelink Ⅱ High-Speed Eye Tracker.The duration time,average fixation duration,average saccade amplitude,fixation counts and saccade counts were compared between the two groups of children.Results The dyslexic children had longer total fixation duration and average fixation duration (F=7.711,P＜0.01;F=4.520,P＜0.05),more fixation counts and saccade counts (F=7.498,P＜0.01;F=11.040,P＜0.01),and a smaller average saccade amplitude (F=29.743,P＜0.01) compared with controls.But their performance in the picture vocabulary test was the same as those of the control group.The eye movement indexes were affected by the difficulty of the pictures and words,all eye movement indexes,except saccade amplitude,had a significant difference within groups (P＜0.05).Conclusions Chinese dyslexic children have abnormal eye movements in picture searching,applying slow fixations,more fixations and small and frequent saccades.Their abnormal eye movement mode reflects the poor ability and strategy of visual information processing。

Abstract：Background Birth asphyxia may result in multiple organ dysfunction such as lung injury.Inhalation of nebulized nitric oxide precursor can selectively reduce pulmonary hypertension.However,it is unknown whether such precursors can alleviate lung injury induced by hypoxia.We evaluated the effect of inhalation of nebulized nitroglycerine and sodium nitroprusside on acute hypoxic lung injury in newborn piglets.Methods Acute hypoxic lung injury was induced by inspiring 10% O2 for 1 hour.Twenty-four anaesthetized and mechanically ventilated piglets (5-7 days old) were randomly divided into four groups:(1) group S,not hypoxic;(2) group C,nebulized saline after hypoxia;(3) group NTG,nebulized nitroglycerine after hypoxia;(4) group SNP,nebulized sodium nitroprusside after hypoxia.Respiratory dynamic compliance and resistance of respiratory system were recorded at baseline,0.5 hour and 1 hour of hypoxia;then 0.5 hour,1 hour,3 hours and 5 hours following hypoxia.After nebulization,arterial blood was collected for measuring methaemoglobin and nitrate/nitrite levels.Right lung tissue,wet-dry ratio and myeloperoxidase level were determined.White blood cell count (WBC),total surfactant phospholipids (TPL) and disaturated phosphatidyl choline (DSPC) of the bronchoalveolar lavage fluid (BALF) were calculated,Left lungs were used for examining pathological changes.Results No significant difference was observed in respiratory dynamic compliance,resistance of respiratory system,wet-dry ratio,levels of methaemoglobin and nitrate/nitrite after nebulization,TPL or DSPC/TPL among four groups.WBC in BALF in groups NTG and SNP significantly decreased as compared with group C:similarly for myeloperoxidase level in lung tissue.Lung histological findings showed infiltration of neutrophils in groups NTG and SNP decreased significantly as compared with group C.Conclusion Inhalation of nebulized nitroglycerine or sodium nitroprusside can alleviate the infiltration of neutrophils,while it affects neither the metabolism of phospholipids nor water content in the lungs。

Abstract：Background Infantile spasms is a severe epileptic encephalopathy,which is refractory to conventional antiepileptic drugs.Adrenocorticotropic hormone (ACTH) has been the major therapy for infantile spasms;however,ACTH therapy is ineffective for some patients.The variations in the receptor genes can contribute to antiepileptic drug resistance.This study was to elucidate the possible associations between the variations of the MC2R gene and ACTH responsiveness in patients with infantile spasms.Methods We screened for variations in the promoter and coding region of the MC2R gene in 91 Chinese patients with infantile spasms and 94 controls,using PCR and a direct sequencing method.The frequencies of the genotypes,alleles and reconstructed haplotypes were analyzed in the cases and controls.The association between ACTH responsiveness and genetic variations of the MC2R gene was also assessed.Results Four single nucleotide polymorphisms (SNPs) were identified in the MC2R promoter,one of which was a novel specimen at position-2 from the transcription start site ATT,-2T＞C.Three SNPs (rs1893220,rs2186944 and -2T＞C)showed a significant difference between the cases and controls (P＜0.05 for all).The frequency of the common TCCT haplotype carrying four-SNP major alleles was significantly lower in the cases (39%) than in the controls (60%)(P=0.00003).The homozygous carriers of the TCCT haplotype had a much lower relative risk than the non-carriers (RR=0.42,95%CI 0.26-0.70,P=0.0001).ACTH responsiveness was strongly associated with the TCCT haplotype (P=0.000082).Compared with non-carriers of the TCCT haplotype,the homozygous and heterozygous carders were more responsive to ACTH therapy (P=0.0002;P=0.0003,respectively).Conclusions Our results indicated that the TCCT haplotype in the MC2R promoter is strongly associated with the responsiveness of the ACTH therapy performed on patients with infantile spasms.The polymorphisms of the MC2R promoter might be one important factor that influences the efficacy of ACTH therapy on infantile spasms。

Abstract：Background Electroencephalogram(EEG)activity in normal subjects and epileptic patients is often closely related to the eye's status such as eye opened(EO),eye closure(ECL)and eyes closed(EC).ECL is the period immediately after closing of the eyes and only Iasts for Jess than 3 seconds if the eyes remain closed.EC is the pened as long as the eyes are closed.Epileptiform changes on EEG induced by ECL or EC are called the changes of ECL sensitivity(ECLS)or EC sensitivity (ECS).ECLS occurs mainly but not exclusively in photosensitive patients and ECS has been seen rarely in photosensitive patients.This study aimed to investigate the relationships among ECLS,ECS.photosensitivity and epilepsy syndromes in children.Methods EEG records from child patients in the EEG Department of Peking University First Hospital dudng the period of May 2005 to Mav 2007 were examined for the presence of ECLS or ECS.Open-close eye tests and intermittent photic stimulations were carried out during video-EEG monitoring for examining ECLS.ECS and photosensitivity.Results Based on ECLS and ECS on their EEGs,30 patients were divided into ECLS group (16 cases)and ECS group (14 cases).There were more boys than girls in the two groups.The mean age of initial detection of ECLS and ECS was 10 years.and the average onset age of seizures was 9 years.The epilepsy syndromes in the ECLS group included idiopathic photosensitive occipital lobe epilepsy,Panayiotopoulos syndrome,symptomatic occipital lobe epilepsy,juvenile myoclonic epilepsy,juvenile absence epilepsy,eyelid myoclonia with absences,epilepsy with grand mal on awakening and pure photosensitive epilepsy with mainly generalized tonic clonic seizures.Those in the ECS group were iuvenile myoclonic epilepsy,idiopathic photosensitive occipital Iobe epilepsy,Panayiotopoulos syndrome and Gastaut type-idiclpathic children occipital epilepsy.Photosensitivity was detected in 88%of Patients with ECLS and 29%of patients with ECS.Conclusions ECLS and ECS are relatively common in females.Comparing with ECS.ECLS is found in more epilepsy syndromes.However,ECS and ECLS could exist in the same epilepsy syndrome.ECLS and ECS can be associated or dissociated with photosensitivity.The rate of ECLS with photosensitivity is higher than that of ECS with photosensitivity,suggesting that mechanisms for ECLS,ECS and photosensitivity may be different but correlated。

Abstract：Background Pelizaeus-Merzbacher disease(PMD)is a rare X-linked recessive disorder with svmptoms including nystagmus,impaired motor development,ataxia,and progressive spasticity.The proteolipid protein 1(PLPl)gene is the only pathogenic gene of PMD.Duplication of the PLP1 gene is the most frequent gene defect.accounting for 500%-70%of PMD cases.whereas point mutations in the coding sequence or the splice sites account for 10%-25%of PMD cases.This study aimed to identify PLP1 mutations in nine unrelated Chinese patients(P1-9)with PMD,and 14 subjects from the family of patient 2 were also described.Methods Genomic DNA was extracted from peripheral blood samples.Gene dosage was determined using the multiplex ligation-dependent probe amplification (MLPA).All 7 exons and exon-intron boundanes of the PLP1 gene were amplified and analyzed using direct DNA sequencing.Reaults Of these nine patients,there were four transitional.four classical,and one connatal PMD according to their clinical and radiological presentations.PLP1 duplications were identified in patients 1-7 with PMD.Their mothers were PLP1 duplications carriers as well.Both duplication carders and normal genotypes of PLP1 were identified in the family members of patient 2.A c.51 7C＞T(p.P173S)hemizygous missense mutation in exon 4 was found in patient 8 with PMD,and his mother was shown to be a heterozygote of this mutation.Conclusions We identified seven genomic duplications and one missense mutation(p.P173S)of the PLP1 gene in eight Chinese patients with PMD.This is the report about PLP1 mutations in PMD patients from the mainland of China。

Abstract：Background Aortic root replacement with pulmonary autograft (Ross procedure) has the advantages of good haemodynamics and growth potential without the need for anticoagulation.In this study,we reviewed our expedence of the Ross procedure for patients with aortic valve disease.Methods From October 1994 to January 2005,42 Ross procedures were performed in our centre.There were 30 males and 12 females.The mean age was 28+15 years (range,5-56 years).Congenital heart disease (CHD) with aortic valve stenosis (AS) and/or aortic valve insufficiency (A1) in 40 cases including one associated with ventdcular septal defect (VSD),degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis (SBE) with A1 in 1 were studied.The diagnosis was made by ultracardiography (UCG) in all patients.The mean aortic valve annulus diameter (AVD) was (2.45±0.31) cm and pulmonary valve annulus diameter (MPVD) was (2.34±0.21) cm.All patients had normal pulmonary valves.The New York Heart Association (NYHA) function class was Ⅱ in 36 cases and Ⅲ in 6 cases.The operation was performed under moderate hypothermic cardiopulmonary bypass (CPB) with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft.Results There was no early hospital mortality.Postoperative UCG showed normal aortic valve function in all our patients.The mean gradient across the aortic valve was (6.11±0.12) mmHg.The left ventricular diastole diameter (LVDD)decreased significantly from (62±5) mm to (56±3) mm (P＜0.001).The mean postoperative left ventricular ejective fraction (LVEF) was 0.49±0.23.All patients were in NYHA class Ⅰ-Ⅱ.Follow-up was completed in 38 cases for a mean period of 3.2 years (range 1-10 years).All survivors were in NYHA class Ⅰ with normal neo-aortic and pulmonary valve function.One patient died after secondary operation due to homograft fungal endocarditis 1 year after the Ross procedure.The cause of death was uncontrolled bleeding.Another patient suffered from cardiogenic shock and was on extracorporeal membrane oxygenation (ECMO) for 10 days postoperatively.This patient was subsequently self-discharged from hospital due to financial issues and he was excluded from follow-up.Conclusion The Ross procedure is an excellent technique to treat aortic valve disease.Our data show that it can be performed safely with good eady and mid-term clinical outcomes。

Abstract：Background Although tongue cancer is a common disease of the head and neck,the choice of neck treatment between elective neck dissection and "watchful waiting" remains controversial for patients with early stage NO oral tongue carcinoma.Methods On the basis of the current state of head and neck cancers a decision analysis model was created to compare two treatment strategies for early tongue cancer.Expected value (EV) was calculated according to the literature which met the defined criteria.Sensitivity analyses were performed.Results The results showed that the decision model favored elective neck dissection (EV=0.87),over "watchful waiting"(EV=0.77).One-way sensitivity analyses demonstrated that the outcome was influenced by regional recurrence,threshold value of 0.28 for the elective neck dissection group and 0.17 for the "watchful waiting" group,and a salvage rate threshold value 0.73 for the "watchful waiting" group.Conclusions These results suggested that elective neck dissection strategy of the neck should be applied for early stage NO oral tongue carcinoma patients with no clinical nodal metastases.When the occult lymph node metastases rate was less than 0.17 and the salvage rate was more than 0.73,"watchful waiting" strategy would be preferable。

Abstract：Background Treatment of cavemous dural arteriovenous fistulas (DAVF) is usually made by a transartedal approach.However,in many complicated patients,treatments via transarterial approaches can not be achieved,and only an operation via a transvenous approach is feasible.We aimed to study the feasibility of transarterial embolJzation of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavemous DAVF via a transvenous approach.Methods From August 2006 to August 2007,six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach.Three cases were male and the other three were female.Their ages ranged from 36 to 69 years old.The fistula was in the right lateral cavernous sinus in one case,in the left lateral cavernous sinus in another,and in the bilateral cavernous sinus in 4 cases.One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk;one was fed by the branches of the left internal carotid artery and left extemal carotid artery;four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery.One case was drained via one lateral inferior petrosal sinus;three were drained via bilateral inferior petrosal sinuses;one was drained via one lateral ophthalmic and facial veins;one was drained via the infedor petrosal sinus and the ophthalmic and facial veins.Four were embolized via the inferior petrosal sinus,and two were embolized via the ophthalmic and facial veins.Results Among six cases of complicated cavernous DAVF,four were fully embolized with Onyx by a single operation,and two cases were fully embolized with Onyx following two operations.Transient headache was found after operation in all patients,but was cured after several days by the symptomatic treatments.In one case,the first operation via the inferior petrosal sinus was a failure;the feeding branches of the external carotid artery were embollzed,and transient facial palsy was appeared after operation.The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications.One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations,and transient abducens nerve palsy occurred after embolization.Conclusions Because Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn,cavernous sinus via transvenous catheterization and emboUzation is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas,especially those for which operations via transarterial approaches have failed,or spontaneous cavemous dural arteriovenous fistulas。

Accumulating evidence suggests that the Th1 immune response induced by various antigens such as oxidized low density lipoprotein (ox-LDL) and heat shock proteins (HSPs) play a key role in the process of atherosclerosis.1 Dendritic cells (DCs) are the most potent antigen-presenting cells (APCs) in the body with the unique ability to initiate a primary immune response to certain antigens by the activation of "naive" T cells.2 The maturation of DC with the upregulation of costimulatory molecules such as CD83,CD40,CD86,and major histocompatibility complex (MHC) class molecules such as human leukocyte antigen (HLA)-DR,is required for DC to activate T cells。

Abstract：Severe acute respiratory syndrome (SARS) first emerged in Guangdong province,China in November2002.During the following 3 months,it spread rapidly across the world,resulting in approximately 800 deaths.In 2004,subsequent sporadic cases emerged in Singapore and China.A novel coronavims,SARS-CoV,was identified as the etiological agent of SARS.1,2 This virus belongs to a family of large,positive,single-stranded RNA viruses.Nevertheless,genomic characterization shows that the SARS-CoV is only moderately related to other known coronaviruses.3 In contrast with previously described coronaviruses,SARS-CoV infection typically causes severe symptoms related to the lower respiratory tract.The SARS-CoV genome includes 14 putative open reading frames encoding 28 potential proteins,and the functions of many of these proteins are not known.4 A number of complete and partial autopsies of SARS patients have been reported since the first outbreak in 2003.The predominant pathological finding in these cases was diffuse alveolar damage (DAD).This severe pulmonary injury of SARS patients is caused both by direct viral effects and immunopathogenetic factors.5 Many important aspects of the pathogenesis of SARS have not yet been fully clarified.In this article,we summarize the most important mechanisms involved in the complex pathogenesis of SARS,including clinical characters,host and receptors,immune system response and genetic factors。

Hypoxia is encountered under many physiological and pathophysiological situations. Although both intermittent hypoxia (IH) and continuous hypoxia (CH)result in decreases in arterial O2,there are striking differences in the response of the physiological systems to CH and IH.Obstructive sleep apnea-hypopnea syndrome (OSAHS),characterized by frequently recurrent intermittent hypoxia/reoxygenation (IH/ROX)as its obvious pathological trait,is clearly associated with an increased risk of cardiovascular disorders,particularly hypertension,1 and IH/ROX may be the primary pathological basis for OSAHS complicated hypertension.2

Abstract：Objective To review the major achievements in dyslexia in Chinese characters,hoping to give some clues for future studies.Data sources Both Chinese and English language literature search using PUBMED,and original articles published in main Chinese and international journals.Study selection After reviewing the literature,54 articles were selected that specifically addressed the stated purpose.Results The results of studies about the subtypes,cerebral basis,reading processing model,event-related potential (ERP) and saccadic features between English and Chinese dyslexia are different.Conclusions In the last ten years,great progress has been made in the study of dyslexia in Chinese characters.However,there are still many problems and shortcomings which need to be investigated。

Anumber of studies have investigated the effects of stress on mental health and cardiovascular diseases and the relationship between stress and various components of the immune system,and they found that chronic stress is associated with suppression of a variety of immune parameters.However,acute stress is often associated with transient increases in immune activation.1 A few studies have also examined the slgA response to occupational stress.Zeier et al2 measured salivary sIgA in air traffic controllers before and immediately after radar working sessions lasting approximately 100 minutes。

Acute myeloid leukemia (AML) M4Eo type is a hematological malignancy with abnormal eosinophilia,which is often accompanied by inv(16).The Ets variant gene 6 (ETV6),mapped to 12p13,is an ETS family transcription factor that is essential for hematopoietic processes,1 The ETV6 gene-involved chromosomal translocations have been found in many hematological malignancies characterized by fusing to a number of different partner genes;mainly coding for tyrosine kinases or transcription factors which are important for the initiation,progress and prognosis of disease.2 In particular,the ETV6 gene has been reported to be fused to ABL in acute lymphocytic leukemias (ALL),3 and chronic myeloid leukemia (CML).4 However,there have been few domestic reports of ETV6 fusion genes,especially in cases of acute leukemia.We investigated 3 cases of AML-M4Eo patients using Split-signal Fluorescence in situ hybridization (FISH) and found one case with a translocation between 12p13 and 1q25 co-occurring with an inv(16).The ETV6/ARG (ABL-related gene) fusion transcript was confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR).This is the report of ARG involvement in a translocation in a human malignancy。

Retroperitoneal tumors are difficult to distinguish,especially because they share common radiological features with tumors of the liver.1 When we come across such tumors,the clinical diagnosis is often confusing.Here,we report a case of retroperitoneal schwannoma which mimicked a cystic right lobe hepatic tumor。

Coronary chronic total occlusion (CTO),defined as a total occlusion of duration ＞3 months,remains a technical challenge for the interventional cardiologists.The major limitation in percutaneous coronary intervention (PCI) of CTO is the inability to penetrate and cross the occlusion with a guidewire.It was reported that the immediate angiographic success rate varied from 50%to 70% using the standard antegrade techniques,1 To improve this suboptimal success rate,the authors firstly introduced retrograde approach through the collateral channels as a novel technique2 and successfully recanalized a left main CTO using this technique when demonstrating the live cases in Transcatheter Cardiovascular Therapeutics (TCT) 2005.Recently,modified techniques based on the retrograde approach have demonstrated that this approach could provide a high success rate with PCI.3-5 In the present report,we described a new method,wire trapping technique combined with retrograde approach,which was applied successfully in three patients with CTO。

Hernia of the lung is defined as a protrusion of lung tissue,covered by parietal and visceral pleurae,through an abnormal opening in the chest wall,diaphragm or mediastinum.1 It is a relatively uncommon condition.We report a case of lung hernia following cavitation in malignant lung mass。

This article summarizes the major new findings on clinical management for benign prostatic hyperplasia (BPH) that were presented at the annual meeting of the American Urological Association (AUA) in May 2008.The management of symptomatic BPH has been changed significantly over the last decade in response to the availability of new treatment options.Prior to the 1980s,open prostatectomy was the only widely accepted intervention for BPH.Since then,the advent of new medical therapies for BPH and the introduction of a range of minimally invasive therapies have provided for men with lower urinary tract symptoms (LUTS) secondary to BPH.1 In this year's AUA meeting,several new findings were reported in the filed of BPH which involved epidemiology,clinical progression,drug therapy and new technologies in surgical therapy of BPH。