2011年 · 第124卷第20期

Cough is a common condition in clinical settings.Importantly,chronic cough without obvious abnormal chest X-ray findings accounts for about 20％-30％ of respiratory clinic visits,and yields a high rate of misdiagnosis and mistreatment.1 Up to 80％ of patients with chronic cough were diagnosed with other disorders,such as “chronic bronchitis” or “chronic pharyngolaryngitis”.2,3 As many as 50％ of female patients with cough may develop urinary incontinence,which can interfere seriously with their daily living,including work and school performance.4 Along with the increasing demand for a high-quality life among Chinese people,cough as an important issue should be properly addressed by both clinicians and patients。

Cough is a defensive physiological reflex of the human body that enables vital clearance of secretions and harmful elements from the respiratory tract;however,frequent and intense coughing may adversely impact on a patient's work,daily life and social activities.Cough is one of the most commonly observed symptoms in clinical practice arising from a wide range of aetiologies.A chronic cough may be overlooked by clinicians,particularly if reassured by the normal appearance on a chest radiograph.Furthermore,70％-80％ of these patients are readily mislabelled or diagnosed with “chronic bronchitis” or “bronchitis” in China,then typically treated with substantial but ineffective courses of antibiotics,or subjected to repeated investigations as a result of a diagnosis that is unclear,and may thus suffer more discomfort and fimancial burden from their disease。

Abstract：Background The current theory of dyspnea perception presumes a multidimensional conception of dyspnea.However,its validity in patients with cardiopulmonary dyspnea has not been investigated.Methods A respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort,affective aspects,and behavioral items was administered to 396 patients with asthma,chronic obstructive pulmonary disease (COPD),diffuse parenchymal lung disease,pulmonary vascular disease,chronic heart failure,and medically unexplained dyspnea.Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis.The separation of patient groups was achieved by a variance analysis on symptom factors.Results Seven factors appeared to measure three dimensions of dyspnea:sensory (difficulty breathing and phase of respiration,depth and frequency of breathing,urge to breathe,wheeze),affective (chest tightness,anxiety),and behavioral (refraining from physical activity) dimensions.Difficulty breathing and phase of respiration occurred more often in COPD,followed by asthma (R2=0.12).Urge to breathe was unique for patients with medically unexplained dyspnea (R2=0.12).Wheeze occurred most frequently in asthma,followed by COPD and heart failure (R2=0.17).Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R2=0.04).Anxiety characterized medically unexplained dyspnea (R2=0.08).Refraining from physical activity appeared more often in heart failure,pulmonary vascular disease,and COPD (R2=0.15).Conclusions Three dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups.These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea。

Abstract：Background Pulmonary angiography is widely performed in pulmonary hypertension patients,but its immediate effects on right heart hemodynamics and safety are not well known.The objective of this study was to investigate the right heart hemodynamic effects and safety of pulmonary angiography in Chinese patients with pulmonary hypertension.Methods Between January 2008 and June 2009,pulmonary hypertension patients undergoing pulmonary angiography were consecutively enrolled.Pulmonary angiography was performed during breath-holding after deep breathing.The baselineclinical data,hemodynamic measurements before and after pulmonary angiography and complications occurring within 48hours after angiography were recorded.Results Ninety-five patients were included.All received non-ionic contrast medium with a volume of (75.7±29.8) ml.Angiography reduced heart rate in patients with baseline mean pulmonary arterial pressure ≥ 60 mmHg (change of heart rate:(-3.1±7.0) beats/min,P=0.005),increased mean right atrial pressure,diastolic and end-diastolic right ventricular pressure in patients with baseline mean pulmonary arterial pressure ＜60 mmHg (all P ＜0.05).Patients with decreased mean pulmonary arterial pressure (change of mean pulmonary arterial pressure ≤ -10 mmHg) had the highest total pulmonary resistance (P=0.009 vs.no change in mean pulmonary arterial pressure (change of mean pulmonary arterial pressure,-10 mmHg to 10 mmHg); P=0.03 vs.increased mean pulmonary arterial pressure (change of mean pulmonary arterial pressure ≥ 10 mmHg)) and the lowest cardiac output (P=0.018 vs.no change in mean pulmonary arterial pressure; P=0.013 vs.increased mean pulmonary arterial pressure).There were 7 complications (7％),with 6 related to catheter and only 1 directly related to angiography.All complications were mild and no death occurred.Conclusion Pulmonary angiography has minimal effect on right heart hemodynamics and is safe in pulmonary hypertension patients。

Abstract：Background X-linked inhibitor of apoptosis (XIAP)-associated factor 1 (XAF1) is a new tumor suppressor.Low expression of XAF1 is associated with poor prognosis of human cancers.However,the effect of XAF1 on lung cancerremains unknown.In this study,we investigated the expression of XAF1 and its role in squamous cell lung cancer.Methods Cancer tissues,cancer adjacent tissues and normal lung tissues were collected from 51 cases of squamous cell lung cancer.The expression of XAF1 mRNA was determined by reverse transcription-polymerase chain reaction (RT-PCR).The expression of XAF1 protein was determined by Western blotting and immunohistochemical staining.Ad5/F35-XAF1 virus was generated.Cell proliferation and apoptosis were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method and flow cytometry (FACS),respectively.Results The levels of XAF1 protein and mRNA in cancer tissues were significantly lower than those in cancer adjacent and normal lung tissues (P ＜0.05).The low expression of XAF1 was associated with tumor grade,disease stage,differentiation status and lymph node metastasis in squamous cell lung cancer patients.The restoration of XAF1 expression mediated by Ad5/F35-XAF1 virus significantly inhibited cell proliferation and induced apoptosis in a dose- and time-dependent manner.Conclusion XAF1 is a valuable prognostic marker in squamous cell lung cancer and may be a potential candidate gene for lung cancer therapy。

Abstract：Background Early detection and diagnosis is urgent for the sake of effective treatment strategy for lung cancer.However,a convenient,economical and relatively precise method is not available.We here report a prospective study to find the possible value of the combined use of four popular tumor markers in the early diagnosis of lung cancer among patients with suspicious nodules in the lung.Methods Six hundred and sixty inpatients with suspicious nodules in the lung were divided into a lung cancer group and a benign pulmonary tumor group according to post-operative histological examinations.Serum levels of four tumor markers including squamous cell carcinoma antigen (SCC),carcinoembryonic antigen (CEA),Cyfra 21-1 and neuron specific enolase (NSE) were assayed for each patient.Receiver operating characteristic (ROC) curves were constructed for each tumor marker.The power of lung cancer diagnosis of each tumor marker,as well as a combination of them were analyzed and compared.Results The serum levels (median,range) of SCC,CEA,Cyfra 21-1 and NSE were 0.44 (0.01-35.70) ng/ml,2.49(0.30-26.78) ng/ml,2.30 (0.82-73.33) ng/ml and 10.54 (0.10-56.41) ng/ml respectively in lung cancer group,and were 0.32 (0.01-0.90) ng/ml,1.60 (0.20-8.93) ng/ml,1.41 (0.72-4.82) ng/ml and 9.36 (6.56-24.24) ng/ml respectively in the benign pulmonary tumor group.The difference in each tumor marker between the two groups was significant (P ＜0.05).The ROCs of SCC,CEA,Cyfra 21-1 and NSE were 0.702 (95％ CI,0.654-0.751),0.611 (95％ CI,0.563-0.659),0.650(95％ CI,0.601-0.700) and 0.598 (95％ CI,0.542-0.654) respectively,indicating very low power of these four tumor markers.When a combination of SCC,CEA,Cyfra 21-1 and NSE were employed,the diagnosis power was strengthened.Conclusion SCC,CEA,Cyfra 21-1 and NSE are valuable in the early diagnosis of lung cancer among suspicious nodules in the lung,especially when they were assayed together for one patient。

Abstract：Background The correct diagnosis of etiology of fungal infection after bone marrow transplantation is very important to the choice of antifungal drugs and a premise for improvement of therapeutic efficacy.This study aimed to compare high-resolution computed tomography (HRCT) findings of the pulmonary fungal infections to determine whether the etiology of various fungal infections could be diagnosed with HRCT.Methods Eighty-five cases were enrolled.According to the pathogens responsible for fungal infections,the patients were classified into three groups including invasive aspergillosis (n=52),candidiasis (n=19) and cryptococcosis (n=14)groups.All the patients underwent HRCT scans.Two independent radiologists retrospectively analyzed the HRCT scans regarding CT patterns and distribution of lung abnormality.Results Most fungal infections in the three groups occurred in the neutropenic phase.There was no significant difference in the constituent ratio of fungal infections at different phases after bone marrow transplantation among the three groups.Agreement between the two observers for all the CT characteristics of fungal infections was excellent (k＞0.75).There was a significant difference in occurrence ratio of mass among the three groups (P=0.02).Occurrence ratio of mass (43.3％,13/30) in the group with invasive aspergillosis was higher than in each of other two groups (20.0％,2/10;14.3％,1/7).There was no significant difference in other CT characteristics of nodules or masses; including number,margin,halo sign,cavitation and air-crescent sign.There was no significant difference in number,margin,air bronchogram and distribution of air-space consolidation.Conclusions The HRCT appearance of various pulmonary fungal infections has a great deal of overlap and is nonspecific.Mass is more common in invasive aspergillosis,which is helpful to the diagnosis of invasive aspergillosis after bone marrow transplantation。

Abstract：Background Early clinical trials with the Endeavor zotarolimus eluting stent (ZES) in western populations demonstrated low rates of target lesion revascularization with a favorable safety profile including low late stent thrombosis with up to 5 years of follow-up.The aim of this clinical registry study was to evaluate real world clinical performance of the ZES coronary system in Chinese patients.Methods The China Endeavor Registry is a prospective,multicenter registry assessing the safety of the ZES system in a real world patient population.It was conducted at 46 centers in China in routine treatment of patients with coronary artery stenosis,including patients with clinical characteristics or lesion types that are often excluded from randomized controlled trials.The registry included 2210 adult patients who underwent single-vessel or multi-vessel percutaneous coronary intervention.The primary end point was the rate of major adverse cardiac events (MACE) at 12 months.Results The 12-month rate of MACE for all patients in the registry was 3.03％.Cardiac death or myocardial infarction rate was 1.28％ and target lesion revascularization rate was 1.66％,non-target lesion target vessel revascularization (TVR) was 0.52％,TVR was 2.18％,and target vessel failure was 3.22％.There was only one case of emergent cardiac bypass surgery.The 12-month overall incidence of all Academic Research Consortium (ARC)-defined stent thrombosis was 0.43％.Conclusion Mid-term results from the real-world China Endeavor Registry suggest that Endeavor ZES was safe and effective in Chinese patients。

Abstract：Background Duloxetine is approved for the treatment of generalized anxiety disorder (GAD) in the United States and elsewhere.This study aimed to assess the efficacy,tolerability,and safety of duloxetine in Chinese patients with GAD.Methods This 9-site study consisted of double-blind treatment for 15 weeks either with duloxetine 60-120 mg or with placebo.Patients with at least moderately severe GAD and a Sheehan Disability Scale (SDS) global functioning impairment total score ≥12 were included in this study.Patients who were randomly assigned to duloxetine received 60 mg for 7 weeks; at that point,for nonresponders the dose was increased to 120 mg for the remaining 8 weeks.The primary efficacy measure was mean change from baseline to endpoint on the Hospital Anxiety and Depression Scale-Anxiety subscale score (HADS-A).Secondary efficacy measures included the Hamilton Anxiety Rating Scale (HAMA),the SDS,and pain measures.Safety and tolerability were assessed.Results Baseline characteristics did not differ significantly between treatment groups.Mean age of the subjects (n=210)was 37.6 years,50.5％ were female,and 74.3％ completed the 15 weeks treatment.Patients treated with duloxetine had significantly greater improvement compared to placebo on the HADS-A (mean change -6.6 vs.-4.9,respectively,P=0.022).Improvement in anxiety was greater with duloxetine treatment at 7 weeks and continued through 15 weeks for both the HADS-A and the HAMA total score (0.01 ≤ P ＜0.05).Compared with placebo,duloxetine was also associated with greater improvement on most secondary measures,but not on the SDS global functioning score.Nausea,dizziness,and somnolence occurred significantly more frequently as treatment-emergent adverse events with duloxetine treatment compared with placebo treatment.Conclusions Duloxetine 60-120 mg once daily is effective and well-tolerated for the treatment of patients with GAD in China。

Abstract：Background Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders during childhood,characterized by the core symptoms of hyperactivity,impulsivity and inattention and puts great burden on children themselves,their families and the society.Osmotic release oral system methylphenidate (OROS-MPH) is a once-daily controlled-release formulation developed to overcome some of the limitations associated with immediate-release methylphenidate (IR-MPH).It has been marketed in China since 2005 but still lacks data from large-sample clinical trials on efficacy and safety profiles.The aim of this study was to evaluate the effectiveness and safety of OROS-MPH in children aged 6 to 16 years with ADHD under naturalistic clinical setting.Methods This 6-week,multi-center,prospective,open-label study enrolled 1447 ADHD children to once-daily OROS-MPH (18 mg,36 mg or 54 mg) treatment.The effectiveness measures were parent-rated Inattention and Overactivity With Aggression (IOWA) Conners I/O and O/D subscales,physician-rated CGI-I and parent-rated global efficacy assessment scale.Blood pressure,pulse rate measurement,adverse events (AEs) and concomitant medications and treatment review were conducted by the investigator and were served as safety measures.Results A total of 1447 children with ADHD (mean age (9.52±2.36) years) were enrolled in this trial.Totally 96.8％children received an OROS-MPH modal dose of 18 mg,3.1％ with 36 mg and 0.1％ with 54 mg at the endpoint of study.The parent IOWA Conners I/O score at the end of week 2 showed statistically significant (P ＜0.001) improvement with OROS-MPH (mean:6.95±2.71) versus the score at baseline (10.45±2.72).The change in the parent IOWA Conners O/D subscale,CGI-I and parent-rated global efficacy assessment scale also supported the superior efficacy for OROS-MPH treatment.Fewer than half of 1447 patients (511 (35.3％)) reported AEs,and the majority of the events reported were mild (68.2％).No serious adverse events were reported during the study.Conclusion This open-label,naturalistic study provides further evidence of effectiveness and safety of OROS-MPH in school-aged children under routine practice。

Abstract：Background Primary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI).This study aimed to determine the clinical outcomes of tirofiban combined withthe low molecular weight heparin (LMWH),dalteparin,in primary PCI patients with acute STEMI.Methods From February 2006 to July 2006,a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups:unfractionated heparin (UFH) with tirofiban (group Ⅰ:60 patients,(61.2±9.5) years),and dalteparin with tirofiban (group Ⅱ:60 patients,(60.5±10.1) years).Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined.Bleeding complications during hospitalization were also examined.Results There were no significant differences in sex,mean age,risk factors,past history,inflammatory marker,or echocardiography between the 2 groups.In terms of the target vessel and vascular complexity,there were no significant differences between the 2 groups.During the first 7 days,emergent revascularization occurred only in 1 patient (1.7％) in group Ⅰ.Acute myocardial infarction (AMI) occurred in 1 (1.7％) patient in group Ⅰ and in 1 (1.7％) in group Ⅱ.Three (5.0％)patients in group Ⅰ and 1 (1.7％) in group Ⅱ died.Total in-hospital MACE during the first 7 days was 4 (6.7％) in group Ⅰ and 2 (3.3％) in group Ⅱ.Bleeding complications were observed in 10 patients (16.7％) in group Ⅰ and in 4 patients (6.7％) in group Ⅱ,however,the difference was not statistically significant.No significant intracranial bleeding was observed in either group.Four years after PCI,death occurred in 5 (8.3％) patients in group Ⅰ and in 4 (6.7％) in group Ⅱ.MACE occurred in 12 (20.0％) patients in group Ⅰ and in 10 (16.7％) patients in group Ⅱ.Conclusions Dalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH.Although there was no statistically significant difference,LMWH decreased the bleeding complications compared with UFH。

Abstract：Background Iliac vein compression syndrome (IVCS),the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae,is not an uncommon condition.The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS.Methods Between January 1997 and September 2008,296 patients received interventional therapy in the left common iliac vein.In the second stage,170 cases underwent saphenous vein high ligation and stripping.Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.Results The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases,of whom 272 received stent implantation therapy.Most of the patients achieved satisfactory results on discharge.During the follow-up period,varicose veins were alleviated in 98.7％ of the patients,and leg swelling disappeared or was obviously relieved in 84％ of cases.About 85％ of leg ulcers completely healed.The total patency rate was 91.7％ as evaluated with color ultrasound and 91.5％ with ascending venography.Conclusions Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients。

Abstract：Background Computed tomography (CT)-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions.The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population.Methods CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010.A chest radiograph was taken after the biopsy.Data about basic patient information,final diagnosis,and complications secondary to biopsy procedure (pneumothorax and bleeding) were extracted.Results The diagnostic efficiency of CT-guided lung biopsy was 94.8％; only 53 patients did not get a final diagnosis from lung biopsy.Final diagnoses found 639 malignant lesions (63.0％) and 322 benign lesions (31.8％).Pneumothoraxoccurred in 131 patients and 15 required insertion of an intercostal drain.Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients.The overall complication rate was 18.5％.Conclusions CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy.It can be safely performed in clinical trials。

Abstract：Background Intraoperative ultrasound (IOUS) has been increasingly used as a guiding tool during neurosurgical procedures.In this study,we aimed to evaluate the potential application of intraoperative ultrasound assisted surgery in the resection of small,deep-seated,or ill-defined lesions.Methods Eighty-six consecutive patients with small,deep-seated,or ill-defined intracerebral lesions were studied prospectively.An improved intraoperative imaging technique and surgical setup were practiced during the surgery.IOUS was performed in three orthogonal imaging planes (horizontal,coronal and sagittal).Results Histopathological diagnoses of these 86 cases included cavernomas,metastases,hemangioblastomas,gliomas,and radiation necrosis.Forty-seven of the 86 lesions (54.7％) were small and deep-seated,34/86 (39.5％) were ill-defined,and 5/86 (5.8％) were small,deep-seated,and ill-defined.Sonograms in the horizontal plane were obtained in all 86 cases.Sonograms in the sagittal plane and in the coronal plane were obtained only in 52 cases and in 46 cases,respectively,due to technical limitation.In 13 cases,sonograms in all three orthogonal planes were available.All lesions were successfully identified and localized by IOUS.Total resection was performed in 67 lesions (77.9％) and partial resection was performed in 19 lesions (22.1％).Conclusions We propose IOUS to be performed in three orthogonal planes when surgery is planned for small,deep-seated,or ill-defined brain lesions.By applying this simple,improved technique,surgeons can perform resection of these lesions precisely。

Abstract：The clinical spectrum of the 2009 pandemic influenza A (H1N1) infection ranged from self-limited mild illness to progressive pneumonia,or even a fatal outcome.We summarize the clinical manifestations,risk factors for severe and fatal cases,pathologic findings and treatment of this disease in this paper based on current reports from different regions of the world。

Abstract：Autopsy has played a unique role in the progression of clinical medicine,medical education,epidemiology,and public health.However,the autopsy rate has been decreasing during the past several decades worldwide,and its necessity is frequently argued.Autopsy-based research in China,a country with the world's largest population,is very important for studying the spectrum and epidemiology of diseases as well as for discovering new diseases.This article summarizes the brief history of autopsy in China and analyzes the cause of its decline in recent decades by reviewing previously published papers,review articles,self-collected materials,and private correspondence.Since the first officially permitted autopsy in 1913,China witnessed the highest autopsy rate between 1950 and 1970,and since then the autopsy rate began to decline as it in other parts of the world.The main reasons for the reduction in autopsy rates in China include negligence by hospital administrators and relevant government authorities,unmotivated clinicians,helpless pathologists,unenforceable regulations and laws,and local cultures and customs。

Abstract：Background Heme oxygenase-1 (HO-1) is an enzyme,which catabolizes heme into carbon monoxide,biliverdin and free iron.The induction of this enzyme is an important cytoprotective mechanism,which occurs as an adaptive and beneficial response to a wide variety of oxidant stimuli.HO-1 inducibility is mainly modulated by a (GT)n polymorphism in the promoter region,and has been shown that short (S) repeats are associated with greater up-regulation of HO-1,compared with long (L) repeats.Methods In the present study,250 healthy Greek individuals have been screened in order to estimate the frequencies of (GT)n alleles in the HO-1 gene.Results Nineteen different alleles,ranging from 17 to 39 repeats,with (GT)23 and (GT)30 being the most common ones,were identified.Conclusion The possible role of this polymorphism in disease states is discussed。

Abstract：Background Pulmonary artery sling (PAS) is a rare congenital heart anomaly and may cause unexplained respiratory symptoms in infants.Since the non-specific respiratory symptoms of PAS may lead to misdiagnosis,the aim of this study was to clarify the clinical and imaging features of this disease for timely diagnosis and treatment.Methods Clinical histories,physical examinations and imaging studies were retrospectively evaluated in nine infants with PAS.Chest X-ray,echocardiography and contrast-enhanced computed tomography (CT) with 3-dimensional reconstructions were performed in all patients and three of them received surgical treatment.Results Nine cases included six males and three females with a mean age of (4.3±2.8) months ranging from 2 to 11 months old.All patients had respiratory symptoms including recurrent cough,stridor and wheezing.The onset of symptoms was within 3 months in all cases and three children had symptoms only a few days after birth.The chest X-ray showed pneumonia in all cases.Contrast-enhanced CT showed the tracheal compression at different lengths in every case.The echocardiograph findings of PAS were anomalous origins of the left pulmonary artery from the posterior aspect of the right pulmonary artery.Of the 9 cases,8 cases were diagnosed correctly by echocardiography.Of the complicated abnormalities,there were one with secundum atrial septal defect,one with patent foramen ovale and three with persistent left superior vena cava.None of them were complicated with significant blood dynamic changes.Conclusions Infants with recurrent respiratory symptoms such as chronic cough,stridor and wheezing,should be examined for the possible presence of congenital pulmonary artery sling.As a noninvasive technique,echocardiography is very helpful and should be the first-choice modality for the diagnosis of pulmonary artery sling.Contrast-enhanced CT,clearly demonstrating the anatomy of pulmonary artery sling and the position and extent of trachea compression,is necessary for the final diagnosis and pre-operation evaluation。

Abstract：Background Invasive pulmonary mycosis is the most common type of invasive fungal infection.It is often severe and difficult to treat,and is accompanied by high mortality.In this study,we aimed to evaluate the efficacy and safety of intravenous itraconazole followed by oral itraconazole solution in the treatment of invasive pulmonary mycosis and to determine the distribution of different fungi species.Methods This was a multi-center,open-label study which enrolled 71 patients who were diagnosed as invasive pulmonary mycosis between July 2007 and January 2009.All patients received intravenous itraconazole therapy followed by oral itraconazole solution with a total treatment duration of 6 weeks.Intravenous itraconazole was given at a dose of 200 mg bid (intravenous infusion every 12 hours) for the first two days,200 mg qd for the subsequent 12 days.Sequential oral itraconazole solution was given at a dose of 100 mg bid for 4 weeks.Efficacy and safety were assessed according to clinical as well as microbiological criteria.Results Seventy one patients participated in this study.Of the 60 patients in the full analysis dataset,the clinical response rate was 61.7％ and the mycological eradication rate was 66.7％.The overall response rate was 66.7％.Drug-related adverse events occurred in 18.0％ of patients:hypokalemia,liver function impairment and mild gastrointestinal side effects were the most common.One patient suffered from severe adverse event,with limb and facial swelling.Conclusion This study showed that in patients with invasive pulmonary mycosis,intravenous itraconazole followed by oral itraconazole solution therapy was safe and effective。

Abstract：A 52-year-old female patient with Hashimoto encephalopathy was admitted to hospital for clinical treatment,and the findings on MR spectroscopy (MRS) and MR imaging (MRI) in the brain were reported.MRS revealed the decreases in N-acetylaspartate (NAA/Cr=1.19) and myo-inositol peaks,and the elevations in lipid,lactate,glutamate/glutamine multiplet and choline (Cho/Cr=1.21) peaks which supported a cerebral inflammatory change,in addition to multifocal hyperintensities on T2WI and fluid-attenuated inversion recovery (FLAIR) images,slight hyperintensities on diffusion weighted imaging (DWI),hypointensities on T1WI.The atrophy of the brain was revealed on follow-up MRI two years later。

Abstract：Littoral cell angioma is a recently described rare vascular tumor of the spleen.The clinical course of this benign tumor is asymptomatic in most patients.Herein,we described three patients with littoral cell angioma detected during physical examination.A brief discussion and review of a handful of cases of splenic littoral cell angioma,which have been previously reported in the English language literature,are performed in this paper。

Abstract：Drug-eluting stents have changed the practice in interventional cardiology.With the widespread use of these stents important safety concerns regarding stent thrombosis and formation of coronary artery aneurysm have been expressed.While the majority of attention was focused on stent thrombosis,the formation of coronary aneurysm was only described in anecdotal reports.We report on a patient who suffered from very late stent thrombosis in association with coronary artery aneurysm formation secondary to drug-eluting stent but not to bare-metal stent。

Abstract：A 30-year-old female patient with coexisting ankylosing spondylitis and rheumatoid arthritis was diagnosed and treated.The human leukocyte antigen (HLA)-B27 is a predisposing factor of ankylosing spondylitis and HLA-DR4 is a predisposing factor of rheumatoid arthritis.This patient was HLA-B27 and HLA-DR4 positive,and ankylosing spondylitis manifested before rheumatoid arthritis.After disease modifying anti-rheumatic drugs successfully arrested ankylosing spondylitis activity the patient conceived and delivered a healthy baby.One year later,she developed peripheral polyarthritis and was diagnosed with rheumatoid arthritis.We hypothesized that pregnancy may be one of the environmental factors that can activate rheumatoid arthritis,and that disease modifying anti-rheumatic drugs play an important role in keeping the disease under control。

Abstract：In this report,a full account of an extremely rare case on esophageal intramural dissection (EID) is presented.A 56-year-old female patient,misdiagnosed as esophageal mediastinal fistula under endoscopic view,was diagnosed correctly as EID with contained esophageal perforation in the operation and cured by thoracic esophagectomy。

Abstract：Ureteral fibroepithelial polyp accompanied by intussusception is a rare occurrence.Currently,most ureteral polyps could be removed readily by ureteroscopy.Nevertheless,endoscopic resection can be difficult in patient with a large polyp,especially accompanied by an intussusception.We described our experience and laparoscopic technique for treatment of a symptomatic 63-year-old woman who presented with a pedunculated,9-cm-long,left lower ureteral,fibroepithelial polyp accompanied by a 2-cm-long intussusception。

To the Editor:Meningitis caused by Enterococcus casseliflavus (E.casseliflavus) is extremely rare.Here we report an unusual case of meningitis caused by E.casseliflavus coexisting with refractory cerebrospinal fluid (CSF) leakage following endoscopic endonasal resection of skull base chondrosarcoma。