2013年 · 第126卷第02期

Approximately 70 species are accepted in the genus Cryptococcus;1 however,only two species,Cryptococcus neoformans (C.neoformans,serotypes A,AD and D) and C.gattii (serotypes B and C) are responsible for almost all human cryptococcal infections,2,3 and resulted in over 1 million new cases of cryptococcosis in the world each year with over 600 000casualties.4 It is generally assumed that cryptococcal infections are acquired by inhalation of fungal spores,desiccated cells,or poorly encapsulated yeasts from environmental niches,such as decayed wood debris of certain tree species or bird droppings.5 Epidemiological surveys have shown that C neoformans caused about 80％ of cryptococcosis cases globally each year,particularly in immunocompromised persons,such as human immunodeficiency virus (HIV)-infected people and acquired immunodeficiency syndrome (AIDS) patients,2,3 while C.gattii primarily infects apparently immunocompetent hosts,and is mainly responsible for the remaining cases of cryptococcosis.6,7

Abstract：Background Tp15,Tp17,Tp45,and Tp47 are outer-membrane proteins found in Treponema pallidum,the etiologic agent of syphilis.These proteins are potent antigens and are potential markers for the serological detection of syphilis.The present study analyzed antibodies to these protein antigens (TP-IgM and TP-IgG) in human serum and investigated the expression of these antibodies during different stages of syphilis.Methods Serum samples were collected from 69 subjects (male 45,female 24) diagnosed with syphilis and analyzed by Western blotting for the expression of IgM and IgG against the four protein antigens.Expression levels of the target antibodies were compared during the same stage of syphilis as well as between different stages of this disease.Results In subjects with primary syphilis,the positive rate of Tp45 IgM was higher than that of other TP-IgM.Tp15 IgM was detected only in subjects with tertiary syphilis.Similarly,the seroprevalence of Tp45 IgG in primary syphilis was higher than for other TP-IgG No target TP-IgM was detected in subjects with latent syphilis.In subjects with secondary syphilis,the expression level of Tp15 IgG (138.73±20.16) was higher than for other target TP-IgG In subjects with tertiary syphilis,all target TP-IgG were detected.In subjects with tertiary or latent syphilis,the expression levels of Tp45 IgG (121.33±11.04 and 110.10±40.19,respectively) were higher than those of other target TP-IgG.The expression levels of all Tp-IgM were similar before or after anti-syphilis treatment.In comparison,the expression levels of all TP-IgG decreased compared with the pre-treatment levels,and this decrease was statistically significant (both P ＜0.05) for Tp17 IgG and Tp47 IgG.Conclusions After Treponema pallidum infection,Tp45 IgM appeared first and Tp15 IgM occurred during later stages.The positive rates of all TP-IgG increased with the duration of this disease.Anti-syphilis treatment reduced the expression levels of Tp17 IgG and Tp47 IgG.Larger-scale studies are required to further validate the value of Tp15,Tp17,Tp45,and Tp47 as markers for the early detection of primary and latent syphilis。

Abstract：Background The clinical and histopathological characteristics of basal cell carcinoma (BCC) have been relatively well studied in Caucasian population.To characterize BCC in Chinese population,we analyzed the association of the histopathological subtypes with gender,age and anatomical location in this study.Methods The clinical and histopathological data of 243 BCC cases diagnosed at three hospitals in Beijing from January 2000 to April 2009 were reviewed retrospectively.Gender,age,location and histopathological subtype were analyzed.Results Among 243 patients enrolled,118 were males and 125 were females.The male/female ratio was 0.94∶1.The mean age was (65.16±12.62) years old.The head and neck were the most common sites of BCC (77.4％).Of the BCCs,53.9％ were nodular,18.9％ superficial and 18.5％ infiltrative-morphoeic.The nodular,infiltrative-morphoeic and micronodular subtypes were predominant located on the head and neck,whereas the trunk was the most common location for the superficial subtype (P ＜0.05).The age at first presentation for females was lower than that for males (P＜0.05).The age at first presentation for the superficial BCCs was younger than the non-superficial subtypes (P ＜0.05).Women with superficial BCC subtype visited hospital earlier than men (P ＜0.05).Conclusions Consistent with previous reports in Caucasian patient,our study find that different histopathological subtypes of BCC has distinct clinical features.It is speculated that the mechanisms underlining the pathogenesis of the superficial BCC may be different than those of non-superficial subtypes of BCC。

Abstract：Background Trichophyton rubrum (T.rubrum) represents the most important agent of dermatophytosis in humans.T.rubrum infection causes slight inflammation,and tends to be chronic and recurrent.It is suggested that it may result from the failure of epithelial cells to recognize T.rubrum effectively and initiate effective immune responses.The C-type lectin receptors (CLR) and toll-like receptors (TLR) are the two major pattern recognition receptors (PRRs) that recognize fungal components.Therefore,the purpose of the study was to analyze the expression of those PRRs and the cytokines in HaCaT cells stimulated with heat-inactivated T.rubrum conidia and hyphae,respectively.Methods HaCaT cells were unstimulated or stimulated with heat-inactivated T.rubrum conidia and hyphae (1×106 and 1.5×10s colony-forming unit (CFU) in 2 ml medium,respectively) for 6,12 and 24 hours.The mRNA expression of PRRs involved in recognizing fungal pathogen-associated molecular patterns (PAMPs) and signaling molecules were measured by quantitative reverse transcription polymerase chain reaction (RT-PCR).Meanwhile,surface toll-like receptor (TLR) 2,TLR4 and Dectin-1 were analyzed by fluorescence-activated cell sorter (FACS) 24 hours after treatment.The cytokines were detected in cell culture supernatants of HaCaT cells in 12 and 24 hours after treatment.Results HaCaT cells constitutively expressed mRNA of membrane-bound TLR1,2,4 and 6,Dectin1 and DC-SIGN,but not Dectin-2 or Mincle.Heat-killed T.rubrum did not significantly upregulate gene transcriptions of the PRRs of HaCaT cells.Heat-inactivated T.rubrum conidia significantly reduced the surface expression of TLR2 and Dectin-1,and suppressed the secretions of interferon-inducible protein-10 (IP-10) and monocyte chemotactic protein-1 (MCP-1) of HaCaT cells,while heat-killed T.rubrum hyphae significantly induced the secretions of IP-10 and MCP-1.Conclusion The cell-wall antigens of T.rubrum fail to activate transcriptional expression of PRRs and induce a lower immune response of HaCaT cells by limited cytokines secretion。

Abstract：Background Oculócutaneous albinism (OCA) is a heterogeneous and autosomal recessive disorder in all populations worldwide.The mutational spectra of OCA are population-specific.Some OCA patients carry mutations from different OCA genes.In this study,we investigated the frequency of digenic mutations in Chinese OCA patients.Methods Genomic DNAs were extracted from the blood samples of 184 clinically diagnosed OCA patients and 120 unaffected subjects.The amplified DNA segments of the exons and exon-intron boundaries were screened for mutations of TYR,OCA2,TYRP1,SLC45A2,and HPS1 by direct sequencing.To exclude the previously unidentified alleles from polymorphisms,samples from 120 unaffected controls were sequenced for the same regions of variations.Results In all 184 patients,134 had two pathologic mutations on one locus.Eleven cases had no apparent pathologic mutations in any of the genes studied.Among the remaining 39 patients who had only one pathologic mutation,five patients (2.7％ in total) were found to carry the mutational alleles on a second locus in TYR,OCA2 or SLC45A2.Of the five digenic OCA patients,four patients were clinically diagnosed as OCA2 and one patient as OCA1.A previous unidentified allele p.G188D in SLC45A2 was identified,which was not present in the 120 unaffected controls.Conclusions The identification of the digenic OCA patients suggests the synergistic roles among TYR,OCA2 and SLC45A2 during melanin biosynthesis,which may cause OCA under digenic mutations.This information will be useful for gene diagnosis and genetic counseling of OCA in China。

Abstract：Background The development of angiosarcoma in oedematous tissue is referred to as Stewart-Treves syndrome (STS).This rare and fatal complication is associated with chronic post mastectomy lymphoedema and radiotherapy for breast cancer.Angiosarcoma spread is facilitated by the formation of blood vessels (angiogenesis) and lymph vessels (lymphangiogenesis).In the future antiangiogenic therapy may improve the poor outcome of current treatments.There was evidence that blocking the angiogenenesis would inhibit progression of angiosarcoma.It seems reasonable to hypothesize that blocking the lymphangiogenesis may yield similar results.Although angiosarcomas commonly derive from blood vessels,in case of STS angiosarcomas chronic lymphoedema may suggest its lymphatic origin.The goal of this study was to visualize interstitial space and lymphatics in the central and peripheral regions of STS angiosarcoma.Methods On tissue samples obtained from STS angiosarcoma we have performed:first colour stereoscopic lymphography to visualise the morphology of lymphatic vessels and extracellular spaces,second immunohistochemical staining specific for lymphatic vessels endothelium (LYVE-1) and blood endothelial cells (CD31,factor Ⅷ) and prolymphangiogenic vascular endothelial growth factor (VEGF-C) for precise identification of lymphatic endothelia.STS angiosarcoma morphology was assessed by comparison of pictures obtained on lymphography,microscopy and confocal microscopy.Results STS angiosarcomas present heterogenous morphology with areas dominated by hemangiosarcoma and lymphangiosarcoma structures.STS angiosarcoma expressed phenotypes of both blood and lymphatic endothelia.LYVE-1 and VEGF-C is expressed by STS angiosarcoma and may be used to discriminate tumour differentiation.Morphology of lymphatic vessels and spaces in the tumour suggest absence of their normal lymphatic function.Conclusions Our results confirmed both hemangio-and lymphangiogenic origin of STS angiosarcoma.Expression of VEGF-C makes STS angiosarcoma a good candidate for targeted antilymphangiogenic therapy.However,morphology of intratumoral lymphatics on colour lymphography suggested their impaired function,which can hamper drug distribution。

Abstract：Background Single incision laparoscopic colectomy has been performed in recent years,and has been shown to be feasible and safe.This study was to assess the feasibility of single incision laparoscopic right hemicolectomy and to compare the differences in different approaches.Methods This retrospective study included eighteen patients with carcinoma of caecum and ascending colon,undergoing single incision laparoscopic right hemicolectomy.This study also compared single incision laparoscopic right hemicolectomy using different approaches:(1) single incision multiport,(2) single access port and (3) glove port.Results There was no statistical difference in surgical outcomes.Concerning the surgeon's satisfaction toward three methods,overcrowding and durability were similar but the single incision multiport was associated with the highest gas-leak and the "glove" port was associated with poor durability.However,the method of single incision multiport has the lowest average cost of the special trocar or port in each operation.The operative time and blood loss of the operations in this study were comparable to previous publications.Conclusion There was no significant difference between different approaches of single incision laparoscopic right hemicolectomy for colonic cancer in right side colon。

Abstract：Background We have recently reported that RhoA may regulate the invasion and metastasis of breast cancer cells as an upstream signal of ezrin in vitro.In this study,we examined the relationship of RhoA signaling activity with ezrin expression in breast cancer and its prognostic significance in patients with breast cancer.Methods Paraffin tumor sections of breast cancer were collected retrospectively from 487 patients diagnosed between 2001 and 2004.Immunohistochemical methods were used to detect the expression of RhoA,phosphorylated (activated) RhoA,and ezrin.Results Ezrin overexpression was detectable in 15.2％ of 487 invasive breast cancers.The majority (85.1％) of ezrin-overexpressing tumors coexpressed phosphorylated RhoA; 78.8％ of tumors with phosphorylated RhoA cooverexpressed ezrin.Patients whose cancers showed overexpression of ezrin or expression of phosphorylated RhoA had shorter survival rates.Conclusions RhoA activation is important in human breast cancer due to its upregulation of ezrin; thus,agents that target phosphorylated RhoA may be useful in the treatment of tumors with ezrin overexpression。

Abstract：Background Gene therapy and epigenetic therapy have gained more attention in cancer treatment.However,the effect of a combined treatment of gene therapy and epigenetic therapy on head and neck squamous cell carcinoma have not been studied yet.To study the mechanism and clinical application,human laryngeal carcinoma cell (Hep-2) tumor-bearing mice were used.Methods A xenograft tumor model was established by the subcutaneous inoculation of Hep-2 cells in the right armpit of BALB/c nu/nu mice.The mice with well-formed tumor were randomly divided into six groups.Multisite injections of rAd-p53 and/or 5-aza-dC were used to treat tumor.Tumor growth was monitored by measuring tumor volume and growth rate.p53 and E-cadherin protein levels in tumor tissues were detected by immunohistochemical staining.The mRNA levels were monitored with FQ-PCR.Results Gene therapy was much more effective than single epigenetic therapy and combined therapy.The gene therapy group has the lowest tumor growth rate and the highest expression levels of p53 and E-cadherin.Conclusions The combined treatment of gene and epigenetic therapy is not suggested for treating head and neck carcinoma,because gene therapy shows an antagonistic effect to epigenetic therapy.However,the mechanisms of action are still unclear。

Abstract：Background Leukotrienes are arachidonic acid derivatives long known for their inflammatory properties.Leukotrienebased inflammation has been demonstrated to play a crucial role in atherosclerosis,a major risk factor for several human diseases.Recently,human genetic studies from us and others suggest that single nucleotide polymorphisms (SNPs) in leukotriene pathway genes influence the risk of atherosclerotic diseases such as stroke.This study aimed to assess the role of additional leukotriene pathway genes as a stroke risk factor within the Chinese Han population.Methods We sequenced the promoter,exonic,and intronic regions of leukotriene A4 hydrolase (LTA4H) and arachidonate 5-lipoxygenase (ALOX5),and then genotyped five SNPs in LTA4H and four SNPs in ALOX5 among 691 cases with stroke and 732 controls from the Chinese population.Results We detected a significant association between an intronic SNP in LTA4H (rs6538697) and stroke in our subjects (adjusted odds ratio,recessive model,1.75; P=0.022); and the SNP rs2029253 in ALOX5 was associated with a decreased risk of stroke (adjusted odds ratio,0.76; 95％ confidence interval,0.59-0.97).Conclusion Genetic variants in LTA4H and ALOX5 may modulate the risk of stroke in the Chinese Han population。

Abstract：Background Lupus hepatitis is yet to be characterized based on its clinical features and is often difficult to differentially diagnose from other liver diseases.We aimed to elucidate clinical,histopathological and immunopathological features of lupus hepatitis and to evaluate primarily the effectiveness of liver immunopathological manifestations on differential diagnosis of lupus hepatitis from other liver diseases.Methods A retrospective study was performed to analyze clinical features of lupus hepatitis in 47 patients out of 504 inpatients with systemic lupus erythematosus (SLE) in First Affiliated Hospital of Sun Yat-sen University,China from May 2006 to July 2009,and to evaluate the association between lupus hepatitis and SLE activity.Additionally,liver histopathological changes by hematoxylin and eosin (HE) staining and immunopathological changes by direct immunofluorescence test in 10 lupus hepatitis cases were analyzed and compared to those in 16 patients with other liver diseases in a prospective study.Results Of 504 SLE patients,47 patients (9.3％) were diagnosed to have lupus hepatitis.The prevalence of lupus hepatitis in patients with active SLE was higher than that in those with inactive SLE (11.8％ vs.3.2％,P ＜0.05).The incidence of hematological abnormalities in patients with lupus hepatitis was higher than that in those without lupus hepatitis (40.4％ vs.21.7％,P ＜0.05),such as leucocytes count (2.92×109/L vs.5.48×109/L),platelets count (151×109/L vs.190×109/L),serum C3 and C4 (0.34 g/L vs.0.53 g/L; 0.06 g/L vs.0.09 g/L) (P ＜0.05); 45 of 47 (95.7％) lupus hepatitis patients showed 1 upper limit of normal (ULN) ＜serum ALT level ＜5 ULN.The liver histopathological features in patients with lupus hepatitis were miscellaneous and non-specific,similar to those in other liver diseases,but liver immunopathological features showed positive intense deposits of complement 1q in 7/10 patients with lupus hepatitis and negative complement 1q deposits in all patients with other liver diseases (Fisher's exact test,P=0.011).Conclusions Lupus hepatitis was not infrequent in active SLE patients which would be one of the indices indicating SLE activity.Positive intense deposit of complement 1q in liver may be a characteristic immunopathological feature of lupus hepatitis,which provides a new way to differentially diagnose lupus hepatitis from other liver diseases。

Abstract：Background Invasive aspergillosis (IA),which is mainly caused by Aspergillus fumigatus (A.fumigatus),is a major cause of morbidity and mortality in immunocompromised patients.Despite considerable progress in currently available antifungals the mortality still remains high in critically ill patients.U0126 which is a highly selective inhibitor of MEK1 and MEK2 in the RAF/MEK/ERK pathway in mammalian cells has been demonstrated to have an anti-proliferative role in cancer cells.The purpose of this study was to explore the role of U0126 on growth inhibition and activation of mitogen-activated protein kinases (MAPKs) in A.fumigatus.Methods Germination percentage and hyphae growth in A.fumigatus treated with U0126 were observed and compared with untreated controls.Western blotting analysis was used to detect changes in activation of SakA,MpkA and MpkB.Results U0126 inhibited germination and hyphae growth in A.fumigatus and enhanced the phosphorylation of SakA and MpkA under oxidative stress.U0126 at 10 μmol/L did not block the activation of MpkB during nitrogen starvation stress.Conclusion U0126 shows promise as an antifungal candidate and the MAPK pathway may be a possible antifungal drug target for A.fumigatus。

Abstract：Background The long-term effects of bone marrow-derived cells (BMC) transplantation in patients with acute myocardial infarction (AMI) have not been established.The present meta-analysis of randomized controlled trials with follow-up ≥2 years was performed to investigate the long-term effects of BMC therapy in patients after AMI.Methods Specific terms were used to conduct a systematic literature search of MEDLINE,EMBASE,the Cochrane Library and the Cochrane Central Register of Controlled Trials,and the China Biological Medicine Disk database from their inception to March 2012.A standardized protocol was used to extract information,and random effect model was used to analyze all data except major adverse events.Results Five trials comprising 510 patients were included.Compared with controls,BMC therapy significantly improved left ventricular ejection fraction (LVEF) (4.18％,95％ CI:2.02％ to 6.35％,P=0.0002),while mildly but not significantly reduced left ventricular end-systolic volume (-4.47 ml,95％ CI:-10.92 to 1.99,P=-0.17) and left ventricular end-diastolic volume (-2.29 ml,95％ CI:-9.96 to 5.39,P =0.56).Subgroup analysis revealed that significant improvement of LVEF induced by BMC therapy could be observed in patients with baseline LVEF ≤42％,but disappeared in those with baseline LVEF ＞42％.There were trends in favor of BMC therapy for most major clinical adverse events,though most differences were not significant.Conclusions Intracoronary BMC infusion in patients with AMI seems to be safe and may further improve LVEF on top of standard therapy; especially the beneficial effects could last for long term.The findings need to be validated in the future。

Abstract：Objective To summarize the recent findings on the epidemiology of medically important,opportunistic invasive fungal infections (IFIs) in China and discuss the relevant social,economical reasons and medical factors.Data sources We performed a comprehensive search of both English and Chinese literatures of opportunistic IFIs from China up to April 2012.Study selection Relevant literatures involving researches and cases/case series were identified,retrieved and reviewed.Results The incidence of opportunistic IFIs in China was steadily increasing.The incidence and mortality of IFIs were different in patients with various underlying conditions/diseases,from 4.12％ to 41.18％ and 9.8％ to 60.0％,respectively.Candida species,Aspergillus species and Cryptococcus neoformans species complex were the most frequent isolated pathogens.Other uncommon opportunistic IFIs were also been reported,including trichosporonosis,mucormycosis,hyalohyphomycosis (hyaline hyphomycetes) and phaeohyphomycosis (dematiaceous hyphomycetes).Reports of Chinese patients differed from those of many other countries as there were a higher number of patients without identifiable underlying diseases/conditions.Conclusions Because of the rapid economic development,changing population structure and a growing number of immunocompromised hosts with risk factors,today opportunistic IFIs in China have a significant impact on public health,associated with high morbidity/mortality and higher care costs.Now information related to the epidemiology of opportunistic IFIs in China is still sparse,so we need more organized groups of clinical scientists performing related researches to help the clinicians to obtain more accurate epidemiological characteristics。

The human spine carries the weight of the trunk,upper extremities,and head,and provides an extensive range of motion.Due to heavy use and lack of vasculature,the intervertebral discs degenerate much more rapidly than other structures of the human body.12Intervertebral disc degeneration is mostly age-related,and spinal disorders associated with disc degeneration have a significant impact on society.3,4 Indeed,low back pain affects nearly three-quarters of the population sometime in their life.3 Surgical strategies for treatment of disc degenerative disease (DDD) include removal of pathological discs and fusion of intervertebral bodies or facet joints with or without instrumentation.Spinal fusion enhances the stability of the spine and decreases the formation of pseudo-unions;however,this procedure is also associated with breakage or loosening of the instruments and acceleration of adjacent segment degeneration.4,5 As an alternative to disc fusion,artificial disc (AD) replacement using a disc prosthesis results in a greater degree of segment motion.68 Complications of AD include periprosthetic ossification,neurological deficit,prosthetic looseness or breakage,and even cervical kyphosis.8 Since conservative methods for treatment of DDD eventually fail and surgical interventions have significant drawbacks and complications,non-operative (biological) strategies such as growth factor injection,stem cell transplantation,and gene therapy have begun to receive more attention.4,9-11

The development of hospital information has been carried out for nearly 50 years,and originally started as the hospital information system (HIS).1 So far HIS is the most widely and deeply used management system for hospitals in China.2 "General function standard for hospital information system" issued by China's Ministry of Health in 2002 defined that "The hospital information system refers to using of computer hardware and software technology,network communications technology,and other modem technology to comprehensively manage personnel,logistics,and finance in various departments in hospital.Gather,store,treat,extract,transport,aggregate,and process data in various stages of the medical activities,so that provide comprehensive and automatic information management and service to the hospital." As a result,comprehensive management based on personnel,logistics,finance,and hospital overall operation management are always the focus of hospital information construction.3,4

The identification of the first molecular defect leading to Mendelian Susceptibility to Mycobacterial Disease (MSMD),1 a rare syndrome conferring predisposition to disease caused by weakly virulent mycobacteria (such as Mycobacterium bovis,Bacille Calmette Guérin vaccines and environmental mycobacteria),has led to a paradigm shift in the field of primary immunodeficiencies in the last two decades.The "classic" patient with multiple immunologic abnormalities,conferring a broad susceptibility to multiple and recurrent infectious diseases caused by both weakly pathogenic and more virulent microorganisms,was the main Primary Immunodeficiency (PID) phenotype identified.Since 1996,mutations causing MSMD have been found in at least 6 genes related to interferon (IFN)-γ-mediated immunity.2 Intriguingly,this has opened the door to the identification of a molecular pathogenesis in patients affected by a narrow to extremely narrow susceptibility to bacterial,viral and fungal infections.3-7 These patients,more common than originally thought,are often otherwise healthy and are not prone to other unusually severe infections。

Shoulder pain is the most common complication of laparoscopic operations) The incidence and severity of shoulder pain has been well documented.2 This complication was commonly regarded as the result of CO2 pneumoperitoneum,which induced extension and stimulation to the diaphragmatic muscle.The incidence and severity of shoulder pain was correlated to the pressure and duration of CO2 pneumoperitoneum.3,4 However,we noticed that in non-pneumoperitoneum laparoscopic operations,patients experienced a higher incidence and more severe post-operative shoulder pain.This was a challenge to the theory that pneumoperitoneum induces shoulder pain.Therefore a more detailed study was required to provide more objective data to explain this phenomenon。

Hepatocellular carcinoma (HCC) is a major threat to human health in China with high morbidity and mortality.Surgical resection and liver transplantation are the most promising treatments for HCC.The majority of patients,however,are not eligible for surgery due to advanced tumor,multifocal disease or poor liver reserve.1 Recently,transarterial chemoembolization (TACE) improved survival compared with best supportive care in two individual clinical trials.2 Sorafenib is a multikinase inhibitor that targets both tumor cell proliferation and angiogenesis.The current standard of practice is to treat BCLC stage B HCC with TACE alone and more advanced (BCLC stage C) HCC with sorafenib only.1However,TACE activates hypoxia-inducible factor (HIF)-1 responses to hypoxia,which may stimulate VEGF and promote angiogenesis.The observed angiogenesis is related to up-regulation of local angiogenic factors which in turn promote tumor regrowth,increasing the risk of metastases and a poor outcome。

Sinistral portal hypertension (SPH) is usually caused by pancreatic pathology and is characterized by splenic vein thrombosis with or without portal vein thrombosis.1 The increased pressure caused by splenic vein occlusion is transmitted via the short gastric and gastroepiploic veins to the portal system.The reversal of blood flow in the left gastric vein results in gastric varices.In patients with SPH,especially those with occlusion of both the splenic and portal veins,the main or even the only pathway of splenic venous return to the portal vein is via the gastric varices,and these patients require special management during gastric surgery。

Spontaneous rupture and bleeding from the carotid artery in acute promyelocytic leukemia (APL) patients leading to pseudoaneurysm (PSA) formation has not been reported.We first successfully treated an APL patient with left internal carotid artery rupture during chemotherapy leading to PSA using ultrasound-guided thrombin injection (UGTI).A 10-year-old girl,who was diagnosed with APL,suddenly experienced left neck swelling,which expanded gradually and was not associated with pain,dizziness,palpitations,or labored breathing 2 days after the third session of chemotherapy (mitoxantrone + cytarabine) in a local hospital.She had no history of injury。

A54-year-old male smoker was admitted to our hospital after undergoing the drainage of a left peritonsillar abscess.Ten days prior to admission (day 1),he complained of a "scratchy" throat with a fever of 38.5°C.He had an enlarged left tonsil with prominent exudate;white blood cell count (WCC) 8.8×109/L;platelet count (Pit) 103 × 109/L;chest X-ray was normal in a medical clinic.Then the patient received an intravenous injection of 4 million units of penicillin G every 6 hours and 500 mg of oral azithromycin once daily.But his condition worsened with a temperature of 41°C and laryngoscopy confirmed a marked left-sided peritonsillar abscess which was drained.On day 10,the patient was transferred to our hospital after developing persistent fever,rigors,left-sided neck pain,pain on swallowing and purulent bloody sputum.On examination,his temperature was 39.6°C,pulse 95 beats/min;respiratory rate 25 breaths/min and blood pressure 110/80 mmHg (1 mmHg=0.133 kPa).The left side of his neck was swollen and tender,anterior to the sternocleidomastoid muscle。

Central neurocytoma (CN),first described by Hassoun et al in 1982,is a rare neuronal tumor of the central nervous system,and accounts for 0.25％-0.5％ of all intracranial tumors.CN commonly occurs as an intraventricular mass but may also occur as a periventricular parenchymal mass or even in locations remote from the ventricles,in which case it is termed as an extraventricular neurocytoma (EVN) (cerebral).EVNs show a wide variability with regard to morphologic features,cellularity,and proliferation rate and are more frequently associated with poorer clinical outcomes than CNs.1 To our knowledge,little is known regarding the treatment of atypical neurocytomas。

Essential tremor (ET),characterized by a postural and/or kinetic tremor and primarily manifested in the upper extremities,head,and other parts of the body,is one of the most common neurological disorders.1 The traditional target for the neurosurgical treatment of ET,the ventral intermedius nucleus (Vim) of the thalamus,has confirmed that chronic deep brain stimulation (DBS) is an effective,standard,and primary procedure for ET.However,the loss of tremor suppression due to tolerance of chronic Vim stimulation,accompanied by other adverse effects,such as paresthesias,dysarthria,dysequilibrium,hyperhidrosis,and localized pain,has necessitated changes in the stimulation target in some patients.Therefore,an alternative target for ET stimulation is required.Although targeting the subthalamic nucleus (STN) also has complications,such as dyskinesia,dysarthria,paresthesias,diplopia,mood changes,depression,and restless leg syndrome,in view of the evidence that STN could be the target for patients with tremors associated with Parkinson's disease (PD),STN was elected in two ET patients in our study with positive effects.Our research is reported to have explored the possibilities of STN-DBS in the treatment of ET。

To the editor:Typhoid fever is a very common infective disease in Asian and underdeveloped countries.1,2 Typhoid fever in its first week of illness manifest with fever,headache,abdominal pain,gastrointestinal symptom like anorexia,nausea,vomiting,constipation;with or without specific signs like relative bradycardia,hepatomegaly,splenomegaly and abdominal tenderness developing in second week of illness.Complications like acute abdomen,intestinal perforation,pneumonia,psychosis,ataxia,altered sensorium,pancreatitis,hepatitis and nephritis are likely to develop in third to fourth week of illness.3,4 Initial presentation with aseptic meningitis,pancreatitis,hepatitis,glomerulonephritis and thrombocytopenia is a very rare manifestations of typhoid fever.5

To the editor:Primary lymphoma of the breast is extremely rare.Here we report a case of a diffuse large B-cell lymphoma in a 20-year-old female patient.Some of the sonographic features were similar to those of a carcinoma,and this lesion may have been easily misdiagnosed as breast cancer. A 20-year-old female presented with a one-month history of a rapid growth mass in her right breast.On clinical examination,a right-breast oval mass was palpated in the upper-outer quadrant,no tenderness,no adhesions with the skin,no orange peel-like changes,and no nipple retraction or elevation.In the right axillary region,enlarged lymph nodes were found,and there were no other enlarged superficial lymph nodes.Blood examination was normal,and urinalysis was negative.Chest X-ray and abdominal ultrasonography were also normal.Breast ultrasonography revealed a hypoechoic mass (size:3.8 cm × 1.8 cm × 1.4 cm) in the upper-outer quadrant with ill-defined boundaries and an irregular shape.The inner echo of the mass was heterogeneous and the posterior echo was substantially enhanced (Figure 1)。

To the editor:I read with great interest the recent article by Liu et al.1 Icariin exerts its beneficial effects in osteoporosis in a number of ways. Icariin accentuates osteoblast maturation.Icariin increases the activity of alkaline phosphatase and up regulates receptor activator of nuclear factor κ-B ligand (RANKL) expression thereby enhancing bone formation.2 It also affects the bone morphogenic protein-2 (BMP-2)/Smad4 pathway and thereby up regulates both BMP-2 and Smad4 expression leading to the formation of calcified nodules in bone tissue.In fact,icariin exhibits greater efficacy in increasing osteogenic differentiation in comparison to other natural flavonoids such as genistein.3 Besides the above mentioned effects,up regulation of osteoprogeterin is another of the effects of icariin。