2014年 · 第127卷第02期

Abstract：Background Self-monitoring of blood glucose (SMBG) by individuals with type 2 diabetes (T2D) is crucial for long-term health,yet numerous cultural,economic and health factors can reduce SMBG.Most studies on SMBG adherence have come out of the US and Europe,and their relevance to Asia is unclear.The aims of the present study were to assess the current state of SMBG in China and analyze demographic and diabetes-related characteristics that may influence it.Methods In this multi-center,cross-sectional study,5 953 individuals with T2D from 50 medical centers in 29 provinces across China filled out a standardized questionnaire that requested information on demographic characteristics,education level,occupation,income,lifestyle risk factors,duration of diabetes,chronic complications,and frequency of SMBG.Respondents were also asked whether their glycosylated hemoglobin (HbA1c) had been checked in the past 6 months.The most recent values for fasting plasma glucose,2-hour postprandial blood glucose and HbA1c were recovered from medical records.Results Only 1 130 respondents (18.98％) performed SMBG with the recommended frequency,while 4 823 (81.02％) did not.In fact,nearly 2 105 (35.36％) reported never performing SMBG.In the subset of 3 661 individuals on insulin therapy,only 266 (7.27％) performed SMBG at least once a day,while 1 210 (33.05％) never performed it.In contrast,895 of 2 292 individuals (39.05％) on diet/exercise therapy or oral hypoglycemic therapy never performed it.Multivariate Logistic regression identified several factors associated with SMBG adherence:female gender,higher education level,higher income,longer T2D duration and education about SMBG.Conclusions SMBG adherence in our Chinese population with T2D was less frequent than that in developed countries.Several factors influence SMBG adherence:gender,education level,income,T2D duration,therapy regimen and exposure to education about SMBG。

Abstract：Background The effectiveness and safety of initiating biphasic insulin aspart 30 in patients who were poorly controlled on oral glucose-lowering drugs were studied in randomized controlled trials,while results from clinical practice remain limited.This subgroup analysis was to provide such findings from a large-scale non-interventional study.Methods A1chieve was a multinational,prospective,open-label,non-interventional,24-week study in patients with type 2 diabetes initiating insulin analogues in 28 countries across Asia,Africa,Europe,and Latin America.After physician had taken the decision to use this insulin,any patient with type 2 diabetes who was not treated with or who had started the study insulin within 4 weeks before inclusion was eligible.Patients were treated with study insulin alone or in combination with oral glucose-lowering drugs.Data on adverse drug reactions,hypoglycemia and glycemic control were collected at baseline,week 12 and 24.This is a report of a Chinese subgroup analysis from the A1chieve study.Results Totally,4 100 patients constituted this subgroup.No serious adverse drug reactions were reported.Rates of total,major,nocturnal hypoglycemic events (events/patient per year) were 1.47,0.10,0.31 at baseline and 1.35,0.00,0.22 at week 24,respectively.Glycemic control was improved as measured by hemoglobin A1c (mean 9.3％ to 7.0％,reduction -2.3％),fasting plasma glucose (mean 10.2 to 6.8 mmol/L,reduction-3.5 mmol/L) and postprandial plasma glucose (mean 14.4 to 8.8 mmol/L,reduction-5.6 mmol/L),all P ＜0.001.Change in mean body weight was +0.3 kg (P ＜0.001).Conclusion In this subgroup analysis of the A1chieve study,biphasic insulin aspart 30 improved glycemic control with low risk of hypoglycemia。

Abstract：Background Lymphocyte function and homeostasis is associated with immune defence to infection.Apoptosis of lymphocytes might be a considerably important component which has an impact on immunity to infections in people with hyperglycemia.The aim of this study was to explore the mitochondrial apoptosis pathway of lymphocyte in diabetic patients.Methods Sixty patients with type 2 diabetes mellitus and fifty healthy volunteers were included in this study.Annexin V and propidiumiodide (Pl) were joined in the isolated lymphocytes and the rate of lymphocyte apoptosis was calculated with flow cytometry.Observation of the lymphocytes was done using transmission electron microscopy; mitochondria had been extracted and then mitochondrial membrane potential (MMP) was detected to assess mitochondrial function; the mRNA level of Bcl-2,cytochrome c (Cyt-C),caspase-9 and caspase-3 were analyzed by real-time reverse transcriptionpolymerase chain reaction (RT-PCR).Results Apoptosis rate of lymphocyte was significantly higher in diabetic group than that in normal control group (P ＜0.05).Transmission electron microscopy showed lymphocyte shrinkage and breakage,chromatin condensation and less mitochondria; a fall in MMP levels was also evident; Bcl-2 concentration was reduced and the expressions of caspase-9,caspase-3 and Cyt-C were elevated (P ＜0.05) in diabetic patients.Conclusions The rate of lymphocyte apoptosis was significantly higher in type 2 diabetic patients than that in normal population.Mitochondrial apoptosis pathway may play a very important role in decreasing function of lymphocyte in diabetes。

Abstract：Background Statin therapy has affected glucose homoeostasis of type 2 diabetes patients,which could be related with bile acids metabolism.Whether bile acid metabolism and the expression of farnesoid X receptor (FXR),liver X receptor-α (LXR-α) and sterol regulatory element-binding protein (Srebp)-1c is regulated by hyperglycemia,or whether simvastatin therapy led to higher glucose is related with down-regulated expression of FXR in diabetic rats remained unclear.Methods Forty male Wistar rats were randomly divided into four groups:normal control rats,insulin resistance rats,diabetic model rats,and the late simvastatin induced diabetic rats.Normal control rats were fed with standard diet,others were fed with high-fat diet.Diabetic model rats were induced by a single intraperitoneal injection of streptozotocin (STZ).The late simvastatin induced diabetic rats started simvastatin administration after STZ induced diabetic model rats.Characteristics of fasting blood glucose (FPG),lipid files and total bile acids (TBAs) were measured and the oral glucose tolerance test (OGTT) was performed after overnight fasting at the eighth weekend.RNA and protein levels of FXR,LXR-α and Srebp-1c were tested by Western blotting and reverse transcription polymerase chain reaction (RT-PCR).Results The insulin resistance rats showed higher glucose,lipid files and lower expression of FXR compared with normal control rats (P ＞0.05).The diabetic model rats showed significantly higher glucose,lipid files,TBA and lower expression of FXR compared with insulin resistance rats (P ＜0.05).The late simvastatin induced diabetic rats displayed higher glucose and TBA and lower expression of FXR compared with diabetic model rats (P ＜0.05).Conclusions Changes in bile acid homeostasis,including the alterations of bile acid levels and bile acid receptors,are either a cause or a consequence of the metabolic disturbances observed during diabetic models.Statin therapy induced hyperglycemia may be related with FXR,SHP,LXR-α and Srebp-1 pathways。

Abstract：Background Hyperglycemia may accelerate liver fibrosis.Currently,there is no effective treatment for liver fibrosis induced by type 2 diabetes.The study aim was to investigate whether RhoA/Rho kinase (ROCK) pathway is involved in liver fibrosis in the rats with type 2 diabetes and define the protective effects of fasudil on livers.Methods A rat model of type 2 diabetes was established by high fat diet combined with streptozotocin (30 mg/kg,intraperitoneal injection).Animals were randomly assigned to 3 groups:control rats,untreated diabetic rats that received vehicle and fasudil-treated diabetic rats that received ROCK inhibitor fasudil hydrochloride hydrate (10 mg/kg per day,intraperitoneal injection,for 14 weeks).The morphological features of liver were observed by HE staining.Accumulation of collagen in livers was determined by Masson staining and the measurement of hydroxyproline.The mRNA expression of transforming growth factor-β1 (TGFβ1),connective tissue growth factor (CTGF),type-Ⅰ,and type-Ⅲ procollagen was assessed with real-time polymerase chain reaction.The phosphorylation of myosin phosphatase target subunit-1 (MYPT1)and the protein levels of TGFβ1 and α-smooth muscle actin (α-SMA) were evaluated by Western blotting.Results Compared with control rats,untreated diabetic rats showed higher values of collagen and hydroxyproline in livers (P ＜0.01),the phosphorylation of MYPT1 and the protein levels of TGFβ1 and α-SMA were increased (P ＜0.01),and the mRNA expression of TGFβ1,CTGF,type-Ⅰ,and type-Ⅲ procollagen was upregulated (P ＜0.01); compared with untreated diabetic rats,treatment with fasudil signifcantly reduced values of collagen and hydroxyproline (P ＜0.01),and decreased the phosphorylation of MYPT1 and the levels of TGFβ1 and α-SMA (P ＜0.01),concomitant with the downregulation of TGFβ1/CTGF,type-Ⅰ,and type-Ⅲ procollagen mRNA expression (P ＜0.01).Conclusions Fasudil ameliorates liver fibrosis in rats with type 2 diabetes at least partly by inhibiting TGFβ1/CTGF pathway and α-SMA expression.Inhibition of RhoA/ROCK may be a novel therapeutic target for liver fibrosis in diabetic non-alcoholic steatohepatitis。

Abstract：Background Spine is the most common site of bone metastases in patients with cancer.Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the dose to spinal cord.The purpose of this study was to evaluate the safety and efficacy of CyberKnife(R) radiation therapy for spinal metastases.Methods Seventy-three lesions in 62 patients treated with CyberKnife radiotherapy from September 2006 to June 2010 for spinal metastases were retrospectively reviewed.Thirteen tumors in 12 patients had received prior radiation.Patients were followed clinically and radiographically for at least 12 months or until death.In all patients,the spinal cord and thecal sac were contoured for dose-volume constraints,and maximum doses to 0.1,0.5,1,2,and 5-ml volumes were analyzed.Results Using the CyberKnife System,20-48 Gy in one to five fractions for unirradiated patients,and 21-38 Gy in one to five fractions for the previously irradiatied patients,were delivered.Median 2-Gy normalized Biological Equvaient Dose (nBED) of unirradiated targets and irradiated targets were 49.6 Gy10/2 (range,31.25-74.8 Gy10/2) and 46.9 Gy10/2 (range,29.8-66 Gy10/2),respectively.With a median follow-up of 9.4 months (range,2.5-45 months),twenty-nine patients (46.7％) were alive,whereas the others died of progressive disease.Fifty-six patients (93.3％) reported complete or partial reduction of pain after CyberKnife radiotherapy at one-month follow-up,17 patients (28.3％) reported some degree of pain relief after first fraction of the treatment course.Two patients experienced local recurrence at fifth and ninth months postradiotherapy.Median maximum nBED for spinal cord and thecal sac of naive targets were 68.6 Gy2/2 (range,8.3-154.5Gy2/2) and 83.5 Gy2/2 (range,10.5-180.5 Gy2/2),respectively.Median maximum nBED for spinal cord and thecal sac for the re-irradiated targets were 58.6 Gy2/2 (range,17.7-140 Gy2/2) and 70.5 Gy2/2 (range,21.7-141.3 Gy2/2),respectively.No patient developed radiation related myelopathy during the follow-up period.Conclusion Cyberknife radiotherapy is clinically effective and safe for spinal metastases,even in previously irradiated patients。

Abstract：Background The aim of this research was to analyze the perioperative factors of regular hepatectomy and irregular hepatectomy.The superiority of the clinical application of the two methods was compared in the perioperative period.Methods From 1986 to 2011,1798 patients underwent consecutive liver resections with regular hepatectomy and irregular hepatectomy at the Air Force General Hospital of People's Liberation Army and the General Hospital of Chinese People's Liberation Army.Their medical documentation was investigated retrospectively.Results In patients on whom regular hepatectomy and irregular hepatectomy were performed,there was no significant difference in perioperative blood loss,complications,in-hospital mortality,hospital stay,and so on.But in regular hepatectomy,operating time was an independent risk factor (P ＜0.001,OR=1.004).Conclusions There was no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy。

Abstract：Background Accurate detection of human epidermal growth factor receptor 2 (HER2) expression and gene amplification is crucial for the application of HER2-specific therapy and for evaluating the response of patients with breast cancer.A uniform and standard procedure of immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) needs to be established for evaluating the HER2 status in breast cancer tissues for the treatment of patients with real HER2-positive tumors.The present multicenter study was aimed to examine the HER2 status in breast cancer specimens from Chinese patients using both IHC and FISH methods.Methods A multicenter study was performed on the HER2 status in 3 149 breast cancer specimens from different ethnic populations and areas in China by IHC and FISH assays.The potential association of HER2 status with demographic and clinical characteristics was analyzed.Results The positive rates for HER2 over-expression and HER2 amplification were 23.3％ and 27.5％ in this study,respectively.The concordance between IHC and FISH was 71.2％ (K=0.494,P ＜0.001).Furthermore,72.9％ of specimens with IHC 2+ were negative to FISH.The discordance rates among laboratories were from 5％ to 28％ for IHC and 1％ to 16％ for FISH.HER2 amplification was associated significantly with advanced tumor stage (Ⅲ or Ⅳ,P=0.002),large tumor size (＞5 cm,P=0.002),moderate and poor histological grades (P ＜0.0001),post-menopause (P ＜0.0001),ER-PR-(P=0.002),and having ＞4 lymph nodes affected (P ＜0.0001) in this population.The positive rates of HER2 amplification in specimens from Man and Hui Chinese were significantly higher than that in other Chinese populations.There are slightly higher positive rates of HER2 expression and amplification in Chinese patients with breast cancer.Conclusion These findings may provide new insights into understanding the epidemiological features of HER2 expression and amplification,and may be valuable for clinical practice。

Abstract：Background In March 2013,human cases of infection with a novel A (H7N9) influenza virus emerged in China.The epidemic spread quickly and as of 6 May 2013,there were 129 confirmed cases.The purpose of this study was to analyze the epidemiology of the confirmed cases,determine the impacts of bird migration and temperature changes on the H7N9 epidemic,predict the future trends of the epidemic,explore the response patterns of the government and propose preventive suggestions.Methods The geographic,temporal and population distribution of all cases reported up to 6 May 2013 were described from available records.Risk assessment standard was established by analysing the temperature and relative humidity records during the period of extensive outbreak in three epidemic regions in eastern China,including Shanghai,Zhejiang and Jiangsu provinces.Risk assessment maps were created by combining the bird migration routes in eastern China with the monthly average temperatures from May 1993 to December 2012 nationwide.Results Among the confirmed cases,there were more men than women,and 50.4％ were elderly adults (age ＞61 years).The major demographic groups were retirees and farmers.The temperature on the days of disease onset was concentrated in the range of 9℃-19℃; we defined 9℃-19℃ as the high-risk temperature range,0℃-9℃ or 19℃-25℃ as medium risk and ＜0℃ or ＞25℃ as low risk.The relative humidity on the days of disease onset ranged widely from 25％ to 99％,but did not correlate with the incidence of infection.Based on the temperature analysis and the eastern bird migration routes,we predicted that after May,the high-risk region would move to the northeast and inland,while after September,it would move back to north China.Conclusions Temperature and bird migration strongly influence the spread of the H7N9 virus.In order to control the H7N9 epidemic effectively,Chinese authorities should strengthen the surveillance of migrating birds,increase poultry and environmental sampling,improve live poultry selling and husbandry patterns and move from a "passive response pattern"to an "active response pattern" in focused preventive measures。

Abstract：Background Overactive bladder (OAB) is a series of symptoms with high prevalence in elderly people.This study was conducted using the overactive bladder symptom score (OABSS) to evaluate the efficacy of solifenacin succinate for the treatment of OAB.Methods This was a prospective,multicenter,single-arm,12-week study that enrolled 241 OAB patients.The patients received 5-10 mg/day solifenacin.Changes in OABSS,symptoms from voiding diary,perception of bladder condition (PPBC) score,international prostate symptom score (IPSS) and quality of life (QOL) were evaluated at weeks 0,4,and 12.The relationship between OABSS and PPBC score or parameters of voiding diary was also evaluated.Results At baseline,the mean OABSS for all patients was 9.41±2.40,and was reduced significantly at week 12 (-3.76 points; 61.21％,P ＜0.0001).The OABSS subscore,PPBC score,IPSS,and QOL were also significantly reduced during the study (P ＜0.0001).The overall incidence of adverse events was 19.91％ (44 cases).The gastrointestinal system was the most commonly affected (11.31％).Around 5.88％ of the cases had adverse events related to the genitourinary system.There was a strong correlation between OABSS and urinary symptoms that was recorded in the 3-day voiding dairy.Conclusions We showed that solifenacin was clinically effective for relieving OAB symptoms,considering the balance between efficacy,patients' well-being,and tolerability.OABSS integrates four OAB symptoms into a single score and can be a useful tool for research and clinical practice。

Abstract：Objective To review the advances of studies on vitamin D receptor and its role in the pathogenesis of diabetic nephropathy.Data sources A comprehensive search of the PubMed literatures without restriction on the publication date was carried out using keywords such as vitamin D receptor and diabetic nephropathy.Study selection Articles related to vitamin D receptor and diabetic nephropathy were selected and carefully analyzed.Results The ligands as well as construction and tissue distribution of vitamin D receptor were summarized.Pathogenesis of diabetic nephropathy was analyzed.The mechanisms underlying the renoprotective role of vitamin D receptor including inhibition of renin-angiotensin system,anti-inflammation,anti-fibrosis and the reduction of proteinuria were reviewed.Mounting evidences from animal and clinical studies have suggested that vitamin D therapy has beneficial effects on the renal systems and the underlying renoprotective mechanisms of the vitamin D receptor-mediated signaling pathways is a hot research topic.Conclusion Our study suggests that vitamin D receptor has a great potential for preventing the progression of diabetic nephropathy via multiple mechanisms。

Abstract：Objective To review the current status and progress on pig islet xenotransplantation.Data sources Data used in this review were mainly from English literature of Pubmed database.The search terms were "pig islet" and "xenotransplantation".Study selection The original articles and critical reviews selected were relevant to this review's theme.Results Pigs are suggested to be an ideal candidate for obtaining available islet cells for transplantation.However,the potential clinical application of pig islet is still facing challenges including inadequate yield of high-quality functional islets and xenorejection of the transplants.The former can be overcome mainly by selection of a suitable pathogen-free source herd and the development of isolation and purification technology.While the feasibility of successful preclinical pig islet xenotranplantation provides insights in the possible mechanisms of xenogeneic immune recognition and rejection to overwhelm the latter.In addition,the achievement of long-term insulin independence in diabetic models by means of distinct islet products and novel immunotherapeutic strategies is promising.Conclusions Pig islet xenotransplantation is one of the prospective treatments to bridge the gap between the needs of transplantation in patients with diabetes and available islet cells.Nonetheless,further studies and efforts are needed to translate obtained findings into tangible applications。

In China,the morbidity of alcoholic liver diseases (ALD)is increasing,which is the second cause of liver diseases after viral hepatitis.An epidemiological survey of 99 subjects in Kweichow Maotai Distillery who have drunk a lot of Maotai liquor for a long time showed that fatty livers were predominate and the incidence of hepatic fibrosis and cirrhosis was relatively low.1 Now,we carried out an animal experiment to investigate the mutation of P53 gene in liver tissues of primary hepatocellular carcinoma (HCC) induced by compound factors。

Multivariate modeling has demonstrated that the proliferation index (PI) of tumor cells is one of the str ongest prognostic factors related to the survival of patients with astrocytic tumors.Studies have indicated that the glioma regenerative cells derived from nestin-positive (N+) cells after chemotherapy.Early removal of N+ cells can block the malignant progress of tumor.2 However,few studies compared the PI between N+ cells and glial fibrillary acidic protein (GFAP)-positive (GFAP+) cells in human astrocytic tumors.In the present study,we investigated the distribution and proliferation ofN+ cells and GFAP+ cells in human astrocytic tumors to clarify the role these cells play in the cytopathology of these tumors。

The combination of intracytoplasmic sperm injection (ICSI) with artificial oocyte activation has overcome repeated fertilization failure after ICSI due to sperm defects in activating oocyte,resulting in pregnancies and births for many couples.1-3 However,in comparison to the growing data illustrating the effectiveness of artificial oocyte activation in reproductive medicine,the safety of this approach has not been well studied.Previously,we demonstrated that the activated embryos derived from unfertilized oocytes after ICSI could develop to blastocyst stage,similar to normal embryos,as evidenced by dual color fluorescence in situ hybridization (FISH) on sex chromosomes.3 However,before artificial oocyte activation is accepted as a clinical strategy,further safety studies of the offspring need to be carefully evaluated。

Dermatofibrosarcoma protuberans (DFSP) is a poorly differentiated interstitial tumor that originates from the dermis.It occurs predominantly in the 20-50-year-old males.DFSP generally presents as local pink plaques or nodules and subsequently develops into nodular masses accompanied by infiltrative growth to the surrounding tissue,including muscle and bone.1 The predilection sites are mainly the trunk (50％-60％),upper limb (25％),and head and neck (10％-15％).Although rarely metastatic,DFSP is frequently followed by a significantly high rate of regional recurrence due to indolent subcutaneous tissue spread.Wide excision is suggested to be the principal therapeutic measure of DFSP2 The difficulties of resection and reconstruction are relatively increased compared with other parts because of the low thickness of the skin and subcutis in the chest wall and because DFSP is more likely to invade bony structures.We herein summarize and report our experiences with wide excision and local reconstruction of the chest wall DFSP according to its own characteristics。

The distal radius is the third most common site for giant cell tumors of bone.1,2 This tumor is known to be very locally aggressive and recurs in situ quite frequently after excision.3,4 En bloc resection,removing a wide margin through normal tissue planes,ensures the lowest rate of recurrence.4 Wrist arthroplasty using the fibular head as a non-vascularized graft has been established as one of the procedures of choice because of its similarity in shape to the distal radius.5 Several articles have reported satisfactory functional results after reconstruction.5,6 However,the longest follow-ups available so far were all less than 20 years,and few articles focused on the radiographic changes of the carpus。

Low grade endometrial stromal sarcoma (LGESS) is a very rare malignant tumor.The standard treatment of LGESS is total hysterectomy with bilateral adnexectomy.Fertility preserving treatment for LGESS is rarely reported and the prognosis needs to be studied.Here we report a case of term birth pregnancy after fertility preserving treatment for LGESS。

Gallbladder cancer is the most common malignant tumor of the biliarv tract and the fifth most common malignancy of the gastrointestinal tract.1 In general,metastases of gallbladder carcinoma tends to occur in the regional lymph nodes and liver,while extra-abdominal and blood-borne metastases are relatively infrequent.2 Here we present an unusual case presenting with scalp metastasis from gallbladder cancer.To the best of our knowledge,only two similar cases have been documented in published literatures。

To the editor:Takayasu arteritis (TA) is a rare form of large vessel vasculitis,predominantly affecting the aorta and its main branches.In March 2012,a 59-year-old Chinese woman with 33 years of TA,was admitted to our Emergency Department for acute coronary syndrome.Serum cTnI was 0.631 ng/ml,electrocardiogram showed extensive T wave inversion.On physical examination,we found weak pulse on both sides of radial artery and femoral artery,bruits over right subclavian artery.Blood pressure of right arm was 70/58mmHg (1 mmHg=0.133 kPa),and 68/58 mmHg for the left。

To the editor:Human immunodeficiency virus (HIV) infection is an epidemic of modern era.Primary HIV infection usually presents as fever,fatigue,lymphadenopathy,myalgia,nausea and diarrhoea.Neurological symptoms may present during primary infection in 9％ of patients usually as aseptic meningitis or opportunistic infections.The occurrence of Guillian-Barre syndrome (GBS) during seroconversion of HIV is rare.1 We report a case of patient who presented with acute onset quadriparesis diagnosed as acute inflammatory demyelinating polyneuropathy with simultaneous HIV positive with previous HIV negative status。

To the editor:Little is known about the management of acute myocardial infarction (AMI) in patient with polycythemia vera (PV),especially in those with primary percutaneous coronary intervention (PCI)。

To the editor:A 24-year-old symptomless man was admitted to local hospital for aortic valve regurgitation and ascending aorta aneurysm in August 2008,he received aortic valve and ascending aorta replacement and recovered well.In October 2009,he began to have progressive exertional dyspnoea,echocardiography showing prosthetic valve detached and severe paravalvular leakage.The patient ever had recurrent oval aphthae,genital ulcer and folliculitis,and blood analysis showed higher level of C-reactive protein (CRP)and erythrocyte sedimentation rate (ESR);then he was diagnosed as Behcet's disease。

To the editor:Urinary tract infection has a reported prevalence of 14％ in febrile infants younger than 8 weeks.Urinary tract infections in newborns are sometimes associated with urological anatomic abnormalities.Anterior urethral valves (AUV) are extremely rare congenital entities which cause obstructive uropathy in the lower urinary tract of children and may be difficult to diagnose.Most urinary tract infections are caused by gram-negative bacilli,particularly Escherichia coli.(E.coli) has a high antibiotic resistance,and most strains are multi-drug resistant.We present a newborn with AUV in order to emphasize the importance of identifying urinary tract infection in a male infant。