Recent progress in the treatment of intractable sialolithiasis / 北京大学学报(医学版)

Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.

Three-dimentional radiographic features of 67 maxillary radicular cysts / 北京大学学报(医学版)

OBJECTIVE@#To analyze the three-dimensional radiographic characteristics of maxillary radi-cular cysts using cone-beam computed tomography (CBCT) and spiral CT.@*METHODS@#Clinical records, histopathological reports, and CBCT or non-enhanced spiral CT images of 67 consecutive patients with maxillary radicular cysts were retrospectively acquired, and radiographic features, including size, shape, expansion, internal structure and relationship with the surrounding tissues, were analyzed. The lesions were divided into three types according to the involved tooth number, as follows: type Ⅰ (single tooth), the epicenter of the cyst was located at the apex of a nonvital tooth, without involvement of the neighbo-ring tooth; type Ⅱ (adjacent tooth involvement), the cyst was located at the apex of a nonvital tooth with involvement of the mesial and/or distal tooth root; and type Ⅲ (multi-teeth), the cyst involved the apexes of ≥4 teeth. Besides, these cysts were classified as another three types on sagittal views, as follows: centripetal, the root apex was oriented centripetally to the center of the cyst; palatal, the cyst was located mainly at the palatal side of the apex; and labial/buccal, the cyst was located mainly at the labial/buccal side of the apex.@*RESULTS@#Totally, 67 patients with maxillary radicular cysts were acquired, including 38 males and 29 females, and their ages ranged from 13 to 77 years. Among them, 46 lesions (68.7%) were located in the anterior maxilla and 65 (97.0%) were round or oval. Labial/buccal cortex expansion was present in 43 cases (64.2%) and palatal cortex expansion in 37 cases (55.2%). The nasal floor was invaded in 27 cases (40.3%), the maxillary sinus was invaginated in 26 cases (38.8%), and root resorption was present in 9 cases (13.4%). The average diameter of lesions was (20.89±8.11) mm mesio-distally and (16.70±5.88) mm bucco-palatally. In spite of the 4 residual cysts, the remaining 63 lesions included 14 type Ⅰ, 26 type Ⅱ and 23 type Ⅲ cysts according to the involved tooth number. Besides, the 63 lesions included 46 centripetal, 15 palatal and 2 buccal cysts on sagittal views.@*CONCLUSION@#The maxillary radicular cysts were frequently well-circumscribed round or oval radiolucency, with significantly different sizes. According to the involved tooth number, it can be divided into single tooth, adjacent tooth involvement and multi-teeth types. On sagittal views, the root-cyst relationship was centripetal in most cases, while a minority of cysts expanded palatally or buccally.

Endoscopy-assisted sialodochoplasty for the treatment of severe sialoduct stenosis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effects of endoscopy-assisted sialodochoplasty for the treatment of severe sialoduct stenosis with concurrent megaducts.@*METHODS@#From Jul.2010 to Dec. 2016, 8 patients presenting with severe parotid duct stenosis and 3 patients with occlusion of the Wharton's duct underwent endoscopy-assisted sialodochoplasty.All these patients had concurrent severe ductal ectasiaand manifested a painful swelling of the involved salivary glands.The diameter of ectasia and length of stenosis of the sialoducts were measured preoperatively by sialography, computed tomography, or ultrasonography. The megaducts were opened transorally and sutured to the buccal or oral floor mucosa, therefore creating a neo-ostium. All the patients were followed up periodically after operation. The treatment effects were evaluated by clinical signs, sialogram and sialometry.@*RESULTS@#The length of the Stensen's duct stenosis was 5-12 mm, and the diameter of the concurrent ectasia was 8-16 mm. The length of the Wharton's duct stenosis was 10-20 mm, and the diameter of the concurrent ectasia was 6-8 mm.The neo-ostiums healed uneventfully 2 weeks after operation. The duration of the follow-up varied from 6 to 78 months (median: 24 months). Among the 8 patients with Stensen's duct stenosis, two experienced re-obliteration of the neo-ostium, but the buccal bulge and clinical symptoms disappeared; one reported recurrent clinical symptoms after initial alleviation, which could be controlled with self-massaging; the remaining 5 patients had satisfactory clinical results, i.e., disappearance of the obstruction symptoms and buccal bulge, patent ostium,clean saliva and improvement of the ductal ectasia on sialogram. Three patients with Wharton's duct occlusion were asymptomatic with clear saliva and patent ostium;two exhibited approximately normal appearance and one showed improvement of the sialogram.Sialometry was performed in 9 patients with patent neo-ostium of the involved glands,the resting saliva flow rate of the affected glands showed no differences compared with the normal side, and stimulated flow rate showed a significant increase, though less than the control side.The clinical results included good in 5 patients, fair in 4 patients, and poor in 2 patients, with a total effective rate of 82% (9/11).@*CONCLUSION@#Endoscopy-assisted sialodochoplasty appears to be effective and can be a viable option for patients presenting with severe sialoducts tenosis and concurrent ectasia.

Inhibitory effect of combination of tanshinoneⅠ,metformin and aspirin on malignant melanoma model mice / 中国药理学与毒理学杂志

OBJECTIVE To explore the antitumor effects of combined tanshinoneⅠ(TanⅠ),metformin (Met) and aspirin (Asp) on malignant melanoma in mice and the possible mechanisms. METHODS C57BL/6 mice were injected with 0.1 mL B16F10 cells(2.8×109L-1)to establish the subcutaneous trans-plantation tumor model at the right forelimbs axillary.Then,the mice were divided into 8 groups according to body mass,including model group, TanⅠgroup(20 mg·kg-1,ip),Asp group(210 mg·kg-1,orally in drinking water), Met group (70 mg·kg-1, orally in drinking water), Asp+Met group, TanⅠ+Asp group, TanⅠ+Met group and TanⅠ+Asp+Met group,10 mice in each group.Each mouse drank about 7 mL of water every day for a total of 18 d.The mouse body mass was measured every other day and the tumor diameter was calculated every day. The mice were sacrificed after treatment, the tumor mass was measured and the tumor inhibitory rates were counted. The histopathological changes of the liver and spleen were observed with HE staining. The percentage of lymphocytes in the tumor tissue such as CD8+T,CD4+T and Treg cells was detected by flow cytometry.Inflammatory factors such as interleukin-6 (IL-6),IL-1β and tumor necrosis factor-α (TNF-α) were detected by ELISA. RESULTS The body mass (including tumor mass)of mice in different groups increased during the experiment,but that of TanⅠ+Asp+Met group increased more slower than in model group(P<0.01).At the end of the experiment,no lesions were seen in any liver or spleen tissue by pathological observation,and the number of survivors was 8/10(model group),8/10(TanⅠgroup),7/10(Asp group),7/10(Met group),8/10(TanⅠ+Asp group), 8/10 (TanⅠ+Met group), 7/10 (Asp+Met group) and 5/10 (TanⅠ+Asp+ Met group), respectively. Compared with model group,there were no obvious changes in tumor volume or tumor mass in TanⅠ, Asp and Met groups and other two-two joint groups,but the tumor volume and tumor mass in TanⅠ+Asp+ Met group were significantly decreased (P<0.01, P<0.05), and the tumor inhibitory rate in this group was 46.2%.Compared with the model group,the percentage of CD8+T cells increased(P<0.05) in TanⅠ+Asp+Met group,but there were no significant changes in other groups.The contents of IL-6, IL-1β and TNF-α in tumor tissue of TanⅠ+Met group were much higher than in model group(P<0.01, P<0.05,P<0.05)and the content of IL-6 increased in TanⅠ+Asp+Met group(P<0.01).CONCLUSION Combination of TanⅠ,Asp and Met can effectively inhibit the growth of melanoma in mice,which may be related to the increasing percentage of CD8+T lymphocytes and IL-6 in tumor tissue.However there are possibly some side effects.

The neuroprotective effects of grape seed proanthocyanidin on rat brain injury caused by chronic intermittent hypoxia

Chronic intermitted hypoxia including sleep breathing disorder leads to brain injury. This study explores the potential therapeutic effects of grape seed proanthocyanidin as a neuroprotective agent. A rat model of chronic intermittent hypoxia was employed, and the animals were given low or high doses of grape seed proanthocyanidin. The ultrastructure changes in the brain, the biochemical components, and the animal behavior were examined. The results showed that with hypoxia exposure, neuronal mitochondria exhibited injuries at ultrastructural level, with increased malondialdehyde (MDA) content and reduced superoxide dismutase (SOD) activity. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining revealed increased cell apoptosis in hippocampus. In Morris water maze the animals showed decreased learning abilities, when compared to normal control. The administration of grape seed proanthocyanidin treatment reversed all these observed changes, and improved the learning behavior. We concluded that grape seed proanthocyanidin could alleviate the brain injury caused by hypoxia from sleep breathing disorder.

An evaluation of self -efficacy application on the rehabilitation of hemiplegic patients after ischemic stroke / 预防医学

Objective To evaluate the effect of self -efficacy training on hemiplegic patients after ischemic stroke. Methods Sixty cases were randomly divided into control group (n =30 )and self -efficacy training group (n =30).The self -efficacy group received rehabilitation training according to the self -efficacy theory (5 times /week, 40 min /per time,1 0 weeks of intervention).The movement and balance function were evaluated using Fugl -Meyer score (FMA)and the activities of daily living were evaluated by the task analysis scale and Barthel index.The self -efficacy level and quality of life were evaluated by the general self -efficacy scale (GSES)and medical outcomes study (SF -36).Results The scores of FMA,Barthel,SF -36 and GSES had no significant differences between the two groups before training (P >0.05 )and all indexes improved after training.Six scores of Barthel and all scores of FMA,SF -36 and GSES of self -efficacy group were significantly higher than those of control group after training (all P <0.05 ).Conclusion Self -efficacy application could improve the motor function on the rehabilitation of hemiplegic patients after ischemic stroke.

Effect of shenxiong huayu capsule on cerebral ischemia/reperfusion injury and the expression of GAP43 in hippocampal CA1 of rats / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the effect of Shenxiong Huayu Capsule (SHC) on the cerebral ischemia-reperfusion (IR) injury and the expression of growth associated protein 43 (GAP43) after total cerebral IR in the hippocampal CA1 region of rats.</p><p><b>METHODS</b>Totally 100 male adult SD rats were randomly divided into five groups, i.e., the control group, the model group, the group A (by taking SHC once daily), the group B (by taking SHC twice daily), and the group C (by taking SHC thrice daily), 20 in each group. The total IR model was prepared by improved Pulsinelli's 4-vessel occlusion method. Morphological changes of the hippocampal CA1 region were observed by HE staining at day 1, 3, 7, and 14. The expression of GAP43 in the hippocampal CA1 region was detected using immunohistochemical assay at day 1, 3, 7, and 14. Meanwhile, the behavioral score was determined. The expression of GAP43 in the hippocampal CA1 region was detected using Western blot at day 14.</p><p><b>RESULTS</b>Compared with the control group, the expression of GAP43 increased in the model group, the behavioral score was elevated, degenerated neurons increased, and survival neurons decreased in the model group (all P < 0.05). Compared with the model group, the expression of GAP-43 increased (with the most significant difference seen in the group C, P < 0.01), the behavioral score significantly decreased, degenerated neurons decreased, and survival neurons increased in each HSC group (all P < 0.05). Survival neurons obviously increased at day 14, of which, most number of survival neurons and highest contents of GAP43 protein could be seen in the group C, showing statistical difference when compared with those of the group A and the group B (P < 0.01).</p><p><b>CONCLUSION</b>SHC had protective effect on total cerebral IR in the hippocampal CA1, which might be associated with increased expression of GAP43.</p>

Adenovirus mediated BIMS transfer induces growth supression and apoptosis in Raji lymphoma cells / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To transfer pro-apoptotic BIM directly into tumor cells bypass the complicated biological processes of BIM activation so as to reverse the chemoresistance of cancer cells.</p><p><b>METHODS</b>BIMS was specifically amplified from HL-60 cells by RT-PCR, confirmed to be correct by sequencing and cloned into shuttle vector pAdTrack-CMV carrying a green fluorescence protein gene to generate a recombinant plasmid pAdTrack-CMV-BIMS. This plasmid and adenovirus backbone plasmid pAdEasy-1 were linearized and electroporated into E.coli BJ5183 host bacteria to mediate homologous recombination. The positive clone was identified by restrict endonuclease digestion. The recombinant pAdEasy-CMV-BIMS was transferred into HEK293 cells for packaging and amplification. The successful construction of recombinant human BIMS adenovirus (Ad-BIMS) was demonstrated by Western blot. To test whether Ad-BIMS has the capability of inducing apoptosis of tumor cells, Ad-BIMS was used to infect GC resistant Burkitt lymphoma Raji cells.</p><p><b>RESULTS</b>After infected for 2-5 days, BIMS expression in Raji cells was detected by RT-PCR and Western blot. The significant growth retardation and apoptosis of Raji cells were also observed by MTT and flow cytometry.</p><p><b>CONCLUSION</b>These results indicated that BIMS might be a potential candidate of gene therapy for chemoresistant tumor cells.</p>

Expression of Ku70 and Bax in hippocampus CA1 following cerebral ischemia/reperfusion injury in diabetic rats / 第二军医大学学报

Objeceive To compare the expression of Ku70 and Bax in hippocampus CA1 between normal rats and diabetic rats following cerebral ischemia/reperfusion, so as to explore the roles of Ku70 and Bax in aggravating cerebral ischemial reperfusion mjury nn diabetes. Meehods Totally 72 male SD rats were divided into 3 groups randomly: sham operated (SO) group, normoglycemia global cerebral ischemia/reperfusion (NCI) group, and diabetic global cerebral ischemia/reperfusion (DCI) group. The rats in DCI group were treated by streptozodn (STZ) and improved Puliinelii's foue-vessel occlusion method to estabiish diabetic global cerebral ischemia/reperfusion modll. Andanimals in NCI group were not gvven STZ, and other treatments were iimllar to those in the DCI group. Animals in the SO group only had blood vessels exposed. Changes of neuron pathology in hippocampus CA1 were observed by H-E stammg under iight microscopy at 1, 6, 24, and 48 h after lschemial reperfusion; expresioon of Ku70 was detected by immunohistochemistry and Western blotting analyils, and expresioon of Bax was detected by immunohistochemistry. Resules The neuron structure in hippocampus CA1 of rats was damaged nnNCI group, and the density of survival neuronswas significanely lower than that nn the SO group at all studied time ponnts(P<0. 05); the neuron structure damage nn DCI group was more severe, and the demity of sunival neurons was signiticanely lower than that of the NCI group at all studied time points(P<0. 05). The expresioon of Ku70 at 1 and 6 h nn NCI group was signiticanely higher than that in the SO group (P<0. 05), and that at 24 and 48 h was signiticanely lower than that nn the SO group(P<0. 05); Ku70 expression nn DCI group was significanely lower than that nn the NCI group at all studied time ponnts(P<0. 05). Bax expresioon in NCI group was signiticanely higher than that in the SO group at all studied time points(P<0. 05), and that in DCI group was signiticanely higher than that in the NCI group at all studied time ponnts (P<0. 05). Conclusion Diabetes can aggravate global cerebral ischemia/reperfusion injury, which may be related to Ku70 Expression decrease and Bax Expression Increase.

Clinical analysis of Epstein-Barr virus-associated hemophagocytic syndrome in children / 中国实验血液学杂志

The primary infection of Epstein-Barr virus (EBV) may results in hemophagocytic syndrome, known as EBV-associated hemophagocytic syndrome (EBV-AHS), but the clinical risk factors complicating this fatal disease in children with infectious mononucleosis (IM) are unknown. The aim of this study was to identify clinical features of EBV-AHS and to evaluate the curative effect of HLH-2004 protocol. The clinical and laboratory data of 644 IM children including 27 children developed into EBV-AHS and 43 HPS children associated with other diseases were retrospectively analyzed and logistic regression was used to identify the clinical risk factors complicating EBV-AHS. The results showed as follows: (1) the prevalence of EBV-AHS in IM children was 4.2% (27/644), and the prevalence in group aged younger than 3 years was higher than in other age groups. The incidence age of EBV-AHS was significantly younger than that of other HPS patients; (2) Liver function damage of group aged older than 7 years was much more severe in HPS patients. (3) Compared with other HPS patients, male patients were more common and liver function damage was severe in EBV-AHS patients, especially in the patients aged at 2 years or younger. (4) The fatality rate in the EBV-AHS patients was 37.0% (10/27). (5)After treatment with HLH-2004 protocol, the fatality rate in patients with EBV-AHS decreased from 50.0% to 18.2%, the overall survival (OS) of 3 years significantly increased (P = 0.032). It is concluded that IM is a benign self-limited disease, of which only about 4.2% patients will develop into EBV-AHS. Clinical risk factors identified in this study may be helpful for early diagnosis of IM children with complicated EBV-ASH, the HLH-2004 protocol can obviously improve prognosis of EBV-HPS.

Protective effects of edaravone on diffuse brain injury in rats / 世界急诊医学杂志（英文）

BACKGROUND: Edaravone can alleviate brain injury and improve neurological functions and symptoms. This study aimed to investigate the effect of edaravone on the p38Mitogen-activated protein kinases/Caspase-3 (p38MAPK /Caspase-3) pathway after diffuse brain injury (DBI) in rats. METHODS: DBI models were established according to the description of Marmarou's method. A total of 250 rats were divided (random number) into four groups: control group (CG, n=45), model group (MG, n=77), low-dose edaravone group (n=67, dosage 5 mg/kg) and high-dose edaravone group (n=61, dosage 10 mg/kg). After 1, 6, 24, 48, and 72 hours after injury, brain tissues were collected. The changes of neuron morphous in the hippocampal region were observed through Nissl staining. The expression levels of phosphorylated p38MAPK and caspase-3 were detected by immunohistochemistry and Western blotting respectively. Learning and memory function were tested with Morris water maze from the 3rd to 7th day after injury. RESULTS: Some neurons had histopathologic changes of necrosis and apoptosis in the model group compared with the control group. The phosphorylated p38MAPK expressions increased at 1, 6, 4, and 48 hours (P<0.05), but no significant difference was observed at 72 hours (0.54±0.19 vs. 0.40±0.14, P>0.05). Caspase-3 expressions increased at 6, 24, 48, and 72 hours respectively (P<0.05), but there was no significant difference at 1 hour (0.59±0.29 vs. 0.40±0.17, P>0.05). From the 3rd to 6th day during the Morris water maze test, the latency to find the platform was significantly prolonged (P<0.05) and times of rats crossing the platform was decreased on the 7th day (2.28±1.18 vs. 8.20±1.52, P<0.05). The phosphorylated p38MAPK expressions decreased at 6, 24 and 48 hours respectively in the low dose edaravone group compared with the model group (P<0.05), whereas no significant difference was seen at 1 hour (1.66±0.80 vs. 1.85±0.86, P>0.05). Caspase-3 expression decreased at 6, 24, 48, and 72 hours (P<0.05). The latency to find the platform was significantly shortened (P<0.05), and times of rats crossing the platform increased (4.17±1.15 vs. 2.28±1.18, P<0.05). The above mentioned parameters changed more significantly in the high-dose edaravone group than in the low-dose edaravone group. CONCLUSION: Edaravone can alleviate brain tissue damage after DBI, inhibit p38MAP signal activation after early injury, reduce the expression of caspase-3, and promote the recovery of neurological function in the late period.

Clinical risk factors for Epstein-Barr virus-associated hemophagocytic syndrome in children with infectious mononucleosis / 中华儿科杂志

<p><b>OBJECTIVE</b>To compare the clinical features of infectious mononucleosis (IM) and Epstein-Barr virus (EBV)-associated hemophagocytic lymphohistiocytosis (EBV-AHS) and identify the clinical risk factors in IM patients complicated with EBV-AHS.</p><p><b>METHOD</b>A retrospective study was carried out to analyze the clinical and laboratory data of 414 IM and 16 EBV-AHS children from January, 2000 to April, 2006. Then Logistic regression was used to identify the risk factors for progression to EBV-ASH.</p><p><b>RESULTS</b>(1) The incidence of EBV-AHS among the IM children was 3.72% (16/430). There were significant differences between EBV-ASH and IM children in duration of fever (20 days vs. 7 days, P < 0.001), the peaks of fever (40.0 degrees C vs. 39.0 degrees C, P < 0.001), the degree of hepatomegaly (3.5 cm vs 2.0 cm below costal arch, P < 0.05) and splenomegaly (2.75 cm vs. 1.0 cm below costal arch, P < 0.05), while the incidence of isthmitis in EBV-AHS patients was markedly lower than that of IM patients (37.5% vs. 91.1%, P < 0.01). (2) Pancytopenia was often observed in EBV-AHS patients and significant differences between two groups were found in median of leukocytes (3.1 x 10(9)/L vs. 12.8 x 10(9)/L, P < 0.001), median of neutrophils (0.53 x 10(9)/L vs. 3.17 x 10(9)/L, P < 0.001), mean of hemoglobin (80 g/L vs. 120 g/L, P < 0.001) and median of platelet (27.5 x 10(9)/L vs. 183 x 10(9)/L, P < 0.001). (3) Hepatic derangement evidenced by elevated serum enzymes, hyperbilirubinemia and hypoalbuminemia in EBV-ASH children was much more severe than that in IM children, especially LDH level (2128.5 U/L vs. 445 U/L, P < 0.001) and AST level (489 U/L vs. 59 U/L, P < 0.001). (4) The clinical risk factors for IM patients progressing to EBV-ASH were lasting fever >/= 10 days (OR = 8.097, P = 0.008), LDH > 1000 U/L (OR = 7.998, P = 0.033), hypo-albuminemia (albumine < 35 g/L, OR = 7.838, P = 0.038), neutrophils < 1.5 x 10(9)/L (OR = 7.587, P = 0.022) and Plt < 100 x 10(9)/L (OR = 7.190, P = 0.027). The mortality of EBV-AHS in the patients was 50.0% (8/16).</p><p><b>CONCLUSION</b>Most of IM children clinically manifest self-limited process, but about 3.72% of whom may progress to fatal EBV-ASH. The clinical risk factors for EBV-AHS are lasting fever > 10 days, LDH > 1000 U/L, hypoalbuminemia, neutropenia and Plt < 100 x 10(9)/L. EBV-ASH is an extremely dangerous state with high mortality. Repeated bone marrow examinations are helpful for diagnosis in time.</p>

Clinical Analysis of 25 Cases of Langerhans Cell Histiocytosis / 实用儿科临床杂志

Objective To explore the clinical and laboratory characteristics of langerhans cell histiocytosis (LCH) in children, so as to improve diagnosis level and decrease misdiagnosis rate.Methods Twenty-five cases of LCH from Jan.1996 to Feb.2006 were analyzed by retrospective study. The clinical data were collected and abstracted for information regarding clinical symptom, physical sign, laboratory examination, imaging,pathology,diagnosis and treatment.Results Some laboratory findings in hemogram, bone marrow examination and chest X-ray were non-specific.The X-ray characteristic of skeleton was osteolysis. Computerized tomography and magnetic resonance imaging were important in defining the extent of lesion in fundus cranii and sella.Seven cases were examined for anti-Epstein-Barr virus(EBV) IgM, 3 cases were positive;5 and 3 cases out of 10 cases showed humoral and cellular immunity abnormality,respectively. The misdiagnosis rate was 52%,1 case had been misdiagnosed for 7 years. Chemotherapy was effective in the future.Conclusions The clinical manifestations of LCH varies widely, leading to high rate of misdiagnosis.The etiology of LCH is unclear,and some of our patients show the evidence of EBV infection or immunity abnormality. Definitive diagnosis of LCH is based on pathology. Ultrastructure and immunophenotype should be done to improve diagnosis level.