Occurrence and aetiology of acute respiratory diseases: results of a longterm surveillance programme

Totals of 58,661,000 acute respiratory disease (ARD) cases, 1,376,651 bronchitis and pneumonia complications, and 93,042 deaths from influenza, bronchitis, pneumonia or chronic pulmonary affection were notified during 11 years of ARD surveillance from 1975 to 1986. All ARD seasons started with the first phase in September-December; this increase in morbidity was caused chiefly by adenoviruses, parainfluenza viruses, rhinoviruses and M. pneumoniae. Second wave of ARD morbidity occurring in January-April used to be explosive and was associated with an influenza epidemic in 9 of the 11 seasons; only in 1978/79 and 1984/85 the ARD epidemics were caused by adenoviruses and especially RSV, the share of influenza being minimal. Pneumonia and bronchitis excesses occured during epidemics caused by M. pneumoniae in 1975/76, 1980/81 and 1985/86. Particularly high mortality excesses occurred in 1976, 1977 and 1983 during epidemics elicited by a new drift variants of influenza A(H3N2). Identification of viral agent of M. pneumoniae attempted in 5474 ARD cases was successful at 37.4%. The respective contributions of parainfluenza viruses, adenoviruses, influenza A virus and RSV to overall aetiologically identified morbidity were 14.2, 13.9, 13.8, and 12.0%. Mixed infections (2-3 agents identified simultaneously) accounted for 14.6% of cases. Type B influenza virus, rhinoviruses, enteroviruses and herpes simplex virus contributed only by 5.6-7.8%. In ordinary seasons the share of M. pneumoniae in aetiologically identified ARD morbidity was 0.6-3.8%; this agent displayed predominance at 5-year cycles, when accounting for 20.5-38.9% of cases. The most frequently detected agents in individual age groups were as follows: in preschool children parainfluenza (18.6%), RSV (16.6%), and adenoviruses (17.4%); in school children M. pneumoniae (26%), influenza A and B (10.2 and 14.7% respectively), and adenoviruses (10.7%); in adolescents and young adults influenza type A (20.2%), M. pneumoniae (15.0%), and rhinoviruses (13.3%); in adults above 25 years age influenza A virus (38%), and other respiratory viruses at a frequency lower than 10% each.     

Viruses in community-acquired pneumonia in children aged less than 3 years old: High rate of viral coinfection

The occurrence of viral coinfections in childhood pneumonia has received little attention, probably because suitable detection methods have been lacking. Between November 2004 and October 2006, the presence of 14 respiratory viruses in children aged less than 3 years old with community-acquired pneumonia were investigated using molecular or immunochromatographic techniques and/or viral culture. A total of 315 children (338 episodes) were included, and hospitalization was required in 178 episodes. At least one virus was detected in 66.9% of the episodes and simultaneous detection of two or more viruses was frequent (27% of the episodes with viral detection). The most frequently detected virus was respiratory syncytial virus (n = 67: 33 subgroup A, 33 subgroup B, 1 not typed), followed by human bocavirus (n = 48), rhinovirus (n = 46), human metapneumovirus (n = 39: 13 genotype A2, 8 B1, 5 B2, 1 A1, 12 not genotyped) and parainfluenza viruses (n = 38: 1 type 1, 3 type 2, 22 type 3, 11 type 4 and 1 not typed). The 14 viruses investigated were found in viral coinfections, which were more frequent in children aged less than 12 months. Except for adenovirus, the incidence of which was low, the percentage of viral coinfection ranged between 28.2% and 68.8%. Children with viral coinfection more frequently required hospital admission than those with single viral infection. It is concluded that viral coinfections are frequent in children aged less than 3 years old with community-acquired pneumonia and can be a poor prognostic factor.     

Assessment of potential epidemiologic danger of sources of respiratory syncytial infection by biological properties of the pathogen

Biological properties of 188 strains of respiratory syncytial (RS) virus isolated from 93 institutionalized children during 4 years of observations were correlated with the form and stage of the infectious process, frequency of ARD, and blood group of the children for the evaluation of the epidemiological hazard of sources of RS infection. The degree of virulence of a strain was evaluated by its yields in human embryo lung culture and sensitivity to antibodies (avidity). In clinically manifest forms of RS infection more virulent strains were isolated than in inapparent infections and transitory asymptomatic virus-carrier state. Among the strains derived from children with frequent ARD, highly and moderately virulent strains were prevalent (in 72.7% high and moderate yields in cell culture, and 94.2% low avidity to antibodies) whereas children with rare ARD yielded mainly low virulent strains (70% none or low yields, and 62.5%--highly sensitive to antibodies). The RS virus strains isolated from children with A (II) blood group were found to be less sensitive to antibodies.     

Results of coded trials of the activity of the trivalent subunit influenza vaccine Grippovak in Moscow kindergartens in December 1983 through the 1st quarter of 1984

During the autumn-winter epidemic of influenza-like diseases in December, 1983--first quarter, 1984, in Moscow commissioned coded observations on the effectiveness of prophylactic vaccination against influenza of 3-7-year-old children with a preparation "Grippovak SE-AZh" were carried out in day-care centers. In the previous large-scale trials, 1981-1984, the "Grippovak" had been evaluated positively as a completely harmless, serologically and immunologically active preparation reducing 3-3.5-fold the number of laboratory-verified cases of viral type A and B influenza in the vaccinees. In 1986, however, the "Journal of Microbiology, Epidemiology, Immunology" (JMEI, 2: 49-54) published a paper whose authors, on behalf of the Commission which had checked the preparation in the day-care centers (Z.A. Bashliaeva, A.A. Sumarokov, et al.), came to a conclusion that "Grippovak" was ineffective in children. Other members of the above Commission disagreeing with this conclusion made a repeat analysis of the decoded materials of the observations in the day-care centers using computer methods and demonstrated that because of significant prevalence of non-influenza ARD cases and recurrent (up to 44%) ARD cases in children in the 4 months of observation, it was impossible to judge the effectiveness of the vaccine by comparison of the total incidence of influenza and ARD from the clinical data alone in the vaccinees and controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of dipyridamole efficacy as an agent for preventing acute respiratory viral diseases

The epidemiological effectiveness of a low molecular interferon inducer, dipyridamole, as a means of prevention of influenza and ARD was studied in a double-blind epidemiological trial in a period of seasonal rise of ARD (Dec., 26, 1984-March 13, 1985). A statistically significant decrease of ARD incidence (1.91-fold) in the experimental group was confirmed by the results of serological studies and titrations of serum interferon in paired sera collected before the prevention and 10 days after its termination in selected subgroups from the experimental and control groups. The results indicate that the use of dipyridamole may be effective for mass prevention of influenza and ARD.     

Regulation of the immune response in Plasmodium falciparum malaria. III. Proliferative response to antigen in vitro and subset composition of T cells from patients with acute infection or from immune donors.

T cells from patients with acute Plasmodium falciparum malaria were investigated for their proliferative responses in vitro to malarial antigen. Of 26 patients, 14 had acute and short lived (less than or equal to 8 days) disease episodes, most of them for the first time, while 12 had been ill for more than 8 days at the time of the blood samples were taken. The lymphocytes from the first group gave a weak, and apparently P. falciparum specific proliferation, peaking after 3-4 days, but waning within 5-6 days, suggesting the induction of suppression. No such responses were obtained with control antigen consisting of normal RBC membranes. The P. falciparum antigen-induced proliferative response was completely lacking in the second group of patients. Since both groups responded equally to T cell mitogen, the results are indicative of a malaria specific non-responsiveness. In contrast T cells from a group of apparently immune donors living in highly endemic P. falciparum malaria areas developed strong and long lasting proliferative responses to P. falciparum antigen with a peak on days 5-6. T cells from acutely infected P. vivax patients did not respond to either the P. falciparum antigen or to the control antigen. The cellular basis of the proliferative responses were investigated by surface marker studies with monoclonal antibodies. Within the T cell preparations, the T4+/T8+ cell ratio was close to normal for both the immune donors and for those with acute P. vivax infection. In contrast, this ratio was depressed for both groups of patients with acute P. falciparum infection. However, this was due to reduced number of circulating T4+ cells in the patients with short disease episodes whereas it was due to increased numbers of T8+ cells, probably including suppressor cells, in those who were ill for more than 8 days.     

Alcohol-related death and associated risk factors in urban middle-aged males

Alcohol-related disorders belong to the spectrum of major non-infectious diseases in Western societies which can be prevented by means that have not yet been fully implemented. Total consecutive mortality in a population of 10353 middle-age males invited to take a part in a preventive medical population program in Malm? was followed up for 3.5-8.5 years (mean 4.5) after the time of invitation and analysed in relation to participation or non-participation and forensic or in-hospital autopsy. Entry characteristics in the 7935 males who attended the screening were compared in order to evaluate risk factor patterns for the major categories of premature death during the follow-up period. Even in the males participating in the screening, alcohol-related deaths (ARD) constituted a major mortality category, comprising 55 of 218 cases, whereas cancer comprised 61 and coronary heart disease (CHD) 50 of the premature deaths in this group. Both in the ARD and CHD categories of male premature mortality, significant and distinctly differential risk factor patterns were found; in CHD for smoking, cholesterol, serum triglycerides and systolic blood pressure, and in ARD for gamma-glutamyltransferase, questionnaire alcoholism screening test and, inversely, serum cholesterol and serum creatinine. In both groups of diseases, these risk factors could be combined into highly predictive multiple logistic risk factor functions. The discriminative power of this instrument was even higher in ARD than in CHD deaths. In consequence, these factors may be applied both as indicators of the ARD risk and as signals and instrument for directed preventive measures in analogy with previously well established and tested methods for the regulation of blood pressure, serum lipids, etc. in the conquest of the cardiovascular diseases.     

Human bocavirus in Italian patients with respiratory diseases.

BACKGROUND: hBoV, a recently discovered parvovirus, can be present in the respiratory tract of patients with acute respiratory diseases (ARD), but its etiologic involvement in the underlying diseases is still uncertain. OBJECTIVE: To determine in a retrospective study, the prevalence of hBoV, compared with common respiratory viruses (RV), in respiratory specimens from patients with ARD. STUDY DESIGN: A total of 335 specimens obtained over 7 years were examined. Two hundred were nasal swabs from infants hospitalized for ARD, 84 were nasal swabs or bronchoalveolar lavages from adults with pneumonia, bronchopneumonia or asthma, and 51 were nasal swabs from healthy children. RESULTS: The overall rate of hBoV detection in specimens from infants with ARD, which was 4.5%, varied slightly from year to year, except for the period 2000-2002, when no specimen was positive. Unlike other RV, no seasonal variation in hBoV incidence was noted. Infants with hBoV infection suffered either from bronchiolitis or from bronchopneumonia and 5 out of 9 cases yielded no co-infecting viral pathogen. Only one sample from an adult was hBoV positive. None of the nasal swabs from healthy subjects tested hBoV-positive. CONCLUSIONS: The findings indicate that hBoV can cause ARD in infants.     

The effects of selected probiotic strains on the development of eczema (the PandA study)

Background:  Modification of the intestinal microbiota by administration of probiotic bacteria may be a potential approach to prevent allergic disease. We aimed to study primary prevention of allergic disease in high-risk children by pre- and postnatal supplementation of selected probiotic bacteria.
Methods:  In a double-blind, randomized, placebo-controlled trial, a mixture of probiotic bacteria selected by in-vitro experiments ( Bifidobacterium bifidum, Bifidobacterium lactis, and Lactococcus lactis ; Ecologic^® Panda) was prenatally administered to mothers of high-risk children (i.e. positive family history of allergic disease) and to their offspring for the first 12 months of life.
Results:  Parental-reported eczema during the first 3 months of life was significantly lower in the intervention group compared with placebo, 6/50 vs 15/52 ( P  = 0.035). After 3 months, the incidence of eczema was similar in both groups. Cumulative incidence of parental-reported eczema at 1 and 2 years was 23/50 (intervention) vs 31/48 (placebo) and 27 (intervention) vs 34 (placebo), respectively. The number needed to treat was 5.9 at age 3 and 12 months and 6.7 at age 2 years. The intervention group was significantly more frequently colonized with higher numbers of Lc. lactis. Furthermore, at age 3 months, in vitro production of IL-5 (146 pg/ml vs 72 pg/ml; P  = 0.04) was decreased in the probiotic-group compared with the placebo-group.
Conclusions:  This particular combination of probiotic bacteria shows a preventive effect on the incidence of eczema in high-risk children, which seems to be sustained during the first 2 years of life. In addition to previous studies, the preventive effect appears to be established within the first 3 months of life.     

Family history and risk of atopic dermatitis in children up to 4 years

BACKGROUND: The aetiology of atopic dermatitis (AD) is presumably multi-factorial, with interactions between genetic and environmental factors. OBJECTIVE: To investigate the relation between atopic family history and development of AD up to 4 years. METHODS: Using annual questionnaires, we studied the cumulative incidence of AD in 0-4-year-olds in a prospective birth cohort of 4089. Atopic diseases in parents and siblings were recorded at birth. The occurrence of serum immunoglobulin E (IgE) antibodies to inhalant and food allergens was analysed in 2614 4-year-olds, and AD was divided into non-IgE-associated and IgE-associated. RESULTS: Of the children without atopic parents, 27.1% developed AD; of those with single or double parental atopic history, 37.9% and 50.0%, respectively, did so. The effects of parental history of eczema and of atopic respiratory disease (ARD) did not differ significantly, nor did those of maternal and paternal history. Parental history of ARD increased the risk significantly more for IgE-associated AD than for non-IgE-associated AD (odds ratio (OR) 2.0; 95% confidence interval (CI) 1.5-2.8 vs. OR 1.3; 95% CI 1.0-1.8), whereas the two forms lacked major differences in the effect of parental eczema. A history of eczema in older siblings was a risk indicator for both forms of AD (OR 2.1; 95% CI 1.4-3.3 vs. OR 1.8; 95% CI 1.2-2.6). CONCLUSIONS: We found no difference between the effects of maternal and paternal atopic history. Parental eczema was a risk factor for AD irrespective of its association with IgE, but parental history of ARD mainly increased the risk of IgE-associated AD.     

Recovery of lordotic activity by dorsal deafferentation of the preoptic area in male and androgenized female rats

Lordotic activity was examined in male and neonatally androgenized female rats following dorsal deafferentation of the preoptic area (POA). Female pups were injected with various doses (100, 250, 500, or 1000 micrograms) of testosterone propionate (TP) on day 3 postpartum. Ten weeks after birth, all animals were castrated, then half of the castrated males and females in each group were subjected to dorsal deafferentation of the POA (anterior roof deafferentation: ARD) by using an L-shaped Halász knife in order to transect the dorsal forebrain efferents which are thought to exert an inhibitory influence on the lordosis mediating mechanism. Animals were implanted subcutaneously with Silastic tubes containing estradiol-17 beta (E2). Observations of lordosis behavior were carried out 5, 10, and 15 days after implantation of E2. Three to six hours before each behavioral test, all rats were injected with 0.5 mg progesterone. Regardless of the dose of TP given neonatally, androgenized females, as well as males, showed low levels of lordotic behavior. In contrast, males with ARD and androgenized females with ARD displayed lordosis more frequently than males without ARD, and androgenized females without ARD. Lordotic activity in the androgenized females with ARD was negatively correlated with the dose of TP given neonatally. The ARD females injected with a large dose (1000 micrograms) of TP neonatally were significantly less receptive than those injected with lower doses of TP and ARD males. These results suggest that a large dose of neonatal TP may cause permanent changes in not only the neural substrates for lordosis inhibition affected by ARD but also other structures involved in lordosis facilitation.     

Role of Abelcet in children with febrile neutropenia

AIM OF STUDY: In order to optimise the use of new forms of Amphotericine B (Ampho B), a decisional tree was created at the end of 2001 in the paediatric hemato-oncology unit for the empirical antifungal treatment in febrile neutropenic children: the standard remained conventional Ampho B and Abelcet was proposed in case of antecedent or occurrence of a deterioration of the renal function (DRF). In order to validate the place of Abelcet we initiated a retrospective study over year 2002. RESULTS: 21 treatments were begun in 14 children for a median duration of 8 days (1-48 days). Three kind of indications were found: DRF antecedent (10 episodes: A group), DRF occurrence during a treatment with conventional Ampho B (7 episodes: B group), age lower than 1 year (3 episodes). 81% of the children were thus treated according to the decisional tree. The clinical tolerance was good in 90% of the cases, with a premedication in half of the cases. The study of the renal function showed a good renal tolerance for 6 episodes out of 9 evaluable in A group, 3 resolutions and 2 stabilisation of the renal failure for the 5 evaluable episodes of the B group. Seven to ten days of treatment by Abelcet were necessary to obtain the renal failure resolved. CONCLUSION: This study confirms the interest of Abelcet in the empirical antifungal treatment in febrile neutropenic children and specially in children having antecedents of DRF related or not to a treatment with conventional Ampho B.     

Incidence and recurrence of acute otitis media in Taiwan's pediatric population

OBJECTIVE:

To report the incidence and recurrence of acute otitis media (AOM) in Taiwan''s pediatric population.

METHODS:

Information from children (aged< = 12 years) with a diagnosis of AOM was retrieved from the 2006 National Healthcare Insurance claims database. We calculated the cumulative incidence rate and the incidence density rate of recurrent AOM within one year after the initial diagnosis in 2006. We used a multivariate logistic regression model to assess the predictors for recurrence of AOM.

RESULTS:

The annual incidence rate of AOM was estimated to be 64.5 cases per 1,000 children. The overall one-year cumulative incidence rate of recurrence was 33.1%, and the incidence density rate was 33.5 cases per 100 person-years, with the highest figure (41.2 cases per 100 person-years) noted for children aged 0-2 years. Recurrence was significantly associated with age, gender, place of treatment, and physician specialty.

CONCLUSION:

AOM remains a major threat to children''s health in Taiwan. Male children and very young children require more aggressive preventive strategies to reduce the risk of recurrence.     

抗CD3单克隆抗体在预防肾移植术后急性排斥反应中的作用

目的 :观察抗CD3单克隆抗体在预防肾移植术后急性排斥反应的作用。方法 :16 4例肾移植患者分为两组 ,4 2例移植术后应用抗CD3单克隆抗体 (5mg d)为治疗组 ;其它 12 2例为对照组。观察移植术后人 肾存活率、急性排斥反应及CMV感染的发生率。结果 :治疗组 1年、2年及 3年人存活率与对照组无显著差异 ,而治疗组移植肾存活率明显高于对照组(P <0 0 5 )。治疗组急性排斥反应发生率 (18 6 % )比对照组 (2 8 7% )低 ,P <0 0 5 ,且首次急性排斥反应发生时间明显延长 ,对MP冲击治疗效果好。治疗组CMV感染的发生率 (33 3% )高于对照组 ,P <0 0 5。结论 :肾移植术后预防性使用抗CD3单克隆抗体对提高移植肾存活率 ,降低急性排斥反应发生率有较好的作用 ;用药期间应注意预防及治疗CMV感染。     

常住北京市城区少儿血清维生素A和25-羟基维生素D水平分析

目的:检测北京市城区少儿冬季血清维生素A(VA)和25-羟基维生素D(25-OH VD)水平,分析营养状况。方法:2012年12月至2013年2月本院儿童保健门诊体检的0-14岁少儿292例,按年龄分为0-1岁、2-3岁、4-6岁和7-14岁四组,完成问卷调查和体格检查后,采用高效液相色谱法测定每例少儿血清VA水平,采用高效液相质谱串联法测定每例少儿血清25-OH VD水平,分析各年龄组VA、25-OH VD水平差异及每组低水平VA、25-OH VD检出率。结果:(1)292例少儿血清VA平均水平为(1.09±0.29)μmol/L,不同年龄组VA水平有显著性差异(F=10.96,P0.01),以0-1岁组最低(0.9±0.31)μmol/L;所有受检少儿低水平VA检出率为43.84%(128/292),不同年龄组低水平VA检出率有显著性差异(χ2=34.74,P0.01),0-1岁组检出率最高(76.32%)。(2)292例少儿血清25-OH VD平均水平(22.12±8.51)ng/ml,不同年龄组水平有显著性差异(F=7.56,P0.01),7-14岁组最低(18.34±6.34)ng/ml;所有受检者中低水平25-OH VD检出率为80.17%(233/292),不同年龄组低水平25-OH VD检出率有显著性差异(χ2=13.79,P0.05),4-6岁组最高(87.05%)。结论:冬季,常住北京市城区0-1岁幼儿的VA最低,7-14岁的25-OH VD最低,值得关注。     

One-year endometrial safety evaluation of a continuous combined transdermal matrix patch delivering low-dose estradiol-norethisterone acetate in postmenopausal women

OBJECTIVE: To evaluate the safety and endometrial protection of low-dose transdermal estradiol (E2)/norethisterone acetate (NETA) patches (Estalis 25/125) in terms of post-treatment incidence of endometrial hyperplasia/cancer after 1 year of treatment in postmenopausal women with intact uteri. METHODS: Patients were randomized to receive either transdermal E2/NETA (delivering daily doses of E2 25 microg and NETA 125 microg; applied every 3-4 days) or oral E2/NETA (E2 1mg and NETA 0.5 mg; given daily) in this open-label study. The primary variable was the incidence of endometrial hyperplasia/cancer based on endometrial biopsies; secondary variables included vaginal bleeding/spotting patterns, patch adhesion, safety and tolerability. RESULTS: Six hundred and seventy-seven patients were randomized (507 in the transdermal group and 169 in the oral group; one did not receive study drug) and >80% completed the study. There were no cases of endometrial hyperplasia or cancer in either group and the upper limit of the one-sided 95% confidence interval in the transdermal group was 0.85%. Over time, both treatments were associated with a decreasing frequency of spotting/bleeding days. The overall incidence of adverse events (AEs) was comparable in both groups, and the majority was mild-to-moderate in intensity. Breast tenderness was the most frequently reported AE (transdermal 19.9% versus oral 28.4%). AEs related to the gastrointestinal system were more frequent with oral E2/NETA, and episodes of spotting and bleeding were more frequent with transdermal E2/NETA. Local skin tolerability of the transdermal matrix system was good. CONCLUSIONS: Transdermal E2/NETA (25 and 125 microg) provided adequate endometrial protection in postmenopausal women when evaluated according to CPMP/CHMP criteria, achieved a high rate of amenorrhea, and was well tolerated.     

Incidence and outcome of bacterial and fungal infections following nonmyeloablative compared with myeloablative allogeneic hematopoietic stem cell transplantation: a matched control study.

Infections contribute significantly to morbidity and mortality after myeloablative allogeneic hematopoietic stem cell transplantation (HSCT). Whether recipients of nonmyeloablative HSCT have different posttransplantation infection risk was unknown. We therefore analyzed the incidence and risk of bacteremia during the first 100 days and of fungal infection during the first 365 days posttransplantation for 56 consecutive patients with hematological malignant disease who received nonmyeloablative HSCT (case patients). We compared the results with those among 112 control patients who received conventional myeloablative HSCT during the same years (January 1997-April 2000). Control patients were matched (2:1) for cytomegalovirus (CMV) risk group, HSC source, donor type, age, and underlying disease. Most donors (93%) were HLA-matched and related. Case patients had shorter periods of neutropenia (absolute neutrophil count, <100/mm3) than did control patients (median, 0 days; range, 0-11 versus 9 days; range, 4-25; P < .0001). This finding was associated with fewer episodes of bacteremia during the first 30 days (9% versus 27%; P = .01) and a trend to fewer episodes of bacteremia during the first 100 days posttransplantation (27% versus 41%, P = .07). Overall survival was significantly improved in case patients compared with control patients (day 100, 93% versus 81%; P = .04). During the first year posttransplantation, invasive aspergillosis occurred at a similar rate (case patients, 15%; control patients, 9%; P value not significant). Multivariate risk factor analyses identified neutropenia and CMV disease as the major factors associated with bacteremia and aspergillosis, respectively. We conclude that shorter periods of severe neutropenia in nonmyeloablative HSCT are associated with decreased risk of early bacteremia, although risk of fungal infection late after HSCT persists. This risk is an important consideration for the future development of preventive strategies.     

肌阵挛失神癫痫的临床及神经电生理学研究

目的：提高对肌阵挛失神癫痫（EMA）的认识。方法：收集2005年3月至2011年6月确诊为EMA的患儿5例,对其临床及神经电生理特征进行回顾性分析。结果：5例患儿以2岁零4个月至5岁起病,平均起病年龄4岁。3例以肌阵挛失神（MA）为唯一或主要发作形式,2例以全身强直阵挛发作（GTCS）首发,分别于1年和3年后转变为MA;临床表现为频繁的双侧节律性肌阵挛抽动。EEG＋EMG联合检查可见在EEG双侧同步的3Hz节律性棘慢波放电的同时,同步的EMG记录可见3Hz肌阵挛电活动和逐渐增强的强直性肌肉收缩电位。过度换气试验及闪光刺激均易诱发脑电一临床发作。发作间期EEG均见全导棘慢波,2例双额区尤显。治疗主要为丙戊酸钠单药或联合其他抗癫痫药物,分别随访6个月至4年,5例均有效（4例发作控制,1例仍有些许发作伴学习困难）。结论：EMA是一种以MA为主要发作类型的儿童期癫痫综合征,EMA的诊断主要依赖于临床症状观察和EEG＋EMG记录,早期准确诊断,正确选用抗癫痫药物,有助于远期预后改善。     

Immunoconglutinin response in patients with acute viral respiratory disease

Immunoconglutinin response was studied in military recruits experiencing naturally-acquired acute respiratory disease (ARD) in the course of their training. The study population was divided into a group that experienced clinically the most severe disease (the `ill' category) and a group that had the mildest infections (the `well' category). None of the individuals in the study population were entirely free of illness during the 10-week period of observation. Significant differences in the mean immunoconglutinin titre levels were found between the ill and the well subjects (P<0·01). There was also a significant trend in titre levels during the period of observation for the ill subjects (P<0·01) and no significant trend for the individuals in the well category. The significant curvilinear trend for the ill subjects indicated that for this group a peak titre was reached at about the sixth week of training or approximately 3 weeks following the peak incidence of the acute illness. It is concluded that immunoconglutinin can be considered as a `convalescent-phase reactant', which could serve as a useful parameter of activity and severity of the disease process.