Upregulation of Immunoglobulin‐related Genes in Cortical Sections from Multiple Sclerosis Patients

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS). Microarray‐based global gene expression profiling is a promising method, used to study potential genes involved in the pathogenesis of the disease. In the present study, we have examined global gene expression in normal‐appearing gray matter and gray matter lesions from the cortex of MS patients, and compared them with cortical gray matter samples from controls. We observed a massive upregulation of immunoglobulin (Ig)‐related genes in cortical sections of MS patients. Using immunohistochemistry, the activation of Ig genes seems to occur within plasma cells in the meninges. As synthesis of oligoclonal IgGs has been hypothesized to be caused by the activation of Epstein–Barr virus (EBV)‐infected B‐cells, we screened the brain samples for the presence of EBV by real‐time quantitative polymerase chain reaction (qPCR) and immunohistochemistry, but no evidence of active or latent EBV infection was detected. This study demonstrates that genes involved in the synthesis of Igs are upregulated in MS patients and that this activation is caused by a small number of meningeal plasma cells that are not infected by EBV. The findings indicate that the Ig‐producing B‐cells found in the cerebrospinal fluid (CSF) of MS patients could have meningeal origin.     

卡介菌多糖核酸治疗小儿咳嗽变异性哮喘

目的：观察卡介菌多糖核酸注射液在小儿咳嗽变异性哮喘治疗应用的疗效。方法：将本科40例咳嗽变异性哮喘患儿，随机分为治疗组和对照组（各20例）。治疗组给予BCG—PSN＋必可酮气雾剂，对照组：给予单用必可酮气雾剂吸入，连续吸入6周，观察疗效，并进行统计学处理。结果：治疗组总有效率为95％，对照组总有效率为70％，统计学处理总有效率有显著差异（P〈O．01）。结论：卡介菌多糖核酸（polysaccharide nucleic acidfraction of BCG，BCG—PSN）能有效地控制咳嗽变异性哮喘（CVA）的呼吸道的反复感染，提高免疫功能；与必可酮配合，能有效地控制CVA的复发。     

Controlled Epstein–Barr virus reactivation after allogeneic transplantation is associated with improved survival

Epstein–Barr virus reactivation (EBV‐R) frequently occurs in patients having allogeneic hematopoietic stem cell transplantation (HSCT). We evaluated the impact of controlled EBV‐R on survival of 190 patients (114M/76F, median age: 51 yr, range 18–69), having HSCT for hematological malignancies (105 acute leukemias and myelodysplasias, 71 lymphoproliferative disorders, 14 others). Overall survival (OS) and progression‐free survival (PFS) were compared between patients with and without EBV‐R. Of 138, patients had reduced‐intensity conditioning regimen. Various stem cell sources (141 PB, 33 umbilical cord blood and 16 bone marrow) were used. Patients with EBV‐R had longer PFS and OS than those without EBV‐R: PFS at 2 yr 69% vs. 51% and at 5 yr 47% vs. 38% (P < 0.04); OS at 2 yr 76% vs. 64% and at 5 yr 63% vs. 47%) (P < 0.001). The use of rituximab had no impact on OS and PFS, but it reduced the intensity of GVHD, despite the fact that TRM was not significantly different between the two groups of patients. So, rituximab may have an additional effect to other factors on PFS and OS. In multivariate analysis, antithymocyte globulin administration was not a significant factor for PFS (P = 0.68) and for OS (P = 0.81). Circulating NK cells were significantly increased by 22% (P = 0.03) in EBV‐R patients with no differences for other parameters. Controlled EBV‐R in the setting of HSCT is associated with better OS and PFS, with a significant increase in circulating NK cells.     

Obstructive sleep apnea (OSA): A complication of acute infectious mononucleosis infection in a child

Independently, obstructive sleep apnea (OSA) and infectious mononucleosis are not uncommon in the pediatric population, but acute onset of OSA, as a respiratory complication in the setting of acute EBV infection is extremely uncommon. Previous reports of this clinical entity are sparse and from nearly two decades ago. Urgent adenotonsillectomy was commonly advocated. This complication may be managed medically with systemic corticosteroids and non-invasive continuous positive airway pressure (CPAP), and a case is presented to highlight an updated management approach to this rarely encountered clinical problem in children.     

Monitoring Infection with Epstein–Barr Virus among Seromismatch Adult Renal Transplant Recipients

Patients who undergo Epstein–Barr virus (EBV) seromismatch (D+/R − ) transplants have a higher risk for the development of post‐transplant lymphoproliferative disorder (PTLD). Adult renal transplant recipients at a single institution were prospectively monitored for EBV during the first year post‐transplant. Over a 2‐year period, 34 patients (7.78%) were identified as being EBV D+/R − recipients. Patients who developed symptoms or had persistent viremia were pre‐emptively administered rituximab. Six recipients were discharged without monitoring on the protocol. Of those six, three (50%) developed PTLD and all three lost their grafts. Twenty (60.6%) of the 34 recipients developed viremia during the first year post‐transplant. Of the recipients who became viremic, six (30%) received rituximab. None of the six who received rituximab‐developed PTLD. We found that recipients who were not monitored on the protocol were more likely to have PTLD and graft loss compared to those who were (p = 0.008). Post‐transplant monitoring of adults who undergo EBV D+/R − kidney transplants for viremia and symptoms associated with EBV infection may prompt intervention which reduces the incidence of PTLD within the first year. Use of rituximab in preventing PTLD among patients with primary EBV infection requires further prospective study to determine its overall safety and efficacy.     

瑞芬太尼联合硝酸甘油控制性降压在鼻内镜手术中的应用

目的比较瑞芬太尼和瑞芬太尼联合硝酸甘油在全麻下鼻内镜手术中控制性降压效果。方法鼻内镜下鼻息肉、鼻窦炎手术病人共40例,ASAⅠ或Ⅱ级,用随机数字表分为瑞芬组和瑞硝组,每组20例,咪达唑仑、丙泊酚、瑞芬太尼和维库溴铵静脉复合全麻气管插管,2组术中均以瑞芬太尼0.1～0.2μg·kg~(-1)·min~(-1)、丙泊酚2～5 mg·kg~(-1)·h~(-1)持续泵输,维库溴铵4 mg·h~(-1),静脉注射。瑞硝组加用硝酸甘油静脉滴注,开始剂量5μg·min~(-1),调节滴速使收缩压维持在12 kPa(90 mmHg)左右。观察降压前(T_0)、降压后5 min(T_1)、30 min(T_2)、60 min(T_3)和停止降压后5 min(T_4)的收缩压和心率,计算心肌氧耗指数,瑞芬太尼、丙泊酚用量,手术时间和病人苏醒时间。结果2组病人年龄、性别和体重间差别无统计学意义(P>0.05)。T_1时2组血压明显下降,与T_0比较,均P<0.01,且瑞硝组降压程度明显大于瑞芬组(P<0.01),降压后的T_1,T_2瑞硝组心率加快,与瑞芬组相比有非常显著意义(P<0.01);降压期的氧耗指数,瑞硝组低于瑞芬组(P<0.05,P<0.01);停止降压后,瑞芬组血压和心率变化与T_3比,无统计学意义(P>0.05),但瑞硝组血压和心率均明显增加(P<0.01);瑞芬组的瑞芬太尼、丙泊酚用量和手术时间明显大于瑞硝组(P<0.01),2组病人的苏醒时间差异无统计学意义(P>0.05)。结论鼻内镜手术瑞芬太尼在常用剂量范围内作控制性降压虽比较平稳,但难以达到目标血压,联合硝酸甘油后效果明显,并可减少麻醉药用量和手术时间,减少病人医疗费用。     

鼻咽癌裸鼠移植瘤及其相应体外细胞株的建立与特性研究

从新鲜鼻咽活检组织建立了一株鼻咽癌（ＮＰＣ）裸鼠移植瘤株（ＳＵＮＴ一１）及其相应的体外传代上皮细胞株（ＳＵＮＥ一１）。证实ＳＵＮＴ一１和ＳＵＮＥ一１为典型低分化鳞癌细胞，染色体分析二者均为人类肿瘤核型。以ＰＣＲ技术检测ＳＵＮＴ一１的Ｐ１～Ｐ１８和ＳＵＮＥ一１直到第６１代培养的细胞中的ＥＢＶ一ＤＮＡ均为阳性。用原位溶细胞电泳技术（Ｉｎｓｉｔｕｌｙｉｎｇｇｅｌ）ＥＢＶ探针Ｓｏｕｔｈｅｒｎｂｌｏｔ分析，亦显示相应的ＥＢＶＤＮＡ区带。ＥＢＶ基因组为线性特征，且在ＳＵＮＴ一１Ｐ１８和ＳＵＮＥ一１Ｐ５３细胞的电镜检查中均发现直径为９６一１００ｎｍ的ＥＢＶ样颗粒。用不对称ＰＣＲ一ＳＳＣＰ检测，显示有Ｐ５３第８外显子突变。带ＥＢＶ基因的ＮＰＣ瘤株及相应的上皮细胞株建立，为从分子水平、细胞水平上研究肿瘤的发生发展过程，以及治疗等方面提供了丰富的和更切合人体肿瘤的材料和模型。     

Glycoglycerolipid analogues active as anti-tumor-promoters: the influence of the anomeric configuration

The in vitro anti-tumor promoting effect of monohexanoates of 2-O-alpha-D-gluco- and galactopyranosyl-sn-glycerol on the 12-O-tetradecanoylphorbol-13-acetate (TPA) induced Epstein-Barr virus early antigen (EBV-EA) activation was evaluated and compared to the potencies of the corresponding beta-anomers. The results show that the inversion of the anomeric configuration from beta to alpha does not seem to significantly influence the activity, which is present, as for the beta-anomers, even at 1x10 mol ratio without any cytotoxicity.     

复方中药对EB病毒DNA的降解及放射增敏作用机理的研究

本介绍了以EB病毒DNA作为放射线的靶分子及中药的作用底物，用PCR法研究中药对EB病毒DNA分子的作用及对放射线的影响，结果表明，本实验所用的复方中药对EB病毒DNA分子有明显的降解作用，同时尚有放射增敏作用。我们以为中药可能直接作用于DNA分子的结合蛋白而使其降解，并通过同一方式而产生放射增敏作用。同时,用DNA作为靶分子及用PCR方法研究中药及射线对靶分子的影响，不失为一种直观、灵敏而准确的新的研究方法。     

Pediatric lymphocytic interstitial pneumonitis in an HIV-negative child with pulmonary Epstein-Barr virus infection

Lymphocytic interstitial pneumonitis (LIP) in children has been most commonly associated with human immunodeficiency virus (HIV) infection. Epstein-Barr virus (EBV) associated LIP without HIV infection has been reported only in adults. EBV associated LIP has been reported in children, but only with concurrent HIV infection. We report a case of EBV associated, HIV negative LIP in a child.