Bullous pemphigoid associated with acquired hemophilia A: A case report

BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated with autoimmune diseases,cancers, medication use, pregnancy, and the post-partum period. Bullous pemphigoid(BP) is a chronic autoimmune subepidermal blistering disease associatedwith tissue-bound and circulating autoantibodies against BP antigens 180 (BP180)and 230 (BP230). AHA-associated BP has a high mortality rate;hence, the understandingof this disease must improve.CASE SUMMARY A 69-year-old man presented with erythema, blisters, blood blisters, and crustsaccompanied by severe pruritus for more than 20 days, and ecchymosis andswelling on his left upper arm for 3 days. Pathological examination revealed asubepidermal blister that contained eosinophils. Laboratory tests showed that theBP180 autoantibody levels had increased, isolated activated partial thromboplastintime was notably prolonged (115.6 s), and coagulation FⅧ activity wasextremely low (< 1.0%). Furthermore, the FⅧ inhibitor titer had greatlyincreased (59.2 Bethesda units). Therefore, the patient was diagnosed as having BP associated with AHA, prescribed 0.05% topical halometasone cream, and transferred to a higher-level hospitalfor effective treatment;however, he died after 2 days.CONCLUSION AHA associated BP is rare, dangerous, and has a high mortality rate. Therefore, its timely diagnosis and effectivetreatment are necessary.

Magnetic resonance imaging of extraocular rectus muscles abnormalities in acute acquired concomitant esotropia

AIM:To investigate the difference of medial rectus(MR)and lateral rectus(LR)between acute acquired concomitant esotropia(AACE)and the healthy controls(HCs)detected by magnetic resonance imaging(MRI).METHODS:A case-control study.Eighteen subjects with AACE and eighteen HCs were enrolled.MRI scanning data were conducted in target-controlled central gaze with a 3-Tesla magnetic resonance scanner.Extraocular muscles(EOMs)were scanned in contiguous image planes 2-mm thick spanning the EOM origins to the globe equator.To form posterior partial volumes(PPVs),the LR and MR cross-sections in the image planes 8,10,12,and 14 mm posterior to the globe were summed and multiplied by the 2-mm slice thickness.The data were classified according to the right eye,left eye,dominant eye,and non-dominant eye,and the differences in mean cross-sectional area,maximum cross-sectional area,and PPVs of the MR and LR muscle in the AACE group and HCs group were compared under the above classifications respectively.RESULTS:There were no significant differences between the two groups of demographic characteristics.The mean cross-sectional area of the LR muscle was significantly greater in the AACE group than that in the HCs group in the non-dominant eyes(P=0.028).The maximum cross-sectional area of the LR muscle both in the dominant and non-dominant eye of the AACE group was significantly greater than the HCs group(P=0.009,P=0.016).For the dominant eye,the PPVs of the LR muscle were significantly greater in the AACE than that in the HCs group(P=0.013),but not in the MR muscle(P=0.698).CONCLUSION:The size and volume of muscles dominant eyes of AACE subjects change significantly to overcome binocular diplopia.The LR muscle become larger to compensate for the enhanced convergence in the AACE.

Knowledge of Hospital Acquired Infections (HAIs) among Medical Students in a Tertiary Hospital in Jos North Local Government Area, Plateau State, Nigeria

Background: Hospital Acquired Infections (HAIs) remain a common cause of death, functional disability, emotional suffering and economic burden among hospitalized patients. Knowledge of HAIs is important in its prevention and control. This study seeks to assess the knowledge of Hospital Acquired Infections (HAIs) among medical students in a Tertiary Hospital in Jos North Local Government Area, Plateau State, Nigeria. Methods: This was a descriptive cross-sectional study done in October 2019 among clinical medical students using a Multistage sampling technique. Data was collected using a self-administered structured questionnaire and analyzed using the IBM SPSS 20 (Statistical Package for the Social Sciences). Ethical approval was granted by Bingham University Teaching Hospital, Ethics Committee, Jos, Plateau State. Results: A total of 219 students in the clinical arm of the College of Medicine and Health Sciences were selected. A higher proportion (97.7%) of respondents knew about Hospital Acquired Infections and 85.4% knew that Hospital Acquired infections occur in the hospital, and (86.3%) considered patients contagious with half (58.9%) considered patients as the most important source of HAIs, followed by care givers (13.2%), then doctors including medical students and interns (10.0%) and lastly nurses (8.7%). The majority of respondents (70.8%) considered Surgical Wound Infections to be the most commonly occurring HAI, followed by UTIs (69.9%), RTIs (61.2%), BSIs (37.0%) and others (0.9%). The clinical thermometer was the instrument that most commonly transmits HAIs (82.6%), then followed by stethoscope (62.1%), white coats (53.9%), and blood pressure cuff (51.1%). Most respondents knew the infectious substances, like blood (96.3%), nasal discharge (82.6%), saliva (85.3%), and faeces (79.4%) transmitted HAIs, 72.6% of the respondents said that they were aware of the recommended hand washing techniques by WHO. Conclusion: The majority of students 91.3% had good knowledge while 8.7% had poor knowledge of HAIs. Lower classes had more respondents with poor knowledge. This finding was statistically significant (p = 0.002, Chi-square 12.819). Students are encouraged to keep up the level of knowledge they have about HAIs. These students can help improve the knowledge of those whose knowledge level is low. Government and NGOs should support sponsorship for capacity-building events targeted at HAIs for healthcare workers and medical students.

Botulinum toxin type A in treating early-stage patients with small-angle acute acquired comitant esotropia

AIM:To investigate botulinum toxin A(BTXA)efficacy on small-angle(≤25Δ)acute acquired concomitant esotropia(AACE)in early-stage patients.METHODS:The electronic medical record data of AACE patients during March 2019 and June 2023 were collected in this retrospective and hospital-based cohort study.A total of 72 small-angle AACE patients received BTXA extraocular muscle injection.Patients were grouped by onset-to-treatment time(Group A:≤6mo,Group B:>6mo).Deviation of esotropia,eye alignment and stereopsis were analyzed at the period of pre/post-injection(1wk,1,3,and 6mo).Orthophoria rate at 6mo(horizontal deviation<10Δand binocular single vision)were considered as outcome index.RESULTS:There were no significant baseline differences(P>0.05)between two groups except onset-to-treatment time(2mo vs 11mo,P<0.001).Higher orthophoria rates were in Group A at last follow-up(94.74%vs 73.53%,P=0.013).Post-BTXA deviations of two groups at 1mo showed no difference(P>0.05);while in 3 and 6mo Group A was significantly smaller than group B(all P<0.001).No statistically significant differences were observed among all post-BTXA deviations of near and distance in Group A.In Group B,deviation at 3mo(near:2Δvs 0,P<0.001;distance:4Δvs 0,P<0.001)and 6mo(near:6Δvs 0,P<0.001;distance:6Δvs 0,P<0.001)was significant increased compared to deviation at 1wk after treatment.Group A showed better stereopsis recovery in last follow-up compared to Group B(80″vs 200″,P=0.002).Both groups obtained improved stereopsis after treatment(Group A:80″vs 300″,P<0.001;Group B:200″vs 300″,P=0.037).CONCLUSION:BTXA is effective for AACE with small deviation(≤25Δ)in early stage.Delayed treatment(>6mo)may reduce BTXA efficacy.Early BTXA intervention benefits long-term eye alignment and stereopsis recovery.

Neuropsychological Profile of a Patient with Acquired Brain Damage Following Vascular Lesion of the Left Anterior Cingulate Cortex

Stroke is a physiological alteration associated with changes in blood flow that can result in sudden-onset cognitive impairment. It has a heterogenous clinical presentation with varying degrees of severity correlated with specific central nervous system zones or areas, and its prognosis is uncertain. This case study describes a 62-year-old male patient with acquired brain damage of the anterior cingulate cortex as a result of an ischemic event in the territory of the left anterior cerebral artery. Cognitive function was assessed using the neuropsychological executive function and frontal lobe test battery (BANFE-2) as well as other neuropsychological tests. The results show a profile of higher mental functions characterized by the presence of dysexecutive syndrome with marked behavioral alteration and diencephalic amnesia. .

Systemic acquired resistance, NPR1, and pathogenesis-related genes in wheat and barley

In Arabidopsis, systemic acquired resistance （SAR） is established beyond the initial infection by a pathogen or is directly induced by treatment with salicylic acid （SA） or its functional analogs, 2,6-dichloroisonicotinic acid （INA） and benzothiadiazole （BTH）. NPR1 protein is considered the master regulator of SAR in both SA signal sensing and transduction. In wheat （Triticum aesfivum） and barley （Hordeum vulgare）, both pathogen infection and BTH treatment can induce broad-spectrum resistance to various diseases, including powdery mildew, leaf rust, Fusarium head blight, etc. However, three different types of SAR-like responses including acquired resistance （AR）, systemic immunity （SI）, and BTH-induced resistance （BIR） seem to be achieved by activating different gene pathways. Recent research on wheat and barley NPR1 homologs in AR and SI has provided the initial clue for understanding the mechanism of SAR in these two plant species. In this review, the specific features ofAR, Si, and BIR in wheat and barley were summarized and compared with that of SAR in model plants of Arabidopsis and rice. Research updates on downstream genes of SAR, including pathogenesis-related （PR） and BTH-induced genes, were highlighted.

Efficacy and Safety of Intravenous Moxifloxacin Versus Cefoperazone with Azithromycin in the Treatment of Community Acquired Pneumonia

Summary： To compare the efficacy, safety, and tolerability of intravenous moxifloxacin with those of a commonly used empirical antibiotic regimen, cefoperazone and azithromycin in the treatment of community acquired pneumonia （CAP） in adult patients requiring initial parenteral therapy, 40 patients with CAP were divided into two groups, a moxifloxacin group （n=20） and a control group （n=20）, which were treated for 7 to 14 days. The patients in the moxifloxacin group were intravenously given 400 mg of moxifloxacin （AveloxR） once a day. Patients in the control group were administered 2.0 g of cefoperazone twice a day and azithromycin 0.5 g once a day. Clinical, bacteriological, and laboratory examinations were performed before the treatment, and at the end of the treatment. Our results showed that there was no significant difference in the clinical efficacy rate between two treatment groups at end of therapy （90 % for moxifloxacin, 95 % for cefoperazone plus azithromycin） （P〉0.05）. The bacteriologic eradication rate at the end of treatment was 90 % in the moxifloxacin group and 80 % in the cefoperazone-plus-azithromycin group, whereas there was no significant difference between the two groups （P〉0.05）. In addition, both drugs were well-tolerated in this trial, with the number of drug-related adverse events being comparable. It is concluded that moxifloxacin is an effective and well-tolerated treatment for CAP and was equivalent to the com- monly used empirical treatment of cefoperazone plus azithromycin. Moxifloxacin is likely to offer clinicians an alternative for reliable empirical CAP treatment in the face of increasing antibiotic resistance.

Clinical efflcacy of botulinum toxin type A on acute acquired comitant esotropia

AIM: To investigate the effects of micro-injection of botulinum toxin A(BTXA) on acute acquired comitant esotropia(AACE). METHODS: A total of 33 AACE patients who underwent BTXA micro-injection at Renmin Hospital of Wuhan University from September 1^(st), 2019 to July 1^(st), 2021 were retrospective analyzed. Esotropia, eye alignment, stereopsis, and complications were examined at baseline(except complications), 1wk, 1, 3, and 6mo after injection. RESULTS: The average angle of deviation before injection was(+20.24±6.80)^(Δ) at near and(+24.76±6.43)^(Δ) at distance, while(+5.15±5.85)^(Δ) at near and(+7.30±6.17)^(Δ) at distance 6mo after treatment(P<0.05). Six months after injection, the stereopsis of patients had improved. The number of patients having no stereopsis(>800 seconds of arc) decreased from 11 to 3. The number of patients having peripheral stereopsis(300-800 seconds of arc), macular stereopsis(70-200 seconds of arc) and central concave stereopsis(≤60 seconds of arc) increased from 10 to 11, 10 to 12, and 2 to 7, respectively. At the follow-ups at 1wk, 1, 3, and 6mo after injection, success rates were 96.97%, 96.97%, 93.94% and 87.88%, respectively. One week after injection, two patients(6.07%) showed subconjunctival hemorrhage;three patients(9.09%) showed limited eye movement and one patient(3.03%) showed mild vertical strabismus. All the symptoms disappeared by the final follow-up.CONCLUSION: Micro-injection of BTXA can reduce diplopia and improve binocular vision function of AACE patients. Furthermore, the operation is relatively safe with few complications, making it an ideal treatment modality for AACE.

Systemic Acquired Resistance and Signal Transduction in Plant

Systemic acquired resistance (SAR), known as the broad-spectrum, inducible plant immunity, is a defense response triggered by pathogen infection. The response starts from the recognition of plant resistance (R) with the corresponding avirulence (avr) gene from the pathogen. There are some genes for convergence of signals downstream of different R/avr interacting partners into a single signaling pathway. Salicylic acid (SA) is required for the induction of SAR and involved in transducing the signal in target tissues. The SA signal is transduced through NPR1, a nuclear-localized protein that interacts with transcription factors that are involved in regulating SA-mediated gene expression. Some chemicals that mimic natural signaling compounds can also activate SAR. The application of biochemical activators to agriculture for plant protection is a novel idea for developing green chemical pesticide.

Analysis of independent risk factors for acute acquired comitant esotropia

comitant esotropia(AACE).METHODS:A retrospective cohort study was conducted by analyzing 83 patients(case group)with AACE who underwent strabismus correction surgery from January 1,2021 to June 30,2022.Totally 73 outpatient volunteers were recruited during the same period as the normal control group.The case group’s binocular vision time,near and distance esotropia angle,and near stereo vision function were recorded,and the age,gender,refractive status,and best-corrected visual acuity(BCVA)of both groups were analyzed.Additionally,multiple logistic regression analysis was conducted using an eye usage condition questionnaire to determine the independent risk factors for AACE.RESULTS:In the case group,61 patients(73.49%)had myopia,with a mean equivalent spherical power(SE)of-3.35±3.31 D(range:+2.75 to-10.62 D)of the right eye and-2.87±3.35 D(range:+2.75 to-11.12 D)of the left eye.The average duration of diplopia in the case group was 29.83±35.72mo,of which 80 patients(96.39%)were primarily with distance diplopia.The near and distance esotropia angle after wearing glasses were 52.36±20.95 prism degree(PD)and 56.71±19.54 PD,respectively,and there was no statistically significant difference between the two(t=1.38,P=0.169).The incidence of improper glasses wearing and unhealthy eye habits in the case group was significantly higher than those in the control group(P<0.05).Close-up work without glasses[β=2.30,odds ratio(OR)=10,95%confidence interval(CI)2.35-42.51,P=0.002]and near work in supine position(β=1.80,OR=6.02,95%CI 3.29-11.02,P<0.001)were independent risk factors for AACE.CONCLUSION:Patients with AACE mainly present with distance diplopia,and there is a high degree of variation in myopia.Near work without wearing glasses and in supine position are independent risk factors for AACE.

Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh

Nosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities such as isolation units, bed space, and sinks;inadequate waste management, contaminated equipment, inappropriate use of antibiotics and transmission of infection from the hands of healthcare workers and family caretakers due to inadequate hand washing. Nosocomial infections increase the costs of healthcare due to added antimicrobial treatment and prolonged hospitalization. Since the prevalence of nosocomial infections is generally higher in developing countries with limited resources, the socio-economic burden is even more severe in these countries. This review summarizes the current knowledge on the risks of hospital acquired infections and summarizes current recommendations for the development of hospital infrastructure and the institution of protocols to reduce these infections in LMICs such as Bangladesh.

Pseudomonas aeruginosa Community Acquired Pneumonia with Septicemia in a Previously Healthy Woman

A previously healthy 53-year-old woman was urgently hospitalized due to septic shock. She was diagnosed with bacterial pneumonia based on chest radiograph and computed tomography findings of right upper lobe consolidation. Sputum Gramstain at the time of admission showed gram-negative rods with phagocytosis. Intravenous meropenem was immediately initiated as empiric antibacterial therapy. Bacterial culture specimens from sputum and blood were positive for Pseudomonas aeruginosa. Following appropriate antibiotic therapies, the patient recovered from a shock state and gradually became well. There has been no evidence of recurrence at 6 months after discharge. P. aeruginosa community acquired pneumonia with septicemia is rapidly progressive and often fatal. The choice of initial empiric antibiotic treatment that is active against P. aeruginosa is critical in improving outcome.

Study on inflammatory factors and curative effect of Rhizoma Imperata on community acquired pneumonia based on TLR4/NF-κB signaling pathway

Objective:To investigate the curative effect of Rhizoma Imperata in the treatment of patients with community-acquired pneumonia and its influence on inflammatory factors related to TLR4/NF-κB signaling pathway,so as to seek new drugs for the treatment of community-acquired pneumonia.Methods:120 patients with community-acquired pneumonia who were treated in Department of respiratory medicine,the First Affiliated Hospital of Hainan Medical College from November 2019 to September 2020 were collected and randomly divided into control group and experimental group,with 60 patients in each group.The control group was given cefuroxime sodium injection,and the experimental group was given cefuroxime sodium injection+Baimao root decoction.The levels of high-sensitivity C-reactive protein(CRP)and the level of serum CRP in the two groups before and after treatment were compared Objective To observe the expression of procalcitonin(PCT),IL-6,IL-8,TNF-αand TLR4/NF-κB mRNA levels,and to observe the effect of Radix Imperata Rubra on community-acquired pneumonia.Results:The fever,cough,expectoration subsided time and chest CT inflammation absorption time of the experimental group were shorter than those of the control group,the difference was statistically significant(P<0.05);the total effective rate of the experimental group(96.67%)was higher than that of the control group(85%),the difference was statistically significant(P<0.05);after treatment,the serum CRP,PCT,IL-6,IL-8,TNF-αin the two groups were lower than before,and the experimental group was significantly lower than the control group,the difference was statistically significant(P<0.05),There was statistical significance(P<0.05);after treatment,TLR4/NF-κB mRNA of the two groups were decreased,and the experimental group was significantly lower than the control group,the difference was statistically significant(P<0.05).Conclusion:In the treatment of cap,Rhizoma Imperata can reduce the levels of CRP,PCT,IL-6,IL-8 and TNF-α.The mechanism is related to inhibiting the activation of TLR4/NF-κB signaling pathway,so as to reduce the release of inflammatory factors and improve clinical symptoms.

Effect of Elephantopus scaber Linn on community acquired pneumonia through TLR4/NF-κB signaling pathway

Objective:To observe the effect of Elephantopus scaber Linn on community-acquired pneumonia and its relationship with the expression of TLR4/NF-κB pathway and the downstream inflammatory cytokines IL-6,IL-8,TNF-α.and to explore its molecular mechanism for the treatment of community-acquired pneumonia,so as to provide new ideas and theoretical basis for the treatment of community-acquired pneumonia.Methods:140 patients with community-acquired pneumonia were randomly divided into observation group and control group,with 70 cases in each group.Observation group:Elephantopus scaber Linn+NS atomized inhalation+intravenous injection of ceftazidine;Control group:intravenous injection of ceftazidine;Meanwhile,70 healthy subjects were selected as the healthy control group.The expressions of TLR4,NF-kB,IL-6,IL-8 and TNF-αin serum of observation group,control group before and after treatment and healthy control group were detected by enzyme linked immunosorbent assay(ELISA),and the efficacy of Elephantopus scaber Linn in the treatment of community acquired pneumonia was observed.Results:Compared with the control group,the observation group was significantly better than the control group in recovery rate,total effective rate,number of days for the disappearance of symptoms such as fever,cough,expectoration,with statistical significance(P<0.05);Compared with the healthy control group,the serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere significantly different(P<0.05)between the observation group and the control group;Serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere significantly different(P<0.05)in the observation group before and after treatment with Elephantopus scaber Linn;Compared with the control group after treatment,there were significantly different(P<0.05)in serum TLR4,NF-κB,IL-6,IL-8 and TNF-αin the observation group after treatment.Conclusion:Serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere highly expressed in patients with community-acquired pneumonia,Elephantopus scaber Linn can decreased the expression of TLR4 and NF-κB in blood,and its downstream inflammatory factors also decreased significantly.There were significantly different(P<0.05)in blood TLR4 and NF-κB between the observation group and the control group after treatment.It is suggested that Elephantopus scaber Linn may inhibit TLR4/NF-kB signal pathway to exert anti-inflammatory effect.Elephantopus scaber Linn has a definite effect and can significantly improve the clinical symptoms,and effectively shorten the treatment cycle.

Acute acquired concomitant esotropia with congenital paralytic strabismus:A case report

BACKGROUND An unusual case of acute acquired concomitant esotropia(AACE)with congenital paralytic strabismus in the right eye is reported.CASE SUMMARY A 23-year-old woman presented with complaints of binocular diplopia and esotropia of the right eye lasting 4 years and head tilt to the left since 1 year after birth.The Bielschowsky head tilt test showed right hypertropia on a right head tilt.She did not report any other intracranial pathology.A diagnosis of AACE and right congenital paralytic strabismus was made.Then,she underwent medial rectus muscle recession and lateral rectus muscle resection combined with inferior oblique muscle myectomy in the right eye.One day after surgery,the patient reported that she had no diplopia at either distance or near fixation and was found to be orthophoric in the primary position;furthermore,her head posture immediately and markedly improved.CONCLUSION In future clinical work,in cases of AACE combined with other types of strabismus,we can perform conventional single surgery for both at the same time,and the two types of strabismus can be solved simultaneously.

NavInfo Acquired Holland’s Mapscape for ＄9.35 million

Beijing NavInfo Science and Technology Co.,Ltd.(NavInfo) fully acquired Mapscape in Nether-lands for 61.64 million RMB (＄9.35 million

Management and Outcome of Pregnant Women with HIV Acquired by Vertical Transmission

The majority of children with perinatally acquired human immunodeficiency virus (HIV) do not survive beyond childhood but this is changing due to the benefit of antiretroviral therapy for the perinatally infected cohort, so affected children are now approaching the age to be mothers. The aim of this article is to evaluate the outcomes of pregnant women with HIV acquired by vertical transmission in our centre and encourage the results obtained in “Thirty Years Later: Pregnancies in Female Perinatally Infected with Human Immunodeficiency Virus-1”, a review article published in this journal in 2012 [2]. We report 6 patients with eight pregnancies with HIV acquired by vertical transmission. They delivered a total of nine newborns between 2004 and 2013. In any case, mother-to-child transmission was reported. The management of pregnant women with HIV acquired by vertical transmission is complicated, since the patients are the most of the cases young and the compliance to the treatment may be poor. The prematurity was the more frequent complication and the cesarean section was the more frequent form of ending. In our case series, mother-to-child transmission was absent.

Remarkable achievements in rice breeding was acquired in the China's “Eighth Five-year plan”

During the China’"Eighth Five-year Plan", the Chinese rice breeders developed hundreds of new rice varieties(combinations) which have higher yield, better rice quality or higher resistance. Among them, 83 new varieties (combinations) were released in the national or provincial levels. In addition, many new germplasms and excellence breeding materials were obtained which is rery useful for the rice breeding in the future.

Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome

AIM：To compare the clinical manifestation of cytomegalovirus（CMV）retinitis and microvascular retinopathy（MVR）in patients with acquired immunodeficiency syndrome（AIDS）in China.METHODS：A total of 93 consecutive patients with AIDS,including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed.Highly active antiretroviral therapy（HAART）status was recorded.HIV and CMV immunoassay were also tested.CD4＋T-lymphocyte count and blood CMV-DNA test were performed in all patients.Aqueous humor CMV-DNA test was completed in 39patients.Ophthalmological examinations including best corrected visual acuity（BCVA,by International Standard Vision Chart）,intraocular pressure（IOP）,slit-lamp biomicroscopy,indirect ophthalmoscopy were performed.RESULTS：In MVR group,the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13.Blood CMV-DNA was 0（0,269 000）and 42 patients（80.77%）did not receive HAART.In CMV retinitis group,13 patients（31.71%）had anterior segment abnormality.The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470（0,1 450 000）.Nineteen patients（46.34%）had not received HAART.MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%,respectively.Two patients with MVR progressed to CMV retinitis during the follow-up period.CONCLUSION：In comparison of CMV,patients with MVR have relatively mild visual function impairment.Careful ophthalmological examination and close follow-up are mandatory,especially for patients who have systemic complications,positive CMV-DNA test and without received HAART.

Analysis of clinical manifestations of symptomatic acquired jejunoileal d i verticil la r disease

AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2)exclusion of congenital diverticula (e.g. Meckel's diverticulum).RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series.CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.