Chronic active Epstein - Barr virus infection(CAEBV) is an uncommon outcome of EBV infection and may present as severe of fulminant syndrome with high- mortality. It is characterized by chronic or recurrent infectious mononucleosis-like symptoms persisting over a long time and by an unusual pattern of anti-EBV antibodies. Although it occurs in immunocompetent individuals, a number of subtle immunologic defects have been reported in patients with CAEBV. Up to now, there are still no diagnostic criteria of CAEBV in China,so the author introduce it with respect to its diagnosis,history,pathogenesis and therapeutic approaches.

Functional magnetic resonance imaging(fMRI) has been widely applied in many fields,such as neurology,psychology,etc.Recently it has also been used to study the visceral hypersensitivity of the gut.This review gives an overview of the basic principle of fMRI and its application in the visceral sensitivity of esophagus and rectum.

Objective To investigate the relationship of body mass index with hiatal hernia (HH) and reflux esophagitis (RE).Methods Two hundreds and twenty seven gastroesophageal reflux disease (GERD) patients with typical acid regurgitation and heartburn were enrolled and categorized into three groups according to body mass index (BMI, kg/m2) as normal weight (18.5≤BMI ＜24), overweight (24≤BMI＜28), and obesity (BMI≥28).RE, non-erosive reflux disease (NERD) and HH were diagnosed by gastroscopy.All the patients underwent ambulatory 24-hour pH monitoring and the pathological acid reflux was considered when the DeMeester score≥15.Effects of BMI on RE and HH were estimated by using logistic regression analysis.Results The percentages of RE and HH were 30.0%(68/227) and 5.7%(13/227), respectively.76.9% (10/13) HH patients had RE. Proportions of RE and HH increased significantly with increasing BMI (P＜0.05), so was that of RE above grade B in three groups (6.4%, 16.9% and 31.6%,P=0.003).DeMeester scores of the three groups were 15.9, 19.8 and 36.9, respectively (P＜0.05).The average 24-hour intra-esophagus pH value of overweight group, was significantly lower than that of normal weight patients in the afternoon and midnight (P＜0.01).Multivariate analysis showed obesity was a risk factor for HH with OR 7.058 (95% CI: 1.294～38.488, P=0.024), male (OR: 2.537, 95% CI: 1.350～4.766, P=0.004), overweight (OR: 1.921, 95% CI: 1.005～3.670, P=0.048), obesity (OR: 3.305, 95% CI: 1.123～9.724, P=0.030) and HH (OR: 6.879, 95% CI: 1.695～27.913, P=0.007) were risk factors for RE.Conclusion BMI has a significant association with HH and RE, obesity is a common risk factor for both HH and RE, HH may induce the development of RE.

Objective To investigate the relationship between HBV genotypes and YMDD motif mutations or BCP mutations in Xiangtan of Hunan Province. Methods HBV genotypes, YMDD motif mutations and BCP mutations were analyzed in 952 HBV infected patients. Results HBV genotyping showed that 698 HBV type B patients and 115 HBV type C patients accounted for 73.32% and 12.08% respectively of all the participants. The rest 139( 14.60% )were genotype B and C mixed infection( B + C ). The analysis of YMDD motif mutations showed that 844 YMDD wild-type which accounted for 88.66% of all the subjects and the remainder were YMDD mutation types, of which 54( 5.67% ) carried YVDD, 53( 5.57% ) YIDD,and 1 YVDD and YIDD mixed infection. Basic Core Promoter mutations showed that 1762A/1764G ( wild type )accounted for 70.59% and 1762T/1764A( mutant ) accounted for 19.75%. The rest 92 patients were 1762T/1764A and 1762A/1764G mixed infection. This study showed no significant difference in the rate of YMDD mutation( 10.04% vs 10.43% ,χ2 =0.017,P＞0.05 ) ,but a significant difference in the types of YMDD mutation(χ2 = 4.836, P ＜ 0.05 )between HBV types B and C. The YVDD mutation was more commonly seen in genotype C( 9.57% ) than in genotype B( 5.88% ). The BCP mutation rate showed a significant difference( 27.36% vs 46.09%, χ2 = 16.478, P ＜ 0.01 ). Genotype C was more frequent than genotype B. The BCP mutation rate showed no significant difference between YMDD Wild-type and YMDD mutation types( 28.67% vs 35.51%, χ2 = 2.139, P ＞ 0.05 ), but most of BCP mutations happened in YVDD mutant type( 61.11% ). Conclusions ( 1 ) The predominant HBV genotypes in Xiangtan were genotype B and genotype C, the major genotype was type B, which display the characteristics of epidemiology in Southern China. ( 2 ) Determination of HBV genotypes before lamivudine therapy was probably not an important pretreatment investigation to predict antiviral responses. ( 3 ) Detection of HBV genotypes, YMDD motif mutations and BCP mutations will contribute to the correct evaluation of prognosis and timely proper management of HBV patients.

Objective To explore the diet features of diarrhea predominant irritable bowel syndrome (IBS-D) with small intestinal bacterial overgrowth (SIBO).Methods IBS-D patients were enrolled in outpatient department of Peking University Third Hospital from March 2015 to April 2016.Healthy volunteers were recruited as controls (HC).All the subjects completed screening examinations,clinical and food investigation,and lactulose methane and hydrogen breath test (LMHBT).The high fat diet is defined as the daily total calories supplying from fat is more than 50％.Results Eighty-eight IBS-D patients and 32 HC were finally enrolled.The positive rate of LMHBT in IBS-D was significantly higher than that of HC [39.8％ (35/88) vs 12.5％ (4/28),P=0.005].The 28 HC with negative LMHBT were enrolled in the follow-up analysis.(1) The BMI of IBS-P (IBS-D with positive LMHBT) was significantly lower than IBS-N (IBS-D with negative LMHBT) [(21.57 ±0.54) vs (23.30 ±0.53) kg/m2,P=0.032].IBS-D patients with SIBO had higher scores of abdominal pain assess.(2) The proportion of dietary protein and carbohydrate in IBS-D was significantly higher than that of HC (14.39％ vs 12.22％,P =0.001;53.94％ vs 46.25％,P =0.003,respectively).The proportion of diet fat was significantly higher in IBS-P than IBS-N[(47.19 ± 2.62) ％ vs (40.74 ± 1.66) ％,P =0.038].(3) The baseline of breath methane in IBS-P was significantly higher than that of in IBS-N [(8.69 ± 0.39) × 10-6 vs (6.39 ± 0.47) × 10-6,P =0.002].IBS-D patients with high fat diet had higher LMHBT positive rate than that of non-high fat diet patients[54.2％ (13/24) vs 17.2％ (11/64),P =0.001].Breath methane peak value was positively correlated with the fat proportion of diet (r =0.413,P =0.022).Conclusions About 39.8％ IBS-D patients diagnosed by Rome 11Ⅲ are combined with SIBO.SIBO may affect IBS-D patients' nutritional status.High fat diet might be one of the risk factors for IBS-D with SIBO.Proper diet structure might reduce the prevalence of IBS-D,especially for IBS-D with SIBO.

Objective To study the role of esophagogastric junction contractile index (EGJ-CI) in evaluating the function of anti-reflux barrier,and in differentiating patients with gastroesophageal reflux disease (GERD) from those with functional heartburn (FH).Methods A total of 115 patients presenting heartburn were enrolled in the study from January 2012 to June 2015.All subjects had completed Gerd-Q questionnaire and undergone gastroscopy,24-hour pH-impedance monitoring and esophageal high-resolution manometry.GERD patients were divided into as reflux esophagitis,acid-nonerosive reflux disease (NERD) and weakly acid-NERD groups.Patients with normal esophageal mucosa,normal acid exposure and negative proton pump inhibitor test were enrolled in FH group.EGJ-CI (mmHg · cm) as well as EGJ rest pressure and 4s integrated relaxation pressure (IRP 4s) were measured.Results Among the 115 patients,18 were reflux esophagitis [(49.0 ± 18.9) years,M ∶ F =10 ∶ 8],25 were acid-NERD [(48.7 ± 14.4) years,M∶F=13∶ 12],37 were weakly acid-NERD [(52.0 ±14.8) years,M∶F=15∶22] and 35 were FH [(53.6 ± 14.8),M∶ F =8∶27].No differences of Gerd-Q scores were noticed between the four groups.(1) Negative correlations were demonstrated between EGJ-CI and esophageal acid exposure time (r =-0.283,P =0.002),EGJ-CI and acid reflux events (r =-0.233,P =0.012),EGJ-CI and weakly acid reflux events (r =-0.213,P =0.022),EGJ-CI and non-acid reflux events (r =-0.200,P =0.032).(2)The value of EGJ-CI was significantly higher in FH patients than in the three subgroups of GERD(all P ＜ 0.01).EGJ rest pressure of FH group was higher than that of acid-NERD (P ＜ 0.01).IRP 4s in acid-NERD group was lower than that of FH and weakly acid-NERD (P ＜ 0.05).(3) The area under curve (AUC) of EGJ-CI was higher than that of EGJ-CIT,EGJ rest pressure or IRP 4s (0.686 vs 0.678,0.641 and 0.578).The cut-off value of EGJ-CI to differentiate GERD from FH was 9.74 mmHg · cm with sensitivity 82.86％ and specificity 51.52％.Conclusions The EGJ-CI values are negatively correlated with esophageal acid exposure time,weakly acid reflux events and non-acid reflux events.Thus it might be used as a metric to reflect the anti-reflux function of EGJ.According to the cut-off value of EGJ-CI 9.74 mmHg · cm,patients with GERD can be sensitively differentiated from patients with FH.

Objective To investigate the therapeutic action of Taurine in patients with cerebral infarction(CI)induced by hyperhomocysteinemia(Hhcy).Methods The 100 CI patients induced by Hhcy were randomly divided to two therapy groups.One group was administered Taurine,the other group was administered Folacin combined with Vitamine B12 for 8 weeks.Before and after treating,the serum levels of homocysteic acid(Hcy),Folacin and Vitamine B12 were detected,NIHSS and BI were evaluated.Results The serum levels of Hcy were significantly decreased after administering in both two groups(all P

Objective To summarize the clinical features,neuroimaging findings and pathological characteristics of demyelinating pseudotumors(DPT)of the brain,and to differentiate it from glioma. Methods The clinical features,neuroimaging findings and pathological characteristics of 35 patients with demyelinating pseudotumors of the brain were summarized,and the diagnosis for 18 of them was confirmed by bioscopy.Results Demyelinating pseudotumors affected adults of both sexes.The onset age of patients ranged from 9 to 69 years old.There was no definite antecedent,and the clinical syndromes were atypical. Neuroimaging scans showed multiple lesions in cerebral hemisphere,while the lesion in brain stem and spinal cord was single.The symptom and neuroimaging were not parallel.While with many or large lesions, the symptoms and signs were less.The lesions were not enhanced on CT scan,but appeared round or patch enhancement on MRI scan.Nine patients with DWI all appeared high density.The myelin basic protein was useful for diagnosis.The typical pathological changes were demyelination,perivascular inflammatory infiltration and reactive gliosis.The Creutzfeuldt cells were also found in these patients.The lesions might become small or disappear after treatment,but could not serve as the criterion to exclude brain neoplasm. Conclusions DPT is a distinct demyelination disease entity,which is confusable with brain neoplasm.It is difficult to distinguish DPT from brain neoplasm with the clinical features and conventional neuroimaging scan.But DWI scan is useful.The pathological changes accord with demyelination,and Creutzfeuldt cells are also found.It is important to apply corticosteroid treatment or biopsy rather than being anxious to excise the lesions.

Objective To estimate the prevalence and risk factors for irritable bowel syndrome (IBS) in China.Methods Cross-sectional studies relevant to IBS conducted among Chinese were identified through the databases including PubMed,Web of Science,the Cochrane Library,CBM,CNKI,Wanfang data and VIP.Quality of studies was assessed according to the criteria for cross-sectional studies recommended by Agency for Healthcare Research and Quality(AHRQ).Analysis of data,publication bias and sensitivity were performed with Stata (Version 12.0).Results A total of twenty-three studies were extracted.No obvious publication bias was detected in all analysis except the effect of depression on IBS prevalence.Pooled prevalence of IBS in China was 6.5％.IBS was more common in women than in men (8.1％ vs 6.8％;OR=1.23,95％CI 1.09-1.38) and high rate in age group between 30 to 59 years (6.9％ ; OR =1.22,95％ CI 1.12-1.32).Intestinal infection history(OR =2.39,95％ CI 1.69-3.38),anxiety (OR =2.95,95 ％ CI 1.94-4.49),depression (OR =1.85,95 ％ CI 1.11-3.09),food allergy (OR =2.80,95％ CI 2.12-3.67) and alcohol consumption (OR =1.15,95％ CI 1.07-1.24) might increase the risk for IBS.There were no significant difference of IBS prevalence between urban and rural areas (OR =0.97,95％ CI 0.72-1.29),neither in different education classes (OR =0.85,95％ CI 0.70-1.03).Sub-group analysis showed IBS prevalence varied apparently with different diagnostic criteria:prevalence defined by Manning was 11.8％ and by Rome Ⅱ and Rome Ⅲ prevalence values were 4.4％ and 8.9％ respectively.Conclusions Pooled prevalence of IBS in China was 6.5％.IBS is more common in age group between 30 to 59 years.Female,history of intestinal infection,anxiety,depression,food allergy and alcohol consumption were risk factors for IBS in Chinese population.

Objective To observe the changes in CD4 + CD25 + regulatory T cells(Treg) and T helper 17 cells (Th17) cells' proportions in the peripheral blood in children with Kawasaki disease(KD) before and after the treatment,and to analyze the role of Treg/Th17 cell imbalance in the pathogenesis of KD.Methods Fifty-two children with acute KD(KD group) and 34 age-matched healthy children(healthy control group) were selected at Jiangxi Provincial Children's Hospital from April to December of 2014.Morning peripheral vein blood was collected from 2 groups:one before the treatment by Immunoglobulin and Aspirin,and the other 3 days after defervescence treatment.Flow cytometry was used to detect proportions of Treg cells and Th17 cells in the peripheral blood.The enzyme linked immunosorbent assay was used to detect the levels of interleukin(IL)-6,IL-10,IL-17,IL-23 and transforming growth factor(TGF)-β.Results Proportion of Treg cells in the acute KD group was remarkably lower than that in the healthy control group [(1.48 ± 0.21) ％ vs.(5.13-± 0.32) ％,t =28.41,P ＜ 0.05],but it was significantly increased after treatment,and there was a significant difference [(4.71 ± 0.36) ％ vs.(1.48 ± 0.21) ％,t =-23.32,P ＜ 0.05].Proportion of Th17 cells in the acute KD group was markedly higher than that in the healthy control group [(8.06 ± 0.48) ％ vs.(2.65 ± 0.50) ％,t =-23.47,P ＜ 0.05],which was significantly decreased after treatment [(3.04 ±0.35) ％ vs.(8.06 ± 0.48) ％,t =25.55,P ＜ 0.05].Compared with the healthy control group,the levels of serum IL-6,IL-17,IL-23 in the acute KD group were significantly increased before treatment,and there were significant differences [(34.53 ± 0.53) ng/L vs.(10.88 ± 0.83) ng/L,t =-72.36;(57.05 ± 0.78) ng/L vs.(14.29 ± 0.98)ng/L,t =-55.29;(45.18 ± 1.52) ng/L vs.(18.25 ± 1.08) ng/L,t =-43.27;all P ＜ 0.05],but after treatment the levels were significantly decreased [(14.94 ± 1.06) ng/L vs.(34.53 ± 0.53) ng/L,t =49.63;(27.64 ± 0.91)ng/Lvs.(57.05±0.78) ng/L,t =26.49;(24.50-±1.13) ng/L vs.(45.18-±1.52) ng/L,t =32.17;allP＜0.05].The levels of serum IL-10,TGF-β in the acute KD group significantly decreased than those of the healthy control group,and there were significant differences [(14.29-± 0.64) ng/L vs.(29.57 ± 0.87) ng/L,t =42.24;(16.88 ±-0.90) ng/L vs.(38.83 ±0.84) ng/L,t =53.51;all P ＜0.05],but after treatment the levels were significantly increased,and there were significant differences [(23.01-± 0.61) ng/L vs.(14.29-± 0.64) ng/L,t =-29.54;(33.47±-0.82) ng/Lvs.(16.88±-0.90) ng/L,t=-40.68;allP＜0.05].Conclusion Imbalance betweenTreg cells and Th17 cells may be an important cause for the immune disorder of KD,the changes in related cytokines are involved in the pathogenesis of KD.